What Is It? - Palm Beach State College Palm Beach State .
How to Save a Life Using Continuous Chest Compression (CCC) CPRWhat is it?Automatic External Defibrillator (AED)How do I use one?1
What to Expect? Sudden Cardiac Arrest (SCA) is the number 1 causeof premature death in the United States, resulting inmore than 365,000 deaths each year. The intent of this PowerPoint presentation is to showhow you can respond to SCA and to help remove anyreluctance you may have to take action to help avictim of SCA.P.S. If you have notalready done so, pleaseplace the presentation inthe Slide Show mode byclicking this icon on thetoolbar below. PressEsc to revert.2
TheReality ofLife somedayeveryone willdie!3
TheProblem Premature Death!4
Causes of Premature Death5
What is Sudden Cardiac Arrest? Not the same as a heart attack. In a heart attack, a blockage in anartery reduces or stops blood flow tothe heart, and the lack of oxygencauses heart tissue to die. BUT, theheart continues to beat. In SCA, the heart is no longer pumpingblood through the body.6
Heart Attack vs. Cardiac ArrestHeart Attack: Blockage in coronary arteryCardiac Arrest: Electrical issue, heart stopspumping Person usually conscious Person is unconscious Upper body discomfortor pain Often no previous symptoms7
Sudden Cardiac Arrest Sudden Cardiac Arrest can occur when theheart’s electrical system malfunctions causingrhythms that are rapid (pulseless ventriculartachycardia) or chaotic (ventricular fibrillation),or both. The irregular heart beat causes the heart tosuddenly stop beating in a coordinated manner.8
This is Normal9
This is Not!Ventricular FibrillationThe Ultimate Medical Emergency10
Sudden Cardiac Arrest “ElectricalProblem# 1”Standstill (Asystole)11
Sudden Cardiac Arrest“ElectricalProblem# 2” VentricularFibrillation (chaotic“quivering”, but NOheartbeat) Often follows aheart attack.12
Sudden Cardiac ArrestBut sometimes. V-Fib can occurtotally unrelated to aheart attack. ElectrocutionHypothermiaCommotio CordisLong Q-T SyndromeLightning StrikeDrug OverdoseNear DrowningArrhythmiaRandom Event13
What to Do? Without Cardio-Pulmonary Resuscitation (CPR), inconjunction with use of an Automated ExternalDefibrillator (AED), the heart will continue its rapiduncoordinated twitching or fluttering until, due to the lackof oxygenated blood in the heart muscle, the muscletires and completely stops, with no electrical ormechanical activity. Brain death follows.14
Time is of the Essence!!!Chance ofsurvival in %10080A victim's chances ofsurvival is reduced by up to10 % with every minutethat passes without CPRand application of a shock,provided by an AED, toprompt the heart‘spacemaker to resumenormal beating.604020051015202530MinutesTo extend life, immediate on-site action is essential!15
Chain of Survival16
How to Save A LifeStep One If you see some one suddenly fall, or comeacross someone who is lying down apparentlyunconscious, shake them and ask (Shout!) “Areyou OK?” If the person does not respond, command anybystander(s). YOU, bring the AED! YOU, call 911!17
How to Save A LifeStep TwoImmediately begin CPR. No checking for pulse or signs of circulation—just go straight to CPR! CPR dramatically increases survival.If you call 911 and do nothing untilEMS arrives, the victim will mostlikely die!
Why CPR? CPR will not usually stopVF but plays animportant part in pushingoxygenated blood to thebrain and heart andprolonging VF so that anAED will be useful.
Why CPR? CPR has resuscitated patients with cardiacarrest from ventricular fibrillation.CPR can double or triple the victim’s survivalrate.For every passing minute without CPR, rateof surviving drops 7-10%.With CPR there is only a 3-4% drop eachminute.Continuous Chest Compression (CCC) onlyCPR should be used for SCA victims.
