Standard 12 - Skills for Care

Standard 12 - Skills for Care
The CARE CERTIFICATE
Basic Life
Support
What you need to know
Standard
THE CARE CERTIFICATE WORKBOOK
Legislation
and basic life
support
Introduction
The information in standard
12 provides knowledge about
the administration of basic life
support.
The information in standard 12 provides knowledge about the administration of basic life
support.
You should also be provided with practical training by your employer to be able to put
the knowledge from this workbook into practice in order to be able to carry out basic life
support competently.
Basic Life Support (BLS)
Basic life support comprises the following elements:
Initial assessment.
Airway maintenance and breathing.
Cardiopulmonary Resuscitation (CPR).
When approaching a casualty, an initial casualty assessment should be conducted; this
initial assessment is called a primary survey. The primary survey is a systematic process
of approaching, identifying and dealing with immediate and/or life-threatening conditions.
The primary survey can be remembered by the acronym DRABCD (or the easy way to
remember: Doctor ABCD).
Further training beyond the Care Certificate
Where an employer wishes to provide training that goes beyond these minimum
requirements for the Care Certificate such as the use of an Automated External
Defibrillator (AED) or an Emergency First Aid at Work course we would encourage this but
these are not necessary in order to meet the requirements of the Care Certificate.
Completion of this standard will not provide you with the competence to become a
first aider. In order to achieve this you would be required to undertake specific first aid
qualifications within your workplace. Whether you need this qualification will be dependent
on your job role and your employer’s assessment of first aid needs.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
2
D
Danger
Prior to
approaching the
casualty, ensure
the safety of
the casualty,
yourself and any
bystanders.
R
A
B
Response
Airways
Breathing
Call 999/Circulation
Defibrillation
After opening the
airway look, listen
and feel for normal
breathing for no
more than 10
seconds
Call an ambulance (999/112)
Ask a helper to call otherwise call
yourself, stay with the casualty
when making the call if possible,
activate speaker function on the
phone to aid communication with
ambulance service.
If an AED arrives,
switch it on and follow
the spoken or visual
prompts. An AED is used
in conjunction with CPR.
Helpful Hint
Noisy Gasps
In the first few
minutes after a
cardiac arrest,
a casualty may
appear to fit and
may be barely
breathing or taking
infrequent, slow
noisy gasps. Do not
confuse this with
normal breathing.
If in any doubt
that breathing is
normal, act as if not
breathing normally
and prepare to start
CPR.
Send someone to get an AED if
available and staff are trained
to use it.
If you’re on your own do not
leave the casualty. Start CPR
If possible,
approach the
casualty from
their feet as
this prevents
hyperextension
of the neck from
a responsive
casualty. Use the
AVPU scale when
checking for a
response.
A–A
lert – Is the casualty moving/talking?
- No – Proceed to V
V–V
oice – Do they respond to speech No – Proceed to P
P–P
lace – Place your hand on their
shoulders and gently shake them
asking ‘Are you alright?’, if NO
response then proceed to U
U–U
nresponsive – Assume the casualty
is unresponsive.
(Provided there is no further danger,
leave in the position found and try to
find out what is wrong, get help
if needed.)
Open the airway
Place the casualty
onto their back.
Open the airway
using the head-tiltchin lift method
(place your hand
on their forehead
and gently tilt back
the head; with your
fingertips under
the point of the
casualties chin, lift
the chin to open
the airway)
Adult
The ‘P’ in the acronym AVPU is sometimes also referred to as ‘Pain’, meaning to cause a minor
pain to see if the person responds. Examples include pinching the ear lobes or finger tips.
3
C
Casualty not breathing
Commence CPR (30
compressions 2 breaths)
Depth of compression 5-6cm at
a rate of 100-120 compressions
per minute.
D
Helpful Hint
Compression only
CPR.
If you are unable,
not trained to, or are
unwilling to give breaths
for a casualty who is
not breathing, give
chest compressions
only. These should be
continuous at a rate of
100– 120 per minute
and to a depth of
5–6 cm.
