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CPR Basics
 
Assess the Scene
Ensure scene is safe
Check 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
 
Assess the Victim
Look for life threatening conditions or injuries
Determine the victims approximate age
CPR guidelines are:
    • Adult CPR - puberty and older
    • Child CPR - 1 year to puberty
    • Infant CPR -birth to 1 year
 
If bystanders are present:
  • Instruct a bystander to call 911
  • Ask for assistance with CPR and proceed to next step
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:
  • FIRST complete five cycles (about 2 minutes) of CPR
  • Call 911 and retrieve AED
  • Perform CPR cycle until EMS takes over or you are too tired to continue

Infants:

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

Begin CPR
C-A-B (Compressions-Airway-Breathing) Order
• Begin Compressions - 30 compressions at a rate of 100-120/minute SWIFT HARD and CONSISTENT
• Open Airway with head tilt–chin lift method, check breathing, AT THE SAME TIME
• Give 2 rescue Breaths 
 
Compressions
    Keep blood flowing to the brain
    Should be swift, hard and consistent
Hands and Position
   •Adult: Two hands 
   •Child: One hand (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
   • 30 compressions then 2 breaths per cycle
   100-120 compressions per minute
   
Continue until EMS arrives, someone else takes over or you are too tired to continue
 
Airway
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:
    •Mouth-to-barrier
    •Mouth-to-nose
    •Mouth-to-stoma (An artificial opening in the neck, such as a breathing tube)
CPR Cycle
    •30 compressions / 2 rescue breaths
    •At a rate of 100-120 compressions per minute
    •Check for signs of breathing (rise/fall of chest)
Continue CPR cycle until:
    •AED becomes available
    •Victim shows signs of life
    •A second rescuer takes over
    •EMS takes over
    •You are too tired to continue
 

  1. What is the correct order for the CPR sequence?

  2. Which is true when performing CPR compressions?

  3. Chest compressions should be

  4. A CPR cycle consists of

 
Airway Obstruction

*If you KNOW the victim is choking

Adult or Child

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

Unresponsive adult or child 

  • Begin CPR
  • Compressions (30)
  • Check Airway Head Tilt/Chin Lift
    • Remove object if dislodged
  • Breaths (2)
  • If breath does NOT go in due to blocked airway
    • Re-tilt head
    • Reattempt breath
    • If breath STILL does not go in, move on to compressions
  • Continue CPR Cycle
  • Remove object if dislodged
  • If victim regains consciousness, move onto their side to recovery position

Infant

Responsive infant: Infant Back Blows

  • 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/Check airway
  • Continue until object is removed or victim becomes unresponsive

Unresponsive infant 

  • Begin CPR
  • Compressions (30)
  • Check airway and open using head tilt/chin lift
  • Perform 5 back blows
    • Remove object if dislodged
  • Breaths (2)
  • If breath does NOT go in due to blocked airway
    • Check airway
    • Perform 5 back blows
    • Check for dislodged item
    • Check airway and re-tilt head
    • Reattempt breath
    • If breath STILL does not go in, move on to compressions
  • Continue infant obstructed airway CPR Cycle:
    • 30 Compressions - Check Airway - Perform 5 Back Blows - Check Airway - Give 2 Breaths - Repeat
  • Remove object if dislodged
  • If victim regains consciousness, encourage vocalization

  1. The Heimlich maneuver, also known as abdominal thrusts, should be performed from behind on:

  2. The Heimlich maneuver back blows should be performed on a choking infant by:

  3. Any non-responsive choking victim should be immediately given:

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.
 
Hands Only CPR
Call or direct bystander to call 911. 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 at all. 
 
  1. If a victim is experiencing agonal breathing CPR must begin immediately. What are the signs of agonal breathing?

  2. Which are true for choking victims?

 
AED-Automated External Defibrillator
 
***AED’s are designed for use on adult victims, however most can be used with pediatric victims with proper pediatric pads.
 
Heart Attack vs Cardiac Arrest
A heart attack and cardiac arrest are often confused with each other. Although a heart attack can lead to cardiac arrest, they are different. A heart attack is usually slow or prolonged death or damage to the heart muscle, whereas cardiac arrest is a sudden electrical malfunction caused by an outside source. Cardiac arrest often results in death if not treated quickly. The only effective lifesaving treatment for cardiac arrest, outside of a hospital, is CPR or the use of an AED.
Signs and Symptoms of Heart Attack
        •Pain, fullness, and/or squeezing sensation in 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.

