How to perform an basic CPR/AED Done by: ITE-CC First Aid Committee Member

What is a CPR Cardiopulmonary resuscitation, commonly known as CPR, is an emergency procedure performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing.

What is DRSABC action plan D- DANGER  Ensure the area is safe for yourself, others and to the casualty R RESPONSE  Check for response by asking name, squeeze the shoulder, Make comfortable and Monitor response. If not response, S SHOUTING  Shout for help by saiding Someone call an Ambulance 995 and Get an AED! After you shout immediately check the Casualty Airway. A AIRWAY  Open mouth by head tilt chin life, If there is foreign object present in the airway, Remove it with fingers. B BREATHIN  Check for breathing by look the chest is it rising up? Listen is there any breathing sound and feel if the air is being breathed by the casualty. C CPR/COMPRESSION/CIRCULATION  If there is no pulse start the CPR by 30 compressions and after the Compressions will be 2 rescue breath/blow until the casualty recovers or until help arrives.

How to perform a CPR on unconscious and not breathing Casualty If an Casualty is unconscious and not breathing, you’ll need to do CPR (which is short for cardiopulmonary resuscitation). CPR involves giving someone a combination of chest compressions and rescue breaths to keep their heart and circulation going to try to save their life. If they start breathing normally again, stop CPR and put them in the recovery position.

Step 1 of 5: Open their airway If they are unconscious, open their airway. Place one hand on the casualty’s forehead and two fingers under their chin. Gently tilt their head back and lift the chin.

Step 2 of 5: Check their breathing Maintain the head tilt and chin lift, and look for chest movement. Listen for the sounds of normal breathing and see if you can feel their breaths on your cheek. If they are not breathing, you need to start CPR (cardiopulmonary resuscitation – a combination of chest pressure and rescue breaths) straight away.

Step 3 of 5: Call for help and start CPR Call 995 for an ambulance, or get someone else to do it. Next you’ll need to perform CPR - cardiopulmonary resuscitation. This involves giving someone chest compressions and rescue breaths to keep their heart and circulation going. If they start breathing normally again, stop CPR and put them in the recovery position.

Step 4 of 5: Giving chest compressions Kneel down beside the casualty on the floor level with their chest. Place the heel of one hand towards the end of their breastbone, in the centre of their chest. Place the heel of your other hand on top of the first hand and interlock your fingers, making sure you keep the fingers off the ribs.  Lean over the casualty, with your arms straight, pressing down vertically on the breastbone, and press the chest down by 5-6cm (2-2½inch). Release the pressure without removing your hands from their chest. Allow the chest to come back up fully – this is one compression. Repeat 30 times, at a rate of about twice a second or the speed of the song ‘Staying Alive’. Give two rescue breaths.

Step 5 of 5: How to give a rescue breath Ensure the casualty’s airway is open. Pinch their nose firmly closed. Take a deep breath and seal your lips around their mouth. Blow into the mouth until the chest rises. Remove your mouth and allow the chest to fall. Repeat once more. Carry on giving 30 chest compressions followed by two rescue breaths for as long as you can, or until help arrives. If the casualty starts breathing normally again, stop CPR and put them in the recovery position.

AED [ Automated External Defibrillator ] An AED can be used safely and effectively without previous training. Therefore, the use of an AED should not be restricted to trained rescuers, However, training should be encouraged to help improve the time to shock, delivery and correct pad placement.

Types of AED [Automated External Defibrillator ] AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocks to victims of cardiac arrest when the ECG rhythm is one that is likely to respond to a shock. Simplicity of operation is a key feature: controls are kept to a minimum, voice, and visual prompts guide rescuers. Modern AEDs are suitable for use by both lay, rescuers and healthcare professionals. All AEDs analyse the victim’s ECG rhythm and determine the need for a shock. The semi- automatic AED indicates the need for a shock, which is delivered by the operator, while the fully automatic AED administers the shock without the need for intervention by the operator. Some semi-automatic AEDs have the facility to enable the operator (normally a healthcare professional) to override the device and deliver a shock manually, independently of prompts.

AED [Automated External Defibrillator ] algorithm

Sequence of actions when using an AED [ Automated External Defibrillator ] The following sequence applies to the use of both semi-automatic and automatic AEDs in a victim who is found to be unconscious and not breathing normally.

Step 1/5 for AED [Automated External Defibrillator ] Follow the adult BLS sequence as described in the basic life support chapter. Do not delay starting CPR unless the AED is available immediately

Step 2/5 for AED [Automated External Defibrillator ] As soon as the AED arrives: If more than one rescuer is present, continue CPR while the AED is switched on. If you are alone, stop CPR and switch on the AED. Follow the voice / visual prompts. Attach the electrode pads to the patient’s bare chest. Ensure that nobody touches the victim while the AED is analysing the rhythm.

Step 3/5 for AED [Automated External Defibrillator ] If a shock is indicated: Ensure that nobody touches the victim. Push the shock button as directed (fully-automatic AEDs will deliver the shock automatically). Continue as directed by the voice / visual prompts. Minimise, as far as possible, interruptions in chest compression.

Step 4/5 for AED [Automated External Defibrillator ] If no shock is indicated: Resume CPR immediately using a ratio of 30 compressions to 2 rescue breaths/blow. Continue as directed by the voice / visual prompts.

Step 5/5 for AED [Automated External Defibrillator ] Continue to follow the AED prompts until: Qualified help arrives and takes over OR the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally OR you become exhausted

Placement of AED [Automated External Defibrillator ] Place one AED pad to the right of the sternum (breast bone), below the clavicle (collar bone). Place the other pad in the left mid-axillary line, approximately over the position of the V6 ECG electrode. It is important that this pad is placed sufficiently laterally and that it is clear of any breast tissue.

References Links: http://www.stjohnnsw.com.au/drsabcd-action-plan/ Links: http://www.sja.org.uk/sja/first-aid-advice/loss-of- consciousness/unconscious-not-breathing/adult.aspx Links: http://www.resus.org.uk/pages/aed.pdf