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CPR: Health Care Provider CPR: Health Care Provider

CPR: Health Care Provider - PowerPoint Presentation

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CPR: Health Care Provider - PPT Presentation

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

compressions cpr life chest cpr compressions chest life support blood heart person airway body shock oxygen supporting rescuer circulation

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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

6

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

9

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

11

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

15

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

16

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

21

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

22

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

31

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

37

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

38

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

39

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

41

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

43

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

45

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

49

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

52

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

53

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

54

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

55

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

56

Suctioning

NOTE:

Use of suctioning should not interfere with definitive care

Limit use of suctioningAdults – 15 secondsChildren - 10 secondsInfants - 5 secondsSlide57

57

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

58

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

60

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

61

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

62

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

63

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

64

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

66

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

67

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

68

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

69

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

70

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

72

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?

73