1. CPR

2. CPR Saves Lives
Cardiopulmonary Resuscitation or CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest victims
CPR followed by AED saves thousands of lives each year
In most cases CPR helps keep victim alive until EMS or AED arrives

3. Circulatory System Basics

4. Circulatory System
Circulatory system consists of heart, blood, and blood vessels.
Transports blood to lungs
Delivers carbon dioxide and picks up oxygen
Transports oxygen and nutrients to all parts of body
Helps regulate body temperature
Helps maintain body’s fluid balance

5. Anatomy of the Heart

6. Coronary Arteries

7. Major Arteries

8. Circulatory System Emergencies

9. Circulatory System Emergencies
Any condition that affects respiration reduces ability to deliver oxygen
Heart conditions
Severe bleeding
Shock
Stroke

10. Cardiac Arrest
Cardiac Arrest (sudden stopping of the heart) may occur as a result of heart attack
Brain damage begins minutes after cardiac arrest
Brain damage becomes irreversible in minutes
Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness

11. Causes of Cardiac Arrest
Heart attack
Drowning
Suffocation
Stroke
Allergic reaction
Diabetic emergency
Prolonged seizures
Drug overdose
Electric shock
Certain injuries

12. Chain of Survival Early Access Early CPR Early Defibrillation
Early Advanced Care

13. Cardiopulmonary Resuscitation (CPR)
CPR helps keep patient alive by circulating some oxygenated blood to vital organs
Ventilations move oxygen into lungs where it is picked up by blood
Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues

14. CPR effective only for a short time
CPR should be started as soon as possible
In some instances, the heart may start again spontaneously with CPR

15. Basic Skills
Rescue Breathing
Chest Compressions

16. Rescue Breathing
The risk of infection from CPR is extremely low but the US Occupational Safety and Health Administration requires that healthcare workers use standard precautions in the workplace, including CPR
Standard Precautions include using barrier devices such as a face mask or bag-mask device when giving breaths.

17. Head Tilt-Chin Lift
Place one hand on the victim’s forehead and push with your palm to tilt the head back.
Place the fingers of the other hand under the bony part of the lower jaw near the chin.
Lift the jaw to bring the chin forward.

18. Jaw Thrust Maneuver
If a victim has a head or neck injury use the jaw thrust maneuver to open the airway.
Place one hand on each side of the victim’s head
Place your fingers
under the angles of
the victim’s lower
jaw and lift with
both hands

19. Mouth to Mouth Breathing
Position yourself at the victim’s side
Perform the head tilt / chin lift
Pinch the victim’s nose and cover his mouth with yours
Deliver air over 1 second to
make the chest rise

20. Mouth to Mask Breathing
Position yourself at the victim’s side.
Place the mask on the victim’s face, using the bridge of the nose as a guide.
Perform the head tilt / chin lift
Deliver air over 1 second to make the chest rise

21. Bag-Mask Breathing Position yourself at the victim’s side.
Place the mask on the victim’s face, using the bridge of the nose as a guide.
Using the EC technique, hold the
mask in place while you hold the
airway open.
Perform the head tilt / chin lift
Squeeze the bag to give breaths
(1 second each) watching for the
chest rise

22. Rescue Breathing
Respiratory Arrest- an adult, child, or infant has a pulse but is not breathing effectively
Rescuers should give breaths without compressions.
Adults
Infants and Children
Give 1 breath every 5-6 seconds (about breaths per minute)
Give 1 breath every 3-5 seconds (about breaths per minute)
Give each breath in 1 second
Each breath should make the chest rise
Check the pulse about every 2 minutes

23. Tracheostomies Opening created in the airway
through which the individual
breathes
Rescue breaths must be
given through the stoma

24. Advanced Airways
Secured airways inserted by physicians or paramedics

25. Chest Compressions

26. Chest Compressions Basics
Position yourself at the victim’s side
Make sure the victim is lying face up on a firm surface
If you suspect a head or neck injury, try to keep the head, neck, and torso in one line when turning

27. Hand Placement
Put the heel of one hand on the center of the victim’s chest on the lower half of the sternum
Put the heel of your other hand on top of the first hand
Straighten your arms and
position your shoulders
directly over your hands

28. Rate and Depth Push hard and fast.
Press straight down at least 2 inches
Deliver compressions in a smooth fashion at a rate of at least 100/min.

29. One-Rescuer
CPR

30. Assess the victim for response and look for normal or abnormal breathing. If there is no response and no breathing, or no normal breathing (i.e. only gasping), shout for help.
Tap and shout, “Are you OK?”

31. 2. If you are alone, activate the emergency response system and get an AED (or defibrillator) if available and return to the victim.

32. 3. Check the victim’s pulse (take at least 5 seconds but no more than 10 seconds).

33. 4. If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of compressions and breaths (30:2 ratio), starting with compressions (C-A-B sequence)

34. CPR Sequence
ASSESSES: Checks for response, no breathing or no normal breathing (5-10 seconds)
ACTIVATES emergency response system
Check for PULSE (carotid) 5-10 seconds
GIVES HIGH QUALITY CPR:
Correct HAND PLACEMENT
ADEQUATE RATE: At least 100/min (30 compressions in 18 seconds or less)
ADEQUATE DEPTH: 2 inches
MINIMIZES INTERRUPTIONS: Gives 2 breaths in less that 10 seconds

35. Chest Compressions Alert
Be careful with your hand position
For adults/children, keep your fingers off patient’s chest
Do not give compressions over bottom tip of breastbone
When compressing, keep elbows straight and hands in contact with patient’s chest at all times
Compress chest hard and fast, but let chest recoil completely between compressions.
Minimize amount of time used giving ventilations between sets of compressions.

