APPLICATIONOFPOCKETMASK

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Maskconnectionportwithone-wayvalve

Exhalationport

Maskport

Filter

Module 10 APPLICATION OF POCKET MASK

Thepocketmaskisabarrierdeviceusedtoproviderescuebreathing.Ithasaone-wayvalvethatpreventsexchangeofsecretionsbetweenthevictimandrescuer.Itismadeoffirmplasticwithacushionedrimandisroughlytriangularinshape.Therimcreatesaflexiblesealaroundthevictim’snoseandmouth.Themaskfitsoverthevictim’smouthandnose.Thenarrowestportionofthemaskisplacedoverthebridgeofthevictim’snose.

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APPLICATION

STEP 1

• Checkthatfilter(ifincluded)issnappedfirmlyinplace.

STEP 3

• Attachone-wayvalvetomaskport.

• Directexhalationportawayfrom‘nose’endofmask.

STEP 2

• Pushoutthedome.

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Note:Ifvictimvomits,removemaskandclearvictim’sairway.Clearmaskassemblybyshakingorsweepingoutforeignmaterial.Blowthroughvalvetoverifyoperation.Re-applymasktovictimandcontinueventilation.

STEP 6

• Removeyourmouthandallowvictimtoexhale.

STEP 5

• Sealasillustrated.• Opentheairwayby

performingagentleheadtilt-chinlift.

• Blowslowlyuntilchestrises.

STEP 4

• Applytherimofthemaskfirstbetweenthevictim’slowerlipandchin.Thiswillretractthelowerlipandkeepthemouthopenunderthemask.

• Positionendmarked‘nose’overthevictim’snose.

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SUMMARYCHECKLIST

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Module 11 SUMMARY ChECKLIST

ADULT ONE-MAN CPR

STEPS ACTION

D : Danger Lookoutforunsafeenvironment,e.g.Electricalcurrent,Fire,PossibleExplosion,Constructionworks,orPoisonousgas• Ensurethatthesceneissafeforyoutohelp

R : Response Establishunresponsiveness• Call,taporgentlyshakethevictim• Calloutloudly:“Hello!Hello!AreyouOK?”

S : ShoutforHelp • Ifnoresponse,Callforambulance995&AED

A : Airway Openairway:HeadTilt-ChinLift

B : Breathing Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)LookfortheriseandfallofthechestListenforairescapingduringexhalationFeelfortheflowofairfromthevictim’smouthandnosemovingpastyourcheeks

C : Circulation Checkforpulseupto10seconds(onlyforHealthcareproviders)Ifnopulseandbreathing,startCPRForlaypersons,thereisnoneedtocheckforpulse.Ifvictimhasnobreathing,startCPR• Locatethelandmarkforchestcompression• Properbodyandhandposition• Compressverticallyatleast5cmdownwardswithcompleterelaxation

ofpressureaftereachcompressionatrateofatleast100perminute• Saymnemonic “1&2&3&4&5&1&2&3&4&10&1&2&3&4&151&2&3&4&20 1&2&3&4&251&2&3&4&30”

CPRCycle • Perform30chestcompressionsfollowedby2breaths• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween400-600ml/breath• Allowlungdeflationbetweeneachbreath

Reassessment • Assessthevictimforpulseandbreathingafterevery5cyclesof30:2(forhealthcareprovidersonly)

• Ifpulseisabsent(ifunsureofpulseandvictimhasNobreathing,assumecardiacarrest),continue30:2

• Forlaypersons,continueperformingCPRuntilhelparrivesorvictimstartsmoving

RecoveryPosition

Placethevictimintherecoverypositionif:• Pulseandbreathingarepresent• Victimisunconsciousandhasnoevidenceoftrauma• Continuetomonitorvictim’spulseandbreathingeveryfewminutesas

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ADULT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS – UNCONSCIOUS)

STEPS ACTION

Conscious victim Ask:“Areyouchoking?”Victimacknowledgesbynodding.Rescuerreplies:“Icanhelp.”Assessment

HeimlichManoeuvreTechnique(NormalSize)

