to PDF - cpr+first aid

to PDF - cpr+first aid
CPR Pro
for the Professional Rescuer
Student Handbook
L
TA
GI
DI
A n
T H sio
EN Ver
UD
ST line
On
OK
BO
ND
–
BLS for Healthcare Providers
CPR Pro
Student Handbook, Version 7.0
Purpose of this Handbook
This ASHI CPR Pro Version 7.0 Student Handbook is solely intended to facilitate certification in an ASHI CPR Pro training class. The information in this
handbook is furnished for that purpose and is subject to change without notice.
ASHI certification may only be issued when an ASHI-authorized Instructor
verifies a student has successfully completed the required core knowledge
and skill objectives of the program.
Notice of Rights
No part of this ASHI CPR Pro Version 7.0 Student Handbook may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying and recording, or by any information storage and retrieval system, without written permission from the American Safety & Health
Institute.
Trademarks
American Safety & Health Institute and the ASHI logo are registered trademarks of the American Safety & Health Institute.
American Safety & Health Institute
1450 Westec Drive
Eugene, OR 97402 USA
800-447-3177
E-mail: [email protected]
Visit our website at hsi.com/ashi
Copyright © 2011 by the American Safety & Health Institute.
All Rights Reserved. Printed in the United States of America.
First Edition—2011
American Safety & Health Institute is a
member of the HSI family of brands.
ISBN 978-936515-23-3
PRN2054 (9/11)
Table of Contents
Section 1 — Sudden Cardiac Arrest
Sudden Cardiac Arrest and Early Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chain of Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Personal Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rescue Breaths — CPR Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rescue Breaths — Bag-Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rescue Breaths — Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Primary Assessment — Unresponsive Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 1 — Chest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 2 — Rescue Breaths — CPR Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 3 — Rescue Breaths — Bag-Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 4 — Rescue Breaths — Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 5 — Primary Assessment — Unresponsive Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4
5
6
6
8
9
10
11
12
Section 3 — BLS Care
Unresponsive and Breathing — Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresponsive, Not Breathing, and Pulseless — CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 6 — Unresponsive and Breathing — Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 7 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Adult . . . . . . . . . .
Skill Guide 8 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Child . . . . . . . . . .
Skill Guide 9 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Infant . . . . . . . . . .
Skill Guide 10 — Unresponsive, Not Breathing, and Pulseless — CPR Adult . . . . . . . . . . . . . . . . . . . . .
Skill Guide 11 — Unresponsive, Not Breathing, and Pulseless — CPR Child . . . . . . . . . . . . . . . . . . . . .
Skill Guide 12 — Unresponsive, Not Breathing, and Pulseless — CPR Infant . . . . . . . . . . . . . . . . . . . . .
13
13
13
16
17
18
19
20
21
22
Section 4 — Defibrillation
Automated External Defibrillators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Basic AED Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Troubleshooting and Other AED Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 13 — Using an AED — Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 14 — Using an AED — Child and Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
23
24
25
26
Section 5 — Team Approach
Team Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 15 — Team Approach — Adult Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 16 — Team Approach — Chid or Infant Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BLS Adult Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BLS Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
28
29
30
31
Section 6 — Foreign Body Airway Obstruction
Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 17 — Choking — Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 18 — Choking — Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skill Guide 10 — Choking — Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table of Contents
CPR Pro for the Professional Rescuer
32
33
34
35
i
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Section 2 — BLS Skills
Table of Contents
Legal Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Good Samaritan Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abandonment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Duty to Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Assault and Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Starting CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stopping CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Advanced Directives and Living Wills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) Orders . . . . . . . . . . . . . . . . . . . . . . . .
37
37
37
37
37
37
37
38
38
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Emotional Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
References and End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Rate Your Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
ii
CPR Pro for the Professional Rescuer
Table of Contents
Section 1 — Sudden Cardiac Arrest
Sudden Cardiac Arrest and Early Defibrillation
Sudden cardiac arrest, or SCA, can occur without warning to anyone, at any time. It is one of the leading causes of death among
adults in the United States.
Each year, an estimated 295,000 out-of-hospital cardiac arrests in
the United States are treated by Emergency Medical Services, or
EMS. Many additional arrests occur and are treated in medical offices or hospitals.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Sudden cardiac arrest happens when the normal electrical impulses in the heart unexpectedly become disorganized. The normally coordinated mechanical contraction of the heart muscle is
lost, and a chaotic, quivering condition known as ventricular fibrillation can occur. Blood flow to the brain and vital organs abruptly
stops. The lack of blood and oxygen to the brain causes someone
to quickly lose consciousness, collapse, and stop breathing.
Brain tissue is especially sensitive to a lack of oxygen. When oxygen is cut off, brain death can occur quickly, within a matter of minutes. Without early recognition and care, the person will not survive.
Cardiopulmonary resuscitation, or CPR, allows a provider to restore
some oxygen to the brain through a combination of chest compressions and rescue breaths. By itself, CPR is only a temporary measure that can buy time until more advanced care can be provided.
The most effective treatment for ventricular fibrillation is defibrillation. To defibrillate, electrode pads are applied to the chest and an
electrical shock is sent between the pads through the heart. This
shock stops ventricular fibrillation so the heart’s normal electrical
activity can return and restore blood flow.
Successful defibrillation is often dependent on how quickly a patient is defibrillated. For each minute a patient is in cardiac arrest,
his/her chance of surviving decreases by about 10 percent. After
as little as 10 minutes, defibrillation is rarely successful. The amount
of time it takes to recognize a problem, activate EMS, and have
EMS respond and defibrillate is usually longer than 10 minutes. In
most cases, it’s too late.
Respiratory and Circulatory Systems
Because the human body cannot store oxygen, it must continually supply tissues and cells with oxygen through the combined actions
of the respiratory and circulatory systems.
The respiratory system includes the lungs and the “airway,” the passage from the mouth and nose to the lungs.
Expansion of the chest during breathing causes suction, which pulls outside air containing oxygen through the airway and into the
lungs. Relaxation of the chest increases the pressure within and forces air to be exhaled from the lungs.
The circulatory system includes the heart and a body-wide network of blood vessels. Electrical impulses stimulate mechanical
contractions of the heart to create pressure that pushes blood throughout the body.
Blood vessels in the lungs absorb oxygen from inhaled air. The oxygen-rich blood goes to the heart and then out to the rest of the body.
Large vessels called arteries carry blood away from the heart. Arteries branch down into very small vessels that allow oxygen to be
absorbed directly into body cells so it can be used for energy production. Veins return oxygen-poor blood back to the heart and lungs
where the cycle repeats.
Sudden Cardiac Arrest
CPR Pro for the Professional Rescuer
1
An automated external defibrillator, or AED, is a small, portable,
computerized device that is simple to operate. Turning on an AED
is as simple as opening a lid or pushing a power button. Once it is
on, an AED will provide voice instructions to guide you through its
use.
An AED automatically analyzes the heart rhythm, determines if a
shock is needed, and charges itself to be ready to defibrillate. An
operator simply pushes a button to deliver the shock when told to
by the AED.
In many cases of sudden cardiac arrest, if defibrillation could be
delivered sooner, more people would survive. Immediate, highquality CPR and early defibrillation with an AED can double or even
triple the chance for survival.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Chain of Survival
The Chain of Survival is used to describe the most effective approach for treating sudden cardiac arrest. It consists of five interdependent links:
• Immediate recognition and activation of EMS quickly initiates the treatment process.
• Early CPR with effective chest compressions buys time for
accessing an AED and improves the chance that defibrillation will work.
• Rapid defibrillation provides the best chance to return the
heart to a normal rhythm.
• Effective advanced life-support procedures and medications used by paramedics, nurses, or doctors help sustain
the chance for recovery and survival.
• And finally, integrated post-cardiac arrest care increases
the likelihood of long-term survival.
If any one of the links is weak or missing, the chances for survival are greatly reduced. The greatest chance for survival exists when all the links in the Chain of Survival are working together.
When describing treatment guidelines for children, someone younger than 1 year
of age is referred to as an infant. Someone between 1 year and the onset of puberty
is referred to as a child. The onset of puberty can be indicated by breast development in females and the presence of armpit hair in males. Anyone at or beyond puberty is considered an adult.
Cardiac arrest occurs less frequently in children and is usually the result of a blocked
airway or the loss of breathing, such as in drowning, choking, or a severe breathing
problem.
Without oxygen, the heart weakens and slows. A child can collapse and, by assessment, appear to be in cardiac arrest. If done early enough, ensuring an open airway
and providing effective rescue breaths as part of CPR can actually prevent cardiac
arrest from occurring. However, if cardiac arrest does occur, CPR and the application
of an AED is the appropriate care.
2
CPR Pro for the Professional Rescuer
Sudden Cardiac Arrest
The Chain of Survival for children includes the following links:
• Effective prevention of the typical causes for airway and
breathing emergencies, to reduce occurrence.
• Early CPR and defibrillation with an AED, to reverse the effects of a weakened heart.
• Prompt activation of EMS, to quickly get professional care.
• Rapid pediatric advanced life-support procedures and
medications used by paramedics, nurses, or doctors, to
help sustain the chance for recovery and survival.
• Integrated post-cardiac arrest care, to increase the likelihood for long-term survival.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Personal Safety
Emergency scenes are often unsafe. Your personal safety is always
the highest priority, even before the safety of a patient. Putting
yourself in danger to aid someone can make the situation worse.
Always pause for a moment before approaching an emergency and
look for obvious hazards. Consider the possibility of hidden dangers. If the scene is unsafe, do not approach. If the location you
are already in becomes unsafe, get out!
When caring for patients, you can be exposed to blood or other
potentially infectious body fluids. Infectious bloodborne diseases
include Hepatitis B, Hepatitis C, and HIV, the virus that causes
AIDS. While the risk of contracting a disease is extremely low, it is
prudent to take simple measures to avoid exposure in the first
place.
Reducing exposure reduces the risk of infection. “Universal Precautions” is an approach that recommends managing all blood and
other body substances as if they are infectious. Use protective barriers between yourself and an ill or injured patient. To be effective,
the approach is the same for everyone, regardless of relationship or
age.
Disposable gloves are the most commonly used barrier. Make sure
there is always a fresh supply of gloves available. If a patient requires rescue breaths, use a CPR mask with a one-way valve to
minimize direct mouth-to-mouth contact.
According to the Occupational Safety and Health Administration,
or OSHA, direct mouth-to-mouth contact is not advised for responding emergency personnel when providing rescue breaths.
Equipment designed to isolate providers from direct contact needs
to be made available to all personnel who potentially respond to
medical emergencies.
Sudden Cardiac Arrest
Latex Allergy
Natural rubber latex allergy is a serious medical problem.
Anyone who uses latex gloves frequently is at risk for
developing it. Simple measures such as the use of nonpowdered latex gloves or non-latex alternatives can stop
the development of latex allergy and new cases of
sensitization.i
Decontaminating Surfaces
Decontaminate all surfaces, equipment, and other
contaminated objects as soon as possible. Clean with a
detergent and rinse with water. Use a bleach solution of
one quarter cup (.06 liter) of household bleach per one
gallon (3.79 liters) of water to sanitize the surface. Spray
on the solution and leave it in place for at least 2 minutes
before wiping.
CPR Pro for the Professional Rescuer
3
Section 2 — BLS Skills
When breathing and circulation stop, there are two critical life-supporting skills you will learn to replace them: chest compressions
and rescue breaths.
Chest Compressions
If the heart stops, it is possible to restore at least some blood flow through the circulatory system by way of external chest compressions. The most effective chest compressions involve the rhythmic
application of downward pressure on the center of the chest. External compressions increase pressure inside the chest and directly
compress the heart, forcing blood to move from the heart to the
brain and other organs.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Compressions on adult patients are done at a rate of at least 100
compressions per minute. The chest is compressed at least two
inches on each compression.
High-quality compressions are a critical component of effective
CPR. Always compress fast and deep and allow the chest to rebound to its normal position at the top of each compression.
Blood pressure is created and maintained with well-performed
compressions. If compressions stop, pressure is quickly lost and
has to be built up again. Minimize any interruptions when doing
compressions.
When compressing properly, you may hear and feel changes in the chest wall. This is normal. Forceful external chest compression is
necessary if the patient is to survive.
The compression technique for children is to use the heel of a single hand on the lower half of the breastbone. Compressions are less
forceful than on an adult. The compression rate is also at least 100 compressions per minute and a child’s chest needs to be compressed at least 1⁄3 of its depth or about 2 inches.
Compressions can be tiring. If necessary, you can use two hands to perform compressions on a child. To perform chest compressions
on an infant, use two fingertips on the breastbone just below the nipple line.
Rescue Breaths — CPR Mask
Rescue breaths are artificial breaths given to someone who is not
breathing or not breathing normally. They are given by blowing air
into the mouth to inflate the lungs. The air you breathe contains
about 21% oxygen. Your exhaled air still contains up to 16–17%
oxygen. This exhaled oxygen is enough to support someone’s life
for a short time.
Before giving rescue breaths, you need to make sure the patient
has an open airway. The airway is the only path for getting air into
the lungs.
Someone who is unresponsive can lose muscle tone. When someone is flat on his or her back, the base of the tongue can relax and
obstruct the airway. This is the most common cause of a blocked
airway in an unresponsive patient.
The tongue is attached to the lower jaw. Moving the jaw forward lifts the tongue away from the back of the throat and opens the
airway.
You can open a patient’s airway by using the head-tilt, chin-lift technique. Place one hand on the forehead. Place the fingertips of
your other hand under the bony part of the chin. Apply firm, backward pressure on the forehead while lifting the chin upward. This will
tilt the head back and move the jaw forward.
4
CPR Pro for the Professional Rescuer
BLS Skills
Maintain the head-tilt with your hand on the forehead. Leave the
mouth slightly open. Avoid pressing into the soft tissue of the chin
with your fingers, as this can also obstruct the airway.
As a trained provider, you should use a protective barrier, such as
a CPR mask, when giving rescue breaths. This will minimize your
exposure to infectious disease. Before using a mask to give rescue
breaths, quickly inspect it to make sure the one-way valve is in
place.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
When giving rescue breaths, avoid blowing too hard or too long.
Air can be pushed into the stomach, making additional breaths
more difficult and increasing the chance of vomiting. Each breath
should be 1 second in length and provide only enough air to create
a visible rise of the patient’s chest.
If you remove your hands from the head, the airway will close again. Open the airway
each time you give rescue breaths. If you cannot get the chest to rise with your first
breath, reposition the head further back by using the head-tilt, chin-lift technique
again, and try another breath.
Rescue breaths for children and infants are performed in the same manner as for
adults. It is recommended that the size of the CPR mask is appropriate for the size
of the patient. Special care should be taken not to give too much air in a single
breath. Provide only enough air to make the chest visibly rise, but no more.
Rescue Breaths — Bag-Mask
A bag-mask device allows rescuers to provide rescue breaths without having to blow into a patient’s mouth. It is not recommended
when performing CPR alone. A CPR mask should be used instead.
It takes significant practice to effectively use a bag-mask. The
provider should consider his or her level of experience before using
a bag-mask. A bag-mask can be used by a single provider, but is
best used by two providers.
Bag-mask rescue breaths for children or infants are done in the
same manner as an adult. It is recommended that the size of the
device is appropriate for the size of the patient.
The use of an oropharyngeal airway, or OPA, is highly recommended with the use of a bag-mask device to help maintain an
open airway. Follow local protocols on the use of OPAs in your setting.
Healthcare providers may use an advanced airway device such as
a laryngeal mask airway, esophageal-tracheal-combitube, or endotracheal tube to maintain an open airway when providing rescue
breaths. When an advanced airway device is in place, remove the
mask from the bag-mask device and attach the bag directly to the
airway device to ventilate. As with other breaths, provide only
enough air to make the chest rise, but no more.
BLS Skills
CPR Pro for the Professional Rescuer
5
Rescue Breaths – Other Considerations
When caring for someone who is seriously injured, establishing an
open airway is a higher priority than protecting a possible injury to
the spine. Without an airway a patient will not survive, regardless
of illness or injury.
When the potential for a neck injury exists, a jaw-thrust, without
head-tilt, can be used to open the airway.
Another barrier option for rescue breaths is to use an overlay CPR
shield. Shields minimize direct contact with a patient, but may not
completely reduce the risk of infection.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
When using an overlay shield or providing mouth-to-mouth rescue
breaths for an infant, cover both the infant’s mouth and nose with
your mouth.
Primary Assessment —
Unresponsive Patient
A primary assessment helps you assess for immediate life-threatening problems, activate the EMS system, and rapidly provide priority care. It is the same for all ages and is performed quickly.
Before anything else, always pause and assess the scene for hazards. If the situation is not safe, do not approach. Help keep others
clear.
A general impression is a quick sense of what has occurred, or is
occurring, when you first observe an emergency scene. This impression can help guide you in your approach.
Does the person appear to be unconscious? A person who appears
to have collapsed and is not moving could have experienced a sudden cardiac arrest. Your immediate assessment and care can be
his/her only chance for survival.
If injured, how was the patient injured? The way in which force creates an injury is called the “mechanism of injury.” Consider the possibility of spinal injury when you suspect there has been significant
force applied to the head, neck, or back.
If it is safe to do so, approach the patient. If he or she appears unconscious, tap or squeeze the shoulder and ask loudly, “Are you
okay?” Use the patient’s name if you know it. For an infant, tap the
foot.
Quickly look at the face and chest for normal breathing. Normal
breathing is effortless, quiet, and regular. If normal breathing is
found, place the patient on his or her side in the recovery position.
Weak, irregular gasping, snorting, or gurgling sounds can occur
early in cardiac arrest. These actions provide no usable oxygen.
This is not normal breathing.
If there is no breathing, or only gasping, have another bystander
activate EMS and get an AED. If you are alone with an adult patient,
immediately call EMS yourself. Get an AED, if one is available, and
quickly return to the patient. The same is true when you are alone,
witness the sudden collapse of a child or infant, and you suspect
ventricular fibrillation as the cause.
6
CPR Pro for the Professional Rescuer
BLS Skills
If you are alone with a child or infant and have not witnessed the collapse, or you
suspect an airway or breathing problem as the cause, continue your assessment
and provide about two minutes of care before leaving to call EMS and get an AED
yourself.
Finish your assessment by feeling for a carotid pulse in the neck. Locate the bony
“Adam’s Apple” and slide the flats of your fingers into the groove between the windpipe and the muscle on the side of the neck closest to you. Compress downward.
