Module 1 Flashcards
(101 cards)
1
Q
First Aid
A
-Initial care when advanced care procedures are not readily available
-Intended to
~Preserve life
~Alleviate suffering
~Prevent further illness or injury
~Promote recovery
-Can be initiated by anyone in any situation
2
Q
First Aid Provider
A
- Recognize, assess, and prioritize the need for first aid
- Provide appropriate first aid care
- Recognize limitations
- Seek professional medical assistance when necessary
3
Q
Recognizing an Emergency
A
-Can be unexpected and confusing
-Get quick sense of what occurred, or is occurring
-Look for important clues
~Location
~Body Position
~Sick or injured
~Is it safe (for you)
4
Q
Recognizing an Emergency
-Questions to ask about the emergency
A
- Does the person appear to be unconscious?
- If you suspect an injury, how do you think it happened?
5
Q
Personal Safety
A
- DON’T BECOME A PATIENT
- Pause
- Look for hazards
- Consider hidden dangers
- If not safe, don’t go in
- If it becomes unsafe, get out
6
Q
Deciding to Help
A
-You might hesitate because you
~Feel like the problem is too big for you to handle alone
-Fear making things worse
-Think you don’t have a lot of medical knowledge
-Think there are others around who might take charge
7
Q
Deciding to Help
-If it is safe to do so, take action
A
- You will likely feel stressed
- Take a deep breath, slow down
- Put what you learn in this program to work
- Your actions can help to protect or save a life
8
Q
Protecting Yourself
A
-You can be exposed to blood or other potentially infectious body fluids
~Risk of contracting a disease is very low
~Wise to take simple measures to avoid exposure
~Other things to look for
*Weapons
*Needles
9
Q
Infectious Bloodborne Diseases
A
-Hepatitis B
~There is a vaccine
-Hepatitis C
-HIV, the virus that causes AIDS
-Exposure can occur through
~Direct contact with open wound or sore
~Absorption through membranes of mouth, nose, and eyes
~A skin puncture with a contaminated object
-Immediately report any exposure to your supervisor
-Follow written exposure control plan for additional care and advice
10
Q
Standard Precautions
A
- Reducing exposure lowers the chance of infection
- This set of protective practices is used whether or not an infection is suspected
- To be effective, your approach is the same for everyone, regardless of relationship or age
11
Q
Personal Protective Equipment (PPE)
A
-Protective barriers worn to prevent exposure to infectious diseases ~Disposable gloves *Make sure readily available *Always use them *Inspect for damage or tears *Always remove gloves carefully **Use soap/water or a sanitizer to clean hands and exposed skin ~Face shields *Prevent mouth, nose, and eye exposure
12
Q
Legal Considerations
A
-Consent
~Everyone has the right to refuse medical treatment
~If responsive, ask if the person wants help before providing care
~Some exceptions… but not at the First Aid level
-Expressed/Informed Consent
~When someone agrees to help after you explain what you would like to do
-Implied Consent
~If unresponsive assume a person would agree to be helped
-Abandonment
~Remain with person until someone with equal or greater emergency medical training takes over
~If alone, may need to leave to get help
~Return to person as soon as you can
~Leave if the scene becomes unsafe
13
Q
Good Samaritan Law
A
-These laws help protect anyone who
~Voluntarily provides assistance, without expecting or accepting compensation
~Is reasonable and prudent
~Does not provide care beyond training received
~Is not grossly negligent, or careless, in delivering emergency care
-Laws vary from state to state but common sense is always appropriate
~Activate EMS or an occupational emergency action plan (EAP)
~If the scene is unsafe, do not enter
~Ask a responsive person for permission before giving care
~Never attempt skills that exceed your training
~Don’t stop until someone with equal or greater training relieves you
14
Q
Calling for Help
A
-Emergency medical services (EMS) is a prehospital emergency medical response system developed within a community
~Uses specialized communication equipment to gather information and dispatch resources to
*Respond directly to emergency scenes
*Provide advanced medical care
*Transport ill or injured people to a hospital
15
Q
Emergency Medical Services (EMS)
A
-To activate EMS call an emergency number, such as 911, when
~Immediate threats to life are present
~Significant mechanism of injury has occurred
~Warning signs of serious illness exist
~Severity of person’s condition uncertain
-Dispatcher will guide you through call and guide you in care
