Agenda

Nurses Educational Opportunities provides BLS classes Monday through Saturday each week. An appointment is required and can be obtained by calling the office in San Diego or Orange County. At the designated appointment time you will be asked to watch a video, take the written test, and demonstrate skills. This First Responder prestudy guide in conjunction with the American Heart Association (AHA) Basic Life Support Text will nicely prepare you for your upcoming class. You must have the new 2010 AHA BLS textbook at the time of the class. This text book is available for an additional charge in both offices. The text book can be shipped to you. An American Heart Association provider card will be presented to you at the completion of the class. Recertification courses require presentation of your recent BLS provider card. A copy of that will also be accepted if you do not have the original. Lay rescuers may provide Hands-Only CPR™ (chest compressions only) once the recognition of unresponsiveness is acknowledged and after 911 is notified. Lay rescuers are not required to check the victims pulse, open the airway or give rescue breaths. (2010 Update)

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Healthcare Professionals should be trained BLS with the 2010 AHA updates which are described in NEO’s First Responder study guide. Recognition of signs and symptoms for the following life threatening situations is imperative to know: Acute Coronary Syndrome (Heart attack) Acute Cerebral Vascular Accident (Stroke) Foreign Body Airway Obstruction Cardiac Arrest 2

NEO Orange County 3303 Harbor Blvd., Suite G3 Costa Mesa, CA 92626 (714) 979-4022

NEO San Diego 10379 Azuaga St, Suite 143 San Diego, CA 92129 (858) 780-2829 1

Objectives
At the end of the course the participant will be able to demonstrate the BLS 2010 updated skills using the adult, child, and infant manikins. They are as follows: Describe the links in the AHA Chain of Survival, including ♥ Early recognition of the need for BLS ♥ Activating emergency response ♥ Performing BLS starting with Chest Compressions ♥ Early defibrillation with the AED or manual defibrillator Describe the steps of CPR ♥ Recognition ♥ In less than 10 seconds, check the pulse ♥ Immediate High Quality Chest Compression Push Hard Push Fast Allow the chest to recoil Minimize interruptions ♥ Open the airway and provide ventilations
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Adult Basic Life Support Team Resuscitation
The steps of BLS have traditionally been presented as a sequence for the single rescuer. There is increased focus on providing CPR as a team because resuscitation in most EMS and healthcare systems involve teams of resuscitators with rescuers performing several actions simultaneously. (2010 Update) Recognition: The first rescuer who arrives at the side of the victim must quickly be sure that the scene is safe. You don’t want to become a victim yourself. Check for response Tap and shout “are you alright.” Scan chest for movement (2010 Update) The victim that is unresponsive with no breathing and/or only gasping, you must immediately activate the EMS and immediately start chest compressions. When you check for breathing, you must assess quickly. We no longer open the airway with the head-tilt, chin-lift. We no longer check for the rise and fall of the chest. This takes to long. (2010 Update) For the victim that is unresponsive and breathing activate the EMS and continue monitoring the victim for cessation of breathing until EMS arrives. Activate the EMS Activate the EMS and call for an AED Remember, you have a team. One of your first responders can call for EMS and/or retrieve the AED.(2010 Update)

Describe the signs and symptoms of 4 major emergencies in adults ♥ Heart attack (ACS) ♥ Stroke (ACVA) ♥ Cardiac arrest ♥ Foreign-Body Airway Obstruction In addition, the participant will be able to demonstrate the following skills using an adult, infant, or child manikin ♥ Rescue breathing Mouth-to-mouth Mouth-to-mask Bag-mask: adult, child, infant ♥ Use of an AED for adults as well as children ♥ Relief of FBAO in the responsive and unresponsive victim of any age. 3

