CPR/AED For Professional Rescuers And Health Care Providers
CPR/AED for Professional Rescuersand Health Care ProvidersHANDBOOK
American Red CrossCPR/AED for Professional Rescuersand Health Care ProvidersHANDBOOK
This CPR/AED for Professional Rescuers and Health Care Providers Handbook ispart of the American Red Cross CPR/AED for Professional Rescuers and Health CareProviders program. By itself, it does not constitute complete and comprehensivetraining. Visit redcross.org to learn more about this program.The emergency care procedures outlined in this book reflect the standard ofknowledge and accepted emergency practices in the United States at the time thisbook was published. It is the reader’s responsibility to stay informed of changes inemergency care procedures.PLEASE READ THE FOLLOWING TERMS AND CONDITIONS BEFOREAGREEING TO ACCESS AND DOWNLOAD THE AMERICAN RED CROSSMATERIALS. BY DOWNLOADING THE MATERIALS, YOU HEREBYAGREE TO BE BOUND BY THE TERMS AND CONDITIONS.The downloadable electronic materials, including all content, graphics, images andlogos, are copyrighted by and the exclusive property of The American National RedCross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, theRed Cross grants you (“recipient”) the limited right to download, print, photocopyand use the electronic materials, subject to the following restrictions: The recipient is prohibited from selling electronic versions of the materials.The recipient is prohibited from revising, altering, adapting or modifying thematerials.The recipient is prohibited from creating any derivative works incorporating, inpart or in whole, the content of the materials.The recipient is prohibited from downloading the materials and putting them ontheir own website without Red Cross permission.Any rights not expressly granted herein are reserved by the Red Cross. The RedCross does not permit its materials to be reproduced or published without advancewritten permission from the Red Cross. To request permission to reproduce orpublish Red Cross materials, please submit your written request to The AmericanNational Red Cross.Copyright 2011 by The American National Red Cross. All rights reserved.The Red Cross emblem, American Red Cross and the American Red Cross logo aretrademarks of The American National Red Cross and protected by various nationalstatutes.Published by StayWell Health & Safety SolutionsISBN: 978-1-58480-494-9
ACKNOWLEDGMENTSThis handbook is dedicated to the thousands of employees and volunteers ofthe American Red Cross who contribute their time and talent to supporting andteaching lifesaving skills worldwide and to the thousands of course participantsand other readers who have decided to be prepared to take action when anemergency strikes.Many individuals shared in the development and revision process in varioussupportive, technical and creative ways. The American Red Cross CPR/AED forProfessional Rescuers and Health Care Providers Handbook was developedthrough the dedication of employees and volunteers. Their commitment toexcellence made this handbook possible.The care steps outlined within this product are consistent with the Guidelines2010 for First Aid and the 2010 Consensus on Science for CardiopulmonaryResuscitation and Emergency Cardiovascular Care. These treatmentrecommendations and related training guidelines have been reviewed bythe American Red Cross Scientific Advisory Council, a panel of nationallyrecognized experts in fields that include emergency medicine, occupationalhealth, sports medicine, school and public health, emergency medical services(EMS), aquatics, emergency preparedness and disaster mobilization.
