2011 SILVER CROSS EMS EMD MARCH CE EMERGENCY MEDICAL DISPATCHER.
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Transcript of 2011 SILVER CROSS EMS EMD MARCH CE EMERGENCY MEDICAL DISPATCHER.
OBJECTIVESReview background information on BLSProvide information on DOAsReview updated information on CPR for the
Adult, Child and Infant victims based on the AHA 2010 Guidelines for Heartsaver
Review procedures for assisting victims that are choking
Troubleshoot possible complications encountered during BLS
When the heart has stopped and the victim is not breathing, CPR is the answer.
Without a constant supply of blood, cells of the body will start to die. Brain damage
begins within 4 to 6 minutes after cardiac arrest. Within 8 to 10 minutes, the damage
may be irreversible. Cardiopulmonary resuscitation will help to circulate oxygenated blood until more advanced medical care can
be performed.
CPRCPR by itself cannot sustain life
indefinitely.
It should be started as soon as possible to give the patient the best chance for survival.
Many patients will need defibrillation and medication to be successfully resuscitated.
It’s all part of the process………….
The Chain of Survival The links in the Chain of Survival include:
Early recognition of cardiac arrest and activation of the 9-1-1 system
Early bystander (or EMD assisted) CPREarly defibrillation by EMRs or other EMS
personnelEarly advanced care by paramedics and
hospital personnel
Possible DOASigns of death
Decapitation: The head is separated from the rest of the body.
Rigor mortis: Temporary stiffening of muscles occurs several hours after death.
Evidence of tissue decomposition: Actual flesh decay occurs only after a person has been dead for more than one day.
Dependent lividity: Red or purple color occurs on the parts of the patient’s body that are closest to the ground.
When to Start CPR CPR should be started on all non-breathing,
pulseless patients, unless they are obviously dead or have a DNR order. (Responders will need to see a valid copy of the order to honor it.)
It is better to start CPR on a person that is later declared dead by a physician than to withhold CPR from someone that could have been saved.
When in Doubt, Resuscitate!
When to Stop CPR (1 of 2)Discontinue CPR only when:
Effective spontaneous circulation and ventilation are restored.
Resuscitation efforts are transferred to another trained person who continues CPR.
A physician orders you to stop.The patient is transferred to properly trained
EMS personnel.
When to Stop CPR (2 of 2)Discontinue CPR only when: (cont’d)
Reliable criteria for death are recognized.You are too exhausted to continue
resuscitation, environmental hazards endanger your safety, or continued resuscitation would place the lives of others at risk.
AHA 2010 RecommendationsAdult (HS 1 Rescuer)
Unresponsive? Call for help & AED
Not breathing or only gasping (Agonal breaths)
Start compressions in the center of the chest between the nipples, at a rate of 100/min and a depth of at least 2 inches, allowing for chest recoil
• 30:2 Ratio of compressions to breaths
• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths
• When rescuers are untrained or not proficient, compressions only can be performed
• PUSH HARD & FAST
AHA 2010 RecommendationsChildren (HS 1 Rescuer)
Unresponsive?Not breathing or only
gaspingStart compressions in
the center of the chest between the nipples, at a rate of at least 100/min
and a depth of 2 inches or 1/3 chest diameter, allowing for chest recoil
• 30:2 Ratio of compressions to breaths
• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths
• After 5 cycles or 2 minutes, call for help, continue cycles
• When rescuers are untrained or not proficient, compressions only can be performed
• PUSH HARD & FAST
AHA 2010 RecommendationsInfant (HS 1 Rescuer)
Unresponsive?Not breathing or only
gaspingStart compressions in
the center of the chest between the nipples, at a rate of at least 100/min
and a depth of 1 1/2 inches or 1/3 chest diameter, allowing for chest recoil
• 30:2 Ratio of compressions to breaths
• After 30 compressions, open the airway with a head tilt-chin lift and deliver 2 breaths
• After 5 cycles or 2 minutes, call for help, continue cycles
• When rescuers are untrained or not proficient, compressions only can be performed
• PUSH HARD & FAST
GENERAL INFO Make sure victim is on a firm, flat surfaceMinimize interruptions to chest
compressions, 1o seconds or lessWatch for chest rise with breathsAttach AED as soon as it is available and
follow the prompts Resume compressions immediately after
administering a shock30 compressions should be given over
approximately 18 seconds (think of the tune Staying Alive)
Recovery Position If the victim is unconscious but breathing: Roll the patient onto one side, as you support
the patient’s head.Place the patient’s face on his or her side so
any secretions drain out of the mouth and the tongue won’t block the airway.
Is It Working?The victim’s color should improve
The chest should be rising with each breath
The compressions and breaths are delivered at the appropriate rate and depth
Possible Complications Broken ribs
Check hand placement and continueGastric Distension (air in the stomach)
Can happen if the airway is not open, re-tilt headMake sure breaths are not given too forcefully or too
fast, give over 1 second each and allow for exhalationGive breaths only until the chest risesBe alert for vomiting and keep airway clear
Chest does not riseReposition head and try breath again. If it’s still not
rising go right to compressionsVictim breathes through a stoma (opening in the neck)
If the chest does not rise with breaths, cover mouth and nose for possible air leakage
Causes of Airway Obstruction The most common airway obstruction is the
tongue.If the tongue is blocking the airway, the head
tilt–chin lift maneuver performed on the unconscious victim should open the airway.
Food is the most common foreign object that causes an airway obstruction.If a foreign body is lodged in the air passage,
you must use other techniques to remove it.
Are you choking?Mild Obstruction
Victim is able to cough or is gagging
Victim is able to speak and breath
Encourage victim to cough and monitor them in case the airway becomes blocked
Severe ObstructionVictim has
ineffective coughVictim is unable to
speak or breathVictim is displaying
the Universal Sign for choking
Prepare to help victim
Management of Foreign Body Airway Obstructions
Airway obstruction in an adult or childIf the victim is conscious, stand behind them and
perform abdominal thrusts.If the victim is obese or pregnant, stand behind
them and perform chest thrusts instead of abdominal thrusts.
If the victim becomes unresponsive:Ensure that the EMS system has been activated.Perform CPR, remembering to check the mouth for
foreign objects before each breath.
Steps for Managing Airway Obstruction in a Conscious Adult or Child
1. Look for signs of choking.
2. Place your fist with the thumb side against the patient’s abdomen, just above the navel.
3. Grasp the fist with your other hand and press into the abdomen with quick inward and upward thrusts.
Management of Foreign Body Airway Obstructions (continued)
Airway obstruction in an infant Use a combination of 5 back slaps (with the heel
of your hand between the shoulder blades) and 5 chest thrusts (with 2 fingers between the nipples on the center of the chest), alternating, until the object is expelled or the victim becomes unconscious.
If the infant becomes unresponsive:Ensure that the EMS system has been activated.Begin CPR, remembering to check the mouth for
the foreign object before each breath.
FYIThe flipcharts will be updated to reflect the new
changes, in the near future. Until then, use the protocol that you’re currently using.
Your current CPR cards are good until the expiration dates printed on the card. Recommended renewal is every 2 years.You previously learned the same skills, the order
has just changed to C-A-B.Hands Only CPR will be encouraged for the lay
rescuer with no training or is not proficient in the skills
For further information on CPR visit the American Heart Association’s website www.heart.org/cpr