CPR Skills for Adults Steps for performing BLS CPR on an Adult 1. Look around to see if it is safe to approach 2. Tap the victim s shoulder and shout Are you okay? 3. Check to see if the victim is breathing by looking at their chest. If they are not breathing, or not breathing normally (only gasping), call 911. 4. Check the carotid pulse on the side of the neck closest to you for 5-10 seconds 5. If no pulse, start with 30 chest compressions on the lower half of the breastbone. * If witness arrest and AED available attach AED and follow prompts. 6. The rate should be at a rate of 100-120 compressions per minute. Depth of 3 to 2.4 inches. 7. Open the airway and give 2 breaths using a pocket mask or bag valve mask (2-rescuer CPR). Do not interrupt chest compressions for more than 10 seconds to provide ventilation. 8. Continue 5 sets of 30 compressions and 2 breaths until the ambulance arrives to take over, the AED arrives, or you are too tired to continue. Defibrillation within 3-5 minutes of collapsed can produce survival rates as high as 50-70% Administered naloxone may be considered for suspected life-threatening opioid-associated emergencies. Steps of Child CPR 1. Make sure the scene is safe to approach 2. Tap the child and shout Are you okay? 3. Check to see if the child is breathing by looking at their chest. If they are not breathing, or not breathing normally (only gasping), call 911. If you are alone, perform CPR for 2 minutes, then call. 4. Check the carotid pulse on the side of the neck closest to you for 5-10 seconds Atlanta Training Center 1
5. If no pulse, begin 30 chest compressions on the lower half of the breastbone with one or two hands. 6. The rate should be at a rate of 100-120 compressions per minute 7. Open the airway and give 2 breaths using a pocket mask or bag valve mask (2-rescuer CPR). 8. Continue 5 sets of 30 compressions and 2 breaths until the ambulance arrives to take over, the AED arrives, or you are too tired to continue. Steps of Infant CPR Infant BLS CPR certification 1. Make sure the scene is safe to approach 2. Tap the baby and shout Are you okay? 3. Check to see if the baby is breathing by looking at their chest. If they are not breathing, or not breathing normally (only gasping), call 911. If you are alone with the baby, perform 5 sets of 30 compressions and 2 breaths, then call. 4. Check the brachial pulse on the upper arm closest to you for 5-10 seconds. 5. If no pulse, start with 30 chest compressions using 2 fingers on chest. 6. The rate should be at a rate of 100-120 compressions per minute. 7. Open the airway and give 2 breaths using a pocket mask or bag valve mask (2-rescuer CPR). 8. Continue 5 sets of 30 compressions and 2 breaths until the ambulance arrives to take over, the AED arrives, or you are too tired to continue. Atlanta Training Center 2
How to use an AED on an adult Learn how to use an AED in the AHA BLS class. 1. Power on the AED and follow the AEDs spoken directions 2. Attach the AED pads to the victim s bare chest. 3. Say in a loud voice clear 4. If the AED advises a shock, clear the victim 5. Press the Shock button 6. Immediately resume CPR. After 5 cycles the AED will prompt you to repeat steps 3 and 4. AED use on a child: Same steps as above except use child CPR pads. If you do not have child CPR pads, use the adult pads. AED use on an infant: A manual defibrillator is preferred to an AED. You should use infant pads if you need to use the aed on a baby. CPR with an Advanced Airway An advanced airway is the use of a laryngeal mask, supraglottic or endotracheal tube. When you use an advanced airway, you do not stop compressions to give breaths like you do during 2 person CPR. Give one breath every 6 seconds and there should be no pause in chest compressions for delivery of breaths. Rescue Breathing If an adult, child, or baby has a pulse but is not breathing properly, you should perform rescue breathing (breaths but no compressions). Adults: Give 1 breath every 5-6 seconds Children: Give 1 breath every 3-5 seconds Infants: Give 1 breath every 3-5 seconds. Note for infants and children: If the pulse is less than 60 beats per minute with signs of poor perfusion, start CPR. Atlanta Training Center 3