TABLE OF CONTENTSSECTION1: THE PROFESSIONAL RESCUERThe Duty to Respond 2Preventing the Spread of Bloodborne Pathogens 3Taking Action 5Recovery Positions 9Summoning More Advanced Medical Personnel 9Moving a Victim 10Breathing Emergencies 10Giving Ventilations 12Airway Obstruction 12Cardiac Emergencies 13Cardiac Arrest 15CPR 15AEDs 17SECTION2: SKILL SHEETSRemoving Disposable Gloves 21Primary Assessment—Adult 22Primary Assessment—Child and Infant 24Recovery Positions 26Giving Ventilations 27Giving Ventilations Using a Bag-Valve-MaskResuscitator—Two Rescuers 28Conscious Choking—Adult and Child 30Conscious Choking—Infant 32Unconscious Choking 34CPR 36Two-Rescuer CPR 38Using an AED 40iv CPR/AED for Professional Rescuers and Health Care Providers
SECTION1THE PROFESSIONAL RESCUER
THE DUTY TO RESPONDIn many professions, there is a job-related duty to act in an emergency andprovide care. Your actions are often critical and may determine whether aseriously injured or ill victim survives.Legal ConsiderationsLaws vary from state to state so you should inquire about your state’s specificlaws for the following legal considerations: Duty to act: The duty to respond to an emergency and provide care.Failure to fulfill these duties could result in legal action. Scope of practice: The range of duties and skills you haveacquired in training that you are authorized by your certification topractice. Standard of care: The public’s expectation that personnel summonedto an emergency will provide care with a certain level of knowledgeand skill. Negligence: Failure to follow a reasonable standard of care, therebycausing or contributing to injury or damage. Consent: A victim’s indication that a rescuer may provide care. Consentmust first be obtained, either verbally or through a gesture, beforeproviding care to an injured or ill victim. To obtain consent:cIdentify yourself to the victim.cState your level of training.cAsk the victim whether you may help.cExplain what you observe.Explain what you plan to do.When an adult is unable to give consent, such as if he or she isunconscious, confused, mentally impaired, seriously injured or seriouslyill, consent is implied. This means the law assumes the victim would giveconsent if able. For a minor, you must obtain consent from a parent orguardian. If the condition is life threatening and a parent or guardian isnot present, consent is implied.c Refusal of care: A victim’s indication that a rescuer may not providecare. Refusal of care must be honored, even if the victim is seriouslyinjured or ill or desperately needs assistance. A victim can refuse some orall care. If a witness is available, have the witness listen to, and documentin writing, any refusal of care. Advance directives: Written instructions that describe a person’swishes regarding medical treatment or health care decisions.Guidance for advance directives, including any required identificationand verification process, is documented in state, regional or local2 CPR/AED for Professional Rescuers and Health Care Providers
laws, statutes and/or protocols and must be followed. Advancedirectives include:cDo Not Resuscitate (DNR) orders (also called Do Not AttemptResuscitation [DNAR] orders).cLiving wills.cDurable powers of attorney.Battery: The unlawful, harmful or offensive touching of a person withoutthe person’s consent.Abandonment: Discontinuing care once it has begun. You must continuecare until someone with equal or more advanced training takes over.Confidentiality: The principle that information learned while providingcare to a victim is private and should not be shared with anyone exceptemergency medical services (EMS) personnel directly associated with thevictim’s medical care.Documentation: An established, written record of the events that tookplace, the care that was provided and the facts you discovered after theincident occurred.PREVENTING THE SPREAD OFBLOODBORNE PATHOGENSBloodborne pathogens, such as bacteria and viruses, are present in blood andbody fluids and can cause disease (Table 1).Table 1: Bloodborne Pathogens of Primary ConcernNameDescriptionVaccineHepatitis BLiver infection causedby the hepatitis B virusHepatitis B vaccination series(must be made availablewithin 10 working days ofinitial assignment, afterappropriate training has beencompleted, to all employeeswho have occupationalexposure)Hepatitis CLiver disease caused by Nonethe hepatitis C virusHIVVirus that causesNoneAIDS; attacks whiteblood cells anddestroys the body’sability to fight infectionSECTION1 - The Professional Rescuer 3
