2006                                                                                      CPR-CLASSES.COM

BLS Healthcare Provider

 2006 Study Guide

Source: HCP AHA Text and St David Healthcare Partnership

 Note: May names are given to those who need the loving touch of healthcare providers.  Those names include, but are not limited to resident, client, patient, subject, occupant and patron.  For the purposes of this instructional document, those who require the rescue services of a healthcare provider shall herein be referred to as, “victim”.  Let none be offended by this reference.

 Basic Life Support (BLS) for Healthcare Providers (HCP) Provider includes:

 • Adult 1 & 2 Rescuer CPR

• Child 1 & 2 Rescuer CPR

• Infant 1 & 2 Rescuer CPR

• Rescue Breathing/Bag-Mask-Ventilation

 • Adult and Child AED

• Adult/Child/Infant Foreign Body Airway

Obstruction

• Written Exam and Skills Check-off.

Major Changes/Key Principles:

. Compression technique is the most important aspect:

. HARD and FAST

. Allow for complete recoil following compression

. Never interrupt compressions for longer than 10 seconds, as interruption reduces blood pressure and coronary perfusion pressure

. Maintain the compression rate of 100/minute

. Ventilations must be controlled—do not hyperventilate:

. Hyperventilation interferes with compressions

. Deliver breaths over 1 second to obtain visible chest rise—not too deep!

. Count the seconds between breaths to control rate—once every 5 seconds for adult, child and infant is acceptable.

 . AED limited to one shock:

. Apply AED while still delivering compressions.

. Stop compression only when AED says, “Analyzing compressions…”

. Safely Shock when prompted.

. Immediately resume 5 cycles of 30:2 compressions WITHOUT a pulse check.

. Then assess and check breathing and pulse.

 Adult Victim Unconscious Foreign Body Airway Obstruction:

. If unable to ventilate reposition the head

. Reattempt ventilation

. Look in the mouth for foreign object and remove only if seen

. Begin compressions at the ratio of 30:2

. Reexamine the mouth after each 2-minute round compressions.

Major Controllable Risk Factors of Heart Attack and Stroke: the focus is on the factors we can change:

 . Cigarette smoking

. Hypertension (high blood pressure)

. High cholesterol level

. Lack of exercise

. Obesity

. Heart Disease

. Transient ischemic attack (TIA)

Symptoms of a heart attack include:

. Chest pain (as in Angina)

. Sweating (Diaphoresis)

. Shortness of breath (SOB) or (Dyspnea)

. Nausea and vomiting (N/V)

. Weakness

. Denial (People who have symptoms often deny that the problem is serious)

STROKE

 A stroke results from an interruption in the flow of blood to specific areas of the brain OR from damage resulting from bleeding into the brain. CPR providers must be able to recognize the signs & symptoms of stoke, which include:

. alteration in consciousness

. severe headache

. aphasia, facial weakness or asymmetry

. poor coordination

. poor balance

. visual disturbance

. slurred speech

. severe dizziness

Early access is critical in the care of victims with stroke because new thrombolytic (fibrinolytic) therapies or clotbusters are available that may minimize consequences of stroke in some victims who can be evaluated and treated within three hours of the onset of symptoms.

HEART ATTACK

For suspected heart attacks, always call 911 immediately to active the EMS system. Do not wait for the “classic picture” of a heart attack before calling 911. (Call 911 when away from the hospital and call your hospital’s emergency number when inside the hospital.) Instruct the victim to lie down or sit quietly until help arrives. Immediate CPR and defibrillation within 3-5 minutes gives the best chance of survival from sudden cardiac arrest.

  In the hospital: call a Code, dial the established emergency number for each building.

 Cardiac arrest in children is most often secondary to severe airway and breathing problems.

 . Another common cause is accidents

. Most accidents can be prevented by implementing safety measures

 VENTILATION

 Correct ventilation is important to provide adequate oxygen and to prevent gastric insufflation (pushing gas down the esophagus into the stomach):

 . Slow, gentle ventilations help avoid gastric insufflation; rapid and forceful ventilations causes gastric insufflation and probable aspiration.