36. AED Automated External Defibrillator

37. AED
Automated External Defibrillator – computerized devices that can identify cardiac rhythms that need a shock, and then can deliver the shock
Used to treat victims of sudden cardiac arrest with ventricular fibrillation - the heart muscle may “quiver” and/or not contract together to pump blood
An electric shock can stop the quivering heart fibers
This allows the muscle fibers of the heart to “reset” so they can begin to contract at the same time

38. Using the AED

39. Power on the AED Open the carrying case or the top of the AED
Turn the power on (some devices will “power on” automatically when you open the lid.

40. Power on the AED Open the carrying case or top of the AED
Turn the power on (some devices will “power on” automatically when you open the lid or case
The AED will guide you through the steps

41. Attach AED pads to victim’s bare chest.
Use adult pads for victims 8 years and older
Peel away the backing from the AED pads
Attach the AED pad to the victim’s bare chest
One in the upper right chest below the collarbone
The other to the side of the left nipple
Attach the pads to the machine
Attach the AED cable to the
device

42. “Clear” the victim and Analyze the rhythm
Be sure no one is touching the victim
Some AED’s will tell you to push a button to analyze, others will begin automatically
Some AED’s may take about 5-15 seconds to analyze

43. If the AED advises a shock, it will tell you to clear the victim
Loudly state a “clear the victim” message
Look to be sure no one is touching the victim
Press the shock button
The shock will produce a sudden contraction of the victim’s muscles

44. Resume CPR
If no shock is needed, and after delivering a shock, immediately resume CPR starting with compressions
After 5 cycles or about 2 minutes, the AED will prompt you to repeat previous steps
If “no shock advised” immediately restart CPR beginning with chest compressions

45. Special Situations
Hairy chest – use a razor (in some cases) or quickly remove the AED pad to remove hair
Water – remove the victim and dry quickly
Implanted defibrillator / pacemaker – do not place the pad on the device
Transdermal medication – remove the patch and wipe with a cloth

46. Operation of an AED Power on the AED
Attach the pads to the victim’s bare chest and cable to the device
“Clear” the victim and analyze the rhythm
If the AED advises a shock, it will tell you to clear the victim
If no shock is advised

47. 2 Rescuer Sequence with an AED
Check for response and check breathing
Check for pulse
Attempt defibrillation with AED
Power on the AED
Attach the pads to the victim’s bare chest
“Clear” the victim and analyze the rhythm
If the AED advises a shock, it will tell you to clear the victim
If no shock is needed, immediately resume CPR, starting with compressions
After 5 cycles or about 2 minutes of CPR, the AED will ask you to clear and analyze the victim

48. CPR Review

49. What is the rate for performing chest compressions for a victim of any age?
100 per minute

50. Describe a way you can allow the chest to recoil completely after each chest compression.
Allow the chest to expand completely between each compression.

51. After you open the airway and pinch the nose of an unresponsive adult or child, what is the best way to give mouth-to-mouth breaths?
Seal your mouth over the victims mouth and give 2 breaths, watching for the chest to rise

52. What is the best way for a rescuer to know that a rescue breath is effective?
The chest will rise with each breath.

53. You must check adequate breathing before giving breaths to an unresponsive adult victim.  You do this by looking for chest rise and feeling for airflow through the victim's nose or mouth.  What other sign should you assess?
Listen for airflow from the victim’s nose or mouth

54. When you do not suspect a cervical spine injury, what is the best way to open an unresponsive victim's airway?
The head tilt / chin lift technique

55. What should be the next step when you find an unresponsive adult victim who has agonal gasps and you have sent someone to activate the emergency response system?
Check the carotid pulse

56. How do you know when to start cycles of chest compressions with breaths for an adult?
The victims is unresponsive, is not breathing, and does not have a pulse.

57. What are the steps common to the operation of all AED's in the correct order?
Power on, attach pads, clear & analyze, clear & deliver shock if advised

58. After you power on an AED and attach the pads to the victim, what is the next step you should do?
Clear the victim so the AED can analyze the heart rhythm

59. What might happen if you touch the victim while the AED is delivering a shock?
The AED could shock you while it is shocking the victim.

60. You are using an AED on an adult victim, and the AED gives a "no shock indicated" (or "no shock advised") message.  Until advanced care personnel arrive, what should you do next?
Leave the pads in place and continue CPR

61. What is the best way to relieve severe choking in a responsive adult?
Perform abdominal thrusts

62. A choking adult becomes unresponsive while you are doing abdominal thrusts for severe choking.  You ease the victim to the floor and send someone to activate your emergency response system.  What should you do next?
Begin CPR, when you open the airway, look for and remove the object if seen, before giving breaths

63. Which of the following statements best describes why you should minimize interruptions when giving chest compressions to any victim of cardiac arrest?
If you minimize interruptions, you increase the victims chance of survival.

64. Breathing stops but the heart still continues for 2-3 minutes
Breathing stops but the heart still continues for 2-3 minutes.  What is this called?
Respiratory arrest.

65. You find a victim lying on his right side
You find a victim lying on his right side.  He is not breathing but has a pulse.  What should you do?
Give a rescue breath every 5 seconds.

66. What happens during a cardiac arrest?
The heart and breathing stop without warning.

67. Before starting chest compressions, you need to check for a pulse
Before starting chest compressions, you need to check for a pulse.  What pulse site should you use?
Carotid

68. A person shows signs of circulation after CPR was started
A person shows signs of circulation after CPR was started.  What should you do?
Place the victim in the recovery position, lying on their side.

69. The purpose of the recovery position is to:
Prevent aspiration.