Legal Considerations –Good Samaritan Act –Consent Sequence of Survival Understanding Heart Disease Understanding Stroke (CVA) Choking - Foreign Body

Cardio Pulmonary Resuscitation for the Community and Workplace

American Health & Safety Institute

Training Center

About the Instructor• Jason Roosevelt

– National Registry of Emergency Medical Technicians• Certified for 14 years

– Adjunct Faculty at Phoenix College• Teaching for 8 years

– ASHI/AHA CPR instructor trainer• Teaching for 8 years

– Phoenix Fire Department• Fire Communications Lead

– 8 Years

Course Outline

Course Outline

• Legal Considerations– Good Samaritan Act– Consent

• Sequence of Survival• Understanding Heart Disease• Understanding Stroke (CVA)• Choking - Foreign Body Airway Obstructions• The ABCD’s of Basic CPR

– Adult >8yrs – Child 1-8yrs– Infant <1yr

• Automated External Defibrillator• Drowning Facts• Test• Skills Evaluation

Reasons for Learning CPR

• It is a frightening feeling to be faced with a person struggling for life – and not know how to help the individual.

• Learning basic life support is a great way to overcome this fear.

• Learning how to correctly perform CPR and safely use an AED can literally bring someone back to life – a family member, friend, coworker, guest – even a stranger.

Reasons for Learning CPR

• CPR and AED can be used when breathing or heartbeat stops for reasons other than heart attack, including traumatic injury, electrocution, drowning, drug overdose, and other conditions.

• Even unsuccessful CPR has potential benefits, such as taking away the “suddenness” of sudden death and providing you and your coworkers, even relatives and friends, some comfort that everything possible was done.

Skill Requirements for Certification

METHOD: Physical skill demonstration by student in classroom assessed by authorized instructor

Adult Child Infant

• Demonstrate proper removal of contaminated gloves

• Place an unconscious, breathing victim in the recovery position.

• Perform effective rescue breathing.

• Perform effective chest compressions.

• Perform effective CPR with 1 provider.

• Safely and correctly attach and operate an AED. Coordinate CPR and AED to minimize interruptions in chest compressions.*

• Perform the steps to manage choking in a responsive victim.

*This program does not require AED training of every rescuer, but strongly recommends it for those with a duty or employer expectation to respond to cardiac arrest.

Legal Considerations

Legal ConsiderationsGood Samaritan Laws (vary by state)

• Designed to protect you from liability if you:– Act in good faith– Avoid recklessness or negligence– Act as any prudent person would in the

same circumstance– Only provide care within the scope of

your training• Duty to act applies to medical professionals

Legal Considerations (continued)

– Once care has been established, you must continue until relieved by an “equal or greater” level of care

– Do not abandon the patient– Do not accept anything in return

Legal Considerations (continued)

CONSENT• Consent is needed before providing care

for a conscious victim, you must first obtain consent by:• Identifying yourself• Tell the victim you have been trained to assist.• Ask the victim if they want help (parents or

guardian must grant consent for a minor before you provide care to a child)

• Expressed Consent (Oral / Written)• Implied Consent

• The law assumes their person would give consent if able to do so. Also applies to a minor when a parent or guardian is not present.

Safety and Health

Safety and Health• Infectious Illnesses

– There are no documented cases where use of training manikins has been responsible for transmission of bacterial, fungal, or viral diseases.

– ASHI Authorized instructors routinely and thoroughly clean and disinfect training manikins.

– Protective face shields are available for every student.

– To prevent spread of infectious illnesses, both instructors and students should clean their hands often, using alcohol-based hand sanitizers or soap and water.

Safety and Health• Infectious Illnesses

Please do not participate if:– Your hands, mouth or lips have skin

lesions.– You are ill.

Safety and Health• To prevent injury during skill practices:

– Avoid awkward or extreme postures of the body.

– Do not practice moving simulated victims if you have a history of back problems.

– Certain skills are not appropriate for student-on-student practice and must be performed on training manikins (abdominal thrusts, rescue breathing, and chest compressions).

– NEVER connect a live AED or an AED training device to a human during training.

Universal Precautions and Protective Equipment


•Reasons for Learning – Bloodborne pathogens are viruses or bacteria

that are carried in blood and can cause disease in people.

– Risk of getting disease while giving BLS/CPR is extremely low.

– Observing universal precautions for victims of all ages will make it lower.


– Universal Precautions is a way to limit the spread of disease by preventing contact with blood and body fluids.

– To “observe universal precautions” means that whether or not you think the victim’s blood or body fluid is infected, you act as if it is.

– Observe universal precautions for victims of all ages.


•Personal protective equipment – A barrier between you and victim’s blood or

body fluid. – Wear disposable, protective gloves. If a glove is

damaged, don't use it!


•Personal protective equipment – Use a rescue breathing mask or face shield

when performing rescue breathing. – Goggles or safety glasses with side protection

should be used to help protect your eyes.– If you find yourself in a first aid situation without

standard personal protective equipment, improvise.


•Use an alcohol-based hand rub to clean your hands and other exposed skin after providing CPR/first aid.

– If an alcohol-based hand rub is not available, wash with soap and water.

– Decontaminate all surfaces, equipment, and other contaminated objects as soon as possible.


• Workers designated by employers to give first aid/CPR must: – Be provided appropriate personal protective

equipment.– Receive additional training on how to eliminate

or reduce exposure. – Know what to do if exposed to blood or other

potentially infectious materials.*

*OSHA Standard 1910.1030

Wrap-Up Scenario

• You are called to attend to a 45-year-old coworker who collapsed in the lunchroom. The person is motionless, her lips purplish-blue. A thin line of fluid streams from the corner of her mouth. – Should you “observe universal precautions”?