OSHA RegulationsOccupational Safety and Health Administration (OSHA) regulations andguidelines: Apply to employees who may come into contact with blood or other bodyfluids that could cause infection.Require employers to have an exposure control plan. Standard PrecautionsStandard precautions are safety measures that combine universal precautionsand body substance isolation (BSI) precautions and are based on theassumption that all body fluids may be infectious. Standard precautions canbe applied through the use of: Personal protective equipment (PPE). Specialized clothing,equipment and supplies that keep you from directly contacting infectedmaterials. PPE should be:cAvailable in your workplace.cIdentified in the exposure control plan.Good hand hygiene. Hand washing is the most effective measure toprevent the spread of infection. Alcohol-based hand sanitizers allow youto clean your hands when soap and water are not readily available andyour hands are not visibly soiled.Engineering controls. Objects used in the workplace that isolate orremove a hazard, reducing the risk for exposure.Work practice controls. Methods of working that reduce the likelihoodof an exposure incident by changing the way a task is carried out (Figure 1).Proper equipment cleaning.After providing care, the equipmentand surfaces you used shouldalways be cleaned and disinfectedor properly disposed (Figure 2).Proper spill cleanupprocedures. If a spill occurs,appropriate measures should betaken to limit and reduce exposureto possible contaminants. 21Courtesy of Terry Georgia4 CPR/AED for Professional Rescuers and Health Care Providers
Preventing InfectionTo prevent infection, follow these procedures and guidelines: Avoid contact with blood and other body fluids.Use CPR breathing barriers when giving ventilations.Wear disposable gloves whenever providing care, particularly if you maycome into contact with blood or body fluids. Also wear protective coverings,such as a mask, eyewear and a gown, if blood or other body fluids can splash.Use gloves that are appropriate for the task and provide an adequatebarrier. Do not use disposable gloves that are discolored, torn orpunctured, and do not clean or reuse disposable gloves.Cover any cuts, scrapes or sores and remove jewelry, including rings,before wearing disposable gloves.Avoid handling items such as pens, combs or portable devices whenwearing soiled gloves.Change gloves before providing care to a different victim.Remove disposable gloves without contacting the soiled part of the glovesand dispose of them in a proper container.If an Exposure OccursIf you are exposed, immediately take the following actions: Clean the contaminated area thoroughly with soap and water. Washneedlestick injuries, cuts and exposed skin.If splashed around the mouth or nose with blood or other body fluids,flush the area with water.If the eyes are involved, irrigate with clean water, saline or sterile irrigantsfor 20 minutes.After any exposure incident: Report the exposure incident to the appropriate person identified in youremployer’s exposure control plan immediately and to the EMS personnelwho take over care.Write down what happened. Include the time and date of the exposureas well as the circumstances of the exposure, any actions taken after theexposure and any other information required by your employer.Seek immediate follow-up care as identified in your employer’s exposurecontrol plan.TAKING ACTIONIn any emergency: Size-up the scene.Perform a primary assessment.Summon more advanced medical personnel if needed.SECTION1 - The Professional Rescuer 5
Scene Size-UpSize-up any emergency scene to determine whether the scene is safe for you,other rescuers, the victim(s) and any bystanders. When sizing up the scene: Use all your senses to check for hazards, such as traffic, unstablestructures, downed electrical lines, swift-moving water, violence,explosions or toxic gas exposure.Put on the appropriate PPE.Determine the mechanism of injury or nature of the illness.Determine the number of injured or ill victims.Determine what additional help may be needed.If the scene appears unsafe, move to a safe distance, notify theappropriate personnel and wait for their arrival.Primary AssessmentDuring the primary assessment, you are checking for any life-threateningconditions, including unconsciousness, absence of breathing, absence of pulseand severe bleeding. Check for responsiveness and, if the victim is conscious, obtain consent.If no response, summon more advanced medical personnel.cNote the victim’s level of consciousness (LOC) using the AVPU scale. Alert: Able to respond to questions Verbal: Able to react to sounds, may