BASIC LIFE SUPPORT (Cardiopulmonary Resuscitation) REVISED STUDY GUIDE (2010 AHA Guidelines) NAME INSTRUCTOR COURSE DATE IT IS NOT THE INTENT OF THIS SUPPLEMENTAL INFORMATION PACKET TO REPLACE THE AMERICAN HEART ASSOCIATION TEXTBOOK. IT IS STRONGLY RECOMMENDED THAT THE STUDENT ACQUIRE THE APPROPRIATE TEXTBOOK IN CONJUNCTION WITH THIS TRAINING PROGRAM. TEXTBOOKS CAN BE OBTAINED AT WWW.EXTENDLIFE.NET OR FROM AN AUTHORIZED AMERICAN HEART ASSOCIATION DISTRIBUTOR. EXTENDLIFE, INC 2012 ALL RIGHTS RESERVED
Heart Attack & Stroke Chart Heart Attack (a.k.a. myocardial infarction) Death of heart muscle due to lack of oxygen. Chest Painuncomfortable pressure, squeezing, tightness. May spread to shoulder, neck, and arms. Sweating, nausea/vomiting, shortness of breath, weakness, denial Lack of exercise High blood pressure Cigarette smoking Obesity (Poor Diet) Diabetes Gender Heredity Age High cholesterol levels Stress Have victim sit or lie down in a comfortable position.!call EMS IMMEDIATELY! Reassure victim and prevent them from exerting themselves. Perform CPR if necessary. And Definition Signs & Symptoms Risk Factors Actions for Survival Stroke (a.k.a. cerebro vascular accident) Blockage of blood flow to the brain. Slurred speech, dizziness, unsteadiness, double vision. Intense, sudden headache. Numbness to one side of body, affecting arm and/or leg. Decreased level of consciousness. Facial Droop Lack of exercise High blood pressure Cigarette smoking Obesity (Poor Diet) Diabetes Gender Heredity Age High cholesterol levels Stress TIA's (transient ischemic attacks) Previous stroke Have victim sit or lie down in a comfortable position.!call EMS IMMEDIATELY! Reassure victim and prevent them from exerting themselves. Perform CPR if necessary.
2010 CPR and AED Guidelines Healthcare Professionals The following CPR steps are the same for all motionless victims with 1 rescuer present: Check Responsiveness Call for Help Check the Carotid Pulse for a Heartbeat simultaneously scan the body for signs of breathing (chest rise, coughing, noise) If breathing, place in the Recovery Position. If NOT breathing and no pulse is detected begin 30 chest compressions followed by two breaths aprox. 2 to 5 seconds apart. Continue this process for 2 minutes (5 cycles) Interrupt compressions as infrequently as possible. Limit interruptions to 10 sec. If pulse is definitely present but NO breathing, provide rescue breathing only (1 breath every 5-6 seconds for adults 3-5 seconds for pediatrics) If a breath does not make the chest rise, re-tilt the head and try another breath. If the breath does not make the chest rise, assume an obstructed airway. Give cycles of 30 chest compressions and 2 breaths. Look for an object in the mouth each time you give breaths. Remove any object you see.
Pre-Adolescence (Child) CPR & Choking Pre-Adolescence breathing Shake victim Very Gently and shout, "Are You OK?" Tell someone to call 911. If alone, yell for help! Carefully tilt forehead back and lift chin. Check breathing for five (5) seconds. Look, listen, and feel. If not breathing, give two (2) slow breaths. Check for pulse for ten (10) seconds on neck with two fingers. If pulse present, give one breath every three to five (3-5) seconds. If no pulse, start CPR. Pre-Adolescence CPR Shake victim Very Gently and shout "Are You OK?" Tell someone to call 911. If alone, yell for help! Carefully tilt forehead back and lift chin. Check Breathing for Five (5) seconds. Look, listen, and feel. If not breathing, give two (2) slow breaths. Check pulse for ten (10) seconds. If no pulse, start CPR. Compress chest thirty (30) times and give two (2) breaths. Compress with 1or 2 hands on chest. Conscious choking Ask "Are You Choking?" If child can cough, speak, or breathe, encourage victim to cough only. If victim cannot speak or breathe... Perform abdominal thrusts until object comes out or until victim becomes unconscious. If victim becomes unconscious, lower to floor, perform unconscious maneuver First look in mouth, and sweep only if you can see object. Try to give two breaths, if unsuccessful Perform up to five abdominal thrusts placing heel of hand below rib cage. Perform mouth sweep only if object is seen and repeat cycle of breaths and thrusts. Poison Control 1-800-222-1222 For emergencies (in the U.S.) call 911
