Week 8 - Medical Emergencies

Breathing Problems

Victims with breathing problems may have a mild or severe blockage of their air passages, may be having a heart attack, stroke or may have experienced a serious injury leading to breathing problems.  Other breathing problems may be caused by medical conditions.  

Signs of breathing problems

• Breathing becoming more difficult
• Very fast or very slow
• Weak and ineffective cough
• Breathing is noisy
• Makes a sound or whistle as air enters or leaves lungs
• Inability to speak or breathe
• Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

Asthma

• Most victims with asthma usually know about their condition and carry an inhaler.  
• Sometimes they may have so much trouble breathing, they may need help with their inhaler
• Assess the scene for safety
• Ask if you can help – retrieve inhaler
• Shake the medicine canister
• Remove the cap
• Attach a spacer, if available and you know how
• Tilt the victim’s head back slightly and instruct to breath out slowly
• Put the inhaler or spacer in the victim’s mouth
• Push down on the medicine canister
• Instruct the victim to breath in slowly and deeply as you push down
• Instruct the victim to hold his breath for 10 seconds and then breathe out slowly
• If no inhaler is available or victim does not get better after using the inhaler
• Call or direct bystander to call EMS
• Stay with the victim until EMS arrives and takes over
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
• Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Choking

When an object becomes lodged in the airway it can be considered a mild to severe airway obstruction, depending on the victim’s inability to breathe.  Good air exchange and the ability to make forceful coughing efforts, is usually present in a mild airway obstruction. If a victim experiences a mild airway obstruction, the victim should be encouraged to continue coughing until the obstruction has been removed.  

Victims with a severe airway obstruction will have poor air exchange and may need immediate care. Victims with a complete airway obstruction will have little to no air exchange and will need immediate care.

The universal sign for choking is grasping the throat.  Not all victims know or use the sign.  It is important to recognize the signs of choking and to take immediate action when a severe airway obstruction occurs. 

Signs of a severe airway obstruction include all or one the following:

• Breathing becoming more difficult
• Weak and ineffective cough
• Inability to speak or breathe
• Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

Caring for Choking victim
Check victim for choking. Elicit response to question, “Are you choking?”  Observe signs of obstruction (speaking and breathing). 

    Responsive Adult or Child - begin Heimlich Maneuver

• Assess the scene for safety
• Ask if you can help
• Call or direct bystander to call EMS
• Move behind the victim
• Reach around the victim’s waist with both arms just above the navel 
• Place a fist with the thumb side against the victim’s abdomen
• Grasp the fist with other hand
• Press into the abdomen with quick inward and upward thrusts
• Continue administering thrusts until the object is removed or the victim becomes unresponsive
• If unable to move behind the victim, have victim lay on the ground and administer abdominal thrusts using both hands in the same location as if they were standing
• If victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call EMS - begin CPR
• Continue CPR cycle until a second rescuer or EMS takes over, you are too tired to continue, or victim begins breathing
• If victim begins breathing, place in recovery position until EMS arrives

Pregnant women should NOT be given the Heimlich Maneuver from behind, but rather given abdominal thrusts to victim while she is lying on the ground.   

    Non-responsive Adult or Child – begin CPR

• Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

     Infant choking - observe signs of obstruction (speaking and breathing) 

• Assess the scene for safety
• Call or direct bystander to call EMS
• Support the infant’s head, neck, and back with hand and forearm
• Use thigh to support your arm
• Give five strong back blows
• Turn the infant over, supporting the head and neck, using your leg or nearby object
• Check mouth and throat for obstruction
• Give five chest compressions, using two fingers and check airway again
• Repeat these steps until the object is removed
• If victim begins breathing, place in recovery position until EMS arrives
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
• Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

Allergic Reactions

People have allergic reactions to many things, including foods, insect stings and bites.  Although many allergic reactions are mild, some can become severe within minutes. People who have severe allergies may carry an epinephrine pen.  Some states and organizations permit first aid rescuers to help people use their epinephrine pens.  First aid rescuers can help administer an epinephrine injection, if permitted to do so by their state regulations and/or company. 

