BASIC LIFE SUPPORT (CARDIOPULMONARY RESUSCITATION) OBJECTIVES: After 5 hours of varied classroom activities, the Level II students ill

!e a!le to: "# define the follo in$ terms: "#" "#& "#( "#) "#5 "#* "#"#/ "#0 "#"" air a% artificial res'iration !asic life su''ort cardiac arrest cardioversion C+, crac.les defi!rillation e1ternal cardiac com'ression 4a thrust techni5ue

"#"2 3eimlich maneuver "#"& res'irator% arrest "#"( resuscitation "#") rhonchi "#"5 ventilation "#"* hee6in$ &# state the $eneral 'rinci'les of !reathin$ and circulation (# e1'lain the Circulation, Air a%, and Breathin$ of Basic Life Su''ort )# identif% the causes of cardiac and res'irator% arrest 5# enumerate si$ns and s%m'toms of cardiac and res'irator% arrest *# mention the methods of artificial res'iration -# discuss the follo in$: -#" indications and contraindications of C+, -#& techni5ue of e1ternal cardiac com'ression /# sho the ta!le of com'arison for 'erformin$ C+, in: /#" adult

/#& children /#( infant /#) 're$nant oman 0# determine a%s in chec.in$ the effectiveness of C+, "2# list $uidelines in 'erformin$ C+, ""# discuss the indications and ste's for: ""#" 3eimlich maneuver ""#& 4a thrust maneuver ""#( !ac. !lo s for infants ""#) chest thrust ""#5 fin$er s ee' "&# demonstrate the !e$innin$ s.ills in: "&#" one man rescuer C+, "&#& t o man rescuer C+, "&#( artificial res'iration

DEFINITION OF TERMS: o Airway It is a tu!ular 'assa$e for movement of air into and out of the lun$# It is

also an oro'har%n$eal tu!e used for mouth to mouth resuscitation#

o Artificial re !irati"# It is the use of cardio'ulmonar% resuscitation or the use of a mechanical device to !reath and 'um' !lood for a 'erson hen their !od% is not a!le to do so#

o Ba ic life $!!"rt It is an emer$enc% treatment of a victim of cardiac or res'irator% arrest throu$h cardio'ulmonar% resuscitation and emer$enc% cardiac care#

o Car%iac arre t It is a sudden cessation of cardiac out'ut and effective circulation# It is usuall% 'reci'itated !% ventricular fi!rillation, ventricular as%stole, deliver% of o1%$en and removal of car!on dio1ide sto's, tissue cells7 meta!olism !ecomes anaero!ic, meta!olic and res'irator% acidosis ensue#

o Car%i"&er i"# It is the restoration of the hearts normal sinus rh%thm throu$h an electric shoc. delivered !% defi!rillation# It is used to slo heart8s normal sinus rh%thm heart or to restore the hen dru$ thera'% is ineffective at doin$ so#

o CPR It is a !asic emer$enc% 'rocedure for life su''ort, consistin$ of artificial res'iration and manual e1ternal cardiac massa$e# It is used in cases of cardiac arrest to esta!lish effective circulation and ventilation to 'revent irreversi!le cere!ral dama$e resultin$ from ano1ia# E1ternal cardiac massa$e com'resses the heart !et een the lo er sternum and the thoracic verte!ral column# 9urin$ com'ressions, !lood is forced into s%stemic and 'ulmonar% circulation and venous !lood refills the heart hen the com'ression is released# :outh to mouth !reathin$ is a mechanical form of ventilation is used concomitantl% ith cardio'ulmonar% resuscitation to o1%$enate the !lood !ein$ 'um'ed throu$h the circulator% s%stem#

o Crac'le It is a common, a!normal res'irator% sound consistin$ of discontinuous !u!!lin$ noises heard u'on auscultation of the chest durin$ ins'iration#

o Defi(rillati"# It is the termination of ventricular fi!rillation or 'ulseless ventricular tach%cardia !% deliver% of an electric shoc. to the 'atients7 'recordium# It is a common emer$enc% measure $enerall% 'erformed !% a 'h%sician, s'eciall% trained nurse, or 'aramedic#

E)ter#al car%iac c"*!re

i"#

It is the action for treatin$ sudden cardiac arrest# It consists of rh%thmic administration of 'ressure on chest all#

o +ei*lic, *a#e$&er It is an emer$enc% 'rocedure of dislod$in$ a !olus of food or other o!structions from the trachea to 'revent as%'h%1iation# The cho.in$ 'erson is $ras'ed from !ehind !% the rescuer, hose fist, ith thum! side in, is 'laced 4ust !elo the victim7s 1i'hoid 'rocess ith the other hand 'laced firml% over the fist# The rescuer then 'ulls the fist firml% and

a!ru'tl% u' ard into the e'i$astrium, forcin$ the o!struction u' the trachea#

o -aw t,r$ t tec,#i.$e It is also called mandi!le thrust, anterior dis'lacement of mandi!le, and tri'le air a% maneuver# This 'rocedure should !e used hen the victim has sus'ected or confirmed s'inal cord trauma, since the nec. can !e su''orted and the air a% o'ened ith minimal movement, thus 'reventin$ further s'inal cord assault#

o Re !irat"ry arre t It can !e caused !% de'ression of the res'irator% center in the medulla

o!lon$ata or interference ith neuromuscular transmission to res'irator% muscles#

o Re $ citati"# It is the 'rocess of sustainin$ the vital function of a 'erson in res'irator%;cardiac failure hile revivin$ him;her, usin$ techni5ue of artificial res'iration and cardiac massa$e, correctin$ action !ase im!alance and treatin$ the cause of failure#

o R,"#c,i It is a lo 'itched sonorous sound caused !% mucus or other fluids movin$ around in the lar$e air a%s#

o /e#tilati"# It is the 'rocess !% hich $ases are moved into and out of lun$s#

o 0,ee1i#2 It is a form of rhonchi, characteri6ed !% a hi$h<'itched musical 5ualit%# It is caused !% a hi$h<velocit% flo of air throu$h a narro ed air a% and is heared durin$ !oth ins'iration and e1'iration#

