CPR and First Aid Application

Steele Canyon High School ENS Department

Cardiopulmonary Resuscitation Understanding how and when to use CPR today

can save someone's life tomorrow. Over a million-and-a-half heart attacks happens

every year. 1 out of every 5 people die before even reaching

a hospital. Cardiac arrest is rapidly becoming the number

one cause of death surpassing trauma. When the heart stops, the absence of

oxygenated blood can cause permanent  brain damage in only a few minutes. Brain death occurs within approximately 8-10 minutes. 

CPR Pearls of Wisdom

Statistics show that the earlier CPR is initiated, the greater the chances of survival. In fact, chances of survival DOUBLE (Holy Smokes) DOUBLE if help is provided within four minutes. Yes…that would be 4 short minutes…

 Amazing that in just this few number of minutes (4) stands the difference between life and death.

CPR Outcome Projections

CPR 0-4 minutes- survival excellent- no brain damage

CPR 4-6 minutes- survival with deficit- brain damage possible

CPR 6-8 minutes-survival with severe deficit- brain damage probable

CPR 8 minutes or more- survival not probable- brain death probable

CPR

Statistics show that the earlier CPR is initiated, the greater the chances of survival. In fact, chances of survival are doubled if help is provided within four minutes. This few minutes can be the difference between life and death.

8 minutes and greater without

CPR….

WOWZER…I told you…You have to start CPR quickly

because after 8

minutes….brain damage is

certain!

CPR

SO…How Does CPR Work??

During cardiac arrest, there is no blood flow to the body. Important organs that don’t receive blood, don’t receive oxygen either.

Chest compressions create a small amount of blood flow to vital organs such as the brain and heart.

CPR The more effective the chest compressions, the

more blood flow is produced. Chest compressions that are too shallow or too slow or chest compressions that are interrupted frequently do not deliver as much blood flow to the brain and heart as effective chest compressions.

Every time chest compressions are restarted following a break in the rescue or an interruption, the first few compressions are not as effective as later compressions. Frequent or prolonged interruptions in chest compressions decrease blood flow and the victim's chance of survival deteriorate.

CPR Con’t  CPR may not always save the victim even when performed

properly, but if started within 4 minutes of cardiac arrest and defibrillation is provided within 10 minutes, a person has a 40% chance of survival.

CPR provides a trickle of oxygenated blood to the brain and heart and keeps these organs alive. Cardio Pulmonary Resuscitation (CPR) serves as an artificial heartbeat  until a defibrillation can shock the heart into a normal rhythm or emergency equipment arrives.

Remember the CAB's of CPR: Circulation, Airway and Breathing

CPR Saves Lives!

CPR may not always save the victim even when performed properly, but if started within 4 minutes of cardiac arrest and defibrillation is provided within 10 minutes, a person has a 40% chance of survival. So be like Nike…and JUST DO IT!

CPR provides a trickle of oxygenated blood to the brain and heart and keeps these organs alive. Cardio Pulmonary Resuscitation (CPR) serves as an artificial heartbeat  until a defibrillation can shock the heart into a normal rhythm or emergency equipment arrives.

Remember the CAB's of CPR: Circulation, Airway and Breathing

American Heart Guidelines

The 2010 guidelines "strongly recommend" that untrained / lay responders (yes…that’s you guys) perform "compression-only" CPR, sometimes known as CCR. However, medical professionals and trained lay people are still urged to give the victim two "rescue breaths" in between each series of 30 chest compressions.

CPR changes All the changes apply only to adult victims who

collapse of cardiac arrest; and artificial respiration is still recommended for children and for adults in a few cases, including near-drowning and drug overdose.

The science behind the change is simple. Adults who have been breathing normally, for several minutes even after cardiac arrest have enough oxygen in the bloodstream to maintain the heart and brain, as long as compressions circulate the oxygen.

