Download performance - Saudi Heart Association

25
PERFORMANCE
Sheets
26
SKILL PERFORMANCE SHEET
Adult 1-Man CPR
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
1. Establish unresponsiveness and effort of breathing (3-5 sec.)
EMS system should be activated (997) and get the AED
2. No effort of breathing, check pulse (if trained 5-10 sec) and immediate chest
compression 30 Compressions Within the first 10-15 seconds.(C-A-B) sequence.
Open airway (head tilt-chin lift). Check for breathing (look, listen, feel).
3. If breathing is absent or inadequate, give 2 breaths (1 second per breath (3 sec.),
Healthcare providers should use a barrier device while lay persons can use any other
means of protecting themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or
towel. Watch chest rise and fall during exhalation.
4. Locate and check carotid pulse or femoral pulse (5-10 sec.). If pulse is present but no
breathing, provide rescue breathing (one breath every 5-6 seconds, about 10 -12
breaths per minute).
5. If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2
minutes) with ratio 30:2 and at a rate of at least 100 per minute. Minimal interruption
during compressions (<10 seconds), Chest compression (depth of 5 cm = 2 inches.)
followed by 2 breaths (1 second/breath). The set of each 30 compressions should take
approximately 15-18 seconds.
6. After 5 cycles of CPR (Approximately 2 minutes) compression: ventilation ratio 30:2 and
at a rate of at least 100 per minute.), check for pulse in carotid or femoral arteries.
According to the findings:
If there is pulse and breathing: Place the victim in the recovery position
carefully,
especially if neck injury is suspected, monitor Vital signs until EMS
arrives.
If there is pulse but no breath ing. Continue rescue breathing, one breath every
5 – 6 sec. (10 - 12/min.), Recheck pulse every 2 minutes.
If there is no pulse, no breathing. Continue CPR, 5 cycles of CPR (Approximately
2 minutes) as mentioned in step 5. Then check pulse in carotid or femoral
arteries (optional every 2-5 minutes). Continue the cycles until success is
achieved or EMS arrives.
Done
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
27
Adult 2 -Man CPR
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
Establish unresponsiveness and effort of breathing (3 - 5 sec.)
Ask a second rescuer to activate the EMS system (997) and get the AED
RESCUER 1
2.
No effort of breathing, check pulse ( if trained 5-10 sec) and immediate chest compression 30
compressions Within the first 10-15 seconds.(C-A-B) sequence.
Open airway (head tilt-chin lift). Check for breathing (look, listen, feel).
3.
If breathing is absent or inadequate, give 2 breaths (1 second per breath 3 sec), Healthcare
providers should use a barrier device while lay persons can use any other means of protecting
themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel. Watch chest rise and fall
during exhalation.
4.
Locate and Check carotid pulse or femoral pulse (5- 10 sec.), If pulse is present but no
breathing, provide rescue breathing (one breath every 5 – 6 sec., 10 – 12 times/per min.).
5.
If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2 minutes)
with ratio 30:2 and at a rate of at least 100 per minute. Minimal interruption during
compressions (<10 seconds) Chest compression (depth of 5 cm = 2 inches.) followed by 2
breaths (1 second/breath). The set of each 30 compression should take approximately 1518 seconds.
RESCUER 2 arrives
Rescuer 1 stays as the ventilator and rescuer 2 acts as the compressor
6.
Continue as 2 man CPR. Rescuer No. 2 immediately starts compression: ventilation cycles. Give
5 cycles (Approximately 2 minutes) with ratio 30:2 as in step 5, followed by 2 breaths (1
second/breath) by Rescuer 1.The pulse is checked at the end of the 2 minutes and every 2
minute thereafter when the switch is made, by rescuer 2 in the carotid or femoral arteries.
According to the findings:
If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected. Monitor Vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, One breath / 5 – 6 sec.
(10 -12 breaths per min.)
If there is no pulse, no breathing: Continue CPR, by recue no.2, 5 cycles of CPR
(Approximately 2 minutes) as in step 6. Then check pulse in carotid or femoral arteries
(every 2 minutes when shift between the rescuers)Continue the cycles until success is
achieved or EMS arrives.
NOTE: Rescuers should switch every 5 cycles of CPR approximately 2 minutes.
Done
1.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
28
1-Man CPR for Children1 Year old to puberty
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
Done
1. Establish unresponsiveness (3-5 sec.)
If second rescuer is available, have him/her activate the EMS system. 997 & get the AED
2. No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel)
(if trained 5-10 sec). If breathing is present place the victim carefully in recovery
position, then check pulse ( if trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30
compressions Within the first 5-10 seconds .
