CPR/AED

Chain of Survival
The

chain of survival are five steps to

help increase the chances of an
injured person of surviving a cardiac
arrest.

Chain of Survival step one

After determining that there is an injury needing

advanced care; if unconscious tap and shout.

Call 911

Questions you will need to answer:

Nature of the emergency?
Where are you?
How many are hurt?
Ages of who is/are hurt
Who are you?
Has treatment started?
Only hang up when instructed to do so by operator.

Chain of Survival step two

Begin CPR

Most adult cardiac arrests (CA) victims heart is

in ventricular fibrillation (VF) - Abnormal chaotic
heart rhythm that prevents the heart from
pumping blood.
CPR will not usually stop VF but plays an
important part in pushing oxygenated blood to
the brain and heart and prolonging VF so that an
AED will be useful.
CPR can double or triple the victims survival
rate
For every passing minute without CPR; rate of
surviving drops 7-10%.
With CPR there is only a 3-4% drop each minute

Chain of Survival step

three
Use an AED

The use of the AED will stun the

fibrillating heart, if the heart is still
viable the normal pacemakers in the
heart will begin firing and start a
normal rhythm.
If used within 5 min; chances of
survival is 49-75%.
Using an AED is simple.

Chain of Survival step four

Advanced

Care EMS

Response time is 7-8 minutes CPR is

extremely important.

Chain of Survival step five

Integrated

post-cardiac arrest care.

How to recognize
major emergencies

Heart Attack

Myocardial infarction

Coronary heart disease is the leading cause of death

in our nation.

During MI - part of heart muscle is starting to die.

Caused by a blockage of an artery (coronary) due
to buildup of cholesterol deposits or a blood clot.
Victims are usually awake and can talk but feels
severe pain

Most critical time is within the first

30 minutes after Sx begin.

Heart Attack

Most common symptoms

Pain or pressure in the center of the chest which last more than 3-5 minutes.

Pain might feel pressure, fullness, squeezing, or heaviness

Pain might spread to shoulder, neck, lower jaw and down arm (usually the
right).

Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then
begin again.

Other Sx lightheadedness, fainting, sweating without fever, nausea,

shortness of breath

Most victims will downplay symptoms, you must take action!!!

Call 911, get the nearest AED, and have the person rest in a position that is
comfortable where they can breathe easily.

Put them in an area that you can get them to the floor easily and paramedics can get
in.

Cardiac Arrest

When the heart stops beating. Usually

caused by VF, which begins where the
heart muscle is injured.
Without blood flow and no pulse the
person becomes unconscious and stops
breathing and collapses.
VF and cardiac arrest may be the only
symptom of a heart attack.
AED is only thing that will stop a VF

Stroke

Its is a rapid onset of neurological

problems like weakness, paralysis in one
or more limbs, difficulty speaking, visual
problems, intense dizziness, facial
weakness, altered consciousness, and
severe headache.
Two causes

blood vessel to brain is blocked by a blood clot

blood vessel to brain breaks

#3 cause of death and #1 cause of

serious disability among Americans

Stroke
Most signs overlooked;
three major signs to
observe

facial droop
arm weakness most
obvious when victim
attempts to extend
arms with eyes closed
one or both may not
move very well
speech difficulties
slurring of words and
sentences
Call 911 immediately if
see signs of stroke

Provide CPR if needed

Foreign body obstruction

Usually caused by food, but can be caused by
many objects
Major signs

Universal choking signal

poor ineffective coughs
inability to speak
high pitched sounds while inhaling
increased difficulty breathing
Blue lips or skin (cyanosis)
Loss of consciousness and responsiveness

Heimlich maneuver in conscious victim

CPR in unconscious victim

CPR - adult

Step one
Make sure area is safe
Check unresponsiveness tap and
shout Are you alright

If no response call 911 or send

someone directly to call

Grab AED if one present or send

someone to get one.

Step two
If possible place
victim supine and
on a hard
surface.