. Ventilation volume should be enough to cause the chest to rise and no more.

. Breaths should be delivered one second causing the chest to just rise.

. Avoid hyperventilation as this interferes with compressions.

 ADULT—Victim (pubescent and after ie.. victim facial hair – breast development)

 One Rescuer Adult CPR:

 A. Establish unresponsiveness.

 Activate EMS (outside the hospital) or call a CODE (inside the hospital, use the emergency number).  This is done first to ensure faster arrival of EMS and use of defibrillator on the adult.

 Open airway, using head tilt/chin lift or jaw thrust method. (Use jaw thrust method in cases of suspected head or neck injury.)

 Look, listen, and feel for signs of adequate breathing.

 B. Give two slow breaths, one second per breath, watching the chest rise with each breath and allowing for exhalation between breaths. Do not over-ventilate.

 C. Check the victim’s carotid pulse and look for other signs of circulation (breathing, coughing, or movement in response to the two rescue breaths)

for 5 - 10 seconds.

 If there is No pulse:

 Begin chest compressions: place two hands between the victim’s nipples in the center of the sternum.  Use The heal of the lower hand directly on the sternum.

  Adult one-rescuer CPR consists of cycles of 30 compressions/2 breaths.

 . Compression should be HARD and FAST.

. The Rate of compressions is 100 per minute.

. Allow for full recoil after each compression, while maintaining contact.

. Perform 5 cycles of 30 compressions and 2 breaths.  This should take approximately 2 minutes.

 Two Rescuers Adult CPR:

First Rescuer:

 A. Establish unresponsiveness.

 Activate EMS/Direct second rescuer shall call 911 or a Code.

 Open the victim’s airway using the head tilt/chin lift or jaw thrust method.

 Look, listen, and feel for signs of adequate breathing.

B. If there is no adequate breathing: Give two slow breaths, one second per breath, watching the chest rise with each breath and allowing for exhalation between breaths.

C. Check the victim’s carotid pulse and other signs of circulation (breathing, coughing, or movement in response to the two rescue breaths) for 5 - 10 seconds.

 Second rescuer: Find the correct hand placement for chest compressions.

 If there is still No pulse, the First Rescuer states, “No Pulse”.

 Second Rescuer immediately begins the round of 30 chest compressions.

 (The rescuer delivering breaths and managing the airway should check for the adequacy of chest compressions by feeling for the victim’s carotid arterial pulse during several chest compressions.)

 Adult two-rescuer CPR consists of cycles of 30 compressions/2 breaths.

 . Compression should be HARD and FAST.

. Rate of compressions is 100 compressions per minute.

. Allow for full recoil after each compression.

. Perform 5 cycles of 30 compression and 2 breaths—should take approximately two minutes.

. Rescuers should switch positions and roles after each two minute round of 5 cycles to avoid fatigue.

Adult Bag-Mask Ventilation for Rescue Breathing

 A. Establish unresponsiveness.

 Activate EMS/Call a Code.

 Open the victim’s airway using the head tilt-chin lift or jaw thrust method.

 Look, listen, and feel for signs of adequate breathing.

 B. If breathing is absent or inadequate, properly position the mask to achieve an effective seal while maintaining the open airway.

 Give two slow breaths (one second per breath), ensure adequate chest rise, and allow for exhalation between breaths.

 C. Check carotid pulse.

 If the adult victim’s Pulse is present:

Continue rescue breathing - one breath every five seconds, or about 10-12 breaths per minute. Count seconds between breaths to control ventilation rate.

Adult Foreign Body Airway Obstruction (Choking)

 For the conscious adult choking victim:

 . Ask: “Are you choking?” If yes is gestured, ask, “Can you speak?” If no, tell the victim you are going to help.

. If the victim displays symptoms of poor or ineffective air exchange:

. Give abdominal thrusts - sharp inward and upward thrusts against the diaphragm between the xyphoid process and umbilicus. This can be done with the victim standing, sitting or lying down.

