Chap 14 "BLS Resuscitation"

If she is in cardiac arrest, and the top of the patient's uterus can be felt at or above the level of the umbilicus, what should be performed

perform manual displacement of the uterus to the patient's left to relieve aortocaval compression while CPR is being performed

How do you ventilate a pt with a stoma

place a bag-mask device or pocket mask device directly over the stoma, close nose and mouth

When performing the abdominal thrust where is the thumb positioned

place the thumb side of one fist against the patient's abdomen while holding your fist with your other hand.

If a pregnant pt is not in cardiac arrest how do you position them

position her on her left side to relieve pressure on the great vessels

How is a pediatric pt positioned when they are struggling to breath

position of comfort

How is the abdominal thrust delivered in what direction

press your fists into the patient's abdomen, using inward and upward thrusts.

What happens to a pt when they get a laryngectomy

pt gets a stoma

Define ventricular tachycardia

rapid contraction of the ventricles that doesn't allow normal filling of the heart

How do you handle an unresponsive breathing child with an obstruction

recovery position unless you suspect injury to the spine, hips, or pelvis.

How do you ventilate a pediatric with a tracheostomy tube

remove the mask from the bag-mask device and connect it directly to the tracheostomy tube to ventilate the child

How do you handle transdermal patches in the way of electrode placement

removed with gloved hand wipe away residue

What occurs first in infants/children typically cardiac arrest or respiratory arrest

respiratory arrest typically

In most cases, cardiac arrest in infants and children follows what

respiratory arrest, which triggers hypoxia and ischemia of the heart.

How much time should it take you recognize that a patient needs BLS and the start of treatment

seconds

If the patient with a severe airway obstruction is unresponsive what is done

start performing chest compressions

What are signs of a severe airway obstruction

suddenly unable to speak or cough, grasps his or her throat, turns cyanotic, and makes exaggerated efforts to breathe. (Stridor may be present)

How must the pt be placed for CPR to start

supine on a hard surface

In children, especially those older than 8 years, you can use what technique to provide compressions

the heel of one or both hands to compress the chest

Ensure enough space around the patient for

two rescuers to perform CPR Note: If possible, log roll the patient onto a long backboard

Where is the usual placement of a pace maker/ACIDs

upper left side of the chest (just below the clavicle)

Define hyperventilation

ventilating too fast or with too much force

Do you give CPR to a child with a pulse less than 60

yes

What is the respiration ratio for children

deliver a breath every 2-3 seconds (20 to 30 breaths/min).

BLS is uses what sequence for cardiac arrest

C-compressions A-Air way B-Breathing

What are the stages of brain oxygen deprivation (5)

0-1 cardiac irritability 0-4 brain damage likely 4-6 brain damage possible 6-10 brain damage likely 10-more irreversible brain damage

How do you place electrode pads around pacemakers/implanted defibrillators

1 inch (2.5 cm) away from the device

How long should the delivery of a breath take

1 sec breath

What is the ratio of compressions for adult CPR pts and how many compressions a minute does this achieve (2)

1. 100-120 in a minute 2. 30:2

What are the compression depths in adults and infants/children (2)

1. 2-2.4" adult 2. 1.5" inch deep pediatric

What doe's ALS provide that can benefit BLS (3)

1. Cardiac monitoring 2. Administration of intravenous (IV) fluids and medications 3. Use of advanced airway adjuncts

What steps are conducted for finding an unresponsive pt (4)

1. Determine unresponsiveness and check for breathing and a pulse simultaneously. 2. If pulse is present but breathing is absent, then open the airway and attempt to ventilate. a. If the first ventilation does not produce visible chest rise, then reposition the airway and reattempt to ventilate. 3. If both ventilation attempts do not produce visible chest rise, then perform 30 compressions, open the airway, and look in the mouth. a. Attempt to carefully remove any visible object.

What is the process of CPR on an infant that is unresponsive (3)

1. Do not check for a pulse before starting compressions. 2. Open the airway and look in the mouth. a. If you see an object that can be easily removed, then remove it with your finger and attempt to ventilate. b. If you do not see an object, then resume chest compressions. 3. Continue the sequence of chest compressions, opening the airway, and looking inside the mouth until the obstruction is relieved or ALS providers take over.