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Check the carotid pulse When you check for pulse, you must take less than 10 seconds to assess. Anything greater than 10 seconds takes to long and prolongs initiation of chest compressions. (2010 Update) The key is to keep the blood circulating and minimize interruptions (2010 Update) Do not spend more than 10 sec. checking for a pulse If you find a pulse, support the victim with rescue breathing If you can’t get a pulse within 10 seconds, initiate CPR starting with 30 chest compressions followed by 2 breaths (2010 Update) Immediately!!! Place your hands in the lower half of the breast bone of the chest and begin chest compressions (2010 Update) ♥ Push hard – at least 2 inches in depth for the adult. ♥ Push fast – at a rate of at least 100 X minute. When reading the questions on the test, be careful. Look for the word “rate”. That must alert you to the answer of 100X min. ♥ Allow the chest to fully recoil ♥ Minimize interruptions ♥ One-man and two-man adult CPR compression to ventilation ratio should be 30:2 ♥ Provide ventilations Open the airway – head tilt, chin lift or jaw thrust Seal your mouth over the victims mouth and give two rescue breaths – just enough to make the chest rise and fall The healthcare provider should use the barrier device for one-man CPR Two healthcare provider should ventilate using the bag/mask

With advanced airway in place, compression rate remains at 100 X min with one breath every 6-8 sec. When the AED or Crash Cart arrives, connect the device to the victim as soon as possible. The probability of successful defibrillation diminishes rapidly over time. After the AED delivers a shock, immediately restart CPR beginning with chest compressions. When the AED or Crash Cart arrives ♥ Place the AED at the head of the victim ♥ Power on the AED – That means you “turn it on” ♥ Choose the correct size pads/paddles ♥ Attach the pads/paddles to the chest ♥ Attach the electrode cable to the AED ♥ Clear to analyze ♥ If shock indicated, clear the victim and self . ♥ Deliver a shock. Do not touch the victim during the “shock” or it could shock you while shocking the victim. ♥ If the AED gives you a “no shock indicated” continue BLS

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Life Threatening Emergencies
The major components of the circulatory system are the heart, arteries and veins. The heart pumps blood to the arteries. The arteries take the oxygenated blood to the muscles. The veins take blood back to the heart, thus releasing carbon dioxide in the lungs. When a person goes into cardiac arrest their circulatory system is no longer moving oxygen via the blood through the body. When you give a person rescue breaths you are pushing oxygen into the lungs. When you give a person chest compressions you cause the heart to pump so that it can move the blood in its normal path and keep the person oxygenated. Immediate Chest Compressions are imperative to provide a flow of oxygen-rich blood to the heart and brain and “buys time’ until defibrillation. The rescuer should not take the time to “open the airway, look, listen and feel for the rise and fall the chest, and should not provide rescue breaths.” That takes to long!!! Immediate chest compressions are needed to keep the oxygen rich blood pumping to the heart. Instead of AIRWAY – BREATHING – CHEST COMPRESSIONS (ABC’S) we should now focus on CHEST COMPESSIONS – AIRWAY – BREATHING (CAB).(2010 Update) The Four Life Threatening Adult Emergencies are as follows: Cardiac Arrest In cardiac arrest circulation ceases and vital organs do not get enough oxygen. Therefore, the victim will not be breathing and will not have a pulse. Victims of early cardiac arrest will often have agonal breathing. Heart Attack (ACS) This occurs when an area of the heart is deprived of blood flow. When the blood flow to the heart muscle is blocked for a sufficient period, the muscle

is damaged from the inadequate oxygen supply. The signs and symptoms may include the following: ♥ Sweating ♥ Nausea ♥ Vomiting ♥ Shortness of Breath ♥ Chest pain possibly radiating to the arm or jaw ♥ Skin that is cool, clammy Have any victim with these symptoms sit or lie down while you call 911. The key issue in treating Acute Coronary Syndrome is preventing major adverse cardiac events. (2010 Update) Stroke (CVA) This happens when there is a blood clot or bleeding in the brain. Recognizing the signs and symptoms of a stroke is critical to early intervention and treatment. The presentation of stroke may be subtle. The signs and symptoms are as follows: ♥ Headache ♥ Weakness ♥ Trouble speaking ♥ Hypertension, elevated blood pressure, is a major risk factor for stroke. The best chance the stroke victim has for survival is fibronolytic therapy within 3 hours of onset. A non-contrast CT-Scan is required before treatment can be administered. A window of 3.5-4 hours has not been approved by the U. S. Food and Drug Administration.(2010 Update)

