CPR notes
Possible behaviors for individuals that are choking
panicked, confused, or surprised facial expression. May be running and/or flailing around, may place hands on their throat, may hear strider, skin changes, etc.
Obstructed airway
patient is RESPONSIVE but cannot cough, speak, or breathe.
Anterior lateral position for AED
patient's upper right chest below the right clavicle, to the right of the sternum and other pad on lower left chest along the midaxillary line a few inches below the left armpit.
compressor
responsible for compressions
ventilator
responsible for ventilations
Cardiac arrest in children often occurs because
result of a preventable injury such as trauma, drowning, choking, or electrocution.
Infant
someone under the age of 1
Recorder
this team member records and communicates key data during the resuscitation effort
AED steps
turn it on; remove clothing and other obstructions; place pads; let it analyze and instruct everyone to clear, place hands above the chest so you're ready to deliver CPR right away after the shock is or is not delivered. After a shock is delivered, or NO shock is indicated, immediately begin CPR. You do NOT NEED TO WAIT FOR THE AED to prompt you. Perform CPR and ventillations until all the other signs and/or AED starts reanalyzing
AED
a portable electronic device that automatically analyzes the patient's heart rhythm and provides defibrillation, an electrical shock that may help the heart re-establish a perfusing rhythm.
responsive adult choking steps
1. 1. First call for additional resources and obtain the patient's consent. "Are you choking can you speak?" Call for the rapid response team. "My name is Maggie, can I help you?" Yes. 2. For abdominal thrust steps: Stand behind the person with one foot in front of the other for stability.If possible, place your front foot in between the patients feet. 3. Using one or two fingers, find the patients navel, then make a fist with your other hand and place the thumb side of your fist against the middle of the abdomen just above the navel. Grab your fist with your other hand. 4. Give quick inward and upward thrusts. Be sure to make each thrust an attempt to dislodge the object. 5. CONTINUE GIVING THRUSTS UNTIL the object is forced out, cough forcefully, speak or breathe, or patient becomes unresponsive.
if someone becomes unresponsive during obstructive airway
1. Carefully lower them to a firm, flat surface while protecting their head. 2. Send someone to get an AED and summon additional resources (if appropriate and you have not already done so) 3. Immediately begin CPR starting with chest compressions. 4. After each set of compressions, open the patients mouth and look for the object before attempting ventillations. IF you see the object in the patients mouth, remove it using a finger sweep. NEVER perform a blind finger sweep. 5. Give 2 ventilations ****Never try more than 2 ventilations during one cycle of CPR, even if the chest does not rise. Continue performing CPR cycles, checking for an object before each set of ventilations.
Respiratory arrest child or infant
********** If the child or infant is unresponsive, not breathing normally (or only gasping) but has a pulse, they are in respiratory arrest: Deliver 1 ventilation every 3 to 5 seconds; each ventilation should last about 1 second and make the chest begin to rise. Continue ventilations. Check the pulse and breathing about every 2 minutes. If the pulse decreases to 60 bpm or less with signs of poor perfusion, begin CPR.
How to check the infant's brachial pulse
, place two fingers on the inside of the exposed upper arm. Do not use your thumb because it has its own detectable pulse.
AED for children older than 8 years old or weighing more than 55 lbs
- Place one pad on the right of the sternum and below the clavicle. Place the other on the left side of the chest on the midaxillary line, a few inches below left armpit. - NEVER use Pediatric AED pads ona c hild older than 8 or weighing more than 55 lbs.
When delivering ventilations during cpr, if the chest does not rise after the first breath,
-reopen the airway-make a seal and try a second ventilation.-If the second ventilation is not successful, move directly back to compressions and check the airway for an obstruction before attempting subsequent ventilations.-If an obstruction is found, remove it and attempt ventilations.Never perform a blind finger sweep..
Single provider CPR for a child
1. Check for safety of the room and visual assessment, check for any severe bleeding, etc. 2. If you saw the patient fall, call for EMS team and for an AED if necessary. 3. Shout-tap-shout sequence 4. Check for breathing and pulse- slightly past neutral position 5-10 seconds. 5. Make sure the child is on a flat surface, faced up and make sure it's at a good working height for the provider. 6. Begin CPR within 10 seconds of recognizing cardiac arrest. Compress the chest about 2 inches deep 7. use a rate of 100-120 cpm 8.The ratio of compressions to ventilations when the only provider for a child is 30:2
CPR for children with MULTIPLE providers
1. Compress the chest to about 2 inches 2. provide 15 compressions and 2 ventilations using BVM 3. Switch positions by saying switch instead of 1, about every 2 mins. 4. Depress the bag about halfway for a child as well.
