Tuesday, February 12, 2013

CPR

I have been CPR certified for years through my first profession of Dental Assisting. The protocols have changed over the years but basically as long as you are doing something it is better than nothing. The class is always taught in my dental office by fireman/EMT Jason Underwood. He is hilarious and makes the class super enjoyable and fly by with his insane stories. The new protocols as of this last year are pretty simple. But it will also depend on if you are "working" someone (giving them CPR) by yourself or have help. The way you will do CPR has age limits but these of course depend on the size of person not just age. Example: you come across a 8 year old in 5 year olds body size you will treat them as a child, not adult. Also clothing must be removed to get proper CPR done, also in case patient doesn't revive and EMT's need to shock patient they will need no clothing on anyway. Yes this does mean as embarrassing as it is you will need to remove ladies bras... but better alive and embarrassed right?
If you alone find an unresponsive adult (ages 8 and older) you will first...
  1. check patient to see if they respond (try to wake them up) if they don't check for breathing (look for chest rise).
  2. Call for Help then call 911, if there is an AED machine available (shock machine) get this at this time.
  3. Check for pulse. (carotid artery, this can be found if you go to either left or right side of throat below jaw)
  4. If no pulse-START COMPRESSIONS. Using both hands intertwine hands, lock elbows, and find middle of sternum, start compressing, you want to go about 2 inches down. Press HARD and FAST. Do 30 compressions. (You may hear noises of breaking bones or calcification, keep going, having a broken bone is better than being dead.)
  5. Open Airway and give 2 breaths. Tilt head back all the way by lifting chin. You should see the chest rise. DO NOT give anyone you don't know health history of breaths without a mask. As sad as this sounds you are no good to anyone dead yourself if you contract a disease.  (Hep A, B, C, TB, and AIDS) Compressions are better than nothing so don't feel bad. (the fireman who taught our class had a friend on the force who contracted Hep from a 8 month old baby he did CPR on and died leaving his 3 young children and wife alone at the young age of 36. He figured "what could a baby have?" Patient died 5 years later from it's disease as well.) Masks are cheap and can be found online for about $20. Get one keep it in your car, purse, at home etc. 
  6. Resume compressions. Another 30. 
  7. Reassess victim after 5 cycles of this. 30 compressions/2 ventilations. If nothing use AED machine at this time, most of them now days are fool proof. Clothing must be off and kits will have instructions on how to use it. STAND CLEAR, do not touch them at ALL. It will shock you and give you a wicked charley horse.
 2 person CPR Adults
Same thing but take turns compressing and breathing. (30 compressions 2 breaths.)You don't want to tire if you don't have to.
Adult rescue breathing:
patient found with a pulse. 1 breath every 5 seconds. Reassess patient pulse every 2 minutes. Call 911.
Adult foreign Airway body obstruction (conscious patient):
  1. Ask victim if they are choking
  2. Ask victim if they can speak (if victim is coughing/speaking, they are getting air do nothing unless it stops, DO NOT leave them alone however, stay in case it becomes a full obstruction)
  3. Get behind patient
  4. Place one fist just above belly button, thumbs inward, grasp first hand w/ second hand
  5. Pull your fists inward and upward rapidly 5 times
  6. Reassess patient- repeat above steps until victim can breathe or becomes unconscious. 
Patient who becomes unconscious
  1. Carefully support patient to ground
  2. Call for Help/911
  3. Start chest compressions (no pulse check- 30 compressions)
  4. Look into mouth prior to breathing to see if you can see object obstructing airways, If you can use fingers to remove it, if not 2 breathes. 
  5. If ventilation doesn't cause chest to rise readjust head and try again. If no rise repeat compressions
Obese or pregnant women:
5 chest thrusts instead

1 person child (1-8years) CPR
Same as  adult just use one hand instead of two for compressions 30 compressions/ 2 breaths, you will want to tilt chin less than adult. 5 cycles. If no response call 911 and continue.

2 person child or infant CPR
15 compression instead and take turns, 10 cycles. Call 911.

Child airway obstruction
Same as adult but use one hand and don't push inward and upward with as much force.

1 person Infant (under 1) CPR
  1. check for unresponsiveness
  2. yell for help/911
  3. check for pulse (brachial artery, inside of arm)
  4. If no pulse start compressions, 2 fingers 30 compressions, support head with other hand on forehead
  5. open airway, don't tilt head far it closes of airways, 2 SMALL breathes (the amount of air you could fill with just cheeks puffed up, you can pop their lungs...) watch for chest rise.
  6. resume compressions
  7. reassess after 5 cycles
  8. if you haven't call 911 now!
Infant airway obstruction
5 back blows between shoulder blades, babies stomach laid length wise over forearm tucked into body palm supporting head (football hold) use other hand for blows. Follow this with 5 chest thrusts. After each cycle elevate child to see if it's breathing. 

Child and infant rescue breathing w/ pulse
1 breath every 3 seconds, reassess every 2 minutes.

Hope this helps, please feel free to ask me or call your local fire department/ EMT service with any questions or to get certified!!!! You can save someones life but hopefully you will never have to use it! :)

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