Health Care Provider Study Review Guide

Healthcare providers risk occupational exposure to communicable diseases such as HIV and Hepatitis B viruses through contact with blood and body fluids. OSHA’S " Universal Precautions" policy states that if workers have exposure to blood or body fluids, they should use personal protection such as latex gloves for hands, protective eye wear and gowns and use barriers if they have to perform rescue breathing.

"Good Samaritan" legislation helps minimize the fear of litigation so rescuers will feel comfortable helping a victim.

Risk Factors for Cardiovascular Disease - Several factors increase a person’s chances of having a heart attack or stroke. The more risk factors a person has the greater the likelihood that he will have a heart attack or stroke.

Risk factors that cannot be changed - heredity, male gender, and increasing age.

Risk factors that can be changed or managed - cigarette smoking, blood cholesterol, diabetes, physical inactivity, obesity, stress and high blood pressure. Making positive changes like eating foods low in fat, salt and cholesterol such as fish, fresh fruits and vegetables, exercising regularly, quitting smoking and getting treatment for high blood pressure and diabetes will help reduce the risk of cardiovascular disease.

Coronary artery disease (CAD) - affects the arteries that supply blood to the heart muscle. Narrowing of the arteries in the heart can lead to a heart attack. CAD may show up as:

Angina pectoris-temporary chest pain or pressure brought on by physical activity. The pain usually lasts between 2-15 minutes and is relieved by rest and nitroglycerin. If rest and nitroglycerin do not relieve chest pain in 15 minutes, 911 should be called and the patient should be evaluated at the hospital for possible heart attack.
Heart attack- usually occurs when a blood clot completely blocks a coronary artery and kills heart tissue. Symptoms of a heart attack include chest pain that can be described as pressure, fullness or a squeezing sensation located in the center of the chest behind the breastbone. The pain may spread to the jaw, shoulder, neck, and upper back or down one or both arms and usually lasts more than 15 minutes. Other symptoms of a heart attack are fainting, cold clammy skin, nausea, shortness of breath and denial that he could be having a heart attack. This denial behavior is usually what causes the victim to delay getting medical treatment in a timely manner. As a person waits to get treatment, heart muscle dies and the risk of complications or death increases. If a person who is experiencing heart attack symptoms tries to deny there is a problem and is having symptoms of a heart attack, the rescuer should go ahead and activate EMS and monitor the patient until they arrive.

Stroke- results from the blockage or rupture of an artery in the brain. Symptoms include: intense headache of sudden onset, facial, arm or leg weakness or numbness, double vision or loss of vision, especially in one eye, difficulty walking, talking, swallowing or loss of consciousness. Treatment is the same as for heart attack. If symptoms persist for more than 15 minutes, activate EMS and monitor the patient until they arrive. High blood pressure is the number one risk factor for stroke.

Chain of Survival-is the sequence of steps that a rescuer initiates to save a person’s life that is in cardiac arrest. CPR alone is not enough to save lives in most cases. It is, however, a vital link in the chain of survival that must be performed until more advanced life support is available. The chain of survival is: Early Access (call 911), Early CPR, Early Defibrillation and Early Advanced Care. Effective emergency cardiac care depends on the strong interaction between all 4 parts of this chain. If any link is weak or missing, the chance of survival is lessened.

Most victims of cardiac arrest will require early defibrillation (within 3-5 minutes) to be resuscitated successfully.

If a rescuer needs to perform CPR on an adult and he is alone, he should activate the EMS before starting CPR. If the victim is a child or infant, the rescuer should perform approximately 1 minute of CPR first to deliver some oxygen and then activate the EMS system, because respiratory failure usually causes circulatory failure in children. Injuries are also the leading cause of death in children older than 1 year old.

General rules of CPR are:

The rescuer never does anything that the victim can do adequately for himself such as breathing etc.
The rescuer always checks each step such as airway, breathing and circulation before administering CPR.

Sequence of CPR-This sequence is the same for adults, children and infants except where stated. According to AHA guidelines, infants are under 1 year of age, children are 1 year to adolescent and adults are adolescent and older.

When a person collapses, the following steps should be done in this order:

Check the scene to be sure it is safe for the rescuer to enter- if scene is not safe,DO NOT ENTER! Call 911.
Put on barriers to protect against blood /body fluids exposure.
Check for responsiveness- this is the way to prevent a rescuer from performing CPR on someone who has only fainted.
Call for help-send someone to activate EMS.
Perform ABCD Check:

ABCD CHECK

A=Airway Open the airway with the head tilt/chin lift maneuever if the rescuer does not suspect head, neck or back injury. Put one hand on the forehead and place two fingers of the other hand under the bony part of the chin and lift up. This movement lifts the tongue off the airway and allows air to pass unobstructed.

