Transcript Aquatic Plyometrics

Understanding the 2010 CPR/ECC
and First Aid Guidelines
David C. Berry, PhD, LAT, ATC
Associate Professor and Athletic Training Program Director
Department of Kinesiology
Saginaw Valley State University
University Center, MI
Objective
• Examine the 2010 CPR, Emergency Cardiac
Care (ECC) and First Aid treatment guidelines
and recommendations and the rational and
science behind these suggested changes.
International Liaison Committee on
Resuscitation (ILCOR)
Representatives1
Heart and Stroke Foundation of Canada
Resuscitation Council of Asia
European Resuscitation Council
American Heart Association
InterAmerican Heart Foundation
Resuscitation Council of Southern Africa
Australian/New Zealand
Committee on
Resuscitation
CPR-ECC Review Process
1. Development of specific task force(s) (e.g., basic life support (BLS)).
2. Identification of topics requiring an evidence evaluation by the task force(s).
3. Formulation of hypothesis on these topics and appointment of international experts as
worksheet authors for each hypothesis.
4. Worksheet authors goals: (1) search for and critically evaluate evidence on the hypothesis, (2)
summarize the evidence review, and (3) draft treatment recommendations.1
5. The evidence is then presented, discussed, and debated, with task forces and resuscitation
councils meeting daily to draft summaries.
6. The Consensus on CPR and ECC Science and Treatment Recommendations (CoSTR) is then
developed and published simultaneously in Circulation and Resuscitation.
CPR-ECC Review Process
• Individual organizations draft their specific
guidelines for their population served,
remembering to clarifying the most important
skills needed to perform in an emergency
situation to improve patient outcomes.
First Aid Review Process
• National First Aid Science Advisory Board
(Co-founded by the AHA and ARC) reviewed
and evaluated the scientific literature regarding
first aid treatment guidelines.2
• Similar process to CPR-ECC guidelines;
however, this review was the most compressive
review ever completed looking to answer ……
First Aid Review Process
1. What are the most common emergency conditions that lead to significant
morbidity and mortality?
2. In which of these emergency conditions can morbidity or mortality be
reduced by the intervention of a first aid provider?
3. How strong is the scientific evidence that interventions performed by a first
aid provider are safe, effective, and feasible?
Lay Rescuer CPR/ECC Key
Recommendations and Guidelines
Chain of Survival3
Chain of Survival
Post-Cardiac Arrest Care
• Designed to emphasize protocols for optimizing
cardiovascular and neurological function to improve
survival of victims with resumption of spontaneous
circulation (ROSC) after cardiac arrest.1
• Includes– Optimizing cardiopulmonary function/vital organ perfusion after
ROSC.
– Transporting to an appropriate hospital/critical care unit with a
comprehensive post–cardiac arrest treatment system.
– Identify and treat ACS and other reversible causes.
– Control temperature to optimize neurologic recovery
– Anticipate, treat, and prevent multiple organ dysfunction. This
includes avoiding excessive ventilation and hyperoxia.
Simplified ILCOR Universal Adult
BLS Algorithm1
Simplified Universal Adult BLS
Algorithm4
American Heart Association
Emphasis on Chest Compressions
New for 2010
• Bystanders NOT trained in CPR should provide
Hands-Only™ (compression-only) CPR for the
adult patient who suddenly collapses, with an
emphasis to “Push Hard and Fast” on the
center of the chest.
• Continue Hands-Only™ CPR until1. AED arrives and is ready for use or
2. EMS or another responder(s) takes over care.
Emphasis on Chest Compressions
Why Change?
• Compression-only bystander CPR has been
shown to substantially improve survival
following adult out-of-hospital cardiac arrests
compared with NO bystander CPR.5-8
Emphasis on Chest Compressions
How can bystander CPR be effective without
rescue breathing?