. Use chest thrusts for victims who are pregnant or obese.

. Continue thrusts until airway cleared or person becomes unconscious.

 Choking Victim Becomes Unconscious or is Found Unconscious

 A. Establish unresponsiveness.

 Activate EMS/Call a Code.

 Open airway, using the head tilt/chin lift or jaw thrust method.

 Look, listen, and feel for adequate breathing.  No blind finger sweeps.

 B. Give breath – if unable to ventilate: probable inadequate airway.

 Reposition the adult victim’s head - reattempt to ventilate.

 If the rescuer is unable to ventilate, the probable cause is airway obstruction.

 C. Begin compressions at 100/minute at a ratio of 30:2 (No abdominal thrusts).

 Check the victim’s mouth after each round of compressions for foreign object prior to ventilations.

 Adult CPR and AED:

 A. Establish unresponsiveness.

Activate EMS (outside the hospital) or call a CODE, if in the hospital. Send someone to get the AED.

 Open the victim’s airway using the head tilt-chin lift or jaw thrust method. (Use jaw thrust method in cases of suspected neck injury.)

 Look, listen, and feel for adequate breathing.

 B. If there is no adequate breathing: Give two slow breaths, one second per breath, watching the chest rise with each breath and allow for exhalation between breaths.

 C. Check the victim’s carotid pulse and other signs of circulation (breathing, coughing, or movement in response to the two rescue breaths) for 5 - 10 seconds.

 If there is No pulse: Begin compressions at a rate of 100/minute at a ratio of 30:2.

 Witnessed Arrest: Use AED immediately—apply pads while continuing compressions.

 Un-witnessed Arrest (found down): Perform two minutes of compressions at 30:2 ratio, call 911 and then apply AED.

  Using the AED

 . If there is more than one rescuer, continue compressions, while preparing to use AED.

. Before using the AED, dry the victim’s chest, remove him from standing water, remove medication chest patches, avoid implanted pacemakers and avoid jewelry.

. Place the AED next to the victim. (Turn it on-Put it on – Plug it in) POWER ON the AED and follow the prompts.

. Attach electrode pads in the proper position as seen on the pad.

. Stop compressions and clear the victim, (do not touch the victim) while the AED is analyzing.

. If AED advises shock, check and call, “All clear”.  If the victim is clear, press the SHOCK button when advised.

. Immediately perform two minutes of compressions at the rate of 100/minute at a ratio of 30:2.  Do not routinely pause after shock to check the pulse.

. Reassess pulse and breathing and re-shock the victim as advised.

 CHILD Victims

 (Pre-Pubescent; prior to 12 or 14 years of age)

 One Rescuer Child CPR

 A. Establish unresponsiveness.

 Call, “Help!” If a bystander is available, send that person to activate EMS.

 Open the victim’s airway using head tilt-chin lift or jaw thrust method.

 Look, listen, and feel for adequate breathing.

 B. If there is no adequate breathing: Give two slow breaths (one second per breath).  Watch the chest rise with each breath. Allow for exhalation between breaths.

 C. Check the carotid or femoral pulse and other signs of circulation (breathing, coughing, or movement) for 5 - 10 seconds.

 If there is no pulse or the pulse is less than 60/min. with signs of poor perfusion: Begin chest compressions with one or two hands at the rate of 100 per minute.

 Place heel of one or two hands between the victim’s nipples.

 Use one or two hands for compression depending on size of the rescuer and the victim.

 Give chest compressions at the rate of 100/minute and a ratio of 30 compressions to 2 breaths.

 Continue compressions for five cycles which takes about 2 minutes.

 After two minutes of CPR, if no help has arrived, activate EMS/call a Code.

 Two Rescuer Child CPR

 First Rescuer for Child CPR:

 A. Establish unresponsiveness.

 Activate EMS/Direct second rescuer to call a Code.

 Open the victim’s airway, using the head tilt-chin lift or jaw thrust method.

