3.3 CPR and AED integration in cardiac emergencies
5 min read•august 7, 2024
and AEDs are lifesaving tools in cardiac emergencies. They work together to keep blood flowing and restart the heart. Knowing how to use them correctly can mean the difference between life and death.
This section covers the basics of CPR techniques, operation, and how to integrate them effectively. We'll look at proper hand placement, compression depth, and AED pad placement. These skills are crucial for anyone who might need to respond to a cardiac emergency.
CPR Fundamentals
Chain of Survival Steps
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- Early recognition and activation of emergency response system to quickly get help on the way
- Immediate high-quality CPR to maintain blood flow to vital organs (brain, heart)
- Rapid using an AED to shock the heart back into a normal rhythm
- Advanced life support provided by emergency medical services (EMS) personnel
- Post- care in a hospital setting to treat the underlying cause and manage complications
High-Quality CPR Techniques
- Proper hand placement on the lower half of the sternum in the center of the chest
- Compression depth of at least 2 inches (5 cm) for adults to ensure adequate blood flow
- Compression rate of 100-120 per minute, allowing full chest recoil between compressions
- Minimize interruptions in to less than 10 seconds
- Avoid excessive ventilation, as it can decrease cardiac output and survival rates
Compression-to-Ventilation Ratios
- 30:2 ratio for single rescuers, providing 30 chest compressions followed by 2 breaths
- Continuous chest compressions with asynchronous ventilations every 6 seconds for advanced life support providers
- 15:2 ratio for two-rescuer CPR in infants and children, with 15 compressions followed by 2 breaths
- Ratio may be modified based on the patient's age, number of rescuers, and presence of an advanced airway
Hands-Only CPR for Bystanders
- Hands-only CPR involves providing continuous chest compressions without
- Recommended for untrained bystanders or those unwilling to perform mouth-to-mouth ventilations
- Dispatcher-assisted CPR instructions often guide bystanders to perform hands-only CPR
- Hands-only CPR has been shown to be as effective as conventional CPR in the first few minutes of cardiac arrest
CPR Certification and Training
- Certification courses teach proper CPR techniques, AED use, and choking relief
- American Heart Association (AHA) and American Red Cross (ARC) offer widely recognized certification programs
- Healthcare providers require Basic Life Support (BLS) certification, which includes CPR and AED training
- Certification typically lasts for two years before requiring renewal
- Regular training and practice are essential to maintain skills and confidence in performing CPR
AED Integration
AED Operation and Prompts
- AEDs are designed to be user-friendly with voice and visual prompts guiding the rescuer
- Power on the AED and follow the device's instructions
- AED will analyze the heart rhythm and determine if a shock is needed
- If a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) is detected, the AED will charge and instruct the rescuer to deliver the shock
- Resume CPR immediately after shock delivery or if no shock is advised
Proper Pad Placement
- Remove clothing from the patient's chest and ensure the skin is dry
- Apply one pad on the upper right side of the chest, just below the collarbone
- Place the other pad on the lower left side of the chest, below the armpit
- For infants and small children, use pediatric pads (if available) and place one pad on the front of the chest and the other on the back
- Ensure pads are adhered securely to the skin and not touching each other
Safe Shock Delivery
- Ensure no one is touching the patient before delivering the shock to avoid accidental electrocution
- Loudly state, "Clear!" and visually check that everyone is clear of the patient
- Press the shock button when instructed by the AED
- Immediately resume CPR after the shock, starting with chest compressions
- Continue CPR until the AED prompts to stop for the next rhythm analysis or until advanced life support arrives
CPR-AED Sequence
- Perform CPR until the AED is available and ready to use
- Turn on the AED and follow the prompts
- Attach the AED pads to the patient's bare chest as directed
- Allow the AED to analyze the heart rhythm, ensuring no one is touching the patient
- Deliver a shock if advised by the AED, ensuring everyone is clear of the patient
- Resume CPR immediately after the shock, starting with chest compressions
- Continue the CPR-AED sequence until advanced life support arrives or the patient shows signs of life
AED Maintenance and Readiness
- Regularly check the AED's battery life and replace batteries as needed
- Ensure are within their expiration date and replace if necessary
- Perform routine maintenance as specified by the manufacturer
- Store the AED in an easily accessible location and ensure all potential rescuers know its location
- After each use, replace used electrode pads, batteries, and other consumables
- Document the use of the AED and any maintenance performed
Post-Resuscitation Care and Considerations
Post-Resuscitation Care Priorities
- Continuously monitor the patient's vital signs, including heart rhythm, blood pressure, and oxygen saturation
- Provide supplemental oxygen and advanced airway management as needed
- Treat underlying causes of the cardiac arrest (heart attack, drug overdose, etc.)