Why or why not? – What protective equipment should you

wear/use?

Sequence of Survival


• Recognition of an Emergency• Rapid Access to EMS • Rapid CPR• Rapid Defibrillation (AED)• Paramedics (ACLS) • Hospital care


– Early recogniti

on

– Early CPR

– Early – Defibrillati

on

– Early ALS


• Assess– Scene Safety - PROTECT YOURSELF FIRST– Check for life threatening Conditions– Size up the nature of injuries and victim ages

• Alert– Call 9-1-1. Send someone if possible

• Attend– Attend to the victims needs

• Remove from immediate danger• Treat life threatening wounds• Control bleeding• Determine if CPR is required

• Stay until more help arrives

Adult Sequence of Survival

• Early recognition of SCA and rapid activation of an Emergency Action Plan or EMS. – Includes assistance by emergency medical

dispatch personnel who are specially trained to provide telephone CPR instructions.

• Early CPR. – Victims of cardiac arrest need immediate CPR. – CPR provides a small but vital amount of blood

flow to the heart and brain. – CPR increases the chances that a shock will

allow heart to start working effectively.

Adult Sequence of Survival

• Early Defibrillation– Survival rates are highest when immediate

CPR is provided and defibrillation occurs within 3 to 5 minutes.

• Early ALS – Advanced life support involves medical

procedures and medications used by paramedics, nurses, and doctors to manage a patient’s vital signs and organ systems to increase the chances of survival and recovery.

Child Sequence of Survival

• Key aspects for best survival and quality of life in children

Prevention

Basic Life Support

Early Access

Early ALS

Prevention


• Prevention – Accidental injury is a leading killer of children 14 and

under worldwide. – Most accidental injuries can be prevented by taking simple

safety measures.

• Basic Life Support (BLS) – When infants or children stop breathing but their heart

continues to beat and BLS is quickly provided, survival with normal (or near normal) brain function is as much as 70%.

– CPR first! When a rescuer, who is alone, finds a child unresponsive and not moving, give about 2 minutes of CPR before calling 911 or attaching an AED.

– However, if you see a child collapse suddenly and an AED is available, attach it immediately.


• Early Access. – Alert EMS, or activate Emergency Action Plan

promptly.

• Early ALS. – Advanced life support involves medical

procedures and medications used by paramedics, nurses, and doctors to manage a patient’s vital signs and organ systems to increase the chances of survival and recovery.

Wrap Up Scenario - Adult

• A 49-year-old man feels exhausted while working late at the office on a critical project with an impending deadline. Suddenly he has a sense that something bad is going to happen, but dismisses it to stress. Moments later, he collapses. He is found next to his overturned chair – blue and not breathing – by a coworker about 8 minutes later. The coworker calls 9-1-1 and begins CPR. Firefighters arrive in about 6 minutes, take over CPR, attach an AED, and shock the victim once, then continue CPR. An ambulance arrives 3 minutes later and paramedics begin advanced life support. Despite everyone’s best effort, the man is not resuscitated. – What may have contributed to this outcome?

Wrap Up Scenario - Child

• A 4-year-old child is discovered missing during a family get together. Fifteen frantic minutes later the child is pulled unconscious and not breathing from a neighbor’s unfenced backyard pool. CPR is started immediately. Paramedics arrive in 3 minutes, take over CPR, begin advanced life support, and transport the child to a nearby trauma center. The child is not successfully resuscitated. – What may have contributed to this outcome?

Heart Disease

Heart Disease•Reasons for Learning

– If oxygenated blood flow to the heart is cut off, a part of the heart will die, causing disability or death.

– Fast action can save lives.

Heart muscle damage from inadequate blood supply

Heart Disease•Acute Coronary Syndromes (ACS).

– Major complication of heart disease– Term applies to a number of conditions and

symptoms that occur when heart does not get enough oxygenated blood flow.

– ACS is the cause of sudden cardiac arrest in most adult victims.

U.S. Heart Disease Death Rates, 1996–2000Adults Ages 35 Years and Older, by County (CDC)

Understanding Heart Disease• Heart Disease

– Atherosclerosis • Build up of fatty

deposits (Plaque) on the inside walls of the arteries

• Diminishes the ability to flow oxygenated blood to the body.

• Leads to Coronary Artery Disease

Understanding Heart Disease

– Angina Pectoris ( Chest Pain )• Chest Pain or discomfort that occurs

due to reduction in blood flow or oxygen to the heart muscle.

• Usually relieved after a few moments of rest or with medication (typically nitroglycerin, NTG) may assist with med but not administer to patient

Understanding Heart Disease• Myocardial Infarction • (Heart Attack)

• A heart attack is when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing the heart muscle to die.

Heart Attack Risk Factors• Risk Factors that cannot be changed

– Heredity – Family history – Increasing Age– Male Gender

• Risk Factors that can be changed– Smoking– Stress– Poor diet habits– Hypertension (high blood pressure)– Diabetes (uncontrolled)– High cholesterol – Obesity – Lack of physical activity

Signs and Symptoms of a Heart Attack • Classic Heart Attack Symptoms

– Chest discomfort with light-headedness (weak/dizzy), fainting, sweating, nausea or shortness of breath.

– Chest Pain that may radiate into the neck, shoulders, back, arms, or jaw

– Uncomfortable pressure, squeezing, and tightness in the chest that lasts more than a few minutes.

– Pale or ashen colored skin.– Fear of impending doom (feeling like

something extremely bad is going to happen but not sure what).

