3.3 CPR and AED integration in cardiac emergencies

CPR 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, AED 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 defibrillation using an AED to shock the heart back into a normal rhythm
• Advanced life support provided by emergency medical services (EMS) personnel
• Post-cardiac arrest 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 chest compressions 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 rescue breaths
• 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 electrode pads 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