AHA Basic Life Support (BLS)

Pocket masks have a ________ valve, which diverts exhaled air, blood, or bodily fluids away from the rescuer.

1-way

Definition of adult

adolescents (ie, after the onset of puberty) and older

Check pulse If you do not feel a pulse within ___(a)___ seconds, begin ___(b)___, starting with ___(c)___.

a) 10 seconds b) high-quality CPR c) chest compressions

When giving compressions, rescuers should switch compressors every ___(a)___ cycles of CPR (about every ___(b)___ minutes), or sooner if fatigued.

a) 5 b) 2

For victims 8 years of age and older, use [child/adult] pads.

adult

ALS stands for...

advanced life support

Why is defibrillation important?

It "resets" the electrical system of the heart and can restore a regular cardiac rhythm.

To perform a pulse check in an infant, palpate a _______ pulse.

brachial

ROSC stands for...

Return of spontaneous circulation

(High quality CPR) Allow complete chest recoil after each compression [T/F]

T

If 2 rescuers are present, use a compression-to-ventilation of _____:_____.

15:2

[Do/Do not] move the victim during compressions.

Do not

Define rescue breathing.

Process of giving breaths to an unresponsive victim who has a pulse but is not breathing

30:2 CPR involves...

Rescue + breath

Out-of-hospital cardiac arrest (OHCA)

1. Lay rescuers (recognize victim's distress, call for help, start CPR, initiate public-access defibrillation until EMS arrives) 2. EMS 3. ICU

CPR cycle (number of compressions to breaths)

30 compressions to 2 breaths

(Rescue breathing for infants and children) Give ___ breath every ___ to ___ seconds (12 to 20 breaths per minute).

- 1 breath - 3 to 5 seconds

(Rescue breathing for adults) Give ___ breath every ___ to ___ seconds (about 10 to 12 breaths per minute).

- 1 breath - 5 to 6 seconds

Rescuer actions for mild airway obstruction:

- As long as good air exchange continues, encourage the victim to continue coughing. - Do not interfere with the victim's own attempts to relieve the obstruction, but stay with the victim and monitor the condition. - If mild airway obstruction continues or progresses to signs of severe airway obstruction, activate the emergency response system.

(AED) If you identify an implanted defibrillator/pacemaker:

- Avoid placing AED pad directly over the implanted device - Follow normal steps for operating AED

Signs of severe airway obstruction:

- Clutching throat with thumb and fingers, making the universal choking sign. - Unable to speak or cry. - Poor air exchange. - Weak, ineffective cough or no cough at all. - High pitched noise while inhaling or no noise at all. - Increased respiratory difficulty. - Possible cyanosis.

To prevent gastric inflation:

- Deliver each breath over 1 second. - Deliver just enough air to make the victim's chest rise.

You can tell if you have successfully removed an airway obstruction in an unresponsive victim if you:

- Feel air movement and see the chest rise when you give breaths - See and remove a foreign body from the victim's mouth

Signs of mild airway obstruction:

- Good air exchange - Can cough forcefully - May wheeze between coughs

Rescuer actions for severe airway obstruction:

- If victim is an adult or child, ask him if he is choking. If victim nods "yes" and cannot talk, severe airway obstruction is present. - Take steps immediately to relieve the obstruction. - If severe airway obstruction continues and the victim becomes unresponsive, start CPR. - If you are not alone, send someone to activate the emergency response system. If you are alone, provide about 2 minutes of CPR before leaving to activate the emergency response system.

The following techniques are used to give breaths in infants:

- Mouth-to-mouth-and nose - Mouth-to-mouth

AED pad anterolateral placement:

- Place one AED pad directly below the right collarbone - Place other pad to the side of the left nipple, with the top edge of the pad a few inches below the armpit

2 thumb-encircling hands technique is preferred over the 2-finger technique because it:

- Produces better blood supply to the heart muscle - Helps ensure consistent depth and force of chest compressions - May generate higher blood pressures

ventricular fibrillation (VF)

- arrest rhythm - heart's electrical activity becomes disordered - heart does not pump blood

Common examples of opioids:

- hydrocodone - morphine - heroin

(Closed-loop communication) Team leader should:

- call each team member by name and make eye contact when giving attention - don't assign additional tasks until you are sure that the team member understands the instruction

Main components of CPR

- chest compressions - airway - breathing

(Closed-loop communication) Team members should:

- confirm that you understand each task to which you are assigned by verbally acknowledging the task - tell the team leader when you have finished a task

When interrupting chest compressions to give 2 breaths with a barrier device:

- deliver each breath over 1 second - note visible chest rise with each breath - resume chest compressions in less than 10 seconds

Special circumstances may require the rescuer to take additional actions when placing AED pads for a victim who:

- has a hairy chest - is immersed in water or has water covering the chest - has an implanted defibrillator or pacemaker - has a transdermal medication patch or other object on the surface of the skin where the AED pads are to be placed

If victim is not breathing normally or is only gasping and has no pulse, and the collapse was sudden and witnessed, then...

