CPR/AED/First Aid

Training
by
Rob Sundquist, MS ATC LAT
Director of Sports Medicine/Head Athletic Trainer
Creekview High School
 Chain of Survival
 The chain of survival are four steps to help
increase the chances of an injured person
of surviving a cardiac arrest.
 Chain of Survival – step one

 After determining that there is an injury needing

advanced care; if unconscious tap and shout.
 Call 911
– Questions you will need to answer:
– Nature of the emergency?
– Where are you?
– How many are hurt?
– Ages of who is/are hurt
– Who are you?
– Has treatment started?
– Only hang up when instructed to do so by operator.
 Chain of Survival – step two
 Begin CPR
– Most adult cardiac arrests (CA) victims heart is in
ventricular fibrillation (VF) - Abnormal chaotic heart
rhythm that prevents the heart from pumping
blood.
– CPR will not usually stop VF but plays an important
part in pushing oxygenated blood to the brain and
heart and prolonging VF so that an AED will be
useful.
– CPR can double or triple the victims survival rate
– For every passing minute without CPR; rate of
surviving drops 7-10%.
– With CPR there is only a 3-4% drop each minute
 Chain of Survival – step three
 Use an AED
– The use of the AED will stun the fibrillating
heart, if the heart is still viable the normal
pacemakers in the heart will begin firing and
start a normal rhythm.
– If used within 5 min; chances of survival is
49-75%.
– Using an AED is simple.
 Chain of Survival – step four
 Advanced Care – EMS
– Response time is 7-8 minutes – CPR is
extremely important.
How to recognize major
emergencies
 Heart Attack
Myocardial infarction
 Coronary heart disease is the leading cause of death in
our nation.
 During MI - part of heart muscle is starting to die.
 Caused by a blockage of an artery (coronary) due to
buildup of cholesterol deposits or a blood clot.
 Victims are usually awake and can talk but feels
severe pain
 Most critical time is within the first 30
minutes after Sx begin.
 Heart Attack
 Most common symptoms
– Pain or pressure in the center of the chest – which last more than 3-5 minutes.

– Pain might feel pressure, fullness, squeezing, or heaviness

– Pain might spread to shoulder, neck, lower jaw and down arm (usually the right).

– Pain lasts 3-5 minutes. Sometimes will stutter, stop momentarily but then begin again.
 Other Sx – lightheadedness, fainting, sweating without fever, nausea, shortness of
breath

– Most victims will downplay symptoms, you must take action!!!

– Call 911, get the nearest AED, and have the person rest in a position that is comfortable
where they can breathe easily.
 Put them in an area that you can get them to the floor easily and paramedics can get in .
 Cardiac Arrest
 When the heart stops beating. Usually
caused by VF, which begins where the heart
muscle is injured.
 Without blood flow and no pulse the person
becomes unconscious and stops breathing
and collapses.
 VF and cardiac arrest may be the only
symptom of a heart attack.
 AED is only thing that will stop a VF
 Stroke