3.
4.
5.
6.
If breathing is absent or inadequate, give 2 breaths (1 second per breathn3 sec.),
Healthcare providers should use a barrier device while lay persons can use any other
means of protecting themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel.
Watch chest rise, allow for exhalation between breaths.
Locate and check carotid or femoral pulse (if trained 5-10 sec.). Take between
If pulse is present but no breathing, provide rescue breathing (1 breath every 3 – 5
seconds, 12 – 20 breaths per minute)
If no pulse, Start CPR. Give 5 cycles (approx. 2 minutes) compression: ventilation ratio
30:2 and at a rate of at least 100 per minute. Minimal interruption during compressions
(<10 seconds). Chest compression (depth at least ⅓ the depth of the chest about 2
inches) followed by 2 breaths (1 second per breath).
After 5 cycles of CPR (approx. 2 minutes, if rescuer is alone, activate EMS, 997 then
check for pulse in carotid or femoral arteries, and breathing. According to findings;
If there is pulse and breathing Place the victim in recovery position carefully,
monitor vital signs until EMS arrives.
IF there is pulse but no breathing. Continue rescue breathing, 1 breath every 3
- 5 sec. (12 – 20 per minute.)
If there is no pulse and breathing. Continue CPR Give 5 cycles of CPR (approx.
2 minutes) as in step no.5; continue so on until success is achieved or EMS
arrives.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
29
2-Man CPR for Children 1 Year old to puberty
Student Name___________________________________ code # _____________ batch no.________
1.
2.
Performance Guidelines
Establish unresponsiveness (3 - 5 sec.)
If second rescuer is available, have him/her activate the EMS system. (997) & get the AED.
RESCUER 1
No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if
Done
trained 5-10 sec). If breathing is present place the victim carefully in recovery position, then
3.
4.
5.
6.
check pulse ( if trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30
compressions Within the first 5-10 seconds.
If breathing is absent or inadequate, give 2 breaths (1 second per breath 3 sec.) Healthcare providers
should use a barrier device while lay persons can use any other means of protecting themselves, e.g.
Shamagh, Ghuthra, shayla, handkerchief or towel. Watch chest rise and fall during exhalation
Locate and Check Carotid or femoral pulse(if train ed 5 - 10 sec.)
If pulse is present but no breathing, provide rescue breathing (one breath every 3- 5 sec., 12 – 20
times/per minute).
If no pulse or heart rate less than 60bpm with signs of poor perfusion, start CPR. Give 5 cycles
(approximately 2 minutes), compression: ventilation ratio 30:2 and at a rate of at least 100
compressions per min. Minimal interruption during compressions (<10 seconds), Chest compression
depth ⅓ the depth of the chest about 5cm. Followed by 2 breaths (1 breath/second).
NOTE: Use one-hand / two hand compression method according to the size of the child
RESCUER 2 arrives
Continue as 2 man CPR. Rescuer No. 2 immediately starts to Give 5 cycles (approximately 2 minutes),
compression: ventilation ratio 15:2 and at a rate of at least 100 compressions per min. Minimal
interruption during compressions (<10 seconds), Chest compression depth ⅓ the depth of the chest
about 4cm. Followed by 2 breaths by rescuer no.1(1 breath/second).
The pulse is checked at the end of the 2 minutes and every 2 minute thereafter when the switch is
made, by rescuer 2 in the carotid or femoral arteries. According to the findings:
If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected. Monitor Vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, One breath
Every 3 – 5 sec. (12 -20 breaths/min.)
If there is no pulse, no breathing: Continue 2 man CPR as in step 6.
Continue so on until success is achieved or EMS arrives.
NOTE: Rescuers should switch every 5 cycles of CPR.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
30
Infant One-Man CPR
Student Name___________________________________ code # _____________ batch no.________
1.
2.
Performance Guidelines
Done
Establish unresponsiveness (3-5 sec.)
If second rescuer is available, have him or her activate the EMS System.
997
No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if
trained 5-10 sec). If breathing is present place the victim carefully in recovery position, then
check pulse (if trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30
compressions Within the first 5-10 seconds.
3.
4.
5.
6.
If breathing is absent or inadequate, give 2 breaths (1 second per breath 3 sec.). Healthcare
providers should use a barrier device while lay persons can use any other means of
protecting themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel. Watch chest
rise, allow for exhalation between breaths.
Locate and check brachial pulse (if trained 5-10sec.)
If pulse is present but there is no breathing, provide rescue breathing (1 breath every 3 - 5
seconds, 12 – 20 breaths per minute).