For infants, feel for the brachial pulse on the inside of the upper arm. Lay your fingers
across the arm and compress inward.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Pulse checks can be difficult in emergency situations, even for experienced providers. If a pulse is clearly felt and breathing is absent
or abnormal, provide continuous rescue breaths, or rescue breathing. If the pulse is absent, or you are not certain within 10 seconds,
perform CPR, starting with compressions.
When a pulse is clearly felt but is less than 60 beats per minute for
a child or infant, the heart may not be providing enough blood flow
to the body. Look for signs of poor perfusion, such as pale or blue
tissue color. Perform CPR, starting with compressions, if rescue
breathing alone does not improve the patient’s appearance.
BLS Skills
CPR Pro for the Professional Rescuer
7
Skill
Guide
1
Chest Compressions
Adult
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Position patient face up on flat, firm surface.
Kneel close to chest. Place heel of one hand on
center of chest. Place heel of second hand on top
of first. You can interlace your fingers to help
keep off chest.
• Position your shoulders directly above your
hands. Lock your elbows and use upper body
weight to push.
• Push hard, straight down at least 2 inches. Lift
hands and allow chest to fully rebound. Without
interruption, push fast at a rate of at least 100
times per minute.
Child
• Position child face up on flat, firm surface. Place
heel of one hand on lower half of breastbone, just
above the point where the ribs meet.
• Position your shoulder directly above your hand.
Lock your elbow and use upper body weight to
push.
• Push hard, straight down at least 1⁄3 the depth of
the chest, or about 2 inches. Lift hand and allow
chest to fully rebound. Without interruption, push
fast at a rate of at least 100 times per minute.
• Compressions can be tiring. If desired, use two
hands, as with adults.
Infant
• Place the tips of two fingers on the breastbone
just below the nipple line.
• Push hard, straight down at least 1⁄3 the depth of
the chest, or about 11⁄2 inches. Lift fingers and
allow chest to fully rebound. Without interruption,
push fast at a rate of at least 100 times per
minute.
• With two or more providers, compress the
breastbone using two thumbs, with your fingers
encircling the chest.
8
CPR Pro for the Professional Rescuer
Skill Guide 1
Skill
Guide
2
Rescue Breaths
CPR Mask
Position Mask
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Inspect mask to make sure one-way valve is in
place.
• Place mask flat on patient’s face by laying top of
mask over bridge of nose.
• Use thumb and forefinger to control the top of
mask.
• Use thumb of other hand to control the bottom of
the mask.
Open Airway
• Tilt head and lift chin.
• Bring face up into mask to create an airtight seal
and open airway.
Give Breath
• Take a normal breath and blow through valve
opening to deliver breaths.
• Each breath should be 1 second in length. Create
a visible rise of chest, but no more.
• Remove your mouth and let patient exhale
completely. Take a fresh breath in between
breaths.
Jaw-Thrust Technique
• An alternative method to open an airway for rescue
breaths is the jaw-thrust technique. It is a
convenient and effective approach when using a
CPR mask or bag-mask.
• Positioned above the patient, place mask flat on
patient’s face.
• Place your palms and thumbs on both sides of the
mask. Hook your fingers under the angles of the
jaw, just below the ears.
• Lift and tilt head. Use counter pressure against
cheeks to displace the jaw and move it forward.
• If you suspect the possibility of spinal injury in the
neck, use jaw-thrust without head-tilt to open the
airway. If this does not establish an airway, use
head-tilt to do so.
Skill Guide 2
CPR Pro for the Professional Rescuer
9
Skill
Guide
3
Rescue Breaths
Bag-Mask
Prepare Bag-Mask
• When possible, have two providers use bagmask.
• Provide rescue breaths with CPR mask until bagmask is ready.
• Inspect bag-mask to make sure it is ready for use.
• If using supplemental oxygen, connect to bagmask, adjust flow rate to at least 10-12 liters per
minute, and allow reservoir bag to fill completely.
• Position yourself above patient’s head.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Position Mask
• While a second provider holds bag with both
hands, place mask flat on patient’s face.
• Place your palms and thumbs on both sides of
the mask. Hook your index fingers under the
angles of the jaw, just below the ears.
• Lift and tilt head. Use counter pressure against
cheeks to displace the jaw with your fingers and
move it upward.
• If you suspect the possibility of spinal injury in the
neck, use jaw-thrust without head-tilt to open the
airway. If this does not establish an airway, use
head-tilt to do so.
Deliver Breaths
• Have second provider squeeze bag to deliver
breaths.
• Each breath should be 1 second in length. Create
a visible rise of chest, but no more.
Using Bag-Mask with One Provider
• Prepare bag-mask. Position yourself above
patient. Place mask flat on patient’s face.
• Use thumb and index finger of one hand around
valve in a “C” shape to press mask against face.
• Use remaining fingers in an “E” shape to hook
bony part of chin.
• Lift and tilt head. Lift and displace jaw upward
with fingers on chin. If you suspect neck injury do
not tilt head unless needed to open airway.
• Squeeze bag to deliver breaths. Each breath
should be 1 second in length. Create a visible rise
of chest, but no more.
10
CPR Pro for the Professional Rescuer
Skill Guide 3
Skill
Guide
4
Rescue Breaths
Other Considerations
Jaw-Thrust without Head-Tilt
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• If you suspect neck injury, position yourself above
patient’s head and place mask flat on patient’s
face.
• Place your palms and thumbs on both sides of
the mask. Hook your index fingers underneath
the angles of the jaw, just below the ears.
• Use counter pressure against the cheeks to
displace the jaw with your fingers and move it
upward without tilting the head.
• If you find the jaw-thrust does not open the
airway, use jaw-thrust with head-tilt, or the headtilt, chin-lift technique instead.
Using a CPR Shield
•
•
•
•
Place breathing port of shield over or into mouth.
Spread shield flat over face.
Place one hand across forehead.
Hook fingertips of your other hand under bony
part of chin.
• Tilt head and lift chin to open airway.
Give Breath
• Seal nose by pinching nostrils closed over or
under shield.
• Take a normal breath. Open your mouth wide.
Press it on shield around patient’s mouth to
create airtight seal. Blow through shield to deliver
breath.
• Each breath should be 1 second in length. Create
a visible rise of chest, but no more.
• Remove your mouth and let patient exhale
completely. Take a fresh breath in between
breaths.
• When providing rescue breaths for an infant,
cover infant’s mouth and nose with your mouth.
Note: The same technique can be used to provide mouth-to-mouth rescue breaths if you elect not to use a barrier device.
Skill Guide 4
CPR Pro for the Professional Rescuer
11
Skill
Guide
5
Primary Assessment
Unresponsive Person
Assess Scene
• Pause and assess scene for safety.
• If unsafe, or if it becomes unsafe at any time,
GET OUT!
• If safe, approach the patient.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Check for Response
• If patient appears unresponsive, tap or squeeze
shoulder. Ask loudly, “Are you okay?”
• Use patient’s name if you know it.
• For infants, try tapping foot.
Look for Normal Breathing
• Position patient face up on a firm, flat surface.
• Look quickly at face and chest for normal
breathing. Normal breathing is effortless, quiet,
and regular.
• Weak, irregular, gasping, snorting, or gurgling is
NOT considered normal.
• If normal breathing is found, place an uninjured
patient on side in a recovery position.
Activate EMS and get an AED
• If unresponsive, send another person to activate
EMS and get an AED.
• If alone with an adult, place in a recovery position
and do this yourself.
• When alone with a child or infant, provide 2
minutes of care first.
Feel for Pulse
• Slide fingers into groove on side of neck. For
infants, lay fingers across inside of upper arm.
• If pulse is not obvious within 10 seconds, assume
it is absent.
• If patient is not breathing, or only gasping, and
has an obvious pulse, perform rescue breathing.
• If patient is not breathing, or only gasping, and
has no pulse, perform CPR.
12
CPR Pro for the Professional Rescuer
Skill Guide 5
Section 3 — BLS Care
Unresponsive and Breathing – Recovery Position
Even if a patient is breathing normally, a lack of responsiveness is still considered to be a life-threatening condition that requires immediate care.
There are a variety of things that can result in unresponsiveness,
including medical conditions such as stroke or seizures, or external
factors, such as alcohol or drug overdose. Regardless of the cause,
the greatest treatment concern is the ability of the patient to maintain a clear and open airway.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Positioning an uninjured, unresponsive, breathing patient in the recovery position can help maintain and protect the airway. This position uses gravity to drain fluids from the mouth and keep the
tongue from blocking the airway.
If an unresponsive person has been seriously injured, do not move
him or her unless you are alone and need to leave to get help.
Frequently assess the breathing of anyone placed in the recovery
position. The condition can quickly become worse and require additional care.
Unresponsive, Not Breathing, and
Has a Pulse — Rescue Breathing
When a patient is unresponsive, not breathing or only gasping, but
has a pulse you can clearly feel, he or she is in a condition known
as respiratory arrest. Without immediate intervention, this can
progress quickly to cardiac arrest. The treatment is to provide ongoing rescue breaths, or rescue breathing.
For an adult patient, provide 1 rescue breath every five to six seconds, or about ten to twelve breaths per minute. Deliver each
breath over one second and make the chest visibly rise, but no
more.
The rate of rescue breaths for children and infants is one breath
every three to five seconds, or about twelve to twenty breaths per
minute.
