CPR & First Aid/AED

Moving A Victim: Consider

-Victim's height and weight -Your own physical strength -Obstacles (such as stairs or narrow passages) -Distance to be moved -Whether others are available to assist -Victim's condition -Whether the equipment needed to move the victim is readily available

Modified HAINES recovery position

Move the victim into the modified high arm in endangered spine, or H.A.IN.E.S., recovery position to keep the airway open and clear, even if a spinal injury is suspected. Examples of situations in which this position is appropriate include if you are alone and have to leave the person (for example, to call for help) or if you cannot maintain an open and clear airway because of fluids or vomit. 1. KNEEL AT THE SIDE 2. ROLL THE VICTIM AWAY FROM YOU ■■ Lift the arm farthest from you up next to the head, with the victim's palm facing up. ■■ Take the arm closest to you and place it next to his or her side. ■■ Bend the leg farthest from you up. ■■ Using your hand closest to the head, cup the base of the skull in your palm and carefully slide your forearm under the shoulder closest to you. c■ Do not lift or push the head or neck. ■■ Place your other hand under the arm and hip closest to you. ■■ Using a smooth motion, roll the victim away from you by lifting with your hand and forearm until the victim is on his or her side. c■ Keep the victim's head in contact with his or her extended arm and support the head and neck. 3. PLACE THE TOP LEG ON THE OTHER WITH BOTH KNEES IN A BENT POSITION 4. ALIGN THE ARM ON TOP WITH THE UPPER BODY ■■ If you must leave to get help, place the hand of the victim's upper arm palm side down with the fingers under the armpit of his or her extended lower arm.

Ventilations

Once you've given 30 compressions, give 2 ventilations. Open the airway using the head-tilt/chin-lift technique while making a complete seal over the mouth and nose with a resuscitation mask. Deliver 2 quick ventilations, one right after the other. Each ventilation should last about 1 second and make the chest clearly rise.

Face-Up Position

Place the victim in the face-up position, especially if a head, neck or spinal injury is suspected. Maintain an open airway.

Duty to act

The duty to respond to an emergency and provide care. Failure to fulfill these duties could result in legal action.

Oxygen & The Body

The human body needs a constant supply of oxygen to survive. After entering the nose and mouth, air travels down the throat, through the trachea and into the lungs. This pathway from the mouth and nose to the lungs is called the airway. With a breathing emergency, the air cannot travel freely and easily into the lungs.

Confidentiality

The principle that information learned while providing care to a victim is private and should not be shared with anyone except EMS personnel who are directly associated with the victim's medical care.

Standard of care

The public's expectation that personnel summoned to an emergency will provide care with a certain level of knowledge and skill.

Scope of practice

The range of duties and skills acquired in training, which are authorized by your certification to practice.

Battery

The unlawful, harmful or offensive touching of a person without the person's consent.

AED Maintenance

be familiar with the various visual and audible prompts that warn of malfunction or low battery; read the operator's manual thoroughly; periodically check equipment; have a fully charged backup battery and properly sealed, unexpired AED pads available in the correct size; replace all used accessories; and make sure that the machine is in proper working order before placing it back in service.

When an adult is unable to give consent, such as if he or she is unconscious, confused, mentally impaired, seriously injured or seriously ill,

consent is implied.

To obtain consent:

-Identify yourself to the victim. -State your level of training. -Ask the victim whether you may help. -Explain what you observe. -Explain what you are planning to do.

If the condition is life threatening and a parent or guardian is not present

consent is implied

Refusal of care

-A victim's indication that a rescuer may not provide care. -Refusal of care must be honored, even if the victim is seriously injured or ill or desperately needs assistance. -A victim can refuse some or all care. If a witness is available, have the witness listen to, and document in writing, any refusal of care.

Causes of Hypoxia

-An obstructed airway -Shock -Inadequate breathing -Drowning -Strangulation -Choking -Suffocation -Cardiac arrest -Respiratory infection -Head trauma -Carbon monoxide poisoning -Complications of general anesthesia

Mechanical Obstructions

- due to a foreign body obstructing the airway: -In adults, the obstruction most commonly is food. -In children younger than 4 years of age, the obstruction most often involves large chunks of food or small objects, such as toys and balloons.

