CPR Chapter Two

1.) Hands-Only CPR: Usually a single rescuer who only performs chest compressions. The rescuer has little to no training. 2.) 30:2 CPR: Rescuer(s) perform chest compressions and rescue breaths, there is usually moderate training. 3.) Multirescuer Coordinated CPR: A high-performance team who is severely trained and has the ability to use equipment (AED, pocket mask, bag mask) when performing CPR efforts.

Chest compression, airway, and breathing.

1.) Verify scene safety. 2.) Check the victim for responsiveness. Tap the victim's shoulder and shout, "Are you OK?" 3.) If the victim is unresponsive, shout for nearby help. 4.) Activate the emergency response system. 5.) If you are alone, leave the victim's side to obtain the AED/defibrillator and emergency equipment. If someone else is available, send that person to get it.

Hospital: Activating a specific hospital code, medical emergency team, or rapid response team. Prehospital: Activating EMS, paramedics, medical units, or advanced life support, or calling for backup. Workplace/Facility: Calling 9-1-1 or activating specific Occupational Safety, and Health Administration or workplace emergency response protocols.

Assess for breathing and a pulse.

They should assess a victim's breathing and pulse simultaneously, as this will minimize delay in starting CPR. Doing so should take no more than ten seconds.

To assess a victim's breathing, the rescuer must scan the victim's chest for rise and fall for no more than ten seconds. It is important to note that gasping does not count as normal breathing.

To assess an adult victim's pulse, the rescuer must palpate a carotid pulse.

An abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. This is not considered to be normal breathing, and may be a sign of cardiac arrest. This may sound like a snort, snore, or groan.

1.) Locate the trachea (on the side closest to you), using 2 or 3 fingers. 2.) Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse. 3.) Feel for a pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse, begin CPR, starting with chest compressions.

If the victim is breathing normally and a pulse is present, then monitor the victim. If the victim is not breathing normally but a pulse is present, the provide rescue breathing (checking for a pulse every two minutes). If the victim is not breathing normally and does not have a pulse, then begin high-quality CPR. When the AED becomes available, use it as prompted. Return to CPR until EMS takes over or victim begins to move.

Each time chest compressions are stopped, the blood flow to the heart and brain decreases significantly. It takes several compressions to resume this blood flow. Therefore, the more/longer interruptions in chest compressions, the lower the blood supply to the heart and brain is.

30:2

~ Compress at a rate of 100 to 120/min. ~ Compress the chest at least 2 inches (5 cm) on an adult. ~ Allow the chest to recoil (reexpand) completely after each compression. ~ Minimize interruptions in compressions. ~Refrain from moving victim until EMS arrives.

If the victim is on a soft surface- such as a mattress-, the force used to compress the chest will simply push the body into the soft surface. A firm surface allows compression of the chest and heart to create blood flow.

1.) Position yourself at the victim's side. 2.) Ensure that the victim is lying faceup on a firm, flat surface. 3.) Position your hands and body to perform chest compressions. ~ Put the heel of one hand in the center of the victim's chest, on the lower half of the breastbone (sternum). ~ Put the heel of your other hand on top of the first hand. ~ Straighten your arms and position you shoulders directly over your hands. 4.) Give chest compressions at a rate of 100 to 120/min. 5.) Press down at least 2 inches (5 cm) with each compression. Ensure that you push straight down on the victim's breastbone (sternum). 6.) At the end of each compression, make sure you allow the chest to recoil completely. 7.) Minimize interruptions to chest compressions.

Incomplete chest recoil reduces the filling of the heart between compressions and reduces the blood flow created by chest compressions.

If you have difficulty pushing deeply during compressions, put one hand on the breastbone to push on the chest. Grasp the wrist of that hand with your other hand to support the first hand as it pushes the chest. This technique is better for rescuers with joint conditions, such as arthritis.

The two methods for opening a victim's airway are the head tilt-chin lift and jaw thrust.

A jaw thrust, as it reduces the neck and spine movement. Switch to a head tilt-chin lift maneuver if the jaw thrust is unsuccessful.

1.) Place one hand on the victim's forehead and push with your palm to tilt the head back. 2.) Place the fingers of the other hand under the bony part of the lower jaw near the chin. 3.) Lift the jaw to bring the chin forward.

~ Do not press deeply into the soft tissue under the chin, as this might block the airway. ~ Do not close the victim's mouth completely.

Head tilt-chin lift.

1.) Place one hand on each side of the victim's head. You may rest your elbows on the surface on which the victim is lying. 2.) Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward. 3.) If the lips close, push the lower lip with your thumb to open the lips.

A barrier device is one type of personal protective equipment designed to protect rescuers from exposure to infection when in close contact with victims. Examples include pocket masks.

Extremely low.

A pocket mask is a device that is used for mouth-to-mouth breaths. A pocket mask usually has a 1-way valve which diverts exhaled air, blood, or bodily fluids away from the rescuer. The 1-way valve allows the rescuer's breath to enter in the victim's mouth and nose and diverts the victim's exhaled air away from the rescuer. It comes in three sizes: adult, child, and infant.

Because the rescuer can perform chest compressions and breaths without having to reposition themselves every time they have to change from compressions to breaths.

