with First Aid August 2017 v21 Getting Started 2 Introductions CPR HCP with First Aid Instructor amp Staff CPR HCP with First Aid Provider Candidates CPR Health Care Provider Registration Form ID: 728060
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Slide1
CPR: Health Care Provider with First Aid
August 2017 v2.1Slide2
Getting Started
2
Introductions
CPR: HCP with First Aid Instructor & Staff
CPR: HCP with First Aid Provider Candidates
CPR: Health Care Provider Registration FormStatement of UnderstandingDAN Membership FormOther Administrative ProceduresCourse LogisticsSlide3
Course Overview
3
Course Overview
Basic Life Support
Respiration and Circulation
Scene Safety Initial Assessment & Positioning for CareStarting CPR: Supporting Circulation Continuing CPR: Supporting Respiration Use of AEDs During CPRForeign Body Airway ObstructionSlide4
4
Course Overview (continued)Control of External Bleeding
Bandaging & Wound Management
Shock Management
Lifting & Moving
Emergency Assistance Plan Skills Final Assessment and Review
Course Overview Slide5
5
Oxygen is vital for lifePrimary concern
initiating and maintaining circulation through compressions
delivering oxygen to vital organs
Airway obstructions impede oxygen delivery
4-6 minutes without oxygen vital organs (especially the brain) and tissues begin to dieImmediate action is crucial to survivalBasic Life SupportSlide6
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Key Steps during
C
ardio-
P
ulmonary ResuscitationCheck for responsiveness activate EMSQuickly check for normal breathing and a pulseProvide chest compressions if not breathing normally and no pulseProvide rescue breaths
Basic Life SupportSlide7
7
CPR Goal – provide critical blood flow to vital organs
Probably will not restart the heart
Delays damage to vital organs
Improves chances of successful defibrillation
Ensure that EMS has been activatedBasic Life SupportSlide8
8
Heart AttackTerm used to describe symptoms associated with blockage of arteries supplying the heart
Rescuer’s role with unresponsive individual
is to initiate CPR (use AED if available) and activate EMS
Rescuer’s role with a responsive individual
is supportiveAssist to position of comfortActivate EMSAid with medications if prescribed nitroglycerine : every five minutes up to 3 doses
Basic Life SupportSlide9
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Heart Attack Signs and SymptomsHeavy pressure or squeezing pain center of chest
Shoulder, arm, neck or jaw pain
Shortness of breath
Sweating
Nausea and vomitingIndigestion, heartburnSense of impending doomBasic Life SupportSlide10
10
Drowning
Defined as impaired respiration due to submersion/immersion in a liquid
Either fatal or non-fatal
Requires multifaceted medical interventions
Responder’s roleInitiate CPR immediately if unresponsive with supplemental oxygenMonitor vital signs if responsive, provide oxygen, be prepared to initiate CPR if necessaryTransport to nearest medical facilityBasic Life SupportSlide11
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5 Links inThe Chain of Survival
Basic Life SupportSlide12
12
Recognition of a problem shouldbe followed by rapid action
Call for help
immediately
after determining an adult is unresponsiveThe sooner EMS is called, the sooner advanced medical care is availableExceptions: if a child, infant or the victim of drowning and you are alone, do 2 minutes of CPR before calling EMS Early Access
Basic Life SupportSlide13
13
Early CPR
Early and aggressive CPR
supports life until advanced care is available
CPR keeps oxygenated blood
circulating to the brain and heartBasic Life SupportSlide14
Rapid Defibrillation
Sudden Cardiac Arrest (SCA) is aleading killer of adultsSCA often results from abnormal
heart rhythm called
Ventricular Fibrillation,
where the heart muscle quivers ineffectively
Defibrillation is the single most important intervention in cardiac arrest14
arrest
Basic Life SupportSlide15
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Advanced Life SupportIncludes:
Advanced Airways
IV Medications
Advanced Heart Monitoring
Stabilizes patient for transport to hospitalGood ALS care revolves around good BLS care !
