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CardioPulmonary Resuscitation Legal considerations Standard precautions Heart disease and stroke Sequence of survival Assess>Alert>Attend (ABCs) CPR FBAO/Choking ASHI certification Conducts thorough review of all relevant literature and developed standards in collaboration with the American Heart Association (AHA) and other organizations Course includes same content as American Heart Association, American Safety and Health Institute, American Red Cross, and the National Safety Council basic CPR courses Need to renew ever two years LEGAL CONSIDERATIONS Good Samaritan laws protect you if: - Avoid recklessness and negligence. Act prudently. Act within the scope of your training. Don’t stop until a trained professional relieves you, never allow for a degradation in level of care Do not accept anything in return for services. If you are at work and if it is expected in your normal work duties to provide first aid to your level of training you and your employer will not necessarily be protected from liability Standard Precautions (aka Universal Precautions or Body Substance Isolation) ALL blood and other body fluids should be considered potentially infections. One of the biggest transmission risk is Hepatitis, very hardy virus that can live in a drop of blood for > 16 hrs Take precautions to protect yourself: Use latex gloves, eyewear, & rescue breathing mask/device, when assisting ANYONENO EXCEPTIONS Sequence of Survival (S.O.S.) 1. 2. 3. 4. 5. 6. Recognition of an emergency Rapid activation of EMS (911) Citizen responder provides life-sustaining care (CPR). Automated External Defibrillation (AED) EMS arrives and transports Hospital care (ALS/ACLS) Heart Attack [aka myocardial infarction (MI)] 1st Aid Signs and Symptoms Chest discomfort/severe chest pain & light headedness, fainting, sweating, nausea/vomiting, difficulty breathing. Pressure or pain in chest that lasts more than a few minutes. Pain may spread to shoulders, neck, back, jaw or arms. Pale or ashen skin. Unconscious Access ABC’s CPR if needed Alert EMS Defibrillation if needed and trained Transport to Hospital Conscious Oxygen Place position of comfort (POC) Comfort patient Help with medication Transport to Hospital Stroke Symptoms Sudden numbness of face, arm or leg, especially on one side of the body. Sudden dizziness or lack of balance Sudden confusion, trouble speaking, or slurred speech Sudden loss of vision, usually in one eye Loss of consciousness. A sudden and intense headache (worst one ever!) 1st Aid Unconscious Access ABC’s Alert EMS Transport to Hospital Conscious Maintain Airway Alert EMS Place patient on affected side Comfort patient Oxygen Give nothing by Mouth What is CPR? CardioPulmonary Resuscitation. Used when a patient is not breathing and has no pulse. Usually, not enough alone to save a patient. Important step while waiting for EMS to arrive. Buys patient time, 4-7 mins. before irreversible brain damage occurs. Basic Life Support (BLS) Assess> Alert > Attend 1. Assess • • Assess scene for safety Assess patient for life-threatening conditions Alert 2. • Alert EMS – If alone, give 2 mins of CPR than call 911. Attend 3. • Attend to patient and provided necessary care. Positioning the Patient To properly assess and provide care, patient should be lying on back (if conscious and verbal position of comfort may be appropriate) Only move patient to provide necessary care or avoid imminent danger Patient should be moved if: Unconscious and lying face down Patient is breathing but unconscious If you have to leave an unconscious breathing victim unattended Vomiting patient Imminent danger Log Roll/Recovery position If alone: 1. Kneel down at waistline of patient. 2. Attempt to roll the patient as a single unit. 3. Grasp the patient’s opposite shoulder and hip and roll the patient towards you. As soon as movement begins, remove your hand from the patients shoulder and support his head and neck until the patient is flat on back If you have assistance: One person should stabilize head and neck as the other responder rolls the patients’ body. Recovery Position (for breathing victim) For use with a breathing patient with no suspected spinal injury 1. Kneel at the patient’s waist. 2. Place the arm of the patient that is closest to you up and out. 3. Bend the leg of the patient that is opposite you upward. 