https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/equipment-decontamination https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/254.mp4 Equipment Decontamination Equipment Decontamination https://d3imrogdy81qei.cloudfront.net/video_images/455/equipment-decontamination.jpg Yes 245 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/equipment-setup https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/255.mp4 Equipment Setup Equipment Setup https://d3imrogdy81qei.cloudfront.net/video_images/457/equipment-setup.jpg Yes 209 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/HCP-adult-rescue-breathing-skill-eval https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/256.mp4 Adult Rescue Breathing (Healthcare Provider) Adult Rescue Breathing (Healthcare Provider) https://d3imrogdy81qei.cloudfront.net/video_images/459/HCP-adult-rescue-breathing.jpg Yes 226 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/conscious-adult-choking-skill-eval https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/268.mp4 Conscious Adult Choking Conscious Adult Choking https://d3imrogdy81qei.cloudfront.net/video_images/483/conscious-adult-choking.jpg Yes 123 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/bleeding-control-skill-eval https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/280.mp4 Bleeding Control Bleeding Control https://d3imrogdy81qei.cloudfront.net/video_images/507/bleeding-control.jpg Yes 230 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/remediation-skill-eval https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/281.mp4 Remediation Remediation https://d3imrogdy81qei.cloudfront.net/video_images/509/remediation.jpg Yes 491 https://app.protrainings.com/courses/instructor-skill-evaluator/bloodborne/videos/creating-class https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/393.mp4 Creating a Class To start this segment, you will need to be logged in. You can do this by going to www.procpr.org, where you can login with your username and password.  When you click on the Instructor tab, you will be directed to the Instructor Dashboard.  In this section, we will cover how to: begin creating new classes, adding students, purchasing additional certificates, download forms and documents, and monitor student progress.  https://d3imrogdy81qei.cloudfront.net/video_images/733/2-creating-class.jpg Yes 233 https://app.protrainings.com/courses/instructor-skill-evaluator/bloodborne/videos/registering-students https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/395.mp4 Registering Students This segment will cover how to add a student to an existing class.  You can do this by clicking on the class name.  If a student has already been registered, simply search for them by entering first and last name, username, email, or phone number.  Note: these will only be students that you have previously entered into the database.  In order to register a new student, you can fill in the appropriate fields.  This information entered will be used upon completion of the course.  The most important information to have is the first and last name the student will need on their certification card. We have designed the weekly video email and newsletter updates to provide ongoing education and increase customer relation and loyalty to the instructor and ProTrainings. Creating a username for the student - a suggestion is to use the students first and last name, followed by the instructor’s four digit registry number.  Passwords can be duplicated for multiple students.  The student can change their password once they are logged in. If the student is already registered, click on the Add Student to Class link. To complete this process, click on the instructor Dashboard tab. You can verify this by checking the student roster for the student’s name. Benefits: student shipping address can be mailed directly to the student.  In order to utilize this feature, you can check the shipping box, and enter the students mailing address.  In order to ensure this will be the delivery address for the certification, this can be updated at any point before the instructor checks the student off as complete.  If you are unaware of the student’s mailing address, the certificate will automatically be mailed to the instructor.  https://d3imrogdy81qei.cloudfront.net/video_images/737/4-registering-students.jpg Yes 122 https://app.protrainings.com/courses/instructor-skill-evaluator/bloodborne/videos/approving-students https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/396.mp4 Approving Students This section will show you how to approve a student for completion.  You can perform this function by viewing the Classroom Report page.  On this page, you can approve individual or multiple students.  To mark as complete, simply mark the box next to the student.  If you would like to mark all as complete, utilize the Check All at the top or bottom of the list. As long as you have enough certification units pre-purchased, a certificate will be automatically mailed from the ProTrainings Corporate office.  If an address has not been established, a message will appear - this will need to be established in order to complete the certification process.  (Refer to Registering Students for this function.) Note: once completed, you will notice the student is now paid. You will have the capability to print and provide the student(s) with a temporary wallet card or a wall mount.   https://d3imrogdy81qei.cloudfront.net/video_images/739/5-approving-students.jpg Yes 74 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/classroom-skills https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/398.mp4 Conducting Classroom Skills Conducting Classroom Skills https://d3imrogdy81qei.cloudfront.net/video_images/743/7-conduct-classroom-skills.jpg Yes 273 https://app.protrainings.com/courses/instructor-skill-evaluator/bloodborne/videos/probloodborne-instructor-training https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/652.mp4 ProBloodborne Instructor Training This video provides the necessary details to train a ProBloodborne Instructor. Topics covered include: required materials, instructor responsibilities, how to present the course, testing requirements, and course completion. https://d3imrogdy81qei.cloudfront.net/video_images/1101/probloodborne-instructor-training.jpg Yes 229 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics--intro-to-moving-people https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/671.mp4 Welcome to Ergonomics for Healthcare Workers One of the major contributors of healthcare worker injury is the frequent heavy lifting and repositioning of persons that exceed the lifting capacity of most caregivers. The implementation of a safe lifting and moving people program can greatly reduce the risk of injury. https://d3imrogdy81qei.cloudfront.net/video_images/1139/healthcare-ergonomics--intro-to-moving-people.jpg Yes 243 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics-what-to-look-for https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/672.mp4 Ergonomic Hazards to Look For in Healthcare It is important for every employer to analyze the jobs and work tasks of employees to identify potential future ergonomic problems before actual injuries, especially reportable injuries occur. This can be accomplished by using ergonomic risk analysis tools, reviewing injury logs, seeking employee input, and examining similar industries. For example, manual lifting of people should be minimized in all cases and eliminated when feasible. We do this by eliminating any conditions that would require manual movement or lifting of persons and by implementing proper lifting devices. https://d3imrogdy81qei.cloudfront.net/video_images/1141/healthcare-ergonomics-what-to-look-for.jpg Yes 203 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics---proper-nutrition https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/673.mp4 Why do we need Proper Nutrition? Proper nutrition plays a large role in how much the body can handle. It is important to drink enough water (6-8 glasses a day), eat proper food with the right balance of proteins and carbohydrates, and get a full amount of rest so the body can compensate to lift appropriately. https://d3imrogdy81qei.cloudfront.net/video_images/1143/proergonomics---proper-nutrition.jpg Yes 109 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics-fitness-and-stretching--part-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/674.mp4 Ergonomic Stretches for the Workplace: Part 1 When your muscles are strong, stretched, flexible, and well oxygenated, the risk of injury can be greatly reduced when lifting and moving people. https://d3imrogdy81qei.cloudfront.net/video_images/1145/proergonomics-fitness-and-stretching--part-1.jpg Yes 219 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics-fitness-and-stretching-part-2 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/675.mp4 Ergonomic Stretches: Part 2 - Stretching Tendons and Ligaments Stretching is one of the most valuable measure you can take to help reduce injuries in the workplace. Implement a basic routine that fits into your lifestyle and your physical abilities. Learn several examples of stretching each muscle group individually from head to toe. https://d3imrogdy81qei.cloudfront.net/video_images/1147/proergonomics-fitness-and-stretching-part-2.jpg Yes 631 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics-fitness-and-stretching-part-3 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/676.mp4 Ergonomic Stretches: Part 3 - Physical Fitness Fitness is one of the most important compensating function that will help us to lift properly and reduce the risk of injury. Excess body weight causes cumulative stress disorder from the added workload on the body. Starting a regular routine of exercise that will build muscle, control weight, and support good cardiovascular function will help you to perform you job duties better and minimize injuries. https://d3imrogdy81qei.cloudfront.net/video_images/1149/proergonomics-fitness-and-stretching-part-3.jpg Yes 172 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics-requirements https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/677.mp4 Requirements for Training Frequency A person needs to be trained in ergonomics when a problem job is identified, when assigned to a known problem job, when new hazards are identified, or at least every three years. Proper training can help a person stay healthy for a long-lasting life. https://d3imrogdy81qei.cloudfront.net/video_images/1151/proergonomics-training.jpg Yes 52 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics-fitness-and-stretching-part-4 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/678.mp4 Ergonomic Stretches: Part 4 - How to do Crunches It is vital to strengthen the core muscles because the abdominal muscles play a major role in compensating for the back when lifting or moving people or objects. Some great exercises that can be done to help protect the back from injury are crunches or quarter sit-ups. https://d3imrogdy81qei.cloudfront.net/video_images/1153/proergonomics-fitness-and-stretching-part-4.jpg Yes 86 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics-how-and-why-to-lift-correctly https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/679.mp4 How to Correctly Lift Objects If we move people or things incorrectly, we can cause ourselves or others injury. Some key elements of proper lifting are keeping the back straight, head up, the load close to your body, and avoiding twisting. https://d3imrogdy81qei.cloudfront.net/video_images/1155/healthcare-ergonomics-how-and-why-to-lift-correctly.jpg Yes 129 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics-single-person-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/680.mp4 Single Person Lift - Can One Person Operate a Hoyer Lift? From an ergonomics standpoint, you would only lift assist someone by yourself when the person can support his or her own weight while standing with support. If a person cannot support his or her own weight, you would need at least two people to perform the lift. While performing a lift assist, a gait belt should be used. https://d3imrogdy81qei.cloudfront.net/video_images/1157/healthcare-ergonomics-single-person-lift.jpg Yes 465 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---2-person-floor-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/681.mp4 Two Person Lift from the Floor It is always best to lift people with the help of a second person. Lifting a person from the floor requires coordination and good communication to avoid injuries. https://d3imrogdy81qei.cloudfront.net/video_images/1159/healthcare-ergonomics---2-person-floor-lift.jpg Yes 135 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---2-person-chair-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/682.mp4 Two Person Chair Lift Lifting a person from a chair should be well thought out and planned. The taller caregiver should be positioned at the head, while the shorter caregiver should be positioned at the legs. The helps to ensure that the patient's head will remain higher than the feet. https://d3imrogdy81qei.cloudfront.net/video_images/1161/healthcare-ergonomics---2-person-chair-lift.jpg Yes 100 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---2-person-transfer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/683.mp4 Two Person Chair Transfer This move is best for lifting a person out of a chair and placing him or her into another seat, such as a portable toilet, wheelchair, or more comfortable chair. https://d3imrogdy81qei.cloudfront.net/video_images/1163/healthcare-ergonomics---2-person-transfer.jpg Yes 161 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---using-a-mechanical-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/684.mp4 How to Use a Mechanical Lift When a patient is not able to bear weight on his or her feet, a mechanical lift should be used. A mechanical lift takes the strain out of lifting and drastically reduces the risk of injury. While using any mechanical device it is important to communicate with the patient to keep him or her calm. Make sure to use the proper sling and adjust the straps to fit the patient properly. https://d3imrogdy81qei.cloudfront.net/video_images/1165/healthcare-ergonomics---using-a-mechanical-lift.jpg Yes 377 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---transfer-from-a-bed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/685.mp4 How to Transfer a Patient from a Bed One of the most difficult situations care-providers have that tests the limits of proper ergonomics is transferring a person from a bed. As much as possible, use proper ergonomics and take some precautions. Using a draw-sheet is very helpful. Position the receiving surface even or just slightly lower than the patients surface. https://d3imrogdy81qei.cloudfront.net/video_images/1167/healthcare-ergonomics---transfer-from-a-bed.jpg Yes 313 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---emergency-clothes-drag https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/686.mp4 How to Perform an Emergency Clothes Drag Emergency moves are used when it is necessary to get a person to safety, quickly.  Urgent and emergency moves can be high risk for the caregiver and the patient. Remember to use proper ergonomics with a straight back, head up and using the legs to lift. Roll up and grasp the clothing firmly, using the palm of the hands facing up, behind the neck of the patient. Holding firmly walk backwards, dragging the patient. https://d3imrogdy81qei.cloudfront.net/video_images/1169/healthcare-ergonomics---emergency-clothes-drag.jpg Yes 115 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---emergency-blanket-drag https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/687.mp4 How to Perform an Emergency Blanket Drag A blanket can be used to move a person in an emergency. First, the patient needs to be rolled onto the blanket. Hold the top of the blanket like a sling and walk backwards, dragging the patient. https://d3imrogdy81qei.cloudfront.net/video_images/1171/healthcare-ergonomics---emergency-blanket-drag.jpg Yes 102 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---emergency-under-arm-wrist-drag- https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/688.mp4 How to Perform an Emergency Under Arm Wrist Drag This under arm wrist drag move requires a lot of strength and good ergonomic technique. Again, this move would only be used in an emergency. Place the person in a semi-sitting position. Move your hands under the arms of the patient and grasp the opposite wrists of the patient. Now, stand up slightly, lifting the patient's head and back off the ground, and walk backward, dragging the patient. https://d3imrogdy81qei.cloudfront.net/video_images/1173/healthcare-ergonomics---emergency-under-arm-wrist-drag-.jpg Yes 72 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics---recognizing-msds https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/689.mp4 What are Symptoms of Musculoskeletal Disorders? A MSD (Musculoskeletal Disorder) is an injury and a disorder of the muscles, nerves, tendons, ligaments, cartilage, and spinal disks. Slips, trips, falls, crushing injuries or other similar accidents do not cause MSDs. https://d3imrogdy81qei.cloudfront.net/video_images/1175/proergonomics---recognizing-msds.jpg Yes 87 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics---establishing-a-written-policy https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/690.mp4 How to Establish a Written Ergonomics Policy OSHA provides several templates to follow. Use the who, what, when, where, and why questions to develop a policy. An example of questions to ask when creating a written policy include: who is at risk, what job functions are most risky, when should employees get trained, where do ergonomic principles apply, why should employees implement a safety program, how can a safety program be implemented in the workplace? https://d3imrogdy81qei.cloudfront.net/video_images/1177/proergonomics---establishing-a-written-policy.jpg Yes 235 https://app.protrainings.com/courses/ergonomics/healthcare/videos/healthcare-ergonomics---benefits-of-implementing-a-safe-moving-people-program https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/691.mp4 Benefits of a Safe Patient Handling Program Businesses that implement a safe moving and lifting people program can reduce staff turn-over, reduce training and administrative costs, improve employee morale, and increase patient comfort. https://d3imrogdy81qei.cloudfront.net/video_images/1179/healthcare-ergonomics---benefits-of-implementing-a-safe-moving-people-program.jpg Yes 215 https://app.protrainings.com/courses/ergonomics/healthcare/videos/proergonomics---fitness-and-stretching---part-5 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/692.mp4 Ergonomic Stretches: Part 5 - Good Nutrition and Posture As a recap, incorporate a good stretching program into your lifestyle. At least 6-8 glasses of water a day is necessary for proper nutrition and hydration. Keep excess weight off through good nutrition, limiting simple sugars, and practicing a good exercising habit. Lastly, good posture is a large part of preventing injuries. https://d3imrogdy81qei.cloudfront.net/video_images/1181/proergonomics---fitness-and-stretching---part-5.jpg Yes 106 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--introduction-and-what-to-look-for https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/693.mp4 Ergonomics for the Workplace and Hazards to Consider Manual lifting of materials and repetitive movements should be eliminated when feasible or minimized. Conditions in the workplace need to be analyzed to see what may be leading to injuries. Reports, injury logs, and worker compensation claims can help discover where problem areas are. Identified risk areas need to be fixed to protect workers from injury and employers from needless costs. https://d3imrogdy81qei.cloudfront.net/video_images/1183/workplace-ergonomics--introduction-and-what-to-look-for.jpg Yes 214 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--pallet-truck https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/694.mp4 How to Use a Pallet Truck Safely A pallet truck is an excellent tool that can help lift a heavy load without causing harm to yourself or others. https://d3imrogdy81qei.cloudfront.net/video_images/1185/workplace-ergonomics--pallet-truck.jpg Yes 107 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--loading-a-cart https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/695.mp4 Ergonomic Cart Loading While loading a cart, a second person should hold the cart from moving while the load is placed. https://d3imrogdy81qei.cloudfront.net/video_images/1187/workplace-ergonomics--loading-a-cart.jpg Yes 27 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--two-wheel-dolly https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/696.mp4 Correctly Using a Two Wheel Dolly A two-wheel dolly can significantly reduce lifting and the risk of injury when used properly to move heavy objects. https://d3imrogdy81qei.cloudfront.net/video_images/1189/workplace-ergonomics--two-wheel-dolly.jpg Yes 61 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--single-person-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/697.mp4 Single Person Lift There will be times a lift requires 1 person. Ask yourself if any lifting device could be used, is the load not too heavy to lift safely, can another person help, is the pathway clear, etc...  With the head up and back straight, keep the load close to the body and lift with the legs. https://d3imrogdy81qei.cloudfront.net/video_images/1191/workplace-ergonomics--single-person-lift.jpg Yes 137 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--two-person-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/698.mp4 Two Person Lift When performing a two-person lift, one person will take the lead and call out when to lift and when to lower. https://d3imrogdy81qei.cloudfront.net/video_images/1193/workplace-ergonomics--two-person-lift.jpg Yes 75 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--two-person-box-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/699.mp4 Two Person Box Lift When lifting a box with two people, plan the lift and think about how heavy it is. Ask yourself, "Instead, can I get a device to lift it with?" One person will take the lead and give commands to control the lift. https://d3imrogdy81qei.cloudfront.net/video_images/1195/workplace-ergonomics--two-person-box-lift.jpg Yes 88 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics---moving-unusual-objects https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/700.mp4 Moving Unusual Objects When moving an unusual object, try to determine how heavy the object may be. First determine if you can use a lifting device or another person. If you have to lift the object manually, position the object so you can lift is. Keep the head up, back straight, object close to the body, and lift using the legs. https://d3imrogdy81qei.cloudfront.net/video_images/1197/workplace-ergonomics---moving-unusual-objects.jpg Yes 60 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--conveyor-belts https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/701.mp4 Conveyor Belts The conveyor belt allows easy moving of objects. https://d3imrogdy81qei.cloudfront.net/video_images/1199/workplace-ergonomics--conveyor-belts.jpg Yes 33 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics---establishing-a-written-policy https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/702.mp4 How to Establish a Written Ergonomics Policy Many templates exist that allow an employer to create a written policy for workplace ergonomics. When creating a policy one should ask: who does this policy pertain to, what causes injures to workers, when do ergonomics standards apply, where do I keep the policy for easy access and conducting training, why train people in ergonomics, and how do the workers use the devices put into place to help reduce injuries.   https://d3imrogdy81qei.cloudfront.net/video_images/1201/workplace-ergonomics---establishing-a-written-policy.jpg Yes 270 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-erognomics--benefits-and-cost-effectiveness https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/703.mp4 Benefits of Ergonomics in the Workplace There are many benefits to implementing a workplace ergonomics training program. Employers can drastically reduce costs and worker injuries that last a lifetime. https://d3imrogdy81qei.cloudfront.net/video_images/1203/workplace-erognomics--benefits-and-cost-effectiveness.jpg Yes 57 https://app.protrainings.com/courses/ergonomics/general/videos/workplace-ergonomics--implementing-an-ergonomics-program https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/704.mp4 Implementing an Ergonomics Program in the Workplace Employees need to implement ergonomics training to reduce the risk of injury. If an action trigger has occurred, the employer must conduct a full in-depth training on the specific equipment or job functions involved. https://d3imrogdy81qei.cloudfront.net/video_images/1205/workplace-ergonomics--implementing-an-ergonomics-program.jpg Yes 82 https://app.protrainings.com/courses/ergonomics/healthcare/videos/why-pro-ergonomics https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/726.mp4 Why Pro Ergonomics Learn why you should take the Pro Ergonomics training course. Beyond simply satisfying compliance requirements, choosing to take a course in ergonomics could have the positive impact of protecting you from potentially permanent and chronic injuries that could affect you for the rest of your life. https://d3imrogdy81qei.cloudfront.net/video_images/1249/why-pro-ergonomics.jpg Yes 102 https://app.protrainings.com/courses/ergonomics/office/videos/repetitive-stress-injury-prevention-part-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/838.mp4 Repetitive Stress Injury Prevention: Proper Ergonomics for Computer Work Information on preventing repetitive stress injuries like tennis elbow (epicondylitis), carpal tunnel syndrome, tendinitis, reflex sympathetic dystrophy, and ganglion cyst. https://d3imrogdy81qei.cloudfront.net/video_images/1465/repetitive-stress-injury-preveintion-part-1.jpg Yes 229 https://app.protrainings.com/courses/ergonomics/office/videos/repetitive-stress-injury-prevention-part-2 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/839.mp4 Repetitive Stress Injury Prevention: Ergonomic Keyboard Position Information on preventing repetitive stress injuries like tennis elbow (epicondylitis), carpal tunnel syndrome, tendinitis, reflex sympathetic dystrophy, and ganglion cyst. https://d3imrogdy81qei.cloudfront.net/video_images/1467/repetitive-stress-injury-preveintion-part-2.jpg Yes 407 https://app.protrainings.com/courses/ergonomics/office/videos/office-ergonomics-monitors-part-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/840.mp4 Ergonomic Monitor Position: Distance From Monitor Proper positioning and frequent breaks from computer monitors can be crucial to prevent eye and other postural strain.   https://d3imrogdy81qei.cloudfront.net/video_images/1469/office-ergonomics-monitors-part-1.jpg Yes 243 https://app.protrainings.com/courses/ergonomics/office/videos/monitors-part-2 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/841.mp4 Ergonomic Monitor Position: Monitor Height Proper positioning and frequent breaks from computer monitors can be crucial to prevent eye and other postural strain.   https://d3imrogdy81qei.cloudfront.net/video_images/1471/monitors-part-2.jpg Yes 356 https://app.protrainings.com/courses/ergonomics/office/videos/monitors-part-3 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/842.mp4 Ergonomic Desk Setup: Two Monitors Proper positioning and frequent breaks from computer monitors can be crucial to prevent eye and other postural strain. https://d3imrogdy81qei.cloudfront.net/video_images/1473/monitors-part-3.jpg Yes 216 https://app.protrainings.com/courses/ergonomics/office/videos/desks-document-holders-and-phones https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/843.mp4 Ergonomic Desk Setup: Document Holders, Keyboards, and Phones Proper placement of items on the desk can help reduce injury from excessive reaching, poor posture, and repetitive actions. https://d3imrogdy81qei.cloudfront.net/video_images/1475/desks-document-holders-and-phones.jpg Yes 263 https://app.protrainings.com/courses/ergonomics/office/videos/good-working-position-and-chairs https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/844.mp4 Ergonomic Position for Computer Work Proper adjustment of office chairs and using good posture throughout the day can prevent some of the most common office related postural strain and stress injuries. https://d3imrogdy81qei.cloudfront.net/video_images/1477/good-working-position-and-chairs.jpg Yes 262 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/intoduccion-a-patogenos-de-sangre https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1223.mp4 Introducción a patógenos sanguíneos Este curso está dirigido a personas que necesitan capacitación sobre control de infecciones y patógenos de la sangre que cumplen con OSHA, de acuerdo con la norma OSHA 29 CFR 1910.1030, como parte de sus requisitos de trabajo, ya que pueden enfrentar exposición laboral a patógenos de transmisión sanguínea y enfermedades infecciosas. https://d3imrogdy81qei.cloudfront.net/video_images/2075/intro-to-bloodborne-pathogens-2013.jpg Yes 162 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/intro-to-bloodborne-pathogens https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1223.mp4 Intro to Bloodborne Pathogens Welcome to the ProBloodborne course! In this course, you'll learn: How to protect yourself or other employees from getting bloodborne diseases What potential diseases you could get by coming into contact with blood and other bodily fluids What to do if someone at your workplace comes into contact with blood and bodily fluids The goal of this course is simple – To help you get the information you need, including the skills and knowledge to prevent diseases from bloodborne pathogens. Who is the ProBloodborne Course For? This course is for anyone who needs OSHA compliant bloodborne pathogens and infection control training according to OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) as part of their job requirement. People who may face exposure to bloodborne pathogens and infectious diseases who need this course include: Healthcare providers Daycare providers Homecare workers Teachers Tattoo artists General workplace employees The ProBloodborne training course follows the OSHA standard requirements, which states: Proper training is required at the time of initial assignment to tasks where occupational exposure may take place. Annual training of all employees shall be provided within one year of their previous training. Employers shall provide additional training when changes occur, such as the modification of tasks or procedures, or when the institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created. What Does the ProBloodborne Course Include? This course includes the following training. You'll learn about: Basic terms related to bloodborne pathogens How bloodborne pathogens and infectious diseases are spread The responsibilities of healthcare professionals to avoid spreading bloodborne pathogens and infectious diseases HIV and AIDS Hepatitis B Hepatitis C How to reduce the risks of exposure Engineering controls Workplace practices to protect yourself and other employees Personal protection equipment Safe injection practices Skin diseases Exposure control plans Proper cleanup and decontamination procedures Hazardous disposal Follow-up procedures when incidents occur Got Questions? We Have Answers! Don't forget, whenever you have questions, we have an interactive system in place to answer them, whether by email, chat, or phone support. In this course, as with all of our courses, you are never alone. A Word About How Diseases are Spread In the next lesson, we'll be diving deeper into how bloodborne pathogens and OPIM (other potentially infectious materials) are spread. So, consider this a short primer to get you ready. Exposure to blood and infectious diseases occurs across a wide variety of occupations, as you've already seen, including healthcare workers, emergency response providers, public safety personnel, and other workers, particularly those involved in body arts like tattoos and piercings. Exposure can occur both directly and indirectly. Direct contact transmission occurs when infected blood or OPIM from one person enters the body of another. For example, direct contact transmission can occur through infected blood splashing in the eye or from directly touching the OPIM of an infected person. Some bloodborne pathogens are also transmitted by indirect contact. Indirect contact transmission can occur when a person touches an object that contains the blood or OPIM of an infected person. These objects include soiled dressings, equipment, and work surfaces contaminated with an infected person's blood or OPIM. For example, indirect contact can occur when a person picks up blood-soaked bandages with a bare hand and the pathogens enter through a break in the skin on that person's hand. For any bloodborne disease to spread, all five of the following conditions must be met: There must be an adequate number of pathogens or disease-causing organisms in the environment. There needs to be a reservoir or source that allows the pathogen to survive and even multiply, such as blood. There must be a mode of transmission from source to host. There must be an entrance through which the pathogen enters the host. The host must be susceptible to that pathogen, as opposed to being immune to it. To understand how infections occur, think of these five conditions as pieces of a puzzle. All of the pieces must be in place for the picture to be complete. If any one of the conditions is missing, an infection cannot occur. https://d3imrogdy81qei.cloudfront.net/video_images/2075/intro-to-bloodborne-pathogens-2013.jpg Yes 162 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/como-se-propagan-los-patogenos-de-sangre https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1224.mp4 Cómo se propagan los patógenos de la sangre Los patógenos transmitidos por la sangre son microorganismos (como los virus) que están presentes en la sangre humana y pueden causar enfermedades en los humanos. Estos patógenos incluyen, entre otros, el virus de la hepatitis B (VHB), la hepatitis C (VHC) y el virus de la inmunodeficiencia humana (VIH). La fuente principal de patógenos en la sangre potenciales es la sangre y los fluidos corporales específicos. El objetivo es prevenir la propagación de patógenos transmitidos por la sangre mediante la interrupción de la forma en que se propagan utilizando estrategias de control de la infección. La principal forma en que se propagan las infecciones como la hepatitis B, la hepatitis C o el VIH es a través del contacto sexual o el abuso de drogas por vía intravenosa. https://d3imrogdy81qei.cloudfront.net/video_images/2077/how-bloodborne-pathogens-are-spread-2013.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/how-bloodborne-pathogens-are-spread https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1224.mp4 How Bloodborne Pathogens are Transmitted What are Bloodborne Pathogens? In this lesson, we'll take a look at how one gets ill from a bloodborne pathogen or infectious disease. But first, how about a couple of definitions? Bloodborne Pathogen – A bloodborne pathogen is a microorganism that's present in human blood and can cause disease in humans. Infectious Disease – An infectious disease is a disease (also caused by microorganisms like bacteria, virus, fungus, etc.) that enters the body through various biological routes. It's important to note that not all bloodborne pathogens and infectious diseases are created equally, as some can produce mild symptoms, while others can be life-threatening. The Chain of Infection For any disease to spread, several conditions must be present. This is known as the chain of infection. And if you recall from the last lesson, those conditions are as follows: There must be an adequate number of pathogens or disease-causing organisms in the environment. There needs to be a reservoir or source that allows the pathogen to survive and even multiply, such as blood. There must be a mode of transmission from source to host. There must be an entrance through which the pathogen enters the host. The host must be susceptible to that pathogen, as opposed to being immune to it. Pro Tip #1: Infection control strategies help prevent disease transmission by interrupting one or more links in the chain of infection. Sources of Bloodborne Pathogens The primary source of potential bloodborne pathogens is blood and specific bodily fluids, like semen and vaginal secretions. However, there are other bodily fluids that may contain bloodborne pathogens, especially if they are visibly contaminated with blood. Those sources include: Cerebrospinal fluid in the brain Synovial fluid in the joints Pleural fluid in the lungs Amniotic fluid in and around the uterus Pericardial fluid around the heart Peritoneal fluid in the abdomen Urine, feces, saliva, and a few other fluids don't typically carry bloodborne pathogens, however … Pro Tip #2: Because it's so difficult to identify contaminated body fluids or know for sure if those fluids are contaminated with blood, it's important to treat ALL bodily fluids as potential threats that could include bloodborne pathogens. How Bloodborne Pathogens and OPIM Get into the Body There are four basic modes of transmission: Direct Contact – Direct contact transmission occurs when microorganisms are transferred from an infected person to another person. An example would be a tattoo artist with an open, uncovered cut or wound, in which blood from a client/source comes in contact with that wound. Parenteral Exposure – Parenteral exposure is when infected blood and/or bodily fluids are introduced into the body through piercing or puncturing the skin. An example would be getting stuck with a contaminated needle or being cut with a sharp object that's been contaminated. Indirect Contact – Indirect contact is when a contaminated object (tools, needles, etc.) makes contact with a person's skin or mucous membranes, like those found in the eyes, mouth, nose, and ears. Which is why it's so important to decontaminate any objects that have blood on them. Airborne Transmission – Airborne transmission occurs when droplets or small particles that contain an infectious agent remain active in the air and are then inhaled into the body. An example of this would be tuberculosis. While airborne transmission is possible, most cases of bloodborne pathogen infections do not fall into this category. Some Risks are Higher than Others While it's important to consider all blood and bodily fluids potential threats, there are some methods of transmission that are more common than others. Highest Potential Risks The most common ways bloodborne pathogens and OPIM are spread are: Getting stuck with an infected needle Sexual contact Other than sexual contact, the highest potential risks are when a contaminated, sharp object punctures or cuts the skin, such as with an infected needle, a broken piece of contaminated glass, or getting cut by a razor that was also used by an infected person. Pro Tip #3: Fans of the TV show Live PD will be familiar with police protocol before searching a person – a protocol that includes asking if that person has any sharp objects or needles that could poke, stab, or cut them. If you weren't sure why police officers do this, now you know. Medium Potential Risks Medium risks involve situations where blood and bodily fluids get into an open cut or are absorbed through a mucous membrane – eyes, nose, ears, mouth, etc. Like our tattoo artist example from above. Lowest Potential Risks The lowest potential risks include situations where contaminated objects come in contact with inflamed skin, acne, skin abrasions, etc. Which brings up a good point. Pro Tip #4: Knowing how bloodborne pathogens and OPIM are spread is important to be sure. But so is knowing what prevents those microorganisms from spreading. And the number one line of defense is intact skin. In fact, the CDC (Center for Disease Control) has stated that there is no known risk of exposure to bloodborne pathogens and infectious diseases through intact skin. Which means casual contact – like handshaking, hugging, touching doorknobs, etc. – are not considered threats in normal situations. https://d3imrogdy81qei.cloudfront.net/video_images/2077/how-bloodborne-pathogens-are-spread-2013.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/vih-y-sida https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1225.mp4 VIH y SIDA El virus de la inmunodeficiencia humana causa el SIDA, trastorno de inmunodeficiencia adquirida, en el cual el sistema inmunológico se vuelve incapaz de combatir la enfermedad. El VIH se transmite principalmente por contacto sexual. Menos del 1% de los profesionales médicos se infectan a través de la exposición laboral. No se transmite por contacto casual, como un apretón de manos, compartir alimentos o asientos de inodoro. No hay vacunación ni cura para el VIH. https://d3imrogdy81qei.cloudfront.net/video_images/2079/hiv-and-aids-2013.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hiv-and-aids https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1225.mp4 HIV and AIDS HIV stands for human immunodeficiency virus. It attacks the body and harms the immune system by destroying the white blood cells that fight infection. Which in turn diminishes the body's ability to protect itself against disease. If left untreated, HIV will eventually progress into AIDS – acquired immunodeficiency syndrome. In this lesson, we'll take a look at transmission rates, symptoms (though very problematic and unreliable), and how you can better protect yourself from infection. Pro Tip #1: On average, it takes 10 years for the HIV virus to progress into AIDS. However, this average varies greatly person to person, and is affected by a number of factors like health status, behavioral characteristics, medications taken, etc. Since 1996, with the introduction of powerful retroviral therapies, the natural progression of HIV to AIDS has been slowed. AIDS Statistics in the U.S. There are around 1.1 million people living with HIV in the United States. What is perhaps even more troubling is that around 18 percent aren't even aware they have been infected, as they haven't been tested and symptoms don't exist or aren't noticeable. Around 50,000 people become infected with HIV each year and approximately 15,000 each year die from AIDS. HIV Infection Rates by Category According to CDC From highest to lowest, these are the ways in which people are infected with HIV each year in the U.S. Category 2011 2018 Male to male sexual contact 62% 66% Heterosexual contact (females) 18% 16% Heterosexual contact (males) 10% 8% Injection drug use (male) 5% 4% Injection drug use (female) 3% 3% Male to male sexual contact and IDU 3% 4% Other 1% 1% Other includes babies who are born from infected mothers, blood transfusions, and needle sticks, among other less common reasons. Of the babies that contract HIV, this can occur before birth, during birth, or during breastfeeding. Pro Tip #2: Out of the estimated 50,000 people per year infected with HIV, less than one percent is due to a work-related incident. What does this mean for you? Of all the ways people contract HIV, very few will become infected in the workplace, even in professions (like yours) where the risk is higher. Warning: Don't let that lull you into a false sense of security. Part of the reason that number is so low is because proper infection control policies are routinely put in place for many professions who are around bloodborne pathogens and OPIM. Follow your policies and procedures, and your chances will likely go well below that one percent. HIV Signs and Symptoms If left unchecked, HIV is a deadly virus that eventually will spread to AIDS. But how do you know if you've been infected with HIV? Get tested! That's the only sure way to know. However, sometimes there are signs. (Often there are no symptoms, which is why it's a good idea to get tested if there's any question or doubt.) Symptoms, when present, can include: Fever Fatigue Night sweats Weight loss Rash Dry cough Pro Tip #3: The HIV virus is actually quite fragile (outside the body) and will die within seconds after being exposed to air. Inside the body, the amount of the virus present in body fluid and the physiological condition of the host will determine how long the virus lives. It's important to note – There is currently no vaccine or cure for HIV or AIDS. Some Important HIV/AIDS Takeaways How HIV is spread is important, as this happens mostly through unprotected sex and from sharing needles or syringes. Only a very small fraction of one percent of people are infected while providing medical care, and most of these are due to sticks from dirty needles. While this may seem obvious to many, particularly medical professionals, HIV (like other bloodborne pathogens and OPIM) cannot be spread by casual contact, such as hugging, handshaking, doorknobs, toilet seats, etc. Pro Tip #4: Remember, symptoms are not reliable and may not be present for many years, which means numerous people infected with HIV will never know they have it until those symptoms appear or … through proper testing. A Word About Pathogens and the Diseases and Conditions They Cause Let's take a quick look at the variety of pathogens that exist and the conditions and diseases they cause. Viruses Hepatitis, measles, mumps, chicken pox, meningitis, rubella, influenza, warts, colds, herpes, HIV (which causes AIDS), genital warts, smallpox, avian flu, Ebola, and Zika. Bacteria Tetanus, meningitis, scarlet fever, strep throat, tuberculosis, gonorrhea, syphilis, chlamydia, toxic shock syndrome, Legionnaires' disease, diphtheria, food poisoning, Lyme disease, and anthrax. Fungi Athlete's foot, ringworm, and histoplasmosis. Protozoa Malaria, dysentery, Cyclospora, and giardiasis. Rickettsia Typhus and Rocky Mountain spotted fever. Parasitic Worms Abdominal pain, anemia, lymphatic vessel blockage, lowered antibody response, and respiratory and circulatory complications. Prions Creutzfeldt-Jakob disease (CJD) or bovine spongiform encephalopathy (mad cow disease). Yeasts Candidiasis (also known as thrush). https://d3imrogdy81qei.cloudfront.net/video_images/2079/hiv-and-aids-2013.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hepatitis-b-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1226.mp4 Virus de la hepatitis B La hepatitis B se reproduce en el hígado causando inflamación y posiblemente cirrosis, insuficiencia hepática o cáncer de hígado. Las personas pueden tener hepatitis B durante meses antes de que aparezcan los síntomas, por lo que se puede transmitir fácilmente a otras personas sin saberlo. A diferencia del VIH, el virus de la hepatitis B puede vivir fuera del cuerpo durante al menos 7 días o más en sangre seca. Es mucho más fácil atrapar este virus de la exposición. El virus se propaga principalmente por contacto sexual y abuso de drogas por vía intravenosa. https://d3imrogdy81qei.cloudfront.net/video_images/2081/hepatitis-b-virus-2013.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hepatitis-b https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1226.mp4 Hepatitis B Virus In this lesson, we're going to take a look at the Hepatitis B virus, also known as HBV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis B infection in the U.S. When a person is first infected with the Hepatitis B virus, it begins as an acute infection (meaning short in duration) and can range from very mild conditions with few or no symptoms to a serious condition requiring hospitalization. The Hepatitis B virus reproduces in the liver, which causes inflammation. This, in turn, can also lead to cirrhosis of the liver, liver cancer, and liver failure. An acute infection is defined by duration – the first six months after the person is exposed to the virus. Some people's bodies can fight the infection and rid it from their systems. While others become chronically infected (meaning long-term). Pro Tip #1: What does a chronic infection mean in practical terms? It means the virus remains in the blood, affects and damages liver cells over time, which causes illnesses like cirrhosis of the liver, liver failure, liver cancer, and eventually death. The good news – Around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. The other 10 percent of people who contract Hepatitis B fall into that chronic category outlined above. Warning: Hepatitis B is particularly devastating for infants and young children, as the majority will be at a much greater risk of developing a chronic infection. In most kids, Hepatitis B is a silent killer, and left unchecked will slowly destroy the liver over a period of 20 years or more. How Hepatitis B is Contracted and Spread Hepatitis B is contracted in the same ways as HIV. It's mainly spread through sexual contact with an infected person, or as a result of sharing needles or syringes with an infected person. And, like HIV, the infection can be passed from mother to unborn (or just-born) baby, especially if the infant came into contact with blood or other bodily fluids through breaks in the skin like cuts or sores. Pro Tip #2: Do not expect a person with chronic Hepatitis B to look or appear sick. The virus cares little about appearances and will spread regardless. Hepatitis B Statistics in the U.S. It is estimated that up to 1.2 million people in the U.S. have a chronic Hepatitis B infection 38,000 people each year become infected with the Hepatitis B virus 3000 people each year die from liver disease caused by Hepatitis B The number of infections has significantly decreased since 1990, thanks to routine Hepatitis B vaccinations Hepatitis B Signs and Symptoms Much like with HIV and AIDS, signs and symptoms for Hepatitis B are unreliable and may or may not be present. And why proper testing for both is the only sure-fire way to know if an infection is present. Hepatitis B symptoms include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay-colored stools Abdominal discomfort Fever Pro Tip #3: The Hepatitis B virus is up to 100 times easier to catch than HIV. There are several reasons for this including the virus' size, as it's much smaller than HIV, and the fact that the Hepatitis B virus can live outside the body for at least seven days, depending on specific conditions. Also, like HIV, Hepatitis B cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with doorknobs, water fountains, and toilets. Hepatitis B Vaccine This is where the Hepatitis B and HIV similarities end, as there is an effective vaccine for Hepatitis B that is administered in three doses over a six-month period. The vaccine is safe, as it's made from non-infectious materials and cannot cause one to become infected with the Hepatitis B virus. Also, severe problems or allergic reactions are rare. The Hepatitis B vaccine is around 80 – 95 percent effective in providing protection against the virus, but only in situations where all three doses of the vaccine are administered. Pro Tip #4: It's probably a good idea to not assume the vaccine worked. It's easy enough to confirm your newly developed immunity to the Hepatitis B virus but wait at least one to two months after completing the vaccine series before getting tested. *It should be noted, that at this time, booster doses of the Hepatitis B vaccine are not recommended. Consider Getting the Hepatitis Vaccine if … There are some people who are more likely to be occupationally exposed to the Hepatitis B virus than others, and that includes: Tattoo artists, or anyone who performs body piercings or body art People who administer first aid routinely Professionals who provide medical care Employees responsible for assisting in bathroom care People who work in medical and/or dental offices People who handle medical waste Employees who perform custodial duties that involve the cleaning of decontaminated surfaces – blood and other possibly infectious materials Anyone whose job will, or might, expose them to the Hepatitis B virus must be offered the vaccine for free through their employer. Employees who do not want the vaccine will need to complete a vaccine declination form. https://d3imrogdy81qei.cloudfront.net/video_images/2081/hepatitis-b-virus-2013.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hepatitis-c-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1227.mp4 Virus de la hepatitis C El virus de la hepatitis C (VHC) se reproduce en el hígado y causa inflamación y posiblemente cirrosis, insuficiencia hepática o cáncer de hígado, muy parecido al virus de la hepatitis B. Sin embargo, el VHC es un virus diferente con sus propios rasgos. Una persona puede estar infectada y no tener signos ni síntomas, y puede vivir con el virus durante décadas sin saberlo, mientras que el virus causa daño al hígado. Alrededor del 80% de las personas expuestas desarrollan una infección crónica. Solo alrededor del 20% son capaces de eliminar el virus mediante la creación natural de inmunidad. El VHC se transmite principalmente a través del contacto con la sangre de una persona infectada a través de agujas. No hay cura ni vacunación contra el VHC. https://d3imrogdy81qei.cloudfront.net/video_images/2083/hepatitis-c-virus-2013.jpg Yes 201 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hepatitis-c https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1227.mp4 Hepatitis C Virus In this lesson, we're going to take a look at the Hepatitis C virus, also known as HCV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis C infection in the U.S. You're going to notice numerous similarities with the Hepatitis B virus. However, there will also be some significant and crucial differences to make note of. Much like the Hepatitis B virus, Hepatitis C can exhibit very mild conditions with few or no symptoms to a serious condition requiring hospitalization. It's not unusual for someone infected with Hepatitis C to live for decades with the disease and not know it, all the while the virus is slowly destroying their liver. The Hepatitis C virus reproduces in the liver, which causes inflammation. This in turn can also lead to cirrhosis of the liver, liver cancer, and liver failure. Some people who are exposed to Hepatitis C can fight the infection and rid it from the body. While others become chronically infected. You may recall that this is where we gave you some good news in the last lesson, as around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. While the other 10 percent of people who contract Hepatitis B will become chronic. The problem is that with Hepatitis C, those numbers are practically inverted, as around 80 percent of those exposed develop a chronic infection, while the other 20 percent will clear the virus from their systems and develop and natural immunity to it. How Hepatitis C is Contracted and Spread Pro Tip #1: Hepatitis C is spread a little differently compared to Hepatitis B and HIV. While the latter two viruses are mainly spread through sexual contact with an infected person, Hepatitis C is spread mostly through blood, including sharing needles with an infected person (mostly due to injected drug use) and through getting tattoos and piercings with unsterilized equipment. Less common ways of contracting Hepatitis C in the U.S. include receiving blood, blood products, or organs that have been infected with the Hepatitis C virus. However, these instances are much less common since blood screening became available in 1992. Also, like both HIV and Hepatitis B, the infection can be passed from mother to unborn (or just-born) baby. And in healthcare settings, it can also be passed on through needle stick injuries. It's worth noting that these are both rare, as is spreading the disease through sexual intercourse. It should be noted that personal items that are contaminated with infected blood and then shared with others also present a risk – items like razors and toothbrushes, for example. Pro Tip #2: People who are infected with HIV face a much greater risk of also contracting Hepatitis C. Also, like both Hepatitis B and HIV, Hepatitis C cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with pubic items like doorknobs, water fountains, and toilets. And there is no evidence of virus transmission from food handlers, teachers, or other service providers in the absence of blood to blood contact. Hepatitis C Statistics in the U.S. It is estimated that around 3.2 million people in the U.S. have a chronic Hepatitis C infection 17,000 people each year become infected with the Hepatitis C virus 12,000 people each year die from liver complications caused by Hepatitis C Hepatitis C Signs and Symptoms Much like with HIV and Hepatitis B, signs and symptoms for Hepatitis C are unreliable and may or may not be present. And why proper testing for all the above is the only sure-fire way to know if an infection is present. Hepatitis C symptoms (which mirror those of Hepatitis B) include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay colored stools Abdominal discomfort Fever Hepatitis C Treatment Unfortunately, there is neither a Hepatitis C vaccine or a known cure. There are, however, new drugs that have come on the market that studies have shown can provide big improvements to those in need of Hepatitis C treatment. In some studies, those infected with the Hepatitis C virus who took one or more new drugs approved by the FDA showed up to a 90 percent success rate in eliminating the disease. The downside is the expense. Treatments can cost tens of thousands of dollars, making them financially available to only a select few who can afford them. A Word About Bloodborne Pathogens – Signs and Transmission Let's quickly recap the symptoms of the diseases covered in this section (Hepatitis B, C, and HIV) along with the modes of transmission for each. It may help to see the side-by-side comparisons for the purpose of retaining the information. HIV Symptoms: May or may not be present in the early stages. Late-contact stage symptoms may include fever, headache, fatigue, diarrhea, skin rashes, night sweats, loss of appetite, swollen lymph glands, significant weight loss, white spots in the mouth or vaginal discharge (signs of yeast infection), and memory or movement problems. Contraction: HIV is spread through both direct and possibly indirect contact with blood, semen, and vaginal fluid. Hepatitis B Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis B is spread through both direct and indirect contact with blood and semen. Hepatitis C Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis C is spread through both direct and indirect contact with blood and semen. https://d3imrogdy81qei.cloudfront.net/video_images/2083/hepatitis-c-virus-2013.jpg Yes 201 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/enfermedades-de-la-piel https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1228.mp4 Enfermedades de la piel La piel es el órgano más grande del cuerpo. Contiene vasos sanguíneos, receptores sensoriales, nervios y glándulas sudoríparas. Está formado por la epidermis y la dermis y varía en grosor de 1,5 a 4 mm o más. La piel es la primera línea de defensa contra la infección. Las enfermedades, los trastornos y las afecciones de la piel incluyen personas con forúnculos, heridas infectadas, llagas abiertas, abrasiones o lesiones dermatológicas que lloran. Las enfermedades cutáneas más comunes incluyen bacterias, virus y hongos. https://d3imrogdy81qei.cloudfront.net/video_images/2085/skin-diseases-2013.jpg Yes 224 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/skin-diseases https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1228.mp4 Skin Diseases This lesson will cover a variety of skin diseases and disorders, including some information on the human body's largest organ, how skin disorders are spread, signs and symptoms, and a word about the body's natural defenses. Skin diseases and disorders include boils, open sores, infected wounds, abrasions, weeping dermatological lesions, and more. It's important that anyone with these sorts of conditions abstain from working if there's any chance that they can contaminate healthcare supplies, work surfaces, body art equipment, etc. Ideally, your skin should be free of rashes and infection, particularly for healthcare providers, caregivers, tattoo artists, and the like. Alternatively, you can also cover all open sores and wounds with bandages to avoid any potential spread of disease, if the condition isn't too severe or contagious. The Largest Organ in the Body Yes, as you probably guessed (or maybe already knew), it's your skin! Your skin contains blood vessels, sensory receptors, nerves, and sweat glands. The thickness varies person to person, from around 1.5 millimeters to 4 millimeters. Pro Tip #1: Most people probably don't spend much time thinking about their skin beyond a few wrinkles. But this would be disrespectful, as your skin is the first line of defense against infection, but only if it's intact. The Three Layers of Skin Epidermis – The epidermis is the thick outer layer that we most likely associate as being our skin. But there's much more to it than that. Dermis – The dermis is the flexible second layer of our skin. It's composed mostly of connective tissue and filled with blood vessels and nerves. Hypodermis – The hypodermis is the innermost layer, also known as the subcutaneous layer, and is composed of fatty material. Commonly Spread Skin Diseases Skin diseases and disorders can be the result of bacteria, viruses, or fungus. Bacteria Staphylococcus aureus is a type of germ that about 30 percent of people have on their skin and carry in their noses. Most of the time, staph does not cause any harm. However, sometimes staph causes infections. In healthcare settings, these staph infections can be serious or fatal. Staph infections look like pimples or boils or something similar. And most of the time, staph infections are easily treatable. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's more difficult to treat than most strains of staph as it's resistant to some commonly used antibiotics. MRSA infections can look like typical skin wounds and infected sores. However, since they can be resistant to antibiotic treatment, they sometimes tend not to heal and even get worse. People contract MRSA infections through contact with infected mucous membranes, skin, or contaminated objects. Most of the time, MRSA infections are limited to the skin. But more severe, life-threatening infections can occur elsewhere in the body – frequently among patients with compromised immune systems in a healthcare setting. Viruses The herpes simplex virus is a commonly spread skin infection that causes herpes. Herpes can appear in various parts of the body, most commonly on the face, scalp, arms, neck, and upper chest. Herpes is usually indicated by small round blisters. When broken, these blisters can secrete a clear or yellowish fluid. Contraction of herpes occurs from contact with infected saliva, mucous membranes, and skin. Fungus Commonly spread fungus-related skin disorders include athlete's foot and ringworm. The only real difference between the two is location, as ringworm can develop on the skin, hair, nails, and scalp. Whereas athlete's foot only occurs in the feet, mostly between the toes. The two both present similar signs – red, patchy, flaky, itchy skin. They're both also highly contagious and easily spread from one person to another, or through infected surfaces in warm, moist environments, like shower floors for example. Keeping areas susceptible to athlete's foot clean and dry will go a long way to preventing the spread of the fungus. Pro Tip #2: Some people are more prone to developing skin disorders, including anyone with a history of the following diseases and conditions: Hepatitis B and C HIV and AIDS Diabetes Hemophilia or other blood disorders Other skin diseases or lesions Allergies or adverse reactions to pigments, dyes, latex, etc. Other immune disorders A Word About the Body's Natural Defenses The human body has several natural defenses that prevent infectious microorganisms from entering it. The body is very much dependent on intact skin and mucous membranes in the mouth, nose, and eyes to keep infectious microorganisms out. When the skin isn't intact, infectious microorganisms can enter through openings, like abrasions, cuts, and sores. Mucous membranes in the mouth, nose, and eyes also work to protect the body from these same invaders, often by expelling them through a cough or sneeze. Should all the body's barriers fail and a germ enters, the immune system will begin working to fight the pathogen. Pro Tip #3: Mucous membranes are less effective than skin at keeping bloodborne pathogens out of the body. All the more reason to treat your skin with the ultimate care. The immune system's basic tools for handling these invaders are antibodies and white blood cells. Special white blood cells have the ability to travel around the body and identify invading pathogens. Once detected, white blood cells gather around the pathogen and release antibodies to fight the infection. While antibodies can usually rid the body of pathogens, this isn't always the case. Some pathogens, once inside the body, can thrive, multiply, and overwhelm the immune system. This combination of preventing pathogens from entering the body and destroying them once they enter is necessary for good health and contributes to a little something called homeostasis, or balance/stability in all physiological processes. https://d3imrogdy81qei.cloudfront.net/video_images/2085/skin-diseases-2013.jpg Yes 224 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/reducir-riesgos-de-patogenos-de-sangre https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1229.mp4 Cómo reducir tus riesgos Siga las precauciones estándar. Al igual que las precauciones universales, que incluyen la identificación de sangre y unos pocos fluidos corporales que tienen el potencial de contener patógenos transmitidos por la sangre, precauciones estándar significa tratar toda la sangre, fluidos corporales, piel no intacta (como abrasiones, granos o llagas abiertas) y membranas mucosas (dentro de los ojos, boca, nariz) como si pudieran transportar patógenos transmitidos por la sangre y enfermedades infecciosas. Esto incluye prácticas de inyección seguras, manejo seguro de equipos o superficies potencialmente contaminados en el entorno del paciente y etiqueta respiratoria o para la tos. La clave es eliminar la exposición a toda la sangre, fluidos corporales y otros materiales potencialmente infecciosos. https://d3imrogdy81qei.cloudfront.net/video_images/2087/how-to-reduce-your-risk-2013.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/reduce-risk-of-bloodborne-pathogens https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1229.mp4 How to Reduce Your Risk In this lesson, you'll learn how to minimize your risk of exposure to all bloodborne pathogens and other potentially infectious materials (OPIM). Your first line of defense when it comes to these threats is known as standard precautions. Standard precautions include maintaining personal hygiene, using personal protective equipment (PPE), engineering controls, work practice controls, and proper equipment for cleaning contaminated areas and surfaces, along with the proper cleanup procedures. Standard precautions represent the minimum infection prevention practices that everyone must follow, based on your employer's control plan. These precautions are key to eliminating exposure to all blood and bodily fluids. Remember, it's better to assume that all bodily fluids carry the risk of disease and/or infection, rather than the opposite – to assume there is no risk. So, what are the standard precautions? Standard Bloodborne and OPIM Precautions Standard precautions can be broken down into two areas – proper use of handwashing and the appropriate use of personal protective equipment, or PPE. Handwashing Pro Tip #1: While it may seem simple, handwashing is the single most effective way to prevent infection. To be as safe as possible, follow the three handwashing guidelines below. Wash your hands before and after contact is made with clients or patients. Wash your hands as often as needed – as they become visibly soiled or when exposed to possibly infectious materials. Wash your hands using soap and hot water immediately after removing your gloves. Pro Tip #2: What if you don't have access to soap and water? In these cases, you can substitute soap and water with an alcohol-based hand sanitizer. If you routinely find yourself in these situations, it may be a good idea to carry some hand sanitizer with you. Personal Protective Equipment Personal protective equipment includes things like gloves, gowns, and masks and should be used or worn whenever the exposure to body fluids is anticipated. Warning: Wearing gloves is not a reason to forego handwashing and in no way will eliminate the necessity for handwashing, which is, once again, the single most effective way to prevent infection. Your Employee Exposure Control Plan An exposure control plan is simply a written plan that's provided by your employer, the aim of which is to eliminate or minimize your occupational exposure to blood and OPIM. While the details may vary from one employer to the next, every relevant workplace must provide easily accessible copies of this plan to its employees. Each exposure control plan must include two things: A determination of exposure by job classification and … The implementation of various methods of exposure control, including:a. Universal or standard precautionsb. Engineering and work practice controlsc. Personal protective equipmentd. Information on the Hepatitis B vaccinee. Communication of hazards to employees and the required trainingf. Recordkeepingg. Procedures for evaluating circumstances surrounding exposure incidentsh. Post exposure evaluation and follow-upi. The implementation of methods for all of the above Pro Tip #3: Universal Precautions are a set of precautions designed to prevent transmission of HIV, the Hepatitis B virus (HBV), and other bloodborne pathogens when providing care; these precautions consider blood and OPIM of all patients potentially infectious. These are OSHA-required practices that require you to treat ALL blood and OPIM as if known to be infectious. Protecting Yourself from Bloodborne Pathogens and OPIM The fundamental method of protecting yourself against pathogens and infection is by controlling the hazards. This can be accomplished a number of ways, including: Elimination. Get rid of all hazards or hazardous tasks if possible. Substitution. Replace hazards or hazardous tasks with safer equipment and/or safer methods. Engineering controls. Use devices such as self-sheathing needles and sharps containers to block or remove your risks of getting stuck, poked, or cut. Personal Protective Equipment (PPE). Know where your PPE is located and how to properly use it. Also, keep in mind that PPE only protects you if you use it. Work practice and administrative controls. It's important to follow the policies and procedures for your workplace to eliminate all risks associated with bloodborne pathogens and OPIM. What exactly is a work practice control? A work practice control is any measure that reduces the likelihood of exposure by changing the way a task is carried out. When followed, all of these protection methods will help make your workplace and your work activities much safer. https://d3imrogdy81qei.cloudfront.net/video_images/2087/how-to-reduce-your-risk-2013.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/controles-de-practicas-de-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1230.mp4 Prácticas de trabajo y controles de ingeniería Los Controles de práctica laboral reducen la probabilidad de exposición al alterar la forma en que se realiza una tarea. Los controles administrativos incluyen seguir toda la capacitación, los requisitos legales, las políticas y los procedimientos relacionados con el control de infecciones en sus instalaciones. Los controles de ingeniería aíslan o eliminan los peligros de los patógenos transmitidos por la sangre en el lugar de trabajo. Estos incluyen recipientes para la eliminación de objetos punzantes, agujas autocubiertas y dispositivos médicos más seguros. Los controles de ingeniería deben ser examinados y mantenidos o reemplazados en un horario regular para asegurar su efectividad. https://d3imrogdy81qei.cloudfront.net/video_images/2089/work-practice-and-engineering-controls-2013.jpg Yes 214 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/work-practice-controls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1230.mp4 Work Practice and Engineering Controls In this lesson, we're going to take a closer look at work practice controls, administrative controls, and engineering controls, so that you can have a deeper understanding of not only what they are, but why they're important. Work Practice Controls A work practice control is any measure that reduces the likelihood of being exposed to blood or other pathogens by changing the way a task is carried out. Administrative Controls Administrative controls are changes in work procedures such as written safety policies, rules, supervision, schedules, and training with the goal of reducing the duration, frequency, and severity of exposure to hazardous chemicals or situations. Administrative controls include the completion of all relevant training, any and all legal requirements that must be met and adhered to, and all the policies and procedures related to infection control at your workplace. Engineering Controls An engineering control measure is one that eliminates, isolates, or removes a hazard from the workplace; things used in the workplace to help reduce the risk of an exposure. Engineering controls include: Sharps disposal containers Needle containment devices Other safety devices that prevent handlers from getting cut or poked Pro Tip #1: Engineering controls should be examined and/or maintained on a regular set schedule to ensure their maximum effectiveness. Make sure these controls are in place at your workplace to minimize your risk of exposure. Examples of Workplace, Administrative, and Engineering Controls This list is in no way meant to be a complete accounting of all controls, but rather to give you a good idea of what workplace, administrative, and engineering controls look like in the workplace. Food, drink, etc. You shouldn't eat, drink, smoke, apply cosmetics, or handle contact lenses in any and all work areas where there exists the possibility of exposure to bloodborne pathogens and other potentially infectious materials. Trash disposal. When disposing of any trash that contains contaminated materials, do not compress the trash with your hand. Also, when carrying contaminated materials for disposal, be sure to carry the trash away from your body in case of spillage. Environment and work surfaces. All equipment and surfaces in your work environment should be thoroughly cleaned and decontaminated after all contact with blood, other body fluids, and other potentially infectious materials. Contaminated sharp objects. When dealing with contaminated needles and other sharp objects (routinely shortened to just sharps) there are certain guidelines to follow, such as not using bent needles, recapping needles, or trying to remove questionable needles. All needles and sharps must also be placed into appropriate sharps containers immediately after use. Warning labels. Warning labels should be affixed to all regulated waste and other containers that are used to store, transport, or ship other potentially infected materials. Labels must be fluorescent orange or red, or at least predominantly orange or red, to indicate a possible threat, along with lettering and symbols in a contrasting color. Personal protective equipment. All employees must be provided with personal protective equipment by their employer and at no cost to the employee. Examples of PPE include:a. Gloves – Wear gloves whenever the potential exists of touching blood, bodily fluids, or other potentially contaminated items.b. CPR shields and protective eyewear – Use these items when there's a likelihood of blood and OPIM being secreted or splashed.c. Gowns – Wear a gown when the potential exists of getting blood and other bodily fluids on any clothing or exposed skin.d. Masks and respirators – Use whenever there's a potential risk of coming into contact with airborne infectious diseases. Pro Tip #2: Having personal protective equipment at your workplace is great, but do you know what's even better? Knowing exactly where all PPE is located and being able to properly use them. Be sure PPE is available at your workplace and that you've been appropriately trained to use them. If you're in a profession where you have access to a first aid kit at work, be sure it's properly stocked with all necessary items, such as gloves and CPR face shields or rescue masks. Cleaning Rather than Disposing? If you are tasked with laundering contaminated items – like reusable gowns – rather than disposing of them, make sure you follow your facility's specific procedures for cleaning and handling these items. General laundry procedures will include: Wearing personal protective equipment whenever handling contaminated laundry Keeping contaminated laundry separate from non-contaminated laundry Bagging potentially contaminated laundry in the same area in which it was used, rather than transporting it elsewhere to bag Using leak-proof bags for wet contaminated laundry Transporting contaminated laundry in properly labeled bags, especially when shipping it to an offsite facility A Work Practice Cheat Sheet As you now know, work practice controls reduce the likelihood of exposure by changing the way a task is carried out, which helps reduce the risk of an exposure incident. This cheat sheet is not meant to be complete, however these are some of the more common controls you'll likely face. Place all sharps items in puncture-resistant, leak-proof containers that are both labeled and available at the point of use. Avoid splashing, spraying, and splattering droplets of blood or OPIM when performing all procedures. Remove and dispose of soiled protective clothing as soon as possible. Clean and disinfect all equipment and work surfaces that may have been soiled by blood or OPIM. Wash your hands thoroughly with soap and water immediately after being exposed to any potentially contaminated materials and be sure the sink is not located in a food preparation area. Use alcohol-based hand sanitizers when handwashing facilities are not available. Do not eat, drink, smoke, apply cosmetics or lip balm, handle contact lenses, or touch your mouth, nose, or eyes when you are in an area where you may be exposed to infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/2089/work-practice-and-engineering-controls-2013.jpg Yes 214 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/desechos-regulados https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1231.mp4 Desechos regulados Los desechos regulados son la sangre líquida o semilíquida u otros materiales potencialmente infecciosos (OPIM) y los artículos contaminados que podrían liberar sangre u otros materiales potencialmente infecciosos en estado líquido o semilíquido si se comprimen. Esto también incluye artículos que se apilan con sangre seca u otros materiales potencialmente infecciosos y son capaces de desprenderse o liberar estos materiales durante el manejo. Los residuos debidamente etiquetados y agrupados deben manejarse de acuerdo con los procedimientos de eliminación de la instalación, los requisitos estatales y locales. No lo deseche en la basura normal. https://d3imrogdy81qei.cloudfront.net/video_images/2091/regulated-waste-2013.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/regulated-waste https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1231.mp4 Regulated Waste In this lesson, we'll cover what regulated waste is as defined by OSHA, along with some standard protocols for handling and disposing of it. The OSHA bloodborne pathogens standard defines regulated waste as: Any liquid or semi-liquid blood or other potentially infectious material. Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed or rung out. Items that are caked with dried blood or OPIM and are capable of flaking off and releasing these materials during handling. Contaminated sharps. Pathological and microbiological wastes containing blood or OPIM. How to Dispose of Regulated Waste Pro Tip #1: It's important to note that all properly labeled and bundled waste should be handled according to your facility's disposal procedures. It's also important to consider any state or local requirements that may apply to regulated waste disposal in your area. Having said that, here are a few guidelines to follow when disposing of regulated waste. Warning: While this should go without saying, never dispose of potentially contaminated waste into normal trash receptacles. Regulated Waste Containers All blood and other potentially infectious materials must be disposed of in properly labeled biohazard containers, in either a red bag or a predominantly orange or red container that has been imprinted with the biohazard symbol. Regulated waste containers must be: Sealable. You must be able to completely close and seal the container. Properly constructed. The container must be able to properly handle its contents without fail. Leak-proof. The regulated waste container must prevent leakage of all fluids and materials while handling, storing, transporting, and shipping. Sharps Containers All items falling into this category – like needles, syringes, and razors – must be placed into sealable, leak-proof, puncture-resistant containers. The containers must also be properly labeled or color-coded. Pro Tip #2: Regardless of type, all regulated waste containers should be routinely inspected and replaced, and they should never be allowed to overfill. A Word About OSHA's Regulations Since OSHA may be the reason you're taking this course, let's dig a little deeper into what the employer's responsibilities are when it comes to following those regulations. Pro Tip #3: Safety is job number one. If you notice that your employer is falling short of adhering to guidelines or not providing everything on this list, you may want to consider asking someone. OSHA regulations regarding bloodborne pathogens have placed specific responsibilities on employers for the protection of employees (like you). These include all of the following: Identifying positions or tasks covered by the bloodborne and OPIM standard precautions. Creating an exposure control plan to minimize the possibility of exposure and making the plan easily accessible to all employees. Developing and putting into action a written schedule for cleaning and decontaminating environments and work surfaces at the workplace. Creating a system for easy identification of soiled material and its proper disposal. Developing a system of annual training for all covered employees. Offering the opportunity for employees to get the hepatitis B vaccination at no cost. Establishing clear procedures to follow for reporting an exposure. Creating a system of recordkeeping. In workplaces where there is potential exposure to injuries from contaminated sharps, soliciting input from non-managerial employees with potential exposure regarding the identification, evaluation, and selection of effective engineering and work practice controls. (In other words, the feedback of those being exposed.) If a needlestick injury occurs, recording the appropriate information in the sharps injury log, including:a. The type and brand of device involved in the incidentb. The location of the incidentc. A description of the incident Maintaining a sharps injury log in such a way that protects the privacy of employees. Ensuring the confidentiality of all employees' medical records and exposure incidents. https://d3imrogdy81qei.cloudfront.net/video_images/2091/regulated-waste-2013.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/procedimientos-de-limpieza-de-fluidos-corporales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1232.mp4 Limpieza de fluidos corporales Comience limpiando la mayor cantidad de líquido posible y deseche los materiales saturados en un desecho regulado o en una bolsa de riesgo biológico. Si algo de la sangre o el líquido está en sus guantes, quítese los guantes, use un guante para quitarse el otro y deséchelos en la bolsa de riesgo biológico. Ponte un nuevo par de guantes. Una vez que se haya limpiado la sangre visible, use la solución desinfectante y rocíe el resto del derrame. Límpielo para eliminar todos los restos de fluidos corporales. Luego, retire el segundo par de guantes y deséchelos. Rocíe toda la superficie y deje que se evapore para finalizar el proceso de descontaminación. https://d3imrogdy81qei.cloudfront.net/video_images/2093/body-fluid-cleanup-2013.jpg Yes 385 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/body-fluid-cleanup-procedures https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1232.mp4 Body Fluid Cleanup In this lesson, you'll learn how to clean and disinfect contaminated surfaces, whether floors, tables, or equipment. But first, let's address some safety issues pertaining to cleanup. Personal Protective Equipment Before disinfecting any contaminated areas or surfaces, first ask yourself if you have the proper PPE – personal protective equipment – to complete the job safely. PPE you may need includes: Gloves, always Face shield and/or eye protection An apron or gown In most cases, these three items will be enough, and in many instances, gloves alone will suffice. When should you use a disposable apron or gown? Whenever there's a reasonable chance you could get bloodborne pathogens or other potentially infectious materials on your clothing. The biggest problem involved with getting pathogens on clothing is cross-contamination, and we'll get into this more in a minute. When should you use a face or eye shield? Whenever there's a reasonable chance of spraying or splashing. If you're cleaning dried blood off a counter, you probably don't need to go that extra mile. But what if you were disinfecting a piece of machinery with many parts at or around eye level? Mostly it just comes down to common sense. Having the proper cleanup equipment and personal protective equipment is the first step in any cleanup project. Make sure you have everything you need for the task at hand. And always err on the side of caution. Pro Tip #1: Not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Also, one pair of gloves isn't going to cut it. In order to keep from re-contaminating the scene, or even contaminating another scene, you'll change your gloves a few times in the course of one cleanup job. Which brings up a good point … Warning: Pay attention to what you're touching with your contaminated gloves. It should go without saying to avoid touching any part of yourself, but also be sure not to touch clean surfaces or equipment that hasn't been contaminated. But if you do, it's not the end of the world; just remember to disinfect those as well. Cleaning Supplies Matter There are only two essential supplies you need: paper towels and bleach. Don't use toilet paper or napkins or even low-quality paper towels. The paper towels you use should be commercial grade and able to withstand the task at hand without falling apart. Bleach is super cheap and super effective, so there's no point in substituting. However, if you are going to substitute, make sure the cleaner or disinfectant you're using is up for the job. As in specifically manufactured to kill microorganisms and protect against all viruses, bacteria, and other pathogens and infectious materials. Body Fluid Cleanup Procedure The first thing you want to do is make sure the scene is safe. If there are any sharp objects, like broken glass or needles, remove those using tongs (or another safe method) and put all sharps into a contaminated sharps disposal container so you can disinfect them or dispose of them properly later. For the purpose of instruction, let's assume you're cleaning off a table with a modest amount of dried blood. There is no chance of spraying or splashing, and unless you're really reckless, you shouldn't have to worry about contaminating your clothing. Pro Tip #2: The CDC (Centers for Disease Control and Prevention) recommends a bleach solution of one part bleach to nine parts water. This solution should be strong enough to kill any bloodborne pathogens and infectious materials you may encounter. Put on your 1st pair of medical grade gloves and remove any sharp objects. Wipe up as much of the dried blood as you can using a paper towel. Be sure to keep the blood isolated to the table or the paper towels. If you get some on the floor, be sure to disinfect it as well. Remove your 1st pair of gloves as shown in the video – using glove on glove for the first, and bare finger against your wrist for the second. Throw away both gloves. Put on your 2nd pair of medical grade gloves. Mix your bleach solution in a spray bottle and liberally spray the solution on the table where the dried blood was located. Wipe down with paper towels and make sure all the blood is visibly gone. Remove your 2nd pair of gloves using the same protective method as before. Put on your 3rd pair of gloves. (Yes, this is a bit of a pain. But if you don't do it this way, there's no point in cleaning up, as the risk of infection will likely still remain thanks to dirty gloves.) Lightly mist the surface of the table with your bleach solution and allow it to evaporate. The time it takes for the liquid solution to evaporate equals the time it takes to completely kill any pathogens remaining. Pro Tip #3: In general, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection, whether the barrier is a piece of protective clothing or a safe container to dispose of infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/2093/body-fluid-cleanup-2013.jpg Yes 385 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/retirar-y-desechar-guantes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1233.mp4 Retirado de guantes El guante en guante, la piel sobre la regla de la piel evita la contaminación. Agarrar el exterior de un guante cerca de la muñeca. Tire del guante hacia abajo y sáquelo de su mano, girándolo de adentro hacia afuera. Coloca el primer guante en una bola en el puño de tu mano enguantada. Usando los dedos debajo del guante en la muñeca de la otra mano, tire del segundo guante hacia abajo y sáquelo de la mano, dándole la vuelta al revés. Deseche los guantes adecuadamente y lávese las manos. https://d3imrogdy81qei.cloudfront.net/video_images/2095/glove-removal-2013.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/glove-removal-and-disposal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1233.mp4 Glove Removal Your gloves are your first line of defense against bloodborne pathogens and other potentially infectious materials when cleaning up and disinfecting a scene. In this lesson, we'll show you the exact procedure of how to properly and safely remove them. You don't want blood and other bodily fluids to touch your skin, but you especially don't if you have cuts, scrapes, abrasions, or other openings in the skin. Even hangnails could pose a problem and provide an opening for a foreign invader to enter. Remember, not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Ideally, you'll have nitrile gloves. As latex allergies are becoming more common, nitrile gloves provide a better option for many people. Pro Tip #1: While putting on your gloves may sound like common sense and something not requiring instruction, there are three important points to note: Gloves will sometimes stick together, and this may make getting them on more difficult than it should be. (Though most gloves now have a coating or powder on them to prevent this.) Which is why you may have seen someone blow a puff of air into the wrist to make squeezing a hand in easier. This is not appropriate when it comes to infectious materials cleanup, even with clean gloves. Also, you don't want to spread any germs you may have onto the clean gloves. Size matters. Gloves come in many sizes. If your employer has only small or medium size gloves and you're a 300-pound man with sausage fingers, good luck. And do you know what happens when you try and squeeze an extra-large hand into a small glove? Well, let's just say it'll look like your hand is wearing a halter top, and your protection will go bye-bye. So, make sure your employer has your glove size in stock. Because one size rarely fits all. Inspect the gloves for defects, like holes, rips, or cuts. Just like our halter top gloves scenario above, if your gloves have any type of hole, you're not getting that protective barrier you need to stay safe, and you could wind up spreading a pathogen rather than containing and cleaning it up. Safety first, always. Remember, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection. When it comes to gloves, they're like having an additional protective layer of skin. How to Remove Contaminated Gloves If you've seen the video lesson that corresponds with this written version, you may have noticed that glove removal is not a normal process for most people and one that may require a bit of practice to perfect. And since perfection equals being disease and infection-free, practicing taking off your contaminated gloves may not be the worst idea. Pro Tip #2: Keep in mind your goal as it pertains to glove removal – keeping the contaminated materials on one side and your skin on the other. The two sides should always remain separate. To this end, the glove removal process is as follows: Pinch the palm side of one glove on the outside near your wrist. (Glove on glove contact only.) Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand. Wad up the dirty glove into the palm of your still-gloved hand. Pro Tip #3: You want to completely wad the glove up into that hand so the other glove can easily pass over your fist and not catch on any of the material from the first glove. However, you don't want to squeeze so hard that infectious material comes oozing out. Carefully slip two fingers under the wrist of the other glove. Avoid touching the outside of the glove. (Skin on skin contact only.) Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand. The other glove is now contained inside. By now, you should be holding the inside lining of one glove with the other glove trapped deep down inside. You can also do this with a bloody gauze pad or contaminated paper towel in one of your gloved hands, as all items will wind up at the bottom of the first glove removed. Warning: When removing your gloves, it's important that you don't snap the glove material, so make sure you have a good grip and work slowly and carefully. Snapping the glove's materials could send pathogens and infectious materials flying – into eyes and other mucous membranes or onto clean surfaces. Toss both gloves into the trash along with other PPE. Ideally, you'll have access to a trash receptacle that you can open using a foot pedal. And make sure the liner is appropriate for handling bloodborne pathogens and other potentially infectious materials per your regulations. And finally, wash your hands thoroughly with soap and running water, if available. Otherwise, rub your hands thoroughly with an alcohol-based hand sanitizer if they are not visibly soiled and then wash your hands as soon as it is practical. https://d3imrogdy81qei.cloudfront.net/video_images/2095/glove-removal-2013.jpg Yes 230 https://app.protrainings.com/courses/bls/healthcare/videos/wash-your-hands https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1234.mp4 Handwashing Hand washing is the most important and effective infection control technique. And while all of you already wash your hands regularly, in this lesson we're going to teach you the proper ways to wash and disinfect your hands to greatly reduce your chances of contamination. When Should You Wash Your Hands? Wash your hands whenever they're visibly dirty, but also: Before having any contact with clients/patients Before putting on your gloves Before performing any procedures After contact with a client's skin, bodily fluids, excretions, non-intact skin, wound dressings, and contaminated items After using the bathroom After touching garbage After removing your gloves Proper Hand-Washing Technique Pro Tip #1: In a world filled with technological advances and new and improved items at every turn, the old standard when it comes to handwashing is still the superior choice – soap and water – as it's still the best way to reduce the number of germs in most situations. Use a disposable paper towel to turn on the sink faucet. Thoroughly wet your hands. Apply a generous amount of soap. Rub your hands together, covering all the surface areas – backs of hands, between fingers, under nails – for at least 20 seconds. Rinse your hands under the running water. Dry your hands with a disposable paper towel. Use that towel to turn off the sink faucet. If soap and water aren't available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol. Alcohol-based hand sanitizers will quickly reduce the number of microbes on your hands, but it doesn't eliminate all types of germs. Proper Use of Hand Sanitizer Hand sanitizers that are alcohol-based are great options if soap and water aren't available. But make sure you work them into your skin as thoroughly as you would wash your hands with soap and water. Fill the palm of one hand with hand sanitizer, as you'll need enough to apply a very generous layer to both hands. Spread the hand sanitizer around your palms, top of hands, between fingers, and work it into every crevice or wrinkle, including cuticles, nail beds, and under rings. Don't ignore your wrists and try to cover all areas. Continue to massage the hand sanitizer into your hands for 20 seconds. Pro Tip #2: All medical personnel should have a watch with a second hand, as there are numerous situations where you'll need to record the exact time or use that second hand to keep track of the time – like to see when 20 seconds has passed when using a hand sanitizer. On that note, if you suspect that your watch may have become contaminated in the course of helping a patient or cleaning up a scene, you're going to need to put that watch into the bloodborne equivalent of the concussion protocol. This protocol could be different for everyone, based on their own unique work practice controls that are covered under the bloodborne pathogens rule. So, know the specifics of your situation and workplace. However, in general, you'll want to remove the watch using proper personal protective equipment and sanitize and disinfect it appropriately. A Word About Personal Protective Equipment Personal protective equipment (PPE) is equipment that is appropriate for your job duties and should be available to you in your workplace. A PPE includes all specialized clothing, equipment, and supplies that keep you from coming in direct contact with infected materials. These include CPR breathing barriers, disposable gloves, gowns, masks, shields, and protective eyewear. Disposable Latex-Free Gloves Wear disposable, latex-free gloves for all patient contact. There are powder-free gloves available as well as disposable latex-free gloves made of vinyl. Also consider nitrile gloves, as many consider them the preferred option when working with bloodborne pathogens. Eye Protection Safety glasses with side shields are a great way to protect your eyes in certain situations. If there's a risk of splashing or spraying of bodily fluids, use goggles or a full-face shield, as they'll greatly reduce the risk of contamination of the mouth, nose, and eyes. CPR Breathing Barriers CPR breathing barriers include resuscitation masks, shields, and BVMs. CPR breathing barriers help protect you against disease transmission when performing CPR or giving ventilations to a patient. Masks A mask is a personal protective device worn on the face that's designed to cover at least the nose and mouth, and which helps to reduce the risk of inhaling hazardous airborne particles, gases, and vapors. A high-efficiency particulate air mask will filter out at least 95 percent of airborne particles. Remember that masks must be fit-tested to be effective. Gowns In situations where there are large amounts of blood or other possibly infectious materials, consider wearing a disposable gown. If your clothing becomes contaminated, remove it and shower as soon as possible. And wash the clothes in a separate load. https://d3imrogdy81qei.cloudfront.net/video_images/2097/handwashing-2013.jpg Yes 182 https://app.protrainings.com/courses/bls/healthcare/videos/lava-tus-manos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1234.mp4 Lavado de manos El lavado de manos es la técnica de control de infección más importante. Después de quitarse el equipo de protección personal, lávese siempre bien las manos frotándolas con un jabón antimicrobiano o usando un gel a base de alcohol. https://d3imrogdy81qei.cloudfront.net/video_images/2097/handwashing-2013.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/infecciones-asociadas-a-atencion-de-salud https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1235.mp4 Infecciones asociadas a la atención de salud Las Precauciones Estándar deben seguirse sin importar el estatus de infección sospechada o confirmada del paciente, en cualquier entorno donde se proporcionan servicios médicos. Estas prácticas están diseñadas tanto para proteger al profesional de la salud, como para evitar que el profesional de la salud propague infecciones entre los pacientes. Las Precauciones Estándar incluyen: higiene de las manos, uso de equipo de protección personal (ejemplos de éste son guantes o batas o mascarillas), prácticas de inyección segura, manejo seguro de equipos o superficies potencialmente contaminados dentro del entorno del paciente, e higiene respiratoria y el manejo de la tos. https://d3imrogdy81qei.cloudfront.net/video_images/2099/hospital-associated-infections-2013.jpg Yes 325 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/hospital-associated-infections https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1235.mp4 Hospital Associated Infections In any healthcare setting, standard precautions must be followed when a patient is either suspected or confirmed of having an infection. In this lesson, we'll dig a little deeper into common infections in healthcare settings, along with certain practices that will help stop the spread of infection and keep you safe. It's important that you follow all practices that are designed to protect both yourself – the healthcare professional – as well as the patients you serve, as infections can easily spread from patient to healthcare provider and then onward to other patients. Such practices include: Handwashing and hygiene Use of personal protective equipment like gloves, gowns, and masks Safe injection practices Safe handling of potentially contaminated equipment or surfaces in a healthcare setting Respiratory hygiene and cough etiquette As a healthcare professional, part of your job is to protect against the spread of bloodborne pathogens and infectious diseases. Furthermore, healthcare providers have an ethical and professional responsibility to adhere to scientifically accepted or evidence-based practices and principles of infection control and to monitor the performance of those for whom the healthcare provider is also responsible. Pro Tip #1: Multiple states publish best practices for infection control. Some states include a legal responsibility to adhere to these infection control practices that are in place. So, make sure you're following the proper guidelines at your healthcare facility. Common Hospital Associated Infections (HAI) Hospital-associated infections are those that originate or occur in a healthcare or healthcare-like setting. If you're thinking that this sounds like an oxymoron, in that people go to hospitals to get well – not sicker – you'd be right, and yet … Warning: The CDC estimates that each year in the U.S. alone, hospital-associated infections account for 1.7 million infections, and of those cases, 99,000 result in death. That's yearly! These infections can be associated with a number of procedures and devices, such as the use of catheters and ventilators. The most common class of hospital-associated infections are bloodstream infections like pneumonia, ventilator-associated pneumonia, urinary tract infections, and surgical site infections. Urinary Tract Infections Urinary tract infections are the most common type of hospital-associated infections and are often the result of a catheter or tube that has been used to empty urine from the bladder. Bacteria can enter the body at the site where an IV or catheter is inserted. Also, a local infection can develop in the skin around the catheter. Bacteria can also enter the blood through veins that go near the heart and cause a more serious infection known as sepsis. Pro Tip #2: The deeper and longer a catheter is in place, the greater the chance of it resulting in an infection. Ventilator-Associated Pneumonia Ventilator-associated pneumonia occurs when bacteria and other germs enter the lungs from an endotracheal tube that has been attached to a ventilator. When bacteria begin to grow in the tube, an infection develops that can lead to pneumonia. Surgical Site Infections Having surgery can increase the potential risk of getting an infection, as surgery provides a pathway for bacteria to enter a normally sterile part of the body. The risk of infection is also present post-surgery, as wounds can easily become infected when dressings are changed. Common Pathogens that Cause Hospital Associated Infections There are a few common pathogens most responsible for causing hospital-associated infections, and these are: Staphylococcus aureus Pseudomonas aeruginosa E. coli Klebsiella Clostridium difficile (C-diff) Pro Tip #3: MRSA (Methicillin-Resistant Staphylococcus Aureus) is a strain of staph that is resistant to the broad-spectrum antibiotics that are commonly used to treat it. As a result, and as you might imagine, MRSA can be fatal. Pseudomonas Aeruginosa Pseudomonas aeruginosa is another pathogen that is highly resistant to antibiotics. For this reason, it can lead to more serious infections like septicemia, urinary tract infections, pneumonia, and chronic lung infections. E. Coli E. coli is characterized by severe stomach cramps, diarrhea (often bloody), and vomiting. Some strains of E. coli can be life-threatening. Klebsiella Klebsiella is a gram-negative bacterium that can cause different types of serious hospital-associated infections like pneumonia, bloodstream infections, wound and surgical site infections, and meningitis. Clostridium Difficile (C-diff) C-diff can lead to gastrointestinal infections, as spores are easily transferred to patients mainly via the hands of healthcare professionals who previously touched a contaminated surface or piece of equipment. C-diff is often the result of overuse or improper use of antibiotics. Patients most at risk are the elderly, particularly those who were already on antibiotics. When it comes to infectious diseases, particularly those that most commonly originate (or are spread) in healthcare settings, prevention is the best strategy for reducing the incidences of hospital-associated infections. Pro Tip #4: Keep in mind the extraordinary number of infections (1.7 million) that originate each year in American healthcare settings, along with the staggering number of deaths as a result (99,000). Then examine ways in which you, the healthcare provider, can help reduce this risk so that patients can get the help they need, rather than getting sicker. https://d3imrogdy81qei.cloudfront.net/video_images/2099/hospital-associated-infections-2013.jpg Yes 325 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/practicas-seguras-de-inyeccion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1236.mp4 Prácticas seguras de inyección Al recibir una inyección, la protección contra infecciones, incluyendo patógenos de la sangre, es un requisito y una expectativa básica en cualquier lugar donde se proporciona atención de salud. Para los empleados, la Ley de Seguridad y Prevención por Pinchazos de Aguja requiere dispositivos médicos apropiados, comercialmente disponibles, más seguros y eficaces diseñados para eliminar o minimizar la exposición ocupacional. Siempre que se producen prácticas inseguras de inyección, es un indicativo de que el personal de salud no conoce, no entiende, o no se adhiere a los principios básicos de control de infecciones y técnica aséptica. https://d3imrogdy81qei.cloudfront.net/video_images/2101/safe-injection-practices-2013.jpg Yes 606 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/safe-injection-practices https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1236.mp4 Safe Injection Practices A basic expectation that exists in any healthcare setting is the protection from an infection (blood and other potentially infectious materials) while receiving an injection. In this lesson, we'll cover some ways in which you can better help protect the patient, as well as yourself. Safer Devices Equals a Safer Environment For employers, the Needlestick and Prevention Act requires that they provide appropriate, effective, safe, and commercially available medical devices that are designed to eliminate or minimize your occupational exposure if ever unsafe injection practices occur. However, combining those safer devices with a better awareness of the potential risks, along with aseptic infection control techniques, should ultimately be your goal, as thousands of infections occur each year in the U.S. as a result of unsafe injection practices. Warning: The most common unsafe injection practices include re-using needles, using multiple-dose medications or bags of solutions, and administering the same intravenous medications to multiple patients. Safe injection practices are instrumental to following the standard precautions and include safe sharps disposal practices – such as using leak-proof, puncture-resistant appropriate sharps containers – along with using sharps and needle devices that have been engineered with injection protections. This includes any time you withdraw blood or other bodily fluids, access a patient's vein or artery, or administer medications and other fluids. An example of a device with injection protection would be an angiocatheter with a button on the side that allows you to easily withdraw the needle once inserted into the catheter, while the catheter remains in the patient's vein. The needle now has a protective covering so there is no risk of getting poked and can safely be disposed in a sharps container. Pro Tip #1: Don't bend, break, or recap needles. However, if you must recap a needle, do so using the one-hand method shown in the video for this lesson. A recapping situation would include withdrawing medication from a multi-dose vial. Rather than leave on a tray or table with the needle exposed, you can use the one-hand method to reinsert the needle into its protective sheath while waiting to administer the medication to the patient. Aseptic Techniques Equals a Safer Environment Make sure to always use aseptic techniques to avoid the contamination of sterile injection equipment. This includes washing your hands, using clean gloves, and using alcohol wipes to clean injection portals, the tops of vials, and the skin where needles will be inserted. Remember to always change your gloves between patients and between tasks that may increase the chances of infection. And it's a good idea to have a generous supply of gloves so you don't run out. Pro Tip #2: Never administer medication from a single syringe to multiple patients, even if the needle has been replaced. Needles and syringes are sterile, single-use items. You can remember this rule with this little ditty: 1 needle, 1 syringe, 1 time only! Other single-use pieces of equipment are fluid infusion and administration sets (IVs, IV bags, tubing, connectors, etc.) and syringe and needle cannulas. One use, one time, then dispose of these items safely. And remember, if any sterile item touches a non-sterile item, throw it away and get another. When preparing an injection, keep work areas free of clutter and wash your hands appropriately. Gloves are not usually required when giving an injection, but there are some exceptions: If excessive bleeding is expected If other bloodborne pathogen risks exist If you have dry, cracked skin or cuts, abrasions, etc. If using a glass ampule, don't use your bare fingers to open it. Instead, use a gauze pad to break the seal and use a filtered needle when drawing from any glass ampule. Then change to a non-filtered needle before administering the medication to the patient. Also, make sure to check the name, dosage, and proper delivery method before administering any medications. And never re-enter the same vial with the same needle and syringe; always use a new needle and syringe. Single-Dose vs. Multi-Dose Vials Use single-dose vials whenever possible to reduce the chances of infection, especially when the same medication is being administered to multiple patients. And do not combine the contents of one vial to another. If you are using multi-dose vials, make sure both the syringe and the needle are sterile. If there is any doubt, toss them out. Store all medication vials according to the manufacturers' recommendations and don't keep multi-dose vials in patient treatment areas. Also, don't use bags or bottles of IV solutions as a common source of supply for multiple patients. Pro Tip #3: Whenever performing spinal lumbar puncture procedures, be sure to wear a surgical mask when placing the catheter or injection material into the spinal canal or the subdural space. OSHA's Requirements OSHA requires that any exposure control plan reflect how employers implement new developments in control technology. OSHA requires employers to solicit input from employees who are responsible for direct patient care, and this includes the identification, evaluation, and selection of better engineering and work practice controls. OSHA also requires that certain employers establish and maintain a sharps injury log of all percutaneous injuries from contaminated sharps. The sharps injury log must include the location of the incident, the device involved, and a description of the incident (at minimum) to properly evaluate future risks and device effectiveness. Employers are required to record all work-related sharps injuries involving contaminated objects on both the OSHA 300 log and the OSHA 301 log. Warning: If you're ever stuck by a needle or other sharp, or get blood or OPIM in your eyes, nose, mouth, or by contact with broken skin, immediately flood the exposed area with water. Clean any wound or broken with soap and water or a skin disinfectant if available. Report the incident to your employer and get immediate medical attention. https://d3imrogdy81qei.cloudfront.net/video_images/2101/safe-injection-practices-2013.jpg Yes 606 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/incidentes-de-exposicion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1237.mp4 Incidentes y reporte de exposición Un incidente de exposición se define como una membrana mucosa específica, piel rota o contacto por punción con sangre u OPIM que resulta del desempeño de los deberes de un empleado. Si una persona ha estado expuesta, debe descontaminar primero, reportar el incidente a un supervisor y buscar tratamiento médico. Una evaluación médica inmediata confidencial posterior a la exposición, un tratamiento profiláctico (tratamiento para ayudar a prevenir una infección) y un seguimiento debe ser realizado por un médico sin costo para el empleado. El papeleo debe completarse tan pronto como sea posible después del incidente, pero el tratamiento médico no debe demorarse completando el papeleo primero. https://d3imrogdy81qei.cloudfront.net/video_images/2103/exposure-incident-and-reporting-2013.jpg Yes 132 https://app.protrainings.com/courses/bloodborne-pathogens/healthcare/videos/exposure-incident https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1237.mp4 Exposure Incident and Reporting Being exposed to a bloodborne pathogen or other potentially infectious materials is a serious topic. In this lesson, we'll go over what to do if you ever find yourself in that situation, along with some responsibilities that your employer bears. An exposure incident is defined as contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Contact specifically means contact with mucous membranes (eyes, nose, mouth, etc.), broken skin, or through a puncture-related incident, or in any situation where there exists a high probability of contamination. What to do if You are Exposed If you are exposed, take the following steps immediately: Clean the contaminated area thoroughly with soap and water. Wash needlestick injuries, cuts, and exposed skin with soap and water. Flush out any splashes of blood and OPIM to the mouth and nose with water. If the eyes are involved, irrigate with clean water, saline, or sterile irrigants for 20 minutes. Seek immediate follow-up care as identified in your department exposure control plan. Pro Tip #1: You'll also need to report the incident and complete all the appropriate forms as soon as possible after the exposure incident. However, DO NOT delay medical treatment to fill out paperwork. Medical treatment should include an immediate post-exposure evaluation, prophylaxis treatment, and the appropriate follow up care, all of which should be conducted by a physician at no cost to the employee. Exposure Incident Reporting An exposure incident should include the following: The time, date, and location of the exposure. An account of all the people involved, including the exposed person, names of their first aid providers, and if possible, the name of the source individual. The circumstances of the exposure, any actions taken after the exposure, and any other information required by your employer. Pro Tip #2: What do we mean by if possible from point number two above? The situation could include a source that is unknown. Or state or local laws may prohibit the identification of the source of the infection. However, if the source is known and if that person gives consent, tests should be conducted as soon as possible, particularly for Hepatitis B, Hepatitis C, and HIV. Report the exposure incident to the appropriate person identified in your employer's exposure control plan (often the infection control officer). There will be forms to fill out and continued follow-up, which will proceed according to your employer's policies. Your employer's exposure control plan must specify who should be contacted and what procedures need to be done to follow-up. This includes the employer's responsibilities to provide post-exposure prophylaxis when medically indicated, counseling, and the evaluation of reported illnesses at no charge. https://d3imrogdy81qei.cloudfront.net/video_images/2103/exposure-incident-and-reporting-2013.jpg Yes 132 https://app.protrainings.com/courses/sexual-harassment/videos/introduction-harassment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1239.mp4 What does Sexual Harassment Training cover? Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act. Employers are encouraged to take steps necessary to prevent sexual harassment from occurring. They should clearly communicate to employees that sexual harassment will not be tolerated, by providing sexual harassment training to their employees, establishing an effective complaint or grievance process, and taking immediate and appropriate action when an employee complains. https://d3imrogdy81qei.cloudfront.net/video_images/2107/introduction-harassment.jpg Yes 174 https://app.protrainings.com/courses/sexual-harassment/videos/what-is-sexual-harassment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1240.mp4 What is Sexual Harassment? Because sexual attraction can play a role in the day-to-day social exchange between employees, the distinction between invited, uninvited-but-welcome, offensive-but-tolerated, and flatly rejected sexual advances may be difficult to discern. Each individual employee has the responsibility to refrain from sexual harassment in the workplace. An individual employee who sexually harasses a fellow worker is, of course, liable for his or her individual conduct.  https://d3imrogdy81qei.cloudfront.net/video_images/2109/what-is-sexual-harassment.jpg Yes 244 https://app.protrainings.com/courses/sexual-harassment/videos/how-to-stop-sexual-harassment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1241.mp4 How to Stop Sexual Harassment If an employee believes he or she is being sexually harassed, the employee should clearly and directly express that the conduct is unwelcome and tell the harasser to stop, report the harassment to the employer, and act promptly. An employee who thinks he or she has been the victim of sexual harassment can file a complaint, called a charge of discrimination, with the EEOC.  https://d3imrogdy81qei.cloudfront.net/video_images/2111/how-to-stop-sexual-harassment.jpg Yes 274 https://app.protrainings.com/courses/sexual-harassment/videos/preventing-sexual-harassment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1242.mp4 Preventing Sexual Harassment It is the employer's duty to prevent and correct harassment. Prevention is the best tool to eliminate sexual harassment in the workplace. To prevent harassment, employers should have a written policy that is clearly and regularly communicated to employees and effectively implemented.  https://d3imrogdy81qei.cloudfront.net/video_images/2113/preventing-sexual-harassment.jpg Yes 252 https://app.protrainings.com/courses/sexual-harassment/videos/employer-responsibility https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1243.mp4 Employers Responsibility for Harassment in the Workplace If an employer determines that harassment occurred, it should take immediate measures to stop the harassment and ensure that it does not recur. An employer should conduct a prompt, thorough, and impartial investigation and carefully document in writing the detailed information of any discussions and investigation details. https://d3imrogdy81qei.cloudfront.net/video_images/2115/employer-responsibility.jpg Yes 278 https://app.protrainings.com/courses/cpr/students/videos/bienvenido-a-la-rcp-para-estudiantes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1261.mp4 Bienvenido a la RCP para estudiantes Estamos muy emocionados de darte esta oportunidad para aprender RCP y primeros auxilios sin costo, porque como instructor de clase y como un paramédico de la calle, Sabía que algunos de los mejores rescatistas que teníamos en la sociedad eran personas como tú. Eres lo suficientemente fuerte para hacer RCP y primeros auxilios, eres lo suficientemente valiente para participar, y te preocupas lo suficiente para ayudar. Así que lo único que queda por hacer para hacerte un verdadero rescatador es entrenarte. Así que empecemos. https://d3imrogdy81qei.cloudfront.net/video_images/2195/student-cpr-introduction.jpg Yes 57 https://app.protrainings.com/courses/cpr/students/videos/student-cpr-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1261.mp4 Student CPR Introduction Welcome to ProTrainings' Student CPR. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And at the end, we'll give you a little information on why learning CPR is so important, along with a short story that will drive the point home. Your instructor for the duration of your Student CPR course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a co-founder of ProTrainings. In other words, you're in good hands. We're so excited to provide you with the opportunity to learn lifesaving CPR and first aid skills at no cost. Why would we do this? Because we know that some of the best rescuers in our communities are young people just like you. You're strong enough to perform the skills necessary for high-quality CPR. You're courageous enough to get involved. And you're caring enough to want to help someone in need. The total course time includes 1 hour and 34 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your Student CPR course curriculum is pretty substantial. Some of the important things you'll be learning are: Introductory CPR Training• The Five Fears of CPR Rescue Heart Attack and Stroke• Stroke• Heart Attacks Cardiac Arrest Training• Adult, Child, Infant CPR• Adult, Child, Infant AED• Hands-Only CPR Choking Training• Adult, Child, Infant Choking (Conscious)• Adult, Child, Infant Choking (Unconscious) First Aid Training• Shock Management• Bleeding Control Student CPR is a mission-based program dedicated to training students to be confident, knowledgeable responders. This is accomplished by offering a high-quality program that is flexible enough to adapt to unique classroom situations and is offered at no cost to the school or student. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. You can find us on both Facebook (Student CPR) or Twitter (@RoyOnRescue). Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important We believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR. Meet Liz, a Young Rescuer Liz Lindgren, a student from Champlin Park High School, was driving with her family to her sister's school. They were going through a curve in the road when a motorcycle in front of them hit its muffler on the ground while turning too quickly to switch lanes. Liz and her sister ran over to the motorcyclist, who was showing no signs of life. Liz began performing CPR immediately with 30 chest compressions. Liz shares her thought process: "If I had to, I was going to do two breaths, but then he started moaning and his eyes were starting to move." Emergency responders arrived soon after that and took the man to the hospital. You never know when the skills you're about to learn can help save a life and gaining confidence in your skills is a big part of performing high-quality CPR. Remembering that as you progress through each lesson will serve you well. Welcome again to Student CPR. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/2195/student-cpr-introduction.jpg Yes 57 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/control-de-infecciones-para-profesionales-del-arte-corporal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1307.mp4 Control de infecciones para profesionales del arte corporal https://d3imrogdy81qei.cloudfront.net/video_images/2347/infection-control-for-body-art.jpg Yes 257 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/infection-control-for-body-art https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1307.mp4 Infection Control for Body Artists In this lesson, we'll be covering infection control procedures and techniques for body artists. You'll learn how bloodborne pathogens and infectious diseases are spread as well as a number of aseptic techniques to protect yourself and your clients. Tattoo artists and body piercers must be fully aware of all potential dangers of their work procedures and how to prevent infection. They also must follow health and safety practices and cleaning techniques to protect themselves, as well as their clients, from bloodborne pathogens and communicable diseases that include viruses, bacteria, and fungi. As most of you are well aware, tattoos are done by injecting ink into the dermis – the inner layer of skin – with a needle attached to a handheld tool where the needle vibrates up and down at a rate of several hundred times per minute. Infections can be spread through unsterilized equipment, contaminated ink, the mishandling of needles, and the improper cleaning of surfaces and clients' skin prior to all procedures. And bacteria, viruses, and fungi can all be present on the skin of the person receiving the tattoo or piercing. Warning: Infections can spread quickly and easily. A tattoo or piercing needle that comes in contact with skin where germs are located can contaminate the needle or ink and then become the source of infection. Adopt Aseptic Techniques to Control Infection It's so important for body art professionals to use aseptic techniques for tattoos and body art procedures. Aseptic techniques are used to prevent cross contamination, or in other words, prevent the transmission of germs from one person to another or from one surface to another. Pro Tip #1: Germs are not visible to the naked eye, which probably isn't a shock to you. But it's important to mention this because visible blood or body fluids on surfaces or instruments is not necessary for an infection to be transmitted. When working with clients, all surfaces and used equipment should be considered contaminated and thoroughly cleaned. (Or what we call – better safe than sorry.) The goal of using aseptic techniques is to protect both the body art professional and the client. Aseptic techniques include the following principles: Body art professionals should cover his or her own skin if there are wounds, infections, dermatitis, etc. All clothing must be clean. Never let used equipment come in contact with clean or sterilized equipment. Maintain cleanliness of all supplies by storing them in a sanitary manner that protects all items from contamination. Make sure disinfectants are properly stored and chemicals are properly labeled. Use barriers to protect yourself, like single use gloves and gowns. Use proper hand hygiene. When wearing gloves that may have body fluids on them, don't touch any other items. Remove contaminated gloves before doing anything with sterile items. Before giving tattoos or piercings, properly clean and prepare clients' skin with antiseptic. Use ink from single use containers and only use on one client. However, ink stored in bulk containers can be transferred to single use containers. Dispose of single use containers after each person and each use. Never mix ink with tap water; only use distilled or sterile water. Use disposable single use needles and follow safe injection practices. Immediately dispose of contaminated needles, dressings, gloves, and other disposable items. Maintain a clean environment by using proper disinfectant and disinfect all chairs and work surfaces between each client. Clean and sterilize all reusable tools and equipment. Place all needles and other sharps that have come in contact with skin or body fluids into puncture resistant containers, known as sharps containers. Pro Tip #2: If you are using a sterilization machine, like an autoclave, make sure it's regularly tested and serviced. Pro Tip #3: Normally, you'll find a line at the top of sharps containers that will indicate that they are full.  However, sharps containers need to be emptied when they are 2/3 to 3/4 of the way full.  Be sure to make sure they are labeled and disposed of properly.  It's important to note that these are merely general guidelines to help protect you and your clients. Each workplace should have a written exposure control plan that outlines the proper procedures that are specific to your facility in regard to the proper disposal of regulated waste. The use of engineering controls, work practice controls, and all personal protective equipment should be customized to your own individual workplace. Pro Tip #4: In California it is not required to have red biohazard waste bags. https://d3imrogdy81qei.cloudfront.net/video_images/2347/infection-control-for-body-art.jpg Yes 257 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/posibles-problemas-medicos-con-el-arte-corporal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1308.mp4 Posibles problemas médicos con el arte corporal https://d3imrogdy81qei.cloudfront.net/video_images/2349/medical-issues-with-body-art.jpg Yes 147 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/medical-issues-with-body-art https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1308.mp4 Possible Medical Issues with Body Art In this lesson, we’ll be looking at some of the possible medical issues that come with tattoos and body art procedures like piercings. These health hazards are for those people receiving these services and also for those people providing these services. However, for the providers, your risk is always going to be higher just based on the amount of exposure you have compared to your clients. Piercings and tattoos have become increasingly popular over the last decade, and while most people may not think about the risks involved, they really should. Some of those risks include bloodborne pathogens, general skin infections, serious infections, allergic reactions, keloids, nerve damage, and bleeding. Let’s look at each one. Bloodborne Pathogens Bloodborne pathogens include Hepatitis B, Hepatitis C, and HIV. These pathogens can be spread when dirty needles are reused. They can also be spread when tattoo artists and body art professionals don’t use the proper aseptic cleanup techniques you’ll be learning about in subsequent lessons. General Skin Infections The most common risks associated with giving or receiving tattoos and piercings comes in the form of general skin infections. These infections are not considered medically significant or serious and are characterized by: Redness Swelling Pain Pus-like drainage Serious Infections While your chances of getting a serious infection is much lower than other possibilities on this list, they can also occur. Serious infections include: Impetigo MRSA (methicillin-resistant Staphylococcus aureus) Cellulitis Pro Tip #1: It should be mentioned that oral piercings carry an especially high risk, because the mouth is home to a disproportionate number of bacteria, which translates to a higher than average risk of infection at the site of the piercing. Besides infection, metal jewelry in the mouth can also damage gums and teeth. Allergic Reactions Allergic reactions are another common medical issue, particularly when it comes to materials like tattoo dyes, various metals used in piercings, and the like. If an allergic reaction is present at the site of the tattoo or piercing, some of the usual signs include: Pain Itchy rash Bumps Swelling Skin blotches Keloids Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the person's skin or red to dark brown in color. A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain, and changes in texture. This type of scar can form during the healing process. Tattoos cause damage to the skin – essentially numerous deep puncture wounds – and keloids can occur as a result. The problem is compounded by the fact that keloid scars don’t go away or become diminished over time the way other types of scars do. Nerve Damage There does exist the possibility of accidentally damaging a nerve during a piercing procedure. This is more common above the eyebrow or along the bridge of the nose. As a result, both long-term and short-term neurological damage could ensue. Serious Bleeding While a serious bleeding incident is unlikely, there are certain people who are more at risk than others. People on certain medications or those with medical disorders that can affect bleeding should be a little more cautious. Tattoos typically heal within two weeks when they are properly cared for. Healing times for piercings can range from a few weeks to over a year depending on what body part was punctured and how specifically it was punctured. Pro Tip #2: Longer healing times increase the risk of getting a site infection. A site infection can then result in a serious bloodstream infection if proper care is not taken. All body art professionals should always provide the client with after care instructions that explain in detail the risks involved and how to prevent those risks from becoming reality. Proper care to protect the site of the tattoo or piercing also has a positive effect on the quality of the image or piercing. https://d3imrogdy81qei.cloudfront.net/video_images/2349/medical-issues-with-body-art.jpg Yes 147 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/la-ley-de-seguridad-para-arte-corporal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1310.mp4 La ley de Seguridad para Arte Corporal - AB300 y AB1168 https://d3imrogdy81qei.cloudfront.net/video_images/2353/california-ab300-safe-body-art-act.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/california-ab300-safe-body-art-act https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1310.mp4 Safe Body Art Act - AB300 and AB1168 In this lesson, you'll be learning about all of the requirements that you'll need to follow and everything that you will need to provide to a local enforcement agency in order to practice body art safely and within the confines of the law. The California Safe Body Art Act* regulates tattooing, branding, body piercing, and permanent makeup for body art procedures in California. This ordinance requires that all California body art practitioners must do the following: Annually register with the county in which you work Annually receive bloodborne pathogen training Provide the proper documentation to clients on the Hepatitis B vaccine status Obtain specific health information from all clients Obtain informed consent from all clients Every client that you serve must read and sign an informed consent form that includes: A description of the procedure What to expect after the procedure A statement regarding the permanent nature of body art procedures A notice that tattoo inks, dyes, and pigments have not been approved by the FDA A statement that the health consequences of using these products is still unknown The safe body art act also requires owners of body art studios to: Obtain a local health permit Operate the facility in a safe and clean manner Maintain a written procedure for the safe operation of the facility Maintain records of training and equipment sterilization Warning: You should not perform any body art procedures in California if you are not registered with a local enforcement agency. In order to register with a local enforcement agency, all body artists must provide the following: 1. Proof that you are at least 18 years old. 2. Evidence of having been given the Hepatitis B vaccine, including applicable boosters, unless you can demonstrate an immunity to the Hepatitis B virus or have complied with current federal OSHA Hepatitis B vaccination declination requirements. 3. Evidence of OSHA bloodborne pathogen training. Pro Tip #1: You must provide proof of no less than two hours of bloodborne pathogen exposure control training that is consistent with section 119307 and Cal-OSHA bloodborne standard 5193 of Title 8. For those of you interested in reading more or if suffering from chronic insomnia, the complete code and standard can be easily accessed online. Also, this training must be provided by a person knowledgeable in exposure control and infection prevention in a body art setting and approved by a local enforcement agency. In addition, a copy and explanation of local applicable city and county ordinances that pertain to bloodborne pathogen transmission control in body art must be reviewed. 4. A self-certified knowledge of and commitment to meeting all state laws and relevant local regulations that pertain to body art safety. 5. You must provide the local enforcement agency with any required documentation that includes, but is not limited to, dates, type, and location of the work to be performed, and the name and contact information of the registrant's supervisor or supervisors. 6. Your business address and the address at which you will be performing any activities that are regulated by this chapter. 7. Payment of the registration fee directly to the local enforcement agency. This California health and safety code is intended to protect both practitioners and clients from the transmission of infectious diseases through the minimum statewide standards for people who perform tattoos, body piercing, branding, or the application of permanent cosmetics. Pro Tip #2: While these requirements can sometimes feel overpowering or in some way that they are impeding you, you should also keep in mind that they are in place to keep you the body art practitioner safe, along with the clients that have put their trust in you to have a safe procedure done. When you consider the consequences, both in regard to the law and in acquiring an infectious disease, I think you'll see that these requirements make a lot of sense and why practicing your skills safely and effectively to prevent needless infection is so vitally important.   *The California Safe Body Art Act, AB300 and AB1168, states that a person shall not perform body art if he or she is not registered with the local enforcement agency. This video will review the requirements for registration and other details included in the Safe Body Art Act. https://d3imrogdy81qei.cloudfront.net/video_images/2353/california-ab300-safe-body-art-act.jpg Yes 230 https://app.protrainings.com/courses/fire-safety/videos/fire-safety-prevention https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1572.mp4 Prevention of Fires There are so many ways for workplace fires to start— electricity, chemicals, flammable liquids, combustible materials, compressed gases, smoking, and even poor housekeeping. It is every employee's responsibility to be aware of fire hazards and to take the steps necessary to prevent workplace fires. No matter what type of workplace, potentially unsafe conditions can be anticipated. However, unsafe conditions can be corrected or properly controlled, and accidents can be prevented.  https://d3imrogdy81qei.cloudfront.net/video_images/2787/fire-safety-prevention.jpg Yes 293 https://app.protrainings.com/courses/fire-safety/videos/fire-safety-emergency-action-plans https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1573.mp4 Emergency Action Plans An emergency action plan is simply a well-thought-out plan of what to do if a fire occurs. The key components include methods of notifying people of a fire, such as alarms, a plan for getting out of the building safely, and means for containing or controlling a fire. The plan must take into consideration the unique features of each building and its occupants. Each employee must be made familiar with the facility’s fire safety systems. They need to know the building escape routes and learn the location and how to use manual pull alarms, fire extinguishers, smoke detectors, stairwells, fire doors, and emergency exits. https://d3imrogdy81qei.cloudfront.net/video_images/2791/fire-safety-emergency-plans.jpg Yes 278 https://app.protrainings.com/courses/fire-safety/videos/fire-extinguisher-use https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1574.mp4 Fire Extinguisher Use Fire extinguishers are divided into five categories -- class A, B, C, D, and K. Each one is used on different types of fires. Each fire extinguisher also has a numerical rating that serves as a guide for the amount of fire the extinguisher can handle. The higher the number, the more fire-fighting power. The ABC extinguisher is the most common type for general use. It is important to know what type of extinguisher you are using and how to use it properly. As a general rule, remember PASS to use a fire extinguisher- P-pull the pin, A-aim at the base of the fire, S-squeeze, and S-sweep from side to side.  https://d3imrogdy81qei.cloudfront.net/video_images/2789/fire-safety-extinguishers.jpg Yes 316 https://app.protrainings.com/courses/fire-safety/videos/fire-safety-blankets https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1575.mp4 Fire Blankets Some areas, like a commercial kitchen, may be required to have fire blankets. They are perfect for grease fires, as they will not spread a grease fire; it will simply extinguish it with a smothering action and in doing so will protect the user from burns.  https://d3imrogdy81qei.cloudfront.net/video_images/2785/fire-safety-fire-blankets.jpg Yes 82 https://app.protrainings.com/courses/self-defense/videos/self-defense-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1599.mp4 Introduction and How to Train in Self Defense at Home Over 2.5 million people report being assaulted each year in the United States. Over 80% of these violent crimes are committed without a weapon. Getting trained in basic self defense techniques will help you be confident in order to effectively defend yourself against an attack, no matter your gender or size. The training videos in this course will be provided in the following format: first, you will see a potential threat in a scenario; Second, the skill of how to stop the threat will be shown in detail; Third, you will see the skill performed in real time; Lastly, you will be taught how you can practice the skill at home.  https://d3imrogdy81qei.cloudfront.net/video_images/2833/self-defense-introduction.jpg Yes 287 https://app.protrainings.com/courses/self-defense/videos/four-fears-part-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1600.mp4 Four Fears of Self Defense - Part 1 Many people don't learn self defense because of fear. The top four fears are: Fear of not knowing when to use self-defense. Fear of overreacting when a threat is not real. Fear of getting sued. Fear of not knowing what to do or doing it wrong.  These four fears can be easily overcome. https://d3imrogdy81qei.cloudfront.net/video_images/2835/four-fears-part-1.jpg Yes 122 https://app.protrainings.com/courses/self-defense/videos/four-fears-part-2 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1601.mp4 Four Fears of Self Defense - Part 2 The fear of, "What if I overreact when a threat is not real?", can be easily overcome by understanding what a true threat is. Ask yourself, "Has the person threatened me? Do I feel like I'm going to be harmed?" A person who postures, bumps into you, or tries to grab you is a true threat and you should use self defense tactics. https://d3imrogdy81qei.cloudfront.net/video_images/2837/four-fears-part-2.jpg Yes 106 https://app.protrainings.com/courses/self-defense/videos/four-fears-part-3 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1602.mp4 Four Fears of Self Defense - Part 3 The reason this training was developed is to overcome the fear, "What if I don't know what to do or I do it wrong"?  This training will teach you skills that you can practice at home so you can defend yourself in most situations. With your wit, some training, and bare hands you can escape from most any attack.  https://d3imrogdy81qei.cloudfront.net/video_images/2839/four-fears-part-3.jpg Yes 171 https://app.protrainings.com/courses/self-defense/videos/pepper-spray https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1603.mp4 How to Use Pepper Spray Pepper spray is one of the most effective tools for quickly neutralizing a threat. For pepper spray to be effective, you need to have it when you need it and have it early. It should be easily accessible like attached on a purse, bookbag or keychain. Remember the acronym, RASE. Recognize a threat; Acquire, Arm, Aim the pepper spray; Spray at the eyes and face of the victim sweeping side to side; Escape quickly from the attacker.  https://d3imrogdy81qei.cloudfront.net/video_images/2841/pepper-spray.jpg Yes 196 https://app.protrainings.com/courses/self-defense/videos/hand-to-hand-self-defense-tactics https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1604.mp4 Hand to Hand Self Defense Tactics Human beings have soft several targets that we should aim for when we are trying to neutralize an attacker. First, aiming for the eyes can blind or cause pain. The nose can be struck and cause bleeding that can confuse and stop an attacker. The throat, or the Adams apple, can be struck which will injure the the attacker and stop him. Although the stomach is soft, it can be difficult to cause enough pain to stop the attacker. A hard strike to the groin on a male will cause an attacker great pain and will most likely cause him to stop. Joints like the elbows or wrists can be effective but require more precision and force. You body has several parts that can be used as weapons against a threat: the skull, the open palm of the hand, hammer fist with knuckles closed, elbow, the knee, and the foot. https://d3imrogdy81qei.cloudfront.net/video_images/2843/hand-to-hand-self-defense-tactics.jpg Yes 467 https://app.protrainings.com/courses/self-defense/videos/hair-grab https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1607.mp4 How to Defend Against a Hair Grab The hair grab is when an aggressor grabs you by the hair. By grabbing the wrist and pulling him down, you can use a knee strike or palm strike to the side of his face to neutralize the aggressor and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2845/hair-grab.jpg Yes 156 https://app.protrainings.com/courses/self-defense/videos/choke-from-behind https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1608.mp4 How to Defend Against a Choke from Behind When an aggressor grabs you around the neck from behind, there are a few different things you can do. You might use a palm strike the nose, and elbow strike to the face, a hammer first to the genitals, or a knee strike to the genitals.  https://d3imrogdy81qei.cloudfront.net/video_images/2847/choke-from-behind.jpg Yes 166 https://app.protrainings.com/courses/self-defense/videos/choke-from-the-front https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1609.mp4 How to Defend Against a Choke from the Front When an aggressor grabs you around the neck from the front, you have a couple of different things you could do. Grab the aggressor's wrists, pull down and deliver a knee strike to the genitals. You may also be able to bring your arms up and over, trapping his hands, and deliver a palm strike to the face. https://d3imrogdy81qei.cloudfront.net/video_images/2849/choke-from-the-front.jpg Yes 133 https://app.protrainings.com/courses/self-defense/videos/headlock-from-the-side https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1621.mp4 How to Defend Against a Headlock from the Side If a person comes from the side and gets you in a headlock, you can neutralize them without a lot of strength. By driving the side of your hand into the aggressors neck, then grabbing the back of the aggressor's head, you can then give knee strikes and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2889/headlock-from-the-side.jpg Yes 119 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-behind-arms-in https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1622.mp4 How to Defend Against a Bear Hug from Behind: Arms In This video shows what to do when an aggressor grabs you from behind with your arms in. First squat down which brings the aggressor's head close to yours. Give head butts, then a hammer fist strike to the groin. https://d3imrogdy81qei.cloudfront.net/video_images/2891/bear-hug-from-behind-arms-in.jpg Yes 129 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-behind-arms-out https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1623.mp4 How to Defend Against a Bear Hug from Behind: Arms Out In this scenario, an aggressor grabs you from behind with your arms out. You can squat down and deliver and elbow strike to one side and then the other. If the person releases, then give a hammer fist strike to the groin and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2893/bear-hug-from-behind-arms-out.jpg Yes 154 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-the-front-arms-in https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1624.mp4 How to Defend Against a Bear Hug from the Front: Arms In When an aggressor grabs you from the front with your arms trapped in, it can be frustrating because you have no arms to strike with. You can step back with one foot and deliver knee strikes to the groin. When the aggressor bends over from the pain, give a knee strike to the face and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2895/bear-hug-from-the-front-arms-in.jpg Yes 121 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-the-front-arms-out https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1625.mp4 How to Defend Against a Bear Hug from the Front: Arms Out In this scenario an aggressor grabs you from the front with your arms out. With your arms free, you can grab their back and bring the aggressor tight toward you. Drive your leg back and launch your knee up into the aggressor's groin. The pain will most likely make the aggressor let go. Deliver and palm strike into his face and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2897/bear-hug-from-the-front-arms-out.jpg Yes 119 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-behind-with-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1626.mp4 How to Defend Against a Bear Hug from Behind with Lift This video shows what to do when an aggressor grabs you from behind and lifts your feet off the ground. Swing your feet back in between his legs so he can't throw you. Give head butts to the face which will cause the aggressor to drop you. Give hammer fist to the groin, a knee strike to the face, and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2899/bear-hug-from-behind-with-lift.jpg Yes 171 https://app.protrainings.com/courses/self-defense/videos/bear-hug-from-the-front-with-lift https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1627.mp4 How to Defend Against a Bear Hug from the Front with Lift In this situation the aggressor has grabbed you from the front and lifted your feet off the ground. Swing a leg back and deliver a forceful knee strike to the groin. The aggressor will most likely drop you down at this point. With your feet on the ground, grab the aggressors shoulders, pull down, and give another knee strike to the groin or a palm strike to the face and escape. https://d3imrogdy81qei.cloudfront.net/video_images/2901/bear-hug-from-the-front-with-lift.jpg Yes 159 https://app.protrainings.com/courses/self-defense/videos/wrist-grab-escapes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1628.mp4 Wrist Grab Escapes In this video you will learn how to escape a wrist grab, whether single or double. Slap the wrist away and grab your pepper spray. If the aggressor grabs both wrists, quickly bring your hands up to your face and forcefully push the aggressor away. https://d3imrogdy81qei.cloudfront.net/video_images/2903/wrist-grab-escapes.jpg Yes 212 https://app.protrainings.com/courses/self-defense/videos/mount-escape https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1629.mp4 Mount Escape This scenario shows what to do when everything else has failed and you find yourself in a life and death, or rape situation, where the aggressor has pushed you down to the ground and is on top of you. This is a more advanced move that will take practice to get good at it. This technique does not require great strength, rather good technique. If the aggressor has his hands on your neck in a choke, you can trap his hands, bring your knee up, bridge up, pound fists into the genitals, and retreat. https://d3imrogdy81qei.cloudfront.net/video_images/2905/mount-escape.jpg Yes 281 https://app.protrainings.com/courses/self-defense/videos/escaping-aggressor-between-the-legs https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1630.mp4 Escaping Aggressor Between the Legs The whole goal of self-defense training is to help prevent you from getting into the position where the aggressor is on top of you between your legs. In this worst case scenario, there are some things you can do to escape. The first priority is to prevent the aggressor from choking you unconscious. You can grab the aggressors wrist and pull them down to release the pressure off your neck. You would then brace a foot down and scoot your hips out. Brace a foot against aggressor's pelvis, give knee strikes to the head or palm strikes to the face. https://d3imrogdy81qei.cloudfront.net/video_images/2907/escaping-agressor-between-the-legs.jpg Yes 274 https://app.protrainings.com/courses/self-defense/videos/rear-choke-against-wall https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1631.mp4 How to Defend Against a Rear Choke Against a Wall In this scenario you are facing a wall when an aggressor grabs you from behind and starts to choke you. To escape you would trap the aggressor's arms, give an elbow strike, pull aggressor down and give a knee strike. https://d3imrogdy81qei.cloudfront.net/video_images/2885/rear-choke-against-wall.jpg Yes 205 https://app.protrainings.com/courses/self-defense/videos/front-choke-against-wall https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1632.mp4 How to Defend Against a Front Choke Against a Wall When an aggressor chokes you from the front, you would first reach your arm around and trap the aggressor's arms. Then, give and elbow strike to the face followed by a knee strike to the groin. https://d3imrogdy81qei.cloudfront.net/video_images/2887/front-choke-against-wall.jpg Yes 164 https://app.protrainings.com/courses/sexual-harassment/videos/sexual-harassment-diversity https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1661.mp4 Diversity in the Workplace Diversity in the workplace can be summed up in one simple phrase: "Treat others the way you want to be treated." A workplace where employees practice diversity and inclusiveness on a daily basis is highly valuable. Diversity is recognizing and respecting human differences and similarities. Both employers and employees will reap many benefits in a diverse and inclusive environment, such as a positive working environment, increased communication, respect, increased cooperation, teamwork, better employee participation, loyalty, and prevention of civil rights violations. In general, every employee has the responsibility to treat all people with respect and dignity at all times with inclusion and fairness. This includes every person no matter their race, orientation, color, language, national origin, religion, gender, age, genetics, physical or mental ability, political affiliation, socio-economic status, veteran status, or other. https://d3imrogdy81qei.cloudfront.net/video_images/2931/sexual-harassment-diversity.jpg Yes 330 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/capacitacion-a-patogenos-sanguineos-para-artistas-del-cuerpo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1867.mp4 Bienvenido a la capacitación a patógenos sanguíneos para artistas del cuerpo https://d3imrogdy81qei.cloudfront.net/video_images/3339/intro-to-bloodborne-pathogens-tattoo.jpg Yes 204 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/intro-to-bloodborne-pathogens-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1867.mp4 Intro to Bloodborne Pathogens Welcome to ProTraining's Bloodborne for Body Art training course. In this lesson, we'll give you a run-down of what you can expect from your course, what's included in the course, and the OSHA requirements that this course meets and maybe even exceeds. Pretend for a second that you're a body artist (should be easy) who regularly comes into contact with client's blood and bodily fluids on occasion and answer the following questions: Do you know how to protect yourself from bloodborne diseases? Do you know what potential diseases you may face if you come into contact with someone's blood or bodily fluids? Would you know what to do if a client started bleeding and blood got on the floor, surfaces, and tools and equipment? Well, not to worry. The goal of this ProBloodborne for Body Art training course is to help you answer these questions with a resounding, yes. We'll provide you with all the knowledge and skills necessary to prevent you from getting a disease from a bloodborne pathogen. Will ProBloodborne for Body Art Meet OSHA's Requirements? This ProBloodborne for Body Art training course is intended for body artists who need OSHA compliant bloodborne pathogens and infection control training. It follows the requirements of OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) that requires the following: Training must be given at the time of initial assignment to tasks where occupational exposure may take place. Annual training for all employees shall be provided within one year of their previous training. Employers shall provide additional training when changes such as the modification of procedures or tasks or the institution of new tasks or procedures affect the employee's occupational exposure. This additional training may be limited to addressing the new exposures created. Pro Tip #1: As a body artist, you can face exposure to bloodborne pathogens and infectious diseases when you perform tattoos, piercings, and the like. Keep in mind as you progress through this course the importance of what you're learning. All it takes is one misstep or poor decision to impact your life in profound and negative ways. So, while OSHA is requiring you to be here, it's also in your best interest to get as much from this course as you can. (As you move through this course's written content, you'll be greeted with periodic Pro Tips and Warnings. Just like the Dummies series of books you're likely familiar with, these sections are of particular importance and should be given special consideration.) What is Included in the ProBloodborne for Body Art Course? This course includes the following bloodborne pathogens and infection control training: Basic terms related to bloodborne pathogens How bloodborne pathogens and infectious diseases are spread Infection control for body artists Medical issues with tattoo and piercings Sterilization procedures for body art professionals The Safe Body Art Act AB300 HIV and AIDS Hepatitis B Hepatitis C How you can reduce your risks of exposure Engineering controls Work practices to protect yourself Personal protective equipment Skin diseases Exposure control plans Proper cleanup and decontamination procedures Hazardous waste disposal Procedures to follow if an exposure incident occurs This course is intended to be no less than two hours of valuable training related to bloodborne pathogens and infection control, especially related to the body art profession. In other words, we created this course specifically for you! The entire course consists of lecture videos, written course lessons, as well as opportunities for you to ask questions if they arise via chat, email, or phone. Simply connect with the instructor if you ever have questions. Pro Tip #2: As we learn better by doing, it's important to practice the skills you'll be learning in this course, such as putting on clean gloves, removing contaminated gloves, cleaning contaminated surfaces, tools, and equipment, and even practicing how to wash your hands appropriately. Some of it may seem silly – like washing your hands – but we assure you it's not! At the conclusion of your lecture series, you'll move on to taking your written test. Passing the test will verify that you have retained the valuable information required to be certified for your annual bloodborne pathogens training, specifically for body artists. It is also a great idea to give yourself some hands-on practice before before working with BBP. We also would like to encourage you to opt in to our reminder emails – weekly emails that provide additional training videos just a couple minutes long that will cover a new topic on bloodborne pathogens and infection control. The emails arrive weekly until it's time to renew the following year. To conclude your introductory course lesson, we want to thank you for coming to ProTrainings for your bloodborne pathogens training program. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3339/intro-to-bloodborne-pathogens-tattoo.jpg Yes 204 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/como-se-propagan-los-patogenos-de-sangre-artistas-del-cuerpo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1868.mp4 Cómo se propagan los patógenos de la sangre https://d3imrogdy81qei.cloudfront.net/video_images/3341/how-bloodborne-pathogens-are-spread-tattoo.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/how-bloodborne-pathogens-are-spread-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1868.mp4 How Bloodborne Pathogens are Spread In this lesson, we'll take a look at how one gets ill from a bloodborne pathogen or infectious disease. But first, how about a couple of definitions? Bloodborne Pathogen – A bloodborne pathogen is a microorganism that's present in human blood and can cause disease in humans. Infectious Disease – An infectious disease is a disease (also caused by microorganisms like bacteria, virus, fungus, etc.) that enters the body through various biological routes. It's important to note that not all bloodborne pathogens and infectious diseases are created equally, as some can produce mild symptoms, while others can be life-threatening. The Chain of Infection For any disease to spread, several conditions must be present. This is known as the chain of infection. And if you recall from the last lesson, those conditions are as follows: There must be an adequate number of pathogens or disease-causing organisms in the environment. There needs to be a reservoir or source that allows the pathogen to survive and even multiply, such as blood. There must be a mode of transmission from source to host. There must be an entrance through which the pathogen enters the host. The host must be susceptible to that pathogen, as opposed to being immune to it. Pro Tip #1: Infection control strategies help prevent disease transmission by interrupting one or more links in the chain of infection. Sources of Bloodborne Pathogens The primary source of potential bloodborne pathogens is blood and specific bodily fluids, like semen and vaginal secretions. However, there are other bodily fluids that may contain bloodborne pathogens, especially if they are visibly contaminated with blood. Those sources include: Cerebrospinal fluid in the brain Synovial fluid in the joints Pleural fluid in the lungs Amniotic fluid in and around the uterus Pericardial fluid around the heart Peritoneal fluid in the abdomen Urine, feces, saliva, and a few other fluids don't typically carry bloodborne pathogens, however … Pro Tip #2: Because it's so difficult to identify contaminated body fluids or know for sure if those fluids are contaminated with blood, it's important to treat ALL bodily fluids as potential threats that could include bloodborne pathogens. How Bloodborne Pathogens and OPIM Get into the Body There are four basic modes of transmission: Direct Contact – Direct contact transmission occurs when microorganisms are transferred from an infected person to another person. An example would be a tattoo artist with an open, uncovered cut or wound, in which blood from a client/source comes in contact with that wound. Parenteral Exposure – Parenteral exposure is when infected blood and/or bodily fluids are introduced into the body through piercing or puncturing the skin. An example would be getting stuck with a contaminated needle or being cut with a sharp object that's been contaminated. Indirect Contact – Indirect contact is when a contaminated object (tools, needles, etc.) contacts a person's skin or mucous membranes, like those found in the eyes, mouth, nose, and ears. Which is why it's so important to decontaminate any objects that have blood on them. Airborne Transmission – Airborne transmission occurs when droplets or small particles that contain an infectious agent remain active in the air and are then inhaled into the body. An example of this would be tuberculosis. While airborne transmission is possible, most cases of bloodborne pathogen infections do not fall into this category. Some Risks are Higher than Others While it's important to consider all blood and bodily fluids potential threats, there are some methods of transmission that are more common than others. Highest Potential Risks The most common ways bloodborne pathogens and OPIM are spread are: Getting stuck with an infected needle Sexual contact Other than sexual contact, the highest potential risks are when a contaminated, sharp object punctures or cuts the skin, such as with an infected needle, a broken piece of contaminated glass, or getting cut by a razor that was also used by an infected person. Pro Tip #3: Fans of the TV show Live PD will be familiar with police protocol before searching a person – a protocol that includes asking if that person has any sharp objects or needles that could poke, stab, or cut them. If you weren't sure why police officers do this, now you know. Medium Potential Risks Medium risks involve situations where blood and bodily fluids get into an open cut or are absorbed through a mucous membrane – eyes, nose, ears, mouth, etc. Like our tattoo artist example from above. Lowest Potential Risks The lowest potential risks include situations where contaminated objects come in contact with inflamed skin, acne, skin abrasions, etc. Which brings up a good point. Pro Tip #4: Knowing how bloodborne pathogens and OPIM are spread is important to be sure. But so is knowing what prevents those microorganisms from spreading. And the number one line of defense is intact skin. In fact, the CDC (Center for Disease Control) has stated that there is no known risk of exposure to bloodborne pathogens and infectious diseases through intact skin. Which means casual contact – like handshaking, hugging, touching doorknobs, etc. – are not considered threats in normal situations. https://d3imrogdy81qei.cloudfront.net/video_images/3341/how-bloodborne-pathogens-are-spread-tattoo.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/vih-y-sida-artistas-corporales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1869.mp4 VIH y SIDA https://d3imrogdy81qei.cloudfront.net/video_images/3343/hiv-and-aids-tattoo.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hiv-and-aids-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1869.mp4 HIV and AIDS HIV stands for human immunodeficiency virus. It attacks the body and harms the immune system by destroying the white blood cells that fight infection. Which in turn diminishes the body's ability to protect itself against disease. If left untreated, HIV will eventually progress into AIDS – acquired immunodeficiency syndrome. In this lesson, we'll take a look at transmission rates, symptoms (though very problematic and unreliable), and how you can better protect yourself from infection. Pro Tip #1: On average, it takes 10 years for the HIV virus to progress into AIDS. However, this average varies greatly person to person, and is affected by a number of factors like health status, behavioral characteristics, medications taken, etc. Since 1996, with the introduction of powerful retroviral therapies, the natural progression of HIV to AIDS has been slowed. AIDS Statistics in the U.S. There are around 1.1 million people living with HIV in the United States. What is perhaps even more troubling is that around 18 percent aren't even aware they have been infected, as they haven't been tested and symptoms don't exist or aren't noticeable. Around 50,000 people become infected with HIV each year and approximately 15,000 each year die from AIDS. HIV Infection Rates by Category According to CDC From highest to lowest, these are the ways in which people are infected with HIV each year in the U.S. Category 2011 2018 Male to male sexual contact 62% 66% Heterosexual contact (females) 18% 16% Heterosexual contact (males) 10% 8% Injection drug use (male) 5% 4% Injection drug use (female) 3% 3% Male to male sexual contact and IDU 3% 4% Other 1% 1% Other includes babies who are born from infected mothers, blood transfusions, and needle sticks, among other less common reasons. Of the babies that contract HIV, this can occur before birth, during birth, or during breastfeeding. Pro Tip #2: Out of the estimated 50,000 people per year infected with HIV, less than one percent is due to a work-related incident. What does this mean for you? Of all the ways people contract HIV, very few will become infected in the workplace, even in professions (like yours) where the risk is higher. Warning: Don't let that lull you into a false sense of security. Part of the reason that number is so low is because proper infection control policies are routinely put in place for many professions who are around bloodborne pathogens and OPIM. Follow your policies and procedures, and your chances will likely go well below that one percent. HIV Signs and Symptoms If left unchecked, HIV is a deadly virus that eventually will spread to AIDS. But how do you know if you've been infected with HIV? Get tested! That's the only sure way to know. However, sometimes there are signs. (Often there are no symptoms, which is why it's a good idea to get tested if there's any question or doubt.) Symptoms, when present, can include: Fever Fatigue Night sweats Weight loss Rash Dry cough Pro Tip #3: The HIV virus is actually quite fragile (outside the body) and will die within seconds after being exposed to air. Inside the body, the amount of the virus present in body fluid and the physiological condition of the host will determine how long the virus lives. It's important to note – There is currently no vaccine or cure for HIV or AIDS. Some Important HIV/AIDS Takeaways How HIV is spread is important, as this happens mostly through unprotected sex and from sharing needles or syringes. Only a very small fraction of one percent of people are infected while providing medical care, and most of these are due to sticks from dirty needles. While this may seem obvious to many, particularly medical professionals, HIV (like other bloodborne pathogens and OPIM) cannot be spread by casual contact, such as hugging, handshaking, doorknobs, toilet seats, etc. Pro Tip #4: Remember, symptoms are not reliable and may not be present for many years, which means numerous people infected with HIV will never know they have it until those symptoms appear or … through proper testing. A Word About Pathogens and the Diseases and Conditions They Cause Let's take a quick look at the variety of pathogens that exist and the conditions and diseases they cause. Viruses Hepatitis, measles, mumps, chicken pox, meningitis, rubella, influenza, warts, colds, herpes, HIV (which causes AIDS), genital warts, smallpox, avian flu, Ebola, and Zika. Bacteria Tetanus, meningitis, scarlet fever, strep throat, tuberculosis, gonorrhea, syphilis, chlamydia, toxic shock syndrome, Legionnaires' disease, diphtheria, food poisoning, Lyme disease, and anthrax. Fungi Athlete's foot, ringworm, and histoplasmosis. Protozoa Malaria, dysentery, Cyclospora, and giardiasis. Rickettsia Typhus and Rocky Mountain spotted fever. Parasitic Worms Abdominal pain, anemia, lymphatic vessel blockage, lowered antibody response, and respiratory and circulatory complications. Prions Creutzfeldt-Jakob disease (CJD) or bovine spongiform encephalopathy (mad cow disease). Yeasts Candidiasis (also known as thrush). https://d3imrogdy81qei.cloudfront.net/video_images/3343/hiv-and-aids-tattoo.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/virus-de-la-hepatitis-b https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1870.mp4 Virus de la hepatitis B https://d3imrogdy81qei.cloudfront.net/video_images/3345/hepatitis-b-virus-tattoo.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hepatitis-b-virus-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1870.mp4 Hepatitis B Virus In this lesson, we're going to take a look at the Hepatitis B virus, also known as HBV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis B infection in the U.S. When a person is first infected with the Hepatitis B virus, it begins as an acute infection (meaning short in duration) and can range from very mild conditions with few or no symptoms to a serious condition requiring hospitalization. The Hepatitis B virus reproduces in the liver, which causes inflammation. This in turn can also lead to cirrhosis of the liver, liver cancer, and liver failure. An acute infection is defined by duration – the first six months after the person is exposed to the virus. Some people's bodies can fight the infection and rid it from their systems. While others become chronically infected (meaning long-term). Pro Tip #1: What does a chronic infection mean in practical terms? It means the virus remains in the blood, affects and damages liver cells over time, which causes illnesses like cirrhosis of the liver, liver failure, liver cancer, and eventually death. The good news – Around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. The other 10 percent of people who contract Hepatitis B fall into that chronic category outlined above. Warning: Hepatitis B is particularly devastating for infants and young children, as the majority will be at a much greater risk of developing a chronic infection. In most kids, Hepatitis B is a silent killer, and left unchecked will slowly destroy the liver over a period of 20 years or more. How Hepatitis B is Contracted and Spread Hepatitis B is contracted in the same ways as HIV. It's mainly spread through sexual contact with an infected person, or as a result of sharing needles or syringes with an infected person. And, like HIV, the infection can be passed from mother to unborn (or just-born) baby, especially if the infant came into contact with blood or other bodily fluids through breaks in the skin like cuts or sores. Pro Tip #2: Do not expect a person with chronic Hepatitis B to look or appear sick. The virus cares little about appearances and will spread regardless. Hepatitis B Statistics in the U.S. It is estimated that up to 1.2 million people in the U.S. have a chronic Hepatitis B infection 38,000 people each year become infected with the Hepatitis B virus 3000 people each year die from liver disease caused by Hepatitis B The number of infections has significantly decreased since 1990, thanks to routine Hepatitis B vaccinations Hepatitis B Signs and Symptoms Much like with HIV and AIDS, signs and symptoms for Hepatitis B are unreliable and may or may not be present. And why proper testing for both is the only sure-fire way to know if an infection is present. Hepatitis B symptoms include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay colored stools Abdominal discomfort Fever Pro Tip #3: The Hepatitis B virus is up to 100 times easier to catch than HIV. There are several reasons for this including the virus' size, as it's much smaller than HIV, and the fact that the Hepatitis B virus can live outside the body for at least seven days, depending on specific conditions. Also, like HIV, Hepatitis B cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with doorknobs, water fountains, and toilets. Hepatitis B Vaccine This is where the Hepatitis B and HIV similarities end, as there is an effective vaccine for Hepatitis B that is administered in three doses over a six-month period. The vaccine is safe, as it's made from non-infectious materials and cannot cause one to become infected with the Hepatitis B virus. Also, severe problems or allergic reactions are rare. The Hepatitis B vaccine is around 80 – 95 percent effective in providing protection against the virus, but only in situations where all three doses of the vaccine are administered. Pro Tip #4: It's probably a good idea to not assume the vaccine worked. It's easy enough to confirm your newly developed immunity to the Hepatitis B virus but wait at least one to two months after completing the vaccine series before getting tested. *It should be noted, that at this time, booster doses of the Hepatitis B vaccine are not recommended. Consider Getting the Hepatitis Vaccine if … There are some people who are more likely to be occupationally exposed to the Hepatitis B virus than others, and that includes: Tattoo artists, or anyone who performs body piercings or body art People who administer first aid routinely Professionals who provide medical care Employees responsible for assisting in bathroom care People who work in medical and/or dental offices People who handle medical waste Employees who perform custodial duties that involve the cleaning of decontaminated surfaces – blood and other possibly infectious materials Anyone whose job will, or might, expose them to the Hepatitis B virus must be offered the vaccine for free through their employer. Employees who do not want the vaccine will need to complete a vaccine declination form. https://d3imrogdy81qei.cloudfront.net/video_images/3345/hepatitis-b-virus-tattoo.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/virus-de-la-hepatitis-c https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1871.mp4 Virus de la hepatitis C https://d3imrogdy81qei.cloudfront.net/video_images/3347/hepatitis-c-virus-tattoo.jpg Yes 200 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hepatitis-c-virus-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1871.mp4 Hepatitis C Virus In this lesson, we're going to take a look at the Hepatitis C virus, also known as HCV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis C infection in the U.S. You're going to notice numerous similarities with the Hepatitis B virus. However, there will also be some significant and crucial differences to make note of. At the end of the lesson, we'll provide you with a Word about the signs and transmission of bloodborne pathogens. Much like the Hepatitis B virus, Hepatitis C can exhibit very mild conditions with few or no symptoms to a serious condition requiring hospitalization. It's not unusual for someone infected with Hepatitis C to live for decades with the disease and not know it, all the while the virus is slowly destroying their liver. The Hepatitis C virus reproduces in the liver, which causes inflammation. This in turn can also lead to cirrhosis of the liver, liver cancer, and liver failure. Some people who are exposed to Hepatitis C can fight the infection and rid it from the body. While others become chronically infected. You may recall that this is where we gave you some good news in the last lesson, as around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. While the other 10 percent of people who contract Hepatitis B will become chronic. The problem is that with Hepatitis C, those numbers are practically inverted, as around 80 percent of those exposed develop a chronic infection, while the other 20 percent will clear the virus from their systems and develop and natural immunity to it. How Hepatitis C is Contracted and Spread Pro Tip #1: Hepatitis C is spread a little differently compared to Hepatitis B and HIV. While the latter two viruses are mainly spread through sexual contact with an infected person, Hepatitis B is spread mostly through blood, including sharing needles with an infected person (mostly due to injected drug use) and through getting tattoos and piercings with unsterilized equipment. Less common ways of contracting Hepatitis C in the U.S. include receiving blood, blood products, or organs that have been infected with the Hepatitis C virus. However, these instances are much less common since blood screening became available in 1992. Also, like both HIV and Hepatitis B, the infection can be passed from mother to unborn (or just-born) baby. And in healthcare settings, it can also be passed on through needle stick injuries. It's worth noting that these are both rare, as is spreading the disease through sexual intercourse. It should be noted that personal items that are contaminated with infected blood and then shared with others also present a risk – items like razors and toothbrushes, for example. Pro Tip #2: People who are infected with HIV face a much greater risk of also contracting Hepatitis C. Also, like both Hepatitis B and HIV, Hepatitis C cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with pubic items like doorknobs, water fountains, and toilets. And there is no evidence of virus transmission from food handlers, teachers, or other service providers in the absence of blood to blood contact. Hepatitis C Statistics in the U.S. It is estimated that around 3.2 million people in the U.S. have a chronic Hepatitis C infection 17,000 people each year become infected with the Hepatitis C virus 12,000 people each year die from liver complications caused by Hepatitis C Hepatitis C Signs and Symptoms Much like with HIV and Hepatitis B, signs and symptoms for Hepatitis C are unreliable and may or may not be present. And why proper testing for all the above is the only sure-fire way to know if an infection is present. Hepatitis C symptoms (which mirror those of Hepatitis B) include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay colored stools Abdominal discomfort Fever Hepatitis C Treatment Unfortunately, there is neither a Hepatitis C vaccine nor a known cure. There are, however, new drugs that have come on the market that studies have shown can provide big improvements to those in need of Hepatitis C treatment. In some studies, those infected with the Hepatitis C virus who took one or more new drugs approved by the FDA showed up to a 90 percent success rate in eliminating the disease. The downside is the expense. Treatments can cost tens of thousands of dollars, making them financially available to only a select few who can afford them. A Word About Bloodborne Pathogens – Signs and Transmission Let's quickly recap the symptoms of the diseases covered in this section (Hepatitis B, C, and HIV) along with the modes of transmission for each. It may help to see the side-by-side comparisons for the purpose of retaining the information. HIV Symptoms: May or may not be present in the early stages. Late-contact stage symptoms may include fever, headache, fatigue, diarrhea, skin rashes, night sweats, loss of appetite, swollen lymph glands, significant weight loss, white spots in the mouth or vaginal discharge (signs of yeast infection), and memory or movement problems. Contraction: HIV is spread through both direct and possibly indirect contact with blood, semen, and vaginal fluid. Hepatitis B Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis B is spread through both direct and indirect contact with blood and semen. Hepatitis C Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis C is spread through both direct and indirect contact with blood and semen. https://d3imrogdy81qei.cloudfront.net/video_images/3347/hepatitis-c-virus-tattoo.jpg Yes 200 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/enfermedades-y-trastornos-de-la-piel https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1872.mp4 Enfermedades y trastornos de la piel https://d3imrogdy81qei.cloudfront.net/video_images/3349/skin-diseases-tattoo.jpg Yes 233 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/skin-diseases-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1872.mp4 Skin Diseases and Disorders In this lesson, we'll be covering all things related to skin diseases and disorders, including the three layers of skin and various conditions like MRSA, herpes simplex, fungal conditions, and who is most prone to getting skin diseases and disorders, along with most importantly – the best line of defense against such conditions. What do We Mean by Skin Disorders and Diseases? Skin diseases, disorders, and other conditions include people who have the following: Boils Infected wounds Open sores and cuts Abrasions Weeping dermatological lesions Pro Tip #1: Anyone with these skin conditions should absolutely avoid working if there is any likelihood at all that they could contaminate healthcare supplies, body art equipment, or work surfaces. Just like someone with the flu should avoid working, so too should people with any of the conditions listed above. Workers skin should be free from all rashes and infections. Healthcare workers, tattoo artists, and caregivers should always cover any open sores with bandages to avoid the spread of infection. Getting to Know Your Own Skin Skin is the largest organ of the body and if you think about it, it's not even close. Your skin contains blood vessels, sensory receptors, nerves, and sweat glands. Your skin is made up of several layers and varies in thickness from around 1.5mm to 4mm or more. Pro Tip #2: Skin is the first line of defense against infection … as long as it's intact. If it's not intact, it should be covered. And if it's not intact and not covered, it's not defending you against anything. The Three Layers of Skin The three layers of skin are: The Epidermis – the thick outer layer of tissue that you affectionately know as your skin. The Dermis – this strong second layer of connective tissue is filled with blood vessels and nerves. The Hypodermis – this layer lies just below the dermis, is fattier than the other two, and is sometimes called the subcutaneous layer. Warning: The reason that tattoo artists, in particular, have such a high risk is that they use needles that puncture these layers of skin multiple times per minute, making it much more possible to become infected. Commonly Spread Skin Diseases Let's take a look at some of the more commonly spread skin diseases, starting with … Staphylococcus Aureus Staphylococcus aureus is a bacterium that is commonly found on the skin and noses of some individuals. Most of the time, staph does not cause any major harm. Staph infections can look like pimples, boils, or other skin conditions and most are easily treatable. Methicillin-Resistant Staphylococcus Aureus (MRSA) MRSA infections can look like ordinary skin wounds, boils, or infected sores. However, most of the time, these sores appear not to heal and may even get worse. People contract MRSA infections by touching infected mucous membranes, skin, or contaminated objects. Most MRSA infections are limited to skin infections. More severe or life-threatening MRSA infections occur most frequently among patients in healthcare settings with altered immune systems. Herpes Simplex Herpes simplex is a commonly spread skin disease that is a virus. It's generally found on the face, scalp, arms, neck, and upper chest. It is usually indicated (appears) as a small, round blister and when broken can secrete a clear or yellowish fluid. People typically contract herpes by touching infected saliva, mucous membranes, or skin. Fungal Skin Diseases Some common skin diseases that are fungus-related are athletes foot and ringworm. Fungal infections cause red, patchy, flaky, and itchy areas of skin. They are also contagious and can be easily spread from one person to another. Fungal skin diseases are usually spread when infected areas of a person or surface (showers, floors, benches, etc.) are touched by a non-infected person. To combat fungal infections, affected areas should be kept clean and dry. Who is Most Prone to Skin Diseases and Disorders? Some people with the following conditions are more prone to getting skin disorders: People with a history of Hepatitis B or C People with HIV or AIDS People with diabetes People with a history of hemophilia or other blood diseases and disorders People with a history of allergies or adverse reactions to pigments, dyes, latex, etc. People with a history of other immune disorders Pro Tip #3: It should be noted that healing may be adversely affected by receiving a tattoo or other body art for all individuals listed above. https://d3imrogdy81qei.cloudfront.net/video_images/3349/skin-diseases-tattoo.jpg Yes 233 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/como-reducir-tus-riesgos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1873.mp4 Cómo reducir tus riesgos https://d3imrogdy81qei.cloudfront.net/video_images/3351/reduce-risk-of-bloodborne-pathogens-tattoo.jpg Yes 176 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/reduce-risk-of-bloodborne-pathogens-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1873.mp4 How to Reduce Your Risk with Standard Precautions In this lesson, you'll learn how to minimize your risk of exposure to all bloodborne pathogens and other potentially infectious materials (OPIM). Your first line of defense when it comes to these threats is known as standard precautions. Standard precautions include maintaining personal hygiene, using personal protective equipment (PPE), engineering controls, work practice controls, and proper equipment for cleaning contaminated areas and surfaces, along with the proper cleanup procedures. Standard precautions represent the minimum infection prevention practices that everyone must follow, based on your employer's control plan. These precautions are key to eliminating exposure to all blood and bodily fluids. Remember, it's better to assume that all bodily fluids carry the risk of disease and/or infection, rather than the opposite – to assume there is no risk. So, what are the standard precautions? Standard Bloodborne and OPIM Precautions Standard precautions can be broken down into two areas – proper use of handwashing and the appropriate use of personal protective equipment, or PPE. Handwashing Pro Tip #1: While it may seem simple, handwashing is the single most effective way to prevent infection. To be as safe as possible, follow the three handwashing guidelines below. Wash your hands before and after contact is made with clients or patients. Wash your hands as often as needed – as they become visibly soiled or when exposed to possibly infectious materials. Wash your hands using soap and hot water immediately after removing your gloves. Pro Tip #2: What if you don't have access to soap and water? In these cases, you can substitute soap and water with an alcohol-based hand sanitizer. If you routinely find yourself in these situations, it may be a good idea to carry some hand sanitizer with you. Personal Protective Equipment Personal protective equipment includes things like gloves, gowns, and masks and should be used or worn whenever the exposure to body fluids is anticipated. Warning: Wearing gloves is not a reason to forego handwashing and in no way will eliminate the necessity for handwashing, which is, once again, the single most effective way to prevent infection. Your Employee Exposure Control Plan An exposure control plan is simply a written plan that's provided by your employer, the aim of which is to eliminate or minimize your occupational exposure to blood and OPIM. While the details may vary from one employer to the next, every relevant workplace must provide easily accessible copies of this plan to its employees. Each exposure control plan must include two things: A determination of exposure by job classification and … The implementation of various methods of exposure control, including:a. Universal or standard precautionsb. Engineering and work practice controlsc. Personal protective equipmentd. Information on the Hepatitis B vaccinee. Communication of hazards to employees and the required trainingf. Recordkeepingg. Procedures for evaluating circumstances surrounding exposure incidentsh. Post exposure evaluation and follow-upi. The implementation of methods for all of the above Pro Tip #3: Universal Precautions are a set of precautions designed to prevent transmission of HIV, the Hepatitis B virus (HBV), and other bloodborne pathogens when providing care; these precautions consider blood and OPIM of all patients potentially infectious. These are OSHA-required practices that require you to treat ALL blood and OPIM as if known to be infectious. Protecting Yourself from Bloodborne Pathogens and OPIM The fundamental method of protecting yourself against pathogens and infection is by controlling the hazards. This can be accomplished a number of ways, including: Elimination. Get rid of all hazards or hazardous tasks if possible. Substitution. Replace hazards or hazardous tasks with safer equipment and/or safer methods. Engineering controls. Use devices such as self-sheathing needles and sharps containers to block or remove your risks of getting stuck, poked, or cut. Personal Protective Equipment (PPE). Know where your PPE is located and how to properly use it. Also, keep in mind that PPE only protects you if you use it. Work practice and administrative controls. It's important to follow the policies and procedures for your workplace to eliminate all risks associated with bloodborne pathogens and OPIM. What exactly is a work practice control? A work practice control is any measure that reduces the likelihood of exposure by changing the way a task is carried out. When followed, all of these protection methods will help make your workplace and your work activities much safer. https://d3imrogdy81qei.cloudfront.net/video_images/3351/reduce-risk-of-bloodborne-pathogens-tattoo.jpg Yes 176 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/controles-de-ingenieria-administrativos-y-de-practicas-laborales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1874.mp4 Prácticas de trabajo y controles de ingeniería https://d3imrogdy81qei.cloudfront.net/video_images/3353/work-practice-and-engineering-controls.jpg Yes 210 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/work-practice-and-engineering-controls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1874.mp4 Work Practice, Administrative and Engineering Controls In this lesson, we're going to take a closer look at work practice controls, administrative controls, and engineering controls, so that you can have a deeper understanding of not only what they are, but why they're important. Work Practice Controls A work practice control is any measure that reduces the likelihood of being exposed to blood or other pathogens by changing the way a task is carried out. Administrative Controls Administrative controls are changes in work procedures such as written safety policies, rules, supervision, schedules, and training with the goal of reducing the duration, frequency, and severity of exposure to hazardous chemicals or situations. Administrative controls include the completion of all relevant training, any and all legal requirements that must be met and adhered to, and all the policies and procedures related to infection control at your workplace. Engineering Controls An engineering control measure is one that eliminates, isolates, or removes a hazard from the workplace; things used in the workplace to help reduce the risk of an exposure. Engineering controls include: Sharps disposal containers Needle containment devices Other safety devices that prevent handlers from getting cut or poked Pro Tip #1: Engineering controls should be examined and/or maintained on a regular set schedule to ensure their maximum effectiveness. Make sure these controls are in place at your workplace to minimize your risk of exposure. Examples of Workplace, Administrative, and Engineering Controls This list is in no way meant to be a complete accounting of all controls, but rather to give you a good idea of what workplace, administrative, and engineering controls look like in the workplace. Food, drink, etc. You shouldn't eat, drink, smoke, apply cosmetics, or handle contact lenses in any and all work areas where there exists the possibility of exposure to bloodborne pathogens and other potentially infectious materials. Trash disposal. When disposing of any trash that contains contaminated materials, do not compress the trash with your hand. Also, when carrying contaminated materials for disposal, be sure to carry the trash away from your body in case of spillage. Environment and work surfaces. All equipment and surfaces in your work environment should be thoroughly cleaned and decontaminated after all contact with blood, other body fluids, and other potentially infectious materials. Contaminated sharp objects. When dealing with contaminated needles and other sharp objects (routinely shortened to just sharps) there are certain guidelines to follow, such as not using bent needles, recapping needles, or trying to remove questionable needles. All needles and sharps must also be placed into appropriate sharps containers immediately after use. Warning labels. Warning labels should be affixed to all regulated waste and other containers that are used to store, transport, or ship other potentially infected materials. Labels must be fluorescent orange or red, or at least predominantly orange or red, to indicate a possible threat, along with lettering and symbols in a contrasting color. Personal protective equipment. All employees must be provided with personal protective equipment by their employer and at no cost to the employee. Examples of PPE include:a. Gloves – Wear gloves whenever the potential exists of touching blood, bodily fluids, or other potentially contaminated items.b. CPR shields and protective eyewear – Use these items when there's a likelihood of blood and OPIM being secreted or splashed.c. Gowns – Wear a gown when the potential exists of getting blood and other bodily fluids on any clothing or exposed skin.d. Masks and respirators – Use whenever there's a potential risk of coming into contact with airborne infectious diseases. Pro Tip #2: Having personal protective equipment at your workplace is great, but do you know what's even better? Knowing exactly where all PPE is located and being able to properly use them. Be sure PPE is available at your workplace and that you've been appropriately trained to use them. If you're in a profession where you have access to a first aid kit at work, be sure it's properly stocked with all necessary items, such as gloves and CPR face shields or rescue masks. Cleaning Rather than Disposing? If you are tasked with laundering contaminated items – like reusable gowns – rather than disposing of them, make sure you follow your facility's specific procedures for cleaning and handling these items. General laundry procedures will include: Wearing personal protective equipment whenever handling contaminated laundry Keeping contaminated laundry separate from non-contaminated laundry Bagging potentially contaminated laundry in the same area in which it was used, rather than transporting it elsewhere to bag Using leak-proof bags for wet contaminated laundry Transporting contaminated laundry in properly labeled bags, especially when shipping it to an offsite facility A Work Practice Cheat Sheet As you now know, work practice controls reduce the likelihood of exposure by changing the way a task is carried out, which helps reduce the risk of an exposure incident. This cheat sheet is not meant to be complete, however these are some of the more common controls you'll likely face. Place all sharps items in puncture-resistant, leak-proof containers that are both labeled and available at the point of use. Avoid splashing, spraying, and splattering droplets of blood or OPIM when performing all procedures. Remove and dispose of soiled protective clothing as soon as possible. Clean and disinfect all equipment and work surfaces that may have been soiled by blood or OPIM. Wash your hands thoroughly with soap and water immediately after being exposed to any potentially contaminated materials and be sure the sink is not located in a food preparation area. Use alcohol-based hand sanitizers when handwashing facilities are not available. Do not eat, drink, smoke, apply cosmetics or lip balm, handle contact lenses, or touch your mouth, nose, or eyes when you are in an area where you may be exposed to infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/3353/work-practice-and-engineering-controls.jpg Yes 210 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/desechos-regulados-para-artistas-del-cuerpo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1875.mp4 Desechos regulados https://d3imrogdy81qei.cloudfront.net/video_images/3355/regulated-waste-tattoo.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/regulated-waste-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1875.mp4 Regulated Waste In this lesson, we'll cover what regulated waste is as defined by OSHA, along with some standard protocols for handling and disposing of it. The OSHA bloodborne pathogens standard defines regulated waste as: Any liquid or semi-liquid blood or other potentially infectious material. Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed or rung out. Items that are caked with dried blood or OPIM and are capable of flaking off and releasing these materials during handling. Contaminated sharps. Pathological and microbiological wastes containing blood or OPIM. How to Dispose of Regulated Waste Pro Tip #1: It's important to note that all properly labeled and bundled waste should be handled according to your facility's disposal procedures. It's also important to consider any state or local requirements that may apply to regulated waste disposal in your area. Having said that, here are a few guidelines to follow when disposing of regulated waste. Warning: While this should go without saying, never dispose of potentially contaminated waste into normal trash receptacles. Regulated Waste Containers All blood and other potentially infectious materials must be disposed of in properly labeled biohazard containers, in either a red bag or a predominantly orange or red container that has been imprinted with the biohazard symbol shown below. Regulated waste containers must be: Sealable. You must be able to completely close and seal the container. Properly constructed. The container must be able to properly handle its contents without fail. Leak-proof. The regulated waste container must prevent leakage of all fluids and materials while handling, storing, transporting, and shipping. Sharps Containers All items falling into this category – like needles, syringes, and razors – must be placed into sealable, leak-proof, puncture resistant containers. The containers must also be properly labeled or color coded. Pro Tip #2: Regardless of type, all regulated waste containers should be routinely inspected and replaced, and they should never be allowed to overfill. A Word About OSHA's Regulations Since OSHA may be the reason you're taking this course, let's dig a little deeper into what the employer's responsibilities are when it comes to following those regulations. Pro Tip #3: Safety is job number one. If you notice that your employer is falling short of adhering to guidelines or not providing everything on this list, you may want to consider asking someone. OSHA regulations regarding bloodborne pathogens have placed specific responsibilities on employers for the protection of employees (like you). These include all of the following: Identifying positions or tasks covered by the bloodborne and OPIM standard precautions. Creating an exposure control plan to minimize the possibility of exposure and making the plan easily accessible to all employees. Developing and putting into action a written schedule for cleaning and decontaminating environments and work surfaces at the workplace. Creating a system for easy identification of soiled material and its proper disposal. Developing a system of annual training for all covered employees. Offering the opportunity for employees to get the hepatitis B vaccination at no cost. Establishing clear procedures to follow for reporting an exposure. Creating a system of recordkeeping. In workplaces where there is potential exposure to injuries from contaminated sharps, soliciting input from non-managerial employees with potential exposure regarding the identification, evaluation, and selection of effective engineering and work practice controls. (In other words, the feedback of those being exposed.) If a needlestick injury occurs, recording the appropriate information in the sharps injury log, including:a. The type and brand of device involved in the incident b. The location of the incidentc. A description of the incident Maintaining a sharps injury log in such a way that protects the privacy of employees. Ensuring the confidentiality of all employees' medical records and exposure incidents. https://d3imrogdy81qei.cloudfront.net/video_images/3355/regulated-waste-tattoo.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/limpieza-de-fluidos-corporales-para-artistas-del-cuerpo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1876.mp4 Limpieza de fluidos corporales para artistas del cuerpo https://d3imrogdy81qei.cloudfront.net/video_images/3357/body-fluid-cleanup-tattoo.jpg Yes 460 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/body-fluid-cleanup-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1876.mp4 Body Fluid Cleanup In this lesson, you'll learn how to clean and disinfect contaminated surfaces, whether floors, tables, or equipment, along with some safety issues pertaining to cleanup. But first, let's begin by a better understanding of what an appropriate disinfectant is. Appropriate Disinfectants Cleaning up after every procedure is required to ensure that employees are not exposed to blood or other potentially infectious materials that remain on surfaces and equipment from previous procedures. Appropriate disinfectants include: Bleach solution EPA registered tuberculocidal EPA registered sterilants Products registered as effective against HIV and HBV A thorough list of these products can be found at www.epa.gov. These products can be used to comply with California section 5193 provided that the surfaces on which they are used have not become contaminated with agents or volumes or concentrations for which higher levels of disinfectant are required. Disinfectants should always be used according to the manufacturer's label instructions including: The concentration The volume The contact time Personal Protective Equipment Before disinfecting any contaminated areas or surfaces, first ask yourself if you have the proper PPE – personal protective equipment – to complete the job safely. PPE you may need includes: Gloves, always Face shield and/or eye protection An apron or gown In most cases, these three items will be enough, and in many instances, gloves alone will suffice. When should you use a disposable apron or gown? Whenever there's a reasonable chance you could get bloodborne pathogens or other potentially infectious materials on your clothing. The biggest problem involved with getting pathogens on clothing is cross-contamination, and we'll get into this more in a minute. When should you use a face or eye shield? Whenever there's a reasonable chance of spraying or splashing. If you're cleaning dried blood off a counter, you probably don't need to go that extra mile. But what if you were disinfecting a piece of machinery with many parts at or around eye level? Mostly it just comes down to common sense. Having the proper cleanup equipment and personal protective equipment is the first step in any cleanup project. Make sure you have everything you need for the task at hand. And always err on the side of caution. Pro Tip #1: Not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Also, one pair of gloves isn't going to cut it. In order to keep from re-contaminating the scene, or even contaminating another scene, you'll change your gloves a few times in the course of one cleanup job. Which brings up a good point … Warning: Pay attention to what you're touching with your contaminated gloves. It should go without saying to avoid touching any part of yourself, but also be sure not to touch clean surfaces or equipment that hasn't been contaminated. But if you do, it's not the end of the world; just remember to disinfect those as well. Cleaning Supplies Matter There are only two essential supplies you need: paper towels and bleach. Don't use toilet paper or napkins or even low-quality paper towels. The paper towels you use should be commercial grade and able to withstand the task at hand without falling apart. Bleach is super cheap and super effective, so there's no point in substituting. However, if you are going to substitute, make sure the cleaner or disinfectant you're using is up for the job. As in specifically manufactured to kill microorganisms and protect against all viruses, bacteria, and other pathogens and infectious materials. Body Fluid Cleanup Procedure The first thing you want to do is make sure the scene is safe. If there are any sharp objects, like broken glass or needles, remove those using tongs (or another safe method) and put all sharps into a contaminated sharps disposal container so you can disinfect them or dispose of them properly later. For the purpose of instruction, let's assume you're cleaning off a table with a modest amount of dried blood. There is no chance of spraying or splashing, and unless you're really reckless, you shouldn't have to worry about contaminating your clothing. Put on your 1st pair of medical grade gloves and remove any sharp objects. Wipe up as much of the dried blood as you can using a paper towel. Be sure to keep the blood isolated to the table or the paper towels. If you get some on the floor, be sure to disinfect it as well. Remove your 1st pair of gloves as shown in the video – using glove on glove for the first, and bare finger against your wrist for the second. Throw away both gloves. Put on your 2nd pair of medical grade gloves. Mix your bleach solution in a spray bottle and liberally spray the solution on the table where the dried blood was located. Wipe down with paper towels and make sure all the blood is visibly gone. Remove your 2nd pair of gloves using the same protective method as before. Put on your 3rd pair of gloves. (Yes, this is a bit of a pain. But if you don't do it this way, there's no point in cleaning up, as the risk of infection will likely still remain thanks to dirty gloves.) Lightly mist the surface of the table with your bleach solution and allow it to evaporate. The time it takes for the liquid solution to evaporate equals the time it takes to completely kill any pathogens remaining. Pro Tip #2: The CDC (Centers for Disease Control and Prevention) recommends a bleach solution of one part bleach to nine parts water. This solution should be strong enough to kill any bloodborne pathogens and infectious materials you may encounter. Pro Tip #3: In general, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection, whether the barrier is a piece of protective clothing or a safe container to dispose of infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/3357/body-fluid-cleanup-tattoo.jpg Yes 460 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/retirado-de-guantes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1877.mp4 Retirado de guantes https://d3imrogdy81qei.cloudfront.net/video_images/3359/glove-removal-tattoo.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/glove-removal-tattoo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1877.mp4 Glove Removal Your gloves are your first line of defense against bloodborne pathogens and other potentially infectious materials when cleaning up and disinfecting a scene. In this lesson, we'll show you the exact procedure of how to properly and safely remove them. You don't want blood and other bodily fluids to touch your skin, but you especially don't if you have cuts, scrapes, abrasions, or other openings in the skin. Even hangnails could pose a problem and provide an opening for a foreign invader to enter. Remember, not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Ideally, you'll have nitrile gloves. As latex allergies are becoming more common, nitrile gloves provide a better option for many people. Pro Tip #1: While putting on your gloves may sound like common sense and something not requiring instruction, there are three important points to note: Gloves will sometimes stick together, and this may make getting them on more difficult than it should be. (Though most gloves now have a coating or powder on them to prevent this.) Which is why you may have seen someone blow a puff of air into the wrist to make squeezing a hand in easier. This is not appropriate when it comes to infectious materials cleanup, even with clean gloves. Also, you don't want to spread any germs you may have onto the clean gloves. Size matters. Gloves come in many sizes. If your employer has only small or medium size gloves and you're a 300-pound man with sausage fingers, good luck. And do you know what happens when you try and squeeze an extra-large hand into a small glove? Well, let's just say it'll look like your hand is wearing a halter top, and your protection will go bye-bye. So, make sure your employer has your glove size in stock. Because one size rarely fits all. Inspect the gloves for defects, like holes, rips, or cuts. Just like our halter top gloves scenario above, if your gloves have any type of hole, you're not getting that protective barrier you need to stay safe, and you could wind up spreading a pathogen rather than containing and cleaning it up. Safety first, always. Remember, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection. When it comes to gloves, they're like having an additional protective layer of skin. How to Remove Contaminated Gloves If you've seen the video lesson that corresponds with this written version, you may have noticed that glove removal is not a normal process for most people and one that may require a bit of practice to perfect. And since perfection equals being disease and infection-free, practicing taking off your contaminated gloves may not be the worst idea. Pro Tip #2: Keep in mind your goal as it pertains to glove removal – keeping the contaminated materials on one side and your skin on the other. The two sides should always remain separate. To this end, the glove removal process is as follows: 1. Pinch the palm side of one glove on the outside near your wrist. (Glove on glove contact only.)2. Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand.3. Wad up the dirty glove into the palm of your still-gloved hand. Pro Tip #3: You want to completely wad the glove up into that hand so the other glove can easily pass over your fist and not catch on any of the material from the first glove. However, you don't want to squeeze so hard that infectious material comes oozing out. 4. Carefully slip two fingers under the wrist of the other glove. Avoid touching the outside of the glove. (Skin on skin contact only.) 5. Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand. The other glove is now contained inside. By now, you should be holding the inside lining of one glove with the other glove trapped deep down inside. You can also do this with a bloody gauze pad or contaminated paper towel in one of your gloved hands, as all items will wind up at the bottom of the first glove removed. Warning: When removing your gloves, it's important that you don't snap the glove material, so make sure you have a good grip and work slowly and carefully. Snapping the glove's materials could send pathogens and infectious materials flying – into eyes and other mucous membranes or onto clean surfaces. 6. Toss both gloves into the trash along with other PPE. Ideally, you'll have access to a trash receptacle that you can open using a foot pedal. And make sure the liner is appropriate for handling bloodborne pathogens and other potentially infectious materials per your regulations. 7. And finally, wash your hands thoroughly with soap and running water, if available. Otherwise, rub your hands thoroughly with an alcohol-based hand sanitizer if they are not visibly soiled and then wash your hands as soon as it is practical. https://d3imrogdy81qei.cloudfront.net/video_images/3359/glove-removal-tattoo.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/el-procedimiento-correcto-para-lavarse-las-manos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1878.mp4 El procedimiento correcto para lavarse las manos https://d3imrogdy81qei.cloudfront.net/video_images/3361/handwashing.jpg Yes 193 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/handwashing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1878.mp4 Handwashing Handwashing is the single most important infection control technique. And while you may think you already know how to wash your hands properly, the techniques you'll learn in this lesson will be much better suited to keeping you safe in your workplace. When exactly should you wash your hands? You should disinfect or wash your hands whenever they are visibly dirty or contaminated. You should also wash your hands: Before any contact with clients or patients Before putting on gloves Before performing any procedures After taking gloves off After using the bathroom After touching garbage After contact with clients or patients and especially after contact with:• Non-intact skin• Bodily fluids• Excretions• Wound dressings• Contaminated items How should you practice proper handwashing? Pro Tip #1: When it comes to properly disinfecting your hands, new and improved doesn't exist. Washing your hands with soap and water is still the best way to reduce the number of germs in most situations. But what if you don't have access to a sink, hot water, and soap? In these situations, use an alcohol-based hand sanitizer, but make sure it contains at least 60 percent alcohol. Alcohol-based hand sanitizers are a great second option and can quickly reduce the number of microbes on your hands in many situations. Warning: While alcohol-based sanitizers are a great option in the absence of a nearby sink, hot water, and soap, they will not eliminate all types of germs. So, if it's just a matter of a slight inconvenience, washing your hands with soap and water is worth that inconvenience. How should you properly clean your hands with an alcohol-based hand sanitizer? The technique is quite simple and there are just three important points to keep in mind: You need enough hand sanitizer to fill the palm of one hand. Spread the sanitizer everywhere on your hands – between your fingers, in every crevice and wrinkle, under any rings you have on, into your cuticles, under nail beds, around your wrists, and so forth. Work the sanitizer into your hands for a minimum of 20 seconds or until your hands are dry. Pro Tip #2: Make sure to follow your own policies and procedures as outlined by your individual employer or your industry, as indications can be different for when the use of alcohol-based sanitizers are deemed appropriate. What if you're wearing a lot of jewelry or a watch that you suspect has been contaminated? In certain cases, or with certain individuals, removing jewelry and a watch will be required before cleaning and disinfecting your hands. If this is the case, make sure you remove these items using personal protective equipment and store them together someplace safe – more as it relates to the spread of infection, not as it relates to the items themselves. After cleaning your hands, you can return to those items and sanitize them as necessary, following the engineering controls and work practices covered under OSHA's Bloodborne Pathogen Rule. How should you properly wash your hands using soap and water? Again, the technique is quite simple. It's just a matter of following the proper guidelines: 1. Use a disposable paper towel to turn the faucet on.2. Thoroughly wet your hands with water. Pro Tip #3: If you're concerned about wasting water when using a sink with manual faucet controls, you can always ask a coworker to help turn the faucet on and off for you. 3. Apply a good amount of soap.4. Rub the soap into your hands for at least 20 seconds, just as you did with the alcohol-based hand sanitizer, covering all areas including the backs of your hands, under fingernails, between fingers, and so forth.5. Rinse your hands off under running water.6. Dry your hands using disposable paper towels.7. Use that disposable towel to turn the faucet off and discard the towel when done. https://d3imrogdy81qei.cloudfront.net/video_images/3361/handwashing.jpg Yes 193 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/incidentes-y-reporte-de-exposicion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1879.mp4 Incidentes y reporte de exposición https://d3imrogdy81qei.cloudfront.net/video_images/3365/exposure-incident-and-reporting.jpg Yes 132 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/exposure-incident-and-reporting https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1879.mp4 Exposure Incident and Reporting Being exposed to a bloodborne pathogen or other potentially infectious materials is a serious topic. In this lesson, we'll go over what to do if you ever find yourself in that situation, along with some responsibilities that your employer bears. An exposure incident is defined as contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Contact specifically means contact with mucous membranes (eyes, nose, mouth, etc.), broken skin, or through a puncture-related incident, or in any situation where there exists a high probability of contamination. What to do if You are Exposed If you are exposed, take the following steps immediately: Clean the contaminated area thoroughly with soap and water. Wash needlestick injuries, cuts, and exposed skin with soap and water. Flush out any splashes of blood and OPIM to the mouth and nose with water. If the eyes are involved, irrigate with clean water, saline, or sterile irrigants for 20 minutes. Seek immediate follow-up care as identified in your department exposure control plan. Pro Tip #1: You'll also need to report the incident and complete all the appropriate forms as soon as possible after the exposure incident. However, DO NOT delay medical treatment to fill out paperwork. Medical treatment should include an immediate post exposure evaluation, prophylaxis treatment, and the appropriate follow up care, all of which should be conducted by a physician at no cost to the employee. Exposure Incident Reporting An exposure incident should include the following: The time, date, and location of the exposure. An account of all the people involved, including the exposed person, names of their first aid providers, and if possible, the name of the source individual. The circumstances of the exposure, any actions taken after the exposure, and any other information required by your employer. Pro Tip #2: What do we mean by if possible from point number two above? The situation could include a source that is unknown. Or state or local laws may prohibit the identification of the source of the infection. However, if the source is known and if that person gives consent, tests should be conducted as soon as possible, particularly for Hepatitis B, Hepatitis C, and HIV. Report the exposure incident to the appropriate person identified in your employer's exposure control plan (often the infection control officer). There will be forms to fill out and continued follow-up, which will proceed according to your employer's policies. Your employer's exposure control plan must specify who should be contacted and what procedures need to be done to follow-up. This includes the employer's responsibilities to provide post-exposure prophylaxis when medically indicated, counseling, and the evaluation of reported illnesses at no charge. https://d3imrogdy81qei.cloudfront.net/video_images/3365/exposure-incident-and-reporting.jpg Yes 132 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/conclusion-del-curso-sobre-patogenos-transmitidos-por-la-sangre https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1880.mp4 Conclusión https://d3imrogdy81qei.cloudfront.net/video_images/3367/conclusion.jpg Yes 31 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/conclusion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1880.mp4 Conclusion Congratulations! This concludes your bloodborne pathogens training for body art course. We hope you took away a lot of valuable and helpful information that will not only help make you a more professional body art practitioner but can also help stop needless infections from occurring client to client. We hope you enjoyed this training. And now you'll be moving on to the final step of this program and finishing up your certification process. Thank you again for using ProTrainings Bloodborne Pathogens for Body Art course. Go forth and work safely! https://d3imrogdy81qei.cloudfront.net/video_images/3367/conclusion.jpg Yes 31 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/procedimientos-de-esterilizacion-de-equipos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1881.mp4 Procedimientos de esterilización de equipos para profesionales del arte corporal https://d3imrogdy81qei.cloudfront.net/video_images/3363/equipment-sterilization-procedures-for-body-art-professionals.jpg Yes 257 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/equipment-sterilization-procedures-for-body-art-professionals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1881.mp4 Equipment Sterilization Procedures for Body Art Professionals In this lesson, you'll learn how to clean and sterilize your body art tools and instruments, from the all-important step of removing them from procedural areas to the final steps of sterilization and packaging. Pro Tip #1: In addition to following basic infection control principles, all reusable equipment must be properly sterilized.  It's important that you take this process seriously and follow all local requirements for the activities presented in this lesson.  They are designed to help prevent infection and provide safe and quality service. Cleaning and Sterilization Steps The following steps should help you with the cleaning and sterilization of contaminated instruments in your body art studio. 1. Use Proper Decontamination Areas Do not clean contaminated equipment where you use it; it must be taken to a specially designated decontamination area. This area must have a sink with cold and hot running water to properly clean and disinfect the equipment. 2. Wear Your PPE It's important to protect yourself when cleaning and decontaminating equipment, which means wearing your personal protective equipment. Pro Tip #2: Keep in mind that it's far easier to prevent an exposure incident than it is to recover from an accidental biological or chemical exposure. 3. Presoak Instruments But not overnight. Soaking them too long can result in the equipment developing corrosions and biofilms which will make cleanup harder than it should be. Keep equipment and instruments in a holding solution for a short time period. This will make cleanup and decontamination easier as well.  4. Clean Instruments There are two general approaches here – ultrasonic cleaning and handwashing. This is the first step before using an autoclave. a. Ultrasonic Cleaning Do not mistake this for sterilization, because it's not. Instead, it uses ultrasonic waves and an appropriate cleaning solvent. Make sure to follow the manufacturer's instructions on your machine. It's also important to disassemble all grips, tubes, and tips after cleaning to allow for better sterilization. b. Handwashing Instruments should be submerged while scrubbing them to reduce splattering and the chance of cross-contamination. After washing, rinse thoroughly and allow all instruments to air dry before sterilization. 5. Packaging for Autoclave All equipment should be packaged in special set up packs with color change indicators or packaged individually in peel packs with color change indicators. Keep hinged instruments in the open position. Be sure that all packages are dated and initialed by the preparer. Pro Tip #3: If a sterilized package accidentally opens, gets punctured, or gets wet, you have to resterilize and repackage. 6. Sterilize with the Autoclave Anyone using an autoclave needs to be trained on how to use an autoclave. There are no training wheels! Sterilization requires varying degrees of time depending on: The load How items are arranged The packaging of materials Temperature Type of sterilizing agent Make sure to follow the manufacturer's instructions on your autoclave. Proper sterilization also means monitoring the autoclave and keeping sterilization logs for at least three years. Monitoring includes things like monthly spore testing, and checking or recording the following: Time Temperature Pressure Color indicators on each package Integrator in each load At the minimum, a class five integrator must be used in each load. Sterilization logs should include the following: Run date Load number Initials of person running the load Start time End time Temperature Pressure Actions take if there's a sterilization failure Remember: Sterilization logs should be kept for 3 years Once sterilization is complete, it's important to properly store all equipment and instruments. This means storing items in a dry and clean cabinet or a tightly covered container reserved for storing sterilized equipment. Also important – all sterilized instruments need to remain in their sterile packaging until opened, and a good time to do that is in front of the client, so he or she can see your commitment to their safety and will tell every friend they've ever had to go see you for all future body art needs. https://d3imrogdy81qei.cloudfront.net/video_images/3363/equipment-sterilization-procedures-for-body-art-professionals.jpg Yes 257 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/intoduccion-a-patogenos-de-sangre-en-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1882.mp4 Introducción a patógenos sanguíneos en trabajo Este curso está dirigido a personas que necesitan capacitación sobre control de infecciones y patógenos de la sangre que cumplen con OSHA, de acuerdo con la norma OSHA 29 CFR 1910.1030, como parte de sus requisitos de trabajo, ya que pueden enfrentar exposición laboral a patógenos de transmisión sanguínea y enfermedades infecciosas. https://d3imrogdy81qei.cloudfront.net/video_images/3369/intro-to-bloodborne-pathogens-workplace.jpg Yes 260 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/intro-to-bloodborne-pathogens-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1882.mp4 Intro to Bloodborne Pathogens Welcome to Bloodborne Pathogens in the Workplace. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course. And more importantly, we'll explain exactly why this information is so particularly vital to your safety, and the safety of those around you. Before we dig into too deeply, it's important to understand why this training is important for you, if you could be possibly exposed to bloodborne pathogens in the workplace. You see, bloodborne pathogens are invisible. Therefore, it's impossible to know if they exist or not in blood or blood products … until you contract an infectious disease, and it's too late. What You Will Learn in this Course Some of the important things we'll be teaching you in this course are: How to recognize potentially dangerous situations in your workplace Simple steps to better protect yourself by using:• Personal protective equipment (PPE)• Engineering controls• Work practice controls• How to clean up body fluid spills appropriately Pro Tip #1: The skills you will learn in this course could not only save your life, but as already mentioned, since we're dealing with infectious diseases, these skills might also keep those people you care about around you safe as well. The Goals of this Course Do you know how to protect yourself from a bloodborne pathogen? Do you know what potential diseases You could face if you come in contact with blood or other body fluids? Do you know what to do if a person is bleeding and blood got on the floor and other surfaces? The goal of this bloodborne pathogens course for the workplace is simple – to help you answer those vitally important questions above. And also to give you the knowledge and the skills necessary to prevent you from getting a disease from a bloodborne pathogen. This course is intended for employees who need OSHA compliant bloodborne pathogen and infection control training. This course follows OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) which requires the following: Training must be given at the time of initial assignment to the tasks or occupational exposure that may take place. Annual training for all employees shall be provided within one year of the previous training. Employers shall provide additional training when any workplace changes affect the employees' occupational exposure, such as when there is:a. A modification of procedures b. A modification of tasks c. The institution of new procedures d. The institution of new tasks This additional training may be limited to address the new exposures that have been created. Lessons You'll Find in this Couse ProBloodborne for the Workplace includes the following bloodborne pathogen and infection control training: Basic terms related to bloodborne pathogens How bloodborne pathogens and infectious diseases are spread HIV/AIDS Hepatitis B Hepatitis C How to reduce your risk of exposure Engineering controls Work practices to protect yourself Personal protective equipment (PPE) Skin diseases Exposure control plans Proper cleanup and decontamination procedures Hazardous disposal Procedures to follow if an exposure incident occurs This course is intended to be equivalent to no less than 1.5 hours of training related to bloodborne pathogens and infection control, especially as it is related to the workplace. This entire program consists not only of lecture videos but also written course content (like this) and opportunities for you to ask questions via chat, email, and phone to the instructor who taught you. It's also important to take the time necessary to practice the skills you will be learning in these videos, such as: Putting on clean gloves Removing contaminated gloves Cleaning contaminated surfaces and equipment Proper handwashing techniques Warning: While some of these may sound stupid to you, we assure you they are not. These simple yet effective skills may be the difference between living with an infectious disease and not having to deal with that nightmare. In other words, it will serve you well to take all of the skill training seriously. At the conclusion of this lecture series and your practice with hands-on components, you will then go on to the written test, at which point you will be verified whether or not you retained this vital information that is required for your annual bloodborne pathogen certification specifically for the workplace. We also encourage you to remember this: As long as you have opted into our reminder emails, you will receive important updates about the latest changes for the training topics that we will be covering in this initial training. It's important to retain these valuable skills as they will help protect you from needless infections from bloodborne pathogens. https://d3imrogdy81qei.cloudfront.net/video_images/3369/intro-to-bloodborne-pathogens-workplace.jpg Yes 260 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/como-se-propagan-los-patogenos-de-sangre-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1883.mp4 Cómo se propagan los patógenos de la sangre Los patógenos transmitidos por la sangre son microorganismos (como los virus) que están presentes en la sangre humana y pueden causar enfermedades en los humanos. Estos patógenos incluyen, entre otros, el virus de la hepatitis B (VHB), la hepatitis C (VHC) y el virus de la inmunodeficiencia humana (VIH). La fuente principal de patógenos en la sangre potenciales es la sangre y los fluidos corporales específicos. El objetivo es prevenir la propagación de patógenos transmitidos por la sangre mediante la interrupción de la forma en que se propagan utilizando estrategias de control de la infección. La principal forma en que se propagan las infecciones como la hepatitis B, la hepatitis C o el VIH es a través del contacto sexual o el abuso de drogas por vía intravenosa. https://d3imrogdy81qei.cloudfront.net/video_images/3371/how-bloodborne-pathogens-are-spread-workplace.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/how-bloodborne-pathogens-are-spread-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1883.mp4 How Bloodborne Pathogens are Spread In this lesson, we'll take a look at how one gets ill from a bloodborne pathogen or infectious disease. But first, how about a couple of definitions? Bloodborne Pathogen – A bloodborne pathogen is a microorganism that's present in human blood and can cause disease in humans. Infectious Disease – An infectious disease is a disease (also caused by microorganisms like bacteria, virus, fungus, etc.) that enters the body through various biological routes. It's important to note that not all bloodborne pathogens and infectious diseases are created equally, as some can produce mild symptoms, while others can be life-threatening. The Chain of Infection For any disease to spread, several conditions must be present. This is known as the chain of infection. And if you recall from the last lesson, those conditions are as follows: There must be an adequate number of pathogens or disease-causing organisms in the environment. There needs to be a reservoir or source that allows the pathogen to survive and even multiply, such as blood. There must be a mode of transmission from source to host. There must be an entrance through which the pathogen enters the host. The host must be susceptible to that pathogen, as opposed to being immune to it. Pro Tip #1: Infection control strategies help prevent disease transmission by interrupting one or more links in the chain of infection. Sources of Bloodborne Pathogens The primary source of potential bloodborne pathogens is blood and specific bodily fluids, like semen and vaginal secretions. However, there are other bodily fluids that may contain bloodborne pathogens, especially if they are visibly contaminated with blood. Those sources include: Cerebrospinal fluid in the brain Synovial fluid in the joints Pleural fluid in the lungs Amniotic fluid in and around the uterus Pericardial fluid around the heart Peritoneal fluid in the abdomen Urine, feces, saliva, and a few other fluids don't typically carry bloodborne pathogens, however … Pro Tip #2: Because it's so difficult to identify contaminated body fluids or know for sure if those fluids are contaminated with blood, it's important to treat ALL bodily fluids as potential threats that could include bloodborne pathogens. How Bloodborne Pathogens and OPIM Get into the Body There are four basic modes of transmission: Direct Contact – Direct contact transmission occurs when microorganisms are transferred from an infected person to another person. An example would be a tattoo artist with an open, uncovered cut or wound, in which blood from a client/source comes in contact with that wound. Parenteral Exposure – Parenteral exposure is when infected blood and/or bodily fluids are introduced into the body through piercing or puncturing the skin. An example would be getting stuck with a contaminated needle or being cut with a sharp object that's been contaminated. Indirect Contact – Indirect contact is when a contaminated object (tools, needles, etc.) makes contact with a person's skin or mucous membranes, like those found in the eyes, mouth, nose, and ears. Which is why it's so important to decontaminate any objects that have blood on them. Airborne Transmission – Airborne transmission occurs when droplets or small particles that contain an infectious agent remain active in the air and are then inhaled into the body. An example of this would be tuberculosis. While airborne transmission is possible, most cases of bloodborne pathogen infections do not fall into this category. Some Risks are Higher than Others While it's important to consider all blood and bodily fluids potential threats, there are some methods of transmission that are more common than others. Highest Potential Risks The most common ways bloodborne pathogens and OPIM are spread are: Getting stuck with an infected needle Sexual contact Other than sexual contact, the highest potential risks are when a contaminated, sharp object punctures or cuts the skin, such as with an infected needle, a broken piece of contaminated glass, or getting cut by a razor that was also used by an infected person. Pro Tip #3: Fans of the TV show Live PD will be familiar with police protocol before searching a person – a protocol that includes asking if that person has any sharp objects or needles that could poke, stab, or cut them. If you weren't sure why police officers do this, now you know. Medium Potential Risks Medium risks involve situations where blood and bodily fluids get into an open cut or are absorbed through a mucous membrane – eyes, nose, ears, mouth, etc. Like our tattoo artist example from above. Lowest Potential Risks The lowest potential risks include situations where contaminated objects come in contact with inflamed skin, acne, skin abrasions, etc. Which brings up a good point. Pro Tip #4: Knowing how bloodborne pathogens and OPIM are spread is important to be sure. But so is knowing what prevents those microorganisms from spreading. And the number one line of defense is intact skin. In fact, the CDC (Center for Disease Control) has stated that there is no known risk of exposure to bloodborne pathogens and infectious diseases through intact skin. Which means casual contact – like handshaking, hugging, touching doorknobs, etc. – are not considered threats in normal situations. https://d3imrogdy81qei.cloudfront.net/video_images/3371/how-bloodborne-pathogens-are-spread-workplace.jpg Yes 309 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/vih-y-sida-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1884.mp4 VIH y SIDA El virus de la inmunodeficiencia humana causa el SIDA, trastorno de inmunodeficiencia adquirida, en el cual el sistema inmunológico se vuelve incapaz de combatir la enfermedad. El VIH se transmite principalmente por contacto sexual. Menos del 1% de los profesionales médicos se infectan a través de la exposición laboral. No se transmite por contacto casual, como un apretón de manos, compartir alimentos o asientos de inodoro. No hay vacunación ni cura para el VIH. https://d3imrogdy81qei.cloudfront.net/video_images/3373/hiv-and-aids-workplace.