[Music] welcome welcome welcome good evening everybody this is Nurse Unice with Florida training academy and we're going to give everybody a few moments um about one minute to get on and we will begin our review and so I'm just going to go ahead and go to the comments if you would please type your name and let me know where you are viewing from and so again this is Nurse Unice and I am located in Jacksonville Florida and we'll get started in about 45 more seconds hi hi Nelly I am good how are you doing yes it's cold in Jacksonville you know if it gets less than 70 degrees we're cold so but it's nice to have you on tonight okay everybody so we're going to go ahead and get started thank you all for joining all right so if you missed our introduction my name is Unice I'm a registered nurse and the owner of Florida training academy and tonight's video we're going to do CPR questions tomorrow it'll be infection control and tomorrow we'll try to start around 8:00 pm and of course I will post that in the community section and I will go ahead and repeat that information again towards the end of this video so hi Lois all right so let's begin number one what should you do first if you are alone and find an unconscious adult victim with no pulse a says administering AED B call 911 C deliver one minute of CPR D deliver two minutes of CPR what do you think the best answer is hi Lisa from Orlando and you know I don't give you much time to think so we'll reveal the answer in three two yes sren it is B anyone else great job so it is B because it said an adult victim if an adult VI victim is pulseless if they're in Cardiac Arrest it is more than likely due to an abnormal heart rhythm so if you're out and about you don't have an AED with you we need you to call for help right away you are calling 911 because we need those Advanced responders those First Responders to get there so we can of course get the AED put on this person as quickly as possible after you call 911 while you have them on the phone of course they're going to ask you to do a quick assessment you can start CPR after you phone 911 so great job good job cine number two if someone suffers Cardiac Arrest meaning that their heart went into an electrical Rhythm or it stopped all together either way there's no profusing blood so let me repeat this number two if someone suffers Cardiac Arrest how long should you take before starting CPR a 20 seconds B 10 seconds c one minute or D 30 seconds hi M I don't want to mispronounce the first name so I'll just say the last name matelis I do apologize if I said it wrong but hello all right you all in three 2 one we'll reveal the answer it's 10 seconds so it is B you're going to hear that a lot that's like a common theme with CPR you only get 10 minutes to assess excuse me 10 seconds to assess so you have to be on that chest starting chest compressions within 10 seconds and if you take your hands off the chest for any reason if they're still in Cardiac Arrest the goal is to be back on that chest within 10 seconds so B was the correct answer for number two number three this is a long one while walking in the park Park you see an unconscious adult the adult is not breathing and doesn't have a pulse what's the best thing you should do a perform CPR without excuse me perform CPR with chest compressions and rescue breathing B provide rescue breathing only C perform chest compressions only D call 911 and wait for the EMS to arrive in other words you're not doing CPR you're just waiting and then e is either a or C there's an unconscious adult that does not have a pulse what do you think the best answer is all right any takers M Lois Nelly Sandrine we're revealing the answer in three two one and everybody is not D because all it said was call 911 and just wait remember in the last one I was saying youd have to call 911 and start CPR so the answer wasn't D it was actually either a or C so um yes you want to call 911 but D wasn't correct because after calling 911 you're not going to wait for every 1 minute you delay in starting your chest compressions the adult victim loses 10% of their brain function and in our area it takes the paramedics the ambulance about seven to 10 minutes to get to you so if there is a cardiac emergency we need people standing by who know what to do so the answer is a or C because about 10 years ago the American Heart Association through their research found that people were unwilling to provide Aid because they didn't want to do mouth to mouth and so the rescue breathing is actually optional if you don't have protective equipment you can perform chest compressions without breaths and we call that compression only CPR so if you feel like given this person you don't know a rescue Breath by all means do so so that's why it could be a however if you just want to profuse blood and do chest compressions you can also do that so you don't have to risk your life to help save someone else's life okay number four you try to give an unresponsive adult a rescue breath and the chest does not appear to rise when you give the first breath what do you do next a perform abdominal thrust D do chest compressions only C stop CPR and wait for EMS D repeat the head tilt chin lift maneuver and attemp the breath again you tried to give a breath but you didn't see any chest rise what do you do oh you all are quiet toight tonight Lois for this one is not C cuz you don't want to stop CPR and wait for EMS so everybody in three two and one it is Diz and dog so whenever you try to give a breath and you do the head tilt chin lift the tongue is blocking the back of the throat so this person may not have an obstructed Airway it's not the they choked it's just that right now they're in cardiac arrest and because they don't have any tone or any musculature um their tongue is collapsed so whenever you do the head tilt chin lift you're actually move maneuvering the tongue so that when you give the breath the tongue