The survival and recovery of critically injured or ill victims depends on

- early recognition and response -early activation of the EMS system -care being provided until more advanced medical personnel take over

Anatomical Obstructions

- involve blockages by anatomical structures: -Anatomical obstructions are most often due to the tongue. When a person becomes unconscious, the tongue loses muscle tone and falls back, blocking the airway.

Hepatitis B

- live infection caused by the Hep B virus - vaccination series must be made available within 10 working days of initial assignment, after appropriate training has been completed, to all employees who have occupational exposure

Hepatitis C

- liver disease caused by Hep C virus - no vaccines

Respiratory Arrest

- victim has stopped breathing - results form respiratory distress or from heart attack or airway obstruction

To prevent the spread of bloodborne pathogens and other diseases, certain procedures and guidelines should be followed.

-Avoid contact with blood and other body fluids. -Use CPR breathing barriers when giving ventilations. -Wear disposable gloves when providing care, particularly if you may come into contact with blood or body fluids. Also wear protective coverings, such as a mask, eyewear and a gown, if blood or other body fluids can splash. -Use gloves that are appropriate for the task and provide an adequate barrier. Do not use disposable gloves that are discolored, torn or punctured, and do not clean or reuse disposable gloves. -Before putting on disposable gloves, cover any cuts, scrapes or sores and remove jewelry, including rings. -Avoid handling items such as pens, combs or portable devices when wearing soiled gloves. -Change gloves before providing care to a different victim. -Remove disposable gloves without contacting the soiled part of the gloves and dispose of them in a proper container.

Head, Neck and Spinal Injuries Include

-Changes in LOC. -Severe pain or pressure in the head, neck or spine. -Loss of balance. -Partial or complete loss of movement of any body part. -Tingling or loss of sensation in the hands, fingers, feet or toes. -Persistent headache. Unusual bumps, bruises or depressions on the head, neck or back. -Seizures. -Blood or other fluid emanating from the ears or nose. -External (visible) bleeding from the head, neck or back. -Impaired breathing or vision as a result of the injury. -Nausea or vomiting. -Bruising of the head, especially around the eyes and behind the ears.

Primary Assessment

-Check for life-threatening conditions, which include unconsciousness, absence of breathing, absence of pulse and severe bleeding. -Check for responsiveness and, if the victim is conscious (tap & talk), obtain consent. If no response, summon more advanced medical personnel. -Note the victim's level of consciousness, or LOC, using the AVPU scale. (The victim may be alert, verbal, responsive only to painful stimuli, or unconscious.) -If the victim is unconscious, open the airway and quickly check for breathing (jaw thrust) (rise & fall of chest, breath sounds) -Check circulation; for a pulse @ carotid artery on same side you are, if infant=brachia For victims of hypoxia, such as drowning victims, and for children and infants who are more likely to experience respiratory emergencies, give 2 ventilations. -Quickly scan for severe bleeding. (pathogens, pressure bandage during CPR, splints) Provide care as needed.

Pulse

-Check the carotid pulse in adults. -Check the brachial pulse in children.

Choking is a result of:

-Chewing food poorly. -Consuming alcohol before or during meals. -Eating too fast or talking or laughing while eating. -Walking, playing or running with food or objects in the mouth. -Wearing dentures.

If you are exposed, immediately take the following actions:

-Clean the contaminated area thoroughly with soap and water. Wash needlestick injuries, cuts and exposed skin. -If splashed around the mouth or nose with blood or other body fluids, flush the area with water. -If the eyes are involved, irrigate with clean water, saline or sterile irrigants for 20 minutes.

Chest Compressions

-Compressions force blood to empty from the heart and allow the heart's chambers to fill with blood when the chest returns to its normal position. -This helps to keep blood containing oxygen moving throughout the body.

When the heart stops

-Damage to the heart muscle from disease or injury can disrupt the heart's electrical system. -The two most common treatable abnormal rhythms associated with sudden cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). -With V-fib, the ventricles quiver without any organized rhythm, the electrical impulses fire at random, creating chaos, and the heart is unable to pump and circulate blood. -V-tach occurs when an abnormal electrical impulse originates in the ventricles instead of at the sinoatrial (SA) node. The impulse fires rapidly, preventing the chambers from filling, and the heart is not able to pump effectively.