3ENERAL PRINCIPLES OF BREAT+IN3 AND CIRCULATION "# Air that enters the lun$s contains a!out &"= of o1%$en and onl% trace amounts of car!on dio1ide# Air that is e1haled from the lun$s contains a!out &2= Car!on 9io1ide# &# The ri$ht side of the heart 'um's !lood to the lun$s, here !lood 'ic.s u' the o1%$en and releases them to the !od%# (# The o1%$enated !lood then returns to the left side of the heart, here it is 'um'ed to the tissue of the !od%# )# In the ca'illaries, the !lood releases o1%$en and ta.es in car!on dio1ide after hich it flo s !ac. to the ri$ht side of the heart# 5# All tissues re5uire o1%$en, !ut the !rain re5uires more o1%$en than an% other tissue#

*# >hen !reathin$ and circulation sto's, this is called ?Clinical 9eath@ Aafter 2<) minutes of sto' !reathin$ and circulation, !rain dama$e is not li.el%# 3o ever, )<* minutes ould result in 'ossi!le !rain dama$eB# -# >hen the !rain has !een de'rived of o1%$enated !lood for a 'eriod of * minutes or more, an irreversi!le dama$e ould 'ossi!l% occur, this is called ?Biolo$ical 9eath@, hich is over "2 minutes of o1%$en de'rivation to the !rain causes !rain dama$e# /# >hen !reathin$ sto's, the 'ulse and circulation ma% continue for some time, this is a condition .no n as ?,es'irator% Arrest#@ In this case, onl% rescue !reathin$ is re5uired since the heart action continues to circulate !lood to the !rain and to the rest of the !od%# 0# >hen circulation sto's, the 'ulse disa''ears and !reathin$ sto's at the same time soon thereafter# This is called ?Cardiac Arrest@# >hen cardiac arrest occurs, !oth rescue !reathin$ and chest com'ressions are re5uired to o1%$enate the !lood and circulate it to the !rain# T,e Circ$lati"#4 Airway4 a#% Breat,i#2 "f Ba ic Life S$!!"rt C+, is a 'rocedure that7s as sim'le as Circulation, Air a%, and Breathin$# Cirst, assess the victim# Tr% to $et a res'onse from the 'erson# Sha.e them $entl%, hile callin$, ?Are %ou o.a%@ If the 'erson isn7t res'onsive, activate the emer$enc% medical s%stem# Then !e$in in the CAB7s: Circulation, Air a%, and Breathin$# Continue C+, ithout sto''in$ until advanced life su''ort is availa!le# Circ$lati"#4 Airway4 a#% Breat,i#2 f"r A%$lt

C f"r CIRCULATION It is the movement of blood through the beating of the heart or the emergency measure of CPR. If the 'erson is trained to ta.e the 'ulse, it is 'erformed as follo s: chec. for 'ulse, 'lace %our fin$ers on the victim7s Adam7s a''le and slide them to the side until %ou find a $roove in the nec. a!ove the carotid arter%# Chec. for 'ulse for no more than "2 seconds# If there is no !reathin$, cou$hin$ or movement after the rescue !reaths !ut there is circulation, continue rescue !reathin$# Chec. for si$ns of circulation re$ularl%, the 'atient mi$ht fall into cardiac arrest at an% time# If there is no circulation: 'osition the hand !efore $ivin$ a C+,# The hand must !e 'laced t o fin$ers a a% from here the ri!s meet to$ether# If no circulation is detected, !e$in chest com'ressions# Correct 'osition for C+,: the arms are full% e1tended and the thrusts are $iven from the hi's, continue until there is: !reathin$, cou$hin$ or movement or other si$ns of circulation return# Common mista.es in 'erformin$ chest com'ressions include loo.in$ !ac. and forth and !endin$ the el!o s# It is im'ortant to note that, 'articularl% in elderl% 'atients, cre'itations Athe shatterin$ if !ones in the ri! ca$e and sternum hich can !e !oth heard and feltB ill often occur#

A f"r AIR0AY The protection and maintenance of the patients airway including the use of airway adjuncts such as an oral or nasal airway. If the 'erson is unres'onsive, o'en the !loc.ed air a%, 5uic. ins'ection of the mouth ma% reveal a !loc.ed air a%# If 'ossi!le, the 'atient should !e 'laced on his;her !ac. on a firm surface# The ne1t ste' is to $et a further vie of the mouth and throat, and to ma.e as much s'ace for !reathin$ as ma% !e 'ossi!le: In the 'ossi!ilit% of a nec. in4ur%, liftin$ the chin;4a

enou$h to sta!ili6e the air a%# In other cases, tiltin$ the head !ac. ill lift the ton$ue a a% from the !ac. of the mouth, o'enin$ the air a%#

