Module 10 APPLICATION OF POCKET MASK APPLICATION OF POCKET MASK The pocket mask is a barrier device used to provide rescue breathing. It has a one-way valve that prevents exchange of secretions between the victim and rescuer. It is made of firm plastic with a cushioned rim and is roughly triangular in shape. The rim creates a flexible seal around the victim s nose and mouth. The mask fits over the victim s mouth and nose. The narrowest portion of the mask is placed over the bridge of the victim s nose. Mask connection port with one-way valve Exhalation port Mask port Filter Rim 46 47
APPLICATION STEP 1 Check that filter (if included) is snapped firmly in place. STEP 2 Push out the dome. STEP 3 Attach one-way valve to mask port. Direct exhalation port away from nose end of mask. STEP 4 Apply the rim of the mask first between the victim s lower lip and chin. This will retract the lower lip and keep the mouth open under the mask. Position end marked nose over the victim s nose. STEP 5 Seal as illustrated. Open the airway by performing a gentle head tilt-chin lift. Blow slowly until chest rises. STEP 6 Remove your mouth and allow victim to exhale. Note: If victim vomits, remove mask and clear victim s airway. Clear mask assembly by shaking or sweeping out foreign material. Blow through valve to verify operation. Re-apply mask to victim and continue ventilation. 48 49
Module 11 SUMMARY CHECKLIST ADULT ONE-MAN CPR SUMMARY CHECKLIST D : Danger R : Response Look out for unsafe environment, e.g. Electrical current, Fire, Possible Explosion, Construction works, or Poisonous gas Ensure that the scene is safe for you to help Establish unresponsiveness Call, tap or gently shake the victim Call out loudly: Hello! Hello! Are you OK? If no response, Call for ambulance 995 B : Breathing Check for breathing : Look, Listen, & Feel (up to 10 seconds) Feel for the flow of air from the victim s mouth and nose moving past your cheeks If no breathing, Give 2 short breaths (1 sec/breath; Volume of air : 400 600ml /breath) Allow lung deflation between each breath Check for pulse / *signs of circulation (10 seconds) If no pulse and *signs of circulation, start CPR Locate the landmark for chest compression Proper body and hand position Compress vertically 4-5 cm downwards with complete relaxation of pressure after each compression at rate of 100 per minute Say mnemonic 1&2&3&4&5&1&2&3&4&10&1&2&3&4&15&1&2&3&4&20 &1&2&3&4&25 &1&2&3&4&30 Perform 30 chest compressions followed by 2 breaths Assess the victim for pulse and signs of circulation after every 5 cycles of CPR 30:2 If pulse is absent (if unsure of pulse and victim has no *signs of circulation, assume cardiac arrest), continue CPR 30:2 If pulse is present, assess victim for breathing If breathing is absent, perform rescue breathing by counting: 2-a-thousand,3-a-thousand,4-a-thousand,5-a-thousand after each breath Give 12 rescue breaths in 1 minute Place the victim in the recovery position if : Victim is unconscious and has no evidence of trauma Continue to monitor victim s pulse, *signs of circulation and breathing every few minutes as this can stop suddenly C : Circulation CPR Cycle Re-assessment Rescue Breathing Recovery Position 50 51
ADULT TWO-MAN CPR ADULT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS UNCONSCIOUS) [ Switching ] Re-assessment Rescue Breathing Recovery Position Start one-man CPR 30 chest compressions followed by 2 breaths. Appear and say: I know 2-man CPR, can I help? Acknowledge by nodding head and complete the cycle of 30 chest compressions followed by 2 breaths and then re-assess pulse and *signs of circulation (10 seconds) Locate the landmark for chest compressions while is assessing circulation If pulse is absent (if unsure of pulse and victim has no *signs of circulation, assume cardiac arrest), says: No pulse, start CPR. Start chest compression by counting: 1&2&3&4&5&1&2&3&4&10&1&2&3&4&15&1&2&3&4&20 &1&2&3&4&25& 1&2&3&4&30 Gives 2 breaths after has completed every 30 chest compressions Repeat the cycles : : deliver 2 breaths : perform 30 chest compressions Initiate the switch of roles by counting : 1&2&3&4&5&1&2&3&4&10&1&2&3&4&15&1&2&3&4&20 &1&2&3&4&25&Switch&2&3&4&30 Complete the 2 breaths before moving to the victim s chest to take up compression position Moves to the victim s head and assess for pulse (if unsure of pulse and victim has no *signs of circulation, assume