check for D anger

S end for help

check R Esponse
give C PR
check A irways
check for B reathing
apply a D efibrillator
Check for Danger
(Hazards/Risks/Safety?)
to you
to others
to casualty

For example; electrical wires,

gases, aggressive relatives,
water, etc.

Remove yourself and the

casualty to an area of safety
Check the casualty for a response.

Use the COWS Method

C an you hear me?
O pen your eyes
W hat is your name?
S queeze my hand

Gently squeeze shoulders

(i.e. the trapezoid muscle)

If casualty is unresponsive call for

help.
 Call 911 for
Metro Manila,

Image: betsyweber
If no signs of life unconscious, not
breathing and not moving,
start CPR (cardiopulmonary
resuscitation)

CPR involves giving;

30 compression and 2 breaths
100-120 compressions per minute

(useful tunes for compression rate

are Staying Alive by the Bee Gees,
Another one Bites the Dust to name a The recommended point of
few) compresions is the midline over
the lower half of the sternum.
Remember to push hard and fast,
straight arms.

Revival checks conducted

every 2 minutes
(look for pulse & signs of life)

Should swap person doing

compressions every 2min (so they
dont become tired and perform
ineffective compressions)
Doing CPR on Infants
use two fingers instead of using hands to You should check
deliver compressions.
for vital signs every
Give 30 compression & 2 breaths 2 minutes.
100-120 compressions per minute

CPR should continue until the

when delivering breaths do not overdo the
amount, as you may cause a lung to rupture. return of spontaneous
circulation or you are relieved
by a qualified professional.
FAST CPR
 RATE
2015 (Updated): In adult victims of cardiac
arrest, it is reasonable for rescuers to
perform chest compressions at a rate of 100
to 120/min

2010 (Old): It is reasonable for lay rescuers

and HCPs to perform chest compressions at a
rate of at least 100/min.
 Updates 2015: Emphasis on Chest
Compressions

1. Untrained lay rescuers should provide

compression-only (Hands-Only) CPR

2. In addition, if the trained lay rescuer is able to

perform rescue breaths, he or she should add rescue
breaths in a ratio of 30 compressions to 2 breaths.

3. The rescuer should continue CPR until an AED

arrives and is ready for use, EMS providers take
over care of the victim, or the victim starts to move.
RATE
2015 (Updated): In adult victims of cardiac
arrest, it is reasonable for rescuers to
perform chest compressions at a rate of 100
to 120/min

2010 (Old): It is reasonable for lay rescuers

and HCPs to perform chest compressions at a
rate of at least 100/min.
 CHEST COMPRESSION

2015 (Updated): During manual CPR, rescuers

should perform chest compressions to a depth of
at least 2 inches (5 cm) for an average adult, while
avoiding excessive chest compression depths
(greater than 2.4 inches [6 cm]).

2010 (Old): The adult sternum should be

depressed at least 2 inches (5 cm).
 WHY ?
The number of chest compressions delivered per
minute during CPR is an important determinant of
return of spontaneous circulation (ROSC) and
survival with good neurologic function.

The actual number of chest compressions delivered

per minute is determined by the rate of chest
compressions and the number and duration of
interruptions in compressions (eg, to open the
airway, deliver rescue breaths, allow AED analysis)
 STUDY:
In most studies, more compressions are associated with higher survival rates, and fewer

compressions are associated with lower survival rates. Provision of adequate chest compressions

requires an emphasis not only on an adequate compression rate but also on minimizing

interruptions to this critical component of CPR.

An inadequate compression rate or frequent interruptions (or both) will reduce the total number

of compressions delivered per minute.

New to the 2015 Guidelines Update are upper limits of recommended compression rate and

compression depth, based on preliminary data suggesting that excessive compression rate and

depth adversely affect outcomes

 WHY?

Compression depth may be difficult to judge without

use of feedback devices, and identification of upper
limits of compression depth may be challenging.

Most monitoring via CPR feedback devices suggests

that compressions are more often too shallow than
they are too deep.
 Chest Recoil ( 2015 Updated)

2015 (NEW) It is reasonable for rescuers to avoid leaning on

the chest between compressions, to allow full chest wall
recoil for adults in cardiac arrest.

2010 (Old): Rescuers should allow complete recoil of the

chest after each compression, to allow the heart to fill
completely before the next compression.
 WHY ?
Full chest wall recoil occurs when the sternum returns to its
natural or neutral position during the decompression phase
of CPR.

Chest wall recoil creates a relative negative intrathoracic

pressure that promotes venous return and cardiopulmonary
blood flow. Leaning on the chest wall between compressions
precludes full chest wall recoil.

Incomplete recoil raises intrathoracic pressure and reduces

venous return, coronary perfusion pressure, and myocardial
blood flow and can influence resuscitation outcome
 Ventilation During CPR With an
Advanced Airway 2015 (Updated):
2015 (NEW) It may be reasonable for the provider to deliver 1
breath every 6 seconds (10 breaths per minute) while continuous
chest compressions are being performed (ie, during CPR with an
advanced airway).

2010 (Old): When an advanced airway (ie, endotracheal tube,

Combitube, or laryngeal mask airway) is in place during 2-person
CPR, give 1 breath every 6 to 8 seconds without attempting to
synchronize breaths between compressions (this will result in
delivery of 8 to 10 breaths per minute).
 Why: This simple single rate for adults,
children, and infantsrather than a range of
breaths per minuteshould be easier to
learn, remember, and perform
RECAP
Check the airway is open
and clear of obstructions.

Use a head tilt, chin lift to

open the airway.
Use a jaw thrust for patients
with suspected spinal cord,
head, neck and facial trauma.
(usually done on patients with a
GCS < 8. Not recommended for
unexperienced people).
In an unconscious patient,
the tongue is the most
common cause of
obstruction.

Also check the airway for

blood, vomit & any other
foreign materials.

If breathing begins place in

recovery position.

Vassia Atanassova - Spiritia


In clinical situations use a
face mask to administer the
breaths.
Look, listen and feel for
breathing, up to 10 seconds.
is chest rising and falling?
can you hear or feel air from mouth or
nose?
In Australia it is no longer
recommended to deliver
rescue breaths but rather
continue straight to CPR.
CPR should be the chief
priority.
image: c0d3in3 via Flickr
If Defibrillator is
available, apply and
follow voice
prompts.

Remember when
shocking to get
everyone to stand
well back.
Keep checking for signs of life.
 Airway Management
Note the next two slides are specific to allied
health professionals and medical students. It
is a reminder of some devices used for airway
management.
Oropharyngeal Airway Nasopharyngeal Endotracheal Laryngeal mask
(guedels) Airway tube

Images from wikipedia & flickr

 Airway Management
Once the Guedel or
Nasopharyngeal airway is
inplace,
Apply face mask
Use the resuscitator to
provide ventilations
Attach 15L of oxygen to
resuscitator
If performing ventilation manually ensure a tight seal between the mask
and the face.

Where possible have one person firmly holding the face mask down and
the other ventilating.
 BLS - whats coming up

We shall now cover the following aspects

of Basic Life Support.
Care for Bleeding
Care for Shock
First Aid for Sprains & Strains
Care for Dislocations & Fractures
Poisoning
Burns
Diabetic Emergency
1. Apply Pressure to the
Wound

2. Raise and Support injured

part

3. Bandage Wound

4. Check Circulation below

wound

5. If severe bleeding persists,

give nothing by mouth &
call emergency services
1. Assess Casualty (DRSABCD)

2. Call emergency

3. Position Casualty
1. Keep the casualty lying down if
possible.
2. Elevate legs 10-12inches unless
you suspect a spinal injury

4. Treat any other injuries

5. Ensure Comfort
1. Cover casualty to maintain warmth
2. Provide casualty with fresh air

6. Monitor & Record breathing and

pulse
1. Weak rapid pulse

2. Cold, clammy skin

3. Rapid breathing

4. Faintness/dizziness

5. Nausea

6. Pale face, fingernails, lips

 RICE
R est
I ce, apply a cold pack. Do
not apply ice directly to
skin.
C ompress, use an elastic
or comforting wrap not to
tight.

E levate, above heart level

to control internal bleeding.
Follow DRSCABD. Then proceed with I A-C-T.

I mmobilise area. Use jackets, pillows, blankets and so on.

Stop any movement by supporting injured area.

A ctivate emergency services.

Call 112 or 000.

C are for shock. See care for shock slide.

T reat any additional secondary injuries.

Follow DRSCABD & Check Materials Safety Data Sheet if possible .

Signs & Symptoms

Abdominal pain
Drowsiness
Nausea/vomiting
Burning pains from mouth to stomach
Difficulty in breathing
Tight chest
Blurred vision
and so on.
1. Remove Casualty from Danger
(follow DRSCABD & remember
STOP, DROP & ROLL)

2. Cool the burnt area

(hold burnt area under cold
running water for a minimum of
20 minutes.)

3. Remove any constrictions

(e.g. clothing & jewellery)

4. Cover Burn
(place sterile, non-stick dressing
over burn)

5. Calm Casualty
Follow DRS CABD

Try to determine whether the

individual is suffering from a
high (e.g. thirsty) or a low
(hungry) blood sugar.

If you are unsure, then the

best option is to give the
person a sweet drink, as it is
more important to maintain
minimum blood sugar levels.
isafmedia via flickr

Monitor individual & wait for

arrival of medical assistance.
 Standard Precautions
Standard Precautions are standard, safe work practices
that are to be applied to all patients regardless of their
known or presumed infectious status.

Standard Precautions are particularly Standard Precautions include steps

important in cases with: such as:
Blood (including dried blood) hand washing
All other body fluids, secretions and use of appropriate personal
excretions (excluding sweat), protective equipment (eg.
regardless of whether they contain gloves)
visible blood management of sharps, and
Non-intact skin immunisation of health care
Mucous membranes workers.
Q.1: What are the elements of high Quality CPR

-Push hard Push Fast

-Allow Chest to Complete Recoil
-Minimize Interruption
-Ventilate Adequately
Q.2: When you will use an AED

a. After 2 cycle of CPR

b. 1 half to 3 minutes of CPR
c. Immediately after its ready
d. Not necessary
Q.4: What is the compression rate for adult CPR

100-120 compression/minutes
Q.5: Depth of Chest Compression for adult

a. At least 2 inches
b. Not more than 2.4 inches
c. less than 2 inches
d. A and B
e. B and C
Q.5: Maximum time limits for CPR interruption

10 seconds
Q.6: Chain of Survival for OHCA