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/hiv-and-aids-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1884.mp4 HIV and AIDS HIV stands for human immunodeficiency virus. It attacks the body and harms the immune system by destroying the white blood cells that fight infection. Which in turn diminishes the body's ability to protect itself against disease. If left untreated, HIV will eventually progress into AIDS – acquired immunodeficiency syndrome. In this lesson, we'll take a look at transmission rates, symptoms (though very problematic and unreliable), and how you can better protect yourself from infection. Pro Tip #1: On average, it takes 10 years for the HIV virus to progress into AIDS. However, this average varies greatly person to person, and is affected by a number of factors like health status, behavioral characteristics, medications taken, etc. Since 1996, with the introduction of powerful retroviral therapies, the natural progression of HIV to AIDS has been slowed. AIDS Statistics in the U.S. There are around 1.1 million people living with HIV in the United States. What is perhaps even more troubling is that around 18 percent aren't even aware they have been infected, as they haven't been tested and symptoms don't exist or aren't noticeable. Around 50,000 people become infected with HIV each year and approximately 15,000 each year die from AIDS. HIV Infection Rates by Category According to CDC From highest to lowest, these are the ways in which people are infected with HIV each year in the U.S. Category 2011 2018 Male to male sexual contact 62% 66% Heterosexual contact (females) 18% 16% Heterosexual contact (males) 10% 8% Injection drug use (male) 5% 4% Injection drug use (female) 3% 3% Male to male sexual contact and IDU 3% 4% Other 1% 1% Other includes babies who are born from infected mothers, blood transfusions, and needle sticks, among other less common reasons. Of the babies that contract HIV, this can occur before birth, during birth, or during breastfeeding. Pro Tip #2: Out of the estimated 50,000 people per year infected with HIV, less than one percent is due to a work-related incident. What does this mean for you? Of all the ways people contract HIV, very few will become infected in the workplace, even in professions (like yours) where the risk is higher. Warning: Don't let that lull you into a false sense of security. Part of the reason that number is so low is because proper infection control policies are routinely put in place for many professions who are around bloodborne pathogens and OPIM. Follow your policies and procedures, and your chances will likely go well below that one percent. HIV Signs and Symptoms If left unchecked, HIV is a deadly virus that eventually will spread to AIDS. But how do you know if you've been infected with HIV? Get tested! That's the only sure way to know. However, sometimes there are signs. (Often there are no symptoms, which is why it's a good idea to get tested if there's any question or doubt.) Symptoms, when present, can include: Fever Fatigue Night sweats Weight loss Rash Dry cough Pro Tip #3: The HIV virus is actually quite fragile (outside the body) and will die within seconds after being exposed to air. Inside the body, the amount of the virus present in body fluid and the physiological condition of the host will determine how long the virus lives. It's important to note – There is currently no vaccine or cure for HIV or AIDS. Some Important HIV/AIDS Takeaways How HIV is spread is important, as this happens mostly through unprotected sex and from sharing needles or syringes. Only a very small fraction of one percent of people are infected while providing medical care, and most of these are due to sticks from dirty needles. While this may seem obvious to many, particularly medical professionals, HIV (like other bloodborne pathogens and OPIM) cannot be spread by casual contact, such as hugging, handshaking, doorknobs, toilet seats, etc. Pro Tip #4: Remember, symptoms are not reliable and may not be present for many years, which means numerous people infected with HIV will never know they have it until those symptoms appear or … through proper testing. A Word About Pathogens and the Diseases and Conditions They Cause Let's take a quick look at the variety of pathogens that exist and the conditions and diseases they cause. Viruses Hepatitis, measles, mumps, chicken pox, meningitis, rubella, influenza, warts, colds, herpes, HIV (which causes AIDS), genital warts, smallpox, avian flu, Ebola, and Zika. Bacteria Tetanus, meningitis, scarlet fever, strep throat, tuberculosis, gonorrhea, syphilis, chlamydia, toxic shock syndrome, Legionnaires' disease, diphtheria, food poisoning, Lyme disease, and anthrax. Fungi Athlete's foot, ringworm, and histoplasmosis. Protozoa Malaria, dysentery, Cyclospora, and giardiasis. Rickettsia Typhus and Rocky Mountain spotted fever. Parasitic Worms Abdominal pain, anemia, lymphatic vessel blockage, lowered antibody response, and respiratory and circulatory complications. Prions Creutzfeldt-Jakob disease (CJD) or bovine spongiform encephalopathy (mad cow disease). Yeasts Candidiasis (also known as thrush). https://d3imrogdy81qei.cloudfront.net/video_images/3373/hiv-and-aids-workplace.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/hepatitis-b-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1885.mp4 Virus de la hepatitis B La hepatitis B se reproduce en el hígado causando inflamación y posiblemente cirrosis, insuficiencia hepática o cáncer de hígado. Las personas pueden tener hepatitis B durante meses antes de que aparezcan los síntomas, por lo que se puede transmitir fácilmente a otras personas sin saberlo. A diferencia del VIH, el virus de la hepatitis B puede vivir fuera del cuerpo durante al menos 7 días o más en sangre seca. Es mucho más fácil atrapar este virus de la exposición. El virus se propaga principalmente por contacto sexual y abuso de drogas por vía intravenosa. https://d3imrogdy81qei.cloudfront.net/video_images/3375/hepatitis-b-virus-workplace.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/hepatitis-b-virus-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1885.mp4 Hepatitis B Virus In this lesson, we're going to take a look at the Hepatitis B virus, also known as HBV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis B infection in the U.S. When a person is first infected with the Hepatitis B virus, it begins as an acute infection (meaning short in duration) and can range from very mild conditions with few or no symptoms to a serious condition requiring hospitalization. The Hepatitis B virus reproduces in the liver, which causes inflammation. This, in turn, can also lead to cirrhosis of the liver, liver cancer, and liver failure. An acute infection is defined by duration – the first six months after the person is exposed to the virus. Some people's bodies can fight the infection and rid it from their systems. While others become chronically infected (meaning long-term). Pro Tip #1: What does a chronic infection mean in practical terms? It means the virus remains in the blood, affects and damages liver cells over time, which causes illnesses like cirrhosis of the liver, liver failure, liver cancer, and eventually death. The good news – Around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. The other 10 percent of people who contract Hepatitis B fall into that chronic category outlined above. Warning: Hepatitis B is particularly devastating for infants and young children, as the majority will be at a much greater risk of developing a chronic infection. In most kids, Hepatitis B is a silent killer, and left unchecked will slowly destroy the liver over a period of 20 years or more. How Hepatitis B is Contracted and Spread Hepatitis B is contracted in the same ways as HIV. It's mainly spread through sexual contact with an infected person, or as a result of sharing needles or syringes with an infected person. And, like HIV, the infection can be passed from mother to unborn (or just-born) baby, especially if the infant came into contact with blood or other bodily fluids through breaks in the skin like cuts or sores. Pro Tip #2: Do not expect a person with chronic Hepatitis B to look or appear sick. The virus cares little about appearances and will spread regardless. Hepatitis B Statistics in the U.S. It is estimated that up to 1.2 million people in the U.S. have a chronic Hepatitis B infection 38,000 people each year become infected with the Hepatitis B virus 3000 people each year die from liver disease caused by Hepatitis B The number of infections has significantly decreased since 1990, thanks to routine Hepatitis B vaccinations Hepatitis B Signs and Symptoms Much like with HIV and AIDS, signs and symptoms for Hepatitis B are unreliable and may or may not be present. And why proper testing for both is the only sure-fire way to know if an infection is present. Hepatitis B symptoms include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay-colored stools Abdominal discomfort Fever Pro Tip #3: The Hepatitis B virus is up to 100 times easier to catch than HIV. There are several reasons for this including the virus' size, as it's much smaller than HIV, and the fact that the Hepatitis B virus can live outside the body for at least seven days, depending on specific conditions. Also, like HIV, Hepatitis B cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with doorknobs, water fountains, and toilets. Hepatitis B Vaccine This is where the Hepatitis B and HIV similarities end, as there is an effective vaccine for Hepatitis B that is administered in three doses over a six-month period. The vaccine is safe, as it's made from non-infectious materials and cannot cause one to become infected with the Hepatitis B virus. Also, severe problems or allergic reactions are rare. The Hepatitis B vaccine is around 80 – 95 percent effective in providing protection against the virus, but only in situations where all three doses of the vaccine are administered. Pro Tip #4: It's probably a good idea to not assume the vaccine worked. It's easy enough to confirm your newly developed immunity to the Hepatitis B virus but wait at least one to two months after completing the vaccine series before getting tested. *It should be noted, that at this time, booster doses of the Hepatitis B vaccine are not recommended. Consider Getting the Hepatitis Vaccine if … There are some people who are more likely to be occupationally exposed to the Hepatitis B virus than others, and that includes: Tattoo artists, or anyone who performs body piercings or body art People who administer first aid routinely Professionals who provide medical care Employees responsible for assisting in bathroom care People who work in medical and/or dental offices People who handle medical waste Employees who perform custodial duties that involve the cleaning of decontaminated surfaces – blood and other possibly infectious materials Anyone whose job will, or might, expose them to the Hepatitis B virus must be offered the vaccine for free through their employer. Employees who do not want the vaccine will need to complete a vaccine declination form. https://d3imrogdy81qei.cloudfront.net/video_images/3375/hepatitis-b-virus-workplace.jpg Yes 294 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/hepatitis-c-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1886.mp4 Virus de la hepatitis C El virus de la hepatitis C (VHC) se reproduce en el hígado y causa inflamación y posiblemente cirrosis, insuficiencia hepática o cáncer de hígado, muy parecido al virus de la hepatitis B. Sin embargo, el VHC es un virus diferente con sus propios rasgos. Una persona puede estar infectada y no tener signos ni síntomas, y puede vivir con el virus durante décadas sin saberlo, mientras que el virus causa daño al hígado. Alrededor del 80% de las personas expuestas desarrollan una infección crónica. Solo alrededor del 20% son capaces de eliminar el virus mediante la creación natural de inmunidad. El VHC se transmite principalmente a través del contacto con la sangre de una persona infectada a través de agujas. No hay cura ni vacunación contra el VHC. https://d3imrogdy81qei.cloudfront.net/video_images/3377/hepatitis-c-virus-workplace.jpg Yes 201 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/hepatitis-c-virus-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1886.mp4 Hepatitis C Virus In this lesson, we're going to take a look at the Hepatitis C virus, also known as HCV, including signs and symptoms, ways to protect yourself, and some statistics for Hepatitis C infection in the U.S. You're going to notice numerous similarities with the Hepatitis B virus. However, there will also be some significant and crucial differences to make note of. Much like the Hepatitis B virus, Hepatitis C can exhibit very mild conditions with few or no symptoms to a serious condition requiring hospitalization. It's not unusual for someone infected with Hepatitis C to live for decades with the disease and not know it, all the while the virus is slowly destroying their liver. The Hepatitis C virus reproduces in the liver, which causes inflammation. This in turn can also lead to cirrhosis of the liver, liver cancer, and liver failure. Some people who are exposed to Hepatitis C can fight the infection and rid it from the body. While others become chronically infected. You may recall that this is where we gave you some good news in the last lesson, as around 90 percent of those infected (adults and older children) with the Hepatitis B virus will be able to fight the virus and expel it from their bodies within a few months and subsequently develop an immunity to it. While the other 10 percent of people who contract Hepatitis B will become chronic. The problem is that with Hepatitis C, those numbers are practically inverted, as around 80 percent of those exposed develop a chronic infection, while the other 20 percent will clear the virus from their systems and develop and natural immunity to it. How Hepatitis C is Contracted and Spread Pro Tip #1: Hepatitis C is spread a little differently compared to Hepatitis B and HIV. While the latter two viruses are mainly spread through sexual contact with an infected person, Hepatitis C is spread mostly through blood, including sharing needles with an infected person (mostly due to injected drug use) and through getting tattoos and piercings with unsterilized equipment. Less common ways of contracting Hepatitis C in the U.S. include receiving blood, blood products, or organs that have been infected with the Hepatitis C virus. However, these instances are much less common since blood screening became available in 1992. Also, like both HIV and Hepatitis B, the infection can be passed from mother to unborn (or just-born) baby. And in healthcare settings, it can also be passed on through needle stick injuries. It's worth noting that these are both rare, as is spreading the disease through sexual intercourse. It should be noted that personal items that are contaminated with infected blood and then shared with others also present a risk – items like razors and toothbrushes, for example. Pro Tip #2: People who are infected with HIV face a much greater risk of also contracting Hepatitis C. Also, like both Hepatitis B and HIV, Hepatitis C cannot be spread through casual contact, such as hugging, handshaking, or coming into contact with pubic items like doorknobs, water fountains, and toilets. And there is no evidence of virus transmission from food handlers, teachers, or other service providers in the absence of blood to blood contact. Hepatitis C Statistics in the U.S. It is estimated that around 3.2 million people in the U.S. have a chronic Hepatitis C infection 17,000 people each year become infected with the Hepatitis C virus 12,000 people each year die from liver complications caused by Hepatitis C Hepatitis C Signs and Symptoms Much like with HIV and Hepatitis B, signs and symptoms for Hepatitis C are unreliable and may or may not be present. And why proper testing for all the above is the only sure-fire way to know if an infection is present. Hepatitis C symptoms (which mirror those of Hepatitis B) include, but are not limited to: Yellow skin, known as jaundice Yellowing eyes Tiredness and fatigue Loss of appetite Nausea Dark urine Joint pain Clay colored stools Abdominal discomfort Fever Hepatitis C Treatment Unfortunately, there is neither a Hepatitis C vaccine or a known cure. There are, however, new drugs that have come on the market that studies have shown can provide big improvements to those in need of Hepatitis C treatment. In some studies, those infected with the Hepatitis C virus who took one or more new drugs approved by the FDA showed up to a 90 percent success rate in eliminating the disease. The downside is the expense. Treatments can cost tens of thousands of dollars, making them financially available to only a select few who can afford them. A Word About Bloodborne Pathogens – Signs and Transmission Let's quickly recap the symptoms of the diseases covered in this section (Hepatitis B, C, and HIV) along with the modes of transmission for each. It may help to see the side-by-side comparisons for the purpose of retaining the information. HIV Symptoms: May or may not be present in the early stages. Late-contact stage symptoms may include fever, headache, fatigue, diarrhea, skin rashes, night sweats, loss of appetite, swollen lymph glands, significant weight loss, white spots in the mouth or vaginal discharge (signs of yeast infection), and memory or movement problems. Contraction: HIV is spread through both direct and possibly indirect contact with blood, semen, and vaginal fluid. Hepatitis B Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis B is spread through both direct and indirect contact with blood and semen. Hepatitis C Symptoms: Jaundice, fever, dark urine, clay-colored bowel movements, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain Contraction: Hepatitis C is spread through both direct and indirect contact with blood and semen. https://d3imrogdy81qei.cloudfront.net/video_images/3377/hepatitis-c-virus-workplace.jpg Yes 201 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/enfermedades-de-la-piel-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1887.mp4 Enfermedades de la piel La piel es el órgano más grande del cuerpo. Contiene vasos sanguíneos, receptores sensoriales, nervios y glándulas sudoríparas. Está formado por la epidermis y la dermis y varía en grosor de 1,5 a 4 mm o más. La piel es la primera línea de defensa contra la infección. Las enfermedades, los trastornos y las afecciones de la piel incluyen personas con forúnculos, heridas infectadas, llagas abiertas, abrasiones o lesiones dermatológicas que lloran. Las enfermedades cutáneas más comunes incluyen bacterias, virus y hongos. https://d3imrogdy81qei.cloudfront.net/video_images/3379/skin-diseases-and-disorders-workplace.jpg Yes 224 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/skin-diseases-and-disorders-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1887.mp4 Skin Diseases and Disorders This lesson will cover a variety of skin diseases and disorders, including some information on the human body's largest organ, how skin disorders are spread, signs and symptoms, and a word about the body's natural defenses. Skin diseases and disorders include boils, open sores, infected wounds, abrasions, weeping dermatological lesions, and more. It's important that anyone with these sorts of conditions abstain from working if there's any chance that they can contaminate healthcare supplies, work surfaces, body art equipment, etc. Ideally, your skin should be free of rashes and infection, particularly for healthcare providers, caregivers, tattoo artists, and the like. Alternatively, you can also cover all open sores and wounds with bandages to avoid any potential spread of disease, if the condition isn't too severe or contagious. The Largest Organ in the Body Yes, as you probably guessed (or maybe already knew), it's your skin! Your skin contains blood vessels, sensory receptors, nerves, and sweat glands. The thickness varies person to person, from around 1.5 millimeters to 4 millimeters. Pro Tip #1: Most people probably don't spend much time thinking about their skin beyond a few wrinkles. But this would be disrespectful, as your skin is the first line of defense against infection, but only if it's intact. The Three Layers of Skin Epidermis – The epidermis is the thick outer layer that we most likely associate as being our skin. But there's much more to it than that. Dermis – The dermis is the flexible second layer of our skin. It's composed mostly of connective tissue and filled with blood vessels and nerves. Hypodermis – The hypodermis is the innermost layer, also known as the subcutaneous layer, and is composed of fatty material. Commonly Spread Skin Diseases Skin diseases and disorders can be the result of bacteria, viruses, or fungus. Bacteria Staphylococcus aureus is a type of germ that about 30 percent of people have on their skin and carry in their noses. Most of the time, staph does not cause any harm. However, sometimes staph causes infections. In healthcare settings, these staph infections can be serious or fatal. Staph infections look like pimples or boils or something similar. And most of the time, staph infections are easily treatable. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's more difficult to treat than most strains of staph as it's resistant to some commonly used antibiotics. MRSA infections can look like typical skin wounds and infected sores. However, since they can be resistant to antibiotic treatment, they sometimes tend not to heal and even get worse. People contract MRSA infections through contact with infected mucous membranes, skin, or contaminated objects. Most of the time, MRSA infections are limited to the skin. But more severe, life-threatening infections can occur elsewhere in the body – frequently among patients with compromised immune systems in a healthcare setting. Viruses The herpes simplex virus is a commonly spread skin infection that causes herpes. Herpes can appear in various parts of the body, most commonly on the face, scalp, arms, neck, and upper chest. Herpes is usually indicated by small round blisters. When broken, these blisters can secrete a clear or yellowish fluid. Contraction of herpes occurs from contact with infected saliva, mucous membranes, and skin. Fungus Commonly spread fungus-related skin disorders include athlete's foot and ringworm. The only real difference between the two is location, as ringworm can develop on the skin, hair, nails, and scalp. Whereas athlete's foot only occurs in the feet, mostly between the toes. The two both present similar signs – red, patchy, flaky, itchy skin. They're both also highly contagious and easily spread from one person to another, or through infected surfaces in warm, moist environments, like shower floors for example. Keeping areas susceptible to athlete's foot clean and dry will go a long way to preventing the spread of the fungus. Pro Tip #2: Some people are more prone to developing skin disorders, including anyone with a history of the following diseases and conditions: Hepatitis B and C HIV and AIDS Diabetes Hemophilia or other blood disorders Other skin diseases or lesions Allergies or adverse reactions to pigments, dyes, latex, etc. Other immune disorders A Word About the Body's Natural Defenses The human body has several natural defenses that prevent infectious microorganisms from entering it. The body is very much dependent on intact skin and mucous membranes in the mouth, nose, and eyes to keep infectious microorganisms out. When the skin isn't intact, infectious microorganisms can enter through openings, like abrasions, cuts, and sores. Mucous membranes in the mouth, nose, and eyes also work to protect the body from these same invaders, often by expelling them through a cough or sneeze. Should all the body's barriers fail and a germ enters, the immune system will begin working to fight the pathogen. Pro Tip #3: Mucous membranes are less effective than skin at keeping bloodborne pathogens out of the body. All the more reason to treat your skin with the ultimate care. The immune system's basic tools for handling these invaders are antibodies and white blood cells. Special white blood cells have the ability to travel around the body and identify invading pathogens. Once detected, white blood cells gather around the pathogen and release antibodies to fight the infection. While antibodies can usually rid the body of pathogens, this isn't always the case. Some pathogens, once inside the body, can thrive, multiply, and overwhelm the immune system. This combination of preventing pathogens from entering the body and destroying them once they enter is necessary for good health and contributes to a little something called homeostasis, or balance/stability in all physiological processes. https://d3imrogdy81qei.cloudfront.net/video_images/3379/skin-diseases-and-disorders-workplace.jpg Yes 224 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/controles-de-practicas-de-trabajo-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1888.mp4 Prácticas de trabajo y controles de ingeniería Los Controles de práctica laboral reducen la probabilidad de exposición al alterar la forma en que se realiza una tarea. Los controles administrativos incluyen seguir toda la capacitación, los requisitos legales, las políticas y los procedimientos relacionados con el control de infecciones en sus instalaciones. Los controles de ingeniería aíslan o eliminan los peligros de los patógenos transmitidos por la sangre en el lugar de trabajo. Estos incluyen recipientes para la eliminación de objetos punzantes, agujas autocubiertas y dispositivos médicos más seguros. Los controles de ingeniería deben ser examinados y mantenidos o reemplazados en un horario regular para asegurar su efectividad. https://d3imrogdy81qei.cloudfront.net/video_images/3381/work-practice-and-engineering-controls-workplace.jpg Yes 214 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/work-practice-and-engineering-controls-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1888.mp4 Work Practice and Engineering Controls In this lesson, we're going to take a closer look at work practice controls, administrative controls, and engineering controls, so that you can have a deeper understanding of not only what they are, but why they're important. Work Practice Controls A work practice control is any measure that reduces the likelihood of being exposed to blood or other pathogens by changing the way a task is carried out. Administrative Controls Administrative controls are changes in work procedures such as written safety policies, rules, supervision, schedules, and training with the goal of reducing the duration, frequency, and severity of exposure to hazardous chemicals or situations. Administrative controls include the completion of all relevant training, any and all legal requirements that must be met and adhered to, and all the policies and procedures related to infection control at your workplace. Engineering Controls An engineering control measure is one that eliminates, isolates, or removes a hazard from the workplace; things used in the workplace to help reduce the risk of an exposure. Engineering controls include: Sharps disposal containers Needle containment devices Other safety devices that prevent handlers from getting cut or poked Pro Tip #1: Engineering controls should be examined and/or maintained on a regular set schedule to ensure their maximum effectiveness. Make sure these controls are in place at your workplace to minimize your risk of exposure. Examples of Workplace, Administrative, and Engineering Controls This list is in no way meant to be a complete accounting of all controls, but rather to give you a good idea of what workplace, administrative, and engineering controls look like in the workplace. Food, drink, etc. You shouldn't eat, drink, smoke, apply cosmetics, or handle contact lenses in any and all work areas where there exists the possibility of exposure to bloodborne pathogens and other potentially infectious materials. Trash disposal. When disposing of any trash that contains contaminated materials, do not compress the trash with your hand. Also, when carrying contaminated materials for disposal, be sure to carry the trash away from your body in case of spillage. Environment and work surfaces. All equipment and surfaces in your work environment should be thoroughly cleaned and decontaminated after all contact with blood, other body fluids, and other potentially infectious materials. Contaminated sharp objects. When dealing with contaminated needles and other sharp objects (routinely shortened to just sharps) there are certain guidelines to follow, such as not using bent needles, recapping needles, or trying to remove questionable needles. All needles and sharps must also be placed into appropriate sharps containers immediately after use. Warning labels. Warning labels should be affixed to all regulated waste and other containers that are used to store, transport, or ship other potentially infected materials. Labels must be fluorescent orange or red, or at least predominantly orange or red, to indicate a possible threat, along with lettering and symbols in a contrasting color. Personal protective equipment. All employees must be provided with personal protective equipment by their employer and at no cost to the employee. Examples of PPE include:a. Gloves – Wear gloves whenever the potential exists of touching blood, bodily fluids, or other potentially contaminated items.b. CPR shields and protective eyewear – Use these items when there's a likelihood of blood and OPIM being secreted or splashed.c. Gowns – Wear a gown when the potential exists of getting blood and other bodily fluids on any clothing or exposed skin.d. Masks and respirators – Use whenever there's a potential risk of coming into contact with airborne infectious diseases. Pro Tip #2: Having personal protective equipment at your workplace is great, but do you know what's even better? Knowing exactly where all PPE is located and being able to properly use them. Be sure PPE is available at your workplace and that you've been appropriately trained to use them. If you're in a profession where you have access to a first aid kit at work, be sure it's properly stocked with all necessary items, such as gloves and CPR face shields or rescue masks. Cleaning Rather than Disposing? If you are tasked with laundering contaminated items – like reusable gowns – rather than disposing of them, make sure you follow your facility's specific procedures for cleaning and handling these items. General laundry procedures will include: Wearing personal protective equipment whenever handling contaminated laundry Keeping contaminated laundry separate from non-contaminated laundry Bagging potentially contaminated laundry in the same area in which it was used, rather than transporting it elsewhere to bag Using leak-proof bags for wet contaminated laundry Transporting contaminated laundry in properly labeled bags, especially when shipping it to an offsite facility A Work Practice Cheat Sheet As you now know, work practice controls reduce the likelihood of exposure by changing the way a task is carried out, which helps reduce the risk of an exposure incident. This cheat sheet is not meant to be complete, however these are some of the more common controls you'll likely face. Place all sharps items in puncture-resistant, leak-proof containers that are both labeled and available at the point of use. Avoid splashing, spraying, and splattering droplets of blood or OPIM when performing all procedures. Remove and dispose of soiled protective clothing as soon as possible. Clean and disinfect all equipment and work surfaces that may have been soiled by blood or OPIM. Wash your hands thoroughly with soap and water immediately after being exposed to any potentially contaminated materials and be sure the sink is not located in a food preparation area. Use alcohol-based hand sanitizers when handwashing facilities are not available. Do not eat, drink, smoke, apply cosmetics or lip balm, handle contact lenses, or touch your mouth, nose, or eyes when you are in an area where you may be exposed to infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/3381/work-practice-and-engineering-controls-workplace.jpg Yes 214 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/reducir-riesgos-de-patogenos-de-sangre-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1889.mp4 Cómo reducir tus riesgos Siga las precauciones estándar. Al igual que las precauciones universales, que incluyen la identificación de sangre y unos pocos fluidos corporales que tienen el potencial de contener patógenos transmitidos por la sangre, precauciones estándar significa tratar toda la sangre, fluidos corporales, piel no intacta (como abrasiones, granos o llagas abiertas) y membranas mucosas (dentro de los ojos, boca, nariz) como si pudieran transportar patógenos transmitidos por la sangre y enfermedades infecciosas. Esto incluye prácticas de inyección seguras, manejo seguro de equipos o superficies potencialmente contaminados en el entorno del paciente y etiqueta respiratoria o para la tos. La clave es eliminar la exposición a toda la sangre, fluidos corporales y otros materiales potencialmente infecciosos. https://d3imrogdy81qei.cloudfront.net/video_images/3383/how-to-reduce-your-risk-workplace.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/how-to-reduce-your-risk-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1889.mp4 How to Reduce Your Risk In this lesson, you'll learn how to minimize your risk of exposure to all bloodborne pathogens and other potentially infectious materials (OPIM). Your first line of defense when it comes to these threats is known as standard precautions. Standard precautions include maintaining personal hygiene, using personal protective equipment (PPE), engineering controls, work practice controls, and proper equipment for cleaning contaminated areas and surfaces, along with the proper cleanup procedures. Standard precautions represent the minimum infection prevention practices that everyone must follow, based on your employer's control plan. These precautions are key to eliminating exposure to all blood and bodily fluids. Remember, it's better to assume that all bodily fluids carry the risk of disease and/or infection, rather than the opposite – to assume there is no risk. So, what are the standard precautions? Standard Bloodborne and OPIM Precautions Standard precautions can be broken down into two areas – proper use of handwashing and the appropriate use of personal protective equipment, or PPE. Handwashing Pro Tip #1: While it may seem simple, handwashing is the single most effective way to prevent infection. To be as safe as possible, follow the three handwashing guidelines below. Wash your hands before and after contact is made with clients or patients. Wash your hands as often as needed – as they become visibly soiled or when exposed to possibly infectious materials. Wash your hands using soap and hot water immediately after removing your gloves. Pro Tip #2: What if you don't have access to soap and water? In these cases, you can substitute soap and water with an alcohol-based hand sanitizer. If you routinely find yourself in these situations, it may be a good idea to carry some hand sanitizer with you. Personal Protective Equipment Personal protective equipment includes things like gloves, gowns, and masks and should be used or worn whenever the exposure to body fluids is anticipated. Warning: Wearing gloves is not a reason to forego handwashing and in no way will eliminate the necessity for handwashing, which is, once again, the single most effective way to prevent infection. Your Employee Exposure Control Plan An exposure control plan is simply a written plan that's provided by your employer, the aim of which is to eliminate or minimize your occupational exposure to blood and OPIM. While the details may vary from one employer to the next, every relevant workplace must provide easily accessible copies of this plan to its employees. Each exposure control plan must include two things: A determination of exposure by job classification and … The implementation of various methods of exposure control, including:a. Universal or standard precautionsb. Engineering and work practice controlsc. Personal protective equipmentd. Information on the Hepatitis B vaccinee. Communication of hazards to employees and the required trainingf. Recordkeepingg. Procedures for evaluating circumstances surrounding exposure incidentsh. Post exposure evaluation and follow-upi. The implementation of methods for all of the above Pro Tip #3: Universal Precautions are a set of precautions designed to prevent transmission of HIV, the Hepatitis B virus (HBV), and other bloodborne pathogens when providing care; these precautions consider blood and OPIM of all patients potentially infectious. These are OSHA-required practices that require you to treat ALL blood and OPIM as if known to be infectious. Protecting Yourself from Bloodborne Pathogens and OPIM The fundamental method of protecting yourself against pathogens and infection is by controlling the hazards. This can be accomplished a number of ways, including: Elimination. Get rid of all hazards or hazardous tasks if possible. Substitution. Replace hazards or hazardous tasks with safer equipment and/or safer methods. Engineering controls. Use devices such as self-sheathing needles and sharps containers to block or remove your risks of getting stuck, poked, or cut. Personal Protective Equipment (PPE). Know where your PPE is located and how to properly use it. Also, keep in mind that PPE only protects you if you use it. Work practice and administrative controls. It's important to follow the policies and procedures for your workplace to eliminate all risks associated with bloodborne pathogens and OPIM. What exactly is a work practice control? A work practice control is any measure that reduces the likelihood of exposure by changing the way a task is carried out. When followed, all of these protection methods will help make your workplace and your work activities much safer. https://d3imrogdy81qei.cloudfront.net/video_images/3383/how-to-reduce-your-risk-workplace.jpg Yes 182 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/desechos-regulados-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1890.mp4 Desechos regulados Los desechos regulados son la sangre líquida o semilíquida u otros materiales potencialmente infecciosos (OPIM) y los artículos contaminados que podrían liberar sangre u otros materiales potencialmente infecciosos en estado líquido o semilíquido si se comprimen. Esto también incluye artículos que se apilan con sangre seca u otros materiales potencialmente infecciosos y son capaces de desprenderse o liberar estos materiales durante el manejo. Los residuos debidamente etiquetados y agrupados deben manejarse de acuerdo con los procedimientos de eliminación de la instalación, los requisitos estatales y locales. No lo deseche en la basura normal. https://d3imrogdy81qei.cloudfront.net/video_images/3385/regulated-waste-workplace.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/regulated-waste-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1890.mp4 Regulated Waste In this lesson, we'll cover what regulated waste is as defined by OSHA, along with some standard protocols for handling and disposing of it. The OSHA bloodborne pathogens standard defines regulated waste as: Any liquid or semi-liquid blood or other potentially infectious material. Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed or rung out. Items that are caked with dried blood or OPIM and are capable of flaking off and releasing these materials during handling. Contaminated sharps. Pathological and microbiological wastes containing blood or OPIM. How to Dispose of Regulated Waste Pro Tip #1: It's important to note that all properly labeled and bundled waste should be handled according to your facility's disposal procedures. It's also important to consider any state or local requirements that may apply to regulated waste disposal in your area. Having said that, here are a few guidelines to follow when disposing of regulated waste. Warning: While this should go without saying, never dispose of potentially contaminated waste into normal trash receptacles. Regulated Waste Containers All blood and other potentially infectious materials must be disposed of in properly labeled biohazard containers, in either a red bag or a predominantly orange or red container that has been imprinted with the biohazard symbol. Regulated waste containers must be: Sealable. You must be able to completely close and seal the container. Properly constructed. The container must be able to properly handle its contents without fail. Leak-proof. The regulated waste container must prevent leakage of all fluids and materials while handling, storing, transporting, and shipping. Sharps Containers All items falling into this category – like needles, syringes, and razors – must be placed into sealable, leak-proof, puncture-resistant containers. The containers must also be properly labeled or color-coded. Pro Tip #2: Regardless of type, all regulated waste containers should be routinely inspected and replaced, and they should never be allowed to overfill. A Word About OSHA's Regulations Since OSHA may be the reason you're taking this course, let's dig a little deeper into what the employer's responsibilities are when it comes to following those regulations. Pro Tip #3: Safety is job number one. If you notice that your employer is falling short of adhering to guidelines or not providing everything on this list, you may want to consider asking someone. OSHA regulations regarding bloodborne pathogens have placed specific responsibilities on employers for the protection of employees (like you). These include all of the following: Identifying positions or tasks covered by the bloodborne and OPIM standard precautions. Creating an exposure control plan to minimize the possibility of exposure and making the plan easily accessible to all employees. Developing and putting into action a written schedule for cleaning and decontaminating environments and work surfaces at the workplace. Creating a system for easy identification of soiled material and its proper disposal. Developing a system of annual training for all covered employees. Offering the opportunity for employees to get the hepatitis B vaccination at no cost. Establishing clear procedures to follow for reporting an exposure. Creating a system of recordkeeping. In workplaces where there is potential exposure to injuries from contaminated sharps, soliciting input from non-managerial employees with potential exposure regarding the identification, evaluation, and selection of effective engineering and work practice controls. (In other words, the feedback of those being exposed.) If a needlestick injury occurs, recording the appropriate information in the sharps injury log, including:a. The type and brand of device involved in the incidentb. The location of the incidentc. A description of the incident Maintaining a sharps injury log in such a way that protects the privacy of employees. Ensuring the confidentiality of all employees' medical records and exposure incidents. https://d3imrogdy81qei.cloudfront.net/video_images/3385/regulated-waste-workplace.jpg Yes 98 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/procedimientos-de-limpieza-de-fluidos-corporales-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1891.mp4 Limpieza de fluidos corporales Comience limpiando la mayor cantidad de líquido posible y deseche los materiales saturados en un desecho regulado o en una bolsa de riesgo biológico. Si algo de la sangre o el líquido está en sus guantes, quítese los guantes, use un guante para quitarse el otro y deséchelos en la bolsa de riesgo biológico. Ponte un nuevo par de guantes. Una vez que se haya limpiado la sangre visible, use la solución desinfectante y rocíe el resto del derrame. Límpielo para eliminar todos los restos de fluidos corporales. Luego, retire el segundo par de guantes y deséchelos. Rocíe toda la superficie y deje que se evapore para finalizar el proceso de descontaminación. https://d3imrogdy81qei.cloudfront.net/video_images/3387/body-fluid-cleanup-procedures-workplace.jpg Yes 385 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/body-fluid-cleanup-procedures-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1891.mp4 Body Fluid Cleanup In this lesson, you'll learn how to clean and disinfect contaminated surfaces, whether floors, tables, or equipment. But first, let's address some safety issues pertaining to cleanup. Personal Protective Equipment Before disinfecting any contaminated areas or surfaces, first ask yourself if you have the proper PPE – personal protective equipment – to complete the job safely. PPE you may need includes: Gloves, always Face shield and/or eye protection An apron or gown In most cases, these three items will be enough, and in many instances, gloves alone will suffice. When should you use a disposable apron or gown? Whenever there's a reasonable chance you could get bloodborne pathogens or other potentially infectious materials on your clothing. The biggest problem involved with getting pathogens on clothing is cross-contamination, and we'll get into this more in a minute. When should you use a face or eye shield? Whenever there's a reasonable chance of spraying or splashing. If you're cleaning dried blood off a counter, you probably don't need to go that extra mile. But what if you were disinfecting a piece of machinery with many parts at or around eye level? Mostly it just comes down to common sense. Having the proper cleanup equipment and personal protective equipment is the first step in any cleanup project. Make sure you have everything you need for the task at hand. And always err on the side of caution. Pro Tip #1: Not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Also, one pair of gloves isn't going to cut it. In order to keep from re-contaminating the scene, or even contaminating another scene, you'll change your gloves a few times in the course of one cleanup job. Which brings up a good point … Warning: Pay attention to what you're touching with your contaminated gloves. It should go without saying to avoid touching any part of yourself, but also be sure not to touch clean surfaces or equipment that hasn't been contaminated. But if you do, it's not the end of the world; just remember to disinfect those as well. Cleaning Supplies Matter There are only two essential supplies you need: paper towels and bleach. Don't use toilet paper or napkins or even low-quality paper towels. The paper towels you use should be commercial grade and able to withstand the task at hand without falling apart. Bleach is super cheap and super effective, so there's no point in substituting. However, if you are going to substitute, make sure the cleaner or disinfectant you're using is up for the job. As in specifically manufactured to kill microorganisms and protect against all viruses, bacteria, and other pathogens and infectious materials. Body Fluid Cleanup Procedure The first thing you want to do is make sure the scene is safe. If there are any sharp objects, like broken glass or needles, remove those using tongs (or another safe method) and put all sharps into a contaminated sharps disposal container so you can disinfect them or dispose of them properly later. For the purpose of instruction, let's assume you're cleaning off a table with a modest amount of dried blood. There is no chance of spraying or splashing, and unless you're really reckless, you shouldn't have to worry about contaminating your clothing. Pro Tip #2: The CDC (Centers for Disease Control and Prevention) recommends a bleach solution of one part bleach to nine parts water. This solution should be strong enough to kill any bloodborne pathogens and infectious materials you may encounter. Put on your 1st pair of medical grade gloves and remove any sharp objects. Wipe up as much of the dried blood as you can using a paper towel. Be sure to keep the blood isolated to the table or the paper towels. If you get some on the floor, be sure to disinfect it as well. Remove your 1st pair of gloves as shown in the video – using glove on glove for the first, and bare finger against your wrist for the second. Throw away both gloves. Put on your 2nd pair of medical grade gloves. Mix your bleach solution in a spray bottle and liberally spray the solution on the table where the dried blood was located. Wipe down with paper towels and make sure all the blood is visibly gone. Remove your 2nd pair of gloves using the same protective method as before. Put on your 3rd pair of gloves. (Yes, this is a bit of a pain. But if you don't do it this way, there's no point in cleaning up, as the risk of infection will likely still remain thanks to dirty gloves.) Lightly mist the surface of the table with your bleach solution and allow it to evaporate. The time it takes for the liquid solution to evaporate equals the time it takes to completely kill any pathogens remaining. Pro Tip #3: In general, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection, whether the barrier is a piece of protective clothing or a safe container to dispose of infectious materials. https://d3imrogdy81qei.cloudfront.net/video_images/3387/body-fluid-cleanup-procedures-workplace.jpg Yes 385 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/retirar-y-desechar-guantes-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1892.mp4 Retirado de guantes El guante en guante, la piel sobre la regla de la piel evita la contaminación. Agarrar el exterior de un guante cerca de la muñeca. Tire del guante hacia abajo y sáquelo de su mano, girándolo de adentro hacia afuera. Coloca el primer guante en una bola en el puño de tu mano enguantada. Usando los dedos debajo del guante en la muñeca de la otra mano, tire del segundo guante hacia abajo y sáquelo de la mano, dándole la vuelta al revés. Deseche los guantes adecuadamente y lávese las manos. https://d3imrogdy81qei.cloudfront.net/video_images/3389/glove-removal-and-disposal-workplace.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/glove-removal-and-disposal-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1892.mp4 Glove Removal Your gloves are your first line of defense against bloodborne pathogens and other potentially infectious materials when cleaning up and disinfecting a scene. In this lesson, we'll show you the exact procedure of how to properly and safely remove them. You don't want blood and other bodily fluids to touch your skin, but you especially don't if you have cuts, scrapes, abrasions, or other openings in the skin. Even hangnails could pose a problem and provide an opening for a foreign invader to enter. Remember, not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out. Ideally, you'll have nitrile gloves. As latex allergies are becoming more common, nitrile gloves provide a better option for many people. Pro Tip #1: While putting on your gloves may sound like common sense and something not requiring instruction, there are three important points to note: Gloves will sometimes stick together, and this may make getting them on more difficult than it should be. (Though most gloves now have a coating or powder on them to prevent this.) Which is why you may have seen someone blow a puff of air into the wrist to make squeezing a hand in easier. This is not appropriate when it comes to infectious materials cleanup, even with clean gloves. Also, you don't want to spread any germs you may have onto the clean gloves. Size matters. Gloves come in many sizes. If your employer has only small or medium size gloves and you're a 300-pound man with sausage fingers, good luck. And do you know what happens when you try and squeeze an extra-large hand into a small glove? Well, let's just say it'll look like your hand is wearing a halter top, and your protection will go bye-bye. So, make sure your employer has your glove size in stock. Because one size rarely fits all. Inspect the gloves for defects, like holes, rips, or cuts. Just like our halter top gloves scenario above, if your gloves have any type of hole, you're not getting that protective barrier you need to stay safe, and you could wind up spreading a pathogen rather than containing and cleaning it up. Safety first, always. Remember, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection. When it comes to gloves, they're like having an additional protective layer of skin. How to Remove Contaminated Gloves If you've seen the video lesson that corresponds with this written version, you may have noticed that glove removal is not a normal process for most people and one that may require a bit of practice to perfect. And since perfection equals being disease and infection-free, practicing taking off your contaminated gloves may not be the worst idea. Pro Tip #2: Keep in mind your goal as it pertains to glove removal – keeping the contaminated materials on one side and your skin on the other. The two sides should always remain separate. To this end, the glove removal process is as follows: Pinch the palm side of one glove on the outside near your wrist. (Glove on glove contact only.) Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand. Wad up the dirty glove into the palm of your still-gloved hand. Pro Tip #3: You want to completely wad the glove up into that hand so the other glove can easily pass over your fist and not catch on any of the material from the first glove. However, you don't want to squeeze so hard that infectious material comes oozing out. Carefully slip two fingers under the wrist of the other glove. Avoid touching the outside of the glove. (Skin on skin contact only.) Pull the glove slowly and carefully toward your fingertips, turning it inside out as you pull it off your hand. The other glove is now contained inside. By now, you should be holding the inside lining of one glove with the other glove trapped deep down inside. You can also do this with a bloody gauze pad or contaminated paper towel in one of your gloved hands, as all items will wind up at the bottom of the first glove removed. Warning: When removing your gloves, it's important that you don't snap the glove material, so make sure you have a good grip and work slowly and carefully. Snapping the glove's materials could send pathogens and infectious materials flying – into eyes and other mucous membranes or onto clean surfaces. Toss both gloves into the trash along with other PPE. Ideally, you'll have access to a trash receptacle that you can open using a foot pedal. And make sure the liner is appropriate for handling bloodborne pathogens and other potentially infectious materials per your regulations. And finally, wash your hands thoroughly with soap and running water, if available. Otherwise, rub your hands thoroughly with an alcohol-based hand sanitizer if they are not visibly soiled and then wash your hands as soon as it is practical. https://d3imrogdy81qei.cloudfront.net/video_images/3389/glove-removal-and-disposal-workplace.jpg Yes 230 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/lavado-de-manos-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1893.mp4 Lavado de manos El lavado de manos es la técnica de control de infección más importante. Después de quitarse el equipo de protección personal, lávese siempre bien las manos frotándolas con un jabón antimicrobiano o usando un gel a base de alcohol. https://d3imrogdy81qei.cloudfront.net/video_images/3391/handwashing-workplace.jpg Yes 190 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/handwashing-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1893.mp4 Handwashing Hand washing is the most important and effective infection control technique. And while all of you already wash your hands regularly, in this lesson we're going to teach you the proper ways to wash and disinfect your hands to greatly reduce your chances of contamination. When Should You Wash Your Hands? Wash your hands whenever they're visibly dirty, but also: Before having any contact with clients/patients Before putting on your gloves Before performing any procedures After contact with client's skin, bodily fluids, excretions, non-intact skin, wound dressings, and contaminated items After using the bathroom After touching garbage After removing your gloves Proper Hand-Washing Technique Pro Tip #1: In a world filled with technological advances and new and improved items at every turn, the old standard when it comes to handwashing is still the superior choice – soap and water – as it's still the best way to reduce the number of germs in most situations. Use a disposable paper towel to turn on the sink faucet. Thoroughly wet your hands. Apply a generous amount of soap. Rub your hands together, covering all the surface areas – backs of hands, between fingers, under nails – for at least 20 seconds. Rinse your hands under the running water. Dry your hands with a disposable paper towel. Use that towel to turn off the sink faucet. If soap and water aren't available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol. Alcohol-based hand sanitizers will quickly reduce the number of microbes on your hands, but it won't eliminate all types of germs. Proper Use of Hand Sanitizer Hand sanitizers that are alcohol based are great options if soap and water aren't available. But make sure you work them into your skin as thoroughly as you would wash your hands with soap and water. Fill the palm of one hand with hand sanitizer, as you'll need enough to apply a very generous layer to both hands. Spread the hand sanitizer around your palms, top of hands, between fingers, and work it into every crevice or wrinkle, including cuticles, nail beds, and under rings. Don't ignore your wrists and try to cover all areas. Continue to massage the hand sanitizer into your hands for 20 seconds. Pro Tip #2: All medical personnel should have a watch with a second hand, as there are numerous situations where you'll need to record the exact time or use that second hand to keep track of the time – like to see when 20 seconds has passed with the hand sanitizer. On that note, if you suspect that your watch may have become contaminated in the course of helping a patient or cleaning up a scene, you're going to need to put that watch into the bloodborne equivalent of the concussion protocol. This protocol could be different for everyone, based on their own unique work practice controls that are covered under the bloodborne pathogens rule. So, know the specifics for your situation. However, in general, you'll want to remove the watch using proper personal protective equipment and sanitize and disinfect it appropriately. A Word About Personal Protective Equipment Personal protective equipment (PPE) is equipment that is appropriate for your job duties and should be available to you in your workplace. A PPE includes all specialized clothing, equipment, and supplies that keep you from coming in direct contact with infected materials. These include CPR breathing barriers, disposable gloves, gowns, masks, shields, and protective eyewear. Disposable Latex-Free Gloves Wear disposable, latex-free gloves for all patient contact. There are powder-free gloves available as well as disposable latex-free gloves made of vinyl. Also consider nitrile gloves, as many consider them the preferred option when working with bloodborne pathogens. Eye Protection Safety glasses with side shields are a great way to protect your eyes in certain situations. If there's a risk of splashing or spraying of bodily fluids, use goggles or a full-face shield, as they'll greatly reduce the risk of contamination of the mouth, nose, and eyes. CPR Breathing Barriers CPR breathing barriers include resuscitation masks, shields, and BVMs. CPR breathing barriers help protect you against disease transmission when performing CPR or giving ventilations to a patient. Masks A mask is a personal protective device worn on the face that's designed to cover at least the nose and mouth, and which helps to reduce the risk of inhaling hazardous airborne particles, gases, and vapors. A high-efficiency particulate air mask will filter out at least 95 percent of airborne particles. Remember that masks must be fit-tested to be effective. Gowns In situations where there are large amounts of blood or other possible infectious materials, consider wearing a disposable gown. If your clothing becomes contaminated, remove it and shower as soon as possible. And wash the clothes in a separate load. https://d3imrogdy81qei.cloudfront.net/video_images/3391/handwashing-workplace.jpg Yes 190 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/incidentes-de-exposicion-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1894.mp4 Incidentes y reporte de exposición Un incidente de exposición se define como una membrana mucosa específica, piel rota o contacto por punción con sangre u OPIM que resulta del desempeño de los deberes de un empleado. Si una persona ha estado expuesta, debe descontaminar primero, reportar el incidente a un supervisor y buscar tratamiento médico. Una evaluación médica inmediata confidencial posterior a la exposición, un tratamiento profiláctico (tratamiento para ayudar a prevenir una infección) y un seguimiento debe ser realizado por un médico sin costo para el empleado. El papeleo debe completarse tan pronto como sea posible después del incidente, pero el tratamiento médico no debe demorarse completando el papeleo primero. https://d3imrogdy81qei.cloudfront.net/video_images/3393/exposure-incident-and-reporting-workplace.jpg Yes 132 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/exposure-incident-and-reporting-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1894.mp4 Exposure Incident and Reporting Being exposed to a bloodborne pathogen or other potentially infectious materials is a serious topic. In this lesson, we'll go over what to do if you ever find yourself in that situation, along with some responsibilities that your employer bears. An exposure incident is defined as contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Contact specifically means contact with mucous membranes (eyes, nose, mouth, etc.), broken skin, or through a puncture-related incident, or in any situation where there exists a high probability of contamination. What to do if You are Exposed If you are exposed, take the following steps immediately: Clean the contaminated area thoroughly with soap and water. Wash needlestick injuries, cuts, and exposed skin with soap and water. Flush out any splashes of blood and OPIM to the mouth and nose with water. If the eyes are involved, irrigate with clean water, saline, or sterile irrigants for 20 minutes. Seek immediate follow-up care as identified in your department exposure control plan. Pro Tip #1: You'll also need to report the incident and complete all the appropriate forms as soon as possible after the exposure incident. However, DO NOT delay medical treatment to fill out paperwork. Medical treatment should include an immediate post-exposure evaluation, prophylaxis treatment, and the appropriate follow up care, all of which should be conducted by a physician at no cost to the employee. Exposure Incident Reporting An exposure incident should include the following: The time, date, and location of the exposure. An account of all the people involved, including the exposed person, names of their first aid providers, and if possible, the name of the source individual. The circumstances of the exposure, any actions taken after the exposure, and any other information required by your employer. Pro Tip #2: What do we mean by if possible from point number two above? The situation could include a source that is unknown. Or state or local laws may prohibit the identification of the source of the infection. However, if the source is known and if that person gives consent, tests should be conducted as soon as possible, particularly for Hepatitis B, Hepatitis C, and HIV. Report the exposure incident to the appropriate person identified in your employer's exposure control plan (often the infection control officer). There will be forms to fill out and continued follow-up, which will proceed according to your employer's policies. Your employer's exposure control plan must specify who should be contacted and what procedures need to be done to follow-up. This includes the employer's responsibilities to provide post-exposure prophylaxis when medically indicated, counseling, and the evaluation of reported illnesses at no charge. https://d3imrogdy81qei.cloudfront.net/video_images/3393/exposure-incident-and-reporting-workplace.jpg Yes 132 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/conclusion-trabajo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1914.mp4 Conclusión Gracias por tomar nuestro curso de patógenos transmitidos por la sangre, creado específicamente para el lugar de trabajo. https://d3imrogdy81qei.cloudfront.net/video_images/3441/conclusion-bloodborne-pathogens-workplace.jpg Yes 37 https://app.protrainings.com/courses/bloodborne-pathogens/general/videos/conclusion-bloodborne-pathogens-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1914.mp4 Conclusion Thank you for taking our Bloodborne Pathogens course, created specifically for the workplace. https://d3imrogdy81qei.cloudfront.net/video_images/3441/conclusion-bloodborne-pathogens-workplace.jpg Yes 37 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/bienvenido-a-los-patogenos-sanguineos-de-california https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1953.mp4 Bienvenido a los patógenos sanguíneos de California para el arte corporal https://d3imrogdy81qei.cloudfront.net/video_images/3525/ca-body-art-introduction.jpg Yes 73 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/ca-body-art-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1953.mp4 California Body Art Introduction Welcome to your California-compliant bloodborne pathogen for body art course. In a subsequent lesson, we'll get into the specifics of the entire course including everything you can expect to learn, as well as some helpful tips and a few requirements. However, in this short lesson, we'd just like to welcome you to your ProTrainings California Body Art course. While licensed paramedic Roy Shaw will be leading you in the video series, these accompanying written lessons will help reinforce what Roy teaches you. Plus, occasionally you'll find some important supplemental information as well. In this course, you'll learn all the specific laws that are in place in California specifically; laws that are in place to help protect you the body art professional as well as the clients you serve. The California Safe Body Art Act requires that all body art professionals complete a two-hour* bloodborne pathogens training course, which includes watching all the videos in this series, before taking and passing your final exam. This course should help you become as compliant as possible with proper body art infection control techniques so you can continue to practice your skills in a safe and effective manner. If you have any questions during your course, please reach out to our customer solutions team at any point, whether you have questions about the videos or the course in general. We are always here to serve you. Now let's get started!   *This course is designed to take 2-3 hours to complete. The course includes training in the CA AB300 / AB1168 law and meets the training requirements for California Body Art Professionals. https://d3imrogdy81qei.cloudfront.net/video_images/3525/ca-body-art-introduction.jpg Yes 73 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/primeros-auxilios-para-artistas-del-cuerpo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1954.mp4 Primeros auxilios para artistas del cuerpo https://d3imrogdy81qei.cloudfront.net/video_images/3527/body-art-first-aid-intro.jpg Yes 42 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/body-art-first-aid-intro https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1954.mp4 Body Art First Aid Intro If you've been in the body art profession for very long, you probably already know that there are many different types of people with many different sensitivities to various things. Not only could a client have a severe anaphylactic reaction when exposed to certain inks and dyes, but they can also get an infection, as you now know, or have other medical problems while you are working on them. While this section is optional, it's also important, because you just don't know. An emergency can happen at any time, which means whether you want to or not, you may just find yourself in a situation where this information could help you. And more importantly, help the clients you serve. Imagine you have a person in your tattoo chair who is afraid of needles and unfamiliar with what you're about to do, and as soon as you begin giving them a tattoo, they go unconscious. Would you know what to do? Would you know how to treat someone having a medical emergency? Would you be prepared to save a client's life if that client suddenly became unresponsive or stopped breathing or lost their pulse? In this very important but optional program, we will be teaching you those exact skills so that if faced with an emergency, you will be able to confidently answer yes to all of the above questions. Here is a preview of the lessons in this section of your body art course: Stroke Heart attacks Adult CPR Adult AED Hands-only CPR Venous bleeding Arterial bleeding Shock Diabetes Seizure Allergic reactions Strongly consider watching each of these videos the way you would any videos pertaining to body art specifically. It just might mean the difference between feeling helpless and helping save someone's life. https://d3imrogdy81qei.cloudfront.net/video_images/3527/body-art-first-aid-intro.jpg Yes 42 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/seguridad-de-las-maquinas-de-arte-corporal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/1955.mp4 Seguridad de las máquinas de arte corporal https://d3imrogdy81qei.cloudfront.net/video_images/3529/body-art-machine-safety.jpg Yes 127 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/body-art-machine-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/1955.mp4 Body Art Machine Safety In this lesson, we'll be taking a look at body art machine safety, and what exactly that means for you, the body art professional. The gist of this lesson is this: parts must be replaceable or able to be sterilized in order to be considered safe for both you and your clients. Now let's get to those details. Safe Machines vs. Unsafe Machines As you probably know, there are a variety of tools used for body art procedures. Many of these tools have the potential to give your clients a life-threatening infection if not properly cleaned or if not properly functioning. Pro Tip #1: Your main responsibility is to ensure all of the tools you are using are safe. Traditional tattooing coil machines have the potential for cross-contamination between clients. Therefore, the machine must be decontaminated and all removable parts of the machine must be changed between each and every client. And what happens if you fail to do this? If you fail to change removable parts and decontaminate the machine, this can lead to cross-contamination. As you also probably know, there are many different tattooing machines that are used for body art procedures. Some of these machines are safe, and some of these machines are not. Part of your job is figuring out which is which. If a tattooing machine has replaceable parts and can be taken apart down to a sealed motor, this is a type of machine that is likely going to be safe to use. It's important that all of the parts of the machine all the way back to the motor are replaced with sterile parts for each and every client. Also, the motor housing must be disinfected between each client. Warning: If a machine cannot be taken apart, this is a good indication to you that it is unsafe and should not be used. Any hand tools that you use for body art procedures must be designed as a completely disposable tool. Alternatively, these tools can be designed to be used with single-use needle groups. One or the other; the choice is yours. Dangerous Practices that are Major Violations There are a few dangerous practices that are considered major violations of the California Body Art Act and these include: Using a machine that allows pigment back up into the motor Failing to replace all machine parts back to the motor between each client Failing to decontaminate the machine between each client Failing to change needles, needle tubes, rubber bands, and grommets Using unsafe tools that cannot be easily cleaned and/or sterilized Reusing needles Pro Tip #2: Remember, only steam autoclaves are allowed for sterilizing reusable equipment. Items like a tattoo machine itself and any power cords that cannot withstand being sterilized in a steam autoclave must be washed and disinfected with an appropriate disinfectant between each client. In addition, any items that cannot be properly sterilized must be bagged or blocked using a barrier when in use. Practicing safe body art procedures keeps everyone safe, and this includes being safe from the law. https://d3imrogdy81qei.cloudfront.net/video_images/3529/body-art-machine-safety.jpg Yes 127 https://app.protrainings.com/courses/bls/healthcare/videos/five-fears-part-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2017.mp4 The Five Fears of CPR Rescue One common problem we see with training is when people have persistent fears that they can't shed, it prevents them from attempting to make a rescue. In this lesson, we're going to address those fears and hopefully eliminate them, so you'll have the confidence to push through and make a difference when faced with an emergency. The five fears are: Uncertainty of skills. You're worried that you don't know what to do, and that you'll do more harm than good. Might hurt or kill the patient. You're worried that a mistake on your part will spell trouble for the patient. Lawsuits. You're worried about getting sued, whether someone only thinks you did something wrong or you actually did do something wrong. Threat of contracting a disease. You're worried about blood and bodily fluids that contain pathogens that you would then contract. The scene is unsafe. You're worried that the scene may be unsafe and that you'll become a victim, too. At first glance, these fears may sound reasonable. However, let's tackle them one by one using some common sense that should help you eliminate your fears, so that you can become the best rescuer that you can be. Uncertain of Skills This should only be a real concern if there's no way for you to refresh your training. However, since we designed our course content to be viewed whenever it's convenient for you, rather than when an instructor is ready to teach, there's really no excuse. Whenever you feel that you're deficient in a particular area of training, go back to the training library for a refresher. It's self-paced and available 24/7. You can also ask a supervisor or someone with more experience for help. Pro Tip #1: Effort and knowledge are the cures for uncertainty. If you put in the time and master your skills, this uncertainty will vanish, and you'll be amazed that you were ever apprehensive to begin with. Might Hurt or Kill the Patient When a person is unconscious, isn't breathing normally, and has no pulse, they're already dead. And while it may sound silly to say this, it's true: Their condition cannot get worse. That patient will remain dead unless someone with life-saving skills gets involved. This alone should alleviate a lot of fear and worry about making the situation worse. During CPR compressions, a lot of new students worry about the possibility of breaking ribs or injuring a patient some other way. But this isn't really possible. Read that first paragraph again – the patient is dead and cannot get worse. However, with help, they may get better. Lawsuits The good news is that since 1985's Good Samaritan Act, people who attempt to help others are protected legally, with a couple of exceptions: If you intended to hurt the victim If you go above and beyond your level of training The Good Samaritan Act has essentially immunized people from lawsuits when they try to help others in need. Threat of Contracting a Disease As long as you have your equipment with you, this shouldn't be much of a concern. Equipment like gloves and one-way rescue masks will keep those nasty pathogens, if there are any, on the patient's side, while you the rescuer remain on your side. That's why we have this equipment – to help keep rescuers safe. So, make sure you have it with you and that you're using it, and this fear will quickly become a moot point. A Word About Hands-Only CPR Research has shown that, especially with adults and in the first few minutes, hands-only CPR is just as effective as full CPR. So, if you don't feel comfortable or confident in doing full CPR, or if you're lacking protective equipment, hands-only CPR will still benefit the patient. The Scene is Unsafe This is actually a legitimate fear and a reason to delay a rescue attempt. You can still call 911 and get EMS on the way. But if the scene is dangerous, don't do anything that will make you the next victim. Don't be a hero. If you go into a situation that can get you hurt or killed, you'll be unable to perform the rescue you're there for, so you do no good to anyone. Remain at a safe distance until the scene becomes safe, and then go in. These five fears prevent around 90 percent of people from using the skills they learned. It's natural to have them, but it's essential to shed them. Put in the time and effort when it comes to your training and crush those fears. Become more empowered than you ever thought possible and go forth and rescue confidently. https://d3imrogdy81qei.cloudfront.net/video_images/3595/five-fears-part-1-2015.jpg Yes 308 https://app.protrainings.com/courses/bls/healthcare/videos/cinco-temores-parte-1-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2017.mp4 Los cinco temores La mayoría de las personas son muy reacias a involucrarse en proveer CPR y Primeros Auxilios. La razón principal de esta reticencia es el miedo. La gente tiende a tener cinco temores relacionados con el rescate. 1. Demandas judiciales: No tengas miedo de intentar salvar una vida que necesite ahorrar debido al temor de ser demandado. Cada estado tiene leyes del Buen Samaritano que le protegen de la responsabilidad cuando usted voluntariamente proporciona ayuda de emergencia a otro individuo. No se puede herir a alguien que ya está en peligro de morir haciendo algo para salvar sus vidas. 2. No está seguro de las habilidades: Entender que la RCP sólo ralentiza el progreso de la muerte clínica a la muerte biológica, pero no lo detendrá! Sabemos que cualquier combinación de números durante las respiraciones de rescate a las compresiones ayudará a ganar tiempo para que el EMS use un AED y ACLS para administrar medicamentos. Los números son pautas, no la regla. (Lo cual es parte de la razón por la cual la RCP de manos únicas se ha convertido en una alternativa tan popular para rescatar la respiración). 3. Puede herir o matar al paciente: Esto va de la mano con el número dos. La persona ya está muerta. ¿Cuánto peor puede hacer el paciente físicamente? Incluso la Reanimación Cardiopulmonar es mejor que no hacer nada. Sólo ayudará a la persona a hacer algo en lugar de nada. 4. Enfermedad: Este temor ha existido desde hace algún tiempo y se puede resolver ordenando un anillo de llave u otro escudo accesible de RCP y guantes protectores. De esta forma, siempre estás preparado para las peores circunstancias. La RCP con manos solamente puede ser una buena alternativa si no tiene equipo de protección personal o si no se siente cómodo dando respiraciones de rescate. 5. Escena Insegura: El único temor que los rescatistas deben tener miedo es el miedo de una escena insegura. No te conviertas en otro paciente. Asegúrese de que, si va a entrar en un área para rescatar a alguien, que el área circundante es lo suficientemente seguro para que no se convierta en otra víctima. https://d3imrogdy81qei.cloudfront.net/video_images/3595/five-fears-part-1-2015.jpg Yes 308 https://app.protrainings.com/courses/bls/healthcare/videos/heart-attacks https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2018.mp4 Heart Attacks In this lesson, we're going to take a closer look at heart attacks, including: What they are and why they happen If there's anything we can do to help control or prevent them The signs and symptoms of a heart attack for both men and women What Causes a Heart Attack? A heart attack occurs when something occludes a blood vessel that feeds the heart. When this happens, the heart muscle begins to starve of oxygen, which causes pain plus any number of other symptoms, the totality of which is known as a heart attack. Some common ways patients may describe their symptoms include: A squeezing feeling or tightness in their chest Like something is sitting on their chest Pain that may radiate into arms, or the neck, jaw, and teeth in some cases Classic Signs and Symptoms of a Heart Attack Women often experience their own unique set of signs and symptoms that typically differs from what men may experience. So, consider this list to be men-centric, as in the classic symptoms of a heart attack. The more typically female symptoms will follow. Heavy sweating Crushing chest pain Pain that may radiate into other areas, most typically the arms Shortness of breath Weakness Nausea Dizziness Women can experience the symptoms listed above, however, the most common symptoms of a heart attack for women are: Back pain, like a muscle strain or pulled muscle Feeling achy Indigestion Warning: One problem is the way in which heart attacks are depicted in movies and on TV, as it's always a sweaty guy clutching his chest. But that's mostly only true for half the population. And if the other half (some would say, better half) are expecting those same symptoms and getting something that feels more like the flu than a heart attack, this could delay a proper response, and the patient could suffer because of that delay. Conditions with Similar Signs and Symptoms There are a number of other ailments that have been known to mimic a heart attack, including: Angina Pneumonia Pleuritis Broken ribs Pro Tip #1: Angina is a condition marked by severe chest pain, often spreading to the shoulders, arms, and neck, and is caused by a reduced blood supply to the heart. It's still a concern. Just not as concerning. Warning: It's better to rule out a heart attack after being checked out by EMS personnel or a physician than it is to dismiss symptoms as something minor. When in doubt, check it out. Once a heart attack is suspected, call 911 immediately and activate EMS. Get an ambulance on the way. If it turns out to be indigestion, you can always send them away when they arrive. Or better yet, they can examine the patient and rule a heart attack out. If a heart attack is suspected and EMS isn't activated, all that's being accomplished is slowing down a response time and treatment should things worsen. Someone's life may ultimately depend on those wasted minutes or seconds. Heart Attack Risk Factors You can really separate this into two separate categories – factors we can control and factors we cannot. Controllable Risk Factors Diet Exercise Stress Smoking Blood pressure Diabetes These are all huge factors when it comes to preventing cardiovascular disease, heart attacks, and stroke. Controlling diabetes and blood pressure, if high. Stopping smoking, if applicable. And eating better, exercising more, and relieving stress in healthy ways. These are all areas of improvement everyone can control. Uncontrollable Risk Factors Genetics Gender Age Race When it comes to uncontrollable risk factors, the hand you're dealt is the hand you're going to have to play. And unfortunately, certain people will always be predisposed to having a higher risk of heart attacks. Helping Heart Attack Patients in Other Ways Once you recognize the symptoms of a heart attack, you activate EMS, and both you and the patient wait comfortably for them to arrive, right? Well, not always. Pro Tip #2: For some reason it's human nature to deny the existence of a heart attack – just a bit of acid reflux most likely – which only delays getting help. It's also common for heart attack suspects to want to drive themselves to the hospital. Both are obviously dangerous and NOT recommended. While Waiting for the Ambulance One of the first treatments that even paramedics will use is aspirin. Aspirin may prevent a worsening of the heart attack and it could even relieve some of the symptoms. If you have aspirin, and if the patient can take it, offer it to them. Aspirin is effective because it basically acts as platelet lubricant once it's absorbed into the bloodstream. It better enables the platelets to slide by each other rather than getting stuck together and creating an even bigger clot. Does the patient have nitroglycerin tabs or spray? Can you get it for them if they cannot? Usually, the best thing you can do for someone who's having a heart attack, or showing the symptoms, is to reassure them that you'll be with them until help arrives. Tell them they're in good hands, in good care, but don't lie to them and tell them everything will be OK. Simply keep them calm and make them as comfortable as possible until EMS personnel arrive. https://d3imrogdy81qei.cloudfront.net/video_images/3597/heart-attacks-2015.jpg Yes 477 https://app.protrainings.com/courses/bls/healthcare/videos/ataques-cardiacos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2018.mp4 Ataques cardiacos Es importante reconocer el problema antes de que el corazón se detenga. Usted puede notar signos y síntomas como sudoración, dificultad para respirar, dolor en el pecho y náuseas. Lo mejor que puedes hacer es prevenir un ataque al corazón. La enfermedad cardiovascular es el asesino número uno en América y es lo que conduce a ataques al corazón. Puede prevenir enfermedades cardiovasculares con una dieta saludable, ejercicio regular, controlar el estrés, controlar la diabetes, controlar la presión arterial alta y dejar de fumar. Si cree que alguien está teniendo un ataque al corazón, llame al 911 inmediatamente. Es importante sentarle y tranquilizarlo para reducir su nivel de ansiedad hasta que llegue la ayuda. https://d3imrogdy81qei.cloudfront.net/video_images/3597/heart-attacks-2015.jpg Yes 477 https://app.protrainings.com/courses/bls/healthcare/videos/stroke https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2019.mp4 Stroke In this lesson, we're going to go over what a stroke is, what the signs and symptoms are that will indicate to you that there's an emergency, and what to do if you suspect a stroke. And we'll even teach you an easy-to-remember acronym to make your stroke assessment a little easier. What is a Stroke? A stroke, also called a cerebrovascular accident (CVA), is a disruption of blood flow to a part of the brain, which may cause permanent damage to brain tissue if not appropriately treated in a timely manner. There's a common analogy that works well to describe what a stroke is – a stroke is like a heart attack in the brain. This analogy works because what typically causes a stroke is usually what causes a heart attack – a blocked blood vessel – only in the brain rather than the heart. When a blood vessel blockage occurs, it starves the brain of oxygenated blood, which will quickly result in neurological effects in the patient's body. A stroke can also be caused by a bursting of a blood vessel rather than a blockage. In these cases, the condition is known as a hemorrhagic stroke, and is normally the result of an aneurism. The important takeaway is that hemorrhagic stroke is treated differently than strokes that occur from blood vessel blockage. What are the Signs and Symptoms of a Stroke? Using the acronym FAST, you'll be able to navigate quickly through the list of stroke symptoms and systematically check them off as you go. And ultimately, if the patient is having a stroke, call 911 and activate EMS. F – Facial Droop If you're having a difficult time assessing the patient for facial droop, ask them to smile at you. If the droop isn't initially very pronounced, it will be when the patient tries to smile. Does the smile look normal? Or is one corner of the mouth lower than the other? A – Arm Raise both of the patient's arms out in front of them and ask the patient to hold that position. Does one arm fall lower than the other? Or do they both remain in the position you left them? If one arm does begin to fall, as the patient cannot hold it up, it will likely be the arm on the same side of the body as the facial droop. S – Slurred Speech During medical emergencies, patients are naturally panicked, and it can affect their speech. To better assess for this stroke sign, ask them a question – like what their birth date is – or to repeat a certain phrase, like "I love blueberries". If the patient answers with slurred speech, you can check another item off your FAST checklist. T – Time Time is of the essence when it comes to treating stroke victims. But it's also important to know what time symptoms began in each victim, as this will matter when healthcare professionals begin trying to recirculate oxygenated blood back into the brain's tissue. Your quick actions and attention to detail will go a long way to helping the patient recover with as little long-lasting damage as possible. What to do if You Suspect a Patient is Having a Stroke If you haven't already called 911 and activated EMS, do so immediately. Expediting treatment is key to the patient regaining as much quality of life as they can. While waiting for EMS to arrive, reassure the patient. Tell them you're not going anywhere and that you'll take good care of them. And make them as comfortable as possible while you wait. A Word About the Signs and Symptoms of Stroke Other than the stroke alert criteria in FAST that you should be looking for, there are a few other signs and symptoms of stroke that may help you assess the patient better. Loss of vision or disturbed vision in one or both eyes; the pupils may also be of unequal size Sudden severe headache; you may hear the patient describe the pain as the worst headache ever Confusion, dizziness, agitation, loss of consciousness, or other severe altered mental states Loss of balance or coordination, trouble walking, or ringing in the ears Incontinence Pro Tip #1: it's important to understand the difference between a full-blown stroke and a TIA (Transient Ischemic Attack), sometimes called a mini-stroke. The latter is caused by reduced blood flow to a part of the brain, but unlike a stroke, the signs and symptoms disappear within a few minutes or hours of onset. With a TIA, after a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain is more likely to suffer permanent damage. https://d3imrogdy81qei.cloudfront.net/video_images/3599/stroke-2015.jpg Yes 409 https://app.protrainings.com/courses/bls/healthcare/videos/ataque-cerebral-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2019.mp4 Accidente cerebrovascular Hay dos tipos principales de apoplejía. El más común es cuando un coágulo bloquea una arteria que lleva la sangre al cerebro. Esto es causado por una Trombosis Cerebral o Embolia Cerebral. El segundo golpe más común es un sangrado. Esto es cuando un vaso sanguíneo se rompe en el cerebro, también llamado derrame hemorrágico. Los primeros signos de un derrame cerebral son entumecimiento, dificultad para hablar, debilidad, parálisis en un lado del cuerpo, visión borrosa o pérdida repentina de la visión, brazo o pierna caídos, caída de la cara o boca que gotea, inestabilidad, confusión hablando o entendiendo el habla. https://d3imrogdy81qei.cloudfront.net/video_images/3599/stroke-2015.jpg Yes 409 https://app.protrainings.com/courses/bls/healthcare/videos/universal-precautions-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2020.mp4 Universal Precautions in the Workplace This lesson deals with situations in which an injury or illness in the workplace leads to the presence of blood or other potentially infectious materials in the environment. It should go without saying that the scene must be cleaned up. But who does the cleanup? And more importantly, how can it be done safely? Often there are no specific employees who are designated to handle such cleanup jobs. But in other situations, there may be. If an employee was so designated, he or she would fall under the Type A category of the bloodborne pathogens rule. Such employees need to undergo specific training in bloodborne pathogens before being allowed to clean up a potentially infectious scene – training like that which is provided at ProBloodborne.com. However, for the general employee who volunteers (or not) to clean up the scene – or anyone with possible access, like first responders – this lesson is for you. A fairly common question people have is, how do I know if the scene contains bloodborne pathogens or other types of infectious materials? While that's an excellent question, the answer is likely to disappoint – Most of the time, you really don't know. The only way to know that if a scene contains pathogens is to get a sample into a laboratory and under a microscope. Assume the worst and be diligent, but most importantly … Safety First Pro Tip #1: What's the most important thing when it comes to a scene that you suspect to be infectious? Protect yourself. You must protect yourself against exposure to potentially infectious materials before engaging in any cleanup. The best way to protect yourself is by wearing gloves. And while it may sound silly, it pays to inspect your gloves before putting them on. Make sure there aren't any holes. Blow some air into a glove and hold the wrist end shut. Do you notice any air escaping through a leak? This is a great way to test for pinholes that you wouldn't be able to see. Warning: Defective gloves DO NOT protect against infectious diseases as well as gloves that aren't defective. If that's the one thing standing between you and them, better to take that one thing (your gloves) seriously. Solution Time All you need is water and household bleach, but more specifically, 1 part bleach to 9 parts water. In other words, take your pale or bucket and fill it with 1 cup of bleach and 9 cups of cold tap water. This is a simple solution but strong enough to kill most hepatitis, HIV, and other infectious pathogens. Application Time You can apply the bleach solution a couple of ways. Fill a spray bottle and spray the solution on contaminated surfaces and objects. Or dip a rag or towel into the solution and wipe those items down instead. Pro Tip #2: Consider wearing goggles, a face mask, and an apron if there's a chance of getting hit with splatter or spray of possibly infectious materials while cleaning up the scene. Better safe than sorry. An Example Situation A worker has an accident that leaves blood on an electric saw. Follow the steps below to safely clean it. Spray the saw with the bleach solution. Let it sit for 30 seconds or so. Wipe the saw down. Throw the rag or towel in the trash. (At this point, you may not be able to see visible signs of contamination, but that doesn't mean you got it all after one go.) Spray the bleach solution on the saw again. Let the saw air dry. Pro Tip #3: Letting the possibly contaminated saw air dry after the second go-around with the bleach solution is a great method of disinfecting it. When You're Done After you've cleaned all the tools and work surfaces that were affected, you'll want to properly dispose of your gloves, which involves taking them off without touching them. Remove the first glove using only glove-on-glove contact, by grabbing the wrist part of one glove (the outer part) and peeling it off. Bunch up the glove you just took off and work it into your other hand and make a fist, with the glove inside. Take one of your un-gloved fingers and using only skin-on-skin contact, push it under the wrist part of the glove and peel the second glove off. Warning: Be careful when taking off your gloves that you don't accidentally snap the material and send possibly infectious substances into the air and around the scene. Remember that initially, you'll be removing these gloves in a pretty unfamiliar way; just something to be aware of. Throw both gloves into the trash bin you've been using to dispose of your rags or towels, seal the bag up properly, and toss it into the nearest dumpster. Pro Tip #4: For larger cleanup jobs, consider getting special biohazard bags. However, it may be a good idea for jobs of any size, no matter how small, as those bags are a great way to alert others of the potential hazards inside, like waste management personnel. https://d3imrogdy81qei.cloudfront.net/video_images/3601/reduce-risk-of-bloodborne-pathogens-2015.jpg Yes 338 https://app.protrainings.com/courses/bls/healthcare/videos/precauciones-universales-lugar-de-trabajo-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2020.mp4 Precauciones universales en el lugar de trabajo Siga las Precauciones Estándar. Al igual que las Precauciones Universales que incluyen la identificación de sangre y algunos fluidos corporales como el potencial de contener patógenos transmitidos por la sangre, las Precauciones Estándar significan tratar toda la sangre, fluidos corporales, piel intacta (como abrasiones, espinillas o llagas abiertas) (Dentro de los ojos, la boca, la nariz) como si pudieran llevar patógenos transmitidos por la sangre y enfermedades infecciosas. Esto incluye prácticas seguras de inyección, manipulación segura de equipo o superficies potencialmente contaminadas en el ambiente del paciente y etiqueta respiratoria o de tos. La clave es eliminar la exposición a toda la sangre, fluidos corporales y otros materiales potencialmente infecciosos. https://d3imrogdy81qei.cloudfront.net/video_images/3601/reduce-risk-of-bloodborne-pathogens-2015.jpg Yes 338 https://app.protrainings.com/courses/bls/healthcare/videos/agonal-respiration-not-breathing-normally https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2022.mp4 Agonal Respiration (Not Breathing Normally) Agonal respiration is an abnormal pattern of breathing and brainstem reflex characterized by gasping and gulping breaths that are accompanied by strange vocalizations. Agonal respiration is one sign of respiratory and cardiac arrest. Historically, this type of breathing has been difficult to identify and describe, especially for lay people, which can slow or hinder care and response times for cardiac arrest victims. A Word About Cardiac Arrest Cardiac arrest occurs when the heart stops beating or beats too ineffectively to circulate blood to vital organs, including the brain. When heartbeats are weak, irregular, or uncoordinated, blood can't flow through the arteries to the rest of the body. If circulation is hampered or halted in any way, the body's organs cannot receive the oxygen they need to function normally. As a result, organ failure can occur. Brain damage sets in between 4-6 minutes, and after 8-10 minutes, this damage will likely be irreversible. Cardiovascular disease is the leading cause of death in the world and in the U.S., where it accounts for approximately 1 in 3 deaths. Cardiovascular disease is also the primary cause of cardiac arrest, but there are others, including: Drowning Choking Drug overdose Severe injury Brain damage Electrocution Warning: As more than 300,000 out-of-hospital cardiac arrests occur each year in the U.S., it's vital that lay rescuers and EMS professionals understand that early recognition – which is more difficult with agonal respiration – and quick action can have a tremendous impact on survival rates. Cardiac Chain of Survival To effectively respond to cardiac emergencies, it helps to understand the Cardiac Chain of Survival. Following the links in these chains – adult and pediatric – will give patients the best chance of survival. Warning: For each minute that CPR and/or defibrillation are delayed, the chance of survival is reduced by 7-10 percent. Adult Cardiac Chain of Survival Recognize the emergency and call 911 – the sooner medical personnel are called the sooner EMS can provide care for the patient. Early CPR – supplying blood and oxygen to vital organs can prevent brain damage and death. Early defibrillation – this electrical shock may restore an effective heart rhythm and increase the victim's chance of survival. Advanced life support – Medical personnel can help provide the proper equipment and medication needed to continue lifesaving care. Integrated post-cardiac arrest care – Integrated care can optimize ventilation and oxygenation and treat hypotension immediately after the return of spontaneous circulation. Pediatric Cardiac Chain of Survival Injury prevention and safety – ways to prevent cardiac arrest in children. Early CPR Early Emergency Care – Rapid activation of the EMS system or response team to get help on the way quickly. Pediatric advanced life support Integrated post-cardiac arrest care Agonal Respiration Continued Agonal respiration is characterized by abnormal breathing attempts in which the patient appears to be gasping or gulping. (Think of a fish as it tries to breathe out of the water to get an idea of what agonal respiration looks like.) These respiratory attempts originate from the lower brain stem neurons as higher, more complex neurons become increasingly hypoxic – lacking in oxygen. Agonal Respiration occurs in around 40 percent of early cardiac arrest victims. Aggressive CPR attempts are often hindered or slowed due to misinterpretation or misunderstanding of this serious condition. Pro Tip #1: It's important to remember that, when it comes to agonal respiration, these attempts from the body to breathe are routinely misinterpreted as normal breathing. However, even though it may appear the victim is breathing, he or she is not exchanging air well and will require immediate assistance to increase his or her survival rate. While lay rescuers describe agonal respiration in a number of ways, the good news is that 911 dispatchers have become better equipped to recognize all the ways in which people describe it, leading to better assistance and improved response times. https://d3imrogdy81qei.cloudfront.net/video_images/3603/agonal-respiration-not-breathing-normally-2015.jpg Yes 92 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-agonica-no-respirar-normalmente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2022.mp4 Respiración agónica (no respirar normalmente) Un signo de parada cardiaca se describe como respiración agonal. Esto ocurre cuando una persona está haciendo un jadeo o tragarse el movimiento y no está respirando normalmente. La respiración agónica ocurre en el 40% de los paros cardiacos tempranos. Saber cuándo una persona es respiratoria agonal puede prevenir intentos agresivos de RCP. https://d3imrogdy81qei.cloudfront.net/video_images/3603/agonal-respiration-not-breathing-normally-2015.jpg Yes 92 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adult-cpr-lay-rescuer-community https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2023.mp4 Adult CPR In this lesson, we'll cover how to administer CPR on an adult victim. In situations where CPR is needed, you personally may have witnessed the victim exhibit symptoms and go unresponsive. Others may have witnessed the incident. Or no one was around to see what really happened. If someone was there to witness the incident, what they likely would have noticed is a victim who: Loses their balance Clutches their chest Collapses to the ground or floor If you arrive on the scene after this happens, in cardiac arrest emergencies, the victim will usually also be unresponsive and not breathing normally, if at all. Let's assume for this lesson that that's how you found the victim. And that CPR is required. CPR is a combination of chest compressions and ventilations that circulates blood and oxygen to the brain and other vital organs for a person whose heart and breathing have stopped. Oxygen is vital for life and it's only a matter of minutes before the brain begins to be negatively impacted. How to Provide Care Warning: Don't let the repetition of this next paragraph lull you into overlooking or dismissing the importance of scene safety. What if you show up to the scene and there's a live electrical wire, or poisonous gases in the air, and this is why the victim collapsed? Don't make assumptions, and don't become another victim. Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue shield available and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Pro Tip #1: As long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation. If you've determined at this point that the victim is unresponsive and not breathing normally continue immediately with CPR, beginning with chest compressions. Pro Tip #2: Chest compression landmarks: Aim for the center of the chest, between the nipples and on the lower one-third of the sternum. Hand placement: Place your first palm on that landmark and interlock the fingers on your top hand over your first. Lean over the victim, position your hands as indicated above, and in the video, and lock your elbows. Use your upper body weight to supply the force needed for chest compressions and compress at a depth between 2 – 2.4 inches. Perform 30 chest compressions at a rate between 100 – 120 compressions per minute, which amounts to around two compression every second. Make sure you allow the victim's chest to come all the way back up before performing your next compression. Pro Tip #3: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Lift the victim's chin and tilt his or her head back. Grab the rescue shield and place it over the victim's mouth and nose. Pinch the victim's nose and open their mouth. Deliver two breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Pro Tip #4: Don't forget to watch the victim's chest when providing breaths. If the chest doesn't rise, then you might be dealing with another problem and one that likely includes an obstructed airway. Go right back into 30 chest compressions followed again by two breaths. Continue to perform 30 chest compressions to two breaths until EMS arrives, an AED is located, someone equally trained can relieve you, or the victim becomes responsive and begins breathing normally again. A Few Common Questions About Adult CPR Why is it important to use your upper body weight when performing chest compressions? If you need to perform CPR for a longer period of time, using only your upper body strength will begin to fatigue you. As you become fatigued, your compression rate and depth may falter, as would the quality of CPR and the victim's chances of recovering. Can I stop doing CPR once I've started? Once you begin CPR, it's important not to stop. If you must stop, do so for no longer than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue. Is there anything else I can do to help a cardiac arrest victim? The best thing you can do in these situations is to provide high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. So, what constitutes high-quality CPR? High-Quality CPR Performing chest compressions at a rate of 100-120 per minute Compressing to a depth of at least 2 inches but not exceeding 2.4 Allowing for full recoil after each compression Minimizing pauses in compressions Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise Pro Tip #5: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Low-Quality CPR Compressing at a rate slower than 100 per minute or faster than 120 per minute Compressing to a depth of less than two inches or greater than 2.4 inches Leaning on the chest between compressions or performing compressions while not directly over the victim's heart Interrupting compressions for greater than 10 seconds Providing excessive ventilation – too many breaths or breaths with excessive force https://d3imrogdy81qei.cloudfront.net/video_images/3605/adult-cpr-lay-rescuer-community-2015.jpg Yes 216 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adulto-rcp-rescatista-lego-comunidad-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2023.mp4 RCP en adultos La RCP para adultos se realiza comprobando la capacidad de respuesta del paciente, la respiración anormal y el contacto con los servicios de emergencia. A continuación, compruebe si hay un pulso durante 10 segundos como máximo y comience la RCP si el paciente no tiene pulso. Realice 30 compresiones a una velocidad de 100-120 por minuto ya una profundidad de 2-2.4 pulgadas en el centro del pecho. Estas 30 compresiones deben ser seguidas de dos respiraciones de rescate, y repetir el ciclo hasta que llegue un DEA o servicios de emergencia. https://d3imrogdy81qei.cloudfront.net/video_images/3605/adult-cpr-lay-rescuer-community-2015.jpg Yes 216 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-cpr-profa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2024.mp4 Child CPR In this lesson, we'll cover how to perform CPR on a child. Much of the process will look the same as adult CPR, but there are some subtle yet crucial differences to take note of. Like in the last lesson, we'll assume that in this scenario, a child has suddenly collapsed and you don't know why. Pro Tip #1: The victim could be in this condition for any number of reasons and it's not a bad idea to consider some of these when you're doing your assessment of the scene and the victim. Is there a live electrical wire nearby? Could the victim have been bitten by a snake? (Incidentally, these two fictional scenarios also drive home the point of scene safety.) Regardless of what led to the child's condition, all you know for sure is that the victim is unresponsive and not breathing normally, if at all. And that CPR is required. What is a Child? According to guidelines, a child is anyone from one-year to the first signs of puberty. And if you just wondered about ambiguity, you'd be correct to be concerned. Let's say puberty begins around age 14. This can still be problematic since some 14-year olds are tiny, while others are bigger than many adults. Which is why it's a better idea to judge the victim by size rather than by age. This should also help reduce wasted time. Instead of having to think about it, just look, decide, and begin. Pro Tip #2: To complicate matters further, the size of your hands also matters. You see, the size of the patient determines whether you use two hands during chest compressions or just one, which means it's much more a matter of ratio (your hand size to their chest size), than it is their size alone. So, perhaps a better way of deciding whether the victim is "adult-size" or "child-size," is to see how your hands fit over their compression point. Depth Compression Matters The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. Pro Tip #3: While two inches may represent an average chest compression depth for children, it's best not to use a fixed depth. Instead, compress to a depth 1/3 the depth of the chest when performing CPR. How to Provide Care Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue shield available and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Remember, as long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation. If you've determined at this point that the victim is unresponsive and not breathing normally continue immediately with CPR, beginning with chest compressions. Remember your landmarks, which don't change when performing CPR on children: Aim for the center of the chest, between the nipples and on the lower one-third of the sternum. Hand placement: If you've determined that you should use two hands, based on the size of the victim, place your first palm on that landmark, just as you would for adults, and interlock the fingers on your top hand over your first. One-Hand placement: Place your first palm on the same landmark … and that's it. Lean over the victim, position your hand(s) as indicated above, and in the video, and lock your elbows. Use your upper body weight to supply the force needed for chest compressions and compress at a depth equal to 1/3 the depth of the child's chest. Perform 30 chest compressions at a rate between 100 – 120 compressions per minute, which amounts to around two compressions every second. Remember to allow the child's chest to come all the way back up before performing your next compression. Remember, to maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Lift the child's chin and tilt his or her head back slightly. Grab the rescue shield and place it over the victim's mouth and nose. Pinch the child's nose and open their mouth. Deliver two rescue breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Don't forget to watch the victim's chest when performing chest compressions. If the chest doesn't rise, then you might be dealing with another problem and one that likely includes an obstructed airway. Go right back into 30 chest compressions followed again by two rescue breaths. Continue to perform 30 chest compressions to two rescue breaths until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again. https://d3imrogdy81qei.cloudfront.net/video_images/3607/child-cpr-profa-2015.jpg Yes 222 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/rcp-ninos-pro-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2024.mp4 RCP en niños Si un niño no responde y no está respirando, comience la RCP. Realizar compresiones torácicas con una mano en el centro del pecho durante treinta compresiones. Estas compresiones deben realizarse a una profundidad de por lo menos 1/3 de la profundidad del pecho. Dar dos respiraciones más, seguido por 30 compresiones, y repetir hasta que el niño revive o un DEA está disponible, o avanzado soporte de vida llega. https://d3imrogdy81qei.cloudfront.net/video_images/3607/child-cpr-profa-2015.jpg Yes 222 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adult-aed-lay-rescuer-community https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2026.mp4 Adult AED In this lesson, we'll cover how to use an AED on an adult victim. An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm. Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the rescuer, or someone else, that could result in electrocution? Pro Tip #1: If the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient. If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if it is a concern, you can disconnect it and remove it from the pathway to the heart. Necklaces should be moved to the side. Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads. Piercings shouldn't cause any problems. It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. There are no special considerations for pregnant women. Pro Tip #2: It's OK to be just as aggressive with a pregnant woman as you would any other victim. The primary focus should be on the mother, as saving her will also help save the baby. The care you provide to the mother won't put the baby in any more jeopardy. How to Provide Care Let's assume a few things: The scene is safe, and your gloves are on You or a bystander called 911 You have an AED, whether you found one or had it with you The victim is unresponsive and not breathing normally CPR is already in progress Remember, as long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation. However, when it comes to AEDs, they supply their own instructions. Well, at least after the first step below. AED Technique for Adults Pro Tip #3: This is really the anti Pro Tip, as you don't need to be a pro to execute it. The AED will tell you what to do and what it's doing, like "remove clothing" or "analyzing rhythm." All you have to do is follow along. Turn on the AED. Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. (AEDs will typically include a pair of scissors somewhere on the unit.) Attach the AED pads to the victim's chest. The pads should have a diagram on placement if you need help. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side of the victim's side, under the left breast. Make sure they adhere well. Plug the cable into the AED and be sure no one is touching the victim. The AED should now be charging and analyzing the rhythm of the victim's heart. If the scene is clear and no one is touching the victim, push the discharge button to deliver a shock. Then go right back into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Perform 30 chest compressions. Grab the rescue shield and place it over the victim's mouth and nose. Lift the victim's chin and tilt his or her head back. Deliver two rescue breaths. Continue with CPR until the AED interrupts you. At some point, it will reanalyze the victim's heart rhythm and again advise you on what to do next. If the AED advises a shock, do that. If it advises you to NOT shock the victim, continue with CPR only, again over the pads. (The AED will continue to reanalyze.) Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until EMS arrives, the patient is responsive and breathing normally, or someone who's equally trained or better can relieve you. A Couple Special AED Considerations There could be special situations that go beyond what you found in the list that opened this lesson. These include using an AED on a victim who's wearing an implantable device and a victim with an excessive amount of chest hair. Implantable Devices Implantable devices, like pacemakers, are sometimes located below one of the collarbones in the area where one of the AED pads should go. This can be problematic as the device could interfere with shock delivery. An ICD (Implantable Cardioverter-Defibrillator) is another common implantable device you may encounter. It's sort of like a mini version of an AED, as it detects abnormal heart rhythms and restores them to normal. If one of these devices is visible – a small lump can sometimes be seen or felt – or if you know the victim has one in a specific location, do not place the AED pad on top of it. Instead, adjust the placement of the pad to avoid the device. Excessive Chest Hair Chest hair rarely interferes with AED pad adhesion, but it is nonetheless a possibility. If the victim has excessive chest hair, press firmly on the pads when placing them on the victim's chest. If you get an error message, like check pads, or something similar, remove them and replace with new pads. Some of the victim's chest hair will likely come off with the old pads, which may solve the problem. However, if the AED still refuses to work, you'll have to shave the victim's chest (or cut some of the hair) before applying a third round of pads. https://d3imrogdy81qei.cloudfront.net/video_images/3611/adult-aed-lay-rescuer-community-2015.jpg Yes 244 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adulto-dea-rescatista-lego-comunidad-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2026.mp4 DEA en adultos Si el paciente es un paro cardiaco presenciado, compruebe primero para asegurar que la escena es segura. Compruebe la capacidad de respuesta del paciente y póngase en contacto con los servicios de emergencia. Compruebe si hay un pulso durante no más de 10 segundos. Encienda el DEA si el paciente no tiene pulso y no respira. Adjunte las almohadillas AED al paciente, y no toque al paciente mientras se analiza el DEA. Después de un choque se entrega, comenzar la RCP durante unos 5 ciclos o dos minutos. El DEA se interrumpirá después de dos minutos y volverá a analizar al paciente. Siga las instrucciones del AED hasta que llegue el soporte de vida avanzado. https://d3imrogdy81qei.cloudfront.net/video_images/3611/adult-aed-lay-rescuer-community-2015.jpg Yes 244 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-aed-fa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2027.mp4 Child AED AED pads come in an adult size and a pediatric size, for patients less than 8 years old or 55 pounds - roughly 25 kilograms. However, remember, if you do not have pediatric pads and the patient is less than 8 years old or less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forgo using an AED. If placing the pads on the chest, pads cannot touch. If using adult size pads on a child, you may place them one on the center of the chest and the other on the center of the back to avoid touching, like you would for an infant. Also, remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? If for some reason the scene isn't safe enough to use an AED, move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. And one last reminder: It's OK if the victim or the victim's clothing is wet, as long as the area where pads will be placed is dry and you or the victim aren't submerged in water or connected by it. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? (With children, shouting their name may help.) If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS.. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. If you've determined at this point that the victim is unresponsive, not breathing normally, continue immediately with your AED. AED Technique for Children Turn on the AED. Remove the patient's clothing to reveal a bare chest. There are two pad placement options for children based on their size. The pads should have a diagram on placement if you need a reminder. Determining the size for pad location can be as simple as if the pads look like they will touch each other on the chest, then use the front and back locations. For small children, attach one AED pad to the center of the child’s chest, roll the child onto his or her side, and attach the second pad to the center of the back, between the shoulder blades.  For larger children placement is the same as an adult. One on the upper right chest, just below the collar bone. The other pad is placed on the lower left side of the chest, mid axillary line, below the breast. Plug the cable into the AED and be sure no one is touching the patient, including yourself. Some AEDs will have the cable already plugged into the device. The AED should now be analyzing the heart rhythm.  The AED will find one of two options, either a shockable rhythm or a non-shockable rhythm. For a shockable rhythm, the AED will charge itself to deliver the shock. If the scene is clear and no one is touching the patient, push the flashing shock button. Some AEDs will shock automatically, so be sure to listen to the directions of the AED. For a non-shockable rhythm or after the AED does shock, we immediately go right back into CPR starting with compressions. It's OK to perform CPR over the pads, so don't worry about moving them. Perform 30 compressions that go about 2 inches deep, or 1/3 the depth of the chest, and at a rate of between 100 and 120 compressions per minute, which amounts to almost two compressions per second. Grab the appropriately-sized rescue mask or face shield and seal it over the victim's face and nose and tilt back the head to open the airway. Breathe into the rescue mask or face shield and wait for the chest to rise and fall before administering the second breath. Continue with 30 compressions to 2 breaths. Every 2 minutes of CPR, the AED will analyze the heart again. Follow the directions and go right back into CPR. Continue this cycle until help arrives, the patient is responsive and breathing normally, the scene becomes unsafe for you, or the next level of care takes over. A Word About AED Precautions When using an AED, there are several precautions to keep in mind. Some of these may be obvious (and a repeat of what you've already learned in this course), while others may not be. Since alcohol is flammable, do not use anything with alcohol on it to wipe the patient's chest or back dry. While it's OK to use adult pads on a child, the reverse isn't entirely true, as pediatric pads may not deliver enough energy to defibrillate the adult patient. Do not touch the patient while the AED is conducting an analysis, as this may affect the analyzation process. Before delivering an AED shock, make sure no one is touching the patient or any of the resuscitation equipment. Do not use an AED if there are flammable or combustible materials or gases present. Do not operate an AED inside a moving vehicle, as the movement can affect the analysis and shock incorrectly. Do not use an AED if the victim is in contact with free-standing water or in the rain. Move the patient first. Do not place AED pads on top of any patches or implantable devices. Remove patches first and adjust the pads as necessary to avoid devices like a pacemaker.   https://d3imrogdy81qei.cloudfront.net/video_images/3613/child-aed-fa-2015.jpg Yes 250 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/dea-nino-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2027.mp4 DEA en niños Compruebe la capacidad de respuesta del paciente, póngase en contacto con los servicios de emergencia y compruebe si hay un pulso. Encienda el DEA si el paciente no está respirando normalmente. Adjunte las almohadillas DEA al paciente, y no toque al paciente mientras se analiza el DEA. Después de un choque se entrega, comenzar la RCP durante unos 5 ciclos o dos minutos. El DEA se interrumpirá después de dos minutos y volverá a analizar al paciente. Siga las instrucciones del DEA hasta que llegue el soporte de vida avanzado. https://d3imrogdy81qei.cloudfront.net/video_images/3613/child-aed-fa-2015.jpg Yes 250 https://app.protrainings.com/courses/bls/healthcare/videos/hands-only-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2029.mp4 Hands-Only CPR Hands-only CPR is designed for the untrained lay rescuer or someone who isn't comfortable or confident giving mouth-to-mouth resuscitation. Research suggests that hands-only CPR is most effective on adults, as cardiovascular problems are often the cause of their cardiac arrest. Whereas, in children, the majority of their cardiac arrest events have to do with respiratory deficiencies. Of course, performing full CPR – a combination of 30 compressions to two rescue breaths – is always going to provide the best chances for a positive outcome. However, hands-only CPR is better than no CPR at all; even on children. How to Provide Care The first thing you want to do is make sure the scene is safe and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get a response, proceed with the following steps. Call 911 and activate EMS. Put your phone on speaker so the dispatcher can assist you. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 2-2.4 inches deep – for adults – or 1/3 the depth of the victim's chest and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Pro Tip #1: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Continue to perform chest compressions until help arrives or the victim is responsive and breathing normally. Pro Tip #2: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. A Word About Other Cardiovascular Emergencies There are a number of conditions that can mirror cardiac arrest or make diagnosis difficult. Knowing what those are and how they're caused may help eliminate any confusion. Angina Pectoris Angina pectoris is a medical term that simply means pain in the chest. It occurs when the heart requires more oxygen than it is receiving, usually due to the arteries being too narrow. It's often triggered when the patient is exercising or becomes too excited or emotionally upset. Arrhythmias Arrhythmias are electrical disturbances in the heart that affect its regular rhythm. Some people with arrhythmias don't experience any cardiovascular problems, while in others, an arrhythmia can indicate a greater underlying problem that could lead to heart disease, stroke, or heart attack. Atrial Fibrillation Atrial fibrillation is a common type of abnormal heart rhythm, where the upper two chambers (the atria) are not coordinating their beats with the two lower chambers (the ventricles). This causes an irregular and often rapid heart rate that results in inadequate circulation to the ventricles. Atrial fibrillation is usually not life threatening, however, it could lead to a stroke or heart attack. Congestive Heart Failure Congestive heart failure is a chronic condition in which the heart can no longer pump blood effectively, thereby limiting circulation throughout the body. This can result in high blood pressure and fluid buildup – which can contribute to difficulty breathing and weight gain. People with congestive heart failure will often experience swelling of the face, hands, feet, legs, and ankles. Hypertension Hypertension, or high blood pressure, is one of the many risk factors for heart attacks and stroke. A person has hypertension if their blood pressure is higher than 140/90 mmHg. There are numerous causes of hypertension, including certain medications, stress, and high sodium intake, or underlying conditions like kidney abnormalities and/or an adrenal gland tumor. Diabetes People with diabetes often experience problems with their nerves and nervous system. In these cases, a person with this type of diabetes-related complication may experience what's known as a silent heart attack, as the brain and nervous system don't produce any symptoms, or produce warning signs that are too mild to notice. If this is the case, special diagnostic tests may be required to get confirmation of a heart attack. https://d3imrogdy81qei.cloudfront.net/video_images/3617/hands-only-cpr-2015.jpg Yes 199 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-solo-manos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2029.mp4 RCP solo con manos La RCP de manos únicas ayuda a alentar a los rescatistas a involucrarse que de otra manera no podrían ayudar. Los equipos de rescate entregan compresiones de 2-2.4 pulgadas de profundidad a una velocidad de 100-120 compresiones por minuto sin la necesidad de entregar respiraciones de rescate en el medio. La RCP con manos únicas elimina el temor de transmitir enfermedades al eliminar el componente boca a boca de la RCP. https://d3imrogdy81qei.cloudfront.net/video_images/3617/hands-only-cpr-2015.jpg Yes 199 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/unconscious-adult-choking-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2033.mp4 Unconscious Adult Choking In this lesson, we'll cover how to help an adult choking victim who is unconscious. In our fictional scenario, the adult victim went unconscious while you were trying to help them. The method of care will closely resemble performing CPR, which you recently learned, however, there are subtle differences to pay attention to. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on, and that you have your rescue shield handy. Help lower the victim to the ground or floor, so they don't fall and injure themselves. Pay extra attention to supporting their head and neck. Call 911 and activate EMS if you haven't already done so. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the victim's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Pro Tip #1: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Remember to make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. Pro Tip #2: There are no complications when performing chest compressions on a pregnant woman, as you're not near the womb and baby when doing them. Proceed as you would for any other adult patient. Lift the victim's chin and tilt his or her head back. Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps. Grab the rescue shield and place it over the victim's mouth and nose. Pinch the victim's nose and open their mouth. Deliver a rescue breath and watch for the victim's chest to rise. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. If the rescue breaths go in this time – causing the chest to rise and fall – reassess the victim for signs of breathing normally and/or responsiveness. Pro Tip #3: Let's assume your compressions were able to dislodge the obstruction and you got it out of the victim's mouth. At this point, either they're breathing normally and becoming more responsive, or they're not. If not, continue to perform 30 compressions to two rescue breaths. Continue to perform CPR until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again. How You can Increase the Effectiveness of CPR It's important to understand what constitutes high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. With that in mind, here are two lists (cheat sheets) to use when practicing CPR – one list of what to do and what of what NOT to do. What is High-Quality CPR? Performing chest compressions at a rate of 100-120 per minute Compressing to a depth of at least 2 inches but not exceeding 2.4 (for adults) Allowing for full recoil after each compression Minimizing pauses in compressions Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the victim's chest to rise What is Low-Quality CPR? Compressing at a rate slower than 100 per minute or faster than 120 per minute Compressing to a depth of less than two inches or greater than 2.4 inches Leaning on the chest between compressions or performing compressions while not directly over the victim's heart Interrupting compressions for greater than 10 seconds Providing excessive ventilation – too many breaths or breaths with excessive force https://d3imrogdy81qei.cloudfront.net/video_images/3625/unconscious-adult-choking-first-aid-2015.jpg Yes 160 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asfixia-adulto-inconsciente-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2033.mp4 Asfixia en adulto inconsciente Una vez que una víctima de asfixia se convierte en inconsciente, asegúrese de que EMS se ha activado. Dar 30 compresiones torácicas. Compruebe el objeto en la boca del paciente y barrerlo si es posible. Intente respirar. Si no hay aumento de pecho y caída, reposicione la vía aérea e intente otra respiración. Si todavía no entra aire, realice 30 compresiones torácicas, revise el objeto nuevamente y, si es posible, retírelo. Intente respirar. Si no hay aumento de pecho y caída, reposicione la vía aérea e intente otra respiración. Continúe este proceso hasta que la vía aérea esté abierta y el aire entre en los pulmones. https://d3imrogdy81qei.cloudfront.net/video_images/3625/unconscious-adult-choking-first-aid-2015.jpg Yes 160 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/unconscious-child-choking-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2034.mp4 Unconscious Child Choking In this lesson, you'll learn how to help a choking victim who is an unconscious child. Just as with our last fictional choking scenario, this victim went unconscious while you were trying to help them. Much of this lesson will look exactly like the unconscious adult choking lesson that you just finished. However, keep in mind that we learn through repetition and you can always expect a nugget or two (or seven) that wasn't in the last lesson. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on, and that you have your rescue shield handy. Help lower the child to the ground or floor, so they don't sustain a trauma from a hard fall. Pay extra attention to supporting their head and neck. Call 911 and activate EMS if you haven't already done so. Enlist the help of a bystander if one is available. Locate the area over the heart to begin chest compressions. Pro Tip #1: While likely a refresher, it's important to remember your CPR compressions landmark – center of the chest on the lower third of the sternum. And don't forget, that to maximize cardiac output, position yourself directly over the victim's chest and not off to one side. If you're not directly over the heart, you may not adequately compress it. Stand or kneel directly over the victim's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 1/3 the depth of the victim's chest and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Remember, once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. Lift the victim's chin and tilt his or her head back slightly. Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps. Grab the rescue shield and place it over the victim's mouth and nose. Pinch the victim's nose and open their mouth. Deliver a rescue breath and watch for the victim's chest to rise. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. If the rescue breaths go in this time – causing the chest to rise and fall – reassess the victim for signs of breathing normally and/or responsiveness. Remember, we're assuming your chest compressions were able to dislodge the obstruction and you got it out of the victim's mouth. At this point, either they're breathing normally and becoming more responsive, or they're not. If not, continue to perform 30 compression to two rescue breaths. Continue to perform CPR until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again. A Few Common Random Questions that (may) Pertain to Choking Victims What are the differences between child CPR and adult CPR? There are three distinct differences to be aware of. Opening the Airway While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground. Remember, with infants, that tilt is even less pronounced, as in neutral or slightly sniffing. With infants, it's more about distancing the chin from the chest, due to a neck that's still in the stubby stage. Performing Compressions The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand. But since human beings tend to come in many different sizes, stick to your 1/3 the depth of the chest and you'll never be wrong. Using AEDs As you recently learned, AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the victim. If your cardiac arrest victim weighs more than 55 pounds, continue using the adult AED pads. If the victim weighs less than 55 pounds, use pediatric AED pads if available. And yes, you'll have to guess when it comes to their weight. How well do compressions work for dislodging an obstruction? Just because your choking victim went unconscious, there's no reason to panic, as chest compressions work surprisingly well for removing airway obstructions. Performing those compression perfectly will also help. If the victim begins breathing again but it's not “normal breathing”, what are some signs I can look for? Just as there are many reasons why a person would experience respiratory or airway issues, there are also numerous signs and symptoms that can alert you to a problem, including: The person is unable to speak, can only speak a few words, or has a hoarse-sounding voice excessive use of abdominal muscles to breathe muscles between the ribs pull in on inhalation pursed lips breathing nasal flaring fatigue Adequate breathing means that respiratory rate – 12-20 for adults, 15-30 for children, 25-50 for infants – depth and effort are all normal. https://d3imrogdy81qei.cloudfront.net/video_images/3627/unconscious-child-choking-first-aid-2015.jpg Yes 190 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asfixia-nino-inconsciente-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2034.mp4 Asfixia en niño inconsciente Una vez que un niño asfixia víctima se convierte en inconsciente, asegúrese de que EMS se ha activado. Dar 30 compresiones torácicas. Compruebe el objeto en la boca del paciente y barrerlo si es posible. Intente respirar. Si no hay aumento de pecho y caída, reposicione la vía aérea e intente otra respiración. Si todavía no entra aire, realice 30 compresiones torácicas, revise el objeto nuevamente y, si es posible, retírelo. Intente respirar. Si no hay aumento de pecho y caída, reposicione la vía aérea e intente otra respiración. Continúe este proceso hasta que la vía aérea esté abierta y el aire entre en los pulmones. https://d3imrogdy81qei.cloudfront.net/video_images/3627/unconscious-child-choking-first-aid-2015.jpg Yes 190 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/arterial-bleeding-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2036.mp4 Arterial Bleeding Arterial bleeding is the most severe and urgent type of bleeding injury. It can occur due to a penetrating injury, blunt trauma, or from damage to organs or blood vessels. As arterial bleeding is pumped directly from the heart to the rest of the body, this type of bleeding has a few distinctions: The blood is bright red in color due to its high oxygen concentration The blood tends to spurt due to the heart pumping it to the wound The pressure is higher than other types of bleeding, so it will not clot or stop as easily Warning: The pressure will only subside as blood volume decreases. This is a life-threatening situation and tissue will quickly begin to die due to lack of oxygen. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. Pro Tip #1: The most important thing with an arterial bleeding wound is to apply pressure and stop the bleeding. Apply pressure. Stop the bleeding. Keep these in mind as you progress through this lesson. Find the source of the bleeding. You may have to remove or cut away clothing to reveal the wound. Pro Tip #2: An arterial bleed can be a frightening situation. Reassure the victim and let them know that you'll stay with them until additional help arrives and that you'll take good care of them while you wait. Cover the wound as long as no impaled objects are protruding from it. Ideally, a sterile pad or bandage would work best, but use whatever you have available, so long as it's clean. Apply direct and constant pressure to the wound. If the victim is conscious and can assist, this will help. Warning: Remember, arterial wounds will be pulsating or spurting, and it will likely take several dressing pads to control the bleeding. So, don't be surprised by the amount of blood or the difficulty you may experience in controlling it. Apply new pressure pads or bandages as needed, if blood begins to soak through the one(s) already applied. DO NOT remove the old bandage or pad, as this can strip the wound of blood trying to clot and only delay your ability to control the bleeding. After bleeding is controlled, you can begin to wrap the wound using an elastic bandage. Start at the furthest point from the body and wrap over any and all dressing pads you placed over the wound. (If the wound is on the arm, begin wrapping at the end where the fingers are.) Wrap around the wound at least an inch on each side and overlap the bandage as you wrap. Go down the arm, up the arm, and repeat as many times as necessary. Pro Tip #3: To apply even more pressure to a difficult wound, twist the bandage one time directly over the wound and repeat as necessary. This will tighten-up the pressure where pressure is most needed. When done wrapping, cut the end of the bandage and either tape it down or tuck it into the wrap to hold it in place. An arterial bleed is an automatic 911 call. It's always a good idea to activate EMS in an emergency. You can always cancel the call or send them away once they arrive. But if the situation suddenly turns dire, you'll be glad knowing they're on the way. Warning: Watch for signs of shock. Does the victim appear pale, sweaty, or cold? (Shock is very dangerous and something we'll get into more in a subsequent lesson.) Also monitor the victim for difficulties breathing, circulation problems, or other injuries you may not have noticed earlier. At this point, the victim should be stabilized and the bleeding under control. If you activated EMS, simply wait for them to arrive. If EMS is not on the way, you can find another way to get the victim to the next level of medical care, most likely an emergency room. A Few Common Arterial Bleeding Questions Should I elevate the wound above the heart? No, not anymore. While this was once the protocol for dealing with a bleeding wound, we're no longer doing this. Should I apply a tourniquet if I cannot control the bleeding? Yes, but only if you can't stop the bleeding and it's a matter of life and death. Cutting off circulation to any part of the body is a serious event and best left to professionals. Can I let the victim drive himself or herself to the hospital? No, especially not in this case, as blood loss from an arterial wound can be severe and cause reactions that don't mix well with operating a moving vehicle. However, in general, this should be avoided. There may be a chance that the victim has difficulty seeing his or her own blood, which could cause psychogenic shock. It's always better if the victim is a passenger rather than the driver. How do I know if I wrapped the wound too tightly? This can be a real concern and one reason we only use tourniquets in serious situations, as you don't want to cut off blood supply to ANY part of the body for too long. Look at the fingers or toes or whatever extremities are closest to the wound. Are the nail beds still pink or are they beginning to turn blue? Pinch a nail and the fleshy underside between two of your fingers. The nail should turn pale and then return to a pink color a couple seconds later. If it doesn't, the bandage is too tight. It's important to try and not cover fingers and toes with the bandage if possible, so that this test can be performed. https://d3imrogdy81qei.cloudfront.net/video_images/3631/arterial-bleeding-child-2015.jpg Yes 236 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/sangrado-arterial-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2036.mp4 Sangrado arterial El sangrado arterial se caracteriza por una sangre roja más brillante que puede palpitar o chorro. Aplique presión directa con un vendaje. Si hay fugas de sangre, aplique más apósitos en la parte superior. Nunca quite un vendaje. Una vez que el sangrado está bajo control, use gasa de rodillo para asegurar el vendaje, comenzando en el extremo distal y trabajando hacia el corazón. Usted puede girar la gasa para aplicar más presión. Asegúrese de que la sangre no esté goteando y que el vendaje no tenga efecto de torniquete. Eleve la herida y llame a EMS o lleve al paciente al hospital más cercano. https://d3imrogdy81qei.cloudfront.net/video_images/3631/arterial-bleeding-child-2015.jpg Yes 236 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/concussion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2038.mp4 Concussion This lesson is for those times when a head injury may have led to one of the more common and serious injuries – concussions. Pro Tip #1: Concussions occur as the brain moves abruptly from side to side inside the skull, essentially bouncing off the walls that protect it. In serious concussion cases, the brain can shut down immediately, causing the victim to lose consciousness. Even in situations that don't involve a loss of consciousness, a person who exhibits other concussion signs and symptoms are at least mildly concussed. Part of your job is to determine if the victim is concussed and how severe it is by reading the signs and asking open-ended questions. Warning: The most important thing to keep in mind as you deal with someone who has sustained a head injury, as soon as it appears to be a concussion, that deserves an immediate 911 call. Even if the patient begins to recover, concussions are too traumatic and can develop into something more life-threatening. How to Assess and Treat a Concussion As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim. Are you OK? Can you hear me? If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions." "Do you remember what just happened?" "Do you know if you hit your head?" If you suspect a head injury, ask questions about headaches, blurred vision, nausea, while also looking over the victim for concussion symptoms including: Eye-tracking – can they follow your finger Blurred vision, which indicates swelling in the brain Dizziness, loss of balance Nausea, vomiting Loss of memory Dazed and confused If the victim exhibits any of these symptoms, it's best to call 911 immediately. If they don't, continue assessing them. "Do you know what day it is?" "Do you know what year it is?" If the victim answers those two questions incorrectly, you're likely dealing with someone who has hit their head and may have a concussion. Which as you know by now, deserves a 911 call. Pro Tip #2: When it comes to head injuries, it's better to be safe than sorry. Get the patient to the ER whenever in any doubt and get them properly examined. Always err on the side of patient welfare. Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock. Remember, if you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call. In concussion cases, the patient will likely require a 24-hour observation period to make sure that symptoms and swelling in the brain are reduced, which is the norm. However, these issues and symptoms can also worsen. A Word About Injuries to the Head The problem is that the head lacks the padding often present in other areas of the body. Which means it can easily be injured. And that injury can easily be considered serious. There are two main types of head injuries – open and closed. An open head injury is one that breaks or penetrates the skull. Excessive bleeding can occur and controlling that bleeding will be vital for a positive outcome. The other type is a closed head injury. Closed head injuries occur when the brain strikes against the inside of the skull and when the skull remains intact. These injuries are much more difficult to detect as there is a decided lack of visible clues. The four subtypes of head injuries are: Concussion Skull fractures Penetrating wounds Scalp injuries Let's take a deeper look into the physical, emotional, and behavioral signs and symptoms of a concussion. Physical symptoms include: Headache Blurry vision Nausea or vomiting Dizziness Sensitivity to noise or light Balance problems Feeling sluggish Emotional symptoms include: Irritability Sadness Heightened emotions Nervousness or anxiety Behavioral symptoms include: Sleeping more or less than usual Difficulty falling asleep Changes in playing habits for kids Changes in eating habits Thinking and remembering skills may also be impacted and include the following symptoms: Difficulty thinking clearly Difficulty remembering events that occurred just prior to the incident and just after the incident Difficulty remembering new information Difficulty concentrating Feeling mentally foggy Difficulty processing information https://d3imrogdy81qei.cloudfront.net/video_images/3635/concussion-2015.jpg Yes 190 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/conmocion-cerebral-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2038.mp4 Conmoción cerebral https://d3imrogdy81qei.cloudfront.net/video_images/3635/concussion-2015.jpg Yes 190 https://app.protrainings.com/courses/bls/healthcare/videos/cpr-conclusion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2039.mp4 Conclusion Congratulations on completing your ProTrainings course. We hope it was everything you thought it would be … and more. The good news is that you’re now ready to take your exam. Remember that muscles that don’t get used begin to atrophy. Even those mental muscles. The same goes for the newly acquired skills you’ve just gained, as they can easily be forgotten if not used or refreshed regularly. Don’t let all that important knowledge get flabby. To that end, we have a free weekly video training series delivered via email that you can easily sign up for that will deliver important training right to your inbox in small doses. If you’d like to sign up for this training, you can do so here (if you're not already registered). Now that you’ve acquired these all-important life-saving skills, don’t let the fear of infectious disease stand in the way of you becoming someone’s potential hero. To combat this fear, you can get a keyring CPR shield through ProTrainings that will protect you from a disease no matter the situation. And as long as you have your keys with you, you’ll be protected. You may be in a situation where you’re not required to practice on a mannequin or perform a skills test. However, if you find out later that your employer does require this, or if you simply think this would be great practice for you (Spoiler Alert: It is!), ProTrainings has you covered with a mannequin solution for all your skills practice and training. If you’re interested in this mannequin training solution, contact ProTrainings and we’ll have one delivered to you at a convenient time. Also, for anyone who has taken one of our 100 percent online courses and still requires an evaluation, now or in the future, you can do that with a simple phone call to ProTrainings at any time Thanks again for choosing ProTrainings as your training resource. But before we sign off, we’d just like you to consider WHY you’ve chosen to learn these skills. Life is a precious thing. It’s something that should be appreciated, savored, and celebrated. As a skilled rescuer, you have enormous power to help people in need. To give back to them the one resource that is truly extinguishable – time. Time for everything that matters to them. Keep the WHY in your mind as you work hard to keep the skills you just learned fresh and valuable. Now, go forth and rescue! https://d3imrogdy81qei.cloudfront.net/video_images/3637/conclusion-2015.jpg Yes 87 https://app.protrainings.com/courses/bls/healthcare/videos/conclusion-rcp-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2039.mp4 Conclusión ¡Felicitaciones por completar su programa ProTrainings! Ahora usted está listo para tomar su prueba. Vea este video para obtener más información sobre nuestros servicios de soporte adicionales y productos diseñados pensando en usted. https://d3imrogdy81qei.cloudfront.net/video_images/3637/conclusion-2015.jpg Yes 87 https://app.protrainings.com/courses/bls/healthcare/videos/how-to-access-ems-through-technology https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2040.mp4 How to Access EMS Through Technology The last few decades have seen a surge in the amount of technology available to the public. It affects every facet of our lives, including how we interface with and access Emergency Medical Services, along with how they're able to respond to those emergencies. This lesson will help you better understand a few aspects of using the technology available to you, including how best to leverage it to your advantage while also navigating through some of its nuances. Text Messaging Certain areas of the country have aggressively adopted text message ability to reach 911 and access EMS. However, it's important to understand that this capability doesn't exist in all locations, so it pays to be aware of the situation in your particular area before having to depend on a service that doesn't yet exist. There are obvious advantages to having this text service available, particularly for people who are hearing impaired. Or for people working in loud environments, such as factories and nightclubs. It makes sense in any situation where it's difficult to hear through either the speakerphone feature or the regular speaker. But even though it makes sense, it doesn't mean it's going to be available just yet. Using Your Cell Phone to Call 911 This is the preferred way to contact EMS, via your cell phone and talking to them directly. Speaking will always be faster than texting, especially during an emergency. A cell phone allows for hands-free communication, as you can put it on speakerphone, lay it down, and continue to help the patient while on the phone with an EMS dispatcher who can talk you through any problems you may encounter. While cell phones have truly been game-changers in this industry, there are a couple of nuances to be aware of. Does the phone in question have locking capabilities? Let's say someone other than you is trying to use your phone to call 911, but it's locked. Most cell phones these days have an emergency word that will bypass the lock and allow the user to use the phone to dial 911. This is particularly important in a situation where you hand your phone to a bystander to call 911 … a bystander who likely doesn't know your code. Time is of the essence in any emergency and seconds can sometimes matter a great deal. All cell phones are a little different when it comes to accessing EMS. It pays, not only to become familiar yourself, but also to teach others in your household how to call 911 from all the cell phones in your home. This should also include nannies, babysitters, and anyone else in a similar position. Applications and Software There have been some exciting technological developments in the areas of apps and software. One such program enables access to nearby bystanders and volunteers who are trained and available to help in case of an emergency. Pulse Point is one such application. After the trained rescuer registers with Pulse Point, they are entered into the pool of rescuers within a particular geographical area who can be notified of local emergencies. It allows those who have been trained in CPR and first aid to respond quickly in a crisis if they're nearby and available. AED Locator It's normal to be in a situation where you may need an AED but you don't have one or know where the closest one is. While this situation may be normal now, it may not be for long. Publicly available AEDs are currently being put into a database and added to a logistical map. The way it works is, if you're in need of an AED, you check your AED locator for the nearest one in your area that's been cataloged and is ready for use. As more and more are added to the database, more and more will be available when nearby emergencies occur, saving time and lives. Landline Phones and VOIP Voice-over IP applications and phones have become extremely popular. Much like cell phones, you can move them and the service from office to office or home to home, while still maintaining the same phone number and account. However, if you moved and failed to register your new location or update your account with the new information, calling 911 will be useless. The dispatcher will have no way of knowing where you're calling from. With landlines there's also a nuance to consider, as it pertains to offices. In most offices or businesses, there's usually an outbound number that must be pressed to get an outside line. In an emergency, when heads can be a bit scrambled, or for visitors who may not know that number, it's a good idea to write it down and display it prominently at every phone. Technology is great when it helps and when it speeds things up, like the time it takes to find an AED. But don't let it slow you down. Take the necessary steps to ensure that you're comfortable with all the technology available to you, as well as those coming around the next corner. https://d3imrogdy81qei.cloudfront.net/video_images/3639/how-to-access-ems-through-technology-2015.jpg Yes 269 https://app.protrainings.com/courses/bls/healthcare/videos/como-acceder-sem-con-tecnologia-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2040.mp4 Cómo acceder a los SEM mediante la tecnología Cuando intente acceder a Servicios de Medicina de Emergencia a través del 911, aquí hay algunas cosas a considerar. La mensajería de texto es una buena manera de ponerse en contacto con el servicio de mensajería instantánea (EMS) cuando se encuentra en un área alta o tiene problemas de audición; Sin embargo, tenga en cuenta que no está disponible en todas partes. La forma preferida de acceder a EMS es marcar 911 a través de un teléfono celular. La ubicación de un teléfono fijo debe ser precisa para que la operadora sepa de dónde está llamando. https://d3imrogdy81qei.cloudfront.net/video_images/3639/how-to-access-ems-through-technology-2015.jpg Yes 269 https://app.protrainings.com/courses/bls/healthcare/videos/when-cpr-doesnt-work https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2041.mp4 When CPR Doesn't Work This is the last lesson in the cardiac arrest section, and a difficult topic to tackle for most. Whether you're a licensed paramedic, family member, neighbor, or stranger, the question remains the same for many people: Why didn't CPR work? That's a fair question. Even when you do everything perfectly, the desired outcome often isn't what you expected or hoped for. However, some of that hope and desire can be rooted in a misunderstanding of what CPR really is, which is the point of this lesson. CPR was designed to buy time, and nothing more. During cardiac arrest the heart is either in a fibrillatory state, meaning it's wiggling around in a disordered fashion, or it's completely asystolic, meaning it's not contracting at all. When a heart is healthy and operating as it should, it beats from top to bottom in a very organized way utilizing one-way valves. It works perfectly to circulate oxygenated blood throughout the entire body, and it does so efficiently. However, during cardiac arrest, regardless of what caused it, the heart is unable to circulate blood and oxygen and the body begins to die. The patient isn't breathing. There's no pulse. At this point, that person is clinically dead. Now, it doesn't mean that person will remain that way, as there is a difference between clinical death and biological death. What CPR aims to do, specifically the compressions, is to make up for the circulation that isn't happening naturally. The reality, though, is that even when CPR is performed perfectly, it's delivering only a small percentage of what the body needs to survive. It wasn't designed to be equal to artificial life support. Remember, it's simply a way to buy time. People have this idea that if they perform chest compressions on an unresponsive person, the body will remain alive. And he or she will remain alive so long as the chest compressions continue. But this isn't the case. CPR doesn't stop the dying process. It slows down biological death a little. But that's all it does. The hope is that after activating EMS or calling in a code, that you can buy enough time until help arrives – an AED, a manual defibrillator, advanced life support, oxygenation, drugs, etc. – and the underlying cause of the cardiac arrest can be addressed. The truth is that we all have an expiration date. Experienced paramedics who've treated dozens of cardiac arrest victims will tell you that some that should have survived, did not. And some that looked as if they had no chance of survival, did just that. All you can do is give each cardiac arrest patient the best chance of survival. CPR was never meant to directly save lives. This may sound strange, but the reality is that CPR just keeps people dead longer. You must approach CPR with this understanding, along with an understanding of cardiovascular physiology. The difference between what CPR really is versus our perceptions of it can be vast. The truth is this: no matter whether we perform high quality CPR, the person remains dead, regardless of who they are. If you do everything correctly and the patient remains unresponsive, you didn't fail. The patient simply remained dead, for whatever reason. However, this unfavorable outcome doesn't negate one very important fact – by performing high quality CPR, you gave the patient the best possible chance of survival. Because if you don't perform CPR, except for a bonafide miracle, that person will rapidly go from clinical death to biological death and remain that way. That's why an important takeaway is this: people in cardiac arrest don't die. They simply remain dead. Now, you may be asking yourself, if CPR rarely works, is it even worth trying? EMS professionals will tell you that the people they saved using CPR show amazing amounts of appreciation, as they get to spend another Christmas with their families. They get the pleasure of seeing another birthday come and go. So, yes, it is worth trying. And in fact, the act of trying should be viewed as a success, as it's own reward, regardless of the outcome. Imagine if you were in cardiac arrest. There's nothing more beautiful than knowing that someone did everything possible to try and save your life. The effort and the act of helping is all that matters. At least, that's how it should be viewed. Something to remember – we don't know at what point victims of cardiac arrest can no longer sense or hear what's happening around them. The research is unclear. However, some have come back from cardiac arrest and were able to recount certain aspects of their own life-saving protocol while unconscious. Even if that person remains dead, there is a chance that their last impression or experience in this physical world was that of love; that someone cared enough (even strangers) to put themselves in a position that might clearly be outside their comfort zone, and risk horrible failure, for that slight chance to help another human being live. Isn't that the greatest gift we can give to another? This is why CPR should never be measured in terms of failure and success. Because failure is not making an attempt to help in the first place. The success comes with the effort, and nothing more. If you've ever performed CPR on a cardiac arrest victim, but the patient still remained dead, hopefully this greater understanding of what CPR really is has brought some peace to you, as the pain, agony, and guilt can be immense. Go forth and rescue confidently! And be at peace with yourself when you do. https://d3imrogdy81qei.cloudfront.net/video_images/3641/preview.png Yes 632 https://app.protrainings.com/courses/bls/healthcare/videos/cuando-rcp-no-funciona-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2041.mp4 Cuando la RCP no funciona La RCP es un intento de compensar la circulación en el corazón que no está sucediendo normalmente. La RCP no detiene el proceso de morir; Simplemente disminuye la muerte celular biológica. La esperanza es que este procedimiento puede comprar tiempo para que el ccsme llegue a probar otros métodos de restaurar la circulación apropiada de la sangre oxigenada por todo el cuerpo para comprar aún más tiempo de modo que la razón subyacente por la cual la persona entró en paro cardiaco en el primer lugar puede ser Explorado Si la RCP no funciona, recuerde que le dio a esa persona la mejor oportunidad de sobrevivir. https://d3imrogdy81qei.cloudfront.net/video_images/3641/preview.png Yes 632 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/intro-to-profirst-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2043.mp4 ProFirstAid Introduction Welcome to ProFirstAid. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And at the end, we'll give you a little information on why learning CPR is so important. Your instructor for the duration of your ProFirstAid course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and a co-founder of ProCPR and ProFirstAid. In other words, you're in good hands. We created ProFirstAid with you in mind. Regardless of your occupation, you'll be getting the best training available for infant, child, and adult CPR and first aid. Your schedule is probably hectic, which is why ProFirstAid is available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. The list of occupations that can benefit from the ProFirstAid course is long and includes: Daycare providers Elementary/Middle School Teachers Elementary/Middle School Coaches Foster parents Nannies / Babysitters Bus Drivers Tour Guides Others who require Pediatric CPR (adult, child, and infant) and First Aid to meet OSHA requirements The total course time includes 4 hours and 22 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your ProFirstAid course curriculum is extremely substantial. Some of the important things you'll be learning are: Introductory CPR & First Aid Training• Latest Updates• The Five Fears of CPR Rescue• Accessing EMS with Technology Medical Emergencies• Stroke• Heart Attacks Universal Precautions Cardiac Arrest Training• Adult, Child, Infant CPR• AED Training• Hands-Only CPR Choking Training• Adult, Child, Infant Choking (Conscious)• Adult, Child, Infant Choking (Unconscious) Bleeding Control• Capillary, Venous, Arterial Bleeding• Amputation• Shock• Tourniquets• Hemostatic Agents• Animal & Human Bites Injuries• Mechanism of Injury• Secondary Survey• Musculoskeletal Injuries• Head, Neck, and Back Injuries• Concussion• Burns• Eye Injuries Sudden Illness• Fainting• Diabetes• Seizure• Snake Bites• Allergic Reactions & EpiPen• Asthma• Recovery Position Heat & Cold Emergencies Prevention• Car Backing• Child Proofing the Home• Poison Control• Pool Safety• Child Abuse and Neglect ProFirstAid is an adult, child and infant, pediatric CPR/AED, and First Aid 2-year certification. If you are currently certified with Red Cross, AHA, National Safety Council, ASHI, or Medic First Aid, you are welcome to utilize the ProFirstAid.com program and receive a new, two-year ProFirstAid certificate. Individuals are free to train, refresh, and test at no charge any time 24/7! ProFirstAid's class is nationally accredited and follows the latest American Heart Association, ECC/ILCOR guidelines. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. More than 65,000 satisfied professionals just like yourself have completed this ProFirstAid course. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next person who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important ProFirstAid is different from the typical CPR and first aid courses. We believe that high-quality CPR training is something everyone should be able to access, for free. So, rather than paying simply to learn CPR, the payment is at the very end, only for those who need a certification card for work. We also believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR differently. Gaining confidence in your skills is a big part of performing high-quality CPR and administering vital first aid. Remembering that as you progress through each lesson will serve you well. Welcome again to ProFirstAid. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3645/intro-to-profirst-aid-2015.jpg Yes 45 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/introduccion-Pro-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2043.mp4 Introducción a primeros auxilios https://d3imrogdy81qei.cloudfront.net/video_images/3645/intro-to-profirst-aid-2015.jpg Yes 45 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/venous-bleeding-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2045.mp4 Venous Bleeding Uncontrolled bleeding is the number one cause of preventable deaths due to a trauma. While venous bleeding is usually less serious than arterial bleeding, it still can pose a serious health risk to the victim. Venous bleeding can be the result of external trauma, as in something cutting or puncturing a vein, or internal trauma, due to a broken bone or organ damage. Venous bleeding involves blood that is returning to the heart, so there won't be as much pressure as arterial bleeding. However, the blood loss can still be severe. Venous bleeding distinctions are: The blood is dark red, not bright like arterial bleeding The blood flow is steady but not spurting; it can still be quick, though The pressure is lower than arterial bleeding so it's usually easier to control How to Provide Care The good news when it comes to venous bleeding wounds is that applying constant pressure for 2-3 minutes will usually be enough to control the bleeding. Pro Tip #1: In most cases, these types of wounds clot pretty easily. However, keep in mind that this won't always be the case, especially if the victim is on blood-thinning medications or has a bleeding disorder. Also, unless the patient is showing signs and symptoms of a life-threatening emergency, you probably won't need to call 911. Just make sure to always err on the side of patient safety if you're ever uncertain. As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. Find the source of the bleeding. You may have to remove or cut away clothing to reveal the wound. Cover the wound as long as no impaled objects are protruding from it. Ideally, a sterile pad or bandage would work best, but use whatever you have available, so long as it's clean. Apply direct and constant pressure to the wound. If the victim is conscious and can assist, this will help. Apply new dressing pads or bandages as needed, if blood begins to soak through the one(s) already applied. DO NOT remove the old bandage or pad, as this can strip the wound of blood trying to clot and only delay your ability to control the bleeding. After bleeding is controlled, you can begin to wrap the wound using an elastic bandage. Start at the furthest point from the body and wrap over any and all dressing pads you placed over the wound. (If the wound is on the arm, begin wrapping at the end where the fingers are.) Wrap around the wound at least an inch on each side and overlap the bandage as you wrap. Go down the arm, up the arm, and repeat as many times as necessary. Remember, to apply even more pressure to a difficult wound, twist the bandage one time directly over the wound while wrapping it and repeat as necessary. This will tighten-up the pressure where pressure is most needed. When done wrapping, cut the end of the bandage and either tape it down or tuck it into the wrap to hold it in place. Pro Tip #2: It's always important to monitor the victim for signs of shock – pale, cool, sweaty, trouble breathing, etc. Shock can escalate a situation very quickly; better to catch it early and call 911 and activate EMS immediately if you do. A Few Common Venous Bleeding Questions How do I know if stitches are required? When you remove pressure, do the folds of skin around the cut begin to come apart, or does the skin appear to be staying together. If the skin is coming apart, stitches are likely necessary. If not, the wound will probably heal on its own and stitches can be avoided. As can a trip to the emergency room. When should I call 911? Call 911 immediately if … The victim is showing signs of shock The victim is having trouble breathing or losing consciousness You cannot stop the bleeding The situation is life-threatening in any way What about the wound getting infected? Before you wrap the wound, it's a good idea to properly clean it using an antibacterial ointment if you have one. This will combat any bacteria that may have gotten into the cut and reduce the chances of infection. As will properly wrapping the wound to avoid any dirt or debris from getting into it. Also, don't forget about the chances of tetanus. If the victim was cut by something dirty and hasn't had a tetanus shot in the last 10 years, a trip to the emergency room is a necessity regardless of the severity of the wound. https://d3imrogdy81qei.cloudfront.net/video_images/3649/venous-bleeding-child-2015.jpg Yes 137 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/sangrado-venoso-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2045.mp4 Sangrado venoso https://d3imrogdy81qei.cloudfront.net/video_images/3649/venous-bleeding-child-2015.jpg Yes 137 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/capillary-bleeding-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2046.mp4 Capillary Bleeding While you're probably familiar with veins and arteries, capillaries may warrant a quick definition. Capillaries are tiny blood vessels linking arteries and veins that transfer oxygen and other nutrients from the blood to all body cells and remove waste products. Generally speaking, there are three types of bleeding. Arterial is the worst of the three and the hardest to control, as it's under pressure and gushes. Then there's venous bleeding – those wounds drip and ooze and are under negative pressure. And then there's capillary bleeding. Capillary bleeding has the classic appearance of a road rash type of wound. Anyone who has fallen off a bike or while playing sports likely has some experience with this type of bleeding injury. Capillary bleeding distinctions are: The blood tends to ooze or bubble up on the surface of the wound The pressure is very low and will usually clot on its own or with minimal direct pressure The blood is mixed with serous fluid Serous fluid is a yellowish liquid that is made up of proteins and water. It's the same fluid that fills a burn blister and is the body's attempt to heal the wound. How to Provide Care Don't get too distracted by the obvious abrasive wound which isn't probably life-threatening. Instead, think about other areas and possible injuries that may require care and may even be life-threatening, such as: Head wounds, concussions Neck or spinal injuries Fractures Ask the victim if they're hurt anywhere else, and if they're experiencing any other pain. Once you've established that you're only dealing with an abrasion, treat it using the steps below. As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. (If you don't have gloves, wash your hands or use an alcohol-based hand sanitizer.) Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. Find the source of the bleeding. You may have to remove or cut away clothing to reveal the wound. Clean the wound using clean, potable water. Pour or run water over the abrasion while brushing off blood and debris – dirt, loose pebbles, etc. Pro Tip #1: While capillary bleeding wounds tend not to be as serious as arterial or venous, the pain is usually more severe. If you encounter embedded debris in the wound, save it for medical personnel who can numb the area before removing those objects. Dab the wound with (ideally) a sterile pad or bandage. However, anything clean will work, like napkins or tissue. Once the wound is clean and dry and the bleeding has stopped, apply an antibacterial cream (if you have one) to stop any chance of infection. Apply a bandage large enough to cover the entire wound. A standard size band aid isn't going to cut it. If you have a first aid kit, check for a 3”x4” sterile dressing pad. Then put the antibacterial cream directly on the pad, then apply that side to the victim's abrasion. Pro Tip #2: While a bandage would be nice, it's not really necessary. (The antibacterial cream is far more important.) Just make sure the victim is careful with the wound while in transport to a place where a bandage can be applied. To hold the bandage in place, fix two pieces of medical tape (from the first aid kit you hopefully have), one to the top of the dressing bandage and one to the bottom. Ask the victim to hold the bandage in place while you tape it over their wound. Remember, even though capillary bleeding injuries aren't usually serious, it's always important to monitor the victim for signs of shock – pale, cool, sweaty, trouble breathing, etc. Shock can escalate a situation very quickly; better to catch it early and activate EMS immediately if you do. A Few Common Capillary Bleeding Questions Can I clean the wound using hydrogen peroxide? While you may have heard about using hydrogen peroxide for wound cleaning, the medical community is steering rescuers away from this practice, as peroxide is a little too harsh on body tissue. Instead, clean the wound using clean, potable water. It's a much better option. Why are capillary bleeding wounds usually more painful than arterial or venous bleeding wounds? Capillary bleeding injuries affect the epidural layer where the nerve endings are located, which is why they can be more painful than other types of bleeding injuries. What's the biggest area of concern with capillary bleeding injuries? With arterial and venous bleeding injuries, controlling bleeding is the chief concern. However, with capillary bleeding injuries, reducing the chance of infection is BY FAR the greatest area of concern. Remember, these injuries usually involve a collision between a large surface area of the body and an external surface area that's likely far less than sterile, leaving some of that unsterile surface inside the fresh wound. https://d3imrogdy81qei.cloudfront.net/video_images/3651/capillary-bleeding-child-2015.jpg Yes 271 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/sangrado-capilar-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2046.mp4 Sangrado capilar https://d3imrogdy81qei.cloudfront.net/video_images/3651/capillary-bleeding-child-2015.jpg Yes 271 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/amputation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2047.mp4 Amputation An amputation from trauma involves the loss of an extremity like a finger or toe but could also include an arm or a leg. It's important to not get too distracted looking for the amputated part and focus on the wellbeing of the victim. As amputation injuries often occur in machine accidents, the amputated part can get thrown quite a distance from the scene of the accident. It may also be covered in saw dust or shavings of some kind, which could make finding it more problematic. If there are other people on the scene, you may want to consider asking for help to locate the missing part. Amputation injuries are quite serious. It’s important to assess the patient beyond the amputation, including: Did the victim lose consciousness? If so, did they hit their head and are now suffering from a concussion? Is the victim showing signs of being in shock? How to Provide Care Clean-cut amputations bleed less than you might expect and often less than crushed extremities or partial amputations. The reason for this is that the arteries contract up into the stump and clamp down, which helps to control the bleeding for at least the first few minutes following the amputation. After you make sure the scene is safe, proceed with the following steps. Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol. If the victim is conscious and not in shock or showing signs of other life-threatening injuries, ask him or her to help apply pressure to the wound. If there is already a cloth or dressing pad covering the stump, don’t remove it, as this will pull off some of the clotting blood. Apply a second piece of gauze padding and, if necessary, subsequent pieces until bleeding is controlled and apply pressure. If the victim can't help apply pressure, you'll need to manage it yourself or ask someone to assist you. Pro Tip 1: With amputation injuries, there will sometimes be a protruding bone fragment. These can be very sharp and may cut you while you attend to the victim. Therefore, it's important to be careful when dressing the wound. If you're not, you could easily: Damage the bone further Cause more pain to the victim Introduce bacteria into the wound Once you've controlled the bleeding, meaning it is no longer leaking through the dressing pads, it's time to wrap the wound with a roller gauze bandage. Pro Tip 2: Your goal in wrapping the wound is to apply enough pressure to hold the dressing pads in place and control the bleeding. Be careful not to wrap so tight that you cut off circulation. Remember to use the pinch test on finger and toe nails if appropriate and you are able to. If blood begins to leak through while you're wrapping the wound, simply insert another dressing pad and continue wrapping. If you need extra pressure at that point, twist the bandage over the wound area. This will apply a bit more torque and should help control the bleeding. When you're done wrapping, tuck or tape the end of the bandage. By this point, the bleeding should be controlled, and the patient should be stable. Continue assessing the victim for signs of shock or other health concerns. How to Handle the Amputated Extremity If you or someone at the scene were able to find the amputated part, it’s important that you handle it properly using the following steps. Make sure it's clean. Wrap it in a sterile gauze pad, preferably an abdominal dressing pad if you have one. This will offer much more insulation than regular pads and help protect the part from cold damage. Place the part into a sealable plastic bag. Put the bag with the part between two cold packs or into a bag filled with ice water and seal that bag. Warning: The amputated part has no blood flowing through it, which makes it much more susceptible to frost bite and tissue damage. You want to keep it cold, not frozen. It's also important to keep it dry. When skin becomes water logged and gets pruney, this is actually the onset of that tissue breaking down and will make reattachment more difficult. Pro Tip 3: It's important to keep the amputated part with the victim and, if possible, out of sight from the victim. You don't want to encourage psychosomatic shock, but you want the surgeons at the hospital to have access to both victim and part immediately. As amputations are serious injuries, you should be continually assessing the victim for signs of shock or other life-threatening conditions. A Word About Early Signs of Shock We will be discussing shock in great detail in the next lesson, but it's important to know that it's a progressive condition. Symptoms may seem minor at first, but the situation can quickly get worse. Your rapid response is vital. Early symptoms of shock include: The victim expresses anxious or apprehensive feelings The victim's body temperature is lower than normal The victim's breathing is quicker than normal The victim's pulse has increased The victim's blood pressure has decreased The victim's skin appears pale or clammy If you suspect that the victim is in shock, it's important to call 911 immediately. It's impossible to know when an individual will go into shock, but with amputation injuries you may want to consider the threat more elevated. And knowing the warning signs and being able to spot them early on could make a big difference. https://d3imrogdy81qei.cloudfront.net/video_images/3653/amputation-2015.jpg Yes 463 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/amputacion-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2047.mp4 Amputación https://d3imrogdy81qei.cloudfront.net/video_images/3653/amputation-2015.jpg Yes 463 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/tourniquets https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2048.mp4 Tourniquets Tourniquets are tight, wide bands placed around an arm or a leg to constrict blood vessels in order to stop blood flow to a wound. Generally, tourniquets should only be considered if the venous or arterial bleeding incident is life-threatening and if EMS response will be delayed. Other reasons to consider using a tourniquet include: If bleeding cannot be controlled by direct pressure If the injury is in a location where direct pressure isn't possible If multiple people need help with life-threatening injuries and help is limited If the scene is unsafe or becoming unsafe Warning: Tourniquets can be extremely painful. Therefore, it's best to warn the victim beforehand. And tell them why they'll be wearing a tourniquet. How to Provide Care If you have a commercial tourniquet, great. If not, anything that you can wrap around an injured limb will work – a piece of rope, an insulated wire. Tie that into a knot and then insert a screwdriver, stick, or pen and begin twisting to tighten. Your goal in using a tourniquet is to control bleeding before hypovolemic shock sets in due to blood loss. Pro Tip 1: What may seem like a wound that won't stop bleeding, may just be due to pressure that's not being applied directly over the wound. Bandages can slip. Victims could be in shock and not applying as much pressure as it appears. Make certain that direct pressure truly fails before considering a tourniquet. We will assume that you've already made sure the scene is safe, and you're wearing latex-free gloves or have thoroughly washed your hands and have determined that the victim is currently not in shock. Apply the tourniquet over the extremity where the injury as occurred and a couple inches above the wound to limit tissue damage. Avoid wrapping around joints and follow the manufacturer's instructions. Secure the tourniquet as tightly in place as possible. Slowly tighten the tourniquet handle until bleeding stops. Fasten the handle to the tourniquet. Test the victim's toenail or fingernail to make sure you get a delayed capillary response, so you know the tourniquet is working as it should. Write down on the victim's dressing what time the tourniquet was applied and give that information to EMS. The ABCs of Bleeding Regardless of the bleeding incident, it's important to understand these simplified steps to trauma care response: A – Alert! Call 911.B – Bleeding. Find the bleeding injury.C – Compress. Apply pressure and stop the bleeding by: Applying direct pressure with a clean cloth or dressing pads. Using a tourniquet. Packing or stuffing the wound and then applying pressure. A Word About Perfusion Perfusion is how your body's circulatory system delivers oxygen and nutrients to your organs, all of which require varying amounts of perfusion. Your heart, for instance, requires constant perfusion to continue working. Your brain can last four-to-six minutes without perfusion, before damage begins to set in. Your kidneys can last 45 minutes and your skeletal system about two hours. What does this have to do with tourniquets? Pro Tip 2: It's important to keep in mind that limiting perfusion is a bad thing. But when we apply a tourniquet to a victim, that's exactly what we're doing. We're voluntarily cutting off the supply of oxygen and nutrients to a part of someone's body. So, it bears repeating: Tourniquets should only be considered if the venous or arterial bleeding incident is life-threatening and if EMS response will be delayed. https://d3imrogdy81qei.cloudfront.net/video_images/3655/tourniquets-2015.jpg Yes 363 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/torniquetes-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2048.mp4 Cómo aplicar un torniquete https://d3imrogdy81qei.cloudfront.net/video_images/3655/tourniquets-2015.jpg Yes 363 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/hemostatic-agents https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2049.mp4 Hemostatic Agents A hemostatic dressing is any dressing treated with an agent or chemical that assists with the formation of blood clots. Much like tourniquets, hemostatic dressings are used with direct pressure to help control severe, life-threatening bleeding. Hemostatic dressings are usually only considered an option if: The bleeding is life-threatening The standard procedure of direct pressure failed The injury is located where a tourniquet wouldn't work, such as the torso, abdomen, groin, and neck A tourniquet was unavailable or ineffective How to Provide Care After you make sure the scene is safe, proceed with the following steps. Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol. If the victim is conscious and not in shock or showing signs of other life-threatening injuries, ask him or her to help apply pressure to the wound. Once you determine that direct pressure alone isn't working, and you've decided against using a tourniquet, apply a hemostatic agent or dressing to the wound followed by more direct pressure. Pro Tip 1: Hemostatic agents come in powders and dressing pads of numerous sizes. For large open wounds, you can pour the powder into the wound which will help speed up blood coagulation and clotting. If you're using hemostatic dressing with a large open wound, make sure you pack the dressing deep into the wound and apply continuous pressure until the bleeding is controlled. Hemostatic agents are an ideal option when EMS services are delayed or unavailable, perhaps in a wilderness setting, or when normal bleeding control options are ineffective. And like tourniquets, when it comes to hemostatic agents, you're just trying to buy some time before getting the victim to a surgical center for proper care. A Word About Internal Bleeding Internal bleeding is the blood loss from veins, arteries, and capillaries into spaces inside the body. This can be caused by injuries like blunt force trauma and fractures, but also due to certain medical conditions. Internal bleeding can also include external bleeding from the same incident. Consider how a knife wound could cause both internal and external bleeding simultaneously. Common signs of internal bleeding include: Discoloration of the skin Bruising and tenderness Nausea, vomiting, or coughing up blood Discolored, painful, tender, swollen, or firm tissue Victim protectively guarding the injury area Rapid pulse or breathing Moist, cool skin Pale or bluish skin Drop in blood pressure If you suspect that someone is bleeding internally, call 911 immediately and help keep the victim as still and calm as possible to reduce the heart's blood output. Also keep an eye on the victim for any signs of shock. Pro Tip 2: When internal bleeding is from the capillary blood vessels, the result is bruising around the wound area and is not serious. To reduce discomfort for the victim, you can apply an ice pack to the area. Like internal bleeding, injuries requiring a hemostatic dressing should be considered serious. And as with all bleeding injuries, you simply want to find the bleeding and stop the bleeding, by any means necessary. https://d3imrogdy81qei.cloudfront.net/video_images/3657/hemostatic-agents-2015.jpg Yes 105 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/agentes-hemostaticos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2049.mp4 Agentes hemostáticos https://d3imrogdy81qei.cloudfront.net/video_images/3657/hemostatic-agents-2015.jpg Yes 105 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/mechanism-of-injury https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2050.mp4 Mechanism of Injury Physical injuries run the gamut from soft tissue injuries like bruises, cuts, and burns to those involving the musculoskeletal system and/or the head, neck, and back. While injuries can vary greatly, the tools of discovery you'll use to help you assess patients will not. When you arrive on the scene, you'll apply the mechanism of injury method to help you gain a greater understanding of what possible injuries the patient may have based, in large part, on how he or she may have sustained those injuries. How to Apply the Mechanism of Injury Method As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim. Are you OK? Can you hear me? If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. Ask yourself questions like: Is the victim favoring an area or limb? Is there noticeable bleeding, protruding limbs, or other injuries? Is the victim demonstrating any concussion symptoms? Is there an obvious cause of the injury – slippery walkway, etc.? Is the victim demonstrating any airway, breathing, or circulation problems? Warning: If the patient does begin showing signs of decreasing levels of consciousness or any problems involving breathing, airway, and/or circulation – numbness, tingling, inability to move limbs – call 911 immediately. Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. Do you know what happened today? Are you in any pain?" Pro Tip #1: Ask the victim open-ended questions when you're assessing them, rather than yes and no questions. So, instead of asking, does your head hurt?, ask, do you have pain anywhere? Asking yes and no questions can often lead them down the wrong road. During your assessment, involve family members and friends who are nearby and may have witnessed the accident. They'll also be able tell you if the victim is behaving normally or has any medical problems or allergic reactions to medications. This is even more important when dealing with injuries to children. Pro Tip #2: Don't be too myopic. Even though the injury may seem obvious, that doesn't mean another injury isn't also lurking. Keep this in mind as you perform a full head-to-toe examination of the patient. A Word About Soft Tissue Injuries Soft tissues include all the layers of skin, fat, and muscles in the human body. The largest organ is the skin, as it contains three layers of its own – epidermis (outer area that protects against bacteria), dermis (deep layer that protects the nerves), and hypodermis (the deepest layer that protects blood vessels). Soft tissue injuries are classified as closed wounds or open wounds. A closed wound is an injury that occurs beneath the surface of the skin, meaning that the outer layer of skin is still intact. There is usually internal bleeding, even if only minimally in the form of a bruise. An open soft tissue wound involves a break in the skin's outer layer, like a cut, and usually involves external bleeding – arterial, venous, or capillary. Burns deserve a special distinction as a soft tissue injury and are classified as superficial, partial thickness, and full thickness. Closed Wounds Closed wounds occur beneath the surface of the skin and are usually the result of blunt force. The contusion can be minor, like stubbing your toe, to more serious examples of blunt force trauma, like those sustained in motor vehicle accidents. Swelling and discoloration are normal in closed wounds as these are part of the healing process. Closed wounds become more serous when they affect the deeper layers, those that protect larger blood vessels and vital organs. Heavy internal bleeding can occur from a contusion or hematoma and when it affects those deeper layers, the signs may not be immediately noticeable. Opened Wounds Open wounds are those that affect the outer layer of the skin. There are six types of open wounds: Abrasions – scrapes, rug burns, road rashes, etc. – abrasions are more painful due to the presence of nerve endings nearby but don't involve much bleeding as the capillaries are mostly affected. Amputations – the loss of a limb – amputations are serious injuries that rely on controlling blood loss and shock. Avulsions – part of skin peeled away – avulsions can be very painful, and bleeding can be heavy. Crush injuries – extreme weight or force crushes a body part – crush injuries can cause great internal damage to blood vessels and vital organs. Punctures – gun shot wounds, stabbing wounds, etc. – punctures are smaller wounds that typically close around the wound, thereby limiting the amount of external bleeding. However, the puncture can also result in internal bleeding. Lacerations – cut from a sharp object – lacerations vary in severity depending on several factors, including the type of bleeding that the laceration has caused – arterial, venous, or capillary. https://d3imrogdy81qei.cloudfront.net/video_images/3659/mechanism-of-injury-2015.jpg Yes 226 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/mecanismo-lesion-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2050.mp4 Mecanismo de lesión https://d3imrogdy81qei.cloudfront.net/video_images/3659/mechanism-of-injury-2015.jpg Yes 226 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/secondary-survey https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2051.mp4 Secondary Survey The secondary survey is simply a head-to-toe examination that you'll perform on injury victims who are awake and responsive. It's important to remember to not get too focused on one obvious symptom. If you come upon a patient with an obvious arterial bleeding wound, remain focused on other potential head-to-toe problems, as you help care for the more obvious injury. How to Conduct a Head-to-Toe Exam As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim. Are you OK? Can you hear me? If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. Pro Tip #1: Even though the patient is awake and responsive, symptoms can always worsen. And conditions that didn't seem life-threatening a minute ago, may seem so now. If at any point things do get worse, call 911 and activate EMS. Remember to ask yourself questions like: Is the victim favoring an area or limb? Is there noticeable bleeding, protruding limbs, or other injuries? Is the victim demonstrating any concussion symptoms? Is there an obvious cause of the injury – slippery walkway, etc.? Is the victim demonstrating any airway, breathing, or circulation problems? Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. Do you know what happened today? Are you in any pain?" Notice how much they are able to move. Are they nodding when you ask a question? Are they able to move their fingers and toes? "Can you wiggle your fingers?" Look for the early signs of shock. Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body. When organs don't receive enough blood, the body begins to conserve blood flow by limiting it to legs, arms, and the skin. This insufficient blood volume is one thing that can lead to shock, as can low levels of plasma and fluids in the blood and airway obstruction. Early signs of shock include: Nervousness Rapid heart rate or breathing Anxiousness Sweaty Fearful Clammy skin Pro Tip #2: A quick way to find out if a victim has a circulation problem, which could be a sign of shock, is to pinch a fingernail bed on the patient and count how long it takes to return to a normal pink color. Longer than 3-4 seconds could be a sign that something else is wrong. "Can you wiggle your toes?" Continue working your way down the victim, noticing any potential issues or conditions beyond the obvious. Also, make sure they're in a position of comfort, whether that's sitting, laying down, or getting to their feet and stretching out their legs. Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? Warning: It's important to remember that this secondary survey is only for patients who are awake and responsive. If at any point, a once responsive patient goes unresponsive, call 911 immediately and activate EMS. A Word About Chest Injuries Chest injuries are one of the leading causes of trauma deaths in the U.S. each year. Chest injuries are most commonly the result of falls, vehicular accidents, workplace accidents, and direct blows or crushing incidents. Warning: The area around the chest, abdomen, and pelvis contain several vital organs. Therefore, any life-threatening injury in one of these areas can be particularly fatal if left untreated. There are several types of chest injuries: Blunt Trauma Any blow to the chest or abdomen that doesn't penetrate the skin would be considered a blunt trauma injury. Common symptoms include shortness of breath, chest pain, and rapid pulse. Traumatic Asphyxia Traumatic asphyxia occurs due to a severe lack of oxygen caused by a physical trauma, typically one in which the victim was crushed or pinned. Common symptoms include shock, distended neck veins, bluish discoloration, black eyes, broken blood vessels in the eyes, bleeding from the nose or ears, and coughing up blood. Fractured Ribs Fractured ribs, though painful, are rarely life-threatening. For victims, breathing will be labored for a while and deep breaths, in particular, will be very painful. Flail Chest Multiple rib fractures in multiple places results in flail chest. Flail chest is especially serious if it includes the presence of a loose section of ribs that could puncture a lung. Pneumothorax A pneumothorax is the collapse of a lung that results from too much air in the chest cavity. At the very least, breathing will be difficult. At the worst, it could lead to respiratory distress. Hemothorax A hemothorax is excessive lung pressure due to the accumulation of blood between the chest wall and lungs, which prevents the lungs from properly expanding. https://d3imrogdy81qei.cloudfront.net/video_images/3661/secondary-survey-2015.jpg Yes 169 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/valoracion-secundaria-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2051.mp4 Valoración secundaria https://d3imrogdy81qei.cloudfront.net/video_images/3661/secondary-survey-2015.jpg Yes 169 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/head-neck-and-back-injuries-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2052.mp4 Head, Neck, and Back Injuries If you come upon a person who appears to have taken a fall, or was injured in an accident, and there are no bystanders around who witnessed the accident, you'll need to assess the victim to determine the exact injuries and their severity. Hopefully the victim will be able to help, who in this lesson, we are assuming is conscious, alert, and not exhibiting more serious issues involving airway, breathing, circulation, etc. The most important thing to keep in mind as you deal with someone who has sustained potential injuries to their head, neck, and/or back, is minimizing movement, as you inquire more into what happened and how the victim is feeling. How to Provide Care You're going to begin the same way you do with all accidents and illnesses, by making sure the scene is safe, that your gloves are on, and that you have your rescue mask with one-way valve handy if you have one. Begin calling out to the victim to assess whether or not he or she is responsive before touching them. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, check the victim for breathing, airway, or circulation problems. If you've determined that the victim is not responsive, not breathing normally, and doesn't have a pulse, call 911 immediately and go right into CPR. Pro Tip #1: Are there any bystanders around that can assist you in calling 911, locating an AED, etc.? Also, if you're ever unsure how to handle a rescue situation, call 911, put the phone on speaker, and follow the instructions from dispatch while you wait for help to arrive. For the sake of this lesson, we'll assume the victim is breathing normally, has a pulse, and is at least partially responsive. In these cases, proceed with the following steps. Introduce yourself to the victim: "Hi, my name's _____. I'm here to help you. I'm going to ask you some questions; try not to nod. Answer with yes or no. And try not to move other parts of your body.""Do you remember what just happened?""Do you know if you hit your head?""Do you know what day it is?""Do you know what year it is?" If the victim answers the last two questions incorrectly, you're likely dealing with someone who has hit their head and may have a concussion. This altered mental state is enough of a concern to call 911 and activate EMS if you haven't already done so. Otherwise, begin doing a head-to-toe exam in case there are other potentially serious injuries. On the victim's head: Is there blood in the ears? Is there blood in the nose? Does the patient have any broken teeth? Are the pupils equal size and responsive to light? Pro Tip #2: Put your hand over the victim's eyes for a second or two then remove it and see if their pupils react. If they do not, it could be due to a concussion and swelling in the brain. Check their arms and legs for any deformities. If the victim is responsive, you can ask them to squeeze one of your fingers or try to wiggle a toe. Pro Tip #3: When looking over the victim, remember not to move them. Instead, move your body for better assessment angles. Head, neck, and back injuries should be taken seriously; in most cases, it's going to be best to call 911 and activate EMS. Remember, we can always send them away when they arrive – so, better safe than sorry. Reassure the victim while you wait for EMS to arrive. Let them know you'll stay with them until help arrives, and comfort them if they get agitated. A Few Common Head, Neck, and Back Questions How do I know if the injuries are serious enough to call 911? It's not always going to be easy to figure out if EMS is required as you tend to a victim with head, neck, or back injuries. It may be a situation where the victim is able to get up and has no significant lasting injuries. Or it could be a situation that doesn't appear serious initially but suddenly becomes serious. If at any point the situation warrants it, call 911 immediately. There's a tremendous amount of gray area there, but also remember that it's better to call 911 and not need them … than it is to NOT call 911 and suddenly realize that you need them. What are some signs and symptoms of a concussion? Concussion symptoms include those that are physical, emotional, and behavioral, all of which are listed below. Physical symptoms include: Headache Blurry vision Nausea or vomiting Dizziness Sensitivity to noise or light Balance problems Feeling sluggish Emotional symptoms include: Irritability Sadness Heightened emotions Nervousness or anxiety Behavioral symptoms include: Sleeping more or less than usual Difficulty falling asleep Changes in playing habits for kids Changes in eating habits How can I know if the victim has pain or injuries that aren't visible to me? The answer to this question is simple – ask them. In all the confusion, something this simple may escape you. But while you're doing a head-to-toe exam of the victim, try and remember to ask them if anything hurts and where their pain is located. https://d3imrogdy81qei.cloudfront.net/video_images/3663/head-neck-and-back-injuries-child-2015.jpg Yes 212 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/lesiones-cabeza-cuello-espalda-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2052.mp4 Lesiones de cabeza, cuello y espalda https://d3imrogdy81qei.cloudfront.net/video_images/3663/head-neck-and-back-injuries-child-2015.jpg Yes 212 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/musculoskeletal-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2053.mp4 Musculoskeletal Injuries The musculoskeletal system is actually the combination of two specific systems – the muscular system and the skeletal system, including each of your 206 bones. And let's not forget the ligaments, tendons, and joints that hold it all together. Breaks, strains, sprains, and soft tissue injuries are some of the most common types of injuries that you'll likely encounter, in everyone from the elderly to youth sports participants. How to Assess and Handle a Musculoskeletal Injury As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim. Are you OK? Can you hear me? If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions." "Do you remember what just happened?" "How much pain or discomfort are you in?" So long as the patient is conscious, alert, and breathing normally, activating EMS can likely wait while you investigate further, as calling 911 is often not required with these types of injuries. Pro Tip #1: The real question that needs answering is this: Does this injury require activating EMS, a visit to the ER, or is it something the patient can shake off? So, how do we answer that question? With musculoskeletal injuries, the patient will often times be self-splintering – instinctively holding the area in pain – when you find them. That injury will be obvious, so make sure you also look for those that aren't. "Do you hurt anywhere else?" Also begin to further assess the injured area. If clothing is in the way, cut around that area to expose the injury. Look for bruising, swelling, some kind of deformity or abnormal angulation, bone fragments, bleeding, etc. Do you see any signs of a serious injury? Or a developing condition? How is the victim's skin color? Are the nail beds bluish or pink and normal? Poor circulation can be serious and warrants an immediate 911 call. Ask the patient how he or she feels. People, especially adults, have a sense of whether or not an injury is serious. With children, you may have to read between the lines a bit and pay more attention to body language and whether they're becoming more concerned about the injury or less concerned. If the two of you are coming to the same conclusion – that maybe the injury isn't that bad, help them walk it off, so to speak. Assist them in whatever way they need – getting to their feet or by helping to support their body weight. If it's not bad, as you suspected, they'll be fine. However, if the inverse is obvious, that the patient is in pain and the injury is now causing more discomfort, help them back into a comfortable position, call 911, and help protect and stabilize the injured area as best as you can until help arrives. Pro Tip #2: If you can safely stabilize an injury, do so. But make sure stabilization won't cause secondary problems, increase the patient's discomfort, or aggravate the injury. Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock. Remember, if you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call. A Word About the Musculoskeletal System Injuries to muscles, bones, and joints can be difficult to detect. Knowing the specific mechanisms of the injury will provide important clues about which body parts are likely injured. There are three basic mechanisms of injury: Direct force – when the injury is located at the point of impact Indirect force – when the injury is located some distance from the point of impact Twisting force – when the injury is caused by a rotating force There are four basic types of musculoskeletal injuries to keep in mind when assessing patients, each of which is caused by one of the mechanisms above. Fractures Fractures are bones that are broken or damaged – chipped, cracked, etc. Fractures can either be closed, meaning the skin over the injury is intact. Or they can be open, in that the injury is exposed, making it much more serious. Open fractures are more prone to infection. And they can include excessive bleeding that may be difficult to control. Dislocations Dislocations are the displacement of a bone. When a severe force causes a bone to move one joint away from its normal position, this is known as a dislocation. Dislocations also typically result in ligaments and tendons that have been stretched, torn, or displaced. Shoulders and fingers dislocate more easily than other areas of the body. Sprains Sprains occur when ligaments are torn or stretched. The greater the number of ligaments involved, the more severe the sprain. Strains Strains are similar to sprains but involve muscles and tendons instead of ligaments. And as tendons are stronger than muscles, making them more resistant to injury, when dealing with strains, they're more likely to involve a muscle than a tendon. https://d3imrogdy81qei.cloudfront.net/video_images/3665/musculoskeletal-injuries-2015.jpg Yes 388 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/lesiones-musculoesqueleticas-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2053.mp4 Lesiones musculoesqueléticas https://d3imrogdy81qei.cloudfront.net/video_images/3665/musculoskeletal-injuries-2015.jpg Yes 388 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/fainting https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2056.mp4 Fainting This lesson focuses on what to do when you come upon a patient who has just fainted. Fainting is defined as a temporary loss of consciousness that's usually related to temporary insufficient blood flow to the brain. Fainting is also referred to as syncope, blacking out, or passing out. There are a number of reasons why a person would pass out and many of those are not at all life-threatening. In fact, when someone faints, the biggest concern is usually the victim's inability to protect themselves as they're falling, which can lead to a number of things going wrong – broken bones, head or face injuries, etc. In many fainting situations, there is no one around who witnessed the accident. Which means you may need to put on your detective hat to properly discover potential injuries. How to Assess and Treat a Patient who Faints As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Pro Tip #1: The first thing you'll want to do is to assess for life-threatening conditions, including head and neck injuries. After ruling out more serious conditions, begin to see if the patient has a simple problem, like low blood sugar or dehydration that contributed to his or her passing out. When you come upon a fainting victim, as long as there is nothing more serious going on, they will likely be awake and responsive. They may be sitting up already or are ready to sit up with your help. At this point you'll want to interview the patient to see what's going on. "Can you tell me what happened here today?" "Do you hurt anywhere?" It's common for fainting victims to be weak and dizzy afterward. The important thing is that the patient is awake and responsive enough to answer your questions. However, continue to monitor for: Airway issues Breathing problems Weak or rapid pulse Pale, clammy skin Pale and clammy skin are signs of shock. If you determine the patient to be in shock, that warrants an immediate 911 call and activation of EMS. As always, err on the side of patient welfare. Pro Tip #2: Just because the situation doesn't appear serious doesn't mean it can't suddenly become serious. If you don't have an AED already, it's a good idea to send someone at the scene to go find one. If, for instance, the fainting was caused by a serious heart dysrhythmia, an AED could be lifesaving. It's typical for fainting victims to begin to recover under their own powers. As they are coming around, gauge their mental alertness, ask again about the presence of pain, and of course, continue to assess for signs of something more serious: Decreased level of consciousness Airway, breathing, or circulation problems Signs of shock Long-bone fractures Varying degrees of responsiveness If you, at any point, notice any of the above, call 911 and activate EMS or call in a code if you're in a healthcare setting. Then treat the patient accordingly. A Word About Syncope and Presyncope Syncope, or fainting, is caused due to a temporary reduction in blood flow to the brain. Depriving the brain of its normal blood flow can cause it to momentarily shut down. When this happens, it triggers a fainting episode or syncope. But what specifically triggers fainting? There are a number of things that trigger it, including: Emotional shock Pain Certain medical conditions Overexertion In pregnant women and older people – getting up from a seated or lying position Syncope can occur without warning. Or there could be some early signs, such as dizziness, the feeling of being lightheaded, or feeling like your about to faint. Together, these symptoms have a name – presyncope. How to Prevent Someone in Presyncope from Fainting Help the patient lay down. Continue to monitor the patient's breathing and level of consciousness. Instruct and help the patient perform physical counter-pressure maneuvers (PCM). Three Examples of Physical Counter-Pressure Maneuvers Have the patient grip one hand at the fingers with the other and try to pull them apart without letting go. They should hold the grip for as long as they can or until their symptoms disappear. Have the patient hold a rubber ball or similar object in their dominant hand and then squeeze the object for as long as they can or until their symptoms disappear. Have the patient cross one leg over the other and squeeze them together tightly. Have them hold this position for as long as they can or until their symptoms disappear. Physical counter-pressure maneuvers help raise the patient's blood pressure through skeletal muscle contraction and, in many cases, will resolve symptoms of faintness. Let the patient know to avoid holding their breath while performing the maneuvers. An easy way to avoid this is to engage the patient and keep him or her talking. https://d3imrogdy81qei.cloudfront.net/video_images/3671/fainting-2015.jpg Yes 234 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/desvanecimiento-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2056.mp4 Desvanecimiento https://d3imrogdy81qei.cloudfront.net/video_images/3671/fainting-2015.jpg Yes 234 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/diabetes-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2057.mp4 Diabetes In this lesson, you'll learn how to help a person with a blood sugar emergency. Some things to keep in mind about blood sugar problems: Signs and symptoms are the same for low blood sugar and high blood sugar Blood sugar issues will get worse without treatment Without treatment, the person could become unresponsive and die The three most common signs and symptoms of someone experiencing a blood sugar issue are: Confusion Coordination issues Talking nonsense A person with a blood sugar issue might also randomly fidget with something and appear quite out of it. There are two major types of diabetic emergencies – high blood sugar and low blood sugar. High blood sugar is different than low blood sugar for a few important reasons. The signs and symptoms of high blood sugar can take hours or days to appear. It usually involves noticeable increases in thirst and urination, as the body tries to rid itself of excess sugar. (Incidentally, these are often the first signs of diabetes.) There's very little treatment that can be provided outside of a healthcare environment. In high blood sugar emergencies, call 911 or get the person to an emergency room for treatment. Pro Tip #1: The latter stages of a high blood sugar emergency will involve something called ketoacidosis, which produces a tell-tale sign of a fruitiness or cheap wine smell on the breath. While you cannot do anything about high blood sugar, you can provide help to those suffering from low blood sugar emergencies. Warning: Low blood sugar emergencies can easily catch people by surprise, as symptoms can appear in seconds or minutes. Some common signs and symptoms of low blood sugar include: Dizziness Lethargy Confusion Slurred speech Agitation How to Provide Care Treatment for low blood sugar can be summed up with one word: Sugar. However, some delivery methods are faster than others. And some sugars aren't really sugars at all. Let's explain. Sugary food sources are abundantly available, which makes them good options in a diabetic emergency. However, you'll want to steer clear of the carbs, particularly grains and fibers, as these are slow digesting and will hinder the quick fix you're looking for. Instead, focus on candy, or better yet, drinks. Sodas and especially orange juice are great food options. Just make sure the ingredients in your “medicine” includes sugar and not a sugar substitute. So, no diet sodas for sure. A Better Option – Glucose Tabs, Liquid, Gel This option is especially key for known diabetics or friends and family members of known diabetics. Glucose products have been specially designed to be absorbed quickly. These products are more beneficial for reasons beyond how fast they work though, including: Long shelf life Stable in extreme heat and cold Small, easy to carry in a purse, backpack, etc. While glucose products are a great option for all of these reasons, they can be quite difficult to open. They naturally come sealed to avoid tampering, and while not particularly difficult to open when lucid and sober, when you're confused and dizzy and in the grips of a diabetic emergency, it could be problematic. Not to worry. Simply remove the seal in advance of any emergencies, and you may just shave some precious time off the delivery of treatment. Pro Tip #2: Known diabetics should know what their glucose dose is, just like any other type of medicine. This is something a physician can address. Knowing how much glucose you need in a diabetic emergency may be invaluable, and a much better option than guessing. A Few Common Questions About Diabetic Emergencies How long does it take for glucose products to work? It can take up to 15 minutes to feel the effects of consuming sugar or glucose after a hypoglycemic event. Known diabetics will hopefully know what their dose is and how long to wait after the first dose before taking another. If the person having the diabetic emergency isn't a known diabetic, you'll have to guess when it comes to dosing. If symptoms aren't improving after a couple of doses (for glucose products) or a full 16-ounce bottle of soda or orange juice, there could be something else going on; call 911 and activate EMS if you haven't already done so. What if the person having the diabetic emergency is having trouble swallowing or keeping food and fluids down? A person can only consume a glucose or sugar product if they are able to swallow safely. If their sugar event has escalated to the point where they cannot control their swallow reflex, it's too late. Sugar will need to be administered through an IV or by intermuscular injection. Call 911 immediately and activate EMS if this is the situation. In what other situations should I call 911? Any situation beyond the scope of your care should involve a 911 call. But as it pertains to diabetic emergencies, call 911 if the victim: Isn't breathing normally Loses consciousness Loses a pulse Goes into shock This is your first hypoglycemic event You may have gone through a diabetic emergency before, either involving yourself or someone else. But if this is your first diabetic emergency, be on the safe side (whether you're the victim or the rescuer) and call 911. https://d3imrogdy81qei.cloudfront.net/video_images/3673/diabetes-child-2015.jpg Yes 483 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/diabetes-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2057.mp4 Las emergencias diabéticas https://d3imrogdy81qei.cloudfront.net/video_images/3673/diabetes-child-2015.jpg Yes 483 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/seizure-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2058.mp4 Seizure In this lesson, you'll learn how to treat a child or adult who goes into a seizure or has just come out of one, including when to call 911. A person can have a seizure for too many reasons to mention. As you are concerned, why it happened isn't important. Being able to recognize it and treat it is the key. For you to know if a seizure took place, ideally you or someone else saw the patient go into a tonic state that exhibited the following signs: Hands are gripped and pointed inward The patient is actively seizing The patient ends the seizure in the postictal state (relaxed recovery) Pro Tip #1: Some seizure victims will be known epileptics and many of the people around them will probably know how to care for one and have been through it before. But if you're helping a person you don't know to be an epileptic, treat this event as the person's first seizure. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. However, if the victim is in the middle of a seizure, you'll want to start with the following: Call 911 and activate EMS. (Or better yet, ask a bystander to do it while you help the victim.) Protect the victim from any environmental hazards, like sharp objects. Pro Tip #2: There are many different types of seizures, some of which can be more active than others and involve the victim violently contracting and releasing. It's also quite common for a seizure victim to hit his or head on the floor or ground while seizing. Warning: Never try to hold down or prevent a seizing person from a having a seizure. All you can do for them is to keep them safe during the episode. Place something under the seizing victim's head like a coat or hoodie or even your hand. After the seizure has passed, begin a secondary assessment of the victim. Do you notice any major injuries or airway obstructions? Are there any other potentially life-threatening issues? Get the victim into a recovery position. The Recovery Position To help keep the victim's airway open and clear, put them into the following recovery position. You want gravity to work with you, as there could be saliva, blood (if the victim bit his or her tongue), or eventually vomit that may need to come out, rather than back into the victim's airway. Elevate the arm closest to you and bring it up over the victim's head before placing it on the ground. Bring the victim's furthest leg over their other leg so that their legs are crossed. Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the victim toward you and onto their side. Pro Tip #3: Always roll the victim toward you, not away. You'll have better control over them and will be much less likely to accidentally roll them too far and onto their face. Plus, being able to see their face could be important for visual clues of how they're doing. Support the head while you place the victim's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway. Bend the victim's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the victim from rolling over. While waiting for EMS to arrive, continue to assess the victim for breathing and recovery signs, like talking. Any signs that the person is becoming more responsive are good signs. Remember, if the victim begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive. A Few Common Questions About Seizures What about putting something into the victim's mouth to keep them from biting or swallowing their tongue? This practice is no longer recommended. DO NOT put anything into a seizing person's mouth. All you can do is keep them comfortable and safe during the ordeal. What if the person stops breathing while in the recovery position? If there any problems at all – the victim isn't breathing normally, loses a pulse, loses consciousness, etc. – roll them back onto their back and treat them accordingly. If the person stops breathing but still has a pulse, perform rescue breathing. If the victim stops breathing and loses his or her pulse, begin full CPR. Why do seizure victims seem confused after a seizure? A person who has just experienced a seizure – essentially an electrical storm in the brain – will be low on oxygen. As a result, they may be confused or combative and this will likely last a few minutes. https://d3imrogdy81qei.cloudfront.net/video_images/3675/seizure-child-2015.jpg Yes 377 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/convulsiones-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2058.mp4 Convulsiones https://d3imrogdy81qei.cloudfront.net/video_images/3675/seizure-child-2015.jpg Yes 377 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/snake-bites https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2059.mp4 Snake Bites In this lesson, you'll learn how to treat a patient who has been bitten by a venomous snake. When dealing with snake bite victims, there is one special point to take note of: If you have the snake, DO NOT bring it to the hospital, just take a picture from a safe distance or remember key features of the snake so the venom can be identified. Just don't get bit yourself trying to look at or take a picture of the snake. How to Treat a Patient who has been Bitten by a Snake As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Call 911 and activate EMS. Give them as much information as possible so that the patient gets routed to a hospital that has the correct antivenom. Get the patient into a comfortable position – seated or laying down – where they can be as calm as possible. They could become dizzy, and you don't want them falling and injuring themselves. Reassure the patient – tell him or her that they're in good hands, that EMS is on the way, and that they'll be taken good care of. You don't want them to get excited, nervous, or agitated, as the patient's heart rate will increase and circulate the venom faster. Warning: What you don't want to do – You don't want to use a cold pack; these have been widely ruled out now. And you certainly don't want to suck out the venom, unless you have a special fondness for urban myths. Keep the patient's snake-bitten limb or area level with the heart, if possible.  Raising or lowering of the extremity may both be correct, but that would depend on the species of snake and the condition of the patient.  Get the patient into the ambulance with as little movement as possible. Is there a golf cart around? How about a stretcher? How close can the ambulance get? You don't want them walking, or moving, any more than is absolutely necessary. Get the patient to the correct hospital with the correct antivenom and the life-saving treatment they may need. A Word About Venomous Snakes Snakebites kill few people in the United States. Of the estimated 7000 to 8000 people reportedly bitten each year, fewer than five die. And most of those deaths occur because the person has an allergic reaction, is in poor health, or because too much time passes before the person receives medical care. When it comes to the biggest threat, rattlesnakes account for most snakebites and nearly all of the deaths from snakebites. Venomous snakebite signs and symptoms include: One or two distinct puncture wounds, which may or may not bleed. The exception is the coral snake, whose teeth leave a semicircular mark Severe pain and burning at the wound site immediately after or within four hours of the bite Swelling and discoloration at the site of the bite immediately after or within four hours of the incident If the bite is from a venomous snake such as a rattlesnake, copperhead, cottonmouth, or coral snake, call 911 and activate EMS for more advanced medical personnel. To give care until help arrives, simply follow the steps outlined above. And if you're interested in more of what not to do, we have a list for that, too: Do not apply ice Do not cut the wound Do not apply suction Do not apply a tourniquet Do not use electric shock, like from a car battery https://d3imrogdy81qei.cloudfront.net/video_images/3677/snake-bites-2015.jpg Yes 185 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/mordeduras-serpiente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2059.mp4 Mordeduras de serpiente https://d3imrogdy81qei.cloudfront.net/video_images/3677/snake-bites-2015.jpg Yes 185 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/allergic-reactions https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2060.mp4 Allergic Reactions While there are only around 1500 deaths each year in the U.S. from severe allergic reactions, it is nonetheless frightening how quickly these allergic reactions can occur. Around 50 million Americans suffer from an allergy, and this is a number that's apparently on the rise. One theory as to why has to do with our too-sterile modern life. One that includes: Antibacterial soap Hand sanitizer Air-tight homes An increase in environmental pollutants It seems our body's immune systems aren't developing as effectively to fight germs and other foreign invaders like they were in the past. The most common causes of all allergic reactions are from foods (number one) and insects (number two). Children are most affected when it comes to food allergies. And while most kids outgrow their food allergies, according to the CDC, the number of children with food allergies rose by 18 percent in a 10-year span from 1997 to 2007. Pro Tip #1: While most kids outgrow most food allergies, there is one that cannot be outgrown – the peanut. Sadly, peanut allergies are for life. What Causes an Allergy? The job of your immune system is to protect your body from foreign invaders – various bacteria, germs, and viruses. A healthy immune system protects the body even in the presence of these invaders. However, when there is an allergy present, the immune system will mistakenly target and overreact to a threat that doesn't really exist. This results in your immune system attacking a harmless substance that has recently been eaten, inhaled, injected, or come into contact with the skin. And that substance is called an allergen. An allergen can be introduced to the body a number of times with no trouble. Then, for seemingly no reason, the body one day decides to flag that allergen as a foreign invader, which triggers the body to attack the allergen. And to further complicate matters, the body will remember the allergen and produce specific antibodies that will attack the allergen even more fiercely next time it's introduced into the body. Pro Tip #2: This is why allergic reactions are often more severe the second or third time – the build-up of antibodies and larger battles. When the immune system attacks the allergen, high quantities of histamine and other chemicals are released into the surrounding tissues. Depending on the part of the body affected, symptoms can include: Itching Hives and rash Sneezing Wheezing Swelling of the face Runny nose Nausea There is one particular kind of allergic reaction that can be especially life-threatening – anaphylaxis. Anaphylaxis is a severe and sudden allergic reaction that affects many parts of the body at the same time within mere minutes of the allergen coming into contact with the body. Warning: Anaphylaxis can cause the body's blood vessels to suddenly dilate – as in opening all the way up, which can lead to anaphylactic shock. Anaphylactic shock can cause a sudden drop in blood pressure resulting in organs like the brain quickly becoming oxygen-starved. Anaphylactic shock will cause death if not treated. One common and basic treatment for anaphylactic shock is epinephrine (or an epi-pen), as it constricts blood vessels and opens the airway, thereby reducing the effects of the allergen. The most common causes of anaphylaxis are bees and other stinging insects, latex, medications and the following foods: Nuts Fish Shellfish Eggs Milk The most common cause of severe, life-threatening allergic reactions is by far the peanut. How to Treat for Allergic Reactions As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." The first things you'll want to look for are the signs and symptoms of allergic reactions and anaphylactic shock: Trouble breathing Wheezing Tightness in the throat Itchiness on the tongue Swelling of the face Hives Pale skin Rapid heart rate Low blood pressure Nausea Vomiting Diarrhea Dizziness How children typically describe an allergic reaction may better help understand some of the signs: It feels like there's hair on your tongue You experience tingling Your mouth itches It feels like something is stuck in your throat Your lips feel tight Your body feels weird all over Warning: The key element with allergic reactions is time. Don't wait. Call 911 immediately. If available, use an epi-pen. But don't wait for symptoms to get better. The three steps to providing care for allergic reactions are: Recognize the signs early Call EMS or a code if in a healthcare setting Assist the patient with an epi-pen if needed Pro Tip #3: Keep the patient calm. Sit them down. Make sure they're comfortable. To make breathing easier, have the patient sit straight up and lean forward. If the patient is feeling faint or is losing consciousness, lie them down, elevate their legs, and keep them warm. Talk to them, reassure them, but be prepared to begin CPR if they suddenly stop breathing or become completely unresponsive. Warning: There is the possibility of a secondary reaction after the first. Which is why the patient should be monitored for four to six hours after the initial allergic reaction. A Word About how to Know if it's Anaphylaxis? Depending on the situation, there may be different things to watch out for as you put the puzzle pieces together. Here's a cheat sheet that may help. Situation #1: You know that the patient has been exposed to an allergen. What to Look For: Trouble breathing OR Signs and symptoms of shock Situation #2: You think the patient may have been exposed to an allergen. What to Look For: Any TWO of the following: A skin reaction Swelling of the face, neck, tongue, or lips Trouble breathing Signs and symptoms of shock Nausea, vomiting, cramping, or diarrhea Situation #3: You do not know if the patient has been exposed to an allergen. What to Look For: A skin reaction (such as hives, itchiness, or flushing) OR Swelling of the face, neck, tongue, or lips PLUS Trouble breathing OR Signs and symptoms of shock https://d3imrogdy81qei.cloudfront.net/video_images/3679/allergic-reactions-2015.jpg Yes 464 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/reacciones-alergicas-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2060.mp4 Reacciones alérgicas https://d3imrogdy81qei.cloudfront.net/video_images/3679/allergic-reactions-2015.jpg Yes 464 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/how-to-use-an-epipen-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2061.mp4 How to Use an EpiPen There's nothing as scary as a severe and sudden allergic reaction (called anaphylaxis), as the body reacts to a foreign substance that produces a number of different symptoms simultaneously, and usually within mere minutes of the allergen coming into contact with the body. Anaphylactic shock will cause death if not treated. Epinephrine is the first line of defense when it comes to treating anaphylaxis. And the sooner it's administered, the less severe the allergic reaction. In this lesson, we'll cover what anaphylactic shock is, what it does to the body, and how we can help someone who's having a severe allergic reaction until advanced medical personnel arrive. Anaphylaxis Effects on the Body During a severe allergic reaction, there are two biological mechanisms working together, albeit while moving in opposite directions. Blood vessels relax and dilate. As this happens, blood and other fluids leak into the body's tissues, which decreases blood pressure and will eventually starve vital organs of oxygen. At the same time, the airway begins to tighten. The bronchioles and alveoli sacs are filling with mucus and other fluids and breathing becomes more and more difficult. People with a history of allergic reactions should always carry an epinephrine pen. Pens are single dose, pre-filled, automatic injection devices, also known as epi-pens. The following instructions are specifically for Epi-Pen brand. If you're using a different brand of epi-pen, be sure to follow the manufacturer's instructions. How to Provide Care Before we get into how to use an epi-pen, let's look at some common signs and symptoms of an allergic reaction, which include: Hives Itchiness Swollen tongue Scratchy throat Pale Lightheaded Difficulty breathing Pro Tip #1: Any time an epi-pen is used, be sure to call 911 and activate EMS. The person, even if feeling better, must seek further medical attention after a severe allergic reaction. Especially if this is their first allergic reaction. Make sure the epi-pen isn't expired. Remove the pen's safety cap. Grip the pen in your hand with the tip pointing down. Warning: Never put your thumb, fingers, or hand over the tip of the pen (or the back); you may accidentally inject yourself while treating the victim. Firmly push the tip of the pen into the victim's outer thigh at a 90-degree angle and until you hear the pen click. Needles can penetrate clothing. Keep the auto-injector firmly pressed against the patient's thigh; hold for a minimum of three seconds. Pull the epi-pen straight out. Warning: Make sure you don't pull the pen out at an angle. This can cause a lot of pain and bleeding. And if blood comes out of the leg (along with some epinephrine), there's a good chance the effectiveness of the shot will be reduced. Rub the area for 10 seconds, as this will increase absorption of the epinephrine within the leg muscle. Pro Tip #2: A second epi-pen may be used if symptoms persist or recur and if EMS has been delayed for more than 5 to 10 minutes. Usually the patient will notice some airway relief pretty quickly, as the tightness in the throat begins to dissipate. There are, however, some unfortunate side effects that some patients may experience, including: Rapid heartbeat Shakiness Feelings of anxiety Dizziness Headache A Few Common Questions About Anaphylaxis Should I administer the epinephrine, or should I let the victim do it? Let the victim handle the epi-pen if they're able to. If dealing with a small child or someone who's unable to do it themselves, assist as needed. If you do have to assist, try and get permission to do so for reasons of liability. The American Heart Association recommends helping in the following scenarios: Only assist if/when: The patient has a previous diagnosis of anaphylaxis and has been prescribed an epinephrine auto-injector The patient is having signs and symptoms of anaphylaxis The patient requests your help using an auto-injector Your state laws permit giving assistance What if there are complications while waiting for EMS to arrive? It's always a good idea to monitor for other issues while waiting for paramedics to arrive, like loss of consciousness, an increase in breathing difficulties, respiratory arrest, and cardiac arrest. If the person stops breathing but still has a pulse, perform rescue breathing. If the victim stops breathing and loses his or her pulse, begin full CPR. Pro Tip #3: Remember, you can always call 911 and put the phone on speaker. Dispatch can help walk you through any first aid scenarios you may not be comfortable with. Also, it's important to understand that once a person loses consciousness and a pulse, they're technically already dead. And there's no way to make that situation any worse. If the victim begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive. Are there different doses of epinephrine? Yes. Epinephrine devices are available in different doses, as the dose of epinephrine is based on weight – 0.15 mg for children weighing between 33 and 66 pounds, and 0.3 mg for children and adults weighing more than 66 pounds. People with a known history of anaphylaxis would be wise to carry an anaphylaxis kit containing at least two doses of epinephrine with them at all times. https://d3imrogdy81qei.cloudfront.net/video_images/3681/how-to-use-an-epipen-child-2015.jpg Yes 274 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/como-usar-epipen-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2061.mp4 Cómo usar un Epipen https://d3imrogdy81qei.cloudfront.net/video_images/3681/how-to-use-an-epipen-child-2015.jpg Yes 274 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asthma https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2062.mp4 Asthma Anyone who has experienced an asthma attack will tell you what a frightening situation it can be, as your airways tighten and no matter what you do, you simply cannot get enough oxygen into your lungs. Pro Tip #1: Want to know what it feels like to have an asthma attack? Imagine only being able to breathe using a thin, plastic coffee stir straw. That would approximate how a severe asthmatic attack would feel. In this lesson we'll discuss one of the best medications for acute and chronic asthma attacks (Albuterol) and how to use it correctly. How to Treat a Patient with Asthma As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Pro Tip #2: Albuterol comes in a small aerosol container with an actuator. Whether the patient's asthma is exercise induced or persistent, the effect should be the same regardless. In this lesson, we're going to include the use of a spacer with the Albuterol dispenser. Spacers are really expensive, which probably contributes to many people not using one, and sort of resembles a small plastic sippy cup. The spacer goes between the patient's mouth and the Albuterol dispenser. Warning: When not using a spacer, much of the medication, instead of going into the patient's lungs and bronchials where it should go, winds up sitting at the back of the throat and on the tongue. This obviously decreases the dosage and the effectiveness of that dose. How to Administer Albuterol Using a Spacer Pro Tip #3: Before using your Albuterol device, make sure it has actuations remaining. To find this information, look on the back of the dispenser. Most devices have a number there inside a little window that corresponds with the number of actuations remaining. And don't forget to check the expiration date! Shake the Albuterol container just prior to using it. You don't have to shake for long. A few seconds will do the trick. Insert the Albuterol mouthpiece into the end of the spacer where it fits. (It will be obvious.) Place the other end of the spacer into the patients mouth. Make sure he or she completely exhales first. Push down on the Albuterol dispenser one time and instruct the patient to hold his or her breath for 10 seconds. Instruct the patient to exhale. Pro Tip #4: A normal dosage of Albuterol for most adults is two inhalations and children may be one or two doses. So we need to always ask the patient about their specific dosage. Repeat – patient exhales out all air, puts spacer into their mouth, dispense Albuterol, hold for 10 seconds, and exhale. If the patient doesn't get relief from two injections, ask them what their prescribed amount of time is between injections and doses. If the patient is still having trouble breathing, call 911 and activate EMS. They could be suffering from a persistent asthma attack that cannot be stopped with a simple rescue inhaler of Albuterol. Get help on the way immediately, in case the patient begins having a true respiratory emergency. It's important to avoid assumptions that the patient will get better after administering a dosage of Albuterol. Always be prepared for anything. A Word About Asthma Triggers Asthma is an illness in which the airways swell. An asthma attack happens when an asthma trigger, such as exercise, cold air, allergens, or other irritants, causes the airways to suddenly swell and narrow. This makes breathing difficult, which can be very frightening. The Centers for Disease Control and Prevention (CDC) estimates that approximately 24 million Americans are diagnosed with asthma in their lifetimes. Asthma is more common in children and young adults than in older adults, but its frequency and severity are increasing in all age groups. You can often tell when a person is having an asthma attack by the hoarse, whistling sound the person makes while inhaling and/or exhaling. This sound, known as wheezing, occurs because air becomes trapped in the lungs. But what exactly triggers an asthma attack? A trigger is simply anything that sets off an attack. And they can be very different for different people. Common asthma triggers include: Dust, smoke, and air pollution Exercise Plants Molds Perfume Medications Animal dander Temperature extremes and changes in the weather Strong emotions, such as anger, fear, or anxiety Infections, such as colds or other respiratory infections Usually, people diagnosed with asthma control their attacks by controlling environmental variables (exposure to those triggers) and through medication and other forms of treatment. https://d3imrogdy81qei.cloudfront.net/video_images/3683/asthma-2015.jpg Yes 264 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asma-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2062.mp4 Asma https://d3imrogdy81qei.cloudfront.net/video_images/3683/asthma-2015.jpg Yes 264 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/recovery-position https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2063.mp4 Recovery Position In this lesson, you'll learn how to safely use the recovery position, for those times when you encounter a patient who is breathing but unconscious. The recovery position is used in the following scenario: The patient is unresponsive The patient is breathing normally The patient has good skin color, good circulation It's not an immediate CPR situation How to Put a Patient into the Recovery Position As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. In this situation the patient is unresponsive to your taps and shouts, which elicits an immediate 911 call and finding and/or preparing an AED for use, as you begin to assess the scene for clues of what happened. The patient could have ended up unconscious for a number of reasons: Passed out or fainted Suffering from low blood sugar Seizure Electrocution Warning: If you suspect electrocution, take extra measures to make sure the scene is safe. Is the power source still active? Is it still touching the patient? To help keep the patient's airway open and clear, put them into the recovery position using the following steps: Warning: Only use the recovery position if you don't suspect fractures, or serious neck and back injuries. Elevate the arm closest to you and bring it up over the patient's head before placing it on the ground. Bring the patient's furthest leg over their other leg so that their legs are crossed. Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the patient toward you and onto their side. Support the head while you place the patient's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway. Bend the patient's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the patient from rolling over. Pro Tip #1: The purpose of the recovery position is to expel any foods or liquids that come up. What comes up needs to come out. If it doesn't, it could find its way into the patient's lungs. The recovery position is also a great way for the patient to lay safely while waiting for EMS. Using the patient's leg as a kickstand allows his or her body to use gravity without the threat of them rolling completely over. Pro Tip #2: You want gravity working with you as you wait for EMS to arrive. It's important to eliminate the risks of the patient choking or an obstructed airway. Having the patient facing downward will help negate those risks. Warning: If the patient loses their pulse or stops breathing, immediately roll them onto their back and start CPR. Continue to reassess the patient while you wait for EMS to respond, particularly for signs of shock, responsiveness, airway, breathing, and circulation. And treat accordingly should the situation change. A Word About the Signs of Inadequate Breathing Inadequate breathing requires careful monitoring. You may not notice all of the signs and symptoms at once, and some can be hard to spot. If you see any of them, be prepared to give assisted ventilation. When the patient has to expend too much effort to breathe and their breathing has become inadequate, you'll notice the following signs: Muscles between the ribs pull in when the patient breathes in. As the patient enhales, you may notice the muscles pulling inward between the ribs, above the collarbone, around the muscles of the neck and below the rib cage. Pursed lips breathing. The patient exhales through pursed lips, like a whistling motion. This maneuver helps control the patient's breathing pattern. Flaring out of the nostrils on inhalation can be a sign of inadequate breathing in children and infants. Apparent signs of fatigue are also an indication of labored breathing. Excessive use of abdominal muscles to breathe, as in when the patient is using the abdominal muscles to force air out of the lungs. Sweating and anxiousness are also signs of severe respiratory distress. A patient who is sitting upright and leaning forward with hands on knees could be doing so because they're struggling to breathe. Abnormal breathing sounds are also a great sign of inadequate breathing. Listen for abnormal sounds such as wheezing or crackling. Wheezing or whistling sounds indicate restricted air flow and are common with conditions such as asthma, allergic reactions, and emphysema. If the patient has a fine cracking sound on inhalation, that may indicate fluid in the lungs. https://d3imrogdy81qei.cloudfront.net/video_images/3685/recovery-position-2015.jpg Yes 227 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/posicion-lateral-seguridad-recuperacion-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2063.mp4 Posición lateral de seguridad https://d3imrogdy81qei.cloudfront.net/video_images/3685/recovery-position-2015.jpg Yes 227 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/heat-cold-emergencies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2064.mp4 Heat-Related Emergencies As you know, the human body runs at an internal temperature of 98.6 degrees Fahrenheit, or 37 degrees Celsius. The control center responsible for regulating this internal temperature is located in the brain, and more specifically, the hypothalamus. The hypothalamus receives information and adjusts body functions to maintain this optimal temperature. The temperature range – that which allows cells to stay alive and healthy – is actually quite narrow, at between 97.8 degrees and 99 degrees. Let's quickly look at the process of how the body cools down on its own. The hypothalamus detects a rise in blood temperature. Blood vessels close to the surface of the skin begin to dilate. This brings more blood to the surface and allows heat to escape. At the end of this lesson, we'll get into the five general ways in which the body can be cooled externally, along with several types of heat-related conditions to watch out for. How to Treat for a Heat-Related Emergency Heat-related emergencies typically occur in hot environments and when the patient hasn't been rehydrating enough to compensate for water loss. Common symptoms of a heat-related emergency include: Profuse sweating Dizziness Extreme thirst Cramping, usually in arms or legs Warning: Losing fluids can be very serious. In the absence of proper medical treatment, if the condition cannot be reversed, it will likely progress to the next level which is heatstroke. Pro Tip #1: If the patient suddenly goes from wet to dry and stops sweating, it's because the patient's body doesn't have enough fluids to lose. This is a good indication that the warning above is now likely a reality, making the situation that much more serious. Your number one goal when dealing with a heat-related emergency is to cool the patient down any way you can. Ideally, the patient is able to get some fluids down. But if for some reason they aren't able to drink or swallow or can't hold fluids down, you'll need to cool them off externally. Find a water source and some containers or a hose and begin pouring water over the victim, including their clothing, to help bring their core temperature down to a safe level. Another great aid in these situations is the cold pack. If you have some available, try placing them under the patient's armpits, the back of the neck, or forehead. Pro Tip #2: The key to successfully treating someone who is having a heat-related emergency begins by recognizing that emergency. Time is crucial. Once you've diagnosed the problem, the next step is reversing the condition by cooling them down. If at any point, the patient becomes unresponsive, goes unconscious, or is not able to breathe normally, call 911 immediately and activate EMS. Then begin CPR. A Word About Heat-Related Emergencies There are several types of heat-related conditions to be aware of, but let's first look at the general ways in which the body can be cooled. Radiation Radiation involves the transfer of heat from one object to another, though without physical contact. The human body also loses heat due to radiation, mostly through the head, feet, and hands. Convection Convection occurs when cold air moves over the skin and carries heat away. The faster the flow of air, the faster the body will be cooled. Convection is why warm skin feels cooler in a breeze. Convection also assists in the evaporation process. Conduction Conduction occurs when the body is in direct contact with something that is cooler than the body's temperature. Conduction allows the body's heat to transfer to the cooler object. Think about swimming in a cold lake or leaning against a cool slab of stone. Evaporation Evaporation is the process by which a liquid or solid becomes a vapor. When body heat causes one to perspire and the perspiration evaporates, the heat that was absorbed into the sweat dissipates into the air which cools off the skin. Respiration The last way in which the body can cool itself is through respiration. Before air is exhaled, it's warmed by the lungs and airway. Respiration accounts for around 10 to 20 percent of heat loss. There are several types of heat-related illnesses (hyperthermia) to be aware of, including dehydration, exercise-associated muscle cramps, exertional heat exhaustion, and heatstroke. Dehydration Dehydration occurs when there is an inadequate supply of water in the body's tissues. Dehydration can be serious and life-threatening, particularly for the very young and very old. Symptoms, which include fatigue, headaches, irritability, nausea, and dizziness, will worsen as the body continues to lose water. Exercise-Associated Muscle Cramps Muscle cramps are thought to occur due to a combination of fluid and electrolyte loss through sweating. Muscle cramps typically come on quickly and after rigorous work or exercise and are particularly more common in warmer environments. Exertional Heat Exhaustion Exertional Heat Exhaustion occurs when the body loses more fluids than are replenished. As this happens, the body will divert blood from the surface of the body to vital organs like the heart and brain. This type of heat-related illness is usually the result of intense physical activities and often in hot and humid climates – athletes, firefighters, construction workers, etc. Heatstroke Heatstroke is the most serious type of heat-related illness and can be life-threatening if quick action isn't taken. As there is a progressive nature to these conditions, ignoring the warning signs of exertional heat exhaustion can quickly lead to a body that will become overwhelmed by heat and begin to stop functioning. https://d3imrogdy81qei.cloudfront.net/video_images/3687/heat-cold-emergencies-2015.jpg Yes 220 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/emergencias-relacionadas-calor-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2064.mp4 Emergencias relacionadas con el calor https://d3imrogdy81qei.cloudfront.net/video_images/3687/heat-cold-emergencies-2015.jpg Yes 220 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/car-backing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2067.mp4 Car Backing / Reversing This lesson deals with car backing emergencies and how you can prevent them. You're probably well aware of the extreme number of lives lost each year on U.S. roads and highways. But how many of you give consideration to lives lost by another type of traffic accident – those involving vehicles backing up? A number of lives are lost each year from slow-backing accidents, and many of these occur at home in the driveway. The problem is that, even when you're alert and paying attention while backing up, children can still dart behind your vehicle and get quickly into a blind spot in the time it takes to glance at the rearview mirror. Warning: When a small child is behind a vehicle, the driver often cannot see the child in any of the mirrors, creating a dangerous blind spot for the child. Which is why adopting a safe routine for backing up is so important. Create a Safe Backing Routine It's important to have a policy or protocol in place that you can execute each time before you even put the car in reverse to ensure your children are safe before backing out. You can put together a safe backing routine a number of ways, but one that works well is to establish a visible gathering place for all the kids. The gathering place should be in a location you can see them and in front of the vehicle. Do a head count. When all kids are accounted for, put the vehicle in reverse and back out slowly. Be sure to continue to monitor the children for any movement, but also in a way that allows you to scan mirrors for traffic and other people. Backing up at a minimal speed is important, as it may be necessary to suddenly stop in case there's an emergency. Pro Tip: A car moving slowly is a car with the ability to stop quickly. (Not really Pro Tip material, but better than leaving you Pro Tipless this lesson.) Remember that an ounce of prevention is worth a pound of cure. And that any moments of inconvenience are well worth the bit of extra effort. A Word About Lightning Yes, lightning! While it has absolutely nothing to do with car backing emergencies, it does deserve special recognition, as an ounce of prevention is truly worth a pound of cure when it comes to lightning strikes. In the U.S., there are more deaths each year due to lightning strikes (100) than due to any other weather-related hazard or event, including blizzards, hurricanes, floods, tornadoes, earthquakes, and volcanic eruptions. During a lightning strike, the lightning travels back and forth between the ground and the cloud many times during that one visible flash. How's that, you ask? Well, lightning travels at a swift 300 miles per second. The list of possible effects on someone who has been struck by lightning include: Thrown through the air Clothes burned off Heart stops beating Neurological damage Fractures Loss of hearing Loss of sight A single lightning strike can wreak havoc on the human body, as it can deliver up to 50 million volts of electricity, or enough to light 13,000 homes. Precautions You Can Take to Avoid Being Struck by Lightning During storms, it pays to use common sense and to respect the power of nature. Use the following precautions to stay safe in inclement weather. Postpone activities promptly and remember that thunder and lightning can strike without rain. Go inside a completely enclosed building. If you cannot find one, a cave is a good option, but move as far back as possible from the cave entrance. Watch cloud patterns and conditions for signs of an approaching storm. Designate safe locations and use them at the first sound of thunder. And remember, every five seconds between the flash of lightning and the sound of thunder equals one mile of distance. Use the 30-30 rule. When you see lightning, count the seconds until you hear thunder. If that time is 30 seconds or less, the thunderstorm is within six miles. Seek shelter immediately. The threat of lightning continues for a much longer period than most people realize. So, wait at least 30 minutes after the last clap of thunder before leaving the shelter. If inside during a storm, keep away from windows. Injuries may occur from flying debris or glass if a window breaks. Stay away from plumbing, electrical equipment, and wiring during a thunderstorm. Water and metal are both excellent conductors of electricity. Do not use a corded telephone or radio transmitter except for emergencies. Bonus Precaution: If the movie Caddyshack taught us anything, it's the dangers of golfing during a thunderstorm. Hit the clubhouse for an hour or three, or postpone entirely. https://d3imrogdy81qei.cloudfront.net/video_images/3693/car-backing-2015.jpg Yes 110 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/reversa-auto-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2067.mp4 Reversa / marcha atrás en auto https://d3imrogdy81qei.cloudfront.net/video_images/3693/car-backing-2015.jpg Yes 110 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-proofing-the-home https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2068.mp4 Child Proofing the Home Child-proofing a home is essential to protect children against normal household items that could present a risk to them, such as sharp objects, and choking and electrical hazards. Pro Tip: To see what a child sees, you have to get to their level. So, drop down to your hands and knees and begin crawling around the house looking for hazards that children can get into. You may be surprised what you notice seeing things from that perspective. How to Child Proof a Home There are a number of hazards in any home to be aware of, including: Choking hazards. Any loose item that can fit into a child's mouth will likely end up … in a child's mouth. It takes just a few minutes to pick these items up and prevent a possible emergency. Electrocution hazards. Items that may not be a choking hazard can still be put into an electrical outlet. If those items are metal, that could be a problem. Children are naturally curious and tend to exist according to the mantra, I wonder what happens if. Burn threats. Young kids aren't big enough to reach the stove yet, but that doesn't mean that burn hazards don't exist. Watch where you put hot beverages like coffee, tea, and soup. On the edge of a low-lying tabletop that can be reached by an infant is a burn waiting to happen. Staircase threats. Staircases are dangerous environments for small children. Keep doors to stairs closed or use an adjustable safety gate that fits into stairways. Also, keep stairs clear of items that everyone, adults included, can trip over. Child-proofing a home will greatly help eliminate these unnecessary hazards. Prevention takes only a bit of time and effort, but it can make a huge difference in the health and lives of the children in that home. A Word About Helping a Conscious Choking Infant Since the biggest threat, and reason for child-proofing a home, is likely choking, let's take a look at the exact technique for helping a conscious choking infant. You'll be performing a combination of back slaps and chest thrusts to try and dislodge the airway obstruction. But first, if there is a parent or legal guardian present, make sure to get permission before beginning the following procedure. Back Slap and Chest Thrust Technique for Infants Place your thumb and index finger over the baby's cheekbones and around the face. Make sure you're supporting the infant's head and neck. Turn the infant over so they are facing down. Rest the infant's body on your forearm, so their legs are straddling your bicep. Hold the baby at about a 30-45-degree angle, so the head is lower than the feet. This will allow gravity to assist, rather than hinder, your efforts. Using your other palm, perform five back slaps between the infant's shoulder blades. Using the same hand that you just used to perform the back slaps, hold the back of their head and neck and turn the baby over so they are facing up. Draw an imaginary line across the infant's nipples and place two fingers on the sternum in the center of the infant's chest. Your fingers should be perpendicular to the chest, meaning your knuckles are directly above your fingers. Make sure the head is lower, just like before, at around a 30-45-degree angle. Perform five chest thrusts, much like you would when performing CPR on an infant. It's important that you keep the infant's body stabilized when doing the back slaps and chest thrusts. If you allow the infant's body to move downward with each slap or thrust, you'll minimize the effects necessary to force enough air up the trachea to remove the obstruction. Continue to perform a combination of back slaps and chest thrusts until the object comes out and the infant is breathing normally again. If you called 911, let them come anyway, so the infant can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. And they can do a quick assessment for internal bleeding or other damage. If you did not call 911, it's always a good idea for you or someone else to take the infant into an urgent care center, hospital, or to see their physician to determine if more care is necessary. This conscious infant choking procedure is around 80 percent effective if you perform the back slaps and chest thrusts properly. If you couldn't remove the obstruction, the infant will go unconscious pretty quickly. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious infant choking procedure. https://d3imrogdy81qei.cloudfront.net/video_images/3695/child-proofing-the-home-2015.jpg Yes 140 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/hogar-a-prueba-ninos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2068.mp4 Hogar a prueba de niños https://d3imrogdy81qei.cloudfront.net/video_images/3695/child-proofing-the-home-2015.jpg Yes 140 https://app.protrainings.com/courses/bls/healthcare/videos/pool-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2069.mp4 Pool Safety Every year numerous lives are needlessly lost to drowning incidents, and many of those lost are young children. In this lesson, you'll learn how to recognize a drowning victim and how to help them to safety. Many times, a person who is a true drowning victim behaves differently than we might expect. They're likely not yelling for help, as they could be taking in water and unable to speak. It's important to understand what a drowning victim looks like. Signs of a potential drowning victim include: Exaggerated movements Head bobbing up and down at water line Arms flailing Making little noise beyond sounds of splashing How to Safely Rescue a Potentially Drowning Victim Once you've identified a potential drowning victim, use the following methods to rescue them and help them safely out of the pool. Pro Tip #1: The protocol for rescuing a drowning victim can be summed as such: Reach. Throw. Don't go. DO NOT swim out to get them unless you're a trained and certified lifeguard. Otherwise, you could end up a second drowning victim. Try to reach the victim from the side of the pool. If the victim is close enough, make sure you stay low to the ground and maintain a low center of gravity, while reaching out to them with your hand. Pull them out of the pool or assist them in getting to the nearest ladder and then out. Turn a towel into a rope. If you can't reach the victim with a hand, grab a towel and coil it up into a makeshift rope. Swing one end out to the drowning victim while you hang onto the other end. Drag the towel in with the victim in tow and help them out of the water. Use a pole or leaf skimmer. A swimming pool usually has these sorts of poles laying around, either for rescue purposes or cleaning and maintenance. And they often can telescope in and out, making them ideal to aid a drowning victim who is further away from the side of the pool. Pro Tip #2: If using a pole to assist a drowning victim, make sure you're standing with your forward-leading foot out in front of you. Lean back and use your weight as a counterbalance. Extend the pole and lower it down beside the victim. Once they grab it, lean back and pull them to safety. Use a life jacket or floatation device. If the victim is too far out to reach any other way, see if there are some floatation devices, like pool noodles or life jackets that you can toss out to them. Once the victim has the floatation device, instruct them to kick their feet and encourage them to keep coming, as they're likely exhausted and scared. Pull them to safety once they reach the side of the pool. If you called 911 and activated EMS, it's a good idea to keep them coming, especially if the victim took in some water. There could be some potential breathing issues or an aspirational pneumonia developing. Warning: If the victim is unresponsive when pulled from the water, begin CPR immediately. And always call 911 as soon as you think there's an emergency. If it turns out there isn't an emergency, you can always cancel the 911 call. But if turns out to be a real emergency, you'll be glad you activated EMS. A Word About Drowning When it comes to drowning, there are several critical facts and statistics to be aware of. Some important statistics. Drowning is the fifth most common cause of death from accidental injury in the United States for all ages, and it rises to the second leading cause of death for children ages 1 to 14. And males are more than three times more likely to drown than females. On the threat of drowning. Younger children can drown at any moment, even in as little as an inch of water. Young children commonly drown in home pools. Children with seizure disorders are 13 times more likely to drown than those without such disorders. Early recognition is key. Most people who are drowning spend their energy trying to keep their mouth and nose above water. As you learned earlier, recognizing someone who seems to be having trouble in the water, but is not calling out for help, may help save their life. There are three types of water-related victims: A distressed swimmer who is too tired to continue but afloat. A drowning victim who is active and vertical but not moving forward. A drowning victim who is passive, floating, or submerged and not moving. Don't become a victim yourself. Only those trained in swimming rescues should enter the water to assist with drowning emergencies. For your safety, look for a lifeguard before attempting a rescue, have the appropriate safety equipment, call for additional resources immediately if you do not have that equipment, and only swim out if you have the proper training, skills, and equipment. https://d3imrogdy81qei.cloudfront.net/video_images/3697/pool-safety-2015.jpg Yes 340 https://app.protrainings.com/courses/bls/healthcare/videos/seguirdad-piscina-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2069.mp4 Seguridad en la piscina https://d3imrogdy81qei.cloudfront.net/video_images/3697/pool-safety-2015.jpg Yes 340 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-abuse https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2070.mp4 Child Abuse and Neglect Child abuse and neglect is a very serious topic and not one that anyone enjoys reading about. But it's vitally important, especially for those of you working in an industry mandated to report any suspicions of abuse and neglect. Pro Tip #1: A mandated reporter is a person required by law to report reasonable suspicions of abuse and neglect, such as teachers, day care providers, EMS personnel, coaches, camp staff, and other professionals. According to statistics from the U.S. Department of Health and Human Services, 679,000 children were the victims of abuse and neglect in 2013, and in that same year 1500 children died as a result. Of those 679,000 child abuse victims, 80 percent suffered from neglect, 18 percent from physical abuse, and nine percent from sexual abuse. These numbers indicate a serious problem that has become far too common. In this lesson, you'll learn the key indicators for recognizing abuse and neglect in children. How to Recognize Abuse and Neglect Child abuse is a prevalent problem that can occur anywhere, including: Child day care centers Schools Religious institutions Recreational and athletic facilities Camps Residential facilities The child's home What is Neglect? Neglect by a parent or primary caregiver is the most prominent type of child abuse. It's defined as a failure to provide adequate food, clothing, shelter, supervision, or medical attention. Indications of neglect include a child who … Looks undernourished Appears lethargic and tired Has poor hygiene Is inappropriately dressed for the weather Sustains injuries due to lack of supervision Has poor self esteem Has trouble relating to others What is Physical Abuse? Physical abuse is defined as non-accidental physical injury to a child – by striking, shaking, throwing, burning, biting, cutting, etc. Pro Tip #2: All kids get bumps and bruises from time to time, particularly those that are more adventurous or into sports. It's important for you to understand when those injuries occur due to abuse versus regular childhood mishaps. Physical indications of physical abuse include: Questionable bruises, cuts, and welts Cuts and bruises to the torso, back, buttocks, and thighs Injuries in various stages of healing, indicating abuse over time Bruises shaped like the objects that were used – belt buckle, electrical cord, etc. Burns like those from cigarettes, particularly on the soles of the feet, palms of the hands, back, and buttocks Immersion burns like you would get from scalding hot water Burns in the shape of irons, stove top burners, etc. Rope burns, especially on the arms, legs, neck, and torso Fractures Black eyes Behavioral indications of physical abuse include when the child is … Uncomfortable with physical contact Wary of adults Apprehensive when other children cry Emotionally unstable, aggressive one moment, withdrawn the next Frightened of own parents Afraid to go home – perpetually arrives to school early and stays late Trying to hide the injuries – reluctant to change in front of others, wears clothes to conceal injuries Pro Tip #3: Does the child have a history of running away from home? A child with a long history of repeated attempts to run away can also be cause for concern, particularly when combined with any other indicators of abuse. What is the Difference Between Discipline and Abuse? This comes up occasionally as corporal punishment (spankings and such) are still allowed in certain areas of the U.S. What defines discipline? It is a learning process to teach appropriate behavior. What defines abuse? Inflicting pain; that's it. There's no learning objective. It's usually the result of anger, frustration, and loss of control. How Can You Tell the Difference Between Abuse and Accidental Injury? As mentioned earlier, kids get hurt sometimes; it's part of being a kid. But sometimes it's much more than that. And while injuries from abuse and accident can look similar, there are some important differences you should know about. When it comes to accidental cuts and bruises, the areas most affected are on the outside of the body, like knees and elbows. However, with abuse, the common areas are the stomach and buttocks. As frequency goes up, the chances of accidental injury go down. Look for injuries, especially bruises, in different stages of healing, as in different colors. This may become a moot point if the child is a tackle football player. Do the injuries resemble an object – like a wooden spoon or electrical cord – or appear in a pattern. These are pretty suspicious circumstances and most likely from an adult. Has the parent or primary caregiver provided the same story as the child? Does their relationship appear normal, or does the child appear afraid of the parent or caregiver? What is Sexual Abuse? Sexual abuse is a complex type of child abuse and is defined as any illegal sexual act upon a child including incest, rape, indecent exposure, fondling, child prostitution, and child pornography. There are often no visible signs to accompany sexual abuse, or else they're too subtle to notice or attributed to something else. Add to that how the adult abuser is usually able to manipulate the child into silence and uncovering sexual abuse becomes even more difficult. For the child, this sort of manipulation is beyond their scope of understanding. It's emotionally confusing. And it results in a wide range of emotional responses. Indications of child sexual abuse include when the child has … Inappropriate knowledge of sex Sexually explicit drawings An unexplained fear of a person or place or is attempting to avoid a familiar adult Nightmares or sleep disruptions Become withdrawn Guilt and shame issues Symptoms of depression and anxiety Wild mood swings Pro Tip #4: The best indicator is when a child says so. Take statements seriously. Resolve doubt in favor of the child. And err on the side of protection. Three Ways Sexually Abused Children Share Their Experience Because of the secrecy involved or the fact they're told something bad will happen, children who are sexually abused rarely tell anyone. They may, however, provide a mix of clues if you're paying attention. Here are three examples of things a child suffering from sexual abuse may say. Indirectly – My babysitter keeps bothering me. Disguised – What would happen if a girl was being touched in a bad way and she told someone? With strings attached – I'm having a problem, but if I tell you about it, you have to promise not to tell anyone. When dealing with a child who has been sexually abused, listen, remain calm, and encourage the child to talk, but never press them. Be honest. Tell them the truth, which is that you may need to tell someone in order to get them the help they need. If you ever suspect abuse or neglect, report your suspicion to local law enforcement or child protective services in your area. And if you're a mandated reporter, you have a legal responsibility to report. https://d3imrogdy81qei.cloudfront.net/video_images/3699/child-abuse-2015.jpg Yes 896 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/abuso-infantil-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2070.mp4 Abuso y abandono infantil https://d3imrogdy81qei.cloudfront.net/video_images/3699/child-abuse-2015.jpg Yes 896 https://app.protrainings.com/courses/bls/healthcare-first-aid/videos/first-aid-advanced-intro https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2071.mp4 ProFirstAid Advanced Introduction Welcome to ProFirstAid Advanced. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. Your instructor for the duration of your ProFirstAid Advanced course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a cofounder of ProCPR and ProTrainings. In other words, you're in good hands. We created ProFirstAid Advanced with you in mind. In our busy modern world, it's hard to imagine fitting anything else into our already jam-packed schedules and especially several hours' worth of CPR and first aid training. Since your schedule is already hectic, we created ProFirstAid Advanced to be available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. ProFirstAid Advanced is a course we designed specifically for healthcare professionals like yourself who need infant, child, and adult CPR training that also includes using a bag valve mask, AED, and a team approach to CPR for two rescuers, as well as all of the first aid components. The list of occupations that can benefit from the ProFirstAid Advanced course is long and includes: CNAs LPNs LVNs Deputy Sheriffs Firefighters Lifeguards Forestry Other Health Care Professionals who also require First Aid The total course time includes about 5 hours and 30 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual from the top of your video course page. Additionally, if you want the hands on skill evaluation, we can easily add that option on. What You Will Learn in this Course Your ProFirstAid Advanced course curriculum is extremely substantial. Some of the important things you'll be learning are: Introductory First Aid Training• The Five Fears of CPR Rescue Heart Attack and Stroke• Stroke• Heart Attacks Cardiac Arrest Training• Adult, Child, Infant, Neonatal CPR• Adult CPR Team Approach• Hands-Only CPR AED Training• 2-person AED• Adult, Child, Infant AED Choking Training• Adult, Child, Infant Choking (Conscious)• Adult, Child, Infant Choking (Unconscious) Bleeding Control• Capillary, Venous, Arterial Bleeding Shock Control• Shock• Fainting Ongoing Assessment for Injury and Illness• Mechanism of Injury• Secondary Survey• Musculoskeletal Injuries• Amputation• Head, Neck, and Back Injuries• Seizure• Eye Injuries• Allergic Reactions• Snake Bites• Diabetes Heat and Cold Emergencies• Snow Safety - Prevention, Hypothermia, Frostbite• Heat and Cold Emergencies• Burns Prevention• Car Backing• Child Proofing the Home• Poison Control• Pool Safety• Child Abuse and Neglect Respiratory Arrest Training• Adult, Child, Infant Rescue Breathing• Adult Bag Valve Mask Two Rescuer Skills Training• Adult, Child, Infant 2 Rescuer CPR Bloodborne Pathogens• Reducing Your Risk• Exposure Incident ProFirstAid Advanced is an online CPR (adult, child, and infant) and First Aid certification course for the healthcare provider. We also have our ProCPR course that covers BLS without the first aid portion. If you are currently certified with Red Cross, AHA, National Safety Council, ASHI, or Medic First Aid, you are welcome to utilize the Advanced.ProFirstAid.com program and receive a new, two-year ProFirstAid Advanced certificate. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Welcome again to ProFirstAid Advanced. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3701/first-aid-advanced-intro-2015.jpg Yes 49 https://app.protrainings.com/courses/bls/healthcare-first-aid/videos/introduccion-avanzada-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2071.mp4 Introducción a primeros auxilios avanzados https://d3imrogdy81qei.cloudfront.net/video_images/3701/first-aid-advanced-intro-2015.jpg Yes 49 https://app.protrainings.com/courses/bls/healthcare/videos/adult-rescue-breathing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2072.mp4 Adult Rescue Breathing In this lesson, we're going to look at how and when to use rescue breathing on an unconscious adult patient. The main factor when it comes to rescue breathing is whether or not you can find a pulse. As you know, if the patient isn't breathing normally and doesn't have a pulse, you go immediately into CPR. However, if when assessing the patient, you do find a pulse and are confident that it is a pulse, that's when you'll use rescue breathing. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. Look one more time for signs the patient is breathing normally. If you've determined at this point that the victim is unresponsive, not breathing normally (as you now know from previous lessons, agonal respiration is not breathing normally and should be considered the same as NO respirations), but does have a pulse, continue immediately with rescue breathing. Rescue Breathing Technique for Adults Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand, three one-thousand, four one-thousand, five one-thousand … On six one-thousand, breathe into the rescue mask again. Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse. Pro Tip #1: You're going to continue to perform one rescue breath every six seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every six seconds for two more minutes. And so on. Pro Tip #2: Make sure the patient's chest rises as you perform your rescue breaths. If it doesn't, this could indicate an airway obstruction. Warning: If at any point you discover that the patient's pulse is gone, go immediately into full CPR and use an AED if you have one available. A Word About the Respiratory System The respiratory system is divided into two parts – the upper airway tracts and the lower airway tracts. The lower airway tracts access the respiratory system through the nose and mouth. As air is inhaled through the nose, it's warmed and humidified. Air inhaled through the mouth goes over the tongue and into the pharynx. The pharynx is divided into three parts – the nasopharynx, the oropharynx, and the laryngopharynx. The nasopharynx lies behind the nasal cavity. The oropharynx is located behind the oral cavity and is the shared passageway for both food and air. The laryngopharynx is the lowest part of the throat and divides into two passageways. The back portion is the entrance to the esophagus, which is the passageway for food. The front portion is the larynx, which is the continuation of the respiratory system. Above the larynx is the epiglottis – a flap of cartilage that folds down over the larynx to close it off to the trachea during swallowing, so that food doesn't enter. Incidentally, this only works if the person is conscious. After air travels through the pharynx, it then passes through the larynx. At the top of this structure is the hyoid bone (a horseshoe-shaped bone that helps support the structure of the larynx), made mostly of cartilage, muscle, and membranes. Below the hyoid bone are the thyroid and cricoid cartilages, which form the larynx. The lower airway tract begins below the vocal cords and consists of the trachea, bronchi, and lungs. The trachea is a hollow tube that's supported by rings of cartilage. It extends downward until it divides into two branches called bronchi, that connect with each lung. The two bronchi are also hollow tubes and supported by cartilage. And they, too, divide – into lower airways called bronchioles. Bronchioles are thin hollow tubes that remain open and lead to the alveoli. The alveoli – small sacs that form the end of the airway – number in the millions. Each alveolus shares a wall with capillary blood vessels. This point, where the walls of the alveoli and the walls of the capillaries come into contact, is where external respiration takes place – that all-important exchange of oxygen and carbon dioxide between the respiratory and circulatory systems. https://d3imrogdy81qei.cloudfront.net/video_images/3703/adult-rescue-breathing-2015.jpg Yes 144 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-adultos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2072.mp4 Respiración de rescate en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3703/adult-rescue-breathing-2015.jpg Yes 144 https://app.protrainings.com/courses/bls/healthcare/videos/child-rescue-breathing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2073.mp4 Child Rescue Breathing This lesson focuses on how to perform rescue breathing on an unconscious child for the healthcare provider. As you'll soon see, there's one important distinction compared with rescue breathing for adults. As you learned in the last lesson, what you find during your patient assessment will determine whether you'll perform full CPR or only rescue breathing. During your assessment, use your eyes and ears – is the chest rising and falling? Is the patient making any sounds that may indicate normal breathing? Is the patient showing signs of oxygen deprivation, like blue around the lips? How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? Pro Tip #1: There are two different sizes of rescue masks with one-way valves. There's an adult/child size and an infant size. You should always carry both, but if you don't and the mask you do have is too big, try turning it upside down. What you're aiming for is a good seal over both the nose and mouth. If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. Look one more time for signs the patient is breathing normally. If you've determined at this point that the child is unresponsive, not breathing normally but does have a pulse, continue immediately with rescue breathing. Pro Tip #2: So, you know that agonal respiration isn't normal breathing. But do you know what it looks like? Have you ever seen a fish out of water gasping for air? It's similar to that. However, the important thing to remember is that while it really does look like breathing, it really isn't. Rescue Breathing Technique for Children Grab an appropriately-sized rescue mask and seal it over the child's face and nose. Lift the victim's chin and tilt his or her head back slightly – just past perpendicular. Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand … On two or three one-thousand, breathe into the rescue mask again. Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse. Pro Tip #3: The sequence has changed. With children, you're going to perform one rescue breath every two to three seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every two to three seconds for two more minutes. And so on. Remember to make sure the patient's chest rises as you perform your rescue breaths. If it doesn't, this could indicate an airway obstruction. Remember, if at any point you discover that the patient's pulse is gone, go immediately into full CPR and use an AED if you have one available. A Word About Respiratory Emergencies Identifying a respiratory emergency quickly and providing high-quality care is essential, as we humans cannot survive long without oxygen. The human brain is quick to be impacted by oxygen deprivation. After 4-6 minutes, brain damage is possible. Between 6-10 minutes, brain damage is likely. And after 10 minutes, it's all but certain. Reasons for breathing difficulties are numerous and include: An obstruction Low oxygen environment The presence of poisonous gases Infection Trauma Poor circulation Other health issues There are two types of respiratory emergencies – respiratory distress and respiratory arrest. During respiratory distress, breathing is difficult, labored, and/or restricted in some way. During respiratory arrest, breathing stops entirely. Respiratory distress is often a sign of more serious health conditions and should be taken seriously. As for the causes of respiratory distress, they include: A partially obstructed airway Illness Chronic conditions such as asthma Electrocution, including lightning strikes Heart attack Injury to the head, chest, lungs, or abdomen Allergic reactions Drugs Poisoning Emotional distress When assessing a patient for respiratory distress, listen, watch, and ask. Does their breathing look and sound labored? And how does the patient feel? Ask them to see if the optics are as bad as their symptoms. And as for the signs and symptoms of respiratory distress, they include: Slow or rapid breathing Unusually deep or shallow breathing Gasping for breath Wheezing, gurgling, or high-pitched noises Unusually moist or cool skin Flushed, pale, ashen, or bluish skin color Shortness of breath Dizziness or light-headedness Pain in the chest or tingling in the hands, feet, or lips Apprehensive or fearful feelings https://d3imrogdy81qei.cloudfront.net/video_images/3705/child-rescue-breathing-2015.jpg Yes 153 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-ninos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2073.mp4 Respiración de rescate en niños https://d3imrogdy81qei.cloudfront.net/video_images/3705/child-rescue-breathing-2015.jpg Yes 153 https://app.protrainings.com/courses/bls/healthcare/videos/infant-rescue-breathing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2074.mp4 Infant Rescue Breathing This lesson focuses on how to perform rescue breathing on an unconscious infant for the healthcare provider. And there are a few differences between adult/child rescue breathing and delivering rescue breaths to an infant that we'll highlight below. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your infant-sized rescue mask with a one-way valve handy and begin calling out to the infant to assess whether or not he or she is responsive. Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.) If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the baby's feet, shoulder, or rub their belly. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. Look one more time for signs the infant is breathing normally. If you've determined at this point that the infant is unresponsive, not breathing normally but does have a pulse above 60 beats per minute, continue immediately with rescue breathing. Pro Tip #1: Notice that with infants, we check for a pulse using the brachial artery rather than the carotid artery. Also, keep in mind that a weak pulse can be considered the same as no pulse in infants. The dividing line is 60 beats per minute. If lower, begin CPR immediately. If above, establish that the infant isn't breathing normally, then begin rescue breathing. Rescue Breathing Technique for Infants Grab a small-sized rescue mask and seal it over the infant's face and nose. Place something firm under the infant's shoulders (if possible) to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand … On three one-thousand, breathe into the rescue mask again. Pro Tip #2: What does slightly sniffing look like? Imagine you've just walked into a kitchen and caught the whiff of a freshly baked apple pie. You turn your head upward ever so slightly to catch a better smell. Ever so slightly, or neutral, is our goal when delivering rescue breaths to infants. The sequence for infants is the same as the sequence for children – one rescue breath every two to three seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every two to three seconds for two more minutes. And so on. Warning: As an infant's lungs are considerably smaller than the lungs of adults and even children, be careful not to force air in beyond the full point. To do this, watch closely as you deliver rescue breaths and stop when the chest reaches its apex. Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse. Pro Tip #3: As adults don't normally breathe one breath every two to three seconds, there's a chance you may become hyperventilated while doing rescue breathing. To combat this, take in a deep breath, hold it, and use that air to deliver a few rescue breaths. This is especially important if you feel like you're about to begin hyperventilating. Remember, if at any point you discover that the patient's pulse has disappeared, go immediately into full CPR and use an AED if you have one available. A Word About Pediatric Considerations and Respiratory Emergencies It's really important to quickly recognize breathing emergencies in children and infants and to provide treatment before their hearts stop beating. In adults, when their hearts stop beating, it's typically because of a disease. However, in children and infants, their hearts are usually healthy. Which is why when a child's or an infant's heart stops beating, it's usually the result of a breathing emergency. When helping a child with respiratory problems, keep in mind that a lower airway disease may be caused by birth problems or infections such as bronchiolitis, bronchospasms, pneumonia, or croup. Several of the illnesses and diseases that affect respiratory systems in infants and children are preventable through vaccines. These include: Diphtheria Measles, mumps, and rubella Whooping cough Pneumococcal disease Mycoplasma pneumonia Chickenpox Some diseases that may not have respiratory symptoms might still be spread through respiratory transmissions, such as mumps and severe diarrhea. https://d3imrogdy81qei.cloudfront.net/video_images/3707/infant-rescue-breathing-2015.jpg Yes 132 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-bebe-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2074.mp4 Respiración de rescate en bebés https://d3imrogdy81qei.cloudfront.net/video_images/3707/infant-rescue-breathing-2015.jpg Yes 132 https://app.protrainings.com/courses/bls/healthcare/videos/opioid-overdose https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2075.mp4 Opioid Overdose As the opioid epidemic rages on and grows, learning how to treat for opioid overdose becomes even more important. And that's the focus of this lesson – learning how to assess for, and provide treatment for, opioid/opiate overdose. Opioids are central nervous system depressants. The central nervous system is responsible for controlling every organ, system, and function in the human body, including both the respiratory system and the cardiovascular system. When the central nervous system becomes depressed too much, these organs, systems, and functions will begin to slow down and eventually cease to operate. Who is at Risk of an Opioid Overdose? While you're right to think that addicts and illegal drug users are most at risk, the truth is that anyone who takes an opiate or opioid is at risk of overdosing, particularly when: An amount is taken beyond the prescribed dose It's taken in combination with other central nervous system depressants, like alcohol The patient has an unknown medical condition that creates a hypersensitivity to opioids Common opiates/opioids include: Heroin Morphine Codeine Methadone Hydrocodone (brand names: Vicodin, Lortab) Oxycodone (brand name: Percocet) There are some commonly used drugs that can cause signs and symptoms similar to an opioid overdose, including: Cocaine LSD Ecstasy Tranquilizers Marijuana Pro Tip #1: While the standard and immediate treatment for opioid overdose (spoiler alert: Naloxone) works well to reverse the condition and revive the patient, if their problem is one related to another substance, like those in the list above, naloxone will have zero effect. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If the patient is unconscious, you'll want to assess for normal breathing and determine if the patient has a pulse. As you know by now, the presence of a pulse but not normal breathing means you'll go right into rescue breathing. While the absence of both means you'll perform full CPR. While it may not always be possible to be certain of an opiate/opioid overdose, there are some signs to point in that direction, including: Drugs or empty drug packages near the victim Very slow respiration Pinpoint pupils Treatment for Opioid Overdose For patients with known or suspected opiate/opioid addiction issues, the immediate course of treatment is administering naloxone, either by intramuscular injection or intranasal mist. Of course, make sure administering naloxone is allowed per your organization's regulations and protocols. Pro Tip #2: The recommended dose of naloxone is 2mg for the rapid reversal of overdose symptoms when respiratory distress is present. The benefit of using a nasal atomizer is that it will administer the naloxone in a readily available form, like a fine mist which the patient can quickly absorb. To administer naloxone via the nasal atomizer, proceed with the following steps: Assemble the nasal atomizer per the instructions. Tilt the patient's head back slightly. Position the nasal atomizer into one nostril and briskly spray half of the amount (approximately 1cc). Position the nasal atomizer into the other nostril and spray the remaining naloxone. Wait 3-5 minutes. Continue to perform rescue breathing or CPR while waiting for the naloxone to take effect. If there isn't any change in the patient after 3-5 minutes, administer a second dose of naloxone. If a second dose doesn't revive the patient, something else is likely wrong. Either there aren't any opiates in the patient's system. Or they're unusually strong or plentiful and will require more naloxone. A Word About the Signs and Symptoms of Substance Abuse and Misuse Many of the signs and symptoms of substance abuse and misuse are similar to those of other medical emergencies. Which means you cannot necessarily assume that individuals who are stumbling, disoriented, or have a fruity, alcohol-like odor on the breath are intoxicated by alcohol or other drugs, as this may also be a sign of a diabetic emergency. As in other medical emergencies, you don't have to be certain of your diagnosis for substance abuse or misuse to provide care. It can be helpful, however, if you notice certain clues that suggest what the problem really is. Such clues will also help you provide as much complete information to advanced medical personnel so that they can continue providing prompt and appropriate care. Often these clues will come from the patient, bystanders, or the scene itself. As mentioned earlier, look for containers, pill bottles, drug paraphernalia, and signs of other medical problems. If the patient is incoherent or unconscious, try to get information from any bystanders or family members. Since many of the physical signs of substance abuse mimic other conditions, you may not be able to determine that a patient has overdosed. To provide care, you only need to recognize abnormalities in breathing, skin color and moisture, body temperature, and behavior, any of which may indicate a condition requiring professional help. https://d3imrogdy81qei.cloudfront.net/video_images/3709/opioid-overdose-2015.jpg Yes 290 https://app.protrainings.com/courses/bls/healthcare/videos/sobredosis-opioides-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2075.mp4 Sobredosis de opioides https://d3imrogdy81qei.cloudfront.net/video_images/3709/opioid-overdose-2015.jpg Yes 290 https://app.protrainings.com/courses/bls/healthcare/videos/adult-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2076.mp4 Adult CPR A patient who is unconscious, not breathing normally, and has no pulse is in cardiac arrest and needs CPR. CPR is a combination of chest compressions and ventilations that circulates blood and oxygen to the brain and other vital organs for a person whose heart and breathing have stopped. Remember the five links in the Adult Cardiac Chain of Survival: Recognize the cardiac emergency and call 911 Early CPR Early defibrillation Advanced life support Integrated, post-cardiac arrest care How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally (as you now know, agonal respiration is not breathing normally and should be considered the same as NO respirations), and has no pulse, continue immediately with CPR. CPR Technique for Adults Pro Tip #1: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Pro Tip #2: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. A Word About High-Quality CPR It's important to understand what constitutes high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. High-Quality CPR Performing chest compressions at a rate of 100-120 per minute Compressing to a depth of at least 2 inches but not exceeding 2.4 Allowing for full recoil after each compression Minimizing pauses in compressions Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise Low-Quality CPR Compressing at a rate slower than 100 per minute or faster than 120 per minute Compressing to a depth less than two inches or greater than 2.4 inches Leaning on the chest between compressions or performing compressions while not directly over the victim's heart Interrupting compressions for greater than 10 seconds Providing excessive ventilation – too many breaths or breaths with excessive force Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life with the patient breathing normally again, an AED becomes available and ready to use or you getting too exhausted to continue. https://d3imrogdy81qei.cloudfront.net/video_images/3711/adult-cpr-2015.jpg Yes 243 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-adultos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2076.mp4 RCP en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3711/adult-cpr-2015.jpg Yes 243 https://app.protrainings.com/courses/bls/healthcare/videos/child-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2077.mp4 Child CPR Much of what was covered in the last section – Adult CPR – will apply in this section – Child CPR. There will, however, be some subtle but crucial differences that will be highlighted. But first, let's recap the five links in the Child Cardiac Chain of Survival: Injury prevention and safety Early CPR Early Emergency Care Pediatric advanced life support Integrated post-cardiac arrest care Child-related cardiac arrests are typically the result of a hypoxic event, such as: Drowning Choking/airway obstruction Exacerbation of asthma Due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation. Warning: Laryngeal spasms (sudden spasm of the vocal cords) may occur in these situations, making passive ventilation during chest compressions minimal or nonexistent. Administering high-quality CPR can help overcome this oxygenation problem. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the child is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. CPR Technique for Children Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go roughly 2 inches deep, or 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Grab the appropriately-sized rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly – just past perpendicular. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. A Word About the Differences Between Child CPR and Adult CPR This section began by mentioning a few subtle differences between adult CPR and child CPR. There are four distinct differences to be aware of. Opening the Airway While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hyperextension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground. Performing Compressions The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions at 1/3 of the child's chest and using just one hand. Compressions to Ventilations Ratio If there is only a single responder, continue using the 30 compressions to two ventilations ratio. However, if there are two responders, that ratio changes to 15 compressions to two ventilations. Using AEDs AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the child. If the child weighs more than 55 pounds, continue using the adult AED pads. If the child weighs less than 55 pounds, use pediatric AED pads if available. Warning: It's vitally important that the AED pads do not touch each other. If the child is too small for adult pads, and you do not have pediatric pads, place one on the center of the sternum and the other on the child's back between the scapulae. https://d3imrogdy81qei.cloudfront.net/video_images/3713/child-cpr-2015.jpg Yes 112 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-ninos-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2077.mp4 RCP en niños https://d3imrogdy81qei.cloudfront.net/video_images/3713/child-cpr-2015.jpg Yes 112 https://app.protrainings.com/courses/bls/healthcare/videos/neonatal-bls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2080.mp4 Neonatal BLS Neonates are newborns who are less than a month old. It's important to note that there are some significant differences between resuscitating neonates compared to infants. As with infants, it's most common for the respiratory drive or lack of oxygen to contribute to the neonate's unresponsiveness versus a cardiac-driven event. This is important as it reflects how we perform rescue breaths and CPR. The following CPR instructions are for respiratory distress. Pro Tip #1: The rescue mask for neonates is extremely small. It's important to have rescue masks to fit every size patient, as an adult mask could prove useless when trying to resuscitate a newborn. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin to assess whether or not the newborn is responsive. If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the newborn's feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. Pro Tip #2: If the newborn's pulse is 100 beats per minute or less but not less than 60, perform rescue breathing – one rescue breath every two to three seconds. If the newborn's pulse is less than 60, begin to perform full neonatal CPR – three chest compressions followed by one rescue breath. CPR Technique for Neonates Just as you would for infants (the landmarks are the same), draw an imaginary line across the newborn's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the baby's chest, meaning your knuckles are directly above your fingers during compressions. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on neonates, use only your fingers to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go to a depth of 1/3 of the newborn's chest cavity, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform three chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Breathe once into the rescue mask and wait for the chest to rise and fall. Continue to perform three chest compressions to one rescue breath for two minutes then reassess for vital signs. If the neonate's pulse is still slow or there is no pulse, continue CPR until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Pro Tip #3: Although most situations involving an unresponsive neonate will be due to a respiratory problem, remember that there is a difference in how we resuscitate an unresponsive newborn who has had a cardiac-related event that led to their current condition. If their condition was due to a congenital heart defect or cardiac arrest, perform 15 compressions to two rescue breaths and repeat. Performing Neonate CPR in a Two-Responder Setting This two-responder scenario is more likely to be found in a clinical or professional health setting. It allows the responders to incorporate things like high-flow oxygen with a bag valve mask and the use of circumferential thumb compressions. This is much more efficient when performing just three compressions to every breath, as one responder can handle the bag while the other performs the compressions. A Word About Vital Signs (By Age) Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations. For Adults (12 years and older) Pulse rate – 60 to 100 beats per minuteRespirations – 12 to 20 breaths per minute For Children (1 year to 12 years old) Pulse rate – 80 to 100 beats per minuteRespirations – 15 to 30 breaths per minute For Infants (1 month to 12 months old) Pulse rate – 100 to 140 beats per minuteRespirations – 25 to 50 breaths per minute For Neonates (full term to 30 days) Pulse rate – 120 to 160 beats per minuteRespirations – 40 to 60 breaths per minute https://d3imrogdy81qei.cloudfront.net/video_images/3719/neonatal-bls-2015.jpg Yes 376 https://app.protrainings.com/courses/bls/healthcare/videos/svb-bls-neonatal-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2080.mp4 Soporte vital básico (BLS) neonatal Aunque la reanimación neonatal no es necesariamente parte del programa normal de BLS (Soporte Vital Básico), creemos que es importante que aquellos que tienen un bebé de menos de un mes o aquellos que trabajan con neonatos, comprendan la diferenciación entre la RCP infantil o del bebé y la reanimación neonatal. https://d3imrogdy81qei.cloudfront.net/video_images/3719/neonatal-bls-2015.jpg Yes 376 https://app.protrainings.com/courses/bls/healthcare/videos/adult-aed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2081.mp4 Adult AED An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm. Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? Pro Tip #1: If the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from any water first, then use the AED. These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient. If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if it is a concern, you can disconnect it and remove it from the pathway to the heart. Necklaces should be moved to the side Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads Piercings shouldn't cause any problems It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it There are no special considerations for pregnant women Pro Tip #2: It's OK to be just as aggressive with a pregnant woman as you would any other patient. The primary focus should be on the mother, as saving her will also help save the baby. The care you provide to the mother won't put the baby in any more jeopardy. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED. AED Technique for Adults Turn on the AED. Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. Make sure they adhere well. Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About Abnormal Heart Rhythms The most common abnormal heart rhythm that causes cardiac arrest is known as ventricular fibrillation, or V-fib, for short. When in V-fib, the patient's heart ventricles fibrillate, or quiver, without any organized rhythm. Electrical impulses fire randomly, which prevents the heart from pumping and circulating blood. Another less common and less life-threatening abnormal heart rhythm is called ventricular tachycardia, or V-tach, for short. In V-tach, the heart is controlled by an abnormal electrical impulse that fires too fast for the heart's chambers to completely fill, which disrupts the heart's ability to pump and circulate blood. Both V-fib and V-tach typically result in no pulse and no normal breathing. https://d3imrogdy81qei.cloudfront.net/video_images/3721/adult-aed-2015.jpg Yes 353 https://app.protrainings.com/courses/bls/healthcare/videos/dea-adulto-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2081.mp4 DEA para adultos Ahora vamos a cubrir DEA en un adulto con un único rescatista para el profesional de la salud. https://d3imrogdy81qei.cloudfront.net/video_images/3721/adult-aed-2015.jpg Yes 353 https://app.protrainings.com/courses/bls/healthcare/videos/spinal-injury---jaw-thrust https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2084.mp4 Spinal Injury - Jaw Thrust This section is about providing care for someone who has taken a fall or sustained a physical injury that may appear to include the spine, and how you should proceed in these situations. Before we get into the jaw thrust CPR technique, there are some other things to keep in mind first. When you encounter a victim who appears to be immobile and in pain, you want to minimize their movement as much as possible, as you inquire more about what happened, how the patient is feeling, and whether or not you need to activate EMS. If the victim is conscious, let them know who you are and that you're there to help. Instruct the patient to not move and avoid nodding, and to answer your questions verbally, as you continue to assess his or her condition. Look specifically for head wounds and bleeding – from the head, nose, and ears. Check to see if the person has any broken teeth and if their pupils are responsive to light. Pro Tip #1: To check for responsiveness to light, simply place one hand over the patient's eyes and then remove it. Do the pupils react? If not, the victim could have a possible concussion and swelling of the brain. If you suspect this to be the case, call 911 immediately. Otherwise, if the victim is conscious, has a heartbeat, and is breathing normally, you may not have to call 911, at least while you continue to assess the situation. Some questions you should ask include: Do you remember what happened? Did you hit your head? Can you tell me what hurts? Can you move your arms, legs, fingers, toes? Do you know what day it is? Do you know what year it is? Should the victim answer one of those last two questions incorrectly, you may be dealing with someone who may have an altered mental state, likely due to a head injury. Remember, if you suspect a head injury at any point during your evaluation, call 911 immediately. Warning: If the patient is showing signs of paralysis, this could potentially lead to spinal shock. You may recall learning about the signs of shock in the bleeding control course material – pale, cold, sweaty, etc. If the patient does go into shock, this could lead to the patient becoming unresponsive and requiring CPR. Pro Tip #2: If you see signs of shock, cover the patient with a blanket or coat. It's important to keep them warm while you continue to reassess for airway or circulation problems. Should the patient become unresponsive or begin having trouble breathing normally, or go into full cardiac arrest, proceed with CPR using the jaw thrust technique to avoid any potential and/or further spinal injuries. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the patient's forehead and tap on his or her collarbone, while also reminding yourself not to move the neck or head. If you still do not get a response, proceed with CPR as you normally would. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse (or brachial pulse in infants), located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Jaw thrust Technique when Performing CPR The purpose of the jaw thrust technique is to minimize cervical spine movement. It requires two responders. One should be positioned at the head of the patient, while the other begins chest compressions as you normally would. When you get to the point of delivering two breaths into the rescue mask, proceed with the following steps: Place the apex of your rescue mask over the bridge of the victim's nose. Seal the bell part of the mask just below the patient's bottom lip and above the chin. Place both of your thumbs on top of the mask, as your fingers fan out and over the sides of the patient's face. As you push down on the mask with your thumbs, use your fingers to grab the mandible, or jaw, and pull it up into the mask. Pro Tip #3: The jaw line goes down then hooks at the back of the jaw, providing the leverage points you'll be using to pull the jaw upward, into the mask. Warning: Remember that you do not want to perform a normal head tilt, chin lift on a patient who you suspect may have a spinal injury. The only scenario when you would use the normal maneuver is if you are the lone responder and you have no choice. As you pull the jaw up into the mask, give one rescue breath, wait for the chest to rise and fall, and give one more rescue breath in the same manner. Continue with CPR – chest compressions followed by jaw thrust rescue breaths – until help arrives, an AED arrives, or the patient is responsive and breathing normally. A Word About Two-Responder CPR When two responders are available, responder one should size up the scene and make sure it's safe, begin the primary patient assessment, and then begin chest compressions. Responder two should call for help, get/find an AED, or prepare its readiness if you have one, while responder one continues with 30 chest compressions followed by two rescue breaths. Continue this way until responder two is ready to jump in and take over or until the AED is ready to use. When the AED is ready, responder one should move to the patient's head while responder two gets into a hovering position to perform chest compressions. Switch positions when the responder performing chest compressions becomes fatigued. Pro Tip #4: The best time to switch positions is while the AED is analyzing the patient. Use an agreed upon term like switch, and make sure the responder doing the chest compressions is counting out loud so the other responder can anticipate the switch. https://d3imrogdy81qei.cloudfront.net/video_images/3727/spinal-injury---jaw-thrust-2015.jpg Yes 386 https://app.protrainings.com/courses/bls/healthcare/videos/lesion-espinal-traccion-mandibular-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2084.mp4 Lesión espinal - tracción mandibular Tenemos una persona aquí que parece que se cayó por las escaleras. No había espectadores alrededor para darnos un testimonio ocular de qué pasó exactamente. No sabemos si se golpeó la cabeza, no sabemos cuántos escalones cayó, lo que sí sabemos es que está tendido en la base de una serie de escalones, un tramo de escalera y parece estar dolorido. Lo que vamos a hacer es intentar minimizar el movimiento del paciente a medida que comenzamos a averiguar más sobre lo que pudo haber ocurrido y qué está pasando. Recuerda, el objetivo de hacerlo es para averiguar si necesitamos llamar al 911 y obtener ayuda en camino o si esta persona está lo suficientemente bien para poder volver a la vida normal y simplemente salir de ello. https://d3imrogdy81qei.cloudfront.net/video_images/3727/spinal-injury---jaw-thrust-2015.jpg Yes 386 https://app.protrainings.com/courses/bls/healthcare/videos/adult-bag-valve-mask https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2085.mp4 Bag Valve Mask This lesson will focus on how to use your bag valve mask, why we might use it instead of the traditional mouth to mask rescue technique, and any concerns that may come with using a bag valve mask (BVM). There are three sizes of bag valve mask systems – infant, child and adult. There are many mask sizes and styles as well from neonate and infant all the way up to adult. Having the correct size mask helps to create a good seal for the breaths or ventilations. Having the proper size bag ensures enough air is given without an unnecessary risk of too much air into the lungs. Pro Tip #1: If you only have the adult-size bag valve system, it is not recommended to use on infants or children. Giving too much air can cause trauma to the lungs as well as a decrease in blood flow to the heart. Therefore, for best patient care, using the appropriately sized bag valve for each patient is recommended. Some aspects to be aware of concerning bag valve masks: Sometimes the oxygen reservoir will be attached right out of the bag from the manufacturer; other times you'll have to attach it yourself. The reservoir is meant to be used with 100 percent oxygen, so when you ventilate the patient, they're getting a higher concentration of oxygen to compensate for any oxygen deprivation they may be experiencing. You may have to first attach the oxygen tubing to the oxygen inlet on the bag as well as the oxygen source (tank or wall mount). Pro Tip #2: If you don't see the oxygen reservoir bag inflating, or if it's inflating too slowly, put your thumb over the outlet inside the mask. This will seal the bag system so no oxygen is escaping, and the reservoir will fill more quickly. The oxygen should be set to high flow to fill the reservoir more quickly and to keep the reservoir inflated while ventilating the patient. When sealing the mask over the patient's face, there are a couple important points to note: The shape of the mask: You have the apex part of the mask that goes over the patient's nose, and the bell part of the mask (the wider end) that goes around the victim's chin and under the bottom lip. The specific method for holding and attaching the mask: The CE method. Your index finger and thumb form the C and go around the stem of the mask and are used to balance pressure on one side of the mask when attaching it, while your palm will put pressure on the other side of the mask. Your other three fingers will form the E, as they grab the patient's mandible, or jaw line, and draw it up into the mask. Warning: Do not push the mask down onto the patient's face. This will not provide a proper seal and may even block the airway. It's your fingers and palm that creates the seal, and it's the drawing of the mandible into the mask that provides the proper head tilt, chin lift before delivering your ventilations. When a second responder comes in handy: If certain facial features are complicating the sealing of the mask, incorporate the second responder into the effort. Responder one uses two hands to create the seal, while responder two provides the ventilations using the bag. Warning: If you do not see the patient's chest rise and fall, your seal is not tight or the airway is not open, and the patient is not receiving the life-saving oxygen they need. Pro Tip #3: If there is no way to get a proper seal, there are other adjuncts available, but these may be considered advanced life support techniques in your area. Supraglottic airways – these are designed to fit the stem of the bag valve without the mask and can help deliver a secured airway with ventilations. Endotracheal tubes – these are also designed to be used with the stem of the bag valve and assist with delivering oxygen. Both options are possibilities if the mask isn't fitting or sealing properly. Pro Tip #4: If you're not able to deliver ventilations successfully using the bag valve mask, don't use it. Set it aside and use a regular rescue mask with a one-way valve and deliver breaths with the mouth to mask technique. Don't waste time that the patient doesn't have, as they are likely becoming anoxic by the second. The benefits of using a bag valve mask: They can be safer when it comes to infection control. They can deliver higher concentrations of oxygen with each breath. Another important note: Bag valve masks work best when incorporated into the team approach. Bag valve masks require practice to perfect. So, if you're supposed to be using one as part of your own particular protocol or if you simply see the benefits of using it when compared to the traditional mouth to mask rescue technique, practice as much as you can first. What do they say about practice? It makes perfect. And perfect use of the bag valve mask could mean the difference between life and death. https://d3imrogdy81qei.cloudfront.net/video_images/3729/adult-bag-valve-mask-2015.jpg Yes 415 https://app.protrainings.com/courses/bls/healthcare/videos/bolsa-valvula-mascarilla-adulto-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2085.mp4 Ventilación con bolsa válvula mascarilla https://d3imrogdy81qei.cloudfront.net/video_images/3729/adult-bag-valve-mask-2015.jpg Yes 415 https://app.protrainings.com/courses/bls/healthcare/videos/adult-cpr-2-rescuer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2086.mp4 Adult CPR 2 Rescuer In this section, we're going to cover two-responder adult CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.) The advantage of having a second, fully-trained and experienced rescuer is that the two of you can share in tasks and responsibilities. Rather than one of you having to do it all on your own. The type of rescue mask you're using doesn't change the two-responder technique when it comes to the sharing of duties; neither does the presence or absence of supplemental oxygen. Pro Tip #1: The advantage of two -responder CPR is the alleviation of rescuer fatigue. Performing the compressions and rescue breaths yourself will begin to tire you over time and perhaps diminish the quality of CPR being administered. The assessment phase is similar to one-responder situations, however, while one of you is assessing the scene and patient, the other can get the equipment ready to perform CPR, try to locate an AED if one isn't present, call 911 or a code, etc. Once chest compressions begin, that's when the efforts of each responder will begin to coordinate, including the important switch at the two-minute mark. Warning: The point of two-responder CPR is to limit fatigue and maintain the delivery of high-quality CPR. So, don't negate this benefit. Be sure to coordinate a switch at the two-minute mark so neither of you are performing chest compressions for longer than two minutes without a rest. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your bag valve mask, or rescue mask with a one-way valve (or bag valve mask when there are two responders), handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Two-Responder CPR Technique for Adults Responder one: Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Pro Tip #2: Counting with the correct cadence and out loud will help you maintain a consistent rhythm. However, when there are two responders, counting out loud is even more important. It allows the other responder to anticipate the delivery of rescue breaths and the all-important switching of duties. Responder two: Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. (When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do.) Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath. Responder one: Go right back into your 30 chest compressions. Responder two: Go right back to delivering two rescue breaths. Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties. Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask. Continue to perform 30 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About Considerations for Older Adults In older adult patients, a general decrease in pain perception may cause a different reaction to a heart attack. Older adults often suffer what is known as a silent heart attack, meaning there is a lack of common symptoms we most often associate with heart attacks – chest pain or pressure, for instance. For these older adult patients, the symptoms of a heart attack mostly tend to include general weakness or fatigue, aches or pains in the shoulders, and indigestion and/or abdominal pain. https://d3imrogdy81qei.cloudfront.net/video_images/3731/adult-cpr-2-rescuer-2015.jpg Yes 237 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-adultos-2-rescatistas-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2086.mp4 RCP en adultos 2 rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/3731/adult-cpr-2-rescuer-2015.jpg Yes 237 https://app.protrainings.com/courses/bls/healthcare/videos/child-cpr-2-rescuer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2087.mp4 Child CPR 2 Rescuer In this section, we're going to cover two-responder child CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.) Much of what was covered in the last section – Adult CPR with Two Responders – will apply in this section – Child CPR with Two Responders. There will, however, be some subtle but crucial differences that are highlighted below. Pro Tip #1: When performing chest compressions on a large child, use two hands as you would for an adult. But when performing compressions on a smaller child, use just one hand to assure you're not compressing with too much force. Pro Tip #2: The rate of compressions to rescue breaths changes during child CPR when two responders are present. Instead of performing 30 compressions to two rescue breaths, reduce the number of compressions to 15 for every two rescue breaths. It's worth mentioning again – The assessment phase is similar to one-responder situations, however, while one of you is assessing the scene and patient, the other can get the equipment ready to perform CPR, try to locate an AED if one isn't present, call 911 or a code, etc. Once chest compressions begin, that's when the efforts of each responder will begin to coordinate, including the important switch at the two-minute mark. The importance of having a fresh compressor cannot be overstated. Performing high-quality compressions will help bring the pulse pressure up as well as keeping the blood pressure as high as possible. Having two responders working together as a coordinated team will ensure the highest quality CPR gets delivered, which will give the patient the greatest chance of survival. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the child is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Two-Responder CPR Technique for Children Responder one: Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. With smaller children, it may help to draw an imaginary line across the nipples. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Remember: Use only one hand when performing chest compressions on smaller children. Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go 2 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 15 chest compressions. Remember that counting out loud is even more important when two responders are working together. It allows the other responder to anticipate the delivery of rescue breaths and the all-important switching of duties. Responder two: Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. (When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with children, the head-tilt, chin lift is less pronounced than it is during adult CPR.) Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath. Responder one: Go right back into your 15 chest compressions. Responder two: Go right back to delivering two rescue breaths. Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties. Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask. Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About Ventilations Artificial ventilation is the method of forcing air into the lungs of a patient who is not breathing on their own. The oxygen in the ventilated air will be absorbed by blood flowing through the lungs and carried to the body's tissues and vital organs. There are several ways to provide this ventilation, including: Mouth to mask using a one-way valve Using a bag valve mask with or without supplemental oxygen Mouth to mouth Mouth to nose Mouth to nose ventilation may be required if no ventilation equipment is present and if you are unable to create a proper seal over the patient's mouth. Mouth to Mouth Ventilation Steps Open the patient's airway past neutral using the head tilt, chin lift maneuver. Pinch the patient's nose shut. Create a seal over the patient's mouth using your mouth, or over the mouth and nose for an infant. Blow air into the patient's mouth. Break the seal slightly on the inhale and reseal before administering the next breath. https://d3imrogdy81qei.cloudfront.net/video_images/3733/child-cpr-2-rescuer-2015.jpg Yes 229 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-ninos-2-rescatistas-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2087.mp4 RCP en niños 2 rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/3733/child-cpr-2-rescuer-2015.jpg Yes 229 https://app.protrainings.com/courses/bls/healthcare/videos/adult-cpr-team-approach https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2090.mp4 Adult CPR Team Approach This lesson focuses on the team approach to CPR when three or more responders or healthcare professionals are involved. There are three main takeaways from this section: It's important to establish who the team leader is in any team approach to life support. The team leader is the orchestrator for everyone else in the rescue process and directs all the action. It's important for all involved to communicate effectively, and to use what's known as closed-loop communication. Closed-loop communication refers to a command (from the team leader) that has been heard by the team member executing that command and repeated back. This establishes that each command is understood and about to be executed. It's also important to take notes and log times. This includes all facets of the rescue attempt – when chest compressions begin, when the first shock is executed, what drugs are being administered and when, etc. The Role of Team Leader The team leader is orchestrating the actions of the other team members – who is doing what and when – but also monitoring the others for quality assurance. If the team leader sees that something is being done incorrectly or could be improved upon, it's his or her job to point out the intended improvement or change in rescue care and encourage that team member through positive reinforcement. A Typical Division of Duties in a Three-Team-Member Approach Responder one: Begins performing the correct number of chest compressions based on the size of the patient and counting out loud. Responder two: Takes a position at the victim's head and readies the bag valve mask for use, performing two rescue breaths after a round of compressions have been completed and making sure that the chest rises and falls each time. Responder three: Takes notes of responder one and two's actions and times of each action. Responder three will also assist in some other aspect of care, if needed, including getting the AED ready. Responder three is also ready to jump in elsewhere when the switch occurs – when the compressor's two minutes are up and responder one switches places with responder two or three. All three responders are communicating all vital information to the rest of the team while they work. The team leader will indicate when a switch is about to occur, who is taking over for whom, if an IV should be established, what drugs will go into the IV, as well as dosages, and other important information and directives. A good team approach is vital in a rescue situation. It ensures that everyone is doing his or her job to the highest standards of care. In short, good practices and habits in a team approach leads to more saved lives. A Word About Advanced Airways If a patient has an advanced airway such as a supraglottic airway device or an endotracheal tube, CPR will be performed a little differently. A supraglottic airway device, which allows for improved ventilation, is an advanced airway that does not enter and directly protect the trachea like an endotracheal tube. When using a supraglottic airway device, like a laryngeal mask airway, a minimum of two responders must be present. Responder one provides one ventilation every six seconds, which is about 10 ventilations per minute. At the same time, responder two is performing compressions at the normal rate of between 100 and 120 compressions per minute. It's important to note that there is no pause between compressions or ventilations, and responders do not use the standard 30:2 compressions to ventilations ratio. Advanced airway devices provide a continuous delivery of compressions and ventilations without any interruptions. https://d3imrogdy81qei.cloudfront.net/video_images/3739/adult-cpr-team-approach-2015.jpg Yes 448 https://app.protrainings.com/courses/bls/healthcare/videos/abordaje-en-equipo-rcp-adulto-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2090.mp4 Abordaje en equipo para RCP en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3739/adult-cpr-team-approach-2015.jpg Yes 448 https://app.protrainings.com/courses/bls/healthcare/videos/unconscious-adult-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2091.mp4 Unconscious Adult Choking This unconscious adult choking lesson is for situations where you find a person who is unconscious, and you suspect they became unresponsive due to an airway obstruction. Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the patient has a pulse but isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction. In this scenario, you would treat this patient as an unconscious adult choking victim. The method of care will closely resemble performing CPR, however there are subtle differences to pay attention to. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy. Assess the patient to make sure he or she is not breathing normally and is unconscious. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Pro Tip #1: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Remember to make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. Pro Tip #2: There are no complications when performing chest compressions on a pregnant woman, as you're not near the womb and baby when doing them. Proceed as you would for any other adult patient. Lift the victim's chin and tilt his or her head back slightly. Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps. Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. If the rescue breaths go in this time – causing the chest to rise and fall – check for a carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every five seconds for two minutes. After two minutes, reassess for a pulse and check again for normal breathing. If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every five seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths. Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About High Quality CPR It's important to understand what constitutes high quality CPR, as performing CPR correctly will give the victim the best chance of survival. High Quality CPR Performing chest compressions at a rate of 100-120 per minute Compressing to a depth of at least 2 inches but not exceeding 2.4 Allowing for full recoil after each compression Minimizing pauses in compressions Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise Low Quality CPR Compressing at a rate slower than 100 per minute or faster than 120 per minute Compressing to a depth of less than two inches or greater than 2.4 inches Leaning on the chest between compressions or performing compressions while not directly over the victim's heart Interrupting compressions for greater than 10 seconds Providing excessive ventilation – too many breaths or breaths with excessive force Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue. https://d3imrogdy81qei.cloudfront.net/video_images/3741/unconscious-adult-choking-2015.jpg Yes 216 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-adulto-inconsciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2091.mp4 Asfixia en adulto inconsciente https://d3imrogdy81qei.cloudfront.net/video_images/3741/unconscious-adult-choking-2015.jpg Yes 216 https://app.protrainings.com/courses/bls/healthcare/videos/unconscious-child-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2092.mp4 Unconscious Child Choking This unconscious child choking lesson is for situations where you find a child who is unconscious, and you suspect they became unresponsive due to an airway obstruction. Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the child has a pulse but isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction. In this scenario, you would treat this patient as an unconscious child choking victim. The method of care will closely resemble performing CPR on a child, however there are subtle differences to pay attention to. Pro Tip #1: There is also one important distinction when performing rescue breaths on a child who has a pulse but isn't breathing normally versus an adult – one rescue breath every three seconds for two minutes, which has been highlighted in the steps below to help you remember. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy. Assess the patient to make sure he or she is not breathing normally and is unconscious. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Remember that to maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Conduct compressions that go about 2 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Remember to allow for full recoil of the chest cavity after performing each chest compression. You want to allow the chest to come all the way back to the neutral position before performing another compression. Lift the victim's chin and tilt his or her head back slightly – just past perpendicular. Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps. Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. If the rescue breaths go in this time – causing the chest to rise and fall – check for a carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every three seconds for two minutes. After two minutes, reassess for a pulse and check again for normal breathing. If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every three seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths. Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About the Differences Between Child CPR and Adult CPR There are four distinct differences to be aware of. Opening the Airway While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground. Performing Compressions The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand. Compressions to Ventilations Ratio If there is only a single responder, continue using the 30 compressions to two ventilations ratio. However, if there are two responders, that ratio changes to 15 compressions to two ventilations. Using AEDs AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the child. If the child weighs more than 55 pounds, continue using the adult AED pads. If the child weighs less than 55 pounds, use pediatric AED pads if available. Warning: It's vitally important that the AED pads do not touch each other. If the child is too small for adult pads, and you do not have pediatric pads, place one on the center of the sternum and the other on the child's back between the scapulae. https://d3imrogdy81qei.cloudfront.net/video_images/3743/unconscious-child-choking-2015.jpg Yes 180 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-nino-inconsciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2092.mp4 Asfixia en niño inconsciente https://d3imrogdy81qei.cloudfront.net/video_images/3743/unconscious-child-choking-2015.jpg Yes 180 https://app.protrainings.com/courses/bls/healthcare/videos/bleeding-control-arterial-bleeding https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2094.mp4 Arterial Bleeding Arterial bleeding is the most severe and urgent type of bleeding. It can occur due to a penetrating injury, blunt trauma, or from damage to organs or blood vessels. As arterial bleeding is pumped directly from the heart to the rest of the body, this type of bleeding has a few distinctions: The blood is bright red in color due to its high oxygen concentration The blood tends to spurt due to the heart pumping it to the wound The pressure is higher than other types of bleeding, so it will not clot or stop as easily Warning: The pressure will only subside as blood volume decreases. This is a life-threatening situation and tissue will quickly begin to die due to lack of oxygen. How to Provide Care A person who is the victim of arterial bleeding will instinctively grab and cover the wound to reduce the amount of blood flow, if that person is conscious and able to. To best assist in treating the wound, you should: Make sure the scene is safe. Put on latex-free gloves if available. If you don't have gloves, wash your hands or use an alcohol-based hand sanitizer. Find the source of the bleeding; you may have to remove clothing over the wound. Make the switch from the victim's hand to a dressing pad or a clean cloth. Apply pressure. The wound will be pulsating, and it will likely take several dressing pads to control the bleeding. If the victim is conscious and can assist, this will help. Ask the victim to maintain pressure over the dressing pad or cloth. The blood will probably soak through, so apply a second pad on top of the first, rather than removing it. Continue to apply firm, direct pressure over the wound. If the victim is becoming light-headed from the blood loss, have them sit or lie down. The goal is to control the bleeding to the point where the wound is not leaking through each new dressing pad. If blood continues to leak through, continue to apply another pad or piece of cloth until it stops. Consider using a tourniquet if – you cannot control the bleeding with dressing pads and the blood loss is extreme. This is a life-threatening situation and last resort. In most cases, even arterial bleeding can be controlled using pressure plus dressing and bandages. Once you have the bleeding controlled, it's time to wrap the wound. Using an ACE roller bandage like you find in most first aid kits, start from the end of the extremity where the injury is located. If the wound is on the wrist, began wrapping from the hand. Pro Tip #1: it's important to extend the bandage several inches beyond the wound on both sides. This will help keep the wound clean and limit the chances of infection. When wrapping the wound, if extra pressure is required, twist the bandage once over the wound and continue wrapping. Repeat as often as necessary. To finish, tuck the end of the bandage into the wrap to hold it in place. Pro Tip #2: While pressure is important to control the bleeding, you don't want to cut off circulation to the extremity on which the wound occurred. Pinch a nail and the fleshy underside between two of your fingers (if the wound occurred on an arm or a leg). The nail should turn pale and then return to a pink color a couple seconds later. If it doesn't, the bandage is too tight. It's important to try and not cover fingers and toes with the bandage if possible, so that this test can be performed. At this point, you'll want to decide whether to call 911 for EMS services or transport the victim to the emergency room by private vehicle. Call 911 if: The victim has lost consciousness or is showing signs of losing consciousness The victim is exhibiting signs of shock – pale, cold, sweaty skin You cannot stop the bleeding A Word About Dressings and Bandages Dressings are sterile pads used to absorb blood and other fluids, help promote clotting, and prevent infection. Gauze pads are most common. Most dressing pads are porous, which allows air to circulate to the wound and promote healing. Common sizes range from 2-4-inch squares. Universal or trauma dressings are larger in size and used for larger wounds. Occlusive dressings are not porous, which means no air or fluids can pass through, and typically used for abdominal wounds. Bandages are strips of material used to hold the dressing in place, maintain pressure over the wound, control bleeding, and protect from dirt and infection. The most common type of bandage is the roller bandage that is usually made of gauze and comes in assorted widths and lengths. These are the type of bandages you find in most first aid kits. However, there are other types of bandages including: Pressure bandage – for more pressure and a snugger fit Bandage compress – thick gauze dressing attached to a gauze bandage Elastic bandage – type of roller bandage typically used for muscles, bones, and joints Triangular bandage – large bandage that can folded and used as a sling As arterial bleeding is the most severe type of bleeding, it's important to properly assess the situation quickly as a rapid response is vital for a positive outcome. If you feel like the situation is too serious to handle yourself, it's important that you or someone else at the scene call 911 immediately. https://d3imrogdy81qei.cloudfront.net/video_images/3747/bleeding-control-arterial-bleeding-2015.jpg Yes 300 https://app.protrainings.com/courses/bls/healthcare/videos/es-control-hemorragia-sangrado-arterial https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2094.mp4 Sangrado arterial https://d3imrogdy81qei.cloudfront.net/video_images/3747/bleeding-control-arterial-bleeding-2015.jpg Yes 300 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/bleeding-control-venous-bleeding https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2095.mp4 Venous Bleeding Uncontrolled bleeding is the number one cause of preventable deaths due to a trauma. While venous bleeding is usually less serious than arterial bleeding, it still can pose a serious health risk to the victim. Venous bleeding can be the result of external trauma, as in something cutting or puncturing a vein, or internal trauma, due to a broken bone or organ damage. Venous bleeding involves blood that is returning to the heart, so there won't be as much pressure as arterial bleeding. However, the blood loss can still be severe. Venous bleeding distinctions are: The blood is dark red, not bright like arterial bleeding The blood flow is steady but not spurting; it can still be quick, though The pressure is lower than arterial bleeding so it's usually easier to control How to Provide Care A person who is the victim of venous bleeding will likely be applying pressure to the wound or cut by the time you arrive to help. Some things to keep in mind with venous bleeding are: It will often stop on its own in 4-6 minutes It's usually easy to control with direct pressure What may seem like a lot of blood is likely to just be smeared, dripping blood which often looks like more than it really is As always, the first thing you should do is make sure the scene is safe. After that, proceed with the following steps. Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol. Find the source of the bleeding and ask the victim if he or she is cut anywhere else to make sure you're not missing another wound. Place a dressing pad or cloth over the wound. Apply pressure. At this point, the one dressing pad will usually be enough to control venous bleeding. However, you may also want to consider assessing the severity of the cut. Pro Tip 1: When you remove pressure, do the folds of skin around the cut begin to come apart, or does the skin appear to be staying together. If the skin is coming apart, stitches are likely necessary. If not, the wound will probably heal on its own and stitches can be avoided. As can a trip to the emergency room. If a trip to the emergency room is warranted but EMS services are not, it's still a good idea to have someone else drive the victim. There may be a chance that the victim has difficulty seeing his or her own blood, which could cause psychogenic shock. It's always better if the victim is a passenger rather than the driver. Before you wrap the wound, make sure it's properly cleaned using a bacterial ointment if you have one. This will combat any bacteria that may have gotten into the cut and reduce the chances of infection. Pro Tip 2: Consider the chances of tetanus. If the victim was cut by something dirty and hasn't had a tetanus shot in the last 10 years, a trip to the emergency room is a necessity regardless of the severity of the wound. After cleaning the wound, reapply a dressing pad that completely covers the area. Wait and see if the bleeding stops or if it leaks through. Most venous cuts will stop after applying the first pad. Warning: There are reasons why venous bleeding cannot be easily controlled and these include: the victim has a bleeding disorder or is on blood thinners. Make sure to ask the victim if it appears that the bleeding is difficult to stop. It's now time to wrap the wound, and taping the pad is usually sufficient. Just be aware to maintain constant pressure while you tape. And as before with arterial bleeding, pinch the finger or toe nails if the extremities are involved and see if blood returns to the nails. You don't want to cut off blood supply. Your goals in tapping or bandaging the wound are: Maintain pressure and control bleeding Cover completely so dirt and debris cannot get inside the cut At this point it's always a good idea to make sure the patient is stable and not in shock. If their skin has good color and isn't cold or clammy, and if they haven't lost consciousness, EMS probably will not be needed. A Word About Disease Transmission To reduce your risk of disease transmission, there are a few guidelines to keep in mind: Avoid contact with the victim's blood by wearing latex-free gloves and protective eyewear if you have them. Avoid touching your mouth, nose, and eyes while providing care, and don't drink or eat anything before washing your hands. Wash your hands thoroughly after providing care, even if you wore gloves. Always dispose of the gloves or change gloves before helping someone else. As venous bleeding is often not a severe injury, it's still important to remember that it still has the potential to become a serious situation, especially if bleeding cannot be controlled or the victim goes into shock. When in doubt, it's best to call 911 and let the EMS professionals handle the situation. https://d3imrogdy81qei.cloudfront.net/video_images/3749/bleeding-control-venous-bleeding-2015.jpg Yes 214 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/control-hemorragia-sangrado-venoso https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2095.mp4 Sangrado venoso https://d3imrogdy81qei.cloudfront.net/video_images/3749/bleeding-control-venous-bleeding-2015.jpg Yes 214 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/bleeding-control-capillary-bleeding https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2096.mp4 Capillary Bleeding While you're probably familiar with veins and arteries, capillaries may warrant a quick definition. Capillaries are tiny blood vessels linking arteries and veins that transfer oxygen and other nutrients from the blood to all body cells and remove waste products. Capillary bleeding has the classic appearance of a road rash type of wound. Anyone who has fallen off a bike or while playing sports likely has some experience with this type of bleeding injury. Capillary bleeding distinctions are: The blood tends to ooze or bubble up on the surface of the wound The pressure is very low and will usually clot on its own or with minimal pressure The blood is mixed with serous fluid Serous fluid is a yellowish liquid that is made up of proteins and water. It's the same fluid that fills a burn blister and is the body's attempt to heal the wound. How to Provide Care Capillary bleeding is usually not a concern in healthy people. The blood vessels are quite small, and the pressure is minimal. Some things to keep in mind with capillary bleeding are: Because it affects the epidermal layer where the nerve endings are located, it can be more painful than other types of bleeding injuries Infection is likely to be the biggest area of concern Thoroughly cleaning the wound is the greatest weapon against infection, particularly if the victim fell on a dirty surface As always, the first thing you should do is make sure the scene is safe. After that, proceed with the following steps. Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol. Remove any visible debris from the wound – dirt, sand, pebbles, and shavings of glass or metal. Blot the area with a dressing pad and apply direct pressure if the bleeding hasn't stopped on its own. Thoroughly clean the wound with soap and water. Apply an over-the-counter triple antibiotic to the area using a clean dressing pad. Pro Tip 1: When cleaning off debris from the wound, if you notice that those things are embedded into the wound, the victim will need to make a trip to the ER, where the medical staff will probably need to numb the area before removing the debris. The nerve endings could be quite raw, and it's important to keep in mind that the victim may be in a good deal of pain. Once the wound is cleaned and the antibiotic has been applied, put a fresh dressing pad over the area. Make sure it's large enough to cover the wound completely with room to spare on all sides. Using medical grade tape, if you have it, hold the dressing pad in place with a couple strips of tape or however much is needed. Let the victim know that he or she can replace the pad with a large band aid after a day or two. Pro Tip 2: It's important to help the victim understand what the signs of infection are, as this is likely to be the biggest threat with capillary bleeding wounds. Signs of infection include: Puss oozing or draining from the wound The wound becomes puffy and more painful A wound that begins to turn red around the site Warning: Capillary bleeding is usually not a life-threatening injury, but infections could be. If the victim notices any of the above, it's important that he or she go to the ER or their doctor to avoid the chance of serious infection. However, keeping the wound area clean is often enough to avoid this complication. Also let the victim know what a healthy outcome of capillary bleeding looks like: The wound will begin to scab over after 48 – 72 hours After a couple of more weeks, it should be completely healed as the scab begins to fall off A Word About Life-Threatening Bleeding While capillary bleeding is often very easy to control, it's important to understand the concept of the Golden Hour – the critical first hour after a traumatic bleeding injury has occurred. During the Golden Hour: The risk of shock is at its highest Extensive blood loss can quickly result in death Quick action and proper intervention will result in the victim's best chance of survival As all bleeding injuries occur from arteries, veins, and capillaries, it's important to understand what a life-threatening bleeding incident looks like. Blood that is spurting out of a wound. Blood that won't stop coming out of a wound. Blood that is pooling on the ground. The victim's clothing is soaked with blood. Bandages that are soaked with blood. Loss of part, or all, of an arm or leg. Bleeding in a victim who is confused or unconscious. If you experience any of these situations while providing care, be aware that these can be life-threatening, and you should call 911 immediately and get EMS involved. Capillary bleeding is often the least severe type of bleeding injury, but don't get lulled into a false sense of security. Any bleeding situation can become serious. And it deserves repeating that with capillary bleeding, it's especially important to clean the wound well to reduce the chances of infection. https://d3imrogdy81qei.cloudfront.net/video_images/3751/bleeding-control-capillary-bleeding-2015.jpg Yes 235 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/es-control-hemorragia-sangrado-capilar https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2096.mp4 Sangrado capilar https://d3imrogdy81qei.cloudfront.net/video_images/3751/bleeding-control-capillary-bleeding-2015.jpg Yes 235 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/head-neck-and-back-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2098.mp4 Head, Neck, and Back Injuries If you come upon a patient who appears to have taken a fall, or was injured in an accident, and there are no bystanders around who witnessed the accident, you'll need to figure out the mechanism of injury. Hopefully the victim will be able to help, who in this lesson, we are assuming is conscious, alert, and not exhibiting more serious issues involving airway, breathing, circulation, etc. The most important thing to keep in mind as you deal with someone who has sustained potential injuries to their head, neck, and/or back, is minimizing movement, as you inquire more into what happened and how the patient is feeling. Pro Tip #1: Part of your job is to figure out if EMS is required as you tend to them. It may be a situation where the victim is able to get up and has no significant injuries. Or it could be a situation that doesn't appear serious initially, but suddenly becomes serious. If at any point the situation warrants it, call 911 immediately. How to Handle a Patient with Head, Neck, and Back Injuries As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim. Are you OK? Can you hear me? If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. When dealing with potential back and neck injuries, it's best not to touch the patient while you assess them. Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions; try not to nod. Answer with yes or no. And try not to move other parts of your body." "Do you remember what just happened?" "Do you know if you hit your head?" "Do you know what day it is?" "Do you know what year it is?" If the victim answers the last two questions incorrectly, you're likely dealing with someone who has hit their head and may have a concussion. This altered mental state is enough of a concern to call 911 and activate EMS if you haven't already done so. The fact that you're able to talk with the patient is a good sign. It indicates that they're awake, breathing normally, and have a pulse, all of which indicate a lack of an immediate emergency. However, that doesn't mean the situation cannot suddenly change. As you're talking with the victim, you're also looking them over for injuries, beginning with their head. Is there blood in the ears? Is there blood in the nose? Does the patient have any broken teeth? Are the pupils equal size and responsive to light? Pro Tip #2: Put your hand over the victim's eyes for a second or two then remove it and see if their pupils react. If they do not, it could be due to a concussion and swelling in the brain. Determine how injured they are by seeing how much they can move and with open-ended questions. "Can you tell me what hurts?" "Can you wiggle your fingers?" "Can you wiggle your toes?" A victim in paralysis is prone to going into spinal shock. Remember, shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body. Early signs of shock to look for include: Nervousness Rapid heart rate or breathing Anxiousness Sweaty Fearful Clammy skin Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock. Warning: Should you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call. If at any point during your assessment, the patient goes unresponsive, appears to be having trouble breathing normally, or goes into full cardiac arrest, activate EMS and treat the patient accordingly until help arrives, an AED arrives, or the patient is responding positively. A Word About Injuries to the Neck and Spine Injuries to the neck and spine can damage soft tissue and bone, including the spinal cord. Unfortunately, assessing the level of this damage on the scene, and without proper diagnostic equipment, is very difficult. Which is why you should always proceed with caution. Some common situations in which serious neck and spine injuries tend to be seen include: Swimming pool diving accidents Vehicular accidents Accidents that include a broken hard hat or helmet Some common symptoms for serious neck injury are: Obvious lacerations or swelling Impaled object Excessive external bleeding Difficulty speaking Air escaping through the trachea and/or larynx An airway obstruction Some common symptoms for serious spine injury are: Back pain or pressure Pain with movement Numbness, weakness, tingling in limbs or extremities Loss of feeling in limbs or extremities Breathing problems Loss of bladder and bowel control https://d3imrogdy81qei.cloudfront.net/video_images/3755/head-neck-and-back-injuries-2015.jpg Yes 229 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/lesiones-cabeza-cuello-espalda https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2098.mp4 Lesiones de cabeza, cuello y espalda https://d3imrogdy81qei.cloudfront.net/video_images/3755/head-neck-and-back-injuries-2015.jpg Yes 229 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/diabetes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2100.mp4 Diabetes In this lesson, you'll learn how to treat a patient with a blood sugar emergency. Some things to keep in mind about blood sugar problems: Signs and symptoms are the same for low blood sugar and high blood sugar Blood sugar issues will get worse without treatment Without treatment, a patient could become unresponsive and die The three most common signs and symptoms of someone experiencing a blood sugar issue are: Confusion Coordination issues Talking nonsense A person with a blood sugar issue might also randomly fidget with something and appear quite out of it. Pro Tip #1: Even though the signs of high blood sugar are the same as those for low blood sugar, in patients suffering from high blood sugar, those symptoms will come on much more slowly and will likely be less intense. How to Treat a Blood Sugar Event As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Pro Tip #2: When a patient has high blood sugar, the body will try to rid itself of it through urination, and failing that, through hyperventilation. Which is why, in patients with high blood sugar, you'll often notice a hint of fruit or cheap wine on their breath. The reason for this is called ketoacidosis – a byproduct of unused sugars in the body that become toxic. Pro Tip #3: If a patient is showing signs of a blood sugar issue, rule it out using sugar – either over-the-counter products like soda or professional glucose products specifically for diabetic events. Follow the pro tip above as long as the patient is coherent enough to follow commands and isn't getting agitated or aggressive. Then begin encouraging the consumption of sugar or glucose. Warning: A patient can only consume a glucose or sugar product if they are able to swallow safely. If their sugar event has escalated to the point where they cannot control their swallow reflex, it's too late. Sugar will need to be administered through an IV or by intermuscular injection. If the patient did have low blood sugar, you should notice improvements in 10 to 15 minutes. If the symptoms aren't improving after 15 minutes, there could be something else going on; call 911 and activate EMS. Professional glucose products like tabs and gels are your best bet, as they're designed for quick absorption. They're also encased in more stable packaging, meaning they can withstand freezing temperatures and other environmental threats. If you don't have any glucose products available, a full-sugar soda is your best option. Candy bars aren't a bad option either. However, more fibrous snacks will take too long to be absorbed by the body. Pro Tip #4: Most patients with sugar problems will know the dosage of sugar or glucose they need in emergencies like this. Read labels on the packaging and multiply or divide as needed to get the proper dosage. Keep in mind that high fructose corn syrup burns much more quickly compared to the longer-acting dextrose you'll find in many glucose products. If this was the patient's first sugar event, follow up with EMS to make sure they get the help they need moving forward. If this wasn't the patient's first sugar event, and they can explain what likely caused it, help them get back on their plan to avoid it happening again. And encourage them to check-in with their physician to make sure everything is all right. A Word About Diabetic Emergencies Diabetes mellitus is one of the leading causes of death and disability in the U.S. In 2016, 29 million Americans had diabetes, while another 86 million had prediabetes – a condition that increases your risk for developing type 2 diabetes and other chronic diseases like kidney disease, heart disease, gum disease, stroke, and amputations. The Two Types of Diabetes Type 1 Diabetes – Also known as juvenile diabetes or insulin-dependent diabetes, this condition results in a body that produces little to no insulin. Which is why most people who have type 1 diabetes inject themselves with insulin daily. Type 2 Diabetes – More common than type 1 diabetes, type 2 is characterized by a body that produces insulin, but either the cells can't use it effectively or not enough is being produced. People with type 2 diabetes can often improve their symptoms and regulate their blood glucose levels with dietary changes and sometimes medications. High Blood Glucose High blood glucose, or hyperglycemia, is when the body's insulin level is too low, and the sugar level is too high. However, the body cannot transport that sugar into the cells without insulin. Which results in a body that's about to have an energy crisis. The body then attempts to meet its need for energy by using other stored food and energy sources, such as fats. However, converting fat to energy is less efficient, produces waste products, and increases the acidity level in the blood, causing a condition known as diabetic ketoacidosis (DKA), which could ultimately result in a diabetic coma. Low Blood Glucose The exact inverse of the above – Low blood glucose, or hypoglycemia, occurs when the body's insulin level is too high, and the sugar level is too low. This can happen for a number of reasons, including when the patient: Takes too much insulin Fails to eat adequately Over-exercises and burns off sugar faster than normal Experiences great emotional stress Regardless of whether you're dealing with a patient who has type 1 diabetes or type 2 diabetes, the signs and symptoms are the same: Dizziness, drowsiness, or confusion Irregular breathing Abnormally weak or rapid pulse Feeling and looking ill Abnormal skin characteristics https://d3imrogdy81qei.cloudfront.net/video_images/3759/diabetes-2015.jpg Yes 500 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/diabetes-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2100.mp4 Diabetes https://d3imrogdy81qei.cloudfront.net/video_images/3759/diabetes-2015.jpg Yes 500 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/seizure https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2101.mp4 Seizure In this lesson, you'll learn how to treat an adult patient who goes into a seizure or has just come out of one. A person can go into a seizure for too many reasons to mention. As you are concerned, why it happened isn't important. Being able to recognize that it did happen is the key. For you to know if a seizure took place, ideally you or someone else saw the patient go into a tonic state that exhibited the following signs: Hands are gripped and pointed inward The patient is actively seizing The patient ends the seizure in the postictal state (relaxed recovery) How to Treat a Patient who is Actively Seizing There are a few important things that you can do when a person is suffering from a seizure to help protect them from further harm. First, is there anything around the patient that could injure them, such as sharp objects? If there is, remove the threat from the scene or move the patient to a safer area. If the patient is having a zootomic clonic seizure – in which they are fluctuating between contracting and relaxing – they could bang their head on the ground. To protect their head, simply cup your hands together and place them underneath the patient's head. Warning: Never hold down a seizing patient or try to stop the seizure in any way. Just support and protect the patient during the seizure. Then, once the seizure is over, assess for more serious situations like cardiac arrest. How to Treat a Patient after a Seizure Pro Tip #1: There are several things to do post-seizure, but the most important is calling 911 and activating EMS if it hasn't already been done. As soon as you determined that the patient had a seizure, and you don't know if the patient is an ongoing epileptic, call 911 immediately. After EMS has been activated, begin to assess the patient for a couple of things. Is the patient moving and breathing normally again? Are they beginning to return to consciousness? If the patient isn't moving or breathing normally, and isn't responsive to your taps and shouts, go right into CPR and retrieve or find an AED. If the patient is beginning to breathe normally again, does the breathing appear to be agonal respirations or more corrective breathing? To help keep the patient's airway open and clear, put them into the following recovery position. Elevate the arm closest to you and bring it up over the patient's head before placing it on the ground. Bring the patient's furthest leg over their other leg so that their legs are crossed. Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the patient toward you and onto their side. Support the head while you place the patient's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway. Bend the patient's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the patient from rolling over. Pro Tip #2: A person who has just experienced a seizure – essentially an electrical storm in the brain – will be low on oxygen. As a result, they may be confused or combative and this will likely last a few minutes. While waiting for EMS to arrive, continue to assess the patient for breathing and recovery signs, like talking. Any signs that the patient is becoming more responsive are good signs. If the patient begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive. A Word About Pediatric Seizures A seizure is a disorder in the brain's electrical system, which is sometimes marked by loss of consciousness and often by uncontrollable muscle movement, also referred to as convulsions. In children, febrile seizures are the most common type of seizure. These seizures occur with a rapidly-rising or excessively-high fever, typically higher than 102° F. Children with febrile seizures may exhibit some or all of the following signs and symptoms: Sudden rise in body temperature Jerking of the head and limbs Loss of bladder or bowel control Confusion Drowsiness Crying out Becoming rigid Holding the breath Rolling the eyes upward To assess what type of seizure the child has had and why, it's important to ask good questions: Has the child ever had seizures before? If so, is the child on medications for them? If not, is there a family history of seizures? Does the child have diabetes? If so, what type of insulin/medication is being used and when was the last time it was given? Has the child started taking any new medications lately? If the child takes medications, is it possible there may have been an overdose? Could the child have taken someone else's medication by accident? Could the child have ingested anything poisonous? Has the child had a recent injury, particularly a head trauma? Has the child seemed sick or had a high fever, stiff neck, or headaches? What did the seizure look like? Did it involve the child's whole body, or only one half of the body? Did it start in one area and progress to the rest? Did the child fall when the seizure began and if so, was it possible the child's head struck an object or the floor? These are just some of the questions you can use to help decipher what type of seizure the child had and why. https://d3imrogdy81qei.cloudfront.net/video_images/3761/seizure-2015.jpg Yes 246 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/convulsiones https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2101.mp4 Convulsiones https://d3imrogdy81qei.cloudfront.net/video_images/3761/seizure-2015.jpg Yes 246 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/how-to-use-an-epipen https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2102.mp4 How to Use an EpiPen Epinephrine is the first line of defense when it comes to treating anaphylaxis. And the sooner it's administered, the less severe the allergic reaction. Remember, anaphylaxis is a severe and sudden allergic reaction that affects many parts of the body at the same time within mere minutes of the allergen coming into contact with the body. Anaphylaxis can cause the body's blood vessels to suddenly dilate, which can lead to anaphylactic shock. Anaphylactic shock can cause a sudden drop in blood pressure resulting in organs like the brain quickly becoming oxygen starved. Anaphylactic shock will cause death if not treated. People with a history of allergic reactions should always carry an epinephrine pen. Pens are single dose, pre-filled, automatic injection devices, also known as epi pens. The following instructions are specifically for Epi Pen brand. If you're using a different brand of epi pen, be sure to follow the manufacturer's instructions. How to Use an Epi Pen Pro Tip #1: Any time an epi pen is used, be sure to call 911 and activate EMS. The person, even if feeling better, must seek further medical attention after a severe allergic reaction. Remove the pen's safety cap. Grip the pen in your hand with the tip pointing down. Warning: Never put your thumb, fingers, or hand over the tip of the pen; you may accidentally inject yourself while treating the patient. Firmly push the tip of the pen into the patient's outer thigh at a 90-degree angle and until you hear the pen click. Needles can penetrate clothing. Keep the auto injector firmly pressed against the patient's thigh; hold for 3 seconds. Pull the epi pen straight out. Warning: Make sure you don't pull the pen out at an angle. This can cause a lot of pain and bleeding. And if blood comes out of the leg, there's a good chance the effectiveness of the shot will be reduced. Rub the area for 10 seconds, as this will increase absorption of the epinephrine within the leg muscle. Pro Tip #2: A second epi pen may be used if symptoms persist or recur and if EMS has been delayed for more than 5 to 10 minutes. Usually the patient will notice some airway relief pretty quickly, as the tightness in the throat begins to dissipate. There are, however, some unfortunate side effects that some patient's may experience, including: Rapid heartbeat Shakiness Feelings of anxiety Dizziness Headache Pro Tip #3: Once you administer an epinephrine injection, make note of the time it was delivered and tell EMS when they arrive. A Word About Epinephrine Epinephrine is a drug that slows or stops the effects of anaphylaxis. If a patient is known to have an allergy that could lead to anaphylaxis, they may carry an epinephrine auto-injector (an epi pen) that can deliver a single dose of the drug. Epinephrine devices are available in different doses, as the dose of epinephrine is based on weight – 0.15 mg for children weighing between 33 and 66 pounds, and 0.3 mg for children and adults weighing more than 66 pounds. People with a known history of anaphylaxis would be wise to carry an anaphylaxis kit containing at least two doses of epinephrine with them at all times. Why a second dose? Because more than one dose may be needed to stop a strong anaphylactic reaction. It's important to remember that a second dose is administered only if emergency medical responders are delayed and the patient is still having signs and symptoms of anaphylaxis 5 to 10 minutes after administering the first dose. It's important to act fast when a patient is having an anaphylactic reaction, as difficulty breathing and shock are both life-threatening conditions that could suddenly erupt. If the patient is unable to self-administer the medication, you may need to help them with the epi pen. Only assist if/when: The patient has a previous diagnosis of anaphylaxis and has been prescribed an epinephrine auto-injector The patient is having signs and symptoms of anaphylaxis The patient requests your help using an auto-injector Your state laws permit giving assistance https://d3imrogdy81qei.cloudfront.net/video_images/3763/how-to-use-an-epipen-2015.jpg Yes 140 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/como-usar-epipen https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2102.mp4 Cómo usar un Epipen https://d3imrogdy81qei.cloudfront.net/video_images/3763/how-to-use-an-epipen-2015.jpg Yes 140 https://app.protrainings.com/courses/bls/healthcare/videos/procpr-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2103.mp4 Welcome to ProCPR Welcome to your ProCPR BLS course designed for healthcare professionals. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. Your instructor for the duration of your ProCPR course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a co-founder of ProTrainings. In other words, you're in good hands. We created ProCPR with you in mind, the busy healthcare professional. In our modern world, it's hard to imagine fitting anything else into our already jam-packed schedules and especially several hours' worth of CPR training. Since your schedule is already hectic, we created ProCPR to be available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. The list of occupations that can benefit from the ProCPR course is long and includes: Physicians Physician Assistants Nurse Practitioners Nurses EMTs Paramedics Firefighters Lifeguards Physical Therapists Respiratory Therapists X-Ray Technologists Pharmacists Dentists Personal Trainers Other Health Care Professionals The total course time includes 3 hours and 9 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your ProCPR course curriculum is quite substantial. Some of the important things you'll be learning are: Introductory CPR Training• Latest Updates• The Five Fears of CPR Rescue• Accessing EMS with Technology Medical Emergencies• Stroke• Heart Attacks Universal Precautions Respiratory Arrest Training• Adult, Child, Infant Rescue Breathing• Opioid Overdose Cardiac Arrest Training• Adult, Child, Infant, Neonatal CPR• Hands-Only CPR• AED Training• Spinal Injury Multiple Rescuer Skills• Bag Valve Mask• 2-Rescuer CPR & AED• CPR Team Approach Choking Training• Adult, Child, Infant Choking (Conscious)• Adult, Child, Infant Choking (Unconscious) Bleeding Control• Arterial Bleeding• Shock If you need first aid as well, you can take our ProFirstAid Advanced course that covers BLS & First Aid. The curriculum for this course was based on the latest American Heart Association and ECC/ILCOR guidelines for CPR and BLS. The ProCPR curriculum has also been submitted to and approved by hundreds of state and national boards and third-party accrediting organizations since 2005. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. Nearly 230,000 satisfied professionals just like yourself have completed this ProCPR course. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next healthcare provider who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Welcome again to ProCPR. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3765/procpr-introduction-2015.jpg Yes 48 https://app.protrainings.com/courses/bls/healthcare/videos/introduccion-pro-rcp https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2103.mp4 Introducción a ProRCP En este curso, cubriremos la RCP, DEA y bolsa válvula máscara en bebés, niños, adultos, dos personas, una persona. También abordaremos el enfoque en equipo, específicamente para profesionales de la salud. Cuando diseñamos ProCPR, mantuvimos en mente la agenda ocupada de la atención médica. Por eso lo desarrollamos para estar disponible las 24 horas del día, los 7 días de la semana. Así que se basa en tu horario, y no el de los instructores. Así que con eso, vamos a empezar. https://d3imrogdy81qei.cloudfront.net/video_images/3765/procpr-introduction-2015.jpg Yes 48 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/intro-to-profirst-aid-basic https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2105.mp4 ProFirstAid Basic Introduction Welcome to ProFirstAid Basic. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And at the end, we'll give you a little information on why learning CPR is so important. Your instructor for the duration of your ProFirstAid Basic course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a co-founder of ProCPR and ProFirstAid. In other words, you're in good hands. We created ProFirstAid Basic with you in mind. In our busy modern world, it's hard to imagine fitting anything else into our already jam-packed schedules and especially several hours' worth of CPR and first aid training. Since your schedule is already hectic, we created ProFirstAid Basic to be available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. Regardless of your occupation, you'll be getting the best training available for adult CPR and first aid; important skills you can use in the workplace and also at home. The list of occupations that can benefit from the ProFirstAid course is long and includes: Construction Workers Manufacturing Forestry Transportation Workplace Emergency Response Team Electricians Security Personnel Adult Foster Care Restaurant Staff Home Health Care Aids Hotel Staff CNAs High School Teachers High School Coaches Others who require Adult CPR (does not work with children or infants) and First Aid to meet OSHA requirements The total course time includes 3 hours and 21 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your ProFirstAid course curriculum is extremely substantial. Some of the important things you'll be learning are: Introductory First Aid Training• The Five Fears of CPR Rescue Heart Attack and Stroke• Stroke• Heart Attacks Cardiac Arrest Training• Adult CPR• Adult AED• Hands-Only CPR Choking Training• Conscious Adult Choking• Unconscious Adult Choking Bleeding Control• Capillary, Venous, Arterial Bleeding Shock Control• Shock• Fainting Ongoing Assessment for Injury and Illness• Mechanism of Injury• Secondary Survey• Musculoskeletal Injuries• Amputation• Head, Neck, and Back Injuries• Seizure• Eye Injuries• Allergic Reactions• Snake Bites• Diabetes Heat and Cold EmergenciesSnow Safety - Prevention, Hypothermia, Frostbite• Heat and Cold Emergencies• Burns Prevention• Car Backing• Child Proofing the Home• Poison Control• Pool Safety• Child Abuse and Neglect Bloodborne Pathogens• Reducing Your Risk• Exposure Incident ProFirstAid Basic is CPR and First aid certification that meets OSHA guidelines for the general workplace. If you are looking to certify in all ages CPR, then a better option would be our ProFirstAid course that cover CPR & First Aid for all ages. If you are currently certified with Red Cross, AHA, National Safety Council, ASHI or Medic First Aid, you are welcome to utilize ProFirstAid.com and receive a new, two-year ProFirstAid Basic certificate. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. Nearly 52,000 satisfied professionals just like yourself have completed this ProFirstAid Basic course. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next person who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important ProFirstAid Basic is different from the typical CPR and first aid courses. We believe that high-quality CPR training is something everyone should be able to access, for free. So, rather than paying simply to learn CPR, the payment is at the very end, only for those who need a certification card for work. We also believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR differently. Gaining confidence in your skills is a big part of performing high-quality CPR and administering vital first aid. Remembering that as you progress through each lesson will serve you well. Welcome again to ProFirstAid Basic. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3769/intro-to-profirst-aid-basic-2015.jpg Yes 53 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/introduccion-pro-primeros-auxilios-basico https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2105.mp4 Introducción a primeros auxilios básicos Nosotros diseñamos ProFirstAid Básico para cubrir las áreas de RCP para adultos y Primeros Auxilios para profesionales ocupados como tú. Algunos de ustedes lo necesitan no solo para el trabajo, sino quizás también en el hogar. https://d3imrogdy81qei.cloudfront.net/video_images/3769/intro-to-profirst-aid-basic-2015.jpg Yes 53 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/adult-cpr-profa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2106.mp4 Adult CPR Adult CPR is performed by first contacting emergency services. Next, if the patient is not breathing, begin chest compressions followed by two rescue breaths. Perform 30 compressions at a rate of 100-120 per minute and a depth of 2-2.4 inches in the center of the chest. These 30 compressions should be followed by two rescue breaths, and repeat the cycle until an AED or emergency services arrives. https://d3imrogdy81qei.cloudfront.net/video_images/3771/adult-cpr-profa-2015.jpg Yes 158 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/rcp-adultos-pro-primeros-auxilios https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2106.mp4 RCP en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3771/adult-cpr-profa-2015.jpg Yes 158 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/adult-aed-profa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2107.mp4 Adult AED If the patient is a witnessed cardiac arrest, first check to assure the scene is safe. Check for patient responsiveness, contact emergency services. Turn on the AED if the patient is not breathing. Attach the AED pads to the patient, and do not touch the patient while the AED analyzes. After a shock is delivered, begin CPR for about 5 cycles or two minutes. The AED will interrupt after two minutes and reanalyze the patient. Continue to follow the AED's instructions until advanced life support arrives. https://d3imrogdy81qei.cloudfront.net/video_images/3773/adult-aed-profa-2015.jpg Yes 214 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/dea-adultos-pro-primeros-auxilios https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2107.mp4 DEA en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3773/adult-aed-profa-2015.jpg Yes 214 https://app.protrainings.com/courses/cpr/adults/videos/procpr-basic-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2108.mp4 ProCPR Basic Introduction Welcome to ProCPR Basic. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And at the end, we'll share with you some important information about why learning high-quality CPR is so vital. Your instructor for the duration of your ProCPR Basic course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a co-founder of ProTrainings. In other words, you're in good hands. We created ProCPR Basic to be both efficient and effective, and we developed it with you in mind. Your schedule is probably hectic, which is why ProCPR is available whenever you are, 24 hours a day, seven days a week, as opposed to when an instructor is available. You can squeeze in a quick lesson whenever you have a few minutes to spare. The list of occupations that can benefit from the ProCPR Basic course is long and includes: Construction Workers Manufacturing Forestry Transportation Workplace Emergency Response Team Electricians Security Personnel Adult Foster Care Restaurant Staff Home Health Care Aids Hotel Staff CNAs High School Teachers High School Coaches The total course time includes 1 hour and 27 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your ProCPR Basic course curriculum is quite substantial. Some of the important things you'll be learning are: Introductory CPR Training• The Five Fears of CPR Rescue Medical Emergencies• Stroke• Heart Attacks• Shock Cardiac Arrest Training• Adult CPR• AED• Hands-Only CPR Choking• Adult Choking- Conscious and Unconscious Bloodborne Pathogens• Reducing Your Risk• Glove Removal• Hand Hygiene If you require first aid as part of your certification, check out our Adult CPR & First Aid course. Our Adult CPR course is a 2-year certification. If you are currently certified with Red Cross, AHA, National Safety Council, ASHI, or Medic First Aid, you are welcome to re-certify with this course. Individuals are free to train, refresh, and test at no charge any time 24/7! This course is nationally accredited and follows the latest American Heart Association, ECC/ILCOR guidelines. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. Nearly 47,000 satisfied professionals just like yourself have completed this ProCPR Basic course. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next person who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important ProCPR Basic is different from the typical CPR course you're probably accustomed to taking. We believe that high-quality CPR training is something everyone should be able to access, for free. So, rather than paying simply to learn CPR, the payment is at the very end, only for those who need a certification card for work. We also believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR differently. Gaining confidence in your skills is a big part of performing high-quality CPR. Remembering that as you progress through each lesson will serve you well. Welcome again to ProCPR Basic. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3775/procpr-basic-introduction-2015.jpg Yes 41 https://app.protrainings.com/courses/cpr/adults/videos/introduccion-pro-rcp-basico https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2108.mp4 Introducción a ProRCP básico https://d3imrogdy81qei.cloudfront.net/video_images/3775/procpr-basic-introduction-2015.jpg Yes 41 https://app.protrainings.com/courses/cpr/all-ages/videos/community-cpr-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2109.mp4 Community CPR Introduction Welcome to the ProTrainings' Community CPR. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And at the end, we'll give you a little information on why learning CPR is so important. Your instructor for the duration of your Community CPR course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and is also a co-founder of ProTrainings. In other words, you're in good hands. We created Community CPR with you in mind. In our busy modern world, it's hard to imagine fitting anything else into our already jam-packed schedules and especially several hours' worth of CPR training. Since your schedule is already hectic, we created Community CPR to be available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. Furthermore, you'll be able to absorb the vital skills associated with infant, child, and adult CPR over time by opting in to our email reminder system. Over the next couple of years, you'll continue to receive these refresher video lessons to keep your skills sharp should you ever need them; important skills that you can use in the workplace, and also at home. The list of people that can benefit from the Community CPR course are: Middle and High School Students Parents  People that need CPR but not First Aid certification The total course time includes 2 hours and 2 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your Community CPR course curriculum is quite substantial. The lessons you're about to dive into are as follows: Introductory CPR Training• Welcome to Community CPR• 2015 Guidelines Update - CPR• The Five Fears of CPR Rescue• How to Access EMS Through Technology Medical Emergencies• Heart Attacks• Stroke Universal Precautions• Universal Precautions in the Workplace• Handwashing Cardiac Arrest• Agonal Respiration (Not Breathing Normally)• Adult, Child, Infant CPR• Adult, Child, Infant AED• Hands-Only CPR• When CPR Doesn't Work Choking• Adult, Child, Infant Choking (Conscious)• Adult, Child, Infant Choking (Unconscious) Bleeding Control• Arterial Bleeding• Shock Conclusion• Special Considerations for CPR, AED, & Choking• Conclusion Community CPR certification includes adult, child, and infant CPR. Individuals are free to train, refresh, and test at no charge any time 24/7! The Community CPR certification is nationally accredited and follows the latest American Heart Association, ECC/ILCOR guidelines. This course is great for people who do not need a first-aid certification. Generally, people who need to be certified for daycare or the general workplace (OSHA Compliance) should take our ProFirstAid certification instead, as it includes adult, child, and infant CPR with a first aid component. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. When you combine all of the ProTrainings courses, several hundred thousand satisfied people just like yourself have completed one of our courses. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next person who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important Community CPR is different from typical CPR courses. We believe that high-quality CPR and first aid training is something everyone should be able to access, for free. So, rather than paying simply to learn CPR, the payment is at the very end and only for those who need a certification card. We also believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR. Gaining confidence in your skills is a big part of performing high-quality CPR. Remembering that as you progress through each lesson will serve you well. Welcome again to Community CPR. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3777/community-cpr-introduction-2015.jpg Yes 48 https://app.protrainings.com/courses/cpr/all-ages/videos/introduccion-rcp-comunidad https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2109.mp4 Introducción a RCP para la comunidad Bienvenido a ProTrainings Community CPR. Roy Shaw es un paramédico licenciado y su instructor para este curso. Aprenda a su propio ritmo y disfrute. https://d3imrogdy81qei.cloudfront.net/video_images/3777/community-cpr-introduction-2015.jpg Yes 48 https://app.protrainings.com/courses/cpr-first-aid/first-aid-only/videos/profirstaid-only-intro https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2110.mp4 ProFirstAid Only Intro Welcome to ProFirstAid Only. In this lesson, we'll be giving you a rundown of everything you can expect to learn in this important course and even a few specifics of the course. And even though you'll just be learning hand's only CPR, at the end we'll give you a little information on why learning CPR is so important. Your instructor for the duration of your ProFirstAid Only course is Roy Shaw. Roy is a licensed paramedic with years of both real-world and instructor experience and also a cofounder of ProCPR and ProFirstAid. In other words, you're in good hands. We created ProFirstAid Only with you in mind. In our busy modern world, it's hard to imagine fitting anything else into our already jam-packed schedules and especially several hours' worth of first aid training. Since your schedule is already hectic, we created ProFirstAid Only to be available whenever you are, 24 hours a day, seven days a week. You can squeeze in a quick lesson whenever you have a few minutes to spare, whether it's day or night, weekend or workday. It's there when you need it. Regardless of your occupation, you'll be getting the best training available for adult, child, and infant first aid. Whether it's a sudden illness or an injury-related emergency, you'll be better prepared to handle it thanks to the skills you're about to learn; important skills that you can use in the workplace, and also at home. The list of occupations that can benefit from the ProFirstAid Only course is long and includes: Individuals who have CPR certification and require First Aid only to meet OSHA and other requirements Construction Workers Manufacturing Forestry Transportation Electricians Security Personnel Adult Foster Care Restaurant Staff Home Health Care Aids Hotel Staff CNAs High School Teachers High School Coaches The total course time includes 2 hours and 56 minutes of video training as well as knowledge reviews, a final test, remedial help, and time spent reviewing downloaded material, like the student manual that comes with this course. You can download that manual here: Student Manual. What You Will Learn in this Course Your ProFirstAid Only course curriculum is quite substantial. Some of the important things you'll be learning are: Introductory First Aid Training• The Five Fears of CPR Rescue Heart Attack and Stroke• Stroke• Heart Attacks Choking• Conscious Choking Bleeding and Shock• Capillary, Venous, Arterial Bleeding• Shock Management Sudden Illness and Injury• Mechanism of Injury• Secondary Survey• Musculoskeletal Injuries• Amputation• Head, Neck, and Back Injuries• Seizure• Eye Injuries• Allergic Reactions• Snake Bites• Diabetes• Burns  Heat and Cold Emergencies• Snow Safety - Prevention, Hypothermia, Frostbite• Heat and Cold Emergencies Prevention• Car Backing• Child Proofing the Home• Poison Control• Pool Safety• Child Abuse and Neglect Bloodborne Pathogens• Reducing Your Risk• Glove Removal• Hand Hygiene Pro First Aid Only is an online first aid certification that meets OSHA guidelines for the general workplace where CPR certification is not required. If you need ONLY first aid training without CPR, you are welcome to utilize this course and receive a new, two-year First Aid Only certificate. And if you ever decide to become CPR certified in the future, check out our CPR & First Aid course for all ages. Those of you old enough to remember may recall that McDonald's signs used to include a running total of the number of hamburgers sold until that number outgrew the sign. More than 14,000 satisfied professionals just like yourself have completed this ProFirstAid Only course. And although our numbers aren't growing as quickly as McDonald's, we do sincerely hope that you'll be the next person who has a satisfying experience. Pro Tip: Please keep this in mind as you progress through your course: Although this is an online course, we are still available to answer any questions you may have. Don't be shy. If you ever need help, reach out and we'll be here for you. Also worth mentioning is that the written course material that accompanies each video lesson (like this one) will often have some additional information that isn't in the video. And you'll occasionally find areas of emphasis labeled as Pro Tips and Warnings that will be highlighted and difficult to miss. Why Learning High-Quality CPR is Important ProFirstAid Only is different from the typical first aid courses. We believe that high-quality CPR and first aid training is something everyone should be able to access, for free. So, rather than paying simply to learn CPR and first aid, the payment is at the very end, only for those who need a certification card for work. We also believe that the problem with CPR isn't that everyone is doing CPR incorrectly. The bigger problem is that people aren't doing CPR at all. That's why we start with the "why." Why are people afraid to rescue? What happens when CPR doesn't work? These are just a few of the parts of the training that will make even the most seasoned professional walk away from the course learning something new or thinking about CPR and first aid differently. Gaining confidence in your skills is a big part of performing high-quality CPR (even hand's only CPR) and administering vital first aid. Remembering that as you progress through each lesson will serve you well. Welcome again to ProFirstAid Only. Now, let's get started! https://d3imrogdy81qei.cloudfront.net/video_images/3779/profirstaid-only-intro-2015.jpg Yes 47 https://app.protrainings.com/courses/cpr-first-aid/first-aid-only/videos/introduccion-solo-pro-primeros-auxilios https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2110.mp4 Introducción a primeros auxilios solamente https://d3imrogdy81qei.cloudfront.net/video_images/3779/profirstaid-only-intro-2015.jpg Yes 47 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adult-cpr-community-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2111.mp4 Practice: Adult CPR Learn how to give CPR to an adult who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3781/adult-cpr-community-lay-rescuer-practice-2015.jpg Yes 118 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/cpr-adulto-comunidad-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2111.mp4 Práctica: RCP en adultos Aprenda a dar CPR a un adulto que está inconsciente y no respira observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3781/adult-cpr-community-lay-rescuer-practice-2015.jpg Yes 118 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-cpr-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2112.mp4 Practice: Child CPR Learn how to give CPR to a child who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3783/child-cpr-lay-rescuer-practice-2015.jpg Yes 80 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/cpr-nino-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2112.mp4 Práctica: RCP en niños Aprenda a darle RCP a un niño que está inconsciente y no respira observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3783/child-cpr-lay-rescuer-practice-2015.jpg Yes 80 https://app.protrainings.com/courses/bls/healthcare/videos/hands-only-cpr-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2114.mp4 Practice: Hands Only CPR When doing hands-only or compression-only CPR, you do not do cycle breathing. You simply continue chest compressions until EMS arrives. Learn this skill by watching the procedure be performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3787/hands-only-cpr-practice-2015.jpg Yes 85 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-solo-manos-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2114.mp4 Práctica: RCP solo con manos Al hacer las manos solamente o la compresión solamente RCP, usted no hace la respiración del ciclo. Simplemente continúe las compresiones torácicas hasta que llegue el ccsme. Aprenda esta habilidad viendo el procedimiento ser realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3787/hands-only-cpr-practice-2015.jpg Yes 85 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/adult-aed-community-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2115.mp4 Practice: Adult AED Learn how to give CPR with an AED to an adult who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3789/adult-aed-community-lay-rescuer-practice-2015.jpg Yes 220 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/dea-adulto-comunidad-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2115.mp4 Práctica: DEA en adultos Aprenda a dar RCP con un DEA a un adulto que está inconsciente y no respira observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3789/adult-aed-community-lay-rescuer-practice-2015.jpg Yes 220 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/child-aed-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2116.mp4 Practice: Child AED Learn how to give CPR with an AED to a child who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3791/child-aed-lay-rescuer-practice-2015.jpg Yes 211 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/dea-nino-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2116.mp4 Práctica: DEA en niños Aprenda a dar CPR con un DEA a un niño que está inconsciente y no respira observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3791/child-aed-lay-rescuer-practice-2015.jpg Yes 211 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/unconscious-adult-choking-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2118.mp4 Practice: Unconscious Adult Choking Learn how to give CPR to an adult who is unconscious and choking by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3795/unconscious-adult-choking-lay-rescuer-practice-2015.jpg Yes 95 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asfixia-adulto-inconsciente-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2118.mp4 Práctica: Asfixia en adulto inconsciente Aprenda a dar RCP a un adulto que está inconsciente y ahogándose observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3795/unconscious-adult-choking-lay-rescuer-practice-2015.jpg Yes 95 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/unconscious-child-choking-lay-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2119.mp4 Practice: Unconscious Child Choking Learn how to give CPR with an AED to a child who is unconscious and choking by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3797/unconscious-child-choking-lay-rescuer-practice-2015.jpg Yes 112 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asfixia-nino-inconsciente-rescatista-lego-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2119.mp4 Práctica: Asfixia en niño inconsciente Aprenda a dar RCP con un DEA a un niño que está inconsciente y ahogándose observando el procedimiento realizado en un maniquí. https://d3imrogdy81qei.cloudfront.net/video_images/3797/unconscious-child-choking-lay-rescuer-practice-2015.jpg Yes 112 https://app.protrainings.com/courses/bls/healthcare/videos/adult-rescue-breathing-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2121.mp4 Practice: Adult Rescue Breathing Learn how to perform rescue breathing on an unconscious adult who is not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3801/adult-rescue-breathing-practice-2015.jpg Yes 82 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-adultos-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2121.mp4 Práctica: Respiración de rescate en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3801/adult-rescue-breathing-practice-2015.jpg Yes 82 https://app.protrainings.com/courses/bls/healthcare/videos/child-rescue-breathing-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2122.mp4 Practice: Child Rescue Breathing Learn how to perform rescue breathing on an unconscious child who is not breathing by watching the procedure performed on a manikin. https://d3imrogdy81qei.cloudfront.net/video_images/3803/child-rescue-breathing-practice-2015.jpg Yes 64 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-ninos-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2122.mp4 Práctica: Respiración de rescate en niños https://d3imrogdy81qei.cloudfront.net/video_images/3803/child-rescue-breathing-practice-2015.jpg Yes 64 https://app.protrainings.com/courses/bls/healthcare/videos/infant-rescue-breathing-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2123.mp4 Practice: Infant Rescue Breathing Learn how to perform rescue breathing on an unconscious infant who is not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3805/infant-rescue-breathing-practice-2015.jpg Yes 68 https://app.protrainings.com/courses/bls/healthcare/videos/respiracion-rescate-bebe-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2123.mp4 Práctica: Respiración de rescate en bebés https://d3imrogdy81qei.cloudfront.net/video_images/3805/infant-rescue-breathing-practice-2015.jpg Yes 68 https://app.protrainings.com/courses/bls/healthcare/videos/adult-cpr-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2124.mp4 Practice: Adult CPR Learn how to give CPR to an adult who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3807/adult-cpr-practice-2015.jpg Yes 92 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-adulto-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2124.mp4 Práctica: RCP en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3807/adult-cpr-practice-2015.jpg Yes 92 https://app.protrainings.com/courses/bls/healthcare/videos/child-cpr-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2125.mp4 Practice: Child CPR Learn how to give CPR to a child who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3809/child-cpr-practice-2015.jpg Yes 104 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-nino-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2125.mp4 Práctica: RCP en niños https://d3imrogdy81qei.cloudfront.net/video_images/3809/child-cpr-practice-2015.jpg Yes 104 https://app.protrainings.com/courses/bls/healthcare/videos/adult-aed-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2127.mp4 Practice: Adult AED Learn how to give CPR with an AED to an adult who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3813/adult-aed-practice-2015.jpg Yes 240 https://app.protrainings.com/courses/bls/healthcare/videos/dea-adulto-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2127.mp4 Práctica: DEA en adultos https://d3imrogdy81qei.cloudfront.net/video_images/3813/adult-aed-practice-2015.jpg Yes 240 https://app.protrainings.com/courses/bls/healthcare/videos/child-aed-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2128.mp4 Practice: Child AED Learn how to give CPR with an AED to a child who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3815/child-aed-practice-2015.jpg Yes 256 https://app.protrainings.com/courses/bls/healthcare/videos/dea-nino-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2128.mp4 Práctica: DEA en niños https://d3imrogdy81qei.cloudfront.net/video_images/3815/child-aed-practice-2015.jpg Yes 256 https://app.protrainings.com/courses/bls/healthcare/videos/two-person-aed-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2130.mp4 Practice: Two Person AED Watch how to two people can work together to give CPR with an AED to an unconscious adult who is not breathing. This procedure acted out on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3819/two-person-aed-practice-2015.jpg Yes 247 https://app.protrainings.com/courses/bls/healthcare/videos/dea-dos-personas-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2130.mp4 Práctica: DEA dos personas https://d3imrogdy81qei.cloudfront.net/video_images/3819/two-person-aed-practice-2015.jpg Yes 247 https://app.protrainings.com/courses/bls/healthcare/videos/adult-cpr-two-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2131.mp4 Practice: Adult CPR Two Rescuer Watch how to two people can work together to give CPR to an unconscious adult who is not breathing. This procedure acted out on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3821/adult-cpr-two-rescuer-practice-2015.jpg Yes 188 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-adultos-dos-rescatistas-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2131.mp4 Práctica: RCP en adultos dos rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/3821/adult-cpr-two-rescuer-practice-2015.jpg Yes 188 https://app.protrainings.com/courses/bls/healthcare/videos/child-cpr-two-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2132.mp4 Practice: Child CPR Two Rescuer Watch how two people can work together to give CPR to an unconscious child who is not breathing. This procedure acted out on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3823/child-cpr-two-rescuer-practice-2015.jpg Yes 141 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-ninos-dos-rescatistas-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2132.mp4 Práctica: RCP en niños dos rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/3823/child-cpr-two-rescuer-practice-2015.jpg Yes 141 https://app.protrainings.com/courses/bls/healthcare/videos/infant-cpr-two-rescuer-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2133.mp4 Practice: Infant CPR Two Rescuer Watch how two people can work together to give CPR to an unconscious infant who is not breathing. This procedure acted out on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3825/infant-cpr-two-rescuer-practice-2015.jpg Yes 148 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-bebes-dos-rescatistas-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2133.mp4 Práctica: RCP en bebés dos rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/3825/infant-cpr-two-rescuer-practice-2015.jpg Yes 148 https://app.protrainings.com/courses/bls/healthcare/videos/unconscious-adult-choking-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2135.mp4 Practice: Unconscious Adult Choking (Healthcare Provider) Learn how to rescue an unconscious adult that is choking by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3829/unconscious-adult-choking-practice-2015.jpg Yes 102 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-adulto-inconsciente-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2135.mp4 Práctica: Asfixia en adulto inconsciente (asistencia médica) https://d3imrogdy81qei.cloudfront.net/video_images/3829/unconscious-adult-choking-practice-2015.jpg Yes 102 https://app.protrainings.com/courses/bls/healthcare/videos/unconscious-child-choking-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2136.mp4 Practice: Unconscious Child Choking Learn how to rescue an unconscious child that is choking by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3831/unconscious-child-choking-practice-2015.jpg Yes 97 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-nino-inconsciente-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2136.mp4 Práctica: Asfixia en niño inconsciente https://d3imrogdy81qei.cloudfront.net/video_images/3831/unconscious-child-choking-practice-2015.jpg Yes 97 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/adult-aed-workplace-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2138.mp4 Practice: Adult AED Learn how to give CPR with an AED to an adult who is unconscious and not breathing by watching the procedure performed on a manikin. https://d3imrogdy81qei.cloudfront.net/video_images/3835/adult-aed-workplace-practice-2015.jpg Yes 276 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/dea-adulto-lugar-de-trabajo-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2138.mp4 Práctica: DEA en adulto https://d3imrogdy81qei.cloudfront.net/video_images/3835/adult-aed-workplace-practice-2015.jpg Yes 276 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/adult-cpr-workplace-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2139.mp4 Practice: Adult CPR Learn how to give CPR to an adult who is unconscious and not breathing by watching the procedure performed on a mannequin. https://d3imrogdy81qei.cloudfront.net/video_images/3837/adult-cpr-workplace-practice-2015.jpg Yes 96 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/rcp-adulto-lugar-de-trabajo-practica https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2139.mp4 Práctica: RCP en adulto https://d3imrogdy81qei.cloudfront.net/video_images/3837/adult-cpr-workplace-practice-2015.jpg Yes 96 https://app.protrainings.com/courses/pets/first-aid/videos/introduction-to-pet-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2140.mp4 Welcome to Pet First Aid Welcome to your ProTraining's Pet First Aid course. In this introductory lesson, we'll be introducing you to Charlie, a one-and-a-half-year-old Springer Spaniel, who received the care he needed to recover fully from his health scare. We'll also tell you a few of the important things you'll be learning in this course, along with one crucial warning you should definitely heed. Your video instructor for this course is Dr. Bobbi Conner, Dr. of Veterinary Medicine. And while the video content is very thorough, we're also providing you with written lessons (like this one) for every video in the course. In these written lessons, you'll come across the occasional Pro Tip, those things you might want to pay extra attention to, along with a few Warnings, which you should pay even more attention to. Meet Charlie – Heat Stroke Survivor As mentioned above, Charlie is a one-and-a-half-year-old Springer Spaniel with boundless energy. While playing in the yard one fine day with his family, he was enjoying himself way too much to take a break from all the fun, so he pushed himself a bit too hard. Charlie Began stumbling and then finally collapsed. His family immediately suspected that he was suffering from heatstroke. While mom went to get the car, dad instinctively grabbed Charlie and dunked him in the kiddie pool to cool off. Charlie's family rushed him to the hospital and by the time they arrived, his temperature had begun to return to normal. His family was right; it turned out that Charlie had all the classic signs of heatstroke and was actually required to stay in the hospital for several days. However, thanks to the quick actions by Charlie's family, he was able to quickly get back home and experienced no long-term problems, which can be rare with heat stroke victims. What You Can Expect to Learn In this course, we're going to equip you with all the tools you need to: Recognize problems with your pet early Know when to provide care Know how to provide care appropriately What information you need to gather to help your veterinarian ensure the best possible outcome and maybe even save you a little money Prompt and affective pet first aid can sometimes replace the need for veterinary care. However, in most situations, what you will be learning are simply the first steps that you can take to prevent an emergency situation from getting worse while you also transport your pet to the veterinarian. Warning: It's better to be safe than sorry. If at any time you do not feel that you are able to manage the situation with your pets injury or illness, do not hesitate. Seek veterinarian care immediately. Medical emergencies often require prompt attention, even those involving our furrier family members. Welcome again to your ProTrainings' Pet First Aid course. We truly hope it becomes a difference-maker for you and your pets. https://d3imrogdy81qei.cloudfront.net/video_images/3839/introduction-to-pet-first-aid.jpg Yes 107 https://app.protrainings.com/courses/pets/first-aid/videos/making-a-cat-and-dog-first-aid-kit https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2141.mp4 Making a Cat and Dog First Aid Kit In this lesson, we'll be walking you through all the items that you will need to put together for your pet first aid kit, so you can be prepared in the event of an emergency or some type of natural disaster. Perhaps not surprisingly, your pet first aid kit will look very similar to a human first aid kit, with a few important additions that obviously wouldn't apply to humans, beginning with … Muzzles Muzzles can help protect your pet in case there is an emergency. There are a few different types of muzzles, such as a basket muzzle, however, nylon mesh muzzles are more common and may be more comfortable. Just make sure that whatever muzzle you choose is appropriately sized. Pro Tip #1: While we tend to think of muzzles only for dogs, a cat muzzle is also a good idea in certain situations. Cat muzzles typically cover the nose, mouth, and eyes. Covering the eyes is especially helpful as it sometimes can help your feline family member remain calm in an emergency. Transport Items It's important during an emergency for you to have a way to transport your pet safely to the veterinarian. For small dogs and cats, an appropriately sized carrier may be the best choice. It's also a good idea to choose a carrier that can be taken apart and has a top and bottom half, which will make it easier for you to put your pet in and take your pet out. For large dogs, transportation can be a little trickier. You may have to use a sling or a large board or just simply some human help. And, as some of you know, transporting cats safely in a vehicle can be even trickier. Pro Tip #2: For a makeshift sling, you can use a large towel. A towel can also be multi-functional as you can use it to support your dog or keep him or her warm during a crisis. Disposable Gloves Latex gloves are another item that you'll want to have in your pet first aid kit. Non-latex gloves are preferred as people commonly have latex allergies even if they are not aware. When choosing disposable gloves, make sure you choose a size that is appropriate for your hands. Your disposable gloves should fit snugly. If they are too loose, you're going to have a difficult time using them. Nail Clippers Make sure you have a set or two of nail clippers in your first aid kit, and make sure they are appropriately sized for your pet – large clippers for large dogs, and small clippers for small dogs and cats. Styptic Powder Styptic powder is a substance that causes bleeding to stop. One type is a styptic pencil. These are made from alum and sulfate salts of potassium aluminum, though some are made from ammonium salts. It's important to have something on hand for nail bleeding, especially if you are clipping your pets nails at home. Leashes It's a good idea to have a leash for your pet that does not require a collar, as sometimes emergencies occur while your pet is not wearing one. In those situations, it's important to have a slip lead type leash, even if it's just a backup. Slip lead leashes have a looped end that can easily be adjusted for the size of your pet's head. Simply slip the loop over the head and tighten to a snug fit. Thermometer In an emergency, it could be important to get your pets vital signs and one of the most important vitals is temperature. Because taking your pets temperature can be difficult, it's best to use a quick read thermometer that will take your pet's temperature in just six to eight seconds. You should be able to find one at your local pharmacy. Wound Care Items Wound care items are particularly important for your pet first aid kit. If your pet suffers any type of injury, you'll want to have the materials on hand that are needed to clean, cover, and protect the wound. Electric Clippers Electric Clippers can be used to trim around a wound to provide easier and better exposure. It can be difficult to know how bad an injury is if you cannot see it through all your pet's fur. Hydrogen Peroxide/Isopropyl Alcohol Hydrogen peroxide and isopropyl alcohol are helpful when cleaning wounds and are also multifunctional. However, it's important to keep in mind that these items do expire. Warning: Be mindful to check all expiration dates for everything in your pet first aid kit on a regular basis and throw away and replace all expired items. Gauze Bandages There are two types of gauze bandages that you may want to consider – gauze squares and roll gauze. These can both be useful for covering various pet wounds and injuries. Antibiotic Ointment A triple antibiotic ointment like Neosporin is a handy item to have in your pet first aid kit. Lubrication Jelly Lubrication Jelly is probably something you wouldn't think about for a pet first aid kit, but it's important, nonetheless. You can find sterile water-based lubrication jelly in single-use packets or tubes; however, packets are preferred as they are easier to keep clean while the tubes can become contaminated. Tape You will want to have different types of tape in your pet first aid kit. The two types you'll most want to have on hand are adhesive tape and non-adhesive tape. Non-adhesive tape, also known as a cohesive wrap, won't stick to your pet's skin, which could be useful in certain situations. Scissors Scissors are another useful item for your kit, but make sure you buy bandage scissors specifically. This type of scissors has a blunt end on one of the blades, so when cutting bandages, you won't accidentally cut your pet's skin. Sterile Eye Wash For ocular emergencies, it's a good idea to have some sterile eyewash in your first aid kit. There may be situations when your pet suffers an eye injury or gets foreign matter in an eye. A sterile eye wash will allow you to flush out your pet's eye. Contact Information Pro Tip #3: It may sound a bit strange but contact information may be the most important part of your pet first aid kit. You don't want to be scrambling around during an emergency, so keep updated contact information for your regular veterinarian, a local emergency vet contact, and the phone number for animal poison control hotline. Disaster Kit A disaster kit is also an important item in case of a natural disaster. In addition to information on your pet's veterinary care, you'll also want to have information on hand regarding where you can keep your pet in case of a disaster. There may be times when you can keep your pet with you, in which case you'll want to have a list of pet-friendly hotels both in your immediate area and perhaps even statewide. Or there may be other times when you will need someone to care for your pet like friends and family members or a local animal shelter or pet boarding house. Having this information unhand during a disaster will greatly reduce the time you'll spend preparing to evacuate, as well as your stress in the moment. Other items for your disaster kit include: Medications; you may want to have these in your pet first aid kit as well Pet food, including food bowels or containers Bedding for your pets Toys and treats; these may help keep your pets calm and comfortable in stressful times Pro Tip #4: Having your pet first aid kit and your disaster kit together and in a convenient location is also important. You'll save time and reduce stress knowing that these items are intact and ready for service. In other words, adopt the Boy Scout motto: Be prepared! https://d3imrogdy81qei.cloudfront.net/video_images/3841/making-a-cat-and-dog-first-aid-kit.jpg Yes 428 https://app.protrainings.com/courses/pets/first-aid/videos/aggressive-dog-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2142.mp4 Aggressive Dog Safety In this lesson, we'll go over ways in which you can stay safe while trying to help your dog. While it may seem unimaginable to you, your pet could turn on you if she feels threatened in an emergency. At the end of the lesson, we'll provide you with a Word about heat and dog safety. The first rule of providing any kind of first aid is to ensure the safety of the first responders, and in this case, that means you. Before approaching your pet in an emergency, always check to make sure the scene or environment is safe and that you feel comfortable approaching. The most common reason for a first responder to be injured trying to help an animal is from bites and scratches. Even the most well-behaved and docile dogs can become aggressive when they are afraid or in pain. Fortunately, if you should get bitten or scratched, the risk of transmission of an infectious disease from pet to human is very low. Signs that Your Pet may Become Aggressive That are some signs or indications that your dog may become aggressive with you during an emergency situation; these include, but are not limited to: Growling Baring or showing of teeth Raised fur on the back and shoulders Cowering or moving away Urinating Lip smacking Warning: If you see any of these signs or other signs of aggression, do not approach your dog until you can get help or the animal calms down. It's important to mention one more time, this list is not complete. Ways You can Stay Safe While Helping Your Dog Ideally, in these types of situations, you'll have a Gentle Leader on hand. A Gentle Leader headcollar fits securely over your dog's nose. The nose loop redirects her head towards you when she pulls forward, which prevents her from pulling. It also helps you get her full attention. Pro Tip: If you feel comfortable approaching your dog but you don't have a Gentle Leader, you can use a slip lead leash instead to achieve a similar result. Take the loop end of a slip lead and pass it over your dog's nose, mouth, and neck and pull it snug behind her ears. Before transporting a dog in pain, it's also important to try and muzzle the animal. Take your appropriately sized muzzle and pass it over your dog's nose and clasp it in the back behind her ears. If you don't have an appropriately sized muzzle, you can use a strip of gauze or some other soft material. Make a loop on one end, like you were beginning to tie a knot (but don't tighten). Pass that loop over your dog's snout and pull it snug, but not too tight. Cross it under her chin and tie it into a bow behind her ears. And make sure you can remove it easily if needed. Watch the corresponding video for this lesson for practice. If your dog becomes aggressive or more agitated while being muzzled, skip this step and attempt to transport your animal without one; just use common sense and heed the first rule from above – ensure your own safety first. For small dogs, you can try to use a towel as a muzzle if you don't have one that fits. Cover the animals head with the towel and wrap your arms around your dog to restrain her. In this position, she won't be able to bite or scratch you. In some cases, with smaller animals, you can grab the skin behind their neck – that loose scruff that mothers use to instinctively carry their pups around. This may help prevent your dog from turning to bite or scratch you. Warning: It's worth mentioning again – it's always important to remember that if it's not safe to approach your dog, wait until you get help or the animal calms down on her own. https://d3imrogdy81qei.cloudfront.net/video_images/3843/safety-with-dogs.jpg Yes 162 https://app.protrainings.com/courses/pets/first-aid/videos/aggressive-cat-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2143.mp4 Aggressive Cat Safety In this lesson, we're going to provide you with some signs of aggression in cats and show you some techniques you can use to safely restrain your cat if he or she becomes aggressive. It's important to note that even docile cats can become aggressive, especially if they're sick or injured. At the end of this lesson, we'll provide you with a Word about winter safety tips for your dog or cat. Signs that Your Cat may Become Aggressive Signs of aggression in cats includes: Hissing or yowling Flattening or pinning the ears back against the back of the head Raising the fur along the back of the spine Flicking or moving the tail back and forth Crouching or moving away from you Warning: If you are not sure how to safely restrain your cat by yourself, it's better to wait until you can get some help or until he calms down on his own. Techniques for Restraining Your Cat There are a number of methods you can use to restrain your cat, even when he doesn't want to be restrained, and these include: Grab the scruff on the skin behind his neck Wrap him in a towel Place him inside a disassembled carrier and then reassembling it Use an empty laundry basket to trap him, then slide a piece of cardboard underneath him Using the Scruff Behind the Neck Face your cat away from you. Grab the loose skin on the back of his neck. Place your other hand behind the first to hold him more securely. Using a towel Face your cat away from you. Cover him using a large enough towel to cover him completely, including his head. Wrap him up in the towel; like a cat burrito, if that helps. Scoop him up inside the towel. Most cats will calm down using this method, and everyone has large towels laying around. Using a Disassembled Carrier Disassemble your carrier. Face your cat away from you. Coax or place your cat inside the carrier. Once calm and contained within the carrier, put the lid back on. Pro Tip #1: You can use this technique any time you need to place your cat inside a carrier. And it's much easier than trying to shove your cat – calm or not – through a small hole. Using an Empty Laundry Basket and Cardboard Face your cat away from you. Trap your cat inside an overturned and empty laundry basket. Once in place, if you need to transport him, slide a piece of cardboard underneath him. How to Muzzle Your Cat There may be times when you'll need to muzzle your cat. However, it may difficult to do on your own, especially if your cat is agitated. A second person may be required to hold him steady. Face your cat away from you or sideways in your lap; whatever works best and is easiest. Grab your cat muzzle. Slide the muzzle over his face, making sure his nose goes into the small hole on the muzzle. Continue to slide the muzzle over his face, making sure the larger portion of material covers his eyes. Secure the muzzle behind his head; many cat muzzles come with Velcro straps making this quick and easy. Pro Tip #2: Covering your cat's eyes is essential for helping him calm down. Not only will he become less fearful once muzzled, but a muzzle will also keep his mouth closed and prevent him from biting you. https://d3imrogdy81qei.cloudfront.net/video_images/3845/safety-with-cats.jpg Yes 171 https://app.protrainings.com/courses/pets/first-aid/videos/introduction-to-knowing-your-pet https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2144.mp4 Knowing What's Normal for Your Pet In this next section, we're going to get into pet behaviors for you to monitor at home, how to understand what's normal for your pet, how to get your pet's vital signs, and a few important odds and ends all designed to help you understand your pet better. However, in this particular lesson, we're going to get into the importance of knowing your pet. Pro Tip #1: It's important to remember, especially after you've completed this course, that you know your pet better than anyone, even your vet. Keep this in mind and don't shy away from this fact. It could be really important at some point. What is Normal for Your Pet? It's really important that you are able to recognize and identify problems with your pet, or what's not normal. But before doing that, you'll need to understand what is normal. Warning: Consider this the before it's too late warning. By their very nature, pets will try to hide things from you. Sometimes, they're able to do this for a long time, until the thing they're hiding becomes really severe. Learn to notice the subtle changes in your pets. If you're able to pick up on any of these, you'll be better able to identify problems earlier and before they reach that severe stage. Doing so will also help you alert your veterinarian of what the problem might be. (Remember, you know your pet better than anyone.) Unfortunately, even the most observant pet owners can sometimes miss these subtle changes or not understand the significance of them. Don't be a constant worrier, but you also shouldn't lull yourself into thinking everything is always fine. Knowing what's normal with your pet is absolutely key to being able to identify what's wrong. It's also key in ensuring that your pets live long and healthy lives. https://d3imrogdy81qei.cloudfront.net/video_images/3847/introduction-to-knowing-your-pet.jpg Yes 65 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-behavior-changes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2145.mp4 Cat and Dog Behavior Changes In this lesson, we’re going to go over cat and dog behaviors you should monitor at home, specifically eating habits, bathroom habits, and social habits or behaviors. Doing so may help you get a jump on a problem before it becomes serious. Pro Tip #1: We mentioned this in a previous lesson but it’s worth repeating: Before you can determine what’s abnormal for your cat or dog, you first have to understand what is normal for your pet. Consider the following three behaviors a good starting point. Eating Habits The first pet behavior you should be keeping an eye on may also be the easiest to monitor – your cat or dog’s eating habits. First, ask yourself the following questions: What are my pet’s normal eating habits? Is he or she a voracious eater, gobbling down food as fast as you can put it in the food bowl? Or does my pet eat more slowly and graze when it comes to food time? If your dog or cat normally eats quickly, and suddenly, he or she is pushing around food in the bowel like a disgruntled child moving lima beans around a dinner plate, that’s a good sign there may be a problem. Also, keep in mind how much your pet normally eats. If your pet is typically a voracious eater and then one day leaves half the food in the food bowl uneaten, again, this could be a sign of a problem. Pro Tip #2: What should you do if you notice a problem in one of these three pet behaviors? Investigate further! Something tells me we’ll be getting into the how in subsequent lessons. Bathroom Habits Another behavior you should consider monitoring is your pet’s bathroom habits. Again, you should be asking the following: What is normal for my dog or cat? How often is my dog asking to go outside? How often is my cat making trips to the litter box? Bathroom behavior is significant when it deviates from the norm. A simple change in bathroom habits – either an increase or a decrease – can be an early warning sign that something is not quite right with your pet. Social Habits The last cat or dog behavior you should try monitoring is your pet’s social habits or behaviors. Ask yourself the following questions to get a sense of what’s normal for your pet: How does my cat or dog interact with me? How does my cat or dog interact with other family members? How does my cat or dog interact with the other pets in the household? If your dog normally greets you at the door every time you come home from work, or really whenever you’re away, and then one day he isn’t there when you come in, this could be a signal that something is wrong. Alternatively, if your cat typically wants nothing to do with your dog – as in leaving the room as soon as your dog enters – and then you notice one day that your cat didn’t go anywhere, this again could be a problem. It might be a mistake to think that maybe your cat suddenly had a change of heart and now loves dogs. Likely, your cat isn’t feeling well, and you should attempt to find out why. Understanding what’s normal for your pet is the foundation on which much of this course is built. Get to know your pet as an individual. Get to know your pet’s normal behaviors in these three areas listed above. If you do, you’ll be better equipped to notice when something isn’t right. https://d3imrogdy81qei.cloudfront.net/video_images/3849/cat-and-dog-behaviors.jpg Yes 95 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-pulse-rate https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2146.mp4 Cat and Dog Pulse Rate In this lesson, we'll be digging into the first vital sign you should be monitoring and checking in your pet – resting heart rate. If you ever have any concerns about how your pet is feeling, the first thing you should do is check his or her heart rate. This is often an important indicator of how your pet is feeling and doing physically. Your pet's heart rate will vary dramatically depending on a few factors, including: The activity level of your pet The anxiety level of your pet The general health of your pet Pro Tip #1: You may have noticed in the first paragraph that we used the phrase resting heart rate. It's really important that you measure the heart rate of your pet while he or she is at rest and calm, in order to get a more consistent measurement over time. Why is it important to get a consistent measurement over time? Well, remember, it's all about what's normal vs. what's abnormal. If you measure your pet's heart rate at times when he or she is not at rest, this will produce inconsistent measurements and normal will be unattainable. Normal Heart Rate Ranges for Dogs and Cats The normal heart rate for a dog at rest is between 40 and 100 beats per minute. The normal heart rate for a cat at rest is between 80 and 140 beats per minutes. Again, it's really important to remember that these heart rate numbers will be very different if your pet: Is anxious Just finished running around or exercising Is experiencing some stress Pro Tip #2: Raise your hand if you think your pet gets stressed out at the vet. What pet doesn't, right? For this reason, your veterinarian will always get a different heart rate measurement than what you'll get at home, when your pet is calm. The vet's office is a stressful environment for pets, and all those vital signs may be affected. (You can go ahead and put your hand down now.) How to Measure Your Pet's Heart Rate Wait until your pet is nice and calm and laying down. This is the perfect opportunity to measure his or her heart rate. 1. Ideally, your pet will be laying on his or her side, like Quinn was in the corresponding video for this lesson.2. Locate the femoral artery on the inside of your pet's thigh by placing your hand there. This artery runs down the inside and middle of the thigh along the bone.3. Once you find it – you should be able to feel it pulsating – put three fingers on that area and hold it. Pro Tip #3: You may recall in the video that Dr. Bobbi used the top leg to get that measurement rather than lifting up the top leg to access the bottom leg. Your dog or cat will likely remain calmer if you're not using their legs like a wishbone, so curl your hand under that top leg instead. And remember, practice makes perfect! 4. Once you feel those pulsations, it time to measure. Using a clock or watch with a second hand, count the pulsations for six seconds.5. Multiply the number of pulsations by 10. This will tell you your pet's resting heart rate for one minute.6. Compare your findings with the range listed above for your dog or cat. Getting to know your pet's normal resting heart rate, along with checking it whenever you suspect something is wrong, will alert you if something really is amiss. If your pet's resting heart rate is abnormal, as in outside that range and different from what you normally get, this is a pretty good indication that something is wrong. In this case, you should look at other signs of trouble like: What are your pet's other vital signs (don't worry, we'll be getting to those)? How is your pet otherwise doing/feeling? Are his or her behaviors normal – eating habits, bathroom habits, and social habits? If your pet is otherwise bright, alert, and isn't showing any unusual signs, a slightly elevated or depressed heart rate may not be a concern. However, if you discover other signs of trouble, this could be an indication of a bigger problem and warrants further investigation, and maybe even a trip to the veterinarian. https://d3imrogdy81qei.cloudfront.net/video_images/3851/cat-and-dog-pulse-rate.jpg Yes 157 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-gum-color https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2147.mp4 Cat and Dog Gum Color In this lesson, we're going to discuss a vital sign that you should be checking regularly, and one that you may not have considered important – gum color. At the end of this lesson, we're going to provide you with a Word about some foot problems common in pets, and more specifically, broken nails. Gum color is another thing you'll want to be familiar with on your cats and dogs. As we've already said, and will continue to repeat, you have to know what's normal with your pet before you can determine what's abnormal. Being able to distinguish between the two will help you recognize when something isn't right. Normal Gum Color Healthy gums in both cats and dogs will have a nice bubble gum pink color. However, don't mistake areas of pigmentation for gum color. Pro Tip: When assessing your pet's gums, focus on the larger areas of the gums as a whole, rather than those pigmented spots and smaller areas. This pigmentation is normal, so don't be alarmed if your pet has some. How to Check Your Pet's Gums The easiest way to assess gum color in your cats or dogs is to gently peel back the upper lip and take a quick peek. It may help if your pet isn't feeling hyperactive and is in a more docile state, say, after chasing the mailman around the block a couple of times. You might recall from the corresponding video for this lesson, Quinn had some pigmented areas, but overall, his gums were a light bright pink color in general. This is the color you want to see. So, if you don't remember, watch that video again to see exactly the color your looking for in your pet's gums. Warning: If while checking your pet's gums you notice a different color – white, pale pink, blue, or other colors – this isn't normal. If you do find any abnormalities in your pet's gums, it's time to examine the rest of your cat or dog. If your pet's gums do look abnormal, you'll want to check the following: Other vital signs How your pet is doing/feeling How your pet is behaving If you notice more abnormalities, this should be an indication that something could be wrong. It also should warrant a trip to the vet's office. https://d3imrogdy81qei.cloudfront.net/video_images/3853/cat-and-dog-gum-color.jpg Yes 59 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-breathing-rate https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2148.mp4 Cat and Dog Breathing Rate In this lesson, we're going to instruct you how to measure your pet's breathing rate and tell you when you should be concerned. At the end of this lesson, we're going to share with you a harrowing story about how one family's fun day of winter hiking that quickly turned into an emergency situation when one of their dogs fell through the ice. First, we'd like to note that in first aid and healthcare, there are a lot of interchangeable terms, and even more acronyms, most of which we're sparing you from having to absorb. So, when we mention breathing rate, it's important to understand that this can also be called respiratory rate. Respiratory rate is another key vital that you should be familiar with in your pets. The normal breathing rate for both dogs and cats is between 10 and 30 breaths per minute. Pro Tip: Are you ready for your daily reminder – getting to know what's normal for your pet is so important. Look again at that range above. It's quite expansive or large. And the reason is because not all members of the same species have been created equally; there will be differences and some of them can be vast. So, learning what the normal (resting) breathing rate is in your pet could be important one day to determine when something is a bit off. How to Measure Your Pet's Breathing Rate Always measure your pet's breathing rate while he or she is at rest. Just like with their heart or pulse rate (see, two terms for everything), activity, stress, and anxiety can skew those numbers. Wait till your dog or cat is laying down and rested. Watch the rise and fall of the chest. As your pet breathes in, the chest will expand or rise. As your pet breathes out, the chest will contract or fall. Get to where you can easily notice both deep breaths and shallow breaths, because just like us humans, pets will also have breaths that are deeper and easier to notice than others. You may remember in the corresponding video for this lesson, that Quinn's breaths could be subtle or shallow and also deep and more easily observed. Once you've got that down, simply count each breath. One inhalation and one exhalation (cycle of in and out) counts as one full breath. You want to do this for 15 seconds. And since your eyes can't be in two places at one time (unless you're in the circus and your one skill is exactly that), you may want to set an alarm on your cell phone. Take your 15 second number and multiply that by 4. This will tell you your pet's respiratory rate or breaths per minute. Warning: Anything faster than 40 breaths per minute could be a cause for concern, especially if your pet's resting breathing rate is usually at the low end of the scale we showed you above. Do you remember what to do when you notice that one vital is a bit off? That's right! Check other vital signs and ask yourself how your pet is otherwise feeling, doing, and behaving. Are these outside the norm? if they are, it's probably time to see your veterinarian.   https://d3imrogdy81qei.cloudfront.net/video_images/3855/cat-and-dog-breathing-rate.jpg Yes 83 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-temperature https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2149.mp4 Cat and Dog Temperature In this lesson, we'll be showing you how to take your pet's temperature – both by yourself and with the help of a friend or family member. We'll also go over the normal temperature range for cats and dogs and the equipment you'll need to take your pet's temperature. Your pet's temperature is another key vital sign you'll want to become familiar with, and since this is the last vital we'll be discussing, we're going to assume (by now) that you know the importance of knowing what's normal for your pet. (See how we snuck that reminder in anyway, even after saying we didn't need to.) The normal temperature range for cats and dogs is between 99.5°F and 102°F. As you can see, that range is smaller than you're used to with other vital signs. That should tell you that temperature is a vital that needs to be more exact than the others. How to Measure Your Pet's Temperature To measure your pet's temperature, you only need three items: A quick read thermometer Lubrication An understanding of how long a centimeter or inch is Pro Tip #1: At first, this most likely isn't going to be comfortable for you or your pet. However, as far as your pet is concerned, if you can begin checking all their vitals while they're puppies, this is probably going to become routine pretty quickly, which should make it easier for them. As far as you're concerned, you'll just need to get over the squeamish part of the task, if you are feeling that way. Temperature Measuring Steps – Solo Have your thermometer ready and lubed up. Get your pet into a comfortable position, either laying down or standing. Look just under your pet's tail or nubbin if there isn't much of a tail. Find the entrance to the rectum. Gently insert the thermometer between 1 centimeter and 1 inch into the rectum. Press the button on the thermometer. Wait until it beeps; it will let you know when it has a reading. Removed the thermometer. Read the temperature and make a physical or mental note of it. Decide if you should be concerned. If your pet's temperature is outside the normal range we provided above, check your pet's other vital signs and ask yourself, again, how he is doing, feeling, and behaving. And is this outside the norm for him? Temperature Measuring Steps – with Help Especially in the beginning, it may be easier for you to take your pet's temperature if you have some help. If you do have help, it may also be easier to take your pet's temperature, certainly for dogs, while he is standing. 1. Have your thermometer ready and lubed up.2. Get your pet into a standing position, facing away from you, the temperature checker.3. Your helper will be on the front half, while you're positioned on the back half of your pet. Pro Tip #2: While you're preparing to get his temperature, your helper can distract, talk, or pet him; basically, keeping him occupied and busy but still calm. 4. Look just under your pet's tail or nubbin if there isn't much of a tail.5. Find the entrance to the rectum.6. Gently insert the thermometer between 1 centimeter and 1 inch into the rectum.7. Press the button on the thermometer.8. Wait until it beeps; it will let you know when it has a reading.9. Removed the thermometer.10. Read the temperature and make a physical or mental note of it.11. Decide if you should be concerned. It might be easier to watch the corresponding video for this lesson and follow along with Dr. Bobbi. Seeing and doing is always going to trump reading and doing. Warning: While this may be common sense, it deserves a mention, nonetheless. Even though animal to human transmission of infectious disease is low, you'll still want to wash, sanitize, or disinfect the thermometer after using it. https://d3imrogdy81qei.cloudfront.net/video_images/3857/cat-and-dog-temperature.jpg Yes 155 https://app.protrainings.com/courses/pets/first-aid/videos/introduction-to-cat-and-dog-illness https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2150.mp4 Introduction to Cat and Dog Illness In this next section of your pet first aid course, we’re going to cover many illnesses and symptoms that you can monitor at home. Doing so to the best of your ability will help you recognize a problem early when your pet isn’t feeling well or an emergency in which you’ll need to act quickly. At the end of the lesson, we’ll provide you with a Word about using hydrogen peroxide on your pets. Long ago a myth began and over the years it seems to have grown. What is this myth? That you can check your dog’s nose and based on the temperature or moisture level, you can determine how your dog is feeling. Sadly, this isn’t true. If only it were that easy. In this next section, we’ll be going over several things like: How to assess your pet’s health and wellness at home. Some ways in which you can provide first aid for your pets at home, either before or instead of going to the vet, or to allow safer transport to the vet in case of an emergency. How to recognize an emergency and when you should escalate care quickly, as in seeking immediate veterinary care vs. making an appointment and waiting a while to see the vet. Understanding the difference between a minor illness and an emergency will be key, as will properly responding to either. By the end of this section, you may just discover that gauging your pet’s health is easier than it sounds; though maybe still not as easy as checking for a cool, wet nose.   https://d3imrogdy81qei.cloudfront.net/video_images/3859/introduction-to-cat-and-dog-illness.jpg Yes 53 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-vomiting-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2151.mp4 Cat and Dog Vomiting Care In this lesson, we'll be covering an often-familiar site for anyone with children or pets – vomiting. At the end of the lesson, we'll provide you with a Word about the three human foods you never want to feed your pets. Vomiting is one of the most common symptoms in dogs that may or may not be problematic, as vomiting can be caused by a variety of problems and for numerous reasons. Pro Tip: If your pet has been vomiting, it's important to dig a little deeper into why it's happening. You'll want to do the following: Figure out how often it's happening Determine if other behaviors have changed Determine if your pet's vital signs have changed Inspect the environment for clues What kind of clues should you be looking for? Look around to see if any of your pet's (or children's) toys are suddenly missing. Are there items or areas of the house that have recently been chewed on by your pet. If your pet is also lethargic or has some vital signs that are abnormal, this could be an early sign of a severe problem and could warrant a trip to the vet. However, if your pet is otherwise doing and feeling fine and behaving normally, you might want to begin by imposing a skipped meal and see how your pet responds to that. If your pet's vomiting hasn't gone away after a full day, then this is when you should consider a trip to your vet for further evaluation. Bloat (GDV) Bloat or gastric dilatation-volvulus, also thankfully known as GDV, is a medical condition that affects dogs in which the stomach becomes overstretched and rotated by excessive gas content. This is a life-threatening condition in pets and occurs most often in dog breeds that are considered large or very large. Signs of GDV tend to come on very suddenly and produce anxiousness or agitation in the dog. Other signs of GDV include: Excessive drooling Attempted vomiting that doesn't produce anything, like dry heaves Distended midsection or belly Vital sign abnormalities Warning: Bloat or GDV is a very serious condition and indicates an emergency situation. Seek veterinary care immediately if you suspect it.   https://d3imrogdy81qei.cloudfront.net/video_images/3861/cat-and-dog-vomiting-care.jpg Yes 96 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-diarrhea https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2152.mp4 Cat and Dog Diarrhea In this lesson, we'll be covering diarrhea in your cats and dogs, coming right on the heels of dog and cat vomiting, which are pretty commonly seen in combination. At the end of this lesson, we'll provide you with a Word about why dogs eat grass. Diarrhea is another common problem in both cats and dogs, and as mentioned above, can be accompanied with vomiting or exist all by itself. If your pet is otherwise acting normal, feeling and behaving normally, and has normal vital signs, you can watch the diarrhea situation more closely for a day or two and see if it goes away on its own. However, if your pet's diarrhea persists beyond two days, you should make an appointment to see your vet as this could indicate a bigger problem. Pro Tip: Pet diarrhea is common. Bloody stools are not. If your pet's diarrhea has any blood in it – whether bright red or dark red – this should warrant an immediate trip to your veterinarian. Warning: Also worth mentioning – if your pet develops a severe case of bloody diarrhea suddenly, this could be a life-threatening situation, and immediate veterinary care should be sought.   https://d3imrogdy81qei.cloudfront.net/video_images/3863/cat-and-dog-diarrhea.jpg Yes 50 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-peeing-problems https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2153.mp4 Cat and Dog Peeing Problems In this lesson, we'll be going over some common urinary problems you might experience with your pets and what you should do if you notice the signs and symptoms. Your pet's urinary habits are another thing you should be monitoring at home. And why are these habits important? Yes, that's right; because getting to know what's normal for your dog or cat is important for understanding when something is not normal and when swift action should be taken. When Your Pet is Having Trouble Urinating In situations where your pet is straining to urinate, you may notice some discoloration – red or browned colored urine. This is often combined with frequent trips outside or to the litter box. This could indicate a lower urinary tract problem, such as a urinary tract infection or stones. Warning: In situations where your pet is straining to urinate but cannot seem to produce any urine, this could indicate a potential life-threatening emergency and veterinary care should be sought immediately. If you notice that your cat is in and out of the litter box frequently or is yowling while trying to urinate, this could be a sign of a problem. Pro Tip #1: Male cats have an increased risk for developing lower urinary tract obstructions. If you have a male cat, consider monitoring him more closely for any signs and symptoms of a urinary tract problem. Signs of a urinary problem can come on quickly and seemingly out of the blue. These include, in addition to those obvious signs we've outlined above: Depression Lethargy Vomiting Lack of appetite Abdominal pain That last sign is something you may feel rather than see, depending on how much fur your pet has. It will usually feel like a firm swollen area around your pet's midsection. If you notice any of those signs and symptoms, especially when accompanied with the obvious signs of a urinary problem, you should seek veterinary care immediately. When Your Pet is Urinating too Frequently On the other hand, difficulty urinating may not be your pet's problem. However, urinating too frequently can also be a problem. When we say urinating too frequently, this includes frequent trips outside or to the litter box or a normal number of trips but combined with producing a larger than normal volume of urine. Urinating more than normal can indicate a serious illness like diabetes or Cushing syndrome, also known as hyperadrenocorticism. Cushing syndrome is an extremely complex condition that involves many areas of the body. It results from an excess of cortisol and its effects on the body. Cortisol is the body's main stress hormone. Pro Tip #2: It might not always be easy to monitor your pet's urinary habits, so also look for signs that your pet is drinking more than usual. Animals with frequent urination will also have an increased thirst. If you notice that your pet is drinking more, it's really important that you don't attempt to limit access to drinking water. This could lead to dehydration and more problems. Alternatively, if you notice your pet is urinating more frequently – asking to go outside more or more trips to the litter box – pay attention to how much water your dog or cat is drinking. This information may be helpful for your veterinarian should you need to bring your cat or dog in for an evaluation. While increased urination is not usually life threatening, always remember to check your pet's vital signs for any other abnormalities. And always remember to ask yourself how your pet is otherwise doing, feeling, and behaving, and if any of that is out of the ordinary. If you do notice other abnormalities, this is a good sign of trouble and you should see your veterinarian as soon as possible. However, if you do not notice any other abnormalities – meaning your pet is doing otherwise fine – consider making an appointment to see your vet so your pet can be evaluated at a later time. And continue to monitor the situation.   https://d3imrogdy81qei.cloudfront.net/video_images/3865/cat-and-dog-peeing-problems.jpg Yes 129 https://app.protrainings.com/courses/pets/first-aid/videos/loss-of-appetite-in-pets https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2154.mp4 Loss of Appetite in Pets In this lesson, we're going to cover what you should do if your pet suddenly stops eating.  If you notice your dog suddenly loses her appetite, take note; it could be important. But the first thing you should do is ask yourself: is my pet normally a voracious eater or more of a picky eater? If you have a picky eater who suddenly stops eating, it's probably less of a concern. But if you have a voracious eater that will eat whatever you put in front of her, this may be more of a concern. Pro Tip: Regardless of the answer to that question above, if your pet stops eating, this is something you should investigate, and by now, you know exactly how to do that – Check vitals and ask yourself if your pet is behaving, and otherwise doing, normally. A Problem with the Food? If everything else is normal with your pet, her refusal to eat may be a sign that something is wrong with the food. Just as you would know if you took a drink of sour milk that had long ago expired, your dog would also know if something is wrong with what she's eating or drinking. For this reason, assuming her vital signs and other behavioral signs are normal, try offering her a different type of food and see how she responds. Make sure it's a treat she loves or a favorite food. If she eats that food, then your dog or cat food may have something wrong with it. You could try calling the company to see if there have been other complaints or maybe even a recall. But regardless, you should definitely buy some new food. Your new food can be the same food as before, but make sure it comes from a different batch, perhaps with a different lot number than the current pet food you have. When You Should be Concerned You should be concerned if your investigations revealed more problems with your pet's vital signs and behavior, obviously, but you should also be concerned if your pet's lack of appetite persists and if you have already ruled out the food being the issue. Any number of things could cause your pet to stop eating. Some of those things are nothing to be worried about. But some of them are. Err on the side of caution. A trip to the vet is never a bad idea.   https://d3imrogdy81qei.cloudfront.net/video_images/3867/loss-of-appetite-in-pets.jpg Yes 74 https://app.protrainings.com/courses/pets/first-aid/videos/lethargic-dogs-and-cats https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2155.mp4 Lethargic Dogs and Cats In this lesson, we'll be getting into the subject of lethargy in your pets, what specifically to look for, and what you should to do about it.  There are times when you may notice that your dog or cat is just acting a bit off. And while you may feel like something might be wrong, you just can't put your finger on it. Enter lethargy. Pro Tip: The signs of lethargy can be quite vague, which means assessing for it in your pets may not be an easy thing to do. It's important to remember that you know your pet better than anyone, and if you think something is off, trust your gut instinct and investigate further. What's the first thing you should do? Whomever just shouted, get your pet's vital signs, yes, that's correct. And well done! After getting those, look for any behavioral changes. If your pet is eating and drinking and all of the vital signs are normal, it's OK to keep an eye on your pet's lethargy for a while, especially if there is a reason for her lethargy. Normal Reasons for Your Pet's Lethargy Any number of things can contribute to lethargy in your dog or cat, but there are a couple you can try to rule out immediately. The good news is that if the reason is related to one of these, you can probably rest a little easier. Has your dog just finished playing or exercising more than normal? Dogs are like kids; they'll play until they drop. If your dog just played fetch for three hours, she may just be a little worn out. Has there been a change in your pet's environment? Did you introduce any new pets into your homes, perhaps a new child, or a recent move into a new house or apartment? Is your mother-in-law visiting? That seems to throw everyone off a little. If you've determined that your pet has a good reason for her lethargy and everything else with her seems normal and healthy, just keep an eye on it. However, if it persists more than a couple of days, you should probably investigate it further and consider making an appointment with your veterinarian. When to See Your Vet Because lethargy is such a vague sign or symptom to measure, and because it could be caused by any number of things or situations, there's not a lot you can do about it at home, other than take notes about your pet's recent vital signs and behaviors. Warning: Do not give your pet any medications, even if it's all-natural kava kava or whatever. This could only complicate matters. What you should do is simple. Take notes regarding: How your pet is otherwise feeling? How your pet is behaving? What vital signs have you measured? When did you take those vitals? Is your pet still eating and drinking? Any information that you think may help your vet better diagnose and treat your pet's lethargy should be collected, written down, and taken to the vet's office.   https://d3imrogdy81qei.cloudfront.net/video_images/3869/lethargic-dogs-and-cats.jpg Yes 91 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-weakness-or-collapse https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2156.mp4 Cat and Dog Weakness or Collapse In this lesson, we're going to cover weakness in your pets, including four conditions or situations that can trigger weakness. We'll also cover sudden collapse – a severe form of weakness – and what you should do if your pet suddenly collapses. There are some illnesses in dogs and cats that can cause weakness. Signs and symptoms of weakness include when your pet is: Not as active as normal Not exercising as much or as long as normal Not using her legs or using them less than normal Holding her head lower than normal If you notice any of these signs and symptom of weakness, take note of what's going on with your pet so you can tell your vet. Specifically, you'll want to note: What is exactly going on with your pet or the signs you've noticed How often you notice the signs of weakness Her vital signs Any behavioral changes Sudden Collapse in Pets Sudden collapse is a sever form of weakness. While it can be scary to have a pet that suddenly collapses, it's important to stay focused and calm and determine if your pet has lost consciousness. If she has lost consciousness, immediately check for a pulse. If you cannot feel a pulse, begin CPR. (Which you will learn how to perform in a subsequent lesson.) If you can feel a pulse or your pet is still conscious, or regains consciousness, take note of a few things so you can tell your vet, including: What is her heart rate? What is her respiratory rate? What was she doing before she collapsed? What did her collapse event look like? How long did this collapse event last? If she regained consciousness, what did she do after her collapse? Pro Tip #3: Don't discount the importance of telling your vet as much information as possible. The more you can provide, the better he or she will be able to help your pet. https://d3imrogdy81qei.cloudfront.net/video_images/3871/cat-and-dog-weakness-or-collapse.jpg Yes 210 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-seizures https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2157.mp4 Cat and Dog Seizures In this lesson, we'll be covering cat and dog seizures – what they look like, the stages or phases of a seizure, and how your dog or cat will typically respond to a seizure.  A seizure is a startling sign of abnormal activity in the brain. While there are many different types of seizures, our focus will be on grand mal seizures — also known as generalized tonic-clonic seizures. During the Seizure During the seizure, your pet will lose consciousness, then become stiff. This is the tonic phase of the seizure and can last anywhere from 15 to 30 seconds. This is followed up with repetitive jerking movements that can last anywhere from 30 to 60 seconds. During this jerking stage of a seizure, your pet may also urinate or defecate. You might also notice a repetitive biting motion. This is common in both dogs and cats during a seizure. After the tonic-clonic phase, your pet will transition into what's known as the postictal phase. During this stage, your pet won't be completely back to normal, although she will have regained consciousness. She may also become glassy eyed and unsteady or uncoordinated. This phase can last a few minutes up to several hours. Pro Tip: Safety First! When caring for your pet during a seizure, the most important thing to keep in mind is not letting your pet or yourself become injured. Never put your hand in or around your pet's mouth while she is having a seizure. Also, while you should never try and restrain a pet that is having a seizure, you should make sure that your pet won't injure herself by falling off a piece of furniture or down the stairs during a seizure. After the Seizure Although it will likely be difficult to remain calm during a seizure, it's really important to take note of what happened so you can inform your veterinarian. Specifically, try to note: What happened right before the seizure began? How long did the seizure last? How long did the tonic-clonic activity or phase last? How long did the postictal phase last? Also, after the seizure has ended, remember to get your pet's vital signs. This information will also be important for your vet. Warning: Most seizures will stop on their own after a minute or two. If your pet has a seizure lasting longer than five minutes or has multiple seizures in a 24-hour period, this should be considered an emergency and should warrant an immediate trip to your veterinarian. If your pet has ongoing seizure activity, she could overheat as a result, which means you'll need to help keep her cool. Consider bathing her with cool water after a seizure or have air conditioning or cool air blowing on her during transport to the vet. It's also important to keep her temperature below 104°F. Once you get to the vet's office, they'll be able to help take control of her post seizure care and keep her temperature down as well. https://d3imrogdy81qei.cloudfront.net/video_images/3873/cat-and-dog-seizures.jpg Yes 153 https://app.protrainings.com/courses/pets/first-aid/videos/body-temperature-emergencies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2158.mp4 Body Temperature Emergencies In this lesson, we're going to be providing you with some important knowledge of how body temperature increases and decreases work and how you should generally respond, leading up to the next two lessons on hypothermia and hyperthermia.  How Core Body Temperature Works When you feel cold, this is simply your temperature being lower than what your brain wants it to be. Your typical response is to shiver, wrap yourself up in a blanket or put on a coat, and eventually seek a warmer environment, if at all possible. When you feel hot, the same thing applies. Your body temperature is higher than what your brain wants it to be and you respond by sweating, becoming flushed, and eventually seeking a cooler environment. Your pet's body temperature fluctuations work in exactly the same ways. Pro Tip #1: It's important to remember that what your pet's actual body temperature is may not be the same as what your pet's brain wants it to be. While that sounds like a fantastic Zen riddle, we assure you, it's not. The best example of what we mean is the seasonal flu. Your temperature could be higher than normal, and yet, your brain wants it to be higher still. And why? To combat the invading flu virus. (Brain always knows best … usually.) So that above example is what we'd call a temperature change due to an internal factor. Those situations are in contrast to what you should do for temperature changes due to an external factor, like exercising in the heat of summer or sitting in a hot car. Pro Tip #2: It's important to recognize the difference between an internal factor (even though the flu virus was obtained externally) and an external factor. Remember, if the brain has changed the set point due to internal factors vs. changes due to external factors, your response changes as well. A Good Rule to Follow A good rule of thumb is to always go along with what your pet's brain wants your pet's temperature to be. If she wants to warm up, help her do that. And if she wants to cool off, help her do that, too. It is often really that simple.   https://d3imrogdy81qei.cloudfront.net/video_images/3875/body-temperature-emergencies.jpg Yes 81 https://app.protrainings.com/courses/pets/first-aid/videos/hypothermia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2159.mp4 Hypothermia In this lesson, we'll be introducing you to hypothermia emergencies that you may encounter, especially if you live in parts of the world where winter means snow and ice and all those lovely single-digit temperature readings. Before we get into how you should handle a hypothermia emergency, let's address the signs and symptoms of hypothermia. These include: Recent exposure to extreme cold Weakness Lethargy Low body temperature Pro Tip #1: If you live in an unforgivably cold climate and your pet has been outside a while in those frosty temperatures, get into the habit of checking her temperature after she comes back inside. If her temperature is normal, great! But if it's low, she'll need to be warmed up a bit. What to do in Case of Hypothermia Since warming too aggressively or quickly can be problematic, this should happen under veterinary care. Which means your role in this is to gently warm your pet in a way that keeps her comfortable for the ride to the nearest veterinary facility. Wrap your pet in a large towel or blanket to help her body begin to rewarm naturally. And wrap her in something that will also keep her more comfortable on the way to see the vet. Pro Tip #2: Just remember that you DO NOT want to actively warm your pet after a hypothermia emergency. This can be counterproductive. Just wrap up your pet so she doesn't continue to lose excessive body heat. It's kind of like stopping the bleeding, but then letting the vet handle the stitches. Most importantly, get to the vet as soon as you can. When Hypothermia isn't Hypothermia Let's say your pet is showing signs of hypothermia minus the exposure to cold temperatures. This is a bad sign, as the likely cause of low body temperature in a pet with no exposure to cold is a circulatory issue, and possibly even circulatory failure. This can be very serious and definitely warrants an immediate trip to the nearest veterinary care facility. https://d3imrogdy81qei.cloudfront.net/video_images/3877/hypothermia.jpg Yes 71 https://app.protrainings.com/courses/pets/first-aid/videos/hyperthermia-heat-stroke-sun-stroke https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2160.mp4 Hyperthermia (Heat Stroke / Sun Stroke) In this lesson, we'll be covering hyperthermia or heat stroke in your pet, including the signs and symptoms and how you should handle this condition should it arise. At the end of the lesson, we'll dig a little deeper into the dangers of heat exhaustion; and we'll explain the difference between that and heat stroke. Heat stroke, or hyperthermia, is caused by an extreme elevation in body temperature and occurs when your pet has suffered an inability to cool herself. It's also a severe life-threatening condition that can lead to organ damage and dysfunction. A classic example of heat stroke is when a dog is locked inside a vehicle on a day when the ambient, or room, temperature can easily exceed 120°F even on a pleasant 75°F day. Dogs playing outside in the heat who tend to overexert themselves is another cause of heat stroke; in particular, dogs who suffer from the inability to pant effectively – like those with short snouts, such as pugs or bulldogs. This can also happen in older dogs who have laryngeal problems. Pro Tip #1: In case you're not an English teacher or a physician, let's quickly explain the difference between hyper and hypo. Hyper is a prefix that means excess or exaggeration, while hypo is a prefix that means under or beneath. Both hyper and hypo are usually used as prefixes, which are elements or partial words added to the beginning of a base word to modify its meaning. Signs and Symptoms of Heat Stroke It's so important that you're able to recognize the signs and symptoms of heat stroke. Doing so might mean the difference between your pet surviving a heat related emergency or succumbing to one. Pro Tip #2: The problem is that many of the signs and symptoms we've covered in this course are very similar for a number of conditions, including heat stroke. Therefore, context is vital. What was your pet doing before the problem began? What was the environment like? And so on. You may need to put your Scooby Doo hat on … though if you own a large dog and live in Phoenix, AZ, your Spidey senses should always be tingling during the summer, and maybe even fall and spring. Signs and symptoms of heat stroke include: Weakness Lethargy Persistent panting Body temperature above 105°F Warning: If you measure your pet's rectal temperature and discover that it's 105°F or greater, this is an early sign of heat stroke, and you'll need to begin cooling your pet down immediately. What to do if You Suspect Your Pet Has Heat Stroke If you suspect heat stroke, begin cooling your pet down immediately however you can. Do you have a hose outside with cold running water? How about a bathtub with the same? Also, a good idea is to wrap your pet in a large wet towel. And finally, you'll want to transport your pet to the vet as soon as possible, preferably still wrapped in that cool, wet towel. Cats can also develop heat stroke, though it's far less common. The signs and symptoms will be the same, as will the treatment you can provide while getting him to the vet. A Word About Heat Exhaustion Heat exhaustion is the precursor to heatstroke and is a direct result of the body overheating. When heat exhaustion is not addressed, heatstroke can follow. For Cara Armour and one of her pups, heat exhaustion came on suddenly and out of the blue, and on a breezy 70°F morning. During an early morning walk, one of Cara's dogs, Debbie, began throwing up a lot of water and the treats she had recently eaten. Then her breathing became shallow, despite all the running around. This is when Cara knew something was wrong. She began checking those vital signs we preach so often, then began to investigate possible causes as she and her husband carried Debbie back to the car. The moral of the story is pretty simple: how fast normal can change to not. And how you should always be prepared to deal with an emergency. If you'd like to read the entire story, check out Cara's article for the ProPetHero blog: What's Up Wednesday – Heat Exhaustion. https://d3imrogdy81qei.cloudfront.net/video_images/3879/hyperthermia-heat-stroke-sun-stroke.jpg Yes 88 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-fever https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2161.mp4 Cat and Dog Fever In this lesson, we're going to dig into cat and dog fever, while also reiterating once more the difference between external factors that can cause heating vs. internal factors that can do the same.  