1.) Position yourself at the victim's side. 2.) Place the pocket mask at the victim's face, using the bridge of the nose as a guide for correct position. 3.) Seal the pocket mask against the face. ~ Using your hand that is closer to the top of the victim's head, place the index finger and thumb across the victim's mask. ~ Place the thumb of your other hand along the edge of the mask. 4.) Place the remaining fingers of your second hand along the bony margin fo the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. 5.) While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face.

The air we breathe in contains about 21% oxygen. The air we breathe out contains about 17% oxygen.

Because we use a relatively small amount of the oxygen we breathe, the air that the rescuer breathes out provides the victim with much-needed oxygen.

~ Deliver each breath over one second. ~ Note visible chest rise with each breath. ~ Resume chest compressions in less than ten seconds.

A bag-mask device is a type of barrier device used to provide positive-pressure ventilation to a victim who is not breathing or not breathing normally. It consists of a bag attached to a face mask. If the bag is self-inflating, a bag-mask device may be used with or without an oxygen supply. If not attached to oxygen flow, it provides about 21% oxygen from room air.

There are commonly three bag-mask device sizes- Infant (small), child (medium), and adult (large). The mask should extend from the bridge of the nose to the cleft of the chin. It should cover the nose and mouth but not compress the eyes. The mask contains a cup that should provide an airtight seal. If the seal is not airtight, ventilation will be ineffective.

1.) Position yourself directly above the victim's head. 2.) Place the mask on the victim's face, using the bridge of the nose as a guide for correct position. 3.) Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open. ~ Perform a head tilt. ~ Place the mask on the face with the narrow portion at the bridge of the nose. ~ Use the thumb and index finger of one hand to make a "C" on the side of the mask, pressing the edges of the mask to the face. ~ Use the remaining fingers to lift the angles of the jaw (3 fingers form an "E"), open the airway, and press the face to the mask. 4.) Squeeze the bag to give breaths (1 second each) while watching for chest rise. Deliver each breath over 1 second, whether or not you use supplementary oxygen.

When 2 rescuers use the bag-mask device, 1 rescuer opens the airway with a head tilt-chin lift (or jaw thrust) and holds the mask to the face while the other rescuer squeezes the bag. The first rescuer uses both hands to seal the mask to the patient's face and lift the jaw. The thumbs and index fingers of each hand forms a "C" to seal the mask against the face. The 3 remaining fingers of each hand form an "E," lifting both sides of the jaw into the mask. The rescuer should be careful not to press too hard on the mask, because that could push the patient's jaw down and block the airway.

During CPR, jaw thrust and bag-mask ventilation are more effectively performed when 2 or more rescuers are providing ventilation. One rescuer must be positioned above the victim's head and use both hands to open the airway, lift the jaw, and hold the mask to the face while the second rescuer squeezes the bag. The second rescuer is positoned at the victim's side.

1.) Verify that the scene is safe for the rescuers and the victim. 2.) Check for responsiveness. Tap the victim's shoulder and shout, "Are you OK?" 3.) If the victim is not responsive: The first rescuer assesses the victim and, if no mobile phone is available, sends the second rescuer to activate the emergency response system and retrieve the AED and emergency equipment. 4.) While the second rescuer is activating the emergency response system and locating the AED and emergency equipment, the first rescuer checks the victim for breathing and a pulse. This is done simultaneously and should not take more than ten seconds. 5.) If the victim is not breathing normally or is only gasping and has no pulse, immediately do the following: ~One rescuer begins high-quality CPR, starting with chest compressions. Remove or move the clothing covering the victim's chest so that you can locate the appropriate hand placements for compressions. This will also allow placement of AED pads when the AED arrives. ~ Once the second rescuer returns and 2- rescuer CPR is provided, rescuers should switch compressors frequently (about every 2 minutes or 5 cycles, typically when the AED is analyzing the rhythm) so that the CPR quality is not reduced because of fatigue. 6.) Use the AED as soon as it becomes available and follow the prompts. 7.) After shock delivery or if no shock is advised, immediately resume high-quality CPR, starting with chest compressions. Continue to provide CPR and follow the AED prompts until advanced life support providers take over or the victim starts to breathe, move, or otherwise react.

They should switch compressors after every five cycles of CPR (about every two minutes), or sooner if fatigued.

Rescuer One.) Location: At victim's side Duties: 1.) Make sure victim is faceup on a firm, flat surface. 2.) Perform chest compressions. ~ Compress at a rate of 100 to 120/min. ~ Compress chest at least 2 inches (5 cm) for adults. ~ Allow the chest to recoil completely after each compression. ~ Minimize interruptions in compressions (try to limit any interruptions in chest compressions to less than 10 seconds). ~ Use a compression-to-ventilation ratio of 30:2. ~ Count compressions out loud. 3.) Switch compressors about every 5 cycles or 2 minutes (or more frequently if fatigued). Take less than 5 seconds to switch. Rescue Two.) 1.) Maintain an open airway by using either ~ Head tilt-chin lift ~ Jaw thrust 2.) Give breaths, watching for chest rise and avoiding excessive ventilation. ~ Encourage the first rescuer to perform compressions that are deep enough and fast enough and to allow complete chest recoil between compressions. ~ When only 2 rescuers are available, switch compressors about every 5 cycles or 2 minutes (or more frequently if fatigued). Take less than 5 seconds to switch.