 Look, listen, and feel for signs of adequate breathing.

 B. Give two slow breaths (one second per breath), watching the chest rise with each breath. Allow for exhalation between breaths.

 C. Check carotid pulse and other signs of circulation (breathing, coughing, or movement) for 5 - 10 seconds.

 Second rescuer for Child CPR:

 If there is still No pulse, the First Rescuer states, “No Pulse” and the second rescuer begins chest compressions.

 Place heel of one or two hands between the victim’s nipples.

 Use one or two hands for compression depending on size of the rescuer and victim.

 Child two-rescuer CPR consists of cycles of 15 compressions/2 breaths.

 The Rate of compressions is 100 per minute.

 Recheck pulse after two minutes and every few minutes thereafter.

 Switching rescuer positions: Switch rescuer positions after every two minute cycle. The compression rescuer becomes the ventilation rescuer and vise versa.

 Check pulse and respirations and resume compressions, if indicated.

Child Bag-Mask Ventilation for Rescue Breathing

 A. Establish unresponsiveness.

 Call, “Help!” If a second rescuer is available, send that person to activate EMS.

 Open the victim’s airway using the head tilt-chin lift or jaw thrust method.

 Look, listen, and feel for signs of adequate ventilation.

 B. If breathing is absent or inadequate; properly position the mask to achieve an effective air-tight seal while holding the airway open.

 Give two slow breaths (one second per breath), ensure adequate chest rise, and allow for exhalation between breaths.

 C. Check the victim’s carotid pulse and look for other signs of circulation.

 If the victim’s Pulse is present, continue rescue breathing at one breath every 3-5 seconds, or about 12-20 breaths per minute.

 If the rescuer is alone with the victim, rescue breath for two minutes and then activate EMS/call a Code.

 Child Foreign Body Airway Obstruction (Choking)

 If the choking child victim is conscious:

 . The rescuer asks, “Are you choking?” If the victim nods yes, the rescuer asks, “Can you speak?” If the victim nods no, the rescuer tells the victim that they are going to help.

. If a victim displays symptoms of poor or ineffective air exchange, give abdominal thrusts. This means sharp inward and upward thrusts against the diaphragm between the xyphoid process and umbilicus. This can be done with the victim standing, sitting or lying down, but only while conscious.

. Use chest thrusts for victims who are obese.

. Continue thrusts until airway is cleared or victim becomes unconscious.

 If the choking child victim becomes unconscious or is found unconscious:

 A. Establish unresponsiveness.

 Activate EMS/Call a Code.

 Open the victim’s airway using head tilt-chin lift or jaw thrust method. Look for the foreign body in the victim’s mouth. Do not perform a blind sweep.

 B. Give two breaths. If unable to ventilate: probable inadequate airway. Reposition the victim’s head and reattempt to ventilate.  If still unable to

Ventilate the victim: probable obstruction.

 C. If the child victim is unresponsive and has an obstructed airway, begin chest compressions at the rate of 100/minute at a ratio of 30:2 for one rescuer or 15:2 for two rescuers.

 Check the mouth after each round of compressions for foreign object prior to ventilations.

 AED use in the Child Victim: (one year old to puberty or 12-14 years of age)

 AED units may include both Adult electrode pads and Pediatric electrodes.

 Pediatric electrode pads will be smaller and may include a voltage regulator on the lead wires that prevent the child from receiving an adult shock. Some models have a “teddy bear” or a pink plug at the end of the cable that connects with the AED.  Note that there is no evidence that an adult shock harms the child heart.

 Pad placement depends on the size of the child:

 . Pads should be placed in the same position as with an adult—under the right clavicle to the right of the sternum and on the left chest below the nipple.

. UNLESS the child is so small that the pads are within one inch of each other in which case place the pads on the anterior chest over the sternum and on the posterior chest over the spine.

 . If pediatric electrodes are unavailable, use the adult pads as above.

 The AED sequence with the child is the same as with the adult. The EXCEPTION is that the AED is used AFTER two minutes of CPR, regardless of whether the arrest is witnessed or unwitnessed.

