Transcript G2010 Webinar Final - National Safety Council

An Overview and Explanation
of the 2010 CPR and ECC
Guidelines
®
Webinar Presenter
Barbara Caracci
Director of Program Development
and Training, First Aid Programs
National Safety Council
nsc.org
Objectives
At the end of this webinar you will be able to:
• Identify how CPR will change under the new
guidelines
• Identify changes in first aid protocols under the
new guidelines
• Anticipate shelf dates for NSC courses
• Get answers to your G2010 technical
questions
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Overview of Key Changes in
CPR
1. Recognizing cardiac arrest based on
assessing unresponsiveness + absence of
normal breathing
2. No more “Look, Listen and Feel”
3. ABC becomes CAB
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Overview of Key Changes in
CPR, cont’d.
4. Focus on how to provide high-quality CPR
5. De-emphasis on pulse check for health
care providers
6. Hands-Only CPR for untrained lay
rescuers
7. AEDs for all ages—infants, children, adults
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1.
Assessing unresponsiveness and
absence of normal breathing
• Tap and shout “Are you okay?”
• Simultaneously note whether person is not
breathing or is not breathing normally (only
gasping)
• A person with absent or abnormal breathing
needs CPR
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2. No more “Look, Listen and
Feel”
• Positioning head, achieving a seal, etc.
takes time (app. 18 seconds)
• Blood flow depends on compressions
− Delays in/interruptions of compressions should
be minimized
• Chest compressions can be started almost
immediately
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3. ABC becomes CAB
• For adults, children (age 1 – onset of puberty) and
infants (birth – age 1) excluding newly born
• No human or animal evidence for CAB
• What we know:
– During first minutes of ventricular fibrillation cardiac arrest,
rescue breaths are not as important as chest compressions
– Chest compressions provide blood flow to heart and brain
– Studies of out of hospital cardiac arrest showed survival higher
when bystanders attempted CPR vs. no CPR
– Animal studies show delays or interruptions in compressions
reduced survival
• CAB ensures that person receives compressions early
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4. Focus on how to provide
high-quality CPR
• Chest compressions
– Push hard and push fast
• At least 100 / minute (vs. app. 100 / minute)
• Compression depth at least 2 inches in adults
– 2 inches in children (= 1/3 AP diameter)
– 1 ½ inches in infants (= 1/3 AP diameter)
• Allow complete recoil of the chest after each compression
• Maximize number of compressions per minute
– Minimize interruptions
• Compression-ventilation ratio of 30:2
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4. Focus on how to provide
high-quality CPR, cont’d.
• Compression-ventilation ratio of 30:2
− Based on
• Consensus among experts
• Published case series
− Further studies are needed
• Rescue breaths—no change from 2005
− 2 ventilations, each delivered over 1 second
− Sufficient to produce visible chest rise
− Excessive ventilations are harmful
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5. De-emphasis on pulse check
for health care providers
• Supported by science
– Healthcare providers (HCP) take too long to
check
– They have difficulty determining if pulse is
present or absent
– Pulse check interrupts compressions
• HCP should take no more than 10 seconds to
check
– If no definite pulse within 10 seconds, start
compressions
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6. Hands-Only (H-O) CPR for
untrained lay rescuers
• Only 20% - 30% of adults with out-ofhospital cardiac arrests receive any
bystander CPR
• Panic is a major obstacle to bystander CPR
• H-O bystander CPR substantially improves
survival compared with no CPR
• Simpler H-O CPR may help overcome
panic/reluctance
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Hands-Only vs. 30:2
• No prospective study shows better outcomes
• One recent study showed survival better with 30:2 for
children
• Data support breathing an important part of successful
resuscitation for
– Asphyxial cardiac arrests in adults and children
– Prolonged cardiac arrests
• Trained rescuers should give conventional CPR (30:2)
– Call 9-11 and provide H-O at a minimum
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7. AEDs for all ages—infants,
children, adults
• For all people with ventricular fibrillation,
survival rates highest when immediate CPR
provided and defibrillation occurs within 3 –
5 minutes of collapse
• Insufficient evidence to recommend for or
against delaying defib. to provide CPR
• Use AED as soon as it is available
• Provide chest compressions immediately
after shock
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7. AEDs for all ages—infants,
children, adults, cont’d.
• Infants (≤ 1 year of age )
– Manual defib. preferred
• If unavailable, use AED with dose attenuator
– If unavailable, use standard AED
• Children (1 – 8 years of age)
– Use AED with dose attenuator
• If unavailable, use standard AED
• Adult (≥ 8 years of age)
– Use standard AED
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Overview of New First Aid
Guidelines
• A paucity of scientific evidence for
interventions
• Many recommendations extrapolated from
healthcare professionals’ experience
• Evidence supporting these guidelines has
limitations
• More research in first aid is needed
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General Changes in First Aid
• Positioning the victim
– Explains meaning of HAINES recovery position
(High Arm IN Endangered Spine)
– Shock position
• Supine
• If no evidence of trauma, raise feet 6 – 12 inches
– Oxygen
• Still insufficient evidence for chest discomfort/shortness
of breath
• May be beneficial for divers with decompression
injury
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Changes in First Aid for Medical
Emergencies
• Asthma
– First aid providers should become familiar with inhalers so
they can assist a person
• Anaphylaxis
– Seek medical assistance if symptoms persist rather than
routinely administering a second dose of epinephrine
• Chest discomfort
– Assume chest discomfort is cardiac until proven otherwise
– While waiting for EMS, encourage person to chew 1 adult or
2 “baby” aspirin if person has no allergy/contraindications
(e.g., recent GI bleeding)
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Changes in First Aid for Injury
Emergencies
• Bleeding
– Direct pressure
• Focus is on holding manual direct pressure for a long time
• Use pressure bandage if it is not possible to provide
manual pressure
– Tourniquets
• Commercially available better than improvised
• Potential adverse effects and difficulty in proper application
• Use only if
– Direct pressure is not effective/ possible
– You have been properly trained
– Hemostatic agents
• Routine use not recommended
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Changes in First Aid for Injury
Emergencies, cont’d.
