1. Chain of Survival
   1. Early Recognition and Call for Help
      1. CA occurs in 1/4 to 1/3 of ptx with myocardial ischaemia within 1st hour after onset of pain
      2. Key observations to start CPR
         1. Unresponsiveness
         2. Not breathing normally
   2. Early CPR
      1. Can 2x or 4x survival from CA
      2. Trained? = compressions + ventilation
      3. Not trained? = compressions only
   3. Early Defibrillation
      1. Within 3-5 min = survival rates 50-70%
      2. 1 min of delay = reduces survival by 10-12%
   4. Post Resuscitation Care
2. Critical Need for Bystanders to Act
   1. 1st few mins after termination of VF
      1. Rhythm = slow
      2. Force of contractions = weak
      3. Therefore, continue compressions until adequate cardiac function returns
   2. Bystander CPR
3. Recognition of Cardiac Arrest
   1. Agonal breaths
      1. Slow
      2. Deep
      3. Snoring sound
      4. Originate from brain stem
         1. Reamins functioning for some time even when hypoxic
4. Adult BLS Sequence
   1. Starting Chest Compressions
      1. 5cm depth but not more than 6cm
      2. Rate of 100-120 / min
      3. Allow chest to completely recoil after each compression
      4. Deflate air-filled matresses
      5. Change every 2 minutes, as chest depth reduces
   2. Hand Position
      1. Confined Space?
         1. Over the head CPR
         2. Straddle CPR
   3. Ventilation
      1. 500-600ml (6-7ml/kg)
         1. Volume required to allow the chest to rise visibly
      2. 1s duration
      3. CPR should not be interrupted for >10s
      4. Mouth-to-Nose Ventilation
         1. If victim's mouth is seriously injured
         2. CPR provider assisting a victim in the water
         3. Difficult to achieve mouth-to-mouth seal
      5. Mouth-to-Tracheostomy Ventilation
   4. Compression-Ventilation Ratio
      1. Animal data supports 15:2
      2. Mathematical model suggests 30:2 is best compromise between blood flow and O2 delivery
   5. Compression Only CPR
      1. Arterial O2 stores deplete in 2-4 min
5. Use of an AED
   1. Paediatric
      1. 1-8yo = paediatric pads + attenuator or paediatric mode on defib
      2. Low incidence of shockable rhythms
   2. Continue CPR whilst AED brought on site
      1. Do not delay defib
   3. Check rhythm after every 2 minutes of chest compressions
   4. Fully-Automated AEDs
      1. Shockable rhythm
         1. AED will deliver shock without further action from the CPR provider
   5. Public Access Defibrillation
      1. Residential area ROSC < Public Area Rosc
         1. Fewer witnessed arrests
         2. Lower bystander CPR rates
         3. Fewer shockable rhythms
      2. 60-80% of CA occur at home
      3. VF found less so in homes vs. public
6. Foreign Body Airway Obstruction (Choking)
   1. Recognition
      1. Key to successful outcome
      2. Usually occurs during eating/ drinking
      3. Increased Risk Factors
         1. Reduced conscious levels
         2. Drug/ ETOH intoxication
         3. Neurological impairment
            1. Reduced swallowing + cough reflexes
            2. E.g. Stroke, Parkinson's Disease
         4. Respiratory disease
         5. Mental impairment
         6. Dementia
         7. Poor dentition
         8. Older age
      4. Severe Airway Obstruction
         1. Unable to speak
         2. Weakening cough
         3. Struggling or unable to breath
   2. Tx for Mild Airway Obstruction
      1. Coughing
         1. High and sustained airway pressures
         2. May expel foreign body
      2. Back blows/ abdominal thrusts/ chest compressions may cause HARM
         1. Reserved for severe airway obstruction ptx
      3. Remain under observation until they improve
   3. Tx for Severe Airway Obstruction
      1. Conscious adults + children >1yo
         1. Back blows/ slaps
         2. Abdominal thrusts
         3. Chest thrusts
   4. Unresponsive victim/ Unconscious victim
      1. CPR!
   5. Follow-Up
      1. Persistent cough
      2. Difficulty swallowing
      3. Sensation of an object stuck in the throat
7. Paediatric BLS
   1. 5 rescue breaths
   2. 15:2 compression:ventilation
   3. Give CPR for 1 minute BEFORE going for help if ALONE
   4. Compress chest by 1/3 of its depth
   5. 2 fingers in <1yo
   6. 1 or 2 hands for >1yo