Medical Emergencies: CPR and Choking Coconuts Beach Bar and Grill Restaurant 15208 Red Hollow Road Gravois Mills, MO 65247 Cassie Wilhelm Manager Cell: 573-789-5030

Table of Contents Introduction………………………………………3 Procedure #1-CPR………………………………4 CPR on Adults…………………..……………...5-6 CPR on Children………… ……………………7-8 Supporting Information for CPR………………9 Procedure #2-Choking…………..……..........10 Choking-Adult and Child………..............11-12 Choking-Infant………………………………13-14 Supporting Information for Choking……….15 Additional Resources………………….……...16 References………………………………………17

Introduction The purpose of this manual is to prepare the Coconut’s employees to respond to potential medical emergencies. Using this manual, employees will learn proper CPR techniques and how to assist choking victims within the restaurant. The employees will be able to follow step-by-step instructions and demonstrate the skills necessary to render aid. This manual covers determining when CPR is needed and how it is performed. This manual also covers identifying the signs of choking and rendering assistance to a choking victim. Different techniques for rendering aid to adults/children and infants are clearly defined in this manual. Steps to take after a choking victim’s airway is cleared, and after rendering CPR are included.

CPR The purpose of this procedure is to teach employees when to perform CPR, how to perform CPR and what to do after CPR. Cardiopulmonary Resuscitation is an emergency procedure; performed in an effort to manually reserve intact brain function until further measures are taken to restore natural blood circulation and breathing in a person. It is indicated in those who are unresponsive with no breathing or abnormal breathing.

CPR on an Adult (ages 8+) Check the scene to make sure it is safe. Shake or tap the adult and shout, “Are you okay?” Watch chest and nostrils for signs of breathing. Have another person call 911, and place the victim flat on their back. (Do not leave the victim until CPR has been performed for at least 2 minutes. IF not breathing then begin……. GIVE 30 CHEST COMPRESSIONS: Place hands on top of each other, palm down. Then push hard and push fast in the middle of the chest at least 2 inches deep between the separation of the ribs and below the nipples thirty times. Let the chest fully rise between each compression.

CPR on an Adult Continued… Look, listen, and feel for any breathing. Place your ear over the mouth and nose, watch for chest movement, feel for breath on your cheek. GIVE 2 RESCUE BREATHS: Tilt the head back and lift the chin up. (As to open the airway.) Pinch the nose shut, then make a complete seal over the person’s mouth with ones own mouth. Blow in for about 1 second to make the chest clearly rise. (Give rescue breaths, one after the other.) Return back to chest compressions and repeat this cycle until the victim begins breathing again or help arrives. If the victim begins breathing again, place him or her in the recovery position: Laying on their left side with their head resting on their left arm.

CPR on a Child (ages 2-8) Check to make sure the scene is safe. Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?" Tell someone to call 911, (and do not leave the child until CPR has been performed for at least 2 minutes.) Carefully place the child on his or her back on a flat and firm surface. IF no signs of breathing, begin: PERFORM 30 CHEST COMPRESSIONS: Place the heel of one hand in the center of the child’s chest on the breastbone and just below the nipples. While the other hand is placed on the child’s forehead, keeping the head tilted back to create an airway. Press down on the child's chest hard and fast so that it compresses about 1/3 to 1/2 deep into the chest. Let the chest fully rise between each compression.

CPR on a Child Continued…. Look, listen, and feel for any signs of breathing. Open the airway. Lift up the chin with one hand and at the same time, tilt the head by pushing down on the forehead with the other hand. Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek. IF the child is not breathing: GIVE 2 RESUCE BREATHS: Pinch the nose closed and form a tight seal with your mouth over the child’s mouth. Each breath should take a second and make the chest rise. Continue CPR (30 chest compressions, followed by 2 breaths repeated.) If the child begins to breath, place him or her in the recovery position: Laying on their left side with their head resting on their left arm. Attached is a link that demonstrates how to perform CPR on an adult and child. http://www.youtube.com/watch?v=1wj-zixnz2s

Supporting Information To become CPR certified: Visit your local health center to see when classes are offered or go www.redcross.org/CPR-Training CPR Video: http://www.youtube.com/watch?v=1wj-zixnz2s

Choking The purpose of this procedure is to teach employees the signs of choking and how to care for someone who is choking. January 2013 Choking is the severe difficulty of breathing caused by compression or obstruction of the larynx or trachea. This is a medical emergency and can be treated by forcefully coughing, back blows, or doing the Heimlich Maneuver.

