CPR Pro for the Professional Rescuer - Health & Safety Institute

CPR Pro for the Professional RescuerRecommended Class SchedulesClasses are often populated by students with differentlevels of experience. This makes a single minute-byminuteapproach to lesson planning unrealistic.The recommended class schedule is intended toguide the Instructor, not impose an artificially rigid instructionalplan. Instructors should always ask aboutprevious training and attempt to connect participants’past experience and knowledge to the current learningexperience.SCA and Early Defibrillation 5Personal Safety 5BLS Skills 30BLS Care 60Defibrillation 30Team Approach 30Choking 15Breaks 20Evaluation 60Total Approximate Minutes 255Total Approximate Hours 4–5RenewalStudents returning before the end of their certificationperiod can renew their certification in a training classthat focuses on achieving the listed core skills objectivesthrough skills practice and evaluation. As thetraining progresses, Instructors need to constantlyevaluate the level of cognitive understanding withinthe group being trained and review core knowledgeobjectives as needed.Renewal training is typically shorter than initial training.However, the amount of reduced time is dependenton the level to which the group still understandsthe cognitive information within the program. Frequentrefreshers during the certification period canhelp improve this.Challenging the ProgramExperienced students can challenge the ASHI CPRPro training program using performance evaluations.Participants must arrive prepared for skill testing andmust perform competently without assistance on performanceevaluations for all covered age groups. Awarm-up or skills review session may be conductedbefore the challenge, but must be clearly separatedfrom the challenge itself. Students who cannot performcompetently without assistance have not successfullycompleted the challenge. If unsuccessful,students still seeking certification must attend andcomplete a training class.Online Blended TrainingBlended training combines the convenience of onlinelearning with a shortened practical skills session inorder to meet both knowledge and skill objectives.The online learning platform used for ASHI blendedtraining classes is ASHI Learning. This specially designedweb-based learning system allows for a varietyof sensory interactions to provide users witha low-stress, easy-to-use, and convenient wayto learn cognitive information.It is important to note that students must successfullycomplete both the online and skillsportions of blended training. Completion of theonline portion alone will not result in certification.The entire administrative process for blendedtraining is done through Training Center Manager.A Training Center purchases blendedtraining credits, which include a student seat inan online class and Student Handbook.Training Centers schedule classes and add students.Students are notified by email of enrollmentin the online class. Student progress can bemonitored online.To successfully complete the online class, studentscomplete all of the lessons. Check marks will indicatewhich lessons have been completed. When all of thelessons are finished, the student will have the capabilityof printing a completion certificate for the class.A student will also have to achieve a passing scoreon the included online exam in order to complete theonline class.Skill practice and evaluation is done face-to-face in aclassroom setting. Instructors must conduct and documentstudent skill performance for the core skill objectiveslisted for the class being taught. Skill practiceis accomplished using the same approaches availablefor non-blended classroom training. Sessionscan be conducted for groups or for individuals. Individualscan also challenge the skills session in orderto receive certification.Video Guided PracticeHaving students practice CPR skills along with avideo demonstration has been shown to be an effectivemeans of acquiring CPR skills. Video guidedpractices are included with the ASHI CPR Pro ProgramVideo for adult, child, and infant single providerCPR. Instructors have a choice to use this optionwhen practicing these skills.CPR Pro for the Professional Rescuer5

