CPRAbbreviation for cardiopulmonary resuscitation

Adult Chain of Survival1. Immediate recognition & activation of EMS2. Early CPR3. Rapid defibrillation4. Advanced life support5. Post-cardiac care

Pediatric Chain of Survival1. Prevention of cause2. Early CPR3. Activation of EMS4. Advanced life support5. Post-cardiac care

EMSabbreviation for Emergency Medical Service

2010 AHA (American Heart Association) Guideline BLS (Basic Life Support) sequence is...1. "C.A.B." C- chest compressions A - open airway B - Breathing2. High Quality CPR3. Focus on Team CPR4. Removed the step "Look, Listen and Feel" step from assessment and replaced with -check victim for 2 things simultaneously - responsiveness and breathing.

High Quality CPR*Compression rate of at least 100 per minute (100/min)*Compression depth of 1/3 of anterior-posterior diameter of chest. 2" in an adult and 1 1/2 " in an infant*Complete chest recoil & minimizing interruptions & avoid excessive ventilations.

Team approach CPRFirst rescuer starts CPR, second rescuer activates EMS & 3rd rescuer performs ventilations or gets the AED

AEDAutomated External Defibrillator

VICTIMS of ALL AGESStart with "C. A. B."! 

Compressions, Open Airway and Breathing in that order.

BLS consists of 3 main parts:1. Chest Compressions2. Airway3. Breathing & defibrillation

Overview of initial Adult BLS steps:Step 1: Check scene safety and assess victim for normal or abnormal breathing - Shout for help.Step 2: Alone rescuers activate the EMS & get the AED if available and return to victim.Step 3: Check pulse (take at least 5 seconds and no more that 10 seconds) start compressions.

Assessment of scene safety:1. Check scene to make sure it is safe for you and the victim.2. Tap victim's shoulder and shout "Are you okay?"3. Check breathing.

Agonal graspAbnormal breathing; may be present in the first minutes of suddent cardiac arrest. The gasps may sound like a snort, snore or groan.

Pulse checkAdults palpate carotid pulse (should take no longer than 10 seconds)

Carotid pulsepulse site - locate the trachea using 2-3 fingers, slide 2-3 fingers into groove between trachea and muscle at the side of neck, feel for at least 5 seconds no more than 10 seconds.

Lone rescuer CPR ratio for all AGES:30 compressions to 2 ventilations

Chest compression technique:1. Position yourself at victims side2. Victim is lying faceup on firm surface3. Place heel of one hand on the center of victim's chest on the lower half of breastbone4. Put heel of other hand on top of hand on chest and PUSH HARD & FAST5. Rate 100 compressions per minute6. Push down 1/3 depth of chest7. Allow for chest recoil8. Minimize interruptions

Why firm surface?If a firm surface is under the victim, the force you use will be more likely to compress chest & heart to create blood flow rather than push victim into a soft surface.

Moving victim?DO NOT MOVE the victim while CPR in progress unless victim is in a dangerous environment.

Opening airway?Two methods are used:Head tilt-chin lift and Jaw thrust

Head tilt-chin liftPlace one hand on victim’s forehead and push with your palm the head back; place the fingers of the other hand under the bony part of the lower jaw and lift jaw to bring chin forward.

Things to avoid with head tilt-chin lift:Do not press deeply into soft tissue under chin this may block airway. Do not use thumb to lift chin. Do not close victim's mouth completely.

Infection Risk?Risk of infection with CPR is extremely low; however, OSHA requires healthcare workers to use standard precautions.

Lone rescuer mouth to mouth breaths:Use a mask at victim's side so you can easily go from chest compressions to ventilations.

Steps when using mask to give breaths:1. Position yourself at victim's side.2. Place mask on the victim's face, using bridge of the nose as a guide.3. Seal the mask against the face.4. Perform a head tilt-chin lift.5. Deliver air over 1 second to make the victim's chest rise.

Bag mask deviceConsist of a bag attached to a face mask; most common method that healthcare providers use to give positive-pressure ventilation. Not recommended by a lone rescuer.