Infant CPR & Choking Breathing Infant CPR Infant Choking Tap baby's feet and shout "Are You OK" If alone, yell for help! Carefully tilt forehead back and lift chin. Open airway only slightly. Check breathing for five (5) seconds. Look, listen, and feel. Give two (2) slow puffs. Place your mouth over nose and mouth of baby. Check for pulse for ten (10) seconds on the inside of upper arm against bone. If pulse present, give one puff every three (3) seconds for one minute. Tap baby's feet and shout "Are You OK" If alone, yell for help! Carefully tilt forehead back and lift chin. Open airway only slightly. Check breathing for five (5) seconds. Look, listen, and feel. Give two (2) slow puffs. Place your mouth over nose and mouth of baby. Check for pulse for ten (10) seconds on the inside of upper arm against bone. If no pulse, start CPR. Do 5 cycles of thirty (30) compressions and two (2) puffs for two minutes, then call 911 If baby makes no noise, doesn't cry but is trying to, face is turning blue... Supporting head, neck, and chest with one arm and baby s face towards floor... Perform up to five (5) back slaps. Then, with opposite arm, support head, neck, and back. Perform up to five (5) chest thrusts using two (2) fingers on baby's chest. Continue cycle of back slaps and chest thrusts until baby begins to cry or becomes unconscious If baby becomes unconscious, check mouth, give two (2) puffs; give back slaps and chest thrusts. Repeat. When performing back slaps and chest thrusts, keep baby's head lower than body Choking unconscious Tap baby's feet and shout "Are You OK" If alone, yell for help! Carefully tilt forehead back and lift chin. Open airway only slightly. Check breathing for five (5) seconds. Look, listen, and feel. Attempt to give two (2) slow puffs. If they don't go in, reattempt. Perform back blows and chest thrusts, check mouth, attempt puffs. Repeat. If the first puff doesn't go in, reposition the airway and try again.
Complications of CPR Vomiting is the most frequently encountered complication of CPR. If the victim starts to vomit, turn the head to the side and try to sweep out or wipe off the vomit. Continue with CPR. The spread of infection from the victim to the rescuer is exceedingly rare. Most cardiac arrests occur in people's homes - relatives or friends will be the ones needing to do CPR. Even CPR performed on strangers has an exceedingly rare risk of infection. There is NO documentation of HIV or AIS ever being transmitted via CPR. Checking the Pulse The pulse check is now an option with lay rescuers. Instead, if you see no signs of life (defined as breathing normally, coughing or moving) you should begin to pump on the chest. Please note that the pulse check is still expected of health care providers. Heart Attack A Heart Attack (Myocardial Infarction or MI) occurs when a coronary artery is completely obstructed and no blood flows past the obstruction. As a result, that part of the heart muscle dies. This obstruction is caused by a clot and occurs in an artery that previously had an atherosclerotic plaque. According to the American Heart Association, more than one million heart attacks occur per year in the U.S. Some people think that every episode of chest pain or angina is actually a heart attack. This is not correct; angina is reversible and does not cause death of the heart muscle cells. Some people think that when you have a heart attack your heart stops beating. Although heart attacks can lead to this, the proper term for when the heart stops beating is cardiac arrest.
CPR for Cats & Dogs CPR for cats and dogs is similar to CPR for humans These directions assume the animal is unconscious and the risk of being bitten by the animal is not present 1. First open the mouth and make sure the air passage is clear. Remove any obstruction. 2. Next extend the head and give several artificial respirations: a. For large dogs: close the animal's jaw tightly and breathe into the nose. The animal's chest should rise. b. For small dogs and cats you may be able to cover the nose and mouth with your mouth as you breathe. The animal's chest should rise. c. The rate of breaths depends on the size of the animal i. Dogs over 60 lbs: 10 breaths per minute ii. Animals 11 to 60 lbs: 15 breaths per minute iii. Animals 10 lbs or less: 20 breaths per minute 3. Next perform chest compression a. For large dogs you may be able to position the dogs on its back and compress the chest just like for humans. b. For small dogs, and cats, as well as large dogs with funnel chests, you may need to lay the animal on its side and compress the side of the rib cage. Alternatively you can position the animal on its back and press on both sides of the rib cage. c. The rate of chest compressions varies with the size of the animal i. Dogs over 60 lbs: 100 compressions per minute ii. Animals 11 to 60 lbs:100 compressions per minute iii. Animals 10 lbs or less: 100 compressions per minute 4. Remember to alternate breaths with compressions: The ratio of compressions to breaths should be approximately the same as for humans: 30:2. Continue doing this until the animal responds or begins to breathe on its own.