If the victim has no head;nec. in4ur%, $entl% tilt the head !ac. !% liftin$ the chin ith one hand hile 'ushin$ do n on the forehead ith %our other hand# Once the air a% is o'en, lean over and 'ut %our ear close to the victim7s mouth# A"Bloo. at the chest for movement, A&Blisten for the sound of !reathin$, A(Bfeel for !reath on %our chee.# If the victim is !reathin$, roll the 'erson onto his or her side as a unit Athe recover% 'ositionB# If none of these si$ns is 'resent, the 'erson isn7t !reathin$# If o'enin$ the air a% doesn7t cause the 'erson to s'ontaneousl% start !reathin$, %ou7ll have to 'rovide rescue !reathin$# B f"r BREAT+IN3 The actual flow of air through respiration, natural, or artificial respiration often assisted by emergency o ygen. +ro'er chec.in$ of the 'atient7s res'iration: the hel'er listen to the !reath, tries to feel die air flo in$ on her chee., the chest $oin$ u' and do n and see the movements of the chest# After o'enin$ the victim7s air a%, !reathin$ effort is chec.ed# +lacin$ one7s chee. in front of the victim7s mouth Aa!out (<5 cm a a%B, hile loo.in$ at the chest of the 'atient should allo one to detect an% of the follo in$ si$ns: A"Bfeelin$ the airflo on the chee., A&Bhearin$ the airflo , A(Bfeelin$ the chest rise and fall, A)Bseein$ the chest rise and fall# If there is no !reathin$, artificial res'iration is commenced !ut if the 'erson is not !reathin$ normall%, $ive t o rescue !reaths# After deliverin$ t o !reaths, chec. for si$ns of circulation, such as !reathin$, cou$hin$, movement or res'onsiveness# Dee'in$ the head tilted, once a$ain 'lace %our ear near the mouth and listen, feel and loo. for si$ns of !reathin$ hile %ou atch for movement# The !est a% to $ive rescue !reathin$ is !% usin$ the mouth<to<mouth techni5ue: A"B usin$ the thum! and forefin$er of %our hand that7s on the victim7s forehead, 'inch the 'erson7s nose shut#

Be sure to .ee' the heel of %our hand in 'lace so the 'erson7s head remains tilted# Dee' %our other hand under the 'erson7s chin, liftin$ u', A&B as %ou .ee' an air<ti$ht seal ith %our mouth on the victim7s mouth, immediatel% $ive t o full !reaths#

Airway4 Breat,i#24 a#% Circ$lati"# f"r I#fa#t Airway f"r I#fa#t Cor infants and children, !e careful hen handlin$# 9on7t tilt the head !ac. too far# An infant7s nec. !ends so easil% that if the head is tilted !ac. too far, the !reathin$ 'assa$es ma% !e !loc.ed instead of o'ened# ,emem!er: is the victim unres'onsiveE If so, shout for hel', 'osition the child, and o'en the air a%#

Breat,i#2 f"r I#fa#t Cor an infant ho isn7t !reathin$, don7t tr% to 'inch the nose shut# Cover !oth the mouth and nose ith %our mouth and !reathe slo l% A"#2 to "#5 seconds 'er !reathB# Fse enou$h volume and 'ressure to ma.e the chest rise# >ith a small child, 'inch the nose, cover the mouth, and !reathe the same as for infant# ,emem!er: Chec. for !reathin$# If there7s no !reathin$, $ive & full !reaths# Loo. for chest rise, listen for sounds of !reathin$, feel !reath on %our chee.# Circ$lati"# f"r I#fa#t Cor infants, chec. for a 'ulse !% feelin$ on the inside of the u''er arm

mid a% !et een the el!o and the shoulder# Chec. for the 'ulse in a small child the same a% %ou ould in an adult# Cor chest com'ression in infants and small children, use onl% one hand# Gou can sli' %our other hand under the !ac. of an infant to $ive firm su''ort# Cor infants, use onl% the ti's of the middle and rin$ fin$ers to com'ress the chest at the sternum# 9e'ress the sternum !et een H to " inch at a rate of at least "22 times a minute# Cor small children, use onl% the heel of one hand# 9e'ress the sternum !et een " and " H inches, de'endin$ on the child7s si6e# The rate should !e /2 to "22 times a minute# In the case of !oth infants and small children, $ive !reaths durin$ a 'ause after ever% fifth chest com'ression# ,emem!er: If the victim still isn7t !reathin$, attem't to chec. the carotid 'ulse for a fe seconds# If there7s no 'ulse or %ou can7t locate the 'ulse and the child is still unres'onsive, !e$in " minute of C+,# Then send someone to activate the local emer$enc% num!er hile %ou 'erform C+,# Continue to do C+, until hel' arrives#

CAUSES OF RESPIRATORY ARREST: O!struction or !loc.in$ is one of the causes of res'irator% arrest# Anatomical o!struction occurs hen a ton$ue o!structs the 'har%n1 and eventuall% dro's !ac.# :echanical o!structions is defined hen a forei$n o!4ect lod$es into the 'har%n1, and hen there is fluid stimulation in the !ac. of the throat# Other causes of res'irator% arrest include diseases such as dru$ 'oisonin$, in hich the res'irator% center of the !rain !ecomes de'ressed if one overdoses on narcotic dru$s# Common s%m'toms of narcotic dru$s include ea. 'ulse, ver% rela1ed muscles, cold and clamm% s.in, and dee' slee'#

9ro nin$ is a form of suffocation# The air su''l% to the lun$s is sto''ed !% ater or s'asm of the lar%n1# 3an$in$, 'lanned or accidental, !loc.s the air 'assa$e and leads to res'irator% and cardio'ulmonar% arrest# +ressure on the throat should !e removed at once and a''ro'riate first aid care rendered as needed# Ias 'oisonin$ most t%'icall% involves car!on mono1ide 'oisonin$# It is created !% the incom'lete com!ustion of fossil fuels# The immediate first aid is to remove the source of 'oisonous $as, and institution of artificial res'iration# Asthma and e'i$lotitis are also other causes of res'irator% arrest#

