HEALTH SCIENCE 170 FOR MIDTERM STUDY GUIDE

Adult In-Hospital Cardiac Chain of Survival

As the third link of the adult in Hospital Cardiac Chain of Survival, early high quality CPR keeps oxygen rich blood flowing and helps delay brain damage and death. It should be initiated immediately, starting with compressions once cardiac arrest is recognized.

ROSC (return of spontaneous circulation)

When your efforts with CPR successfully resume a normal heart rhythm.

Providers should try chest thrusts if they cannot reach far enough around the patient

the patient might be pregnant; the patient is in a bed or in a wheelchair with features that make abdominal thrusts difficult to do; or back blows or abdominal thrusts are not effective in dislodging the object.

Ventilations

1 ventilation every 6 seconds for an adult patient and every 2-3 seconds for a child or infant, with each ventilation lasting about 1 second and making the chest rise.

5 reasons to stop CPR

1. EMS or other trained personnel arrives 2. AED is on scene and ready to use 3. Too exhausted to continue 4. Signs of life 5. Scene unsafe

The correct rate of compressions is the same among adults, children and infants:

100 to 120 per minute.

A child is defined as someone from the age of 1 year to the onset of puberty

As evidenced by breast development in girls and underarm hair development in boys (usually around the age of When providing CPR and using an AED, follow child guidelines and use appropriately sized equipment.

BVM Advantages and Disadvantages

BVM ventilations should be performed as a two-person technique as it provides better seal and ventilation volume. A two-person technique for BVM ventilations (also referred to as bag-mask ventilations) is the preferred methodology because it provides better seal and ventilation volume. To perform this technique, one provider seals the mask and maintains an open airway while the other provider delivers ventilations. When there is only one provider to deliver ventilations, providers may consider using a pocket mask over a BVM resuscitator for better seal and ventilation volume.

Team Leader is responsible for the the patient's status

Communication to the code team regarding status and care is one of the primary responsibilities of a team leader, along with tasks such as monitoring performance and facilitating a debriefing session. The team leader may have been first to respond to the emergency and is not always the most senior-level provider.

Compression to ventilation rates in both children and infants are 15:2 if performed by two or multiple rescuers.

Compression-to-ventilation ratio when performing single/solo is always 30:2.

Chocking

For a responsive adult or child with an obstructed airway, providers should first give up to 5 back blows until the obstruction is relieved or, if not relieved, transition to up to 5 abdominal thrusts. If the obstruction is not relieved, they should continue with cycles of 5 back blows followed by 5 abdominal thrusts until the obstruction is relieved.

AED Pads:

For infants and children aged 8 or younger or weighing less than 55 pounds (25 kg), use pediatric AED pads, if available. If pediatric AED pads aren't available - or if the AED doesn't have a pediatric setting → it's safe to use adult AED pads or adult levels of energy for these patients.

Compression Depths

For infants, compression depth should be about 1 ½ inches; for a child, about 2 inches, and for an adult, at least 2 inches.

Advanced Airway

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. When a patient has a suspected head, neck or spinal injury, use the modified jaw thrust maneuver to open the airway.

Femoral and carotid pulse check

It is appropriate to check the cartoid or femoral pulse when the patient shows signs of ROSC and multiple providers are present.

Pregnancy and CPR

New to the lessons is what to do when giving CPR with 20 weeks pregnancy condition. Multiple providers is a must! Perform high-quality CPR and continuous left uterine displacement (LUD). LUD is a technique used in a pregnant patient to move the gravid uterus up and toward the left to relieve pressure on the inferior vena cava and maximize the return of blood to the heart and cardiac output. They should perform continuous LUD until infant the is delivered, even if ROSC is achieved. High quality CPR with continuous left uterine displacement (LUD) should be performed on a pregnant patient with a fundus or at above umbilicus or fetal age known to be greater than or equal to 20 weeks.

Amount of time to check for signs of life

Providers should assess breathing and pulse for no more than 10 seconds. Once cardiac arrest is recognized, they should begin CPR immediately and use an AED when it is available.

Steps to approach a victim

Scene safety and general impression then check for responsiveness (i.e., perform the shout-tap shout sequence). Then, they should open the airway and simultaneously check for breathing and a pulse. At the same time, they should scan the body for life-threatening bleeding. Finally, they should use the results of the rapid assessment (short version of DOTS) to recognize the severity of the emergency condition and determine their immediate course of action.

The most effective way to perform CPR on an infant is the thumb encircling technique even from the side of the infant.

Stranding to the side of the infant with your hips at a slight angle, provide chest compressions using the encircling thumbs techniques and deliver ventilations with a pocket mask or face shield. When performing single-provider CPR, providers should use the encircling thumbs technique. Standing or kneeling at the side of the infant with your hips at a slight angle, place both thumbs (side-by-side) on the center of the infant's chest, just below the nipple line. Encircle the infant's chest toward the back with your other fingers to provide support. Then use both thumbs at the same time to provide 30 chest compressions (about 1 ½ inches deep and at a rate of 100-120 compressions per minute). As you compress the chest, allow for complete chest recoil. Then, deliver 2 ventilations using a pocket mask or face shield. Remember, a BVM should not be used for single-provider CPR. The encircling thumbs technique is preferred and most effective!

CCF equation

Time Delivering Compressions/Total Duration of Resuscitation Event.

Do not become fatigued, switch every 2 minutes:

To minimize fatigue, providers should switch off performing compressions every 2 minutes (which usually occurs during the time of AED analysis).

Limit interruptions to CPR less than 10 seconds:

To provide high quality chest compressions, you must use correct hand placement and body position, compress at a proper depth rate, and allow full chest recoil to allow oxygen flow through the heart. Do not CPR more than 10 seconds. When a patient has a suspected head, neck or spinal injury, use the modified jaw-thrust maneuver to open the airway.

Closed-loop communication

Used to prevent misunderstandings; the receiver confirms that the message has been received and understood.

Communicate

With a team leader if a task has been overlooked: A team member should always communicate with a team leader if they feel they are lacking any knowledge or skills, if they identify something the team leader may have overlooked or if they recognize a dangerous situation or need for urgent action. This is also a critical aspect of crew resource management; when a problem arises, team members should get the team leader's attention, state their concern, describe the problem as they see it and suggest a solution.

critical thinking

providers constantly identify new information (e.g., the patient is experiencing cardiac arrest), adapt to the information logically to determine their best next actions (e.g., begin CPR) and anticipate how those actions will affect the patient (i.e., improve patient outcomes).