CPR/AED/First Aid Training by Rob Sundquist, MS ATC LAT Director of Sports Medicine/Head Athletic Trainer Creekview High School

Chain of Survival The chain of survival are four steps to help increase the chances of an injured person of surviving a cardiac arrest.

Chain of Survival – step one After determining that there is an injury needing advanced care; if unconscious tap and shout. Call 911 Questions you will need to answer: Nature of the emergency? Where are you? How many are hurt? Ages of who is/are hurt Who are you? Has treatment started? Only hang up when instructed to do so by operator.

Chain of Survival – step two Begin CPR Most adult cardiac arrests (CA) victims heart is in ventricular fibrillation (VF) - Abnormal chaotic heart rhythm that prevents the heart from pumping blood. CPR will not usually stop VF but plays an important part in pushing oxygenated blood to the brain and heart and prolonging VF so that an AED will be useful. CPR can double or triple the victims survival rate For every passing minute without CPR; rate of surviving drops 7-10%. With CPR there is only a 3-4% drop each minute

Chain of Survival – step three Use an AED The use of the AED will stun the fibrillating heart, if the heart is still viable the normal pacemakers in the heart will begin firing and start a normal rhythm. If used within 5 min; chances of survival is 49-75%. Using an AED is simple.

Chain of Survival – step four Advanced Care – EMS Response time is 7-8 minutes – CPR is extremely important.

How to recognize major emergencies

Heart Attack Myocardial infarction Coronary heart disease is the leading cause of death in our nation. During MI - part of heart muscle is starting to die. Caused by a blockage of an artery (coronary) due to buildup of cholesterol deposits or a blood clot. Victims are usually awake and can talk but feels severe pain Most critical time is within the first 30 minutes after Sx begin.

Heart Attack Most common symptoms Pain or pressure in the center of the chest – which last more than 3-5 minutes. Pain might feel pressure, fullness, squeezing, or heaviness Pain might spread to shoulder, neck, lower jaw and down arm (usually the right). Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again. Other Sx – lightheadedness, fainting, sweating without fever, nausea, shortness of breath Most victims will downplay symptoms, you must take action!!! Call 911, get the nearest AED, and have the person rest in a position that is comfortable where they can breathe easily. Put them in an area that you can get them to the floor easily and paramedics can get in.

Cardiac Arrest When the heart stops beating. Usually caused by VF, which begins where the heart muscle is injured. Without blood flow and no pulse the person becomes unconscious and stops breathing and collapses. VF and cardiac arrest may be the only symptom of a heart attack. AED is only thing that will stop a VF

Stroke Its is a rapid onset of neurological problems like weakness, paralysis in one or more limbs, difficulty speaking, visual problems, intense dizziness, facial weakness, altered consciousness, and severe headache. Two causes blood vessel to brain is blocked by a blood clot blood vessel to brain breaks #3 cause of death and #1 cause of serious disability among Americans

Stroke Most signs overlooked; three major signs to observe facial droop arm weakness – most obvious when victim attempts to extend arms with eyes closed – one or both may not move very well speech difficulties – slurring of words and sentences Call 911 immediately if see signs of stroke Provide CPR if needed

Foreign body obstruction Usually caused by food, but can be caused by many objects Major signs Universal choking signal poor ineffective coughs inability to speak high pitched sounds while inhaling increased difficulty breathing Blue lips or skin (cyanosis) Loss of consciousness and responsiveness Heimlich maneuver in conscious victim CPR in unconscious victim

CPR - adult

Step one Make sure area is safe Check unresponsiveness – tap and shout – “Are you alright” If no response – call 911 or send someone directly to call Grab AED if one present or send someone to get one.

Step two If possible place victim supine and on a hard surface. If victim is prone – roll over Try protecting the neck as much as possible if you suspect neck injury

Begin CAB’s C = Circulation If not breathing or see abnormal breathing begin chest compressions Agnal breathing – gasps that occur at the beginning of CA – not efficient – act as they are not breathing No checking for pulse or signs of circulation just go straight to CPR Place one palm on the chest between the nipple line Interlock your other hand on top of the hand on the chest Bring your shoulder over the top Make sure you have a wide base (knees spread just outside your shoulders) Press down 1 ½ -2 inches at a rate of 100 compressions per minute – hard and fast Make sure chest recoils completely Complete 30 compressions and then give two breaths. Do not stop unless and AED is available, victim moves, or you substituted out (if two rescuers are available – switch every five cycles of 30:2 – approx two minutes) – reduces fatigue

A = Airway B = Breathing Head tilt and Chin lift If you do not detect normal breathing – give two breaths lasting 1 second each (may use barrier) Watch chest rise, allow exhalation before next breath. If breaths do not go in – reposition head and try again. Practice

Practice Practice compressions 30 times twice – alternate with partner – no breaths 60 sec test – just compressions – try to get 95-105 compressions – allows to learn rhythm. Perform 1-2 times or as needed Two minute test – performing 30:2 (includes breath) - should complete five cycles in that time.