• Patients often deny signs and symptoms

First Aid for a Heart Attack• First Aid

– Have victim sit down and rest quietly.– Loosen any tight clothing.– If victim has known heart condition, help the

person take his or her medication. • Usually nitroglycerin, placed or sprayed

under tongue. – If chest discomfort/pain is unimproved or

worsens 5 minutes after 1 dose has been taken, call 9-1-1 immediately.

First Aid for a Heart Attack• First Aid

– If the victim does not have a history of aspirin allergy, 9-1-1 operator may recommend victim chew an aspirin while awaiting arrival of EMS providers.

– Usual dose is a half or whole adult aspirin tablet (162 to 325 mg.) chewed and swallowed.

– If it’s available and you are properly trained, give emergency oxygen.

– Comfort, calm, and reassure victim until EMS arrives. – If victim becomes unresponsive and is not breathing

normally, start CPR.

Heart Attack Facts• This year, about 1.5 million Americans will

suffer a heart attack. Greater than 500,000 of those are fatal.

• Coronary Heart Disease (CHD) caused 1 of 5 deaths (479,305) in the USA in 2003 in both men and women.

• About 50% of deaths occur within 1 hour of heart attack – outside the hospital.

• Almost 14 million Americans have a history of heart attack or angina.

• A heart attack occurs about every 20 seconds with a resulting death every minute.

Wrap up Scenario• You are attending to a coworker, an

overweight female in her 50s. The woman is complaining of shortness of breath, back pain, and feeling like she’s going to throw up. She also has a mild ache in her chest and is very embarrassed that she has caused such a fuss at work.

– What should you do? Why?

Stroke“Brain Attack”

Stroke“Brain Attack”

• Reason for Learning– Limiting the extent of brain damage caused by

a stroke depends strongly on the victim, family members, or bystanders recognizing the signs and symptoms and activating EMS.

Stroke • Cerebral Vascular

Accident (CVA)– Stroke is a “Brain

Attack”.– Similar to a Heart

Attack, a CVA occurs in the brain.

– Blood supply to a part of the brain is cut off or greatly decreased.

– There are two different types of strokes: Ischemic and Hemorrhagic

Stroke Types• Ischemic strokes: occur when a blood

vessel becomes narrow or clogged. Preventing blood flow to the brain. – Of the 2 main types of stroke, the

ischemic stroke occurs 80%-85% of the time.

• Hemorrhagic strokes: occur when the wall of a blood vessel becomes weak and blood leaks out into the brain.– Hemorrhagic strokes tend to be more

serious than ischemic strokes. Death occurs in 30-50% of people with this type of stroke.

Stroke - TIA• Transient Ischemic Attack (TIA) or

“mini-stroke”– Similar to a stroke except that, with a

TIA, the symptoms go away completely within 24 hours. People who have a TIA are very likely to have a stroke in the near future.

Stroke – Signs and Symptoms• Sudden numbness or weakness in the face or

extremities• Especially prevalent on one side of the body

• Sudden and intense headache. Worst Ever!• Sudden loss of coordination, loss of balance, or

diminished to no vision on one side• Sudden onset of confusion or difficulty speaking

• Trouble following commands or thoughts processes

• Slurred speech• Sudden and intense headache

• Will describe as the “Worst headache I’ve ever experienced”

Stroke Facts• About 700,000+ strokes occur in the

United States each year.• Third largest cause of death (behind heart

diseases and cancers)• Leading cause of serious, long-term

disability in US• CVA Killed 157,804 people in 2003. • Of every 5 people that die from CVA 2 are

men and 3 are women.

First Aid for Strokes or TIA’s• First Aid

– If you suspect a stroke, ask victim to; • Smile.• Raise both arms.• Speak a simple sentence.

– If victim has any trouble with these tasks, he or she may be having a stroke.

– Alert EMS or activate your Emergency Action Plan immediately.

First Aid for Strokes or TIA’s

• First Aid – If properly trained, give emergency oxygen.– Comfort, calm, and reassure while awaiting

EMS.– If victim is breathing and unconscious, place in

recovery position.

Wrap Up Scenario• While participating in an exercise class,

your friend stops working out and complains of being dizzy. She takes a sip of water, but it runs out the corner of her mouth. Moments later, she can’t move her left leg or arm, and the left side of her face looks limp. She sounds drunk when she speaks.


Sudden Cardiac Arrest

Sudden Cardiac Arrest (SCA)• Reason for Learning

– SCA is one of the leading causes of death among adults in North America.

Sudden Cardiac Arrest (SCA)

• SCA occurs when the heart's electrical system malfunctions, and the heart abruptly stops working without warning. – When SCA occurs, most victims have an

abnormal heart rhythm called ventricular fibrillation (VF).

– The most common cause of VF is a poor supply of oxygen to heart, most commonly caused by heart attack.

– Low oxygen can cause heart’s natural electronic signals to become disorganized.

– This causes twitching of the heart muscle (VF) and prevents coordinated contraction.

Sudden Cardiac Arrest (SCA)• SCA (cont.)

– Heart stops pumping blood and oxygen to itself and to brain.

– Lack of blood flow and oxygen causes victim to lose consciousness immediately.

– Unless CPR is performed and a shock is delivered to heart to restore its regular rhythm, brain death can occur within minutes.

Electrical tracing of ventricular fibrillation

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Sudden Cardiac Arrest (SCA)• Automated External Defibrillator (AED)

– Small, portable computerized device attached with wires and pads to the chest of victim.

– Checks heart rhythm, decides if rhythm is VF, and if so, gives heart an electric shock.