Bag-Mask 2-Rescuer CPR

Follow these steps in 2-rescuer bag-mask ventilations'1. Position yourself directly above the victim's head.2. Place the mask on the victim's face, using the bridge of the nose as a guide.3. Use the E-C clamp technique to hold the mask in place.4. Squeeze the bag to give breaths (1 second each) while watching chest rise.

E-C clamp techniquePlace the thumb and first finger around the top of the mask (forming a "C") while using the third, fourth and fifth fingers (forming an "E") to lift the jaw.

2-Rescuer Adult BLS/Team CPR sequence:Specific dutiesRescuer 1: At victim's side - starts CPRRescuer 2: At victim's head - administer ventilationsSwitch duties every 5 cycles or about 2 minutes, taking less than 5 seconds to switch.

Effective teams communicate continuously:Rescuer 1 - counts out loud when giving compressions so that rescuer 2 is ready to give ventilations to minimize interruptions.

Jaw- thrustIf the victim has a head or neck injury and you suspect a spine injury; use jaw thrust method to open the airway.1. Place one hand on each side of the victim's head, resting your elbows on the surface on which the victim is lying.2. Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward.3. If the lips close, push the lower lip with your thumb to open lips.

Ventricular fibrillationsHeart muscles fibers quiver and do not contract together to pump blood.

DefibrillationA defibrillator delivers an electric shock to stop ventricular fibrillation so the heart muscle may begin to contract effectively and begin to generate a pulse (called return of spontaneous circulations, or ROSC)

Universal steps for operating an AED:1. POWER ON the AED2. Attached AED pads to victim's chest3. "CLEAR" the victim and ANALYZE the rhythm4. If the AED advises a shock, it will tell you to "CLEAR" the victim.5. PRESS the SHOCK button

6. If no shock is needed and after any shock delivery, immediately resume CPR if rhythm not restored7. After 5 cycles or about 2 minutes of CPR, the AED will prompt you to repeat these steps.

Minimize time between last compression and shock delivery:The shock is much more likely to be effective if it is less than 10 seconds between last compression and delivery of shock.

Facts in attaching AED pads:1. Hairy chest - either quickly shave the area where pads are placed or place a set on and pull off quickly to remove hair so that a new pad set will stick.2. Do not use in water. If a victim is lying in water or chest covered in water; move them and dry off chest.3. Pacemaker - do not place directly over device.4. Transdermal medication patches - Do not place over med. pads. Remove and wipe the area clean before attaching the AED pad.

InfantFrom birth to 12 months of age

ChildFrom 1 year to puberty

Signs of puberty:Chest and underarm hair on males and breast development in females.

Key differences between child and adult CPR:1. 15 compressions to 2 ventilations for 2-rescuer CPR2. Commpression depth - 1/3 the depth of the chest.3. May use 1 or 2 hand chest compressions for very small children.4. If you did not witness the arrest and are alone, provide 2 minutes of CPR for a child before leaving to activate the EMS.5. If the arrest is sudden and witnessed, leave the child to activate the EMS and get the AED.

Child CPR facts:Many infants and children are thought to develop respiratory arrest and bradycardia before they develop cardiac arrest. If such children receive prompt CPR before development of cardiac arrest they have a high survival rate. For this reason a lone rescuer finds an unresponsive child who is not breathing or only grasping should provide 5 cycles of CPR (about 2 minutes) before activating EMS.

Child pulse check:Carotid or femoral artery

Femoral arteryPulse site located in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the abdomen.

Why breaths are important for infants and children?In contrast, infants and children who develop cardiac arrest often have respiratory failure or shock that reduces the oxygen content in the blood even before the onset of arrest. Thus chest compressions alone are not effective for delivering oxygen to the heart and brain as the combination of compressions plus breaths.

Key differences for infant CPR:1. Location of pulse check - brachial artery in infants.2. 2 fingers for single rescuer and 2 thumb-encircling hands for 2-rescuer.3. Compression depth 1/3 of chest = 1 1/2 "4. 2-rescuer ration = 15:25. Activate the EMS system same as with children. If you did not witness the arrest and are alone, provide 2 minutes of CPR for a child before leaving to activate the EMS. If the arrest is sudden and witnessed, leave the child to activate the EMS and get the AED.

