LESSON 8 - HeartSafe First Aid Training
Contents
1. May 2012 page 11 8 Occupational First Aid Level 3 Training Guide Lesson 11 The Chain of Survival the Chain of Survival is a series of steps aimed at decreasing death and disability due to sudden cardiac arrest CHAIN OF SURVIVAL e Early recognition e Early access e Early CPR e Early defibrillation e Early advanced care OFAL3 e early recognition of warning signs e early access e early CPR e early defibrillation e early advanced care Electrical Activity in the Heart the heart contains an electrical system that sends out impulses that tell the heart when to contract to pump blood the leader of this electrical system is the sino atrial SA node the SA node e is the body s pacemaker e sends out 60 to 100 impulses per minute in a resting adult WorkSafeBC May 2012 page 11 9 Occupational First Aid Level 3 Training Guide Lesson 11 types of rhythms that have no palpable pulse and are life threatening include ABNORMAL ELECTRICAL IMPULSES e Ventricular Fibrillation VF e Ventricular Tachycardia VT e Pulseless electrical activity PEA e Asystole e ventricular fibrillation VF e ventricular tachycardia VT e pulseless electrical activity PEA e asystole Ventricular fibrillation VF VENTRICULAR FIBRILLATION e Uncoordinated electrical impulses e No pumping action or pulse e Most frequent rhythm in SCA e Most effective treatment is defibrillation e uncoordinated el2. WorkSafeBC May 2012 page 11 11 Occupational First Aid Level 3 Training Guide Lesson 11 Automated External Defibrillators there are many models of AEDs available on the market e Differences exist between models Operational controls Protocols in programming may not be current Visual or audio capabilities Battery replacement 4 Data collection method e Must have training for your specific model OFAL3 66 the operation of each is basically the same but there are some differences e operational controls e protocols in programming may not be current visual and audio capabilities battery replacement data collection method data collection is the electronic recording of patient information while protocols are performed when the AED is attached to the patient if an AED is supplied at your workplace the employer MUST ensure you receive training in the operation of that specific model where a defibrillation program exists in the workplace medical oversight is recommended but is not specifically required by the Occupational Health amp Safety Regulation AEDs are not on the list of equipment required to be supplied by the employer for BC workplaces WorkSafeBC May 2012 page 11 12 Occupational First Aid Level 3 Training Guide Lesson 11 Components of an AED unit in addition to the AED an AED unit should consist of COMPONENTS OF AN AED UNIT e Protective case weather proof e Extra battery e 2 sets
3. 11 SUMMARY the attendant must be able to recognize and manage cardiac emergencies questioning should be thorough enough to gather all the relevant information about the patient s symptoms chest pain can be a symptom of angina or heart attack e with angina the pain 4 is relieved by rest and oxygen usually lasts less than 15 minutes e with a heart attack the pain is not relieved by rest oxygen or nitroglycerin lasts longer than 30 minutes the management for angina follows the priority action approach and includes MANAGEMENT OF ANGINA e Position of comfort e Primary survey amp oxygen e Investigate the pain e Assist with medication e Decision e place the patient in a comfortable position e perform a primary survey and apply oxygen at 10 Ipm e investigate the pain because there is no history of trauma question the patient using the PPQRRST mnemonic e assistthe patient in taking nitroglycerin medication if required e patients with chest pain not relieved by nitroglycerin rest and oxygen are in the RTC WorkSafeBC May 2012 page 11 35 Occupational First Aid Level 3 Training Guide Lesson 11 e known angina conditions where pain is relieved by taking medication and rest may be able to return to work depending on the type of tasks involved this may require discussion with the supervisor the management for heart attack follows the priority action approach and includes MANAGEMENT OF A H
4. Aid Level 3 Training Guide PARTICIPANT PRACTICE 11 05 Lesson 11 Manage cardiac arrest with two rescuers AED immediately on scene manage a supine patient in cardiac arrest 1 scene assessment 1 Attendant approach the patient from the front identify yourself and attempt to communicate with the patient 2 Attendant activate the worksite emergency response procedures e if calling for the ambulance instruct the person to say there is an unresponsive adult and to report back 1 Attendant open the airway with a head tilt chin lift and check for breathing 1 Attendant move one hand up to the neck while maintaining the head tilt and assess for a carotid pulse 2 Attendant instruct a helper to update the ambulance that the worker is in cardiac arrest 1 Attendant start CPR e expose the chest as necessary e place hands in the centre of the chest between the nipples interlock fingers lock elbows and start chest compressions WorkSafeBC May 2012 no danger one worker patient was found slumped over in a chair and was carefully positioned on floor by co workers the patient does not respond to verbal stimuli this patient is in the RTC Note it is important for the team of Attendants to communicate with each other regarding findings and actions there is no breathing the need for C spine control and jaw thrust will depend on the mechanism there is no pulse Note
