Introduction

• CPR - Cardiopulmonary Resuscitation

• CPR is the heart of any first-aid program

• 4 R’s of CPR

  • Risk: factors in your life for developing heart disease or having a stroke

  • Recognize: how to recognize a developing emergency

  • React: what to do when you see a developing emergency

  • Resuscitate: how to do CPR, how to use an AED, and how to help someone who is choking

• Chain of Survival

  • Chain of Survival - the emergency response system needed to improve survival from emergencies

    • Early activation of emergency response

    • Performing early CPR

    • Providing early defibrillation with an AED

    • Advanced resuscitation (paramedics, not you)

    • Post-cardiac arrest care (paramedics, not you)

    • Recovery (paramedics, not you)

• The Heart and When it Breaks

  • What is a Heart Attack?

    • Oxygen is carried by blood through a network of blood vessels, nourishing the organs of the body → without circulating blood, and without oxygen, these organs start to die.

    • Other organs, like the heart, last longer without oxygen, but only minutes longer.

    • the heart needs oxygen delivered to its tissues.

    • The heart has its own blood vessels that supply its muscle → The blood vessels include a network of arteries and veins.

      • When one of these arteries becomes blocked (e.g. by plaque, which is junk like fat or cholesterol), the area of the heart muscle that the artery nourishes is suddenly deprived of circulation... no blood circulating,

      • no oxygen → the person experiences chest pain.

      • angina - if the narrowing or blockage opens up after a little bit, the pain goes away until next time

        • Many people take nitroglycerin when they get angina - helps open up circulation, relieves pain.

      • If the artery stays blocked, the pain remains and the area of affected heart muscle starts to die. This is what is

        called a heart attack (doctors call this a myocardial infarction.)

  • What is Cardiac Arrest

    • when a heart stops beating, it is no longer pumping blood to the rest of the body → the heart is in cardiac arrest

    • can occur when the heart muscle is suffering because it can’t get oxygen, it gets irritable

    • the hearts main muscles (ones around the ventricles) lose their rhythmic pumping actions and may start to fibrillate

    • this is a squirmy kind of muscle contraction that doesn’t pump blood - called ventricular fibrillation

    • most common kind of cardiac arrest and is also most treatable with defibrillation

  • What is CPR

    • emergency lifesaving procedure, performed when someone’s heart stops beating

    • often taught as Compression-Only CPR

  • What is Defibrillation

    • an automated external defibrillator (AED) is a small computerized device that delivers a special kind of show to the heart

    • when the heart is in ventricular fibrillation, the AED is trying to stop the squirmy action and kick start it

    • trying to rest the heart muscle and restore its smooth pumping action

    • when you deliver the shock and the heart stops fibrillation you have de-fibrillated it → called defibrillation

  • PAD: Public Access Defibrillation

    • look for new, small, easy to use defibrillators hanging on walls in lots of places, like fire extinguishers

    • Lifeguards, security guards, hotel desk clerks, servers are being trained to use them → for general public to use

  • What is a Stroke?

    • Arteries to the heart can get blocked by junk like fat or cholesterol, the area of the heart muscle that the artery nourishes suddenly receives no circulation(no blood circulation so no oxygen), and the person experiences a heart attack

    • same in the brain

    • an artery can become blocked by junk like fat or cholesterol

    • when the area of the brain nourished by that artery has no oxygen, gets damaged

    • as a result, a person may have slurred speech, vision problems, sudden weakness of face, arm, or leg

1. Risk Factors - Heart Disease and Stroke

• risk factor is something that increases the chance of heart disease or stroke

• if you have several relatives with heart trouble, you may be at risk

• this and getting older are two risk factors that you cannot control

• some risk factors you can control. like the following

  • diet

    1. Eating lots of vegetables and fruit.

    2. Choosing whole grain foods.

    3. Eating protein foods.

    4. Limiting highly processed foods.

    5. Making water your drink of choice

  • Smoking

    • major risk factor for heart disease and smoke

    • causes lung cancer and stinky breath

    • worst, most direct, most personal kind of air pollution

    • even if you don’t smoke, smokers around you are offering you second hand air pollution

  • High Blood Cholesterol

    • means lots of fat in the blood

    • this risk factor has a lot to do with what we eat - some cholesterol is produced by our body, while other fat comes from our food

    • too much cholesterol can cause heart disease or stroke

    • to help reduce your chances of having high cholesterol, eat more vegetables, fruits and grain products, limit the amount of fat in your diet and get plenty of physical exercise

  • High Blood Pressure

    • can damage heart and blood vessels, increasing chances of having a heart attack or stroke

    • means heart has to work harder to pump blood through those pipes (your blood vessels)

