Why do we need AED training?

Sudden death is not a rare event; each year close to 350,000 people suffer a cardiac arrest and without immediate treatment, a significant number die. Sudden death can occur at any time and in any location; the individual may suddenly stop breathing, lose consciousness, and collapse.

EMS ARRIVAL

When you come across a person who is having a cardiac arrest, the first thing to do is to call 911. But depending on where you are, the average time for EMS to arrive at the scene can vary from 5-to 10 minutes; and if it is rush hour the delay can even be more. When a person develops a cardiac arrest, the brain can only survive without blood for no more than 3-4 minutes. For each minute of delay in defibrillation, the odds of survival are significantly reduced by 10%. Even if the individual survives, residual brain damage is common. 

Brain Injury

Even with successful CPR most patients will have various types of neurological deficits which may take months or years to recover. Because the nerves are very sensitive to the lack of oxygen, there is a risk of permanent brain damage. So if there is going to be a delay in EMS arrival the only chance of protecting the brain and other organs is having access to an AED. 

However, even if you get access to an AED it is also important to request the services of emergency medical professionals. But once the victim’s heart rhythm is restored, the odds of survival are markedly improved but immediate care in an intensive care setting is necessary.

AEDs

AEDs have been around for about half a century and studies show that when used promptly, they can restore normal heart rhythm following a cardiac arrest. The latest AEDs are portable, light, rugged, user-friendly, and come with visual and verbal prompts. Because AEDs are effective in restoring heart rhythm after a heart attack, today they can be found in many places. This includes most work and public places including airplanes, railway stations, governmental buildings, and most sports arenas.

The latest AEDs can guide the rescuer on how to perform CPR and where to place the electronic pads on the victim’s body. These high-tech electrical pads can quickly sense the victim’s heart rhythm. And if there is a need will administer a shock to restore the heart rhythm.

Who can use an AED?

Because a cardiac arrest is a life-threatening emergency that requires immediate treatment, virtually anyone can use an AED. Even a child can use these devices in an emergency. More sophisticated AEDs are primarily used by healthcare workers who have good knowledge and training in the treatment of heart attacks. Most lay people usually use the simpler AEDs found in public places. There are at least 6 types of AEDs on the market for public use and they all work similarly. But still, a first-time responder should have some idea how these devices operate and when to use them.

Are there laws regarding the use of AEDS?

Over the past few years, all US states have defibrillator laws that protect the manufacturer. These laws also protect the bystander who provides CPR and uses the AED on a patient who has suffered a cardiac arrest.

What is the current status of AEDs in the US?

Currently, almost all states are working to do the following:

  • Ensure that AEDs are readily available in all public places
  • Encourage the public to learn how to use AEDs
  • Ensure that all AEDs on the market meet the manufacturer’s standard
  • Develop a registry of AED locations in every city
  • Create good samaritan laws to protect citizens from liability
  • Create a list of registered AED users who are certified

Operating an AED

The latest AEDs are so simple to use that even a child can operate the device. As soon as you remove the device from the box turn it on as it will provide verbal prompts on how to proceed.

However, before you use the AED it is important to know the signs of a cardiac arrest. If you come across an individual that has fainted or is unresponsive, before you use an AED you should do the following:

  1. Time is critical and you should move quickly and accomplish the below tasks within 10-15 seconds
  2. First, check if the individual is responsive/ ask the individual in a loud voice if he is okay?
  3. Quickly check the breathing, pulse and if he or she is unresponsive
  4. If there is no pulse and the individual is not breathing, ask someone to call 911
  5. If you are alone, call 911 before you start the resuscitation process
  6. Speak loudly if you see anyone approach you and ask if they find an AED; these devices like fire extinguishers will be found on the walls in glass cases.
  7. Turn the on switch on the AED as it will give you step by step instructions. The prompts will tell you how to check the pulse, breathing and where to place the electrode pads on the victim’s chest
  8. The electrical pads will immediately sense the victim’s heart rhythm and deliver a shock if needed. If the machine plans to deliver a shock, it will tell the user to stand back and press the red button to deliver the shock
  9. Once the defibrillator delivers the shock, you should start CPR. The AED will guide the user through the steps of CPR. 
  10. Continue this process until emergency personnel arrive.

Watch videos

To get some idea how to use an AED, the Red Cross has online videos that can be viewed for free. 

Why do we need CPR training?

In-Pulse CPR is an American Heart AHA Training Center (TC)

Introduction

According to the CDC, heart disease is the leading cause of death in the U.S. Each year heart disease claims the lives of more than 600,000 people. And the numbers are gradually increasing each year. According to data released by the American Heart Association, more than 50% of cardiac arrests occur away from a healthcare setting. Tragically, more than 88% of these individuals who suffer cardiac arrest away from a healthcare facility die. The good news is that CPR can save lives if performed promptly.

Chance to Save a life

We live in a hectic fast-paced world. And accidents happen all the time- they may occur anywhere and any time. It is not often that one gets a chance to save a life. But by knowing CPR it can help you save someone; the individual maybe your child, parent, or even a stranger. The most beneficial thing about CPR is that training is not time consuming. It only requires a few hours of dedicated study time. The courses are given by trained professionals who ensure that you learn the basic information. Knowing how to perform CPR can be empowering as it gives you the confidence to deal with an arrest. Once you take a course in CPR, the basic techniques of saving a life will stay with you forever.

Why CPR Matters

Cardiopulmonary resuscitation (CPR) is a life-saving technique that can help maintain blood flow to the brain and other organs during an arrest. Here are some reasons why knowing CPR is critical.