You may recall from a previous lesson the difference between a dog heating up due to a virus vs. a hot environment. In one instance, your brain is telling your body to heat up as a form of protection. While in the other, it's hardly a matter of protection; instead it's a matter of survival. Being able to recognize the difference between these two scenarios will again be important for this lesson. If your pet has a fever, she'll also have an elevated temperature. But unlike those cases of overheating due to external factors, she won't feel warm and she won't be trying to cool herself off. Her brain has instructed her body to get warmer, not cooler. This is similar to what happens when people get a fever. Just like when you get the seasonal flu, a cold shower is the last thing you would want. The same is also true for your pet when she has a fever. In fact, she may still want to get warmer and may even be shivering. If she is, wrap her up in a blanket. Pro Tip: It's important to not give any medications to your pet, even if she has a fever. Medications like aspirin and acetaminophen (Tylenol) are made for humans and may actually be harmful for your pet, depending on the underlying cause of the fever. In some cases, those medications may even be toxic to your pets, and actually, Tylenol is just that to cats. It's also important to assess your pet's behaviors and vital signs to determine what's going on with her. If everything else appears normal, it may be reasonable to keep an eye on her and make a veterinary appointment in a day or two. However, if you notice more abnormalities in addition to the fever, you should probably seek immediate veterinary care. Always err on the side of caution and know that emergencies can pop up suddenly.   https://d3imrogdy81qei.cloudfront.net/video_images/3881/cat-and-dog-fever.jpg Yes 68 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-shock-assessment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2162.mp4 Cat and Dog Shock Assessment In this lesson, we'll be covering a serious condition known as shock. We'll provide you with some signs and symptoms of shock and what you should do if you suspect that your pet is in shock. In addition to the obvious signs of illness or injury in your pets, you need to be aware of the signs of shock as well. Shock, also called circulatory shock, is a severe condition where your pet's blood flow becomes dangerously low. When this happens, it can lead to organ damage and dysfunction if not treated properly and quickly. As your pet's personal first responder, you'll want to keep an eye out for the signs of shock that we'll be detailing below. The problem with shock is that it can come on suddenly, often right after an injury, or it can come on much more slowly, as in hours or even days. And it should be noted that noticing changes that take place more slowly may be more difficult to spot. Warning: If you think your pet may be in shock but you're not sure, it's really important to keep a close eye on the situation, especially if you're not taking your pet to the veterinarian immediately. The Signs of Shock Fortunately, the signs of shock are fairly easy to recognize. You may even notice one or more by simply doing your regular behavioral assessments or while checking your pet's vital signs. Heart Rate One of the first signs of shock is the change to your pet's heart rate. For dogs, a normal heart rate while he is sick or injured is somewhere between 60 and 140 beats per minute. If your dog is in shock, that heart rate will likely be very rapid and could easily jump to above 140 beats per minute. For cats, the heart rate situation is a little different, as it can spike or slow down. A normal heart rate for sick or injured cats is likely to be around 180 beats per minute or higher. But for a cat in shock, that heart rate can exceed 220 beats per minute or dive below 140 beats per minute. Pro Tip #1: If your cat's heart rate drops to below 140 beats per minute, this is very concerning and should warrant an immediate trip to see the vet. Other signs of shock in your cat or dog include: Lethargy Weakness Gum color changes Lower than normal rectal temperature Cool ear tips, toes, or tip of the tail Behavioral changes If your cat or dog is in shock, he or she will not be acting normally and will likely be exhibiting signs of feeling dull or weak. You may recall that a normal healthy gum color is a nice bubble gum pink. If that color changes to white or very pale pink, this could be a problem. During circulatory shock, blood circulation is compromised and may not reach all areas, hence the cool ear tips, toes, or tail tips. How will you know if these are cool? You'll just have to touch those areas and see if you notice a temperature change or what you'd consider cooler than normal for your pet. Pro Tip #2: If you notice all these symptoms together in your cat or dog, this could be a sign that your pet is going into shock. Shock is VERY serious and there isn't much you can do at home. Therefore, transporting your pet to the veterinarian as soon as possible will be your best course of action and treatment. Transporting Your Pet to the Vet You may recall some transportation tips from previous lessons, like removing the lid on your cat's carrier, rather than stuffing him through a small hole. Those tips will serve you well if you discover your pet is in shock. Three things you'll want to focus on as far as transportation goes is: Wrap your pet up in a blanket. Keep him as warm and comfortable as possible during the drive to the vet. Keep your pet as calm as you can. Do not give your pet any medications, unless you've spoken to your veterinarian and they recommended that course of treatment. Keep in mind that shock can occur at any time, but it's more likely to happen after an injury or during an illness or medical emergency. Being ultra-aware of your pet's vital signs and behavior during these moments could really help. https://d3imrogdy81qei.cloudfront.net/video_images/3883/cat-and-dog-shock-assessment.jpg Yes 126 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-bleeding-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2163.mp4 Cat and Dog Bleeding Care In this lesson, we're going to go over bleeding care for your cat and dog, including the three types of bleeding – capillary, venous, and arterial – and how you should proceed for each type. Bleeding accidents can happen with cats, but they tend to occur more regularly with dogs. It's important to remember that before approaching any animal who has been injured, make sure the scene is safe and make sure you'll be safe approaching your pet. Pro Tip #1: Animals in pain can lash out. If your pet is injured and in pain, strongly consider putting a muzzle on the animal first, before attempting to move or help your pet. The 3 Types of Bleeding 1. Capillary Capillary bleeding wounds are the most minor. Capillary bleeding resembles a road rash type of wound that children will routinely get falling off a bike. The color is light red, and the wound is only on the surface – the uppermost layer of skin. 2. Venous Venous bleeding wounds are deeper and more severe than capillary bleeding but are not under pressure like arterial bleeding. These wounds are characterized by steady oozing or running of dark red-colored blood. And even though it's not under pressure, there may still be a lot of blood to deal with. 3. Arterial As the name suggests, arterial bleeding comes from the arteries. This is the most severe type of bleeding injury. The color is also dark red, like venous bleeding, but the blood will be spurting rather than simply oozing. Arterial bleeding injuries can be life-threatening. How to Control the Bleeding When it comes to bleeding wounds, controlling the bleeding will be your number one priority, at least initially. The steps outlined below can be used for all three types of bleeding wound, but just know that controlling the blood loss will get progressively more difficult as you move from capillary wounds to more severe wounds. 1. Grab an appropriately sized gauze pad from your first aid kit. 2. Place the gauze on top of the wound and apply direct pressure. 3. Hold the gauze in place for at least five minutes; resist the urge to remove the gauze and peak at the wound. 4. After five minutes have passed, gently lift up the gauze to inspect the wound. Pro Tip #2: As clots begin to form, the bleeding will slow down and eventually stop. However, if you accidentally rip, or even wipe, away a clot while removing the gauze, you may be back to step one. So, take care lifting the gauze off your pet's wound. 5. If you notice that the bleeding has stopped, it's time to move on to wound care, which we'll get into in a later lesson. But if the bleeding hasn't stopped, apply more gauze – on top of the existing gauze – and apply pressure for five more minutes. You can do this three times. If your third attempt at controlling the bleeding falls short, it's time to load your pet into the car for a ride to see the vet. With venous bleeding and especially with arterial bleeding, your ability to stop the bleeding will be more difficult. Which means the gauze pads may get soaked with blood. That's normal with deeper wounds. Just remember to NOT remove the other layers of gauze as you apply more. Layer them. Don't replace. Those clots will come off, remember. What happens if you don't have gauze or run out of it? Any clean towel, like a dish towel or a hand towel, will work fine. Also, with deeper wounds, you'll want to secure the gauze pads in place using roll gauze or some other type of bandage. Simply wrap the wound over the gauze, snugly but not too tight. You don't want to cut off your pet's blood supply to the site of the wound … unless that's your intention. There may be instances when a tourniquet may be warranted. Let's say your dog suffers a wound on her leg that you cannot get to stop bleeding. You know you have to go to the vet, but you want to secure the wound and control the bleeding before you do. Warning: A tourniquet is a serious method of wound care, as it will also stop blood from flowing to other tissues, which can cause problems. If it's going to take you longer than 10 minutes to get your pet to the vet, stop every 10 minutes or so to loosen the tourniquet briefly, before retightening it. This will allow blood flow to vital tissues. Having said that, if a tourniquet is a necessity, make sure you place it above the wound or between the wound and the heart. You want it to be tight, obviously, but not too tight. Watch the corresponding video for this lesson to practice. Again, for minor wounds, once the bleeding has stopped, you can move on to wound care. But for deeper and more serious wounds, your goal is to control the bleeding long enough to get your pet to veterinary care. https://d3imrogdy81qei.cloudfront.net/video_images/3885/cat-and-dog-bleeding-care.jpg Yes 227 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-nail-bleeding https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2164.mp4 Cat and Dog Nail Bleeding In this lesson, you'll be learning about a few different types of bleeding incidents that your cat or dog may experience at some point and what you can do to help. At the end of the lesson, we'll provide you with a Word about some tips for cutting your pet's nails. For some cases of bleeding, it may be difficult or maybe even impossible for you to control the bleeding at home. Which, as you know by now, means a trip to see your veterinarian. Once at the vet's office, they may need to sedate or even anesthetize your pet and use surgical procedures to help control the bleeding. A classic example of this would be lacerations to the tongue. Imagine your pet has a cut on his or her tongue. Now imagine trying to hold a piece of gauze on your pet's tongue for five very long minutes. Sound problematic? We agree, which is why a tongue laceration is likely something you can't control at home on your own, which means … you guessed it! Another common cause of bleeding at home, as you may be familiar with, is clipping nails too short. The problem with this sort of injury is that the bleeding can go on for a very long time. How to Stop Your Pet's Feet from Bleeding So, you've just cut a little too short while trimming your pet's nails. (Whoops!) Now what do you do? Don't worry, it's an easy fix. Get your pet first aid kit and grab your styptic powder. Unscrew the cap then pour a little of the powder into the cap. Take your pet's bleeding paw and gently dip it into the powder. That's it! Now, the powder will adhere to the area that's bleeding on your pet's toe, so you don't have to worry too much about aim. Also, you don't need to worry about wiping it away. Just leave it on; it will fall away on its own. But it will help stop your pet's bleeding toe. What if you don't have any styptic powder in your first aid kit. Do you have any cornstarch laying around the kitchen? In a pinch, that can be used instead of styptic powder. The last type of bleeding incident is what we call spontaneous bleeding or bleeding that doesn't appear to have a cause, as far as you can tell. This type of bleeding can be caused by a number of things, like a clotting disorder or tumors in the body. Warning: No matter the cause of spontaneous bleeding, just know that this is a serious situation and almost always indicates a greater problem. By now you know the drill – get your pet to the veterinarian as quickly as you can if you notice bleeding without any apparent cause.   https://d3imrogdy81qei.cloudfront.net/video_images/3887/cat-and-dog-nail-bleeding.jpg Yes 91 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-wound-treatment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2165.mp4 Cat and Dog Wound Treatment In this lesson, you'll be learning how to treat your pet's wounds. We'll be covering two techniques – one for body wounds and another for limb wounds. And, of course, we'll help you understand when to provide care at home and when to seek professional veterinary care. At the end we will provide a Word about ear wounds as they can require added care.   You may not think about it often, but an intact layer of skin is our best protection against all the threats of the outside world. However, when your pet suffers an injury, that skin layer breaks and leaves your pet susceptible to infections that are caused by bacteria, viruses, fungi, or other pathogens. Getting immediate wound care is really important when your pet suffers an injury. And as you've learned in this course, step one to helping your pet is always to make sure the scene is safe and that it's also safe to approach your pet. However, even once you determine scene safety, you should still muzzle your pet to make sure he doesn't bite you. Remember, an injured pet or a pet in pain may lash out. Pro Tip #1: After making sure the scene is safe, you'll need to know what kind of bleeding injury you're dealing with. If you suspect venous or arterial bleeding, make sure to get that under control first, before even thinking about wound care, and get your pet to the vet as quickly as you can. If your pet's wound is only a surface wound (as in a capillary bleeding incident), you should be able to get that under control pretty easily and quickly and then move on to wound care. Warning: Certain wounds, as you know, require veterinary care, like those venous or arterial bleeding wounds. However, any wounds that cover a large surface area should also warrant a trip to the vet, even if the wound isn't bleeding that much. Steps to Treat Body Wounds 1. Get your sterile lubricant from your first aid kit and apply a generous amount into the wound. You can't really use too much. 2. After filling the wound with lubricant, grab your electric clippers and clip the area around the wound. Leave a wide margin so it's easier to work with. Pro Tip #2: When using clippers, make sure the bottom or flat end is flush against your pet's skin, rather than at an angle. Trimming at an angle may cause some skin irritation or razor burn. 3. Clean your pet's freshly clipped skin using isopropyl alcohol and a gauze pad. Wipe the area around the wound but be careful not to get any alcohol in the wound. 4. Get a large amount of warm water and pour it over the wound. Clean the entire area in and around the wound. 5. Wipe away any remaining lubricant and obvious debris like dirt or pebbles. 6. Decide whether or not to bandage the wound. For minor wounds, you may be able to leave them uncovered. They'll typically scab over and heal in several days. Steps to Treat Limb Wounds For wounds on a limb, you should be more concerned about infection than just about anything else, as your pet will need to go outside or to the litter box, etc. Which means bandaging the wound is more of a priority than with body wounds. Let's assume you've cleaned and disinfected the wound and you're now ready to wrap over it. Place a gauze pad or strip directly on the wound. Grab your roll gauze to secure the gauze pad in place. Wrap around the wound and gauze, but not too tight. Just snug enough to hold the gauze in place. Also, make sure to wrap above and below the nearest joint (or two), which will help keep the bandage from slipping off due to normal pet activities. Grab your cohesive wrap and apply that next. It will stick to the layer of gauze but not to your pet. Don't pull snugly AT ALL. No resistance; just lay it over and wrap around. Grab your adhesive tape and apply one strip to the top of the bandaged limb and one at the bottom to hold the ends in place. Warning: Monitor your pet's toes. If the bandage is too tight, you may notice that your pet's toes are splayed out or signs of swelling. If you do, take off the bandage and try again, looser this time. Remove the bandage and check the wound daily. Minor wounds will only need to be covered for a day or two. One thing you're looking for, other than signs of healing, are signs of infection. Signs of Secondary Infection Whether you cared for your pet's wound or your veterinarian did, you'll still want to monitor your pet for signs of infection. Those signs include: Redness around the wound Swelling around the wound Signs your pet is in pain Discharge of pus around the wound Foul odors If you notice any of these signs of infection, that's right. Take your pet to the vet ASAP. And as always, remember to monitor your pet's vital signs and any behavioral changes. https://d3imrogdy81qei.cloudfront.net/video_images/3889/cat-and-dog-wound-treatment.jpg Yes 382 https://app.protrainings.com/courses/pets/first-aid/videos/lame-dog-and-cat-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2166.mp4 Lame Dog and Cat Care In this lesson, we'll be teaching you about lameness in your dog or cat, what that may look like in your pet, and how you can inspect your pet for the signs of lameness. Lameness or limping can be caused when your pet suffers an injury that produces pain in the limbs. These injuries can occur in the soft tissues like muscles, ligaments, and tendons, or even in the bony structures in your pet's legs. Warning: As with all first aid situations, first make sure the scene is safe and that it's safe to approach your pet. And even if you assess the scene to be safe, still watch your pet for any signs of aggression. A pet in pain is a pet that can lash out. Lameness in Your Pet Lameness can come in a range of severity. When your pet has a more severe case of lameness, this is often seen as your pet holding a limb off the ground and not letting it touch. In other cases, your pet may be putting some weight on that limb or at least toe-touching the floor or ground. Pro Tip #1: Usually the severity of the injury will correlate with the degree of lameness. If you notice severe lameness in your pet and he or she is in a lot of pain, transport your pet to veterinarian care as soon as possible. If your pet's lameness is relatively mild or appears to be improving, you can keep an eye on it at home, and we'll show you some things below that you can do to better evaluate the severity of the lameness. How to Perform a Lameness Inspection on Your Pet Before approaching your pet for an inspection, you should first apply a muzzle. When an animal is in pain, sometimes the only way the pet may know how to tell you is by turning around and snapping at you. 1. Make sure your pet is lying on his side. 2. Begin by feeling his legs, starting with the toes and moving up the leg from there. Begin with the limbs closest to you, or the top limbs. Gently squeeze each area as you move up the leg. Feel for any lumps, bumps, or areas where he responds to your touching. Inspect the front leg, then the back. Pro Tip #2: If your pet is feeling some pain, he may let you know by turning toward you, looking at you, whimpering, or even trying to bite you. 3. If you don't feel any abnormalities or you don't elicit a response from your pet with just touching, move to manipulating the joints. Again, start with the toes on the front leg. 4. Move each toe individually, back and forth, using the full range of motion. Monitor your pet for a response as you do. 5. After the toes, move to the wrists or carpus. Same as above, flex and extend the joint using a full range of motion. Then move on to the elbow joint, and then finally the shoulder joint. Pro Tip #3: In the corresponding video for this lesson, Dr. Bobbi was inspecting Quinn's legs from behind. However, it may be easier from the other side. Do what is easiest or most comfortable. And watch the video and practice along as often as needed. If after your inspection of the front leg joints you don't find anything unusual, move to the back leg and perform the same inspection. The joints move a bit differently and the terms are different, but the theory and application are the same. Just remember to use a full range of motion. How to Treat Lameness at Home If you are able to identify the source of your pet's pain during your inspection, one thing you can do is apply an ice pack to that area. Grab some ice from your freezer. Put it into a Ziplock or resealable bag. Apply it directly to the area on your pet that seemed to be the source of the pain. Hold the bag in place for 10 to 15 minutes. This is assuming your pet tolerates the ice bag. If it causes a lot of stress or anxiety in your pet, it may not be worth it. Pro Tip #4: You can safely use an ice bag on your pet for stretches of 10 to 15 minutes, four to six times per day. The ice pack should help with inflammation if there is any and maybe even reduce some of the pain. However, the inflammation reduction benefits will only occur for around the first 24 hours. The pain reduction benefits may last longer. If you are not able to control your pet's pain at home, it's medication time. But not medications you have lying around your house that haven't been specifically prescribed for this exact need. They may not be appropriate. However, if you have some meds at home you think may work, contact your vet and get his or her approval. Finally, your pet's lameness or limping should improve after a couple days. But if it persists beyond that or gets worse, it's time to visit your veterinarian. https://d3imrogdy81qei.cloudfront.net/video_images/3891/lame-dog-and-cat-care.jpg Yes 278 https://app.protrainings.com/courses/pets/first-aid/videos/severe-pet-lameness https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2167.mp4 Severe Pet Lameness In this lesson, we're going to follow up the last one on lameness care and focus on severe lameness. We'll provide you with some signs to watch out for that may indicate a more serious situation.  Sometimes, what looks like lameness caused by an injury may actually be a problem that's caused by an underlying neurologic disorder. In these types of situations, when you inspect your pet's limbs, you won't find any reaction from your pet or any source of the pain. Signs of Severe Pet Lameness You may recall some of the symptoms and signs of lameness from the last lesson. With severe lameness, the signs are much different and include the following: You may notice that your pet is suddenly walking with an abnormal gate. It may appear as though he or she is lacking coordination, or is now walking with what we call, a drunken sailor gate. You might also notice that your pet is knuckling over on some limbs, or in other words, scraping the ground with the tops of his or her feet. Another sign of severe pet lameness is when your pet walks in a way that crosses over his or her legs. Warning: Any of these signs or symptoms may be an indication of a serious neurologic condition. If you notice any of the above, get your pet to the vet's office immediately, as this condition can progress to a point where your pet is unable to use his or her limbs at all. Pro Tip: It's equally important to be careful during transport. Make sure not to move your pet too much. You don't want to make the injury (if indeed there is one) or the condition any worse until your veterinarian can do a thorough evaluation of your pet.   https://d3imrogdy81qei.cloudfront.net/video_images/3893/severe-pet-lameness.jpg Yes 56 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-burn-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2168.mp4 Cat and Dog Burn Care In this lesson, you'll be learning about cat and dog burn care, including the difference between serious and superficial wounds, and how you should handle each.  Fortunately, burns are quite uncommon for dogs and cats. However, the biggest risks to your pet, in the event of a burn, include: Secondary infection Fluid loss Electrolyte imbalances For these reasons, burns should be taken very seriously, and most pets who suffer a burn injury should be properly evaluated by your veterinarian. Having said that, the severity of burn injuries can vary greatly. Some burn wounds can be superficial. These wounds can be seen as fur that has been singed away or a reddened patch of skin that may look a bit raw. Pro Tip: If your pet has a superficial burn and that wound is confined to a small area, it might be appropriate to treat the wound at home and closely monitor your pet for any other serious signs of trouble, like infection. However, if that burn wound involves a larger surface area on your pet or is a deeper burn wound – meaning you notice blistering or charring of your pet's skin – you need to get your pet to a veterinarian as soon as possible. How to Treat a Superficial Burn Wound at Home Again, even though we've mentioned this repeatedly, it bears mentioning once more – make sure the scene is secure and that it's safe to approach your pet if you suspect he or she has suffered a burn wound. Begin by checking your pet's vital signs. Pay particular attention to his or her respiratory system. A pet that has been in a fire will likely be at risk of suffering from smoke inhalation. If your pet is showing any breathing abnormalities, this can be a life-threatening situation and deserves an immediate trip to see the vet. Skip the burn wound care for now; the respiratory situation takes precedence. If your pet seems to be breathing normally, you can cool off any burned areas with cool water. Do not use ice water or ice. Your goal here is to stop the spread of any more heat. A burn may continue to produce more heat for a while after the actual incident. Once your pet's burn is thoroughly cooled off, wrap him or her in a towel or blanket and transport your pet to the veterinarian for further evaluation and care. Warning: Burns are not the type of injury to take lightly, and there's just so much you can do at home. A trip to the vet will almost always be warranted, whether or not you decide to treat a superficial wound before going. https://d3imrogdy81qei.cloudfront.net/video_images/3895/cat-and-dog-burn-care.jpg Yes 95 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-fractures-and-spinal-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2169.mp4 Cat and Dog Fractures and Spinal Injuries In this lesson, we'll be going over fractures and spinal injuries, including some signs to watch out for if you suspect these types of injuries in your pet. We'll also tell you about the number one warning you should heed if your pet does have one of these injuries.  Dogs and cats may become injured after a trauma. Common traumas include: Getting hit by a vehicle Falling from a substantial height Being attacked by another animal Generally, with pet trauma, the injuries can be potentially severe and should be taken seriously. You should get your pet to the veterinarian as quickly as you can, but you should do so as safely as you can. Pet Fractures Some common areas where your pet may suffer a fracture include the long bones – the upper and lower legs at the front and back of your animal. If your pet does suffer a fracture, you may notice a few signs, including: Your pet is not putting any weight on a limb Your pet has a severe limp Your pet has a dangling limb Your pet's limb is pointed at a strange angle Pro Tip: Be aware that there is often a lot of swelling with fracture injuries. If there is, some of the signs above may not appear obvious. If you suspect your pet has suffered a fracture, you should transport her to the veterinarian immediately. However, you also need to make certain that you're transporting her safely. You want to minimize all movement from the injured area, which will help not make the injury worse. Pet Spinal Injuries With spinal injuries, your pet can develop signs of pain when moving, particularly when it comes to the head, neck, and trunk. Or she might have trouble moving her hind limbs. She may also have trouble moving any limbs. If you suspect a spinal injury, you'll want to check your pet's vital signs. With spinal injuries, in particular, you want to pay special attention to her breathing or respiratory rate, as these can become abnormal with certain spinal injuries. Warning: This bears repeating! Transporting your pet quickly to the vet's office is crucial. But equally important is transporting her safely. Take extra care, especially when loading her into your vehicle, not to make her injuries worse by moving the injured area. https://d3imrogdy81qei.cloudfront.net/video_images/3897/cat-and-dog-fractures-and-spinal-injuries.jpg Yes 86 https://app.protrainings.com/courses/pets/first-aid/videos/safe-moving-of-injured-dogs-and-cats https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2170.mp4 Safe Moving of Injured Dogs and Cats In this lesson, we're going to answer the one pressing question you may have asked yourself during this course, as we've mentioned numerous times about safe transport to the vet – how exactly do I transport them safely?  For dogs and cats who suffer an injury, you want to make sure you're able to transport them to the veterinarian safely. As you know by now, the first thing you want to do is make sure the scene is secure and that you can safely approach your pet. Pro Tip: Since getting hit by a vehicle is one of the more common pet injuries, if you find yourself in this situation, make sure it's safe to go into the road after your pet. Try to position your vehicle so that it blocks traffic and make it obvious to those around you that something is wrong. You can turn on your headlights and hazards, both of which should help. Once you feel safe and comfortable approaching your pet, the first thing you'll want to do is muzzle your animal. Remember, an animal in pain may try to bite you. Once the muzzle is in place, you can begin the process of getting your pet into your vehicle for transport. Transporting Smaller Animals With smaller animals, simply lift them (if you're able to safely) and gently place them into their carrier. Get them into the car. And transport them to the vet's office as quickly as you can. Transporting Larger Animals Larger animals are a bit trickier to lift, for obvious reasons. If you're unable to lift your pet (safely, as in not making the injuries worse) you can use a towel as a sling. It's important to note that this method really only works if your pet still has the use of two or more limbs. If your pet has injured his front legs, slide the towel under his chest and place it up near his armpits. You'll want to then lift gently just to support your pet's weight. This should allow you to safely walk your pet to the car. If your pet has injured his hind limbs, slide the towel back toward his belly. Again, lift gently to support his weight and guide your pet to the car so you can transport him to the veterinarian. For larger animals that are unable to walk at all, you're probably going to need to get some help. Once the muzzle is in place, get a blanket from your first aid kit or linen closet. Or, if you have a stiff board that you can put your pet on, that may be a safer and more secure way to get your pet into your vehicle and on to your vet. Let's assume you'll be using a blanket rather than a board. Grab your blanket and place it in front of your pet. Get his feet and legs onto the blanket first, then quickly and gently lift the rest of him onto the blanket. You'll need to make this a coordinated effort between you and your helper. It'll help if you agree to count to three. Make sure you know whether you're lifting on three or right after three. Once your pet is on the blanket, one of you can grab one end while the other grabs the other. Lift him up and into your vehicle. It'll be a lot easier if you can get your car as close to your pet as possible, especially with larger animals who are unable to walk at all. https://d3imrogdy81qei.cloudfront.net/video_images/3899/safe-moving-of-injured-dogs-and-cats.jpg Yes 120 https://app.protrainings.com/courses/pets/first-aid/videos/recognizing-cat-and-dog-poisoning https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2171.mp4 Recognizing Cat and Dog Poisoning In this lesson, we're going to dive into how to recognize when you dog or cat has ingested a toxic substance and is now showing signs of poisoning. We're also going to supply you with some important information for your pet first aid kit.  Dogs and cats are naturally curious. They typically explore their environment using their mouths and noses. This makes them particularly susceptible to potentially ingesting a substance that is toxic to them. The Signs of Poisoning The signs of poisoning can come on suddenly within minutes, or those signs can occur hours or even days following the ingestion of a toxin. Also, as you're about to see, those signs of poisoning are numerous and incredibly varied. Common General Signs of Poisoning Some of the more common signs of poisoning can include the following: Drooling Vomiting Diarrhea Neurologic Signs of Poisoning If your pet has been exposed to a toxin, he or she might also display some neurologic signs of poisoning. These can include: Stumbling Muscle twitching or tremors Depression Hyperactivity Seizures Unconsciousness Other Signs of Poisoning Other possible signs of pet poisoning can also include the following: Bleeding Mouth ulcers Skin ulcers Pro Tip #1: If you suspect or know that your pet has been exposed to a substance that is poisonous, contact your veterinarian immediately and/or call the ASPCA Animal Poison Control Hotline at 1-888-426-4435 as soon as possible. If you call your vet first, in cases involving some of the more uncommon toxins, your veterinarian may request that you call poison control for more information. They are, after all, the experts on such matters. More so than even your vet. Be Prepared with Information that can Help If you do suspect your pet has been exposed to a poison or toxin, when you contact your vet or poison control, there is some information that will be extremely helpful to have on hand. Try to determine the following, if you can: What did your pet get into (the specific poison if you know)? How much poison might your pet have been exposed to? How long has it been since the exposure/potential exposure? What is the weight of your pet? Have you noticed any behavioral or vital signs changes? Pro Tip #2: How can you tell how much poison your pet ingested? Well, it depends on the poison. If your pet got into a pill bottle, how may pills were there before and how many are there now. If your small dog just got into a large chocolate cake, how much is left and how much was there before? Having this information on hand can greatly assist your veterinarian or poison control in providing prompt and effective care and treatment solutions. Pro Tip #3: If you don't already have the number for the Animal Poison Control Hotline in your first aid kit, you may consider doing that now. Remember, contact information is one of the more important items in your kit and it helps if that contact information is complete. https://d3imrogdy81qei.cloudfront.net/video_images/3901/recognizing-cat-and-dog-poisoning.jpg Yes 97 https://app.protrainings.com/courses/pets/first-aid/videos/common-pet-poisons https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2172.mp4 Common Pet Poisons In this lesson, we'll be covering some of the more common sources of poisoning for dogs and cats. Specifically, we'll be looking at medications, human food, and house plants that are all toxic or potentially toxic to your dogs and cats at home. Medications that are Toxic to Dogs and Cats One of the most common sources of poisoning for dogs and cats are medications and this includes human medications, those prescribed for pets, and even over the counter medications. Pro Tip #1: Since some medications can be potentially toxic to your pets, it's so important to safely store them out of reach of your curious dog or climbing cat, or in other words, any place your furry family members cannot get to. Also worth mentioning, it's a really good idea to keep a list of the medications in your household for reference, just in case something does happen. Warning: Never give any medication to your pet that has not been specifically prescribed for him AND for the intended purpose. Even a medication that is prescribed for your pet can be dangerous to him in certain situations, particularly pain meds and anti-inflammatory meds. You also don't want to give one of your pets a medication that was prescribed for another. And never purchase a medication for a larger animal and divide it between two or more smaller animals. And finally, just because some medications are available over the counter, this doesn't mean they will be safe for your pets. Please don't assume. When in doubt, consult with your veterinarian. Human Foods that are Toxic to Dogs and Cats Besides medications, people food is another potential source of toxicity in dogs and cats. It's a good idea, as stated above for meds, to always check with your vet before feeding your pet anything other than their regular food. After all, some of the foods toxic to pets may surprise you. Some common foods that are not safe for dogs and cats include, but are certainly not limited to: Chocolate Grapes or raisins Onions Garlic powder The artificial sweetener xylitol Old, moldy foods Pro Tip #2: Again, this is NOT an exhaustive list, but rather just some of the more common foods that are toxic to pets. Before giving your pet human food, always first consult with someone in-the-know, like your veterinarian. House Plants that are Toxic to Dogs and Cats House plants are another potential source of toxicity to your dogs and cats. A good example of this are lilies. These flowers are toxic to pets and for some reason some dogs and cats are drawn to eating certain parts of the plant. And the problem is that consumption can cause severe kidney damage. You may recall from the previous lesson's Word section that lilies were first on the list of house plants that are toxic to plants. If you skipped that read, we urge you to take another look, as you may inadvertently have one or more of those common, yet pet toxic plants in your home or yard. Pet toxic house plants can cause signs and symptoms ranging from stomach upset to heart problems. The ASPCA Animal Control website has an extensive list of plants with photos to help guide you on which plants are safe for your pets and which are not. If you'd like to check out that important resource, you can do so here: aspca.org/pet-care/animal-poison-control. Also listed on that link above are people foods to avoid feeding your pet and poisonous household products that you should keep away from your pets. Before bringing any plant into your home or yard, please consult the list at that link above. And be sure to use it as a valuable resource for those other categories of pet toxins and poisons. https://d3imrogdy81qei.cloudfront.net/video_images/3903/common-pet-poisons.jpg Yes 128 https://app.protrainings.com/courses/pets/first-aid/videos/dangerous-cat-poisons https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2173.mp4 Dangerous Cat Poisons In this lesson, you'll be learning about dangerous cat poisons. While it may seem that the canine is the star of this course, that's not so in this lesson, as it's all cat centric. We'll be specifically looking at topical flea medications and/or other topical or contact poisons. At the end of the lesson, we'll be providing you with a very special Word on the top 10 dangers for your cat and other household hazards that may be toxic to your furry friends. Topical Canine Flea Medications Some of the more common causes of poisoning in cats is the inadvertent application of topical canine flea medications. Warning: Flea medications that specifically contain pyrethrins or permethrin can be severely toxic to cats. These toxins can cause a range of symptoms in your cats, including severe full body tremors, seizures, and even death. Pro Tip #1: Unfortunately, flea medication products on the market are not always labeled as being toxic to cats. So, if you do not find a warning on the package, still do not assume it is safe. Instead, to be safer rather than sorry, you'll want to be very diligent before purchasing any flea medications for your cat. What You Should do in Case of a Topical Poison First off, you don't always want to bathe your cat if you suspect an adverse reaction to a contact poison as some toxins can be activated by water. The best course of action is to consult with Animal Poison Control or your local veterinarian before bathing your cat. Pro Tip #2: If you've been told you can bathe your cat as a means of washing away any poison or toxic residue, make sure you only use warm water, not hot, along with a mild shampoo or dish detergent that has been approved by your vet and rinse your cat thoroughly. Why shouldn't you use hot water? For the same reason you don't want to dry your cat with a hair dryer. Heating up your cat's skin can cause problems, as this will also increase blood flow to that area where the toxin or contact poison is or was residing, thereby increasing the rate of absorption of the toxin or poison. For this reason, after bathing your cat, make sure you dry him or her off with a clean towel instead. And once bathed, be sure and transport your cat to the vet for further care. https://d3imrogdy81qei.cloudfront.net/video_images/3905/dangerous-cat-poisons.jpg Yes 73 https://app.protrainings.com/courses/pets/first-aid/videos/making-a-cat-or-dog-vomit https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2174.mp4 Making a Cat or Dog Vomit In this lesson, we're going to discuss whether or not you should induce vomiting in your pet following the ingestion of a toxic substance. We'll also go over how exactly you can induce vomiting in your pet, if your vet or Animal Control has given you clearance to do so. At the end of the lesson, we'll provide you with a Word about some of the everyday items you carry around with you that may dangerous to your dog or cat, including items you may not consider dangerous at all. If your dog or cat ingests a toxic substance, it may be important for you to induce vomiting as soon as possible to avoid further absorption or digestion of that toxin. However, it's important to understand that inducing vomiting isn't always recommended in every situation. Pro Tip #1: For that reason, we advise you to contact Animal Poison Control or your local veterinarian for guidance on whether or not you should try to induce vomiting. And in case you didn't get the number from a previous lesson – ASPCA Animal Poison Control Hotline: 1-888-426-4435. Remember to put this into your contact information part of your pet first aid kit. If You are Recommended to Induce Vomiting Pro Tip #2: If vomiting is recommended for your pet by either your vet or Animal Poison Control, and you are more than 10 to 15 minutes away from the nearest veterinarian facility, you still want to ensure that your pet is breathing normally, isn't depressed or overly anxious, and is fully conscious before attempting to induce vomiting. How to Induce Vomiting Items you'll need to have on hand, meaning in your pet first aid kit, are 3 percent hydrogen peroxide and a syringe or turkey baster. Then simply follow the steps below. Get your items from your pet first aid kit and measure out your dose, which is 1 teaspoon of hydrogen peroxide per 10 pounds of your pet's body weight and put it into the syringe or turkey baster. Hold your pet firmly and squeeze the hydrogen peroxide into the side of your pet's mouth. This should get him or her to swallow the liquid easier. Once you've given the dose of hydrogen peroxide, transport your pet to the nearest veterinarian facility, while also monitoring your pet to see if he or she does vomit. Pro Tip #3: Your pet should vomit within 15 minutes, but this isn't always the case. If your pet doesn't, you can repeat the dose once more, ideally while in transit so as to not lose any more time. If two doses of hydrogen peroxide do not prove successful in inducing your pet to vomit, by now you should be getting closer to a veterinarian facility, and once there, they will have the proper medications that should help induce vomiting. Otherwise, your pet may need to have his or her stomach pumped. A Word About Pet Dangers We Carry with Us Everyday The number of everyday items we all lug around that may be toxic for your pets may surprise you. Think about the items you carry in your bag, purse, or backpack each day – those sweets for the afternoon doldrums, medications, car keys, hand sanitizer, cell phones, and so much more. Now ask yourself, while also looking into your bag, which of these might be toxic to my pets? Any ideas? Well, pet expert Cara Armour can help you figure out which of your daily items are toxic to pets, in an important blog article she wrote for the ProPetHero blog: The Pet Dangers We Carry with Us Everyday. Your pets may be at risk without you knowing it, especially if you have pups or kittens that tend to be more curious than older dogs and cats. The good news is that you've learned about many poisons or toxins that you should keep away from your pets in this course. The top five items you should store as safely as you can include: Chocolate Xylitol (remember to check ingredient labels) Hand sanitizer Prescriptions and over the counter medications Asthma inhalers Asthmas inhalers apparently smell appealing to pets and kind of look like chew toys, but when it comes to puppies, what doesn't look like a chew toy? The problem is that if your pet gets into your inhaler, the repercussions can be quite serious. While you now know the items to store more safely in your purse, bag, or backpack, we probably all would agree that accidents still happen. If you follow that link above to the full article, Cara also shares with you what to do if your pet does get into your bag and accidently ingests or is exposed to a toxin or poisonous substance. https://d3imrogdy81qei.cloudfront.net/video_images/3907/making-a-cat-or-dog-vomit.jpg Yes 91 https://app.protrainings.com/courses/pets/first-aid/videos/pet-eye-washing https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2175.mp4 Pet Eye Washing In this lesson, we'll be going over pet eye washing, specifically showing you how it's done.  How to Flush Out Your Pet's Eye First off, you'll need to restrain your pet. Some pets may be OK with this, while others, probably your feline friends, will not be. So, it may take a second person to hold Fluffy still while you perform the following eye washing steps. This will also help ensure you're actually spraying into an eye, rather than all over your kitchen. 1. Grab your sterile saline solution from your pet first aid kit.2. Tilt your pet's head back a little to allow gravity to do some of the work. Warning: When washing your pet's eye, make sure you don't touch the tip of the bottle to the actual eye. You want to get close, but not so close that you actually do more damage. Account for squirming! 3. Aim, squeeze, spray! Again, as you begin flushing out your pet's eye, he or she isn't going to take the matter as well as you probably hope. So, expect your pet to try and wiggle free as you begin doing this.4. Depending on how that first attempt of a flush went, you will likely want to flush some more. You want to flush a fairly large amount and ensure that the eye is thoroughly cleaned out to dislodge any foreign matter or to just simply irrigate the eye thoroughly.5. Clean up the wayward saline sprays. This will probably get messy, so expect that too. Pro Tip: Even though this can be a messy procedure for you and an uncomfortable or anxious experience for your pet, doing so can make a huge difference in making your pet's eye feel much better. https://d3imrogdy81qei.cloudfront.net/video_images/3909/pet-eye-washing.jpg Yes 51 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-snake-bites https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2176.mp4 Cat and Dog Snake Bites In this lesson, we'll be discussing cat and dog snake bites. We'll get into the four types of venomous snakes present in the U.S. and the four general toxins that those snakes' venoms contain, each coming with different sets of symptoms.  There are four types of venomous snakes living in the United States. These include: Rattlesnakes Copperheads Cottonmouths Coral snakes Pro Tip #1: It's important to know what venomous snakes live in your area, so that you can be on the lookout for the signs and symptoms that are caused by a bite from that/those particular venomous snakes. If you witness your pet being bitten by a snake or interacting with a snake, there's really little you can do in the way of providing first aid to your pet. However, what you can do that is equally important, if not more so, is to get a photo of the snake in question. Warning: You don't need to get close to a snake to take its picture, and you can skip with the pleasantries and requests to say cheese! Seriously, though, don't get so close that you might get bitten yourself. In case it wasn't obvious, each venomous snake comes with its own antivenom. Which means knowing what type of snake bit your pet could save some time trying to figure it out blindly. Snake Bite Myths to Ignore This point really deserves its own heading, as there are more myths around treating snake bites than there are venomous snakes in the U.S. Here are a few common myths. Apply a tourniquet. Apply ice. Make an incision and suck out the venom. While some of these may work in the movies, none of them are advisable or recommended, and this includes in people or pets who have been bitten by a poisonous snake. Instead, the most important things you can do involve identifying the snake and transporting your pet to the veterinarian as quickly as you can. And if you cannot identify the snake, your vet may be able to help with that based on your pet's symptoms and the location of the country you're located in. Warning: Even if your pet isn't showing any signs of a snake bite, after coming into contact with a snake, it's still important to get him or her to your vet. In many cases, it's very difficult, or even impossible, to identify the signs of a snake bite. Signs and Symptoms of a Venomous Snake Bite Obviously, not all snake bites will be witnessed. In these cases, it is important to become familiar with the signs and symptoms of a venomous snake bite, particularly for those venomous snakes in your area. In general, there are four toxins contained within a snake's venom. And some snakes may have more than one type of toxin in their venom. These four toxins include: Neurotoxins. Signs of neurotoxins include weakness progressing to paralysis. Cardiotoxins. Signs of cardiotoxins include an abnormal heart rhythm and even a stoppage in heart function. Cytotoxins. Cytotoxins can cause local tissue damage, and the signs can be seen as swelling or bruising of the affected bite area. Hemotoxins. Hemotoxins can cause red blood cell destruction or lead to anemia or blood clotting disorder, and the signs can be seen as bleeding from the site of the bite. Pro Tip #2: It's always important to watch your pet's behaviors and monitor his or her vital signs if you suspect a snake bite. If you spot any abnormalities, seek veterinary care immediately, even if you do not suspect a snake bite, which, by now, is a message you're used to hearing. Treatment for Cat and Dog Snake Bites Pets that are bitten by a venomous snake may require antivenom, fluid therapy, pain medications, or even a blood transfusion. And in some cases, multiple vials of antivenom will be needed, while in others, no antivenom will be necessary. It's worth mentioning one more time – the signs of a venomous snake bite may not be obvious. But if you know that your pet has been around a venomous snake, it's important to have him or her monitored by a veterinary team as soon as possible, and generally for a day or two. https://d3imrogdy81qei.cloudfront.net/video_images/3911/cat-and-dog-snake-bites.jpg Yes 155 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-spider-bites https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2177.mp4 Cat and Dog Spider Bites In this lesson, we're going to discuss an uncommon hazard for your pet: venomous spider bites. We'll also be giving you a little information on the three types of venomous spiders you're likely to find in the U.S.  Venomous spider bites in the U.S. are not common and this includes those involving pets. In fact, it's very unlikely that you'll ever need to take your pet in to see your veterinarian because of a venomous spider bite. But that doesn't mean it's not possible. An important thing to note about venomous spider bites and pets is that we don't know if the bites themselves are uncommon, or if those bites are more common than we think, and they simply go unrecognized. Venomous Spiders in the U.S. to be Aware Of In the United States, there are three venomous spiders you should be aware of: Brown recluses Hobo spiders Black widows Each of these venomous spiders carry different concerns and their bites produce different symptoms. Brown Recluses Brown recluse spiders are usually between 6 and 20 mm in length (0.24 and 0.79 inches) but may grow larger. While typically light to medium brown, they range in color from whitish to dark brown or blackish gray. A bite from a brown recluse spider can cause local tissue damage and destruction as well as pain for your pet. Hobo Spiders Hobo spiders sometimes build their webs in or around human habitations. The hobo spider lays its eggs in September and they hatch during late spring. They vary considerably in appearance, and identification can be difficult. However, a hobo spider is typically 7 to 14 mm in body length (0.28 to 0.55 inches) and brownish in color. A bite from a hobo spider causes damage similar to a brown recluse – local tissue damage and destruction and pain – but of the two spiders, the brown recluse is more of a concern. Black Widows There are several types of black widow spiders in North America: Southern Black Widow, Western Black Widow, and Northern Black Widow. Female widow spiders, in general, are typically dark brown or a shiny black in color when they are full-grown, and usually exhibit a red or orange hourglass on the underside of the abdomen. Some may have a pair of red spots or have no marking at all. The male widow spiders often exhibit various red or red and white markings on the upper side of the abdomen. The venom of widow spiders contains a neurotoxin, which can cause headaches, abdominal pain, and stomach upset. The black widow spider is the one in this group of venomous spiders to be most concerned about. Pro Tip: Unless you see your pet interacting with one of these venomous spiders, it's probably going to be unlikely that you or your veterinarian will suspect a spider bite, given how uncommon they actually are. Treatment for Venomous Spider Bites If your pet gets bitten by one of these venomous spiders, the course of treatment mostly includes supportive care. However, in severe black widow bite cases, there is an antivenom available in the U.S. https://d3imrogdy81qei.cloudfront.net/video_images/3913/cat-and-dog-spider-bites.jpg Yes 56 https://app.protrainings.com/courses/pets/first-aid/videos/allergies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2178.mp4 Allergies In this lesson, you'll be learning about allergies, including both long-standing allergies and those that come on suddenly. We'll provide you with some signs and symptoms for each type and tell you when it's appropriate to see a veterinarian for every situation. Allergies are a sign that your pet's body is overreacting to an exposure to some type of foreign substance. There are two types of allergies – sudden onset allergies and long-standing allergies. Sudden onset allergies, as the name implies, are those that come on suddenly. Sudden onset allergies are typically caused by things like:a. Insect stingsb. Medicationsc. Vaccinations Long-standing allergies, by contrast, do not usually come on suddenly but develop over time. Long-standing allergies are typically caused by things like:a. Different foodsb. Environmental allergies like grass or pollens Sudden Onset Allergies If your pet is experiencing a mild yet sudden allergic reaction, the signs you will usually see include: Pain Facial swelling Scratching Hives – red raised bumps on the skin Vomiting If you see any of these signs in your dog or cat, it's time to check those vital signs. What you discover will determine your next course of action. If Your Pet's Vital Signs are Normal If you've checked your pet's vitals and they all appear normal, you can contact your vet for some advice. He or she may recommend you give your pet some over-the-counter diphenhydramine, also known by the brand name Benadryl. However, your veterinarian may recommend you bring your pet in for an evaluation. Pro Tip #1: If your vet does recommend giving your pet Benadryl over the counter, you should monitor your pet closely afterward. If at any time her symptoms get worse or if her signs are not improving after 30 to 60 minutes, you'll need to take her in for a veterinary evaluation right away. If Your Pet's Vital Signs are Abnormal Let's say you check your pet's vitals and notice some abnormalities. This can be a sign of a worse condition or greater problem. in situations like these, it's important to be aware of a condition called severe anaphylaxis shock, as it can be life-threatening. In particular, if you notice the following signs of anaphylaxis shock, this may be a real cause for concern: Light pink or dark red gums A fast pulse rate A fast breathing rate Weakness Collapse Warning: This could be very serious. If you notice any of these signs, transport your pet to a veterinarian facility as soon as possible. And DO NOT give your pet any medications unless first instructed by your vet. Long-Standing Allergies Dogs and cats, like people, can develop long-standing allergies to things like food and other environmental allergens. If your pet is suffering from this type of allergy, signs you might see include the following: Hair loss Reddened skin Raised bumps on the skin, like papules or pimples If you notice any of these signs, you'll want to make an appointment to talk to your veterinarian about long-term treatment options. However, even with treatments, flare-ups can still occur. When a flare-up does occur, it can cause moist and reddened skin that can be intensely itchy. Pro Tip #2: If your pet has long-standing allergies and suffers from a flare-up, it's important to limit your pet's ability to scratch, lick, or chew those affected areas on her body, as this can cause or spread secondary bacterial infections. How do you keep your pet from doing any of the above? Well, the two best ways to do this are using a cone collar or other ways to prevent your pet from reaching the affected areas such a suitical recover suit. Surely you've seen the cones before. They're perfect for preventing your pet from the chewing and licking that will likely just cause more problems. And if you haven't had a pet need one of these cones before, beware that she will not like wearing it. If you do put a cone on your pet, keep it on until you can get seen by your veterinarian and until you can get your pet's long-standing allergic reaction or flare-up under control. Better your pet has a bruised ego or feels uncomfortable for a few days than contracting a bacterial infection. https://d3imrogdy81qei.cloudfront.net/video_images/3915/allergies.jpg Yes 161 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-breathing-problems-respiratory-distress https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2179.mp4 Cat and Dog Breathing Problems (Respiratory Distress) In this lesson, we'll be covering cat and dog breathing problems, also known as respiratory distress. We'll provide you with a list of signs and symptoms to watch out for, as well as some information on what normal breathing looks like in order to contrast that with troubled breathing.  If you've ever had the wind knocked out of you, you know what a frightful situation that can be and the panic that can cause. Because when the wind gets knocked out of you, it's difficult to know when or if you'll be able to take your next breath. Pets likely experience a similar sensation known as dyspnea (difficult or labored breathing) or severe respiratory distress. And experiencing this condition is probably just as scary for them as it would be for you. Pro Tip #1: It's really important to understand what normal breathing looks like so you can pick up on the subtle changes to your pet's breathing before severe respiratory distress sets in. When you watch your cat or dog breathe, you want to see the chest expanding and contracting. It should move out slightly on the inspiration (inhalation) and fall back to baseline on the expiration (exhalation). Your pets abdominal muscles will move slightly with every breath, and this is normal. As is panting, as this is also considered a normal breathing pattern. Warning: What isn't normal are abdominal muscles that are flexing or becoming engaged with each breath. This is a sign of labored breathing and should be considered serious. Signs of Respiratory Distress in Your Pets Pro Tip #2: If you notice that your pet is suddenly having to work harder to breathe than she normally does, and she hasn't just finished playing or exercising, this is a sign that she's in trouble. In this case, you need to get your pet to veterinary care as soon as possible. Some specific signs you may see in your pet if she is having trouble breathing include engaging other muscles for inspiration, which can be seen as nostril flaring, and using neck muscles on inspiration when taking a deep breath. On the expiration, some signs to watch out for include abdominal muscles that become engaged, as we've mentioned, or a cough that occurs simultaneously with the expiration. Some animals might also sit or lay differently than what is normal for them. This includes extending the neck or head and splaying the elbows out. In some cases, you even hear strange or loud breathing sounds, or you may notice that your pet is breathing faster or deeper than normal. And finally, you might notice a discoloration of the gums, particularly blue or white. To recap, the signs of respiratory distress in your pet include the following: Breathing harder than normal while at rest Flaring nostrils Using neck muscles Using abdominal muscles Coughing during expiration Spread elbows Louder or faster breathing Discoloration of the gums If you see any of those signs listed above, you need to get your pet to a veterinarian as soon as possible. There isn't much you can do at home to help with respiratory distress or breathing problems, but you should try to keep your pet calm. Once at the vet's office, he or she will be able to provide much more care in the way of supplemental oxygen, sedation if required, and also recommend various tests to help decide the next best course of action. https://d3imrogdy81qei.cloudfront.net/video_images/3917/cat-and-dog-breathing-problems-respiratory-distress.jpg Yes 130 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-choking-conscious https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2180.mp4 Cat and Dog Choking (Conscious) In this lesson, you'll be learning what to do if your dog or cat is suddenly choking and cannot breathe. We'll be sharing with you three techniques, with one being specifically for smaller dogs and cats. Choking can occur suddenly in dogs and cats who are chewing on food, treats, or a toy. If your pet is choking, she may suddenly react in a variety of ways, including: Becoming very anxious Pawing at her face Visibly struggling to breathe You may also notice that her gums have turned blue or grayish in color. Pro Tip #1: While this is a scary situation for both you and your pet, it's so important for you to stay calm and assess your pet. It's no secret that the human brain works better when calm. If your pet is conscious, the first thing you'll want to do is inspect her mouth. To look into her mouth, you'll need to pry her jaws open (taking care not to get bitten), grasp her tongue, and pull it forward. Pro Tip #2: Trying to grab a slippery tongue is no easy task. To make it easier, use a piece of gauze or the sleeve of your shirt to pull the tongue forward. Once you've done that, use your finger to check the back of her mouth and try to dislodge the object. Warning: You need to be careful doing this, as you can inadvertently push the stuck object further in and make it even more stuck. Modified Heimlich Thrusts for Larger Dogs If trying to dislodge the object with your fingers didn't work, you may need to provide modified Heimlich thrusts, and this will vary based on the size of your pet. Pro Tip #3: For larger dogs, find the area just behind the sternum – that bony area along the middle part of the chest and along the ribs. When you can no longer feel bones or ribs and you feel only soft belly, you'll know you're in the right spot. The Technique – Your Pet is Laying Down Locate the area we've described above. Place one cupped hand over the other fist and place both on that spot. Give 5 quick abdominal thrusts. You want to do this back toward the spine and forward toward the head. Go back to the mouth and see if the thrusts dislodged the object. The Technique – Your Pet is Standing Up If you or your pet are more comfortable doing this while she is in a standing position, follow the steps below. Get behind your dog. Put your hand or hands behind where the ribs end, or in other words, on her belly just below the ribs. Place two hands on that spot just as before, or one if you're holding your pet's front half with one hand. Give 5 quick abdominal thrusts toward the spine and her head. Go back to the mouth and see if the thrusts dislodged the object. If the abdominal thrusts don't work, it's time to switch to back blows. Back Blow Technique Find your pet's shoulder blades by feeling for the boney structures along her back, just at the top of her front legs. Find the spot just behind the shoulder blades. Give 5 quick blows to the back in the direction toward the head, so in other words, at a bit of an angle. Go back to the mouth and see if the thrusts dislodged the object. Continue to alternate between abdominal thrusts and back blows, checking the mouth in-between, until either you dislodge the object, or your pet becomes unconscious, which we'll cover in the next lesson. Modified Heimlich Thrusts for Smaller Dogs and Cats For cats and smaller dogs, the technique might be easier if you perform it while your pet is standing upright on her two hind legs. Hold your pet in that standing position with her spine along your chest. Find the soft area of her belly, just below the firm area that includes the ribs and sternum. Give 5 quick abdominal thrusts with either one hand or two. You may find it easier to hold your pet up (under her front armpits) using one hand while you perform the thrusts with the other. Make sure the thrusts are up and back, always in the direction of head. Go back to the mouth and see if the thrusts dislodged the object. It should go without saying (and yet, here we are saying it anyway) that watching these techniques is much better than reading about them. To practice or for a quick refresher, watch the corresponding video for this lesson, as Dr. Bobbi shows you in much greater detail exactly how to perform each of these techniques listed above. https://d3imrogdy81qei.cloudfront.net/video_images/3919/cat-and-dog-choking-conscious.jpg Yes 221 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-choking-unconscious https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2181.mp4 Cat and Dog Choking (Unconscious) In this lesson, we'll be piggybacking off what you learned in the last lesson, as the steps for providing first aid to an unconscious choking dog or cat will be similar to that of a conscious choking pet. However, there are still some crucial differences to be aware of. If your dog or cat becomes unconscious at any point, or if you found your pet that way, the first thing you'll want to do is check her mouth and look for an object that may be lodged in her throat. Pro Tip #1: Even though your pet is unconscious, this doesn't mean you still cannot get bitten inadvertently or push the object further in and getting it more stuck in the process. Take extra care with this step and keep those two things in mind. Remember, to look into your pet's mouth, you'll need to pry her jaws open, grasp her tongue, and pull it forward. You likely recall from the last lesson that trying to grab a slippery tongue is no easy task. To make it easier, use a piece of gauze or the sleeve of your shirt to pull the tongue forward. Once you've done that, use your finger to check the back of her mouth and try to dislodge the object. Pro Tip #2: As Dr. Bobbi points out in the video, you'll want to be in front of your dog, rather than behind. Dr. Bobbi is in that position simply so you can see the way she's performing each technique. How to Perform Rescue Breaths If your pet becomes unconscious and stops breathing, you'll then need to begin performing rescue breaths. To give rescue breaths, follow the steps below. 1. Wrap one hand around your pet's mouth/snout and hold it closed. 2. Cover your pet's nostrils completely with your mouth. Pro Tip #3: In the video, you may have noticed that Dr. Bobbi didn't do this, as her dog, Callie, was conscious and you could do some harm performing this maneuver on a dog that is breathing and isn't choking. 3. If you are providing aid to a smaller dog or a cat, you may be able to get your entire mouth over your pet's nostrils and mouth, just as first responders often do with infants and babies. This works best as it creates a better seal and helps ensure the effectiveness of each rescue breath. 4. Give 5 quick rescue breath breaths. As you perform each rescue breath, make sure you're looking at your pet's chest. You should notice a visible rise and fall with every rescue breath you provide. If you don't see the chest rise and fall, it won't be effective, and you should try to create a better seal. 5. After 5 rescue breaths with visible chest rise and fall, perform the abdominal thrusts or back blows that you learned in the last lesson. Pro Tip #4: As you do all of this, you should also be monitoring your pet's pulse rate at the same time. If at any time you notice that your pet's pulse disappears, you'll need to begin CPR as soon as possible, which you'll learn in a subsequent lesson. How many times do you need to perform this sequence? As often as necessary, meaning until the object is dislodged. And if you do succeed in dislodging the object that your pet was choking on, you'll still want to take her in to see a veterinarian, as she may have injured her lungs or the back of her throat. To recap, the steps to perform on an unconscious choking pet are as follows: Check the mouth and try to dislodge the object. Perform 5 rescue breaths. Perform 5 abdominal thrusts or back blows. Repeat as needed. Check the pulse rate every 2 cycles – check mouth, rescue breaths, and ab thrusts or back blows. Perform CPR if you discover your pet has no pulse. In the last lesson, we advised you to alternate between abdominal thrusts and back blows, and this is still a good idea. It's difficult to know which will work best and doing both may improve your chances of a favorable outcome. Simply perform one technique during the first cycle and the other during the second, and then check for a pulse. https://d3imrogdy81qei.cloudfront.net/video_images/3921/cat-and-dog-choking-unconscious.jpg Yes 121 https://app.protrainings.com/courses/pets/first-aid/videos/pet-near-drowning https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2182.mp4 Pet Near Drowning In this lesson, we're going to go over what you should do if you find your pet submerged in water and he or she has suffered a near-drowning.  Some pets love the water and love swimming, and those pets are likely the canines in your household and not your cats. Regardless of their love of water or hatred of it, there's still a good chance that your pet may be exposed at some point to backyard pools, lakes, rivers, and oceans. It's always a good idea to be prepared for anything, and this includes what to do in the event of a near drowning. Dogs and cats that suffocate while being submerged underwater is a situation that can happen for a variety of reasons. Your pet may have been swimming along just fine and then suddenly became fatigued. Or your pet may have a condition that prevents them from swimming effectively or perhaps your pet is just more susceptible to ingesting water for whatever reason. How it happened isn't nearly as important as what you should do next. How to Rescue Your Pet from a Near Drowning If you notice your pet submerged in water, remove him completely from the water. You'll want to put him into the best position to help drain the water from his system, meaning through his nose and mouth. The technique for this is as follows: For smaller pets that you can easily lift off the ground, lift your pet's rear half up in the air, while also lowering his head. Point his head downward toward the ground in almost a headstand position. For larger animals that you cannot lift off the ground, simply lift the hind end up to get the head pointed downward. Pro Tip: Gravity is your friend in these situations. If ever you get flustered and have trouble remembering what to do, just think about it logically. You need to get that water out of your pet and the best way to do that is with an assist from gravity. After you've done this, you'll want to assess your pet's vital signs, even if he appears fine and dandy and fully recovered. If your pet is still unconscious at this point, you'll need to perform rescue breathing. And if there's no pulse, you may have to begin full CPR. Warning: Even if your pet isn't showing any signs of trouble following his near-drowning, he still may have ingested a very large amount of water, and this in itself can lead to complications, such as an electrolyte imbalance. Therefore, it's always a good idea to have him evaluated by a veterinarian as quickly as you can. https://d3imrogdy81qei.cloudfront.net/video_images/3923/pet-near-drowning.jpg Yes 84 https://app.protrainings.com/courses/pets/first-aid/videos/pet-cpr-introduction https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2183.mp4 Pet CPR Introduction In this lesson, we'll be introducing you to pet CPR for your dog or cat, including knowing when to begin providing CPR efforts (as three conditions must be met), along with outcome rates, and how you'll know when it's time to stop.  Cardiopulmonary resuscitation (also known as CPR) is used in patients who have stopped breathing and whose hearts have also stopped beating. When this happens, that person or pet will now be in cardiopulmonary arrest. Pro Tip #1: When the heart fails to pump oxygenated blood throughout the body, the brain and other important tissues can suffer damage after just a couple of minutes. Therefore, it's really important for you to understand the time component that is involved with providing CPR. CPR consists of two main components: Providing rescue breaths. Performing high-quality chest compression. The goal of CPR is to pump the heart manually, which will circulate that oxygenated blood, until the heart begins to beat on its own. Without this vital intervention, a patient or a pet who suffers from cardiopulmonary arrest will almost certainly die. Success rates of CPR performed on people have been fairly well studied, but this isn't necessarily so when it comes to success rates in veterinary medicine. However, generally, dogs and cats who require CPR will survive around 10 percent of the time. Pro Tip #2: Yes, that statistic is a bit gloomy, but it's important for you to know that CPR is much more likely to fail than succeed. However, the sooner you can initiate CPR efforts, the more likely that your pet will have a good outcome. It's also important to know that without those CPR efforts, that good outcome practically falls to zero percent, which is why medical professionals teach that at that point, the patient is already dead; therefore, it's better to do something than nothing. CPR should only be performed on pets who have actually suffered cardiopulmonary arrest. It's important that you're able to recognize the signs, or the three conditions that must be met. Three Signs or Conditions Before Providing CPR 1. Your pet will lose consciousness, meaning he will no longer be able to respond to you.2. Your pet will stop breathing or stop breathing normally. Pro Tip #3: Determining this can be tricky. Some pets will stop showing any signs of normal breathing, while others will continue what we call agonal or gasping breathing. This is not considered normal breathing, and it's important that you understand the difference. 3. Your pet will have no pulse rate. This also can be difficult to assess for, particularly in an emergency. However, remember how vital the time component is. You should only spend 10 to 15 seconds looking for a pulse before moving on to CPR. If you cannot find a pulse for your pet quickly and the first two conditions are met, begin CPR efforts immediately. There is little risk that you'll cause harm if you perform CPR on a patient or pet who doesn't need it. Warning: There is a far greater risk of delaying CPR efforts for a pet who really needs it. How Long Should You Perform CPR on Your Pet? There aren't really any clear guidelines for how long CPR efforts should continue before you decide to stop. Logically speaking, the longer your pet goes without proper blood flow, the higher his chances of a poor outcome. Some guidelines recommend performing CPR for at least 20 minutes, then stopping at that point if you are not successful. Having said that, there have been plenty of reports involving people and pets who have survived prolonged CPR efforts. One instance in which this is sometimes the case, is for near drowning incidents in cold or icy waters. However, in general, dogs and cats that typically survive CPR efforts were revived after around 10 minutes or less on average. https://d3imrogdy81qei.cloudfront.net/video_images/3925/pet-cpr-introduction.jpg Yes 142 https://app.protrainings.com/courses/pets/first-aid/videos/cat-and-dog-cpr-demonstration https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2184.mp4 Cat and Dog CPR Demonstration In this lesson, we'll be taking you through a cat and dog CPR demonstration. Obviously, watching the corresponding video for this lesson and practicing along on a stuffed animal will be the best approach to learning these techniques, and you should consider doing so until you feel comfortable performing high-quality CPR. Before you begin chest compressions, it's important that you're in the correct position. You'll want your pet on his side and either is fine. And you'll be positioned directly over him. Pro Tip #1: When you give chest compressions, it's important to lock your elbows and allow the weight of your body to assist you. If you're too close to your pet and are unable to lock your elbows, you'll tire much more quickly, and those compressions will likely be less effective. Two Different Hand Positions Your hand position is determined by the size of your pet. For dogs that are 25 pounds or larger, put your hands over the widest part of the chest and back a little, closer to the spine in the middle of the chest. For cats and smaller dogs, you're going to want to put your hands directly over the heart. To find the heart, bend your pet's top leg in and find the point on the elbow. Where that point meets the chest is roughly where your pet's heart is located. For really small animals, you can also put your thumb and fingers on the sides of the chest, where the heart is located, and squeeze that area with just one hand. Regardless of which location you compress, you'll want to put one hand on top of the other, just like Dr. Bobbi demonstrated in the video, unless compressing with one hand. The Proper CPR Technique Now that you know where to put your hands and how to put your hands, let's focus on some specifics regarding those compressions. Each compression should be performed at a depth of 1/3 to 1/2 the depth of the chest. They should also be performed evenly and at the same rate – 100 to 120 chest compressions per minute. Pro Tip #2: Make sure to allow for full recoil after each compression. What does this mean? You'll want to compress the full depth and then allow the chest to fully rise, before performing another compression. One time down and one time up equals one full compression. The rate of chest compressions can be tricky at first. One way to think about it is that you'll be delivering around 2 full compressions every second. And if you require a little trick, you can perform compressions to a couple of different songs (in your head). Staying Alive by the Bee Gees or Another One Bites the Dust by Queen are excellent choices and not bad as far as 70s songs go either. 1 Person CPR Cycle Ideally, you'll have help, but this may not always be the case. If it's just you, you'll want to do the following: Perform 30 chest compressions. Give 2 rescue breaths. Check for a pulse; remember to spend only 10 to 15 seconds. If you do not detect a pulse, go immediately back into performing 30 more chest compressions. 2 Person CPR Cycle If you do have help, you'll be able to provide better quality CPR with fewer interruptions and alternate roles to limit fatigue, as chest compressions can be exhausting. One of you performs continuous chest compressions. While the other gives one rescue breath every 6 to 8 seconds. Switch after 2 minutes, while one of you also checks for a pulse. Pro Tip #3: One vital key to providing high-quality CPR is to limit interruptions. This cannot be overstated! Again, if you do not find a pulse, continue with 2 more minutes of CPR, following the same instructions as above. However, if you do detect a pulse, get your pet to the veterinarian as soon as possible for further care. CPR Review In a nutshell, the cat and dog CPR technique is as follows: Find the center of the chest in larger pets or the heart in smaller pets – where the elbow meets the chest. Lock your elbows and make sure you're directly above your spot. Compress to a depth of 1/3 to 1/2 the depth of your pet's chest. Make sure to allow for full recoil – all the way down, all the way up. Compress at a rate of 100 to 120 chest compressions per minute, whether or not you use a song for help. If there are two of you, switch positions every 2 minutes to avoid fatigue and check for a pulse when you do. Otherwise, check for a pulse after performing 30 chest compressions and giving 2 rescue breaths. Continue to perform high-quality CPR until your pet's pulse returns or after 10 to 20 minutes have passed. https://d3imrogdy81qei.cloudfront.net/video_images/3927/cat-and-dog-cpr-demonstration.jpg Yes 227 https://app.protrainings.com/courses/pets/first-aid/videos/pet-end-of-life https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2185.mp4 Pet End-of-Life In this lesson, we'll be addressing a difficult and painful topic – pet end of life. At the end of the lesson, we'll share with you an important resource that may help you better determine when exactly is the right time to let your pet go. One of the great tragedies of life is that our pets will never live as long as we do nor as long as we would like them to. No matter your individual circumstances, it will be difficult to say goodbye to a beloved friend and family member once that day comes. While some pets may pass away quietly at home, in many situations, a pet's quality of life will decline over time and it will be up to you whether or not to consider humane euthanasia. In other situations, this sort of decision will be thrust upon you suddenly after a tragic emergency leaves your pet in poor health. Either way, it's a difficult choice to make. However, be sure and discuss the matter with your veterinarian. He or she will be able to discuss all your options, including euthanasia, and whether or not that decision is right for you. Pro Tip #1: It's important to understand what euthanasia is and what it involves so you can make an informed decision. What is Euthanasia? Euthanasia literally means good death. In most situations, your vet will place a catheter in your pet's leg to deliver the medications, which will be an overdose of an anesthetic drug. As the medication is given to your pet, she will begin to go to sleep as if going under for a surgical procedure. As the vet continues to push the medication, this will then bring about a painless and peaceful death. What Happens Next? After your pet has passed away, either by euthanasia or not, you'll have a number of options for how you want to handle her remains. Many people elect for pet cremation, and in many situations, you may be able to choose to have your pet individually cremated which will allow you to get her ashes returned to you. Alternatively, if it's legal to do so in your area, you may also consider burying your pet on your own properly. Pro Tip #2: Once your pet has passed away, you'll undoubtedly go through a grieving process. And while this period is difficult for everyone, your vet will have some information that may help – resources for local support groups or online resources you can reach out. No matter how you grieve, as this is very much an individual thing, it's important to take care of yourself during this time and seek support if need be. And while this time is never easy, try to focus on the good times you shared with your pet and how lucky you were to have found each other in the first place.   https://d3imrogdy81qei.cloudfront.net/video_images/3929/pet-end-of-life.jpg Yes 125 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/animal-and-human-bites https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2370.mp4 Animal and Human Bites In this lesson, you'll learn what to do when you come across patients who've been bitten by animals and/or humans. There are a few considerations that differentiate animal and human bites. However, for the most part, general first aid care will be the same for both. How to Treat for Animal and Human Bites As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Let's quickly differentiate between minor wounds and serious wounds. A minor wound is defined as bites that caused teeth marks, bruising, or scratching. When you encounter minor wounds, simply wash the area thoroughly with soap and water. For scratches, apply an antibiotic ointment to prevent infection, then cover the area with a clean bandage. A serious bite wound is one in which the skin has been punctured or torn and is bleeding. A victim with an open bite wound must seek advanced treatment from a physician due to the high risk of infection. A serious bite wound can include severe bleeding. Unless the wound is still oozing or spurting blood, wash the area with soap and water, apply sterile dressing, and seek advanced medical treatment. If the wound is still bleeding, apply direct pressure with a clean dry cloth or sterile gauze pad and first stop the bleeding. Apply a bandage once the bleeding has been controlled. If your serious bite wound does include arterial or severe bleeding, apply direct pressure, call 911, and watch for signs of shock. A severe bleeding incident is one in which the wound is spurting or pulsating blood and the bleeding is difficult to control. Special Considerations for Human Bites The most common type of human bite occurs among young children who are curious, angry, or frustrated. Children at day care centers are most at risk for human bite wounds. Most human bite wounds among children are harmless, as more serious child bite wounds are very unusual. The biggest threat when it comes to human bites is infection, as human saliva contains hundreds of species of bacteria. In fact, a bite wound is more likely to become infected if it came from a human versus an animal. Pro Tip #1: For any human bite wounds that break the skin, the patient will need to seek advanced medical care due to the risk of infection. And while highly unlikely, bloodborne pathogens like HIV and hepatitis B or C can be transmitted by human bites. Special Considerations for Animal Bites Most animal bites come from domestic pets like cats and dogs and typically involve young children. The biggest threat with animal bites, even domesticated animals, is the risk of rabies. If the animal bite included the skin being punctured by a non-immunized animal, or from an animal whose immunization status is unknown, the patient will need to be treated by a physician immediately. Pro Tip #2: Most rabies cases involve wild animals, like foxes, raccoons, skunks, and the most common rabies carrier of them all – bats. If you suspect that a patient was bitten by one of the above, keep in mind the need to seek swift medical treatment for rabies. Warning: Tetanus can be a concern in both animal and human bites. If a patient suffered a deep bite wound and he or she hasn't had a tetanus shot in more than five years, a booster shot should be encouraged. When it comes to animal and human bites, just following the general first aid guidelines, particularly for bleeding control and infection control, will encompass the majority of the treatment you provide. A Word About Animal Bites Dog bites are the most common among all types of wild and domestic animals. It's important that when a person is bitten, that they are quickly removed from the situation if possible. It's equally important to do so in a way in which you're not endangering yourself or others. Clean minor wounds with soap and clean water and do your best to control bleeding with major wounds. If the patient is bleeding severely, apply pressure and control it as best you can until advanced medical personnel arrive. Tetanus and rabies immunizations may be necessary, so it's vital that bites from any wild or unknown domestic animals be reported to the local health department or another agency according to local protocols. If the animal is still loose, follow local protocols regarding contacting animal control to capture the animal. Try to obtain and provide a description of the animal and the area in which the animal was last seen. https://d3imrogdy81qei.cloudfront.net/video_images/4229/animal-and-human-bites.jpg Yes 249 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/mordeduras-animales-y-humanos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2370.mp4 Mordeduras de animales y humanos https://d3imrogdy81qei.cloudfront.net/video_images/4229/animal-and-human-bites.jpg Yes 249 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/adult-cpr-lay-rescuer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2436.mp4 Adult CPR In this video, learn how to conduct a skill evaluation on someone performing CPR on an adult lay rescuer. Have your skill evaluation sheets on hand for you to refer to while watching this demonstration. https://d3imrogdy81qei.cloudfront.net/video_images/4323/adult-cpr-lay-rescuer.jpg Yes 191 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/residuos-regulados-para-artistas-del-cuerpo-en-California https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2441.mp4 Residuos regulados para artistas del cuerpo en California https://d3imrogdy81qei.cloudfront.net/video_images/4347/ca-body-art-regulated-waste.jpg Yes 55 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/ca-body-art-regulated-waste https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2441.mp4 Regulated Waste for California Body Artists In this lesson, we'll cover what regulated waste is as defined by OSHA, along with some standard protocols for handling and disposing of it. The OSHA bloodborne pathogens standard defines regulated waste as: Any liquid or semi-liquid blood or other potentially infectious material (OPIM). Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed or rung out. Items that are caked with dried blood or OPIM and are capable of flaking off and releasing these materials during handling. Contaminated sharps. Pathological and microbiological wastes containing blood or OPIM. How to Dispose of Regulated Waste Pro Tip #1: It's important to note that all properly labeled and bundled waste should be handled according to your facility's disposal procedures. It's also important to consider any state or local requirements that may apply to regulated waste disposal in your area. Having said that, here are a few guidelines to follow when disposing of regulated waste. Warning: While this should go without saying, never dispose of potentially contaminated waste into normal trash receptacles. Regulated Waste Containers All blood and other potentially infectious materials must be disposed of in properly labeled biohazard containers, in either a red bag or a predominantly orange or red container that has been imprinted with the biohazard symbol shown below. Regulated waste containers must be: Sealable. You must be able to completely close and seal the container. Properly constructed. The container must be able to properly handle its contents without fail. Leak-proof. The regulated waste container must prevent leakage of all fluids and materials while handling, storing, transporting, and shipping. Sharps Containers All items falling into this category – like needles, syringes, and razors – must be placed into sealable, leak-proof, puncture-resistant containers. The containers must also be properly labeled or color-coded. Pro Tip #2: Regardless of type, all regulated waste containers should be routinely inspected and replaced, and they should never be allowed to overfill. A Word About OSHA's Regulations Since OSHA may be the reason you're taking this course, let's dig a little deeper into what the employer's responsibilities are when it comes to following those regulations. Pro Tip #3: Safety is job number one. If you notice that your employer is falling short of adhering to guidelines or not providing everything on this list, you may want to consider asking someone. OSHA regulations regarding bloodborne pathogens have placed specific responsibilities on employers for the protection of employees (like you). These include all of the following: Identifying positions or tasks covered by the bloodborne and OPIM standard precautions. Creating an exposure control plan to minimize the possibility of exposure and making the plan easily accessible to all employees. Developing and putting into action a written schedule for cleaning and decontaminating environments and work surfaces at the workplace. Creating a system for easy identification of soiled material and its proper disposal. Developing a system of annual training for all covered employees. Offering the opportunity for employees to get the hepatitis B vaccination at no cost. Establishing clear procedures to follow for reporting an exposure. Creating a system of recordkeeping. In workplaces where there is potential exposure to injuries from contaminated sharps, soliciting input from non-managerial employees with potential exposure regarding the identification, evaluation, and selection of effective engineering and work practice controls. (In other words, the feedback of those being exposed.) If a needlestick injury occurs, recording the appropriate information in the sharps injury log, including:a. The type and brand of device involved in the incidentb. The location of the incidentc. A description of the incident Maintaining a sharps injury log in such a way that protects the privacy of employees. Ensuring the confidentiality of all employees' medical records and exposure incidents. https://d3imrogdy81qei.cloudfront.net/video_images/4347/ca-body-art-regulated-waste.jpg Yes 55 https://app.protrainings.com/courses/acls/certification/videos/introduction-to-acls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2442.mp4 Introduction to ACLS Welcome to the ProACLS course. This ACLS (Advanced Cardiovascular Life Support) course was designed specifically for you, the busy healthcare professional. In this lesson, we'll get into the benefits of choosing ProTrainings for your ACLS education. We'll get into the WHY regarding your chosen field and career path. And at the end of the course, we'll provide you with some advanced cardiovascular life support survival rates. We designed ProACLS with three core components in mind: Ease of use Learning efficiency Paced at your own speed ProACLS is available 24/7, whether you're watching a video for the first time, the third time, or coming back after several months for a quick refresher. We're here whenever you need us to be, regardless of your schedule. We'll get into specific course objectives in a subsequent lesson, but in this course, you can expect to gain all the guidelines and knowledge about current ACLS regulations. Which will ultimately lead to meeting and exceeding the most important course objective: Providing you with enough real-world knowledge so that when you're a team leader or team member during a cardiac emergency, you can feel as confident as possible to contribute to a positive outcome in that patient's life. Becoming that kind of confident takes action to achieve – as in, gaining a deeper knowledge than you already possess. Along with honing and refining the necessary skills that many of you already have. Which leads to an important point: Participants in the ProACLS course are required to have basic knowledge and skills pertaining to basic life support and basic cardiac life support. Which brings up another great point: Warning: Some things in this course may be familiar to you already, and if they are, that's not always a good thing. We tend to passively listen, read, and learn when things sound familiar. And when this happens, you're much more likely to miss a point or two that one day you may need. Fight this human tendency and you'll get much more from this course. If you're wondering, what can I expect from the ProACLS course, that's a great question. Here is a list of the knowledge and skills you'll be required to learn in order to successfully complete your course. Appropriate basic life support competency Electrocardiogram rhythm interpretation for all core ACLS rhythms Knowledge of airway management including all appropriate adjuncts ACLS drug and pharmacological knowledge Practical applications of ACLS rhythms and drugs Effective high-performance team skills Learning these important and valuable skills takes commitment and dedication, and it may require that you watch the videos more than once. It may mean practicing case scenarios several times until they become automatic. However, what you'll get from that confidence isn't nearly as important as what you can do with that confidence – making a difference when it matters most and possibly saving someone's life. Throughout the course you can also expect a few Warnings from time to time, like the above warning, and even more Pro Tips, when the information warrants highlighting. And when there's a need for supplemental information, you'll find a section at the end of these written course lessons that go beyond the video components. One other thing before we begin, keep in mind WHY you've chosen this field. Life is a precious thing. It's something that should be appreciated, savored, and celebrated. As a healthcare provider, you have enormous power to help people in need. To give back to them the one resource that is truly extinguishable – time. Time for everything that matters to them. Keep the WHY in your mind as you work your way through this course. A Word About Advanced Cardiovascular Life Support Survival Rates ACLS providers face an important challenge — functioning as a team to implement and integrate both basic and advanced life support to help save a life. The 2020 American Heart Association guidelines update for CPR and ECC reviewed evidence that has shown that in both out-of-hospital and in-hospital settings, many cardiac arrest patients do not receive high-quality CPR, and the majority do not survive. One study of in-hospital cardiac arrest showed that the quality of CPR was inconsistent and did not always meet the AHA guidelines and recommendations. However, over the years, patient outcomes post-cardiac arrest have still improved. Cardiac Arrest Survival Data Out-of-Hospital Year Bystander CPR % Survival % 2012 41.0 11.4 2013 40.1 9.5 2014 40.8 10.4 2015 45.9 10.6 In-Hospital Year Survival % 2012 23.1 2013 23.9 2014 22.7 2015 25.5 To analyze these findings, a back-to-basics evidence review refocused on the essentials of CPR, the links in the Chain of Survival, and the integration of BLS with ACLS. Minimizing the interval between stopping chest compressions and delivering a shock improves the chances of shock success and patient survival. Experts believe that high survival rates from both out-of-hospital and in-hospital sudden cardiac death are possible when utilizing strong systems of care. High survival rates have been associated with several key elements: Training of knowledgeable healthcare providers Planned and practiced response Rapid recognition of sudden cardiac arrest Prompt delivery of CPR Defibrillation as soon as possible and within 3 to 5 minutes of collapse Organized post-cardiac arrest care When you can implement these elements early, ACLS has the best chance of producing a successful outcome. https://d3imrogdy81qei.cloudfront.net/video_images/4349/introduction-to-acls.jpg Yes 71 https://app.protrainings.com/courses/acls/certification/videos/acls-course-overview https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2443.mp4 ACLS Course Overview The ProTrainings' ACLS course has been designed for the busy healthcare professional who participates in, or directs the management of, cardiovascular emergencies and cardiac arrest situations. In this course overview lesson, we'll be covering your course goals or objectives and basically outline everything that will be in the course from A to Z. And at the end of the lesson, we'll provide you with a word about medical emergency teams and rapid response teams. The aim of this course is to help you enhance your skills, including being better able to recognize and treat cardiopulmonary arrest, post-cardiac arrest, acute arrhythmias, stroke, and acute coronary syndrome, or ACS for short. Throughout this ACLS program, you'll be actively participating, by combining cognitive and interactive simulation, while working through scenarios based on actual medical emergencies. And by the end of your training program, you should be much more equipped at improving the outcomes of adult patients who are suffering from cardiac arrest and other cardiopulmonary emergencies. Your training should also help you become more effective at recognizing and intervening with the proper care in any cardiac-related emergency. It doesn't matter if you're a healthcare provider who works in a pre-hospital setting or you're part of a larger in-hospital team. ProTrainings' ACLS course will help you enhance your skills regardless of where you work and when you work. ACLS Course Objectives Your ACLS certification course includes the following 9 objectives: Evaluating and treating adult patients with basic life support skills, including the provision of early chest compressions and the proper utilization and timing of an automated external defibrillator. Recognizing and managing respiratory arrest in adult patients. Recognizing and managing acute coronary syndrome, including the appropriate characteristics. Recognizing and managing the signs and symptoms of stroke, including the appropriate characteristics. Recognizing and treating both bradyarrhythmias and tachyarrhythmias that could result in cardiac arrest or complicate the resuscitation process and outcome. Recognizing and treating cardiac arrest, including immediate post-cardiac arrest care. Evaluating your resuscitation efforts during cardiac arrest scenarios through continuous assessment of cardiopulmonary resuscitation, including monitoring patients' physiological responses and delivering real-time feedback in a team setting. Demonstrating effective communication as either team leader or as a team member in a high-performing team, while also recognizing the impact of team dynamics on overall team performance. Becoming more proficient with the proper administration of ACLS medications. Now let's go over the ProTrainings' ACLS course design. To help you achieve these important objectives, we've included practice sessions and megacode evaluations. These practice learning stations will give you the opportunity to actively engage and learn from the following: The simulation of clinical cardiac emergency scenarios The video demonstrations of these scenarios Scenario-based role playing Practicing effective high-performing team behaviors During the testing phase of your ACLS course, you'll be required to pass a megacode evaluation station in order to properly validate the achievement of your course objectives. Also, a simulated cardiac arrest scenario will help evaluate you in the following areas: Your competency of all core case materials and skills Your competency of ACLS algorithms Your adequate understanding of arrythmia interpretation Your proper use of appropriate ACLS drugs and therapies Your ability to perform effective leadership skills within a high-performing team environment A Word About Medical Emergency Teams and Rapid Response Teams Many hospitals have incorporated the use of medical emergency teams (MET) or rapid response teams (RRT). The purpose of these teams is to improve patient outcomes by properly identifying and treating early clinical deterioration. In-hospital cardiac arrest is often preceded by physiologic changes in the patient. In fact, recent studies have shown that nearly 80 percent of hospitalized patients with cardiorespiratory arrest first had abnormal documented vital signs for up to eight hours before the actual arrest occurred. The vast majority of these changes can and should be recognized by monitoring routine vital signs. Proper intervention before this clinical deterioration or cardiac arrest should be possible. The Route of Care for the Unstable Patient: Rapid Response Team → Code Team → Critical Care Team The management of life-threatening cardiac emergencies requires the integration of multidisciplinary teams that can involve rapid response teams, cardiac arrest teams, and intensive care specialists to achieve the ultimate goal – the survival of the patient. Team leaders, in particular, have an essential role in this coordinated effort of care with other team members and other specialists. https://d3imrogdy81qei.cloudfront.net/video_images/4351/acls-course-overview.jpg Yes 228 https://app.protrainings.com/courses/acls/certification/videos/the-cardiac-conduction-system https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2444.mp4 The Cardiac Conduction System In this section of the PALS course, we're going to cover the cardiac conduction system and all of its components, and we'll start with a deep dive into the biomechanical and electromechanical actions of the heart. In this lesson, we'll take a closer look at the heart and how it functions as a circulatory muscle, including the mechanisms that allow it to function. The myocardium is a muscle unlike any other muscle that we have in our bodies. What makes it so unique is its ability to generate its own electrical impulses, known as automaticity. Pro Tip #1: Automaticity is the body's ability to do things without occupying the mind and with low-level details required, allowing it to become an automatic response pattern or habit. One particularly special part of the heart muscle is located in the superior aspect of the right atrium, called the sinoatrial node, or SA node for short. It works like an internal/biological pacemaker. This SA node, when the heart is functioning as it was designed to function, generates an electrical impulse that travels through the myocardium in a very organized and deliberate way. The SA node generates electrical impulses at a rate between 60 and 100 times per minute. If we were to follow the pathway of that electrical impulse from the SA node to the place where it terminates, that place would be at the end of the Purkinje fibers. Pro Tip #2: The Purkinje fibers are specialized conducting fibers composed of electrically excitable cells that are larger than cardiomyocytes with fewer myofibrils and many mitochondria and which cells conduct cardiac action potentials more quickly and efficiently than any other cells in the heart. After the SA node initiates that electrical impulse, it then travels via pathways, known as internodal pathways, throughout the right and left atria. It then depolarizes the myocardia cells which causes the heart muscle in the atrium to contract. From the atria, that electrical impulse travels along the pathway to the atrial ventricular node, or the AV node, where it's strategically delayed before moving through the bundle of His, or AV bundle, and ultimately to the Purkinje fibers. The Purkinje fibers travel down through and around the ventricles, thereby completing the electromechanical cycle of one complete heartbeat. The delay in the AV node, which is located in the left lower wall of the right atrium, is a very necessary process. This delay allows the ventricles to beat independently of one another, which allows them to operate as a double pump action. If for whatever reason, the SA node doesn't operate properly as the primary impulse generator, or our biological pacemaker, the AV node can then begin sending its own electrical impulse instead; providing the heart with a failsafe mechanism or backup electrical generator. While the AV node can generate its own electrical impulses, it does so at a much slower rate, which ranges between 40 and 60 impulses per minute. When the AV node is called upon to generate this electrical impulse, it travels from the AV node through the bundle of His and eventually reaches the Purkinje fibers, which wrap around the ventricles we mentioned earlier, and once again completing the electromechanical cycle of one complete heartbeat. This ventricle contraction then circulates the majority of oxygenated blood throughout the rest of the body. Pro Tip #3: The bundle of His is the bundle of cardiac muscle fibers that conducts the electrical impulses that regulate the heartbeat, from the AV node in the right atrium to the septum between the ventricles, and then to the left and right ventricles. Upon reaching the bundle of His, that electrical impulse then travels down the length of the intraventricular septum, which leads to the left and right bundle branches. The left bundle branch has two fascicles (or bundle of fibers) due to its size, since the left ventricle is larger than the right ventricle, which has only one fascicle. These bundle branches ultimately terminate, or lead into, the Purkinje fibers, which then depolarize the ventricular cells and cause the ventricular muscles to contract. In situations where both the SA and AV nodes aren't able to generate electrical impulses properly, the Purkinje fibers located within the ventricles then become the primary pacemaker source. The problem with this scenario is that the Purkinje fibers only generate electrical impulses in the range of around 15 to 40 beats per minute. This rate is usually too slow to produce adequate systolic blood pressure or oxygenate the cells in the body. https://d3imrogdy81qei.cloudfront.net/video_images/4353/the-cardiac-conduction-system.jpg Yes 235 https://app.protrainings.com/courses/acls/certification/videos/overview-and-team-roles-and-responsibilities https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2445.mp4 Overview and Team Roles and Responsibilities The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments that: Take place simultaneously and Are performed efficiently and effectively in as little time as possible. In this lesson, you'll learn about how these high-functioning teams operate, including a breakdown of the individual roles and responsibilities for each. As successful resuscitation rates increase, so do the chances that the patient receives the best chance for a positive, long-term outcome. And for a resuscitation attempt to be successful, all parts must be performed correctly by a high-performing team of highly trained, organized, and communicative healthcare professionals. Successful high-performance teams take a lot of work and don't just happen by chance. Each individual in a team must have the expertise to perform his or her job and a high-level mastery of their resuscitation skills. And they have to function as one cohesive unit, which requires a focus on communication within the team dynamic. It doesn't matter if you're a team leader or a supportive team member. All members of a resuscitation team are equal, and each plays a vital role in any team resuscitation scenario. Pro Tip #1: What does matter is your ability to not only understand your role, but also the roles of others on your team. When you know the roles and responsibilities of each team member, you can anticipate what's coming next, which will increase the ability of the team to communicate, improve the efficiency and performance of the resuscitation, and the chances for the patient to have a positive outcome. Now that you understand the importance of understanding the roles and responsibilities of each team member, let's look at some common duties and requirements for each. High-Performing Resuscitation Team Roles The roles of each team member must be carried out in a proficient manner based on the skills of each team member and their scope of expertise and practice. It's vitally important that each member of a resuscitation team: Understands and are clear about their role assignments Are prepared to fulfill their role and responsibilities Have working knowledge regarding algorithms Have had sufficient practice in resuscitation skills Are committed to the success of the ACLS resuscitation There are a total of six team member roles and each are critical to the success of the entire team. Team leader Compressor Airway manager AED/Monitor/Defibrillator IV/IO medications provider Time recorder Now let's look at the roles and responsibilities of each. Team Leader The team leader is required to have a big picture mindset. This includes the following duties: Keep the resuscitation team organized and on track Monitor the team's overall performance and accuracy Back up any other team member when appropriate Train and coach other team members when needed and provide feedback Facilitate all actions and understanding during the code Focus on the comprehensive care of the patient Assign remaining roles to the other team members Make appropriate treatment decisions based on proper diagnosis Every symphony needs a conductor, just as every successful resuscitation team needs a team leader for the group to operate effectively and efficiently. The team leader has a responsibility to ensure that all team members are playing their individual role to the best of their abilities, and this includes doing things the right way at the right times. But perhaps the biggest responsibility of the team leader centers on his or her ability to communicate clearly and effectively and explain to team members the specifics of resuscitation care, such as: Pushing hard and fast in the center of the patient's chest Ensuring the complete chest recoil Minimizing interruptions in chest compressions Avoiding excessive ventilations The team leader assigns the remaining roles to the other team members and makes appropriate treatment decisions based on proper diagnosis and interpretation of the patient's signs and symptoms. The team leader also provides feedback to the team and assumes any team roles that other team members cannot perform or if some team members are not available. Compressor The team member in charge of compressions should know and follow all the latest recommendations and resuscitation guidelines to maximize their role in basic life support. Chest compressions are vital when performing CPR. So vital, in fact, that this team member often rotates with another team member (usually the AED/monitor/defibrillator) to combat fatigue. The best time to switch positions is after five cycles of CPR, or roughly two minutes. This would occur at the same time of a rhythm check and defibrillation if one is needed. However, if you're feeling fatigued, it's better to not wait if the quality of chest compressions has diminished. Often the depth of chest compressions become more shallow and less effective as the compressor become fatigued. Airway Manager The airway manager is in charge of all aspects concerning the patient's airway. This includes opening, ventilating with a bag valve mask and maintaining a patent airway. And if within their scope of practice placing an advanced airway when needed. AED/Monitor/Defibrillator As you might have guessed, this team member is in charge of bringing the defibrillator if one is not already present and operating the defibrillator. This team member is also the most likely candidate to share chest compression duties with the compressor. Pro Tip #2: It's important to understand how important high-quality CPR is to the overall resuscitation effort. The compressions must be performed at the right depth and rate. ACLS begins with basic life support, and that begins with high-quality CPR. If BLS isn't effective, the whole resuscitation process will be ineffective as well. IV/IO/Medications Provider This team member is in charge of all vascular duties, including: Initiating vascular access using whatever technique is appropriate Administering medications with accuracy and timeliness as directed by the team leader Providing feedback or advice when appropriate Time Recorder The time recorder is responsible for keeping a rolling record of time for: All specific resuscitation interventions All medications or treatments administered The frequency and duration of any CPR interruptions The time recorder also announces to the team when/if a next treatment or more medication is due. If no one person is available to fill the role of time recorder, the team leader will assign these duties to another team member or handle them herself/himself. https://d3imrogdy81qei.cloudfront.net/video_images/4355/overview-and-team-roles-and-responsibilities.jpg Yes 424 https://app.protrainings.com/courses/acls/certification/videos/effective-communication https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2446.mp4 Effective Communication In order for a resuscitation team to be successful, they must practice effective communication. In this lesson, we'll be getting into some specific techniques or tips to help you achieve this vital element for positive patient outcomes. It's important that each member of a resuscitation team knows their individual roles and how to function as part of their team. And how to communicate those roles and duties effectively to other team members. Warning: Communication is a vital component in all walks of life. But when that communication is often a matter of life and death, it becomes even more vital. Don't discount just how important effective communication is for a resuscitation team. Techniques to Improve Communication Good communication doesn't happen by accident; it takes work. It's important to remember, when it comes to communication or any other aspect of your job, that the patient must always come first. It's vital that all resuscitation team members know their individual roles, how to function within those roles, and how to communicate effectively in a team environment to fulfill the goals and objectives and to increase patient survival rates during a cardiac arrest event. Now let's look at the eight essential elements of effective communication for a resuscitation team. 1. How to Establish Clear Roles and Responsibilities It's important that every team member knows and understands each of his or her duties on the team. However, it's also important that you understand the roles and responsibilities of the other team members. Understanding everyone's role and properly communicating specifics of each role will be crucial for helping the patient. Having a basic understanding of each role will allow you to fill in for other team members in situations where there aren't enough members to fill all required roles. During a code, the team leader will decide who fills in or will take on the role herself/himself. It's important that the team leader not get too myopic and instead always concentrate on the bigger picture. It's also important for all team members to assist the team leader in accomplishing this. Even in situations where there are enough team members, unclear roles and responsibilities will often lead to poor overall team performance. Which is why it's important for the team leader to effectively communicate to each member what their role is. All team members will have different levels of skills based on their individual training and experience, which is why it's important for the team leader to be aware of these proficiencies and properly assign responsibilities to those who can handle them. 2. Know Your Limitations Every team member must know their own ACLS capabilities and limitations. This will help the team leader to properly evaluate all available resources, assign duties to those who can handle them, and call for assistance if needed. Pro Tip #1: Asking for help should never be considered a sign of weakness or incompetence. It's better to be honest about your skills and experience and get the appropriate help when needed, than to do something that will negatively impact the team and ultimately the patient. 3. How to Perform Constructive Intervention There will be times when the team leader will have to intervene. For instance, if a team member isn't handling a specific action correctly, it may be necessary for the team leader to take over that duty or reassign it to another member of the team. However, it's equally important that the team leader handle the situation professionally and tactfully. Pro Tip #2: Team leader should always avoid a confrontation with a member of the team. These will only serve to produce negative consequences for the patient. This includes avoiding any statements that may appear derisive or hostile. And watch your tone. Remember, often it's not what you say, but how you say it. 4. How to Communicate Knowledge Sharing Research shows that knowledge sharing is a critical component of effective resuscitation team performance. It's important for team leaders to avoid becoming fixated on a specific treatment or diagnosis, or that myopic mindset we mentioned above. This is called fixation error. There are three common types of fixation errors that a team leader may communicate by saying things like: Everything is OK Only this is the correct way Do anything but this When resuscitation efforts are ineffective, it's important to go back to the basics and talk as a team. For instance, the team leader can do this by recapping out-loud what has been done that hasn't worked and encourage feedback from members of the team. Maybe there's something that was missed. Or something else that may produce a better outcome. Sharing knowledge is crucial, especially in those moments when things aren't working. Pro Tip #3: All team members should communicate any changes in the patient's condition. This will help the team leader to make calculated, informed decisions correctly. 5. How to Summarize and Reevaluate The team leader should always be asking herself or himself questions pertaining to the patient's condition. Monitoring their condition and reevaluating the situation is essential. These questions can include: What is the current status? What treatments have been performed? What changes in the patient have those treatments produced? What are the latest assessment findings that will help me proceed with providing the best care possible? Pro Tip #4: Team leaders should summarize and reevaluate the patient's condition out loud through regular updates to the team. Verbalizing everything to the team is important for effective communication, efficient team leading, and ultimately providing better care to the patient. Reviewing the resuscitation efforts and mapping out the next steps is vitally important, not only for better communication, but also for better patient care. And don't forget to get input or information from the time recorder. 6. How to Perform Closed-Loop Communication When a team leader gives an assignment or an order, closed-loop communication is how we make certain that the message was understood and is being executed. It serves as confirmation and must be done before the team leader assigns another task. So, what does closed-loop communication look like? Once the team leader assigns a task or provides direction, the exact message must be repeated by the team member that the message was directed towards. That's it! Simply repeat the message and then began to execute the order. 7. How to Use Clear Messages Giving concise, clear orders is essential for any successful resuscitation team. This includes good enunciation and a tone of voice that's calm and clear. The message should be direct and absent of emotion. Shouting or flustered speech in a frantic manner isn't going to help the situation. It'll only serve to waste time, as the team member may feel rushed or confused and may even impair that team member's ability to think clearly about the task they're performing. It's also important that team members aren't talking over one another. Only one person on the team should be talking at a time. 8. How to Practice Mutual Respect Mutual respect is vital for effective and efficient communication. It's obviously the professional way to communicate with peers. But also, members of a resuscitation team who work together in a respectful and supportive manner will have more success achieving favorable outcomes. Pro Tip #5: All members of a resuscitation team work diligently toward the same goal. No one is better than anyone else, regardless of their training, experience, or expertise. Every team member, including the team leader, should recognize the value the other team members provide and leave the ego at home. Practicing these communication techniques will help you establish an efficient and successful ACLS resuscitation team. A team that will better serve the community, produce more positive outcomes, and increase survival rates for those they serve. https://d3imrogdy81qei.cloudfront.net/video_images/4357/effective-communication.jpg Yes 412 https://app.protrainings.com/courses/acls/certification/videos/pharmacology https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2447.mp4 Pharmacology In this section of your ACLS course, we're going to look at the current ACLS pharmacological treatments, including some important things to keep in mind as you progress through this section of your course. At the end of the lesson, we'll look at the finer points of resuming CPR while a defibrillator is charging. It's important to remember that no medication will work the way you expect it to or want it to unless the patient's biological status, at the cellular level, works the way you want it to or expect it to. What do we mean by this? We know that there has been a lot of research done that better helps us understand that when a patient is in cardiac arrest, at the cellular level they have a very specific amount of time before clinical death transitions into biological or cellular death. In other words, permanent death. As cellular hypoxia progresses into cellular death, the body's ability to react to treatments, including the medications we'll be covering in this section, become much more difficult and much more unlikely. For this reason, it's vitally important that, as a healthcare professional, you are able to provide highly effective basic life support skills. These are foundational skills and extremely important for any and all successful ACLS outcomes. ACLS Medications The variety of medications that we'll cover in this section of the course are only one part of any successful resuscitation (and one part of the chain of survival) and will include: Adenosine Amiodarone Aspirin Atropine Dopamine Epinephrine Fibrinolytic Agents Lidocaine Magnesium sulfate Morphine sulfate Nitroglycerin Oxygen Procainamide The ACLS Chain of Survival Essentially, basic life support helps the patient by buying them time. Time it takes the body to transition from clinical death to biological, cellular, and permanent death. The ACLS medications listed above that we'll be digging into in subsequent lessons are just one small part of any successful resuscitation. ACLS is the next level in the chain of survival that includes four main components: The administration of medications EKG and ECG monitoring Advanced airways Other treatment options Your goal is to help keep the patient in a state of survivability until, ultimately, you're able to get them appropriate and definitive treatment that will hopefully and ideally reverse their life-threatening condition. The Administration of Medications As you begin to learn about, or refresh your knowledge of, these current ACLS medications, we'll be breaking down each into four distinct categories: The drug and its effects The drug's indications The drug's precautions and contraindications The drug's appropriate dosage A Word About Resuming CPR While the Defibrillator is Charging It's important to continue to perform high-quality CPR until a defibrillator arrives and is attached to the patient. The team should assign team member roles and responsibilities as well as organize the appropriate interventions to minimize interruptions in chest compressions. Doing so accomplishes the most critical interventions for VFib or pulseless V-tach – CPR with minimal interruptions in chest compressions and defibrillation during the first minutes of arrest. The American Heart Association does not recommend continued use of an AED (or the automatic mode) when a manual defibrillator is available and when the healthcare provider's skills are sufficient for rhythm interpretation. The reasons is simple – rhythm analysis and shock administration with an AED may result in prolonged interruptions in chest compressions. Shortening the interval between the last chest compression and the ensuing shock by even a few seconds can help improve shock success. Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock. For example, after verifying that the patient has a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue performing them until the defibrillator is fully charged. The operator of the defibrillator should deliver the shock as soon as the compressor removes his or her hands from the patient's chest and after all providers are clear of contact with the patient. Use of a multimodal defibrillator in manual mode can help reduce the duration of chest compression interruptions that are required for rhythm analysis when compared to automatic mode. However, this could increase the frequency of inappropriate shocks. Individuals who are not comfortable interpreting cardiac rhythms can and should continue to use an AED. When using an AED, follow the device's prompts or know your device-specific manufacturer's recommendations. It's important that all healthcare providers be knowledgeable of how their defibrillator works, and whenever possible, limit interruptions in chest compressions for rhythm analysis and shock delivery. https://d3imrogdy81qei.cloudfront.net/video_images/4359/pharmacology.jpg Yes 111 https://app.protrainings.com/courses/acls/certification/videos/adenosine https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2448.mp4 Adenosine In this lesson, we'll go over the medication adenosine and all of its effects, including indications, precautions and contraindications, and adult dosages. At the end of the lesson, we'll provide you with a Word about defibrillation. Adenosine is effective at terminating narrow complex SVT due to a reentry involving the AV or sinus node. It's used for unstable narrow complex reentry tachycardia and should be given to the patient while also preparing to cardiovert. Pro Tip #1: It's important to note that adenosine does not convert atrial fibrillation, atrial flutter, or ventricular tachycardia. Adenosine Indications Indications for adenosine include: Narrow complex SVT Unstable narrow complex reentry tachycardia Regular and monomorphic wide complex tachycardia As a diagnostic maneuver for stable narrow complex SVT Adenosine Precautions and Contraindications There are some adenosine precautions and contraindications to be aware of, including: Poison induced tachycardia Drug induced tachycardia 2nd degree heart blocks 3rd degree heart blocks Adenosine is safe to administer to pregnant patients. Pro Tip #2: Adenosine is less effective in patients who are taking theophylline or caffeine. And if administered for irregular polymorphic wide complex tachycardia or V-tach, it could cause a deterioration including hypotension. Adenosine side effects include: Transient periods of flushing Chest pain Chest tightness Brief periods of asystole Brief periods of bradycardia Ventricular ectopy Pro Tip #3: Reduce the initial dose of adenosine to 3mg in patients who are also receiving dipyridamole or carbamazepine, in heart transplant patients, or if adenosine is given by central venous access. Remember, transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVT. Adult Dosage of Adenosine Adenosine should be delivered via rapid IV push and follow the steps below when administering the drug. 1. First, place the patient in a moderate reverse Trendelenburg position before administering the drug. It is highly recommended that whatever extremity in which adenosine is administered is elevated.2. Rapidly administer the initial bolus of 6 mg over 1 to 3 seconds.3. Follow the adenosine with a normal saline bolus of 20 ml. A 2nd dose of 12 mg of adenosine can be given after 1 to 2 minutes if needed.4. While administering the medication, make sure to record the rhythm strip. Pro Tip #4: Draw up the adenosine dose and saline flush in two separate syringes. Attach both syringes to the IV injection port that's closest to the patient. Clamp the IV tubing above the injection port. Push the IV adenosine as quickly as possible. While maintaining pressure on the adenosine plunger, push the normal saline flush as quickly as possible after the adenosine. 5. Unclamp the IV tubing.6. Monitor the outcome. A Word (or Two) About Defibrillation The Purpose of Defibrillation Defibrillation does not restart the heart. Defibrillation only stuns the heart and briefly terminates all electrical activity, including V-Fib and pulseless V-tach. If the heart is still viable, its normal pacemakers can eventually resume electrical activity, such as a return of spontaneous rhythm, that ultimately results in a perfusing rhythm. In the first minutes after successful defibrillation, however, any spontaneous rhythm is typically slow and may not create pulses or adequate perfusion. The patient needs CPR, beginning with chest compressions, for several minutes until sufficient heart function resumes. Also, not all shocks will lead to successful defibrillation. Which is why it's important to resume high-quality CPR immediately after a shock, beginning with chest compressions. Clearing for Defibrillation To ensure safety during defibrillation, always announce the shock warning. State the warning firmly and in a forceful voice before delivering each shock. This entire shock warning sequence should take less than 5 seconds: Announce the shock – clear! Check to make sure you're clear of contact with the patient, the stretcher, or other equipment. Make a visual check to make sure that no other member of the team is touching the patient, stretcher, or other equipment. Make sure oxygen isn't flowing across the patient's chest. Deliver the shock to the patient. When pressing the shock button, the operator of the defibrillator should be facing the patient, not the machine. This helps to ensure coordination with the chest compressor and to verify that no one accidentally resumed contact with the patient. You don't necessarily need to say, clear (as you could choose another word), but you must warn other members of the team that you are about to deliver a shock and that everyone must stand clear of the patient. Though, uniformity isn't a bad thing, and if all are expecting to hear, clear, that might still be the best option. https://d3imrogdy81qei.cloudfront.net/video_images/4361/adenosine.jpg Yes 182 https://app.protrainings.com/courses/acls/certification/videos/amiodarone https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2449.mp4 Amiodarone In this lesson, we'll go over the medication amiodarone and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, we give you a Word on rhythm checks after defibrillation. Amiodarone is an effective treatment for a wide variety of atrial and ventricular tachyarrhythmias in pediatric patients. It can prolong AV conduction and ultimately slow the heart rate by elongating the AV refractory period, QRS, and the Q to T intervals. Because amiodarone is an alpha and beta-blocker (while also blocking sodium, potassium, and calcium channels), it is a well-known drug for its multi-channel blocking capabilities. Amiodarone Indications Some indications for the drug amiodarone, as an antiarrhythmic drug, is that it will be used specifically for its broad range of electrophysiological effects. Pro Tip #1: Amiodarone is primarily chosen for ACLS as a first-line antiarrhythmic agent for cardiac arrest because it has shown to be clinically effective and reliable for improving the rate of return of spontaneous circulation (also known as ROSC) and improved ROSC to hospital admission in adults with refractory VFib or pulseless V-tach. Amiodarone may also be considered when VFib and V-tach are unresponsive to: CPR Defibrillation Epinephrine Amiodarone Precautions and Contraindications Now let's look at some amiodarone precautions and contraindications. Warning: With amiodarone, there are multiple complex drug interactions, so care must be taken when using this medication. And do not administer amiodarone with other drugs that prolong the QT interval, such as procainamide. A rapid infusion of amiodarone could lead to hypotension. However, during cardiac arrest, there isn't any blood pressure and therefore the American Heart Association recommendation is still to use an amiodarone rapid IV push for the treatment of antiarrhythmias. It's important to remember that when using multiple doses of amiodarone, which can be cumulative doses of greater than 2.2 grams over a 24-hour period, significant hypotension has been noted in clinical trials. Because the terminal elimination and half-life of amiodarone is so long – having a half-life sometimes lasting as long as 40 days – amiodarone can be a complicated medication to work with and around when treating a patient who has experienced a return of spontaneous circulation. Which means that using amiodarone may eliminate the option of using other medications until it has been effectively eliminated from the body. Adult Dosage of Amiodarone When using amiodarone to treat V-Fib or pulseless V-tach cardiac arrest which is unresponsive to CPR, shock, and vasopressors, a first dose is given at 300 mg via IV or IO push. And a second dose is delivered at half that, or 150 mg, also via IV or IO push. For life-threatening arrhythmias, a maximum accumulated dose is 2.2 grams via IV over a 24-hour period. For patients with a pulse but also suffering from a life-threatening arrhythmia, administer amiodarone via rapid infusion and delivered at 150 mg IV over the first 10 minutes, which equals 15 mg per minute. This dose can be repeated also via rapid infusion every 10 minutes as needed, up to the maximum dose of 2.2 grams in a 24-hour period. When administering amiodarone via slow infusion, deliver the medication at 360 mg IV over a 6-hour period, or 1  mg per minute. A maintenance infusion can be given at 540mg IV over 18 hours, or 0.5 mg per minute. Pro Tip #2: Remember, these infusions should not exceed 2.2 grams over a 24-hour period. And when delivered at this maximum dosage, the effects can last up to 40 days. A Word About the Resumption of CPR and Rhythm Checks Post-Defibrillation Resume CPR After defibrillating an adult patient, you should: Immediately resume CPR, starting with chest compressions Not perform a rhythm check or pulse check at this time unless the patient is beginning to show signs of life or advanced monitoring indicates ROSC Establish IV or IO access The American Heart Association guidelines recommend that healthcare providers tailor the sequence of their rescue actions based on the presumed etiology of the arrest. Also, ACLS providers that are functioning within a high-performance resuscitation team may choose the optimal approach for minimizing interruptions in chest compressions. Examples of optimizing CCF and high-quality CPR are the use of different protocols such as: 3 cycles of 200 continuous compressions with passive oxygen insufflation and airway adjuncts Compression-only CPR in the first few minutes after the arrest Continuous chest compressions with asynchronous ventilation once every 6 seconds with the use of a bag-mask device A default compression-to-ventilation ratio of 30:2 should be used by healthcare providers with less training or experience or if the 30:2 ratio is your established protocol. Rhythm Checks Conduct a rhythm check after 2 minutes of CPR and be careful to minimize interruptions in chest compressions. Remember, the pause in chest compressions when checking the patient's rhythm should not exceed 10 seconds. If a non-shockable rhythm is present and the rhythm is organized, one of the team members should try to palpate a pulse. And if there is any doubt about the presence of a pulse, immediately resume CPR. Remember to perform a pulse check, ideally during rhythm analysis, only if an organized rhythm is present. If the rhythm is organized and you detect a palpable pulse, proceed to post-cardiac arrest care. If your rhythm check reveals a shockable rhythm, resume chest compressions if indicated while the defibrillator is charging. https://d3imrogdy81qei.cloudfront.net/video_images/4363/amiodarone.jpg Yes 225 https://app.protrainings.com/courses/acls/certification/videos/aspirin https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2450.mp4 Aspirin In this lesson, we'll go over the medication aspirin, or ASA, and all of its effects, including indications, precautions and contraindications, and pediatric dosages. At the end of the lesson, you'll find a Word about vasopressors. Aspirin blocks the formation of Thromboxane A2, thus inhibiting the sticking together of platelets and thus also reducing clot formation. The use of aspirin for myocardial infarctions helps reduce the chances of death and also the probability of reinfarction in stroke victims. Aspirin Indications The use of aspirin is indicated in the presence of signs and symptoms of acute coronary syndromes (ACS) such as those patients suffering from: Chest pain Chest pressure Discomfort, like pain radiating into the neck, jaw or down either arm Another reason for administering aspirin is when there are ECG changes that are consistent with acute coronary syndromes. A few examples of this would include, but are not limited to, ST elevation, depression, or T-wave inversion. Aspirin Precautions and Contraindications Now let's look at some aspirin precautions and contraindications. Before administering aspirin, be sure to ask the patient if he or she has any known hypersensitivities like Samter's Triad. This is a serious condition that can lead to a serious reaction when those patients are given aspirin. Pro Tip #1: Samter's Triad is a chronic condition defined by asthma, sinus inflammation with recurring nasal polyps, and aspirin sensitivity. It's also called aspirin-exacerbated respiratory disease (AERD), or ASA triad. You will also need to know, before giving a patient aspirin, if they have any bleeding disorders, like hemophilia, active ulcer disease, or recent gastrointestinal bleeding. Also, take heed of the Pro Tip above and ask the patient if he or she has a severe allergy like anaphylaxis or asthma-related to aspirin, as compared to more moderate sensitivities like sneezing or stuffiness. Adult Dosage of Aspirin A proper adult aspirin dose is 2 to 4 chewable aspirins or 162 to 324 mg of non-enteric coated aspirin as soon as possible following the onset of symptoms. Aspirin suppositories – usually in a 300 mg dosage – are also a safe alternative if the patient has any severe nausea, vomiting, or gastrointestinal disorders. Pro Tip #2: It's important to note, that in order to achieve a rapid therapeutic blood level of aspirin, you should instruct the patient to chew the oral aspirin before swallowing. A Word About Vasopressors While there is evidence that the use of vasopressors favors initial resuscitation with ROSC, research is still lacking on the effect of the routine use of vasopressors at any stage during the management of cardiac arrest on the rates of survival to hospital discharge. Vasopressors Used During Cardiac Arrest Vasopressors optimize cardiac output and blood pressure. The vasopressor used during cardiac arrest is: Epinephrine – 1 mg delivered IV or IO and repeated every 3 to 5 minutes. If IV or IO access cannot be established or for some reason is delayed, instead give epinephrine 2 to 2.5 mg diluted in 5 to 10 ml of sterile water or normal saline and injected directly into the patient's endotracheal tube. It's important to remember that the endotracheal route of drug administration results in variable and unpredictable drug absorption and blood levels. Epinephrine Although healthcare providers have used epinephrine for years during resuscitation, there haven't been many studies conducted to address the question of whether it improves outcomes in human patients. Epinephrine administration improves the return of spontaneous circulation as well as hospital admission rates. However, large studies have not been conducted to evaluate whether survival is actually improved. Because there haven't been any large studies to confirm long-term patient outcomes, we must rely on the positive short-term effects of increased return of spontaneous circulation and the increased hospital admission to support the use of epinephrine in cardiac arrest cases. No studies demonstrate improved rates of survival to hospital discharge or neurologic outcome when comparing standard epinephrine doses with initial high-dose or escalating-dose epinephrine. Therefore, the American Heart Association does not recommend the routine use of high-dose or escalating doses of epinephrine. Epinephrine is believed to: Stimulate adrenergic receptors Produce vasoconstriction Increase blood pressure and heart rate Improve perfusion pressure to the brain and heart Repeat epinephrine doses of 1 mg via IV or IO every 3 to 5 minutes during cardiac arrest. Remember, follow each dose given by peripheral injection with a 20 ml flush of IV fluid and elevate the extremity above the level of the heart for 10 to 20 seconds. https://d3imrogdy81qei.cloudfront.net/video_images/4365/aspirin.jpg Yes 143 https://app.protrainings.com/courses/acls/certification/videos/atropine https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2451.mp4 Atropine In this lesson, we'll go over the medication atropine and all of its effects, including indications, precautions and contraindications, and adult dosages. At the end of this lesson, we provide a Word about the various routes of access for drug administration. Atropine sulfate is an anticholinergic or antiparasympathetic, sometimes referred to as a parasympatholytic drug. A parasympatholytic agent is any substance or activity that has the effect of reducing the activity of the parasympathetic nervous system. Pro Tip #1: An anticholinergic agent is a substance that blocks the action of the neurotransmitter acetylcholine at synapses in the central and the peripheral nervous system. These agents inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The parasympathetic nervous system is often described as the rest and digest part of the autonomic nervous system. Atropine works by blocking this action. The autonomic nervous system is a control system that acts mostly unconsciously as it regulates bodily functions, such as the heart rate, respiratory rate, pupillary response, digestion, urination, and sexual arousal. Atropine Indications Now let's take a look at some indications for atropine. Atropine is one of the few ACLS medications that can be delivered via an endotracheal tube. However, vascular access is still the preferred route and, in most cases, would be the preference. Pro Tip #2: Atropine should be your first choice of treatment of symptomatic sinus bradycardia, as it may be the most beneficial in the presence of atrioventricular nodal blocks. Atropine Precautions and Contraindications There are a couple of precautions and contraindications when it comes to administering atropine. It is well known that atropine use during pulseless electrical activity (PEA) and asystole usually has no therapeutic benefit. Also important to remember, is that atropine most likely will not affect type 2, 2nd degree or 3rd degree AV blocks or blocks in non-modal tissue. Adult Dosage of Atropine Let's take a closer look at the adult dose of atropine. For bradycardia with or without acute coronary syndrome (ACS), administer 1 mg of atropine every 3 to 5 minutes or as needed. And make sure not to exceed a total dose of 0.04mg/kg or a total of 3 mg. Pro Tip #3: It's recommended to use a shorter dosing interval, such as every 3 minutes, and higher doses in severe clinical conditions. For organophosphate poisoning, you may need to use 2 – 4mg of atropine or higher to reverse the life-threatening symptoms of such a poisoning. The good news, as it relates to administering atropine, is that giving the drug via the intraosseous (IO) route has been found to be just as effective as intravenous (IV) infusion for rapid delivery of the drug. Pro Tip #4: Because large amounts of atropine may be required in patients with organophosphate poisoning, reconstitution of powdered atropine may be a viable option, especially when there is a mass casualty setting. Warning: It's also important to remember to utilize your personal protective equipment when treating patients with organophosphate toxicity to reduce and prevent the risk of cross-contamination with other rescuers. A Word About the Routes of Access for Drugs In this Word, we'll look at the priorities of access routes along with some specifics concerning the intravenous route. In the following Word section in the dopamine lesson, we'll finish up by looking at both the intraosseous route and the endotracheal route, along with a little information on fluid administration. Prioritizing Drug Access Routes The obvious priorities during cardiac arrest are high-quality CPR and early defibrillation. While the insertion of an advanced airway and drug administration are of secondary importance. It's important to understand that no drug given during cardiac arrest has been shown to improve survival rates to hospital discharge or improved neurologic function after cardiac arrest. Historically in ACLS, healthcare providers have administered medications via either the IV or endotracheal route. However, endotracheal absorption of medications is poor and unpredictable which makes optimal drug dosing problematic. Because of this, the IV or IO route will always be preferred. Intravenous (IV) Route A peripheral IV will be preferred for medication and fluid administration unless central line access is already available. However, central line access isn't necessary during most resuscitation attempts. Central line access could cause interruptions in CPR and complications during insertion, including vascular laceration, hematomas, and bleeding. Also, insertion of a central line in a non-compressible vessel is a relative, but not absolute, contraindication to fibrinolytic therapy in patients with acute coronary syndrome. Establishing a peripheral line, by contrast, does not require an interruption of CPR. Drugs, however, typically require 1 to 2 minutes to reach the central circulation when administered via the peripheral IV route. If a medication is administered via the peripheral venous route, administer it as follows: Administer the medication by bolus injection unless otherwise specified Follow the drug with a 20 ml bolus of IV fluid Elevate the extremity for about 10 to 20 seconds to facilitate the delivery of the medication into the central circulation https://d3imrogdy81qei.cloudfront.net/video_images/4367/atropine.jpg Yes 162 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/lavado-de-manos-para-artistas-corporales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2452.mp4 Procedimiento correcto de lavado de manos para artistas corporales https://d3imrogdy81qei.cloudfront.net/video_images/4369/handwashing-for-body-artists.jpg Yes 80 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/handwashing-for-body-artists https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2452.mp4 Handwashing for Body Artists Handwashing is the single most important infection control technique. And while you may think you already know how to wash your hands properly, the techniques you'll learn in this lesson will be much better suited to keeping you safe in your workplace. When exactly should you wash your hands? You should disinfect or wash your hands whenever they are visibly dirty or contaminated. You should also wash your hands: Before any contact with clients or patients Before putting on gloves Before performing any procedures After taking gloves off After using the bathroom After touching garbage After contact with clients or patients and especially after contact with:• Non-intact skin• Bodily fluids• Excretions• Wound dressings• Contaminated items How should you practice proper handwashing? Pro Tip #1: When it comes to properly disinfecting your hands, new and improved doesn't exist. Washing your hands with soap and water is still the best way to reduce the number of germs in most situations. But what if you don't have access to a sink, hot water, and soap? In these situations, use an alcohol-based hand sanitizer, but make sure it contains at least 60 percent alcohol. Alcohol-based hand sanitizers are a great second option and can quickly reduce the number of microbes on your hands in many situations. Warning: While alcohol-based sanitizers are a great option in the absence of a nearby sink, hot water, and soap, they will not eliminate all types of germs. So, if it's just a matter of a slight inconvenience, washing your hands with soap and water is worth that inconvenience. How should you properly clean your hands with an alcohol-based hand sanitizer? The technique is quite simple and there are just three important points to keep in mind: You need enough hand sanitizer to fill the palm of one hand. Spread the sanitizer everywhere on your hands – between your fingers, in every crevice and wrinkle, under any rings you have on, into your cuticles, under nail beds, around your wrists, and so forth. Work the sanitizer into your hands for a minimum of 20 seconds or until your hands are dry. Pro Tip #2: Make sure to follow your own policies and procedures as outlined by your individual employer or your industry, as indications can be different for when the use of alcohol-based sanitizers are deemed appropriate. What if you're wearing a lot of jewelry or a watch that you suspect has been contaminated? In certain cases, or with certain individuals, removing jewelry and a watch will be required before cleaning and disinfecting your hands. If this is the case, make sure you remove these items using personal protective equipment and store them together someplace safe – more as it relates to the spread of infection, not as it relates to the items themselves. After cleaning your hands, you can return to those items and sanitize them as necessary, following the engineering controls and work practices covered under OSHA's Bloodborne Pathogen Rule. How should you properly wash your hands using soap and water? Again, the technique is quite simple. It's just a matter of following the proper guidelines: Use a disposable paper towel to turn the faucet on. Thoroughly wet your hands with water. Apply a good amount of soap. Rub the soap into your hands for at least 20 seconds, just as you did with the alcohol-based hand sanitizer, covering all areas including the backs of your hands, under fingernails, between fingers, and so forth. Rinse your hands off under running water. Dry your hands using disposable paper towels. Use that disposable towel to turn the faucet off and discard the towel when done. Pro Tip #3: If you're concerned about wasting water when using a sink with manual faucet controls, you can always ask a coworker to help turn the faucet on and off for you. https://d3imrogdy81qei.cloudfront.net/video_images/4369/handwashing-for-body-artists.jpg Yes 80 https://app.protrainings.com/courses/acls/certification/videos/dopamine https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2453.mp4 Dopamine In this lesson, we'll go over the medication dopamine and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, we conclude our look at the various access routes for medication delivery. Dopamine is a naturally occurring catecholamine – any of a class of aromatic amines that includes a number of neurotransmitters – that has direct alpha- and beta-adrenergic effects depending on the dose administered. When medium doses are administered, like between 5 and 10 mcg/kg per minute in adult patients, dopamine will act directly on the beta 1 receptors, which causes an increase in both myocardial contractility and heart rate. Pro Tip #1: Contractility is the inherent strength and vigor of the heart's contraction during systole. According to Starling's Law, the heart will eject a greater stroke volume at greater filling pressures. For any filling pressure, the stroke volume will be greater if the contractility of the heart is greater. When dopamine is administered in doses greater than 10 mcg/kg per minute, the alpha receptors are typically stimulated. This causes an increase in systemic vascular resistance, also known as vasoconstriction. Dopamine Indications Now let's take a look at dopamine indications. Dopamine can be quite effective in treating hypotension when there are signs and symptoms that the patient is in shock and is usually used as a second-line drug for symptomatic bradycardia after atropine. Dopamine Precautions and Contraindications Dopamine has a couple precautions and contraindications to be aware of. Pro Tip #2: Dopamine can cause tachyarrhythmias and, as already mentioned, excessive vasoconstriction, which means that it should be used with caution in any patients who are suffering from cardiogenic shock with associated symptoms of congestive heart failure. Warning: It's vitally important to correct hypovolemia with volume replacement before initiating dopamine therapy. Adult Dosage of Dopamine Now let's look at the adult dosage of dopamine. The adult dosage of dopamine should be administered via IV and the most common infusion rate is between 5 and 20 mcg/kg per minute. You want to be sure to titrate the dosage and drip rate to the patient's response slowly and carefully. A Word About the Routes of Access for Drugs In the last Word, we looked at the priorities of access routes along with some specifics concerning the intravenous route. In this Word section, we'll finish up by looking at both the intraosseous route and the endotracheal route, along with a little information on fluid administration. Intraosseous (IO) Route Medications and fluids administered during resuscitation can be safely and effectively delivered via the IO route if IV access is not available. Important points to remember about IO access are: IO access can be established in all age groups IO access can often be achieved in 30 to 60 seconds The IO route of drug administration is preferred over the endotracheal (ET) route and may also be easier to establish in cardiac arrest patients Any ACLS medication or fluid that is given via IV can also be administered via IO IO cannulation provides access to a non-collapsible marrow venous plexus, which serves as a rapid, safe, and reliable route for the administration of medications, crystalloids, colloids, and blood during resuscitation. This technique uses a rigid needle, preferably a specially designed IO or bone marrow needle from an IO access kit. Endotracheal (ET) Route Both IV and IO routes of medication administration are preferred over the endotracheal route of administration. When considering the administration of medications via the endotracheal route during CPR, it's important to keep these concepts in mind: The optimal dosage of most medications delivered via the endotracheal route is not known The normal dosage of medications administered via the endotracheal route is roughly 2 to 2.5 times the intravenous route CPR will need to be interrupted so the medications don't regurgitate up the endotracheal tube Studies have demonstrated that epinephrine, vasopressin, and lidocaine are absorbed into the circulatory system after administration via the endotracheal route. When administering medications via the endotracheal route, dilute the dose in 5 to 10 ml of normal saline or sterile water, then inject the medications directly into the endotracheal tube. Fluid Administration It's important that healthcare providers titrate fluid administration and vasoactive or inotropic agents as needed to properly optimize blood pressure, cardiac output, and systemic perfusion. The optimal post-cardiac arrest blood pressure isn't known. However, a mean arterial pressure of 65 mm Hg or greater is a reasonable goal. In hypovolemic patients, the ECF volume is typically restored with normal saline or lactated Ringer's solution. Avoid D5W because it will reduce serum sodium too quickly. Serum electrolytes should be appropriately monitored. D5W refers to 5 percent Dextrose in Water (also known as D5). It's an isotonic carbohydrate solution that contains glucose as the solute. When it's used, the glucose is quickly absorbed by the cells and utilized for energy, leaving only water behind, which is then a hypotonic solution. https://d3imrogdy81qei.cloudfront.net/video_images/4371/dopamine.jpg Yes 109 https://app.protrainings.com/courses/acls/certification/videos/epinephrine https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2454.mp4 Epinephrine In this lesson, we'll go over the medication epinephrine and all of its effects, including indications, precautions and contraindications, and adult dosages. Epinephrine, also commonly referred to as epi, is a chemical that narrows the blood vessels and opens the airways in the lungs. And it's also commonly known as adrenaline. Adrenaline is a hormone that is secreted mainly by the medulla of the adrenal glands and functions primarily to increase cardiac output and to raise blood glucose levels. Epinephrine is typically released during periods of acute stress and its effects are a built-in defense mechanism and what prepares an individual for either a fight or flight response. For this reason, it's also a primary medication for non-perfusing cardiac arrest in pediatric patients. One common effect of epinephrine is reversing low blood pressure. Epinephrine is a sympathomimetic drug. Sympathomimetic drugs mimic the effects of the sympathetic nervous system and are thus used to increase the heart rate and blood pressure. Drugs in this category are usually the synthetically produced equivalent to what is endogenous (naturally occurring) in the human body. Epinephrine is also a naturally occurring catecholamine. It possesses positive alpha- and beta-adrenergic effects. Its alpha effects result in vasoconstriction, thus increasing the blood pressure. Its selective beta1 effects result in increased heart rate (positive chronotropy) and increased myocardial contractility (positive inotropy). While its selective beta2 effects cause a relaxation of bronchial smooth muscle (bronchodilation). Epinephrine Indications Now let's take a look at epinephrine indications. Epinephrine is used in cardiac arrest arrhythmias such as V-Fib, pulseless V-tach, asystole, and pulseless electrical activity (PEA). Epinephrine can also be used in symptomatic bradycardia and for the treatment of severe hypotension. Epinephrine can be administered after atropine as an alternative to infusing dopamine. It has also been established that epinephrine can be administered when external pacing and atropine fail and when bradycardia causes hypotension. It's safe to administer epinephrine with phosphodiesterase enzyme inhibitors, and it's also an effective treatment for anaphylaxis. Pro Tip #1: It's recommended that epinephrine be combined with large volumes of fluids, corticosteroids, and antihistamines. Epinephrine Precautions and Contraindications Epinephrine has a few precautions and contraindications that we should note. Care should especially be taken when administering epinephrine in cases where raising the patient's blood pressure and increasing their heart rate might cause myocardial ischemia, angina, and increase the demand for myocardial oxygen. Pro Tip #2: It should be noted that high doses of epinephrine do not improve neurological outcomes or survival rates and may actually contribute to post-resuscitation complications like myocardial dysfunction. In healthcare settings, we commonly see high doses of epinephrine treatment with poisoning and drug-induced shock. Adult Dosage of Epinephrine Now let's look at the adult dosage of epinephrine. Warning: Epinephrine is available in two concentrations and it's important to know when to use each, and to pay extra attention to which concentration you're actually using when administering epinephrine to patients. The two available concentrations are 1:1000 and 1:10,000. And for cardiac arrest in adult patients, you should deliver via IV or IO at 1 mg or 10 ml of 1:10,000 every 3 to 5 minutes during resuscitation. Follow each dose of epinephrine with 20 ml of normal saline as a flush. And elevate the patient's arm in which the medication was delivered for 10 to 20 seconds after the dose has been administered. If you encounter a situation where there is no IV or IO access, epinephrine may be delivered via the endotracheal route at 2 to 2.5 mg diluted in 10 ml of normal saline. Pro Tip #3: Higher doses of epinephrine – up to 0.2 mg per kg of body weight may be used for specific indications like beta-blocker or calcium channel blocker overdose. If you're administering epinephrine as a continuous infusion, the initial rate is 0.1 to 0.5 mcg per kg per minute. An example of this would be if you're giving epinephrine to a patient weighing 90 kg, you'd give the patient between 9 and 45 mcg per minute and titrated to a positive patient response. In cases of profound bradycardia or hypotension, deliver 2 to 10mcg per minute of epinephrine titrated to a patient response delivering a drip via an IV infusion. And add 1mg of epinephrine (or 1ml of 1:1000 solution) to a 250ml or 500ml of normal saline. For treatment of anaphylactic shock, an epinephrine concentration of 1:1000 should be given at .01mg per kg of body weight via intermuscular delivery. https://d3imrogdy81qei.cloudfront.net/video_images/4373/epinephrine.jpg Yes 245 https://app.protrainings.com/courses/acls/certification/videos/fibrinolytic-agents https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2455.mp4 Fibrinolytic Agents In this lesson, we'll go over the use of fibrinolytic medications and all of their effects, including indications, precautions and contraindications, and adult dosages. Fibrinolytic medications are not usually found in advanced cardiac life support pharmacological drug cards specifically. However, their use is vitally important to reperfusion therapies. Fibrinolytic drugs – also called thrombolytic drugs – are any medication that is capable of stimulating the dissolution of blood clots, or as they're sometimes referred to as – thrombus. These types of drugs work by activating something referred to as fibrinolytic pathways. Pro Tip #1: This is important because it differentiates fibrinolytic medications from anticoagulant drugs, routinely referred to as heparin and Coumadin – Two common anticoagulants that work by preventing normal clotting factors from functioning correctly, thereby inhibiting the blood from clotting. Fibrinolytic medications, which prevent the formation of blood clots by suppressing the function of multiple clotting factors that are normal and present in the blood, are different from anticoagulants. Pro Tip #2: There are numerous fibrinolytic agents on the market, each of which may produce varying mechanisms of action. And while there are similarities between these are anticoagulants, fibrinolytic drugs produce the therapeutic effect of breaking down the fibrin and fibrinogen matrix of a thrombosis (fibrinolysis), thus fragmenting the clot that is obstructing an artery and reestablishing distal blood flow. Fibrinolytic Indications Now let's take a look at some indications for fibrinolytic medications. The most common indication for the use of fibrinolytic medications include the following two: Acute myocardial infarction, also known as AMI. Acute ischemic stroke, also known as AIS. In patients with acute myocardial infarction, fibrinolytic drugs would be indicated if the ST-segment elevation is consistent with a myocardial infarction of greater than or equal to 1mm in two or more contiguous leads. Contiguous leads are next to one another anatomically speaking. They view the same general area of the heart (specifically the left ventricle). Fibrinolytic drugs can also be indicated if the signs and symptoms of a myocardial infarction last longer than 15 minutes and less than 12 hours and if PCI (percutaneous coronary intervention) is not available within 90 minutes of medical contact. If the indication is related to ischemic stroke, patients may qualify if they suffer from sudden onset of a focal neurological deficit such as: Slurred speech Facial droop Weakness on one side of their body Paralysis on one side of their body Patients may also qualify for fibrinolytic medications if the stroke symptoms do not seem to be self-resolving, which is what you usually see when it's a transient ischemic attack (or TIA) and the signs and symptoms are present for up to three hours but not greater than 4.5 hours. Fibrinolytic Precautions and Contraindications There are a few precautions and contraindications when it comes to administering fibrinolytic medications that you should be aware of. When using fibrinolytic drugs, there are several patient factors that would exclude their use, which include (but are not limited to): Hypertension with systolic blood pressure greater than 180 to 200mm HG Right arm vs. left arm blood pressure differences greater than 15mm HG Significant head or facial trauma within the past 3 months Prior intracranial hemorrhage A bleeding disorder or internal bleeding within the prior 2 to 4 weeks The use of a current anticoagulant treatment Pregnancy A serious systemic disease which would include advanced cancer or kidney disease Ischemic stroke greater than 3 hours or less than 3 months Pro Tip #3: However, that last contraindication would not include the current condition being considered for the current fibrinolytic treatment. Adult Dosage of Fibrinolytic Medications The adult dosage for fibrinolytic treatments can be a little complex because the dose of the treatment would depend on the exact fibrinolytic medication being used. Having said that, there are three major classes of fibrinolytic drugs: tissue plasminogen activator (tPA), streptokinase (SK), and urokinase (UK). While drugs in these three classes all have the ability to effectively dissolve blood clots, they differ in their detailed mechanisms in ways that alter their selectivity for fibrin clots. https://d3imrogdy81qei.cloudfront.net/video_images/4375/fibrinolytic-agents.jpg Yes 208 https://app.protrainings.com/courses/acls/certification/videos/lidocaine https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2456.mp4 Lidocaine In this lesson, we'll go over the medication lidocaine and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, you'll find a Word about STEMI. Lidocaine works by bringing about negative inotropic (meaning, modifying the force or speed of the contraction of muscles) effects and antiarrhythmic actions in the heart which weaken the force of muscular contractions and can calm erratic and uncoordinated electro myocardial activity. In other words, lidocaine decreases automaticity and suppresses ventricular arrhythmias. Lidocaine Indications Now let's take a look at lidocaine indications. Due to lidocaine's antiarrhythmic properties, the primary use of lidocaine is for cardiac arrest from ventricular fibrillation (VFib) and pulseless ventricular tachycardia. Lidocaine is also an effective medication for treating the following conditions: Stable monomorphic ventricular tachycardia (V-tach) with preserved ventricular function Stable polymorphic V-tach with normal baseline A QT interval and preserved lower ventricular function when ischemia is treated, and electrolyte balance is corrected Stable polymorphic V-tach with baseline and QT interval prolongation when torsade's is suspected Lidocaine Precautions and Contraindications Now let's go over the precautions and contraindications for lidocaine. Lidocaine should not be used a prophylactic treatment in patients with acute myocardial infarction. It has also been suggested that you should reduce the maintenance dose in the presence of impaired liver function or lower ventricular dysfunction. And you should discontinue the infusion immediately if signs of toxicity develop. Lidocaine would be contraindicated if the patient has a known hypersensitivity to lidocaine or its derivatives, such as xylocaine, Novocain (also known as procaine), and similar drugs. And also in patients with sinus bradycardia and atrioventricular blocks. Adult Dosage of Lidocaine Now let's look at the adult dosage of lidocaine. For adult dosages when treating for cardiac arrest from VFib or pulseless V-tach, the initial dose is 1 to 1.5 mg per kg via IV or IO. And remember, lidocaine is one of those drugs that can also be administered via an endotracheal tube. For refractory VFib, an additional 0.5 to 0.75 mg per kg may be given via IV push. This can be repeated after 5 to 10 minutes. And the maximum number of lidocaine doses should not exceed 3 and the total amount should not exceed 3 mg per kg. For perfusing arrhythmias like stable V-tach, wide complex tachycardia, or uncertain type or significant ectopy, doses range from 0.5 to 0.75 mg per kg, up to 1 to 1.5 mg per kg. This can also be repeated at 0.5 to 0.75mg per kg every 5 to 10 minutes, up to that maximum dose of 3 mg per kg. For a maintenance infusion, give 1 to 4 mg per minute equal to 30 to 50 mcg per kg per minute. And remember, a micro drip infusion set is needed in order to deliver the appropriate dose. Pro Tip: A common and simple calculation for mixing a lidocaine drip is this: IV bag amount (usually in ml) × the dose ordered (usually mg per minute) × the drip set (drops per minute) ÷ the drug on hand (usually in mg). This should equal the correct drops per minute you'll need. A Word About STEMI ST-Elevation Myocardial Infarction (STEMI) is a very serious type of heart attack during which one of the heart's major arteries is blocked. Patients with STEMI usually have complete occlusion of an epicardial coronary artery. The mainstay of treatment for STEMI is early reperfusion therapy achieved with primary PCI or fibrinolytics. Reperfusion therapy for STEMI is probably the most important advancement in the treatment of cardiovascular disease in recent years. Early fibrinolytic therapy has been established as the standard of care for patients with STEMI who present within 12 hours after the onset of symptoms with no contraindications. Reperfusion therapy reduces mortality and saves heart muscle – the shorter the time to reperfusion, the greater the benefit. A 47 percent reduction in mortality has been noted when fibrinolytic therapy is provided in the first hour after the onset of symptoms. Delay of Therapy can be Critical It's important that routine consultation with a cardiologist or another physician does not delay the diagnosis and treatment except in equivocal or uncertain cases. Consultation can delay therapy and is associated with an increase in hospital mortality rates. Potential delays during the pivotal in-hospital evaluation period can occur in several key areas: from door to data (ECG), from data to decision, and from decision to drug (or PCI). These four major points of in-hospital therapy – Door, Data, Decision, and Drug – are commonly referred to as the 4 D's. All healthcare providers should focus on minimizing these delays at each of these points. Out-of-hospital transport time accounts for only 5 percent of delays to treatment time, while ED evaluation accounts for between 25 and 33 percent of these delays. In the next lesson – Magnesium Sulfate – we'll continue our Word on STEMI, specifically – early reperfusion therapy. https://d3imrogdy81qei.cloudfront.net/video_images/4377/lidocaine.jpg Yes 210 https://app.protrainings.com/courses/acls/certification/videos/magnesium-sulfate https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2457.mp4 Magnesium Sulfate In this lesson, we'll go over the medication magnesium sulfate, sometimes referred to as simply mag sulfate, and all of its effects, including indications, precautions and contraindications, and adult dosages. At the end of the lesson, we conclude our look at STEMI. Magnesium sulfate affects the SA node by slowing down its impulse rate, and it also reduces the automaticity in partially depolarized cells. Magnesium sulfate causes vasodilation, and when administered rapidly, can also create hypotension. Magnesium Sulfate Indications Now let's take a look at magnesium sulfate indications. Magnesium sulfate is effective as an anticonvulsant and antiarrhythmic and is used to treat polymorphic ventricular tachycardia with a pulse Magnesium sulfate is recommended for use in cardiac arrest only in cases of torsade's de pointes or suspected cases of hypomagnesemia. Whenever you see these conditions present, this is when you would use magnesium sulfate. Magnesium sulfate is also indicated for life threatening ventricular arrythmias due to digitalis toxicity. Pro Tip: Digitalis toxicity (DT) occurs when you take too much digitalis (also known as digoxin or digitoxin), a medication used to treat heart conditions. Signs of toxicity include nausea, vomiting, and an irregular heartbeat. Magnesium Sulfate Precautions and Contraindications Magnesium sulfate is contraindicated for patients with central nervous system depression or hypermagnesemia. And caution must be taken when used on patients with renal impairment as well. Routine administration of magnesium sulfate in hospitalized patients with acute myocardial infarction is also not recommended. Adult Dosage of Magnesium Sulfate Now let's look at the adult dosage of magnesium sulfate. The administration of magnesium sulfate in pulseless cardiac arrest is 1 to 2 grams (or 2 to 4ml) of a 50 percent solution diluted in 10ml of D5W or normal saline via slow IV or IO push over 5 to 20 minutes. When dealing with adult patients with torsade's with a pulse or acute myocardial infarction with hypomagnesemia, a loading dose will be required of 1 to 2 grams mixed in 50 to 100ml of D5W or normal saline via IV over a 5 to 60-minute period. This should then be followed with a .5 to 1 gram per hour IV titrated to control torsade's de pointes. A Word About STEMI We provided an introduction into ST-Elevation Myocardial Infarction (STEMI) in the last Word section of the Lidocaine lesson. In this Word, we'll dig a little deeper into STEMI. Early Reperfusion Therapy Healthcare providers should rapidly identify patients with STEMI and quickly screen them for indications and contraindications to fibrinolytic therapy by using a fibrinolytic checklist if appropriate. The first qualified physician who encounters a patient with STEMI should interpret or confirm the 12-lead ECG, determine the risk vs. benefit of reperfusion therapy, and direct administration of fibrinolytic therapy or activation of the PCI (percutaneous coronary intervention) team. Early activation of PCI can occur with established protocols. The following time frames are recommended by the American Heart Association: For PCI, the goal for ED door-to-balloon inflation time is 90 minutes. In patients presenting to a non-PCI-capable hospital, the time from first medical contact to device should be less than 120 minutes when primary percutaneous coronary intervention is considered. If fibrinolysis is the intended reperfusion, an ED door-to-needle time (needle time relates to the beginning of infusion of a fibrinolytic agent) of 30 minutes is the goal that's considered the longest acceptable time. It goes without saying that systems should strive to achieve the shortest time possible. Patients who are ineligible for fibrinolytic treatment should be considered for transfer to a PCI facility regardless of the delay. The system should strive for a door-to-departure time of 30 minutes after a transfer decision has been made. Adjunctive treatments can also be indicated. Use of PCI The most frequently used form of percutaneous coronary intervention is coronary intervention with stent placement. Optimally performed primary PCI is the preferred reperfusion strategy over fibrinolytic administration. Rescue PCI should be used early after fibrinolytics in patients who may have persistent occlusion of the infarct artery, although this term has been recently replaced by the term pharmacoinvasive strategy. PCI has been shown to be superior to fibrinolysis in the combined end points of death, stroke, and reinfarction in many studies for patients presenting between 3 and 12 hours after onset. However, these results have been achieved in experienced medical settings involving skilled healthcare providers at skilled PCI facilities – those performing more than 200 PCl's for STEMI with cardiac surgery capabilities. Considerations for the use of PCI include the following: PCI is the treatment of choice for the management of STEMI when it can be performed effectively with a door-to-balloon time of less than 90 minutes from first medical contact by a skilled provider at a skilled PCI facility. Primary PCI can also be offered to patients presenting to non-PCI-capable healthcare centers if PCI can be initiated promptly within 120 minutes from first medical contact. The TRANSFER AMI (Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction) trial supports the transfer of high-risk patients who receive fibrinolysis in a non-PCI center within 12 hours of symptom onset to a PCI center within 6 hours of fibrinolytic administration to receive routine early coronary angiography and PCI if indicated. For patients admitted to a hospital without PCI capabilities, there may be some benefit associated with transfer for PCI versus administration of on-site fibrinolytics in terms of reinfarction, stroke, and a trend to lower mortality when PCI can be performed within 120 minutes of first medical contact. PCI is also preferred in patients with contraindications to fibrinolytics and is indicated in patients with cardiogenic shock or heart failure complicating myocardial infarctions. https://d3imrogdy81qei.cloudfront.net/video_images/4379/magnesium-sulfate.jpg Yes 137 https://app.protrainings.com/courses/acls/certification/videos/morphine-sulfate https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2458.mp4 Morphine Sulfate In this lesson, we'll go over the medication morphine sulfate and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, we take a look at respiratory distress. Morphine sulfate is a mu-opioid receptor agonist used to relieve pain. It produces analgesic effects by binding to mu-opioid receptors in the central nervous system. Morphine Sulfate Indications Now let's take a look at morphine sulfate indications. Morphine sulfate is indicated for chest pain that is refractory to the use of nitroglycerin. Morphine Sulfate Precautions and Contraindications Now let's go over the precautions and contraindications for morphine sulfate. Opioids, like morphine sulfate, are known to depress the respiratory system and may also lower blood pressure. For this reason, consider using a reduced dosage in older patients or those patients with an altered level of consciousness. Adult Dosage of Morphine Sulfate Now let's look at the adult dosage of morphine sulfate. Morphine sulfate may be given to patients in 2 to 4 mg increments via slow IV push. Additional morphine can be given in doses of 2 to 8 mg 5 to 15 minutes after the first dose. Pro Tip: Be sure to titrate the dose of morphine to the patient's response and effects. If you notice signs of hypotension, hypoventilation, bradycardia, or any other serious central nervous system depression symptoms appear, naloxone may be given at 0.4 to 2 mg via IV to reverse the opioid side effects. Also, be aware that gastrointestinal upset may occur in higher doses as well. A Word About Respiratory Distress As respiratory depression can occur with the use of morphine sulfate, we're going to dive a little deeper into the three types of respiratory issues – respiratory distress, respiratory failure, and respiratory arrest. In this Word, we'll first look at respiratory distress. Normal and Abnormal Breathing The average respiratory rate for an adult is about 12 to 16 respirations per minute. Normal tidal volume of 8 to 10 ml per kg will maintain normal oxygenation and the elimination of CO2. Tachypnea occurs when the patient's respiratory rate is above 20 respirations per minute, while bradypnea occurs when their respiratory rate falls below 12 respirations per minute. A respiratory rate below 6 respirations per minute (known as hypoventilation) will require assisted ventilation with a bag-mask device or an advanced airway with 100 percent oxygen. Respiratory Distress Respiratory distress is a clinical state that is characterized by an abnormal respiratory rate (such as tachypnea) or effort. The respiratory effort may be increased (such as nasal flaring, retractions, and the use of accessory muscles) or it may be inadequate (like hypoventilation or bradypnea). Respiratory distress can range from mild to severe. For instance, a patient with mild tachypnea and a mild increase in respiratory effort with changes in airway sounds would be considered in mild respiratory distress. A patient with marked tachypnea, a significantly increased respiratory effort, a deterioration in skin color, and changes in their mental status would be considered in severe respiratory distress. Severe respiratory distress can be an indication of respiratory failure. Clinical signs and symptoms of respiratory distress will typically include a few, or all, of the following signs: Tachypnea Increased respiratory effort, such as nasal flaring and retractions Inadequate respiratory effort, such as hypoventilation or bradypnea Abnormal airway sounds, such as stridor, wheezing, and grunting Tachycardia Pale, cool skin; however, it's important to note that some causes of respiratory distress, such as sepsis, may cause the skin to get warm, red, and diaphoretic Changes in the patient's level of consciousness and/or agitation The use of abdominal muscles to assist the patient with breathing It's also important to note that these indicators may vary in severity. Respiratory distress should be apparent when a patient tries to maintain adequate gas exchange despite airway obstruction, reduced lung compliance, or lung tissue disease. As the patient begins to tire or as respiratory function or effort (or both) deteriorate, adequate gas exchange cannot be maintained. When this happens, clinical signs of respiratory failure will develop. https://d3imrogdy81qei.cloudfront.net/video_images/4381/morphine-sulfate.jpg Yes 90 https://app.protrainings.com/courses/acls/certification/videos/nitroglycerin https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2459.mp4 Nitroglycerin In this lesson, we'll go over the medication nitroglycerin and all of its effects, including indications, precautions and contraindications, and adult dosages. At the end of the lesson, we'll continue our look at respiratory problems, specifically respiratory failure. Nitroglycerin is a nitrate that causes smooth muscle relaxation, which produces systemic venous pooling of blood through the action of vasodilation. This, in effect, decreases venous blood flow return to the heart and also reduces preload as well as venous after load. Pro Tip #1: The administration of nitroglycerin should be monitored closely so as to not cause detrimental hypotension. Nitroglycerin Indications Now let's take a look at nitroglycerin indications. Nitroglycerin is indicated to relieve chest discomfort that is suspected to be the result of acute myocardial infarction, otherwise known as AMI. Nitroglycerin can also be effective in relieving cardiogenic pulmonary edema that is related to left side heart failure. Nitroglycerin Precautions and Contraindications Now let's go over the precautions and contraindications for nitroglycerin. There are multiple situations when the use of nitroglycerin may not be indicated or may even be contraindicated and harmful to the outcome of the patient. Here are some examples of those contraindicated situations: The patient is suffering from low systolic blood pressure of less than 90mm HG The patient has a right-sided ventricular infarction The patient is using medications like tadalafil, better known as Cialis or Adcirca The patient has severe bradycardia of fewer than 50 beats per minute The patient has a tachycardia greater than 100 beats per minute in the absence of heart failure Different from tadalafil, but in the same class of complications with nitroglycerin, when a patient may be taking a phosphodiesterase type 5 (a class of medication that includes Sildenafil) within the past 24 hours, this could cause severe hypotensive side effects if the patient is using that medication and also taking nitroglycerin. Pro Tip #2: It's vitally important to gather a thorough medications list from the patient, a reliable family member, or the patient's caregiver to avoid any serious contraindications that could occur when mixing these types of medications. Adult Dosage of Nitroglycerin Now let's look at the adult dosage of nitroglycerin. There are three methods of administering nitroglycerin: Nitroglycerin can be administered sublingually (under the tongue) in a dose of 0.4 mg, which is typically one tablet. This dose can be repeated in 5-minute intervals to a maximum dose of 3 tablets. Nitroglycerin can also be administered via a sublingual spray in metered doses. One spray of nitroglycerin will usually be the equivalent of a 0.4 mg tablet. This, too, can be repeated in 5-minute intervals to a maximum dose of 3 sprays. And finally, nitroglycerin can also be administered via IV and may be increased to 10 mcg per minute every 3 to 5 minutes until you've reached the desired effect. Warning: And as mentioned in the Pro Tip at the top of this lesson, it's important to closely monitor the patient's serial blood pressure and treat hypotension accordingly. A Word About Respiratory Failure In the last lesson on morphine sulfate, we took a look at respiratory distress. In this Word, we'll look at respiratory failure. Respiratory failure is a clinical state of inadequate oxygenation, ventilation, or both. Respiratory failure is often the end stage of respiratory distress. If there is abnormal central nervous system control of breathing or muscle weakness, the patient may show little or no respiratory effort despite being in respiratory failure. In these types of situations, you will have to identify the patient's respiratory failure based on clinical findings. It's important to confirm the diagnosis with objective measurements, such as pulse oximetry or blood gas analysis. You should suspect the probability of respiratory failure if you notice some or all of the following signs: Marked tachypnea Bradypnea, apnea (late) Increased, decreased, or no respiratory effort Poor to absent distal air movement Tachycardia (early) Bradycardia (late) Cyanosis Stupor or coma (late) Respiratory failure can result from upper or lower airway obstruction, lung tissue disease, and disordered control of breathing, such as apnea or shallow, slow respiration. When respiratory effort is not adequate, respiratory failure can occur without the usual signs of respiratory distress. Respiratory failure is a clinical state that requires intervention to prevent its deterioration into cardiac arrest. Respiratory failure can occur with a rise in arterial carbon dioxide levels (hypercapnia), a drop in blood oxygenation (hypoxemia), or both. https://d3imrogdy81qei.cloudfront.net/video_images/4383/nitroglycerin.jpg Yes 177 https://app.protrainings.com/courses/acls/certification/videos/oxygen https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2460.mp4 Oxygen In this lesson, we'll go over oxygen therapy and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of this lesson, we'll provide you with a Word about respiratory arrest. Oxygen is an atmospheric gas that increases the saturation of hemoglobin oxygen and when used at therapeutic concentrations, it can aid the oxygenation of certain tissues as long as the patient isn't in shock or has some other complication, like carbon monoxide poisoning. This could affect the distribution or reception of oxygen molecules within the body and its cells. Oxygen Indications Now let's take a look at oxygen indications. The primary indication for the use of oxygen in ACLS is the presence of hypoxemia, which would be representative of an SpO2 of less than 94 percent, severe respiratory distress, as in asthma, and respiratory depression, as in opioid overdose. When you administer oxygen therapy after the return of spontaneous circulation, otherwise known as ROSC, it's important to deliver sufficient oxygenation to maintain an SpO2 that's greater than, or equal to, 92 percent but less than 98 percent. Oxygen Precautions and Contraindications There are few, if any, known precautions and contraindications for oxygen therapy use in the true hypoxic patient. Precautions should be based on new and ongoing research that reveals the vasoconstrictive properties that hyperoxia may produce. Pro Tip #1: If you begin to hyper oxygenate a normoxic cardiac patient, studies and research indicate that you might cause lower oxygen absorption and distribution to the patient's vital organs that need oxygenation during a coronary crisis. Adult Dosage of Oxygen Now let's look at the adult dosage of oxygen. The appropriate dose of oxygen will be dependent on the patient's needs and unique oxygen requirements. Oxygen therapy can be delivered via several different methods, and the percent of oxygenation will be regulated by the flow of oxygen per minute as well as the delivery adjunct you use. When delivering oxygen via nasal cannula is indicated, you should deliver it at a rate between 2 and 6 liters per minute. If a nonrebreather mask is used, that flow rate should be increased to between 12 and 15 liters per minute. If the patient's respiratory system is distressed or depressed, or for those patients who are completely apneic (not breathing), the delivery of oxygenated ventilations would be via a positive pressure device like a bag valve mask. In this case, the oxygen flow should be set at 15 liters per minute. Pro Tip #2: It's important, according to current guidelines, to titrate the oxygen therapy to maintain an SpO2 of at least 94 percent but less than 100 percent. Equally important, is to remember that a restricted airway will affect the therapeutic response of oxygenation treatment. The use of basic or advanced airway adjuncts may be needed to open or maintain a patent airway in order to treat the patient effectively. Pro Tip #3: It's important to always monitor the signs and symptoms of the patient, along with electronic and technical monitoring systems, so as to properly treat the patient. Rather than simply relying on electronic and technical monitoring systems alone. In other words, if the SpO2 reads 92 percent but the patient's skin appears normal, they could have an underlying blood disorder like anemia, which can impede the cyanosis due to a lack of hemoglobin and give the inaccurate appearance of adequate oxygenation. A Word About Respiratory Arrest In the last two lessons, we took a look at respiratory distress and respiratory failure. In this Word, we'll look at respiratory arrest. Respiratory arrest is defined as the absence of breathing and is usually caused by an event such as drowning or head injury. For an adult in respiratory arrest, providing a tidal volume of approximately 500 to 600 ml (or 6 to 7ml per kg) should be sufficient. This would be consistent with a tidal volume that produces a visible chest rise in the patient. Patients with an airway obstruction or poor lung compliance may require high pressures to be properly ventilated (in other words, to make the chest visibly rise). A pressure relief valve on a resuscitation bag-mask device may prevent the delivery of a sufficient tidal volume in these patients. Which is why it's important to make sure that the bag-mask device allows you to bypass the pressure relief valve and use high pressures, if necessary, to achieve visible chest expansion. Excessive ventilation is unnecessary and can cause gastric inflation and the resulting complications, like regurgitation and aspiration. More importantly, excessive ventilation can be harmful as it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. As a healthcare provider, you should work to avoid excessive ventilation, as in too many breaths and/or too large a volume of breaths, during respiratory arrest and cardiac arrest. https://d3imrogdy81qei.cloudfront.net/video_images/4385/oxygen.jpg Yes 223 https://app.protrainings.com/courses/acls/certification/videos/procainamide https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2461.mp4 Procainamide In this lesson, we'll go over the medication procainamide and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, we provide you with a Word about wide complex tachycardias. Procainamide is effective at slowing the conduction in the atria, ventricles, and the His-Purkinje system by prolonging the P-R and Q-T intervals and the refractory period of the AV node. Procainamide also slows the refractory period within the atria and ventricles and slows the conduction velocity. Procainamide Indications Now let's take a look at procainamide indications. Procainamide is effective for the treatment of supraventricular tachycardia that returns after vagal maneuvers and adenosine are ineffective. Procainamide is also effective at treating the following: Stable wide complex tachycardia of uncertain origin Stable monomorphic ventricular tachycardia with normal QT intervals Atrial fibrillation with a rapid ventricular rate of response in patients with Wolff Parkinson White syndrome Recurrent ventricular fibrillation Pulseless ventricular tachycardia Procainamide Precautions and Contraindications Warning: it's important that you're aware of any known patient sensitivity to procainamide or similar medications before administering it. Also important to note is that digitalis toxicity may complicate an already existing AV conduction depression. Other procainamide contraindications would include: 3rd degree heart block Preexisting prolongation of the QRS complexes Preexisting prolongation of the QT intervals Pro Tip #1: The use of procainamide should be avoided in patients with prolonged QT intervals and associated congestive heart failure (CHF). Adult Dosage of Procainamide Now let's look at the adult dosage for procainamide. Pro Tip #2: The use of procainamide is limited in ACLS for cardiac arrest due to its requirements of slow infusion, as well as its occasional unknown effectiveness. If you're administering procainamide for recurrent ventricular fibrillation and pulseless V-tach, you should give 20mg per minute via IV infusion up to total max dose of 17mg per kg. For supraventricular tachycardia, atrial fibrillation, and wide complex tachycardia of uncertain origin, administer procainamide at 20mg per minute via IV infusion up to a total maximum dose of 17mg per kg. For maintenance doses of procainamide, administer the drug at 1 to 4mg per minute titrated to the desired effect and the patient response. It's important to note that the use of procainamide should be stopped if any of the following occurs: Arrhythmia suppression The onset of hypotension The QRS complex widens by more than 50 percent of its pretreatment width The maximum dose of 17mg per kg is reached A Word About Wide Complex Tachycardias Since wide complex tachycardias are one instance in which you may administer procainamide, let's take a broader look at it. Wide-complex tachycardias are defined as a QRS of 0.12 seconds or more. The most common types of life threatening wide complex tachycardias that are likely to deteriorate to ventricular fibrillation are: Monomorphic ventricular tachycardia Polymorphic ventricular tachycardia You should determine if the rhythm is regular or irregular: A regular wide complex tachycardia is presumed to be ventricular tachycardia or supraventricular tachycardia with aberrancy. An irregular wide complex tachycardia can be the following:a. Atrial fibrillation with aberrancyb. Pre-excited atrial fibrillation, such as atrial fibrillation using an accessory pathway for antegrade conductionc. Polymorphic ventricular tachycardia/torsade's de pointes These are all advanced rhythms requiring expert consultation. If the rhythm is likely ventricular tachycardia or supraventricular tachycardia in a stable patient, treat the condition based on the algorithm for that rhythm. If the rhythm etiology cannot be determined and is regular in its rate and monomorphic, recent research and evidence suggests that adenosine administered via IV is relatively safe for both treatment and diagnosis. IV antiarrhythmic drugs may be effective. The American Heart Association recommends procainamide, amiodarone, or sotalol. In the case of irregular wide-complex tachycardia, management of the condition should be focused on controlling the rapid ventricular rate, the conversion of hemodynamically unstable atrial fibrillation to sinus rhythm, or both. Again, expert consultation is advised. https://d3imrogdy81qei.cloudfront.net/video_images/4387/procainamide.jpg Yes 181 https://app.protrainings.com/courses/acls/certification/videos/ecg-interpretation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2463.mp4 ECG Interpretation To successfully manage a patient who is in cardiac arrest, the caregiver must carefully, immediately, and systematically identify the cardiac rhythm and choose the most appropriate treatment algorithm. In the following lessons, we'll look at different cardiac dysrhythmias that can lead to cardiac arrest, their characteristics, and the appropriate therapies used to treat and correct the particular dysrhythmia whenever possible. However, in this lesson, we'll first look at interpreting the information on ECGs. Pro Tip #1: It's important to remember that knowing the patient's medical history, including all the events that have led up to the medical emergency, will greatly aid you in determining if there's any chance of reversing underlying causes for the cardiac arrest. An example of the above would be assessing the patient using the five H's and five T's. (Which will be discussed in detail in the secondary survey section of this program.) The Five Hs Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo or hyperkalemia Hypothermia The Five Ts Tension pneumothorax Tamponade Toxins Thrombosis (coronary) Thrombosis (pulmonary) Pro Tip #2: It's also important to remember that until an underlying cause has been identified and corrected, pharmacological and electrical therapies might offer little or no help when trying to resuscitate a cardiac arrest victim. When assessing the electrical activity of a patient's heart, it's vital to recognize the underlying dysrhythmia and know how to treat it appropriately to restore a perfusing cardiac rhythm. A sinus rhythm is defined as any cardiac rhythm where depolarization of the cardiac muscle begins at the sinus node, which is characterized by the presence of correctly oriented P-waves on the electrocardiogram. An ECG waveform represents each electrical event in the cardiac conduction system during a cardiac cycle. However, this doesn't mean that the heart muscle is reacting properly or in correlation with the electrical patterns. It simply shows that the electrical events that may stimulate myocardial function are happening. (This will be discussed in more detail when we look at each individual rhythm.) Waveforms Explained For the following explanations, we'll be assuming that the waveform is normal, and that normal mechanical function is occurring. The P-Wave The P-wave is the first waveform in the complete waveform complex, and it's normally found upright in healthy patients. It represents the depolarization of both the right and left atria, which occurs at the same time. The PR Segment The segment between the P-wave and the R-wave represents the delay of the electrical circuit in the AV node. This segment shows the time it takes from the end of the P-wave to the beginning of the ventricular response, represented by the QRS complex. The QRS Complex The QRS complex is the combination of three of the graphical deflections seen on a typical electrocardiogram (EKG or ECG). It is usually the central and most visually obvious part of the tracing; in other words, it's the main spike seen on an ECG line. The Q-Wave The Q-wave represents the first activity of the ventricular depolarization and is usually the first negative deflection after the P-wave in the complete complex. (We'll discuss the significance of Q-wave formations specifically as it relates to certain dysrhythmias in each of the rhythm evaluations.) The R-Wave The R-wave is the first positive deflection after the P-wave. The S-Wave The S-wave is the first negative deflection after the R-wave. The ST Segment The ST segment represents the timeframe between ventricular polarization and repolarization. It's the baseline of the cardiac cycle and, therefore, electrically neutral; there should be no inflection or deflection as it's isoelectric. Pro Tip #3: An ST elevation or depression of more than 1mm can be clinically significant and may indicate an underlying cardiac issue, either acutely or chronically. The T-Wave The T-wave represents repolarization of the ventricles and should be seen moving in the same general direction as the QRS segment. If the T-wave is inverted, this could also indicate a potential cardiac problem. It's quite helpful for healthcare providers to have a repeatable and easy method for interpreting ECG rhythms, which is why we'll be following a serial pattern for reading and interpreting all ECGs. Interpreting ECG Rhythms The pattern of interpretation most commonly used is to look at the following: Is the rhythm regular or irregular? Is the heart rate normal, fast, or slow? To determine the patient's heart rate The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds. Each larger square is 5mm in length and represents .20 seconds. Therefore a 6 second interval would be 30 large squares. To determine the heart rate, count the number of QRS complexes over this 6 second interval and multiply by 10. Are the P-waves present? Do they occur regularly? Is there one P-wave for each QRS complex? Are they smooth, rounded, and upright? Do they all have a similar shape? Does the PR interval fall within the norm of .12 to .20 seconds? Is it constant? On the QRS complex, is the QRS interval less than .12 seconds? Is it wide or narrow? Are they similar in appearance? When using a systematic approach for interpreting ECG rhythms, you'll help yourself and your teammates to efficiently and effectively diagnose underlying cardiac conditions. Which, goes without saying, will also help the cardiac patient. https://d3imrogdy81qei.cloudfront.net/video_images/4389/ecg-interpretation.jpg Yes 351 https://app.protrainings.com/courses/acls/certification/videos/normal-sinus-rhythm https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2464.mp4 Normal Sinus Rhythm When talking about treating a patient for something that we consider abnormal, it's always helpful to define and understand what normal looks like, in this case, for a normal sinus rhythm. In this lesson, we'll look more closely at an example of a normal sinus rhythm on an ECG (aka EKG) for an adult patient and see what findings and measurements are considered normal, and what to be on the lookout for that would be considered abnormal. And at the end of the lesson, we'll provide a Word about acute coronary syndrome. *Normal Sinus Rhythm ECG/EKG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above graphic, it's regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? Remember, to determine the patient's heart rate you'll want to observe the following areas on the ECG paper printout and perform the following calculations. The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds. Each larger square is 5mm in length and represents .2 seconds. Therefore a 6 second interval would be 30 large squares. To determine the heart rate, count the number of QRS complexes over this 6 second interval and multiply by 10. In the ECG above, the rate is 80 beats per minute, and this is normal. For an adult patient, the normal heart rate range is 60 to 100 beats per minute. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? Do they occur regularly? Is there one P-wave for each QRS complex? Are the P-waves smooth, rounded, and upright? Do all the P-waves have a similar shape? The answer to each of those questions is, yes, meaning the P-waves are normal. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal for an adult patient, meaning between .12 and .20 seconds, or is it contained within one large square on the readout? Is the PR interval constant? The answer to both questions is, yes. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? Pro Tip: As long as the QRS fits within two small squares on the ECG printout and is not greater than three small squares, it's within the normal range. Is the QRS complex wide or narrow? If it's narrow, such as on the ECG printout above, then that's considered normal. Are the QRS complexes similar in appearance or are there noticeable differences? For the above ECG readout, the answer is, they're similar in appearance and thus normal. So, what is your cardiac interpretation? (This is something we'll be asking ourselves each time we look at a new ECG rhythm.) Based on these questions and on the findings from the ECG readout above, it's safe to say that the patient has a normal sinus rhythm. We have a regular rhythm. We have a normal heart rate. The P-waves look normal, with each being followed by a QRS complex. The PR interval is between .12 and .20 seconds. The QRS is less than .12 seconds. Unless the patient has no pulse or other serious signs or symptoms, it's safe to assume that there is nothing of significance, in a negative sense, from this patient's cardiac rhythm. A Word About Acute Coronary Syndrome As an ACLS provider, you should have the basic knowledge to assess and stabilize patients with acute coronary syndrome (ACS). In these cases, you will use the ACS algorithm as your guide to clinical strategy. The initial 12-lead ECG is used in all ACS cases to classify patients into one of three ECG categories. Each of these categories has different strategies of care and management needs. The three ECG categories are ST-segment elevation suggesting ongoing acute injury, ST-segment depression suggesting ischemia, and nondiagnostic or normal ECG. All three are outlined in the ACS Algorithm. Key components of these cases are: Identification, assessment, and triage of acute ischemic chest discomfort Initial treatment of possible ACS Emphasis on early reperfusion of the patient with ACS/STEMI (ST-Elevation Myocardial Infarction) Rhythms for ACS Sudden cardiac death and hypotensive bradyarrhythmias may occur with acute ischemia. You should learn to anticipate these rhythms and be prepared for immediate attempts at defibrillation and administration of medication or electrical therapy for symptomatic bradyarrhythmias. https://d3imrogdy81qei.cloudfront.net/video_images/4391/normal-sinus-rhythm.jpg Yes 183 https://app.protrainings.com/courses/acls/certification/videos/atrial-fibrillation-acls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2465.mp4 Atrial Fibrillation Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. In this lesson, we'll look at the three types of atrial fibrillation and then look at a typical ECG readout for an adult patient in AFib and provide a cardiac interpretation. And at the end of the lesson, we'll look at some common causes and side effects of AFib in adult patients. The Three Types of Atrial Fibrillation 1. Paroxysmal Paroxysmal, or transient atrial fibrillation, is defined by the following: Episodes that stop on their own Episodes that last anywhere from seconds to minutes, hours, or even up to one week 2. Persistent Persistent atrial fibrillation is defined by the following: Episodes that last longer than one week Episodes that last less than one week but are only stopped using either pharmacological intervention or electrical cardioversion 3. Long-Standing Persistent Long-standing persistent atrial fibrillation, formerly known as chronic or permanent atrial fibrillation, is defined as episodes that last longer than a year. Atrial fibrillation occurs when multiple electrical impulses are being generated in the atria and at the same time, which causes chaotic myocardia responses. AFib can diminish the preload and effectiveness of the cardiac contractions. This action could then cause the development of microemboli due to stagnant blood flow from the atria. In certain instances, this will even lead to a rapid ventricular response that's secondary to a reentry problem. Pro Tip: The electrical pattern on an ECG will have no discernible P-waves, but instead, will show fibrillatory waves between each QRS complex. And because there's a lack of coordinated electrical impulses generated from the atria traveling through the AV node into the ventricles, the result is usually an irregular ventricular response, which also occurs irregularly. Now let's take a look at an ECG for an adult patient in atrial fibrillation. *Atrial Fibrillation ECG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's 80 beats per minute, which is within normal range, but it's also variable because of its irregularity. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No! Do they occur regularly? The answer is obviously no again. Is there one P-wave for each QRS complex? No. Are the P-waves smooth, rounded, and upright? No, only fibrillatory waves are present. Do all the P-waves have a similar shape? Again, that answer is no, because they aren't present. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning between .12 and .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? Yes, it is within the normal range. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial fibrillation. We have an irregular rhythm. We have a rate that is 80 beats per minute but also variable/irregular. The P-waves are missing. There is no PR interval. The QRS is less than .12 seconds and thus normal. Common Causes and Side Effects of AFib in Adult Patients The causes of AFib are numerous, but some common underlying reasons for it are: Congestive heart failure Previous history of damage to the SA node Conductive system dysfunction, from either current or past myocardial infarction A traumatic injury An underlying disease Past or present use of harmful drugs A metabolic disorder Common side effects of AFib include but aren't limited to: A higher risk for coronary, cerebral, or pulmonary embolism and as a result of the increased potential for microemboli to develop, secondary to the lack of circulation of blood from the atria. Rapid ventricular response which can accelerate the ventricular rate to above 100 beats per minute. AFib combined with higher ventricular rates may decrease the amount of blood ejected from the heart due to the lack of, what is sometimes referred to as, the preloading atrial kick. https://d3imrogdy81qei.cloudfront.net/video_images/4393/atrial-fibrillation-acls.jpg Yes 281 https://app.protrainings.com/courses/acls/certification/videos/atrial-flutter https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2466.mp4 Atrial Flutter Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate. In this lesson, we'll look at why/how atrial flutter occurs, and then look at a typical ECG readout for an adult patient in atrial flutter and provide a cardiac interpretation at the end. On an ECG, atrial flutter typically includes sawtooth-like F-waves, which are either the result of an ectopic atrial pacemaker or because of rapid reentry pathways somewhere within the atria, but outside of the SA node. The origin of this ectopic pacemaker is usually somewhere in the lower atrium and closer to the AV node, thereby resulting in that distinct sawtooth wave pattern. Pro Tip #1: Due to this erratic electrical activity, the normal function of the SA node is usually suppressed and noneffective. Which is why, instead of a P-wave, atrial flutter will produce flutter, or F-waves. And as a result of the depolarization of the atria in an abnormal manner, the classic F-waves of atrial flutter resemble a sawtooth, hence the name. Now let's take a look at an ECG for an adult patient in atrial flutter. *Atrial Flutter ECG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is variable and dependent on the ratio of F-waves to the QRS complexes. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's variable due to its irregularity. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present, and do they resemble normal P-waves or just those sawtooth type of F-waves? Since the answer is, they resemble sawtooth style F-waves, all of the other P-wave questions you normally ask yourself do not apply, once you notice the F-wave flutter. There are no real SA node P-waves present. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning between .12 and .20 seconds or is it contained within one large square on the readout? The answer is no, because it's variable and there are no P-waves. Is the PR interval constant? Again, this is non-applicable because of the above answer. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? Yes, it is within the normal range. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial flutter. We have a variable rhythm that is dependent on the ratio of F-waves to the QRS complexes. We have a variable heart rate due to its irregularity. The P-waves are not normal and resemble sawtooth style F-waves. The PR interval is variable and there are no normal P-waves. The QRS is less than .12 seconds and thus normal. From the ECG alone, it would indicate that the patient is in atrial flutter Pro Tip #2: Structural heart disease is the usual cause of atrial flutter. In the same way that atrial fibrillation complicates adequate ventricular preload filling, atrial flutter complicates circulation and especially when it is accompanied by a syndrome called rapid ventricular rate or response. What is rapid ventricular rate or response? In some cases of AFib, the fibrillation of the atria causes the ventricles, or lower chambers of the heart, to beat too fast. When this happens, it's called a rapid ventricular rate or response, or RVR for short. Pro Tip #3: The faster the ventricular response, the more likely it is that the patient's circulation will be compromised. When the ventricles beat too rapidly, they aren't able to fill completely with blood from the atria. As a result, they can't efficiently pump blood out to meet the needs of the body. This can ultimately lead to heart failure. https://d3imrogdy81qei.cloudfront.net/video_images/4395/atrial-flutter.jpg Yes 178 https://app.protrainings.com/courses/acls/certification/videos/asystole https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2467.mp4 Asystole The term asystole simply refers to an absence of ventricular activity, which means the patient will exhibit no discernible electrical activity on an ECG readout. In most cases, asystole is a lethal arrhythmia and survival is extremely rare. In this lesson, we'll look at an ECG readout for a patient in asystole, tackle those H's and T's and provide some corresponding information about their diagnostic use, and at the end of the lesson, provide some information on asystole and technical problems. Asystole is a cardiac standstill where there is no discernable electrical activity. It Is represented by a straight flat, or almost flat, line on an ECG. Warning: However, do not rely on an ECG alone for your diagnosis of a patient in cardiac arrest. It's a good idea to always confirm it clinically, because what appears to be a flat line on the ECG can also be caused by a loose ECG lead. Now let's take a look at an ECG for a patient in asystole. *Asystole ECG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, there is no heart rhythm. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, there is no rate and no pulse. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No, making any other questions about QRS non-applicable. However, in some cases, a small P-wave can be seen but it isn't followed by any other waveforms. Pro Tip #1: If you notice these small P-waves on the ECG that aren't followed by any other waveforms, this can mean that, in rare cases, the atrial pacemaker may be trying to send an impulse but has no ventricular reaction. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning between .12 and .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? No. In fact, there is no evidence of a QRS complex, making any other questions about QRS non-applicable. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in asystole. Because there is no myocardial, electrical, or mechanical activity, there is no pulse and no circulation of blood and oxygen. Pro Tip #2: Asystole is most commonly seen following a period of unconverted ventricular fibrillations or ventricular tachycardia. And while asystole is most commonly seen after extended, untreated, and sudden cardiac arrest, it can also be caused by reversible conditions outlined below. The most common reversible causes of asystole can best be remembered by keeping in mind the H's and T's. H's and T's The following H's and T's are designed to help you identify (and easily remember) potentially reversible causes of cardiac arrest or factors that may be complicating your resuscitative efforts. The H's The T's Hypothermia Toxins Hyper or hypodalemia Tamponade Hypoxia Tension pneumothorax Hydrogen ion (acidosis) Thrombosis (pulmonary) Hypovolemia Thrombosis (coronary) A Word About Asystole and Technical Problems Asystole is a specific diagnosis. However, a flat line is not. The term flat line is nonspecific and can be the result of several possible conditions, including the absence of cardiac electrical activity, lead or other equipment failure, and/or operator error. Some defibrillators and monitors will signal the operator when a lead or other equipment failure occurs. However, some of these problems do not apply to all defibrillators. For a patient with cardiac arrest and asystole, you should quickly rule out any other causes of an isoelectric ECG, such as: Loose leads or those that are not connected to the patient or defibrillator/monitor No power source to the defibrillator/monitor Signal gain (amplitude/signal strength) that is too low https://d3imrogdy81qei.cloudfront.net/video_images/4397/asystole.jpg Yes 106 https://app.protrainings.com/courses/acls/certification/videos/ventricular-fibrillation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2468.mp4 Ventricular Fibrillation Ventricular fibrillation (also called VFib or VF) is caused by multiple ectopic electrical impulses which depolarize the myocardium in a chaotic fashion. This results in a quivering (or fibrillatory) heart that cannot produce a pulse or adequate cardiac output. In this lesson, we'll dig a little deeper into ventricular fibrillation and then look at a typical ECG readout for a patient in VFib and provide a cardiac interpretation. And at the end of the lesson, we'll provide a preview of the medications we'll be looking at in the following section of your ProACLS course. Now let's take a look at an ECG for a patient in ventricular fibrillation. *Ventricular Fibrillation ECG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's somewhere between 200 and 250 beats per minute and thus, extremely fast. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No. Do they occur regularly? No. Is there one P-wave for each QRS complex? No. Are the P-waves smooth, rounded, and upright? No, only fibrillatory waves are present. Do all the P-waves have a similar shape? Again, that answer is no, because normal P-waves aren't present. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning between .12 and .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? No. In fact, there is no evidence of a QRS complex. Is the QRS complex wide or narrow? Not applicable. Are the QRS complexes similar in appearance or are there noticeable differences? Not applicable, since not present. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in ventricular fibrillation. We have an irregular rhythm. We have no heart rate and no pulse. The P-waves are missing; there are only fibrillatory waves present. There is no PR interval. The QRS is nonexistent. When a patient is in ventricular fibrillation, the heart has no organized rhythm as well as no coordinated contractions. The electrical activity is very chaotic. The heart quivers and it does not pump blood. Therefore, pulses are not palpable. Ventricular fibrillation may be preceded by a brief period of ventricular tachycardia with or without a pulse. Pro Tip: VFib is a non-perfusing and lethal dysrhythmia that is most commonly seen during the first few minutes of cardiac arrest. Because of this, it's important that high-quality CPR be administered as soon as possible, including defibrillation, to increase that patient's chance of a successful resuscitation. A Word About Pharmacology (A Preview) It's important that you know basic information about medications and other interventions used in the ACLS algorithms. A basic understanding of pharmacology information includes the indications, contraindications, and methods of administration for each. You'll also need to know when to use which drug based on each clinical situation. Medications and interventions that we'll be looking at in detail in the upcoming ProACLS course section are: Adenosine Adenosine is a prescription drug used for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PVST), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). Adenosine is available under the following different brand names: Adenocard, and Adenoscan. Amiodarone Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat. Aspirin Aspirin, also known as acetylsalicylic acid (or ASA), is a medication used to treat pain, fever, or inflammation. Specific inflammatory conditions which aspirin is used to treat include Kawasaki disease, pericarditis, and rheumatic fever. Aspirin can also be given shortly after a heart attack to decrease the risk of death. And it can be used long-term to help prevent future heart attacks, ischemic strokes, and blood clots in people with a higher than normal risk. Atropine Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Dopamine Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure. Epinephrine Adrenaline, also known as epinephrine, is a hormone and medication. Adrenaline is normally produced by both the adrenal glands and a small number of neurons in the medulla oblongata where it acts as a neurotransmitter involved in regulating visceral functions. It's used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat. Fibrinolytic Agents Thrombolytic drugs, or fibrinolytic agents, are used to help dissolve blood clots. Blood clots can occur in any vascular bed. However, when they occur in coronary, cerebral, or pulmonary vessels, they can be immediately life-threatening. Coronary thrombi are the cause of myocardial infarctions. Cerebrovascular thrombi produce strokes. And pulmonary thromboemboli can lead to respiratory and cardiac failure. Lidocaine Lidocaine is used to relieve nerve pain after shingles (infection with the herpes zoster virus). This type of pain is called post-herpetic neuralgia. Lidocaine helps to reduce sharp/burning/aching pain as well as discomfort caused by skin areas that are overly sensitive to touch. Lidocaine belongs to a class of drugs known as local anesthetics. It works by causing a temporary loss of feeling in the area where you apply the patch. Lidocaine is available under the following different brand names: Lidocaine CV, and Lidopen. Magnesium Sulfate Magnesium sulfate is a naturally occurring mineral used to control low blood levels of magnesium. Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy. Magnesium sulfate is available under the following different brand names: MgSO4. Morphine Morphine is a pain medication of the opiate family which is found naturally in a number of plants and animals. It acts directly on the central nervous system to decrease feelings of pain. Morphine can be taken for both acute pain and chronic pain. It's frequently given for pain stemming from myocardial infarction and also during labor. And it can be administered a number of different ways, including by mouth, by injection, intravenously, and rectally. Nitroglycerin Nitroglycerin belongs to the group of medicines called nitrates. It works by relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload. Nitroglycerin is often used to prevent angina that's caused by coronary artery disease. And it can be used to relieve an angina attack that's already occurring. Oxygen Oxygen is the odorless gas that is present in the air and necessary to maintain life. Oxygen may be given in a medical setting, either to reduce the volume of other gases in the blood or as a vehicle for delivering anesthetics in gas form. It can be delivered via nasal tubes, an oxygen mask, or an oxygen tent. Patients with lung disease or damage may need to use portable oxygen devices on a temporary or permanent basis. Procainamide Pronestyl (procainamide hydrochloride) is a cardiac antiarrhythmic drug used to help keep the heart beating normally in people with certain heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). The brand name Pronestyl is discontinued in the U.S. Generic versions may be available. https://d3imrogdy81qei.cloudfront.net/video_images/4399/ventricular-fibrillation.jpg Yes 100 https://app.protrainings.com/courses/acls/certification/videos/bradycardia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2583.mp4 Bradycardia There can be many forms of bradycardia. Commonly seen blocks include sinus bradycardia, and for multiple blockages, complete and 3rd-degree heart block. In this lesson, we’ll look more closely at an example of what bradycardia looks like on an ECG for an adult patient and see what findings and measurements lead us to that conclusion. It’s vital to remember that if there are signs of bradycardia, regardless of whatever underlying reasons that are causing the patient to display symptoms related to bradycardia, we must first treat for the bradycardia, as it takes precedent over those underlying causes. *Bradycardia ECG for Adult Patient 1. The Heart Rhythm The first thing you’ll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above graphic, it’s regular. 2. The Heart Rate Next, you’ll want to look at the heart rate of the patient. What is the patient’s heart rate? Is it normal? Or is it too slow or too fast? In this case, it’s too slow, as the rate is less than 60 beats per minute. 3. P-Wave After looking at the heart rate, check to see if the patient’s P-waves look normal by asking yourself the following few questions. Are the patient’s P-waves present? In this case, the answer is, yes. Do they occur regularly? The answer is yes again. Is there one P-wave for each QRS complex? Yes, there is. Are the P-waves smooth, rounded, and upright? The answer is again, yes. Do all the P-waves have a similar shape? Yes, they all have a similar shape. 4. PR Interval Next, look at the PR interval on the patient’s ECG readout and ask yourself the following questions: Is the PR interval normal, meaning between .12 and .20 seconds or is it contained within one large square on the readout? The answer is yes, it’s between .12 and .20 seconds, consistent, and contained within one large square. Is the PR interval constant? Yes, it is. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .12 seconds? Yes, the QRS interval is between .06 and .11 seconds. Remember, as long as the QRS fits within two small squares on the ECG printout and is not greater than three small squares, it’s within the normal range. Is the QRS complex wide or narrow? In this case, it’s narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it’s safe to say that this patient is in sinus bradycardia. We have a regular rhythm. We have a slower than normal heart rate, at less than 60 beats per minute. The P-waves look normal, with each being followed by a QRS complex. The PR interval is between .12 and .20 seconds. The QRS is between .06 and .11 seconds. And the P:QRS ratio is 1:1. Bradycardia in adults can result from many things – from benign causes like aerobic exercise to pathological causes, such as: Structural heart disease Damage to the electrical conduction system (usually related to a past heart attack) Hypoxia Metabolic dysfunction Certain medications Pro Tip: To properly treat an adult patient in bradycardia, it’s important to get a thorough patient history, including a list of medications that the patient is taking, along with any other past medical problems that may have contributed to their bradycardia. Having said that, if the patient is showing symptoms related to their bradycardia, you should begin treating them for it while also asking yourself the following questions: What is the underlying cause of the bradycardia? Is that underlying cause reversible? Additional Bradycardia Information Bradycardia is defined as a slower than normal heart rate. The heart rates of adults at rest is usually between 60 and 100 beats per minute. For adults with bradycardia, their hearts beat fewer than 60 times a minute. Symptomatic Bradycardia Symptomatic bradycardia is defined as a heart rate less than 60 beats per minute that elicits signs and symptoms. However, the heart rate is typically less than 50 beats per minute. Symptomatic bradycardia exists when the following three criteria are present: The heart rate is slow. The patient has symptoms. The symptoms are due to the slow heart rate. https://d3imrogdy81qei.cloudfront.net/video_images/4539/bradycardia.jpg Yes 103 https://app.protrainings.com/courses/acls/certification/videos/supraventricular-tachycardia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2584.mp4 Supraventricular Tachycardia Supraventricular tachycardia, or SVT, refers to a tachycardia originating above the bundle of His, typically involving a reentrant circuit within or near the AV node. Unlike normal sinus rhythm, where the SA node drives a controlled, regular rate, SVT involves an abnormal electrical circuit that bypasses or overrides that normal pacemaker mechanism, resulting in a rapid heart rate. In this lesson, we'll take a deeper dive into supraventricular tachycardia for the adult patient, including looking more closely at an example of what it looks like on an ECG and see what findings and measurements lead us to our conclusion. Understanding Tachycardia Tachycardia simply describes an abnormally fast heart rate. And there are a several different types of tachycardias – narrow complex or wide complex and regular or irregular. To be more specific, if the QRS interval is less than 0.12 seconds in length, that signifies a narrow complex tachycardia, or SVT. If the QRS interval is greater than 0.12 seconds, that signifies a wide complex tachycardia, and we'll get more into wide complex tachycardias in a subsequent lesson. However, just know that this is significant because it's measurable and can tell us if the cause is atrial-based or ventricular-based. If the patient's heart rate is too fast for their condition or the condition of their heart, the result is usually a decrease in cardiac output, poor perfusion of oxygenated blood, and a decrease in blood pressure. Supraventricular Tachycardia (SVT) With SVT, that stimulus comes from a rogue myocardial cell that stimulates an erratic atrial contraction, or a series of erratic atrial contractions, like those found in patient's with atrial fibrillation and atrial flutter. Remember, Atrial fibrillation (also called AFib) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. And as you know, Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate. Pro Tip #1: While these appear to be the same, the difference is in the beat. Atrial flutter and atrial fibrillation are both abnormal heart rhythms. However, in atrial fibrillation, the atria beat irregularly, while in atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat. The important thing to note with SVT is that it can persist until there is medical intervention, or it can be intermittent and self-limiting and can come and go without warning. By looking at an ECG readout alone, SVT can be difficult to differentiate from sinus tachycardia, AFib, or AFL. However, there are things that you can look at to help you determine which rhythm is being displayed. Now let's take a look at an ECG for a patient with supraventricular, or narrow complex, tachycardia. *Narrow Complex Supraventricular Tachycardia ECG for Adult Patient 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's too fast and greater than 100 beats per minute. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? Yes, the P-waves are present and upright. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal for an adult patient, meaning between 0.12 and 0.20 seconds, or is it contained within one large square on the readout? Yes, it is. Is the PR interval constant? Yes. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than 0.12 seconds? Yes, the QRS interval is between 0.06 and 0.11 seconds. Is the QRS complex wide or narrow? In this case, it's narrow. Pro Tip #2: It's unusual for SVT to present with a wide complex QRS. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in supraventricular tachycardia. We have a regular rhythm. We have a faster than normal heart rate at greater than 100 beats per minute. The P-waves are present and upright. The PR interval is between 0.12 and 0.20 seconds. The QRS is between 0.06 and 0.11. The P:QRS ratio is 1:1. From the ECG alone, it would indicate that the patient is in SVT. However, patient signs and symptoms must be taken into account to properly identify the rhythm correctly and to determine whether or not treatment is necessary. The leading causes of most tachycardias are: Heart disease Electrolyte imbalance Medications Hypoxemia Other causes of hemodynamic instability Regardless of the cause, if the patient is unstable, rapid treatment must be given immediately to correct the cause of the tachycardia. Pro Tip #3: Keep in mind, a narrow complex tachycardia is less likely to cause hemodynamic instability and, in some cases, can be a normal response to the body requiring better circulation due to fear, exercise, or due to moderate bleeding resulting in blood volume issues. https://d3imrogdy81qei.cloudfront.net/video_images/4541/supraventricular-tachycardia.jpg Yes 132 https://app.protrainings.com/courses/acls/certification/videos/atrioventricular-blocks https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2586.mp4 Atrioventricular Blocks In this lesson, we're going to look at the four types of atrioventricular blocks, usually called AV heart blocks or AV blocks for short. The four types are: 1st degree heart block 2nd degree type 1 heart block 2nd degree type 2 heart block 3rd degree heart block We'll include an example ECG for each, so you can see the differences, while also reading about those differences. 