CAUSES OF CARDIAC ARREST A cardiac arrest is the cessation of cardiac functionin$ herein the heart sto's !eatin$# Often a cardiac arrest is une1'ected and sudden# >hen it occurs, the heart no lon$er 'um's !lood to an% of the or$ans of the !od%# Breathin$ then sto's, and the 'erson !ecomes unconscious and lim'# >ithin &2 to )2 seconds of cardiac arrest, the victim is clinicall% dead# After ) to * minutes, the lac. of o1%$en su''l% to the !rain causes 'ermanent and e1tensive dama$e# Ventricular fi!rillation is a ra'id, irre$ular heart rh%thm 'reventin$ an% circulation of !lood# It is also the dramatic slo in$ of heart rate due to failure of its 'acema.er to 'ro'erl% function or severe heart !loc.# Electrocution, 3%'othermia, sudden loss of !lood 'ressure, ischemic heart disease, arteriosclerosis, h%'er.alemia, h%'o.alemia, ta!lets of to1ins, and m%ocardial infection are also factors causin$ cardiac arrest# The most common si$ns of a heart attac. is a sensation of s5uee6in$, 'ain, fullness, or 'ressure in the center of the chest#

Cardiac arrest can result from man% causes, such as m%ocardial infarction and coronar% throm!osis# These sto' the effectiveness of heart action# Cardiac arrest is also a cause of cardiac in4ur%# It is most commonl% caused !% a ea'on, !ut could also result from chest trauma, as incurred in an automo!ile accident# SI3NS AND SYMPTOMS OF RESPIRATORY ARREST A res'irator% arrest or a 'ulmonar% arrest is the cessation of !reathin$# It often occurs as a result of a !loc.ed air a%, !ut it can occur follo in$ a cardiac arrest and for other reasons# A res'irator% arrest is 'receded !% short, shallo !reathin$# The !reathin$ !ecomes increasin$l% la!ored# Then the 'erson !ecomes flushed and disoriented and e1'eriences feelin$ of suffocation#

SI3NS AND SYMPTOMS OF CARDIAC ARREST The three cardinal si$ns of a cardiac arrest are a'nea, or the tem'orar% cessation of !reathin$, a!sence of a carotid or femoral 'ulse, and dilated 'u'ils# The 'erson7s s.in a''ears 'ale or $ra%ish and feels cool# C%anosis is evident hen res'irator% function fails !efore heart failure occurs# Other si$ns include: sudden unconsciousness, uno!taina!le !lood 'ressure, a!sence of heart!eat, and an unres'onsive 'atient#

MET+ODS OF ARTIFICIAL RESPIRATION ARTIFICIAL /ENTILATION 9urin$ res'irator% arrest, %ou must 'rovide o1%$en ithin ) to * minutes, or !iolo$ical death ill follo # Gou can restore the o1%$en su''l% !% e1halin$ into the victim7s mouth, nose, or tracheal stoma# These 'rocedures can !e used for an% victim, ith a''ro'riate modification for the 'atient7s si6e, a$e, and res'irator% rate# M"$t,5t"5M"$t, /e#tilati"#

Gou can restore o1%$enation throu$h mouth<to<mouth ventilation !% inflatin$ the victim7s lun$s ith e1haled air# To do so, %ou dou!le %our tidal volume !% ta.in$ dee' !reaths and e1hale directl% into the victim7s mouth# E1haled air 'rovides a!out "/= o1%$en and &= car!on dio1ide, sufficient to achieve an artificial o1%$en tension of !et een 52 to *2 torr# M"$t,5t"5N" e /e#tilati"#

These are situations in hich mouth<to<mouth ventilation cannot !e 'erformed# These include trismus, or involuntar% contractions of the 4a muscles, and traumatic 4a or mouth in4ur%# There are also times hen it is difficult to maintain a ti$ht seal ith the li's usin$ the mouth<to<mouth

method# In these situations, mouth<to<nose ventilation should !e 'erformed# M"$t,5t"5St"*a /e#tilati"#

Gou can ventilate 'atients ith tracheostomies or lar%n$ectomies directl% throu$h the stoma or tu!e# These 'atients can !e identified !% an o!vious stoma, tracheostom%, or lar%n$ectom% tu!e in 'lace# Some 'atients ear a :edic Alert ta$ or !racelet that tells %ou a stoma is 'resent# If no chest e1'ansion occurs, %ou should loo. for 'rescence of the stoma#

I#%icati"# "f CPR +eo'le ho are unconscious or have colla'sed +eo'le ith cardiac or res'irator% arrest to hel' start or induce s'ontaneous !reathin$ or heart !eat that has !een 'reviousl% sto''ed# +eo'le ith im'aired $as e1chan$e due to air a% o!struction Cailure of chest to rise and fall durin$ res'iration# A!sence of 'ulse u'on 'al'ation of victim7s carotid arter% +eo'le ho have dro ned and remain unconscious and unres'onsive +eo'le ho !ecome unconscious from 'reviousl% cho.in$ from an%thin$ that has o!structed their air a%#

C"#trai#%icati"# "f CPR +atient7s +atient7s ith cervical in4ur% to 'revent the 'ossi!ilit% of creatin$ ith fracture in sternum, ri!s or thoracic !one to 'revent ithin the further dama$e to the fractures alread% 'resent# 'uncturin$ or laceratin$ an% of the visceral or$ans thoracic cavit% or a!domen# +atient7s ith s'inal in4ur%# If the 'h%sician has an order 9J, A9o Jot ,esuscitateB for the 'atient Victims ho is unres'onsive to avoid an% le$al im'lications and ith severe crushin$ in4uries to face and nec. cannot have ould further com'licate an% res'ect 'atient ri$hts# mechanical ventilation 'erformed as it in4uries that ere alread% 'resent# +eo'le ho are conscious# >hen the 'atient is announced dead as noted or said !% the 'h%sician 'resent mortis# Tec,#i.$e f"r e)ter#al car%iac c"*!re i"# ith indicators or evidence such findin$s as ri$or

