cpr

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2 American Heart Saver Institute, LLC • www.AmericanHeartSaver.com

CPR / AED Student Workbook Pediatrics and Adult












Table of Contents:Introduction ..........................................................................5

AdultChest Compressions..............................................................6Rescue Breaths ....................................................................7CPR Mask.............................................................................8CPR Shield............................................................................9Assessment........................................................................10Signs to Perform .................................................................11Using an AED .....................................................................12Chest Compressions............................................................13Rescue Breaths ..................................................................14Using an AED .....................................................................14Assessment........................................................................15Assessment not breathing ..................................................16













Infant CPR...........................................................................16Chest Compression .............................................................17Rescue Breaths ..................................................................18Gasping.............................................................................18

Choking in an Adult........................................................19-21Child Choking.................................................................21-22Infant Choking ....................................................................23Using a Bag-Valve-Mask ....................................................24


CPR and AED for Children












ReferencesThis course is based upon the following standards, guidelines, and recommendations:

• “2010 American Heart Association Guildlines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science.” Circulation 122, suppl. 2 (2010): S639-S946

• “2010 American Heart Association and American Red Cross Guidelines for First Aid.” Circulation 122, suppl. 3 (2010): S934-S946

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INTRODUCTION•In this course you’ll learn how to perform CPR and use an AED.

•This course is blended with a video and a chance to practice skills. Upon successfully completing this course, you will receive a Heartssaver CPR & AED card valid for 2 years.

•CPR stands for cardiopulmonary Resuscitation and is used when a person is not breathing or for an unresponsive choking adult or child victim who has an obstruction below jaw level.

•Adult CPR age starts above puberty or going through the stage of puberty.

•Child CPR ages starts at 1 to puberty

•Infants CPR age is less than one













A compression is an action that involves pushing at the center of the chest.

Before attempting compressions, ensure:



• The victim is lying on his or her back on a firm, flat surface.

• Remove all necessarily clothing

• Place the heel of one hand at the center of the chest at least 2 inches above the breastbone, place the other hand on top of the first.

• Push at a rate of 100 compressions per minute at least 2 inches.

• Allow the chest to recoil.

• Switch with a partner after 2 minutes












Rescue Breaths are effective together with compressions to provide oxygen to the brain. It is important to do a head tilt chin lift to ensure the airway is open start by doing the following:

• Place one hand onthe forehead and two fingers of your other hand under the chin

• With the head in a tilted position, pinch the nose.

• Give one breath over a second covering the victim’s mouth

• Give a total of 2breaths beforestarting compressions.

• Look for chest rise

If the chest does not rise, re tilt head and try again, do not exceed 10 seconds of interruptedcompressions.













USING A CPR MASKA mask is used to protect a rescuer from any contaminated disease.



• Ensure that the one-way valve is in place.

• Place the mask over the victim’s mouth and nose

• Tilt the head and chin to create an airtight seal, and to

open the airway.

•Place your thumb on the bottom of the mask while

two fingers lift under the chin

•• Use the thumb and forefinger to control the top of the

mask

• Give 2 breaths (one for each second), while you look

for chest rise.












USING A CPR SHIELD• Place breathing port of shield over or into mouth.

• Spread shield flat over face

• Perform a head tilt chin lift by placing on hand on the forehead and two fingers of the other hand under the chin.

• Pinch nostrils to seal nose.

• Put your mouth over the shield over thevictim’s mouth.

• Give 2 breaths, over one second each, allowing thevictim to exhale completely.













Assessment Steps for unresponsive and breathing:

• Make sure the scene is safe

• Check for responsiveness by tapping and shouting onthe shoulder

• If unresponsive, ask a bystander to call 911

• If alone with victim, check for breathing before calling 911

• To check for breathing, look for chest rise, or check thecarotid artery.