When performing rescue breathing, assess the pulse about every two minutes. Take no longer than ten seconds to do so. If the pulse
is absent, or you are unsure, perform CPR starting with compressions.
If rescue breathing does not improve the appearance of a child or infant (such as pale or blue tissue color) with a heart rate under 60
beats per minute, perform CPR instead.
Unresponsive, Not Breathing, and Pulseless — CPR
When a patient is unresponsive, is not breathing or only gasping, and has no pulse, he or she is considered to be in cardiac arrest
and requires CPR.
Once you start CPR, do the best you can. A patient without breathing or circulation cannot survive. Nothing you do can make the
outcome any worse.
Without interruption, perform continuous cycles of 30 chest compressions and 2 rescue breaths. Remember to compress hard and
fast, and allow the chest to rebound to its normal position after each compression. After 30 compressions, tilt the head, lift the chin,
provide two rescue breaths, and resume compressions. Do this quickly, in less than 10 seconds.
Continue CPR until an AED is ready, another provider or EMS personnel take over, or you are too tired to continue. If an AED becomes
available, turn it on immediately and follow the AED’s voice instructions for using it.
BLS Care
CPR Pro for the Professional Rescuer
13
If you are unable or unwilling to give rescue breaths, perform
compression-only CPR. Without interruption, provide ongoing
compressions at a rate of at least one hundred compressions per
minute until an AED is ready, another provider or EMS personnel
take over, or you are too tired to continue.
Performing CPR on a child or infant is very similar to performing
CPR on an adult. When performing CPR alone, provide continuous
cycles of 30 chest compressions and 2 rescue breaths.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
14
CPR Pro for the Professional Rescuer
BLS Care
Special CPR Considerations
Fluids in Airway
If vomiting has occurred, gurgling is heard, or fluids are visible in the mouth, log-roll the patient on to his or her side to quickly drain
fluids. Roll the patient without twisting, keeping the head, neck, and torso in line. Remove any material still in the mouth with a gloved
finger.
Neck Breather
Some people breath through a surgically created opening in the neck called a stoma. Use a CPR mask over the stoma to give rescue
breaths.
Pregnancy
Chest compressions may not be effective when a woman who is 6 months pregnant or more is lying flat on her back. This is because
the baby puts pressure on a major vein that returns blood to the heart.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
If possible, prop up the woman slightly on her left side using a rolled blanket (or similar) when performing chest compressions. This will
reduce this pressure and provides the most blood flow to mother and baby. Perform chest compressions higher on the breastbone,
slightly above the center.
Hypothermia
Handle cold people gently to prevent cardiac arrest. Get inside or out of the wind. Prevent additional heat loss by removing wet clothes
and insulating the patient from further exposure.
If the body is frozen solid, the nose and mouth are blocked with ice, and chest compression is impossible, do not start CPR. When
defibrillating, if the patient does not respond to one shock, focus on continuing CPR and re-warming the patient before repeating the
defibrillation attempt.
Drowning
Due to the hypoxic nature of drowning, and the effective treatment of rescue breaths, the initial approach for a person who has drowned
focuses on getting rescue breaths initiated as rapidly as possible.
With personal safety as a priority, get to the patient as quickly as you can and remove from the water as soon as possible. If you are
trained to do so, and it does not delay removal, provide rescue breaths while still in the water.
Do not attempt to provide chest compressions in the water. Do not attempt to remove water from the airway or lungs using abdominal
thrusts.
Once a drowning patient is removed from the water, establish an open airway and assess for normal breathing. If absent or only gasping,
provide two rescue breaths that make the chest visibly rise. Assess for a pulse for no longer than 10 seconds. If the pulse is absent, or
if you are not certain, begin chest compressions. Provide continuous cycles of 30 compressions and 2 rescue breaths. If performing
CPR with two rescuers for a child or infant, provide continuous cycles of 15 compressions and 2 rescue breaths instead.
Attach an AED as soon as one is available. Dry the chest before applying pads.
Be prepared for vomiting when caring for someone who has drowned. If vomiting occurs, quickly roll the person onto his or her side to
drain fluid from the mouth. Sweep solid matter out with your gloved finger.
Anyone who has received some form of resuscitation for drowning needs to have follow-up evaluation and care in a hospital, regardless
of his or her condition after the event.
Electric Shock
Consider any fallen or broken wire extremely dangerous. Do not touch (or allow your clothing to touch) a wire, patient, or vehicle that
could be energized. Do not approach within 8 feet of it.
Notify the local utility and have trained personnel sent to the scene. Metal or cable guard-rails, steel wire fences, and telephone lines
may be energized by a fallen wire and may carry the current a mile or more from the point of contact. Never attempt to handle wires
yourself unless you are properly trained and equipped.
Start CPR if indicated, as soon as it is safe to do so.
Lightning Strike
When multiple patients are struck by lightning at the same time, give the highest priority to those without signs of life. Start CPR if
indicated, as soon as it is safe to do so. Because many patients are young, they have a good chance for survival if immediate CPR is
given. Remove smoldering clothing, shoes, and belt to prevent burns.
Cardiac Arrest and Injury
Someone in cardiac arrest due to injury is unlikely to survive. If it is clear injury has caused the arrest, do not start CPR.
BLS Care
CPR Pro for the Professional Rescuer
15
Skill
Guide
6
Unresponsive and Breathing
Recovery Position
Assess Patient
• Pause and assess scene. Scene is safe!
• Tap or squeeze shoulder. Ask loudly, “Are you
okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing present!
• Have someone alert EMS and get an AED.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Prepare
• Extend arm nearest to you up alongside head.
• Bring far arm across chest and place back of
hand against cheek.
• Grasp far leg just above knee and pull it up so
foot is flat on ground.
Roll
• Grasp shoulder and hip and roll patient toward
you. Roll in a single motion, keeping head,
shoulders, and torso from twisting.
• Roll far enough for face to be angled forward.
• Position elbow and knee to help stabilize head
and body.
Suspected Injury
• If patient has been seriously injured, do not move
unless fluids are collecting in airway, or you are
alone and need to leave to get help.
• During roll, make sure head ends up resting on
extended arm and head, neck, and torso are
inline.
16
CPR Pro for the Professional Rescuer
Skill Guide 6
Skill
Guide
7
Unresponsive, Not Breathing, and Has a Pulse
Rescue Breathing – Adult
Assess Patient
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Pause and assess scene. Scene is safe!
• Tap or squeeze shoulder. Ask loudly, “Are you
okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for obvious carotid pulse in the neck.
Pulse present!
Open Airway
• Tilt the head; lift the chin to establish an airway.
• If you suspect neck injury, use jaw-thrust without
head-tilt.
Give Rescue Breaths
• Provide 1 rescue breath every 5-6 seconds
(10-12 breaths per minute).
• Give each breath in 1 second. Make the chest
visibly rise, but no more.
• Don’t stop! Continue until another provider or the
next level of care takes over, the patient clearly
shows signs of life, or you are too tired.
• Reassess carotid pulse about every 2 minutes.
Take no longer than 10 seconds.
Skill Guide 7
CPR Pro for the Professional Rescuer
17
Skill
Guide
8
Unresponsive, Not Breathing, and Has a Pulse
Rescue Breathing – Child
Assess Patient
• Pause and assess scene. Scene is safe!
• Tap or squeeze shoulder. Ask loudly, “Are you
okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for a carotid pulse in the neck. Pulse
present and 60 BPM or greater!
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Open Airway
• Tilt the head; lift the chin to establish an airway.
• If you suspect neck injury, use jaw-thrust without
head-tilt.
Give Rescue Breaths
• Provide 1 rescue breath every 3-5 seconds
(12–20 breaths per minute).
• Give each breath in 1 second. Make the chest
visibly rise, but no more.
• Don’t stop! Continue until another provider or the
next level of care takes over, the child clearly
shows signs of life, or you are too tired.
• Reassess carotid pulse about every 2 minutes.
Take no longer than 10 seconds.
18
CPR Pro for the Professional Rescuer
Skill Guide 8
Skill
Guide
9
Unresponsive, Not Breathing, and Has a Pulse
Rescue Breathing – Infant
Assess Patient
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Pause and assess scene. Scene is safe!
• Tap foot. Shout loudly. No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for a brachial pulse on inside of upper arm.
Pulse present and 60 BPM or greater!
Open Airway
• Tilt the head; lift the chin to establish an airway.
• If you suspect neck injury, use jaw-thrust without
head-tilt.
Give Rescue Breaths
• Provide 1 rescue breath every 3-5 seconds
(12-20 breaths per minute).
• Give each breath in 1 second. Make the chest
visibly rise, but no more.
• Don’t stop! Continue until another provider or the
next level of care takes over, the infant clearly
shows signs of life, or you are too tired.
• Reassess brachial pulse about every 2 minutes.
Take no longer than 10 seconds.
Skill Guide 9
CPR Pro for the Professional Rescuer
19
Skill
Guide
10
Unresponsive, Not Breathing, and Pulseless
CPR — Adult
Assess Patient
• If safe to do so, tap or squeeze shoulder. Ask
loudly, “Are you okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for an obvious carotid pulse in neck. Take
no longer than 10 seconds. No pulse!
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Give 30 Chest Compressions
• Place heel of one hand on center of chest. Place
heel of second hand on top of first.
• Using upper body weight, push hard, at least 2
inches in depth.
• Push fast, at least 100 times per minute. Allow
chest to fully rebound.
