CAB Sequence: Compressions, Airway, Breathing for cardiac risk patients.
Brain damage possible if the brain is without oxygen for more than 4-6 minutes.
CPR (Cardiopulmonary Resuscitation)
Purpose: Re-establish circulation and artificial ventilation in a patient with no pulse.
Steps:
High-quality chest compressions.
Opening the airway.
Rescue breathing (2 breaths over 1 second).
BLS vs. ALS
Definition: BLS is basic care, ALS (Advanced Life Support) includes advanced procedures such as cardiac monitoring, IV fluids, medications, advanced airway adjuncts.
Chain of Survival: Recognition, high-quality CPR, rapid defibrillation, emergency services, ALS and post-arrest care, recovery.
Assessing the Need for BLS
Scene Survey: Always begin with surveying the scene.
Primary Assessment: Evaluate ABCs.
Determine Responsiveness: Responsive (no CPR), unresponsive (may need CPR), assessment within 10 seconds.
Differences in Infants and Children: Respiratory issues often lead to cardiac arrest (unlike adults where cardiac issues precede respiratory arrest).
AED (Automatic External Defibrillator)
Usage: Vital in the chain of survival, should be applied ASAP.
Children: Apply after the first 5 cycles of CPR (use pediatric size pads if available).
Special Situations: Pacemakers, wet patients, transdermal medication patches.
Positioning for CPR
Supine Position on Firm Surface: Ensures effective CPR.
Check Breathing & Pulse: Simultaneous assessment, max 10 seconds.
Chest Compressions: Rhythmic and of equal duration, avoid leaning between compressions.
Airway Management
Head Tilt–Chin Lift: For non-traumatic patients.
Jaw-Thrust Maneuver: For those with potential trauma.
Recovery Position: For patients breathing adequately with no spinal injury.
Ventilation Devices: Use barrier devices when ventilating (e.g., pocket mask, bag valve mask).
CPR Techniques: One and Two-Rescuer
One-Rescuer Adult CPR: 30 compressions followed by 2 ventilations (30:2 ratio).
Two-Rescuer Adult CPR: Switch every 2 minutes to maintain high-quality compressions.
Devices and Techniques: Active compression-decompression CPR, Impedance Threshold Device (ITD), and Load-Distributing Band CPR.
Infant and Child CPR
Focus: On airway and breathing.
Causes of Arrest: Injury, infection, foreign body, submersion, etc.
Techniques:
Infants: Two fingers for compressions, two-thumb encircling for two-rescuers.
Children: Heel of one or both hands.
Rescue Breathing: 1 breath every 2-3 seconds (12-20 breaths/min).
Foreign Body Airway Obstruction: Various techniques based on age and situation.
When to Interrupt or Stop CPR
Interruption: Only if absolutely necessary (e.g., moving down stairs).
Stop: Mnemonic STOP (Starts breathing/pulse, Transferred to higher training, Out of strength, Physician's direction).
Special Circumstances
Opioid Overdose: Use Narcan if allowed.
Pregnancy: High-quality CPR, left-side positioning, manual displacement of the uterus if in cardiac arrest.
Grief Support for Family Members
Importance: Crucial emotional support during and after resuscitation.
Education and Training
For EMTs: Frequent practice necessary using mannequins.
For the Public: Advocate for CPR training in communities.
Review Questions
Key Points: Brain damage (4-6 minutes without oxygen), chain of survival, proper CPR positioning, pulse check duration (5-10 seconds), gastric distension, load-distributing band, when to interrupt CPR, and recognizing foreign body obstructions.
End of Chapter Summary
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