5. at rest 5 because there is no history of trauma the attendant must investigate the pain using the PPQRRST mnemonic Position Provokes Quality Radiates Relieves Severity Timing WorkSafeBC May 2012 on approach the patient is pale and complains of chest pain A large delivery arrived and my assistant is off today My angina pain flared up sat down and took my nitro The boss sent me to see you no breathing is 24 shallow and effective skin is cool pale and dry radial pulse is present no pain anywhere else the patient has a known history of angina the pain is behind the breastbone feels squeezing 5 out of 10 and has lasted 4 minutes there is nothing different about this pattern of angina attack page 11 19 Occupational First Aid Level 3 Training Guide Lesson 11 6 assess the patient s medication patient produces nitroglycerin spray and there are instructions e read instructions of use on the container 1 dose every 5 minutes to a total of 3 doses 7 decision no need to transport patient to medical since there is a known history aid at this time continue assessment wait to see if medication will work 8 assess vital signs and continue to monitor patient the patient is starting to feel better pain subsided in about 5 minutes after taking 1 dose of medication vital signs are now normal 9 patient can return to work inform supervisor to en
6. of pads e Disposable razor e Cloth or towel e User manual e protective case weather proof if AED to be exposed to an outside environment if to be used in a cold environment approaching freezing a heated case may be a way of keeping the AED warm e extra unexpired unused battery e 2sets of AED pad electrodes e disposable razor e acloth or towel e user or instruction manual WorkSafeBC May 2012 page 11 13 Occupational First Aid Level 3 Training Guide Lesson 11 Considerations when purchasing an AED CONSIDERATIONS FOR AED PURCHASE e Ruggedness of the unit e Ease amp speed to replace battery e Length of pad wires e Ease of clearing debris from blocked pad sockets e Visual display e Loudness of audio prompts OFAL3 e the ruggedness of the unit in consideration to the area in which it will be stored and used e the ease and speed of the battery replacement e the length of the wires on the AED pad electrodes e the likelihood of the pad sockets where the pad electrodes plug into the AED unit becoming plugged with dirt or mud and the ease of clearing them e if the unit has a visual display necessary if it is to be used in a noisy environment e the loudness of the audio prompts if it is to be used in a noisy environment CONSIDERATIONS FOR AED PURCHASE cont e Method of keeping unit warm e Method of data storage amp retrieval Removable data card e Internal memory Type of co
7. open and turn on the AED e follow voice prompts wait while the AED completes a self evaluation e plug the cables into the AED e ensure the AED pads are not expired or torn and are connected to the cables 9 attach the AED e expose the patient s chest and prepare the chest for the AED pads e remove the backing from the pads and place one pad below the patient s right clavicle and the other pad on the left side of the chest just inferior to nipple level 10 analyze the heart rhythm e ensure no one is touching the patient and everyone is standing clear e follow voice prompts or press the analyze button WorkSafeBC May 2012 Lesson 11 Note the AED model at the workplace may operate differently Note the employer must ensure that the Attendant is trained on the specific model used at the workplace patient s chest is dry there is no chest hair there are no medication patches or any implanted medical devices the AED gives a Shock Advised prompt page 11 29 Occupational First Aid Level 3 Training Guide 11 12 13 14 15 16 deliver a shock e state I m clear everyone is clear do not touch the patient e press the shock button if the AED advises administer 2 minutes of CPR e instruct a helper to watch what you are doing as they will be doing the compressions after the next cycle e place hands in the centre of the chest between the nipples interlock fing
