I wanted to add a little part I know you
just took CPR but I wanted to add a
little part on the numbers and make it
applicable for first responders for EMS
so we're going to look at the assessment
the steps rate ratio hands placement
depth adult child and infant some things
to remember and using an AED that
contribute to how you're going to
integrate CPR into the EMS world so
since 2010 American Heart Association is
kind of the leading standard on
science-based evidence for the best
outcomes with CPR first thing we want to
do is check the scene for safety if
somebody was electrocuted if they were
involved in an accident there's
something that could be at risk for you
to walk into that scene so check the
scene first shake and shout the victim
they appear to be unresponsive see if
you can get their attention and touch
them and as you're doing this kind of
look for that chest moving listen for
any kind of noises check that pulse the
sooner you check the pulse of the
carotid artery in the adult the faster
that you can determine that there's not
one and the quicker that you can start
compressions so this person is been
laying there maybe four minutes without
their pulse without their heart beating
and so the faster that you change that
and with your compress compressions
actually create a pulse the person has
the better outcome so we're gonna check
that pulse for five seconds no more than
ten now we don't use our thumb we use
our two fingers the second two digits
making sure that if we use our thumb we
actually have a pulse on our thumb and
we could think we feel a pulse so if you
think you feel a pulse but you're not
sure we go ahead and say no pulse no
more than ten seconds if no pulse
activate whatever kind of response maybe
it's an ambulance you're a first
responder or maybe it's a backup crew
maybe it's Fire Rescue somebody else
because the two of you on a crew cannot
take care of that and start compressions
think about it like this you can
probably hold your breath for a few
minutes or at least a minute but you
can't go very long without your heart
beating so stay on the chest continuous
cardiac compressions
actually
and heart says those who get the most
compressions are the ones who live so
place the heel of one hand between the
nipple line if it appears and nib line
is kind of saggy and I want to be crude
but if it's an older lady and the nipple
line is low just you're going to be on
the lower half of the sternum stay away
from that little notch called the
xiphoid process right there where the
ribs come together at the inferior
portion if that breaks off it goes right
into the liver and causes it to lacerate
place the other hand on top of the first
hand so that you can compress down about
two inches the first couple of
compressions you may feel cartilage kind
of making some noise just like knuckles
do when you pop them that's not broken
bones you'll know when you break a bone
it's a true snap as you come up from
those compressions make sure you have
full chest recoil you're not pushing
halfway down because what you're doing
is pushing the blood out of the heart by
squeezing the sternum the breastbone
towards the backbone and then by
relaxing allowing it to completely
refill all of the valves and the
circulatory system keep that blood
moving in one direction that's why we
want to see good chest recoil person
needs to be on a firm surface so if
they're in bed drag them to the floor
compress 30 times at a rate of at least
100 so the sweet spot is going to be 120
and if you count one and two and three
and four and five and six at least in
your head don't count aloud your guitar
in that way that's going to be the
correct rate after 30 compressions pause
for no more than 10 seconds to give two
ventilations we talked about that in the
previous lecture on airway that you want
to use a an airway mask of some sort
whether it be a pocket mask like a mouth
to mask or a bag valve mask in fact if
you don't have a mask if you don't have
a barrier of some sort it's actually
better that you don't do any
mouth-to-mouth and you do continuous
compressions until other help arrives
you're going to do five of those cycles
32 to is one side we're going to do five
of those cycles in about two minutes
after two minutes after your fifth cycle
you reassess by checking the pulse at
the same time respirations no more than
seconds then it's time to rotate the
rescuers so kind of think of a CPR
response team like a pig crew
everybody's got one role if you ever
watched any of the car races everybody's
got one role so my role is thirty thirty
two to five cycles of compressions two
minutes well if I do it really good I
might get tired so I'm going to have
somebody else take over that role switch
those rescuers so we don't get tired all
the compressions stay really effective
when the AED shows up we want to go
ahead and use it
continue your compressions the second
rescuer remove the clothing so
compressions are still going on while
we're attaching this we turn the AED on
first thing we want to do is turn it on
number one we turn it on because it's
going to tell us what to do number two
if I attach the electrodes and do
everything else and turn it on it's
going to give me about 20 seconds to do
all that stuff I've already done it's
designed it's a computer but it's
designed to not cause stress so you
could imagine if we turn this thing on
it's like attach electrodes attached
electrodes why don't you attach the
electrodes kinda reminds me of a GPS
system even when you miss your turn it's
very nice and says you know at the next
intersection making legal u-turn is very
nice but - you turn it on attach the
electrodes to the chest and it's
preferred that we do sternum in a peg so
to the right of the sternum under the
clavicle or the collarbone and the left
one on the ribs straight across from it
some of them are designed to be put on
below the nipple line in the front and
below the shoulder blade on the left
side in the back then plug in that pads
connector to the AED what it's going to
do now is analyze it'll tell you
analyzing heart rhythm do not touch the
patient so we don't touch during that
time but when it says shock advised and
it's going to charge a lot of them are
designed to take more than 10 seconds to
charge and that's a good time for us to
get back on the chest and do at least a
few more compressions and communicate
very well with whoever is pushing that
