ABCs & CPR

Remember that you play an important role in the chain of survival for the patient.

Activation of the EMS System:
This means to call 9-1-1 as soon as possible so that emergency responders can get to the scene as soon as possible to start advanced training later.

Early CPR
If CPR is warranted, START IMMEDIATELY. Compressions to the chest provide essential blood flow to crucial organs if the heart stops beating.

Early Defibrillation
This is just as important as recognizing an emergency and starting CPR. Early defibrillation is a key player in patient survival. You will learn how to properly use an AED (Automated External Defibrillator) if it is available to you in an emergent situation. If no AED is available, understand that paramedics arriving to the scene will assess the patient and provide defibrillation if appropriate.

Early Advanced Care
This includes Paramedics, Nurses, and Doctors. The patient in cardiac arrest requires proper CPR, medications and other advanced critical interventions.


Injured Children

  • Trauma is leading cause of death in children across the US. This is mostly due to car accidents.
  • The leading cause of medical deaths in children are respiratory problems that cause the heart to stop working correctly.
  • If you see a child that is not breathing and does not appear to have signs of circulation (i.e. movement), give 2 minutes of CPR FIRST, then call 911.


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    Age Classification

    Adults:
    For purposes of CPR & First Aid, adults are considered to have reached the "age of puberty."

    Children:
    For purposes of CPR & First Aid children are considered to be older than one year but have not reached the "age of puberty."

    Infants:
    For purposes of CPR & First Aid, infants are considered to be under one year of age.


    Questions

  • Is the situation safe for you to provide care?
  • When you walk up to patient, what do you see?
  • Is there any bleeding?
  • Is the patient awake or unresponsive?
  • What is your general impression of the patient?
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    Let's Begin

    Early activation of 911
    If you are alone: Shout for help. If no one responds to shouts for help, activate 911 then quickly return to the patient and provide CPR. If someone responds, direct them to call 911 and then continue providing CPR. Is there an AED around? Nowadays, AED's are readily available in airports, business, and many other commercial settings. Early defibrillation saves lives! If there is an AED nearby, hook the patient up to the pads and let it determine whether the patient is in a life threatening "shockable" rhythm. If there is someone else present, have one person initiate CPR and the someone else activate 911.

    Determine Responsiveness/Activate 9-1-1
    Is the Patient Responsive? If not, attempt to awaken the patient by shouting his or her name and taping him or her on the shoulder. If this does not work, follow the steps below:

    ACTIVATE 9-1-1
    The person should be placed on their back and on a firm surface whenever possible. BE SPECIFIC - DIRECT A SINGLE PERSON TO CALL 9-1-1 For example, don't ask, "Can someone call 9-1-1?" Instead say "You, call 9-1-1!"


    Remember Your ABC's

    A= Airway
    Is there airway open? If not, adjust the head so it opens up the airway. (Head-tilt-chin-lift)

    B= Breathing
    Are they breathing? If so what quality? I.e. Fast, slow, barely breathing, gasping.

    C= Circulation
    Is the patient showing signs of circulation (i.e. movement)?


    Airway

    Open the Airway:
    Use the Head-Tilt Chin-Lift Maneuver.

    Reasons for Opening the Airway:
    Opening the airway, removes the tongue from blocking the airway. When a patient is unresponsive, lying on his or her back, the large tongue can fall back into the mouth and prevent proper airflow. By correctly positioning the head, you are helping to displace the tongue and open up the airway.




    Breathing

    Visualize:
    Take a Look at the Chest to See If it is Rising and Falling.

    Hear:
    Listen to See if the Patient is Breathing.

    Touch:
    Feel the Chest to See if it Rises and Falls. Check for Breathing for at least 5 Seconds.

    If No Breathing is found, Give 2 Breaths to Make the Chest Rise.
  • If the chest does not rise, reposition the airway to the proper position and attempt to provide another breath to the patient again. Do this only once and then move on.
    • If Breathing is found, place the patient in the HAINES Recovery Position
  • If You Do Not Wish to or Cannot Give Breaths to the Patient, You May Do Compression Only CPR.
    • Some viruses and bacteria may be spread while performing Mouth-to-Mouth. This is why it is important to use a barrier device if possible.

