Functional circulation is fundamental in the treatment of severely ill patients. Cardiac arrest or cardiovascular collapse with insufficient circulation is common in emergency medicine and intensive care. A pre-planned action plan and access to relevant emergency equipment is necessary to be able to handle a cardiac arrest quickly and efficiently.
- Start with chest compressions
- 30 compressions in succession and then 2 insufflations
- Hand placement in the middle of the chest
- The CPR shall last at all times
- Do not stop for breathing or pulse control
- Replace the person doing chest compressions every other minute
- Just quit CPR if spontaneous and normal breathing returns
Focus is placed on good chest compressions without interruption.The compression depth must be at least 5 cm. The compression rate shall be at least 100/minute but not more than 120/minute. If you are unskilled in CPR or feel unsure, you can only make compressions in all conditions in anticipation of ambulance. If you are trained in CPR, you should provide CPR with ratio 30:2 on adults as well as on children
Abnormal so-called agonal breathing is often a sign of cardiac arrest. An inflation should provide a visible increase in the thorax, unspecified volume.
Intubation should only be done by experienced personnel if there can be minimal interruptions in the CPR.
A defibrillation followed by two minute CPR. Minimize the breaks when giving compressions before and after defibrillation as far as possible.
Adrenaline should be given in the dose of 1 mg every 3-5 minutes as before. Atropine disappears as “considering” drug at PEA / asystole.
- Detect cardiac arrest, alert and retrieve emergency equipment
- Emergency equipment “Rescue trolley”
- Breathing mask/Breathing balloon/
- Defibrillator/Electrocardiograph device (ECG)
- CPR board (plank)
- Oxygen/Suction device
Give cardiothoracic compressions 100/min. If untreated cardiac arrest > 5 min or unwitnessed cardiac arrest, start CPR for 2 minutes before analysis of heart rhythm. The frequency should be 100 compressions per minute. Replace the person doing compressions after every 2 minute CPR period.
Analyze the ECG-rhythm
Control the pulse only if organized rhythm exists.
Biphasic 150/200 J, Monophasic 360 J or as recommended by the manufacturer. Very fine VF is not defibrillated.
Give 1 mg i.v. every 4 minutes until you know about pulse-inducing rhythm. At asystole/PEA, the first dose is given immediately at VF/VT after 3 defibrillations.
Give single dose of 300 mg Cordarone for continued VF/VT after 3 defibrillations. Give 150 mg supplement dose for continued VF/VT after another 2 defibrillations.
If the child shows no signs of life:
- Start cardiac and pulmonary resuscitation (CPR) with five insufflations
- Then make three series with 30 compressions and two insufflations
- Alarm others
- Continue CPR switching between 30 compressions and two insufflations until help is in place or the child breathes normally
Cardiopulmonary Resuscitation (CPR) to infants
CPR is going to last all the time. Do not stop breathing or pulse control. If possible, replace the one that compresses every two minutes. Just quit CPR if the child begins to breathe normally. Keep in mind that you should not take too long between compression and inflation.
Check in turn: Consciousness. Breathing. Are there any signs of life? Does the baby touch, swallow or breathe normally? Then give the necessary help.
- Is the child aware? Shout to the baby and nip or shake it gently in the shoulders. If the child does not respond, cry out loudly for help from the surrounding area. Put the child on the back.
- Does the child breathe?
- Create open airway
- See if the chest and stomach moves and what color the child has. Listen if air flows in and out through the mouth and nose. Feel the airflow against your chin. If the child breathes normally: put it in a stable side body position. Continue to check that the baby is breathing. Alarm. If the child does not breathe: Give five slow insufflations. If it is not possible to insufflate air or if the chest is not raised when blowing, there may be some objects in the child’s throat.
The open airway can be created in two different ways: Jaw lift. Carefully bend the child’s head backwards by placing one hand on the child’s forehead. Lift the child’s jaw with the other hand’s pointer and middle finger. In younger infants it is important not to bend the head too far backwards. Bending the head back too strongly may cause airway blocking. Lift the jaw manually. Put one hand on the child’s forehead. Now use the other hand’s thumb to grab the point of the chin of the little child and the mandibel of children over a year. Hold your index finger over the chin and lift the chin upwards. Ventilations.
Infants zero to one years old
Make a jaw lift. Put your mouth over the baby’s mouth and nose. Blow slowly in air for 1-1.5 second, five times. Blow in so much air that the chest is raised and lowered. Check signs of life, any spontaneous movements, swallowing or normal breathing in conjunction with the insufflations.
Infants zero to one years old
The baby can lay on hard surfaces. Start with five insufflations. Use the pointer and middle finger and press the lower third of the sternum. Press 30 times, almost two compressions per second. Each time you push down the baby’s chest a third. Release the chest between the compressions. After 30 compressions, you make two blowouts. Then start over again, with 30 compressions followed by two insufflations. If you’re alone, call 911 (local alarm number) after three series with 30 compressions and two insufflations. Then continue with cardiovascular and pulmonary resuscitation, 30 compressions and two insufflations until the helper is in place or the child breathes normally.
Children 1 years old to puberty
Clamp the nostrils with thumb and index finger. Put your mouth over the baby’s mouth and slowly blow it in for 1-1.5 second, five times. Blow in so much air that the chest is raised and lowered. Check signs of life, movements, swallowing or normal breathing in conjunction with the insufflations .
Does the child show life signs?
If the child shows signs of life but does not breathe normally: Make 20 insufflations for one minute and then call 112. If possible, carry the child to the phone if you are alone. Then continue with insufflations. About 20 insufflations per minute are right. If the child does not show any signs of life: Give cardiac and pulmonary resuscitation (CPR).