Heart Attack Signs & Symptoms

-Discomfort, pressure or pain that is persistent and ranges from mild discomfort to an unbearable crushing sensation in the chest -Discomfort, pressure or pain possibly spreading to the shoulder, arm, neck, jaw, stomach or back, which usually is not relieved by resting, changing position or taking medication -Pain that comes and goes (such as angina pectoris) -Difficulty breathing, such as breathing at a faster than normal rate or breathing noisily -Pale or ashen skin, especially around the face -Sweating, especially on the face -Dizziness or light-headedness -Possible loss of consciousness -Nausea or vomiting

Advance directives include:

-Do Not Resuscitate (DNR) orders (also called Do Not Attempt Resuscitation [DNAR] orders). -Living wills. -Durable powers of attorney.

Engineering and work practice controls

-Engineering controls are objects used in the workplace that isolate or remove a hazard, reducing the risk for exposure. -Work practice controls are methods of working that reduce the likelihood of an exposure incident by changing the way a task is carried out.

Giving Ventilations: Drowning

-For a drowning victim (adult, child or infant) give 2 ventilations after you check for breathing and a pulse. -Many victims who have been submerged vomit because water has filled the stomach or air has been forced into the stomach during ventilations.

Opening the Airway

-From the side, use the head-tilt/chin-lift technique. -From above the victim's head, use the jaw-thrust (with head extension) maneuver. -If a head, neck or spinal injury is suspected, use the jaw-thrust (without head extension) maneuver. -For a child, tilt the head slightly past a neutral position but not as far as you would for an adult. -For an infant, tilt the head to a neutral position.

Good hand hygiene

-Hand washing is the most effective measure to prevent the spread of infection. -Alcohol-based hand sanitizers allow you to clean your hands when soap and water are not readily available and your hands are not visibly soiled.

Choking: Special Considerations

-If a victim is too large for you to reach around to give abdominal thrusts, or if the victim is pregnant, give back blows and chest thrusts. -To give chest thrusts, stand behind the victim. Place a fist against the center of the victim's chest, or slightly higher if the victim is pregnant. -Grab your fist with your other hand and give quick, inward thrusts.

Giving Ventilations: Victim with a Stoma

-If the victim has a stoma, keep the airway in a neutral position as you determine whether he or she is breathing by looking, feeling and listening with your ear over the stoma. -To give ventilations, make an airtight seal with a round pediatric resuscitation mask around the stoma or the tracheostomy tube and blow into the mask.

After any exposure incident:

-Immediately report the exposure incident to the appropriate person identified in your employer's exposure control plan and to the EMS personnel who take over care. -Write down what happened. Include the time and date of the exposure as well as the circumstances of the exposure, any actions taken after the exposure and any other information required by your employer. -Seek immediate follow-up care as identified in your employer's exposure control plan.

signs and symptoms of hypoxia

-Increased breathing and heart rates -Cyanosis -Changes in LOC -Restlessness -Chest pain

Caring for Respiratory Distress

-Maintain an open airway. -Summon more advanced medical personnel. -Help the victim rest in a comfortable position that makes breathing easier. -Reassure and comfort the victim. -Assist the victim with any prescribed medication. -Keep the victim from becoming chilled or overheated. -Administer emergency oxygen, if it is available and you are trained to do so.

signs and symptoms of a heart attack more common in women

-More atypical chest pain: sudden and sharp but short-lived pain outside of the breastbone -Shortness of breath -Nausea or vomiting -Jaw pain -Back pain -Unexplained fatigue or malaise

Types of Breathing

-Normal (effective) breathing is regular, quiet and effortless. -Isolated or infrequent gasping in the absence of other breathing in an unconscious victim may be agonal gasps, which can occur after the heart has stopped beating. Agonal gasps are not breathing. Care for the victim as though he or she is not breathing at all.

Personal protective equipment, or PPE

-PPE consists of specialized clothing, equipment and supplies that keep you from directly contacting infected materials. -PPE should be available in your workplace and identified in the exposure control plan.

Causes of Breathing Emergencies

-Partial airway obstruction. -Illness. -Chronic conditions, such as asthma and emphysema. -Electrocution, including lightning strikes. -Heart attack. -Injury to the head, chest, lungs or abdomen. -Allergic reactions. -Drug overdose. -Poisoning. -Emotional distress. -Anaphylactic shock. -Non-fatal drowning.