Choking: Adult and Child The same techniques can be used on a choking adult and child. The techniques change when dealing with a choking infant. Look for signs of distress: The person cannot speak or cry out, breathing is labored-gasps or wheezes, person violently coughs or gurgles, the person clutches their throat or mouth, or tries to induce vomiting. The person’s face may turn blue if breathing is not restored within a certain time. Ask the person, “Are you choking?” Encourage them to cough as hard as possible, if this does not help: Bend the victim over at the waist and PERFORM 5 HARD BLOWS with the heel of the hand to the upper back of the victim between the shoulder blades.

Choking: Adult and Child Continued… GIVE 5 ABDOMINAL THRUSTS: Heimlich Maneuver Standing behind the victim: Place a fist with the thumb side against the middle of the person’s abdomen, just above the navel; and cover your fist with your other hand. Give 5 quick, upward abdominal thrusts. Continue care by giving sets of 5 back blows and 5 abdominal thrusts until the object is forced out, or the person can cough forcefully or breathe. Attached is a link that demonstrates the proper techniques to care for a choking adult or child. http://www.youtube.com/watch?v=SwJlZnu05Cw

Choking: Infant It is more difficult to assess an infant who is choking. Look for signs of choking: gasps or wheezes, sharp cries, blue color of the face, motionless body or face. If it is apparent the infant is choking: Pick the infant up and carefully position him or her face-up on one forearm, cradling the back of their head with that hand. Then Place the other hand and forearm on his front, so that the infant is sandwiched between both forearms. Use your thumb and fingers to hold the face and turn the infant over so that they are now facedown along the other forearm. Lower your arm onto your thigh and make sure that the infant’s head is lower that his or her chest. DELIVER 5 BACK BLOWS: Using the heel of your hand, deliver five firm back blows between the infant's shoulder blades while maintaining support of the head and neck by firmly holding the infant’s face between your thumb and fingers.

Choking: Infant Continued… After the 5 back blows, place your hand on the back of the infant’s head with your arm along the spine. Carefully turn the infant over while keeping your other hand and forearm on his or her front. Supporting the head and neck, lower your arm and the infant onto your thigh, still keeping the infant’s head lower than the chest. DELIVER 5 CHEST BLOWS: Using the pads of two or three fingers in the center of the infant’s chest, just below the nipples, perform 5 chest thrusts by pushing straight down on the chest 1 ½ inches. Allow the chest to fully rise between each thrust. Repeat back blows and chest thrusts. (5 blows, 5 thrusts.) Continue the cycle until the object is forced out or the infant starts to cough forcefully, cry, or breathe on his or her own. Attached is a link that demonstrates how to treat a choking infant. http://www.youtube.com/watch?v=axqIju9CLKA

Supporting Information Choking is a serious medical emergency and that is why it is important to be prepared and know what to do if a situation like this arises. The information presented in this section is found online at on any secure medical site, and the information is update. The video links provided are demonstration videos that aid in the learning process of assisting choking victims. Contact or visit www.redcross.org to learn more.

Suggested Resources To Learn more visit: www.redcross.org www.babycenter.com OR visit your local health center and obtain pamphlets, instructions, and video demonstrations on CPR and Choking. For questions or concerns regarding this procedure manual: Contact the Manager at Coconuts: 573-372-6500

References Ignatavicius, D. and Workman, M.L. (2010) 6th Ed. Medical-Surgical Nursing. Patient-Centered Collaborative Care. 1(1). Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D. (2010) 4th Ed. Maternal Child Nursing Care. 1(1). http://www.babycenter.com/0_infant-first-aid-for-choking-and-cpr-an-illustrated-guide_9298.bc http://www.mayoclinic.com/health/first-aid-choking/FA00025 www.redcross.org/CPR-Training YouTube: http://www.youtube.com/watch?v=axqIju9CLKA http://www.youtube.com/watch?v=SwJlZnu05Cw http://www.youtube.com/watch?v=1wj-zixnz2s