What is Continuous ChestCompression (CCC) Only CPR? CCC is a method of resuscitation developedthrough extensive research at UA Sarver HeartCenter for use by layperson bystanders. CCC is recommended by the AHA for SCAvictims. CCC means continuous forceful chestcompressions to circulate the victim’s bloodthrough their brain and heart. No mouth-to-mouth breaths are necessary.21
CCC vs. Conventional CPR In conventional CPR, chest compressions andrescue breaths are provided at a ratio of 30compressions to 2 breaths. CCC-CPR is what its name implies—continuouschest compressions are given to the victim withno time taken to give rescue breaths through thevictim’s mouth.22
Why isn’t Rescue Breathingnecessary?During Cardiac Arrest: The lungs are full of air. The blood is full of oxygen. Circulating the oxygenated blood is the key.23
Why might “Rescue Breathing”be harmful in SCA? People are less likely to perform CPR in the firstplace if breaths have to be given. It causes interruption of chest compressions;stops blood flow to the brain. Increased pressure in the lungs and chest fromthe rescue breaths decreases blood return to theheart.24
Chest Compressions OnlyBlood FlowingTo The BrainCompressions Breaths (30:2)Pausing forbreaths meansNo Blood FlowBlood FlowingTo The BrainEwy GA, et al. Circulation.2007;116(22):2525-30.25
What stops people from doingCPR?Fear / ConcernSolutionMouth-to-Mouth (Yuck Factor) Chest Compressions OnlyHarming the PersonBetter than DeadLegal ConsequencesGood Samaritan LawWon’t Perform ProperlyEasier to DoPhysically UnableDo Your Best / Call For Help26
When is it OK to use CCC-CPR? CCC-CPR is for use on adults ( 8 years old) whosuddenly collapse and are unconscious andunresponsive. This is the vast majority. Conventional (30:2) CPR is still best for victims ofdrowning and choking, infants and children, drugoverdoses and collapse due to breathingproblems. Attempting any kind of CPR is better than noattempt.27
How do I do CCC-CPR?With the victim on the floor:1. Kneel beside them.2. Place the heel of one hand on top of the other.3. Lock your elbows.4. Aim for the middle of the chest (on the sternum between the nipples).5. Push as hard and as fast as you can (try for 100 compressions/minute).6. Take turns with another person when tired. If two rescuers are available,switch every 200 compressions ( two minutes) – reduces fatigue.28
Chest Compressions:Rate and Depth1002 inchesCompressions per Minutein depth Aftereach compression,take all weight off thechest. Allows the heart to refill. Beat of “Staying Alive!!”29
Are they breathing? Gasping is a sign of cardiac arrest. Majority of people with cardiac arrest gasp. DO NOT stop chest compressions if they gasp.30
Putting it all together Please Click:AHA - Hands Only CPR Video31
What about CPR for infants andchildren? For infants (less than one year old) and children (ageone to 8 years old), if you are alone, you should performconventional CPR first for two minutes performing fivecycles of 30:2 – then call 911. Reason is that most child and infant cardiac arrests are due toasphyxiation (little or no oxygen in their blood), so they willbenefit more from immediate CPR.For both infants and children, conventional CPR is givenat a rate of 30 compressions followed by 2 rescuebreaths (100 compressions/minute).In all cases, conventional CPR starts with compressionsfirst! Then the breathing.
Infant CPR ( 1 year old)Position the infant on a firmsurface while maintainingthe airway. Place two fingersin the middle of the sternumjust below (one finger) a linebetween the nipples.Use two fingers to compress thechest one-third to one-half itsdepth at a rate of at least 100per minute. Allow the sternum toreturn to its normal positionbetween compressions. Place your mouth over the infant’s nose and mouth and puff the air in. If unsure if it is a child or not, if it can fit on your arm, treat as an infant.
Child CPR (Ages 1 to 8)Place the heel of one or bothhands in the center of the chest,in between the nipples.Compress the chest one-third toone-half its depth at a rate of at least100 compressions per minute. Useone hand on chest, with the otherhand on forehead for balance and tokeep head properly positioned. Pinch victim’s nose. Give enough breath to make the chest rise.
Other CPR ConsiderationsQ. Can you break people’s ribs doing CPR?A. Yes. Studies have shown that this can occur, but that the fracturesdid not cause any serious bleeding and, thus, mortality. Other theother hand, the chance of surviving SCA is near zero for a victimwho does not immediately receive CPR, followed by use of an AEDand after care. Q. What should I do if I am getting tired from giving chestcompressions before more help arrives?A. Continue to provide hard and fast chest compressions withminimal interruption to the best of your ability. It is hard work, andmost people will get tired after only a few minutes of delivering anytype of CPR. If someone else is nearby, ask them to take over afterabout 2 minutes or about 200 compressions. If you are alone, thenjust do your best.
How to Save A LifeStep ThreeUse an AED—Defibrillate. The only effective treatment for ventricular fibrillationSCA is a defibrillation shock — an electrical pulsethrough the heart — which can restore a normal heartrhythm. In order to be effective in treating VF, defibrillationtreatment must be administered within the first fewminutes. The AHA guideline for the interval of time from leavingan SCA victim to returning with an AED is 3 minutes.
