Healthcare Provider CPR Certification Class

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Introduction

Healthcare - CPR / AED Certification Class

Welcome to our Healthcare CPR certification class!

The CDC (Center for Disease Control) has issued information stating that the most common cause of death in the United States is cardiovascular disease. The risk of heart disease can be dramatically increased for patients who are obese, those who are inactive, people with high levels of stress in their lives, high levels of cholesterol, high blood pressure and smoking. These factors are all avoidable, but there are also factors which patients cannot control which can contribute to an increased risk of heart disease. These factors include a patient’s age, sex, genes and whether or not the patient suffers from diabetes of either type.

Heart disease can cause the heart to stop, and restarting the heart in good time can save the patient’s life and allow them to seek life-prolonging treatment. When a patient’s heart stops, the patient is likely to die within 10 minutes as the oxygen supply to the brain is cut off. Between six and 10 minutes after the heart stops, irreversible brain damage is likely to occur. Between four and six minutes after the patient’s heart stops, brain damage is still a possibility, but the brain can survive between zero and four minutes without oxygen with very little risk of permanent brain damage. CPR can ensure that the blood is kept moving around the body and that oxygen continues to be supplied to the brain.

CPR for 2 Rescuers

For patients without an advanced airway:

Adults and children over 12: 30 chest compressions should be performed and then two long breaths should be administered. Repeat this cycle.

Children and infants: 15 chest compressions should be performed and then two long breaths should be administered. Repeat this cycle.

For patients with an advanced airway:

Adults and children over 12, young children and infants: chest impressions should be continuously performed at a rate of between 100 and 120 compressions per minute. One breath should be performed once every six seconds.

When to stop CPR

You should only stop CPR under the following circumstances:

You are in danger
A pulse is regained
The patient’s heart has been stopped for more than half an hour
You become exhausted and cannot continue
The chest compressions rupture a lung, puncture the skin, cause significant fractures or severe bruising of the chest and ribs

Recommendation

Rescuers who are not trained in CPR should still administer chest compressions as it is very easy for them to be instructed by an emergency services operator over the phone. An ambulance should always be called as soon as possible if you find a patient in need of CPR. CPR should only be performed to buy the patient time before the emergency services arrive and qualified medical professionals are able to take over and accompany the patient to hospital.

Note: The priority for a healthcare provider should always be to alert the emergency services as well as performing CPR, especially if the rescuer is attending the scene alone. – Introduction Note: Healthcare Provider CPR Certification Class.

Bloodborne pathogens to be aware of:

You should be careful of Hepatitis B and C, HIV and tuberculosis as it is possible for all of these diseases to be passed on through an exchange of bodily fluids. If there is blood in the patient’s mouth and you perform a lifesaving breath, there is a chance that a bloodborne disease they are carrying could be passed on to you. You should be aware of this at all times and you do not have to perform a breath if you do not feel safe and comfortable doing so.

Coronavirus CPR Guidelines

Coronavirus CPR Guidelines:

Healthcare providers are the profession at the highest risk for contracting COVID-19. Many work in close contact with patients suspected or confirmed to have the disease. To improve their safety and limit their exposure, updates have been made to existing CPR recommendations. These include limiting personnel attending to a patient, encouraging bystander CPR, and emphasizing providing at least hands-only CPR.

First responders are advised to put on PPE before entering the scene. CPR should consist of cycles of thirty compressions and two rescue breaths. When giving rescue breaths, a bag-mask that has a tight seal and filter should be used. Alternatively, continuous chest compressions with passive oxygenation can be provided whilst wearing a protective medical mask. Mechanical CPR devices can be used for patients who meet the height and weight requirements to reduce aerosolization risk.

For adult victims, it is recommended to provide at least hands-only CPR after a cardiac arrest is known to have occurred. The healthcare provider and/or victim should wear a face mask to reduce the risk of contagion for the safety of both, as well as any none-household bystanders.

For children, chest compressions should be performed and mouth-to-mouth ventilation may be considered. Again, mask-wearing is advised for both the healthcare provider and/or victim.

What is Personal Protective Equipment?