8. 15 lpm have the helper giving the compressions switch with another helper every 2 minutes after 2 minutes of CPR follow voice prompts to allow the AED to re analyze the heart rhythm repeat cycles of analyze shock or no shock and 2 minutes of CPR until a physician assumes responsibility patient is transferred to ambulance personnel the attendant is physically exhausted and unable to continue cycles of No Shock Advised followed by 2 minutes of CPR have been ongoing for 30 minutes without even the temporary return of a pulse in patients with normal temperatures not hypothermic after 30 minutes resuscitation efforts may be stopped follow the procedure outlined in the Reference and Training Manual on page 368 Appendix B Fatalities spontaneous circulation and breathing are restored WorkSafeBC May 2012 Lesson 11 1 second per breath just enough to see the chest rise Note in the case of a hypothermic patient in cardiac arrest assess pulse and respiration for 1 minute attach the AED administer 1 shock if advised keep the patient warm prepare the spine board move the patient onto the spine board secure the patient with 2 straps place a sandbag on either side of the head load and secure the spine board into a basket stretcher initiate transport continue CPR enroute if possible turn up the heat in the transport vehicle to help warm the patient page 11 31 Occupational First
9. EART ATTACK e Position of comfort e Primary survey amp oxygen e Investigate the pain e Arrange for transport RTC e Offer 325 mg Aspirin ASA e Assess vital signs OFAL3 e position the patient for comfort do not allow the patient to move unassisted keep the patient as quiet and calm as possible e conduct a primary survey and administer oxygen at 10 lpm keep the patient comfortably warm e investigate the pain question the patient using the PPQRRST mnemonic e all patients with suspected heart attacks are in the RTC e offer the patient two 80 mg of chewable ASA or one regular adult strength 325 mg ASA tablet to chew if available not lbuprophen or Acetaminophen e assess and monitor vital signs en route or while waiting for transport The management for cardiac arrest is the delivery of good quality CPR until an Automated External Defibrillator is available REVIEW READING FROM LESSONS 1 11 FOR LESSON 12 WorkSafeBC May 2012 page 11 36 Occupational First Aid Level 3 Training Guide Lesson 11 Name Assignment Answer Sheet O O IT E 2 A B C D O O O E 3 A B C D O O O E 4 A B C D O O O E 5 A B C D O O O E 6 A B C D O O O E 7 A B C D O O O E 8 A B C D O O O E 9 A B C D O O O E 10 A B C D O O IT E WorkSafeBC May 2012 page 11 37 Occupational First Aid Level 3 Training Guide Lesson 11 WorkSafeBC May 2012 page 11 38
10. Occupational First Aid Level 3 Training Guide Lesson 11 LESSON 11 OBJECTIVE Each participant will identify circulatory emergencies and manage critical interventions The procedures will follow the guidelines in the Occupational First Aid Reference and Training Manual LESSON OUTLINE e cardiac emergencies e cardiac emergency management Reference Part 5 Chapter 12 traumatic cardiac emergencies Part 5 Chapter 13 non traumatic cardiac Part 5 Chapter 14 cardiopulmonary resuscitation WorkSafeBC May 2012 page 11 1 Occupational First Aid Level 3 Training Guide Lesson 11 INSTRUCTOR ACTIVITY Lecture AS THE WORK FORCE AGES THE INCIDENTS OF CARDIAC EMERGENCIES WILL BECOME MORE COMMON RECOGNITION AND PROPER MANAGEMENT MAY SAVE A CO WORKERS LIFE Cardiac Emergencies heart conditions can result from traumatic or non traumatic incidents heart conditions include HEART CONDITIONS e Angina e Heart attack e Cardiac arrest e angina the reduction of oxygen to the heart muscle due to a narrowing of the heart s arteries coronary arteries lack of oxygen may cause pain which is referred to as angina pectoris e heart attack the lack of oxygen to the heart muscle due to a complete blockage of a coronary artery myocardial infarction e cardiac arrest the heart has stopped beating or beats too irregularly or too weakly to circulate blood effectively causes include cardiovascular disease most comm
11. art rhythm is re analyzed air goes in 1 second per breath just enough to see the chest rise page 11 33 Occupational First Aid Level 3 Training Guide 14 switch positions after each cycle and repeat cycles of analyze shock or no shock and 2 minutes of CPR until e a physician assumes responsibility e patient is transferred to ambulance personnel e the attendant is physically exhausted and unable to continue e cycles of No Shock Advised followed by 2 minutes of CPR have been ongoing for 30 minutes without even the temporary return of a pulse in patients with normal temperatures not hypothermic after 30 minutes resuscitation efforts may be stopped follow the procedure outlined in the Reference and Training Manual on page 368 Appendix B Fatalities e spontaneous circulation and breathing are restored WorkSafeBC May 2012 Lesson 11 Note in the case of a hypothermic patient in cardiac arrest assess pulse and respiration for 1 minute attach the AED administer 1 shock if advised keep the patient warm prepare the spine board move the patient onto the spine board secure the patient with 2 straps place a sandbag on either side of the head load and secure the spine board into a basket stretcher initiate transport continue CPR enroute if possible turn up the heat in the transport vehicle to help warm the patient page 11 34 Occupational First Aid Level 3 Training Guide Lesson