  1. CPR can save a life. When you come across an emergency, the first action is to call 911 but it usually takes EMS a few minutes to arrive. During these precious few minutes, you have the perfect opportunity to save a life. If you have training in CPR, then you can apply the technique to assist the victim until the first responders arrive. By performing CPR ASAP, you can preserve blood flow to the brain and other organs.
  2. Save the life of your loved one. The vast majority of cardiac arrests do not occur in a hospital but in a home. More importantly, many of the victims of sudden cardiac arrest may not have any known risk factors for heart disease. By knowing CPR, you can save the life of a loved one.
  3. Improve your confidence. Studies show that about 30-50% of individuals who suffer a cardiac arrest never receive life saving assistance from bystanders. The reason bystanders may not want to perform CPR is because they may not have the proper training, fear of getting involved, or are not confident about their skills. Anyone can learn how to perform CPR. It is not a complex technique to master and is a technique that people of all ages can easily master. According to the American Heart Association, nearly 2/3rd of Americans who witness a cardiac emergency feel helpless at administering CPR. But by learning the technique once, the key information will be etched in the brain forever. Taking a course can greatly reduce your fears and boost your confidence in the event you have to administer CPR.
  4. Prevent brain death. When the heart stops pumping blood, it only takes 4-6 minutes before the nerves in the brain start to die. Thus it is vital to restore blood flow to the brain as soon as possible. CPR can effectively maintain blood flow to the brain and other vital organs. This increases the chance that the individual may survive and make a complete recovery. Data show that when CPR is initiated within 2 minutes of a cardiac arrest, the chance of survival immediately doubles.
  5. CPR improves your medical knowledge. There is no question that people who take CPR classes are a little smarter than those who do not when it comes to managing a cardiac arrest. By knowing CPR you will have the tools to save a life. Taking classes in CPR not only builds confidence in you but it will equip you with all the knowledge needed to perform a life-saving technique and save a life. The CPR training will allow you to make the appropriate decisions in running cardiac arrest
  6. CPR classes are part of life and learning. Finally learning CPR is not difficult at all and it is a great technique to know just in case you encounter an individual with cardiac arrest. CPR classes should be part of everyone’s education. It is a work-related skill that has benefits that go way beyond the classroom as you may save the life of a loved one.

CPR in Babies

Introduction

There are some subtle differences in performing CPR in babies compared to adults and older children. Babies are not only smaller in size but are also fragile- CPR done inappropriately can cause damage to many internal organs in children less than 1 year of age. But it is important to know how to perform CPR in babies as it can save a life.

Causes of arrest in Babies

When CPR is done properly it can help deliver oxygen to the brain and other organs until trained emergency personnel arrive or the baby recovers.

In general, babies have varied causes for cardiac arrest but the majority of cases are due to an illness or a major injury. Very rare is cardiac arrest in a baby from underlying congenital heart disease.

It is important for everyone that while one can obtain the basics of CPR in babies from reading an online course, there is no substitute for a real hands CPR training course. The basic CPR skills in babies are simple and can be easily learned in several hours.

Offering CPR to a baby

First, check if the baby is responsive to touch or voice. You also need to check if the baby is breathing or only gasping. You need to initiate CPR if the baby is not:

  • Breathing or is gasping
  • Moving or appears lifeless
  • Responding to touch
  • Wake up
  • Alert

Initiating CPR

  1. If you are alone and have a smartphone, initiate CPR while calling 911 but use the speaker to communicate at the same time
  2. Do not leave the baby to make the call.
  3. After 2 mins of CPR (roughly 5 cycles), search for an AED
  4. If you are alone and do not have a smartphone, start CPR for 2 minutes and then call 911 from a landline and see if you can find an AED
  5. If you have someone else with you, ask that person to call 911 stat and get an automated external defibrillator ASAP while you initiate CPR

Chest Compressions

  1. Place the infant on a firm flat surface
  2. Avoid too much time looking for a pulse in a baby
  3. Place two fingers on the middle of the breastbone, just below the nipple line
  4. Perform 30 quick chest compressions. Each time push fast and hard enough to move the baby’s chest about 3-4 cm. Count loud with every chest compression
  5. Try to deliver about 100-120 chest compressions every minute.
  6. In between each compression, allow the baby’s chest to revert back to its original position- this will help ensure blood flowing to the baby’s brain and other organs

Rescue Breathing

  1. First, you need to open the airway: Place the palm of your left hand on the baby’s forehead. Then place two fingers of the right hand, on the chin and gently tilt the head back- this should open the airway.
  2. Place your mouth over the baby’s mouth and nose, forming a tight seal. Give two breaths. Each breath should be enough to cause the baby’s chest to rise. The breath should not be more than 1 second.
  3. The chest should rise. Remove your mouth and watch the chest fall. 
  4. If the baby’s chest does not rise, quickly reposition the forehead and form a tight seal and perform rescue breathing
  5. Give cycles of 30 chest compressions and 2 breaths during the two-minute cycle. 
  6. Continue until EMS arrives or until the baby starts to breathe again.
  7. Two minutes of CPR will permit you to perform 5 cycles of 30 chest compressions with two rescue breaths. 
  8. While 2 minutes of CPR may not sound long, it is quite tiring. Therefore, if you are not alone, you should switch as a performer every 2 minutes.

Recovery position

If the baby starts to breathe on his or her own, there is a chance that it may vomit and this can make breathing difficult. Hence, it is important to place all babies in a recovery position. The chin should be slightly angled from the chest and the face should rest on a flat surface. You have to make sure that nothing is covering or blocking the baby’s nose or mouth. By placing the baby in the recovery position, this will allow for the airway to remain open.

CPR In Children

The protocol for CPR in children is similar to that in adults.

Safety First

  1. Always make sure that the child is away from any impending danger. CPR should always be done in a safe location
  2. The next step is to check the child’s level of consciousness. Do this by tapping the child on the shoulder and asking, “Are you okay?’ Or ‘Can you hear me?’
  3. The third step is to quickly scan the child to see if he or she has any obvious injuries, medical issues, or bleeding

Check for Breathing

  1. Quickly check if the child is breathing on his own. You may have to put your ear next to the child’s nose or mouth and you may feel breath on your cheeks. At the same time, check to see if the child’s chest is moving.
  2. If the child is unconscious but you can see the chest moving, call 911 and wait for EMS to arrive. Children who can breathe do not need CPR

All the above maneuvers should not take more than 10-15 seconds. Time is of the essence and one has to be fast

Call 911

  1. If you are alone with the unresponsive child, call 911 after you have performed 2 mins of CPR.
  2. If there is help available, ask the other person to call 911 and also look for an AED.

