BLS for Health Care Providers Course Study Cards

To minimize interruptions in chest compressions, what should Valerie do during the AED analysis and shock?

Hover over the patient's chest, ensuring that she is not touching the patient.

Assess

-perform visual survey -check for responsiveness -simultaneously check for breathing and pulse -determine the need for additional resources (if you see life-threatening bleeding, immediately use any available resources to control the hemorrhage, including a tourniquet or hemostatic dressing if one is available

You demonstrate high-quality CPR by keeping interruptions in CPR to less than _____ seconds.

10 seconds

Now that your hands are positioned correctly, where should you place them on the patient's torso?

The correct hand position to perform chest compressions is the center of the patient's chest on the lower half of the sternum.

While orienting a new medical assistant to the facility, you find a patient who is unresponsive in the exam room. You yell to the medical assistant, "Go get the AED!" Which response by the medical assistant demonstrates closed-loop communication?

"I'll go get the AED."

an adult patient who has collapsed is unresponsive. When conducting a rapid assessment of the patient, you simultaneously check breathing and a carotid pulse for at least 5 seconds, but no more than

10 seconds

How many back blows should you perform on a responsive choking infant?

- 5 ------------ Perform 5 firm back blows, with each one separate from the others. If back blows do not dislodge the object, try chest thrusts.

What is the correct volume of air to deliver during BVM ventilations?

- 700 mL -------------------------- That's right. When using the bag-valve-mask resuscitator, depress the bag about halfway to deliver a volume of 400 to 700 mL.

A well-organized team response when performing high-quality CPR includes ensuring that providers switch off performing compressions every _____ minutes.

2

Proper spill cleanup procedures:

If a spill occurs, appropriate measures should be taken to limit and reduce exposure to possible contaminants.

Switch positions every 2 minutes

When providing CPR with multiple providers, smoothly switch positions about every 2 minutes. This should take less than 10 seconds. The compressor calls for a position change by saying "switch" in place of the number 1 in the compression cycle.

You are providing high-quality CPR on a 6-year-old patient who weighs 44 pounds. The AED arrives. It does not have a pediatric setting and includes only adult AED pads. What should you do?

Use the adult AED pads.

What is the correct way to perform back blows?

Using the heel of your hand, firmly strike between the scapulae.

Duty to Act

the duty to respond to an emergency and provide care. Failure to fulfill these duties could result in legal action

receiver

the person for whom the message is intended

Mr. Goodman is unresponsive. Valerie must now simultaneously check for breathing and a pulse for no more than ___.

- 10 ---------------------- Yes, that's correct. When checking for a pulse and breathing, assess the patient for no more than 10 seconds.

Stephanie properly opened the airway and delivered ventilations. Which statement about delivering ventilations to an infant in cardiac arrest is true?

When using a BVM, depress the bag about halfway to make the chest begin to rise

When drowning is suspected as the cause of cardiac arrest in a child or infant, deliver 2 initial ventilations before starting CPR. You may also consider delivering 2 initial ventilations before starting CPR on a child or infant with a primary respiratory etiology. True or False?

- True

You and another provider have recognized that an adult patient is in cardiac arrest. An advanced airway is not in place. Which actions demonstrate appropriate care?

-Begin CPR immediately after identifying cardiac arrest. -You use a compression-to-ventilation ratio of 30:2.

Dr. Dave performed chest compressions at the proper depth. What is the correct chest compression depth for an infant?

- 1.5 inches ------------- That's right. The correct chest compression depth for Olivia is about 1½ inches. The correct rate of compressions is 100 to 120 per minute.

You and another provider are performing CPR on an infant who is in cardiac arrest. He does not have an advanced airway in place. You demonstrate appropriate technique for high-quality CPR by performing _____ compressions and 2 ventilations.

- 15 compressions and 2 ventilations.

Reassess and Document

-After providing care, it is important to reassess the patient and the effectiveness of your interventions to determine next steps based on your findings. -Always document to establish a record of the events that took place, the care you provided and the facts you discovered.

You enter your patient's room and find them lying supine in bed seemingly unresponsive. After assessing breathing and pulse for no more than 10 seconds and determining the patient is in cardiac arrest, when should you start CPR?

- Immediately ---------- That's right. After assessing breathing and pulse for no more than 10 seconds and determining the patient is in cardiac arrest, start CPR immediately and use an AED when it is available.

A child is unresponsive and not breathing. You and another provider are present. You stay with the child to begin CPR. Which actions would be appropriate for the second provider to do?

-Retrieve the AED and BVM. -Activate EMS or the resuscitation team

Assess, Recognize and Care

The concept of Assess, Recognize and Care is a systematic, continuous approach for rapid assessment, accurate recognition, and immediate care in emergency situations. Because an acutely ill patient's condition can change rapidly (for better or for worse), you must continuously assess the patient, recognize what is happening with the patient and provide care accordingly.

Battery

The unlawful, harmful or offensive touching of a patient without the patient's consent.

You initiate CPR on a 12-month-old male patient. Which BLS guideline should you follow?

child

How long should Jamal wait before administering the second dose of naloxone?

- 2 to 3 minutes ----------------- No, that's incorrect. Jamal should wait 2 to 3 minutes before administering the second dose. Jamal may repeat the dose every 2 to 3 minutes if Liz does not respond.

When performing abdominal thrusts, you should perform quick, inward and ______ thrusts.

- "upward" ---------------------- Perform quick inward and upward abdominal thrusts in order to ensure they are most effective.

What is the correct rate of ventilation delivery for a child or infant in respiratory arrest or respiratory failure?

- 1 ventilation every 2 to 3 seconds ------------- A pediatric patient experiencing respiratory arrest or respiratory failure should receive 1 ventilation every 2 to 3 seconds.

What is the correct rate of ventilation delivery for an adult in respiratory arrest or respiratory failure?

- 1 ventilation every 6 seconds

You are providing care for an adult patient in respiratory arrest. Which actions demonstrate appropriate care?

- Deliver 1 ventilation every 6 seconds. - Continue to check breathing and pulse every 2 minutes. If pulse becomes absent, start CPR.

You determine your patient is in cardiac arrest and start CPR immediately. Amanda returns and announces the code team is on the way and Ryan returns stating, "I have the AED and resuscitation equipment." What should the team do next?

- You should immediately perform 30 chest compressions, while Amanda prepares to deliver 2 ventilations. Ryan should set up the AED, attach the pads and tell everyone to "clear" as the AED begins to analyze. -------------------- You and Amanda should perform CPR cycles at a ratio of 30 compressions to 2 ventilations, while Ryan sets up the AED and attaches the pads. When the AED begins to analyze, Ryan should tell everyone to "Clear." This will minimize interruptions, a key principle of high-quality CPR.

Coordinated, efficient, effective teamwork is essential to provide high-quality CPR, improve patient outcomes and deliver expert care. Think about all of the activities performed during a resuscitation. For example:

-AED pads are applied. -AED must charge. -Pocket mask or BVM might need to be repositioned. -Airway might need to be reopened. -Other trained providers arrive and relieve you. -Providers switch positions. -Advanced airway might need to be inserted. -Pulse checks might be done. *All of these activities could affect your ability to maintain contact with the patient's chest.

Which of the following statements about performing chest compressions for adults are true?

-Allow the chest to fully recoil after each compression. -If using a feedback device, make sure the compressions are no more than 2.4 inches (6 cm) deep. -Provide smooth compressions at a rate of 100 to 120. -Compress the chest to a depth of at least 2 inches (5 cm).

When applying the AED pads, Ana-Lisa used an anterior/posterior placement. When should providers use this placement method for a child?

-If the manufacturer recommends the use of an anterior/posterior pad placement. -If the AED pads risk touching each other.

Identify the situations in which it is safe to use an AED.

-If the patient is experiencing cardiac arrest as a result of a traumatic injury -If the patient is pregnant -If the patient is wearing jewelry or has body piercings, providing the AED pads are not placed directly over any metallic jewelry or piercings -If the patient has a pacemaker or implantable cardioverter-defibrillators (ICDs), providing the AED pads are not placed directly over the device -If the patient is lying on a metal surface, providing the AED pads do not touch the surface and no one is touching the patient during shock

What should you do if ROSC is achieved?

-Monitor the patient until the advanced cardiac life support team takes over. -Stop CPR/AED use. -Check for breathing and pulse.

Which of the following correctly depicts the anterior/lateral position for AED pad placement?

-Patient's upper right chest, below the right clavicle to the right of the sternum -Patient's lower left chest along the midaxillary line, a few inches below the left armpit

You arrive with an AED and prepare to apply the pads while the BLS team continues to provide CPR. You apply the pads using the anterior/lateral pad placement.

-Patient's upper right chest, below the right clavicle to the right of the sternum -Patient's lower left chest along the midaxillary line, a few inches below the left armpit

You and a team of trained providers are performing CPR on an adult patient. One team member has gone to get additional resources and the AED. Which of the following statements are true about AED use?

-The compressor should continue providing compressions until the AED pads are applied and the AED prompts that it is analyzing. -Team members should rotate roles every 2 minutes, which is generally during the AED analysis, to prevent compressor fatigue. -After the shock is delivered, the team should immediately resume CPR. They do not need to wait for the AED prompt.

You and another provider are performing CPR on an adult patient in cardiac arrest. An advanced airway is not yet in place. Which actions demonstrate appropriate care?

-You use the same hand position and compression rate and depth as you would for single-provider CPR. -One provider focuses on rapid assessment and starting CPR; the other calls for additional resources and gets the AED. -You use a compression-to-ventilation ratio of 30:2.

team leader

-assigns and understands team roles -sets clear expectations -prioritizes, directs and acts decisively -encourages and allows team input and interaction -focuses on the big picture -monitors performance while providing support -acts as a role model -re-evaluates and summarizes progress -leads a debriefing session

when communicating (sending) information

-speak clearly and deliberately -covey information in an organized fashion -"close the loop" by waiting for feedback from the team member responsible for carrying out the action. If feedback is not provided, seek it before continuing.

You have been performing multiple-provider CPR on a patient in cardiac arrest. The patient is now showing signs of return of spontaneous circulation (ROSC). Which action(s) would the team perform?

-stop CPR -Check for breathing and pulse -Monitor the patient until the advanced cardiac life support team takes over.

What is the correct ventilation rate for an adult patient in respiratory arrest?

1 ventilation every 5 to 6 seconds

You would use pediatric AED pads for which children?

1. 2-year-old weighing 27 lbs 2. 5-year-old weighing 43 lbs

In addition to EMS, you immediately request which resources? Select all that apply.

1. AED 2. Resuscitation equipment 3. Naloxone ------------------- Yes, that's correct. You should immediately request an AED and resuscitation equipment regardless of whether Liz is in respiratory arrest/failure or cardiac arrest. When opioid overdose is suspected, request naloxone at the same time as the AED. Naloxone can be used to temporarily reverse the respiratory failure or arrest caused by opioid overdose.

What are the causes of cardiac arrest in a pregnant patient?

1. Anesthesia 2. Fever 3. Eclampsia ---------------------- Causes of cardiac arrest in a pregnant patient are fever, eclampsia, and anesthesia.

You are working as part of a high-performance BLS team. Which roles would you and the other providers most likely fill?

1. Compressor 2. AED operator 3. Team leader 4. Airway manager/ventilator

You are working with a BLS team performing CPR on a 62-year-old female patient. Which actions demonstrate high-quality CPR?

1. Deliver smooth ventilations that last about 1 second each and make the chest begin to rise 2. Allow for full chest recoil after each compression. 3. Compress the chest at a rate of 100 to 120.

Valerie has established that Mr. Goodman is in cardiac arrest and she has exposed the chest. She must immediately begin CPR while Joanne retrieves and sets up the AED. Which actions should the team take to ensure that they are providing high-quality CPR?

1. Provide smooth compressions at a rate of 100 to 120 compressions per minute and the death of at least 2 inches. 2. Allow the chest to fully recoil after each compression. 3. Minimize interruptions in compressions to less then 10 seconds. 4. Avoid excessive Ventilations. ------------------------------ That's right. Provide smooth compressions at a rate of at least 100 to 120 per minute and a depth of at least 2 inches. Allow the chest to fully recoil after each compression; compression and recoil times should be approximately equal. Minimize interruptions in chest compressions to less than 10 seconds. Provide smooth, effortless ventilations that last about 1 second each and make the chest begin to rise; allow the air to exit before delivering next ventilation. Avoid excessive ventilations.

The Cardiac Chain of Survival describes six actions that, when performed in rapid succession, increase the patient's likelihood of surviving sudden cardiac arrest. Place the links of the In-Hospital Adult Cardiac Chain of Survival in the correct order.

1. Surveillance and prevention 2. Recognition of cardiac emergency & Activation of the emergency response system 3. early high-quality CPR 4. early defibrillation 5. integration post-cardiac arrest care 6. recovery

During analysis, the providers will switch roles and transition to multiple-provider CPR. When Ana-Lisa takes over chest compressions, which compression-to-ventilation ratio should the team use?

15:2

the cardiac chain of survival describes five actions that, when performed in rapid succession, increase the patient's likelihood of surviving sudden cardiac arrest. Place the links of the In-Hospital Adult Cardiac Chain of Survival in the correct order

1. surveillance and prevention 2. activation of the emergency response system 3. early CPR 4. early defibrillation 5. integrated post-cardiac arrest care

After recognizing that Olivia is in cardiac arrest, Dr. Dave should initiate CPR within ____ seconds.

10

Mr. Goodman is unresponsive. Valerie must now simultaneously check for breathing and a pulse for at least 5 seconds but no more than ___.

10

BLS single provider key components

30:2 30 compressions 2 ventilations When you are the only provider present, you must complete the rapid assessment, perform CPR, and use the AED, when one is available. Performing CPR can be exhausting, so you should attempt to find additional resources as soon as possible during the rapid assessment. *Remember: When you are the only provider present, the ratio of compressions to ventilations for an adult is 30 compressions to 2 ventilations.

When Liz does not immediately respond to the naloxone, you and Kara continue with CPR and AED use. Jamal prepares to deliver a second dose. How long should you wait before administering it?

4 minutes

You are preparing to deliver ventilations to an adult patient experiencing respiratory arrest. You should give 1 ventilation every:

5 to 6 seconds

Joanne and Valerie switched to operating the BVM. While Joanne sealed the mask, Valerie depressed the bag. What is the correct volume of air to deliver during ventilations?

700 mL (depress about half the bag)

You are caring for a child who is in respiratory arrest with a central pulse of 55 bpm and signs of poor perfusion. What should you do?

????

Refusal of Care

A competent patient's refusal of care from a healthcare provider. Refusal of care must be honored, even if the patient is seriously injured or ill or desperately needs assistance. A patient can refuse some or all care. If a witness is available, have the witness listen to any refusal of care, and document it in writing.

Myocardial Infarction

A myocardial infarction (MI), or heart attack, refers to the necrosis (death) of heart tissue as a result of insufficient delivery of oxygenated blood to the heart. The sooner the signs and symptoms are recognized and treated, the lesser the degree of damage to the heart. Even patients who have had an MI before may not recognize the signs because each MI may present differently.

You are providing compressions on a 6-month-old who weighs 17 pounds. Which compression depth is appropriate for this patient?

About 1½ inches

You initiate CPR on an 11-year-old female patient who shows signs of puberty, including breast development. Which BLS guideline should you follow?

Adult

You and another provider are caring for a patient who is in cardiac arrest. You suspect that your patient has overdosed on an opioid. When should you administer intranasal naloxone?

