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cpr training

CPR Training

A theoretical approach to Flight Attendant Training carried out by major airlines and flight attendant training institutes

 

General Information

Normal Heart and Lung Anatomy and Function

The heart, a muscle about the size of a clenched fist, is located in the center of the chest behind the breastbone (sternum) and in front of the spine. It has four valves that regulate the flow of blood through four heart chambers and into the pulmonary artery and the aorta.

The function of the heart is to pump blood to the lungs, where it picks up oxygen, and then to the rest of the body. Oxygen is required by all cells of the body to carry out their normal functions. When the heart stops (cardiac arrest), oxygen is not circulated and the oxygen stored in the brain and other vital organs is depleted very fast.

The lungs are basically air sacs surrounded by capillaries. Nerve impulses from the brain to the chest muscles and the diaphragm cause a person to breathe.
 

As the air sacs fill with air, the blood around them picks up oxygen from the air and carries it back to the heart, which pumps it throughout the body. When air is inhaled, only 1/4 of the oxygen gets taken up by the blood; the rest it exhaled. This is why mouth-to-mouth breathing can provide the victim with enough oxygen (about 16% of the rescuers' breath) to help prevent biological death.

RESPIRATORY ARREST

Respiratory arrest occurs when breathing stops. The heart may continue to pump blood for several minutes, carrying existing stores of oxygen to the brain and the rest of the body. Rescue Breathing, a gradual procedure which provides artificial respiration, must be administered to keep the lungs supplied with oxygen. Prompt rescue efforts for the victim of respiratory arrest or choking (foreign body airway obstruction) can prevent death.

CARDIAC ARREST

Cardiac arrest occurs when the heart stops beating. Cardiopulmonary Resuscitation (CPR) should be administered immediately. CPR is a manual procedure which combines artificial respiration and artificial circulation to keep blood circulating and carrying oxygen to the brain, heart and other parts of the body.

CAUSES OF SUDDEN DEATH

Every flight attendant training program carried out by the airlines have the CPR training component as part of the mandatory training curriculum

Sudden death can happen to anyone at any age. Some common causes are:

  • Respiratory Distress
  • Heart Disease
  • Drug Overdose
  • Smoke Inhalation
  • Drowning
  • Electrocution
  • Trauma
  • Allergic Reaction
  • Choking
  • Suffocation
  • Inhalation/ingestion of a chemical

CLINICAL VS. BIOLOGICAL DEATH

Clinical death means that the heart beat and breathing have stopped. This is best thought of as near or apparent death and may be reversed. ("Sudden Death" is abrupt or unexpected clinical death.)

Biological death is permanent brain death due to lack of oxygen. This death is final.

Administering CPR during the first few minutes of clinical death may return the victim back to productive life. Without CPR, biological death will occur. When CPR is started within 4 minutes, the victim's chances of surviving are four times greater than if the victim did not receive CPR until after 4 minutes. Speed in starting CPR is key in saving lives.

RESCUE EQUIPMENT

CPR/Mask/Latex Gloves

When performing Rescue Breathing, CPR, or the Heimlich maneuver, latex gloves should always be worn and both CPR masks be readily available. Two CPR masks, along with two boxes of latex gloves (100 gloves per box), are provided on all aircraft. The masks will be contained in a plastic drawstring bag. The latex gloves and masks will be secured with the Velcro stripping securing the First Aid Kit. The masks and gloves will be considered part of the Cabin Equipment Checklist, but will not be considered a "NO GO" item.

If masks and gloves are not on an aircraft, fill out a Flight Attendant Report of Irregularity and obtain the missing item from a Provisioning Agent at Provisioning city.

INSTRUCTIONS FOR USE

Prior to using the CPR mask, remove the instruction ring from the Seal Easy Cushion Mask. Removing the instruction ring will allow you to make a better seal with the mask.

CPR MASKS CAN BE USED FOR ADULT, CHILD AND INFANT

Open the victim's airway and place the assembled mask over victim's nose and mouth. Align the opening of the CPR mask with the victim's open mouth. Apply pressure with your hand to create a complete seal. If a leak is detected, simply reposition your hand until you obtain a complete seal. When a victim has a beard or mustache, obtaining a good seal may be more difficult.

Portable Oxygen Bottle (POB)

Portable Oxygen Bottles (POBS) are available for use as needed. Two bottles are secured in the forward right overhead bin, one bottle is secured in mid-cabin right overhead bin, and one bottle is secured in the aft right overhead bin. Refer to the Flight Attendant Manual, Emergency Chapter for instruction on use of the POB.