Standard precautions can be applied through the use of:

-Personal protective equipment, or PPE -Good hand hygiene -Engineering and work practice controls -Proper equipment cleaning -Proper spill cleanup procedures

Bloodborne pathogens, such as bacteria and viruses, are:

-Present in blood and body fluids. -Can cause disease.

Respiratory Distress

-Slow or rapid breathing -Unusually deep or shallow breathing -Shortness of breath or noisy breathing -Gasping for breath -Wheezing, gurgling or high-pitched noises -Dizziness, drowsiness or light-headedness -Changes in level of consciousness (LOC) -Increased heart rate -Chest pain or discomfort -Skin that is flushed, pale, ashen or bluish -Unusually moist or cool skin -Inability to speak in full sentences -Tingling in the hands, feet or lips -Feelings of apprehension or fear

Summoning More Advanced Medical Personnel when:

-Unconsciousness or an altered LOC, such as drowsiness or confusion. -Breathing problems such as trouble breathing or no breathing. -Chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that. radiates to the shoulder, arm, neck, jaw, stomach or back. -Persistent abdominal pain or pressure. -Severe external bleeding, or bleeding that spurts or gushes steadily from a wound. -Vomiting blood or passing blood. -Severe burns. -Suspected poisoning. -Seizures. -Stroke, the symptoms of which include sudden weakness on one side of the face/facial droop, sudden weakness on one side of the body, sudden slurred speech or trouble getting words out, or a sudden severe headache. -Suspected or obvious injuries to the head, neck or spine. -Painful, swollen, deformed areas, such as those that occur with a suspected broken bone or an open fracture. -Or the victim's condition is not clear or is worsening.

Size-Up the Scene

-Use all of your senses to check for hazards, such as traffic, unstable structures, downed electrical lines, swift-moving water, violence, explosions or toxic gas. -Put on the appropriate personal protective equipment, or PPE. -Determine the mechanism of injury, or MOI, or nature of the illness. -Determine the number of injured or ill victims. Request additional help, if needed. -And if the scene appears unsafe, move to a safe distance, notify the appropriate personnel and wait for their arrival.

Suspect injury to the head, neck or spine if the victim:

-Was involved in a motor-vehicle, motorcycle or bicycle crash as an occupant, rider or pedestrian. -Was injured as a result of a fall from greater than standing height. -Complains of neck or back pain, tingling in the extremities or weakness. -Is not fully alert. -Appears to be intoxicated. -Appears frail or older than 65 years of age or is a child younger than 3 years of age. -Has an obvious head, neck or spinal injury.

Advance directives

-Written instructions that describe a person's wishes regarding medical treatment or health care decisions. -Guidance for advance directives, including any required identification and verification process, is documented in state, regional or local laws, statutes and/or protocols and must be followed.

When To Move a Victim

-You are faced with immediate danger. -You must get to another victim who may have a more serious problem. -Or moving the victim is necessary to provide proper care.

Conscious Choking

-conscious person with a partially or completely blocked airway may clutch at his or her throat -If the person is coughing, encourage continued coughing. -If the person cannot cough, speak, cry or breathe, take immediate action. -To clear an obstructed airway, give back blows and abdominal or chest thrusts.

Unconscious Choking

-lower the victim to the ground, -open the mouth and -look for an object. If you see an object, use a finger sweep to remove it. If you do not see an object, or if you have removed an object, reopen the airway and attempt to give ventilations. If the chest does not rise with the first ventilation, retilt the head and give another ventilation. If the chest still does not clearly rise, give 30 chest compressions. (remove mask when giving compressions) Look for an object(grasp the tongue and lower jaw between your thumb and fingers and lift the jaw) in the mouth and, if one is seen, remove it with a finger sweep. Attempt to give 2 ventilations. Provide care as needed. If the ventilations still do not make the chest clearly rise, repeat steps 2-5. ■■ If the ventilations make the chest clearly rise, check for breathing and a pulse for no more than 10 seconds. c■ If unconscious but breathing, place in a recovery position. c■ If unconscious and no breathing but there is a pulse, give ventilations. dc■ If unconscious and no breathing or pulse, begin CPR.

