CPR (Hands Only) + AED

1. CardiacArrest andYou
2. Hands-Only Cardio Pulmonary Resuscitation
3. Automated External Defibrillation (AED)
Cardiac Arrest and You
• Introduction

- Based on national health statistics from the MOH in 2015, Singapore, ischemic heart
disease (lack of blood circulation to heart muscles) is the 3rd most common cause of
death
- According to a 2015 study* conducted in Singapore, 2374 people collapsed in an out-
of-hospital setting from sudden cardiac arrest, of which, 1656 (69.8%) occurred at
home.
- Bystander CPR was performed on 1284 (54.1%) casualties and bystander defibrillation
was performed on 97 (4.1%) of them.
- Only 77 (3.24%) casualties survived to be discharged with good-to-moderate
neurological functions.
CirculatorySystem
The heart
• Left side heart pumps
Oxygen Rich blood to rest
of your body

• Right sided heart pumps

blood into lungs topick up
oxygen then flows to left
side of heart

• Heart Rate : 60-100/min

Important Facts onOxygen

Inhale - 21% of Oxygen (Air)

Exhale – 16% Oxygen Used

by body – 5 % Oxygen
What happens during a heart attack?

A heart attack occurs

when cholesterol deposits
and / or blood clots block
one of the coronary
arteries supplying the
heart muscle. The heart
muscles beyond the
blocked vessel dies due
to lack of oxygenated
blood. This is heart attack.
 Risks Factors for HeartAttacks
• Smoking
Smoking promotes the development of plaques within the coronary
arteries and increases the risk of heart attack by two-fold. This habit
should be avoided altogether

• Blood Pressure
If the blood pressure is high, there will be tremendous stress on the
heart. Frequent blood pressure checks and reduction of salt in the diet is
important. Those with high blood pressure should take their medicines
and check their blood pressure regularly as instructed
 Risks Factors for Heart Attacks
• Blood Sugars
Avoid a diet high in carbohydrates or refined sugars and control body
weight through diet and exercise. If you have diabetes, take your
medications regularly as instructed.

• Blood Lipids
Manage blood lipids (fats) by avoiding foods high in fats. Doing regular
exercise could improve your blood lipid profile and take your
medications regularly as instructed.
 Symptoms of a Heart Attack
Pain
• Described as tightness or discomfort either over the chest
or upper part of the abdomen. This pain may also spread to
the left shoulder, left arm, neck or lower jaw. Some may
mistake this for indigestion or fatigue.
Shortness of breath
• A sudden difficulty in breathing may be a warning sign of a
heart attack.
Other Symptoms
• Sweating, nausea, vomiting or dizziness
 HeartAttack!
Management
• Place casualty in comfortable half sitting position
• Call 995 for SCDF
• Monitor vital signs
• Check medical history
• If casualty unconscious,check breathing,if needed
perform CPR
http://www.nhlbi.nih.gov/health/health-topics/topics/cad/printall-index.html
What happens in a Cardiac Arrest?
• When a portion of the heart muscles dies, it
affects the electrical impulses within the
heart.
• The orderly flow of electrical signals within
the heart is disrupted.
• This is a dangerous situation and an irregular,
chaotic electrical rhythm called Ventricular
Fibrillation (VF) develops in many cases.
What happens in a Cardiac Arrest?
• When VF occurs, the heart does not pump the blood to the
rest of the body. This is a state of cardiac arrest and the
casualty will be unconscious and stops breathing normally.
• At the start of a cardiac arrest, the oxygen level in the blood
decreases, causing brain damage.
• If this situation is reversed immediately, survival chance could
be as high as 90%. With a 6 minutes delay, this drops to 40–
50% and at 9 minutes, it is a dismal 10%
• To avoid this, immediate CPR and defibrillation are key
components for increased chances of survival.
Common causes of Cardiac Arrest
A heart attack is the most common cause of cardiac arrest.
There are other causes, which include:

- Drug overdose
- Choking
- Smoke inhalation
- Severe Trauma
- Drowning
- Electrocution
- Severe allergy
- Stroke
 Chain ofSurvival

1st Link 2nd Link 3rd L ink 4th Link 5th Link

Early Early CPR Early EMS Early

Recognition (brain damage Defibrillation Advanced
andAccess occurs after 4 – 6 Care
minutes)
 Chain ofSurvival
• First Ring: Early Recognition and Access
• Call for ambulance (dial 995) and get an AED if visible and near-by. Follow the
SCDF dispatcher’s instructions.