• Wounds and abrasions
– Irrigate superficial wounds/abrasions with large
volume of warm or room temperature water,
with or without soap
• No foreign matter in wound
– Apply antibiotic ointment or cream if no known
allergies to the antibiotic
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Changes in First Aid for Injury
Emergencies, cont’d.
• Potential spine injuries
– Risk factors increased to include:
• Sensory deficit or muscle weakness involving
the torso or upper extremities
• Children 2 years of age or older with evidence
of head/neck trauma
– Spine stabilization now called spinal
motion restriction
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Changes in First Aid for Injury
Emergencies, cont’d.
• Sprains and strains
– Cool with a plastic bag or damp cloth filled with a
mixture of ice and water
– Limit each application of cold to ≤20 minutes. If that
length of time is uncomfortable, limit application
to 10 minutes
• Fractures
– If far from definitive health care, stabilize extremity
in a splint in position found.
– If splint is used, it should be padded
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Changes in First Aid for Injury
Emergencies, cont’d.
• Human and animal bites
– Irrigate human and animal bites with copious
amounts of water
• Snakebites
– Apply a pressure immobilization bandage around
the entire length of the bitten extremity
• Pressure tight and snug enough to allow a finger
to be slipped under it
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Changes in First Aid for Injury
Emergencies, cont’d.
• Jellyfish stings
– Wash liberally with vinegar asap for 30 seconds
– Baking soda slurry may be used instead
– After nematocysts removed/deactivated, immerse in
hot water for at least 20 minutes
• Dental injuries
– Place tooth in milk or clean water if milk is not
available
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Changes in First Aid for
Environmental Emergencies
• Cold emergencies
– Hypothermia
• If victim is far from definitive health care, begin active
rewarming although the effectiveness of active
rewarming has not been evaluated
– Frostbite
• Treat minor/superficial frostbite with rapid rewarming (skinto-skin contact such as a warm hand)
• Severe/deep frostbite—re-warm within 24 hours
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– Immerse in warm (body temperature) water, 20 – 30 minutes
– Do not place chemical warmers on skin
– Protect frostbitten parts from refreezing and quickly evacuate
patient for further care
Changes in First Aid for
Environmental Emergencies
• Heat emergencies
– Divided into 3 categories of increasing
severity
• Heat cramps
• Heat exhaustion
• Heat stroke
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Changes in First Aid for
Environmental Emergencies,
cont’d.
• Heat cramps
– First aid includes rest, cooling off and
drinking a sports drink.
– Stretching, icing and massaging painful
muscles helpful
– No exercise until symptoms resolved
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Changes in First Aid for
Environmental Emergencies,
cont’d.
• Heat exhaustion
– Identifies causes, signs and symptoms,
and chance of advancing to heat stroke
– Treat vigorously
•
•
•
•
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Lie down in a cool place
Shed as many clothes as possible
Cool with cool water spray
Encourage cool fluids, preferably sports drink
Changes in First Aid for
Environmental Emergencies,
cont’d.
• Heat stroke
– Identifies signs and symptoms
– Begin immediate cooling
•
•
•
•
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Immerse up to chin in cold water
Activate EMS system
Requires emergency treatment with IV fluids
Do not force victim to drink fluids
Changes in First Aid for Poison
Emergencies
• Poison emergencies
– If the person exhibits any signs and
symptoms of a life threatening condition after
exposure, activate EMS immediately
•
•
•
•
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Sleepiness
Seizures
Difficulty breathing
Vomiting
Putting It All Together
NSC Course Shelf Dates, 2011
• April 7
– NSC First Aid, CPR & AED
– NSC First Aid, CPR & AED Online
– NSC Train-the-Trainer
• April 14
– NSC CPR & AED
• April 21
– NSC First Aid
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Putting It All Together
NSC Course Shelf Dates, 2011
• June
– NSC Basic Life Support for Healthcare and
Professional Rescuers
• July
– Spanish version of NSC First Aid, CPR & AED
• August
– NSC Pediatric First Aid, CPR & AED
– NSC Advanced First Aid, CPR & AED (formerly
called First Aid Taking Action)
• September
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– Emergency Medical Responder (formerly called
First Responder)
Technical Questions?
Please e-mail any
questions to:
[email protected]
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What You Have Learned
• How CPR will change under the new
guidelines
• The changes in first aid protocols under the
new guidelines
• The shelf dates for NSC courses
• Where to submit your G2010 technical
questions
nsc.org
Thank You For Attending!
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