need to be stimulated torespond Painful: Responds to painful stimuli Unresponsive: Does not respond to any stimuliOpen the airway and quickly check for breathing and a definite pulse.cNormal (effective) breathing is regular, quiet and effortless. Isolatedor infrequent gasping in the absence of other breathing in anunconscious victim may be agonal gasps, which can occur after theheart has stopped beating. Agonal gasps are not breathing. Care forthe victim as though he or she is not breathing at all.For drowning and other victims of hypoxia and for children andinfants who are more likely to experience respiratory emergencies,give 2 ventilations.Quickly scan for severe bleeding.Opening the AirwayTo open the victim’s airway: From the side, use the head-tilt/chin-lift technique.From above the victim’s head, use the jaw-thrust (with head extension)maneuver.If a head, neck or spinal injury is suspected, use the jaw-thrust (withouthead extension) maneuver.6 CPR/AED for Professional Rescuers and Health Care Providers
ADULT, CHILD ANDINFANT: AGES IN THISGUIDEFor the purpose of the skills inthis guide: 3 4For a child, tilt the head slightly past aneutral position but not as far as youwould for an adult (Figure 3). Foran infant, tilt the head to a neutralposition (Figure 4).Anyone approximately12 years old or older is anadult.Anyone age 1 year toabout 12 years is a child.An infant is anyoneyounger than 1 year.However, for the purposeof operating an automatedexternal defibrillator (AED),anyone 1 to 8 years ofage or weighing less than55 pounds is considered achild. If precise age or weightis not known, use your bestjudgment and do not delaycare while determining age.Giving Ventilations—Special SituationsSuspected Head, Neck or Spinal InjurySuspect an injury to the head, neck or spine if the injured victim: Was involved in a motor-vehicle, motorcycle or bicycle crash as anoccupant, rider or pedestrian.Was injured as a result of a fall from greater than standing height.Complains of neck or back pain, tingling in the extremities or weakness.Is not fully alert.Appears to be intoxicated.Appears frail or older than 65 years of age or is a child younger than3 years of age.Has an obvious head, neck or spinal injury.Check for the following signs and symptoms of a possible head, neck or spinalinjury before you attempt to provide care: Changes in LOCSevere pain or pressure in the head, neck or spineLoss of balancePartial or complete loss of movement of any body partSECTION1 - The Professional Rescuer 7
Tingling or loss of sensation inthe hands, fingers, feet or toesPersistent headacheUnusual bumps, bruises ordepressions on the head, neckor backSeizuresBlood or other fluids in the earsor nose 5 External bleeding of the head, neck or backImpaired breathing or vision as a result of the injuryNausea or vomitingBruising of the head, especially around the eyes and behind the earsIf you suspect an unconscious victim has a head, neck or spinal injury, takecare of the airway and breathing first. Open the airway by using the jaw-thrust(without head extension) maneuver (Figure 5).Drowning VictimsAnyone who experiences respiratory impairment from submersion in water isa drowning victim. Drowning may or may not result in death. Do not enter thewater unless you are specifically trained to perform in-water rescues. For anadult, a child or an infant, give 2 ventilations after you check for breathing anda pulse. White or pinkish foam in the airways and exuding from the mouth andnostrils can be characteristic of drowning victims. Wipe this away fromthe mouth and nose.Many victims who have been submerged vomit because water has filledthe stomach or air has been forced into the stomach during ventilations.VomitingIf the victim vomits when you give ventilations:1.2.3.Quickly turn the victim onto hisor her side to keep the vomitfrom blocking the airway andentering the lungs.cSupport the head and neckand turn the body as a unit.After vomiting stops, clear thevictim’s airway by wiping themouth out using a finger sweep(Figure 6). Suction if necessaryand you are trained to do so.Turn the victim onto his or herback and continue withventilations.68 CPR/AED for Professional Rescuers and Health Care Providers