  

Rescue Breathing

Adult/child/Infant

  • Check for consciousness-
  • Gently shake and shout, "Are you okay?"
  • Call for help
  • Flight Attendant bring POB, CPR masks, and gloves
  • Notify the Captain
  • If victim is in seat, place on floor, face up
  • Open airway
  • Head tilt/Chin lift (infant-neutral position)
  • Check for breathing (5 seconds)
  • Look, Listen and Feel
  • Give 2 breaths (infant-puffs), if no breathing,
  • Give breaths slowly and stop when you see chest starting to rise
  • Check for pulse/breathing (5 seconds)
  • Adult/Child - Carotid artery (neck)
  • Infant-Brachial artery (inside of upper arm)

HAS PULSE/NO BREATHING:

Begin Rescue Breathing

  • Adult - 1 breath every 5 seconds
  • 12 Cycles= 1 minute
  • Count 1 one thousand, 2 one thousand, 3 one thousand, 4 one thousand B-R-E-A-T-H-E
  • Child/infant- 1 breath every 3 seconds
  • 20 Cycles= 1 minute
  • Count 1 one thousand, 2 one thousand
  • B-R-E-A-T-H-E
  • Recheck pulse/breathing after 1 minute (5 seconds)

HAS PULSE/HAS BREATHING

Administer 02, monitor pulse/breathing each minute thereafter

CARDIOPULMONARY RESUSCITATION (CPR)

ONE RESCUER CPR

  • ADULT/CHILD/INFANT
  • Check for consciousness
  • Gently shake and shout, "Are you okay?"
  • Call for help
  • Flight Attendant bring POB, CPR masks, and gloves Notify the Captain
  • If victim is in seat, place on floor, face up
  • Open airway
  • Head tilt/chin lift (Infant-neutral position)
  • Check for breathing (5 seconds)
  • Look, Listen and Feel
  • Give 2 breaths (infant-puffs), if no breathing
  • Give breaths slowly and stop when you see chest starting to rise
  • Check for pulse/breathing (5 seconds)
  • Adult/child - Carotid artery (neck)
  • Infant - Brachial artery (inside of upper arm)

NO PULSE/NO BREATHING

  • Begin CPR (start with compressions)
  •   Adult- 15 compressions/2 breaths
  •   4 cycles= 1 minute
  •   count 1,2,3..15 B-R-E-A-T-H-E, B-R-E-A-T-H-E
  • Child/infant-5compressions/1 breath
  •   20 cycles= 1 minute
  •   count 1,2,3,4,5 B-R-E-A-T-H-E
  • Recheck pulse/breathing after 1 minute (5 seconds)
  • NO PULSE/NO BREATHING
  • Continue CPR (Start with compressions).
  • Recheck pulse/breathing every few minutes thereafter.

HAS PULSE/NO BREATHING

Administer Rescue Breathing and recheck pulse/breathing every minute

HAS PULSE/HAS BREATHING

Administer CPR, monitor pulse/breathing each minute thereafter

CPR CHANGE OVER PROCEDURE-ONE RESCUER CPR

  • Should the first Rescuer administering CPR become exhausted, a 2nd Rescuer can relieve them. The first Rescuer should complete at least 4 cycles of CPR before attempting to "change over"
  • The " change over( should occur after the completion of a compression/breath cycle.
  • The first Rescuer will start the cycle with compressions by stating, Change, 2, 3, 4, 5...1 5. Give 2 breaths. Recheck pulse/breathing.
  • The 2nd Rescuer should kneel next to the victim on the opposite side of the first Rescuer and position hands to start chest compressions.
  • If NO PULSE/NO BREATHING, the 2nd Rescuer should continue CPR starting with compressions.
  • If victim HAS PULSE/NO BREATHING, the 2nd Rescuer will continue first aid with Rescue Breathing.

HEIMLICH MANEUVER

CHOKING/OBSTRUCTED AIRWAY

Choking is caused by an object blocking the air passage and results in respiratory difficulty. The person is unable to breathe and his heart could stop if the object is not removed.

Common Causes:

  • Trying to swallow large pieces of food that are poorly chewed.
  • Drinking alcohol before or during eating.
  • Talking excitedly or laughing while eating, or eating too fast.
  • Walking, playing or running with objects in the mouth.

Types of Airway Obstructions

  • Partial airway obstruction - good air exchange
  • Partial airway obstruction - poor air exchange
  • Complete airway obstruction

Partial Airway Obstruction - Good Air Exchange

Symptoms:

  • Red face
  • Can cough forcefully
  • Restricted breathing/Wheezing between breaths
  • Possible difficulty in speaking
  • May progress to poor air exchange

First Aid:

  • Loosen collar
  • Try to communicate. Ask, "Can you speak?"
  • Stay with the person and encourage them to continue coughing.
  • Do nothing until it becomes a partial airway obstruction-poor air exchange or a complete airway obstruction.

