CHALLENGE

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CHALLENGE

• CPR/AED FOR THE Lay Responder

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CHALLENGES

• Challenges provide an opportunity for those with
  current or expired certifications to recertify or
  to extend the length of their certifications
  without taking a complete course. Participants
  must pass the written test with a score of 80 or
  higher and be able to successfully demonstrate
  the appropriate skills to the instructor without
  prior demonstration from the instructor.
• This PowerPoint presentation is designed to
  assist in preparation of a successful Challenge.
  The format is very brief because we are making
  this available to lifeguards who are Challenging
  in order to extend their Lifeguard Training
  Certification. Our assumption is that you are
  using this material as a review and should not
  require the specifics for each topic. If you
  have questions, refer to your text or question
  the instructor before the Challenge begins.

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CHALLENGE COURSE OUTLINE

• Written Exam 30-55 Questions. 80 .
• Skills.
• Removing Gloves.
• Primary Survey.
• Rescue Breathing (Adult, Child, Infant)
• Conscious Choking (Adult, Child)
• Unconscious Choking (Adult, Child, Infant)
• Adult CPR/AED

• Child CPR/AED
• Infant CPR
• Standard First Aid

Student CPR Training Mask Must Be Used During
Rescue Breathing.
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Concerns for Lay Responders

• Liability
• Unsure what to do
• Disease Transmission
• Afraid of causing more pain/injury
• Scene not safe
• Other people watching
• Not knowing its an emergency

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OBTAIN CONSENT

• Tell the victim your name your level of
  training.
• Can I help?
• What may be wrong -- what I can do to help.

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VICTIM DOES NOT GIVE CONSENT?

• DO NOT GIVE CARE.
• Call 9-1-1.
• Victim is unconscious, confused, seriously ill,
  under age -- not able to give consent --
  consent is implied.

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STANDARD PRECAUTIONS

• Avoid contact
• Blood.
• Other body fluids.
• Protective equipment
• Disposable gloves.
• Breathing barriers.
• Footwear.
• Wash hands with soap and water.

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PREVENTIVE STEPS WHEN BLOOD SPILL OCCURS

• Clean up immediately.
• Use protective equipment.
• Wipe up the spill.
• Flood area for 20 minutes -- ¼ cup bleach/1
  gallon water.
• Dispose of material properly.

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EMERGENCY ACTION STEPS
CHECK CALL CARE
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CHECK THE SCENE

• Scene is safe ?
• What happened ?
• Victims ?
• Bystanders ?
• Anyone providing care ?
• 9-1-1 ?
• CHECK THE VICTIM

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MOVING A VICTIM

• MOVES
• Clothing Drag.
• Two-Person Seat Carry.
• Walking Assist.
• Blanket Drag.
• Foot Drag.

• MOVE ONLY IF
• Scene becoming unsafe.
• To reach another victim with more serious injury.
• To provide proper care.

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CHECK FOR SIGNS OF LIFEA AIRWAYB
BREATHINGC CIRCULATION
13
important reminder
TO OPEN THE AIRWAY DO A HEAD TILT AND CHIN
LIFT NO BREATHING? GIVE 2 BREATHS FOR 1 SECOND
EACH
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ADULT 12 YEARS AND UPIf breaths went in, look
for severe bleeding as you place your hands to
start chest compressions.CHILD 1 YEAR TO 12If
breaths go in, check for pulse, groove at side of
the neck for 10 seconds INFANT NEWBORN TO 1If
breaths go in, check for pulse, on inside of arm
between elbow and shoulder for 10 secnds
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CALL 9-1-1 ADULT FIRST IF THEY ARE
UNCONSCIOUS CHILD OR INFANT - AFTER 2 MINUTES OF
CARE IF ALONE AND NO KNOWN HEART CONDITION OR DID
NOT WITNESS COLLAPSE
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CARE FOR THE CONDITIONS YOU
FINDADULT No breathing 2 breaths and begin CPR
30 COMPRESSIONS/2 BREATHSCHILD/INFANT No
breathing has pulse Rescue Breathing 1breath/3
seconds 40 breaths /2 minutes then recheck
pulseNo breathing/no pulse begin CPR 30
COMRESSIONS/2 BREATHS 2 minutes5 cycles of 30/2
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AIRWAY OBSTRUCTION

• VICTIM CLUTCHING THROAT WITH BOTH HANDS USUALLY
  CHOKING.
• UNCONSCIOUS TONGUE OFTEN BLOCKS AIRWAY.

• PARTIAL OBSTRUCTION WHEEZING SOUDS STILL
  MOVING AIR.
• COMPLETE CANNOT SPEAK BREATHE COUGH.