Standbehindthevictim.Positiononefootbetweenthevictim’slegsLocatethelandmark:• Placeyourarmsaroundthevictim’sabdomenandlocatethenavel• Withonehandplace2fingersjustabovethenavel• Makeafistwiththeotherhand• Placethumb-sideofthefistagainsttheabdomenabovethe2fingers• Releasethe2fingersbutmaintainthefistontheabdomen• Leanthevictimforwardandgraspthefistwiththeotherhand• Givesuccessiveinward-upwardthrusts• Checkifforeignbodyisexpelledaftereverysetof5abdominalthrusts• Repeatthrustsuntiltheforeignbodyisdislodgedorthevictimbecomes

unconscious

ChestThrustTechnique(Pregnant&Obese)

Standbehindthevictim.Positiononefootbetweenthevictim’slegsLocatethelandmark:• Placearmsunderthevictim’sarmpitstoencirclethechest• Makeafistwithonehand• Placethumb-sideoffistonthemiddleofthevictim’sbreastbone• Graspthefistwiththeotherhandandgivesuccessivequickbackwardthrusts• Checkifforeignbodyisexpelledaftereverysetof5chestthrusts• Repeatthrustsuntiltheforeignbodyisdislodgedorthevictimbecomes

unconscious

Unconscious victim

Whenvictimbecomesunconscious.Proceedwiththefollowingsteps:• Positionthevictimonafirm,flatsurface• Callforambulance995

• Start30chestcompressions(Thelandmark&techniqueisthesameasforadultCPR)

• Openairway:HeadTilt-ChinLift• Checkairwayandremoveanyobviousforeignbodies

• Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)• Ifbreathingisabsent,attempttoventilate(1stattempt)• Ifairwayisstillblocked,re-positionthevictim’sheadandreattempttoventilate• Attempt2ndventilation• Ifairwayisstillblocked,perform30chestcompressions• Proceedtoheadtilt-chintiltandcheckforforeignbody• RepeatSteptillhelparrivesorabletogive2successfulventilations

• Checkpulse(forhealthcareprovidersonly)andbreathingonceairwayiscleared.• Ifpulseisabsent(ifunsureofpulseandvictimhasnobreathing,assumecardiac

arrest),continueCPR30:2

RecoveryPosition Placevictimintherecoverypositionif:• Pulseandbreathingarepresent• Continuetomonitorvictim’spulseandbreathingeveryfewminutesasthiscan

stopsuddenly

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INFANT CPR

STEPS ACTION

D : Danger Lookoutforunsafeenvironment,e.g.Electricalcurrent,Fire,PossibleExplosion,Constructionworks,orPoisonousgas• Ensurethatthesceneissafeforyoutohelp

R : Response Establishunresponsiveness:• Call,taporgentlyshaketheinfant’sshouldertoelicitresponse• Ifyouarealone,immediatelystartCPR30:2forapprox.2minutes

S : ShoutforHelp • Ifasecondrescuerispresent,askhimorhertocallforambulance995

A : Airway Openairway:HeadTilt-ChinLift

B : Breathing Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)LookfortheriseandfallofthechestListenforairescapingduringexhalationFeelfortheflowofairfromtheinfant’smouthandnosemovingpastyourcheeks

C : Circulation Checkforbrachialpulseupto10seconds(onlyforHealthcareproviders)Ifpulseisabsent(ifunsureofpulseandinfanthasnobreathing,assumecardiacarrest),start30:2Forlaypersons,thereisnoneedtocheckforpulse.Ifinfanthasnobreathing,startCPRLocatelandmarkforchestcompression:• Drawanimaginarylinebetweennipples• Placeindexfingerontheimaginaryline• Placeyourmiddleandringfingersnexttotheindexfinger• Movethe3fingerstothecentreofthesternum(breastbone)• Positionthefingersupright• Liftofftheindexfingerbutmaintainthemiddleandringfingerscontactonthe

sternum(breastbone)• Leanforwardandplaceyourcheekneartheinfant’smouthandnose• Useyourmiddleandringfingerstocompressthesternum(breastbone)by4cm