Removing Disposable Gloves

-never touch bare skin 1. Pinch Glove: pinch the palm side of one glove near your wrist. Carefully pull the glove off so that is is inside out. 2. Slip 2 Fingers Under the Glove: hold the glove in the palm of your gloved hand. Slip 2 fingers under the glove at the wrist of the remaining gloved hand. 3. Pull Glove Off: pull the glove until it comes off inside out. The first glove should end up inside the glove you just removed. 4. Dispose of Gloves and Wash Hands: after removing gloves dispose of gloves and other personal protective equipment (PPE) in a proper biohazard container. -Wash your hands throughly with soap and running water, if available. Otherwise, rub hands thoroughly with an alcohol-based hand sanitizer if hands are not visibly soiled.

Heart Attack

-often is caused by blockages from plaque buildup or blood clots, which affect the ability of the heart to pump effectively. -A heart attack can lead to cardiac arrest, where the heart ceases to function as a pump. -When the heart muscle experiences a loss of oxygenated blood, the result is a heart attack, also known as a myocardial infarction, or MI. -The most common cause of heart attacks is cardiovascular disease. Other causes include -respiratory distress, -electrocution and -traumatic injury.

Giving Ventilations Using a Bag-Valve Mask Resuscitator

-one to position and seal the mask and open the airway and -one to give ventilations by slowly squeezing the bag.

standard precautions

-safety measures that combine universal precautions and body substance isolation, or BSI, precautions. -They are based on the assumption that all body fluids may be infectious.

Immediate Care of a Heart Attack

-summoning more advanced medical personnel; -having the victim stop any activity and rest; -loosening tight or uncomfortable clothing; -monitoring the victim closely until more advanced medical personnel take over, noting any changes in the victim's appearance or behavior; -comforting the victim; -assisting the victim with medications, such as nitroglycerine or aspirin, and administering emergency oxygen, if available and you are trained to do so; and -being prepared to perform CPR and use an automated external defibrillator, or AED.

Recovery Positions

-used when victim is unconscious, but breathing -Face-up position -Modified HAINES recovery position -Infant recovery position

HIV

-virus that causes AIDS -attacks WBCs and destroys the body's ability to fight infection - no vaccines

Administering Aspirin

-when the signs first begin in a conscious victim -never takes place of more advanced medical care -If the victim is conscious and able to take medicine by mouth, ask: -Are you allergic to aspirin? Do you have a stomach ulcer or stomach disease? Are you taking any blood thinners, such as Coumadin® or warfarin? Has a doctor told you not to take aspirin? -If the victim answers no to all of these questions, consider administering two chewable low-dose (162-mg) aspirins, or up to one 5-grain (325-mg) adult aspirin tablet, with a small amount of water.

Brain without oxygen

0 min: breathing stops. heart will soon stop beating 4-6 min: brain damage possible 6-0 min: brain damage likely over 10 min: irreversible brain damage certain

Primary Assessment: Adult

1. CHECK FOR RESPONSIVENESS ■■ Tap the shoulder and shout, "Are you okay?" 2. IF NO RESPONSE, SUMMON MORE ADVANCED MEDICAL PERSONNEL ■■ If face-down, roll the victim onto his or her back while supporting the head, neck and back. 3. OPEN THE AIRWAY AND CHECK FOR BREATHING AND A PULSE ■■ Check for no more than 10 seconds. ■■ Look, listen and feel for breathing. ■■ Feel for a pulse by placing two fingers in the middle of the victim's throat then sliding them into the groove at the side of the neck closest to you. Press lightly. -Note: For a breathing emergency (e.g., drowning, hypoxia), give 2 ventilations prior to Step 4. If the chest does not clearly rise when giving ventilations, the airway might be blocked. Provide care for an unconscious choking victim. 4. QUICKLY SCAN FOR SEVERE BLEEDING 5. PROVIDE CARE AS NEEDED ■■ If no breathing or pulse, perform CPR. ■■ If no breathing but there is a pulse, give 1 ventilation about every 5 seconds. ■■ If there is severe bleeding and the victim is breathing, provide first aid care for the bleeding. ■■ If unconscious but breathing, leave the victim in a face-up position and maintain an open airway. Place in a modified high arm in endangered spine (H.A.IN.E.S.) recovery position only if you: c■ Are alone and must leave the victim (e.g., to call for help). c■ Cannot maintain an open and clear airway because of fluids or vomit.

