CPR

Standard Precautions

Always take the same protective approach regardless of relationship or age

Dragging

Dragging is the most effective emergency move

Nosebleeds

Occurs when small blood vessel inside nostril ruptures Pinch soft portion of nose with thumb and index finger; hold for about 10 minutes

Implied Consent

When person is unresponsive, consent is implied

Multiple Providers

Working together can improve quality, minimize interruptions

If Life-Threatening Condition is Found or Suspected

Activate EMS and provide indicated care

Children and Infants

Ages in relation to CPR Infant is younger than 1 year of age Child is 1 year of age to onset of puberty Adult is onset of puberty and older Children are more likely to experience a secondary cardiac arrest Emphasis on delivering high-quality rescue breaths is important

Establishing an Airway

Airway is only path to get air containing oxygen to lungs Tongue will likely block airway when person is unresponsive, flat on back Head tilt-chin lift technique moves tongue and opens airway Airway is higher priority than suspected spinal injury

Direct Pressure

Applied directly to bleeding site until bleeding stops Standard method for controlling bleeding Use protective barriers

You and your coworker are loading boxes into a truck on a busy street when a bicyclist, riding on the sidewalk, suddenly collides with your coworker. The bicyclist rides away, apparently uninjured, but the man who was struck is still holding his abdomen and groaning. You have been trained as a first aid provider and think you can help, but you hesitate because you are unsure about your ability to help. What should you do?

Approach and offer to help your coworker.

Rescue Breaths

Artificial breaths given by blowing air into the mouth to inflate the lungs Enough oxygen in exhaled air to provide what is needed

Delivering Breaths

Each breath about 1 second in length Only enough air to create visible rise of chest, but no more During CPR, give 2 breaths at a time, quickly as possible within 10 seconds Children and Infants — Rescue breaths for are performed in the same manner as for adults. Special care should be taken to not give too much air in a single breath. Provide only enough air to make the chest visibly rise, but no more

Signs

Early signs difficult to detect Serious signs emerge gradually

Sudden Cardiac Arrest (SCA)

Electrical system of heart malfunctions, results in ventricular fibrillation Affected person abruptly becomes unresponsive, stops breathing

Recognizing an Emergency

Emergency scenes can be confusing Form a general impression of what happened

Secondary Cardiac Arrest

End result of a loss of an airway or breathing Without oxygen, heart progressively weakens, then stops Requires CPR with effective rescue breaths

Consent

Everyone has right to refuse treatment Make it clear you are trained and there to help

Thermal Burns

If burning or flames still present, act immediately to extinguish it Cool burn with cool or cold water as quickly as possible Early cooling can reduce pain and minimize risk and damage Cool for at least 10 minutes Watch for signs of overcooling on large burns, such as shivering Children more likely to have complications from overcooling

Tourniquets

If direct pressure is unable to control bleeding, use a tourniquet around limb to stop blood flow Considered a first step in bleeding control when it is clear direct pressure cannot be used

Provide Indicated Care

If not breathing or only gasping, perform CPR beginning with compressions If breathing normally and uninjured, place person in side-lying recovery position to protect airway

Asthma

Medical condition in which certain things can trigger physical reaction in lungs, making it difficult to breathe Inhaler devices deliver quick-relief medication to control symptoms If person has inhaler, assist him or her in using it Activate EMS if no response to medication within 5 minutes, or symptoms seem serious, or gets worse

High-Quality CPR

Minimize interruptions CPR is tiring; take turns performing CPR by switching every few minutes

Fainting

Momentary loss of consciousness caused by drop in blood pressure and blood flow to the brain Lay person on ground Consider elevating legs 6 to 12 inches

Chain of Survival

Most effective approach to manage sudden cardiac arrest All links in chain must be strong for person to survive

Early Defibrillation

Most effective way to end ventricular fibrillation, and restore normal heartbeat AEDs allow bystanders to defibrillate earlier than EMS

Survival

Needs hospital treatment to survive

Stroke

Occurs when blood supply to portion of brain is interrupted resulting in damage to brain tissue Symptoms vary, may include weakness on one side of body; confusion; difficulty in speech, sight, or balance Medications are available in hospitals that can limit brain damage from stroke; they need to be given as early as possible. Stroke assessment (FAST) can help you recognize stroke, and get person to hospital for stroke treatment faster Activate EMS if person cannot perform any of the requested stroke assessment action

