CPR/AED/First Aid Training 2018 4th Quarter In-Service Friday December 21, 2018 Saturday - December 22, 2018 Sunday December 23, 2018 1.0 hrs by Rob Sundquist, MS ATC LAT Director of Sports Medicine/Head Athletic Trainer
Chain of Survival The chain of survival are four steps to help increase the chances of an injured person of surviving a cardiac arrest.
Chain of Survival step one After determining that there is an injury needing advanced care; if unconscious tap and shout. Call 911 Questions you will need to answer: Nature of the emergency? Where are you? How many are hurt? Ages of who is/are hurt Who are you? Has treatment started? Only hang up when instructed to do so by operator.
Chain of Survival step two Begin CPR (Cardiopulmonary resuscitation) Most adult cardiac arrests (CA) victims heart is in ventricular fibrillation (VF) - Abnormal chaotic heart rhythm that prevents the heart from pumping blood. CPR will not usually stop VF but plays an important part in pushing oxygenated blood to the brain and heart and prolonging VF so that an AED (Automated External Defibrillator) will be useful. CPR can double or triple the victims survival rate For every passing minute without CPR; rate of surviving drops 7-10%. With CPR there is only a 3-4% drop each minute
Chain of Survival step three Use an AED The use of the AED (Automated External Defibrillator) will stun the fibrillating heart, if the heart is still viable the normal pacemakers in the heart will begin firing and start a normal rhythm. If used within 5 min; chances of survival is 49-75%.
Chain of Survival step four Advanced Care EMS Response time is 7-8 minutes CPR is extremely important.
How to recognize major emergencies
Heart Attack Myocardial infarction (MI) Coronary heart disease is the leading cause of death in our nation. During MI - part of heart muscle is starting to die. Caused by a blockage of an artery (coronary) due to buildup of cholesterol deposits or a blood clot. Victims are usually awake and can talk but feels severe pain Most critical time is within the first 30 minutes after Signs and Symptoms begin.
Heart Attack Most common symptoms Pain or pressure in the center of the chest which last more than 3-5 minutes. Pain might feel pressure, fullness, squeezing, or heaviness Pain might spread to shoulder, neck, lower jaw and down arm (usually the right). Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again. Other Signs and Symptoms lightheadedness, fainting, sweating without fever, nausea, shortness of breath Most victims will downplay symptoms, you must take action!!! Call 911, get the nearest AED, and have the person rest in a position that is comfortable where they can breathe easily. Put them in an area that you can get them to the floor easily and paramedics can get in.
Cardiac Arrest When the heart stops beating. Usually caused by VF (Ventricular fibrillation), which begins where the heart muscle is injured. Without blood flow and no pulse the person becomes unconscious and stops breathing and collapses. VF and cardiac arrest may be the only symptom of a heart attack. AED is only thing that will stop a VF
Stroke Its is a rapid onset of neurological problems like weakness, paralysis in one or more limbs, difficulty speaking, visual problems, intense dizziness, facial weakness, altered consciousness, and severe headache. Two causes blood vessel to brain is blocked by a blood clot blood vessel to brain breaks #3 cause of death and #1 cause of serious disability among Americans
Most signs overlooked; three major signs to observe facial droop arm weakness most obvious when victim attempts to extend arms with eyes closed one or both may not move very well speech difficulties slurring of words and sentences Call 911 immediately if see signs of stroke Provide CPR if needed Stroke
Foreign body obstruction Usually caused by food, but can be caused by many objects Major signs Universal choking signal poor ineffective coughs inability to speak high pitched sounds while inhaling increased difficulty breathing Blue lips or skin (cyanosis) Loss of consciousness and responsiveness Heimlich maneuver in conscious victim CPR in unconscious victim
CPR - adult
Step one Make sure area is safe Check unresponsiveness tap and shout Are you alright If no response call 911 or send someone directly to call Grab AED if one present or send someone to get one.
If possible place victim supine and on a hard surface. If victim is prone roll over Try protecting the neck as much as possible if you suspect neck injury Step two
Begin CAB s C = Circulation If not breathing or see abnormal breathing begin chest compressions Agonal breathing gasps that occur at the beginning of CA not efficient act as they are not breathing No checking for pulse or signs of circulation just go straight to CPR Place one palm on the chest between the nipple line Interlock your other hand on top of the hand on the chest Bring your shoulder over the top Make sure you have a wide base (knees spread just outside your shoulders) Press down 1 ½ -2 inches at a rate of 100 compressions per minute hard and fast Make sure chest recoils completely Complete 30 compressions and then give two breaths. Do not stop unless and AED is available, victim moves, or you substituted out (if two rescuers are available switch every five cycles of 30:2 approx two minutes) reduces fatigue
A = Airway Head tilt and Chin lift B = Breathing If you do not detect normal breathing give two breaths lasting 1 second each (may use barrier) Watch chest rise, allow exhalation before next breath. If breaths do not go in reposition head and try again. Practice
Practice Practice compressions 30 times twice alternate with partner no breaths 60 sec test just compressions try to get 95-105 compressions allows to learn rhythm. Perform 1-2 times or as needed Two minute test performing 30:2 (includes breath) - should complete five cycles in that time.