    ***Anaphylaxis is the most severe form of allergic reaction.  It has a rapid onset and may cause death.  

Signs and Symptoms of Allergic Reaction

• Difficulty breathing
• very fast or very slow
• noisy and/or wheezing
• Inability to speak or breathe
• Swelling and itching skin
• Facial and/or tongue swelling
• Low blood pressure
• Vomiting 
• Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

    Caring for Victim of Allergic Reaction

• Asses the scene for safety
• Call or direct a bystander to call EMS
• Ask the victim if you can help
• Determine if victim has epinephrine pen

    With Epinephrine Pen

• Can help someone with a severe allergic reaction breathe more easily
• Contains a small amount of medicine which can be injected through clothing
• Takes several minutes to take effect
• Given on the side of the thigh
• Retrieve epinephrine pen
• Hold the pen in your fist without touching either end (needle comes out of one end)
• Push the end with the needle hard against the side of the victim’s thigh (about halfway between the hip and knee)
• Give the injection through clothes or on bare skin
• Hold the pen in place for approximately 10 seconds
• Remove the needle by pulling the pen straight out  
• Dispose of the pen properly
• Note the time of the injection
• Stay with victim until EMS arrives
• If victim does not respond to first dose, and EMS does not arrive within 5-10 minutes a repeat dose may be administered
• Remain with victim and record any changes in victim
• Report findings to EMS when they arrive
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
• Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

    Without Epinephrine Pen

• Remain with victim until EMS arrives and takes over
• Record any changes in victim
• Report findings to EMS when they arrive
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
• Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Heart Attack

A heart attack is the death or damage to the heart muscle and may lead to a victim’s death. A heart attack usually develops within the first 4 hours of after the onset of symptoms. A heart attack increases the chance of cardiac arrest in victims and unlike with a cardiac arrest, the heart usually does not stop beating. Early recognition of signs and symptoms can improve a victim’s chance of survival. 

Signs and Symptoms of a Heart Attack

• Pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, toothache, headache
• Shortness of breath
• Nausea, vomiting and/or general upper abdominal discomfort
• Heartburn and/or indigestion
• Arm pain (commonly in the left arm, but may be both)
• Overall fatigue
• Sweating
• Some victims (about ¼ of all heart attacks) are silent, without chest pain or symptoms

***Women, the elderly and people with diabetes are more likely to have atypical signs of a heart attack – ache in the chest, heartburn or indigestion, or an overall uncomfortable feeling in the back, jaw, neck or shoulder.

Caring for a Heart Attack Victim
   
 If victim is NOT breathing:

• Assess the scene for safety
• Call or direct a bystander to call EMS
• Retrieve AED, if available
• Check breathing
• Begin CPR
• Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

    If victim is breathing:

• Assess the scene for safety
• Call or direct bystander to call EMS
• Ask if you can help
• Encourage victim to remain calm and in a comfortable position (recovery position if possible)
• Offer 1 adult dose or 2 low dose aspirin, if certain the victim is experiencing a heart attack and has no known allergy
• Stay with victim until EMS arrives and takes over 
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all - begin CPR
• Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
• If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 minute 

Week 7: First Aid Basics

First aid is the immediate care given to someone in an emergency situation, due to an illness or injury before EMS(Emergency Medical Services) arrives and takes over. Most of the time first aid is provided by a bystander (or by the victim) with minimal or no medical equipment. First aid is usually provided for minor illnesses and injuries. However, first aid may also be provided to someone who has a more serious illness or injury, such as a heart attack or severe bleeding.

Important Terms

Fear of being sued has caused reluctance for bystanders to become rescuers in emergency situations. However, initial rescuers are rarely sued and in most emergencies you are not legally required to provide first aid.

Good Samaritan Law – provides protection against lawsuits for persons who are acting in good faith, while providing reasonable first aid. These laws are not a substitute for competent first aid or for staying within the scope of rescuer training. Laws vary from state to state, and it is important to become aware of your state’s guidelines.

Although laws vary, Good Samaritan protection generally applies when the rescuer is:

• Acting in an emergency situation
• Acting in good faith, indicating that he or she has good intentions
• Acting without compensation
• Not guilty of malicious misconduct or gross negligence toward the victim (intentionally NOT following established medical guidelines)

Duty to Act – requires an individual to provide first aid when they have a legal duty. If a rescuer does not have a legal duty to provide care he or she is not required to provide first aid.

Duty to act may imply in the following situations:

• When it is a requirement of employment. If you are designated as responsible for providing first aid to meet Occupational Safety and Health Administration (OSHA) requirements and you are called to emergency, you are required to provide first aid. (some examples of occupations that may require a duty to act include, but are not limited to: park rangers, athletic trainers, law enforcement officers, life guards, teachers)
• When a pre-existing responsibility to a person exists. If you have a pre-existing relationship and are responsible for a person, for example a parent, you must give first aid if they need it (some examples of pre-existing relationships are parent/child, driver/passenger).