If casualty is breathing normally but still unresponsive, place into
the recovery position if safe to do so, check for further injuries
(conduct a secondary survey). Check breathing regularly, if the
casualty deteriorates or stops breathing normally, be prepared to
commence CPR immediately.
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) should be administered to a casualty who is not
breathing normally and who shows no signs of life. CPR is a method of combining chest
compressions with ‘effective rescue breaths’ in order to artificially circulate blood and to put
air into the lungs. The depth of compressions is as follows:
Adult: 5–6 centimetres (similar to the short side of a credit card) using both hands.
Child (1 year to onset of puberty): – compress at least one third of the chest’s depth
(5cm), using one hand.
Infant (0–1 years of age) – compress at least one third of the chest’s depth
(4cm), using two fingers.
The rate of compression should be 100–120 compressions per minute. 30 chest
compressions should be administered prior to moving on to breaths (called ‘expired air
ventilation’).
After completing 30 chest compressions, two effective breaths should be administered
directly into the casualty’s mouth, or in the case of an infant, into their mouth and nose.
Each breath should take one second to complete and the casualty’s chest should rise as in
normal breathing; this is known as ‘effective rescue breathing’. Turn your head and watch
the chest rise and fall, then administer the second breath.
Please note: CPR must be practiced in a simulated environment as part of the Care
Certificate training arranged by your employer. The use of this workbook alone is not
sufficient to provide you with the skills to perform CPR, and is not sufficient to achieve the
competences required for award of the Care Certificate.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
4
D
R
A
Danger
Response
Airways
Prior to
approaching the
child or infant,
ensure their safety,
your safety and
the safety of any
bystanders.
INFANT
1. Talk to the infant.
2. Gently stimulate the
infant.
3. If a response
is gained, check
for further injuries
(secondary survey)
and contact the
emergency services if
required.
CHILD
1. Talk to the child
2. Gently stimulate the
child and ask loudly
‘Are you alright?’.
3. If a response
is gained, check
for further injuries
(secondary survey)
and contact the
emergency services if
required.
Infant and child
Open the airway
Place the infant/child
onto their back.
Open the airway
using the head-tiltchin lift method
(place your hand
on their forehead
and gently tilt back
the head; with your
fingertips under the
point of the infants/
child’s chin, lift the
chin to open the
airway)
B
Breathing
After opening the
airway look, listen
and feel for normal
breathing for no
more than 10
seconds
Helpful Hint
Noisy Gasps
In the first few
minutes after a
cardiac arrest, a
casualty may be
barely breathing or
taking infrequent,
slow noisy gasps.
Do not confuse
this with normal
breathing. If in
any doubt that
breathing is
normal, act as
if not breathing
normally and
prepare to start
CPR.
C
Call 999/Circulation
Call an ambulance (999/112)
Ask a helper to call otherwise call
yourself. If you are on your own
perform CPR for 1 min before going for
help
(5 initial rescue breaths before starting
chest compressions). Stay with the
casualty when making the call if
possible or if able to carry the infant or
child whilst summoning help, activate
speaker function on the phone to
aid communication with ambulance
service.
Send someone to get an AED if
available
D
Defibrillation
If an AED arrives,
switch it on and
follow the spoken
or visual prompts.
An AED is used in
conjunction with
CPR.
Casualty not breathing
Commence CPR, 5 initial
rescue breaths
(30 compressions
2 breaths)
Depth of compression
4 cm for an infant, 5 cmfor a child at a
rate of 100-120 compressions
per minute.
If the infant or child is breathing normally but still unresponsive,
place into the recovery position if safe to do so, check for
further injuries (conduct a secondary survey). Check breathing
regularly, if the casualty deteriorates or stops breathing
normally, be prepared to commence CPR immediately.
Helpful hint
The free emergency telephone number across the UK is 999. It can be used to request ambulance, police or fire service help, and in some places also HM
Coastguard and/or local mountain rescue services (the 999 operator will ask you which service you want to be put through to). If you need to use a locked mobile
’phone whose unlock number you don’t know, you should still be able to dial 999 on it. The European emergency number, 112, also works in the UK—calls to it
automatically divert to the 999 service.
5
Obstructed airway (adult)
The main aim of the respiratory system is to supply oxygen to all parts of the body.