1st Degree AV Heart Block First-degree heart blocks are usually caused by a delayed, inconsistent, and sometimes absent electrical conduction pathway traveling through the AV node and can exhibit the following signs on an ECG readout. *1st Degree AV Heart Block ECG for Patient 1. Rhythm regular 2. Rate normal or slow 3. P-waves present and upright 4. PR interval prolonged, beyond 0.20 seconds 5. QRS complex between 0.06 and 0.11 seconds (narrow) 6. P:QRS ratio 1:1 There is usually little to no clinical significance with this type of heart block. 2nd Degree Type 1 AV Heart Block (Mobitz Type 1) Second-degree type 1 heart blocks, also known as Mobitz type 1 or Wenckeback's AV blocks, is commonly caused by: Heart disease affecting the AV node Vagal stimulation that's often associated with difficult bowel movements Coughing fits Certain medications An ECG for a patient with Mobitz type 1 will exhibit the following signs. *2nd Degree Type 1 (Mobitz type 1) AV Heart Block ECG for Patient 1. Rhythm regularly irregular 2. Rate normal or slow 3. P-waves present and upright 4. PR interval progressively lengthening until a P-wave is not followed by a QRS, then resets 5. QRS complex between 0.06 and 0.11 seconds 6. P:QRS ratio 1:1 until the P-wave is blocked Pro Tip #1: The QRS complex will become progressively delayed at the AV node until it completely disappears. When this happens, the ECG will only show a P-wave but no QRS following it. 2nd Degree Type 2 AV Heart Block (Mobitz Type 2) The third type of heart block is regularly known as a Mobitz type 2 block. It usually occurs when the heart block is below the AV node. A Mobitz type 2 block is usually caused by more advanced heart disease and can also originate from damage below the bundle of His. Because of this, Mobitz type 2 can deteriorate more quickly into a symptomatic dysrhythmia and could eventually become a 3rd-degree heart block. An ECG for a patient with Mobitz type 2 will appear to have intermittent blocks where some P-waves do not have a QRS complex following, and there's typically no elongation of the PR interval. *2nd Degree Type 2 (Mobitz type 2) AV Heart Block ECG for Patient 1. Rhythm variable, depending on the P:QRS ratio 2. Rate variable, but usually slow 3. P-waves present and upright 4. PR interval between 0.12 and 0.20 seconds 5. QRS complex usually wide > 0.12 seconds, but can be narrow < 0.12 seconds 6. P:QRS ratio variable – 2:1, 3:1, 4:1 and greater 3rd Degree AV Heart Block The fourth and last type of heart block is called a 3rd degree or complete AV heart block and is the most serious of the four. A 3rd-degree heart block occurs when the electrical conduction is completely blocked between the atria and the ventricles. The exact location of the block can vary, however it's usually around the AV node or lower but will disassociate the SA pacemaker from the AV or bundle of His pacemakers. Pro Tip #2: When this happens, a 3rd degree AV heart block will create an ECG readout that shows regular P-waves, regular QRS waves, but they'll be at different rates that are completely disassociated altogether. An ECG for a patient with a 3rd-degree heart block will exhibit the following signs. *3rd Degree AV Heart Block ECG for Patient 1. Rhythm regular 2. Rate ventricular rate is bradycardic between 20 and 40 beats per minute, normal atrial rate 3. P-waves present and upright, though independent of the ventricle rate 4. PR interval variable with no set pattern 5. QRS complex greater than 0.12 seconds 6. P:QRS ratio variable The clinical significance of this type of dysrhythmia is serious. The patient will usually be symptomatic and unstable due to their very slow bradycardic heart rhythm and rate. Pro Tip #3: This type of heart block is preventing any pace that originates from the SA node. Therefore, the ventricular pacemaker will stimulate a pulse rate closer to 20 to 40 beats per minute, which is usually not enough to maintain a stable blood pressure. This is why the ECG readout will usually display wide QRS complexes. Studies have shown that 3rd degree AV heart blocks may be transient or permanent, depending on underlying causes. https://d3imrogdy81qei.cloudfront.net/video_images/4545/atrioventricular-blocks.jpg Yes 287 https://app.protrainings.com/courses/acls/certification/videos/pulseless-electrical-activity https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2587.mp4 Pulseless Electrical Activity Pulseless electrical activity, most commonly known as PEA, is a condition where the electrical activity of the heart is not accompanied by a palpable or effective pulse. It's important to find out the potential cause, correct it, and hopefully get a pulse back for that patient. In this lesson, we'll look closer at PEA, outline several possible causes, including an important caveat or warning. And at the end of the lesson, we'll provide an additional Word on pulseless electrical activity. Treatable Causes for PEA It's always important to treat the patient's symptoms, rather than rely on the ECG readout alone. Underlying and treatable causes for PEA include: Pulmonary thrombosis Coronary thrombosis Tension pneumothorax Cardiac tamponade Hypovolemia Hyperkalemia Hypoxia Hydrogen ion (acidosis) Pro Tip: It's important to rule out any and all of the treatable H's and T's as underlying causes for pulseless electrical activity in order to correct the mechanical disassociation that could be causing the cardiac arrest. Warning: The ECG interpretation for a patient exhibiting signs of PEA could be the same as normal sinus rhythm. Which is why treating the patient's symptoms, particularly when it comes to pulseless electrical activity, is so important. Rather than merely reacting to and relying on the rhythms that are being displayed on the ECG monitor. An Additional Word on Pulseless Electrical Activity Pulseless electrical activity (PEA) is not a specific rhythm. Instead it's a term used to describe any organized electrical activity – but not VFib or asystole — on an ECG or cardiac monitor that is associated with no palpable pulses. Pulsations can be detected by an arterial waveform or Doppler study. However, pulses are not palpable. The rate of electrical activity may be slow (which is most common), normal, or fast. Very slow PEA can also be referred to as agonal. When a patient is in PEA, the ECG can display normal or wide QRS complexes, as well as other abnormalities, which include: Low or high-amplitude T-waves Prolonged PR and QT intervals Atrioventricular disassociation Complete heart block Ventricular complexes without P-waves It's important to remember to assess the patient's monitored rhythm and note the rate and width of the QRS complexes. And as mentioned above, PEA can be caused by reversible conditions easily remembered as the H's and T's. Warning: One important takeaway is this: Unless you can quickly identify and treat the cause of PEA, the rhythm will likely deteriorate to asystole. The adult cardiac arrest algorithm is the most important algorithm to know for adult resuscitation. This algorithm outlines all of the assessment and management steps you'll need to know for all pulseless patients who do not initially respond to basic life support interventions, including the first shock from an AED. The algorithm consists of the two pathways for a cardiac arrest: A shockable rhythm, such as VFib or pulseless V-tach A non-shockable rhythm, such as asystole or PEA Common medications used to treat VFib or pulseless V-tach include: Epinephrine Norepinephrine Lidocaine Magnesium sulfate Dopamine Oxygen Other medications, depending on the cause of the V-tach or pulseless V-tach arrest Common medications used to treat asystole and PEA include: Epinephrine Other medications, depending on the cause of the asystole or PEA arrest https://d3imrogdy81qei.cloudfront.net/video_images/4547/pulseless-electrical-activity.jpg Yes 82 https://app.protrainings.com/courses/acls/certification/videos/wide-complex-tachycardia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2588.mp4 Wide Complex Tachycardia Many wide complex tachycardias originate in the ventricles, but not all. The ones that don't include a bundle branch block, and a ventricular reentry problem, where the ventricles contract too early after a partial repolarization – like a pre-excited tachycardia or Wolff-Parkinson-White (WPW) syndrome. In this lesson, we'll look at monomorphic ventricular tachycardia (including an ECG), polymorphic ventricular tachycardia, or (thankfully) PVT for short (also including an ECG), and pulseless ventricular tachycardia. And at the end of the lesson, we'll provide a Word about treatments based on the type of tachycardia. Monomorphic Ventricular Tachycardia One very common V-tach is called monomorphic ventricular tachycardia, which means that all of the complexes are the same size, direction, and shape. It's usually caused by an ectopic pacemaker located somewhere in the ventricles. An ECG for a patient with monomorphic V-tach will exhibit the following signs. *Monomorphic V-tach ECG for Pediatric Patient 1. Rhythm regular, but could also be slightly irregular 2. Rate between 100 and 200 beats per minute 3. P-waves rarely discernible 4. PR interval not discernible 5. QRS complex greater than .11 seconds, wide and strange-looking 6. P:QRS ratio does not exist The main problem with this type of fast and wide complex tachycardias is that the hemodynamics are unstable. The heart rate is so fast that it inhibits the atrium from prefilling and preloading the ventricles before the next contraction. In these cases, it's important to know whether or not the patient is stable or unstable. Pro Tip #1: If the patient is stable, try to learn more about why the patient could be experiencing this type of arrhythmia. And remember, wide complex V-tach can sometimes be caused by heart disease, electrolyte imbalance (especially potassium) and a Q to T interval prolongation. If the patient is stable, check to see if their rhythm is supraventricular or ventricular in origin. Warning: If the patient is unstable, immediate treatment is vital. Polymorphic Ventricular Tachycardia Poly simply means multiple and describes the origin of electrical foci in the ventricles. In fact, polymorphic V-tach is caused by multiple ventricular foci with the resulting QRS complexes varying in axis, amplitude, and duration. Polymorphic V-tach can also be described as bi-directional V-tach, which is another type of polymorphic V-tach that is commonly associated with digoxin toxicity, commonly known as torsades de pointes. Along with digoxin toxicity, we often see polymorphic V-tach with hypokalemia or hypomagnesemia. An ECG for a patient with polymorphic V-tach will exhibit the following signs. * Polymorphic Ventricular Tachycardia ECG for Pediatric Patient 1. Rhythm irregular 2. Rate between 200 and 250 beats per minute 3. P-waves not discernible 4. PR interval missing 5. QRS complex variable, but greater than .11 seconds, wide and strange 6. P:QRS ratio missing In torsades, it can sometimes appear that the apex of the V-wave changes from top to bottom and back again. And actually, torsades (French in origin) literally translates as a twisting of points. The most important thing to remember with this type, along with monomorphic wide-complex V-tach, is that both can become pulseless V-tach or VFib pretty quickly. Pulseless Ventricular Tachycardia Pro Tip #2: One important thing to remember is that wide complex V-tach can present with or without a pulse and you may even see pulseless V-tach in a cardiac arrest patient. However, in most cases, pulseless V-tach will quickly deteriorate into VFib. Also keep in mind that pulseless V-tach is treated the same as VFib and that recognition of the condition and treatment for it will be vital for a potential positive outcome. Pro Tip #3: An ECG interpretation for pulseless V-tach can be the same for pulsed V-tach. The difference is that the patient is unresponsive, not breathing normally, and has no pulse. A Word About Treatments Based on Type of Tachycardia Distinguish between supraventricular and ventricular rhythms can be difficult. Most wide complex tachycardias are ventricular in origin, particularly if the patient is older or has underlying heart disease. If the patient is pulseless, you should treat the rhythm as VFib and follow the cardiac arrest algorithm. If the patient has a wide complex tachycardia and is also unstable, you should assume it's V-tach until proven wrong. The amount of energy required for cardioversion of V-tach is determined by the following morphologic characteristics. 1. If the patient is unstable but has a pulse with regular, uniform wide complex V-tach, or monomorphic V-tach: Treat with synchronized cardioversion and an initial shock of 100 joules If there is no response to the first shock, it's reasonable to increase the dose in a stepwise fashion 2. Arrhythmias with a polymorphic QRS appearance, or polymorphic V-tach, such as torsades de pointes, will usually not permit synchronization. If the patient has polymorphic V-tach: Treat as VFib with high-energy, unsynchronized shocks, such as defibrillation doses If there is any doubt about whether an unstable patient has monomorphic or polymorphic V-tach, don't delay treatment for further rhythm analysis. Instead, go right into providing high-energy, unsynchronized shocks. https://d3imrogdy81qei.cloudfront.net/video_images/4549/wide-complex-tachycardia.jpg Yes 254 https://app.protrainings.com/courses/acls/certification/videos/acls-philosophy https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2772.mp4 ACLS Philosophy Before we get into the depth of the ACLS course, it's important to go over the philosophies of ACLS, which is the subject of this important lesson. And at the end of the lesson, we'll provide you with a word about the optimization of ACLS. If you look back 10 or 20 years, ACLS training and certification has changed significantly. Two decades ago, it was more about the technical aspects of acquiring the skills necessary for certification and training. A couple examples of this: If you were learning about intubating a patient, you'd be expected to show or prove that you could actually perform this skill on a dummy or mannequin. You'd have to demonstrate the proper use of the techniques involved. And you'd have to show that you could properly use the appropriate tools to get the job done successfully. If you were learning about starting an IV, you would have been expected to demonstrate that you could actually start an IV on a mannequin. However, these days, it's important to point out that advanced cardiovascular life support training and certification is NOT about the technical aspect of the job or the skills acquisition part of the job. Today, ACLS training is more about learning and understanding all the signs and symptoms of emergent cardiovascular problems that require advanced cardiovascular life support care, in order to help stabilize the patient and possibly save a person's life. Pro Tip #1: So, in a sentence, ACLS training and certification has gone from techniques to greater understanding. Knowing that upfront will serve you well as you progress through your ACLS course. Having said that, though, it's probably fair to assume that not all of you are as polished when it comes to your advanced cardiovascular life support skills as you need to be, or as you want to be. And yet, the situation may exist for some of you where you could be called upon to assume the team leader role in a cardiovascular emergency one day. For this reason, we have built this ACLS certification course, or re-certification for some, so that each of you can pretend at some point to assume those all-important team leader responsibilities and that role in general. In fact, to pass your ProTrainings' ACLS course, you must fulfill the obligations and demonstrate the responsibilities of a team leader. You will be expected to show that you can sufficiently orchestrate and execute a code and perform it as well as can be expected. However, we also understand that in your particular role and organization, you may never be put into that type of position. But since none of us can predict the future, and since these skills can potentially be vital at some point, we encourage you to receive this education and training in the most serious way. Our hope and expectation is that you will practice the different scenarios in a way, regardless of the chances of you being put into one of these positions, in which you can say to yourself – if for some reason I'm ever called upon to be a team leader, I'll have the confidence and understanding of not only the cognitive skills, but also the tactile skills. And ultimately be able to make a difference in a patient's life in a positive way. Which is why we have this challenge for you: If there are any skills that you do not feel comfortable with but maybe one day you'll be called upon to use, take the onus upon yourself. Be the best healthcare professional you can be and seek out the additional education and practice that you need. And sharpen any skills you feel deficient in. Take advantage of this self-paced ACLS training program. And become the best ACLS provider that you can be. After all, you never know when you'll be called upon to execute those life-saving skills. A Word About the Optimization of ACLS CPR can be defined as a series of lifesaving actions that can improve the chances of survival after cardiac arrest. And while the optimal approach to CPR can vary, depending on the rescuer, the patient, and whatever resources are available, the fundamental challenge remains how to achieve early and effective CPR. One way to maximize the effectiveness of CPR, and thus improve patient survival rates, is by limiting chest compression interruptions. ACLS is best optimized when a team leader can effectively integrate high-quality CPR with minimal interruptions of high-quality compressions with advanced life support strategies, such as defibrillation, medication therapy, and advanced airways. The importance of minimizing these interruptions in chest compressions cannot be overstated. For instance, studies have shown that reducing the interval between pausing chest compressions and shock delivery can increase the predicted shock success. Which is why interruptions in compressions should only be limited to those critical interventions, such as interruptions for rhythm analysis, shock delivery, intubation, and so forth. And even then, those interruptions must always be minimized to less than 10 seconds. https://d3imrogdy81qei.cloudfront.net/video_images/5003/acls-philosophy.jpg Yes 202 https://app.protrainings.com/courses/acls/certification/videos/overview-of-primary-assessment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2773.mp4 Overview of Primary Assessment In this lesson, we'll cover the primary patient assessment by thoroughly checking the ABCDE's in ACLS for unconscious patients who are in full arrest that are either cardiac or respiratory in nature. However, all ACLS healthcare providers should conduct a primary assessment after first completing a basic life support assessment. This BLS assessment includes checking for responsiveness with taps and shouts, and if the patient is found to be unresponsive, calling 911 or calling in a code. Also check the patient for breathing and a pulse and defibrillate if necessary. However, for unconscious patients who need a more advanced level of assessment and management, you should conduct a primary assessment first. During your primary assessment, continue to assess and perform all actions appropriately until the patient is transferred to the next level of care. Pro Tip #1: Oftentimes, members of a high-performance team will perform the assessment and actions in ACLS simultaneously. However, if this isn't the case, it's important to remember, per the latest guidelines, to assess the patient first then perform the appropriate actions. Keep in mind, when you get into the scenario-based testing part of this course, it's formatted in a linear fashion to simplify and clarify the vital skills needed to successfully pass the test. However, real-life ACLS codes have many working parts, many of which will happen dynamically and simultaneously to expediate important assessments, treatments, and therapies in order to help save the patient's life. The following is a breakdown of the primary ACLS primary assessment by using the ABCDE method. Airway It's vital to maintain an open airway in an unconscious patient. The ways in which you'll accomplish this include: Head tilt, chin lift Basic airway adjuncts like:• Oropharyngeal Airway (OPA)• Nasopharyngeal Airway (NPA) Advanced healthcare providers can use advanced airways if basic airways are not sufficient or if capnography is vital to a successful resuscitation. The different types of advanced airways include, but are not limited to: Endotracheal tubes Esophageal tracheal tubes Laryngeal tubes Laryngeal masks Pro Tip #2: It's important to weigh the costs vs. the benefits of advanced airway placements if they'll interrupt chest compressions. If a bag valve mask ventilation is adequate, you might want to wait before inserting a more advanced airway until the patient doesn't respond to initial resuscitation attempts with CPR and defibrillation or until ROSC occurs. Also keep in mind that some advanced airway devices, such as laryngeal masks and laryngeal tubes, can be placed while chest compressions continue. It's important to confirm the proper placement of all advanced airways. This can be done by a physical examination of the airway or a quantitative waveform from capnography readings. And CPR should be properly integrated with ventilations after intubating the patient to optimize pulse pressures and oxygenation of vital organs and cells. Pro Tip #3: Because movements from CPR and transportation can alter or dislodge an advanced airway, it's important to use a securing device to hold the advanced airway in place. And remember to monitor airway placement with continuous quantitative waveform capnography. Also, make note of your organization's protocols and operating procedures when using prescribed devices for tube immobilization. Breathing When assessing a patient's breathing, it's important to ask yourself, are ventilations and oxygenation adequate? For arrest patients, administer 100 percent oxygen, once ROSC is achieved, then 92%-98%, but for all other patients, titrate oxygen administration to achieve oxygen saturation of 94 percent or greater by pulse oximetry. And monitor quantitative waveform capnography and oxyhemoglobin saturation. Of course, you should rely on the visual of the patient's chest rising and falling to confirm breath compliance. But quantitative waveform capnography will better help you understand how well CPR and rescue breathing are working to oxygenate the patient and how well that patient is processing that oxygen from a biological perspective. Circulation It's important to assess and reassess the quality of CPR by monitoring the quantitative waveform capnography. And if PETCO2 is less than 10ml of mercury, this may be a sign that you should work to improve CPR quality. Pro Tip #4: If you're able to monitor intra-arterial pressures, and the relaxation phase or diastolic pressure is less than 20 ml of mercury, attempt to improve CPR quality by assessing compression depth, rate, and hand placement. Attach a monitor and defibrillator to check for arrhythmias or cardiac arrest rhythms like: Ventricular fibrillation Pulseless ventricular tachycardia Asystole Pulseless electrical activity Lastly, be sure to provide defibrillation cardioversion as needed. Obtain IV or IO access to deliver adequate fluid replacement, medications, and give appropriate drugs to manage rhythm and blood pressure. And later, check glucose levels, temperature, and incorrect perfusion. Disability When it comes to disability, check the patient for neurologic function and quickly assess for responsiveness, levels of consciousness, and pupil dilation, which may indicate brain death or viability, but not in every case. Assess disability using the acronym AVPU: A - Is the patient Alert?V - Does the patient respond to your Voice?P - Does the patient respond to Painful stimulus?U - Is the patient Unresponsive? Exposure Exposure is a reminder for healthcare providers to remove the patient's clothing and perform a good physical examination. While doing so, look for signs of trauma, such as: Bleeding Burns Unusual markings Medical alert bracelets https://d3imrogdy81qei.cloudfront.net/video_images/5005/overview-of-primary-assessment.jpg Yes 409 https://app.protrainings.com/courses/acls/certification/videos/acls-secondary-survey-overview https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2774.mp4 ACLS Secondary Survey Overview In this lesson, we'll get into some details on performing a secondary assessment for ACLS healthcare providers. And at the end of the lesson, we'll discuss some common questions, with answers, you may encounter during the assessment phase. Performing a secondary assessment overview in ACLS is different than performing a primary assessment in ACLS. And it's significantly different than performing a primary assessment in basic life support situations. In a nutshell, a secondary assessment ACLS overview is the process of differentiating between two or more conditions that share similar signs and symptoms. This includes a focused medical history, as well as thoroughly searching through the H's and T's for any intriguing underlying causes that may have contributed to the patient's condition. Pro Tip: Gathering a focused medical, and non-medical, history of the patient is highly recommended during the secondary survey. Ask yourself specific questions that are related to that history as well as the patient's presentation. To this end, use the following acronym and memory aide during your evaluations – SAMPLE. S - What are the patient's Signs and Symptoms?A - Does the patients have any Allergies?M - Is the patient taking any Medications, including the last dose?P - Is there anything in the patient's Past medical history that could be related?L - What was the Last meal that the patient consumed?E - What Events may have led to the patient's current condition? The answers to the above questions during your secondary assessment may help lead you to a correct and informed diagnosis and an appropriate course of treatment to help reverse the patient's condition and restore their health. Of particular importance are the H's and T's. To help you discover and treat any underlying causes that may have led to this event, consider the H's and T's to ensure you aren't overlooking any likely or dangerous possibilities. The H's and T's can help create a road map for you as you attempt to find possible diagnoses and the ensuing interventions and treatment options for your patient. The H's and T's are a tried and true reminder that can help you rule out some possibilities and also confirm other possibilities, and it's the focus of the next lesson. Some Helpful Q&A that May Help You During Your Secondary Assessment and Beyond In this section, we'll go over some common questions you may encounter in ACLS and specifically during the assessment phases. What are the most common causes of cardiac arrest? This is where the H's and T's can help you in identifying potential reversible causes of cardiac arrest as well as emergency cardiopulmonary conditions. The most common causes of cardiac arrest are: H's T's Hypovolemia Tension pneumothorax Hypoxia Tamponade (cardiac) Hydrogen ion (acidosis) Toxins Hypo/hyperkalemia Thrombosis (pulmonary) Hypothermia Thrombosis (coronary) Should I start CPR if I'm not sure if the patient has a pulse? If you aren't sure about the presence of a pulse, you should still begin cycles of compressions and ventilations. Unnecessary compressions are less harmful than failing to provide compressions if the patient needs them, as delaying or failing to start CPR in a patient without a pulse reduces the chance of their survival. How can I differentiate agonal gasps from normal breathing? As you know, agonal gasps are not considered normal breathing. And they may be present in the first minutes after sudden cardiac arrest. A patient with agonal gasps usually appears to be drawing air in very quickly. The mouth may be open, and the jaw, head, and/or neck will sometimes move with the gasps. Gasps can appear forceful or weak. Some time may pass between each gasp because they usually happen at a slow rate. The sound of the gasp can resemble a snort, snore, or groan. The important thing to remember is that gasping is not normal breathing and, instead, is a sign of cardiac arrest. What are some things to be aware of when trying to minimize CPR interruptions? As an ACLS provider, you must make every effort to minimize any interruptions in chest compressions. When you do have to interrupt compressions, try to limit those interruptions to no longer than 10 seconds, except in extreme circumstances, such as removing the patient from a dangerous environment. When you interrupt chest compressions, blood flow to the brain and heart stops. To this end, try and avoid the following: Prolonged rhythm analysis Frequent or inappropriate pulse checks Taking too long to give breaths to the patient Unnecessarily moving the patient How should I handle patients with DNAR orders? During basic life support, primary assessments, and secondary assessments, you should be aware of the reasons to stop or withhold resuscitative efforts, such as: Rigor mortis has set in Indicators of do-not-attempt-resuscitation (DNAR) status, like discovering a bracelet, anklet, or written documentation There is a threat to the safety of providers Out-of-hospital providers need to be aware of EMS-specific policies and protocols applicable to these situations. In-hospital providers and high-performance teams should be aware of any directives or specific limits to resuscitation attempts that are in place. For instance, some patients may consent to CPR and defibrillation but not to intubation or invasive procedures. Many hospitals will record this in the medical record. https://d3imrogdy81qei.cloudfront.net/video_images/5007/acls-secondary-survey-overview.jpg Yes 105 https://app.protrainings.com/courses/acls/certification/videos/acls-secondary-survey-hs-and-ts https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2775.mp4 ACLS Secondary Survey H's and T's In this lesson, we'll be going over the most common causes of cardiac arrest, which we touched on briefly at the end of the last lesson, as presented as what's commonly referred to as the H's and T's. This lesson will include a little information on common treatments for specific H's and T's, and at the end of the lesson, we'll provide you with a Word about diagnosing and treating underlying causes. Common Causes of Cardiac Arrest – the H's Hypovolemia – can often be corrected with fluid replacement. Hypoxia – can be corrected with appropriate oxygenation and tissue perfusion. Hydrogen ion or acidosis (respiratory or metabolic) – if respiratory, you can correct it with oxygen and respirations, and if metabolic, you might need sodium bicarbonate to correct it. Hypokalemia – when dealing with hypokalemia, you may need to administer potassium. Hyperkalemia – when dealing with hyperkalemia, you need to administer calcium chloride. Hypothermia Pro Tip #1: It's important to remember that with hypokalemia, you may see flat T-waves on the ECG, as well as something called U-waves. If you do see these, administer potassium magnesium per the protocols. Common Causes of Cardiac Arrest – the T's Tension pneumothorax – can often be relieved with needle decompression and later with a chest tube. Cardiac tamponade – this would require surgical intervention to correct. Toxins Pulmonary thrombosis – this would require a corrective procedure or thrombolytic therapy. Coronary thrombosis – the same as above is applicable, but additionally, treatment may also include percutaneous coronary intervention, commonly known as PCI. Pro Tip #2: Percutaneous Coronary Intervention, or PCI, (formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis. Warning: It's important to note that the most common causes of pulseless electrical activity (PEA) are hypoxia and hypovolemia, and both are potentially reversible. Which is why it's vital to look for evidence of these problems when assessing your patients. A Word About Diagnosing and Treating Underlying Causes Patients in cardiac arrest, such as VFib, pulseless V-tach, asystole, and PEA, require rapid assessment and management, as their cardiac arrest may be caused by an underlying and potentially reversible issue or condition. If you can quickly identify a specific condition that has caused or contributed to PEA and correct it, you may achieve ROSC. The identification of the underlying cause is extremely important in cases of PEA and asystole. When you're searching for the underlying cause, consider the following: Consider frequent causes of PEA by recalling the H's and T's Analyze the ECG for clues to the underlying cause Recognize hypovolemia Recognize drug overdose and/or poisoning Hypovolemia Hypovolemia is a common cause of PEA and initially produces the classic physiologic response of a rapid, narrow-complex tachycardia. And it typically produces increased diastolic and decreased systolic pressures. As the loss of blood volume continues, blood pressure will drop and will eventually become undetectable. However, the narrow QRS complexes and rapid rate will continue. You should consider hypovolemia as a cause of hypotension, which can deteriorate to PEA. Providing quick treatment can often reverse this pulseless state by rapidly correcting the hypovolemia. Common nontraumatic causes of hypovolemia can include occult internal hemorrhage and severe dehydration. Cardiac and Pulmonary Conditions Acute coronary syndromes involving a large amount of heart muscle can present as PEA. That is, occlusion of the left main or proximal left anterior descending coronary artery can present with cardiogenic shock rapidly progressing to cardiac arrest and PEA. However, in patients with cardiac arrest and without known pulmonary embolism, routine fibrinolytic treatment provided during CPR shows no benefit and is therefore not recommended. Massive or saddle pulmonary embolism obstructs flow to the pulmonary vasculature and causes acute right heart failure. In patients with cardiac arrest due to presumed or known pulmonary embolism, you should consider administering fibrinolytics. Pericardial tamponade may be a reversible condition. In the peri-arrest period, volume infusion in this condition may help while definitive therapy is initiated. Tension pneumothorax can often be effectively treated once recognized. Drug Overdoses or Toxic Exposures Certain drug overdoses and toxic exposures may lead to peripheral vascular dilatation and/or myocardial dysfunction with resultant hypotension. Your approach to poisoned patients should be aggressive, as the toxic effects can progress rapidly and may be of limited duration. In these situations, myocardial dysfunction and arrhythmias may be reversible. Numerous case reports confirm the success of many specific limited interventions with one thing in common: they buy time. Treatments that can provide this level of support include: Prolonged basic CPR in special resuscitation situations Extracorporeal CPR Intra-aortic balloon pumping Renal dialysis Intravenous lipid emulsion Specific drug antidotes, such as digoxin immune Fab, glucagon, and bicarbonate Transcutaneous pacing Correction of severe electrolyte disturbances, such as potassium, magnesium, calcium, and acidosis Specific adjunctive agents It's important to note that if the patient shows signs of ROSC, post-cardiac arrest care should be initiated. https://d3imrogdy81qei.cloudfront.net/video_images/5009/acls-secondary-survey-hs-and-ts.jpg Yes 103 https://app.protrainings.com/courses/acls/certification/videos/what-is-respiratory-arrest https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2776.mp4 What is Respiratory Arrest? Respiratory arrest cases occur when a patient has a pulse but is not breathing normally. It's important to remember that agonal aspirations is not considered normal breathing. In this lesson, we'll cover signs of respiratory distress and respiratory arrest, normal respiratory rates for adults, and some tools you may use when helping to properly oxygenate a patient in either respiratory distress or arrest. At the end of the lesson, we'll take a more in-depth look at airway management. Pro Tip #1: One sure-fire reliable sign of inadequate breathing is when the patient's breathing attempts do not produce visible signs of chest rise and fall. If you're unsure whether breathing is normal or not, look for this tell-tale sign. Respirations are only considered effective if there's enough volume of air inspired to circulate oxygen to the patient's brain and other vital organs, along with enough volume of air expelled to remove the proper amount of CO2. Pro Tip #2: The key element for helping a patient with respiratory problems is to recognize respiratory distress quickly and treat it appropriately before it transitions into respiratory arrest, which is much more serious and more difficult to treat. Signs of respiratory distress include: Pale, cool skin Changes in the patient's level of consciousness Changes in the patient's level of agitation The use of abdominal muscles to assist in breathing Wheezing Tachypnea (fast breathing) Bradypnea (slow breathing) The normal breathing rate for an adult is between 12 and 20 breaths per minute. Respiratory rates that are less than 8 breaths per minute require the healthcare provider to assist the patient with ventilations using a bag valve mask, a basic airway, or an advanced airway with 100 percent oxygen, or titrate to ensure SpO2 is greater than or equal to 94%. Pro Tip #3: As mentioned above, agonal gasps are not normal breathing. A patient who gasps will often look like he or she is drawing air in very quickly. The mouth can be open, and the jaw, head, or neck can move with the gasps. Gasps can appear forceful or weak. Some time can pass between gasps because they usually happen at a slow rate. The gasp can sound like a snort, snore, or groan. Again, this type of gasping is not normal breathing. Instead it is a sign of cardiac arrest. Tools such as capnography and oxygen saturation monitors can help to determine if enough oxygen is being delivered to the patient. Warning: Although oxygen is vitally important for a patient in respiratory distress or respiratory arrest, keep in mind that more oxygen isn't always better. Excessive ventilation can actually be harmful to the patient by reducing venous return and decreasing cardiac output. A Word About Airway Management Management Initial management for a patient in respiratory arrest involves maintaining a patent airway using a combination of manual head positioning and the insertion of a basic airway adjunct, such as an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). Positive-pressure ventilations are then provided using a bag-valve mask or a pocket mask device at a rate of 10 breaths per minute, or around 1 breath every 6 seconds. You should ensure that supplemental oxygen is attached to the ventilatory device you are using to deliver high concentrations of oxygen. Foreign Body Airway Obstruction (FBAO) A foreign body, such as a piece of food, can obstruct the airway and prevent the patient from moving air. FBAO is suspected when there is airway resistance and/or a lack of chest rise and fall when the airway is open, and attempts are made to ventilate. This is clearly a serious emergency that should be immediately corrected. Further management of the patient would obviously be futile if the airway is not patent. If the chest does not rise visibly and/or there is resistance during your initial attempts to ventilate the patient, reposition their head, and then reattempt to ventilate the patient. If subsequent breaths do not produce visible chest rise, you should perform 30 chest compressions to attempt to dislodge the obstruction. If your chest compressions fail to dislodge the airway obstruction, visualize the vocal cords with a laryngoscope, and remove the obstruction using Magill forceps. Advanced Airway Management While there are numerous advanced airway devices that you can use to secure a patient's airway, endotracheal intubation provides the best protection against aspiration if the patient regurgitates. Patients in both respiratory and cardiac arrest usually require prolonged ventilatory support and are at an increased risk for regurgitation and aspiration of stomach contents. Therefore, you should secure the patient's airway with an endotracheal tube or another advanced airway device. https://d3imrogdy81qei.cloudfront.net/video_images/5013/what-is-respiratory-arrest.jpg Yes 105 https://app.protrainings.com/courses/acls/certification/videos/respiratory-arrest-case-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2777.mp4 Respiratory Arrest Case Teaching In this lesson, we're going to take a look at a respiratory case that you could be confronted with at some point in your career. And at the end of the lesson, we'll take a brief look at alternative airway devices. For the purpose of this lesson, we're making you the team leader throughout this entire scenario, a move that will be repeated throughout this section of your ProACLS course. Here's what you know about the scene and situation. You have just come upon a 25-year-old male who appears to be unresponsive. Witnesses tell you that the man was wheezing and having a difficult time breathing. He then collapsed, which is how you find him. Your initial assessment recap: 25-year-old male Appears to be unresponsive Was having a difficult time breathing The patient then collapsed Let's also assume that the scene is safe and all personal protective equipment is available or in use. Pro Tip #1: While we've probably pointed this out before, it's important to remember that before engaging in any advanced life support actions, that you first practice basic life support. Proper Steps for Treating a Patient in Respiratory Arrest 1. The first thing you need to do is verify that the patient is indeed unresponsive. To this end, you (the team leader) direct a team member to use the tap and shout sequence to determine responsiveness. You find the patient to be unresponsive and call in a code team. 2. You direct a team member to check the patient for a pulse and signs of normal breathing. Your team finds that the male patient has a pulse but is not breathing normally. 3. You then direct the team member in charge of airway management to place a basic airway adjunct and begin rescue breathing with a bag valve mask at 15 liters per minute with oxygen. 4. You direct the airway management team member to give 1 breath every 6 seconds. Pro Tip #2: Make sure to look for visible signs of good chest rise and fall to ensure the rescue breaths are effective. 5. You then direct the team member in charge of the defibrillator and monitor to get a set of vitals and attach the ECG monitor to the patient. The vitals the team member gives you are as follows: a. Blood pressure: 100/70b. Pulse rate: 120 and weakc. O2 saturation: 94 percentd. ECG: normal sinus rhythm How do You Proceed with this Information? Since the ECG is showing a normal sinus rhythm, oxygenation is good, and the patient's blood pressure is normal, you continue providing rescue breathing and consider possible causes for the patient's respiratory arrest. In preparation for further treatment, you also decide to place an advanced airway and establish an IV. A Word About Alternative Airway Devices If you find yourself in a situation where endotracheal intubation is unsuccessful, and basic airway management techniques do not provide adequate ventilation, alternative airway devices that allow you to secure a patent airway should be considered. The laryngeal mask airway (LMA) is inserted blindly into the airway while it is guided in place using your middle finger. The mask, when properly seated, will cover the esophagus and facilitate airflow into the lungs. Dual-lumen airway devices, such as the esophageal Combitube, are also acceptable alternatives to intubation. Dual-lumen devices are also blindly advanced into the airway and will come to rest in the esophagus in most situations. Proper verification of its placement is accomplished by ventilating into the tube that produces clear and equal breath sounds and no epigastric sounds. This can also be confirmed with waveform capnography. Other alternative advanced airway devices, such as the King LT, and supraglottic airway devices, such as the LMA and iGel, may also be considered as alternatives to endotracheal intubation. https://d3imrogdy81qei.cloudfront.net/video_images/5015/respiratory-arrest-case-teaching.jpg Yes 115 https://app.protrainings.com/courses/acls/certification/videos/what-is-acute-coronary-syndrome https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2778.mp4 What is Acute Coronary Syndrome? In order for you to be a functional ACLS healthcare provider, you must have the basic knowledge and skills to recognize and treat patients with acute coronary syndrome, or ACS for short. In this lesson, along with the next lesson, you'll be learning how to assess and treat the ACS patient following the latest recommendations and guidelines. And at the end of the lesson, we'll provide you with a brief Word on the goals of therapy for patients with acute coronary syndromes, along with EMS and hospital-based components. An initial 12 lead ECG is used as part of the identification process for all ACS cases. The three ECG categories for ACS include the following: ST-segment elevation, which suggests an acute myocardial infarction (or AMI). ST-segment depression, which suggests ischemia Nondiagnostic or normal ECG STEMI (ST-Elevation Myocardial Infarction) will be the focus of this section as it is the most time-sensitive for reperfusion therapies and can also limit the amount and extent of the myocardial damage. Although 12 lead ECG interpretation is beyond the scope of this ACLS provider course, some practitioners who are already ACLS certified will have already been trained in the interpretation and reading of 12 lead ECGs. For those particular healthcare providers, this ACS case summarizes identification and treatment of STEMI patients. Pro Tip: Remember, the main goal of a STEMI acute coronary syndrome is to reperfuse myocardial tissue that is being damaged by the blockage. Reperfusion may involve the use of coronary angiography with a balloon, angioplasty, and angioplasty with a stent, also known as PCI –percutaneous coronary intervention. When PCI is used as the initial reperfusion treatment for STEMI, it's referred to as a primary PCI. Treatments other than primary PCI include, but are not limited to: Oxygen Aspirin or ASA Nitroglycerin sublingual tablet or spray Fibrinolytic therapies Heparin – UHF (Unfractionated Heparin) Heparin – LWMH (Low Molecular Weight Heparin) A Word About the Primary Goals of Therapy for Patients with Acute Coronary Syndromes The primary goals of therapy for patients with acute coronary syndromes (ACS) are to: Reduce the amount of myocardial necrosis that can occur in patients with acute myocardial infarction (AMI), thus preserving left ventricular function, preventing heart failure, and limiting other cardiovascular complications. Prevent major adverse cardiac events, such as death, nonfatal myocardial infarction, and the need for urgent revascularization. Treat acute, life-threatening complications of ACS, such as ventricular fibrillation (VFib), pulseless ventricular tachycardia (pVT), unstable tachycardias, symptomatic bradycardias, pulmonary edema, cardiogenic shock, and mechanical complications of acute myocardial infarction. Prompt diagnosis and treatment offers the greatest potential benefit for myocardial salvage. Therefore, it is imperative that all healthcare providers are able to recognize patients with potential acute coronary syndromes in order to initiate evaluation, appropriate treatment, and management as quickly and effectively as possible. EMS Components EMS components include: Prehospital ECGs The notification of the receiving facility of a patient with possible ST-segment elevation myocardial infarction (also known as a “STEMI alert") The activation of the cardiac catheterization team to shorten the reperfusion time Continuous review and quality improvement Hospital-Based Components Hospital-based components include: ED Protocols• Activation of the cardiac catheterization laboratory• Admission to the coronary ICU• Quality assurance, real time feedback, and healthcare provider education Emergency Physician• Empowered to select the most appropriate reperfusion strategy• Empowered to activate the cardiac catheterization team as indicated Hospital Leadership• Must be involved in the process and committed to support rapid access to STEMI reperfusion therapy https://d3imrogdy81qei.cloudfront.net/video_images/5017/what-is-acute-coronary-syndrome.jpg Yes 129 https://app.protrainings.com/courses/acls/certification/videos/acute-coronary-syndrome-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2779.mp4 Acute Coronary Syndrome Teaching In this lesson, we're going to let you play the role of team leader during an acute coronary syndrome emergency. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 55-year-old male who is conscious and alert. As you interview the patient and ask him how he's feeling, you learn that he is responsive, has an open airway, and is suffering from shortness of breath. You also learn that he was watching TV when the symptoms began, which was about 3 hours ago. And he's now complaining of chest pain, pressure in the chest, and is sweating. Your initial assessment recap: 55-year-old male Conscious and alert Shortness of breath Chest pain and pressure Sweating Symptoms began 3 hours previous You know the patient has a pulse and is breathing, so the next step is to check for more in-depth vital signs. As the team leader, you ask another available member of your team to attach a blood pressure cuff and place the patient on an O2 saturation monitor. A more detailed pulse check is taken, and his respiratory rate and temperature check are also assessed. However, even before vital signs are recorded, a first drug may be given to the patient if you suspect a heart attack, and that first drug would be aspirin. If this is the case, first ask the patient if he's allergic to aspirin or has problems with gastrointestinal bleeding. Pro Tip #1: Keep in mind, there's a difference between aspirin sensitivity and having an anaphylactic reaction to aspirin. Also, stomach upset doesn't qualify as gastrointestinal bleeding. If the patient answers yes to either of those two questions above, aspirin may be contraindicated. However, in our fictional scenario, the patient has no aspirin allergy, nor does he have any gastrointestinal bleeding issues. In this case, the correct dose would be somewhere between 160 and 324 mg of chewable aspirin, and in this particular scenario, you administer 324 mg. The team member now has the patient's vital signs and tells you the following: Pulse: 124 beats per minute and regular Respiratory rate: 22 Blood pressure: 140/90 Skin: cool and pale O2 saturation: 92 percent Based on this information, you decide that the patient is stable at the moment. One thing to keep in mind, however, is that the goal for oxygen therapy is to titrate the amount given to achieve at least 94 percent saturation. Pro Tip #2: It's not necessary and even potentially harmful to use high-flow oxygen to bring the O2 saturation higher, as high-flow oxygen therapy can reduce cardiac output and stroke volume, which can cause vasoconstriction at a time when you especially need vasodilation. Also, remember that oxygen is not recommended for an O2 saturation of 94 percent or greater. But since your patient has an O2 saturation of 92 percent, it would be appropriate to begin a low-flow amount of oxygen via nasal cannula between 2 and 4 liters per minute. Now that the patient's basic vital signs are known and oxygen has been established, it's important to get a 12-lead ECG on the patient. This will help you in assessing his need for fibrinolytic therapy. Pro Tip #3: Within the first 10 minutes of contact with a healthcare provider, a 12-lead ECG, a targeted patient history, and a physical exam all need to be done to assess whether or not fibrinolytic therapy is appropriate. When assessing a 12-lead ECG, an ST elevation or depression would create a strong suspicion of injury or ischemia. In this scenario, however, it looks like a normal sinus rhythm. And at this time, it's important to gain IV access to draw blood to send to the lab. A good choice for that would be an 18-gauge IV with normal saline at a TKO rate – a rate that flows just enough to keep the vein open. And since the patient is still complaining of chest pain and his blood pressure is above 90 systolic, nitroglycerin should be administered. Before giving the patient nitroglycerin, it's important to ask him if he's taken any erectile dysfunction drugs or any other medications that would behave in a vasodilatory fashion within the last 24 to 48 hours. If the patient has, nitroglycerin would be contraindicated. If the patient can have nitroglycerin, it would be given in a 0.4mg tablet or spray sublingually, and this can be repeated every 5 minutes for pain as long as his blood pressure remains above 90 systolic. Tell your patient that you're going to give him a tablet of nitroglycerin to be dissolved under his tongue, and that this should help with his pain. Pro Tip #4: Talk to your patient and tell him what to expect. In this situation, you could also mention that the nitroglycerin may cause a little bit of a headache or a tingling sensation under the tongue as normal side effects. It's important to monitor the patient closely and look for changes in his status, such as his level of chest pain and blood pressure, which should be assessed at least every 5 minutes (or serial vitals) in order to consider additional doses of nitroglycerin. In this scenario, the patient's level of pain is still at an 8 out of 10 and his blood pressure is 120/88. This would indicate the recommendation for a second dose of nitroglycerin, again at 0.4mg sublingually. It would also be appropriate to run another 12-lead ECG to see if any changes have occurred. The most important interventions early on for an ACS patient are: Provide adequate oxygenation Administer pharmacological interventions to reduce pain and anxiety Perform timely assessments:• 12-lead ECG• History• Blood labs The patient should be evaluated early for the possibility of fibrinolytic therapy, catheter lab consideration for percutaneous coronary intervention (PCI), or to be transferred for continued care at a cardiac unit. https://d3imrogdy81qei.cloudfront.net/video_images/5019/acute-coronary-syndrome-teaching.jpg Yes 343 https://app.protrainings.com/courses/acls/certification/videos/what-is-stroke https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2780.mp4 What is Stroke? In this lesson, we're going to look at the major types of stroke of which you should be familiar. But first, the word stroke is a general term that refers to an acute neurological impairment following an interruption in blood supply to a specific area of tissue within the brain. Although immediate stroke care is vital for every patient, the point of this particular lesson is about reperfusion therapy for acute ischemic stroke. There are two major types of stroke: Ischemic stroke – this type of stroke accounts for almost 87 percent of all strokes. It's usually caused by an embolism which occludes an artery and affects the subsequent tissue of the brain that that particular artery affected. Hemorrhagic stroke – this type of stroke accounts for around 13 percent of all strokes. It occurs when a blood vessel in the brain ruptures and bleeds into the surrounding tissue which causes damage. Warning: In cases of suspected or confirmed hemorrhagic stroke, fibrinolytic therapy is contraindicated, and the use of anticoagulants is to be avoided. Around 795,000 people have a new or recurrent stroke each year in the U.S., which is why stroke remains a leading cause of death in the U.S. Pro Tip #1: It's important to realize that early recognition and treatment of acute ischemic stroke is vital because IV fibrinolytic treatment should be provided as quickly as possible. Over the years, there have been significant improvements in stroke care because of the combined efforts between public education, 911 dispatch, early detection by EMS and triage, systematic hospital stroke protocol, and better overall management of stroke units. There has also been an increase in appropriate fibrinolytic therapies and overall stoke care has definitely improved. In many cases, ACLS providers are well within the scope of being qualified to identify and manage the initial care of patients who are displaying acute stroke symptoms. In stroke cases, it's important to recognize that while an ECG is helpful, it should not take priority over obtaining a computed tomography, known commonly as a CT scan. Pro Tip #2: It's also important to remember that no one arrhythmia is specific for or related to stroke. However, an ECG may help identify some evidence of a recent acute myocardial infarction or an arrhythmia such as atrial fibrillation, which could have caused that embolic stroke. Many stroke patients demonstrate arrhythmias, but if the patient is hemodynamically stable, treatment of such arrhythmias are not usually indicated. It is generally accepted and recommended to initiate and maintain cardiac monitoring during the first 24 hours of observation in patients who have experienced an acute ischemic stroke in order to detect atrial fibrillation and other potentially life-threatening arrhythmias. This is important because the goal of stroke care is to minimize brain injury and maximize recovery. Stroke Chain of Survival The American Heart Association and the American Stroke Association have developed a stroke chain of survival that is similar to the chain of survival for sudden cardiac arrest. The stroke chain of survival correlates actions to be taken by patients, family members, and healthcare providers in order to maximize stroke recovery. The established links in the stroke chain of survival are as follows: Rapid recognition and reaction to the stroke warning signs. Rapid EMS dispatch by calling 911. Rapid EMS system transport and pre-arrival notification to the receiving hospital by the EMTs. Rapid diagnosis and treatment upon arrival to the appropriate hospital. Patients with acute ischemic stroke have what is referred to as time-dependent benefit for fibrinolytic therapies, which is similar to patients with a myocardial infarction that demonstrates ST-segment elevation. However, in stroke cases, this time-dependent benefit is much shorter. Pro Tip #3: It's important to remember that the critical time period for the administration of IV fibrinolytic therapies begins with the onset of symptoms. The critical time periods from hospital arrival are as follows: The immediate general assessment should be within 10 minutes The immediate neurological assessment should be performed within 25 minutes The acquisition of a CT scan (or CAT scan) of the patient's head should be done within 25 minutes The interpretation of the scan should be completed within 45 minutes The administration of fibrinolytic therapies should be within 60 minutes from the time of emergency department arrival The administration of fibrinolytic therapies may be delivered in as much as 3 to 4.5 hours in some select patients timed from the onset of symptoms The administration of endovascular therapy should be within 6 hours in select patients timed from the onset of symptoms The admission to a monitored hospital bed should be within 3 hours https://d3imrogdy81qei.cloudfront.net/video_images/5021/what-is-stroke.jpg Yes 314 https://app.protrainings.com/courses/acls/certification/videos/stroke-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2781.mp4 Stroke Teaching In this lesson, we're going to let you play the role of team leader during a stroke emergency. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 70-year-old female patient. A friend of hers told you that she was watching TV when she started to feel weak and suddenly had difficulty speaking. Her left side also became very weak. When her friend tried to help her stand up, as told to you by the friend, your patient was unable to walk on her own. She is conscious and breathing normally but appears agitated. As you ask the patient a few questions, you notice that she's having difficulty speaking and also giving appropriate answers. Her friend said that she noticed the difficulty of speaking about 30 minutes ago. Your initial assessment recap: 70-year-old female Difficulty speaking Left side weakness Conscious and breathing normally Because the initial signs indicate a possible stroke, you should perform a stroke assessment. If you're a pre-hospital provider, you might want to perform an abbreviated assessment, known as the Cincinnati Prehospital Stroke Scale (CPSS). This abbreviated stroke assessment consists of four elements: Facial droop Arm drift Speech Time If you're an in-hospital provider, you might want to perform a more detailed full NIH stroke score to more completely document the patient's neurological status. During your patient's assessment, you found her to be conscious and alert. However, the patient does have facial droop, left arm drift, and has trouble speaking. This is enough information to call for a stroke team to respond and also order an emergency CAT/CT scan. The next step is to obtain a full set of vitals for this patient. So, you direct one of your team members to place a blood pressure cuff on the woman and also an O2 saturation monitor. The team member now has the patient's vital signs and tells you the following: Pulse: 78 beats per minute Respiratory rate: 18 Blood pressure: 124/100 Skin: warm and dry O2 saturation: 96 percent Based on your patient's vital signs, you determine that she does not need oxygen. At this time, you attach the monitor and get a 12-lead ECG. And as you look at the 12-lead printout, you see a normal sinus rhythm. You then direct the team member to continue checking the woman's blood pressure every 5 minutes and keep a close eye on any changes in her breathing. Pro Tip #1: An important diagnostic tool for potential stroke is blood glucose. Hypoglycemia or low blood glucose can mimic stroke symptoms, such as confusion and slurred speech, so it's important to rule this out. You direct a team member to check the patient's glucose level and find that it's normal at around 90. In order to consider fibrinolytic therapy, you need to determine the time since the onset of symptoms. And since the woman arrived at the emergency room, it's been another 15 minutes. Remember, symptoms began 30 minutes before the woman arrived into your care. Since the patient's blood pressure, O2 saturation, and blood glucose levels are all within normal limits, and since symptoms started less than 3 hours ago, you decide that this patient may be a good candidate for rtPA. Pro Tip #2: rtPA, also known as recombinant tissue plasminogen activator, includes specific medications like alteplase, reteplase, and tenecteplase. These are often used in clinical medicine to treat embolic or thrombotic stroke. Indications for rtPA include: Symptom onset less than 3 hours No history of strokes Normal blood glucose levels No blood thinners No contraindicated medications No other contraindications A clear CT scan If the patient has no history or previous strokes, isn't on blood thinners or contraindicated medications, or has other contraindications, then the CT scan will be the determining factor. If the CT scan shows no hemorrhage, you'll be able to go with rtPA. To get ready for this potential drug therapy, this would be the time to start an IV. You direct a team member to start an IV – 18 gauge antecubital with normal saline. And you'll keep this at a TKO rate. Remember, the goal is to recognize the patient's potential stroke signs early and get her the appropriate fibrinolytic therapy, or the most appropriate reperfusion strategy, in a timely remember. https://d3imrogdy81qei.cloudfront.net/video_images/5023/stroke-teaching.jpg Yes 212 https://app.protrainings.com/courses/acls/certification/videos/what-is-pulseless-arrest-v-fib https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2782.mp4 What is Pulseless Arrest V-fib? In this lesson, we're going to cover pulseless arrest and ventricular fibrillation. And at the end of the lesson, we'll provide you with a Word about cardiac arrest rhythms in general. Ventricular fibrillation, also known as VFib, and pulseless ventricular tachycardia, also known as V-tach, are lethal dysrhythmias that do not produce a pulse. VFib is the most common initial dysrhythmia in cardiac arrest patients and will regress to asystole if it isn't treated in a short amount of time. That treatment includes rapid defibrillation. Warning: Rapid defibrillation is vital. How vital? For every single minute that defibrillation is delayed, the chance of the patient surviving is reduced by a full 10 percent. The key steps to treating VFib are as follows: Rapid assessment to confirm the patient's cardiac arrest Starting CPR Applying the defibrillator Delivering the first shock Performing high quality CPR Performing high-quality CPR is equally vital, as is performing it with as few interruptions as possible. High-quality CPR is performed by giving cycles of compressions at a depth of 2 to 2.4 inches and at a rate of 100 to 120 compressions per minute, followed by 2 full rescue breaths that cause the chest to rise and fall. Pro Tip #1: Equally important is changing the CPR compressor, if available, every 2 minutes to avoid fatigue. Compressor fatigue leads to a shallower compression depth and a slower than optimal rate, both of which significantly and detrimentally affect the quality of CPR being performed. After the initial defibrillator shock has been delivered, it's important to then establish IV or IO access in order to deliver medications and fluids. The first medication that should be administered is epinephrine (or epi for short) at 1mg of the 1:10,000 concentration via rapid IV or IO push every 3 to 5 minutes. After that initial dose of epi is delivered, a second shock is then given. At this point you should also consider placing an advanced airway with capnography. Pro Tip #2: Remember that once an advanced airway is in place, your CPR compressions then become continuous. The compressions are still 100 to 120 per minute, along with the same depth, but you'll now deliver 1 breath every 6 seconds. If the patient remains in persistent VFib following the initial defibrillator shock and the first dose of epi, the next medication to be given is amiodarone at 300mg via rapid IV or IO push. A second dose of amiodarone can be given at 150mg. This dose can only be repeated one time after 3 to 5 minutes. Successful treatment of VFib continues by: Providing high-quality CPR Reassessing the patient's cardiac rhythm every 2 minutes Delivering a defibrillator shock if the VFib remains present And giving medications as indicated. A Word About Cardiac Arrest Rhythms This Word section covers the dysrhythmias that do not produce a palpable pulse, which leads to cardiac arrest. It is crucial to recognize and treat these rhythms as quickly as possible to improve the patient's chances of survival. Ventricular Fibrillation and Pulseless Ventricular Tachycardia The origin of ventricular fibrillation is due to multiple ectopic ventricular pacemakers, which depolarize in a random and chaotic fashion and spread throughout the myocardium. This results in uncontrolled myocardial quivering, or fibrillating, and does not produce cardiac output or a pulse. Ventricular fibrillation is clinically significant because it is a lethal dysrhythmia and, as mentioned already above, is the most common initial rhythm in sudden cardiac arrest for adult patients, and often occurring in public places or non-hospital settings. As you've already learned, immediate defibrillation is vital when it comes to managing ventricular fibrillation. Ventricular fibrillation of relatively large amplitude is often initially seen but becomes less coarse and less responsive to defibrillation as minutes pass. Myocardial ischemia or infarction and sudden cardiac rhythm disturbances are the most common causes of ventricular fibrillation in adults. Ventricular tachycardia (V-tach), can present with or without a pulse. Pulseless V-tach can occur in patients with cardiac arrest. While not as often as ventricular fibrillation, ventricular tachycardia can be witnessed as the first rhythm in cardiac arrest before it deteriorates further into ventricular fibrillation. Pulseless V-tach treatment is the same as ventricular fibrillation, as both require immediate defibrillation. Asystole The term asystole in cardiac arrest refers to ventricular asystole. Often, if you were to look at the monitor closely, you'll notice that there are still P-waves and atrial depolarization but no conduction to the ventricles. This results in a total absence of mechanical activity in the myocardium. For obvious reasons, ventricular asystole does not produce a pulse because the ventricles are not beating. It is usually the result of untreated ventricular fibrillation that will eventually degenerate into fine VFib and ventricular standstill or asystole. Other causes of asystole include severe hypoxia, acidosis, or electrolyte abnormalities. Pulseless Electrical Activity (PEA) PEA is not a particular cardiac rhythm. Rather, it's a condition in which an organized cardiac rhythm is not accompanied by a palpable pulse. PEA can be caused by anything that impedes myocardial mechanical activity or causes profound shock. Treatable causes of PEA include the H's and T's: hypoxia, hydrogen ion (acidosis), hypovolemia, hyperkalemia, hypothermia, toxins, cardiac tamponade, tension pneumothorax, pulmonary thrombosis, and coronary thrombosis. https://d3imrogdy81qei.cloudfront.net/video_images/5025/what-is-pulseless-arrest-v-fib.jpg Yes 147 https://app.protrainings.com/courses/acls/certification/videos/pulseless-arrest-v-fib-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2783.mp4 Pulseless Arrest V-fib Teaching In this lesson, we're going to let you play the role of team leader during a cardiac emergency – pulseless arrest VFib. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 56-year-old male patient who arrived at the ER complaining of moderate to severe chest pains and discomfort. He also has some weakness and shortness of breath. And symptoms have been ongoing for about 4 hours. Over the last 2 hours, his pain has intensified and is now radiating up into his neck, jaw, and down his left arm. When you ask him to assess his level of pain from 1 to 10, he says it's currently a 9. He also mentions that he's beginning to feel nauseous and may even vomit. As you continue to ask him more questions, he suddenly stops responding and now appears unconscious. Your initial assessment recap: 56-year-old male Severe chest pain Radiating into jaw, neck, left arm Pain currently at 9/10 Now appears unconscious Let's assume the scene is safe and your personal protective equipment is in place. You begin by instructing a team member to perform a tap and shout sequence to confirm the patient's unresponsiveness. And he remains unconscious and unresponsive. At this point, you call in a code or ask for additional help depending on you and your team's experience and level of expertise. Help is on the way. Your team checks for a carotid pulse and signs of normal breathing as you all begin gathering the appropriate equipment, which may or may not already be in the room. Your team finds no pulse and no signs of breathing. Someone in the team either places a CPR board under the patient or if he's on a hospital bed with a CPR button, you activate it at this time. Doing so will deflate the bed and create a hard surface, which will aid CPR efforts. Now is the time when you'll take a leadership role and assign team member roles. You begin by directing the recorder to record all times, treatments, and any other associated and relevant notes for that protocol. You assign a compressor and a monitor/defibrillator and remind the team that high-quality CPR must be given – 30 compressions at 2 to 2.4 inches deep and at a rate of 100 to 120 compressions per minute followed by 2 rescue breaths. Pro Tip #1: It's important for everyone on your team to remember that high-quality CPR has risen to the top of importance even in ACLS, so you communicate this to everyone on your team. You assign an airway person and directions to begin ventilations. An example of exactly how you might do this, especially if you're not used to being team leader is: Please prepared a basic airway adjunct and ventilate with 100 percent oxygen delivered via bag valve mask at 12 breaths per minute. Pro Tip #2: Now is a good time to begin thinking about advanced airways if protecting the patient's airway is important or if oxygenation with basic airways is insufficient. In order to obtain 100 percent oxygenation, you need to turn the oxygen regulator to 15 liters per minute and allow the bag valve mask reservoir to fill prior to giving ventilations. During CPR, the monitor/defibrillator team member is preparing the patient for rapid defibrillation – the ECG monitor and defibrillator pads are placed on the patient appropriately and as soon as ready, you'll give directions to your team to pause CPR to check the patient's underlying rhythm. You tell everyone, stand clear while the rhythm is analyzed. It indicated that the patient is in VFib. CPR is continued while the automated defibrillator charges (or if the defibrillator is manual, shocks will be delivered at 360 joules.) Once the defibrillator is fully charged, the monitor/defibrillator team member calls out, everyone stand clear; shocking on 3; 1-2-3. The monitor/defibrillator person then pushes the shock button. CPR resumes and you prepare the team for medications delivery. Pro Tip #3: While both IV and IO are acceptable, try IV first and only move to IO if you're unable to obtain patient IV access for effective medication and fluid delivery. Your team is able to get patent IV access via an 18 gauge in the left antecubital and start the patient on normal saline. The recorder team member states, It's been 2 minutes. You instruct the compressor and monitor/defibrillator to switch positions to have a fresh compressor at all times. This switch should occur at least every 2 minutes or sooner if you recognize insufficient compressions due to fatigue. As the compressor calls out the last few compressions – 28, 29, 30 – that's when the switch occurs. After 2 ventilations are delivered, the monitor/defibrillator switches positions with the compressor and readies his or her hands in the appropriate chest position, then begins effective chest compressions immediately after the last ventilation. Now is the time for the first medication delivery. You call out the drug order for 1mg of 1:10,000 concentration of epi via IV push flushed with 20cc of normal saline and wait for the IV/medication team member to repeat the order back to you, which they do. You verify the repeated order by saying, That's correct. CPR resumes for 2 more minutes. At the end of that cycle, you call out, Stop compressions, and allow the ECG to check the patient's rhythm. You find that the patient is still in VFib, so you call out for another shock to be delivered. At this time, you decide to secure an advanced airway to maintain the airway, give synchronous compressions with rescue breaths, and have the ability to monitor capnography. As the team leader, you request an advanced airway using an endotracheal tube. Someone on the team measures for it and inserts a #6 endotracheal tube with a stylet. The ET tube balloon is inflated after it passes between the left and right lobes. You also check the patient's stomach for any air sounds. Pro Tip #4: If you cannot detect any stomach air sounds and there are good breath sounds bilaterally, you know that the ET tube is in the correct spot. The recorder calls out, We're at 4 minutes. You instruct the rest of the team to stand clear of the patient while his rhythm is checked and then announce another switch for the compressor and monitor/defibrillator team members. The patient is still in VFib, so you prepare the team for a third shock. You instruct everyone to continue CPR and also direct the medication team member to prepare the next round of medication – amiodarone at 300mg followed by 20cc of normal saline. The medications team member repeats the order and you confirm it's correct. A second dose of amiodarone may be given for persistent VFib, which is half the initial dose, or 150mg, and administered after 2 more minutes of CPR and another shock if the rhythm has not converted. Alternatively, epi can be given every 3 to 5 minutes instead and staggered between shocks and CPR. This scenario continues until all treatment options have been exhausted and all possible causes have been ruled out. https://d3imrogdy81qei.cloudfront.net/video_images/5027/pulseless-arrest-v-fib-teaching.jpg Yes 504 https://app.protrainings.com/courses/acls/certification/videos/what-is-pulseless-electrical-activity https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2784.mp4 What is Pulseless Electrical Activity? In this lesson, we're going to cover a type of cardiac arrest known as pulseless electrical activity or PEA for short. At the end of the lesson, we'll provide you with an in-depth Word about the underlying causes of cardiac arrest (and PEA), otherwise known as the H's and T's. PEA is an organized rhythm without a pulse where the electrical activity of the heart may appear normal, but the heart muscle is not responding. What is super unique about PEA is that the heart muscle is completely disassociated from the electrical activity. Pro Tip #1: Any rhythm can deteriorate into PEA. So, it's really important to closely monitor the patient's pulse, blood pressure, and any underlying conditions he or she might have. Remember, performing high-quality CPR is the initial treatment for PEA. In addition to CPR, identifying the underlying causes early, such as the H's and T's, and providing treatment quickly, is the key to reversing most pulseless electrical activity. As mentioned above, some of the more common reversible causes of PEA can be more easily remembered by the H's and T's. The H's and T's PEA is associated with many conditions. As healthcare providers, you should memorize the list of common causes to keep from overlooking an obvious cause of PEA that might be reversed by appropriate treatment. The most common causes of cardiac arrest are presented as H's and T's as indicated below. The H's The T's Hypovolemia Tension pneumothorax Hypoxia Tamponade (cardiac) Hydrogen ion (acidosis) Toxins Hypokalemia Thrombosis (pulmonary) Hyperkalemia Thrombosis (coronary) Hypothermia     Of the H's and T's, hypovolemia and hypoxia are the two most common underlying and potentially reversible causes of PEA. Which is why it's important to look for evidence of these problems as you assess the patient. In these two cases – hypovolemia and hypoxia – it's vital to recognize the condition early and treat for it quickly with volume replacement and oxygen therapy. Pro Tip #2: Remember, pulseless electrical activity is not a shockable rhythm. Treatment involves high-quality CPR, proper airway management, IV or IO therapy, and the appropriate medication therapy. The primary medication to treat PEA is 1mg of epinephrine 1:10,000 concentration every 3 to 5 minutes via rapid IV or IO push. However, in order to correct PEA, the ultimate goal will always be to identify and treat the underlying cause of the cardiac arrest. A Word About the Underlying Causes of Cardiac Arrest In this Word section, we're going to take a closer look at the H's and T's, since they are so vitally important in treating PEA and other types of cardiac arrest. Hypovolemia Look for: a history of trauma or severe dehydration, flat jugular veins, and ECG is rapid with narrow ORS complexes. Treat with: give a 500ml bolus of normal saline and then reassess. Hypoxia Look for: profound cyanosis, suggestive blood gas readings, and airway problems. Treat with: effective oxygenation and ventilation. Hydrogen ion (acidosis) Look for: a history of diabetes, such as hyperglycemic ketoacidosis, suggestive blood gas readings, bicarbonate-responsive preexisting acidosis, and renal failure. Treat with: effective oxygenation and ventilation first, then consider sodium bicarbonate. Hyperkalemia/hypokalemia Look for: a history of renal failure, recent dialysis, diuretic use, and abnormal ECG findings. Treat with: calcium chloride and sodium bicarbonate for hyperkalemia, and cautious infusion of potassium and magnesium for hypokalemia. Hypothermia (spontaneous or environmental) Look for: a history of recent exposure to cold environment and low core body temperature. Treat with: remove from the cold environment, perform active internal rewarming, and limit defibrillations to one attempt and withhold cardiac medications until the core body temperature is raised above 86°F (30°C). Toxins (intentional/accidental overdose) Look for: a history of ingestion, empty bottles at the scene, abnormal neurologic exam, bradycardia, tachycardia, and a prolonged Q-T interval. Treat with: intubation, activated charcoal, antidotes specific to ingestion (naloxone for narcotics and sodium bicarbonate for tricyclic antidepressants), and hemodialysis for certain agents. Tamponade (cardiac) Look for: a history of thoracic trauma or invasive cancer, pulses not palpable during CPR, and jugular venous distention. Treat with: pericardiocentesis. Tension pneumothorax Look for: a history of thoracic trauma, pulses not palpable during CPR, jugular venous distention, absent breath sounds on the affected side, decreased compliance when ventilating, and contralateral tracheal shift (late) Treat with: needle decompression (thoracentesis) Thrombosis (coronary, ACS) Look for: a history suggestive of acute myocardial infarction (AMI) and ST-segment and T-wave changes Treat with: PCI or fibrinolytics Thrombosis (pulmonary) Look for: a sudden onset of dyspnea and pleuritic chest pain shortly before the arrest, cyanosis that persists despite supplemental oxygen, pulses not palpable during CPR, and jugular venous distention. Treat with: anticoagulation or fibrinolytic therapy. https://d3imrogdy81qei.cloudfront.net/video_images/5029/what-is-pulseless-electrical-activity.jpg Yes 126 https://app.protrainings.com/courses/acls/certification/videos/pulseless-electrical-activity-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2785.mp4 Pulseless Electrical Activity Teaching In this lesson, we're going to let you play the role of team leader during another cardiac emergency – pulseless electrical activity (PEA). From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 42-year-old male patient who fell out of a tree stand while hunting. He fell about 12 feet and may have landed on a tree stump. He walked back to his house and shortly after began to develop breathing difficulty and chest discomfort. While interviewing the patient, he tells you that his breathing is getting more labored and he's feeling lightheaded. Your initial assessment recap: 42-year-old male Fell about 12 feet Difficulty breathing Chest discomfort You place the patient on O2 via nasal cannula at 4 liters and his vital signs are taken: Blood pressure: 98/68 Pulse: 112 and tachy Respirations: 20 and shallow The patient begins to become less coherent and stops responding to your questions. Let's assume the scene is safe and your personal protective equipment is in place. You begin by instructing a team member to perform a tap and shout sequence to confirm the patient's unresponsiveness. And he remains unconscious and unresponsive. Your team checks for a carotid pulse and signs of normal breathing as you all begin gathering the appropriate equipment. Your team finds no pulse and no signs of breathing. Someone in the team either places a CPR board under the patient or if he's on a hospital bed with a CPR button, you activate it at this time. Doing so will deflate the bed and create a hard surface, which will aid CPR efforts. CPR has been initiated – 30 compressions at a depth of 2 to 2.4 inches deep at a rate between 100 and 120 compressions per minute and followed by 2 rescue breaths. Now is the time when you'll take a leadership role and assign team member roles. You begin by directing the recorder to record all times, treatments, and any other associated and relevant notes for that protocol. You assign an airway person and directions to begin with a basic airway providing breaths using a bag valve mask at 15 liters of oxygen at cycles of 30 compressions to 2 rescue breaths. While compressions are being given, you direct the monitor/defibrillator team member to attach the defibrillator pads to get the patient's initial rhythm and shock him if needed. As soon as the pads are on, you give directions to your team to pause CPR to check the patient's underlying rhythm. You tell everyone, Stand clear while the rhythm is analyzed. It shows what looks like a slow normal sinus rhythm. You call for the airway manager to check again for a pulse, or the compressor if the airway manager is busy. No pulse can be found, and you determine that the patient is in PEA. You direct the team to continue performing high-quality CPR and call for an IV to be established with an 18-gauge needle, start him on normal saline, and prepare to give medications. The recorder team member states, It's been 2 minutes. You instruct the compressor and monitor/defibrillator to switch positions to have a fresh compressor at all times. This switch should occur at least every 2 minutes or sooner if you recognize insufficient compressions due to fatigue. You take a quick look at the monitor – no longer than 10 seconds – to see if a shock needs to be given or CPR resumed. In this scenario, you still see what looks like a slow normal sinus rhythm and ask again for a pulse check. There is still no pulse; the patient is still in PEA. You direct the compressor to continue performing CPR and call for the first medication delivery. You call out the drug order for 1mg of 1:10,000 concentration of epi via IV push flushed with 20cc of normal saline and wait for the IV/medication team member to repeat the order back to you, which they do. You verify the repeated order by saying, That's correct. Pro Tip #1: Remember, flushing the line ensures that the medication gets into the central circulatory system more effectively. Also important to remember, CPR does not stop for the delivery of medications. At this time, you decide to secure an advanced airway to maintain the airway, give synchronous compressions with rescue breaths, and have the ability to monitor capnography. As the team leader, you request an advanced airway using an endotracheal tube. Someone on the team measures for it and inserts a #7 endotracheal tube with a stylet. The ET tube balloon is inflated after it passes between the left and right lobes. You also check the patient's stomach for any air sounds. Remember, if you cannot detect any stomach air sounds and there are good breath sounds bilaterally, you know that the ET tube is in the correct spot. The chest is also showing signs of good chest rise and fall, which also indicates the tube placement was accurate. When the ET tube is in place and capnography is attached, you look to see if compressions and rescue breaths are effective, and CPR quality looks great. The recorder calls out, We're at 4 minutes. The compressor and monitor/defibrillator team member switch again after the second dose of epi is given and flushed with 20cc of normal saline. Pro Tip #2: As team leader, part of your duties is to either encourage the CPR compressor when compressions are good or make suggestions to improve quality if they are not. You decide that now is a good time to ask the team for feedback to help determine why the patient is in PEA. You do this by considering the reversible H's and T's: The H's The T's Hypovolemia Tension pneumothorax Hypoxia Tamponade (cardiac) Hydrogen ion (acidosis) Toxins Hypokalemia Thrombosis (pulmonary) Hyperkalemia Thrombosis (coronary) Hypothermia     Since you're not sure if the trauma/fall is to blame for the PEA, or if something else is, you're open to suggestions from the team. The team considers the effects of the head and/or chest trauma from the fall and someone suggests tension pneumothorax could be the cause. You think about this but eventually dismiss it – the patient has good equal lung sounds and has great compliance when giving ventilations, which indicates it's probably not tension pneumothorax. Another member of the team suggests that chest trauma may be causing the PEA due to cardiac tamponade: Blunt trauma to the chest Low blood pressure Fast heart rate Fast breathing This sounds like a good suggestion and all measures for correcting it are expedited. However, what if all reversible causes have been eliminated and the patient remains in cardiac arrest? As team leader, you may reach a point when a decision to stop resuscitation may have to be made, especially if EtCO2 is less than 10 after 20 minutes of high-quality CPR and all treatment options have been exhausted. In many cases, PEA will deteriorate into asystole over time. It's never easy to call it quits. Everyone has invested a lot of effort and time and everyone on the team wants to see the patient survive. However, if nothing is working and the patient's condition isn't improving or is deteriorating further, you may have to make the hard decision to conclude the resuscitation attempt. https://d3imrogdy81qei.cloudfront.net/video_images/5031/pulseless-electrical-activity-teaching.jpg Yes 431 https://app.protrainings.com/courses/acls/certification/videos/what-is-asystole https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2786.mp4 What is Asystole? Asystole, sometimes referred to as a flat line on the monitor, represents an absence of both electrical and mechanical activity in the heart. In this lesson, we'll dig a little deeper into what it is and how it can be treated. And at the end of the lesson, you'll find a Word about the duration of resuscitative efforts. Pro Tip #1: It's important to understand that if a patient has no pulse and this is confirmed in one lead, there are a few things you can double-check to confirm this, such as: Are all the leads on correctly? Are all the leads attached to the patient with good contact? Does the ECG have a sufficient power supply? Is the amplitude set correctly to determine asystole vs. fine VFib? Like pulseless electrical activity (PEA), it's also important to determine what may have caused the patient's asystole, or in other words, examine the H's and T's. If you can figure out why the patient went into cardiac arrest, looking at the H's and T's will help you determine the possibility of treating any reversible causes of the asystole. Those H's and T's are: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypokalemia Hyperkalemia Tension pneumothorax Cardiac tamponade Toxins Cardiac thrombosis Coronary thrombosis Pro Tip #2: Asystole is not a shockable rhythm. So, treatment will involve high-quality CPR, airway management, IV or IO therapy, and medication therapy – specifically 1mg of epinephrine 1:10,000 concentration every 3 to 5 minutes via rapid IV or IO push. Having said that, it's rare for asystole to be reversed, especially if the patient has been in asystole for a long duration of time. Stopping resuscitation efforts is never an easy choice to make, and this is a gross understatement. However, if the patient is not responding to all of your basic and advanced cardiac life support treatment attempts, the decision to terminate resuscitation will need to be made. If you have a high degree of certainty that the patient will not respond to further ACLS interventions, then it would be appropriate to stop. When to Terminate Resuscitative Efforts As stated above, this will never be an easy decision. And the decision to do so must be based on your specific protocols and consideration of the following criteria: The time from the patient's collapse to CPR The time from the patient's collapse to your first defibrillation attempt The underlying causes if you've found any The patient's response to your resuscitation measures When the patient's EtCO2 is less than 10 after 20 minutes of CPR All of the above should be considered before deciding to terminate your resuscitation attempts in all patients in asystole. A Word About the Duration of Resuscitative Efforts While we already provided you with a list of criteria above that you can use to make this very difficult decision, let's dig a little deeper into the duration of resuscitative efforts. Deciding to terminate resuscitative efforts can never be as simple as an isolated time interval. If the return of spontaneous circulation of any duration occurs, it may be appropriate to consider extending your resuscitative efforts. Experts have developed clinical rules to assist in decisions to terminate resuscitative efforts for in-hospital and out-of-hospital arrests. However, you should also familiarize yourself with the established policy or protocols for your hospital or EMS system. For Out-of-Hospital Arrest You should consider the continuation of out-of-hospital resuscitative efforts until one of the following occurs: Restoration of effective, spontaneous circulation and ventilation Transfer of care to a senior emergency medical professional The presence of reliable criteria indicating irreversible death You, the rescuer, are unable to continue because of exhaustion or dangerous environmental hazards or because continued resuscitation will place the lives of others in jeopardy A valid DNAR order is presented Online authorization from the medical control physician or by prior medical protocol for the termination of resuscitation It might also be appropriate to consider other issues, such as drug overdose and severe prearrest hypothermia, due to submersion in icy water, for instance, when deciding whether to extend resuscitative efforts. Special resuscitation interventions and prolonged resuscitative efforts might be indicated for patients with hypothermia, drug overdose, or other potentially reversible causes of the arrest. https://d3imrogdy81qei.cloudfront.net/video_images/5033/what-is-asystole.jpg Yes 112 https://app.protrainings.com/courses/acls/certification/videos/asystole-case-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2787.mp4 Asystole Case Teaching In this lesson, we're going to let you play the role of team leader during a cardiac emergency – asystole. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 30-year-old female patient who was found unconscious in her office by coworkers. Witnesses tell you that she was emotionally distraught and may have had a chronic illness, as well as using different pain pills. By the time you find her, she appears cyanotic and seems to be unresponsive. You direct a member of your team or an assistant to check her responsiveness using taps and shouts and you get no response. You call in a code or ask for additional help depending on your situation and area of practice. Your initial assessment recap: 30-year-old female Found unconscious Appears cyanotic Is unresponsive Let's assume the scene is safe and your personal protective equipment is in place. You begin by instructing a member of your team to check for a carotid pulse and signs of normal breathing as you all begin gathering the appropriate equipment, which may or may not already be in the room. Your team finds no pulse and no signs of breathing. Someone in the team either places a CPR board under the patient or if she's on a hospital bed with a CPR button, you activate it at this time. Doing so will deflate the bed and create a hard surface, which will aid CPR efforts. CPR is initiated. Now is the time when you'll take a leadership role and assign team member roles. You begin by directing the recorder to record all times, treatments, and any other associated and relevant notes for that protocol. You assign a compressor and a monitor/defibrillator and remind the team that high quality CPR must be given – 30 compressions at 2 to 2.4 inches deep and at a rate of 100 to 120 compressions per minute followed by 2 rescue breaths. You assign an airway person and directions to begin ventilations. An example of exactly how you might do this, especially if you're not used to being team leader is: Please prepared a basic airway adjunct and ventilate with 100 percent oxygen delivered via bag valve mask at 12 breaths per minute. Remember, now is a good time to begin thinking about advanced airways if protecting the patient's airway is important or if oxygenation with basic airways is insufficient. In order to obtain 100 percent oxygenation, you need to turn the oxygen regulator to 15 liters per minute and allow the bag valve mask reservoir to fill prior to giving ventilations. During CPR, the monitor/defibrillator team member is preparing the patient for defibrillation – the ECG monitor and defibrillator pads are placed on the patient appropriately and as soon as ready, you'll give directions to your team to pause CPR to check the patient's underlying rhythm. You tell everyone, stand clear while the rhythm is analyzed. It indicated that the patient is in asystole. You decide to double-check that everything is working by asking yourself and the team the following questions: Are all the leads on correctly? Are all the leads attached to the patient with good contact? Does the ECG have a sufficient power supply? Is the amplitude set correctly to determine asystole vs. fine VFib? All answers point to the patient being in asystole and you instruct your team to continue providing high-quality CPR. While CPR resumes, you prepare the team for medications delivery. Pro Tip #1: Since asystole is not a shockable rhythm, you move immediately to gaining IV (or IO) access via an 18 gauge in the antecubital and call for 1mg of epinephrine 1:10,000 concentration via IV push flushed with 20cc of normal saline – to ensure the medication gets into the patient's central circulatory system. And perhaps most importantly, you instruct your team to continue CPR while the medication is being administered. The recorder team member states, It's been 2 minutes. You instruct the compressor and monitor/defibrillator to switch positions to have a fresh compressor at all times. This switch should occur at least every 2 minutes or sooner if you recognize insufficient compressions due to fatigue. You take a quick look at the monitor to see if there any changes in the patient's rhythm – no longer than 10 seconds – before deciding if you need to deliver a shock or continue with CPR. You tell the team that the patient is still in asystole and to continue with high quality CPR. At this time, you decide to secure an advanced airway to maintain the airway, give synchronous compressions with rescue breaths, and have the ability to monitor capnography. As the team leader, you request an advanced airway using an endotracheal tube. Someone on the team measures for it and inserts a #7 endotracheal tube with a stylet. The ET tube balloon is inflated after it passes between the vocal cords and lung sounds are oscillated for ET tube placement accuracy. Pro Tip #2: Both upper lobes and over the stomach are checked to ensure proper placement of the tube – in the trachea and not the esophagus. If you cannot detect any stomach air sounds and there are good breath sounds bilaterally, you know that the ET tube is in the correct spot. And it is. You tell your team, CPR quality looks good. Let's make sure to monitor capnography. The recorder calls out, It's been 4 minutes since the first dose of epi. You call for a second dose of epinephrine at 1mg 1:10,000 concentration via IV push followed by 20cc of normal saline. The medications team member repeats the order and you confirm it's correct. You keep an eye on chest compressions and remember to change compressors every 2 minutes or if you notice fatigue setting in to ensure adequate compressions throughout the code. You tell your team that CPR is looking good or you make suggestions for improvements. At this time, you encourage suggestions from your team as to why this patient may be in asystole. You consider the H's and T's: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypokalemia Hyperkalemia Tension pneumothorax Cardiac tamponade Toxins Cardiac thrombosis Coronary thrombosis Pro Tip #3: As a healthcare professional, you never know when a patient will survive against all odds and scientific reasoning. For this reason, you instruct your team to work with enthusiasm and high expectations throughout the resuscitation. However, it's also important to understand that studies have shown that asystole represents what's termed, the final rhythm. In other words, cardiac function and electrical activity have diminished over time until there is no perceivable electrical or mechanical activity in the patient. At which point, the patient, is biologically or permanently dead. Unless there are special circumstances, as provided in the last lesson's Word section, such as hypothermia or drug overdose, a prolonged resuscitation effort beyond 20 minutes is usually futile. As the team leader, you may have to consider stopping resuscitation, especially if the EtCO2 is less than 10 after high quality CPR and all other treatment options have been exhausted. https://d3imrogdy81qei.cloudfront.net/video_images/5035/asystole-case-teaching.jpg Yes 416 https://app.protrainings.com/courses/acls/certification/videos/what-is-bradycardia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2788.mp4 What is Bradycardia? In this lesson, we're going to cover bradycardia, including some things to be aware of when dealing with bradycardic patients, types of bradycardia, and some information on the best courses of treatment to resolve that patient's bradycardia. And at the end of the lesson, we'll dig a little deeper into the types of bradycardia. Absolute bradycardia is defined as a pulse rate less than 60 beats per minute. During your patient assessment, it's important to determine whether any life-threatening signs and symptoms are present that have been caused by that bradycardia. Bradycardia can present itself in several different cardiac rhythms, which include sinus bradycardia and varying degrees of AV heart blocks. Pro Tip #1: Regardless of the patient's rhythm, if their heart rate is too slow and the patient has symptoms from that slow heart rate, bradycardia should be treated to increase the heart rate and improve perfusion. For patients who are asymptomatic, you should continue to provide care with close monitoring and choose which appropriate treatment and care should be given. The primary treatment for symptomatic bradycardia includes the following: 1. Administration of supplemental oxygen if pulse oximetry is below 94 percent and establish IV access.2. Monitor the patient's ECG rhythm.3. Obtain a 12 lead as soon as possible, but don't delay therapy to get it.4. Administration of atropine at 1 mg via rapid IV push to increase the patient's heart rate.5. If atropine is proving to be ineffective, consider transcutaneous pacing. Pro Tip #2: If there are serious signs and symptoms that the patient is unresponsive, the first line of treatment should be transcutaneous pacing rather than atropine. 6. Consider the administration of other medications such as:a. An epinephrine infusion at between 2 to 10 mcg per minuteb. A dopamine infusion at between 5 and 10 mcg per kg per minute Warning: If you are dealing with a conscious patient who needs transcutaneous pacing, you may want to consider sedation first to help alleviate their discomfort. Some patients may present with relative bradycardia when their heart rate is over 60 beats per minute, but they present with a low blood pressure or decreased level of consciousness. In these cases, the same interventions would be required as a patient with absolute bradycardia. An Additional Word About Bradycardia As already mentioned above, bradycardia is defined by a heart rate of less than 60 beats per minute. This can result in a decrease in cardiac output, which may lead to a patient becoming clinically unstable if the patient's heart cannot compensate for the decreased rate by increasing its ability to pump more blood with each heartbeat. Also mentioned above, absolute bradycardia is defined as any heart rate less than 60 beats per minute. While relative bradycardia is a term used to describe a heart rate that is greater than 60 beats per minute but too slow given the patient's condition. For example, the patient may have a heart rate of 70 beats per minute, while also experiencing altered mental status, hypotension, or other signs of hemodynamic compromise. This would be considered a clinically significant bradycardia because the heart rate is not adequate for their clinical condition. Hypoxemia is a common cause of bradycardia. Other causes of bradycardia include medications, structural damage, and metabolic dysfunction, such as electrolyte abnormalities and thyroid disease. The ACLS algorithm is a guideline for the treatment of clinically significant bradycardia. Sinus Bradycardia Sinus bradycardia can result from excess vagal stimulation, which slows SA node discharge. This may result from hypoxia, structural heart disease, damage to the cardiac electrical conduction system, medications, such as beta-blockers and calcium channel blockers, and metabolic dysfunction. The clinical significance of sinus bradycardia is that it can result in decreased cardiac output. ln those patients who routinely engage in aerobic exercise, sinus bradycardia could be a normal finding. Idioventricular Rhythm Idioventricular rhythms occur when a ventricular focus acts as the primary pacemaker for the heart. This is identified by a slow ventricular rate of 20 to 40 beats per minute and a wide and bizarre appearance of the QRS complexes. Because atrial activity is absent, there are no P waves preceding each QRS complex. The clinical significance of idioventricular rhythm is that it can result in decreased cardiac output and poor perfusion. In the absence of atrial contraction, a reduced volume of blood is ejected into the ventricles. In addition, the ventricular rate is slow, which may result in a reduced cardiac output. Heart Blocks As mentioned in the opening of this lesson, bradycardia can present itself in several different cardiac rhythms, which include varying degrees of atrioventricular (AV) heart blocks. AV heart blocks are caused by delayed, inconsistent, or absent electrical conduction through the AV node. These are classified as first degree, second degree (Mobitz type l and II), and third-degree. https://d3imrogdy81qei.cloudfront.net/video_images/5037/what-is-bradycardia.jpg Yes 133 https://app.protrainings.com/courses/acls/certification/videos/bradycardia-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2789.mp4 Bradycardia Teaching In this lesson, we're going to let you play the role of team leader during a cardiac emergency – bradycardia. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 78-year-old female patient who is pale and diaphoretic. She tells you that she is feeling dizzy and weak and also that she began feeling this way about 3 hours ago. She also tells you that her condition seems to be getting worse. She is conscious and alert, which means that at the moment she's stable. And since she doesn't seem to have any life-threatening conditions, you determine that the first step should be to get a good set of vitals, which you have instructed an assistant to get. Your initial assessment recap: 78-year-old female Pale and diaphoretic Feels dizzy and weak Conscious and alert Your assistant tells you that the patient's vital signs are: Respiratory rate: 20 Pulse rate: 48 and irregular Blood pressure: 78/40 SPO2: 94 percent Based on these vital signs, you don't need to start oxygen immediately. However, the patient is obviously bradycardic and hypotensive. And in order to know if the patient's hypotension and bradycardia are related to her heart arrythmia or another cause, you decide to get an ECG reading. The assistant attached the ECG monitor to the patient and takes a quick look at her rhythm. As you look at the monitor, you see narrow QRS complexes along with regular P-waves, until the entire QRS is dropped. You recognize that this rhythm indicates 2nd degree, Mobitz type II heart block. And because this type of heart block is below the bundle of His, it could turn into complete heart block rather quickly. Pro Tip #1: Since hypotension and bradycardia are a concern, you direct the assistant to start an IV in order to consider administering atropine to the patient. But if the patient was unstable, as in unconscious and pulseless, you would then begin with transcutaneous pacing instead. However, since the patient is still responsive, you choose atropine as the first treatment option. You direct the assistant to give 1 mg of atropine via rapid IV push and wait for the assistant to repeat the order back to you, which she does. She follows the order and administers the atropine. After a minute has passed, you recheck the patient's vital signs and find the following: Respiratory rate is still around 20 Heart rate is still around 46, irregular, and weak Blood pressure has not improved and is 76/40 The pulse oximeter is still reading 94 percent Based on these new set of vitals, it appears that the atropine has been ineffective. As you come to this conclusion, the assistant tells you that the patient's heart rate and blood pressure just both went down, and now suddenly the patient just went unconscious. You now have a situation where the patient has an unstable bradycardia, which means you need to begin transcutaneous pacing as quickly as you can. You direct the assistant to apply the pacing pads and turn the pacer on. Pro Tip #2: Individual protocols will dictate specifics and vary from place to place. However, the American Heart Association guidelines recommend starting at 60 beats per minute and as the pacer is running, turn up the milliamps until the heart muscle is captured. In our scenario, you achieve consistent capture at 70 milliamps. Once you have that consistent capture, you should then turn the machine's interval up 2 to 5 milliamps – just enough to keep the capture. In this scenario, you decide to turn it up to 75. Pro Tip #3: Once you have consistent capture at 60 beats per minute, you turn up the rate until symptoms improve, which is typically between 60 and 70 beats per minute. In our scenario, you turn the rate up to 68 beats per minute. You then begin to see the patient becoming responsive again. Upon checking her vitals once more, you have: Respiratory rate of 16 Heart rate of 68 under capture with a transcutaneous pacemaker Blood pressure of 96/60 Pulse oximeter up to 96 percent Once the patient's perfusion improves, you need to continue to monitor the patient closely and work on improving perfusion further by trying to determine her cause of the bradycardia, and then treat it accordingly. Warning: Keep in mind that transcutaneous pacing can be really uncomfortable for a conscious patient. You may want to consider some sort of pain management while also considering whether or not to move the patient to the next level of care for further cardiac treatment. https://d3imrogdy81qei.cloudfront.net/video_images/5039/bradycardia-teaching.jpg Yes 258 https://app.protrainings.com/courses/acls/certification/videos/what-is-tachycardia https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2790.mp4 What is Tachycardia? In this lesson, we're going to cover tachycardia, including some things to be aware of when dealing with tachycardic patients, types of tachycardia, underlying causes, and some information on the best courses of treatment to resolve that patient's tachycardia. Tachycardias can be both stable and unstable. In adults, tachycardia is technically defined as heart rates greater than 100 beats per minute. Types of Tachycardia Common types of tachycardia include: Atrial fibrillation Atrial flutter Sinus tachycardia Supraventricular tachycardia (SVT) Ventricular tachycardia Ventricular fibrillation Causes of Tachycardia Many things can cause tachycardia, including semi-benign causes such as fever or stress. More serious causes of tachycardia include: Shock Medications Metabolic dysfunction Hypoxemia Damage to the heart muscle Perfusion problems may develop when the patient's heart beats too fast and the ventricles are not able to fill properly with blood, which is technically called ejection fraction compromise. This occurs due to a lack of preload before the heart fully contracts and can cause a decrease in cardiac output and poor perfusion, which can lead to hemodynamic instability. Pro Tip #1: It's important to quickly assess a tachycardic patient and determine if their signs and symptoms are the result of the tachycardia. It's equally important to find underlying causes of the tachycardia and treat those causes. Patients with heart rates between 100 and 150 beats per minute will rarely have symptoms related to the tachycardia. Rather, symptoms in this range are normally the result of other medical issues. However, the higher the heart rate, the more likely that the tachycardia is the culprit of the patient's symptoms. For this reason, a thorough primary and secondary survey will help you properly assess the patient's condition. Identifying and Treating Tachycardia When you have a patient with tachycardia, the first step is to identify whether or not the patient is stable. A stable patient has no serious signs or symptoms as a result of the increased heart rate, such as: Altered mental status Chest pain Hypotension Other signs of shock For stable patients, you should do the following: Check their vital signs Monitor their oxygen saturation Give oxygen as needed Get an ECG or 12 lead Identify their heart rhythm Start an IV Pro Tip #2: If you determine a patient to be unstable, as in one that has some of those more serious symptoms listed in the list above, synchronized cardioversion is the treatment of choice and should be done immediately. Remember, electrical therapy can cause some discomfort. If time permits and the patient is conscious, consider sedation. But if time does not permit, you may need to defibrillate regardless of sedation. If you have a patient with no pulse, treat this rhythm as if it was ventricular fibrillation (VFib) and follow the pulseless arrest algorithm. Pro Tip #3: The first step to identifying tachycardic heart rhythms is to determine if the QRS complexes are wide or narrow. Wide QRS complexes are .12 seconds or greater, while narrow QRS complexes are less than .12 seconds. Narrow complex tachycardias typically originate above the ventricles. While wide complex tachycardias typically originate in the ventricles and pose a higher risk of deteriorating into cardiac arrest. For patients with regular narrow complex stable tachycardia: It's appropriate to first attempt vagal maneuvers. If that doesn't work, give adenosine at 6mg via rapid IV push. If the patient does not convert and remains stable, give a second dose of adenosine at 12mg via rapid IV push. Pro Tip #4: While you understand the side effects of adenosine, your patient probably does not. So, after administering the medication, tell them they may get a feeling of breathlessness, a flushed feeling, or the feeling that their heart is skipping a beat. And let them know these side effects will pass quickly. For stable patients with irregular narrow complex QRS tachycardia, it's probably atrial fibrillation (AFib), atrial flutter (AF), or a multi-focal atrial tachycardia and would require expert consultation to treat. For stable patients with regular or irregular wide complex QRS tachycardia, this would usually be treated with antiarrhythmics like procainamide or amiodarone and will also require expert consultation. It's also important to remember that management and treatment of wide complex stable tachycardia requires advanced knowledge of ECG rhythm interpretation and antiarrhythmic therapy. https://d3imrogdy81qei.cloudfront.net/video_images/5041/what-is-tachycardia.jpg Yes 248 https://app.protrainings.com/courses/acls/certification/videos/tachycardia-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2791.mp4 Tachycardia Teaching In this lesson, we're going to let you play the role of team leader during a cardiac emergency – stable and unstable tachycardia. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. In this scenario, you've been presented with a 35-year-old male patient who is conscious and alert. You begin by asking him how he feels. During your primary assessment, you find him to be responsive, his airway open, and his breathing is rapid. He tells you that symptoms began while he was at work. It was a very stressful day and symptoms began about an hour before you saw him. His chief complaints are that his heart feels like it's racing, he's experiencing some dizziness, and also some weakness. Your initial assessment recap: 35-year-old male Conscious and alert Symptoms began about one hour ago Heart is racing Feels dizzy Feels weak Since the patient doesn't appear to have any life-threatening conditions, you direct a team member to get a good set of vitals. A member of your team a few minutes later tells you that the patient's vital signs are: Respiratory rate: 24 Pulse rate: 188 Blood pressure: 110/70 Skin: cool and pale SPO2: 92 percent Based on his O2 saturation, you decide to start oxygen immediately and you do so at 4 liters via nasal cannula. Your goal is to titrate oxygen to keep his O2 saturation level at 94 percent or higher. After oxygen has been started, you then decide that you need to get an ECG reading. You ask a team member to do this and after an ECG has been attached and you look at the readout, you see a narrow complex supraventricular tachycardia (SVT). Since the patient is stable, you direct a team member to first try vagal maneuvers. However, that didn't work, so you now opt for drug therapy and direct a team member to start an antecubital IV 18 gauge with normal saline at a TKO rate. Now that you have the IV established, you decide to try administering adenosine at 6mg via rapid IV push. You remind the team member in charge of medications to flush the line with 20ml of saline after giving the adenosine, so the medication gets completely into the central circulatory system. You begin to consider a second dose of adenosine at 12mg in 1 to 2 minutes if this first dose doesn't work and if the patient is still stable. After that first dose of adenosine, you take a look at the monitor and see that the patient is still in SVT. You direct a team member to get a new set of vitals. The team member comes back with the following information: Respiratory rate: 18 and shallow Pulse rate: 174 and weak Blood pressure: 94/70 Skin: cool and pale SPO2: 94 percent As you begin to consider getting a 12 lead ECG attached to the patient, he suddenly goes unconscious. Now that you have an unstable patient, that possible second dose of adenosine is off the table, so you direct the defibrillator team to perform synchronized cardioversion. The defibrillator pads are applied, and the defibrillator is set for a synchronized shock of 50 joules. A defibrillator team member announces, Clear, charging, shocking at 50 joules on 3 – 1,2,3, and delivers a shock to the patient. You again look at the monitor to see if there are any changes in the patient's rhythm, and this time, you see a normal sinus rhythm at 80 beats per minute. The patient's rhythm has been successfully converted. The patient begins to regain consciousness after a few seconds. As he is becoming more responsive, you direct a team member to get a new set of vitals, as you continue to monitor the patient for changes. https://d3imrogdy81qei.cloudfront.net/video_images/5043/tachycardia-teaching.jpg Yes 202 https://app.protrainings.com/courses/acls/certification/videos/what-is-the-megacode https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2792.mp4 What is the Megacode? In this lesson, we'll provide you with a brief overview of the megacode. And at the end of the lesson, we'll provide you with an additional Word on the approach to unstable tachycardias, that you learned about in the last two lessons. Back in the day, megacodes were known to cause mega stress, and were widely considered one of the most fearful things that healthcare providers could imagine doing as it relates to their ACLS certification course. Why, you might ask? Because megacodes are so dynamic, much like a difficult word problem or riddle that you've been tasked with solving. And since not everyone loves word problems or riddles, think of megacodes like you would a puzzle, if that helps. Unlike an IRS audit or a colonoscopy, we're going to try to make megacodes as enjoyable as possible, and as simple as possible. And by the time you've completed and mastered your ACLS training at ProACLS, you'll feel confident that you'll be able to make a difference in your community, as in saving lives. Megacode testing scenarios combine knowledge and protocols of multiple ACLS algorithms. These can include any of the following: Acute coronary syndrome Acute stroke Cardiac arrest Pulseless VFib or V-tach Asystole Pulseless electrical activity (PEA) Bradycardia Tachycardia, whether stable or unstable To be a successful ACLS provider, you need to know about: Appropriate therapies Appropriate drugs Drug doses used in each ACLS algorithm When to use which drug based on the situation and patient And you need to know how to identify and interpret basic arrest and pre-arrest cardiac rhythms so you can know their proper treatments as well, related to the ECG. Pro Tip: It's important to remember that providing good ACLS always begins with providing high-quality basic life support. Make sure that you take full advantage of all the training provided by ProACLS so that you can have a rock-solid knowledge base and become as proficient with your skills as possible, in order to be ready to handle any life-threatening emergency. By gaining and building upon this knowledge base, you'll be able to increase the rate of survival for those people you help, which may mean returning loved ones back to family and friends once again. A Word About the Approach to Unstable Tachycardia A tachyarrhythmia, as in a rhythm with a heart rate greater than 100 beats per minute, has many potential causes and can be either symptomatic or asymptomatic. The key to managing a patient with any tachycardia is to determine whether pulses are present. If pulses are present, you should first determine whether the patient is stable or unstable and then provide treatment based on the patient's condition and their rhythm. If the tachyarrhythmia is sinus tachycardia, you should conduct a diligent search for the cause of the tachycardia. Treatment and correction of this cause will usually improve the signs and symptoms. Unstable tachycardia exists when the heart rate is too fast for the patient's clinical condition and the excessive heart rate causes symptoms or an unstable condition because the heart is: Beating so fast that cardiac output is reduced; this can cause pulmonary edema, coronary ischemia, and hypotension with reduced blood flow to vital organs, such as the brain or the kidneys. Beating ineffectively so that coordination between the atrium and ventricles, or the ventricles themselves, reduces cardiac output. Signs and Symptoms Unstable tachycardia leads to serious signs and symptoms that include the following: Hypotension Acutely altered mental status Signs of shock Ischemic chest discomfort AHF Rapid Recognition The two keys to managing patients with unstable tachycardia are: Rapid recognition that the patient is significantly symptomatic or even unstable. Rapid recognition that the signs and symptoms are caused by the tachycardia. The first step is to quickly determine whether the patient's tachycardia is producing hemodynamic instability and serious signs and symptoms or whether the signs and symptoms are producing the tachycardia. Making this determination can be difficult. Many experts suggest that when a heart rate is less than 150 beats per minute, it's unlikely that the symptoms of instability are caused primarily by the tachycardia unless there is impaired ventricular function. While a heart rate greater than 150 beats per minute is usually an inappropriate response to physiologic stress, such as fever and dehydration, or other underlying conditions. Indications for Cardioversion Rapid identification of symptomatic tachycardia will help you determine whether you should prepare for immediate cardioversion. For example: Sinus tachycardia is a physiologic response to extrinsic factors, such as fever, anemia, or hypotension/shock, which create the need for a compensatory and physiological increase in heart rate. There is usually a high degree of sympathetic tone and neurohormonal factors in these settings. Sinus tachycardia will not respond to cardioversion. In fact, if a shock is delivered, the heart rate often increases. If the patient with tachycardia is stable, patients may await expert consultation because treatment has the potential for harm. Atrial flutter typically produces a heart rate of approximately 150 beats per minute. Atrial flutter at this rate is often stable in the patient without heart or serious systemic disease. At rates greater than 150 beats per minute, symptoms are often present, and cardioversion is often required if the patient is unstable. If the patient is seriously ill or has underlying cardiovascular disease, symptoms may be present at lower rates. It's important to know when cardioversion is indicated, how to prepare the patient for it, and how to switch the defibrillator/monitor to operate as a cardioverter. https://d3imrogdy81qei.cloudfront.net/video_images/5045/what-is-the-megacode.jpg Yes 106 https://app.protrainings.com/courses/acls/certification/videos/megacode-teaching https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2793.mp4 Megacode Teaching In this lesson, we're going to let you play the role of team leader during a megacode emergency, also known as the granddaddy of all cardiac emergencies. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations. A megacode scenario will require a combined knowledge of procedures and treatments from many or all ACLS algorithms. In this scenario, you've been presented with a 45-year-old male patient who now appears unresponsive. Witnesses state that the victim was choking, and the object was removed. He was brought to advanced medical care because afterward he had difficulty breathing. While you're talking with the patient, he goes unresponsive. It's important to remember to use basic life support skills before any advanced life support skills. Your initial assessment recap: 45-year-old male Appears unresponsive Was choking but object removed Brought to medical care for difficulty breathing You or a member of your team check for responsiveness using taps and shouts. His unresponsiveness is confirmed so you call in a code and check for a pulse and signs of normal breathing. You find that the patient is in respiratory arrest. You call for an advanced airway, either an NPA or OPA, to be inserted, then start rescue breaths with a bag valve mask at 15 liters of oxygen delivered at 1 breath every 6 seconds. You call for his vitals to be taken and an ECG monitor to be attached. According to the ECG, the patient has a normal sinus rhythm with pre ventricular contractions (PVC) at 78 beats per minute but they are irregular. Knowing that a rhythm with multiple and frequent PVCs could quickly deteriorate, you start an IV to administer saline and other medications. And a short time later, the monitor is indicating that no pulse is being detected. It now looks like the patient is in ventricular fibrillation (VFib). You check the patient for a pulse to confirm and do not find one. You now call for CPR at 30 compressions to 2 rescue breaths, while defibrillator pads are applied. When the pads are in place, you instruct everyone to stand clear while the rhythm is analyzed. VFib is still present on the ECG. Using a monophasic defibrillator, you ask that it be charged to 360 joules to shock the patient. CPR resumes immediately after delivery of the first shock. Since the patient is in VFib, a first shock has been delivered, and an IV has been established, it's now time to administer the first medication – epinephrine at 1 mg 1:10,000 concentration. Pro Tip #1: You remind your team that CPR must continue during drug administration, because doing so will help circulate the medication throughout the body and especially into the heart. After the recorder lets you know that it's been 2 minutes since CPR began, you call for the compressor and monitor/defibrillator team members to switch. it's important that you always have a fresh compressor that can deliver high quality compressions between 100 and 120 compressions per minute and at the appropriate depth. However, during the switch and before resuming CPR, you take a quick look at the monitor. It reveals persistent VFib. You then call for another shock with the monophasic defibrillator at 360 joules. This time, when you check the monitor, you notice that the patient now has a normal sinus rhythm. You check for a pulse to confirm a perfusing rhythm. You find a pulse, but the patient still isn't breathing You call for rescue breaths to continue at 1 breath every 6 seconds. And you call for a set of vitals to determine the next course of treatment. You find a blood pressure of 88 systolic after achieving ROSC (return of spontaneous circulation). Pro Tip #2: A systolic blood pressure below 90 requires a 1 to 2-liter bolus of normal saline in order to raise the patient's blood pressure. Since the patient is still in respiratory arrest, you call for an ET tube to be put in place and begin to monitor capnography. With capnography in place, you can verify proper tube placement when a persistent waveform is present at 35 to 40 mmHg. Capnography measures the concentration of carbon dioxide in the patient's exhaled air at the end of expiration. The CO2 detected by capnography in this exhaled air is produced in the body and delivered to the lungs by circulating blood. Pro Tip #3: This is why it's so helpful to know when compressions are being done correctly, by producing circulation though the body that gets that CO2 out to the lungs to be exhaled. This helps you know that CPR is effective or when the body is returning biologically, and you can see that exchange of gases – oxygen and CO2. Your megacode scenario ends with you calling for a 12 lead ECG and another set of vitals as you and your team begin to consider the underlying causes that went into this patient's cardiac arrest. And by finding those causes, you can begin correcting them and save the patient's life. https://d3imrogdy81qei.cloudfront.net/video_images/5047/megacode-teaching.jpg Yes 315 https://app.protrainings.com/courses/acls/certification/videos/post-cardiac-arrest-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2794.mp4 Post Cardiac Arrest Care There has been substantial research and success in post-resuscitation care and recovery. Because of this, it has become an extremely important part of an aggressive ACLS resuscitation program. In this section of your ProACLS course, we'll be discussing the most current guidelines for achieving the most effective and successful recovery post-resuscitation and return of spontaneous circulation available today. This section will follow the latest recommendations provided by the American Heart Association and has been taken from the latest ECC published protocols. Now let's look at the return of spontaneous circulation (ROSC) and post-cardiac arrest care. Post Cardiac Arrest Programs Every healthcare system should implement a comprehensive and multidisciplinary system of care in a universal and consistent manner for the treatment of post-cardiac arrest patients to assure the very best of outcomes. All post-cardiac arrest programs should address the following: Targeted temperature management (TTM) Hemodynamic and ventilation optimization Immediate coronary reperfusion Percutaneous coronary intervention (PCI) for eligible patients Neurological care and prognostication Cognitive impairments Other structured interventions Post Cardiac Arrest Syndrome Pro Tip #1: It's important to understand that patients who have experienced a return of spontaneous circulation after cardiac arrest, regardless of the setting, have a complex combination of pathophysiological processes that are described as post-cardiac arrest syndrome. Post cardiac arrest syndrome includes the following: Post arrest brain injury Post arrest myocardial dysfunction Systemic ischemia Reperfusion response Persistent, acute, and chronic pathologies that may have participated in the cardiac arrest itself Post-cardiac arrest syndromes play a significant role in patient mortality and should be taken very seriously. Support for Caregivers Post Cardiac Arrest In addition to patient support, caregivers are also vulnerable. They should receive comprehensive discharge planning that includes: Medical and rehabilitative recommendations Return to normal activity expectations Return to work expectations This caregiver support should begin immediately during the patient's initial hospitalization and continue for as long as it's needed. Return to Normal Life Post Cardiac Arrest Returning to normal life after a traumatic event is never an easy thing. And it can be a challenge for both the patient and their primary caregiver. For this reason, a structured assessment should be part of any post-cardiac arrest care plan to assess for: Anxiety Depression Post-traumatic stress Fatigue And again, this assessment should be done for both the cardiac arrest survivor and any of their caregivers. Post Cardiac Arrest Care for Healthcare Providers It's not just the cardiac arrest survivors and their caregivers who need support after a traumatic cardiac arrest event. Both in-hospital and out-of-hospital healthcare providers may also experience emotional or psychological effects after providing care for patients in cardiac arrest. Pro Tip #2: The work of healthcare providers is never easy, and good outcomes are never guaranteed. When a patient dies following a cardiac arrest event, healthcare providers are at their most vulnerable. This is when emotional support is most needed. Following a cardiac arrest event, debriefing and referrals should be offered for follow-up care for emotional support. This should be provided for everyone involved, including lay rescuers, EMS providers, and hospital-based healthcare workers. A team debriefing can also be beneficial to allow for a review of the team's performance and quality improvement. A Word About Post Cardiac Arrest Treatment Providers should ensure an adequate airway and support breathing immediately after ROSC. Unconscious patients usually require an advanced airway for mechanical support of breathing. Providers should also elevate the head of the bed 30 degrees if tolerated by the patient to reduce the incidence of cerebral edema, aspiration, and ventilatory-associated pneumonia. Proper placement of an advanced airway, particularly during patient transport, should be monitored by waveform capnography. The oxygenation of the patient should be monitored continuously with pulse oximetry. While 100 percent oxygen may have been used during initial resuscitation, providers should titrate inspired oxygen to the lowest level required to achieve an arterial oxygen saturation of 92 to 98 percent to avoid potential oxygen toxicity. Hyperventilation is common after cardiac arrest and should be avoided because of the potential for adverse hemodynamic effects. Hyperventilation increases intrathoracic pressure, which decreases preload and lowers cardiac output. The decrease in PaCO2 seen with hyperventilation can also decrease cerebral blood flow directly. Ventilation should be started at 10 per minute and titrated to achieve a PetCO2 of 35 to 40 mmHg or a PaCO2 of 40 to 45 mmHg. Healthcare providers should frequently reassess vital signs and monitor for recurrent cardiac arrhythmias by using continuous ECG monitoring. If the patient is hypotensive, fluid boluses can be administered. If TTM is indicated, cold fluids may be helpful for the initial induction of hypothermia. If the patient's volume status is adequate, infusions of vasoactive agents may be initiated and titrated to achieve a minimum SBP of 90 mmHg or greater or a mean arterial pressure of 65 mmHg or more. Some advocate higher mean arterial pressures to promote cerebral blood flow. Brain injury and cardiovascular instability are the major factors that determine survival after cardiac arrest. Because TTM is currently the only intervention demonstrated to improve neurologic recovery, it should be considered for any patient who is comatose and unresponsive to verbal commands after ROSC. The patient should be transported to a location that reliably provides this therapy in addition to coronary reperfusion and other goal-directed post-arrest care therapies. Clinicians should treat the precipitating cause of cardiac arrest after ROSC and initiate or request studies that will further aid in evaluating the patient. It is essential to identify and treat any cardiac, electrolyte, toxicologic, pulmonary, and neurologic precipitants of the arrest. Overall, the most common cause of cardiac arrest is cardiovascular disease and associated coronary ischemia. Therefore, a 12-lead ECG should be obtained as quickly as possible to detect ST elevation or LBBB. Coronary angiography should be performed emergently for OHCA patients with suspected cardiac etiology of arrest and ST elevation on ECG. When there is a high suspicion of AMI, local protocols for the treatment of AMI and coronary reperfusion should be activated. Coronary angiography, if indicated, can be beneficial in post-cardiac arrest patients regardless of whether they are awake or comatose. Even in the absence of ST elevation, emergent coronary angiography is reasonable for patients who are comatose after OHCA of suspected cardiac origin. Concurrent PCI and TTM are safe, with good outcomes reported for some comatose patients who have undergone PCI. Critical care facilities that treat patients after cardiac arrest should use a comprehensive care plan that includes acute cardiovascular interventions, use of TTM, standardized medical goal-directed therapies, and advanced neurologic monitoring and care. Neurologic prognosis may be difficult to determine during the first 72 hours after resuscitation. This should be the earliest time to prognosticate a poor neurologic outcome in patients not treated with TTM. For those treated with TTM, providers should wait 72 hours after the patient returns to normothermia before prognosticating by using clinical examination where sedation or paralysis can be a confounder. Many initially comatose survivors of cardiac arrest have the potential for a full recovery. For this reason, it's important to place patients in a hospital critical care unit where expert care and neurologic evaluation can be performed and where appropriate testing to aid prognosis can also be performed promptly. https://d3imrogdy81qei.cloudfront.net/video_images/4997/post-cardiac-arrest-care.jpg Yes 182 https://app.protrainings.com/courses/acls/certification/videos/optimization-of-cardiopulmonary-function https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2795.mp4 Optimization of Cardiopulmonary Function In this lesson, we're going to cover post cardiac arrest interventions, such as targeted temperature management, hemodynamic and ventilation optimization, immediate coronary reperfusion with PCI, glycemic control, and neurologic care and prognostication. Targeted Temperature Management According to the latest national guidelines update for CPR and ECC, it is recommended that targeted temperature management interventions, also known as TTM, be administered to comatose adult patients with ROSC after cardiac arrest by selecting and maintaining a constant temperature somewhere between 32 and 36 degrees Celsius, or 89.6 to 95.2 degrees Fahrenheit, for at least 24 hours. Comatose is technically defined as lacking meaningful response to verbal commands. Hemodynamic and Ventilation Optimization Hemodynamic and ventilation optimization is the next intervention in post arrest care. Pro Tip #1: Although ACLS providers often use 100 percent oxygen while performing their initial resuscitation, you should titrate inspired oxygen during post cardiac arrest care to the lowest level required to achieve arterial oxygen saturation of 92 to 98 percent whenever possible. Doing so may help prevent any potential complications associated with oxygen therapy. Warning: Remember, excessive ventilations with high oxygen levels can have adverse hemodynamic effects, especially when intrathoracic pressures increase and because of a potential decrease in cerebral blood flow when partial pressure of carbon dioxide (PaCO2) in arterial blood decreases. It's important that healthcare providers start ventilation rates at 10 per minute. The goal is to achieve normocarbia – a partial pressure of end-tidal carbon dioxide (PetCO2) of 30 to 40 mmHg or a PaCO2 of 35 to 45 mmHg. This is a reasonable goal unless patient factors prompt more individualized treatments. Other PaCO2 targets may be tolerated for specific patients. An example of this would be when a higher PaCO2 may be more appropriate in a patient with an acute lung injury or high airway pressures. Likewise, mild hypercapnia might be a beneficial treatment as a temporary measure when treating cerebral edema. But hyperventilation could cause cerebra vasoconstriction. Pro Tip #2: Health care providers should note that when a patient's temperature is below normal, laboratory values reported for PaCO2 might be higher than actual values. In addition, healthcare professionals should titrate fluid administration in vasoactive or inotropic agents as needed to optimize blood pressure, cardiac output, and systemic perfusion. While optimal post cardiac arrest blood pressure remains unknown, a mean arterial pressure of 65 mmHg or greater is a reasonable goal per scientific studies and current guidelines. Immediate Coronary Reperfusion with PCI When treating for a return of spontaneous circulation in patients where coronary artery occlusion is suspected, rescuers should transport patients to a capable and reliable facility known for providing coronary reperfusion and other goal-directed post cardiac arrest care therapies. The decision to perform percutaneous coronary intervention (PCI) can be made irrespective of coma or a decision to induce hypothermia, because concurrent PCI and hypothermia are feasible and safe and have reported good outcomes. Glycemic Control Altering glucose concentration within a lower range of 80 to 110 mg/dL should not be attempted because of the increased risk of hypoglycemia. The latest guidelines update for CPR and ECC does not have a recommended specific target range of glucose management in adult patients with a return of spontaneous circulation after cardiac arrest. Neurologic Care and Prognostication The American Heart Association guidelines have established the following: the goal of post cardiac arrest management is to return the patient to their prearrest function levels. Reliable early prognostication on neurological outcome is an essential component of post cardiac arrest care. However, optimal timing is important to consider. In patients treated with TTM, prognostication using clinical examinations should be delayed for at least 72 hours after the return of normothermia. For those patients not treated with TTM, the earliest time is 72 hours after cardiac arrest and potentially longer if the residual effects of sedation or paralysis confounds the clinical examination. https://d3imrogdy81qei.cloudfront.net/video_images/5001/optimization-of-cardiopulmonary-function.jpg Yes 298 https://app.protrainings.com/courses/acls/certification/videos/conclusion-acls https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2796.mp4 Conclusion Congratulations on completing your Advanced Life Support course. We hope it was everything you thought it would be … and more. The good news is that you're now ready to take your exam. Remember that muscles that don't get used begin to atrophy. Even those mental muscles. The same goes for the newly acquired skills you've just gained, as they can easily be forgotten if not used or refreshed on a regular basis. Don't let all that important knowledge get flabby. To that end, we have a free weekly video training series delivered via email that you can easily sign up for that will deliver important training right to your inbox in small doses. If you'd like to sign up for this training, you can do so here: Sign Up. Now that you've acquired these all-important life-saving skills, don't let the fear of infectious disease stand in the way of you becoming someone's potential hero. To combat this fear, you can get a keyring CPR shield through ProTrainings that will protect you from disease no matter the situation. And as long as you have your keys with you, you'll be protected. You may be in a situation where you're not required to perform a mannequin skills test and practice. However, if you find out later that your employer does require this, or if you simply think this would be great practice for you (Spoiler Alert: It is!), ProTrainings has you covered with a mannequin solution for your skills practice and training. If you're interested in this mannequin training solution, contact ProTrainings at 616-855-2500 and we'll have one delivered to you at a time that's convenient. Also, for anyone who has taken one of our 100 percent online courses and still requires an evaluation, now or in the future, you can do that with a simple phone call to ProTrainings at any time. Thanks again for choosing ProTrainings as your training resource. But before we sign off, we'd just like you to consider WHY you've chosen this field. Life is a precious thing. It's something that should be appreciated, savored, and celebrated. As a healthcare provider, you have enormous power to help people in need. To give back to them the one resource that is truly extinguishable – time. Time for everything that matters to them. Keep the WHY in you mind as you work every day to help those who need it most. Now, go forth and rescue! https://d3imrogdy81qei.cloudfront.net/video_images/4999/conclusion-acls.jpg Yes 87 https://app.protrainings.com/courses/acls/certification/videos/acls-adult-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2814.mp4 Adult CPR Teaching In this lesson, we're going to cover adult CPR, including exactly how to provide care. A patient who is unconscious, not breathing normally, and has no pulse is in cardiac arrest and needs CPR. At the end of the lesson, we'll provide you with a Word on high-quality CPR. CPR is a combination of chest compressions and ventilations that circulates blood and oxygen to the brain and other vital organs for a person whose heart and breathing have stopped. Remember the five links in the Adult Cardiac Chain of Survival: Recognize the cardiac emergency and call 911 Early CPR Early defibrillation Advanced life support Integrated, post-cardiac arrest care How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally (as you now know, agonal respiration is not breathing normally and should be considered the same as NO respirations), and has no pulse, continue immediately with CPR. CPR Technique for Adults 1. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.2. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Pro Tip #1: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. 3. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.4. Perform 30 chest compressions. Pro Tip #2: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. 5. Grab the rescue mask and seal it over the victim's face and nose.6. Lift the victim's chin and tilt his or her head back slightly.7. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.8. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. A Word About High-Quality CPR It's important to understand what constitutes high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. High-Quality CPR Performing chest compressions at a rate of 100-120 per minute Compressing to a depth of at least 2 inches but not exceeding 2.4 Allowing for full recoil after each compression Minimizing pauses in compressions Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise Low-Quality CPR Compressing at a rate slower than 100 per minute or faster than 120 per minute Compressing to a depth of less than two inches or greater than 2.4 inches Leaning on the chest between compressions or performing compressions while not directly over the victim's heart Interrupting compressions for greater than 10 seconds Providing excessive ventilation – too many breaths or breaths with excessive force Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue. https://d3imrogdy81qei.cloudfront.net/video_images/4979/acls-adult-cpr.jpg Yes 246 https://app.protrainings.com/courses/acls/certification/videos/acls-adult-aed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2815.mp4 Adult AED Teaching In this lesson, we're going to cover using an AED on an adult patient, including the exact technique and steps you'll use when faced with a cardiac emergency that requires the use of an AED. An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm. Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? Pro Tip #1: If the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient. If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if it is a concern, you can disconnect it and remove it from the pathway to the heart. Necklaces should be moved to the side Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads Piercings shouldn't cause any problems It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it There are no special considerations for pregnant women Pro Tip #2: It's OK to be just as aggressive with a pregnant woman as you would any other patient. The primary focus should be on the mother, as saving her will also help save the baby. The care you provide to the mother won't put the baby in any more jeopardy. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED. AED Technique for Adults Turn on the AED. Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. Make sure they adhere well. Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. https://d3imrogdy81qei.cloudfront.net/video_images/4981/acls-adult-aed.jpg Yes 356 https://app.protrainings.com/courses/acls/certification/videos/basic-airways https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2890.mp4 Basic Airways In this lesson, we'll cover the exact procedure for inserting a basic airway. And at the end of the lesson, we'll provide you with a Word about bag-mask ventilation. Basic airways are adjuncts that help direct air and oxygen around natural obstacles in the mouth, like the tongue. There are two types of basic airways: Oropharyngeal Airway (OPA) – OPAs are primarily used for patients who are usually unconscious and have no gag reflex. Nasopharyngeal Airway (NPA) – NPAs are basic airways that are inserted in patients who have a gag reflex and might be semi-conscious. Pro Tip #1: The correct size of both OPAs and NPAs are very important in order to not cause further harm to the patient, or in some cases, even block the airway entirely. To measure for an OPA, connect or place the tip of the flange to the side of patient's mouth and the base of the curved plastic to the earlobe area. As mentioned briefly above, it's important to check the patient for a gag reflex if you're not sure about their level of consciousness and responsiveness. A trick of the trade for checking for a gag reflex is to rub the patient's eyelid and see if they have a blinking reflex. If you notice that they do, you should opt for an NPA as the patient will be better able to tolerate it while/if they are still somewhat conscious. To measure for an NPA, hold the airway next to the patient's face and gauge the length from the edge of the nostril to the earlobe. However, if you're certain that the patient is unresponsive and there isn't a gag reflex, prepare a properly sized OPA as indicated in the Pro Tip above. Pro Tip #2: Make sure you have either a portable suction device or a battery-operated or regular concurrent suction catheter. Once you begin to insert the OPA, if the patient does have a gag reflex, they could vomit, and you'll need to clean that out of their airway. Alternatively, you may notice some blood, mucous, or something else in the airway that you'll need to suction. It's important to note that when suctioning the patient's airway, you should never take longer than 10 seconds at a time before oxygenating the patient again. Procedure for Inserting an OPA You may want to consider re-watching the corresponding video lesson for the exact procedure as watching will always be superior to reading. Make sure you perform a head tilt chin lift on the patient. Invert the OPA tube, so the end or tip follows the roof of the mouth and continue to insert downward until it gets closer to the back of the oral pharynx. Twist the OPA tube a full 180 degrees as you continue to insert it further and until it's in place. Pro Tip #3: If you're wondering why you begin by inserting the OPA tube backward, essentially, it's done this way to help move the patient's tongue out of the way and bring it forward. This will better allow you to put air behind the tongue and into the lungs. A Word About Bag-Mask Ventilation A bag-mask ventilation device consists of a ventilation bag attached to a face mask. Bag mask ventilation devices have been a mainstay of emergency ventilation for decades and are the most common method of providing positive-pressure ventilation. When using a bag-mask ventilation device, you should deliver approximately 600ml of tidal volume sufficient to produce the patient's chest to rise over one full second. It's important to note that bag-mask ventilation is not the recommended method of ventilation for a single healthcare provider while they are also administering CPR. Instead, a single healthcare provider should use a pocket mask to provide ventilations, if one is available. It's much easier for two trained rescuers to provide bag-mask ventilation, as one rescuer can open the airway and seal the mask to the patient's face while the other squeezes the bag. And when there are two rescuers, both should be watching for visible chest rise. The universal connections that are present on all airway devices will allow you to connect any ventilation bag to numerous adjuncts. Valves and ports can include: One-way valves to prevent the patient from rebreathing exhaled air Oxygen ports for administering supplemental oxygen Medication ports for administering medications Suction ports for clearing the patient's airway Ports for quantitative sampling of end-tidal CO2 You can also attach other adjuncts to the patient end of the valve, including a pocket face mask, laryngeal mask airway, laryngeal tube, esophageal tracheal tube, and an endotracheal tube. https://d3imrogdy81qei.cloudfront.net/video_images/5011/basic-airways.jpg Yes 127 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/equipo-de-arte-corporal-y-productos-quimicos https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/2917.mp4 Equipo de arte corporal y productos químicos: etiquetado y almacenamiento adecuados https://d3imrogdy81qei.cloudfront.net/video_images/5227/body-art-storage-chemicals-and-labels.jpg Yes 187 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/body-art-storage-chemicals-and-labels https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/2917.mp4 Body Art Storage, Chemicals, and Labels In this lesson, you'll be learning how to properly store and label chemicals and hazardous waste. Cross-contamination is always a concern when mixing possibly contaminated objects, surfaces, and gloves with sterilized objects, surfaces, and gloves. Being super aware when handling any of the above items will be required. To maintain a safe and sanitary environment in your tattoo or body art studio, it's vital that all supplies, equipment, personal protective equipment (PPE), and chemicals are stored properly and labeled appropriately with proper signage. Proper Storage of Sterilized Supplies and Equipment Properly storing machines, instruments, ink, PPE, and supplies used in body art procedures can help minimize the possibility of cross-contamination. Proper storage refers to two main components: Items are kept in closed storage. Closed storage areas are clean and dry and protected from dust, aerosols, and other chemicals. Sterilized instruments should be placed in clean, dry, labeled, and covered containers or stored in labeled cabinets that can be closed and can still protect from dust and water contamination. Pro Tip #1: Only handle sterilized packages with clean gloves. Touching sterilized items with bare hands or gloves that were used during a body art procedure can easily result in cross-contamination. The pathogen can then be transferred to the sterilized item once the package has been opened. Pro Tip #2: On that same note, sterilized packages should always be evaluated before use and instruments should never be used if the package they came from was wet, torn, or punctured. Bathrooms do not make for good storage rooms and should not be used to store machines, instruments, PPE, or any other supplies used in body art procedures. Proper Storage of Chemicals The most common chemicals in most body art studios are cleaning chemicals and disinfectants. All chemicals must be properly stored and labeled at all times, regardless of whether or not that chemical is hazardous or nonhazardous. Proper labeling and storage can help prevent accidental contamination and misuse. The manufacturer's label must be present, as this will contain some vital information like the common product name, product ID, supplier ID, and the GHS pictogram and hazard statements. Pro Tip #3: Never cover up or remove the manufacturer's label or hazardous information on any chemicals. For any reason! In general, all chemicals must be stored in labeled, closed containers inside a closed storage area that can prevent contamination to machinery, instruments, ink, PPE, supplies, and work surfaces. Chemicals also must be used in a manner consistent with the manufacturer's label. Proper Storage of Regulated Waste For all biohazardous waste or sharps containers, warning labels must be attached to all containers used for the storage or transport of all potentially infectious materials. Labels must be orange or red/orange with a biohazard symbol in a contrasting color. Every procedure area should have a container for the disposal of sharps waste that is: Rigid Puncture resistant Leak-proof Closeable Sealable This waste should be labeled with the words sharps waste or with the international biohazard symbol and the word biohazard. All bags or containers of regulated waste or contaminated laundry must also be labeled with the biohazard symbol and those same words. https://d3imrogdy81qei.cloudfront.net/video_images/5227/body-art-storage-chemicals-and-labels.jpg Yes 187 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/regulaciones-de-arte-corporal-del-condado-de-la https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3003.mp4 Regulaciones de arte corporal del condado de L.A. https://d3imrogdy81qei.cloudfront.net/video_images/5403/l.a.-county.jpg Yes 418 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/la-county https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3003.mp4 L.A. County Body Art Regulations In this lesson, we'll be going over body art regulations specific to L.A. County, including forms and documents you'll be expected to keep on hand or provide to clients, along with the particular laws and regulations you'll be expected to follow. The California Safe Body Art Act is a chapter of the California health and safety code. It is intended to protect both you the body art professional, and the clients you serve, from the transmission of infectious diseases through the minimum statewide standards. This is intended for people who perform services like tattooing, branding, body piercing, and the application of permanent cosmetics. Pro Tip #1: In L.A. County, anyone who performs these types of services must submit a body art practitioners annual registration form. However, if you are only doing piercings of the ear with mechanical devices that use disposable, single-use pre-sterilized studs and clasps or solid needles, you do not need to register. And if that was the case, you probably wouldn't be taking this course. Body art practitioners who are currently registered with another California enforcement agency can still operate as a guest artist in L.A. County, at either an event or a body art studio. You can do so for up to five consecutive days but not longer than 15 days total each year. L.A. County Registration for Body Art Professionals Be sure to download the student manual with the course for all the forms and documents you'll need. In addition, for body art annual registration forms and other important documents, go to www.publichealth.lacounty.gov and type “body art” into the search bar. The registration application will require basic contact information for all locations where you'll be practicing – business name, facility address, etc. The body art professional annual registration form must be submitted annually and include the following: A valid government-issued photo ID showing an age of 18+ Proof of completing the L.A. County approved bloodborne pathogen exposure control training Certification of the Hepatitis B vaccine or evidence of immunity, statement of contraindication for medical reasons, or a vaccination declination statement 2” x 2” passport photo Warning: A public health permit must be secured before operating in a body art studio. Operating without a permit is a misdemeanor and may result in a penalty of three times the cost of the license or the registration. For a body art facility to receive a public health permit, the following must be verified: A current infection control prevention and contamination plan A clean environment free of insects and rodents Walls, floors, and ceilings that are smooth, free of holes, and washable Posted current certifications A contract for the removal of all sharps waste Waste containers with liners in procedures areas and decontamination areas Pro Tip #2: Properly labeled sharps containers must be within arms reach of practitioners in procedure and decontamination areas, and procedure areas must have adequate lighting and a handwashing sink with hot (110F+) and cold running water, liquid soap, and single-use disposable towels in a touchless dispenser. Decontamination Areas If using only disposable, single-use pre-sterilized instruments, a decontamination area is not required. However, if your instruments are sterilized for reuse, the following requirements must be met for your decontamination area. It must be separate from procedure areas by a minimum of five feet or by a cleanable barrier It must have a sink with cold and hot running water for cleaning and disinfecting It must contain only equipment used for the sterilization of medical instruments; in other words, it shouldn't double as a storeroom It's important to test your sterilization unit using a commercial and biologic indicator monitoring system. The times you want to use it include upon the initial installation of your sterilizing unit, after any repairs, and at least monthly. Sterilization units should be loaded, operated, decontaminated, and maintained according to the manufacturer‘s specifications. Each instrument peel pack must have an appropriate indicator and each sterilization load must be monitored with a class five integrator. A written log of each sterilization cycle must be retained on-site and should include: Date Contents Exposure time Temperature Results of class five integrator Pro Tip #3: Each sterilization pack must be inspected prior to storing it and again prior to using it. Client Safety In addition to facility requirements, you'll also be subject to certain requirements for the clients you serve. Clients should be at least 18 years old for any tattoo, permanent cosmetic, piercing of nipples or genitals, or branding regardless of parental consent. However, clients under 18 can still receive piercings in other areas if performed in the presence of a parent or guardian. Clients must be provided with informed consent forms before having any procedure done, regardless of age. They must read and sign a consent form that should include: Description of the procedure Aftercare instructions Statement regarding the permanent nature of the procedure Statement that inks, dyes, and pigments are not FDA approved The consent form should also include a client health questionnaire to determine if the client has anything in their medical history that would be problematic – diabetes, allergic reactions to latex and antibiotics, history of herpes infection or bleeding disorders, medication history, etc. And finally, the client should receive instructions for post-procedure care. https://d3imrogdy81qei.cloudfront.net/video_images/5403/l.a.-county.jpg Yes 418 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/periodo-de-incubacion-de-la-hepatitis-y-el-vih https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3004.mp4 Período de incubación de la hepatitis y el VIH https://d3imrogdy81qei.cloudfront.net/video_images/5405/incubation.jpg Yes 197 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/incubation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3004.mp4 Incubation Period of Hepatitis and HIV In this lesson, we are going to take a look at incubation periods for a few of the most common bloodborne pathogens that you will encounter over the course of doing normal business. The three bloodborne pathogens that we will be looking at are Hepatitis B, Hepatitis C, and HIV. Bloodborne pathogens are viruses that reproduce and live in the blood. Although prevention using personal protective equipment is important, it's also vital to know how long after exposure before each virus produces signs and symptoms in the infected person. This is what's known as the incubation period, and it fluctuates based on the virus. Hepatitis B Virus (HBV) The Hepatitis B virus can live outside the body in dried blood or a blood product for two-plus weeks. The incubation period after exposure to the virus is between three weeks and three months, with an average incubation period of six to eight weeks. The Hepatitis B virus may or may not produce any symptoms when it is present in the body. When symptoms are present, they can include: Fatigue Sore muscles Fever Loss of appetite Nausea Abdominal pain Vomiting Jaundice In 50 percent of all hepatitis B cases, no symptoms are present. And in acute cases of Hepatitis B, the disease rarely causes death. Around 5 percent of infected people will develop chronic Hepatitis B. Of those people, 25 percent will develop conditions such as liver cancer and cirrhosis of the liver after 10 to 30 years of becoming infected. Hepatitis C Virus (HCV) The Hepatitis C virus, also known as HCV, is very similar to HBV. However, there are a few key differences that you should be aware of. The incubation period for the Hepatitis C virus after exposure is between 2 and 26 weeks, with an average incubation period of seven weeks. The symptoms of the Hepatitis C virus are also similar to the symptoms for the Hepatitis B virus, except in the majority of cases there are no symptoms present. Around 85 percent of those infected will develop chronic hepatitis C. it's important to note that with chronic infections, the person will remain contagious. Around 25 percent of all people with chronic Hepatitis C will also develop cirrhosis of the liver and liver cancer after 10 to 30 years of becoming infected, if it goes untreated. HIV Virus HIV is a bloodborne pathogen that attacks the immune system rather than the liver, like the hepatitis viruses. The HIV virus is inactivated after just a few seconds to minutes after exposure to air. However, like some of the Hepatitis viruses, it may persist longer in undried blood. The incubation period for the HIV virus is between six weeks and six months. This is the amount of time that it will usually take to show up on a blood test. If left untreated, the HIV virus will eventually lead to AIDS, but this can take many years to develop. Signs of the HIV virus are very similar to flu-like illnesses, producing symptoms that include fatigue and sore muscles. These symptoms tend to develop just a few weeks after infection. In most people who are infected with the HIV virus, symptoms will usually disappear for years, until symptoms of a more advanced disease begin to show up. These symptoms include: Weight loss Recurring infections Swollen glands Pro Tip #1: The initial HIV infection can be very difficult to recognize, as symptoms are often absent or mild. It's also important to remember that these bloodborne pathogens can live outside of the body on surfaces, equipment, and instruments if they are not decontaminated properly. Warning: Cross-contamination and improper use of personal protective equipment can lead to life-threatening consequences, as can poor decision making or non-adherence to prevention control techniques. The prevention of infection is the key when dealing with bloodborne pathogens. This means using your personal protective equipment correctly and at all times. This means properly decontaminating all work surfaces and contaminated areas. And it means making sure to follow all infection control procedures for your facility. Taking these crucial preventative steps will help protect yourself as well as your clients. https://d3imrogdy81qei.cloudfront.net/video_images/5405/incubation.jpg Yes 197 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/que-es-la-sifilis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3005.mp4 ¿Qué es la sífilis? https://d3imrogdy81qei.cloudfront.net/video_images/5407/syphilis.jpg Yes 225 https://app.protrainings.com/courses/bloodborne-pathogens/body-art-california/videos/syphilis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3005.mp4 Syphilis In this lesson, we're going to take a look at the syphilis virus, including how people get syphilis, the four stages of syphilis, and the signs and symptoms of the disease. Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore – typically on your genitals, rectum, or mouth – and spreads from person to person via skin or mucous membrane contact with these sores Body art practitioners need to make sure that they are aware of diseases and how to prevent spreading them, especially those that can be present on certain areas of the skin. The Centers for Disease Control and Prevention (CDC) has provided the following information on syphilis: Syphilis is a sexually transmitted disease, also known as an STD. Syphilis can have very serious complications when it is not treated. Syphilis is simple to cure with the proper treatment. Warning: when a pregnant woman has syphilis, the infection can be transmitted to her unborn baby depending on how long the woman has been infected. There exists a high risk of stillbirth or giving birth to a baby who dies shortly thereafter. When left untreated, syphilis in pregnant women results in infant death up to 40 percent of the time. Pro Tip #1: A person usually gets syphilis by direct contact with a syphilis sore. The most common mode of transmission is through contact with a syphilis sore during vaginal, anal, or oral sex. Syphilis sores can often be found on and/or around the penis, vagina, anus, in the rectum, on the lips, and around the mouth. The average time between getting the syphilis virus and the start of the first symptom is usually around 21 days, however this period can range from 10 to 90 days. The Four Stages of Syphilis Syphilis has been divided into four stages: primary, secondary, latent, and tertiary. To complicate matters, each stage of syphilis has its own set of signs and symptoms associated with it. Primary Syphilis Stage A person in the primary stage of syphilis generally has one or more sores at or around the original site of the infection. As already mentioned, these sites usually include around the genitals, around the anus, inside the rectum, or in or around the mouth. Syphilis sores are usually, but not always, firm, round, and painless. These sores typically last between three and six weeks and will heal regardless of whether or not the person infected receives treatment. Pro Tip #2: Even after a syphilis sore goes away, treatment is still required. If left untreated, there is nothing stopping the infection from moving to stage two, secondary syphilis. Syphilis can also invade the nervous system during any stage of infection. This can cause neuromuscular and ocular complications such as paralysis and blindness. Secondary Syphilis Stage Symptoms of secondary syphilis include, but are not limited to: Skin rash Swollen lymph nodes Fever The symptoms of primary and secondary syphilis can be mild or maybe not even noticeable at all. However, if it is left untreated, the syphilis infection will then move to the latent stage and possibly even the tertiary stage. The secondary stage of syphilis usually begins with a rash on one or more areas of the body. This rash can show up along with primary sores, while the sores are healing, or even several weeks after the sores have healed. A secondary syphilis rash usually looks like rough, red, or reddish-brown spots on the penis, the hands, and/or the bottom of the feet. A syphilis rash usually isn't itchy and sometimes it can be so faint that the person infected won't even notice. Latent Syphilis Stage The latent stage of the syphilis infection does not come with any visible signs or symptoms of the disease. However, if the person infected does not receive treatment, the infection can continue to harbor the syphilis virus in the body for many more years with no signs or symptoms. Tertiary Syphilis Stage The tertiary stage of the syphilis infection is often associated with severe medical problems that are directly related to it. These more serious problems can affect the heart, the brain, or other vital organs in the body. Tertiary syphilis is extremely serious and occurs somewhere between 10 and 30 years after the person was first infected. This stage of the disease can do great damage to internal organs and even result in death. Most physicians will be able to diagnose a syphilis infection with the help of multiple tests. With the right kind of antibiotic from a health care provider, syphilis can be cured. However, it's important to point out that treatment will probably not undo any of the damage that the syphilis virus has already caused. https://d3imrogdy81qei.cloudfront.net/video_images/5407/syphilis.jpg Yes 225 https://app.protrainings.com/courses/pals/certification/videos/welcome-to-propals-introduction-and-philosophy https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3090.mp4 Welcome to ProPALS: Introduction and Philosophy Welcome to the ProPALS course. This PALS (Pediatric Advanced Life Support) course was designed specifically for you, the busy healthcare professional. ProPALS is available 24/7, whether you're watching a video for the first time, the third time, or coming back after several months for a quick refresher. We're here whenever you need us to be, regardless of your schedule. We'll get into specific course objectives in the next lesson, but in this course, you can expect to gain all the guidelines and knowledge about current PALS regulations. Which will ultimately lead to meeting and exceeding the most important course objective: Providing you with enough real-world knowledge so that when you're a team leader during a pediatric emergency, you can feel as confident as possible to contribute to a positive outcome in that patient's life. Becoming that kind of confident takes action to achieve – as in, gaining a deeper knowledge than you already possess. Along with honing and refining the necessary skills that many of you already have. It takes commitment and dedication, and it may require that you watch the videos more than once. It may mean practicing case scenarios several times until they become automatic. However, what you'll get from that confidence isn't nearly as important as what you can do with that confidence – making a difference when it matters most and possibly saving a child's life. Warning: Some things in this course may be familiar to you already, and if they are, that's not always a good thing. We tend to passively listen, read, and learn when things sound familiar. And when this happens, you're much more likely to miss a point or two that one day you may need. Fight this human tendency and you'll get much more from this course. A Word About Important PALS Metrics Some of this will be a preview of things to come. But it's important to set the table before sitting down for a meal. We're not animals, after all. How we define infant: An infant is a boy or girl who is less than one year old, but excluding newborns, also known as neonates. How we define child: A child is a boy or girl who is one year old up until signs of puberty, after which, we tend to put them into the adult category. For boys, first signs of puberty usually include the presence of chest hair and/or underarm hair. For girls, first signs of puberty include the first signs of breast development. In this course, when we refer to infants and children, this is how we define those terms. However, as you can see, there are a lot of years between infant and the first signs of puberty, and there may be times when being more precise will benefit you. Like understanding normal respiratory rates, heart rates, and blood pressure rates by age. When you know what's normal, encountering rates that are NOT normal are often the first signs that something is wrong. The following rates are according to the AHA (American Heart Association). Respiratory Rates by Age Infant 30 – 53 Toddler 22 – 37 Preschooler 20 – 28 School-age child 18 – 25 Adolescent 12 – 20 Bradypnea – a slower than normal respiratory rateTachypnea – a faster than normal respiratory rateApnea – the absence of respiration, defined as longer than 15 seconds Three Types of Apnea 1. Central apnea – when there is no respiration because of an abnormality or suppression of the brain or spinal cord.2. Obstructive apnea – when airflow is completely or partially blocked.3. Mixed apnea – when there are periods of both central apnea and obstructive apnea. Heart Rates by Age   Awake Sleeping Neonate 100 – 205 90 – 160 Infant 100 – 180 90 – 160 Toddler 98 – 140 80 – 120 Preschooler 80 – 120 65 – 100 School-age child 75 – 118 58 – 90 Adolescent 60 – 100 50 – 90 Bradycardia – a slower than normal heart rateTachycardia – a faster than normal heart rateCardiac arrest – the absence of a heart rate Blood Pressure Rates by Age   Systolic Diastolic Mean Neonate 67 – 84 35 – 53 45 – 60 Infant 72 – 104 37 – 56 50 – 62 Toddler 86 – 106 42 – 63 49 – 62 Preschooler 89 – 112 46 – 72 58 – 69 School-age child 97 – 115 57 – 76 66 – 72 Preadolescent 102 – 120 61 – 80 71 – 79 Adolescent 110 – 131 64 – 83 73 – 84 Systolic pressure (top number) – the amount of pressure in the arteries while the heart is contractingDiastolic pressure (bottom number) – the amount of pressure in the arteries when the heart is between beats https://d3imrogdy81qei.cloudfront.net/video_images/5537/welcome-to-propals-introduction-and-philosophy.jpg Yes 98 https://app.protrainings.com/courses/pals/certification/videos/course-objectives-and-completion-requirements https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3091.mp4 Course Objectives and Completion Requirements This ProPALS course is specifically for healthcare providers who directly participate in the management of respiratory and cardiovascular emergencies in pediatric patients. In this lesson, we'll explain the course objectives and what you'll gain from the course, along with what's required to complete the course. The Goal of ProPALS The goal of this PALS course is two-fold: Assessment – to train all healthcare providers to recognize respiratory emergencies, shock, and cardiopulmonary emergencies in pediatric patients. Treatment – to train all healthcare providers to intervene with high-quality individual and team skills. Your ProPALS Objectives After successfully completing ProPALS, you should be able to provide the following skills and knowledge to all pediatric patients. Recognize the early signs of cardiac arrest and begin CPR within 10 seconds of beginning your primary assessment. Perform the highest quality CPR per the current basic life support (BLS) guidelines and recommendations. Identify whether or not the patient requires immediate intervention. Provide pediatric advanced life support per the current guidelines and recommendations. Recognize and treat pediatric respiratory distress and failure. Identify and provide treatment for both compensated and decompensated shock in pediatric patients. Interpret core arrhythmias and manage all stable and unstable pediatric patients using all appropriate medications and electrical therapy. Describe all the signs and symptoms of unstable pediatric patients with an arrhythmia. Perform as an effective team leader, apply the use of proper team dynamics, and implement post-cardiac arrest management. Pro Tip #1: To be successful in the ProPALS course, you should already have a foundation of previously acquired advanced level skills. Your ProPALS Skills Mastery Depending on your licensure level and areas of expertise, you will be expected to be proficient in the following skills. Placing an advanced airway in a pediatric patient, such as an endotracheal tube Obtaining vascular access using an IO or an IV Recognizing basic arrhythmias Performing defibrillation and cardioversion Knowing basic PALS pharmacology information, including: Indications Contraindications Advanced life support medications Approved methods for administering those medications The Completion of ProPALS There are three parts of the ProPALS course that need to be completed: Complete all video training. Pass all the skills scenarios with a perfect score. Take and pass the final exam. Video Training Though video training will be instrumental for most of you, it is not a strict requirement for those of you who are taking this course for recertification reasons. (Though it pays to make sure you know all current guidelines, as these tend to change.) If you feel confident that you've retained all of your PALS information from a previous trip through this course, you may opt to skip the video training. Skills Scenarios It's important that you're able to pass all skills scenarios, and for this reason, we've set up ProPALS so that you cannot take the final exam until all skills scenarios have been passed with perfect scores of 100 percent. In these simulated case skills scenarios, you'll have the opportunity to interact and put your PALS knowledge into practice, as you actively participate as the team leader. The skills scenarios will allow you to practice identifying and treating pediatric conditions by applying a systematic approach to pediatric assessment using current PALS algorithms and practicing effective resuscitation team dynamics. Why must you score 100 percent on all skills scenarios before moving on to the final exam? Pediatric advanced life support includes extremely critical and precise techniques, medications, dosages, and procedures. You know how getting close is good enough when playing horseshoes? With PALS, extreme precision is the only thing that's good enough. One day, you'll be very thankful for your mastery of the vital skills scenarios that you'll gain from these strict course requirements. Pro Tip #2: As healthcare professionals ourselves, we know that you don't want to take any chances or unnecessary risks, and this includes not being exactly sure what to do in all situations. Remember, not recognizing a condition or responding incorrectly could literally be the difference between someone living and someone dying. Final Exam After watching all the video training and scoring perfect scores on all skills scenarios, it's time to take the final exam. And pass it, of course! Some Tips that may Help You The video training is a valuable tool to help you gain real-world knowledge of pediatric advanced life support skills. Remember, they're always available, so you can review them whenever you like and as many times as you need. However, we also have a ProPALS student manual that you can download and review. The manual includes information on PALS treatment algorithms and ECG recognition and even some additional information that the videos do not. Sadly, not all material works perfectly in a video format. You'll be much better served by using the student manual in conjunction with the video content. However, if you don't use the manual and you find yourself with questions or feeling like you're missing out on crucial content, there's a good chance you'll find those answers and some finer details in the manual. In case you missed the link to the student manual, you can download your copy here. (coming soon) https://d3imrogdy81qei.cloudfront.net/video_images/5539/course-objectives-and-completion-requirements.jpg Yes 270 https://app.protrainings.com/courses/pals/certification/videos/high-performance-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3092.mp4 High-Performance PALS The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments that: Take place simultaneously and Are performed efficiently and effectively in as little time as possible. In this lesson, you'll learn about how these high-functioning teams operate, including a break down of the individual roles and responsibilities for each. As successful resuscitation rates increase, so do the chances that the patient receives the best chance for a positive, long-term outcome. And for a resuscitation attempt to be successful, all parts must be performed correctly by a high-performing team of highly trained, organized, and communicative healthcare professionals. Successful high-performance teams take a lot of work and don't just happen by chance. Each individual in a team must have the expertise to perform his or her job and a high-level mastery of their resuscitation skills. And they have to function as one cohesive unit, which requires a focus on communication within the team dynamic. It doesn't matter if you're a team leader or a supportive team member. All members of a resuscitation team are equal, and each plays a vital role in any team resuscitation scenario. Pro Tip #1: What does matter is your ability to not only understand your role, but also the roles of others on your team. When you know the roles and responsibilities of each team member, you can anticipate what's coming next, which will increase the ability of the team to communicate, improve the efficiency and performance of the resuscitation, and the chances for the patient to have a positive outcome. High-Performing Resuscitation Team Roles Now that you understand the importance of understanding the roles and responsibilities of each team member, let's look at some common duties and requirements for each. Team Leader The team leader is required to have a big-picture mindset. This includes the following duties: Keep the resuscitation team organized and on track Monitor the team's overall performance and accuracy Back up any other team member when appropriate Train and coach other team members when needed and provide feedback Facilitate all actions and understanding during the code Focus on the comprehensive care of the patient Assign remaining roles to the other team members Make appropriate treatment decisions based on proper diagnosis Every symphony needs a conductor, just as every successful resuscitation team needs a team leader for the group to operate effectively and efficiently. The team leader has a responsibility to ensure that all team members are playing their individual role to the best of their abilities, and this includes doing things the right way at the right times. But perhaps the biggest responsibility of the team leader centers on his or her ability to communicate clearly and effectively and explain to team members the specifics of resuscitation care. A Typical Resuscitation team is dependent on the environment, as teams in hospital settings can be quite large, while those in pre-hospital settings (EMS and first responders) might include just two or three healthcare providers. A typical large team simply means a more precise division of duties, while smaller teams will be required to share duties. Typical Large Team – will include a team leader, a compressor, an airway manager, an AED/monitor/defibrillator, an IV/IO/medications provider, and a time recorder. Typical Small Team – will include a team leader and airway manager, a compressor and IV/IO/medications provider, and an AED/monitor/defibrillator and compressor. (In a small team, recording can be done by any team member but is often handled by the team leader.) In this ProPALS course, our emphasis will be on the small team approach. However, it's important to understand that roles can always expand based on need and the number of healthcare providers present. Pro Tip #2: You likely noticed that compressor was listed twice in the small team example. And the reason for this is simple: As you fatigue, the quality of CPR diminishes. As the quality of CPR diminishes, so does the patient's chance for a positive outcome. Compressor The team member in charge of compressions should know and follow all the latest recommendations and resuscitation guidelines to maximize their role in basic life support. Chest compressions are vital when performing CPR. So vital, in fact, that this team member often rotates with another team member (usually the AED/monitor/defibrillator) to combat fatigue. The best time to switch positions is after five cycles of CPR, or roughly two minutes. However, if you're feeling fatigued, it's better to not wait if the quality of chest compressions has diminished. Airway Manager The airway manager is in charge of all aspects concerning the patient's airway. This includes opening the airway and maintaining it. And using equipment like a bag valve mask or more advanced airway adjuncts as needed. AED/Monitor/Defibrillator As you might have guessed, this team member is in charge of bringing an AED to the scene (unless one is already present) and operating the AED. This team member is also the most likely candidate to share chest compression duties with the compressor. IV/IO/Medications Provider This team member is in charge of all vascular duties, including: Initiating vascular access using whatever technique is appropriate Administering medications with accuracy and timeliness as directed by the team leader Providing feedback or advice when appropriate Time Recorder The time recorder is responsible for keeping a rolling record of time for: All specific resuscitation interventions All medications or treatments administered The frequency and duration of any CPR interruptions The time recorder also announces to the team when/if a next treatment or more medication is due. If no one person is available to fill the role of time recorder, the team leader will assign these duties to another team member or handle them herself/himself. Every successful resuscitation team includes members who understand his or her individual role, as well as the roles of other team members, and is prepared to effectively do their part. This includes having a good working knowledge of PALS algorithms along with acquiring sufficient skills practice. And wouldn't you know it, that's exactly what you'll be learning in this course. https://d3imrogdy81qei.cloudfront.net/video_images/5541/high-performance-pals.jpg Yes 463 https://app.protrainings.com/courses/pals/certification/videos/effective-communication-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3093.mp4 Effective Communication In order for a resuscitation team to be successful, they must practice effective communication. In this lesson, we'll be getting into some specific techniques or tips to help you achieve this vital element for positive patient outcomes. It's important that each member of a resuscitation team knows their individual roles and how to function as part of their team. And how to communicate those roles and duties effectively to other team members. Warning: How important is effective communication? Without it, you greatly increase your odds for confusion, procedures being done incorrectly, medication errors, and disagreements among team members, that also increase the chances for the above to occur. And, of course, all of this reduces the patient's chances for survival. Techniques to Improve Communication Good communication doesn't happen by accident; it takes work. It's important to remember, when it comes to communication or any other aspect of your job, that the patient must always come first. 1. Establish Clear Roles and Responsibilities It's vital that every team member knows and understands each of his or her duties on the team. However, it's also important that you understand the roles and responsibilities of the other team members. Understanding everyone's role and properly communicating specifics of each role will be crucial for helping the patient. All team members will have different levels of skills based on their individual training and experience, which is why it's important for the team leader to be aware of these proficiencies and properly assign responsibilities to those who can handle them. 2. Know Your Limitations Every team member must know their own limitations. This will help the team leader to properly evaluate all available resources, assign duties to those who can handle them, and call for assistance if needed. Pro Tip #1: Asking for help should never be considered a sign of weakness or incompetence. It's better to be honest about your skills and experience and get the appropriate help when needed, than to do something that will negatively impact the team and ultimately the patient. 3. Constructive Intervention There will be times when the team leader will have to intervene. For instance, if a team member isn't handling a specific action correctly, it may be necessary for the team leader to take over that duty or reassign it to another member of the team. However, it's equally important that the team leader handle the situation professionally and tactfully. Pro Tip #2: Team leaders should always avoid a confrontation with a member of the team. These will only serve to produce negative consequences for the patient. This includes avoiding any statements that may appear derisive or hostile. And watch your tone. Remember, often it's not what you say, but how you say it. 4. Knowledge Sharing In situations where your resuscitation efforts are proving to be ineffective, it's important to get back to the basics and talk as a team to try and solve the problem. For instance, the team leader can do this by recapping out-loud what has been done that hasn't worked and encouraging feedback from members of the team. Maybe there's something that was missed. Or something else that may produce a better outcome. Sharing knowledge is crucial, especially in those moments when things aren't working. Pro Tip #3: All team members should communicate any changes in the patient's condition. This will help the team leader to make calculated, informed decisions correctly. 5. Summarizing and Reevaluating The team leader should always be asking herself or himself questions pertaining to the patient's condition. Monitoring their condition and reevaluating the situation is essential. These questions can include: What is the current status? What treatments have been performed? What changes in the patient have those treatments produced? What are the latest assessment findings that will help me proceed with providing the best care possible? Pro Tip #4: Team leaders should summarize and reevaluate the patient's condition out-loud through regular updates to the team. Verbalizing everything to the team is important for effective communication, efficient team leading, and ultimately providing better care to the patient. 6. Closed-Loop Communication When a team leader gives an assignment or an order, closed-loop communication is how we make certain that the message was understood and is being executed. It serves as confirmation and must be done before the team leader assigns another task. So, what does closed-loop communication look like? Once the team leader assigns a task or provides direction, the exact message must be repeated by the team member that the message was directed towards. That's it! Simply repeat the message and then began to execute the order. 7. Clear Messages Giving concise, clear orders is essential for any successful resuscitation team. This includes good enunciation and a tone of voice that's calm and clear. The message should be direct and absent of emotion. Shouting or flustered speech in a frantic manner isn't going to help the situation. It'll only serve to waste time, as the team member may feel rushed or confused and may even impair that team member's ability to think clearly about the task they're performing. 8. Mutual Respect Mutual respect is vital for effective and efficient communication. It's obviously the professional way to communicate with peers. But also, members of a resuscitation team who work together in a respectful and supportive manner will have more success achieving favorable outcomes. Pro Tip #5: All members of a resuscitation team work diligently toward the same goal. No one is better than anyone else, regardless of their training, experience, or expertise. Every team member, including the team leader, should recognize the value the other team members provide and leave the ego at home. Practicing these communication techniques will help you establish an efficient and successful resuscitation team. A team that will better serve the community, produce more positive outcomes, and increase survival rates for those they serve. https://d3imrogdy81qei.cloudfront.net/video_images/5543/effective-communication-pals.jpg Yes 391 https://app.protrainings.com/courses/pals/certification/videos/ill-or-injured-child-systematic-approach https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3094.mp4 Ill or Injured Child Systematic Approach When assessing an ill or injured child, your goal is to recognize conditions quickly, especially if they're life threatening or could become life threatening if care and treatment are not provided as soon as possible. In this lesson, we'll go over this systematic approach to assessing a child in these circumstances. And we'll provide tips and details for this approach. An approach that can best be summed up this way: Evaluate, identify, and intervene. If you find that the child isn't breathing and doesn't have a pulse, begin full CPR and rescue breathing immediately. If the child has a pulse and is breathing, there are still some important signs to look for including: Respiratory distress Respiratory failure Signs of shock These are the most common issues for pediatric patients that can quickly deteriorate into respiratory arrest and eventually cardiac arrest. Evaluate, Identify, Intervene This is the big picture approach to helping an ill or injured child. It includes recognizing any life-threatening emergencies and intervening with the proper treatment. However, if there aren't any immediate life-threatening issues, you'll move on to your initial and primary assessment that will focus on medical history and a physical exam to evaluate for any secondary conditions that may need to be addressed. Evaluation tools you might want to use include lab tests, radiographic tests, and other advanced tests. But to begin your assessment, you'll use a systematic approach in order to be more consistent and to reduce the chances of missing something important. Form an Initial Impression The first thing you'll want to do is quickly observe the child for anything obvious. Evaluate their appearance, breathing, and circulation. Doing this should help you determine if there is an urgent need for care and to recognize any life-threatening issues. Perform a Primary Assessment When performing your primary assessment, and after your shouts and taps, if the child is still unresponsive, call for help immediately and activate EMS. Check for Pulse and Signs of Breathing If the child isn't breathing, but has a pulse, begin rescue breathing – 1 breath every 3 seconds. If the child isn't breathing and has no pulse, begin full CPR. Pro Tip #1: If the child's heart rate is below 60 beats per minute with signs of poor perfusion, go immediately into chest compressions and full CPR. However, if you don't find any life-threatening conditions, continue to perform your initial assessment by looking at three distinct areas: overall appearance, effort when breathing, and circulatory status. Pro Tip #2: It's important to keep the child as calm as possible. This will usually include having a parent or primary caregiver nearby that can help, if practical, while you continue to assess the patient. You may need to get creative and find ways to put the child at ease during your evaluation process. Overall Appearance While evaluating the overall appearance of a pediatric patient, there are a few things to look for: Look at the child's ability to interact and level of consciousness. Look at the child's eyes. Do you notice an unusual stare or gaze, like the child isn't all there mentally? Does the child appear to be looking through you, rather than at you? Look at the child's reactions. Does the child appear to be in any pain? Look to see if the child is acting normally. How is their body position, verbal responses, or the reactions we noted above? Pro Tip #3: How do you know what normal looks like? If there's a parent or caregiver present, get their help, and ask them if their child is acting normally or differently. Otherwise, you'll have no way of knowing what this child's version of normal looks like. Effort When Breathing Does the child appear to be having trouble breathing? Look first at their body position, then the amount of accessory muscle tone, and finally audible sounds of breathing that can be heard without a stethoscope. Body Position Is the child in what we call a tripod position – leaning forward with their hands on their knees. This is usually done to keep pressure off the lungs and diaphragm, which makes labored or inadequate breathing a little more easily accomplished. Accessory Muscle Tone Do you see any signs of retractions, nasal flaring, or signs of accessory muscles being used to aid breathing? Audible Sounds of Breathing Do you hear stridor or unusually deep or shallow respirations, wheezing, grunting, or crackles? If you see any of these signs of respiratory distress, don't delay. This is an emergency situation that can quickly lead to respiratory arrest in a child. Circulatory Status This is the last step of your initial assessment and one that you'll use the child's overall color to determine. Ask yourself, does the child have pale, mottled, or cyanotic looking skin? If you notice a strange complexion that you suspect may be due to cyanosis, look at the mucous membrane on the inside of the child's lips, their fingertips, or their nailbeds. Cyanosis of the lips and fingernails are early signs of circulatory compromise and oxygenation issues and symptoms that the child has inadequate oxygen in their blood. If the child has a flushed appearance, this could indicate fever or shock. If the child has bruising on their skin, this could indicate an injury and/or internal bleeding. The idea of this systematic approach is to quickly assess how well the child is perfusing through your observation. Pro Tip #4: Use the ABCDE method as part of your primary assessment: airway, breathing, circulation, disability, and exposure. After your primary assessment, perform a secondary assessment to determine other conditions that may require treatment. And always remember to continually evaluate, identify, and intervene, when necessary and as the child's condition changes. https://d3imrogdy81qei.cloudfront.net/video_images/5557/ill-or-injured-child-systematic-approach.jpg Yes 416 https://app.protrainings.com/courses/pals/certification/videos/child-cpr-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3095.mp4 Child CPR First, let's recap the five links in the Child Cardiac Chain of Survival: Injury prevention and safety Early CPR Early Emergency Care Pediatric advanced life support Integrated post-cardiac arrest care Child-related cardiac arrests are typically the result of a hypoxic event, such as: Drowning Choking/airway obstruction Exacerbation of asthma Due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation. Warning: Laryngeal spasms (sudden spasm of the vocal cords) may occur in these situations, making passive ventilation during chest compressions minimal or nonexistent. Administering high-quality CPR can help overcome this oxygenation problem. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the child is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. CPR Technique for Children Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go roughly 2 inches deep, or 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm. Grab the appropriately-sized rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly – just past perpendicular. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression. A Word About the Differences Between Child CPR and Adult CPR This section began by mentioning a few subtle differences between adult CPR and child CPR. There are four distinct differences to be aware of. Opening the Airway While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground. Performing Compressions The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand. Compressions to Ventilations Ratio If there is only a single responder, continue using the 30 compressions to two ventilations ratio. However, if there are two responders, that ratio changes to 15 compressions to two ventilations. Using AEDs AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the child. If the child weighs more than 55 pounds, continue using the adult AED pads. If the child weighs less than 55 pounds, use pediatric AED pads if available. Warning: It's vitally important that the AED pads do not touch each other. If the child is too small for adult pads, and you do not have pediatric pads, place one on the center of the sternum and the other on the child's back between the scapulae. https://d3imrogdy81qei.cloudfront.net/video_images/5545/child-cpr-pals.jpg Yes 114 https://app.protrainings.com/courses/pals/certification/videos/infant-cpr-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3096.mp4 Infant CPR As you have read already, there are some differences between performing CPR on an adult versus a child. And when it comes to infant CPR, there are even more differences, as you should now be well aware of after the last section on Infant Landmarks. Infant-related cardiac arrests are typically the result of: Drowning Choking/airway obstruction Electrocution Just as with child CPR, due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the infant is responsive. Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.) If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the baby's feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. CPR Technique for Infants Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that. If you don't, there are some tricks to fitting an adult mask onto an infant, such as turning the mask upside down. Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About CPR Compression Rate and Depth Performing proper chest compressions is essential for providing high quality CPR, which greatly improves the patient's chances for a successful outcome. While it's not entirely understood, it's believed that chest compressions increase the level of pressure inside the chest cavity, which squeezes the heart to stimulate a contraction. This helps to send oxygenated blood through the arteries to the brain and other vital organs. Chest compressions also increase the likelihood of a successful AED shock for the patient, particularly if several minutes have elapsed since the patient collapsed or suffered an incident leading to respiratory distress. Chest compression effectiveness is reduced if: Compressions are too shallow The compression rate is too fast or too slow There isn't a full recoil of the chest cavity There are interruptions during CPR The patient isn't laying on a firm, flat surface Warning: Compression rates that exceed 120 per minute tend to have a negative impact on compression depth, perhaps due to responders rushing through them. Regardless, if compression rate exceeds 120 per minute, you are less likely to compress the full two-inch minimum (for adults), thereby reducing the effectiveness of CPR. When it comes to compression depth, research suggests that depths greater than 2.4 inches can lead to non-life-threatening injuries, such as broken or fractured ribs. If you are a novice or unsure if you're compressing at the correct depth, a feedback device might be helpful. https://d3imrogdy81qei.cloudfront.net/video_images/5547/infant-cpr-pals.jpg Yes 226 https://app.protrainings.com/courses/pals/certification/videos/aed-for-infants-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3097.mp4 AED for Infants The methods of defibrillating an infant are basically the same as defibrillating a child. One important distinction involves AED pad size. AED pads come in an adult size and a pediatric size, for patients less than 55 pounds or roughly 25 kilograms. For infants (around one year old or less), as they are considerably smaller than children, having the right pad size becomes even more important. However, remember, if you do not have pediatric pads and the patient is less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forego using an AED. Also, remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? If for some reason the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. And one last reminder: It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. And with infants, since one pad will be attached to the back, that area must also be dry. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.) If you don't get an initial response, place your hand on the infant's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED. AED Technique for Infants Turn on the AED. Remove the patient's clothing to reveal a bare chest and back. Attach one AED pad to the infant's chest, carefully roll the infant on his or her side, and attach the second pad to the back. The pads should have a diagram on placement if you need a reminder. Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to their chest, meaning your knuckles are directly above your fingers during compressions. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go roughly 1.5 inches deep, or 1/3 the depth of the infant's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the appropriately-sized rescue mask and seal it over the victim's face and nose. Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About AED Precautions When using an AED, there are several precautions to keep in mind. Some of these may be obvious (and a repeat of what you've already learned in this course), while others may not be. Since alcohol is flammable, do not use anything with alcohol on it to wipe the patient's chest or back dry. While it's OK to use adult pads on a child, the reverse isn't entirely true, as pediatric pads may not deliver enough energy to defibrillate the patient. Do not touch the patient while the AED is conducting an analysis, as this may affect the analyzation process. Before delivering an AED shock, make sure no one is touching the patient or any of the resuscitation equipment. Do not use an AED if there are flammable or combustible materials or gases present, including free-flowing oxygen. Do not operate an AED inside a moving vehicle, as the movement can affect analysis. Do not use an AED if the victim is in contact with free-standing water or in the rain. Move the patient first. Do not place AED pads on top of any patches or implantable devices. Remove patches first and adjust the pads as necessary to avoid devices like a pacemaker. https://d3imrogdy81qei.cloudfront.net/video_images/5549/aed-for-infants-pals.jpg Yes 273 https://app.protrainings.com/courses/pals/certification/videos/neonatal-bls-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3098.mp4 Neonatal BLS Neonates are newborns who are less than a month old. It's important to note that there are some significant differences between resuscitating neonates compared to infants. As with infants, it's most common for respiratory drive or lack of oxygen to contribute to the neonate's unresponsiveness versus a cardiac-driven event. This is important as it reflects how we perform rescue breaths and CPR. The following CPR instructions are for respiratory distress. Pro Tip #1: The rescue mask for neonates is extremely small. It's important to have rescue masks to fit every size patient, as an adult mask could prove useless when trying to resuscitate a newborn. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin to assess whether or not the newborn is responsive. If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the newborn's feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. Pro Tip #2: If the newborn's pulse is 100 beats per minute or less but not less than 60, perform rescue breathing – one rescue breath every three seconds. Rescue breathing (for pulse rates between 60 and 100) – one breath every three seconds, enough air for the newborn's chest to rise and fall. Do this for two minutes. Then check again for a brachial pulse. If the newborn's pulse is less than 60, begin to perform full neonatal CPR – three chest compressions followed by one rescue breath. CPR Technique for Neonates Just as you would for infants (the landmarks are the same), draw an imaginary line across the newborn's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the baby's chest, meaning your knuckles are directly above your fingers during compressions. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on neonates, use only your fingers to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go to a depth of 1/3 of the newborn's chest cavity, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform three chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Breathe once into the rescue mask and wait for the chest to rise and fall. Continue to perform three chest compressions to one rescue breath for two minutes then reassess for vital signs. If the neonate's pulse is still slow or there is no pulse, continue CPR until help arrives, an AED arrives, or the victim is responding positively and breathing normally. Pro Tip #3: Although most situations involving an unresponsive neonate will be due to a respiratory problem, remember that there is a difference in how we resuscitate an unresponsive newborn who has had a cardiac-related event that led to their current condition. If their condition was due to a congenital heart defect or cardiac arrest, perform 15 compressions to two rescue breaths and repeat. Performing Neonate CPR in a Two-Responder Setting This two-responder scenario is more likely to be found in a clinical or professional health setting. It allows the responders to incorporate things like high-flow oxygen with a bag valve mask and the use of circumferential thumb compressions. This is much more efficient when performing just three compressions to every breath, as one responder can handle the bag while the other performs the compressions. A Word About Vital Signs (By Age) Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations. For Adults (12 years and older) Pulse rate – 60 to 100 beats per minuteRespirations – 12 to 20 breaths per minute For Children (1 year to 12 years old) Pulse rate – 80 to 100 beats per minuteRespirations – 15 to 30 breaths per minute For Infants (1 month to 12 months old) Pulse rate – 100 to 140 beats per minuteRespirations – 25 to 50 breaths per minute For Neonates (full term to 30 days) Pulse rate – 120 to 160 beats per minuteRespirations – 40 to 60 breaths per minute https://d3imrogdy81qei.cloudfront.net/video_images/5623/neonatal-bls-pals.jpg Yes 338 https://app.protrainings.com/courses/pals/certification/videos/child-cpr-2-rescuer-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3099.mp4 Child CPR (2 Rescuer) In this section, we're going to cover two-responder child CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.) Pro Tip #1: When performing chest compressions on a large child, use two hands as you would for an adult. But when performing compressions on a smaller child, use just one hand to assure you're not compressing with too much force. Pro Tip #2: The rate of compressions to rescue breaths changes during child CPR when two responders are present. Instead of performing 30 compressions to two rescue breaths, reduce the number of compressions to 15 for every two rescue breaths. It's worth mentioning again – The assessment phase is similar to one-responder situations, however, while one of you is assessing the scene and patient, the other can get the equipment ready to perform CPR, try to locate an AED if one isn't present, call 911 or a code, etc. Once chest compressions begin, that's when the efforts of each responder will begin to coordinate, including the important switch at the two-minute mark. The importance of having a fresh compressor cannot be overstated. Performing high-quality compressions will help bring the pulse pressure up as well as keeping the blood pressure as high as possible. Having two responders working together as a coordinated team will ensure the highest quality CPR gets delivered, which will give the patient the greatest chance of survival. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the child is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Two-Responder CPR Technique for Children Responder one: Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. With smaller children, it may help to draw an imaginary line across the nipples. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Remember: Use only one hand when performing chest compressions on smaller children. Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart. Conduct compressions that go 2 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 15 chest compressions. Remember that counting out loud is even more important when two responders are working together. It allows the other responder to anticipate the delivery of rescue breaths and the all-important switching of duties. Responder two: Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. (When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with children, the head-tilt, chin lift is less pronounced than it is during adult CPR.) Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath. Responder one: Go right back into your 15 chest compressions. Responder two: Go right back to delivering two rescue breaths. Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties. Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask. Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About Ventilations Artificial ventilation is the method of forcing air into the lungs of a patient who is not breathing on their own. The oxygen in the ventilated air will be absorbed by blood flowing through the lungs and carried to the body's tissues and vital organs. There are several ways to provide this ventilation, including: Mouth to mask using a one-way valve Using a bag valve mask with or without supplemental oxygen Mouth to mouth Mouth to nose Mouth to nose ventilation may be required if no ventilation equipment is present and if you are unable to create a proper seal over the patient's mouth. Mouth to Mouth Ventilation Steps Open the patient's airway past neutral using the head-tilt, chin-lift maneuver. Pinch the patient's nose shut. Create a seal over the patient's mouth using your mouth, or over the mouth and nose for an infant. Blow air into the patient's mouth. Break the seal slightly on the inhale and reseal before administering the next breath. https://d3imrogdy81qei.cloudfront.net/video_images/5625/child-cpr-2-rescuer-pals.jpg Yes 231 https://app.protrainings.com/courses/pals/certification/videos/overview-of-respiratory-emergencies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3101.mp4 Overview of Respiratory Emergencies Any abnormal respiratory rate or effort is a condition known as respiratory distress. In this lesson, we'll go over the importance of early recognition of respiratory emergencies, the proper head position for treatment, and some tips, techniques, and equipment used in respiratory emergencies. Respiratory emergencies can vary greatly, from something as benign as tachypnea that's self-limiting all the way to agonal gasps. It's important to know the latest guidelines for PALS when treating for respiratory distress, and this includes conditions like hypoventilation (inadequate respiratory effort), bradypnea (slow respiratory rate), and irregular breathing issues. It's vital that all PALS providers are well-prepared to identify respiratory conditions quickly and easily, whether you're dealing with something easily treatable – like suctioning an airway secretion or administering oxygen – to more serious conditions that are less obvious, harder to identify, and that can quickly deteriorate into respiratory failure. The latter will require immediate and appropriate intervention most often using advanced airway techniques, including assisted bag mask ventilation. Pro Tip #1: When it comes to infants and children, respiratory distress can quickly progress to respiratory failure and that system failure can eventually deteriorate into cardiac arrest. Neurologically intact survival to the hospital for infants and children is much more likely before cardiac arrest, than it is after. Proper Positioning for Good Ventilation One of the more common airway complications can be attributed to poor positioning of the pediatric patient, and thus poor airway access. To combat any potential alignment issues, make sure the child is laying down and facing upward. The head and neck should be in a slightly sniffing position, which is more neutral than tilted, or ever so slightly tilted. Be sure not to hyperextend the child's neck, as this can also impede the airway. Instead, flex the child's neck forward at the shoulders while extending the child's head. To achieve the slightly sniffing head position, consider how your head and neck react when you walk into a kitchen and smell a freshly baked apple pie. Pro Tip #2: If the child is two years or older, use padding under the shoulder blades, if available, which should help maintain the proper positioning and make it easier to adequately oxygenate the patient. And if this doesn't help, assess for further airway obstructions. Gastric Inflation A frequent problem that can occur during bag mask ventilation is inflation or distension of the stomach. If this happens, it's much more probable that the patient will regurgitate gastric stomach contents, which can contribute to both acute and chronic respiratory issues. Some common reasons for gastric inflation include: Partial airway obstruction when high airway pressure is required. When ventilating patients with poor lung compliance. While ventilating a patient with a bag valve mask, particularly if:a. The volume of oxygen delivered is too greatb. The pressure created is too highc. The patient is unconscious or in full arrest and has poor gastroesophageal sphincter tone Pro Tip #3: To prevent these situations from occurring, ventilate at a rate of 1 breath every 3-5 seconds and avoid creating too high of a peak pressure during ventilations. Deliver only enough pressure and air to see full chest rise and no more. Warning: Delivering too much pressure and air could result in bypassing the esophageal sphincter, which means putting air into the stomach instead. Cricoid Pressure Though cricoid pressure is allowed for use in PALS, research suggests that the advantages are insufficient to make it a routine procedure. However, having said that, if you have an unresponsive victim and a second healthcare provider who can perform the cricoid pressure separate from other advanced life-saving duties, using it may be a good idea to prevent gastric inflation. If there is evidence of gastric inflation, advanced healthcare providers are allowed to decompress the gastric pressure by inserting a naso or orogastric tube to help avoid gastric reflux. Suctioning Devices In PALS, both portable and mounted suction devices can be used. Advantages of portable devices include transporting them to wherever needed. However, a common disadvantage is the poor or inadequate suctioning power, even at max capability. A bulb or syringe style device is simple to use but has the same disadvantage, as it too offers little suction power. The benefit of these, however, is that they don't require a power source. However, they tend to only work on small patients and for very light secretions. Pro Tip #4: A suction force of negative 80mm to negative 12mm of mercury is usually required to remove most airway secretions. Wall mounted devices, while not portable, are usually more powerful and can offer much greater suctioning power. But the lack of portability limits the scenarios in which they can be used. It's important to use an appropriate suction device whenever secretions, vomit, or blood is in the oropharynx, nasopharynx, or trachea. It's equally important to use one immediately after birth if there is evidence of a meconium stain. Warning: Remember to suction the newborn's mouth first, as baby's are mouth breathers. Then suction the nasal passages after. Common Complications with Suctioning Some of the more common suctioning complications include: Soft tissue injuries Agitation Gagging and vomiting Vagal stimulation It's important to understand and avoid these complications whenever possible, and to know the potential risks when suctioning a patient. Types of Suction Devices There are two common types of suction devices: rigid and soft. Rigid suction catheters are most commonly used for suctioning the oropharynx when there are thick secretions like vomit and blood. Soft, flexible suction catheters are most commonly used for aspiration of thin secretions from the oropharynx and nasopharynx or for suctioning an advanced airway like an endotracheal tube. Pro Tip #5: A color coded link-based resuscitation tape is really helpful when trying to find the appropriate size of soft catheter to use for advanced airways. It's also important to limit suctioning to 10 seconds to help avoid the possibility of hypoxemia. All healthcare professionals can greatly improve the outcomes of respiratory emergencies by quickly and properly identifying and treating respiratory distress and respiratory failure early and proactively. Doing so will limit the chances of that child's condition deteriorating into cardiac arrest. https://d3imrogdy81qei.cloudfront.net/video_images/5551/overview-of-respiratory-emergencies.jpg Yes 383 https://app.protrainings.com/courses/pals/certification/videos/tools-to-monitor-oxygenation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3102.mp4 Tools to Monitor Oxygenation In this lesson, we're going to look at some helpful tools for monitoring and oxygenating patients, beginning with … Pulse Oximeter The pulse oximeter is one of the most popular and frequently used tools to monitor oxygenation. It measures the oxygen saturation in the patient and any trend in oxygen saturation. It works by measuring the percentage of hemoglobin that's fully saturated or bound with oxygen molecules. Warning: It's important to note that oxygen saturation does not equal oxygen delivery to tissues, and the pulse oximeter doesn't provide any information on the effectiveness of ventilation or the elimination of carbon dioxide. An effective pulse oximeter needs pulsatile blood flow in order to determine oxygen saturation and will display an inaccurate reading unless the pulse rate matches the ECG monitor. Which is why it's a good idea to look for other ways to determine the oxygenation and gas exchange of the patient. Reevaluate the patient if the pulse oximeter: Signals a decrease in oxygenation saturation Indicates a weak pulse rate Shows an inaccurate pulse rate Doesn't detect a pulse at all Pro Tip #1: It's important to not make assumptions when there's a failure in the pulse oximeter, as what's deemed an equipment failure may be indicating an actual change in the patient's condition. If you encounter such a problem, reevaluate the patient and determine if the patient is stable or requires additional care. And if you don't have an infant probe, use an adult eProbe positioned around the infant's hands or feet. Capnography A capnography is used to monitor the concentration or partial pressure of carbon dioxide in the expired air. Normal expired air in a person with proper circulation and respiration contains 35-40 mmHg of CO2, and this will be indicated on the digital readout. If CPR is being performed and you find a sudden and sustained rise in CO2 to 35-40 mmHg, this is likely an indication of spontaneous circulation. Pro Tip #2: When CO2 is absent, as measured with the capnography, either the endotracheal tube is in an incorrect position or there is no circulation in the patient. The goal with CPR is to see a reading of greater than 10 mmHg. If the reading is less than that, CPR rate and depth should be adjusted to improve circulation. Endotracheal Intubation Intubation with an endotracheal tube should be considered whenever a patient is unable to maintain an effective airway, oxygenation, or adequate ventilation on their own. Warning: It's vital that all PALS providers know their limitations, as well as their areas of proficiency and expertise, if you might be called upon to intubate a patient. Which is why you should always take advantage of any opportunities to hone your skills and get more experience in securing advanced airways. At some point, the need will arise. If an intubated patient's condition begins to deteriorate, check the following to rule out treatable problems: Is the tube displaced from the trachea? Has the tube gone into the right or left main stem bronchus? Has an obstruction developed due to thick secretions, blood, foreign objects, or pus? Is there a kink in the endotracheal tube? Has the patient developed a simple or tension pneumothorax? Has the equipment failed? Possible reasons for equipment failure include: A disconnection in O2 supply from the ventilation system A lean in the ventilator A power supply failure A malfunction of the valves in the bag or circuit Pro Tip #3: If you encounter a mechanical failure, go back to the basics and begin to manually ventilate the patient using a bag valve mask if the patient is on a ventilator. Looking for Signs of Correction There are some signs of correction to look for in the patient and in the equipment readings, including: Check to see if the patient's chest is rising and falling with ventilations. Check to see if there are good lung sounds upon auscultation. (Listen over the patient's stomach to rule out accidental esophageal intubation.) Check all monitors including the capnography, ECG monitor, pulse oximeter, and heart rate monitor. Suction the endotracheal tube if you suspect an obstruction. If the tube is kinked because the patient woke up or is agitated, consider using sedatives and analgesics with or without neuromuscular blockers. If you cannot confirm proper tube placement in an airway, direct visualization of the tube passing through the glottis is recommended. Pro Tip #4: If you suspect that the cause of a patient's deterioration is due to a misplaced tube or equipment failure, remove the original tube and ventilate the patient using a bag mask device, as this might be your best course of treatment until you find an appropriate advanced airway solution. When to Use Medications If you have a patient who is complicating their oxygenation and ventilation because they've become agitated, after ruling out all other possible causes, consider medicinal treatment to correct the problem. If using an analgesic, consider Fentanyl or Morphine If using a sedative, consider Lorazepam or Midazolam If using a neuromuscular blocker, consider Succinylcholine Warning: If you're intending to use a paralytic agent, you must be certain that you can adequately oxygenate and ventilate the patient using basic airway management solutions. https://d3imrogdy81qei.cloudfront.net/video_images/5553/tools-to-monitor-oxygenation.jpg Yes 355 https://app.protrainings.com/courses/pals/certification/videos/management-of-respiratory-emergencies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3103.mp4 Basic and Advanced Airways In this lesson, you'll learn about basic and advanced airways, including some common examples of each and things to pay attention to when using them. Basic Airways Basic airways are adjuncts that help direct air and oxygen around natural obstacles in the mouth, like the tongue. There are two types of basic airways: Oropharyngeal Airway (OPA) – OPAs are primarily used for patients who are usually unconscious and have no gag reflex. Nasopharyngeal Airway (NPA) – NPAs are basic airways that are inserted in patients who have a gag reflex and might be semi-conscious. Pro Tip #1: The correct size of both OPAs and NPAs are very important in order to not cause further harm to the patient, or in some cases, even block the airway entirely. To measure for an OPA, connect or place the tip of the flange to the side of patient's mouth and the base of the curved plastic to the earlobe area. Warning: If for any reason, a basic airway isn't effective in managing the airway for respirations, an advanced airway should be considered immediately. Advanced Airways The two most common types of advanced airways are endotracheal tubes and laryngeal masks. When considering an advanced airway, it's important to recognize that these procedures require a high level of competency to avoid unnecessary injuries to soft tissues and to properly secure the airway in order to effectively oxygenate the patient. If you feel as though you haven't been adequately prepared or don't have enough experience with advanced airway techniques, you should consider getting another PALS provider who is more comfortable and experienced using these procedures. Pro Tip #2: When considering the intubation of a child with an upper airway obstruction, you should understand that this is a high-risk procedure. Furthermore, use of a neuromuscular blockade should only be considered if the child can be sufficiently oxygenated with bag mask ventilation. Oxygen Delivery Devices In this section, we'll cover the most common ways to deliver oxygen therapy and the levels of oxygenation that each are capable of producing. For Low Flow Oxygen Nasal cannula Simple oxygen mask with no rebreather reservoir For High Flow Oxygen Non-rebreather mask with a reservoir High flow nasal cannula There are several factors that will affect the level of true oxygen therapy delivered to the patient, regardless of the delivery mechanisms, including: The oxygen flow into the device itself The ability of the child to inspire the oxygenated air How well the device adheres to the child's face Oxygen percentages of O2 delivered will be different for each device. Nasal Cannula When using a nasal cannula, expect a concentration of between 22-60 percent depending on the flow and the ability of the child to inspire the gas. There are both high flow nasal cannulas and low flow nasal cannulas. A low flow nasal cannula will be close to the low end of that scale above, or 22 percent. While a high flow cannula will be closer to the high end, or 60 percent. Pro Tip #3: A high flow cannula can be adjusted from 4 liters per minute to 40 liters per minute. It can also be titrated to produce additional inspiratory and expiratory pressure which may help to improve the patient's workload while trying to breathe. Simple Oxygen Mask When delivering low flow oxygen, you can expect delivery rates between 35-60 percent. And the oxygen flow rate should be set to between 6 liters per minute and 10 liters per minute. A simple oxygen mask cannot deliver a high oxygen concentration greater than 60 percent. For greater oxygen delivery, you'll need to use other delivery mechanisms, like high flow oxygen systems, which are much more reliable for delivering higher concentrations. Non-Rebreathing Mask A non-rebreathing mask is capable of delivering up to 95 percent oxygen at a flow rate between 10-15 liters per minute. However, this depends on how well the mask seals to the patient's face. It's also important to remember to adjust the oxygen flow rate to keep the reservoir bag inflated, which will affect the oxygen percentage delivered to the patient. Treatments for Upper Airway Obstructions One of the most common methods for treating an upper airway obstruction, like asthma, is with a nebulizer. A nebulizer can be used to humidify the air in order to help thin secretions or deliver medications, such as epinephrine or albuterol. When using a nebulizer, it should be used in conjunction with 5-6 liters per minute of low flow oxygen in order to appropriately nebulize the solution. A nebulizer can be used with a face mask or using a tea pipe style delivery mechanism. The delivery system you choose should be dependent on the patient's age and level of consciousness. https://d3imrogdy81qei.cloudfront.net/video_images/5555/management-of-respiratory-emergencies.jpg Yes 322 https://app.protrainings.com/courses/pals/certification/videos/normal-sinus-rhythm-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3106.mp4 Normal Sinus Rhythm When talking about treating a patient for something that we consider abnormal, it's always helpful to define and understand what normal looks like, in this case, for a normal sinus rhythm. In this lesson, we'll look more closely at an example of a normal sinus rhythm on an ECG for a pediatric patient and see what findings and measurements are considered normal, and what to be on the lookout for that would be considered abnormal. *Normal Sinus Rhythm ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above graphic, it's regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? Remember, to determine the patient's heart rate you'll want to observe the following areas on the ECG paper printout and perform the following calculations. The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds. Each larger square is 5mm in length and represents .2 seconds. Therefore a 6 second interval would be 30 large squares. To determine the heart rate, count the number of QRS complexes over this 6 second interval and multiply by 10. It's also important to understand that when it comes to pediatric patients, normal heart rates vary based on the age of the patient. For example, a normal heart rate for a 12-year-old will probably be bradycardic for an infant or a newborn. You may recall seeing some important stats or metrics in the PALS welcome lesson, and the normal ranges for heart rates by age might be worth repeating here. Heart Rates by Age   Awake Sleeping Neonate 100 – 205 90 – 160 Infant 100 – 180 90 – 160 Toddler 98 – 140 80 – 120 Preschooler 80 – 120 65 – 100 School age child 75 – 118 58 – 90 Adolescent 60 – 100 50 – 90 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? Do they occur regularly? Is there one P-wave for each QRS complex? Are the P-waves smooth, rounded, and upright? Do all the P-waves have a similar shape? 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? Is the PR interval constant? 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Pro Tip #1: As long as the QRS fits within two small squares on the ECG printout and is not greater than two and one-quarter small squares, it's within the normal range. Is the QRS complex wide or narrow? If it's narrow, such as on the ECG printout above, then that's considered normal. Are the QRS complexes similar in appearance or are there noticeable differences? So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it's safe to say that the patient has a regular sinus rhythm. We have a regular rhythm. We have a normal heart rate. The P-waves look normal, with each being followed by a QRS complex. The PR interval is less than .20 seconds. The QRS is less than .09 seconds. Unless the patient has no pulse or other serious signs or symptoms, it's safe to assume that there is nothing of significance, in a negative sense, from this patient's cardiac rhythm. PALS Arrythmias: A Foundational Fact to Keep in Mind When it comes to arrhythmias in pediatric patients, consider the following when evaluating the heart rate and rhythm in any seriously ill or injured child: Establish what the child's typical heart rate and baseline rhythm is Establish the child's level of activity and clinical condition, including baseline cardiac function Children with congenital heart disease may have underlying conduction abnormalities. Interpret the child's heart rate and rhythm by comparing them to the child's baseline heart rate and rhythm. Children with poor baseline cardiac function are more likely to become symptomatic from arrhythmias than children with normal cardiac function. https://d3imrogdy81qei.cloudfront.net/video_images/5559/normal-sinus-rhythm-pals.jpg Yes 172 https://app.protrainings.com/courses/pals/certification/videos/bradycardia-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3107.mp4 Bradycardia There can be many forms of bradycardia. Commonly seen blocks include sinus bradycardia, and for multiple blockages, complete and 3rd-degree heart block. In this lesson, we'll look more closely at an example of what bradycardia looks like on an ECG for a pediatric patient and see what findings and measurements lead us to that conclusion. It's vital to remember that if there are signs of bradycardia, regardless of whatever underlying reasons that are causing the patient to display symptoms related to bradycardia, we must first treat for the bradycardia, as it takes precedent over those underlying causes. *Bradycardia ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above graphic, it's regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's too slow, as the rate is less than 60 beats per minute. Remember, to determine the patient's heart rate you'll want to observe the following areas on the ECG paper printout and perform the following calculations. The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds. Each larger square is 5mm in length and represents .2 seconds. Therefore a 6-second interval would be 30 large squares. To determine the heart rate, count the number of QRS complexes over this 6-second interval and multiply by 10. It's also important to understand that when it comes to pediatric patients, normal heart rates vary based on the age of the patient. For example, a normal heart rate for a 12-year-old will probably be bradycardic for an infant or a newborn. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? In this case, the answer is yes. Do they occur regularly? The answer is yes again. Is there one P-wave for each QRS complex? Yes, there is. Are the P-waves smooth, rounded, and upright? The answer is again yes. Do all the P-waves have a similar shape? Yes, they all have a similar shape. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is yes, it's less than .20 seconds and contained within one large square. Is the PR interval constant? Yes, it is. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Yes, it is. Remember, as long as the QRS fits within two small squares on the ECG printout and is not greater than two and one-quarter small squares, it's within the normal range. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it's safe to say that this patient is in sinus bradycardia. We have a regular rhythm. We have a slower than normal heart rate, at less than 60 beats per minute. The P-waves look normal, with each being followed by a QRS complex. The PR interval is less than .20 seconds. The QRS is less than .09 seconds. Proper oxygenation and ventilation are crucial to raise the heart rate for a child with this ECG bradycardic readout. Pro Tip: For a child in bradycardia with a pulse rate less than 60 and signs of poor perfusion, despite oxygen and ventilation, you must begin chest compressions followed by full CPR immediately. Additional Bradycardia Information Bradycardia is defined as a heart rate that is slow when compared with a normal heart rate range for that specific child's age, his or her level of activity, and his or her clinical condition. Symptomatic Bradycardia Symptomatic bradycardia is defined as a heart rate slower than normal for the child's age, which is usually less than 60 beats per minute, associated with cardiopulmonary compromise. Cardiopulmonary Compromise Cardiopulmonary compromise is defined as hypotension, acutely altered mental status, as in a decreased level of consciousness, and signs of shock. Warning: Bradycardia is an unfortunate sign of impending cardiac arrest in all pediatric patients, particularly when it is associated with hypotension and/or symptoms of poor tissue perfusion. Which is why we advise immediate CPR, in spite of adequate oxygenation and ventilation, for all pediatric patients whose heart rate is less than 60 beats per minute. https://d3imrogdy81qei.cloudfront.net/video_images/5561/bradycardia-pals.jpg Yes 137 https://app.protrainings.com/courses/pals/certification/videos/sinus-tachycardia-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3108.mp4 Sinus Tachycardia Sinus tachycardia is a common response to a variety of conditions. It's often associated with a child who is: Anxious Crying Febrile (has a fever) Ill or injured In this lesson, we'll look more closely at an example of what sinus tachycardia looks like on an ECG for a pediatric patient and see what findings and measurements lead us to that conclusion. Pro Tip #1: When treating a tachycardic child without signs and symptoms of cardiac compromise, you should search for the underlying cause of that patient's tachycardia. For a tachycardic child with a pulse and not in cardiac compromise, you should assess for signs of: Hypotension Altered mental status Shock Other life-threatening hemodynamic instabilities Pro Tip #2: What does hemodynamic instability mean? It means that unless healthcare providers do something, the process is unstable and in danger of failing. Some common examples of hemodynamic instability include circulatory collapse, shock (particularly decompensating shock), hypoperfusion, and cardiovascular failure. If you discover signs or symptoms of any of those during your initial assessment, management includes supporting the airway, breathing, and circulation (or the ABCs) of the patient, which include: Providing oxygen as needed Obtaining vital signs, including blood pressure and pulse oximetry ECG monitoring or by attaching defibrillator pads Establishing IV/IO vascular access Now let's take a look at an ECG for a patient in sinus tachycardia. *Sinus Tachycardia ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the above graphic, it's regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's too fast, as the rate is 120 beats per minute. Remember, the definition of a normal heart rate will vary based on the child's age. For example, the normal heart rate for an 11-year-old patient might be bradycardic for an infant. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? In this case, the answer is yes. Do they occur regularly? The answer is yes again. Is there one P-wave for each QRS complex? Yes, there is. Are the P-waves smooth, rounded, and upright? The answer is again yes. Do all the P-waves have a similar shape? Yes, they all have a similar shape. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is yes, it's less than .20 seconds and contained within one large square. Is the PR interval constant? Yes, it is. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Yes, it is. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it's safe to say that this patient is in sinus tachycardia. We have a regular rhythm. We have a faster than normal heart rate, at 120 beats per minute. The P-waves look normal, with each being followed by a QRS complex. The PR interval is less than .20 seconds. The QRS is less than .09 seconds. Unless you see signs of circulatory compromise in this patient, direct your attention to finding and treating the underlying cause for the tachycardia. But if the patient is unstable, rapid and effective treatment must be provided to correct the cause of the tachycardia. Additional Sinus Tachycardia Information Tachycardia can be a sign of a serious condition. A heart rate that is greater than 180 beats per minute in an Infant or toddler, and greater than 160 beats per minute in any child two years old or older, warrants further assessment. Hypotension Hypotension can be a threatening sign of imminent cardiac arrest in pediatric patients. When hypotension develops in a pediatric patient who's in shock, physiologic compensatory mechanisms — like tachycardia and vasoconstriction – have likely failed. Hypotension with hemorrhage is thought to be consistent with an acute loss of 20 to 25 percent of circulating blood volume. Hypotension in septic shock can occur from loss of intravascular volume and inappropriate vasodilation or severe vasoconstriction and inadequate cardiacoutput. The development of bradycardia in a child with hypotension and poor perfusion is a threatening sign. Management of the patient's airway and breathing and support of adequate intravascular volume, cardiac function, and perfusion are required to prevent cardiac arrest. Hypoxemia Hypoxemia occurs when your blood oxygen levels fall below a certain point. This can result in shortness of breath, headache, and confusion or restlessness. As it pertains to this lesson, tachycardia may also develop in response to hypoxemia, as a means of increasing cardiac output. As tissue hypoxia worsens, these signs of cardiopulmonary distress become more severe. https://d3imrogdy81qei.cloudfront.net/video_images/5563/sinus-tachycardia-pals.jpg Yes 156 https://app.protrainings.com/courses/pals/certification/videos/supraventricular-tachycardia-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3109.mp4 Supraventricular Tachycardia Narrow complex tachycardia, also called supraventricular tachycardia or SVT for short, is caused by some sort of stimulus originating above the patient's ventricles, as opposed to the normal stimulus that's generated by the SA node. In this lesson, we'll take a deeper dive into supraventricular tachycardia for the PALS patient, including looking more closely at an example of what it looks like on an ECG and seeing what findings and measurements lead us to our conclusion. With SVT, that stimulus comes from a rogue myocardial cell that stimulates an erratic atrial contraction or a series of erratic atrial contractions like those found in patient's with atrial fibrillation and atrial flutter. Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate. Pro Tip #1: While these appear to be the same, the difference is in the beat. Atrial flutter and atrial fibrillation are both abnormal heart rhythms. However, in atrial fibrillation, the atria beat irregularly, while in atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat. The important thing to note with SVT is that it can persist until there is medical intervention, or it can be intermittent and self-limiting, and can come and go without warning. By looking at an ECG readout alone, SVT can be difficult to differentiate from sinus tachycardia, AFib, or AFL. However, there are things that you can look at to help you determine which rhythm is being displayed. Now let's take a look at an ECG for a patient in supraventricular tachycardia. *Supraventricular Tachycardia 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is regular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's too fast. SVT usually presents with a heart rate of 220 beats per minute in infants or 180 in children. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No! P-waves for SVT will either not be present or abnormal, and in this case, they aren't present. And thus, the answers to all other P-wave questions will also be no. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Yes, it is. Is the QRS complex wide or narrow? In this case, it's narrow. Pro Tip #2: It's unusual for SVT to present with a wide complex QRS. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in supraventricular tachycardia. We have a regular rhythm. We have a faster than normal heart rate, and faster than sinus tachycardia, with a rate of 270. Pro Tip #3: SVT is always more symptomatic than sinus tachycardia. Sinus tachycardia has a rate of 160 – 220 (infants) and 120 – 160 (older children), while SVT has a rate of 220 – 320 (infants) and 160 – 280 (older children). The P-waves are missing. There is no PR interval. The QRS is less than .09 seconds and thus normal. From the ECG alone, it would indicate that the patient is in SVT. However, patient signs and symptoms must be taken into account to properly identify the rhythm correctly and to determine whether or not treatment is necessary. Pro Tip #4: Usually a patient with SVT will have a history of vague or non-specific symptoms or palpitations along with sudden onset. In addition, the patient's history is often not compatible with sinus tachycardia. In other words, the patient won't have a fever, won't be dehydrated, and won't be exhibiting any other identifying causes for the SVT. Unlike with sinus tachycardia, the heart rate doesn't vary with activity, such as when a child is moving around, cries, or becomes agitated. Keep in mind, though, that if the patient is hemodynamically unstable, such as in hypotension, quick and effective treatment must be provided to correct the abnormal heart rhythm. https://d3imrogdy81qei.cloudfront.net/video_images/5565/supraventricular-tachycardia-pals.jpg Yes 165 https://app.protrainings.com/courses/pals/certification/videos/atrioventricular-blocks-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3110.mp4 Atrioventricular Blocks In this lesson, we're going to look at the four types of atrioventricular blocks, usually called AV heart blocks or AV blocks for short. The four types are: 1st-degree heart block 2nd-degree heart block 2nd-degree type 2 heart block 3rd-degree heart block We'll include an example ECG for each, so you can see the differences, while also reading about those differences. 1st Degree AV Heart Block First-degree heart blocks are usually caused by a delayed, inconsistent, and sometimes absent electrical conduction pathway traveling through the AV node and can exhibit the following signs on an ECG readout. *1st Degree AV Heart Block ECG 1. Rhythm regular 2. Rate normal or slow 3. P-waves present and upright 4. PR interval prolonged, beyond .20 seconds 5. QRS complex between .06 and .11 seconds 6. P:QRS ratio 1:1 There is usually little to no clinical significance with this type of heart block. 2nd Degree AV Heart Block (Mobitz Type 1) Second-degree heart blocks, also known as Mobitz type 1 AV blocks, is commonly caused by: • Heart disease affecting the AV node• Vagal stimulation that's often associated with difficult bowel movements• Coughing fits• Certain medications An ECG for a patient with Mobitz type 1 will exhibit the following signs. *2nd Degree (Mobitz type 1) AV Heart Block ECG 1. Rhythm regularly irregular 2. Rate normal or slow 3. P-waves present and upright 4. PR interval progressively widening 5. QRS complex between .06 and .11 seconds 6. P:QRS ratio 1:1, until the P-wave is blocked Pro Tip #1: The QRS complex will become progressively delayed at the AV node until it completely disappears. When this happens, the ECG will only show a P-wave but no QRS following it. 2nd Degree AV Heart Block (Mobitz Type 2) The third type of heart block is regularly known as a Mobitz type 2 block. It usually occurs when the heart block is below the AV node. A Mobitz type 2 block is usually caused by more advanced heart disease and can also originate from damage below the bundle of His. Because of this, Mobitz type 2 can deteriorate more quickly into a symptomatic dysrhythmia and could eventually become a 3rd-degree heart block. An ECG for a patient with Mobitz type 2 will appear to have intermittent blocks where some P-waves do not have a QRS complex following, and there's typically no elongation of the PR interval. *2nd Degree (Mobitz type 2) AV Heart Block ECG 1. Rhythm variable, depending on the P:QRS ratio 2. Rate variable, but usually slow 3. P-waves present and upright 4. PR interval between .12 and .20 seconds 5. QRS complex between .06 and .11 seconds 6. P:QRS ratio variable – 2:1, 3:1, 4:1 and greater 3rd Degree AV Heart Block The fourth and last type of heart block is called a 3rd degree complete AV heart block and is the most serious of the four. A 3rd-degree heart block occurs when the electrical conduction is completely blocked between the atria and the ventricles. The exact location of the block can vary, however it's usually around the AV node or lower but will disassociate the SA pacemaker from the AV or bundle of His pacemakers. Pro Tip #2: When this happens, a 3rd-degree AV heart block will create an ECG readout that shows regular P-waves, regular QRS waves, but they'll be at different rates that are completely disassociated altogether. An ECG for a patient with a 3rd-degree heart block will exhibit the following signs. *3rd Degree AV Heart Block ECG 1. Rhythm regular 2. Rate bradycardic and between 20 and 40 beats per minute 3. P-waves present and upright 4. PR interval variable with no set pattern 5. QRS complex greater than .11 seconds 6. P:QRS ratio variable The clinical significance of this type of dysrhythmia is serious. The patient will usually be symptomatic and unstable due to their very slow bradycardic heart rhythm and rate. Pro Tip #3: This type of heart block is preventing any pace that originates from the SA node. Therefore, the ventricular pacemaker will stimulate a pulse rate closer to 20 to 40 beats per minute, which is usually not enough to maintain a stable blood pressure. This is why the ECG readout will usually display wide QRS complexes. Studies have shown that 3rd-degree AV heart blocks may be transient or permanent, depending on underlying causes. https://d3imrogdy81qei.cloudfront.net/video_images/5567/atrioventricular-blocks-pals.jpg Yes 287 https://app.protrainings.com/courses/pals/certification/videos/atrial-fibrillation-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3111.mp4 Atrial Fibrillation Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. In this lesson, we'll look at the three types of atrial fibrillation and then look at a typical ECG readout for a patient in AFib and provide a cardiac interpretation at the end. The Three Types of Atrial Fibrillation 1. Transient Transient atrial fibrillation is defined by the following: Episodes that stop on their own Episodes that last anywhere from seconds to minutes, hours, or even up to one week 2. Persistent Persistent atrial fibrillation is defined by the following: Episodes that last longer than one week Episodes that last less than one week but are only stopped using either pharmacological intervention or electrical cardioversion 3. Long-Standing Persistent Long-standing persistent atrial fibrillation, formerly known as chronic or permanent atrial fibrillation, is defined as episodes that last longer than a year. Atrial fibrillation occurs when multiple electrical impulses are being generated in the atria and at the same time, which causes chaotic myocardia responses. AFib can diminish the preload and effectiveness of the cardiac contractions. This action could then cause the development of microemboli due to stagnant blood flow from the atria. In certain instances, this will even lead to a rapid ventricular response that's secondary to a reentry problem. Pro Tip #1: The electrical pattern on an ECG will have no discernible P-waves, but instead, will show fibrillatory waves between each QRS complex. And because there's a lack of coordinated electrical impulses generated from the atria traveling through the AV node into the ventricles, the result is usually an irregular ventricular response, which also occurs irregularly. Now let's take a look at an ECG for a patient in atrial fibrillation. *Atrial Fibrillation ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's 80 beats per minute, but it's also irregular. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No! Do they occur regularly? The answer is obviously no again. Is there one P-wave for each QRS complex? No. Are the P-waves smooth, rounded, and upright? No, only fibrillatory waves are present. Do all the P-waves have a similar shape? Again, that answer is no, because they aren't present. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Yes, it is within the normal range. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial fibrillation. We have an irregular rhythm. We have a rate that is 80 beats per minute but also irregular. The P-waves are missing. There is no PR interval. The QRS is less than .09 seconds and thus normal. Pro Tip #2: Atrial fibrillation is rare in children. However, it can occur in pediatric patients with cardiomyopathy, and/or following complex heart surgery, and even more rarely in children with otherwise normal heart function. For pediatric patients in atrial fibrillation, expert care and consultation is required to properly treat that child. A Word About Survival Rates from Pediatric Cardiac Arrest Survival rates from pediatric cardiac arrest vary according to the location of the arrest and the presenting rhythm. According to the American Heart Association, the rate of survival to hospital discharge is higher if the arrest occurs in a hospital (43 percent) compared with out-of-hospital care (8 percent). Intact neurological survival is also greater if the cardiac arrest occurs while the patient is in a hospital. It should be noted that the survival rate is higher (25 to 34 percent) when the patient's presenting rhythm is shockable (VF or pVT) compared to asystole (7 to 24 percent). The survival rate for a presenting rhythm of pulseless electrical activity is around 38 percent for in-hospital cardiac arrests. However, when VF or pVT develop as a secondary rhythm during the resuscitation attempt for children in-hospital, survival rates are lower than those observed in cardiac arrests with non-shockable rhythms (11 percent vs. 27 percent, survival to discharge). The highest survival rates (around 64 percent) occur when there is bradycardia and poor perfusion, and when chest compressions and ventilation are provided before pulseless arrest develops. https://d3imrogdy81qei.cloudfront.net/video_images/5569/atrial-fibrillation-pals.jpg Yes 211 https://app.protrainings.com/courses/pals/certification/videos/atrial-flutter-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3112.mp4 Atrial Flutter Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate. In this lesson, we'll look at why/how atrial flutter occurs, and then look at a typical ECG readout for a patient in atrial flutter and provide a cardiac interpretation at the end. On an ECG, atrial flutter typically resembles sawtooth-like F-waves, which are either the result of an ectopic atrial pacemaker or because of rapid reentry pathways somewhere within the atria, but outside of the SA node. The origin of this ectopic pacemaker is usually somewhere in the lower atrium and closer to the AV node, thereby resulting in that distinct sawtooth wave pattern. Pro Tip #1: Due to this erratic electrical activity, the normal function of the SA node is usually suppressed and noneffective. Which is why, instead of a P-wave, atrial flutter will produce flutter, or F-waves. And as a result of the depolarization of the atria in an abnormal manner, the classic F-waves of atrial flutter resemble a sawtooth, hence the name. Now let's take a look at an ECG for a pediatric patient in atrial flutter. *Atrial Flutter ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is variable and dependent on the ratio of F-waves to the QRS complex. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, it's variable due to its irregularity. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present, and do they resemble normal P-waves or just those sawtooth type of F-waves? Since the answer is, they resemble sawtooth style F-waves, all of the other P-wave questions you normally ask yourself do not apply, once you notice the F-wave flutter. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is no, because it's variable and there are no P-waves. Is the PR interval constant? Again, this is non-applicable because of the above answer. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? Yes, it is within the normal range. Is the QRS complex wide or narrow? In this case, it's narrow. Are the QRS complexes similar in appearance or are there noticeable differences? In this case, we can see that each looks similar. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in atrial flutter. We have a variable rhythm that is dependent on the ratio of F-waves to the QRS complex. We have a variable heart rate due to its irregularity. The P-waves are not normal and resemble sawtooth style F-waves. The PR interval is variable and there are no normal P-waves. The QRS is less than .09 seconds and thus normal. From the ECG alone, it would indicate that the patient is in atrial flutter. Pro Tip #2: Structural heart disease is the usual suspect for causing atrial flutter. It can develop in newborn infants who have normal hearts and in children with congenital heart disease, particularly after cardiac surgery. In the same way that atrial fibrillation complicates adequate ventricular preload filling, atrial flutter complicates circulation and especially when it is accompanied by a syndrome called rapid ventricular rate or response. What is rapid ventricular rate or response? In some cases of AFib, the fibrillation of the atria causes the ventricles, or lower chambers of the heart, to beat too fast. When this happens, it's called a rapid ventricular rate or response, or RVR for short. Pro Tip #3: The faster the ventricular response, the more likely it is that the patient's circulation will be compromised. When the ventricles beat too rapidly, they aren't able to fill completely with blood from the atria. As a result, they can't efficiently pump blood out to meet the needs of the body. This can ultimately lead to heart failure. https://d3imrogdy81qei.cloudfront.net/video_images/5571/atrial-flutter-pals.jpg Yes 160 https://app.protrainings.com/courses/pals/certification/videos/wide-complex-tachycardia-including-torsades https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3113.mp4 Wide Complex Tachycardia (including Torsades) Many wide complex tachycardias originate in the ventricles, but not all. The ones that don't include a bundle branch block, and a ventricular reentry problem, where the ventricles contract too early after a partial repolarization – like a pre-excited tachycardia or Wolff-Parkinson-White (WPW) syndrome. In this lesson, we'll look at monomorphic ventricular tachycardia (including an ECG), polymorphic ventricular tachycardia, or (thankfully) PVT for short (also including an ECG), and pulseless ventricular tachycardia. And at the end of the lesson, we'll give you a word or two on pulseless electrical activity. Monomorphic Ventricular Tachycardia One very common V-tach is called monomorphic ventricular tachycardia, which means that all of the complexes are the same size, direction, and shape. It's usually caused by an ectopic pacemaker located somewhere in the ventricles. An ECG for a patient with monomorphic V-tach will exhibit the following signs. *Monomorphic V-tach ECG 1. Rhythm regular, but could also be slightly irregular 2. Rate between 100 and 200 beats per minute 3. P-waves rarely discernible 4. PR interval not discernible 5. QRS complex greater than .11 seconds, wide and strange looking 6. P:QRS ratio does not exist The main problem with this type of fast and wide complex tachycardias is that the hemodynamics are unstable. The heart rate is so fast that it inhibits the atrium from prefilling and preloading the ventricles before the next contraction. In these cases, it's important to know whether or not the patient is stable or unstable. Pro Tip #1: If the patient is stable, try to learn more about why the patient could be experiencing this type of arrythmia. And remember, wide complex V-tach can sometimes be caused by heart disease, electrolyte imbalance (especially potassium) and a Q to T interval prolongation. If the patient is stable, check to see if their rhythm is supraventricular or ventricular in origin. Warning: If the patient is unstable, immediate treatment is vital. Polymorphic Ventricular Tachycardia Poly simply means multiple and describes the origin of electrical foci in the ventricles. In fact, polymorphic V-tach is caused by multiple ventricular foci with the resulting QRS complexes varying in axis, amplitude, and duration. Polymorphic V-tach can also be described as bi-directional V-tach, which is another type of polymorphic V-tach that is commonly associated with digoxin toxicity, commonly known as torsades de pointes. Along with digoxin toxicity, we often see polymorphic V-tach with hypokalemia or hypomagnesemia. An ECG for a patient with polymorphic V-tach will exhibit the following signs. *Polymorphic Ventricular Tachycardia ECG 1. Rhythm irregular 2. Rate between 200 and 250 beats per minute 3. P-waves not discernible 4. PR interval missing 5. QRS complex variable, but greater than .11 seconds, wide and strange 6. P:QRS ratio missing In torsades, it can sometimes appear that the apex of the V-wave changes from top to bottom and back again. And actually, torsades (French in origin) literally translates as a twisting of points. The most important thing to remember with this type, along with monomorphic wide-complex V-tach, is that both can become pulseless V-tach or VFib pretty quickly. Pulseless Ventricular Tachycardia Pro Tip #2: One important thing to remember is that wide complex V-tach can present with or without a pulse and you may even see pulseless V-tach in a cardiac arrest patient. However, in most cases, pulseless V-tach will quickly deteriorate into VFib. Also keep in mind that pulseless V-tach is treated the same as VFib and that recognition of the condition and treatment for it will be vital for a potential positive outcome. Pro Tip #3: An ECG interpretation for pulseless V-tach can be the same for pulsed V-tach. The difference is that the patient is unresponsive, not breathing normally, and has no pulse. A Word About Pulseless Electrical Activity Pulseless electrical activity (PEA), which will be covered in more detail in a subsequent lesson, is not a specific rhythm. Instead it's a term used to describe any organized electrical activity – but not VFib or asystole — on an ECG or cardiac monitor that is associated with no palpable pulses. Pulsations can be detected by an arterial waveform or Doppler study. However, pulses are not palpable. The rate of electrical activity may be slow (which is most common), normal, or fast. Very slow PEA can also be referred to as agonal. When a patient is in PEA, the ECG can display normal or wide QRS complexes, as well as other abnormalities, which include: Low or high-amplitude T waves Prolonged PR and QT intervals Atrioventricular disassociation Complete heart block Ventricular complexes without P-waves It's important to remember to assess the patient's monitored rhythm and note the rate and width of the ORS complexes. PEA can be caused by reversible conditions easily remembered as the H's and T's. We addressed the H's and T's briefly in a prior lesson and will dig a little deeper into them in the lesson on asystole. Warning: One important takeaway is this: Unless you can quickly identify and treat the cause of PEA, the rhythm will likely deteriorate to asystole. https://d3imrogdy81qei.cloudfront.net/video_images/5573/wide-complex-tachycardia-including-torsades.jpg Yes 254 https://app.protrainings.com/courses/pals/certification/videos/ventricular-fibrillation-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3114.mp4 Ventricular Fibrillation Ventricular fibrillation (also called VFib or VF) is caused by multiple ectopic electrical impulses which depolarize the myocardium in a chaotic fashion. This results in a quivering (or fibrillatory) heart that cannot produce a pulse. In this lesson, we'll dig a little deeper into ventricular fibrillation and then look at a typical ECG readout for a patient in VFib and provide a cardiac interpretation at the end. Now let's take a look at an ECG for a patient in ventricular fibrillation. *Ventricular Fibrillation ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, the rhythm is irregular. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, there is no rate and no pulse. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No. Do they occur regularly? No. Is there one P-wave for each QRS complex? No. Are the P-waves smooth, rounded, and upright? No, only fibrillatory waves are present. Do all the P-waves have a similar shape? Again, that answer is no, because normal P-waves aren't present. 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? No. In fact, there is no evidence of a QRS complex. Is the QRS complex wide or narrow? Not applicable. Are the QRS complexes similar in appearance or are there noticeable differences? Not applicable, since not present. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in ventricular fibrillation. We have an irregular rhythm. We have no heart rate and no pulse. The P-waves are missing; there are only fibrillatory waves present. There is no PR interval. The QRS is nonexistent. From the ECG alone, it would indicate that the patient is in VFib. Pro Tip #1: VFib is a non-perfusing and lethal dysrhythmia that is most commonly seen during the first few minutes of cardiac arrest. Because of this, it's important that high-quality CPR be administered as soon as possible, including defibrillation, to increase that patient's chance of a successful resuscitation. An Additional Word About Ventricular Fibrillation When a patient is in ventricular fibrillation, the heart has no organized rhythm as well as no coordinated contractions. The electrical activity is very chaotic. The heart quivers and it does not pump blood. Therefore, pulses are not palpable. Ventricular fibrillation may be preceded by a brief period of ventricular tachycardia with or without a pulse. Primary ventricular fibrillation is not common in children. In studies involving pediatric cardiac arrest, VFib was the initial rhythm in between 5 to 15 percent of both out-of-hospital cardiac arrests (OHCA) and in-hospital cardiac arrests (IHCA). The overall prevalence may be higher because VFib can occur early during cardiac arrest and quickly deteriorate to asystole. VFib has been reported in up to 27 percent of pediatric in-hospital arrests at some point during the resuscitation. VFib without a previously known underlying cause is rare but can sometimes occur in otherwise healthy teens during sports activities. The cause of VFib can also be due to an undiagnosed cardiac abnormality or channelopathy, such as long QT syndrome – a heart rhythm condition that can potentially cause fast and chaotic heartbeats. A sudden impact to the chest due to a collision or from a moving object can also result in commotio cordis, or agitation of the heart, that leads to VFib. Also consider the H's and T's for other potential reversible causes. Pro Tip #2: The H's and T's of PALS/ACLS is a mnemonic used to help recall the major contributing factors to pulseless arrest including pulseless electrical activity (PEA), Asystole, VFib, and V-tach. (In the next lesson – Asystole – we'll provide some more information on those H's and T's.) The survival rate and outcome of patients with VFib or pulseless V-tach, as the initial arrest rhythm, are generally better than those of patients presenting with asystole or PEA. And as mentioned above, the outcome can be improved by prompt recognition and with the administration of high-quality CPR and defibrillation. https://d3imrogdy81qei.cloudfront.net/video_images/5575/ventricular-fibrillation-pals.jpg Yes 76 https://app.protrainings.com/courses/pals/certification/videos/asystole-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3115.mp4 Asystole The term asystole simply refers to an absence of ventricular activity, which means the patient will exhibit no discernible electrical activity on an ECG readout. In most cases, asystole is a lethal arrhythmia and survival is extremely rare. In this lesson, we'll look at an ECG readout for a patient in asystole, tackle those H's and T's and provide some corresponding information about their diagnostic use, and at the end of the lesson, provide some information on the principles of management of pediatric arrhythmias. Asystole is a cardiac standstill where there is no discernable electrical activity. It Is represented by a straight flat, or almost flat, line on an ECG. Warning: However, do not rely on an ECG alone for your diagnosis of a child in cardiac arrest. It's a good idea to always confirm it clinically, because what appears to be a flat line on the ECG, can also be caused by a loose ECG lead. Now let's take a look at an ECG for a patient in asystole. *Asystole ECG 1. The Heart Rhythm The first thing you'll want to look at is the heart rhythm. Does the heart rhythm look regular? Or does it look irregular? In the ECG above, there is no heart rhythm. 2. The Heart Rate Next, you'll want to look at the heart rate of the patient. What is the patient's heart rate? Is it normal? Or is it too slow or too fast? In this case, there is no rate and no pulse. 3. P-Wave After looking at the heart rate, check to see if the patient's P-waves look normal by asking yourself the following few questions. Are the patient's P-waves present? No, making any other questions about QRS non-applicable 4. PR Interval Next, look at the PR interval on the patient's ECG readout and ask yourself the following questions: Is the PR interval normal, meaning less than .20 seconds or is it contained within one large square on the readout? The answer is no, because there isn't a PR interval. Is the PR interval constant? Again, this in non-applicable since there isn't a P-wave. 5. QRS Complex The last thing you should look at to determine if the sinus rhythm is normal or not is the QRS complex and ask yourself these questions while you do: Is the QRS interval less than .09 seconds? No. In fact, there is no evidence of a QRS complex, making any other questions about QRS non-applicable. So, what is your cardiac interpretation? Based on these questions and on the findings from the ECG readout above, it would appear that this patient is in asystole. Because there is no myocardial, electrical, or mechanical activity, there is no pulse and no circulation of blood and oxygen. Pro Tip #1: Asystole is most commonly seen following a period of unconverted ventricular fibrillations or ventricular tachycardia. And particularly in pediatric patients, hypoxia and shock can lead to asystole without appropriate and immediate intervention. The most common reversible causes of asystole can best be remembered by keeping in mind the H's and T's. H's and T's Cardiac arrest in pediatric patients is often associated with a reversible condition. However, you're likely to miss one of them, if you don't make a conscious effort to think about reversible causes or complicating factors when assessing a child with cardiac complications. The following H's and T's are designed to help you identify (and easily remember) potentially reversible causes of cardiac arrest in children or factors that may be complicating your resuscitative efforts. The H's The T's Hypothermia Toxins Hyper or hypokalemia Tamponade Hypoxia Tension pneumothorax Hydrogen ion (acidosis) Thrombosis (pulmonary) Hypovolemia Thrombosis (coronary) Pro Tip #2: It's also important to consider unrecognized trauma, such as abdominal injuries and hemorrhage, as a potential cause of pediatric cardiac arrest, particularly when assessing and treating infants and younger children. A Word About Principles of Management of Pediatric Arrhythmias This will be a brief Word, but it could also be an important one. Whenever a pediatric patient has an abnormal heart rate or rhythm, you'll need to quickly determine if that arrhythmia is causing hemodynamic instability or other signs of deterioration. The signs of instability in a child with arrhythmia include the following: Respiratory distress or failure Shock with poor end-organ perfusion, which may occur with or without hypotension Irritability or a decreased level of consciousness Chest pain or a vague feeling of discomfort in older children Sudden collapse Your priorities during the initial management of arrhythmias are the same as they would be for all critically ill pediatric patients – support the ABCs first (airway, breathing, and circulation) and then treat the underlying cause. https://d3imrogdy81qei.cloudfront.net/video_images/5577/asystole-pals.jpg Yes 111 https://app.protrainings.com/courses/pals/certification/videos/pulseless-electrical-activity-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3116.mp4 Pulseless Electrical Activity Pulseless electrical activity, most commonly known as PEA, is a condition where the electrical activity of the heart is not accompanied by a palpable or effective pulse. In this lesson, we'll look closer at PEA, and outline several possible causes, including an important caveat or warning. And at the end of the lesson, we'll provide a preview of the next section in the ProPALS course: PALS Pharmacology. Treatable Causes for PEA It's always important to treat the patient's symptoms, rather than rely on the ECG readout alone. Underlying and treatable causes for PEA include: Pulmonary thrombosis Coronary thrombosis Tension pneumothorax Cardiac tamponade Hypovolemia Hyperkalemia Hypoxia Hydrogen ion (acidosis) Pro Tip: It's important to rule out any and all of the H's and T's as underlying causes for pulseless electrical activity in order to correct the mechanical disassociation that could be causing the cardiac arrest. Warning: The ECG interpretation for a patient exhibiting signs of PEA could be the same as normal sinus rhythm. Which is why treating the patient's symptoms, particularly when it comes to pulseless electrical activity, is so important. Rather than merely reacting to and relying on the rhythms that are being displayed on the ECG monitor. A Word About Pharmacology (A Preview) It's important that you know basic information about medications and other interventions used in the PALS algorithms. A basic understanding of pharmacology information includes the indications, contraindications, and methods of administration for each. You'll also need to know when to use which drug based on each clinical situation. Medications and interventions that we'll be looking at in detail in the upcoming ProPALS course section are: Adenosine Adenosine is a prescription drug used for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PVST), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). Adenosine is available under the following different brand names: Adenocard, and Adenoscan. Amiodarone Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat. Atropine Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Dopamine Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure. Epinephrine Adrenaline, also known as epinephrine, is a hormone and medication. Adrenaline is normally produced by both the adrenal glands and a small number of neurons in the medulla oblongata where it acts as a neurotransmitter involved in regulating visceral functions. It's used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat. Lidocaine Lidocaine is used to relieve nerve pain after shingles (infection with the herpes zoster virus). This type of pain is called post-herpetic neuralgia. Lidocaine helps to reduce sharp/burning/aching pain as well as discomfort caused by skin areas that are overly sensitive to touch. Lidocaine belongs to a class of drugs known as local anesthetics. It works by causing a temporary loss of feeling in the area where you apply the patch. Lidocaine is available under the following different brand names: Lidocaine CV, and Lidopen. Magnesium Sulfate Magnesium sulfate is a naturally occurring mineral used to control low blood levels of magnesium. Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy. Magnesium sulfate is available under the following different brand names: MgSO4. Oxygen Oxygen is the odorless gas that is present in the air and necessary to maintain life. Oxygen may be given in a medical setting, either to reduce the volume of other gases in the blood or as a vehicle for delivering anesthetics in gas form. It can be delivered via nasal tubes, an oxygen mask, or an oxygen tent. Patients with lung disease or damage may need to use portable oxygen devices on a temporary or permanent basis. Procainamide Pronestyl (procainamide hydrochloride) is a cardiac antiarrhythmic drug used to help keep the heart beating normally in people with certain heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). The brand name Pronestyl is discontinued in the U.S. Generic versions may be available. https://d3imrogdy81qei.cloudfront.net/video_images/5579/pulseless-electrical-activity-pals.jpg Yes 57 https://app.protrainings.com/courses/pals/certification/videos/pals-pharmacology-overview https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3117.mp4 PALS Pharmacology Overview In this section of your ProPALS course, we're going to cover the current PALS pharmacological treatment options. And in this lesson, we'll go over some important things to keep in mind as you progress through this section of your course. It's important to remember that no medication will the work the way you want it to unless the patient's biological status is such that the patient's body, at the cellular level, is able to respond favorably to that medication. What does that mean? When a person is in cardiac arrest, that person, at the cellular level, has only a short amount of time before clinical death progresses to biological or cellular death. (These two terms, cellular death and biological death are interchangeable, and we'll often use just one or the other, rather than both.)   As you can see in the video above, clinical death occurs around the six-minute mark, after the patient's breathing and heart rate have stopped. While biological death occurs around the 10-minute mark. Pro Tip #1: As cellular hypoxia progresses to cellular death, the body's ability to react favorably to treatment becomes more difficult and more unlikely. Which is why it's important to provide high-quality and highly effective basic life support. This is the vital foundation for any successful PALS treatment, as effective basic life support buys you and the patient time by delaying the onset of biological death. PALS Medications The variety of medications that we'll cover in this section of the course are only one part of any successful resuscitation (and one part of the chain of survival) and will include: Adenosine Amiodarone Atropine Dopamine Epinephrine Lidocaine Magnesium sulfate Oxygen Procainamide The PALS Chain of Survival Advanced life support is the next level in the chain of survival for pediatric patients. This chain of survival includes: The administration of medications ECG monitoring Advanced airways Other treatment options Pro Tip #2: The goal of the PALS chain of survival is to keep the patient in a state of survivability, by delaying cellular death, until you can get the patient appropriate and definitive treatment that will reverse their life-threatening conditions. Pediatric Drug Dosages Compared with adult drug dosages, pediatric dosages vary greatly depending on that child's size. One helpful tool to determine a child's medication dosage for pediatric emergencies is known as a color-coded length-based tape, such as a Broselow tape. The Broselow Tape, also called the Broselow pediatric emergency tape, will help you quickly determine a pediatric patient's weight so that you can better calculate their drug dosage. How to Use a Broselow Tape To use a Broselow tape, simply lay it next to the pediatric patient and measure from their head to their toes. The tape will then relate the child's height to his or her weight and provide you with information on: The medication dosage that child needs The size of resuscitation equipment that you should use The level of AED shock that you'll need to deliver for defibrillating the patient Pro Tip #3: The Broselow tape is designed for children up to approximately 12 years old, with a maximum weight of around 36 kilograms or 80 pounds. Medication Breakdown As we review the PALS medications in the upcoming lessons, we'll be breaking down the drugs into four distinct categories: The medication and its effect The medication's indications The medication's precautions and contraindications The appropriate dosages for each medication A Word About Medication Therapy for Pediatric Cardiac Arrest Your objectives as a PALS provider for administering medications to pediatric patients during cardiac arrest include: Increase coronary and cerebral perfusion pressures and blood flow Stimulate spontaneous or more forceful myocardial contractility Accelerate the patient's heart rate Correct and treat the possible cause for the patient's cardiac arrest Suppress, or treat for, any arrhythmias Medications that can be used while treating pediatric patients in cardiac arrest will be covered in detail in the upcoming lessons. But it's important to keep these objectives in mind as you progress through this section of your course. https://d3imrogdy81qei.cloudfront.net/video_images/5581/pals-pharmacology-overview.jpg Yes 158 https://app.protrainings.com/courses/pals/certification/videos/adenosine-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3118.mp4 Adenosine In this lesson, we'll go over the medication adenosine and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Adenosine is effective at terminating supraventricular tachycardia, as it temporarily blocks conduction through the AV node for around 10 seconds. Pro Tip #1: It's important to note that adenosine does not convert atrial fibrillation, atrial flutter, or other tachycardias that are caused by mechanisms other than a re-entry through the AV node. Adenosine Indications Indications for adenosine include: Supraventricular tachycardia, or SVT Tachycardias that are caused by a re-entry at the SA node As a diagnostic tool to distinguish atrial flutter from SVT Adenosine Precautions and Contraindications There are some adenosine precautions and contraindications to be aware of, including: Adenosine needs to be administered by rapid IV push Pro Tip #2: The most common cause of failure when administering adenosine tends to occur when the medication is pushed too slowly. There is typically a brief period of around 10-15 seconds of bradycardia, asystole, or 3rd degree heart block that can occur when administering adenosine Pro Tip #3: If treating a child who is old enough to understand what is happening to them, you should consider warning them that they might feel a little uncomfortable for a few seconds following adenosine administration. Which brings up a greater point of emphasis – always try to reassure a pediatric patient that they are in good hands and that you are there to help them and will take good care of them. Pediatric Dosage of Adenosine Warning: despite the dosage information that follows, the initial dose of adenosine should be decreased by approximately 75 percent for any pediatric patient who is also receiving carbamazepine or dipyridamole or those patients who have undergone a heart transplant. Pediatric dosages of adenosine should be delivered either via IV or IO and with a rapid push that will deliver the medication as quickly as possible. The initial dose of adenosine is .1mg per kilogram of bodyweight (or .1mg/kg), for a maximum dose of 6mg, followed by a normal saline bolus flush of up to 20ml or 20cc. Pro Tip #4: The primary difference between a cc (cubic centimeter) and an mL (milliliter) is this: Cubic centimeters are used for solid amounts, while milliliters are used for fluid amounts. Otherwise, the measurements are the same and there is no difference in volume. So, 1cc will always equal 1ml. If the first does of adenosine does not convert the patient's rhythm, a second dose of .2mg/kg can be administered, for a maximum dose of 12mg of adenosine. And just as before, flush that second dose with a normal saline bolus flush of 20cc, which will help get the medication into the patient's circulatory system much faster. Pro Tip #5: Make sure you or a member of your team are recording the ECG rhythm during the full drug administration and treatment process, including any changes that might occur. A Word About Medication Administration During CPR Ideally, you'll want to administer IO/IV medications during compressions because the blood flow generated by the compressions will help circulate the medications being administered. According to the 2015 AHA Guidelines Update for CPR and ECC, it's recommended that medications be administered during compressions and immediately before (if compressions are performed while the defibrillator is charging) or after shock delivery. Doing so means that the medications have more time to circulate before the next rhythm check and shock delivery, if required. All team members who are responsible for administering resuscitation drugs should anticipate and prepare the next drug dose that might be needed after the next rhythm check. All team members should also be familiar with the Pediatric Cardiac Arrest Algorithm and refer to it during the resuscitation attempt to anticipate the next interventions. Drug tables, charts, or other references should be readily available to expedite the calculation of drug doses. And remember, the use of a color-coded length-based resuscitation tape will help facilitate your rapid estimation of the appropriate drug doses for each pediatric patient based on that patient's weight. Endotracheal administration of resuscitation drugs will result in lower blood concentrations than instances where the same dose is administered intravascularly or via IO. Studies have also suggested that the lower epinephrine concentration that's achieved when the medication is delivered by the endotracheal route may produce transient β-adrenergic effects. The β-adrenergic effects can be detrimental to the pediatric patient and may cause hypotension, lower coronary artery perfusion pressure and flow, and reduce the potential for the return of spontaneous circulation (ROSC). Another disadvantage of endotracheal medication delivery is that chest compressions must be interrupted in order for the medications to be delivered via this route. https://d3imrogdy81qei.cloudfront.net/video_images/5583/adenosine-pals.jpg Yes 150 https://app.protrainings.com/courses/pals/certification/videos/amiodarone-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3119.mp4 Amiodarone In this lesson, we'll go over the medication amiodarone and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Amiodarone is an effective treatment for a wide variety of atrial and ventricular tachyarrhythmias in pediatric patients. It can prolong AV conduction and ultimately slow the heart rate by elongating the AV refractory period, QRS, and the Q to T intervals. Because amiodarone is an alpha and beta blocker (while also blocking sodium, potassium, and calcium channels), it is a well-known drug for its multi-channel blocking capabilities. Amiodarone Indications Some indications for the drug amiodarone, as an antiarrhythmic drug, is that it will be used specifically for its broad range of electrophysiological effects. Pro Tip #1: Amiodarone is primarily chosen for pediatric advanced life support as a first line antiarrhythmic agent for cardiac arrest because it has shown to be clinically effective and reliable for increasing the survival rates to hospital admission. However, it's not nearly as effective for increasing survival rates to hospital discharge when compared to other medications. Amiodarone may also be considered for the treatment of: Pulseless V-tach VFib Hemodynamically stable SVT refractory to vagal maneuvers and adenosine Amiodarone Precautions and Contraindications Now let's look at some amiodarone precautions and contraindications. Warning: With amiodarone, there are multiple complex drug interactions, so care must be taken when using this medication. A rapid infusion of amiodarone could lead to hypotension. However, during cardiac arrest, there isn't any blood pressure and therefore the American Heart Association recommendation is still to use an amiodarone IV push for the treatment of pulseless conditions. Warning: Do not administer amiodarone with other drugs that prolong the QT interval, such as procainamide. Because the terminal elimination and half-life of amiodarone is so long, the medication can be a complicated drug to work with and around when treating a pediatric patient who has experienced a return of spontaneous circulation. Therefore, amiodarone administration could eliminate the option of using certain medications until it has been effectively eliminated from the body. Pro Tip #2: When it comes to long-term amiodarone therapy, a pediatric cardiologist or similarly experienced PALS provider should be in charge of its long-term use. Pediatric Dosage of Amiodarone When using amiodarone to treat VFib or pulseless V-tach, a first dose will be 5mg/kg via IV or IO push. This dose may be repeated 1-2 times for refractory VFib or pulseless V-tach. For life threatening arrhythmias, a maximum accumulated dose is 2.2 grams via IV or IO over a 24-hour period. For supraventricular or ventricular arrhythmias with poor perfusion, a loading dose of 5mg/kg infused over 20 to 60 minutes may be given. Repeat doses of 5mg/kg may be given up to a maximum of 15mg/kg per day as needed. A Word About Vascular Access for Pediatric Patients in Cardiac Arrest The priorities for drug delivery routes during pediatric advanced life support are, in order of preference: Intravenous (IV) Intraosseous (IO) Endotracheal (ET) When a critically ill child goes into cardiac arrest, there is a chance that vascular access may have already been established. However, if vascular access has not been established, it should be done immediately. During resuscitation, peripheral IV access is the first choice if it can be accomplished quickly. However, this may prove to be difficult in critically ill or injured children. Therefore, pay attention to the time it takes and limit the time you spend trying to obtain IV access. If IV access has not already been established and you cannot achieve reliable IV access immediately, establish IO access instead. IO access is still useful as the initial vascular access in cases of cardiac arrest in pediatric patients. If both IV and IO access aren't available for the delivery of medications, the endotracheal route is your next best option. Intravenous (IV) Drug Delivery While a central venous catheter provides a more secure route of vascular access than a peripheral catheter does, central venous access isn't required during the vast majority of resuscitation attempts. And furthermore, its placement requires interruptions during chest compressions, which are not advisable. The complications with central catheter placement attempts that are made during chest compressions could include the following: Vascular lacerations Hematomas Pneumothorax Bleeding If a central venous catheter is already in place, then that will be the preferred route for medication and fluid administration. Central venous administration of drugs does provide more rapid onset of action and higher peak concentration than peripheral venous delivery. Even though establishing peripheral venous access does not require the interruption of chest compressions and CPR, medication delivery to the central circulation could be delayed. To improve medication delivery to the central circulation, you should do the following when using a peripheral IV catheter infusion system: Administer the medication by bolus injection Administer the medication while chest compressions are being performed Follow medication administration with a 5ml normal saline flush to move the medication from the peripheral circulation to the central circulation At the end of the next lesson on Atropine, we'll provide some information on using the intraosseous (IO) route. And at the end of the subsequent lesson on Dopamine, we'll dig deeper into using the endotracheal route. https://d3imrogdy81qei.cloudfront.net/video_images/5585/amiodarone-pals.jpg Yes 195 https://app.protrainings.com/courses/pals/certification/videos/atropine-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3120.mp4 Atropine In this lesson, we'll go over the medication atropine and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Atropine sulfate is a parasympatholytic drug that increases sinus or atrial pacemakers and enhances atrioventricular conduction. In general, atropine accelerates the heart rate by reducing the activity of the parasympathetic nervous system. Pro Tip #1: A parasympatholytic agent is any substance or activity that has the effect of reducing the activity of the parasympathetic nervous system. The parasympathetic nervous system is often described as the rest and digest part of the autonomic nervous system. Atropine works by blocking this action. The autonomic nervous system is a control system that acts mostly unconsciously as it regulates bodily functions, such as the heart rate, respiratory rate, pupillary response, digestion, urination, and sexual arousal. Atropine Indications Now let's take a look at some indications for atropine. First of all, atropine is recommended over epinephrine and is used for the treatment of bradycardia in pediatric patients when that bradycardia is due to: Excessive vagal tone Cholinergic drug toxicity, like organophosphates Complete atrioventricular blocks Pro Tip #2: Atropine should be your first choice of treatment of symptomatic AV blocks due to primary bradycardia. If the pediatric patient with symptomatic AV block does not positively respond to atropine, the child may require pacing – the act or process of regulating or changing the timing or intensity of cardiac contractions. Atropine Precautions and Contraindications There are a couple of precautions and contraindications when it comes to administering atropine. Be aware that the patient may experience tachycardia following the administration of atropine. However, atropine-induced tachycardia is generally well tolerated in most pediatric patients. Atropine is not recommended, and has no therapeutic benefit, for pulseless rhythms such as asystole, pulseless electrical activity (PEA), V-tach, or VFib. Pediatric Dosage of Atropine Let's take a closer look at the pediatric dose of atropine. Atropine, whether administered via IV or IO, will be delivered at .02mg/kg. You can deliver a second dose after five minutes one time if needed. The minimum dose of atropine is 0.1mg. And the maximum single dose of atropine is 0.5mg. Atropine can also be administered via an endotracheal (ET) tube if either IV or IO access is not an option. And the ET tube dose of atropine is .04 to .06mg/kg. A Word About Vascular Access for Pediatric Patients in Cardiac Arrest As mentioned in the previous Word section of the amiodarone lesson, the priorities for drug delivery routes during pediatric advanced life support are, in order of preference: Intravenous (IV) Intraosseous (IO) Endotracheal (ET) In the previous lesson, we covered IV administration in pediatric patients. In this lesson, we'll dig a little deeper into administering medications via the IO route. Intraosseous (IO) Drug Delivery If, for whatever reason, IV access is not available when treating a pediatric patient, medications and fluids can be safely and effectively delivered via the IO route. In fact, the intraosseous route is also useful as the initial route of vascular access, rather than merely the backup to IV, in cases of pediatric cardiac arrest. Important points to note about IO access include the following: IO access can be established in pediatric patients in all age groups IO access can often be achieved quickly, as in 30 to 60 seconds The IO route is preferred over the endotracheal tube route Any medication or fluid that can be administered intravenously can also be administered via the intraosseous route IO cannulation can provide access to a non-collapsible marrow venous plexus, which serves as a safe, reliable, and rapid route for the administration of resuscitation medications and fluids in pediatric patients. The technique includes using a rigid needle, preferably one that has been specifically designed for IO use, or bone marrow needle. Although an IO needle with a stylet is preferred to prevent obstruction of the needle with the cortical bone during insertion, standard hypodermic needles, spinal needles, and butterfly needles can also be used effectively and inserted successfully. Powered IO insertion devices are widely used in the U.S. and are commercially available and used by both military and civilian healthcare providers, such as the battery-powered EZ-IO, hand-powered Fast1, Fast Combat, and Fast Responder models. https://d3imrogdy81qei.cloudfront.net/video_images/5587/atropine-pals.jpg Yes 148 https://app.protrainings.com/courses/pals/certification/videos/dopamine-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3121.mp4 Dopamine In this lesson, we'll go over the medication dopamine and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Dopamine is a naturally occurring catecholamine – any of a class of aromatic amines that includes a number of neurotransmitters – that has direct alpha and beta adrenergic effects depending on the dose administered. When the dose administered is greater than 5mcg/kg per minute in pediatric patients, dopamine will act directly on the beta 1 receptors, which causes an increase in both myocardial contractility and heart rate. Pro Tip #1: Contractility is the inherent strength and vigor of the heart's contraction during systole. According to Starling's Law, the heart will eject a greater stroke volume at greater filling pressures. For any filling pressure, the stroke volume will be greater if the contractility of the heart is greater. When the dose of dopamine administered is between 10 and 20mcg/kg per minute, the alpha receptors are typically stimulated. This causes an increase in systemic vascular resistance, also known as vasoconstriction. Warning: Infusion rates greater than 20mcg/kg per minute could result in excessive vasoconstriction and can also contribute to tissue damage that cannot be repaired. Dopamine Indications Now let's take a look at dopamine indications. Dopamine can be quite effective in treating hypotension when there are signs and symptoms that the patient is in shock. A dopamine infusion can be titrated to treat shock associated with poor contractility or systemic vascular resistance that is unresponsive to fluid administration. Dopamine Precautions and Contraindications Dopamine has a few precautions and contraindications to be aware of. Pro Tip #2: Dopamine can cause tachyarrhythmias and, as already mentioned, excessive vasoconstriction, which means that it should be used with caution in any pediatric patients who are suffering from cardiogenic shock with associated symptoms of congestive heart failure. Warning: It's vitally important to correct hypovolemia with volume replacement before initiating dopamine therapy. Pediatric Dosage of Dopamine Now let's look at the pediatric dosage of dopamine. Dopamine should be administered via IV or IO access and the most common infusion rate is between 2 and 20mcg/kg per minute. However, make sure to titrate the dosage and drip rate to the patient's response. A Word About Vascular Access for Pediatric Patients in Cardiac Arrest As mentioned in the previous two Word sections, the priorities for drug delivery routes during pediatric advanced life support are, in order of preference: Intravenous (IV) Intraosseous (IO) Endotracheal (ET) In the previous two lessons, we covered IV and IO administration in pediatric patients. In this lesson, we'll dig a little deeper into administering medications via the endotracheal route. Endotracheal (ET) Drug Delivery The IV and IO routes are preferred over the endotracheal route when administering medications. However, lipid soluble medications can be administered via the ET route. These include atropine, epinephrine, naloxone, lidocaine, and vasopressin. However, it's important to note that there are limited human studies about ET vasopressin administration as well as limited studies that can provide dosing guidelines for most medications administered via the ET route. If you are considering the administration of medications to pediatric patients via the ET route while also performing CPR, keep these ideas in mind as you do: Drug absorption from the tracheobronchial tree is unpredictable, which means that the concentrations and effects of the medication being administered will be unpredictable. The optimal dose of most medications administered via the ET route is unknown.a. The administration of medications into the trachea results in lower blood concentrations of that medication than when the same dose is administered via the IV or IO routes.b. Animal studies suggest that the lower epinephrine concentrations achieved when medications are delivered via the ET route may produce transient but detrimental β-adrenergic-mediated vasodilation. Recommended dosages of medications administered via the ET route are higher than for those administered by both the IV and IO routes.a. For instance, the recommended dose of epinephrine that is administered via the ET route is 10 times the dose of epinephrine administered via the IV and IO routes.b. While the typical dose of other medications delivered via the ET route is 2 to 3 times the dose that will need to be administered via the IV and IO routes. https://d3imrogdy81qei.cloudfront.net/video_images/5589/dopamine-pals.jpg Yes 118 https://app.protrainings.com/courses/pals/certification/videos/epinephrine-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3122.mp4 Epinephrine In this lesson, we'll go over the medication epinephrine and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Epinephrine, also commonly referred to as epi, is a chemical that narrows the blood vessels and opens the airways in the lungs. And it's also commonly known as adrenaline. Adrenaline is a hormone that is secreted mainly by the medulla of the adrenal glands and functions primarily to increase cardiac output and to raise blood glucose levels. Epinephrine is typically released during periods of acute stress and its effects are a built-in defense mechanism and what prepares an individual for either a fight or flight response. For this reason, it's also a primary medication for non-perfusing cardiac arrest in pediatric patients. One common effect of epinephrine is reversing low blood pressure. Epinephrine Indications Now let's take a look at epinephrine indications. Epinephrine is used in cardiac arrest arrhythmias such as VFib, pulseless V-tach, asystole, and pulseless electrical activity (or PEA). Epinephrine can also be used in symptomatic bradycardia and for the treatment of severe hypotension. Epinephrine can be administered via a nebulizer for the treatment of croup and other upper airway obstructions. And it's also an effective treatment for anaphylactic reactions. Epinephrine Precautions and Contraindications Epinephrine has a few precautions and contraindications that we should note. Care should especially be taken when administering epinephrine in cases where raising the patient's blood pressure and increasing their heart rate might cause myocardial ischemia and increase the demand for myocardial oxygen. Pro Tip #1: It should be noted that high doses of epinephrine do not improve neurological outcomes or survival rates and may actually contribute to post-resuscitation complications like myocardial dysfunction. Pediatric Dosage of Epinephrine Now let's look at the pediatric dosage of epinephrine. Warning: Epinephrine is available in two concentrations and it's important to know when to use each, and to pay extra attention to which concentration you're actually using when administering epinephrine to patients. The two available concentrations are 1:1000 and 1:10,000. And for cardiac arrest in pediatric patients, you should use the 1:10,000 concentration at .01mg/kg and it should be administered via the IV or IO route. This dose can be repeated every 3 to 5 minutes. And make sure to follow the epinephrine dose with a bolus of 20cc of normal saline to flush the line and get the drug into the central circulatory system more appropriately, thus increasing its effectiveness. If you encounter a situation where there is no IV or IO access, epinephrine may be delivered via the endotracheal route with a dose of .1mg/kg of the 1:1000 concentration. But remember, that concentration is only for an ET delivery. For the treatment of anaphylactic shock, an epinephrine concentration of 1:1000 is given to patients who weigh less than 30kg (or roughly 66 pounds) at .15mg IM (intramuscular) or subcutaneously into the thigh. And this dose may be repeated as necessary. A Word About the Management of Shock in Pediatric Patients We'll be getting more into the treatment of shock in pediatric patients in the next section – Case Studies – however, consider this Word as either a preview of things to come or supplemental information that could come in handy later. Supporting Airway, Oxygenation, and Ventilation With pediatric patients who are exhibiting signs and symptoms of shock, it's important to maintain an open airway and support oxygenation and ventilation. To do this, provide a high concentration of supplementary O2 to all pediatric patients with shock. Usually, O2 is best delivered via a high-flow O2 delivery system. And sometimes O2 delivery must be combined with ventilatory support if the patient's mental status is impaired, respirations are ineffective, or the patient's breathing effort is significantly increased. Appropriate interventions can include noninvasive positive airway pressure or mechanical ventilation after endotracheal intubation. Vascular Access Once the patient's airway is open and oxygenation and ventilation are supported,obtain vascular access for the administration of medications and for fluid resuscitation. For patients with compensated shock, initial attempts at peripheral venous cannulation are appropriate. For patients with hypotensive shock, immediate vascular access is critical and is best accomplished by the intraosseous (IO) route if peripheral IV access is not readily available or easily achieved. Depending on your individual experience and expertise and, of course, the clinical circumstances, central venous access could prove useful. However, it's important to remember that gaining central venous access will take longer than the placement of IO access. https://d3imrogdy81qei.cloudfront.net/video_images/5591/epinephrine-pals.jpg Yes 171 https://app.protrainings.com/courses/pals/certification/videos/lidocaine-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3123.mp4 Lidocaine In this lesson, we'll go over the medication lidocaine and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Lidocaine works by bringing about negative inotropic (meaning, modifying the force or speed of the contraction of muscles) effects and antiarrhythmic actions in the heart which weaken the force of muscular contractions and can calm erratic and uncoordinated electro myocardial activity. In other words, lidocaine decreases automaticity and suppresses ventricular arrhythmias. Lidocaine Indications Now let's take a look at lidocaine indications. Due to lidocaine's antiarrhythmic properties, the primary use of lidocaine is for cardiac arrest from ventricular fibrillation (VFib) and pulseless ventricular tachycardia. Pro Tip #1: In pediatric patients, either amiodarone or lidocaine would be used for shock resistant refractory VFib or pulseless V-tach. Lidocaine Precautions and Contraindications Lidocaine has one important precaution and contraindication that we should note. Lidocaine would be contraindicated if the patient has a known hypersensitivity to lidocaine or its derivatives, such as xylocaine, novocaine (also known as procaine), and similar drugs. Pediatric Dosage of Lidocaine Now let's look at the pediatric dosage of lidocaine. For pediatric dosages, the initial lidocaine IV or IO dose is 1mg/kg. A maintenance infusion can be given at between 20 and 50mcg/kg per minute. Pro Tip #2: You should repeat the initial dose of lidocaine if the infusion is started more than 15 minutes after the initial dose. A Word About Medication Therapy for Shock in Pediatric Patients We'll be getting more into the treatment of shock in pediatric patients in the next section – Case Studies – however, consider this Word as either a preview of things to come or supplemental information that could come in handy later. Medication therapy is used in the management of shock to affect heart rate, myocardial contractility, and vascular resistance. The choice of agent, or agents, will be determined by the child's physiologic state. Vasoactive agents are indicated when shock persists despite adequate volumeresuscitation to optimize preload. For example, a pediatric patient with septic shock who remains hypotensive with signs of vasodilation despite the administration of fluid boluses could benefit from a vasoconstrictor. The administration of vasoactive medications can be potentially harmful if the pediatric patient hasn't been sufficiently fluid resuscitated first. However, in pediatric patients with cardiogenic shock, vasoactive agents should be used early since fluid resuscitation isn't key to improving myocardial function and may even contribute to pulmonary edema and respiratory failure. Most pediatric patients with cardiogenic shock will benefit from a vasodilator (provided that the patient's blood pressure is sufficient) to decrease systemic vascular resistance (SVR) and increase cardiac output and tissue perfusion. lnotropes, phosphodiesterase inhibitors (such as the inodilator milrinone), vasodilators, and vasopressors are classes of pharmacologic agents that are commonly used in the treatment of shock in pediatric patients. Now let's look at vasoactive therapies typically used in the treatment of pediatric shock. Vasoactive Medications by Class and Pharmacologic Effects Class: Inotropes Medication: Dopamine Epinephrine Dobutamine Effects: Increase cardiac contractility Increase heart rate Produce variable effects on SVR Class: Phosphodiesterase Inhibitors (lnodilators) Medication: Milrinone Effects: Decrease SVR Improve coronary artery blood flow Improve contractility Class: Vasodilators Medication: Nitroglycerin Nitroprusside Effects: Decrease SVR Decrease venous tone Class: Vasopressors (vasoconstrictors) Medication: Epinephrine (dosages >0.3 mcg/kg per minute) Norepinephrine Dopamine (dosages > 10 mcg/kg per minute) Vasopressin Effects: Increase SVR Increase myocardial contractility (except vasopressin) For more specific categories of shock, lifesaving diagnostic assessments and therapeutic interventions may be required that may be beyond the scope of practice of many PALS providers. For example, there's a chance you may not be trained to interpret an echocardiogram or perform a thoracostomy or pericardiocentesis. Which is why it's important to recognize your own limitations to your own scope of practice and ask for help when needed. Early subspecialty consultation (such as pediatric critical care, pediatric cardiology, and pediatric surgery) is an essential component of shock management in pediatric patients and can influence the outcome. https://d3imrogdy81qei.cloudfront.net/video_images/5593/lidocaine-pals.jpg Yes 104 https://app.protrainings.com/courses/pals/certification/videos/magnesium-sulfate-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3124.mp4 Magnesium Sulfate In this lesson, we'll go over the medication magnesium sulfate, sometimes referred to as simply mag sulfate, and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Magnesium sulfate affects the SA node by slowing down its impulse rate, and it also reduces the automaticity in partially depolarized cells. Magnesium sulfate causes vasodilation, and when administered rapidly, can also create hypotension. Magnesium Sulfate Indications Now let's take a look at magnesium sulfate indications. Magnesium sulfate is effective as an anticonvulsant/antiarrhythmic and is used to treat polymorphic ventricular tachycardia with a pulse Magnesium sulfate is recommended for use in cardiac arrest only in cases of torsades de pointes or suspected cases of hypomagnesemia. Whenever you see these present in pediatric patients, this is when you would use magnesium sulfate. Magnesium Sulfate Precautions and Contraindications Magnesium sulfate is contraindicated for pediatric patients with central nervous system depression or hypermagnesemia. And caution must be taken when used on patients with renal impairment as well. Pediatric Dosage of Magnesium Sulfate Now let's look at the pediatric dosage of magnesium sulfate. For the treatment of torsades, the pediatric dose is between 25 and 50mg/kg via IV with a maximum dose of 2 grams. A Word About Identifying Respiratory Problems by Severity We'll be digging into respiratory arrest and specific upper and lower airway issues in the following Case Studies section of your ProPALS course. So, consider this a bit of a preview of things to come, but with some additional information thrown in. Identifying the severity of a respiratory problem in pediatric patients will help you decide the most appropriate interventions. It's important to be aware and alert for signs of, specifically, respiratory distress and respiratory failure. In this lesson, we'll highlight respiratory distress and respiratory failure. Identifying Respiratory Distress in Pediatric Patients Respiratory distress is a clinical state characterized by an increase in respiratory rate and effort. Respiratory distress can span a wide spectrum, from mild tachypnea with increased effort to severe distress with impending respiratory failure. A description of the severity of respiratory distress in pediatric patients will typically include a description of the respiratory rate and effort, the mental status of the child, and the quality of their breathing sounds. It's important to understand that signs of severe respiratory distress can also indicate respiratory failure. The Signs of Respiratory Distress in Pediatric Patients Signs of mild respiratory distress include: Mottling Mild tachypnea A mild increase in respiratory effort (such as nasal flaring and retractions) Abnormal airway sounds (such as stridor, wheezing, and grunting) Signs of severe respiratory distress (and possible respiratory failure) include: Abnormal airway sounds Pale and cool skin or cyanosis Marked tachypnea and apnea A significant or insufficient respiratory effort (such as hypoventilation or bradypnea) Low oxygen saturation (hypoxemia) despite high-flow supplementary oxygen A decreased level of consciousness (such as the patient being less responsive or completely unresponsive) Respiratory distress is usually apparent when the pediatric patient attempts to maintain adequate gas exchange despite their airway obstruction, lung tissue disease, or reduced lung compliance. As the patient tires or as respiratory effort or function (or both) deteriorate, adequate gas exchange cannot be maintained. When this happens, clinical signs of respiratory failure will develop. Identifying Respiratory Failure in Pediatric Patients Respiratory failure is a clinical state of insufficient oxygenation and ventilation, and sometimes both. Respiratory failure is usually recognized by the patient's abnormal appearance and behavior (especially an altered level of consciousness, which may be characterized by a depressed level of consciousness or agitation), reduced responsiveness, and poor color. Even though respiratory failure is often the result of a progression of respiratory distress, it can also occur with little or no respiratory effort. And at times, the recognition of respiratory failure may require laboratory testing (such as blood gas) to confirm your diagnosis. However, in other pediatric patients, the clinical examination will be sufficient to identify the patient's respiratory failure. Signs of Severe Respiratory Distress and Probable Respiratory Failure Signs of severe respiratory distress include: Marked tachypnea Tachycardia Cyanosis An increase or decrease in respiratory effort Poor distal air movement Low oxygen saturation (hypoxemia) despite high-flow oxygen administration Signs of probable respiratory failure include: Cyanosis A decreased level of consciousness Absent distal air movement Very rapid, or insufficient, respiratory rate or possible apnea A significant, insufficient, or absent respiratory effort Extreme tachycardia; bradycardia will often indicate a life-threatening deterioration Low oxygen saturation (hypoxemia) despite high-flow supplementary oxygen Respiratory failure can be the result of upper or lower airway obstruction, lung tissue disease, and disordered control of breathing (such as apnea or shallow and slow respirations). When the patient's respiratory effort is insufficient, respiratory failure can occur without the typical signs of respiratory distress, as listed above. Respiratory failure is a clinical state that requires immediate intervention to prevent the patient's deterioration into cardiac arrest. https://d3imrogdy81qei.cloudfront.net/video_images/5595/magnesium-sulfate-pals.jpg Yes 83 https://app.protrainings.com/courses/pals/certification/videos/oxygen-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3125.mp4 Oxygen In this lesson, we'll go over oxygen therapy, and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Oxygen is an atmospheric gas that increases the saturation of hemoglobin oxygen and when used at therapeutic concentrations, it can aid the oxygenation of certain tissues as long as the patient isn't in shock or has some other complication, like carbon monoxide poisoning. This could affect the distribution or reception of oxygen molecules within the body and its cells. Oxygen Indications Now let's take a look at oxygen indications. The primary indication for the use of oxygen in PALS is the presence of hypoxemia, which would be representative of an SpO2 of less than 94 percent, severe respiratory depression or distress, as in asthma, and respiratory distress or depression, as in opioid overdose. When you administer oxygen therapy after the return of spontaneous circulation, otherwise known as ROSC, it's important to deliver sufficient oxygenation to maintain an SpO2 that's greater than, or equal to, 94 percent. Oxygen Precautions and Contraindications There are few, if any, known precautions and contraindications for oxygen therapy use in the true hypoxic patient. Precautions should be based on new and ongoing research that reveals the vasoconstrictive properties that hyperoxia may produce. If you begin to hyperoxygenate a normoxic cardiac patient, studies indicate that you might cause lower oxygen absorption and distribution to the patient's vital organs that need oxygenation. Pediatric Dosage of Oxygen Now let's look at the pediatric dosage of oxygen. The appropriate dose of oxygen will be dependent on the patient's needs and unique oxygen requirements. Oxygen therapy can be delivered via several different methods, and the percent of oxygenation will be regulated by the flow of oxygen per minute as well as the delivery adjunct you use. When delivering oxygen via nasal cannula is indicated, you should deliver it at a rate between 2 and 6 liters per minute. If a nonrebreather mask is used, that flow rate should be increased to between 10 and 15 liters per minute. If delivering oxygenated ventilations via a positive pressure device like a bag valve mask, in this case, the oxygen flow should be set at 15 liters per minute. Pro Tip #1: It's important, according to current guidelines, to titrate the oxygen therapy to maintain an SpO2 of at least 94 percent. Equally important, is to remember that a restricted airway will affect the therapeutic response of oxygenation treatment. The use of basic or advanced airway adjuncts may be needed to open or maintain a patent airway in order to treat the patient effectively. Pro Tip #2: Though we've said it before, it bears repeating. Always monitor the signs and symptoms of the patient … not just the monitor. An example of this might be, if the SpO2 reads 92 percent but the patient's skin appears normal, they could have an underlying blood disorder like anemia, which can impede the cyanosis due to a lack of hemoglobin and give the inaccurate appearance of adequate oxygenation. A Word About Identifying Respiratory Problems by Type We'll be digging into respiratory arrest and specific upper and lower airway issues in the following Case Studies section of your ProPALS course. So, consider this a bit of a preview of things to come, but with some additional information thrown in. Respiratory distress or failure can be classified as one or more of the following types: Upper airway obstruction Lower airway obstruction Lung tissue disease Disordered control of breathing Respiratory issues often do not occur in isolation. A pediatric patient can have more than a single cause of respiratory distress or failure. For example, a patient might have disordered control of breathing which was caused by a head injury and then develop pneumonia (a type of lung tissue disease). A patient might also exhibit symptoms consistent with more than one class of respiratory abnormality. Upper Airway Obstruction Obstruction of the upper airways can occur in the nose, pharynx, or larynx. And obstructions can range from mild to severe. The signs of upper airway obstruction include: An increased respiratory rate and effort An increased inspiratory respiratory effort (such as inspiratory retractions, the use of accessory muscles of respiration, and nasal flaring) Stridor (usually inspiratory but can also be expiratory) A change in the patient's voice, cry, or the presence of a barking cough Drooling, snoring, or gurgling sounds Poor chest rise Poor air entry on auscultation Lower Airway Obstruction Obstruction of the lower airways can occur in the lower trachea, the bronchi, or the bronchioles. The signs of lower airway obstruction include: An increased respiratory rate An increased respiratory effort (such as retractions, nasal flaring, and prolonged expiration) Possible decreased air movement on auscultation A prolonged expiratory phase associated with increased expiratory effort (such as when expiration becomes an active rather than a passive process) Wheezing (most commonly expiratory but could also be inspiratory or biphasic) Coughing In this next lesson on procainamide, we'll provide a Word on the other two types of respiratory distress and failure: lung tissue disease and disordered control of breathing. https://d3imrogdy81qei.cloudfront.net/video_images/5597/oxygen-pals.jpg Yes 204 https://app.protrainings.com/courses/pals/certification/videos/procainamide-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3126.mp4 Procainamide In this lesson, we'll go over the medication procainamide and all of its effects, including indications, precautions and contraindications, and pediatric dosages. Procainamide blocks sodium channels which prolongs the refractory period of both the atria and the ventricles. It also reduces the speed of intraventricular conduction, which prolongs the QT, QRS, and PR intervals. Procainamide Indications Now let's take a look at procainamide indications. For pediatric patients, procainamide can be used to treat a variety of atrial and ventricular arrhythmias. It can also be used to treat hemodynamically stable SVT refractory to vagal maneuvers and the medication adenosine, because procainamide can terminate SVT that is resistant to other medications. Procainamide is also effective at treating atrial flutter, atrial fibrillation, and suppressing pulsed V-tach. Procainamide Precautions and Contraindications Warning: Caution must be taken when administering procainamide, as it shortens the effective refractory period of the AV node and increases AV nodal conduction. Procainamide can also increase heart rate when used to treat ectopic atrial tachycardia and atrial fibrillation. And, like amiodarone, may also increase the risk of polymorphic V-tach, also commonly known as torsades de pointes. Pro Tip #1: It's important to note that the use of procainamide along with other agents (like amiodarone) that prolong the QT interval is not recommended without expert consultation. Due to procainamide's potent vasodilating effects, this medication can cause hypotension in children. Also, the dose should be reduced for patients with poor renal or cardiac rhythm. Pediatric Dosage of Procainamide Now let's look at the pediatric dosage for procainamide. The initial dose of procainamide should be an infusion of 15mg/kg over a period of 30 to 60 minutes with continuous ECG monitoring and frequent blood pressure monitoring. It's also important that procainamide be administered by slow infusion to avoid toxicity from heart block, hypotension, and the prolongation of the QT interval. A Word About Identifying Respiratory Problems by Type We'll be digging into respiratory arrest and specific upper and lower airway issues in the following Case Studies section of your ProPALS course. So, consider this a bit of a preview of things to come, but with some additional information thrown in. You may remember from the previous lesson that respiratory distress or failure can be classified as one or more of the following types: Upper airway obstruction Lower airway obstruction Lung tissue disease Disordered control of breathing In the last Word, we went into detail on signs and symptoms of upper and lower airway obstruction. In this Word, we'll dig deeper into the remaining two types: lung tissue disease and disordered control of breathing. Lung Tissue Disease Lung tissue disease is a condition that's used to describe a disease involving the substance (such as parenchyma or tissue) of the lung. While in this state, the pediatric patient's lungs become stiff due to fluid accumulation in the alveoli, interstitium, or both, and requires increased respiratory effort during inspiration and exhalation. Therefore, retractions and accessory muscle use are common. Hypoxemia is often distinct due to alveolar collapse or reduced oxygen diffusion caused by pulmonary edema fluid and inflammatory debris in the alveoli. Tachypnea is also common and often quite noticeable as well. A pediatric patient will frequently attempt to counteract alveolar and small airway collapse by increasing their efforts to maintain an elevated end-expiratory pressure, which is often manifested by grunting respirations. The signs of lung tissue disease include: Tachypnea (often evident) Increased respiratory effort Grunting Crackles, or rales, and decreased air movement Diminished breath sounds Tachycardia Hypoxemia (despite the administration of supplementary O2 Disordered Control of Breathing While in the state of disordered control of breathing, there is inadequate respiratory effort. Often the parent will say something like, their child is breathing funny or not breathing normally. There can be periods of increased respiratory rate, effort, or both, and followed by decreased rate, effort, or both. Also common is that the patient's respiratory rate or effort may be continuously inadequate. The net effect is often hypoventilation leading to hypoxemia and hypercarbia. The signs of disordered control of breathing include: Variable or irregular respiratory rate and pattern (tachypnea alternating with bradypnea) Variable respiratory effort Shallow breathing with inadequate effort (often resulting in hypoxemia and hypercarbia) Central apnea (such as apnea without any respiratory effort) Normal or decreased air movement https://d3imrogdy81qei.cloudfront.net/video_images/5599/procainamide-pals.jpg Yes 134 https://app.protrainings.com/courses/pals/certification/videos/what-is-bradycardia-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3127.mp4 What is Bradycardia? In this lesson, we're going to cover bradycardia, including some things to be aware of when dealing with bradycardic pediatric patients, types of bradycardia, underlying causes, and some information on the best courses of treatment to resolve that patient's bradycardia. It's important to understand that there are many types of bradycardia. You may recall from a previous lesson that bradycardia is defined as a slower than normal heart rate for that child's age, activity level, and their current clinical condition. Pro Tip #1: When a pediatric patient is presenting with bradycardia and is also hypotensive, this is usually a sign that they are experiencing cardiopulmonary compromise. When this happens, that child could possibly be in cardiac arrest very soon if not provided with treatment immediately. Types of Bradycardia The two most common types of bradycardia in pediatric patients are: Sinus bradycardia Atrioventricular blocks, also called AV blocks Causes of Bradycardia The possible underlying causes of pediatric bradycardia can include: Hypoxia Drug interactions Heart defects Metabolic dysfunction Traumatic injuries Pro Tip #2: It's important to remember that asymptomatic sinus bradycardia can be normal, especially in athletes, and may not require treatment. However, it's also equally important to remember that if the bradycardia, regardless of the underlying cause, is causing the patient to display serious or life-threatening symptoms related to that bradycardia, the patient must be treated immediately so that symptoms can be corrected. Identifying and Treating Bradycardia Identifying and treating reversible causes is the most effective treatment for resolving symptomatic bradycardia. Symptomatic bradycardia is a heart rate slower than normal for the child's age (usually less than 60 beats per minute) associated with cardiopulmonary compromise. Cardiopulmonary compromise is defined as hypotension, an acutely altered mental status (such as a decreased level of consciousness), and other signs of shock. Because hypoxemia is the most common cause of bradycardia in children, it's vital to provide proper ventilation and oxygenation early. Cardiac and oxygen saturation monitoring, blood pressure, and common vitals, also need to be obtained as early as possible. In addition, the initiation of a patent IV or IO must be a high priority. A 12-lead ECG should be done if it is available. However, it's important to not delay treatment in order to get the 12-lead. Pro Tip #3: A 12-lead ECG displays, as the name implies, 12 leads which are derived by means of 10 electrodes. Three of these leads are easy to understand, since they are simply the result of comparing electrical potentials recorded by two electrodes – one electrode is exploring, while the other is simply a reference electrode. If the patient isn't showing signs of hypotension or other signs of cardiopulmonary compromise, you can continue with oxygenation, continue to observe the patient, and consider further expert consultation if needed. If the patient's bradycardia persists and there are signs of poor perfusion after oxygen treatment, the next course of action is to administer medications. Medications for Bradycardia If using medications, administer epinephrine at .01mg/kg of 1:10,000 via IV or IO. This can be repeated every 3 to 5 minutes. In cases where the patient is dealing with a primary AV block or increased vagal tone, atropine would by your drug of choice – instead of epinephrine – at .02mg/kg. This can be repeated once for a total of .04mg/kg. Pro Tip #4: When a pediatric patient's heart rate drops below 60 beats per minute with signs of poor perfusion, such as seen with an altered mental status or other signs of shock, it's vital to begin chest compression immediately. And cardiac pacing may be considered if either epinephrine and/or atropine are not effective. A Quick Word About Evaluating Heart Rate and Rhythm in Pediatric Patients You should ask yourself the following two questions when evaluating the heart rate and rhythm in any seriously ill or injured pediatric patient: What is the child's normal heart rate and baseline rhythm? What is the child's level of activity and clinical condition, including baseline cardiac function? It's important to note that children with congenital heart disease may have underlying conduction abnormalities. Interpret the patient's heart rate and rhythm by comparing them to that child's baseline heart rate and rhythm. Pediatric patients with poor baseline cardiac function are more likely to become symptomatic from arrhythmias than those with normal cardiac function. https://d3imrogdy81qei.cloudfront.net/video_images/5601/what-is-bradycardia-pals.jpg Yes 194 https://app.protrainings.com/courses/pals/certification/videos/what-is-tachycardia-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3128.mp4 What is Tachycardia? In this lesson, we're going to cover tachycardia, including some things to be aware of when dealing with tachycardic pediatric patients, types of tachycardia, underlying causes, and some information on the best courses of treatment to resolve that patient's tachycardia. When an infant or child's heart rate is greater than normal for their age, activity level, and clinical condition, that patient is considered tachycardic. Types of Tachycardia Common types of tachycardia include: Atrial fibrillation Atrial flutter Sinus tachycardia Supraventricular tachycardia (SVT) Ventricular tachycardia Ventricular fibrillation Causes of Tachycardia Many things can cause tachycardia, including semi-benign causes such as fever or stress. More serious causes of tachycardia include: Shock Medications Metabolic dysfunction Hypoxemia Damage to the heart muscle Perfusion problems may develop when the patient's heart beats too fast and the ventricles are not able to fill properly with blood. This can cause a decrease in cardiac output and poor perfusion, which can lead to hemodynamic instability. Pro Tip #1: The faster the heart rate, the more likely it is that the tachycardia is the cause of the patient's symptoms. However, a thorough primary and secondary survey of the patient will help you properly assess any underlying conditions. Identifying and Treating Tachycardia It's important to treat the underlying cause first when dealing with a tachycardic pediatric patient. Important steps in caring for an infant or child with tachycardia are: Maintain a patent airway and provide adequate oxygenation. Your goal is to maintain an oxygen saturation of at least 94 percent. After that, you'll want to get a cardiac monitor attached to the patient to correctly evaluate what the underlying rhythm is and if you can, obtain a 12-lead ECG. However, as stated in the last lesson, do not delay treatment while trying to obtain a 12-lead. There are some helpful signs to aid you in identifying the type of tachycardia seen on the ECG. First, determine if the QRS is wide or narrow. A narrow/normal QRS for pediatric patients is 0.9 seconds or less. Pro Tip #2: Narrow complex tachycardias typically originate above the ventricles. By contrast, wide complex tachycardias typically originate in the ventricles and have a higher risk of deteriorating into full cardiac arrest. Before we distinguish the different rates for SVT vs. sinus tachycardia, it's important to note that the main difference between the two is that sinus tachycardia (though difficult to see on an ECG) will have P-waves, while SVT does not. Therefore, SVT is more unstable and the rate with sinus tachycardia can sometimes change with activity. Having said that, if the patient has a normal QRS, you'll still need to determine whether that patient has sinus tachycardia or SVT. Sinus Tachycardia Sinus tachycardia for an infant is usually a heart rate of less than 220 beats per minute. While sinus tachycardia for a child is typically a heart rate of less than 180 beats per minute. It's important to note that a patient's history will usually be consistent with the cause of their tachycardia. With sinus tachycardia, P-waves are present and normal and the QRS is also normal. And the heart rate will vary with the patient's level of activity. Usually, sinus tachycardia does not require treatment. Instead, it's important to search for, and treat for, the cause of the tachycardia. Supraventricular Tachycardia (SVT) SVT for an infant is usually a heart rate of greater than 220 beats per minute. While sinus tachycardia for a child is typically a heart rate of greater than 180 beats per minute. With SVT, QRS is normal but P-waves are usually absent. Patient history will usually reveal an abrupt change in heart rate. Alternatively, it can also be ambiguous as to what caused the change. And heart rate does not vary with the level of activity. Regarding treatment for patients with regular narrow complex stable tachycardia, it's appropriate to first attempt vagal maneuvers. With children, have them attempt to blow through a narrow straw. With infants, place a bag of ice over the upper half of their face, making certain to not obstruct the airway. Medications and Treatment for Tachycardia If vagal maneuvers don't work, it may be time to consider medications, specifically adenosine at .1mg/kg via rapid IV push, followed with a 20cc bolus of normal saline to expediate the medication delivery. If the patient doesn't convert and remains stable, a second dose can be given at .2mg/kg, again via rapid IV push, and again, chase the treatment with a 20cc bolus of normal saline. For stable patients with an ECG rhythm that shows irregular narrow complex QRS tachycardia – while unusual – could be atrial fibrillation, atrial flutter, or multi-focal atrial tachycardia. Pro Tip #3: The situation above may require expert consultation for proper treatment. For stable patients with regular or irregular wide complex QRS tachycardia, it's wise to seek expert consultation as well. Often, antiarrhythmics are used to treat wide complex stable tachycardias, such as procainamide or amiodarone. However, the management and treatment of wide complex stable tachycardias requires advanced knowledge of ECG rhythm interpretation and antiarrhythmic therapy. If a child is experiencing SVT or wide complex tachycardia and remains stable and doesn't respond to medication therapy, consult with a pediatric cardiologist before proceeding with synchronized cardioversion. For a child with unstable tachycardia, such as a child with hypotension, synchronized cardioversion would be the appropriate first choice. Sedation, if needed and if time allows, would also be appropriate. But don't delay cardioversion that's required to stabilize a patient. Cardioversion for Tachycardia For a child with unstable tachycardia, start with an energy dose of .5 to 1 joules/kg. If the initial dose is ineffective, increase the electrical dose to 2 joules/kg. Warning: Make certain that the defibrillator is set to cardioversion and not defibrillation. Make sure to record and monitor the ECG before, during, and after each cardioversion attempt. And after cardioversion has been successful, obtain a 12-lead ECG, then pass this patient on to the appropriate next stage of treatment. https://d3imrogdy81qei.cloudfront.net/video_images/5603/what-is-tachycardia-pals.jpg Yes 401 https://app.protrainings.com/courses/pals/certification/videos/what-is-respiratory-distress-upper-airway-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3129.mp4 What is Respiratory Distress - Upper Airway? In this lesson, we're going to cover upper airway respiratory distress, including causes, signs and symptoms, treatment options in general, and some information on the best courses of treatment for a few specific causes of respiratory distress in pediatric patients. Respiratory distress is an important subject to cover, and it's important to note that upper airways obstructions can present mild to severe symptoms and include the large airway anatomy – such as the nose, pharynx, and larynx. Because children and infants have much smaller airways than adults, they are more susceptible to these types of obstructions. Remember, a child's trachea is roughly the size of their pinky finger. Pro Tip #1: Also, in children and infants with a decreased level of consciousness, the tongue itself can cause the obstruction, because when the muscles relax, the tongue can fall to the back of the throat and obstruct the oral pharynx part of the airway. Common Causes of Upper Airway Respiratory Distress There are several common causes of upper airway respiratory distress in pediatric patients, and these include: Food or other small foreign body objects Infections, such as epiglottitis or croup Thick secretions in the nasal passages Swelling of the airway due to conditions like anaphylaxis or epiglottitis And less common causes include: Mass-like abscesses Congenital conditions affecting the airway Trauma that causes a narrowing of the airway Signs and Symptoms The signs and symptoms of upper airway obstructions are different than those for lower airway obstructions, as they occur mostly during inspiration and include: Inspiratory retractions The use of accessory muscles Nasal flaring Hoarseness Snoring Drooling Changes in voice or cry sounds Barking seal-like cough Stridor-like sounds Usually, as upper airway obstructions worsen, breathing will become more labored and faster. Pro Tip #2: However, it's important to note that in the later stages with severe hypoxia, breathing becomes slower and will eventually stop altogether if left untreated. Early recognition, identification, and treatment of respiratory distress in infants and children is vital to achieve a good outcome and also for their survival, as respiratory distress can quickly progress into respiratory failure and cardiac arrest. Identifying and Treating Upper Airway Obstructions Treatments for specific causes will often vary, however there are some general methods used to treat a child in respiratory distress, and these include: Proper positioning – put the patient into a comfortable position that keeps the airway open to help support their breathing efforts, such as: Sitting the child upright so their head is above their heart Leaning the child forward if they're really distressed Helping the child remain calm, perhaps by holding a toy or stuffed animal Check the patient's lung sounds and apply an oxygen saturation monitor while the child is still on room air, which will help establish a good baseline for their SpO2 levels Administer high flow oxygen immediately for respiratory arrest and remember the goal – keep the patient's oxygen saturation above 94 percent Consider suctioning as needed after oxygen therapy is established Assess the patient's blood pressure, pulse and respiratory rates, temperature, and ECG It's also important to identify and treat specific types or causes of upper airway obstruction based on the patient's signs and symptoms. Identifying and Treating Croup Croup is most commonly identified by: That seal-like barking cough Stridor lung sounds Retractions, in severe cases For treating croup, administer nebulized epinephrine at 5ml of 1:1000 as indicated. And after initial airway treatment has been initiated, establish IV or IO access to administer corticosteroids if required. A commonly recommended corticosteroid for croup is dexamethasone at .6mg/kg delivered via IV or IO. Pro Tip #3: It's important to reassess the patient's vitals after the initial treatment and continue to monitor them closely. You should also be prepared to intubate if respiratory failure occurs. Treating Anaphylaxis For pediatric patients with anaphylaxis, treat with intramuscular epinephrine, as this is considered the first course of treatment for this condition. Depending on the patient's specific signs and symptoms, you should also consider: Corticosteroids Albuterol Antihistamines Treating for Foreign Body Obstructions If the patient has a foreign body obstruction, where they cannot cough or breathe, that obstruction must be removed immediately with proper basic life support. Techniques you can use to remove an obstruction are: Abdominal thrusts Back slaps Chest thrusts For mild cases of foreign body obstructions, you'll recognize this as the child will still be able to make sounds, like coughing forcefully. Pro Tip #4: Do not try to physically remove the obstruction in these cases. Instead, call for expert consultation, if time allows. And if the patient's status remains stable, you should still see if surgical intervention or deep suctioning is required. Always remember to allow the infant or child to remain in the most comfortable position possible and always monitor them closely for deteriorating symptoms. And if they do deteriorate, treat them accordingly. https://d3imrogdy81qei.cloudfront.net/video_images/5605/what-is-respiratory-distress-upper-airway-pals.jpg Yes 336 https://app.protrainings.com/courses/pals/certification/videos/what-is-respiratory-distress-lower-airway https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3130.mp4 What is Respiratory Distress - Lower Airway? In this lesson, we're going to cover lower airway respiratory distress, including causes, signs and symptoms, treatment options in general, and some information on the best courses of treatment for a few specific causes of respiratory distress in pediatric patients. At the end of the lesson, we'll provide a Word about head bobbing or seesaw respirations, which often indicate that the child or infant has an increased risk for further deterioration. Common Causes of Lower Airway Respiratory Distress The two most common causes of lower airway respiratory distress in pediatric patients are: Asthma Bronchiolitis These conditions cause obstructions to the lower airway specifically in the: Lower trachea Bronchi Bronchioles In contrast to upper airway obstructions, lower airway obstructions are typically more apparent during the expiratory phase (rather than inspiratory) of the respiration cycle. Signs and Symptoms The signs of lower airway obstruction include: An increased respiratory rate An increased respiratory effort (such as retractions, nasal flaring, and prolonged expiration) Possible decreased air movement on auscultation A prolonged expiratory phase associated with increased expiratory effort (such as when expiration becomes an active rather than a passive process) Wheezing (most commonly expiratory but could also be inspiratory or biphasic) Cough For instance, wheezing most commonly occurs during expiration – specifically a prolonged expiration that takes more effort – and can often be recognized as: Retractions Nasal flaring Active process, like attempting to blow air out of the lungs Pro Tip #1: In infants and children, when lower airway obstructions worsen, inspiratory retractions become more noticeable as respiration effort becomes more difficult. Lung disease can also appear as a lower airway obstruction. Lung disease causes a child's lungs to become stiff, and increased effort during inspiration and expiration is often identified by: Retractions and accessory muscle use Accumulation of fluid Inflammation in the alveoli or interstitium Because small airways in the lower lungs collapse, you might even see grunting respirations, as these are often present as a result of increased respiratory efforts. Identifying and Treating Lower Airway Obstructions Just as with upper airway obstructions, early recognition, identification, and treatment of respiratory distress in infants and children is extremely vital for a positive outcome and to increase their chances of survival. And remember, respiratory distress can quickly progress into respiratory failure and cardiac arrest. Treatments for specific causes will often vary, however there are some general methods to treat a child in respiratory distress, and these include: Proper positioning – put the patient into a comfortable position that keeps the airway open to help support their breathing efforts, such as: Sitting the child upright so their head is above their heart Leaning the child forward if they're really distressed Helping the child remain calm, perhaps by holding a toy or stuffed animal Pro Tip #2: If the child is lying on a bed, such as in a hospital or ambulance, put the head of the bed into an elevated position, which can be easier than having the child use their own strength to remain in an elevated-head position. Check the patient's lung sounds and apply an oxygen saturation monitor while the child is still on room air, which will help establish a good baseline for their SpO2 levels Administer high flow oxygen immediately for respiratory arrest and remember the goal – keep the patient's oxygen saturation above 94 percent Assess the patient's blood pressure, pulse and respiratory rates, temperature, and ECG It's also important to identify and treat specific types or causes of lower airway obstruction based on the patient's signs and symptoms. Treating Asthma If asthma is causing the child's lower airway obstruction, treat the patient via a nebulizer with 2.5mg of albuterol and the possible administration of corticosteroids. Treating Bronchiolitis If the child is suffering from bronchiolitis, suctioning the oral or nasal passages as needed will be your best course of treatment. However, assess the need for further treatment and consider laboratory and other tests such as: Viral studies Chest X-rays Arterial blood gas Once the pediatric patient is stabilized, initiate medical consultation for effective and ongoing managed definitive care. And remember to allow the infant or child to remain in the most comfortable position possible and always monitor them closely for deteriorating symptoms. And if they do deteriorate, treat them accordingly. A Word About Head Bobbing or Seesaw Respirations Head bobbing and seesaw respirations will often indicate that the child has an increased risk for deterioration. Head Bobbing Head bobbing is caused when the pediatric patient has to use their neck muscles to assist with breathing. The child will lift their chin and extend their neck during inspiration and allow their chin to fall forward during expiration. Head bobbing is most commonly seen in infants and can be a sign of respiratory failure. Seesaw Respirations Seesaw respirations are present when the patient's chest retracts, and their abdomen expands during inspiration. During expiration, the movement reverses, as the patient's chest expands, and the abdomen moves inward. Seesaw respirations typically indicate an upper airway obstruction. However, they can also be indicated in severe lower airway obstructions, lung tissue disease, and states of disordered control of breathing. Seesaw respirations are characteristic of infants and children with neuromuscular weakness. And it's important to note that this inefficient form of ventilation can quickly lead to fatigue. https://d3imrogdy81qei.cloudfront.net/video_images/5607/what-is-respiratory-distress-lower-airway.jpg Yes 202 https://app.protrainings.com/courses/pals/certification/videos/what-is-respiratory-arrest-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3131.mp4 What is Respiratory Arrest? If a pediatric patient is left in a state of respiratory distress too long, after a while, that will lead to the subject of this lesson – complete respiratory arrest. Remember, a patient in respiratory arrest has a pulse but no respirations. Advanced life support begins with excellent basic life support skills. So, if you believe the patient to be unresponsive, verify that by tapping on the child's collarbone and shouting. Step 1 – Call for Advanced Care If you still do not get a response, call for advanced level care and assistance, as this will be your first step in resolving the respiratory arrest. In a hospital setting, call in a medical code and follow your appropriate local respiratory and/or cardiac arrest protocol. In pediatric patients, it's important to not let their respiratory arrest deteriorate into a more significant arrest – cardiac arrest. Pro Tip #1: Practice makes perfect, especially in an emergency situation. So, make sure you're following and carrying out the code in the same ways you've practiced, which will lead to a more efficient and effective emergency response team effort and the delivery of good resuscitation team care. In a pre-hospital setting, get assistance as needed from another advanced life support unit, which may include a higher level of transportation. This will be relevant in certain communities that use a basic life support ambulance that is then intercepted by another advanced life support vehicle and team. Step 2 – Assess for Circulation and Breathing The next thing you'll want to do is assess the patient for circulation and breathing, including checking for a pulse. On a child, check the carotid pulse. On an infant, check the brachial pulse. And look at the patient's face and chest, while checking for a pulse, for any signs of breathing. Pro Tip #2: Remember, for a patient in respiratory arrest, you'll find a pulse but no adequate breathing. Also worth mentioning again – agonal respirations (or snoring respirations) do not qualify as normal and effective breathing and should be considered the same as no adequate breathing. Step 3 – Rescue Breathing and Airway Management At this point, you will have decided to begin to provide rescue breathing, but first open the airway with a proper head-tilt, chin lift. If you have a folded towel, blanket, or diaper available, placing it under the patient's shoulders may help achieve the proper positioning, which will help keep the airway open. Make sure, though, not to hyperextend the patient's neck, as this will produce the opposite effect – closing the airway, rather than keeping it open. Placing a basic airway can help keep the tongue out of the back of the throat and ensure more successful ventilations. Get an oropharyngeal airway (OPA) measurement by placing it along side the patient's face, from the corner of the mouth to the lower tip of the ear. Warning: Getting a proper measurement is important. If the OPA is longer than that area or too wide for the patient, this could cause a blockage of the airway and defeat the purpose. Pro Tip #3: Remember to check for a gag reflex before you attempt to place an OPA into the patient's airway. If there is a gag reflex, do not attempt an OPA, as this can cause the patient to vomit, which could seriously complicate airway management and oxygenation. Deliver 1 rescue breath every 3 seconds for a child or infant, which is about 20 breaths per minute. Breaths should be given with a bag valve mask at 15 liters per minute of oxygen. Step 4 – Assess the Patient's Vital Signs After you've begun to deliver rescue breathing, attach a heart rate monitor and assess the patient's vitals: Oxygen saturation Blood pressure Pulse rate As rescue breaths are delivered, it's important to monitor their effectiveness by watching the patient's chest. Do you see it rise and fall? And if the patient is intubated, monitor capnography and avoid gastric inflation. Step 5 – Advanced Airway and IV or IO Access The next step is to place an advanced airway and gain IV or IO access. And remember, if the patient's pulse rate drops below 60 beats per minute, start chest compressions immediately. Pro Tip #4: Also, as part of your resuscitation protocol and care, keep in mind that you'll want to look for, and treat, any underlying causes of the patient's respiratory arrest. https://d3imrogdy81qei.cloudfront.net/video_images/5609/what-is-respiratory-arrest-pals.jpg Yes 242 https://app.protrainings.com/courses/pals/certification/videos/what-is-child-aed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3132.mp4 What is Child AED? The methods of defibrillating a child are basically the same as defibrillating an adult. One important distinction involves AED pad size. AED pads come in an adult size and a pediatric size, for patients less than 55 pounds or roughly 25 kilograms. Pro Tip #1: If you do not have pediatric pads and the patient is less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forego using an AED. Warning: Remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? If for some reason the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. Pro Tip #2: It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED. AED Technique for Children Turn on the AED. Remove the patient's clothing to reveal a bare chest. Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go roughly 2 inches deep, or 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. After one round of CPR, let the AED analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About Special AED Situations Some special considerations should be given when using an AED in certain situations. These include using an AED on a patient who's wearing an implantable device, a patient who's suffering from hypothermia, and a patient with an excessive amount of chest hair. Implantable Devices Implantable devices, like pacemakers, are sometimes located below one of the collarbones in the area where one of the AED pads should go. This can be problematic as the device could interfere with shock delivery. An ICD (Implantable Cardioverter-Defibrillator) is another common implantable device you may encounter. It's sort of like a mini version of an AED, as it detects abnormal heart rhythms and restores them to normal. If one of these devices is visible – a small lump can sometimes be seen or felt – or if you know the patient has one in a specific location, do not place the AED pad on top of it. Instead, adjust the placement of the pad to avoid the device. Hypothermia As already mentioned, patients who are wet pose no problems when using an AED, provided they are not submerged in water, water is not connecting the patient with the responder or anyone else, and the wet clothing is removed from the upper torso and the chest is dried off. Patients who are suffering from hypothermia do not require rewarming before using the device. However, you will want to handle them gently, as shaking them could result in V-fib. Excessive Chest Hair Chest hair rarely interferes with AED pad adhesion, but it is nonetheless a possibility. If the patient has excessive chest hair, press firmly on the pads when placing them on the victim's chest. If you get an error message, like check pads, or something similar, remove them and replace with new pads. Some of the patient's chest hair will likely come off with the old pads, which may solve the problem. However, if the AED still refuses to work, you'll have to shave the patient's chest before applying a third round of pads. This is why it's important to have a safety razor in your AED kit. https://d3imrogdy81qei.cloudfront.net/video_images/5611/what-is-child-aed.jpg Yes 327 https://app.protrainings.com/courses/pals/certification/videos/what-is-shock-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3133.mp4 What is Shock? In this lesson, we'll go over shock in general, four of the most common types of shock in pediatric patients, and some information on treating shock. Let's first put shock into the proper perspective – when a person dies, it's almost always due to some form of shock, regardless of what caused the shock. The definition of shock (inadequate tissue perfusion) means that the body is unable to circulate blood with adequate oxygenation into the vital organs and the rest of the body. Shock can occur due to several different things, like: Loss of blood Sepsis Impaired heart function Anaphylaxis While there are many different subcategories and causes of shock, the types we'll be focusing on here are: Hypovolemic shock Distributive shock Cardiogenic shock Obstructive shock Hypovolemic Shock Hypovolemic shock is characterized by low cardiac output and is caused by incidences like severe bleeding and blood loss. In patients with hypovolemic shock, initially their systolic blood pressure may appear normal but there will be a narrow pulse pressure. Peripheral pulses will be weak or absent and the patient's level of consciousness will decrease as the shock progresses. The body will continue to shunt blood flow to the extremities in order to increase blood flow to the vital organs, right up until the latter stages of hypovolemic shock. Distributive Shock While a patient is in distributive shock (like sepsis shock or neurogenic shock), systemic vascular resistance is reduced, which leads to excessive vascular space. Blood flow is severely reduced to vital organs, which results in poor distribution of oxygen. Pro Tip #1: Unlike hypovolemic shock, peripheral perfusion may appear to be adequate, as blood flow to the extremities may actually be increased because of their reduced vascular resistance. Extremities can also be warm due to the widening of the blood vessels and greater blood flow to the skin. The signs and symptoms of distributive shock can seem contradictory and can lead to confusion when diagnosing it. Cardiogenic Shock Cardiogenic shock is a failure of the heart to pump correctly and is distinguished from other types of shock by a marked increase in respiratory effort. One key to treating cardiogenic shock is to increase cardiac output. This is typically done with medications, which helps improve myocardial function. Unlike hypovolemic and distributive shock, fluid replacement must be done slowly over time. Rapid fluid replacement will reduce cardiac output and oxygenation and can increase the risk for pulmonary edema. Obstructive Shock Obstructive shock occurs when a mechanical or physical obstruction limits blood flow. Examples of what can cause this form of shock are: Cardiac tamponade Tension pneumothorax Pulmonary embolism Pro Tip #2: The signs and symptoms of obstructive shock are quite similar to hypovolemic shock, which brings up a good point. To best determine the type of shock you're dealing with and the proper course of treatment, investigate the underlying causes that put the patient into their condition. An example of this would be how a blunt force trauma to the chest would indicate a high risk for tension pneumothorax or a cardiac tamponade situation. In contrast, external bleeding would be more indicative of hypovolemic shock. Immediate recognition and correction of the underlying cause of obstructive shock is extremely important for the patient's survival. Shock in Pediatric Patients With infants and children, all types of shock can quickly lead to the ultimate failure of the body – cardiac arrest. Especially if it isn't treated early. The progression to cardiac arrest is particularly fast in infants and children that have gone from a state of compensated shock – when their heart is racing, and respiratory rate is high. Then suddenly, the body exhausts. At this point, they go into late stage decompensated shock, which is a difficult syndrome to get the patient out of. Which is why early recognition and treatment of shock are critical to saving a child's life. Shock Treatments First line of treatment in pediatric shock is to maintain an open airway and deliver high-flow supplemental oxygen. After the airway is open and oxygen is in place, the next priority is vascular access. If the child is in hypotensive shock, vascular access for fluid replacement is critical. Pro Tip #3: Typically, placing an IO is more effective and efficient than placing an IV, especially when the child is in vascular compromise or even vascular collapse. Once the IV or IO is in place, a bolus of an isotonic crystalloid, such as normal saline, should be administered at 20ml/kg over 5 to 10 minutes. A bolus of 20ml/kg may be repeated if necessary. Warning: If signs of pulmonary edema occur or the signs of shock worsen, stop the bolus immediately. Because hypoglycemia is common in critically ill children and infants, blood glucose levels need to be checked early in your course of treatment. If low glucose levels aren't identified early and treated, brain injuries can occur. Hyperglycemia can also be present and contribute to the shock symptoms. Which is why it's important to remember to look for the H's and T's and treat the underlying causes of shock. If the child or infant remains hypotensive after the bolus of fluid is administered, you can consider administering epinephrine with IV or IO access at .1 – 1mcg/kg per minute. You can also consider administering dopamine via IV or IO access at 10 – 20mcg/kg per minute. And finally, norepinephrine via IV or IO access at .1 – 2mcg/kg per minute. Pro Tip #4: Remember, when treating for shock in pediatric patients, especially after medications have been administered, it's vital to frequently reassess their respiratory, cardiovascular, and neurological status to help determine their needs for further treatment. Serial and frequent vitals are so important up until, and after, the child or infant has been stabilized and passed to the next level of care. https://d3imrogdy81qei.cloudfront.net/video_images/5615/what-is-shock-pals.jpg Yes 393 https://app.protrainings.com/courses/pals/certification/videos/what-is-pulseless-arrest https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3134.mp4 What is Pulseless Arrest? In this lesson, we'll cover pulseless arrest, including the two types of pulseless arrest, and how to treat for the most common type – ventricular fibrillation, or VFib. Pulseless arrest is one of the more anxious situations for most healthcare providers, particularly when it involves pediatric patients. VFib and ventricular tachycardia, or V-tach, are both lethal dysrhythmias that do not produce a pulse. Trauma, or severe injuries, are one of the leading causes of out-of-hospital cardiac arrest in children. Even so, the treatment for pediatric trauma victims in cardiac arrest is the same as it is for children in non-traumatic cardiac arrest. Which is to support the patient's ABCs: Airway Breathing Circulation Pro Tip #1: In pediatric cases where the arrest is due to a mechanical form of shock and in which treatment can be performed immediately to relieve the cause of the obstructive shock, you should still follow the same algorithm. Ventricular Fibrillation (VFib) VFib is the most common initial dysrhythmia in cardiac arrest patients and will regress further to asystole if it isn't immediately treated. The key steps to treating VFib are as follows: Rapid assessment to confirm the cardiac arrest. Immediately beginning high quality CPR. Applying the defibrillator and delivering the first shock as soon as possible. Pro Tip #2: Delivering a first shock as soon as possible is extremely important, as statistically, every minute that defibrillation is delayed, the chance of survival is reduced by about 10 percent. As a healthcare professional, providing high quality CPR is always a priority. But for a child or infant, high quality CPR needs to be performed with as few interruptions as possible. This means a number of things, but it starts with giving cycles of 15 chest compressions at a depth of 1/3 the depth of the chest and at a rate of 100 to 120 compressions per minute. This should be followed by 2 rescue breaths, and make sure it's enough to get the patient's chest to rise and fall. Pediatric Compression Depth Chest compression depth will vary based on the patient's size, so these are merely averages: Child chest compressions – about 2 inches in depth.Infant chest compressions – about 1.5 inches in depth. Pro Tip #3: To ensure the quality of CPR being performed remains high, change the compressor every 2 minutes – or sooner if needed – to avoid fatigue, which often leads to less than optimal CPR compressions. VFib Treatment After the initial defibrillation shock has been delivered, an IV or IO needs to be established in order to administer medications. The first medication given is epinephrine, and this should be administered using the 1:10,000 concentration at .01mg/kg via either IV or IO push every 3 to 5 minutes. And remember that a 20cc bolus of normal saline should be pushed after that to get the medication into the patient's circulatory system. After the initial dose of epinephrine has been delivered, and after a second shock is given, consider placing an advanced airway with capnography. Also, once the advanced airway is in place, continue to perform high quality chest compressions at a rate of 100 to 120 per minute. And 1 rescue breath is given every 6 seconds synchronized with those compressions. If the patient remains in persistent VFib after the initial shocks and epinephrine administration, the next medication to be given is amiodarone at 5mg/kg via rapid IV or IO push. Two more doses of amiodarone may be repeated. The successful treatment of VFib continues with: High quality CPR Reassessing the patient's cardiac rhythm every 2 minutes Delivering another shock if VFib is still present Giving medications as indicated Pro Tip #4: Any pulseless arrest, such as VFib, V-tach, or even PEA and asystole, needs to include nearly continuous high-quality CPR. The ONLY thing that should interrupt CPR are brief rhythm checks. Also important to note – you do not want to interrupt CPR to administer drugs. IV or IO administration of medications should be given while chest compressions are being performed in order to get the drugs circulated to the patient's heart and throughout their body, and to keep good circulation to their vital organs and tissues. Aggressive and non-interrupted CPR has shown great improvement to pediatric patient outcomes, and more importantly, their improved post-resuscitation quality of life. https://d3imrogdy81qei.cloudfront.net/video_images/5617/what-is-pulseless-arrest.jpg Yes 259 https://app.protrainings.com/courses/pals/certification/videos/what-is-asystole-pals https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3135.mp4 What is Asystole? Asystole means that there is no discernible electrical activity in the heart that can be seen on the ECG monitor and there also isn't any pulse. Survival rates are very poor when a child or infant is in asystole, and for this reason, it's always important to emphasize the prevention of injuries and the aggressive treatment of illnesses that can lead to cardiac arrest. In this lesson, we'll cover the steps you should take to try and resuscitate a pediatric patient in asystole. And at the end of the lesson, we'll include circumstances in which survival rates and resuscitation efforts fare better than the average. Pro Tip #1: As a healthcare provider, it's vital to focus on early recognition and treatment of all respiratory distress, respiratory failure, and shock BEFORE it deteriorates into cardiac arrest. Identifying and treating preventable causes for the cardiac arrest, such as using the H's and T's, is equally crucial when it comes to saving the life of an injured or ill child. Taps and Shouts If you have a patient who appears unresponsive, begin by tapping and shouting to verify. If the patient is still unresponsive at this point, you should: Call in a code in a hospital setting Get assistance from another advanced life support unit or higher level of transportation in pre-hospital settings Assess for the ABC's At this point, you'll want to begin assessing for signs of circulation and breathing. Begin by checking the patient's pulse. In children, check for the carotid pulse. In infants, check for the brachial pulse. And observe the patient's face and chest, while you do, for any signs of normal breathing. High Quality CPR At this point, if the patient is still unresponsive, isn't breathing normally, and has no pulse, begin performing high quality CPR immediately and with as few interruptions as possible. Perform CPR in cycles of 15 chest compressions at a depth of 1/3 the depth of the chest at a rate of 100 to 120 compressions per minute. This should be followed by 2 rescue breaths, and make sure it's enough to get the patient's chest to rise and fall. Chest compression depth will vary based on the patient's size, so these are merely averages: Child chest compressions – about 2 inches in depth.Infant chest compressions – about 1.5 inches in depth. And remember, to ensure the quality of CPR being performed remains high, change the compressor every 2 minutes – or sooner if needed – to avoid fatigue, which often leads to less than optimal CPR compressions. The airway person should be measuring the patient and preparing the proper size basic airway adjunct and ventilating the patient with 100 percent oxygen delivered via a bag valve mask at 15 liters per minute. Defibrillator pads should be applied right away after the compressions and rescue breaths have begun. After which, the team leader will tell everyone to stand clear while the AED analyzes the patient's rhythm. If the patient is in asystole, it's important to double check some things that may be affecting this type of ECG rhythm by asking yourself the following questions: Are all the leads on correctly? Are all the leads attached to the patient with good contact? Does the ECG have a sufficient power supply? Is the amplitude set correctly to determine asystole vs. fine VFib? If you can answer yes to all the above, the team leader should make sure the team knows to continue providing high quality CPR, as asystole is not a shockable rhythm. Establish IV or IO Access Now is the proper time to move to establishing IV or IO access in order to begin administering medications and replacing fluids. It's helpful to have a length-based color-coded resuscitation tape, like a Broselow tape, so you can determine quickly and efficiently the weight of the patient for calculating drug doses and the correct size of resuscitation equipment you'll need. An example: The average nine-month-old would measure within the red area of a length-based resuscitation tape. If the patient falls within this red area, you can quickly estimate their weight to be around 8kg (17-18 pounds), which lets you know that you'll need a 22-24 gauge IV catheter or an 18-15 gauge IO needle. Administering Medications After an IV or IO has been established, the team leader should call for an epinephrine concentration of 1:10,000 at .01mg/kg via IV or IO push, followed by 20cc of normal saline. This will ensure that the medication gets into the central circulatory system. Pro Tip #2: It's important to continue to perform chest compression while the medication is being given in order to help circulate it properly, as well as ensuring that the patient is getting the best circulation of oxygen to vital organs and tissues. And finally, it's important for basic life support to minimize CPR breaks while giving medications or starting an advanced airway. In circumstances where IV or IO access isn't available, but you have an endotracheal tube in place, epinephrine could be administered via the ET tube, however the ratio of the medication will be different – a concentration of 1:1000 at .1mg/kg. Pro Tip #3: Medications delivered via an ET tube are not as desirable as via IV or IO as the results are not as predictable. However, the potential benefit of the medication outweighs any negatives regarding the method of delivery. Insert Advanced Airway After initial treatment has begun, it's a good time to insert an advanced airway if you haven't done so already. After an ET tube or another advanced airway is in place, move to continue performing chest compressions, but the breaths will now change to 1 breath every 6 seconds. And remember to switch compressors every 2 minutes and/or when the compressor calls for a switch. When the switch is announced, the airway person would finish the next breath. Before the next rescuer begins compressions, this is a good time for a quick look at the monitor for any changes in the patient's rhythm. But this should take no longer than 10 seconds. And CPR should be quickly resumed if there aren't any changes. Capnography should also be attached at this time to monitor the quality of the compressions and gas exchange. And repeated doses of epinephrine can be given at .01mg/kg of 1:10,000 via IV or IO push every 3-5 minutes. Once initial treatments have begun, it's also important to ask yourself and the team to consider the causes for the asystole, especially any reversible H's and T's such as: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypokalemia Hyperkalemia Tension pneumothorax Cardiac tamponade Toxins Cardiac thrombosis Coronary thrombosis Pro Tip #4: As a healthcare provider, it's important to remember that you won't know when a patient will survive, even when it goes beyond all scientific reasoning. So, rescue with confidence and enthusiasm and know that miracles do sometimes happen. A patient in asystole is there because all cardiac function and electrical activity have diminished over time. At this point, the patient is biologically dead. However, there are some circumstances, such as poisoning and hypothermia, that will warrant longer resuscitation efforts than others. For instance, if a child drowns in icy cold water, survival can be possible after being underwater for as long as 40 minutes and after CPR efforts have lasted greater than two hours. When drowning occurs in icy water, rewarming to a core temperature of at least 30 degrees Celsius (86 degrees Fahrenheit) is recommended before CPR efforts are terminated, as the heart is often unresponsive to resuscitative efforts until the core temperature is increased. It's never an easy decision for a team leader to stop resuscitation efforts, especially with infants and children. However, after all available treatment options have been considered and attempted, potential reversible causes have been exhausted, and special circumstances have been taken into account, the decision to stop resuscitation will be necessary. https://d3imrogdy81qei.cloudfront.net/video_images/5619/what-is-asystole-pals.jpg Yes 482 https://app.protrainings.com/courses/pals/certification/videos/rosc-and-post-cardiac-arrest-care https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3136.mp4 ROSC and Post Cardiac Arrest Care Every healthcare system should implement a comprehensive and multidisciplinary system of care in a universal and consistent manner for the treatment of post cardiac arrest patients in order to ensure the best outcomes. In this lesson, we'll cover the goals after the return of spontaneous circulation (also known as ROSC), including the two phases of treatment post resuscitation to help ensure the patient's future survival and long-term care. When a pediatric patient has a return of spontaneous circulation after cardiac arrest, there are two important phases of care that should follow: First phase: The continuation of advanced life support. Second phase: To focus on neurologic and core temperature management to protect the patient's core components as they recover from such a traumatic event. The First Phase of ROSC During this phase, you'll continue to provide advanced life support for any immediate life-threatening conditions and focus on the ABC's – airway, breathing, and circulation. Because respiratory complications and hemodynamic instability are primary early causes of mortality after ROSC, it's vital to provide optimal oxygenation and ventilation. One of the goals during phase one is keep an SpO2 of greater than 94 percent. Certain diagnostic tools should be utilized to optimize care such as: Monitor end-tidal CO2 with capnography Assess arterial blood gas Obtain a chest X-ray to confirm proper endotracheal tube position in the mid trachea In addition, perfusion needs to be stabilized and cardiopulmonary function needs to be monitored. Another goal during phase one is to treat any persistent shock. This may require fluid boluses of 20ml/kg or medications such as epinephrine and/or dopamine. Adequate blood pressure also must be maintained, and any arrhythmias need to be properly treated. And lastly, any reversible or contributing causes of the cardiac arrest, such as the H's and the T's, need to be identified and treated. The Second Phase of ROSC The main goal during the second phase of care after the return of spontaneous circulation, is to maintain and provide neurologic care for the patient, along with targeted temperature management. An adequate blood glucose level and adequate sedation, along with the appropriate analgesia, need to be maintained during the second phase of ROSC. In the first few hours following a successful resuscitation, the appropriate fluid maintenance needs to be administered depending on the child's hemodynamic condition. Pro Tip #1: It's important to note that the common cause of morbidity in the latter stages following a return of spontaneous circulation typically result from multi-organ failure or serious brain injury, or a combination of both. It's equally important to understand that children who experience a return of spontaneous circulation after cardiac arrest, might also experience a complex combination of pathophysiological processes including: Brain injury Myocardial dysfunction Systemic ischemia Organ system dysfunction Persistent conditions, such as those that may have led to the cardiac arrest in the first place. In order to stabilize the patient and provide the best outcome for them, the treatment of these complicated and multisystem pathologies will most likely require a consultation with a pediatric specialist and other expert healthcare providers and team members. The key to successful and long-term care following a return of spontaneous circulation includes the following: Stabilize the pediatric patient Provide continuous and close monitoring of the patient Frequently assess the patient for any changes in their condition And finally, the advanced life support provider will also want to transfer the patient to the appropriate and effective definitive next level of care and do so as soon as possible. https://d3imrogdy81qei.cloudfront.net/video_images/5621/rosc-and-post-cardiac-arrest-care.jpg Yes 213 https://app.protrainings.com/courses/pals/certification/videos/what-is-infant-2-rescuer-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3217.mp4 What is Infant 2 Rescuer CPR? In this section, we're going to cover two-responder infant CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.) Also, it's important to have the right size mask. But if you don't have an infant size mask, proceed using an adult size. Pro Tip #1: There is one variation that can be used when doing compressions on an infant or baby when a second responder is present, which is known as circumferential compressions. To perform circumferential compressions, wrap your fingers around the sides of the infant's chest, placing both thumbs over the compression point just below the nipple line. One of your thumbnails should be resting on the top of the other. If for some reason you're not able to perform circumferential compressions, then revert back to the normal compression procedure for infants – using your fingers at an angle perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions. Remember that little force will be required when performing compressions on an infant. Pro Tip #2: The rate of compressions to rescue breaths during infant CPR is the same as with children – 15 compressions for every two rescue breaths. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the infant is responsive. Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.) If you don't get an initial response, place your hand on the infant's forehead and tap on the bottom of his or her feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Two-Responder CPR Technique for Infants Responder one: 1. Draw an imaginary line across the infant's nipples and place your thumbs on top of one another on the lower part of the center of the sternum to perform circumferential compressions.2. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your thumbs to supply the force for the chest compressions, and count as you perform them.3. Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.4. Perform 15 chest compressions. Responder two: 5. Grab the bag valve rescue mask and seal it over the infant's face and nose.6. If available, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.7. When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with infants, the head-tilt, chin lift is neutral or slightly sniffing.8. Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath. Responder one: 9. Go right back into your 15 chest compressions. Responder two: 10. Go right back to delivering two rescue breaths. Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties. Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask. 11. Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About Considerations for Pediatric Patients Cardiac emergencies in children and infants are usually secondary to respiratory problems and airway restrictions. While congenital heart conditions are possible, they aren't common. When cardiac arrest occurs in children and infants, it's usually caused by one of the following: Airway and breathing problems Traumatic injuries or incidents – drowning, electrocution, poisoning, etc. A hard blow to the chest Congenital heart disease Sudden infant death syndrome (SIDS) https://d3imrogdy81qei.cloudfront.net/video_images/5613/what-is-infant-2-rescuer-cpr.jpg Yes 223 https://app.protrainings.com/courses/hipaa/general/videos/welcome-to-prohipaa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3534.mp4 Welcome to ProHIPAA Welcome to your HIPAA compliance training course at ProHIPAA. This course is for anyone who needs a greater understanding of the importance of safeguarding Protected Health Information (PHI) and the ways in which you can do that, whether you're a trusted medical professional or a business associate who supports a medical professional or healthcare organization. In this course, you'll learn: Why cybercriminals want protected health information All the HIPAA/HITECH requirements The current state of HIPAA compliance This course also includes sections on: Why PHI is valuable Recent data breaches Current industry fines The importance of encrypted email Your responsibilities under the HIPAA law Keep these in mind as you proceed through this course, as well as a few important course objectives: The importance of government regulations The current state of HIPAA/HITECH and your obligations under the law How you can better protect and properly handle all PHI and ePHI Thanks for choosing ProHIPAA. Let's begin! A Word About PHI (Protected Health Information) Since safeguarding PHI is the entire reason for HIPAA's existence, let's take a closer look at what constitutes Protected Health Information. PHI is that health information that can identify an individual to whom the information belongs to. HIPAA's Privacy Rule was established to help protect PHI while in the care of either covered entities or business associates. This includes whether a covered entity or business associate is sending, receiving, or storing this information. Covered Entities and PHI A covered entity is: A healthcare provider that conducts administrative and financial transactions in electronic form. A healthcare clearinghouse. A health plan. The most common examples of a covered entity are your doctor's office and your dentist's office. Business Associates and PHI HHS.gov defines a business associate as, “A person or entity (other than a member of the covered entity's workforce) that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of protected health information.” A common example of a business associate would be a third-party billing service that handles payment transactions on behalf of your doctor's or dentist's office. What Information is Considered PHI? The two key elements to whether or not a piece of information can be considered PHI are: The H stands for Health, so the information in question must be healthcare-related. The information also must be identifiable. If the information in question cannot be used to identify the person it belongs to, then it isn't considered PHI. Common pieces of information that are identifiable are names, addresses, dates of birth, and social security numbers. Everything an identity thief needs. There are actually 18 HIPAA identifiers, which will be listed at the end of this section. Protected Health Information can include: Demographic info Medical records, lab reports, etc. Services and procedures Payment and billing info PHI can be found in three forms: Electronic form On paper Delivered orally/spoken HIPAA Identifiers Remember that for information to be considered PHI, it must be identifiable. Here are 18 identifiers as outlined in the Privacy Rule. Names (Full or last name and initial). All geographical identifiers smaller than a state, except for the initial three digits of a zip code if, according to the current publicly available data from the U.S. Bureau of the Census: the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. Dates (other than year) directly related to an individual. Phone numbers. Fax numbers. Email addresses. Social security numbers. Medical record numbers. Health insurance beneficiary numbers. Account numbers. Certificate and license numbers. Vehicle identifiers (including serial numbers and license plate numbers). Device identifiers and serial numbers. Web Uniform Resource Locators (URLs). Internet Protocol (IP) address numbers. Biometric identifiers, including finger, retinal, and voice prints. Full face photographic images and any comparable identifying images Any other unique identifying number, characteristic, or code, except the unique code assigned by the investigator to code the data. https://d3imrogdy81qei.cloudfront.net/video_images/6311/welcome-to-prohipaa.jpg Yes 98 https://app.protrainings.com/courses/hipaa/general/videos/the-history-of-hipaa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3535.mp4 The History of HIPAA In this lesson, we'll dig a little deeper into what HIPAA is, what it covers, the evolution of protecting healthcare patient data, and the benefits that this legislation produces. In the 1990s, as the internet was coming onto the scene and growing rapidly, congress recognized the need to establish a system that would help enforce the rights of patients and at the same time, protect the privacy of their medical records. This need and the realization of it led to the creation of the Health Insurance Portability and Accountability Act of 1996, better known as HIPAA. Eventually, additional layers of protection would follow with more legislation. As health records were becoming digitized, this led to the HITECH Act of 2009, also known as the Health Information Technology for Economic and Clinical Health Act of 2009. And finally … The Omnibus rule of 2013 expanded how technology companies protected healthcare data, while also enforcing the security and policies set forth by the Health and Human Services Office for Civil Rights. This important U.S. legislation provides data privacy and security provisions for safeguarding medical information. It includes the portability of insurance information between covered entities and providers to insurance companies. And it covers the protection and privacy of healthcare information transmitted electronically. Obvious benefits of such legislation include helping to improve the standardization and efficiency in healthcare data and helping to prevent discrimination and fraud. A Word About PHI Guidelines Remember, for information to be considered PHI – Protected Health Information – it must be healthcare-related and it must be identifiable, as in used to identify the person whose information it is. PHI can include demographic information, medical records, services rendered, and payment and billing information. And more importantly, as it pertains to this section, PHI can be: In electronic form In paper form Orally delivered And now let's turn from the theoretical to the practical with a question: What can covered entities and business associates do to better protect this information? It depends on how the information was delivered or in what form it currently resides. But whatever form that PHI takes, we have a set of guidelines that will help you protect it. (On a side note, if you were longing for some lists, you're going to be very excited.) In-Person Conversations Guidelines Discuss Patients PHI in private. Use an office with a door whenever possible or leave areas where others can overhear. Be aware of those around you and lower your voice when discussing a patient's health information. If possible, point out health information on paper or on-screen nonverbally when discussing a patient's health information. Telephone Conversations Guidelines Follow the above guidelines plus … Don't use names; instead say "I have a question about a patient." Never give PHI over the phone when talking to unknown callers. Never leave PHI on voice messages. Instead leave a message requesting a return call to discuss a patient, and leave only your name and phone number. Do not discuss PHI over unencrypted cellular or portable (wireless) phones or in an emergency, as the transmissions can be intercepted. Texting Guidelines Use a secure text messaging system. Develop, document, and implement your organization's mobile device policies and procedures to safeguard health information. Faxing Guidelines Put fax machines in a safe location. That means in places where people don't have access to them who shouldn't. Use a cover sheet clearly identifying the intended recipient and include your name and contact information on the cover sheet. Do not include or reference any PHI on the cover sheet. Confirm the fax number is correct before sending. Whenever possible, send all faxes containing patient health information only when the authorized recipients are there to receive them. Verify that the fax was received by the authorized recipient; check the transmission report to ensure the correct number was reached and, when necessary, contact the authorized recipient to confirm receipt. Deliver received faxes to the recipient as soon as possible. Do not leave faxes unattended at the fax machine. Emailing Guidelines Do not include PHI in the subject line or the body of an email. Transmit PHI only in a password-protected attachment. (MS Word and MS Excel both provide password protection.) Include a confidentiality attachment in any emails that contain attachments with PHI. Do not send attachment passwords in the same email as the attachment. Include your contact information (at minimum, your name and phone number) as part of the email. Set email sending options to request an automatic return receipt from your recipients. Request that email recipients call to discuss specific patient data. Do not store emails or email attachments with PHI on your hard drive. Instead, copy and store to a secure server. Delete all emails and their attachments when they are no longer needed. Courier and Regular Mail Guidelines Use sealed and secured envelopes to send PHI. Verify that the authorized person accepting the package has received it. Deliver all mail promptly to the recipient. Mailboxes must be in safe areas and not located in public or high-traffic areas. Inter-Office Mail Guidelines Put PHI in closed inter-office envelopes. As an added precaution, put PHI in a sealed envelope first. Identify the recipient by name and verify the mail center address. Distribute inter-office mail promptly to recipients. Do not leave it unattended in mailboxes. Where practical, use lockable containers (e.g. briefcases) to transport correspondence that contains PHI. https://d3imrogdy81qei.cloudfront.net/video_images/6313/the-history-of-hipaa.jpg Yes 83 https://app.protrainings.com/courses/hipaa/general/videos/who-is-required-to-comply-with-hipaa-laws https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3536.mp4 Who is required to comply with HIPAA laws? In this lesson, we'll go over who's required to comply with HIPAA laws and the group the law directly applies to – covered entities. You may notice a bit of overlap from the lesson – What is HIPAA. Not to worry; it's all part of the secret sauce. Repetition is how we learn. Covered entities include: Healthcare providers Health plans Healthcare Clearing Houses What is a Covered Entity? A covered entity is any provider of medical or other health-related services, or a person that has access to protected health information. Examples include healthcare providers and health plans, but also organizations and individuals that provide billing services or are paid in connection with these services in the normal course of doing business. What is a Health Plan? A health plan is any individual or group plan that provides or pays the cost of healthcare services, such as an HMO, an insurance company, and Medicaid and Medicare. What is a Business Associate? A business associate is any company or individual with direct or incidental access to PHI or ePHI. Business associates are required to have in place: A risk assessment plan Proper training Specific policies and procedures Examples of business associates include: IT vendors Call centers Court reporters Cloud providers Legal services providers Suppliers and manufacturers with access to PHI and ePHI Business associates have the same requirements as covered entities to protect PHI and are required to notify covered entities of any potential and/or active data breaches. Business associates must also comply with HIPAA requirements by signing a contractual agreement with the covered entity – known as a Business Associate Agreement (BAA). A Word About Protecting PHI at Workstations At the end of the last lesson, we took a look at some guidelines and best practices for protecting PHI during communications, whether they be written, spoken, or electronic. In this section, we're going to tackle workstation use and workstation security and provide you with some guidelines for keeping them safe and secure. Along with workstation use and workstation security, there are two other standards when it comes to HIPAA's Physical Safeguards for protecting PHI – facility access controls and device and media controls. (Which we'll likely address in detail at another time.) HIPAA's Security Rule defines Physical Safeguards as “physical measures, policies, and procedures to protect a covered entity's electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion.” Workstation Use The HIPAA Privacy Rule defines a workstation as any "electronic computing device, for example, a laptop or desktop computer, or any other device that performs similar functions, and electronic media stored in its immediate environment." Inappropriate use of workstations increases a covered entities risk, including those pertaining to virus attacks and other breaches. To comply with the workstation use standard, HIPAA requires all covered entities to: "Implement policies and procedures that specify the proper functions to be performed, the manner in which those functions are to be performed, and the physical attributes of the surroundings of a specific workstation of class of workstation that can access electronic protected health information." It should be noted that this workstation use standard also includes remote work environments – any work from a remote location (home, travel, satellite office) – where employees have access to ePHI. Workstation Security Workstation security is another standard that has been put in place to better protect PHI. This standard requires covered entities to: "Implement physical safeguards for all workstations that access electronic protected health information, to restrict access to authorized users." So, what are some safeguards or guidelines that will help protect PHI and ePHI at workstations? What a well-timed question. Computer Workstation Guidelines to Protect PHI To help protect PHI at workstations, consider implementing the following strategies: Use password protected screen savers, and turn off computers, or at least log out of the network when not at your desk. Position computer monitors so they are not visible to others. Secure workstations and laptops with passwords. Change passwords on a regular basis. Do not leave laptops, other work-related devices, or PHI visible or unsecured in a car, home office, or in any public areas. Ensure that all PHI – including that used outside of the work environment – is protected using appropriate measures such as being stored in locked desks and file cabinets. Never remove original copies of PHI without your supervisor's approval. Store files that contain PHI on a secure server; not on your workstation hard drive. https://d3imrogdy81qei.cloudfront.net/video_images/6315/who-is-required-to-comply-with-hipaa-laws.jpg Yes 84 https://app.protrainings.com/courses/hipaa/general/videos/important-hipaa-terminology https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3537.mp4 Important HIPAA Terminology This lesson is all about learning some important definitions to better help you understand HIPAA terminology. There will, of course, be a little repetition. HIPAA Health Insurance Portability and Accountability Act of 1996. HITECH Health Information Technology for Economic and Clinical Health Act of 2009. Pro Tip #1: The goal of HITECH is to promote the adoption and meaningful use of health information technology and significantly expand the HIPAA privacy rule and security standards as new requirements concerning privacy and security of PHI are enacted. PHI Protected Health Information (patients’ personal and medical information). ePHI Electronic Protected Health Information. This includes all personal health information that is stored, and/or transmitted, electronically. Common examples of ePHI include: Faxes Emails Data backup Cloud providers Patient portals Removable media Secure texting Whether the health information is being stored or transmitted, it must be encrypted first. Business Associate Any person or organization that supports the healthcare industry in some fashion and performs functions and activities in support of a covered entity. Business Associate Requirements Per HITECH regulations, business associates are now legally required to be compliant with the HITECH Act. This includes assuming financial liability for any and all data breaches caused by their organization or employees. All business associates are required to have: A risk assessment Proper training A Book of Evidence Risk Assessment A set of government mandated questions to help organizations identify gaps in risk, to their organization and to the covered entities they serve. This includes a risk report with a road map to resolving any potential problems. There are three sections on a risk assessment along with three types of questions. Sections on Risk Assessment Administrative Technical Physical Types of Risk Assessment Questions Standard Required Addressable Standard questions measure a covered entity to ensure confidentiality, integrity, and availability of ePHI, while in the custody and care of covered entities and/or business associates. Pro Tip #2: Covered entities and business associates must comply with the applicable standards provided in the Security Rule with respect to all ePHI. Required questions are those that must be implemented by covered entities and/or business associates. Addressable questions, while not optional, do provide covered entities some additional flexibility with respect to compliance with the security standard. All organizations must determine their level of risk to PHI. If a risk is deemed reasonable, appropriate security measures will need to be applied. Book of Evidence The Book of Evidence is a customized book of policies and procedures that all organizations are required to create. The Book of Evidence illustrates how that organization handles all PHI and ePHI. This includes: Data breach notifications Disaster recovery policies Privacy and patient policies Privacy Policy A privacy policy explains how covered entities and business associates handle PHI. All covered entities are required by law to provide patients with a copy of their privacy policy upon request. Business associates must also be able to provide their privacy policies to both internal employees and external companies – also known as downstream suppliers – and for government audits. A Word About the Disposal of PHI The disposal of all protected health information (PHI) comes with its own set of requirements set forth by the HIPAA Privacy and Security Rules. These are steps that covered entities take when they dispose of PHI. Shred all hard copies containing PHI when the copies are no longer needed. Place hardcopies to be recycled in locked recycle bins if available. Delete all soft copy files containing PHI from all computers and from the server when the information is no longer needed within the record retention requirements. Destroy all disks, CDs, and other pieces of hardware that contained PHI before disposing of them. Do not reuse disks and/or CDs that contained PHI without thoroughly sanitizing them first. Contact the IT department for the proper procedures before transporting or transferring equipment and sanitizing hard drives and other media. Return the PHI (medical records) to the patient, if this requirement is stipulated in any contractual agreements. Many states impose requirements on covered entities to retain this information and make it available for a limited time, as is appropriate. Health and Human Services encourages all covered entities to consider the steps that other prudent healthcare organizations and health information professionals are taking to protect patient privacy in connection with record disposal. https://d3imrogdy81qei.cloudfront.net/video_images/6317/important-hipaa-terminology.jpg Yes 222 https://app.protrainings.com/courses/hipaa/general/videos/what-is-a-covered-entity https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3538.mp4 What is a Covered Entity? In this lesson, we'll go over some basics of covered entities – what covered entities are, some examples of covered entities, and what requirements covered entities all share. And at the end of the lesson, we'll provide you with a Word about the differences between covered entities and business associates. What is a Covered Entity? A covered entity is any provider of medical or other health services or people that have or handle PHI (protected health information). Covered entities include the following: Healthcare providers Health plans Organizations and/or individuals that provide billing services or are paid in connection with services in the normal course of conducting business Pro Tip: The key phrase to remember as it relates to covered entities, is that they handle PHI. This is the common element that all covered entities share. You may recall from a previous lesson that PHI is health information that can identify an individual to whom the information belongs to. HIPAA's Privacy Rule was established to help protect PHI while in the care of either covered entities or business associates. This includes whether a covered entity or business associate is sending, receiving, or storing this information. The two key elements to whether or not a piece of information can be considered PHI are: The H stands for Health, so the information in question must be healthcare-related. The information also must be identifiable. If the information in question cannot be used to identify the person it belongs to, then it isn't considered PHI. Common pieces of information that are identifiable are names, addresses, dates of birth, and social security numbers. Everything an identity thief needs. What are Some Examples of Covered Entities? The list of covered entities is quite substantial and includes the following: Physicians Optometrists Dentists Nurses Mental health providers Radiologists Laboratories Pharmacies Call centers Durable medical equipment providers Hospitals Ambulance companies Healthcare workers Case managers Social workers As you can see, the list of covered entities extends well beyond healthcare professionals themselves and even beyond healthcare institutions like hospitals and clinics. What is Required of a Covered Entity? A covered entity is required to comply with all of HIPAA's regulations. These would include the following: They are required to have risk assessments They are required to have compliance training for staff They are required to have a Book of Evidence that contains all the proper policies and procedures on how to handle PHI A Word About the Differences Between Covered Entities & Business Associates First, let's define what a business associate is. What is a Business Associate? A business associate is any business or person that provides a service for a covered entity, or a certain function or activity, when that service, function or activity involves the access to PHI that is maintained by the covered entity. Examples of business associates include, but aren't limited to: Lawyers Accountants IT contractors Billing companies Cloud storage services Email encryption services The key phrase from above that really defines a business associate is this: the access to PHI that is maintained by the covered entity. What (Again) is a Covered Entity? Remember, HIPAA covered entities are healthcare providers, health plans, and organizations – like healthcare clearinghouses – that electronically transmit health information for transactions covered by HHS' standards. Without going too far down the rabbit hole, health plans are defined as health insurance companies, company health plans, government programs that pay for healthcare, and HMO's. Healthcare clearinghouses are defined as transcription service companies that format data to make it compliant and organizations that process non-standard health information. Here is the key element to remember – even if an entity is a healthcare provider, health plan, or healthcare clearinghouse, they are not considered a HIPAA covered entity if they do not transmit any information electronically for transactions that HHS has adopted standards. Remember, a business associate is an entity – either an individual or a company – that is provided with access to protected health information for the purpose of providing services for a HIPAA covered entity. Business associates are required to sign a contract with the covered entity, which is called a business associate agreement (BAA), that outlines the responsibilities of the business associate and explains what is required of them to comply with HIPAA Rules. (This is something we will tackle in more detail in a subsequent lesson.) So, what is the Difference? Covered entities have PHI (protected health information) while business associates merely have access to PHI. It's a bit of an ambiguous distinction, but an important distinction, nonetheless. https://d3imrogdy81qei.cloudfront.net/video_images/6319/what-is-a-covered-entity.jpg Yes 62 https://app.protrainings.com/courses/hipaa/general/videos/what-is-protected-health-information https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3539.mp4 What is PHI? In this lesson, we'll be going into some detail on what PHI is. At the end of the lesson, we'll dig into when PHI really isn't PHI, or in other words, exceptions to PHI. In a nutshell, PHI (protected health information) is any information that is individual to a patient – past, present, or future – about the care provided, whether physical or mental, for an individual. This can include documentation of doctor visits, charts and notes made by physicians and other healthcare staff, healthcare payment information, claim status, and the coordination of healthcare benefits. Pro Tip #1: It's worth noting that HIPAA covers all forms of PHI, including electronic, paper, and even oral/spoken. Many people forget that PHI is also covered under spoken word. Be especially mindful when disclosing healthcare-related information with anyone – other patients, staff, and business associates. You may recall from the corresponding video for this lesson that one patient overheard two healthcare employees talking about another patient's health information. When in doubt, always assume that someone might be listening. And do everything you can to make sure private conversations take place in private locations. Think of PHI the way you would classified information. You have been given clearance to see it. But it's your responsibility to keep it safe and from falling into the wrong hands at all times. A More In-Depth Look at PHI Under HIPAA rules and regulations, PHI is considered as any identifiable health information that is used, maintained, stored, or transmitted by covered entities and business associates. As mentioned above, PHI is health information in any form, including physical records, electronic records, or spoken information. This means that PHI includes health records, health histories, lab test results, and medical bills. Pro Tip #2: The key point to remember regarding PHI, is that to be considered PHI, it must include individual identifiers, such as patient names, social security numbers, driver's license numbers, insurance details, and birth dates, when they are linked with health information. Demographic information can also be considered PHI under HIPAA Rules. There are in total 18 identifiers for PHI and these include the following: Names Dates, except year Telephone numbers Geographic data Fax numbers Social security numbers Email addresses Medical record numbers Account numbers Health plan beneficiary numbers Certificate/license numbers Vehicle identifiers and serial numbers including license plates Web URLs Device identifiers and serial numbers Internet protocol addresses Full face photos and comparable images Biometric identifiers, such as retinal scans and fingerprints Any unique identifying number or code Can PHI be Disclosed for Public Health Activities? The short answer is, yes. However, it's limited to the CDC (Center for Disease Control and Prevention), public health authorities – federal or state – and OSHA. OSHA is unique because it can request information without authorization or the need to sign a business association agreement. Pro Tip #3: One caveat to remember, though, is that covered entities should reasonably limit the amount of PHI given in these circumstances to what is considered a necessary amount and nothing more. Remember, less is more when it comes to sharing personal health information. So, why would OSHA request PHI? They could do so in the event of a natural disaster or a state of emergency in an attempt to determine the demographics of an affected area. Perhaps they need to mobilize the national guard, first responders, or military personnel to aid such an emergency. It's important to remember, that if contacted by someone in the government about sharing PHI, you must ensure their legitimacy. Request relevant phone numbers and email addresses and ask for a written request. A Word About the Exceptions to PHI You may be tempted to think that all health information is considered PHI under HIPAA, but this isn't true, and there are some exceptions. One determining factor is who records the information. A good example of this would be health trackers, such as physical devices worn on the body or apps on mobile phones. These devices can record health information such as heart rate or blood pressure, which would be considered PHI under HIPAA rules if the information was recorded by a healthcare provider or was used by a health plan. However, under the HIPAA rules, this information only applies to HIPAA covered entities and their business associates. This means that if a device manufacturer or app developer hasn't been contracted by a HIPAA covered entity and also isn't a business associate, the information recorded would not be considered PHI under HIPAA rules. The same rules apply to education or employment records. Let's say a hospital holds data on its employees, which can include some health information like allergies or blood types. However, HIPAA rules do not apply to this type of information. Also, it's important to remember that under HIPAA, PHI ceases to be PHI if it's stripped of all identifiers listed above that can tie the information to an individual. When those identifiers are removed, the health information is technically referred to as de-identified PHI, and thus, HIPAA rules no longer apply. https://d3imrogdy81qei.cloudfront.net/video_images/6321/what-is-protected-health-information.jpg Yes 260 https://app.protrainings.com/courses/hipaa/general/videos/privacy-and-security-rules https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3540.mp4 Privacy and Security Rules In this lesson, we're going to cover the HIPAA Privacy Rule and the Security Rule. We'll dig into the three safeguards – administrative, physical, and technical – and include rules and examples for each. The HIPAA Privacy Rule establishes standards for protecting patients' medical records and other protected health information (PHI). It specifies two important things: What rights patients have over their information and requires covered entities to protect that information. What usage and disclosures are authorized or required. The privacy and security rules allow healthcare providers to share PHI electronically for treatment purposes as long as they apply reasonable safeguards when doing so. A couple of examples of this would be when a physician consults with another physician by secured email regarding a patient's condition, or when a healthcare provider exchanges PHI through electronic medical records for patient care. Covered entities need to engage in safeguards to protect this information. These safeguards include: Administrative safeguards Physical safeguards Technical safeguards Pro Tip #1: All covered entities need to perform risk analyses to determine what measures need to be taken to reduce risks and vulnerabilities to an appropriate level. Administrative Safeguards Administrative safeguards include office rules and procedures that help keep protected health data secure. To accomplish this, covered entities should designate security officials who are responsible for the following: Developing and implementing that covered entity's security policies and procedures Determining who should be authorized to access PHI Training all staff in these security policies and procedures Applying the appropriate sanctions against workforce members who violate those policies and procedures Performing periodic risk assessments of how well the security policies and procedures are meeting the requirements of HIPAA's Security Rule Example of Administrative Safeguard An example of an administrative safeguard would be allowing only office managers to send protected health information in electronic form. Physical Safeguards Physical safeguards under the HIPAA Security Rule include the following: Limiting physical access to all facilities while also ensuring that only authorized access is allowed Implementing that covered entity's policies and procedures specify the proper use of access to computers and/or the position of screens and monitors in all patient areas Putting into place policies and procedures regarding the physical transfer, removal, disposal, and reuse of all electronic media, such as computer hard drives Example of Physical Safeguard An example of a physical safeguard would be keeping all patient files in a locked room that only specified and authorized personnel have access to. Technical Safeguards Technical safeguards under the HIPAA Security Rule include the following: Implementing all hardware, software, and/or procedural mechanisms to record and examine access and other activities in all information systems that contain or use protected health information Implementing policies and procedures to ensure that electronic measures are put in place to confirm that all protected health information is not improperly altered or destroyed Implementing technical security measures that guard against unauthorized access to all PHI that is transmitted over an electronic network Example of Technical Safeguard A couple of examples of technical safeguards would be using data encryption and also strong passwords to better protect files from unauthorized access. Pro Tip #2: HIPAA's Privacy Rule gives much-needed flexibility to healthcare providers and plans to create their own privacy policies that are tailored to fit their size and needs. However, no matter the size of the covered entity, whether that entity is a small optometrist office or a large hospital with thousands of employees, each covered entity is required to have a written privacy policy. In general, all covered entities must do everything they can to secure all patient records that contain personally identifiable information so that information isn't readily available to those people who do not need it. You may recall the list of those 18 PHI identifiers that we provided in the last lesson. Also, covered entities must always release only as much protected health information as is necessary to address the specific needs of the entity that is requesting the information, or what the HIPAA regulation refers to as the minimum amount necessary to satisfy the inquiry. You might also recall from the last lesson, that when it comes to transmitting or sharing protected health information, less is always more. https://d3imrogdy81qei.cloudfront.net/video_images/6323/privacy-and-security-rules.jpg Yes 247 https://app.protrainings.com/courses/hipaa/general/videos/what-are-patients-rights-with-phi https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3541.mp4 What are Patients' Rights with PHI? In this lesson, we're going to go over patients' rights, what information requires authorization, what information does not require information, and give you a few examples along the way. At the end of the lesson, we'll provide you with an additional Word about patient health information privacy rights. Most of us believe that our medical information and other health information is private and should be protected, and many want to know who has this information. The HIPAA Privacy Rule gives patients rights over their health information and sets rules and limits on who can look at and receive their protected health information. Covered Entities and Patients' Rights Pro Tip #1: All covered entities are required to provide individuals a private practice policy if requested at all times. Healthcare organizations' private practice policy should describe several things, including: How medical information about the patient will be used and disclosed How patients can get access to their medical information if it is requested The process for patients to use when filing complaints regarding their PHI What types of uses and disclosures of PHI are permitted What types of uses and disclosures require authorization These patient rights include asking for a copy of their healthcare provider's rights and privacy policies when they visit their primary physician or local hospital. All patients are entitled to see or get a copy of his or her own medical records that each healthcare practice or organization keeps. Pro Tip #2: All covered entities must provide an accounting of all protected health information disclosures that are made for treatment, payment, and healthcare operations during the prior six years upon request. This includes all financial records as they are tied to the healthcare services. One important caveat for patients: If you are receiving medical care while also paying for your own medical services, you are not required to disclose any protected health information with your health plan. Patient Authorization Pro Tip #3: Patient authorization is necessary for covered entities, like healthcare organizations, to obtain an individual's personal health information and billing information for purposes other than treatment, payment, or healthcare operations. However, it is not required in order for the patient to receive treatment. And as you'll see below, there are some exceptions that should be noted. A common question many physicians have is: Can I see a patient without getting written authorization? The answer is, yes, you can. However, it's a good idea to update their medical records and make a note of that when or if it happens. Sharing Patient Information Without Authorization: Referrals and Treatment: When referring a patient to another healthcare provider, you do not need written authorization from the patient to share their health information necessary for treatment purposes. Worker’s Compensation and OSHA: In the event of a worker’s compensation claim or a directive from OSHA, physicians can provide patient information without the need to receive authorization from the patient. Other circumstances that do not require patient authorization are situations when there's a need to alert law enforcement officials of an imminent danger, either to the patient himself/herself or if the patient is a danger to others. An example of this would be trying to protect a minor from abuse. If you're a physician who suspects abuse, you are authorized to report it. Another example: The HIPAA Privacy Rule allows covered healthcare providers to disclose protected health information about students to school nurses, physicians, or other healthcare providers for treatment purposes without requiring authorization of the student or the student's parents or guardians. For instance, a student's primary care physician can discuss a student's medication or other healthcare needs with a school nurse who will administer medications and provide care to the student while he or she is at school. A Word About Patient Health Information Privacy Rights For patients, knowing their rights is the first step to protecting them. How can Patients get Their Health Information? As noted at the beginning of this lesson, patients can ask to see or get a copy of their medical records and other health information. However, if they want a copy, they may have to put their request in writing and pay for the cost of copying and mailing. In most cases, their copies must be given to them within 30 days. How can Patients Change Their Health Information? Patients can ask to change any wrong information in their file or add information if they think something is missing or incomplete. For example, if a patient and his or her hospital agree that the file has the wrong results for a test, the hospital must change it. Even if the hospital believes the test result is correct, patients still have the right to have their disagreement noted in their file. In most cases, the file should be updated within 60 days. How can Patients Know Who Has Seen Their Health Information? By law, patients' health information can be used and shared for specific reasons not directly related to their care, like making sure doctors give good care, making sure nursing homes are clean and safe, reporting when the flu is in the patients' area, or reporting as required by state or federal law. In many of these cases, patients can find out who has seen their health information. Patients have two options: Learn how their health information is used and shared by their doctor or health insurer. Let their providers or health insurance companies know if there is information they do not want to share. https://d3imrogdy81qei.cloudfront.net/video_images/6325/what-are-patients-rights-with-phi.jpg Yes 162 https://app.protrainings.com/courses/hipaa/general/videos/hipaa-breaches-violations-and-penalties https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3542.mp4 HIPAA Breaches, Violations and Penalties In this lesson, we'll be taking an introductory look at HIPAA data breaches, violations, and penalties. And at the end of the lesson, we'll look at some of the more recent healthcare data breaches and what caused them. In 2008, total HIPAA breach fines were a scant $100,000. And while this may sound like a pretty good amount of money, we've seen these data breach fines jump up every year in ways that may shock you, culminating with a record year in 2017, which no doubt will be broken once 2018's figures are calculated. Here's a look at how those data breach fines have been growing exponentially:   2008 $100,000   2010 $1.3 million   2012 $4.8 million   2014 $7.9 million   2016 $20.7 million   2017 $23 million   2018 $28.6 million         As you can see, not only has there been a steady increase in fines every year, but they've been increasing at a pace beyond rapid. Pro Tip: It's important for covered entities to have policies and procedures in place. One way to do this is by creating a Book of Evidence. Not only is this a HIPAA requirement, but it can help protect businesses in case of a data breach, violation, or audit. We'll be digging into the Book of Evidence in a subsequent lesson. You may recall from the corresponding video for this lesson, how an employee had sticky notes containing passwords in her workstation and in plain sight. This would be an obvious violation of HIPAA security policies and an obvious example that common sense is actually pretty uncommon. If like the person in the video, you also can't remember passwords, find a better way to keep them handy and secure, rather than just handy. Putting those sticky notes under your keyboard may seem like a good place, but that's kind of like putting your house keys under your welcome mat or your car keys on top of the visor – in other words, places thieving people will no doubt look. And since you are required by law to have passwords in order to access PHI, make sure those passwords are complex and your storage location secure. A Word About Recent Healthcare Data Breaches This Word section is simply to provide you with an idea of how common, varied, and potentially devastating these data breaches can be, by highlighting a few of the more recent healthcare data breaches, as of the end of the year 2019. New Mexico Hospital Discovers Malware on Imaging Server Discovered on November 14, 2019 Roosevelt General Hospital in Portales, New Mexico recently discovered malware on a digital imaging server used by its radiology department. The malware may have allowed cybercriminals to gain access to the radiological images of around 500 patients. The malware infection was discovered on November 14, 2019 and prompt action was taken to isolate the server in order to prevent further unauthorized access and block communications with the attackers' command and control server. The IT department was able to remove the malware and rebuild the server and all patient data was recovered. A scan was conducted to identify any vulnerabilities and the hospital is now satisfied that the server is secured and protected. The investigation into the breach did not uncover any evidence to suggest that PHI and medical images were viewed or stolen by the hackers, but the possibility of unauthorized data access and PHI theft could not be ruled out. CMS Blue Button 2.0 Coding Bug Exposed PHI of 10,000 Medicare Beneficiaries Discovered on December 4, 2019 The Centers for Medicare and Medicaid Services (CMS) recently discovered a bug in its Blue Button 2.0 API that exposed the PHI of around 10,000 Medicare beneficiaries. Access to the Blue Button API was temporarily suspended while the CMS completed a comprehensive code review. On December 4, 2019, the CMS was alerted to a data anomaly with the Blue Button API by a third-party application partner. The CMS confirmed the data anomaly and immediately suspended access to the production environment while the matter was investigated. The CMS determined the anomaly was due to a coding bug. That bug potentially allowed data to be shared with incorrect Blue Button 2.0 applications and the wrong beneficiaries. The CMS determined that 30 applications were impacted by the bug, in addition to the thousands of people whose PHI was exposed. Colorado Department of Human Services and Sinai Health System Alert Patients About HIPAA Breaches Discovered on November 6, 2019 The State of Colorado recently notified 12,230 individuals about an impermissible disclosure of some of their protected health information as a result of a mailing error. The error occurred on a Colorado Department of Human Services mailing of notices to reapply for food and cash assistance programs. The error was discovered on November 6, 2019. The investigation revealed 10,879 notice to reapply forms had been sent out that contained the information of incorrect individuals. The information of 12, 230 individuals had been incorrectly included on the forms. The information included names, employers, whether the person had a vehicle, and a limited amount of other information related to household resources. No addresses, dates of birth, financial information, Social Security numbers, or other information required for identity theft and fraud were disclosed. Some Important Points While these data breach incidents aren't likely to make national headlines the way other healthcare data breaches involving millions of people have over the last year, they are still important for a couple of reasons: Frequency – These all happened in the last several weeks of 2019, which begs the question: how often is too often? How they occurred – All three of these breaches were caused in different ways – malware, a computer bug, and a mailing error. While it would be easy to chalk up data breaches to hackers and cybercriminals, the truth is that human/employee error accounts for a large number of them as well. https://d3imrogdy81qei.cloudfront.net/video_images/6327/hipaa-breaches-violations-and-penalties.jpg Yes 94 https://app.protrainings.com/courses/hipaa/general/videos/why-cybercriminals-want-phi https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3543.mp4 Why Cybercriminals Want PHI In this lesson, we'll be covering why cybercriminals want PHI, the value of PHI on the black market, and some examples of what ransomware looks like. We'll also show you some ways you can protect PHI and ePHI and what your obligation is in the event of a data breach at your place of employment. And at the end of the lesson, we'll have a one question quiz that we're certain you'll pass. As of 2019, the healthcare industry has the 4th largest number of data breaches among the top five business sectors in the U.S. These sectors include, in order of the number of breaches from highest to lowest: Financial services Retail Government Healthcare Manufacturing Since healthcare ranks as high as it does for data breaches, it's important that you actively protect PHI and ePHI at all times. The Value of PHI on the Black Market When credit card numbers and bank account numbers are stolen, their lifespan is very short, as they're only useful until the victim cancels the card or closes the account. Pro Tip #1: The information contained in medical records is much more valuable than credit card numbers and bank account numbers and has a much broader utility. This information can be used to commit multiple types of fraud and/or identity theft and (here's the important part) does not change even after it has been compromised. You can't cancel your social security number, for instance. For this reason, the value of this type of personal data to cybercriminals is much higher than credit card numbers and bank account information alone. This information in a vacuum only has a selling price of $1 to $2 in the underground market. However, when a single credit card number is stolen and sold as part of a complete identity profile, that price in the underground market increases dramatically and jumps to around $720. As we've learned from recent Equifax breaches and the WannaCry ransom attacks, along with dozens or hundreds of lesser profile electronic attacks, PHI is extremely valuable to cybercriminals who can create and sell these identity packages on the dark web. How You Can Help Protect PHI The reasons outlined above is why it's so vital that you actively protect PHI and ePHI at all times. Over the last few years alone, and just using ransomware cases as an example, these types of cybersecurity threats have increased by more than 500 percent. Platforms used for ransomware attacks are platforms you likely use daily at work (professionally and personally while at work) and include: Business applications USB drives Social media Website attachments Email Warning: Be especially cautious when using USB drives, as they are usually used in multiple locations and can therefore become infected easily, as well as spread those infections equally easily. Having said that, email is still the most common offender and medium for distributing ransomware and other potentially harmful bugs and viruses. When it comes to email, there are two places to be especially aware of as far as viruses go: Around 38 percent of all viruses come embedded in the email itself, which means just opening the email is enough to possibly contribute to a data breach. Around 28 percent of all viruses come inside an attachment, which is why you never open an attachment from a recipient you don't know. However, … Pro Tip #2: There is no reason to get to the suspicious attachment stage. If you ever receive a suspicious-looking email, DO NOT OPEN IT! Simply delete it and notify those in your organization responsible for such things, like your compliance officer, IT company, and so forth. You may recall the example in the corresponding video for this lesson. The employee notices that an email looks weird and asks her manager what she should do. The manager shows her the proper way to handle such an email – mark it as junk and then empty the junk folder. The other important lesson from the video example is letting your privacy officer know when you receive a suspicious email, in case other employees receive the same email. It only takes one instance of an employee opening an email containing a virus that can lead to a data breach. Quiz: You just received a strange-looking email; what do you? I do not open it I delete the email I notify my manager, privacy officer, etc. All of the above If you answered D, congratulations! You just demonstrated uncommon sense. Seriously though, it's about good decision making and making those good decisions habitual. https://d3imrogdy81qei.cloudfront.net/video_images/6329/why-cybercriminals-want-phi.jpg Yes 193 https://app.protrainings.com/courses/hipaa/general/videos/hipaa-social-media-mobile-devices-email-and-faxes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3544.mp4 HIPAA and Social Media, Mobile Devices, Email and Faxes In this lesson, we'll be covering HIPAA law as it applies to social media, mobile devices, email, and faxes. And at the end of the lesson, we'll provide you with a brief Word about guidelines for properly disposing of protected health information, or PHI. HIPAA Law & Social Media HIPAA law covers all PHI in electronic formats (also known as ePHI). This includes the following social media platforms: Facebook Twitter Snapchat Instagram Any and all others Pro Tip #1: While we as a society find it absolutely necessary to share everything on social media these days – including contrary opinions and meals we're about to consume – never under any circumstance should you disclose patient information, like names and treatments, on any social media platform. Remember, though we're sure you know better, common sense is not all that common, which is why these things need to be said. And why we have to also note that if you do any of the above, you could be personally liable financially and criminally for disclosing any protected health information on social media platforms. HIPAA Law & Mobile Devices Mobile devices include but are not limited to: Smartphones Tablets Laptops Pro Tip #2: While disclosing PHI on social media is always a no-no, mobile devices can be used to share protected health information IF appropriate safeguards are in place. What does IF mean? In short, we're referring to encryption. If you are sharing PHI on mobile devices, you have to use an encrypted texting or chatting platform. You cannot simply just pick up your phone and text PHI to a doctor, nurse, health plan, insurance company, etc. Why can't you do this? Because standard texting platforms: Have only limited encryption Are not HIPAA compliant Use a cloud that stores all text messages HIPAA Law & Email Platforms Standard email platforms are also not compliant according to HIPAA, and these include: Gmail Hotmail AOL (which may or may not be extinct) Yahoo! Any local IT provider's email platform All emails sent through the above free platforms are subject to automated processing. Your email and sensitive patient data will be scanned for targeted advertising when using those platforms. Pro Tip #3: It's important to note that while Google has chosen to not sign a business associate agreement (BAA) when using their Gmail platform, their paid service – G Suite – has signed BAAs. Other paid email platforms may also be acceptable, like Microsoft Office 365. The key is the provider's willingness to sign a business associate agreement. HIPAA Law & Faxes Faxes are an approved and HIPAA compliant means of sending PHI. However, you still need to be mindful when doing so. This means always using a cover sheet before sending a fax that contains protected health information. What if you send a fax containing PHI in error? If this happens, you need to contact the receiver and notify them to destroy the fax. Likewise, if you receive a fax containing PHI in error, you must notify the sender and also destroy the information. A Word About guidelines for Properly Disposing of PHI Disposing of PHI is of the utmost importance, particularly in our modern digital world where deleted tweets aren't really ever gone. The following PHI disposal guidelines should ensure that you and your organization remain HIPAA compliant. Shred all hard copies containing PHI when the copies are no longer needed Place hardcopies to be recycled in locked recycle bins if available Delete all soft copy files containing PHI from your computer and from the server when the information is no longer needed within the record retention requirements Destroy all disks, CDs, etc., that contained PHI before disposing of them Do not reuse disks or CDs that contained PHI without sanitizing them first Contact your IT department before transporting or transferring equipment for proper procedures to move equipment and to sanitize hard drives and other media Return the PHI to the sender, if this requirement is stipulated in any contractual agreements https://d3imrogdy81qei.cloudfront.net/video_images/6331/hipaa-social-media-mobile-devices-email-and-faxes.jpg Yes 112 https://app.protrainings.com/courses/hipaa/general/videos/how-to-be-proactive-to-be-hipaa-compliant https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3545.mp4 How to be Proactive to be HIPAA Compliant In this lesson, we're going to look at ways you can reduce the risks to your business as it pertains to data breaches. To this end, we'll show the 3 Pillars of Success that should help eliminate your risks and keep you HIPAA compliant. And at the end of the lesson, we'll provide you with a Word about the duties of a HIPAA compliance officer. There are several common issues we've seen over the years that greatly contribute to you or your organization not being HIPAA compliant, which increases your risk of suffering through a data breach. Those issues include: Your organization's and staff's understanding of HIPAA and HITECH laws Limited or no training on how to properly handle PHI, including ePHI and oral conversations A lack of risk assessments to help identify your risks to PHI A limited, or no, Book of Evidence that includes your organization's policies and procedures Not using the proper business associate agreements (BAAs) The use of Gmail, Yahoo, MSN, AOL, and other unsecure platforms for the transmission of PHI So, how can you and your organization be more proactive at reducing your risks and becoming more HIPAA compliant? You can institute what we describe as the 3 Pillars of Success The 3 Pillars of Success The 3 Pillars of Success are: Risk Assessments A Book of Evidence Compliance Training Let's look at each of these in more detail. Risk Assessments Your business or organization must perform a regularly scheduled compliance risk assessment. We recommend doing this on at least an annual basis to ensure that all staff understand any changes within your organization and/or business environment that could contribute to it being less secure. A Book of Evidence A Book of Evidence is a basic HIPAA requirement and contains all of your organization's policies and procedures on handling PHI and ePHI, including, among other things, your business continuity plan, data breach plan, and how to handle unauthorized access of protected health information. Compliance Training Compliance training is an essential part of any security plan and ensures that you and your staff understand how to better protect PHI and follow all of your organization's policies and procedures. The human firewall is the best kind of firewall, but it cannot properly function without training and education. The more you and your employees understand the risks involved and how to handle PHI, the better your organization's chances of reducing the risks of data breaches and the subsequent risks to your business. A Word About the Duties of a HIPAA Compliance Officer HIPAA requires that one or more people within a covered entity or business associate is assigned the duties of a HIPAA Compliance Officer. How much work is involved depends on the size of the covered entity or business associate along with the amount of PHI involved. And in smaller organizations, it is often the case that the duties of a HIPAA Compliance Officer are divided between a Privacy Officer and a Security Officer. (Our crystal ball says that we'll be digging into these roles in later lessons.) The typical duties of a HIPAA Compliance Officer include: Gaining a thorough knowledge of the HIPAA Privacy and Security Rules and the solutions available that will allow him or her to develop a HIPAA compliance program. After developing a HIPAA compliance program, the compliance officer should document progress towards its implementation, which would include creating a system that enables the officer to monitor the status of the organization's HIPAA compliance. That system should allow the officer to prioritize efforts towards compliance and communicate priorities to others in the organization. It should also act as a conduit through which compliance concerns can be raised and organizational changes coordinated. The HIPAA Compliance Officer is responsible for developing training programs and executing training courses. These should be designed to help employees understand HIPAA compliance and how any changes implemented will affect their specific duties. The HIPAA Compliance Officer is also responsible for monitoring the Department of Health & Human Services' and their state's regulatory requirements. When new regulations or guidelines are introduced, the officer must adjust their organization's HIPAA compliance program to reflect those changes. It's important to understand that HIPAA regulations do not define exactly what the duties of a HIPAA Compliance Officer are. Instead, HIPAA leaves it to each covered entity or business associate to establish their own duties according to their specific requirements. Thus, in order for an organization to effectively establish the duties of a HIPAA Compliance Officer, it is necessary for that organization to first understand what those specific requirements are. And part of that would entail undertaking a risk assessment. https://d3imrogdy81qei.cloudfront.net/video_images/6333/how-to-be-proactive-to-be-hipaa-compliant.jpg Yes 107 https://app.protrainings.com/courses/hipaa/general/videos/hipaa-foundation-conclusion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3546.mp4 HIPAA Foundation Conclusion In this lesson, we'll quickly recap what you've learned in your ProHIPAA course, and at the end of the lesson, you'll find a Word (or two) about HITECH – what it is, what the goals of the law are, and why it's important. We've gone over what the HIPAA and HITECH laws are, who manages the laws, and who is required to comply. You've learned about covered entities, business associates, and more about PHI than you probably thought possible, and for very good reasons as you now know. For those of you also taking the HIPAA for Leaders course, you'll learn more about HITECH and business associates in that course. Pro Tip: It's important to note that both covered entities and business associates share in the responsibility to protect personal health information at all times. If you are a covered entity doing all you can to be HIPAA compliant, but you're working with a business associate who isn't, this still poses a significant problem, as all it takes is one weak link in the chain. For this reason, it's important for all covered entities to ensure that each of their business associates is a trusted partner, has their best interest in mind at all times, and more importantly, is committed to protecting the health data of all of your customers and/or patients. We've covered what the value of PHI is on the black market ($700 when part of a larger identity package) and why cybercriminals want PHI. We've looked a little into areas where PHI can be compromised and even a few recent instances in which PHI was compromised. It's critical to always protect PHI, not only for the safety and security of your customers and patients but also for the legacy and operational integrity of your own business or organization. A data breach isn't just costly in terms of fines. It's also costly in terms of reputation and possible future revenue losses. Knowing that Your Organization is HIPAA Compliant – Priceless! If you don't feel confident in your business or organization's ability to become or remain HIPAA compliant, it pays to engage a trustworthy HIPAA compliance partner who can guide you through your HIPAA compliance journey. Even though you've now learned what it takes to become HIPAA compliant, you may still need helping getting there. And you certainly have a better understanding of the damage that could occur if your business or organization isn't compliant and suffers a data breach. If you ever feel like you need further assistance, as in a HIPAA compliance guide who can navigate you through those muddy waters, contact us ProHIPAA.com or call us at 844-722-8898. Thank you, and remember that we're always here to help you. A Word About HITECH The HITECH Act (Health Information Technology for Economic and Clinical Health Act) was introduced during the Obama administration and signed into law on February 17, 2009. The Goals of the HITECH Act The HITECH Act was established to promote and expand the adoption of health information technology, specifically, the use of electronic health records by healthcare providers. The Act also removed some of the loopholes in the HIPAA Act by tightening up the language of HIPAA. This helped to ensure that all business associates were complying with HIPAA Rules, and when health information was compromised, notifications were sent to the affected individuals in a timely manner. Tougher penalties for HIPAA compliance failures were also introduced to add an extra incentive for healthcare organizations and their business associates to comply with the HIPAA Privacy and Security Rules. The Importance of the HITECH Act Prior to the introduction of the HITECH Act, only 10 percent of hospitals had adopted electronic health records. In order to advance healthcare, improve efficiency and care of patients, and make it easier for health information to be shared between different covered entities, electronic health records needed to be adopted. The HITECH Act introduced incentives to encourage hospitals and other healthcare providers to make the change from paper records to electronic records. Had the Act not been passed, there is a good chance that many healthcare providers would still be using paper records today. The HITECH Act also helped to make certain that healthcare organizations and their business associates were complying with the HIPAA Privacy and Security Rules, were implementing safeguards to keep personal health information private and confidential, were restricting the uses and disclosures of health information, and were honoring obligations to provide patients with copies of their medical records upon request. The Act did not make compliance with HIPAA mandatory. That was already a requirement. However, it did make certain that entities found not to be in compliance could be issued substantial fines. Penalties help increase compliance, and sometimes the only language that businesses understand is one that affects the bottom line. https://d3imrogdy81qei.cloudfront.net/video_images/6335/hipaa-foundation-conclusion.jpg Yes 77 https://app.protrainings.com/courses/hipaa/leaders/videos/welcome-to-prohipaa-for-leaders https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3547.mp4 Welcome to ProHIPAA for Leaders Welcome to the ProHIPAA for Leaders course. If you've just taken the General HIPAA course, you likely have a solid foundation on HIPAA already. In this introductory lesson, we'll be going over what you can expect to learn in this course and what your course objective will be. And at the end of the lesson, we'll provide you with a Word about HIPAA Privacy Officers and HIPAA Security Officers. If your business or organization is in the healthcare industry and works as a covered entity or business associate, you're required to have annual HIPAA compliance training for you and your staff. You're also required to conduct periodic risk assessments and have a Book of Evidence on hand that outlines your practice or organization's policies and procedures. In the course, you'll learn about what it takes to be an effective privacy officer, compliance officer, and trusted business associate. What You Can Expect to Learn In your ProHIPAA for Leaders course, you'll learn the following: Why risk assessments are required About the HITECH Act of 2009 About the Omnibus Rule of 2013 About the importance of customized policies and procedures to create your Book of Evidence Why business associate agreements are required About the types of violations we often see in the healthcare industry today Why you – as a compliance officer or privacy officer – are key to ensuring your business or organization becomes compliant How to handle complaints and audits from the Office for Civil Rights or attorneys Your Course Objective The objective of ProHIPAA for Leaders is to train you on how to properly handle PHI, ePHI, and a data breach. Or better yet, how to reduce your chances of a data breach. A Word About HIPAA Privacy Officers and HIPAA Security Officers If you just completed the General HIPAA course at ProHIPAA, you may recall some additional information on the duties of a HIPAA Compliance Officer. You might also remember how those duties can be handled by one person or shared – in smaller organizations and businesses – with the person (or people) responsible for privacy and security duties. In this Word, we're going to look at duties for both HIPAA Privacy Officers and HIPAA Security Officers for larger businesses and organizations that have one or more people in each of those positions. HIPAA Privacy Officer A HIPAA Privacy Officer is responsible for developing a privacy program that is HIPAA compliant if one doesn't already exist. Or, if your business already has a privacy program in place, a privacy officer is in charge of ensuring that all privacy policies to protect the integrity of PHI are enforced. Among the duties of a HIPAA Privacy Officer are: Overseeing or developing ongoing employee privacy training Conducting risk assessments Developing HIPAA compliant procedures where necessary Monitoring compliance with the privacy program Investigating incidents in which a breach of PHI may have occurred Reporting breaches as necessary Ensuring patients' rights in accordance with state and federal laws In order to fulfill the duties of a HIPAA Privacy Officer, the appointed person will have to keep up to date with relevant state and federal laws. HIPAA Security Officer The duties of a HIPAA Security Officer are quite similar to those of a privacy officer, but with a security focus rather than privacy. The appointed person will be responsible for: Developing security policies Implementing procedures, training, and risk assessments Monitoring compliance of the security policies However, the focus of a HIPAA Security Officer is compliance with the Administrative, Physical, and Technical Safeguards of the Security Rule. In this respect, the duties of a HIPAA Security Officer can include such diverse topics as the development of a Disaster Recovery Plan – the mechanisms in place to prevent unauthorized access to PHI, and how ePHI is transmitted and stored. Due to how similar these duties are, the roles of a HIPAA Privacy Officer and HIPAA Security Officer are often performed by the same person in smaller organizations and businesses. And in even smaller businesses, one person could be in charge of handling the duties of a HIPAA Compliance Officer as well. https://d3imrogdy81qei.cloudfront.net/video_images/6337/welcome-to-prohipaa-leadership.jpg Yes 120 https://app.protrainings.com/courses/hipaa/leaders/videos/proper-transportation-of-phi-and-ephi https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3548.mp4 Proper Transportation of PHI and ePHI In this lesson, we're going to show you how NOT to transport PHI (aka: explain a little more about common sense). And at the end of the lesson, we're going to take a look at healthcare data breach statistics, which clearly show why lessons like this are important. You probably recall from the corresponding video for this lesson, that nurse Joy decided to go into a grocery store and leave patient records, along with her computer, in plain sight …. and with her windows down and her doors presumably unlocked. It probably wasn't much of a shock to you when someone came along and took it all easily right through her open window. This is poor security! Nurse Joy didn't properly secure the PHI, ePHI, or even her computer. You could use this example when training your staff about properly securing PHI. And while this all may seem a bit too much like an abuse of common sense, there have no doubt been numerous real-life incidents just like this, only with better acting. Quiz: What should nurse Joy have done differently? a) Rolled up her windowsb) Locked her car doorsc) Placed the PHI and her computer out of sightd) All of the above If you chose D, you are correct! If you need to transport medical records or mobile devices that contain PHI, make sure to do all of the above to keep it secure. However, just taking PHI off-premises could also be a no-no, and therefore must be documented in your policies and procedures, along with secure means of transporting personal health information if it is allowed. A Word About Healthcare Data Breach Statistics Healthcare data breach statistics clearly show that there has been an upward trend in data breaches over the past nine years, with 2018 seeing more data breaches reported than any other year since records first started being published in 2009. Warning: The prevalence of this problem is a bit shocking. Between 2009 and 2018 there have been 2546 healthcare data breaches involving more than 500 records. Those breaches have resulted in the theft/exposure of 189,945,874 healthcare records. That equates to more than 59% of the population of the United States. Healthcare data breaches are now being reported at a rate of more than one per day. There has been a general upward trend in the number of records exposed each year, with a massive increase in 2015. This was far and away the worst year in history for breached healthcare records with more than 113.27 million records exposed. The best year was 2012, with just 2,808,042 healthcare records exposed. The good news is that the situation has improved since 2015 with successive decreases in the number of exposed records. Although that trend did not continue in 2018. The number of exposed records more than doubled from 5,138,179 records in 2017 to 13,236,569 records in 2018. However, that is still far lower than those outrageous 2015 statistics. The Largest Healthcare Data Breaches To understand how enormous this problem is, let's look at the three largest healthcare breaches to date, all of which occurred in 2015. All three were caused by a hacking or IT incident. And all three covered entities involved were health plans. 1. Anthem Inc. 78,800,000 individuals affected 2. Premera Blue Cross 11,000,000 individuals affected 3. Excellus Health Plan Inc. 10,000,000 individuals affected That's three incidents affecting 100 million people, or roughly 30 percent of the U.S. population. And all three occurring in the same year. Hacking is the Leading Cause Data breach statistics show hacking is now the leading cause of healthcare data breaches, although it should be noted that healthcare organizations are now much better at detecting hacking incidents. The low hacking/IT incidents in earlier years could be partially due to the failure to detect hacking incidents and malware infections quickly. Many of the hacking incidents between 2014 and 2018 occurred many months, and in some cases years, before they were detected. Hacking isn't the Only Cause As with hacking, healthcare organizations are getting better at detecting internal breaches and also reporting those breaches to the Office for Civil Rights. While hacking is the main cause of breaches, unauthorized access/disclosure incidents are not far behind. Healthcare data breach statistics show HIPAA covered entities and business associates have got significantly better at protecting healthcare records with administrative, physical, and technical controls such as encryption. Although unencrypted laptops and other electronic devices are still being left unsecured in vehicles and locations accessible by the public. Many of these theft/loss incidents involve paper records, which can equally result in the exposure of large amounts of patient information. Yes, the video example for this lesson seems extraordinarily laughable, and yet, this actually happens. Just because you have more sense than that, it would be unwise to assume all the employees in your business or organization share that uncommon sense. Which is why lessons like this still must exist. https://d3imrogdy81qei.cloudfront.net/video_images/6339/proper-transportation-of-phi-and-ephi.jpg Yes 110 https://app.protrainings.com/courses/hipaa/leaders/videos/what-is-a-business-associate https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3549.mp4 What is a Business Associate? In this lesson, we're going to dig into business associates – who they are, what their requirements are, and also include some examples of common business associates. At the end of the lesson, we'll take a more in-depth look into the business associate agreement. A business associate is any company or individual with access to PHI or ePHI in support of a covered entity's business. Business associates are required to have the same policies and procedures when it comes to accessing and protecting PHI as covered entities. Just like covered entities, business associates are required to protect personal health information at all times. They're also required to notify their covered entity of any potential or active data breaches. And in a bigger picture sort of way, business associates must help protect their covered entities at all times. Pro Tip: Business associates are required to immediately notify their covered entity when a breach of unsecured PHI is discovered. Waiting will only compound the problem and is a breach of HIPAA law. Business associates can include the following: IT service companies Cloud service providers Laboratories Lawyers Consultants Benefits managers Claims processing firms Data transmission service providers Technology companies Suppliers and manufacturers with access to PHI You may recall the corresponding video for this lesson involving an uncomfortable exchange with Tom the IT guy. Office manager Mary left a medical file laying on the counter and Tom unknowingly wandered over to have a look. This one incident is actually responsible for two violations – 1) not securing PHI and 2) looking at PHI when you do not have permissible access. Unfortunately for Tom, he doesn't know he's not supposed to look … until he already has looked. Moral of the story: Don't leave medical files laying around for others to look at. Business Associate Agreements Business associates must comply with all HIPAA requirements by providing written contractual agreements to their covered entities. Included in these agreements is: The business associate will only use the covered entities protected health information for proper purposes The business associate will safeguard the covered entity's PHI from misuse The business associate will comply with all of HIPAA's security requirements and will ensure that all administrative, physical, and technical safeguards are followed to keep the covered entity's PHI safe If a business associate violates any part of the HIPAA rules and regulations or is in violation of the business associate agreement with the covered entity, the business associate will be held accountable for both types of penalties. In instances where a business associate uses a subcontractor, also known as a downstream supplier, that subcontractor is required by HIPAA to have a contractual agreement with their business associate. Subcontractors are essentially held to the same HIPAA requirements when it comes to accessing and using protected health information. And like business associates, they are also accountable for any and all penalties when there is a breach of that contract. A Word About the HIPAA Business Associate Agreement A HIPAA business associate agreement is a contract between a HIPAA covered entity and a vendor used by that covered entity. As you already know, a HIPAA-covered entity is typically a healthcare provider, health plan, or healthcare clearinghouse that conducts transactions electronically. A vendor of a HIPAA covered entity that needs to be provided with protected health information in order to perform duties on behalf of the covered entity is called a business associate (BA) under HIPAA. A vendor is also classed as a business associate if, as part of the services provided, ePHI passes through their systems. A signed HIPAA business associate agreement must be obtained by the covered entity before allowing a business associate to come into contact with PHI or ePHI. Since the passing of the HITECH Act and its incorporation into HIPAA in 2013 via the HIPAA Omnibus Final Rule, subcontractors used by business associates are also required to comply with HIPAA. As you now know, all business associates must likewise obtain a signed HIPAA business associate agreement from its subcontractors before access is given to PHI or ePHI. And if subcontractors use vendors that require access to PHI or ePHI, they too need to enter into business associate agreements with their subcontractors. The business associate agreement should stipulate that the business associate (or subcontractor) must implement appropriate administrative, technical, and physical safeguards to ensure the confidentiality, integrity, and availability of ePHI and meet the requirements of the HIPAA Security Rule. Some of those measures may be stated in the business associate agreement or it may be left to the discretion of the business associate. The business associate agreement should also include the allowable uses and disclosures of PHI to meet the requirements of the HIPAA Privacy Rule. In the event that PHI is accessed by individuals unauthorized to view the information, such as an internal breach or cyberattack, the business associate is required to notify the covered entity of the breach and may be required to send notifications to individuals whose PHI has been compromised. The timescale and responsibilities for notifications should be detailed in the agreement. A business associate should also be made aware of the consequences of failing to comply with the requirements of HIPAA. Business associates can be fined directly by regulators for HIPAA violations. Both the Department of Health and Human Services' Office for Civil Rights and state attorneys general have the authority to issue financial penalties for violations of HIPAA Rules. At the end of the next lesson, we'll cover a few more details about business associate agreements that you may want to be aware of. https://d3imrogdy81qei.cloudfront.net/video_images/6341/what-is-a-business-associate.jpg Yes 226 https://app.protrainings.com/courses/hipaa/leaders/videos/what-is-hitech https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3550.mp4 What is HITECH? In this lesson, we're going to cover the HITECH Act, including its goals, its importance, and a few details. At the end of the lesson, we're going to provide you with answers to some common business associate agreement questions. The HITECH Act (Health Information Technology for Economic and Clinical Health Act) was introduced during the Obama administration and signed into law on February 17, 2009. The HITECH Act expanded the responsibilities of business associates under the security and privacy rules. Responsibilities and requirements for covered entities and their business associates include: Providing notification following a breach of unsecured protected health information Limitations on the sale of PHI, marketing, and fundraising communications Stronger individual rights to access electronic medical records Restriction of the disclosure of certain information Only using PHI for proper purposes Protect PHI at all times The Goals of the HITECH Act The HITECH Act was established to promote and expand the adoption of health information technology, specifically, the use of electronic health records by healthcare providers. The Act also removed some of the loopholes in the HIPAA Act by tightening up the language of HIPAA. This helped to ensure that all business associates were complying with HIPAA Rules, and when health information was compromised, notifications were sent to the affected individuals in a timely manner. Tougher penalties for HIPAA compliance failures were also introduced to add an extra incentive for healthcare organizations and their business associates to comply with the HIPAA Privacy and Security Rules. The Importance of the HITECH Act Prior to the introduction of the HITECH Act, only 10 percent of hospitals had adopted electronic health records. In order to advance healthcare, improve efficiency and care of patients, and make it easier for health information to be shared between different covered entities, electronic health records needed to be adopted. The HITECH Act introduced incentives to encourage hospitals and other healthcare providers to make the change from paper records to electronic records. Had the Act not been passed, there is a good chance that many healthcare providers would still be using paper records today. The HITECH Act also helped to make certain that healthcare organizations and their business associates were complying with the HIPAA Privacy and Security Rules, were implementing safeguards to keep personal health information private and confidential, were restricting the uses and disclosures of health information, and were honoring obligations to provide patients with copies of their medical records upon request. The Act did not make compliance with HIPAA mandatory. That was already a requirement. However, it did make certain that entities found not to be in compliance could be issued substantial fines. Penalties help increase compliance, and sometimes the only language that businesses understand is one that affects the bottom line. Some Common Business Associate Agreement Questions Who does a business associate agreement apply to? Covered entities can be fined for not having a HIPAA business associate agreement in place or for having an incomplete agreement in place. And even if one wasn't in place, business associates are still obligated to comply with the HIPAA Security Rule. However, the issue for many covered entities is they are often unsure who a HIPAA business associate agreement actually applies to. The Department of Health and Human Services defines a business associate as a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity, if that helps. However, exclusions to this definition exist and it may be the case that the scope of a covered entity's relationship with a vendor changes over time. As you can see, it's not exactly black and white, or even finite. Can you insist that every contractor sign a BAA? Some covered entities have taken a better-safe-than-sorry approach to address their definition issues and have executed agreements with all entities they have business relationships with. Even when not required. Recent research funded by the California Healthcare Foundation found that many covered entities were entering into agreements with other covered entities unnecessarily and were also entering into agreements with vendors who had no access to PHI and were never likely to. What does access to ePHI include? Many vendors are not given PHI to perform tasks on behalf of the covered entity, but ePHI passes through their systems. Many software solutions touch ePHI which means the software provider is classed as a business associate. There are exceptions for entities that merely act as conduits through which ePHI simply passes, although most cloud service and software providers are not excepted from compliance with HIPAA and BAAs are required. Can I use a business associate agreement template? There are many HIPAA business associate agreement templates available, but care should be taken before they are used. Before using such a template, it's important to check for whom that template has been designed to make sure it's relevant. It should also be personalized to include all of the requirements stipulated by the covered entity. https://d3imrogdy81qei.cloudfront.net/video_images/6343/what-is-hitech.jpg Yes 91 https://app.protrainings.com/courses/hipaa/leaders/videos/what-is-a-risk-assessment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3551.mp4 What is a Risk Assessment? In this lesson, we'll be going over what a risk assessment is, the purpose of risk assessments, and the benefits of having one regularly. At the end of the lesson, we'll provide you with a Word about what a HIPAA risk assessment should consist of. A risk assessment is a process that helps your business or organization identify any potential risks and analyze what could happen if a breach or mishandling of PHI or ePHI occurs. Risk assessments are required by the Office for Civil Rights. To become compliant, you must attest to 100 questions that the OCR provides. By conducting a thorough risk assessment, you should have a better idea of the amount of a risk your business or organization has, along with your exposure of all protected health information. Pro Tip #1: The important thing to remember is that all covered entities and business associates are required by law to conduct a risk assessment. The goals of doing a risk assessment are understanding your vulnerabilities if any exist and the potential of a data breach. A risk assessment can help identify areas where you can better secure all types of patient health data, from ePHI to paper charts. Pro Tip #2: All covered entities and business associates must also produce a risk report from the risk assessment. The risk report should detail the level of the risk and a remediation plan to resolve any and all risks to PHI and ePHI. ProHIPAA recommends that all covered entities and business associates conduct an annual risk assessment to comply with all regulations and determine your level of risk from year to year. This yearly approach to risk assessments will help ensure that any changes in your business or organization haven't affected the security of the protected health information of your patients or customers. A Word About What a HIPAA Risk Assessment Should Consist Of The U.S. Department of Health and Human Services (HHS) acknowledges that there is no specific risk analysis methodology. This may be due to covered entities and business associates varying significantly in size, complexity, and capabilities. However, HHS does provide an objective of a HIPAA risk assessment – to identify potential risks and vulnerabilities to the confidentiality, availability, and integrity of all PHI that an organization creates, receives, maintains, or transmits. In order to achieve these objectives, the HHS suggests an organization should: Identify where PHI is stored, received, maintained, or transmitted Identify and document all potential threats and vulnerabilities Assess current security measures that are currently in place to safeguard PHI Assess whether the current security measures are being used properly Determine the likelihood of a reasonably anticipated threat Determine the potential impact of a data breach involving PHI Assign risk levels for vulnerability and impact combinations Document the risk assessment and take action where necessary A HIPAA risk assessment is not a one time or singular exercise. Assessments should be reviewed periodically, and as new work practices are implemented, or new technology is introduced. HHS does not provide guidance on the frequency of reviews other than to suggest they may be conducted annually depending on an organization´s circumstances. Do You Need a HIPAA Privacy Risk Assessment? Due to the requirement for business associates to conduct risk assessments being introduced in an amendment to the HIPAA Security Rule, many covered entities and Business Associates overlook the necessity to conduct a HIPAA privacy risk assessment. A HIPAA privacy risk assessment is equally as important as a security risk assessment but can be a much larger undertaking depending on the size of the organization and the nature of its business. In order to complete a HIPAA privacy risk assessment, an organization should appoint a privacy officer who can identify organizational workflows and get a big picture view of how the HIPAA Privacy Rule will impact the organization's operations. Thereafter the privacy officer needs to map the flow of PHI both internally and externally in order to conduct a gap analysis to identify where breaches may occur. The final stage of a HIPAA privacy risk assessment should be the development and implementation of a HIPAA privacy compliance program. The program should include policies to address the risks to PHI identified in the HIPAA privacy risk assessment and should be reviewed as suggested by the HHS as new work practices are implemented or new technology is introduced. https://d3imrogdy81qei.cloudfront.net/video_images/6345/what-is-a-risk-assessment.jpg Yes 82 https://app.protrainings.com/courses/hipaa/leaders/videos/policies-procedures-and-the-book-of-evidence https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3552.mp4 Policies, Procedures and the Book of Evidence In this lesson, we'll be covering HIPAA policies and procedures (aka: The Book of Evidence), including what the Book of Evidence should consist of and one very important key point to remember when putting together your own Book of Evidence. At the end of the lesson, we'll provide you with a Word about how to become HIPAA compliant. Every business or practice that has access to PHI and ePHI is required to have a set of policies and procedures in place on how to handle all protected health information. This set of policies and procedures is what we refer to as the Book of Evidence. Pro Tip #1: One important thing to remember about your Book of Evidence is that it must be customized to your own unique snowflake that is your business or practice. Yes, downloadable online templates are available. And yes, using them is a very bad idea. Your own Book of Evidence must be relevant to your own exact business. What Should a Book of Evidence Include? Without spoiling the ending, any thorough Book of Evidence should include: The responsibilities of the covered entity or business associate The use and disclosure of the PHI they have access to The individual rights of patients (if pertinent) How to handle a breach of protected health information Pro Tip #2: Your Book of Evidence must be present – in the office of the business or practice – and must be provided to the Office for Civil Rights should they ever request to see it. Your Book of Evidence also must reflect the dates of the latest changes to the law. We also recommend storing a copy online or through a local network for disaster recovery and business continuity purposes. There is a common misconception that a Book of Evidence is one size fits all. Again, it's not! It must be customized to fit your own unique business or practice. Also, don't forget to store a printed copy on site and a copy at an offsite location or cloud-based location. A Word About How to Become HIPAA Compliant Before getting into how to become compliant, it may be best to answer the question, what is HIPAA compliance? HIPAA compliance involves fulfilling the requirements of the Health Insurance Portability and Accountability Act of 1996, its subsequent amendments, and any related legislation such as the Health Information Technology for Economic and Clinical Health (HITECH) Act. Typically, the next question is, what are the HIPAA compliance requirements? That question is not so easy to answer as some of the requirements of HIPAA are intentionally vague. This is so HIPAA can be applied equally to every different type of covered entity or business associate that comes into contact with PHI. While it is possible to use a HIPAA compliance checklist to make sure all aspects of HIPAA are covered, it can be a difficult process for organizations unfamiliar with the intricacies of HIPAA Rules to develop a HIPAA compliance checklist and implement all appropriate privacy and security controls. However, you will certainly need to use a HIPAA compliance checklist to make sure your organization, product, or service incorporates all of the technical, administrative, and physical safeguards of the HIPAA Security Rule. You must also adhere to the requirements of the HIPAA Privacy and Breach Notification Rules. If you get anything wrong and fail to safeguard ePHI, as a HIPAA business associate, you can be fined directly for HIPAA violations by the HHS' Office for Civil Rights, state attorneys general, and other regulators. Criminal charges may also be applicable for some violations. HIPAA compliance can, therefore, be daunting. To ensure you cover all elements on your HIPAA compliance checklist and leave no stone unturned, it is worthwhile seeking expert guidance from HIPAA compliance experts. Many firms offer HIPAA compliance software to guide you through your HIPAA compliance checklist, ensure ongoing compliance with HIPAA Rules, and provide you with HIPAA certification. https://d3imrogdy81qei.cloudfront.net/video_images/6347/policies-procedures-and-the-book-of-evidence.jpg Yes 94 https://app.protrainings.com/courses/hipaa/leaders/videos/what-is-a-business-associate-agreement https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3553.mp4 What is a Business Associate Agreement? In this lesson, we're going to look briefly at what a business associate agreement (BAA) is and what some of the common elements of a BAA are. At the end of the lesson, we'll take a look at some common HIPAA violations. A business associate agreement is a required contract between a covered entity and a business associate who has direct or incidental access to PHI or ePHI. A business associate agreement will contain details on how each entity will be responsible in handling PHI and can include: Required compliance training A risk assessment Financial liabilities Responsibilities if and when a data breach occurs Pro Tip: A business associate agreement is required and holds business associates accountable to handle PHI and ePHI securely and safely. Business associates are required to have: A risk assessment HIPAA compliance training Policies and procedures, also known as a Book of Evidence A Word About 10 Common HIPAA Violations The most common HIPAA violations that have resulted in financial penalties are the failure to perform an organization-wide risk analysis to identify risks to the confidentiality, integrity, and availability of protected health information (PHI); the failure to enter into a HIPAA-compliant business associate agreement; impermissible disclosures of PHI; delayed breach notifications; and the failure to safeguard PHI. But before we get into the top 10 list, let's answer a couple of important questions first. Are Data Breaches HIPAA Violations? Data breaches are now a fact of life. Even with multi-layered cybersecurity defenses, data breaches are still likely to occur from time to time. The Office for Civil Rights (OCR) understands that healthcare organizations are being targeted by cybercriminals and that it is not possible to implement impregnable security defenses. Being HIPAA compliant is not about making sure that data breaches never happen. HIPAA compliance is about reducing risk to an appropriate and acceptable level. Just because an organization experiences a data breach, it does not mean the breach was the result of a HIPAA violation. The OCR breach portal now reflects this more clearly. Many data breaches are investigated by OCR and are found not to involve any violations of HIPAA Rules. Consequently, the investigations are closed without any action being taken. How are HIPAA Violations Discovered? HIPAA violations can continue for many months, or even years, before they are discovered. The longer they are allowed to persist, the greater the penalty will be when they are eventually discovered. It is therefore important for HIPAA covered entities to conduct regular HIPAA compliance reviews to make sure HIPAA violations are discovered and corrected before they are identified by regulators. There are three main ways that HIPAA violations are discovered: Investigations into a data breach by OCR (or state attorneys general). Investigations into complaints about covered entities and business associates. HIPAA compliance audits. Even when a data breach does not involve a HIPAA violation, or a complaint proves to be unfounded, OCR may uncover unrelated HIPAA violations that could warrant a financial penalty. 