CPR/AED

1. CPR/AED

2. Chain of Survival • The chain of survival are five steps to help increase the chances of an injured person of surviving a cardiac arrest.

3. Chain of Survival – step one • After determining that there is an injury needing advanced care; if unconscious tap and shout. • Call 911 • Questions you will need to answer: • Nature of the emergency? • Where are you? • How many are hurt? • Ages of who is/are hurt • Who are you? • Has treatment started? • Only hang up when instructed to do so by operator.

4. Chain of Survival – step two • Begin CPR • Most adult cardiac arrests (CA) victims heart is in ventricular fibrillation (VF) - Abnormal chaotic heart rhythm that prevents the heart from pumping blood. • CPR will not usually stop VF but plays an important part in pushing oxygenated blood to the brain and heart and prolonging VF so that an AED will be useful. • CPR can double or triple the victims survival rate • For every passing minute without CPR; rate of surviving drops 7-10%. • With CPR there is only a 3-4% drop each minute

5. Chain of Survival – step three • Use an AED • The use of the AED will stun the fibrillating heart, if the heart is still viable the normal pacemakers in the heart will begin firing and start a normal rhythm. • If used within 5 min; chances of survival is 49-75%. • Using an AED is simple.

6. Chain of Survival – step four • Advanced Care – EMS • Response time is 7-8 minutes – CPR is extremely important.

7. Chain of Survival – step five • Integrated post-cardiac arrest care.

8. How to recognize major emergencies

9. Heart AttackMyocardial infarction • Coronary heart disease is the leading cause of death in our nation. • During MI - part of heart muscle is starting to die. • Caused by a blockage of an artery (coronary) due to buildup of cholesterol deposits or a blood clot. • Victims are usually awake and can talk but feels severe pain • Most critical time is within the first 30 minutes after Sx begin.

10. Heart Attack • Most common symptoms • Pain or pressure in the center of the chest – which last more than 3-5 minutes. • Pain might feel pressure, fullness, squeezing, or heaviness • Pain might spread to shoulder, neck, lower jaw and down arm (usually the right). • Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again. • Other Sx – lightheadedness, fainting, sweating without fever, nausea, shortness of breath • Most victims will downplay symptoms, you must take action!!! • Call 911, get the nearest AED, and have the person rest in a position that is comfortable where they can breathe easily. • Put them in an area that you can get them to the floor easily and paramedics can get in.

11. Cardiac Arrest • When the heart stops beating. Usually caused by VF, which begins where the heart muscle is injured. • Without blood flow and no pulse the person becomes unconscious and stops breathing and collapses. • VF and cardiac arrest may be the only symptom of a heart attack. • AED is only thing that will stop a VF

12. Stroke • Its is a rapid onset of neurological problems like weakness, paralysis in one or more limbs, difficulty speaking, visual problems, intense dizziness, facial weakness, altered consciousness, and severe headache. • Two causes • blood vessel to brain is blocked by a blood clot • blood vessel to brain breaks • #3 cause of death and #1 cause of serious disability among Americans

13. Stroke • Most signs overlooked; three major signs to observe • facial droop • arm weakness – most obvious when victim attempts to extend arms with eyes closed – one or both may not move very well • speech difficulties – slurring of words and sentences • Call 911 immediately if see signs of stroke • Provide CPR if needed

14. Foreign body obstruction • Usually caused by food, but can be caused by many objects • Major signs • Universal choking signal • poor ineffective coughs • inability to speak • high pitched sounds while inhaling • increased difficulty breathing • Blue lips or skin (cyanosis) • Loss of consciousness and responsiveness • Heimlich maneuver in conscious victim • CPR in unconscious victim

15. CPR - adult

16. Step one • Make sure area is safe • Check unresponsiveness – tap and shout – “Are you alright” • If no response – call 911 or send someone directly to call • Grab AED if one present or send someone to get one.