Did you know that your chance of surviving aVentricular Fibrillation SCA is less than 5%without an AED? If used within 5 min, chances of survival is 49-75%. Using an AED is safe, simple and highly successful.37
Using an AED is safe. The AED is a computerized device that will analyze therate, size and wave shape of human cardiac rhythm. It will not shock a properly functioning heart. It will not shock a heart that has stopped (VF is notpresent). It will advise shocks ONLY if there is a shockable rhythm.
Using an AED is safe. Using an AED is safe for you as well. The State of Florida has a“Good Samaritan Act”, alaw that protects you fromcivil liability when yourespond to a medicalemergency.
Using an AED is simple.Computer technologycoaches the user whatto do.VisualPromptsAudiblePrompts“Don’t touch patient—analyzing.”“Shock advised. Don’t touchpatient. Press flashing shockbutton.”“No shock advised”“Start CPR”
Using an AED is simple.Adhesive ElectrodesCorrectPlacementWellIllustratedUsing an AED is virtually mistake-proof!
Using an AED is simple.Voice prompts take you through each step and arerepeated as needed.One (or two) button operation makes it easy to use.It will not advance to the next step unless you completethe previous one.It automatically monitors the patient's cardiac rhythm anddetermines if the patient requires a defibrillation shock.If no shock is needed, it will not deploy the shock.YOU CAN NOT USE THIS A WRONG WAY !!!Take theFEAR out 42
Using an AED is highly successful.Sudden Cardiac Arrest Reversal RatesCPR OnlyEMS/ERCPR/AED0-2%5-15%30-75%
The Universal AED Symbol44
About AEDs While there are many styles of AEDs they allwork the same. The first step is to turn the unit on and follow thevoice prompts.45
Our AEDs Palm Beach State College has 45 AEDs at its 4 campuses. We have 3differentmodels. They are situated so as to achieve a 3-minute response.46
Our AEDs – Model 1 LIFEPAK CR Plus, made by Medtronic (now Physio-Control)Spare padsCase openVisual instructionsPadsLid upAutomatic—No shockbutton47
Our AEDs – Model 2 Powerheart G3, made by Cardio ScienceAutomatic—Noshock buttonPadsCase openLid upSpare padsVisual promptPads48
Our AEDs – Model 3 HeartStart FRx, made by PhilipsShock buttonPads inside49
Our AED LocationsThe location maps for our AEDs can be found online EDLocationMap.pdf.50
Our AEDs AED batteries and pads have a 2- to 4-year expirationdate. Our Security Officers check the AEDs each month toensure that they are carrying a proper charge. Batteries and pads are replaced upon expiration or asnecessary.51
And now, how to use an AED.1.Turn on the AEDFollow the voice prompts and/or visual commands.AED’s can be turned on with either:A buttonOR BYOpening the cover.52
How to Use an AED2.Expose the chest Open shirt/blouse (rip open!) or cut clothing ifnecessary. Remove any medication patches. Make sure chest is clean and dry. CPR should be ongoing.53
How to Use an AED3.Attach padsFirst: Remove pads from packet. Remove backing from pads, one at a time, thenplace them as shown on the pads.54
How to Use an AED3. Attach pads (continued)One pad goes on the upper right chest belowcollarbone.Stick padsfirmly to theskin. One pad goes on the left side chest wall. CPR should be ongoing.55
How to Use an AED4.Plug in Connector (if necessary) If necessary, plug inpad connector to unit. There is usually aflashing light beside theslot. CPR should be ongoing.56
How to Use an AED5. Stay clearWhen the AED so advises, stop CPR.Make sure that nobody, including yourself, istouching the victim.Say, “Everyone stand clear!”57
How to Use an AED6. Allow AED to analyze the rhythmOnce the pads are in place, the AED will “analyze”the heart rhythm to determine if a shock should beadministered.Touching the victim will interrupt the AED’s analysis. There are 4 electrical rhythms that the heart can be inwhen the heart stops beating, only 2 of which areshockable, ventricular fibrillation and pulselessventricular tachycardia.If “Shock advised”, shock victim and resume CPR.If “No shock advised”, then resume CPR.58
How to Use an AED7.Deliver the shockIf AED prompts a shock: Make sure no one istouching the victim. Push the “Shock” button. Some AEDs will shock automatically, includingtwo of the College’s models.59
How to Use an AED8.If no shock advised If no shock is advised, continue CPR. EffectiveCPR may lead to a shockable rhythm. Every 2 minutes follow the AED prompts. Stop CPR if you see signs of life (breathing,movement).60
