2025 CPR

Adult

Child

Infant

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READY, SET,GO AND KEEP GOING !!

• Ideally, only seconds should pass between the time you recognize a patient needs BLS and the start of treatment.
• Permanent brain damage is possible if brain is without oxygen for 4 to 6 minutes.
• Cardiopulmonary resuscitation (CPR)
• Reestablishes circulation and artificial ventilation in a patient who is not breathing and has no pulse
• CPR steps
1. Restore circulation (perform chest compressions).
2. Open the airway.
3. Restore breathing (provide rescue breathing).

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THE CLOCK is TICKING ….tick tock tick tock

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THIS IS WHERE YOU AND YOUR PARTNER SHOULD BE !

BLS VERSUS ALS …. YOU ARE BLS ….

BLS differs from advanced life support (ALS).

ALS involves:

Cardiac monitoring

Intravenous fluids and medications

Advanced airway adjuncts

STAY IN YOUR LANE ….

IT IS THE BEST WAY TO SAVE LIVES….

CHAIN OF SURVIVAL

WHAT DO WE NEED TO DO FIRST ..

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Always begin by surveying the scene. SCENE SAFETY

Complete primary assessment as soon as possible.

Evaluate ABCs.

Determine unresponsiveness.

Should take less than 10 seconds

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Basic principles of BLS are same for infants, children, and adults.

Although cardiac arrest in adults usually occurs before respiratory arrest, the reverse is true for infants and children.

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NEXT STEPS

• TAP AND SHOUT “ARE YOU OKAY” PINCH THE TRAPIZEUS MUSCLE SEE IF HE WINCE OR MOVE . IF UNWITNESSED AND YOUR ALONE CALL 911 AND BEGIN CPR IF PEOPLE ARE AROUND HAVE SOMEONE CALL 911 AND GET AND AED .
• Vital link in the chain of survival
• Should be applied to cardiac arrest patients as soon as available
• If you witness cardiac arrest, begin CPR and apply the AED as soon as it is available.
• If a shock is given as soon as is delivered start another cycle of CPR

CHILDREN AND INFANTS

• Children and Infants
• Start CPR. As soon as AED available get it on .
• Use pediatric-sized pads and dose-attenuating system.
• If neither is available, then use an AED with adult-sized pads with anterior-posterior placement.
• Refer to first slide for hand or finger placement

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SPECIAL CONSIDERATIONS

• Special situations
• Pacemakers and implanted defibrillators
• Wet patients
• Transdermal medication patches
• 1. Pacemakers and implanted defibrillators
• a. Place electrodes at least 1 inch (2.5 cm) away from the device.
• 2. Wet patients
• a. If the patient is in water, pull the patient out and dry the skin before attaching the AED pads.
• b. If the patient is in a small puddle of water or in the snow, the AED can be used, but the patient’s chest should be dried as much as possible.
• 3. Transdermal medication patches
• a. Remove the patch and wipe the skin to remove any residue prior to attaching the AED pad.

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NOW THIS IS COMPRESSIONS

• For CPR to be effective, patient must be supine on firm, flat surface.
• Must be enough space for two rescuers to perform CPR
• Quickly check for breathing and a pulse.
• Visualize the chest for signs of breathing.
• Palpate for a carotid pulse
• Provide external chest compressions.
• Apply rhythmic pressure and relaxation to lower half of sternum.
• Compressions squeeze heart, acting as a pump to circulate blood.
• Avoid leaning on the chest in between compressions.
• Allow the chest to completely recoil between compressions.
• Proper hand positioning is crucial.
• Injuries can be minimized by proper technique and hand placement.

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UNDERSTANDING ANATOMY

• Compression and relaxation should be rhythmic and of equal duration (a 1:1 ratio). B. Pressure on the sternum must be released so that the sternum can return to its normal resting position between compressions. THAT MEANS 50% COMPRESSING AND 50% RELAXING

AIRWAY ,AIRWAY ,AIRWAY

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• To perform the head tilt–chin lift maneuver, place one hand on the patient’s forehead and apply firm backward pressure with your palm to tilt the head back. Next, place the tips of the index and middle fingers of your other hand under the lower jaw near the bony part of the chin. Lift the chin upward, bringing the entire lower jaw with it, helping to tilt the head back
• To perform the jaw-thrust maneuver, maintain the head in neutral alignment and place your fingers behind the angles of the lower jaw, and move the jaw upward.

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NEED TO BREATHE FOR THEM

• The combination of lack of oxygen and too much carbon dioxide in the blood is lethal.
• If patient is not breathing, ventilations can be given by one or two EMS providers.
• Use a barrier device.

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PUT IT TOGETHER

• 1 PERSON CPR Adult
• Single rescuer gives both chest compressions and artificial ventilations.
• Ratio of compressions to ventilations is 30:2.
• TWO PERSON CPR
• Always preferable to one-rescuer CPR
• Less tiring
• Facilitates effective chest compressions
• Switching rescuers during CPR is critical to maintain high-quality compressions.
• Recommended to switch positions every 2 minutes
• Numbers are the same for adult 30:2 for child and infant 15:2
• Do not interrupt CPR for more than 10 seconds or one flight of steps .