10 Most Common HIPAA violations Listed below are 10 of the most common HIPAA violations, together with examples of HIPAA-covered entities and business associates that have been discovered to be in violation of HIPAA Rules and have had to settle those violations with OCR and state attorneys general. In many cases, investigations have uncovered multiple HIPAA violations. In no particular order, the 10 most common HIPAA violations are: Snooping on healthcare records Failure to perform an organization-wide risk analysis Failure to manage security risks / lack of a risk management process Failure to enter into a HIPAA-compliant business associate agreement Insufficient ePHI access controls Failure to use encryption or an equivalent measure to safeguard ePHI on portable devices Exceeding the 60-day deadline for issuing breach notifications Impermissible disclosures of protected health information Improper disposal of PHI Denying patients access to health records/exceeding timescale for providing access https://d3imrogdy81qei.cloudfront.net/video_images/6349/what-is-a-business-associate-agreement.jpg Yes 54 https://app.protrainings.com/courses/hipaa/leaders/videos/how-to-handle-a-data-breach-and-violations https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3554.mp4 How to Handle a Data Breach and Violations In this lesson, we're going to tackle your worst nightmare – there's been a data breach or HIPAA violation and you need to take action. We'll provide you with the necessary steps to handle such an event, and at the end of the lesson, we'll provide you with a few more details about the HIPAA Breach Notification Rule. Let's assume your business or organization has had a breach. These are the steps you need to take now that the breach has occurred. Notify your privacy or compliance officer and let him or her know about the breach. Initiate a data breach risk assessment. Notify all impacted individuals within the required time frame. Provide a formal report to the HHS within 60 days unless your state requires it sooner. Notify your local media if the breach impacted more than 500 individuals. Pro Tip #1: HIPAA regulations require you to notify impacted individuals within 60 days. However, multiple states like Texas, Wisconsin, North Carolina, Alabama, and others have more stringent laws that require notification to take place more quickly. Other states appear to be following suit. So, the moral of the story: Time is of the essence. Once your privacy officer has been alerted of the breach, he or she must initiate a data breach risk assessment to determine what PHI was breached and how many individuals have been affected. A formal report must be compiled and reported to the HHS within 60 days. You also must notify all impacted individuals within the same amount of time. However, if your state law is more stringent, you must abide by the state law. Media Notice Rule The media notice rule requires covered entities to report breaches that involved more than 500 individuals to local news outlets. If dealing with this size of breach, your privacy officer would need to contact local television and newspaper outlets and provide a notification of the breach. Here is just some of the information that a breach notification should include: A brief description of the breach The types of information involved in the breach The steps affected individuals should take to protect themselves from potential harm A brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches Pro Tip #2: If a covered entity has insufficient or out of date contact information for 10 or more individuals, the covered entity must substitute an individual notice by either posting a notice on their website for at least 90 days or by providing the breach notification to all major media outlets in the areas affected. A Word About the HIPAA Breach Notification Rule The HIPAA Breach Notification Rule requires covered entities to notify patients when there is a breach of their ePHI. The Breach Notification Rule also requires entities to promptly notify the Department of Health and Human Services of such a breach of ePHI and issue a notice to the media if the breach affects more than 500 patients. There is also a requirement to report smaller breaches – those affecting fewer than 500 individuals – via the OCR web portal. These smaller breach reports should ideally be made once the initial investigation has been conducted. The OCR only requires these reports to be made annually. Breach notifications should include the following information: The nature of the ePHI involved, including the types of personal identifiers exposed The unauthorized person who used the ePHI or to whom the disclosure was made (if known) Whether the ePHI was actually acquired or viewed (if known) The extent to which the risk of damage has been mitigated Breach notifications must be made without unreasonable delay and in no case later than 60 days following the discovery of a breach. When notifying a patient of a breach, the covered entity must inform the individual of the steps they should take to protect themselves from potential harm, include a brief description of what the covered entity is doing to investigate the breach and the actions taken so far to prevent further breaches and security incidents. https://d3imrogdy81qei.cloudfront.net/video_images/6351/how-to-handle-a-data-breach-and-violations.jpg Yes 141 https://app.protrainings.com/courses/hipaa/leaders/videos/what-penalties-apply-to-violations-of-privacy-rule-requirements https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3555.mp4 What Penalties Apply to Violations of Privacy Rule Requirements? In this lesson, we're going to cover all things related to HIPAA violation penalties and what the true costs are to your business or practice if this should happen to you. At the end of the lesson, we'll provide you with a Word about what constitutes a HIPAA violation. The United States Department of Health and Human Service's Office for Civil Rights is responsible for administrating and enforcing the HIPAA standards and may conduct investigations and compliance reviews whenever they see fit. Should you be found to be in violation of any privacy rule requirements, your business or practice could be responsible for paying civil penalties. These penalties are for each violation and can be stacked if there are multiple violations with respect to a single individual. Penalties also depend on the type of violation. Civil penalties, for instance: Can range from $100 to $50,000 per violation Can go up to a maximum of $1.5 million per year Criminal penalties on the other hand: Can range up to $250,000 in fines Can result in 10 years imprisonment for those knowingly or improperly disclosing information or obtaining information under false pretenses Can result in even higher penalties for violations designed for financial gain or deemed as malicious harm Pro Tip: That's just the federal side of the penalty puzzle. State laws can also inflict their own set of fines to your business or practice. The True Cost of a Data Breach Let's go over the details of the cost of a data breach to your business or practice. Here are a few costs you may be subjected to: Health and Human Services fines up to $1.5 million per violation or per year. Federal Trade Commission fees up to $16,000 per violation. Class action lawsuits from between $1000 and $500,000 since no one usually sues for less than $500,000. State Attorney General can inflict fines of between $150,000 and $6.8 million. Business or patient loss up to 50 percent. The costs associated with offering ID monitoring and free credit reports to all people impacted, or somewhere around $10 to $30 per person. Lawyer fees of at least $2000+. Breach notifications costs of at least $1000. Business associate changes and technology repairs of around $5000+. A Word About What Constitutes a HIPAA Violation There is much talk of HIPAA violations in this course, but what actually constitutes a HIPAA violation? A HIPAA violation has occurred when a HIPAA covered entity – or a business associate – fails to comply with one or more of the provisions of the HIPAA Privacy, Security, or Breach Notification Rules. A violation may be deliberate or unintentional. An example of an unintentional HIPAA violation is when too much PHI is disclosed, and the minimum necessary information standard is violated. When PHI is disclosed, it must be limited to the minimum necessary information to achieve the purpose for which it is disclosed. Financial penalties for HIPAA violations can be issued for unintentional HIPAA violations, although, as mentioned above, the penalties will often be at a lower rate than willful violations of HIPAA Rules. An example of a deliberate violation is unnecessarily delaying the issuing of breach notification letters to patients and exceeding the maximum timeframe of 60 days following the discovery of a breach to issue notifications, which is a clear violation of the HIPAA Breach Notification Rule. Many HIPAA violations are the result of negligence, such as the failure to perform an organization-wide risk assessment. Financial penalties for HIPAA violations have frequently been issued for risk assessment failures. Penalties for HIPAA violations can potentially be issued for all HIPAA violations, although the Office for Civil Rights typically resolves most cases through voluntary compliance, issuing technical guidance, or accepting a covered entity or business associate's plan to address the violations and change policies and procedures to prevent future violations from occurring. It should be noted that financial penalties for HIPAA violations are reserved for the most serious violations of HIPAA Rules. https://d3imrogdy81qei.cloudfront.net/video_images/6353/what-penalties-apply-to-violations-of-privacy-rule-requirements.jpg Yes 131 https://app.protrainings.com/courses/hipaa/leaders/videos/do-i-need-a-privacy-officer-or-security-officer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3556.mp4 Do I need a Privacy Officer or Security Officer? In this lesson, we'll be going into some detail regarding the duties of both HIPAA Privacy Officers and HIPAA Security Officers and where and how those duties sometimes intersect. At the end of the lesson, we'll provide you with a Word about HIPAA violation classifications. One important thing to remember is that you are required by law to have someone appointed as a privacy officer and a security officer at your business or practice. However, it's equally important to point out that these roles can be combined in certain situations and given to just one individual. Pro Tip #1: While you can appoint one person as privacy officer and security officer, it's not something that we would recommend. Separating these duties adds a second pair of eyes or ensures a certain amount of checks and balances. What are the Duties of a HIPAA Privacy Officer? In order to fulfill the duties of a HIPAA Privacy Officer, you would be responsible for the following: Developing a HIPAA compliant privacy program if one does not already exist Ensuring that all privacy policies are in place and capable of protecting the integrity of all PHI and ePHI Enforcing all the privacy policies that are in place Delivering or overseeing ongoing employee privacy training Conducting regularly scheduled risk assessments Developing HIPAA compliant procedures where necessary Monitoring compliance with the privacy program Investigating any and all incidents in which a breach of PHI or ePHI may have occurred Reporting breaches as they occur Ensuring all patient rights in accordance with all state and federal laws Keeping up to date with all relevant state and federal laws At this point in your lesson, you may be asking yourself, what is the contrast between a security officer and a privacy officer. (Or you may just be contemplating lunch.) The duties of a HIPAA Security Officer are in fact similar to those of a HIPAA Privacy Officer, in as much as the appointed person will be responsible for the development of all security policies, the implementation of all procedures, training, risk assessments, and monitoring compliance. Pro Tip #2: Having said all that, the focus of a security officer is to ensure compliance with the administrative, physical, and technical safeguards of the HIPAA Security Rule. What are the Duties of a HIPAA Security Officer? The duties of a HIPAA Security Officer can include, but aren't limited to, the following: Developing a disaster recovery plan Putting into place the mechanisms to prevent unauthorized access to PHI and ePHI Deciding how all electronic PHI (ePHI) is transmitted and stored As previously mentioned, while it isn't ideal or recommended, due to the similarity in duties, the roles of a HIPAA Privacy Officer and a HIPAA Security Officer can be performed by the same person. The one caveat: It works best in smaller businesses, practices, or organizations. Customized for Your Business You can complete all the required actions to be HIPAA and HITECH compliant yourself, since all HIPAA and HITECH laws are applicable and must be customized to your exact needs. If you feel that the technical policies and procedures are too overwhelming, however, we would recommend you use a HIPAA compliance guide (like ourselves at ProHIPAA) who can guide you through your HIPAA journey. A Word About HIPAA Violation Classifications Are you curious about what happens if you violate HIPAA? Well, that depends on the severity of the violation. The Office for Civil Rights prefers to resolve HIPAA violations using non-punitive measures, such as with voluntary compliance or issuing technical guidance to help covered entities address areas of non-compliance. However, if the violations are serious, have been allowed to persist for a long time, or if there are multiple areas of noncompliance, financial penalties may be appropriate. There are four categories that are used for the penalty structure. They are as follows: Tier 1: A violation that the covered entity was unaware of and could not have realistically avoided, had a reasonable amount of care had been taken to abide by HIPAA Rules. Tier 2: A violation that the covered entity should have been aware of but could not have avoided even with a reasonable amount of care, but still falling short of willful neglect of HIPAA Rules. Tier 3: A violation suffered as a direct result of willful neglect of HIPAA Rules, in cases where an attempt has been made to correct the violation. Tier 4: A violation of HIPAA Rules constituting willful neglect, where no attempt has been made to correct the violation. In the case of unknown violations, where the covered entity could not have been expected to avoid a data breach, it may seem unreasonable for covered entities to be issued with a fine. The Office for Civil Rights understands this and has the discretion to waive a financial penalty. The penalty cannot be waived, however, if the violation involved willful neglect of Privacy, Security and Breach Notification Rules. https://d3imrogdy81qei.cloudfront.net/video_images/6355/do-i-need-a-compliance-partner-or-privacy-officer.jpg Yes 155 https://app.protrainings.com/courses/hipaa/leaders/videos/what-do-i-do-if-i-get-a-hipaa-complaint https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3557.mp4 What do I do if I get a HIPAA Complaint? In this lesson, we'll be covering what you should do if you get a HIPAA complaint, including steps you should take if you both get a complaint and suffer a data breach. At the end of the lesson, we'll stick with our recent looks at HIPAA violations with a Word about HIPAA violation penalty structure. If You Receive a HIPAA Complaint If you receive a compliant from a patient or a business about your handling of protected health information, you should remedy the situation using the following steps: Make a note of the complaint in your incident log. Provide a complaint form to the patient or business making the complaint to complete. The form is used to help explain the complaint in detail. Your privacy officer should conduct a thorough formal investigation into the complaint to identify if any policies or procedures were not followed and if there was a potential data breach that could have impacted PHI. If you Suffer a Data Breach Let's say you take a complaint seriously and discover it was not only valid, but PHI was indeed breached. What do you do now? If your privacy officer does identify that PHI has been breached, take the following steps: Log the data breach into a data breach log. Perform a risk assessment to help identify security gaps and vulnerabilities. Notify all of the impacted individuals of the data breach. Be mindful of time – report the data breach before the standard federal 60-day notification or state notification if it is more restrictive. After a risk report has been created from the risk assessment, you must document your remediation plan and remediate the risks in a timely manner. A Word About HIPAA Violation Penalty Structure Each category of violation carries a separate HIPAA penalty. It is up to the Office for Civil Rights to determine a financial penalty within the appropriate range. They will consider a number of factors when determining penalties, such as the length of time a violation was allowed to persist, the number of people affected, and the nature of the data exposed. An organization´s willingness to assist with an Office for Civil Rights' investigation is also taken into account. The general factors that can affect the level of financial penalty also include prior history, the organization's financial condition, and the level of harm caused by the violation. You may recall in the last Word section of the last lesson, how there was a tier system when it comes to HIPAA's penalty structure. Well, there's also a tier system when it comes to assessing fines. Tier 1: Minimum fine of $100 per violation up to $50,000. Tier 2: Minimum fine of $1,000 per violation up to $50,000. Tier 3: Minimum fine of $10,000 per violation up to $50,000. Tier 4: Minimum fine of $50,000 per violation. The above fines for HIPAA violations are those stipulated by the HITECH Act. It should be noted that these are adjusted annually to take inflation into account. A data breach or security incident that results from any violation could see separate fines issued for different aspects of the data breach under multiple security and privacy standards. For instance, a fine of $50,000 could, in theory, be issued for any violation of HIPAA rules, however minor they turn out to be. A fine can also be applied on a daily basis. For example, if a covered entity has been denying patients the right to obtain copies of their medical records, and had been doing so for a period of one year, the Office for Civil Rights may decide to apply a penalty per day that the covered entity has been in violation of the law. Therefore, the penalty would be multiplied by 365, not by the number of patients that have been refused access to their medical records. https://d3imrogdy81qei.cloudfront.net/video_images/6357/what-do-i-do-if-i-get-a-hipaa-complaint.jpg Yes 75 https://app.protrainings.com/courses/hipaa/leaders/videos/what-is-an-audit-and-how-do-i-handle-it https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3558.mp4 What is an audit and how do I handle it? In this lesson, we'll be covering what an audit by the Office for Civil Rights could entail, ways to help prevent an audit or make one go more smoothly, and why having a Book of Evidence is so vital. At the end of the lesson, we'll stick with our recent looks at HIPAA violations with a Word about criminal penalties for HIPAA violations. An audit by the Office for Civil Rights requires you to provide the following: A copy of your last risk assessment A copy of your last risk report Your HIPAA compliance training logs Your Book of Evidence Pro Tip #1: When it comes to HIPAA in general, and particularly with audits, it's imperative for all business associates and covered entities to be as proactive (rather than reactive) as possible. What does being proactive look like? Great question! You can be proactive, first and foremost, by covering all your bases regarding the following: Conduct annual risk assessments. Conduct annual compliance training. Stay current with all of your policies and procedures. Rely on Your Book of Evidence As we've stated before, your Book of Evidence is a HIPAA requirement (and not a suggestion). A good Book of Evidence must include, but isn't limited to, the following: Your policies and procedures for how to handle PHI and ePHI Your business continuity plan Your data breach plan Pro Tip #2: Having your Book of Evidence ready at all times can help an audit process go much more smoothly and hopefully speed things up a bit as well, especially if your Book of Evidence is up-to-date and all of your training records are current. A Word About Criminal Penalties for HIPAA Violations Before we dig into a word about criminal penalties for HIPAA violations, let's first look at if HIPAA violations can even be criminal. Can HIPAA Violations be Criminal? When a HIPAA covered entity or business associate violates HIPAA Rules, civil penalties can be imposed. When healthcare professionals violate HIPAA, it's often their employer that receives the penalty, but not always. If healthcare professionals knowingly obtain or use PHI for reasons that are not permitted by the HIPAA Privacy Rule, they may be found to be criminally liable for the HIPAA violation under the criminal enforcement provision of the Administrative Simplification subtitle of HIPAA. Criminal HIPAA violations are prosecuted by the Department of Justice, which is increasingly taking action against individuals that have knowingly violated HIPAA Rules. There have been several cases that have resulted in substantial fines and prison sentences. Criminal HIPAA violations include theft of patient information for financial gain and wrongful disclosures with intent to cause harm. A lack of understanding of HIPAA requirements may not be a valid defense. When an individual knowingly violates HIPAA Rules, knowingly means that they have some knowledge of the facts that constitute the offense, not that they definitely know that they are violating HIPAA Rules. Criminal Penalties for HIPAA Violations As you probably know by now, criminal penalties for HIPAA violations are divided into separate tiers, with the term and an accompanying fine decided by a judge based on the facts of each individual case. As with the Office for Civil Rights, a number of general factors are considered which will affect the penalty issued. If an individual has profited from the theft, access, or disclosure of PHI, it may be necessary for all payments received to be refunded, in addition to the payment of a fine. The three tiers of criminal penalties for HIPAA violations are: Tier 1: Reasonable cause or no knowledge of violation – Up to 1 year in jail. Tier 2: Obtaining PHI under false pretenses – Up to 5 years in jail. Tier 3: Obtaining PHI for personal gain or with malicious intent – Up to 10 years in jail. In recent months, the number of employees discovered to be accessing or stealing PHI (for various reasons) has increased. The value of PHI on the black market is considerable, and this can be a big temptation for some individuals. It is therefore essential that controls are put in place to limit the opportunity for individuals to steal patient data, and for systems and policies to be put in place to ensure improper access and theft of PHI is identified promptly. All staff likely to come into contact with PHI as part of their work duties should be informed of the HIPAA criminal penalties and that violations will not only result in loss of employment, but potentially also a lengthy jail term and a heavy fine. State attorneys general are cracking down on data theft and are keen to make examples out of individuals found to have violated HIPAA Privacy Rules. A jail term for the theft of HIPAA data is therefore highly likely. https://d3imrogdy81qei.cloudfront.net/video_images/6359/what-is-an-audit-and-how-do-i-handle-it.jpg Yes 60 https://app.protrainings.com/courses/hipaa/leaders/videos/hipaa-leadership-conclusion https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3559.mp4 Conclusion In this lesson, we'll simply be recapping what you've learned in your ProHIPAA course and at the end, make you an offer that is perhaps too good to pass up. In this course, you've learned what the HIPAA and HITECH laws are, who manages the laws, and who is required to comply. You've learned about covered entities, business associates, and more about PHI than you probably thought possible, and for very good reasons as you now know. Pro Tip: It's important to note that both covered entities and business associates share in the responsibility to protect personal health information at all times. If you are a covered entity doing all you can to be HIPAA compliant, but you're working with a business associate who isn't, this still poses a significant problem, as all it takes is one weak link in the chain. For this reason, it's important for all covered entities to ensure that each of their business associates is a trusted partner, has their best interest in mind at all times, and more importantly, is committed to protecting the health data of all of your customers and/or patients. In this course, you've also learned what the value of PHI is on the black market ($700 when part of a larger identity package) and why cybercriminals want PHI. We've looked a little into areas where PHI can be compromised and even a few recent instances in which PHI was compromised. It's critical to always protect PHI, not only for the safety and security of your customers and patients, but also for the legacy and operational integrity of your own business or organization. A data breach isn't just costly in terms of fines. It's also costly in terms of reputation and possible future revenue losses. Through this leadership course, you've also learned about the responsibilities of a HIPAA Privacy Officer, a HIPAA Security Officer, and business associates. You've learned about the importance of business associate agreements (BAAs), why you are required to have regularly scheduled risk assessments, and why you need a customized Book of Evidence that includes all of your policies and procedures. Knowing that Your Organization is HIPAA Compliant – Priceless! If you don't feel confident in your business or organization's ability to become or remain HIPAA compliant, it pays to engage a trustworthy HIPAA compliance partner who can guide you through your HIPAA compliance journey. Even though you've now learned what it takes to become HIPAA compliant, you may still need help getting there. And you certainly have a better understanding of the damage that could occur if your business or organization isn't compliant and suffers a data breach. If you ever feel like you need further assistance, as in a HIPAA compliance guide who can navigate you through those muddy waters, contact us ProHIPAA.com or call us at 844-722-8898 to schedule your complimentary risk review. Thank you again for choosing ProHIPAA. We are honored to help you become (and stay) HIPAA compliant. We look forward to serving you again in the future, because your legacy matters. https://d3imrogdy81qei.cloudfront.net/video_images/6361/hipaa-leadership-conclusion.jpg Yes 120 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/detalles-del-vih-sida https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3702.mp4 Detalles del VIH / SIDA https://d3imrogdy81qei.cloudfront.net/video_images/6635/hiv-details.jpg Yes 435 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hiv-details https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3702.mp4 HIV Details In this lesson, we're going to look at more details and facts about HIV and AIDS than you may have thought even existed. We'll look more closely at what these acronyms actually refer to, who is most at risk, some HIV and AIDS statistics, how the disease is transmitted, signs and symptoms, and the period of communicability. What is HIV and AIDS? HIV stands for human immunodeficiency virus. The virus can lead to acquired immunodeficiency syndrome (AIDS) if not properly treated. HIV attacks the body's immune system, specifically the CD4 cells (also known as T cells) which help the immune system fight off the infection. Warning: Unlike other viruses, the human body cannot completely rid itself of HIV, even with treatment. Once you get it, you have it for life. When untreated, HIV reduces the number of T cells in the body, making it more likely that the person infected will get other infections or infection-related cancers. Over time, HIV can destroy so many cells that the body cannot fight off future infections and diseases. Opportunistic infections or cancers then take advantage of a very weakened immune system and signal that the person has AIDS – the last and most advanced stage of HIV infection. It can take from two to 15 years to develop depending on the individual. AIDS is actually defined by the development of certain cancers or infections or other severe clinical manifestations. Who is Most at Risk of Contracting HIV or AIDS? There are a number of behaviors and conditions that put an individual at a greater risk of contracting HIV and these include: Unprotected anal and vaginal sex Having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis Sharing contaminated needles, syringes, and other injecting equipment and drug solutions when injecting drugs Receiving unsafe injections, blood transfusions, tissue transplantation, and medical procedures that involve unsterile cutting or piercing HIV and AIDS Statistics At the end of 2015, it's estimated that 1.1 million people aged 13 or older were living with HIV infection in the U.S., including an estimated 162,500 people (around 15 percent) whose infection had not been diagnosed. See stats from 2018. Some statistics for 2016 include: The number of new HIV diagnoses in the U.S. was 39,782• 32,131 diagnoses among adult and adolescent males aged 13 or older• 7529 diagnoses among adult and adolescent females• 122 diagnoses among children younger than 13 years old There were 1.8 million new cases of HIV discovered worldwide There were 36.7 million people living with HIV worldwide There were 19.5 million people receiving medications to treat HIV, known as antiretroviral therapy (ART) There were one million deaths from AIDS-related illnesses Sub-Saharan Africa bears the heaviest burden of HIV and AIDS cases worldwide, with around 64 percent of all new HIV infections. Other regions significantly affected include: Asia and the Pacific Latin America and the Caribbean Eastern Europe and Central Asia How is HIV Transmitted? HIV is mostly transmitted through sexual behaviors and needle or syringe use, though as you'll soon see, there are a few other less common modes of transmission. Transmission via Sexual Behaviors Transmission through sexual activities includes: Having anal or vaginal sex with someone who has HIV without using a condom or taking medications to prevent HIV For the HIV negative partner, receptive anal sex (bottoming) is the highest risk behavior, but you can also get HIV from insertive anal sex (topping) Pro Tip #1: Either partner can get HIV through vaginal sex, though it's less risky than receptive anal sex. Transmission via Needle or Syringe Use Transmission through needle or syringe use is most commonly seen with people sharing needles/syringes, rinse water, or other equipment used to prepare drugs for injection with someone who has HIV. Pro Tip #2: HIV can live in a used needle or syringe for up to 42 days depending on the temperature and other factors. Transmission via Bodily Fluids Only certain body fluids from an infected person can transmit HIV, such as: Blood Semen Pre-seminal fluid Rectal fluids Vaginal fluids Breast milk These fluids must come in contact with mucous membranes or damaged tissue or be directly injected into the bloodstream from a needle or syringe for transmission to occur. Mucous membranes can be found, as you already have learned, in the mouth, ears, nose, and eyes, but also inside the rectum, vagina, and penis. These various mucous membranes also offer routes of transmission. Transmission via Less Common Modes HIV can be spread less commonly from mother to child during pregnancy, birth, or breastfeeding, and also through needle stick injuries. In extremely rare cases, HIV has been transmitted by: Oral sex Receiving blood transfusion, blood products, or organ or tissue transplants that have been contaminated with HIV Eating food that has been pre-chewed by an HIV infected person, usually among infants Being bitten by a person with HIV Contact between broken skin, wounds, or mucous membranes and HIV infected blood or body fluids contaminated with blood Deep open mouth kissing if both people have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner Pro Tip #3: The average HIV/AIDS incubation period is 10 years! Signs and Symptoms of HIV and AIDS About 40 to 90 percent of those infected have flu-like symptoms within two to four weeks after becoming infected. While other people don't feel sick at all during this stage, which is also known as acute HIV infection. These flu-like symptoms can include: Fever Chills Rash Night sweats Muscle aches Sore throat Fatigue Swollen lymph nodes Mouth ulcers These symptoms can last anywhere from a few days to several weeks. Warning: During this time, HIV infection may not show up on some types of HIV tests, but people who have it are highly infectious and can spread the infection to others. The Period of Communicability Some things to keep in mind as it relates to communicability are: All antibody positive people carry the HIV virus Infectiousness is presumed to be lifelong, although successful treatment with combination antiretroviral therapy (cART) can lower the viral load in the blood and semen to undetectable levels Treatment can slow the progression from one stage to the next Treatment can also dramatically reduce the chance of transmitting HIV to someone else https://d3imrogdy81qei.cloudfront.net/video_images/6635/hiv-details.jpg Yes 435 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/etapas-del-vih-sida https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3703.mp4 Etapas del VIH / SIDA https://d3imrogdy81qei.cloudfront.net/video_images/6637/hiv-and-aids-stages.jpg Yes 281 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hiv-and-aids-stages https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3703.mp4 HIV and AIDS Stages In this lesson, we're going to take a look at the three stages of HIV infection, as well as explore some common symptoms, and finally, we'll look at the three types of tests that are available to diagnose the infection. When people contract the HIV virus and do not opt for any type of treatment, they will usually progress through all three stages of the disease process – from acute HIV infection to the clinical latency period and ultimately the last phase – AIDS. Stage 1 – Acute HIV Infection Acute HIV infection typically occurs within two to four weeks after the person has been infected with the HIV virus. It usually is accompanied with flu-like symptoms which can last a few weeks, as this is the body's natural response to the infection. People in Stage 1 have large amounts of the HIV virus in their blood and are extremely contagious. To compound problems, people in Stage 1 are often unaware that they even have the infection and may not feel sick immediately or at all. To confirm HIV infection, testing is necessary. And we'll get into more details about these tests later in the lesson. Pro Tip #1: People who suspect that they may have the HIV infection, especially if there's a chance they obtained it through drugs or sex and also have flu-like symptoms, should get tested as soon as possible. Stage 2 – Clinical Latency (HIV Inactivity or Dormancy) Stage 2 is sometimes referred to as the asymptomatic HIV infection period or chronic HIV infection. During this stage of the disease, the HIV virus is still active, but it reproduces at very low levels. A person in Stage 2 may not have any symptoms at all or feel sick in any way. If not treated, this period can last 10 plus years, though some people may progress through this stage faster than others. For those taking medications to treat their HIV, like with antiretroviral therapy (ART), Stage 2 can last several decades. Pro Tip #2: It's important to note that people in Stage 2 can transmit the HIV infection to others. However, if taking medications like ART that suppress the infection, they will likely have very low levels of the virus in their blood, which means they are less likely to transmit the virus than someone not receiving treatment. At the end of Stage 2, the viral load begins to increase and the CD4 cell count begins to decrease. As this happens, the HIV infected person may begin having symptoms that often accompany Stage 3. Stage 3 – Acquired Immunodeficiency Syndrome (AIDS) Stage 3 is obviously the most severe phase of HIV infection. People who have AIDS will have badly damaged immune systems and are more likely to get an increasing number of severe illnesses as a result. These types of illnesses are sometimes referred to as opportunistic illnesses. Without any type of treatment, people in Stage 3 typically survive about three years. A diagnosis of AIDS is confirmed when the CD4 cell count drops below 200 cells/mm or if the person develops one of those opportunistic illnesses mentioned above. People with AIDS will have a high viral load and will be very infectious. Common symptoms of Stage 3/AIDS include: Chills Fever Sweating Swollen lymph glands Weakness Weight loss HIV/AIDS Testing and Diagnosis The only way to know for sure if someone has the HIV infection or AIDS is to get tested. The Centers for Disease Control and Prevention (CDC) recommends that everyone between the ages of 13 and 64 get tested for HIV as part of their routine healthcare checkups. Knowing your HIV status provides you with important information that will help you take the necessary steps to keep you and your partner healthy moving forward. If an individual tests positive for HIV infection, medications and treatment can result in remaining healthy for many more years and greatly reduce the chance of transmitting the disease to their sex partner. And if an individual tests negative, there are more prevention tools available today that can help prevent HIV infection than ever before and keep that person from contracting the disease. HIV and Pregnancy Pregnant women should be tested for HIV and should begin treatment immediately if tests come back positive. If an HIV-positive woman receives treatment for HIV infection early during her pregnancy, the risk of transmitting HIV to her baby can be very low. The 3 Types of HIV/AIDS Tests Available 1. Nucleic Acid Test (NAT) This test looks for the actual HIV virus in the blood and is usually considered very accurate during the early stages of HIV infection. However, this test is quite expensive and not routinely used unless the individual recently had high risk or possible exposure and they're also exhibiting early symptoms of HIV infection. 2. Antigen/Antibody Test This test looks for HIV antibodies and antigens in the blood. An antigen is a part of a virus that triggers an immune response. If you've been exposed to HIV, antigens will show up in your blood before HIV antibodies are made. This test can usually find HIV within two to six weeks of infection. 3. Antibody Test Antibodies are produced by the body in reaction to the presence of a virus. An HIV antibody test measures the presence of antibodies in response to the presence of HIV. The most common HIV antibody tests are ELISA (EIA) and Western Blot. These tests can now be performed on samples of oral (mouth) fluid. https://d3imrogdy81qei.cloudfront.net/video_images/6637/hiv-and-aids-stages.jpg Yes 281 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/prevencion-y-tratamiento-del-vih-sida https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3704.mp4 Prevención y tratamiento del VIH / SIDA https://d3imrogdy81qei.cloudfront.net/video_images/6639/hiv-prevention-and-treatment.jpg Yes 395 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hiv-prevention-and-treatment https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3704.mp4 HIV Prevention and Treatment In this lesson, you'll learn about HIV preventive techniques, regardless of your individual circumstances, and the HIV treatment options that are currently available. And you'll learn a little about how those infected with the disease can still live long and healthy lives. Firstly, all individuals can reduce their risk of HIV infection by making better choices and limiting their exposure simply by using a few prevention techniques. Prevention Techniques Using Condoms For many, this means correct and consistent use of male and female condoms during vaginal and/or anal penetration, which can protect against the spread of sexually transmitted infections, including HIV. Evidence shows that male latex condoms have an 85 percent or greater protective effect against HIV and other sexually transmitted infections (STIs). Testing and counseling for HIV and STIs is vitally important. It is strongly advised for people who have exposure to any of the risk factors. It's also strongly advised that people learn about their infection status (as in getting tested) and access prevention services without delay. The World Health Organization (WHO) recommends testing for partners and couples. They also recommend assisted partner notification approaches for those who have been confirmed to be HIV positive. This helps people with HIV receive support to inform their partners on their own or with the help of a healthcare provider. Tuberculosis Screening Tuberculosis (TB) is the most common presenting illness for people infected with HIV and is also the leading cause of death at around 37 percent. TB is fatal if it goes undetected and untreated. Therefore, early detection and prompt treatment can help prevent those deaths. Symptoms of tuberculosis include: Coughing up blood Fever Chest pain Chills Weight loss Night sweats Chronic cough Lack of appetite Fatigue Pro Tip #1: HIV testing and TB screening is routinely offered at HIV care centers. For anyone who suspects either, they should get tested immediately. If diagnosed, individuals with HIV and active TB should urgently begin effective TB treatment, including for multidrug resistant TB and ART. For individuals with HIV but not active TB, it's wise to pursue TB preventative therapy. Voluntary Medical Male Circumcision (VMMC) VMMC reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percent. VMMC is a key preventative technique that's supported in 15 countries in African with rates of HIV infection and low circumcision rates. This type of prevention is regarded as a good approach to reach men and adolescent boys who don't often seek healthcare services. Antiretroviral (ART) for Prevention Using ARTs, the risk of transmitting the HIV virus to an uninfected partner can be reduced by as much as 96 percent. The WHO recommends the initiation of ART in all people living with HIV, as it can significantly reduce HIV transmission. Pre-Exposure Prophylaxis (PrEP) PrEP is an oral prevention technique that involves the daily use of ARV drugs by HIV-negative people to block the acquisition of HIV. The WHO recommends PrEP as a preventative measure for all people who have a higher than normal risk of HIV infection as part of a combination of preventative approaches. The WHO also expanded their recommendation to include HIV-negative women who are pregnant or breastfeeding. Post Exposure Prophylaxis (PEP) PEP involves the use of ARV drugs within 72 hours of exposure to the HIV virus. PEP also includes counseling, first aid care, HIV testing, and the administration of a 28-day course of ARV drugs with follow up care. The WHO recommends PEP use for both occupational and non-occupational exposures and for both adults and children. Harm Reduction Measures for Drug Users People who inject drugs should take precautions against becoming infected with HIV. These precautions include: Using sterile injecting equipment like needles and syringes Not sharing drug-using equipment and drug solutions Treatment of opioid dependence, particularly opioid substitution therapy HIV testing and counseling HIV treatment and care Risk-reduction education and the provision of naloxone Access to free condoms The management of STIs, TB, and viral hepatitis Elimination of Mother-to-Child Transmission (EMTCT) The transmission of HIV from HIV-positive mothers to their babies during pregnancy, labor, delivery, or while breast feeding is called mother-to-child transmission (MTCT). In the absence of any interventions during these stages, the rates of HIV transmission from mother to child is between 15 to 45 percent. MTCT can be nearly prevented if both mother and baby are provided with ARV drugs as early in the pregnancy as possible and also during breast feeding. HIV Treatment HIV treatment involves taking medications that slow the progression of the virus in the body. HIV-type of viruses are called retroviruses, and drugs that are used to treat them are called antiretrovirals (ARVs). These drugs are always given in combination with other ARVs. This combination approach is what's known as antiretroviral therapy (ART). Although there is no cure for HIV, ART can help keep HIV-infected people healthy for many years and greatly reduce the chances of transmitting HIV to their partners if they are taken correctly and consistently. ART reduces the amount of the virus in the blood (viral load) and body fluids. ART is recommended for all people living with HIV regardless of how long they've had the virus or how healthy they appear and feel. HIV treatment is most successful when those infected know what to expect and are committed to taking their medications exactly as they are prescribed. Working with a healthcare provider on a treatment plan can help those infected manage the disease more effectively. https://d3imrogdy81qei.cloudfront.net/video_images/6639/hiv-prevention-and-treatment.jpg Yes 395 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-la-hepatitis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3705.mp4 ¿Qué es la hepatitis? https://d3imrogdy81qei.cloudfront.net/video_images/6641/what-is-hepatitis.jpg Yes 67 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/what-is-hepatitis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3705.mp4 What is Hepatitis In this lesson, we're going to begin to dig into the various types of hepatitis, of which, you'll learn about in more detail in subsequent lessons. Also in this lesson, we'll provide you with some hepatitis statistics and important information from the Centers of Disease Control and Prevention (CDC) on the three most common types of hepatitis, and at the end of the lesson, we'll go over some medical definitions that you'll encounter in this course. The short definition of hepatitis is: Inflammation of the liver. Hepatitis can merely be a self-limiting condition – an illness or condition which will either resolve on its own or which has no long-term harmful effect on a person's health – or it can progress into other health problems like fibrosis (scarring), cirrhosis of the liver, and liver cancer. The Five Types of Hepatitis There are five types of hepatitis and some of them are more common than others. The five types, thankfully, are referred to with letters, rather than long, impossible to pronounce medical terms. Those types are A, B, C, D, and E. Pro Tip #1: The important takeaway from this lesson is this – hepatitis is a serious concern and should be taken seriously. Hepatitis can lead to illness and even death. And it has the potential for outbreaks, as in spreading in an epidemic way. Hepatitis B and C are likely the types of hepatitis you've heard the most about, as these are the two most common types. Hepatitis B and C lead to chronic disease in hundreds of millions of people around the world, and together, are the most common cause of liver cirrhosis and liver cancer. What Causes Hepatitis? The most common cause of hepatitis are the hepatitis viruses themselves. However, coming into contact with these viruses isn't the only way you can contract hepatitis. Other possible causes include: Getting other infections Ingesting toxic substances like alcohol and certain drugs Having an autoimmune disease Ingesting contaminated food or water (Hepatitis A and E) Hepatitis Statistics in the United States According to the CDC, these are the number of cases reported of Hepatitis types A, B, and C in the U.S. for the year 2017. Pro Tip #2: Acute simply means sudden, severe, or short term, while chronic means long-lasting or long-term. These are terms you'll hear often throughout this course.   Acute Chronic Hepatitis A 6700 cases not applicable There is a vaccine for this type of Hepatitis and the main mode of transmission is the oral ingestion of fecal matter, or in other words, not washing properly after using the bathroom. Hepatitis B 22,200 862,000 There is also a vaccine for Hepatitis B and the main causes are through sex and exposure to bloodborne pathogens. Hepatitis C 44,700 2.4 million There is no vaccine for Hepatitis C and the main cause of the disease is by coming into contact with a bloodborne pathogen. A Word About Definitions in this Course As you're a body artist and not a medical doctor, nurse, or paramedic, we don't expect you to know the definitions of all the words you'll encounter in this course. However, knowing a few important ones could mean the difference between properly ingesting the information and glossing over it and retaining very little. Blood Blood refers to not only human blood, but also human blood components, and products made from human blood. Bloodborne Pathogens Bloodborne Pathogens refers to the pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, the hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Contaminated Contaminated refers to the presence, or the reasonably anticipated presence, of blood or other potentially infectious materials on an item or surface. Contaminated Sharps Sharps refers to any item that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, etc. Contaminated sharps are those sharp items that have been contaminated. Decontamination Decontamination refers to the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Engineering Controls Engineering Controls refers to certain controls (sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace. Exposure Incident Exposure Incident refers to specific eyes, mouths, other mucous membranes, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Parenteral Parenteral refers to the act of piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions. Personal Protective Equipment (PPE) Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment. Regulated Waste Regulated Waste refers to liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. Source Individual Source Individual refers to any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components. Sterilize Sterilize refers to the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. Work Practice Controls Work Practice Controls refers to controls that reduce the likelihood of exposure by altering the manner in which a task is performed (prohibiting recapping of needles by a two-handed technique). https://d3imrogdy81qei.cloudfront.net/video_images/6641/what-is-hepatitis.jpg Yes 67 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-hepatitis-a https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3706.mp4 ¿Qué es hepatitis A? https://d3imrogdy81qei.cloudfront.net/video_images/6643/what-is-hepatitis-a.jpg Yes 288 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/what-is-hepatitis-a https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3706.mp4 What is Hepatitis A In this lesson, we'll be going in-depth into all things Hepatitis A, including what it is, who's at risk, how common it is in the U.S., how it's transmitted, the signs and symptoms, how it's diagnosed, treatment options, and saving the best for last – how to prevent it. What is Hepatitis A? Hepatitis A is a highly contagious liver infection that is caused by the Hepatitis A virus (HAV). The virus can be found in the feces of people who are infected with the virus and is most often transmitted through the consumption of food and water. Most people in areas of the world that have poor sanitation have been infected with the Hepatitis A virus. The infection does not cause chronic liver disease and is rarely fatal. However, the Hepatitis A virus can cause debilitating symptoms of fulminant Hepatitis (acute liver failure), which IS often fatal. Who is Most at Risk of Getting Hepatitis A? The chances of contracting Hepatitis A really depend on your environment and your associations with others. Those most at risk include: People with direct contact with someone who has Hepatitis A Travelers to countries where Hepatitis A is common Men who have sexual contact with other men People who use drugs, whether they are injectable or non-injectable Household member and caregivers of recent adopted children from countries where Hepatitis is prevalent People with clotting factor disorders, such as hemophilia People who are working with nonhuman primates How Common is Hepatitis A in the U.S.? In 2015, there were an estimated 2800 Hepatitis A cases in the U.S. alone, and since sanitation and hygiene are much better in the U.S. than in many other countries, you would expect those numbers to be significantly higher in developing areas around the world. Pro Tip #1: Hepatitis A rates have declined by more than 95 percent since the Hepatitis A vaccine first became available in 1995. Those who do have a higher risk of becoming infected with Hepatitis A may want to consider getting vaccinated. It should be noted that children in the U.S. are routinely vaccinated between their first and second birthdays. How is Hepatitis A Transmitted? The Hepatitis A virus is transmitted primarily by the fecal-oral route. The fecal-oral route (also called the oral-fecal route or orofecal route) describes a particular route of transmission of a disease wherein pathogens in fecal particles pass from one person to the mouth of another person. In other words, this usually occurs when an uninfected person ingests food and/or water that has been contaminated with the feces of an infected person. Which is why mothers everywhere always ask, did you wash your hands? A Special Point About Food and Water Contamination It's not just undercooked or raw foods that can become contaminated with the Hepatitis virus. In fact, food can become contaminated with the virus at any point on its journey from seed to food, and this includes: During the growing process During the harvesting process During the processing process While being handled After cooking Even while frozen As Hepatitis A relies on dirty conditions to thrive, areas of the world where there are poor sanitary conditions or poor personal hygiene are prime environments for contracting Hepatitis A. Also, Hepatitis A can be transmitted through close personal contact with someone who is infected with the virus, such as having sexual contact or caring for someone who is ill with the disease. What are the Signs and Symptoms of Hepatitis A? Before getting into the signs and symptoms of Hepatitis A, it's worth noting that the incubation period for the disease is between 15 and 50 days, with 28 days being the average incubation period. The signs and symptoms of Hepatitis A can range from mild to severe and include: Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Clay colored stools Joint pain Jaundice (yellowing of the skin) Pro Tip #2: Just because you don't have all the symptoms doesn't necessarily mean you haven't been infected with the virus. Not everyone, particularly adults, will have all of these symptoms. However, adults will generally have more than children. Infected children under the age of six will not usually show any symptoms associated with Hepatitis A, and only 10 percent of them will develop jaundice. However, among older children and adults, the infection will usually cause jaundice, along with other more severe symptoms, in 70 percent of the cases. Also noteworthy is that the severity of the disease plus fatal outcomes are both higher in older age groups. How is Hepatitis A Diagnosed? The problem is that cases of Hepatitis A are not clinically distinguishable from other types of acute viral Hepatitis. A specific diagnosis is made by the detection of HAV-specific Immunoglobulin (IgM) antibodies in the blood of those suspected of having the virus. Another diagnostic test is the reverse transcriptase polymerase chain reaction. Reverse transcription polymerase chain reaction is a laboratory technique combining reverse transcription of RNA into DNA and amplification of specific DNA targets using polymerase chain reaction … just in case you were interested. How is Hepatitis A Treated? Sadly, there are no specific (as in good) treatments for Hepatitis A. recovery from symptoms following infection is often slow and may take several weeks or months, which makes vaccination all the more appealing of an option. Instead, therapies are usually aimed at maintaining comfort and adequate nutritional balance, including the replacement of fluids that are lost from vomiting and diarrhea. How is Hepatitis A Prevented? The most effective ways to prevent Hepatitis A include: Improved sanitation• Proper community sewage disposal Following food safety recommendations Immunization Adequate supplies of safe water Personal hygiene practices• Regular handwashing with safe water And in case you're not entirely sure how to wash your hands, not to worry; we have a whole lesson devoted to just that coming up later. https://d3imrogdy81qei.cloudfront.net/video_images/6643/what-is-hepatitis-a.jpg Yes 288 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/detalles-de-la-hepatitis-b https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3707.mp4 Detalles de la hepatitis B https://d3imrogdy81qei.cloudfront.net/video_images/6645/hepitits-b-details.jpg Yes 666 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/hepatitis-b-details https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3707.mp4 Hepatitis B Details In this lesson, we'll be covering everything to do with Hepatitis B including what it is, the various classifications, who is most at risk, how common it is in the U.S., how it's transmitted, the signs and symptoms, how it is diagnosed, and treatment and prevention options. What is Hepatitis B? Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause both acute and chronic infections, it's very contagious, and it can be easily spread from one person to another. Hepatitis B Classifications There are two classifications of Hepatitis B: acute and chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first six months after exposure to the virus. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in the body. Who is Most at Risk for Hepatitis B? People most at risk of getting Hepatitis B include: People who have sex with an infected person People with multiple sex partners People who have a sexually transmitted disease Men who have sex with other men People who share injectable drugs, needles, syringes, and other drug equipment People who live with an infected person Infants born to infected mothers People who are exposed to blood at work Hemodialysis patients People who travel to countries with moderate to high rates of infection How Common is Hepatitis B in the U.S.? Acute Hepatitis B Since routine vaccinations have been available, rates of acute infections have declined by approximately 82 percent since 1991 and have dramatically declined particularly among children. In 2015, there were an estimated 19,200 new cases of Hepatitis B virus infections, though the actual number is likely much higher since many people don't know they're infected, don't have symptoms, and have never been tested. Chronic Hepatitis B It is estimated that between 850,000 and 2.2 million people in the U.S. have a chronic infection. And globally, approximately 240 million people are infected, contributing to around 786,000 deaths each year. How is Hepatitis B Transmitted? Hepatitis B is spread when blood, semen, and other body fluids infected with the virus enters the body of a person not infected. People can become infected during activities like: Birth, as it can be spread from mother to child Sex with an infected partner Sharing needles, syringes, and other drug-injection equipment Sharing items like razors and toothbrushes with infected people Direct contact with blood or open sores of an infected person Exposure to blood from needlesticks and other sharp instruments The incubation period is between 45 and 160 days with 120 days being average. Signs and Symptoms of Hepatitis B Acute Hepatitis B Signs and symptoms of acute infection include: Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Clay colored bowel movements Jaundice (yellow skin or eyes) Pro Tip #1: Symptoms usually last a few weeks; however, some people can be ill for as long as six months. Chronic Hepatitis B Some people have ongoing symptoms similar to acute Hepatitis B but most individuals with a chronic infection remain symptom free for as long as 20 or 30 years. Around 15 to 25 percent of people with a chronic infection develop serious liver conditions like cirrhosis (scarring) or liver cancer. Pro Tip #2: Even as the liver becomes diseased, some people still won't have symptoms. However, certain blood tests for liver function may show abnormalities. How is Hepatitis B Diagnosed? The number one way to diagnose Hepatitis B is with a blood test. And there are a number of those available. Hepatitis B Surface Antigen (HBsAg) Test This test looks for Hepatitis B Surface Antigens, a protein on the surface of the Hepatitis B virus. It can be detected in the blood during an acute or chronic infection. The body normally produces antibodies to HBsAg as part of the immune response to the infection. A positive test means that a person has acute or chronic Hepatitis B and it can be spread to others. A negative test means there is no sign of the virus in the blood. Hepatitis B Surface Antibody (anti-HBs) Test This is an antibody that is produced by the body in response to the Hepatitis B Surface Antigen. A positive test means that the person is protected or immune from getting the virus for one or two reasons: 1. The person was successfully vaccinated.2. The person had an infection and recovered from it, meaning they can't get it again. Total Hepatitis B Core Antibody (anti-HBc) Test This is an antibody that is produced by the body in response to a part of the Hepatitis virus called a core antigen. The meaning of this test often depends on the results of two other tests – anti-HBs and HBsAg. A positive test means the person is currently infected with the virus or was infected in the past. IgM Antibody Core Antigen (IgM anti-HBc) Test This test is used to detect an acute infection. A positive test means the person was infected with the virus within the last six months. Hepatitis B “e” Antigen (HBeAg) Test This is a protein found in the blood when the virus is present during an active infection. A positive test means the person has high levels of the virus in their blood and can easily spread it to others. The test is also used to monitor the effectiveness of treatment for chronic Hepatitis B. Hepatitis B e Antibody (HBeAb or anti-HBe) Test This is an antibody produced by the body in response to the Hepatitis B “e” antigen. A positive test means the person has a chronic infection but is also at a lower risk of liver problems, as they have low levels of the virus in their blood. Hepatitis Viral DNA Test This test is used to detect the presence of the virus DNA in the person's blood. A positive test means the virus is multiplying in the body, which means the person is highly contagious and can spread the virus to others more easily. If a person has a chronic infection, the presence of viral DNA means they are possibly at an increased risk for liver damage. The test is also used to monitor the effectiveness of drug therapy for chronic Hepatitis B virus infection. Hepatitis B Treatment Options Acute Hepatitis B Sadly, no medications are available to treat an acute infection. The best treatment options are focused on support. Therefore, during an acute infection, doctors recommend: Rest Adequate nutrition Fluids Possibly hospitalization Chronic Hepatitis B Treatment options for a chronic infection include: Regular monitoring for signs of liver disease progression Oral medications (oral antiviral agents) like Tenofovir and Entecavir – the most potent drugs on the market to suppress the virus and rarely leading to drug resistance. Hepatitis B Prevention The first line of defense is vaccination. The hepatitis vaccine includes a sequence of shots that stimulate a person's natural immune system to protect against HBV. After it's given, the body makes antibodies that protect against the virus. The vaccine is recommended for: All infants starting with a first dose at birth All adolescents and children under the age of 19 who have not been vaccinated People who are sex partners with those infected with the virus People who have multiple sex partners People who have a sexually transmitted disease Men who have sex with other men People who share needles, syringes, and other drug-injecting equipment People with close household contact with an infected person Healthcare and public safety workers who are at risk of exposure to blood or contaminated body fluids People with end-stage renal disease including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients Residents and staff of facilities for developmentally disabled people Travelers to regions where there is moderate to high rates of infection People with chronic liver disease People with HIV infection Anyone who wants to be protected from the virus Vaccinations are also recommended for anyone who works at: Sexually transmitted disease treatment facilities HIV testing and treatment facilities Facilities providing drug abuse treatment and prevention services Healthcare settings that target services to injection drug users Healthcare settings targeting services to men who have sex with other men Chronic hemodialysis facilities and end-stage renal disease programs Correctional facilities Institutions and nonresidential day care facilities for developmentally disabled people https://d3imrogdy81qei.cloudfront.net/video_images/6645/hepitits-b-details.jpg Yes 666 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-el-herpes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3708.mp4 ¿Qué es el herpes? https://d3imrogdy81qei.cloudfront.net/video_images/6647/what-is-herpes.jpg Yes 598 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/what-is-herpes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3708.mp4 What is Herpes In this lesson, we're going to look at herpes, including some shocking statistics, the two types of herpes, how it's transmitted, how it's diagnosed, treatment options, and how to prevent herpes. The herpes infection is caused by the herpes simplex virus (HSV). There are two categories or types of herpes – herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Herpes simplex virus type 1 refers mainly to oral herpes, which appears mostly as cold sores. Herpes simplex virus type 2 refers to genital herpes. Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes HSV-1 is highly contagious and is a larger problem around the world than most would think. Most HSV-1 infections are acquired during childhood and infection is lifelong. Also, most HSV-1 infections are oral herpes (rather than genital) that occur in and around the mouth. The incidence rates of HSV-1 are profound. In 2012, there were an estimated 3.7 billion people worldwide under 50 years of age with the infection. The highest area of prevalence was in Africa, at around 87 percent of the population. The lowest area of prevalence was in the Americas, at between 40 and 50 percent. In 2012, there were 140 million people between the ages of 15 and 49 with the genital version of HSV-1 and prevalence once again varied by region. Most genital HSV-1 infections occurred in the Americas, Europe, and the Western Pacific region, where it continues to be acquired well into adulthood. In other regions, like Africa, most HSV-1 infections are acquired in childhood, well before the age that most begin having sexual contact. Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes – How is it Transmitted? This infection is mostly transmitted by mouth to mouth contact via sores, saliva, and surfaces in and around the mouth. The other mode of transmission is oral to genital contact, which is the cause of genital type 1 herpes. Pro Tip #1: HSV-1 can be transmitted from oral or skin surfaces that appear normal and healthy, as in an absence of signs and symptoms. However, it's equally important to know that the greatest risk of becoming infected is when there is the presence of obvious and active sores. Individuals who already have HSV-1 oral herpes are unlikely to also be infected with HSV-1 genital herpes. In rare circumstances, an infection can be transmitted from mother to baby during birth. The incubation period for HSV-1 oral herpes is between 2 and 12 days. Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes – Signs and Symptoms There are often no signs and symptoms of HSV-1 oral herpes. However, if there are, those symptoms include: Tingling, itching, and burning sensation around the mouth prior to sores appearing Painful blisters and open sores in and around the mouth, such as cold sores Clusters or groups of painful blisters that ooze clear, yellowish fluid that will crust over This type of infection comes and goes, and the frequency of recurrences varies from person to person. Oral symptoms, in particular, can result in intense pain at the onset of infection, making eating and drinking difficult. Symptoms can appear on lips, gums, the front of the tongue, inside the cheeks, in the throat, and on the roof of the mouth. Gums can become mildly swollen and red and may bleed. Symptoms aren't limited to the oral areas and can extend down the chin and neck. Lymph nodes in the neck are often swollen and painful. For people in their teens or 20s, sore throats with swollen sores and a grayish coating on the tonsils are also common symptoms. Pro Tip #2: Herpes is highly communicable (easily transmitted to others). The secretion of the virus in saliva can occur for up to seven weeks after recovery from stomatitis – inflammation of mouth and lips. And people with primary genital lesions are infectious for 7-10 days. Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes HSV-2 is also widespread around the world and is almost exclusively sexually transmitted and the main cause of genital herpes, though as you've just learned the HSV-1 virus can also cause genital herpes. Infection with HSV-2 is also lifelong and incurable. The incidence rates of HSV-2 are just slightly less shocking than HSV-1. Annually, 776,000 people in the U.S. get a new HSV-2 herpes infection. Slightly more than 15 percent of people ages 14 to 49 have an HSV-2 infection. HSV-2 is more common for women than men (20.3 percent vs. 10.6 percent) as genital infection is more easily transmitted from men to women. Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes – How is it Transmitted? This type of herpes is mainly transmitted during sex through contact with genital surfaces, skin, sores, or fluids of someone infected with the virus. HSV-2 can be transmitted from skin in or around the genitals and anal area that appears normal and symptom-free. And in rare circumstances, it can be passed from mother to baby during birth. The incubation period for HSV-2 genital herpes is between 2 and 12 days. Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes – Signs and Symptoms Like HSV-1, HSV-2 can also be present without any symptoms at all or just mild symptoms that go unnoticed or are mistaken for something else. When symptoms are present, they include: One or more small blisters on or around the genitals, rectum, or mouth Fever Body aches Swollen lymph nodes Headache Pro Tip #3: The first outbreak usually includes longer-lasting symptoms (like sores or lesions) and a greater chance of transmitting the infection to others. Symptoms of recurrent outbreaks also include: Localized genital pain and tingling Shooting pain in the legs, hips, and buttocks Recurrent symptoms can occur hours or days before the eruption of lesions, which are typically shorter in duration and less severe than the first outbreak. How is Herpes Diagnosed? HSV-1 (Oral Herpes) HSV-1 diagnosis is done through an Immunosorbent Assay (ELISA) test. This is a blood test that looks for antibodies to the HSV-1 virus in the blood. This is a highly sensitive test and will only detect the presence of HSV-1 antibodies. HSV-2 (Genital Herpes) HSV-2 diagnosis is done using a Polymerase Chain Reaction (PCR) test. This test produces rapid and accurate results and is increasingly being used. A viral culture requires a sample from a lesion and if viral growth is found, a procedure will differentiate the HSV-1 virus from the HSV-2 virus. Pro Tip #4: With the shocking statistics presented in this lesson, you may be inclined to be tested immediately. However, the CDC does not recommend screening for the general population. Having said that, there are several scenarios where HSV tests may be recommended and these include: People with recurrent genital symptoms People with a clinical diagnosis of genital herpes even though lab tests have not been done to confirm an infection People who have a sex partner with herpes People who have another STD or have multiple sex partners People who have HIV What are the Treatment Options for Herpes? As already mentioned, there is no cure for either type of herpes. However, antiviral medications can prevent or shorten outbreaks for those who are infected. Also, antiviral medications can reduce the chance of spreading the disease to others. At this time, there is no commercially available vaccine to protect against either herpes virus. What are the Prevention Techniques for Herpes? Herpes prevention looks like a recipe for becoming a Buddhist monk and includes: For HSV-1 (Oral Herpes) Avoid oral contact with others and sharing objects that come in contact with saliva Abstain from oral sex to avoid the transmission of herpes to the genitals of all sex partners For HSV-2 (Genital Herpes) Abstain from sexual contact Be in a long-term, mutually monogamous relationship with sex partners who have been tested and shown to be uninfected https://d3imrogdy81qei.cloudfront.net/video_images/6647/what-is-herpes.jpg Yes 598 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-el-molusco-contagioso https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3709.mp4 ¿Qué es el molusco contagioso? https://d3imrogdy81qei.cloudfront.net/video_images/6649/molluscum-contagiosum.jpg Yes 391 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/molluscum-contagiosum https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3709.mp4 Molluscum Contagiosum In this lesson, we'll be diving into molluscum contagiosum, a condition most of you are probably not familiar with in the slightest. We'll predictability provide information on what it is, who's most at risk, how it's transmitted, the signs and symptoms, how it's diagnosed, as well as treatment options and prevention strategies. Molluscum is an infection caused by a poxvirus (molluscum contagiosum virus) that usually results in a benign, mild skin disease with lesions that can appear anywhere on the body. The good news is that molluscum is self-resolving, which means it typically goes away on its own. Lesions are small, raised, and usually white, pink, or flesh colored. They have a dimple or pit in the center, are smooth and firm, and can range in size from 2-5mm, or about the size of a pinhead to the size of a pencil eraser. Mollusca can appear alone or in groups and can occur anywhere on the body, including the face, neck, arms, legs, abdomen, and genitals. However, they are rarely found on the palms and soles of the feet. Who is Most at Risk? Molluscum is most common in, but not limited to, children between the ages of one and 10 years of age. People with weakened immune systems (HIV, cancer) are also at risk, and the growths for these individuals may be larger and more difficult to treat. People with atopic dermatitis are also at risk, due to breaks in the skin, as are people who live in warm, humid climates with crowded living conditions. How is Molluscum Transmitted? There are a few ways that molluscum is transmitted including: Person to person contact, including sexual contact By touching contaminated objects Shaving and electrolysis Pro Tip #1: Molluscum is easily spread to other areas of the body by touching or scratching lesions then touching somewhere else, which is known as autoinoculation. The virus remains on the top layer of skin (epidermis) and does not circulate throughout the body. Once lesions are gone, so too is the virus. And when that happens, it cannot be spread to others. The incubation period for molluscum is from two weeks to six months. Signs and Symptoms of Molluscum Molluscum appears as a small, pearly-white bump on the skin with a central depression, possibly secreting a white cheesy substance. Lesions are between 2-5mm, usually painless and may become inflamed, red, and swollen. These bumps will usually disappear spontaneously within six to 12 months but could linger for up to four years. Most cases involve children over the age of one, and there is only one known case of an infant becoming infected. How is Molluscum Diagnosed? Lesions are classified in one of three ways: Lesions that are found on the face, trunk, and limbs of a child. Sexually transmitted lesions on the abdomen, inner thighs, and genitals of sexually active adults. Diffuse, recalcitrant eruptions on people with AIDS and other immunosuppressive disorders. The period of communicability is unknown but likely lasts as long as lesions persist. Molluscum Treatment Options Because molluscum is self-limiting in healthy people, treatment is usually not necessary. However, issues such as lesion visibility, underlying atopic diseases, and the desire to prevent transmission may prompt treatment. And treatment is usually recommended if lesions are in the genital area. Treatment consists of medications or physical removal by the following means: Cryotherapy – freezing with liquid nitrogen Cutting, scraping, or scooping Laser therapy Pro Tip #2: Under the heading of don't try this at home, physical removal requires a trained healthcare provider. Anesthesia may be required, and removal can result in pain, irritation, and scarring. Oral cimetidine (medication) is an alternative treatment for small children who are afraid of the pain associated with removal or because of the avoidance of scarring. It should be noted that facial Mollusca don't respond as well to this treatment as do lesions elsewhere on the body. Prevention of Molluscum The best way to prevent molluscum is to follow good hygiene habits. The virus only lives on the skin. Once lesions are gone, the virus is gone and cannot be spread to others. Handwashing is the best line of defense, as it removes the germs that may have been picked up from other people or surfaces with germs on them. Pro Tip #3: Do not touch, scratch, or pick at lesions. Doing so can spread the virus to other parts of the body and other people who come in contact with you. It's also important to keep lesions clean and covered at all times, and it's a good idea to keep them dry as well. Be especially careful during sporting activities, like taking part in contact sports like football, wrestling, and basketball. And don't share equipment like towels, clothing, swimsuits, baseball gloves, helmets, and personal items like hairbrushes, wrist watches, and bar soap if you have an infection. If you have lesions around the genitals – penis, vulva, vagina, and anus – avoid sexual contact until after seeing a healthcare provider. https://d3imrogdy81qei.cloudfront.net/video_images/6649/molluscum-contagiosum.jpg Yes 391 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/la-tina https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3710.mp4 La tiña https://d3imrogdy81qei.cloudfront.net/video_images/6653/ringworm.jpg Yes 415 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/ringworm https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3710.mp4 Ringworm In this lesson, you'll be learning all about ringworm – what it is, who is most at risk, signs and symptoms, along with the customary treatment options and prevention techniques. Ringworm is a common infection of the skin and nails that are caused by a fungus. The infection is called ringworm because it causes an itchy red circular red rash. However, there are also different types of ringworm that have a variety of names based on the location. In fact, there are approximately 40 different species of fungi that can cause ringworm. Areas of the body that can be affected by ringworm include: Feet Hands Fingernails and toenails Groin area – inner thighs, buttocks, etc. Scalp Beard area on face and neck Arms and legs Who is Most at Risk? You have a higher risk of getting ringworm if you: Live in a warm climate Have close contact with an infected person or animal Share clothing, bedding, or towels with an infected person Participate in sports with skin-to-skin contact, such as wrestling Wear tight or restrictive clothing Have a weakened immune system Ringworm is a fungal infection caused by mold-like parasites that live on cells in the outer layer of the skin. And it can be spread in the following ways: Human to human through skin-to-skin contact with an infected person. Animal to human by touching an animal with ringworm, such as petting or grooming dogs and cats. It's also fairly common in cows. Object to human by contact with infected objects, surfaces, etc. Soil to human by contact with infected soil, though this is rare and requires prolonged exposure. The incubation period is between four and 14 days after exposure. Signs and Symptoms of Ringworm Ringworm can affect the skin on almost any area of the body, as well as fingernails and toenails. The symptoms typically depend on the body part affected but generally include: Itchy skin Ring-shaped rash Red, scaly, cracked skin Hair loss There are two different classifications of ringworm lesions – classic and severe. Classic lesions – a raised, scaly ring with a central clearing Severe lesions – scalier in nature, more like a superimposed bacterial infection The symptoms and type of ringworm depend on the location of the body affected. Feet – ringworm on the feet is known as athlete's foot and is known by red, swollen, peeling, itchy skin between the toes, particularly the pinky toe and the toe next to it. The soles and heels can also be affected, and in severe cases, the skin can blister. Scalp – also known as tinea capitis, it appears as scaly, itchy, red, circular bald spots that can grow in size. There can be multiple spots if the infection spreads, and this type is more common in children. Groin – also known as jock itch, it also appears as scaly, itchy, red spots, usually on the inner thighs. Beard – also known as tinea barbae, it also appears as scaly, itchy, red spots on the cheeks, chin, and upper neck. The spots can crust over or be filled with pus. Affected areas may result in hair falling out. Ringworm Diagnosis There are a few ways to diagnose ringworm. By physical exam, including a thorough patient history. This is usually sufficient. By microscopy using a potassium hydroxide (KOH) stain using scrapings from a lesion placed in a drop of KOH and examined under a microscope for the presence of fungal hyphae. It's inexpensive, easy to perform, and highly sensitive. By ultraviolet light, known as a Wood's lamp. This test is not normally useful; however, it is for two uncommon species – microsporum canis and audouinii. By culture, using a fungal culture test to confirm a diagnosis if other tests are inconclusive. This test is more specific that the KOH stain, but it takes up to three weeks for results. The period of communicability – a person can spread ringworm as long as lesions are present, and the presence of a viable fungus persists on contaminated surfaces and materials. Ringworm Treatment Options Treatment depends on the location of the ringworm and the severity. Some forms can be treated using over-the-counter (OTC) medications, while others require a prescription medication, which will be stronger. Ringworm on the skin, such as athlete's foot and jock itch, can usually be treated with OTC antifungal creams and powders, typically applied for two to four weeks. Pro Tip: Ringworm on the scalp often needs to be treated with prescription antifungal medications taken orally. Creams, lotions, and powders will not work for this form of ringworm. Healthcare providers should be contacted if this type of infection gets worse or doesn't go away. Ringworm Prevention Techniques For athletes involved in close-contact sports, they should: Shower immediately after practice or competition Keep all gear and uniforms clean Not share gear and uniforms with others For everyone else who wants to avoid getting ringworm, they should: Keep their skin clean and dry Wear shoes that allow air to circulate around the feet Not walk barefoot in locker rooms and public showers Keep finger and toenails short and clean Change their socks and underwear daily Not share clothing, bedding, and towels with someone who has ringworm Wash their hands with soap and water after touching animals, and if you suspect your animal has ringworm, take it to the vet immediately https://d3imrogdy81qei.cloudfront.net/video_images/6653/ringworm.jpg Yes 415 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/la-sarna https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3711.mp4 La sarna https://d3imrogdy81qei.cloudfront.net/video_images/6651/scabies.jpg Yes 360 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/scabies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3711.mp4 Scabies In this lesson, we'll be digging into all things scabies related – what it is (the digging into will make more sense then), a common type of scabies, how it's transmitted, the signs and symptoms, how it's diagnosed, and the various ways to prevent and treat scabies. What is Scabies? Scabies is a contagious infestation of the skin by human itch mites, otherwise known as, for you Latin-speaking students, sarcoptes scabiei var. hominis. The microscopic scabies mite burrows (or digs) into the upper layer of your skin where it then decides to hunker down, live, and lay some eggs. Scabies infestations are frequently complicated by the presence of bacterial infections, leading to the development of skin sores that can cause more serious conditions such as septicemia, heart disease, and chronic kidney disease. Scabies represents one of the most common dermatological conditions and skin diseases for those living in developing countries. Crusted Norwegian Scabies This severe form of scabies involves the presence of thick crusts of skin that contain large numbers of scabies mites and eggs. It's very contagious and can easily be spread to others by direct skin to skin contact or by contact with items like bedding, clothing, and furniture. And it might not show the usual symptoms – rash and itching. Pro Tip #1: People with crusted scabies should receive quick and aggressive medical treatment to prevent further infestations and outbreaks. You'll recognize it by the crustiness of the skin around the infestations. Crusted scabies can more easily occur in the following groups of people: Those with weakened immune systems The elderly The disabled The debilitated How is Scabies Transmitted? Pro Tip #2: Scabies is usually spread by direct and prolonged skin to skin contact with someone who has been infested. It generally must be prolonged. For this reason, it's spread easily and frequently to sex partners. Scabies can also be spread among household members who aren't sexually active, though less so, by sharing or touching infested items like clothing, bedding, furniture, etc. The incubation period for scabies is between two and six weeks after being infested. It should be noted that a person infested with scabies can spread the condition to others during this time and even when no symptoms are present. The period of communicability lasts until all mites and eggs have been destroyed by treatment, which usually consists of two courses of treatment one week apart. Itching can still persist for two more weeks following the successful eradication of mites and eggs. Signs and Symptoms of Scabies Pro Tip #3: For anyone who has previously had scabies, signs and symptoms can appear much sooner – one to four days after exposure. Common scabies symptoms include: Severe itching, especially at night (earliest and most common symptom) Pimple-like rash is also quite common Scabies can affect much of the body, or it can be limited to common areas, such as: Between fingers Wrists Armpits Penis Nipples Waist Buttocks Shoulder blades How is Scabies Diagnosed? Diagnosis is usually done by appearance – the distribution of a rash and the presence of burrows (where scabies mites make their home in the skin). Diagnosis is usually confirmed by the identification of mites, mite eggs, and mite fecal matter and can be done by carefully removing a mite from the end of its burrow using the tip of a needle, or by scraping the skin. It's then examined under a microscope. It's important to understand that a person can still be infested with scabies even if no mites, eggs, or fecal matter are found. Typically, there are fewer than 10 to 15 mites present on an entire body of an infested person. However, for those with crusted scabies, there can literally be thousands of mites. It should go without saying, that anyone with crusted scabies is highly contagious. Scabies mites can live on a person for as long as one to two months and off a person for usually not longer than 48 to 72 hours. And mites will die if they are exposed to temperatures greater than 50 C and 122 F for at least 10 minutes. Scabies Treatment The main treatment for scabies is scabicide (in lotion or cream). This is the most common medication used to kill scabies mites and some even kill the eggs. It must be applied all over the body, from head to toe. It's only available with a doctor's prescription, and all people in the same household should be treated at the same time to avoid reinfestation. There are over-the-counter lotions and creams used to treat scabies, but these have not been tested or approved. Warning: For infants, ONLY permethrin or a sulfur ointment should be used. Scabies Prevention and Control Scabies is prevented by avoiding direct skin-to-skin contact with an infected person or with the items that an infected person has used, like bedding, clothing, and such. Also, all bedding and clothing worn or used by an infected person three days prior to completing treatment should be machine washed with hot water and a hot dryer cycle, or dry cleaned. Items that cannot be washed or dry cleaned can be disinfested by storing them in closed plastic bags for several days to one week. Scabies mites will not usually survive more than two to three days away from human skin. Institutional outbreaks of scabies can be difficult to control and require swift and aggressive treatment to avoid further spread. Rooms used by people with crusted scabies should be thoroughly cleaned and vacuumed. And environmental disinfestation using pesticides sprays or fogs are usually not necessary and discouraged. https://d3imrogdy81qei.cloudfront.net/video_images/6651/scabies.jpg Yes 360 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-la-tuberculosis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3712.mp4 ¿Qué es la tuberculosis? https://d3imrogdy81qei.cloudfront.net/video_images/6655/tuberculosis.jpg Yes 496 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/tuberculosis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3712.mp4 Tuberculosis In this lesson, we'll be looking deeper into tuberculosis (TB). We'll examine what the disease is, the two TB-related conditions, who is most at risk, the incidence rate in the U.S., how it's transmitted, and the treatment options and preventative measures people most at risk can take. TB is caused by a bacterium appropriately called mycobacterium tuberculosis. The bacteria usually attack the lungs, but it can also attack any part of the body including the kidneys, brain, and spine. TB is one of the world's deadliest diseases (though not in the U.S.), and while very contagious, it's also curable and preventable. TB-Related Conditions There are two TB-related conditions: 1. Latent TB Infection (LTBI) LTBI is present when an infected person has the TB germs in the body but isn't sick due to the germs not being active. There are usually no symptoms of TB disease and that person cannot spread the disease to others. However, that same person could still develop TB disease in the future. Often, treatment is given to prevent the person from developing TB disease. 2. TB Disease TB disease is present when the TB germs are active. In these situations, the germs multiply and destroy tissue in the body. Symptoms are usually present. People with TB disease in the lungs and throat can spread the TB germs to others and are also prescribed treatment, usually drugs. Who is Most at Risk? There are two groups of people most at risk of getting TB. 1. People recently infected with TB bacteria People who have come in close contact with a person infected with the TB bacteria, people who have immigrated from high-rate areas around the world, and children under the age of five who have tested positive for the TB bacteria are most at risk. People with high rates of TB transmission include: Homeless people Injection drug users People who have HIV People working in or living in places where there are high-risk individuals:• Hospitals• Homeless shelters• Correctional facilities• Nursing homes• Residential homes for people with HIV 2. People with medical conditions that weaken the immune system Those with weakened immune systems are particularly vulnerable, and this includes babies and younger children. Others who typically have weakened immune systems include: People who have HIV Substance abusers People with silicosis People with severe kidney disease People with low bodyweight People with diabetes mellitus Organ transplant recipients People with head or neck cancer People on corticosteroids People receiving specialized treatments for rheumatoid arthritis and Crohn's disease Incidence Rates in the U.S. Incidence rates of TB in the U.S. are low. In 2016, there were only a total of 9272 TB cases reported, which represents a decrease of 2.9 percent from 2015. The national incidence rate is 2.9 cases per 100,000 people, which also represents a decrease from 2015 of 3.6 percent. How is TB Transmitted? The TB bacteria is spread by airborne transmission, meaning through the air from one person to another. The bacteria are put into the air when a person with TB in the lungs and throat cough, speak, or sing. People in the vicinity then breathe in that bacteria and become infected. The bacteria settle in the lungs and begin to grow. They can then move through the blood to other parts of the body, namely the kidneys, brain, and spine. Pro Tip #1: It's equally important to know how TB is NOT transmitted: by shaking hands, sharing food and drink, contact with bed linens or toilet seats, using toothbrushes, or kissing. It's passed via airborne transmission only. Signs and Symptoms of TB TB symptoms depend on where in the body the TB bacteria are growing. Usually, TB grows in the lungs (pulmonary TB) and this can cause: Bad cough lasting three or more weeks Pain in the chest Coughing up blood or phlegm Other more general symptoms can also include: Weakness or fatigue Weight loss Loss of appetite Chills Fever Night sweats TB Testing and Diagnosis There are two kinds of tests to detect the TB bacteria in the body. 1. TB Skin Test The Mantoux tuberculin skin test (TST) is performed by injecting a small amount of fluid called tuberculin into the skin on a person's arm. That person then must return 48 to 72 hours later to have a healthcare provider check for their reaction. The diagnosis depends on the size of the raised, hard area or swelling on the arm that results from the injection. It should be noted that this is the preferred TB test for children under five years of age. 2. TB Blood Test The TB blood test, also called Interferon-gamma release assay or IGRA, is done when a healthcare provider draws blood from a person suspected of having TB and sends it to the lab for analysis and results. Regardless of which test is done, a positive test is a sign that the person tested is infected with the TB bacteria and additional tests must be done to see if it's a latent TB infection or TB disease A negative test is a sign that the person's body did not react to the testing and neither latent TB infection nor TB disease are likely. TB Treatment Options There are 10 drugs currently approved by the FDA for treating TB. In addition, the CDC offers a guide for a basic treatment schedule. TB Prevention Techniques There is a TB vaccine known as the Bacille Calmette-Guerin vaccine. It's used in many countries that have high rates of infection to prevent childhood TB and also meningitis, miliary disease, and it's especially recommended for both children and healthcare workers. Preventative measures also include education, training, and counseling about TB infection and who is most at risk. Testing and evaluating those most at risk is also vital, as is: Coordinating efforts between local and state health departments and high-risk healthcare and congregate settings Ensuring the proper cleaning, sterilization, and disinfection of equipment that may be contaminated Adequate local or general ventilation of working areas Cleaning the air using high-efficiency particulate air (HEPA) filtration or ultraviolet germicidal irradiation Using posters and signs to remind people to use proper cough etiquette, like covering the mouth, and respiratory hygiene Pro Tip #2: The period of communicability for TB is from an assigned date of three months prior to symptom onset or positive testing. An individual is considered no longer communicable two weeks after the completion of effective treatment, which would cause a significant reduction in symptoms. https://d3imrogdy81qei.cloudfront.net/video_images/6655/tuberculosis.jpg Yes 496 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/que-es-el-impetigo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/3713.mp4 ¿Qué es el impétigo? https://d3imrogdy81qei.cloudfront.net/video_images/6657/impetigo.jpg Yes 284 https://app.protrainings.com/courses/bloodborne-pathogens/body-art/videos/impetigo https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3713.mp4 Impetigo In this lesson, we'll be looking at impetigo – what it is, who is most at risk of getting it, how it's transmitted, what the signs and symptoms are, along with how impetigo is diagnosed, treated, and prevented. Impetigo is a bacterial skin infection that's caused by one of two types of bacteria – streptococcus (strep) or staphylococcus (staph). The bacteria enter the body most often after the skin has been injured or irritated from other skin problems like eczema, poison ivy, insect bites, burn, or cuts. Impetigo is one of the most highly contagious skin infections and it mainly affects children. However unlikely, adults can also get impetigo. Impetigo usually appears as red sores on the face, particularly around the nose and mouth, but it can also appear on the hands and feet. When the sores break open, a honey-colored crust follows. Pro Tip #1: Children often get impetigo after they have a cold or when allergies flare up. All the nose wiping and nose blowing makes the skin under the nose especially raw and helps create the perfect environment. However, it can also develop in completely healthy skin. Who is Most at Risk? There are several factors that will increase the risk of getting impetigo and these include: Age, as it's much more common in children ages two to five Crowded living conditions Spreads more easily in schools and childcare settings Warm and humid climates, which is why impetigo is more common in summer Participating in certain contact sports, like wrestling and football Having uncovered broken skin, as bacteria usually enter the body this way How is Impetigo Transmitted? Impetigo is spread mainly by person to person contact, like with kids playing together at recess or through contact sports. It can be spread by touching items belonging to an infected person – towels, bedding, clothing – but this is far less common. Also important to note, impetigo is mostly confined to humans. Pro Tip #2: The period of communicability if left untreated can last weeks or months. However, after just 24 hours of appropriate treatment, this is usually enough to stop the possibility of the person still being infectious. The incubation period for strep is one to three days, while the incubation period for staph is four to 10 days. Signs and Symptoms of Impetigo Sores typically begin as small red spots and change to blisters that eventually crack open. They can remain small as a pimple or grow large as a coin. They aren't usually painful but they're often itchy. The sores can also increase in number, as well as size. And can eventually ooze fluid that then crusts over. Testing and Diagnosis for Impetigo Impetigo doesn't usually require anything other than a quick diagnosis done by a physician based solely on the physical appearance of the sores; lab testing is generally not necessary. Impetigo Treatment Options An antibiotic ointment applied directly to the affected areas is typically enough to treat impetigo. Though, soaking the infected areas in warm water first may help, as removing the scabs first will help ensure the antibiotics can better penetrate the skin. In rare cases where there are numerous sores, a physician might prescribe an oral antibiotic. And it's important to finish whichever treatment the doctor prescribes, even if the sores have already healed, to prevent the infection from returning. Impetigo Prevention Techniques To prevent getting impetigo, the best thing you can do is keep your skin clean and dry and wash any cuts, scrapes, or insect bites as they happen. A little soap and water is usually sufficient. If your child is infected, consider cutting his or her nails short to prevent them from hurting themselves or transmitting the infection to other areas in case they begin to scratch. To prevent the spread of impetigo, gently wash the affected areas with mild soap and water and cover those areas lightly with gauze. Wash your clothing, bedding, towels, and other items daily and do not share them with others. Wear gloves when applying antibiotic ointment, and don't forget to wash your hands immediately afterward. https://d3imrogdy81qei.cloudfront.net/video_images/6657/impetigo.jpg Yes 284 https://app.protrainings.com/courses/self-defense/videos/how-to-practice-without-a-partner https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3841.mp4 How to Practice Self Defense without a Partner There may be a situation, or a time, when a training partner is just not available. Maybe the schedules didn't work out, who knows, you've got extra time on your hands. Heavy bags are available at most any sporting goods stores. I would suggest one that is a longer one, there are free-standing heavy bags. Depending on what your budget is, there are punching bags that are more anatomically correct. They actually look like a boxer or a human being. You can practice even if you don't have a training partner available. Get comfortable with your body motion. Again, be careful. You can hurt yourself in training. Take it slow, get your technique down first. Start pivoting on the tops of your toes. Get in shape, and prepare yourself to be able to escape these assault situations. https://d3imrogdy81qei.cloudfront.net/video_images/6897/how-to-practice-without-a-partner.jpg Yes 225 https://app.protrainings.com/courses/hipaa/general/videos/what-is-hipaa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3933.mp4 What is HIPAA? In this lesson, you'll learn what HIPAA is, the role it plays in healthcare, and who is mandated to follow its requirements, along with relevant real-world examples. What is HIPAA? HIPAA is an acronym that stands for – Health Insurance Portability and Accountability Act of 1996. Congress passed this landmark act to provide the following: The portability of insurance The protection and privacy of healthcare information The standardization and efficiency in healthcare data The prevention of discrimination and fraud What is HIPAA's Role in Healthcare? HIPAA gives the U.S. Department of Health and Human Services the responsibility of adopting rules to help individuals and companies keep important health information private. HIPAA protects against unauthorized disclosure of any protected health information that pertains to healthcare patients. HIPAA establishes a national set of security standards for protecting certain health information that is held or transferred electronically. In addition to privacy and security, administrative provisions were also included in HIPAA to improve the efficiency and effectiveness of the healthcare system. These provisions include: Specific transaction standards and code sets A national standard of unique identifiers for employers, health plans, and healthcare providers Data security and electronic signatures Pro Tip #1: HIPAA compliance is highly dependent on the size, function, administration, and type of entity or business association. Therefore, this training module is not intended to be a comprehensive HIPAA compliance guide. Warning: Entities and business associates that are regulated by HIPAA's privacy and security rules are obligated to comply with all federal and state requirements and should not rely on this training alone as a source of legal information or advice. In addition, to ensure compliance with HIPAA, covered entities and business associates should regularly perform a risk assessment to track access to PHI and periodically evaluate the effectiveness and security measures that have been put into place. Who is Mandated to Follow HIPAA's Requirements? HIPAA law applies directly to two particular groups known as covered entities and business associates, and these can include: Healthcare providers Health plans Healthcare clearinghouses Tech companies Cloud service providers Anyone with access to PHI What is a Healthcare Provider? A healthcare provider is any provider of medical or other health services or any organization or person who transmits health information in electronic form. This includes organizations and individuals who provide billing services or are paid in connection to services in the course of doing business. Common examples include: Physicians Dentists Optometrists Nurses Mental health providers Radiology centers Chiropractors Psychologists Pharmacies Durable Medical Equipment (DME) providers Hospitals Ambulance companies Home healthcare workers Social workers What is a Health Plan? A health plan is any individual or group plan that provides or pays the cost of healthcare services, such as an HMO, an insurance company, and Medicaid and Medicare. What is a Healthcare Clearinghouse? A healthcare clearinghouse is a public or private entity that processes healthcare transactions from one form to another in a required format. An example would be a third-party billing service that ensures that all information between a doctor's office and an insurance company complies with all HIPAA requirements. Pro Tip #2: HIPAA applies to employers only to the extent that they operate in one of these three groups. Furthermore, the same standards apply to covered entities in both the public and private sectors. If a company offered healthcare services and treatment to employees onsite – like an onsite clinic – the employer would be a covered entity and would be required to follow all HIPAA requirements. What is a Business Associate? A business associate is any company or individual with direct or incidental access to PHI or ePHI. Business associates are required to have in place: A risk assessment plan Proper training Specific policies and procedures Examples of business associates include: IT vendors Call centers Court reporters Cloud providers Legal services providers Suppliers and manufacturers with access to PHI and ePHI Business associates have the same requirements as covered entities to protect PHI and are required to notify covered entities of any potential and/or active data breaches. Business associates must also comply with HIPAA requirements by signing a contractual agreement with the covered entity – known as a Business Associate Agreement (BAA). The BAA states that a business associate will only use protected health information for proper purposes and will safeguard it from misuse. Business associates must also comply with all HIPAA security requirements and will ensure administrative, physical, and technological safeguards are in place. If a business associate violates the BAA, they will be in violation of the contract with the covered entity and in violation with HIPAA. In which case, the business associate will be held accountable for all penalties from both violations. Pro Tip #3: If a business associate uses subcontractors, HIPAA requires contractual agreements between them. Subcontractors are held to the same HIPAA requirements when it comes to protected health information. https://d3imrogdy81qei.cloudfront.net/video_images/7075/what-is-hipaa-new.jpg Yes 316 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/introduction-to-texas-hb300-training https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3942.mp4 Introduction to Texas HB300 Training Hi, this is Dawn from ProHIPAA, I will be your compliance guide. Today, we will be learning about the Texas Law HB300. You are taking this course because you either live in the great state of Texas like me or you do business in the great state of Texas. https://d3imrogdy81qei.cloudfront.net/video_images/7091/introduction-to-texas-hb300-training.jpg Yes 28 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/what-is-texas-house-bill-300 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3943.mp4 What is Texas House Bill 300? Texas House Bill300 also known as Texas HB300 was effective on September 1, 2012. This bill significantly expands patient privacy protections for Texas covered entities beyond those federal requirements known as "HIPAA" and "HITECH." Texas HB 300 expanded legal requirements by:  revising the definition of a "covered entity"; increasing mandates on covered entities, including requiring customized employee training; establishing standards for the use of electronic health records ("EHRs"); granting enforcement authority to several state agencies; and increasing civil and criminal penalties for the wrongful electronic disclosure of PHI. https://d3imrogdy81qei.cloudfront.net/video_images/7093/what-is-texas-house-bill-300.jpg Yes 51 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/what-is-a-covered-entity-under-hb300 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3944.mp4 What is a Covered Entity under HB300? HB300 significantly expands the definition of a Texas "covered entity." A "covered entity" is now defined as any person/entity who:  For commercial, financial, or professional gain, monetary fees, or dues, or on a cooperative, nonprofit, or pro bono basis, engages, in whole or in part, and with real or constructive knowledge, in the practice of assembling, collecting, analyzing, using, evaluating, storing, or transmitting protected healthinformation;  comes into possession of protected health information; obtains or stores protected health information under this chapter; or is an employee, agent, or contractor of a person insofar as the employee, agent, or contractor creates, receives, obtains, maintains, uses, or transmits protected health information. This revised definition is broad and includes not only health care providers but those entities and individuals who under the “HIPAA Privacy Rule,” a federal regulation that protects the privacy of individually identifiable health information, would be classified as business associates and health care payers. In addition, the Texas Act’s “covered entity” definition includes governmental units, information or computer management entities, schools, health researchers, health care facility, clinics, and persons who maintain an Internet site. As a result, this revision impacts any entity that conducts business in Texas and collects, uses, and/or stores PHI. While HITECH only covers law firms representing covered entities, HB300 has expounded upon those regulations to cover any law firm handling medical records, health insurance records, or healthcare billing records. https://d3imrogdy81qei.cloudfront.net/video_images/7095/what-is-a-covered-entity-under-hb300.jpg Yes 129 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/what-training-is-required-under-hb300 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3945.mp4 What Training is Required under HB300? Under HB300, mandatory customized employee training regarding state and federal patient privacy and security laws is required. Training must cover federal and state regulatory requirements as well as include the covered entity’s course of business and employees’ scope of employment as it relates to PHI use and disclosure. Employees of covered entities must complete training at least once every two years and not later than 60 days after their hire date. A covered entity shall require an employee of the entity who attends a training program described above to sign, electronically or in writing, a statement verifying the employee's attendance at the training program. The covered entity shall maintain the signed or electronic training record. https://d3imrogdy81qei.cloudfront.net/video_images/7097/what-training-is-required-under-hb300.jpg Yes 53 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/medical-records-and-enforcement-authority https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3946.mp4 Medical Records and Enforcement Authority Medical Records: Under the new law, Texas covered entities must provide patients with their EHRs in electronic format within 15 business days after receipt of a written request. The Texas Health and Human Services Commission will soon recommend a standard format for the release of EHRs that is consistent with federal law. Now let’s talk about Enforcement Authority: Following the Office of Civil Rights’ recent lead, the website of the Office of the Attorney General of Texas will contain consumer access to public health information to educate members of the public, including the steps to take to file a complaint with applicable state agencies and their contact information. These state agencies will file annual complaint reports to the Attorney General of Texas. Then, the Attorney General will provide an annual report to the Texas Legislature that includes an overview and statistical analysis of the complaints received. https://d3imrogdy81qei.cloudfront.net/video_images/7099/medical-records-and-enforcement-authority.jpg Yes 63 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/duties-of-covered-entities-to-provide-notice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3947.mp4 Duties of Covered Entities to Provide Notice Now let’s discuss the covered entities duty to provide Notice: The law also broadens the scope of covered entities’ Notice of Privacy Practices or other general notices to inform patients about how their e-PHI is used and disclosed. Note that for some entities, this will mean the need to issue a notice if the PHI is subject to electronic disclosure, e.g., for entities such as business associates that would not be required to issue a Notice of Privacy Practices under the HIPAA Privacy Rule. A covered entity shall provide notice to an individual for whom the covered entity creates or receives protected health information if the individual's protected health information is subject to electronic disclosure. A covered entity may provide general notice by:  posting a written notice in the covered entity's place of business; posting a notice on the covered entity's Internet website; or posting a notice in any other place where individuals whose protected health information is subject to electronic disclosure are likely to see the notice. https://d3imrogdy81qei.cloudfront.net/video_images/7101/duties-of-covered-entities-to-provide-notice.jpg Yes 68 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/breach-notifications-under-hb300 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3948.mp4 Breach Notifications under HB300 Covered entities must also notify an individual if a breach of that individual’s sensitive personal information, including that individual’s protected health information, has occurred, meaning if that information was acquired or reasonably believed to have been acquired by an unauthorized person. Although HB300 does not specifically define “sensitive personal information”, it incorporates the definition set forth in the Texas Business and Commerce Code and thus includes: an individual’s first name or first initial and last name in combination with any one or more of the following items, if the name and the items are not encrypted: Social Security number; Driver’s license number or government issued identification number; or Account number or credit or debit card number in combination with any required security code,access code, or password that would permit access to an individual’s financial account; or information that identifies an individual and relates to: the physical or mental health or condition of the individual; the provision of health care to the individual; or payment for the provision of health care to the individual. This means that documents that you handle on a daily basis, such as initial client information sheets, tax returns, bank statements, etc. may fall under the umbrella of sensitive information that must be safeguarded pursuant to HB300. https://d3imrogdy81qei.cloudfront.net/video_images/7103/breach-notifications-under-hb300.jpg Yes 97 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/hb300-penalties https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3949.mp4 HB300 Penalties In addition, HB300 authorizes civil penalties ranging from $5,000 to $1.5 million for data breaches, depending on the severity, the covered entity’s compliance program, if entity was certified, and its efforts to correct the violation. Besides these increased civil monetary penalties, a data breach may also be classified as a felony. Audits: The Attorney General is also authorized by HB300 to work in tandem with The OCR and the Texas Department of Insurance in conducting audits of a covered entity. This includes monitoring the results of that audit. While certainly the focus seems to be on covered entities within the health care industry, anyone or any business with access to PHI should already be taking appropriate measures to ensure they are compliant with Texas HB300. https://d3imrogdy81qei.cloudfront.net/video_images/7105/hb300-penalties.jpg Yes 60 https://app.protrainings.com/courses/hipaa/texas-hb300/videos/conclusion-to-hb300-training-course https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/3950.mp4 Conclusion to HB300 Training Course In conclusion, Texas HB300 dramatically expanded the HIPAA and HITECH Regulations already in place. The most significant change is the definition of a Covered Entity and required training. If you handle or come in contact with PHI or ePHI you are considered a Covered Entity and must take appropriate measures to protect PHI at all times. If you still have questions or need a guide to help you navigate this law please call us at 844-722-8898. https://d3imrogdy81qei.cloudfront.net/video_images/7107/conclusion-to-hb300-training-course.jpg Yes 48 https://app.protrainings.com/courses/covid/videos/signs-and-symptoms-of-coronavirus-covid-19 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4306.mp4 Signs and Symptoms COVID-19 Understanding Coronavirus Symptoms and Risks 1. Incubation Period and Symptoms A lot remains to be learned about Coronavirus (COVID-19), but certain symptoms are well-known: Incubation Period: World Health Organisation (WHO) suggests up to 14 days, sometimes longer. Symptoms Onset: Typically manifests in about 5 days. 2. Severity and Recovery Rates Based on WHO data from 44,000 patients: Severity: 81% developed mild symptoms, 14% severe, and 5% critically ill. Death Rate: Estimated between 1-2%, though figures may vary as the situation evolves. Recovery: Approximately 80% recover without medical intervention; some remain asymptomatic. 3. Main Symptoms The primary symptoms of coronavirus include: High Temperature: Feeling hot to touch on chest or back. Continuous Cough: Persistent coughing for more than an hour, or multiple episodes in 24 hours. Loss of Smell or Taste: Inability to smell or taste, or alteration in smell or taste perception. Most individuals with coronavirus experience at least one of these symptoms. 4. Additional Symptoms Other possible symptoms include: Headache Shortness of breath Tiredness Nasal congestion Sore throat Diarrhoea Muscle aches Nausea and vomiting Symptoms often start mildly and progress gradually. 5. Risks and Precautions Some individuals may be asymptomatic carriers, posing a risk of transmission: High-Risk Groups: Elderly or those with existing medical conditions should seek medical attention for symptoms. Medical Attention: Contact medical services if symptoms of fever, cough, or breathing difficulties arise; avoid visiting hospitals directly. https://d3imrogdy81qei.cloudfront.net/video_images/7807/Signs_and_Symptoms_COVID-19-01.jpg Yes 152 https://app.protrainings.com/courses/covid/videos/treatment-of-coronavirus-covid-19 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4307.mp4 Treatment of Coronavirus COVID 19 COVID-19 Treatment Overview Learn about the current treatment options for COVID-19. Supportive Care and Symptom Management COVID-19 currently has no specific recommended treatment. Supportive care and symptom management are essential while the body fights the illness. Isolation and Antibiotics If you suspect COVID-19, isolate yourself or the affected individual from others until recovery. Antibiotics are ineffective against viruses like COVID-19. Hospitalization for Severe Cases More serious cases may require hospitalization, where patients receive close monitoring and additional treatments such as supplemental oxygen, fluids, and medications. Intensive Care Treatment In intensive care units, patients with severe respiratory distress are provided with non-invasive respiratory support or placed on a ventilator to assist breathing while combating the infection. Updates on Treatment We will continue to update information on treatments as more becomes known about effective medications and interventions. https://d3imrogdy81qei.cloudfront.net/video_images/7995/Treatment_of_Coronavirus_COVID_19-01.jpg Yes 76 https://app.protrainings.com/courses/covid/videos/avoiding-close-contact https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4357.mp4 Avoiding Close Contact Preventing COVID-19 Transmission Understanding COVID-19 Transmission Learn how COVID-19 spreads and preventive measures: Transmission via Respiratory Droplets Fact: COVID-19 spreads through respiratory droplets: Human to human contact and infected surfaces are common sources of transmission. Respiratory droplets are emitted during coughing or sneezing. Precautions to Take Important preventive measures: Avoid Close Contact: Stay at least two metres (about six feet) away from anyone showing symptoms. Avoid hugs, kisses, and handshakes to minimize the risk of transmission. Never Touch Your Face: Even when wearing a face mask, avoid touching your face to prevent infection. Caring for Suspected or Confirmed Cases If you're caring for someone with COVID-19: Encourage the use of tissues by the infected individual. Ensure you use proper protective gear and maintain hand hygiene. https://d3imrogdy81qei.cloudfront.net/video_images/7815/Avoiding_Close_Contact-01.jpg Yes 90 https://app.protrainings.com/courses/covid/videos/hand-washing-corona https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4358.mp4 Hand Washing Importance of Handwashing During Pathogen Outbreaks Keeping Hands Clean: Essential in Times of Outbreak Learn about the critical importance of hand hygiene during pathogen outbreaks: Thorough Hand Cleaning Key points from the World Health Organisation (WHO): Ensure thorough hand cleaning for at least 20 to 30 seconds. This duration allows the soap to effectively clean your hands, as soap requires time to work. Jewellery Removal and Proper Handwashing Steps for effective handwashing: Remove all rings, except a plain wedding band. Turn on the tap and wet your hands. Apply soap, covering all surfaces of both hands evenly. Thoroughly dry your hands to prevent bacterial spread. Awareness of Surface Contact Additional consideration: Be mindful of surfaces touched before and after handwashing to avoid reinfection. https://d3imrogdy81qei.cloudfront.net/video_images/7835/Hand_Washing-01.jpg Yes 230 https://app.protrainings.com/courses/covid/videos/hand-gels https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4359.mp4 Hand Gels Effective Hand Hygiene with Alcoholic Hand Gel Importance of Handwashing Amid COVID-19 Outbreak Discover the significance of hand hygiene during the COVID-19 pandemic: Using Alcoholic Hand Gel as an Alternative When tap and anti-bacterial soap are unavailable, alcoholic hand gel serves as a suitable substitute: Alcoholic hand gel is an effective alternative if traditional handwashing facilities are not accessible. Ensure the hand gel contains at least 60% alcohol for optimal effectiveness. Technique for Using Alcoholic Hand Gel Follow these steps for proper hand hygiene with alcoholic hand gel: Apply the gel to your hands, covering all surfaces. Rub your hands together for 20 to 30 seconds, ensuring thorough coverage. Allow the gel to air dry naturally, which typically takes less than a minute. https://d3imrogdy81qei.cloudfront.net/video_images/7833/Hand_Gels-01.jpg Yes 100 https://app.protrainings.com/courses/covid/videos/preventing-catching-and-spreading https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4360.mp4 Preventing the Spread of COVID-19 COVID-19 Prevention and Treatment Advice No Medication Available for COVID-19 Understanding treatment options and prevention methods: No Cure for COVID-19 Fact: No specific medication is available to cure COVID-19: Antibiotics: Ineffective against viruses; not prescribed for COVID-19. Elderly and those with existing medical conditions are more susceptible to severe symptoms. Current Treatment Approach Fact: Treatment focuses on managing symptoms rather than curing the virus: Administering non-specific but appropriate medications to alleviate symptoms. Rumours of remedies like garlic or sesame oil lack evidence of effectiveness according to WHO. UV lamps do not kill the virus and can cause skin irritation. Preventing Infection Important preventive measures: Hand Hygiene: Wash hands frequently with soap and water or use alcohol hand gel. Avoid using hot air hand dryers; they dry hands but do not kill the virus. Temperature Checking: Non-contact thermometers detect fever, a sign of COVID-19 infection. Catch coughs and sneezes with disposable tissues; dispose of them immediately. Avoid touching eyes, nose, and mouth with unwashed hands. Avoid close contact with sick individuals. Surface Cleaning: COVID-19 can survive on surfaces for up to 3 days; thorough surface cleaning is crucial. https://d3imrogdy81qei.cloudfront.net/video_images/7813/Preventing_the_Spread_of_COVID-19-01.jpg Yes 139 https://app.protrainings.com/courses/covid/videos/cleaning-a-surface https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4361.mp4 Cleaning a Surface Effective Surface Cleaning to Prevent COVID-19 Transmission Understanding Surface Contamination with Coronavirus Learn about the longevity of coronavirus on various surfaces: Importance of Proper Surface Cleaning Ensure thorough cleaning with appropriate antibacterial wipes to prevent virus spread: Use specialized antibacterial wipes to effectively clean surfaces without further contamination. Avoid using regular wipes, as they may spread the virus instead of eliminating it. Surfaces Requiring Regular Cleaning Identify key surfaces that should be regularly wiped and disinfected: Healthcare sector facilities, including equipment and high-touch areas. Toilets, sinks, and other frequently used areas in both public and private settings. Classroom tables and shared surfaces in educational institutions. Mobile phone screens, which are often overlooked but can harbor viruses. Effectiveness of Surface Cleaning Regular cleaning routines can significantly reduce COVID-19 transmission: By diligently cleaning these surfaces and more, you can help mitigate the spread of the virus. https://d3imrogdy81qei.cloudfront.net/video_images/7837/Cleaning_a_Surface-01.jpg Yes 96 https://app.protrainings.com/courses/covid/videos/coping-with-the-stresses-of-covid-19 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4362.mp4 Coping with the Stress of COVID-19 Coping with COVID-19 Stress: World Health Organisation Advice 1. Acknowledge Your Feelings The current COVID-19 outbreak can evoke various emotions: Sadness Stress Confusion Fear Anger It's essential to recognise and address these feelings. 2. Seek Support Advice from the World Health Organisation includes: Talk to Someone: Reach out to family, friends, or health workers for support. Professional Help: Consider speaking to a counsellor or health worker if you feel overwhelmed. 3. Healthy Coping Strategies To manage stress effectively, avoid unhealthy coping mechanisms: Avoid Substance Use: Refrain from using smoking, alcohol, or drugs to deal with emotions. Limit Media Exposure: Reduce exposure to distressing media coverage and seek information from credible sources like WHO.INT. https://d3imrogdy81qei.cloudfront.net/video_images/7809/Coping_with_the_Stress_of_COVID-19-01.jpg Yes 99 https://app.protrainings.com/courses/covid/videos/helping-children-to-cope https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4363.mp4 Helping Children to Cope Supporting Children During COVID-19: World Health Organisation Advice Understanding Children's Response to Stress Children may react differently to stress compared to adults. It's crucial to: Offer Support: Listen to their concerns and provide extra reassurance, love, and attention. Stay Connected: Keep children close to their parents and family, maintaining regular contact via phone or messages if separation occurs. Maintain Routines: Stick to regular schedules and routines to provide stability. Encourage Play: Create opportunities for children to play and relax, promoting their emotional well-being. Providing Information and Education It's essential to equip children with accurate information about COVID-19: Share Facts: Provide children with factual information about the virus, including its impact and preventive measures. Reduce Risk: Explain how they can reduce the risk of infection through hygiene and safety practices. https://d3imrogdy81qei.cloudfront.net/video_images/7811/Helping_Children_to_Cope-01.jpg Yes 110 https://app.protrainings.com/courses/covid/videos/using-gloves-corona https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4364.mp4 Using Gloves Gloves Usage Guidelines During COVID-19 Outbreak Introduction Gloves have become increasingly common during the COVID-19 outbreak, serving various purposes beyond first aid. Types of Gloves Various types of gloves are available, typically in nitrile or vinyl materials and different colours. Putting on Gloves When donning gloves: Ensure Clean Hands: Remove any sharp objects from hands to prevent glove damage. Check for Damage: Inspect gloves for holes or tears; replace if found. Change Between Patients: Swap gloves between patients to prevent cross-contamination. Removing Gloves Proper removal is crucial: Contain Spread: Remove gloves carefully to avoid splattering contaminants. Dispose Correctly: Dispose of used gloves properly to prevent contamination. Conclusion Adhering to proper glove usage guidelines is essential for containing the spread of infection during the COVID-19 pandemic. https://d3imrogdy81qei.cloudfront.net/video_images/7831/Using_Gloves-01.jpg Yes 133 https://app.protrainings.com/courses/covid/videos/medical-masks https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4366.mp4 Medical Masks Guidelines for Using Medical Masks During COVID-19 Introduction Medical masks, primarily intended for healthcare professionals, are now increasingly utilized by the general public amidst the recent Coronavirus outbreak. Preparation Before Applying a Mask Before wearing a mask: Hand Hygiene: Wash hands thoroughly for at least 20 seconds or use alcohol hand gel. Mask Inspection: Check the mask for any defects or damage. Proper Orientation: Ensure the mask is worn with the correct side up and facing the right direction. Avoid Touching Face: Refrain from touching your face while wearing the mask to prevent contamination. Removing the Mask When taking off the mask: Hand Hygiene: Wash hands thoroughly and use alcohol hand gel to prevent transferring infections to your face. Safe Disposal: Dispose of the mask properly after removal. Hand Hygiene Again: Wash hands again after removing the mask. Conclusion Following these guidelines ensures proper usage and disposal of medical masks, contributing to effective infection prevention during the COVID-19 pandemic. https://d3imrogdy81qei.cloudfront.net/video_images/7819/Medical_Masks-01.jpg Yes 129 https://app.protrainings.com/courses/covid/videos/ffp1-2-and-3-masks https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4367.mp4 FFP1, 2 and 3 Masks Guide to Filtering Face Piece (FFP) Masks for Protection Overview Filtering Face Piece (FFP) masks come in three main types: FFP1, FFP2, and FFP3. These masks are primarily utilised in industries to safeguard against airborne particles. Key Requirements For FFP masks: CE Marking: Ensure the masks are CE marked, indicating compliance with recognized standards. Standard Compliance: They must also be marked with the appropriate standard, typically EN 149:2001 for disposable respirators. Protection Levels The additional markings (FFP1, FFP2, FFP3) denote the protection level: FFP1: Basic protection FFP2: Moderate protection FFP3: Highest level of protection However, while FFP3 masks offer the best protection against Coronavirus COVID-19, effectiveness cannot be guaranteed. Pre-Use Checks and Proper Usage Before using an FFP mask: Pre-Use Check: Inspect the mask for any defects. Fit Checking: Ensure proper fit according to manufacturer's instructions. Effectiveness Test: Conduct a simple breath test to confirm effectiveness. Leakage Detection: Readjust the respirator if any leakage is detected around the face. https://d3imrogdy81qei.cloudfront.net/video_images/7821/FFP1__2_and_3_Masks-01.jpg Yes 115 https://app.protrainings.com/courses/covid/videos/how-to-apply-an-ffp3-mask https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4368.mp4 How to Apply an FFP3 Mask Instructions for Proper Fit of Respirator Masks Importance of Proper Seal Respirator masks are effective only with a good seal between the mask edges and your face. Breaking the seal compromises protection. Brand Consideration The masks featured in our video are from 3M. If using a different brand, refer to the instructions before application. Fitting Instructions Follow these steps each time you wear a mask: Clean-Shaven Face: Ensure your face is clean-shaven; respirators should not be worn with stubble, beards, or other facial hair beneath the mask area. Prepare the Mask: With the reverse side up, separate the top and bottom panels using the tabs. Pull the chin and nose panel tabs until the nose clip bends, forming a cup shape. Ensure both panels are fully unfolded. Position the Mask: Hold the mask with the open side towards your face. For VALVED respirators, hold the sides of the valve to keep the mask in position. For UNVALVED respirators, cup it in one hand. Secure Straps: Using your other hand, pull each strap over your head. Place the upper strap across the crown of your head and the lower strap below your ears, ensuring they are not twisted. Adjust Fit: Use the tabs to adjust the top and bottom panels for a comfortable fit. Ensure the panels are not folded and that the tabs lie flat. Mould Nose Clip: With both hands, mould the nose clip to the shape of your nose for a close fit and good seal. Check Seal: Cover the front of the respirator with both hands without disturbing the fit. For UNVALVED respirators, exhale sharply; for VALVED respirators, inhale sharply. If air leaks, readjust the nose clip or straps to eliminate leakage. Final Checks: If you cannot achieve a proper fit, do not enter the hazardous area. Removal To remove the mask: Hold and Lift: Hold the corners of the respirator on both sides of your face between your finger and thumb. Lift the respirator away from your face and then upwards until the headbands come away from your head. Dispose and Wash Hands: Avoid touching the face-piece with your hands as much as possible. Dispose of the respirator immediately in a clinical waste bag and do not reuse. Wash your hands thoroughly. https://d3imrogdy81qei.cloudfront.net/video_images/7823/How_to_Apply_an_FFP3_Mask-01.jpg Yes 153 https://app.protrainings.com/courses/covid/videos/the-correct-procedure-for-removing-an-ffp3-respirator https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4369.mp4 Removing PPE and FFP3 Respirators Proper Removal of FFP3 Respirator Follow Manufacturer Instructions While there are generic steps for removing a FFP3 respirator, always adhere to specific manufacturer instructions. When to Change FFP3 Respirators FFP3 respirators should be changed: After Each Use: Ensure a fresh respirator is used for each session. If Breathing Becomes Difficult: Replace the respirator if breathing becomes challenging. If Damaged: Discard damaged respirators immediately. If Contaminated: Dispose of respirators contaminated with body fluids like respiratory secretions. Monitor your mask's condition during use and have multiple masks available. Use each mask only once and only for one patient. Post-Removal Hand Hygiene After removing personal protective equipment (PPE), perform hand hygiene immediately after removal and disposal. Maintain your respirator mask during this process. The only PPE to remove within a contaminated area are gloves, gowns or aprons, and eye protection. Final Disposal and Handwashing Upon leaving the contaminated area: Dispose of Respirator: Remove and dispose of your respirator mask. Handwashing: Wash your hands thoroughly after respirator disposal. https://d3imrogdy81qei.cloudfront.net/video_images/7827/Removing_PPE_and_FFP3_Respirators-01.jpg Yes 77 https://app.protrainings.com/courses/covid/videos/using-masks-correctly https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4370.mp4 Using Masks Correctly Proper Use of Face Masks Introduction Following the COVID-19 outbreak, the use of face masks has become more widespread. However, it's essential to understand the correct way to use them for maximum effectiveness. Key Points for Proper Use Correct Application: Ensure the mask is worn correctly, with the right side facing out and covering both the nose and mouth. Avoid Touching: Refrain from touching the mask once it's on, except when removing it. No Sharing: Never share your mask with others to maintain hygiene. Inspection: Always inspect your mask before wearing it to ensure it's intact. Storage: Store unused masks in a clean, dry place to prevent contamination. Single Use: Dispose of your mask properly after each use to avoid the risk of contamination. Hand Hygiene: Wash your hands thoroughly before and after using a mask to reduce the risk of infection. https://d3imrogdy81qei.cloudfront.net/video_images/7829/Using_Masks_Correctly-01.jpg Yes 94 https://app.protrainings.com/courses/covid/videos/what-you-can-do https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4372.mp4 What You Can Do Protecting Against Coronavirus (COVID-19) Understanding COVID-19 COVID-19 is the disease caused by the coronavirus. The term "COVID-19" stands for "corona virus disease 2019." Transmission and Protection Coronavirus is highly transmissible, primarily through droplets spread when coughing. Protecting yourself is crucial. Basic Advice: Wash Hands: Thoroughly wash hands with soap and water for at least 20 seconds. Use Hand Gel: Alcohol-based hand sanitizers are effective alternatives. Cover Coughs and Sneezes: Use a tissue or your sleeve, not your hands, and dispose of tissues immediately. Avoid Close Contact: Stay away from unwell individuals and practice self-isolation if necessary. Avoid Touching Face: Refrain from touching eyes, nose, or mouth to prevent transmission from hands. Practice Good Hygiene: Challenge and alter routines to minimize contact with others. No Treatment: Currently, there is no specific treatment for COVID-19; focus on symptom management. Stay Vigilant and United As there is no cure for COVID-19, remaining vigilant and implementing preventive measures are crucial in combating the virus. https://d3imrogdy81qei.cloudfront.net/video_images/7839/What_you_can_do-01.jpg Yes 170 https://app.protrainings.com/courses/covid/videos/self-isolation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4373.mp4 Self Isolation Self-Isolation Guidelines for COVID-19: What You Need to Know Understanding Self-Isolation Learn about the importance and guidelines of self-isolation: Purpose of Self-Isolation Discover why self-isolation is crucial in slowing down the spread of COVID-19: Explore the origins of virus transmission and the need for isolation to curb infection rates. Understand the duration of self-isolation for different demographics in various countries. Rules and Recommendations Know the essential rules and practices associated with self-isolation: Learn protocols for managing household interactions and receiving deliveries. Understand the importance of support from friends and family, including virtual communication methods. Emphasize the significance of maintaining a healthy diet and self-care to prevent worsening symptoms. Adhere strictly to the rule: no visitors if COVID-19 is present. Community Preparation Prepare for potential community-wide self-isolation: Encourage responsible behaviour such as avoiding panic buying to ensure equitable access to supplies. Consider the needs of vulnerable individuals who may face challenges in obtaining essential goods. Advocate for early preparation and reasonable stockpiling without excessive hoarding. https://d3imrogdy81qei.cloudfront.net/video_images/7843/Self_Isolation-01.jpg Yes 263 https://app.protrainings.com/courses/covid/videos/a-developing-situation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4374.mp4 An ongoing situation Impact of Coronavirus Pandemic Global Impact The Coronavirus pandemic has affected countries worldwide, leading to varying degrees of impact and a high death rate. Evolution of the Pandemic Since the launch of this course, the world has experienced multiple phases of lockdowns and relaxations to control virus spread. New Variants Challenge Efforts to contain the virus have become more challenging due to the emergence of new variants, complicating containment measures. Continued Restrictions Expectations are for ongoing restrictions globally to minimize virus transmission, ranging from full lockdowns to social interaction limitations. Importance of Hygiene Practices such as hand hygiene and overall cleanliness remain crucial in daily life to combat the virus's spread. Adherence to Guidelines While infection and death rates may have decreased from peak levels, adherence to strict rules, social distancing, and hygiene protocols remains essential. Improvements in Treatment Treatment protocols for COVID-19 have become more effective over time as medical understanding of the virus has increased, but severe cases and fatalities still occur. Stay Informed For the latest restrictions and guidelines specific to your area, refer to your local government's official websites for up-to-date information. https://d3imrogdy81qei.cloudfront.net/video_images/7841/An_ongoing_situation-01.jpg Yes 82 https://app.protrainings.com/courses/anaphylaxis/videos/course-summary-USA https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4377.mp4 Course Summary Completing Your ProTrainings Course: Next Steps This guide outlines the final steps you need to take to successfully complete your ProTrainings course and prepare for the test. Reviewing Course Materials Maximize your chances of success by revisiting any course materials as needed. Accessing Video Content Again Remember, you have the option to review any of the videos before taking the test, ensuring a thorough understanding of the content. Preparing for the Test Approach your test with confidence by thoroughly preparing using the resources provided. Utilizing ProTrainings Resources Make the most of the ProTrainings materials to ensure you're fully prepared for the assessment. Final Words of Encouragement We thank you for choosing ProTrainings and wish you the best of luck with your test. Good Luck! With the right preparation and review, you're set to succeed in your ProTrainings course test. https://d3imrogdy81qei.cloudfront.net/video_images/7849/Course_Summary-01.jpg Yes 84 https://app.protrainings.com/courses/covid/videos/course-introduction-non-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4380.mp4 Course Introduction Welcome to Your ProTrainings Online Course Experience This introductory guide will walk you through the structure and features of the ProTrainings online training course, designed for a global audience. Course Adaptation for International Use While based in the UK, this course is adapted for international application. For specific legislation and requirements in your region, please consult your local authorities. Course Structure and Accessibility The course is flexible and user-friendly, designed to accommodate your schedule and learning preferences. Interactive Learning Modules Engage with a series of instructional videos, knowledge review questions, and a completion test. Resume the course where you left off, across any device, including computers, smartphones, or tablets. Additional Learning Resources Supplementary text is available on each page to enhance understanding, with optional subtitles for videos. Continuous Learning and Updates Stay informed and refreshed with weekly emails featuring course updates, new videos, and relevant news. Email Notifications Opt-in for weekly emails to keep your skills up-to-date. You have the freedom to subscribe or unsubscribe at any time. Conclusion and Support We are committed to providing a comprehensive and engaging learning experience. Thank you for choosing ProTrainings, and we wish you the best in your learning journey. https://d3imrogdy81qei.cloudfront.net/video_images/7857/course_introduction-01_(1).jpg Yes 128 https://app.protrainings.com/courses/covid/videos/r-value-and-disease-spread https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4553.mp4 R Value and disease spread Understanding the R-Value: What You Need to Know Deciphering the R-Value Explore the significance of the R-value in understanding disease transmission: What is the R-Value? Learn about the mathematical term "R nought" and its implications: Understand that the R-value indicates the contagiousness of an infectious disease. Recognize it as a crucial factor in policy decisions for implementing control measures. Interpreting R-Values Decipher the meaning of different R-values: Know that an R-value of 5 suggests rapid and widespread transmission of the virus. Understand that an R-value of 1 indicates a steady rate of disease transmission. Aim for an R-value below 1 to achieve a decline in disease spread. Historical Perspective Reflect on the impact of R-values in historical pandemics: Consider the devastating effects of the 1918 flu pandemic, estimated to have an R-value between 1.4 and 2.8. https://d3imrogdy81qei.cloudfront.net/video_images/8199/R_Value_and_disease_spread-01.jpg Yes 94 https://app.protrainings.com/courses/anaphylaxis/videos/course-overview-anaphylaxis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4742.mp4 Course overview Before we start this course, we will first look at what will be covered during the training. The course is divided into categories, and in each category there are a number of videos. You can pause, or watch again any video on the course and as we regularly update our courses you will be able to see any new videos as they are released. This may be an online course, but if you have any questions during the course you can contact us by phone, email, or via the online chat facility. You work through the categories and videos on this course in the following order: Firstly, what anaphylaxis is, living with anaphylaxis, allergic reactions and activating the Emergency Medical Services. Autoinjector types, storage and disposal is also another category of this course. This includes who can prescribe auto-injectors and the safe storage and disposal of them. Signs, Symptoms and treatment of Anaphylaxis is the third category of the course. This will inform you of basic first aid advice, schools and teachers and anaphylaxis, giving a second dose of medications and biphasic anaphylactic response. Then we look at Immunotherapy drugs and Idiopathic Anaphylaxis. And finally, the last category will give you the basic knowledge and skills that you need when using an auto-injector. https://d3imrogdy81qei.cloudfront.net/video_images/8449/course-overview-anaphylaxis.jpg Yes 83 https://app.protrainings.com/courses/anaphylaxis/videos/about-anaphylaxis-reactions https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4743.mp4 About Anaphylaxis Contrary to popular belief, anaphylaxis has actually been around for a very long time, but in recent years it has become much more of a problem. Anaphylaxis is a serious type of allergic reaction, which can occur through a whole variety of ways. These include by eating or drinking, for example peanuts or milk, inhaling, for example dust, injecting, such as the result of a bee sting, or even by simply touching or coming into close contact with something. The substance which causes the allergic reaction is called the allergen. For example, if someone ate something with eggs in, and that caused an allergic reaction, then the egg would be the allergen. Allergens are unique to each person, meaning not everyone who experiences reactions is allergic to the same allergens. Consequently, of course, not everyone is allergic to something, meaning not everyone will be at risk of anaphylaxis. So for the majority of people, if they are stung by a bee, all that will happen is the local pain and discomfort of the sting. However, for those that are allergic to bee stings, the problem can become much more serious, the signs and symptoms can be much more complicated and can even be fatal if not treated correctly and urgently. This is going to be very stressful for the individual and they are probably going to have a lot of trouble breathing. I am sure that everyone watching this video will be familiar with food labels such as “This product may contain nuts” or “possible allergens within food”. Looking back not so long ago, allergens did not need to be highlighted on food packaging, but FDA regulations passed in 2004 under the Food Allergen Labelling and Consumer Protection Act meant that this needed to be present on food products labelled on or after January 1, 2006. This is because allergic reactions and anaphylaxis are becoming more and more prevalent in today’s society. There's lots of thought into why this has become an increasing problem more than it was maybe 25 years ago. Now, due to these FDA regulations, you can look at the packaging of food and better identify the risk of allergens. You might hear announcements on airplanes where a passenger has a severe peanut allergy and therefore the consumption of nuts on the plane is being forbidden. So you can see that allergies and anaphylaxis are prevalent in many different areas, and as the years pass will only continue to increase in their prevalence. The houses we live in are also playing a part in this change. Houses are a lot more controlled now in terms of temperature and humidity, whereas older houses would have had open cracks in the windows and have been generally less clean. Central heating can cause problems as we now live in much more of a controlled environment. This means that at a younger age, our bodies are exposed to fewer harmful substances, meaning we don’t build up the antibodies to resist certain things and anaphylaxis has links with asthma, which is also an increasing problem. In this course we're going to be talking about the different treatment methods that are available, but in all cases where you suspect anaphylaxis you should call the EMS. Anaphylaxis is something that comes on very quickly and even if you can give the auto-injector and the person can appear to feel better very, very quickly, advanced medical help should still be sought. Results from a 2015-2016 survey of more than 38,000 children indicate that nearly 8 percent have food allergies, and the CDC reports that between the two periods of 1997-1999 and 2009- 2011, food allergy prevalence among children increased by 50 percent. https://d3imrogdy81qei.cloudfront.net/video_images/8451/about-anaphylaxis-.jpg Yes 233 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-definition https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4744.mp4 What is Anaphylaxis The CDC defines anaphylaxis as “a sudden and severe allergic reaction that may cause death.” Not everyone has allergies, and not everyone who has allergies will be susceptible to going into anaphylactic shock. Also, just because someone has an allergic reaction does not mean that they will then go on to experience anaphylaxis.  The reaction may start suddenly within seconds, or take minutes or even hours to develop following contact with the allergen. Common food triggers include peanuts and tree nuts, fish and shellfish, citrus fruit, eggs, and dairy products such as milk and cheese. Other allergens include venom from stinging or biting insects, medicines – most commonly antibiotics, aspirin or ibuprofen, or substances such as latex. Allergic reactions can manifest in many different ways, however anaphylaxis has a few common signs and symptoms, one of the most common being breathing difficulties. This is because all of the small tubes in the lungs which deliver oxygen swell up, and consequently the person cannot get enough oxygen into their body. If this happens, they will be breathing very quickly but each breath will be very shallow. Anaphylaxis can also cause a drop in the person’s blood pressure which may make them faint or even go unconscious. This is also the body’s response to not receiving enough oxygen. This is because fainting normally makes the person fall to the floor, which in turn makes it easier for blood to get back to the head, and also puts a bit less strain on the heart and lungs. Other signs and symptoms of an allergic reaction include a rapid heartbeat, cold clammy skin, confusion or nausea. It is worth mentioning that the more serious the reaction, the more seriously these signs and symptoms will present. https://d3imrogdy81qei.cloudfront.net/video_images/8453/what-is-anaphylaxis-.jpg Yes 123 https://app.protrainings.com/courses/anaphylaxis/videos/life-with-anaphylaxis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4745.mp4 Living with Anaphylaxis For patients living with an allergy that may cause them to go into anaphylactic shock, there are many things to consider. First of all, make sure you know what triggers the allergy, and do your best to avoid these things at all times. Unfortunately this may mean that patients will not be able to do everything or perhaps eat what they want, but it is essential that you minimise the risk of reaction as much as possible. On top of this, they must know how to recognise the signs and symptoms of anaphylaxis, and make sure their close friends and family are also aware. Having as much awareness as possible can help not only save this patient’s life, but also others who have allergies. The medication used to treat someone in anaphylactic shock will be covered in more depth later on in the course. This fast-acting medication is stored in and administered using what is called an auto-injector. This does as the name suggests, and automatically injects the drug into the patient. When living with the risk of anaphylaxis, the patient must ensure that not only is the auto-injector not expired and properly maintained, but it must also always be kept close by the owner. There is no point having it stored safely at home if they are having an anaphylactic reaction in the middle of a field, miles away, and need their medicine. Not only this, but make sure that you understand how and when to correctly take the medication, otherwise it is useless. Practicing with an auto-injector trainer is often really helpful to the patient, as they can repeat the training if they don’t feel confident. https://d3imrogdy81qei.cloudfront.net/video_images/8455/living-with-anaphylaxis-.jpg Yes 107 https://app.protrainings.com/courses/anaphylaxis/videos/minor-allergic-reactions https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4746.mp4 Minor allergic reactions We have spoken about full, allergic, anaphylactic reactions, but now we are going to take a step back and briefly talk about minor allergic reactions. These are allergic reactions that do not affect the respiratory system. One of the more common minor allergic reactions presents itself in the form of a rash, or even simply a bit of redness on the skin. Cases like these are not necessarily treated in the same way as anaphylactic reactions. It may be that creams can be applied to the affected area, or it can be treated using certain tablets. An example could be antihistamine tablets, such as Benadryl, Allegra, or Claritin, that a patient takes when they come into contact with an allergen. Even something like hay fever is still an allergic reaction, but it’s not having the same, full blown effect that an anaphylactic reaction has. It's quite important to recognise the difference between the major anaphylactic reactions and other, more minor reactions. You can get advice on both major and minor reactions from your doctor, pharmacist, or online. Just be sure that if you use the internet that the source is a recognised and trusted one. Something like hay fever, for example, there are websites and non-profits or charities around that can offer support. If someone has any type of minor reaction you must still be vigilant. Just because it’s a minor reaction at the moment doesn’t mean that it won’t develop into something worse in the future. If the condition of the patient starts to become at all worrying, you must activate the emergency services immediately. https://d3imrogdy81qei.cloudfront.net/video_images/8457/minor-allergic-reactions.jpg Yes 107 https://app.protrainings.com/courses/anaphylaxis/videos/common-causes-of-allergic-reactions https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4747.mp4 Common causes of allergic reactions As we have already discussed, people may be allergic to a number of different substances, referred to as allergens. People who are allergic to one substance are often allergic to others. Some of the most common allergens include:- Venom from insect bites and stings, especially those of bees, wasps, hornets, and yellow jackets- Foods, including nuts, shellfish, crustaceans, peanuts, milk, eggs and chocolate- Plants, including contact with poison ivy, poison oak, and pollen from ragweed and grasses- Medications, including penicillin and other antibiotics, aspirin, seizure medications, muscle relaxants and over-the-counter remedies- And finally, other things such as dust, latex, glue, soaps and make-up https://d3imrogdy81qei.cloudfront.net/video_images/8459/common-causes-of-allergic-reactions.jpg Yes 60 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-activating-ems https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4748.mp4 Activating the EMS For anybody experiencing an anaphylactic reaction, you must activate the emergency medical services on the nation-wide number, 911. This works no matter what state you are in and will connect you to the nearest dispatcher. It’s a toll-free number and most mobile phones will allow you to call 911 even if the phone is locked and you don’t have the unlock code. When you call the emergency services, it is important to give them some basic information. You must make sure that they know early on that this is an anaphylactic reaction. This means that they will send someone out to you very quickly, but they will need further information from you. They will need to know who the person is, and they may ask you about their age or gender, and of course where exactly you are. Now sometimes knowing where you are is not always that easy. It may be you have travelled somewhere and are not sure of the exact address. If you are dialling from a landline phone, the emergency services can usually track you very, very easily. Have a look at the phone. It may well be that something close by has the address on. Maybe a panel if you are calling from a payphone, where there'll be a little card that actually says your location. If you are dialling on a mobile but you’re unsure exactly, then tell them where you think you are. They will be able to triangulate your signal, so maybe they just need to know what else around you can see. Emergency medical services will give you lots of information during the call, and will also instruct you on what you should be doing. You will be able to ask them questions. Tell them if the anaphylactic drug been delivered. If you are worried, they can stay on the phone right up until the paramedics arrive, and when they do, you need to tell them exactly what has happened and what medical treatment has been given. If the person has had one or even two auto-injector doses, they will need to know that so they know what drugs that they can then give, without the danger of overdosing. Any treatment you have given, hand to the paramedics when they arrive, they will be able to see the exact type and make of the drug, and exactly the dose that's been given. If you are at work, it's a good idea to make sure you know who has been trained in CPR and first aid. In a workplace, you may have a special emergency plan, so people should know if a certain person is susceptible to anaphylaxis. You would dial the emergency services first, but you must also then activate the in-house first aider. If you have got any doubts about what to do in the workplace, please ask your manager. If you are working in a child setting, perhaps in a school, there will also be policies and procedures in place as to where the drugs are kept, so in the case of an emergency you can access them quickly. The most important thing, if someone is having an allergic reaction, is that you must dial the emergency medical services immediately and tell them you have an anaphylactic emergency. While you are waiting for the emergency medical services to arrive, you should monitor for other issues, such as loss of consciousness, an increase in breathing difficulties, respiratory arrest, and cardiac arrest. If the person stops breathing but still has a pulse, perform rescue breathing. If the victim stops breathing and loses his or her pulse, begin full CPR. If the victim begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive. https://d3imrogdy81qei.cloudfront.net/video_images/8461/activating-the-ems-.jpg Yes 212 https://app.protrainings.com/courses/anaphylaxis/videos/what-is-auto-injector https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4749.mp4 What is an Auto-Injector? More than 50 million Americans experience some type of allergy each year, so it is relatively likely that you will come into contact with someone who may be at risk of a severe allergic reaction and then going on to experience anaphylaxis. The main drug used to treat anaphylaxis is called either epinephrine or adrenaline. Our bodies are constantly making small amounts of adrenaline, and it is also known as the “fight or flight” chemical. You may have heard of having a pit in your stomach when you are nervous or scared, and this is actually due to excess adrenaline being made to be ready to either “fight”, continue with what you are doing, or “flight”, run away and don’t do it. Auto-injectors contain a pre-measured dose of adrenaline, which is much more than the usual body produces. When injected into the body, the adrenaline is quickly fired into the bloodstream and helps to open back up the airway of the patient, allowing them to breathe again. This is why someone with serious allergies should always carry an auto-injector with them, on their person. Using conventional syringes takes way too much time, and if you yourself are having an anaphylactic attack, there is no way you will cope with drawing a drug out of a bottle in the same way a trained doctor would do. Also, the fact that auto-injectors contain a pre-measured dose of adrenaline means there is no chance of either not injecting enough in, or going to the other extreme and overdosing. This is why auto-injectors are so useful. There are many types of auto-injectors, and the most common ones are very easy to handle and use. They are available to anyone who could be susceptible to anaphylaxis. Even though there are many types of auto injector, they should all be administered into the top quarter of the thigh. The main auto injectors being used are the EpiPen®, the AUVI-Q®, the Adrenaclick®, and a number of generics. We will look into each of them in more detail, as well as cover the differences between them in separate videos. https://d3imrogdy81qei.cloudfront.net/video_images/8463/what-is-an-auto-injector-.jpg Yes 137 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-prescriptions https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4750.mp4 Who prescribes auto injectors? Auto-injectors are a prescription-only medicine, which means that only a doctor can prescribe one once he knows you need it. However, there is an exception to the rule regarding prescriptions in many U.S. states. You should check your state’s website for the exact information. Many have passed epinephrine auto-injector laws in the past few years allowing certain organizations (also commonly known as “authorized entities”) to either directly purchase auto-injectors from the pharmacy without a prescription or to obtain a prescription for an auto-injector on behalf of the entity as the patient rather than an individual. Examples of authorized entities may include schools, recreation camps, day care facilities, youth sports leagues, amusement parks, restaurants, sports arenas, and places of employment. Many of these laws also require regular auto-injector training, such as this course, in order to be permitted to administer an auto-injector to a patient. It is important to recognize that auto-injectors come in different dosages depending upon the size of the person. Generally, children between 33 and 66 pounds should use a smaller dosage than an adult would. For children under 33 pounds, you should not administer the auto-injector and call 911 immediately to determine what to do next. Be sure to always read the label on the auto-injector before use, both too much or too little epinephrine could affect the patient’s recovery. The doctor is involved in actually deciding which drug you'll be given. What he's going to look at is the problem you have, what you are allergic to, any previous problems, the effectiveness of previous drugs, and also your lifestyle. So you are going to need to keep going back to the doctor to make sure that you have the correct treatment for your condition. If you need any advice on this, contact your doctor’s office and speak with either the doctor, or one of the nurses. The pharmacist is the person who will actually hand over the drug to you, but they can also offer further help, should you need it. They can give you advice on the units, they can tell you about storage. They can also dispose of medicines if you have some expired drugs you need to get rid of. So there is lots of help out there for you. Just ask. Talk to your doctors, talk to your pharmacists, and anybody else you think can give you useful advice. https://d3imrogdy81qei.cloudfront.net/video_images/8465/who-prescribes-auto-injectors-.jpg Yes 157 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-storage-disposal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4751.mp4 Storage and disposal Your auto-injector must be stored correctly, but you must also be aware that different auto-injectors will have different temperature ranges and requirements that they can be kept under. So you need to make sure you know how to correctly store your particular unit, and then actually go on and store it correctly. You can get this information from the manufacturer's website, from your pharmacist or doctor, or on the ProTrainings website. Now generally speaking, all auto-injectors have to remain in set temperature ranges, you can't allow them to freeze or reach too high a temperature. If this happens, the shape of the chemical will change, which can render it useless. Most auto-injectors are quite resistant to temperature changes and will be able to resist small changes, however it is the extremes which you need to guard against. With regards to cold temperatures, for example if you are going to put them into your coat pocket and you are out in a very snowy or frosty day, then you must look at what the minimum temperature of that environment is. Err on the side of caution, do not risk taking your auto-injector into an area which is likely to reach either extremely hot or cold temperatures. If you have an auto-injector left in the car on a hot sunny day, the temperature inside your car can get extremely hot, so you may need to make special arrangements to keep the unit cooler. Perhaps have an insulated storage box within your car, or maybe even just put it in the trunk of the vehicle. So make sure to check exactly with the manufacturers as to what the temperature extremes for your particular unit are. Other requirements may be that the unit must have a UV protecting case. UV light comprises of sunlight between a particular wavelength range, which can make it not only dangerous to humans, but can also affect certain chemicals. For example, the EpiPen unit has a special case that protects it from UV light, since the adrenaline inside the EpiPen can be seriously affected by the sun’s rays. So, keep the unit in whatever storage case it comes in, not only may it offer protection against UV light, but it will also obtect against dust, dirt and other potential hazards. There are different times when you are going to need to dispose of an auto-injector, and you need to take special precautions when doing this. One example would be once you have actually used it, and another would be if it becomes damaged or expired – meaning the medicine is still in the unit. If you have actually used an auto-injector, you should always give that to the paramedic or medical professional on the scene. That way they can tell exactly what has been administered to the patient. In times where both the unit and the medicine needs to be disposed of, you would need to take it back to your pharmacist, doctor or hospital and they can dispose of it correctly. Never just put these straight into the trash, as not only do they contain a needle, but also potentially dangerous medicine if not administered correctly and not expired. https://d3imrogdy81qei.cloudfront.net/video_images/8467/storage-and-disposal-.jpg Yes 186 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-storage-pharmacist https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4752.mp4 Storage of auto injectors - Pharmacist comments Auto-injectors are a device to administer an injectable preparation into the skin without the skills that a professional such as a doctor or nurse would have. They are designed for yourself and myself, as members of the public, to use. And the auto-injector as a pen has the dosage, a unit dose of medication that is required. The storage requirements are that they remain within the packaging that they come. That they are safety, that they function correctly when you pull them out of there. Do not open them and store them outside of the container that they come in. Do read the instructions carefully as to how they should be stored in the temperatures. In general, they can be carried everywhere, but do not leave them on the windscreen of your car, do not leave them in the refrigerator with your sandwiches. Do make sure that you read that and follow the instructions on there. Always carry them in the original container that they have been supplied in. https://d3imrogdy81qei.cloudfront.net/video_images/8469/storage-of-auto-injectors---pharmacist-comments-.jpg Yes 74 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-signs-symptoms https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4753.mp4 Signs and Symptoms of Anaphylaxis Common allergies children suffer from are to food substances such as peanuts, and even a very small trace of nut can cause someone to have an anaphylactic reaction. This will normally come on very quickly, however sometimes it can take a few hours. If you suspect any anaphylactic reaction, you need to activate the EMS immediately. Signs and symptoms of anaphylaxis include:- General symptoms, such as itchy, watery eyes, a headache, or a runny nose.- Skin problems, such as a swelling of the face, lips, tongue, neck, or hands. Or an itching, hives, rashes, or generally red skin. Breathing problems, such as cough, a difficulty swallowing, rapid breathing, difficulty in breathing, noisy breathing, a change in or loss of voice, a high pitched noise during inhalation, wheezing, or a sharp burning sensation in the chest and throat. Serious breathing problems are a sign that this person may be experiencing a severe allergic reaction. Heart or circulation problems, such as increased heart rate, decreased blood pressure, excessive sweating, or cool and clammy skin. Mental status problems, including confusion, agitation, hallucinations, fainting or a loss of consciousness. https://d3imrogdy81qei.cloudfront.net/video_images/8471/signs-and-symptoms-of-anaphylaxis-.jpg Yes 88 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-first-aid-advice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4754.mp4 Basic First Aid Advice The purpose of first aid is to prevent the patient getting worse and this can be performed with some simple, easy skills. Before entering into a rescue scene, the rescuer should perform an initial assessment to ensure that the scene is safe. Next, personal protective equipment should be worn to protect the rescuer. The ABCD concept is designed to give the rescuer a guide of what to do, in what order, during a first aid emergency when the person is unconscious. First of all, there is "A". This stands for the Airway, which starts at the mouth and nose and ends at the lungs. It is very important that this is not blocked, as it delivers oxygen to the lungs. You can check that it is not blocked by opening the airway. This is done by tilting the head back and lifting the chin. After this, you must check to see if the person is breathing. You need to Look, Listen and Feel for any signs of breathing for 10 seconds. If they are not breathing you must commence CPR and check for Circulation, which is what C stands for. You can do this by checking what is called capillary refill. Gently but firmly push the blood in the thumb towards the body. If the blood returns in 2 seconds then there is adequate circulation. The next thing the patient needs is "D" - Defibrillation, where an electric shock interrupts a cardiac arrest and hopefully allows the heart to start again. If alone, the rescuer may need to put the patient into the recovery position, whilst leaving to contact emergency services, if the patient is breathing. If the patient is not breathing, call the EMS and then perform CPR. The recovery position allows the patient to breathe easily, stay safe, whilst removing the risk of them choking, should they vomit. https://d3imrogdy81qei.cloudfront.net/video_images/8473/basic-first-aid-advice-.jpg Yes 114 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-for-teachers https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4755.mp4 Schools and teachers When you're dealing with an anaphylactic emergency in either a child or an adult, the actual treatment is the same. However, when you're dealing with a child there are certain other things you need to think about. One of these is that the fact that the child is going to be very scared, maybe they've had an anaphylactic reaction before, and now they're really worried because they know what it's like. So, you have to guide them through using their auto-injector as quickly as possible. The quicker the drug is injected into the child, the quicker the problem will go away. The child will know this and you need to encourage them to inject themselves without delay, to therefore make themselves feel better. The child may be scared about putting the needle into themselves but again, just try and tell them that the drug will help them and it will make them feel better very quickly. There are other things that need to be taken into account when working with children. These may be written policies from an employer, duty of care, and you may need to have a signature from the parent who could possibly allow you to administer the drug to the child should there be an emergency. There will also be other records that you need to keep, such as: - What are the names of the children in school or a play centre that have anaphylaxis, what drug do they use, where are the drugs kept, what does the prescription say, how is it delivered, do they need one or two auto-injectors? - Do the children carry it with them to class or is it stored in a special location? - All these types of record-keeping will be planned out by your employer, so it's important to find out exactly what their policies are in relation to the storage of anaphylactic medication, and also what their treatment policies are. The first aid procedures will be the same. Activate the emergency services, give the patient their drug, but also consider other policies that may differ from one workplace to another. If you're working with children on a day-to-day basis, the most important thing you can do is talk to their parents or guardians. They should be able to give you all the information you need to best care for their child. So when you're talking to the parents, make sure you understand whether or not they've had an anaphylactic problem in the past. If so, how did they handle it? It may be that the parent says that the child is very adult about it and they just get their auto-injector out and deliver the drug without fuss. Others may say that the child gets very upset and scared. The more information you have the better. As somebody looking after children it may well be that you have quite a few in your care, so make sure that you keep their records up to date. Also, talk to the children themselves, they will be able to help you. Make sure you know and understand any developments with their treatment. Just keep reminding them where their drugs and treatments are, so you're communicating with the child and they know how important it is. https://d3imrogdy81qei.cloudfront.net/video_images/8479/schools-and-teachers-.jpg Yes 176 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-second-dose https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4756.mp4 Giving a second dose Sometimes, one auto-injector is not enough, so doctors may well prescribe a second one. If you or the patient has delivered one auto-injector, and they're feeling worse, or certainly no better at all, then it may be that you need to administer a second dose between five and 15 minutes after the first. Remember, these are single dose syringes, so you can't deliver it twice from the same unit. So use a brand new unit and inject the medicine in the exact same way. Make sure that the paramedics know exactly what's happened, that two auto-injectors have been used instead of just the one. This is very important because the paramedics may well give further drugs, so they need to know what's actually in the patient’s system already. Otherwise there could be a risk of overdosing, or other interactions between various chemicals. Having a second dose is not needed for everybody, so patients must consult their doctor individually. Remember that they won't prescribe something if they don't think that it’s needed. Reasons for a second auto-injector vary from things like body size and age, and also what's happened in the past. It may well be that in previous attacks two drugs have been required, so two are now routinely prescribed. If you're caring for a child then again, get advice from their parents or themselves as to whether they need to have one or two doses. https://d3imrogdy81qei.cloudfront.net/video_images/8475/giving-a-second-dose-.jpg Yes 92 https://app.protrainings.com/courses/anaphylaxis/videos/biphasic-anaphylaxis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4757.mp4 Biphasic Anaphylactic Response We have looked at a single anaphylactic reaction but now we are looking at a possible Biphasic anaphylactic response. A biphasic response means that there are two separate and distinct reactions that are separated in time. Consequently with anaphylaxis, this would be an immediate reaction to the trigger which is then followed by a recurrence of symptoms after an interval of time. Being exposed again to the allergen is not necessary for a biphasic reaction to occur. This reaction can happen between 2 and 72 hours after the first incident, so perhaps long after discharge from the hospital. This can occur in as many as 20 percent of cases. The biphasic reaction can be less, equally or more severe than the initial reaction, ranging from mild symptoms to a potentially fatal reaction. Biphasic reactions do not always show the same symptoms as the initial reaction. Predicting if a second reaction will occur is not easy but the more severe the reaction or when two auto-injectors are initially needed, the higher the chance of a recurrence. Being aware of a possible biphasic response is important if you are caring for someone, so you can monitor them closely just in case. If you are administering first aid then it may be worth telling them, or their parents or guardians, to watch for additional symptoms after hospital discharge. Knowing this is important, but remember that every patient is sent to the hospital after experiencing anaphylaxis and will be advised on the actual care they think is needed after discharge. Finally, always make sure you have a spare auto-injector once discharged from hospital, just in case, and that you monitor the patient closely for up to 72 hours after the first attack. https://d3imrogdy81qei.cloudfront.net/video_images/8477/biphasic-anaphylactic-response-.jpg Yes 115 https://app.protrainings.com/courses/anaphylaxis/videos/reporting-requirements https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4758.mp4 Reporting Requirements An anaphylactic emergency that has happened in the workplace would be recorded in the accident book, and you do need to make sure that the correct accident records are kept. This would be the standard accident book in your workplace. You would document who has had the problem and you would also write down in the book what treatment they've had and who put the information in there. You'd also need to follow general policies within your company. If you're unsure about this, talk to your manager. There may be a separate medications record of who has them and what exactly they have. Also, if you deliver any medications, you may need to record this separately. If your organization is an “authorized entity” that is permitted to have undesignated auto-injectors on-site, you may also be subject to additional reporting requirements by your state if an auto-injector has been administered. Please refer to your local state laws for details on how to file a report. https://d3imrogdy81qei.cloudfront.net/video_images/8481/reporting-requirements.jpg Yes 70 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-administration https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4759.mp4 When to Administer an Epinephrine Auto-Injector It can be difficult to know whether an allergic reaction has progressed to the point where it is necessary to use an auto-injector to treat the person. If they have a known history of allergies and allergic reactions and have come into contact with an allergen that has been known to cause this type of reaction in the past, this may be an indicator that an auto-injector is needed. If the person is having difficulty breathing and appears to be in severe respiratory distress, along with any other warning signs of an allergic reaction, such as throat closing, swelling of the tongue or lips and loss of consciousness, you should administer the epinephrine auto-injector immediately. https://d3imrogdy81qei.cloudfront.net/video_images/8483/when-to-administer-an-epinephrine-auto-injector-.jpg Yes 48 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-recovery-position https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4760.mp4 Anaphylaxis patient position There are different positions to help a patient to recover from an anaphylactic reaction, depending on their condition. When the patient is using their auto-injector they should either lie flat or be sat down. If the symptoms are affecting breathing, the patient may be more comfortable in either the semi-recumbent position, resting on someone else or on pillows. They will find it easier to breathe in this position. If the patient is feeling cold, dizzy, weak or they are clammy or sweaty, they may have low blood pressure, so you should lay them down with their legs raised up on a chair or something similar, which allows blood to return to the head. It is important to not suddenly stand up after using the auto-injector as a sudden change in body position may lower the blood pressure drastically, which could make the condition much worse. If you are caring for someone, when lying them down, it is a good idea to turn their head to one side to prevent them from breathing in vomit, should they suddenly be sick. If the patient looks like they may vomit, turn them on their side in preparation, and if anyone becomes unconscious, you should always place them in the recovery position. However, if they stop breathing, then you should begin CPR. To put the patient into the recovery position, make sure they are on their back and take the hand nearest to you and place it at 90 degrees from the body with the elbow bent. Lean across them and pull their other hand across their body by the thumb and then interlock your fingers and hold their hand against their face on the side nearest to you. With your other hand grip their leg furthest away from you and lift it so that the foot is flat on the floor. Move your hand on the far side of the knee and pull them towards you using the leg as a lever and keeping their head supported with your other hand. Remove your hand from their hand and open their airway by tilting the head back. Their hand will remain by their face to support it. Then tidy up their leg so it is not reducing circulation, which will also support them better. Check they are breathing, that the airway is open, continuing to closely monitor their breathing and vital signs until the EMS arrives. If one is available you can cover them with a blanket to keep them warm. Remember in all cases of anaphylaxis you must call the EMS, even if the patient is feeling better. https://d3imrogdy81qei.cloudfront.net/video_images/8535/anaphylaxis-patient-position-.jpg Yes 147 https://app.protrainings.com/courses/anaphylaxis/videos/allergies-covid-19 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4761.mp4 Allergies and COVID-19 There are some relations that need to be made between the Coronavirus pandemic and allergies. For example, some medications can affect a person’s immune system, which may make them more liable to the more serious signs and symptoms of COVID-19, should they contract the virus. Most anti-allergy medications do not affect immunity, however this doesn’t mean that this doesn’t happen with some medications. If you are at all worried, you should consult your doctor or allergy team. The Asthma and Allergy Foundation of America have stated “Antihistamines do not suppress the immune system. There is no reason to think they would increase your chances of getting a virus or a bacterial infection.” If you are self-isolating and can’t get the required medications, you must arrange for someone else to buy over the counter drugs for you. You may also be able to arrange for prescriptions by mail from your pharmacy to help you if you know in advance that you need to self-isolate. https://d3imrogdy81qei.cloudfront.net/video_images/8485/allergies-and-covid-19-.jpg Yes 69 https://app.protrainings.com/courses/anaphylaxis/videos/anaphylaxis-practice https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4762.mp4 Practice and keeping up to date Now we are going to look at training and practice. The training element that you are undertaking within this course gives you the basic knowledge and skills you need, however training is all about practicing regularly. People who are diagnosed with anaphylaxis may be given a training unit to practice on. The advantage of these is that you can practice again and again on a regular basis. You can just make sure that you're happy with how to use the unit, how to deliver the drug, and that you keep your skills fresh. But also, if you've got friends or family, get them to practice as well. They can try using it on themselves or try using it on you. They are completely safe, with no drug in them and are very, very easy to use. https://d3imrogdy81qei.cloudfront.net/video_images/8487/practice-and-keeping-up-to-date-.jpg Yes 53 https://app.protrainings.com/courses/anaphylaxis/videos/immunotherapy-drugs https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4765.mp4 Immunotherapy drugs Peanut allergies are becoming more and more common in children, and this usually continues into adulthood. In severe cases, a peanut allergy can be life threatening, and at this moment in time there is no approved treatment for it. A current study is investigating a new drug and its effectiveness to reduce the symptoms seen in people with severe peanut allergies. The new drug being tested is called AR101 and it’s based on peanut protein, with the idea being that the dose is gradually increased to build up tolerance. This treatment is not a cure to peanut allergies, rather its aim is to make people with severe allergies less likely to experience a serious reaction if they are exposed to peanuts. This drug is not available in all countries but it has been licensed in the USA by the Food and Drug Administration or FDA, as an approved drug in the reduction of allergic reaction incidence and severity in patients aged 4-17 years old with a peanut allergy. The trial involved a total of 555 participants, 499 children and 56 adults, and was carried out in 10 countries in North America and Europe. The study compared the drug AR101 with a dummy powder, a placebo. Some participants received the real drug, which was gradually increased over a 12 month period. The other participants received the placebo, which was also gradually increased over 12 months. It is important to note that all tolerance tests were conducted in a research facility under medical supervision. This meant that participants could receive immediate medical attention if they experienced a severe allergic reaction. So, what were the results? Well, the research showed that young people with peanut allergies could experience a reduction in the severity of their symptoms, and a greater ability to tolerate small amounts of peanut protein following treatment with AR101 compared with the placebo. The study also showed that although this treatment appeared to work in children and adolescents, it had no significant effect in adults. The reason behind this has not yet been made clear. There are continuous ongoing studies for peanut allergies in the attempt to offer some hope for parents and children with serious peanut allergies. We must point out that tolerance testing should never be attempted at home. Allergic reactions can be life threatening if not treated immediately. https://d3imrogdy81qei.cloudfront.net/video_images/8491/immunotherapy-drugs.jpg Yes 152 https://app.protrainings.com/courses/anaphylaxis/videos/idiopathic-anaphylaxis-diagnosis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4766.mp4 Idiopathic Anaphylaxis Sometimes, people are diagnosed as having what the doctor may call idiopathic anaphylaxis. This special type of anaphylaxis means that the cause for the anaphylactic reaction is unknown. During idiopathic anaphylaxis, the reaction is normally exactly the same and the signs and symptoms are typical. If the doctor diagnoses this, they will advise you to stay away from all of the most common allergens like shellfish, peanuts and eggs. This is because it could be that there may be more than one thing you are allergic to. Sometimes, the doctor will diagnose the condition as idiopathic, but then later on you may realise that you only get anaphylactic reactions after eating certain foods or after being stung by something. The doctor may also ask you to undertake allergy testing and physical examinations. In cases of idiopathic anaphylaxis, it is essential that you always carry around your prescribed auto-injector, as you cannot always stay away from allergens. Many people with idiopathic anaphylaxis see a decrease in reactions as their life goes on, again however, it is unclear why this is. https://d3imrogdy81qei.cloudfront.net/video_images/8489/idiopathic-anaphylaxis-.jpg Yes 77 https://app.protrainings.com/courses/anaphylaxis/videos/course-intro-anaphylaxis https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4767.mp4 Course Introduction Welcome to this ProTrainings Epinephrine Auto-Injector and Anaphylaxis course. Throughout this course, you will watch a series of videos, answer some knowledge review questions and then finally take a short completion test. You can start and stop the course as often as you wish and return to it exactly where you left off. You can also watch any of the videos again, at any time, during and after the course. The course can be viewed on any device, so if you wish you can start watching it on your computer and finish it on your smart, phone or tablet. On each page of the course, there is text available to read about the subject covered, to further support the video and there is also additional help available if you initially answer any of the questions incorrectly. The course includes subtitles which you can view by clicking the CC icon if you wish. You can change the size and colour of the subtitles from the bottom right of the player. If you want you can select from the options on the bottom right of our player to show an additional smaller video player that stays on the screen as you read the text, allowing you to read and watch the video at the same time. Once you have passed the test your completion certificate and other downloads will all be available for you to print off. There are many resources and links to support your training and these can also be accessed from the course home page. We are constantly updating our courses, so check back regularly to view any new material. We give you access to the course for 8 months from when you started it, even after you've passed your test. We offer free company dashboards, so if you're responsible for staff training in your workplace and you'd like more information on our company solutions, please contact us by email, phone or by using our online chat facility. This may be a course that's delivered online but we offer you complete support throughout your training. Finally, with all our online courses you will receive an email every Monday morning, to keep your skills fresh and to see any new videos that we add to the course. These emails also include news from our blog and you can choose to receive them, or stop them, at any time. We hope you enjoy your course and thank you for choosing ProTrainings. Good luck! https://d3imrogdy81qei.cloudfront.net/video_images/8493/course-introduction-anaphylaxis-usa-.jpg Yes 125 https://app.protrainings.com/courses/covid/videos/coronavirus-how-to-keep-up-to-date-- https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4772.mp4 Coronavirus - How to keep up to date This course is designed to give general information on Coronavirus and COVID 19 but it is not always possible to be up to date with the latest information as it is released. The government advice for every country and region can change daily, and this needs to be considered as you work through the course. We are updating the course regularly with more information but if you need to know the current exact rules in your region or country you need to refer to your local government website or health authority. For example, in the UK you can look on the NHS website and to see laws and guidelines you can look at the English, Welsh, Scottish or Northern Irish governments websites. There are similar sites in the different states in the USA and for individual countries worldwide. The World Health Organisation or WHO website has more guidelines covering a wide variety of sectors and there are lots of leaflets and videos on Coronavirus. Other ways of keeping up to date are to watch and read the news regularly, where you will see the latest updates and analysis on what the changes will mean to you. If you are looking on the internet, look only at a reliable website to ensure you do not follow the wrong advice and do not base your information on social media posts.   https://d3imrogdy81qei.cloudfront.net/video_images/8505/coronavirus-how-to-keep-up-to-date--.jpg Yes 85 https://app.protrainings.com/courses/anaphylaxis/videos/auvi-q https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4792.mp4 The Auvi-Q® There are 3 types of AUVI-Q auto-injectors. The first one, which is white and purple, has 0.1 milligrams of epinephrine, and is for infants and toddlers weighing 16.5 to 33lbs. The next step up is for children weighing 33 to 66lbs, contains 0.15milligrams of the drug, and has a light blue casing. Finally, the red cased auto-injector is for anyone weighing 66lbs or more, and contains a much higher 0.3 milligrams of the medicine. If you have the white and purple unit and are injecting an infant or toddler, you should hold the leg firmly in place while administering an injection. All units come equipped with a set of voice instructions, so the unit will literally tell you what you need to do. Should this part of the unit malfunction however, the unit will still work as an auto-injector, meaning you can still use it to inject the drug. To start using the unit, pull off the bottom part of the case, which will activate the instructions. Then it will tell you to pull the red safety guard off of the bottom of the unit, which exposes the site where the needle will come out. After that, put the same end, which is black, against the outer thigh and push in firmly. Once in place, it will countdown for two seconds and should not be moved until you hear it say “injection complete”. After that, you can remove the unit from the leg. When administering AUVI-Q to an infant or toddler, their leg should be held firmly in place. This stops them from flailing their legs about, should they become scared. However if they are having a serious allergic reaction then the medicine must be administered, otherwise the reaction could prove to be fatal. Always follow instructions to make sure that nothing goes wrong. https://d3imrogdy81qei.cloudfront.net/video_images/8539/the-auvi-q.jpg Yes 110 https://app.protrainings.com/courses/anaphylaxis/videos/amneal https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4793.mp4 Amneal Epinephrine Auto-injectors As with all auto-injectors, the Amneal Epinephrine Auto-Injector contains a prefilled dose of adrenaline to be used during serious allergic reactions or anaphylaxis. This training unit is black and beige colored, but the actual units you would be using are black and yellow, which makes them easily identifiable in a possible time of panic. When using the Amneal Epinephrine Auto-Injectors, first of all, you have to grab both ends of the unit and then twist and pull to separate the outer shell casing. You need to remove both sides of the casing. Otherwise, you may drop the unit, which could damage the medicine inside or possibly cause it to either leak or malfunction. Once the outer shell casing has been removed, the actual auto-injector is exposed, but be sure to keep the casing nearby, as it is used after the adrenaline has been administered. As with most auto-injector units, instructions on how to use it are printed on the actual unit. Be sure to read these, even if you think you know what you are doing. Remember that sometimes there may have been some changes made that you did not know about. Once you are holding the Amneal Epinephrine Auto-Injector, you must first pull off the smaller cap, which is the back end of the unit. In this training unit, the cap is yellow, but the actual unit would have a blue cap. Next, you should pull off the larger blue cap, which is located in the front end. This exposes the bright red end of the unit, which indicates that is where the needle will come out of. Hold the Amneal Epinephrine Auto-Injector unit as you would with any other auto-injector, remembering to keep your fingers and thumb away from either end, just in case it is the wrong end. Then gently place the red needle end against the outer thigh and push it into the leg. This injects the adrenaline and must be held in place for 10 seconds. After that, you must pull the unit out, away from the leg. This exposes the needle, so be careful not to injure either yourself or others. Then you must carefully put the needle end back into the black half of the outer casing. Next, return the yellow end back in place and finally twist it until you hear a click, sealing the container. When the EMS arrive, make sure to give the auto-injector to them, as medical professionals need to know what medicines have been administered in what dosages. https://d3imrogdy81qei.cloudfront.net/video_images/8537/the-impax.jpg Yes 149 https://app.protrainings.com/courses/anaphylaxis/videos/allergy-medical-id-tags https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4805.mp4 Medical ID tags for allergies When you are dealing with a patient, one big problem you have is finding out what existing medical conditions they have, so the use of ID tags can be really really helpful. So these can be built into different sections, we've got an example of some here, but the first ones we've got are general medical tags. So with these, you can write general medical information down and this one here is one where you'd actually write on a card and you insert that card into the strap and then you can just wear that around your wrist. There are others which are a rubber band type and on the inside you can write medical information but on there always use a pen that is permanent. Do not use one that will easily rub off. And there are lots of other general ones you can have which could be metal ones, necklaces or, metal bracelets around the wrist. You can then have ones that are specific to the individual condition they have so, for example, we've got some here which are for anaphylaxis. So these would be in the form of a rubber band and they would be something that an adult or a child could wear and they come in different sizes. So, if you've got a child with a small wrist you can have a smaller one on them and on these they literally state this person has got anaphylaxis so it doesn't actually say on that band what they have got an allergy to but on this one on the inside you can see they've got a little band and you can actually write what the person is allergic to. There are others which are this type which is the clip around the wrist. This one in particular is a child one which clips around their wrist and on the inside you can put the medical data as well on there. Other ways of identifying with anaphylaxis we've got keyrings which will hook on to maybe a case where their auto-injector is and also there are little stickers the child could wear or they could have them on their books or things like that, and at least that tells them what they're allergic to. This particular one says that they're allergic to tree nuts and peanuts. Other ones you can have are unique to individual conditions. So here we've got two which are for people with diabetes and again they can put emergency contact details on the inside and this one here says that the person has epilepsy so, if you're dealing with something you need to look out for all types of ID bracelet whether this type or whether the metal type because you're not necessarily going to know what's wrong with that person. If someone's feeling unwell and maybe they're unable to talk to you then you would know that they have got that relevant condition. An example of this very good one would be somebody who has a seizure, you are not sure whether they are having this seizure for the first time but if they're wearing a medical alert bracelet you would know this person suffers from epilepsy. https://d3imrogdy81qei.cloudfront.net/video_images/8557/medical-id-tags-for-allergies-.jpg Yes 157 https://app.protrainings.com/courses/anaphylaxis/videos/auto-injector-expire-dates https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4809.mp4 Checking Auto Injector and Expiry Dates It is important to check your auto-injector to ensure that it's in date, undamaged and it has been stored correctly to ensure that it's fit for use when needed. Check the expiry date printed on the auto-injector to make sure that it has not expired or, if it is close to expiring, make sure you've ordered a replacement from your doctor. Most manufacturers of auto-injectors have an expiry notification service where you enter the expiry date of a unit as soon as you receive it and then they send you an email or a text when they are needing to be replaced. Carry out a visual inspection to ensure that nothing is damaged and, depending on the brand, you may also be able to see the solution to ensure that it hasn't changed in appearance. Many brands are stored in UV protection cases to prevent them from damage from the sun. Ensure you store your auto-injector within the temperature ranges of the brand. This means not storing it where it can get very hot, like in a car in summer, or very cold where it could freeze in winter. Always keep your auto-injector in the case it comes with to protect it from damage. If you have a second auto-injector or units kept at different locations, make sure you always check these at the same time. If you detect any problems with your auto-injector ask your doctor or pharmacist for advice. It's very important to always make sure that they are ready for use to make sure that they're effective in treating an anaphylactic reaction. https://d3imrogdy81qei.cloudfront.net/video_images/8569/checking-auto-injector-and-expiry-dates-.jpg Yes 92 https://app.protrainings.com/courses/covid/videos/long-covid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4931.mp4 Long COVID Understanding Post-COVID-19 Syndrome (Long COVID) What is Post-COVID-19 Syndrome? Post-COVID-19 syndrome, also known as "long COVID," refers to lingering symptoms that persist for weeks or months after the initial infection has resolved. Recovery Duration The recovery period from COVID-19 varies from person to person. While some individuals may start feeling better within days or weeks, others may experience symptoms for an extended period. Typical Recovery: Most individuals fully recover within 12 weeks. Varied Duration: Symptoms may persist longer, regardless of the initial severity of the illness. Common Symptoms of Long COVID Long COVID symptoms can be diverse and may include: Extreme tiredness Shortness of breath Chest pain or tightness Problems with memory and concentration ("brain fog") Difficulty sleeping (insomnia) Heart palpitations or dizziness Pins and needles Joint pain Depression and anxiety Tinnitus Earaches Feeling sick, diarrhoea, stomach aches, loss of appetite High temperature, cough, headaches, sore throat, changes to sense of smell or taste Skin rashes Seeking Medical Help If you experience symptoms persisting for 4 weeks or longer after a COVID-19 infection, consider contacting your GP for assistance. Consultation: Your doctor will inquire about your symptoms and assess their impact on your daily life. Diagnostic Tests: Tests such as blood tests, blood pressure checks, and chest x-rays may be recommended to further evaluate your condition. Care and Support: Your GP can provide information, advice, and referrals to specialized rehabilitation services to aid in symptom management and recovery. https://d3imrogdy81qei.cloudfront.net/video_images/8783/Long_COVID-01.jpg Yes 139 https://app.protrainings.com/courses/covid/videos/coronavirus-vaccines https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4933.mp4 Coronavirus Vaccines Understanding COVID-19 Vaccines Introduction The development of COVID-19 vaccines offers hope for the future amidst the pandemic. Let's explore the key aspects of three prominent vaccines: Pfizer, Oxford AstraZeneca, and Moderna. Vaccine Mechanisms The vaccines work differently: Pfizer and Moderna: Contain mRNA, which prompts the body's immune response. Oxford AstraZeneca: Utilizes the spike protein of the coronavirus, incorporated into an adenovirus vector. Immune Response Upon vaccination: Immune Activation: The immune system generates defensive cells, including memory cells, providing long-term protection. Memory Cells: Offer lifelong immunity by recognizing and swiftly responding to future encounters with the virus. Vaccine Storage and Administration Proper storage and administration are crucial: Pfizer: Stored at -70°C initially, then at 2-8°C for up to 5 days after thawing. Oxford AstraZeneca: Stored at 2-8°C for varying durations, depending on whether the vial is opened or unopened. Moderna: Arrives frozen and should be stored at 2-8°C after thawing. Administration: Given intramuscularly, typically in the deltoid muscle of the arm. Consult with your doctor to understand the benefits and risks associated with COVID-19 vaccination or boosters. https://d3imrogdy81qei.cloudfront.net/video_images/8787/Coronavirus_Vaccines-01.jpg Yes 220 https://app.protrainings.com/courses/covid/videos/coronavirus---myths https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4934.mp4 Coronavirus - Myths Debunking COVID-19 Myths Understanding Coronavirus Misconceptions Dispelling myths about coronavirus and vaccines: Myth: Lockdowns Aim to Eradicate the Virus Fact: Lockdowns are not aimed at eradicating the virus completely: Lockdowns aim to minimise virus spread. They prevent healthcare systems from being overwhelmed. Buying time for scientists to develop long-term solutions, such as vaccines. Myth: Vaccines Underwent Less Rigorous Testing Fact: Vaccines underwent thorough testing despite the rapid development: Funding availability and simultaneous testing stages accelerated the process. Financial resources: Swift funding due to the pandemic urgency. Simultaneous testing: Testing stages overlapped, reducing time significantly. This expedited vaccine development without compromising safety. https://d3imrogdy81qei.cloudfront.net/video_images/8789/Coronavirus_-_Myths-01.jpg Yes 94 https://app.protrainings.com/courses/covid/videos/pulse-oximetry-and-covid-19 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/4936.mp4 Pulse Oximetry and Covid 19 Pulse Oximeter: Monitoring Heart Rate and Oxygen Levels Understanding Pulse Oximeters A pulse oximeter is a vital tool for monitoring heart rate and blood oxygen levels, especially during the COVID-19 pandemic. Function: Measures heart rate and blood oxygen levels by shining light on the finger. Accessibility: Affordable and user-friendly. Using a Pulse Oximeter Here's a step-by-step guide on using a pulse oximeter: Preparation: Remove nail polish/false nails and warm hands if cold. Procedure: Rest hand on chest at heart level, switch on oximeter, and place on finger. Stabilization: Wait for reading to stabilize (at least a minute). Recording: Record highest result after stable reading (for five seconds). Monitoring Guidelines Follow these guidelines for effective monitoring: Frequency: Take readings three times daily, ideally at consistent times. Documentation: Record readings, symptoms, and overall feeling on paper or online sheets. Interpreting Results Understanding the significance of blood oxygen levels and heart rate: Ideal Levels: Blood oxygen: 95% - 99%; Heart rate: 50 - 90 bpm. When to Seek Help: Contact a Doctor if blood oxygen falls to 93-94%, or seek emergency services if it drops below 92%. Where to Get a Pulse Oximeter If you need a pulse oximeter, visit our store at ProTrainings.uk/store. https://d3imrogdy81qei.cloudfront.net/video_images/8793/Pulse_Oximetry_and_Covid_19-01.jpg Yes 150 https://app.protrainings.com/courses/cpr-instructor/healthcare-bls-instructor-complete/videos/instructor-introduction-2020 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/5033.mp4 Instructor Introduction Welcome to the ProTrainings Instructor Training program. https://d3imrogdy81qei.cloudfront.net/video_images/8983/instructor-introduction-2020.jpg Yes 177 https://app.protrainings.com/courses/anaphylaxis/videos/epipen-usa2 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/5073.mp4 EpiPen® The EpiPen is an auto-injector that administers adrenaline and is carried by people who suffer from anaphylaxis so that it can be used if the person goes into anaphylactic shock.There are two types of EpiPen, the EpiPen and the EpiPen Junior. To avoid accidents and prevent damaging the EpiPen, they should always be kept in their case when not in use.  There are easy to read instructions down the side of each pen and these should be read to make sure you use it correctly.The blue cap shows you the top of the EpiPen, this is the safety cap that makes sure that the needle does not come out when not in use. Once removed, the unit is live. The cap can be replaced without the EpiPen being used; however, you must do so carefully as you could inject yourself accidentally with the adrenaline.When using an EpiPen, you should first remove it from its case. Then lie down with your legs slightly raised to keep blood flowing, or if breathing is difficult then just sit down.Remove the safety cap and gently push the auto-injector into the thigh. This can be done through clothing, but make sure that the needle will not go through any thick seams in the clothes or anything in a pocket.Once the needle has hit, hold it in place for 3 seconds and then remove it. Stay where you are until the emergency services arrive, if you are treating someone and they are unconscious, place them in the recovery position.  When the EpiPen has been used, a needle cover will appear automatically over the needle, to prevent any needle injuries. The used EpiPen should be given to the emergency services after use so that they can see exactly what has been administered to the patient, and they can also dispose of it properly. Should a second dose be required, repeat the process, and make sure that you give both to the emergency services. https://d3imrogdy81qei.cloudfront.net/video_images/9051/epipen-usa2.jpg Yes 112 https://app.protrainings.com/courses/pals/certification/videos/cardiac-arrest-in-pregnancy https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/5074.mp4 Cardiac Arrest in Pregnancy In this lesson, we're going to cover treatment options for both the mother and the baby when the mother experiences a cardiac arrest event. At the end of this lesson, we'll explain why the new recommendations were made. There are several special considerations that you will need to make for a pregnant patient in cardiac arrest. First, the treatment priorities for the mother should focus on the following options: High-quality CPR Oxygenation Fibrillation ACLS medications Pro Tip #1: By saving the mother, the baby will have a far greater chance of survival. In addition to the above priorities to the mother's care, there also needs to be one healthcare provider whose only responsibility is to care for the newborn. The Importance of Oxygenation and Airway Management Because a pregnant patient is more likely to have hypoxia, it's vitally important to place a high priority on oxygenation and proper airway management during resuscitation. Also because of potential interference with maternal resuscitation, fetal monitoring should NOT be attempted during cardiac arrest. Warning: Compression of the mother's arteries and veins from the baby in the abdomen can impede venous return and decrease cardiac output. To help relieve compression of the mother's abdominal aorta and inferior vena cava, left lateral uterine displacement should be done with one or two hands by pushing or pulling the abdomen to the mother's left side. You should also consider that the initial efforts from maternal resuscitation may not be successful, and you should begin to prepare for perimortem cesarean delivery. These efforts should begin immediately. Pro Tip #2: Ideally, perimortem cesarean delivery should be done within five minutes during resuscitation efforts and following the mother's cardiac arrest. Care for the Newborn Immediately After Birth After the baby is born, inflation and ventilation of the lungs will be your top priority. If the infant is born with meconium-stained amniotic fluid, routine endotracheal suctioning for both vigorous and non-vigorous infants is NOT recommended. ET suctioning should only be done if the airway obstruction is suspected after providing positive pressure ventilation. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions. If the newborn requires vascular access immediately following birth, the umbilical vein is the recommended route. If IV access is not feasible, it may be reasonable to use the IO route instead. Consider the Reversible Causes of Cardiac Arrest: The Hs & Ts With any pregnant patient, it is especially important to consider and treat the reversible causes of cardiac arrest in order to provide the best possible chances of survival. In addition to the Hs and Ts, other common causes of maternal cardiac arrest are: Hemorrhage Heart failure Amniotic fluid embolism Sepsis Aspiration pneumonitis Venous thromboembolism Preeclampsia and eclampsia Complications of anesthesia Team Planning is Vital for Good Outcomes To achieve the best possible outcomes for the mother and newborn, healthcare providers need to conduct team planning with the following: Obstetrics Neonatal Anesthesiology Intensive care Emergency Cardiac arrest services A Word About Why These New Recommendations Were Made The recommendations for managing cardiac arrest in pregnancy were reviewed in the 2015 Guidelines Update and a 2015 AHA scientific statement. Airway, ventilation, and oxygenation are particularly important in the setting of pregnancy because of an increase in maternal metabolism, a decrease in functional reserve capacity due to the gravid uterus, and the risk of fetal brain injury from hypoxemia. Evaluation of the fetal heart is not helpful during maternal cardiac arrest, and it may distract from necessary resuscitation elements. In the absence of data to the contrary, pregnant women who survive cardiac arrest should receive targeted temperature management just as any other cardiac arrest survivors would, with consideration for the status of the fetus that may remain in utero. https://d3imrogdy81qei.cloudfront.net/video_images/9053/cardiac-arrest-in-pregnancy.jpg Yes 190 https://app.protrainings.com/courses/pals/certification/videos/cuffed-and-uncuffed-et-tubes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/5076.mp4 Cuffed and Uncuffed ET Tubes In this lesson, you will be learning when to use cuffed ET tubes vs. uncuffed ET tubes along with some things to be aware of when making your decision. We'll also provide you with some information on cuffed ET tube benefits, verifying tube placement, and cuff pressures. At the end of the lesson, you'll find out why key changes were made in the PALS recommendations and what those changes are. Selecting appropriate equipment and medications for infant and child intubation is vital. Many providers have historically preferred the use of uncuffed ET tubes for infants and children because the normal pediatric airway narrows below the vocal cords. This creates an anatomical seal around the distal end of the tube. In settings such as pre-hospital or when the patient is moved around, uncuffed ET tubes may need to be changed to cuffed tubes to maintain a patent airway. Cuffed ET Tube Benefits The benefits of using cuffed ET tubes at the beginning of a resuscitation attempt for pediatric patients are: The improvement in the accuracy of capnography Better tidal volume delivery Reductions in the need for a potential tube change Warning: Reintubation is a high-risk procedure. It should be avoided whenever possible. Using a cuffed tube can decrease the risk of airway trauma by decreasing the need for tube changes. Cuffed ET tubes may also decrease the risk of aspiration. Beware of High Cuff Pressure However, cuffed tubes can cause airway damage when too high of pressure is used in the cuff. Careful attention must be made when selecting the correct tube size, position, and cuff inflation. Pro Tip #1: Cuff inflation pressure should normally be less than 20-25 cm of H2O. However, it's important to consider that ET tube cuff pressures could change during transport, altitude changes, and with increasing airway edema. Verifying Tube Placement After placing an ET tube, it is important to verify proper tube placement. Oscillations of breath sounds missed in the tube or chest rise may be good indicators of proper placement. Pro Tip #2: For patients with a pulse, oscillations of breath sounds and chest rise are not the most reliable signs. Either a colorimetric detector or capnography should be used to access initial tube placement. Another point to be aware of when managing an infant's or child's airway is that cricoid pressure during bag-mask ventilation and intubation is not recommended. Even though it has historically been used to minimize the risk of gastric contents refluxing into the airway, it may reduce the effectiveness of bag-mask ventilation and significantly reduce the success of intubation. A Word About Key Changes in the PALS Recommendations More than 20 000 infants and children have a cardiac arrest each year in the United States. Despite increases in survival and comparatively good rates of good neurologic outcome after pediatric IHCA, survival rates from pediatric OHCA remain poor, particularly in infants. Recommendations for pediatric basic life support (PBLS) and CPR in infants, children, and adolescents have been combined with recommendations for pediatric advanced life support (PALS) in a single document in the 2020 Guidelines. The causes of cardiac arrest in infants and children differ from cardiac arrest in adults, and a growing body of pediatric-specific evidence supports these recommendations. Key issues, major changes, and enhancements in the 2020 Guidelines include the following: Algorithms and visual aids were revised to incorporate the best science and improve clarity for PBLS and PALS resuscitation providers. Based on newly available data from pediatric resuscitations, the recommended assisted ventilation rate has been increased to 1 breath every 2 to 3 seconds (20-30 breaths per minute) for all pediatric resuscitation scenarios. Cuffed ETTs are suggested to reduce air leaks and the need for tube exchanges for patients of any age who require intubation. The routine use of cricoid pressure during intubation is no longer recommended. To maximize the chance of good resuscitation outcomes, epinephrine should be administered as early as possible, ideally within 5 minutes of the start of cardiac arrest from a non-shockable rhythm (asystole and pulseless electrical activity). For patients with arterial lines in place, using feedback from continuous measurement of arterial blood pressure may improve CPR quality. After ROSC, patients should be evaluated for seizures; status epilepticus and any convulsive seizures should be treated. Because recovery from cardiac arrest continues long after the initial hospitalization, patients should have formal assessment and support for their physical, cognitive, and psychosocial needs. A titrated approach to fluid management, with epinephrine norepinephrine infusions if vasopressors are needed, is appropriate in resuscitation from septic shock. On the basis largely of extrapolation from adult data, balanced blood component resuscitation is reasonable for infants and children with hemorrhagic shock. Opioid overdose management includes CPR and the timely administration of naloxone by either lay rescuers or trained rescuers. Children with acute myocarditis who have arrhythmias, heart block, ST-segment changes, or low cardiac output are at high risk of cardiac arrest. Early transfer to an intensive care unit is important, and some patients may require mechanical circulatory support or extracorporeal life support (ECLS). Infants and children with congenital heart disease and single ventricle physiology who are in the process of staged reconstruction require special considerations in PALS management. Management of pulmonary hypertension may include the use of inhaled nitric oxide, prostacyclin, analgesia, sedation, neuromuscular blockade, the induction of alkalosis, or rescue therapy with ECLS. https://d3imrogdy81qei.cloudfront.net/video_images/9057/cuffed-and-uncuffed-et-tubes.jpg Yes 152 https://app.protrainings.com/courses/pals/certification/videos/pals-ecg-interpretation https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/5832.mp4 ECG Interpretation To successfully manage a patient who is in cardiac arrest, the caregiver must carefully, immediately, and systematically identify the cardiac rhythm and choose the most appropriate treatment algorithm. In the following lessons, we'll look at different cardiac dysrhythmias that can lead to cardiac arrest, their characteristics, and the appropriate therapies used to treat and correct the particular dysrhythmia whenever possible. However, in this lesson, we'll first look at interpreting the information on ECGs. Pro Tip #1: It's important to remember that knowing the patient's medical history, including all the events that have led up to the medical emergency, will greatly aid you in determining if there's any chance of reversing underlying causes for the cardiac arrest. An example of the above would be assessing the patient using the six H's and five T's. (Which will be discussed in detail in the secondary survey section of this program.) The Six Hs Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo or hyperkalemia Hypothermia Hypoglycemia The Five Ts Tension pneumothorax Tamponade Toxins Thrombosis (coronary) Thrombosis (pulmonary) Pro Tip #2: It's also important to remember that until an underlying cause has been identified and corrected, pharmacological and electrical therapies might offer little or no help when trying to resuscitate a cardiac arrest victim. When assessing the electrical activity of a patient's heart, it's vital to recognize the underlying dysrhythmia and know how to treat it appropriately to restore a perfusing cardiac rhythm. A sinus rhythm is defined as any cardiac rhythm where depolarization of the cardiac muscle begins at the sinus node, which is characterized by the presence of correctly oriented P-waves on the electrocardiogram. An ECG waveform represents each electrical event in the cardiac conduction system during a cardiac cycle. However, this doesn't mean that the heart muscle is reacting properly or in correlation with the electrical patterns. It simply shows that the electrical events that may stimulate myocardial function are happening. (This will be discussed in more detail when we look at each individual rhythm.) Waveforms Explained For the following explanations, we'll be assuming that the waveform is normal, and that normal mechanical function is occurring. The P-Wave The P-wave is the first waveform in the complete waveform complex, and it's normally found upright in healthy patients. It represents the depolarization of both the right and left atria, which occurs at the same time. The PR Segment The segment between the P-wave and the R-wave represents the delay of the electrical circuit in the AV node. This segment shows the time it takes from the end of the P-wave to the beginning of the ventricular response, represented by the QRS complex. The QRS Complex The QRS complex is the combination of three of the graphical deflections seen on a typical electrocardiogram (EKG or ECG). It is usually the central and most visually obvious part of the tracing; in other words, it's the main spike seen on an ECG line. The Q-Wave The Q-wave represents the first activity of the ventricular depolarization and is usually the first negative deflection after the P-wave in the complete complex. (We'll discuss the significance of Q-wave formations specifically as it relates to certain dysrhythmias in each of the rhythm evaluations.) The R-Wave The R-wave is the first positive deflection after the P-wave. The S-Wave The S-wave is the first negative deflection after the R-wave. The ST Segment The ST segment represents the timeframe between ventricular polarization and repolarization. It's the baseline of the cardiac cycle and, therefore, electrically neutral; there should be no inflection or deflection as it's isoelectric. Pro Tip #3: An ST elevation or depression of more than 1mm can be clinically significant and may indicate an underlying cardiac issue, either acutely or chronically. The T-Wave The T-wave represents repolarization of the ventricles and should be seen moving in the same general direction as the QRS segment. If the T-wave is inverted, this could also indicate a potential cardiac problem. It's quite helpful for healthcare providers to have a repeatable and easy method for interpreting ECG rhythms, which is why we'll be following a serial pattern for reading and interpreting all ECGs. Interpreting ECG Rhythms The pattern of interpretation most commonly used is to look at the following: Is the rhythm regular or irregular? Is the heart rate normal, fast, or slow? To determine the patient's heart rate The horizontal axis of ECG paper grids is where time is measured. Each small square is 1mm in length and represents .04 seconds. Each larger square is 5mm in length and represents .20 seconds. Therefore a 6 second interval would be 30 large squares. To determine the heart rate, count the number of QRS complexes over this 6 second interval and multiply by 10. Are the P-waves present? Do they occur regularly? Is there one P-wave for each QRS complex? Are they smooth, rounded, and upright? Do they all have a similar shape? Does the PR interval fall within the norm of .12 to .20 seconds? Is it constant? On the QRS complex, is the QRS interval less than .12 seconds? Is it wide or narrow? Are they similar in appearance? When using a systematic approach for interpreting ECG rhythms, you'll help yourself and your teammates to efficiently and effectively diagnose underlying cardiac conditions. Which, goes without saying, will also help the cardiac patient. https://d3imrogdy81qei.cloudfront.net/video_images/10394/pals-ecg-interpretation.jpg Yes 350 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/nosebleeds https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6487.mp4 Nosebleeds In this lesson, we're going to cover nosebleeds and how to apply first aid in the event you or someone you know gets one. Nosebleeds, also known medically as epistaxis, can catch us off guard and happen when we least expect them. However, they’re often quite harmless and can usually be managed easily. Each year, around 60 million people get nosebleeds in the United States alone. They are most likely to occur in the winter when cold weather and indoor heating dry the nasal passages. Most nosebleeds are minor and the bleeding will often stop on its own, but some people may require medical attention. This lesson will teach you the proper way to handle them. But before we proceed, bear in mind that while most nosebleeds are benign, there are exceptions. Pro Tip #1: If a nosebleed is intense, continues for over 20 minutes, or pairs with other symptoms, one should seek immediate medical help. It's important to note that if someone is on prescription blood thinners, their risk of a continued hemorrhage increases significantly, as these medications can intensify bleeding and challenge the standard control techniques. It's important and recommended that these patients seek further medical attention. First Aid Steps for Nosebleeds While nosebleeds are usually nothing to worry about, the presence of blood can make people feel anxious or queasy, particularly if it is their own blood. Reassure the affected person and urge them to stay calm. Ask the nosebleed victim to sit down and lean forward slightly, as this helps keep the blood from trickling down the back of the throat. Once you have your safety gloves on, or if the individual can do it themselves, pinch the soft section of the affected person's nostrils just past the nasal bone. Hold this pinch for about 10-15 minutes without releasing any of the pressure. This simple act applies pressure on the blood vessels of the nose and helps facilitate clotting. If the victim has any blood pooling in their mouth or throat, instruct them to carefully spit it out rather than swallow it. It is important to contain the blood spray or splatter through this process, which can be associated with sneezing, coughing, spitting, or speaking. Pro Tip #2: A backward tilt could lead to potential complications like aspiration or ingestion and vomiting. So step two is more vital than it may sound. Eye protection along with a face shield may be necessary - in addition to gloves – to fully protect the care provider appropriately. If no PPE (Personal Protective Equipment) is available, be sure to stand next to the patient, rather than in front of their face, as this may help protect you. Pro Tip #3: It's important to note that while a cold compress can help constrict blood vessels, cold blood does not clot swiftly. If you choose to use an ice pack, it is suggested to be placed on the bridge of the nose or the rear of the neck. Once the victim's nose stops bleeding, encourage the patient to resist the urge to blow their nose, as this can dislodge the clot and cause the nose to begin bleeding again. One common misconception is to pack the nose with gauze or tissue. This should be avoided in a first-aid scenario. And remember, only a physician should decide on medical nose packing. Also, for those patients who may be on blood thinners, the pressure might need to be maintained longer, and a physician's intervention may be required. Utilizing these first-aid methods, most nosebleeds can be managed easily. But remember, persistent bleeding, recurring episodes, or additional symptoms or complications may warrant prompt medical attention via a 911 emergency services phone call. A Word About Applying Pressure to a Stubborn Nosebleed The two most important factors when successfully controlling a nosebleed are: The amount of pressure applied. The amount of time the pressure is maintained. Remember that the pressure must be firm, and it must be maintained for a long time. Methods of applying pressure include pinching the nose with your fingers or using gauze or cloth placed over the nose and then pinching. If bleeding continues, try adjusting where you are pinching the nose or adjusting the pressure with which you are pinching the nose. About Hereditary Hemorrhagic Telangiectasia HHT is a genetic disorder in which blood vessels do not develop normally leading to bleeding that can be serious or life-threatening. A person with HHT may form abnormal capillaries or abnormal capillary connections between the arteries and veins. Capillaries are tiny blood vessels that pass blood from arteries to veins. The abnormal blood vessels formed in HHT are often fragile and can burst, which then causes bleeding. Men, women, and children from all racial and ethnic groups can be affected by HHT and experience the problems associated with this disorder, some of which are serious and potentially life-threatening. Nosebleeds are the most common sign of HHT, resulting from small abnormal blood vessels within the inside layer of the nose. While rare, it's important to understand that sometimes a nosebleed is a sign of a greater underlying problem. https://d3imrogdy81qei.cloudfront.net/video_images/11618/nosebleeds.jpg Yes 188 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/hemorragias-nasales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6487.mp4 Hemorragias nasales https://d3imrogdy81qei.cloudfront.net/video_images/11618/nosebleeds.jpg Yes 188 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/treating-ear-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6488.mp4 Ear Injuries In this lesson, we'll take a look at both external and internal ear injuries and how to apply first-aid treatment for both. Ear injuries can occur due to various causes, such as trauma, loud noises, or foreign objects that have been accidentally or purposely inserted into the ear. Knowing how to assess and provide initial first aid treatment for any ear injury is essential to minimize discomfort and prevent further complications. This lesson will guide you through the assessment and first aid treatment options for some of the more common ear injuries. Pro Tip #1: Before we begin, it's important to note that ear injuries can range from minor to severe. In cases of severe ear injury or if the injury involves hearing loss, it's crucial to seek medical assistance. Therefore, assessment of the ear injury is vital. Having said that, even in the event of a severe ear injury, you should still provide first aid to alleviate discomfort. Now let's take a look at how to assess and provide first-aid treatment for an ear injury. First Aid Treatment for External Ear Injuries Inspect the external ear for any visible injuries, cuts, or bleeding. If there is bleeding, apply gentle pressure with a clean cloth or sterile gauze to control it. Maintain pressure until the bleeding stops. Do not insert any objects into the ear canal, and do not attempt to clean the ear extensively. If there are signs of infection, such as redness, swelling, or discharge, seek medical attention. First Aid Treatment for Foreign Objects in the Ear If a foreign object - such as a small toy or insect – is visible and can be easily removed without pushing it in further, use clean tweezers or your fingers to fish it out. However, remember to use EXTREME caution and try to remove it gently. Avoid using sharp objects or excessive force, as this may cause injury or push the object deeper into the ear potentially causing permanent hearing loss. If the object cannot be easily removed, or if moving the object causes pain, discomfort, or bleeding, be sure to stop and seek medical attention. First Aid Treatment for Bleeding from in the Ear Foreign bodies or significant head trauma can lead to bleeding from the ear canal. For this type of bleeding injury, it is best to quickly seek medical attention. As for the bleeding, loosely apply a dressing or other clean materials to the outside of the ear and track how much blood came out, such as how many gauze pads or towels were used. Pro Tip #2: If you try to apply direct pressure, this could cause a build-up of pressure in the ear and cause an increase in pain or lead to other complications. Monitoring the victim and asking how they are doing will help determine if the pain is suddenly getting worse. If it is, it might be caused by this direct pressure. Remember, while these first aid measures can provide initial relief, seeking professional medical care for significant ear injuries, severe pain, changes in hearing, or especially head trauma that causes bleeding from the ear is essential. A Word About Basilar Skull Fractures Basilar skull fractures are fractures that occur in the base of the skull, which is the area at the bottom of the skull that supports the brain. Symptoms related to the ear that can occur with basilar skull fractures include: Battle's Sign: This refers to bruising behind the ear and is a common sign of basilar skull fracture. It typically appears a few days after the injury and is due to bleeding beneath the skin. Hearing Loss: Basilar skull fractures can affect the structures of the middle and inner ear, leading to conductive or sensorineural hearing loss. Conductive hearing loss occurs when sound waves cannot reach the inner ear due to damage to the ear canal, eardrum, or middle ear bones. Sensorineural hearing loss occurs due to damage to the inner ear or auditory nerve. Tinnitus: Ringing or buzzing in the ear (tinnitus) can occur as a result of the injury to the inner ear structures. Ear Bleeding: Bleeding from the ear canal (otorrhagia) can occur if the fracture involves damage to the temporal bone or surrounding structures. Dizziness and Vertigo: Damage to the inner ear or vestibular system can cause dizziness, vertigo (the sensation of spinning), and imbalance. Facial Nerve Dysfunction: Fractures involving the temporal bone can affect the facial nerve (cranial nerve VII), leading to facial weakness or paralysis on the affected side. CSF Leak: In severe cases of basilar skull fracture, cerebrospinal fluid (CSF) can leak from the nose or ear (otorrhea). This can be a serious complication requiring medical attention. https://d3imrogdy81qei.cloudfront.net/video_images/11620/treating-ear-injuries.jpg Yes 150 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/lesiones-del-oido https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6488.mp4 Lesiones del oído https://d3imrogdy81qei.cloudfront.net/video_images/11620/treating-ear-injuries.jpg Yes 150 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/dental-and-oral-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6489.mp4 Dental and Oral Injuries In this lesson, we'll take a look at dental and oral injuries and how you can apply first aid to treat them. Dental and oral injuries, such as tooth, tongue, or lip injuries, can occur unexpectedly and may require immediate first aid. Knowing how to assess and provide initial treatment can help alleviate pain and prevent further complications. This lesson will guide you through the assessment phase and first aid treatment options for some of the more common dental and oral injuries. Pro Tip: Before we begin, it is really important to remember that dental and oral injuries can vary in severity. For more severe injuries, seeking prompt dental or medical assistance is crucial. However, in minor cases, you can provide initial first aid to alleviate discomfort and help the healing process. First Aid Treatment for Tooth, Tongue, and Lip Injuries If a permanent tooth is lost, follow the first aid steps below. Try to locate the tooth and handle it only by the crown. Avoid contact with the root – the part that is hidden in the gums - as touching this could damage the tooth. If the tooth is dirty, gently and quickly rinse the tooth with water. Do not scrub or remove any tissue fragments. Gently reposition the tooth back into its socket and have the patient bite on a clean cloth, such as a piece of gauze, to hold it in place. If the first option is not possible, place it in a suitable storage medium, such as milk, saliva, or a tooth preservation kit, and seek dental care immediately, as the chance of saving a knocked-out tooth decreases with time. Additionally, according to the latest guidelines of the International Association of Dental Traumatology, it is not recommended to replant a primary tooth. It is still advisable to place the tooth in a storage medium and seek further evaluation by a dentist. There are many other dental injuries that could occur, but there is very little we can do about these. The best recommendation is not to move or irritate the area and seek immediate dental care. If there's bleeding from the tongue or lip, have the person rinse their mouth with water to clear any blood. You can gently clean the injured area with a damp cloth or gauze pad to remove debris. This will allow you to assess the extent of the injury. Apply direct pressure to the wound with a clean cloth or sterile gauze to control bleeding. If there is significant bleeding or the wound is deep, seek immediate medical attention since this may lead to breathing problems as blood can make breathing increasingly difficult. It may also cause the patient to swallow blood which can quickly lead to nausea and vomiting, further compromising the airway. Encourage the person to avoid hot or spicy foods and to maintain good oral hygiene. Remember, while these first aid measures can provide relief, seeking professional dental or medical care is always essential. A Word About Dental Avulsion Injuries A dental avulsion injury - also known as a knocked-out tooth - can damage both the tooth and the supporting soft tissue and bone, resulting in the permanent loss of the tooth. Dental avulsion is relatively uncommon compared to other dental injuries but can occur in various age groups, particularly among children and young adults involved in sports or accidents. It most commonly affects children and adolescents, often due to falls or sports-related injuries. The peak incidence is seen in the 7-14 age group. Studies suggest that dental avulsion accounts for approximately 0.5 to 3 percent of all dental injuries. It tends to affect males more frequently than females, possibly due to higher participation rates in contact sports. Participation in contact sports (e.g., football, hockey, and basketball), inadequate use of mouthguards during sports activities, and accidents (falls and collisions) are significant risk factors. Immediate reimplantation of an avulsed tooth is believed to result in the greatest chance of tooth survival. The longer a tooth is out, the more likely it will be permanently lost. In situations that do not allow for immediate reimplantation of an avulsed tooth, it is beneficial to temporarily store it in a variety of solutions that are shown to prolong the viability of dental cells. If available, place the avulsed tooth in Hanks' Balanced Salt Solution or in another oral rehydration salt solution, or wrap the tooth in cling film to prevent dehydration and improve the likelihood of successful replantation by a dental professional. This should always be done as quickly as possible. If an avulsed permanent tooth cannot be immediately replanted in either Hanks’ Balanced Salt Solution, oral rehydration salt solutions, or cling film, store the tooth in cow’s milk or saliva, as these are your best secondary options. Keeping the tooth "safe" in the saliva inside the person's mouth is also not suggested as the patient will often keep moving the tooth around which can further damage to the roots of the tooth. An avulsed tooth should never be stored in tap water.  