PPE (Personal Protective Equipment) keeps you safe from blood, hazardous materials, and OPIM. PPE includes:

Face shields
CPR shields
Gloves
Goggles
Gowns
Masks

All Personal Protective Equipment promotes safety by creating a barrier between you and the infection/hazardous materials. Before arriving at the scene of the accident, you must assess the situation to determine the risks and to use the proper PPE.

PPE examples include CPR shields provide protection against exposure when performing CPR. Face shields provide splash and high impact protection, while gloves protect against exposure from skin contact with chemicals, infectious agents, cold, heat, and cutting objects. For proper protection, be sure to use the correct hand.

Goggles are designed to reduce the risk of exposure to laser radiation, chemical splashes, or flying debris. Gowns are used to prevent the penetration of infectious blood, hazardous materials, or other OPIM. Masks are used to protect the employee from airborne materials or liquid contaminating the face.

The Good Samaritan

Healthcare - CPR / AED Certification Class

A version of the Good Samaritan Law exists in most countries. It was put in place in order to protect anyone who offers emergency assistance to someone in need. As long as the ‘samaritan’ is acting voluntarily without expecting to be compensated or paid for their services, they will receive legal protection when assisting someone who is ill, has suffered an injury or is immediate danger for whatever reason.

This includes offering legal protection to those who perform CPR in order to preserve life. This means that if the patient is injured in the process of you assisting them, you should not be prosecuted for having harmed them if you were doing your best to save their life.

Note: It is important to remember that when it comes to CPR, timing is key and acting as soon as possible is vital. Healthcare providers should not hesitate too long in making a decision as to whether or not to perform CPR and should be reassured that the Good Samaritan Law will protect them as long as they do their best to preserve life. – The Good Samaritan Note: Healthcare Provider CPR Certification Class.

When to Activate Emergency Response System

Wherever possible, a call to the emergency services and CPR should begin at the same time. If there is anyone else in the vicinity, ask them to call the emergency responders and retrieve the nearest AED whilst you begin to perform CPR.

If you are on your own and there is nobody else nearby to ask for help, leave the patient if you have to in order to seek help, retrieve the AED and call the emergency services.

If there are lots of people around, do not be afraid to assert your authority and ask others to perform certain tasks. Strong leadership is often required in these situations.

How to do Hands-Only CPR

Hands-Only CPR:

If you witness a sudden cardiac arrest and attempt CPR, you can dispense with the mouth-to-mouth breathing. According to the American Heart Association, performing hands-only CPR can be just as effective as performing CPR with mouth-to-mouth. That means chest compressions alone are sufficient until trained responders arrive on the scene.

Do note that conventional CPR is still the way to go with children and infants. However, as most pediatric cardiac arrests are caused by asphyxiation, it may not be possible to perform rescue breaths. If so, go ahead with the hands-only method as it is better than no CPR at all.

To perform hands-only CPR, first, kneel beside the person who needs assistance. Get into position by placing the heel of one hand on the center of their chest, and the heel of the other hand over the first hand. Interlace your fingers. Keep your shoulders lined directly over your hands and your arms straight.

Once in position, start pushing hard and fast. Make use of your body weight to help make compressions, which should be at least two inches deep and occur at a rate of at least one-hundred compressions per minute. Allow the chest to rise completely between each compression.

From there, keep pushing until you see breathing or obvious indications of life. You can also stop once a trained responder or EMS professional is ready to take over or an AED becomes available. Stopping may also be necessary if you are unable to carry on due to exhaustion or the scene becomes unsafe.

Understanding Duty to Act

Duty to act is the duty requiring a person to take necessary action in order to prevent harm to another person or to the general public. Whether you are required to follow through depends on the situation and the relationship between the parties. In some cases, breach of duty may put a party at liability for damages.

For laypersons, duty to act requires that you provide care if you have a legal duty. If you do not have a legal duty to provide care, you are not required to provide it.

Fear of providing care

There are a number of factors to weigh up when considering providing care. COVID-19 is an important concern, but the risk of contracting diseases can be reduced by wearing personal protective devices like masks, gloves, and gowns that limit exposure.

If you feel fear of providing care due to possible legal issues, know that rescuers who provide care without a legal duty and act in good faith are protected by Good Samaritan laws.

