Intro

Question 1

Intro - mid-1950s

Answer 1

—In mid-1950s, a medical study found that a high # of Americans were dying prematurely from heart disease
—1 of every 3 deaths was directly related to sudden cardiac arrest
—to improve chance of surviving, the medical community began researching a US army tech. That used mouth-to-mouth resuscitation and cardiac massage on pulse less victims
—after determining its effectiveness in combating sudden cardiac arrest, a CPR program was developed and taught to emergency room physicians
—over time - the tech. Became even more effective and taught to all healthcare professionals

Question 2

By late 1950s and early 60s

Answer 2

—a civilian cardio-pulmonary resuscitation program had been developed to combat the high incidence of heart disease and sudden cardiac arrest in America

—in 1963, a CPR committee was formed to start a “life-saving” campaign that would teach cardiopulmonary resuscitation (CPR) to citizens who had no medical background

—by early 1970s, hundreds of thousands of Americans had been taught CPR
—though survival rates began to increase, still to this day, only one in 5 American adults know how to appropriately and effectively perform CPR

Question 3

How many cases per year

Answer 3

According to a 2015 report, there are 326,000 cases of out-of-hospital sudden cardiac arrests each year
—Americans will likely witness someone needing bystander assistance in order to survive

Question 4

Victims of sudden cardiac arrest normally suffer from 1 of 2 conditions

Answer 4

1. A massive “sudden death” heart attack caused by blockage of a coronary artery
2. Or a lethal electrical disturbance in the heart called dysrhythmia

Question 5

Regardless of cause initial treatment remains same:

Answer 5

HIGH-QUALITY, “FAST-N-HARD” CARDIOPULMONARY RESUSCITATION

The human body is strong, however without a cont. supply of oxygen being delivered to the body by a properly functioning heart and lungs, the vital organs will quickly begin to shut down
—when this begins, irreversible brain damage and multi-system failure follow within 4-6 min.

Question 6

The chain of survival
—4 steps

Answer 6

1. Early recognition that an emergency requiring assistance is occurring
   —the sooner help (911) is called, the sooner EMS will arrive and take over the care of the victim - thus doubling chance of survival
2. Early “fast-n-hard” CPR
   —when a bystander CPR is initiated quickly, it helps keep the vital organs sufficiently oxygenated until an AED or EMS personnel can arrive to assist
3. Early defibrillation with AED/defibrillator
   —in the first few minutes of most cardiac arrest situations, an electrical shock delivered by an AED/defibrillator may return the victim’s heart to a “more norma” rhythm
4. Early advanced life support by EMS/fire dept.
   —EMS personnel have the advanced knowledge and equipment to perform life-saving interventions while transporting the victim to a hospital

EARLY ACCESS —> EARLY CPR —> EARLY DEFIBRILLATION —> EARLY ADVANCED CARE

Question 7

Once a victim is found to be breathless

Answer 7

Once a victim is found to be breathless, rapid recognition and accurate CPR intervention can double a victim’s chance of survival and reduce the risk of permanent brain injury

Question 8

“Fast-n-hard” CPR

Answer 8

—fast-n-hard CPR is unlikely to restart a victim’s heart, but it is highly effective in maintaining some flow of oxygenated blood to the body’s organs and tissues until an AED can be used or definitive medical care initiated
—it delays tissue death and extends the brief window of opportunity for successful resuscitation
—this helps prevent the victim from suffering permanent brain damage, especially when it’s initiated within a few minutes of the victim’s collapse

Question 9

One of the most important steps in saving a victim of sudden cardiac arrest is

Answer 9

Rapid recognition followed by citizen involvement
—fast-n-hard CPR provides paramedics with the needed time to reach the victim and initiate advanced resuscitation measures
—someone nearby must immediately realize that a life-threatening event is occurring and quickly call for professional help (911)
—then if emergency care isn’t rendered within first few minutes of sudden cardiac arrest (fast n hard CPR), the victim will most likely not recover

It can take an ambulance 15+ minutes after receiving a 911 call to arrive
—therefore fast n hard CPR is crucial in chain of survival

Question 10

The best way to prevent the progression of irreversible brain death is for bystanders to:

Answer 10

1. Recognize an emergency exists that requires CPR
2. Call for help and request bystanders to locate an AED and bring it to you
3. Perform high-quality CPR while awaiting an AED/defibrillator or the EMS unit to arrive
   —AED = automatic external defibrillator

While waiting for professional help, don’t be afraid that your intervention will worsen the victim’s condition - can only help!