  1. When it is suspected someone is having a heart attack, ALWAYS call 911 immediately. At what point should you begin CPR?

 
Signs and Symptoms of cardiac arrest
Cardiac arrest symptoms are sudden and immediate and include:
        •Collapse
        •No pulse
        •No breathing
        •Loss of consciousness
Treating a heart attack OR cardiac arrest
If victim is NOT breathing:
    •Call or direct a bystander to call EMS
    •Retrieve AED
    •Check breathing
    •Perform CPR (if the victim is NOT breathing or only gasping)
        •Victims in cardiac arrest often have agonal breathing (also known as agonal gasps)
        •Agonal breaths do not provide adequate oxygen to the body and can be described as gurgling, moaning, snorting, agonal or labored breathing
        •Healthcare providers must be able to distinguish between agonal breathing and adequate breathing
    •Continue CPR Cycles until EMS or second rescuer takes over, AED becomes available or you are too tired to continue.
If victim IS breathing:
    •Call or direct bystander to call EMS
    •Encourage victim to remain calm and in a comfortable position (recovery position if possible)
    •Offer 1 adult dose of aspirin
    •Stay with victim until EMS takes over
CPR must be started and continue until defibrillator (AED) becomes available.  
**If an AED is immediately available, following an adult's collapse, perform 2 minutes of the CPR cycle BEFORE attaching electrodes.
 
AED Use
About AEDs
        •Analyzes the victim’s heart rhythm
        •Determines and advises when shock is needed
        •Delivers electrical shock to victim in cardiac arrest
        •Reestablishes a heart rhythm which will generate a pulse
AED Use Overview 
DO NOT DELIVER SHOCK IF ANY OF THE FOLLOWING CONDITIONS EXIST:
*Someone is touching the victim     *The victim is alert    *The victim is wet or in water.
        •Remove victim from any standing water or metal surfaces
        •Dry chest if noticeably wet
        •Remove enough hair from chest for pads to make good skin contact
        •If victim has a transdermal medication patch, remove the patch and clean area prior to attaching pads
        •Use appropriate AED pads
        •Apply AED pads to bare chest and the cable to AED unit
       •Place the unit between you and victim – by victim’s shoulder
        •Turn on the AED and follow voice prompts
        •Stand clear
        •Wait for unit to analyze the heart rhythm
        •Deliver shock, if needed
        •Perform CPR cycle
 
AED Pad Placement
When placing pads, be sure they do not touch each other
       Adult:
        •Place one pad on the upper right chest
        •Place the second pad on the left of ribcage (4-6 inches below the armpit)
        •If victim has a pacemaker, place the AED pad at least 1 inch to the side of the implanted device
       Child: 
        •Use adult or pediatric pads
        •Place one pad between right nipple and collarbone
        •Place the second pad on the left rib cage (3-4 inches below the armpit)
        Infant: 
        •Use infant pads only
        •One pad should be placed in the center of the CHEST and the second pad to the center of BACK
 

  1. If an AED is immediately available following an adult's collapse, you should:

  2. Adult and Child pads should be placed one on the victims upper right chest and one on the victims left rib cage. Infant pads should be placed

 
AED Shock Administration
After pads are placed, wait for AED to analyze the rhythm
If a shock IS indicated
        •Do NOT touch the victim
        •Ensure no one else is touching the victim
        •Press the shock button
After shock is delivered
        •Keep pads on the victim
        •Complete 2 minutes of CPR cycle
        •Reassess the victim’s condition
        •Follow AED voice prompts to repeat cycle
Continue following AED voice prompts, administering CPR cycle and AED shock until
        •The victim shows signs of life
        •A second rescuer or EMS takes over
        •You are too tired to continue     
 
If NO shock is indicated
        •Continue CPR cycle if the victim is unresponsive
        •Reassess the victim’s condition
        •Check heart rhythm with AED at end of each cycle and follow AED voice prompts
        •Continue CPR cycle/AED check until a second rescuer or EMS takes over or you are too tired to continue
 

  1. If the AED indicates a shock to be given, AFTER administering shock you should

  2. If NO shock is indicated and victim is unconscious