"# +osition the victim in a su'ine or firm surface# &# Elevate the le$s (2 to )2 de$rees A>ood ard :aneuverB for 5 to "5 seconds to initiate s'ontaneous cardiac activit%# (# E1'ose the victim7s chest so that he or she can identif% the correct hand 'osition# )# The rescuer should choose a 'osition close to the victim7s u''er chest so that the ei$ht of the !od% can !e used for com'ression# 5# The rescuer should ne1t identif% the lo er third of the sternum, as this is the 'oint here ventricles are most effectivel% com'ressed !et een the sternum and the thoracic s'ine# *# The rescuer can locate the distal ti' of the 1%'hoid 'rocess in t o a%s: A# The rescuer mar.s this 'oint ith three fin$ers on one hand,

hile 'lacin$ the heel of the other hand on to' of the hand, interloc.in$ them, on the sternum ith el!o s strai$ht# B# The rescuer identifies the lo er mar$in of the 'ortion of the victim7s ri! ca$e that is closest to the rescuer and to 'al'ate the ri! ca$e to the midline to locate the notch here the ri!s meet the sternum# The rescuer 'laces t o fin$ers on the 4unction, and the heel of the other hand 'ro1imal to the fin$er# Once he or she o!tains the landmar., the rescuer 'laces the other hand on to' of the hand on the sternum and interloc.s them# -# The rescuer accom'lishes ECC ith ei$ht of the !od% e1ertin$ force on the outstretched arms, el!o s held strai$ht# The rescuer should .ee' the shoulders over the victim and use a roc.in$ motion from the hi's to create do n ard 'ressure# /# The rescuer should a''l% com'ression re$ularl%, rh%thmicall%, and ithout !ouncin$#

INDICATIONS AND STEPS IN PERFORMIN3: +ei*lic, Ma#e$&er Indications: Cho.in$ adults

Cho.in$ children

Ste's: To 'erform the 3eimlich maneuver on a conscious 'erson ho is standin$ or sittin$:

"# Stand !ehind the 'erson and ra' %our arms around his or her aist# &# :a.e a fist ith one hand, tuc. the thum! inside the fist, and 'lace the fle1ed thum! a$ainst the 'erson7s e'i$astrium, i#e#, !elo the 1i'hoid 'rocess# A 'rotrudin$ thum! could inflict in4ur%# (# >ith the other hand, $ras' the fist and 'ress it into the 'erson7s a!domen ith a firm, 5uic. u' ard thrust# Avoid ti$htenin$ %our arms around the ri! ca$e, and thrust it in the direction of %our chin# 9eliver one 5uic. thrust# )# 9eliver successive thrusts as se'arate and com'lete movements# ,e'eat the 'rocess until o!struction is removed or the victim loses consciousness# 5# If the 'erson !ecomes unres'onsive, the rescuer should move the 'erson to the $round, activate the Emer$enc% :edical Services AE:SB S%stem, and !e$in C+,# *# If the 'erson is conscious and alone durin$ the incident, the% can attem't to dislod$e the forei$n !od% ith self< administered a!dominal thrusts, 'erformed !% 'ressin$ his or her first into the a!domen or 'ushin$ the a!domen a$ainst a firm surface such as a counter to', sin., chair !ac., railin$, or ta!le to'# To 'erform the 3eimlich maneuver on an unconscious 'erson ho is l%in$ on the $round: "# +lace the 'erson su'ine, and .neel, 'refera!l% astride or to the side of the 'erson7s thi$hs# &# +lace the heel of one hand sli$htl% a!ove the 'erson7s navel and

ell !elo

the ti' of the 1i'hoid 'rocess, i#e#, in the e'i$astric area#

(# +lace other hand directl% on to' of the first# :a.e sure shoulders are over the 'erson7s a!domen and el!o s are strai$ht# )# +ress the heel of the first hand into the a!domen ith a 5uic. u' ard thrust# Be sure to direct the thrust in the midline of the a!domen, not to the left or ri$ht# The ei$ht of the shoulders and trun. su''lies 'o er for the thrust# 5# If the 'erson !ecomes unres'onsive, the rescuer should move the 'erson to the $round, activate the Emer$enc% :edical Services AE:SB S%stem, and !e$in C+,#

-aw5T,r$ t Ma#e$&er Indications: A 'erson ho has or is sus'ected of havin$ a s'inal in4ur% A 'erson ho has or is sus'ected of havin$ a nec. in4ur%

Ste's: "# +lace one hand on each side of the victim7s head, restin$ %our el!o s on the surface on hich the victim is l%in$# &# Ira! the an$les of the victim7s lo er 4a , and lift ith !oth hands# If the li's close, retract the lo er li' ith one thum!# (# If mouth<to<mouth !reathin$ is necessar% hile maintainin$ the 4a thrust maneuver, close the victim7s nostrils !% 'lacin$ chee. ti$htl%

a$ainst them#

Bac' Bl"w a#% C,e t T,r$ t

Indications: Ste's: "# Straddle the infant over one arm ith his or her face do n and lo er the trun. at a!out a si1t% de$ree an$le# Cradle the infant7s head and nec. in one hand, and rest forearm on %our for su''ort# &# Fsin$ the heel of the other hand, deliver as man% as five !ac. !lo s ra'idl% and forcefull% !et een the shoulder !lades# (# >hile su''ortin$ the infant7s head, sand ich her or his !od% !et een hands, then turn onto the !ac., .ee'in$ the head lo er than the trun.# La% the infant on one thi$h or over the entire la'# )# +osition the middle and rin$ fin$ers of the other hand on the lo er third of the infant7s sternum, a''ro1imatel% one fin$er7s !readth Cho.in$ infants