CPR Pro for the Professional RescuerRegardless of the method used to practice, Instructorsmust still evaluate for the competent performanceof skills to issue a certification card.To use video guided practice in a classroom, makesure each student has an appropriate CPR manikinand CPR mask for giving rescue breaths. Arrange studentsin a manner that allows for clear viewing of thevideo presentation.Each age group (adult, child, and infant) has a guidedpractice video that progresses through singleproviderCPR skill learning. First students will learnhow to perform external chest compressions andthen rescue breaths. Next they will learn the steps ofprimary assessment for an unresponsive patient andthen they will put everything together to practice performingthe entire sequence of CPR.Roam through the class and watch for the competentperformance of skills. Replay segments of the videoif additional practice is required for that segment.Remote Skills Practice and EvaluationStudents can practice and be evaluated on their skillsremotely through the use of internet video technology.Both the Instructor and the student will need an appropriatecomputer and computer video camera thatare hooked up to the internet. Adequate internetbandwidth is essential to make sure accurate timingcan be measured.Skills evaluation can be recorded or can be done live.Competent performance of skills is required for acceptance.If the skills evaluation is recorded and is not acceptable,the Instructor must have a live (phone or online)conversation with the student to remediate skill performance.If the skills evaluation is live, remediationcan be done immediately. In either case, the studentmust be allowed some additional practice time beforebeing evaluated again.Instructional DesignASHI promotes an instructional approach that isbased on simple and practical applications. The focusis on gaining the skills and building the confidence tohandle an emergency situation. Skills are best learnedand retained by repeat practice. Instructors can makethe most of class time by limiting lectures to essentialknowledge, and focusing on hands-on skill practice.Four-step Instructional ApproachStep 1: Present the Knowledge ContentSample curricula provide the key information abouteach topic. Lecturing too far beyond this material willreduce skill practice time and should be avoided.Step 2: Demonstrate SkillsDemonstrations may be done live or by video. Whendemonstrating skills, a high-quality performance isessential because students will tend to copy it.When giving a demonstration, consider using theWHOLE-PART-WHOLE method:• WHOLE: Demonstrate the entire skill, beginning-to-end,briefly naming each action or step.• PART: Demonstrate the skill again, step-bystep,integrating information and facts whilepointing out common errors in technique. Presentonly the knowledge necessary to for thestudent to adequately perform the skill. To help,have students look at the appropriate SkillGuide as you demonstrate.• WHOLE: Demonstrate the entire skill again —in real time — without comment. Perform itwithout remarks, interruption, or explanation.This helps students get a feel for the tempo ofthe skill and the opportunity to observe the sequenceof actions before they practice.Step 3: Allow Adequate Time for Students to Practicethe SkillsBreak students into small groups with the requiredequipment for the practice. Have one student act asa coach by reading the skill steps from the Skill Guidewhile another student performs the skill on a manikinor on another student who is playing the role of the illor injured patient. Have students rotate through theroles until all have played each role.An Instructor should circulate through the classroom,answering questions, correcting errors in technique,and providing constructive feedback and positive reinforcement.Avoid anxiety-producing, perfection-orientedskill checks. A stimulating, but non-threatening,environment is best for learning.Alternatively, when it is available, use video guided instructionto practice. Students watch and practicealong with a video demonstration of skills. Studentscan also practice along with an Instructor doing theskill. Allow time for each student to adequately imitatethe skills.More experienced or returning students may enjoy ascenario- or problem-based learning approach. Scenariosheets are available to support this approach.6 CPR Pro for the Professional Rescuer

CPR Pro for the Professional RescuerStudents who have not completed the required PerformanceEvaluations or have been scored incompetenton one or more have not successfully completedthe class.Sign and return all Performance Evaluations to theTraining Center responsible for the class.When conducting Performance Evaluations:• Students must perform and not verbalizeskills.• Students do not have to perform skills perfectly,just reasonably to achieve the desiredoutcome.• Evaluate consistently between students.• Avoid excessive communication.