If head, neck or back injury is suspected, do the simultaneous jaw thrust with cervical spine immobilization. Without lifting the head back, lift the chin up. This movement lifts the tongue off the airway without moving the head, neck and back which could cause damage to the injured area. The most common cause of airway obstruction in unconscious victims of all ages is improper opening of the airway, which leaves the tongue sitting on the airway.

B=Breathing- involves two steps.

1.To check breathing, the rescuer needs to look, listen and feel for breathing. He should turn his head and look at the victim’s chest to see if the chest is rising and falling, listen to see if he can hear breathing and feel for breath on his cheek. All three steps should be done simultaneously.
2. If no breathing is detected, the rescuer should pinch the victim’s nose and deliver 2 slow, full breaths delivered over a period of 1 second/breath. The rescuer should look at the chest and deliver only enough breath to expand the chest adequately. If the breaths are given too quickly or too forcefully, air is likely to enter the stomach rather than the lungs. This can cause gastric inflation. Gastric inflation frequently develops during mouth-to-mouth, mouth-to-mask, or bag-mask ventilation and can result in serious complications such as vomiting, aspiration, or pneumonia. Special precautions should be given to delivering breaths with the correct force and speed to avoid gastric inflation. A special breathing situation is drowning. If the victim has been in cold water submersion, his metabolism slows. Recovery may be complete even after 10-40 minutes of submersion; so CPR and life support should continue for that amount of time. After a victim has been rescued form the water, if the victim is not breathing, rescue breathing should be done (1 breath every 5-6 seconds for adults or 10-12 breaths/minute, 1 breath every 3-5 seconds for infants and children or 12-20 breaths/minute.) These rates are to be delivered in any situation where a victim is not breathing but has a heartbeat.

Bag/mask Ventilation: The American Heart Association recommends that healthcare providers use bag-mask or other barrier devices when providing rescue breathing to victims during CPR. If supplemental oxygen is available, it should be used with the barrier device to deliver rescue breaths. Barrier devices should be readily available in the workplace. These devices come in various sizes to use on adults, children and infants. Be sure to use the correct size for the victim to ensure a good seal can be made.

There are two basic types of barrier devices:

Face shields

Face mask/bags

Correct use of these devices requires practice to be effective. The most important aspect to remember when using barrier devices is to place the device over the mouth and nose and create a good seal so air cannot leak out during rescue breaths.

Face shields: Made from clear plastic or silicon sheet that is placed over the victim's face. Breaths are delivered through a hole or tube. Make sure the shield used has a one- way valve to prevent material in the victim's mouth from passing into the rescuer's mouth during rescue breathing. Leave the shield in place between rescue breaths while chest compressions are being performed. These barrier devices can be carried on a key ring so they are available anywhere that CPR might be performed. Replace the face shield with a mouth-to-mask barrier with supplemental oxygen as soon as possible.

Face Masks: Made from firm plastic with a cushioned ring or rim. These masks are usually triangular or circular in shape. Care should be taken to place the mask over the nose and mouth properly so a good seal can be made. Rescuers can use a face mask by kneeling next to the victim (lateral technique) or at the top of the victim's head (cephalic technique). The lateral technique is used most often for 1 rescuer CPR while the cephalic works well for 2 rescuer CPR or one rescuer rescue breathing situations.

Lateral Technique: To use the lateral technique with a face mask perform the following steps:

1. Apply the mask to the victim's face using the bridge of the nose for correct positioning.

2. Place the index finger and thumb of the hand closest to the victim's head along the edge of the mask making a "C" on the mask to hold it in place and make a seal.

3. Use the thumb of the other hand to firmly hold the lower edge of the mask and make a tight seal. Place the remaining fingers of that hand along the bony part of the jaw to perform a head tilt-chin lift maneuver to open the airway.

4. Perform 2 slow rescue breaths (each breath delivered over 1 breath/second). Make sure the chest rises and falls with each rescue breath given.

Cephalic Technique: To use the cephalic technique with a face mask perform the following steps:

1. Kneel directly above the victim's head.

2. Apply the mask to the victim's face using the bridge of the nose for correct positioning.

3. Place the base of both thumbs along the sides of the mask.

4. Place both index fingers behind the angles of the jaw and lift the jaw into the mask as you tilt the head back. Squeeze the mask on both sides against the victim's face to make a tight seal.

5. Deliver 2 slow rescue breaths each breath (delivered over 1 breath/second). Make sure the chest rises and falls with each rescue breath given.

If the rescuer feels the victim might have head, neck or back injuries, care should be taken to use the jaw -thrust manuever with cervical spine immobilization to open the airway.

