RCR & DEA Niveau C Réanimation cardio-respiratoire et défibrillation externes automatiques SLIDE NOTES: please insert your name as the course conductor Use this websites to get up to date figures and interesting facts to share with your participants. (i.e. heart attack, stoke, heart disease, causes of a cardiac arrest etc…) ------ www.heartandstroke.ca Current (Oct 2010) examples: Heart disease claimed 17.1 million lives globally last year – most heart disease is preventable.   Causes of a Heart Attack Atherosclerosis – narrowing of the coronary arteries causes 90% of heart attacks

Plan du cours Bienvenue, présentations, tâches administratives Notre Mission & Vision La loi du bon samaritain & questions juridiques Contraction de maladie / Dispositifs de protection Anatomie du coeur Facteurs de risque de maladies du coeur Crise cardiaque, Attaque ischémique , Angine , Crise cardiaque RCR pour les adultes Position de recouvrement RCR pour les nourrissons et l’enfant Étouffement OR Suffocation Arrêt cardiaque Rythme cardiaque Défibrillateur externe automatisé (DEA) Quiz Questions / Suivi SLIDE NOTES: please insert the times for each module based on the start and end times for your course.

canfitpro NOTRE MISSION NOTRE VISION Forte de l’union avec ses membres, canfitpro fournit les meilleures expériences et formations en conditionnement physique, des plus accessibles, abordables et réalisables au monde. NOTRE VISION En tant que leader mondial de l’éducation en conditionnement physique et mieux-être, canfitpro motive chaque personne à jouir d’une vie passionnée et comblée grâce à une activité physique dynamique, sécuritaire et efficace. Review the mission for Can-Fit-Pro

Cinq craintes communes Faire la mauvaise chose / rendre les choses pires. Être poursuivi. Sécurité personnelle. Maladies. Composer avec du sang / des situations répugnantes. KEY POINTS: Participants can relieve some of these fears by taking first aid courses, keeping a first aid kit handy and making sure the scene is safe. How do we make things worse? (moving people, doing things we are not trained to do, do nothing?) Discuss HIV, Hep.B, Hep.C. (blood bourne pathogens) Wearing gloves, glasses, masks, etc.

La loi du bon samaritain Identifiez-vous. Demandez la permission. Agissez raisonnablement. (ne pas couper, coudre ou palper) Restez avec la victime. KEY POINTS: Ontario – Bill 20, April 2001 Must ask casualty if they want us to help them, casualty’s have the right to refuse help. ( Consent ) We can help unconscious casualty’s because of implied consent. This means casualty’s who are unconscious would want us to help them in an emergency. Only do what you are trained to do, nothing more, nothing less. Don’t leave casualty till another trained rescuer takes over, or EMS arrives. ( Abandonment )

Questions juridiques Une fois la RCR commencée, vous devez continuer jusqu’au moment où : Il est nécessaire de quitter les lieux pour appeler aux services d’urgence (RCR pour les enfants/nourrissons) Un passant aussi compétant ou plus compétant que vous arrive et peut prendre la relève Continuer de donner les soins est impossible en toute sécurité Vous êtes épuisé et incapable de continuer If a bystander does initiate aid to a victim, they must not leave the scene unless: It is necessary, in order to activate EMS Someone with equal or higher training arrives and can take over Continuing to give aid is unsafe If the victim is a child, consent must be obtained from a parent or guardian. However, if the parent or guardian is absent, intoxicated, or delusional (or if the rescuer has a reasonable belief that they are), consent is implied. REFERENCES: Good Samaritan Law (n.d.). Retrieved December 8, 2006 from http://www.elaws.gov.on.ca/DBLaws/Source/Statutes/English/2001/S01002_e.htm)

Questions juridiques – le consentement Il faut obtenir le consentement de la victime avant de lui donner des soins Le consentement est implicit si : La victime est inconsciente La victime a moins de 18 ans et se trouve sans parent ou tuteur La victime est intoxiquée ou délirante, ou si le secouriste croit raisonnablement que ce soit le cas Consent to provide aid is implied if the victim is unconscious If the victim is conscious and over 18yrs of age, consent to provide aid must be obtained (unless the victim is intoxicated or delusional, or the rescuer has reasonable belief they are, in which case, the courts are very forgiving. The legal phrase is “peril invites rescue”.) REFERENCES: Good Samaritan Law (n.d.). Retrieved December 8, 2006 from http://www.elaws.gov.on.ca/DBLaws/Source/Statutes/English/2001/S01002_e.htm)

Contraction de maladie / Dispositifs de protection Les gants, les écrans protecteurs et les masques sont les dispositifs de protection les plus utilisés. Le masque facial est plus efficace que l’écran protecteur à protéger le secouriste. Disease transmission during CPR practice (during a course) has not been noted in research that began tracking in 1960 Over the last 30 years, only 15 cases of disease transmission have been noted In an effort to reduce the risk of disease transmission, the following is recommended: If you are a first aid responder at your workplace, gloves and a barrier device should be provided Barrier devices should have a one way valve to prevent the transfer of fluid from the victim to the rescuer Barrier devices and gloves should be included in all first aid kits If CPR has been performed, every effort should be made to determine if the victim had any contagious disease. In addition, medical treatment should be provided to the rescuer This same access to medical care should be provided to the victim to reduce his or her risk from exposure to the rescuer This picture depicts a face shield (top left), a face mask (top right) and gloves (bottom) REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Disease Transmission and Cardiopulmonary resuscitation. (n.d.). Retrieved December 11, 2006 from http://wwwold.macewan.ca/nw/hsfacentral/bls/Diseasetrans.htm