Choking Adult or Child 1. In mild obstruction, encourage the patient to continue coughing, but do nothing else except monitor for deterioration. 2. In severe obstruction in a conscious patient: Stand to the side and slightly behind the victim, support the chest with one hand and lean the victim well forwards (so that the obstructing object comes out of the mouth rather than going further down the airway). Give up to five sharp back blows between the shoulder blades with the heel of your other hand (checking after each if the obstruction has been relieved). If unsuccessful, give up to five abdominal thrusts. Stand behind the victim (who is leaning forward) put both arms around the upper abdomen and clench one fist, grasp it with the other hand and pull sharply inwards and upwards. Continue alternating five back blows and five abdominal thrusts until successful or the patient becomes unconscious.1. Stand or kneel behind the victim and make a fist above their navel. 3. In an unconscious patient: Lower the patient to the floor. Call an ambulance immediately. Begin CPR (even if a pulse is present in the unconscious choking victim). Choking Infant 1. Kneel or sit with the infant on your lap. 2. Hold the infant facedown, resting on your forearm. Support the infant s head with your hand. 3. Deliver 5 back slaps between the infant s shoulder blades using the heel of your hand. 4. Support the baby s head and flip them over while supporting their head. Give 5 chest thrusts over the lower half of the breastbone. Repeat until object comes out or baby becomes unconscious. If baby becomes unconscious, start CPR. Atlanta Training Center 4
FIRST AID Checking the Conscious Victim Check the scene for safety. Then check the victim for any life threatening conditions (Unconscious, difficult or no breathing, no pulse and severe bleeding). If any of these are present, Call 911. For any conscious victim always get permission to help. Take precautions against the transmission of disease (wear gloves). Ask the victim (what happened, are you feeling pain, numbness or tingling anywhere, any allergies, are you taking any medications and when did you last eat or drink anything) Do a visual check of the victim from head to toe (note any bruises, bumps, look for bleeding, sweating, is the skin pale or red, look for signs of pain or trouble breathing) Look for signs of shock: rapid breathing and/or pulse, nausea or vomiting, skin color pale or sweating, restlessness and any blue tint to the skin. If present, treat for shock: call 911, monitor breathing and circulation, control any bleeding- common cause for shock, if possible get the victim to lay down some may not want to-don t force the issue, if possible keep the legs flat, keep the victim from getting too warm or chilled, reassure the victim, do not give the victim anything to eat or drink. In emergencies when there is more than one victim, any victim who has a life threatening condition is the priority to receive care. Use the mnemonic S.A.M.P.L.E. Signs or symptoms Allergies Medications Pertinent past history Last oral intake (food or drink) Events leading to emergency Atlanta Training Center 5
Shock Look for signs of shock: rapid breathing and/or pulse, nausea or vomiting, skin color pale or sweating, restlessness and any blue tint to the skin. If present, treat for shock: call 911, monitor breathing and circulation, control any bleedingcommon cause for shock, if possible get the victim to lay down some may not want to-don t force the issue, KEEP LEGS FLAT, keep the victim from getting too warm or chilled, reassure the victim, do not give the victim anything to drink or eat. Stages of Shock Stage 1: Initial Stage of Shock The first of the stages of shock is reversible, but there aren't any signs to indicate shock at this stage. Cells begin to change due to issues with perfusion and oxygenation. Perfusion is the method used by arteries to deliver blood to capillary beds in body tissues. Without this nutritive blood and an adequate oxygen supply, the cells switch to anaerobic metabolism, producing pyruvic and lactic acid. Stage 2: Compensatory Stage of Shock During the compensatory stage of shock, the body tries to reverse the results of the initial stage. Physiological, neural, hormonal, and biochemical reactions are employed to correct the imbalances. Hyperventilation is one such mechanism. This causes an increased rate of breathing which, in turn, may help to get more oxygen flowing to the cells and neutralize the newly acidic conditions. Another mechanism is the catecholamine response. Hypotension, or low blood pressure, due to the reduced volume of blood flow triggers this response. Catecholamines are hormones released by the adrenal glands. These hormones increase heart rate and attempt to increase blood pressure. A third mechanism used in the compensatory stage of shock is the renin-angiotensin response. During this response, a hormone called vasopressin is released into the bloodstream. Vasopressin helps to retain fluid and triggers vasoconstriction. Stage 3: Progressive Stage of Shock If the stages of shock progress to the third stage before the initial cause is corrected, damages become more severe and can be irreversible. Cellular function continues to deteriorate, anaerobic metabolism leads to increased metabolic acidosis, and the compensatory mechanisms can no longer maintain the balance required to protect the organs. Atlanta Training Center 6