CPR con’tThe new guidelines also call for faster and more forceful compressions than in years past. The new standard is to compress the chest at least two inches on each push, at a rate of 100 compressions per minute. The AHA says the perfect pace is that of the Bee Gees' "Staying Alive."  There has been a change in the recommended sequence for the lone rescuer to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) The lone rescuer should begin CPR with 30 compressions rather than ventilation to reduce delay to first compression. Increase the depth of chest compressions to 2 inches for adults & children and 1.5 inches for infants.

Compression Only CPR

Add Ken Jeong Video http://youtu.be/n5hP4DIBCEE

Adult CPR

American Heart Association guidelines notes that

adult CPR standards are used on those persons8 years of age and older.

Adult CPR

A

AGE 8 AND…………………….............…..UP

Adult CPR

Before you begin. The first step of CPR is to assess the victim and

check responsiveness. Gently (key word here) shake the victim and

shout, "Are you OK?“ ** If the person answers, CPR is not needed.

(No matter HOW cute they are!)If the person is unresponsive or unconscious, or showing signs of a stroke or heart attack, call 911 immediately and initiate the CAB's of CPR which include: C-Circulation, A-Airway,  B-Breaths

Adult CPR

In case of emergency  DO NOT…I REPEAT…DO NOT▪ ...leave the victim unattended. (Send

someone else for help)!▪ ...make the victim drink or eat.▪ ...throw water on the victim's face. …Really

Sicko??▪ ...put the victim into a sitting position. ▪ ...slap his/her face. (Or any other part of their

body)!

Adult CPR

Add a picture of person down

Adult CPRCirculation 

  In order to determine if the victim's heart is beating or

not, place YOUR two fingertips on his carotid artery, located in the depression between the windpipe and the neck muscles, and apply slight pressure for several seconds.

If you feel a soft bump against your fingers the person has a pulse. This is a good thing!

REMEMBER…your victim could have a very slow heart rate, so wait several seconds to give a slow heart time to beat.

Adult CPR- Compressions

Compressions  When performing chest compressions, proper hand placement is very important. To locate the correct hand position place two fingers at the sternum (the spot where the lower ribs meet) then put the heel of your other hand next to your fingers.

Place one hand on top of the other and interlace the fingers . Lock your elbows and using your body's weight, compress the victim's chest. The depth of compressions should be at least 2 inches - remember: 2 hands, 2 inches . Count aloud as you compress 30 times at the rate of about 3 compressions for every 2 seconds or approximately 100 compressions per minute.

Adult CPR- Compressions Picture of correct hand placement.

This is not a grope fest friends…and no one should be engaged once you are done doing CPR.

This is a life saving measure…not a date!

Adult CPR- Airway

Airway:  Clear the airwayPut the person on his or her back on a firm surface. Kneel

next to the person's neck and shoulders. Open the person's airway using the head tilt-chin lift. Put your palm on the person's forehead and gently push down. Then with the

other hand, gently lift the chin forward to open the airway. Check for normal breathing, taking no more than 10 seconds: Look for chest motion (rising up and down), listen for breath sounds, and feel for the person's breath on your

cheek and ear. Gasping or gurgling is NOT normal breathing. If the person isn't breathing normally or you

aren't sure, consider rescue breathing if you are trained to do so.

Adult CPR- Airway So your positioning looks like this to

open the airway

Adult CPR- BreathingBreathing:  Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head tilt-chin lift), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head tilt-chin lift and then give the second breath.

Adult CPR Review

Remember -  you may be the victim's only chance of survival. You can increase that chance by 40% simply by administering Cardio Pulmonary Resuscitation (CPR). DO NOT BE AFRAID TO ASSIST SOMEONE IN NEED!

Check the victim for unresponsiveness Shout and gently shaking him/her. If there is no

response, Call 911 and return to the victim. Pulse Check Location - Carotid artery (neck)

CirculationIf the victim has no pulse, begin chest compressions.  Push down with 2 hands 2 inches, 30 times right between the nipples (Yes, I said that).  Pump at the rate of 100/minute, faster than once per second.

