Introduction to Health Care Professional CPR / AED
The
leading cause of death in the US according to the Center for Disease
Control (CDC.gov) is cardiovascular disease. Risk factors for
cardiovascular disease are: smoking, high blood pressure, high
cholesterol, lack of exercise, stress and obesity. Factors which are
unavoidable are: age, sex, hereditary and diabetes. It's important to
note that death is most likely to occur after 10 minutes of a loss of
oxygen to the brain. From 6 to 10 minutes brain damage is expected. From
4 to 6 minutes brain damage is very possible and from 0 to 4 minutes
brain damage is virtually non-existent. However, CPR should still be
performed.
It's important to note that the latest 2010 AHA
guidelines recommends un-confident performers should at least perform
chest compressions upon the patient since studies show chest
compressions can be as effective as the combination of CPR.
CPR for 2 Rescue Workers
Roles are to be switched every 5 cycles (2 mins) at a ratio of 30:2 Compressions to Breaths.
When to stop CPR
If
the patient regains a pulse, if the area becomes unsafe, if cardiac
arrest last longer than 30 minutes, if the rescuer(s) is too exhausted
or ordered to stop.
Or, if these complications arise:
Fractures, punctures, lung ruptures or collapses, rib separation, bruises of the heart and/or lungs.
Bloodborne
Pathogens to be aware of: Hepatitis B and C (HBV / HCV), Human
Immunodeficiency Virus (HIV) as well as Tuberculosis (TB).
The Good Samaritan
Any
persons who assist those who are injured, ill or in peril are protected
by the Good Samaritan Law. As long as they're acting voluntary, without
expectation of reimbursement or compensation while performing such aid,
on site-they'll have legal protection. Remember, when performing CPR
every second counts so, unless required otherwise, don't hesitate to
call 911, perform CPR or external chest compressions immediately.
Adult CPR
C is for Circulation - Adult Compressions
Chest
compressions Circulate the blood within the patient. It's important to
place your hands correctly upon the patient's chest when performing
compressions. To do so, find the point where the patient's ribs meet
(just below both halves) and interlock your fingers with both hands.
Make sure you're kneeling beside the patient's shoulders. Once in
position, lock your elbows and use your body's weight to compress 2
inches upon the patient's chest. Make sure to let the patient's chest
rise after each compression.
Remember, CPR should be administered until help arrives.
A is for Airway. Clear the Airway
Check
for any obstructions, such as: tongue, foreign objects, vomit, swelling
or food blocking the patient's throat or windpipe (finger-swipe, if
necessary).
Make sure the patient is on a solid/firm surface (on
his/her backside). Next, kneel beside the patient's neck/shoulders. Open
the patient's Airway by tilting the head back with the palm of 1 hand
as the other hand gently lifts the chin. For no longer than 10 seconds,
check for life: listen for any sounds, put your cheek beside the
patient's mouth to feel for breathing and look for any motions. If, for
whatever reason, you're unable to perform the tilt-head chin-lift
maneuver, perform the jaw-thrust maneuver: kneel above the patient's
head, rest your elbows on the surface, place 1 hand on both sides of the
patient's jaw, stabilize the patient's head with your forearms, use
your index finger to lower the patient's jaw as you use your thumb to
retract the patient's lower lip. If the patient is assumed lifeless,
perform mouth-to-mouth.
Chest compressions should be performed on patient's who are obese or pregnant.
B is for Breathing. Mouth-to-Mouth
Rescue
Breathing is widely known to be performed mouth-to-mouth-it can also be
performed mouth-to-nose, mouth-to-mask and mouth-to-stoma, but in rare
cases. Breathing tasks: Adults - 1 breath 3-5 seconds (10-12 per min),
Children - 1 breath 3-5 seconds (12-20 per min). While still performing
the Airway technique pinch the patient's nose shut. With a complete seal
over the patient's mouth, with your mouth, breathe into the patient
until you see the chest inflate. If the chest does not inflate repeat
the Airway technique. Once the chest inflates take a second breath. When
performing the breathing technique make sure to give 1 breath for 1
second.