doesn't block the breath so if you try to give a breath and you don't see chest rise and fall just put the head back down reposition again and reattempt your breath if you still don't have a breath that goes through within 10 seconds we need you back on that chest doing your compressions again and we'll try that again after our 30 compressions and we'll learn more about the numbers in a few moments number five after offering resuscitation in the event of a cardiac arrest um and your patient starts breathing what is the best recovery position to put them in to maintain a clear Airway and this one's a little tricky so let me read all of them a in a still position b in a left lateral position C in a lateral position head dependent on something and no pressure on the chest or D in a lateral position head dependent on something with pressure on the chest and I know most of the time you hear be in a lateral position but give me another option because in this case the answer is not b but Lois you're close it's not B all right everybody we'll reveal the answer in 3 two one and I even have a picture here for you so that it will make more sense so Cates um in a stable true lateral position um you want to have the head dependent on something and no pressure on the chest so once the image actually shows um you're going to see that we support their head by placing their head on their arms what happens is you still want to see the chest moving because we have them in a lateral position or the um recovery position after cardiac arrest because we think the person might vomit um so you don't want their face towards the ground so you want to keep them on the side if you're unable to put their arms under their head you can use a pillow or a purse and so that's what it means by head dependent on something and you don't want any pressure on the chest so you don't want them laying on their chest number six you're walking along the sidewalk and see an unconscious child what a scary sight the child is in Cardiac Arrest what is the first thing you should do if you did a perform 2 minutes of CPR B call 911 and listen to everything before you give me your answer C perform chest compressions or D provide rescue breathing so we talked about adults if an adult goes into a cardiac arrest more than likely it was their heart being in an abnormal Rhythm think of Demar Hamlin when he was hit on the football field he immediately collapsed with children and infants is a little bit different if they go into cardiac arrest it's normally not their heart that causes the arrest it's their Airway they don't have enough oxygen and then the heart muscle ends up dying and that's what causes their cardiac arrest so if you have a child and you didn't witness the arrest automatically assume they don't have enough oxygen your first priority would not be the C 911 so with that being said what's the best answer close everybody it's going to be a we need you to perform two minutes of CPR so I want to go back and repeat that write some notes if there is a child or an infant and you did not witness the arrest you don't know how long that child has been on that ground if you have your cell phone yes by all means whoop it out call 911 put it on speaker phone but if we don't have a cell phone don't leave that child to go call 911 right away we need you doing two minutes of CPR including giving breaths to make sure that we get some oxygenated blood to that child's brain then you can leave the go call 911 so unwitnessed arrest in a Child 2 minutes of CPR first and you call 911 second and then don't forget the reason that a child or infant goes into a rest is usually not cardiac it's respiratory so great job ladies and gentlemen number seven while po while performing CPR on a child interruptions to chest compression should be limited to a less than 10 seconds B less than 15 seconds C less than 20 seconds or D one minute and I gave you this answer already so Lois you have it great job Lois anyone else hey John from Kenya oh please be safe and enjoy I wish you well on your exams today all right so anyone else going to give an answer tonight looks like you have it Lois it is a yes M less than 10 seconds so whenever you're it doesn't matter the age whenever you're performing CPR if you have to stop your chest compressions to give breaths to use the AED whatever the case may be try to get back to that chest within 10 seconds okay number eight while you are performing CPR on a child another rescuer appears on the scene what do you do next a transport the child immediately B wait until you feel exhausted then ask the second rescuer to replace you C ask the second rescuer to help with CPR to minimize fatigue D ask the second rescuer to give rescue breaths at a ratio of 30-2 this one's tricky the answer is not D give me another answer it is C John you're right great job and Nelly I'm going to explain to you why is not D all right so whenever their second rescuer comes up they don't have to be certified in CPR to take over but according to the American Heart Association guidelines if you have help about every two minutes or five Cycles you should be switching out once you have help and let's say you had a pocket mask or a back mask device where you can be giving breaths to this child or an infant if there are two or more Rescuers I want you to write this number down if there are two or more Rescuers your ratio switches it's no longer 30 compressions followed by two breaths it'll be 15 compressions followed by two breaths that means that within two minutes you're giving that child double the quantity of breaths because it's two of you now if you try to do 15 to two by yourself you're going to be exhausted because you're trying to breathe 20 breaths per minute while giving this child 20 breaths per minute so I'm going to recap regardless of the age if it's a single rescuer for all ages it is 30 compressions followed by two breaths but for children