CPR & AED

1. CPR & AED Level C Cardiopulmonary Resuscitation & Automated External Defibrillator

2. Course Outline • Welcome, Introductions, Administration • Mission & Vision • Good Samaritan Act & Legal Issues • Disease Transmission & Barrier Devices • The heart • Risk Factors for Heart Disease • Stroke, T.I.A, Angina and Heart Attack • Adult Cardiopulmonary Resuscitation (CPR) • Recovery Position • Infant and Child CPR • Choking • Cardiac Arrest Information • Heart Rhythms • Automated External Defibrillator (AED) • Quiz • Questions and Wrap Up

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4. Five Common Fears Doing the wrong thing / making things worse Getting sued Personal safety Diseases Dealing with blood / gross situations

5. The Good Samaritan Act • Identify yourself • Ask Permission • Act Reasonable (no cutting, sewing or poking) • Stay with victim

6. Legal Issues • Once you initiate aid to a victim, you must continue CPR unless: • It is necessary in order to activate EMS (infant CPR sequence) • Someone with equal or greater training takes over • Continuing to provide assistance would be unsafe • You are physically exhausted

7. Legal Issues • Consent must be obtained from a victim before a rescuer can provide assistance. • Consent is implied if; • Victim is unconscious • Victim is under 18 yrs of age and no guardian is available • The victim is intoxicated or delusional, or the rescuer at least believes they are

8. Disease Transmission / Barrier Devices Barrier devices are typically available as a face shield or face mask. A face mask is ideal as it reduces exposure to the rescuer (a face shield does not reduce risk as much as a face mask).

9. The Human Heart The function of the heart is to circulate (pump) blood throughout the body to provide oxygen and nutrients and to remove waste products.

10. The Human Heart The heart has four chambers

11. The Human Heart The heart's electrical system controls the synchronized and rhythmic pumping efficiency of the heart. The Heart’s Electrical Path

12. The Human Heart Problems with the heart's electrical system can cause heart rhythm disorders that may lead to sudden cardiac arrest (SCA).

13. What is the number one killer of north americans? 13

14. Risk Factors • Diabetes • Age • High Blood Pressure • Being Overweight • Gender • High Blood Cholesterol • Excessive Alcohol Consumption • Family History • Physical Inactivity • Smoking • Stress

15. Risk Factors Not preventable • Age • Gender • Family History Preventable • Diabetes • High Blood Pressure • High Blood Cholesterol • Being Overweight • Excessive Alcohol Consumption • Physical Inactivity • Smoking • Stress

16. Signs and Symptoms Signs: A sign is an objective indication of something that is typically detected by a physician; a sign is discovered by a physician. Symptoms: A symptom is a subjective indication of something that is typically reported by a patient; a symptom is experienced by a patient.

17. Heart Attack, Angina & Cardiac Arrest Angina: a disease caused by the narrowing of the coronary artery. Heart Attack: death to an area of the HEART muscle due to a lack of oxygen. Cardiac Arrest: complete cessation of cardiac activity (heartbeat).

18. Heart Attack

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20. Stroke & TIA Ischemic Stroke Ischemic stroke is a life-threatening event in which part of the brain does not receive enough oxygen, usually due to a blood clot lodged in a cerebral artery.

21. Stroke & TIA Signs and Symptoms • numbness • sudden weakness • trouble speaking • vision problems • severe headache • dizziness

22. Assess Environment • Check for hazards (ladder, glass, chemicals, etc.) • What is the risk to you? What, if any, further risk is there to the victim? • What happened? • How many victims are there? • Is the scene changing? • Is there an AED or First Aid kit close by?

23. Determine Responsiveness Shout or speak loudly to victim and ask if they are okay. Squeeze or pinch shoulders.

24. Activate EMS

25. Activate EMS • Provide the dispatcher with the number of victims, age, gender condition and location of emergency. • Stay on line until the dispatcher tells you it is okay to hang up. • If a bystander calls EMS, ask them to report back to you to ensure that EMS has been activated. • Ask dispatcher the estimated timeof arrival for EMS.

26. Utilizing Bystanders • Phone EMS • Wait for EMS • AED available • Remove hazards from scene • Crowd control • Get supplies (e.g., blankets) • Protect victim’s belongings • Write down details of incident

27. Open Airway Perform a head tilt, chin lift by placing the heel of one hand on the victim’s forehead, and the fingers of the other hand under victim’s chin. Tilt head back to allow airway to open.

28. Check for Breathing A victim that is gasping for air is not considered “breathing”. Place your ear over the victim’s mouth and nose to allow you to be able to listen and feel for exhaled air (5 sec). Watch the victim’s chest to see if there is any movement.