~Will ask for basic information
*Type of emergency
*Location
*Care being provided
~Answer clearly and concisely
~Resources will be notified to respond while you are no the line
~With mobile phone, activate EMS and use speaker to listen and provide care simultaneously
16
Q
Emergency Action Plans (EAP)
A
-Step-by-step procedures on hw to report and respond to emergencies
~EAPs account for worksite layout, size, and features
~Activating an EAP my be
*Dialing 911
*Notifying centralized communications person
*Activating in-house emergency team
~Know how to report and respond to emergencies at work
~Develop EAP for your home and review it with household
17
Q
Poison Help Line
A
-Poison control centers offer free, confidential medical advice 24/7 through the national Poison Help line at 1-800-222-1222
-Primary resources for
~Poisoning information
~Care for suspected poisonings
18
Q
Emergency Moves
A
-If necessary to move someone, the most effective move is a drag
~Pill in direction of long axis of body
~Never pull on person’s head or a person’s body sideways
~Use your legs, not your back
~Keep person as close to your body as possible
~Avoid twisting
~Consider the person’s weight
~Know your physical ability and respect your limitations
-Extremity Drag
~Grasp and pull on the ankles or forearms
-Blanket Drag
~Roll the person onto a blanket and drag the blanket
19
Q
Respiratory System
A
-Primary Purpose
~Bring oxygen into the body
~Remove carbon dioxide (waste)
-Airway
~The passageway by which air is moved in and out of the body
-Respiration
`the process by which oxygen and carbon dioxide are moved in and out of the blood stream
20
Q
Ventilation
A
-Boyle’s Law
-Pulmonary Ventilation
~The physical process by which air is moved in and out of the lung
-Inspiration (Inhalation)
~As volume increase, pressure decreases
~A decrease in pressure draws air into the lungs
~ACTIVE PROCESS
-Expiration (Exhalation)
~As volume decreases, pressure increases
~An increase in pressure drives air out of the lungs
~PASSIVE PROCESS
21
Q
The Upper Airway
A
-Air enters through the nose and mouth
~Nasal airway humidifies/warms the air entering the airway
-Passage ways meet at the back of the throat
~Pharynx
-Air passes down through the glottis into the trachea (windpipe)
~Epiglottis is a “flap” that folds over the glottis to prevent food/liquids from entering the lungs
22
Q
The Lower Airway
A
–Air passes through the trachea into the right and left bronchi
-The bronchi branch into smaller passageways called the bronchioles
~Like branches of a tree
-Bronchioles get smaller and smaller until they end at very small air sacs called the alveoli
23
Q
The Lower Airway
-Alveoli
A
-Tiny air sacs that have a thin, single cellular membrane
-Alveoli increase the surface area within the lung to allow for gas exchange
-600 million alveoli in the lungs
~Creates 70 square meters of surface area
~About the size of a tennis court
24
Q
Gas Exchange (Respiration)
A
-Due to differences in concentration, gasses move between the blood stream (pulmonary capillaries) and the alveoli
~Oxygen moves from the alveoli into the bloodstream
~Carbon dioxide moves from the bloodstream into the alveoli
25
The Cardiovascular System
```
-Primary Purpose
~Moves oxygen to the tissues to be used for metabolism
~Removes carbon dioxide from the tissue
-3 Components
~The heart (pumps)
~Blood (fluid)
~The blood vessels (pipes)
```
26
The Heart
-A muscle that pumps blood throughout the body
~The electrical system of the heart stimulates the muscle to contract in a coordinated manner
~During contraction (systole), blood is forced out of the heart and throughout the body
~During relaxation (diastole), the heart fills with blood to prepare for the next contraction
27
The Blood
- A fluid that contains red blood cells, white blood cells, plasma, and platelets
- Plasma is the LIQUID PORTION that contains clotting factors, nutrients, and electrolytes
- Red blood cells are the OXYGEN-CARRYING COMPONENT of blood
28
The Blood Vessels
- Pipes that transport blood throughout the body
- Arteries are high-pressure vessels that carry blood away from the heart
- Capillaries are tiny vessels that allow for gas exchange to take place
- Veins are low-pressure vessels that carry blood back to the heart
29
Coronary Arteries
- Supply blood to the heart muscle
| - Circulation to the heart muscle happens when the heart relaxes
30
Tissue Perfusion
- Occurs within the capillaries
- Nutrients and waste are exchanged between the tissue and the bloodstream
- The brain and the heart are the most sensitive to decreases in perfusion
31
Why is Carbon Dioxide so important?