After initiating CPR

Proper equipment cleaning:

After providing care, the equipment and surfaces used should always be cleaned and disinfected or properly disposed.

Your Role After an Exposure Incident

After the exposure incident has occurred, it important to: -Report the incident immediately to the appropriate person identified in your facility's infection/exposure control plan. -Write down what happened, including the time, date and circumstances, actions taken and any other information required by your employer. -Seek immediate follow-up care according to your facility's infection/exposure control plan.

While simultaneously checking for breathing and a pulse, you correctly adhere to which time interval?

At least 5 seconds but no more than 10

During a resuscitation, the team leader assigns team roles and tasks to each member. You recognize that a task has been overlooked. Which is the most appropriate action?

Alert the team leader immediately and identify for them what task has been overlooked.

The systematic and continuous approach to providing emergent patient care includes which three elements?

Assess, Recognize, Care

After performing a rapid assessment on an adult patient, you determine that they are not breathing, their central pulse is absent and they have no life-threatening bleeding. You recognize that the patient is experiencing:

Cardiac arrest

As you continue performing 5 back blows and 5 chest thrusts, Mrs. Clark becomes unresponsive. Jenna is getting the AED, BVM and additional resources. What should you do now?

Carefully lower Mrs. Clark to a firm, flat surface. Then immediately begin CPR, starting with chest compressions.

What is the correct area of the chest to perform chest thrusts?

Center of the chest on the lower half of the sternum

You do not see an object. You deliver 2 ventilations but do not see the chest rise. What is the best course of action?

Continue performing cycles of 30 compressions and 2 ventilations, checking for an object before each set of ventilations.

Continue providing CPR cycles

Continue providing cycles of 30 compressions followed by 2 ventilations until: -You see signs of ROSC, such as patient movement or normal breathing. -An AED is ready to analyze the patient's heart rhythm. -Other trained providers take over and relieve you from compression or ventilation responsibilities. -You are presented with a valid do not resuscitate (DNR) order. -You are alone and too exhausted to continue. -The situation becomes unsafe. Practice Note: Upon achieving ROSC, supplemental oxygen should be used based on your facility's protocols to maintain a normal oxygen saturation level while avoiding hyperoxygenation. Providers should use a pulse oximeter to monitor oxygen saturation.

You perform a rapid assessment and determine that your patient is experiencing cardiac arrest. On the basis of your assessment findings, you begin CPR to improve the patient's chances of survival. Which term refers to clearly and rationally identifying the connection between information and actions?

Critical thinking

Your Role During an Exposure Incident

Even with the best use of standard precautions, exposures do occur. When an exposure incident occurs, follow these steps as well as any steps outlined by your healthcare facility: -Wash needlestick injuries, cuts and exposed skin. -If blood or other body fluids are splashed around the mouth or nose, flush the area with water. -If eyes are involved, irrigate with clean water, saline or sterile irrigant solution for 20 minutes. -Clean the contaminated area thoroughly with soap and water.

Negligence

Failure to follow a reasonable standard of care, thereby causing or contributing to injury or damage.

Provide 30 chest compressions

For adults, compress the chest to a depth of at least 2 inches (5 cm). If you are using a feedback device, make sure the compressions are no more than 2.4 inches (6 cm) deep. Provide smooth compressions at a rate of 100 to 120 per minute. Allow the chest to fully recoil after each compression. Avoid leaning on the patient's chest at the top of the compression, because doing so impedes venous return and prevents the heart from filling completely. This, in turn, decreases cardiac output.

A child with an obstructed airway becomes unresponsive. Which action would be most appropriate to do first?

Gently lower the child to the ground and immediately begin CPR, starting with chest compressions.

An adult patient has stopped breathing but has a pulse. Which action would be appropriate?

Give 1 ventilation every 5 to 6 seconds

Now that your hands are positioned correctly, where should you place them on the patient's torso?

Hand position to perform chest compressions is the: - Center of the patient's chest on the lower half of the sternum.

Mouth-to-Nose Ventilations

If you are unable to make a complete seal over the patient's mouth, you may need to use mouth-to-nose ventilations instead. -With the patient's head tilted back, close the mouth by pushing up on the chin. -Seal your mouth around the patient's nose and breathe into the nose. -If possible, open the patient's mouth between ventilations to allow air to escape.

Provide Care

Implement appropriate care based on your understanding of the patient's condition. Proper care cannot be provided without effective assessment and accurate recognition of the patient's condition. The care you provide may include: -Repositioning and monitoring an unresponsive patient who is breathing normally and has a pulse. -Delivering ventilations to a patient in respiratory arrest. -Performing CPR on a patient in cardiac arrest. -Clearing an obstructed airway. -Administering naloxone to a patient experiencing an opioid overdose.

Myocardial infarction immediate care

In cases of suspected MI, administer two to four low-dose (81-mg) aspirin or one 325-mg adult aspirin based on your facility's protocols. Make sure that the patient chews the medication. Depending on your level of training, additional care may include administration of oxygen, other medications and diagnostic tests. Each healthcare facility establishes interventions and standard protocols for adult patients who are suspected or confirmed to be experiencing an MI. As a healthcare professional engaged in clinical patient care, it is important to be familiar with your own facility's protocols.

While simultaneously checking for breathing and a pulse, you correctly adhere to which amount of time?

No more than 10 seconds -------------- You should simultaneously check breathing and a pulse for no more than 10 seconds. At the same time, you should scan the body for life-threatening bleeding. If you determine that the patient is not breathing and their central pulse is absent, you should initiate CPR immediately. Taking more than the recommended time may delay lifesaving CPR measures.

Engineering controls:

Objects used in the workplace that isolate or remove a hazard, reducing the risk of exposure.

What should the team do after Jenna completes 30 chest compressions?

Open Mrs. Clark's mouth, look for an object and perform a finger sweep if an object is seen.

While on break in the cafeteria, a person sitting at a nearby table begins choking. The person looks panicked and frightened. You go over to help and note that the person is not able to breathe, speak or cough. You summon additional resources and obtain consent. Which action would you do next?

Perform abdominal thrusts.

You come upon a child who has collapsed. The child is not breathing normally and does not have a pulse. You are alone and have no immediate access to a phone or other form of communication. Which action would you do first?

Perform about 2 minutes of CPR, starting with chest compressions.

What is the first step of the Pediatric Cardiac Chain of Survival?

Prevention of arrest

when you asked the daughter to assist you with Mrs. Price, you took advantage of a readily available resource to find a solution. this is an example of

Problem solving

You are alone and caring for a 9-month-old infant with an obstructed airway who becomes unresponsive. Which action should you perform first?

Provide 30 chest compressions.

You will switch "compressor" roles with Ryan during the AED analysis. What actions should the team do during the analysis to ensure the switch occurs in less than 10 seconds?

Ryan should hover his hands a few inches over the patient's chest, preparing to take over compressions. You and Amanda should clear the patient while preparing to deliver ventilations and operate the AED. After the shock is delivered or if no shock is advised, Ryan should immediately begin compressions—he does not need to wait for the AED prompt shock delivered.

To quickly assess for an opioid overdose, you should use the opioid overdose triad. This includes pinpoint pupils, respiratory depression, and unconsciousness or severe sleepiness.

TRUE

You and your co-worker Jake are operating a BVM during multiple-provider CPR for an adult. You manage the airway while Jake delivers ventilations. Which statement correctly describes the appropriate technique for operating the BVM?

Seal the mask with two hands using the E-C technique.

After determining that Theo is unresponsive, Amy must open the airway using the head-tilt/chin-lift technique and simultaneously check for breathing and a pulse. To accurately assess Theo's breathing, she should open the airway to a ________ position.

Slightly past-neutral

How is a child defined in terms of CPR care?

Someone from the age of 1 to the onset of puberty

Personal protective equipment (PPE)

Specialized clothing, equipment and supplies that prevent direct contact with potentially infectious materials. PPE includes gloves, CPR breathing barriers, gowns, face shields, protective eyewear and biohazard bags.

You are alone caring for a 4-month-old infant who has gone into cardiac arrest. Which is the most effective CPR technique to perform until help arrives?

Standing to the side of the infant, provide chest compressions using the two-finger technique and deliver ventilations with a pocket mask.

You and your colleagues have been providing high-quality CPR for and using the AED on Mr. Sauer. While providing ventilations, you notice that Mr. Sauer moves and appears to be breathing. What is the correct course of action?

Stop CPR, check for breathing and a pulse and monitor Mr. Sauer until the advanced cardiac life support team takes over.

After Ana-Lisa took over compressions, Joe and Amy worked together to operate the BVM. Joe maintained an open airway and sealed the mask with both hands in the E-C position, while Amy delivered ventilations. This is the recommended technique for operating the BVM when enough providers are available. True or false?

TRUE

For every 1 minute delay in CPR and defibrillation, the patient's chance of survival is reduced by 7% to 10%.

TRUE

Joanne correctly applied the AED pads using the anterior/lateral position. However, if Mr. Goodman had a pacemaker or ICD, she would adjust pad placement as necessary to avoid placing the AED pads directly over the pacemaker or ICD. True or false?

TRUE *Note: A pacemaker or ICD may be placed in the right upper chest near the clavicle or in the abdomen.

What is a reason you would choose to perform chest thrusts instead of abdominal thrusts for an adult with an obstructed airway?

The patient is in a wheelchair.

The team continued to provide high-quality CPR until the rapid response team arrived and relieved them. In which situations would the team stop performing CPR?

Theo spontaneously moves. Remember, you should continue CPR until: -Other trained providers arrive and relieve you. -You see signs of return of spontaneous circulation (ROSC), such as spontaneous movement or normal breathing. -You are presented with a valid do not resuscitate (DNR) order. -You are too exhausted to continue. -The situation becomes unsafe.

Consent

To obtain consent from an adult patient, follow these steps: -Identify yourself to the patient or legal guardian. -State your level of training. -Explain what you observe. -Explain what you plan to do. -Ask for permission from the patient or legal guardian to provide care. If a patient is unresponsive, has an altered mental status, is mentally impaired or is unable to give consent verbally or through a gesture, then consent is implied. **Alert** -Always follow your local laws and regulations as they relate to consent. See Lesson 4 for information on obtaining consent for children and infants.permission for something to happen or agreement to do something.

Sadie is a 2.5-year-old child weighing 28 pounds. To perform high-quality chest compressions, you may need to use a one-hand technique.

True. For a smaller child, you may need to use a one-hand technique to perform high-quality chest compressions. When using a one-hand technique, be sure you are able to compress the chest about 2 inches.

Maggie is 4 years old and weighs 42 pounds. You simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.

True. For children like Maggie, you should simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.

Confidentiality

While providing care to a patient, you may learn details about the patient that are private and confidential. Do not share this information with anyone except personnel directly associated with the patient's medical care.

communication with the team

includes verbal (spoken words) and nonverbal messages conveyed through body language (gestures and facial expressions)

Dr. Dave performed chest compressions at the proper depth. What is the correct chest compression depth for an infant?

about 1½ inches

Amy performed high-quality chest compressions on Theo. What is the correct chest compression depth for a child?

about 2 inches

a patient reports episode of severe chest pressure that last about 3 to 4 minutes and are unrelieved by rest or position changes. The patient is pale and diaphoretic. You suspect a myocardial infarction (MI). Which information would be most important for you to keep in mind when preparing to care for this patient?

administering aspirin is an immediate care step for cases where MI is suspected

Rapid assessment of Mrs. Bailey's breathing reveals irregular, gasping breaths. You correctly identify this pattern of breathing as:

agonal breaths

Dr. Dave's next step is to check for responsiveness. Choose the correct location to tap Olivia as part of the shout-tap-shout sequence.

bottom of the foot

an adult in the waiting room has collapsed to the floor. The environment is safe. Upon reaching the person, you use the "shout-tap-shout" sequence to:

check for responsiveness

You stop to check breathing and pulse and clearly state: "I cannot locate a pulse." You recognize that Mr. Henderson is now experiencing which emergency condition? You direct Gloria to prepare the AED as you begin CPR, starting with the immediate delivery of chest compressions followed by ventilations.

cardiac arrest

after performing a rapid assessment, you find that an adult patient is unresponsive, is not breathing and does not have a pulse. you recognize that the patient is experiencing:

cardiac arrest

An 8-year-old child experiences cardiac arrest. On which area would you would complete a pulse check?

carotid artery (neck)

Next, Amy must simultaneously check for breathing and a pulse. Choose the recommended location to perform the pulse check.

carotid pulse (neck) Amy should simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.

Gloria arrives with the AED and BVM. What intervention should the team perform next?

deliver ventilation

practicing and debriefing

members of effective high-performance teams keep their skills and knowledge current, and they practice together regularly. in addition, effective high-performance teams hold debriefing sessions after each resuscitation event -the purpose of the debriefing session is to take a closer look at the decisions that were made and the actions that were taken, with the goal of identifying opportunities for improvement at the system, team and individual levels -the team leaser leads the debriefing session, which typically follows a constant format

Mrs. Bailey is unresponsive. You suspect she may have a head injury. Which technique should you use to open Mrs. Bailey's airway?

modified jaw-thrust maneuver

You are working with Mr. Henderson in the physical therapy center. He grimaces and says: " I can't catch my breath." Then he collapses to the ground. You notice he appears pale and cyanotic. What do you do first?

perform the shout-tap-shout sequence

problem solving

refers to the ability to use readily available resources to find solutions to challenging situations or issues that arise.

example of closed loop communication

sender --> message-->receiver-->feedback

Scope of Practice

the range of duties and skills you have acquired in training that you are authorized to perform by your certification to practice.

team leader responsibilities

the team leader overseas the entire emergency situation and ensures that everyone works as a team to help promote the best possible outcome for the patient

review

the team leader provides a brief recap of the emergency and the interventions that were used

summarize

the team recaps the main take-away points and develops a list of action items

reflect

the team reflects on the actions they took and why, discusses the pros and cons of those actions and identifies changes that could be made to improve future outcomes

this is an example of effective family communication

true

After determining an adult patient is unresponsive, what is the best site to check for a pulse?

- Carotid Artery

Kirron arrived and took over compressions. To ensure high-quality CPR, providers should switch off giving compressions every ___ minutes or sooner if the provider giving compressions is fatigued.

2

What is the first step of the In-Hospital Pediatric Cardiac Chain of Survival?

- Surveillance and prevention

Paloma is 9 years old and weighs 62 pounds. Single-provider CPR is in progress and you have just arrived with the AED. You set up the AED and apply pediatric AED pads while CPR continues. Best Course of Action? True/False?

- False -------------------- False. Since Paloma is 9 years old and weighs more than 55 pounds, you should use adult AED pads or adult electrical settings. Never use pediatric AED pads or a pediatric electrical setting on a child older than 8 years or weighing more than 55 pounds. That's because the shock delivered will not be sufficient.

For most infants and children up to the age of 17 years, you must obtain consent from the child's parent or legal guardian if they are present regardless of the child's level of consciousness. True or false?

- True

An adult patient is unresponsive. You have opened their airway and are simultaneously checking for breathing and a pulse. To check for breathing, which actions are appropriate to do?

- Look to see whether the chest rises and falls. - Listen for escaping air. - Feel for breathing against the side of your cheek.

You should switch roles about every 2 minutes, which usually occurs during the time of AED analysis, or sooner if the compressor is becoming fatigued. True or false?

- YES

After providing care, it is important to reassess the patient and the effectiveness of your interventions to determine if you need to implement another appropriate care measure. True or false?