Breathing is essential to life.
The airway can be obstructed in a variety of ways including foreign bodies (food or other
items), allergic reactions, asthma, blood, vomit and infections. An obstruction can cause
minor or major breathing difficulties and, in severe circumstances, may cause the casualty
to become unconscious and unresponsive.
Someone who is choking will have either a partial or complete obstruction of the airway.
The severity of the blockage will determine the difficulty in breathing.
Recognition
Grasping at the throat area.
Difficulty in breathing and speaking.
Difficulty in crying or making a noise.
Redness of the face.
Eyes enlarged and watering.
Displaying distress.
Treatment
This should not be carried out by any worker who has not successfully completed
formal practical training provided by their employer.
Encourage the casualty to lean forward and cough.
If the obstruction remains:
administer a maximum of 5 sharp blows between the shoulder blades.
If the obstruction still remains:
administer a maximum of 5 abdominal thrusts (or chest thrusts for an infant).
If the obstruction is still not relieved, continue alternating five back blows with five
abdominal thrusts and call for help.
Start CPR if the casualty becomes unresponsive:
Support the casualty carefully to the ground.
Immediately call the ambulance service.
Begin CPR with chest compressions.
Obstructed airway (infant and child)
An obstruction can cause minor or major breathing difficulties and, in severe
circumstances, may cause the infant or child to become unconscious or unresponsive.
Recognising a choking infant or child
Grasping at the throat area.
Difficulty in breathing and speaking (in the case of a child).
Difficulty in crying or making a noise.
Redness of the face.
Eyes enlarged and watering.
Displaying distress.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
6
With a complete obstruction the infant or child may show the above signs but also the skin
colour may develop a blue/grey tinge; they will get progressively weaker and eventually
they will become unconscious.
Treating a choking infant
Consider the safest action to manage the
choking child:
If the infant is coughing effectively,
then no external manoeuvre is
necessary, monitor continuously.
If the infants’ coughing is, or is
becoming, ineffective, shout for
help immediately and determine the
infant’s conscious level.
Conscious choking infant
If the infant is still conscious but has
absent or ineffective coughing, give
back blows.
If back blows do not relieve
choking, give chest thrusts. These
manoeuvres create an ‘artificial
cough’ to increase intrathoracic
pressure and dislodge the foreign
body.
Back blows
Support the infant in a head-downwards, prone position, to enable gravity to assist
removal of a foreign body, a seated or kneeling first aider should be able to support
the infant safely across their lap.
Support the infant’s head by placing the thumb of one hand at the angle of the lower
jaw, and one or two fingers from the same hand at the same point on the other side
of the jaw.
Do not compress the soft tissues under the infant’s jaw, as this will exacerbate the
airway obstruction.
Deliver up to 5 sharp back blows with the heel of one hand in the middle of the back
between the shoulder blades.
The aim is to relieve the obstruction with each blow rather than to give all 5.
THE CARE CERTIFICATE WORKBOOK
Chest thrusts
Turn the infant into a head-downwards supine position. This is achieved safely by
placing your free arm along the infant’s back and encircling the occiput with your
hand.
Support the infant down your arm, which is placed down (or across) your thigh.
Identify the landmark for chest compression (lower sternum approximately a finger’s
breadth above the xiphisternum i.e. lowest part of the breastbone).
Deliver up to 5 chest thrusts. These are similar to chest compressions, but sharper in
nature and delivered at a slower rate.
The aim is to relieve the obstruction with each thrust rather than to give all 5.
Following chest thrusts reassess the infant:
If the object has not been expelled and the infant is still conscious, continue the
sequence of back blows and chest thrusts.
Call out, or send, for help if it is still not available.
Do not leave the child at this stage.
If the object is expelled successfully, assess the infant’s clinical condition. It is possible that
part of the object may remain in the respiratory tract and cause complications. If there is
any doubt, seek medical assistance.
Helpful Hint
Under no circumstances should abdominal thrusts be performed on an infant. These
must be replaced with chest thrusts.
Treating a choking child
Consider the safest action to manage the choking child:
If the infant is coughing effectively, then no external manoeuvre is necessary, monitor
continuously.
