CPR and AED Use for Healthcare Providers Based on 2010 AHA Guidelines

Globally, cardiovascular disease (CVD) is the leading cause of adult death – far exceeding cancer, respiratory disease, and infectious diseases such as HIV/AIDS, tuberculosis and malaria – even in developing countries. The risk factors for cardiovascular disease are many and include: Men > 40 years Women > 50 years Obesity Sedentary life style Diabetes

High blood pressure High cholesterol Menopause Tobacco smoking

Cardiovascular disease has been identified as a major contributing factor to many cases of cardiac arrest, heart attack and stroke. Sudden Cardiac Arrest - Each year, in the United States alone, sudden cardiac arrest accounts for more than 350,000 deaths – almost 1000 deaths per day! Sudden Cardiac Arrest occurs when a patient’s heart suddenly stops beating normally. This causes blood and oxygen to stop flowing to the brain. If the brain is deprived of oxygen for 4 – 6 minutes, it will begin to die. Once brain death occurs, the patient can no longer be saved. However, if bystanders recognize cardiac arrest and begin CPR immediately, their chest compressions can reestablish blood flow to the brain, preventing brain death and buying the patient valuable time. Immediate initiation of CPR and use of an AED within 3 – 5 minutes may increase

the victim’s survival rate to over 80%!!

In an effort to decrease deaths due to cardiac arrest, The American Heart Association and its partner organizations stress education in the following:

1) Early Recognition of a Problem 2) Early Access to 911 3) Early CPR

4) Early Defibrillation 5) Early Advanced Care

Recognizing Signs and Symptoms of: HEART ATTACK (blockage in a blood vessel in the heart)

Chest pain – dull, crushing, burning

Back pain – upper or lower

Pain in either arm

Pain that radiates from one area to another – ie. back or chest to neck and/or jaw

Nausea

Vomiting

Shortness of breath or trouble breathing

Cold, clammy sweat

Feeling of fullness or indigestion

Mental distraction or “disconnect”

Increased foot or hand pain (diabetics)

Denial

1. Always call 911 for any suspected heart attack – time is critical! 2. Have the patient sit comfortably or lie down and rest. 3. Ask the patient to cough forcefully at regular intervals. 4. If the patient is conscious, can swallow and is not allergic to aspirin, have

him/her chew and swallow one 325 mg aspirin tablet (or four 81 mg “baby aspirin”).

5. Be prepared to start the steps of CPR and use an AED.

STROKE (blockage in a blood vessel or bleeding into the brain)

Loss of balance

Paralysis or loss of muscle control on one side of the body

Facial droop

Slurred, unintelligible or inappropriate speech

Altered mental status

Sudden severe headache with no known cause

Blurred vision

Eye pain

1. Always call 911 for a suspected stroke! Treatments must begin within 3 hours of the first onset of symptoms.

2. Never administer aspirin if a stroke is suspected. 3. Be prepared to start the steps of CPR and use an AED.

CPR for Adults and Pubescent Children (Breast development in females and chest or underarm hair in males)

Check the scene for Safety. Look all around to make sure there is nothing which might

injure you or your patient.

Check the person for Responsiveness. Tap the top of the person’s shoulder with

emphasis and shout loudly, “Are you OK? Can you hear me?”

While checking for responsiveness, simultaneously check for signs of normal breathing. If there is no sign of breathing, or no normal breathing (only gasping, wheezing or snoring) then:

Call 911 and Get an AED, or call a “code” and get a crash cart. If bystanders can

assist, designate someone to, “Call 911” and someone else to, “Get an AED”.

Check Pulse for circulation, 5 – 10 seconds. Place one hand on the patient’s forehead and

tilt his head back. Use two fingers to check the carotid pulse on the side closest to you.

If there is no pulse, Do 30 Chest Compressions.

o Push hard – compress the patient’s chest at least 2”. o Push fast – do at least 100 compressions per minute. o Position the patient on his back on the floor. Move or

remove clothing from the patient’s chest. Kneel at his side. Place the heel of one hand on the breastbone in the center of the patient’s chest. Place the heel of your second hand on top of the first. Lock your elbows. Get your shoulders up over your hands. Press straight down through the heels of your hands. After each push, release pressure to let the chest come back to its normal position.

If there is still no sign of normal breathing, Open the patient’s Airway. Use the “head-tilt,

chin-lift” method or “jaw thrust”, if two other rescuers are available.

Give 2 Breaths that make the chest rise.

o Pinch the patient’s nostrils closed, make a tight seal over the patient’s mouth with your

mouth, and breathe into the patient. (Or use a barrier device to deliver breaths.) Allow the patient to exhale between breaths. Each breath should be delivered over one second.

Keep repeating cycles of 30 compressions and 2 breaths until help arrives or you can use the AED.