Mouth-to-Stoma VentilationsKeep the airway in a neutral position as you look, listen and feel for breathingwith your ear over the stoma. To give ventilations, make an airtight seal witha round pediatric resuscitation mask around the stoma or the tracheostomytube and blow into the mask.RECOVERY POSITIONSIf the victim is unconscious but breathing, leave that person in a face-upposition and maintain an open airway, especially if a head, neck or spinalinjury is suspected. However, there are a few situations in which a victimshould be moved into a modified high arm in endangered spine (H.A.IN.E.S.)recovery position to keep the airway open and clear even if a spinal injury issuspected, including: If you are alone and must leave the victim (e.g., to call for help).If you cannot maintain an open and clear airway because of fluidsor vomit.SUMMONING MORE ADVANCEDMEDICAL PERSONNELSummon more advanced medical personnel for any of the followingconditions: Unconsciousness or an altered LOC, such as drowsiness orconfusionBreathing problems (e.g., trouble breathing or no breathing)Chest pain, discomfort or pressure lasting more than a few minutes, thatgoes away and comes back or that radiates to the shoulder, arm, neck,jaw, stomach or backPersistent abdominal pain or pressureSevere external bleeding (bleeding that spurts or gushes steadily froma wound)Vomiting blood or passing bloodSevere (critical) burnsSuspected poisoningSeizuresStroke (sudden weakness on one side of the face/facial droop, suddenweakness on one side of the body, sudden slurred speech or troublegetting words out, or a sudden severe headache)Suspected or obvious injuries to the head, neck or spineSECTION1 - The Professional Rescuer 9
Painful, swollen, deformed areas (suspected broken bone) or anopen fractureThe victim’s condition is not clear or is worseningMOVING A VICTIMMove an injured victim only when: You are faced with immediate danger.You must get to another victim who may have a more serious problem.It is necessary to provide proper care.BREATHING EMERGENCIESBreathing problems can be identified by watching and listening to thevictim’s breathing and by asking how the victim feels. Because oxygen is vitalto life, always ensure that the victim has an open airway and is breathing. Avictim who can speak or cry is conscious, has an open airway, is breathingand has a pulse.Respiratory DistressA victim who is having difficulty breathing is experiencing respiratory distress(Figure 7).Signs and Symptoms of Respiratory Distress Slow or rapid breathingUnusually deep or shallow breathingShortness of breath or noisy breathingGasping for breathWheezing, gurgling orhigh-pitched noisesDizziness, drowsiness orlight-headednessChanges in LOCIncreased heart rateChest pain or discomfortSkin that is flushed, pale, ashenor bluishUnusually moist or cool skinInability to speak in full sentencesTingling in the hands, feet or lips7Feelings of apprehension or fear10 CPR/AED for Professional Rescuers and Health Care Providers
Caring for Respiratory Distress Maintain an open airway.Summon more advanced medical personnel.Help the victim rest in a comfortable position that makes breathingeasier.Reassure and comfort the victim.Assist the victim with any of his or her prescribed medication.Keep the victim from becoming chilled or overheated.Administer emergency oxygen, if it is available and you are trained todo so.Respiratory ArrestA victim who has stopped breathing is experiencing respiratory arrest.Caring for Respiratory ArrestIf a victim has a pulse but is not breathing, begin giving ventilations.HypoxiaHypoxia is a condition in which insufficient oxygen reaches the cells.Causes of Hypoxia An obstructed airwayShockInadequate rdiac arrestHead traumaCarbon monoxide poisoningComplications of general anesthesiaSigns and Symptoms of Hypoxia Increased breathing and heart ratesCyanosis (a condition that develops when tissues do not get enoughoxygen and turn blue, particularly in the lips and nail beds)Changes in LOCRestlessnessChest painSECTION1 - The Professional Rescuer 11
GIVING VENTILATIONSGiving ventilations is a technique for breathing air into a victim to provide theoxygen necessary to survive.Continue giving ventilations until: The victim begins to breathe on his or her own.Another trained rescuer takes over.More advanced medical personnel take over.You are too exhausted to continue.The victim has no pulse, in which case you should begin CPR or use anAED if one is available and ready to use.The scene becomes unsafe.AIRWAY OBSTRUCTIONAirway obstructions can be mechanical or anatomical. Any foreign bodylodged in the airway is a mechanical obstruction. The most common typeof anatomical airway obstruction is the tongue.Caring for Airway ObstructionsA conscious person who is clutching the throat is showing what is commonlycalled the universal sign of choking. The airway may be partially or completelyobstructed. If the person is coughing, encourage continued coughing. If theperson