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