Stage 4: Refractory Stage of Shock Burns The stages of shock will eventually lead to the refractory stage if the cause of shock cannot be fixed. At this stage, the organs completely fail and lead to death. It is important to understand the stages of shock in order to recognize and prevent the progression to this final stage. Burns are classified based upon their depth. A first degree burn is superficial and causes local inflammation of the skin. Sunburns often are categorized as first degree burns. The inflammation is characterized by pain, redness, and a mild amount of swelling. The skin may be very tender to touch. Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin. Third degree burns are deeper still, involving all layers of the skin, in effect killing that area of skin. Because the nerves and blood vessels are damaged, third degree burns appear white and leathery and tend to be relatively painless. For all burns, the wound should be cooled down with lots of cool water. This will reduce the continued burning of the skin. Cover the wound with dry sterile dressing to prevent infection. Do not use ice or ointments on the burn wound. Monitor the ABC s and monitor for signs of shock. Controlling Bleeding The two basic steps to controlling bleeding are listed below. Always watch victims of bleeding emergencies for signs of shock. Wear gloves to prevent disease transmission. These steps are done in order and you move onto the next step only if bleeding continues. 1. Direct Pressure- apply sterile dressing to the wound and press down firmly 2. Pressure bandage- apply addition dressing and wrap with a roller bandage. Tie a knot directly over the wound for additional pressure. If the bleeding continues, make certain 911 has been called, add additional dressing and wrap another roller bandage around the wound. When direct pressure is not effective for severe or life-threatening bleeding, the use of a hemostatic dressing combined with direct pressure may be considered but requires training in proper application and indications for use..a victim without obvious injuries should be monitored for internal bleeding. The signals to watch for include: Atlanta Training Center 7
Complaints of pain. Tender, swollen & bruised body part. Vomiting or coughing up blood. Excessive thirst. Faint, confused or drowsy. If you suspect internal bleeding, do not move the victim. Call 911 immediately and provide care for any symptoms you observe. Treatment of Open Chest Wounds A first aid provider caring for an individual with an open chest wound may leave the wound open. If a dressing and direct pressure are required to stop bleeding, care must be taken to ensure that a blood-saturated dressing does not inadvertently become occlusive. Bone and Muscle Injuries General care for injuries to muscles and joints include minimizing movement of the injured area & Rest, Immobilize, Cold, Elevate (RICE). Whenever you suspect an injury to a bone, joint or muscle you should treat the injury like a broken bone. Check the scene and victim. If the victim is unable to move a body part, or a life threatening condition is present, then call 911. Apply a splint only if you must move the victim and it causes no additional pain. Steps to Apply a Sling Support the injured body part above and below the injured area Check for feeling, warmth and skin color below the injury Tie a slip knot to the short point of a triangular bandage Place the knot behind the elbow and spread the triangular bandage under the injured area (arm for example) and over the uninjured shoulder. Minimize movement of the injured area Bring the sling over the front of the injured arm and tie a knot at side the neck away from the injury. The hand should be higher than the elbow. Secure the arm to the chest with a folded bandage. Leave the uninjured arm free. Check for feeling, warmth and skin color below the injury Atlanta Training Center 8