!elo

an ima$inar% line dra n !et een the ni''les# 9eliver as

man% as five 5uic. chest thrusts, thrustin$ strai$ht !ac.# 5# ,e'eat the c%cle of !ac. !lo s and chest thrusts until the o!4ect is e1'elled or the infant !ecomes unconscious# *# If the infant !ecomes unconscious, use a $entle ton$ue<4a ith one little fin$er# Attem't rescue !reathin$# -# If the infant7s chest does not rise and fall, 'erform !ac. !lo s and chest thrusts as descri!ed# Continue the se5uence of ste's listed a!ove# Fi#2er Swee! Indications: lift to o'en the mouth# If an o!structin$ o!4ect can !e seen, s ee' it out

A victim

ho is unres'onsive or unconscious ith com'lete CBAO

ACorei$n Bod% Air a% O!structionB Ste's: "# O'en the mouth !% $ras'in$ the ton$ue and lo er 4a thum! and fin$ers and liftin$ the 4a a a% from the !ac. of the throat# &# ,emove solid material !% insertin$ the inde1 fin$er of the free hand alon$ the inside of the 'erson7s chee. and dee' into the throat# >ith one fin$er hoo.ed, use a s ee'in$ motion to tr% to dislod$e and lift out the forei$n material# (# Clear out li5uid material such as mucus, !lood, and emesis, ith a !et een u' ard# This 'ulls the ton$ue

scoo'in$ motion, usin$ t o fin$ers ra''ed ith a tissue or a 'iece of cloth#

Si2# t,at I#%icate Effecti&e CPR The rescuer is a!le to see the victim7s chest rise durin$ the inter'osed ventilations and feel a carotid 'ulse# 9ilated 'u'ils of the e%es ill !e$in to constrict as an indication that the victim7s vision is focused# S.in color im'roves from its 'revious 'ale condition or ill !e$in to return to its ori$inal tone# 3eart!eat returns s'ontaneousl% S'ontaneous $as'in$ res'onse is seen to facilitate the need to inta.e more air for the victim Victim !ecomes conscious +resence of a 'ulse is felt u'on 'al'ation of the victim7s carotid arter% ,es'irations continue to occur

Si2# w,e# t" t"! CPR S < S'ontaneous circulation occurs in res'onse to mechanical ventilationK !reathin$ and 'ulse return T < Turn over to the 'h%sician O< O'erator has $otten tired and e1hausted P< +h%sician has declared the victim dead

3$i%eli#e i# !erf"r*i#2 CPR "# C+, should not !e interru'ted for more than 5 seconds, e1ce't for endotracheal intu!ation or for movin$ a victim# In these cases, the interru'tion should not e1ceed "5 seconds &# Interru'tions should !e smooth, re$ular and uninterru'ted (# Victim should !e sta!ili6ed !efore trans'ortation to a more convenient site# )# The shoulders of the rescuer should !e com'letel% released after each com'ression# 5# The 'ressure on the chest should !e 'laced directl% a!ove the victim7s sternum to 'rovide the most effective thrusts# *# The sternum should !e de'ressed to the correct de$ree accordin$ to the si6e and a$e of the victim# -# The 1i'hoid 'rocess should not !e com'ressed !ecause of the dan$er of laceratin$ the liver from the !one fra$ments of a !ro.en or fractured 1i'hoid 'rocess# /# Iastric distention should not !e relieved durin$ C+, unless it !ecomes so severe that it interferes ith ventilation# 0# C+, is used onl% in cases of sudden cardiac arrest, res'irator% arrest, or !oth# "2# Cirst aid $iver must .no doin$ com'ression# the 'ro'er 'ositionin$ of the hand u'on

""# +lace 'atient on a flat surface to facilitate the 'ro'er of C+,#

'erformance

"&# Avoid com'ressin$ the chest too dee'l% to 'revent the 'ossi!ilit% of fracturin$ the !ones that are affected durin$ chest com'ressions#

BE3INNIN3 S6ILLS: 78 O#e5*a# CPR i# a%$lt 9 c,il%re# Bef"re y"$ (e2i# Assess the situation !efore startin$ C+,:

"# "#Is the 'erson conscious or unconsciousE

&# If the 'erson a''ears unconscious, ta' or sha.e his or her shoulder and as. loudl%, LAre %ou ODE@

(# If the 'erson doesnMt res'ond and t o 'eo'le are availa!le, one should call 0"" or the local emer$enc% num!er and one should !e$in C+,# If %ou are alone and have immediate access to a tele'hone, call 0"" !efore !e$innin$ C+, N unless %ou thin. the 'erson has !ecome unres'onsive !ecause of suffocation Asuch as from dro nin$B# In this s'ecial case, !e$in C+, for one minute and then call 0""#

)# If an AE9 is immediatel% availa!le, deliver one shoc. if advised !%

the device, then !e$in C+,

Re*e*(er t,e CAB Thin. CAB N Circulation, Breathin$ and Air a% N to remem!er the ste's e1'lained !elo #

CIRCULATION: Re t"re (l""% circ$lati"# wit, c,e t c"*!re

i"#

"# +lace the heel of one hand over the center of the 'ersonMs chest, !et een the ni''les# +lace %our other hand on to' of the first hand# Dee' %our el!o s strai$ht and 'osition %our shoulders directl% a!ove %our hands# &# Fse %our u''er !od% ei$ht Anot 4ust %our armsB as %ou 'ush strai$ht do n on Acom'ressB the chest & inches Aa''ro1imatel% 5 centimetersB# +ush hard and 'ush fast N $ive t o com'ressions 'er second, or a!out "&2 com'ressions 'er minute# (# After (2 com'ressions, tilt the head !ac. and lift the chin u' to o'en the air a%# +re'are to $ive t o rescue !reaths# +inch the nose shut and !reathe into the mouth for one second# If the chest rises, $ive a second rescue !reath# If the chest doesnMt rise, re'eat the head<tilt, chin<lift maneuver and then $ive the second rescue !reath# ThatMs one c%cle# If someone else is availa!le, as. that 'erson to $ive t o !reaths after %ou do (2 com'ressions#