Le coeur humain La fonction du cœur est de faire circuler (pomper) le sang dans le corps pour lui fournir de l’oxygène et des nutriments et pour récupérer les déchets. Your heart is a muscular organ that acts like a pump to send blood throughout your body all the time. The heart: * is a muscle about the size of your fist. * weighs approximately one pound. * is located behind and slightly to the left of the breastbone * pumps about 5 liters of blood every minute, or 7000 liters of blood every day. Cycle cardiaque

Le cœur possède quatre chambres Le coeur humain Le cœur possède quatre chambres Chambres de gauche Chambres de droite Atrium gauche Atrium droit Ventricule gauche Ventricule droit The upper and lower chambers are separated by walls of non-conducting tissue, which contain one-way valves to allow blood to flow between them. These heart valves also ensure the forward motion of blood. The heart is separated into right and left sides, with each side performing a unique function: * The right side of the heart receives deoxygenated blood from the body and sends it to the lungs to pick up oxygen. * The left side of the heart receives oxygenated blood from the lungs and sends it to the rest of the body where the oxygen is delivered to organs such as the brain and kidneys.

Système électrique du coeur Le coeur humain Le circuit électrique du coeur Système électrique du coeur Nœud sino-auriculaire (SA) Faisceau internodal antérieur Faisceau internodal moyen Faisceau internodal postérieur Nœud auriculo-ventriculaire (AV) Faisceau de Bachmann Voies de conduction Branche droite du faisceau Le système électrique du cœur contrôle la synchronisation et le rythme de l’efficacité de pompage du cœur. In order for the heart to squeeze and pump blood, it needs a sort of spark plug, an electrical impulse, to start a heartbeat. The electrical impulse starts on the right side of the upper chamber in an area called the sinus node. The sinus node is the normal pacemaker of the heart and controls the heart rate. The heart normally beats faster when you are exercising or excited and it beats more slowly when you are at rest or sleeping. The impulse leaves the sinus node and travels a set path through the upper chambers, the atria, causing them to contract and squeeze blood into the lower chambers. The electrical signal then reaches the atrioventricular (AV) node. The AV node is in the middle of the heart, between the atrium and the ventricle. The signal is delayed in the AV node and then spreads through the lower chambers. The ventricles contract, sending blood throughout the body. The entire heartbeat starts again, beginning with an impulse in the sinus node.

Le coeur humain Des problèmes du système électrique du cœur peuvent mener à un désordre rythmique qui peut conduire à un arrêt cardiaque subit (ACS). An irregularity in the heart's electrical system is called an arrhythmia, which can cause the heart to beat too slowly (bradycardia), too fast (tachycardia), or not in sequence (asynchrony). An arrhythmia can compromise the heart's ability to pump and circulate blood through the body and brain.

Quel est le tueur numéro un de nord-américains ? Cardiovascular Disease is number one. 30% of premature deaths in Canada is heart disease Cardiovascular diseases include heat attack, sudden cardiac arrest and stroke. Statistics Canada: http://www.statcan.gc.ca/pub/84f0209x/84f0209x2006000-eng.pdf

Facteurs de risque Diabète Age Hypertension Embonpoint Sexe Hypercholestérolémie Consommation excessive d’alcool Antécédents familiaux Sédentarité Tabagisme Stress Origine ethnique AVC ou ICT antérieur This slide indicates the different risk factors for heart attack and stroke in no particular order. Show this slide in preparation of a more in depth discussion on risk factors. SUGGESTED TEACHING TIPS: Stand Up/Sit Down Game: With this list showing on the screen, have participants identify a risk factor as preventable by standing up. If they feel a risk factor is not preventable, have them sit down. The next slide will show them the correct category for each risk factor. REFERENCES: Heart and Stroke Foundation. (2006). Taking Control. [Brochure].

Facteurs de risque Contrôlables Incontrôlables Diabète Hypertension Hypercholestérolémie Embonpoint Consommation excessive d’alcool Sédentarité Tabagisme Stress Incontrôlables Age Sexe Antécédents familiaux This slide depicts the correct categorization for the different risk factors. If you played the game, have course participants see how many they correctly identified as preventable or not preventable. REFERENCES: Heart and Stroke Foundation. (2006). Taking Control. [Brochure].