12. atient using the PPQRRST mnemonic e assist the patient in taking nitroglycerin medication if required e patients with chest pain not relieved by nitroglycerin rest and oxygen are in the RTC e known angina conditions where pain is relieved by taking medication and rest may be able to return to work depending on the type of tasks involved this may require discussion with the supervisor WorkSafeBC May 2012 page 11 7 Occupational First Aid Level 3 Training Guide Lesson 11 Management of Heart Attack MANAGEMENT OF A HEART ATTACK e Position of comfort e Primary survey amp oxygen e Investigate the pain e Arrange for transport RTC e Offer 325 mg Aspirin ASA e Assess vital signs OFAL3 e position the patient for comfort do not allow the patient to move unassisted keep the patient as quiet and calm as possible e conduct a primary survey and administer oxygen at 10 lpm keep the patient comfortably warm e investigate the pain question the patient using the PPQRRST mnemonic e all patients with suspected heart attacks are in the RTC e offer the patient two 80 mg of chewable ASA or one regular adult strength 325 mg ASA tablet to chew if available it must be ASA not Ibuprofen or Acetaminophen e assess and monitor vital signs en route or while waiting for transport Management of Cardiac Arrest sudden cardiac arrest SCA is an abrupt unexpected loss of heart pump function WorkSafeBC
13. compressions switch with another helper every 2 minutes continue with the sequence of continuous compressions performed by the helper and 1 ventilation every 6 to 8 seconds given by the Attendant until e the AED arrives e aphysician assumes responsibility e patient is transferred to ambulance personnel e the attendant is physically exhausted and unable to continue e spontaneous breathing and circulation are restored e CPR has been ongoing for 30 minutes without even the temporary return of a pulse in patients with normal temperatures WorkSafeBC May 2012 Lesson 11 Note if a helper is not available or cannot compress adequately cycles of 30 compressions and 2 ventilations are performed by the Attendant 1 second per breath just enough to see the chest rise the AED arrives after 11 2 minutes of compressions page 11 25 Occupational First Aid Level 3 Training Guide 15 instruct the helper to continue with compressions 16 while the AED is prepared and the pads are attached prepare the AED position the AED on the operator side of the patient so the unit and the entire patient can be seen open and turn on the AED follow voice prompts wait while the AED completes a self evaluation plug the cables into the AED ensure the AED pads are not expired or torn and are connected to the cables 17 attach the AED prepare the patient s chest for the AED pads work around the helper doing
14. ectrical impulses can occur at a rate of up to 300 times a minute e no pumping action so no pulse WorkSafeBC May 2012 page 11 10 Occupational First Aid Level 3 Training Guide Lesson 11 e most frequent rhythm in sudden cardiac arrest e most effective treatment is defibrillation ventricular tachycardia VT is a heart rhythm that can be so fast that the heart does not have time to fill with blood between contractions leading to a loss of cardiac output and loss of pulse with pulseless electrical activity PEA the SA node sends a signal to contract but the heart does not respond or there is no blood in the system to pump asystole flat line occurs when there is no electrical activity in the heart Defibrillation DEFIBRILLATION e VF amp VT require an immediate shock e Defibrillator shocks the heart Stops all electrical activity Allows SA node to regain control VF and pulseless VT are abnormal heart rhythms that need to be shocked immediately the defibrillator sends a shock through the heart that e stops all electrical activity e allows the SA node to regain its role in providing effective electrical impulses the longer the time period between the onset of VF or VT to defibrillation the smaller the chances of patient survival the chance for survival decreases approximately 10 for each minute delay in defibrillation PEA and asystole do not respond to defibrillation and so are called non shockable rhythms