Give 2 Rescue Breaths
• Tilt head; lift chin to establish airway. If you
suspect neck injury, use jaw-thrust without headtilt.
• Make chest visibly rise over one second with
each breath, but no more.
• Take a fresh breath between breaths.
• Take no longer than 10 seconds to give breaths.
Repeat Cycles
• Provide continuous cycles of 30 compressions
and 2 rescue breaths.
• Don’t stop! Continue until an AED is ready,
another provider or the next level of care takes
over, the person clearly shows signs of life, or you
are too tired.
20
CPR Pro for the Professional Rescuer
Skill Guide 10
Skill
Guide
11
Unresponsive, Not Breathing, and Pulseless
CPR — Child
Assess Patient
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• If safe to do so, tap or squeeze shoulder. Ask
loudly, “Are you okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for an obvious carotid pulse in the neck.
Take no longer than 10 seconds. No pulse (or
less than 60 BPM with signs of poor perfusion)!
Give 30 Chest Compressions
• Place heel of one hand on lower half of
breastbone.
• Using upper body weight, push hard, at least 1⁄3
the depth of the chest, or about 2 inches.
• Push fast, at least 100 times per minute. Allow
chest to fully rebound.
• Compressions are tiring. If desired use two
hands, as with adults.
Give 2 Rescue Breaths
• Tilt head; lift chin to establish airway. If you
suspect neck injury, use jaw-thrust without
head-tilt.
• Make chest visibly rise over one second with
each breath, but no more.
• Take a fresh breath between breaths.
• Take no longer than 10 seconds to give breaths.
Repeat Cycles
• Provide continuous cycles of 30 compressions
and 2 rescue breaths.
• Don’t stop! Continue until an AED is ready,
another provider or the next level of care takes
over, the child clearly shows signs of life, or you
are too tired.
Skill Guide 11
CPR Pro for the Professional Rescuer
21
Skill
Guide
12
Unresponsive, Not Breathing, and Pulseless
CPR — Infant
Assess Patient
• If safe to do so, tap foot. Shout loudly.
No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for an obvious brachial pulse on inside of
upper arm. Take no longer than 10 seconds.
No pulse (or less than 60 BPM with signs of
poor perfusion)!
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Give 30 Chest Compressions
• Place two fingertips on breastbone just below
nipple line.
• Push hard, at least 1⁄3 the depth of the chest, or
about 11⁄2 inches.
• Push fast, at least 100 times per minute. Allow
chest to fully rebound.
Give 2 Rescue Breaths
• Tilt head; lift chin to establish airway. If you
suspect neck injury, use jaw-thrust without headtilt.
• Make chest visibly rise over one second with
each breath, but no more.
• Take a fresh breath between breaths.
• Take no longer than 10 seconds to give breaths.
Repeat Cycles
• Provide continuous cycles of 30 compressions
and 2 rescue breaths.
• Don’t stop! Continue until an AED is ready,
another provider or the next level of care takes
over, the infant clearly shows signs of life, or you
are too tired.
22
CPR Pro for the Professional Rescuer
Skill Guide 12
Section 4 — Defibrillation
Automated External Defibrillators
AEDs are designed to be simple to operate. Voice instructions, lights, and screen prompts guide an operator through use. There are
many different brands of AEDs, but the same basic steps for operation apply to all of them.
• Turn on the AED. This starts voice instructions and readies the device for use. Opening the lid will turn on the power with
some AEDs. With others, a power button is pressed.
• Allow the AED to analyze the heart rhythm. An AED automatically starts analyzing once the pads are in place. If defibrillation is required, the AED will charge to get ready for
shock delivery.
• Deliver a shock if directed to by the AED. While keeping
others clear, a button is pressed on most AEDs to deliver a
shock.
Immediately after a shock is delivered, CPR is resumed, starting
with chest compressions. Voice instructions and additional analysis
by the AED will guide you through further care.
Basic AED Operation
High-quality CPR along with rapid defibrillation using an AED provides the most effective early treatment for sudden cardiac arrest.
Defibrillation pads must be applied to a bare chest. If needed, quickly tear or use scissors to remove clothing, including undergarments.
The pads have pictures on them to assist in proper placement.
Carefully look at the pictures to ensure the pads are properly
placed. Peel the pads from the backing sheet one at a time and
place them exactly as indicated in the pictures.
AEDs automatically start analyzing once the pads are in place.
Movement can interrupt the analysis. Be certain that no one is
touching the patient.
If defibrillation is required, an AED will charge to deliver a shock.
Give a verbal warning and look to make sure no one, including you,
is in contact with the patient before delivering the shock. Immediately after delivering the shock, resume CPR, starting with chest
compressions. When a shock is not indicated by the AED, simply
resume CPR as well.
Continue to follow any additional AED voice instructions. Don’t stop
until the patient shows signs of life, another provider or EMS personnel take over, or you are too tired to continue.
If the patient responds, stop CPR and place him or her in a recovery position. Leave the AED on and attached in case cardiac arrest
occurs again.
Defibrillation
CPR Pro for the Professional Rescuer
23
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Adhere the defibrillation pads to the patient’s bare chest.
Pads are placed in specific locations to direct the electrical
shock through the heart. Most pads are pre-connected to
the device, but some AEDs require you to plug in a connector.
Cardiac arrests involving children are primarily caused by the initial
loss of the airway or breathing. Well-performed CPR with effective
rescue breaths may be the only treatment required for successful
resuscitation of a child. However, conditions can occur for which
defibrillation of a child or infant is warranted.
Most AEDs have specially designed pads or mechanisms available
that reduce the defibrillation energy to a level more appropriate for
a smaller body size. If an AED specifically equipped for use on a
child or infant is not available, an AED configured for an adult can
be used instead, placing the adult pads on the front and back of
the child’s or infant’s chest.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Troubleshooting and Other
AED Considerations
AEDs are designed to detect problems during use and guide you
through corrective actions. If a troubleshooting message occurs,
stay calm and follow the AED’s voice instructions.
Automatic Shock Delivery
Some AEDs deliver a shock automatically after charging.
An accidental shock can be prevented by making sure no
one is in contact with the person being defibrillated.
If the AED indicates a problem with the pads, the pads are not completely adhered to the skin or there is a poor connection to the AED.
Press pads firmly, especially in the center, to make sure they are
adhering well. Make sure the pads cable connector is firmly connected to the AED.
If the chest is wet, remove the pads and wipe the chest dry. Apply
a new set of pads. If pads do not stick due to chest hair, pull the
pads off and quickly shave the hair. Attach another set of pads.
Another troubleshooting message may indicate that analysis has
been interrupted due to movement. Stop all sources of movement,
such as chest compressions or rescue breaths.
If a message indicates the need to replace a battery, there may only
be enough energy for a limited number of shocks. If the AED fails
to operate, the depleted battery should be removed and replaced
with a new one.
A patient should be removed from standing water before an AED
is used. It is okay to use an AED when a patient is lying on a wet
surface, such as in the rain or near a swimming pool. An AED
should never be immersed in water or have fluids spilled on it.
AEDs can also be used safely on metal surfaces, such as gratings
or stairwells. Make sure the pads do not directly touch any metal
surface.
Someone may have a surgically implanted device in the chest, such
as a pacemaker or an implantable cardioverter-defibrillator. A noticeable lump and surgical scar may be visible. If an implanted device is in the way of normal pad placement, adjust the placement
so the pad edge is at least one inch away from the device.
Defibrillating over medication patches could reduce the effectiveness of the shock. If a medication patch is interfering with placement, use a gloved hand to peel off the patch. Quickly wipe away
any remaining residue before placing pads.
24
CPR Pro for the Professional Rescuer
Defibrillation
Skill
Guide
13
Using an AED
Adult
Assess Patient
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• If safe to do, Tap or squeeze shoulder. Ask loudly,
“Are you okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for an obvious carotid pulse in neck. No
pulse!
Perform CPR
• Provide continuous cycles of 30 compressions
and 2 rescue breaths.
• Continue until AED begins to analyze heart.
When Available, Attach AED
• Position AED close to head. Turn on power to
start voice instructions. Bare chest. If wet or
sweaty, wipe dry.
• Remove pads from packaging. Look at pictures
on pads to ensure accurate placement.
• Peel first pad from backing and place below right
collarbone, above nipple, and beside breastbone.
• Place second pad on left side, over ribs, and a
few inches below armpit.
If Indicated, Deliver Shock
• Allow AED to analyze heart. Stop all movement,
including CPR.
• If shock is advised, CLEAR everyone from patient
and press shock button to deliver shock.
• If a shock is NOT advised, immediately resume
CPR, starting with chest compressions.
Resume CPR
• Immediately after delivering shock, resume CPR,
starting with chest compressions. Follow any
additional voice instructions from AED.
• Continue until another provider or the next level
of care takes over.
• If patient responds, stop CPR and place in
recovery position. Leave AED on and attached.
Skill Guide 13
CPR Pro for the Professional Rescuer
25
Skill
Guide
14
Using an AED
Child and Infant
Assess Patient
• If safe to do so, tap or squeeze shoulder. Ask
loudly, “Are you okay?” No response!
• Look quickly at face and chest for normal
breathing. Occasional gasps are NOT considered
normal. Normal breathing absent!
• Have someone alert EMS and get an AED.
• Check for obvious carotid pulse in the neck. No
pulse (or less than 60 BPM with signs of poor
perfusion)!