and infants once you have a second rescuer on the scene it is no longer 30 to2 it's 15 to2 and the reason you're doing that is so that you can maximize those breaths to help reverse this child's arrest so great job team and there's our answer number nine what is the latest recom recommendation for CPR compression depth in an adult is it a one to two inches b 2 inches c 2 to 2.4 Ines or D 2 to 2.6 inches so if you didn't study this it's going to be hard if you to answer this it's not D Nelly said c you're absolutely right Nelly that is correct anyone else three 2 one yes May so everybody the answer is 2 to 2.4 inches and that's just textbook that's American heart but I have to throw a monkey wrench in there because it's two to 2.4 inches for an average size adult you all we're working on a berry atric unit today and if you don't know what berryatric means that's usually your obese patient so usually they're in your facility because they're either being evaluated for weight loss surgery or they're postop they just had their surgeries so for our scenario tonight we have a 400b patient who went into cardiac arrest we cannot compress two to 2.4 in that will not be deep enough so there is another fraction that we use and we call it 13d the depth of the chest so you would bring that side view of the chest when you do your compressions a third of the way in because we have to get past the fat the muscles and the breast bone there is a possibility that we may break ribs but if we don't press deep enough we're never going to get to the heart and if we don't compress on that hard we're not going to circulate any blood to the brain the person's going to end up brain dead so any damage we do to that chest we can fix that with time and medication but if you don't compress deeply enough we cannot reverse that brain damage okay so it's 2 to 2.4 inches or another rule of thumb is one3 number 10 according to the American Heart Association guidelines what is the recommended chest compression rate during Cardiac Arrest management is it a 100 to 120 compressions per minute B 90 to 100 compressions per minute C less than I think it says 80 compressions per minute and then D is less than 60 per minute so how fast do you think we have to compress per minute here we go in three two and one and the answer is a 100 up to 120 compressions per minute what song do we compress to anyone do you want to put it in the chat there's a song I think it was created in the 70s really really popular I'm going to type it in if no one beats me to it you are correct Capri it is a and the song that you want to compress to is stand Alive by the bgs so every time that beat drops h h h h that would be your compression pace and if you compress at that pace that is more than 100 beats per minute and you would be in line with a American Heart Association guidelines so regardless of the age we compress at a rate of 100 up to 120 compressions per minutes um per minute and that would be the appropriate rate the next one number 11 chest compressions on an infant are delivered with the a entire hand b fingers C the heel of the Palm or D knuckles chest compressions on the Infant are delivered with what we'll reveal the answer in three two and one yes andren yes Donette yes Renee it is B it's the fingers and as soon as the image shows I have two images there sometimes we have patients where or excuse me we have caregivers who have arthritis and so whenever you see the two thumbs meeting in the center we call that the two thumb encircling hand technique which is permitted if you cannot use your two fingers so if you're using the two fingers on the infant's breast to perform the chest compressions but your fingers Tire just alternate and use the other position all are allowable so great job team number 12 how many breaths should be given during a two rescuer CPR on an adult with an advanced Airway an advanced Airway whenever someone goes into a respiratory arrest or distress in the hospital um you'll usually see like an intubation tube we call it an endot tral tube we'll connect them to the vent but sometimes we have to take them off the vent so let's say this person who was on a vent goes into the cardiac arrest we're not going to leave them on the vent we're going to connect a bag to their tube and we're going to give breaths how frequently do we give a breath is it one every 10 seconds two every 30 seconds one every six seconds or one breath every two seconds so what I want you to think about m is how many breaths do we breathe normally per minute what's our normal range respirations it's 12 to 20 so try to whenever you do the math try to give me an answer that will result in at least you know close to 12 breaths per minute and that answer would be C yes Renee it is C you want to give one breath every six seconds and I'm hopefully on this next page so this is an image of somebody who um and it's not real it's just an actor somebody who is intubated um and so we have them connected to a vent we would detach the vent connect the bag um but another type of person who has an advanced Airway is somebody who has a tracheostomy if somebody has has that incision in their throat with the tube coming out CPR would not be mouth to mouth it would be mouth to stom but instead of putting our mouths on their tracheostomy we detach the mask from the bag and we give one breath every six seconds directly through their tra while someone else is doing chest compressions nonstop and the reason why I have to talk to you all about this especially as CNAs and caregivers is because when you press that code button you're calling the rapid response team you don't get to leave you're right there you're part of the action and sometimes we may have to intubate that patient and so I just want you to be familiar with some of these terms so that when you see us doing things in the hospital you'll understand them okay all right so number 13 what is the