cannot cough, speak, cry or breathe, provide immediate care. Backblows and abdominal thrusts or chest thrusts are used to effectively clear anobstructed airway.Special Considerations for ChokingIf you cannot reach far enough around the victim to give effective abdominalthrusts or if the victim is obviously pregnant or known to be pregnant, giveback blows followed by chest thrusts.To perform chest thrusts:1.Stand behind the victim andmake a fist with one hand.2. Place the thumb side of the fistagainst the center of the victim’schest, or slightly higher on thevictim’s chest if she is pregnant.3. Grab your fist with your otherhand and give quick, inwardthrusts (Figure 8). Look over thevictim’s shoulder so that his or herhead does not hit your face whenyou perform the chest thrusts.812 CPR/AED for Professional Rescuers and Health Care Providers
Conscious Choking Victim Who Becomes UnconsciousIf a conscious choking victim becomes unconscious, carefully lower the victimto the ground, open the mouth and look for an object. Continue to providecare for an unconscious choking victim.CARDIAC EMERGENCIESHeart AttackWhen the muscle of the heart experiences a loss of oxygenated blood, theresult is myocardial infarction (MI), or heart attack.Causes of Heart AttacksHeart attacks usually result from cardiovascular disease, but other commoncauses include: Respiratory distress.Electrocution.Traumatic injury.Other common conditions caused by cardiovascular disease include: Coronary heart disease, also known as coronary artery disease.Stroke, also called a brain attack.Recognizing a Heart AttackHeart attack pain can be confused with the pain of indigestion, muscle spasmsor other conditions, often causing people to delay getting medical care. Brief,stabbing pain or pain that gets worsewhen bending or breathing deeplyis not usually caused by a heartproblem. Summon more advancedmedical personnel and provideprompt care if the victim shows any ofthe following signs and symptoms: Chest discomfort or pain thatis severe, lasts longer than3 to 5 minutes, goes away andcomes back, or persists evenduring rest (Figure 9)Discomfort, pressure or pain thatis persistent and ranges fromdiscomfort to an unbearablecrushing sensation in thechest, possibly spreading tothe shoulder, arm, neck, jaw,stomach or back, and usuallynot relieved by resting, changingposition or taking medication9SECTION1 - The Professional Rescuer 13
Pain that comes and goes (such as angina pectoris)Difficulty breathing, such as at a faster rate than normal or noisy breathingPale or ashen skin, especially around the faceSweating, especially on the faceDizziness or light-headednessPossible loss of consciousnessNausea or vomitingSome individuals may show no signs at all. Women may experience differentsigns. The chest pain or discomfort experienced by women may be sudden,sharp but short-lived pain outside the breastbone. Women are somewhatmore likely to experience some of the other warning signs, such as: Shortness of breath.Nausea or vomiting.Back or jaw pain.Unexplained fatigue or malaise.Caring for a Heart AttackIf you think someone is having a heart attack: Take immediate action and summon more advanced medical personnel.Have the victim stop any activity and rest.Loosen tight or uncomfortable clothing.Closely monitor the victim until more advanced medical personnel takeover. Note any changes in the victim’s appearance or behavior.Comfort the victim.Assist the victim with medication, such as nitroglycerin or aspirin, andadminister emergency oxygen, if available and trained to do so.Be prepared to perform CPR and use an AED.Administering AspirinYou may be able to help a conscious victim who is showing early signsof a heart attack by offering an appropriate dose of aspirin when the signs firstbegin, if local protocols allow or medical direction permits. Administration ofaspirin should never take the place of more advanced medical care.If the victim is conscious and able to take medicine
CPR _ 36 Two-Rescuer CPR _38 Using an AED _40. SECTION1 THE PROFESSIONAL RESCUER. 2 CPR/AED for Professional Rescuers and Health Care Providers THE DUTY TO RESPOND In many professions, there is a job-related duty to act in an emergency and provide care. Your a
CPR AED FIRST-AID CERTIFICATION CLASS TAKE TEST ONLINE TAKE TEST ONLINE CPR AED FIRST-AID CERTIFICATION CLASS Infant CPR: 2 rescuers - in the event of infant rescue with 2 prepared rescuers one of the rescuers will use a one-way valve to initiate breathing while the other rescuer performs the chest compressions.
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