 Its is a rapid onset of neurological problems

like weakness, paralysis in one or more limbs,
difficulty speaking, visual problems, intense
dizziness, facial weakness, altered
consciousness, and severe headache.
 Two causes
– blood vessel to brain is blocked by a blood clot
– blood vessel to brain breaks
 #3 cause of death and #1 cause of serious
disability among Americans
 Stroke
 Most signs overlooked;
three major signs to
observe
– facial droop
– arm weakness – most
obvious when victim
attempts to extend arms
with eyes closed – one or
both may not move very
well
– speech difficulties –
slurring of words and
sentences
– Call 911 immediately if
see signs of stroke
 Provide CPR if needed
 Foreign body obstruction
 Usually caused by food, but can be caused by many
objects
 Major signs
– Universal choking signal
– poor ineffective coughs
– inability to speak
– high pitched sounds while inhaling
– increased difficulty breathing
– Blue lips or skin (cyanosis)
– Loss of consciousness and responsiveness
 Heimlich maneuver in conscious victim
 CPR in unconscious victim
CPR - adult
 Step one
 Make sure area is safe
 Check unresponsiveness – tap and
shout – “Are you alright”
– If no response – call 911 or send someone
directly to call
 Grab AED if one present or send
someone to get one.
 Step two
 If possible place
victim supine and
on a hard surface.
– If victim is prone –
roll over
– Try protecting the
neck as much as
possible if you
suspect neck injury
 Begin CAB’s
– C = Circulation
 If not breathing or see abnormal breathing begin chest compressions
– Agnal breathing – gasps that occur at the beginning of CA – not efficient
– act as they are not breathing
– No checking for pulse or signs of circulation just go straight to
CPR
– Place one palm on the chest between the nipple line
– Interlock your other hand on top of the hand on the chest
– Bring your shoulder over the top
– Make sure you have a wide base (knees spread just outside your
shoulders)
– Press down 1 ½ -2 inches at a rate of 100 compressions per minute –
hard and fast
– Make sure chest recoils completely
– Complete 30 compressions and then give two breaths.
– Do not stop unless and AED is available, victim moves, or you
substituted out (if two rescuers are available – switch every five cycles
of 30:2 – approx two minutes) – reduces fatigue
– A = Airway
 Head tilt and Chin lift
– B = Breathing
 If you do not detect normal breathing – give two
breaths lasting 1 second each (may use barrier)

 Watch chest rise, allow exhalation before next

breath.
 If breaths do not go in – reposition head and try
again.
 Practice
 Practice
– Practice compressions 30 times twice –
alternate with partner – no breaths
– 60 sec test – just compressions – try to get
95-105 compressions – allows to learn
rhythm. Perform 1-2 times or as needed
– Two minute test – performing 30:2 (includes
breath) - should complete five cycles in that
time.
 During the beginning stages of CA – chest compressions
are more important than breaths. Oxygen level will stay
high for the first few minutes but blood is not moving to
due to the heart not pumping.
– Breathing becomes as important as the length of CPR continues

 Very important to limit interruptions of chest

compressions.

 Be mindful not to give to many breaths, too much

breath or too forceful – may cause gastric filling and the
resultant complications, and/or cause diminished blood
flow and reduce survival.
 Vomiting/other breathing
 If someone does throw up – do not panic.
– Roll victim towards you. Use your body to hold them.
– Clean out the mouth – roll back and continue.
 Mouth to nose
– Use when it is impossible to use the mouth due to
injury.
 Face shields and masks – may be used -
– Very little chance of transfer of bodily fluids if perform
mouth to mouth without mask.
– Using shield or mask can slow down the CPR process
– “Chest compression only” CPR is more beneficial than
no CPR at all.
 Recovery position
 If victim begins breathing and having a
pulse then turn victim to their side with
lower arm in front.
 No position is perfect- just make sure they
are stable, near a true lateral position, and
there is no pressure on the chest to impair
breathing
 Potential neck injury
 If two or more responders
– One stabilizes the neck – they will be in charge if victim
needs to be moved
– Place hands on the sides of the head and neck, using
your hands to cup around the neck.
– Place pressure on head with forearms near the ears
– Elbows should be on the ground, wrists in ulnar deviation
so that they come in contact with the head.
 This will limit the amount of movement that will occur if you have
to move your body, for example moving so that CPR can be
administered or when EMS puts on a neck brace.
– If movement is necessary then move body as one.
CPR – Child and infant
 Child CPR (ages 1-8)
 Similarities with Adult CPR
– Location on chest for compressions is the same – nipple line
– Ratio of compressions to breaths the same – 30:2

 Differences with Adult CPR

– In the chain of survival you will perform CPR first for two
minutes performing five cycles of 30:2 – then call 911 (if you are
alone)
 Reason is that most child and infant cardiac arrests are due from
asphyxiation, so they will benefit more from the CPR.

– The depth you use for compression is 1/3 to ½ depth of the

chest. Use one or two hands – which ever is more comfortable.
 Infant CPR
 Similarities with adult CPR
– 30:2 ratio of compressions to breaths

 Similarities with Child

– Perform CPR first in the Chain of Survival, for the same reasons.
 If small enough you may carry to phone with you after completing the five
cycles – use speaker phone
– Depth of compressions.