• During SCA (with VF), rescue breaths initially are not as
important as chest compressions because the oxygen
level in the blood remains adequate for the first several
minutes after cardiac arrest.4
• Animal models suggest gasping or agonal gasps do allow
for some oxygenation and carbon dioxide
(CO2)elimination.9-10
“C-A-B” rather than “A-B-C”
New for 2010
• Initiate chest
compressions before
ventilations.
Why Change?
• Beginning CPR with 30
compressions rather than
2 ventilations leads to a
shorter delay to first
compression11-13
providing vital blood
flow to the heart and
brain.
Elimination of “Look, Listen, and
Feel”
New for 2010
• “Look, listen, and feel”
was removed from the
CPR sequence.
• After delivery of 30 chest
compressions, the lone
rescuer will open the
airway and deliver 2
breaths, each for 1
second.
Why Change?
• With the new “chest
compressions first”
sequence, CPR is
performed if the adult is
unresponsive and not
breathing or not
breathing normally.3
• Look, Listen and Feeling
is also inconsistent and
time consuming.
Chest Compression Rate
“At Least 100 per Minute”
New for 2010
Why Change?
• Reasonable for lay
rescuers to perform chest
compressions at a rate of
at least100
compression/min.
• More adequate chest
compressions per minute
was associated with
higher survival rates
• Fewer compressions
were associated with
lower survival rates.14-15
Chest Compression Depth
New for 2010
Why Change?
• Adult and child sternum
should be depressed at
least 2 inches (5 cm).
• Infant sternum should be
depressed at least 1 ½
inches (4 cm).
• Science suggests that
compressions of at least 2
inches was more effective
than compressions of 1
½ inches.16-18
• Believed confusion exists
when a depth range is
recommended, so 1
compression depth is
now recommended for
all ages.
Healthcare Provider CPR/ECC
Recommendations and Guidelines
Healthcare Provider Adult BLS
Algorithm4
Emphasis on Chest Compressions
New for 2010
Why Change?
• Effective chest
compressions are
emphasized, but
optimally all healthcare
providers should be
trained in BLS, thus it is
reasonable to provide
chest compressions and
rescue breaths for cardiac
arrest victims.
• Healthcare providers
should be trained to
perform both
compressions and
ventilations.3
• If healthcare providers
are unable to perform
ventilations, the provider
should activate the
emergency response
system and provide
chest-only compressions.
Activation of Emergency Response
System
New for 2010
Why Change?
• Healthcare providers
should check for
response while looking at
the patient to determine
if breathing is absent or
not normal.
• Healthcare providers
should not delay
activation of the
emergency response
system but should obtain
2 pieces of information
simultaneously:
1. Responsiveness
2. No breathing or no
normal breathing.4
Cricoid Pressure
New for 2010
Why Change?
• The routine use of
cricoid pressure for
patient of cardiac arrest is
NOT recommended.
• RCTs demonstrated
cricoid pressure delayed
or prevented placement of
an advanced airway and
that aspiration may occur
even with application of
pressure.26-29
• Manikin studies30-32 found
the maneuver difficult for
both expert and
nonexpert rescuers.
Healthcare Provider and Lay Rescuer
Consistent Adult Changes
• Change in CPR Sequence– C-A-B Rather Than A-B-C
• Chest Compression Depth
– Adult sternum should be depressed at least 2
inches (5 cm).
• Chest Compression Rate
– At Least 100/minute
Key BLS Components for Adult,
Children, and Infants3
Key BLS Components for Adult,
Children, and Infants3
Electric Therapies
Adult
• The 2010 International Consensus on Science
With Treatment Recommendations statement
contains no major differences or dramatic
changes for adult defibrillation compared to the
2005 International Consensus statement.33
Electric Therapies
Pediatric
New for 2010
Why Change?
• A pediatric doseattenuator AED should
be used for children ages
1-to-8.
• For infants (<1 year of
age), a manual
defibrillator is preferred.
• If neither unit is available,
an AED without a dose
attenuator may be used
for both age groups.