-Carbon dioxide (CO2) is a by-product (waste) of metabolism
-Excess CO2 will react with water and create an acid
-The body wants to be at a specific pH range
~7.35 to 7.45
~Acidosis due to too much CO2 can impair bodily functions and be harmful
32
Sudden Cardiac Arrest (SCA)
-Sudden Cardiac Arrest (SCA) can happen with little or no warning
~Individual abruptly becomes unresponsive and collapses
*Abnormal gasping can occur
*Breathing may stop
~Likely cause is disruption to heart's electrical system
*Electrical pulses become disorganized
*Ventricle fibrillation occurs
*Blood flow with oxygen it carries stops
*Brain damage occurs rapidly
*Quickly leads to death
33
AHA Statistics on SCA
```
-In the US
~356,000 out-of-hospital cardiac arrests annually
~Survival to hospital admission is around 29%
*39.5% if in public places
*27.5% at home
*18.2% at nursing home
~Survival to hospital discharge
*10.8%
~Large regional variation in survival
*DUE TO LAYPERSON CPR
```
34
What happens during SCA
-In adults, SCA most commonly occurs from a diseased heart
~90-95% have underlying coronary artery disease
~Risk factors include obesity, smoking, high blood pressure, diabetes
-Reduced blood flow to be heart muscle due to build up in the coronary arteries starves the muscle of oxygen
~Irritates the heart muscle
-Irritated heart muscle starts to dysfunction
-Electrical activity is no longer coordinated
~Cardiac Dysrhythmia or Arrhythmia
-Heart no longer contracts in a coordinated manner
~The heart stops or arrests
-Blood is no longer effectively circulated throughout the body
-If circulation stops, brain damage occurs within minutes
~Brain damage begins in 4-6 minutes
~Brain damage irreversible in 8-10 minutes
*Circulation must be restored within 4-6 minutes
-Medical professionals cannot get there fast enough to start treatment and prevent brain damage
-Laypersons (you) must act in order to make a difference
-If the heart stops due to Coronary Artery Disease, the blood stream usually still has a reserve of oxygen
~In this case, lack of oxygen is not the immediate problem! It is a lack of blood flow to the heart muscle and to the brain that is the problem
~This is true for MOST adult Sudden Cardiac Arrest
35
Cardiopulmonary Resuscitation (CPR)
-CPR is the immediate treatment for a suspected cardiac arrest
~Allows a bystander to restore limited oxygen to the brain through
*Chest compressions
*Rescue breaths
~CPR alone is not enough
36
Early Defibrillation
-The most effective way to end fibrillation is defibrillation
~Shock is sent through heart to stop ventricular fibrillation, allowing normal activity to return
~Success dependent on how quickly defibrillation occurs
*Each minute in cardiac arrest chance of survival declines by ~10%
*After as few as 10 minutes, survival is unlikely
*Time from recognition of arrest to EMS arrival usually longer than 10 minutes
37
Automated External Defibrillator (AED)
-A small, portable, computerized device that is simple to operate
~Open lid or push power button
~Provides voice instructions to guide attachment and use automatically
*Analyzes heart rhythm
*Determines if shock is needed
*Charges itself to ready to defibrillate
*Operator pushes button to deliver shock when prompted by AED
38
Chain of Survival
-The greatest change of survival exists when all the links are strong
~Early recognition of cardiac arrest and activation of EMS
~Immediate CPR with high-quality chest compressions
~Rapid defibrillation to the heart
~Effective basic and advanced EMS care and transport
~Effective post-cardiac arrest care at a hospital
39
Secondary Cardiac Arrest
-Hazardous breathing conditions in a confined space, drowning, and drug overdoses can result in secondary cardiac arrest
~Without oxygen, heart weakens until signs of life become difficult or impossible to assess
~Immediate CPR, with effective rescue breaths, may be only chance to restore them
40
Opioid Overdose
-Opioids, taken in excess, can depress and stop breathing
~Naloxone
*Temporarily reverses life-threatening effects of opioids
*Easily administered with autoinjector device or aerosol sprayed into nose
*Becoming more readily available to lay providers
*Laws regarding administration of naloxone vary by city and state; know the laws in your area
41
Children and Infants
```
-More likely to experience secondary cardiac arrest
~Age groups for CPR care
*Infant is younger that 1 year of age
*Child is 1 to puberty
