DETAILED PROGRAM for Refresher on Chest Compressions, Ventilations, CPR

20-25 people (60-75 min requires 4 manikins)

Time / Content / Comment
RESOURCES(Prepare before class)
Registrations
Student Names, Professional IDs and emails are all required for pre-registrationfor a class. Each student to be provided with a login name and password upon arrival to the class.
Instructor to have an personal login and 3 extras.
Materials
Student handouts on summary of each skill.
Student handout on SmartMan color coding of bar graphs
SmartMan should be set up and ready to run – open up one of your personal log ins and select an item from the Compressions and Ventilations menu so you are sure that the manikin does not need calibrating.
Calibrate the compressions and ventilations on the manikin if necessary
Set up overhead projector / computer with SmartMan for introductory
demonstration / Reguirements:
Pre-Register
Student Handouts
Instructor Lesson
4 SmartMan Units with PC’s
1 system connected to Overhead Projector
1 USB Stick
INTRO
1 min / INTRODUCTIONOrally present to the whole class
Aims of this program
What they are supposed to learn
How they will practice and how they will be tested
Why CPR is important? / Talking to Whole Group
This is review for most people but you need to explicitly review what is correct
2 – 3 min / INSTRUCTION Orally present to whole class
Review specific component skills and how to perform them. See attached page for each skill to be mastered. Summary sheets are to be handed out to students. Specific tips on how to get a better performance.
SmartMan and accuracy.
SmartMan and visual feedback.
How to use the feedback to improve.
How to develop consistency at a high level (muscle memory). You will come back every 90 days to make sure you are performing correctly. Set a target level for yourself which you want to reach.
The Blind Test at the end when they are ready. / Talking to Whole Group.
INSTRUCTIONS CHEST COMPRESSIONS
PREPARE: Connect SmartMan to OHP, Login and be ready to demo Chest Compressions Practice. This will be 30 comps, a pause for 4 seconds then another 30 comps.
Also prepare the other SmartMan Units as the hands-on will require them as well. / PREPARE
COMPS
1 min / INSTRUCTIONS
SAY: SmartMan produces a bar each time you press on the chest.
The target color for the right rate and right depth is bright green.
  • If it is too deep or too shallow it will be dark green.
  • If it is too fast it is orange.
  • If it is too slow it is red.
  • If you fail to release the chest you will see a red bar beneath the bar
/ LECTURE
COMPS
1 min / INSTRUCTIONS Do 30 chest compression (as you do them)
SAY: I’ll now do 30 chest compressions, wait 4 seconds, then 30 more compressions. Notice that the colored bars respond as I press on the chest. Notice that the horizontal green lines on the screen show the depth that to aiming for.
DO:Begin Chest Compressions. Start too deep and too fast
SAY: (As you do them), these are too deep and too fast; they are orange and way over the 2” line.
DO:Slow Down
SAY:Now you can see that I am going at the correct rate, the bars are not orange anymore but I am still going too deep (dark green).
DO:Go less deep
SAY:Now you can see that I am going the correct depth. The bright green you can see now is always what I am aiming for.
DO: Finish the 1st set of 30, when you are waiting the 4 seconds,
SAY: Because we are just working on compressions, wait the 4 seconds as if someone was giving the victim ventilations. Now I do the next set of 30 compressions.
DO: Do a bunch of 10 or so compressions that are very good, now do several where there are non-full releases.
SAY: Those red lines across the bottom of the bar mean that I have not allowed the chest to fully release.
DO: When you have completed the cycle, it will show the first set of compressions.
SAY: You see the orange bars when I started which were all too fast and too deep. Firstly I corrected the rate and then I corrected the depth.
SAY: The bright green means that I am performing compressions that are very good for the victim. Notice that it is very important to allow the chest to fully recoil. The red bar means that I was still leaning on the chest.
SAY:Now we will break into groups so that everyone gets a chance to practice. / DEMO
to Whole Group using
OHP
COMPS
15 min / INSTRUCTIONS Hands-on for each student. This will take each person 3-4 minutes. That is 15 minutes for 25 people on 4 manikins.
SAY:
Login under your own name.
Click on Compressions. Select 30 Compressions PRACTICE.You do 30 compressions, wait for 4 seconds and then do another 30 compressions.
When you are ready, you cue the computer by pressing the SPACE BAR.
SAY:This is just a practice so you get used to the feel of the manikin and the feedback. Try a few, and see how the screen produces the colors; try a few too fast, or too deep; At the end of the first 30, rest for 4 seconds, then try and get them right. If you are getting them perfect, memorize the feel of your body. If you are getting some other colors, change how you are performing.
SAY:Once you feel comfortable, go to the Menu and select 30 Compressions TEST. Here you will do 5 sets of 30 compressions; at the end of the first 30, wait the 4 seconds as if someone was giving breaths and so on for the next 2 sets of 30 compressions
Okay, let’s give it a go.
INSTRUCTIONS Watch the time and encourage people to get on with it. / HANDS-ON
Each Student
INSTRUCTION VENTILATIONS
PREPARE: Connect SmartMan to OHP, Login and be ready to demo Rescue Breaths Practice. This will involve doing rescue breaths for one minute..