• If breathing, make sure the airway is clear by performing a head tilt chin lift and roll victim on recovery position

• Call 911, and return to victim to monitor breathing














Assessment for unresponsive and not breathing• Make sure the scene is safe• Check for responsiveness by tapping and shouting on the shoulder• If unresponsive, ask a bystander to call 911• If alone with victim, check for breathing before calling 911• To check for breathing, look for chest rise, or check the carotid artery. • If breathing, make sure the airway is clear by performing a head tilt chin lift and roll victim on recovery position• Call 911, and return to victim to monitor breathing

CPR is performed for three reasons:1. To give the patient a chance of survival

2. The patient may be an organ donor and CPR is used to keep the organs Oxygenated

3. Practice - you may not resuscitate the patient but the next time you need to perform CPR you will be a little more experienced.













The rescuer should only stop CPR if one of three things happen:

1. The patient is resuscitated

2. Advanced Life Support takes over

3. When the rescuer is physically exhausted

What Is an Automated External Defibrillator?

An automated external defibrillator (AED) is a portable device that checks the heart rhythm. If needed, it can send an electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest (SCA).SCA is a condition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it's not treated within minutes. In fact, each minute of SCA leads to a 10 percent reduction in survival. Using an AED on a person who is having SCA may save the person's life.

http://www.nhlbi.nih.gov/health/health-topics/topics/scda/

Overview

To understand how AEDs work, it helps to understand how the heart works.

The heart has an internal electrical system that controls the rate and rhythm of the heartbeat. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood. The process repeats with each new heartbeat.

Problems with the electrical system can cause abnormal heart rhythms called arrhythmias (ah-RITH-me-ahs). During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the body. These arrhythmias cause SCA.

The most common cause of SCA is an arrhythmia called ventricular fibrillation (v-fib). In v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly.

http://www.nhlbi.nih.gov/health/health-topics/topics/hhw/

http://www.nhlbi.nih.gov/health/health-topics/topics/arr/

Another arrhythmia that can lead to SCA is ventricular tachycardia (TAK-ih-KAR-de-ah). This is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer.

In people who have either of these arrhythmias, an electric shock from an AED can restore the heart's normal rhythm. Doing CPR (cardiopulmonary resuscitation) on someone having SCA also can improve his or her chance of survival.

AEDs are lightweight, battery-operated, portable devices that are easy to use. Each unit comes with instructions, and the device will even give you voice prompts to let you know if and when you should send a shock to the heart.

Learning how to use an AED and taking a CPR course are helpful. However, if trained personnel aren't available, untrained people also can use an AED to help save someone's life.

You often find AEDs in places with many people, such as shopping malls, golf courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools. You also can purchase a home-use AED.

When Should an Automated External Defibrillator Be Used?

Using an automated external defibrillator (AED) on a person who is having sudden cardiac arrest (SCA) can save the person's life.

The most common cause of SCA is an arrhythmia called ventricular fibrillation (v-fib). In v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly.

Another arrhythmia that can lead to SCA is ventricular tachycardia. This is a fast, regular beating of the ventricles that may last for a few seconds or much longer.

In people who have either of these arrhythmias, an electric shock from an AED can restore the heart's normal rhythm (if done within minutes of the onset of SCA).

How Does an Automated External Defibrillator Work?

Automated external defibrillators (AEDs) are lightweight, battery-operated, portable devices that are easy to use. Sticky pads with sensors (called electrodes) are attached to the chest of the person who is having sudden cardiac arrest (SCA).

The electrodes send information about the person's heart rhythm to a computer in the AED. The computer analyzes the heart rhythm to find out whether an electric shock is needed. If a shock is needed, the AED uses voice prompts to tell you when to give the shock, and the electrodes deliver it.Using an AED to shock the heart within minutes of the start of SCA may restore a normal heart rhythm. Every minute counts. Each minute of SCA leads to a 10 percent reduction in survival.

How To Use an Automated External Defibrillator ?

Before using an automated external defibrillator (AED) on someone who you think is having sudden cardiac arrest (SCA), check him or her.

If you see a person suddenly collapse and pass out, or if you find a person already unconscious, confirm that the person can't respond. Shout at and shake the person to make sure he or she isn't sleeping.Never shake an infant or young child. Instead, you can pinch the child to try to wake him or her up.

Call 9–1–1 or have someone else call 9–1–1. If two rescuers are present, one can provide CPR (cardiopulmonary resuscitation) while the other calls 9–1–1 and gets the AED.

Check the person's breathing and pulse. If breathing and pulse are absent or irregular, prepare to use the AED as soon as possible. (SCA causes death if it's not treated within minutes.)