If no pulse or heart rate less than 60bpm with signs of poor perfusion, start CPR. Give 5 cycles
(approximately 2 minutes), compression: ventilation ratio 30:2 and at a rate of at least 100
compressions per min. Minimal interruption during compressions (<10 seconds), Chest compression
depth ⅓ the depth of the chest about 4cm. Followed by 2 breaths (1 breath/second).
After 5 cycles of CPR (approximately 2 minutes), compression: ventilation ratio 30:2 and at a rate of
at least 100 compressions per min. Minimal interruption during compressions (<10 seconds), Chest
compression depth ⅓ the depth of the chest about 4cm. Followed by 2 breaths (1 breath/second); If
rescuer is alone, activate EMS, 997 then check for pulse in brachial artery, and breathing.
According to findings;
If there is pulse and breathing Place the victim in recovery position Carefully, monitor
vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, 1 breath every 3 - 5 sec.
(12 – 20 per minute.)
If there is no pulse and breathing. Continue CPR Give 5 cycles as in step no.6, continue
so on until success is achieved or EMS arrives.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
31
Infant Two-Rescuer CPR
Student Name___________________________________ code # _____________ batch no.________
1.
2.
Performance Guidelines
Establish unresponsiveness (3 - 5 sec.)
If second rescuer is available, have him or her activate the EMS system. (997)
RESCUER 1
No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if
Done
trained 5-10 sec). If breathing is present place the victim carefully in recovery position, then
3.
4.
5.
6.
check pulse (if trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30
compressions Within the first 5-10 seconds.
If breathing is absent or inadequate, give 2 breaths (1 second per breath (3 sec.). Healthcare
providers should use a barrier device while lay persons can use any other means of protecting
themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel. Watch chest rise, allow for
exhalation between breaths.
Locate and check brachial pulse (if trained 5-10sec.)
If pulse is present but there is no breathing, provide rescue breathing (1 breath every 3 - 5
seconds, 12 – 20 breaths per minute).
If no pulse or heart rate less than 60bpm with signs of poor perfusion, start CPR. Give 5 cycles
(approximately 2 minutes), compression: ventilation ratio 30:2 and at a rate of at least 100
compressions per min. Minimal interruption during compressions (<10 seconds), Chest compression
depth ⅓ the depth of the chest about 4cm. Followed by 2 breaths (1 breath/second).NOTE: Use 2
thumbs/encircling hands compression technique
RESCUER 2 arrives
Continue as 2 man CPR. Rescuer No. 2 immediately start 5 cycles (approximately 2 minutes),
compression: ventilation ratio 15:2 and at a rate of at least 100 compressions per min. Minimal
interruption during compressions (<10 seconds), Chest compression depth ⅓ the depth of the chest
about 4cm. Followed by 2 breaths (1 breath/second), by Rescuer 1.
The pulse is checked at the end of the 2 minutes and every 2 minute thereafter when the switch is
made, by rescuer 2 in the brachial artery. According to the findings:
If there is pulse and breathing: Place the victim in the recovery position carefully, especially if
neck injury is suspected. Monitor Vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, One breath every 3 – 5 sec. (12 -20
breaths/min.)
If there is no pulse , no breathing: Continue 2 man CPR as in step 6. continue so on until
success is achieved or EMS arrives.
NOTE: Rescuers should switch every 5 cycles of CPR.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Complete
Needs more practice
Choose one:
SKILL PERFORMANCE SHEETS
32
Adult Foreign Body Airway Obstruction
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
1.
2.
3.
Done
Ask “Are you choking?” If the patient nods " yes" and uses the universal sign of choking,
immediately intervene by:
Stand behind the victim and give Abdominal Thrusts (Heimlich maneuver), aiming to increase
the intrathoracic pressure and expel the foreign body.
NOTE: Use Chest thrusts for pregnant or obese victim
Repeat thrusts with a distinctive movement to achieve expulsion of the foreign body or the
victim becomes unconscious
Adult Foreign Body Airway Obstruction – Victim becomes unconscious
4.
5.
6.
7.
8.
Put the victim in the ground and activate the EMS system or send someone to activate. (997)
Observe for breathing normality or absence, If breathing is absent or inadequate, open the
airway and try to ventilate. If unsuccessful, re-open the airway and try to ventilate again. If
still unsuccessful begin cycles of chest compression and ventilation with the ratio 30:2.
Every time the airway is opened to give breaths, open the mouth wide and look for the
object. If you see an object removes it using finger sweep. Then try to ventilate, If
unsuccessful, re-open the airway and try to ventilate again, If still unsuccessful begin cycles
of chest compression and ventilation with the ratio 30:2.