Start CPR

If there is no sign of breathing, start CPR ASAP

Chest compressions in a child

  1. First, gently place the child on his/her back against a firm surface
  2. Place the heel of one hand on the center of the chest at the nipple line. If the child is older, then you may want to use two hands to perform CPR- you can do this by placing the other hand on top of the first hand.
  3. In a child, the chest should be compressed by about 2 inches. It is vital not to compress the ribs as they are fragile and susceptible to fracture
  4. Perform 30 chest compressions at a rate of 100 per minute. Let the chest rise completely between each push
  5. After the first 30 compressions, quickly check to see if the child has resumed breathing
  6. If there is no breathing, resume CPR until EMS arrives.

Rescue Breathing

First, check to see if the child has resumed breathing from the CPR

  • To open the child’s airway, lift the chin up with your right hand and at the same time, tilt the head back with the other hand by pushing down on the forehead. 
  • If you suspect that the child has a head or neck injury, do not tilt or manipulate the neck
  • To perform rescue breathing, cover the child’s mouth with yours, pinch the nose and give breaths
  • Give the child two breaths and each time check to see if the chest rises. Each breath should take no more than 1 second.
  • If you do not see the chest rise with the first breath, retilt the head and ensure that you have a proper seal with your mouth before giving the 2nd breath.
  • If the second breath does not cause the chest to rise, there may be an object blocking the child’s airway. Check the mouth quickly to see if there is any food or foreign body.

Continue CPR

If the child has not resumed breathing, continue with CPR and rescue breathing 

  1. Offer two breaths for every 30 chest compressions
  2. If another individual is assisting you, perform 15 compressions followed by 2 breaths.
  3. Continue the cycle of 30 chest compressions and 2 breaths until the child resumes breathing or emergency help arrives.

What If You Are Alone

  • If you are alone with the child and have already performed 2 minutes of CPR or about 4 cycles of compression and rescue breathing) call 911 and look for an AED.

Using an AED

  1. As soon as an AED is available it should be utilized.
  2. For children less than 9 years of age, use a pediatrics automated external defibrillator if available.
  3. If a pediatric AED is not available, you may have to use the standard AED

AED use

  1. Turn on the AED
  2. Today almost all AEDs are automated and provide verbal directions on usage.
  3. Ensure that the child’s chest is dry and attach the pads as shown on the AED machine
  4. You will then be provided with step by step directions on how to use the AED from this point.
  5. Continue chest compressions and follow the AED prompts until the child resume breathing or emergency help arrives.

The only way to be proficient at CPR is to keep updated with the course and assist others when the opportunity arises.

Dad Saves Daughter’s Life with CPR after Seeing It Performed on TV Show

It suddenly happened in the summer of 2021. An unexpected cardiac arrest. This time the victim was a 4-year-old girl.

Fortunately, the girl’s father, Mat Uber, 46, of Carmel, Indiana, saved the little girl’s life after deploying CPR – something he remembered from watching The Office, a sitcom on NBC.

Mr. Uber spoke of the horrifying moment when he realized he had to move fast to rescue his daughter, Vera Posey.

A sudden cardiac arrest (SCA)  during a game of tag was the reason. Having watched CPR on the series, The Office, Uber revived his daughter using what he had remembered. He said Steve Carrell, who played MIchael Scott on the TV show, performed CPR on one of the episodes.

After a few seconds of laughter during the game of chase, Uber’s daughter suddenly slowed down. He said he saw her lying on the ground when he turned around.

Uber added he thought she had hit her head. At that moment, his mind flashbacked to the TV show and CPR. He urged his 16-year-old daughter to call an ambulance.

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In the episode, a CPR teacher visits Dunder Mifflin to educate the staff on how to do chest compressions in tune to the Bee Gees’ 1970s tune Stayin’ Alive.

Uber said, he wondered, “‘What do I know about CPR?’ I don’t have formal training.” He added that the scene from The Office suddenly came to him during that panic-stricken moment. He needed to do something to keep his daughter alive, and do it immediately.

The family later found out that Vera had a life-threatening and rare syndrome that affects the heart’s rhythm called calmodulinopahty.

Paramedics used a defibrillator (AED) to shock Vera’s heart back to a normal while resuming  CPR and resuscitation efforts.

At Riley Hospital for Children in Indianapolis, Uber and his wife discovered that their daughter had gone into cardiac arrest. According to Uber, Vera had no warning signs before the event.

Little Vera received a cardioverter defibrillator (ICD), an implantable device that shocks the heart into working if it stops functioning. Uber hopes that his family’s story will inspire people to get officially certified in CPR and AED.

The father added that Vera is “. . . doing spectacularly [well]. We’re incredibly lucky.”

While CPR, no doubt, saves lives, knowing how to use an automated defibrillator (AED) ensures increased survival rates.

Because it is a medical emergency, sudden cardiac arrest (SCA) must be taken seriously. That is why both CPR and AED training are imperative. When an AED is used, an electric shock is delivered to the heart via the AED. A heart that has stopped beating is brought back into rhythm by applying a jolt of electricity.

Needless to say, both CPR and defibrillation work best when performed as soon as possible following the  onset of an SCA. SCA survivability decreases at an alarming rate with each passing minute.

First responders, such as police officers and paramedics, are familiar with the steps used for defibrillation. If someone is showing signs or symptoms of SCA, call 9-1-1 immediately. The sooner you seek assistance, the sooner they can start receiving life-saving care.

Bystanders can use AEDs and do not need to be emergency personnel. The portable devices often are found at public sites, such as golf courses, airports, cansinos, malls, and hotels.