Bleeding

Occurs when blood vessels are damaged Reduces amount of oxygen that can be delivered to the body If heavy or uncontrolled, can become life threatening

Shock

Occurs when poor blood flow creates shortage of oxygen to tissues Potential result of any serious illness or injury Can become life-threatening if not treated early

Choking

Occurs when solid object enters narrowed part of airway, becomes stuck

Electrical Burns

Occurs when there is direct contact with an energized object Be safe; turn off any electrical current before touching person Electrical shock can cause abnormal heart rhythm; if safe, perform CPR and use an AED if available

Abandonment

Once started, remain with person until you can transfer care

Steps for Care

Primary assessment to determine if cardiac arrest occurred Begin CPR with compressions; ongoing cycles of 30 compressions and 2 rescue breaths When AED arrives, use immediately Continue until another provider or EMS takes over, or too exhausted to continue

Poison Help Line

Provides free and confidential medical advice on poisonings anytime 1-800-222-1222

When Dragging

Pull person lengthwise Use your legs, not your back Keep weight close to you

You have responded to help a customer who has collapsed in the store you work at. Your assessment shows he is unresponsive and not breathing. You ask another coworker to activate EMS and get the store's AED. You start CPR. What does CPR do to help improve the person's chance for survival?

Restores limited oxygen to the brain to delay brain cell death

You hurry to the maintenance shop for a report of an employee who is ill. You arrive to a crowd outside the shop building and find that there are two employees involved. One looks very ill and describes being overcome by fumes in a poorly ventilated area. The other employee is motionless on the ground. You conduct a primary assessment on her and find she is unresponsive and not breathing. You ask another employee to activate EMS and get an AED, and then begin CPR. What do you suspect is the underlying problem?

Secondary cardiac arrest due to a loss of breathing

Breathing Difficulty, Shortness of Breath

Serious medical emergency Generally caused by underlying medical illness At rest, normal breathing is regular, effortless Suspect difficulty when you see increased rate, effort Bluish purple tissue indicates lack of oxygen in blood

Do Your Best

Someone in cardiac arrest will not survive without help Nothing you can do can make the outcome worse

First Aid Provider

Someone trained to give life-supporting care prior to arrival of professional providers

Emergency Action Plan (EAP)

Step-by-step procedure for managing emergencies in your workplace

Children and Infants

Steps for caring for cardiac arrest on a child or infant very similar to those for an adult

As a trained provider, you respond to a situation in which CPR is already being performed for an employee who has collapsed. An AED is coming but has not yet arrived. The CPR provider looks exhausted. What should you do to smoothly integrate yourself to take over doing the CPR?

Switch at the end of the CPR cycle while the current provider is giving rescue breaths.

If AED Is Attached

Switch during CPR pause when AED analyzes, which is about every 2 minutes

Before AED Arrives

Switch places at end of CPR cycle while rescue breaths are being given

Seizure

Triggered by excessive electrical activity in the brain, causes uncontrolled muscle convulsions Typically occurs without warning Protect person from injury Do not tightly restrain person Roll person to his or her side if possible Do not put anything in person's mouth Most seizures last only a short time Responsiveness will gradually improve after seizure stops

At the elementary school where you teach, one of your students tells you that another child fell off the play structure at recess. Concerned, you approach the child who fell and ask her what happened. She tells you she hit her belly on one of the bars when she fell and that it hurt a lot at first, but that it feels better now. You are concerned whether she injured herself internally. What early signs do you look for?

Unease, restlessness, and worry

Stabilize Injury

Unstable bone ends can damage surrounding tissue Encourage person to not move or use injured limb Use padding in gaps around and below limb to stabilize If needed, manually stabilize above and below injury site

Compression-Only CPR

Untrained bystanders encouraged to provide compression-only CPR, which is a limited approach As trained provider, provide both compressions and breaths If unwilling or unable to give rescue breaths, provide uninterrupted compressions

Using Barrier Devices

Use barrier device like CPR mask or overlay shield to give rescue breaths

Considerations

Use chest thrusts if person is pregnant or obese If alone, press abdomen quickly against rigid surface, such as back of a chair

Personal Protective Equipment (PPE)

Use disposable gloves and other barriers when responding in an emergency

Gasping

Weak, irregular gasping sounds provide no useable oxygen, not normal breathing

AED Operation

Same basic operation steps apply to all AEDs Turn on AED Adhere defibrillation pads to bare chest Allow AED to analyze the heart Deliver shock if directed by AED