CON’T Airways

Tilt the head back and listen for breathing. Use caution moving a neck that has sustained trauma.

Breathing If not breathing normally and you have been trained, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths.  Each breath should take 1 second. DO NOT GIVE MOUTH TO MOUTH without some form of contamination barrier.

Child CPR

Child CPR By the American Heart

Association's® guidelines Child CPR

is administered to ANY victim under the age of 8. Children have a better chance of survival if CPR

is performed immediately.

Child CPR

The most common reasons children stop breathing and their heart stops beating are

the following:

Choking, suffocation, and strangulation. Drowning. Injuries. Poisoning. Infection. Heart disease, brain disease or medical

conditions that affect breathing.

Child CPR

Child CPR

 Check for responsiveness Shake or tap the child gently.

See if the child moves or makes a noise. Shout, "Are you OK?" 

If there is no response, shout for help. Send someone to call 911. Do not leave

the child alone to call 911 until AFTER you have given about 1-2 minutes of

CPR.

Child CPR- Circulation

CIRCULATIONRestore blood circulation!

Check if the child's heart is beating. In order to do that,  find carotid artery in

the neck. Place your two fingertips on it and apply

light pressure for several seconds. If no circulation is detected, begin chest

compressions. 

Child CPR

child pulse check

Child CPRCOMPRESSIONS

Count aloud as you compress 30 times, followed by 2 breaths. Perform this cycle 2 times - 30 chest compressions followed by 2 breaths - after which remember to check the victim's carotid artery for pulse as well as any signs of consciousness. DO NOT FORGET TO DIAL 911.

Check the child's carotid artery for pulse by placing two fingertips and applying slight pressure on his carotid artery for 5 to 10 seconds.

A child's smaller and more fragile body requires less pressure when performing compressions. The rule to remember is 1 hand, 1 inch. If you feel or hear slight cracking sound, you may be pressing too hard. Apply less pressure as you continue. Even if you do hear cracks, do not stop.

Child CPR

When performing chest compressions on a child… proper hand placement is even more crucial than with adults. Place two fingers at the sternum (the bottom of the rib cage where the lower ribs meet) and then put the heel of your other hand directly on top of your fingers.

Child CPRAIRWAY 

Open the airway

Lift up the chin with one hand. At the same time, push down on the forehead with the other hand.

Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose.

Watch for chest movement. Feel for breath on your cheek. If there is none, check the tongue. It can obstruct the airway and prevent the child from breathing on his

own. (Of course, so can a peanut or Lego…)

Child CPRBREATHING

Keep in mind that children’s lungs are much smaller and require you use shallower breaths. Watch victim’s chest to

prevent stomach distention.If the child is not breathing: 

Cover the child's mouth tightly with your mouth Pinch the nose closed. (Because booger are gross…just

kidding here)! Keep the chin lifted and head tilted Give two slow breaths. Do NOT give large, full, forceful

breaths. If the chest does NOT rise, try the chin lift-head tilt again,

and give two more breaths. If the chest still doesn't rise, check to see if something is blocking the airway and try to remove it carefully.

Child CPR Review

Child CPR is for children under the age of 8. The procedure is similar to that for adults with some minor differences.

Procedure for Child CPR:Check for unresponsiveness

Shouting and gently shaking the child.

If no response…give 2 minutes of CPR before calling  911.

CAB’S Circulation

If the child is still not breathing normally, coughing or moving, begin chest compressions.  Push down with 1 hand 1 inch ,30 times right between the nipples.  Pump at the rate of 100/minute, faster than once per second. Pulse Check Location - Carotid artery (neck)

AirwaysTilt the head back and listen for breathing. Watch for tongue obstructions and use caution with a known trauma.

Breathing If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 small breaths.  Each breath should take about one (1) second.

Infant CPR

Infant CPRAccording to the AHA  guidelines, Infant CPR

is administered to any child under the age of

12 months.