If an arrhythmia is detected, an AED is programmed to deliver an electric shock. The programming only allows the current to be transmitted to SCA victims. CPR should be given until you can gain access to an AED.

If you or a loved one is at risk for an SCA, you might consider getting advice from a doctor about adding an AED in your home. SCAs can happen without warning. Make sure you are equipped by learning CPR and the AED process.

How CPR Saved One Golfer’s Life

On July 30, 2013, Ralph Harms, 78, was out on the course with his son Joe and friend Doug Green. At the fourth hole, Ralph was excited. He shouted, “Yeah, baby!” after nailing a long putt.

However, three days later Harms awoke in the hospital. He had gone into cardiac arrest and did not recall anything until then.

He compared the event to suddenly switching off a light switch. He did not experience any signs that anything was wrong.

Ralph’s son, Joe, learned CPR from his father about 4 years earlier. At the time, the two men were watching football and saw an ad about getting CPR certified. To maintain his certification, the elderly Harms continued to maintain his endorsement every two years. Ralph remembered showing Joe how to perform chest compressions during a break in the game.


According to Ralph, it was good Joe remembered how to do the compressions, as he would never have been able to tell his tale of survival.

As Doug dialed 9-1-1 on his mobile phone, Joe performed CPR on his Dad. Ralph’s heart stopped three times while emergency personnel were on the way. Joe continued the chest compressions while he waited for help.

For the first three days of his recovery, Ralph was kept in in a drug-induced state of unconsciousness.

The knowledge and use of CPR were both critical to Ralph’s survival. Again, because of CPR, Ralph survived so he could tell people about his experience.

CPR saves lives and does not take a lot of time to learn. Moreover, you can glean this must-have skill easily anytime.

Besides saving lives, learning CPR and AED, in combo, prevents brain death and reduces recovery times. CPR is used when the heart stops beating during a cardiac arrest,

Brain death typically happens four to six minutes after the heart has stopped pumping. When CPR is performed, the brain and other vital organs get the oxygen they need to continue to operate.

Two minutes of cardiopulmonary resuscitation (CPR) increases a person’s chances of survival twofold. The longer a patient goes untreated the greater the physical toll it takes.

While you don’t have to get formal training in CPR, it still is better to have it. In the event of an emergency, phone 9-1-1 immediately.

If a bystander is present, start CPR while he or she calls 9-1-1 and looks for an automatic external defibrillator (AED). This will save you valuable time. Defibrillators (AEDs) are devices that shock the heart and restart it.

Aim to do 100 to 120 pushes each minute in the middle of the chest. The American Heart Association (AHA) recommends that you time the compressions. Hands-only CPR is an alternative to mouth-to-mouth CPR, and does not require breathing into the mouth of the victim.

Continue giving CPR until medical help arrives.

When the heart stops beating abruptly and unexpectedly, it is called a sudden cardiac arrest (SCA). If this occurs, essential organs, such as the brain and heart, are deprived of their blood  and oxygen supply. If SCA isn’t treated within minutes, it frequently results in death.

An understanding of the heart’s mechanisms helps in defining SCA. The heart’s electrical system regulates the heartbeat’s pace and rhythm. Therefore, the heart’s circuitry, when it malfunctions, leads to an arrhythmia or irregular heartbeat.

Arrhythmias come in various forms. As a result, the heart may beat too fast or too slow. In some cases, it may beat erratically. Arrhythmias that prevent the heart from pumping blood to the body trigger an SCA.

It is important to distinguish between an SCA and a heart attack. A heart attack happens when blood flow to a portion of the heart  is disrupted. The heart normally doesn’t stop beating immediately during a heart attack. Even after a heart attack, an SCA may still occur during recovery.

An SCA may also strike healthy individuals with no history of heart disease or another predisposing condition. Therefore, don’t discount the importance of CPR and AED training. With the knowledge you receive, you might very well end up saving the life of someone you love.

Child Respiratory Emergencies

My son was two years old when I returned to work in 2005.  Each day, I strapped him into his car seat to take him to and from his childcare center.  One afternoon, as I drove my son home, I heard a strange sound from the backseat.  I looked in the rearview mirror and my stomach dropped.  His lips were blue, and the strange sound I was hearing were his attempts at gasping for breath.  I took him straight to the emergency room, where the staff treated him using a nebulizer and told me to see his pediatrician right away.  I did, and the hospital’s diagnosis was confirmed – pediatric asthma.

For about three years, I strapped a mask over my son’s face while he sat in my lap and breathed in Albuterol, a bronchodilator that restored his breathing to normal.  The attacks were often sudden – often enough for me to keep the nebulizer in the car and the Albuterol in my purse.  A few times I even rushed into coffee shops or fast-food restaurants and begged them to let me use an outlet to plug in the nebulizer so I could treat my son right away.

Respiratory emergencies are frightening, and, according to Registered Respiratory Therapist Nancy Johnson, respiratory disorders are the second leading cause for parents to take children to the ER.  They are the number one cause for children under the age of four.  Johnson also notes that children under respiratory distress deteriorate quickly and “airway urgencies can quickly progress to airway emergencies.”  She uses the ABCDE Assessment Tool to assess respiratory conditions:

  • Airway (Is it obstructed?)
  • Breathing (Are there signs of distress?)
  • Circulation (Does their color look OK?)
  • Disability (Are they functioning normally?)
  • Exposure (Are there any wounds or notable injuries?)

Approximately half of children with pediatric asthma outgrow it, and my son was in that lucky half.  However, while his asthma was a threat, I received training in child and baby CPR.  Fortunately, I never had to use it, but the knowledge gave me peace of mind.

Does CPR really save lives? Yes, it does.

By Liv Hernandez

Does CPR really save lives? Yes, it does. There is one recent news story that can attest to that. The CDC estimates that administering CPR to a person suffering from cardiac arrest can double their chances for survival. Cardiac arrest can strike an individual at any time or place.

