Transcript CPR/AED/First Aid Training

CPR/AED/First Aid
Training
10th HPE NOTES
Chain of Survival
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The chain of survival are four steps to help
increase the chances of an injured person of
surviving a cardiac arrest.
Chain of Survival – step one
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After determining that there is an injury needing advanced care;
if unconscious tap and shout.
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Call 911
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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.
Chain of Survival – step two
Begin CPR
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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
Chain of Survival – step three
Use an AED
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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 4975%.
Using an AED is simple.
Chain of Survival – step four
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Advanced Care – EMS
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Response time is 7-8 minutes – CPR is extremely
important.
How to recognize
major emergencies
Heart Attack
Myocardial infarction
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Coronary heart disease is the leading cause of death in our nation.
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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
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Most critical time is within the first 30 minutes
after Sx begin.
Heart Attack
Most common symptoms
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Pain or pressure in the center of the chest – which last more than 3-5 minutes.
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Pain might feel pressure, fullness, squeezing, or heaviness
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Pain might spread to shoulder, neck, lower jaw and down arm (usually the right).
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Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again.
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Other Sx – lightheadedness, fainting, sweating without fever, nausea, shortness of breath
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Most victims will downplay symptoms, you must take action!!!
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Call 911, get the nearest AED, and have the person rest in a position that is comfortable where they
can breathe easily.
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Put them in an area that you can get them to the floor easily and paramedics can get in.
Cardiac Arrest
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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
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
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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
Stroke
Most signs overlooked; three
major signs to observe
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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
Foreign body obstruction
Usually caused by food, but can be caused by many objects
Major signs
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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
CPR - adult
Step one
Make sure area is safe
Check unresponsiveness – tap and shout –
“Are you alright”
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If no response – call 911 or send someone
directly to call
Grab AED if one present or send someone
to get one.
Step two
If possible place victim
supine and on a hard
surface.
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If victim is prone – roll
over
Try protecting the neck
as much as possible if
you suspect neck injury
Begin CAB’s
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C = Circulation
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If not breathing or see abnormal breathing begin chest compressions
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Agnal breathing – gasps that occur at the beginning of CA – not efficient – act as
they are not breathing
No checking for pulse or signs of circulation 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 1 ½ -2 inches at a rate of 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
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A = Airway
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Head tilt and Chin lift
B = Breathing
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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
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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.
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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.
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Breathing becomes as important as the length of CPR continues
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Very important to limit interruptions of chest compressions.
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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.
Vomiting/other breathing
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If someone does throw up – do not panic.
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Mouth to nose
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Roll victim towards you. Use your body to hold them.
Clean out the mouth – roll back and continue.
Use when it is impossible to use the mouth due to injury.
Face shields and masks – may be used 
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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.
Recovery position
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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
Potential neck injury
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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.
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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.
CPR – Child and infant
Child CPR (ages 1-8)
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Similarities with Adult CPR
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Location on chest for compressions is the same – nipple line
Ratio of compressions to breaths the same – 30:2
Differences with Adult CPR
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In the chain of survival you will perform CPR first for two minutes
performing five cycles of 30:2 – then call 911 (if you are alone)
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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 1/3 to ½ depth of the chest. Use
one or two hands – which ever is more comfortable.
Infant CPR
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Similarities with adult CPR
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30:2 ratio of compressions to breaths
Similarities with Child
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Perform CPR first in the Chain of Survival, for the same reasons.
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Depth of compressions.
Differences with CPR
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If small enough you may carry to phone with you after completing the five cycles – use
speaker phone
You will perform chest compressions one finger below nipple line
You will place your mouth over mouth and nose of infant
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
Practice
Foreign Body Airway
Obstruction (FBAO)
Heimlich Maneuver
Choking
Universal sign of choking – hand around
throat
Ask questions
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Are you choking? Can you speak? May I help
you? – Very important.
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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
Abdominal thrusts
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Place yourself behind victim scissor you legs
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Place hands on navel
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place hands on chest if woman is pregnant or victim is severely
overweight
Pull in and up
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Front leg between victims legs
Slightly bend knees
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
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Only difference with CPR is you check mouth for object before breaths.
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Finger sweep only if you see object.
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Practice
Infant FBAO
Infant –
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Conscious – place infant on forearm with babies mouth
between fingers – back blows to upper back
Unconscious –
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after back blows - five compressions –
look for object
give breath
repeat cycle – back blows, compressions, look and breaths
Finger sweep if see object
Practice
Automated External
Defibrillator
AED
What is an AED?
Automated external defibrillator – is an computerized
defibrillator
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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.
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will not shock a properly functioning heart
will not shock a heart that has stopped – VF is not present
Universal steps of AED use
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Place AED parallel to patients left ear
Power on the AED first
Some automatically turn on when opened
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Attach the AED to the patients chest with electrode pads
Remove clothing – to bear chest
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Be kind to females
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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 of placing the pads
on)
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Analyze rhythm
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Make sure everyone is clear (must say “stand clear of the victim”). No
contact
Push analyze
Charge AED if shock is required (some machine charge automatically)
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Shock if indicated – (after checking everyone is clear
again)
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.
