Basic Life Support Chapter 13

4 Emergency Action Steps Survey the scene Primary Survey Call 911 Secondary Survey

Step 1-Survey the Scene Your #1 priority is scene safety!!! Check the scene for: Fire Gasoline Explosive Materials Other cars Hazardous Chemicals During the primary assessment, you are checking for any life-threatening conditions, including unconsciousness, absence of breathing, absence of pulse and severe bleeding. ■ Check for responsiveness and, if the victim is conscious, obtain consent. If no response, summon more advanced medical personnel. Note the victim’s level of consciousness (LOC) using the AVPU scale. ●  Alert: Able to respond to questions ●  Verbal: Able to react to sounds, may need to be stimulated to respond ●  Painful: Responds to painful stimuli ●  Unresponsive: Does not respond to any stimuli

Primary Assesment During the primary assessment, you are checking for any life-threatening conditions, including unconsciousness, absence of breathing, absence of pulse and severe bleeding. ■ Check for responsiveness and, if the victim is conscious, obtain consent. If no response, summon more advanced medical personnel. Note the victim’s level of consciousness (LOC) using the AVPU scale. ●  Alert: Able to respond to questions ●  Verbal: Able to react to sounds, may need to be stimulated to respond ●  Painful: Responds to painful stimuli ●  Unresponsive: Does not respond to any stimuli

Emergency Action Steps 2-4 Primary Survey Check for life threatening injuries (A,B,Cs) Check for consciousness (tap and shout) Call 911 Secondary Survey Check for non life threatening injuries

Cardiopulmonary Resuscitation (CPR) CPR combines rescue breathing and chest compressions. Rescue breathing supplies oxygen to the lungs/blood. Chest compressions circulate blood throughout the body. CPR is only performed whenever the heart and lungs stop working.

Respiratory and Cardiac Arrest Respiratory arrest: the absence of breathing. Cardiac arrest: the absence of a heart beat. Full arrest: the absence of both a heart beat and breathing.

How Long Before I Die? After 4-6 minutes without a heart beat or breathing, brain cells begin to die and you are considered biologically dead.

The Chain of Survival

10 Steps to CPR

Step #1 Determine Consciousness Determine if the victim is conscious or unconscious. Tap or shake the victim gently and shout, “Are you OK?” Important to prevent unnecessary CPR to a conscious victim.

Step #2 CALL 911 and get the AED If the person does not respond to touch or voice call EMS for help and get an AED (if available).

Step #3 Position the victim. To perform a rescue, the victim must be lying on their back. Perform a log roll if they are face down. Victim should be on a flat, firm surface. If a person is on the bed, what should you do?

Step #4 Get into the rescuer position. Kneel close to the victim’s shoulders in a position to perform rescue breathing, and if needed, chest compressions.

These first four steps must be completed within seconds These first four steps must be completed within seconds! Time is critical!!!

Step#5 Open the airway Airway must be positioned to allow air to enter and escape. Head-tilt/chin-lift maneuver Jaw thrust maneuver (if a spinal injury is suspected)

JAW THRUST MANUEVER

Step #6 Assess Signs of Life. Place your ear over the victims mouth and watch the chest for movement. Look, listen and feel for breathing and a pulse for 5-10 seconds. Check carotid pulse for adult and child Check brachial pulse for infant If the victim is breathing, maintain an open airway and place in recovery position If the victim is not breathing, perform CPR.

Step #7 Perform rescue breathing. If the victim is not breathing but has a pulse Typically, this victim will be a child or infant Use one hand to pinch the victims nose closed. Use your mouth to completely cover the victims mouth (for infant cover nose and mouth) If available use a face shield, pocket mask, or bag valve mask (BVM).

Step #7 con’t… Only blow enough oxygen to make the chest gently rise.

Step #7 Perform rescue breathing. If the victim is not breathing but has a pulse If your victim has a pulse, continue rescue breathing giving 1 breath every 5 seconds for adult If your victim has a pulse, continue rescue breathing giving 1 breath every 3 seconds for child or infant Breaths should last about 1 second for an adult, child, and infant.

Step #7 cont… Reassess Circulation (Pulse). After 12 cycles of rescue breathing (60 seconds) recheck for a pulse. Check for a pulse for about 5-10 seconds. If a pulse is present but the person is not breathing, continue rescue breathing. If a pulse is not present, begin chest compressions.