Signes et symptômes d’arrêt cardiaque Signe: Un signe est une indication objective de quelque chose qui est généralement détecté par un médecin; le médecin découvre les signes d’une maladie. Symptôme: : Un symptôme est une indication subjective de quelque chose qui d’habitude est rapporté par un malade; le malade ressent des symptômes. Discuss the definitions of signs and symptoms and the difference between the two Have participants come up with things they feel would be signs and symptoms (and which category they would fall in) for heart disease REFERENCES: Lifesaving Society. (2006). First Aid Award Guide, Training Guide for First Aid, CPR and AED Programs. Author

ACV & AIT Attaque ischémique Une attaque ischémique est un événement qui menace la vie pendant laquelle une partie du cerveau ne reçoit pas suffisamment d’oxygène habituellement à cause d’un caillot de sang logé dans une artère cérébrale. Caillot de sang Explain picture to show what causes stroke. Maladie de l’artère carotide

ACV & AIT Signes et signaux Engourdissement. Faiblesse soudaine. Difficulté d’élocution. Problèmes de vision. Mal de tête sévère. Étourdissement KEY POINTS: Blood flow is blocked to brain Call EMS(911) If casualty is conscious lay on back with head and shoulders slightly elevated If unconscious, assess ABC’s if breathing place in the HAINES recovery position

CC, angine & AC Angine: une maladie causée par le rétrécissement de l’artère coronaire. . Crise cardiaque: mort d’une partie du muscle CARDIAQUE à cause d’un manque d’oxygène. Arrêt cardiaque: arrêt complet de l‘activité cardiaque (battement). KEY POINTS: Damage to muscle is caused by a blockage to one of the coronary arteries by a build up of plaque, clots, etc. Once heart stops beating casualty is clinically dead.

Crise cardiaque Crise cardiaque KEY POINTS: Caillot de sang Plaque de cholestérol Artères coronaires Muscle en santé Muscle mourant KEY POINTS: Explain the diagram showing heart attack Death of cardiac tissue and muscle.

Crise cardiaque P A S D E âleur nxiété Udation ouleur poitrine ssoufflement F I N aiblesse générale indigestion ausée KEY POINTS: Activity: Give your hand a heart attack Get class to stand and raise one arm over head and tell them to open and close their fists for a minute or two; ask participants what they feel (should be similar to s/s of a heart attack), put other hand down in front of you and bring hand down beside the other (hands should be side by side), look at both hands and explain the differences between each hand Lead into signs and symptoms of heart attack.

Faire l’examen des lieux Y a-t-il des dangers (verre, produits chimiques, échelle, etc.) ? Quels sont vos risques? Y a-t-il d’autres risques pour la victime ? Qu’est-ce qui s’est produit ? Combien y a-t-il de victimes ? Y a-t-il des changements sur les lieux ? Y a-t-il un DEA ou une trousse de premiers soins à proximité ? Discuss things that rescuers might be looking for should they come across a victim Utilize scenarios specific to the locations some of the class participants might be working for examples (e.g., a fitness centre). REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Supply.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Vérifier l‘état de conscience Parler fort ou crier “Ça va?” Toucher la victime, pincer les épaules Discuss the importance of checking for responsiveness Ensure participants know that when they ask victim if they are okay, it must be done in a loud, audible voice REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Contacter les services d'urgence POLICE ■ FEU ■ MÉDICAL URGENCE The subsequent slides describe what information is required in order to properly activate EMS

Contacter les services d'urgence Donner au répartiteur les renseignement suivants: le nombre de victimes, leur âge, leur sexe, leur état et l’adresse de l’urgence. Rester en ligne jusqu’à ce que le répartiteur vous dise de raccrocher. Si un passant fait l’appel aux services d’urgence, demander-lui de revenir sur les lieux confirmer qu’il a appelé des secours Demander le délai approximatif avant l’arrivée du personnel paramédical. Discuss how you activate EMS (typically it is by calling 911, but often, there are other ways. E.g., universities have their own internal emergency system, remote towns may have a different emergency number) Review the key pieces of information that should be given to the EMS dispatcher Have participants practice making EMS calls, and having a bystander make the call on his or her behalf SUGGESTED TEACHING TIPS: Set up an area in the classroom that is designated as the “phone” Have participants simulate real calls by going to this area and picking up phone (a cell phone could be used as a prop for this skill) REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Utiliser les passants Téléphoner aux services d’urgence Attendre le personnel paramédical Enlever des objets dangereux du lieu Éloigner les curieux Chercher du matériel (couvertures, etc.) Mettre les effets personnels de la victime en lieu sûr Noter les détails de l’incident Bystanders are often available at the scene of emergencies, and can be very helpful to the rescuer. This slide depicts some of the ways in which a bystander could be used. SUGGESTED TEACHING TIPS: Before showing the content on this slide, have participants brainstorm about different ways a bystander can assist in a rescue Have participants practice giving instructions to a partner as if they were a bystander (note if the instructions are clear, concise, and helpful to the rescue) REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Dégager les voies respiratoires Basculer le tête en arrière en mettant le talon d’une main sur le front de la victime et les doigts de l’autre main sous son menton pour le soulever. Les voies respiratoires s’ouvrent lorsque la tête est basculée en arrière. The key to successful rescue breathing is a proper head tilt/chin lift Show a demonstration of a proper head tilt/chin lift, and have participants practice this skill on a partner and/or mannequin REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Insufflations Pincer le nez de la victime, prendre une inspiration normale et couvrez la bouche de la victime avec votre bouche. Donner deux insufflations (souffler pendant une seconde chaque fois). Vérifier que le thorax se soulève à chaque insufflation. To provide a rescue breath, you must ensure that there is a tight seal around the victim’s mouth, either with your mouth or a barrier device Pinch the victim’s nose. This prevents the breath you provide from escaping out the nose without ever making it to the lungs The rescuer should watch the victim’s chest to ensure it rises with each breath. This will ensure that the breath is going in (no obstruction) Before providing the second breath, ensure that the chest has returned to its’ normal position REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author. Attendre que le thorax reprenne sa position normale avant de donner une autre insufflation.