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Choking

♥ Early recognition of foreign-body airway ♥

Infant and Child Basic Life Support Team Resuscitation
Many key issues in pediatric BLS are the same as adult BLS Keep in mind it is a “Team Effort” for the child as well as in the adult. Children are consider 1-12 years of age Infants are considered <1 year of age Recognition: Check for scene safety Check for response Tap and shout “are you alright.” Scan chest for movement. (2010 Update) The victim that is unresponsive with no breathing and a heart rate less than 60 bpm, you must immediately activate the EMS and start both chest compressions and breaths (2010 Update) When you check for breathing, you must assess quickly. We no longer open the airway with the head-tilt, chin-lift. We no longer check for the rise and fall of the chest. This takes too long. . (2010 Update) When you check for pulse, you must take less than 10 seconds to assess. Anything greater than 10 seconds takes to long, and prolongs the initiation of chest compressions.(2010 Update) The key is to keep the blood circulating and minimize interruptions. Activate the EMS Activate the EMS and call for an AED Remember, you have a team. One of your first responders can call for the AED or the EMS. Check a carotid or femoral pulse if the child is >1 y/o Check for a brachial pulse if the child is <1y/o Do not spend more than 10 seconds checking for a pulse. (2010 Update) 10

obstruction (FBAO), or choking, is the key to successful outcome. It is important to distinguish this emergency from fainting, stroke, heart attack, seizure, drug overdose, or other conditions that cause sudden respiratory failure but require different treatment. An adult choking victim will not be able to cough or talk. The choking victim will often place one of their hands on their neck/throat. This is the universal sign for choking. If the responsive adult is choking, ask if they are choking. If they nod “yes” immediately perform as many abdominal thrusts to remove the obstruction. If the adult becomes unresponsive and the foreign body has not been removed by abdominal thrust, gently support the unresponsive victim to the ground, call 911 immediately, begin chest compressions for 2 minutes or until the foreign body is forced out. After 2 minutes of chest compressions open the airway, if you can see the foreign body remove it and give 2 rescue breaths followed by 30 compressions until the victim becomes responsive or 911 arrives.

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If a pulse cannot be detected, or is less than 60 bpm, healthcare providers should begin CPR. A heart rate less than 60 bpm is an ominous sign. (2010 Update) If the child has a heart rate greater than 60 and is not breathing the healthcare provider must give breaths without chest compressions. . (2010 Update) If you can’t get adequate pulse within 10 seconds, initiate BLS starting with 30 chest compressions followed by 2 breaths. (2010 Update) ♥ Immediately!! Place your hands on the lower half of the breastbone. ♥ Push hard - for the child at least one third the anterior to posterior of the chest approximately 2 inches in depth for the infant, at least one third the anterior to posterior depth of the chest approximately 1 ½ inches. ♥ Push fast – at a rate of at least 100 X minute. (2010 Update) ♥ Allow the chest to fully recoil ♥ Minimize interruptions ♥ One-man CPR the compression to ventilation ratio should be 30:2 ♥ Two-man CPR the compression to ventilation ratio for the child and the infant should be 15:2. ♥ Compressions for a child can be accomplished using one hand or two hands, depending on the size of the child to accomplish the appropriate depth. ♥ Compressions for an infant can be accomplished using 2-finger or 2-thumb encircling technique (which produces better blood flow). Provide ventilations Open the airway – head tilt-chin lift, or jaw thrust Give two rescue breaths – just enough to make the chest rise and fall. The healthcare provider should use the barrier 11

device for one-man CPR Two healthcare providers should use the bag/mask to ventilate. Ventilation with bag/mask should be 1 breath every 3-5 seconds. As soon as possible, connect an AED or defibrillator. If indicated deliver a shock. For infants, a manual defibrillator is preferred over an AED. (2010 Update) If using an AED for a child , a pediatric dose attenuator is preferred. . (2010 Update) If neither is available an AED without a pediatric dose may be used. . (2010 Update) When the AED or Crash Cart arrives ♥ Place the AED at the head of the victim ♥ Power on the AED (that means you turn it on) ♥ Choose the correct size pads or paddles ♥ Attach the pads or paddles to the chest ♥ Attach the electrode cable to the AED ♥ If shock indicated, clear the victim and yourself . ♥ Deliver a shock. Do not touch the victim during the “shock” or it could shock you while shocking the victim. ♥ Return to CPR beginning with Chest Compressions ♥ You may reanalyze with pulse checks in 2 minutes (5 cycles) of CPR