Basic Life SupportSlide16
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Post Cardiac-Arrest CareInvolves:
Maintaining airway
Heart Monitoring
Hospital interventions
to treat theunderlying cause of the cardiac arrestBasic Life SupportSlide17
17
Duty of Care Legal obligation to provide care
Bystanders:
no legal obligation to respond
may have obligation to notify authorities
Health care providers: acting in capacity of their profession may have a legal obligation to respondOther professionals (dive instructors, dive safety team members): may include an obligation to provide careALWAYS ask permission before rendering aid of any kind “My name is _____. I know first aid. May I help you?”Responsive person must give permissionPermission is assumed for unresponsive personBasic Life SupportSlide18
Basic Life Support
18
Emotional Stress
Anxiety is normal
CPR does not always workEven when coupled with advanced cardiac care Seek counseling rather than blame yourselfYou did not do anything wrongYou did not make the condition worseCPR is only one link in the chain of survival Slide19
19
Avoid becoming an injured personThink S A F E
Scene SafetySlide20
20
Oxygen is essential for life and required for cellular function
Hypoxia is oxygen deficiency
Anoxia is the absence of oxygen
Respiratory system
provides the interface between the atmosphere and the bloodstream for gas exchangeIntake of oxygenRemoval of CO2 Respiratory system is comprised of theupper airway (mouth, nose, pharynx), the trachea, and the lungsThe smallest structures are the alveoli
Pulmonary gas exchange takes place at the alveolar-capillary membrane
Respiration and CirculationSlide21
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Circulatory System includes the heart and blood vesselsPrimary function is pumping blood, transporting oxygen and nutrients to tissues and
removing waste products
Arteries
carry blood from the heart to the body tissuesVeins carry blood from the body tissues back to the heartCapillaries the smallest blood vessels where nutrients and waste products are exchanged at the tissue cellular levelRespiration and CirculationSlide22
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Risk of Infection
Minimal,
but present
Infection may happen
via contact with infected blood and other body tissuesNot transmitted through casual contactNot transmitted through intact skinUse barriers to further minimize riskScene SafetySlide23
23
Exposure
Milk the wound,
encourage it to bleed
Wash
with soap and waterFlush eyes, nose and mouth with large amounts of running waterWash contaminated material off as quickly as possibleSeek medical evaluation and counseling
Scene SafetySlide24
24
Hepatitis B (HBV)
Affects the liver
50-100 x
more infectious than HIV
Effective vaccination is availableScene SafetySlide25
25
Hepatitis CAffects the liver
About 40%
of infected people recover fully
Symptoms
may take many years to developMany infected people become chronic carriers may not realize they are infected.Less contagious than Hepatitis BNo immunization available
Scene SafetySlide26
26
Human Immunodeficiency Virus (HIV)
Affects the immune system,
causes AIDS
HIV
is the virus AIDS is the disease caused by the virusSymptoms may take years to developLeast infectious of the 3 major pathogensNo immunization available
Scene SafetySlide27
27
Standard Precautions
Use PPE (Personal Protective Equipment)
Gloves, face masks, eye protection, gowns
Avoid contaminated sharp objects
Dispose of sharps in an approved containerThoroughly wash hands after providing care
Scene SafetySlide28
28
Assessing ResponsivenessTap and shout
“are you OK?”
State your name and desire to help
If the injured diver responds,
leave in position foundIf the injured diver does not respond, scan quickly to determine if he is breathing normally, and simultaneously check for a pulseCall or send someone to call EMS immediately
Initial AssessmentSlide29
29
Pulse Check: Adult/Child
Use carotid artery in the neck
Place two fingers on “Adam’s Apple”
Slide fingers toward you and slightly upward into groove on side of neck
Allow 5-10 secondsAdjust pressure to locate pulse but avoid excessive pressure
Initial AssessmentSlide30
30
Pulse Check: Infant
Use brachial artery on upper arm
Place two fingers on inner arm just under armpit
Find groove formed by muscles
Use gentle pressureAllow 5-10 secondsAdjust pressure to locate pulse but avoid excessive pressure
Initial AssessmentSlide31
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Recovery Position
Good position to
help protect the airway
Continually