 Note that pediatric AED pads are not to be used on adults.  The lesser shock would not defibrillate the adult heart.

 INFANT

 (Birth to one year of age)

 One Rescuer Infant CPR

 A. Establish unresponsiveness.

 Call, “Help!” If second rescuer is available, send that person to activate EMS.

 Open the infant’s airway, using head tilt/chin lift or jaw thrust method.

 Look, listen, and feel for adequate breathing, while giving care to avoid over extending the infant’s head.

 B. Give two slow breaths (one second per breath), watching the chest rise with each breath.

 C. Check brachial pulse for 5 - 10 seconds.

 If there is no pulse or the pulse is less than 60/min with signs of poor perfusion, begin chest compressions at least 100/minute.

 Maintain the victim’s open airway by keeping a hand on the infant’s forehead.

 Begin chest compressions, using two finger technique, just one finger’s width below nipple line.

 Begin compressions at the rate of 100/min and ratio of 30 compressions to 2 breaths.

 After two minutes of CPR, 5 cycles of 30:2, if no help has arrived, activate EMS/call a Code.

 Two Rescuers Infant CPR

 First Rescuer:

 A. Establish unresponsiveness.

 Activate EMS by directing the second rescuer to call 911 or a Code.

 Open the victim’s airway, using head tilt/chin or jaw thrust method.

 Look, listen, and feel for adequate breathing.  Give care to avoid hyperextension of the head.

 B. Give two slow breaths (one second per breath), watching the chest rise with breaths. Allow for exhalation between breaths.

 C. Check the victim’s brachial pulse and look for other signs of circulation (breathing, coughing, or movement) for 5 - 10 seconds.

 The second rescuer finds the correct hand placement for chest compressions. Use two thumb-encircling hand compression technique, directly on the sternum just below the nipple line.

 If the victim has No pulse, the First Rescuer states, “No Pulse”.

 The Second Rescuer begins chest compressions at a minimum rate of 100/minute and depth of one half to one third of the size of the thorax.

 Infant two-rescuer CPR consists of cycles of 15 compressions/2 breaths.

 Recheck pulse after two minutes.  Rescuers may switch positions every two minutes.

 Rescue Breathing

 A. Establish unresponsiveness.

 Call, “Help!”  If second rescuer is available, send that person to activate EMS or call a code.

 Open the victim’s airway, using head tilt/chin lift or jaw thrust method.

 Look, listen, and feel for adequate breathing.

 B. If breathing is absent or inadequate, give two slow breaths (one second per breath), watching the chest rise with each breath.

 C. Check the infant’s brachial pulse.

 If the Pulse is present:

 Continue rescue breathing - one breath every 3-5 seconds, or about 12-20 breaths per minute.

 If the rescuer is alone with the respiratory arrest victim, activate EMS/call a Code after two minutes of rescue.

 Infant Foreign Body Airway Obstruction (Choking)

 Conscious choking infant:

 Confirm absent or ineffective air exchange (ineffective cough, no strong cry).

 Give five back blows, with head lower than body, infant face down.  The rescuer uses the heal of one hand at the base of the shoulder blades for back blows.

 Turn infant face up.

 If the obstruction is still present in the airway, give five chest thrusts using same finger position as for CPR chest compressions.

 Repeat steps until obstruction relieved or infant becomes unconscious.

 If the choking infant becomes Unconscious or is Found Unconscious

 A. Establish unresponsiveness.

 Call, “Help!” If second rescuer is available, send that person to activate EMS.

 Open the infant’s airway, using head tilt/chin lift or jaw thrust method.

 Look, listen, and feel for adequate breathing and for the foreign body. 

Do not attempt a blind finger sweep.

 B. Attempt two rescue breaths. If unable to ventilate and the chest does not rise, reposition head and reattempt to ventilate.

 If efforts to ventilate are unsuccessful and the chest does not rise, the rescuer concludes that the infant’s airway is still obstructed.