*Adult is puberty and older
~Chain of survival
*Prevention of emergencies
*Early CPR with rescue breaths
*Prompt EMS activation
*Effective EMS care
*Effective post arrest care
```
42
The Goals of CPR
- Circulate (move) blood throughout the body in order to prevent cell death (Chest Compressions)
- Restore oxygen and remove carbon dioxide from the blood stream (Rescue Breaths)
- Restart the electrical system of the heart to get it to start beating effectively again (Defibrillation)
43
Chest Compressions
-Pushing on the heart in order to circulate blood throughout the body
~Chest compressions alone will almost NEVER restart the hear
~The goal of chest compressions is simply to preserve brain and heart cells for a little longer
~One of the most important steps to increasing survivability
-Quality matters; focus of high-quality techniques
~Compress deeply, more than 2 inches
~Compress fast, 100-120 times per minute
8do not let speed result in shallow compression depth
~Allow chest wall to fully recoil between compression
*Avoid leaning on chest at top of each compression
~Normal to hear and feel changes in the chest wall
*Forceful external chest compressions may cause chest injury, but are critical if person is to survive
*Reassess hand positioning and continue compression
44
Minimize Interruptions in chest compressions
-Interruptions occur at some points in CPR
~Changing who is doing compressions
~AED is analyzing
~Providing rescue breaths
-Unnecessary interruptions should be avoided
~Occur usually when people hesitate or are unsure of what to do next
~If people are unsure of what to do, just continue chest compressions
45
Chest Compressions
| -Children and infants
-Compression technique for children similar to that of adults
-Children
~Use heel of 1 hand on lower half of breastbone
~If this is difficult or is you are tired, use both hands
-Infants
~Use tips of 2 fingers on breastbone
~Just below the nipple line
46
Hands-Only CPR
-Created due to a lack of bystander CPR
~Remember, the blood still has some oxygen in it
~While rescue breaths are important, they are far less important than immediate chest compressions
~Chest compressions without rescue breaths are effective
*MINIMIZE INTERRUPTIONS IN CHEST COMPRESSIONS
47
Rescue Breaths
-Artificial breaths given by blowing air into mouth of inflate lungs
~Air you breathe contains ~21% oxygen
~Exhaled air contains 16-17% oxygen
~Exhaled oxygen is enough to support someone's life
48
Establishing an Airway
-You need to make sure there is an open airway
~The tongue is the most common airway obstruction in adults
~An unresponsive person can lose muscle tone
~Flat on back, base of tongue can relax and obstruct airway
~Lifting jaw forward, while keeping mouth open, pulls tongue away from back of throat and opens airway
-Open a person's airway by using the head tilt-chin lift technique
~Place hand on forehead, fingertips of other hand under chin
~Apply firm, backward pressure on forehead while lifting chin upward, tilting head back and moving jaw forward
~Avoid pressing into soft tissue of chin with fingers, this can obstruct airway
~Leave mouth slightly open
~Establishing an open airway is higher priority than protecting possible injury to spine
49
Using Barrier Devices
-Using a protective barrier when giving rescue breaths to minimize exposure to infectious disease
~CPR mask
~Overlay shield
50
Delivering Breaths
-Each breath should be ~1 second long, only enough air to create a visible rise of the chest
~2 breaths given as a time, quickly, in less than 10 seconds
*Let person exhale between breaths
*Take regular breaths before delivering 2nd
*If you remove your hands, airways will close
*Open airway each time give rescue breath
~If cannot get chest to rise, reposition head further back and try another breath
~Avoid blowing too hard or long
*Pushes air into stomach, make breaths more difficult and increases chance of vomiting
-Same for children and infants as for adults
~If possible use appropriately sized barrier device for children or infant
~Do not give too much air in a single breath
*Only enough to make chest visibly rise
~If using an adult CPR mask with infant, rotate 180 degrees for better seal
~When using a shield or no barrier device
*Cover infant's mouth and nose with your mouth for airtight seal
51
Bag Valve Mask (BVM)
-Alternative breathing device
-Commonly used by healthcare professionals, lifeguards, etc..
-Takes practice
~Over inflation is a real issue with a BVM
~Do not "wring out" the BVM
~Only give enough are to see chest rise
~Do not squeeze too fast; deliver the breath over 1 second
52
Automatic External Defibrillator (AED)
-Delivers a shock to the heart (360 joules)
~The goal is to STOP the electrical activity of the heart
~Interrupts the V.Fib
*De fibrillation
~Allows the heart to restart
-AEDs are simple to use; voice, lights, and screen instructions guide you
~Open lid or hit power to turn on
~Adhere defibrillation pads to bare chest
*Remove clothing from torso
*Locate and pull out defibrillation pads
*Pads have pictures to show proper placement
*Peel pads from backing sheets and place as shown in pictures
*One below right collarbone, above nipple, beside breastbone
*Other pad lower on left side, over rib and few inches below armpit
~Allow AED to analyze heart rhythm
*Automatically analyzes once pads in place
*Most pads already connected to device
*Stop CPR
*Be certain that on one is touching the person
*If defibrillation advised, AED will begin to charge for shock delivery
~Deliver shock if directed by AED
*Make sure no one is in contact with person before delivering shock
*For most AEDs, a button is pressed to deliver the shock
*Once delivered, immediately resume CPR, starting with chest compressions
53
Automated External Defibrillation (AED)
| -Children and Infants
-Most AEDs have specially designed pads or mechanisms
-Steps same for child of infant as for adults
-Pad placement is different for smaller chests
~Place one pad on center of chest below collarbones
~Attach second pad on center of back between shoulder blades
-Use AED configured for adult of one specifically equipped for child or infant is not available
54
AED Troubleshooting and Considerations
-Designed to detect problems during use and guide corrective actions
~If troubleshooting message occurs, stay calm and follow voice instructions
~CPR should be provided, without interruption, until problem corrected or another AED becomes available
~Do not pause CPR longer that 10 seconds
~If problem with pads is indicated
*Press pads firmly, especially in center
*Make sure pads' cable connector is firmly connected to AED
-If chest is wet, dry before applying pads
~If chest becomes wet after application
*Remove pads
*Dry chest
*Apply new set of pads, if available
~If chest hair excessive, shave hair in areas where pads will be placed
~If pads placed on chest hair, not adhering
*Remove pads and shave hair
*Attach new set of pads, if available, or re-apply original pads
-Other troubleshooting messages
~If analysis interruption due to movement, stop all sources of movement (chest compressions or rescue breaths)
~If need to replace a battery, may be only enough energy for limited number of shocks and only a few more minutes of operation
~If AED fails to operate, depleted battery should be removed and replaced with new one
~If battery need replacement during resuscitation, it should be replaced during a CPR interval
-A person should be removed from standing water before using AED
~Okay when lying on wet surface
~AED should never be immersed in water or have fluid spilled on it
-AED can be used safely on metal surfaces
~Make sure pads do not directly touch any metal surface
-Risk of shocking the CPR provider is extremely low
55
AED Troubleshooting and Considerations
| -Surgically implanted device in chest
- Noticeable lump and surgical scar visible
| - If device in way of pad placement, place edges at least 1-inch from device
56
AED Troubleshooting and Considerations
| -Defibrillating over medical patches can reduce effectiveness of shock
-If patch interfering with placement
~Use gloved hand to peel off patch
~Wipe away remaining residue
~Replace pads
57
AED Locations
-Know where AEDs are located at work, school, stores, etc.
~The earlier defibrillation occurs, the better
~PulsePoint APP
*Get when CPR certified
58
What is a primary Assessment?
-A process by which a first aid provider can identify immediate life-threats
~Should be standardized
*Always go through the same process
~When a problem has been identified, address is immediately (if possible)
~Should identify obvious problems pertaining to
*Airway
*Breathing
*Circulation
*Disability
*Exposure
59
The Process
```
-Remember, the process should be consistent. Perform it the same way every time! This will help when you are stressed
~Scene Assessment
~Standard Precautions
~General Impression
~EMS Activation
~Airway/Breathing Assessment
~Circulation
*If you identify a problem at any point during the primary assessment, stop the assessment to provide care (if possible)
```
60
Scene Assessment
-Is the scene safe?
~If the scene is unsafe, consider your own safety before the safety of the patient
~Use the mnemonic SETUP
*Stop- pause to identify hazards
*Environment- Consider your surroundings
*Traffic- look out for vehicles
*Unknown Hazards- Things that are not apparent
*Personal Safety- Use protective barriers
~Maintain situational awareness, this is not your emergency!
