Week 2 - Adult CPR

Assess

Assess the Scene

• Determine 
• If it is safe to help
• Number of victims
• if you will need additional assistance from EMS
• What personal protective devices are readily available to you

Assess the Victim

• Check the victim for responsiveness
• Tap on victim’s shoulder and shout “Are you okay?”
• Look at the victim’s chest and face
• Determine if the victim is breathing normally
• Agonal breathing is NOT normal breathing and needs care

Activate EMS

• Call 911 or direct a bystander to call 911 and return
• Caller should give dispatcher victim’s location, details of emergency situation including how many victims are injured and what treatment is occurring 
• Request AED machine, if available

Check Pulse

• Check for pulse (about 10 seconds) in the carotid artery in the neck
• If unable to locate a pulse, do not waste valuable time searching, immediately begin CPR

CPR Cycle

Perform cycles of 30 compressions (at a rate of 100-120 per minute) and then administer 2 rescue breaths

    Compression depth:

• Adult: At least 2 inches, but no more than 2.4 inches

     Position: 

• On the breastbone (sternum)

C-A-B Order

Rescuers should assume cardiac arrest has occurred when encountering adults who have collapsed or are found unconscious. Immediately call or have a bystander call 911 and begin CPR.  

Use the C-A-B (Compressions-Airway-Breathing) Order

• Begin 30 Compressions
• Open Airway with head tilt–chin lift and check breathing, AT THE SAME TIME
• Give 2 rescue Breaths 

Compressions

For an unconscious adult immediately begin 30 chest compressions, at a rate of 100-120 compressions per minute.  Administer to the breastbone (sternum).  Compressions should be swift, hard and consistent with a depth of at least 2, but no more than 2.4 inches of the chest.  Avoid leaning on the victim’s chest between compressions to allow for full chest recoil. 

Airway

Open the victim’s airway, using the head tilt-chin lift method and AT THE SAME TIME check for breathing (5-10 seconds).  Look into the victim’s mouth for an obstruction.  If you see an obstruction, remove it immediately. 

    If the victim is breathing:

• Place the victim in the recovery position

    If the victim is not breathing:

• Administer - Rescue breaths

Breathing

Administer 2 rescue breaths (1 second each). 

    If the first breath does not make the chest rise:

• Re-tilt the head and try the breath again 

    After administering 2 rescue breaths

• Resume compressions 

Continue CPR Cycle until: 

• AED becomes available
• Victim shows signs of life
• A second rescuer takes over
• EMS arrives and takes over
• You are too tired to continue

Part one of our new weekly series: CPR Basics

Assess the Scene

Check the scene for safety hazards BEFORE providing care.

• You and the victim should be in a safe location, free of imminent danger or hazards.
• Check the person for responsiveness
  • Tap on victim’s shoulder and shout “Are you okay?”
• Call 911 or direct a bystander call 911
• Apply personal protective equipment (PPE)
• Check for pulse (about 10 seconds)
• Request AED machine, if available

If you are alone:

Adults:

• FIRST call 911
• Retrieve AED, if available
• Perform CPR cycle until EMS takes over or you are too tired to continue

Children and Infants:

• FIRST complete five cycles (about 2 minutes) of CPR
• Call 911
• Perform CPR cycle until EMS takes over or you are too tired to continue

Always provide care first for unresponsive victims of hypoxic arrest (i.e. lack of oxygen to the brain due to drowning, injury, drug overdose, stroke, etc…).

Naloxone, if available, may be administered by a bystander if suspected life-threatening opioid overdose has occured. 

Assess the Victim

Assess the approximate age and size of the victim. Suggested guidelines for administering CPR are as follows:

• Adult CPR: should be administered to victims who have reached the onset of puberty and older.
• Child CPR: should be administered to victims who have not reached the onset of puberty and are not considered infants (approximately 1 year to the onset of puberty).
• Infant CPR: should be administered to victims who are younger than toddler aged (approximately birth to 1 year).

Compressions - Airway - Breathing

C-A-B (Compressions-Airway-Breathing) Order

• Begin Compressions
• Open Airway with head tilt–chin lift method, check breathing, AT THE SAME TIME
• Give 2 rescue Breaths

Head Tilt-Chin Lift Method

Use one hand on the forehead to tilt the victim’s head back. AT THE SAME TIME place the other hand under the victim’s chin, lift the chin to open the airway and displace the tongue. Look into the victim’s mouth for an obstruction. If you see an obstruction, remove it immediately.