Repeat step 6 till chest raise, if chest raised, check pulse and continue 5 cycles of CPR about 2
minutes.
Repeat steps 7 and reassess the pulse every 2 minutes; According to findings:
If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected. Monitor Vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, one breath every 5 – 6
sec. (10 - 12/min.)
If there is no pulse and no breathing. Continue maneuvers of adult CPR .
Adult Foreign Body Airway Obstruction – Victim found unconscious
Establish unresponsiveness and effort of breathing. (3-5 sec.) EMS system should be
activated (997) and get the AED
No effort of breathing, check pulse(if trained) and immediate chest compression 30
10.
Compressions Within the first 10-15 seconds.(C-A-B) sequence.
11. Open airway (head tilt-chin lift). Check for breathing (look, listen, feel). (5-10 sec)
If FBO suspected Repeat steps 5,6,7 and 8
9.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
33
Child Foreign Body Airway Obstruction
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
1.
2.
3.
Ask “Are you choking?” If the patient nods " yes" and uses the universal sign of choking, immediately
intervene by:
Stand behind the victim and give Abdominal Thrusts (Heimlich maneuver), aiming to increase the
intrathoracic pressure and expel the foreign body.
NOTE: Use Chest thrusts for obese victim. Kneel down if the victim is short stature.
Repeat thrusts with a distinctive movement to achieve expulsion of the foreign body or the victim
becomes unconscious
Child Foreign Body Airway Obstruction – Victim becomes unconscious
4.
5.
6.
7.
8.
Put the victim in the ground and activate the EMS system or send someone to activate. (997)
Observe for breathing normality or absence, If breathing is absent or inadequate, open the airway
and try to ventilate. If unsuccessful, re-open the airway and try to ventilate gain. If still unsuccessful
begin cycles of chest compression and ventilation (30:2).
Every time the airway is opened to give breaths, open the mouth wide and look for the object. If you
see an object removes it using finger sweep. Then try to ventilate, If unsuccessful, re-open the airway
and try to ventilate again, If still unsuccessful begin cycles of chest compression and ventilation with
the ratio 30:2.
Repeat step 6 till chest raise, if chest raised, check pulse and continue 5 cycles of CPR about 2
minutes.
Repeat steps 7 and reassess the pulse every 2 minutes; According to findings:
If there is pulse and breathing: Place the victim in the recovery position carefully, especially
if neck injury is suspected. Monitor Vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, one breath every 3 – 5 sec. (12
- 20/min.)
If there is no pulse and no breathing. Continue maneuvers of Child CPR .
Child Foreign Body Airway Obstruction – Victim found unconscious
9.
10.
11.
Establish unresponsiveness and effort of breathing (3-5 sec.)
If second rescuer around ask him to activate the EMS system (997) and get the AED
No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if trained 510 sec). If breathing is present place the victim carefully in recovery position, then check pulse (if
trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30 compressions
Within the first 5-10 seconds.
Open airway (head tilt-chin lift). Check for breathing (look, listen, feel). (5-10 sec)
If FBO suspected Repeat steps 5,6,7 and 8 butting in consideration the activation of the EMS system
(997) after the first 2 minutes of CPR.
Comments: ____________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Complete
Needs more practice
Choose one:
Done
34
SKILL PERFORMANCE SHEETS
Infant Foreign Body Airway Obstruction
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines – concious
1.
2.
3.
Done
Confirm airway obstruction. Check for serious breathing difficulty, ineffective cough, weak
or absent cry.
Give up to 5 back blows, turn the infant carefully using both hands supporting the face and
the back of the head and give 5 chest Thrusts.
Repeat blows and thrusts until effective or victim becomes unconscious
Infant Foreign Body Airway Obstruction – Infant becomes unconscious
1.
2.
Establish unresponsiveness (3-5 sec.)
If second rescuer is available, have him or her activate the EMS System. 997
No effort of breathing, Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if
trained 5-10 sec). If breathing is present place the victim carefully in recovery position,
then check pulse (if trained A,B,C the same sequence no change).
If untrained or in pre hospital, apply (C-A-B) sequence with immediate chest compression 30
compressions Within the first 5-10 seconds.
3.
4.
Open the airway and look in the mouth, remove an object only if it is visible. Do not use a
Blind finger sweep.
Try to ventilate. If ventilation is unsuccessful, re-open the airway and try to ventilate again.
If still unsuccessful.