- Initiate targeted temperature management (therapeutic hypothermia) to improve neurological outcomes
- Transfer the patient to a hospital with comprehensive post-cardiac arrest care capabilities
Legal and Ethical Considerations
- Good Samaritan laws protect rescuers who provide CPR and use AEDs in good faith
- Obtain consent for CPR and AED use whenever possible, but implied consent applies in emergency situations
- Respect patient's advanced directives (DNR orders) if known
- Maintain patient confidentiality and privacy when discussing the incident
- Document the resuscitation attempt, including the use of CPR and AED, for legal and quality improvement purposes
Key Terms to Review (20)
2 minutes of CPR before AED use: The guideline of performing 2 minutes of CPR before using an Automated External Defibrillator (AED) emphasizes the importance of initiating chest compressions to improve blood circulation and oxygen delivery to the brain and vital organs during a cardiac emergency. This initial intervention increases the chances of survival and prepares the heart for defibrillation, as it allows time for emergency responders to arrive and assess the situation. Understanding this sequence is crucial in integrating CPR and AED effectively in cardiac emergencies.
30:2 compression-to-breath ratio: The 30:2 compression-to-breath ratio is a guideline for performing cardiopulmonary resuscitation (CPR) on adults, which involves delivering 30 chest compressions followed by 2 rescue breaths. This technique is crucial for providing effective oxygenation and circulation during cardiac emergencies, helping to maintain blood flow to vital organs until advanced medical help arrives.
ABC Assessment: The ABC Assessment is a systematic approach used in emergency situations to evaluate a patient's vital functions, specifically focusing on Airway, Breathing, and Circulation. This assessment is crucial for identifying life-threatening conditions and initiating appropriate interventions quickly. The ABC sequence helps prioritize actions that can save lives, particularly during cardiac emergencies, severe allergic reactions, or when gathering important patient history.
Adult CPR: Adult CPR, or cardiopulmonary resuscitation for adults, is a life-saving technique used in emergencies when someone's heart has stopped beating or they are not breathing. This process involves a combination of chest compressions and rescue breaths to maintain blood flow and oxygenation until professional medical help arrives. Understanding the specifics of adult CPR is crucial, especially as it differs from child and infant CPR in terms of technique and depth of compressions. Additionally, integrating CPR with the use of an Automated External Defibrillator (AED) enhances the chances of survival during cardiac emergencies.
AED: An Automated External Defibrillator (AED) is a portable medical device used to treat people experiencing sudden cardiac arrest. It works by analyzing the heart's rhythm and delivering an electric shock if necessary, allowing the heart to re-establish an effective rhythm. Understanding how to use an AED is crucial, as it integrates with CPR techniques, enhances survival rates during cardiac emergencies, and emphasizes the importance of hands-on practice in first aid training.
American Heart Association Guidelines: The American Heart Association (AHA) Guidelines are evidence-based recommendations designed to enhance the quality of cardiovascular care and improve patient outcomes during cardiac emergencies and other medical situations. These guidelines serve as a foundational resource for best practices in performing CPR, using AEDs, recognizing strokes, and making ethical decisions in first aid scenarios, ensuring consistency and effectiveness in life-saving interventions.
Call for Help: Calling for help refers to the critical action of seeking assistance in emergency situations to ensure that the necessary medical care is provided promptly. This action is vital across various scenarios, including recognizing emergencies, performing CPR, managing choking incidents, and communicating effectively with emergency responders. The ability to call for help can significantly impact the outcome of an emergency by facilitating timely interventions and connecting with professional resources.
Cardiac arrest: Cardiac arrest is a critical medical condition where the heart suddenly stops beating, leading to a cessation of blood flow to the brain and other vital organs. This emergency requires immediate intervention to prevent death or severe brain damage. Recognizing the signs of cardiac arrest and knowing how to respond effectively can save a life, emphasizing the importance of understanding emergency action steps, CPR techniques, and special considerations for vulnerable populations such as older adults.