15. ers lock elbows and perform 30 chest compressions using a pocket mask ventilate the patient with 2 breaths instruct the helper to watch what you are doing regarding compression depth and timing and give 30 chest compressions ventilate the patient with 2 breaths instruct the helper to kneel close to the side of the patient and place their hands in the centre of the chest interlock their fingers lock their elbows so their arms are straight and start compressing e ensure a depth of at least 5 cm a rate of at least 100 per minute and a full recoil of the chest between compressions WorkSafeBC May 2012 Lesson 11 Note if a No Shock prompt was given then 2 minutes of CPR is administered before the heart rhythm is re analyzed compress the chest at least 5 0 cm 2 inches at a rate of at least 100 per minute push hard push fast allow the chest to recoil after each compression air goes in 1 second per breath just enough to see the chest rise air goes in Note if a helper is not available or cannot compress adequately cycles of 30 compressions and 2 ventilations are performed by the Attendant page 11 30 Occupational First Aid Level 3 Training Guide 17 ventilate the patient once every 6 to 8 seconds timed with the recoil phase of the compression 18 19 between ventilations insert an oral airway and apply oxygen switch to the bag valve mask for the ventilations with the oxygen at
16. he patient 3 activate the worksite emergency response procedures e if calling for the ambulance instruct the person to say there is an unresponsive adult and to report back 4 open the airway with a head tilt chin lift and check for breathing Note the assessment of the breathing and pulse should not take longer than 10 seconds 5 move one hand up to the neck while maintaining the head tilt and assess for a carotid pulse 6 request any other OFA attendants or workers trained in CPR to assist and instruct a helper to update the ambulance that the worker is in cardiac arrest WorkSafeBC May 2012 no danger one worker patient was found slumped over in a chair and was carefully positioned on floor by co workers the patient does not respond to verbal stimuli this patient is in the RTC there is no breathing the need for C spine control and jaw thrust will depend on the mechanism there is no pulse page 11 28 Occupational First Aid Level 3 Training Guide 7 ensure the patient is on a hard surface NOTE all patients who are in cardiac arrest must receive CPR unless there is clear evidence that death has occurred for example if there is decapitation transection decomposition an adult patient who has been submerged in water for over 60 minutes or in certain triage situations 8 prepare the AED e position the AED on the operator side of the patient so the unit and the entire patient can be seen e
17. if the cardiac arrest was caused by drowning 2 ventilations would be given before starting compressions page 11 32 Occupational First Aid Level 3 Training Guide 10 11 12 13 2 Attendant prepare and attach the AED e prepare the patient s chest for the AED pads work around the Attendant doing the compressions 2 Attendant analyze the heart rhythm e instruct the 1 Attendant stop compressions and don t touch the patient e ensure no one is touching the patient and everyone is standing clear e follow voice prompts or press the analyze button 2 Attendant deliver a shock e state I m clear everyone is clear do not touch the patient e press the shock button if the AED advises 2 Attendant begin compressions 1 Attendant using a pocket mask ventilate the patient once every 6 to 8 seconds timed with the recoil phase of the compressions e between ventilations insert an oral airway and apply oxygen e switch to the bag valve mask for the ventilations with the oxygen at 15 lpm after 2 minutes of CPR follow voice prompts to allow the AED to re analyze the heart rhythm WorkSafeBC May 2012 Lesson 11 patient s chest is dry there is no chest hair there are no medication patches or any implanted medical devices the AED gives a Shock Advised prompt Note if a No Shock prompt was given then 2 minutes of CPR is administered before the he
18. ingers lock elbows and perform 30 chest compressions using a pocket mask ventilate the patient with 2 breaths instruct the helper to watch what you are doing regarding compression depth and timing and give 30 chest compressions ventilate the patient with 2 breaths WorkSafeBC May 2012 Lesson 11 there is no pulse a worker goes to get the AED Note the AED is used as soon as it is available Note if the cardiac arrest was caused by drowning 2 ventilations would be given before starting compressions compress the chest at least 5 0 cm 2 inches at a rate of at least 100 per minute push hard push fast allow the chest to recoil after each compression air goes in 1 second per breath just enough to see the chest rise air goes in page 11 24 Occupational First Aid Level 3 Training Guide 12 18 14 instruct the helper to kneel close to the side of the patient and place their hands in the centre of the chest interlock their fingers lock their elbows so their arms are straight and start compressing e ensure a depth of at least 5 cm a rate of at least 100 per minute and a full recoil of the chest between compressions ventilate the patient once every 6 to 8 seconds timed with the recoil phase of the compression e between ventilations insert an oral airway and apply oxygen e switch to the bag valve mask for the ventilations with the oxygen at 15 lpm e have the helper giving the