 Differences with CPR

– You will perform chest compressions one finger below nipple line
– You will place your mouth over mouth and nose of infant
– You will only puff air in
– If unsure if it is a child or not, if it can fit on your arm, then treat as an
infant
 Practice
Foreign Body Airway
Obstruction (FBAO)
Heimlich Maneuver
 Choking
 Universal sign of choking – hand around
throat
 Ask questions
– Are you choking? Can you speak? May I
help you? – Very important.
 If they say no leave them alone until they pass
out – then it is assumed they want help.
 If a person can speak or can cough -
do not help
 Abdominal thrusts
 Place yourself behind victim scissor you legs
 Front leg between victims legs
 Slightly bend knees
 Place hands on navel
 place hands on chest if woman is pregnant or victim is severely
overweight
 Pull in and up
 continue until object is out or they pass out
 Use chest thrusts if you are unable to circumvent the abdomen
 If pass out lower them carefully to the floor begin CPR
 Only difference with CPR is you check mouth for object before
breaths.
 Finger sweep only if you see object.
 Practice
 Infant FBAO
 Infant –
– Conscious – place infant on forearm with babies
mouth between fingers – back blows to upper back
– Unconscious –
 after back blows - five compressions –
 look for object
 give breath
 repeat cycle – back blows, compressions, look and breaths
 Finger sweep if see object
 Practice
Automated External
Defibrillator
AED
 What is an AED?
 Automated external defibrillator – is an computerized
defibrillator
 it can analyze heart rhythm
 recognize shockable rhythm
 advise the operator whether the rhythm should be shocked
 very easy to use

 AED’s computer chips analyze the rate, size and wave

shape of human cardiac rhythm.
 will not shock a properly functioning heart
 will not shock a heart that has stopped – VF is not present
 Universal steps of AED use
 Place AED parallel to patients left ear
 Power on the AED first
 Some automatically turn on when opened
 Attach the AED to the patients chest with electrode pads
 Remove clothing – to bear chest
 Be kind to females
 Dry patient or shave chest in area of electrode placement if needed
 Place one pad above right nipple and one to the side and below the left
nipple. (CPR is continued up to the point of placing the pads
on)
 Analyze rhythm
 Make sure everyone is clear (must say “stand clear of the victim”). No
contact
 Push analyze
 Charge AED if shock is required (some machine charge automatically)
 Shock if indicated – (after checking everyone is clear
again)
 Begin CPR for five cycles then analyze again
 If shock is advisable again you clear everyone and shock
 If shock is not advisable – continue with CPR
 If victim has pulse and is breathing put into recovery
position.
 DO NOT take off pads or turn off AED until prompted by EMS
 Special Considerations
 Water
 Must remove victim from water or wet surface
 Dry before attaching pads
 Metal surfaces
 Is victim lying on metal surface? – if so move victim
 The metal surface may cause the shock form the AED to hit you.
 Children
 Children 8 and older use as soon as possible
 Children 1-8 – CPR for two minutes before using AED
 Transdermal medications
 Remove patch and wipe clean before attaching AED pads
 Implanted pacemakers and defibrillators
 Do not place an AED electrode directly over implanted device.
 Move at least one inch to the side of device
 Practice
First Aid
 Medical emergencies
 Breathing difficulties
 Asthma problems are increasing
 Most have medicines
 May need assist victim is administrating
 If symptoms continue to get worse call 911
 Anaphylaxisis
 Severe reaction to allergen
 Victim may have epinephrine injector
 May need to administer
 Call 911 if medicine is not administered
 Seizures
 General rules – 1) Prevent injury 2) ensure open airway 3) maintain
open airway after seizure is completed – place in recovery position
 Never try to restrain victim, place anything in the mouth.
 Injury emergencies
 Bleeding
 Direct pressure best way
 If bleeding continues add more gauze or cloth; do not
remove gauze or cloth
 Use elastic bandage to apply pressure to gauze and hold it
in place.