Vérifier la respiration Placer votre oreille à côté de la bouche et du nez de la victime pour vous permettre de sentir et d’entendre la respiration. Regarder si the thorax de la victime se relève. La respiration agonale n’est pas une respiration. Before initiating the CPR sequence, you must ensure that the victim is not breathing To do this, place your ear over the victim’s mouth and nose. Listen and feel for breath, and watch to see if the chest rises This breathing check must last a minimum of 5 seconds REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Compressions Placer le talon d’une main sur la poitrine de la victime . Centrer la main entre les mamelons. Placer l’autre main sur la première (pour un enfant, mettre une ou deux mains sur la partie inférieure du sternum). Pousser fort et vite (100 compressions à la minute). Compter “un et, deux et, trois et”, etc. Après chaque compression, relâcher la pression sur le thorax pour le laisser reprendre sa position de repos. Chest compressions create blood flow by increasing intrathoracic pressure and compressing the heart This blood flow that is generated delivers a small, but very important amount of oxygen and other matters to the brain and heart Compressions are most effective when performed on a hard surface Depression of the sternum (breastbone) should be about 2 inches or 5 cm for an adult and 1/3 the depth of the chest for a child The chest should return to its normal position between compressions to allow the return of blood to the heart The rate of 100 compressions every minute was established using animal studies in which it was found that the greatest success rate for CPR occurred when compressions were delivered at a rate of 80 or more per minute SUGGESTED TEACHING TIPS: Have participants get a piece of paper and draw a line on it that they think is 2 inches, or 5 cm long. This should help give them an idea of how deep a compression should be Have participants practice compressions on a mannequin while a partner counts the number of compressions being delivered over a one minute period REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

APPLICATION Compressions La prise des repères pour les compressions est entre les mamelons de la victime La profondeur des compressions: 5 cm, 2 pouces Viser 100 compressions à la minute, ou un peu moins que 2 compressions à la seconde show participants how much 5cm or 2inches is on a ruler or other device Have participants practice landmarking and providing compressions on a partner or mannequin Ensure that participants know the chest must fully return to its starting position between each compression Time the class while doing compressions to ensure that they are performing them at an appropriate pace REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author. APPLICATION

RCR pour les adultes (Un intervenant) Faire l’examen des lieux Vérifier l’état de conscience Obtenir de l’aide en contactant les soins d’urgence Obtenir un DEA si possible Dégagez les voies respiratoires Vérifiez la respiration Prendre ses repères et commencer les compressions Donner deux insufflations 30 compressions:2 insufflations jusqu’à ce que le personnel paramédical arrive ou la victime réagisse Review the proper sequencing of Adult CPR (One rescuer) with the participants Have them practice the entire sequence in proper order on a partner or mannequin Correct sequencing is provided below: 1)     assess environment 2)     determine unresponsiveness 3)     activate EMS (Emergency Medical System) 4)     attempt to get AED-trained responder if possible 5)     open airway 6)     check for breathing (no more than 5 sec.) 7)     landmark and begin chest compressions (30 compressions:2 breaths) 8)     depth of compressions is approximately 5 cm, or 2 inches) 9) aim for approximately 100 compressions every minute (or just under two compressions per second) provide two rescue breaths (watch for chest to rise) 11) continue with this until EMS takes over or an AED-trained responder takes over, or victim responds if victim moves, reassess and treat accordingly REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.).   American Heart Association. (2006). Heartsaver Instructor Manual. Author.

Position de recouvrement Si vous êtes convaincu que la victime n’est pas blessée à la tête ou à la colonne vertébrale, il est recommandé de la mettre en position de côté si elle est inconsciente, mais respire sans aide. Cette position est stable, vous permet de garder les voies respiratoires ouvertes, de vérifier les signes vitaux et de faire l’examen secondaire de la victime. discuss times when you would use recovery position and when you would not use recovery position You WOULD use recovery position when: victim is unconscious and breathing; victim is conscious but lightheaded; rescue breathing and/or CPR has been successful and victim begins to breathe You would NOT use the recovery position if: victim is not breathing; a head or neck injury is suspected; any other life threatening injuries exist The following explains how to place a victim in to recovery position: place victim in a semi-prone position (as long as a spinal injury is not suspected) put the arm nearest you straight out and perpendicular to the victim’s body hold palm of farthest arm and pull to place it under the victim’s ear or neck bend the knee of the far leg so it points up and pull the bent knee towards you (protecting head while rolling) rest top leg on ground in front of bottom leg to stabilize lower body position allows you to continually assess victim for any changes REFERENCES: American Heart Association. (2005). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112(24) (Suppl.). Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author. Lifesaving Society. (2006). First Aid Award Guide, Training Guide for First Aid, CPR and AED Programs. Author.

RCR pour les enfants: Différences Profondeur des compressions: 1/3 de la profondeur de la poitrine Se servir d’une main pour faire les compressions Donner 5 cycles de compressions et insufflations avant d’appeler les services d’urgence Child CPR is very similar to adult CPR The differences are important to note as the depth of compressions is described in relation to the size of the child as opposed to cm or inches (1/3 the depth of the chest) Because a child has a much smaller chest, it is not necessary to perform compressions using two hands. Begin landmarking as you would for an adult victim, but for a child, only use one hand to provide compressions If a child is found to be unresponsive, 5 cycles of compressions and breaths should be given before EMS is called. This differs from adult CPR in which EMS is immediately activated (note: if a bystander is available, it is always better to have EMS activated immediately by them. These guidelines apply only if a rescuer is alone) REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author.

