1. CPR & AED
Lesson 5

2. Lesson 5 – CPR
CPR is a lifesaving technique that must be learned by every health care worker.
CPR is short for cardiopulmonary resuscitation.
Cardio means heart.
Pulmonary means lungs.
Resuscitation means to restore to life.
There for bringing the heart and lungs “back to life”
CPR
CPR is a lifesaving technique that must be learned by every health care worker. CPR is short for cardiopulmonary resuscitation. Breaking down these words helps to provide a description of the procedure:
Cardio means heart.
Pulmonary means lungs.
Resuscitation means to restore to life.
Therefore, cardiopulmonary resuscitation is bringing the heart and lungs “back to life.”

3. Lesson 5 – Basic Life Support
CPR is part of a life-saving system called Basic Life Support (BLS).
BLS includes the following steps:
Recognizing sudden cardiac arrest, heart attack, stroke, and airway obstructions.
Implementing cardiopulmonary resuscitation (CPR).
Performing defibrillation.
Basic Life Support
CPR is part of a life-saving system called Basic Life Support (BLS). BLS includes the following steps:
Recognizing signs of sudden cardiac arrest, heart attack, stroke, and airway obstructions.
Implementing cardiopulmonary resuscitation (CPR).
Performing defibrillation.
Health care workers must learn the techniques of BLS so that they can act quickly and correctly in emergency situations.

4. Lesson 5 – Cardiac Arrest
Cardiac arrest is when the heart suddenly stops circulating blood effectively through the body.
When cardiac arrest occurs, the electrical impulses in the heart become altered.
Ventricular fibrillation is a chaotic heart rhythm that makes the heart unable to pump blood effectively.
Cardiac Arrest
Cardiac arrest is when the heart suddenly stops beating. The causes of cardiac arrest include the following conditions:
Heart disease
Respiratory shock
Electrocution
Drowning
Choking
Drug overdose
Trauma
When cardiac arrest occurs, the electrical impulses in the heart become altered. Ventricular fibrillation is a chaotic heart rhythm that makes the heart unable to pump blood effectively. Ventricular fibrillation can lead to death if the condition is not reversed.

5. Lesson 5- Cardiac Arrest vs Heart Attack
Cardiac Arrest occurs when the heart malfunctions and stops beating unexpectedly.
CA is an “electrical” problem. Triggered by electrical malfunction in the heart causing irregular heartbeats. With pumping action disrupted the heart cant pump blood to the brain, lungs, or other organs.
Coronary Artery Disease, Cardiomyopathy, Long QT Syndrome, Marfan Syndrome
Heart attack occurs when blood flow to the heart is blocked.
HA is a “circulation” problem. Caused by a blocked artery that prevents oxygen-rich blood from reaching a section of the heart. That part of the heart normally nourished by that artery begins to die.

7. Lesson 5 – Detecting Cardiac Arrest
When cardiac arrest occurs, blood stops flowing, and vital organs do not receive oxygen.
The following items may indicate that a patient is suffering from cardiac arrest:
No response: Patients do not respond to touch or sound.
No breathing: Patients have stopped breathing, or they gasp unsuccessfully for breath.
No circulation: Patients do not move and do not have a pulse.
Detecting Cardiac Arrest
When cardiac arrest occurs, blood stops flowing, and vital organs do not receive oxygen. The following items may indicate that a patient is suffering from cardiac arrest:
No response: Patients do not respond to touch or sound.
No breathing: Patients have stopped breathing, or they gasp unsuccessfully for breath.
No circulation: Patients do not move and do not have a pulse.