Rescue Breaths

Keep airway open with head tilt-chin lift method. Administer one rescue breath (1 second). Observe chest for rise and fall. If breath does not go in, re-tilt head and administer second rescue breath (1 second). Observe chest for rise and fall AT THE SAME TIME as administering rescue breaths.

Use one of the following methods to administer rescue breaths:

• Mouth-to-barrier
• Mouth-to-nose
• Mouth-to-stoma (an artificial opening in the neck, such as a breathing tube)

Chest compressions, which keep oxygen flowing to the brain, is the single most important factor in life saving procedures.

Chest Compressions

Chest compressions should be swift, hard and consistent, at a rate of 100-120 per minute.

Use

• Adult: Two hands (heel of dominant hand)
• Child: One hand (heel of dominant hand)
• Infant: Two fingers

Depth

• Adult: At least 2 inches, but no more than 2/4 inches
• Child: At least 1/3 depth of the child’s body (or 2”)
• Infant: At least 1/3 depth of the infant’s body (or 1 ½”)

Position

• Adult and child: On the breastbone (sternum)
• Infant: On the breastbone, just below nipple line

Rate

• 100-120 compressions per minute

CPR Cycle

Perform 30 compressions then administer 2 rescue breaths

• At a rate of 100-120 compressions per minute
• Check for signs of breathing (rise/fall of chest)

Continue CPR cycles until:

• AED becomes available
• Victim shows signs of life
• A second rescuer takes over
• EMS takes over
• You are too tired to continue

Identify Airway Obstruction

Partial air exchange

• Mild: victim is able to produce forceful cough
• Severe: victim is able to produce weak, ineffective cough
• Complete blockage: victim is unable to breathe, cough or speak

Common causes for airway obstruction

• Tongue, foreign object, vomit, allergic reaction, spasm, swelling

Caring for Airway Obstruction

Responsive adult or child: Heimlich Maneuver

• Abdominal thrusts just above navel
• Continue until object is removed or victim is unresponsive
• Chest thrusts should be used for larger or pregnant victims

Responsive infant

• Support infant’s head and lay face-down over your forearm
• Support forearm with thigh
• Give five back blows
• Roll infant face up
• Check for breathing
• Continue until object is removed or victim is unresponsive

Unresponsive adult or child (if breath does NOT go in)

• Re-tilt head
• Reattempt breath
• Begin CPR
• Check airway
• Remove object

Unresponsive infant (if breath does NOT go in)

• Re-tilt head
• Reattempt breath
• Begin CPR
• Check airway
• Remove object

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First Aid for chemical exposure

First aid is the first help given to a person who has developed a sudden disease or trauma, or in other words, to anyone who is in need of immediate assistance to save their life. It is the first available help given until the medical attention is provided.

The main goal of first aid can be summarized into 3P’s. They are

·       Protect the victim’s life

·       Protect from further damage

·       Promote the quality of life with good prognosis

The chemical exposure is a common type of poisoning happens in day-to-day life. We deal with many chemicals in our daily life, for example, toilet cleaners, dishwashers and so on. Therefore, exposure from these chemicals cannot be always prevented. Generally, the spraying of these chemicals happens on the skin and into the eyes.

The first help needed to stop the action of the chemicals on our skin or in the eyes is to move away from the location of the accident or exposure. The most important step is to rinse or flush the area with water, continuously. The washing of these areas does not mean rough washing, DO NOT touch the surface. Rather, by the flushing or rinsing with water.

Generally, the duration required to perform rinsing or flushing water can last for 15-20 minutes duration. However, the exact time of the duration of this procedure depends on the type and of the strength of the chemical. According to that, the medical community has designed an approximate timescale for certain types of chemicals. Moreover, they are

·       5 minutes of rinsing and flushing for mild irritants.

·       15-20 minutes of this procedure for moderate –severe chemicals and this stage is enough to cause acute poisoning.

·       30 minutes of this procedure for corrosives

·       60 minutes of this procedure for very strong alkalis

These are approximate values; however, the strong chemicals need immediate hospitalization of the victim. The flushing or rinsing can be achieved in the transporting vehicle or in the ambulance. If exposed to harsh chemicals, please call the Poison Control center and 911.

Moreover, the chemical exposures of moderate – severe exposure and more than that of serious exposure can cause severe acute poisoning at the same time and can compromise the airway, breathing and of circulation disturbances. This can be relieved by proper inspection of the victim and if there is trouble breathing, perform the resuscitation according to the CAB method.

In summary, this shows us that even seemingly small first aid steps can prevent the death in difficult and life threatening situations.

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