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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