RCR pour les nourrissons: Differences Frotter le pied de la victime et cliquer des doigts près de son oreille pour susciter une réaction Profondeur des compressions: ½ de la profondeur de la poitrine Se servir de deux doigts pour faire les compressions Couvrir la bouche et le nez de la victime avec votre bouche et donner de douces insufflations Compléter 5 cycles de compressions et insufflations et avant d’appeler les services d’urgence Infant CPR is very similar to adult CPR The differences are important to note as the depth of compressions is described in relation to the size of the infant as opposed to cm or inches (1/3 the depth of the chest) Because an infant has a much smaller chest, it is not necessary to perform compressions using two hands. The fingers of one hand often provide enough strength to compress the chest to the proper depth (landmarking is done just below the nipple line of the infant) If an infant is found to be unresponsive, 5 cycles of compressions and breaths should be given before EMS is called. This differs from adult CPR in which EMS is immediately activated (note: if a bystander is available, it is always better to have EMS activated immediately by them. These guidelines apply only if a rescuer is alone) REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author.

Le visage change de couleur. Étouffement Ne peut parler. Ne peut tousser. Mains au cou. Le visage change de couleur. KEY POINTS: What do choking victims look like? (look of panic, face red and hands at throat, etc) Food is most common cause of obstruction for adults Avoid talking/laughing with food in mouth Keep small objects out of reach of children Casualty may become unconscious in less than 45 seconds 4 to 6 minutes brain cells start to die At 10 minutes some permanent brain damage Activity: How long can you hold your breath?; first ask “how long do you think it takes before someone goes unconscious” (participant answers/discussion), have them all hold breath at same time while you time to see how long they last - Correct answers: 45 seconds = pass out; 4-6 minutes = organ damage; 10 minutes = irreversible damage

Étouffement Adulte ou enfant conscient Déterminer le degré d’obstruction (obstruction légère ou grave) Si l’obstruction est légère, encourager la victime à tousser et rassurer-la. Si l’obstruction est grave, crier pour obtenir de l’aide, débuter le cycle de 5 tapes dans le dos et 5 poussées abdonminales jusqu’à les voies respiratoires de la victime soient dégagées ou que lavictime perde conscience Landmarks Back blows: heel of your hand between the shoulder blades of the victim abdominal thrusts, make a fist and put thumb above the belly button. Grab this fist with the other hand Here is the sequencing for Obstructed Airway Management for a Conscious Victim (Adult or Child) determine how severe the obstruction is if mild, encourage coughing and reassure victim if severe, shout for help, start cycles of 5 back blows and 5 abdominal thrusts until airway is clear, or victim becomes unconscious (see steps for unconscious victim, but begin at step #3) **NOTE: If the rescuer is unable to get his or her arms around a victim due to either obesity or pregnancy, back blows (with victim leaning forward) and chest thrusts, such as those performed during CPR should be provided** Have participants practice obstructed airway management on a mannequin or partner Activity: Partner Role Play; Partner 1 leaves the room while partner 2 is given a chocking scenario from PRO TRAINER (i.e. pregnant, wheel chair, mild vs severe etc…) REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author.

Étouffement Adulte ou enfant inconscient Vérifier l’état de conscience Faire l’examen des lieux Faire appel aux services d’urgence Demander un DEA ou un secouriste compétant en l’usage du DEA, si possible Dégager les voies respiratoires Vérifier la respiration Prendre les repères et donner 30 compressions Regarder dans la bouche pour voir si l’objet est débloqué (L’enlever seulement s’il est visible) Essayer de donner une insufflation , si le premier essai ne réussit pas, repositionnez la tête et donnez une 2ème insufflation Répéter jusqu’à ce que l’objet soit expulsé ou le personnel paramédical arrive Have participants practice obstructed airway management on a mannequin or partner REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author.

Étouffement : Nourrisson Conscient à inconscient Déterminer le degré d’obstruction Donner 5 tapes dans le dos avec le talon de la main et ensuite faire 5 poussées thoraciques en utilisant deux doigts Continuer jusqu’à ce que l’objet soit expulsé ou jusqu’à ce que la victime perde conscience Si la victime perd conscience, commencer la RCR pour les nourrissons have participants practice infant choking on a doll or mannequin Landmarking for chest thrusts is the same as that for infant CPR Here is the proper sequencing for Obstructed Airway Management for a Conscious Victim (Infant) determine how severe the obstruction is perform 5 back blows followed by 5 chest thrusts continue until obstruction is removed or victim becomes unconscious (see steps for unconscious victim, but begin at chest compressions) If victim regains consciousness and/or breathing, direct caregiver to take victim to physician Note: if infant becomes unconscious, follow steps for infant CPR beginning at chest compressions) REFERENCES: American Heart Association. (2006). Heartsaver AED Student Workbook. Author. Canadian Red Cross. (2001). Basic Life Support CPR/AED. [Brochure]. Author.