)# If the 'erson has not !e$un movin$ after five c%cles Aa!out t o minutesB and an automatic e1ternal defi!rillator AAE9B is availa!le,

a''l% it and follo

the 'rom'ts# The American 3eart Association

recommends administerin$ one shoc., then resumin$ C+, N startin$ ith chest com'ressions N for t o more minutes !efore administerin$ a second shoc.# If %ouMre not trained to use an AE9, a 0"" o'erator ma% !e a!le to $uide %ou in its use# Trained staff at man% 'u!lic 'laces are also a!le to 'rovide and use an AE9# Fse 'ediatric 'ads, if availa!le, for children a$es " to /# 9o not use an AE9 for infants %oun$er than a$e "# If an AE9 isnMt availa!le, Continue C+, until there are si$ns of movement or until emer$enc% medical 'ersonnel ta.e over#

AIR0AY: Clear t,e airway

"# +ut the 'erson on his or her !ac. on a firm surface# &# Dneel ne1t to the 'ersonMs nec. and shoulders# (# O'en the 'ersonMs air a% usin$ the head<tilt, chin<lift maneuver# +ut %our 'alm on the 'ersonMs forehead and $entl% tilt the head !ac.# Then ith the other hand, $entl% lift the chin for ard to o'en the air a%# )# Chec. for normal !reathin$, ta.in$ no more than five or "2 seconds: Loo. for chest motion, listen for !reath sounds, and feel for the 'ersonMs !reath on %our chee. and ear# Ias'in$ is not considered to !e normal !reathin$# If the 'erson isnMt !reathin$ normall% and %ou are trained in C+,, !e$in mouth<to<mouth !reathin$# If %ou !elieve the 'erson is unconscious from a heart attac. and %ou havenMt !een trained in emer$enc% 'rocedures, s.i' mouth<to<mouth rescue !reathin$ and 'roceed directl% to chest com'ression#

BREAT+IN3: Breat,e f"r t,e !er "# ,escue !reathin$ can !e mouth<to<mouth !reathin$ or mouth<to<nose !reathin$ if the mouth is seriousl% in4ured or canMt !e o'ened#

"# >ith the air a% o'en Ausin$ the head<tilt, chin<lift maneuverB 'inch the nostrils shut for mouth<to<mouth !reathin$ and cover the 'ersonMs mouth ith %ours, ma.in$ a seal# &# +re'are to $ive t o rescue !reaths# Iive the first rescue !reath N lastin$ one second N and atch to see if the chest rises# If it does rise, $ive the second !reath# If the chest doesnMt rise, re'eat the head<tilt, chin<lift maneuver and then $ive the second !reath# (# Be$in chest com'ressions to restore circulation # :8 O#e5*a# CPR i# I#fa#t "# Surve% the scene a# If scene is safe, a''roach the victim;s# !# If scene is not safe, !rin$ the victim;s and !%standers to a safe 'lace# &# Inform the infant7s $uardian, ?I can see that %our;the !a!% is unconscious#@ Introduce %ourself Astate %our name and inform that %ou are a trained rescuerB to the victim and as. consent to hel'# a# If consent is $iven, ta.e the infant from the $uardian# +lace infant in a smooth, hard and flat surface in su'ine 'osition# !# If consent is not $iven, e1'lain to the $uardian the need to hel' the infant# Sta% ith the infant until the $uardian $ives %ou consent to hel'# (# Assess the infant7s consciousness !% tic.lin$ the sole of the infant7s foot# O!serve if the infant is !reathin$# If infant does not res'ond

and has no !reathin$, activate Emer$enc% :edical S%stem AE:SB# As. the infant7s $uardian or an% !%stander to call the emer$enc% hotline in the local area for an am!ulance# State to the infant7s $uardian or !%stander to tell the emer$enc% res'onders to !rin$ infant Ba$<Valve :as. ABV:B and :anual;Automated E1ternal 9efi!rillator AAE9B# State also the s'ecific location of the infant, num!er of casualties, the situation, and to leave the infant7s $uardian7s or the !%stander7s com'lete name and contact num!er to the emer$enc% res'onders in case or return call# Instruct also to dro' the call last# )# Chec. the !rachial 'ulse at the inner as'ect of the infant7s u''er arm usin$ t o or more fin$ers Ae1ce't the thum!B of one hand for a minimum of 5 and ma1imum of "2 seconds# a# If infant has no 'ulse and no !reathin$, 'erform C+,# !# If infant has 'ulse !ut no !reathin$, 'erform rescue !reathin$# c# If infant has 'ulse and has !reathin$, 'lace infant in recover% 'osition# 5# C+,: " c%cle of C+, consists of (2 chest com'ressions and & !reaths for !oth one<man and t o<man rescue# +erform 5 c%cles of C+, ithin & min# Aa''ro1imatel% &) seconds;c%cleB# After 5 c%cles of C+,, loo., listen and feel for !reathin$ and chec. !rachial 'ulse for a minimum of 5 and ma1imum of "2 seconds# a# Chest Com'ressions: Fse t o fin$ers Arin$ and middle fin$er of one handB# Locate chest com'ression site, one fin$er!readth !elo the ima$inar% ni''le line# Su''ort the infant7s head ith the other hand# Com'ress to a de'th of ";( to ";& of the infant7s chest and at a rate of at least "22com'ressions;minute# 9o not 'ause !et een com'ressions# ,elease the 'ressure on the infant7s chest