check to ensure condition does not deteriorateDo not use for individuals with suspected spinal, hip, or pelvic injury
Initial AssessmentSlide32
32
Log RollProtect
neck and spine
Use to move the person onto his back
If the person is:
unresponsive not breathing normally does not have a definite pulse call for EMS & initiate CPR
Initial AssessmentSlide33
33
Call for help firstLocate position for compressions
imaginary line between nipples
Stack hands on each other
center of chest along imaginary line Use heels of hands for compressions fingers off chest wallPosition shoulders directly over hands elbows lockedPivot from hips keeping back and arms straightRelease compression pressure without losing contact with chest wall Starting CPR - Adult
Supporting CirculationSlide34
34
Start with compressions
at a rate of 100-120 compressions per minute
Compressions too fast:
adequate heart refill with bloodCompressions too slow: inadequate circulationCompress to depth of 2-2 ½ inches/5-6 cm 30 compressions, then 2 ventilationsStarting CPR - Adult
Supporting CirculationSlide35
35
One rescuer is the “compressor” one rescuer is the “ventilator”Continue with compressions at a rate of
100-120 per minute
Compress to depth of 2-2 ½ inches/5-6 cm
30 compressions, then pause compressions for 2 ventilationsSwitch roles every 2 minutes/5 cycles reduces rescuer fatigue maintains effectivenessTwo-Rescuer CPR - Adult
Supporting CirculationSlide36
36
Children generally considered 1 year to puberty consider size for compression effectiveness
If alone
do 2 minutes of CPR then call EMS
Locate position for compressions
same as for adultUse one or two hands in center of the chestStart with compressions at a rate of 100-120 compressions per minute30 compressions, then 2 ventilationsCompress to a depth of approximately 2 inches/5 cm (1/3 chest depth)
Starting CPR - Child
Supporting CirculationSlide37
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One rescuer is the “compressor”, one rescuer is the “ventilator”Continue compressions at a rate of 100-120 compressions per minute
Depth 1/3 depth of chest
Compression : Ventilation Ratio changes to 15 :2
Switch roles every 10 cycles/2 minutes
Two-Rescuer CPR - ChildSupporting CirculationSlide38
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Infants considered less than 1 yearIf alone
do 2 minutes of CPR then call EMS
Locate compression site
-
imaginary line between nipplesUse 2-3 fingers in center of chestCompress to a depth of 1/3 depth of chest Start with compressions at a rate of 100-120 compressions per minute30 compressions, then 2 ventilationsStarting CPR - Infant
Supporting CirculationSlide39
Supporting Circulation
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One rescuer is the “compressor”,
one rescuer is the “ventilator”
Continue compressions at a rate of 100-120 compressions per minute
Compress to a depth of 1/3 chest depthCompression:Ventilation Ratio changes to 15 :2Switch roles every 10 cycles/2 minutesTwo-Rescuer CPR - InfantSlide40
40
Critical Steps for Rescue Breathing
ADULTS:
Use head-tilt-chin-lift
to open airway
Create seal with barrier device (or mouth to mouth directly on the person while pinching nose closed)Rescue breaths sufficient for gentle chest rise-and-fall, no more1 second breath1 second for exhale1 second for next breath
If rescue breaths do not go in, reposition head and try again
Supporting RespirationSlide41
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Rescue Breathing for Children
Same technique as for adults
Use head-tilt-chin-lift
to open airway
Create seal with barrier device (or mouth to mouth directly on the child while pinching nose closed)Adjust rescue breath volume for smaller lung capacity; should be sufficient for gentle chest rise-and-fall, no more1 second breath1 second for exhale1 second for next breath
Supporting RespirationSlide42
42
Rescue Breathing for Infants
Use less extension on head-tilt-chin-lift
to open airway
Create seal
with barrier device Turn oronasal mask 180◦OR cover mouth and nose with your mouth to ventilateOnly use puffs of air for rescue breaths volume should be sufficient for gentle chest rise-and-fall, no more
Supporting RespirationSlide43
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Compression:Ventilation Ratios
Victim
One Rescuer
Two Rescuers
How to CompressDepth
Adult30:230:2Two Hands
2-2 ½ inches (5-6 cm)Child
30:2
15:2
One or two hands
2 inches
(1/3
of chest depth)
Infant
30:2
15:2
Two or three fingers (one rescuer)
Two
thumbs
(two rescuers)
1/3 chest depth
NOTE: The rate of compressions is 100-120/minute for all ages
Supporting RespirationSlide44
