Emergency care 10th edition

United States Coast Guard
EMT Refresher Training
2005 American Heart Association CPR Updates

Explanations by Lesson
Lessons 4 and 5 – Airway
† The jaw thrust maneuver is recommended in spine injured patients. If you are unable to ventilate the patient using the jaw thrust maneuver the head tilt-chin lift is then used. † Hyperventilation/hyperoxygenation of patients in cardiac arrest performed before and after procedures such as suctioning should not interfere with chest compressions as this will decrease perfusion from CPR. † In artificial ventilation, breaths are given for one second at the rate of 10-12 per minute. The rate is 8-10 per minute if an advanced airway is in place. † Ventilations should be performed causing noticeable chest rise. The AHA no longer provides a recommended volume in mls. † Partial foreign body airway obstruction (FBAO) is now referred to as “mild” and complete FBAO is now referred to as “severe.” † Unresponsive patients with suspected FBAO receive chest compressions (rather than abdominal thrusts) at the normal CPR rate and ratio (30:2 and 100/minute). † Finger sweeps are no longer provided on any patient unless an foreign object can
Lesson 9 – Pharmacology Review
† The AHA has recommended that nitroglycerin not be given to patients with systolic blood pressures below 90 mmHg. Since nitroglycerin can cause a drop in blood pressure, many EMS system protocols actually prohibit nitroglycerin unless the patient has a blood pressure greater than 100-120 mmHg. Always follow your local protocols. † Aspirin continues to be recommended by the AHA for patients with chest pain of suspected cardiac origin. Follow your local protocols.
Lesson 11 – Cardiac Emergencies and Defibrillation
† Acute Coronary Syndrome (ACS) is a term used by the AHA to describe conditions causing chest pain and myocardial infarction (heart attack). † The AHA has recommended that nitroglycerin not be given to patients with systolic blood pressures below 90 mmHg. Since nitroglycerin can cause a drop in blood pressure, many EMS system protocols actually prohibit nitroglycerin unless the patient has a blood pressure greater than 100-120 mmHg. Always follow your local protocols. † Nitroglycerin should not be given to patients who have taken any medication for erectile dysfunction. In most cases at least 48-72 hours should have passed since the patient last took one of these medications. Follow your local protocols. † Pulse checks are for a maximum of 10 seconds. † CPR compressions should be performed at a rate of 100/minute and of sufficient depth (hard and fast). Switch rescuers when performing two-rescuer CPR to prevent fatigue. † It is critical to limit interruptions in CPR. When CPR is stopped perfusion stops. † There are significant changes to the defibrillation sequence including: Increasing use of biphasic defibrillators has caused the AHA not to issue specific recommendations on the energy level per shock. Shocks should be delivered at the energy level determined by the device. This applies to biphasic units only. o If the patient has been down for several minutes you will perform CPR for 2 minutes (5 cycles of 30:2) rather than defibrillating first. You will still defibrillate first (when an AED is immediately available) if the arrest is witnessed, if CPR is in progress when you arrive, or if the down time was less than a few minutes. o Shocks are given one at a time (instead of sets of three shocks) o After delivery of a shock or a “no shock advised” message, CPR will be performed for two minutes (5 cycles of 30:2) before checking a pulse.
Lesson 12 – Altered Mental Status
† Some hospitals have been granted designation as a “stroke center.” Patients with suspected strokes are transported to these facilities when possible and according to local protocols.
Lesson 17 – Obstetrics and Gynecology
† You will note that newborns are now called “newly born.” This term refers to
Lesson 24 – Pediatric Emergencies
† The AHA now defines child as 1 year of age to puberty. Puberty is often reached at about 12-14 years of age and is determined by the presence of facial hair, axillary hair, breast development, etc. † Back blows are now referred to as back slaps. † Do not perform blind finger sweeps on any patient unless an object is seen. † If alone, perform 5 cycles of 30:2 (about two minutes) on an infant or child

Source: http://www.zazainteractive.com/portfolio/coastguard/pdfs/USCG%20CPR%20Guidelines.pdf