Very important to limit interruptions of chest compressions. During the beginning stages of CA – chest compressions are more important than breaths. Oxygen level will stay high for the first few minutes but blood is not moving to due to the heart not pumping. Breathing becomes as important as the length of CPR continues Very important to limit interruptions of chest compressions. Be mindful not to give to many breaths, too much breath or too forceful – may cause gastric filling and the resultant complications, and/or cause diminished blood flow and reduce survival.

Vomiting/other breathing If someone does throw up – do not panic. Roll victim towards you. Use your body to hold them. Clean out the mouth – roll back and continue. Mouth to nose Use when it is impossible to use the mouth due to injury. Face shields and masks – may be used - Very little chance of transfer of bodily fluids if perform mouth to mouth without mask. Using shield or mask can slow down the CPR process “Chest compression only” CPR is more beneficial than no CPR at all.

Recovery position If victim begins breathing and having a pulse then turn victim to their side with lower arm in front. No position is perfect- just make sure they are stable, near a true lateral position, and there is no pressure on the chest to impair breathing

Potential neck injury If two or more responders One stabilizes the neck – they will be in charge if victim needs to be moved Place hands on the sides of the head and neck, using your hands to cup around the neck. Place pressure on head with forearms near the ears Elbows should be on the ground, wrists in ulnar deviation so that they come in contact with the head. This will limit the amount of movement that will occur if you have to move your body, for example moving so that CPR can be administered or when EMS puts on a neck brace. If movement is necessary then move body as one.

CPR – Child and infant

Child CPR (ages 1-8) Similarities with Adult CPR Location on chest for compressions is the same – nipple line Ratio of compressions to breaths the same – 30:2 Differences with Adult CPR In the chain of survival you will perform CPR first for two minutes performing five cycles of 30:2 – then call 911 (if you are alone) Reason is that most child and infant cardiac arrests are due from asphyxiation, so they will benefit more from the CPR. The depth you use for compression is 1/3 to ½ depth of the chest. Use one or two hands – which ever is more comfortable.

Infant CPR Similarities with adult CPR Similarities with Child 30:2 ratio of compressions to breaths Similarities with Child Perform CPR first in the Chain of Survival, for the same reasons. If small enough you may carry to phone with you after completing the five cycles – use speaker phone Depth of compressions. Differences with CPR You will perform chest compressions one finger below nipple line You will place your mouth over mouth and nose of infant You will only puff air in If unsure if it is a child or not, if it can fit on your arm, then treat as an infant Practice

Foreign Body Airway Obstruction (FBAO) Heimlich Maneuver

Choking Universal sign of choking – hand around throat Ask questions Are you choking? Can you speak? May I help you? – Very important. If they say no leave them alone until they pass out – then it is assumed they want help. If a person can speak or can cough - do not help

Abdominal thrusts Practice Place yourself behind victim scissor you legs Front leg between victims legs Slightly bend knees Place hands on navel place hands on chest if woman is pregnant or victim is severely overweight Pull in and up continue until object is out or they pass out Use chest thrusts if you are unable to circumvent the abdomen If pass out lower them carefully to the floor begin CPR Only difference with CPR is you check mouth for object before breaths. Finger sweep only if you see object. Practice

Infant FBAO Infant – Finger sweep if see object Practice Conscious – place infant on forearm with babies mouth between fingers – back blows to upper back Unconscious – after back blows - five compressions – look for object give breath repeat cycle – back blows, compressions, look and breaths Finger sweep if see object Practice

Automated External Defibrillator AED

What is an AED? Automated external defibrillator – is an computerized defibrillator it can analyze heart rhythm recognize shockable rhythm advise the operator whether the rhythm should be shocked very easy to use AED’s computer chips analyze the rate, size and wave shape of human cardiac rhythm. will not shock a properly functioning heart will not shock a heart that has stopped – VF is not present

Universal steps of AED use Place AED parallel to patients left ear Power on the AED first Some automatically turn on when opened Attach the AED to the patients chest with electrode pads Remove clothing – to bear chest Be kind to females Dry patient or shave chest in area of electrode placement if needed Place one pad above right nipple and one to the side and below the left nipple. (CPR is continued up to the point of placing the pads on) Analyze rhythm Make sure everyone is clear (must say “stand clear of the victim”). No contact Push analyze Charge AED if shock is required (some machine charge automatically)

Shock if indicated – (after checking everyone is clear again) Begin CPR for five cycles then analyze again If shock is advisable again you clear everyone and shock If shock is not advisable – continue with CPR If victim has pulse and is breathing put into recovery position. DO NOT take off pads or turn off AED until prompted by EMS

