Frederick CPR Instruction

Here is a brief chart based review of the AHA's classification scheme.  Most Drugs fall into the 2A and 2B categories. Early CPR would be a Class 1, Level B intervention.

In a study by Weil Institute of Critical Care Medicine,  The researches found that cooling the cranium (In the study they sprayed coolant into the nasal cavity) showed that the subjects had immediate post ROSC (return of spontaneous circulation) benefits of increased arterial pressure and increased coronary perfusion pressure (CPP), and were less likely to return to ventricular fibrillation (in the study, 50 percent less likely!)

Overall core temperatures remained the same.  Brain temperatures in the cooled subjects were approximately 3 degrees centigrade cooler, however. 

"Conclusion: In this model, selective head cooling rapidly reduces brain temperature during CPR. These reductions in brain temperature increase arterial and CPP immediately following ROSC, resulting in greater hemodynamic stability and less recurrence of VF."


Link to the abstract is here: http://www.benechill.com/wp/wp-content/uploads/2010/10/20-abstract-hemodynamics.pdf

Question: Why 15:2 ratio of compressions to ventilations in child CPR for Healthcare Providers?

Answer:

The biggest reason why children are 15:2 with 2 rescuer Healthcare Provider CPR is  because children are very much more likely to have cardiac arrest secondary to respiratory issues and lack of oxygen.  Children and infants generally have very strong hearts that want to beat on their own.  If the heart stops, it is usually because it has not been supplied enough oxygen. 

An adult heart tends to stop (patient tends to go into pulseless arrest) for truly cardiac reasons, and therefore, a 30:2 ratio remains the preferred ratio for adults. Also, single rescuer CPR in children and infants remains 30:2, because it takes quite a bit of time to switch back and forth between breathing and compressions.  Once two rescuers are present, however, this ratio can be changed to 15:2, maximizing oxygenation in children and infants, while still minimizing interruptions in compressions.

Note, however, that the ration of compressions to ventilations in Heartsaver (non-healthcare provider) CPR remains always 30:2 for simplicity sake, and due to the fact that working as a team is not covered in the Heartsaver course.

Question: Why is it vital to not hyperventilate a patient receiving CPR?

Answer:

A new study has shown an inclination by emergency medical services personnel to hyperventilate (providing too many breaths, and too deep) patients throughout CPR of out-of-hospital cardiac arrest. A follow-up animal study showed ventilation rates just like those in the field which resulted in higher accrued intrathoracic (chest) pressures, decreased coronary perfusion pressures, and reduced survival.

During the recoil phase in CPR, a vacuum is formed inside the chest, drawing blood back to the heart. excessive and deep ventilations mean that less blood returns to the heart between compressions, doubtless reducing the effectiveness of CPR.

At Carpenter CPR, we emphasize the importance of providing breaths at proper intervals, and ONLY providing breath until the chest just begins to rise.

Question: Why is it necessary to let the chest fully recoil during CPR?


Answer:

Since pushing on the chest is pressing the heart between the sternum and spine, you need to let the chest recoil to permit the blood to re-fill the chambers before pressing the chest (pumping the heart) once more.  Complete chest recoil is vital, because, as the chest rises, the negative pressure created actually "draws" blood back to the heart, much like pulling back on the plunger fills a super soaker. this allows for maximum possible output with each compression during CPR.