CPR & BASIC FOR CHILDREN Student Guide
Contents First Aid provider 4 Legal Considerations 5 Disease Transmission & Universal Precautions 6 Unconscious & not breathing - CPR 7 CPR- Child & Infant Sequence 8 CPR Adult Sequence 9 Personal Safety 10 Checking for Response 11 Checking for Breathing 12 Chest Compressions 13 Rescue Breaths 15 Recovery Position 17 Choking 18 Control of Bleeding 21 Burns and Scalds 23 Heat Exhaustion 25 Heat Stroke 26 P2
Purpose CPR & BASIC CPR & Basic First Aid for Children Student Guide This Safe Hands CPR and Basic First Aid for Children student guide is intended to facilitate understanding and certification in a Safe Hands basic training class. The information has been furnished for that purpose and is subject to change. A Safe Hands certificate of achievement may only be issued when a Safe Hands instructor verifies that a student has successfully completed the required core knowledge and learning objectives of the programme. This course has been designed to aid understanding of first aid techniques solely for personal use and does not teach or allow the participant impart this knowledge to others as an instructor. P3
First Aid Provider First Aid Provider A first aid provider is someone trained in the delivery of initial emergency procedures. Using limited equipment they will perform a primary assessment and undertake the necessary interventions until emergency services arrive. The responsibilities of a first aid provider include: Recognising an emergency Making the decision to help Ensuring Personal Safety Getting medical help Supporting individual and providing basic first aid care The goal of Safe Hands first aid training is to help you gain the knowledge, skills and confidence necessary to manage a medical emergency until more advanced help is available. P4
Legal Considerations Some people fear being sued as a result of providing emergency first aid in an emergency situation. If you make the decision to provide assistance to someone you do not know in an emergency, it is important to always ask a responsive person for their consent. If you are dealing with a child then consent from a parent or guardian should always be gained. When a person is unresponsive, the legal concept of Implied consent allows the provider to help without asking on the assumption that the individual would agree to be helped if responsive. Please be aware that no good Samaritan law exists in the UAE at present. P5
Disease Transmission & Universal Precautions When caring for someone, there is a risk that you may be exposed to blood and other potentially infectious bodily fluids. It is important wherever possible to take precautions to avoid exposure to such fluids. Examples of infectious bloodbourne diseases include: Hepititis C Hepititis B HIV Exposure can occur through direct contact with an open wound or sore, or through the mucous membranes of the mouth, nose and eyes. It can also occur through a skin puncture with a contaminated sharp object. The term Universal Precautions is an approach that recommends treating all bodily fluids as if they were infectious unless you are certain you know otherwise. P6
Unconscious and not breathing - CPR CPR (Cardio Pulmonary Resuscitation) is a method used to maintain the airway, breathing and circulation of an individual without the use of any equipment. CPR may be done when a person stops breathing or the heart stops beating (like when a person has a heart attack or almost drowns). When it s possible that the person may get better, CPR is an important life-saving technique. CPR can help keep oxygenated blood circulating in the body, which can help prevent brain and organ damage. CPR is performed by using a combination of rescue breaths and chest compressions. The following pages will explain the CPR techniques used on adults, children and infants. P7
CPR - Child and Infant Sequence CPR & BASIC Safe to Approach? Check Responses Tap & Shout, Flick Heel, Pinch Earlobe Call emergency services Check Breathing look for signs of life Not Breathing Normally? 30 Chest Compressions using one hand or two fingers 2 Rescue Breaths 30 Chest Compressions Note: if you are performing CPR as a result of a child or infant drowning, 2 rescue breaths should be given before starting compressions. P8
CPR - Adult Sequence Safe to Approach? Check Responses Tap & Shout Call emergency services Check Breathing look for signs of life Not Breathing Normally? 30 Chest Compressions using two hands 2 Rescue Breaths 30 Chest Compressions ** Continue cycle of 30 compressions to two rescue breaths until advanced medical help arrives, the individual responds or you become too exhausted to continue. P9
Step 1. Ensure Personal Safety CPR & BASIC The scene of an emergency can often be unsafe. Personal safety should always be your highest priority before the safety of an ill or injured person. Putting yourself in danger could potentially result in you making the situation worse. Always check the scene before approaching an emergency situation and look for any signs of danger or obvious hazards. If the scene is unsafe, do not approach and wait until advanced help arrives. P10
Step 2. Check Responses It is important to assess whether the person you are trying to help is responsive. After ensuring personal safety, approach the individual and follow instructions below: Infant: shout loudly, flick their heel, pinch their earlobe gently. Child Give Command (dependent on age), tap shoulder, shout loudly. Adult Give Command, Tap or shake shoulder lightly, squeeze hand, shout loudly. P11