17. Step two • If possible place victim supine and on a hard surface. • If victim is prone – roll over • Try protecting the neck as much as possible if you suspect neck injury

18. Begin CAB’s • C = Circulation • If not breathing or see abnormal breathing begin chest compressions • Agnal breathing – gasps that occur at the beginning of CA – not efficient – act as they are not breathing • Check for pulse or signs of circulation (at least 5sec nomore than 10sec) just go straight to CPR • Place one palm on the chest between the nipple line • Interlock your other hand on top of the hand on the chest • Bring your shoulder over the top • Make sure you have a wide base (knees spread just outside your shoulders) • Press down 2 inches at a rate of at least 100 compressions per minute – hard and fast • Make sure chest recoils completely • Complete 30 compressions and then give two breaths. • Do not stop unless and AED is available, victim moves, or you substituted out (if two rescuers are available – switch every five cycles of 30:2 – approx two minutes) – reduces fatigue

19. A = Airway • Head tilt and Chin lift • B = Breathing • If you do not detect normal breathing – give two breaths lasting 1 second each (may use barrier) • Watch chest rise, allow exhalation before next breath. • If breaths do not go in – reposition head and try again. • Practice

21. Practice • Practice compressions 30 times twice – alternate with partner – no breaths • 60 sec test – just compressions – try to get 95-105 compressions – allows to learn rhythm. Perform 1-2 times or as needed • Two minute test – performing 30:2 (includes breath) - should complete five cycles in that time.

22. During the beginning stages of CA – chest compressions are more important than breaths. Oxygen level will stay high for the first few minutes but blood is not moving to due to the heart not pumping. • Breathing becomes as important as the length of CPR continues • Very important to limit interruptions of chest compressions. • Be mindful not to give to many breaths, too much breath or too forceful – may cause gastric filling and the resultant complications, and/or cause diminished blood flow and reduce survival.

23. Vomiting/other breathing • If someone does throw up – do not panic. • Roll victim towards you. Use your body to hold them. • Clean out the mouth – roll back and continue. • Mouth to nose • Use when it is impossible to use the mouth due to injury. • Face shields and masks – may be used - • Very little chance of transfer of bodily fluids if perform mouth to mouth without mask. • Using shield or mask can slow down the CPR process • “Chest compression only” CPR is more beneficial than no CPR at all.

24. Recovery position • If victim begins breathing and having a pulse then turn victim to their side with lower arm in front. • No position is perfect- just make sure they are stable, near a true lateral position, and there is no pressure on the chest to impair breathing

25. Potential neck injury • If two or more responders • One stabilizes the neck – they will be in charge if victim needs to be moved • Place hands on the sides of the head and neck, using your hands to cup around the neck. • Place pressure on head with forearms near the ears • Elbows should be on the ground, wrists in ulnar deviation so that they come in contact with the head. • This will limit the amount of movement that will occur if you have to move your body, for example moving so that CPR can be administered or when EMS puts on a neck brace. • If movement is necessary then move body as one.

26. CPR – Child and infant

27. Child CPR (ages 1-Puberty)Child AED (ages 1-8yrs) • Similarities with single rescuer Adult CPR • Location on chest for compressions is the same – nipple line • Ratio of compressions to breaths the same – 30:2 • Differences with Adult CPR • In the chain of survival-If arrest is unwittnessed you will perform CPR first for two minutes performing five cycles of 30:2 – then call 911 (if you are alone) • Reason is that most child and infant cardiac arrests are due from asphyxiation, so they will benefit more from the CPR. • The depth you use for compression is 2 inches or 1/3 depth of the chest. Use one or two hands – which ever is more comfortable. • Compression/respiration ratio 15-2

28. Infant CPR • Similarities with single rescuer adult CPR • 30:2 ratio of compressions to breaths • Similarities with Child • Perform CPR first in the Chain of Survival, for the same reasons. • If small enough you may carry to phone with you after completing the five cycles – use speaker phone • Depth of compressions 1/3 depth of the chest or 1 1/2 inches or 4 cm • Differences with CPR • Check responsiveness by thumping or slapping the foot • Check pulse in the upper arm / brachial artery • If no pulse or if the pulse is present but below 60bpm you initiate compression • You will perform chest compressions one finger below nipple line • You will only puff air in • If unsure if it is a child or not, if it can fit on your arm, then treat as an infant • 2-rescuer – thumb-encircle chest; compression/resp ratio 15-2

29. Remember… Do Not tilt an infants head too far or it will actually occlude the airway.For infant mouth to mouth respiration you cover the mouth and nose with your mouth.