Once the breathing technique is applied you will continue the C-A-B's.
Child CPR
Child CPR ages 1-8
Perform
all the same tasks mentioned for an Adult: check for safety and
consciousness and ask the child, "Are you okay?" Several times or, until
the child's alert. If there's no response administer CPR. In a child's
case you must administer 5 reps of CPR before, calling 911. Unless you
can have someone else to call. Check the child's pulse by placing 2
fingers on the carotid artery (against the throat/windpipe). If there
isn't a pulse begin compressions.
C is for Circulation - Child Compressions
Make
sure the child is resting upon a solid/firm surface. Before you begin
compressions determine if 1 hand could be used instead of 2 depending on
the size of the child. It's important to note that when performing
chest compressions on a child do NOT exceed 1/2 the depth of the child's
circumference. It should be between 1/3 and 1/2. Make sure your hands
are placed correctly upon the child's chest (in the middle of the chest,
just below the ribs). Follow the same steps when performing CPR on an
adult. 30 compressions and 2 breaths equaling 5 reps. Do NOT forget to
call 911. Repeat process.
Check again for pulse.
A is for Airway - Clear the Airway
Kneel
beside the child's shoulders/neck. Perform the 3 steps as you would
with an adult-Tilt-chin and open mouth while listening and feeling for
any sounds/breathing, for 10 seconds. Make sure nothing is blocking the
airway. If the child isn't showing any signs of life proceed to the
Breathing technique.
B is for Breathing - Mouth-to-Mouth
Make
sure to perform the same Breathing task upon the child as you would
upon the adult. Children's lungs are much smaller than adults so make
sure to give a lesser breath when performing this task upon a child.
After tilting the head and chin, squeeze the nose shut. Seal your mouth
over the child's mouth and perform the Breathing task.
Remember,
give one breath into the child's lungs while making sure the child's
chest inflates. If the child's chest doesn't inflate repeat the airway
technique. Once, the chest inflates, perform the next step.
Infant CPR
Infant CPR ages 12 months or younger
Before
attempting CPR on an infant make sure to check for safety and
consciousness. For infants make sure to administer CPR before, calling
911. Never leave the infant alone. Perform 5 reps of CPR with the same
ratio of 30:2 Compressions over Breathing.
C is for Circulation - Infant Compressions
Before
attempting any chest compressions check the infants pulse. You can find
the pulse just under the upper arm. If no pulse is felt begin chest
compressions. When performing compressions upon an infant use EXTREME
caution. Just below the infants nipples, in the center of the chest,
just below the middle horizontal line, place 2 fingers for compression.
Remember, 100 compressions per minute - 30:2 Compressions over Breathing.
Perform
5 reps of Compressions over Breathing or about 2 minutes and then, call
911. Continue CPR until help arrives or until the infant begins to
breathe again. Compressions will be pressed at about 1 and 1/2 inches of
circumference.
A is for Airway - Clear the Airway
As you
would with an adult or child, make sure to lay the infant on a
solid/firm surface on its back. Make sure to kneel beside the infant's
shoulders while placing 1 hand on the infant's forehead as the other
hand gently lifts the chin.
Once again, check for any signs of life.
Look,
listen and feel for any breathing for 10 seconds. Remember to place
your cheek just in front of the infant's mouth while checking for a
pulse under the upper arm. If the infant isn't showing any signs of life
begin the Breathing technique.
B is for Breathing - Mouth-to-Mouth
Breathing into an infant is different than breathing into an adult or child.
Place
your entire mouth over the infant's mouth and nose when you breathe
into the infant. Make sure to perform this task with less breath than
you would with a child. If the chest rises complete the second breath,
each for 1 second. If the chest doesn't rise make sure to check for
anything blocking the Airway of the infant and repeat the process.