During the beginning stages of CA chest compressions are more important than breaths. Oxygen level will stay high for the first few minutes but blood is not moving to due to the heart not pumping. Breathing becomes as important as the length of CPR continues Very important to limit interruptions of chest compressions. Be mindful not to give to many breaths, too much breath or too forceful may cause gastric filling and the resultant complications, and/or cause diminished blood flow and reduce survival.
Vomiting/other breathing If someone does throw up do not panic. Roll victim towards you. Use your body to hold them. Clean out the mouth roll back and continue. Mouth to nose Use when it is impossible to use the mouth due to injury. Face shields and masks may be used - Very little chance of transfer of bodily fluids if perform mouth to mouth without mask. Using shield or mask can slow down the CPR process Chest compression only CPR is more beneficial than no CPR at all.
Recovery position If victim begins breathing and having a pulse then turn victim to their side with lower arm in front. No position is perfect- just make sure they are stable, near a true lateral position, and there is no pressure on the chest to impair breathing
Potential neck injury If two or more responders One stabilizes the neck they will be in charge if victim needs to be moved Place hands on the sides of the head and neck, using your hands to cup around the neck. Place pressure on head with forearms near the ears Elbows should be on the ground, wrists in ulnar deviation so that they come in contact with the head. This will limit the amount of movement that will occur if you have to move your body, for example moving so that CPR can be administered or when EMS puts on a neck brace. If movement is necessary then move body as one.
CPR Child and infant
Child CPR (ages 1-8) Similarities with Adult CPR Location on chest for compressions is the same nipple line Ratio of compressions to breaths the same 30:2 Differences with Adult CPR In the chain of survival you will perform CPR first for two minutes performing five cycles of 30:2 then call 911 (if you are alone) Reason is that most child and infant cardiac arrests are due from asphyxiation, so they will benefit more from the CPR. The depth you use for compression is 1/3 to ½ depth of the chest. Use one or two hands which ever is more comfortable.
Infant CPR Similarities with adult CPR 30:2 ratio of compressions to breaths Similarities with Child Perform CPR first in the Chain of Survival, for the same reasons. If small enough you may carry to phone with you after completing the five cycles use speaker phone Depth of compressions. Differences with CPR You will perform chest compressions one finger below nipple line You will place your mouth over mouth and nose of infant You will only puff air in If unsure if it is a child or not, if it can fit on your arm, then treat as an infant Practice
Foreign Body Airway Obstruction (FBAO) Heimlich Maneuver
Choking Universal sign of choking hand around throat Ask questions Are you choking? Can you speak? May I help you? Very important. If they say no leave them alone until they pass out then it is assumed they want help. If a person can speak or can cough - do not help
Abdominal thrusts Place yourself behind victim scissor you legs Front leg between victims legs Slightly bend knees Place hands on navel place hands on chest if woman is pregnant or victim is severely overweight Pull in and up continue until object is out or they pass out Use chest thrusts if you are unable to circumvent the abdomen If pass out lower them carefully to the floor begin CPR Only difference with CPR is you check mouth for object before breaths. Finger sweep only if you see object. Practice
Infant FBAO Infant Conscious place infant on forearm with babies mouth between fingers back blows to upper back Unconscious after back blows - five compressions look for object give breath repeat cycle back blows, compressions, look and breaths Finger sweep if see object Practice
Automated External Defibrillator AED
What is an AED? Automated external defibrillator is an computerized defibrillator it can analyze heart rhythm recognize shockable rhythm advise the operator whether the rhythm should be shocked very easy to use AED s computer chips analyze the rate, size and wave shape of human cardiac rhythm. will not shock a properly functioning heart will not shock a heart that has stopped VF is not present
Universal steps of AED use Place AED parallel to patients left ear Power on the AED first Some automatically turn on when opened Attach the AED to the patients chest with electrode pads Remove clothing to bear chest Be kind to females Dry patient or shave chest in area of electrode placement if needed Place one pad above right nipple and one to the side and below the left nipple. (CPR is continued up to the point of placing the pads on) Analyze rhythm Make sure everyone is clear (must say stand clear of the victim ). No contact Push analyze Charge AED if shock is required (some machine charge automatically)
Shock if indicated (after checking everyone is clear again) Begin CPR for five cycles then analyze again If shock is advisable again you clear everyone and shock If shock is not advisable continue with CPR If victim has pulse and is breathing put into recovery position. DO NOT take off pads or turn off AED until prompted by EMS
Special Considerations Water Must remove victim from water or wet surface Dry before attaching pads Metal surfaces Is victim lying on metal surface? if so move victim The metal surface may cause the shock form the AED to hit you. Children Children 8 and older use as soon as possible Children 1-8 CPR for two minutes before using AED Transdermal medications Remove patch and wipe clean before attaching AED pads Implanted pacemakers and defibrillators Do not place an AED electrode directly over implanted device. Move at least one inch to the side of device Practice
First Aid
Medical emergencies Breathing difficulties Asthma problems are increasing Most have medicines May need assist victim is administrating If symptoms continue to get worse call 911 Anaphylaxisis Severe reaction to allergen Victim may have epinephrine injector May need to administer Call 911 if medicine is not administered Seizures General rules 1) Prevent injury 2) ensure open airway 3) maintain open airway after seizure is completed place in recovery position Never try to restrain victim, place anything in the mouth.