Step 3. Check for breathing CPR & BASIC If the person you are trying to help is unresponsive, the next step in your assessment is to determine whether the individual is breathing. This can be done by using the look, listen and feel method. Place your hand on the forehead of the child Tilt the head back slightly Position your ear above the mouth Place one hand on the chest Look for movement of the chest Listen for sounds of breathing Feel for chest rise and air flow against the ear P12
Step 4. Chest Compressions If the heart stops, it is possible to restore some blood flow through the body by performing external chest compressions. External compressions increase pressure inside the chest and directly compress the heart, forcing blood to move from the heart to the brain and other organs. Compressions should always be performed fast and to an adequate depth. If compressions stop, the pressure built within the body can be quickly lost and has to then be built up again. For this reason, it is better to try and minimise any interruptions between compressions. P13
Chest Compressions Child Place heel of one hand in centre of the chest on lower half of breastbone. Push hard, straight down at least 1/3 the depth of chest or about 2inches. Without interruption, push fast at a rate of 100 times per minute. If needed, use two hands as with adults. Infant Place two fingers on the breastbone, just below the nipple line. Push hard, straight down at least 1/3 the depth of the chest or about 1 1/2 inches. Without interruption, push fast at a rate of 100 times per minute. Adult Place heel of one hand on centre of chest, then the heel of the second hand on top interlocking the fingers. Push hard, straight down at least 2 inches Push fast at a rate of 100 times per minute. Perform 30 chest compressions P14
Step 5. Rescue Breaths Rescue breaths are artificial breaths given to someone who is no longer breathing. They are achieved by blowing air into the mouth to inflate the lungs. Before giving rescue breaths, it is important to make sure there is an open airway, the airway is the only path for getting air into the lungs. You can open an infants, child s or adults airway by performing the head-tilt, chin-lift technique. This is achieved by placing one hand on the forehead and placing the fingertips of your other hand under the bony part of the chin. Apply firm backward pressure on the forehead while lifting the chin upward. This will tilt the head back and move the jaw forward. P15
Adult and Child Perform the head-tilt, chin-lift manoeuvre. Pinch nostrils to seal nose. Take a normal breath and open mouth wide. Press your mouth against the mouth of the adult or child and create an air tight seal. Blow to deliver breath. Each breath should be 1 second in length and enough to create a visible rise of the chest, but no more. Remove your mouth and let the adult/ child exhale completely. Take a fresh breath between breaths. Infant When delivering rescue breaths to an infant, it may be more effective to create a seal over the infants mouth and nose with your mouth depending on their size. Deliver 2 Rescue Breaths P16 Rescue Breaths
Unresponsive and Breathing - Recovery position Even if a child is breathing normally, a lack of responsiveness is still considered to be a life-threatening condition that requires immediate care. There are a variety of things that can cause a child to become unresponsive. Regardless of the cause, the greatest treatment concern is to maintain a clear, open airway. Positioning an uninjured, unresponsive child in the recovery position can help to maintain and protect the airway. This position uses gravity to drain fluids from the mouth and keep the tongue from blocking the airway. If an unresponsive child has been seriously injured, do not move them unless you are alone and need to leave to get help. Frequently assess the breathing of anyone placed in the recovery position. P17
Choking Choking can occur when a solid object enters a narrow part of the airway and becomes stuck. Young children are particularly at risk of choking because of the small size of their air passages, inexperience with chewing and a natural tendency to put objects in their mouths. On inhalation, the object can be drawn tighter into the airway and block air from entering the lungs. A forceful thrust between the ribs and up into the diaphragm can compress air in the chest and force the object out. It is important to be able to recognise the difference between a mild blockage and a sever blockage. With a mild blockage, a child can still speak, cough or gag. This type of blockage is usually cleared by coughing. Encourage a child with a mild blockage to cough forcibly. P18
Choking - Child and Adult Assess Ask the child are you choking? If child nods yes or is unable to speak or cough - act quickly. Have someone call emergency services if possible. Position yourself Kneel or stand behind the child, reach around and locate navel. Make a fist with one hand and place thumb side against abdomen just above navel and below the ribs. Grasp fist with other hand. Give Thrusts Quickly thrust inwards and upwards into ab-domen. Repeat. Each thrust must be given with intent of expelling object. Continue until child can breathe normally. If child becomes unresponsive, lay on flat surface and begin CPR starting with chest compressions. Look in mouth for object before giving each set of rescue breaths. Remove object if seen. P19