The viability of an avulsed tooth stored in any of the above solutions is limited. And reimplantation of the tooth within an hour after avulsion provides the best chance for tooth survival. Following the loss of a permanent tooth, it is essential to seek rapid medical assistance for reimplantation. The long-term success of replantation depends on various factors, including the extra-alveolar time (time the tooth is out of its socket), the storage medium used for transporting the tooth, and the condition of the tooth and surrounding tissues. Complications may include pulp necrosis (death of the tooth's inner tissue), infection, root resorption (breakdown of the tooth root), and periodontal issues. Prevention is often a key to avoiding oral injuries while playing contact sports. The proper use of mouthguards is highly recommended. https://d3imrogdy81qei.cloudfront.net/video_images/11622/dental-and-oral-injuries.jpg Yes 176 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/lesiones-dentales-y-bucales https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6489.mp4 Lesiones dentales y bucales https://d3imrogdy81qei.cloudfront.net/video_images/11622/dental-and-oral-injuries.jpg Yes 176 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/penetrating-trauma https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6490.mp4 Penetrating Trauma In this lesson, we'll go over the treatment options for penetrating injuries like gunshot wounds, knife stabbings, or any other type of similar penetrating trauma. Penetrating injuries can often be life-threatening and will usually require immediate treatment. Knowing how to assess and provide first aid for these injuries can make a critical difference in the outcome of the victim.  In this lesson, we will guide you through the assessment phase and initial treatment of penetrating injuries. Pro Tip #1: Before we begin, it's essential to remember that first aid is not a substitute for professional medical care. In the case of penetrating injuries, it is vital to call emergency services immediately. Your main goal is to provide initial care and support until professional medical help arrives. First Aid Steps for Penetrating Trauma Injuries As always, the first thing you want to do is ensure that the scene is safe. Carefully assess the scene for any ongoing danger and ensure your safety and the safety of others before approaching the injured person. If there is an active threat, prioritize your safety and seek a safe location before providing aid. Your safety and the safety of others is always the most important step. Once you have determined that the scene is safe, follow the steps below. Step 1: Call 911 for help. If you cannot call emergency services yourself, ask someone else at the scene to do this, providing others are in the vicinity, as you may have your hands full with the victim. Step 2: Provide accurate details to emergency services about the situation, including your location and the nature of the injury. Calling for professional medical help is crucial for the injured person's survival. Also, remaining calm, if possible, will help to ensure the proper communication of vital information Step 3: Control the bleeding by applying direct pressure to the wound using a clean cloth, a sterile dressing, or even your gloved hand. Pro Tip #2: It is always recommended that you utilize universal precautions. Use personal protective equipment (PPE) at all times. Protecting yourself should not be overlooked. Step 4: Maintain pressure until medical professionals take over. If the object causing the penetration is still in the wound, don't remove it, as it may be acting as a plug to control the bleeding. If you believe there is a possibility that the penetrating item such as a bullet, knife, or other item may have gone through the body, check to see if there is a wound where the object came out. With bullets especially, the exit wound is usually larger than the entry wound. Pro Tip #3: Controlling the bleeding is of the utmost importance. Apply firm and continuous pressure to the wound. Treating the wound with a dressing and bandage will help the clot to form and stop the bleeding. Step 5: Once the bleeding has been controlled, help the victim get into a comfortable position, preferably lying flat on the ground if possible. Then, cover the injured person with a blanket or any available material to help maintain their body heat. This can reduce the risk of hypothermia, help with the clotting process, and provide comfort to the victim. Step 6: Lastly, provide reassurance. Keep the injured person calm and reassure them that help is on the way. It's important not to lie to them or give them false hope. Minimizing their movement to avoid exacerbating the injury, keeping them calm, and reassuring them that you are taking good care of them can all aid in their recovery. Pro Tip #4: Do not probe or irrigate the wound. Inserting objects into the wound or attempting to clean the wound extensively may cause further damage or introduce infection. It's important to resist the urge to probe or irrigate the wound. Your focus should be on controlling bleeding, keeping them warm, providing comfort and reassurance, and waiting for professional medical help to arrive. Remember, in most cases, maintaining the victim’s airway, breathing, and circulation will be the most important steps in a critical penetrating trauma emergency, as cardiac arrest may become an additional threat. These are the basic steps for providing the initial care for a penetrating injury. Once emergency medical services arrive, they'll take over and provide the appropriate medical treatment. A Word About Cardiac Arrests Associated with Penetrating Traumas According to the American Heart Association, basic and advanced life support for the trauma patient are fundamentally the same as that for the patient with a primary cardiac arrest, with a focus on support of the airway, breathing, and circulation. Cardiopulmonary deterioration associated with trauma has several possible causes including: Hypoxia secondary to respiratory arrest, airway obstruction, large open pneumothorax, tracheobronchial injury, or thoracoabdominal injury Injury to vital structures, such as the heart, aorta, or pulmonary arteries Severe head injury with secondary cardiovascular collapse Underlying medical problems or other conditions that led to the injury, such as sudden cardiac arrest Diminished cardiac output or pulseless arrest from tension pneumothorax or pericardial tamponade Extreme blood loss leading to hypovolemia and diminished delivery of oxygen Even with a rapid and effective out-of-hospital response, victims with out-of-hospital cardiac arrest due to trauma rarely survive. Those patients with the best outcome from trauma arrest generally are young, have treatable penetrating injuries, have received early endotracheal intubation, and undergo prompt transport to a trauma care facility. Remembering your CPR training during a penetrating trauma injury could be vital for whomever you're administering first aid to should they fall victim to a cardiac arrest. It pays to be prepared. https://d3imrogdy81qei.cloudfront.net/video_images/11624/penetrating-trauma.jpg Yes 222 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/traumatismos-penetrantes https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6490.mp4 Traumatismos penetrantes https://d3imrogdy81qei.cloudfront.net/video_images/11624/penetrating-trauma.jpg Yes 222 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/spider-bites-tick-bites-and-scorpion-stings https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6491.mp4 Spider Bites, Tick Bites and Scorpion Stings This first aid lesson is for the treatment of spider bites, tick bites, and scorpion stings. While these encounters can be alarming and sometimes painful, knowing the proper first aid steps can help ensure a swift and effective response and recovery. It's important to keep in mind that millions of people are bitten or stung by spiders, ticks, and scorpions every year in the United States alone, and most of these are harmless. However, in this lesson, we’re going to focus on generalized treatment and what to watch for in more severe cases. Remember that the priority is always safety. Once you and the victim are out of harm's way, see if there is a way to identify what bit or stung you, as this can help identify appropriate treatment if needed. But only do this if it can be done safely. Since all of these bites or stings will have punctured the skin, gently washing with soap and water is always the recommended first step. If you notice any concerning reactions or symptoms, seek medical help immediately. In that case, watch for skin discoloration or blistering, nausea, abdominal pain, difficulty breathing, change in responsiveness, or significant pain. If there are no immediate health concerns, here are the steps to handle these bites or stings. First Aid Steps for Spider Bites If you're in a geographical area where there are venomous spiders, remove yourself from the vicinity to avoid further bites.> It's important to identify the spider responsible for the bite whenever safe and possible. Wash the bite area with mild soap and water. Elevate the bitten extremity and apply a cold compress or an ice pack wrapped in a thin cloth to the bite site. Elevating the bitten extremity will help reduce pain and swelling. Leave the compress or ice pack on the bite site for about 10-15 minutes each hour. Symptoms Associated with Spider Bites Symptoms associated with spider bites can vary from minor to severe. Although extremely rare, death can occur in the most severe cases. Possible symptoms resulting from a spider bite include the following: Itching or rash Pain radiating from the site of the bite Muscle pain or cramping Reddish to purplish color or blister Increased sweating Difficulty breathing Headache Nausea and vomiting Fever Chills Anxiety or restlessness High blood pressure Pro Tip #1: For suspected or confirmed bites from venomous spiders, such as black widows or brown recluse spiders, it's crucial to seek immediate medical attention. Call emergency services or visit the nearest hospital. First Aid Steps for Tick Bites The important thing to remember with tick bites is that the longer the tick is attached, the more likely it is to transmit diseases. So acting quickly is definitely in the victim's best interest. Remove the tick promptly using a pair of fine-tipped tweezers. Grasp the tick as close to the skin's surface as possible. Pull the tick away from the skin steadily and slowly with firmness, and try to avoid twisting or crushing the tick during this process. The skin will tent, and the tick will eventually let go. Clean the area with mild soap and water. Pro Tip #2: If you're concerned about tick-borne diseases, you can preserve the tick in a sealed container or a plastic bag. This may assist healthcare professionals in identifying the tick and determining the risk of disease transmission. Please note that if the head comes off and stays embedded in the skin, call emergency services or visit the nearest hospital. A Word of Caution Avoid folklore such as painting the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible – not waiting for it to detach. If you develop a rash or fever within several days to weeks after removing a tick, see your doctor. Tick Bite Bot: An Interactive Tool for Dealing with Tick Bites The CDC has an interactive tool that can assist you in the removal of attached ticks and also advise you on when to seek medical attention. This online mobile-friendly tool asks a series of questions covering topics such as tick attachment time and symptoms. Based on the user's responses, the tool will then provide information on first-aid treatment options. First Aid Steps for Scorpion Stings Like with spider bites, remember to first remove yourself from the area to prevent further stings. Clean the sting site with mild soap and water. Apply a cold compress or an ice pack wrapped in a cloth to the sting site to help with the pain. Pro Tip #3: While most scorpion stings are harmless, seeking medical attention is essential to be safe, as venomous species can be fatal to humans. Call emergency services or visit the nearest hospital immediately. When it comes to scorpions, prevention is key. Be proactive and take precautions by checking your clothing and inside your shoes before putting them on wherever these creatures are common. And remember that if you are stung, stay calm and follow the steps above. And as always, seek professional medical help whenever necessary. Symptoms Associated with Scorpion Stings Symptoms usually subside within 48 hours, although stings from a bark scorpion can be life-threatening. Symptoms of a scorpion sting may include: A stinging or burning sensation at the injection site Extreme pain when the sting site is tapped with a finger Restlessness Convulsions Roving eyes Staggering gait Thick tongue sensation Slurred speech Drooling Muscle twitches Abdominal pain and cramps Respiratory depression https://d3imrogdy81qei.cloudfront.net/video_images/11616/picaduras-de-escorpiones-garrapatas-y-aranas.jpg Yes 211 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/picaduras-de-escorpiones-garrapatas-y-aranas https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6491.mp4 Picaduras de escorpiones, garrapatas y arañas Ahora discutiremos el tratamiento de primeros auxilios para picaduras de arañas, picaduras de garrapatas y picaduras de escorpiones. Estos encuentros pueden ser alarmantes, pero conocer los pasos adecuados puede ayudar a garantizar una respuesta rápida y efectiva. Primero, sepa que millones de personas son mordidas o picadas cada año solo en los Estados Unidos. y la mayoría de estas son inofensivas. Queremos enfocarnos en el tratamiento generalizado y en qué observar en casos más graves. La prioridad siempre es la seguridad. Una vez que usted y la víctima estén a salvo, vea si hay una forma de identificar qué lo mordió o picó, ya que esto puede ayudar a identificar el tratamiento adecuado si es necesario. Dado que todas estas mordeduras o picaduras habrán perforado la piel, se recomienda siempre lavar suavemente con jabón y agua. Si se notan picaduras o signos o síntomas preocupantes, busque ayuda médica de inmediato. En ese caso, observe si hay decoloración o ampollas en la piel, náuseas, dolor abdominal, dificultad para respirar, cambio en la capacidad de respuesta, o dolor significativo. Si no hay preocupaciones inmediatas, aquí es cómo podemos manejar estos casos de manera independiente siempre y cuando no se noten síntomas preocupantes. Para las arañas: Si se encuentra en un área conocida por las arañas venenosas, aléjese del lugar para evitar más mordeduras. Es importante identificar la araña responsable de la mordedura. Luego, lávese con jabón suave y agua. Para reducir el dolor y la hinchazón, eleve la extremidad mordida y aplique una compresa fría o una bolsa de hielo envuelta en un paño delgado en el lugar de la mordedura. Déjelo actuar durante unos 10-15 minutos cada hora. Para mordeduras sospechosas o confirmadas de arañas venenosas como las viudas negras o las arañas reclusas pardas, es crucial buscar atención médica inmediata. Llame a los servicios de emergencia o diríjase al hospital más cercano. Ahora hablemos de las garrapatas. Si encuentra una garrapata adherida a su piel, retírela rápidamente ya que cuanto más tiempo estén adheridas, más probable es que transmitan enfermedades. Use unas pinzas de punta fina para agarrar la garrapata lo más cerca posible de la superficie de la piel. Tire de ella alejándola de la piel de manera constante y lenta con firmeza, evitando torcer o aplastar la garrapata. La piel se tensará y la garrapata finalmente se soltará. Limpie el área con agua y jabón suave. Si está preocupado por las enfermedades transmitidas por garrapatas, puede conservar la garrapata en un recipiente sellado o una bolsa de plástico. Esto puede ayudar a los profesionales de la salud a identificar la garrapata y determinar el riesgo de transmisión de enfermedades. Tenga en cuenta que si la cabeza se desprende y queda incrustada en la piel, esto es una llamada al profesional médico para pedir ayuda. Ahora hablemos de los escorpiones. Aléjese del área para prevenir más picaduras. Limpie el sitio de la picadura con jabón suave y agua, similar a las mordeduras de araña, y aplique una compresa fría o una bolsa de hielo envuelta en un paño en el sitio de la picadura para ayudar con el dolor. Aunque la mayoría de las picaduras de escorpión son inofensivas, buscar atención médica es esencial para estar seguro, ya que las especies venenosas pueden ser mortales para los humanos. Llame a los servicios de emergencia o diríjase el hospital más cercano inmediatamente. Recuerde, la prevención es clave, así que tome precauciones revisando su ropa y vistiendo la indumentaria adecuada siempre que estas criaturas sean comunes. Mantenga la calma y siga estos pasos si se encuentra con una mordedura o picadura. Y siempre busque ayuda médica profesional cuando sea necesario. https://d3imrogdy81qei.cloudfront.net/video_images/11616/picaduras-de-escorpiones-garrapatas-y-aranas.jpg Yes 211 https://app.protrainings.com/courses/hazcom/videos/comprendiendo-comunicacion-peligros https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6834.mp4 Comprendiendo la Comunicación de Peligros: Protegiendo su Lugar de Trabajo Comprendiendo la Comunicación de Peligros: Cómo Proteger su Lugar de Trabajo ¿Qué es la Comunicación de Peligros? Los productos químicos peligrosos se encuentran en casi todos los lugares de trabajo, desde pequeñas oficinas hasta grandes instalaciones industriales. Y no estamos hablando solo de ácidos fuertes o solventes industriales. Productos de uso diario como limpiadores de hornos, tóner de copiadoras y cloro para piscinas pueden representar riesgos para la salud si no se manejan correctamente. Para garantizar la seguridad en el lugar de trabajo, OSHA estableció la Norma de Comunicación de Peligros (HazCom) en 1983. Las actualizaciones más recientes entraron en vigor en 2024, alineando la norma con la Revisión 7 del Sistema Globalmente Armonizado (GHS), con ciertos elementos de la Revisión 8. ¿El propósito? Otorgar a los trabajadores el “Derecho a Comprender” los productos químicos que encuentran — no sólo saber qué existen, sino comprender plenamente cómo mantenerse seguros al trabajar con ellos. Consejo #1: La actualización más reciente de HazCom refuerza el cambio del “Derecho a Saber” al “Derecho a Comprender”, poniendo énfasis en la comprensión más que en la simple conciencia. Reconociendo los Peligros Químicos No todos los productos químicos son peligrosos, pero OSHA exige que los fabricantes e importadores evalúen cada uno y lo clasifiquen en una o más de las siguientes categorías de peligro: Peligros Físicos – Productos químicos que presentan riesgos como inflamabilidad, explosividad o propiedades oxidantes. Peligros para la Salud – Productos químicos que pueden causar irritación, problemas respiratorios, daño a órganos, daño reproductivo o cáncer. Otros Peligros – Riesgos como polvo combustible, asfixiantes simples o efectos ambientales. Esta clasificación se comunica a través de las etiquetas químicas y las Hojas de Datos de Seguridad (SDS), que proporcionan información esencial sobre manipulación y respuesta ante emergencias. Advertencia: El uso frecuente no significa que un producto químico sea inofensivo. Siempre revise la etiqueta y la SDS antes de utilizar cualquier producto químico. Responsabilidades del Empleador Los empleadores deben mantener un programa actualizado de comunicación de peligros, que incluye: Mantener un inventario de todos los productos químicos peligrosos en el lugar de trabajo. Informar a los empleados sobre los riesgos asociados con los materiales peligrosos. Asegurar que todos los envases de materiales peligrosos estén correctamente etiquetados. Identificar tareas que puedan exponer a los empleados a productos químicos peligrosos. Capacitar a los empleados sobre prácticas seguras de trabajo, procedimientos de emergencia y medidas de protección requeridas, incluido el EPP. Comunicar cualquier nuevo peligro o información actualizada. Garantizar que los empleados puedan acceder fácilmente a las SDS en todo momento. Consejo #2: OSHA exige que la capacitación se imparta de una manera que los empleados puedan comprender. Esto puede incluir el uso de lenguaje sencillo, demostraciones o traducciones cuando sea necesario. Comprendiendo las Etiquetas Químicas Los empleados deben recibir capacitación para reconocer los elementos clave de las etiquetas y el formato estandarizado de las SDS. Cada etiqueta de producto químico peligroso debe incluir: Identificador del Producto – El nombre o código utilizado para identificar el producto químico. Palabra de Advertencia – Indica el nivel de gravedad del peligro: “Peligro” para riesgos más graves, “Advertencia” para riesgos menos severos. Declaraciones de Peligro – Describen la naturaleza específica del peligro. Declaraciones de Precaución – Medidas recomendadas para el uso seguro. Pictogramas – Símbolos estandarizados con marco rojo que representan visualmente clases específicas de peligro. Información del Proveedor – Nombre, dirección y número de teléfono del fabricante o importador. Para envases pequeños (100 mL o menos), OSHA permite una etiqueta simplificada, pero la etiqueta completa debe aparecer en el empaque exterior. Advertencia: Nunca ignore las actualizaciones de etiquetas. Los fabricantes están obligados a actualizar las etiquetas y las SDS cuando haya nueva información disponible. Siempre verifique si existen actualizaciones antes de usar un producto químico. Si el producto ya fue liberado para envío, la etiqueta actualizada puede proporcionarse con el envío en lugar de estar en el envase. La Importancia de la Capacitación La capacitación en HazCom no es solo una formalidad; es un requisito crítico de seguridad. Cuando se introducen nuevos productos químicos o se identifican nuevos riesgos, los empleadores deben proporcionar capacitación actualizada que cubra: Prácticas seguras de trabajo Procedimientos de emergencia Equipo de protección personal (EPP) requerido Consejo #3: Si no comprende una etiqueta o una SDS, hable y consulte a su empleador. OSHA protege su derecho a comprender los peligros que enfrenta en el trabajo. Su Derecho a Comprender Si alguna vez tiene preguntas sobre los peligros químicos, las etiquetas o la información de las SDS, pregunte. Comprender los riesgos potenciales y las medidas de protección es su derecho. Mantenerse informado significa mantenerse seguro. Consideraciones Adicionales para Empleadores y Trabajadores Además del etiquetado y la clasificación, la Norma de Comunicación de Peligros de OSHA también garantiza que los lugares de trabajo cuenten con medidas claras de seguridad, tales como: Directrices de Almacenamiento Adecuado – Algunos productos químicos deben almacenarse por separado para evitar reacciones peligrosas. Equipo de Protección Personal (EPP) – Los empleadores deben proporcionar y mantener el equipo de protección adecuado para manipular productos químicos peligrosos. Preparación para Emergencias – Los lugares de trabajo deben contar con procedimientos claros para derrames químicos, exposición accidental y respuesta ante emergencias. Derechos de los Trabajadores – Los empleados tienen derecho a rechazar el trabajo si creen que están siendo expuestos a peligros sin la capacitación o protección adecuada. Consejo #4: Incluso si no trabaja directamente con productos químicos peligrosos, debe conocer los peligros presentes en su lugar de trabajo. La exposición inesperada puede ocurrir durante derrames, accidentes o incluso durante el mantenimiento rutinario. Para obtener todos los detalles sobre la Norma de Comunicación de Peligros de OSHA, consulte el 29 CFR 1910.1200 y el programa de comunicación de peligros de su lugar de trabajo. https://d3imrogdy81qei.cloudfront.net/video_images/12344/understanding-hazard-communication-protecting-your-workplace.jpg Yes 250 https://app.protrainings.com/courses/hazcom/videos/understanding-hazard-communication-protecting-your-workplace https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6834.mp4 Understanding Hazard Communication: Protecting Your Workplace Understanding Hazard Communication: Protecting Your Workplace What is Hazard Communication? Hazardous chemicals are found in nearly every workplace—from small offices to large industrial facilities. And we're not just talking about strong acids or industrial solvents. Everyday items like oven cleaners, copier toner, and pool chlorine can pose health risks if not handled correctly. To ensure workplace safety, OSHA established the Hazard Communication Standard (HazCom) in 1983. The most recent updates took effect in 2024, aligning the standard with GHS Revision 7, with select elements from GHS Rev. 8. The purpose? To give workers the “Right to Understand” the chemicals they encounter—not just knowing they exist, but fully grasping how to stay safe around them. Pro Tip #1: The latest HazCom update reinforces the shift from the Right to Know to the Right to Understand, placing emphasis on comprehension over mere awareness. Recognizing Chemical Hazards Not all chemicals are dangerous, but OSHA requires manufacturers and importers to evaluate each one and classify it under one or more of the following hazard categories: Physical Hazards – Chemicals that pose risks like flammability, explosiveness, or oxidizing properties. Health Hazards – Chemicals that can cause irritation, respiratory issues, organ damage, reproductive harm, or cancer. Other Hazards – Risks such as combustible dust, simple asphyxiants, or environmental effects. This classification is communicated through chemical labels and Safety Data Sheets (SDS), which provide essential handling and emergency information. Warning: Frequent use doesn't mean a chemical is harmless. Always review the label and SDS before using any chemical. Employer Responsibilities Employers must maintain an up-to-date hazard communication program, which includes: Maintaining an inventory of all hazardous chemicals in the workplace. Informing employees about the risks associated with hazardous materials. Ensuring all hazardous material containers are labeled correctly. Identifying tasks that may expose employees to hazardous chemicals. Training employees on safe handling, emergency procedures, and required protective measures, including PPE. Communicating any new hazards or updated information. Ensuring employees can easily access Safety Data Sheets at all times. Pro Tip #2: OSHA requires training to be delivered in a way employees can understand. That may include using plain language, demonstrations, or translations if necessary. Understanding Chemical Labels Employees must be trained to recognize key label elements and the standardized SDS format. Every hazardous chemical label must include: Product Identifier – The name or code used to reference the chemical. Signal Word – Indicates the level of hazard severity: “Danger” for more serious risks, “Warning” for less severe ones. Hazard Statements – Describe the specific nature of the hazard. Precautionary Statements – Recommended measures for safe use. Pictograms – Standardized red-framed symbols that visually represent specific hazard classes. Supplier Information – Manufacturer/importer name, address, and phone number. For small containers (100 mL or less), OSHA allows a simplified label, but the full label must appear on the outer packaging. Warning: Never ignore label updates. Manufacturers are required to update labels and SDSs when new information becomes available. Always check for updates before use. If a chemical has already been released for shipment, the updated label may be provided with the shipment rather than on the container itself. The Importance of Training HazCom training isn't just a formality—it's a critical safety requirement. When new chemicals are introduced or new risks are identified, employers must provide updated training that covers: Safe work practices Emergency procedures Required personal protective equipment (PPE) Pro Tip #3: If you don't understand a label or SDS, speak up and ask your employer immediately. OSHA protects your right to understand the hazards you face at work. Your Right to Understand If you ever have questions about chemical hazards, labels, or SDS information—ask. Understanding potential risks and protective measures is your right. Staying informed means staying safe. Additional Considerations for Employers and Workers Beyond labeling and classification, OSHA's Hazard Communication Standard also ensures that workplaces have clear safety measures in place, such as: Proper Storage Guidelines – Some chemicals must be stored separately to avoid dangerous reactions. Personal Protective Equipment (PPE) – Employers must provide and maintain the right protective gear for handling hazardous chemicals. Emergency Preparedness – Workplaces should have clear procedures for chemical spills, accidental exposure, and emergency response. Worker Rights – Employees have the right to refuse work if they believe they are being exposed to hazards without proper training or protection. Pro Tip #4: Even if you don't work directly with hazardous chemicals, you should still be aware of the hazards present in your workplace. Unexpected exposure can happen during spills, accidents, or even routine maintenance. For full details on OSHA's Hazard Communication Standard, refer to 29 CFR 1910.1200 and consult your workplace's hazard communication program. https://d3imrogdy81qei.cloudfront.net/video_images/12344/understanding-hazard-communication-protecting-your-workplace.jpg Yes 250 https://app.protrainings.com/courses/hazcom/videos/actualizaciones-norma-comunicacion-peligros https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6835.mp4 Actualizaciones Clave en la Norma de Comunicación de Peligros Actualizaciones Clave en la Norma de Comunicación de Peligros Alineación con los Estándares Globales La Norma de Comunicación de Peligros de OSHA ha sido revisada con cambios importantes para mejorar la seguridad en el lugar de trabajo y garantizar una comunicación clara y consistente sobre los peligros químicos. Estas actualizaciones alinean los estándares de HazCom de OSHA con la Revisión 7 del Sistema Globalmente Armonizado (GHS), lo que aporta mayor consistencia a la forma en que la información química se clasifica y etiqueta en todo el mundo. Con cada revisión, OSHA perfecciona su enfoque de comunicación de peligros para reflejar avances científicos y mejores prácticas de la industria. Estas actualizaciones tienen como objetivo mejorar la protección de los trabajadores, simplificar el cumplimiento normativo y facilitar el comercio internacional al asegurar que los peligros químicos sean comprendidos universalmente. Hojas de Datos de Seguridad Estandarizadas (SDS) Una de las actualizaciones más importantes es el formato estandarizado de las Hojas de Datos de Seguridad (SDS). Anteriormente conocidas como Hojas de Datos de Seguridad de Materiales (MSDS), las SDS ahora siguen un formato uniforme de 16 secciones para facilitar la localización rápida de información esencial de seguridad, como manipulación, almacenamiento y primeros auxilios. Consejo Profesional #1: Si está acostumbrado a trabajar con MSDS, tómese el tiempo para familiarizarse con el formato SDS. Las secciones estructuradas permiten una identificación de peligros más rápida y eficiente. Cada sección de la SDS proporciona detalles específicos sobre el producto químico, incluyendo: Identificación – Nombre del producto químico, datos del fabricante y uso recomendado. Identificación de peligros – Clasificación de peligros, pictogramas requeridos y palabras de advertencia. Composición / Información sobre los ingredientes – Composición química y detalles sobre secretos comerciales. Medidas de primeros auxilios – Acciones inmediatas de respuesta ante exposición. Medidas de lucha contra incendios – Cómo controlar incendios químicos. Medidas en caso de liberación accidental – Procedimientos para la contención y limpieza de derrames. Manipulación y almacenamiento – Almacenamiento adecuado y precauciones necesarias. Controles de exposición y EPP – Equipo de protección personal requerido. Propiedades físicas y químicas – Características como puntos de ebullición y solubilidad. Estabilidad y reactividad – Información sobre reactividad y productos peligrosos de descomposición. Información toxicológica – Efectos en la salud y riesgos de exposición. Información ecológica – Datos sobre el impacto ambiental. Consideraciones sobre la eliminación – Manejo y eliminación adecuada de residuos. Información sobre transporte – Guías para el transporte seguro. Información reglamentaria – Cumplimiento con leyes federales, estatales y locales. Otra información – Detalles adicionales relevantes de seguridad. Nota: Las Secciones 12–15 son requeridas bajo el GHS, pero OSHA no las hace cumplir. Rangos de Concentración para Secretos Comerciales Para equilibrar la seguridad de los trabajadores y la protección de información propietaria, OSHA ahora permite el uso de rangos de concentración prescritos para secretos comerciales en lugar de valores exactos. Este cambio se alinea con el sistema WHMIS de Health Canada y otros estándares internacionales, promoviendo la transparencia mientras protege formulaciones confidenciales. Consejo Profesional #2: En una emergencia médica, los fabricantes de productos químicos deben revelar las concentraciones exactas de los ingredientes a un profesional médico autorizado cuando se solicite para fines de tratamiento, incluso si el ingrediente está protegido como secreto comercial. Nuevas y Actualizadas Definiciones Para mejorar la claridad y fortalecer la comunicación de peligros, OSHA ha introducido nuevas definiciones y ha refinado algunas existentes: Nuevas definiciones: Envío a granel – Grandes cantidades de materiales peligrosos enviadas sin empaques individuales. Polvo combustible – Partículas finamente divididas que pueden encenderse bajo ciertas condiciones. Sólido, líquido y gas – Definiciones estandarizadas para mejorar la consistencia en la clasificación. Paquete exterior inmediato – El primer nivel de empaque que contiene un material peligroso. Médico u otro profesional de salud autorizado (PLHCP) – Define a los profesionales responsables de evaluar exposiciones en el lugar de trabajo. Liberado para envío – Especifica cuándo un producto se considera listo para el transporte. Definiciones revisadas: Exposición o expuesto – Aclara cómo los trabajadores pueden entrar en contacto con productos químicos peligrosos. Producto químico peligroso – Refinado para alinearse con la investigación más reciente en toxicología y seguridad química. Peligro físico – Criterios más precisos para identificar riesgos de incendio, explosión y reactividad. Cambios en las Clasificaciones de Peligros Se realizaron varias modificaciones en las clasificaciones de peligros para mejorar la comprensión de los trabajadores y garantizar mejores estándares de seguridad: Aerosoles: Ahora incluye una nueva categoría para aerosoles no inflamables, ampliando la clasificación más allá de los aerosoles inflamables. Explosivos desensibilizados: Introducidos como una nueva clase de peligro para mejorar la clasificación de explosivos químicamente estabilizados. Gases inflamables: Ahora incluyen gases pirofóricos dentro de esta categoría en lugar de listarlos por separado. Consejo Profesional #3: Estas actualizaciones garantizan una mejor clasificación de peligros y mayor consistencia en el comercio global. Los trabajadores deben revisar las SDS actualizadas para mantenerse informados sobre nuevos riesgos. Adopción por los Planes Estatales e Impacto para las Empresas Todos los planes estatales deben adoptar disposiciones que sean al menos tan efectivas como la norma revisada de HazCom de OSHA. Esto garantiza un estándar de seguridad uniforme en todo el país. Además, se estima que estas actualizaciones generarán un ahorro neto de aproximadamente $29.8 millones anuales al simplificar el cumplimiento mientras se mejora la protección de los trabajadores. Los empleadores deben actualizar sus programas de seguridad en el lugar de trabajo para alinearse con estas revisiones, asegurando que las SDS, los sistemas de etiquetado y los materiales de capacitación reflejen las normas más recientes. Las empresas se benefician de estos cambios al reducir la confusión regulatoria, mejorar el reconocimiento de peligros y promover lugares de trabajo más seguros. Su Derecho a Comprender Estas actualizaciones refuerzan el cambio de OSHA de "Derecho a Saber" a "Derecho a Comprender", garantizando que los trabajadores no solo conozcan los peligros, sino que también puedan interpretar y aplicar correctamente la información de seguridad química. Consejo Profesional #4: Si no está seguro sobre una clasificación o un cambio en una etiqueta y no entiende su significado, no asuma que es algo menor. Revise la SDS, consulte a su supervisor o consulte las directrices de OSHA 29 CFR 1910.1200 para obtener aclaraciones. Actualización de aclaración: En octubre de 2024, OSHA emitió correcciones técnicas a HazCom 2024. Estas incluyeron correcciones a los umbrales de toxicidad dérmica, los puntos de corte de clasificación para peligros reproductivos y actualizaciones a las declaraciones de peligro para “producto químico bajo presión”. Aunque son cambios menores, garantizan una alineación completa con la intención de OSHA y con los estándares internacionales. https://d3imrogdy81qei.cloudfront.net/video_images/12346/key-updates-in-hazard-communication-standards.jpg Yes 185 https://app.protrainings.com/courses/hazcom/videos/key-updates-in-hazard-communication-standards https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6835.mp4 Key Updates in Hazard Communication Standards Key Updates in Hazard Communication Standards Aligning with Global Standards OSHA’s Hazard Communication Standard has undergone key revisions to improve workplace safety and ensure clear, consistent communication about chemical hazards. These updates align OSHA’s HazCom standards with the Globally Harmonized System (GHS) Revision 7, bringing greater consistency to how chemical information is classified and labeled worldwide. With each revision, OSHA refines its approach to hazard communication to reflect scientific advancements and industry best practices. These updates aim to enhance worker protection, streamline compliance efforts, and improve international trade by ensuring that chemical hazards are universally understood. Standardized Safety Data Sheets (SDS) One of the most significant updates is the standardized format for Safety Data Sheets (SDS). Formerly known as Material Safety Data Sheets (MSDS), SDS now follows a consistent 16-section format to make locating essential safety information—such as handling, storage, and first aid—quick and straightforward. Pro Tip #1: If you're used to working with MSDS, take time to familiarize yourself with the SDS format. The structured sections allow for faster and more efficient hazard identification. Each SDS section provides specific details about the chemical, including: Identification – Chemical name, manufacturer details, and recommended use. Hazard Identification – Classification of hazards, required pictograms, and signal words. Composition/Information on Ingredients – Chemical composition and trade secret details. First-Aid Measures – Immediate response actions for exposure. Firefighting Measures – How to control chemical fires. Accidental Release Measures – Procedures for spill containment and cleanup. Handling and Storage – Proper storage and precautions. Exposure Controls and PPE – Required protective equipment. Physical and Chemical Properties – Characteristics such as boiling points and solubility. Stability and Reactivity – Information on reactivity and hazardous decomposition products. Toxicological Information – Health effects and exposure risks. Ecological Information – Environmental impact data. Disposal Considerations – Proper waste management and disposal. Transport Information – Guidelines for safe transportation. Regulatory Information – Compliance with federal, state, and local laws. Other Information – Additional relevant safety details. Note: Sections 12–15 are required under GHS but are not enforced by OSHA. Trade Secret Concentration Ranges To balance worker safety and proprietary protections, OSHA now permits the use of prescribed concentration ranges for trade secrets instead of exact values. This change aligns with Health Canada’s WHMIS and other international standards, promoting transparency while safeguarding confidential formulations. Pro Tip #2: In a medical emergency, chemical manufacturers must disclose exact ingredient concentrations to a licensed medical professional upon request for treatment purposes—even if the ingredient is otherwise protected as a trade secret. New & Updated Definitions To enhance clarity and improve hazard communication, OSHA has introduced new definitions and refined existing ones: New Definitions: Bulk Shipment – Large quantities of hazardous materials shipped without packaging. Combustible Dust – Finely divided particles that can ignite under specific conditions. Solid, Liquid, and Gas – Standardized definitions to improve classification consistency. Immediate Outer Package – The first level of packaging that encloses a hazardous material. Physician or Other Licensed Health Care Professional (PLHCP) – Defines medical professionals responsible for workplace exposure evaluations. Released for Shipment – Specifies when a product is considered ready for transportation. Revised Definitions: Exposure or Exposed – Clarifies how workers may come into contact with hazardous chemicals. Hazardous Chemical – Refined to align with the latest toxicology and chemical safety research. Physical Hazard – More precise criteria for identifying fire, explosion, and reactivity risks. Changes to Hazard Classifications Several modifications have been made to hazard classifications to improve worker understanding and ensure better safety standards: Aerosols: Now includes a new category for non-flammable aerosols, expanding beyond the previous focus on flammable aerosols. Desensitized Explosives: Introduced as a new hazard class to improve classification of chemically stabilized explosives. Flammable Gases: Now incorporates pyrophoric gases into the category rather than listing them separately. Pro Tip #3: These updates ensure better hazard classification and global trade consistency. Workers should review SDS updates to stay informed on any new risks. State Plan Adoption & Business Impact All state plans must adopt provisions that are at least as effective as OSHA’s revised HazCom standard. This ensures a uniform safety standard across the country. Additionally, these updates are expected to generate an estimated net cost savings of $29.8 million annually by streamlining compliance while improving worker protection. Employers must update workplace safety programs to align with these revisions, ensuring that SDSs, labeling systems, and training materials reflect the latest standards. Businesses benefit from these changes by reducing regulatory confusion, improving hazard recognition, and ensuring safer workplaces. Your Right to Understand These updates reinforce OSHA’s shift from "Right to Know" to "Right to Understand"—ensuring that workers are not just aware of hazards but can effectively interpret and act on chemical safety information. Pro Tip #4: If you’re unsure about a classification or label change and aren't sure what it means, don’t assume it’s minor. Check the SDS, ask your supervisor, or consult OSHA’s 29 CFR 1910.1200 guidelines for clarification. Clarification Update: In October 2024, OSHA issued technical corrections to HazCom 2024. These included corrections to dermal toxicity thresholds, classification cutoffs for reproductive hazards, and updated hazard statements for “chemical under pressure.” While minor, these changes ensure full alignment with OSHA’s intent and international standards. https://d3imrogdy81qei.cloudfront.net/video_images/12346/key-updates-in-hazard-communication-standards.jpg Yes 185 https://app.protrainings.com/courses/hazcom/videos/pictogramas-comunicacion-peligros https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6836.mp4 Comprendiendo los Pictogramas de Comunicación de Peligros El Papel de los Pictogramas en la Comunicación de Peligros La Norma de Comunicación de Peligros de OSHA utiliza nueve pictogramas estandarizados en las etiquetas de productos químicos para proporcionar una identificación rápida y clara de los peligros. Estos símbolos, enmarcados en rojo y sobre un fondo blanco, están estandarizados tanto para envíos nacionales como internacionales, garantizando una comunicación consistente de los peligros entre industrias y países. Reconocer y comprender estos símbolos es una habilidad fundamental para la seguridad en el lugar de trabajo y el manejo de productos químicos. Los pictogramas no son solo símbolos; son advertencias visuales diseñadas para ayudar a los trabajadores a tomar las precauciones necesarias antes de manipular sustancias peligrosas. Cada pictograma proporciona información sobre la naturaleza y la gravedad del peligro, permitiendo a los empleados reaccionar de manera adecuada. Ya sea utilizando equipo de protección personal, siguiendo procedimientos específicos de manejo o asegurando un almacenamiento adecuado, los pictogramas son un elemento clave de la comunicación de peligros en el lugar de trabajo. Los Nueve Pictogramas de Comunicación de Peligros Cada pictograma representa un tipo específico de peligro químico. Comprender estos símbolos es crucial para la seguridad en el lugar de trabajo, ya que proporcionan advertencias visuales inmediatas sobre posibles peligros. Pictograma de Peligro para la Salud: Representa riesgos graves para la salud, incluyendo: Carcinogenicidad (sustancias que pueden causar cáncer) Mutagenicidad (mutaciones genéticas) Toxicidad reproductiva (afecta la fertilidad o el desarrollo) Sensibilización respiratoria Toxicidad en órganos (por exposición única o repetida) Toxicidad por aspiración Consejo Profesional: Si ve este símbolo en una etiqueta, revise siempre la Hoja de Datos de Seguridad (SDS) para comprender cómo ocurre la exposición y qué equipo de protección personal (EPP) se requiere. Pictograma de Llama: Indica peligros relacionados con incendios, incluyendo: Sustancias inflamables Sustancias pirofóricas Materiales que se autocalientan Sustancias que emiten gases inflamables Sustancias autorreactivas y peróxidos orgánicos Advertencia: Nunca almacene productos químicos inflamables cerca de fuentes de calor o llamas abiertas. Incluso pequeñas cantidades de estos materiales pueden encenderse bajo las condiciones adecuadas. Pictograma de Signo de Exclamación: Se utiliza para peligros moderados, tales como: Irritación de la piel y los ojos Sensibilización cutánea Toxicidad aguda (sustancias dañinas pero no necesariamente mortales) Efectos narcóticos Irritación del tracto respiratorio Peligros ambientales relacionados con el agotamiento de la capa de ozono (opcional) Consejo Profesional: Que un producto químico tenga un signo de exclamación no significa que sea seguro manipularlo sin EPP. Siga siempre las instrucciones de manejo y los requisitos de ventilación. Pictograma de Cilindro de Gas: Identifica gases bajo presión, que pueden presentar riesgos como: Explosión por la rápida expansión del gas Asfixia si se libera en espacios confinados Quemaduras por frío de gases licuados Advertencia: Los gases comprimidos pueden ser peligrosos incluso sin una fuente de ignición. Asegure siempre los cilindros de gas correctamente para evitar caídas o fugas. Pictograma de Corrosión: Se utiliza para sustancias que causan: Corrosión o quemaduras en la piel Daño ocular Corrosión de metales Consejo Profesional: Los materiales corrosivos pueden causar daño retardado. Incluso si la exposición inicial parece leve, busque atención médica si los síntomas empeoran. Pictograma de Bomba Explosiva: Representa peligros explosivos, incluyendo: Sustancias explosivas Sustancias autorreactivas Peróxidos orgánicos Advertencia: Algunos materiales explosivos pueden ser inestables incluso bajo condiciones normales de almacenamiento. Guárdelos siempre de acuerdo con las directrices de la SDS. Pictograma de Llama sobre un Círculo: Identifica oxidantes—sustancias que pueden provocar o intensificar incendios al liberar oxígeno. Consejo Profesional: Los oxidantes no solo se queman; hacen que otros materiales se quemen con mayor intensidad. Manténgalos alejados de sustancias inflamables. Pictograma de Calavera y Tibias Cruzadas: Una de las advertencias más graves, que indica toxicidad aguda: Puede ser mortal o tóxico si se inhala, se ingiere o se absorbe a través de la piel Advertencia: La exposición incluso a pequeñas cantidades de estos productos químicos puede ser mortal. Nunca los manipule sin EPP adecuado y ventilación. Pictograma del Medio Ambiente: No es obligatorio bajo OSHA, pero se utiliza para productos químicos que representan un peligro para la vida acuática (toxicidad acuática). Consejo Profesional: La Norma de Comunicación de Peligros de OSHA exige 8 de los 9 pictogramas del GHS. El pictograma del medio ambiente no es obligatorio bajo la norma HazCom de OSHA, pero puede aparecer en las etiquetas para mantener consistencia internacional. Recordatorio: Aunque no sea obligatorio, la seguridad ambiental sigue siendo importante. Siga siempre los procedimientos adecuados de eliminación para prevenir la contaminación. Importancia del Reconocimiento de los Pictogramas Cada uno de estos pictogramas cumple un papel vital en la seguridad en el lugar de trabajo, ayudando a identificar productos químicos peligrosos y asegurando que se sigan las precauciones necesarias. Los empleadores están obligados a capacitar a los empleados sobre el significado de estos símbolos, cómo responder a los peligros asociados y los procedimientos adecuados de manejo y almacenamiento. El reconocimiento adecuado de los peligros reduce lesiones en el lugar de trabajo, previene exposiciones químicas y asegura el cumplimiento de las regulaciones de OSHA. Familiarizarse con estos pictogramas le ayudará a responder rápida y correctamente en caso de derrames, fugas o accidentes. Consejo Profesional: Siempre revise las Hojas de Datos de Seguridad (SDS) y las etiquetas para obtener información adicional de seguridad más allá del pictograma. Para obtener información más detallada sobre estos símbolos y los riesgos asociados, consulte las directrices más recientes de la Norma de Comunicación de Peligros de OSHA. https://d3imrogdy81qei.cloudfront.net/video_images/12348/understanding-hazard-communication-pictograms.jpg Yes 164 https://app.protrainings.com/courses/hazcom/videos/understanding-hazard-communication-pictograms https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6836.mp4 Understanding Hazard Communication Pictograms The Role of Pictograms in Hazard Communication OSHA’s Hazard Communication Standard uses nine standardized pictograms on chemical labels to provide quick, clear identification of hazards. These symbols, framed in red and set against a white background, are standardized for both domestic and international shipments, ensuring consistent communication of hazards across industries and borders. Recognizing and understanding these symbols is a fundamental skill for workplace safety and chemical handling. Pictograms are not just symbols; they are visual warnings designed to help workers take necessary precautions before handling hazardous substances. Each pictogram provides insight into the nature and severity of the hazard, allowing employees to react appropriately. Whether it’s wearing protective equipment, following specific handling guidelines, or ensuring proper storage, pictograms are a key element of workplace hazard communication. The Nine Hazard Communication Pictograms Each pictogram represents a specific type of chemical hazard. Understanding these symbols is crucial for workplace safety, as they provide immediate visual warnings about potential dangers. Health Hazard Pictogram: Represents serious health risks, including: Carcinogenicity (cancer-causing chemicals) Mutagenicity (genetic mutations) Reproductive toxicity (impacting fertility or development) Respiratory sensitization Organ toxicity (from single or repeated exposure) Aspiration toxicity Pro Tip: If you see this symbol on a label, always check the Safety Data Sheet (SDS) to understand how exposure occurs and what personal protective equipment (PPE) is required. Flame Pictogram: Indicates fire-related hazards, including: Flammable substances Pyrophoric chemicals Self-heating materials Substances that emit flammable gases Self-reactives and organic peroxides Warning: Never store flammable chemicals near heat sources or open flames. Even small quantities of these materials can ignite under the right conditions. Exclamation Mark Pictogram: Used for moderate hazards, such as: Skin and eye irritation Skin sensitizers Acute toxicity (harmful but not fatal chemicals) Narcotic effects Respiratory tract irritation Environmental hazards related to ozone depletion (optional) Pro Tip: Just because a chemical is marked with an exclamation mark doesn't mean it’s safe to handle without PPE. Always follow handling instructions and ventilation requirements. Gas Cylinder Pictogram: Identifies gases under pressure, which may pose risks like: Explosion due to rapid gas expansion Asphyxiation if released in confined spaces Cold burns from liquefied gases Warning: Compressed gases can be dangerous even without ignition. Always secure gas cylinders properly to prevent them from falling or leaking. Corrosion Pictogram: Used for substances that cause: Skin corrosion or burns Eye damage Corrosion to metals Pro Tip: Corrosive materials can cause delayed damage. Even if initial exposure seems minor, seek medical attention if symptoms worsen. Exploding Bomb Pictogram: Represents explosive hazards, including: Explosive chemicals Self-reactives Organic peroxides Warning: Some explosive materials are unstable even under normal storage conditions. Always store them according to SDS guidelines. Flame Over Circle Pictogram: Identifies oxidizers—substances that can cause or intensify fires by releasing oxygen. Pro Tip: Oxidizers don't just burn; they make other materials burn more intensely. Keep them away from flammable substances. Skull and Crossbones Pictogram: One of the most serious warnings, signaling acute toxicity: Can be fatal or toxic if inhaled, swallowed, or absorbed through the skin Warning: Exposure to even small amounts of these chemicals can be deadly. Never handle without proper PPE and ventilation. Environment Pictogram: Non-mandatory under OSHA, but used for chemicals that pose a hazard to aquatic life (aquatic toxicity). Pro Tip: OSHA’s Hazard Communication Standard enforces 8 of the 9 GHS pictograms. The Environment pictogram is not mandatory under OSHA’s HazCom Standard, but it supports international consistency and may still appear on labels. Reminder: Even if not required, environmental safety still matters. Always follow proper disposal procedures to prevent contamination. Importance of Pictogram Recognition Each of these pictograms plays a vital role in workplace safety, making hazardous chemicals easy to identify and ensuring necessary precautions are followed. Employers are required to train employees on the meaning of these symbols, how to respond to the associated hazards, and proper handling and storage procedures. Proper hazard recognition reduces workplace injuries, prevents chemical exposures, and ensures compliance with OSHA regulations. Familiarizing yourself with these pictograms will help you respond quickly and correctly in case of spills, leaks, or accidents. Pro Tip: Always review Safety Data Sheets (SDSs) and labels for additional safety details beyond the pictogram alone. For a deeper dive into these symbols and their associated risks, refer to OSHA’s latest Hazard Communication Standard guidelines. https://d3imrogdy81qei.cloudfront.net/video_images/12348/understanding-hazard-communication-pictograms.jpg Yes 164 https://app.protrainings.com/courses/hazcom/videos/interpretando-etiquetas-comunicacion-peligros https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6837.mp4 Interpretando las Etiquetas de Comunicación de Peligros para la Seguridad Por Qué Son Importantes las Etiquetas Cuando necesita saber si un producto químico es peligroso, la etiqueta es su primera fuente de información. La Norma de Comunicación de Peligros de OSHA exige que todas las etiquetas sigan un formato estandarizado, brindándole información rápida y confiable sobre los riesgos químicos. Aunque las etiquetas pueden variar ligeramente entre fabricantes, los componentes principales siempre son consistentes. Los fabricantes, importadores y distribuidores de productos químicos son responsables de etiquetar cada recipiente que sale de sus instalaciones. Estas etiquetas deben ser legibles, en inglés, y permanecer visibles en el recipiente. A su vez, los empleadores deben asegurarse de que las etiquetas permanezcan intactas y no sean removidas ni dañadas una vez que el producto se encuentre en el lugar de trabajo. Aunque el inglés es obligatorio, se pueden incluir idiomas adicionales como apoyo para trabajadores que no hablen inglés (siempre que el texto en inglés también esté presente). El Etiquetado en la Práctica En ciertas situaciones, se pueden utilizar sistemas alternativos como carteles, hojas de proceso o boletos de lote si comunican eficazmente la información necesaria sobre los peligros y permanecen accesibles en el área de trabajo durante cada turno. Por ejemplo, transferir un producto químico a un recipiente secundario todavía requiere etiquetado, a menos que el producto químico sea transferido y utilizado inmediatamente por el mismo empleado durante el mismo turno. Consejo Profesional #1: Aclaración sobre Actualización de EtiquetasSi un producto químico ha sido liberado para envío (es decir, ya está empaquetado y etiquetado para su venta), no es necesario volver a etiquetarlo si surge nueva información sobre peligros. Sin embargo, los envíos futuros deben incluir etiquetas actualizadas. Esto garantiza información actual sin obligar a procesos costosos de reetiquetado. Consejo Profesional #2: Flexibilidad en la ComunicaciónOSHA aclaró en 2024 que las etiquetas deben colocarse físicamente en los recipientes, a menos que la parte receptora haya aceptado explícitamente un método alternativo. La opción de transmitir etiquetas electrónicamente se incluyó por error en versiones anteriores del lenguaje y ha sido eliminada para evitar confusión y asegurar una comunicación consistente de los peligros. Elementos Requeridos en Cada Etiqueta Toda etiqueta de un producto químico peligroso debe incluir lo siguiente: Identificador del Producto – El nombre o número que vincula la etiqueta con la Hoja de Datos de Seguridad (SDS). Palabra de Advertencia – Indica la gravedad del peligro (por ejemplo, “Peligro” para riesgos graves o “Advertencia” para riesgos menos severos). Declaraciones de Peligro – Frases estandarizadas que describen la naturaleza y el grado del peligro. Declaraciones de Precaución – Instrucciones sobre el manejo seguro, almacenamiento, respuesta y eliminación. Pictogramas – Símbolos visuales que representan los tipos de peligro (por ejemplo, llama o calavera y tibias cruzadas). Identificación del Proveedor – Nombre, dirección y número de teléfono del fabricante o importador. Para recipientes pequeños (100 mL o menos), OSHA permite un etiquetado reducido – normalmente solo el identificador del producto, pictogramas, palabra de advertencia y una referencia a la etiqueta completa en el empaque exterior – siempre que la etiqueta completa aparezca en el empaque externo. Interpretación de una Etiqueta de Ejemplo En un recipiente correctamente etiquetado encontrará los seis elementos requeridos. Así es como suelen aparecer: Pictogramas: Indicios visuales que muestran el tipo de riesgo (por ejemplo, inflamabilidad o peligro para la salud). Palabra de Advertencia: Aparece de forma destacada. Por ejemplo, “Peligro” indica un producto químico de alto riesgo. Declaración de Peligro: Proporciona detalles. Ejemplo: “Líquido y vapor altamente inflamables. Puede causar daño al hígado y a los riñones.” Declaraciones de Precaución: Guían el uso seguro. Ejemplo: “Mantener el recipiente bien cerrado. Almacenar en un lugar fresco y bien ventilado. Utilizar herramientas que no produzcan chispas.” Instrucciones de Primeros Auxilios: Acciones críticas en una emergencia, como “Retirar inmediatamente la ropa contaminada” y “Enjuagar la piel con agua”. Identificador del Producto e Información del Proveedor: Permiten identificar exactamente la sustancia y saber a quién contactar para obtener más información. Consejo Profesional #3: Recuerde que las etiquetas ofrecen una visión general rápida, no instrucciones completas de manejo. Siempre consulte la SDS para conocer las medidas de seguridad detalladas. Etiquetas NFPA y DOT Además de las etiquetas de OSHA, también puede encontrar etiquetas NFPA o DOT en materiales peligrosos. Etiquetas NFPA 704 Estos símbolos con forma de diamante se utilizan principalmente para la respuesta a emergencias. Presentan cuatro cuadrantes codificados por colores. Azul, rojo y amarillo se califican de 0 (mínimo) a 4 (severo) según el nivel de peligro. 🔵 Azul – Peligro para la Salud: Indica el nivel de daño que una sustancia puede causar con exposición a corto o largo plazo. 0 = Sin peligro 1 = Irritación leve 2 = Incapacitación temporal o posible lesión residual 3 = Lesión grave temporal o lesión permanente moderada 4 = Exposición grave, potencialmente mortal con contacto breve 🔴 Rojo – Peligro de Inflamabilidad: Mide qué tan fácilmente una sustancia puede encenderse. 0 = No se quema 4 = Se enciende fácilmente a temperatura ambiente 🟡 Amarillo – Peligro de Inestabilidad o Reactividad: Indica la probabilidad de que una sustancia explote o reaccione violentamente. 0 = Estable 4 = Puede detonar o explotar en condiciones normales ⚪ Blanco – Códigos de Peligro Especial: OX = Oxidante (por ejemplo, nitrato de amonio) W (tachado) = Reacciona peligrosamente con agua (por ejemplo, potasio) SA = Gas asfixiante simple (por ejemplo, nitrógeno o helio) Las etiquetas NFPA suelen colocarse en edificios, tanques o grandes recipientes fijos para ayudar a los equipos de emergencia a evaluar rápidamente los riesgos químicos durante una emergencia. Etiquetas de Peligro DOT El Departamento de Transporte (DOT) exige etiquetas de peligro en los envíos de productos químicos. Estas: Utilizan colores de fondo distintivos para indicar la clase de peligro (por ejemplo, rojo para inflamables o amarillo para oxidantes). Indican restricciones de transporte y protocolos de emergencia. Deben colocarse tanto en envíos a granel (como camiones cisterna o vagones ferroviarios) como en paquetes más pequeños que contienen materiales peligrosos. Consejo Profesional #4: Si un recipiente ya muestra un pictograma DOT para un peligro específico, no es necesario duplicarlo con un pictograma de OSHA para el mismo peligro. Esto evita confusión y redundancia. Para más información sobre el etiquetado DOT, consulte DOT Chart 17, una guía completa con ilustraciones e instrucciones para cada clase de peligro. Reflexiones Finales Las etiquetas de peligro son su primera línea de defensa al trabajar con productos químicos. Proporcionan información inmediata y práctica y le dirigen a orientaciones más detalladas en la SDS. Conozca el formato de las etiquetas, reconozca los símbolos y siempre haga preguntas si algo no está claro. Su seguridad depende de ello. El Derecho a Comprender comienza con saber cómo leer – y actuar según – las etiquetas de peligro. https://d3imrogdy81qei.cloudfront.net/video_images/12370/decoding-hazard-communication-labels-for-safety.jpg Yes 430 https://app.protrainings.com/courses/hazcom/videos/decoding-hazard-communication-labels-for-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6837.mp4 Decoding Hazard Communication Labels for Safety Why Labels Matter When you need to know whether a chemical is hazardous, the label is your first source of information. OSHA’s Hazard Communication Standard requires that all labels follow a standardized format, giving you quick, reliable information about chemical risks. Even though labels might vary slightly between manufacturers, the core components are always consistent. Chemical manufacturers, importers, and distributors are responsible for labeling each container leaving their facility. These labels must be legible, in English, and remain visible on the container. Employers, in turn, must ensure that the labels stay intact and are not removed or defaced once on-site. While English is mandatory, additional languages may be included to accommodate non-English-speaking workers. Labeling in Practice In certain situations, alternative systems like placards, process sheets, or batch tickets may be used if they effectively communicate the necessary hazard information and remain accessible in the work area throughout each shift. For example, transferring a chemical to a secondary container still requires labeling—unless the chemical is transferred and used immediately by the same employee, during the same shift. Pro Tip #1: Label Updates ClarifiedIf a chemical has been released for shipment—meaning it’s already packaged and labeled for sale—you don’t need to relabel it if new hazard info becomes available. However, any future shipments must include updated labels. This ensures current information without forcing costly relabeling. Pro Tip #2: Optional Communication FlexibilityOSHA clarified in 2024 that labels must be physically provided on containers—unless the receiving party has explicitly agreed to an alternate method. The option to transmit labels electronically was mistakenly included in earlier language and has been removed to avoid confusion and ensure consistent communication of hazards. Required Elements on Every Label Every hazardous chemical label must include the following: Product Identifier – The name or number that links the label to the Safety Data Sheet (SDS). Signal Word – Indicates the severity of the hazard (e.g., “Danger” for serious, “Warning” for less severe). Hazard Statements – Standardized wording that describes the nature and degree of the hazard. Precautionary Statements – Instructions on safe handling, storage, response, and disposal. Pictograms – Visual symbols representing hazard types (e.g., flame, skull and crossbones). Supplier Identification – Name, address, and phone number of the manufacturer or importer. For small containers (100 mL or less), OSHA allows reduced labeling—typically just the product identifier, pictograms, signal word, and a reference to the full label on the outer packaging—so long as the complete label appears on the outer package. Interpreting a Sample Label On a properly labeled container, you’ll find all six required elements. Here’s how they typically appear: Pictograms: Visual clues indicating the type of risk (e.g., flammability, health hazard). Signal Word: Prominently displayed. For example, "Danger" means this is a high-risk chemical. Hazard Statement: Provides detail. Example: "Highly flammable liquid and vapor. May cause liver and kidney damage." Precautionary Statements: Guide safe use. Example: "Keep container tightly closed. Store in a cool, well-ventilated place. Use non-sparking tools." First Aid Instructions: Critical actions to take in an emergency, such as “Remove contaminated clothing immediately” and “Rinse skin with water.” Product Identifier and Supplier Info: Ensures you know the exact substance and who to contact for more information. Pro Tip #3: Remember, labels offer a quick overview, not complete handling instructions. Always consult the SDS for in-depth safety measures. NFPA and DOT Labels In addition to OSHA labels, you might encounter NFPA or DOT labels on hazardous materials. NFPA 704 Labels These diamond-shaped signs are primarily for emergency response. They feature four color-coded quadrants. Blue, Red, and Yellow are rated from 0 (minimal) to 4 (severe) based on the level of hazard. 🔵 Blue – Health Hazard: Indicates the level of harm a substance can cause with short- or long-term exposure. 0 = No hazard 1 = Slight irritation 2 = Temporary incapacitation or possible residual injury 3 = Serious temporary or moderate permanent injury 4 = Severe, potentially fatal exposure with short contact 🔴 Red – Flammability Hazard: Measures how easily a substance ignites. 0 = Will not burn 4 = Ignites easily at room temperature 🟡 Yellow – Instability/Reactivity Hazard: Indicates how likely a substance is to explode or react violently. 0 = Stable 4 = May detonate or explode under normal conditions ⚪ White – Special Hazard Codes: OX = Oxidizer (e.g., ammonium nitrate) W (strikethrough) = Reacts dangerously with water (e.g., potassium) SA = Simple asphyxiant gas (e.g., nitrogen, helium) NFPA labels are typically posted on buildings, tanks, or large fixed containers to help first responders quickly assess chemical risks in emergencies. DOT Hazard Labels The Department of Transportation (DOT) requires hazard labels on chemical shipments. These: Use distinct background colors to denote hazard class (e.g., red for flammables, yellow for oxidizers). Indicate transport restrictions and emergency protocols. Must be placed on both bulk shipments (like tankers or railcars) and smaller non-bulk packages that contain hazardous materials. Pro Tip #4: If a container already displays a DOT pictogram for a specific hazard, you don’t need to duplicate it with an OSHA pictogram for the same hazard. This avoids confusion and redundancy. For more info on DOT labeling, consult DOT Chart 17, a comprehensive guide with visuals and instructions for each hazard class. Final Thoughts Hazard labels are your first line of defense when handling chemicals. They deliver immediate, actionable insights and point you to deeper guidance found in the SDS. Know the label format, recognize the icons, and always ask questions if anything is unclear. Your safety depends on it. The Right to Understand starts with knowing how to read—and act on—hazard labels. https://d3imrogdy81qei.cloudfront.net/video_images/12370/decoding-hazard-communication-labels-for-safety.jpg Yes 430 https://app.protrainings.com/courses/hazcom/videos/hojas-datos-seguridad-sds https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6838.mp4 Navegando las Hojas de Datos de Seguridad (SDS) Navegando las Hojas de Datos de Seguridad (SDS): Una Guía Completa Por Qué Son Importantes las SDS Las Hojas de Datos de Seguridad – o SDS – son documentos estandarizados que proporcionan información esencial sobre la seguridad y el manejo de productos químicos peligrosos. Exigidas por la Norma de Comunicación de Peligros de OSHA, las SDS están diseñadas para mantener a los trabajadores informados, preparados y seguros. Los fabricantes e importadores deben crear una SDS para cada producto químico peligroso que producen o introducen en los Estados Unidos. A su vez, los empleadores deben garantizar que las SDS estén fácilmente accesibles para todos los productos químicos peligrosos presentes en el lugar de trabajo. Consejo Profesional #1: Las SDS pueden almacenarse electrónicamente siempre que estén accesibles en todo momento, especialmente para empleados que se trasladan entre múltiples lugares de trabajo durante un turno. El Formato Estándar de 16 Secciones Cada SDS sigue un formato estandarizado de 16 secciones, adoptado bajo el Sistema Globalmente Armonizado (GHS), lo que facilita localizar información importante de seguridad. A continuación, se muestra un desglose de lo que contiene cada sección, utilizando propano como ejemplo: Identificación – Incluye el nombre del producto (por ejemplo, Propano), sinónimos (por ejemplo, Gas LP), usos recomendados, información de contacto del fabricante y números telefónicos de emergencia. Identificación de Peligros – Incluye pictogramas (por ejemplo, llama o cilindro de gas), la palabra de advertencia (“Peligro”), declaraciones de peligro (“Gas extremadamente inflamable”) y precauciones de seguridad. Composición / Información sobre los Ingredientes – Identifica los componentes químicos y sus concentraciones. En el caso del propano, la SDS suele indicar que contiene aproximadamente entre 80 % y 100 % de propano. Medidas de Primeros Auxilios – Ofrece instrucciones paso a paso sobre qué hacer en caso de exposición. Por ejemplo: “Enjuagar los ojos con agua tibia y buscar atención médica”. Medidas de Lucha contra Incendios – Recomienda los medios de extinción adecuados (por ejemplo, polvo químico seco o CO₂) y el equipo de protección necesario para los bomberos. Medidas en Caso de Liberación Accidental – Describe cómo responder de forma segura a fugas o derrames. En el caso del propano: “Los derrames de producto líquido crean un riesgo de incendio y pueden formar una atmósfera explosiva”. Manejo y Almacenamiento – Describe las precauciones para el manejo y Almacenamiento seguros. El propano es más pesado que el aire y puede acumularse en áreas bajas como sótanos. Controles de Exposición / Protección Personal – Enumera los límites de exposición y el equipo de protección personal necesario, como protección ocular y guantes con aislamiento térmico. Propiedades Físicas y Químicas – Proporciona datos importantes como el punto de ebullición (-44 °F), apariencia (incoloro) y olor (ninguno, a menos que se agregue un odorante). Estabilidad y Reactividad – Advierte sobre condiciones que deben evitarse (por ejemplo, calor o fuentes de ignición) y describe la reactividad química. Información Toxicológica – Detalla los posibles efectos en la salud. El propano se clasifica como un asfixiante simple, lo que significa que puede desplazar el oxígeno y causar asfixia. Secciones 12–15: Información Adicional Aunque OSHA no exige el cumplimiento de las Secciones 12 a 15, estas suelen proporcionar información complementaria valiosa. Importante: OSHA exige que estas secciones aparezcan en la SDS, pero no hace cumplir su contenido, ya que generalmente están reguladas por otras agencias. Información Ecológica – Describe el impacto ambiental. El propano se evapora rápidamente y no se espera que afecte significativamente la vida acuática. Consideraciones sobre la Eliminación – Proporciona pautas para la eliminación segura. Aunque el propano normalmente no se considera un residuo, los cilindros vacíos deben manejarse correctamente para evitar fugas. Información de Transporte – Incluye clasificaciones de envío y la clase de peligro correspondiente (por ejemplo, 2.1 para gas inflamable). Información Reglamentaria – Resume las leyes y regulaciones de seguridad aplicables (por ejemplo, la Proposición 65 de California). Sección 16: Otra Información Esta sección final incluye la fecha de preparación o revisión de la SDS, junto con notas o aclaraciones adicionales relacionadas con la información de seguridad proporcionada. Consejo Profesional #2: En casos de mezclas complejas, los fabricantes pueden emitir una sola SDS que cubra múltiples fórmulas, siempre que compartan propiedades químicas y peligros similares. Consejo Profesional #3: Los ingredientes protegidos como secreto comercial no eximen a los fabricantes de proporcionar información completa de seguridad. Incluso si se omite el nombre exacto del químico o su concentración, la SDS debe explicar cómo manejar el producto de manera segura. Acceso Rápido = Lugares de Trabajo Más Seguros Todos los empleados deben saber cómo acceder e interpretar una SDS. Estos documentos son la referencia principal para: Procedimientos de emergencia Equipo de protección personal (PPE) requerido Manejo y almacenamiento adecuados Respuesta ante derrames y fugas Advertencia: Que un producto químico sea común no significa que sea seguro. Siempre revise la SDS antes de manipular cualquier material peligroso. Para obtener más información sobre la Norma de Comunicación de Peligros de OSHA y el formato de las SDS, consulte 29 CFR 1910.1200. Mantenerse informado es una de las mejores maneras de mantenerse protegido. https://d3imrogdy81qei.cloudfront.net/video_images/12366/navigating-safety-data-sheets-sds.jpg Yes 344 https://app.protrainings.com/courses/hazcom/videos/navigating-safety-data-sheets-sds https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6838.mp4 Navigating Safety Data Sheets (SDS) Navigating Safety Data Sheets (SDS): A Complete Guide Why SDSs Matter Safety Data Sheets—or SDSs—are standardized documents that provide essential safety and handling information about hazardous chemicals. Mandated by OSHA’s Hazard Communication Standard, SDSs are designed to keep workers informed, prepared, and safe. Manufacturers and importers are required to create an SDS for every hazardous chemical they produce or bring into the U.S. Employers, in turn, must ensure that SDSs are readily accessible for all hazardous chemicals present in the workplace. Pro Tip #1: SDSs can be stored electronically as long as they are accessible at all times, especially for employees who travel between multiple job sites during a shift. The Standard 16-Section Format Every SDS follows a globally standardized 16-section format, adopted under the Globally Harmonized System (GHS), making it easier to locate important safety information. Here’s a breakdown of what each section contains, using propane as an example: Identification – Lists the product name (e.g., Propane), synonyms (e.g., LP-Gas), typical uses, manufacturer contact information, and emergency phone numbers. Hazard Identification – Includes pictograms (e.g., flame, gas cylinder), signal word (“Danger”), hazard statements (“Extremely flammable gas”), and safety precautions. Composition/Information on Ingredients – Identifies the chemical components and their concentrations. For propane, the SDS shows it contains 80–100% propane. First-Aid Measures – Offers step-by-step guidance on what to do if exposed. For example: “Flush eyes with lukewarm water and seek medical attention.” Fire-Fighting Measures – Recommends fire extinguishing media (e.g., dry chemical, CO₂) and protective equipment for firefighters. Accidental Release Measures – Describes how to safely respond to leaks or spills. For propane: “Spillages of liquid product create a fire hazard and may form an explosive atmosphere.” Handling and Storage – Covers precautions for safe storage and use. Propane is heavier than air and may accumulate in low areas like basements. Exposure Controls/Personal Protection – Lists exposure limits and required PPE, such as eye protection and thermal-insulating gloves. Physical and Chemical Properties – Provides key data like boiling point (-44°F), appearance (colorless), and odor (none unless an odorant is added). Stability and Reactivity – Warns about conditions to avoid (e.g., heat or ignition sources) and chemical reactivity. Toxicological Information – Details potential health effects. Propane is classified as a simple asphyxiant—it displaces oxygen and can cause suffocation. Sections 12–15: Additional Information While OSHA doesn’t require Sections 12–15, they often provide valuable supplemental details. Important: OSHA enforces only Sections 1 through 11 and Section 16 of the SDS. Sections 12 through 15 are optional under U.S. law, but often included for consistency with global GHS standards. Ecological Information – Describes environmental impact. Propane evaporates readily and is not expected to significantly affect aquatic life. Disposal Considerations – Offers guidelines for safe disposal. While propane isn’t typically considered waste, empty cylinders must be handled properly to prevent leaks. Transport Information – Includes shipping classifications and hazard class (e.g., 2.1 for flammable gas). Regulatory Information – Covers applicable laws and safety regulations (e.g., California’s Proposition 65). Section 16: Other Information This final section includes the SDS preparation or revision date, along with any notes or disclaimers that clarify or expand on the safety information provided. Pro Tip #2: In cases of complex mixtures, manufacturers may issue a single SDS that covers multiple formulas, as long as they share similar chemical properties and hazards. Pro Tip #3: Trade secret ingredients do not exempt manufacturers from providing comprehensive safety information. Even if the exact chemical name or concentration is omitted, the SDS must still explain how to handle the product safely. Quick Access = Safer Workplaces Every employee should know how to access and interpret an SDS. These documents are your go-to reference for: Emergency procedures Required PPE Proper handling and storage Spill and leak responses Warning: Just because a chemical is common doesn’t mean it’s safe. Always review the SDS before handling any hazardous material. For more information on OSHA’s Hazard Communication Standard and SDS formatting, refer to 29 CFR 1910.1200. Staying informed is the best way to stay protected. https://d3imrogdy81qei.cloudfront.net/video_images/12366/navigating-safety-data-sheets-sds.jpg Yes 344 https://app.protrainings.com/courses/hazcom/videos/derecho-comprender-comunicacion-peligros https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/6839.mp4 Su Derecho a Comprender: Comunicación de Peligros y Seguridad ¿Qué es el Derecho a Comprender? Usted tiene el derecho a comprender los peligros químicos en su lugar de trabajo. Este derecho va mucho más allá de simplemente saber que existen productos químicos peligrosos. Garantiza que usted esté: ✔ Informado sobre la presencia y los riesgos de los peligros químicos. ✔ Preparado para manejar sustancias peligrosas de manera segura. ✔ Capacitado para protegerse a sí mismo y a otros mediante el conocimiento y las prácticas adecuadas de seguridad. Este principio es el núcleo de la Norma de Comunicación de Peligros de OSHA, cuyo objetivo es hacer que la seguridad química sea una parte accesible y práctica de su trabajo diario. De “Derecho a Saber” a “Derecho a Comprender” Originalmente, la Norma de Comunicación de Peligros de OSHA se centraba en su “Derecho a Saber.” Los empleadores debían informar a los trabajadores sobre los productos químicos peligrosos y proporcionar acceso a las Hojas de Datos de Seguridad (SDS) y a las etiquetas de advertencia. Pero la simple conciencia no es suficiente. Por eso OSHA evolucionó el estándar hacia el “Derecho a Comprender,” asegurando que los trabajadores realmente comprendan los peligros químicos y sepan cómo mantenerse seguros. ✅ Derecho a Saber: Usted sabe que hay productos químicos peligrosos presentes. ✅ Derecho a Comprender: Usted sabe qué significan esos peligros, cómo protegerse y cómo responder de manera eficaz. Consejo Profesional #1: El Derecho a Comprender le permite participar activamente en la seguridad. Significa poder leer una etiqueta, entender una Hoja de Datos de Seguridad y aplicar esa información en el trabajo. Responsabilidades del Empleador La responsabilidad no termina con proporcionar documentos: los empleadores deben asegurarse de que los trabajadores comprendan la información. Esto significa crear un sistema claro y accesible de comunicación de peligros que respalde comportamientos seguros. Esto es lo que los empleadores deben proporcionar: ✔ Un Programa Escrito de Comunicación de Peligros – Un documento que describe las políticas de la empresa, los requisitos de capacitación y las responsabilidades relacionadas con la seguridad química. ✔ Un Inventario de Productos Químicos Peligrosos – Una lista completa de todas las sustancias peligrosas utilizadas o almacenadas en el lugar de trabajo. Esto permite a los empleados conocer los riesgos que pueden enfrentar en diferentes áreas del trabajo. ✔ Hojas de Datos de Seguridad (SDS) – Documentos detallados para cada producto químico. Deben estar disponibles en todo momento y los empleados deben recibir capacitación sobre cómo interpretarlas y utilizarlas. Consejo Profesional #2: La disponibilidad no es suficiente: los empleados deben realmente comprender la información. Los empleadores son responsables de ofrecer capacitación en un idioma y formato que todos los empleados puedan entender. Aplicando la Comunicación de Peligros en el Lugar de Trabajo El conocimiento solo es útil cuando se aplica. Así es como puede convertir la información en acción: Interpretar Etiquetas y SDS – Reconozca pictogramas, palabras de advertencia, declaraciones de peligro e instrucciones de precaución. Aplicar la Información de Seguridad – Use este conocimiento al manejar productos químicos, almacenarlos o responder a emergencias. Seguir los Procedimientos de Seguridad – Conozca las reglas de su empresa para manejar, almacenar y eliminar materiales peligrosos. Usar el Equipo Correctamente – Asegúrese de comprender cómo usar y llevar el Equipo de Protección Personal (PPE) y otras herramientas de seguridad. Advertencia: Ignorar las instrucciones de las etiquetas o no usar el PPE – incluso por poco tiempo – puede provocar lesiones graves o exposición peligrosa. Trate cada peligro con respeto, sin importar lo familiar que parezca. Tomar Acción: Cómo Protegerse Protegerse comienza con mantenerse informado y seguir las mejores prácticas de seguridad. Esto es lo que puede hacer todos los días: ✔ Sepa dónde su empresa guarda el Programa de Comunicación de Peligros y las SDS. ✔ Revise la SDS antes de usar un producto químico nuevo. ✔ Conozca los procedimientos de emergencia de su empresa. ✔ Siga siempre las advertencias de las etiquetas y las instrucciones de la SDS. ✔ Use el PPE adecuado (por ejemplo, guantes, gafas de seguridad o respiradores) en todo momento. ✔ Informe inmediatamente sobre derrames, fugas o etiquetas dañadas. ✔ Anime a sus compañeros de trabajo a tomar en serio la comunicación de peligros. Consejo Profesional #3: Si algo sobre los peligros de un producto químico o los procedimientos de seguridad no está claro, haga preguntas. OSHA protege su derecho a saber y a comprender. Por Qué Importa el Derecho a Comprender La transición de “Derecho a Saber” a “Derecho a Comprender” le coloca en el centro de su propia seguridad en el trabajo. ✔ Garantiza que no solo conozca los riesgos, sino que esté preparado para actuar. ✔ Reduce lesiones y enfermedades en el lugar de trabajo. ✔ Construye una cultura de seguridad basada en el conocimiento, no solo en el cumplimiento. Al adoptar su Derecho a Comprender, se convierte en un socio activo en la creación de un lugar de trabajo más seguro e informado, tanto para usted como para quienes le rodean. Si alguna vez tiene dudas, hable y pregunte. Comprender es su mejor línea de defensa. https://d3imrogdy81qei.cloudfront.net/video_images/12368/your-right-to-understand-hazard-communication-and-safety.jpg Yes 285 https://app.protrainings.com/courses/hazcom/videos/your-right-to-understand-hazard-communication-and-safety https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/6839.mp4 Your Right to Understand: Hazard Communication and Safety What is the Right to Understand? You have the right to understand the chemical hazards in your workplace. This right goes far beyond just knowing that hazardous chemicals exist. It ensures that you are: ✔ Informed about the presence and risks of chemical hazards. ✔ Prepared to handle hazardous substances safely. ✔ Empowered to protect yourself and others through knowledge and proper safety practices. This principle is at the core of OSHA’s Hazard Communication Standard, which aims to make chemical safety an accessible and actionable part of your daily work experience. From “Right to Know” to “Right to Understand” Originally, OSHA’s Hazard Communication Standard focused on your “Right to Know.” Employers were required to inform workers of hazardous chemicals and provide access to Safety Data Sheets (SDSs) and warning labels. But awareness isn’t enough. That’s why OSHA evolved the standard into the “Right to Understand,” ensuring that workers truly comprehend chemical hazards and know how to stay safe. ✅ Right to Know: You’re aware that hazardous chemicals are present. ✅ Right to Understand: You know what those hazards mean, how to protect yourself, and how to respond effectively. Pro Tip #1: The Right to Understand empowers you to actively participate in safety. It means being able to read a label, understand a Safety Data Sheet, and apply that information on the job. Employer Responsibilities The responsibility doesn’t stop with providing documents—employers must ensure comprehension. This means creating a clear and accessible hazard communication system that supports safe behaviors. Here’s what employers must provide: ✔ A Written Hazard Communication Program – A document that outlines the company’s policies, training requirements, and responsibilities related to chemical safety. ✔ A Hazardous Chemicals Inventory – A comprehensive list of all hazardous substances used or stored on site. This allows employees to know what risks they may face in different parts of the workplace. ✔ Safety Data Sheets (SDSs) – Detailed documents for each chemical. These must be available at all times and employees must be trained on how to interpret and use them. Pro Tip #2: Availability isn’t enough—employees must actually understand it. Employers are responsible for delivering training in a language and format that all employees can grasp. Applying Hazard Communication in the Workplace Understanding is only powerful when it’s applied. Here’s how to turn information into action: Interpret Labels and SDSs – Recognize pictograms, signal words, hazard statements, and precautionary instructions. Apply Safety Information – Use this knowledge when handling chemicals, storing them, or responding to emergencies. Follow Safety Procedures – Know your company’s rules for handling, storing, and disposing of hazardous materials. Use Equipment Properly – Make sure you understand how to wear and use Personal Protective Equipment (PPE) and other safety tools. Warning: Ignoring label instructions or bypassing PPE—even briefly—can lead to serious injury or exposure. Treat each hazard with respect, no matter how familiar it seems. Taking Action: How to Protect Yourself Protecting yourself starts with staying informed and following through with safety best practices. Here’s what you can do every day: ✔ Know where your company keeps the Hazard Communication Program and SDSs. ✔ Review the SDS before using a new chemical. ✔ Learn your company’s emergency procedures. ✔ Always follow label warnings and SDS instructions. ✔ Use the right PPE (e.g., gloves, goggles, respirators) every time. ✔ Report any spills, leaks, or damaged labels immediately. ✔ Encourage coworkers to take hazard communication seriously. Pro Tip #3: If anything about a chemical’s hazards or the safety procedures is unclear, ask questions. OSHA protects your right to know—and understand. Why the Right to Understand Matters The transition from “Right to Know” to “Right to Understand” puts you in the driver’s seat of your workplace safety. ✔ It ensures you are not just aware of the risks—but prepared to act. ✔ It reduces workplace injuries and illnesses. ✔ It builds a safety culture based on knowledge, not just compliance. By embracing your Right to Understand, you become a proactive partner in creating a safer, more informed workplace—for yourself and for those around you. If you’re ever unsure, speak up. Understanding is your strongest line of defense. https://d3imrogdy81qei.cloudfront.net/video_images/12368/your-right-to-understand-hazard-communication-and-safety.jpg Yes 285 https://app.protrainings.com/courses/bls/healthcare/videos/cardiac-chain-of-survival https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7171.mp4 Cardiac Chain of Survival The phrase Cardiac Chain of Survival> is a framework that the American Heart Association uses to describe the events that need to occur in order to increase the chances of one's survival from cardiac arrest. In this lesson, we will be covering the Cardiac Chain of Survival. What follows after this important information is a warning of what you might expect to feel if you're ever put into a rescue situation. The idea behind the Cardiac Chain of Survival is that every step in the chain is as critical as a link is in a chain. Perhaps you've heard that a chain is only as good as its weakest link. The same can be said for the Cardiac Chain of Survival. However, in this case, a weak link also includes any delays in moving from one link to another; delays make cardiac arrest rescue attempts more ineffective. Pro Tip: It's important to remember that maximizing one's chance of survival and recovery from sudden cardiac arrest is dependent on a strong Cardiac Chain of Survival. Cardiac Arrest Chain of Survival The Cardiac Chain of Survival includes the following links: The Recognition and Activation of Emergency Responses  Early High-Quality CPR Early Defibrillation Advanced Resuscitation Post Cardiac Arrest Care Recovery and Survivorship The Recognition and Activation of Emergency Responses - the recognition of cardiac arrest and the activation of the emergency response system is a must do if there is any chance of survival for this victim. This actually goes further into recognizing serious medical problems that will quickly lead to cardiac arrest. Early recognition and treatment of life-threatening conditions can prevent progression to cardiac arrest and improve outcomes. Learn to recognize those early symptoms before cardiac arrest. Early High-Quality CPR - when CPR is performed to the best of your abilities, it significantly improves the chance of survival of the cardiac arrest. Our focus needs to be on good body mechanics to ensure adequate depth and rate for the longest possible time. Stay within the recommended compression rate, provide breaths and minimize any pauses to as short as necessary, but never more than 10 seconds. >Defibrillation - AED accessibility has never been better. AEDs can be usually found in schools, churches, stores, with law enforcement, fire departments, and occasionally even within the home. AEDs have been designed to be easy to use and they work! Use it as soon as it is available. Advanced Resuscitation - advanced resuscitation is usually by emergency medical services (EMS) personnel or within hospitals. This involves advanced treatments like medications and additional treatments that most people do not have access or training with. Post Cardiac Arrest Care - once a victim regains a pulse, there is a long series of assessments and treatments that are involved. We try to stabilize the victim, figure out what caused the problem in the first place, and some therapies to have the best outcomes for the victim. Recovery and Survivorship - recovery includes additional treatment, observation, rehabilitation, and psychological support. This extends beyond the patient to the immediate family members as they are a critical support for the patient. The Cardiac Chain of Survival is a helpful tool to help you remember and organize the steps of cardiac care. However, it is even more important to focus on eliminating any fears you might have that could cause indecision and delays in executing these steps quickly and correctly. Warning:The biggest hurdle may likely be overcoming the fear that prevents people from getting involved in the first place. Knowing that you might expect this fear to arise should also help you prepare for it. And in the next lesson, you'll discover why you really have nothing to lose in trying, and neither does the victim. Even after decades of CPR training being readily available to everyone, the biggest problem we find isn't that people are doing CPR incorrectly. It's that people just aren't doing CPR enough. They let the fear creep in and prevent them from possibly saving a life. Almost all of the reasons people fail to rescue can be categorized into The 5 Fears of CPR Rescue. If you haven't already, please watch our video on The 5 Fears of CPR Rescue and learn how you can remove the fears of getting involved in rescuing someone in cardiac arrest and providing care that just might give that person their best and only chance of survival. https://d3imrogdy81qei.cloudfront.net/video_images/13002/cardiac-chain-of-survival-2025.jpg Yes 128 https://app.protrainings.com/courses/bls/healthcare/videos/cadena-de-supervivencia-cardiaca https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7171.mp4 Cadena de supervivencia cardiaca https://d3imrogdy81qei.cloudfront.net/video_images/13002/cardiac-chain-of-survival-2025.jpg Yes 128 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/infant-cpr-profa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7172.mp4 Infant CPR Infant-related cardiac arrests are typically the result of: Drowning Choking/airway obstruction Electrocution Just as with child CPR, due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the infant is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on his or her forehead and tap on the bottom of the baby's feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Check the infant for breathing - you don’t see any. If you've determined at this point that the victim is unresponsive and not breathing normally, continue immediately with CPR. CPR Technique for Infants Place two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should wrap around the chest. Alternatively, you can give compressions using the heel of 1 hand in the center of the chest. Conduct 30 compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Grab the rescue mask and seal it over the victim's face and nose. Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face.  Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About CPR Compression Rate and Depth Performing proper chest compressions is essential for providing high-quality CPR, which greatly improves the patient's chances for a successful outcome. Chest compressions put pressure on the heart to send oxygenated blood through the arteries to the brain and other vital organs. Chest compressions also increase the likelihood of a successful AED shock for the patient, particularly if several minutes have elapsed since the patient collapsed or suffered an incident leading to respiratory distress. Chest compression effectiveness is reduced if: Compressions are too shallow The compression rate is too fast or too slow There isn't a full recoil of the chest cavity There are interruptions during CPR The patient isn't laying on a firm, flat surface Warning: Compression rates that exceed 120 per minute tend to have a negative impact on compression depth, perhaps due to responders rushing through them. Regardless, if the compression rate exceeds 120 per minute, you are less likely to compress the full 1/3 of the chest for infants and children, thereby reducing the effectiveness of CPR. If you are unsure if you're compressing at the correct depth, a feedback device might be helpful. https://d3imrogdy81qei.cloudfront.net/video_images/13004/infant-cpr-2025.jpg Yes 357 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/rcp-bebe-pro-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7172.mp4 RCP en bebés https://d3imrogdy81qei.cloudfront.net/video_images/13004/infant-cpr-2025.jpg Yes 357 https://app.protrainings.com/courses/bls/healthcare/videos/infant-cpr https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7173.mp4 Infant CPR Infant-related cardiac arrests are typically the result of: Drowning Choking/airway obstruction Electrocution Just as with child CPR, due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the infant is responsive. Are you OK? Baby baby, can you hear me?  If you don't get an initial response, place your hand on his or her forehead and tap on the bottom of the baby's feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery.  At the same time as the pulse check, look, listen and feel for breathing. Spend no more than 10 seconds looking for a pulse and breathing. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. CPR Technique for Infants Place two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should wrap around the chest. Alternatively, you can give compressions using the heel of 1 hand in the center of the chest. Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Grab the rescue mask and seal it over the victim's face and nose. Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face.  Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About CPR Compression Rate and Depth Performing proper chest compressions is essential for providing high-quality CPR, which greatly improves the patient's chances for a successful outcome. Chest compressions increase the pressure on the heart to simulate a contraction. This helps to send oxygenated blood through the arteries to the brain and other vital organs. Chest compressions also increase the likelihood of a successful AED shock for the patient, particularly if several minutes have elapsed since the patient collapsed or suffered an incident leading to respiratory distress. Chest compression effectiveness is reduced if: Compressions are too shallow The compression rate is too fast or too slow There isn't a full recoil of the chest cavity There are interruptions during CPR The patient isn't laying on a firm, flat surface Warning: Compression rates that exceed 120 per minute tend to have a negative impact on compression depth, perhaps due to responders rushing through them. Regardless, if the compression rate exceeds 120 per minute, you are less likely to compress the full 1/3 of the chest for infants and children, thereby reducing the effectiveness of CPR. If you are unsure if you're compressing at the correct depth, a feedback device might be helpful. https://d3imrogdy81qei.cloudfront.net/video_images/13006/infant-cpr-bls-2025.jpg Yes 204 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-bebes-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7173.mp4 RCP en bebés https://d3imrogdy81qei.cloudfront.net/video_images/13006/infant-cpr-bls-2025.jpg Yes 204 https://app.protrainings.com/courses/bls/healthcare/videos/infant-landmarks https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7174.mp4 Infant Landmarks Since the anatomical proportions of a baby are significantly different than that of children and adults, this section will focus on those differences as they relate to performing CPR on an infant. When Assessing an Infant An infant is considered any child under the age of one. When assessing and treating an infant who is in cardiac or respiratory distress, there are a few things to first consider. First, let's look at the signs of a healthy baby. The lips are nice and pink, as is the mucous membrane. The nail beds are also pink. The baby is moving around and appears to be physically fine and healthy. A baby in respiratory distress would likely be agitated or if it becomes even worse - lethargic and have some signs of circumoral cyanosis – blue around the lips – as well as the mucous membrane. The nailbeds might also appear blue. Pro Tip #1: Don't confuse cold hands with signs of respiratory distress. When an infant's hands are cold, they might also appear bluish. Important Infant Landmarks Compression Point and Depth As you open an infant's clothing to expose the chest, you'll want to find the nipple line. Put two thumbs on the center of the infant's chest, directly on the sternum, and slightly below the nipple line. Your fingers will reach around to the baby’s back. The depth of compression for infants is about 1½ inches (or 1/3 the anterior-posterior diameter of the chest). However, the rate of compressions is the same as adults and children – 100-120 compressions per minute. Finding a Pulse Since infants don't have much of a neck, finding the carotid artery can be difficult, which is why we have to use the brachial artery instead. To find the brachial artery, remove the infant's clothing enough to expose one arm. The brachial artery is located on the inside of the arm between the bicep and tricep against the humerus bone. Place your two fingers on the artery to check for a pulse, just as you would for other victims. Pro Tip #2: The reason we don't use our thumbs to check for a pulse is that a thumb has its own detectable pulse, which could easily give a false reading. Opening the Airway There's another thing to keep in mind. Babys have large heads that are disproportionate to the rest of their bodies. Combined with a lack of a neck, this results in a chin that rests on the chest. Before performing compressions, place something firm under the infant's shoulder blades to lift the neck and help tilt the head into a neutral or slightly sniffing position. It's important that this be a firm enough object so the infant doesn't sink down and the head is held in the correct position as you perform compressions. Warning: An infant's airway is only about the size of one of their pinky fingers, which makes the airway much tighter than children and adults. If using the standard head tilt, chin lift, this could actually occlude the airway, making it much more difficult for the baby to breathe. This can also happen when an infant's chin is resting on their chest. When performing compressions, the infant's head and neck should be in a slightly sniffing position. In other words, just a slight upturn of the nose; very close to neutral. (Imagine walking into a room and smelling a fresh apple pie and how your head rises ever so slightly as you sniff.) Compression Variation Technique There is one variation that can be used when doing compressions on a baby, which is using the heel of one hand in the center of the chest. An Infant's Heart The size of an infant's heart is approximately the size of one of their fists. It's located right under the sternum in the center of their chest. Because of its small size, finding the right compression point is critical. A Word About Infant Assessment When assessing the level of consciousness in a baby, tap them on the bottom of the feet rather than the shoulder, as part of your shout-tap-shout sequence. Also, rather than use AVPU (Alert, Verbal, Pain, Unresponsive) to measure and record a patient's level of consciousness, when treating an infant, it's more accurate to use the pediatric assessment triangle: Appearance Effort of breathing Circulation As recognizing an unresponsive infant is your first priority to providing treatment, the assessment triangle should provide you with a better reading of the infant's condition. https://d3imrogdy81qei.cloudfront.net/video_images/13008/infant-landmarks-bls-2025.jpg Yes 195 https://app.protrainings.com/courses/bls/healthcare/videos/puntos-de-referencia-bebes-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7174.mp4 Puntos de referencia en lactantes (bebés) https://d3imrogdy81qei.cloudfront.net/video_images/13008/infant-landmarks-bls-2025.jpg Yes 195 https://app.protrainings.com/courses/bls/healthcare/videos/infant-cpr-2-rescuer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7175.mp4 Infant CPR 2 Rescuer In this section, we're going to cover two-responder infant CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.) Also, it's important to have the right size mask.  Much of what was covered in the last section – Child CPR with Two Responders – will apply in this section – Infant CPR with Two Responders. The one difference being the method of compressions which will be explained below. Pro Tip #1: One variation that should be used when doing compressions on an infant or baby when a second responder is present, is circumferential compressions. To perform circumferential compressions, wrap your fingers around the sides of the infant's chest, placing both thumbs over the compression point just below the nipple line. One of your thumbnails should be resting on the top of the other. If for some reason you're not able to perform circumferential compressions, then an alternative method is the heel of one hand. Remember that little force will be required when performing compressions on an infant. Pro Tip #2: The rate of compressions to rescue breaths during two rescuer infant CPR is the same as with children – 15 compressions for every two rescue breaths. How to Provide Care After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the infant is responsive. Are you OK? Can you hear me?  If you don't get an initial response, place your hand on the infant's forehead and tap on the bottom of his or her feet. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR. Two-Responder CPR Technique for Infants Responder one: Draw an imaginary line across the infant's nipples and place your thumbs next to each other on the lower part of the center of the sternum to perform circumferential compressions. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your thumbs to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 15 chest compressions. Responder two: Grab the bag valve rescue mask and seal it over the infant's face and nose. If available, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with infants, the head-tilt, chin lift is neutral or slightly sniffing. Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath. Be cautious to not over inflate the lungs as this can cause several serious issues. Responder one: Go right back into your 15 chest compressions. Responder two: Go right back to delivering two rescue breaths. Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties. Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask. Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally. A Word About Considerations for Pediatric Patients Cardiac emergencies in children and infants are usually secondary to respiratory problems and airway restrictions. While congenital heart conditions are possible, they aren't common. When cardiac arrest occurs in children and infants, it's usually caused by one of the following: Airway and breathing problems Traumatic injuries or incidents – drowning, electrocution, poisoning, etc A hard blow to the chest Congenital heart disease Sudden infant death syndrome (SIDS) https://d3imrogdy81qei.cloudfront.net/video_images/13010/infant-cpr-2-rescuer-bls-2025.jpg Yes 191 https://app.protrainings.com/courses/bls/healthcare/videos/rcp-bebes-2-rescatistas-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7175.mp4 RCP en bebés 2 rescatistas https://d3imrogdy81qei.cloudfront.net/video_images/13010/infant-cpr-2-rescuer-bls-2025.jpg Yes 191 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/infant-aed-fa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7176.mp4 Infant AED In this lesson, you'll learn how to use an AED on an infant who's gone into cardiac arrest. The methods of defibrillating an infant differ a little from adults and children, so be sure and make note of those differences. As you know, AED pads come in two sizes – adult and pediatric. Pediatric pads are for patients less than 8 years old or 55 pounds or roughly 25 kilograms, while adult pads are for anyone 8 years and older or weighing more than 55 pounds. So, since we are talking about infants, we will always opt for the pediatric pads. However, if you do not have pediatric pads available, use the adult pads. It's far better to use the wrong size pads than it is to forgo using an AED. Studies have shown using adult pads to be safe and effective based on the limited data available. Pro Tip #1: Some AEDs have a key or button that can be used for switching to pediatric energy levels. Be sure to use pediatric settings or pads when possible. Infant-related cardiac arrests are typically the result of: Drowning Choking/airway obstruction Electrocution This is important for reasons of scene safety. If the infant was pulled from a pool, is he or she laying in too much water to safely use an AED? If the infant was electrocuted, is the source of that electricity still a threat? It's always important to make sure the scene is safe before helping another person, but it's especially important when using an AED, where one spark can cause a lot of problems in the wrong situation. (And why we often mention combustible gases and flammable liquids in our scene safety warnings.) How to Provide Care Just like the last two AED lessons, we're going to assume a few things: The scene is safe, and your gloves are on You or someone else has called 911 You have an AED that's ready to use The infant is already in cardiac arrest (not breathing, not conscious, not moving) CPR is already in progress AED Technique for Infants Turn on the AED. Remove the infant's clothing to reveal a bare chest and dry the chest off if it's wet. Since one pad will go on the infant's back, be sure that area is also accessible and dry. Attach one AED pad to the infant's chest, roll the baby over onto his or her side carefully while supporting the head and neck, and attach the second pad to the center of the infant's back between the shoulder blades. Pro Tip #2: The AED should include a diagram on pad placement if you ever need help. And make sure they adhere well and aren't peeling off, as this will affect the AED's effectiveness. Plug the cable into the AED and be sure no one is touching the victim. The AED should now be analyzing the rhythm of the infant's heart. The AED will automatically charge if the AED finds a shockable rhythm. If the scene is clear and no one is touching the victim, push the discharge button to deliver a shock. Then go right back into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Remember, you want to minimize compression interruptions. Don't delay or interrupt compressions any longer than absolutely necessary and this includes after a shock is delivered. Go right back into your compressions. Perform 30 chest compressions. Grab the rescue shield and place it over the victim's mouth and nose. Seal your mouth over the infant's mouth and nose. Deliver two rescue breaths – Breathe into the rescue mask slowly (over one second) and watch for the chest to rise, then stop. Wait for the chest to fall before administering the next breath, this is about two seconds between breaths. Continue with CPR until the AED interrupts you. At some point, it will reanalyze the victim's heart rhythm and again advise you on what to do next. If the AED advises a shock, do that. If it advises you to NOT shock the victim, continue with CPR only, again over the pads. (The AED will continue to reanalyze.) Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until EMS arrives, the patient is responsive and breathing normally, or someone who's equally trained or better can relieve you. A Few Common Questions About AED Use Why is it so important to not disrupt or delay CPR compressions? Current research suggests that minimizing all delays is important for victim recovery, including that first compression after an AED shock. Compressions immediately help get the victim's pulse pressures back up and oxygenated blood circulating again. Will a wet diaper cause a problem with an AED? No. As wetness concerns AED use, as long as the victim isn't submerged in a pool or puddle of water, you should be fine. Keep in mind that the only areas that need to be dry are those where the pads will go. Can I remove the pads if the victim begins breathing normally again? No. Keep the pads on until EMS or other advanced medical personnel take over. The AED will continue monitoring the victim and will advise you again should problems arise, so keep the pads on and the AED turned on. https://d3imrogdy81qei.cloudfront.net/video_images/13012/infant-aed-2025.jpg Yes 329 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/dea-bebe-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7176.mp4 DEA en bebés https://d3imrogdy81qei.cloudfront.net/video_images/13012/infant-aed-2025.jpg Yes 329 https://app.protrainings.com/courses/bls/healthcare/videos/infant-aed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7177.mp4 Infant AED AED pads come in an adult size and a pediatric size, for patients less than 8 years old or 55 pounds or roughly 25 kilograms. However, remember, if you do not have pediatric pads and the patient is less than 8 years old or less than 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forgo using an AED. Also, remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? If for some reason the scene isn't safe enough to use an AED, move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. And one last reminder: It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. With infants, since one pad will be attached to the back, that area must also be dry. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.) If you don't get an initial response, place your hand on the infant's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, immediately use the AED, if available.  If you have a second rescuer, be sure to immediately start CPR while the other rescuer applies and operates the AED. AED Technique for Infants Turn on the AED. Remove the patient's clothing to reveal a bare chest and back. Attach one AED pad to the infant's chest, carefully roll the infant on his or her side, and attach the second pad to the back. The pads should have a diagram on placement if you need a reminder. Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be charging and analyzing the rhythm of the patient's heart. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Place two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should wrap around the chest. Alternatively, you can give compressions using the heel of 1 hand in the center of the chest. Conduct compressions that go roughly 1.5 inches deep, or 1/3 the depth of the infant's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions if there is one rescuer. If you have a second rescuer, then use a 15:2 compression to ventilation ratio. Grab the appropriately-sized rescue mask and seal it over the victim's face and nose. Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath, about 2 seconds. After 2 minutes of CPR, the AED will analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About AED Precautions When using an AED, there are several precautions to keep in mind. Some of these may be obvious (and a repeat of what you've already learned in this course), while others may not be. Since alcohol is flammable, do not use anything with alcohol on it to wipe the patient's chest or back dry. While it's OK to use adult pads on a child, the reverse isn't entirely true, as pediatric pads may not deliver enough energy to defibrillate the patient. Do not touch the patient while the AED is conducting an analysis, as this may affect the analyzation process. Before delivering an AED shock, make sure no one is touching the patient or any of the resuscitation equipment. Do not use an AED if there are flammable or combustible materials or gases present, including free-flowing oxygen. Simply redirect the flow of oxygen away from the patient around the time the AED is going to shock. Do not operate an AED inside a moving vehicle, as the movement can affect the analysis. Do not use an AED if the victim is in contact with free-standing water or in the rain. Move the patient first. Do not place AED pads on top of any patches or implantable devices. Remove patches first and adjust the pads as necessary to avoid devices like a pacemaker. https://d3imrogdy81qei.cloudfront.net/video_images/13014/infant-aed-bls-2025.jpg Yes 271 https://app.protrainings.com/courses/bls/healthcare/videos/dea-bebe-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7177.mp4 DEA para bebés https://d3imrogdy81qei.cloudfront.net/video_images/13014/infant-aed-bls-2025.jpg Yes 271 https://app.protrainings.com/courses/bls/healthcare/videos/two-person-aed-1 https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7178.mp4 2-Person AED Some of this will be a review of what you learned in the cardiac arrest section – using an AED on an adult patient. >An AED (Automated External Defibrillator) is a portable electronic device that analyzes the rhythm of the heart and delivers an electrical shock, known as defibrillation, which helps the heart re-establish an effective rhythm. Warning: When using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? Pro Tip #1: If the scene isn't safe enough to use an AED, drag or move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. These are two important considerations before using an AED, but there are a few other things to note when defibrillating an adult patient. If the victim is female and wearing an underwire bra, it shouldn't present any complications. However, if the bra is a concern, you can adjust the straps or cut it away and remove it. Just make sure the AED pads are on bare skin. Necklaces should be moved to the side Any patches – nicotine, analgesic, nitro gel, etc. – should be removed if they are in the way of the pads Piercings shouldn't cause any problems It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it There are no special considerations for pregnant women Pro Tip #2: When two responders are available, the emphasis will be on a steady supply of compressions. The two responders will orchestrate their movements in a way that minimizes any stoppages or delays in chest compressions, as this will keep oxygen circulating throughout the victim's body – brain, heart, and other vital organs. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy (or bag valve mask when there are two responders) and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Continue to assess the victim's pulse and breathing.  Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. Check for breathing while you are checking for a pulse. The patient may be breathing fast or slow, deep or shallow breathing, etc. Remember, gasping is not normal breathing and may be a sign the victim does not have a pulse. If you've determined at this point that the victim is unresponsive, is not breathing normally, and has no pulse, start CPR with compressions and have the second responder immediately set up and use the AED. Caution: When checking for a pulse, rescuers, including licensed healthcare providers, spend too much time checking for a pulse. Spending more than 10 seconds checking for a pulse shows worse outcomes for patients. If you are not positive you feel a pulse within those 10 seconds, begin compressions. Two-Person AED Technique for Adults Responder one: Locate proper hand placement and begin chest compressions – between the breasts and on the lower half of the sternum. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. Responder two:(while responder one performs compressions) Turn on the AED. Remove the patient's clothing to reveal a bare chest and dry the chest off if it's wet. Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. Make sure they adhere well. Pro Tip #3: This will resemble a back-and-forth sort of dance until the AED is ready to use. If possible, do not stop compressions. Our goal is to apply the AED pads to the victim around the rescuer doing compressions. If you must momentarily pause compressions, begin again as soon as possible. Plug the cable into the AED and be sure no one is touching the patient, including yourself and your partner. The AED should now be analyzing the rhythm of the patient's heart. If the AED finds a shockable rhythm, it will charge and tell everyone to clear from touching the victim. If the scene is clear and no one is touching the patient, push the flashing shock button. Responder two: Immediately take over compressions from responder one. Ensure proper body mechanics and perform 30 chest compressions. It's appropriate to perform CPR over the pads, when needed. It is best practice to not remove the AED pads once they are applied. Responder two: Grab the bag valve rescue mask and seal it over the victim's face and nose. Lift the patient's mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Slowly, over 1 second, compress the bag valve mask about half the volume, or just until you see the chest rise. Wait for the chest to fall, about 2 seconds, before administering the second breath. Pro Tip #4:The AED takes around two minutes to reanalyze the patient, which makes this an ideal time to switch again. After about five cycles of CPR, the AED will analyze the patient again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button Go right into CPR. (This is the switch point.) strong>Responder two goes from AED and valve mask duties to compressions, while responder one takes over bag valve mask duties and control of the AED. Continue this cycle of CPR, re-analyzation, switching positions, charging, shocking, and back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About AED Maintenance For AEDs to function properly, they must be maintained like any other medical device. However, the maintenance they require is minimal. Though AEDs have various self-testing features, it's important that healthcare professionals become familiar with any visual or audible prompts the AED may use to warn of a low battery or malfunction. If the machine detects a malfunction that cannot be easily resolved by addressing the manual, you should contact the manufacturer. It may need to be returned for service. While AEDs require minimal maintenance, it's still important to remember the following: Follow the manufacturer's recommendations for periodic equipment checks Make sure that the batteries are not expired or low energy. Most AEDs have windows that you can easily see the status of the battery. (It may be a good idea to order a new battery months before it expires or is showing that it is low energy.)  Make sure the AED includes the correct defibrillation pads and that they remain sealed. Opened AED pad packaging can cause the pads to dry out and become ineffective when needed Periodically check expiration dates on the defibrillation pads and batteries, and replace as necessary After using your AED, make sure that all the accessories are back in the case and that the machine is in proper working order for its next use If at any time the AED fails to work properly, discontinue its use and contact the manufacturer immediately https://d3imrogdy81qei.cloudfront.net/video_images/13016/2-person-aed-bls-2025.jpg Yes 295 https://app.protrainings.com/courses/bls/healthcare/videos/dea-2-personas-1-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7178.mp4 DEA - 2 personas https://d3imrogdy81qei.cloudfront.net/video_images/13016/2-person-aed-bls-2025.jpg Yes 295 https://app.protrainings.com/courses/bls/healthcare/videos/conscious-adult-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7179.mp4 Conscious Adult Choking This conscious adult choking lesson is for situations where you can see that an adult is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including: They cannot cough They cannot breathe They cannot speak Another sign to look for is the universal sign for choking – when the victim places both of their hands around their throat. The good news is that, even when dealing with a full obstruction, in most situations the obstruction will come out if you perform the back blows and abdominal thrusts correctly. Pro Tip #1: Only worry about calling 911 and activating EMS if doing so is quick and easy, or there is another person nearby that can call. Otherwise, don't waste time calling 911 and go right into assessing and rescuing the victim. How to Provide Care The first thing you want to do is face the person and look them in the eyes. You want confirmation that the victim is choking, and you want to receive permission to help the person. "Are you choking?" The person will probably nod yes. "May I help you?" You'll likely get another nod. If the victim is conscious, it's always a good idea to get permission and it only takes a second. Back Blows Technique for Adults Stand to the side and slightly behind the victim, but facing them with feet shoulder width apart. Support the victim with the seatbelt hold. For this, take one arm and use it to support the chest. Then, lean them forward. Take the heel of your other hand and locate the center of their back between their shoulder blades (scapula)  and deliver 5 forceful back blows. If the airway is still obstructed, move to abdominal thrusts. Abdominal Thrust Technique for Adults Stand behind the victim, placing one foot between the victim’s feet and the other shoulder width apart further behind for a strong stance. Elevate the victim's arms and elbows so you have clear access to the abdominal area. Locate the belly button (navel) using the index finger on your dominant hand and hold it there. This is the landmark you'll use to find the correct abdominal point. On your non-dominant hand, tuck in your thumb and place your fist thumb-first above the finger that's on the belly button, essentially stacking one on top of the other vertically. Pro Tip #2: Make sure you stay below the bottom tip of the rib cage (xyphoid process) and above the belly button (navel). This is the diaphragmatic region where you'll be performing the abdominal thrusts. Take your index finger off the belly button and wrap that dominant hand over your other hand that's positioned on the victim's diaphragm. Keep your elbows out so they're resting on the victim's ribs as little as possible. Thrust up and in and turn your palms upward as you perform each thrust. Perform five abdominal thrusts or until the object comes out. Pro Tip #3: It's important to turn your hands upward as you perform each thrust, as this will bring the diaphragm up and in and compress the lower lobes of the lungs, forcing air to shoot up the trachea and pop the obstruction out. This works in the majority of choking situations. Alternate between Back Blows and Abdominal Thrusts until the object comes out or the victim becomes unconscious. If the object comes out, the victim will begin coughing to help clear the airway and should begin breathing normally again in a matter of seconds. Encourage the victim and let the person know that he or she is OK now and have them sit down if necessary. If the victim goes unconscious, ensure 911 has been called and begin CPR with chest compressions. However, before giving breaths, we check the airway before giving breaths. This is the skill for unconscious choking. If you called 911, let them come anyway, so the person can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. Advanced medical evaluation is still usually encouraged to ensure there is no interal injuries. If you did not call 911, it's always a good idea to encourage the choking victim to see his or her own doctor to make sure everything is OK. If you weren't able to remove the obstruction using the abdominal thrust technique, the victim will go unconscious pretty quickly. Help lower them to the ground, so they don't fall and injure themselves. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious adult choking procedure. Special Consideration for Pregnant Women It's important to remember that when treating a pregnant woman, regardless of the situation, you're actually treating two patients. Saving mom is always the priority, as saving mom will also save the baby. So, be just as aggressive in your treatment. However, you don't want to injure the baby while performing the abdominal thrusts. Which is why you'll be using a different area for the thrusts – directly under the breasts and on top of the sternum. Therefore, if the 5 back blows do not work perform 5 chest thrusts. Switch between back blows and chest thrusts until the object is dislodged, the victim loses consciousness or trained rescuers take over. Pro Tip #4: Besides the point of thrusting, there is only one other difference when dealing with an adult choking victim who's pregnant. The thrusts will be inward only; not up and in. A Word About Types of Airway Obstruction There are two types of airway obstructions – anatomical and mechanical, also referred to as Foreign Body Airway Obstruction (FBAO). Anatomical obstructions occur when a part of the victim's anatomy is causing the blocked airway. It could be due to the tongue, swollen mouth tissues, or a swollen throat. The tongue is the most common type of anatomical obstruction, as it relaxes in unconscious victims when their bodies are deprived of oxygen. Because the tongue tends to relax on the back of the throat in these situations, it can block airflow to the lungs. Mechanical or FBAO obstructions include food, toys, and liquids. Poorly chewed food is the biggest culprit – eating too fast and/or laughing, talking, or running while eating can contribute to choking. And with small children, it's no surprise that toys are also a common choking obstruction. https://d3imrogdy81qei.cloudfront.net/video_images/13018/conscious-adult-choking-2025.jpg Yes 350 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-adulto-consciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7179.mp4 Asfixia en adulto consciente https://d3imrogdy81qei.cloudfront.net/video_images/13018/conscious-adult-choking-2025.jpg Yes 350 https://app.protrainings.com/courses/bls/healthcare/videos/conscious-child-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7180.mp4 Conscious Child Choking This conscious child choking lesson is for situations where you can see that a child is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including: They cannot cough They cannot breathe They cannot speak Another sign to look for is the universal sign for choking – when the victim places both of their hands around their throat. Remember to only worry about calling 911 and activating EMS if doing so is quick and easy, or there is another person nearby that can call. Otherwise, don't waste time calling 911 and go right into assessing the victim. How to Provide Care The first thing you want to do is face the child and look them in the eyes. You want confirmation that the victim is choking, and you want to receive permission to help the child. "Are you choking?" The child will probably nod yes. "May I help you?" You'll likely get another nod. Don't wait too long to receive permission, as children may be a little more flustered than adults. Pro Tip #1: With children, they may not have the same level of awareness as adults. If they're only nodding or making gagging, high-pitched squeaking sounds, these are good indications that the airway is fully obstructed. Pro Tip #2: If the child can respond verbally, that means that they are able to move enough air past the larynx to speak. This is a good indication that something may be stuck but that the airway isn't obstructed. Or it could indicate a partial obstruction of the airway. If there is a parent or legal guardian present, make sure to get permission before beginning the following procedure. Back Blows Technique for Children Stand to the side and slightly behind the victim, but facing them with feet shoulder width apart. You may kneel if needed. Support the victim with the seatbelt hold. For this, take one arm and use it to support the chest. Then, lean them forward. Take the heel of your other hand and locate the center of their back between their shoulder blades (scapula)  and deliver 5 forceful back blows. If the airway is still obstructed, move to abdominal thrusts.   Abdominal Thrust Technique for Children Elevate the victim's arms and elbows so you have clear access to the abdominal area. Locate the belly button using the index finger on your dominant hand and hold it there. This is the landmark you'll use to find the correct abdominal point. Warning: It's important that when helping a choking victim who's shorter than yourself, that you lower yourself to their height. This will limit unnecessary pressure on the rib cage and prevent broken ribs or other possible harm while you perform the abdominal thrusts. On your non-dominant hand, tuck in your thumb and place your fist thumb-first above the finger that's on the belly button, essentially stacking one on top of the other vertically. Remember to stay below the bottom tip of the rib cage (xyphoid process) and above the belly button. This is the diaphragmatic region where you'll be performing the abdominal thrusts. Take your index finger off the belly button and wrap that dominant hand over your other hand that's positioned on the victim's diaphragm. Lower yourself to the height of the child. Keep your elbows out so they're resting on the victim's ribs as little as possible. Thrust up and in and turn your hands upward as you perform each thrust. Perform five abdominal thrusts unless the object comes out or the child becomes unresponsive. Remember to turn your hands upward as you perform each thrust, as this will bring the diaphragm up and in and compress the lower lobes of the lungs, forcing air to shoot up the trachea and pop the obstruction out. This works in the majority of choking situations. If after the five abdominal thrusts, the object is still not out, alternate between 5 back blows and 5 abdominal thrusts. Once the object comes out, the child will begin coughing to help clear the airway and should begin breathing normally again in a matter of seconds. Encourage the victim and let the child know that he or she is OK now and have them sit down if necessary. Children may experience more confusion and fear than adults, so letting them know that they'll be fine is important. If you called 911, let them come anyway, so the child can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. Advanced medical evaluation is still usually encouraged to ensure there are no interal injuries. Pro Tip #3: If you did not call 911, it's always a good idea for you or someone else to take the child into an urgent care center, hospital, or to see their physician. With children, don't leave it up to them to determine if more care is necessary. If you weren't able to remove the obstruction using the abdominal thrust technique, the child will go unconscious pretty quickly. Help lower them to the ground, so they don't fall and injure themselves. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious child choking procedure. https://d3imrogdy81qei.cloudfront.net/video_images/13020/conscious-child-choking-2025.jpg Yes 222 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-nino-consciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7180.mp4 Asfixia en niño consciente https://d3imrogdy81qei.cloudfront.net/video_images/13020/conscious-child-choking-2025.jpg Yes 222 https://app.protrainings.com/courses/bls/healthcare/videos/conscious-infant-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7181.mp4 Conscious Infant Choking This conscious infant choking lesson is for situations where you can see that an infant is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including: They cannot cough They cannot breathe They cannot speak or babble or make any noise Their lips are beginning to show signs of circumoral cyanosis – a blue ring around the lips that indicates early signs of oxygen starvation Signs that the infant is conscious include: The baby is still moving around The baby's eyes are open Remember to activate EMS as soon as possible so long as it doesn’t delay care. If possible, have another person nearby call. Otherwise, don't waste time calling 911 and go right into assessing and helping the infant. How to Provide Care Helping a conscious choking infant isn’t significantly different than helping a child or an adult. You'll still be performing a combination of back slaps and thrusts to try and dislodge the airway obstruction. The biggest difference between infants when compared to adults or children, rather than performing abdominal thrusts, for infants we need to make sure we are performing chest thrusts rather than abdominal thrusts. Warning: Due to the fragile nature of infants performing abdominal thrusts on them could cause severe internal injuries. Chest thrusts should be used for conscious choking infants. If there is a parent or legal guardian present, make sure to get permission before beginning the following procedure. Back Slap and Chest Thrust Technique for Infants Place your thumb and index finger over the baby's cheekbones and around the face. Make sure you're supporting the infant's head and neck. Turn the infant over so they are facing down. Rest the infant's body on your forearm, so their legs are straddling your bicep. Rest your forearm on your leg for additional support. Pro Tip #1: Hold the baby at about a 30-45-degree angle, so the head is lower than the feet. This will allow gravity to assist, rather than hinder, your efforts. Using your other palm, perform five back slaps between the infant's shoulder blades. Using the same hand that you just used to perform the back slaps, hold the back of their head and neck and turn the baby over so they are facing up. Place the heel of your hand on the sternum in the center of the infant's chest. Make sure the head is lower, just like before, at around a 30-45-degree angle. Perform five chest thrusts, much like you would when performing CPR on an infant. Pro Tip #2: It's important that you keep the infant's body stabilized when doing the back slaps and chest thrusts. If you allow the infant's body to move downward with each slap or thrust, you'll minimize the effects necessary to force enough air up the trachea to remove the obstruction. Continue to perform a combination of back slaps and chest thrusts until the object comes out and the infant is breathing normally again. If you called 911, let them come anyway, so the infant can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. Pro Tip #3: If you did not call 911, it's always a good idea for you or someone else to take the infant into an urgent care center, hospital, or to see their physician to determine if more care is necessary. This conscious infant choking procedure is extremely effective if you perform the back slaps and chest thrusts properly. If you weren't able to remove the obstruction, the infant will go unconscious pretty quickly. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious infant choking procedure. A Word About Pediatric Considerations Young children are more prone to choking on small objects like toys, buttons, coins, and balloons. Food, too, is a bigger threat for children under four years old because they don't have a full set of teeth at that age, which means they aren't able to chew their food as well as older children. The American Academy of Pediatrics (AAP) recommends not giving any firm, round food to children under four years old unless it is cut into smaller pieces – ideally smaller than half an inch. They also recommend keeping the following food items away from younger children: Hot dogs Nuts and seeds Chunks of meat or cheese Whole grapes Hard, gooey or sticky candy Popcorn Chunks of peanut butter Raw vegetables Raisins Chewing gum According to the Consumer Product Safety Commission (CPSC), balloons represent the greatest threat to young children, as more have suffocated on non-inflated balloons and pieces of broken balloons than any other type of toy. It's also important to remember to get permission from a parent or legal guardian, if present, before helping a choking infant or child.  https://d3imrogdy81qei.cloudfront.net/video_images/13022/conscious-infant-choking-2025.jpg Yes 213 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-bebe-consciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7181.mp4 Asfixia en bebé consciente https://d3imrogdy81qei.cloudfront.net/video_images/13022/conscious-infant-choking-2025.jpg Yes 213 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/unconscious-infant-choking-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7182.mp4 Unconscious Infant Choking This unconscious infant choking lesson is for situations where you find an infant who is unconscious, and you suspect they became unresponsive due to an airway obstruction. Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the infant isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction. In this scenario, you would treat this patient as an unconscious infant choking victim. The method of care will closely resemble performing CPR on an infant, however there are subtle differences to pay attention to. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy. Assess the infant to make sure he or she is not breathing normally and is unconscious. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions. Pro Tip #1: While repetitive and maybe not necessary, it bears repeating: The prevalence of technology has reached a point where everyone has a cell phone or mobile device. And those devices tend to have speakers making them hands-free. Also remember that in an emergency your adrenaline will likely be spiked and your brain mildly dazed and confused. If you're having trouble remembering your rescue skills, dispatch can help. Draw an imaginary line across the infant's nipples and place your two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should be wrapping around the infant’s chest. Alternatively, you may also use the heel of one hand in the center of the chest. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, and count as you perform them. Conduct 30 chest compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Grab the rescue mask and seal it over the victim's face and nose. Pro Tip #2: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that.  If you can, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Here’s the difference between CPR and unconscious choking - open the airway and look for the object before giving your two breaths. If you see the object, use your pinky finger to sweep out the object. Never do a finger sweep unless you see the object. Place the rescue mask and breathe into the mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. Pro Tip #3: Because infants' mouths are small, it's best to use your pinky finger combined with a hooking motion to sweep out obstructions. If the rescue breaths go in this time – causing the chest to rise and fall – check for breathing. If after no more than 10 seconds, you do not see, hear, or feel breathing, start CPR. >Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally. https://d3imrogdy81qei.cloudfront.net/video_images/13024/unconscious-infant-choking-2025.jpg Yes 217 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/asfixia-bebe-inconsciente-primeros-auxilios-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7182.mp4 Asfixia en bebé inconsciente https://d3imrogdy81qei.cloudfront.net/video_images/13024/unconscious-infant-choking-2025.jpg Yes 217 https://app.protrainings.com/courses/bls/healthcare/videos/unconscious-infant-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7183.mp4 Unconscious Infant Choking This unconscious infant choking lesson is for situations where you find an infant who is unconscious, and you suspect they became unresponsive due to an airway obstruction. Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the infant has a pulse but isn't breathing. You attempt rescue breathing at a rate of one breath every two to three seconds, but your first breath does not produce chest rise. You reposition the airway and try again - still no chest rise. In this scenario, you would treat this patient as an unconscious infant choking victim. The method of care will closely resemble performing CPR on an infant, however there are subtle differences to pay attention to. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy. Assess the infant to make sure he or she is not breathing normally and is unconscious. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions. Draw an imaginary line across the infant's nipples and place your two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should be wrapping around the infant’s chest. Alternatively, you may also use the heel of one hand in the center of the chest. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, and count as you perform them. Conduct 30 chest compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Grab the rescue mask and seal it over the victim's face and nose. Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that.. If you can, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position. Here’s the difference between CPR and unconscious choking - open the airway and look for the object before giving your two breaths. If you see the object, use your pinky finger to sweep out the object. Never do a finger sweep unless you see the object. Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions. Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths. Pro Tip #2: Because infants' mouths are small, it's best to use your pinky finger combined with a hooking motion to sweep out obstructions. If the rescue breaths go in this time – causing the chest to rise and fall – check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse. Pro Tip #3: For infants with a pulse rate lower than 60 beats per minute, you are instructed to override with chest compressions in CPR. But if you're only allowing 10 seconds to check a pulse, how do you know the rate per minute? Multiply the 10-second rate by six, and this will give you the number of beats per minute. If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every two to three seconds for two minutes. After two minutes, reassess for a pulse and check again for normal breathing. If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every two to three seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths. Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally. If you have a second rescuer, rather than 30:2, use a 15:2 compression to ventilation ratio. A Word About Vital Signs (By Age) Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations. For Adults (12 years and older) Pulse rate – 60 to 100 beats per minuteRespirations – 12 to 20 breaths per minute For Children (1 year to 12 years old) Pulse rate – 70 to 120 beats per minuteRespirations – 15 to 30 breaths per minute For Infants (1 month to 12 months old) Pulse rate – 100 to 140 beats per minuteRespirations – 25 to 50 breaths per minute For Neonates (full term to 30 days) Pulse rate – 120 to 160 beats per minuteRespirations – 40 to 60 breaths per minute Pro Tip #4: Infants in distress – not breathing normally – will likely be tachycardic. It's not unusual for them to range between 120-180 beats per minute on the high end, depending on their exact age. It's also not abnormal to feel a fast, slightly thready (or thin) pulse that's becoming weaker. If we cannot correct the breathing issue, infants will quickly deteriorate and have a slowing heart rate until breathing is corrected. https://d3imrogdy81qei.cloudfront.net/video_images/13026/unconscious-infant-choking-bls-2025.jpg Yes 238 https://app.protrainings.com/courses/bls/healthcare/videos/asfixia-bebe-inconsciente-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7183.mp4 Asfixia en bebé inconsciente https://d3imrogdy81qei.cloudfront.net/video_images/13026/unconscious-infant-choking-bls-2025.jpg Yes 238 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/shock-lay-rescuer https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7184.mp4 Shock Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body. It is a serious and potentially life-threatening condition that requires immediate medical care as it is a multi-symptom and complex condition. When organs don't receive enough blood, the body begins to conserve blood flow by limiting it to legs, arms, and the skin. This insufficient blood volume is one thing that can lead to shock, as can low levels of plasma and fluids in the blood and airway obstruction. There are several types of shock, including psychological shock – a psychological condition in which worry and concern send a person into shock, rather than a physical condition. While this shock lesson is in the bleeding control section, it's important to understand that any first aid emergency could send a person into shock. Pro Tip #1: The important thing to remember with shock is that the symptoms are the same regardless of what contributes to it. It's a serious condition that warrants rapid treatment and an immediate 911 call. Besides psychological shock, there are four main types. The Four Main Types of Shock Hypovolemic Shock Hypovolemic shock is caused by a severe lack of blood and bodily fluids. The most common types of hypovolemic shock is dehydration and hemorrhagic shock, which occurs as a result of significant water or blood loss. Obstructive Shock Obstructive shock is caused by an obstruction to blood flow usually within the blood vessels, like a pulmonary embolism – a blood clot in a lung artery. Distributive Shock When there is an inadequate distribution of blood that results in low levels of blood returning to the heart, this can cause distributive shock. Examples include septic shock (due to toxins), anaphylactic shock (due to food allergies), and neurogenic shock (due to spinal cord or brain trauma). Pro Tip #2: One item to keep in mind is when you think of shock, it is the pale, cool, clammy skin. Which is true, unless we have distributive shock. Since distributive shock causes blood vessels to dilate (expand), this causes increased blood flow to the skin often making it warm and flushed (red). Cardiogenic Shock Cardiogenic shock is the result of the heart being unable to pump correctly to supply enough blood to vital organs. This can be caused by an injury to the heart, disease, or trauma. How to Provide Care Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue mask with a one-way valve available if necessary. Warning: If at any point the victim stops breathing normally or becomes unresponsive, begin CPR (or rescue breathing) immediately and continue until medical professionals arrive. Pro Tip #3: The goal of care when the victim is in shock is to find and fix the problem that's sending them into shock. In the case of bleeding injuries, controlling blood loss is the first priority to help allow enough oxygenated blood to circulate, thereby keeping cells and vital organs working properly. The first step is to recognize the signs and symptoms of shock and realize that these can all progress and therefore should be monitored periodically. Look for these early signs of shock: Nervousness Rapid heart rate or breathing Anxiousness Sweaty Fearful Clammy skin As shock progresses, the victim's skin could become more pale, clammier, and the other symptoms could get worse. Clammy skin, incidentally, is due to a restriction in blood flow to the skin and extremities. Pro Tip #4: If you suspect shock, pinch a toenail or fingernail and measure the capillary response – the length of time it takes for blood to refill that nail. If it's more than a few seconds, your victim is likely in shock. How to Deal with a Shock Victim Your quick and competent response may be the difference between life and death. If you suspect the victim is in shock, proceed with the following steps. Call 911 or EMS. Depending on the cause of the shock, time is critical to get them to advance care. Always ensure scene safety for you and other bystanders. Maintain the victim's airway and help them breathe if they're not able to on their own. Begin CPR if unresponsive and not breathing. Help improve their circulation by controlling any bleeding. Start with the worst bleed, first, but all bleeding should be as controlled as possible. Place the victim flat on their back if possible. Do not elevate the legs if injury is suspected or if it causes discomfort. If a victim is breathing normally, but is unconscious with no concerns of spinal injury, another option is the recovery position. This is a great way to protect their airway. Cover the victim with a blanket or coat. Insulate them as best you can and keep them warm. This will help their bodies combat the effects of shock. Do not give shock victims anything to eat or drink as this could cause nausea and vomiting, which in turn can make the shock worse, not to mention this risk of blocking the airway. Stay with the patient and keep them calm. A Few Common Shock Questions Are there any tests I can perform on the victim to better help identify shock? If you suspect shock, pinch a toenail or fingernail and measure the capillary response – the length of time it takes for blood to refill that nail bed. If it's more than a few seconds – or the time it takes to say capillary refill – your victim is likely in shock. How do I know when to call 911? It's always better to be safe than sorry, so call 911 any time it's an actual emergency or if you're unsure what to do or overwhelmed, and how exactly that's defined will vary from rescuer to rescuer. However, as it pertains to this lesson, always call 911 immediately as soon as you suspect shock or as soon as the victim loses consciousness or begins having breathing issues. In other words, err on the side of victim safety. https://d3imrogdy81qei.cloudfront.net/video_images/13028/shock-2025.jpg Yes 143 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/conmocion-rescatista-lego-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7184.mp4 Conmoción https://d3imrogdy81qei.cloudfront.net/video_images/13028/shock-2025.jpg Yes 143 https://app.protrainings.com/courses/bls/healthcare/videos/shock https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7185.mp4 Shock Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body. When organs don't receive enough blood, the body begins to compensate by conserving and limiting blood flow to the legs, arms, and the skin. As shock progresses, more systems shut down until the effects become irreversible and death occurs.  The Four Main Types of Shock Hypovolemic Shock Hypovolemic shock is caused by a severe lack of blood and bodily fluids. The most common types of hypovolemic shock is dehydration and hemorrhagic shock, which occurs as a result of significant water or blood loss. Obstructive Shock Obstructive shock is caused by an obstruction to blood flow usually within the blood vessels, like a pulmonary embolism – a blood clot in a lung artery. Distributive Shock When there is an inadequate distribution of blood that results in low levels of blood returning to the heart, this can cause distributive shock. Examples include septic shock (due to toxins), anaphylactic shock (due to food allergies), and neurogenic shock (due to spinal cord or brain trauma). Pro Tip #1: One item to keep in mind is when you think of shock, it is the pale, cool, clammy skin. Which is true, unless we have distributive shock. Since distributive shock causes blood vessels to dilate (expand), this causes increased blood flow to the skin often making it warm and flushed (red). Cardiogenic Shock Cardiogenic shock is the result of the heart being unable to pump correctly to supply enough blood to vital organs. This can be caused by an injury to the heart, disease, or trauma. How to Provide Care Shock is a serious and potentially life-threatening condition that requires immediate medical care. It is a multi-symptom and complex condition, which is also progressive. Pro Tip #2: The goal of care when the victim is in shock is to find and fix the problem that's sending them into shock. In the case of bleeding injuries, controlling blood loss is the first priority to help allow enough oxygenated blood to circulate, thereby keeping cells and vital organs working properly. The first step is to recognize the signs and symptoms of shock and realize that these can all progress and therefore should be monitored periodically. Look for these early signs of shock: Nervousness Rapid heart rate or breathing Anxiousness Sweaty Fearful Clammy skin As shock progresses, the victim's skin could become more pale, clammier, and the other symptoms could get worse. Clammy skin, incidentally, is due to a restriction in blood flow to the skin and extremities. Pro Tip #3: If you suspect shock, pinch a toenail or fingernail and measure the capillary response – the length of time it takes for blood to refill that nail. If it's more than a few seconds, your victim is likely in shock. How to Deal with a Shock Victim Your quick and competent response may be the difference between life and death. If you suspect the victim is in shock, proceed with the following steps. Call 911 or EMS. Depending on the cause of the shock, time is critical to get them to advance care. Always ensure scene safety for you and other bystanders. Maintain the victim's airway and help them breathe if they're not able to on their own. Begin CPR if unresponsive and not breathing. Help improve their circulation by controlling any bleeding. Start with the worst bleed, first, but all bleeding should be as controlled as possible. Place the victim flat on their back if possible. Do not elevate the legs if injury is suspected or if it causes discomfort. If a victim is breathing normally, but is unconscious with no concerns of spinal injury, another option is the recovery position. This is a great way to protect their airway. Cover the victim with a blanket or coat. Insulate them as best you can and keep them warm. This will help their bodies combat the effects of shock. Do not give shock victims anything to eat or drink as this could cause nausea and vomiting, which in turn can make the shock worse, not to mention this risk of blocking the airway. Stay with the patient and keep them calm. If you have oxygen available, it may be appropriate to provide supplemental oxygen. Always follow local protocols when administering oxygen. https://d3imrogdy81qei.cloudfront.net/video_images/13030/shock-bls-2025.jpg Yes 235 https://app.protrainings.com/courses/bls/healthcare/videos/conmocion-shock https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7185.mp4 Conmoción https://d3imrogdy81qei.cloudfront.net/video_images/13030/shock-bls-2025.jpg Yes 235 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/burns-child https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7186.mp4 Burns Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical. In this lesson, when we talk overall about burns, then how to treat them, starting with thermal burns. Then, we'll discuss some information on chemical and electrical burns. How to Assess and Treat a Burn Injury As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." The first thing you want to do is assess how bad the burn is. To determine the degree of burn, look for the following signs: 1st degree (superficial) – usually presents itself as a pink outer ring; characterized by redness and pain 2nd degree (partial-thickness) – will present itself with blistering skin and is usually very painful 3rd degree (full-thickness) – dark, charred areas; can include life-threatening complications Warning:  The following burns should be seen immediately at a hospital for treatment: Large 2nd burns that involve the face, hands, feet, or genitalia All 3rd degree burns Any burn that has concern for inhalation injury (soot around the nose or mouth, difficulty breathing)  The concerning part about burns is that you may not see the full extent or concern of the injury until hours later. After the burning process has ended, the injured skin starts the healing process. This involves the moving of fluid to the injured area causing swelling, pain, dehydration/shock and other potentially life threatening conditions. Minor seeming injuries may be far more serious if not evaluated or treated by professionals. Sequence of Treatment for Burn Victims Remove the body from the burn. This can mean a few different things – like the presence of smoldering clothing or a victim who's laying in burning embers. Cool the burn. Pour cool clean water over the burn for five to 20 minutes. Your goal is to remove residual heat from the burned tissue. This will stop the burning process. Even room temperature water is appropriate as that is still over 20 degrees cooler than normal body temperature and can remove heat from the skin. Apply loose, dry, sterile dressing over the wound. Begin wrapping above the burn and wrap particularly lightly over the burn. During 3rd degree burns, the nerve endings become damaged, so there is less pain. However, 1st and 2nd degree burns can be quite painful. Pro Tip #1: Observe the patient for signs of shock or dizziness. If they are losing their balance, help them into a seated or lying position, whichever is more comfortable. At the first sign of shock, call 911 and activate EMS immediately. Look for inhalation burns. Is the victim wheezing? Is there some swelling or burns around the face? Have the eyebrows been burned? Is there soot on the inside of the victim's mouth or nose? All of these could signal possible future complications in the form of respiratory issues. Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock. Pro Tip #2: Skin is the major organ that controls your body temperature. If we damage it from a burn, then pour cold or cool water over the body (burned area), the victim could become cold and start to shiver, hypothermia has now set in. Once the burn is cooled, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call. Chemical Burns You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet. When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool clean water. When dealing with wet chemicals, go right into rinsing them off using cool, clean water. Pro Tip #3: Dilution is the solution to pollution. When dealing with chemical burns, rinsing them off with cool, clean water will have a weakening effect, as the chemicals are diluted again and again with every dousing of clean water. Electrical Burns Electrical burn situations require an extra level of safety. Before anything, make sure the energy source has been removed before coming into contact with the patient. This could mean removing the patient from the energy source, cutting the power, or something else. You cannot risk becoming another patient at the scene. Pro Tip #4: There is a significant difference between electrical entry burn wounds and electrical exit burn wounds. Entry wounds look like typical thermal burns. But exit wounds may look more like shotgun exit wounds – huge, explosive, and damaging. Manage the entry wound the same as you would a thermal burn. Manage the exit wound as the situation requires, which will likely include treatment options for tissue damage and excessive bleeding. Warning: As electricity travels through the body it can affect the conductivity of the heart, which could potentially damage the conduction points in the heart and contribute to secondary cardiac issues. With electrical burns, monitoring for heart dysrhythmias for 24 to 72 hours in hospital might be necessary. A Word About Burn Victim Pediatric Considerations It's important to note that children have greater surface areas relative to their weights than adults. This can become a major factor when it comes to staying warm and hydrated. Victims with severe burns tend to lose a lot of water through evaporation and leaking from the burned area. This increases our concerns as it can lead to hypothermia and shock. Monitor the victim for signs of dehyration, shock or hypothermia. Immediately seek advanced medical intervention if any of these are seen. After Burn Care If the burn is minor, and the burning has been completely stopped, at-home treatment might be appropriate. The 2024 ECC Guidelines suggest petrolatum (with or without topical antibiotics such as polymyxin), honey, and aloe have been shown to improve healing time in certain burns. Over the counter pain medications may help with pain when used correctly. All treatment should be under the direction of your physician. https://d3imrogdy81qei.cloudfront.net/video_images/13032/burns-2025.jpg Yes 413 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/quemaduras-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7186.mp4 Quemaduras https://d3imrogdy81qei.cloudfront.net/video_images/13032/burns-2025.jpg Yes 413 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/burns https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7187.mp4 Burns Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical. In this lesson, when we talk overall about burns, then how to treat them, starting with thermal burns. Then, we'll discuss some information on chemical and electrical burns. How to Assess and Treat a Burn Injury As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." The first thing you want to do is assess how bad the burn is. To determine the degree of burn, look for the following signs: 1st degree (superficial) – usually presents itself as a pink outer ring; characterized by redness and pain 2nd degree (partial-thickness) – will present itself with blistering skin and is usually very painful 3rd degree (full-thickness) – dark, charred areas; can include life-threatening complications Warning:  The following burns should be seen immediately at a hospital for treatment: Large 2nd burns that involve the face, hands, feet, or genitalia All 3rd degree burns Any burn that has concern for inhalation injury (soot around the nose or mouth, difficulty breathing)  The concerning part about burns is that you may not see the full extent or concern of the injury until hours later. After the burning process has ended, the injured skin starts the healing process. This involves the moving of fluid to the injured area causing swelling, pain, dehydration/shock and other potentially life threatening conditions. Minor seeming injuries may be far more serious if not evaluated or treated by professionals. Sequence of Treatment for Burn Victims Remove the body from the burn. This can mean a few different things – like the presence of smoldering clothing or a victim who's laying in burning embers. Cool the burn. Pour cool clean water over the burn for five to 20 minutes. Your goal is to remove residual heat from the burned tissue. This will stop the burning process. Even room temperature water is appropriate as that is still over 20 degrees cooler than normal body temperature and can remove heat from the skin. Apply loose, dry, sterile dressing over the wound. Begin wrapping above the burn and wrap particularly lightly over the burn. During 3rd degree burns, the nerve endings become damaged, so there is less pain. However, 1st and 2nd degree burns can be quite painful. Pro Tip #1:Observe the patient for signs of shock or dizziness. If they are losing their balance, help them into a seated or lying position, whichever is more comfortable. At the first sign of shock, call 911 and activate EMS immediately. Look for inhalation burns. Is the victim wheezing? Is there some swelling or burns around the face? Have the eyebrows been burned? Is there soot on the inside of the victim's mouth or nose? All of these could signal possible future complications in the form of respiratory issues. Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock Pro Tip #2: Skin is the major organ that controls your body temperature. If we damage it from a burn, then pour cold or cool water over the body (burned area), the victim could become cold and start to shiver, hypothermia has now set in. Once the burn is cooled, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call. Chemical Burns You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet. When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool clean water. When dealing with wet chemicals, go right into rinsing them off using cool, clean water. Pro Tip #3: Dilution is the solution to pollution. When dealing with chemical burns, rinsing them off with cool, clean water will have a weakening effect, as the chemicals are diluted again and again with every dousing of clean water. Electrical Burns Electrical burn situations require an extra level of safety. Before anything, make sure the energy source has been removed before coming into contact with the patient. This could mean removing the patient from the energy source, cutting the power, or something else. You cannot risk becoming another patient at the scene. Pro Tip #4: There is a significant difference between electrical entry burn wounds and electrical exit burn wounds. Entry wounds look like typical thermal burns. But exit wounds may look more like shotgun exit wounds – huge, explosive, and damaging. Manage the entry wound the same as you would a thermal burn. Manage the exit wound as the situation requires, which will likely include treatment options for tissue damage and excessive bleeding. Warning: As electricity travels through the body it can affect the conductivity of the heart, which could potentially damage the conduction points in the heart and contribute to secondary cardiac issues. With electrical burns, monitoring for heart dysrhythmias for 24 to 72 hours in hospital might be necessary. A Word About Burn Victim Pediatric Considerations It's important to note that children have greater surface areas relative to their weights than adults. This can become a major factor when it comes to staying warm and hydrated. Victims with severe burns tend to lose a lot of water through evaporation and leaking from the burned area. This increases our concerns as it can lead to hypothermia and shock. Monitor the victim for signs of dehyration, shock or hypothermia. Immediately seek advanced medical intervention if any of these are seen. After Burn Care If the burn is minor, and the burning has been completely stopped, at-home treatment might be appropriate. The 2024 ECC Guidelines suggest petrolatum (with or without topical antibiotics such as polymyxin), honey, and aloe have been shown to improve healing time in certain burns. Over the counter pain medications may help with pain when used correctly. All treatment should be under the direction of your physician. https://d3imrogdy81qei.cloudfront.net/video_images/13034/burns-bls-2025.jpg Yes 345 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/quemaduras https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7187.mp4 Quemaduras https://d3imrogdy81qei.cloudfront.net/video_images/13034/burns-bls-2025.jpg Yes 345 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/cold-related-emergncies https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7188.mp4 Cold-Related Emergencies Cold-related emergencies are typically the result of cold temperatures combined with a lack of insulation or protective clothing to deal with those temperatures. How We Lose Heat   Radiation is the most significant and it involves the emission of infrared waves from the skin to cooler surroundings, similar to heat radiating from a stove. Convection contributes the next most heat loss and occurs when warm air or water around the body is replaced by cooler air or water, carrying heat away.  Think of how nice a strong breeze is on a hot day. Conduction is when there is direct contact with other objects. This is often a smaller concern, however, if your skin is in contact with a surface that absorbs heat easily like water, metal or cemet, conduction becomes a much larger concern.  Evaporation is responsible for another large portion of heat loss under normal conditions and becomes the only effective cooling mechanism when the environment is warmer than the skin.  It includes sweat evaporation and moisture loss from the lungs during breathing.    Pro Tip #1:> Protecting yourself from as many of the methods of heat loss as possible will ensure you stay as warm as you can.   Hypothermia begins to set in around the time the patient begins to shiver. And once the core body temperature drops below 95 degrees Fahrenheit, serious side effects ensue, including: Dizziness Delirium/confusion Lethargy Fatigue and weakness Loss of consciousness How to Treat for a Cold-Related Emergency If at any point someone starts showing signs of hypothermia or frostbite, call 911 immediately to activate EMS. Attempt to find warm shelter to keep the patient as comfortable and as warm as possible until help arrives. Monitor for airway, breathing, and circulation issues. If at any point, the patient becomes unresponsive, goes unconscious, or is not able to breathe normally. Then begin CPR. Treatment for hypothermia is a simple concept of just keeping them warm. It can become difficult in different situations though. This following list includes our priorities, but the order of when we conduct them may change based on the circumstances. Insulate the patient's body as best you can until help arrives. Move the patient to a warmer environment if possible. Remove any wet clothing and cover with blankets. Pro Tip #2: One of your best tools for helping you achieve number one above is a mylar blanket. They're common in first aid and emergency kits, and for good reason. They work by reflecting the heat of the patient and are big enough to cover most adults from head to toe. Warning: Wrapping a patient in a mylar blanket should be done gently using the steps below. You want to make sure not to agitate any frost-bitten extremities. Plus, cardiac arrest is also a concern. Aggressive movements can put the heart into a fatal rhythm. Using a Mylar Blanket Unwrap the blanket and tuck it around the patient as much as possible as this can help with both convection and radiation heat losses. For smaller patients, blankets could be placed under the mylar so long as the blanket is dry and the mylar fits completely over the victim and blankets. Pro Tip #3: The patient may be in a fetal position to try and stay warm. This can help decrease heat loss from radiation, convection and conduction. Leave them in this position if they are comfortable and you can continue to assist them in staying warm such as covering them with blankets. Seal the blanket as best you can, but leave room for the patient to breathe, as mylar isn't breathable material. Put another blanket or coat over the patient. Cover the feet and tuck it in around the patient as best you can, including the top of the head. Pro Tip #4: We lose a ton of heat through our feet, hands, and head, so make sure these areas are covered. Top and sides of head, not the face. Warning: Don't forget to protect yourself. When dealing with cold-related emergencies, you're likely putting yourself in the same environment that felled the patient. And since you're likely kneeling on cold pavement, in snow, and may be working with your gloves off for reasons of manual dexterity, pay extra care that you don't also become a victim.> Rewarming Body Parts in the Field A clinical setting is the preferred location for rewarming, so don't worry about it, especially considering that frozen parts that have been warmed could re-freeze causing additional injury. However, it pays to know that you should only rewarm using water between 99 and 104 degrees Fahrenheit. Higher temperatures could burn the patient, not to mention the pain involved. Rewarming is very painful, as the nerve endings begin to come back and the patient begins feeling again. Which is why a setting that can offer analgesics is the best option. Also, rubbing or massaging the frostbitten portion could cause further injury, so it is best to let the body part warm up on its own. Recognizing Frost Nip and Frost Bite The most common body parts to freeze first are the nose, cheeks, ears, feet, hands, and especially the ends of fingers and toes. When frost bitten, these parts will appear white, hard to the touch, and numb or nearly numb to the patient. A Word About Cold-Related Contributing Factors When it comes to cold-related emergencies, there are several contributing factors to be aware of, including the environment and the age of the patient. Anyone can develop hypothermia; however, the risk factors below could put people at higher risk. A cold environment. Though, even if the ambient temperature isn't that low, it can quickly be made worse if the patient isn't properly protected from the cold, including the use of inappropriate clothing. A wet environment. The presence of moisture – perspiration, rain, snow, etc. – will increase the speed at which body heat is lost. Wind. Wind makes the environment a lot colder than the temperature indicates. The higher the wind chill effect, the lower the actual temperature. Age. The very young and very old usually have a harder time staying warm in cold conditions. Body mass, or lack thereof, is one concern, as is their ability to think clearly when it comes to removing themselves from that environment or better protecting themselves with proper clothing. And in older adults, impaired circulation may also be a concern. Medical conditions. People with certain medical conditions, such as hypoglycemia, shock, and head injury, may be at higher risk of developing hypothermia. Drugs and alcohol. Alcohol and certain types of drugs can reduce a person's ability to feel the cold, or can impair judgment and impede rational thought, preventing the patient from taking proper precautions to stay warm. Trauma. If a person is injured and they are facing issues with hypothermia, both conditions may worsen much quicker. Injured victims must be kept as warm as possible. https://d3imrogdy81qei.cloudfront.net/video_images/13036/cold-related-emergencies-2025.jpg Yes 339 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/emergencias-relacionadas-frio-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7188.mp4 Emergencias relacionadas con el frío https://d3imrogdy81qei.cloudfront.net/video_images/13036/cold-related-emergencies-2025.jpg Yes 339 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/eye-injuries https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7189.mp4 Eye Injuries Injuries to the eye can involve the eyeball, the bone, and the soft tissue surrounding the eye. Blunt objects, like a fist or a baseball, can injure the eye and/or the surrounding area. Or a smaller object could penetrate the eyeball. Care for open and closed wounds around the eye as you would for any other soft tissue injury. In this lesson, when we talk about treating an eye injury, assume we're referring to treating an injury from an object. Near the end we'll present some information on the other type of eye injury – chemical injuries.> How to Assess and Treat Eye Injuries As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim. "Hi, my name's _____. I'm a paramedic. I'm going to help you." Once you've ensured that the patient isn't suffering with airway, breathing, or circulation issues, the first thing you want to do is assess what type of eye injury you're dealing with – object or chemical? Both are serious! Pro Tip #1: Eye injuries are serious and always warrant a trip to the ER, whether by calling 911 and activating EMS or by private vehicle. Therefore, the job of the responder is to stabilize the wound, stop the damage, and ready the patient for safe transport. Sequence of Treatment for Eye Injuries Sit the patient down and facing you if possible. Place a small cup over the injured eye to eliminate any more damage or pressure. Ask the victim to hold the cup in place. Pro Tip #2: If you don't have a medical grade cup, a Dixie cup is a suitable alternative. And smaller is better as you'll have tape over it. Using a gauze bandage, begin wrapping over the cup and injured eye, while asking the patient to let go of the cup.  Cover the victim's head two to three times. Tuck or tape the end of the gauze to hold it in place. Pro Tip #3: The injured person has impaired eye sight with one eye covered. Be sure to be extra communicative and always talk to them as you're helping them. Having an eye covered can be disorienting. Make sure the victim's good eye is free and clear of the bandage to prevent even further impairement. Perform a secondary survey as you do the above. Assess the patient for secondary issues, from head to toe. And as always, continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock. A Word About Chemical Eye Injuries This section will mirror the last lesson on the importance of, and strategies for, diluting chemical burns. Only with the eyes, and particularly the mucous membrane, damage can occur very quickly. Meaning your quick actions are essential. There are two types of chemical eye injuries – dry or wet. If you're dealing with dry chemicals, brush as much off the eye as you can before beginning to flush with a solution. If you're dealing with a wet chemical, go right into flushing the eye. Pro Tip #4: Ideally, you'll have a balanced pH solution for moments like this. Otherwise, use what you have access to – tap water, bottled water, etc. Flush the injured eye for at least 20 minutes. Your goal here is to stop the damage from the chemical. Warning: Always rinse from the inside of the eye to the outside of the eye. Flushing the eye the other way – from the outside in – could lead to cross-contamination of the other eye. While readying the patient for transport, and during your secondary survey, make sure the victim didn't get any chemicals into their mouth, nose, ears, etc. if they did, treat accordingly. Prevent Eye Injuries The single most effective measure for both chemical and foreign object injuries is wearing appropriate protective eyewear — ANSI-approved safety glasses or goggles have been shown to reduce workplace eye injuries by up to 90%. For environments involving chemicals, the CDC and OSHA recommend using sealed, indirect-vent goggles rather than standard safety glasses, since chemical splashes can travel around unprotected frames; additionally, knowing the location of the nearest eyewash station and flushing affected eyes with clean water for a minimum of 15–20 minutes is critical to minimizing damage after exposure. https://d3imrogdy81qei.cloudfront.net/video_images/13038/eye-injuries-2025.jpg Yes 230 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/lesiones-oculares-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7189.mp4 Lesiones oculares https://d3imrogdy81qei.cloudfront.net/video_images/13038/eye-injuries-2025.jpg Yes 230 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/poison-control https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7190.mp4 Poison Control Some of the most dangerous areas of any home, especially for young, curious children, are the places where poisons are stored, such as cleaning products and medications. Limiting access to these areas will always be key to preventing catastrophe. Luckily, there are numerous procedures and products that can easily help secure cupboards, drawers, and cabinets that house these dangers. A couple simple ways to better secure household poisons include: Store all medications and dangerous chemicals up high, so they're out of reach for small children Purchase commercial made locks at the hardware store Warning: It's important to understand how a colorful liquid chemical looks to a child. Those bright colors probably look like Kool-Aid, fruit punch, or the latest soda, and appear more delicious than dangerous. Chemicals don't have to be in liquid form to be tempting to children. Another common threat lately are the dishwasher and laundry cleaning pods that children routinely mistake as candy. However, children consuming poisons is just part of the problem. Kids also don't know the difference between consuming a medication that will help them feel better when they're sick and over-consuming that same medication – something that could hurt them or even kill them. Then add to this the fact that these medications are often flavored to taste good so that children will take them. Which is why medicine cabinets deserve the same amount of precaution as those cabinets where poisons are stored. How to Treat for Poisoning Is you suspect poisoning, the first thing to do is look for clues to corroborate that suspicion, such as: Are there pills scattered about? Are there empty pill bottles or packages around? Does the victim have burns or redness around the lips and mouth? Does the victim have unusual stains or odors, particularly breath that smells like gasoline or paint thinner? Is the victim exhibiting signs of drowsiness or mental confusion? Is the victim having difficulty breathing? Has the victim vomited? Pro Tip #1: First aid treatments for poisoning have changed a lot over the years. Which is why if you suspect poisoning you should call the Poison Control Hotline at 1-800-222-1222. Keep this phone number in a prominent location for quick and easy access. Poison Control will work with you to first help identify the poison in question. And then will guide you in providing treatment for that poison. Pro Tip #2: You may have heard to induce vomiting for poisonings. This is rarely true. One more reason to call poison control and get the proper treatment advice based on the poison that was ingested. Warning: If at any point, the patient goes unconscious or stops showing signs of life (moving, breathing normally, etc.), call 911 immediately and activate EMS. A Word About How Poison Enters the Body There are four categories of poisons based on how they enter the body – ingestion, inhalation, absorption, and injection. Ingestion This category is for all the poisons that can be swallowed – common food poisoning culprits like mushrooms and shellfish, recreational drugs, medications, alcohol, and household items like cleaning supplies. Young children are most at risk, as everything they see looks like it should go into their mouths immediately and often does. Older adults are also more at risk, mostly due to medication errors. Inhalation Inhaled poisons are those gases and fumes that are poisonous. The most common inhaled poison is carbon monoxide, as it's odorless, colorless, and tasteless. To further complicate matters, exposure can lead to death in mere minutes. Carbon monoxide comes from car exhaust, tobacco smoke, fires, and defective gas cooking and heating equipment, like furnaces and hot water heaters. Other less common culprits in this category include carbon dioxide, chlorine gas, ammonia, sulfur dioxide, nitrous oxide, chloroform, dry cleaning solvents, fire extinguisher gases, industrial gases, and hydrogen sulfide. Absorption Absorbed poisons can enter the body through the skin or mucous membranes in the eyes, nose, and mouth. Plants are the biggest offenders when it comes to absorbed poisons, and most of us have probably had a run-in with poison ivy once or twice. Chemicals in fertilizers and pesticides are also commonly absorbed poisons, as are topically applied medications. Injection Injected poisons do include those administered by hypodermic needle, such as recreational and medicinal drugs. But more times than not, instances of poisoning by injection are perpetrated through bites and stings. Poisonous snakes, insects, spiders, and marine life are abundant in certain countries, like Australia, while others like their neighbor New Zealand, can boast a total of zero poisonous animals. https://d3imrogdy81qei.cloudfront.net/video_images/13040/poison-control-2025.jpg Yes 175 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/control-envenenamiento-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7190.mp4 Control de envenenamiento https://d3imrogdy81qei.cloudfront.net/video_images/13040/poison-control-2025.jpg Yes 175 https://app.protrainings.com/courses/bls/healthcare/videos/special-considerations-for-cpr-aed-choking https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7191.mp4 Special Considerations for CPR, AED, and Choking Many questions come in related to special considerations for performing CPR, using AEDs, and applying choking skills, so we decided to take the most common of the bunch and share them with you. Along with our recommendations of how to treat different types of patients in light of these considerations. Special Considerations for CPR The three most common concerns we hear when it comes to performing CPR are: The size of the patient. The crunching sound and feeling when performing chest compressions. Impaled objects in the chest. The Size of the Patient This has more to do with the size discrepancy between rescuer and patient than the size of the patient alone. Sometimes, when performing chest compressions, a patient will require more weight than a rescuer can muster. If this happens, ensure you are in the correct position with correct body mechanics or try to recruit a bystander to assist you while you guide them along. Teaching an untrained rescuer how to perform chest compressions isn’t difficult and you can rest easy, knowing that you did everything you can! Crunching and Popping Sounds These sound worse than they usually are. These sounds and crunching feelings could be related to a traumatic injury. But more likely, it's just due to the separation of cartilage from the sternum, which also sounds worse than it is. It may also be ribs that break, especially in older victims. Keep in mind that you're not going to hurt the victim any more, as they are already dead. Anything that you do to help the victim is giving them another chance at life, don’t fear trying to help someone. Impaled Chest Objects The only way an impaled object would keep you from performing chest compressions is if the object were in the exact location. If that's the case, all you can do is call 911, keep the scene safe, and do whatever you can do to control bleeding or other issues. However, if you can, just work around the impaled object and perform compressions to the best of your ability. This situation could also arise when it comes to giving rescue breaths, should the patient have an impaled object in the mouth, face, or airway. Special Considerations for AEDs It's important to understand that to get better use from an AED, you may have to understand and use a few workarounds. And when it comes to using AEDs, these are the four most common concerns we hear. How to handle jewelry. How to handle patches. How to handle underwire bras. How to handle breast tissue that's in the way. Jewelry As the types of jewelry change over the years, questions concerning jewelry also change. When it comes to necklaces, these are easy to move out of the way; no need to take them off. However, with piercings, location matters. If the piercing is directly where a pad would go, or if it appears like it would interfere with the pathway of the electricity, remove the piercing first. Otherwise, piercings shouldn't pose any problems. Patches Nitro patches, pain relief patches, and other types of medication patches come off easily. So, if a patch is resting where an AED patch should go, remove it, wipe the area so it's dry, and apply the pad as normal. Underwire Bras While removing clothing to expose the chest is best, studies have shown that leaving a bra in place is okay when using an AED. If neededimply adjust the bra as needed to place the AED pads on bare skin under the bra straps. The under wires have shown little to no interference with the electricity. It is far better to leave the bra in place and use an AED, than not helping at all. Breast Tissue If you encounter breast tissue where an AED pad should go – likely the mid auxiliary rib cage – simply move it and apply the pad. The AED pad should be placed on the rib cage itself. When the pad is placed on breast tissue, the effectiveness of the AED is reduced.> Special Considerations for Choking The three most common concerns we hear with choking incidents are: What if the choking victim is too large? What if the choking victim is pregnant? What if the obstruction won't come out? The Patient is Too Large Again, we see where a discrepancy in size between rescuer and victim matters. If after the 5 back blows the victim is still choking, but the person you're trying to help is too large for you to get your arms around, enlist the help of a bystander, and like before, you can guide the bystander through the abdominal thrust technique. Otherwise, if there are no bystanders and it's just you, after the back blows, consider using the inward thrusts directly on the sternum instead, just as you would a pregnant woman. Tuck in your thumb, go under the breast, and onto the sternum. Thrust inward, rather than up and inward like you would with abdominal thrusts. Worst case scenario:Perform continuous back blows if you can’t perform the abdominal or chest thrusts. If you cannot remove the object, the victim will eventually pass out, so do not leave them. If you can, safely help them down to the ground, and then continue helping them by beginning chest compressions for an unconscious patient, which can be effective at clearing obstructions as well. The Patient is Pregnant A pregnant patient is really two patients – one primary patient (mother) and one secondary patient (baby). If you suspect a conscious choking female adult to be pregnant, avoid performing abdominal thrusts, as these can injure the uterus or baby. Instead, after the 5 back blows, perform inward thrusts on the sternum as is described above. The Obstruction Won't Come Out This isn't common, but it's scary when it happens. And most of the time, it could have easily been avoided. Certain gooey foods, like marshmallows, can act almost like glue if inhaled. Other items that pose unusual risks include mylar and latex. Coins are also particularly hazardous. If they are swallowed just right, they can act like a one-way valve in the larynx – one that opens with a compression and closes with a rescue breath. In the event of emergencies like this, where difficult obstructions won't come out, EMS personnel also have special tools to assist them, such as suction equipment and forceps that can reach down the throat. https://d3imrogdy81qei.cloudfront.net/video_images/13042/special-considerations-for-cpr-aed--choking-2025.jpg Yes 621 https://app.protrainings.com/courses/bls/healthcare/videos/consideraciones-especiales-RCP-DEA-asfixia-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7191.mp4 Consideraciones especiales para la RCP, DEA, y asfixia https://d3imrogdy81qei.cloudfront.net/video_images/13042/special-considerations-for-cpr-aed--choking-2025.jpg Yes 621 https://app.protrainings.com/courses/bls/healthcare/videos/child-aed https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7278.mp4 Child AED The methods of defibrillating a child are basically the same as defibrillating an adult. One important distinction involves AED pad size. AED pads come in an adult size and a pediatric size, for patients less than 8 years old or 55 pounds - roughly 25 kilograms. Pro Tip #1: If you do not have pediatric pads and the patient is less than 8 years old or 55 pounds, use the adult pads. It's far better to use the wrong size pads than it is to forgo using an AED. Warning: Remember that when using an AED, there are a couple of important things to keep in mind as it relates to your surroundings. Are there combustible gases or liquids at the scene? Are there any liquids that could connect the victim with yourself, the responder, or someone else, that could result in electrocution? If for some reason the scene isn't safe enough to use an AED, move the patient to a safer area where you won't have to worry about explosives or electrocution from water and then use the AED. Pro Tip #2: It's OK if the victim or the victim's clothing is wet, as long as the chest area is dry and you or the victim aren't submerged in water or connected by it. How to Provide Care As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive. Are you OK? Can you hear me? If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps. Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions. Check for breathing and a pulse. Use the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with your AED. AED Technique for Children Turn on the AED. Remove the patient's clothing to reveal a bare chest. Attach the AED pads to the patient's chest. The pads should have a diagram on placement if you need a reminder. The first pad goes on the top right side of the chest. The second pad goes on the bottom left side mid axillary, under the left breast. For small children, attach one AED pad to the center of the child’s chest, roll the child onto his or her side, and attach the second pad to the center of the back, between the shoulder blades.  Plug the cable into the AED and be sure no one is touching the patient, including yourself. The AED should now be analyzing the rhythm of the patient's heart. If it is a shockable rhythm, it will charge automatically and be ready to shock. If the scene is clear and no one is touching the patient, push the flashing shock button. Then go right into CPR. It's OK to perform CPR over the pads, so don't worry about moving them. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them. Consider the size of the child when doing compressions, use one hand for a smaller child and two hands to perform compressions on older children. It also depends on the size and strength of the rescuer if one or two hands are needed to supply the proper chest compressions. Conduct compressions that go 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second. Perform 30 chest compressions. If you have two rescuers, the compression to ventilation ratio is 15:2. Grab the rescue mask and seal it over the victim's face and nose. Lift the victim's chin and tilt his or her head back slightly. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath. After two minutes of CPR, the AED will analyze the patient’s heart rhythm again. If the AED advises you to perform another shock, make sure no one is touching the patient and press the shock button. Go right back into CPR. If the AED says no shock advised, immediately start CPR with compressions unless there are signs of life. Continue this cycle of CPR, re-analyzation, charging, shock, back into CPR until help arrives, the patient is responsive and breathing normally, or the next level of care takes over. A Word About Special AED Situations Some special considerations should be given when using an AED in certain situations. These include using an AED on a patient who has an implantable device and a patient who's suffering from hypothermia. Implantable Devices Implantable devices, like pacemakers, are sometimes located below one of the collarbones in the area where one of the AED pads should go. This can be problematic as the device could interfere with shock delivery. An ICD (Implantable Cardioverter-Defibrillator) is another common implantable device you may encounter. It's sort of like a mini version of an AED, as it detects abnormal heart rhythms and restores them to normal. If one of these devices is visible – a small lump can sometimes be seen or felt – or if you know the patient has one in a specific location, do not place the AED pad on top of it. Instead, adjust the placement of the pad to avoid the device, usually 1 inch away from the device is appropriate.  Hypothermia As already mentioned, patients who are wet pose no problems when using an AED, provided they are not submerged in water, water is not connecting the patient with the responder or anyone else, and the wet clothing is removed from the upper torso and the chest is dried off. Patients who are suffering from hypothermia do not require rewarming before using the device. However, you will want to handle them gently, as shaking them could result in V-fib. https://d3imrogdy81qei.cloudfront.net/video_images/13096/child-aed-bls-2025v2.jpg Yes 256 https://app.protrainings.com/courses/bls/healthcare/videos/dea-nino-es https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7278.mp4 DEA para niños https://d3imrogdy81qei.cloudfront.net/video_images/13096/child-aed-bls-2025v2.jpg Yes 256 https://app.protrainings.com/courses/bls/healthcare/videos/2025-guidelines-updates-bls-and-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7287.mp4 2025 Guidelines Updates - BLS and First Aid In this lesson, we're going to summarize and highlight the latest information from the 2025 American Heart Association Emergency Cardiovascular Care guidelines as they relate to Healthcare Provider CPR. Just like in previous updates, the goal of these guideline changes is simple: to improve the survival of our patients by improving early recognition, high-quality CPR, and early defibrillation. Despite decades of public education, bystander CPR and AED use uremain inconsistent, and outcomes for out-of-hospital cardiac arrest still depend heavily on what happens in the first few minutes. The 2025 ECC updates continue to emphasize that early action by healthcare providers is what truly saves lives. Many of the changes you'll see focus on improving CPR quality, reducing delays, and removing barriers that prevent people from stepping in to help. Initiation of Resuscitation for Adults The ECC continues to reinforce the importance of performing CPR with breaths. If a rescuer is not trained or does not have the ability to safely give breaths, hands-only CPR can be used, as providing compressions alone is still better than doing nothing at all. Whenever feasible, and without delaying chest compressions, CPR should be performed where the person is found, as long as high-quality CPR can be delivered safely and effectively. It's preferred that the patient be in the supine position — meaning on their back — on a firm surface, since firm surfaces improve compression depth and effectiveness. Delays caused by unnecessary movement of the patient are associated with worse outcomes. Chest compressions should be performed with the patient's torso positioned approximately at the level of the rescuer's knees. This positioning improves rescuer body mechanics and reduces fatigue. Rescuers may also consider placing their dominant hand on the sternum when performing compressions, which may further improve overall CPR quality. Pro Tip #1:The key takeaway here is don't delay chest compressions. High-quality CPR, including breaths, can significantly increase the chance of survival. When providing ventilations with a bag-mask device during adult cardiac arrest, it's reasonable for one rescuer to use two hands to open the airway and seal the mask, while a second rescuer squeezes the bag to improve ventilation effectiveness AED Use and Patient Dignity The 2025 guidelines re-emphasized an important barrier to public access defibrillation, particularly for women. Evidence suggests that the need to expose the chest may contribute to lower rates of AED use in female patients. While proper pad placement is always preferred, current evidence shows that successful defibrillation can still occur even when pad placement is not exactly perfect. Because of this, it is reasonable to apply AED pads directly to the skin by simply adjusting clothing or undergarments rather than removing them entirely, when appropriate. The priority remains rapid pad placement and early defibrillation, while maintaining patient dignity and reducing hesitation that can delay care. Mechanical CPR Devices In adult cardiac arrest, the use of a mechanical CPR device should only be considered in specific settings where delivering high-quality manual compressions may be challenging or dangerous. When mechanical CPR is used, rescuers must strictly limit interruptions in chest compressions during deployment and removal of the device. High-quality manual CPR should never be delayed while preparing or positioning a mechanical device. Foreign Body Airway Obstruction For conscious adults and children with severe foreign body airway obstruction, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive. This sequence reflects evidence suggesting that back blows may be more effective and cause fewer injuries than abdominal thrusts alone. In special circumstances — such as late-stage pregnancy or when abdominal thrusts are impractical — chest thrusts should be used instead. For infants, abdominal thrusts are still not recommended. Instead, back blows and chest thrusts continue to be used. Pro Tip #2: A key update in 2025 is that chest thrusts for infants should now be performed using the heel of one hand, placed in the center of the chest, rather than the previously recommended two-finger technique. This change is based on evidence showing improved compression depth and effectiveness during severe airway obstruction. Cardiac Arrest Following Drowning For adults and children in cardiac arrest following drowning, CPR with breaths should be started before AED application. Drowning-related cardiac arrest is typically hypoxic in nature, meaning oxygen deprivation is the primary issue. Early ventilations are critical, and applying an AED first may delay the initiation of effective CPR with breaths — especially since shockable rhythms are less common in drowning cases. Eye Injuries with an Embedded Foreign Object A small but important update: when caring for a person with a foreign object embedded in the eye, rescuers should now cover only the affected eye rather than both eyes. This change is intended to reduce anxiety in the patient by allowing them to maintain vision in the unaffected eye. The previous concept was that if you covered both eyes, then that would reduce the movement of the good and the injured eye. Data shows that with the increased anxiety and potential for further injury caused by the temporary blindness, it would be safe to just bandage the injured eye.  ProTip #3: Our goal is to prevent any further injury to the eyes. Protect the injured eye(s) from any excessive pressure with a shield or cup and seek immediate medical attention. Managing Shock When caring for a person showing signs of shock who remains alert, it is reasonable to place or maintain them on their back. If the person is at risk for airway obstruction — such as decreased alertness or active vomiting — or if they cannot be continuously monitored, it is reasonable to place them in the recovery position, on their side. While elevating the feet has been shown occasionally to help the patient, the effects are often short lasting only a few minutes. Pro Tip #4: In situations where there is no evidence of trauma or injury, such as fainting or dehydration, some studies suggest that raising the feet approximately 6 to 12 inches may still be beneficial. The priority remains placing the patient safely on the ground, keeping them warm, and monitoring for airway compromise or the need for CPR A Unified Chain of Survival The 2025 guidelines introduce a single, standardized Chain of Survival that now applies to infants, children, and adults. It excludes neonates, who follow a separate neonatal chain of survival. This unified approach emphasizes early recognition, early CPR, early defibrillation, and advanced care, as well as recovery as a continuous process across all age groups. CPR in Infants and Children In infants and children, studies consistently show that CPR with both compressions and breaths provides the best chance of survival. However, if providers are unable to give breaths to an infant or child in cardiac arrest due to safety concerns, compression-only CPR is reasonable. Large observational studies show that compression-only CPR is far better than no CPR at all, and significantly improves survival outcomes compared to no bystander intervention. A Word About Left Ventricular Assist Devices (LVADs) An LVAD, or left ventricular assist device, is a mechanical pump that is surgically implanted to help the heart's main pumping chamber — the left ventricle — circulate blood throughout the body. It is used for patients with end-stage heart failure. In unresponsive adults and children with durable LVADs, chest compressions should be performed when there are signs of impaired perfusion. The presence of an LVAD does not eliminate the need for CPR during cardiac arrest. Closing Thoughts The 2025 ECC CPR guideline updates continue to reinforce a simple but powerful message: early recognition, early CPR, and early defibrillation saves lives. These updates are designed to improve CPR quality, reduce delays, and remove the barriers that prevent rescuers from acting — whether that rescuer is a parent, a bystander, or a trained professional. Guidelines will continue to evolve as science advances, but the mission remains the same: recognize the emergency, take action, and do the best you can. CPR doesn't need to be perfect to save a life. Doing something is always better than doing nothing, and confident, informed rescuers make all the difference. https://d3imrogdy81qei.cloudfront.net/video_images/13116/2025-guidelines-updates-bls-and-first-aid.jpg Yes 472 https://app.protrainings.com/courses/bls/healthcare/videos/2025-guidelines-updates-bls-and-first-aid-ES https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7287.mp4 Actualizaciones de las Guías 2025: Soporte Vital Básico y Primeros Auxilios https://d3imrogdy81qei.cloudfront.net/video_images/13116/2025-guidelines-updates-bls-and-first-aid.jpg Yes 472 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/2025-guidelines-update-for-cpr-and-first-aid-adults https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7288.mp4 2025 Guidelines Update for CPR and First Aid for Adults In this lesson, we'll go over the most important updates from the 2025 American Heart Association Emergency Cardiovascular Care guidelines for lay rescuers — that means everyday people like you who may need to help in an emergency. The goal of these updates is simple: help more people survive cardiac arrest by acting fast. When someone's heart stops, every second counts. The 2025 guidelines focus on making CPR easier to do, reducing delays, and encouraging more people to step in and help. Starting CPR in Adults When an adult collapses and is unresponsive, the most important thing you can do is start CPR right away. If you know how to give rescue breaths, you should give both compressions and breaths. But if you're not comfortable giving breaths, don't let that stop you — hands-only CPR is still much better than doing nothing at all. Start CPR where the person is. Moving them wastes valuable time. Lay them on their back on a hard, flat surface — a firm surface helps your compressions work better. Try to kneel beside them so their chest is about level with your knees, as this helps you push down with the right amount of force. You can also try placing the hand closest to their head on the center of their chest first, as this may help improve the quality of your compressions. Pro Tip #1:Don't wait. Don't move them unless you absolutely have to. Just get down and start compressions as soon as possible. Using an AED on Female Patients An AED, or automated external defibrillator, is a device that can reset the heart with an electric shock. One barrier that has been identified is that people sometimes hesitate to use an AED on a woman because they feel uncomfortable exposing her chest. The 2025 guidelines want to clear this up: you do not need to fully remove clothing to use an AED. Simply move clothing or undergarments aside to place the pads directly on the skin. The pads don't have to be in the perfect spot to work. Getting the AED on quickly and delivering a shock is what matters most. Always prioritize speed while being respectful of the patient's dignity. Helping Someone Who Is Choking If an adult is conscious and choking — meaning something is stuck in their airway and they cannot breathe, cough, or speak — here is what to do. Give 5 firm back blows between the shoulder blades, then follow with 5 abdominal thrusts. Keep repeating this cycle until the object comes out or the person goes unconscious. Research shows that back blows can be more effective and safer than abdominal thrusts alone, which is why this combination approach is now recommended. If the person is pregnant or if abdominal thrusts are not possible for any reason, use chest thrusts instead. Cardiac Arrest After Drowning If someone has gone into cardiac arrest after drowning, start CPR with breaths before reaching for an AED. Drowning cuts off oxygen to the body, so getting air into the lungs is the first priority. An AED is less likely to help initially in these cases because the heart rhythm involved in drowning emergencies is usually not one that can be shocked back to normal. Eye Injuries with an Embedded Object If something is stuck in a person's eye, cover only the injured eye — not both. Covering both eyes can make the person feel panicked and disoriented. Keeping the uninjured eye uncovered helps them stay calm and aware of what's happening around them, while still preventing further injury to the injured eye. Caring for Someone in Shock If someone is showing signs of shock — such as pale or clammy skin, weakness, or dizziness — but is still awake and alert, have them lie flat on their back. If they seem drowsy, are vomiting, or you can't keep a close eye on them, roll them onto their side instead. This is called the recovery position, and it helps keep their airway clear. Pro Tip #2: If the person fainted or is dehydrated but has no injuries, some studies suggest that gently raising their feet 6 to 12 inches may help in the short term to improve blood flow. This is not always recommended, but it may be worth trying in the right situation. Just keep in mind that our priority should be keeping them warm, on the ground and making sure to keep their airway clear and monitor for CPR if needed. A Unified Chain of Survival The 2025 guidelines now use one Chain of Survival for everyone — infants, children, and adults. Think of it as a step-by-step path to survival: recognize the emergency, call for help, start CPR, use an AED, and keep going until professional help arrives. Each link in that chain matters, and you are one of those links. Closing Thoughts The message behind all of these updates is simple: act fast, do your best, and don't be afraid to help. You don't have to be a medical professional to save a life. CPR doesn't have to be perfect — it just has to happen. The more confident and informed you are, the more of a difference you can make. https://d3imrogdy81qei.cloudfront.net/video_images/13118/2025-guidelines-update-for-cpr.jpg Yes 356 https://app.protrainings.com/courses/cpr-first-aid/adults/videos/2025-guidelines-update-for-cpr-and-first-aid-adults-ES https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7288.mp4 Actualizaciones de las Guías 2025: RCP en Adultos y Primeros Auxilios https://d3imrogdy81qei.cloudfront.net/video_images/13118/2025-guidelines-update-for-cpr.jpg Yes 356 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/2025-guidelines-update-for-cpr-and-first-aid https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7289.mp4 2025 Guidelines Update for CPR and First Aid for All Ages In this lesson, we're going to summarize the latest information from the 2025 American Heart Association Emergency Cardiovascular Care guidelines as they relate to lay rescuer CPR. The goal of these guideline changes is simple: improve survival by improving early recognition, high-quality CPR, and early defibrillation. For out-of-hospital cardiac arrest, survival rates depend heavily on what happens in the first few minutes. The 2025 ECC updates continue to emphasize that early action by lay rescuers is what saves lives. Many of the changes you'll see focus on improving CPR quality, reducing delays, and removing the barriers that prevent people from stepping in to help. Initiation of Resuscitation for Adults The ECC continues to reinforce the importance of CPR with breaths in adult cardiac arrest. For trained rescuers who are able to provide ventilations safely, compressions and breaths should be delivered together. If a rescuer is not trained or does not have the ability to give breaths, hands-only CPR can be used, as providing compressions alone is far better than doing nothing at all. Whenever feasible, and without delaying chest compressions, CPR should be performed where the person is found, as long as high-quality CPR can be delivered safely and effectively. It's preferred that the patient be on their back, on a firm surface, since firm surfaces improve compression depth and effectiveness. Delays caused by unnecessary movement of the patient are associated with worse outcomes. When possible, chest compressions should be performed with the patient's torso positioned approximately at the level of the rescuer's knees to allow better body mechanics and improved compression depth. Rescuers may also consider placing their dominant hand on the sternum when performing compressions, which may further improve overall CPR quality. Pro Tip #1: The key takeaway is this: don't delay chest compressions. If high-quality CPR can be delivered safely where the patient is found, begin it immediately. This was re-emphasized to include the giving of breaths for high-quality CPR. AED Use and Patient Dignity AEDs have become more widely available and continue to prove their effectiveness everyday. However, statistically, women have a much lower rate of AED use than men. So while the 2025 guidelines address the importance of early AED use, the emphasis was particularly for women. Evidence suggests that the need to expose the chest may contribute to lower rates of AED use in female patients. While proper pad placement is always preferred, current evidence shows that successful defibrillation can still occur even when pad placement is not perfect. What this means is rather than the need to remove all clothing from the chest, it's reasonable to just adjust the clothing and apply AED pads under clothing, directly to the skin.> Pro Tip #2: If needed, rather than removing all clothing from the chest, simply adjust clothing, including bras, to have appropriate pad placement on the skin. This has been shown to be safe and effective Foreign Body Airway Obstruction In conscious adults and children with severe foreign body airway obstruction, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive. Ironically, the back blows are something that was taught years ago. However, this sequence reflects evidence suggesting that back blows may be more effective and cause fewer injuries than abdominal thrusts alone. Remember, for patients in late-stage pregnancy or the rescuer cannot reach their arms around the victim’s waist, chest thrusts should be used instead.  Pro Tip #3: A key update in 2025 is that chest thrusts for infants should now be performed using the heel of one hand, placed in the center of the chest, rather than the previously recommended two-finger technique. This change is based on evidence showing improved compression depth and effectiveness during severe airway obstruction.   Cardiac Arrest Following Drowning When an adult or child is rescued from the water and unconscious and not breathing, CPR with breaths should be started before AED application. Further, if you are in a position that full CPR cannot be started, just performing breaths can still be helpful. This is due to drowning-related cardiac arrest being caused by low oxygen levels. So the idea here is that If we apply the AED immediately without providing ventilations, we still have not addressed the cause of the cardiac arrest. If we delay the application of the AED for a short amount of time, we can provide the needed oxygen back into the victim to stabilize the underlying issue in the first place. Then, when applying and using an AED, resetting the heart should be more effective. Eye Injuries with an Embedded Foreign Object A small but important update: when caring for a person with a foreign object embedded in the eye, rescuers should now cover only the affected eye rather than both eyes. This change is intended to reduce anxiety in the patient by allowing them to maintain vision in the unaffected eye. The previous concept was that if you covered both eyes, then that would reduce the movement of the good and the injured eye. Data is showing that with the increased anxiety and potential for further injury caused by the temporary blindness, it would be safe to just bandage the injured eye.  ProTip #4: Our goal is to prevent any further injury to the eyes. Protect the injured eye(s) from any excessive pressure with a shield or cup and seek immediate medical attention. Managing Shock When caring for a person showing signs of shock who remains alert, it is reasonable to place or maintain them on their back. If the person is at risk for airway obstruction — such as decreased alertness or active vomiting — or if they cannot be continuously monitored, it is reasonable to place them in the recovery position, on their side. While elevating the feet has been shown occasionally to help the patient, the effects are often short lasting only a few minutes. Pro Tip #5: In situations where there is no evidence of trauma or injury, such as fainting or dehydration, some studies suggest that raising the feet approximately 6 to 12 inches may still be beneficial. Though our main focus is getting the patient safely to the ground, keeping them warm and monitoring them for airway concerns, such as vomiting, or the need for CPR. A Unified Chain of Survival The 2025 guidelines introduce a single, standardized Chain of Survival that now applies to infants, children, and adults. This unified approach emphasizes early recognition, early CPR, early defibrillation, advanced care, and recovery as a continuous process across all age groups. CPR in Infants and Children In infants and children, studies consistently show that CPR with both compressions and breaths provides the best chance of survival. However, if a lay rescuer is unable or unwilling to provide breaths to an infant or child in cardiac arrest, compression-only CPR is still reasonable. Large observational studies show that compression-only CPR is far better than providing no CPR at all, and significantly improves survival outcomes compared to no bystander intervention. Lastly, further evidence shows that using 2 fingers for infant chest compressions or chest thrusts are minimally effective. Therefore, the ECC has eliminated the use of two-fingers and recommends using a two-thumb hand encircling technique or the heel of one hand. You will see further demonstrations of both techniques throughout the course. Closing Thoughts The 2025 ECC CPR guideline updates continue to reinforce a simple but powerful message: early recognition, early CPR, and early defibrillation save lives. These updates are designed to improve CPR quality, reduce delays, and remove the barriers that prevent rescuers from acting — whether that rescuer is a parent, a bystander, or a trained professional. Guidelines will continue to evolve as new science emerges, but the mission remains the same: recognize the emergency, take action, and do the best you can. CPR doesn't need to be perfect to save a life. Doing something is always better than doing nothing, and confident, informed rescuers make a measurable difference. https://d3imrogdy81qei.cloudfront.net/video_images/13120/2025-guidelines-update-for-cpr-and-first-aid.jpg Yes 458 https://app.protrainings.com/courses/cpr-first-aid/all-ages/videos/2025-guidelines-update-for-cpr-and-first-aid-ES https://d3imrogdy81qei.cloudfront.net/videos/course_videos/es/7289.mp4 Actualización de las Guías 2025 - RCP y primeros auxilios https://d3imrogdy81qei.cloudfront.net/video_images/13120/2025-guidelines-update-for-cpr-and-first-aid.jpg Yes 458 https://app.protrainings.com/courses/anaphylaxis/videos/adrenaline-nasal-spray-for-anaphylaxis-usa https://d3imrogdy81qei.cloudfront.net/videos/course_videos/en/7433.mp4 Adrenaline Nasal Spray for Anaphylaxis FDA Approves the First Needle-Free Adrenaline Nasal Spray for Anaphylaxis The U.S. Food and Drug Administration (FDA) has approved a major new development in the treatment of severe allergic reactions. For the first time in the US, a needle-free adrenaline nasal spray has been authorised for emergency use in cases of anaphylaxis — a sudden, severe, and potentially life-threatening allergic reaction. A New Alternative to Traditional Adrenaline Auto-Injectors Until now, adrenaline for anaphylaxis has always been delivered by injection, typically using auto-injectors such as the EpiPen. These devices are highly effective, but for some people — particularly those with a strong fear of needles or who struggle to administer an injection during a crisis — they can present challenges. The newly approved nasal spray provides a needle-free, single-dose, ready-to-use alternative. Administered through the nostril, the spray delivers adrenaline rapidly into the bloodstream via the nasal mucosa. Who Can Use It? The spray is approved for: Adolescents and adults weighing 66 lbs or more Children weighing 33 lbs or more (typically around 4 years old and above) It is available in two dose sizes: 1 mg for children weighing 33 to 65 lbs 2 mg for adolescents and adults weighing 66 lbs or more Nasal Spray vs Adrenaline Auto-Injectors The MHRA has emphasised that this new nasal spray does not replace traditional adrenaline auto-injectors. Adrenaline pens remain vital, effective, and life-saving tools. Anyone who currently carries an auto-injector must continue to do so. Instead, the nasal spray adds an additional safe and effective option — particularly helpful for situations where injections are difficult, delayed, or distressing. Key Points to Know The spray can be used even if the casualty has a blocked or congested nose. People at risk of anaphylaxis should always carry two doses, regardless of whether they use a spray or an auto-injector. Each device contains a single dose and is designed for use in the nose only. The spray should be used immediately at the first signs of anaphylaxis. If symptoms continue or worsen, a second dose may be given starting five minutes after the first dose, using a new device and, if possible, the same nostril. Family members, friends, colleagues, and teachers should know how to recognize anaphylaxis and administer treatment. Emergency medical help should always be sought after administering adrenaline. FDA Approval and Safety The decision follows a detailed review of clinical evidence showing that the nasal spray delivers adrenaline safely and effectively. This innovation marks an important advancement, making emergency treatment more accessible and user-friendly for people living with severe allergies. What to Do in Suspected Anaphylaxis Regardless of the type of adrenaline used, the priorities remain unchanged: Recognise the symptoms quickly Administer adrenaline without delay Call 911 immediately Continue to monitor and support the casualty until emergency help arrives This new needle-free adrenaline spray represents a significant step forward in emergency allergy treatment — offering greater choice, improved accessibility, and a potentially easier way to deliver life-saving care when every second counts. https://d3imrogdy81qei.cloudfront.net/video_images/13446/adrenaline-nasal-spray-for-anaphylaxis-usa.jpg Yes 202