19. ional First Aid Level 3 Training Guide Lesson 11 7 activate the worksite emergency response chest pain lasting longer than procedures 30 minutes skin is cool pale and clammy e if calling for the ambulance instruct the person to say there is a responsive adult with chest pain lasting longer than 30 minutes and to report back 8 offer the patient two 80 mg of chewable ASA or it must be ASA not one regular adult strength 325 mg ASA tablet to Acetaminophen or Ibuprofen chew ensure the patient does not have an allergy to ASA 9 package the patient on the spine board 10 reassess the ABC s every 5 minutes 11 continue with the secondary survey en route or while waiting for transport WorkSafeBC May 2012 page 11 22 Occupational First Aid Level 3 Training Guide Lesson 11 PARTICIPANT PRACTICE 11 03 A Safety Alert Students are required to perform CPR compressions during this course Performing CPR compressions on a classmate for real could result in discomfort or injury Students must only simulate compressions if practicing on a classmate Manage cardiac arrest with one rescuer AED not immediately on scene manage a supine patient in cardiac arrest 1 scene assessment no danger one worker patient was found slumped over in a chair and was carefully positioned on floor by co workers 2 approach the patient from the front identify the patient does not respond to yourself and attempt to communicate with the
20. l 3 Training Guide Lesson 11 in order to identify that the condition is heart related ask the following questions INVESTIGATE THE PAIN e P P position provokes e Q quality e R R radiate relief e S severity 9 e T timing ho o e P position where is the pain canthe patient point to the pain e P provokes what makes it worse movement coughing e Q quality describe the pain what does it feel like sharp squeezing etc does this pain differ from the normal pattern of pain e R radiate is the pain localized to one region does it radiate spread to another area e R relief does anything relieve the pain in any way does anything make it feel better e S severity how severe is the pain ona scale of 1 10 how would the patient rate the pain WorkSafeBC May 2012 page 11 6 Occupational First Aid Level 3 Training Guide Lesson 11 e T timing when did the pain start how long has it lasted what was the patient doing at the onset of the pain has the patient had this type of pain before Management of Angina MANAGEMENT OF ANGINA e Position of comfort e Primary survey amp oxygen e Investigate the pain e Assist with medication e Decision e place the patient in a comfortable position e perform a primary survey and apply oxygen at 10 lpm e investigate the pain because there is no history of trauma question the p
21. nnection to a PC Software required Cost e Data to be reviewed by Medical Director OFAL3 69 WorkSafeBC May 2012 page 11 14 Occupational First Aid Level 3 Training Guide Lesson 11 e the method of keeping the unit warm in a cold environment e the method of incident data storage and retrieval removable data card internal memory type of connection to a PC software required cost e this data should be reviewed by the medical director for the AED program at the workplace Special Considerations and Circumstances for AED use CONSIDERATIONS FOR AED USE e Inspection amp maintenance protocols amp logs e Safe for pregnant patients e Carefully remove any patch medications e Place pads 1 away from implanted devices e Pads must be well secured to chest e Shave chest if hairy OFA L3 e establish inspection and maintenance protocols and logs as required by manufacturer s directions e AED use is safe for pregnant patients e carefully remove any patch medications and wipe any excess medication from the chest with a clean cloth or gauze pad e place AED pad electrodes one inch away from implanted pacemakers or implanted defibrillators e ensure AED pad electrodes are well applied to the chest e shave pad area if chest is very hairy WorkSafeBC May 2012 page 11 15 Occupational First Aid Level 3 Training Guide Lesson 11 CONSIDERATIONS FOR AED USE cont e Wipe chest dry if wet e Move pa
22. on cause blunt trauma violence to the chest severe blood loss drowning WorkSafeBC May 2012 page 11 2 Occupational First Aid Level 3 Training Guide Lesson 11 suffocation certain drugs electric shock stroke or other types of brain damage Angina signs and symptoms may vary from person to person but for each individual the pain is of consistent intensity duration and location signs and symptoms of angina include ANGINA SIGNS amp SYMPTOMS e Pain e usually eases with rest O or medication 4 usually lasts less than 15 minutes e Nausea e Apprehension or unease e Pallor e Shortness of breath OFAL3 e pain may occur suddenly or gradually usually located beneath the sternum may radiate in left or right arm neck jaw or back often assumed to be indigestion gas belching described as mild to moderate heavy pressure squeezing or vice like tightness not influenced by deep respiration coughing or movement usually brought on by stress or exertion often eased by rest oxygen or medication usually lasts less than 15 minutes e nausea e apprehension or uneasiness WorkSafeBC May 2012 page 11 3 Occupational First Aid Level 3 Training Guide Lesson 11 e pallor e shortness of breath Heart Attack the signs and symptoms associated with a heart attack are HEART ATTACK SIGNS amp SYMPTOMS e Pain does not ease with rest amp medication e us