If one link of the chain is weak or missing, the chances of survival decrease

Question 11

The common signs and symptoms of a heart attack

Answer 11

Heart attack = myocardial infarction
—most will have common signs associated with the heart’s inability to function (pump) properly

1. Chest or upper body pain / discomfort
2. Shortness of breath
3. A feeling of impending doom
4. Nausea and vomiting

However, about 1/3 of heart attack victims report they did not experience any chest pain - in fact chest pain is often initially mistaken as indigestion but he victim

A tell-tale sign of a true heart attack is when a chest pain victim appears very ill with cool, pale, sweaty skin without a logical explanation (flu with fever, exertion from a marathon, etc.)

Question 12

The common signs and symptoms of a heart attack
1. Chest discomfort / pain

Answer 12

—discomfort or pain in the center of chest (or anywhere in upper chest) that can last for more than a few minutes or may go away and then return
—described as uncomfortable pressure, squeezing, fullness, or crushing pain
—victims often mistake the pain for indigestion or gas - or common to have another explanation for the pain and deny the likelihood of a heart attack

Question 13

The common signs and symptoms of a heart attack
2. Upper body discomfort / pain

Answer 13

—pain or discomfort in one of both arms, shoulders, back, neck, jaw, and/or stomach
—pain may be intense and move from its point of origin to another body region
—this is known as PAIN RADIATION
—ask victims to rate pain on a scale from 1-10
—pain that changes when victim breathes or moves may not be a heart attack but should still be treated as if it is

Question 14

The common signs and symptoms of a heart attack
3. Shortness / loss of breath

Answer 14

—this can occur with or without chest discomfort due to the heart’s inability to pump oxygenated blood effectively during a heart attack

Question 15

The common signs and symptoms of a heart attack
4. Other signs and symptoms

Answer 15

—may include cold sweats, nausea, vomiting, and/or dizziness
—the signs and symptoms of decreased blood flow will be evident
—cool, clammy, and sweaty skin with nausea/vomiting
—victims also often complain of feeling as if “they are going to die”

Question 16

All adults who experience chest pain of any type that lasts longer than ____ minutes should be treated as if they are having a heart attack until it is proven otherwise at the hospital

Answer 16

10 minutes

Question 17

Good Samaritan Laws and Consent to Render Aid

Answer 17

—general public has an apprehension of getting involved - many Americans are reluctant to administer CPR on a stranger out of fear of being sued
—every state is diff., but all 50 states have some form of a law enacted to protect a person from being sued or held liable to attempt to save a person’s life when acting in good faith and w/o any expectation of pay

Good Samaritan laws vary, but for most part the following criteria applies
—any medical assistance such as first-aid, performance of CPR, or clearing of an obstructed airway cannot be conducted in exchange for any type of monetary or material gain for the rescuer
—if rendering first-aid care of any type to a victim, you are not permitted to leave them alone unless:
———it is necessary to call for help (911)
———another rescuer with = or > qualifications takes over
———continuing care becomes dangerous/unsafe for the rescuer
———the victim refuses your first-aid care
—a voluntary responder is not legally liable for the death, disfigurement, or disability of any victim they attempt to assist as long as the responder acted rationally, in good faith, and in accordance with their level of training

Question 18

Consent to render medical care
—informed consent

Answer 18

Informed consent
—to help a conscious victim 18+ years of age in an emergency you must have that individual’s verbal/written permission to do so
—informed consent is the highest degree of legal consent
—must first ask if it is okay to help - if they reduce, you can’t legally touch them as doing so can initiate battery charges against you - but you can help by calling 911
—if the victim becomes unconscious at any time, you may render care even if victim denied help while conscious - this is implied consent

Question 19

Consent to render medical care
—implied consent

Answer 19

Implied consent
—gives rescuer the legal right to render first-aid and/or CPR under the premise that a responsible, competent adult would give permission to render care of perform life-saving interventions if they were able to give the rescuer verbal consent

Implied consent exists if the responder has a reasonable belief that an adult or child is
—unconscious / unresponsive
—pulseless / breathless
—delusional / confused
—intoxicated after ingesting alcohol / drugs
—deemed mentally unfit to make decisions regarding their own safety

Question 20

Consent to render medical care
—parental consent

Answer 20

If victim is under 18 years old and is in presence of parent or legal guardian, you must ask parent or guardian for permission to treat hte minor victim
—if parent or guardian is unavailable or not immediately reachable, the rescuer should care for the child based not he implied consent just as parent would in making decisions for the child

Question 21

Without a victim’s consent, you may be committing a crime that is punishable by law
—assault
—battery

Answer 21

Never force care on a competent adult who is refusing medical care

Assault - the act of causing fear, apprehension, or intentional harm to another person

Battery - the unlawful touching of another person without their consent

Question 22

Universal precautions and personal protective equipment

Answer 22

—many first-responders fear catching a communicable disease while conducting CPR/first aid
—truth is, chance of disease transmitting while rendering emergency care to a victim is nearly zero - as long as responder uses due care and proper precaution measures

