Revision

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Revision Practical on One-Man Adult CPR FBAO
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Learning Objectives

• Recognise
• Unresponsiveness
• Breathlessness
• Pulselessness
• Perform one-man adult CPR proficiently

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Scope of Lesson

• Introduction
• Practical Training on 1 Man CPR
• Practical Training on FBAO
• Conclusion

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• D DANGER
• Look out for unsafe environment, e.g.
• electrical current,
• fire,
• possible explosion,
• construction works, or
• poisonous gas

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R RESPONSETap victims shoulder and shout
Hello! Hello! Are you OK?
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No Response Help! Call Ambulance 995.
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Position the Victim

• For CPR to be effective, the victim must be lying
  flat on his / or her back and on a firm, flat
  surface
• If the victim is lying face down on his side, you
  will need to roll the victim over as a unit onto
  his back.
• Do take care that the head, neck and body are
  supported and turned simultaneously during
  repositioning.

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A AIRWAYHead tilt/Chin lift Push chin down.
Check victims mouth. Clear
foreign body if seen.
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Head tilt/Chin lift is to open the airway. The
most common cause of airway obstruction in the
unconscious victim is occlusion of the airway by
the Tongue.
Place your hand that is nearest victims head on
victims forehead and apply backward pressure to
tilt head back, place 2 fingers of your other
hand under the bony part of jaw near chin and
lift, avoid pressing on soft tissues under jaw,
tilt head backward without closing victims mouth
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Check BreathingLook , Listen and Feel for
breathing up to 10 seconds.
B BREATHING

• Place your ear and cheek over the victims mouth
  and nose while maintaining an open airway.
• Assess for breathing up to 10 seconds.
• Look for the chest to rise and fall
• Listen for air escaping during exhalation
• Feel for the flow of air
• If no breathing, give 2 ventilations.

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Give 2 slow breaths
( each 1 sec between 400
1000 cc )

• Pinch the nose with your thumb and index finger
  to prevent air
• from escaping through the victims nose.
• Take a deep breath and seal your lips around the
  victims mouth.
• Give 2 slow breaths until you see the chest
  rise.
• Release the nostrils after each breath.
• The duration for each breath is 1 second.
• Ventilation volume should be between 400 to 1000
  cc.

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Check Carotid Pulse for up to 10 seconds.
C CIRCULATION
Maintain head tilt with your hand nearest the
victims head on forehead Locate Adams apple or
the centre of the neck (female) with 2 fingers of
hand nearer victims feet Slide your fingers down
into groove of neck on side closest to you Do not
use your thumb because you may feel your own pulse
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If there is no pulse, give CPR 30 chest
compressions 2 ventilations. If there is a
pulse, and no breathing, give rescue breathing at
the rate of 1 ventilation every 5 seconds
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No pulse Start CPR Locate end of sternum using
middle finger
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Place middle finger on the xiphoid process and
index finger next to it.
Put heel of other hand on sternum next to index
finger.
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Perform 30 Compressions (Depth of 4-5 cm, Rate of
approximately 100 per minute)

• Interlace the fingers of both hands and lift the
  fingers off the chest wall
• Straighten both elbows and lock them in position
• Position your shoulder directly over the victims
  chest
• Use your body weight to compress the victims
  chest 4-5 cm
• Bouncing compressions, jerky movements, improper
  hand position and leaning on the chest can
  decrease the effectiveness of resuscitation and
  are more likely to cause injuries
• Do not lift the hands from the chest or change
  position, otherwise correct hand position may be
  lost

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• Count loudly as you compress
• 1 and 2 and 3 and 4 and 5 and
• 1 and 2 and 3 and 4 and 10 and
• 1 and 2 and 3 and 4 and 15
• 1 and 2 and 3 and 4 and 5 and
• 1 and 2 and 3 and 4 and 10 and
• 1 and 2 and 3 and 4 and 30

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Landmark for proper chest compressions
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CPR CYCLE
Perform 5 cycles of 30 compressions 2 breaths
within 2 minute and then Reassess
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Reassessment
After 5 cycles, ending with the 2 breaths, check
the pulse. If there is no pulse, continue with
CPR until victim revives, paramedic arrives or
you are completely exhausted . If pulse has
returned, check breathing. If victim is not
breathing, perform rescue breathing at 12
times/minute (one breath every 5 seconds) by
counting after each breath 2-a-thousand,
3-a-thousand, 4-a-thousand, 5-a-thousand If both
pulse/circulation and breathing have returned,
place the victim in the recovery position and
maintain an open airway Continue to monitor for
breathing and pulse every few (5) minutes as
these can stop suddenly.
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If pulse and breathing have returned,place
victim into Recovery Position.
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Conclusion

• What should you do when you come across someone
  lying on the ground?
• Show the correct method to check the pulse.
• Show the method of locating proper hand position
  for chest compression
• After how many cycles should you reassess the
  victim?
• What should you do after you confirm that the
  victim has no breathing?
• When pulse is present but breathing is not
  present, what should you do?
• What should you do next when both pulse and
  breathing of victim is present?