Injury emergencies Bleeding Direct pressure best way If bleeding continues add more gauze or cloth; do not remove gauze or cloth Use elastic bandage to apply pressure to gauze and hold it in place. The use of tourniquets should be avoided unless in extreme matters The efficacy of elevation and pressure points is inconclusive; if used, use only in conjunction with direct pressure and when there is no apparent fracture or other underlying injury.
Wounds and abrasions Irrigate wounds until free of any foreign matter. Small wounds and abrasions should be cleaned thoroughly then have triple antibiotic ointment placed on it and covered. Larger wounds need to also be cleaned then covered and taken to doctor for possible stitches
Burns Thermal burns Cool burn with cold water until pain ceases Do not cool for more than 10 min. Can lead to further damage Burn blisters cover with loose gauze, but keep intact breaking them can lead to infection Electrical burns Make sure electrical current is shut off before trying to help victim. CPR and defibrillation may be needed as well as burn treatment All electrocution injuries should be checked out by a physician
Spine stabilization Suspect possible spinal injury if Car accident Injured from fall greater than their height Complains of neck pain, tingling, or extremity weakness Is not fully alert Appears to be intoxicated Appears frail or is >65 yrs old Has sustained a head injury - Manually stabilize the neck until help arrives.
Musculoskeletal trauma sprains, strains, contusions, fractures For sprains, strains, contusions apply ice for 20. Sprains elevate and place compression bandage R.I.C.E. rest, ice, compression, elevation If victim has aversion to cold place wet cloth between ice and skin Young kids and elderly especially susceptible Contusion you want to stretch the injury as well as ice If you are unsure of the injury suspect fracture do not move or straighten injury. Place ice on area and splint in position, send to ER. If suspect dislocation splint as is and send to ER.
Dental injuries Avulsed tooth Hold onto by the crown not the root (part embedded into gum Rinse off with water (do not scrub) Either place back into socket or place in glass of milk and see a dentist immediately Clean bleeding wound with saline solution or tap water Use cotton to apply pressure to stop bleeding
Environmental injuries Snakebite Do not suck wound, it will only exasperate the problem In case of Coral snake wrap a bandage around the extremity of the bite it will help slow the poison then get to medical facility immediately. Coral snake bites and sucks Other snake bites, wash area with soap and water, try not to move extremity very much and get to medical facility. Cold injuries Hypothermia Immediately begin re-warming remove wet clothes and wrap body surface with anything at hand; get to medical facility immediately If far from medical facility you begin active warming placing near heat source, placing in warm (not hot) water. Frostbite Remove wet clothing, usually occurs on extremities, do not re-warm if there is any chance it could freeze again or you are close to a medical facility. Use luke-warm water if you are far from medical facility
Heat Injuries Heat cramps muscle cramping, usually due to extreme loss of fluids Get to cooler area Replace fluids Ice and stretch area Heat exhaustion Dizziness, could have flushed skin or cool and clammy, disoriented, nausea, headache Get victim to cool area immediately Place ice on side of neck (carotid artery), arm pits, and groin area Replace fluids Watch for shock; could lead into heat stroke Heat Stroke medical emergency call 911 immediately Extreme disorientation, possible unconsciousness, very little sweating, internal temperature of >105. Cool down by any means
Drowning Get victim out of water as soon as possible Begin CPR immediately If you are alone finish five cycles of CPR before calling 911
Poisons Poison control center 1-800-222-1222 Chemical Burns Brush off any powder and remove all contaminated clothing Alkaline or acid exposure rinse with copious amounts of water. Ingested poisons Do not ingest any medication; milk, activated charcoal, syrup of ipecac unless instructed by poison control
Shock Develops when there is not enough blood flowing to the cells of the body Causes in adults; loss of blood heart attack, allergic reaction Symptoms feel cold and shiver, feel weak, faint, or dizzy, restless, vomit, feel thirsty Treatment Call 911 Put victim on their back If not leg injury or pain raise legs 12 inches Cover victim with blanket If bleeding is visible use direct pressure
Basic First Aid for Medical Emergencies The main purpose of this session is to familiarize you with basic first-aid procedures. By the time the session is over, you should be able to: Recognize the benefits of obtaining first-aid and CPR certification; Identify proper procedures for a variety of medical emergencies; Assist in administering first aid when a co-worker is injured; and Do no further harm.