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Perform CPR
• Provide continuous cycles of 30 compressions
and 2 rescue breaths.
• Continue until AED begins to analyze heart.
Attach AED
• Position AED close to head. Turn on power to
start voice instructions. Bare chest. If wet or
sweaty, wipe dry.
• Remove pads from packaging. Look at pictures
on pads to ensure accurate placement.
• Peel first pad from backing and place in center of
chest just below collarbones.
• Roll child and place second pad on center of
back between shoulder blades.
If Indicated, Deliver Shock
• Allow AED to analyze heart. Stop all movement,
including CPR.
• If shock is advised, CLEAR everyone from child
and press shock button to deliver shock.
• If a shock is NOT advised, immediately resume
CPR, starting with chest compressions.
Resume CPR
• Immediately after delivering shock, resume CPR,
starting with chest compressions. Follow any
additional voice instructions from AED.
• Continue until another provider or the next level
of care takes over.
• If child responds, stop CPR and place in recovery
position. Leave AED on and attached.
26
CPR Pro for the Professional Rescuer
Skill Guide 14
Section 5 — Team Approach
Team Approach
It is common for multiple healthcare providers to respond during a basic life-support emergency. Patient management can be adjusted
as more providers become available.
Begin with single provider care. If additional providers become available, perform CPR using two providers. One provider performs
chest compressions while another gives rescue breaths. For adults, the CPR ratio remains at 30 compressions and 2 rescue breaths.
CPR can be tiring. When other providers are available, take turns
performing compressions. Switch compressors about every two
minutes. Do this quickly, in less than 5 seconds.
For children and infants, switch the CPR ratio to 15 compressions
and 2 rescue breaths when more than one provider is available.
When giving chest compressions to an infant, compress the lower
half of the breastbone using both thumb tips and your hands encircling the sides of the chest. The rate and depth remain the same
as with a single provider.
Multiple treatment interventions can be done at the same time. It
is important to work as a team. When an AED becomes available,
continue CPR, if possible, until the AED is ready to analyze the patient’s heart.
If you are using a bag-mask device, have one provider maintain the
airway and control the mask while another squeezes the bag.
Once an advanced airway device is in place, it is no longer necessary to pause compressions to give breaths. Provide continuous
compressions at a rate of at least 100 compressions per minute. Regardless of patient’s age, provide a single breath every six to
eight seconds, or about eight to ten times a minute.
Team Approach
CPR Pro for the Professional Rescuer
27
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Jaw-thrust with head-tilt can be a convenient and effective method of opening the airway of a non-injured patient when using a CPR
mask, or bag-mask, during two-rescuer CPR. When giving rescue breaths, pause compressions to allow the breaths to be given.
Give breaths quickly, in less than 10 seconds.
Skill
Guide
15
Team Approach
Adult Cardiac Arrest
Single-Provider CPR
• If alone, begin with single provider care.
• As other providers become available, integrate
roles and perform actions simultaneously.
• Work together efficiently as a team.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Two-Provider CPR
• Perform CPR using two providers. One provider
compresses the chest and the other gives rescue
breaths. The ratio remains 30 compressions and
2 rescue breaths.
• Jaw-thrust with head-tilt can be used from above
the head to open the airway.
• Pause compressions to give rescue breaths. Take
no longer than 10 seconds to give breaths.
• Rotate compressors about every 2 minutes. Do
this quickly, in less than 5 seconds.
Integrating Other Interventions
• Integrate other interventions without disruption.
If an AED becomes available, continue CPR, if
possible, until the AED is ready to analyze the
patient’s heart.
• If you are integrating the use of a bag-mask
device, it is best used by two providers. A third
provider needs to continue chest compressions.
• If an advanced airway device is in place, provide
continuous chest compressions of at least 100
compressions per minute. Independent of
compression, provide a single rescue ventilation
every 6–8 seconds creating a visible rise of the
chest, but no more.
28
CPR Pro for the Professional Rescuer
Skill Guide 15
Skill
Guide
16
Team Approach
Child or Infant Cardiac Arrest
Single-Provider CPR
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• If alone, begin with single provider care.
• As other providers become available, integrate
roles and perform actions simultaneously.
• Work together efficiently as a team.
Two-Provider CPR
• Perform CPR using two providers. One provider
compresses the chest and the other gives rescue
breaths. With two providers, the ratio changes to
15 compressions and 2 rescue breaths.
• For an infant, compress the lower half of the
breastbone with both thumb tips and hands
encircling the chest.
• Jaw-thrust with head-tilt can be used from above
the head to open the airway.
• Pause compressions to give rescue breaths. Take
no longer than 10 seconds to give breaths.
• Rotate compressors about every 2 minutes. Do
this quickly, in less than 5 seconds.
Integrating Other Interventions
• Integrate other interventions without disruption.
If an AED becomes available, continue CPR, if
possible, until the AED is ready to analyze the
child’s heart.
• If you are integrating the use of a bag-mask
device, it is best used by two providers. A third
provider needs to continue chest compressions.
• If an advanced airway device is in place, provide
continuous chest compressions of at least 100
compressions per minute. Independent of
compression, provide a single rescue ventilation
every 6–8 seconds creating a visible rise of the
chest, but no more.
Skill Guide 16
CPR Pro for the Professional Rescuer
29
BLS Adult Algorithm
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
BLS Adult Algorithm
CPR Pro for the Professional Rescuer
30
BLS Summary
Child
Infant
Age Determination
Begins with onset of puberty.
About 1 year of age to the onset
of puberty.
Less than 1 year of age.
Scene Safety?
If the scene is unsafe or at
any time becomes unsafe,
GET OUT!
If the scene is unsafe or at
any time becomes unsafe,
GET OUT!
If the scene is unsafe or at
any time becomes unsafe,
GET OUT!
Response?
Tap shoulder, shout name.
Tap shoulder, shout name.
Tap foot, shout out.
Breathing?
Look at face and chest for no
breathing or only gasping.
Look at face and chest for no
breathing or only gasping.
Look at face and chest for no
breathing or only gasping.
Normal Breathing
Present?
Place person in recovery
position and monitor breathing.
Place child in recovery position
and monitor breathing.
Place infant in recovery position
and monitor breathing.
Activate Emergency
Response System/
Get an AED
Send a bystander. When alone,
do it yourself immediately.
Send a bystander. When alone,
perform about 2 minutes of CPR
before doing it yourself.
Send a bystander. When alone,
perform about 2 minutes of CPR
before doing it yourself.
Normal Breathing
Absent?
Palpate for carotid pulse in neck Palpate for carotid pulse in neck
for no more than 10 seconds.
for no more than 10 seconds.
Palpate for brachial pulse in upper
arm for no more than 10 seconds.
Pulse Present?
• Perform rescue breathing;
1 breath every 5-6 seconds
• Monitor carotid pulse every
2 minutes
• If pulse rate is 60 beats per
minute or greater, perform
rescue breathing; 1 breath
every 3-5 seconds
• Monitor carotid pulse every
2 minutes
• If pulse rate is 60 beats per
minute or greater, perform
rescue breathing; 1 breath
every 3-5 seconds
• Monitor brachial pulse every
2 minutes
Rescue Breaths
• Tilt head, lift chin to open
airway first; use jaw-thrust
for suspected neck injury
• 1 second in length
• Make chest visibly rise, but
no more
• Tilt head, lift chin to open airway first; use jaw-thrust for
suspected neck injury
• 1 second in length
• Make chest visibly rise, but
no more
• Tilt head, lift chin to open airway first; use jaw-thrust for
suspected neck injury
• 1 second in length
• Make chest visibly rise, but
no more.
Pulse Absent?
• Perform CPR starting with
compressions
• Single or multiple rescuers provide continuous cycles
of 30 compressions and 2
rescue breaths
• If pulse is absent, or less
than 60 BPM with poor perfusion, perform CPR starting
with compressions
• Single rescuer — provide
continuous cycles of 30:2
• Multiple rescuers — provide
continuous cycles of 15:2
• If pulse is absent, or less
than 60 BPM, with poor perfusion, perform CPR starting
with compressions.
• Single rescuer — provide
continuous cycles of 30:2.
• Multiple rescuers — provide
continuous cycles of 15:2.
Compressions
• Two hands on center
of chest
• At least 2 inches in depth
• Rate of at least 100 times a
minute
• Hard, fast, full rebound,
minimize interruption
• One or two hands on lower
half of breastbone
• At least 1⁄3 depth of chest or
about 2 inches
• Rate of at least 100 times a
minute
• Hard, fast, full rebound,
minimize interruption
• Two fingers on breastbone
just below nipple line
• At least 1⁄3 depth of chest or
about 11⁄2 inches
• Rate of at least 100 times a
minute
• Hard, fast, full rebound,
minimize interruption
Defibrillation with AED
•
•
•
•
•
•
• Use pediatric system; if not
available, use AED for adult
• Turn on power
• Attach pads
• Analyze
• If indicated, deliver shock
• Immediately resume CPR
• Follow voice instructions
• Use pediatric system; if not
available, use AED for adult
• Turn on power
• Attach pads
• Analyze
• If indicated, deliver shock
• Immediately resume CPR
• Follow voice instructions
BLS Summary
Turn on power
Attach pads
Analyze
If indicated, deliver shock
Immediately resume CPR
Follow voice instructions
CPR Pro for the Professional Rescuer
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Adult
31
Section 6 — Foreign Body Airway Obstruction
Choking
Choking can occur when a solid object, such as a piece of food, or small object, enters a narrowed part of the airway and becomes
stuck. On inhalation, the object can be drawn tighter into the airway and block air from entering the lungs.