• AEDs with relatively
high-energy doses (as
high as 9 J/kg) have been
used successfully for
infants in cardiac arrest
with no clear adverse
effects.34
Electric Therapies
Shock First vs. CPR First
Reaffirmation 2010
• When SCA is witnessed and an AED IS immediately
available, rescuers should start CPR with chest
compressions and use the AED as soon as possible.
• When SCA is not witnessed initiate CPR while checking
and preparing for defibrillation.
• Whenever 2 or more rescuers are present, CPR should
be provided while the defibrillator is retrieved.3
Electric Therapies
Electrode Placement
New for 2010
Why Change?
• The anterior-lateral pad
position is the default
electrode placement
when using an AED.
• However, any of 3
alternative pad positions
may be used-
• Studies suggest that all 4
AED pad placements
were equally effective in
defibrillation for VF.35-38
– Anterior-posterior
– Anterior–left infrascapular
– Anterior–right
infrascapular
First Aid Recommendations and
Guidelines
Supplemental (Emergency) Oxygen
No Change From 2005
Why Change?
• Administration of oxygen
is not recommended for
patients with shortness of
breath or chest
discomfort.
• No benefit of
supplementary oxygen
administration was found
in treating patients with
shortness of breath or
chest discomfort.39-41
• Evidence that
supplementary oxygen
for divers with
decompression injury
may be effective.42
New for 2010
• Supplementary oxygen
administration should be
considered as part of first
aid for divers with a
decompression injury.
Epinephrine and Anaphylaxis
New for 2010
Why Change?
• Recommended that if the
symptoms of anaphylaxis
persist despite
administration of an Epipen, rescuers should seek
medical assistance before
administering a 2nd dose of
epinephrine.
• Approximately 18% to
35% of patients
presenting with signs and
symptoms of anaphylaxis
may require a 2nd dose of
epinephrine,43-45 however
the diagnosis of
anaphylaxis can be a
challenging and excessive
epinephrine
administration may
produce complications.2
Aspirin Administration for Chest
Discomfort
New for 2010
Why Change
• Rescuers should advise the
patient to chew 1 adult
(non-coated) or 2 lowdose
“baby” aspirins if the
patient has-
• Aspirin is beneficial when
chest discomfort is due
to an acute coronary
syndrome (ACS),
however, the
administration of aspirin
must never delay EMS
activation.2
– No allergy to or other
– Contraindications to aspirin
(e.g., stroke or recent
bleeding).46-48
Bleeding Control
Tourniquets
No Change From 2005
• The use of a tourniquet to control bleeding of the
extremities is indicated ONLY IF direct pressure is
NOT effective or possible and if the provider has
PROPERLY trained in tourniquet use.
Bleeding Control
Hemostatic Agents
New for 2010
• The routine use of hemostatic agents to control bleeding
as a first aid measure is NOT recommended at this time
for lay responders, but may be considered if direct
pressure and tourniquets are not possible for
professional rescuers.2
Bleeding Control
Pressure Points and Elevation
Reaffirmation
• Elevation and pressure points are not
recommended to control bleeding.2
Why Change?
• This recommendation is made because there is
evidence that other methods of controlling
bleeding are more effective2 and as of 2010 no
studies had examined the hemostatic effects of
elevation to control bleeding.
Bleeding Control
Shock
New for 2010
• If a victim shows evidence of shock, have the
victim lie supine, DO NOT elevate the feet.
Why Change?
• Simplified decision-making.
• There are no studies examining the effects of leg
position (elevation) as a first aid maneuver for
the management of shock.2
Animal Bites
Snakebites
New for 2010
• Care of any venomous
snake bite is now
consistent.
– Place a pressure bandage
around the length of the
bitten extremity with
pressure applied between• 40-70 mm Hg in the upper
extremity
• 55-70 mm Hg in the lower
extremity
Why Change
• Effectiveness of pressure
immobilization has been
shown to be effective and
safe in slowing lymph
flow and the
dissemination of snake
venom.49-51
Animal Bites
Jellyfish
New for 2010
Why Change?