After 5 cycles of CPR (approximately 2 minutes), compression: ventilation ratio 30:2 and at a rate
of at least 100 compressions per min. Minimal interruption during compressions (<10 seconds),
Chest compression depth ⅓ the depth of the chest about 4cm. Followed by 2 breaths (1
breath/second); If rescuer is alone, activate EMS, 997 then check for pulse in brachial artery,
5.
6.
and breathing. According to findings;
If there is pulse and breathing Place the victim in recovery position Carefully, monitor
vital signs until EMS arrives.
If there is pulse but no breathing. Continue rescue breathing, 1 breath every 3 - 5
sec.(12 – 20 per minute.)
If there is no pulse and breathing. Continue CPR Give 5 cycles as in step no.5, continue
so on until success is achieved or EMS arrives.
N.B. : Every time the airway is opened to give breaths, open the mouth and look for the
object and, if one is seen remove it.
Comments:
______________________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
SKILL PERFORMANCE SHEET
35
Performance Evaluation CPR & AED (Adult , Child & Infant )
Student Name___________________________________ code # _____________ batch no.________
Performance Guidelines
Done
1.
Establish unresponsiveness and effort of breathing (3-5 sec.)
EMS system should be activated (997) and get the AED
2.
No effort of breathing, check pulse(if trained) and immediate chest compression 30 compressions
Within the first 10-15 seconds.(C-A-B) sequence.
Open airway (head tilt-chin lift). Check for breathing (look, listen, feel (5-10 sec)
3.
If breathing is absent or inadequate, give 2 breaths (1 second per breath), (3 sec.)
Healthcare providers should use a barrier device while lay persons can use any other means of
protecting themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel.
Watch chest rise and fall during exhalation.
4.
Locate and check carotid pulse or femoral pulse ( brachial for Infant). (5-10 sec.)
If pulse is present but no breathing, provide rescue breathing (one breath every 5-6 seconds, about
10 -12 breaths per minute OR one breath every 3-5 seconds, about 15-20 breath per minute.).
5.
If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2 minutes) with ratio
30:2 and at a rate of at least 100 per minute. Minimal interruption during compressions (<10
seconds), Chest compression (depth of 5 cm = 2 inches.) followed by 2 breaths (1 second/breath). The
set of each 30 compressions should take approximately 15-18 seconds, until AED is available.
AED Skills (AED arrives at any point during basic CPR)
6.
Place the AED next to the victim . POWER ON the AED
7.
Attach electrode pads in the proper positions (as pictured on each of the AED electrodes, sternum
and apex, with proper contact and no overlap of pads).
NOTE: CPR should not be interrupted during this procedure.
8.
Clear the victim during the ANALYZE. Some machines may ask you to press the analysis button,
others will analyze automatically.
The AED may take 5-15 seconds for analysis. (AED advises shock and charges)
9.
Clear before delivering the shock. Ensure no contact with the victim. Loudly announce “I am clear,
you are clear, all are clear” or simply “clear”, then press the shock button. Single shock only to be
delivered at the end of 2 minutes and every 2 minutes thereafter. IN between start CPR 5 cycles of
chest compression: ventilation as per age group. CPR is applied as 1 man CPR, while the second
rescuer only operates the AED.
10. Repeat steps 7-8 until the EMS or ACLS team arrive or until the AED shows “No Shock Indicated”.
Continue monitoring the vital signs and according to findings:
If there is pulse and breathing: Place in the recovery position carefully, especially if neck
injury is suspected, monitor Vital signs & ECG.
If there is pulse but no breathing. Continue rescue breathing, (1 breath every 5 – 6 sec. (10 –
12/min.) for adult or one breath / 3 – 5 sec. (12 – 20 min.) for child and infant)
If there is no pulse and breathing: Continue CPR 5 cycles of CPR (approx. 2 minutes)
compression: ventilation 30:2 ratio and at a rate of least 100 per minute. Minimal
interruption in compressions. Chest compressions depth according to the age of the victim,
then analyze, shock, CPR and so on until success is achieved or EMS arrives.
Comments:______________________________________________________________________
______________________________________________________________________________
Instructor: _____________________________________
Choose one:
Complete
Needs more practice
ACLS PERFORM AIRWAY
36
Teaching
Testing
NAME: ______
_______________________________ Batch #: ______ DATE: ________________
Skills Station 1:
Airway Adjuncts and Intubation
Objectives:
On completion of Testing Station 2, the student will have demonstrated the ability to perform or
demonstrate the following:
1. Ventilate adult manikin using mouth- to -mask technique. (Each participant must have his or her own
mask; masks must not be shared.)
2. Insert esophageal airway into adult intubation manikin and provide effective ventilation.
3. Intubate trachea of adult intubation manikin with endotracheal tube and assess that both lungs can
be inflated simultaneously.