Internal Bleeding

Significant blow can create injury and bleeding inside body Shock may be earliest indication of internal bleeding

Troubleshooting

AEDs designed to detect problems during use If troubleshooting message occurs, follow AED voice instructions

Infectious Bloodborne Diseases

Blood and other body fluids can be potentially infectious

Oxygen and the Human Body

Body does not store oxygen Must continually supply oxygen through respiratory and circulatory systems If process is interrupted, brain cell death occurs in minutes

Musculoskeletal System

Bones, muscles, joints give body shape, allow movement, protect internal organs Long bones form upper and lower parts of limbs; these are the most exposed bones to injury Muscles, ligaments, tendons allow for movement

Chemical Burns

Chemical Burns Caused by direct contact on skin of some chemicals Quickly flush chemical with large amounts of water Prevent additional exposure to person or yourself Brush off dry powder with gloved hand or cloth, then flush with water

Cardiopulmonary Resuscitation (CPR)

Combination of chest compressions and rescue breaths Can restore limited blood flow and oxygen to brain Does not address underlying problem with heart

When Attaching an AED

Continue CPR until the pads are placed and AED analysis begins

You are caring for a coworker who has been injured and is bleeding heavily. Because she is a close friend, it is not important to use personal protective equipment to protect yourself from possible exposure to an infectious disease.

False

Treating Cardiac Arrest

Immediate high-quality CPR and rapid defibrillation can double or triple survival chance from SCA

Injured Tooth

Immediate reimplantation believed to result in greatest chance of tooth survival Keep tooth moist to extend time for successful reimplantation At minimum, have person spit into a cup, place tooth in saliva Get person to dentist quickly, within an hour

You return from your lunch break to your work area and discover a coworker who appears to have collapsed and does not respond to your voice or touch. You immediately begin to help. What legal concept related to providing first aid care applies in this situation?

Implied consent

Burns

Injuries to skin and underlying tissue caused by exposure to extreme heat, chemicals, electrical contact Severity related to depth and size; deep with blisters and broken skin are more serious as are large burns with shallow depth Those involving face, neck, hands, genitals, and feet are considered more serious Make sure it is safe for you to help

Emergency Medical Services (EMS)

Integrated network of resources: communication, response, treatment, and transport for medical emergencies Activated by calling a simple emergency number like 911 Trained dispatcher guides the call Mobile phones allow you to stay with ill or injured person Speakerphone allows communication while providing care

Basic Steps

Introduce yourself and ask to help Look for indication of altered mental status Assess for difficulty breathing Scan body for serious bleeding Look for obvious signs of shock by checking tissue color, skin temperature

A fellow employee collapses near you during a staff meeting. As a trained provider, you move to help. You kneel next to him, squeeze his shoulder, and loudly ask, "Are you all right?" He is unresponsive, so you direct other employees to activate EMS and get the company's AED. You look closely at the face and chest for breathing; he makes a brief gasping snort, but then remains still. What do you do next?

Perform CPR because the gasping is not normal breathing

Severe Blockage

Person cannot inhale air to create effective cough

Spinal Injury

Significant external force can cause serious injury to spine Can result in paralysis, loss of breathing, shock Once damaged, movement can cause additional injury Suspect when obvious injuries to head, neck, or back May have numbness, tingling, burning, loss of sensation in arms or legs Lack of symptoms does not mean spine is not injured; assume spinal injury following significant impact on body Tell person to remain still; manually stabilize head Open airway is higher priority than suspected spinal injury; tilt head and lift chin if necessary If airway becomes threatened by fluids, roll person as needed to clear and protect it

Altered Mental Status

Significant or unusual change in person's personality, behavior, or consciousness Can be caused by medical conditions, alcohol, medication, or drugs Warning sign of serious problem; activate EMS If necessary, place person in recovery position to protect airway

AEDs

Simple to use: voice, light, and screen instructions guide you

Primary Assessment

Simple way to quickly identify if a life-threatening condition is present

Primary Assessment

Simple way to quickly identify if life-threatening condition is present

Mild Blockage

Some ability to inhale; affected person can cough up object

You enter a warehouse door to get to your work area and discover one of your coworkers alone and looking very ill. After talking to him, you are unsure about what is happening, but you feel it could be very serious. Should you activate EMS?

Yes, EMS activation is appropriate if you are unsure of the severity.

Personal Safety

Your safety is the highest priority Make sure scene is safe before approaching to help If the scene is not safe, get out!