• Do not coach students.Written ExamsWritten evaluation is required for successful completionof the ASHI CPR Pro training program.Written Exams for this class can be found online inthe document section of Training Center Manager oryour Instructor Portal.Successful completion of a Written Exam requires acorrect score of 70% or better. Document the successfulcompletion of the written exam on the ClassRoster. When conducting written evaluation, take precautionsto prevent cheating and allow adequate timeto complete the exam.Rate Your ProgramEncouraging students to provide feedback and thenusing that feedback to improve instruction is an essentialaspect of any quality educational effort. All studentsare required to fill out the Rate Your Programclass evaluation in order to get a certification card.Tear-out Rate Your Program class evaluations arefound in the back of each Student Handbook. Theycan also be found online in the document section ofTraining Center Manager or your Instructor Portal.The evaluation allows students the opportunity tocomment on the program materials and on the Instructor’spresentation style and effectiveness.Collect and return the completed Rate Your Programclass evaluations to the Training Center responsiblefor the class.Class RequirementsThe following requirements are necessary to help ensureall students and Instructors experience a safe,enjoyable, and satisfying ASHI CPR Pro training class.Administration• Instructors must teach in accordance with themost recent administrative policies and proceduresas described in the Training Center AdministrativeManual (TCAM).• An Instructor must be authorized to teach theASHI CPR Pro training program in order to issuecertification cards.• There are no minimum age requirements for participationin an ASHI CPR Pro class. However, regardlessof age, students must be able tocompetently perform the required skill objectivesto receive a certification card.• The maximum allowed ratio is 10 students to 1Instructor. A ratio of 6 students per Instructor isrecommended.• The student-to-Instructor ratio for lecture anddiscussion may be exceeded when organizationalrealities make small class size unachievable.However, additional ASHI-authorizedInstructors must be available to maintain thestudent-to-Instructor ratio for skill practice andevaluation.• As part of an initial training class, Instructorsmust use one of the associated visual mediatools designed for the program. This includes theProgram Video, Program PowerPoint® presentation,or the online blended training class. Use ofa visual media tool is highly recommended for renewaltraining.• During a class, Instructors must provide informalevaluation and prompt feedback to studentsabout their skill performance. This will allow studentsto evaluate their skills and correct deficiencies.• An Instructor must verify that each student hasmet the required knowledge and skill objectivesbefore issuing a certification card. Instructorsmust include their registry number on the back ofthe card to validate it.• Each student must fill out and return to the Instructorthe Rate Your Program class evaluation.Completed evaluations must be returned to theTraining Center responsible for the class.8 CPR Pro for the Professional Rescuer

CPR Pro for the Professional Rescuer• Instructors must complete a Class Roster and returnit to the Training Center that is responsiblefor the class.Equipment• Required Equipment– Visual presentation equipment (television,monitor, projector)– Bag-mask devices (6:1 maximum student-todeviceratio)– Adult CPR training manikins (6:1 maximumstudent-to-manikin ratio)– Child CPR training manikins (6:1 maximumstudent-to-manikin ratio)– Infant CPR training manikins (6:1 maximumstudent-to-manikin ratio)– AED training devices and training pads (6:1maximum student-to-device ratio)Materials• Required Instructional Materials– ASHI CPR Pro Instructor Guide (printed ordigital)– ASHI CPR Pro media presentation (ProgramVideo, PowerPoint ® )– ASHI CPR Pro Class Roster– ASHI CPR Pro Performance Evaluations– ASHI CPR Pro Written Exam• Optional Instructional Materials– ASHI CPR Pro Scenario Sheets• Required Student Materials (for each student)– ASHI CPR Pro Student Handbook– ASHI CPR Pro Certification Card– CPR masks (disposable mouthpieces orvalves, if shared)• Optional Student Materials– Pair of disposable barrier glovesHealth and Safety• Screen students for health or physical conditionsthat require modifications of skill practice.• Follow the manufacturer recommendations forthe decontamination of manikins before, during,and after training.• Caution students to avoid awkward or extremepostures of the body.• Caution students to avoid certain skills duringstudent-on-student practice, including chestcompressions, rescue breaths, and abdominal orchest thrusts. These skills are not appropriate forstudent-on-student practice and must be performedon training manikins designed for thatpurpose.• Students must be informed to use proper liftingand moving techniques during a student-on-studentpractice in which a simulated patient ismoved. Students should not participate in thesepractices if they have a history of back problems.Classroom• Classes need to be conducted in a safe andcomfortable environment conducive to learning.