4. Grasp the patient’s hip and shoulders and roll them toward you, resting the patient’s head on the extended arm. The patient’s bent leg should help keep the patient from rolling over. HAINES – High Arm IN Endangered Spine position Use this position WHENEVER you come upon an injured person Preferable to traditional recovery position because there is less head and neck movement ASSESS> Check for Responsiveness: Shake or tap victim’s shoulder, ask loudly “Are you OK?” No response (unconscious) Responsive (Conscious) Call 911, if alone Introduction/request for ALERT> assist for 2 mins consent then call 911 ATTEND> Assess adequateness of Open Airway Check for Breathing for 6 – 10 secs 2 breaths if needed so chest visible rises DO NOT check for Circulation/pulse go straight to CPR or rescue breathing if needed If additional help is available: Control bleeding(?) Care for shock(?) breathing (Adult 12-20 bpm or ~ 1 breath 3 secs) Control bleeding Complete head to toe exam Check vitals Care for shock Administer O2 if available ASSESS>ALERT>ATTEND Assess>Alert>Attend The ABC’s of BLS A = Airway Is Airway open? B = Breathing Check for breathing for 6-10 seconds. C = Compressions GO STRAIGHT TO COMPRESSIONS Open Airway Head tilt-chin lift: Place one hand on patients forehead and place fingers of other hand on patients chin. Tilt head back and lift chin up. Assess Breathing Place side of face over victims mouth, facing down body and… LOOK and patients chest for movement LISTEN for sounds of breathing FEEL for air on your cheek Do this for up to 10 seconds ***If there is any doubt about the rate and quality of the patients breathing, give rescue breaths 1 every 5 secs for adults NO BREATH Start Rescue Breathing Maintain open airway Place mouth to mask barrier on person’s face Provide 2 slow breaths of 1.5-2 seconds Look for chest to rise and fall NO breathing Start CPR 1. 2. 3. 4. 5. 6. 7. 8. After 2 breaths if no breathing detected Find lower half of breastbone/sternum and place heel of hand there (between nipple line). Place other hand on top of first. Interlock fingers of both hands and position self directly above the patient’s chest. With arms straight and elbows locked, press down on the breast bone and deliver 30 compressions, depressing the sternum 1.5-2 inches. Count 1 and 2 and 3 and 4 and 5 and 6 and 7 and 8 and 9 and (then drop and) 10, 11, 12, 13, 14, 15. After 15 compressions, tilt head, lift chin, and deliver 2 slow breaths. Continue CPR in ratio of 30:2 until the patient shows obvious signs of circulation, you are relieved by another rescuer, EMS arrives, you are too exhausted to continue, or a physician instructs you to stop. After 4 cycles of CPR, rescuer should re-assess victim for signs of circulation. SPEED IS THE KEY 100 X MIN!!! Location of Sternum Place heel of hand here X Rescue Breathing Patient is NOT breathing, but DOES have a pulse. For adults, 1 breath/5 seconds For Child (Age 1-8) 1 every 3 secs For Infant (Age< 1) 1 every 3 secs Watch for patient’s chest to rise gently and fall Foreign Body Airway Obstruction (Choking) Partial Airway Obstruction Person is still conscious and can breath Encourage person to cough forcefully A good cough maybe life saving, especially if you are alone and choking. Foreign Body Airway Obstruction (Choking) Complete Airway Obstruction Victim cannot breath and thus cannot cough If Conscious: 1. Look for choking signal (hands on throat) 2. Introduce self and ask for consent 3. Administer abdominal thrusts • • • Stand behind patient and wrap arms around patient’s waist. Make a fist with one hand, place it 2 fingers above the naval with thumb towards naval. Place other hand on fist and perform quick inward and upward thrusts until foreign body is expelled or the patient becomes unconscious. Foreign Body Airway Obstruction (Choking) For Unconscious Victim: Assess>Alert>Attend A = Airway B = Breathing Step 1 Using tongue-jaw lift, look in mouth Perform finger sweep to remove object, avoid blind sweeps Step 2 Attempt to ventilate patient. If unsuccessful, reopen airway and try again. Step 3 Perform Chest Compressions (30 compressions) Repeat steps 1, 2 and 3 until airway clear of EMS takes over If object is removed, clear mouth, give two ventilations that produce visible chest rise C = Compressions BLS Flow Chart Assess Victim “Are you Okay?” Assess Alert Attend Conscious • Introduce Self • Ask consent Choking • Encourage to cough Victim goes unconscious • Access breathing •Attempt rescue breaths *** ALL breaths should be accompanied by Emergency O2 if available. ACTIVATE EMS/CALL 911 Unconscious • A = Airway • B = Breathing If Breathing: • recovery position • O2&1st Aid as needed •Secondary assessment If breaths don’t work: • re-tilt head • finger sweep • chest compressions If Pulse • give rescue breaths • 1/5 sec If Not Breathing: • give 2 breaths If breaths work • check for pulse No Pulse • CPR @ 30/2 Sudden Cardiac Arrest • Claims more than 350,000 lives a year, according to the American Heart Association and can happen to anyone • Second most frequent cause of death in dive accidents after drowning, according to DAN • CARDIOVASCULAR DISEASE IS THE MOST COMMON HEALTH PROBLEM/CONCERN IN DIVE FATALITIES What's Happening? • Heart pumps oxygenated blood throughout the body • Most common cause of Sudden Cardiac Arrest is ventricular fibrillation (VF) VF – a breakup of the heart rhythm that keeps blood flowing. What do you do if you think someone is having a heart attack? •Sit or lay them down in a position of comfort •CALL 911 •Administer O2 if available •Calm and reassure victim •Gather all available basic life support equipment and ready it for use