Primary Assessment: Child and Infant

1. CHECK FOR RESPONSIVENESS ■■ Tap the shoulder and shout. For an infant, you may flick the bottom of the foot. 2. IF NO RESPONSE, SUMMON MORE ADVANCED MEDICAL PERSONNEL ■■ If face-down, roll the victim onto his or her back while supporting the head, neck and back. 3. OPEN THE AIRWAY AND CHECK FOR BREATHING AND A PULSE ■■ Check for no more than 10 seconds. ■■ Look, listen and feel for breathing. ■■ Check for a pulse. c■ For a child, place two fingers in the middle of the throat, then slide them into the groove at the side of the neck closest to you. Press lightly. c■ For an infant, place two fingers on the inside of the upper arm between the elbow and shoulder. Press lightly. -Note: For a witnessed sudden collapse, skip Step 4. 4. IF NO BREATHING, GIVE 2 VENTILATIONS ■■ Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given. -Note: If the chest does not clearly rise during Step 4, the airway might be blocked. Provide care for an unconscious choking victim. 5. QUICKLY SCAN FOR SEVERE BLEEDING 6. PROVIDE CARE AS NEEDED ■■ If no breathing or pulse, perform CPR. ■■ If no breathing but there is a pulse, give 1 ventilation about every 3 seconds. ■■ If there is severe bleeding and the victim is breathing, provide first aid care for the bleeding. ■■ If unconscious but breathing, leave the victim in a face-up position and maintain an open airway. Place in a modified H.A.IN.E.S. recovery position only if you: ■ Are alone and must leave the victim (e.g., to call for help). ■ Cannot maintain an open and clear airway because of fluids or vomit.

Breathing Emergencies

A breathing emergency can be identified by watching and listening to a victim's breathing, observing his or her actions and asking how the victim feels. Because oxygen is vital for life, always ensure a victim has an open airway and is breathing. A victim who can speak or cry: is conscious, has an open airway, is breathing and has a pulse.

CPR

A person in cardiac arrest needs immediate CPR and defibrillation. CPR helps to take over for the heart and the lungs when a victim is in cardiac arrest. CPR is a combination of chest compressions and ventilations. One cycle of CPR equals: 30 compressions and 2 ventilations. Five cycles of CPR should be completed in about 2 minutes. The steps for CPR are the same for an adult or child, and are slightly modified for an infant.

Consent

A victim's indication that a rescuer may provide care. Consent must first be obtained, either verbally or through a gesture, before providing care to an injured or ill victim.

AVPU Scale

A=Alert V=Verbal P=Painful U=Unresponsive

Proper equipment cleaning:

After providing care, the equipment and surfaces used always should be cleaned and disinfected or properly disposed

AED Basics

An automated external defibrillator, or AED, is a portable electronic device that analyzes the heart's electrical rhythm through pads attached to the chest of a person in sudden cardiac arrest. An AED prompts you to deliver an electrical shock to the heart when needed. The delivery of this shock, called defibrillation, helps the heart to re-establish an effective rhythm in a victim who is unconscious, not breathing and has no pulse. If an abnormal heart rhythm is not corrected, asystole, or the cessation of all electrical activity, occurs. An AED is simple and safe to use on anyone in cardiac arrest, even infants and children. The sooner an AED is used in conjunction with CPR being performed, the greater the victim's chance for survival.

Documentation

An established, written record of the events that took place, the care that was provided and the facts that you discovered after the incident occurred.

The Cardiac Chain of Survival

CPR alone may not be enough to help someone survive cardiac arrest. A person in cardiac arrest will have the greatest chance for survival if you follow the four links in the Cardiac Chain of Survival: -early recognition and early access to the EMS system, -early CPR, -early defibrillation -and early advanced medical care.

CPR Breathing Barriers

CPR breathing barriers, such as face shields or resuscitation masks, create a barrier between your mouth and nose and those of the injured or ill victim, and offer protection while you are giving ventilations.

Infant CPR

CPR for an infant differs slightly from CPR for an adult or child in three ways. The first is hand placement. Place the palm of one hand on the forehead to keep the airway open, and then place the pads of two or three fingers of the other hand on the center of the infant's chest, just below the nipple line. The second is depth of compressions, which is about 1½ inches for an infant. Lastly, cover the infant's mouth and nose with a pediatric resuscitation mask when giving ventilations.