• A carpeted floor is preferred. However, blanketsor mats may be used for practice sessions.• Comfortable seating is important and a table orwork area is quite useful.• A monitor stand can help ensure the monitor iseasily visible to all students.• An erasable white board, blackboard, or easeland paper can be very helpful.Classroom Safety• All Instructors must ensure a physically safelearning environment for their students.• Make sure there are no obvious hazards in theclassroom, such as extension cords that can betripped over.• In addition, Instructors should be aware of the locationof the nearest phone, first aid kit, AED, firealarm pull station, and fire extinguisher.• Instructors should have an emergency responseplan in case of serious injury or illness, includingevacuation routes from the classroom.• Students should be discouraged from smoking,eating, or engaging in disruptive or inappropriatebehavior.• When using disposable gloves in skills practice,Instructors must take necessary steps to beaware of students with latex allergies and providesuitable non-latex barrier products for their use inclass.CPR Pro for the Professional Rescuer9

Section 1 — Sudden Cardiac Arrest andEarly DefibrillationSudden Cardiac Arrest and Early DefibrillationReason for LearningRapid response to collapse from sudden cardiac arrest increases the likelihood of a successful outcome.Core Learning Objectives• Upon completion of this training program, a student will be able to describe how to recognize and providetreatment for sudden cardiac arrest.Instructional Tools Available• Student Handbook — Refer students to pages 1–2• PowerPoint ® Presentation — Use slides 1–13• Program Video — 4:09• Additional InformationSample CurriculumKnowledge Content1. Sudden cardiac arrest, or SCA, can occur without warning to anyone, at any time. It is one of the leadingcauses of death among adults in the United States.a. Each year, an estimated 295,000 out-of-hospital cardiac arrests in the United States are treated byEmergency Medical Services, or EMS. Many additional arrests occur and are treated in medical officesor hospitals.2. Sudden cardiac arrest happens when the normal electrical impulses in the heart unexpectedly becomedisorganized.a. The normally coordinated mechanical contraction of the heart muscle is lost, and a chaotic, quiveringcondition known as ventricular fibrillation can occur.3. Blood flow to the brain and vital organs abruptly stops. The lack of blood and oxygen to the brain causessomeone to quickly lose consciousness, collapse, and stop breathing.4. Brain tissue is especially sensitive to a lack of oxygen. When oxygen is cut off, brain death can occurquickly, within a matter of minutes.a. Without early recognition and care, the patient will not survive.5. Cardiopulmonary resuscitation, or CPR, allows a provider to restore some oxygen to the brain through acombination of chest compressions and rescue breaths.6. By itself, CPR is only a temporary measure that can buy time until more advanced care can be provided.7. The most effective treatment for ventricular fibrillation is defibrillation.a. To defibrillate, electrode pads are applied to the chest and an electrical shock is sent between the padsthrough the heart. This shock stops ventricular fibrillation so the heart’s normal electrical activity canreturn and restore blood flow.8. Successful defibrillation is often dependent on how quickly a patient is defibrillated.a. For each minute a patient is in cardiac arrest, his chance of surviving decreases by about 10 percent.After as little as 10 minutes, defibrillation is rarely successful.b. The amount of time it takes to recognize a problem, activate EMS, and have EMS respond and defibrillateis usually longer than 10 minutes. In most cases, it’s too late.Sudden Cardiac Arrest and Early Defibrillation CPR Pro for the Professional Rescuer 11

9. An automated external defibrillator, or AED, is a small, portable, computerized device that is simple tooperate.a. Turning on an AED is as simple as opening a lid or pushing a power button. Once it is on, an AED willprovide voice instructions to guide a provider through its use.b. An AED automatically analyzes the heart rhythm, determines if a shock is needed, and charges itself tobe ready to defibrillate. An operator simply pushes a button to deliver the shock when told to by theAED.10. In many cases of sudden cardiac arrest, if defibrillation could be delivered sooner, more people wouldsurvive.a. Immediate, high-quality CPR and early defibrillation with an AED can double or even triple the chancefor survival.Wrap UpBe sure to ask for and answer any questions students may have.Additional Information