Partial Airway Obstruction - Poor Air Exchange

Symptoms:

  • Weak, ineffective cough
  • A high-pitched noise while inhaling
  • Increased respiratory difficulty
  • Possibly hypnosis (turning blue)

First Aid:

  • Treat as complete airway obstruction
  • Administer Heimlich maneuver

Complete Airway Obstruction

Symptoms:

  • Bluish complexion
  • Cannot speak, breath or cough
  • Clutching at the neck (universal sign for choking: thumb and forefinger of one hand clutching neck)
  • Loss of breathing/possible unconsciousness

First Aid:

Administer Heimlich maneuver

Summaries

COMPLETE AIRWAY OBSTRUCTION-CONSCIOUS

Adult/Child

  • Complete airway obstruction is when a victim cannot speak, breathe, or cough.
  • Call for help
  • Flight Attendant bring POB, CPR masks and gloves
  • Notify Captain
  • Perform Heimlich maneuver - Abdominal thrusts
  • Stand or kneel behind adult or child and wrap your arms around their waist
  • Place thumb side of your fist on the middle of the breastbone (same area as for CPR chest compressions)
  • Grasp fist with other hand and give chest thrusts (quick backward thrusts) Give chest thrusts until:
  • Object is expelled
  • Victim becomes unconscious
  • You are relieved by qualified medical help

COMPLETE AIRWAY OBSTRUCTION-CONSCIOUS

Infant

  • Check for breathing difficulties
  • Call for help
  • Flight Attendant bring POB, CPR masks, and gloves
  • Notify Captain
  • Give 5 back blows
  • Head lower than the trunk
  • Give 5 chest thrusts
  • Head lower than the trunk
  • Repeat steps until:
  • Object is expelled
  • Victim becomes unconscious
  • You are relieved by qualified medical help

COMPLETE AIRWAY OBSTRUCTION - CONSCIOUS VICTIM BECOMES UNCONSCIOUS

Adult/Child

  • If giving abdominal or chest thrusts and person becomes unconscious, lower victim to floor supporting from behind (protect head), lay face up.
  • Call for help
  • Flight Attendant bring POB, CPR masks, and gloves
  • Notify Captain
  • Do a finger sweep - Hoping action of moving to floor may have dislodged the object. (Child - only if object is visible)
  • Open airway and give 2 breaths
  • Give 5 abdominal thrusts
  • Repeat steps until:
  • Object removed by finger sweep
  • Object is expelled
  • You are relieved by qualified medical help

NOTE: If victim is obese/pregnant, use chest thrusts instead of abdominal thrusts.
 

COMPLETE AIRWAY OBSTRUCTION-UNCONSCIOUS

Adult/Child

  • Check for consciousness
  • Gently shake and shout, "Are you okay?.
  • Call for help
  • Flight Attendant bring POB, CPR masks, and gloves
  • Notify Captain
  • If victim is in seat, place on floor, face up
  • Head tilt/chin lift
  • Check for breathing (5 seconds)
  • Look, Listen and Feel
  • Give 2 breaths, if no breathing
  • If after second breath chest does not rise, return head to neutral position. Retilt head - give 2 more breaths
  • If chest still does not rise...
  • Perform the Heimlich maneuver
  • 5 abdominal thrusts
  • Finger sweep (child-if object is visible)
  • If object is not retrieved:
  • Retilt - 2 breaths
  • 5 abdominal thrusts
  • Finger sweep (child-if object is visible)
  • Repeat until:
  • Object is removed by finger sweep
  • Object expelled
  • You are relieved by qualified medical help

COMPLETE AIRWAY OBSTRUCTION-UNCONSCIOUS

Infant

  • Check for consciousness
  • Gently shake and shout, "Are you okay?. Call for help
  • Flight Attendant bring POB, CPR masks, and gloves Notify Captain
  • Place infant on floor, face up
  • Open airway
  • Head tilt/chin lift (neutral position)
  • Check for breathing (5 seconds)
  • Look, Listen and Fee!
  • Give 2 breaths (puffs), if no breathing
  • If after second breath chest does not rise, return head to neutral position. Retilt head - give 2 more breaths (puffs) if chest still does not rise...
  • Perform Heimlich maneuver
  • 5 back blows (head lower than trunk)
  • 5 chest thrusts (head lower than trunk) Finger sweep if object is visible
  • If object is not retrieved:
  • Retilt breaths (puffs)
  • 5 back blows (head lower than trunk)
  • 5 chest thrusts (head lower than trunk) Finger sweep if object is visible
  • Repeat until:
  • Object is removed by finger sweep
  • Object is expelled
  • You are relieved by qualified medical help

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