23. orary return of a pulse in patients with normal temperatures not hypothermic after 30 minutes resuscitation efforts may be stopped follow the procedure outlined in the Reference and Training Manual on page 368 Appendix B Fatalities e spontaneous circulation and breathing are restored WorkSafeBC May 2012 Lesson 11 Note if a No Shock prompt was given then 2 minutes of CPR is administered before the heart rhythm is re analyzed compress the chest 3 8 5 0 cm 1 to 2 inches at a rate of 100 per minute 1 second per breath just enough to see the chest rise Note in the case of a hypothermic patient in cardiac arrest assess pulse and respiration for 1 minute attach the AED administer 1 shock if advised keep the patient warm prepare the spine board move the patient onto the spine board secure the patient with 2 straps place a sandbag on either side of the head load and secure the spine board into a basket stretcher initiate transport continue CPR enroute if possible turn up the heat in the transport vehicle to help warm the patient page 11 27 Occupational First Aid Level 3 Training Guide Lesson 11 PARTICIPANT PRACTICE 11 04 Manage cardiac arrest with one rescuer AED immediately on scene manage a supine patient in cardiac arrest 1 scene assessment 2 approach the patient from the front identify yourself and attempt to communicate with t
24. ped when cycles of No Shock Advised followed by 2 minutes of CPR have been ongoing for 30 minutes CPR has been ongoing for 30 minutes e when an AED is not available CPR is continued and the AED is used as soon as itis brought to the scene Hypothermic Patients in Cardiac Arrest HYPOTHERMIC PATIENTS IN CARDIAC ARREST e Assess pulse amp respiration for up to 1 min e Administer 1 shock if advised e Resume CPR e Keep patient warm e Package amp transport patient e Continue CPR enroute if possible OFA L3 e assess the pulse and respiration for up to 1 minute WorkSafeBC May 2012 page 11 17 Occupational First Aid Level 3 Training Guide Lesson 11 e ifan AED is available and a Shock Advised prompt is given administer 1 shock e resume CPR e keep the patient warm e package and transport e continue CPR enroute if possible WorkSafeBC May 2012 page 11 18 Occupational First Aid Level 3 Training Guide Lesson 11 PARTICIPANT PRACTICE 11 01 Manage chest pain walks to the first aid room manage a patient with chest pain walks to the first aid room 1 scene assessment modified e what happened e did you fall or hurt your head or neck 2 explain that a resting position will be more comfortable and then position the patient at rest in the position of most comfort with support preferably supine 3 conduct the primary survey 4 apply oxygen and keep the patient calm and
25. sure no more moving of cartons or other strenuous work today 10 complete the first aid record and follow up on the patient s condition throughout the day WorkSafeBC May 2012 page 11 20 Occupational First Aid Level 3 Training Guide Lesson 11 PARTICIPANT PRACTICE 11 02 Manage chest pain conscious walks to the first aid room manage a patient with chest pain who walks to the first aid room 1 scene assessment modified e what happened e did you fall or hurt your head or neck explain that a resting position will be more comfortable and then position the patient at rest in the position of most comfort with support preferably supine conduct the primary survey apply oxygen keep the patient calm and at complete rest determine if the patient is on medication because there is no history of trauma the attendant must investigate the pain using the PPQRRST mnemonic WorkSafeBC May 2012 patient is pale sweaty and very anxious was shoveling snow all morning and started feeling pain in my chest no breathing 24 shallow and effective Skin is cool pale and clammy radial pulse present no pain anywhere else patient is on medications for high blood pressure no previous history of chest pain the pain is behind the breastbone feels vice like radiates down the left arm severity is 7 out of 10 has lasted 40 minutes this patient is in the RTC page 11 21 Occupat