In the case of Steve M., it struck him when he was at his home. He was alone, and very scared when the attack came on. Thankfully his son, Skylar, arrived for a visit a short while later. He was shocked to find Steve lying there unconscious on his bathroom floor. Skylar called the paramedics and was informed that it would be a few minutes before they could arrive.

Skylar jumped into action and began administering CPR to Steve. This ended up saving his father’s life. Steve was conscious again by the time the paramedics arrived. This is just one case that proves how life saving CPR can be. Since Cardiac arrest can strike at any time, you could describe it as a sudden killer. Taking the time to learn and become CPR certified means you can save someone’s life.

You can help them become one less statistic. Death rates for cardiac arrest victims are very high. The majority of these attacks occur in public. This increases the chances of the attack being witnessed by a bystander. If this bystander were to administer CPR they could save the victim’s life.

We all live in this world together, so we should all look out for one another. If you look online you will discover many local institutions that will offer you CPR training. If you were in the same situation as Steve from the story, you would want someone to come to your aid. We all would. Learn CPR and start the change first. Help someone and you just might get the help you need in return. As cardiac arrest numbers rise, more people are joining together to become CPR certified. Join them and help save lives. No one wants to be a statistic.

https://www.heart.org/en/affiliates/cpr-saves-lives-steve-munatones-is-here-to-prove-it

https://www.cdc.gov/heartdisease/cpr.htm

Respiratory emergencies in children

Respiratory emergencies in children are not uncommon and when they occur, they are somewhat more difficult to manage than in adults for several reasons. First, the patient is fragile, secondly, the entire oral cavity and upper airway are small and easily prone to obstruction, and third, without having the right tools and equipment, resuscitation can be difficult. Finally, unlike an adult, the child has a limited respiratory reserve and respiratory distress can quickly lead to cardiopulmonary arrest. To know how to manage respiratory emergencies in children, it is important to know some of the common causes and how they present.

Asthma

Asthma is one of the most common lung disorders that affect adults and children. Each year, children lose close to 14 million school days to asthma. The disorder is characterized by recurrent symptoms that are triggered by many factors that include the following:

  • Environment-air pollution, smoking, allergens, poor air quality
  • Indoor allergens like roaches, pet dander, perfumes dust mites, mold, feathers
  • Having a medical condition like allergic rhinitis, atopic eczema, hay fever
  • Use of certain medications like beta-blockers, aspirin
  • Viral and bacterial infections of the upper respiratory tract
  • Stress

Asthma may occur several times a day or it may occur once a month. In most cases, asthma tends to worsen with exercise or at night.

Presentation

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Dry cough

Asthma can present with recurrent symptoms that include:

Diagnosis

The diagnosis of asthma is based on the presentation, pattern of symptoms, and response to treatment. Lung function studies (spirometry) can be used to confirm the diagnosis. Once the diagnosis is made the condition is graded depending on the frequency and intensity of the symptoms. The treatment of asthma is with prescription medications.

Status asthmaticus

Acute asthmatic attack (status asthmaticus) is a medical emergency that presents with severe shortness of breath, chest tightness, and wheezing. The individual will have little or no air entry into the lung and some may not even be able to speak. They may use their accessory muscles to breathe and bluish discoloration of the nails and skin is not unusual. An acute asthmatic attack may be triggered by an infection, allergen, or inappropriate or insufficient use of the asthma medication. These patients need immediate treatment in the nearest emergency room. The treatment goals include:

  1. Reversing the airway obstruction immediately with the use of beta-agonists and corticosteroids
  2. Correcting the hypoxemia by administering oxygen
  3. Prevent complications like respiratory arrest and pneumothorax. 

These patients need to be admitted until the acute attack has subsided. Some may even require admission to the ICU because of the need for mechanical ventilation.

The education of the patient is vital in preventing status asthmaticus. Status asthmaticus can usually be prevented if patients are compliant with their medications, avoid triggers and stress factors. 

Croup

Croup also referred to as laryngobronchitis is caused by a viral infection (usually parainfluenza viruses) and mostly affects children between 6 months to 3 years of age. The condition appears to be more common in males than females and tends to occur during the fall season. Besides viruses, croup can also be caused by many bacteria including H. influenzae and Strep pneumonia. The infection leads to a swelling of the larynx, trachea, and large bronchi, which then causes airway obstruction. The classic symptoms of croup include:

  • Stridor
  • Barking cough
  • Hoarse voice
  • Fever
  • A runny nose may also be present

The symptoms usually start at night and last about 24-48 hours.

While many cases of croup are mild, in some children the symptoms can be quite severe and lead to respiratory distress. The diagnosis of croup is made clinically by excluding other causes of airway obstruction. A lateral x-ray may show the classic narrowing of the upper trachea (steeple sign). The Westley score is used to classify the severity of croup and includes five features:

  • Cyanosis
  • Degree of mental alertness
  • Stridor
  • Muscle retractions 
  • Air entry

Most cases of croup are managed conservatively but those with moderate or severe symptoms need epinephrine and steroids. Oxygen is administered if hypoxia is present. Severe cases also need to be hospitalized and monitored. The rare child may even require mechanical ventilation.

Bronchiolitis

Bronchiolitis is a relatively common childhood lung disorder that is associated with wheezing and respiratory distress. In children, it is often mistaken for asthma. Bronchiolitis is caused by the respiratory syncytial virus and affects children less than 2 years of age. The condition is most common during winter. Children at risk for bronchiolitis include those:

  • Who have associated congenital heart disease
  • Were preterm at birth
  • Are immunodeficient
  • Have exposure to tobacco smoke
  • Have a neurological disorder

Typical symptoms include shortness of breath, wheezing, runny nose, fever, and a cough. While most cases are mild, severe cases can present with grunting, nasal flaring, and an irritable child. 