Two-Rescuer CPR

Clear communication is vital when two rescuers perform CPR together, especially when changing positions. Counting out loud helps rescuers to work together more effectively. Two-rescuer CPR is used -when two rescuers arrive on the scene at the same time and begin CPR together or -when one rescuer is performing CPR and a second rescuer becomes available. In two-rescuer CPR, -one rescuer gives ventilations while -the other performs chest compressions.

Abandonment

Discontinuing care once it has begun. You must continue care until someone with equal or more advanced training takes over.

AED Precautions

Do not use alcohol to wipe the victim's chest dry. Alcohol is flammable. Do not use pediatric AED pads on an adult or on a child older than 8 years, or on a person weighing more than 55 pounds. Do not touch the victim while the AED is analyzing. Touching or moving the victim may affect analysis. Before shocking a victim with an AED, make sure that no one is touching or is in contact with the victim or any resuscitation equipment. Do not touch the victim while the device is defibrillating. You or someone else could be shocked. Do not defibrillate someone when around flammable or combustible materials, such as gasoline or free-flowing oxygen. Do not use an AED in a moving vehicle. Movement may affect the analysis. Do not use an AED on a victim who is in the water. A shock delivered in water could harm rescuers or bystanders. Move the victim and AED away from puddles of water or swimming pools or shelter the victim and the AED from rain before defibrillating. Do not use an AED on a victim wearing a nitroglycerin patch or other medical patch on the chest. With a gloved hand, remove any patches from the chest before attaching the device. Never place AED pads directly on top of medication patches. Do not use a mobile phone or radio within 6 feet of the AED. Electromagnetic and infrared interference generated by radio signals can disrupt analysis. Some men have excessive chest hair that may cause difficulty with AED pad-to-skin contact. If the man's chest is very hairy and you have just one set of pads, carefully shave the victim's chest and attach the pads to his chest. If you have 2 sets of pads, you can try the first set before shaving a man who is hairy but not excessively hairy. Press firmly on the AED pads to attach them to the victim's chest. If you get a "Check pads" or similar message from the AED, remove the pads, shave the chest (ripping off the pads may remove a lot of hair), and replace with new ones (second set).

Compressions

Effective chest compressions are essential in CPR. They circulate blood to the victim's brain and other vital organs. Chest compressions should be hard and fast, performed in a -smooth motion -at a rate of at least 100 compressions per minute -and to a depth of at least 2 inches for an adult. -For a child, the depth should be about 2 inches. It is essential to maintain a steady up-and-down rhythm without pausing between compressions, and to allow the chest to return to its normal position before starting the next compression.

Negligence

Failure to follow a reasonable standard of care, thereby causing or contributing to injury or damage.

Cycles of CPR

Five cycles of CPR should take about 2 minutes to complete, so one cycle of CPR—30 compressions and 2 ventilations—should take about 24 seconds.

Proper spill cleanup procedures

If a spill occurs, appropriate measures should be taken to limit and reduce exposure to possible contaminants.

Giving Ventilations

If the victim is not breathing but has a pulse: POSITION AND SEAL THE RESUSCITATION MASK OPEN THE AIRWAY AND BLOW INTO THE MASK ■■ For an adult, give 1 ventilation about every 5 seconds. ■■ For a child or an infant, give 1 ventilation about every 3 seconds. ■■ Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given. RECHECK FOR BREATHING AND A PULSE ABOUT EVERY 2 MINUTES ■■ Remove the mask, then look, listen and feel for breathing and check for a pulse for no more than 10 seconds. PROVIDE CARE AS NEEDED ■■ If unconscious but breathing, place in a recovery position. ■■ If unconscious and no breathing but there is a pulse, continue giving ventilations. ■■ If unconscious and no breathing or pulse, begin CPR. ■■ If the chest does not clearly rise, provide care for an unconscious choking victim.

Giving Ventilations: Vomitting

If the victim vomits when you give ventilations: -Quickly turn the victim onto his or her side to keep the vomit from blocking the airway and entering the lungs. -Support the head and neck and turn the body as a unit. -After vomiting stops, clear the victim's airway by wiping the mouth out using a finger sweep. -Suction if necessary and you are trained to do so. -Turn the victim onto his or her back and continue with ventilations.