    • can run in families, but diet and stress may affect it too

    • blood pressure can be too high and you might not know it

    • may feel normal, but it is still dangerous

    • blood pressure should be checked regularly

  • Diabetes

    • affects the level of sugar in your blood

    • problem, but can be managed

    • people with diabetes will do better and have fewer complications like heart trouble or stroke if they eat a healthy diet, practice regular physical activity, and follow doctor’s instructions

  • Obesity

    • when a person is obese, their heart has to pump harder all the time to move blood around

  • Lack of Exercise

    • Lack of exercise is another risk factor

    • heart is a muscular organ

    • works better if you keep fit and active

  • Excessive Stress

    • over a long period of time can affect your body - heart problems can be one of the results

  • difference between why your heart works hard - obesity or athletics

    • athletic person may gain weight, but those muscles help the rest of the body’s circulation and functioning, and their muscles that they build are generally healthy

    • when someone gains weight from lack of exercise and poor diet choices, heart has to work harder, doesn’t get the help it needs to manager the circulation required to deliver oxygen to the rest of the body → over time, may fail

  • emergencies needing CPR can happen for a variety of reasons - people of all ages drown, get electrocuted, or bleed from injuries

  • with your CPR training, you will be able to assess if a person with one of these problems needs CPR

II. Recognize

• early Recognition means recognizing someone may be having a heart attack, stroke, or a cardiac arrest

• means understanding the signs that someone is in trouble and being prepared to act

• Signs of a Heart Attack - Look for the 5 ‘Ps’

  • Pain: pain or discomfort, heaviness, tightness, squeezing, burning or pressure in the chest that may spread to the neck, jaw, shoulders, arms, or back.

  • Pale: skin may appear pale and is often sweaty.

  • Puffing: shortness of breath or trouble breathing.

  • Pooped: feeling very tired and/or light-headed.

  • Puking: feeling sick to the stomach or actually vomiting.

  • a person may ex[erience some or all of these - signs can vary and may be different from person to person

  • if the person looks sick and you recognize any or all of the symptops, call 911, or the local emergency number immediately

• Signs of a stroke

  • if you recognizee what might be a stroke: sudden numbness, tingling or weakness of the face, an arm or leg, or speech problems, time is critical

  • new treatments for strokes (eg clotbusters) must be given within a few hours to work

  • call 911 for an ambulance that will take you to the right hospital - do NOT drive yourself

  • FACE acronym -

    • Face - is it drooping?

    • Arms - can you raise both?

    • Speech - is it slurred or jumbled?

    • Time - to call 911 ASAP

• Denial and Fear

  • People often have trouble accepting that they might be experiencing a heart attack or stroke. You might see reactions like:

    • Denial: “I’m too young”; “I’m fine”; “It will go away with a little rest”; the thought,“It can’t be happening to me”

    • Fear: the person may be terrified and afraid to go to the hospital.

  • Be firm. If the signs are there suggesting a heart attack or stroke, the person needs to be taken by ambulance to a hospital quickly.

  • important that you Recognize that what is happening in front of you may be a real

    emergency

• Signs of a Possible Cardiac Arrest

  • If the person is unconscious, unresponsive, and not breathing, assume they are in cardiac arrest

  • if the person still has occasional gasps, treat that as if there is no breathing.

III. React

• What if it Might be a Heart Attack or Stroke?

  • Check for hazards — make sure there is nothing around that can hurt you (e.g. electric wires, traffic, fire, glass, gasoline, hostile animals or people).

  • Holler for help if you are alone. Call 911 for an ambulance.

    → If someone hears you holler, get that person to call 911 and send someone for an AED. Ask someone to get the first-aid kit if you are at school, at work, or at home

  • Helping in an emergency may mean getting physically close to someone. This can be worrisome, but you can still help.

  • Call out to the person to assess responsiveness, call for help, call 911, and send someone for an AED.

  • Before helping a conscious person, you must ask for and get permission to help. Explain that you have had CPR training and ask, “May I help you?”

  • If the person is unconscious or is a young child who is alone, go ahead and help. The law assumes the person wants help - good Samaritan law

  • Provide care just as you would want someone to care for you.

  • If a person has chest pain or discomfort, be aware that many people take nitroglycerin when they get angina. It helps to open up the circulation and relieves the pain.

  • Ask the person if they take nitroglycerin. If yes, then help them by getting it and suggest they take their normal dosage.

  • If a person with chest pain, which might be a heart problem, has Aspirin tablets nearby, suggest chewing or swallowing 2 low-dose (81 mg) pills, or just a regular Aspirin while waiting for the ambulance. If the person already took Aspirin or has been told not to take it in the past, wait for the paramedics instead.

  • If you think the person may be suffering a stroke, no Aspirin.