and Supplementary MaterialsRespiratory and Circulatory SystemsBecause the human body cannot store oxygen, it must continually supply tissues and cells with oxygen through thecombined actions of the respiratory and circulatory systems.The respiratory system includes the lungs and the “airway,” the passage from the mouth and nose to the lungs. Expansionof the chest during breathing causes suction, which pulls outside air containing oxygen through the airwayand into the lungs. Relaxation of the chest increases the pressure within and forces air to be exhaled from the lungs.The circulatory system includes the heart and a body-wide network of blood vessels. Electrical impulses stimulatemechanical contractions of the heart to create pressure that pushes blood throughout the body. Blood vessels in thelungs absorb oxygen from inhaled air. The oxygen-rich blood goes to the heart and then out to the rest of the body.Large vessels called arteries carry blood away from the heart. Arteries branch down into very small vessels that allowoxygen to be absorbed directly into body cells so that it can be used for energy production. Veins return oxygenpoorblood back to the heart and lungs where the cycle repeats.12 CPR Pro for the Professional Rescuer Sudden Cardiac Arrest and Early Defibrillation

Section 2 — BLS SkillsChest CompressionsReason for LearningEffective chest compressions are a vital part of high-quality CPR.Core Learning Objectives• Upon completion of this training program, a student will be able to explain how to perform effective chest compressionsfor adults, children, and infants.• Upon completion of this training program, a student will be able to correctly demonstrate how to perform externalchest compressions for adults, children, and infants.Instructional Tools Available• Student Handbook — Refer students to page 4• PowerPoint ® Presentation — Use slides 31–45• Program Video — 4:00• Demonstration• Practice Session• Skill Guide — Use Skill Guide 1 — Chest CompressionsSample CurriculumKnowledge Content1. If the heart stops, it is possible to restore at least some blood flow through the circulatory system by wayof external chest compressions.2. The most effective chest compressions involve the rhythmic application of downward pressure on the centerof the chest.a. External compressions increase pressure inside the chest and directly compress the heart, forcingblood to move from the heart to the brain and other organs.3. Compressions on adult patients are done at a rate of at least 100 compressions per minute. The chest iscompressed at least two inches on each compression.a. High-quality compressions are a critical component of effective CPR. Always compress fast and deepand allow the chest to rebound to its normal position at the top of each compression.4. Blood pressure is created and maintained with well-performed compressions.a. If compressions stop, pressure is quickly lost and has to be built up again. Minimize any interruptionswhen doing compressions.5. When compressing properly, a provider may hear and feel changes in the chest wall. This is normal.a. Forceful external chest compression is necessary if the patient is to survive.6. The compression technique for children is to use the heel of a single hand on the lower half of the breastbone.Compressions are less forceful than on an adult.a. The compression rate is also at least 100 compressions per minute and a child’s chest needs to becompressed at least 1 ⁄3 of its depth or about 2 inches.7. Compressions can be tiring. If necessary, a provider can use two hands to perform compressions on achild.8. To perform chest compressions on an infant, use two fingertips on the breastbone just below the nippleline.BLS Skills CPR Pro for the Professional Rescuer 17

9. Follow this Skill Guide for Chest Compressions.a. Adulti. Position patient face up on flat, firm surface. Kneel close to chest. Place heel of one hand on centerof chest. Place heel of second hand on top of first. You can interlace your fingers to help keep offchest.ii. Position your shoulders directly above your hands. Lock your elbows and use upper body weight topush.iii. Push hard, straight down at least 2 inches. Lift hands and allow chest to fully rebound. Without interruption,push fast at a rate of at least 100 times per minute.b. Childi. Position child face up on flat, firm surface. Place heel of one hand on lower half of breastbone, justabove the point where the ribs meet.ii. Position your shoulder directly over your hand. Lock your elbow and use upper body weight topush.iii. Push hard, straight down at least 1 ⁄3 the depth of the chest, or about 2 inches. Lift hand and allowchest to fully rebound. Without interruption, push fast at a rate of at least 100 times per minute.iv. Compressions can be tiring. If desired, use two hands, as with adults.c. Infanti. Place the tips of two fingers on the breastbone just below the nipple line.ii. Push hard, straight down at least 1 ⁄3 the depth of the chest, or about 1 1 ⁄2 inches. Lift fingers andallow chest to fully rebound. Without interruption, push fast at a rate of at least 100 times perminute.iii. With two or more providers, compress the breastbone using two thumbs, with your fingers encirclingthe chest.Instructor DemonstrationProvide clear demonstrations of Chest Compressions using Skill Guide 1.