appropriate duration when given rescue breaths is it a a rescue breath every second B rescue breaths should last last 2 seconds excuse me is it C they should last 3 seconds or D they should last 4 seconds think about how long it takes for you to take a breath no Renee the 911 operator told you to press seven no yes it is a great job Liz great job so it's going to be one breath excuse me you deliver your breaths um it should take no more than one second to deliver a breath if you give a big breath so it took you two seconds sometimes the breath instead of it going down into the lungs it can actually go into the esophagus and into the stomach and we can make the person vomit so whenever you're giving a breath just one second release it and then you can give your second breath this is an image of a bag mask device in your hospitals they're going to call them amboo bags but normally when you take your CPR or your BLS exams we don't use brand names so when I talked about us using the bag to deliver the breaths this is the bag that we'll use oh I see Renee instead of telling you yeah and some hopefully she was she was taught according to American Heart standard but that's why your facilities are kind of picky about the brand of CPR that you take because other brands may say different numbers or she just might not have had the the latest information but it's one breath every six seconds number 14 what are the correct steps when operating an AED y'all this is tricky a open the AED case remove the AED pads apply the AED pads to the patient's just and then turn the AED on I'm just going to give youall the answer it is B this was hard for no reason all those options it is B whenever the AED arrives to the scene even if it's your first time ever seeing it turn it on it talks to you and it's going to tell you exactly what to do it is voice guided so when the AED arrives turn it on and then listen follow the prompts when you take your American Heart Association exams remember what I told you always turn it on First and listen second it is voice guided it will tell you exactly what to do number 15 I should not have done you like this but I have to introduce you to some new terms 15 which of the following is not a shockable rhythm a asy b ventricular fib filation or C pulseless ventricular tacac cardia which is not a shockable rhythm so when you put that AED on and it analyzes it is looking for a shockable cardiac arrest Rhythm so it's looking for an abnormal energy that whenever we press that shock button the um electrical impulse will try to normalize the heart's Rhythm or that electrical Rhythm so in other words if the machine doesn't detect energy we cannot deliver a shock and so the best response is going to be a asy asy is the lack of energy and out of all times my image didn't show I do apologize you all there is an image there and it's not showing now asly is the Flatline so whenever a person doesn't have any energy at all the AED will not say shock required the AED is going to say continuous CPR okay so not all rhythms are shockable but that is why you call the advanced Rescuers if you're outside the hospital you call 911 if you're inside the hospital you press the code and your nurses and your doctors will know what to do if we can't use a AED on the person because they're in asy number 16 what should you do after attaching the AED pads on the victim's chest B excuse me a a give abdominal thrust B allow the device to analyze the victim's heart C check if the victim has a pulse or D turn them on their side so it couldn't have been C I thought because tardan means fast but yeah um it says which one we don't shock so that's why it wasn't C cuz C that pulses ventricular T cardia is actually a shockable rhythm so um asly would be the one that's nonshockable Renee so yes everybody great job what word do we say when it's analyzing the Rhythm we need to get everybody away from the bed what's the word that we say I typed it in for you all clear move every everybody back okay so when when it's analyzing we can't touch the victim we have to stop our chest compressions because it's going to pick up our heart rhythm and we don't want to have you know a rhythm that's not accurate or we don't want the machine to say a shock is not indicated because we were still touching and then whenever it analyzes and it says a shock is required and then of course we still make sure everybody's clear because if you're touching that bed when we press that shock button you're also going to get shocked and then we have to call another code team in for you because sometimes the shock is strong enough to send your heart to send a normal Rhythm into an abnormal Rhythm so when they say clear I really need you to move back okay all right and so if you're interested in becoming a CPR instructor we um actually train instructors nationally we have stu um students who fly in from all over it usually takes about two days to complete the process so for example we just had a nurse from New York who just flew down she let us know what her agenda was we completed her instructor course on a Wednesday she did her monitoring session on a Thursday and she flew out of here on a Friday so um it doesn't take long you all can become American Heart Association instructors and I would love to Mentor you all right number 17 why is it necessary for The Rescuer to experience recoil between each compression recoil is letting that chest go back to its normal position so when you compress down those two to 2.4 inches you let your hands in that chest go back to its normal position but why is it a to prevent injury to the patient's organs is it B to allow the hard time to refill with blood is it C to allow blood delivery to the brain or is it D to give rest to The Rescuer why do we allow the chest to recoil m is right good job M it is B so whenever you compress down on that chest you're squeezing all the blood out the heart you're circulating the