29. Recovery Position While a victim is in the recovery position, you are able to continually reassess his or her status, check vitals, and maintain an open airway. An unconscious adult or child who is breathing and has no other life threatening emergencies should be placed in the recovery position.

30. Compressions • Place heel of one of your hands on the victim’s chest. • Centre this hand between the victim’s nipples. • Place your other hand on top of this hand (one or two hands depending on the size of the child). • Push hard and fast (rate should be 100 compressions per minute). • Count “one and, two and, three and”, etc. • Be sure to allow chest to come back to normal position between compressions.

31. Compressions • Landmarking for compressions is just between the nipples of the victim. • Compression depth should be 5 cm, or 2 inches. • Aim for ~100 compressions every minute, or just under two compressions per second.

32. Rescue Breathing • Allow chest to return to normal position before providing next breath. PRACTICE Seal victim’s mouth and pinch the nose closed. Give two normal breaths (allow each breath to be delivered over one second). Ensure the victim’s chest rises.

33. Adult CPR (One Rescuer Sequencing) • Assess environment • Determine unresponsiveness • Activate EMS • Attempt to get AED • Open airway • Check for breathing • Landmark and begin compressions • Provide two rescue breaths • 30 compressions:2 breaths until EMS arrives or victim responds to treatment

34. Child CPR: Differences Depth of compressions is 1/3 the depth of the chest. One or two hands depending on the size of the child. Five cycles of compressions and breaths are performed before activating EMS.

35. Infant CPR: Differences • Breaths are puffs and mouth and nose are sealed with your mouth. • Five cycles of compressions and breaths are performed before activating EMS. Scratch foot to determine responsiveness. Compression depth is 1/3 the depth of the chest. Two fingers used for compressions (just below nipple line).

36. Choking Unable to speak Unable to cough Hands at throat Face changing colour

37. Choking Conscious Adult or Child Determine severity of obstruction. If mild, encourage coughing and reassure victim. If severe, shout for help, start cycles of 5 back blows and 5 abdominal thrusts until airway is clear, or victim becomes unconscious.

38. Choking Unconscious Adult or Child • Assess environment • Determine responsiveness • Activate EMS • Attempt to obtain AED • Open airway • Assess breathing • Landmark and provide 30 chest compressions • Look in mouth for object (remove only if object seen) • Give one rescue breath, if it fails reposition head and try again • Repeat sequence until successful or EMS arrives

39. Choking: Infant Conscious to Unconscious Determine severity of obstruction. Perform five back blows followed by five chest thrusts. Continue until airway becomes clear or victim becomes unconscious. If the infant becomes unconscious begin the infant CPR sequence.

40. Sudden Cardiac Arrest Sudden cardiac arrest occurs when the heart's electrical system malfunctions and the heart stops beating.

41. Did you Know… More than 35,000 Canadian lives are lost each year due to cardiac arrest. Defibrillation improves survival rates by up to 30 % if delivered in the first few minutes. With each passing minute, the probability of survival declines by 7 to 10%. Making defibrillators easily accessible has the potential to save thousands of lives.

42. Did you Know… • Ventricular tachycardia (VT), a dangerously fast rhythm in the lower two chambers of the heart. • Ventricular fibrillation (VF), a rapid and chaotic quivering of the ventricles, which can be triggered by episodes of VT. In SCA, ventricular tachycardia or ventricular fibrillation causes the heart to beat too fast.

43. Did you Know… Normal Sinus Rhythm Sinus arrhythmia refers to the normal increase in heart rate that occurs when you breathe in.

44. Did you Know… Ventricular tachycardia (VT)An abnormal contraction of the ventricles that lead to ventricular fibrillation and sudden death.

45. Did you Know… When the heart is in fibrillation, there is no effective blood being supplied from to any part of the body, breathing stops and cardiac arrest occurs. Ventricular fibrillation (VF)A chaotic heartbeat that often precedes cardiac arrest.

46. Did you Know… • VF is the most common cause of sudden cardiac arrest (SCA)! • The only definitive treatment for SCA is defibrillation - an electric current that "shocks" the heart so that a normal rhythm may resume. Ventricular fibrillation (VF)

47. Did you Know… Asystole (Flat Line)A flat line means the person's heart has stopped altogether.

48. What is an AED? An Automated External Defibrillator (AED) is a machine that can monitor heart rhythms. It can tell if the heart has stopped beating effectively. If required, the machine can then deliver an electric shock to the heart.

49. What is an AED? • The AED does not take the place of CPR. • The AED’s function is to correct the underlying rhythm when the heart is in V-Fib. • CPR's function is to circulate blood and oxygen throughout the body. Do AED units replace the use of CPR?

50. What is an AED? Not everyone can be saved from SCA, even with defibrillation. But early defibrillation, especially when delivered within three minutes of a person's collapse from SCA, does provide the best chance.