com'letel% ithout lettin$ the rescuer7s fin$ers lose contact ith the infant7s chest# After ever% c%cle of A(2B chest com'ressions, $ive & !reaths# !# Breaths: O'en infant7s air a% usin$ head<tilt, chin<lift maneuver in neutral 'osition# Iive !reaths usin$ mouth<to< mouth<and<nose ventilation, o'en %our mouth ide enou$h to cover the infant7s mouth and nose, and do not allo e1haled air to esca'e# +rovide a $entle !lo in ever% !reath, enou$h to ma.e the victim7s chest $entl% rise, forceful !reaths ma% cause victim7s stomach to inflate instead of air $oin$ to the lun$s, the air inside the rescuer7s mouth is enou$h for the infant# Loo. at infant7s chest and 'lace %our chee. near the infant7s mouth and nose after ever% !lo to see if there is chest rise and fall and to listen and feel for !reathin$# After $ivin$ & !reaths, 'erform another c%cle of chest com'ressions# *# ,escue !reathin$: Iive )2 rescue !reaths ithin & minutes, one !reath ever% ( seconds# After $ivin$ )2 rescue !reaths, chec. infant7s 'ulse and !reathin$# a# If infant has 'ulse and has !reathin$, 'lace infant in recover% 'osition A!ur'in$B# Su''ort the !ac. of life of the infant7s head restin$ on the rescuer7s shoulder# Collo <u' E:S# !# If E:S arrives, endorse the victim to them, tell them the situation, the interventions done, then let them ta.e over# ;8 Tw"5*a# CPR i# A%$lt 9 C,il%re# "# ,escuer7s role: Cirst rescuer 'erforms (2 chest com'ressions, hile second rescuer $ives & !reaths usin$ BV:: ,escuer 'ositions him;herself

neat the victim7s head, .neel ith victim7s head !et een rescuer7s le$s# +lace the mas. of the BV: over the victim7s mouth and nose usin$ the C<E method, thum! and 'ointin$ fin$er of one hand formin$ a C over the mas., not allo in$ air to esca'e, hile the ( remainin$ fin$ers formin$ an E to lift the !od% 'art of the victim7s chin# ,escuers should s itch roles after & minutes to 'revent fati$ue# &# ,escuers s itch roles ith minimal interru'tions, it should not ta.e lon$er than 5 seconds# Second rescuer 'erforms chest com'ressions, hile first rescuer $ives !reaths usin$ BV:# (# After &<man C+,, first rescuer chec.s victim7s 'ulse and !reathin$# a# If victim has 'ulse and has !reathin$, 'lace victim in recover% 'osition Aside l%in$B# ,aise the victim7s arm near the rescuer over the victim7s head# Cross the victim7s arm a a% from the rescuer to the victim7s 'ro1imal shoulder# Cross the distal le$ of the victim7s 'ro1imal le$# Su''ort the victim7s distal shoulder and distal hi's then lo$ roll the victim to ards the rescuer# Collo <u' E:S# !# If E:S arrives, endorse the victim to them, tell them the situation, the interventions done, then let them ta.e over# <8 Tw"5*a# CPR i# I#fa#t "# ,escuer7s ,ole: Cirst rescuer 'erforms "5 chest com'ressions# >hile second rescuer $ives & !reaths usin$ BV:: ,escuer 'ositions him;herself near the infant7s head# +lace the mas. of the BV: over the infant7s mouth and nose usin$ the C<E method, thum! and 'ointin$ fin$er of one hand formin$ a C over the mas., not allo in$ air to esca'e, hile the ( remainin$ fin$ers formin$ an E to lift the !od% 'art of the infant7s chin# ,escuers should s itch roles after & minutes to 'revent fati$ue#

&# ,escuers s itch roles ith minimal interru'tions, it should not ta.e lon$er than 5 seconds# Second rescuer 'erforms chest com'ressions, hile the first rescuer $ives !reaths usin$ BV:# (# After &<man C+,, first rescuer chec.s infant7s 'ulse and !reathin$# a# If infant has 'ulse and has !reathin$, 'lace infant in recover% 'osition A!ur'in$B# Su''ort the !ac. of life of the infant7s head restin$ on the rescuer7s shoulder# Collo <u' E:S# !# If E:S arrives, endorse the victim to them, tell them the situation, the interventions done, then let them ta.e over#

BIBLIO3RAP+Y +otter and +err%# !asic "ursing Practice #nd edition,'# /)&</)5 :ars, Bri$itte# "atural $irst %id, ''# 5<"2 >illiams, Li''incott# &anual of "ursing Practice 'th edition, ''"2**< "2*-, "((*<"((/ ,am!o, Beverl% J, Lucile ># "ursing ()ills for Clinical Practice, '' 55(<5*2 Do6ier, Bar!ara, Ilenora E# $undamentals of "ursing Concepts and Procedures, *rd edition, ''# -)2, "(("<"((0 Dheisl, Carol ,en, Sue Ann A# %dult +ealth "ursing, % !iophsychosocial %pproach, ''# (*-, (*0<(-" Le is, Luverne >, Bar!ara T# $undalmental ()ills and Concepts in Patient Care, -th edition,''# *((<*)( Ta%lor, Cillis, and Cemone# $undamental of "ursing, The %rt and (cience of "ursign Care Brent 3, 9aniel L, Jose'h :# %n Introduction to $irst %id, '# -0 :os!% Elsvier, &osby.s Poc)et /ictionary of &edicine, "using and +ealth Professions 0th edition >ei$el, et al# %dvanced 1mergency Care for Paramedic Practice, '# -*2