20/09/2019
CPR: FOR ADULTS
CABD (Circulation, Airway, Breathing, Defibrillate)
There is a common acronym in BLS used to guide providers in the appropriate steps to assess and treat patients in respiratory and cardiac distress. This is CAB-D (Circulation, Airway, Breathing, Defibrillate). The following scenario will help guide you in performing CAB-D.
You find an adult lying on the ground.
Assess to make sure the scene is safe for you to respond to the down patient.
Assess Responsiveness: Stimulate and speak to the adult asking if they are ok. Look at the chest and torso for movement and normal breathing.
If unresponsive:
(One provider) first call the emergency response team and bring an AED to the patient.
(Two providers) Have someone near call the emergency response team and bring the AED.
Place patient supine on a hard flat surface.
Circulation
Check the patient for a carotid pulse for 5-10 seconds. (Do not check for more than 10 seconds.)
If the patient has a pulse:
Move to the airway and rescue breathing portion of the algorithm:
Provide 10 rescue breaths per minute (1 breath every 6 seconds).
Recheck pulse every 2 minutes.
If the patient doesn’t have a pulse:
Begin 5 cycles of CPR (lasts approximately 2 minutes).
Start with chest compressions:
Provide 100 to 120 compressions per minute. This is 30 compressions every 15 to 18 seconds.
Place your palms midline, one over the other, on the lower 1/3 of the patient’s sternum between the ni***es.
lock your arms.
Using two arms press to a depth of 2 to 2.4 inches (5-6cm) or more on the patient’s chest.
Press hard and fast.
Allow for full chest recoil with each compression.
1 cycle of adult CPR is 30 chest compressions to 2 rescue breaths.
If two providers are present: switch rolls between compressor and rescue breather every 5 cycles.
Airway
In the event of an unwitnessed collapse, drowning, or trauma:
Use the Jaw Thrust maneuver. (This maneuver is used when a cervical spine injury cannot be ruled out.):
Place your fingers on the lower rami of the jaw.
Provide anterior pressure to advance the jaw forward.
In the event of a witnessed collapse with no reason to assume a C-spine injury:
Use the Head Tilt-Chin Lift maneuver:
place your palm on the patient’s forehead and apply pressure to tilt the head backward.
place the fingers of your other hand under the mental protuberance of the chin and pull the chin forward and cephalic.
Breathing
Scan the patients chest and torso for possible movement during the “assess unresponsiveness” portion of the algorithm. Watch for abnormal breathing or gasping.
If the patient is breathing adequately:
Continue to assess and maintain a patent airway and place the patient in the recovery position. (Only use the recovery position if its unlikely to worsen patient injury.)
If the patient is not breathing or is breathing inadequately:
If the patient has a pulse:
Commence rescue breaths immediately.
If the patient has no pulse:
Begin CPR. (move to the “Circulation” portion of the algorithm.)
Use a barrier device if available.
Pinch the patient’s nose closed.
Make a seal using your mouth over the mouth of the patient or use a pocket mask or bag mask.
Each rescue breath should last approximately 1 second.
Watch for chest rise.
Allow time for the air to expel from the patient.
During normal CPR without an advanced airway:
Provide approximately 6-8 rescue breaths per minute
During normal CPR with an advanced airway:
Provide 10 rescue breaths per minute (don’t pause chest compressions for breaths).
If patient has a pulse and no CPR is required:
Provide 10 rescue breaths per minute (1 breath every 6 seconds).
Recheck pulse every 2 minutes.
If there is a foreign body obstruction:
Perform abdominal thrusts
Recovery position
(lateral recumbent or 3/4 prone position):
This position is used to maintain a patent airway in the unconscious person.
place the patient close to a true lateral position with the head dependent to allow fluid to drain.
Assure the position is stable.
Avoid pressure of the chest that could impairs breathing.
Position patient in such a way that it allows turning them onto their back easily.
Take precautions to stabilize the neck in case of cervical spine injury.
Continue to assess and maintain access of airway.
Avoid the recovery position if it will sustain injury to the patient.
Defibrillate
Arrival of the AED (Automated External Defibrillator)
Power:
Turn AED On NOW! (early defibrillation is the single most important therapy for survival of cardiac arrest and should be done as soon as it arrives).
Follow verbal AED prompts.
Attachment:
Firmly place appropriate pads (adult/pediatric) to patient’s skin to the indicated locations (pad image).
Analyze:
A short pause in CPR is required to allow the AED to analyze the rhythm.
If the rhythm is not shockable:
Initiate 5 cycles of CPR.
Recheck the rhythm at the end of the 5 cycles of CPR.
If the shock is indicated:
Assure no one is touching the patient or is in mutual contact of a good conductor of electricity by yelling “Clear, I’m Clear, you’re Clear!” prior to delivering a shock.
Press the shock button when the providers are clear of the patient.
Resume 5 cycles of CPR.