8. Lesson 5 – Defibrillation
When a patient is suffering from cardiac arrest, a device called an automated external defibrillator (AED) may be used to shock the heart.
An AED does not restart the heart. Rather, the device stuns the heart so that ventricular fibrillation is stopped.
Defibrillation is most successful when performed within five minutes of the onset of cardiac arrest.
Defibrillation
Defibrillation is one of the most effective ways to restore a heart to its normal rhythm. When a patient is suffering from cardiac arrest, a device called an automated external defibrillator (AED) may be used to shock the heart. An AED does not restart the heart. Rather, the device stuns the heart so that ventricular fibrillation is stopped. Then, if the heart has not suffered too much damage, normal rhythm and blood flow are resumed.
Defibrillation is most successful when performed within five minutes of the onset of cardiac arrest. However, emergency medical services may not arrive with an AED within this amount of time. Therefore, CPR is used to provide critical amounts of blood to vital organs. CPR prolongs the time a patient can survive until an AED becomes available.

9. Lesson 5 – Clinical and Biological Death
Clinical death occurs when the heart stops beating and the patient stops breathing.
Biological death occurs when body cells die. Biological death usually happens four to six minutes after clinical death.
If CPR is performed immediately after clinical death occurs, biological death may be prevented.
The goal is to keep oxygenated blood flowing to vital organs until AED arrives.
Clinical and Biological Death
In the medical field, there are two types of death: clinical and biological. Clinical death occurs when the heart stops beating and the patient stops breathing. Biological death occurs when body cells die. Biological death usually happens four to six minutes after clinical death.
When clinical death occurs, a patient may be revived if CPR is performed right away. During CPR, a rescuer provides oxygen by breathing for the patient and circulating the blood. The goal is to keep oxygenated blood flowing to vital organs until the patient is revived or a defibrillator becomes available. If CPR is performed immediately after clinical death occurs, biological death may be prevented.

10. Lesson 5 – Basic Steps of CPR
Remember CABD
Circulation
Airway
Breathing
Defibrillation
Basic Steps of CPR
CPR can be administered in four basic steps. The letters CABD can be used as a guide to remember these steps.
Circulation
Airway
Breathing
Defibrillation

11. Lesson 5 – Basic Steps of CPR
How to check circulation
Pulse
Skin color & temperature
Nailbed test (capillary refill)
Circulation
“Push hard, push fast”
Compress between 2 and 2.4 inches
Minimize interruptions
Circulation
Oxygenated blood is circulated through the body by pressing on the patient’s chest. This will cause the heart to squeeze the blood into the blood vessels and provide oxygen to the body’s organs, particularly the brain.
“Push hard, push fast” is used by the American Heart Association® to describe correct technique. Each compression should depress the chest at least 2 inches. The chance of hurting the patient is very small, so use all of your strength during compressions. Make sure the chest returns to its normal position between each compression.
Minimize interruptions, including rescue breaths, while giving chest compressions. Pumping blood through the body is the priority.

12. Lesson 5 – Basic Steps of CPR
Airway
To open airway:
Head-tilt, chin-lift
Jaw-thrust
Used if a patient shows signs of a suspected spinal injury.
Airway
After 30 chest compressions, open the patient’s airway and prepare to offer rescue breaths. Remember that interruptions to chest compression must be kept to a minimum, so this must be done quickly.
Open the patient’s airway by tilting the head back, lifting the chin, and opening the mouth. This is called the head-tilt, chin-lift maneuver.
If a patient shows signs of a suspected spinal injury, use the jaw-thrust maneuver instead. Without turning or rotating the patient’s head, push the lower jaw forward with your fingertips.

13. Lesson 5 – Basic Steps of CPR
Breathing
Check by looking for the chest to rise , listen and feel for breaths.
Use face shield
Pinch nose to give breaths
Spend less than 10 seconds positioning the airway and giving breaths
Breathing
Whenever possible, use a protective face shield to avoid direct mouth-to-mouth contact. Give the patient 2 quick rescue breaths by breathing into the patient’s mouth or nose. Spend less than 10 seconds positioning the airway and giving the rescue breaths. Continue the cycle of 30 compression and 2 rescue breaths.
Once an advanced airway has been placed by a health care provider, the breaths are given every 6 to 8 seconds (8 to 10 breaths per minute). Chest compressions are given continuously.