- True ---------- This is true. An acutely ill patient's condition can change rapidly, and deterioration can follow; therefore, frequent assessment, recognition and care are critical. ***** You continue providing CPR, checking for breathing and pulse every two minutes. EMS arrives and transfers Mr. Henderson to the hospital for further management. Your final step is to document the events that took place, the care you provided and the facts you discovered.

Obstructed airway

If the patient is responsive but cannot cough, speak or breathe, they are choking. Obtain consent and immediately begin care for an obstructed airway. See Lesson 5 for more information.

If back blows, abdominal thrusts and/or chest thrusts are not effective or possible, use a combination of basic and advanced airway management techniques based on your training and availability.

- True ----------------------------- A combination of basic and advanced airway management techniques can be used if abdominal thrusts are not effective or possible.

You are ready to apply AED pads to a patient who has a transdermal medication patch. What should you do?

- Before applying AED pads, remove the transdermal medication patch with a gloved hand and wipe away any remaining medication from the skin. --------------- Before applying AED pads, you should remove any transdermal medication patches with a gloved hand and wipe away any remaining medication from the skin.

After exposing the patient's chest, how should your hands be positioned?

- Two hands, one on top of the other, fingers interlaced -------- This is the correct hand position to perform chest compressions for an adult.

Which of these actions are appropriate ways to minimize interruptions in chest compressions?

-Remain in position with the hands a few inches above the patient's chest during shock delivery. -Switch positions while the AED analyzes. -Continue compressions while the AED pads are placed.

AED Device Notes

-Some AEDs and manual defibrillators allow for compressions after the device analyzes the rhythm, while it is charging. Providers may perform compressions from the time the shock-advised prompt is noted through the time that the clear prompt occurs, just before depressing the shock button. Be sure to follow the manufacturer's recommendations and your facility's protocols. -If a monitor defibrillator is available, it may have an AED function. Although the device may look different, follow the same steps.

An adult patient suffers cardiac arrest in bed and requires CPR. When compressing the patient's chest, which technique promotes high-quality CPR?

1. Position yourself so your shoulders are directly over your hands. 2. Place one hand on top of the other and interlace your fingers or hold them up so that they are not resting on the patient's chest 3. Place down a CPR board or activate the system in the bed to ensure a firm CPR surface. 4. Adjust the bed or use a secure step or stool so you are at an appropriate working height.

Team Roles during resuscitation and the integration of Other Trained Providers

Coordination becomes even more important when other trained providers, such as an advanced life support team or code team, arrive. This coordination of all involved is necessary to: -Ensure that all individuals involved work as a team to help promote the best outcome for the patient. -Promote effective perfusion to the vital organs. -Minimize interruptions of chest compressions to less than 10 seconds, which have been shown to improve survival. *Ultimately, the team leader is responsible for this coordination. When other trained providers arrive, the team leader communicates with them, providing them with a report of the patient's status and events.

Advanced Directives

Written instructions that describe a patient's wishes (or the wishes of the parent or legal guardian) regarding medical treatment or healthcare decisions. Guidance for advance directives, including any required identification and verification process, is documented in state, regional or local laws, statutes and/or protocols, and must be followed. Advance directives include: Do Not Resuscitate (DNR) orders, also called Do Not Attempt Resuscitation (DNAR) orders. Physician Orders for Life-Sustaining Treatment (POLST).

When applying the AED pads, Ana-Lisa used an anterior/posterior placement. When should providers use this placement method for a child?

XXX Not quite. For a child, you may use an anterior/posterior placement if the pads risk touching each other or the manufacturer recommends doing so. In this case, Ana-Lisa used the anterior/posterior pad placement according to the manufacturer's recommendation.

analyze

the team reviews and evaluates the qualitative and quantitative data obtained during the resuscitation effort

Once the airway is open, you simultaneously check for breathing and a pulse. Is this the correct course of action?

yes

What is the correct ventilation rate for a pediatric patient in respiratory arrest?

- 1 ventilation every 2 to 3 seconds ---------------- Yes, that's correct. The correct ventilation rate for a pediatric patient is 1 ventilation every 2 to 3 seconds. The correct ventilation rate for an adult patient is 1 ventilation every 6 seconds.

Kirron arrived and took over compressions. To ensure high-quality CPR, providers should switch off giving compressions every ___ minutes or sooner if the provider giving compressions is fatigued.

- 2 minutes ------------------- Yes, that's correct. Providers should switch off giving compressions every 2 minutes—or sooner if the provider giving compressions is fatigued.

Rapid assessment of Mrs. Bailey's breathing reveals irregular, gasping breaths. You correctly identify this pattern of breathing as:

- Agonal Breaths --------------- Agonal breaths are isolated or infrequent gasps that occur in the absence of normal breathing in an unconscious patient. These breaths can occur after the heart has stopped beating and are considered a sign of cardiac arrest. Agonal breaths are not normal breathing. If the patient is demonstrating agonal breaths, you need to care for the patient as if they are not breathing at all.

You have been providing compressions and are starting to fatigue. How do you verbalize the coordination plan to switch?

- Call for a position change by saying "switch" in place of the number one in the last compression cycle. -------------------- When performing high-quality CPR, it is important to work as a team. This includes clearly indicating and completing position switches to avoid exhaustion. For example, you should call for a position change by saying "switch" in place of the number one in the last compression cycle. Note: You should stop compressions while the AED is analyzing heart rhythm.

You are working with Mr. Henderson at an out-patient satellite physical therapy clinic. He reports to you that he has not been feeling well all day. He grimaces and says: "I can't catch my breath." Then he collapses to the ground. You notice he appears unresponsive, pale and cyanotic. What do you do first?

- Check for responsiveness.

To minimize interruptions in chest compressions, what should Valerie do during the AED analysis and shock?

- Clear the patient and prepare to resume CPR immediately after the shock is delivered or if no shock is advised. ----------------------------- During the AED analysis and shock delivery, Valerie should clear the patient and prepare to resume CPR immediately after the shock is delivered or if no shock is advised. Remember never to touch the patient while the AED is analyzing the rhythm or when a shock is being delivered.

Mr. Goodman is exhibiting signs and symptoms of which condition?

- Heart Attack ---------

You are about to start your morning rounds, when you hear a loud crash in Mrs. Bailey's room. When you enter her doorway, you see her lying on the floor with her walker tipped over next to her. You must first perform a visual survey. What actions should you take?

- Observe for any signs of illness or injury, including life-threatening bleeding. - Determine whether any additional help is needed. ----------- Before you help an ill or injured patient, assess for any immediate dangers to make sure that the environment is safe for you and any individuals present during the event. Next, gather an initial impression of the patient's status, which includes looking for life-threatening bleeding. Your ability to quickly formulate an impression of the patient before performing any hands-on techniques helps you to assess whether the emergency is life-threatening. While the initial impression does not identify a specific emergency, it does provide important clues to what might be happening, and it may help determine whether a patient survives. Finally, quickly identify what additional resources you may need in the situation, such as a rapid response or resuscitation team or an advanced life support unit available to respond, or any additional equipment such as an AED.

Which is the correct technique for multiple-provider CPR when an advanced airway is in place?

- One provider delivers 1 ventilation every 6 seconds, while the other provider delivers continuous chest compressions without pausing for ventilations. ------- When an advanced airway is in place during multiple-provider CPR, one provider delivers 1 ventilation every 6 seconds, while the other provider delivers continuous chest compressions without pausing for ventilations.

You must perform single-provider CPR on an adult patient in cardiac arrest. What technique should you use?

- Perform 30 chest compressions at a rate of 100 to 120 per minute. Then deliver 2 ventilations, each lasting about 1 second, with a pocket mask or mouth-to-mouth.

A 32-year-old patient (30 weeks' gestation) goes into cardiac arrest. The fundus is above the umbilicus. How can team members maximize the effectiveness of chest compressions for this patient?

- Position the patient in the supine position and provide manual left uterine displacement ---------------------------- Team members can maximize the effectiveness of chest compressions for this patient by positioning the patient in the supine position and providing manual left uterine displacement.

After providing initial care, which actions must you implement?

- Reassess the patient and the effectiveness of your interventions to determine the next steps. - Apply another appropriate care measure for the initial presenting problem or a new problem. - Document to establish a record of the events that took place, the care you provided and the facts you discovered. All of the above.

Mr. Henderson is unresponsive. You direct Gloria to activate EMS and get the nearby AED and resuscitation equipment. Then, you simultaneously check for breathing, a pulse and life-threatening bleeding. "One one-thousand, two one-thousand, three one-thousand, four one-thousand, five one-thousand..." You note he is not breathing and has a central pulse. You do not see signs of life-threatening bleeding. What emergency condition is Mr. Henderson experiencing?

- Respiratory arrest ------ This is true. The patient is in respiratory arrest. The priority action at this time is to deliver ventilations. Deliver 1 ventilation every 6 seconds for an adult patient, with each ventilation lasting about 1 second and making the chest rise.

You have determined that your patient is unresponsive. What steps of the rapid assessment should you do next?

- Simultaneously check breathing and a pulse for no more than 10 seconds. - Quickly scan down the body looking for blood or other signs and symptoms that might not have been seen during the initial impression.

You are alone performing high-quality CPR when a second provider arrives to take over compressions. When switching roles, you should minimize interruptions in chest compressions to less than how many seconds?

10 seconds

After completing a rapid assessment, you'll use your findings to quickly recognize the emergency condition and determine your immediate course of action. True or false?

- TRUE ---------- True. You should implement appropriate care based on your understanding of the patient's condition. Effective assessment and accurate recognition of the patient's condition allows you to provide proper care. Conditions requiring BLS care may include life-threatening injury or illness, respiratory arrest or failure, cardiac arrest, obstructed airway and opioid overdose.

After the resuscitation event, the BLS team conducted a debriefing session to ensure continuous resuscitation quality improvement. Which observation or data point suggests a need for improvement?

- The chest compression fraction (CCF) was 35%. ------------------------- Yes, that's correct. According to expert consensus, a CCF of at least 60% is needed to promote optimal outcomes, and the goal should be 80%.

When Joanne returns with the AED, what is her first step?

- Turn on the AED and follow the prompts. -------------------- That's right! The first step when using an AED is for Joanne to turn on the AED and follow the prompts. Then, she should attach the AED pads to the patient's bare chest while Valerie continues CPR. Both providers should clear the patient during rhythm analysis and shock delivery. After delivering the shock, they should immediately resume CPR.

Joanne correctly applied the AED pads using the anterior/lateral position. However, if Mr. Goodman had a pacemaker or ICD, she would adjust pad placement as necessary to avoid placing the AED pads directly over the pacemaker or ICD. True or false?

- True ----------------------------- That's correct. When a patient has a pacemaker or ICD, adjust pad placement as necessary to avoid placing the AED pads directly over the device. Note: A pacemaker or ICD may be placed in the right upper chest near the clavicle or in the abdomen.

Joanne and Valerie switched to operating the BVM. While Joanne sealed the mask, Valerie depressed the bag. This is the preferred technique for BVM ventilation. True or false?

- True ------------------------------- That's right. A two-person technique for bag-valve-mask (BVM) ventilations is the preferred methodology for multiple-provider CPR because it provides a better seal and ventilation volume. To perform this technique, one provider seals the mask and maintains an open airway while the other provider delivers ventilations. When there is only one provider to deliver ventilations during multiple-provider CPR, the ventilator may consider using a pocket mask over a BVM resuscitator for a better seal and ventilation volume. However, it is recognized that factors such as limited personnel or the need to perform other time critical interventions may preclude using two-person BVM technique. Also, BVM may be preferred to pocket mask for supplemental oxygen, positive end-expiratory pressure (PEEP) and infection control. In these situations, one-person BVM is acceptable.

Providers are preparing to deliver ventilations with a BVM to a patient in cardiac arrest. One provider seals the mask with both hands using the E-C hand position and simultaneously opens the airway to a past-neutral position. The other provider delivers smooth, effortless ventilations that last about 1 second and make the chest begin to rise. This is the preferred technique for delivering BVM ventilations when an advanced airway is not in place. True or false?

- True. The two-person technique for BVM ventilations is the preferred technique. ----------------- This is true. A two-person technique for bag-valve-mask (BVM) ventilations is the preferred technique as it provides a better seal and ventilation volume. The provider managing the airway should seal the mask using the EC technique and simultaneously opens the airway to a past-neutral position. The other provider should deliver 2 ventilations that last about 1 second and make the chest begin to rise. Remember, ventilations that are too fast or have too much volume can be dangerous. Smooth transitions between compressions and ventilations are also essential to minimize interruptions.

You are evaluating the quality of CPR provided by the BLS team. Which methods would you use for this evaluation?

-Visual observation -Chest compression fraction -Feedback device -Capnography

Which statement(s) are true about your duty to act?

- When a patient experiences a life-threatening emergency in your practice setting, you have a duty to act. - Although a duty to act may not always exist outside your practice setting, being prepared and willing to respond is essential. - Your facility's specific protocols and your scope of practice may determine your appropriate actions.

A 4-year-old child is unresponsive. Her pulse rate is 65 bpm, but she is not breathing normally. Which of the following actions are appropriate?

-Deliver 1 ventilation every 3 to 5 seconds -Check the pulse and breathing about every 2 minutes

team member responsibilities

-have the necessary knowledge and skills to perform their assigned role -stay in their assigned role but assist others as needed, as long as they are able to maintain their own assigned responsibilities -communicate effectively with the team leader if they: *feel they are lacking any knowledge or skills to perform assigned roles *identify something that the team leader may have overlooked *recognize a dangerous situation or need for urgent action -share information with other team members -focus on achieving the goals -ask pertinent questions and share pertinent observations -participate in debriefing sessions

An adult patient is unresponsive. You have opened their airway and are simultaneously checking for breathing and a pulse. To check for normal breathing, which actions are appropriate to do?

-look to see whether the chest rises and falls -feel for breathing against the side of your cheek -listen for escaping air

Which of the following correctly depicts the anterior/lateral position for AED pad placement?

1. Patient's upper right chest, below the right clavicle to the right of the sternum 2. Patient's lower left chest along the midaxillary line, a few inches below the left armpit ------------------- Correct adult AED pad placement is upper right chest, below the right clavicle to the right of the sternum, and left side of the chest along the midaxillary line, a few inches below the armpit.

BLS for Adult single-Provider CPR

1. Provide chest compressions -The compressor exposes the chest. -The compressor performs 30 chest compressions. The compressor centers their hands on the lower half of the sternum and compresses the chest to a depth of at least 2 inches (5 cm) at a rate of 100 to 120 compressions per minute, allowing for full chest recoil. It should take 15 to 18 seconds to perform 30 chest compressions. 2. Deliver ventilations -Seal the pocket mask and simultaneously open the airway to a past-neutral position using the head-tilt/chin-lift technique. Or, use the modified jaw-thrust maneuver if a head, neck or spinal injury is suspected. -Deliver 2 ventilations. Each ventilation should last about 1 second and make the chest begin to rise. *Interruptions of chest compressions should be less than 10 seconds. Therefore, a bag-valve-mask (BVM) is not a practical way to deliver ventilations during CPR when responding alone. -Continue CPR -Provide 30 chest compressions at the proper rate and depth, using correct hand placement and allowing for full chest recoil. -Seal the mask and open the airway. -Deliver 2 ventilations.

Bag-Valve-Mask Resuscitator Ventilations

A BVM resuscitator is a handheld device used to ventilate patients during respiratory arrest or multiple-provider CPR. During single-provider CPR, use of a BVM resuscitator is not recommended because it will increase the time between sets of chest compressions resulting in poor outcomes. Unlike a pocket mask, a BVM resuscitator delivers ambient air rather than the provider's exhaled air. So, the patient receives a higher concentration of oxygen (approximately 20% to 21%) with BVM ventilations than with pocket mask or mouth-to-mouth (approximately 16% to 17%). *If facility protocols allow, supplemental oxygen should be attached to the BVM resuscitator as soon as appropriate and when enough resources are available. Doing so can increase oxygen concentration to approximately 90% to 100%.

In addition to EMS, you immediately request which resources?

AED, BVM and naloxone

You and two nurses have been performing CPR on a 72-year-old patient, Ben Phillips. When Mr. Phillips shows signs of ROSC, where should you perform the pulse check?

At the carotid or femoral artery

You are ready to apply AED pads to a patient who has a transdermal medication patch. What should you do?

Before applying AED pads, remove the transdermal medication patch with a gloved hand and wipe away any remaining medication from the skin.

You enter your patient's room and find them lying supine in bed seemingly unresponsive. After performing a rapid assessment and determining your patient is in cardiac arrest, you call for additional resources and an AED. How soon after recognizing cardiac arrest should you begin compressions?

Begin chest compressions within 10 seconds.

High-Performance Resuscitation Team

Characteristics of a high-performance team include well-defined roles and responsibilities; clear, closed-loop communication; and respectful treatment of others.

Stopping CPR/AED Use

Continue CPR/AED use until: -Other trained providers arrive and relieve you. -You see signs of return of spontaneous circulation (ROSC), such as spontaneous movement or breathing. -You are presented with a valid do not resuscitate (DNR) order. -You are too exhausted to continue. -The situation becomes unsafe. If ROSC is achieved: -Stop CPR/AED use. -Check for breathing and pulse. When the patient shows signs of -ROSC and multiple providers are present, it is appropriate to check the following sites: -Carotid or femoral pulse for a child -Brachial or femoral pulse for an infant -Monitor the child or infant until the pediatric advanced life support team takes over. *Upon achieving ROSC, supplemental oxygen should be used based on your facility's protocols to maintain a normal oxygen saturation level while avoiding hyperoxygenation. Providers should use a pulse oximeter to monitor oxygen saturation.

Upon entering Mr. Cohen's room, you find him on the ground, unresponsive. After immediately initiating the emergency response system, what is your next action according to the Adult In-Hospital Cardiac Chain of Survival?

Early CPR

When providing multiple-provider CPR for an infant, which compression technique should the team use?

Encircling thumbs technique

You and another provider are performing CPR on a 6-month old infant. The provider performing chest compressions would use which technique?

Encircling thumbs technique

Compression Depth

Evidence shows that providing chest compressions at a rate greater than 120 per minute detrimentally affects compression depth because providers are less likely to compress the chest to the minimum depth of at least 2 inches (5 cm) for an adult. Additional evidence shows that compressing the chest to a depth greater than 2.4 inches (6 cm) leads to increased non-life-threatening injuries (such as rib fractures) in the average adult and should be avoided. The upper limits for the rate and depth of compressions exist to improve patient outcomes, but it is also critical to maintain a rate greater than 100 compressions per minute and a depth of at least 2 inches (5 cm). Both rate and depth of compressions are best measured using a feedback device if available.

If the AED came equipped with adult AED pads only, Vickie should not use them. Instead, she should call for someone to bring pediatric AED pads and continue CPR until the new pads arrive. True or false?

False, If pediatric AED pads aren't available—or the AED doesn't have a pediatric setting—it's safe to use adult AED pads or adult levels of energy on Olivia. When using adult AED pads on an infant, use the anterior/posterior pad placement.

When delivering ventilations to Jalen, you open his airway to a neutral position.

False. For children like Jalen, you should open the airway to a slightly past neutral position. If Jalen were an infant, you would open the airway to a neutral position.

To perform compressions on Maggie, you use the two-finger technique (i.e., two fingers centered on the sternum just below the nipple line.)

False. For children like Maggie, use the same technique as you do for an adult: One hand on top of the other with fingers interlaced and off the chest centered on lower half of the sternum, although on small children a one-hand technique is acceptable. The two-finger technique is used for infants during single-provider CPR.

An infant has an obstructed airway but is responsive. When administering back blows to the infant, you would use which technique to deliver the blows?

Heel of the hand between the scapulae

Opioid overdose

If the patient is unresponsive and shows signs and symptoms of opioid overdose (e.g., pinpoint pupils, respiratory depression, unconsciousness or severe sleepiness), follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED and naloxone. -Provide care for the condition found. This will be similar to the care you must provide during any respiratory or cardiac arrest emergency. The primary differences are calling for and administering naloxone.

Child or Infant Cardiac arrest

If the patient is unresponsive, not breathing normally (or only gasping) and has no pulse, they are in cardiac arrest. Follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If you are alone and do not have a mobile phone or other form of communication, you must decide to call first or care first. -Start CPR within 10 seconds of recognizing cardiac arrest following the steps outlined in the Care section. *If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR. *For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).

Team Roles during resuscitation

Leadership/Supportive Roles -Recorder This team member records and communicates key data during the resuscitation effort (for example, data related to interruptions to chest compressions). -Team Leader The team leader assigns roles, sets clear expectations, prioritizes, directs, encourages team input and interaction, monitors the delivery of CPR/AED, makes adjustments in real time and focuses on the big picture. CPR/AED Roles -Airway Manager This team member maintains an open airway and seals the mask. -Ventilator This team member is responsible for ventilations. -Compressor This team member is responsible for chest compressions. -AED Operator This team member manages the AED and relieves the compressor.

You suspect that an unresponsive patient has sustained a neck injury. Which technique should you use to open the patient's airway?

Modified jaw-thrust maneuver

Opioid Overdose in Adults, Children and Infants

Opioid Overdose in Adults, Children and Infants

If the patient is not breathing normally and has no pulse, you must perform single-provider CPR. What should you do?

Perform 30 chest compressions at a rate of 100 to 120 per minute. Then deliver 2 ventilations, each lasting about 1 second, with a pocket mask or mouth-to-mouth.

You open the patient's airway and look, listen, and feel for breathing while simultaneously checking for a carotid pulse. The patient has a pulse but is not breathing. Which action is the priority?

Provide care for respiratory arrest, starting with ventilations.

Multiple Provider CPR Children and Infants

Provide chest compressions The compressor exposes the chest and performs 15 chest compressions. For Children: The compressor centers their hands on the lower half of the sternum and compresses the chest to a depth of about 2 inches (5 cm) at a rate of 100 to 120 compressions per minute, allowing for full chest recoil. For Infants: The compressor centers their thumbs on the lower half of the sternum. Using the encircling thumbs technique, the compressor compresses the chest to a depth of about 1½ inches (3.8 cm), or one-third the anterior-posterior diameter of the chest, and at a rate of 100 to 120 compressions per minute, allowing for full chest recoil. Deliver ventilations The airway manager seals the BVM mask and simultaneously opens the airway to a slightly past-neutral position for children or a neutral position for infants using the head-tilt/chin-lift technique. Or, they use the modified jaw-thrust maneuver if a head, neck or spinal injury is suspected. The ventilator delivers 2 ventilations. Each ventilation should last about 1 second and make the chest begin to rise. Practice Note If only one provider is available to operate the BVM, they take on the role of airway manager and ventilator. Practice Note If a child or infant is in cardiac arrest and an advanced airway is in place, one provider delivers 1 ventilation every 6 to 8 seconds. At the same time, a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 15:2 does not apply because compressions and ventilations are delivered continuously with no interruptions. Switch positions The providers smoothly switch positions about every 2 minutes. This should take less than 10 seconds. The compressor calls for a position change by saying "switch" in place of the number 1 in the compression cycle. Continue CPR The compressor provides 15 chest compressions at the proper rate and depth, using correct hand placement and allowing for full chest recoil. The airway manager maintains an open airway and seals the mask. The ventilator delivers 2 ventilations with the child or infant-sized BVM resuscitator or pocket mask.

After performing a rapid assessment on an adult patient, you determine that they have ineffective ventilation and a central pulse. You recognize that the patient is experiencing:

Respiratory failure

AED Use for Children and Infants

Set up the AED and continue CPR until the AED is ready to analyze -CPR continues until the AED is ready to analyze the rhythm. -While CPR continues, the AED operator: -Turns on the AED. -Attaches the AED pads. -Plugs in the connectors, if necessary. -Ensures that everyone is clear of the patient while the AED analyzes, loudly saying, "Clear." Rotate providers during analysis to prevent fatigue, as needed The new compressor hovers their hands a few inches over the child or infant's chest, preparing to take over compressions immediately after analysis is complete. This helps minimize interruptions in chest compressions to less than 10 seconds. The other provider(s) get into position ready to operate the AED, maintain the mask seal and open airway, and deliver ventilations. Continue CPR The providers continue performing cycles of CPR (15:2) switching roles about every 2 minutes.

Back blows have not dislodged the object. Using a series of 5 back blows and 5 chest thrusts can be effective. True or false?

TRUE

If provided in the first few minutes of cardiac arrest, high-quality CPR can double or triple a patient's chance of survival.

TRUE

The team leader assigns roles, supports the team, monitors the delivery of CPR and makes adjustments in real time. The team members deliver expert care within their assigned roles, assist others as needed (as long as they can maintain their own assigned responsibilities) and communicate effectively with the team leader and each other. True or false?

TRUE

When performing single-provider CPR on Theo, Amy was correct to use a compression-to-ventilation ratio of 30:2. True or false?

TRUE

You should perform early assessment for life-threatening bleeding during the initial impression and the breathing and pulse check. True or false?

TRUE

After the resuscitation event, the BLS team conducted a debriefing session to ensure continuous CPR quality improvement. Which observation or data point suggests a need for improvement?

The chest compression fraction (CCF) was 58%.According to expert consensus, a CCF of at least 60% is needed to promote optimal outcomes, and the goal should be 80%.

Recognize

The patient may be experiencing a life-threatening emergency. Use the findings collected during the rapid assessment to quickly recognize whether a life-threatening emergency is occurring and what condition the patient is experiencing. Emergencies requiring basic life support may include: -Injury or illness. -Respiratory arrest. -Cardiac arrest. -Obstructed airway. -Opioid overdose.

Providers are preparing to deliver ventilations to a patient in cardiac arrest. One provider seals the mask with both hands in the E-C hand position and simultaneously opens the airway to a past-neutral position. The other provider depresses the bag. How much volume should be administered?

The provider should supply 400-700 mL, depressing the bag halfway.

You are providing care for Mrs. Bove, who has an endotracheal tube in place. How does this affect compressions and ventilations?

The team should provide ventilations at a rate of 1 ventilation every 6 seconds without pausing compressions.

Jalen is 6 years old and weighs 50 pounds. He is unresponsive and not breathing but has a pulse. You do not see signs of trauma. You deliver 1 ventilation every 3 to 5 seconds.

True. For children or infants in respiratory arrest, deliver 1 ventilation every 3 to 5 seconds.

Is it safe to use an AED on a patient who is pregnant?

YES

Is it safe to use an AED on a patient who has body piercings?

YES, A patient's jewelry or body piercings do not need to be removed before using an AED, but avoid placing the AED pads directly over any metallic jewelry or piercings. Adjust pad placement if necessary.

The team's action best represents which practice used to prevent errors?

crew resource management

who is the best person to communicate patient status an care completed to the code team?

team leader

When the team switches roles, they should take less than __ seconds.

- 10 Seconds ------------------------ To minimize interruptions in chest compressions, the team should take less than 10 seconds to switch roles.

A 5-year-old child experiences cardiac arrest and requires CPR. You ensure that high-quality CPR is administered when you compress the chest to which depth?

- About 2 inches

You and another provider are performing CPR on a 6-month old infant. The provider performing chest compressions would use which technique?

- Encircling thumbs technique

Dr. Dave should assess Olivia for breathing, a pulse and life-threatening bleeding for no more than 10 seconds. After recognizing that Olivia is in cardiac arrest, he should initiate CPR immediately, true or false?

- TRUE -------------- Good work! Once cardiac arrest is recognized, Dr. Dave should start CPR immediately.

When performing back blows on an adult or child, where should you place the heel of your hand?

- To deliver back blows, use the heel of your hand and firmly strike the patient in the center of the back, between the scapulae.

When performing single-provider CPR on Theo, Amy was correct to use a compression-to-ventilation ratio of 30:2. True or false?

- True ----------------------- That's correct. When performing single-provider CPR on a child, the compression/ventilation ratio is 30:2.

You are performing CPR on an infant. A second provider prepares to apply the AED pads. Where should they place the pads?

-On the back between the scapulae -Middle of the infant's chest on the sternum

You and a team of trained providers are performing CPR on an adult patient. One team member has gone to get additional resources and the AED. Which of the following statements are true about AED use?

1. After the shock is delivered, the team should immediately resume CPR. They do not need to wait for the AED prompt. 2. Team members should rotate roles every 2 minutes, which is generally during the AED analysis, to prevent compressor fatigue. 3. The compressor should continue providing compressions until the AED pads are applied and the AED prompts that it is analyzing

A 4-year-old child is in respiratory failure. Her central pulse rate is 65 bpm. Which of the following actions are appropriate?

1. Deliver 1 ventilation every 3 to 5 seconds 2. Check the pulse and breathing every 2 minutes

You arrive with an AED and prepare to apply the pads while the BLS team continues to provide CPR. You apply the pads using the anterior/lateral pad placement.

1. Patient's upper right chest, below the right clavicle to the right of the sternum 2. Patient's lower left chest along the midaxillary line, a few inches below the left armpit

You are caring for for a 6-month-old infant who is unresponsive, breathing and has a pulse. What should you do?

1. Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/initial interventions. 2. Perform secondary assessment as patient condition allows. 3. Reassess patient, recognize issues and provide care as needed.

You are caring for a pregnant patient (30 weeks gestation) in cardiac arrest. The patient's fundus is above the umbilicus. Which of the following steps are appropriate?

1. Provide continuous high-quality CPR and left uterine displacement. 2. Activate maternal and neonatal resuscitation teams. 3. Make sure AED pads do not incorporate any breast tissue 4. Perform resuscitative cesarean delivery (RCD), if trained, within 5 minutes from the time of arrest.

Vickie has arrived with the AED and will now begin to use it. What are the proper steps for using an AED?

1. Vickie turns on the AED 2. Vickie attaches the AED pads while Dr.Dave continues CPR 3. The team clears the patient during AED analysis & shock delivery 4. The new compressor starts CPR immediately after shock is delivered or if no shock is advised ------------------------------------ That's right. The correct order is as follows: Vickie turns on the AED. Vickie attaches the AED pads while Dr. Dave and Stephanie continue CPR. The team clears the patient during AED analysis and shock delivery. The new compressor starts CPR immediately after shock is delivered or if no shock is advised.

You are evaluating the quality of CPR provided by the BLS team. Which methods could you use for this evaluation?

1. Visual observation 2. Feedback device (depth: 2.4 inches) 3. Chest compression fraction

After the second dose of naloxone, Liz almost immediately makes some sudden movements. Jamal should perform which action(s)? Select all that apply.

XXXXXXXXXX That's not it. When Liz responds to the second dose of naloxone, Jamal should check for responsiveness and assess for breathing and a pulse. Then, he should place Liz in the recovery position and suction her airway, if she begins to vomit. It is important to reassess Liz for any changes in condition, recognize issues and provide care as needed. Naloxone temporarily reverses the effects of the opioid; If Liz stops responding, Jamal should check breathing and pulse, provide care as appropriate and re-administer naloxone, if needed.

If Theo had an advanced airway in place during CPR, what would be the correct rate of ventilation delivery?