4. Intubate trachea of adult intubation manikin with endotracheal tube while esophageal airway is in
place.
5. Intubate trachea of infant intubation manikin with endotracheal tube and assess that both lungs can
be inflated simultaneously.
Time
Skills
Pass
A. Mouth-to-Mask Ventilation W ith Supplemental Oxygen
1. Connect oxygen line with 10L flow.
30 sec
2. Establish airway by head - tilt.
3. Insert oropharyngeal airway with proper technique.
4. Establish seal with mask.
5. Ventilate mouth -to-mask & record 800ml minimumtidal volume on recording
manikin at least three times in 15 seconds.
B. Esophageal Airway (or use optional PTL airway, with appropriate procedure for insertion)
20 sec
1. Assume ventilation is in progress.
2. Grasp jaw between thumb and index finger and lift upward, but keep mouth
open; do not hyperextend neck.
3. With mask attached, insert tubeinto mouth and place it so that the curvature is
the same as that of the pharynx.
4. Advance into esophagus and seal mask firmly over mouth and nose.
5. Ventilate and see if chest rises - inflate cuff with 35 - ml syringe.
6. Check placement of esophagea
l airway by visualizing lung inflation with each
ventilation and by auscultating both sides of chest and over stomach with
stethoscope.
Fail
37
C. Adult Intubation
1. Assume ventilation is in progress.
35 sec
2. Connect laryngoscope blade and handle; check light: check cuff on
endotracheal tube.
3. Hold laryngoscope in left hand.
4. Insert laryngoscope in right side of mouth, moving tongue to the left.
5. Visualize epiglottis, then vocal cords.
6. Insert ETT (endotracheal tube).
7. Inflate cuff with 4 - 6 ml of air.
8. Check placement of ETT by ventilating, visualizing lung inflations, and
auscultating both sides of chest and over stomach with stethoscope.
D. Intubation of Trachea with Esophageal Airway in Place
40 sec
1. Esophageal airway is in place.
2. Intubate trachea.
3. Ventilate through endotracheal tube
.
4. Remove esophageal airway.
E. Infant Intubation
1. Assume ventilation is in progress.
2. Connect laryngoscope blade and handle; check light.
30 sec
3. Hold laryngoscope in left hand .
4. Insert laryngoscope in right side of mouth, moving tongue to left.
5. Visualize epiglottis, then vocal cords.
6. Insert endotracheal tube.
7. Check placement of tube by mouth-to-tube or bag-to-tube ventilation,
observing chest movement and auscultating chest and over stomach
with stethoscope.
Overall Grade (circle one)
Instructor _____________________________________________________________________
Pass
Fail
ACLS PERFORM IV
38
Teaching
Testing
NAME: _____________________________________ batch #: ________ DATE: ______________
Skills Station 2:
PLACEMENT OF INTRAVENOUS FLUID LIFE LINE,
PERIPHERAL AND CENTRAL VEINS
OBJECTIVES:
On completion of Station 4, the student will be able to:
1. Describe the surface markings and the technique for insertion of an intravenous cannula into:
a) A peripheral vein
b) A femoral vein
c) An internal jugular or subclavian vein
2. Assemble the components of an intravenous infusion lifeline.
3. Describe the surface markings and the technique for insertion of an interoseous (IO) cannula
into the shaft of a leg.
NOTE:
Learning during practice is enhanced by utilizing the illustrations from the paper which demonstrate each
approach.
Once the student has learned the site of the venipunctureand the angles of approach for cannulation of
central veins and can demonstrate such on a model, he should practice on a cadaver and finally actually
perform these techniques on a living patient under supervision until the procedure can be performed
safely and efficiently.
Only then can he be considered "certified" to perform central venipuncture. Knowledge of these
performance criteria is only the first step toward acquiring such a skill.
Choose one of each of the following: verbalize and demonstrate landmarks rather than actually doing
venipuncture: 1) Peripheral vein; 2) Femoral vein; and 3) Internal jugular (one approach) or subclavian.
TIME
CRITERIA
I
PERIPHERAL VEINS
60 Sec.
A. ARMS OR LEGS
1.
2.
3.
4.
5.
6.
7.
8.
9.
Apply tourniquet proximally.
Locate vein and cleanse the overlying skin with alcohol or povidone
iodine.
Anesthetize the skinif a large bore cannula is to be inserted in
an awake patient.
Hold vein in place by applying pressure on vein distal to the point of
entry.
Puncture the skin with bevel of needle upward about ½ to 1
Centimeter from the vein and enter the vein either from the side or
from above.
