Essentials
CPR
Before beginning basic life support, CPR, or rescue breathing, activate the appropriate code team.
Adult or adolescent
| Check for unresponsiveness | Gently shake and shout, “Are you okay?” |
| Call for help/call 911 | Immediately call911 for help. If a second rescuer is available, send himto get help or an AED and initiate CPR if indicated. If asphyxial arrest is likely, perform 5 cycles (about 2 min) of CPR before activating EMS. |
| Position patient | Place patient in supine position on hard, flat surface. |
| Open airway | Use head-tilt, chin-lift maneuver unless contraindicated by trauma. |
| If you suspect trauma | Open airway using jaw-thrust method if trauma is suspected. |
| Check for adequate breathing | Look, listen, and feel for 10 sec. |
| Perform ventilations | Do two breaths initially that make the chest rise at 1 second/breath; then one every 5 to 6 sec. |
| If chest doesn’t rise | Reposition and reattempt ventilation. Several attempts may be necessary. |
| Check pulse | Palpate the carotid for no more than 10 sec. |
| Start compressions | |
| Placement | Place both hands, one atop the other, on lower half of sternum between the nipples, with elbows locked; use straight up-and-down motion without losing contact with chest. |
| Depth | One-third depth of chest or 1½″ to 2″ |
| Rate | 100/min |
| Comp-to-vent ratio | 30:2 (if intubated, continuous chest compressions at a rate of 100/min without pauses for ventilation; ventilation at 8 to 10 breaths/min) |
| Check pulse | Check after 2 min of CPR and as appropriate thereafter. Minimize interruptions in chest compressions. |
| Use AED | Apply as soon as available and follow prompts. Provide 2 min of CPR after first shock is delivered before activating AED to reanalyze rhythm and attempt another shock. |
Child (1 year to onset of adolescence or puberty)
| Check for unresponsiveness | Gently shake and shout, “Are you okay?” |
| Call for help/call 911 | Call after 2 min of CPR. Call immediately for witnessed collapse. |
| Position patient | Place patient in a supine position on a hard, flat surface. |
| Open airway | Use head-tilt, chin-lift maneuver unless contraindicated by trauma. |
| If you suspect trauma | Open airway using jaw-thrust method if trauma is suspected. |
| Check breathing | Look, listen, and feel for 10 sec. |
| Perform ventilations | Do two breaths initially that make the chest rise at 1 sec/breath; then one every 3 to 5 sec. |
| If chest doesn’t rise | Reposition and reattempt ventilation. Several attempts may be necessary. |
| Check pulse | Palpate the carotid or femoral for no more than 10 sec. |
| Start compressions | |
| Placement | Place heel of one hand or place both hands, one atop the other, with elbows locked, on lower half of sternum between the nipples. |
| Depth | 1/3 to ½ depth of the chest |
| Rate | 100/min |
| Comp:Vent ratio | 30:2 (if intubated, continuous chest compressions at a rate of 100/min without pauses for ventilation; ventilation at 8 to 10 breaths/min) |
| Check pulse | Check after 2 min of CPR and as appropriate thereafter. Minimize interruptions in chest compressions. |
| AED | Use as soon as available and follow prompts. Use child pads and child system for child age 1 to 8 years. Provide 2 min of CPR after first shock is delivered before activating AED to reanalyze rhythm and attempt another shock. |
Infant (0 to 1 year)
| Check for unresponsiveness | Gently shake and flick bottom of foot and call out name. |
| Call for help/call 911 | Call after 2 minutes of CPR; call immediately for witnessed collapse. |
| Position patient | Place patient in a supine position on a hard, flat surface. |
| Open airway | Use head-tilt, chin-lift maneuver unless contraindicated by trauma. Don’t hyperextend the infant’s neck. |
| If you suspect trauma | Open airway using jaw-thrust method if trauma is suspected. |
| Check breathing | Look, listen, and feel for 10 seconds. |
| Perform ventilations | Do two breaths at 1 second/breath initially; then one every 3 to 5 seconds. |
| If chest doesn’t rise | Reposition and reattempt ventilation. Several attempts may be necessary. |
| Check pulse | Palpate brachial or femoral pulse for no more than 10 seconds. |
| Start compressions | |
| Placement | Place two fingers 1 fingerwidth below nipples. |
| Depth | 1/3 to ½ depth of the chest |
| Rate | 100/minute |
| Comp:Vent ratio | 30:2 (If intubated, continuous chest compression at a rate of 100/min. without pauses for ventilation; ventilation at 8 to 10 breaths/min.) |
| Check pulse | Check after 2 minutes of CPR and as appropriate thereafter. Minimize interruptions in chest compressions. |
Choking
Adult or child (older than 1 year)
Symptoms
Grabbing the throat with the hand
Inability to speak
Weak, ineffective coughing
High-pitched sounds while inhaling
Interventions
Shout, “Are you choking? Can you speak?” Assess for airway obstruction. Don’t intervene if the person is coughing forcefully and able to speak; a strong cough can dislodge the object.
