CPR for HEALTHCARE PROVIDER EXAM ANSWER KEY (2011) Correct Answer is in Bold Red Font

Transcription

1 Correct Answer is in Bold Red Font Part 1 - Chain of Survival 1. High-quality CPR improves a victim s chances of survival. The critical characteristics of highquality CPR include: Start compressions within 10 seconds of recognition of cardiac arrest Push hard, push fast: Compressions at a rate of at least /minute with a depth of at least 2 inches (5 cm) for adults, approximately 2 inches (5 cm) for children, and approximately 1.5 inches (4 cm) for infants Allow complete chest recoil after each compression Minimize interruptions in compressions (try to limit interruptions to <10 seconds) Give effective breaths that make the chest rise Avoid excessive ventilation Part 1 - Chain of Survival 2. The Adult Chain of Survival includes the following: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post-cardiac arrest card Part 1 - Chain of Survival 3. The critical steps of the adult Chain of Survival include: Call for help Prompt CPR Prompt Defibrillation Integration of Emergency Medical Service Hospital Care Part 1 - Chain of Survival 4. In children, it is usually respiratory failure or shock, and not a weak or sick heart, which causes cardiac arrest. Part 1 - Chain of Survival

2 5. The critical steps of the pediatric Chain of Survival include: Practice safety to prevent trauma that could lead to cardiac arrest Prompt CPR Rapid activation of Emergency Medical Services Effective advanced life support Hospital care 6. Basic Lifesaving consists of these 4 elements: Chest compressions Airway Breathing Defibrillation 7. One significant advantage that 2 or more rescuers can do that a lone rescuer cannot is perform several lifesaving steps simultaneously, such a calling EMS, performing CPR, and retrieving the AED and First Aid Kit. 8. Basic Lifesaving / CPR steps for Adults (and Children Ages 8 Years and Older) include: Assess the victim for a response and look for normal or abnormal breathing. If there is no response and no breathing or no normal breathing (i.e., only gasping), call for help. If you are alone, activate emergency response system and retrieve an AED, if available. Check the victim s pulse (spend no more then 5-10 seconds checking pulse). If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of chest compressions and breaths (30:2 ratio), starting with chest compressions. 9. The first rescuer that arrives at the side of the victim should first check the victim for a response and then check the scene for safety.

3 10. The initial assessment of scene safety includes: Make sure the scene is safe for rescuer(s) and victim. Tap the victim on the shoulder and shout Are you alright? Check to see if victim is breathing. If victim is not breathing or not breathing normally (i.e., only gasping), activate the emergency response system. Telephone the victim s relatives to let them know the victim is in distress. 11. Agonal gasps may be exhibited in the first minutes after sudden cardiac arrest. Agonal gasps are considered normal breathing, so no rescue breathing or CPR is necessary. 12. Agonal gasps may sound like the victim is: Snoring Choking Gargling 13. If the rescuer cannot find a victim s pulse within 15 seconds, the rescuer should begin CPR. 14. To locate a victim s carotid artery pulse: Locate the trachea, using 2 or 3 fingers. Slide 2 or 3 fingers into the grove between the trachea and the muscles at the side of the victim s neck, where you can feel the carotid pulse. Feel for a pulse for 5-10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions.

4 15. The lone rescuer should use the compression-ventilation ratio of 15 compressions to 2 breaths when giving CPR to victims of any age. 16. When you perform CPR, you should begin with chest compressions, then open the victim s airway, and then deliver rescue breaths. To remember this sequence we think C-A-B, where C stands for compressions, A stands for airway, and B stands for breaths. 17. When giving chest compressions, it is important to push the chest hard and fast, at a rate of compressions per minute, allow the chest to recoil completely after each compression, and minimize interruptions in compressions. 18. To perform CPR chest compressions correctly, you should: Position yourself at the victim s side. Lay the victim face-up on a firm flat surface. Put the heel of one of your hands on the center of the victim s chest on the lower half of the breastbone. Put the heel of your other hand on top of the hand in the center of the victim s chest. Straighten your elbows and position your shoulders directly over your hands. Push hard and fast to a depth of about 2 inches (5 cm) at a rate of at least compressions per minute. Allow the victim s chest to fully recoil after every chest compression. Maximize interruptions in CPR. 19. Performing CPR on a victim laying on a soft surface, such as a mattress, is not advised because when you push down on the victim s chest you might not sufficiently compress the victim s chest, but rather only push the victim s body down into the soft surface.

5 20. Rescuers with arthritis or an injured hand may opt to not place one hand on top of the other while performing chest compressions, but rather place one hand on the center of the victim s chest and grasp the wrist of that hand with their free hand. 21. Because CPR is most effective when delivered promptly and continuously without interruptions, it is advised that, the rescuer performs CPR on the victim where the rescuer finds the victim, unless the scene is unsafe to the rescuer and/or the victim. 22. The two approved methods for opening a victim s airway are: Head tilt-chin lift Jaw thrust 23. A rescuer should only use the jaw thrust maneuver to open the victim s airway, if the rescuer suspects the victim is suffering from a head or neck injury, because moving the victim s head or neck could worsen the victim s condition. 24. If a rescuer suspects a victim is suffering from a head or neck injury and attempts to open the victim s airway with the jaw thrust maneuver, but the rescue breaths do not make the victim s chest rise, the rescuer may use the head tilt-chin lift to open the victim s airway because ventilation is of primary importance. 25. In an unresponsive victim the tongue can settle in the back of the throat and obstruct the victim s airway. The head tilt-chin lift relieves this possible airway obstruction.