Consent

• Permission from a responsive (alert) person allowing you to provide care.

Implied Consent

• When a victim is unconscious, it is understood that if the person were responsive (alert), he or she would request and allow you to provide care.

Abandonment

• When a rescuer initiates care and fails to continue to provide care until EMS or a second rescuer takes over.

Negligence

• When you have a duty to respond to an emergency situation and you fail to provide care or give inappropriate care which causes injury or harm.

Universal Precautions

• Wearing gloves, gowns, masks, and other protective devices every time you provide care in situations where you may come into contact with bodily fluids.

Clinical Death

• When a victim’s breathing and heartbeat stops. There is a high likelihood that victims who are clinically dead for less than 6 minutes can be revived with little to no cellular damage.

Biological Death

• When a victim’s breathing and heartbeat stops. Persons who are clinically dead for 10 minutes or more may have irreversible damage to brain cells and tissues. Reviving a victim is not likely, however it is not impossible.

Rescuer Concerns

Safety

• Rescuers should never enter unsafe situations. If your safety or that of the victim’s is at risk, do not attempt to provide care. Instead call EMS and wait for EMS support to arrive.

Infectious Disease

• Using personal protective devices, such as gloves, masks, gowns, etc… can reduce your exposure to infectious diseases.

Lawsuits

• States have Good Samaritan laws in place to provide protection for rescuers who are acting in good faith, in situations where the rescuer does not have a legal duty to provide care.

Hurting a Victim

• Victims who are clinically dead are helped when provided care and not often made worse with rescue efforts.

Inability to Save Victim

• Rescuers should focus on providing care to the best of their ability. Basic life support efforts can improve a victim’s chance of survival. Rescuers who have provided care in traumatic situations may feel overwhelming emotions. If a rescuer continues to experience depressed like symptoms it is important to seek support from an outside resource.

Personal Protective Equipment (PPE)

Personal protective equipment should be used when available, prior to providing care. This equipment is designed to minimize exposure to infectious diseases and bodily fluids.

Gloves

• Always use medical exam gloves when providing care
• Check for rips, tears or damage before providing care
• Remove any jewelry that may damage or cause tears
• If you have a latex allergy use alternative vinyl or nitrile gloves
• Remove gloves using skin to skin and glove to glove method
  • Using gloved hand, pinch the wrist of the other gloved hand
  • Pull the glove off while turning inside out, place in palm of gloved hand
  • Using bare hand place fingers inside wrist of gloved hand and remove inside out, collecting the gloves inside each other
  • Dispose of gloves in an appropriate container

Rescue mask/Face shield

• Always use when providing rescue ventilations
• Mask or shield should have a one way valve to prevent exposure to bodily fluids
• Dispose of mask/shield in an appropriate container

Chain of Survival

The Chain of Survival is a common way of describing the order in which rescuers should provide care for a victim of cardiac arrest. Early action can improve the chance of a victim’s survival.

Link One: Early Access

• Rescuer recognizes early warning signs and immediately calls EMS to activate EMS (emergency medical services) to provide early access to care.

Link Two: Early CPR

• Rescuer immediately begins CPR cycle to continue minimal supply of blood to the victim’s heart and brain until defibrillator and EMS personnel take over.

Link Three: Early Defibrillation

• Rescuer utilizes AED (automated external defibrillator) to administer a shock to the victim which may restore the heartbeat in some instances.

Link Four: Early Advanced Care

• EMS arrives and provides advanced cardiac life support care to victim of sudden cardiac arrest. In addition, EMS may provide IV fluids, medications, and use advanced airway devices.

Action at an Emergency

In an emergency situation, the bystander is a vital link between the victim and Emergency Medical Services (EMS). When entering the scene of an emergency situation, it is important to recognize the severity of the emergency before deciding how to respond.

Assess the Scene

Always remember to check the scene for safety hazards BEFORE providing care, it is important to ensure if you and the victim(s) are in a safe location, free of imminent danger or hazards.