Rapid assessment for CHILDREN
1. If the child appears unresponsive, use the shout-tap-shout method to see if they respond. 2. To perform a breathing and pulse check on the child, open airway to SLIGHTLY past neutral and simultaneously check for breathing and carotid pulse for 5 seconds but no more than 10.
Rapid assessment for INFANTS
1. If the infant appears unresponsive, use the shout-tap-shout sequence. TAP them on the bottom of their foot. 2. Open the airway to a NEUTRAL position and simultaneously check for breathing and BRACHIAL pulse for 5 seconds but no more than 10.
CPR for infants SINGLE provider
1. Make sure the crib or tabletop is at a good working height 2.Use 2 fingers for compressions. Index and middle finger typically work. place two fingers on the center of their chest just below the nipple line on the sternum. Press down on the infants chest about 1-1/5 inches at a rate of 100-120 Cpm. 3. To provide ventillations, place the infant sized pocket mask over the infants nose and mouth. Place your fingers on the bony part of the chin and open the airway to a NEUTRAL position. 4. Provide 2 ventillations each lasting about 1 second and making the chest rise. 30:2 with single provider
Responsive choking child
1. Obtain consent from a legal guardian if possible. If not possible, then consent is implied. 2. May want to kneel behind the child to provide effective care. ***Same hand placement as adults for abdominal thrusts, back blows, and chest thrusts.
Obstructive airway for responsive infants
1. Obtain consent from the legal guardian if present, if not present, consent is implied. 2. Place your hand on the infants back, cradling the neck and head with your hand.Plce your forearm along the infants front, supporting the infants jaw with your thumb and fingers. 3. Hold the infant along a face down position along your forearm using your thigh for support and keeping the infants head lower than the body. 4. Use the heal of your hand to deliver back blows between the scapulae keeping your fingers up to avoid hitting the infants head or neck. 5. Perform 5 firm back blows with each one separate from the others. 6. If back blows don't dislodge the object, try chest thrusts.
Infant chest thursts
1. Position the infant between the forearms, supporting the head and neck. Turn the infant face up and lower them onto your thigh with their head lower than their chest. 2. Place two fingers in the center of the infants chest, just below the nipple line. 3. Give 5 chest thursts about 1.5 inches deep. Let the chest recoil after each one. 4. Continue 5 back blows and 5 chest thrusts until the object is forced out, the infant can cough, cry or breathe, or the infant becomes unresponsive.
Chest thrusts
1. Position yourself behind the patient. 2. Place the thumb side of your fist on the center of the patients lower half of the sternum then cover your fist with your other hand and pull STRAIGHT BACK providing a quick INWARD thrust of the patients chest.
Back blows
1. Position yourself to the side and slightly behind the patient. 2. Position your arm diagonally across the patients chest. 3. Bend the patient forward by the waist so that the upper body is parallel to the ground. 4. Using the heal of your hand, give 5 firm back blows between the scapulae. ****If this does NOT work, use a series of 5 back blows and 5 abdominal thrusts until the object is removed.
Pediatric Chain of Survival
1. Prevention of cause 2. Early, high quality CPR 3.Rapid Activation of EMS 4. Effective Advanced life support 5. Post-cardiac care
BLS for adult- single provider CPR
1. Provide chest compressions-The compressor exposes the chest.-The compressor performs 30 chest compressions. The compressor centers their hands on the lower half of the sternum and compresses the chest to a depth of at least 2 inches (5 cm) at a rate of 100 to 120 compressions per minute, allowing for full chest recoil. It should take 15 to 18 seconds to perform 30 chest compressions.2. Deliver ventilations-Seal the pocket mask and simultaneously open the airway to a past-neutral position using the head-tilt/chin-lift technique. Or, use the modified jaw-thrust maneuver if a head, neck or spinal injury is suspected.-Deliver 2 ventilations. Each ventilation should last about 1 second and make the chest begin to rise.*Interruptions of chest compressions should be less than 10 seconds. Therefore, a bag-valve-mask (BVM) is not a practical way to deliver ventilations during CPR when responding alone.-Continue CPR-Provide 30 chest compressions at the proper rate and depth, using correct hand placement and allowing for full chest recoil.-Seal the mask and open the airway.-Deliver 2 ventilations.
