Keys to Survival

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.
  • 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 have pulses, 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 initiate CPR and the other to activate 911. If you are alone, be sure to get the AED after calling 9-1-1 if it is available.

    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. The healthcare professional needs to be cognizant of the possible causes of unresponsiveness and adjust his or her response accordingly. If checking for responsiveness does not work in the manner described, follow the steps below:

    ACTIVATE 9-1-1
    Remember, if this is a sudden collapse, you should be sure to get an AED after calling 9-1-1 if you are by yourself. This is because a sudden collapse is most likely due to a problem with the electrical conductivity of the heart. Another thing to keep in mind is if the cause is due to respiratory compromise or events such as drowning. In these cases, if you are alone, you should provide 5 cycles of CPR (for about 2 minutes) as described here, prior to calling 9-1-1. Again, this is only when there is no one else available to assist.

    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
    Do they have a pulse. If so, where?


    Airway

    Open the Airway:
    Use the Head-Tilt Chin-Lift Maneuver. If you suspect a spinal injury, use the jaw thrust 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. Also, as a healthcare provider, it is recommended that you use a barrier device when performing CPR or rescue breaths.
    • 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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    Inadequate Breathing

    If a patient has a pulse and his/her breathing appears to be inadequate, which may be indicated by a decreased depth of respiration (shallow/not enough air exchange), quality (wheezing, rhonchi/junk, etc…) rate (less than a normal rate), and/or skin color that is bluish or pale, then it is recommended to assist the patient’s breathing at a rate of 10-12 respirations/breaths per minute with a bag-valve mask. Video Resource

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    HAINES Recovery Position

    An unconscious but breathing person should be placed in the HAINES (High Arm IN Endangerd Space) Recovery Position. This position affords better protection to the spine when compared to other positions. It is similar to the lateral recumbant position (with the patient on the side). 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 a pulse.
    This should be done by placing the index and middle finger of your dominant hand on the persons carotid artery. Pulse checks may be done on the brachial artery for infants. You should check for a pulse for no longer than 10 seconds. If no pulse is found, start chest compressions. If a Pulse is Found, Place the Patient in the HAINES Recovery Position. Compressions
    Place the heal 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 CPR. 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.

    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.

    A Note About AEDs
    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

    The following video does not account for pulse checks in the infant. The professional rescuer should check for a pulse in the brachial artery. If no pulse is found within 5-10 seconds, then compressions should take place. This should be done after the infant's airway is assessed.
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    Special Circumstances

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

    Rescue Breathing
    This should occur when the patient is not breathing, but a pulse is present. The healthcare provider should ensure that the patient receives rescue breaths at a rate of 10-12 per minute for adults.


    Special Circumstances Continued

    Rescue breathing should occur at a rate of 12-20 times per minute for the child and infant and 40-60 times per minute for the newborn infant.

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

    Newborn CPR
    Healthcare providers should give compressions and ventilations at a rate of 90 compressions for every 30 breaths at a rate of about 120 per minute for each cycle. The healthcare provider should attempt to avoid simultaneous compressions and ventilations in newborns during CPR. This is due to the increase of pressure within the body which may cause harm to the newborn.


    Advanced Airway

    When an advanced airway, such as an endotracheal tube or laryngeal mask airway has been properly secured on a patient, the healthcare provider should ensure that chest compressions continue as consistently as possible – interrupt as little as possible. The healthcare provider working on the airway should give breaths at a rate of 8-10 per minute making sure not to hyperventilate the patient as this may be harmful. Healthcare providers have a tendency to ventilate the patient excessively.

    It is recommended that healthcare providers change positions between managing the airway and chest compressions every two minutes and interrupt chest compressions as little as possible. However, consider rescuer fatigue. If a rescuer is tired, then it may be necessary to change positions. If this is not the case, then it may not be necessary to change positions.


    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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