- 1 ventilation every 2 to 3 seconds --------------------- That's right. When an advanced airway is in place, one provider should deliver 1 ventilation every 2 to 3 seconds for a child or infant, while the other provider delivers continuous compressions without pausing for ventilations.

When performing multiple-provider CPR on an infant, the compression/ventilation ratio is ____: 2.

- 15:2 ---------------- That's right. When performing multiple-provider CPR on an infant, the compression/ventilation ratio is 15:2.

After the shock is delivered, Ana-Lisa will immediately resume chest compressions. Which compression-to-ventilation ratio should the team use?

- 15:2 -------------------- That's correct! As a single provider, Amy used a 30:2 compression-to-ventilation ratio. The team arrived and prepared the BVM and AED, while Amy completed a cycle of 30 compressions. When Ana-Lisa takes over chest compressions, the team will transition to a 15:2 compression-to-ventilation ratio.

Amy performed high-quality chest compressions on Theo. What is the correct chest compression depth for a child?

- 2 inches --------------------- Amy compressed the chest about 2 inches (5 cm) or one-third the anterior-posterior diameter of the chest.

You initiate CPR on an 11-year-old patient who shows signs of puberty, including breast development. Which CPR/AED guideline should you follow?

- Adult

You are alone providing care for an unresponsive infant with an obstructed airway. You must look in the infant's mouth for the object that is obstructing the airway, and remove it with your pinky if you can see it. When is the appropriate time to perform this step?

- After completing 30 compressions ----------------- After 30 compressions, look in the infant's mouth for the object and if you can see it, remove it using a finger sweep. If you cannot see an object, never perform a blind finger sweep.

Gloria returns with the AED and resuscitation equipment. She states: "I'm on the phone with emergency dispatch." After 2 minutes of delivering ventilations, you stop to check breathing and pulse. You clearly state: "His central pulse is now absent." You recognize that Mr. Henderson is now experiencing which emergency condition?

- Cardiac Arrest -------------- Yes, that's correct. Mr. Henderson is in cardiac arrest—he is not breathing and his central pulse is absent.

As you continue performing 5 back blows and 5 chest thrusts, Mrs. Clark becomes unresponsive. What should you do now?

- Carefully lower Mrs. Clark to a firm, flat surface. Then immediately begin CPR, starting with chest compressions. --------------- Yes, that's correct. Since Mrs. Clark has become unresponsive, carefully lower her to a firm, flat surface while protecting her head and immediately begin CPR, starting with chest compressions.

What is the correct area of the chest to perform chest thrusts?

- Center of the chest on the lower half of the sternum --------------------- Yes, that's correct. The correct area to perform chest thrusts is the lower half of the sternum. To perform the chest thrusts, position yourself behind Mrs. Clark as you would for abdominal thrusts. Place the thumb side of your fist against the center of her chest, on the lower half of the sternum. Then cover your fist with your other hand and pull straight back, providing a quick, inward thrust into her chest. Each thrust should be a distinct attempt to dislodge the object.

An adult in the waiting room has collapsed to the floor. During your visual survey, you determine that the scene is safe, the patient appears unresponsive and they do not appear to have life-threatening bleeding. What is your next step?

- Check for responsiveness.

As you approach Mrs. Bailey you note that she appears unresponsive and you do not see signs of life-threatening bleeding. Which action should you perform next?

- Check for responsiveness. ------------- If the patient appears unresponsive, you need to check for responsiveness. If they are unresponsive, you should activate EMS, rapid response or resuscitation team. Then open the airway to a past-neutral position and check breathing and a pulse for no more than 10 seconds; and at the same time, scan the body for life-threatening bleeding. Finally, you should implement care based on your findings.

You enter an adult patient's room to provide routine care. Noticing the patient slumped over in the recliner, you perform a quick visual survey. This includes which of the following actions?

- Checking for life-threatening bleeding - Obtaining an initial impression of the patient - Determining the need for additional resources

You initiate CPR on a 15-month-old patient. Which CPR/AED guideline should you follow?

- Child

After determining an 8-year-old child is unresponsive, what is the best site to check for a pulse?

- Child's Carotid pulse (on the side of the neck) - or Femoral pulse (on the inner thigh in the crease between their leg and groin)

The AED arrives, and you attach the pads appropriately and clear the area. When the AED is analyzing or delivering a shock, what should you do?

- Clear the patient taking care not to touch the patient. ----------------- It is important to minimize interruptions to compressions during high-quality CPR, but you must remain clear of the patient during analysis and while a shock is delivered.

Quinn does not see an object. He delivers 2 ventilations but does not see the chest rise. What is the best course of action?

- Continue performing cycles of 30 compressions and 2 ventilations, checking for an object before each set of ventilations. --------------------- Yes, that's correct. Continue performing cycles of 30 compressions and 2 ventilations, checking for an object before each set of ventilations. Remember, never try more than 2 ventilations during one cycle of CPR, even if the chest does not rise. Do not interrupt CPR for a breathing and pulse check until Mrs. Clark shows an obvious sign of life.

Stephanie properly opened the airway and delivered ventilations. Which statement about delivering ventilations to an infant in cardiac arrest is true?

- Deliver 2 ventilations that last about 1 second each and make the chest begin to rise. -------------------- Yes, that's correct. When providing ventilations to Olivia, open the airway to a neutral position. Avoid hyperextension or flexion in the neck. Deliver 2 ventilations that last about 1 second and make the chest begin to rise. Minimize interruptions in chest compressions to less than 10 seconds.

When providing multiple-provider CPR for an infant, which compression technique should the team use?

- Encircling thumbs technique ---------------------- That's correct. When multiple providers are present, use the encircling thumbs technique. Place both thumbs (side-by-side) on the center of Olivia's chest just below the nipple line. Then use the other fingers to encircle her chest toward the back, providing support.

If Dr. Dave were alone and providing CPR, which would be the preferred technique?

- Encircling thumbs technique ----------------------- The encircling thumbs technique is now the preferred methodology for single-provider infant CPR. Alternatively, you may consider using the two-finger technique. If the required depth cannot be achieved with either the encircling thumbs technique or the two-finger technique in infants, you may consider using a one-hand technique.

If the AED came equipped with adult AED pads only, Vickie should not use them. Instead, she should call for someone to bring pediatric AED pads and continue CPR until the new pads arrive. True or false?

- FALSE ----------------------- If pediatric AED pads aren't available—or the AED doesn't have a pediatric setting—it's safe to use adult AED pads or adult levels of energy on Olivia. When using adult AED pads on an infant, use the anterior/posterior pad placement.

To perform chest thrusts, perform quick inward and upward thrusts.

- FALSE ------------------------ For chest thrusts, pull straight back, performing quick inward thrusts into the patient's chest. Do not thrust upward.

Ben is a 4-year-old child in cardiac arrest due to drowning. After recognizing that he is in cardiac arrest, you begin CPR immediately starting with compressions. This is the best course of action? True or False

- False ---------------- False. When drowning is suspected as the cause of cardiac arrest in a child or infant, deliver 2 initial ventilations before starting CPR. You may also consider delivering 2 initial ventilations before starting CPR in a child or infant with a primary respiratory etiology.

To perform compressions on Maggie, you use the encircling thumbs technique (i.e., two thumbs centered on the sternum just below the nipple line with fingers encircling the chest). Best Course of Action? True/False?

- False -------------------- False. For children, use the same technique as you do for an adult: One hand on top of the other with fingers interlaced and off the chest centered on lower half of the sternum, although on small children a one-hand technique is acceptable. The encircling thumbs technique is the preferred method used for infants during single-provider and multiple-provider CPR.

When delivering ventilations to Jalen, a 6-year-old patient, you open his airway to a neutral position. Best Course of Action? True/False?

- False ---------------------- False. For children like Jalen, you should open the airway to a slightly past neutral position. If Jalen were an infant, you would open the airway to a neutral position.

Mrs. Bailey is unresponsive. You suspect she may have a head injury. Which technique should you use to open Mrs. Bailey's airway?

- Modified Jaw Thrust --------- If the patient is unresponsive and their airway is not open, you need to open the airway. If a head, neck or spinal injury is suspected, use the modified jaw-thrust maneuver.

The AED analyzes and no shock is advised. Jenna takes over compressions while Quinn manages the airway and delivers ventilations. What should the team do after Jenna completes 30 chest compressions?

- Open Mrs. Clark's mouth, look for an object and perform a finger sweep if an object is seen. ------------------ Yes, that's correct. After 30 compressions, open Mrs. Clark's mouth, look for an object and perform a finger sweep if an object is seen. If you do not see the object, do not perform a blind finger sweep.

You come upon a child who has collapsed. You determine they are in cardiac arrest. You are alone and have no immediate access to a phone or other form of communication. Which action would you do first?

- Perform about 2 minutes of CPR, starting with chest compressions.

After performing a rapid assessment on an adult patient, you determine they are unresponsive, breathing and their pulse is present. You suspect they have a head and neck injury. What actions should you take?

- Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/initial interventions. - Perform secondary assessment as patient condition allows. - Reassess patient, recognize issues and provide care as needed.

You open Liz's airway and simultaneously check for breathing, a pulse and life-threatening bleeding. Liz is not breathing and has a central pulse of 68 bpm. Which action is the priority?

- Provide care for respiratory arrest, starting with ventilations. ----------------- That's right. Liz is in respiratory arrest, so you and the team should immediately deliver ventilations. Liz does not need chest compressions since she is not in cardiac arrest. Administration of naloxone is important, but remember delivering ventilations is the priority over administering naloxone during respiratory arrest.

After determining that Theo is unresponsive, Amy must tell Joe to activate the rapid response team and get the AED and resuscitation equipment. Then, she must simultaneously check for breathing, pulse and life-threatening bleeding. To accurately assess breathing, she should open the airway to a ________ position using the head-tilt/chin-lift technique.

- Slightly Past Neutral position ------------------------------ That's correct. To open Theo's airway using the head-tilt/chin-lift technique, Amy should tilt his head slightly past a neutral position.

Amy recognized that Theo was in cardiac arrest and initiated CPR. If Amy had determined that Theo were in respiratory arrest with a central pulse of ≤ 60 bpm and signs of poor perfusion, which action would she take?

- Start CPR immediately. ------------------- Good work! If Theo were in respiratory arrest with a central pulse rate of ≤ 60 bpm and signs of poor perfusion, Amy would start CPR immediately. She would continue compressions and ventilations checking the pulse and breathing about every 2 minutes. If at any time Theo's central pulse and perfusion improve, Amy would stop CPR and deliver 1 ventilation every 2 to 3 seconds until Theo is ventilating sufficiently. If at any time Theo's central pulse became absent, she would start CPR immediately and use an AED when it is available.

You and additional providers have been caring for a child in respiratory arrest with a pulse of 65 bpm. After 2 minutes, you reassess the child for breathing and a pulse. What should you do if the central pulse decreases to 50 bpm with signs of poor perfusion despite adequate ventilations and oxygen?

- Start CPR immediately. ---------------------- If their central pulse decreases to ≤ 60 bpm with signs of poor perfusion despite adequate ventilations and oxygen, start CPR immediately.

After administering naloxone, Jamal should check for responsiveness and assess for breathing and a pulse. True or false?

- TRUE ---------- This is true. After administering naloxone, check for responsiveness and assess for breathing and a pulse. If Liz responds, place her in a recovery position providing you do not suspect a head, neck, spinal, hip or pelvic injury. If she vomits, suction her airway or call for help to provide suctioning. Reassess Liz for any changes in condition until EMS arrives. If Liz stops responding, immediately reassess breathing and pulse. Then, begin care as appropriate.

Chest thrusts were not effective. You should now attempt a series of 5 back blows and 5 chest thrusts to clear the airway. True or false?

- TRUE ---------------- This is true. If initial back blows and chest thrusts are not effective, attempt a series of 5 back blows and 5 chest (or abdominal) thrusts to clear the airway. Always follow your facility's protocols.

As part of the rapid and primary assessments, you should use the opioid overdose triad. This includes pinpoint pupils, respiratory depression, and unconsciousness or severe sleepiness.

- TRUE ----------------- That's right. The opioid overdose triad consists of pinpoint pupils, respiratory depression, and unconsciousness or severe sleepiness.

Vickie should use an anterior/posterior position for pad placement for Olivia, as shown here. True or false?

- TRUE -------------------- That's right. Use anterior/posterior placement for infants with the anterior pad positioned in the middle of the chest and the posterior pad between the scapulae. Always follow the manufacturer's directions for pad placement.

If the patient with an obstructed airway is a child or shorter than you, it may be better to kneel behind them rather than stand to perform back blows and abdominal thrusts.

- TRUE ---------------------- If the patient with an obstructed airway is a child or shorter than you, it may be better to kneel behind them rather than stand to perform back blows and abdominal thrusts.

An adult patient with an endotracheal tube (ET) in place experiences cardiac arrest and requires CPR. Which of the following statements are true when performing high-quality CPR with an ET tube in place?

- The providers deliver 1 ventilation every 6 seconds. - The providers perform continuous compressions without pausing for ventilations

The team continued to provide high-quality CPR until the rapid response team arrived and relieved them. In which situations would the team stop performing CPR?

- Theo Spontaneously moves --------------------- That's correct. If the team saw signs of return of spontaneous circulation (ROSC), such as spontaneous movement or normal breathing, they would stop performing CPR on Theo. Remember, you should continue cycles of CPR/AED until: The team leader tells you to stop. You are presented with a valid DNR order. Other trained providers arrive to relieve you. You see signs of ROSC. You are too exhausted to continue. The situation becomes unsafe.

When performing back blows on an infant, where should you place the heel of your hand?

- To perform back blows, use the heel of your hand and firmly strike the patient in the center of the back, between the scapulae.

When providing CPR to a child or infant with an advanced airway in place, one provider should deliver 1 ventilation every 2 to 3 seconds, while the other provider delivers continuous chest compressions without pausing for ventilations. True or false?

- True

Maggie is 4 years old and weighs 42 pounds. You simultaneously check for breathing and a pulse (carotid) for no more than 10 seconds. At the same time, you scan the body for bleeding. Best Course of Action? True/False?

- True --------------- True. For children like Maggie, you should simultaneously check for breathing and a pulse (carotid) for no more than 10 seconds. At the same time, you should scan the body for life-threatening bleeding.

You have been caring for a young child in respiratory failure with a central pulse of 56 bpm and signs of poor perfusion. When you reassess them, you find their central pulse is now 68 bpm and their perfusion has improved. You stop CPR and deliver 1 ventilation every 2 to 3 seconds until the patient is ventilating sufficiently. This is the correct action. True or false?

- True ------------------- This is true. For a pulse of ≤ 60 bpm with signs of poor perfusion, start CPR. If pulse and perfusion improve, stop CPR and deliver 1 ventilation every 2 to 3 seconds until patient is ventilating sufficiently.

At the same time, Amy should scan the body for life-threatening bleeding. True or false?

- True -------------------- It's true! Amy should look again for life-threatening bleeding while checking Theo for breathing and a pulse. She should scan down the body looking for blood or other signs and symptoms that might not have been seen during the initial impression.

Sadie is a 2.5-year-old child weighing 28 pounds. To perform high-quality chest compressions, you may need to use a one-hand technique. Best Course of Action? True/False?

- True -------------------- True. For a smaller child, you may need to use a one-hand technique to perform high-quality chest compressions. When using a one-hand technique, be sure you are able to compress the chest about 2 inches.

When you attempt to apply the adult AED pads, you realize they will touch one another on Paloma's chest. Instead of the anterior/lateral position, you use the anterior/posterior position for AED pad placement. Best Course of Action? True/False?