26. the compressions remove the backing from the pads and place one pad below the patient s right clavicle and the other pad on the left side of the chest just inferior to nipple level 18 analyze the heart rhythm instruct the helper stop compressions and don t touch the patient ensure no one is touching the patient and everyone is standing clear follow voice prompts or press the analyze button WorkSafeBC May 2012 Lesson 11 Note the AED model at the workplace may operate differently Note the employer must ensure that the Attendant is trained on the specific model used at the workplace patient s chest is dry there is no chest hair there are no medication patches or any implanted medical devices the AED gives a Shock Advised prompt page 11 26 Occupational First Aid Level 3 Training Guide 19 deliver a shock e state I m clear everyone is clear do not touch the patient e press the shock button if the AED advises 20 administer 2 minutes of CPR e instruct a helper to resume compressions e ventilate the patient once every 6 to 8 seconds 21 repeat cycles of analyze shock or no shock and 2 minutes of CPR until a physician assumes responsibility patient is transferred to ambulance personnel the attendant is physically exhausted and unable to continue cycles of No Shock Advised followed by 2 minutes of CPR have been ongoing for 30 minutes without even the temp
27. tient if in standing water e Place O cylinder amp tubing away from AED e Stop vehicle if used during transport e Read user manual for troubleshooting e wipe the chest with towel or cloth before applying AED pad electrodes if the chest is wet e if attendant or patient in standing water move to dry area e place oxygen cylinder and tubing away from the chest and AED unit e stop vehicle if AED is used during transport e read user manual for troubleshooting Cardiopulmonary Resuscitation or CPR the patient s best chance for survival is the delivery of good quality CPR until an AED is available e cardiac arrest caused by drowning e AED is used as soon as available e If signs of life appear check pulse breathing resumes patient moves patient regains consciousness e May stop if efforis ongoing for 30 minutes when patient is not hypothermic OFAL3 WorkSafeBC May 2012 page 11 16 Occupational First Aid Level 3 Training Guide Lesson 11 e if the cardiac arrest is caused by drowning give 2 ventilations before starting compressions e the AED is used as soon as it is available e if the patient shows any signs of life stop resuscitation efforts and assess the pulse e signs of life include breathing resumes patient moves patient regains consciousness e for patients with normal temperatures not hypothermic where there has not been even a temporary return of a pulse resuscitation efforts may be stop
28. ually lasts longer than 30 minutes e Apprehension e Denial e Marked weakness OFAL3 e pain is the classic symptom may occur suddenly or come on when the patient is at rest usually substernal and often radiates across the chest epigastric discomfort usually associated with belching gas and indigestion desire to defecate may radiate to one or both arms up to neck jaw or through to the back described as choking squeezing vice like burning or intense a feeling of pressure not affected by cough movement or deep respiration usually lasts longer than 30 minutes and is constant rest and medication do not help e apprehension e denial e marked weakness especially in the arms WorkSafeBC May 2012 page 11 4 Occupational First Aid Level 3 Training Guide Lesson 11 HEART ATTACK SIGNS amp SYMPTOMS cont e Shoriness of breath e Sweating e Pallor e Nausea vomiting e Desire to defecate e Weak amp rapid pulse OFAL3 e shortness of breath or difficulty breathing e sweating sometimes profuse e pallor e nausea or vomiting e desire to defecate e weak and rapid pulse in some cases the pulse rate decreases Cardiac Arrest signs and symptoms of cardiac arrest e no breathing e no pulse Cardiac Assessment the nature of the heart condition must be investigated by the first aid attendant as soon as possible WorkSafeBC May 2012 page 11 5 Occupational First Aid Leve
29. verbal stimuli patient this patient is in the RTC 3 activate the worksite emergency response procedures e if calling for the ambulance instruct the person to say there is an unresponsive adult and to report back 4 open the airway with a head tilt chin lift and there is no breathing check for breathing the need for C spine control and jaw thrust will depend on the mechanism WorkSafeBC May 2012 page 11 23 Occupational First Aid Level 3 Training Guide 5 move one hand up to the neck while maintaining the head tilt and assess for a carotid pulse Note the assessment of the breathing and pulse should not take longer than 10 seconds 6 7 NOTE all patients who are in cardiac arrest must receive CPR unless there is clear evidence that death has occurred for example if there is decapitation transection decomposition an adult patient who has been submerged in water for over 60 minutes or in certain triage situations 8 10 11 request any other OFA attendants or workers trained in CPR to assist e instruct bystanders to go get the AED if one is available at the worksite and update the ambulance that the worker is in cardiac arrest ensure the patient is on a hard surface start CPR e expose the chest as necessary e instruct a helper to watch what you are doing as they will be doing the compressions after the next cycle e place hands in the centre of the chest between the nipples interlock f
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