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Many healthcare providers will argue that ventilation is more important than chest compressions for the child because of the frequency of respiratory distress leading to respiratory arrest. This proposed major change in CPR sequencing to compressions before ventilations (C-A-B) led to vigorous debate among experts in pediatric resuscitation. Because most pediatric cardiac arrest are asphyxial, rather than sudden primary cardiac arrest, both intuition and clinical data support the need for ventilations and compressions for pediatric CPR. However, pediatric cardiac arrests are much less common than adult sudden cardiac arrest, and many rescuers do nothing because they are uncertain or confused. Most pediatric cardiac arrest victims do not receive any bystander CPR so any strategy that improves the likelihood of bystander action may save lives. Therefore, the C-A-B approach for victims of all ages was adopted with the hope of improving the chance that bystander CPR may be performed. Lay Rescuer: Hands-Only CPR (2010 Update) (High-quality Compressions-Only) Push Hard Push Fast Allow the Chest to Recoil DO NOT check the pulse. DO NOT open the airway. DO NOT give rescue breaths.

Choking
Choking/foreign body obstruction: ♥ If victim is choking and still moving air encourage him to cough ♥ When air exchange becomes poor and cough less effective and the victim is making high pitched noises and has bluish skin the victim has severe or complete airway obstruction with inadequate air exchange. ♥ Place your fist halfway between bellybutton and sternum The best way to relieve a foreign body obstruction is abdominal thrust, formerly referred to as the Heimlich Push up and inward. Do as many as it takes to relieve the FBAO ♥ When victim looses consciousness the rescuer should send someone to activate the EMS and start CPR beginning with chest compressions Check the pulse within 10 sec If there is no pulse for the adult or a pulse of less than 60 for the child begin chest compressions (30:2). Open the airway (head-tilt chin-lift) and try to ventilate Do not perform finger sweeps to remove any foreign object that you cannot see. If you can see the foreign object you may attempt to remove it. Never do a blind finger sweep on a child. It may push the object back into the throat. Always do 5 cycles of CPR before calling 911 for the child or infant. ♥ If unable to ventilate, begin chest compressions. When possible always use a barrier device to avoid communicable diseases ♥ Hospital = bag/mask ♥ Field = shield

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Adult

Team Resuscitation of Basic Life Support for Adult, Child and Infant
Instructor Presentation and Skills 1. 2. 3. 4. Check for Scene Safety * Check for responsiveness Activate the EMS/AED Check the carotid pulse Do not take more than 10 seconds to check the pulse*

One Man 30:2* Depth=2 in* Ventilate with barrier device*

Two Man 30:2* Depth=2 in* Ventilate with Bag/Mask*

During 2 rescuer CPR the second rescuer must maintain and open airway and give ventilation* Child (one year to puberty) One Man 30:2* Two Man

Provide High Quality CPR Push hard to create blood flow during compressions* Push Fast at a rate of 100X min* Allow the chest to recoil Minimize interruptions Compress the lower half of the breastbone!!!* Provide Effective Ventilation Give 2 slow easy breaths – just enough to see the chest rise and fall. Even Infants!!!! Give 1 breath every 3-5 seconds* After the advanced airway is in place – give one breath every 6-8 sec* 5. When AED arrives Turn it on* Attach appropriate size pads Clear to analyze Clear to shock If indicated - deliver shock Return to chest compressions* If “no shock advised” Return to chest compression* 15

15:2* Depth Compress 1 ½-2 in. or One third the depth of the chest* Ventilate with Barrier device* Ventilate with Bag/Mask*

Heart rate less than 60 bpm is an ominous sign – Begin CPR* *If you have child with a pulse but not breathing – provide breaths without chest compressions*

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Infant (birth to one year) One Man 30:2* Depth Compress at least=1 1/2 in or One third the depth of the chest* Ventilate with barrier device* Ventilate with Bag/Mask* Two Man 15:2*

Skills Practice Adult CPR
You’re in the hospital and you see a man lying on the floor as you round the corner headed to the pharmacy. What do you do? ________Check for scene safety ________ Check for response ________Tap and shout “Are you alright” ________Scan chest for movement. (2010 Update) He’s not breathing. What do you do? ________Initiate someone to activate the EMS and get the AED ________Check for pulse within 10 seconds ________ Start Chest Compressions ________ Demonstrate your high quality chest compressions What is your next step in resuscitation? _________Open the airway _________Give 2 rescue breaths _________Demonstrate ventilation with Barrier Device _________Demonstrate ventilation with Bag/Mask The AED has arrived. What do you want the second responder to do? ________ Open AED and Turn it on ________Attach Pads ________Clear to Analyze ________Clear to Shock ________Shock if indicated ________Continue chest compressions (30:2). In 2 minutes (5 cycles), you reanalyze. There is a pulse. What do you do? _______Check breathing. Support breathing until advanced help. _______ Place in the recovery position.

