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.

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.

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.

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.

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.

feedback

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

sender

the person initiating the communication

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

10

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

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

2

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 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.

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

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.

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)

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

15

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.

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

team leader

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

What is the correct way to perform back blows?

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

Negligence

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

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.

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.

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

1 ventilation every 5 to 6 seconds

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

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.

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.

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.

review

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

analyze

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

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.

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 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

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

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

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.

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

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

True

How is a child defined in terms of CPR care?

Someone from the age of 1 to the onset of puberty

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.

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.

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

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.

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

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.

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

example of closed loop communication

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

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

YES

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

Yes

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

child

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."

Standard of Care

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

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.

Battery

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

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.

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

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

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

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.

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

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

this is an example of effective family communication

true

In addition to EMS, you immediately request which resources?

AED, BVM and naloxone

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.

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

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

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).

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.

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.

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

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).

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.

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

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.

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.

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.

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.

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

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.

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.

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.*

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

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.*

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.

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.

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

-Respiratory depression -Pinpoint pupils -Unconsciousness

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

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.

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

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 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

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

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

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*..

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.

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.

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

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

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

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%.

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 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.

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

About 1½ inches

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 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

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.

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.

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.

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

Assess, Recognize, Care

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.

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

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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

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

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

Proper spill cleanup procedures:

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

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.

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).

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).

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).

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.

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.

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

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.

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 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

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.

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.

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.

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.

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.

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.

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

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

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

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

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

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

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.

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.

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.

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%.

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.

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.

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.

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.

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

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.

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.

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

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.

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.

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

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

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

carotid artery (neck)

communication with the team

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

problem solving

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

message

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

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

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

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

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

yes

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.

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.

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.

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

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.

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.

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.

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

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

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

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 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.

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

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

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

At least 5 seconds but no more than 10

Proper equipment cleaning:

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

Work practice controls:

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

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.

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.

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.

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.

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).

closed-loop communication

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

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

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 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

Laurens response is an example of what type of communication?

closed-loop communication

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

crew resource management

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

deliver ventilation

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

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

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

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