Introduction to Medical Careers Introduction CPR & AED
First Aid Initial care provided for an acute illness or injury, when advanced care procedures are not readily available. Intended to preserve life, alleviate suffering, prevent further illness or injury, and promote recovery
First Aid Provider Responsibilities Recognizing a medical emergency Making the decision to help Identifying hazards and ensuring personal safety Activating the EMS system Providing supportive, basic first aid care
Recognizing an Emergency Quick impression of what is going on or what has happened Injuries occur due to a physical force Mechanism of injury = manner in which a force creates an injury
Personal Safety Highest priority is YOUR SAFETY Use SETUP to help to see if a scene is unsafe
S E T U P S = stop Pause to identify hazards what happened? E = environment Consider your surroundings it is safe? T = traffic Be conscious of vehicles, bikes, people, etc U = unknown hazards Consider things that are not apparent P = personal safety Use protective barriers
Protecting Yourself Standard Precautions A set of protective practices used whether or not an infection is suspected PPE Personal protective equipment Examples? Disinfecting Surfaces: 1 part bleach to 10 parts water
Legal Terms Consent Have to ask a responsive person if they want help An unresponsive person, the legal concept of implied consent allows a provider to help without asking
Good Samaritan Laws What are they? How are you protected? When aren t you protected?
Good Samaritan Laws What are they? Laws or acts protecting those who choose to serve and tend to others who are injured or ill. They are intended to reduce bystanders' hesitation to assist, for fear of being sued or prosecuted for unintentional injury or wrongful death
Good Samaritan Laws Laws help protect anyone who: Voluntarily provides assistance, without expecting or accepting compensation Is reasonable and prudent (having or showing careful good judgment) Does not provide care beyond the training received Is not grossly negligent or completely careless, in delivering emergency care
Washington Good Samaritan Act The Good Samaritan Act 4.24.3000 Persons rendering emergency care or transportation - Immunity from liability - Exclusion. Any person, including but not limited to a volunteer provider of emergency or medical services, who without compensation or the expectation of compensation renders emergency care at the scene of an emergency or who participates in transporting, not for compensation, therefrom an injured person or persons for emergency medical treatment shall not be liable for civil damages resulting from any act or omission in the rendering of such emergency care or in transporting such persons, other than acts or omissions constituting gross negligence or wilful or wanton misconduct. Any person rendering emergency care during the course of regular employment and receiving compensation or expecting to receive compensation for rendering such care is excluded from the protection of this subsection. [1985 c 443.19; 1975 c 58.1.] (Severability - Effective date - 1985 c 443: See notes following RCS 7.69.010.) 4.24.310 Persons rendering emergency care or transportation - Definitions. For the purposes of RCW 4.24.300 the following words and phrases shall have the following meanings unless the context clearly requires otherwise: (1) "Compensation" has its ordinary meaning but does not include nominal payments, reimbursement for expenses, or pension benefits. (2) "Emergency Care" means care, first aid, treatment, or assistance rendered to the injured person in need of immediate medical attention and includes providing or arranging for further medical treatment or care for the injured person. Except with respect to the injured person or persons being transported for further medical treatment or care, the immunity granted by RCW 4.24.300 does not apply to the negligent operation of any motor vehicle. (3) "Scene of an emergency" means the scene of an accident or other sudden or unexpected event or combination of circumstances which calls for immediate action other than in a hospital, doctor's office, or other place where qualified medical personnel practice or are employed. [1985 c 443.20; 1975 c 58.2.; Severability - Effective date - 1985 c 443: See notes following RCW 7.69.010.]
Good Samaritan Law Use common sense Activate EMS or emergency action plan (EAP) immediately If scene is unsafe, don t enter Ask a responsive person for permission before giving care Never attempt skills that exceed your training Once you ve started, don t stop until someone of equal or greater training relieves you
Legal Terms Duty to Act A predetermined requirement to provide care, typically by job description or by relationship. Negligence Occurs when someone is caused further harm due to care that did not meet the expected standards of someone with a duty to act Assault and Battery Placing a person in fear of bodily harm Forcing care on a person against her/his wishes
EMS Activation Immediately activate EMS for: A person is unresponsive A significant mechanism of injury has occurred A warning sign of serious illness exists The severity of a person s condition is unclear
Emergency Moves Only move if clearly endangered or requires life-supporting care Most effective method is dragging Keep in line of long axis of body Types Extremity Clothing Blanket
Sudden Cardiac Arrest (SCA) Cardiac Arrest is the loss of the heart s ability to pump blood to the body SCA occurs when the normal electrical impulses in the heart unexpectedly become disorganized