CPR for infants MULTIPLE providers
1. The person providing chest compressions stands by the infants feet while the person providing ventilations will stand at the infants side, and the other will stand behind the infant to maintain the open airway. 2. With multiple providers for infants, the compressions are provided by using the ENCIRCLING THUMBS Technique. Place both thumbs side by side on the center of the patient's chest just below the nipple line, then use the other fingers to encircle the infants chest toward the back to provide support. Using both thumbs at the same time, compress the chest about 1 and a half inches deep at a rate of at least 100 but no more than 120 compressions per minute. Let the chest recoil after each compression. 3. Use the EC technique to seal the mask while opening the airway using two hands. 4. With multiple providers, the compression ratio is now 15:2. 5. Switch positions about every 2 minutes.
AED use with multiple providers
1. While the other two providers are performing CPR and ventilations at the same time, another provider will attach the AED to the patient. 2. Can switch positions when advised not to touch the patient after connecting the AED device. Person who connected it can now deliver CPR while the other person rests.
mouth to nose ventilations
1. With the patient's head tilted back, close the mouth by pushing up the chin. 2. Seal your mouth around the patient's nose and breathe into the nose. 3. If possible, open the patient's mouth between ventilations to allow air to escape.
components of high quality CPR for adult
1. assure the patient is positioned properly on a firm, flat surface in a supine position and the chest is exposed. 2. immediately begin chest compressions providing 100-120 compressions a minute. 3. compress the chest to at least 2 inches but no more than 2.4. 4. Let the chest recoil after each compression.do NOT lean on the patients chest at the top of the compression. Minimize interruptions to chest compressions. Avoid excessive ventilations.
Mouth to mouth ventilations
1. open the airway to a past neutral position for an adult. 2. Pinch the patient's nose shut. Take a normal breath, make a complete seal over the patients mouth with your mouth and blow into their mouth to deliver 1 ventilation over one second until you see the chest begin to rise.
BLS for Adults 1. Conduct a Rapid assessment
1. perform a visual survey-Check your surroundings for safety.-Gather an initial impression, including whether there is severe, life-threatening bleeding.-Determine the need for additional resources.*The sequence of these steps is not critical if all goals are accomplished. Depending on the setting, additional resources may include emergency medical services (EMS), the rapid response team or the resuscitation team. Follow standard precautions, including using personal protective equipment (PPE), and obtain consent before proceeding if appropriate.2. Check for responsiveness-Shout, "Are you OK?" Use the patient's name if you know it.-Tap the patient's shoulder and shout again (shout-tap-shout).-If the patient is unresponsive and you are alone, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED.-If the patient is unresponsive and you are with another provider, the first provider stays with the patient. Other providers activate EMS, the rapid response team or the resuscitation team, as appropriate, and retrieve the AED, bag-valve-mask (BVM) resuscitator and other emergency equipment.3. Simultaneously check for breathing and pulse-Open the patient's airway to a past-neutral position, using the head-tilt/chin-lift technique. Or, use the modified jaw-thrust maneuver, if you a suspect head, neck or spinal injury.-Simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.
Assessing steps
1. visual survey, 2. check for responsiveness, 3. simultaneously check for breathing and pulse, 4. provide care based on the conditions found.
If the patient is in cardiac arrest with opioid overdose
Begin CPR within 10 seconds of recognizing the patient is in cardiac arrest. As soon as available, use the AED and, if your facility protocol allows, administer naloxone. If you are alone and do not have a mobile device available, perform CPR for about 2 minutes before leaving to call for additional resources. *****Remember, providing high-quality CPR is the priority over administering naloxone during cardiac arrest.
High quality CPR for adults
Deliver 30 chest compressions followed by 2 ventilations for BLS
Respiratory arrest ventilations
Deliver one ventilation every 5-6 seconds. EAch should last about 1 second and make the chest begin to rise. Check the pulse and breathing about every 2 minutes. If you do not find a pulse, begin cpr.
Drowning or hypox event
Deliver two initial ventilations before beginning cpr
BVM resuscitator ventilations
Delivers ambient air. 1. Select an approp size BVM and position yourself behind the patient's head. 2. Place mask over the bridge of the nose and lower it over the nose, mouth, and chin but make sure it does not go past the chin. 3.Form the C E shape with your hand or hands if there are two people. 4. Lift the jaw into the mask to competely seal the mask on the patient. Be sure to maintain an open airway in the past neutral position. 5. Depress the bag about halfway to deliver 400-700 ml of air. Provide each ventilation about 1 second to see the chest begin to rise.
