CPR/AED/First Aid Training

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CPR/AED/First Aid Training

• by
• Rob Sundquist, MS ATC LAT
• Director of Sports Medicine/Head Athletic Trainer
• Creekview High School

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Chain of Survival

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

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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.

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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

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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.

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Chain of Survival step four

• Advanced Care EMS
• Response time is 7-8 minutes CPR is extremely
  important.

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How to recognize major emergencies
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Heart AttackMyocardial 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.

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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.

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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

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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

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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

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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

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CPR - adult
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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.

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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 ABCs
• A Airway
• Head tilt and chin lift

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• B Breathing
• check for breathing by look, listen, feel 10
  seconds, no more
• Place ear over mouth, looking down the body at
  the chest.
• You are looking to see if the chest is rising,
  and if you feel any breaths out of the mouth.
• If you do not detect normal breathing give two
  breaths lasting 1 second each (may use barrier)
• Agnal breathing gasps that occur at the
  beginning of CA not efficient act as they are
  not breathing
• Watch chest rise, allow exhalation before next
  breath.
• If breaths do not go in reposition head and try
  again.
• Practice

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Step two cont.

• C Circulation
• If not breathing begin chest compressions
• 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 more
  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 302
  approx two minutes) reduces fatigue

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• 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 302 (includes
  breath) - should complete five cycles in that
  time.

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• 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.

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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.

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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

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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.

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CPR Child and infant
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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 302
• Differences with Adult CPR
• In the chain of survival you will perform CPR
  first for two minutes performing five cycles of
  302 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.

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Infant CPR

• Similarities with adult CPR
• 302 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

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Foreign Body Airway Obstruction (FBAO)

• Heimlich Maneuver

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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

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Abdominal thrusts

• 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

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Infant FBAO

• Infant
• 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

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Automated External Defibrillator

• AED

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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
• AEDs 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

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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)

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• 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

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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

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First Aid
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Medical emergencies

• Breathing difficulties
• 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.

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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.

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• 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

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• Burns
• Thermal 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

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• 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 gt65 yrs old
• Has sustained a head injury
• - Manually stabilize the neck until help arrives.

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• 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.

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• 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

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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

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• 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
• Replace fluids
• 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
  gt105.
• Cool down by any means

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• 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

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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

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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