- leave the victim to activate the emergency response system - retrieve AED

(AED) Examples of medication patches:

- nitroglycerin - nicotine - pain medication - hormone replacement therapy

AED pad anteroposterior placement:

- place one AED ;ad on left side of the chest, between the victim's left side of the breastbone and left nipple - Place the other pad on the left side of the victim's back, next to the spine

The compression-to-ventilation ratio for 1 rescuer is the [same/different] (____:____) in adults, children, and infants.

- same - 30:2

Signs of heart attack

- severe discomfort in the chest or other areas of the upper body - shortness of breath - cold sweats - nausea/vomiting

Signs of poor perfusion (temperature, altered mental state, pulses, skin):

- temperature: cool extremities - altered mental state: continued decline in consciousness/responsiveness - pulses: weak pulses - skin: paleness, mottling (patchy appearance), later cyanosis (turning blue)

Signs of cardiac arrest

- unresponsive - no normal breathing - no pulse

Pulseless ventricular tachycardia (pVT)

- when the lower chambers of the heart (ventricles) begin contracting at a very fast pace - no pulse can be detected

Rescue breathing (number of breaths per time)

1 breath every 5-6 seconds; 10-12 breaths/min

Compression technique for child:

1 or 2 hands

Definition of children

1 year of age to puberty

The 3 resuscitation triangle roles:

1. Compressor 2. AED/monitor/defibrillator 3. Airway

Things to avoid with head tilt-chin lift:

1. Do not press deeply into soft tissue under chin because this might block the airway. 2. Do not close victim's mouth completely.

Mouth-to-mouth breathing for adults and children:

1. Hold the victim's airway open with a head tilt-chin lift. 2. Pinch the nose closed with your thumb and index finger (hand on forehead). 3. Take a regular breath and seal your lips around the victims mouth, creating an airtight seal. 4. Deliver 1 breath over 1 second. 5. If the chest does not rise, repeat the head tilt-chin lift. 6. Give a second breath and watch for chest rise. 7. If you are unable to ventilate the victim after 2 attempts, promptly return to chest compressions.

2 distinct adult Chains of Survival

1. In-hospital cardiac arrest (IHCA) 2. Out-of-hospital cardiac arrest (OHCA)

Choking relief in a responsive infant:

1. Kneel or sit with the infant in your lap. 2. If it is easy to do, remove clothing from the infant's chest. 3. Hold the infant facedown with the head slightly lower than the chest, resting on your forearm. Support the infant's head and jaw with your hand. 4. Deliver up to 5 back slaps forcefully between the infant's shoulder blades, using the heel of your hand. 5. After delivering up to 5 back slaps, place your free hand on the infant's back, supporting the back of the infant's head with the palm of your hand. 6. turn the infant as a unit while carefully supporting the head and neck. Hold the infant faceup, with your forearm resting on your thigh. Keep infant's head lower than the trunk. 7. Provide up to 5 quick downward chest thrusts in the middle of the chest, over the lower half of the breastbone. 8. Repeat sequence of up to 5 back slaps and up to 5 chest thrusts until the object is removed of the infant becomes responsive.

Locating carotid pulse

1. Locate the trachea (on the side closest to you), using 2 or 3 fingers 2. Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse 3. Feel for a pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse, begin CPR starting with chest compressions.

Mouth-to-mouth-and-nose technique (Infants):

1. Maintain a head tilt-chin lift to keep the airway open. 2. Place your mouth over the infant's mouth and nose and create an airtight seal. 3. Blow into infant's nose and mouth (pausing to inhale b/w breaths). 4. If chest does not rise, repeat the head tilt-chin lift to reopen the airway and try to give a breath that makes the chest rise.

In 2-rescuer CPR, what are the duties of rescuer 2 (breaths)?

1. Maintain an open airway using either - head tilt-chin lift or - jaw thrust 2. Give breaths, watching for chest rise and avoiding excessive ventilation 3. encourage first rescuer to perform compressions that are deep enough and fast enough and to allow complete chest recoil between compressions 4. When only 2 rescuers are available, switch compressors about every 5 cycles or every 2 minutes, taking less than 5 seconds to switch.

In 2-rescuer CPR, what are the duties of rescuer 1 (compressions)?