• To inactivate venom and
prevent further
envenomation, stings
should be liberally washed
with vinegar (4-6% acetic
acid solution) quickly and
for at least 30 secs.
• Once nematocysts are
removed/deactivated, the
pain should be treated
with hot-water immersion.
• Evidence suggests that
vinegar is most effective
solution for inactivation
of the nematocysts. 52-55
• Immersion with water, as
hot as tolerated for about
20 minutes, is most
effective for treating the
pain.52-55
Environmental Emergencies
Heat Stroke
New for 2010
• The most important action to manage heat stroke is
to begin immediate cooling, preferably by
immersing the victim up to the chin in cold
water.56-58
• It is also important to activate the EMS system as
heat stroke requires emergency treatment with
intravenous fluids.2
• Do not try to force the victim to drink liquids if they
have altered mental status.2
Environmental Emergencies
Frostbite
New for 2010
• Better distinction between recognition and care for
minor and severe frostbite.
– Care - minor
• Skin-to-skin contact
– Care – severe
• Rewarmed by immersing extremity in warm (98.6° to
104°F or approximately body temperature) water for
20 to 30 minutes.2
• Chemical warmers should not be placed directly on
frostbitten tissue because they can reach
temperatures that can cause burns.59
Spinal Stabilization
New for 2010
• Maintain spinal motion restriction by manually
stabilizing the head so that the motion of head, neck,
and spine is minimized.2
• Providers should not use immobilization devices
because their benefit in first aid has not been
completely proven and they may be harmful.2
• However, if needed, providers should be properly
trained in their use.2
Ingest Poisons
Treatment With Milk or Water
New for 2010
• There is insufficient evidence to show that milk
or water dilution of ingested poisons produces
any benefit as a first aid measure.2
• Possible adverse effects of water or milk
administration include emesis and aspiration.
Ingest Poisons
Activated Charcoal and Ipecac
• Do Not administer activated charcoal to a patient
ingesting a poisonous substance unless advised by
poison control center or emergency medical
personnel.2
– Activated charcoal is safe to administer60-61 but no
evidence to suggest that it is effective as a component
of first aid.
• Do Not administer syrup of ipecac for ingestions of
toxins as there is no advantage to administering
syrup of ipecac and it may delay care in an advanced
medical facility.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
Nolan JP, et al. Part 1: Executive summary 2010 International Consensus on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With
Treatment Recommendations. Resuscitation. 2010;81S:e1-e25. Available at:
http://www.cprguidelines.eu/2010/costr.php.
Markenson D, et al. Part 17: First Aid: 2010 American Heart Association and American
Red Cross. Circulation. 2010;122;S934-S946. Available at:
http://circ.ahajournals.org/cgi/content/full/122/21/2228.
American Heart Association. Highlights of the 2010 American Heart Association
Guidelines for CPR and ECC. Available at:
http://static.heart.org/eccguidelines/index.html
Swor RA, et al. Part 5: Adult Basic Life Support: 2010 American Heart Association
Guidelines. Circulation. 2010;122;S685-S705. Available at:
http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S685.
Sayre MR, et al. Hands-only (compression-only) cardiopulmonary resuscitation: a call to
action for bystander response to adults who experience out-of-hospital sudden cardiac
arrest: a science advisory for the public from the American Heart Association Emergency
Cardiovascular Care Committee. Circulation. 2008;117:2162–2167.
Ong ME, et al. Comparison of chest compression only and standard cardiopulmonary
resuscitation for out-of-hospital cardiac arrest in Singapore. Resuscitation. 2008;78:119-126.
Bohm K, et al. Survival is similar after standard treatment and chest compression only in
out-of hospital bystander cardiopulmonary resuscitation. Circulation. 2007;116:2908-2912.
Iwami T, et al. Effectiveness of bystander-initiated cardiac-only resuscitation for patients
with out-of-hospital cardiac arrest. Circulation. 2007;116:2900-2907.
Berg RA, et al. Assisted ventilation does not improve outcome in a porcine model of