SCA Causes Heart disease Electrical shock Severe blood loss Drug overdose Severe allergic reaction Drowning
Heart Problems Angina Chest pain caused by reduced blood flow to heart muscle Heart attack When the heart does not function properly, denying the heart muscle of oxygen & causing chest pain (tissue death)
Cardiopulmonary Resuscitation (CPR) The immediate treatment for a suspected cardiac arrest Restore limited oxygen to the brain
Early Defibrillation Most effective way to end fibrillation is defibrillation using an automated external defibrillator (AED) A controlled electrical shock is sent through the heart to stop venricular fibrillation (V-fib) For each minute a person is in cardiac arrest, his chance of surviving decrease by about 10%
Chain of Survival Most effective approach for treating sudden cardiac arrest Immediate Recognition & Activation of EMS Immediate CPR with high-quality chest compressions Rapid Defibrillation Effective basic and advanced EMS care and transport Effective Post-cardiac arrest care at a hospital
Chest Compressions Increases the pressure inside the chest and directly compresses the heart Compress deeply, more than 2 inches Compress fast: 100 to 120 times per minute Allow chest to fully recoil
Chest Compressions Patient face up on flat, firm surface Kneel close to the chest Heel of one hand on center of chest Heel of second hand on top of the first Position shoulders directly above your hands Lock your elbows
AED: Automated External Defibrillator 85% of adults go into an abnormal heart rhythm before their heart totally stops. The most common is Ventricular Fibrillation (V-Fib) Instead of normal squeezing action that the heart used to circulate blood, the heart quivers or shakes when in V-Fib
AED Specifics Ventricular fibrillation does not circulate any blood, so CPR should be done prior to the arrival of the AED. CPR should continue while the AED is being connected to the patient. During the analyze mode and the shock advised period you should not touch the patient. Warn bystanders before shocking a patient and LOOK when you press the button
AED Specifics Chances of successfully defibrillating a patient diminish rapidly over time: roughly 7-10% per minute. De-fib patches are placed: on the right upper portion of chest: below the collarbone and above the nipple left side of chest outside the left nipple and several inches below the armpit.
Automated External Defibrillation Turn on AED Bare chest Open package & place pads on Patients upper right and lower left Clear area to let AED analyze rhythm Clear area to deliver a shock Continue CPR
AED Considerations Make sure the patches stick to the chest Chest needs to be dry Hairy chests need to shaved with razor Special Circumstances Can be used on a wet surface, but not in a puddle Can be used on a metal surface Must remove any medication patches Must remove woman s bra
Other Considerations for AED Movement Battery Medication patches Implanted medical devises Children Emergency Oxygen
PRIMARY ASSESSMENT: Unresponsive Simple way to quickly identify if a lifethreatening condition is present Helps to assess for immediate lifethreating problems
PRIMARY ASSESSMENT: Unresponsive SETUP Medical Statement introduce yourself Check for responsiveness Tap & Shout Unresponsive = call EMS Have someone call 911 & get the AED Check (look) for normal breathing Provide indicated care
PRIMARY ASSESSMENT: Unresponsive Checking for normal breathing Look at face and chest Take no longer than 10 seconds Normal breathing is effortless, quiet, and regular Not normal: weak, irregular gasping, snorting, or gurgling sounds
Unresponsive and Breathing Even if breathing, lack of responsiveness is considered life threating Need to worry about keeping the airway open #1 cause of a blocked airway? Recovery Position Helps maintain airway and lets fluids drain Also known as the HAINES position
Recovery Position Helps protect the airway by using gravity to drain fluids & keep tongue forward Prepare Roll Stabilize Other rolls: Log roll Stomach to back?
1. S.E.T.U.P. 2. MEDICAL STATEMENT and TAP & SHOUT 3. LISTEN FOR RESPONSE (check for responsiveness) 4. CALL 9-1-1, AED, and RETURN 5. LOOK & LISTEN FOR SIGNS OF NORMAL BREATHING 6. BEGIN Compression-Only CPR 7. CONTINUE UNTIL EMS ARRIVES, PATIENT STARTS BREATHING, YOU ARE TOO EXHAUSTED TO CONTINUE, SCENE BECOMES UNSAFE
AED 1. Setup 2. Assess Responsiveness (Tap and shout) 3. Activate EMS and get AED 4. No breathing or signs of circulation perform CPR 5. AED arrives 6. Bare, prepare, and place pads 7. Begin analysis of heart rhythm 8. Clear patient 9. Deliver shock 10. Continue CPR 11. Continue for 5 cycles
CHOKING
Mild Obstruction When a person can speak, cough, or gag Cleared naturally through forceful coughing
ABDOMINAL THRUSTS Heimlich Maneuver How do you know someone is choking? Steps involved:
FOREIGN BODY AIRWAY OBSTRUCTION: CHOKING - CONSCIOUS State: I am certified in First Aid Ask: Are you choking? Can I help you? If yes, direct someone to call 911 Find correct hand position Midline, fist just above the navel Give abdominal thrusts, inward & upward with a clenched fist until obstruction is removed or patient becomes unconscious
ABDOMINAL THRUSTS Heimlich Maneuver Pregnant or Obese Use chest thrusts Person becomes unresponsive Carefully lower to ground If not, activate EMS Begin CPR Look in mouth for an object before giving rescue breaths Continue CPR until person shows obvious signs of life, or another provider or EMS personnel takes over
CHOKING If you are alone: Try to keep coughing if able Find any nearby help Use a chair to force air into your throat Try to push in above your stomach with back on a wall