– If shock is delivered promptly after collapse, many victims can survive without brain damage.

Sudden Cardiac Arrest (SCA)• Signs and Symptoms

– Sudden collapse without warning (some people may experience a racing heartbeat or feel dizzy or faint).

– Unconscious, unresponsive.– May make abnormal grunting, gasping,

or snoring noises.– Victim looks dead.

Sudden Cardiac Arrest (SCA)• First Aid

– Perform CPR, and defibrillate as soon as possible with an AED.

Wrap Up Scenario• While standing in the lunchroom, a

coworker suddenly collapses to the floor. He is unconscious, blue around the lips, and making weird, gasping, grunting sounds.


Emergency Action StepsAssess-Alert-Attend to the ABCDs

• Reason for Learning– The Emergency Action Steps are

intended to help the rescuer respond to an emergency and manage life-threatening problems in a victim of any age.

Emergency Action StepsAssess-Alert-Attend to the ABCDs

• Assess Scene. – If the scene is not safe or at anytime becomes

unsafe, GET OUT! • Assess Victim.

– Not moving? No response? • Alert EMS (Call 9-1-1) or activate Emergency

Action Plan. – Adult/Child >8 years old.

• ALERT as soon as victim is found. Get AED and oxygen (if available).

– Child <8 /Infant. • Give about 5 cycles (about 2 min.) of CPR, then

ALERT. Get AED and oxygen (if available).

ChokingAdult/Child

Foreign Body Airway Obstruction

Conscious - Unconscious

Foreign Body Airway Obstruction• Partially Obstructed Airway

– Conscious victim >1 yr of age– Patient CAN move air in and out of the lungs– Patient CAN speak or cough with good air

exchange– IF Poor air exchange – cyanosis may be

present with some wheezing or DB. (Treat at complete airway obstruction)

• DON’T LEAVE VICTIM ALONE

– Encourage the victim to cough– DO NOT slap or hit victim on the back


Complete Obstruction• Conscious Choking Adult or Child

– Ask victim “Are You Choking”– Ask for consent to render help.

• If victim is a minor ask parent or guardian if possible

– Begin Heimlich maneuver

• Look for the Universal

Distress Signal


• Begin Heimlich Maneuver (Abdominal Thrusts)– Stand or kneel behind the victim and wrap

your arms around the victims waist.– Place one fist over the other

approximately 2 fingers widths above the navel.

– Deliver 5 rapid thrusts inward and upward– Repeat until object is expelled or victim

becomes unconscious • Heimlich maneuver, Back slap, chest thrust are all

acceptable for Conscious victims with Complete Airway Obstruction

The Heimlich Maneuver


• If the victim becomes Unconscious – Lower victim to the floor– Call for help ( 9-1-1)– BEGIN CPR

• If breaths do not make chest rise, reposition and attempt breaths a 2nd time. Continue with chest compressions.

• Check Airway for object after each set of 30 compressions remove if you can see it (NO blind finger sweeps) then attempt to ventilate victim.

Repeat until obstruction is cleared and victim can breathe on their own or equal or greater level of care arrives to take over


• Special Considerations– Pregnancy or Obese

Persons• Chest thrusts replace the

abdominal thrusts.• Place arms under the

armpits to encircle the chest in a conscious patient and repeat until object is expelled.

• In an unconscious patient, depress over the chest area instead of the abdominal region.

Choking - Infant


Conscious - Unconscious

Airway Obstruction – Conscious Infant

• Choking Infant– Conscious– Partial Obstruction

• Observe the infant• Monitor coughing and

breathing to ensure a complete obstruction does not occur

• Check airway, only remove if object is visible


– Complete Obstruction• If infant is unable to cough or

cry due to suspected obstruction.

• Perform 5 Back Blows & 5 Chest Thrusts

– While supporting the head and neck, place the infant face down over one arm

– Position the head lower that the body

– Deliver 5 back blows between the shoulder blades using the heel of one hand


Complete Obstruction (cont)

Sandwich infant between your hands and arms and turn onto infants back

Place 2 fingers between nipple line and deliver 5 quick downward chest thrusts.

– Repeat till object is removed of victim

– becomes unresponsive

Airway Obstruction – Unconscious Infant

• Unconscious Infant

• Begin CPR

– Check Victims mouth for object before attempting to ventilate an unconscious victim.

– Do not perform Blind finger sweep

Cardiopulmonary Resuscitation

(CPR)

The ABCD’s of CPR• How does CPR work?

– Without proper circulation, blood can’t carry oxygen to the vital organs and they begin to sustain permanent damage.

– By performing CPR you are compressing the heart between the sternum and spine to force blood through the arteries to the vital organs.

• Sustaining constant blood pressure will increase the chances of survival.

– Meant to prolong Heart and Brain perfusion until more advanced help arrives.

• Frequently Asked Questions– When should CPR be performed?

• Unresponsive• Not Breathing • No Pulse or no signs of life

– How do I know if I am doing it properly?• Chest will rise with ventilations • Signs of life returns• Pulse is palpable during compressions

The ABCD’s of CPR

• When should CPR not be performed?– When OBVIOUS signs of death are present.

• Rigor Mortis (stiff)• Severe Mutilation• Decapitation• Lividity or pooling of the blood in the

downside of the body.

The ABCD’s of CPR• To Begin CPR

– Assess victim level of responsiveness • Check response to

– Verbal– Shake (tactile stimuli)– Painful Stimuli Rub or Pinch victim momentarily

• Check for signs of life. Checking for pulse to determine if heart is beating is not reliable and no longer recommended.