(Once the rescuer identifies an unresponsive patient with no breathing and no pulse, chest compressions should be initiated within 10 seconds.)

Note: When a second rescuer is available to assist, one rescuer should administer breaths using a barrier device (pocket mask) or bag mask system (preferably attached to oxygen, while the second rescuer delivers chest compressions. After each 2 minutes of CPR (5 cycles of 30 compressions and 2 breaths) the two rescuers should switch roles.

Defibrillate, using the AED.

o Turn the AED on. Lift the cover or activate the on/off button or switch.

o Apply the electrode pads to the patient’s dry, bare chest. Connect electrodes if

prompted.

o Clear the patient, so the AED can analyze. (Move everyone back.)

o Clear the patient, so the AED can shock. o Push the Shock button, if advised. Make sure no one is touching the patient when

the shock button is pushed! Always use the AED as soon as it is available! (Note: EMS systems may institute protocols whereby, in an out-of-hospital setting, where cardiac arrest was not witnessed, 1 ½ - 3 minutes of CPR may be administered while the AED is being retrieved and attached.) Use Child or Pediatric pads, if available, only on infants or children ages 1 – 8 years. Use Adult pads on all patients over 8 years of age, or on a child or infant if pediatric pads are not available. Do not use pediatric pads on an adult.

Important Note: An AED should only be used on a patient who is unresponsive, not breathing and has no

pulse!

CPR for Children (Ages 1 – Puberty) - One Rescuer

If you are ALONE with the child and did NOT witness him collapse:

Check the scene for Safety. Look all around to make sure there is nothing which might

injure you or the child.

Check the child for Responsiveness. Tap the top of the child’s shoulder with emphasis

and shout loudly, “Are you OK? Can you hear me?”

While checking for responsiveness, simultaneously check for signs of normal breathing. If there is no sign of breathing, or no normal breathing (only gasping, wheezing or snoring):

Check Pulse for circulation, 5 – 10 seconds. Place one hand on the child’s forehead and tilt

his head back. Keep the child’s head tilted back and use two fingers to check the carotid pulse on the side closest to you.

If there is no pulse, or the pulse is < 60 beats/minute with signs of poor perfusion:

Do 30 Chest Compressions.

o Push hard – compress the child’s chest at least 1/3 the depth of the chest. o Push fast – do at least 100 compressions per minute.

o Position the child on his back on the floor. Move or remove clothing from his chest. Kneel at the child’s side. Place the heel of one hand on the breastbone in the center of the child’s chest. Lock your elbow. Get your shoulder up over your hand. Press straight down on the child’s chest through the heel of your hand. After each push, release pressure to let the chest come back to its normal position. (For a large child, two hands may be used to do chest compressions, as with an adult.)

If there is still no sign of normal breathing, Open the child’s Airway. Use the “head-tilt,

chin-lift” method.

Give 2 Breaths that make the chest rise.

o Pinch the child’s nostrils closed, make a tight seal over the child’s mouth with your

mouth and breathe into the child. (Or use a barrier device to deliver breaths.) Allow the child to exhale between breaths. Each breath should be delivered over one second.

Do 5 cycles or 2 minutes of CPR (cycles of 30 compressions and 2 breaths) before

calling 911 and getting the AED.

Call 911 and Get an AED.

Defibrillate the child, following the guidelines listed.

If bystanders are present to assist, or you DID witness the child collapse, follow the Adult sequence of events.

CPR for Children (Ages 1 – Puberty) – Two Rescuers

Check the scene for Safety. Look all around to make sure there is nothing which might

injure you or the child.

Check the child for Responsiveness. Tap the top of the child’s shoulder with emphasis

and shout loudly, “Are you OK? Can you hear me?”

While checking for responsiveness, simultaneously check for signs of normal breathing. If there is no sign of breathing, or no normal breathing (only gasping, wheezing or snoring):

The second rescuer should Call 911 and get an AED or Call a “Code” and get a crash cart.

Check Pulse for circulation, 5 – 10 seconds. Place one hand on the child’s forehead and tilt

his head back. Keep the child’s head tilted back and use two fingers to check the carotid pulse on the side closest to you.

If there is no pulse, or the pulse is < 60 beats/minute with signs of poor perfusion:

Do 15 Chest Compressions.

o Push hard – compress the child’s chest at least 1/3 the depth of the chest. o Push fast – do at least 100 compressions per minute.

o Position the child on his back on the floor. Move or remove clothing from his chest. Kneel at the child’s side. Place the heel of one hand on the breastbone in the center of the child’s chest. Lock your elbow. Get your shoulder up over your hand. Press straight down on the child’s chest through the heel of your hand. After each push, release pressure to let the chest come back to its normal position. (For a large child, two hands may be used to do chest compressions, as with an adult.)