A forceful thrust beneath the ribs and up into the diaphragm can compress the air in the chest and create enough pressure to “pop”
the object out of the airway. Direct compression of the chest over the breastbone can also create enough pressure to expel an object.
You must be able to recognize the difference between a mild blockage and a severe blockage. With a mild blockage, a patient can
speak, cough, or gag. This type of blockage is typically cleared by
coughing. Encourage someone with a mild blockage to cough
forcibly. Stay close and be ready to take action if things worsen.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
When a severe blockage occurs, a patient cannot dislodge the object on his or her own. Signs of severe obstruction include very little
or no air exchange, high-pitched wheezing or lack of sound, and
the inability to speak or cough forcefully. A patient with a severe
blockage may hold his or her hands to his or her throat as he or
she attempts to clear an obstruction. Your help is required to save
the patient’s life.
Young children are particularly at risk for choking because of the
small size of their air passages, inexperience with chewing, and a
natural tendency to put objects in their mouths. For a choking child,
the approach is nearly the same as for adults. It might be easier to
kneel behind a choking child to deliver thrusts.
Since infants do not speak, it may be more difficult to recognize choking. A sudden onset differentiates it from other breathing emergencies. Signs include weak, ineffective coughs, and the lack of sound, even when an infant is clearly attempting to breathe.
If you suspect an infant is choking, perform continuous cycles of five back blows and five chest thrusts to expel the object. Do not
perform abdominal thrusts on an infant.
Abdominal and chest thrusts can cause internal injury. Anyone who has been treated with these maneuvers for choking should be
evaluated by EMS or a physician to ensure there are no injuries.
32
CPR Pro for the Professional Rescuer
Choking
Skill
Guide
17
Choking
Adult
Assess Patient
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Ask, “Are you choking?”
• If patient nods yes, or is unable to speak or
cough — act quickly!
• If available, have a bystander activate EMS.
Position Yourself
• Stand behind patient.
• Make a fist with one hand and place thumb side
against abdomen, just above navel and below ribs.
• Grasp fist with other hand.
Give Thrusts
• Quickly thrust inward and upward into abdomen.
• Repeat. Each thrust needs to be given with intent
of expelling object.
• Continue until patient can breathe normally.
If Patient Becomes Unresponsive…
• Carefully lower to ground. Position face-up on a
firm, flat surface.
• If not already done, activate EMS.
• Begin CPR, starting with compressions.
Remove Any Object if Seen
• Look in mouth for an object after each set of
compressions, before giving rescue breaths.
• Continue until patient shows obvious signs of life,
or another provider or the next level of care takes
over.
Skill Guide 17
CPR Pro for the Professional Rescuer
33
Skill
Guide
18
Choking
Child
Assess Child
• Ask, “Are you choking?”
• If child nods yes, or is unable to speak or cough
— act quickly!
• If available, have a bystander activate EMS.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Position Yourself
• Kneel behind child.
• Make a fist with one hand and place thumb side
against abdomen, just above navel and below
ribs.
• Grasp fist with other hand.
Give Thrusts
• Quickly thrust inward and upward into abdomen.
• Repeat. Each thrust needs to be given with intent
of expelling object.
• Continue until child can breathe normally.
If Child Becomes Unresponsive…
• Carefully lower to ground. Position face-up on a
firm, flat surface.
• If alone, provide at least two minutes of care before
activating EMS.
• Begin CPR, starting with compressions.
Remove Any Object if Seen
• Look in mouth for an object after each set of
compressions, before giving rescue breaths.
• Continue until child shows obvious signs of life,
or another provider or the next level of care takes
over.
34
CPR Pro for the Professional Rescuer
Skill Guide 18
Skill
Guide
19
Choking
Infant
Assess Infant
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• Look at infant’s face.
• If infant is silent, unable to cry, or has blue lips,
nails, or skin — act quickly!
• If available, have a bystander activate EMS.
Give 5 Back Blows
• Straddle infant face-down over your forearm, with
head lower than chest.
• Support head by holding jaw.
• Using heel of other hand, give 5 back blows
between shoulder blades.
Give 5 Chest Thrusts
• Sandwich infant between your forearms and turn
onto back, with legs and arms straddling your
other arm.
• Place 2 fingers on breastbone just below nipple
line and give 5 chest thrusts.
• Repeat back blows and chest thrusts until infant
can breathe normally.
• Back blows and thrusts need to be given with
intent of expelling object.
If Infant Becomes Unresponsive…
• Carefully lower to ground. Position face-up on a
firm, flat surface.
• If alone, provide at least two minutes of CPR before
activating EMS.
• Begin CPR, starting with compressions.
Remove Any Object if Seen
• Look in mouth for an object after each set of
compressions, before giving rescue breaths.
• Continue until infant shows obvious signs of life,
or another provider or the next level of care takes
over.
Skill Guide 19
CPR Pro for the Professional Rescuer
35
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Legal Considerations
Good Samaritan Laws
All states have passed what are known as “Good Samaritan laws,” to help encourage bystanders to assist those in need. These laws
help protect anyone who:
• Voluntarily provides assistance, without expecting or accepting compensation,
• Is reasonable and prudent,
• Does not provide care beyond the training received, and
• Is not “grossly negligent,” or completely careless, in delivering emergency care.
Abandonment
Once care has begun, and it is safe to do so, remain with the person until someone with equal or greater emergency medical training
takes over. If alone, it is okay to leave to activate EMS, but return to the person as soon as you can.
Consent
It is appropriate to ask a responsive person if they want help before providing care. To get consent, first identify yourself. Then tell the
patient your level of training and ask if it’s okay to help. “Implied consent” means that permission to provide care to an unresponsive
patient is assumed. This is based on the idea that a reasonable person would give permission to receive lifesaving care if able. Consent
for children must be gained from a parent or legal guardian. When life-threatening situations exist and the parent or guardian is not
available, care should be given based on implied consent. When suffering from a disturbance in normal mental functioning, like
Alzheimer’s disease, a patient may not understand your request for consent. Consent must be gained from a family member or legal
guardian.
Duty to Act
This is a requirement to act toward others and the public with the watchfulness, attention, caution and prudence that a reasonable
person in the same circumstances would use. If a person’s actions do not meet this standard, then the acts may be considered negligent, and any damages resulting may be claimed in a lawsuit for negligence. If you are a state-licensed healthcare provider, first responder, or other professional rescuer expected to give emergency medical care, including CPR, you almost certainly have a duty to
act. However, BLS performed voluntarily on a stranger in need while off duty is generally considered a “Good Samaritan Act.”
Assault and Battery
A criminal act of placing a person in fear of bodily harm. A conscious and aware adult has the right to refuse medical treatment.
Forcing care on a person against his wishes may be considered grounds for this.
Starting CPR
Start CPR for all patients in cardiac arrest unless signs of irreversible death are present, including rigor mortis (limbs of corpse stiff
and impossible to move), dependent lividity (settling of blood in lower portions of body, causing a purplish red discoloration), or conditions are present that are incompatible with life (decomposition, decapitation, massive head injury, etc.). Do not start CPR if it puts
you in danger of injury, or the patient has a valid DNR order. In a mass casualty incident with limited resources, patients requiring
rescue breathing or CPR are considered dead and attempts to resuscitate them should not be started.
Stopping CPR
Do not stop CPR until a healthcare provider or other professional rescuer with equal or more training takes over, you are exhausted,
the scene becomes too dangerous to continue, or the patient shows signs of life. You can also stop if the physician in charge of the
patient decides to order the resuscitation effort stopped (follow local protocol, standard operating procedures, and/or medical direction).
Except when death is obvious, irreversible brain damage or brain death cannot be reliably assessed or predicted. Rescuers should
never make an impulsive decision about the present or future quality of life of a cardiac arrest patient, because such decisions may
be incorrect.
Legal Considerations
CPR Pro for the Professional Rescuer
37
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Good Samaritan laws vary slightly from state to state. Become familiar with the laws in your state and other states where you work
or travel.
Advanced Directives and Living Wills
These are documents authorized by state law that allow a person to appoint someone as his or her representative to make decisions
on resuscitation and continued life support in a situation where a person has lost decision-making capacity (for example, if in a coma).
These documents may also be referred to as “a durable power of attorney.” Advanced directives are statements about what the
patient wants done or not done when the patient can’t speak on his or her own behalf. Laws about advanced directives are different
in each state. You should be aware of the laws in your state.
Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) Orders
The DNR/DNAR order is a kind of advanced directive. This is a specific request not to have CPR performed. In the United States, a
doctor’s order is required to withhold CPR. Therefore, unless the patient has a DNR order, EMS providers and hospital staff should
attempt resuscitation. Patients who are not likely to benefit from CPR and may have a DNR order include those with terminal conditions
from which they are unlikely to recover.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Outside the hospital, healthcare providers, first responders, and other professional rescuers should begin CPR if there is a reasonable
doubt about the validity of a DNAR order or advanced directive, if the patient may have changed his or her mind, or the patient’s best
interests are in question.