Cardiac arrest and CPR Cardiac arrest and CPR: The American Heart Association (AHA) has revised and streamlined its guidelines for resuscitation of people whose hearts have stopped (cardiac arrest). People will no longer be taught to check the pulse of a collapsed person before starting chest compressions and breaths, according to the AHA. Instead, the new guidelines advise checking for normal breathing, movement, and response to touch or questions when deciding whether cardiopulmonary resuscitation (CPR) is necessary. NOTE: The pulse check is now optional. Studies have shown that people who perform CPR are incorrect in their judgment about the presence of a pulse at least 35 percent of the time, according to Vinay Nadkarni, M.D.; chairman-elect of the AHA committee that sets guidelines for emergency cardiac care. Each year in the United States, an estimated 225,000 episodes of sudden cardiac arrest occur outside a hospital, according to AHA president Rosemarie Robertson, M.D., and only 5 percent of people survive. Sudden cardiac arrest occurs when the heart's electrical signals are disrupted. The heart stops beating, or it starts to quiver (ventricular fibrillation). Blood is not pumped to the brain or other vital organs, resulting in collapse and, without prompt treatment, death. A heart attack is not the same as sudden cardiac arrest. A heart attack is the death of heart muscle. Sudden cardiac arrest may be brought on by a heart attack or a drug overdose, or it may result from an accident such as electrical shock or near drowning. The AHA guidelines simplify CPR. Previous instructions varied the ratio of chest compressions and breaths according to the number of rescuers. The new 2005 guidelines say that people giving CPR should perform 30 chest compressions for every 2 breaths regardless of the age of the victim or the number of rescuers involved. The exceptions are newborns (up to 30 days of age) and 2 rescuers with a child victim. The guidelines also call for widespread distribution of portable devices called external defibrillators in ambulances, fire trucks, police cars, public buildings, sports arenas, theaters, airports and airplanes. These computerized units quickly sense whether the heart has stopped and deliver a jolt of electricity to restore the heart's natural rhythm. CPR followed by defibrillation within 2 to 3 minutes of collapse has produced survival rates of up to 50 percent in some studies, Dr. Nadkarni says. With each minute of delay, chance of survival decreases by 7 percent to 10 percent.
What is an Automated External Defibrillator? An automated external defibrillator, called AED for short, is a machine about the size of a laptop computer that delivers a potentially life-saving shock to a person whose heart stops beating with no warning (sudden cardiac arrest). Recent technological advances have made it possible for people with minimal training to provide lifesaving defibrillation using these machines. Do people need shocks of this kind? Sudden cardiac arrest is the leading cause of death in the United States, claiming more than 350,000 lives each year. That's almost a thousand people every day! What causes a sudden cardiac arrest? The most common cause of sudden cardiac arrest is ventricular fibrillation, a rapid chaotic heartbeat that stops blood flow through the heart. Without treatment, death soon follows. How do you treat it? The best treatment for ventricular fibrillation is an electric shock delivered to the heart. The shock, called defibrillation, often stops the heart's chaotic beating, thus allowing it to return to its normal rhythm. AEDs are programmed to deliver such shocks only when needed. You don't have to make the decision. Why should people have an AED in their community or company? To save lives. Does it really work? Of cardiac arrest victims in ventricular fibrillation who received a shock to the heart within a minute or two of collapse, 85 percent survived to be discharged from the hospital. Without any such shock, a victim's chances of survival decrease 7 to 10 percent for each minute lapsed. To make early defibrillation an effective life-saving measure, several steps are essential. The American Heart calls this the Chain of Survival.
The Automated External Defibrillator (AED) FACTS Automated External Defibrillators (AEDs) An AED is a small, portable device that analyzes the heart's rhythm and prompts the user to deliver a defibrillation shock if it determines one is needed. Once turned on, the AED guides the user through each step of the defibrillation process by providing voice and/or visual prompts. AEDs are specially designed for easy use by a "first responder," someone who would be the first person to typically arrive on the scene of a medical emergency. A first responder can be an emergency medical services worker, a firefighter or police officer, or it can be a layperson with minimal AED training. Time to defibrillation, the most critical factor in sudden cardiac arrest (SCA) survival, can be reduced if an AED is "on-site" and can be brought to the victim quickly. This is one of the reasons that survival rates improve in communities with active AED programs. Remember, every minute that passes before defibrillation reduces survival rates by 7-10 percent. The goal is to improve SCA survival rates. On-site AEDs can make the difference. How does an AED work? Once an AED is turned on, it provides prompts to guide the user through the process. One of the first prompts instructs the user to connect the AED to the victim via the adhesive electrodes (pads) placed on the chest. The AED then analyzes the victim's heart rhythm through the electrodes using a built-in computer program. It then determines if a shock is "needed" or "necessary." More specifically: 1. The electrodes placed on the victim's body send the heart rhythm information (ECGs) to the AED. 2. The AED "reads" short segments of the heart's rhythm. It checks characteristics such as frequency, shape, slope, amplitude and heart rate. 3. Based on these characteristics, the AED determines whether a shock is needed and activates the appropriate user prompts. How does the shock "fix" SCA? The delivery of an electrical shock to a heart experiencing SCA briefly stops all electrical activity in the heart. This brief "break" from the previous electrical chaos can be enough for the heart to restart beating with a normal rhythm.
