AMERICAN HEART ASSOCIATION CHANGES IN THE 2010 GUIDELINES AFFECTING ALL RESCUERS AMERICAN HEART ASSOCIATION.

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