Also prepare the other SmartMan Units as the hands-on will require them as well. / PREPARE
VENTS
2 min / INSTRUCTIONS
SAY:Just as in compressions, SmartMan produces a bar each time you perform a skill. When you put air either into the lung or into the stomach, you will see a colored bar. You want to get all bright green bars. In ventilations there are 2 bars:
  • A vertical Bar for Inspiration Rate and Volume,
  • Bright green = right volume of inspiration and right rate of inspiration
  • Red = too slow
  • Orange = too fast
  • A Horizontal Bar for the interval
  • Bright green = correct
  • Red = too slow
  • Orange = too fast
SAY: If you cannot get a seal, you cannot ventilate.
INSTRUCTIONS: Review of Information on how to perform
SAY: You must squeeze the bag slowly so the air goes into the lungs rather than the stomach. It is recommended that the squeeze take 1 second. Then you immediately release the bag.
To perform rescue breaths you do about 10 per minute. Thus a 1 second squeeze,
Immediately release the bag and count for 5 seconds,
Begin next breath / LECTURE
PREPARE: Go back onto the machine which is connected to the OHP. Login, go to Ventilations and do Rescue Breathing Practice.
TECHNIQUE: Get a seal and head tilt-chin lift.
HOW-TO: You must practice getting a seal so you know that you can do it.
  • Position the mask so it is covering the nose and mouth.
  • Make a “C” grip with the thumb and finger.
  • Clamp the mask onto the face by squeezing the lower fingers up into the thumb and finger.
  • While still holding this clamp tightly, raise the head into the proper head tilt position.
TRY IT/ PRACTICE IT: You need to be able to do this. Practice.
CHECK YOURSELF: Learn to recognize the signs of when you have a good seal and when you need to change it to overcome a leak.
  • Can you feel air escape around the seal.
  • Can you hear air escaping
  • Does the chest rise (it will only move a little)
  • Does it sound right
PERFECT IT: Practice it again and again whenever you get a chance.
If you cannot get a seal you cannot perform a ventilation.
You will all get the chance in a minute to practice, first I want you watch how I do ventilations / DEMO
SEAL
3 min / INSTRUCTIONS You want to show them what they are going to see on the screen so they can use the feedback to improve how they perform.
Press the space bar so SmartMan is ready:
SAY: A Quick Review of ventilations
  • Seal and head tilt chin-lift
  • 1 second squeeze
  • Full quick release 1 SECOND
  • Count 4 seconds [ERC – easarlier we said 1 sec squeeze, release and count 5 secs – standardize?]
  • Repeat
SAY: The breath will show as a vertical bar. The volume (500 -600ml) is the lines on the screen. Bright green is what I am trying to produce.
Okay here goes.
DO: Begin rescue breaths. Exaggerate the time between each one.
SAY: 1 second is a very long squeeze. Most people go too quickly.
The horizontal bar across the bottom is the time between breaths. If I do that correctly, it will be bright green as well.
DO: Look at the results. Look at the Percentage. Explain the colors again.
You’ll see that I got a couple of them correct. Rescue greathstakes practice and concentration. / DEMO
VENT
VENTS
10 min / INSTRUCTIONS Do 60 seconds of rescue breaths on the overhead projector so everyone can see.
SAY: (As you do them), these are correct, now I will go too fast, too slow, put some into the stomach, now a few more that are correct.
INSTRUCTIONS At the end of the 10 ventilations (or 60 seconds)
SAY: Practice so you can get a seal. If you cannot skate, you cannot be a hockey player no matter how well you shoot. Everyone will get several chances to practice making a seal before we start the rescue breaths practice
INSTRUCTIONS: Now everyone will get a chance. 4 – 5 people per manikin
SAY: You will perform rescue breaths for 1 minute. Aim for 10 breaths.
Practice 2 or 3 times to get a seal. get a feel for it and a rhythm, I’ll tell you to correct one thing at a time / HANDS-ON each student
INSTRUCTION – 1RESCUER CPR
PREPARE: Connect SmartMan to the computers and have them ready to go. / Prepare
1Per
CPR
3 min / INSTRUCTIONS – 1 RESCUER CPR
INSTRUCTIONS CPR
SAY: CPR is simply a combination of 2 skills; chest compression and ventilations. 1 person CPR is a demanding skill.
You will get tired. You need to refocus yourself to perform accurately. Self check; self monitor your performance; correct it as you continue to perform chest compressions.
SAY:To do the best for the victim you need to remember that chest compressions are a lot more important, so concentrate on them more.
Time off the chest is most detrimental to the victim, Do NOT take more than 4 seconds to do your ventilations. Get at least some breath in the lungs at least once. After 4 seconds you need to be back onto the chest doing the compressions.
SMARTMAN: SmartMan will show both the chest compressions and the ventilations on the screen as you perform.