blood that's how we get the blood to the brain when you let that chest rise again you give the hard time to refill with blood so CPR hurts if you go faster than 100 up to 120 compressions per minute what we find is you're going so fast you're not allowing the hard time to refill with blood so you're doing a lot of work with little benefit to that patient so that is why we say 100 to 120 compressions per minute please don't go faster so great job yes it allows the heart time to refill a all right and there's an image there of a heart and so whenever you're thinking about the heart pumping think about that ketchup bottle when you're trying to get the last bit of ketchup out the ketchup bottle and you kind of like swing the bottle that that's the heart's job the heart is to pump that blood we want to get it all out so it can circulate and then it goes through the system and it comes back through the lungs re oxygenated number 18 what is the correct compression depth for infant CPR so we said adults was 2 to 2.4 Ines I will go ahead and give you child right now child is two inches but this question is asking about infants so would infants be a 2 in B 3 in C hint hint hint 13 of the child's chest diameter or d 1 half of the child's chest diameter what do you all think it is C Renee is SE list great job so I'm going to put it in the chat so for infant compressions the depth is 1.5 in or for all ages one3 depth of the chest so I just put it there in the chat for you so we're pressing that infant chest in and again sometimes we feel like we're going to hurt this infant if we press too much but remember remember right now their bones are not formed they have their whole life if we can get their heart reg going again so to heal but if you don't compress deep enough we're not going to get any blood flow to that brain and that child is going to have neurological deficits so you still need to compress deeply even if it's on an infant oneir or one and a half inches and we're almost done ladies and gentlemen number 19 while you are trying to relieve choking on an infant the infant loses Consciousness what should you do a perform the high maneuver B perform CPR C do continuous back blows or D transport the infant to the nearest hospital you're trying to help this choking baby and they stop moving what should you do I see you Capri all right so a says c m says C A and Renee so no one says b so this is tricky whenever the infant loses Consciousness or a choking victim becomes unresponsive that means that they don't have any Oxygen we put them on the ground or if it's a infant put them on a flat surface we perform CPR so at this point we can't get it up they're now unresponsive they're not moving we have to start circulating the blood the oxygenated blood that remains to the brain and so whenever your Advanced providers come they can they can use Scopes if they need to to go down deeper into the throat but what you're going to do is after your 30 compressions when you'd be giving your two breaths look into the mouth and if you can see the object you can remove it by doing a finger sweep for an infant try to use your pinky for an adult or a child you can use your index finger however if you don't see the object we do not recommend blind sweeps you just can't go in there digging because you can push it down more if you try to give this infant a breath um it may not result in chest rise because we know this infant has a blockage but you keep doing the best you can you keep circulating that blood until the par medic get there number 20 this is the last one and I think you all for joining us tonight so number 20 what's the first thing you should check when entering an emergency emergency situation A the number of victims B the seriousness of the injuries C imminent dangers in the environment D the location of a first aid kid what do you check for first hi Don I think I just saw you there revealing the answer in three two one looks like we have one response anyone else all right Capri all right Renee and Mike great job safety if the scene is not safe you will not approach um I want you to think about here in Florida we had the pulse night club it was shot up by somebody and the paramedics don't go into the building first you all I need you to act like a first responder a paramedic they didn't go in the building first the police went into the building they clear the scene so unless you're trying to act in a role of a police officer you do not go in that scene you want to stay at a safe distance and call for help because at the end of the day I want to make sure that you make it to your fam's also so you all great job remember tomorrow's video is going to be on infection control and we will start that video tomorrow around 8:00 P.M I'm going to go back through the chats now to see what questions you all have but I am so proud of you and I thank you all for spending time even it's only 30 minutes a few days per week I thank you that you chose to spend some time with me so what questions do we all have before you go you know I love you Renee um if it's certification classes you usually they are not free but we do offer knowledge classes so if it's you know if you just want to learn the skills because you're a caregiver um you want you're taking care of Papa then yes you can come in on one of our classes and we will train you for free but whenever certification is attached to it that's professional that's for a job that's when the fees um actually come in all right so anyone else have questions all right so tomorrow is infection control and I think either Friday or satday we'll do one on disasters so you all I appreciate you I thank you so much Capri Renee Lisa Mike it was a lot of you all tonight A dette M Renee Liz oh my my my my my make sure I didn't miss anybody if I missed you blame it on my mind and not on my heart all right everybody have a good evening we're leaving this line in three two and one