  • While waiting for the ambulance, there are several things you can do to make a person more comfortable:

    Position the person so they are most comfortable. Usually sitting or lying down will be best but the person will usually tell you what works best;

    Loosen tight clothing at the neck or waist;

    Talk to the person. Let them know help is on the way. Remember, as much as possible, stay with the person.

    If the person becomes unconscious, they will need your help even more

• What if the Person is in Cardiac Arrest?

  • Holler for help, call 911, send someone for an AED, and start CPR

• What to do Until the Ambulance Gets There

  • Paramedics are trying to find you. Be visible with information. Get out front. Wave and/or flash a light when you see them. What information should you give them about the person?

    • Medications: Gather any medications and put them in a bag if you can.

    • Allergies: Are there any allergies? Ask. Write them down. People who have been ill often wear a Medical Alert bracelet or necklace. It will often have information about the person’s allergies, past medical history, and medications.

• Hazards and Holler, a little PLT (position, loosen, talk), and be visible for the paramedics.

IV. Resuscitate

• Resuscitate - CPR

  • During the pandemic, the Heart and Stroke Foundation of Canada released recommendations to reduce the risk of virus transmission for public responders while performing CPR or using an AED during a cardiac arrest.

    • include recommending the rescuer place a cloth, towel or clothing over the person’s nose and mouth when performing CPR and using an AED on them to help prevent any potential spread of the virus through contaminated air or saliva.

  • 1 rescuer CPR - Adult

    • Remember to say to yourself: “I’ve been trained. I can do this.”

    1. Check for hazards - make sure there’s nothing that can hurt you (electric wires, traffic, glass, gasoline, hostile animals, people)

    2. Assess responsiveness and breathing - tap shoulders, call out to person, look at face and chest for signs of breathing

       note : you are checking an unconscious person for breathing and suddenly the person takes a breath or two - a sort of gasp/sigh - sometimes this happens, especially if a person’s heart has just stopped, but won’t look like

       normal breathing - the person is in cardiac arrest

    3. Call 911, local emergency number (or have someone call for you if the person isn’t moving, isn’t responsive, and isn’t breathing (or there is only an occasional gasp of air)) also, send someone for an AED.

    4. Landmark for chest compressions - Make sure the person is lying on their back on a firm, flat surface.

       Compress the lower half of the person’s breastbone in the centre of the chest, between the nipples.

       Place the heel of hand on the breastbone in the centre of the chest between the nipples. Place the heel of second hand on top of the first so that hands are overlapping and parallel.

       Interlock fingers off the chest, position shoulders directly above the heels of hands, keep arms straight, elbows locked in position

    5. Give chest compressions - Compress straight down on the breastbone. Compress at 5 cm (2 inches) at a rate of 100-120 compressions per minute.

       Push hard, push fast.

       can help to count aloud (1 and 2 and 3 and 4 and 5 and 1 etc.).

       Without losing contact with the chest, allow the chest to return to its normal position between compressions. Find landmark with each new cycle of compressions.

       note: you need to push hard and fast - chest compressions squeeze the heart and all the big blood vessels in the chest (how CPR circulates blood). it only provides 30% of normal circulations, but early CPR is the most important thing to save someone whose heart has stopped

    6. Continue CPR even when someone brings an AED. Stop when the AED is ready to use or when you see signs of life, breathing, movement, or

       Emergency Medical Services (EMS) personnel take over

  • note : if you get tired while doing CPR and there are others around who know

    how to do it, ask for someone to take over.

• resuscitate - defibrillation

  • ventricular fibrillation is when the heart’s main muscles (ones around the ventricles) lose their rhythmic pumping action and may start to fibrillate (squirmy kind of muscle contraction that does not pump blood). called ventricle fibrillation because it is a ventricle that’s fibrillating. by reacting quickly, it is possible to be fixed

  • combination of early CPR and early defibrillation

  • what is an AED

    • device that automatically analyzes heart rhythm and if necessary gives an electrical shock to return a heart to its normal rhythm

    • sticky pads are placed on the chest (right pectoral, above left rib) to allow the AED computer chip to see if the heart’s electrical rhythm is in ventricular fibrillation

    • if it is, computer tells you to stand back, then sends a type of electrical shock through the pads to the heart, tying to reset the heart

    • if the person’s heart starts to beat normally (no longer fibrillating), you have defibrillated someone and saved a life

  • how do I use an AED

    • say “I’ve been trained. I can do this”

    1. call 911 or local emergency number or have someone call for you if the person is not moving, responsive, and breathing. send someone for an AED

    2. Start CPR

    3. if there is an AED

       • turn it on and follow the voice prompts

       • continue CPR while setting up the AED

       • Expose the chest, dry skin, and remove excess hair or medical patches from the person’s chest prior to apply the pads

       • apply the electrode pads to the person’s bare chest

       • stop CPR when the AED tells you, don’t let anyone touch the person. if the AED prompts you to press the shock button, do it (some automatically shock but most will tell you to press a button to shock the person