Arrêt cardiaque subit Un arrêt cardiaque subit survient quand le système électrique du cœur fonctionne mal et que le cœur arrête de battre. Sudden Cardiac Arrest (SCA) is a condition in which the heart stops beating suddenly and unexpectedly due to a malfunction in the heart's electrical system. The malfunction that causes SCA is a life-threatening abnormal rhythm, or arrhythmia. The most common arrhythmia is ventricular fibrillation (VF). Cardiac arrest may have a variety of causes – heart disease, drowning, stroke, electrocution, suffocation, drug overdose, motor vehicle or other injury. Note: Sudden cardiac arrest (SCA) is often confused with a heart attack. A prior heart attack increases one's risk for SCA, but SCA is quite different from a heart attack. A heart attack is caused by a circulation or plumbing problem of the heart, when one (or more) of the arteries delivering blood to the heart is blocked. Oxygen in the blood cannot reach the heart muscle, and the heart muscle becomes damaged. This damage to the heart muscle can lead to disturbances of the heart's electrical system. And a malfunction of the heart's electrical system may cause dangerously fast heart rhythms that can lead to SCA.

Saviez-vous.... Plus de 35,000 Canadiens perdent la vie chaque année à cause d’arrêts cardiaques. Une défibrillation administrée dans les premières minutes augmente jusqu’à 30% le taux de survie. Pour chaque minute qui passe, la probabilité de survie diminue de 7 à 10%. Rendre les défibrillateurs facilement accessibles peut sauver des milliers de vies. When in VF, the heart's rhythm is so chaotic (called "fibrillating") that the heart merely quivers, and is unable to pump blood to the body and brain. Life-threatening arrhythmias include: Ventricular tachycardia (pulseless VT), a dangerously fast rhythm in the lower two chambers of the heart. Ventricular fibrillation (VF), a rapid and chaotic quivering of the ventricles, which can be triggered by episodes of pulseless VT. The only effective treatment for SCA is to deliver an electrical shock using a device called a defibrillator (to de-fibrillate the heart), which stops the chaotic rhythm of a heart in VF, giving it the chance to restart beating with a normal rhythm.

Saviez-vous.... Lors d’un ACS, la tachycardie ventriculaire ou la fibrillation ventriculaire fait battre le cœur trop rapidement. Tachycardie ventriculaire (TV), un rythme dangereusement rapide dans les deux chambres inférieures du cœur. Fibrillation ventriculaire (FV), des palpitations rapides et chaotiques des ventricules qui peuvent être déclenchées par une TV. When in VF, the heart's rhythm is so chaotic (called "fibrillating") that the heart merely quivers, and is unable to pump blood to the body and brain. Life-threatening arrhythmias include: Ventricular tachycardia (pulseless VT), a dangerously fast rhythm in the lower two chambers of the heart. Ventricular fibrillation (VF), a rapid and chaotic quivering of the ventricles, which can be triggered by episodes of pulseless VT. The only effective treatment for SCA is to deliver an electrical shock using a device called a defibrillator (to de-fibrillate the heart), which stops the chaotic rhythm of a heart in VF, giving it the chance to restart beating with a normal rhythm.

Rythme sinusoïdal normal Saviez-vous.... Rythme sinusoïdal normal L’arythmie sinusoïdale se réfère à une augmentation normale du rythme cardiaque qui se produit quand vous inspirez. Normally, the heart beats 60-100 times a minute. This state is called "normal sinus rhythm" or "normal rhythm.” Sinus rates below this range are termed sinus ‘bradycardia’ Sinus rates above this range are termed sinus ‘tachycardia’.

Saviez-vous.... Tachycardie ventriculaire (TV) Une contraction anormale des ventricules qui conduit à une fibrillation ventriculaire et à une mort subite. Pulseless V-Tach is when the ventricles of the heart are contracting very fast, very weakly and not providing sufficient blood to the body.

Saviez-vous.... Fibrillation ventriculaire (FV) Un rythme cardiaque chaotique qui précède souvent un arrêt cardiaque. Quand le cœur est en fibrillation, il n’y a plus de sang qui est fourni aux parties du corps, la respiration s’arrête et un arrêt cardiaque survient. When the heart is in fibrillation, there is no effective blood being supplied from to any part of the body, breathing stops and cardiac arrest occurs.

Fibrillation ventriculaire (FV) Saviez-vous.... Fibrillation ventriculaire (FV) La FV est la cause la plus commune des arrêts cardiaques subits (ACS) ! Le seul traitement efficace pour un ACS est la défibrillation - un courant électrique qui « choc » le cœur afin qu’un rythme normal se rétablisse. Early defibrillation is the key to surviving SCA. Both Pulseless VT and VF can not produce a perfusing pulse. They CAN be successfully converted to a normal sinus rhythm using a defibrillator!

Asystolie (électrocardiogramme plat) Saviez-vous.... Asystolie (électrocardiogramme plat) Un électrocardiogramme plat signifie que le cœur du patient est à l’arrêt complet. A flat line means the person's heart has stopped altogether.

Qu’est-ce qu’un DEA ? Un défibrillateur externe automatique (DEA) est un appareil qui peut contrôler les rythmes cardiaques. Il peut savoir si le cœur d’est complètement arrêté. Si requis, l’appareil peut alors donner un choc électrique au cœur. An AED (Automated External Defibrillator) is a device used to administer an electric shock through the chest wall to the heart. Built-in computers assess the patient's heart rhythm, judge whether defibrillation is needed, and then administer the shock.