14. Lesson 5 – Basic Steps of CPR
Defibrillation
Uses electrical pulses or shocks to help control life-threatening arrhythmias
Use immediately
Resume CPR
Defibrillation
Chest compressions and rescue breaths should be performed until the patient recovers or a defibrillator becomes available.
Once a defibrillator is available, attach and use the device immediately. Without delay, resume CPR after each shock, beginning with compressions.

15. Lesson 5– Chain of Survival
The AHA created the Chain of Survival to illustrate important steps to take during cardiac arrest.
The five links in the Chain of Survival are:
Immediate recognition of the cardiac arrest and activation of EMS system.
Start early CPR.
Perform rapid defibrillation.
Advanced life support after CPR and defibrillation
Post-cardiac arrest care.
Chain of Survival
The American Heart Association created the Chain of Survival to illustrate important steps to take during cardiac arrest. These steps are time-sensitive. They should be implemented by the rescuer as quickly as possible.
The five links in the Chain of Survival are:
1. Immediate recognition of cardiac arrest and then activation of the EMS system.
2. Start early CPR on the patient. Early CPR can greatly increase the patient's survivability.
3. Perform rapid defibrillation.
4. Provide advanced life support after CPR and defibrillation.
5. Post-cardiac arrest care provided after the patient resumes sustained cardiac activity by health care providers.

16. Lesson 5 – CPR Certification
There are specific methods of CPR for adults, children, and infants. CPR rescuers must know how to use these methods properly.
The best way to learn the correct methods is to take a CPR certification course.
To become CPR certified, contact a local branch of the American Red Cross or the American Heart Association.
To stay current you must recertify every 2 years.
CPR Certification
There are specific methods of CPR for adults, children, and infants. In addition, there are methods for a one-person rescue and a two-person rescue. CPR rescuers must know how to use these methods properly. Using an incorrect technique could result in serious injury or even death. The best way to learn the correct methods is to take a CPR certification course. All health care workers must be CPR certified. To become CPR certified, contact a local branch of the American Red Cross or the American Heart Association.

17. Lesson 5 – Adult CPR
Adult CPR may be given to anyone who has reached the onset of puberty. Usually occurs between 12 and 14.
Any patient showing secondary sex characteristics is considered to have entered puberty.
Adult CPR
Adult CPR may be given to anyone who has reached the onset of puberty, which usually occurs between 12 and 14 years of age. If a child has developed secondary sex characteristics, that child will fall under the standards for adult CPR.
The two methods of adult CPR include the one-person rescue and the two-person rescue. In the one-person method, the rescuer must perform both the rescue breathing and the chest compressions. In the two-person method, the first rescuer performs the rescue breathing and the second rescuer performs the chest compressions. Health care workers must be trained in both methods.

18. Lesson 1– Pediatric CPR
Pediatric CPR includes special procedures for children and infants.
Children are between the age of 1 and the onset of puberty.
An infant is less than 1 year old.
Pediatric CPR
Pediatric CPR is used on children who have not yet reached the onset of puberty and do not yet exhibit secondary sex characteristics. Pediatric CPR includes special procedures for children and infants. Children are between the age of 1 and the onset of puberty. An infant is less than 1 year old. Health care workers must be trained in both of these procedures.

19. Lesson 1– Causes of Cardiac Arrest
Heart disease is uncommon in pediatrics. However, cardiac arrest may occur as a result of insufficient oxygen to the brain, heart, and vital organs.
Lack of oxygen is often caused by:
Airway obstruction
Suffocation
Overdose of medication
Consuming household chemicals
Drowning
Asthma and other respiratory disorders
Trauma
Causes of Cardiac Arrest
Heart disease is uncommon in pediatrics. However, cardiac arrest may occur as a result of insufficient oxygen to the brain, heart, and vital organs. Lack of oxygen in children and infants is often caused by:
Airway obstruction
Suffocation
Overdose of medication
Consuming household chemicals
Drowning
Asthma and other respiratory disorders
Trauma