• Be careful to present only the knowledge necessary for the student to reasonably perform the skill.• To help you focus on the skills, use the Skill Guide as you demonstrate and have the students do thesame.Student PracticeBreak students into small groups and have them practice Chest Compressions using Skill Guide 1.• Allow adequate time for practice.• Make sure each group has adequate equipment and materials to practice with.• Have one student coach another student as a “provider” through the skills using manikin as the ill orinjured person. Alternatively, students can practice skills while watching it performed on video or byInstructor.• Circulate through class, answering questions, correcting errors in technique, and providing constructivefeedback and positive reinforcement.Video Guided InstructionInstructors can elect to use a video guided instructional technique for this practice. The Program Video containsspecific segments for this approach.Wrap UpWhen adequate practice has been completed, be sure to ask for and answer any questions students may have.18 CPR Pro for the Professional Rescuer BLS Skills

Section 3 — BLS CareUnresponsive and Breathing — Recovery PositionReason for LearningWhen primary assessment indicates a patient is unresponsive and breathing normally, a provider can supply essentialhelp by maintaining an open and clear airway.Core Learning Objectives• Upon completion of this training program, a student will be able to explain how to protect the airway of an unresponsive,breathing patient.Instructional Tools Available• Student Handbook — Refer students to page 13• PowerPoint ® Presentation — Use slides 94–103• Program Video — 2:35• Instructor Demonstration (optional)• Practice Session (optional)• Skill Guide (optional) — Use Skill Guide 6 — Unresponsive and Breathing — Recovery Position• Case StudySample CurriculumKnowledge Content1. Even if a patient is breathing normally, a lack of responsiveness is still considered to be a life-threateningcondition that requires immediate care.2. There are a variety of things that can result in unresponsiveness, including medical conditions such asstroke or seizures, or external factors such as alcohol or drug overdose.a. Regardless of the cause, the greatest treatment concern is the ability of the patient to maintain a clearand open airway.3. Positioning an uninjured, unresponsive, breathing patient in the recovery position can help maintain andprotect the airway.a. This position uses gravity to drain fluids from the mouth and keep the tongue from blocking the airway.4. If an unresponsive patient has been seriously injured, a provider should not move him unless the provideris alone and needs to leave to get help.5. Frequently assess the breathing of anyone placed in the recovery position.a. The condition can quickly become worse and require additional care.6. Follow this Skill Guide for Unresponsive and Breathing — Recovery Position.a. Assess patienti. Pause and assess scene. Scene is safe!ii. Tap or squeeze shoulder. Ask loudly, “Are you okay?” No response!iii. Look quickly at face and chest for normal breathing. Occasional gasps are NOT considered normal.Normal breathing present!iv. Have someone alert EMS and get an AED.28CPR Pro for the Professional RescuerBLS Care

. Preparei. Extend arm nearest to you up alongside head.ii. Bring far arm across chest and place back of hand against cheek.iii. Grasp far leg just above knee and pull it up so foot is flat on ground.c. Rolli. Grasp shoulder and hip and roll patient toward you. Roll in a single motion, keeping head, shoulders,and torso from twisting.ii. Roll far enough for face to be angled forward.iii. Position elbow and knee to help stabilize head and body.d. Suspected injuryi. If patient has been seriously injured, do not move unless fluids are collecting in airway, or you arealone and need to leave to get help.ii. During roll, make sure head ends up resting on extended arm and head, neck, and torso are in line.Instructor Demonstration (optional)Provide clear demonstrations of Unresponsive and Breathing — Recovery Position using Skill Guide 6.• Be careful to present only the knowledge necessary for the student to reasonably perform the skill.