CPR & AED
Emergency Care Online Course
Recognize when cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED)
Acting in an emergency is important and can make a difference to a victim of injury or illness.
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Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many emergencies, such as a heart attack or near drowning, in which someone's breathing or heartbeat has stopped.
The American Heart Association recommends starting CPR with hard and fast chest compressions. This hands-only CPR recommendation applies to both untrained bystanders and first responders.
The Good Samaritan Law protects individuals who assist those who are injured, ill, or in peril.
As long as someone is acting voluntary and without expectation of reimbursement or compensation while performing such aid on-site, they will have legal protection. When performing CPR, every second counts, so unless unique circumstances apply, don’t hesitate to call 911 and perform CPR immediately.
Before attempting CPR on someone
There are several things you must do. Make sure you and the patient aren’t in any danger. If possible, resolve the risk or move the patient out of harm’s way. If unable to do so for whatever reason, immediately call 911.
Check the patient to determine if they are conscious or not. Do not check for a pulse because time is of the essence and finding a pulse can take too long. Call out to the patient asking, “Are you okay?” Repeat if necessary. If the patient doesn't respond, immediately call 911 and then perform CPR—initiating Circulation, Airway and Breathing tasks (the C-A-B’s). Also, if possible, have someone nearby call 911 and begin CPR, immediately.
Understanding Duty to Act
Duty to act is the duty requiring a person to take necessary action in order to prevent harm to another person or to the general public. Whether you are required to follow through depends on the situation and the relationship between the parties. In some cases, breach of duty may put a party at liability for damages.
For laypersons, duty to act requires that you provide care if you have a legal duty. If you do not have a legal duty to provide care, you are not required to provide it.
Fear of providing care
There are a number of factors to weigh up when considering providing care. COVID-19 is an important concern, but the risk of contracting diseases can be reduced by wearing personal protective devices like masks, gloves, and gowns that limit exposure.
If you feel fear of providing care due to possible legal issues, know that rescuers who provide care without a legal duty and act in good faith are protected by Good Samaritan laws.
If the situation is actively unsafe, do not attempt care. If you or the victim are at risk, it is best to call EMS and wait for support to arrive
Fear of providing care
In some cases, you may be unable to save a victim. Rescuers should still attempt to provide the best care they are able to. A victim’s chances of survival can be improved by even basic efforts at life support. In accidents, victims who are clinically dead may still be helped when given care. Rescue efforts will not worsen their condition.
Following a traumatic situation in which you provided care, you may experience overwhelming emotions. If you continue to feel symptoms like depression, be sure to seek help from a professional source.
Personal Protective Equipment
Putting On Gloves
Use disposable gloves when providing first aid care. If you have a latex allergy, use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged.
Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly.
Out-of-Hospital Chain of Survival
This is the idea that every step in the out-of-hospital chain of survival is critical to a successful outcome, just as every link in a real chain is critical to its integrity. Additionally, a weak link in the out-of-hospital chain of survival also includes any delays in moving from one step to the next.
The earlier these steps take place in an emergency, the better the chance of a patient’s survival.
Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease.
Cardiovascular disease causes damage to the heart and blood vessels. Cardiovascular disease often leads to heart attack or stroke. The best way to survive a heart attack or stroke is to never have one. The key for cardiovascular disease is to focus on prevention.
Signs and Symptoms may include
- Chest discomfort-pressure, tightness, that may radiate to jaw and arms.
- Shortness of breath
- Feeling of weakness
Women present more with shortness of breath, extreme fatigue, or flu-like symptoms About a third of women experience no chest pain.
Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet.
Stroke is the 3rd leading cause of death in the United States. Strokes can be one of two types: ischemic– a clot in a blood vessel that restricts or obstructs blood flow to the brain; hemorrhagic- a blood vessel that ruptures and prevents blood flow to the brain. In either case, the brain is deprived of oxygen and tissue starts to die.
Signs and Symptoms may include
- Numbness or weakness of the face, arm or leg, especially on one side of the body. The acronym FAST helps in assessing a stroke: F– facial droop, A– Arm drift, S– Speech, T– Time
- Confusion, trouble speaking or understanding
- Trouble seeing in one or both eyes
- Trouble walking, dizziness, loss of balance or coordination
- Severe headache with no known cause
Recognize the signs and symptoms of a stroke, activate EMS, give nothing to drink or eat, and keep the patient calm and quiet. Monitor patient and be prepared to start CPR if necessary.
Checking the Scene
Key Questions to ask:
- Is it safe for me to help?
- What happened?
- How many patients are there?
- Am I going to need assistance from
- Do I have my personal protective equipment ready to use?
Check the Patient
Tap and shout. Is there any response?
While checking for responsiveness, look for normal breathing by looking at the person’s chest and face. Is the patient breathing normally?
Agonal respirations are not normal breathing. They would be characterized as occasional gasps. The chest does not rise.
Activate EMS – Call 911
Send someone to call and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.