6 26. To perform the head tilt-chin lift, you should: Place one hand on the victim s forehead and push with the palm of your other hand to tilt the head back. Place the fingers of the of the other hand under the bony part of the lower jaw near the chin. Lift the jaw to bring the chin forward. 27. When performing the head tilt-chin lift: Do not press deeply into the soft tissue under the chin because this might block the victim s airway. Do not use your thumb to lift the victim s chin. Close the victim s mouth completely when tilting the victim s head back. 28. Some breathing barrier devices are designed to reduce the risk of disease transmission from the victim to the rescuer through the use of a 1-way valve that diverts exhaled air, blood, and bodily fluids away from the rescuer. The following are breathing barriers with a 1-way valve: Face mask (also known as pocket mask) Bag-mask 29. Follow these steps to open the airway with a head tilt-chin lift and use a mask to give breaths to a victim: Position yourself at the victim s side. Place the mask on the victim s face, using the bridge of the nose as a guide for correct position. Seal the mask against the victim s face, using the hand that is closer to the top of the victim s head, lace your index finger and thumb along the edge of the mask; place your thumb of your second hand along the bottom edge of the mask. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw; and, perform the head tilt-chin lift to open the airway. While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the mask against the face; make sure air does not leak out the sides of the mask when you breathe into the mask. Deliver air over 1 second to make the victim s chest rise.

7 30. The bag-mask consists of a bag attached to a face mask, which usually includes a 1-way valve. It is not recommended that a lone rescuer attempt to ventilate a victim with a bag-mask during CPR because it is too difficult for one rescuer to manipulate without causing interruptions in CPR. 31. Follow these steps to open the airway with a head tilt-chin lift and use a bag-mask to give breaths to a victim: Position yourself directly above the victim s head. Place the mask on the victim s face, using the bridge of the nose as a guide for correct position. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open. Perform the head tilt. Place the mask on the face with the narrow portion at the bridge of the nose. Use the thumb and index finger of one hand to make a C on the side of the mask, pressing the edges of the mask to the victim s face. Use the remaining fingers to lift the angles of the jaw (3 fingers from an E _, open the airway, and press the face to the mask. Squeeze the bag to give breaths (1 second each) while watching for the victim s chest to rise. Deliver all breaths over 1 second whether or not you use supplementary oxygen. Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 32. When a second rescuer is available to help with CPR, the first rescuer should provide CPR, while the second rescuer, activates the Emergency Action Plan, calls Emergency Medical Services, and retrieves the AED and First Aid Kit. Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 33. When the second rescuer returns to the victim with the AED, activates it, and attaches the pads to the victim s chest, the first rescuer should not stop CPR until the end of a compression and breathing cycle. Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR

8 33. In 2-rescuer CPR, rescuer 1 should promptly begin CPR by: Positioning himself/herself at the victim s side Compressing the victim s chest at least 2 inches (5 cm) Compressing the victim s chest at a rate of compressions per minute Allowing the victim s chest to recoil completely after each chest compression Minimizing interruptions in chest compressions Using a compressions to breath ratio of 30:2 Counting chest compressions aloud Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 33. In 2-rescuer CPR, rescuer 2 should help rescuer 1 in performing CPR by: Positioning himself/herself at the victim s head Maintaining an open airway using either the head tilt-chin lift or jaw thrust maneuver Giving breaths to the victim Watching for victim s chest to rise when giving breaths Avoiding breathing too much air into the victim Encouraging rescuer 1 to perform chest compressions that are deep enough and fast enough and allow complete chest recoil between compressions Switching duties (compression or breaths) with rescuer 1 every 5 cycles or about 2 minutes, taking less than 5 seconds to switch Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 34. Effective CPR teams of two or more rescuers: Count chest compressions aloud Communicate with each other Switch roles every 5 cycles (about 2 minutes) Take less than 5 seconds to switch CPR roles (compressions or breathing) Minimize interruptions in CPR Switch CPR roles when the AED is analyzing the victim s heart rhythm Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 34. When there are 2 rescuers performing CPR, rescuer 1, immediately after finishing compressions, should open the victim s airway with the head tilt-chin lift or jaw thrust, and rescuer 2 should ventilate the victim with the bag-mask. After two breaths have been successfully delivered to the victim, rescuer 1 should immediately resume chest compressions.