- True -------------------- True. If the pads risk touching on a child's chest, you should use the anterior/posterior AED pad placement (i.e., apply one pad to the center of the patient's chest—on the sternum—and one pad to the patient's back between the scapulae).

After Ana-Lisa took over compressions, Joe and Amy worked together to operate the BVM. Joe maintained an open airway and sealed the mask with both hands in the E-C position, while Amy delivered ventilations. This is the recommended technique for operating the BVM when enough providers are available. True or false?

- True ---------------------- Good job! A two-person technique for bag-valve-mask (BVM) ventilations (also referred to as bag-mask ventilations) is the preferred methodology because it provides a better seal and ventilation volume. To perform this technique, one provider seals the mask and maintains an open airway while the other provider delivers ventilations. When there is only one provider to deliver ventilations during multiple-provider CPR, the ventilator may consider using a pocket mask over a BVM resuscitator for a better seal and ventilation volume. However, it is recognized that factors such as limited personnel or the need to perform other time critical interventions may preclude using two-person BVM technique. Also, BVM may be preferred to pocket mask for supplemental oxygen, positive end-expiratory pressure (PEEP) and infection control. In these situations, one-person BVM is acceptable.

Aaliyah is 11 years old and weighs 97 lbs. She shows signs of puberty including breast development. You provide chest compressions at a depth of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm). Best Course of Action? True/False?

- True ----------------------- True. Since Aaliyah has reached the onset of puberty, you should follow adult CPR guidelines. For adults the proper chest compression depth is at least 2 inches (5 cm) but no more than 2.4 inches (6 cm). For children, you would compress to a depth of about 2 inches. For infants, you would compress to a depth of about 1½ inches (3.8 cm) or one-third the anterior-posterior diameter of the chest.

After the shock is delivered (or if no shock is advised) you will switch from single-provider to multiple-provider CPR. Since two providers are now performing CPR and Paloma does not have an advanced airway in place, you switch to a compression/ventilation ratio of 15:2. Best Course of Action? True/False?

- True ----------------------- True. Since two providers are now performing CPR and Paloma does not have an advanced airway in place, you switch to a compression/ventilation ratio of 15:2.

You recognize that Maggie is in cardiac arrest. You are alone and do not have a mobile phone or other form of communication. Although you called out for someone to help and get an AED, nobody responded. You did not witness Maggie collapse, so you provide 2 minutes of CPR before leaving Maggie to get help. Best Course of Action? True/False?

- True ------------------------- True. If you are alone and do not have a mobile phone or other form of communication, you must decide to call first or care first: For an unresponsive child or infant whom you did not see collapse, you should first provide 2 minutes of care based on the conditions found. Then, call for additional resources. For a child or an infant whom you witnessed suddenly collapse or an unresponsive child or infant with a known cardiac condition, you should first call for additional resources. Then, provide care based on the conditions found.

If Theo were a smaller child or toddler, Amy could use a one-hand technique to perform high-quality chest compressions. True or false?

- True ---------------------------- Good work! To perform high-quality chest compressions for Theo, Amy should position one hand on top of the other with fingers interlaced and off the chest, centered on the lower half of the sternum. For a smaller child or toddler, Amy could use the one-hand technique. When using one hand, be sure you are able to compress the chest about 2 inches.

What is the correct way to perform back blows?

- Using the heel of your hand, firmly strike between the scapulae. ---------------- That's right. To perform back blows, position yourself to the side and slightly behind Mrs. Clark. Provide support by placing one arm diagonally across her chest. Then, bend Mrs. Clark forward at the waist so that her upper body is parallel to the ground (or as close as it can be). Using the heel of your other hand, firmly strike her between the scapulae. Make each blow a separate and distinct attempt to dislodge the object.

When is consent to give care implied for a responsive choking child?

- When a parent or guardian is not available to give consent. --------------------- Consent is implied for a responsive choking child when a parent or guardian is not available to give consent.

When performing abdominal thrusts, what is the correct placement of your fist on the patient's abdomen?

- When performing abdominal thrusts, place the thumb side of your fist on the middle of the abdomen, just above the navel.

A 28-year-old patient (27 weeks' gestation) was admitted to the intensive care unit for treatment of pneumonia-related sepsis. The patient goes into cardiac arrest. When should a trained provider perform resuscitative cesarean delivery (RCD)?

- Within 5 minutes from the time of arrest ---------------- RCD should be performed within 5 minutes from the time of arrest.

You and two other providers, Amanda and Ryan, witness an adult patient collapse in the hallway. You perform a visual survey, looking for life-threatening bleeding, and check for responsiveness. When the patient doesn't respond, you tell Amanda to activate the rapid response team and you tell Ryan to retrieve the AED and resuscitation equipment. Then, you open the airway and simultaneously check for breathing, a pulse and life-threatening bleeding. They both repeat your instructions back to you to "close the loop." Did the team respond appropriately?

- YES ------------------------ First, always perform a visual survey, looking for life-threatening bleeding, and check for responsiveness. At least one provider must remain with the patient to initiate care or to monitor the patient, while others retrieve equipment and call for help. It is important to use closed-loop communication to ensure all instructions have been clearly understood.

Is it safe to use an AED on a patient who has body piercings?

- YES -------- A patient's jewelry or body piercings do not need to be removed before using an AED, but avoid placing the AED pads directly over any metallic jewelry or piercings. Adjust pad placement if necessary.

Once the airway is open, you simultaneously check for breathing, a pulse and life-threatening bleeding. Is this the correct course of action?

- YES ---------- Simultaneously checking for breathing, a pulse and life-threatening bleeding is the correct course of action.

As you check Mrs. Bailey's breathing, you look to see whether her chest rises and falls, listen for escaping air and feel for breathing against the side of your cheek. Is this the correct course of action?

- YES ---------------- The correct course of action is to look to see whether the patient's chest rises and falls, listen for escaping air and feel for breathing against the side of your cheek.

Is it safe to use an AED on a patient who is pregnant?

- YES ----------------- It is safe to use an AED on a woman who is pregnant. However, AED pads should not incorporate any breast tissue.

to effectively communicate with family

- demonstrate credibility as well as confidence as well as confidence and empathy -build rapport and establish trust -speak slowly and in terms the family can understand -be prepared to repeat information, if necessary -be open and honest, especially about the patient's condition. minimize family members' fears as necessary, but avoid giving misleading information or false hope. ("Everything is going to be okay") -reassure the family that everything that can be done is being done

Next, Amy must simultaneously check for breathing and a pulse. Choose the recommended location to perform the pulse check.

- simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.

When providing care for an infant, perform chest thrusts about 1½ inches deep.

- true ------------------ You must place your fingers just below the nipple line and perform chest thrusts about 1½ inches deep. When allowing the chest to return to its normal position, remember to keep your fingers in contact with the breastbone.

Multiple Providers for a child or infant

-15:2 -15 compressions -2 ventilations *If a child or infant is in cardiac arrest and an advanced airway is in place, one provider delivers 1 ventilation every 6 to 8 seconds. At the same time, a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 15:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.

You would use pediatric AED pads for which children?

-2-year-old weighing 27 lbs -5-year-old weighing 43 lbs

Single provider for a child or infant

-30:2 -30 compressions *Remember for single-provider infant CPR, use the two-finger technique to provide chest compressions. -2 ventilations

Adjuncts to Ventilations

-Adjuncts to ventilations include supplemental oxygen, basic airways and advanced airways. Always follow your facility protocols when using adjuncts to ventilations. A trained and authorized provider can provide supplemental oxygen or insert an advanced airway as long as it does not delay the administration of chest compressions, ventilations or defibrillation. -Although a BLS provider is not always responsible for providing supplemental oxygen or inserting an advanced airway, you do need to know how to provide ventilations and monitor the patient while they are in place. -Ventilations using a BVM resuscitator deliver approximately 20% to 21% oxygen concentration to the patient. Attaching high-concentration supplemental oxygen to a BVM resuscitator can increase the oxygen concentration to approximately 90% to 100% and is recommended as soon as it is available. When supplemental oxygen is attached to a BVM resuscitator, ventilations are performed the same way. -If a basic airway is in place, care is performed the same way. However, if an advanced airway is in place, care must be performed a little differently. If the patient is in respiratory arrest, deliver 1 ventilation every 6 seconds. If the patient is in cardiac arrest, one provider delivers 1 ventilation every 6 seconds while another provider performs continuous chest compressions (i.e., providers do not pause for ventilations). Therefore, the 30:2 compression-to-ventilation ratio does not apply.

An adult patient with a suspected opioid overdose is in respiratory arrest. Which of the following actions are most appropriate?

-Administer naloxone, if your facility's protocol allows. -Check the pulse and breathing about every 2 minutes. -Provide 1 ventilation every 5 to 6 seconds.

You are working as part of a high-performance BLS team. Which roles would you and the other providers most likely fill?

-Airway manager/ventilator -AED operator -Team leader -Compressor

Child or Infant Call first or care first?

-Call First -For a child or an infant whom you witnessed suddenly collapse, or for an unresponsive child or infant with a known cardiac condition: -Call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. Then, provide care based on the conditions found. -Care First -For an unresponsive infant or child whom you did not see collapse: -Provide 2 minutes of care based on the conditions found. Then, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. *Because most child- or infant-related cardiac arrests occur as a result of a hypoxic event (e.g., an asthma exacerbation, an airway obstruction or a drowning), ventilations and appropriate oxygenation are important for successful resuscitation. Laryngeal spasm may occur in these situations, making passive ventilation during chest compressions minimal or nonexistent. Therefore, it is critical to make sure the child or infant's brain is oxygenated before leaving them to get additional resources.

Myocardial Infarction signs and symptoms

-Chest discomfort or pain that is severe, lasts longer than 3 to 5 minutes, goes away and comes back, or persists even during rest -Discomfort, pressure or pain that is persistent and ranges from discomfort to an unbearable crushing sensation in the chest, possibly spreading to the shoulder, arm, neck, jaw, stomach or back, and usually not relieved by resting, changing position or taking medication -Chest pain that comes and goes (such as angina pectoris) -Difficulty breathing, such as at a faster rate than normal or noisy breathing -Pale or ashen skin, especially around the face -Sweating, especially on the face -Dizziness or light-headedness -Possible altered mental status or level of consciousness -Nausea or vomiting Although women may experience the most common signs and symptoms of MI, such as chest pain, discomfort, nausea or vomiting, they may also experience common atypical warning signs, such as: -Shortness of breath. -Stomach, back or jaw pain. -Unexplained fatigue or malaise. These warning signs may occur with or without chest pain. When women do experience chest pain, it may be atypical—sudden, sharp but short-lived pain outside the breastbone. Like women, other individuals such as those with diabetes or older adults may present with atypical signs and symptoms.

For a patient in respiratory arrest, follow these steps:

-Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. -Continue ventilations. -Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR.

You are working with a BLS team performing CPR on a 62-year-old female patient. Which actions demonstrate high-quality CPR?

-Deliver smooth ventilations that last about 1 second each and make the chest begin to rise. -Allow for full chest recoil after each compression. -Compress the chest at a rate of 100 to 120 per minute.

AED environmental considerations

-Do not use an AED around flammable or combustible materials such as free-flowing oxygen. -It is safe to use an AED when a patient is lying on a metal surface, as long as appropriate precautions are taken. Do not allow the AED pads to contact the metal surface, and ensure that no one is touching the patient when the shock is delivered. -If the patient is lying in a large puddle or submerged in water, remove them from the water before using an AED. However, if they are lying in a small puddle or wet surface, you do not need to remove them providing you and the AED are not in the small puddle. Also, remove a patient's wet clothing from the chest and wipe the patient's chest dry before placing the AED pads. Avoid getting the AED or AED pads wet. -AEDs are safe to use in all weather conditions, including rain and snow. Provide a dry environment if possible, but do not delay defibrillation to do so. Remove a patient's wet clothing from the chest and wipe the patient's chest dry before placing the AED pads. Avoid getting the AED or AED pads wet.

What actions did the team take to minimize interruptions in chest compressions?

-Dr. Dave and Vickie switched roles within 10 seconds during the analysis. -The team continued CPR while Vickie set up and applied the AED pads. -The compressors hovered over Olivia's chest during the AED analysis and shock.

You are delivering ventilations with a bag-valve-mask (BVM) resuscitator to an adult patient in cardiac arrest. Which actions are correct?

-Ensure that the chest begins to rise. -Hold the mask in place with the E-C hand position. -Seal the mask and open the airway by lifting the jaw into the mask.

CPR Cycles

-For adult patients, high-quality CPR includes 30 chest compressions followed by 2 ventilations. Remember, when an advanced airway is in place, the 30:2 ratio does not apply. -When drowning or other hypoxic event is suspected as the cause of cardiac arrest, deliver two initial ventilations before starting CPR. -During single-provider CPR, one provider performs chest compressions and delivers ventilations. However, during multiple-provider CPR, one provider performs chest compressions while one or two other providers manage the airway and deliver ventilations. Remember, providers must smoothly transition between compressions and ventilations to minimize interruptions in compressions to less than 10 seconds.

Respiratory arrest

-If the patient is unresponsive, is not breathing normally (or only gasping) but has a pulse, they are in respiratory arrest. -Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise.

AED Single Provider

-If you do not have an AED with you, call for help and begin CPR. If you have no way of calling for help, place the patient in the recovery position and get the AED. -Turn on the AED and follow the prompts, then expose the patient's chest. -Attach the AED pads using an anterior/lateral or anterior/posterior position according to the manufacturer's recommendation. -If necessary, plug in the connector and push the analyze button. -Tell everyone to "clear" while the AED analyzes. No one, including you, should be touching the patient. -If the AED advises a shock, again tell everyone to "clear." Press the shock button to deliver the shock, then immediately begin CPR. You do not need to wait for the AED prompt. -Continue for about 2 minutes until: -The AED prompts that it is reanalyzing. -The patient shows signs of return of spontaneous circulation. -Other trained providers arrive and relieve you.

A young adult is brought into the emergency department by his mother. After completing a rapid assessment, you determine the patient is in cardiac arrest related to an opioid overdose. While the team initiates CPR, you prepare to administer naloxone. Which route(s) would be most appropriate to administer the naloxone?

-Intramuscular -Intravenous -Intranasal

AED Safety

-It is safe to use an AED on a woman who is pregnant. Remember, the baby's best chance of survival is the mother's survival. -It is safe to use an AED on a woman who is pregnant. Remember, the baby's best chance of survival is the mother's survival. -You should use an AED if a patient is in cardiac arrest and has a pacemaker or ICD. However, you should adjust the pad placement to avoid placing the AED pads directly over the device, because doing so may interfere with the delivery of the shock. A pacemaker or ICD may be placed in the right upper chest near the clavicle or in the abdomen. -Before applying AED pads, remove any medication patches with a gloved hand and wipe away any remaining medication from the skin. -Time is critical in a cardiac arrest situation and chest hair rarely interferes with pad adhesion. However, if the patient has a great deal of chest hair that could interfere with pad-to-skin contact, quickly shave the areas where the pads will be placed before attaching the AED pads. -A patient's jewelry or body piercings do not need to be removed before using an AED, but avoid placing the AED pads directly over any metallic jewelry or piercings. Adjust pad placement if necessary.

You are performing CPR on an 11-month-old infant. A second provider prepares to apply the AED pads, placing the pads at which locations?