Note blood return and advance the catheter either over or through the
needle, depending on which type of catheter
- needle device is
employed. Remove the tourniquet.
Withdraw and remove the needle and attach the intravenous tubing
.
Cover the puncture site with povidone iodine -ointment and a sterile
dressing and tape in place, excluding the point of connection of the
intravenous tubing.
PASS
FAIL
39
60 Sec.
B.
1.
2.
3.
4.
5.
6.
7.
II.
EXTERNAL JUGULAR
Patient in supine, at least 150 head down position, head turned away
toward opposite side.
Cleanse skin, use lidocaine if patient awake and large bore needle used.
Align needle in the direction of the vein with the point aimed toward
the ipsilateral shoulder.
Make venipuncture midway between angle of jaw and midclavicular
line; "tourniqueting" the vein lightly with one finger above the clavicle.
Note blood return.
Advance catheter and remove needle; attach to IV tubing.
Cover puncture site and affix catheter in place
CENTRAL VEINS
60 Sec.
A. FEMORAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
Cleanse the overlying skin with povidone-iodine;this is especially
important in this site because the danger of contamination is great. If
the puncture is being performed electively, shave the hair around the
area.
Locate the femoral artery either by its pulsation or by finding the
midpoint of a line drawn between the anterior superior iliac spine
and the symphysis pubis.
Infiltrate the skin with lidocaine if the patient is awake.
Make the puncture with the needle attached to a 5 or 10 milliliter
syringe two fingerbreadths below the inguinal ligament, medial to the
artery, directing the needle cephalad at a 4-5 degree angle with the skin
or frontal plane (some prefer to enter at a 9-0 degree angle) until the
needle will go no further.
Maintain suction on the syring e and pull the needle back slowly until
blood appears in the syringe, indicating that the lumen of the vein has
been entered.
Remove the syringe and insert catheter with the needle more parallel to
the frontal plane.
Withdraw the needle, leaving the catheter in place.
Connect to intravenous tubing.
Cover the puncture site with povidone- iodine ointment and a sterile
dressing and secure the catheter and tubing in place.
40
60 Sec.
B.
SUBCLAVIAN, INFRACLAVICULAR APPROACH
1.
2.
3.
Patient in supine, at least 150 head down position, head turned away.
Cleanse skin, use lidocaine if patient awake.
Introduce needle attached to a syringe I centimeter below the
junction of the middle and medial thirds of the clavicle.
4. Hold the syringe and needle parallel to the frontal plane(the plane of
the back of the patient).
5. Direct the needle medially, slightly cephalad, and posteriorly behind
the clavicle toward the posterior superior angle of the sternal end of
the clavicle.
6. Establish a good point of reference by firmly pressing the fingertip
into the suprasternal notch to locate the deep side of the superior
angle of the clavicle and directing the course of the needle slightly
behind the fingertip.
7. Advance needle while withdrawing plunger of syringe.
8. When blood appears and vein entered, rotate bevel of needle
caudally; remove syringe and insert catheter to predetermined depth.
9. Remove needle and connect catheter to IV tubing.
10. Cover puncture site, and affix catheter in place.
60 Sec.
C. INTERNAL JUGULAR, POSTERIOR APPROACH
1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient in supine, at least 150 head down position, head turned away.
Cleanse skin, use lidocaine if patient awake.
Introduce the needle under the sternomastoid muscle near the
junction of the middle and lower thirds of the lateral
(posterior) border (5 centimeters above the clavicle or just above
where the external jugular vein crosses the sternomastoid muscle).
Aim the needle caudally and ventrally (anteriorly) toward the
suprasternal notch at an angle of 45 degrees to the sagittal and
horizontal planes and with 15-degree forward angulation
in the frontal plane.
The vein should be entered within 5 to 7 centimeters.
Advance needle while withdrawing plunger of syringe.
When blood appears and vein entered, remove syringe and insert
catheter to predetermined depth.
Remove needle and connect catheter to IV tubing.
Cover puncture site, and affix catheter in place.
41
60 Sec.
D. INTERNAL JUGULAR, MIDDLE OR CENTRAL ROUTE
1.
2.
3.
4.
5.
6.
7.
8.
9.
60 Sec.
Patient in supine, at least 150 head down position, head turned away.
Cleanse skin, use lidocaine if patient awake.
Introduce needle attached to syringe in the center of triangle formed
by two lower heads of sternomastoid muscle and clavicle.
Direct needle caudally, parallel to sagittal plane, at 30-posterior angle
with frontal plane.
If vein is not entered, withdraw needle and redirect it 5 to 10 degrees
laterally.