orange button is usually flashing
because you don't want them to press the
button as you're still touching the
victim as soon as do we deliver the
shock one shock we get back on the chest
and we're there for two minutes now the
he's going to take care of your time you
continue compressions for two minutes be
careful though make sure no one is
touching the victim when you shock if
they have a medication pact put your
gloves on make sure you're wearing
gloves and remove that patch wipe and
dry you never want to put an electrode
an AED patch over a medication patch as
well as implanted devices so if they
have like an internal ad or pacemaker
what you'll do is you'll block the
electricity going through the heart
muscle and you don't want to do that if
you're patient slinging in water water
is a good conductor of electricity so
you'll want to pull them out of that
puddle dry out the chest and then you
are able to defibrillate so that was
yeah ttle for pediatrics child is much
the same we check the pulse of the
carotid artery in the neck place the
heel of one hand between the nipples and
now sometimes people say I have the one
hand and that's as far as I need to
compress I don't know what to do with
the other hand if you find yourself in
that situation it's okay if you put two
hands on the chest especially if you're
smaller you're going to compress about
two inches remember the other one with
the adult at least two inches so really
deep this one if you look at the
anterior posterior diameter of the chest
we're gonna compress about a third to a
half of that you're not going to break
the ribs on kids their bones don't fully
solidify until they're older so they're
pliable we're going to compress again at
a rate of at least 100 that sweet spot
in 1:20 and I like this change with the
new guidelines 2015 because some people
did a heart rate of 180 well that's not
effective either if you go too fast so
over 100 but 121 rescuer pediatric CPR
we're going to do 32 too but since
they're more compact if we have two
rescuers one person at the head with a
pocket mask or a bag mask and the other
person on the chest we can do a 15 to 2
ratio and we still do the full two
minutes before we change her rich who
rescuers or think about a AED use for
the infant check the pulse now at the
brachial artery in the arm the necks a
little harder to find a pulse in place
two fingers one finger with below the
nipple line just like you learned in CPR
class if you do two rescuer CPR some
sometimes the two thumbs
circulating technique is a lot easier
you don't tire out as is fast and we're
going to compress at least a one and a
half inches and again 1/3 1/2 the
interior posterior diameter of the chest
same rate least a hundred with that
sweet spot of 120 one rescuer thirty two
to two rescuers 15 to two so something
that takes you a little bit further than
CPR class so let's say that you you have
someone that your resuscitating they're
not dead until they're biologically dead
they're clinically dead but they're not
biologically dead yet and you use a navy
you get through three nose shock advises
go ahead and transport you're probably
not going to ever have something that
regains a shockable rhythm if you get
six to nine shocks it's like well we
just keep shocking and shocking and
shock we can't stay here forever go
ahead and transport if they regain their
pulse as soon as they do check for
breathing if they're not breathing take
care of that ventilate for them but get
them going so they don't lose that pulse
again don't take off your electrodes
keep the AED attached to it in case you
need to use it again some companies only
carry one set of electrodes and then if
they go back into cardiac arrest and you
remove those you know that's it there's
no putting them back on to me here and
oil on them
you can't analyze with an AED in a
moving vehicle so if they do go back
into cardiac arrest you're going to have
to pull over it'll actually tell you to
stop motion we've started CPR but when
can you stop well the guy sits up and
says hey please get off my chest that's
a good indicator well they're not going
to do that but they're slowly going to
start waking up maybe you start moving
that gives you an indication you should
check a pulse and you should stop if a
physician sometimes a justice of the
peace it depends on your area directs
you to either in person on phone by
radio or your protocols to say you can
do 20 minutes of CPR and then contact
online medical control and call it that
could be a protocol so on an equal or
higher certification takes over for you
if the advanced directive that you
didn't know about arrived so if that
happens make sure you contact all
medical control let them know the
situation and then get their blessing to
stop CPR if for whatever reason the
scene becomes unsafe you need to leave
and you can't drag that victim with you
so you need you can stop if you're the
only one doing CPR and there's no help
coming and you say boy if I do five more
compressions somebody's gonna have to
stop by and do CPR on me then you can
stop but you can't start CPR they they
vomit
they have loose stools you know you
decide oh this was a mistake we got to
stop no you need to contact online
medical control if you're going to do
that after the run realize that most
people who die stay dead but some people
who get the fast response which is a
witness to rest we're the first
responder CPR that's why we like to go
in the communities and teach the
families of victims CPR they that's
lovely when you show up and there's
somebody in the family who started CPR
for the most part though you just see
people standing outside waving you in
and they're laying there dead they've
already gone to mints without oxygen
their chances aren't as good one thing
to know though you jump into every code
as if this is the one even to say only
only 10 out of 100 one out of ten
however you look at ever going to
actually regain a pulse and be
discharged from the hospital you have to
look at each and every one and say this
is it this is this is one that's going
to make the difference otherwise you
kind of go in with the attitude this is
kind of futile you know put your heart
into it and try the best you can you're
the only thing between them and the
grave if you stop the results are
inevitable so just wanted to do a little
recap on CPR and maybe type some loose
ends that make this more kind of
personal to EMS rather than just your
CPR class