Infant CPR

Infant CPR

Infant CPR

PEARLS OF WISDOM FOR INFANT CPR Send someone else to call 911.

Do not leave the child alone to call 911 until you have given  1-2

minute of CPR. Infants have a much better chance

of survival if CPR is performed immediately.

Infant CPR CIRCULATION

Restore blood circulation!   Check if the infant's heart is beating by

  finding the brachial artery located on the inside of the arm near the inside of the

elbow (INSIDE). Place your two fingertips on the fleshy part and apply light pressure for several seconds. If you do not feel a pulse, then the infant's

heart is not beating.  Begin chest compressions.

Infant CPR - Compressions

Use caution when doing compressions on an infant, as a baby's ribcage is  susceptible to damage.

Imagine a horizontal line between the baby's nipples. Place 2 fingers of your one hand just below this imaginary line, in the center of the chest. Gently compress the chest to about one-third to one-half the depth of the chest. Count aloud as you push in rapid rhythm. You should pump at a rate of about 100 times a minute.

DIAL 911. It is criticalGive 2 breaths after every 30 chest compressions. Compressions should be about ½-1 inch deep. Perform CPR for two (2) minutes before calling for help unless you can send someone else while you care for the baby. Continue CPR until you see signs of life or until a professional caregiver relieves you.

Infant CPR

AIRWAY: Clear the airway

Place the baby on his or her back on firm, flat surface, like a table, floor, or ground. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand. Use caution, as baby’s head are more weighty, and can become floppy.

In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, rise and fall, listen for breath sounds, and feel for breath on your cheek and ear. If the infant isn't breathing, begin mouth-to-mouth breathing immediately.

Infant CPR- Rescue Breathing

BREATHING Breathe for the infant

Cover the baby's mouth and nose with your mouth. Give two gentle rescue breaths, or rescue puffs to deliver air. It is not necessary for you to take deep breaths into your lungs, as enough air can be generated from your cheeks to slowly breathe into the baby's mouth taking one second for each breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head tilt-chin lift and then give the second breath. If the chest still doesn't rise, examine the mouth to make sure no foreign objects are inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.

Infant CPR- ReviewInfant CPR should be administered to any victim under the

age of 12 months.

The procedure is as follows:

1. Check the baby for unresponsiveness Pat his/her feet, shoulders or chest.  If no response, give 2 minutes of CPR before calling 911. Pulse Check Location - Brachial artery (arm)

2. Circulation and compressions.    Push down with 2 fingers ½ 1nch, 30 times at the rate of 100 per minute in

the center of the chest just below the nipples.3. Airways.  

Slightly tilt the head into "sniffer's position”. Remember the baby’s head is floppy and heavy

4. Breathing.    If the baby is NOT breathing give 2 small gentle breaths. Cover the baby's

mouth and nose with your mouth. Each breath should be 1 second long. You should see the baby's chest rise with each breath

5. Continue until help arrives.

Automatic External DefibrillatorsAEDs (Automatic External Defibrillators),

used in the first 3-5 minutes of a person collapsing drastically increase the survival rate of people suffering from cardiac arrest.

An AED automatically determines the heart rhythm of a pulseless victim and, if the victim is in a specific type of shockable rhythm called ventricular fibrillation (v-fib), an AED shocks the victim's heart in an attempt to restore its rhythm to normal.

Automatic External Defibrillators- How Does It Work?? When a heart is in v-fib (a quivering presentation), it is still receiving nerve

impulses from the brain. These impulses are firing so chaotically that the heart cannot produce a "beat;" it cannot eject enough blood to keep the circulatory system (and oxygen) flowing through the body.

Brain cells begin to die after 4-6 minutes of oxygen deprivation. The heart will continue its uncoordinated twitching until it stops receiving electrical impulses from the brain, then it will stops all together.