If you are alone and no one is available:
PHONE FIRST for adults and get the AED. Return to start CPR and use the AED for all ages.
CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.
CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose).
If the victim is unconscious with no normal breathing, begin chest compressions.
Give 30 chest compressions at a rate of 100-120 compressions per minute for all ages.
Hand placement for compressions:
Adult – Place heel of hand of the dominant hand on the center of the chest between the nipples. The second hand should be placed on top. Compress 2-2.4 inches deep.
Child – Hand placement is the same as adult. You may choose to use only one hand in the center of the chest between the nipples for a very small child. Compress at least 1/3 the depth of the chest.
Infant – Place two fingers on the center of the chest between the nipples. Compress at least 1/3 the depth of the chest.
Open Airway using head tilt chin lift. Look in the mouth to make sure the air- way is clear. If you see any foreign object, sweep it out right away.
Give 2 breaths lasting 1 second each. Watch for chest rise and fall.
Note: If not using a rescue mask, make sure you make a seal over the mouth on an adult or child and pinch the nose closed each time you give a breath. On an infant, make sure to cover the mouth and nose with your mouth.
Continue cycles of 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene becomes unsafe, or you are too exhausted to continue.
- Check the Scene for Safety
- Check the person for responsiveness and normal breathing
- Call 911
- Give 30 Chest Compressions
- (Adult rate of 100-120 per minute, 2-2.4 inches deep)
- (Child or infant rate of 100-120 per minute, 1/3 depth of chest)
- Open the Airway
- Give 2 Breaths
- Continue cycles of 30 compressions to 2 breaths.
AEDs are designed to shock the heart, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, states whether a shock is advised and then powers up, the operator then pushes a button that will deliver the shock.
Each minute that defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation increases survival rates to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready.
If you are giving CPR to a child or infant and the available AED does not have child pads or a way to deliver a smaller dose, it is still recommended to use the AED even with adult pads. With adult pads for a small child or infant, you would place one pad on the center of the chest and the other on the center of the back between the shoulder blades.
Remove a patient from standing water, such as in a puddle, before AED use. Rain, snow, or a damp surface is not a concern.
Patient should be removed from a metal surface if possible
Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker.
Remove medication patches found on the patient’s chest with a gloved hand.
Never remove the pads from the patient or turn the machine off.
How to Use an AED
Turn the AED on and bare the chest. Dry the chest if it is wet. If there is excessive hair you may need to shave it off
Place the pads. Place one pad on the patient’s upper right chest above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Follow the directions shown on the pads for the AED pad placement.
Quickly check the pads. Make sure pads are pressed down firmly.
Follow AED prompts.
Stand Clear. Do not touch the patient while the AED analyzes
If the AED says, “Shock advised, charging…,” shout, “Clear” and make sure no one is touching the patient. Push the shock button when the AED tells you to.
If no shock is advised give CPR if the patient is not moving and not breathing.
After the Shock, begin CPR.
The AED will reanalyze every 2 minutes and prompt for a shock if needed.
Child and Infant AED Pad Placement
For children 8 years old and younger and infants, an AED with pediatric pads is preferred. If only a standard AED with adult pads is available, it should still be used for children and infants in cardiac arrest. When placing the pads on a child, the pads should not touch.
For a small child or infant, the pads should be placed one in the center of the chest and one in the center of the back between the shoulder blades.
Ask, “Are you choking?
If a person is unable to cough, breath or speak, activate EMS
Adult and Child
- Stand behind the victim with one foot in-between the victims feet and your other foot behind you.
- Place the flat side of your fist just above the patients belly button. Grab the back of your fist with your other hand.
- Administer abdominal thrusts, pulling inward and upward, until the object comes out or the patient becomes unconscious.
Support the infant’s face and place body on your forearm.
- Keep the infant’s head lower than the feet.
- Administer 5 back blows between the shoulder blades with the palm of your hand.
- Support the infant’s head. Turn the baby over onto your other forearm. Give 5 chest thrusts.
- Continue back blows and chest thrusts until object comes out or infant becomes unconscious.
Special Circumstances for Choking:
- If the patient is pregnant or too large to reach around, give chest thrusts instead.
- If you are giving someone abdominal thrusts and the person goes unconscious, lower the patient safely to the ground
- Activate EMS, send someone to call 911
Give 30 chest compressions
Open the airway and check the mouth for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.
Attempt rescue breaths. If breaths do not make the chest rise, reposition head and reattempt rescue breaths.
Give 30 more chest compressions
Open the airway again and check the mouth for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.
Give 2 more breaths.
If breaths do not make the chest rise, reposition head and reattempt rescue breaths. Continue compressions, foreign body check, breathing attempts.
If victim is still unresponsive and not breathing normally, continue CPR with cycles of 30 compressions to 2 breaths.
What are some signs of an Overdose?
- Very small pupils
- Slow or shallow breathing
- An inability to speak
- Faint heartbeat
- Limp arms and legs
- Pale skin
- Purple lips and fingernails
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