44
Rescue Breathing without Compressions
If a pulse is present but the person is not breathing
Open airway
Provide a single rescue breath (all ages)
Continue with a breath every 5-6 seconds for adults3-5 seconds for infantsContinue to monitor pulse every two minutesBe prepared to initiate full CPRSupporting RespirationSlide45
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Special Circumstances with ResuscitationPregnancy
Effective compressions may require manual displacement of the uterus to her left
Reduces pressure on returning blood flow
Opioid OverdoseBecame the leading cause of death between 25-60 year-olds in 2012Can lead to respiratory arrest and cardiac arrestTreat with Naloxone – interferes with action of opioidsCardiopulmonary ResuscitationSlide46
CPR for Drowning Victims
Conduct CPR beginning with ventilations for 2 minutes before activating EMS
Use the A-B-C protocol acronym
to guide CPR efforts when responding to a drowning or immersion incidentSlide47
Supporting Respiration
47
Supplemental Oxygen
May be critical when hypoxia a concern
Infants and children
Drowning/Scuba diving incidentsImproves tissue oxygenationParticipation in DAN’s Emergency Oxygen for Scuba Diving Injuries course is recommendedCompressions only CPROnly if proper barriers for ventilations cannot be utilizedREMINDER: Full CPR always recommended for drowning and scuba diving accidentsSlide48
48
The heart has a natural electrical systemImpulse
should
generate a
heart contraction
Contraction pumps blood to the bodyMost common abnormality during cardiac arrest is ventricular fibrillation Disorganized, ineffective heart muscle contractionsEffective contractions stop, therefore circulation stopsThe solution for fibrillation is . . . defibrillation
Use of Automated External Defibrillators (AEDs)
AEDs During CPRSlide49
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Use of Automated External Defibrillators (AEDs)
continued
Defibrillation generates large shock to reset heart’s electrical system
Assists in re-establishing a normal heart rhythm
AEDs universally provide audible user prompts Follow directionsCPR in conjunction with early defibrillation provides the highest rate of survival from cardiac arrestEach minute defibrillation is delayed reduces survival rate 7-10 %AEDs During CPRSlide50
AEDs During CPR
50
AED Pad Placement
Adults and children
Right side under collar bone
Left chest wall under armFollow illustrations on padsInfantsCenter of chest and center of backFor infants and children use adapter if availableIf adapter is not available, it is still OK to use NOTE:
AEDs can be used in wet environments but chest may need to be dried before placing pads
Note pads are reversedSlide51
AEDs During CPR
51
Cautions
Do not use in standing water
Discontinue use of oxygen and move it away from the individual
TroubleshootingPad placement/attachment most frequent problemFollow illustrations on pads then assure firm attachmentRemoving moisture or shaving off chest hair may be requiredMaintenanceCheck AED status indicator
Replace battery if requiredReplace expired padsSlide52
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ChokingMost common
obstruction:
Adults = food
Children and infants = small objects
Partial obstructions person can speak and/or cough) does not require active interventionComplete obstructions person cannot speak, breathe, or coughrequires rapid assistanceIf the person becomes unconscious
call for help and start CPRFinger sweep
only use when obstruction can be seen
Foreign Body Airway ObstructionSlide53
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Severe Obstruction Intervention
(Adults and Children)
Use abdominal thrusts
(Heimlich maneuver)
Stand behind person, put both arms around themMake fist with one hand, place thumb side against abdomen between navel and tip of sternumGrasp fist with other hand, pull sharply inward & upward.Repeat until object is expelled or the person loses consciousness.IF the individual becomes unconscious Call EMS and begin CPR
Foreign Body Airway ObstructionSlide54
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Severe Obstruction Intervention(Infants)
Infants explore with their mouths,
aspiration of small objects very real concern.
Back Blows/Chest Thrusts Place infant’s head face down along your forearm, support the head in your hand.Keep head lower than the body Deliver five back blows between infant’s shoulder blades.Immediately turn infant over, deliver 5 chest compressions.Maintain support of head Repeat until foreign body is removed and infant begins breathing on own.