Everyone should take a CPR class. Since there are classes in your home town maybe even this evening, no one has any excuses not to take one. MN PA FL

Diagnosis & Treatment

The diagnosis is usually made from the history and clinical presentation. Most mild cases are treated with supportive treatment. However, severe cases of respiratory distress need hospital admission for oxygen and fluid hydration. Some children may benefit from bronchodilators and nebulized epinephrine. If severe cases are left untreated, death can occur. To prevent spread, parents should be encouraged to wash their hands and avoid smoking.

Pneumonia

Pneumonia, although rare in healthy children, can be very serious. It remains the number one killer of children in many nations. Children who have a weak immune system, are under-nourished, or have a disease like HIV are more prone to pneumonia. It can be caused by viruses and bacteria.

Trigger factors for pneumonia include:

  • Air pollution
  • Smoking exposure
  • Asthma
  • Medical conditions like cystic fibrosis

Typical presentation includes:

  • Fever
  • Wet cough
  • General malaise
  • Shortness of breath
  • Anorexia
  • Congestion
  • Chest discomfort.

In addition, children can also present with lethargy, irritability, and poor feeding. 

Diagnosis & Treatment 

The diagnosis of pneumonia is made from the clinical exam, X-rays, and culture. The treatment usually depends on the type and cause of pneumonia. Bacterial pneumonia is treated with antibiotics but viral pneumonia is managed with supportive care. In most cases, children tend to develop severe pneumonia which compromises their breathing; and without treatment, the bacteria can spread into the systemic circulation. 

Besides oxygen, IV fluids, and antibiotics, some children may require mechanical ventilation. Bacterial pneumonia can be prevented but millions of children do not get the recommended three doses of the childhood vaccine. 

Foreign body aspiration

One very common cause of respiratory distress in children is foreign body aspiration. It is the 6th most common cause of accidental death in this population, with the majority of cases occurring in children aged less than 4. Children tend to put everything in their mouth like coins, buttons, batteries, solid food particles, paper, medications, etc and because the childhood airway is narrow, these objects often get stuck in the upper airway. The symptoms of foreign body aspiration are unfortunately non-specific and may include

  • Fever
  • Wheezing
  • Difficulty breathing
  • Chest discomfort
  • Inability to speak
  • Hypoxia. 

The most common location of the foreign body is in the bronchus followed by the trachea and larynx.

Children with complete airway obstruction can present with respiratory failure and cardiac arrest often requiring a surgical airway or rapid intubation. The diagnosis must be suspected in any child with no prior history of any lung disease like asthma and appropriate workup is vital. 

Besides x-rays, bronchoscopy may be required since not all foreign bodies are radiopaque. Prompt removal of the foreign body is necessary to prevent pneumonia, atelectasis, or pneumothorax. In children with respiratory distress, immediate bronchoscopic removal is recommended. The longer the foreign body remains in the airway, the higher the risk of complications like aspiration, pneumonia, or pneumothorax.

Anaphylaxis

Anaphylaxis is a potentially life-threatening emergency usually due to an allergic reaction. Even though cases of anaphylactic shock are not common, they have been increasing gradually over the past few years, especially in children. An anaphylactic reaction can occur within seconds after exposure to an allergen. 

The symptoms may include:

  • Shortness of breath
  • Wheezing, stridor
  • Hypoxia
  • Extreme respiratory distress
  • Inability speak
  • Swelling of the oral and facial area

If not treated immediately, it can quickly lead to cardiorespiratory arrest.

Diagnosis & Treatment

The diagnosis of anaphylaxis is usually clinical and treatment requires immediate administration of EpiPen (IM epinephrine). These individuals should be transported to the nearest emergency room for further treatment including fluids, steroids, and antihistamines. Individuals with allergies should always carry Epipen on them and wear a bracelet indicating their allergies.

Pneumothorax

Pneumothorax is not as common in children as adults, but when it occurs it can quickly compromise respiratory function. The majority of pneumothorax in children are spontaneous but may occur due to trauma or even asthma. Pneumothorax can be life-threatening if it is large (tension pneumothorax). The classic symptoms include:

  • Chest pain
  • Difficulty breathing
  • Shortness of breath

Diagnosis & Treatment

The diagnosis can be made from the presentation, physical exam, and imaging studies. If the patient is in respiratory distress, immediate treatment requires needle insertion in the chest cavity to evacuate the air. Once stabilized, a chest tube can be placed. 

Know the signs and symptoms of respiratory distress in children

Several common disorders can lead to respiratory distress in children. The key for the responders is to recognize signs of respiratory distress because if left untreated death may follow quickly. Classic signs of respiratory distress in children include:

  • Nasal flaring
  • Labored or rapid breathing
  • Use of accessory muscles
  • Wheezing
  • Grunting
  • Muscle retractions
  • Tripod position
  • Lethargy
  • Irritability
  • Cyanosis

Final point

Pediatric respiratory emergencies can be frightening but if one is alert and decisive, death can be prevented. The key is early detection so that the child can be treated accordingly.

References

  1. Respiratory Management in Pediatrics . http://www.creighton.edu/fileadmin/user/EMS/docs/Respiratory_Management_in_Pediatrics.pdf
  • Respiratory Emergencies in Pediatrics. https://www.slideshare.net/tfalgiani/respiratory-emergencies-in-pediatrics

Learning CPR Pays Off with Beach Save

As part of my health science classes, I was asked to take CPR classes. At that time, I thought that this was a complete waste of my $100. Little did I know that this money would one day save someone’s life. After 8 years, I decided that this was the last time I would renew my CPR certificate because I had never had an opportunity to use the technique on anyone. In 2010, I was visiting the beautiful island of Aruba which is famous for its sandy beaches and pristine blue waters. 

At around noon, I watched a young male wade about 50 meters from the shore and suddenly I noticed that he disappeared under the water. I did see his arms flailing and I realized that he was in trouble. I was never a good swimmer and did not even have a life jacket- the thought of us both drowning did cross my mind but my heart overcame my brain reasoning and I swam to where he was. I quickly noticed that he was unresponsive. I had a major struggle pulling a dead weight and struggled to get him near to the shore, where other people helped me pull the individual out of the water. 