• To help you focus on the skills, use the Skill Guide as you demonstrate and have the students do thesame.Student Practice (optional)Break students into small groups and have them practice Unresponsive and Breathing — Recovery Positionusing Skill Guide 6.• Allow adequate time for practice.• Make sure each group has adequate equipment and materials to practice with.• Have one student coach another student as a “provider” through the skills using another student or amanikin as the ill or injured person. Alternatively, students can practice skills while watching it performedon video or by Instructor.• Circulate through class, answering questions, correcting errors in technique, and providing constructivefeedback and positive reinforcement.Wrap UpBe sure to ask for and answer any questions students may have. Use the following case study to help studentsrecall and reinforce key information.Case StudyScenario – You are called to aid a 25-year-old male who has collapsed on the grass outside of the shop wherehe works. The scene appears safe so you begin a primary assessment. You find him to be unresponsive andsee that he is breathing normally. You send another person to activate EMS and get an AED. What do you do?– Roll him into a recovery position and monitor breathing.BLS CareCPR Pro for the Professional Rescuer29

Section 6 — Foreign Body Airway ObstructionChokingReason for LearningRecognizing a patient who is choking and responding with the appropriate care is a simple and effective skill for aprovider to learn.Core Learning Objectives• Upon completion of this training program, a student will be able to describe how to recognize and providetreatment for choking of adults, children, and infants.Instructional Tools Available• Student Handbook — Refer students to page 32• PowerPoint ® Presentation — Use slides 189–215• Program Video — 7:03• Instructor Demonstration (optional)• Practice Session (optional)• Skill Guide (optional) — Use Skill Guide 17 — Choking — Adult, Skill Guide 18 — Choking — Child, and SkillGuide 19 — Choking — Infant• Case StudySample CurriculumKnowledge Content1. Choking can occur when a solid object, such as a piece of food or small object, enters a narrowed part ofthe airway and becomes stuck. On inhalation, the object can be drawn tighter into the airway and block airfrom entering the lungs.2. A forceful thrust beneath the ribs and up into the diaphragm can compress the air in the chest and createenough pressure to “pop” the object out of the airway.a. Direct compression of the chest over the breastbone can also create enough pressure to expel an object.3. A provider must be able to recognize the difference between a mild blockage and a severe blockage.4. With a mild blockage, a patient can speak, cough, or gag. This type of blockage is typically cleared bycoughing.a. Encourage someone with a mild blockage to cough forcibly. Stay close and be ready to take action ifthings worsen.5. When a severe blockage occurs, a patient cannot dislodge the object on his own. Signs of severe obstructioninclude very little or no air exchange, high-pitched wheezing or lack of sound, and the inability tospeak or cough forcefully.a. A patient with a severe blockage may hold her hands to her throat as she attempts to clear an obstruction.A provider’s help is required to save the patient’s life.6. Young children are particularly at risk for choking because of the small size of their air passages, inexperiencewith chewing, and a natural tendency to put objects in their mouths.a. For a choking child, the approach is nearly the same as for adults. It might be easier to kneel behind achoking child to deliver thrusts.7. Since infants do not speak, it may be more difficult to recognize choking. A sudden onset differentiates itfrom other breathing emergencies.Foreign Body Airway Obstruction CPR Pro for the Professional Rescuer 45

a. Signs include weak, ineffective coughs, and the lack of sound, even when an infant is clearly attemptingto breathe.8. If a provider suspects an infant is choking, he should perform continuous cycles of five back blows andfive chest thrusts to expel the object.a. Do not perform abdominal thrusts on an infant.9. Abdominal and chest thrusts can cause internal injury. Anyone who has been treated with these maneuversfor choking should be evaluated by EMS or a physician to ensure there are no injuries.10. Follow this Skill Guide for a Choking Adult.a. Assess patienti. Ask, “Are you choking?”ii. If patient nods yes, or is unable to speak or cough – act quickly!iii. If available, have a bystander activate EMS.b. Position yourselfi. Stand behind patient.ii. Make a fist with one hand and place thumb side against abdomen, just above navel and below ribs.iii. Grasp fist with other hand.c. Give thrustsi. Quickly thrust inward