Check Responsiveness: Checking responsiveness involves assessing whether a person is conscious and aware of their surroundings, typically by using verbal or physical stimuli. This critical step helps responders determine the urgency of the situation and what actions to take next, particularly when prioritizing emergency actions, integrating CPR and AED use during cardiac events, and recognizing and managing choking incidents across different age groups.
Chest compressions: Chest compressions are rhythmic, forceful pushes applied to the center of a person's chest to help maintain blood circulation during cardiac arrest. This critical life-saving technique is an essential component of CPR, where the goal is to artificially circulate blood and supply oxygen to vital organs until professional help arrives. Mastering the technique for different age groups is vital for effective response in emergencies, and knowing how to integrate chest compressions with the use of an AED enhances the chances of survival in cardiac emergencies.
CPR: Cardiopulmonary resuscitation (CPR) is a lifesaving technique used in emergencies when someone's breathing or heartbeat has stopped. It combines chest compressions and rescue breaths to restore blood flow and oxygen to the brain and vital organs, making it crucial in cardiac emergencies and other life-threatening situations.
CPR Protocol: CPR protocol refers to a set of established guidelines and steps that outline the procedures to be followed when performing cardiopulmonary resuscitation on an individual experiencing a cardiac emergency. These protocols are designed to maximize the chances of survival by ensuring immediate and effective response in life-threatening situations, often integrating the use of an Automated External Defibrillator (AED) when available.
Defibrillation: Defibrillation is a medical procedure used to restore a normal heart rhythm by delivering an electrical shock to the heart. This technique is critical in cases of life-threatening arrhythmias, particularly ventricular fibrillation, which can lead to cardiac arrest. The process emphasizes the importance of quick response and effective first aid measures, as timely defibrillation can significantly improve survival rates in cardiac emergencies.
Electrode pads: Electrode pads are adhesive patches used in automated external defibrillators (AEDs) to deliver an electric shock to the heart during a cardiac emergency. These pads contain conductive gel that facilitates the transfer of electrical energy, allowing for the monitoring of the heart's rhythm and delivering defibrillation when necessary. Proper placement and use of electrode pads are crucial for the effectiveness of an AED, ensuring a higher chance of restoring a normal heart rhythm.
Infant CPR: Infant CPR is a lifesaving technique designed to restore breathing and circulation in infants who are unresponsive or not breathing normally. This process involves specific modifications to standard CPR techniques, including different hand placements, compression depths, and the use of gentle breaths due to the fragility of an infant's body. Understanding how to perform infant CPR is crucial for providing immediate care in emergency situations involving young children.
Myocardial infarction: Myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart muscle is blocked for an extended period, leading to tissue damage or death. This condition is typically caused by the buildup of plaque in the coronary arteries, which can rupture and form a clot that obstructs blood flow. Prompt recognition and treatment are crucial to minimize heart damage and improve survival rates.
No pulse detected: No pulse detected refers to the absence of a palpable heartbeat, which is a critical sign indicating that the heart is not effectively pumping blood throughout the body. This condition is often a result of cardiac arrest, where the heart stops functioning, leading to a cessation of blood flow and oxygen delivery to vital organs. Recognizing this state is essential for initiating immediate life-saving interventions like CPR and using an AED, as it signifies the need for urgent medical assistance.
Pulse Check: A pulse check is a quick and essential assessment technique used to determine if a person has a heartbeat. It involves feeling for the pulse at specific points on the body to evaluate circulation and heart function, especially during cardiac emergencies. This procedure is crucial in assessing whether to initiate CPR or use an AED, as it provides vital information on the victim's condition and the need for immediate intervention.
Rescue Breaths: Rescue breaths are controlled breaths given to a person who is not breathing or not breathing adequately, aimed at providing oxygen to their lungs. This technique is critical in both adult, child, and infant CPR techniques, where it is used in conjunction with chest compressions to ensure that oxygen reaches vital organs during cardiac arrest or respiratory failure. Understanding the correct method for delivering rescue breaths is essential for effective emergency response, especially when integrating CPR with an Automated External Defibrillator (AED) during cardiac emergencies.
Unresponsive Patient: An unresponsive patient is an individual who does not react to verbal or physical stimuli, indicating a potential medical emergency requiring immediate attention. This condition is crucial in cardiac emergencies as it often signifies severe underlying issues like cardiac arrest or other life-threatening events that necessitate urgent intervention such as CPR and the use of an AED.