61
Standard Precautions
-PPE-Personal Protective Equipment
-BSI- Body-Substance Isolation
~Nitrile gloves
*You should inspect your gloves after putting them on
*If they get contaminated, think about what you are touching
*Don't forget to take them off carefully
~Consider eye protection
~If at night, can other people see you? Reflective clothing/lights are important
62
General Impression
-As you approach the patient, ask yourself
~Is the patient responsive of unresponsive
~If they appear to be unresponsive, do they respond to stimuli?
*Verbal
*Painful/Tactile
**Tap on the shoulder
**Trapezius (Trap) Squeeze
**Sternal Rub
-If unresponsive, call EMS immediately!
63
Airway/Breathing
```
-Is the patient in a position where their airway is open?
~If not fix it
~Consider head-tilt, chin-lift
-Is the patient breathing?
~Look for chest rise
~Listen for air movement
~Weak, irregular gasping, snorting, or gurgling is not normal breathing
~Check for NO MORE THAN 10 SECONDS
-If breathing is ABSENT or OCCASIONALL GASPING
~Begin CPR
-If the person is breathing
~Place patient in the recovery position
*Even if you hear gurgling (fluid)
*Even if you hear snoring (tongue)
```
64
Recovery Position
-When head, neck, or back injury suspected
~Best to leave person in position found
~If airway threatened, quickly roll person to clear and protect it
*Keep head, shoulders and torso from twisting
~Maintaining an airway is more important to protecting the spine!
-Always preform primary assessment to determine need for CPR
65
Circulation
-Are there any problems with circulation?
~Bleeding
*Stop any bleeding as necessary
~Do they look like that have good circulation
*Skin: warm, Pink, Dry vs. Pale, Cool, Diaphoretic (Sweaty)
~Feel for a pulse
*Carotid pulse
*Radial pulse
*Is it strong or weak?
~Weak pulse and pale skin are indicative of shock
66
Disability
- Is the MENTAL STATUS appropriate?
| - If the patient is unresponsive the answer is NO
67
Exposure
-Is the patient exposed to any environmental hazards
~If cold, keep them warm
~If hot, cool them down
-Expose any injuries that may be present
68
Did You Finish Your Primary Assessment?
- If you finish, start it again
- Continuously assess the patient until additional help arrives
- "The are of assessment is Reassessment"
- If possible, gather more information
69
Caring for Cardiac Arrest
```
-Immediate, high-quality CPR and defibrillation can double or even triple the chance of surviving sudden cardiac arrest
~Pause and assess scene for hazards
~If dangerous, do not approach
~If safe, assess for responsiveness
~If unresponsive, send someone to activate EMS and get an AED
~Check for normal breathing
~If not normal, begin compressions
~Quality matters
*Push hard and fast
*Do not lean on chest
```
70
Caring for Cardiac Arrest
-Immediate, high-quality CPR and defibrillation can double or even triple the chance of surviving sudden cardiac arrest
~After 30 compressions, give 2 rescue breaths
~Establish airway first and give only enough air to see chest rise
~Do this in less than 10 seconds
~Perform ongoing CPR cycles of 30 compressions and 2 rescue breaths
~Compress hard and fast, letting chest fully recoil after each compression
-Use AED immediately when it arrives. If another person available to operate, continue CPR until AED is ready
~Turn on AED
*Adhere defibrillation pads to bare chest
*Allow to analyze heart
*If shock advised, make sure on one touching person before delivering
*After delivered, resume CPR
~AED voice instructions and analysis will guide care
~Do not stop until signs of life, another provider, or EMS takes over, too exhausted to continue, or if the scene becomes too unsafe
71
Caring for Cardiac Arrest
| -If person responds
```
-Stop CPR and place in recovery position
~Leave AED on and attached
-If shock not indicated, resume CPR
~Continue to follow AED's instruction
-Avoid interruptions in compression
-Take turns performing CPR
~Switch compressors every few minutes
~During automatic AED analysis that occurs every 2 minutes is best
-Do the best you can
```
72
Compression-Only CPR
-An approach being widely promoted to people not trained in CPR
~Instruction can be shared via social media, PSAs, or EMS dispatchers
~It is a limited approach
~Rescue breaths are essential for all cardiac arrests, especially children
~Perform both compressions and breaths during CPR
~If unable or unwilling to perform rescue breaths, provide high-quality, uninterrupted compressions at a minimum
73
Multiple Provider Approach to CPR
-Commonly more than one trained provider is available to help when cardiac arrest occurs
~Work together to improve performance and reduce interruptions
~Switch providers every 2 minutes helps to maintain CPR quality
~Communicate about switched ahead of time
~Coordinate your actions to switch smoothly and minimize interruption time
74
Pediatric Assessment Triangle (PAT)
```
-Appearance
~Abnormal Tone
~Low Instructiveness
~Low Concealability
~Abnormal Look/Gaze
~Abnormal Speech/Cry
-Work of Breathing
~Abnormal Sounds
~Abnormal Position
~Retractions
~Flaring
~Apnea/Gasping
-Circulation to skin
~Pallor
~Mottling
~Cyanosis
```
75
PAT
| -Appearance
```
-Abnormal