Help! Emergency! Minutes could make a difference Just imagine: A co-worker is hurt in an accident and blood is gushing from the wound. One of your friends or your client chokes on a piece of food and can t breathe. Someone goes into cardiac arrest right at his workstation. Any one of these things is possible, and it could happen any time. If it did, you d have to act fast. A few critical minutes one way or the other could make the difference between life and death. Would you be ready to act with speed and competence in a workplace medical emergency? There are medical emergencies in workplaces across the country every day. Situations calling for first aid range from burns to cuts and amputations, eye injuries, chemical overexposures, and much more. Do you know how to report a workplace medical emergency? Besides calling 911, you also need to notify a supervisor or manager and provide as much information as you can about the accident. Describe the procedure for reporting workplace accidents and the information trainees should be prepared to provide about the incident. Business & Legal Reports, Inc. 1110
Four Basic Rules 1. 2. Call Bring for help to immediately the victim 4. 3. Do Check no further ABCs harm
Assess the Scene Evaluate the scene Assess safety Prioritize care Check for medical alert tags Do head-to-toe check Move only if necessary Business & Legal Reports, Inc. 1110
No Breathing Administer CPR: Lay the person on his or her back Give chest compressions Tilt head slightly Breathe into the person s mouth Continue until EMS personnel arrive Business & Legal Reports, Inc. 1110
Stop the flow of blood Wear gloves Cover the wound Apply pressure If a body part has been amputated, put it on ice Bleeding Business & Legal Reports, Inc. 1110
Shock Lay the victim down Cover Raise feet In cases where a person has lost a lot of blood, a condition known as shock can develop. Shock is the body s way of reacting to severe injury. A person in shock may appear stunned or confused. To treat shock: Lay the victim down, Cover the victim to keep him or her warm, and Raise the feet slightly above heart level. Business & Legal Reports, Inc. 1110
Anaphylactic Shock Give the victim medication Call for help ASAP Start CPR if necessary Business & Legal Reports, Inc. 1110
Heart Attack Call 911 Make victim comfortable Loosen tight clothing Check for medication Keep victim still Don t give stimulants If the sequence of back blows and abdominal thrusts does not clear the object, and the victim becomes unconscious: Call 911 and follow their instructions. If you can t speak with anyone, further quick action is needed. Try a finger sweep if the object in the throat is clearly visible and accessible with your fingers. Use gloves if possible. Use your index and middle finger to grasp the object. Don t try the finger sweep if there s a chance you ll push the object further down the throat. Lay the person down on his or her back, and perform 5 abdominal thrusts by placing your hands one on top of the other and push the heel of your hand in and up sharply on the abdomen just below the rib cage. Once the object is cleared, check the ABCs (airway, breathing, and circulation). If the person is not breathing, perform CPR until medical help arrives.
Ask a person to speak or cough Deliver 5 back blows Perform abdominal thrusts Repeat sequence of back blows and abdominal thrusts Choking
If Abdominal Thrusts Don t Work Call 911 Finger sweep Abdominal thrusts Check ABCs Perform CPR if not breathing
Electrical Shock Don t touch! Turn power off Call 911 Remove person from live wire Check for breathing Business & Legal Reports, Inc. 1110
Review Do you understand first-aid procedures for: No breathing? Bleeding? Shock? Heart attack? Choking? Electrical shock?
