2011SILVER CROSS EMS

EMD MARCH CEEMERGENCY MEDICAL DISPATCHER

OBJECTIVESReview background information on BLSProvide information on DOAsReview updated information on CPR for the

Adult, Child and Infant victims based on the AHA 2010 Guidelines for Heartsaver

Review procedures for assisting victims that are choking

Troubleshoot possible complications encountered during BLS

When the heart has stopped and the victim is not breathing, CPR is the answer.

Without a constant supply of blood, cells of the body will start to die. Brain damage

begins within 4 to 6 minutes after cardiac arrest. Within 8 to 10 minutes, the damage

may be irreversible. Cardiopulmonary resuscitation will help to circulate oxygenated blood until more advanced medical care can

be performed.

CPRCPR by itself cannot sustain life

indefinitely.

It should be started as soon as possible to give the patient the best chance for survival.

Many patients will need defibrillation and medication to be successfully resuscitated.

It’s all part of the process………….

Source: American Heart Association

The Chain of Survival The links in the Chain of Survival include:

Early recognition of cardiac arrest and activation of the 9-1-1 system

Early bystander (or EMD assisted) CPREarly defibrillation by EMRs or other EMS

personnelEarly advanced care by paramedics and

hospital personnel

Possible DOASigns of death

Decapitation: The head is separated from the rest of the body.

Rigor mortis: Temporary stiffening of muscles occurs several hours after death.

Evidence of tissue decomposition: Actual flesh decay occurs only after a person has been dead for more than one day.

Dependent lividity: Red or purple color occurs on the parts of the patient’s body that are closest to the ground.

When to Start CPR CPR should be started on all non-breathing,

pulseless patients, unless they are obviously dead or have a DNR order. (Responders will need to see a valid copy of the order to honor it.)

It is better to start CPR on a person that is later declared dead by a physician than to withhold CPR from someone that could have been saved.

When in Doubt, Resuscitate!

When to Stop CPR (1 of 2)Discontinue CPR only when:

Effective spontaneous circulation and ventilation are restored.

Resuscitation efforts are transferred to another trained person who continues CPR.

A physician orders you to stop.The patient is transferred to properly trained

EMS personnel.

When to Stop CPR (2 of 2)Discontinue CPR only when: (cont’d)

Reliable criteria for death are recognized.You are too exhausted to continue

resuscitation, environmental hazards endanger your safety, or continued resuscitation would place the lives of others at risk.

It all starts with A-B-CA – Airway

B – Breathing NO?C – Circulation

START COMPRESSIONS!

New Sequence

FOLLOW THIS LINK TO WATCH THE NEW GUIDELINES VIDEO

http://www.youtube.com/watch?v=O9T25SMyz3A

AHA 2010 RecommendationsAdult (HS 1 Rescuer)

Unresponsive? Call for help & AED

Not breathing or only gasping (Agonal breaths)

Start compressions in the center of the chest between the nipples, at a rate of 100/min and a depth of at least 2 inches, allowing for chest recoil

• 30:2 Ratio of compressions to breaths

• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths

• When rescuers are untrained or not proficient, compressions only can be performed

• PUSH HARD & FAST

AHA 2010 RecommendationsChildren (HS 1 Rescuer)

Unresponsive?Not breathing or only

gaspingStart compressions in

the center of the chest between the nipples, at a rate of at least 100/min

and a depth of 2 inches or 1/3 chest diameter, allowing for chest recoil

• 30:2 Ratio of compressions to breaths

• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths

• After 5 cycles or 2 minutes, call for help, continue cycles

• When rescuers are untrained or not proficient, compressions only can be performed

• PUSH HARD & FAST

AHA 2010 RecommendationsInfant (HS 1 Rescuer)

Unresponsive?Not breathing or only

gaspingStart compressions in

the center of the chest between the nipples, at a rate of at least 100/min

and a depth of 1 1/2 inches or 1/3 chest diameter, allowing for chest recoil

• 30:2 Ratio of compressions to breaths

• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths

• After 5 cycles or 2 minutes, call for help, continue cycles

• When rescuers are untrained or not proficient, compressions only can be performed

• PUSH HARD & FAST

GENERAL INFO Make sure victim is on a firm, flat surfaceMinimize interruptions to chest

compressions, 1o seconds or lessWatch for chest rise with breathsAttach AED as soon as it is available and

follow the prompts Resume compressions immediately after

administering a shock30 compressions should be given over

approximately 18 seconds (think of the tune Staying Alive)

Recovery Position If the victim is unconscious but breathing: Roll the patient onto one side, as you support

the patient’s head.Place the patient’s face on his or her side so

any secretions drain out of the mouth and the tongue won’t block the airway.

Is It Working?The victim’s color should improve

The chest should be rising with each breath

The compressions and breaths are delivered at the appropriate rate and depth

Possible Complications Broken ribs

Check hand placement and continueGastric Distension (air in the stomach)

Can happen if the airway is not open, re-tilt headMake sure breaths are not given too forcefully or too

fast, give over 1 second each and allow for exhalationGive breaths only until the chest risesBe alert for vomiting and keep airway clear

Chest does not riseReposition head and try breath again. If it’s still not

rising go right to compressionsVictim breathes through a stoma (opening in the neck)

If the chest does not rise with breaths, cover mouth and nose for possible air leakage

Causes of Airway Obstruction The most common airway obstruction is the

tongue.If the tongue is blocking the airway, the head

tilt–chin lift maneuver performed on the unconscious victim should open the airway.

Food is the most common foreign object that causes an airway obstruction.If a foreign body is lodged in the air passage,

you must use other techniques to remove it.

Are you choking?Mild Obstruction

Victim is able to cough or is gagging

Victim is able to speak and breath

Encourage victim to cough and monitor them in case the airway becomes blocked

Severe ObstructionVictim has

ineffective coughVictim is unable to

speak or breathVictim is displaying

the Universal Sign for choking

Prepare to help victim

Management of Foreign Body Airway Obstructions

Airway obstruction in an adult or childIf the victim is conscious, stand behind them and

perform abdominal thrusts.If the victim is obese or pregnant, stand behind

them and perform chest thrusts instead of abdominal thrusts.

If the victim becomes unresponsive:Ensure that the EMS system has been activated.Perform CPR, remembering to check the mouth for

foreign objects before each breath.

Steps for Managing Airway Obstruction in a Conscious Adult or Child

1. Look for signs of choking.

2. Place your fist with the thumb side against the patient’s abdomen, just above the navel.

3. Grasp the fist with your other hand and press into the abdomen with quick inward and upward thrusts.

Management of Foreign Body Airway Obstructions (continued)

Airway obstruction in an infant Use a combination of 5 back slaps (with the heel

of your hand between the shoulder blades) and 5 chest thrusts (with 2 fingers between the nipples on the center of the chest), alternating, until the object is expelled or the victim becomes unconscious.

If the infant becomes unresponsive:Ensure that the EMS system has been activated.Begin CPR, remembering to check the mouth for

the foreign object before each breath.

FYIThe flipcharts will be updated to reflect the new

changes, in the near future. Until then, use the protocol that you’re currently using.

Your current CPR cards are good until the expiration dates printed on the card. Recommended renewal is every 2 years.You previously learned the same skills, the order

has just changed to C-A-B.Hands Only CPR will be encouraged for the lay

rescuer with no training or is not proficient in the skills

For further information on CPR visit the American Heart Association’s website www.heart.org/cpr

ResourcesAmerican Heart Association’s Highlights of

the 2010 Guidelines for CPR & ECC and other information provided on their website

AAOS Emergency Medical Responder, 5th edition