CPR/AED
Welcome to the CPR/AED re-certification for 2024
Objectives
The objective of this refresher training is to provide personnel with material that meets the annual re-certification requirements for MIEMSS EMT/ALS certifications and/or licenses.
The material in this presentation must be reviewed in its entirety before demonstrating the following skills with a CPR Instructor: Adult 1 & 2 Rescuer CPR; use of AED, BVM, and Lucas. The skills may be accomplished using the "Pit Crew" model as long as providers rotate through all positions during scenarios. All providers must play the initial responder role, performing the initial assessment at least once. Supervisors must document skill verification via MCFRSIT.
After a review of the material contained herein, personnel are expected to take and pass an exam with an accuracy of at least 80%.
THIS IS NOT AN AHA BLS RENEWAL COURSE
This course/presentation will not allow you to receive an AHA BLS Provider card
If you need an AHA BLS Provider card, you must schedule a BLS Provider Renewal class with an AHA BLS Instructor-Contact the BLS Training Coordinator here.
AHA BLS Provider Renewal Course Content
Skills: Adult, Child, Infant, 1 & 2 Rescuer CPR/AED, FBAO
Written test (minimum score 84%)
$3.00 for eCard
The course/presentation you are viewing is required for the MCFRS Annual Re-certification program
High Performance CPR (HPCPR)
Contraindications
Less than 24 hours old;
Meets criteria for Pronouncement of Death in the Field protocol
Adult (>13 years old)
Continuous/uninterrupted compressions,
no pauses for; AED application, removal of clothes, ventilations, AED/defibrillator charging or any ALS skills;
Pauses less than 10 seconds at end of 2 minute cycle to assess pulse and/or defibrillate;
Compression depth --> at least 2 inches but no greater than 2.4 inches;
Compression rate 100-120 per minute;
Ventilate every 10th compression during recoil/upstroke
ADULT (13yrs. or older) -if advanced airway in place, asynchronous ventilations every 6 seconds
PEDIATRIC (1hr to 13 yrs. old) -if advanced airway in place, asynchronous ventilations every 3 seconds
Pediatric (1hr to 13 years old)
Same continuous/uninterrupted compressions as adult;
compression / ventilation ratio 30:2 for single rescuer, 15:2 for two or more rescuers;
Compression rate 100-120 per minute;
Compression depth;
if greater than 1 year old up to 13yrs --> 2 inches
if less than 1 year--> 1.5 inches
Return of Spontaneous Circulation (ROSC)
Refer to the ROSC protocol of the Maryland Medical Protocols (MMP) for patients that are revived
Reference: 2023 Maryland Medical Protocols p. 279
Lucas© (Mechanical CPR)
Contraindications
Less than 13 years old
Procedure
Must not apply until after 2 x two-minute cycles of CPR;
Application must not cause more than 10 second pause in compressions-pauses must be around normal two-minute compression interval, simultaneous with pulse check/rhythm interpretation;
Application may need to take place over 2 or more two-minute cycles in order to keep pauses below 10 seconds;
Place in stand-by mode for ROSC patients
Reference: 2023 Maryland Medical Protocols p.376
Click here to be taken to the training video site for the Lucas 3 (the newest system being purchased by some LFRDs). Choose the Pre-hospital video.
Click here to be taken to the training video site for the Lucas 2.
HPCPR with LUCAS Integration
Termination of Resuscitation (TOR)
Contraindications
Arrest secondary to submersion or hypothermia;
Pregnant
Pediatric TOR (<18 years old non-traumatic; <15 years old traumatic)
BLS clinicians may not terminate for pediatric medical arrest
BLS clinicians may terminate for pediatric trauma arrest if ALS resources generally not available and patient has received minimum of 15 two-minute cycles of HPCPR and during the five AED analyses immediately prior to TOR there was no shock indicated
Reference: 2023 Maryland Medical Protocols p. 53
Pronouncement of Death
Indications
Decapitation;
Rigor mortis;
Decomposition;
Dependent lividity;
Pulseless, apneic in MCI where system resources required for stabilization of living patients;
Pulseless, apneic with injury not compatible with life (except in case of obviously pregnant female, who should be resuscitated and transported to nearest appropriate facility);
Provider has initiated TOR protocol
Reference: 2023 Maryland Medical Protocols p. 60
AED
Highlights
Turn it on;
Perform compressions while charging;
Hover hands over chest during defibrillation-ready to restart compressions;
No pulse check right after defibrillation-immediately continue chest compressions;
If "no shock advised" after 2 minute cycle, check pulse for less than 10 seconds-if none, continue CPR
Contraindications
Newly born (up to 1 hour after birth)
Patient exhibiting signs of life
Watch the following video. Note-they are not performing HPCPR, viewing is simply to review AED use.
Reference: Maryland Medical Protocols p. 270
Credit: American Red Cross, 2016
Neonate and Newly Born CPR
Emergency cardiac care for babies from 1 hour up to 24 hours old is referred to the Universal Algorithm for Pediatric Emergency Cardiac Care for BLS in the Maryland Medical Protocol, p. 34 (below). (At 24hrs old, we refer to the HPCPR Maryland Medical Protocols p. 279).
For babies less than 1 hour old (newly born), refer to chart below and to Maryland Medical Protocol, p. 112
A supporting video on newborn resuscitation follows. Note: Target SPO2 numbers at 3:05 do not line up exactly with the MMP numbers on page 114-the minimum numbers match, but the MMP is more aggressive with the range-as always, follow the MMP where any conflicts arise.
Credit: Social Media and Critical Care, 2013
Foreign Body Airway Obstruction (FBAO)
Please view the video on FBAO removal.
Clinical Practice Guidelines (NEW!)
Pregnant patients in cardiac arrest
If a patient is more than 20 weeks pregnant.
After the floor of care is established, the patient should be transported!
In this order: CPR, AED/defibrillation, mechanical CPR, Uterine Displacement, Ventilation and Airway, Treating reversible causes.
Early Emergency Department notification is crucial (not Suburban).
Expect to hold uterine displacement until patient transfer to definitive care.
Vector Change
If a patient is in Ventricular Fibrillation (VF) and receives more than 3 defibrillation attempts.
A second set of AED pads for the next defibrillation will be placed in an Anterior/Posterior position.
Adding the second set of pads will be done in a 10 sec pulse-check window.
Pre-plan placing the second set of pads and communicate the plan! 10 secs is a very short window of time!
Narcan
We no longer give Narcan in cardiac arrests.
Even in the case of known opioid overdose.
Narcan fixes their respiratory drive --> So does your BVM!
Expect to use a BVM instead of Narcan.
Reference: 2023 Maryland Medical Protocols
Reference: MCFRS Clinical Practice Guidelines
SKILLS PRACTICE
All personnel must practice the following skills with a CPR instructor: Adult 1 & 2 Rescuer CPR; use of AED, BVM, and Lucas. See the list: