1. METHODS & PRINCIPLES USED IN CPR

2. 2 Introduction  Methods and procedures for managing: obstructed airways artificial respiration (AR) cardiopulmonary resuscitation (CPR)  Always consider the height and size of the patient

3. 3 Activating EMS  Activate EMS as soon as you realize the patient requires medical attention beyond your training or the facilities available are inadequate to provide proper attention: Tell someone to call an ambulance. Have them describe the patient and keep it simple Tell them to come back If an AED is available, ask them to bring it to you

4. 4 Activating EMS  Alone with Unresponsive Adult Immediately activate the EMS yourself and get an AED  Alone with Child or Infant Initiate resuscitation techniques for two minutes (five cycles) then activate EMS, and continue until help arrives

5. 5 Clearing the Airway  Repositioning the head Head tilt chin lift Tongue Jaw Lift Jaw Thrust for suspected neck injury

6. 6 Head Tilt - Chin Lift  Palm on patient’s forehead applying firm backward pressure to tilt head back  Lift chin by placing the fingers of your other hand under the bony part of the lower jaw, lift until the teeth are almost together, the mouth is not completely closed  Pressing on the soft tissue under the chin can obstruct the airway

7. 7 Tongue Jaw Lift  Place your thumb in the mouth  Grab the jaw  Lift the mandible up and out  Use other hand to stabilize the head  Do not hyper- extend the neck

8. 8 Jaw Thrust  Place fingers of both hands behind the angle of the patient’s lower jaw  Lift, forcing the mandible forward and tilting the head back  In case of neck injury - this must be used without lifting or moving the head

9. 9 Mild Airway Obstructions  Caused by foreign object (usually eating or chewing)  Patient may use the universal distress signal  May begin to turn blue  Obviously very frightened  Ask “Are you choking?”

10. 10 Mild Airway Obstruction  Signs and Symptoms: the ability to forcibly cough wheezing between coughs

11. 11 Treatment with Good Air Exchange  Prevent further injury  Identify yourself as trained in first aid  Ask permission and offer assistance  Do not attempt abdominal thrusts  Never interfere with the patient’s efforts to clear the airway  Stay with the patient until breathing is normal  Monitor vital signs  Encourage the patient to dislodge the object by coughing  If condition persists, activate EMS  If patient becomes unresponsive, treat for severe airway obstruction

12. 12 Mild Airway Obstruction - Worsening  Poor Air Exchange ineffective or weak coughs high pitched noises while inhaling increased respiratory distress possible cyanosis  Treat this situation as a severe airway obstruction

13. 13 Severe Airway Obstruction  The inability to produce any sound indicates a severe airway obstruction inability to speak, breathe or cough absence of chest movement or air exchange Increased cyanosis

14. 14 Abdominal Thrusts/Back Blows  Conscious Adult or Child position yourself behind the choking patient wrap your arms around their waist make a fist with one hand, place thumb side to abdomen above navel, below sternum grip this fist with the other hand administer five quick upward thrusts

15. Abdominal Thrust/Back Blows  Administer five back blows between the should blades with the heel of your hand  continue until successful or patient becomes unresponsive 15

16. 16 Special Considerations  Pregnant and Grossly Obese Use chest thrust by placing the fist mid-sternum (CPR position)  Elderly Ribs may be fragile

17. 17 Back Blows/Chest Thrusts  Conscious Infant pick up infant while supporting the head and body place infant face down along your forearm, supporting their body on your thigh ensure baby’s head is well supported and lower than their body administer 5 back blows between the shoulder blades with heel of your hand

18. 18 turn infant face up, supporting their body on the opposite thigh ensure baby’s head is well supported and lower than their body landmark and administer 5 chest compressions Back Blows/Chest Thrusts

19. 19 Landmarking for Infant  Place two fingers in the middle of the infant's chest between the nipples  Slide your fingers to just below the nipple line  Administer five chest thrusts with the two fingers. Press down quickly with the two fingers on the centre of the chest.

20. 20 Finger Sweep  Open the mouth.  Grasp both the tongue and the lower jaw  Lift the mandible  Insert the index finger of the other hand along the inside of the cheek and sweep the throat at the base of the tongue  Carefully scoop out the obstruction Only perform when you can see the obstruction.  For infants use your small finger to remove obstruction Look first!

21. 21 Suction  Suction devices are used to remove fluids and vomit from the airway.  There are many devices on the market which all share common instructions and precautions for use.  Suction is applied only to the mouth/oral cavity and upper airway  Apply suction for 5 to 10 seconds at a time, while the tip is being withdrawn.

22. 22 Suction  Signs and symptoms that patient would require the use of a suction: decreased level of consciousness facial injuries involving the mouth or nose any person whose ventilation are being assisted any time an oropharyngeal airway is being used

23. If the choking patient becomes unresponsive, the rescuer will begin with the CPR sequence