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DO NOT take off pads or turn off AED until prompted by EMS
Special Considerations
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Water
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Metal surfaces
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Remove patch and wipe clean before attaching AED pads
Implanted pacemakers and defibrillators
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Children 8 and older use as soon as possible
Children 1-8 – CPR for two minutes before using AED
Transdermal medications
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Is victim lying on metal surface? – if so move victim
The metal surface may cause the shock form the AED to hit you.
Children
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Must remove victim from water or wet surface
Dry before attaching pads
Do not place an AED electrode directly over implanted device.
Move at least one inch to the side of device
Practice
First Aid
Medical emergencies
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Breathing difficulties
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Anaphylaxisis
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Asthma problems are increasing
Most have medicines
May need assist victim is administrating
If symptoms continue to get worse call 911
Severe reaction to allergen
Victim may have epinephrine injector
May need to administer
Call 911 if medicine is not administered
Seizures
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General rules – 1) Prevent injury 2) ensure open airway 3) maintain open
airway after seizure is completed – place in recovery position
Never try to restrain victim, place anything in the mouth.
Injury emergencies
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Bleeding
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Direct pressure best way
If bleeding continues add more gauze or cloth; do not
remove gauze or cloth
Use elastic bandage to apply pressure to gauze and hold it in
place.
The use of tourniquets should be avoided unless in extreme
matters
The efficacy of elevation and pressure points is inconclusive;
if used, use only in conjunction with direct pressure and
when there is no apparent fracture or other underlying injury.
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Wounds and abrasions
Irrigate wounds until free of any foreign matter.
 Small wounds and abrasions should be cleaned
thoroughly then have triple antibiotic ointment
placed on it and covered.
 Larger wounds need to also be cleaned then covered
and taken to doctor for possible stitches
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Burns
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Thermal burns
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Cool burn with cold water until pain ceases
Do not cool for more than 10 min. Can lead to further damage
Burn blisters cover with loose gauze, but keep intact – breaking them
can lead to infection
Electrical burns
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Make sure electrical current is shut off before trying to help victim.
CPR and defibrillation may be needed as well as burn treatment
All electrocution injuries should be checked out by a physician
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Spine stabilization
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Suspect possible spinal injury if…
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Car accident
Injured from fall greater than their height
Complains of neck pain, tingling, or extremity weakness
Is not fully alert
Appears to be intoxicated
Appears frail or is >65 yrs old
Has sustained a head injury
- Manually stabilize the neck until help arrives.
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Musculoskeletal trauma – sprains, strains, contusions,
fractures
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For sprains, strains, contusions – apply ice for 20.
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Sprains elevate and place compression bandage
R.I.C.E. – rest, ice, compression, elevation
If victim has aversion to cold – place wet cloth between ice and skin
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Young kids and elderly especially susceptible
Contusion you want to stretch the injury as well as ice
If you are unsure of the injury suspect fracture – do not
move or straighten injury. Place ice on area and splint in
position, send to ER.
If suspect dislocation – splint as is and send to ER.
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Dental injuries
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Avulsed tooth
Hold onto by the crown not the root (part embedded into
gum
 Rinse off with water (do not scrub)
 Either place back into socket or place in glass of milk and
see a dentist immediately
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Clean bleeding wound with saline solution or tap
water
 Use cotton to apply pressure to stop bleeding
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Environmental injuries
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Snakebite
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Do not suck wound, it will only exasperate the problem
In case of Coral snake – wrap a bandage around the extremity of the bite – it will help slow
the poison – then get to medical facility immediately.
Coral snake bites and sucks
Other snake bites, wash area with soap and water, try not to move extremity very much and
get to medical facility.
Cold injuries
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Hypothermia
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Immediately begin re-warming – remove wet clothes and wrap body surface with anything at hand;
get to medical facility immediately
If far from medical facility you begin active warming – placing near heat source, placing in warm
(not hot) water.
Frostbite
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Remove wet clothing, usually occurs on extremities, do not re-warm if there is any chance it could
freeze again or you are close to a medical facility.
Use luke-warm water if you are far from medical facility
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Heat Injuries
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Heat cramps – muscle cramping, usually due to extreme loss of fluids
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Heat exhaustion
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Get to cooler area
Replace fluids
Ice and stretch area
Dizziness, could have flushed skin or cool and clammy, disoriented, nausea,
headache
Get victim to cool area immediately
Place ice on side of neck (carotid artery), arm pits, and groin area
Replace fluids
Watch for shock; could lead into heat stroke
Heat Stroke – medical emergency – call 911 immediately
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Extreme disorientation, possible unconsciousness, very little sweating,
internal temperature of >105.
Cool down by any means
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Drowning
 Get victim out of water as soon as possible
 Begin CPR immediately
 If you are alone – finish five cycles of CPR before calling 911
Poisons
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Poison control center – 1-800-222-1222
Chemical Burns
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Brush off any powder and remove all contaminated clothing
Alki or acid exposure – rinse with copious amounts of water.
Ingested poisons
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Do not ingest any medication; milk, activated charcoal, syrup
of ipecac unless instructed by poison control
Shock
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Develops when there is not enough blood flowing to the cells of the body
Causes in adults;
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Symptoms
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loss of blood
heart attack,
allergic reaction
feel cold and shiver,
feel weak, faint, or dizzy,
restless,
vomit,
feel thirsty
Treatment
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Call 911
Put victim on their back
If not leg injury or pain raise legs 12 inches
Cover victim with blanket
If bleeding is visible – use direct pressure