american heart association changes in the 2010 guidelines affecting all rescuers american heart...
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AMERICAN HEART ASSOCIATION
CHANGES IN THE 2010 CHANGES IN THE 2010 GUIDELINES AFFECTING GUIDELINES AFFECTING
ALL RESCUERSALL RESCUERS
AMERICAN HEART AMERICAN HEART ASSOCIATIONASSOCIATION
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Health Care Provider*
“PUSH HARD AND PUSH FAST”
At least 100 COMPRESSIONS / MINUTE*
Allow the chest to recoil -- equal compression and relaxation times
<10 seconds for pulse checks or rescue breaths
Compression Depth*
Adults 2”
Child/Infant 1/3 depth of chest 1.5" infant 2" child
Avoid excessive ventilations
A-B-C changed to C-A-B*
Critical element is chest compressions
Delay in A-B
Avoidance of A & B
Early defib
If alone--call and retrieve AED
Exception asphyxial arrest
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
• Cricoid pressure not recommended
• Advanced airway = 1 every 6-8 seconds
• Adult: 1 every 5-6 Peds: 1 every 3
• With advanced airway- no pause
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Dispatcher Identification
• SCA = seizure & agonal gasps
• Trained to ID – ask if breathing is normal
• Only gasping???
• Provide CPR instructions
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
AHA ECC Adult Chain of Survival - New
• Lay Rescuer – Hands-only CPR (untrained vs trained)
– Easier
– Guided by dispatchers
– SR are same
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Simplified Universal BLS algorithm
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Electrical Therapies
• Shock first vs CPR first
• No precordial thump
• CPR devices – no data for• AED in hospital (goal to shock =< 3 mins)
• Use in infants (with or without attenuator)
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
ACLS• Simplified algorithm• Optimized CPR quality with monitoring• Waveform capnography (>12 mmHg)• Atropine deleted (PEA/Asystole)• Chronotropic drugs for brady, then pacing• Adenosine safe for monomorphic wide tachs• Post-cardiac arrest
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
AMERICAN HEART ASSOCIATIONAMERICAN HEART ASSOCIATIONCAPNOGRAPHY
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Post-Cardiac Arrest – ROSC
•Therapeutic Hypothermia
– Remain comatose
– 32-34 degree C (all ages) (89.6-93.2 F)
– 12-24 hours
•PCI
•O2 sat ≥94% & PETCO 35-40
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
• Asthma
• Anaphylaxis
• Pregnancy
• Morbid obesity
• PE
• Electrolyte imbalance
• Toxins
Special Resuscitation Situations
• Hypothermia
• Avalanche
• Drowning
• Electric shock/lightening
• PCI
• Cardiac tamponade
• Cardiac surgery
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Acute Coronary Syndromes•Out of hospital 12-lead•Triage to PCI•Oxygen – > 94 % is the goal (capno)•Morphine – use with caution in UA/non-STEMI
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Stroke
•Stroke-prepared hospitals
•Triage to stroke centers
•TPA up to 4.5 hours
AMERICAN HEART ASSOCIATION:AMERICAN HEART ASSOCIATION:2010 GUIDELINES2010 GUIDELINES
Learning to Mastery
•New CPR Prompts devices
•Online training: http://www.onlineaha.org/
•Instructor network http://ahainstructornetwork.americanheart.org/AHAECC/ecc.jsp?pid=ahaecc.signin&_requestid=133687