Foreign Body Airway ObstructionSlide55
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DrowningAspiration of water can be suspected
BUT
Usually only a small amount
Removal is not part of first aid
Regurgitation common and can compromise airwayTurn victim on side (use recovery position technique)Wipe or suction vomitus from mouthForeign Body Airway ObstructionSlide56
Foreign Body Airway Obstruction
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Suctioning
NOTE:
Use of suctioning should not interfere with definitive care
Limit use of suctioningAdults – 15 secondsChildren - 10 secondsInfants - 5 secondsSlide57
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BloodPrimary function -
transport oxygen and nutrients throughout the body and remove waste products
Two Natural Mechanisms to
Control Bleeding
Vasoconstriction - narrowing of blood vessels reduces blood flow and minimize blood lossActivation of clotting factors (platelets) - blocks blood lossControl of External BleedingSlide58
Control of External Bleeding
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Rescuer Response to Assist Clotting Mechanism
Direct pressure:
use gloved hand to control bleeding
Apply clean or sterile gauze Hold firm pressure until bleeding is controlled Use additional gauze as necessaryBandage only after bleeding stopsSlide59
Control of External Bleeding
59
Tourniquets
Should be:
• Utilized only when direct pressure is not effective
• Wide (at least 2" wide if an improvised tourniquet is used)• Well-padded (6-8 layers of a bandaging material)• Placed 1-2" proximal to the woundMark the injured person’s forehead with a T or TK and time of placementDO NOT REMOVE TOURNIQUETSlide60
Control of External Bleeding
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Tourniquets
Should
NOT
be:• Placed directly over knees, elbows or other joints. Place the tourniquet 1-2" proximal to the joint.• Made of wire or rope, narrow, excessively tight or insufficiently padded band May cause local damage to tissues in minutes.Removed until advanced medical care is available Slide61
Control of External Bleeding
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Hemostatic Dressings
May be used in conjunction with a tourniquet
Should be used where tourniquets cannot be utilized
Other dressing material must be removed to allow direct contact of hemostatic agent with bleeding siteAdvise medical personnel a hemostatic agent was utilizedSlide62
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General ApproachKey role of first aid is to minimize wound contamination and control bleeding
Use
standard precautions
Clean
, wash or wipe away obvious dirtCover wound to provide protectionBandage dressing in place once bleeding has stoppedRemove rings or other jewelry in affected areaBandaging and Wound ManagementSlide63
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Special CircumstancesBandaging joints –
immobilize; maintain position of comfort when possible
Eyes –
cover both injured and uninjured eyes to prevent eye movement
Bandaging and Wound ManagementSlide64
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Special Circumstances (continued)Impaled objects –
leave in place & secure
Exception
– object impaled through the cheek into mouth Gently remove object, dress both inside & outside mouthBandaging and Wound ManagementSlide65
Bandaging and Wound Management
65
Special Circumstances (continued)
Abdominal wounds with exposed organs –
cover with moist dressing, and
leave it aloneSuspected broken bones – Splint in the position found Stabilize the joint above & below the fractureCheck pulses and sensation in injured limbRepeat check every 15 minutesSplints enable immobilization and pain reductionSlide66
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ShockA life threatening condition resulting from inadequate blood supply to brain & vital organs
Possible causes of shock
Hypovolemic shock -
severe fluid loss
(blood or dehydration)Cardiogenic Shock - inadequate pumping of the heartSeptic Shock - circulatory insufficiency due to infectionAnaphylactic Shock - severe allergic reactionInsulin Shock - diabetic reaction to too much insulin
Neurogenic Shock - damage to central nervous system
Shock ManagementSlide67
Shock Management
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Shock
Possible signs of shock
Pale, clammy skin
AnxiousRapid heart and respiratory rateThirstNausea and vomitingWeakness UnconsciousnessTreatment of shock
Address underlying causePosition person on his back or in a position of comfort
Adjust coverings to maintain normal body temperatureNothing by mouth
Call for medical assistanceSlide68
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General Considerations
Moving an injured person strongly discouraged
Exceptions:
To move the person to their back for CPR
Imminent danger (fire, explosive, traffic)When moving is necessary – Protect both first-aid provider and injured/ill personMove in orderly, planned and unhurried fashionUse the safest and easiest methodLifting and MovingSlide69
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Techniques Armpit-Forearm Drag
Reach under armpits from behind grasping
person’s opposite wrist
Pull in direction of body’s long axis
Shirt Drag (if individual is wearing collared shirt) Grasp shoulders and collar of shirt Use shirt to support head and pull along long axisCoat or Blanket DragRoll person onto their side, tuck blanket underneathReturn person to their back, pull other edge of blanket outGather blanket under head and neck for supportPull along long axis of the person’s body
Lifting and MovingSlide70
Lifting and Moving
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Reminders
Maintain a straight rigid back
Bend at hips not waist
Keep your head in a neutral positionLift with legsSlide71
Emergency Assistance Plan
71
Can be a vital resource to save time and engage others
Keep close to phone
List emergency phone numbers
EMSPoison ControlDAN (if a diving environment)Indicated management contact (if work environment)Directions to location if appropriateHave first-aid kit readily availableSee student handbook for content suggestions and additional supplies to have availableSlide72
Skills
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Scene Safety Assessment
Donning and Doffing Gloves
Initial Assessment
Recovery PositionChest CompressionsRescue BreathingFull CPRAED UseForeign Body Airway Obstruction Suctioning
Control of External BleedingApplying a Tourniquet
SplintingShock Management
Sever Allergic ReactionSlide73
Questions?
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