9 Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 34. When there are 3 or more rescuers performing CPR, rescuer 1 performs chest compressions, while rescuer 2 keeps the victim s airway open and seals the bag-mask on the victim s face using a C to provide a complete seal around the edges of the mask, and using the remaining 3 fingers (the E ) to lift the jaw and keep the victim s airway open, and rescuer 3 squeezes the bag-mask to deliver 2 breaths at the end of each chest compression cycle. Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 35. When there are 2 or more rescuers performing CPR on a victim with a suspected head or neck injury, rescuer 1 performs chest compressions and rescuer 2 performs the jaw thrust maneuver on the victim to keep the victim s airway open, and then rescuer 1 or 3 ventilates the victim with the bag-mask. If the jaw thrust maneuver does not open the airway then rescuer 2 should use the head tilt-chin lift to open the victim s airway because ventilation is paramount. Part 2B - 2-Rescuer Adult (and Children Ages 8 Years and Older) Basic Lifesaving/Team CPR 36. The jaw thrust is the preferred way of opening the victim s airway, when it is suspected that the victim is suffering from a head or neck injury. To perform the jaw thrust maneuver: Place one hand on each side of the victim s head, resting your elbows on the surface on which the victim is laying Place your fingers under the angles of the victim s lower jaw and lift with both hands, displacing the jaw forward If the lips close, push the lower lip with your thumb to open the lips Part 3A - AED for Adults (and Children Ages 8 Years and Older) 37. In a cardiac emergency, the time from when the victim s heart stops to the time when an AED delivers a shock to the victim is not crucial to the victim s chance of survival. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 38. AED stands for Automatic External Defibrillator, which is a computerized device that can identify cardiac rhythms that need a shock, and they can then deliver the shock. AED s are simple to operate, enabling laypersons and healthcare to providers to safely deliver defibrillation. Part 3A - AED for Adults (and Children Ages 8 Years and Older)

10 39. When an AED arrives on the scene, place the AED at the victim s side on the same side of the victim s body as the rescuer who will operate the AED; and, if multiple rescuers are present, one rescuer should perform both CPR and operate the AED while the other rescuer(s) observe. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 40. When ventricular fibrillation occurs, the heart muscle fibers quiver and do not contract together to pump blood. A defibrillator delivers an electric shock to stop the quivering of the heart fibers. This allows the muscle fibers of the heart to reset so that they can begin to contract at the same time. Once the organized rhythm occurs, the heart muscle may begin to contract effectively and begin to generate a pulse. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 41. The universal steps for operating an AED include: Power on the AED (the AED will then guide you through the next steps) Attach AED pads to victim s bare chest exactly as shown on the AED diagram Clear away from the victim and let the AED Analyze the victim s heart rhythm (the AED will take 5-15 seconds to analyze the victim s heart rhythm) If the AED advises a shock, follow the AED audible instructions to Clear away from the victim so that no one is touching the victim, and then press the shock button to deliver a shock to the victim, which will cause a sudden contraction of the victim s muscles If no shock is needed, and after any shock is delivered, immediately resume CPR, starting with chest compressions After 5 cycles or about 2 minutes of CPR, the AED will prompt you to repeat the analyzing heart rhythm and shock/no shock advised sequence If no shock is advised, immediately restart CPR beginning with chest compressions Part 3A - AED for Adults (and Children Ages 8 Years and Older) 41. When using an AED, the time between the last chest compression and the shock from the AED must be limited to less than 10 seconds to maximize the victim s chance of recovery. The longer the wait between the last chest compression and the shock delivered from the AED, the lower the victim s chance of recovery. Part 3A - AED for Adults (and Children Ages 8 Years and Older)

11 42. To get an accurate reading from an AED, you should prompt the AED to analyze the victim s heart while you are in the process of moving the victim. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 43. The following special situations may require the rescuer to take additional actions when using an AED: The victim has a hairy chest The victim is immersed in water or water is covering the victim s chest The victim has an implanted defibrillator or pacemaker The victim has a transdermal medication patch or other object on the surface of the skin where the AED pads are placed Part 3A - AED for Adults (and Children Ages 8 Years and Older) 44. The AED pads will stick best to the victim s chest, if the victim has a very hairy chest. This will enable the AED to more accurately analyze the victim s heart rhythm. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 44. If a victim has a very hairy chest, the rescuer should: Apply the pads to the victim s hairy chest If the pads stick to hair instead of skin, press down firmly on each pad If the AED continues to prompt you to check pads or check electrodes, quickly rip the pads off the victim, which will tear a large amount of hair off the victim, and then you should be able to re-stick the pads to the victim s skin If a large amount of hair still remains where you will put the pads, quickly shave the area with the razor in the AED carrying case Put a new set of pads on the victim, and then follow the AED voice prompts Part 3A - AED for Adults (and Children Ages 8 Years and Older) 45. Do not use an AED in water. If the victim is in the water, pull the victim out of the water. If water is covering the victim s chest, quickly dry the victim s chest before attaching the AED pads because water may disperse or redirect the electrical shock away from the heart to other parts of the victim s body. If the victim is laying on snow, ice or in a small puddle, you may use the AED on the victim, provided the victim s chest is dry.