You are stacking shelves in the home goods area of the store where you work when you hear a loud crash and the sound of glass shattering. As a trained first aid provider, you cautiously move to see what happened. A frightened-looking customer is sitting on the floor next to a display that has collapsed. She is surrounded by broken glass. You carefully get to her and let her know you are trained and can help. She appears aware of what has happened and is breathing normally. You scan the floor around her and see a growing pool of blood behind her. The back of her blouse is soaked with blood. What do you do next?

Activate EMS and control the bleeding.

Concussion

Brain injury that results in less immediate or obvious signs Most are temporary and resolve naturally but can progress to life-threatening condition Suspect after a significant head or body blow when a person is unable to recall what happened No concussion evaluation tool available for first aid providers to determine if someone can return to normal activity Person should be evaluated by healthcare provider or EMS as soon as possible Do not let person perform action that could lead to further injury

Switching Providers

CPR is tiring and switching providers about every 2 minutes helps maintain CPR quality Communicate ahead of time about how and when to switch Take less than 5 seconds to switch

Opioid Overdose

Can depress or stop breathing, resulting in secondary cardiac arrest Naloxone can quickly reverse opioid effects Naloxone is being made more available

Brain Injury

Can occur from significant head blow or rapid movements of head Swelling, bleeding inside skull can result in increased pressure; surgery may be only treatment Suspect when blow to the head clearly results in diminished responsiveness Manually stabilize head Be prepared for seizure or cardiac arrest

Chemicals in Eye

Can quickly damage eye tissue Eyes become painful, red, watery Immediately flood eye with large amounts of water; take care not to affect other eye

Children and Infants

Cardiac arrests likely caused by initial loss of airway or breathing Steps the same as for an adult Most have especially designed pads or reduced energy for small body size If specially equipped AED not available, use one configured for adults

Children and Infants

Care for choking on a child is very similar to an adult For infants, repeating cycles of 5 back blows and 5 chest thrusts is recommended

Steps

Check for responsiveness If unresponsive, activate EMS and get AED if available Assess for normal breathing

Hypoglycemia

Diabetic condition of low blood sugar; can be life-threatening Person can act odd or become confused If responsive and can swallow without difficulty, provide some form of sugar If unable to follow simple commands or has difficulty swallowing, give nothing to eat or drink; activate EMS Never administer insulin

Type of Injury

Difficult to distinguish type of injury Treat everything as possible fracture

Vehicle Crash

Do not drag someone from vehicle unless vehicle is on fire

A fire has broken out in the building you are working in, and you are quickly evacuating with other employees. As you are exiting, you find an employee who has collapsed to the floor and is not moving. Smoke is quickly filling the area where you are. What should you do for the collapsed employee?

Drag your coworker from the smoke-filled area to a safer location.

Chest Compressions

External compressions of chest increase pressure inside chest and heart Forces blood to move from chest to rest of body Quality matters Compress deeply, more than 2 inches Compress fast, between 100 and 120 times per minute Allow chest to fully recoil. Avoid leaning on the chest at top of each compression Children and Infants — Chest compressions on children and infants are similar to adults except for hand positioning and the depth of the compressions

Abdominal Thrusts

Forceful thrust beneath ribs and up into diaphragm increases pressure in chest, pops obstruction out of airway Repeat thrusts until person can breathe normally If person becomes unresponsive, perform CPR and look for object each time before giving rescue breaths

Good Samaritan Laws

Help protect you legally in your role as first aid provider Vary from state to state Be familiar with laws where you live and work

Hemostatic Dressing

If direct pressure is unable to control bleeding and injury is located where a tourniquet cannot be applied, consider a hemostatic dressing Impregnated with an agent that speeds up clotting

When to Move Someone

It is best not to move someone unless the person is in danger or requires life-supporting care

Deciding to Help

It is normal to feel hesitant about helping, but don't let that stop you

Considerations

Local cooling can decrease bleeding, swelling, pain Leave limb in position found; do not straighten If limb is blue or pale, circulation is compromised; activate EMS Splinting can reduce pain and prevent further injury; best to rely to EMS personnel to splint

Brain injury that results in less immediate or obvious signs Most are temporary and resolve naturally but can progress to life-threatening condition Suspect after a significant head or body blow when a person is unable to recall what happened No concussion evaluation tool available for first aid providers to determine if someone can return to normal activity Person should be evaluated by healthcare provider or EMS as soon as possible Do not let person perform action that could lead to further injury

Manually stabilize her head.