Universal precautions - practice of avoiding any contact with an individual’s blood or bodily fluids
—use gloves and on-way valve CPR masks for mouth-to-mouth rescue breathing

It is a rescuer’s responsibly to protect themself first and foremost

Question 23

Universal precautions summary

Answer 23

1. Always use the appropriate protective equipment for the situation
   —gloves, goggles, breathing barriers
2. Always remove contaminated material from the area once EMS takes over the care of the victim
   —place gloves and bloody items such as bandages in a hazardous material bag or container box while wearing the proper PPE
3. Always wash your hands and any possible expoed skin with an alcohol-based hand sanitizer or soap and warm water
   —always wash hands - even if gloves were worn
   —wash btwn fingers and under fingernails
4. Clean all surfaces and contaminated objects of your personal equipment
   —use a bleach solution with 1/4 cup bleach to one gallon of water - or a commercial cleaning agent

Question 24

The basics of high-quality cardio-pulmonary resuscitation
1. CHECK

Answer 24

Emergency action steps:
CHECK PHONE REACT (CPR)

1. Check - the victim’s level of consciousness as soon as it is safe to do so
   —make sure scene is safe for you to enter before proceeding - anything hazardous
   —you cannot help someone if you become th edict I’m yourself
   —if ANY potential danger/hazard exists, rescuer must back out of situation, call for additional assistance, retreat from scene, and wait for the proper authority to intervene
   —take a deep breath and assess situation - you don’t know what caused the victim’s potential collapse
   —approach the victim from upwind if possible
   —once you are kneeling beside unresponsive victim, check them by tapping their shoulder and ask them loudly “are you okay?”
   —when assessing the level of consciousness of an infant or small child, you should tap and/or tickle the bottom of their feet - or make noises to wake up an infant

Question 25

The basics of high-quality cardio-pulmonary resuscitation
2. PHONE

Answer 25

CHECK, PHONE, REACT

2. Phone
   —911 or alert EMS by quickest means possible!
   —immediately call for help before initiating care to the victim
   —the key priority is to initiate CPR including rescue-breathing as quickly as possible
   —if you are alone with an unresponsive or pulseless child, and you must leave them to call 911 or alert help — it is appropriate to perform two minutes (5 cycles) or CPR on a child before stopping o call for assistance
   —call and place phone on speaker so you can be hands-free to assist the victim

—seconds count and the goal is rapid CPR, defibrillation, and advanced medical care
—if bystander is nearby, elicit their assistance to call 911 or locate an AED
—have a commanding voice

Question 26

The basics of high-quality cardio-pulmonary resuscitation
3. REACT

Answer 26

CHECK, PHONE, REACT

3. React to the cardiac arrest by delivering high-quality, “hard-n-fast” chest compressions

—it is now believed that the blood of a sudden cardiac arrest victim contains enough oxygen to adequately oxygenate the vital organs and tissues of the body for several minutes
—meaning it may be best to circulate the oxygen that is already contained in the victim’s blood to the vital organs and tissues before initiating rescue breathing
—the beliefs is that a non-trained rescuer wouldn’t be able to deliver adequate rescue breaths to a victim of sudden cardiac arrest quickly enough to justify the time it would take to open the airway and adequately deliver a rescue breath

Remember the body only uses a small % of the oxygen we breathe at once
—therefore, the blood and lungs contain oxygen for several minutes following cardiac arrest
—it is now (as of 2015) appropriate to deliver 30 CHEST COMPRESSIONS before delivering 2 rescue breaths for an adult victim of sudden cardiac arrest

Question 27

CABD

Age breakdowns

Answer 27

C - Circulation / compressions
A - Airway
B - breathing
D - defibrillation

The age breakdowns

Layperson rescuer
Adult: 8-years to adult
Child: 1-8 years old
Infant - 1 month to 1 year old
Newborn: less than one-month

Determining the age of the victim can be a task in itself and determines the type of treatment

Question 28

Age and compression rate, depth, compression / ventilations

Answer 28

Adult (8+ years old)
—compression rate: 100-120 per min.
—compression depth: 2-2.4 in. (4-5 cm.)
—compressions / ventilations - 30 comp. / 2 vent. (6-8 breaths per minute)

Child (1 year to 8 years old)
—rate: 100-120 per min.
—depth: up to 2 in. (1/3 chest diameter)
—compressions / ventilations: 30 comp. / 2 vent. (6-8 breaths per minute)

Infancy (up to 1 year old)
—rate: 100-120 per min.
—depth: about 1.5 in. (3 cm.)
—compressions / ventilations: 30 comp. / 2 vent (6-8 breaths per minute)

Question 29

As of 2015. To maximize simplicity in CPR programs across the board…

Answer 29

It is now reasonable to apply the new recommended adult compression rate of 100 to 120 per minute at 30 compressions to 2 rescue breaths ratio for adults, children and infants