 C. Begin compressions for two minutes at 100/min and ratio of 30:2.

 Recheck mouth after each cycle of 30 compressions for foreign body and remove it, if seen.

 Special Considerations:

 Cricoid Pressure

 Cricoid pressure, or Sellick’s technique, is the application of pressure to the unresponsive victim’s cricoid cartilage.  The pressure pushes the trachea posteriorly, compressing the esophagus against the cervical vertebra. This is effective for preventing gastric inflation during ventilations, which then reduces the risk of vomiting and aspiration.

  Cricoid pressure requires an additional rescuer not involved in compressions or ventilation.

 . Locate the thyroid cartilage (Adam’s apple) with your index finger.

. Slide the index finger to the base of the thyroid cartilage and palpate the prominent horizontal ring below the thyroid cartilage—this is the cricoid cartilage.

. Use the tips of the thumb and index finger to apply firm backward pressure to the cricoid cartilage during inspiration.

 Jaw Thrust

 If the rescuer suspects a cervical or head spine injury, open the airway using a jaw thrust without head extension.  The head and neck must be immobilized to safeguard the spinal cord in traumatic neck and head injury cases.

 Perform the jaw thrust:

 . Place one hand on each side of the victim’s head, resting your elbows on the surface on which the victim is lying or, alternatively, place your thumbs on the victim’s cheekbones.

. Place two fingers under the angles of the victim’s lower jaw and gently, but firmly lift with the fingers of both hands, displacing the jaw forward.

. If the lips close, retract the lower lip with the thumbs.

. The rescuer should attempt ventilations, if indicated.

 Because maintaining a patent airway and providing adequate ventilation is a priority in CPR, use a head tilt-chin lift maneuver if the jaw thrust does not open the airway.

Agonal Gasps

Agonal gasps may happen in the first minutes after sudden cardiac arrest. Gasps are not adequate breathing and the rescuer must provide rescue breathing and, if indicated, compressions.

Recovery Position

Use the recovery position to manage unresponsive victims who have adequate breathing and no head or neck injury. When an unresponsive victim is

breathing spontaneously and adequately, the victim’s tongue, mucus, or vomitus may block the airway.  By placing the victim on his/her side, fluid can drain easily from the mouth to avoid these problems. The rescuer must still closely monitor the victim’s pulse and breathing while the victim is in the recovery position.

 The recovery position is not recommended for infants and small children as it may block the airway if the head is not adequately supported.

 Place the victim in the recovery position using the following steps:

 . Roll the victim to his/her side.

. Position the victim’s arms and head to maintain an open airway.

. Check the victim’s breathing often (look, listen and feel).

. If breathing stops, get the AED, roll the victim to his/her back and start CPR as indicated.   Revised 08/29/2006

2006                                                                                      CPR-CLASSES.COM

♥ One Rescuer CPR - ♥♥ Two Rescuer CPR             * In unconscious foreign body airway obstruction cases do CPR Compressions – CHECK Airway

FOR ADULTS                                                          KEEP THE BLOOD FLOWING!!

<10 seconds for Breathing Check (two slow breaths, if there is no breathing), 10 seconds for Pulse Check then 30 compressions (if there is no pulse or sign)

IN ALL CASES FOR ADULT UNRESPONSIVE CLINICALLY DEAD PEOPLE, ACTIVATE EMS – SEND FOR HELP NOW!!

FOR CHILDREN AND INFANTS: 30 Compressions and 2 Breaths - AIRWAY-----HEAD TILT/CHIN LIFT L BREATHING-----LOOK*LISTEN*FEEL 5-10 SECONDS CHECK CIRCULATION--5 to 10 SECONDS ON ALL PULSE CHECKS + SIGNS OF PRESENT CIRCULATION: MOVING - BREATHING – COUGHING IN RESPONSE TO RESCUE BREATHS -  FOR HEALTHCARE PROVIDERS: PULSE (<60 FOR INFANTS and CHILDREN) WITH SIGNS OF POOR CIRCULATION ► Start CPR   08/29/2006