If victim is prone
roll over
Try protecting the
neck as much as
possible if you
suspect neck
injury

Begin CABs
C = Circulation

If not breathing or see abnormal breathing begin chest

compressions

Agnal breathing gasps that occur at the beginning of CA not

efficient act as they are not breathing
Check for pulse or signs of circulation (at least 5sec
nomore than 10sec) just go straight to CPR
Place one palm on the chest between the nipple line
Interlock your other hand on top of the hand on the chest
Bring your shoulder over the top
Make sure you have a wide base (knees spread just outside your
shoulders)
Press down 2 inches at a rate of at least 100 compressions per
minute hard and fast
Make sure chest recoils completely
Complete 30 compressions and then give two breaths.
Do not stop unless and AED is available, victim moves, or you
substituted out (if two rescuers are available switch every five
cycles of 30:2 approx two minutes) reduces fatigue

 A = Airway
Head tilt and Chin lift

B = Breathing
If you do not detect normal breathing give
two breaths lasting 1 second each (may use
barrier)
Watch chest rise, allow exhalation before next
breath.
If breaths do not go in reposition head and
try again.
Practice

Practice
Practice compressions 30 times twice
alternate with partner no breaths
60 sec test just compressions try to
get 95-105 compressions allows to learn
rhythm. Perform 1-2 times or as needed
Two minute test performing 30:2
(includes breath) - should complete five
cycles in that time.

During the beginning stages of CA chest

compressions are more important than breaths.
Oxygen level will stay high for the first few minutes
but blood is not moving to due to the heart not
pumping.
Breathing becomes as important as the length of CPR
continues

Very important to limit interruptions of chest

compressions.

Be mindful not to give to many breaths, too much

breath or too forceful may cause gastric filling and
the resultant complications, and/or cause diminished
blood flow and reduce survival.

Vomiting/other breathing

If someone does throw up do not panic.

Roll victim towards you. Use your body to hold them.

Clean out the mouth roll back and continue.

Mouth to nose

Use when it is impossible to use the mouth due to

injury.

Face shields and masks may be used -

Very little chance of transfer of bodily fluids if

perform mouth to mouth without mask.
Using shield or mask can slow down the CPR process
Chest compression only CPR is more beneficial
than no CPR at all.

Recovery position
If

victim begins breathing and having

a pulse then turn victim to their side
with lower arm in front.
No position is perfect- just make sure
they are stable, near a true lateral
position, and there is no pressure on
the chest to impair breathing

Potential neck injury

If two or more responders

One stabilizes the neck they will be in charge if
victim needs to be moved
Place hands on the sides of the head and neck, using
your hands to cup around the neck.
Place pressure on head with forearms near the ears
Elbows should be on the ground, wrists in ulnar
deviation so that they come in contact with the head.
This will limit the amount of movement that will occur if you
have to move your body, for example moving so that CPR
can be administered or when EMS puts on a neck brace.

If movement is necessary then move body as one.

CPR Child and

infant

Child CPR (ages 1-Puberty)

Child AED (ages 1-8yrs)

Similarities with single rescuer Adult CPR

Location on chest for compressions is the same nipple
line
Ratio of compressions to breaths the same 30:2

Differences with Adult CPR

In the chain of survival-If arrest is unwittnessed you will
perform CPR first for two minutes performing five cycles
of 30:2 then call 911 (if you are alone)
Reason is that most child and infant cardiac arrests are due
from asphyxiation, so they will benefit more from the CPR.

The depth you use for compression is 2 inches or 1/3

depth of the chest. Use one or two hands which ever
is more comfortable.
Compression/respiration ratio 15-2

Infant CPR

Similarities with single rescuer adult CPR

30:2 ratio of compressions to breaths

Similarities with Child

Perform CPR first in the Chain of Survival, for the same reasons.

If small enough you may carry to phone with you after completing the five
cycles use speaker phone

Depth of compressions 1/3 depth of the chest or 1 1/2 inches or 4 cm

Differences with CPR

Check responsiveness by thumping or slapping the foot

Check pulse in the upper arm / brachial artery
If no pulse or if the pulse is present but below 60bpm you initiate compression

You will perform chest compressions one finger below nipple line
You will only puff air in
If unsure if it is a child or not, if it can fit on your arm, then treat as an
infant

2-rescuer thumb-encircle chest; compression/resp ratio

15-2

Remember Do Not tilt an infants head too far or it will actually occlude the airway.
For infant mouth to mouth respiration you cover the mouth and nose with your mouth.

Foreign Body Airway

Obstruction (FBAO)
Heimlich Maneuver

Choking
Universal sign of choking hand
around throat
Ask questions

Are you choking? Can you speak? May I

help you? Very important.

If they say no leave them alone until they

pass out then it is assumed they want help.

If a person can speak or can cough do not help

Abdominal thrusts

Place yourself behind victim scissor you legs

Place hands on navel

place hands on chest if woman is pregnant or victim is

severely overweight

Pull in and up

Front leg between victims legs

Slightly bend knees

continue until object is out or they pass out

Use chest thrusts if you are unable to circumvent the
abdomen

If pass out lower them carefully to the floor begin CPR

Only difference with CPR is you check mouth for object

before breaths.

Finger sweep only if you see object.