Because he had swallowed water, the first thing I did was place him on his side and pump his stomach. I then started CPR which was another ordeal as I was exhausted from the rescue. Nevertheless, with the help of other people I coordinated the CPR  For the next 12 minutes, there was no sign of life. We all thought he was dead but decided to continue with CPR for another few minutes. We all took turns breathing into his airways and conducting CPR at the same time. 

Finally, just before the ambulance came, we saw some arm movements. The emergency staff transported him to the hospital where he was intubated and resuscitated. I had no idea what his name was, who he was or where he came from. All I could tell was that he was a young  male. For confidentiality reasons, the hospital refused to divulge all details about the individual. In any case, I left my name and number with the nursing staff. Six months later while I was in Toronto, I got a call from a female in Houston; she wanted to thank me for saving her brother. Incredibly he had suffered no adverse effects of the cardiac arrest that lasted about 12 minutes. He was alert and had no neurological or physical deficits. His family wanted to meet me but, alas, I had other things come up. Moral of the story; it is a humbling experience to save a life – it does help to be certified in CPR.

Florida Husband Collapsed

Cardiac arrest happens more than we may think. It is most likely to occur while at home and sadly only about 10 percent of them survive. Cardiac arrest can happen to anyone. You can be young, healthy, old or sickly. Cardiac arrest occurs when the heart stops due to electrical issues and the person stops breathing. When your heart stops pumping blood, your limbs and vital organs, including your brain, do not get the oxygen rich blood that it needs to function.

Learning CPR (cardiopulmonary resuscitation) could be one of the most important things you do for your family and friends. Having an AED (automated external defibrillator) in your home and learning how to use one is also important. The AED is very simple to use and will let you know how to use it and when to use it.

Jennifer and Rich Chap know just how important it is to learn these life saving skills. During the summer of 2012 in Orlando, FL, what started out to be a normal work day for Jennifer ended in her saving her husband’s life. Jennifer was working from home when her cat Buddy started acting strangely as if he was trying to get her attention. She started looking around and found her unresponsive husband collapsed on the kitchen floor gasping for air. He began to take agonal breaths in his wife’s arms. Jennifer sprang to action and called 911 who helped instruct her how to perform CPR until help arrived. When help arrived they took over CPR and used the AED in order to restart Mr. Chap’s heart. Although they were able to get a heartbeat after using the AED, he still wasn’t breathing on his own. The EMT’s had to place an endotracheal tube and use an ambu bag to breathe for him. Since they were unable to feel a pulse at his wrist, they put Rich into therapeutic hypothermia to cool down the body in order to protect the brain. Essentially he was in an induced coma. The doctors were unsure of what his neurological status would be in the future as they were waking him from his coma. Doctors quickly found that answer when Rick’s brother was visiting the hospital and was joking around with Rick. Rick then lifted his arm, turned to his brother, and  used a specific finger to communicate with his brother. Since the incident, Rick is doing well. Jennifer has become an advocate for Sudden Cardiac Arrest awareness and survival

Camping and First Aid safety

Camping is a popular recreational activity throughout the United States, with over 41 million people taking to the wilderness each year to camp in the outdoors.  They have good reasons to do so, as camping has a number of physical and social benefits, including, but not limited to:

  • Improved fitness
  • Stress reduction
  • Increased social connection with family and friends
  • Exposure to fresh, clean air

However, as is the case with any outdoor activity, camping is not without its risks.  Because of camping’s popularity, “Now is a vital time to learn how to manage medical emergencies in remote environments” says Morgan Tilton, a trained Wilderness First Responder.  According to Tilton, issues that campers should be prepared for include musculoskeletal injury, cold injury, infection, blisters and lacerations.

The campsite itself also presents dangers, including burns (from campfires), bug bites and rashes, and injuries from sharp objects, such as utility knives and hatchets.  Lifelong camper and trail racer David Parnell says, “The goal of having a first aid kit is never having to use it, but that objective is not always realistic.” Parnell recommends that every camper’s first aid kit contains –

  • Medications for personal medical conditions
  • Bandages, gauze and medical tape
  • Antibiotic spray or wipes
  • Tweezers (for splinters and ticks) and scissors
  • Moleskin for blisters
  • Burn cream
  • Nitrate or latex gloves
  • Emergency blanket

“Also”, says Parnell, “a mouth-to-mouth resuscitation device is vital to saving someone’s life while performing CPR.”  The leading cause of death in national parks is drowning, and heart attacks are also possible during camping.  Peter Mitchell. Founder of Decide Outside says, “It’s not that the trees, the sun, and the wind cause heart attacks. Heart attacks can happen if you exert yourself in ways you’re not used to.  A two-mile hike may not seem like a big deal, but if you are not active, this may be a lot to ask of your body.”

Preparation is key for a safe camping trip.  A good first aid kit is a must-have, but avid campers should also consider adding first aid and CPR training to their safety arsenal, especially when camping in remote areas where it will take time for responders to arrive.  “Before my training, I was lucky,” says Morgan Tilton.  “I stumbled across a few remote tragedies but was not needed on the scene, and, honestly, I would not have known how to help.  Now that I have training in first aid and CPR, I can.”

What’s the purpose of an AED?

An AED can be the difference between life and death! The survival rate without an AED is 7% but with the use of an AED, the survival rate goes up to 33%! (According to the American Heart Association in 2011) that means out of 100 peaple,7 survive without an AED but 33 survive with an AED!

But what does it do?

What an AED does is take that chaotic heart and stops it for just that moment so maybe it’ll listen to you.