Bag-Mask devices: The most common bag/mask device is the ambu bag. To use with one rescuer:

1. The rescuer stands at the top of the victim's head.

2. Tilt the victim's head back (if there is no head, neck or back injury) Use a jaw -thrust with cervical spine immobilization if head, neck or back injury is suspected.

3. Apply the mask to the face using the bridge of the nose as a guide.

4. Hold the mask in place by using the 3rd, 4th and 5th fingers to hold onto the bony part of the chin while the thumb and index finger of that hand is placed on top of the mask to get a good seal. The other hand compresses the bag to deliver ventilations at a rate of 1-2 seconds if oxygen is used and a rate of 2 seconds if no oxygen is available.

5. If 2 rescuers are available, one rescuer should hold the mask with 2 hands to obtain a good seal and the other rescuer should compress the bag to deliver ventilations.

C=Circulation-involves 2 steps:

1.To check circulation, the rescuer feels for a pulse at the carotid artery for adults, the carotid or femoral artery for children and the brachial or femoral artery for infants for 5-10 seconds. Other ways to check for signs of circulation is to check for breathing, movement, coughing or signs of cyanosis (blueness of skin).

2. If there are no signs of circulation or pulse felt, the victim needs chest compressions as well as rescue breathing to survive.

To perform chest compressions:

Make sure the victim is lying on a hard flat surface.
Kneel next to the victim's chest.
Compression landmark for adult and children is the center of chest, between nipples. For infants the compression landmark is just below the nipple line.
For adults and larger children, use 2 hands with the heel of 1 hand on chest and the other hand on top. For smaller children use the heel of one hand only. For infants when only one rescuer is available use 2 fingers. When 2 rescuers are available use the 2 thumb-encircling hands method..
Compress 11/2-2 inches for adults . Compression depth for children and infants is approximately 1/3 to ½ the depth of the chest. Assessing depth in this manner works for all ages and sizes. If two rescuers are present, one rescuer can check the carotid artery for a transmitted pulse. Each time one rescuer performs a chest compression, the other rescuer should feel a pulse. If no pulse is felt during compressions, the rescuer feeling for a pulse should instruct the rescuer performing compressions to push harder.
The compression rate for all groups is approximately 100/minutes. Please note that the compression rate refers to the speed of compressions, notthe actualnumber of compressions delivered per minute.
The compression-ventilation ratio for adults (both or 2 rescuers) is 30:2 (30 compressions followed by 2 ventilations). For children and infants, the compression-ventilation ratio is 30:2 (30 compressions followed by 2 ventilations) when 1 rescuer is available and for HCP ONLY will switch to 15:2 (15 compressions followed by 2 ventilations) when 2 rescuers are available and working together.Once a rescuer starts CPR, he should not stop unless the patient revives, someone of equal or greater training comes to relieve him, he is too exhausted to continue, or a signed "Do Not Resuscitate" order is presented. If the rescuer loses track of how many cycles have been completed he should:

1. Stop compressions

2. Immediately go up to the victim's head and recheck ABCDs

3. Start a new cycle of CPR continuing to do for the victim what he cannot do adequately for himself

Care should be taken to place hands and fingers in the correct position to avoid injury to the patient as CPR is performed. However, rib fractures, laceration of the liver or other internal complications can be minimized but not totally eliminated by effective technique. If the rescuer feels like he has fractured a rib, he should stop long enough to ensure proper hand placement on the chest and then continue with CPR. Fractured ribs can be treated at the hospital- Dead brain tissue cannot be treated anywhere! All victims should be evaluated by a medical professional for complications, even if they seem fine.

2-Rescuer CPR – To perform 2-man CPR, one rescuer is positioned by the victim’s head and is in charge of breathing and checking ABCs while the other rescuer is positioned at the side or head of the victim and is in charge of compressions and when to change places. Compression rate is 30 compressions /2breaths. While performing chest compressions, the rescuer counts out loud. After 5 cycles of 30:2 the rescuer switch duties taking less than 5 seconds to switch. The effectiveness of chest compressions can be evaluated by checking for a transmitted pulse during the performance of compressions. If no pulse can be felt, the rescuer needs to push harder. Two rescuer CPR can be performed on adults, children and infants. Please refer to the American Heart Association Healthcare Provider Manual for more information on CPR.

D stand for Defibrillation

AED- stands for automated external defibrillator. It is a new and exciting medical advance in emergency cardiac care. AED's are computerized defibrillators that are user friendly and are effective in stopping the most common cause of sudden cardiac-arrest which is ventricular fibrillation. The best chances for a victim to survive cardiac arrest are when immediate bystander CPR is initiated and defibrillation is applied within 3-5 minutes.