~Abnormal or absent cry or speech
~Decreased response to parents or environmental stimuli
~Floppy or rigid muscle tone or not moving
-Normal
~Normal cry or speech
~Responds to parents or to environmental stimuli
*Lights
*Keys
*Toys
~Good muscle tone
*Moves extremities well
```
76
PAT
| -Breathing
-Abnormal
~Increased/excessive (nasal flaring, retractions or abdominal muscle use) or decrease/absent respiratory effort or noisy breathing
-Normal
~Breathing appears regular without excessive respiratory muscle effort or audible respiratory sounds
77
PAT
| -Circulation
```
-Abnormal
~Cyanosis, mottling, paleness/pallor or obvious significant bleeding
*Cyanosis
**Blue skin
*Mottling
**Patchy or irregular colors
-Normal
~Color appears normal for racial group of child
~No significant bleeding
```
78
Caring for Cardiac Arrest
| -Children and infants
-Most cardiac arrests are result of loss of airway or breathing
-Emphasis on effective rescue breaths are part of CPR is important
~Compression-only CPR is associated with lower survivability in children
~However, chest-compression CPR is still better than nothing
-When alone with an unresponsive child or infant, provide 2 minutes of CPR before leaving to activate EMS and get AED
79
Recognizing Cardiac Arrest
```
-If the child or infant is not breathing or is only gasping start CPR immediately
~30 chest compressions
*Single or double hand in children
*2 finger or thumb method in infants
*No research suggesting which is better
~2 rescue breaths
*Watch for adequate chest rise
*Do not over-inflate the lungs
*In infants, give rescue "puff"
~Provide 2 minutes (5 cycles) of CPR, then call 911
```
80
Recognizing Cardiac Arrest
| -If two provides are present
```
-15 chest compressions
~Single or double hand for children
~2 finger or thumb method in infants
~No research suggesting which is better
-2 Rescue breaths
~Watch for adequate chest rise
~Do not over-inflate the lungs
~In infants, give rescue "puff"
~Provide 2 minutes (5 cycles) of CPR, then call 911
```
81
Choking
-Can occur when a solid or small object enters a narrowed part of the airway and becomes stuck
~On inhalation, object can be drawn tighter in and block air from entering lungs
~A forceful thrust beneath ribs and up into diaphragm can pressurize air in chest and pop obstruction out
~Compression of chest over the breastbone can create enough pressure to expel an object
82
Mild Obstruction
-A person can speak, cough, or gag
~Typically cleared naturally through forceful coughing
~Allow someone to try to resolve the problem on his or her own
~Stay close and be ready to take action if things worsen
83
Severe Obstruction
-A person cannot take in enough air to dislodge the object
~Signs of sever obstruction includes
*Very little or no air exchange
*Lack of sound
*Inability to speak or cough forcefully
~Person may hold his or her hand to throat while attempting to clear obstruction
~Person without air exchange requires your help to survive
-Management
~Abdominal Thrusts
~Also known as Heimlich Maneuver
-Stand behind, head to side
-Provide forceful abdominal thrusts until airway is cleared
-If they go unresponsive, begin CPR, occasionally looking inside the airway
84
Pregnant Women
- Perform the same maneuver in the center of the breast bone, same place as you would for CPR
- Can also be used for very obese individuals
- The rest of it is the same
85
What if you're alone
-If possible, move to a location where you can be seen
-Perform abdominal thrusts against a chair or table
~Rolling chairs probably don't work so well
-Place fist above navel while grasping fist with other hand
~Lean over a chair or countertop, drive your fist towards yourself with an upward thrust
86
Choking
| -Children and infants
-Approach for children nearly the same as for adults
~Kneel behind child to deliver thrust
~Use less force
-Chocking in infants differentiated by sudden onset
~Signs include
*Weak ineffective coughs
*Lack of sound even when attempting to breathe
87
Infant Foreign Body Obstruction
-5 back blows
-5 chest compressions
-Repeat until airway is cleared
-No abdominal thrusts
~Concern about damaging the liver
-If unresponsive begin CPR
88
Primary Assessment
| -Responsive Person
-Look for life-threatening problems
-Introduce yourself-
-Check for diminished level of responsiveness, altered mental status, or difficulty breathing
-Scan body for serious bleeding
~If found, control it immediately
89
Assessing Level of Responsiveness
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-Level of Responsiveness
~Alert
~Verbal
~Pain
~Unresponsive
```
90
Assessing Airway and Breathing Status
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-Rate, Depth, Quality
~Assess Respiratory Quality
*Regularity, Abnormal Noises, Labored, Difficulty
~Assess Respiratory Rate
*Adults 12-20
*Children 20-30
*Infants
30-40
~Assess Respiratory Depth
*Deep, Shallow, Regular
```
91
Assessing the Circulation
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-Assess Pulse Rate
~Normal Adult 60-100
~Count Pulse for 15 seconds, multiply by 4
~Count Pulse for 30 sec, multiply by 2
-Assess Pulse Quality
~Regular/Irregular
~Strong/Weak, Location?