1. Make sure victim is faceup on a firm, flat surface 2. Perform chest compressions 3. Switch compressors about every 5 cycles or 2 minutes (or more frequently if fatigued)

Universal steps for operating an AED

1. Open and power on the AED 2. Attach AED pads to victim's bare chest 3. "Clear" victim and allow the AED to analyze the rhythm 4. If AED advises a shock, it will tell you to clear the victim 5. If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions 6. After about 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 & 4

Locating the femoral artery pulse (Child):

1. Place 2 fingers in inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the torso. 2. Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin high-quality CPR, starting with chest compressions.

Locating the brachial pulse (Infants):

1. Place 2 or 3 fingers on the inside of the upper arm, between the infant's elbow and shoulder. 2. Press the fingers to attempt to feel the pulse for at least 5 but no more than 10 second.

Jaw-thrust maneuver:

1. Place one hand on each side of the victim's head; you may rest your elbows on the surface on which the victim is lying. 2. Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward. 3. If lips close, push the lower lip with your thumb to open the lips. Additional notes: - Stabilize patient's head with forearms - Do not tilt or rotate patient's head

Head tilt-chin lift maneuver:

1. Place one hand on victim's forehead and push with your palm to tilt the head back. 2. Place the fingers of the other hand under the bony part of the lower jaw near the chin. 3. Lift jaw to bring the chin forward.

Infant (1 rescuer): 2-finger technique

1. Place the infant on a firm flat surface. 2. Place 2 fingers in the center of the infant's chest, just below the nipple line, on the lower half of the breastbone. Do not press tip of breast bone. 3. Give compressions at a rate of 100 to 120/min. 4. Compress at least 1/3 the AP (about 1.5 inches). 5. At the end of each compression, make sure allow the chest to fully recoil; do not lean on chest. Chest compression and chest recoil time should be about equal. Minimize interruptions in compressions to less than 10 seconds. 6. After every 30 compressions, open the airway with a head tilt-chin lift and give 2 breaths, each over 1 second. 7. After 5 cycles or 2 minutes of CPR, if you are alone and the emergency response system has not been activated, leave the infant (or carry the infant with you) to activate the emergency response system and retrieve the AED. 8. Continue compressions and breaths in a ratio of 30:2, and use AED ASAP.

Infant: 2 thumb-encircling hands technique

1. Place the infant on a firm, flat surface. 2. Place both thumbs side by side in the center of the infant's chest, on the lower half of the breast bone. Thumbs may overlap in very small infants. Encircle the infant's chest and support the infant's back with the fingers of both hands. 3. With your hands encircling the chest, use both thumbs to depress the breastbone at the rate of 100 to 120/min. 4. Compress at least 1/3 the AP diameter of the infant's chest (about 1.5 inches). 5. After each compression, completely release the pressure on the breastbone and allow the chest to recoil completely. 6. After every 15 compressions, pause briefly for the second rescuer to open the airway with head tilt-chin and give 2 breaths, each over 1 seconds. 7. Continue compressions and breaths in a ratio of 15:2 (for 2 rescuers). Switch roles with another provider every 5 cycles or 2 minutes of CPR to avoid fatigue.

How to use a pocket mask:

1. Position yourself at the victim's side. 2. Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct positioning. 3. Seal the mask against the face. - Using your hand that is closer to the top of the victim's head, place index finger and thumb along the top edges of the mask - Place the thumb of your other hand along the bottom edge of the mask 4. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. 4.While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face. 5. Deliver each breath over 1 second. Enough to make the victim's chest rise.

Chest compression technique

1. Position yourself at victim's side 2. Victim is lying face up on a firm, flat surface (if victim is lying facedown, roll them faceup; if victim has a head or neck injury, keep head, neck, and torso in a line when rolling the victim to a faceup position) 3. Position your hands and body to perform chest compressions: - Put heel of one hand in center of the victim's chest, on the lower half of the breastbone (sternum) - Put heel of other hand on top of the first hand - Straighten your arms and position your shoulders directly over your hands 4. Give chest compressions at a rate of 100 to 120/min 5. Press down at least 2 inches with each compression; for each compression, make sure you push straight down on the victim's breastbone 6. Allow chest to recoil 7. Minimize interruptions

Bag-mask ventilation technique:

1. Position yourself directly above the victim's head. 2. Place the mask on the victim's face, using the bridge of their nose as a guide for correct position. 3. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open - perform a head tilt - place the mask on the face with the narrow portion at the bridge of the nose - use thumb and index finger of one hand to make a "C" on the side of the mask, pressing the edges of the mask to the face - use the remaining fingers to lift the angles of the jaw (3 fingers to form an "E"), open the airway, and press the face to the mask 4. Squeeze the bag to give breaths (1 second each) while watching for chest rise; deliver each breath over 1 second, whether or not you use supplementary oxygen

Choking relief in unresponsive adult or child sequence:

1. Shout for help. If someone is available, send them to activate the emergency response system. 2. Gently lower the victim to the ground if you see that they're becoming unresponsive. 3. Begin CPR, starting with chest compression. Do not check for pulse. 4. Each time you open the airway to give breaths, open the victim's mouth wide. Look for the object. 5. After about 5 cycles or 2 minutes of CPR, activate the emergency response system if someone has not already done so.