cardiac arrest) and say : No pulse, continue CPR. Assess the victim for pulse and signs of circulation after every 5 cycles of CPR 30:2 or after every switching of roles If pulse is absent (if unsure of pulse and victim has no *signs of circulation, assume cardiac arrest), continue CPR 30:2 If pulse is present, assess victim for breathing If breathing is absent, perform rescue breathing by counting : 2-a-thousand, 3-a-thousand, 4-a-thousand, 5-a-thousand after each breath Give 12 rescue breaths in 1 minute Place the victim in the recovery position if : Victim is unconscious and has no evidence of trauma Continue to monitor victim s pulse, *signs of circulation and breathing every few minutes as this can stop suddenly Conscious victim Ask: Are you choking? Assessment Victim acknowledges by nodding. Rescuer replies: I can help. Heimlich Stand behind the victim. Position one foot between the victim s legs Manoeuvre Locate the landmark : Technique Place your arms around the victim s abdomen and locate the navel (Normal Size) With one hand place 2 fingers just above the navel Make a fist with the other hand Place thumb-side of the fist against the abdomen above the 2 fingers Release the 2 fingers but maintain the fist on the abdomen Lean the victim forward and grasp the fist with the other hand Give successive inward-upward thrusts Check if foreign body is expelled after every set of 5 abdominal thrusts Repeat thrusts until the foreign body is dislodged or the victim becomes unconscious Chest Thrust Stand behind the victim. Position one foot between the victim s legs Technique Locate the landmark : (Pregnant & Place arms under the victim s armpits to encircle the chest Obese) Make a fist with one hand Place thumb-side of fist on the middle of the victim s breastbone Grasp the fist with the other hand and give successive quick backward thrusts Check if foreign body is expelled after every set of 5 chest thrusts Repeat thrusts until the foreign body is dislodged or the victim becomes unconscious Unconscious When victim becomes unconscious. Proceed with the following steps : victim Position the victim on a firm, flat surface Call for ambulance 995 B : Breathing Check for breathing : Look, Listen, & Feel (up to 10 seconds) Feel for the flow of air from the victim s mouth and nose moving past your cheeks If breathing is absent, attempt to ventilate (1st attempt) If airway is blocked, re-position the victim s head and re-attempt to ventilate (2nd attempt) If airway is blocked again, relieve obstruction by : Perform 30 chest compressions (The landmark and technique is the same as for adult CPR) Repeat steps A & B until able to give 2 successful ventilations. C : Circulation Check pulse and signs of circulation once airway is cleared. If pulse is absent (if unsure of pulse and victim has no *signs of circulation, assume cardiac arrest), continue CPR 30:2 If pulse is present, assess victim for breathing Rescue Breathing If breathing is absent, perform rescue breathing by counting : 2-a-thousand, 3-a-thousand, 4-a-thousand, 5-a-thousand after each breath Perform 12 rescue breaths in 1 minute Recovery Position Place the victim in the recovery position if : Victim is unconscious and has no evidence of trauma Continue to monitor victim s pulse, *signs of circulation and breathing every few minutes as this can stop suddenly 52 53
INFANT CPR INFANT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS UNCONSCIOUS) D : Danger Look out for unsafe environment, e.g. Electrical current, Fire, Possible Explosion, Construction works, or Poisonous gas Ensure that the scene is safe for you to help R : Response Establish unresponsiveness : Call, tap or gently shake the infant s shoulder to elicit response If you are alone, immediately start CPR 30:2 for approx. 2 minutes If a second rescuer is present, ask him or her to call for ambulance 995 B : Breathing C : Circulation Check for breathing : Look, Listen, & Feel (up to 10 seconds) Feel for the flow of air from the infant s mouth and nose moving past your cheeks If no breathing, Give 2 short breaths (1 sec/breath; Volume of air : approx. 