How to Use an AED9.After the shock After the shock is delivered, resume CPR. Donot stop CPR for more than 10 seconds. Do not turn off AED! It will continue to monitorthe victim’s heart rhythm. It is now safe to touch the pads and patient. Every 2 minutes follow the AED prompts.61
How to Use an AED9.After the shock (continued) Stop CPR if you see signs of life (breathing,movement). If breathing is inadequate, assistventilations. Do not remove AED pads! Even if the victimseems to have recovered. The AED is still atwork. If necessary, continue CPR and keep pads onuntil EMS personnel arrive.62
How to Use an AED10. Special Circumstances For:a)b)c)d)e)f)g)h)ChildrenWet personHairy chestBraJewelryImplanted pacemaker/defibrillatorTransdermal medication (patch)Metal surface63
How to Use an AED10a) Children AEDs can be used on children as young asnewborns. Some AEDs have child pads. The College’s LIFEPAK and Powerheart AEDs do nothave child pads.The College’s HeartStart AEDs (red case) have achild key.64
How to Use an AED10a) Children Use child pads if child is younger than 8 and lessthan 55 lbs. If no child pads, adult pads will have to be used. One pad goes in the center of the chest and the2nd pad goes on center of the child’s upper back.65
How to Use an AED10b) Wet person Remove victim from water or wet surface.Dry off victims chest (and back if a child underage 8) before attaching pads.Attach pads following the directions.The rest of the victim does not need to be dry.AEDs can be used on wet surfaces and snow aslong as patient is dry and not in a puddle ofwater.66
How to Use an AED10c) Hairy chest Pads may not stick to victim withhairy chest.AED accessory kit has a razor. Shave ONLY the area of chestthat pads will attach to.Wipe off hair and attach pads.If no razor present, attach padsto chest and see if AED willwork.If AED does not work, continueCPR.67
How to Use an AED10d) Bra Many bras contain metal (lips, underwire).Remove / cut bra if AED padswill touch the metal.AED accessory kithas a scissors.68
How to Use an AED10e) Jewelry Ignore jewelry if it will not touch the AED pads. If in the way, push jewelry to side of neck awayfrom AED pads. Do not waste timeremoving jewelry.69
How to Use an AED10f) Implanted pacemaker/defibrillator Do not place AED pads directly over implanteddevices. Pacemakers are located under the collarbone onright or left side of chest.(Look for the scar.) If located on right side, place AED pad at leastone inch below pacemaker.70
How to Use an AED10g) Transdermal medication (patch) Remove patch and wipe clean before attachingAED pads.10h) Metal surface Is the victim lying on a metal surface? If so,move the victim. The metal surface may cause the shock from theAED to hit you.71
Recovery Position If victim begins breathing and having a pulse,then turn victim to their side with lower arm infront. Leave AED attached. No position is perfect—just make sure they arestable, near a true lateral position, and there isno pressure on the chest to impair breathing.72
How to Save A LifeStep FourEarly Advanced Life Support The EMTs (AKA “The Cavalry”) show up. Although EMS personnel employ haste, it will stilltake them 7 – 8 minutes to arrive, enough timefor someone to die without CPR and an AED.
In the meantime, you may have justsaved a life.CONGRATULATIONS!!
To Summarize:SAVING A LIFE IS EASYIF YOU OBSERVE AN ADULT OR PERSON 8 COLLAPSE OR THEY AREFOUND UNRESPONSIVE:DIRECT SOMEONE TO CALL 9-1-1 AND HAVE THEM STAND BY TO LEADPARAMEDICS TO THE PATIENT.DIRECT SOMEONE TO GET AN AED.START FORCEFUL CHEST COMPRESSIONS AT 100 PER MINUTECONTINUE UNTIL AED OR PARAMEDICS ARRIVE.ATTACH AED TO PATIENT AND FOLLOW VERBAL INSTRUCTIONS.CONTINUE PERFORMING FORCEFUL CHEST COMPRESSIONS ANDFOLLOWING AED INSTRUCTIONS UNTIL ARRIVAL OF PARAMEDICS.75
FINALLYHere is a 17-minute video that will summarizeeverything that has been covered so You can access the video from the Safety andRisk Management web site.
MOREIf you are interested in receiving more extensive“hands-on” training in CPR and how to use anAED, you may enroll in one of the HeartsaverAED classes offered by the Office of HumanResources as part of the Institute of CollegeLearning.
QUESTIONS?
The intent of this PowerPoint presentation is to show how you can respond to SCA and to help remove any reluctance you may have to take action to help a victim of SCA. 2 P.S. If you have not already done so, please place the presentation in the Slide Show mode
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