What are the 3 rules regarding not to start CPR

1. If the scene is unsafe 2. obvious signs of death 3. If the patient and physician have previously agreed on do not resuscitate (DNR) orders

Causes of respiratory problems leading to cardiopulmonary arrest in children are (7)

1. Injury, both blunt and penetrating 2. Infections of the respiratory tract or another organ system (croup, epiglottitis) 3. Foreign body in the airway 4. Submersion (drowning) 5. Electrocution 6. Poisoning or drug overdose 7. Sudden infant death syndrome (SIDS)

What is done for pts with mild airway obstructions (3)

1. Leave these patients alone 2. Observe for signs of a severe airway obstruction 3. Give supplemental oxygen

Once a conscious pt with a blocked airway becomes unconscious what steps are done (4)

1. Lower the pt to the ground and call for help 2. Perform 30 chest compressions. a. Do not check for a pulse before beginning chest compressions. 3. Open the airway and look in the mouth. a. If you see an object that can be easily removed, remove it with your fingers and attempt to ventilate. b. If you do not see any object, resume chest compressions. 4. Repeat steps 2 and 3 until the obstruction is relieved or ALS providers take over.

Performing CPR on a Child

1. Place the child on a firm surface. Identify the location for hand placement, Place the heel of one or two hands in the center of the chest, in between the nipples, avoiding the xiphoid process. 2. Compress the chest at least one-third (2" deep) the anterior-posterior diameter of the chest at a rate of 100 to 120 times/min. Coordinate compressions with ventilations in a 30:2 ratio (one rescuer) or 15:2 (two rescuers), pausing for two ventilations. Reassess for a pulse after 2 minutes. If there is no pulse and an AED is available, then resume CPR and apply the AED pads.

Performing Chest Compressions Adult

1. Place the heel of one hand on the center of the chest (lower half of the sternum). 2. Place the heel of your other hand over the first hand. 3. With your arms straight, lock your elbows and position your shoulders directly over your hands. Depress the sternum at a rate of 100 to 120 compressions per minute, and to a depth of 2 to 2.4 inches (5 to 6 cm) using a downward movement. Allow the chest to return to its normal position; do not lean on the chest between compressions. Compression and relaxation should be of equal duration.

Removing a Foreign Body Airway Obstruction in an Unresponsive Child (5)

1. Position the child on a firm, flat surface. 2. Perform chest compressions using the same landmark as you would for CPR, in between the nipples. 3. Open the airway and look inside the mouth. 4. If an object is visible and can easily be removed, then remove it with your fingers and attempt rescue breathing. 5. If you do not see an object in the mouth, then resume chest compressions. Continue the sequence of chest compressions, opening the airway, and looking inside the mouth until the obstruction is relieved or ALS providers take over.

Performing Infant Chest Compressions (2)

1. Position the infant on a firm surface while maintaining the airway. Place two fingers in the middle of the sternum with one finger just below the nipple line. 2. Use two fingers to compress the chest at least one-third its depth at a rate of 100 to 120 per minute. Allow the sternum to return to its normal position between compressions.

What are the parts of the chain of survival (6)

1. Recognition and activation of the emergency response system 2. Immediate, high-quality CPR 3. Rapid defibrillation 4. Basic and advanced emergency medical services 5. ALS and post-arrest care 6. Recovery

Once you begin CPR, continue until one of the following occur (using the mnemonic STOP):

1. Starts breathing and has a pulse 2. Transferred pt to another provider of equal or higher-level training 3. Out of strength 4. Physician directs you to discontinue

After resuscitation has stopped, these other measures can be helpful (10)

1. Take the family to a quiet, private place. 2. Introduce yourself and anyone with you. 3. Use clear language and speak in a warm, sensitive, and caring manner. 4. Try to exhibit calm, reassuring authority. 5. Use the patient's name. 6. Use eye contact and appropriate touch. 7. Expect that family members will show emotion as they begin the grieving process. 8. While you are still on scene, be supportive but do not hover. 9. Ask if a friend or family member can be called to come and help support them. 10. When you need to leave, turn the family over to someone else.