-On the back between the scapulae -Middle of the infant's chest on the sternum

AED Multiple Providers

-One or more providers perform CPR while another provider prepares and operates the AED. -Turn on the AED and follow the prompts. -Attach the AED pads using an anterior/lateral or anterior/posterior position depending on the manufacturer's recommendation. -The team provides cycles of CPR until the AED prompts to clear for analysis. -As the AED analyzes, switch positions. The provider performing compressions should hover their hands above the patient's chest taking care not to touch the patient. -After the AED delivers a shock or advises "no shock," immediately resume CPR starting with chest compressions. You don't need to wait for the AED to prompt you. -Continue CPR for about 2 minutes until: -The AED prompts that it is reanalyzing. -The patient shows signs of return of spontaneous circulation. -Other trained providers arrive and relieve you. -Switch roles each time the AED analyzes the heart rhythm to relieve the compressor.

Mouth-to-Mouth Ventilations

-Open the airway to a past-neutral position (for an adult). -Pinch the patient's nose shut. Take a normal breath, make a complete seal over the patient's mouth with your mouth and blow into the patient's mouth to deliver 1 ventilation over 1 second until you see the chest begin to rise. -After each ventilation, break the seal and take a breath before resealing your mouth over the patient's mouth. Then deliver the next ventilation. *With mouth-to-mouth ventilations, the air the patient receives contains approximately 16% to 17% oxygen; the oxygen concentration of ambient air is approximately 20%. Breaking the seal after each ventilation and taking a breath can help maintain an oxygen concentration of approximately 16% to 17%. If you do not break the seal and take a breath between ventilations, the second ventilation may contain an oxygen concentration of 0% and a high concentration of carbon dioxide.*

To provide ventilations, you can use the following methods:

-Pocket mask ventilations -Bag-valve-mask resuscitator ventilations -Mouth-to-mouth ventilations -Mouth-to-nose ventilations *Additionally, adjuncts to ventilations include supplemental oxygen, basic airways and advanced airways.*

An adult patient suffers cardiac arrest in bed and requires CPR. When compressing the patient's chest, which technique promotes high-quality CPR?

-Position yourself so your shoulders are directly over your hands. -Place one hand on top of the other and interlace your fingers or hold them up so that they are not resting on the patient's chest. -Keep your arms straight and lock your elbows. Compress the chest using a straight down-and-up motion.

Valerie has established that Mr. Goodman does not have a pulse and is not breathing, and she has exposed the chest. She must immediately begin CPR while Joanne retrieves and sets up the AED. Which actions should the team take to ensure that they are providing high-quality CPR?

-Provide smooth compressions at a rate of 100 to 120 compressions per minute and a depth of at least 2 inches. -Avoid excessive ventilations. -Allow the chest to fully recoil after each compression.

A patient is suspected of an opioid overdose. Which findings would most likely support this suspicion?

-Respiratory depression -Pinpoint pupils -Unconsciousness

Applying Standard Precautions

-You must wear appropriate personal protective equipment (PPE) and follow standard precautions for the particular situation. -Always make sure to review your facility protocols for standard precautions. -Additionally, maintain good health habits (such as maintaining currency with all required and suggested immunizations, getting adequate sleep and exercise, and following a healthy diet) to lower your susceptibility to infection and prevent the spread of infection to others.

You enter an adult patient's room to provide routine care. Noticing the patient slumped over in the recliner, you perform a quick visual survey. This includes which of the following actions?

-determining the need for additional resources -obtaining an initial impression of the patient -assessing for safety

communicating with the family after after a patient's death

-in this situation, provide the information honestly and with compassion, in a straightforward manner, and include information about events that may follow -allow the family to begin processing the information -allow time for the family to begin the grief process. ask whether they would like to contact or have you contact anyone, such as other family members or clergy -anticipate a myriad of reactions by family members, such as crying, sobbing, shouting, anger, screaming or physical lashing out -wait and answer any questions that the family may have

You are about to start your morning rounds, when you hear a loud crash in Mrs. Bailey's room. When you enter her doorway, you see her lying on the floor with her walker tipped over next to her. You must first perform a visual survey. What actions should you take?

-observe for any signs of illness or injury, including life-threatening bleeding -determine whether any additional help is needed -scan the patient's room for any obvious hazards

Conduct a rapid assessment

-perform a quick visual survey -check for responsiveness -opening the patient's airway and simultaneously checking for breathing and a pulse. Then if an unresponsive patient isn't breathing normally and doesn't have a pulse, begin CPR.

you use critical thinking when...

-perform a rapid assessment and determine a course of action -anticipate roles and functions as part of a team based on the patient's presentation and condition -re-evaluate the situation for changes, interpret these changes and modify care accordingly

when receiving information

-provide confirmation that you have received the message and that you understand it by repeating the task back to the sender -acknowledge initiation and completion of the task -speak clearly in a calm tone of voice; avoid speaking over others

When delivering ventilations during CPR, if the chest does not rise after the first breath

-reopen the airway -make a seal and try a second ventilation. -If the second ventilation is not successful, move directly back to compressions and check the airway for an obstruction before attempting subsequent ventilations. -If an obstruction is found, remove it and attempt ventilations. *Never perform a blind finger sweep*..

An adult patient with an endotracheal tube (ET) in place experiences cardiac arrest and requires CPR. Which of the following statements are true when performing high-quality CPR with an ET tube in place?

-the provider delivers 1 ventilation every 6 seconds -The provider performs continuous compressions without pausing for ventilations.

You are providing abdominal thrusts to an adult patient with an obstructed airway when she suddenly becomes unresponsive. Another team member has already left to get the AED and additional resources. Identify the proper steps of care for an unresponsive adult with an obstructed airway.

1. Carefully lower the patient to a firm, flat surface. 2. perform 30 compressions 3. Look for an object in the patients mouth and perform a finger sweep if it is seen. 4. Deliver 2 ventilations. 5. Continue cycles of cpr, checking for an object before each set of ventilations

After the second dose of naloxone, Liz almost immediately makes some sudden movements. Jamal should perform which action(s)? Select all that apply.

1. Check responsiveness and assess for breathing and a pulse. 2. Suction the airway if Liz vomits. 3. Reassess Liz for any changes in condition.

Which of the following statements about performing chest compressions for adults are true?

1. Compress the chest to a depth of at least 2 inches (5 cm). 2. Provide smooth compressions at a rate of 100 to 120. 3. Allow the chest to fully recoil after each compression. ------------- Compress the chest to a depth of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) deep. Provide smooth compressions at a rate of 100 to 120 per minute. Remember to allow the chest to return to its normal position after each compression, achieving complete chest recoil. Be careful not to lean on the patient's chest during compressions. Compression and recoil times should be approximately equal.

Which of these actions are appropriate ways to minimize interruptions in chest compressions?

1. Continue CPR while the AED pads are applied. 2. Immediately resume CPR after the shock is delivered. ----------- It's important to minimize interruptions to CPR during high-quality CPR, so you should continue CPR while the AED pads are placed. During rhythm analysis and shock delivery, you should pause CPR and clear the patient when the AED prompts. After the shock is delivered, you should immediately resume CPR.

You and another provider are delivering ventilations with a bag-valve-mask (BVM) resuscitator to an adult patient in cardiac arrest. Which of the following statements are correct?

1. Hold the mask in place with the E-C hand position 2. Ensure that the chest begins to rise. 3. Seal the mask and open the airway by lifting the jaw into the mask. 4. Bag-valve-mask (BVM) ventilations should be performed as a two-person technique to provide a better seal and ventilation volume.

Identify the situations in which it is safe to use an AED.

1. If the patient is lying on a metal surface, providing the AED pads do not touch the surface and no one is touching the patient during shock 2. If the patient has a pacemaker or implantable cardioverter-defibrillators (ICDs), providing the AED pads are not placed directly over the device 3. If the patient is wearing jewelry or has body piercings, providing the AED pads are not placed directly over any metallic jewelry or piercings 4. If the patient is pregnant, providing the AED pads do not incorporate any breast tissue

A 9-year-old child is in cardiac arrest. You and another provider are present. The child's parents/legal guardians are not present. You stay with the child to begin CPR. Which actions would be appropriate for the second provider to do?

1. Retrieve AED and resuscitation equipment. 2. Activate EMS, rapid response or resuscitation team.

After 2 minutes of delivering ventilations to an adult patient in respiratory arrest, you reassess them for breathing and a pulse. What should you do if the patient's pulse becomes absent?

1. Start CPR immediately and use an AED when it is available -------- When you are caring for an adult patient in respiratory arrest (or respiratory failure), you should check for breathing and a pulse every 2 minutes. If their pulse becomes absent, you should start CPR immediately and use an AED when it is available.

You have been performing multiple-provider CPR and using an AED on an adult patient in cardiac arrest. The patient is now showing signs of return of spontaneous circulation (ROSC). Which action(s) would the team perform?

1. Stop CPR/AED 2. Check for breathing and a carotid or femoral pulse. 3. Monitor the patient until the advanced cardiac life support team takes over.

What priority actions should you take if an adult patient shows signs of ROSC?

1. Stop CPR/AED use. 2. Monitor the patient until the advanced cardiac life support team takes over 3. Check for breathing and a carotid or femoral pulse. --------------- If an adult patient shows signs of ROSC, stop CPR/AED use, check for breathing and pulse, and monitor the patient until the advanced cardiac life support team arrives.

Vickie has arrived with the AED and will now begin to use it. What are the proper steps for using an AED?

1. Vickie turns on the AED 2. Vickie attaches the AED pads while Dr.Dave continues CPR 3. Vicky says, "clear" while the AED analyzes 4. Dr.Dave and Vickie rotate positions 5. Vickie hovers her hands a few inches over Olivia's chest 6. Dr.Dave says, "clear" and pushes the shock button as soon as the AED prompts 7. Dr.Dave and Vickie immediately resume CPR

BLS for Adults 1. Conduct a Rapid assessment

1. perform a visual survey -Check your surroundings for safety. -Gather an initial impression, including whether there is severe, life-threatening bleeding. -Determine the need for additional resources. *The sequence of these steps is not critical if all goals are accomplished. Depending on the setting, additional resources may include emergency medical services (EMS), the rapid response team or the resuscitation team. Follow standard precautions, including using personal protective equipment (PPE), and obtain consent before proceeding if appropriate. 2. Check for responsiveness -Shout, "Are you OK?" Use the patient's name if you know it. -Tap the patient's shoulder and shout again (shout-tap-shout). -If the patient is unresponsive and you are alone, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If the patient is unresponsive and you are with another provider, the first provider stays with the patient. Other providers activate EMS, the rapid response team or the resuscitation team, as appropriate, and retrieve the AED, bag-valve-mask (BVM) resuscitator and other emergency equipment. 3. Simultaneously check for breathing and pulse -Open the patient's airway to a past-neutral position, using the head-tilt/chin-lift technique. Or, use the modified jaw-thrust maneuver, if you a suspect head, neck or spinal injury. -Simultaneously check for breathing and a carotid pulse for at least 5 seconds but no more than 10.

You demonstrate high-quality CPR by keeping interruptions in CPR to less than _____ seconds.

10

A 7-year-old patient goes into sudden cardiac arrest. You initiate CPR and correctly perform chest compressions at which rate?

100 to 120 compressions per minute

When performing multiple-provider CPR on an infant, the compression/ventilation ratio is ____: 2.

15

You and another provider are performing CPR on an infant who is in cardiac arrest. He does not have an advanced airway in place. You demonstrate appropriate technique for high-quality CPR by performing _____ compressions and 2 ventilations.

15

You and your colleagues are performing CPR on a 6-year-old child. What is the compression-to-ventilation ratio during multiple-provider CPR?

15:2

An infant has an obstructed airway and back blows have been ineffective. You attempt chest thrusts. To about which depth would you perform the chest thrusts?

1½ inches

An adult patient becomes unresponsive while you are attempting to clear their obstructed airway. After providing 30 compressions, you open the patient's mouth and look for an object. If you do not see the object, which action should you attempt next?

2 ventilations

BLS multiple providers key components

30:2 30 compressions 2 ventilations When multiple providers are available -the first provider performs the rapid assessment and begins providing CPR, starting with chest compressions. -Meanwhile, another provider calls for additional resources and gets and prepares the AED, if available. -If additional providers are available, they assist with ventilations. ----The providers continue to provide high-quality CPR (30:2), switching roles every 2 minutes and integrating additional resources as appropriate. -If an advanced airway is in place, one provider delivers 1 ventilation every 6 seconds. At the same time, a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 30:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.

You are working in an OB/GYN office when your patient, Mrs. Tribble, suddenly goes into cardiac arrest. While preparing the AED, your colleague reminds you that Mrs. Tribble is 28 weeks pregnant. Which statement is true regarding the use of an AED on a pregnant patient?

AED use is safe for pregnant patients.

A 5-year-old child experiences cardiac arrest and requires CPR. You ensure that high-quality CPR is administered when you compress the chest to which depth?

About 2 inches

AED Maintenance

As with any biomedical device, routine maintenance is necessary to ensure that the device performs properly and safely. AEDs require minimal maintenance, but it is important to check them regularly according to the manufacturer's instructions or your facility's policy to ensure that they are in good working order and ready to use whenever they are needed. -Familiarize yourself with the owner's manual and follow the manufacturer's instructions for maintaining the equipment. -Familiarize yourself with the method the AED uses to indicate the status of the device. Many AEDs have a status indicator that displays a symbol or illuminates to indicate that the AED is in proper working order and ready to respond. -The status indicator may also display symbols indicating routine maintenance (e.g., a battery change) is needed or that a problem with the device has been detected. Some AEDs have a warning indicator that illuminates or beeps if the AED is not in proper working order or is not ready to respond. -Make sure the battery is properly installed and within its expiration date. -Make sure AED pads are adequately stocked, stored in a sealed package and within their expiration date. -After using the AED, make sure that all supplies are restocked and that the device is in proper working order. -If at any time the AED fails to work properly or warning indicators illuminate or beep, take the AED out of service based on manufacturer's recommendations and contact the manufacturer or the appropriate person at your facility, according to your facility's policy.

You enter Ms. Evers's room and notice her lunch splattered on the floor. She is slumped over the bedside table and does not appear to be breathing. You perform a visual survey and determine that the scene is safe. Which is the next appropriate action?

Check for responsiveness.

When you simultaneously check for breathing and a pulse, you note the patient is not breathing normally but has a pulse. What should you do next?

Deliver 1 ventilation every 5 to 6 seconds, each lasting about 1 second, while checking for breathing and pulse about every 2 minutes.

Abandonment

Discontinuing care once it has begun. You must continue care until someone with equal or more advanced training takes over.

Conduct a rapid assessment, which includes performing a quick visual survey and checking for responsiveness, opening the patient's airway and simultaneously checking for breathing and a pulse. Then if an unresponsive patient isn't breathing normally and doesn't have a pulse, begin CPR.

Ensure that the patient is on a firm, flat surface. In a healthcare setting, use a bed with a CPR feature, or place a CPR board under the patient to provide a firm, flat surface. In other settings, move the patient to the floor or ground before beginning CPR. Stand or kneel beside the patient. If the patient is in bed, make sure you are at a good working height.

What are some examples of a patient for whom chest thrusts would be the alternative technique, instead of abdominal thrusts?

Examples of a patient for whom chest thrusts would be the alternative technique to back blows or abdominal thrusts include: - Patient whom you may not be able to reach far enough around to perform abdominal thrusts - Patient whom might be pregnant - Patient in a bed or wheelchair with features that make abdominal thrusts difficult to do - Patient for whom back blows or abdominal thrusts are not effective in dislodging the object

Position your hands correctly

Expose the patient's chest so you can ensure proper hand placement and visualize chest recoil. Place the heel of one hand in the center of the patient's chest on the lower half of the sternum. Place your other hand on top of the first and interlace your fingers or hold them up so that they are not resting on the patient's chest.