An AED takes a heart that’s in Ventricular fibrillation or ventricular tachycardia and stops it for just a moment so we can get our message across and tell the heart what to do. The heart is like a teenager, they’ll argue and argue. There’s all this chaos and you’re trying to get your point across but they’re not listening So, sometimes you just have to yell “STOP!” and they’ll stop, for just a moment so you can quickly get your message across. But soon chaos arises again and you just have to yell “STOP!” again, so you can get your message across and hopefully they’ll listen this time. What an AED does is take that chaotic heart and stops it for just that moment so maybe it’ll listen to you.

What is Ventricular fibrillation and ventricular tachycardia?

Ventricular fibrillation, otherwise known as V fib. V fib is when a heart quivers and shakes very fast and isn’t able to pump blood anywhere                                                                                                                      

Ventricular tachycardia, otherwise known as V tach. V tach is when a heart beats so fast that its not able to pump blood anywhere. Both V fib and V tach cause loss of circulation to the places that need it like: your heart, lungs, brain and other important organs.

V tach

V fib

Normal

Can an AED kill someone?

No, an AED cannot kill someone. Unless the victim is in V fib or V tach, the AED will not allow a shock. You could put an AED on someone who’s alive and well and it will say “no shock advised, continue CPR” or you could put an AED on someone who’s been in the morgue for a few days and it will say the same thing. However, an AED can harm the people around, IF they are touching the victim while the AED is shocking (or if they are in the same puddle as the victim while its shocking.) Just stay clear of the victim while the AED is administering a shock then no harm can be done to anyone from the AED.

Can an AED be used on someone with a pacemaker?

You can use an AED on someone with a pacemaker. If a victim is having a heart attack and they have a pacemaker, then obviously the pacemaker isn’t working. Most new pacemakers are located on the top left, but if the pacemaker is located on the top right, just move the AED pad just a little so the pacemaker is not in the way.

Why should I use an AED?

You should use an AED because the success rate is much higher, (according to the American Heart Association in 2011) there’s a 7% success rate without the use of an AED, but with an AED it’s a 33% success rate! That means Out of 200 people, 14 survive without an AED, but with an AED, 65 people survive! AEDs are useful tools when doing CPR, there easy to use and save time. They improve survival success in cardiac arrest victims.

Common questions

Can I use an AED alone?

Absolutely! The sooner an AED is used, the better the outcome.

Can I take off the pads?

You should not take off the pads. Most hospitals have cord adapters and will use the same pads.

Can I just put the AED on and leave?

No, an AED is almost useless without the use of CPR. An AED stops the heart for just a moment, so you can tell the heart what to do by resuming quality chest compressions.

If you want to find out more information, take one of our classes, we’ll teach you how to use an AED and how to perform CPR. Visit www.inpulsecpr.com for more information about local community classes to attend.

CPR on a Karate Kid

karate cpr

By:  Melissa Grant

On an afternoon in 2015, 10-year-old Samantha’s karate class was performing its usual drills, when, without warning, Samantha dropped to the mat.  “There were absolutely no warning signs that I noticed,” says Samantha.  “My heart rate was always high, so everything felt normal to me.”

Fortunately, her karate instructor knew CPR and immediately jumped into action.  He performed CPR for five minutes as the class looked on, waiting for an ambulance to arrive.  The paramedics administered one shock with an AED.  “Unbelievably, I was awake and talking during the ten minute drive from my arrest site to the hospital.  I spent eight days in the cardiac ICU and was discharged straight from there.”  While in the cardiac ICU, doctors implanted an ICD (Implantable Cardioverter Defibrillator), which administers a shock if Samantha’s heart ever beats above 240 beats per minute.  “Thankfully,” says Samantha, “that’s only happened once.”

According to the Children’s Hospital of Philadelphia, sudden cardiac arrest (SCA) claims the lives of 2,000 children and teens in the United States.  SCA occurs for various reasons.  Samantha does not know what caused her heart to stop in the dojo that day.  “Since then, I have been diagnosed with atrial tachycardia and sinus tachycardia, both of which are now controlled with medication.”

It was hard for Samantha to get used to her limitations and need for medication, but there has been a silver lining.  “Without this experience, I would never have been able to impact my community to the degree I have,” says Samantha. Now 17, Samantha plans to attend nursing school and volunteers at the hospital where she was treated after her SCA.  She is optimistic about her life — a life that was saved by her karate instructor’s CPR training.  “I am encouraging everyone to learn CPR.  It does not take long to learn, but it could allow you to save a life, a life like mine.”

Classroom sales pitch

Vouchers…Keychain Sales…Reviews

WE NEED YOUR HELP. We are asking you to put on a sales hat for a 2-minute sales pitch at each class you teach for In-Pulse. That’s it, 2 minutes to promote the following – Vouchers…Keychain Sales…Reviews. Here is how you do it.

Make sure you mention it while holding up the bag of keychains before and at the end of the class, and have the bag of keychains on the check out desk with a sign for them to see when they come up to get their test graded. Offer it to the Heartcode students too.

[script – before you hand out the BLS exam]

“Our company has a really great in class promotion going on right now.  We are offering class gift certificates / vouchers for $40 each, which is a really good price and a great way to get a close friend or family member into a class. Maybe for your Mom, a babysitter, your spouse. This promotion is good for today only.

Also we are offering multicolored keychain breathing barriers for only $5 a piece. The great thing about these particular barriers is that they come with a one way barrier which is unique for something this small”

[Lastly, when student hands in test, ask them:]

“Are you able to rate me 5 stars in a google review?”

[Hand them a ‘Review Instruction Card’]

[end-script]

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Disclaimer:
Use of any advise on this site is purely at your own risk.  The information supplied is designed to accompany CPR and first aid training not to replace.  In-Pulse CPR, Inc disclaims any liability for losses you incur as a result of inaccuracy of the information provided on this website.  Information on this site is for education, supplemental to examination by and advice of medical professionals.   Any information regarding first aid treatments is not meant to replace the advice of medical professionals including physicians, paramedics, emergency room attendants, nurses or other licensed medical personnel.