Not everyone can be saved from SCA even with defibrillation. However, early defibrillation, especially when delivered within three minutes of a person's collapse from SCA, does provide the best chance. If a shock is needed, the AED will prompt the user to press the button that delivers the shock. It will then advise to return to CPR for approximately 2 more minutes (30 compression and 2 breaths). The AED will re-analyze the heart rhythm to determine if more shocks are needed. If a shockable rhythm is not detected, the AED will prompt the user to check the victim for a pulse, and to perform CPR if needed. Who can use an AED? Almost anyone can learn to operate an AED with a few hours of training - no medical background is needed to use an AED. In fact, the American Heart Association says "AEDs are sophisticated, computerized devices that are reliable and simple to operate, enabling lay rescuers with minimal training to administer this lifesaving intervention" (a defibrillation shock), and "flight attendants, security personnel, sports marshals, police officers, firefighters, lifeguards, family members, and many other trained laypersons have used AEDs successfully." AEDs are designed to help people with minimal training safely use them in tense, emergency situations. They have numerous built-in safeguards and are designed to deliver a shock only if the AED detects that one is necessary. Their ease of use and built-in safety mechanisms make AEDs suitable for use in community or company-wide programs. Why should most public places have an AED? Early defibrillation with an on-site AED can be the difference between life and death. The time to the first defibrillation shock is the most critical factor in determining survival rates for sudden cardiac arrest. With every minute that goes by, survival rates decrease by about 10 percent. That leaves a window of 10 minutes in which to potentially save your life or the life of someone you know, after which survival rates average less than two percent. The best results for defibrillation occur in the first three minutes, measured from the moment the victim collapses to when the defibrillation shock is delivered. On average, it takes EMS teams in the United States 8 to 12 minutes to arrive. That's why having an AED readily accessible wherever groups of people gather makes good preventive sense. Early defibrillation is one of the American Heart Association's (AHA) four cornerstones in the Chain of Survival, which is now the worldwide guideline for response to sudden cardiac arrest. The AHA believes that early defibrillation could save as many as 50,000 lives each year. One of those lives could be yours, or that of someone for which you care. AEDs were introduced in 1979, and since that time hundreds of thousands of AEDs have been placed in police cars, airplanes, airports and bus terminals, hotels and casinos, sports arenas, high schools, manufacturing plants and other public places. The documented increase in survival rates at places with AED programs has raised public awareness about the importance of AEDs and the need for on-site accessibility.
Another important step came in 2000 when President Clinton signed the Cardiac Arrest Survival Act (CASA). Under CASA, the Federal government mandated the placement of AEDs in all federal buildings. CASA also provides immunity from liability for users and acquirers of AEDs. In addition to CASA, all 50 states have passed some form of "Good Samaritan" law, most providing protection for trained users of AEDs. The Federal Aviation Administration recently submitted rules requiring most commercial aircraft to be equipped with AEDs. In addition, the AHA is calling for widespread public access to AEDs, which "has the potential to be the single greatest advance in the treatment of VF cardiac arrest since the development of CPR." Isn't calling 911 enough? Emergency medical service (EMS) professionals and firefighters save many SCA victims each year, but a lack of equipment and time delays keep them from saving many more. Lack of equipment: Unfortunately, not every emergency vehicle carries a defibrillator, the only device that can treat sudden cardiac arrest. Lack of time: In some large metropolitan areas, an ambulance may not even get to the scene in fewer than 10 minutes due to traffic. Moreover, on average, it takes EMS teams in the United States 8-12 minutes to arrive. Therefore, even if an EMS team does have a defibrillator, the response time may not be fast enough to save a victim's life. Survival rates are highest for patients who receive a defibrillation shock within three minutes of collapse. This almost requires that an AED be on-site anywhere groups of people gather and that trained responders are available. Remember, 90-95 percent of all SCA victims die. Documented AED programs have shown that survival rates can rise to 80 to 85 percent when an AED program is in place. Waiting for medical professionals when someone is in sudden cardiac arrest could delay treatment - and could cost the person his or her life. EXTENDLIFE, INC 2012 All Rights Reserved
Extendlife Training Systems recommends you contact one of the AHA distributors listed below to obtain the many products and learning aids available including course textbooks, charts, brochures, and more Authorized American Heart Association Distributors Channing Bete Company One Community Place South Deerfield, MA 01373-0200 1-800-611-6083 www.channing-bete.com Laerdal Medical Corporation 167 Myers Corners Road P.O. Box 1840 Wappingers Falls, NY 12590 1-888-562-4242 www.laerdal.com WorldPoint ECC 1326 S. Wolf Road Wheeling, IL 60090 1-888-322-8350 www.worldpoint-ecc.com
NOTES