If there is still no sign of normal breathing, the second rescuer will Open the child’s Airway. Use the “head-tilt, chin-lift” method or “jaw thrust”, if a third rescuer is available.

Give 2 Breaths that make the chest rise.

o Use a BVM system attached to oxygen (preferably) or use a pocket mask barrier

device. If neither of the above is available, pinch the child’s nostrils closed, make a tight seal over the child’s mouth with your mouth, and breathe into the child.

o Allow the child to exhale between breaths. Each breath should be delivered over one second.

Repeat cycles of 15 compressions and 2 breaths until you can use the AED. After each 2

minutes of CPR, the two rescuers should switch roles

Defibrillate the child, following the guidelines listed.

Rescue Breathing

Perform the steps of CPR. If the patient is not breathing but does have an adequate pulse, you will not perform chest compressions, but will administer rescue breaths. Each breath should be administered over one second, to avoid gastric inflation. For adults: Administer one breath every 5 to 6 seconds. For children or infants: Administer one breath every 3 to 5 seconds. Note: When performing CPR (chest compressions with ventilations) on a patient with an advanced airway in place, you will not need to stop compressions to give breaths. The rescuer performing compressions should compress continuously at a rate of at least 100 compressions per minute. The rescuer ventilating will deliver a breath (one second long) every 6 to 8 seconds. Rescuers should switch roles after 2 minutes (or 5 cycles of 30 compressions) to avoid fatigue. Additional Note: If the patient has a suspected neck or back injury, the jaw thrust maneuver should be used to open the airway for ventilation. The jaw thrust method typically requires three rescuers: one rescuer performs the jaw thrust, the second rescuer delivers breaths and the third rescuer performs compressions. If a jaw thrust does not allow for effective ventilations, the head-tilt chin-lift should be used.

ADULT/CHILD CHOKING RELIEF

You might suspect an adult or child is choking if the person:

Cannot speak

Cannot cough loudly

Makes the choking sign (holds his neck with one or both hands)

Has bluish lips or skin If you suspect the person is choking ask, “Are you choking”. If the person speaks, ask him to cough loudly. If the person nods, “Yes”, tell him you can help him; if he’s an adult, ask his permission to help. “I can help you, is it OK if I help?”

With the person’s permission:

Kneel or stand braced behind the person.

Wrap your arms around the person’s waist.

Make a fist with one hand and place it, thumb-side down, slightly above the person’s belly button, but well below the breast bone.

Grasp that fist with your other hand and give firm upward thrusts into his abdomen.

Give thrusts until the object is forced out and he can breathe, cough, or talk, or until he stops responding.

If the person stops responding:

Lower him gently to the floor and call for help.

Have someone call 911 and get an AED.

Begin the steps of CPR.

Do 30 Chest Compressions.

Open the airway – each time you open the airway to give breaths, open the mouth to look for the object. If you see the object and can safely remove it, do so. If you don’t see the object, or can’t safely reach it, continue with the steps of CPR.

Give 2 Breaths (re-positioning the head after the first breath, if it does not go in.)

Do 30 Chest Compressions.

Repeat the sequence of 30 compressions and 2 breaths (checking the person’s mouth for the object before giving breaths) until help arrives or you can use the AED.

If you cannot get your arms around the person’s waist to do abdominal thrusts (the person is very large or in the late stages of pregnancy):

Wrap your arms around the person’s chest and give chest thrusts – using the same fist technique, place your fist in the center of the chest (same positioning you use for chest compressions) and pull straight back.

Encourage anyone who has choked to consult a healthcare provider after the incident!!

CPR for Infants (Ages 0 – 12 months) – One Rescuer

If you are ALONE with the infant and did NOT witness him collapse:

o Check the scene for Safety. Look all around to make sure there is nothing which might

injure you or the infant.

Check the infant for Responsiveness. Tap the bottom of the infant’s foot, clap over his

face and shout loudly, “Baby, baby, are you OK? Can you hear me?”

While checking for responsiveness, simultaneously check for signs of normal breathing. If there is no sign of breathing, or no normal breathing (only gasping, wheezing or snoring):

Check Pulse for circulation, 5 – 10 seconds. Place the infant’s arm in an “L” position.

Check the brachial pulse using two fingers, on the arm closest to you.

Do 30 Chest Compressions.

Push hard – compress the breastbone at least 1/3 the depth of the infant’s chest. Push fast – do at least 100 compressions per minute.

o Place the infant on a firm, flat, elevated surface. Move clothing from the infant’s chest, if possible. Place two fingers of one hand on the center of the breastbone, just below the nipple line – fingers should be above one-another, not next to each other. Press the infant’s breastbone straight down with your fingers, being careful not to press on the very bottom of the breastbone. After each push, release pressure to let the chest come back to its normal position.