– Eye Movement– Breathing– Gurgling or Snoring (don’t confuse for agonal

respirations)

– Check no longer that 10 seconds. If signs of live are not present continue to ABCD

The ABCD’s of CPR• Airway

– Open the Airway • Head Tilt / Chin

Lift

– Make sure airway is clear from all objects or fluids

The ABCD’s of CPR• A=AIRWAY. Open Airway

• Tilt head, lift chin.

The ABCD’s of CPR• B=BREATHING. Check Breathing

• Look, listen, and feel for at least 5 seconds, but no more than 10.

Adult Child Infant

The ABCD’s of CPR•B=BREATHING. Check Breathing

– Occasional gasps are not normal and are not capable of supplying victim with enough oxygen to sustain life.

The ABCD’s of CPR• Breathing = 2 breaths

– Check for spontaneous respirations

– LOOK - LISTEN - FEEL• Look for the chest to rise and

fall• Listen for air movement • Feel if air movement is coming

from the mouth– Breaths

• Adults/Children - Pinch the nose and make a seal around their mouth

• Infants – cover both mouth and nose

• Give 2 Breaths enough to make the chest rise

• Breaths should last 1 second each in duration

The ABCD’s of CPR•B=BREATHING. Check Breathing

– If the victim is not breathing, not breathing normally, or is only taking occasional gasps, give 2 rescue breaths.

– Give each breath in 1 second. – Make chest visibly rise.

Adult Child Infant

The ABCD’s of CPR• B=BREATHING. Check Breathing• If victim is breathing, or starts breathing at

any time, place in a recovery position. • In this position, there is less chance of

obstruction by the tongue and secretions.

Uninjured victim: regular recovery position.

Injured victim: HAINES recovery position.

The ABCD’s of CPR

• Protective Barriers– Face Shield– Pocket Mask

• Remove mouth from mask to allow patient to exhale after delivering a breath.

– Hepa Filter– Bag Valve Mask

• Protect yourself and your family

from communicable diseases

The ABCD’s of CPR•Rescue Breathing With a Face Shield

– Tilt head and lift chin. – Place face shield over victim’s mouth and nose.– Place your mouth on face shield over victim’s

mouth. – Pinch victim’s nose either under or over shield. – Give 2 rescue breaths that make the chest

visibly rise.

The ABCD’s of CPR•Rescue Breathing With a Mask

– Tilt head and lift chin. – Place mask over victim’s mouth and nose. – Place your mouth around 1-way valve on mask

and give 2 rescue breaths that make chest visibly rise.

– Remove your mouth from mask with each rescue breath and allow victim to exhale.

The ABCD’s of CPR• Special Considerations for Breathing

– Mouth to Nose– Mouth to Stoma– Dentures– Suspected Trauma– Suctioning (if available)

The ABCD’s of CPR

• Compression = 30– Adults = 1 ½” to 2” in depth

• Call for help as soon as the person is unresponsive.

– Child/Infant = 1/3 to ½ the depth of the chest.• May use 1 or 2 hands to achieve compression depth.• Compression and recoil time should be equal. • Count 1, 2, 3, 4, 5……..30• After 30 compressions, reopen the airway and deliver 2

breaths.• Perform 2 minutes of CPR prior to calling 911• 2 Rescuer Infant CPR = 15:2 (Two Hand Encircling)

• Continue the ratio of 30 : 2 for all until obvious signs of life returns, qualified help arrives and relieves you or you are too exhausted to continue.– Do not pause or interrupt CPR unless obvious signs of life

are present.

* CPR is performed at the same ratio for all victims >1 yrs old. (30:2)*

The ABCD’s of CPR• Hand Placement

– Adult • Center of Chest• Between the Nipple Line

– Imaginary Line• 2 Hands, Interlocked

– Child• Center of Chest• Between the Nipple Line

– Imaginary Line• 1 hand or 2

– Dependant on size– Infant

• Center of Chest• 1 finger above nipple line• 2 fingers

The ABCD’s of CPR

The ABCD’s of CPRHemodynamics of Chest Compression

The ABCD’s of CPR• Chest Compressions

– When adult chest compressions are given properly. you may hear an unpleasant sound like knuckles cracking.

– You may feel patient’s breastbone fall in a bit. – This is caused by cartilage or ribs cracking. Any

damage done is not serious so don’t worry about it.

– Forceful external chest compression is critical if patient is to survive without brain damage.

– In infants and toddlers, compressions rarely cause cracked ribs.

The ABCD’s of CPR• Do not stop CPR until:

- A healthcare provider or other professional rescuer with equal or more training takes over.

- The patient shows signs of life.

- You are exhausted, or the scene becomes too dangerous to continue.

The ABCD’s of CPR• Defibrillation

– The process of stopping fibrillation (rapid, uncoordinated heart contraction) by delivering an electric shock to the heart.

Automated External Defibrillator


• Becoming wide spread– Increasingly available

in public areas• Airports, Casinos etc.

– Good Samaritan Laws Apply

Automated External Defibrillator• Most common heart

rhythm in a cardiac arrest is Ventricular Fibrillation.

• Defibrillation is the only way to reverse V-Fib

• Every minute of V-Fib, the patient loses 10% of survival chances.

• V-Fib is responsible for 75 – 85 % of sudden death incidents.

Automated External Defibrillator• How an AED is used

– Only applied to an Unconscious, Apneic, Pulseless patient.

– Recommended for patients 1 year of age and older. (AHA, ASHI)

– AED Will ONLY Shock Ventricular Fibrillation and Pulseless Ventricular Tachycardia

– 1 Shock followed by 2 min of CPR– Address A – B – C’s

• Apply pads to patients bare chest.• Remove excessive jewelry.