Make sure to feel for a pulse and if there isn't one continue performing CPR.
Choking
Choking
is caused by an object blocking the throat or windpipe. Adults often
choke by a large piece of food but children often swallow small toys or
other objects.
Remember, the universal sign for choking is
mimicking choking yourself. Make sure to ask the patient if he/she is
choking because, many times, the person is merely coughing. If the
patient is unconscious make sure to call 911.
Infants 12 months or
younger: rest the patient on your forearm, while also resting your
forearm, on your thigh. Perform 5 thumps with the heel of your hand upon
the infants back. If the patient is still choking turn the infant over,
face-up, and with 2 fingers upon the breastplate perform 5 chest
compressions. Repeat the process until the object is lodged.
Children
and adults: when performing the Heimlich maneuver make sure to stand
behind the person. Lean the person slightly forward and wrap your arms
around his/her waist. Next, press hard with a closed fist into the
abdomen than grab your fist with your other hand. Perform 5 quick
thrusts. If the object still hasn't cleared the patient's
throat/windpipe, repeat the cycle.
Unconscious person: when
performing the Heimlich maneuver on an unconscious person lay the
patient on his/her back. Make sure to clear the patient's airway, if
needed, finger swipe the patient's mouth to pick out any foreign
objects. If you can't see or can't take the object out of the patient's
mouth, make sure to perform CPR. Chest compressions will most likely
clear the patient's airway.
If you're still unable to clear the
patient's airway and/or if the patient still isn't showing signs of
life, make sure to call 911 and continue performing chest compressions.
Fibrillation
Ventricular
Tachycardia is a rapid heartbeat that begins at the bottom chambers of
the heart, named Ventricles. Ventricles are the main heart's main
chambers which pump. Ventricular Tachycardia can be very
life-threatening because it can lead to Ventricular Fibrillation.
Ventricular
Fibrillation is when the cardiac muscles quiver rather than contract.
Ventricular Fibrillation requires immediate medical response. If the
patient receives no attention he/she will fall degenerate with no blood
circulation. After 4 minutes serious brain damage can occur and after 8
minutes brain damage is likely to be severe and can result in death.
Automated External Defibrillator (AED) Guidelines
When should an AED be used?
CPR
is a very important action when saving a patient's life. However, an
AED is crucial towards regaining the natural rhythm of the heartbeat as
well as restarting the patient's heart. CPR should be performed if the
patient is non-responsive and not breathing and an AED should be applied
after performing CPR. If the AED does not bring the patient back to
consciousness CPR should be re-administered. It's crucial to call 911 or
any Emergency Medical Service (EMS) before performing CPR or applying
an AED.
How to use an AED
Turn on the AED - Usually
there will be an "On" button but in some cases there might be a lever.
Remove all clothing from the patient's arms, chest and abdomen-whether
male or female. Attach pads to bare skin on the chest. Make sure to use
the appropriate system for the child or adult (an AED should not be used
on an infant). Place the left pad under the left armpit-to the left of
the nipple and right pad under the collarbone on the right side of the
chest. Make sure to place the pads at least one inch away from any
implanted devices. Next, connect the wiring. Analyze the patient's heart
rhythm. Make sure you DO NOT touch the patient during the defibrillator
process. If the AED does not begin analyzing automatically make sure to
press the analyze button. If a shock is advised then push the shock
button.
Make sure your patient is cleared of any debris such as: metal, large amounts of water, etc...
Newer
AED's only shock once; however, some models do shock up to 3 times. If
the patient is shocked but doesn't regain a pulse immediately perform
CPR for 2 minutes. If a shock is not advised continue CPR. Make sure to
stay clear of any large amounts of water or any metals. Make sure to
shave the patient, if needed, when using an AED. Make sure to place the
pads at least one inch away from any implanted devices or Transdermal
medication patches (or remove patch).