Special Considerations Water Must remove victim from water or wet surface Dry before attaching pads Metal surfaces Is victim lying on metal surface? – if so move victim The metal surface may cause the shock form the AED to hit you. Children Children 8 and older use as soon as possible Children 1-8 – CPR for two minutes before using AED Transdermal medications Remove patch and wipe clean before attaching AED pads Implanted pacemakers and defibrillators Do not place an AED electrode directly over implanted device. Move at least one inch to the side of device Practice

First Aid

Medical emergencies Breathing difficulties Anaphylaxisis Seizures Asthma problems are increasing Most have medicines May need assist victim is administrating If symptoms continue to get worse call 911 Anaphylaxisis Severe reaction to allergen Victim may have epinephrine injector May need to administer Call 911 if medicine is not administered Seizures General rules – 1) Prevent injury 2) ensure open airway 3) maintain open airway after seizure is completed – place in recovery position Never try to restrain victim, place anything in the mouth.

Injury emergencies Bleeding Direct pressure best way If bleeding continues add more gauze or cloth; do not remove gauze or cloth Use elastic bandage to apply pressure to gauze and hold it in place. The use of tourniquets should be avoided unless in extreme matters The efficacy of elevation and pressure points is inconclusive; if used, use only in conjunction with direct pressure and when there is no apparent fracture or other underlying injury.

Wounds and abrasions Irrigate wounds until free of any foreign matter. Small wounds and abrasions should be cleaned thoroughly then have triple antibiotic ointment placed on it and covered. Larger wounds need to also be cleaned then covered and taken to doctor for possible stitches

Burns Thermal burns Electrical burns Cool burn with cold water until pain ceases Do not cool for more than 10 min. Can lead to further damage Burn blisters cover with loose gauze, but keep intact – breaking them can lead to infection Electrical burns Make sure electrical current is shut off before trying to help victim. CPR and defibrillation may be needed as well as burn treatment All electrocution injuries should be checked out by a physician

Spine stabilization Suspect possible spinal injury if… Car accident Injured from fall greater than their height Complains of neck pain, tingling, or extremity weakness Is not fully alert Appears to be intoxicated Appears frail or is >65 yrs old Has sustained a head injury - Manually stabilize the neck until help arrives.

Musculoskeletal trauma – sprains, strains, contusions, fractures For sprains, strains, contusions – apply ice for 20. Sprains elevate and place compression bandage R.I.C.E. – rest, ice, compression, elevation If victim has aversion to cold – place wet cloth between ice and skin Young kids and elderly especially susceptible Contusion you want to stretch the injury as well as ice If you are unsure of the injury suspect fracture – do not move or straighten injury. Place ice on area and splint in position, send to ER. If suspect dislocation – splint as is and send to ER.

Dental injuries Avulsed tooth Hold onto by the crown not the root (part embedded into gum Rinse off with water (do not scrub) Either place back into socket or place in glass of milk and see a dentist immediately Clean bleeding wound with saline solution or tap water Use cotton to apply pressure to stop bleeding

Environmental injuries Snakebite Do not suck wound, it will only exasperate the problem In case of Coral snake – wrap a bandage around the extremity of the bite – it will help slow the poison – then get to medical facility immediately. Coral snake bites and sucks Other snake bites, wash area with soap and water, try not to move extremity very much and get to medical facility. Cold injuries Hypothermia Immediately begin re-warming – remove wet clothes and wrap body surface with anything at hand; get to medical facility immediately If far from medical facility you begin active warming – placing near heat source, placing in warm (not hot) water. Frostbite Remove wet clothing, usually occurs on extremities, do not re-warm if there is any chance it could freeze again or you are close to a medical facility. Use luke-warm water if you are far from medical facility

Heat Injuries Heat cramps – muscle cramping, usually due to extreme loss of fluids Get to cooler area Replace fluids Ice and stretch area Heat exhaustion Dizziness, could have flushed skin or cool and clammy, disoriented, nausea, headache Get victim to cool area immediately Place ice on side of neck (carotid artery), arm pits, and groin area Watch for shock; could lead into heat stroke Heat Stroke – medical emergency – call 911 immediately Extreme disorientation, possible unconsciousness, very little sweating, internal temperature of >105. Cool down by any means

Drowning Get victim out of water as soon as possible Begin CPR immediately If you are alone – finish five cycles of CPR before calling 911

Poisons Poison control center – 1-800-222-1222 Chemical Burns Brush off any powder and remove all contaminated clothing Alki or acid exposure – rinse with copious amounts of water. Ingested poisons Do not ingest any medication; milk, activated charcoal, syrup of ipecac unless instructed by poison control

Shock Develops when there is not enough blood flowing to the cells of the body Causes in adults; loss of blood heart attack, allergic reaction Symptoms feel cold and shiver, feel weak, faint, or dizzy, restless, vomit, feel thirsty Treatment Call 911 Put victim on their back If not leg injury or pain raise legs 12 inches Cover victim with blanket If bleeding is visible – use direct pressure