If the situation is actively unsafe, do not attempt care. If you or the victim are at risk, it is best to call EMS and wait for support to arrive.

In some cases, you may be unable to save a victim. Rescuers should still attempt to provide the best care they are able to. A victim’s chances of survival can be improved by even basic efforts at life support. In accidents, victims who are clinically dead may still be helped when given care. Rescue efforts will not worsen their condition.

Following a traumatic situation in which you provided care, you may experience overwhelming emotions. If you continue to feel symptoms like depression, be sure to seek help from a professional source.

Adult and Adolescent – CPR

Healthcare - CPR / AED Certification Class

Step 1 – Safety

Check the environment to make sure that you are not putting yourself in danger by helping the patient. If it is safe to approach, check to see if the patient is responsive.

Step 2: Pulse Check

Place two fingers on the side of the patient’s neck, up against the windpipe. Press firmly for between five and 10 seconds to feel for a pulse. You can also try placing two fingers between the two wrist bones to find a pulse.

C is for Circulation

Adult and Adolescent Compressions

Circulation

When the heart stops beating, blood stops flowing around the body. Chest compressions work to artificially stimulate the heart, helping it to pump blood around the body.

The patient should be laying flat on a solid surface usually the floor. The rescuer should place one hand on top of the other, and place the base of the palm toward the base of the patient’s sternum. The rescuer should then lock their elbows and position themselves above directly over the patient. They should then use their own body weight to compress the chest of the patient in a rhythmic fashion. The chest should compress at least a minimum of two inches, and the healthcare provider performing the compressions should ensure that they remove their full body weight in between each compression in order to let the heart refill with blood. For an idea of rhythm, try matching the beats of the song “Staying Alive” in your head. Try to be consistent in the timing and rhythm of the compressions, and do not stop for more than 10 seconds if at all possible.

Remember: If there are two of you who are trained and able to perform CPR, you may take it in turns to perform compressions and rescue breaths to conserve energy. – Adult and Adolescent – CPR Note: Healthcare Provider CPR Certification Class.

Chest compression fraction

Chest compression fraction is calculated as the percentage of the time spent performing CPR during a cardiac arrest. Interruptions, whether intended or not, should be kept to a minimum so that the chest compression fraction (ie the time spent attempting to resuscitate the patient) does not fall below 60%.

Should you perform chest compressions on a pregnant woman?

Yes, if she goes into cardiac arrest. If the woman’s baby bump is at or above the umbilicus, chest compressions should be performed with one hand whilst the rescuer pushes the uterus to the patient’s left-hand-side with the other hand.

Should you perform chest compressions on an obese patient?

Yes, you should if they are in cardiac arrest and require CPR.

A is for Airway

Clearing the airway

Make sure that the patient is lying on their back on a firm surface eg. the floor. Kneel down beside them at the height of their shoulders. Tilt the head back slightly by placing your palm on their forehead and lift the chin upwards with the other hand. Place your ear close to their mouth to listen for breathing and watch the chest for any movement. If you cannot hear, feel or see their breathing, mouth-to-mouth is required.

Jaw-Thrust Maneuver:

To perform a jaw-thrust, kneel behind the patient’s head. Place your elbows on the floor either side of the patients head. Put one hand on either side of the patient’s lower jaw. Squeeze your forearms to keep the patient’s head stable in place. Place your index fingers along the jawline and use the thumbs to roll back the lower lip. If there are still no signs of life, start to perform mouth-to-mouth.

B is for Breathing

Rescue breaths, or mouth-to-mouth, are used to artificially introduce oxygen into the patient’s bloodstream when they have stopped breathing. This ensures that oxygen can be delivered to the brain and other vital organs to lower the risk of brain damage if the patient is successfully resuscitated.

Pinch the patient’s nose to form a tight seal. Place your lips over the whole of the patient’s mouth, so that your lips are sealed against theirs. Breathe deeply into their mouth, until you see their chest start to rise. If you cannot see the chest rise, the mouth-to-mouth is not being performed correctly and you may need to try again. Once you see the chest rise, perform another rescue breath before continuing with compressions.

