Chapter 13 BLS Resuscitation
The five links in the chain of survival are:
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.Advanced life support and postarrest care
To ensure that you will deliver the appropriate number of chest compressions during one-rescuer adult CPR, you should compress the patient's chest at a rate of:
100 to 120 compressions per minute.
When performing CPR on an adult, you should compress the chest to what depth and at what a rate of compressions per minute?
2 to 2.4 inches (5 to 6 cm); 100 to 120 compressions per minute
In two-rescuer adult CPR, you should deliver a compression to ventilation ratio of:
30:2
What is the correct compression-to-ventilation ratio for adult CPR?
30:2
What is the proper compression-to-ventilation ratio for adult two-rescuer CPR?
30:2
After ________ minutes without oxygen, permanent brain damage is possible.
4 to 6
load-distributing band (LDB)
A circumferential chest compression device composed of a constricting band and backboard that is either electrically or pneumatically driven to compress the heart by putting inward pressure on the thorax.
head tilt-chin lift maneuver
A combination of two movements to open the airway by tilting the forehead back and lifting the chin; not use for trauma patients.
gastric distention
A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation.
stridor
A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.
ischemia
A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.
recovery position
A side-lying position used to maintain a clear airway in unconscious patients who are breathing adequately and do not have suspected injuries to the spine, hips, or pelvis.
active compression-decompression CPR
A technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression); may increase the amount of blood that returns to the heart, and thus, the amount of blood ejected from the heart during the compression phase.
Impedance threshold device (ITD)
A valve device placed between the endotracheal tube and a bag-valve mask that limits the amount of air entering the lungs during the recoil phase between chest compressions.
Which of the following statements regarding the use of an AED in children is correct?
AED use in children up to 8 years of age involves pediatric pads and an energy reducer
What is the preferred method of removing a foreign body in an unresponsive child?
Abdominal thrusts
advanced life support (ALS)
Advanced lifesaving procedures, including cardiac monitoring, administration of intravenous fluids and medications, and the use of advanced airway adjuncts. EMTs may be trained in some of these areas.
What is the maximum amount of time that should be spent checking for spontaneous breathing in an unresponsive child?
As with an adult, assessing for spontaneous breathing should take no longer than 10 seconds.
What is the correct management of a conscious infant who is choking?
Back blows and chest thrusts
You respond to a call in which a 6-year-old was hit by a car. She is responsive but struggling to breathe. What position should you place her in?
Because the child is responsive, allow her to remain in whatever position is most comfortable.
dependent lividity
Blood settling to the lowest point of the body, causing discoloration of the skin; a definitive sign of death.
Which of the following is NOT an indication to stop CPR once you have started?
Care is transferred to a bystander
Respiratory arrest usually occurs before cardiac arrest in __________.
Children
After an advanced airway device has been inserted during two-rescuer CPR, you should:
Deliver one rescue breath every 6 to 8 seconds
Which intervention(s) would have the MOST positive impact on the cardiac arrest patient's outcome?
Early high-quality CPR and defibrillation are most likely to have a positive impact.
When you are performing CPR on an adult or child, approximately how often should you reassess the patient for return of respirations and/or circulation?
Every 2 minutes
Cardiac arrest occurs in children and adults for the same reasons.
FALSE
A(n) ________ is designed to limit the air entering the lungs during the recoil phase between chest compressions, resulting in negative intrathoracic pressure.
Impendance threshold device (ITD)
Which of the following are effects of hyperventilation?
Increased intrathoracic pressure gastric distention
Which of the following maneuvers should be used to open a patient's airway when a spinal injury is suspected?
Jaw-thrust
Basic Life Support
Noninvasive emergency lifesaving care that is used to treat medical conditions, including airway obstruction, respiratory arrest, and cardiac arrest.
When trying to clear a severe airway obstruction, who should get chest compressions instead of abdominal compressions?
Obese patients Women in late stages of pregnancy
A team of EMTs and paramedics are attempting to resuscitate a man who is in cardiac arrest while his wife and son are present. Which of the following should occur during the resuscitation attempt?
One EMT should update the family on the interventions that have been performed and how the patient has responded
Keep the following factors in mind when using an AED:
Pacemakers and implanted defibrillators Wet patientsTransdermal medical patches
Mild airway obstruction
Patients with a mild (partial) airway obstruction are able to exchange adequate amounts of air, but still have signs of respiratory distress.
Your initial attempt to ventilate an unresponsive, apneic 30-year-old man is met with resistance and you do not see the chest rise. Your second ventilation attempt is also unsuccessful. You should:
Perform 30 chest compressions
When performing CPR on an infant, which of the following is correct?
Perform infant chest compressions using two fingers in the middle of the sternum, just below the nipple line.
CPR will NOT be effective if the patient is:
Prone
hyperventilation
Rapid or deep breathing that lowers the blood carbon dioxide level below normal; may lead to increased intrathoracic pressure, decreased venous return, and hypotension when associated with BVM use.
The AED gives a "no shock" message to a patient who is in cardiac arrest. What should you do?
Resume chest compressions
Performing One-Rescuer Adult CPR
STEP 1: Take Standard precautions. Establish unresponsiveness and call for help. Use your mobile phone if needed. Step 2: Check for breathing and a carotid pulse for no more then 10 seconds Step 3: If breathing and pulse are absent, then perform CPR until an AED is available. give 30 chest compressions at a rate of 100 to 120 per minute. Step 4: Open the airway according to your suspicion of spinal injury Step 5: Give two ventilations of 1 second each and observe for visible chest rise. Continue cycles of 30 chest compressions and 2 ventilations until additional personnel arrive or the patient starts to move.