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BREATHING EMERGENCIES
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SIGNS OF RESPIRATORY DISTRESS

• SKIN
• FLUSHED
• PALE
• ASHEN
• BLUISH
• GASPING
• NOISES
• WHEEZING
• GARGLING
• HIGH-PITCHED

• BREATHING
• SLOW OR RAPID
• SHORTNESS OF BREATH
• DIZZINESS - LIGHTHEADED
• TINGLING
• HANDS FEET
• CHEST PAIN

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important reminder
CHOKING MOST COMMON CAUSE OF RESPIRATORY
EMERGENCY.
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• SKILL CHECK CONSCIOUS CHOKING ADULT/CHILD
• SURVEY SCENE CHECK VICTIM.
• ASK VICTIM ARE YOU CHOKING?
• GET CONSENT.
• VICTIM CANNOT COUGH SPEAK BREATHE.
• 9-1-1.
• BEHIND VICTIM ONE FOOT BETWEEN LEGS KEEP
  YOUR HEAD TO SIDE.
• CHILD? STAND OR KNEEL.
• PLACE FIST AGAINST ABDOMEN.
• GRAB FIST GIVE QUICK, UPWRD THRUSTS.
• CONTINUE OBJECT FORCED OUT VICTIM BEGINS TO
  BREATHE OR COUGH FORCEFULLY VICTIM UNCONSCIOUS.
  

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important reminder
RESPIRATORY DISTRESS
RESPIRATORY ARREST
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• SKILL CHECK RESCUE BREATHING -- ADULT
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• NOT BREATHING MASK -- GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK SIGNS OF CIRCULATION
  REMOVE MASK FEEL FOR PULSE LOOK-LISTEN-FEEL
  FOR SIGNS OF CIRCULATION NO MORE THAN 10
  SECONDS.
• LOOK FOR SEVERE BLEEDING.
• YOU FIND SIGNS OF CIRCULATION GIVE 1 BREATH
  PER 5 SECONDS.

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• SKILL CHECK RESCUE BREATHING -- ADULT
• 1 MINUTE OF RESCUE BREATHING (ABOUT 12 BREATHS)
  RECHECK SIGNS OF CIRCULATION BREATHING lt10
  SECONDS.
• STILL NOT BREATHING CONTINUE RESCUE BREATHING.
  STOP AND CHECK EACH MINUTE.
• NO SIGNS OF CIRCULATION GIVE CPR.

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• SKILL CHECK RESCUE BREATHING -- CHILD
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• NOT BREATHING MASK -- GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK SIGNS OF CIRCULATION
  REMOVE MASK FEEL FOR PULSE LOOK-LISTEN-FEEL
  FOR SIGNS OF CIRCULATION NO MORE THAN 10
  SECONDS.
• LOOK FOR SEVERE BLEEDING.
• YOU FIND SIGNS OF CIRCULATION GIVE 1 BREATH
  PER 3 SECONDS.

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• IF BREATHS DO NOT GO IN
• Reposition the airway and try 2 breaths again
• STILL NOT GOING IN?
• Give up to 30 chest compressions, look in mouth,
  sweep if you see something and try 2 more breaths
• Continue until breaths go in, then repeate youre
  A-B-C and care for conditions found

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• SKILL CHECK RESCUE BREATHING CHILD/INFANT
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 10 SECONDS.
• NOT BREATHING GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK SIGNS OF CIRCULATION -
  FEEL FOR PULSE (BRACHIAL) LOOK-LISTEN-FEEL FOR
  SIGNS OF CIRCULATION NO MORE THAN 10 SECONDS.
• LOOK FOR SEVERE BLEEDING.
• YOU FIND SIGNS OF CIRCULATION GIVE 1 BREATH
  PER 3 SECONDS.

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• SKILL CHECK RESCUE BREATHING -- INFANT
• 2 MINUTE OF RESCUE BREATHING (ABOUT 40 BREATHS)
  RECHECK SIGNS OF CIRCULATION BREATHING.
• STILL NOT BREATHING CONTINUE RESCUE BREATHING.
  STOP AND CHECK EACH MINUTE.
• NO SIGNS OF CIRCULATION GIVE CPR.