Cardiac Emergencies in Infants

It is rare for an infant to suffer a primary cardiac emergency. Usually a child or infant has a respiratory emergency first and then a cardiac emergency develops.

Cardiac Arrest

It occurs when the heart stops beating or beats too irregularly or too weakly to adequately circulate blood to the brain and other vital organs. A victim who is in cardiac arrest: is unconscious, is not breathing and has no pulse. Causes of cardiac arrest in adults include: heart attack, electrocution, respiratory arrest and drowning. Cardiac arrest is rare in children. Causes include: airway and breathing problems, traumatic injury, congenital heart disease, sudden infant death syndrome, or SIDS, and a hard blow to the chest. Cardiopulmonary resuscitation, or CPR, can make a lifesaving difference to a victim in cardiac arrest. Every year more than 300,000 people die of sudden cardiac arrest. The sooner an AED is used and CPR is performed, the more likely the victim is to survive.

Airway Obstructers

Mechanical & Anatomical

CPR Positioning

Proper Hand Position: A victim's clothing should not interfere with finding the proper hand position or giving compressions. If it does, loosen or remove clothing. When performing CPR, the placement of your hands and body position will help to ensure that your compressions are effective. The correct position for performing CPR is to kneel next to the victim at the upper chest. The victim should be lying on a firm, flat surface, such as the floor or the ground. The heel of one hand should be placed on the victim's sternum, or breastbone, in the center of the chest, and the other hand should be directly on top. Interlace the fingers, keeping them off the chest, if possible. Arms and elbows must be straight, with your shoulders directly over your hands. This allows you to use the weight of your upper body to push down instead of relying on your arm muscles.

Giving Ventilations Using BVM

The victim is not breathing but has a pulse: RESCUER 1 POSITIONS THE MASK OVER THE VICTIM'S MOUTH AND NOSE ■ Kneel behind the victim's head. RESCUER 1 SEALS THE MASK RESCUER 1 OPENS THE AIRWAY ■ Place the thumbs along each side of the mask, using the elbows for support. ■ Slide the fingers behind the angles of the victim's jawbone. ■ Push down on the mask with the thumbs, lift the jaw and tilt the head back. RESCUER 2 GIVES VENTILATIONS ■ Squeeze the bag slowly with both hands. ■ For an adult, give 1 ventilation about every 5 seconds. ■ For a child or an infant, give 1 ventilation about every 3 seconds. ■ Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given. RESCUER 2 RECHECKS FOR BREATHING AND A PULSE ABOUT EVERY 2 MINUTES ■ Remove the mask, then look, listen and feel for breathing and check for a pulse for no more than 10 seconds. PROVIDE CARE AS NEEDED ■ If unconscious but breathing, place in a recovery position. ■ If unconscious and no breathing but there is a pulse, continue giving ventilations. ■ If unconscious and no breathing or pulse, begin CPR. ■ If the chest does not clearly rise, provide care for an unconscious choking victim.

CPR in Progress

When CPR is in progress by one rescuer and a second rescuer arrives, the second rescuer should confirm whether more advanced medical personnel have been summoned. If not, the second rescuer should do so before getting the AED or assisting with care.

Hypoxia

insufficient oxygen reaching the cells

For a minor, you must obtain consent from

parent or guardian

The most common sign or symptom of a heart attack is

persistent chest pain -characterized by discomfort or pain that lasts longer than 3 to 5 minutes, that goes away and comes back or that persists even during rest

Infant Recovery Position

place infants in the infant recover position 1. Carefully position the infant face-down along your forearm. 2. Support the infant's head and neck with your other hand while keeping the infant's mouth and nose clear.

if victim has pulse but is not breathing

provide care by giving ventilations

implied consent

the law assumes the victim would give consent if able

For each minute CPR and defibrillation are delayed

the victim's chances for survival are reduced by about 10 percent.

Only Stop CPR when

■■ You see an obvious sign of life, such as breathing. ■■ An AED is ready to use. ■■ Another trained rescuer takes over. ■■ More advanced medical personnel take over. ■■ You are presented with a valid Do Not Resuscitate (DNR) order. ■■ You are too exhausted to continue. ■■ The scene becomes unsafe.