Paloma is 8 years old and weighs 62 pounds. Single-provider CPR is in progress and you have just arrived with the AED. You set up the AED and apply pediatric AED pads while CPR continues.

FALSE. Since Paloma is 8 years old and weighs more than 55 pounds, you should use adult AED pads or adult electrical settings. Never use pediatric AED pads or a pediatric electrical setting on a child older than 8 years or weighing more than 55 pounds. That's because the shock delivered will not be sufficient.

Andres is a 6-month-old patient weighing 17 pounds. You find him motionless. To check responsiveness, you shout "Are you OK?" and tap his shoulder, then shout again.

False. For infants like Andres, you should shout "Are you OK?" and tap the bottom of Andres' foot. Then shout again.

Hand hygiene:

Hand washing is the most effective measure to prevent the spread of infection. Alcohol-based hand sanitizers allow you to clean your hands when soap and water are not readily available and your hands are not visibly soiled.

Continuous Quality Improvement

Healthcare providers and their employers have a responsibility to ensure that they provide the highest quality CPR throughout every resuscitation event. To achieve this goal, it is necessary to gather and use data to inform improvements in individual and team performance. Methods of evaluating CPR quality include visual observation and the use of feedback devices, calculations such as the chest compression fraction, and capnography. Additionally, debriefing after the resuscitation events allows the team to make any necessary changes in order to positively affect the outcome of future resuscitation events.

Mr. Goodman is exhibiting signs and symptoms of which condition?

Heart attack

The AED arrives, and you attach the pads appropriately and clear the area. When the AED is analyzing or delivering a shock, what should you do?

Hover your hands over the patient's chest, taking care not to touch the patient.

Injury or illness

If the patient is responsive (e.g., speaking, moaning, crying or moving around), obtain their consent to provide care, reassure them and take steps to find out what occurred. If the patient is unresponsive or experiencing an altered level of consciousness, is breathing normally and has a pulse, follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If you do not suspect a head, neck, spinal or pelvic injury, place the patient in a side-lying recovery position. -If you suspect a head, neck, spinal or pelvic injury, maintain the patient in their current position. Avoid further moving the patient unless it is absolutely necessary. For example, if you need to leave the patient to call for help and/or get additional resources, place the patient in a side-lying recovery position. -Monitor the patient until EMS, the rapid response team or the resuscitation team arrives.

Cardiac arrest

If the patient is unresponsive, is not breathing normally (or only gasping) and does not have a pulse, they are in cardiac arrest. -Start CPR within 10 seconds of recognizing cardiac arrest and use an AED when it is available. See Lesson 3 for more information. -Remember: Cardiac arrest is different from myocardial infarction (or heart attack); however, a myocardial infarction can lead to cardiac arrest.

Single Provider CPR Children and Infants

If the patient is unresponsive, not breathing normally (or only gasping) and has no pulse, they are in cardiac arrest. Follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If you are alone and do not have a mobile phone or other form of communication, you must decide to call first or care first. -Start CPR within 10 seconds of recognizing cardiac arrest following the steps outlined in the Care section. *If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR. *For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).

BLS for Children and Infants Respiratory arrest with a pulse > 60 bpm

If the patient is unresponsive, not breathing normally (or only gasping) but has a pulse > 60 bpm, they are in respiratory arrest. Follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If you are alone and do not have a mobile phone or other form of communication, you must decide to call first or care first. -Deliver 1 ventilation every 3 to 5 seconds; each ventilation should last about 1 second and make the chest begin to rise. -Continue ventilations. Check the pulse and breathing about every 2 minutes. -If the pulse decreases to 60 bpm or less with signs of poor perfusion, begin CPR as outlined in the Care section and reassess about every 2 minutes. *Signs of poor perfusion in a child or infant include cool, moist skin; pallor, mottling or cyanosis; a weak or thready pulse; decreased capillary refill; and hypotension. *For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).

Child or Infant Respiratory arrest with a pulse ≤ 60 bpm and signs of poor perfusion

If the patient is unresponsive, showing signs of poor perfusion and not breathing normally (or only gasping) but has a pulse ≤ 60 bpm, they are in respiratory arrest. Follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. -If you are alone and do not have a mobile phone, you must decide to call first or care first. -Begin CPR as outlined in the Care section. -Continue ventilations and chest compressions. -Check the pulse and breathing about every 2 minutes. -If the child is not breathing normally and the pulse increases to greater than 60 bpm, stop chest compressions but continue providing 1 ventilation every 3 to 5 seconds. -If the child is not breathing normally but has a pulse less than 60 bpm, continue CPR. *Signs of poor perfusion in a child or infant include cool, moist skin; pallor, mottling or cyanosis; a weak or thready pulse; decreased capillary refill; and hypotension. *For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available).

Recovery Positions

It is important to understand how to use a recovery position, especially when you are alone with a patient. To place a supine adult patient in a recovery position: -Kneel at the patient's side. --Lift the patient's arm closest to you up next to their head. Place the patient's arm farthest from you next to their side. -Grasp their leg closest to you, flex it at the hip and bend the knee toward their head. -Place one of your hands on the patient's shoulder and your other hand on their hip farthest from you. Using a smooth motion, roll the patient toward you by pulling their shoulder and hip with your hands. Make sure the patient's head remains in contact with their extended arm. -Stop all movement when the patient is on their side. -Place their knee on top of the other knee so that both knees are in a bent position. -Place the patient's free hand under their chin to help support their head and airway.

If capnography were in use, an ETCO2 level of ___ would indicate to the team that there could be a problem with the quality of chest compressions.

Less than 10 mmHg

Work practice controls:

Methods of working that reduce the likelihood of an exposure incident by changing the way a task is carried out.

Position your body effectively

Position yourself so your shoulders are directly over your hands. Keep your arms straight and lock your elbows. Compress the chest using a straight up-and-down motion. This allows you to use your body weight rather than your muscular strength, which is more effective and less tiring.

What are some possible behaviors of a patient who is choking?

Possible behaviors of a patient who is choking include: - Panicked, confused or surprised facial expression - Clutching the throat (the universal sign of choking) - Running about - Flailing the arms - Trying to get attention - Stridor (high-pitching squeaking noises) - No noises at all - Flushed, pale or cyanotic skin appearance

If the patient responds to the naloxone, you need to be prepared to perform which action(s) most immediately?

Protect yourselves against a possible violent reaction from Liz, clear the airway if needed and put Liz into a recovery position. Patients who respond after naloxone frequently vomit and may even become violent. Immediately, you should prepare to clear Liz's airway, while keeping your safety in mind. It is not necessary to restrain Liz, and it is often dangerous to do so. Finding out which substances or medications she may have used or ingested is important, but not a priority while she is regaining consciousness.

BLS for Adult 2. Recognize

Recognize the emergency condition and determine your immediate course of action: 1. Respiratory arrest If the patient is unresponsive, not breathing normally (or only gasping) but has a pulse, they are in respiratory arrest. Follow these steps: -If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate. -Call for an AED. -Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. -Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, start CPR within 10 seconds following the steps outlined in the Care section. *For a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available). 2. Cardiac Arrest If the patient is unresponsive, not breathing normally (or only gasping) and has no pulse, they are in cardiac arrest. Follow these steps: - If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate. -Call for an AED. -Start CPR within 10 seconds following the steps outlined in the Care section. *or a suspected or known opioid overdose, administer naloxone per your facility's protocol (if available). *If drowning or another hypoxic event is the suspected cause of cardiac arrest, deliver 2 initial ventilations before starting CPR.

BLS for Adult 3. Provide CPR/AED Care

Review the specific care steps for a patient in cardiac arrest who does not have an advanced airway in place: -Single-Provider CPR -Multiple-Provider CPR -AED Use -Stopping CPR/AED Use

If Theo were a smaller child or toddler, Amy could use a one-hand technique to perform high-quality chest compressions. True or false?

TRUE Amy could use the one-hand technique. When using one hand, be sure you are able to compress the chest about 2 inches.

The code team has arrived to take over resuscitative efforts. Among the members of the BLS team, whose role is it to communicate to the code team the patient's status and the care already provided?

Team leader

Based on her rapid assessment findings, Amy recognized that Theo was in cardiac arrest and initiated CPR. If Theo were unresponsive and not breathing normally but had a pulse of ≤ 60 bpm with signs of poor perfusion, which action would Amy take?

Tell Joe to get help and an AED. Begin CPR. Continue compressions and ventilations. Check the pulse and breathing about every 2 minutes.

Olivia is unresponsive. Dr. Dave needs to assess for breathing, a pulse and life-threatening bleeding. Choose the recommended location to perform the pulse check.

The correct place to check Olivia's pulse is at the brachial artery in the arm.

Standard of Care

The public's expectation that personnel summoned to an emergency will provide care with a certain level of knowledge and skill

An adult patient in respiratory failure may have some ventilation; however, this ventilation is insufficient to sustain needed gas exchange, oxygen and carbon dioxide. True or false?

True

Vickie should use an anterior/posterior position for pad placement for Olivia, as shown here. True or false?

True

When you attempt to apply the adult AED pads, you realize they will touch one another on Paloma's chest. Instead of the anterior/lateral position, you use the anterior/posterior position for AED pad placement.

True. If the pads risk touching on a child's chest, you should use the anterior/posterior AED pad placement (i.e., apply one pad to the center of the patient's chest—on the sternum—and one pad to the patient's back between the scapulae).

You recognize that Maggie is in cardiac arrest. You are alone and do not have a mobile phone or other form of communication. Although you called out for someone to help and get an AED, nobody responded. You did not witness Maggie collapse, so you provide 2 minutes of CPR before leaving Maggie to get help.

True. If you are alone and do not have a mobile phone or other form of communication, you must decide to call first or care first: -For an unresponsive child or infant whom you did not see collapse, you should first provide 2 minutes of care based on the conditions found. Then, call for additional resources. -For a child or an infant whom you witnessed suddenly collapse or an unresponsive child or infant with a known cardiac condition, you should first call for additional resources. Then, provide care based on the conditions found.

Aaliyah is 11 years old and weighs 97 lbs. She shows signs of puberty including breast development. You provide chest compressions at a depth of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm).

True. Since Aaliyah has reached the onset of puberty, you should follow adult CPR guidelines. For adults the proper chest compression depth is at least 2 inches (5 cm) but no more than 2.4 inches (6 cm). For children, you would compress to a depth of about 2 inches. For infants, you would compress to a depth of about 1½ inches (3.8 cm) or one-third the anterior-posterior diameter of the chest.

You will take over compressions during the AED analysis switching from single-provider to multiple-provider CPR. Since two providers are now performing CPR and Paloma does not have an advanced airway in place, you switch to a compression/ventilation ratio of 15:2.

True. Since two providers are now performing CPR and Paloma does not have an advanced airway in place, you switch to a compression/ventilation ratio of 15:2.

After exposing the patient's chest, how should your hands be positioned?

Two hands, one on top of the other, fingers interlaced

Open the airway

Use an adult pocket mask for single-provider CPR or BVM for multiple-provider CPR. Seal the mask and simultaneously open the airway to a past-neutral position. Or, use the modified jaw-thrust maneuver if you suspect a head, neck or spinal injury.

Pocket Mask Ventilations

Use of a pocket mask is recommended during single-provider CPR to limit interruptions in chest compressions. This allows you to remain at the side of the patient and limit unnecessary movement, which could delay your return to chest compressions.

The room is safe to enter. As you approach Mrs. Bailey you do not see any signs of life-threatening bleeding, but she appears unresponsive. Which action should you perform next?

Use the shout-tap-shout sequence to determine responsiveness.

Provide 2 ventilations

While maintaining the mask seal and open airway, provide smooth, effortless ventilations. Each ventilation should last about 1 second and make the chest begin to rise. Avoid excessive ventilations. If you do not have a pocket mask or BVM, provide mouth-to-mouth or mouth-to-nose ventilations.

You and two other providers, Amanda and Ryan, witness an adult patient collapse in the hospital hallway. You perform a visual survey and check for responsiveness. When the patient doesn't respond to the shout-tap-shout sequence, you tell Amanda to activate the rapid response team and Ryan to retrieve the AED and BVM. Then, you open the airway and simultaneously check for breathing and a pulse. They both repeat your instructions back to you to "close the loop." Did the team respond appropriately?

YES

Should Jamal administer naloxone during cardiac arrest to a patient experiencing opioid overdose?

Yes

You and the team delivered one shock to the patient, then performed about 2 minutes of CPR. You have been performing compressions and are starting to fatigue. What should you do?

You should anticipate a compressor change and verbalize the coordination plan to switch. You should switch off compressions when the AED analyzes again.

Amanda returns and announces the code team is on the way and Ryan returns stating, "I have the AED and BVM." After providing 2 minutes of ventilations, you open the airway and simultaneously check for breathing and a pulse. The patient is not breathing normally and does not have a pulse. What should the team do next?

You should immediately perform 30 chest compressions, while Amanda prepares to deliver 2 ventilations. Ryan should set up the AED, attach the pads and tell everyone to "clear" as the AED begins to analyze.

closed-loop communication

a communication technique used to prevent misunderstandings; the receiver confirms that the message has been received and understood

Laurens response is an example of what type of communication?

closed-loop communication

crew resource management

emphasizes the use of all available resources (including people, equipment and procedures) to promote effective and efficient teamwork and reduce the likelihood of human error. when following the principles of crew resource management, all members of the team demonstrate respect for one another and use clear, closed-loop communication -being a member of the team is just as important as being a team leader. Everyone on the team needs to have a voice and be encouraged to speak up if a problem arises -centers around the team leader, who coordinates the actions and activities of team members so that the team function effectively and efficiently. it also guides the team members to communicate directly and openly with the team leader about dangerous or time-critical decisions -when a problem arises, team members must get the attention of the team leader, state their concern, describe the problem as they see it and suggest a solution. the team leader then provides direction, enables the team to work together to resolve the issue

Olivia is unresponsive. Dr. Dave needs to assess breathing and perform a pulse check. Choose the recommended location to perform the pulse check.

he correct place to check Olivia's pulse is at the brachial artery in the arm.

teamwork

is crucial during resuscitation because the ultimate goal is to save a life. an effective coordinated effort by the BLS team improves patient outcomes

Mr. Henderson is unresponsive. After directing Gloria to activate EMS and get an AED and BVM, you simultaneously check for breathing and a pulse. "One one-thousand, two one-thousand, three one-thousand, four one-thousand, five one-thousand..." You note he is not breathing normally but has a pulse. What emergency condition is Mr. Henderson experiencing?

respiratory arrest

feedback

the confirmation by the receiver that the message has been received and understood; an essential element of closed-loop communication

message

the content of the communication: this must be expressed clearly so that everyone involved knows exactly what the message is

sender

the person initiating the communication

critical thinking

thinking clearly and rationally to identify the connection between information and actions. When you use critical thinking, you are constantly identifying new information, adapting to the information logically in order to determine you best next actions and anticipating how those actions will affect the patient.

The team leader assigns roles, supports the team, monitors the delivery of CPR and makes adjustments in real time. The team members deliver expert care within their assigned roles, assist others as needed (as long as they can maintain their own assigned responsibilities) and communicate effectively with the team leader and each other. True or false?

true

As you check Mrs. Bailey's breathing, you look to see whether her chest rises and falls, listen for escaping air and feel for breathing against the side of your cheek. Is this the correct course of action?

yes