Stand behind the person and wrap your arms around the person’s waist (if pregnant or obese, wrap arms around chest).
Make a fist with one hand; place the thumbside of your fist just above the person’s navel and well below the sternum.
Grasp your fist with your other hand.
Use quick, upward and inward thrusts with your fist (perform chest thrusts for pregnant or obese victims).
Continue thrusts until the object is dislodged or the victim loses consciousness. If the latter occurs, activate the emergency response number and provide CPR. Each time you open the airway to deliver rescue breaths, look in the mouth and remove any object you see. Never perform a blind finger-sweep.
Infant (younger than 1 year)
Symptoms
Inability to cry or make significant sound
Weak, ineffective coughing
Soft or high-pitched sounds while inhaling
Bluish skin color
Interventions
Assess that airway is obstructed. Don’t perform the next two steps if infant is coughing forcefully or has a strong cry.
Lay infant face down along your forearm. Hold infant’s chest in your hand and his jaw with your fingers. Point the infant’s head downward, lower than the body. Use your thigh or lap for support.
Give five quick, forceful blows between the infant’s shoulder blades using the heel of your free hand.
After five blows
Turn the infant face up.
Place two fingers on the middle of infant’s sternum just below the nipples.
Give five quick thrusts down, compressing the chest at 1/3 to ½ the depth of the chest or ½″ to 1″ (2 to 2.5 cm).
Continue five back blows and five chest thrusts until the object is dislodged or the infant loses consciousness. If the latter occurs, perform CPR. Each time you open the airway to deliver rescue breaths, look in the mouth and remove any object you see. Never perform a blind finger-sweep.
Calculating drip rates
When calculating the flow rate of I.V. solutions, remember that the number of drops required to deliver 1 ml varies with the type of administration set. To calculate the drip rate, you must know the calibration of the drip rate for each specific manufacturer’s product. As a quick guide, refer to the chart below. Use this formula to calculate specific drip rates:
| Ordered volume | |||||
|---|---|---|---|---|---|
| 500 ml/24 hr or 21 ml/hr | 1,000 ml/24 hr or 42 ml/hr | 1,000 ml/20 hr or 50 ml/hr | 1,000 ml/10 hr or 100 ml/hr | 1,000 ml/8 hr or 125 ml/hr | 1,000 ml/6 hr or 167 ml/hr |
| Drops/ml | Drops/minute to infuse | |||||
|---|---|---|---|---|---|---|
| Macrodrip | ||||||
| 10 | 4 | 7 | 8 | 17 | 21 | 28 |
| 15 | 5 | 11 | 13 | 25 | 31 | 42 |
| 20 | 7 | 14 | 17 | 33 | 42 | 56 |
| Microdrip | ||||||
| 60 | 21 | 42 | 50 | 100 | 125 | 167 |
Blood products
| Blood component | Indications |
|---|---|
| Packed RBCs Same RBC mass as whole blood but with 80% of the plasma removed Volume: 250 ml |
|
| Platelets Platelet sediment from RBCs or plasma Volume: 35 to 50 ml/unit |
|
| Fresh frozen plasma (FFP) Uncoagulated plasma separated from RBCs and rich in coagulation factors V, VIII, and IX Volume: 180 to 300 ml |
|
| Albumin 5% (buffered saline); albumin 25% (salt poor) A small plasma protein prepared by fractionating pooled plasma Volume: 5% = 12.5 g/250 ml; 25% = 12.5 g/50 ml |
|
| Cryoprecipitate Insoluble portion of plasma recovered from FFP Volume: approximately 30 ml (freeze-dried) |
|
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