Athens-Limestone Hospital s1

Athens-Limestone Hospital Education Department CPR Study Guide

Updated with The American Heart Association’s 2010 Guidelines and Recommendations

1 ADULT Chain of Survival: Immediate recognition of cardiac arrest and activation of the EMS/911 Early CPR that emphasizes chest compressions Rapid defibrillation if indicated Effective advanced life support Integrated post-cardiac arrest care

Choking 1. Conscious Choking a. “Are you choking?”- YES b. “Can you speak?”- NO c. “Can I help you?”- YES d. Provide inward and upward abdominal thrust, just above the navel. e. Continue until the object is removed or they become unconscious

2. Unconscious choking a. Call 911 or send bystander b. Begin CPR, starting with compressions c. Open the airway, remove the object if you see it (DO NOT do a blind finger sweep on any age victim) d. Attempt 2 breaths (if the 1st breath does not go in, reposition the head and try again), then resume compressions e. Prior to each breath, look in the airway for the object f. Continue CPR (30:2) g. If you are alone, perform CPR for 2 minutes, then go call 911 3. Adult rescue breathing a. Performed when the victim is not breathing adequately, but has a pulse b. For adults- 1 breath every 5-6 seconds (10-12 per minute) c. Recheck pulse every 2 minutes d. Breaths are effective with chest rising and falling

2 C-A-B Chest Compressions, Airway, Breathing

Adult CPR 1. Determine unresponsiveness, no breathing or no normal breathing (i.e, gasping) 2. Activate EMS, get AED/defibrillator a. Send 2nd rescuer, if available 3. Check pulse within 10 seconds 4. No pulse- begin cycles of 30 compressions and 2 breaths 5. AED/defibrillator arrives- Turn on and follow instructions 6. Check rhythm- shockable? a. Yes- give 1 shock and resume CPR b. No- resume CPR immediately for 2 minutes 7. Check rhythm/pulse every 2 minutes

High-quality CPR Rate of at least 100/min Compression depth at least 2 inches (5 cm) Allow complete chest recoil after each compression Minimize interruptions in chest compressions Avoid excessive ventilation

Advance Airway Once in place, do not stop compressions for breaths. Continuously perform compression and give 8-10 breaths per minute (one breath every 6-8 seconds).

3 Child and Infant Chain of Survival: Community effort that includes prevention Early CPR Prompt access to EMS Rapid advanced life support Integrated post-cardiac arrest care

Child Choking 1. Conscious Choking a. “Are you choking?”- YES b. “Can you speak?”- NO c. “I can help you.” (Ask the parent for permission to help.) d. Provide inward and upward abdominal thrust, just above the navel. e. Continue until the object is removed or they become unconscious

2. Unconscious choking a. Call for help, send bystander to call 911 b. Start chest compressions c. Open the airway, remove the object if you see it (DO NOT do a blind finger sweep on any age victim) d. Attempt 2 breaths (if the 1st breath does not go in, reposition the head and try again), then resume compressions (30:2) e. Prior to each breath, look in the airway for the object f. If you are alone, perform 2 minutes of CPR, then go call 911

3. Child and Infant Rescue Breathing a. Performed when the victim is not breathing adequately, and has a pulse of >60 per minute b. 1 breath every 3-5 seconds (12-20 per minute) c. Recheck pulse every 2 minutes d. Breaths are effective with chest rising and falling

4 Infant Choking 1. Conscious Choking a. Look for signs of choking (bluish skin/lips or high-pitched noises when breathing) b. Pick up infant and give 5 back blows between the shoulder blades, with the head supported and lower than the infant’s legs c. Flip the infant and provide 5 chest thrusts, with 2 fingers, just below the nipple line d. Repeat until the infant is able to cry or becomes unconscious

2. Unconscious Choking a. Call for help, send bystander to call 911 b. Start chest compressions c. Open the airway, remove the object if you see it (DO NOT do a blind finger sweep on any age victim) d. Attempt 2 breaths (if the 1st breath does not go in, reposition the head and try again), then resume compressions (30:2) e. Prior to each breath, look in the airway for the object f. If you are alone, perform 2 minutes of CPR, then go call 911

Child and Infant CPR 1. Determine unresponsiveness, not breathing or only gasping a. Send someone to activate EMS, get AED/defibrillator b. If alone and child suddenly collapses- activate EMS, get AED/defibrillator 2. Check pulse within 10 seconds a. Carotid for child over 1 year old, under check brachial pulse 3. No pulse- begin cycles of 30 compressions and 2 breaths a. Two healthcare providers may do cycles of 15 compressions and 2 breaths 4. After 2 minutes, if EMS had not been activated, then stop call 911 and get AED/defibrillator 5. Check rhythm- shockable? a. Yes- give 1 shock and resume CPR for minutes b. No- resume CPR immediately for 2 minutes 6. Check rhythm/pulse every 2 minutes

5 High-quality CPR Rate of at least 100/min Compression depth of at least 1/3 anterior-posterior diameter of chest, about 1 ½ inches (4 cm) in infants and 2 inches (5 cm) in children Allow complete chest recoil after each compression Minimize interruptions in chest compressions Avoid excessive ventilation

Automatic External Defibrillator (AED) Used when the heart stops beating normally and is in ventricular fibrillation or ventricular tachycardia. Asystole is not a shockable rhythm. AEDs are generally used on adults, but may be used on pediatric patients.

**** “If one is available, the rescuer should use a pediatric dose-attenuator system for attempted defibrillation of children 1-8 years of age with an AED. If the rescuer does not have an AED with pediatric dose-attenuator system, the rescuer should use a standard AED. For infants (<1 year of age), a manual defibrillator is preferred. If a manual defibrillator is not available, an AED with pediatric dose attenuation is desirable. If neither is available, an AED without a dose attenuator may be used.” American Heart Association 2010 Guidelines ****

Adult Defibrillation Sequence: Turn on AED Follow the AED prompts Resume chest compressions immediately after the shock (minimize interruptions)

Pediatric Defibrillation Sequence Turn AED on Follow the AED prompts End CPR cycle (for analysis and shock) with compressions, if possible Resume chest compressions immediately after the shock. Minimize interruptions in chest compressions.

Special Considerations with AED use: Hairy chest- remove enough hair to get good contact with the skin Dry chest if visibly wet Place pad at least 1 inch away from implanted devices. Never place pad on top of implanted device. Remove medication patch and wipe area before AED placement. 6 BLS Healthcare Provider Review Questions:

1. What are 2 ways to open the victim’s airway? Head tilt-chin lift and jaw thrust

2. What is the compression rate for all ages? At least 100 compressions per minute

3. How you know that your breaths are effective? With the rising and falling of the chest

4. If your breath does not go in, what should you do? Reposition the head and try again

5. If you suspect a spine or neck injury, how should you open the airway? Jaw thrust

6. Where do you check for the pulse? Adult- carotid Child- carotid Infant- brachial or femoral

7. Where do you place your hands when doing chest compressions on an adult or child? On the sternum (chest bone), mid-nipple line

8. Are agonal gasps of breath considered adequate breathing? No

9. Can you use adult AED pads on a child? Yes, if pediatric pads are not available

10. What are common signs of a heart attack? Pain in the center of the chest, the pain may radiate to the side, back, neck, jaw or arms, nausea and sweating

11. What are common signs of a stroke? Weakness on one side of the body, trouble speaking, dizziness, drooping mouth