If there is still no sign of normal breathing, Open the infant’s Airway using the “head-tilt,

chin-lift” method. (Place the infant’s head in a neutral position – do not hyper-extend his neck.)

Give 2 Breaths that make the chest rise.

o Place your mouth over the infant’s mouth and nose, making a tight seal, and breathe into

the infant. (Or use a barrier device to deliver breaths.) Allow the infant to exhale between breaths. Each breath should be delivered over one second.

Do 5 cycles or 2 minutes of CPR (cycles of 30 compressions and 2 breaths) before

calling 911.

Call 911

Use an AED

If bystanders are present to assist, or you DID witness the infant collapse, follow the Adult sequence of events.

CPR for Infants (Ages 0 – 12 months) – Two Rescuers

Check the scene for Safety. Look all around to make sure there is nothing which might

injure you or the infant.

Check the infant for Responsiveness. Tap the bottom of the infant’s foot, clap over his

face and shout loudly, “Baby, baby, are you OK? Can you hear me?”

While checking for responsiveness, simultaneously check for signs of normal breathing. If there is no sign of breathing, or no normal breathing (only gasping, wheezing or snoring):

The second rescuer should Call 911 and get an AED or Call a “Code” and get a crash cart.

Check Pulse for circulation, 5 – 10 seconds. Place the infant’s arm in an “L” position.

Check the brachial pulse using two fingers, on the arm closest to you.

If there is no pulse, or the pulse is < 60 beats/minute with signs of poor perfusion:

Do 15 Chest Compressions.

o Push hard – compress the infant’s chest at least 1/3 the depth of the chest. o Push fast – do at least 100 compressions per minute.

o Place the infant on a firm, flat, elevated surface. Move clothing from the infant’s chest, if

possible. Use the “two thumb-encircling hands technique” for chest compressions. Place both thumbs next to each other, or overlapping, on the lower part of the breastbone. Encircle the infant’s chest with your hands. Press the infant’s breastbone straight down with your thumbs, while squeezing with your fingers. Be careful not to press on the very bottom of the breastbone. After each push, release pressure to let the chest come back to its normal position.

If there is still no sign of normal breathing, the second rescuer will Open the infant’s Airway using the “head-tilt, chin-lift” method. (Place the infant’s head in a neutral position –

do not hyper-extend his neck.)

Give 2 Breaths that make the chest rise.

o Use a BVM system attached to oxygen (preferably) or use a pocket mask barrier

device. If neither of the above is available, make a tight seal over the infant’s mouth and nose with your mouth and breathe into the child.

o Allow the infant to exhale between breaths. Each breath should be delivered over one second.

Repeat cycles of 15 compressions and 2 breaths until you can use the AED. After each 2

minutes of CPR, the two rescuers should switch roles

Defibrillate the infant, following the guidelines listed.

INFANT CHOKING RELIEF

You might suspect an infant is choking if he:

Cannot cry

Cannot make sounds

Makes only a high-pitched squeaky sound

Has bluish lips or skin

To relieve the choking, do a series of 5 back slaps, followed by 5 chest thrusts:

Hold the infant face down on your forearm.

Support the infant’s head/jaw in your hand.

Sit or kneel, supporting your forearm on your lap or thigh.

Keep the infant’s head lower than his torso.

Using the heel of your other hand, deliver a series of up to 5 back slaps, mid-way between the infant’s shoulder blades. (Be careful not to deliver slaps too low – below the level of the infant’s shoulder blades.)

If the object does not come out, support the back of the infant’s head and turn the infant over onto your other forearm.

Support your forearm on your thigh or lap, being careful to keep the infant’s head lower than his torso.

Using two fingers of your other hand, do up to 5 chest thrusts, with fingers on the center of the breastbone, just below the nipple line, exactly the way you do chest compressions for CPR.

Repeat sequences of up to 5 back slaps, and up to 5 chest thrusts, until the object comes out or the infant stops responding.

If the infant stops responding call 911 and start the steps of CPR.

Begin the steps of CPR:

Do 30 chest compressions, using two fingers on the infant’s breastbone, just below the nipple line.

Open the airway – each time you open the airway to give breaths, open the mouth to look for the object. If you see the object and can safely remove it, do so. If you don’t see the object, or can’t safely reach it, continue with the steps of CPR.

Give 2 Breaths (re-positioning the head after the first breath, if it does not go in.)

Do 30 Chest Compressions.

Repeat the sequence of 30 compressions and 2 breaths (checking the infant’s mouth for the object before giving breaths) until help arrives or you can use the AED.

Infants who have choked on a hard object should ALWAYS see a healthcare provider!!

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NOTES

(These materials were created as a review/study guide by Rescue One Training for Life, Inc. and are not a product of, nor endorsed by, the American Heart Association.) ©Rescue One Training for Life, Inc. 2010

The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and

has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not represent income to the

Association.

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