and upward into abdomen.ii. Repeat. Each thrust needs to be given with intent of expelling object.iii. Continue until patient can breathe normally.d. If patient becomes unresponsive…i. Carefully lower to ground. Position face-up on a firm, flat surface.ii. If not already done, activate EMS.iii. Begin CPR, starting with compressions.e. Remove any object if seeni. Look in mouth for an object after each set of compressions, before giving rescue breaths.ii. Continue until patient shows obvious signs of life, or another provider or the next level of care takesover.11. Follow this Skill Guide for a Choking Child.a. Assess childi. Ask, “Are you choking?”ii. If child nods yes, or is unable to speak or cough – act quickly!iii. If available, have a bystander activate EMS.b. Position yourselfi. Kneel behind child.ii. Make a fist with one hand and place thumb side against abdomen, just above navel and below ribs.iii. Grasp fist with other hand.c. Give thrustsi. Quickly thrust inward and upward into abdomen.ii. Repeat. Each thrust needs to be given with intent of expelling object.iii. Continue until child can breathe normally.d. If child becomes unresponsive…i. Carefully lower to ground. Position face-up on a firm, flat surface.ii. If alone, provide at least two minutes of care before activating EMS.iii. Begin CPR, starting with compressions.e. Remove any object if seeni. Look in mouth for an object after each set of compressions, before giving rescue breaths.ii. Continue until child shows obvious signs of life, or another provider or the next level of care takesover.46 CPR Pro for the Professional Rescuer Foreign Body Airway Obstruction

12. Follow this Skill Guide for a Choking Infant.a. Assess infanti. Look at infant’s faceii. If infant is silent, unable to cry, or has blue lips, nails, or skin – act quickly!iii. If available, have a bystander activate EMS.b. Give 5 back blowsi. Straddle infant face-down over your forearm, with head lower than chest.ii. Support head by holding jaw.iii. Using heel of other hand, give 5 back blows between shoulder blades.c. Give 5 chest thrustsi. Sandwich infant between your forearms and turn onto back, with legs and arms straddling yourother arm.ii. Place 2 fingers on breastbone just below nipple line and give 5 chest thrusts.iii. Repeat back blows and chest thrusts until infant can breathe normally.iv. Back blows and thrusts need to be given with intent of expelling object.d. If infant becomes unresponsive…i. Carefully lower to ground. Position face-up on a firm, flat surface.ii. If alone, provide at least two minutes of care before activating EMS.iii. Begin CPR, starting with compressions.e. Remove any object if seen.i. Look in mouth for an object after each set of compressions, before giving rescue breaths.ii. Continue until infant shows obvious signs of life, or another provider or the next level of care takesover.Instructor Demonstration (optional)Provide clear demonstrations of the relief of choking using Skill Guides 17–19.• Be careful to present only the knowledge necessary for the student to reasonably perform the skill.• To help you focus on the skills, use the Skill Guides as you demonstrate and have the students do thesame.Student Practice (optional)Break students into small groups and have them practice the relief of choking using Skill Guides 17–19.• Allow adequate time for practice.• Make sure each group has adequate equipment and materials to practice with.• Have one student coach another student as a “provider” through the skills using another student or amanikin as the ill or injured person. Alternatively, students can practice skills while watching it performedon video or by Instructor.• Circulate through class, answering questions, correcting errors in technique, and providing constructivefeedback and positive reinforcement.Wrap UpBe sure to ask for and answer any questions students may have. Use the following case study to help studentsrecall and reinforce key information.Case StudyScenario – You are eating lunch at a restaurant when an 18-year-old male at the table next to you suddenlystands up grasping his hands around his throat. What do you do?– Quickly get to him and ask “Are you choking?” If he nods yes, or is unable to speak or cough, providecontinuous abdominal or chest thrusts until he is able to speak and breathe normally.While you are trying to relieve the obstruction, he suddenly collapses. Now what do you do?– Carefully lower him to the ground. If not already done, activate EMS and begin CPR, starting with compressions.Look in the mouth for an object after each set of compressions before giving rescuebreaths. Remove any object if seen.Foreign Body Airway ObstructionCPR Pro for the Professional Rescuer47

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