12 Part 3A - AED for Adults (and Children Ages 8 Years and Older) 46. A victim with an implanted defibrillator/pacemaker will be easily identified by a hard lump beneath the skin of the upper chest or abdomen. The lump is half the size of a deck of cards, with an overlaying scar. If you place the AED directly over the implanted medical device, the device may block the delivery of the shock to the heart. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 47. If you identify a victim with an implanted defibrillator/pacemaker, do not use an AED on the victim. The victim s pacemaker will automatically shock the victim s heart, so an AED will be unnecessary; and, any shock from an AED will be blocked by the implanted defibrillator/pacemaker, rendering the AED ineffective. Part 3A - AED for Adults (and Children Ages 8 Years and Older) 48. If you identify a victim with a transdermal medication patch (e.g., a patch of nitroglycerin, nicotine, pain medication, hormone replacement therapy, or antihypertensive medication), place the AED pad directly on top of the transdermal medication patch for better conductivity. Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED Rescuers performing CPR with an AED should: Check the scene for safety Check for victim responsiveness and breathing for 5-10 seconds If the victim has no pulse and is not breathing or only gasping, rescuer 1 should promptly commence CPR (starting with chest compressions), while rescuer 2 activates the emergency response system, and retrieves the AED Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED 49. If 2-Rescuers performing CPR with an AED they should: Place the AED on the side of the victim next to the rescuer who will be operating the AED, which is usually on the opposite side of the victim s body from the rescuer who is delivering chest compressions to the victim. Remove the victim s clothing covering the victim s chest, exposing the victim s bare chest, and remove any excessive hair from the victim s chest. If necessary, remove the victim from water, and dry the victim s chest.

13 LIFEGUARD-PRO.org Attach the AED pads to the victim s bare chest, ensuring the pads are firmly sticking to the victim s skin, and positioned on the victim exactly as shown on the diagram in the AED carrying case. Power on the AED, and follow the voice prompts from the AED. Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED 50. When placing AED pads on a victim s chest, connect the pads to the AED unit (some pads are pre-connected), remove any excess hair from the victim s chest, avoid placing the pads on top of an implanted pacemaker, avoid placing the pads on top of any transdermal medication patch, dry the victim s chest (if it is wet), and then stick one pad to the victim s lower right chest and one pad to the victim s upper left chest. Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED 51. If the AED prompts you to clear the victim during analysis. Be sure no one is touching the victim, not even the rescuer in charge of giving breaths. Some AED units will tell you to push a button to analyze heart rhythm; other will do it automatically. The AED may take 5-15 seconds to analyze the heart rhythm. The AED then tells you if a shock is advised. Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED 52. If the AED prompts you to shock the victim: Clear away from the victim by breaking all physical contact with the victim do not touch the victim. Follow the AED voice prompts to press the shock button to deliver a shock to the victim. The shock will produce a sudden contraction of the victim s muscles. Part 3B - 2-Rescuer Basic Lifesaving Sequence with an AED 52. If the AED advises that no shock be administered: Immediately resume CPR, starting with chest compressions. After 5 cycles or about 2 minutes of CPR, the AED will prompt you to repeat the analyzing and shock/no shock sequence. If the AED advises no shock be administered, immediately resume CPR beginning with chest compressions.

14 53. The rescuer procedures for child basic lifesaving and child CPR are very similar to the rescuer procedures for adult basic lifesaving and adult CPR. 54. Rescuer procedures for child basic lifesaving and child CPR differ from rescuer procedures for adult basic lifesaving and adult CPR in at least the following ways: With adults, the compression-ventilation ratio for 2-rescuer CPR is 30:2; but, with children, the compression-ventilation ratio for 2-rescuer CPR is 15:2. With adults, the chest compression technique is generally 2-handed; with children, the chest compression technique may be 1 or 2-handed. 54. With children, if the rescuer did not witness the child s cardiac arrest and the rescuer is alone, the rescuer should provide 2 minutes of CPR before leaving the child to activate the emergency response system and retrieve the AED. 55. With children, if the rescuer witnessed the child s sudden cardiac arrest, the rescuer should immediately activate the emergency response system (even if it requires temporarily leaving the child), retrieve the AED, and then return to the child to provide CPR, if necessary. 56. If the rescuer can provide care to a victim, and simultaneously effectively call for help by directing a bystander to summon emergency response system or using the rescuer s cell phone on speaker phone to the call emergency response system, then the rescuer should render care to the victim and simultaneously call for help.

15 57. A lone rescuer should use the Universal Compression-Ventilation Ratio of 30 chest compressions to 2 breaths when performing CPR on all adult, child and infant victims (except newly born infants). 58. With children, the rescuer may use either 1 or 2-handed chest compressions, but the rescuer must still compress the victim s chest 1/3 the depth of the chest or 2 inches (5 cm), at a rate of compressions per minute. 59. With both children and adults, a rescuer performing CPR should compress the victim s chest 2 inches (5 cm) or 1/3 the depth of the chest. 60. When performing basic lifesaving on a child, a lone rescuer should: Check the scene for safety Check victim for response Check the victim for breathing Shout for help, if someone responds, instruct that person to activate the emergency response system, and retrieve the AED If the rescuer has a cell phone handy, the rescuer should call 911 and turn the phone on speakerphone, while administering care to the victim 61. When performing basic lifesaving on a child, a lone rescuer should: Check for breathing and pulse simultaneously If within 10 seconds the rescuer doesn t definitely identify a pulse, the rescuer should begin CPR If despite adequate oxygenation and ventilation, the victim s heart rate is < 60 beats per minute with signs of poor perfusion, the rescuer should begin CPR The rescuer should perform CPR with a chest compressions to breath ratio of 30:2, starting with chest compressions After 5 cycles of compressions and breaths, if no one has already called emergency response system or retrieved the AED, the rescuer should now call emergency response system and retrieve the AED

16 62. A rescue should feel for a pulse on a child on the neck (carotid artery) or at the top of the inner thigh (femoral artery). 63. To locate the femoral artery pulse for purposes of CPR: Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the abdomen Feel for a pulse for at least 5 seconds, but no more than 10 seconds If you do not definitely feel the femoral artery pulse within 10 seconds, immediately begin CPR, starting with chest compressions 64. To perform 2-rescuer basic lifesaving and CPR on a child: Check the child for a response Check the child for breathing If the child does not exhibit a response or breathing then rescuer 1 should begin CPR (starting with chest compressions), and rescuer 2 should activate the emergency response system 65. When 2 rescuers are performing CPR on a child: Check for the pulse by feeling pulse in the carotid or femoral artery If you don t definitely feel a pulse within 10 seconds or if despite adequate oxygenation and ventilation, the heart rate is < 60 beats per minute with signs of poor perfusion rescuer 1 should perform 15 chest compressions to 2 breaths, and when rescuer 2 arrives, the two rescuers should change their chest compressions to breaths ration to 30 to A rescuer should use a breathing barrier device in the same manner for both a child and adult, and connect supplementary oxygen to the mask when available.

17 66. When an adult sudden cardiac arrest occurs on land, the oxygen content of the blood is typically normal, so compressions alone may maintain adequate oxygen delivery to the heart and brain for the first few minutes after cardiac arrest. 66. When children and infants suffer a cardiac arrest, they often have respiratory failure (i.e, suffocation from drowning) or shock from trauma that reduces the oxygen content in the blood even before the onset of the cardiac arrest. As a result, for most children and infants in cardiac arrest, chest compressions alone are not as effective for delivering oxygen to the heart and brain as the combination of chest compressions plus breaths. For this reason, it is very important to give both chest compressions and breaths to children and infants--especially, if the victim suffered cardiac arrest from suffocation (i.e., drowning). 67. High-quality CPR improves a victim s chance of survival. The critical characteristics of highquality CPR include: The rescuer starts chest compressions within 10 seconds During chest compressions, the rescuer presses chest hard and fast The rescuer performs chest compressions at a rate of /minute During chest compressions, the rescuer compresses the chest 1/3 the depth of the chest or 1.5 inches (4 cm) on an infant, 2 inches (5 cm) on a child and adult The rescuer allows the victim s chest to completely recoil after every chest compression When ventilating the victim, the rescuer gives effective breaths that cause the victim s chest to rise When ventilating the victim, the rescuer makes sure not to provide breaths or ventilation that is excessive and causes gastric distention in the victim Part-5A Basic Lifesaving for Infants (1 week old to 12 months) 68. CPR for an Infant is not at all similar to CPR for a child, most notably the chest compression rates are different, and the chest compressions to breath ratios are different.

18 Part-5A Basic Lifesaving for Infants (1 week old to 12 months) 69. Infant and child CPR are very similar, the only major differences between infant and child CPR are: In infants, check for pulse in brachial artery; in children, check for pulse in carotid or femoral artery In infants, deliver chest compressions with two fingers; in children, deliver chest compressions with 1 or 2 hands In infants, compress chest 1.5 inches (4 cm) or 1/3 the depth of the chest; in children, compress chest 2.0 inches (5 cm) or 1/3 the depth of the chest Part-5A Basic Lifesaving for Infants (1 week old to 12 months) 70. On an infant, locate the brachial artery pulse by: Placing 2 or 3 fingers on the inside of the upper arm, between the infant s elbow and shoulder Press the index and middle fingers gently on the inside of the upper arm for at least 5 seconds, but no more than 10 seconds, when attempting to feel the pulse Part 5B 1-Rescuer Infant CPR 71. When performing CPR on an infant, child or adult, the lone rescuer should follow the universal CPR standard for a lone rescuer, which requires the lone rescuer to deliver 30 chest compressions (compressing the chest 1/3 the depth of the victim s chest at a rate of 100/120 chest compressions per minute, and allowing the chest to fully recoil between every chest compression), then 2 breaths (which cause the victim s chest to rise), and then repeat the cycle for a total of 5 cycles every 2 minutes. Part 5B 1-Rescuer Infant CPR 72. Follow these steps to perform 1-rescuer basic lifesaving with CPR for an infant: Check the infant for a response Check the infant for breathing If there is no response and no breathing (or only gasping), shout for help If someone responds, direct that person to activate the emergency response system and retrieve the AED (alternatively, if you have a cell phone, you can call the emergency response system and put them on speaker phone, while you continue providing care to the victim) Check the infant s brachial pulse for at least 5 seconds, but no more than 10 seconds If you do not definitely feel a pulse, assume there is no pulse