Performing Two-Rescuer Adult CPR
STEP 1: Take standard precautions. Establish unresponsiveness and take positions. STEP 2: Check for breathing and a carotid pulse STEP 3: Begin CPR, starting with chest compressions. Give 30 chest compressions at a rate of 100 to 120 per minute. If the AED is available, then apply it and follow the voice prompts. STEP 4: Open the airway according to your suspicion of spinal injury Step 5:Give two ventilations of 1 second each and observe for visible chest rise. Continue cycles of 30 chest compressions and 2 ventilations until ALS providers take over or the patient starts to move. Reanalyze the patient's cardiac rhythm with the AED every 2 minutes and deliver a shock if needed.
Removing a Foreign Body Airway Obstruction from an Unresponsive Child
Step 1: Take Standard precautions. position the child on a firm, flat surface Step 2: Perform chest compressions using the same landmark as you would for CPR Step 3: Open the airway and look inside the mouth Step 4: If an object is visible and can be easily removed, then remove it with your fingers and attempt rescue breathing. Step 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 of ALS providers take over.
Performing CPR on a child.
Step 1: Take standard precautions. Place the child on a firm surface. Identify the location for hand placement, as shown here. Place the heel of one or two hands in the center of the chest, in between the nipples, avoiding the xiphoid process. Step 2: Compress the chest at least one third 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 mins. If there is no pulse and an AED is available, then resume CPR and apply the AED pads. Step 3: If the child regains a pulse greater then 60 beats/min and resumes effective breathing, then place him r her in a position that allows for frequent assessment of the airway and vital signs during transport.
Steps to performing chest compressions
Step 1: Take standard precautions. Place the heel of one hand on the center of the chest (lower half of the sternum) Step 2: Place the heel of your other hand over the first hand Step 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.
rigor mortis
Stiffening of the body muscles; a definitive sign of death.
If you witness a patient's cardiac arrest and an AED is available, deploy the AED immediately and then begin CPR.
TRUE
jaw-thrust maneuver
Technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward; used for patients who may have a cervical spine injury.
cardiopulmonary resuscitation (CPR)
The combination of chest compressions and rescue breathing used to establish adequate ventilation and circulation in a patient who is not breathing and has no pulse.
The main benefit of using a mechanical device for chest compressions is:
The elimination of rescuer fatigue that results from manual compressions
abdominal-thrust maneuver
The preferred method to dislodge a severe airway obstruction in adults and children; also called the Heimlich maneuver.
return of spontaneous circulation (ROSC)
The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.
chest compression fraction
The total percentage of time during a resuscitation attempt in which active chest compressions are being performed.
In adults, chest compressions should be between 2 and 2.4 inches (5 and 6 cm) in depth and given at a rate of 100 to 120 per minute.
True
When ventilating an apneic adult with a bag-valve mask, you should deliver each breath:
While watching for adequate chest rise
You are off duty and you come across an unresponsive child lying on the ground at a playground. She does not have a pulse and no one witnessed the collapse. What should you do?
You should do 5 cycles of chest compressions (about 2 minutes), then call 9-1-1. Because cardiopulmonary arrest in children is most often the result of respiratory failure, it is critical that you restore oxygenation.
CPR should be initiated when:
a valid living will is unavailable.
Between each chest compression, you should __________.
allow full chest recoil
You and your partner arrive at the side of a 60-year-old woman who collapsed about 7 minutes ago. She is unresponsive, apneic, and pulseless. You should:
begin CPR and apply an AED as soon as it is available
Which of the following is considered an obvious sign of death and would not require the initiation of CPR?
dependent blood pooling
Without practice, your CPR skills will __________.
deteriorate over time
Your conscious patient has a mild partial airway obstruction. You should:
encourage the patient to cough.
Signs of a sudden severe upper airway obstruction include all of the following, EXCEPT:
forceful coughing.
Complications associated with chest compressions include all of the following, EXCEPT:
gastric distention.
Gastric distention will MOST likely occur:
if you ventilate a patient too quickly.
CPR retraining is the MOST effective when it:
involves hands-on practice.
mechanical piston device
is a device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard.
A patient should be placed in the recovery position when he or she:
is unconscious, uninjured, and breathing adequately.
The impedance threshold device (ITD) may improve circulation during active compression-decompression CPR by:
limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling.
While rescuer one is finishing his or her fifth cycle of 30 compressions, rescuer two should:
move to the opposite side of the patient's chest
Basic life support (BLS) is defined as:
noninvasive emergency care that is used to treat conditions such as airway obstruction, respiratory arrest, and cardiac arrest.
CPR is in progress on a pregnant woman. Shortly after manually displacing her uterus to the left, return of spontaneous circulation occurs. Which of the following would MOST likely explain this?
pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness
If an object is visible in the unconscious patient's airway, you should __________.
remove it
Your partner is performing one-rescuer CPR on a middle-aged woman in cardiac arrest. When you apply the AED pads, you note that she has a medication patch over the same area where one of the AED pads will be placed. You should:
remove the medication patch, wipe away any medication residue, and apply the AED pads.
In most cases, cardiopulmonary arrest in infants and children is caused by:
respiratory arrest.
When performing CPR on a child, you should compress the chest:
with one or two hands.