How do you gain access to the airway non trauma and trauma

1. Trauma-jaw thrust 2. Non trauma- head tilt chin lift

What are the dysrhythmias that cause cardiac arrest

1. Ventricular fibrillation (VF) 2. Ventricular tachycardia (VT)

Where is a ITD placed on a pt (2)

1. between the et tube and a bag-mask device 2. placed between the bag and mask if an et tube is not in place

Complications from chest compressions are (3)

1. fractured ribs 2. lacerated liver 3. fractured sternum

What do you do for responsive infants who are choking (4)

1. hold the infant face down with the body resting on your forearm supporting the infant's jaw and face with your hand, keeping the lower body higher than the rest of the body 2. deliver 5 back blows between the infants shoulder blades using the heel of your hand 3. Turn infant face up with the infant's head still below the rest of the body 4. then provide 5 chest thrusts using 2 fingers placed on the lower half of the sternum 1.5" deep 4 cm

Describe how an infant's chest should be compressed (2)

1. only use two fingers to compress an infant's chest 2. two rescuers are performing CPR on an infant, use the two-thumb-encircling-hands technique to deliver chest compressions.

What supplies do you need for pediatric pts for AED use

1. pediatric pads 2. Dose attenuating system (dose reducer)

What are types of barrier devices used in CPR (3)

1. pocket mask 2. one-way valve 3. bag-mask device

Proper chest compressions only pump the equivalent of what of a normal heart beat

1/3

The steps of figuring out if a pt needs CPR should take then than what time

10 seconds

If you have 2 rescuers for an infant/child pt what is the compression ratios

15:2

What is the compression to relaxation ratio

1:1 compression to relaxation ratio

How do you perform CPR on a child alone

2 mins CPR then call for help and retrieve AED

If the child is not breathing and does not have a pulse, then deliver what (one rescuer)

2 rescue breaths after every 30 chest compressions

What is the depth of compression on an adult

2"-2.4" (5-6 cm)

What rate do children consume oxygen more than adults

2x-3x more than adults

If you have two rescuers and conducting CPR on a child what ratios of CPR can you use

30:2 (1 rescuer) 15:2 (2 rescuer)

Permanent brain damage is possible if brain is without oxygen for more than

4 to 6 minutes

BLS following what sequence

A-Airway B-Breathing C-Circulation

If the patient is in water, pull the patient out and dry the skin before attaching the

AED pads

What do AICDs stand for

Automated implanted cardioverter-defibrillator (under skin device)

What occurs first in adults typically cardiac arrest or respiratory arrest

Cardiac arrest typically

When should you suspect obstruction in unresponsive pts

In unresponsive patients, suspect obstruction if maneuvers to open airway and ventilate are ineffective.

Define mild airway obstruction

Patient is able to exchange adequate amounts of air but still has signs of respiratory distress. NOTE: Able to maintain strong cough

what does POLST stand for

Physician Orders for Life-Sustaining Treatment

What can you do to assist avoiding partially obstructing airway in pediatrics when they are laid out supine

Place a wedge of padding under a child's upper chest and shoulders

What doe's cardiopulmonary resuscitation achieve

Reestablishes circulation and artificial ventilation in a patient who is not breathing and has no pulse

Define chest compression fraction

The total percentage of time during a resuscitation attempt in which chest compressions are being performed

Describe the load distributing band CPR or vest CPR

a circumferential compression device composed of a constricting band and a backboard

In adults, foreign body airway obstruction usually occurs during

a meal

In children, airway obstruction usually occurs during

a meal or at play

When do you apply a AED on an infant/child needing CPR

after the first five cycles of CPR

What doe's the mechanical piston device achieve

allows the operator to configure the depth and rate of compressions

When should an AED be applied to a pt

as soon as possible

While giving breaths what needs to be done

assess for pulse

First step of BLS is

assessing if scene is safe and if a pt doe's or doesn't need CPR, done by checking for responsiveness