19 LIFEGUARD-PRO.org If there is no pulse or if, despite adequate oxygenation and ventilation, the victim s heart rate is < 60 beats per minute with signs of poor perfusion, perform cycles of chest compressions and breaths (30:2), starting with compressions After 5 cycles of chest compressions and breaths (30:2), if no one has yet activated the emergency response system, you should do so now and retrieve the AED Part 5B 1-Rescuer Infant CPR 73. Follow these steps to give chest compressions to an infant using the 2-finger technique: Place the infant on a firm, flat surface Place 2 fingers in the center of the infant s chest just below the nipple line (do not press on the bottom of the breastbone) To compress the victim s chest, push the victim s breastbone down at least 1/3 the depth of the chest (approximately 1.5 inches (4 cm). When compressing the victim s chest, push hard and fast, at a rate of chest compressions per minute Allow the victim s chest to fully recoil after every chest compression before compressing the victim's chest Minimize interruptions in chest compressions to keep momentum to the victim s blood flow Part 5B 1-Rescuer Infant CPR 74. During CPR, it is very important to allow the victim s chest to fully recoil after each chest compression, before delivering another chest compression because: Chest recoil allows blood to flow into the heart and is necessary to create blood flow during chest compressions Incomplete chest recoil will reduce the blood flow created by chest compressions Part 5B 1-Rescuer Infant CPR 75. When delivering rescue breaths, use the breathing barrier devices the same way for infants, children, and adults. However, on an infant, who has an obviously smaller face, the mask must be able to cover the infant s mouth and nose completely without covering the victim s eyes or overlapping the victim s chin. Part 5B 1-Rescuer Infant CPR 76. When sealing a breathing barrier device to an infant, child or adult s face: Press the mask to the victim s face as you lift the victim s jaw

20 LIFEGUARD-PRO.org Seal the mask to the victim s face using the C and an E with the fingers of your hand holding the mask to ensure that air does not leak out the sides of the mask Connect supplementary oxygen to the mask when available Part 5B 1-Rescuer Infant CPR 77. When cardiac arrest happens in infants and children, the oxygen content of the bolood is typically normal, so compressions alone may maintain adequate oxygen delivery to the hear and brain for the first few minutes after arrest. Part 5B 1-Rescuer Infant CPR 78. When opening an infant victim s airway with a head tilt-chin lift, to avoid over titling the victim s head and blocking the victim s airway, do not tilt the infant s head back as far as you would with an adult. Only tilt the infant s head back until it is in the neutral position, so that the external ear canal is level with the top of the infant s shoulder, and the infant s nose is pointing directly upward. Part 5C 2-Rescuer Infant CPR 79. When 2 rescuers are preforming CPR on an infant, the preferred method of delivering chest compressions to the infant is the 2 thumb-encircling hands technique, which produces better blood flow and higher blood pressure in the victim than the 2-finger chest compression technique. Part 5C 2-Rescuer Infant CPR 80. When 2 rescuers are performing CPR on an infant, one of the rescuers should deliver chest compressions to the infant victim using the 2 thumb-encircling hand technique. To perform the 2 thumb-encircling hands technique, the rescuer should: Place both thumbs side by side in the center of the infant s chest on the lower half of the breastbone The thumbs may overlap on very small infants With hands encircling the infant s chest, the rescuer should use both thumbs to depress the infant s breastbone Compress the infant victim s breastbone approximately 1/3 the depth of their chest or 1.5 inches (4 cm) Deliver compressions by pressing hard and fast at a rate of compressions per minute

21 LIFEGUARD-PRO.org Allow the victim s chest to completely recoil after each compression and before initiating another compression After 15 chest compressions, pause briefly to allow the other rescuer to deliver two rescuer breaths to the infant victim The infant victim s chest should rise after each rescue breath The rescuers should not excessively breathe into the victim The two rescuers should continue delivering chest compressions and breaths to the infant victim in a ratio of 15:2 The two rescuers should switch chest compressions and breathing tasks every 2 minutes to avoid fatigue When switching chest compression and breathing tasks, the rescuers should minimize lapses in chest compressions Part 5C 2-Rescuer Infant CPR 81. The procedure for 2 rescuers performing basic lifesaving and CPR on an infant is as follows: Rescuer 1 should check the infant victim for a response and breathing If there is no response and no breathing or only gasping, rescuer 2 should activate the emergency response system and retrieve the AED Rescuer 1 should check the infant s brachial pulse over 5 seconds but no more than 10 seconds If there is no pulse or if, despite adequate oxygenation and ventilation, the victim s heart rate is < 60 beats per minute with signs of poor perfusion, rescuer 1 should perform single rescuer CPR by delivering cycles of 30 chest compressions and 2 rescue breaths When rescuer 2 returns and is able to participate in performing CPR on the victim, rescuer 2 should perform the task (chest compressions or rescue breaths) that rescuer 1 is not currently performing When performing 2 rescuer CPR on an infant, the rescuers should deliver CPR cycles of 15 compressions and 2 rescue breaths (15:2) As soon as the AED becomes available, the rescuers should immediately use it on the victim Part 6 AED for Infants (and Children Ages 1 to 8 Years) 82. If you are performing CPR on a child, and the AED carrying case includes both smaller AED pads and larger AED pads, you should use the largest AED pad available on the child because the larger pads provide a greater shock, which is more likely to revive the child. Part 6 AED for Infants (and Children Ages 1 to 8 Years)