If no one knows how long the person has been unconscious, or if an AED isn't readily available, do 2 minutes of CPR. Then use the AED (if you have one) to check the person.

After you use the AED, or if you don't have an AED, give CPR until emergency medical help arrives or until the person begins to move. Try to limit pauses in CPR.

After 2 minutes of CPR, you can use the AED again to check the person's heart rhythm and give another shock, if needed. If a shock isn't needed, continue CPR.

Using an Automated External Defibrillator?

AEDs are user-friendly devices that untrained bystanders can use to save the life of someone having SCA.Before using an AED, check for puddles or water near the person who is unconscious. Move him or her to a dry area, and stay away from wetness when delivering shocks (water conducts electricity).

Turn on the AED's power. The device will give you step-by-step instructions. You'll hear voice prompts and see prompts on a screen.

Expose the person's chest. If the person's chest is wet, dry it. AEDs have sticky pads with sensors called electrodes. Apply the pads to the person's chest as pictured on the AED's instructions.

Place one pad on the right center of the person's chest above the nipple. Place the other pad slightly below the other nipple and to the left of the ribcage.

The image shows a typical setup using an automated external defibrillator (AED). The AED has step-by-step instructions and voice prompts that enable an untrained bystander to correctly use the machine.

Make sure the sticky pads have good connection with the skin. If the connection isn't good, the machine may repeat the phrase "check electrodes."

If the person has a lot of chest hair, you may have to trim it. (AEDs usually come with a kit that includes scissors and/or a razor.) If the person is wearing a medication patch that's in the way, remove it and clean the medicine from the skin before applying the sticky pads.Remove metal necklaces and underwire bras. The metal may conduct electricity and cause burns. You can cut the center of the bra and pull it away from the skin.Check the person for implanted medical devices, such as a pacemaker or implantable cardioverter defibrillator. (The outline of these devices is visible under the skin on the chest or abdomen, and the person may be wearing a medical alert bracelet.) Also check for body piercings.

Move the defibrillator pads at least 1 inch away from implanted devices or piercings so the electric current can flow freely between the pads.Check that the wires from the electrodes are connected to the AED. Make sure no one is touching the person, and then press the AED's "analyze" button. Stay clear while the machine checks the person's heart rhythm.

If a shock is needed, the AED will let you know when to deliver it. Stand clear of the person and make sure others are clear before you push the AED's "shock" button.

Start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened.

Using an AED on an adult



AEDS are simple and safe to use. The AED will determine if the victim needs a shock and will prompt when one is needed. The pads are equipped with a diagram that tells you where to place them:












• Some AEDs tune on automatically when the lid is open, some you have to push the “on” button.

• Follow the prompts

• Place pads on victims chest

• Make sure no one is close or touching victim if

shock is advised!!

CHILD CPRA compression is an action that involves pushing at the center of the chest to allow blood to flow to the brain and heart. Before attempting compressions, ensure:

• The victim is lying on his or her back on a firm, flat surface.


• Place the heel of one hand at the center of the chest at least 2 inches above the breastbone, place the other hand on top of the first.

• For smaller children, use one hand.













• Push at a rate of 100 compressions per minute at least 2 inches.• Allow the chest to recoil.• Switch with a partner every 2 minutes• For two people resuce, perform 15 compressions and 2 breaths













Rescue Breaths are effective since most children's heart stops if they can’t breathe or are having problems doing so.• Place one hand on the forehead and two fingers of your other hand under the chin• With the head in a tilted position, pinch the nose.• Avoid pressing on the soft part of the neck• Give one breath over a second covering the victim’s mouth• Give a total of 2 breaths before starting compressions. • Look for chest riseIf the chest does not rise, re-tilt head and try again, do not exceed 10 seconds of interrupted compressions.














USING AN AED ON A CHILD?

AEDS are simple and safe to use. The AED will determine if the victim needs a shock and will prompt when one is needed. The pads are equipped with a diagram that tells you where to place them.

• Some AEDs tune on automatically when the lid is open, some you have to push the “on” button.• Follow the prompts

• Use pediatrics pads or a child key or switch

• If child looks older than 8 years old,use adult pads, make sure they don’t touch each other on the chest.