38
CPR Pro for the Professional Rescuer
Legal Considerations
Emotional Considerations
Caring for someone in an emergency can create emotional distress, even for healthcare providers. More serious emergencies or a
connection to those involved can intensify these feelings.
Common reactions include:
• Anxiety
• Trembling or shaking
• Sweating
• Nausea
• Fast breathing
• Pounding heartbeat
After an emergency is over, you may begin to experience a variety of reactions. These include:
• Feeling abandoned or helpless,
• Recalling the event over and over
• Self-doubt about not doing enough
• Difficulty concentrating
• Heaviness in the chest
• Upset stomach or diarrhea
• Difficulty sleeping or nightmares
It is important to understand that these feelings are normal and will pass with time. However, there are actions you can take to help
cope with and work through the difficulty.
Informally speak to someone you trust to listen without judgment, such as a family member, friend, or coworker. Get back to a normal
routine as soon as possible. Accept that it will take time to resolve these emotions.
If unpleasant feelings persist, formal assistance from a professional counselor may be helpful as you work through your emotions
surrounding the event.
Emotional Considerations
CPR Pro for the Professional Rescuer
39
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
This is a normal human reaction to a traumatic event. Simply remember to stay calm and accept your limitations as a provider.
References and End Notes
References
The ASHI CPR Pro for the Professional Rescuer Student Handbook is based upon the following standards, guidelines, and treatment
recommendations:
• “2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.” Circulation 122, suppl. 2 (2010): S250-S581.
• “2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science.” Circulation 122, suppl. 3 (2010): S639-S946.
• ANSI Standard Z490.1. “Criteria for Accepted Practices in Safety, Health, and Environmental Training.” American National
Standard, 2009.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
• ASTM Standard F2171-02. “Standard Guide for Defining the Performance of First Aid Providers in Occupational Settings.”
ASTM International, 2009.
• OSHA 3317-06N. “Best Practices Guide: Fundamentals of a Workplace First-Aid Program.” U.S. Department of Labor, Occupational Safety and Health Administration, 2006.
• Other recommendations or sources as referenced by end notes.
End Notes
i. Centers for Disease Control and Prevention. “Preventing Allergic Reactions to Natural Rubber Latex in the Workplace.” The National Institute for Occupational Safety and Health (NIOSH) Alert. http://www.cdc.gov/niosh/docs/97-135/pdfs/97-135.pdf
40
CPR Pro for the Professional Rescuer
References and Resources
Glossary
Abdominal Thrust
Thrusts administered to the abdomen of a responsive, choking person to force air in the lungs to dislodge an object blocking a person’s airway.
Acute Coronary Syndrome (ACS)
Often described as a heart attack, ACS occurs when there is reduced blood flow to the tissues of the heart.
Airway
The passageway between mouth and lungs that allows life-sustaining oxygen into the body.
Automated External Defibrillator (AED)
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
A portable, computerized device that automatically analyzes for life-threatening heart rhythms and provides corrective treatment
through adhesive pads on a person’s chest.
Bloodborne Pathogens
Potentially infectious body fluids.
Bystander
Someone who is present but not taking part in a situation or event.
Cardiopulmonary Resuscitation (CPR)
A combination of rescue breaths and chest compressions performed on a person experiencing cardiac arrest, intended to restore
some oxygen to the brain.
Chain of Survival
A concept of five interdependent links (early access to EMS, early CPR, rapid defibrillation, effective advanced care, and integrated
post-cardiac care) that describe the most effective approach for treating sudden cardiac arrest.
Chest Compression
Pressing down on a person’s chest in a rhythmic motion to increase pressure inside the chest and directly compress the heart to
keep blood circulating to the brain and other internal organs.
Chest Thrust
Thrusts administered on the breastbone of a responsive, choking person to force air in the lungs to dislodge an object stuck in the
person’s airway.
Compression-only CPR
An alternative to conventional (compressions and rescue breaths) CPR in which immediate ongoing chest compressions are provided for a person who has collapsed and is unresponsive and not breathing (or breathing inadequately).
CPR Mask
A protective barrier device used to prevent contact with potentially infectious body fluids while performing rescue breaths on a person. The mask fits over the mouth and nose of the person and includes a breathing valve for the first aid provider to safely administer
rescue breaths.
CPR Shield
A protective barrier device used to prevent contact with potentially infectious body fluids while performing rescue breaths on a person. The shield consists of a flat square of malleable plastic with either a hard plastic breathing valve or a filter.
Glossary
CPR Pro for the Professional Rescuer
41
Defibrillation
The process of passing an electrical shock through the heart to restore a normal pumping rhythm.
Emergency Action Plan (EAP)
A site-specific plan for workplace or home that contains specific procedures on how to respond to internal emergencies and activate
EMS.
Emergency Medical Services (EMS)
The emergency medical response system developed within your community, typically using a specialized emergency communication
network to gather information and dispatch appropriate emergency resources. A first aid provider can activate EMS in an emergency,
usually by calling an emergency number.
Good Samaritan Law
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
A law enacted in all states to legally protect trained providers who voluntarily stop to help, act prudently, do not provide care beyond
training, and are not completely careless in delivering emergency care.
Head-tilt, Chin-lift
A technique intended to open the person’s airway, involving tilting the person’s head back and lifting the person’s chin. Technique
results in the base of the tongue lifting away from the back of the throat.
Heart Attack
Reduced blood flow to the tissues of the heart, also known as acute coronary syndrome. It is usually characterized by pain, severe
pressure, or discomfort in the chest.
Implied Consent
A legal concept referring to the legitimate assumption that an unresponsive person would give permission to be helped if responsive.
Pacemaker or Automated Internal Defibrillator
A surgically implanted device, which may be noticeable by a lump or surgical scar.
Primary Assessment
Checking for immediate life-threatening problems.
Protective Barrier
Anything that helps reduce the risk of exposure to potentially infectious body fluids. Some examples of effective protective barriers
include latex (or non-latex) gloves, and ventilation shields and masks.
Recovery Position
The position in which an unresponsive breathing person is placed to drain fluids from the mouth and keep the tongue from blocking
the airway; place the person on his or her side with head slightly forward.
Rescue Breaths
Artificial breaths given to someone who is not breathing; administered by blowing air into the mouth to inflate the lungs.
Stroke
Occurs when the blood supply to a portion of the brain is suddenly interrupted. Commonly occurs when a blood clot gets caught
in a blood vessel. In most cases, brain cells die. Signs can include numbness of face, arm, or leg, especially on one side of the
body; confusion; change in the ability to speak or understand; change in sight and balance; and severe, sudden headache.
42
CPR Pro for the Professional Rescuer
Glossary
Sudden Cardiac Arrest
Occurs when the normal electrical impulses in the heart unexpectedly become disorganized; the normally coordinated mechanical
contraction of the heart muscle is lost, and a chaotic, quivering condition known as ventricular fibrillation can occur. Blood flow to
the brain and body stops abruptly. It is characterized by a stoppage of breathing, sudden collapse, and loss of consciousness.
Trained Provider
Someone who is trained in the delivery of CPR and use of an AED, until personnel are available to provide more advanced care.
The trained provider is often the first emergency caregiver on the scene and plays a critical role in survival.
Universal Precautions
An approach that recommends handling all blood and other body substances as if they are infectious. To be effective, use protective
barriers between yourself and an ill or injured person, regardless of relationship or age.
This training guide is provided online for individual use only. Reprinting for classroom distribution is prohibited.
Unresponsive
A condition in which the person does not respond in any manner when addressed or tapped by the trained provider.
Ventricular Fibrillation
A chaotic, quivering heart rhythm that interferes with the heart’s ability to pump blood.
Glossary
CPR Pro for the Professional Rescuer
43
Rate Your Program
CPR Pro for the Professional Rescuer
This required course evaluation allows you to rate the training course you have just completed. This evaluation will
provide your training provider with feedback on the quality of the instruction you received.
2–Poor
1–N/A
Thank you for your help.
3–Average
Please rate the following course elements as indicated below. Place a check in the box that
best represents your opinion of the quality of each element.
4–Good
Date of Course ______________________
5–Excellent
Instructor __________________________________________________________
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
Program Content
Organization, pace, and flow
Not too basic, not too complex
Time allowed for skill practice
Increased your confidence and ability to take action
Instructor(s)
Subject knowledge
Enthusiastic, friendly
Sincere, considerate, helpful
Fair, impartial
Organized, effective
Program Materials
Student handbook
3 3 3 3 3
3 3 3 3 3
Audiovisual materials (video, PowerPoint )
®
Physical Facilities
Space
3 3 3 3 3
3 3 3 3 3
3 3 3 3 3
Training equipment
Your overall score for the course
What did you like most about this course? ___________________________________________________________________
_________________________________________________________________________________________________________
What did you like least about this course? ____________________________________________________________________
_________________________________________________________________________________________________________
Would you recommend this course to others?
© 2011 American Safety & Health Institute
3 Yes
3 No
PRN3068 (7/11)
American Safety & Health Institute
1450 Westec Drive
Eugene, OR 97402 USA
800-447-3177 • 541-344-7099 • 541-344-7429 fax
hsi.com/ashi
CPR Pro
Health & Safety Institute — We Make Learning to Save Lives Easy®
American Safety & Health Institute is a member of the HSI family of brands.
ISBN 978-936515-23-3
© 2011 American Safety & Health Institute
PRN2054 (9/11)
UPC Code Space
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertisement