CPR

In which locations do most out-of-hospital cardiac arrest occur? (a) Healthcare clinics (b)Homes (c)Recreational Facilities (d)Shopping Centers

(b) Homes

AED

automated external defibrillator: detects abnormal heart rhythm and gives a shock to return normal heart rhythm

If you suspect that an unresponsive victim has head or neck trauma, what is the preferred method of opening the airway? a) head tilt-chin lift b) jaw thrust c) head tilt-neck lift d) avoid opening the airway

b) jaw thrust

Which statement best describes sudden cardiac arrest? (a) when respiratory distress in adults occurs and the heart rate does not change (b) when the heart rate is 40 to 60/min and respirations increases (c) when the blood flow to the heart is blocked and the heart rate increases (d) when an abnormal rhythm develops and the heart stops beating unexpectedly

(d) when an abnormal rhythm develops and the heart stops beating unexpectedly

use of an AED for infants

-For infants, a manual defibrillator is preferred to an AED for defibrillation -If a manual defibrillator is not available, an AED equipped with a pediatric dose attenuator is preferred -If neither is available, you may use an AED without a pediatric dose attenuator.

What are the 2 arrhythmias that cause cardiac arrest?

-Pulseless ventricular tachycardia (pVT): when the ventricles begin contracting at a very fast pace (rapid heart rate). In extreme cases, the ventricles pump so quickly and inefficiently that no pulse can be detected. Body tissues and organs, especially the heart and brain, no longer receive oxygen. -ventricular fibrillation (VF): is an arrest rhythm. the heart's electrical activity becomes disordered. The heart muscles quiver in a fast, unsynch way so the heart does not pump blood

Signs of poor perfusion

-temperature: cool extremities -altered mental state: continue decline of consciousness/responsiveness -pulses: weak pulse -skin: paleness, mottling (patchy appearance) and late cyanosis (turning blue)

How often should rescue breaths be given in infants and children when a pulse is present?

1 breath every 3-5 seconds (12-20/minute) (vs adult 5-6 seconds or 10-12/min)

what is the correct compression-to-ventilation for a single rescuer of a 3 y/o child?

30 compressions: 2 breaths

Infant and child: breathing and pulse check

Assess breathing and pulse in no more than 10 seconds. Breathing: scan the victim's chest for rise and fall Pulse: -infant: palpate a brachial pulse (under arm close to armpit) -child: palpate a carotid or femoral pulse (inner thigh- b/w hip bone and the pubic bone)

Agonal gasping

Deep, slow breaths/gasps

what is the correct chest compression for an infant?

At least 1/3 the depth of the chest, or 1 1/2 inches

what is the correct compression depth for a child?

At least 1/3 the depth of the chest, or about 2 inches

What is the ratio of chest compressions to breaths when providing CPR to an adult? a)10 compressions to 2 breaths b) 15 compressions to 2 breaths c) 30 compression to 2 breaths d) 100 compressions to 2 breaths

c) 30 compression to 2 breaths

Which victim would need only rescue breathing? a)agonal gasping no pulse b) breathing w/ a weak pulse c) no breathing and a pulse d) no breathing no pulse

c) no breathing and a pulse

After performing high quality CPR for 5 minutes, the team leader frequently interrupts chest compressions to check for pulse even though the victim has no organized rhythm when the AED analyzes the rhythm. Which action demonstrates constructive intervention? a) ask another rescuer what he/she thinks should be done b) say nothing that contradicts the team leader c) suggest to resume chest compressions w/out delay d) wait in the debriefing session afterward to discuss it

c) suggest to resume chest compressions w/out delay

The team leader asks you to perform bag-mask ventilation during a resuscitation attempt, but you have not perfected that skill. What would be an appropriate action to acknowledge your limitations? a) pick up the bag mask and give it to another team member b) pretend you did not hear the requests and hope the team leader chooses someone else to do it c) tell the team leader that you are not comfortable with the task d) try to do it as best you can and hope another team member will see you struggling and take over

c) tell the team leader that you are not comfortable with the task

Main components of CPR?

chest compressions, airway, breathing

Ventilation technique: advanced airway in place ( laryngeal mas airway, supraglottic airway device, endotracheal intubation)

compression rate of 100-120/min continuous compressions w/out pauses for breaths 1 breath every 6 seconds (10 breaths/min) for adults, children, and infants

What action should you take when the AED is analyzing the heart rhythm? a) check the pulse b) continue chest compressions c) give rescue breaths only d) stand clear of the victim

d) stand clear of the victim

The man doesn't respond when you touch his shoulders and shout, "Are you OK?" What is your best next action? a) check his pulse b) start CPR c) start providing rescue breaths d)shout for nearby help

d)shout for nearby help

You find an unresponsive pt. who is lying motionless. Which is the first action you should take? a) activate the emergency response system b) start CPR, beginning w/ chest compression c)start providing rescue breaths d)verify the scene is safe for you and the victim

d)verify the scene is safe for you and the victim

When to start CPR in an infant or a child when providing rescue breaths?

if you notice poor perfusion despite adequate rescue breathing and HR is 60/min or less start CPR

opening airways in infant: keep head in neutral position

if you tilt (extend) and infant's head beyond the neutral (sniffing) position, the infant's airway may become blocked. Maximize airway patency by positioning the infant with the neck in neutral position so the external ear canal is level w/ the top of the infant's shoulder

What does this stand for? What are the steps? IHCA

in-hospital cardiac arrest (1)surveillance, prevention, and treatment of prearrest conditions (2) Immediate recognition (unresponsiveness, no breathing, and no pulse) and activation of emergency response system (3) Early CPR (w/ emphasis on chest compressions) (4)rapid defibrillation (5) post-cardiac arrest condition

What is an arrhythmia? How does it occur?

is an irregular or abnormal heart beat. Occurs when the electrical impulses that cause the heart to beat happen too quickly, too slowly, or erratically.

What are bag mask devices?

it is a bag attached to a face mask used to provide positive-pressure ventilation to victim who is not breathing or not breathing normally

Head tilt chin lift

lifts the tongue, relieving airway obstruction Avoid: pressing deeply into the soft tissue under the chin because it might block the airway & don't close the victim's mouth completely

What are opiods?

medications used primarily for pain relief (ex: morphine and hydrocodone), In high doses they can cause CNS and respiratory depression that can cause cardiac and respiratory arrest

What does this stand for? What are the steps? OHCA

out-of-hospital cardiac arrest (1) recognition of cardiac arrest and activation of emergency response system (2) Early CPR (w/ emphasis on chest compressions) (3) rapid defibrillation (w/ an AED) (4) Advanced life support (rapid stabilization and transport to post-cardiac arrest center) (5) Post-cardiac arrest care

CPR on infant or child

rate for compression: 100 to 120/min and compression-to ventilation ratio is 30:2 (if 2 rescuers present for infant and child use a compression-to ventilation ratio of 15:2) Infant: 2 finger chest-compression (if multiple rescuers: 2 thumb-encircling hands technique). At least 1 1/2 depth Child: 1 or 2 hands. At least 2 inches

Cardiac arrest: What is it? What happens?

sudden cardiac arrest results from an abnormal heart rhythm that causes the heart to quiver so it can no longer pump blood to the brain, lungs, and other organs.--- often a rhythm problem W/in seconds, the person becomes unresponsive and is not breathing (or is only gasping). Death occurs w/in minutes if the victim does not receive immediate lifesaving treatment.

what should you do when using an AED on an infant or a child less than 8 y/o?

use adult AED pads if the AED has no child pads

If a manual defibrillator is not available for an infant victim, which action should you take?

use an AED equipped with a pediatric dose attenuator

Jaw thrust

used if Head tilt chin lift doesn't work or suspected head/spinal injury

Gastric inflation

when air enters the stomach instead of lungs if breathes are given to quickly. Avoid giving: rapid breaths, forceful, or too much volume To reduce rick of gastric inflation: deliver breath over 1 second and deliver just enough to make the chest rise

Respiratory arrest

when breathing completely stops. Apneic. Chest not moving, can still have pulse.

what is important to remember about AED placement on infants

you may need to place 1 pad on the chest and 1 on the back, according to the diagrams on the pads

What is the difference? What is the link? Cardiac arrest vs heart attack

Cardiac arrest: occurs when heart develops an abnormal rhythm and can't pump blood Heart attack: occurs when blood flow to part of the heart muscle is blocked (clot) Link: most heart attacks don't lead to cardiac arrest (only a small percentage of patients with heart attack will develop sudden cardiac arrest). When a sudden cardiac arrest occurs, heart attack is a common cause (other conditions may cause a change in the heart's rhythm).

How to assess for breathing and pulse?

Check simultaneously (no more than 10 seconds) Breathing: scan the victim's chest for rise and fall -if breathing: monitor -if not breathing (only gasping) sign of cardiac arrest Pulse: in adults palpate carotid pulse (b/w the trachea and the muscles at the side of the neck) -no pulse: start CPR

Adult breaths

During CPR after 30 chest compressions give 2 breaths: -deliver each breath over 1 second -note chest rise with each breath resume chest compression in less than 10 seconds

Importance of chest compressions?

Each time you stop, the blood flow to the heart and brain decreases. So the longer the interruptions the lower the blood supply.

What is the most appropriate first step to take as soon as the AED arrives at the victim's side?

Power the AED

2 thumbs encircling technique

Preferred 2-rescuer chest compression technique because it produces: improved blood flow, helps insure consistent depth and force of chest compressions, may generate higher bp

ROSC

Return of Spontaneous Circulation- when circulation returns, a pulse is present

Pediatric chain of survival

(1)prevention of arrest (2) early high-quality bystander SPR (3) Rapid activation of emergency response system (4) Advance life support 9rapid stabilization and transport to post-cardiac arrest care) (5) Post-cardiac arrest care

Which is the most common cause of cardiac arrest in children? (a) Cardiac problems (b)Congenital or acquired hear defect (c) Respiratory failure or shock (d) Infection or sepsis

(c) Respiratory failure or shock

What is the third link in the adult OHCA? (a) Advanced life support (b) High-quality life support (c) Prevention (d) Rapid defibrillation

(d) Rapid defibrillation

Heart attack: What is it? What happens?

occurs when a clot forms in the blood vessel carrying oxygenated blood to the heart muscle. If the blocked vessel is not reopened quickly, the muscle nourished by that vessel begins to die.-- "clot" problem Signs of heart attack may appear immediately or last weeks or longer. Symptoms may include: severe discomfort in the chest or other areas of the upper chest, shortness of breath, cold sweats, nausea/vomiting. (in women it can be different and most likely to experience: pain in the jaw, arms, back, or neck, light headedness, nausea/vomiting) Note: during a heart attack, the heart continues to pump blood but the longer it is untreated the greater the damage to the heart muscle which can trigger an abnormal rhythm that can lead to sudden cardiac arrest

Opening the airway: Breathing (2 methods)

-head tilt-chin lift -jaw thrust

What are the actions if victim: -breathing and pulse is present - not breathing but pulse is present -not breathing (or only gasping) and has no pulse

-breathing and pulse is present: monitor - not breathing but pulse is present: give rescue breath (1 breath/5-6 seconds or about 10-12 breaths/minute), continue checking pulse every 2 mins. if no pulse begin CPR (4) Note: if possible opioid overdose give naloxone if available per protocol -not breathing (or only gasping) and has no pulse: Start CPR

Chest compressions consist of?

-compress at a rate of 100 to 120/min - compress the chest at least 2 inches (5cm) -allow chest to recoil after each compression (allows blood to flow into the heart) -minimize the interruption -can switch compressor after 5 cycles or 2mins (helps reduce fatigue) Note: do not move victim while CPR is in progress unless they are in a dangerous environment or if you can't perform CPR effectively. A firm surface is important as it allows compression of the chest and heart to create blood flow

Special circumstances when placing AED pads:

-hairy chest: shave area because AED will not be able to analyze heart's rhythm -is immersed in water or has water covering the chest: since water is a good conductor of electricity DRY off the chest before attaching AED -implanted defibrillators and pacemakers: may block delivery of shock to heart. If possible AVOID placing AED over the implanted device - transdermal medication patch or other object: do NOT place AED over medication patch (blockage or burns could occur). If it does not delay delivery remove the patch and wipe the area before attaching AED pads

Adult cardiac arrest algorithm

1)Verify scene safety 2)Victim unresponsive>shout for nearby help>Activate emergency response system>get AED and emergency equipment 3) look for no breathing (or only gasping) and check for pulse- w/in 10 seconds: -normal breathing, has pulse: monitor until emergency responders arrive - no normal breathing, has pulse: give rescue breath (1 breath/5-6 seconds or about 10-12 breaths/minute), continue checking pulse every 2 mins. if no pulse begin CPR (4) Note: if possible opioid overdose give naloxone if available per protocol 4)No breathing (or only gasping) and no pulse begin CPR: 30 compressions and 2 breaths. 5) Use AED ASAP - shockable: Give 1 shock. Resume CPR for 2 mins (until prompted by AED to allow for rhythm check). Continue until ALS providers take over or victim starts to move. - not shockable: Resume CPR for about 2 mins (until prompted by AED to allow for rhythm check). Continue until ALS providers take over or victim starts to move. -not shockable:

What are the rate and depth for chest compression in adult?

100-120 compressions/minute and a depth of atleast 2 inches

what is the correct c:v ratio for a 7 y/o child when 2 or more rescuers are present?

15 compressions: 2 breaths

Techniques for giving breaths w/out a barrier device

Adult and children: mouth-to-mouth infants: mouth-to-mouth-an-nose or mouth-to-mouth

Cardiac arrest in adults vs children

Adult: sudden and as a result from a cardiac cause Children: often secondary to respiratory failure and shock - chest compressions alone are not effective as compressions and breaths for delivering oxygenated blood to the heart and brain (b/c cardiac arrest in children are due to respiratory failure)

Antidote for opioid overdose

Naloxone (narcan) can be given by intramuscular, intranasal (quickly absorbed in bloodstream due to the large surface mucous membranes which are rich in capillaries) and intravenous routes. (usually given after starting CPR)

What action should you take when more rescuers arrive? a) assign tasks to other rescuers and rotate compressors every 2 min or more frequently if needed to avoid fatigue b) continue CPR while the AED is attached even if you are fatigued c) wait for the most experienced rescuer to provide direction to the team d) direct the team to assign a team leader and roles while you continue CPr

a) assign tasks to other rescuers and rotate compressors every 2 min or more frequently if needed to avoid fatigue

If a victim of cardiac arrest has an implanted pacemaker or defibrillator, what special steps should be taken? a) avoid placing the AED pad directly over the implanted device b) avoid using the AED to prevent damage to the implanted device c) turn off the implanted device before applying the AED pads d) consider using the pediatric pads to decrease the shock dose delivery

a) avoid placing the AED pad directly over the implanted device

what action can rescuers perform to potentially reduce the risk of gastric inflation? a) delivering each breath over 1 second b)giving rapid, shallow breaths c)using a bag--mask for delivering ventilation d) using the mouth-to-mouth breathing technique

a) delivering each breath over 1 second

What is the appropriate action to demonstrate closed-loop communication when the team leader assigns you a task? a) repeat back to the team leader the task you were assigned b) nod your head as an acknowledge of the assigned task c) start performing the assigned tasks, but do not speak, to minimize noise d) wait for the team leader to address you by name before acknowledging the task

a) repeat back to the team leader the task you were assigned

Several rescuers respond, and you ask them to activate the emergency response and retrieve the AED and emergency equipment. As you check for a pulse and breathing, you notice that the man is gasping for air and making "snorting" sounds. You do not feel a pulse. What is your best next action? a) start CPR, beginning with chest compressions b) monitor the victim until additional, more experienced help arrives c) provide rescue breathing by delivering 1 breath every 5-6 seconds d) find someone to help by retrieving the nearest AED

a) start CPR, beginning with chest compressions

Which step is one of the universal steps for operating an AED? a)placing the pads on the victim's bare chest b) shaving the victim's hairy chest c)removing the victim from water d) finding the victim's implanted pacemakers

a)placing the pads on the victim's bare chest

Delivering a pediatric dose

an attenuator reduces AED shock by about 2/3 but child pads are used to deliver the reduced shock Note: higher dose shock is preferred to no shock

For what age victim is the 2 thumb-encircling hands technique recommended when 2 or more rescuers are present?

an infant younger than 1 year