Call first for a child IF
For a child or an infant whom you witnessed suddenly collapse, or for an unresponsive child or infant with a known cardiac condition: Call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. Then, provide care based on the conditions found.
care first IF
For an unresponsive infant or child whom you did not see collapse: Provide 2 minutes of care based on the conditions found. Then, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED.
*** Various models of AEDs and manual defibrillators function differently.
For example, some AED and manual defibrillators use the anterior/lateral pad placement for children. However, other models use the anterior/posterior pad placement. Or, some AED models come with pediatric AED pads that are smaller and deliver lower levels of energy; whereas, others have a pediatric setting or key instead of specific pediatric pads. Also, some AEDs and manual defibrillators allow for compressions after the device analyzes the rhythm, while it is charging. Providers may perform compressions from the time the shock-advised prompt is noted through the time that the prompt to clear occurs, just before depressing the shock button.
If infant becomes unresponsive while choking
If an infant becomes unresponsive while choking, provide care as you would for an unresponsive adult or child who is choking. (place on flat surface, give CPR, look for object, deliver 2 ventilations) However, use your pinky to remove an object if you see it.
When the opioid overdose patient begins to respond
If the patient begins to breathe normally, check responsiveness and assess for breathing and a pulse. Then place them in a recovery position (on their side) providing you do not suspect a head, neck, spinal, hip or pelvic injury. Monitor them until EMS, the rapid response team or the resuscitation team arrives. If the patient stops responding, begin ventilations or CPR as appropriate and repeat naloxone.
If patient is in respiratory arrest with an opioid overdose
If the patient is in respiratory arrest, deliver 1 ventilation every 5 to 6 seconds for an adult and every 3 to 5 seconds for children and infants. Each ventilation should last about 1 second and make the chest begin to rise. Then, if your facility protocol allows, administer naloxone as soon as it is available. Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR or use an AED if one is available and ready to use. *******Remember, delivering ventilations is the priority over administering naloxone during respiratory arrest.
Respiratory arrest
If the patient is unresponsive, is not breathing normally, or only gasping, but HAS a pulse. You should deliver one ventiliation every 5-6 seconds each should last about 1 second and make the chest begin to rise.
Respiratory arrest complete steps
If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate. Call for an AED. Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, start CPR within 10 seconds following the steps outlined in the Care section.
Step 1: Visual survey
Make sure the enviorment is safe for all people, gather initial impression of the patient which includes looking for severe bleeding. quickly determine the need for additional resources.
Step 3: Simultaneously check for breathing and pulse
Make sure the patient is in a supine up position. If not, roll them that way being cautious of injuries. Open the airway using the head tilt chin lift position or the modified jaw-thrust maneuver if they have any suspected head, neck, or spinal injuries. Simultaneously check for breathing by listening and counting to 5-10 seconds. Then check their carotid artery for 5-10 seconds using two fingers being careful not to obstruct the airway.
Cardiac arrest
Patient is unresponsive, not breathing normally, or only gasping and does NOT have a pulse. Start CPR within 10 seconds of recognizing cardiac arrest and use an AED when it is available.
opioid overdose
Patient is unresponsive- showing signs of pinpoint pupils, respiratory depression, unconsciousness or severe sleepiness.
If the patient responds to the naloxone, you need to be prepared to perform which action(s) most immediately?
Patients who respond after naloxone frequently vomit and may even become violent. Immediately, you should prepare to clear the patient's airway, while keeping your safety in mind. It is not necessary to restrain the patient, and it is often dangerous to do so. Finding out which substances or medications they may have used or ingested is important, but not a priority while they are regaining consciousness.
To quickly assess for an opioid overdose check the overdose triad
Pinpoint pupils, respiratory depression, unconsciousness or severe sleepiness
Cpr placements for ADULT/older child
Place the heal of one hand in the center of the patient's chest on the lower half of the sternum. Place the other hand on top of the first one, interlocking your fingers making sure they do not rest on the patients chest. Make sure your shoulders are directly over your hands and lock your elbows. Use a straight up and down motion.
Respiratory arrest: if ADVANCED airway is in place!