How deep is a compression for an infant

at least one-third its depth of the chest

What should be avoided when delivering chest compressions

avoid leaning over the chest

What do you never do on a pt with airway obstructions

blind finger sweep

Where do you check for a pulse in an infant

brachial artery

Where do you place your hands to deliver a compression for an adult

center of the chest (lower half of the sternum)

Where do you place your heel of your hand to deliver a compression for a child

center of the chest between the nipples

Describe the technique of compressions for obese pts and pregnant pts

chest thrusts

What doe's active compression-decompression achieve

compresses the chest and then actively pulls it back up to its neutral position or beyond, bringing more blood to the heart

Describe how the pulse and breathing status are conducted concerning timing

conducted simultaneously

If a pts device shocks them what do you do

continue CPR and wait 30-60 seconds before delivering a shock from an AED

Impedance threshold device achieves what

designed to limit air entering the lungs during the recoil phase between chest compressions, results in negative intrathoracic pressure that may draw more blood toward the heart NOTE: Not currently recommended for use with conventional CPR

If any one of the links in the chain is absent, the patient is more likely to

die

Define ventricular fibrillation

disorganized quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest

Describe the placement of adult AED pads on infants/children

do not cut the pads to adjust the size. Use the anterior-posterior placement

Define gastric distention

due to hyperventilation, stomach fills with air, and makes pt prone to vomit

How many times should giving compressions should partners switch

every 5 cycles or 2 mins

When are chest thrusts used on standing pts

for women in advanced stages of pregnancy and patients who have obesity

How do you assess responsiveness in children

gently tap child on shoulder and speak loudly

What is the only thing you can do for a pt that is struggling to breath but still some what breathing

give supplemental oxygen

What chest compression fraction should be maintain during CPR

greater than 80%

If the kid is to big for thumb encircling technique and to small for hand over hand compressions what method do you compress with

heel of your hand

Where do you compress an adults chest

in between nipples

Abdominal-thrust maneuver (Heimlich maneuver) is recommended in what kind of pts

in responsive adults and children older than 1 year

If the patient is breathing adequately on his or her own and has no signs of injury to the spine, hip, or pelvis, place the pt how

in the recovery position

If the patient is breathing adequately on his or her own and has no signs of injury to the spine, hip, or pelvis, place him or her how

in the recovery position (placed on side top leg kicked out and top hand on bottom cheek)

What can hyperventilation cause related to the hearts function

increased intrathoracic pressure (pressure on the vena cava reducing blood flow back to the heart)

Where do you place your hands for an abdominal thrust?

just above the umbilicus

Where do you compress and infants chest

just below the nipple line

Where do you place your fingers for compression of an infant

just below the nipple line

How do you perform the abdominal thrust maneuver on a child

kneel behind the child on one knee, wrap your arms around the child's body, and place your fist just above the umbilicus and well below the lower tip of the sternum

Define ischemia

lack of blood flow to a tissue/organ

How is the Heimlich maneuver performed different on an child compared to an adult

less force is applied

A lack of oxygen (hypoxia), combined with too much carbon dioxide in the blood (hypercarbia), is what

lethal

Where do you place the hands for CPR compressions for an adult

lower half of the sternum

What does MOLST stand for?

medical orders for life sustaining treatment

Where do you place your hands for chest thrusts on preggo pts

middle of sternum

Define what an opioid doe's to the body

narcotic that depresses the central nervous system and causes respiratory arrest followed by cardiac arrest

Do agonal gasps count as respirations

no

How long should checking for responsiveness take

no more than 10 seconds

Define BlS (3)

noninvasive emergency life-saving care that is used to treat medical conditions, including: 1. Airway obstruction 2. Respiratory arrest 3. Cardiac arrest

What is the normal heart rhythm is referred to as

normal sinus rhythm

An unresponsive child older than what age that has an airway obstruction is managed in the same manner as an adult

older than 1 year

If the patient is in a small puddle of water or in the snow, the AED can be used, but the

patient's chest should be dried as much as possible.

If you find an unresponsive, apneic, pulseless child, while alone and off duty what is done

perform CPR for 5 cycles (about 2 minutes) and then call the EMS system