Note: Before using an AED physical training is recommended.
Resuscitation (special circumstances)
Drowning
Make
sure to remove the patient's wet clothing and replace it with something
warm and dry. Make sure to perform rescue breaths if the patient is
unconscious. If rescue breaths aren't accessible make sure to perform
chest compressions.
Trauma
Make sure to use the jaw-thrust
maneuver when performing the airway task. Make sure to check for any
injuries, such as: head, spinal and neck, to maintain patient's
protection.
Hypothermia
Hypothermia is considered to be when
the patient's body temperature is below 95 F. Make sure to remove
patient from any damp areas. Make sure to remove any wet materials the
patient might be wearing and replace them with something warm and dry.
If the patient is unconscious make sure to NOT raise the patient's body
parts above the heart. Make sure to check for a pulse for 35-45 seconds.
Electroshock
Make
sure to check for safety before attempting any performance on the
patient. Make sure the patient isn't near any electrical currents or
fuse boxes. CPR is priority 1 for Cardiac arrest patient's, burns,
scrapes and other bodily harms aren't considered priority 1. If the
patient is unresponsive or pulse less, perform CPR.
Rescuers
should be physically & mentally fit as well as skillfully prepared
and readied for emergency responses. Rescuers should be knowledgeable of
all equipment necessary for usage, beforehand.
Now let's review
Infant - Review
AHA
guidelines for infants are under the age of 12 months. The same C-A-B
process is performed with the infant as with children and adults,
besides a few important differences.
Make sure to perform 5 reps
before calling 911, unless someone else can. Make sure to place 2
fingers just under the nipples and below the middle of the chest. Unlike
children and adults you'll place your mouth over the infant's mouth and
nose. The same ration of C-A-B's are used 30:2 at 100 compressions a
minute with 1 second breaths.
Child Review
AHA guidelines
for children are from ages 1-8. The same process is performed with the
child as you would with an adult besides a few differences.
Make
sure to perform CPR before calling 911. The ratio of chest compressions
to breathing is 30:2. Look, Listen and feel for breathing. Make sure
nothing is blocking the airway. Squeeze the nose shut and perform the
Breathing task.
Adult Review
Check to see if the patient is
conscious by shouting "Are you okay?" several times. If the patient
doesn't respond, immediately call 911. Then perform the C-A-B's.
Circulation - use 2 hands for chest compressions at a ratio of 100 per
minute-30 compressions then mouth-to-mouth. Airway - tilt the head back
and listen for breathing and then look for any response. Breathing -
mouth-to-mouth - pinch nose shut sealing the patient's mouth with yours
and breathe once checking for the patient's chest to inflate. If not,
perform the airway technique until chest inflates. 2 breaths every 30
chest compressions-each breath, 1 second.
Remember the order of the tasks being: Circulation, Airway, Breathing (C-A-B).
Choking Review
Choking
is caused by an object blocking the throat or windpipe. The universal
sign for choking is placing both hands around your neck.
Treatment
for infants: Apply 5 thumps to infant's back and 2-finger compression
upon the chest and repeat until the object is lodged. Treatment for
children and adults: perform the Heimlich maneuver (5 quick thrusts).
Treatment for an unconscious person: lay the person on their back on the
ground and perform CPR-not forgetting to clear the airway and to call
911.
When using an AED
Make sure to remove the patient's
clothing from intended placement of the pads. Place the pads on bare
skin. Place the pads away from any implanted devices/medicated patches.
Connect the wires and check the patient's heart rhythm. Shock the
patient if advised too. If not, perform CPR for an additional 2 minutes
and recheck the patient's hearth rhythm.
If you're interested in learning more of if you're interested in becoming Certified please visit us at:
http://www.nationalcprfoundation.com/
We
also offer certifications for First-Aid, Bloodborne Pathogens and Basic
Life Support for Healthcare Professionals, Workplace Employees and the
Community!
-National CPR Foundation