• Second Ring: Early CPR

• The brain cells start dying within 4-6 minutes of cardiac arrest. CPR must be
initiated as soon as possible to provide oxygen and blood flow to the brain
and heart.

• Third Ring: Early Defibrillation

• Automated external defibrillators (AEDs) are increasingly available in the
community, at lift lobbies, void decks, gymnasium, shopping malls, hotels,
airports and schools etc. Apply onto the casualty and be ready to defibrillate.
 Chain ofSurvival
• Fourth Ring: Emergency Medical Services
• Quick access to the scene and transport to the hospital makes a difference to
the casualty’s chances of survival.

• Fifth Ring: Advanced Cardiac Life Support

• Medical teams will provide advanced cardiac Life Support at the hospital. The
first 4 rings will buy time for the casualty to reach advanced care.
Hands-Only Cardio Pulmonary Resuscitation
 DRSABC
Danger : check danger

Response : “hello, hello, are you ok?

Shout : Help, call 995 Ambulance, get 1st aid box.

AED : If there is someone, shout for him to get AED

Breathing : Look for rise and fall of chest. (<10secs)

CPR : Starts CPR, if casualty is not breathing

Perform 100 chest compressions at a rate of 100 – 120 per minute
Do until ambulance arrives, or casualty wakesup or AED analysing
 Adult One-Man CPR - Demo
1. Survey the scene for Danger
2. Check for Response and position casualty
3. Shout - Activate 995 Ambulance & bring AED Open Airway
4. Check Breathing,
5. If NO breathing Locate hand position on the chest
6. Perform Continuous Chest Compression
7. Observe chest rises
8. Continue until Paramedic takes over or regains normal breathing or AED analysing
 CPR - Cardio PulmonaryResuscitation

• When to perform CPR?

No Response & No normal breathing

• Surface
Flat and firm surface

• Purpose
Provide Circulation to the brain and other vital organs
 CPR
1) D- Danger
Survey the scene for dangerbefore
approaching casualty.
 CPR
2) R- Response
Establish unresponsiveness
•Tap the victim’s shoulder gently “Hello, Hello,
Are you ok?”
•Shout “Hello, Hello,Are you ok?”

Both hands tap

on the shoulder
 CPR
3) S- Shout for Help

If the victim isunresponsive,

shout for help:
• Call 995 for SCDF
• First Aid Box

Position victim on his back

- supine and on a flat firm surface
 CPR
4) A – if someone around, ask him to get AED.
 CPR
5) B -Breathing

•Look – chest rise and fall

(Up to 10 seconds)
 CPR
6) C - ChestCompressions

• If no normal breathing,start CPR

No Normal Breathing – Start CPR
 Chest Compression

1 and 2 and 3 and 4 and 5 and

1 and 2 and 3 and 4 and 10 and
1 and 2 and 3 and 4 and 15
-------

1 and 2 and 3 and 4 and 100

COUNT OUT LOUD in practical

session
 Chest Compression

• Place heel of the palm on the lower half

ofthe sternum (breastbone)
• Rate of Compression= 100 - 120 per minute
• Depth = 4 - 6 cm
 Standards for Proper Chest Compressions

• For effective chest compressions, rescuer should “push hard, push fast”.
• Compress the casualty’s chest vertically to a depth of 4 – 6 cm, counting as you compress.
• Make sure you allow complete chest recoil before starting the next chest compression
• Do not lift the heels of your hands off the chest between compressions.
• Continue chest compressions at the rate of 100-120 per minute. If you are a single
rescuer and feeling tired, you may take a rest of not more than 10 seconds (preferably
after 100 compressions).
 Standards for Proper Chest Compressions

• Do not stop chest compressions until paramedics take over or casualty is conscious,
opens his/her eyes, starts talking and has normal breathing as the return of spontaneous
breathing in an out-of-hospital context is extremely rare.
• Provision of continuous chest compressions is highly recommended as any interruption
may negatively affect the survival outcome.
• If casualty regains consciousness, starts talking or has normal breathing, stay with the
casualty and continue to monitor the casualty until arrival of paramedics.
Automated External Defibrillation (AED)
AUTOMATED EXTERNAL DEFIBRILLATION (AED)
 INTRODUCTION
Automated External Defibrillator(AED)
• Check heart rhythm & Advise shock whenneeded.
• Delivers electric shock to theheart, when indicated.