Note: Remember to try not to spend more than 10 seconds performing rescue breaths as it is important to keep the compressions going. – Adult and Adolescent – CPR – B is for Breathing Note: Healthcare Provider CPR Class.

Compressions should be continued at a rate of 120 per minute. If there are two of you, one breath should be given every 6 seconds. If you are on your own, aim to give two rescue breaths for every 30 chest compressions.

CPR on obese patients

Yes, perform Chest Compressions

CPR on pregnant patients

Yes, perform Chest Compressions and a modification if the pregnant woman’s fundus height (baby-bump) is at or above the level of the umbilicus. If the woman’s fundus height is at or above the umbilicus, then High-quality CPR with manual left uterine displacement will be beneficial for relieving aortocaval compression during, the chest compression task. To perform manual left uterine displacement: push the uterus to the patient’s left side with 1 hand while still providing CPR.

Oxygenation and airway management should be prioritized during resuscitation from cardiac arrest in pregnancy because pregnant patients are more prone to hypoxia.

Fetal monitoring should not be undertaken during cardiac arrest in pregnancy because of potential interference with maternal resuscitation.

CPR for opioid poisoning

1. Suspected opioid poisoning

Check for responsiveness
Shout for nearby help
Activate the emergency response system
Get naloxone and an AED if available

2. Is the person breathing normally?

If yes, prevent deterioration:

Tap and shout
Open the airway and reposition
Consider naloxone
Transport to the hospital

Continue assessing responsiveness and breathing.

If no, does the patient have a pulse? Assess for 10 seconds.

If yes, support ventilation:

Open the airway and reposition
Provide rescue breathing or bad-mask device
Give naxolone

If no, start CPR:

Use an AED
Consider naloxone
Use high-quality CPR

Rescuers should always avoid:

Compressions at a rate slower than 100 per minute or faster than 120 per minute
Compressions which are less than two inches deep or more than two and a half inches deep
Leaning on the patient’s chest in between compressions
Interrupting compressions for more than 10 seconds
Administering more than two rescue breaths for every 30 compressions

Click for Summary of Adult & Adolescent CPR

CPR – Components for Adults & Adolescents

Scene safety

Check the environment – making sure it’s safe for rescuers and victims

Recognition of cardiac arrest

Check responsiveness
No breathing or only gasping – ie., no normal breathing
Within 10 seconds – no positive pulse
1. (You can check for a pulse and breathing simultaneously in less than 10 seconds)

Activation of emergency response system

If you do not have a mobile phone – leave the victim and activate the emergency response system while retrieving an AED before performing CPR.
Have someone activate the emergency response system. Perform CPR immediately and use the AED as it becomes available.

Compression- ventilation ratio without advanced airway

1 or 2 rescuers – 30:2

Compression- ventilation ratio with advanced airway

Chest compressions – 100-120/min
Give 1 breath every 6 seconds (10 breaths/min)

Compression rate

100-120/min

Compression depth

At least 2 inches (5 cm)

Hand placement

2 hands on the breastbone (sternum) on the lower half

Chest recoil

Make sure not to lean on the chest of the victim – Allow a full recoil after each chest compression

Minimizing interruptions

Compression interruptions – limit to less than 10 seconds

Rescuers should never

Compress slower than 100/min or faster than 120/min
Compress in-depth less than 2 inches (5 cm) or more than 2.4 (6 cm)
Lean on victim’s chest during compressions
Allow interruption during compressions more than 10 seconds
Provide excessive ventilation during breathing task, ie., excessive breathing with force or too many breaths

Child (Age 1 Year to Puberty) – CPR

Healthcare - CPR / AED Certification Class

For the purposes of CPR, a child is classed as anyone between the age of one and puberty.

If you witnessed the collapse of the child taking place, you may follow the same steps as you would with an adult or an adolescent patient. Check the airway, pulse and look for signs of breathing.

If you did not witness the collapse of the child, but instead have found them in a collapsed condition, start with two minutes of CPR after checking for vital signs. After two minutes, if you are on your own, then leave the patient to retrieve an AED and to make an emergency call. Then return to the patient ASAP and continue with CPR until the response team arrives. If you are with someone else, these steps can happen simultaneously.