 The use of tourniquets should be avoided unless in extreme

matters
 The efficacy of elevation and pressure points is
inconclusive; if used, use only in conjunction with direct
pressure and when there is no apparent fracture or other
underlying injury.
 Wounds and abrasions
 Irrigate wounds until free of any foreign matter.
 Small wounds and abrasions should be cleaned
thoroughly then have triple antibiotic ointment
placed on it and covered.
 Larger wounds need to also be cleaned then
covered and taken to doctor for possible stitches
 Burns
 Thermal burns
 Cool burn with cold water until pain ceases
 Do not cool for more than 10 min. Can lead to further damage
 Burn blisters cover with loose gauze, but keep intact – breaking
them can lead to infection

 Electrical burns
 Make sure electrical current is shut off before trying to help victim.
 CPR and defibrillation may be needed as well as burn treatment
 All electrocution injuries should be checked out by a physician
 Spine stabilization
 Suspect possible spinal injury if…
 Car accident
 Injured from fall greater than their height
 Complains of neck pain, tingling, or extremity weakness
 Is not fully alert
 Appears to be intoxicated
 Appears frail or is >65 yrs old
 Has sustained a head injury

- Manually stabilize the neck until help arrives.

 Musculoskeletal trauma – sprains, strains, contusions,
fractures
 For sprains, strains, contusions – apply ice for 20.
 Sprains elevate and place compression bandage
 R.I.C.E. – rest, ice, compression, elevation
 If victim has aversion to cold – place wet cloth between ice and skin
 Young kids and elderly especially susceptible
 Contusion you want to stretch the injury as well as ice
 If you are unsure of the injury suspect fracture – do not
move or straighten injury. Place ice on area and splint in
position, send to ER.
 If suspect dislocation – splint as is and send to ER.
 Dental injuries
 Avulsed tooth
 Hold onto by the crown not the root (part embedded
into gum
 Rinse off with water (do not scrub)
 Either place back into socket or place in glass of milk
and see a dentist immediately
 Clean bleeding wound with saline solution or tap
water
 Use cotton to apply pressure to stop bleeding
 Environmental injuries
 Snakebite
 Do not suck wound, it will only exasperate the problem
 In case of Coral snake – wrap a bandage around the extremity of the bite – it will help
slow the poison – then get to medical facility immediately.
 Coral snake bites and sucks
 Other snake bites, wash area with soap and water, try not to move extremity very much
and get to medical facility.

 Cold injuries
 Hypothermia
 Immediately begin re-warming – remove wet clothes and wrap body surface with anything at
hand; get to medical facility immediately
 If far from medical facility you begin active warming – placing near heat source, placing in
warm (not hot) water.
 Frostbite
 Remove wet clothing, usually occurs on extremities, do not re-warm if there is any chance it
could freeze again or you are close to a medical facility.
 Use luke-warm water if you are far from medical facility
 Heat Injuries
 Heat cramps – muscle cramping, usually due to extreme loss of fluids
 Get to cooler area
 Replace fluids
 Ice and stretch area
 Heat exhaustion
 Dizziness, could have flushed skin or cool and clammy, disoriented,
nausea, headache
 Get victim to cool area immediately
 Place ice on side of neck (carotid artery), arm pits, and groin area
 Replace fluids
 Watch for shock; could lead into heat stroke
 Heat Stroke – medical emergency – call 911 immediately
 Extreme disorientation, possible unconsciousness, very little sweating,
internal temperature of >105.
 Cool down by any means
 Drowning
 Get victim out of water as soon as possible

 Begin CPR immediately

 If you are alone – finish five cycles of CPR before calling

911
 Poisons
 Poison control center – 1-800-222-1222
 Chemical Burns
 Brush off any powder and remove all contaminated
clothing
 Alki or acid exposure – rinse with copious amounts of
water.
 Ingested poisons
 Do not ingest any medication; milk, activated charcoal,
syrup of ipecac unless instructed by poison control
 Shock
 Develops when there is not enough blood flowing to the cells of the body
 Causes in adults;
 loss of blood
 heart attack,
 allergic reaction
 Symptoms
 feel cold and shiver,
 feel weak, faint, or dizzy,
 restless,
 vomit,
 feel thirsty
 Treatment
 Call 911
 Put victim on their back
 If not leg injury or pain raise legs 12 inches
 Cover victim with blanket
 If bleeding is visible – use direct pressure