– Turn power on and follow prompts. • If advised to shock, perform compressions

immediately after shock is administered– Do not touch the patient while analyzing.


• Special Considerations – Remove excessive jewelry – Water or metal (conduction) – Check for prescription patches

• Nicotine• Nitroglycerine • Birth Control

– Look for implanted medical devices.• Internal Defibrillator or pace maker.

• Pads should be placed 1 – 2 inches from these devices.

The ABCD’s of CPR

• When should I stop performing CPR?– Obvious signs of life return.– Qualified help arrives and relieves you.– You are too exhausted to continue.

• What if the patient vomits?– Roll patient onto their side until vomiting stops.– Clear the airway.– Provide suctioning if available.– Resume CPR as necessary.

Repositioning a Patient


• Only move a patient to remove from immediate danger.

• If the patient is lying face down and airway is compromised.

• If you leave an unconscious victim unattended.

• Vomiting occurs


• Recovery Position– Used for

unconscious, breathing patients with no suspected spinal injuries.

Special Situations for Resuscitations


• Electric Shock• Be sure scene is safe

– Power secured– Contact power company if needed

– Lightning Strike• Heart Rhythm may be interrupted• Also may have severe burns• Scene Safety


• Hypothermia– Subnormal Body Temperature– Erratic heart rhythms may cause arrest– Rate may be very slow

• Assess pulses for 1 minute– If pulses are present

» Attempt to prevent further heat loss. Remove wet garments

» Avoid excessive movement


• Near Drowning/Water Rescue– Assess – Alert – Attend– Provide CPR

• Consider spinal injury• Manage Airway• Watch for Vomiting

• Traumatic Injuries– ABC’s– Stabilize Head and Neck– Use caution when opening the airway

Drowning Facts

Drowning Facts

• Drowning is the second leading cause of death of infants and children younger than 15 in the United States.

• Children less than 5 and adolescents between 15-24 years old have the highest drowning rates.

• For every child who drowns, 4 children are hospitalized for near drowning.

Drowning Facts

• Children less than 1 year of age most frequently drown in bathtubs and buckets.

• Between 1985 – 1994 Phoenix, Arizona lead the nation in drowning and near drowning incidents.

• Drowning is the leading cause of death among children age 1 – 4 in Maricopa County. (AZ Dept. of Health Services)

Did you know?

Did you know?

• Cardiac arrest in children and infants are most commonly a result of hypoxia or respiratory distress.

• Deaths often caused by airway obstructions.

• Sudden Infants Death Syndrome– No known cause or cure

Adult Compression-Only CPR

Adult Compression-Only CPR Reasons for learning

The emergency action steps for compression-only CPR are intended to help a rescuer respond and be able to provide life-supporting care to a suddenly collapsed adult who is unresponsive and not breathing normally.

Adult Compression-Only CPRSkill Objectives

Upon completion of this section, a student should be able to:

Perform effective chest compressions Perform effective adult compression-only

CPR

Adult Compression-Only CPR• When Sudden Collapse Occurs

– If an adult collapses and is found to be unresponsive and not breathing normally:• Immediately begin continuous external chest

compressions• Continue compressions until:

− Another rescuer takes over− An AED is available for use− The victim shows signs of life− EMS providers tell you to stop

ComparisonCompression-only CPR is an alternative to conventional CPR, which combines compressions and rescue breaths

Compression-Only CPR Compressions Alone

Conventional CPR Compressions and Breaths

Importance of Compressions

• Regardless of CPR method, every SCA victim should receive immediate chest compressions with as few interruptions as possible

Emergency Action Steps

Emergency Action StepsAlert

If victim does not respond: Shout for help Send help to alert EMS or initiate the

emergency action plan, and get an AED if one is available

If no other help is available, alert EMS and get an AED yourself

Emergency Action StepsAttend

Once EMS has been alerted: Airway – Open airway

Tilt head, lift the chin Breathing – Check for normal breathing

Look, listen, and feel for at least 5 seconds, but no longer than 10 seconds

Occasional gasps are not normal and do not supply enough oxygen to sustain life

Consider breathing to be absent if this occurs

If victim is not breathing normally: Immediately begin continuous external chest

compressions

Compression Technique Compression details

Hand Position – Middle of the chest, between nipples, with two hands

Compression Method – Hard, fast, complete recoil, with minimal interruption

Compression Depth – 1 1/2 to 2 inches Compression Speed – About 100 times per

minute

ExceptionsThere are other cases of

cardiac arrest that could benefit from the rescue breaths provided in conventional CPR:

Arrests that are not witnessed Arrests in children Arrests initiated by non-heart-related problems

such as drowning or drug overdose

Questions ???

Adult Compression Only CPR Video

IT’S TEST TIME ! ! !