Eye Injuries Splashes Particles in eye Blow to eye Cuts near eye Penetrating objects Business & Legal Reports, Inc. 1110
Burns First-degree burns Reddened, painful skin Second-degree burns Blistering Third-degree burns Charring, deep tissue damage Business & Legal Reports, Inc. 1110
Exposure to Hazardous Materials Eyes Skin Inhalation Ingestion Unprotected exposure to hazardous materials can sicken or even kill a person. These are the basic first-aid procedures for these exposures. For exposures to the eyes, flush with water for 15 minutes and get medical attention. For exposures to the skin, flush with water for 15 minutes and get medical attention for burns and other damage. For inhalation of vapors or gases, move the victim to fresh air immediately. Administer CPR, if necessary. For ingestion, have a co-worker call 911. Another employee can also call your local poison center for more first-aid information, if necessary. Then follow the first-aid instructions in the material safety data sheet, or MSDS. The MSDS is an excellent source of first-aid information. Be sure you know where MSDSs are located and how to find the necessary first-aid information. Tell trainees where to find MSDSs. Then, using sample MSDSs for materials in your workplace, show trainees how to find relevant first-aid information.
Broken Bones Look Ask Treat for shock The rule for treating people who may have broken bones is never to move them unless it s necessary for their safety. Neck and back injuries are especially risky. The wrong move could cause paralysis or death. If you suspect broken bones, call for emergency medical assistance, and instruct the victim not to move. Then look for swelling and deformity. Ask the victim to rate the pain, explain how the injury happened, and if he or she can move the injured limb. Treat for shock if the person shows symptoms. If it seems that a person might have a broken bone, apply ice wrapped in a towel or cloth to the area, and keep the victim comfortable until help arrives. Business & Legal Reports, Inc. 1110
Heat Exhaustion Move to cool place Lay victim down Elevate feet Loosen clothing Give fluids Apply cool compresses Business & Legal Reports, Inc. 1110
Heatstroke Immediately call 911 Cool the person down Monitor Business & Legal Reports, Inc. 1110
Fainting Check for breathing Administer CPR if necessary Call 911 if more than a few minutes If conscious, lay the victim down with feet elevated Fainting can occur when blood pools in the legs, reducing the blood flow to the brain. People may faint when they are standing for a long time in the heat. Fainting can also be brought on by stress. Check a person who has fainted for breathing. If the person is not breathing, begin CPR. If the person does not regain consciousness within a few minutes after fainting, call for emergency medical assistance and continue to monitor breathing. Otherwise, if the person quickly regains consciousness, have the person lie down with feet slightly elevated. Loosen any tight clothing. Then allow the person to rest for 10 or 15 minutes until normal blood flow is restored, and the person feels alright again.
Epileptic Seizures Remove victim from hazards Check for breathing Nothing in the mouth Keep comfortable Call 911 if medical assistance is needed A person having an epileptic seizure may fall to the ground and have convulsions. If a person appears to be having a seizure: Remove victim from any dangerous objects or hazardous situations; Check for breathing; Don t put anything in the victim s mouth; Try to keep the person as comfortable as possible; and Call for emergency medical assistance if the seizure lasts more than 5 minutes without signs of slowing down, if the person has trouble breathing afterwards, or if the person is in pain or other injury is present. Business & Legal Reports, Inc. 1110
Review Do you understand first-aid procedures for: Eye injuries? Burns? Exposure to hazardous materials? Broken bones? Heat exhaustion and heatstroke? Fainting? Epileptic seizures? Now it s time to ask if you understand all the information presented in the previous slides. For example, do you understand what we ve said about first-aid procedures for: Knowing about all these procedures will come in handy should you ever have to assist in a medical emergency involving one of these health problems. Answer any questions trainees have about the information presented in the previous slides. Conduct an exercise, if appropriate. Let s continue to the next slide now and conclude the session with some key points to remember.
Key Points to Remember Medical emergencies can happen anytime. Act quickly, calmly, and correctly. Consider being certified in first aid and CPR. Here are the main points to remember about basic first aid: Medical emergencies can happen anytime on the job. When a co-worker is injured, you have to act quickly, calmly, and correctly. The best way to prepare for workplace medical emergencies is to be certified in first aid and CPR. This concludes the Basic First Aid for Medical Emergencies training session.
Question 1 Place the steps of the Chain of Survival in the correct order from first step to fourth step. A.Use an AED B.Start CPS C.Advanced Care - EMS D.Call 911
Question 2 A sign of a stroke include: A.Sudden slurred speech B.Drooping of one side of the face C.Weakness in an arm D.All of the above
Question 3 Treatment of shock includes: A.Start CPR B.Call 911 C.Raise the feet about 12 inches off the ground D.More than one of the above
Sources www.atlantictraining.com/blog/wpcontent/uploads/2015/06/cpr-by-chs.ppt https://www.mga.edu/risk-management/docs/safetypowerpoints/basic_first_aid.ppt