Advises “Shock” or “No Shock”.

 Features ofAED
ON/OFF BUTTON
Cable Connector

Liquid
Crystal
Display
(LCD)
SHOCK BUTTON

Speaker- voice prompt

 Indications for use of AED

• no response &no normal breathing

• Rescuer is trained in using AEDcompetently

 Cardiac Arrest (HeartAttack)
• A cardiac arrest means stop of heart activity

• At the point of collapse from heart attack,the heart rhythm is in a

chaotic state, which we call as“ ventricular fibrillation “ ( VF)

• If not corrected or converted immediately, casualty dies, as shown as a

flat line or we call as“asystole”.The treatment forVF is called
“Defibrillation”.
Importance of Early Defibrillation
 Why Early Defibrillation?

• VF is the most common initial rhythm in cardiac arrest.

• Defibrillation is the only effective treatment for VF.

• VF degenerates to asystole within 8-10 minutes.

• Minimal chance of survival if the casualty goes into asystole.

 Danger and Safety Precaution
When AED Says “DO NOT TOUCH CASUALTY”
or delivering SHOCK;

AED provider have to shout “STAY

CLEAR” and

Make sure No One is in contact

with Casualty !!!
 Operations of AED
The rescuer must first ascertain that the sceneis safe for use of AED.Must
avoid the following:
a. Metal surface: remove casualty from contact with metal surfaces.These
can conduct electric currents to the rescuer
b. Water: Sweat and moisture are conductors and pose danger to the
rescuer.Also reduces adhesion of pads to chest
c. Gas: Fumes may be flammable and a potential fire hazard
Chest Preparation for AED Pads Placement
Wear gloves

Remove just enough clothing to

place pads - protect modesty!

For females remember to cover

chest after applying the AED pads
 Chest Preparation for AED Pads Placement
5 points to note:
1. Check for jewelry
if present, shift tothe side
2. Check for medicated patches
if present, remove it
3. Check for hairy chest
if present, to shave theareas
4. Check for wet chest
if yes, wipe dry
5. Check for pacemaker
if present, place 4 fingers away from thepacemaker, and
the AEDpad below the 4 fingers
 Electrode Pads Placement
One pad to the rightof
chest just below right
collar bone One pad just below
the left of left nipple
 AED Procedure
WHEN APPLYING AEDPADS,
CPR CAN BEPERFORMED.
AED Procedure
AED :“Analyzing heart rhythm,
Do Not Touch theCasualty!”
-Shout –“Stand Clear” Stop CPR.
AED:“SHOCK Advised, Charging”
- Shout –“Stay Clear.No CPR”
AED: “SHOCK now, Press the
Shock Button now”
-Shout –“Stand Clear”
-Before pressing the Button,Ensure
no one in contact with the casualty
AED Procedure

AED :“Analyzing Heart Rhythm ,”

“No Shock advised, if needed start CPR”
- While AED analyzing,AED operator look at chest
to check forBreathing
• If no breathing – Start CPR
• If breathing present – check for any injuries
and turn casualty to Recovery Position.
Do not disconnect pads and cable from the
AED.
Monitor casualty every few minutes
Perform continuous chest compressions until:

- Paramedic takes over from rescuer

- AED prompts to analyse the casualty or is ready to shock
- Casualty wakes up or regains normal breathing/pulse
 Documentation
Report to medicalpersonnel:
• Particulars of casualty,rescuers
• Time of incident/CPR/AED
• How many AED shocksdelivered

Obtain from medicalpersonnel:

• Name & contact details ofmedical
personnel
• Hospital destination
 Housekeeping
• Replace the AED consumables such as the electrode pads, shaver kit, towel and gloves if used.
• The AED battery must be checked. Contact the vendor of the AED device for advice on battery
replacement.
• If the AED was removed from a box with a key in a thin glass window, the glass may have been
broken to retrieve the key. This glass piece would need to be replaced and the key placed back
onto the holder.
• Most AEDs have a chip that records the resuscitation sequence. Get the AED vendor to print
the record from this chip. It is useful for audit and quality assurance purposes
 Maintenance
• AEDs are almost maintenance-free. Replacement of consumed items in the AED has been
described earlier.

• The battery indicator on the AED needs to be checked daily to ensure that it is still
functional. Once it gives a low-battery display, steps to replace the battery promptly
should be undertaken.
The End