30. Foreign Body Airway Obstruction (FBAO) Heimlich Maneuver

31. Choking • Universal sign of choking – hand around throat • Ask questions • Are you choking? Can you speak? May I help you? – Very important. • If they say no leave them alone until they pass out – then it is assumed they want help. • If a person can speak or can cough - do not help

32. Abdominal thrusts • Place yourself behind victim scissor you legs • Front leg between victims legs • Slightly bend knees • Place hands on navel • place hands on chest if woman is pregnant or victim is severely overweight • Pull in and up • continue until object is out or they pass out • Use chest thrusts if you are unable to circumvent the abdomen • If pass out lower them carefully to the floor begin CPR • Only difference with CPR is you check mouth for object before breaths. • Finger sweep only if you see object. • Practice

33. Infant FBAO • Infant – • Conscious – place infant on forearm with babies mouth between fingers – back blows to upper back • Unconscious – • after back blows - five compressions – • look for object • give breath • repeat cycle – back blows, compressions, look and breaths • Finger sweep if see object • Practice

34. Automated External Defibrillator AED

35. What is an AED? • Automated external defibrillator – is an computerized defibrillator • it can analyze heart rhythm • recognize shockable rhythm • advise the operator whether the rhythm should be shocked • very easy to use • AED’s computer chips analyze the rate, size and wave shape of human cardiac rhythm. • will not shock a properly functioning heart • will not shock a heart that has stopped – VF is not present

36. Universal steps of AED use • Place AED parallel to patients left ear • Power on the AED first • Some automatically turn on when opened • Attach the AED to the patients chest with electrode pads • Remove clothing – to bear chest • Be kind to females • Dry patient or shave chest in area of electrode placement if needed • Place one pad above right nipple and one to the side and below the left nipple. (CPR is continued up to the point when the AED says analyzing rhythm stand clear) • Analyze rhythm • Make sure everyone is clear (must say “stand clear of the victim”). No contact • Push analyze (in necessary) some machine analyze automatically. • Charge AED if shock is required (some machine charge automatically)

37. Shock if indicated – (after checking everyone is clear again) Press the shock button. • Begin CPR for five cycles then analyze again • If shock is advisable again you clear everyone and shock • If shock is not advisable – continue with CPR • If victim has pulse and is breathing put into recovery position. • DO NOT take off pads or turn off AED until prompted by EMS

38. Special Considerations • Water • Must remove victim from water or wet surface • Dry before attaching pads • Metal surfaces • Is victim lying on metal surface? – if so move victim • The metal surface may cause the shock form the AED to hit you. • Children • Children 8 and older use as soon as possible • Children 1-8 – CPR for two minutes before using AED • Transdermal medications • Remove patch and wipe clean before attaching AED pads • Implanted pacemakers and defibrillators • Do not place an AED electrode directly over implanted device. • Move at least one inch to the side of device • Practice

39. How CPR Works • Effective CPR provides 1/4 to 1/3 normal blood flow • Rescue breaths contain 16% oxygen (21%)

40. Start CPR Immediately • Better chance of survival • Brain damage starts in 4-6 minutes • Brain damage is certain after 10 minutes without CPR

41. Do Not Move the Victim Until CPR is Given and Qualified Help Arrives… • unless the scene dictates otherwise • threat of fire or explosion • victim must be on a hard surface • Place victim level or head slightly lower than body

42. Even With Successful CPR, Most Won’t Survive Without ACLS • ACLS (Advanced Cardiac Life Support) • ACLS includes defibrillation, oxygen, drug therapy

43. Survey The Scene, then: RAP • R - Responsiveness • Tap shoulder and shout “Are you ok?”

44. RAP • A - Activate EMS ( if unresponsive) • YOU - call 911 – come back and let me know what they said (another can stay by the phone) • You may have to make the call

45. RAP • P - Position on back • All body parts rolled over at the same time • Always be aware of head and spinal cord injuries • Support neck and spinal column

46. When Can I Stop CPR? • Victim revives • Trained help arrives • Too exhausted to continue • Unsafe scene • Physician directed (do not resuscitate orders) • Cardiac arrest of longer than 30 minutes • (controversial)

47. Checking for CPR Effectiveness • Does chest rise and fall with rescue breaths? • Have a second rescuer check pulse while you give compressions

48. Why CPR May Fail • Delay in starting • Improper procedures (ex. Forget to pinch nose) • No ACLS follow-up and delay in defibrillation • Only 15% who receive CPR live to go home • Improper techniques • Terminal disease or unmanageable disease (massive heart attack)

49. Injuries Related to CPR • Rib fractures • Laceration related to the tip of the sternum • Liver, lung, spleen

50. Complications of CPR • Vomiting • Aspiration • Place victim on left side • Wipe vomit from mouth with fingers wrapped in a cloth • Reposition and resume CPR