You can “shock” a heart back into a normal rhythm, by using an AED. An AED stops the heart from spasuming by sending a small electrical charge through it, working like a reset. The nerve impulses have a chance to resume their normal pattern, allowing the heart to resume beating at its normal pace.

AEDs can be found in many public areas including malls, stadiums and airports. They are extremely easy to use.

WHERE ARE THE SCHOOL AED’S LOCATED??

Automatic External Defibrillators Notes:

AEDs are NOT for use on trauma patients, children under the age of 1, or victims that HAVE a pulse.

Access 911. If you see someone collapse, DON’T WAIT, immediately call 911 and get the medics on the way.

Procedural Use of the AED

If there are other people around, instruct someone to call 911 .

Remain CALM. Panic and chaos does NOT help the situation.

Check the victim's respirations and airway to determine if they are breathing.

If the victim is not breathing, begin rescue breathing (if you are trained to do so) and chest compressions .

Send someone to locate an AED while you continue compressions. Uninterrupted CPR is an important factor in successful recovery of cardiac arrest patients. Ensure effective CPR for the victim at all times, unless the AED machine is actively analyzing or shocking the victim.

AED con’t Attach the AED. Is simple. Ensure the AED pads are

attached to the cable, which is plugged into the AED machine. The victim's chest should be visible for adhesive AED pad placements in the appropriate locations. The AED will include a diagram (typically on the adhesive pads themselves) indicating where each pad goes.

Always follow the instructions on the AED. Typically 1 pad is placed on the victim's right upper chest wall (above the nipple and to the right-from the victim's perspective-of the sternum). The other pad is placed on the victim's left chest/side (axillary armpit line) just below the nipple and pectoral muscle.

Special AED Note

CPR should not be interrupted while the

adhesive AED pads are being applied.

Automatic External DefibrillatorProcedures:

Turn on the AED. Stop CPR and say, "CLEAR!" Ensure that nobody is

touching the victim . Push the "analyze" button on the AED machine.

The AED will automatically analyze the heart rhythm of the victim and inform you, the rescuer, whether shocks are indicated.

A shock is only indicated if the victim's heart is in ventricular fibrillation. If you get a "no shock" message from the AED it can mean one of three things: ▪ the victim that you thought was pulseless… does indeed have a

pulse,▪ the victim has now regained a pulse, ▪ or the victim is pulseless but is not in a "shockable" rhythm

Automatic External DefibrillatorProcedures:

*If a shock is indicated, ensure that everyone is clear of the victim for their safety. This includes you!*Press and hold the shock button located on the face of the AED machine to deliver the pre-determined amount of electrical energy to the heart. The victim may jump or twitch with the delivery of the electrical charge.*Please remember that during this time, the AED machine may be heard giving instructions. Follow those instructions for best success.*After shocks are completed, follow prompts to restart CPR or check patient.

Special AED Note

Do not remove the AED pads to perform

CPR. Leave them in place.

Automatic External Defibrillator

The AED has directionsThat are easy to follow.There are also voice Commands after pads are applied.

Automatic External Defibrillator-Procedure

Repeat the check the victim's rhythm. Use the AED to analyze the victim's rhythm after 2

minutes of CPR. If indicated by the AED, provide the victim with

another shock. If the machine gives a "no shock" message after any

analysis, check the victim's pulse and breathing. If a pulse is present, monitor the victim's airway and provide rescue breathing as needed.

**There are many different AED designs, but all are simple to operate.. As long as you understand the general principles behind an AED, you may be able to save someone's life. DO NOT BE AFRAID TO ACT!

Automatic External Defibrillator

Remember Do NOT use an AED on a trauma

patient. Do NOT use an AED on a child under

1 year old. Do NOT use an AED on a victim with

a PULSE (they may get up and make YOU the trauma).

AED and CPR

Here ends this portion of the lecture material. Please review locations of AED’s on campus.

*Practice station 1: AED Access/Utilization

Please note which location would be quickest to utilize if there was an emergent need.Review time to access from 4 separate locations on campus.