1. Which step should be performed first in the CPR sequence?

a. Start rescue breathing

b. Assess for signs of circulation

c. Compressions

d. Open airway

1. Which step should be performed first in the CPR sequence?

a. Start rescue breathing

b. Assess for signs of circulation

c. Compressions

d. Open airway

2. You find a child unconscious and not

breathing, you should?

a. Begin CPR

b. Call 9-1-1

c. Give abdominal thrusts

d. Place child in the recover position

2. You find a child unconscious and not

breathing, you should?

a. Begin CPR (2 minutes)

b. Call 9-1-1

c. Give abdominal thrusts

d. Place child in the recover position

3. The preferred method of opening the

airway on a victim for the lay person:

a. Neck-tilt

b. Jaw Thrust maneuver

c. Head Tilt / Chin Lift

d. Modified Jaw thrust (trained rescuers)

3. The preferred method of opening the

airway on a victim for the lay person:

a. Neck-tilt

b. Jaw Thrust maneuver

c. Head Tilt / Chin Lift

d. Modified Jaw thrust (trained rescuers)

4. How is responsiveness determined?

a. Back blows

b. Chest Thump

c. Gently tap victims shoulder and ask

“are you ok”

d. Pour ice water on victim

4. How is responsiveness determined?

a. Back blows

b. Chest Thump

c. Gently tap victims shoulder and ask “are you ok?”

d. Pour ice water on victim

5. Compressions-to-breaths ratio for child

CPR is:

a. Same as infant CPR

b. 30 compressions to 1 breath

c. 5 compressions to 1 breath

d. 30 compressions to 2 breaths

5. Compressions-to-breaths ratio for child

CPR is:

a. Same as infant CPR


c. 5 compressions to 1 breath


6. Specific location for back blows for a

conscious, choking infant should be:

a. The lower back

b. Center of back bone

c. Between shoulder blades

d. Back blows are not performed on

infants

6. Specific location for back blows for a

conscious, choking infant should be:

a. The lower back

b. Center of back bone

c. Between shoulder blades

d. Back blows are not performed on

infants

7. If you are alone and find an unresponsive adult victim that is not breathing you should:

a. Apply AED and Shock Patient if needed. b. Call victim’s parents and ask consent to render aid. c. Activate 911. Begin CPR. d. Rush to find an AED

7. If you are alone and find an unresponsive adult victim that is not breathing you should:

a. Apply AED and Shock Patient if needed. b. Call victim’s parents and ask consent to render aid. c. Activate 9-1-1. Begin CPR d. Rush to find an AED

8. How do you locate the compression site

on an adult victim?

a. Four fingers widths above the navel

b. Center of chest between the nipple line

c. Over the xiphoid process

d. Doesn’t matter, as long as you are

doing compressions

8. How do you locate the compression site

on an adult victim?

a. Four fingers widths above the navel

b. Center of chest between the nipple line

c. Over the xiphoid process

d. Doesn’t matter, as long as you are

doing compressions

9. The compression-to-breath ratio for adult

CPR is:

a. 5 compressions to 1 breath


c. 30 compressions to 2 breaths


9. The compression-to-breath ratio for adult

CPR is:

a. 5 compressions to 1 breath



d. 15 compressions to 2 breaths for

10. A good way to determine whether your

rescue breaths are effective is to:

a. Ask the victim

b. Ask a bystander

c. Watch the victims chest rise gently

and fall

d. Stomach should rise and fall

10. A good way to determine whether your

rescue breaths are effective is to:

a. Ask the victim

b. Ask a bystander

c. Watch the victims chest rise gently

and fall

d. Stomach should rise and fall

11. Before giving rescue breaths to an

unconscious non-breathing patient, you must:

a. Perform abdominal thrusts

b. Check the mouth for any foreign

objects

c. Obtain consent from patient

d. Give 2 compressions

11. Before giving rescue breaths to an

unconscious non-breathing patient, you must:

a. Perform abdominal thrusts

b. Check the mouth for any foreign

objects

c. Obtain consent from patient

d. Give 2 compressions

12. Most drowning and near drowning

incidents are preventable:

a. True

b. False

12. Most drowning and near drowning

incidents are preventable:

a. True

b. False

13. The compression-to-breath ratio for an

infant is:

a. 15 compressions to 2 breaths




13. The compression-to-breath ratio for an

infant is:

a. 15 compressions to 2 breaths




(15:2 for 2 rescuer)

14. You find an unresponsive 56 year oldthat is not breathing. You open theairway and give a breath. Upon inhalation you are met with resistance and the chest did not rise and fall. What should you do:

a. Try another breath more forceful breathb. Re-open airway and attempt againc. Give 5 abdominal thrustsd. Start compressions at a rate of 3 : 2

14. You find an unresponsive 56 year oldthat is not breathing. You open theairway and give a breath. Upon inhalation you are met with resistanceand the chest did not rise and fall. What should you do:

a. Try another breath more forceful breathb. Re-open airway and attempt againc. Give 5 abdominal thrustsd. Start compressions at a rate of 3 : 2

15. You and several other rescuers are performing CPR on a person who suffered sudden cardiac arrest in an airline terminal. An AED is available. As you apply the AED electrodes you notice a small lump and scar on the patients chest indicating an implanted medical device. You should:

a. Place pad directly over the device b. Place the pad 1 – 2 inches to the side of the device c. Place the pad next to the device with one edge of the pad touching it. d. Never attach an AED to a patient with an implanted medical device

15. You and several other rescuers are performing CPR on a person who suffered sudden cardiac arrest in an airline terminal. An AED is available. As you apply the AED electrodes you notice a small lump and scar on the patients chest indicating an implanted medical device. You should:

a. Place pad directly over the device b. Place the pad 1 – 2 inches to the side of the device c. Place the pad next to the device with one edge of the pad touching it. d. Never attach an AED to a patient with an implanted medical device

16. You are startled by a loud crash. You rush out your door and see a car smashed

into a utility pole. Electrical lines lie across the roof of the car. The driver is slumped motionless over the wheel. You should:

a. Assess victims responsiveness. Tap and shout, “Are you ok?”

b. Alert EMS. Keep yourself and bystanders away from the unsafe scene c. Use caution when removing patient from car d. Get consent, and then perform a head-to- toe exam.