Advance needle while withdrawing plunger of syringe.
When blood appears and vein entered, remove syringe and insert
catheter to predetermined depth.
Remove needle and connect catheter to IV tubing.
Cover puncture site, and affix catheter in place.
E.
1.
2.
3.
4.
5.
6.
7.
8.
9.
INTERNAL JUGULAR, ANTERIOR APPROACH
Patient in supine, at least 150 head down position, head turned away.
Cleanse skin, use lidocaine if patient awake.
Place the left index and middle fingers (if from the right side) 3
centimeters lateral to the mid - sternal line; the carotid artery is
retracted medially away from the anterior border of the sternomastoid.
Introduce the needle at the midpoint of this anterior border (5
centimeters above the clavicle and 5 centimeters below the angle
of the mandible).
Forming a posterior angle of 30 to 45 degrees with the frontal
plane, direct the needle caudally toward the ipsilateral nipple
and toward the junction of the middle and medial thirds of the clavicle.
Advance needle while withdrawing plunger of syringe.
When blood appears and vein entered, remove syringe and insert
catheter to predetermined depth.
Remove needle and connect catheter to IV tubing.
Cover puncture site, and affix catheter in place.
7 minutes
Instructors (s): ________________________________________ (check) Pass _______ Fail _______
________________________________________ (check) Pass _______ Fail _______
42
INTRAOSSEOUS INFUSION
INTRODUCTION:
Bone shaft acts as non-collapsible vein through
which medication & fluids can be given. It is an old
procedure but become popular recently. It is not
the first choice. A rigid needle is Inserted into the
cavity of a long bone.
Indications:
Used for critical situations when a peripheral IV is
unable to be obtained.
Initiate it after 90 seconds or three unsuccessful IV
attempts.
SITES:
STEPS OF INTRODUCTION OF MEDICATIONS:
1. Select the medication and prepare equipment.
2. Palpate the puncture site and prepare with an
antiseptic solution.
3. Make the puncture.
4. Aspirate to confirm proper placement.
5. Aspirate to confirm proper placement.
6. Connect the IV Tubing.
7. Administer the medication.
8. Monitor the patient for effects.
COMPLICATIONS:
- Fracture
- Infiltration
- Growth plate damage
- Complete insertion
- Pulmonary embolism
- Infection
- Thrombophlebitis
- Air embolism
- Circulatory overload
- Allergic reaction
CONTRAINDICATIONS TO INTRAOSSEOUS
PLACEMENT:
- Fracture to tibia or femur on side of access.
- Osteogenesis imperfecta—congenital bone
disease resulting in fragile bones.
- Osteoporosis.
- Establishment of a peripheral IV line.
ACLS DYSRHYTHMIAS
PERFOMANCE SHEET
Teaching
43
Testing
NAME: ______________________________________________________
BATCH #: ________
DATE: _____________
Recognition of Arrhythmias and Therapeutic Modalities
Objectives:
On completion of Testing Station 3, given an ECG rhythm strip, enter the letter
preceding the ECG strip in the blank preceding the correct ECG Rhythm
description. Complete this within 15 minutes
Correct
letter
Arrhythmias description
NSR with muscular artifact
Normal Sinus Rhythm
Ventricular Bigeminy
Torsade de Pointes
Third-degree Heart Block with multifocal PVC's
Ventricular fibrillation
Sinus tachycardia
Sustained ventricular tachycardia
First-degree AV block
Sinus bradycardia
Overall Grade (Circle one):
Pass
Fail
Instructor: _________________________________________
Pass
Fail
44
ACLS PERFORM MEGACODE
Teaching
NAME: ____________________________
Testing
batch #: ________ DATE: ________________
Objectives:
On completion of Testing Station 4, during a-5minute scenario, the Team Leader will have performed as
follows:
1. Supervised and directed arrest team in a sequence that would lead to successful resuscitation.
2. Monitored arrest team to insure that his/her directions were correctly carried out.
3. Correctly diagnosed arrhythmias and made proper treatment decisions.
4. Operated a defibrillator in the counter shockor cardio versionmode as appropriate and interposed
it into team activity in a safe and proper sequence.
5. Prescribed the appropriate drug(s) in correct dosage.
6. Ordered and interpreted lab data.
Skills (Team Leader)
Pass
Supervision and leadership
Proper sequencingincluding BLS skills
Monitoring other team members
Rhythm diagnosis
Defibrillator operation
Drugs
Ordering and interpretation of lab data
Overall Grade (Circle one)
Instructor ________________________________
___________
______Pass ______ Fail ______
Fail