Provider will deliver one ventilation every six seconds
BLS for adult 2. Recognize
Recognize the emergency condition and determine your immediate course of action:1. Respiratory arrestIf the patient is unresponsive, not breathing normally (or only gasping) but has a pulse, they are in respiratory arrest. Follow these steps:-If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate.-Call for an AED.-Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise.-Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, start CPR within 10 seconds following the steps outlined in the Care section.*For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).2. Cardiac ArrestIf the patient is unresponsive, not breathing normally (or only gasping) and has no pulse, they are in cardiac arrest. Follow these steps:- If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate.-Call for an AED.-Start CPR within 10 seconds following the steps outlined in the Care section.*or a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).*If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR.
Pocket mask ventilations
Recommended to use these in single provider CPR.
When to stop CPR
S- patient starts breathing and has a pulse T- patient transferred to another person trained in BLS O- out of strength to continue P- a physician is present or providing online direction and assumes responsibility of the patient, gives direction to stop situation becomes unsafe
Pocket mask ventilation use
Select an approp size for the patient and assemble it. Place the mask at the bridge of the patient's nose and lower over the patient's nose and mouth making sure it doesn't extend past the chin. Place the webbing between your index finger and thumb at the top of the mask above the valve. Place thumb on other hand along the base of the mask and bent index finger of same hand on the base of the chin. Open the airway past neutral. Take a normal breathe, make a complete seal over the mask valve with your mouth and give two ventilations, each lasting about 1 second long and making the chest rise.
Step 2: check for responsiveness
Shout if they are okay, then use the shout-tap-shout method if no response. If unresponsiveness continues, call for EMS if you are alone and call for an AED. If with another provider, first provider stays with the patient while the other activates the EMS, rapid response team, or resuscitation team to receive an AED and other emergency equipment.
Child
Someone from the age of 1 to the onset of puberty. Evidence based on women's breast size and males armpit hair.
Adolsecent
Someone from the onset of puberty to adulthood.
AED for infants
Sometiems pediatric AED pads are available, if they are, use those on infants and children less than 8 years old and/or weighing less than 55 lbs. These are smaller and will deliver a lower level of energy. - For infants up to 1 year old, use pediatric AED pads, if available. If not available, it is safe to use adult AED pads on infants. - ALWAYS use an anterior posterior pad placement for an infant! - Apply one pad to the center of the infants chest on the sternum. And place the other pad to the infants back between the scapulae.
Proper dose of narcan
The recommended adult dose is 2 mg intranasal or 0.4 mg intramuscular. You may repeat after 4 minutes. Follow facility protocols to determine dosing and timing of naloxone administration.
Alternate obstructive airway techniques
These may be used if abdominal thrusts do not lodge the object out, or if an individual is pregnant, much larger than the provider, in a wheelchair, etc. Examples would be back blows, and chest thrusts.
Team leader
assigns and understands team roles, sets clear expectations, prioritizes, directs and acts decisively
Other indicators of opioid overdose
cyanosis, track use from intravenous drug use, prescription pill bottles, needles, syringes, or other drug related items, or a history of opioid drug use.
Cardiac arrest ventilations
deliver 2 ventilations that last about one second each and make the chest begin to rise.
Crew resource management
emphasizes the use of all available resources to promote effective and efficient teamwork and reduce the liklihood of human error.
After checking over the OD triad, you do what?
immediately request EMS team, AED, and BVM and/or pocket mask, and NALAXONE. Request AED regardless if the person is in cardiac or respiratory arrest.
Airway manager
maintains an open airway and seals the mask
AED operator
manages the AED and relieves the compressor when time.
Cardiac arrest with advanced airway in place for child or infant
one provider delivers 1 ventilation every 6 to 8 seconds. At the same time, a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 15:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.
Cardiac arrest: if ADVANCED airway is in place!
one provider delivers ventilations every six seconds while the other provider continues continuous chest compressions. (providers do not pause for ventilations.)
Naloxone
opioid antagonist
AED for children younger than 8 or weighing less than 55 lbs
use pediatric AED pads if available, if not available, you can use adult AED pads. - Place one pad on the right of the sternum and below the right clavicle. Place the other pad on the left side of the chest on the midaxillary line a few inches below the armpit. - IF the AED pads would touch each other though, use the anterior posterior pad placement instead. They should NEVER touch each other when applied. You can also use the anterior posterior position if the AED prompts you to.