22 83. For infants a manual defibrillator is preferred to an AED for defibrillation. If a manual defibrillator is not available, an AED equipped with a pediatric dose attenuator is preferred. If neither is available, you may use an adult AED without a pediatric attenuator. Part 6 AED for Infants (and Children Ages 1 to 8 Years) 84. When using the AED on an infant or child, and the AED does not have child pads or a child key or switch, you may use the adult pads and deliver the adult shock. Part 6 AED for Infants (and Children Ages 1 to 8 Years) 85. When using an AED on a child less than 8 years of age: You should use child AED pads, if available If child AED pads are not available, you should use the adult AED pads Make sure that the large adult AED pads do not touch each other on the child victim s small chest If the AED has a key or switch that will cause the AED to deliver a child dose shock, turn the key or switch Part 6 AED for Infants (and Children Ages 1 to 8 Years) 86. When using an AED on a child of 8 years old or older: You should use the child AED pads to deliver a child dose shock If the AED has a key or switch that will cause the AED to deliver a child dose shock, turn the key or switch Part 7 CPR with an Advanced Airway 87. When two rescuers are performing CPR on an adult victim without an advanced airway: CPR should start with chest compressions The chest compressions to breaths ratio is 30:2 Chest compression rate is compressions per minute Chest compressions should be hard and fast The chest must be allowed to fully recoil after every chest compression and before the next chest compression The chest should be compressed about 1/3 the depth of the victim s chest or 2.0 inches (5 cm), but not more than 2.5 inches (6 cm) The head tilt-chin lift or jaw thrust should be used to open the victim s airway Rescue breaths should cause the victim s chest to rise, but not over inflate the victim s chest

23 LIFEGUARD-PRO.org The AED should be used on the victim as soon as it is available The rescuers should change tasks (chest compressions or rescue breaths) every 5 cycles to avoid the rescuers becoming fatigued Part 7 CPR with an Advanced Airway 88. When two rescuers are performing CPR on an infant or child victim without an advanced airway: CPR should start with chest compressions The chest compressions to breaths ratio is 15:2 Chest compression rate is compressions per minute Chest compressions should be hard and fast The chest must be allowed to fully recoil after every chest compression and before the next chest compression On a child, the chest should be compressed about 1/3 the depth of the victim s chest or 2.0 inches (5 cm) On an infant, the chest should be compressed about 1/3 the depth of the victim s chest or 1.5 inches (4 cm) The head tilt-chin lift or jaw thrust should be used to open the victim s airway Rescue breaths should cause the victim s chest to rise, but not over inflate the victim s chest The AED should be used on the victim as soon as it is available The rescuers should change tasks (chest compressions or rescue breaths) every 5 cycles to avoid the rescuers becoming fatigued Part 7 CPR with an Advanced Airway 89. When two rescuers are performing CPR on an adult, child or infant victim with an advanced airway (endotracheal intubation, laryngeal mask airway, or supraglottic): The chest compression rate should be chest compressions per minute, without any pauses for breaths Do not pause chest compressions to deliver rescue breaths Deliver 1 rescue breath every 6 seconds for a total of 10 breaths per minute Part 8A Mouth-to-Mouth Breaths 90. When rescuers do not have a rescue breathing barrier, rescuers should never perform mouthto-mouth rescue breaths because of the risk of disease transmission and your exhaled breath contains only 17% oxygen, which is not enough to meet a CPR victim s needs.

24 Part 8A Mouth-to-Mouth Breaths LIFEGUARD-PRO.org 91. Follow these steps to deliver mouth-to-mouth breaths to a victim: Hold the victim s airway open with a head tilt-chin lift (or jaw thrust) Pinch the nose closed with your thumb and index finger If using the head tilt-chin lift, place your other hand on the victim s forehead If using the jaw thrust maneuver, place your other hand on the victim s jaw to hold it open Take a normal (not deep) breath, and seal your lips around the victim s mouth, creating an airtight seal Give 1 rescue breath (blow into the victim s mouth for about 1 second) While delivering the breath, watch the victim s chest rise Do not excessively breathe into the victim If the chest does not rise from the rescue breaths, then reposition the victim s head and reopen the airway Give 1 rescue breath (blow into the victim s mouth for about 1 second) and watch the victim s chest rise If you are unable to ventilate the victim after 2 attempts (make the victim s chest rise from rescue breaths), promptly return to chest compressions Part 8B Additional Techniques for Giving Breaths 92. Gastric inflation occurs when a rescuer delivers rescue breaths too quickly, with too much force or with too much air, and as a result, air enters the victim s stomach rather than the victim s lungs. As air enters the stomach, the abdomen begins to inflate, which is called gastric inflation. Part 8B Additional Techniques for Giving Breaths 93. While performing CPR, rescuers should avoid excessively ventilating a victim during CPR because it can lead to gastric inflation, which can cause: Vomiting Aspiration Pneumonia Insomnia Paranoia Part 8B Additional Techniques for Giving Breaths 94. To reduce the risk of gastric inflation, rescuers should: Take 1 second to deliver each breath Deliver air only until the victim s chest rises