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CHILD AND INFANT

• Cardiac arrest in infants and children follows respiratory arrest.
• Airway and breathing are the focus of pediatric BLS.
• Causes of child respiratory problems:
• Injury
• Infections
• Foreign body
• Submersion
• Electrocution
• Poisoning/overdose
• SIDS

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REPEATING STEPS FOR CHILD AND INFANT

• Determine unresponsiveness.
• Gently tap on the shoulder and speak loudly.
• Check for breathing and a pulse.
• Assessment occurs simultaneously.
• Should take no longer than 10 seconds
• Foreign body obstruction in children is common.
• Place an unresponsive, breathing child in the recovery position.
• The techniques for opening the airway are modified for pediatric patients.
• Place a wedge under the upper chest and shoulders when supine.

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REPEATING STEPS FOR CHILD AND INFANT

• Provide rescue breathing.
• Not breathing and has a pulse:
• 1 breath every 2 to 3 seconds
• Not breathing and no pulse:
• 2 breaths after every 30 compressions
• CPR is a crucial, life-saving procedure.
• If no ALS available at scene:
• Provide transport per local protocols.
• Consider requesting ALS rendezvous en route to hospital

REPEATING STEPS FOR CHILD AND INFANT

• Try not to interrupt CPR for more than a few seconds.
• Chest compression fraction
• The total percentage of time during a resuscitation attempt in which chest compressions are being performed
• Should be at least 80% (the higher the better)

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• THEIR LIFE DEPENDS ON YOU ……

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WHEN NOT TO START CPR !!

• If the scene is not safe
• If the patient has obvious signs of death
• Rigor mortis (stiffening of body)
• Dependent lividity (livor mortis)
• Putrefaction or decomposition of body
• Evidence of nonsurvivable injury
• If the patient and physician have previously agreed on do not resuscitate (DNR) orders:
• When in doubt, begin CPR.

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WHEN NOT TO START CPR !!

• Once you begin CPR, continue until:
• S Patient Starts breathing and has a pulse.
• T Patient is Transferred to another provider of equal or higher-level training.
• O You are Out of strength.
• P Physician directs to discontinue.

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• NYS FOR BLS YOU MAY CALL MEDICAL CONTROL AFTER 20 MINUTES OF CPR WITH NO SHOCKS AND NO ROSC FOR TERMINATION OF CPR.

Foreign Body Airway Obstruction in Adults and Children/FBOA

• Airway obstruction may be caused by:
• Relaxation of throat muscles
• Vomited or regurgitated stomach contents
• Blood
• Damaged tissue
• Dentures
• Foreign bodies
• In adults, usually occurs during a meal
• In children, usually occurs during a meal or at play
• Patient with mild airway obstruction is able to exchange air but with signs of respiratory distress.

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Foreign Body Airway Obstruction in Adults and Children/FBOA

• Sudden, severe obstruction is usually easy to recognize in responsive patients..
• 5 BACK BLOWS 5 ABDOMINAL THRUSTS TILL IT COMES OUT OR THEY GO UNRESPONSIVE
• In unresponsive patients, suspect obstruction if maneuvers to open airway and ventilate are ineffective
• START MODIFIED CPR

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Foreign Body Airway Obstruction in Adults and Children/FBOA

• Unresponsive patients:
• Determine unresponsiveness.
• Check for breathing and a pulse.
• If pulse is present and breathing is absent, attempt ventilation.
• If two attempts do not produce visible chest rise, perform 30 compressions, open airway, and look in mouth.
• Attempt to carefully remove any visible object.
• 1^st breath doesn’t go in re-adjust head try a second time
• If second breath doesn’t go in back to modified CPR
• You must get 2 consecutive breaths to have a patent airway
• Mild airway obstruction encourage the patient to cough !!

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Foreign Body Airway Obstruction in Infants�

• Responsive infants
• Do not use abdominal thrusts.
• Perform 5 back slaps and 5 chest thrusts (compressions).
• In unresponsive infants, begin modified CPR, beginning with chest compressions.
• Do not check for a pulse before starting compressions.
• Open the airway and look in the mouth.
• Remove the object if seen.
• Try to ventilate if unsuccessful after repositioning head resume modified CPR

Special Considerations

• Instead of abdominal-thrust maneuver, use chest thrusts for the following responsive patients:
• Women in advanced stages of pregnancy
• Obese patients
• For obese patients use a wall to stand them up against
• Also for extremely tall people and you’re not.

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Remember

• Adult CPR 30 compressions 2 breaths no matter how many people switch after 2 minutes if there is another rescuer 5 cycles is about 2 minutes
• Child 1 rescuer 30compression 2 breaths 2 rescuer 15 compression 2 breaths switch after 2 minutes if there is another rescuer 10 cycles is about 2 minutes
• Get the AED on ASAP
• Rescue breathing for an adult 1 breath every 6 seconds
• Rescue breathing for a child 1 breath every 3-5 seconds
• The rate of compressions is 100-120 per minute
• Depth on adult 2 to 2.4 inches
• Depth on child and infant 1/3 the depth of the chest

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Questions