Steps for anatomic splint Bind a leg to a leg Using triangle bandage, weave under ankles and knees...tie one leg to the other at the ankles, above & below the knees Check of feeling warmth - color Head, Neck and Back Injuries When you suspect a head, neck or back injury it is important to maintain the position of the victim. Your objective is to hold the affect body part in the same position that you find it. Do not try to straighten or align the position. The victim may complain of pain, pressure or severe headache. Minimize movement of the head, neck or back. Place your hands on both sides of the head and support the victim s head or preventing from moving. Once you begin, you must maintain the position until help arrives. Use of cervical collars by first aid providers is not recommended. For injured persons who meet high-risk criteria for spinal injury, the ideal method for a first aid provider to help prevent movement of the spine requires further study but may include verbal prompts or manual stabilization while awaiting arrival of advanced care providers. Sudden Illness When people become suddenly ill they have comm on symptoms. They appear confused, dizzy, disoriented, may have trouble breathing, become pale or may sweat. We may know they are diabetic or have a seizure disorder. However we may not know the cause of the sudden illness but we can help. The steps to take to help in sudden illness all begin with call 911, for a conscious victim-get permission to help, put on gloves to prevent disease transmission, monitor for breathing and signs of life and keep the victim comfortable. Listed below are 4 specific sudden illnesses, included are the symptoms and First Aid care. Atlanta Training Center 9
Sudden Illness Stroke Call 911 Care Provided Think Face-Arms-Speech-Time (FAST) Ask the person to say a simple sentence and smile: note slurred speech or any drooping of mouth or eye, ask to raise arms: note difficulties / headache. Keep the victim comfortable and do not give anything to drink or eat. Stroke is caused by a sudden blockage of blood flow to the brain Seizure Convulsions, body stiffen, a blank stare, upward rolling of the eyes, when conscious - headache / tired. Diabetic Emergency Feel weak, confused, trouble breathing, sweating, can lose consciousness. Diabetic Emergency results from too much or little sugar in the blood Cushion head with pillow or clothing, move any objects away, loosen clothing from neck and waist Know conditions to call 911. If conscious, give something to eat or drink w/ sugar. Know conditions to call 911. Poisoning/Allergic Reaction Pain, coughing, abnormal pulse rate, sweating, nausea. Move the victim away from source of poisoning, call 911/poison control center (1-800-222-1222), do not induce vomiting unless directed. Epinephrine is recommended for the life-threatening condition of anaphylaxis Atlanta Training Center 10
Environmental Emergencies A victim of heat or cold related emergencies can develop a life threatening condition quickly if the condition is not recognized and care is delayed. A heat emergency victim can progress through the continuum rapidly. HEAT EMERGENCIES: Painful muscle spasms. Level /Signals Heat Cramps Heat Exhaustion Cool moist skin, sweating, headache, dizzy, nausea, weakness. Heat Stroke Red - dry skin, trouble breathing, rapid breathing or pulse, confusion or change in level of consciousness. Can be life threatening if not treated. Care Cool victim, give cool water to drink, gently massage muscle and stretch to relieve spasm. Cool victim, circulate air around victim, give water if conscious, monitor, if victim does not improve, Call 911. Call 911, **cool victim, circulate air, loosen clothing, monitor breathing & pulse, if conscious provide small amount of cool water to drink. IF AVAILABLE PROVIDE CARBOHYDRATE-ELECTROLYTE DRINK ** Rapidly cool by immersing the victim in cold water or bags of ice/ ice water-doused towels Atlanta Training Center 11
COLD EMERGENCIES: Signals Hypothermia Shivering, slow breathing - pulse, glassy stare, confusion, in late stages- no shivering, loss of Care Move the victim to a warm place, monitor breathing pulse and for signs of shock, remove wet clothing, wrap in warm clothes or blankets, provide care as needed. conscious Frostbite Numbness, pins-n-needles, especially in feet, face or hands, waxy appearance to skin, severe frostbite might include blisters to the skin, blue tint to skin. Remove wet clothing and jewelry: Minor conditions SKIN TO SKIN CONTACT; I.E. HOLD AFFECTED AREA BETWEEN YOUR HANDS Large body areas or severe cases i.e. blisters; gradually warm the skin in warm water, cover with dry-sterile dressings, monitor breathing pulse and for shock, provide care as needed. BITES Venomous Snake Bite: pressure immobilization bandage Animal or Human Bite: clean with large amounts of water or saline solution Atlanta Training Center 12