Choking - Infant Assess Look at infants face. If infant is silent, unable to cry, or has blue lips, nails or skin act quickly. Have someone call emergency services if possible. Give 5 Back Blows Straddle infant face down over forearm, support head by holding jaw. Use other hand to give 5 back blows between shoulder blades. Sandwich infant between forearms and roll onto back. Give 5 Chest Thrusts Place 2 fingers on breast bone, just below nipple line and give 5 chest thrusts. Repeat cycle of 5 back blows to 5 chest thrusts until infant can breathe normally. Check for object in mouth after each set of back blows and thrusts. If object can be seen, remove it with finger. If infant becomes unresponsive, lay on flat surface and begin CPR starting with chest compressions. Look in mouth for object before giving each set of rescue breaths. Remove object if seen. P20
Control of Bleeding Blood vessels are present throughout the body, bleeding occurs when tissues are damaged. Bleeding reduces the oxygen carrying capacity of the blood. If heavy or uncontrolled, bleeding can quickly become life threatening. An open wound of similar size in child or adult will result in the same amount of blood loss, but the percentage of loss will be greater for the child. Emergency services must be activated immediately in the event of any heavy bleeding. Arterial bleeding - this will be bright red and will often spurt from a wound. Bleeding from a vein - This will be dark red in colour, the flow will often be heavy but will not spurt as with an arterial bleed. All heavy bleeding must be controlled as soon as possible. P21
Control of Bleeding Apply Direct Pressure Quickly expose and inspect wound. Using a clean absorbent pad, apply direct pressure with flats of fingers directly on point of bleeding. If pad is not available, apply pressure with hand. If Bleeding Continues... If blood soaks through initial pad, apply an-other pad on top, leaving initial pad in place. Apply more pressure with the palm of your hand. Apply Pressure Bandage Wrap a roller gauze or elastic bandage around limb and over injury to provide continuous pressure to wound. Include enough pressure to control bleeding. Ensure that a finger can be slipped under bandage. When a pressure bandage has been applied, an ongoing assessment of limb or area must be made. Look for signs of decreased blood supply. Signs include: cool skin, bluish skin and loss of feeling in area. P22
Burns and Scalds Burns can cause serious physical harm to the body. Typically caused by close exposure to high temperatures, chemical reactions, or electrical currents, burns can vary in severity. Minor Burns Minor burns, a common issue with children include those that involve the outer layer of the skin and result in redness and pain. These include small burns that extend into the deeper layers of the skin and can cause some blistering. Cool the burn with water as soon as possible. Continue cooling until the pain is relieved. This will reduce pain, swelling and the depth of the injury. Leave any blisters intact. Cover the burn with a loose sterile pad. These burns usually heal without further treatment. P23
Critical Burns Deep burns over a large area of the body are the most severe. These burns often result in excessive blistering and destruction of skin tissue. A child s thin skin increases the risk of hypothermia and other complications from severe burns. Make sure the situation is safe for you to help Call emergency services Expose affected area by cutting or tearing away clothing If any clothing is stuck to burn, do not remove it Separate fingers or toes with clean sterile dressings DO NOT apply butter, ointment, lotion or antiseptic Loosely cover burn area with dry, clean pad or clean sheet Give child nothing to eat and drink Await emergency services and monitor child s airway P24
Heat Exhaustion Heat related problems occur when the body s normal temperature-reducing mechanisms get overwhelmed and become insufficient or stop working. Heat exhaustion is common after vigorous physical activity. When exposed to hot, humid temperatures, sweating occurs to cool the skin. Heat exhaustion develops from the combination of an increased internal temperature and the excessive loss of fluids. A smaller volume of water in a child s body means that dehydration can occur quickly, within a matter of hours. If you suspect heat exhaustion, immediately move the child to a cooler place. Loosen or remove excess clothing. Have the child lie down and raise the legs 6-12 inches. Spray the child with water or apply cool wet cloths to head and torso. Use a fan if possible to speed evaporation. Encourage the child to drink fluids. If the child does not improve or seems to get worse, call the emergency services. Signs and symptoms: Heavy sweating Pale, cool skin Nausea and vomiting Headache Dizziness Weakness P25
Heat Stroke Heat stroke is a true life-threatening emergency. It can occur due to overexertion in a hot humid environment or as a result of a break-down in the body s ability to shed heat. In addition to the signs of heat exhaustion, a child with heat stroke will have an altered mental status. The skin can become red, very warm and be completely dry. The child may collapse and have a seizure due to significant increase in body temperature. Call Emergency Services Begin aggressive cooling with available resources Spray or pour water on the child and fan them Cover the child with a wet sheet or towel If available, immerse the child in cool water up to the neck. Provide continuous cooling until Emergency Services arrive. P26