16. You are startled by a loud crash. You rush out your door and see a car smashed

into a utility pole. Electrical lines lie across the roof of the car. The driver is slumped motionless over the wheel. You should:

a. Assess victims responsiveness. Tap and shout, “Are you ok?”

b. Alert EMS. Keep yourself and bystanders away from the unsafe scene c. Use caution when removing patient from car d. Get consent, and then perform a head-to- toe exam.

17. We only perform a blind finger sweep on

infants:

a. True

b. False

17. We only perform a blind finger sweep oninfants:

a. True

b. False

Blind finger sweeps are not performed onany patient of any age.

18. You must leave an unresponsive victim who is breathing to alert EMS. You should:

a. Leave the victim face down b. Leave the victim face up c. Place the victim on their side, in the recovery position d. Use the clothes drag to pull the

victim with you

18. You must leave an unresponsive victim who is breathing to alert EMS. You should:

a. Leave the victim face down b. Leave the victim face up c. Place the victim on their side, in the recovery position d. Use the clothes drag to pull the

victim with you

19. What does the Acronym ABCD stand

for:

a. Ab Bra Ca Dabra

b. Airway, Breathing, Contact, Dial 9-1-1

c. Alert, Barley awake, Convulsing, Dead

d. None of the above

19. What does the Acronym ABCD stand

for:

a. Ab Bra Ca Dabra

b. Airway, Breathing, Contact, Dial 9-1-1

c. Alert, Barley awake, Convulsing, Dead

d. None of the above

20. When sudden cardiac arrest is witnessed,CPR and defibrillation are performedquickly and EMS arrives promptly:

a. Survival is certainb. The chance of survival increasesc. The chance of survival decreasesd. The chance of successful defibrillation decreases

20. When sudden cardiac arrest is witnessedCPR and defibrillation are performedquickly and EMS arrives promptly:

a. Survival is certainb. The chance of survival increasesc. The chance of survival decreasesd. The chance of successful defibrillation decreases

21. You witness a 3 year old collapse in the airport. You rush over to help and realize

he is not breathing. You give your initial breaths and start CPR. At the same time someone else brings over an AED, you should:

a. Not use the AED because the child is under 8 years of age

b. Continue CPR for 2 minutes before using the AED

c. Only use the AED if child pads are available d. Stop CPR, turn on the AED and follow instructions

21. You witness a 3 year old collapse in the airport. You rush over to help and realize

he is not breathing. You give your initial breaths and start CPR. At the same time someone else brings over an AED, you should:

a. Not use the AED because the child is under 8 years of age

b. Continue CPR for 2 minutes before using the AED

c. Only use the AED if child pads are available d. Stop CPR, turn on the AED and follow instructions

22. You and several others are attempting to resuscitate a 14 year old who

collapsed during a school track event. A shock

was just delivered by your AED. There are no signs of circulation. You should:

a. Remove the pads b. Change out the batteries c. Perform two minute of CPR d. Place the child in the recovery position

22. You and several others are attempting to resuscitate a 14 year old who

collapsed during a school track event. A shock

was just delivered by your AED. There are no signs of circulation. You should:

a. Remove the pads b. Change out the batteries c. Perform two minutes of CPR d. Place the child in the recovery position

23. You witness a person collapse outside a a local tavern. The scene is safe and EMShas been alerted. The person is not breathing and has no signs of circulation.You do not have a barrier device immediately available and are uncomfortable providing mouth-to-mouth rescue breathing.You should:

a. Place the person in the recovery positionb. Provide mouth-to-nose rescue breathingc. Provide compression-only CPRd. Prevent for shock, roll patient onto their side

23. You witness a person collapse outside a a local tavern. The scene is safe and EMShas been alerted. The person is not breathing and has no signs of circulation.You do not have a barrier device immediately available and are uncomfortable providing mouth-to-mouth rescue breathing.You should:

a. Place the person in the recovery positionb. Provide mouth-to-nose rescue breathingc. Provide compression-only CPRd. Prevent for shock, roll patient onto their side

24. You are performing rescue breathing ona victim who was pulled unconscious froma swimming pool. After blowing slowly intoyour CPR mask until the victims chest risesyou should:

a. Not remove your mouth from the mask, but allow the victim to exhale

b. Not remove your mouth from the mask, and do not allow the victim to exhalec. Remove your mouth from the mask and

cover the breathing port with your handd. Remove your mouth from the mask and allow

the victim to exhale

24. You are performing rescue breathing ona victim who was pulled unconscious froma swimming pool. After blowing slowly intoyour CPR mask until the victims chest risesyou should:

a. Not remove your mouth from the mask, but allow the victim to exhale

b. Not remove your mouth from the mask, and do not allow the victim to exhalec. Remove your mouth from the mask and

cover the breathing port with your handd. Remove your mouth from the mask and allow the victim to exhale

25. You loved the class and the instructors

who taught you, and you know everything

there is to know about CPR?

a. TRUE

b. FALSE

25. You loved the class and the instructors

who taught you, and you know everything

there is to know about CPR?

a. TRUE – of course

b. FALSE

Questions ?

Comments ?

Surveys

Skills Practice & Testing

Issuance of Cards and Certificates

Survey Information• Please be sure to either complete a survey

today and return it to your instructor, or you may also visit the ASHI website at

http://ashinstitute.org/quality.htm

and choose the RATE OUR PROGRAM link.

Training Center Name: Mt Lemmon Fire District

Class Title: Basic First Aid and CPR/AED for the Lay Person

Documents

Legal Considerations –Good Samaritan Act –Consent Sequence of Survival Understanding Heart Disease Understanding Stroke (CVA) Choking - Foreign Body