• If child is small; use one pad on the back and one in the front.

• Make sure no one is close or touching victim if shock is advised.













Assessment Steps for unresponsive and breathing:

• Make sure the scene is safe• Check for responsiveness by tapping andshouting on the shoulder• If unresponsive, ask a bystander to call 911• If alone with child, check for breathing before calling 911• To check for breathing, look for chest rise,or check the carotid artery.• If breathing, make sure the airway is clear by performing a head tilt chin lift and roll child on recovery position• Call 911, and return to child to monitor breathing


• Check for responsiveness by tapping and shoutingon the shoulder


• If alone with child, check for breathing before calling 911

• If the child is not breathing and you are by yourself, do 5 sets of 30 compressions and 2 breaths before calling 911.

• Open the airway by performing a head tilt chin life and provide 2 rescue breaths over 1 second each.

• Repeat 30 compressions and 2 breaths

• For two people resuce, perform 15 compressions and 2 breaths



Assessment for unresponsive and not breathing:












INFANT CPRCompressions on infants are pushed at a rate of 100 compression per minute and down at least 1 ½ inches.

• Place infant on a table


• Place 2 fingers of one hand on the breastbone justbelow the nipple line.

• Push at a rate of 100 compressions per minute at least 1 ½ inches.

• Allow the chest to recoil.

• Switch with a parthner every 2 minutes

• For two people rescue, perform 15 compressions and 2 breaths













Rescue breathing on infants differs from child andadult. Instead of pinching the nose, cover mouth over nose and mouth or use a mask to cover the nose and mouth. Do not give forceful breaths. If your mouth is too small to cover nose and mouth,select to give breaths through the infant’s nose while holding the infants mouth close.

Assessment Steps for unresponsive and breathing


• Check for responsiveness by tapping and shouting under the infants feet


• If alone with infant, check for breathing before calling 911

• To check for breathing, look for chest rise, orcheck the brachial artery.

• If breathing, make sure the airway is clear byperforming a head tilt chin lift and roll child on recovery position

• Call 911, and return to child to monitor breathing














Assessment for unresponsive and not breathing

• Make sure the scene is safe• Check for responsiveness by tapping and shouting under the child’s feet• If unresponsive, ask a bystander to call 911• If alone with Child, check for breathing before calling 911

• If the child is not breathing or gasping, start CPR with compressions first for 2 minutes then call 911

• Open the airway by performing a head tilt chin life and provide 2 rescue breaths over 1 second each.

• Repeat 30 compressions and 2 breaths• For two people resuce, perform 15 compressions and 2 breaths

Gasping is not breathing; a person usually appears to be drawing air very quickly. A victim may open their mouth and move their jaw, head, or neck. The gasp may sound like a snort, snore or groan.

ADULT CHOKINGThe universal sign of choking includes holding the neck with both hands. • Ask “are you choking?”• If victim nods yes, or is unable to speak, act quickly• If bystanders are present have someone call 911• Get behind the victim, wrapping your arms make a fist with one hand and place thumb side against abdomen, just above navel and below ribs• Grasp the fist with your other hand and give upward thrusts into his or her abdomen.


• Continue thrust until object is forced out and he or she can breathe, cough, or talk, or until victim becomes unresponsive.

• If victim goes unconscious, lay victim on his or her back, check airway for obstruction, remove object if object is above jaw level, if object is below jaw level, begin CPR even if victim is still breathing, this only applies to chocking with an obstruction and unresponsive.












If you are alone and choking, lean over a table or chair, pressing your stomach against the edge of a table or chair.

For a pregnant victim, place arms under the armpits and your hands on the lower half of the breastbone. Pull straight back to give the chest thrust.

For a non pregnant person who is bigger in size, place arms below sternum while you perform upward thrusts or have victim lean over a table or chair.














For a choking victim in a wheelchair:

•Engage the wheelchair's brake if it's not already on.

•Stand or kneel behind the victim's wheelchair. If the back of the wheelchair is too high, turn the person 90 degrees or support her in a standing position.•Lean the victim forward, moving her head and torso down at a slight tilt.• Make a fist with one hand.•Place your fist about a finger's width above the victim's navel with your thumb in contact with his body.• Grab hold of your fist firmly with your other hand.