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• SKILL CHECK UNCONSCIOUS CHOKING
  ADULT/CHILD/INFANT
• SURVEY THE SCENE CHECK VICTIM
  CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT, CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• NOT BREATHING GIVE 2 RESCUE BREATHS.
• BREATHS DO NOT GO IN REPOSITION GIVE 2
  BREATHS AGAIN.
• BREATHS DO NOT GO IN 30 CHEST COMPRESSIONS
• FOREIGN BODY CHECK (FINGER SWEEP IF VISIBLE AND
  SURE YOU CAN REACH).
• USE MASK GIVE 2 RESCUE BREATHS.
• BREATHS STILL DO NOT GO IN REPEAT SEQUENCE OF
  5 ABDOMINAL THRUSTS FOREIGN BODY CHECK
  REATTEMPT RESCUE BREATHS.

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important reminder
HEART ATTACK
CARDIAC ARREST
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important reminder
SIGNS OF A HEART ATTACK
CHEST PAIN (MORE THAN 3-5 MINUTES)
PAIN/DISCOMFORT SPREADING TO SHOULDER, JAW, ARM,
BACK NAUSEA BREATHING DIFFICULTY SWEATING
CHANGE IN SKIN APPEARANCE DIZZINESS OR
UNCONSCIOUSNESS.
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COMMON CAUSES FOR THE HEART TO FAIL
ADULT CARDIO VASCULAR DISEASE
CHILD/INFANT-BREATHING EMERGENCY,BLOW TO
CHEST,TRAUMA
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C P R

• COMBINES RESCUE BREATHING CHEST COMPRESSIONS.
• CIRCULATES OXYGEN RICH BLOOD TO VITAL ORGANS
• MUST NOT BE DELAYED
• MORE SUCCESSFUL WHEN AN AED IS USED AS WELL
• SAVES LIVES!!!!!!!

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CARDIAC CHAIN OF SURVIVAL
EARLY RECOGNITION
EARLY CPR
EARLY DEFIBRILLATION
EARLY ADVANCED LIFE SUPPORT
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• SKILL CHECK CPR -- ADULT
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 10 SECONDS.
• NOT BREATHING MASK -- GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK FOR SEVERE BLEEDING.
• BEGIN CPR LOCATE HAND POSITION GIVE 30 CHEST
  COMPRESSIONS (COMPRESS ABOUT 2 INCHES) FOLLOWED
  BY 2 BREATHS.
• COTINUE UNTIL YOU SEE AN OBVIOUS SIGN OF LIFE,
  AN AED IS READY TO USE, ADVANCED CARE TAKES
  OVER,TOO EXHAULSTED TO CONTINUE

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• SKILL CHECK CPR -- ADULT
• USE MASK GIVE 2 BREATHS.
• REPEAT AT LEAST 3 MORE CYCLES OF 15/2 REMOVE
  MASK RECHECK SIGNS OF CIRCULATION BREATHING
  FOR NO MORE THAN 10 SECONDS.
• STILL NO SIGNS CONTINUE CYCLES OF 15/2
  RECHECK SIGNS EVERY FEW MINUTES.

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• SKILL CHECK CPR -- CHILD
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• NOT BREATHING MASK -- GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK SIGNS OF CIRCULATION
  REMOVE MASK FEEL FOR PULSE LOOK-LISTEN-FEEL
  FOR SIGNS OF CIRCULATION NO MORE THAN 10
  SECONDS.
• LOOK FOR SEVERE BLEEDING.
• NO SIGNS OF CIRCULATION LOCATE HAND POSITION
  GIVE 5 CHEST COMPRESSIONS USING ONE HAND
  (COMPRESS ABOUT 1½ INCHES).

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• SKILL CHECK CPR -- CHILD
• USE MASK GIVE 1 BREATH.
• REPEAT AT LEAST 11 MORE CYCLES OF 5/1 REMOVE
  MASK RECHECK SIGNS OF CIRCULATION BREATHING
  FOR NO MORE THAN 10 SECONDS.
• STILL NO SIGNS CONTINUE CYCLES OF 5/1
  RECHECK SIGNS EVERY FEW MINUTES.

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• SKILL CHECK CPR -- INFANT
• SURVEY SCENE CHECK VICTIM CONSCIOUS?
• GENTLY TAP SHOUT RESPONDS? NO 9-1-1!
• HEAD TILT CHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• NOT BREATHING MASK -- GIVE 2 RESCUE BREATHS.
• BREATHS GO IN CHECK SIGNS OF CIRCULATION
  REMOVE MASK FEEL FOR PULSE (USE BRACHIAL PULSE)
  LOOK-LISTEN-FEEL FOR SIGNS OF CIRCULATION NO
  MORE THAN 10 SECONDS.
• LOOK FOR SEVERE BLEEDING.
• NO SIGNS OF CIRCULATION LOCATE FINGER POSITION.