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Adult Foreign Body Airway Obstruction
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Learning Objectives

• Able to perform the Heimlich Manoeveuvre in the
  conscious adult FBAO victim
• Able to manage an unconscious adult FBAO victim
• Able to manage FBAO in the pregnant and very
  obese victims

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Scope of Lesson

• Introduction
• Practical management of FBAO from Conscious to
  Unconscious
• Conclusion

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Relief of FBAO

• Techniques used in the relief of FBAO include the
  Heimlich Maneuver (abdominable thrusts) and chest
  thrusts (for pregnant and obese victims)
• The Heimlich Maneuver, also known as
  subdiaphramatic abdominal thrusts or abdominal
  thrusts is recommended for relieve of of FBAO in
  responsive adults (gt8 years of age) and child (1
  to 8 years of age)
• The Heimlich abdominal thrusts elevate the
  diaphragm and increase airway pressure, which
  force air out of the lungs. This creates an
  artificial cough and expels the foreign body from
  the airway.
• In obese or pregnant victim, chest thrust is used
  instead.

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Complications from Heimlich Maneuver

• It may damage the internal organs such as rupture
  or laceration of abdominal or thoracic viscera

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Chest Thrust
May be used as an alternative to Heimlich
Maneuver. It is performed on obese or pregnant
victim. 1. To confirm that the victim is
choking, ask Are you choking? If the
victim is choking, he will not be able to Speak,
Breathe or Cough. If YES, say I am
trained, can I help? 2. If the victim is
upright, the rescuer stands behind the victim.
If the victim is sitting, the rescuer kneels
down and positions himself behind the
victim.
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3. Place your arms under the victims armpits to
encircle the chest. Place one fist with thumb
side on the middle of the breastbone. Grasp
fist with the other hand and give successive
quick backward thrusts.. Deliver each
thrust firmly and distinctly with the intent of
relieving the obstruction until the foreign
body is expelled or the victim becomes
unconscious. When the victim becomes
unconscious, the rescuer should activate
emergency medical services by dialing 995 for an
ambulance and begin CPR.
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Conscious Adult Choking
Steps Involved in Relief of FBAO ( Conscious)

• To confirm that the victim is choking, ask Are
  you choking?
• If the victim is choking, he will not be
  able to Speak, Breathe or Cough.
• If YES, say I am trained, can I help?
• If the victim is upright, the rescuer stands
  behind the victim.
• If the victim is sitting, the rescuer kneels
  down and positions himself
• behind the victim.
• Put your arms around the victims abdomen.
• Place fist with thumb side against victims
  abdomen in the mid line about
• 2 fingers breadth above the navel and well
  below the tip of the xiphoid.
• Give quick inward and upward thrusts in one
  motion into the victims
• abdomen until the foreign body is expelled or
  the victim becomes
• unconscious.

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Steps Involved in Relief of FBAO ( Conscious to
Unconscious)

• Ask Are you choking?
• Perform abdominal thrusts (Heimlich maneuver) /
  For pregnant and
• very obese victims, perform chest thrusts.
• If the victim becomes Unconscious,
• Position the victim on his back and call Help!
  Call 995
• Open the airway Perform Head-Tilt-Chin Lift
• Push chin down and check mouth for foreign body
  object
• If foreign body is seen, If foreign body is seen,
  insert the index finger of
• the other hand down along the inside of
  the cheek and deeply into the throat.
• Use a hooking action to dislodge the
  foreign body and maneuver it out of
• the mouth./ Take precaution not to force
  the foreign body deeper into the
• throat. This maneuver is known as the
  finger sweep.

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Finger Sweep
Check for Foreign Body use Push chin down If
foreign body is seen, insert the index finger of
the other hand down along the inside of the cheek
and deeply into the throat.
Use a hooking action to dislodge the foreign body
and maneuver it out of the mouth./ Take
precaution not to force the foreign body deeper
into the throat. This man oeuvre is known as the
finger sweep.
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Steps Involved in Relief of FBAO ( Conscious to
Unconscious)

• Check breathing Look, Listen and See
• If there is no breathing, attempt to ventilate
  (1st ventilation). If the chest
• does not rise, reposition victims head
  and reattempt to ventilate
• (2nd ventilation)
• If the chest does not rise again, give 30 chest
  thrusts. The hand position
• for chest thrusts is the same as chest
  compression performed in CPR.
• Repeat S/N 4 to 8 until there are 2 successful
  ventilations, and check the
• breathing.

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The Self-Administered Heimlich Maneuver

• To treat ones own complete FBAO, make a fist
  with one hand, place
• the thumb side on the abdomen above the navel (2
  fingers breadth) and
• below the xiphoid process, grasp the fist with
  the other hand, and then
• press inward and upward toward the diaphragm
  with a quick motion.
• If unsuccessful, the victim can also press the
  upper abdomen over any
• firm surface such as the back of a chair, side
  of table, or porch railing.
• Several thrusts may be needed to clear the
  airway.

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Conclusion

• Where is the location for the Heimlich Maneuver?
• What to do if the choking victim is pregnant?
• What to do if the victims chest does not rise
  after the first ventilation?
• For an unconscious FBAO casualty, how do you
  reassess after the 30 compressions?
• Do you attempt to do a finger sweep if you see
  only half of a foreign body.