• 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
• Safety
  • If the area is unsafe for the victim or rescuer, move the victim to a safe location, if can be done safely
  • Do not put you or the victim’s safety at risk
  • If you cannot safely provide care, do not become another victim, call EMS and wait for EMS to arrive

Activate EMS

• For serious situations, always call EMS
• Provide vital information to EMS dispatcher
  • Your name and number
  • Location of emergency
  • Information about the type of emergency
  • Number of victims
  • Victim(s) condition
  • What care is being provided at the scene

Assess the Victim

• Check the victim for responsiveness
• Tap on the shoulder and shout, “Are you okay?”
• Ask the victim if you he or she would like you to provide care
• If the victim is facedown and unresponsive, turn the victim over
• Check the victim for breathing
  • If victim is not breathing – begin CPR
  • If victim is breathing – check the victim and provide care
• Check the victim for obvious signs of injury, such as bleeding, broken bones, burns, or bites
• Look for medical information jewelry to determine if the victim has a serious medical condition
• Place the victim in recovery position (on side)
  • If the victim has difficulty breathing because of vomiting, or other secretions
  • you have to leave an unresponsive victim to get help
• If the victim shows signs of shock, have the victim lie flat on back
• If the victim does not show signs of trauma or injury, raise the feet about 6-12 inches.
  • Do not raise the feet if it causes the victim any pain

Provide Care

• Decide to provide care
• Determine what type of care is needed
• Begin care immediately – early care is critical for a victim’s survival

Victim Assessment

When providing care to a victim it is important to identify and correct any condition that may not be immediately life threatening, but may have the potential to become life threatening should they not be corrected.

SAMPLE

Gather information about victim using the SAMPLE history method. Ask victim about the following information

• Signs and symptoms
• Allergies
• Medications
• Past medical history
• Last meal eaten
• Events leading to the injury or illness

Medical information tags may identify allergies, medication, or medical condition

DOTS

Use the DOTS method to check the victim head to toe for the following conditions

• Deformity
• Open wounds
• Tenderness
• Swelling

Head to Toe exam

• Head – look for blood, check eyes, check mouth for loose teeth or blood, check the nose and ears for fluid or blood, look for bruising of the eyes or behind the ears
• Neck – look for bleeding, distention of the jugular vein, open wounds, or tracheal deviation
• Chest –look for blood, broken ribs, open wounds, accessory muscle breathing
• Abdomen –look for bleeding, abdominal wounds, tenderness, bruising
• Legs –look for bleeding, bruising, open wounds, broken bones, deformities
• Pelvis –look for bleeding and instability
• Arms –look for bleeding, bruising, open wounds, broken bones, deformities

While you are waiting for EMS to arrive

• Recheck the victim’s condition using ABC assessment:
  • Airway – use head tilt-chin lift method
  • Breathing – look, listen and feel for breathing
  • Circulation – check for severe bleeding
• Treat for shock
  • Help victim lie on back
  • Keep covered and warm
  • Do not give anything to eat or drink
• Remain with victim and record any changes in the victim’s condition
• Report your findings and care to EMS when they arrive
• If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
  • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
  • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Week 6- Airway Obstruction

Airway Obstruction

People can accidentally choke on many types of objects. Small foods, such as hard candy, peanuts, and grapes can be considered major offenders due to their shape and size.  Nonfood items such as balloons, marbles, toys and coins can often become choking hazards for children and infants.

Identifying Airway Obstructions

When an object becomes lodged in the airway it can be considered a mild to severe airway obstruction, depending on the victim’s inability to breathe.  Good air exchange and the ability to make forceful coughing efforts, is usually present in a mild airway obstruction. If a victim experiences a mild airway obstruction, the victim should be encouraged to continue coughing until the obstruction has been removed.  

Signs of a severe airway obstruction include all or one the following:

• Breathing becoming more difficult
• Weak and ineffective cough
• Inability to speak or breathe
• Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

Victims with a severe airway obstruction will have poor air exchange and may need immediate care.  Victims with a complete airway obstruction will have little to no air exchange and will need immediate care. 

Choking Victims

The universal distress signal for choking is grasping the throat. Choking victims may try to speak and grasp their neck in an attempt to alert others.  It is important to recognize the signs of choking, as not all victims know or use the universal distress signal.  Caring for an airway obstruction for an adult and child are the same while caring for an infant with a severe airway obstruction is different.  

Airway Obstruction - Responsive Adult or Child

Check victim for choking. Elicit response to question, “Are you choking?” Observe signs of obstruction (speaking and breathing). 