20. Rescue Breaths Maintain an open airway using head-tilt
Adult
Maintain an open airway using head-tilt
Pinch nostrils
Give 1 breath every 5-6 seconds
10-12 breaths per minute.
Child & Infant
Maintain an open airway.
Pinch nostrils closed.
Give 1 breath every 3-5 seconds.
12-20 breaths per minute.
Rescue breaths supply oxygen to lungs
Given if victim shows signs of circulation but not breathing.
Recheck for pulse every 2 minutes.
A successful breath results in the chest rising.
Give breath no longer then 1 sec.

22. Compressions
Place heel of one hand on the center of the chest (lower half of sternum)
Place other hand on top and interlock your fingers
Allows the chest to fully recoil between compressions.
Do not interrupt compressions longer then 10 sec.

23. Adult CPR Procedures 1: Check the Scene
1 & 2 Rescuer Ratio-
30 compressions 2 breaths (30:2)
compressions per minute
Compress chest atleast 2 inchs
5 cycles then reassess for pulse and breathing
1: Check the Scene
2: Check for responsiveness & activate emergency plan
3: Check pulse (carotid) while watching and feeling for breaths. No longer then 10 sec (atleast 5).
4: No pulse or breathing give compressions & breaths till AED arrives
If you are alone activate the EMS and get the AED before beginning CPR

24. Child CPR Procedures For 1 Rescuer:
Compress straight down about 2 inches
30x at a rate of times per minute.
Give 2 breaths
Do 5 cycles of 30:2 (2 min)
Reassess for pulse and breathing
2 rescuers: 1 person gives breaths while other does compressions. Switch every 5 cycles (15:2 ratio)
Alone and did not witness collapse, 2 minutes of CPR before activating EMS.
Depress chest about 2 inches (1/3 the depth of chest)
For two rescuers, give 15 compressions followed by 2 breaths
A Variation of Adult CPR Procedure
Child and infant CPR is similar to the procedure for adult CPR. However, there are a few important differences, including:
With pediatric patients, if lone rescuers do not witness the arrest they should begin 2 minutes of CPR before activating the EMS system. In the adult procedure, lone rescuers should always first activate the EMS system.
During compressions on a child patient, depress the chest about 2 inches. In the adult procedure, rescuers should depress the chest at least 2 inches.
If two rescuers are performing CPR, the ratio of compressions to rescue breaths is 15:2. The ratio for lone rescuers and all adult procedures is 30:2.
As with adult CPR, work quickly and minimize interruptions.

25. Infant CPR Procedures
Pulse Check: Brachial pulse, 2 fingers on inside of upper arm between elbow & underarm.
Breaths: seal mouth around nose and mouth
1 Rescuer Hand Placement:
2 fingers in the center of the chest
2 Rescuer Hand Placement:
just below the nipple line 2 or more Rescuers 2 thumb-encircling hands in the center of the chest just below the nipple line
Alone and did not witness, 2 minutes of CPR before activating EMS
Depress chest about 1.5 inches (atleast 1/3 the depth of chest)
1 Rescuer 30:2 ratio
2 Rescuer 15:2 ratio
Use manual defibrillator, if available
A Variation of Adult CPR Procedures
Infant CPR is similar to the procedure for adult CPR. However, there are a few important differences, including:
As with child CPR, if lone rescuers do not witness the arrest they should begin 2 minutes of CPR before activating the EMS system. In the adult procedure, lone rescuers should always first activate the EMS system.
During compressions on an infant patient, depress the chest about 1.5 inches. In the child and adult procedure, rescuers should depress the chest 2 inches.
If two rescuers are performing CPR, the ratio of compressions to rescue breaths is 15:2. The ratio for lone rescuers and all adult procedures is 30:2.
A manual defibrillator is preferred for infant patients, although an automatic defibrillator may be used if a manual defibrillator is not available.
As with adult CPR, work quickly and minimize interruptions.

27. AED