Qu’est-ce qu’un DEA ? Les appareils DEA remplacent-ils l’utilisation de la RCR ? Un DEA ne remplace pas une RCR. La fonction du DEA est de corriger le rythme quand le cœur est en FV. La fonction de la RCR est de faire circuler le sang et l’oxygène dans le corps. While CPR helps to maintain circulation and ventilation in a victim of cardiac arrest for a short period of time, it is unlikely to convert ventricular fibrillation to a normal heart rhythm. Restoring a normal heart rhythm requires defibrillation to be provided within a few minutes of the arrest. Studies have shown that bystander CPR can help to improve survival rates. Bystander CPR is the best treatment that a cardiac arrest patient can receive until a defibrillator and advanced medical care arrive Ask the group “Do AED units replace the use of CPR?” – answer; CPR & the AED unit are ALWAYS used together when an AED unit is available. ***the AED DOES NOT REPLACE CPR*** Explain that CPR increases the chance of survival by 5-6% BUT using an AED increases the chance of survival by 60-70%

Qu’est-ce qu’un DEA ? Ce ne sont pas toutes les personnes qui peuvent survivre à un ACS, même avec une défibrillation. Mais, une défibrillation appliquée tôt assure la meilleure chance de survie spécialement si elle est appliquée pendant les trois premières minutes suivant l’effondrement d’une personne suite à un ACS. Early defibrillation is the intervention that is most likely to improve survival rates. The time between the onset of cardiac arrest and the use of an AED is the major determinant for success of the resuscitation attempt. The cardiac chain of survival is a series of four critical steps. All four steps of the chain must be present to help ensure survival from sudden cardiac arrest. The four steps are: Step one: Early access to care (calling 9-1-1 or another emergency number) Step two: Early cardiopulmonary resuscitation (CPR) Step three: Early defibrillation Step four: Early advanced cardiac life support, as needed The third step, delivering an electrical shock to the heart, which is known as defibrillation, is recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.

Comment fonctionne un appareil DEA Les défibrillateurs fonctionnent en donnant au cœur un choc électrique contrôlé qui force tous les muscles du cœur à se contracter simultanément et, avec un peu de chance, ainsi ramener le cœur à un rythme régulier. Voltage stored by the defibrillator pushes electrical current (a shock) through the chest by way of electrodes or paddles placed on the chest. This brief pulse of current halts the chaotic activity of heart, giving the heart a chance to re-start with a normal rhythm. La défibrillation ramène le cœur à un rythme normal par un choc.

Comment fonctionne un appareil DEA Mettre en marche (ON) l’appareil DEA. Des instructions vocales et visuelles commencent immédiatement. Suivre les messages. Voltage stored by the defibrillator pushes electrical current (a shock) through the chest by way of electrodes or paddles placed on the chest. This brief pulse of current halts the chaotic activity of heart, giving the heart a chance to re-start with a normal rhythm.

SA NODE Call the participants attention to the SA node (i.e. “as we discussed earlier…”)

Quand les électrodes sont fixées sur le patient, le DEA évaluera automatiquement l’état du patient. Biphasic AED units can be used on Adults and Children over the age of 1 (Use pediatric pads if available) The use of AED's with children younger than one year are not recommended by the HSFO/ILCOR Activity: Ask participants “Why are the pads placed where they are? (participant answers/discuss) - Correct answer: “Remember earlier when we discussed the SA node… the electrical signal from the AED interjects the SA node in order to stop the heart allowing the SA node to restore normal heart rhythm. Instructor Side Notes: Monophasic vs. Biphasic Monophasic shock - an electrical pulse that flows one way between two electrode patches or paddles. Biphasic shock - the current (amps) is divided into two phases, so the biphasic waveforms reverse the polarity partway through the pulse. Most manufacturers use biphasic waveforms in their automated and manual defibrillators.

Messages : « Acquisition du rythme cardiaque » et « Ne pas toucher au patient ». Once the pads are on the AED unit will prompt, “Assessing heart rhythm” and “Do not touch the patient” Discuss: the size of the victim; pads must be at least 2 inches apart (for a smaller victim you may need to place one pad on their front and one on their back) Voltage stored by the defibrillator pushes electrical current (a shock) through the chest by way of electrodes or paddles placed on the chest. This brief pulse of current halts the chaotic activity of heart, giving the heart a chance to re-start with a normal rhythm.

Quand il est prêt pour donner un choc, l’appareil annoncera : « Appuyez sur le bouton « Choc » maintenant ». Le bouton s’allumera quand le système sera chargé. When ready to deliver a shock, the unit will advise, “Press the shock button now” and the button will illuminate when system is charged It is VERY important to watch the victim and NOT the AED unit The energy doses given to adult victims have also changed: * If using a manual biphasic defibrillator, most public access AEDs are manual biphasic, with the truncated exponential waveform, start at 150J or 200J. If you start at 150J, increase to 200J for subsequent shocks * If using a manual biphasic defibrillator with the rectilinear waveform, start at 120J. Increase the energy setting to 150J for the second shock and 200J for the third and subsequent shocks. * If using a manual monophasic defibrillator, start at 360 joules (J) and maintain at that energy setting for all subsequent shocks.