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    HAINES Recovery Position

    An unconscious but breathing person should be placed in the HAINES Recovery Position. This position affords better protection to the spine when compared to other positions. At the same time, the position is able to afford protection to the airway by reducing the chance of the person choking on secretions, vomit or other foreign material which may be present in their mouth.

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    Circulation

    Check for Signs of Movement
    If no movement is found, start chest compressions. If Movement is Found, Place the Patient in the HAINES Recovery Position

    Compressions
    Place the heel of your dominant hand in the center of the chest and place your other hand interlocked over the top of that hand. Compressions should be done in intervals of 30 at a rate of at least 100 times per minute and at a depth of 1.5-2.0 inches or 1/3 to 1/2 the depth of the chest. Do not get caught up in the technical details, JUST PERFORM THE COMPRESSIONS. INTERRUPT COMPRESSIONS AS LITTLE AS POSSIBLE. Continue CPR at a ratio of 30 compressions and then 2 breaths.

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    Circulation Continued

    Continue this Process Until one of the following occurs:
    1. Help Arrives.
    2. The Patient Wakes Up.
    3. You Become exhausted and Can No Longer Continue - If many people are present, it is recommended that the role of providing compressions is alternated among rescuers.

    Providing proper compressions is physically demanding and can cause fatigue very rapidly. The goal is to minimize the interruptions in chest compressions, but if a rescuer is fatigued and another rescuer becomes available, it is acceptable to switch roles so fatigue is reduced. Keep in mind, the transfer of rescuers should be quick as to minimize the time between compressions.

    You can get a feel for performing compressions by practicing on a matress, pillow or something with a semi-firm surface. We do not recommend that you practice on a real person!

    Children
    Use the palm of one hand In the center of the chest for compressions Compress 1/3 to 1/2 the depth of the chest

    For Infants
    Cover the infant's mouth and nose to provide breaths. Only blow as much air as you can hold in your cheeks into the baby; do not give a normal/full adult breath because it can cause severe damage to the infants lungs. Use two fingers in the center of the chest or two thumbs encircling the patient for compressions. Compress 1/3 to 1/2 the depth of the chest. Be sure to practice this in the same manner indicated above to get a feel for the process.

    A Note About AED's - Follow the voice prompted instructions that the AED provides. If an AED is available, attach it as soon as possible. Generally, AEDs are simple and easy to use. Be sure to FOLLOW THE INSTRUCTIONS on the unit when performing CPR. Once you open the AED case, apply the pads as shown in the instructions of the AED (most of the pads are labeled with pictures so you know where each pad goes), and hit the ON button. Voice prompted instructions should start right away.

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    Infant CPR Video

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    Special Circumstances

    What if the patient shows signs of circulation, but is not breathing?
  • Consider Foreign Body Airway Obstruction (Choking)


    • Children/Infant Rescue Breathing
  • Give 1 breath every 3-5 seconds.


    • Obese or Pregnant
    If you find that the patient is obese, it may be necessary to alternate rescuers between compressions and rescue breaths. This is because it will be more difficult to perform compressions and tends to wear down the person or people providing assistance. If the patient is pregnant, it is necessary to continue rescue efforts in order to increase the chances of saving both the mother and fetus. A fetus cannot continue to live more than a few minutes without resuscitation efforts inside a mother who has experienced cardiac arrest.


    Recap of CPR

    If you are the only person present
  • Attempt a 30 to 2 ratio. That's 30 compressions, briefly pause and give 2 ventilations (breaths), then repeat until help arrives.
  • Try to maintain a rate of compressions at 100/min.
  • Try to keep interruptions of CPR to a minimum.
  • When you give chest compressions, you create pressure in the chest cavity that actually helps to pump the blood throughout the body and to vital organs. This pressure, (called intra-thoracic pressure) is rapidly lost when you stop giving compressions, even if only for a moment.
  • This quick pause and loss of pressure can decrease the patient's chance of survival!
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    CPR Information

    Here are some things to consider when providing a patient CPR.
  • The patient may vomit because of air getting into stomach with ventilations. This problem can be minimized by providing each breath over 1 second, and not ventilating too fast.
  • Ribs may break or cartilage between ribs may rip: This is quite common, and is no cause for alarm. Continue compressions as normal.
  • Effective CPR can cause strain on ribs and sometimes causes broken ribs. Keep in mind a broken rib can heal, and continue CPR if this happens.
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