       • start CPR again when the AED tells you, follow the voice prompts.follow voice prompts. if you see signs of life, breathing, and/or movement, place person in the recovery position

• resuscitate - choking

  • when a person chokes on food/small object that is lodged in throat, air cannot reach lungs

  • the person may die if immediate help is not given

  • recognize choking person by the universal distress sign of choking: hands to throat

  • when a person chokes, the throat or airway can be mildly or severely blocked

    • mildly blocked airway: allows some air to get in - if a choking person can still speak, cough, or breath the blockage is not complete. encourage the person to cough to try to clear the obstruction themselves

    • severely blocked airway: no air getting in - if that person can’t speak, cough, or breath, you have React quickly. this is a serious emergency

  • adult conscious

    1. assess the airway blockage - say to yourself “i’ve been trained. i can do this” and ask “are you choking? can I help you?”

    2. holler for help - reassure the person, explain what you’re going to do, then call 911 or local emergency number or have someone call for you if that person is having difficulty breathing

    3. give abdominal thrusts(Obstructed Airway Manoeuvre) if the choking person cannot speak, cough, or breathe. stand behind person and wrap arms around their waist. Make a fist with one hand and place the thumb side of that fist in the belly button area, slightly above the belly button and well below where the ribs meet. Grasp fist with other hand and press inward and upward with a sudden forceful thrust’

    4. repeat abdominal thrusts - rapid sequence until the obstruction is removed or the person becomes unconscious. When the obstruction is removed, the person should see a doctor to rule out complications from the obstruction or the abdominal thrusts

  • choking person who becomes unconcious

    • carefully support the person to the ground, and make sure to do

      all the steps linked to CPR

  • recovery position

    • For unconscious person who is breathing: place them into

      the recovery position if injuries permit

    • the person may gag or vomit, and the recovery position will help keep the airway open and allow fluids to drain from the mouth

    • Monitor their breathing carefully. The person may stop breathing again. Stay with the person until medical help takes over

• resuscitate - opioid overdose response training

  • how to help a person in a suspected opioid overdose - any collapsed person with no signs of life needs CPR - still follow the recognize, react, resuscitate sequences regardless of the cause

  • for a suspected overdose, aside from CPR you can also provide Naloxone (medication that can temporarily reverse the effects of opioids

  • what are opioids?

    • drugs prescribed to treat pain

    • may cause the person to feel “high” which has led to problematic use of these drugs

    • you may have heard of: Codeine, Fentanyl, Heroin, Hydrocodone, Hydromorphone, Morphine, Methadone, Oxycodone, Percocet, and Tylenol with Codeine

    • may be taken by injecting with a needle, by mouth (pill or liquid form), through a skin patch, by smoking, or by snorting in powder form

    • strengh of illegally obtained drugs may vary making them particularly dangerous

  • what is fentanyl?

    • powerful opioid prescribed to treat severe pain

    • when prescribed/given @ the right dose, it’s a safe drug

    • can be found in illegally obtained drugs and is often mixed with other drugs

    • can be in any form of a pill or compound

    • sometimes it’s no pill, just something in which fentanyl powder has been mixed into

    • any powder or pills laced with fentanyl or some of the other new opioids may look like any other pill or powder, but their effect is often immediate collapse

  • how do opioid overdoses happen

    • A person who is prescribed an opioid medication for severe pain may accidentally take too many pills, or

      may become confused and take the wrong pills.

    • A person may unknowingly take opioids that are in a drug they are using recreationally.

    • A person may try opioids or even unknown pills to get high and take too many pills.

    • A child may find some in a cupboard and think they are candy

    • some people keep taking opioids maybe as pills or in a stronger form - injecting them with a syringe

    • when a person keeps using opioids, the body may get used to them and develop a strong physical need for more opioids - they can develop an addiction

    • anyone can develop an addiction or experience an opioid overdose, and many overdoses are unintentional - can be due to experimentation with known or unknown substances and frequent or infrequent use

    • opioid use, problematic use, and addiction are not limited by sex, gender, or age, and can affect anyone

    • As you React in an emergency situation and start Resuscitation, you will look for clues about why the person is unconscious. (ex: seeing obvious opioid drugs nearby, opioid overdose history, witness who saw

      the overdose, etc.) These clues can guide your treatment to include Naloxone.

    • can occur in other situations too: be missing pills from the pill bottle of

      an older, confused, or forgetful person who has taken too many, or suspicion that a child ate pills that looked like candies. If there is good evidence, these people may benefit from Naloxone as well.

    • what happens in an opioid overdose?

      • opioid drugs affect how your brain controls your breathing

      • in an opioid overdose, a person may become sleepy, dopey, fall unconscious, and may stop breathing, and can even die from an ovedose