Les appareils DEA sont conçus uniquement pour reconnaître une FV ou une TV et aviser l’utilisateur de donner un choc électrique. The AED makes shock delivery decisions based upon the patient's heart rhythm (VF or pulseless VT), and will not allow a shock to be delivered if not needed. The machine will not let you shock a non-shockable rhythm.

Comment fonctionne un appareil DEA Une défibrillation fonctionne uniquement s’il y a déjà une activité électrique dans le cœur. Un défibrillateur ne fonctionne pas si une personne est en état d’électrocardiogramme plat. Puisque le défibrillateur arrête le cœur, il est insensé d’arrêter un cœur déjà arrêté. The AED makes shock delivery decisions based upon the patient's heart rhythm (VF or pulseless VT), and will not allow a shock to be delivered if not needed. The machine will not let you shock a non-shockable rhythm. Activity: Show the kit and explain what the contents are used for – Group Discussion: special situations (i.e. jewelry, pace maker, hairy, water, nitro glycerin patch etc…) and when NOT to use the AED (Reference: Page 21 in course manual)

Comment fonctionne un appareil DEA Combien de chocs ? Seulement un suivi de la RCR. Quand l’avis est donné pour un choc, donner 1 choc puis reprendre immédiatement 5 cycles ou environ 2 minutes de RCR. Quand l’avis est donné pour ne pas donner un choc, reprendre immédiatement 5 cycles ou environ 2 minutes de RCR. Dès que vous notez un signe évident de circulation, arrêtez la RCR et surveillez l’ABC. Rescuers can optimize the likelihood of defibrillation success by optimizing the performance of CPR, timing of shock delivery with respect to CPR, and the combination of waveform and energy levels. A 1-shock strategy may improve outcome by reducing interruption of chest compressions Activity: Ask participants “Can you accidentally shock someone?” Answer - NO. The AED will not charge up to deliver a shock unless it detects a shockable rhythm. Only after it goes into a "shock advised" mode will it charge up and advise the rescuer to "deliver the shock now". The rescuer simply pushes the button to deliver the shock.

Comment fonctionne un appareil DEA DEA prêt Analyse Peut recevoir un choc Reprendre 5 cycles ou environ 2 minutes de RCR Donner 1 choc Ne peut pas recevoir un choc Algorithme du DEA Refer to page 19 in course manual Determine if the victim is unresponsive and not breathing If two rescuers, one will start CPR while the other sets up the AED and attaches the electrodes If one rescuer, set up the AED and attach the electrodes Describe Algorithm – this is a the general pathway of the AED unit – go through it with the participants

Qu’en est-il de la responsabilité ? Qu’en est-il de la responsabilité ? Elle protège les individus contre la responsabilité pour des dommages qui pourraient survenir conséquemment à leur utilisation d’un DEA pour sauver la vie d’une personne sur les lieux mêmes de l'urgence sauf si les dommages sont la conséquence d’une négligence grossière. Cette loi a pris effet le 3 juillet 2007. The Chase McEachern Act, 2007 - In place in ONTARIO Please visit this website to familiarize yourself with the Chase McEachern Act - Website reference: http://rescue7.smartsimple.com/files/224453/139221/Bill%20171%20fact%20sheet.pdf The “Chase McEachern Act (Heart Defibrillator Civil Liability), 2007” – based on a private member’s bill put forward by Liberal MPP Bruce Crozier (Essex) – is named after 11-year-old Barrie resident Chase McEachern. After being diagnosed with an irregular heartbeat, and hearing that two professional hockey players also have irregular heart beats like his, Chase decided to start a campaign to make defibrillators mandatory in hockey arenas and schools everywhere. On February 9, 2006, Chase passed out while jogging warm-up laps in gym class. He was rushed to hospital but efforts to resuscitate him failed. With the death of the young hockey player, the McEachern family created a tribute fund in honour of their son. A donor made a $100,000 gift to the fund with the condition it be used to put defibrillators in arenas in Grey and Bruce counties. The Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 will: Protects individuals from liability for damages that may occur in relation to their use of an AED to save someone’s life at the immediate scene of an emergency, unless damages are caused by gross negligence; Protect health care professionals from liability for damages that may occur in relation to their use of an AED to save someone’s life at the immediate scene of an emergency, unless damages are caused by gross negligence and unless the AED is used in a hospital or other place having appropriate health care facilities and equipment for the purpose of defibrillation; Protect owners and occupiers of premises on which an AED is installed from liability for any harm that may occur in relation to the use of the AED, provided that the owner or occupier made the AED available for use in good faith without gross negligence and properly maintained the defibrillator. The protection does not apply where the premise is a hospital or other health care facility.

RCR & DEA Quiz Be sure to allow ample time at the end of the course to answer any questions participants may have This is also a good time to review any areas that you feel need extra attention

Questions ? Commentaires ? Be sure to allow ample time at the end of the course to answer any questions participants may have This is also a good time to review any areas that you feel need extra attention

SVP remplir les formulaires d'évaluation et les passer au PRO FORMATEUR avant de quitter. Ensure that all participants were given an evaluation form Have them fill out this form and return to you (important, as you must submit these with your invoice in order to be paid for the course) Once evaluation forms have been returned, hand out course completion certificates

Merci Be sure to thank all participants for their time Stay after class to be available to answer any questions Have additional canfitpro material with you should any participants be interested in other certification courses