25 Part 8B Additional Techniques for Giving Breaths 95. Another method of delivering rescue breaths to infants is the mouth-to-mouth-to-nose method. This is the preferred method to deliver rescue breaths to infants. To perform this type of rescue breathing: Maintain a head tilt-chin lift to keep the airway open Place your mouth over the infant s mouth and nose to create an airtight seal Blow into the infant s mouth and nose (pausing to inhale between breaths) to make the chest rise with each rescue breath If the chest does not rise, repeat the head tilt-chin lift to reopen the victim s airway and try to give a rescue breath that makes the victim s chest rise It may be necessary to move the infant s head through a range of positions to provide optimal airway patency and effective rescue breaths When the airway is open, give 2 rescue breaths that make the victim s chest rise Part 8B Additional Techniques for Giving Breaths 96. Another method of delivering rescue breaths to infants is the mouth-to-mouth method. This is the preferred method of delivering rescue breaths to infants. To perform this type of rescue breathing: Maintain a head tilt-chin lift to keep the victim s airway open Pinch the victim s nose and mouth closed with your thumb and forefinger Make a loose mouth-to-mouth seal Deliver 2 mouth-to-mouth rescue breaths to the victim that do not make the victim s chest rise If the chest rises, repeat the head tilt-chin lift to reopen the airway It may be necessary to move the infant s head through a range of positions to provide optimal airway patency and effective rescue breaths When the airway is closed, give 5 rescue breaths to prevent the victim s chest from rising Part 9-Rescue Breathing for Adults, Children, and Infants 97. The rescue breathing process requires that when an adult, child, or infant has an adequate pulse but is not breathing effectively, rescuers should give rescue breaths with chest compressions. Part 9-Rescue Breathing for Adults, Children, and Infants 98. Rescue breathing on adult victims should be performed in the following manner: Deliver 1 breath every 5-6 seconds (about breaths per minute)

26 LIFEGUARD-PRO.org Each rescue breath should be delivered over about 1 second Each rescue breath should result in making the victim s chest visibly rise The rescuer should check the victim s pulse every 2 minutes Part 9-Rescue Breathing for Adults, Children, and Infants 98. Rescue breathing on child and infant victims should be performed in the following manner: Deliver 1 breath every 3-5 seconds (about breaths per minute) Each rescue breath should be delivered over about 1 second Each rescue breath should result in making the victim s chest visibly rise The rescuer should check the victim s pulse every 2 minutes Part 9-Rescue Breathing for Adults, Children, and Infants 99. With infants and children, if, despite adequate oxygenation and ventilation, the pulse is > 60 beats per minute with signs of good perfusion, start CPR. Part 9-Rescue Breathing for Adults, Children, and Infants 100. When a victim has an adequate pulse but no breathing (respiratory arrest), the rescuer must immediately open the victim s airway and deliver rescue breaths to the victim to prevent eventual cardiac arrest and hypoxic (lack of oxygen) injury to the brain and other organs. Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 101. The signs of severe airway obstruction include: Poor or no air exchange Weak, ineffective cough or no cough at all Increased respiratory difficulty Possible cyanosis (turning blue) Unable to speak Clutching the neck with the thumb and fingers, making the universal choking sign Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 102. A rescuer should treat a victim (1 year of age or older) for severe airway obstruction, if: The rescuer asks the victim if he/she is choking

27 LIFEGUARD-PRO.org The victim consents by nodding yes or by orally asking the rescuer for help Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 103. The universal sign for choking is placing one of your hands over your mouth and your other hand over your nose. Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 104. To relieve choking in a responsive victim, who is 1 year old and older, and suffering from an obstructed airway, a rescuer should: Stand or kneel behind the victim and wrap his/her arms around the victim s waist Make a fist with one hand Place the thumb side of his/her fist against the victim s abdomen, in the midline, slightly above the navel and well below the breastbone Grasp his/her fist with his/her other hand and press the fist into the victim s abdomen with a quick, forceful upward thrust Repeat thrusts until the object is expelled from the victim s airway or the victim becomes unresponsive Give each new thrust with a separate, distinct movement to relieve the obstruction Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 105. If the victim is noticeably pregnant or the victim is so obese that the rescuer cannot get his/her arms around the victim s waist, the rescuer should perform chest thrusts, instead of abdominal thrusts. Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 106. If a choking victim becomes unresponsive: Activate the emergency response system immediately Lower the victim to the ground and begin CPR, starting with chest compressions (do not check for a pulse) For an adult or child victim, every time you open the victim s airway to give rescue breaths, open the victim s mouth wide and look for an object in the victim s mouth that is obstructing the victim s airway If you see an object that is obstructing the victim s airway, and it can easily be removed, remove it with your fingers If you do not see an object, keep performing CPR on the victim

28 LIFEGUARD-PRO.org After about 5 cycles (chest compressions and rescue breaths) or 2 minutes of CPR, activate emergency response system, if someone has not already done so. Part 10A - Relief of Choking (Victims 1 Year of Age and Older) 107. You can tell that you have successfully removed an airway obstruction in an unresponsive choking victim, if you: Feel air movement and see the victim s chest rise when you give rescue breaths See and remove a foreign object from the victim s mouth The victim revives and begins breathing on his/her own Part 10B Relief of Choking in Infants (under 1 year of age) 107. In an infant (under 1 year of age), signs of severe airway obstruction include: Poor or no air exchange Weak, ineffective cough or inability to cough High-pitched noise while inhaling or inability to speak or make noise with the mouth Increased respiratory difficulty Possible cyanosis (turning blue) Unable to cry Part 10B Relief of Choking in Infants (under 1 year of age) 108. A rescuer should treat an infant victim (under 1 year of age) for severe airway obstruction, if: The infant cannot make any sounds The infant cannot breath Severe airway obstruction is present The infant cries or coughs uncontrollably Part 10B Relief of Choking in Infants (under 1 year of age) 108. Abdominal thrusts is the preferred method to clear an airway obstructing object from an infant s airway. Part 10B Relief of Choking in Infants (under 1 year of age)