30ml /breath) Allow lung deflation between each breath Check for brachial pulse and *signs of circulation (10 seconds) If pulse is absent (if unsure of pulse and infant has no *signs of circulation, assume cardiac arrest), start CPR 30:2 Locate landmark for chest compression: Draw an imaginary line between nipples Place index finger on the imaginary line Place your middle and ring fingers next to the index finger Move the 3 fingers to the centre of the sternum (breastbone) Position the fingers upright Lift off the index finger but maintain the middle and ring fingers contact on the sternum (breastbone) Lean forward and place your cheek near the infant s mouth and nose Use your middle and ring fingers to compress the sternum (breastbone) by 2cm Demonstrate correct technique of compression Keep fingers contact on the sternum during each upstroke Say mnemonic 1&2&3&4&5&1&2&3&4&10&1&2&3&4&15&1&2&3&4&20 &1&2&3&4&25 &1&2&3&4&30 Compression rate is at 100 per minute CPR Cycle Perform 5 cycles of 30 chest compressions followed by 2 breaths for approximately 2 minutes Activate EMS if it is not done earlier Assess for pulse, *signs of circulation and breathing after every 5 cycles of CPR 30:2 If pulse is absent (if unsure of pulse and infant has no *signs of circulation, assume cardiac arrest), continue CPR 30:2 If pulse is present, assess infant for breathing Rescue Breathing If breathing is absent, perform rescue breathing by counting : 2-a-thousand, 3-a-thousand after each breath Perform 20 rescue breaths in 1 minute Recovery Position Place the infant in the recovery position if : Infant is unconscious and has no evidence of trauma Continue to monitor infant s pulse, *signs of circulation and breathing every few minutes as this can stop suddenly Conscious infant Assessment Back blows & Chest thrusts Re-assessment Unconscious infant B : Breathing C : Circulation Assess for signs of complete airway obstruction (choking) If infant is choking, attempt to relieve the airway obstruction immediately Support the infant s head and body between your hands and forearms using the Sandwich Manoeuvre Hold the infant s face down and rest your forearm on your thigh Keep the head lower than the trunk Deliver 5 back blows forcefully between the shoulder blades with the heel of your other hand Support the infant s head and body between your hands and forearms after delivering the 5 back blows Turn the infant over on his/her back, resting on your thigh Keep the head lower than the trunk Deliver 5 chest thrusts over the lower half of the sternum (breastbone) by counting aloud 1,2,3,4,5.(landmark for chest thrust is the same as for infant CPR) Check if foreign body is expelled after every set of 5 back blows and 5 chest thrusts and remove if it is visible If the foreign body is expelled successfully, assess the infant for pulse, signs of circylation and breathing If the airway remains obstructed and the infant is conscious, repeat the sequence of 5 back blows and 5 chest thrusts until the foreign body is expelled or the infant becomes unconscious When infant becomes unconscious. Proceed with the following steps : Position the infant on a firm, flat surface Call for ambulance 995 if a second rescuer is available Check for breathing : Look, Listen, & Feel (up to 10 seconds) Feel for the flow of air from the infant s mouth and nose moving past your cheeks If breathing is absent, attempt to ventilate (1st attempt) If airway is blocked, re-position the infant s head and re-attempt to ventilate (2nd attempt) If airway is blocked again, relieve obstruction by : Perform 30 chest compressions (The landmark and technique is the same as for infant CPR) Repeat steps A & B until able to give 2 successful ventilations. Check pulse and signs of circulation once airway is cleared. If pulse is absent (if unsure of pulse and infant has no *signs of circulation, assume cardiac arrest), start CPR 30:2 If pulse is present, assess infant for breathing Rescue Breathing If breathing is absent, perform rescue breathing by counting : 2-a-thousand, 3-a-thousand after each breath Perform 20 rescue breaths in 1 minute Recovery Position Place the infant in the recovery position if : Infant is unconscious and has no evidence of trauma Continue to monitor infant s pulse, *signs of circulation and breathing every few minutes as this can stop suddenly Activate EMS if it is not done earlier 54 55
Notes Notes 56 57
Singapore General Hospital Institute for Medical Simulation & Education 167 Jalan Bukit Merah, Connection One Tower 5, #03-10 Singapore 150167 Tel : 6326 6884 / 6326 6885 / 6321 3651 Fax : 6878 0495 Email : imse@sgh.com.sg Information correct as at 01 March 2010