Practice

Infant FBAO
Infant

Conscious place infant on forearm with

babies mouth between fingers back blows
to upper back
Unconscious

after back blows - five compressions

look for object
give breath
repeat cycle back blows, compressions, look and
breaths

Finger sweep if see object

Practice

Automated External
Defibrillator
AED

What is an AED?
Automated external defibrillator is an computerized
defibrillator

it can analyze heart rhythm

recognize shockable rhythm
advise the operator whether the rhythm should be shocked
very easy to use

AEDs computer chips analyze the rate, size and wave

shape of human cardiac rhythm.

will not shock a properly functioning heart

will not shock a heart that has stopped VF is not present

Universal steps of AED use

Place AED parallel to patients left ear

Power on the AED first
Some automatically turn on when opened

Attach the AED to the patients chest with electrode pads

Remove clothing to bear chest

Be kind to females

Dry patient or shave chest in area of electrode placement if needed

Place one pad above right nipple and one to the side and below the left
nipple. (CPR is continued up to the point when the AED

says analyzing rhythm stand clear)

Analyze rhythm

Make sure everyone is clear (must say stand clear of the victim).
No contact
Push analyze (in necessary) some machine analyze automatically.
Charge AED if shock is required (some machine charge automatically)

Shock if indicated (after checking everyone is clear

again) Press the shock button.
Begin CPR for five cycles then analyze again
If shock is advisable again you clear everyone and shock
If shock is not advisable continue with CPR
If victim has pulse and is breathing put into recovery
position.

DO NOT take off pads or turn off AED until prompted by EMS

Special Considerations

Water

Metal surfaces

Remove patch and wipe clean before attaching AED pads

Implanted pacemakers and defibrillators

Children 8 and older use as soon as possible

Children 1-8 CPR for two minutes before using AED

Transdermal medications

Is victim lying on metal surface? if so move victim

The metal surface may cause the shock form the AED to hit you.

Children

Must remove victim from water or wet surface

Dry before attaching pads

Do not place an AED electrode directly over implanted device.

Move at least one inch to the side of device

Practice

How CPR Works

Effective CPR provides 1/4 to 1/3
normal blood flow
Rescue breaths contain 16% oxygen
(21%)

Start CPR Immediately

Better chance of survival
Brain damage starts in 4-6
minutes
Brain damage is certain after 10
minutes without CPR

Do Not Move the Victim

Until CPR is Given and
Qualified Help Arrives

unless the scene dictates otherwise

threat of fire or explosion
victim must be on a hard surface
Place victim level or head slightly
lower than body

Even With Successful CPR,

Most Wont Survive Without
ACLS
ACLS (Advanced
Cardiac Life
Support)
ACLS includes
defibrillation,
oxygen, drug
therapy

Survey The Scene,

then: RAP

RResponsiveness

Tap shoulder and

shout Are you
ok?

RAP

A - Activate EMS ( if unresponsive)

YOU - call 911 come back and let me know

what they said (another can stay by the phone)
You may have to make the call

RAP

P - Position on back

All body parts rolled over at the

same time
Always be aware of head and
spinal cord injuries
Support neck and spinal column

When Can I Stop

CPR?

Victim revives
Trained help arrives
Too exhausted to continue
Unsafe scene
Physician directed (do not resuscitate orders)
Cardiac arrest of longer than 30 minutes
(controversial)

Checking for CPR

Effectiveness
Does chest rise and fall with rescue
breaths?
Have a second rescuer check pulse
while you give compressions

Why CPR May Fail

Delay in starting
Improper procedures (ex. Forget to pinch
nose)
No ACLS follow-up and delay in
defibrillation

Only 15% who receive CPR live to go home

Improper techniques

Terminal disease or unmanageable disease

(massive heart attack)

Injuries Related to CPR

Rib fractures
Laceration related to the
tip of the sternum

Liver, lung, spleen

Complications of CPR

Vomiting
Aspiration
Place victim on left side
Wipe vomit from mouth with
fingers wrapped in a cloth
Reposition and resume CPR

Stomach
Distension

Air in the stomach

Creates pressure against the lungs

Prevention of Stomach Distension

Dont blow too hard

Slow rescue breathing
Re-tilt the head to make sure the airway is open
Use mouth to nose method

Mouth to Mouth Barrier

Devices

Masks
Shields

If You Are Afraid to

Perform CPR
Call EMS
Open the airway
Give chest compressions

First Aid

Medical emergencies

Breathing difficulties

Anaphylaxisis

Asthma problems are increasing

Most have medicines
May need assist victim is administrating
If symptoms continue to get worse call 911
Severe reaction to allergen
Victim may have epinephrine injector
May need to administer
Call 911 if medicine is not administered

Seizures

General rules 1) Prevent injury 2) ensure open airway 3)

maintain open airway after seizure is completed place in
recovery position
Never try to restrain victim, place anything in the mouth.