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• SKILL CHECK CPR -- INFANT
• GIVE 5 CHEST COMPRESSIONS IN LESS THEN 3 SECONDS
  USING TWO FINGERS (OTHER HAND IS ON INFANTS
  FOREHEAD) (COMPRESS ABOUT ½ TO 1 INCH).
• USE MASK GIVE 1 BREATH.
• REPEAT AT LEAST 19 MORE CYCLES OF 5/1 REMOVE
  MASK RECHECK SIGNS OF CIRCULATION BREATHING
  FOR NO MORE THAN 10 SECONDS.
• STILL NO SIGNS CONTINUE CYCLES OF 5/1
  RECHECK SIGNS EVERY FEW MINUTES.

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• SKILL CHECK TWO-RESCUER CPR -- ADULT
• R-1 SURVEY SCENE CHECK VICTIM CONSCIOUS?
• R-1 TAP SHOUT RESPONDS? NO 9-1-1!
• R-1 HEAD TILTCHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• R-1 NOT BREATHING MASK GIVE 2 RESCUE
  BREATHS.
• R-1 BREATHS GO IN CHECK SIGNS OF CIRCULATION
  FOR NO MORE THAN 10 SECONDS.
• R-2 NO SIGNS OF CIRCULATION LOCATE HAND
  POSITION GIVE 15 COMPRESSIONS AFTER R-1 SAYS
  VICTIM HAS NO SIGNS OF CIRCULATION. BEGIN CPR.
• R-1 CHECKS IF COMPRESSIONS ARE EFFECTIVE
  FEELING CAROTID ARTERY.

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BAG-VALVE-MASK (BVM)

• Used to move more O2.
• Use for respiratory distress.
• Self-inflating bag one-way valve mask.

• Protects against disease.
• Increases O2 levels in blood.
• Highly effective by 2 rescuers tight seal
  effective ventilations.

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• SKILL CHECK BVM RESUCITATOR - TWO-RESCUERS
• R-1 SURVEY SCENE CHECK VICTIM CONSCIOUS?
• R-1 TAP SHOUT RESPONDS? NO 9-1-1!
• R-1 HEAD TILTCHIN LIFT OPEN AIRWAY
  LOOK-LISTEN-FEEL 5 SECONDS.
• R-1 NOT BREATHING MASK GIVES 2 RESCUE
  BREATHS.
• R-1 BREATHS GO IN CHECK SIGNS OF CIRCULATION
  FOR NO MORE THAN 10 SECONDS PATIENT HAS SIGNS
  OF CIRCULATION.
• R-1 ASSEMBLES BVM POSITIONS MASK OF BVM.
• R-2 SEALS MASK OPENS AIRWAY.

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• SKILL CHECK BVM RESUCITATOR - TWO-RESCUERS
• R-1 BEGINS VENTILATIONS BY SQUEEZING BAG JUST
  ENOUGH FOR CHEST TO CLEARLY RISE.
• R-1 1 VENTILATION EVERY 5 SECONDS.
• R-2 COUNTS OUT LOUD ONE-ONE THOUSAND,
  TWO-ONE THOUSAND
• R-1 CHECKS SIGNS OF CIRCULATION BREATHING
  AFTER 12 BREATHS NO MORE THAN 10 SECONDS.
• VICTIM HAS SIGNS OF CIRCULATION R-1 REPLACES
  BVM R-2 SEALS AND OPENS AIRWAY R-1 CONTINUES
  TO VENTILATES.
• VICTIM HAS NO SIGNS OF CIRCULATION RESCUERS
  BEGIN 2 PERSON CPR.

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• SKILL CHECK TWO-RESCUER CPR -- ADULT
• R-1 USE MASK 2 RESCUE BREATHS.
• R-1 R-2 REPEAT 3 MORE CYCLES OF 15/2.
• R-1 REMOVES MASK RECHECKS CIRCULATION
  BREATHING NO MORE THAN 10 SECONDS.
• NO SIGNS OF CIRCULATION R-1 R-2 CONTINUE
  15/2 CYCLES RECHECK EVERY FEW MINUTES.
• TO CHANGE POSITION
• R-2 CALLS CHANGE AT END OF 15.
• R-1 GIVES 2 BREATHS.
• R-2 MOVES TO HEAD CHECKS FOR CIRCULATION
  BREATHING NO MORE THAN 10 SECONDS.

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• SKILL CHECK TWO-RESCUER CPR -- ADULT
• R-1 MOVES TO CHEST FINDS HAND POSITION.
• R-2 NO PULSE, BEGIN CPR.
• R-1 PROVIDES 15 COMPRESSIONS.
• R-2 PROVIDES 2 BREATHS.
• R-1 R-2 CONTINUE 15/2 CYCLES.