METHODS & PRINCIPLES USED

IN CPR

2

Introduction Methods and procedures for managing:

obstructed airways artificial respiration (AR) cardiopulmonary resuscitation (CPR)

Always consider the height and size of the patient

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Activating EMS Activate EMS as soon as you realize the patient

requires medical attention beyond your training or the facilities available are inadequate to provide proper attention: Tell someone to call an ambulance. Have them describe the patient and keep it simple Tell them to come back If an AED is available, ask them to bring it to you

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Activating EMS Alone with Unresponsive Adult

Immediately activate the EMS yourself and get an AED

Alone with Child or Infant Initiate resuscitation techniques for two minutes (five

cycles) then activate EMS, and continue until help arrives

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Clearing the Airway Repositioning the head

Head tilt chin lift Tongue Jaw Lift Jaw Thrust for suspected neck injury

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Head Tilt - Chin Lift Palm on patient’s forehead

applying firm backward pressure to tilt head back

Lift chin by placing the fingers of your other hand under the bony part of the lower jaw, lift until the teeth are almost together, the mouth is not completely closed

Pressing on the soft tissue under the chin can obstruct the airway

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Tongue Jaw Lift Place your thumb in the mouth Grab the jaw Lift the mandible up and out Use other hand to stabilize the head Do not hyper- extend the neck

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Jaw Thrust Place fingers of both hands behind the angle of

the patient’s lower jaw Lift, forcing the mandible forward and tilting the

head back In case of neck injury - this must be used without

lifting or moving the head

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Mild Airway Obstructions Caused by foreign object (usually eating or

chewing) Patient may use the universal distress signal May begin to turn blue Obviously very frightened Ask “Are you choking?”

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Mild Airway Obstruction Signs and Symptoms:

the ability to forcibly cough wheezing between coughs

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Treatment with Good Air Exchange Prevent further injury Identify yourself as trained

in first aid Ask permission and offer

assistance Do not attempt abdominal

thrusts Never interfere with the

patient’s efforts to clear the airway

Stay with the patient until breathing is normal

Monitor vital signs Encourage the patient to

dislodge the object by coughing

If condition persists, activate EMS

If patient becomes unresponsive, treat for severe airway obstruction

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Mild Airway Obstruction - Worsening Poor Air Exchange

ineffective or weak coughs high pitched noises while inhaling increased respiratory distress possible cyanosis

Treat this situation as a severe airway obstruction

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Severe Airway Obstruction The inability to produce any sound indicates a

severe airway obstruction inability to speak, breathe or cough absence of chest movement or air exchange Increased cyanosis

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Abdominal Thrusts/Back Blows Conscious Adult or Child

position yourself behind thechoking patient

wrap your arms around their waist

make a fist with one hand, place thumb side to abdomen above navel, below sternum

grip this fist with the other hand administer five quick upward thrusts

Abdominal Thrust/Back Blows Administer five back blows between the should blades with the heel

of your hand continue until successful or patient becomes unresponsive

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Special Considerations Pregnant and Grossly Obese

Use chest thrust by placing the fist mid-sternum (CPR position)

Elderly Ribs may be fragile

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Back Blows/Chest Thrusts Conscious Infant

pick up infant while supporting the head and body place infant face down along your forearm, supporting

their body on your thigh ensure baby’s head is well supported and lower than

their body administer 5 back blows between the shoulder blades

with heel of your hand

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turn infant face up, supporting their body on the opposite thigh

ensure baby’s head is well supported and lower than their body

landmark and administer 5 chest compressions

Back Blows/Chest Thrusts

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Landmarking for Infant Place two fingers in the middle of the infant's

chest between the nipples Slide your fingers to just below the nipple line Administer five chest thrusts with the two fingers.

Press down quickly with the two fingers on the centre of the chest.

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Finger Sweep Open the mouth. Grasp both the tongue and the

lower jaw Lift the mandible Insert the index finger of the

other hand along the inside of the cheek and sweep the throat at the base of the tongue

Carefully scoop out the obstruction

Only perform when you can see the obstruction.

For infants use your small finger to remove obstruction

Look first!

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Suction Suction devices are used to remove fluids and

vomit from the airway. There are many devices on the market which all

share common instructions and precautions for use.

Suction is applied only to the mouth/oral cavity and upper airway

Apply suction for 5 to 10 seconds at a time, while the tip is being withdrawn.

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Suction Signs and symptoms that patient would require

the use of a suction: decreased level of consciousness facial injuries involving the mouth or nose any person whose ventilation are being assisted any time an oropharyngeal airway is being used

If the choking patient becomes unresponsive, the rescuer will begin with the CPR sequence