Injury emergencies

Bleeding

Direct pressure best way

If bleeding continues add more gauze or cloth;
do not remove gauze or cloth
Use elastic bandage to apply pressure to
gauze and hold it in place.
The use of tourniquets should be avoided
unless in extreme matters
The efficacy of elevation and pressure points is
inconclusive; if used, use only in conjunction
with direct pressure and when there is no
apparent fracture or other underlying injury.

Wounds and abrasions

Irrigate wounds until free of any foreign
matter.
Small wounds and abrasions should be
cleaned thoroughly then have triple
antibiotic ointment placed on it and
covered.
Larger wounds need to also be cleaned
then covered and taken to doctor for
possible stitches

Burns

Thermal burns

Cool burn with cold water until pain ceases

Do not cool for more than 10 min. Can lead to further damage
Burn blisters cover with loose gauze, but keep intact breaking
them can lead to infection

Electrical burns

Make sure electrical current is shut off before trying to help

victim.
CPR and defibrillation may be needed as well as burn
treatment
All electrocution injuries should be checked out by a physician

Spine stabilization

Suspect possible spinal injury if

Car accident
Injured from fall greater than their height
Complains of neck pain, tingling, or extremity
weakness
Is not fully alert
Appears to be intoxicated
Appears frail or is >65 yrs old
Has sustained a head injury

- Manually stabilize the neck until help arrives.

Musculoskeletal trauma sprains, strains,

contusions, fractures

For sprains, strains, contusions apply ice for 20.

Sprains elevate and place compression bandage

R.I.C.E. rest, ice, compression, elevation
If victim has aversion to cold place wet cloth between ice
and skin

Young kids and elderly especially susceptible

Contusion you want to stretch the injury as well as

ice
If you are unsure of the injury suspect fracture do
not move or straighten injury. Place ice on area and
splint in position, send to ER.
If suspect dislocation splint as is and send to ER.

Dental injuries

Avulsed tooth
Hold onto by the crown not the root (part
embedded into gum
Rinse off with water (do not scrub)
Either place back into socket or place in
glass of milk and see a dentist immediately

Clean bleeding wound with saline

solution or tap water
Use cotton to apply pressure to stop
bleeding

Environmental injuries

Snakebite

Do not suck wound, it will only exasperate the problem

In case of Coral snake wrap a bandage around the extremity of the
bite it will help slow the poison then get to medical facility
immediately.
Coral snake bites and sucks
Other snake bites, wash area with soap and water, try not to move
extremity very much and get to medical facility.

Cold injuries

Hypothermia

Immediately begin re-warming remove wet clothes and wrap body surface
with anything at hand; get to medical facility immediately
If far from medical facility you begin active warming placing near heat
source, placing in warm (not hot) water.

Frostbite

Remove wet clothing, usually occurs on extremities, do not re-warm if there

is any chance it could freeze again or you are close to a medical facility.
Use luke-warm water if you are far from medical facility

Heat Injuries

Heat cramps muscle cramping, usually due to extreme loss

of fluids

Heat exhaustion

Get to cooler area

Replace fluids
Ice and stretch area

Dizziness, could have flushed skin or cool and clammy,

disoriented, nausea, headache
Get victim to cool area immediately
Place ice on side of neck (carotid artery), arm pits, and groin area
Replace fluids
Watch for shock; could lead into heat stroke

Heat Stroke medical emergency call 911 immediately

Extreme disorientation, possible unconsciousness, very little

sweating, internal temperature of >105.
Cool down by any means

Drowning
Get victim out of water as soon as possible
Begin CPR immediately
If you are alone finish five cycles of CPR
before calling 911

Poisons

Poison control center 1-800-222-1222

Chemical Burns

Brush off any powder and remove all

contaminated clothing
Alki or acid exposure rinse with copious
amounts of water.

Ingested poisons

Do not ingest any medication; milk, activated

charcoal, syrup of ipecac unless instructed by
poison control

Shock

Develops when there is not enough blood flowing to the cells of the
body
Causes in adults;

Symptoms

loss of blood
heart attack,
allergic reaction

feel cold and shiver,

feel weak, faint, or dizzy,
restless,
vomit,
feel thirsty

Treatment

Call 911
Put victim on their back
If not leg injury or pain raise legs 12 inches
Cover victim with blanket
If bleeding is visible use direct pressure