DemonstratecorrecttechniqueofcompressionKeepfingerscontactonthesternumduringeachupstrokeSaymnemonic“1&2&3&4&5&1&2&3&4&10&1&2&3&4&151&2&3&4&201&2&3&4&251&2&3&4&30”Compressionrateisatleast100perminute

CPRCycle • Perform5cyclesof30chestcompressionsfollowedby2breathsforapproximately2minutes(ForHealthcareprovidersonly)

• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween30ml/breath• Allowlungdeflationbetweeneachbreath

Reassessment • Assessforpulseandbreathingafterevery5cyclesofCPR30:2(forhealthcareprovidersonly)

• Ifpulseisabsent(ifunsureofpulseandinfantisnotbreathing,assumecardiacarrest),continueCPR30:2

• Forlaypersons,continueperformingCPRuntilhelparrivesorinfantstartsmoving

RecoveryPosition • RecoveryPositionPlacetheinfantintherecoverypositionif:• Pulseandbreathingarepresent• Infantisunconsciousandhasnoevidenceoftrauma• Continuetomonitorinfant’spulse&breathingeveryfewminutesasthiscanstop

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INFANT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS – UNCONSCIOUS)

STEPS ACTION

Conscious infant Assessforsignsofcompleteairwayobstruction(choking)Ifinfantischoking,attempttoAssessmentrelievetheairwayobstructionimmediatelyAssessment

Backblows&Chestthrusts

Supporttheinfant’sheadandbodybetweenyourhandsandforearmsusingthe“SandwichManoeuvre”• Holdtheinfant’sfacedownandrestyourforearmonyourthigh• Keeptheheadlowerthanthetrunk• Deliver5backblowsforcefullybetweentheshoulderbladeswiththeheelofyour

otherhand• Supporttheinfant’sheadandbodybetweenyourhandsandforearmsafter

deliveringthe5backblows• Turntheinfantoveronhis/herback,restingonyourthigh• Keeptheheadlowerthanthetrunk• Deliver5chestthrustsoverthelowerhalfofthesternum(breastbone)bycounting

aloud‘1,2,3,4,5’.(landmarkforchestthrustisthesameasforinfantCPR)

Reassessment Checkifforeignbodyisexpelledaftereverysetof5backblowsand5chestthrustsandremoveifitisvisible• Iftheforeignbodyisexpelledsuccessfully,assesstheinfantforpulse&breathing• Iftheairwayremainsobstructedandtheinfantisconscious,repeatthesequence

of5backblowsand5chestthrustsuntiltheforeignbodyisexpelledortheinfantbecomesunconscious

Unconscious infant

Wheninfantbecomesunconscious.Proceedwiththefollowingsteps:• Positiontheinfantonafirm,flatsurface• Callforambulance995ifasecondrescuerisavailable

• Start30chestcompressions(Thelandmark&techniqueisthesameasforInfantCPR)

• Openairway:HeadTilt-ChinLift• Checkairwayandremoveanyobviousforeignbodies

• Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)• Ifbreathingisabsent,attempttoventilate(1stattempt)• Ifairwayisstillblocked,re-positiontheinfant’sheadandreattempttoventilate• Attempt2ndventilation• Ifairwayisstillblocked,perform30chestcompressions• Proceedtoheadtilt-chintiltandcheckforforeignbody• RepeatSteptillhelparrivesorabletogive2successfulventilations

• Checkpulse(forhealthcareprovidersonly)andbreathingonceairwayiscleared.• Ifpulseisabsent(ifunsureofpulseandinfanthasnobreathing,assumecardiac

arrest),continueCPR30:2

RecoveryPosition Placetheinfantintherecoverypositionif:• Pulseandbreathingarepresent• Continuetomonitorinfant’spulseandbreathingeveryfewminutesasthiscan

stopsuddenly• ActivateEMSifitisnotdoneearlier

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SingaporeGeneralHospitalInstitute for Medical Simulation & Education167JalanBukitMerah,ConnectionOneTower5,#03-10,Singapore150167Tel : 6326 6885 / 6326 6884 /63213651Fax : 68780495Email :imse@sgh.com.sg