If the infants’ coughing is, or is becoming, ineffective, shout for help immediately and
determine the infant’s conscious level.
Conscious choking child
If the child is still conscious but has absent or ineffective coughing, give back blows.
If back blows do not relieve choking, give abdominal thrusts. These manoeuvres
create an ‘artificial cough’ to increase intrathoracic pressure and dislodge the foreign
body.
Back blows (In a child over 1 year)
B
ack blows are more effective if the child is positioned head down.
A small child may be placed across the rescuer’s lap as with an infant.
If this is not possible, support the child in a forward-leaning position and deliver the
back blows from behind.
Give 5 sharp blows between the shoulder blades with the heel of the other hand.
If back blows fail to dislodge the object, and the child is still conscious, use abdominal
thrusts.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
8
Abdominal thrusts for children over 1 year:
Stand or kneel behind the child. Place your arms under the child’s arms and encircle
their torso.
Clench your fist and place it between the umbilicus (naval) and the ribcage.
Grasp this hand with your other hand and pull sharply inwards and upwards.
Repeat up to 4 more times.
If the obstruction is still not relieved continue alternating 5 back blows with 5
abdominal thrusts.
Start CPR if the child becomes unresponsive
Support the child carefully to the ground.
Immediately call the ambulance service.
Begin CPR with chest compressions.
Confidentiality
All confidential information regarding infants, children and individuals must be kept
securely and be accessible or available only to those who have a right to access them.
Anyone who is responsible for the storage of records and information must be aware
of their responsibilities under the Data Protection Act (DPA) 1998 and, if relevant, the
Freedom of Information Act (FOI) 2000.
Record keeping
Depending on your specific job role, there will be information and records that will require
completion should an infant, child or adult be involved in an accident, or become ill whilst
in the health or social care setting.
This recorded information in the accident book can:
help to identify trends
help to control health and safety risks
be used for reference in future first aid needs assessments
prove useful for investigations.
Please refer to your employer’s policy and procedures and forms. If you need further
clarity, speak with your manager.
Refresher training
Refresher training should be conducted regularly. It is good practice to complete a
refresher session on basic life support annually. This is not a condition of completion for
the Care Certificate.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
9
The CARE CERTIFICATE
Basic Life
Support
What do you know now?
Standard
THE CARE CERTIFICATE WORKBOOK
Activity 12.1a
Basic life support
Complete the following
sentence with the missing
words.
knowledge
competently
practice
employer
You should be provided with
to be able to put this
practical
training by your
into
able to carry out basic life support
and in order to be
.
THE CARE CERTIFICATE WORKBOOK STANDARD 12
11
Activity 12.2
Basic life support consists
of four elements. From
the list below can you find
two of them? (Place ticks
beside the two.)
List - This term means to identify the
main points which can be written as
bullet points
Initial assessment (primary survey)
Expired air ventilations
Secondary survey
Airway maintenance and breathing
CPR
THE CARE CERTIFICATE WORKBOOK STANDARD 12
12
Activity 12.3
Link the word on the left to
the correct description on
the right.
Danger
A
We need to open this to check for breathing
Response
B
We need to check for no more
than 10 seconds for this
Defibrillation
C
This should be used alongside CPR
Airway
D
Prior to approaching the casualty
visually check the area for ……
Breathing
E
If not breathing commence …
Call 999/Circulation
F
Use the ‘AVPU’ scale when checking for this
THE CARE CERTIFICATE WORKBOOK STANDARD 12
13
Activity 12.4
Answer the question by
filling in the blanks using
the numbers provided.
20
10
100-120
999
30
2
1. Seconds to take to check normal breathing
2. Rate of compressions given per minute during CPR
3. Number of breaths given in a cycle of CPR
4. Number dialled for ambulance services
THE CARE CERTIFICATE WORKBOOK STANDARD 12
14
Activity 12.5
Regarding a choking
casualty (adult): please
place the following in order
of action by labelling
them 1–4.
Give up to five back blows
Start CPR if the casualty becomes unresponsive
Encourage the casualty to cough
Give up to five abdominal thrusts
THE CARE CERTIFICATE WORKBOOK STANDARD 12
15
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