Agonal Breathing Agonal breaths are isolated or infrequent gasping that occurs in the absence of normal breathing in an unconscious patient. These breaths can occur after the heart has stopped beating and are considered a sign of cardiac arrest. Agonal breaths are NOT normal breathing. If the patient is demonstrating agonal breaths, you need to care for the patient as if he or she is not breathing at all.

Step #8 If no signs of life (breathing or pulse) Begin external chest compressions. In adult victim, assume cardiac emergency and immediately start compressions Place the heel of the hand on the persons sternum (about two fingers above the xiphoid process). Center of the chest Rate of compressions for adult, child, and infant is 100 beats per minutes. (FAST)

Step #9- Adult Continue compressions to breaths Thrust the hands straight down at least 2.4 inches for an adult victim. Ratio for compressions to breaths with 1 rescuer is 30:2. If you have two rescuers, one person will do compressions and one will do the breathing, switch every 2 minutes. The ratio for 2 rescuers is still 30:2 for adults.

Step #9- Child and Infant For children compression to breath ratio is 30:2 for 1 rescuer. Compress the chest at least 2 inches using only one hand or for larger children, use two hands. For infants the compression to breath ratio is 30:2 for 1 rescuer. Compress the chest 1/3 of the chest’s depth using either two fingers or the 2 thumbs encircling the chest technique.

Step #9- Child and Infant Two rescuer CPR for both children and infants has a ratio of 15:2.

Step #10 Reassessment. After five cycles (5 sets of chest compressions and 5 sets of breaths), the pulse and breathing should be reassessed. 5 cycles should be about 2 minutes. If there is still no pulse or breathing, continue CPR.

Automated External Defibrillator (AED) An AED is a machine used to detect ventricular fibrillation (VF).

How does an AED work? The AED reads the victims heart rhythm to determine if the victim needs to be shocked.

Choosing AED Pads There are two sizes of AED pads- Adult and Child. Use adult pads if the victim is 8 years of age or older. Use child pads if the victim is between 1 and 7 years of age.

Placement of AED Pads

Using an AED Make sure no one is touching the victim! Touching or moving the victim will disrupt the AED from analyzing heart rhythm. You will get shocked if you are touching the victim! After the AED delivers shock immediately begin CPR if indicated by AED.

Using an AED Only use an AED if the victim has all 3 symptoms: Unconscious No breathing No pulse Special Situations: Victim is under1 year old Hairy chest Submerged in water or is wet Has a pacemaker or defibrillator

Airway Obstruction- Conscious Adult/Child If the victim is able to cough or talk, encourage them to continue coughing and do not interfere. If the victim can not talk or cough perform abdominal thrusts. Abdominal thrusts are done in sets of 5 until the person loses consciousness.

Airway Obstruction- Conscious Adult/Child

Airway Obstruction-Pregnant/Obese If the victim is pregnant or obese, an alternate chest thrust can be used. Chest thrusts are also done in sets of 5.

Airway Obstruction- Unconscious Adult/Child If the victim becomes unconscious, lay the victim down on the ground and immediately begin CPR. 30 compressions to 2 breaths Check the victims airway for obstructions before giving the 2 breaths. If object is found perform a finger sweep to remove the object.

Airway Obstruction for Infants- Conscious Position the infant face down on the forearm. Using the heel of your hand, give 5 forceful back blows between the infants shoulder blades. Turn the infant over onto his back and give 5 chest thrusts.

Airway Obstruction for Infants- Conscious Continue cycles of 5 back blows and 5 chest thrusts until the object comes out or the infant loses consciousness.

Airway Obstruction for Infants- Unconscious Once the infant loses consciousness immediately begin CPR. Perform a finger sweep before giving 2 breaths only if you see the object.

Good Samaritan Law The law protects the “Good Samaritan” from liability if unintended consequences result from their assistance. All 50 states and the District of Columbia have some type of Good Samaritan law. Who is protected under these laws (physicians, emergency medical technicians, and other first responders) and how these laws are implemented vary from state to state. In addition, some states extend Good Samaritan liability protection to cover business and nonprofit entities acting during an emergency.