  • A vertical Bar for Inspiration Rate, Volume,
  • Bright green = right volume of inspiration and right rate of inspiration
  • Red = inspiration rate too slow
  • Orange = inspiration rate too fast
  • A Horizontal Bar for the interval
  • Bright green = correct
  • Red = too slow
  • Orange = too fast
When you give the breath, SmartMan will put a horizontal bar across the bottom. That is the time from theend of thelast(30th) compression to the start of the first ventilation.
When the ventilations are finished, you begin the next set of compressions, the screen will start over. However, at the end the score will take into account all skills and all of the total times. This percentage score is how well the performance affects the survival of the victim. / Lecture
2 min / INSTRUCTIONS CPR
SAY:Here are a few things that we see people do incorrectly. Avoid them.
  • Get your compressions right as these are more important to the victim.
  • Don’t take all day to get the vents done. It is more important to get a single half good vent in in the 4 seconds than to take 8 seconds to get 2 perfect vents
  • Have a spot where you always place the BVM and the way you lay it down. This way it will always be there when you switch to ventilations. As your count gets close to 30, prepare yourself to get two great ventilations done.
  • Do NOT move around the head to do a ventilation
  • You must get at least some air into the lungs at least once or the computer will terminate the activity.
/ TIPS
12 min / INSTRUCTIONS 2cycles of 1 Person CPR
Do 5 x 30:2 twice
SAY:Login, Go to Activities, 1 Person CPR, press the Space Bar to cue the program. Begin when ready.
You will do 5 x 30:2 twice. / HANDS-ON each student
INSTRUCTION – 2 RESCUER CPR
PREPARE: Connect SmartMan to the computers and have them ready to go. / PREPARE
2Person
4 min / INSTRUCTIONS CPR
SAY: Again 2 Rescuer CPR is simply a combination of the other 2 skills; chest compression and ventilations. Remember that chest compressions are a lot more important to the victim so concentrate on them more.
Get at least some breath in the lungs at least once every 30 compressions.
You are a team. One person needs to count out loud; often it is the person doing the compressions. Each breath is a slow squeeze (1 second), quick release (1 second) immediately given another breath (1 seond), quick release, Chest compressions start again.
SMARTMAN: SmartMan will show both the chest compressions and the ventilations on the screen as you perform.
  • A vertical Bar for Inspiration Rate, Volume,
  • Bright green = right volume of inspiration and right rate of inspiration
  • Red = inspiration rate too slow
  • Orange = inspiration rate too fast
  • A Horizontal Bar for the interval
  • Bright green = correct
  • Red = too slow
  • Orange = too fast
When you give the breath, SmartMan will put a horizontal bar across the bottom. That is the time from the endt of the last(30th) compression to the start of the first ventilation.
When the ventilations are finished, you begin the next set of compressions, the screen will start over. However, at the end the score will take into account all skills and all of the total times. This percentage score is how well the performance affectsthe survival of the victim. / Lecture
to Whole Group
1 min / TIPS
The Change Over
On the 5th cycle, change on 25. Get into position alongside your colleague, get your hand onto the chest and after the 25th compression do the 26th compression continuing then without a break in the rate.
The other person scoots to the head, does the head tile-chin lift and gets a good seal, then 2 does the 2 ventilations.
Get at least some air in once on each set.
SAY: here are a few things that we see people do. Avoid them
1)Wait too late to change
2)Take too long to get ventilations in. Be sure to only take 4 seconds / TIPS
12 min / INSTRUCTIONS 2cycles of 2 Resuer CPR with swap over
SAY:Login, Go to Activities, 2 Rescuer CPR Test, press the Space Bar to cue the program. Begin when ready.
The person who logged in will start with compressions. You will do 5 x 30:2. Towards the end of the 5th set of compressions, change over, then repeat the cycle. / HANDS-ON each student
INSTRUCTION – ADVANCED AIRWAY
TIMING OF INTUBATION
NOTE: To perform these skills you need an Ambu Airway SmartMan
PREPARE:Set Up and connect Airway SmartMan. / PREPARE
INSTRUCTIONS
You can use a range of devices.
SAY: Airway SmartMan has a separate activity to help you hone your skills at intubating a victim. This exercise will time how long it takes to place the device and will test for the effectiveness of the seal.
Select the Activity.
When you have all of the gear you need, press the Space Bar or have someone else do that for you.
Each device has a recommended time in which it should eb done. For example an ET should be effectively placed in less than 20 seconds. A King Sysyems and Combitube say it should take less than 12 seconds. / LECTURE
SmartMan
The timer starts running form the time the space bar is pressed.
Place the device, inflate the cuff as quickly as possible.
Using a BVM put air into the device. Aim for about 550 – 600ml of air.
Hold that amount of air for 5 long seconds.
SmartMan will now display the total time, effectiveness of the seal, volume of air inspired. / Rules
Login, select Advanced Airway and the Time Intubation Activity.
At the end, review your results. / HANDS-ON
INSTRUCTION – ADVANCED AIRWAY FULL CPR
CPR with Advanced Airway in place (Continuous Chest Compressions withventilations timed with the release of the chest, and swap over)