Heart rate less than 60 bpm is an ominus sign – Begin CPR* Use the 2-thumb encircling and technique for greater Intrathorasic pressure*

Foreign Body Airway Obstruction (FBOA) 1. Encourage Coughing 2. When the victim becomes stridorous and unable to move air – begin abdominal thrust (formerly called the Heimlich Maneuver) Do as many as it takes to get the obstruction out. 3. When the victim becomes unresponsive – begin CPR starting with chest compression.* Remember when we use to straddle the victim? We don’t do that anymore. Thank God!!!

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Adult Choking
You are at a restaurant and the woman at the table next to you stands up holding her throat. What do you do? _________Encourage coughing She then becomes stridorous and unable to move air. What do you do? __________Provide abdominal thrust. She then becomes unresponsive. What do you do? ________Initiate someone to activate the EMS and get the AED ________Check for pulse within 10 seconds. If not pulse, begin CPR starting with chest compressions.* The AED has arrived. What do you want the second responder to do? ________ Open AED and Turn it on ________Attach Child Pads ________Clear to Analyze ________Clear to Shock ________Shock if indicated ________Continue chest compressions (15:2). In 2 minutes (5 cycles), you reanalyze. There is a pulse. What do you do? _______Check breathing. Support breathing until advanced help. _______ Place in the recovery position.

Child CPR
You are at the soccer field, watching children play on the field. Suddenly, a child collapsed on the ground. He doesn’t appear to be moving. What do you do? _________Check for scene safety ________ Check for response ________Tap and shout “Are you alright” ________Scan chest for movement. (2010 Update) He’s not breathing. What do you do? ________Initiate someone to activate the EMS and get the AED ________Check for pulse within 10 seconds ________ Start Chest Compressions ________ Demonstrate your high quality chest compressions What is your next step in resuscitation? _________Open the airway _________Give 2 rescue breaths _________Demonstrate ventilation with Barrier Device _________Demonstrate ventilation with Bag/Mask

Child Choking
You are at a child’s soccer field and you find a child choking. What do you do? ___________ Pat him/her on the back and encourage him to cough He/She then becomes stridorous and unable to move air. What do you do? __________Provide abdominal thrust. He/She then becomes unresponsive. What do you do? __________Initiate someone to call EMS. __________Check the mouth for FBO and begin CPR starting with chest compressions.

Infant Choking
You are in the hospital, and you see a baby choking in his mother’s arms. She is panicked, and does not know what to do. What should you do? 20

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_______ Hold the baby face down, support the head and neck. _______ Give 5 back slaps. _______ Turn the baby, with the chest facing up, support the head. ________Give 5 chest thrusts. The baby can’t cough out the object, and becomes unresponsive. What do you do? _______ Call for help. Call the Code. _______ Check the pulse. If no pulse, start 30 chest compressions. _______ Give 2 ventilations with a barrier device. A nurse comes to the rescue! Now it’s both of you doing CPR on this baby. How many compresisons : ventilations do you do? _______15:2 for 2-rescuer CPR for the infant.

Notes

Infant CPR
You are babysitting your neighbor’s 6 month old daughter when you notice that she is no longer breathing. What should you do? _________ Check for responsiveness _________ Tap and Shout “Are you alright?” __________Scan chest for movement. (2010 Update) Baby’s not breathing and no signs of circulation. What do you do if you’re a healthcare provider? _________ Call out for someone to activate EMS __________Check for pulse within 10 seconds _________ Start Chest Compressions What is your next step in resuscitation? __________Give 2 rescue breaths The AED has arrived. What do you do now? ________ Open AED and power up ________Attach Pads ________Follow prompts ________Continue with chest compressions.

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The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA course material, do not represent income to the Association.

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