Begin Heimlich Maneuver:

• Move behind the victim
• Reach around the victim’s waist with both arms just above the navel 
• Place a fist with the thumb side against the victim’s abdomen
• Grasp the fist with other hand
• Press into the abdomen with quick inward and upward thrusts
• Continue administering thrusts until the object is removed or the victim becomes unresponsive
• If unable to move behind the patient, have patient lay on the ground and administer abdominal thrusts using both hands in the same location as if they were standing
• If victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call 911 and begin CPR cycle
•  Continue CPR cycle until a second rescuer or EMS takes over, you are too tired to continue, or victim begins breathing
• If victim begins breathing, place in recovery position until EMS arrives

***Pregnant women, in the late stages of pregnancy should NOT be given the Heimlich Maneuver from behind.  Instead rescuer should administer abdominal thrusts to victim while she is lying on the ground.   

Airway Obstruction - Responsive Infant

Check victim for choking. Observe signs of obstruction (speaking and breathing). 

• Support the infant’s head, neck, and back with hand and forearm
• Use thigh to support your arm
• Give strong five back blows
• Turn the infant over, supporting the head and neck, using your leg or nearby object
• Check mouth and throat for obstruction. 
• Give five chest compressions, using two fingers and check airway again
• Repeat these steps until the object is removed
• If the victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call 911 and begin CPR cycle 

CPR Cycle - Unresponsive Choking Victim

Administer 2 rescue breaths

• If first breath does not make chest rise, re-tilt head and give second breath
• After second breath - begin compressions
• Each time you open the airway to give a breath look for an object in the mouth or throat and if seen, remove it

Continue CPR 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 of the chest, but no more than 2.4”
• 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/Child: On the breastbone (sternum), 
• Infant: On the breastbone, just below the nipple line

     Continue CPR 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

Tongue and Airway Obstruction

Airway obstruction in an unresponsive victim lying on his or her back is usually the result of the tongue relaxing in the back of the mouth, restricting air movement.  Opening the airway with the head tilt-chin lift method may be all that is needed to correct this problem.

Week 5 - Hands Only CPR

Hands Only CPR

Mouth to Mouth

Mouth-to-mouth rescue breathing has not posed a serious safety hazard for victims and rescuers; however some rescuers may fear the risk of infectious diseases and are reluctant to give mouth-to-mouth rescue breaths to strangers.                

To avoid the chance that the victim will not receive any care, compression-only or “Hands Only” CPR method can be considered in these situations:

• Rescuer is unwilling or unable to perform mouth-to-mouth rescue breathing.
• An untrained bystander is following dispatcher-assisted CPR instructions.
• Personal protective devices are unavailable. 

Hands Only CPR Cycle

HANDS ONLY: Bystanders who witness a sudden cardiac arrest and try CPR can skip the mouth-to-mouth breathing. The American Heart Association says doing chest compressions alone, or “Hands Only” CPR, until help arrives can be just as good as performing full mouth to mouth CPR.

WHO'S IT FOR? Any adult who collapses, stops breathing and is unresponsive. Children, infants and drowning victims still need mouth-to-mouth breaths. 

WHAT TO DO: First, call or have a bystander call 911.  Then press hard and fast, about 100-120 times per minute, on the middle of the victim's chest.  Continue care until EMS arrives, an AED becomes available or you are too tired to continue.  

***Conventional CPR is recommended for children and infants, however due to the asphyxial nature of most pediatric cardiac arrests, rescue breaths may not be possible.  In these instances, the hands only method is preferred to no CPR.  

Week 4 - Infant 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:

• Infant: At least 1/3 of the infant's body (approximately 1 1/2 inches)

     Position: 

• On the breastbone (sternum), just below the nipple line

C-A-B Order

Immediately have a bystander call 911 and begin CPR.  If you are alone, complete five cycles (about 2 minutes) of CPR before calling for help. 

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 infant immediately begin 30 chest compressions, at a rate of 100-120 compressions per minute.  Administer to the breastbone (sternum), just below the nipple line, using two fingers.  Compressions should be swift, hard and consistent with a depth of at least 1/3 of the infant's body (or 1 1/2").  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

Week 3 - Child 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:

• Child: At least 1/3 of the child's body (approximately 2 inches)

     Position: 

• On the breastbone (sternum)

C-A-B Order

Immediately have a bystander call 911 and begin CPR.  If you are alone, complete five cycles (about 2 minutes) of CPR before calling for help. 

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 child immediately begin 30 chest compressions, at a rate of 100-120 compressions per minute.  Administer to the breastbone (sternum), using one had for children under the onset of puberty.  Compressions should be swift, hard and consistent with a depth of at least 1/3 of the child's body (or 2").  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

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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