-Assess Skin
~Temperature and Color
~Pink, Warm, Dry
~Pale, Cool, Clammy
-Not and Treat any Bleeding
~Start with direct pressure
```
92
Primary Assessment
-Responsive Person
~Look for obvious signs of shock
-Check face for tissue color, indicates amount of blood circulating below skin
~Normal tissue color is light pink
~Paleness indicates blood loss or shock
~Bluish color indicates lack of oxygen
-Depending on skin tone, may be easier to check in palms of hands, fingernails, or inside the lip
93
Primary Assessment
-Responsive Person
~Check Skin Temperature
-Touch forehead with your bare wrist
~Normal skin feels warm and dry
~Cool, wet skin can be an indication of shock
94
Disability
```
-Looking for any immediate changes to NEURO functions
~Are they alert/oriented
*Person
*Place
*Time
*Events
~Do they have any NEURO DEFECITS
*Can they feel and move all of there extremities
```
95
Secondary Assessment
-If no life-threatening problems OR you're waiting for EMS to arrive, gather info about ill or injured person
~Identify what happened, if primary or chief complaint
*If person cannot answer, ask bystanders
~Consider hidden injuries if force impacted body
~If suspect injury to head, neck, or back, instruct person to remain still
~Look for clues (Medications or containers)
~Check for medical alert jewelry identifying a condition
96
Secondary Assessment
| -Physically assess the person, evaluating body from head to toe for signs of illness or injury using DOTS mnemonic
```
-Deformities
~Unusual body presentation, differences from other side
-Open Injuries
~Bleeding injuries
-Tenderness
~Painful areas, especially when touched
-Swelling
~Swollen and discolored body areas
```
97
Deformity
-Typically due to fracture or dislocation
~Could be a chronic deformity... ask the patient
~Deformity can disrupt blood flow
~May lead to long-term complication
98
Open Wounds
```
-Primary risk of bleeding, secondary risk of infection
~Lacerations
~Abrasions
~Avulsions
~Penetrations
~Burns
```
99
Tenderness and Swelling
```
-Indicative of some type of injury. Could be from a medical problem
~Tenderness- Painful to touch
~Swelling
*Sometimes subtle, compare to other side
*May be accompanied by bruising
**Ecchymosis
**Contusion
*Remove anything that may be constricting
```
100
Secondary Assessment
| -Ask questions to gather more information using SAMPLE
```
-Signs and symptoms
~Such as pain, nausea, dizziness
-Allergies
~Things person may be allergic to
-Medications
~Person has been prescribed or is taking
-Past Medical Problems
~That may be related to what is going on
-Last oral intake
~When and what person last ate or drank
-Events leading to problem
~What a person was doing just prior to problem occurring
```
101
Signs and Symptoms
| -Signs are things you observe or measure, Symptoms are things the patient experiences
```
-Symptoms
~Nausea/Vomiting
~Upset stomach
~Diarrhea
~Pain
~Dizziness
~Weakness
~Fatigue
~Headache
~Blurred Visions
~Loss of sensation
-Signs
~Rash/discolored skin
~Hives
~Changes in heart rate
~Fever
~Dilated/constricted pupils
~Slurred speech
~Disorientation
```