• Make a quick in-and-up thrust against the victim's diaphragm. You may need to repeat thrusting several times before the object is expelled.• Repeat until the choking person can breathe, the object is expelled or the victim loses consciousness. • Call for medical help using 911 or another emergency number if necessary.If victim can cough loudly or make sound, choking is mild. Stand by and encourage victim to cough. Phone 911.

CHILD CHOKINGA child is considered age 1 to puberty. Puberty and above is considered an adult. If you are not sure, if victim looks younger than 8 years old, perform child CPR or the Heimlich maneuver.


• Ask “are you choking?”• If child nods yes, or is unable to speak, act quickly• If bystanders are present have someone call 911• Get behind the child, wrapping your arms make a fist with one hand

and place thumb side against abdomen, just above navel and below ribs

• Grasp the fist with your other hand and giveupward thrusts into his or her abdomen.












• Continue thrust until object is forced out and he or she can breathe, cough, or talk, or until child becomes unresponsive.

• If victim goes unconscious, lay victim on his or her back, check airway for obstruction, remove object if object is above jaw level, if object is below jaw level, begin CPR even if victim is still breathing, this only applies to chocking with an obstruction and unresponsive.

If child is smaller in size, knee with holding child against you while performing thrusts.Perform chest thrusts on a larger child who is choking.














INFANT CHOKINGChoking -Have severe difficulty in breathing becauseof a constricted or obstructed throat or a lack of air.

When an infant has severe choking, use back slaps and chest thrusts to help remove the object from blocking the airway.

• Hold the infant face down on yourforearm, supporting the head and jaw with your hand.

• Give 5 back slaps with the other hand using the heel of your hand between the shoulder blades.













• If the object does not come out after 5 back slaps,turn the infant onto his or her back, supportingthe head.

• Give 5 chest thrusts using 2 fingers of your other handbelow the nipple line• Repeat giving 5 back slaps and 5 chest thrusts until the infant can breathe, cough, or cry or until he or she stops breathing.

Using a bag-valve-mask (BVM) is an important skill. Following are guidelines for doing it well:

1. Use an oral or nasal airway to deliver oxygen beyond the patient's tongue.

2. Obtain a good mask-face seal by forming a C with your thumb and forefinger. Use your other fingers to grasp the jaw, holding the mask firmly against the face.

3. In some patients, obtaining a seal may be difficult. An assistant may use two hands to obtain the seal.

4. Be cognizant of the tidal volume being delivered. For both adults and (PEDS) children, tidal volume should be about 10 to 15 cc/kg. A 12 kg 1-year-old child should receive a tidal volume of 120 to 180 cc, while a 70 kg adult should receive a tidal volume of 700 to 1050 cc. Watch for rise and fall of the chest as an indication that the patient is being well ventilated.














5. If possible, use a BVM with an attached pressure monitor. These disposable devices are inexpensive and may be adapted to most BVMs. Knowing how much pressure is being generated helps the BVM user deliver the correct tidal volume. These monitors measure tracheal pressure in cm of H2O. A pressure of 20 to 30 cm H2O is usually the goal. Too much pressure results in gastric distension.

6. PEDS: Ventilatory rate varies from 20 ventilations per minute in small children to 12 to 15 ventilations per minute in adults. In severe asthma, a rate of only

7 to 8 ventilations per minute may be indicated.

7. Cricoid pressure (Sellick's maneuver) should be optional and may not prevent gastric insufflation and regurgitation.

8. It is very useful to sense the degree of resistance felt when the lungs are ventilated. Decreased lung compliance is an important component of asthma and lung contusion. Under these circumstances,

it may be necessary to use unusually large amounts of pressure.

9. A form of PEEP may be administered with a BVM by maintaining compression of the bag for about a second at the end of the inspiratory cycle. This is sometimes referred to as "recruitment" because it allows delayed opening of alveoli, recruiting more effective ventilation in the face of atelectasis. Oxygen saturation can sometimes be improved with this maneuver.













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American Heart Saver Institute, LLC Po Box 2673 | Ocala, FL 34478

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