Brachial arteryPulse site - on the inside of the upper arm, between the infant's elbow and shoulder.

2 Finger chest compression techniques:1. Place infant on firm surface.2. Place 2 fingers in the center of the infant's chest just below the nipple line. Do not press on the bottom of the breastbone.3. Push hard and fast. 1/3 chest depth; rate 100/min4. Allow complete chest recoil.5. Minimize interruptions

Caution in infants:Keep head in neutral position - if you tilt an infant's head beyond the neutral position airway may be blocked.

2-Thumb Encircling hands chest compression technique:1. Place both thumbs side by side in the center of the infant's chest on the lower half of the breastbone. The thumbs may overlap in small infants.2. Encircle the infant's chest and support the infant's back with the fingers of both hands.3. With your hands encircling the chest, use both thumbs to depress the breastbone approximately 1/3 depth.

4. Deliver compressions in a smooth fashion at a rate of 100/min5. Allow for chest recoil.

AED children and infants:Use a child pad and child system for children.A manual defibrillator is preferred for an infant or an AED equipped with a pediatric dose attenuator is preferred.

Advanced airwayEndotracheal intubation (tube placed in trachea), laryngeal mask airway (tube placed in larynx), or supraglottic

Ratio rate with an advanced airway:Compression rate of at least 100/min. without pauses for breaths. Breaths are given every 6-8 seconds (8-10 breaths per minute) without any attempting to deliver breaths between compressions.

Mouth to Mouth breathing without pocket mask:Hold the victim's airway open with head tilt-chin lift, pinch nose closed with your thumb and index finger, take a regular breath and seal your lips around the victim's mouth creating a tight airtight seal and give 1 breath. Watch to make sure the chest rise as you give the breath. If the chest does not rise; reposition the head and try again. Attempt 2 attempts and return to chest compressions.

Rescue breathingIf an adult, child or infant has a pulse but is not breathing you should administer breaths and continue to check pulse every 2 minutes.

Rescue breathing for an adultGive 1 breath every 5-6 seconds (about 10-12 breaths per minute)

Rescue breathing for a child and infantGive 1 breath every 3-5 seconds (about 12-20 breaths per minute)

Mild airway obstruction signs:Good air exchangeCan cough forcefullyMay wheeze between coughs

Treatment of mild airway obstruction:Encourage the victim to continue spontaneous coughing and breathing efforts.Do not interfere with the victim's own attempts to expel the foreign body.

If condition persists, activate the EMS

Severe Airway Obstruction signs:Poor or no air exchangeWeak, ineffective cough or no cough at allHigh-pitched noise while inhaling or no noise at allIncreased respiratory ratePossible cyanosis (turning blue)Unable to speakClutching the neck with the thumb and fingers,

Treatment of severe airway obstruction:Ask the victim if he or she is choking. If the victim nods yes and cannot talk, severe airway obstruction is present and you must try to relieve the obstruction.

Universal sign of choking;Clutching the neck with the thumb and fingers

Heimlich maneuverAbdominal thrusts to relieve choking in a responsive victim. Stand or kneel behind the victim and wrap your arms around the victim's waist. Make a fist with one hand. Place the thumb side of your fist against the victim's abdomen, in the midline, slightly above the navel and well below the breastbone. Grasp your fist with your other hand and press your fist into the victim's abdomen with a quick, forceful upward thrust. Repeat thrusts until the object is expelled from the airway or the victim becomes unresponsive. Give each new thrust with a separate, distinct movement to relieve the obstruction.

Pregnant and Obese Choking victims:Perform chest thrusts instead of abdominal thrusts.

Unresponsive choking victim 1 year or older:Activate the EMSLower the victim to the ground and begin CPR starting with compressions.Every time you open the airway for ventilations, look for the object. If you see an object that can easily be removed; remove it. If not, keep doing CPR.