Choking relief in an unresponsive infant:

1. Shout for help. If someone responds, send them to s=activate the emergency response system. Place infant on flat, firm surface. 2. Begin CPR with 1 extra step; each time you open the airway, look for the object in the back of the throat. If you see an object and can easily remove it, remove it. 3. After about 2 minutes of CPR, activate the emergency response system.

Abdominal thrusts with victim standing or sitting sequence:

1. Stand or kneel behind the victim and wrap your arms around the victim's waist. 2. Make a fist with one hand. 3. Place the thumb side of your fist against the victim's abdomen, in the midline, slightly above the navel and well below the breastbone. 4. Grasp your fist with your other hand and press your fist into the victim's abdomen with a quick, forceful upward thrust. 5. Repeat thrusts until the object is expelled from the airway or the victim becomes unresponsive. 6. Give each new thrust with a separate, distinct movement to relieve the obstruction.

The 3 leadership roles:

1. Team leader 2. Administer medication 3. Timer/recorder

Adult 1-rescuer BLS sequence

1. Verify scene safety, check for responsiveness, and get help 2. Assess for breathing and pulse 3. Locate carotid pulse 4. Determine next actions 5. Attempt with defibrillation with the AED 6. Resume with high-quality CPR

Opioid-Associated Life-Threatening Emergency Response Sequence Summary

1. Verify scene safety. 2. Assess breathing and pulse. 3. Determine next actions based on breathing and pulse.

How to verify scene safety, check for responsiveness, and get help:

1. Verify that the scene is safe 2. Check for responsiveness; "Are you ok?" 3. If victim is unresponsive, shout for help 4. Activate emergency response system (9-1-1, mobilize code team, notify ALS) 5. Get AED/defibrillator and emergency equipment

(After AED use) Immediately resume high-quality CPR, starting with chest compressions after:

1. a shock is delivered 2. AED prompts "no shock advised"

The 2 common AED pad placement positions:

1. anterolateral 2. anteroposterior

When giving chest compressions, it is important to:

1. compress at a rate of 100 to 120/min 2. compress the chest at least 2 inches 3. allow chest to recoil completely after each compression 4. minimize interruptions in compressions

Two methods for opening the airways

1. head tile-chin lift 2. jaw thrust

(High quality CPR) Compress at _____ the depth of the chest, about _____ inches, for infants.

1/3, 1.5 inches

(High quality CPR) Compress at _____ the depth of the chest, about _____ inches, for children.

1/3, 2 inches

The universal rate for compressions in all cardiac arrest victims is _______ to _______/min.

100 to 120

(High quality CPR) Compress at a depth of at least ____ inches for adults.

2 inches

Compression technique for infant:

2-finger chest compressions

Heart attack occurs when...

blood flow to part of the heart muscle is blocked

Why is chest recoil important?

Allows blood to flow into the heart

What happens in sudden cardiac arrest?

Death occurs within minutes if the victim does not receive immediate lifesaving treatment.

ECC stands for...

Emergency cardiovascular care

Gastric inflation

Filling of the stomach with air

What does performing the head tilt-chin maneuver do?

The head tilt-chin maneuver relives airway obstruction, by lifting the tongue, in an unresponsive victim

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

Use an AED with a pediatric dose attenuator.

If a head or neck injury is suspected, use what maneuver to open the airway? Why?

Use jaw-thrust maneuver to reduce neck and spine movement.

Why is a bag-mask used?

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

If victim is pregnant or obese, perform ___(a)___ thrusts instead of ___(b)___ thrusts.

a) chest b) abdominal

It is important to give both ___(a)___ and ___(b)___ for infants and children during high-quality CPR.

a) compressions b) breaths

Naloxone may be given by ___(a)___, ___(b)___, and ___(c)___ routes.

a) intramuscular b) intranasal c) intravenous

Links in the Chain of Survival for an adult who has cardiac arrest in the hospital are: - Surveillance, prevention, and treatment of ___(a)___ - Immediate ___(b)___ of cardiac arrest and ___(c)___ of the emergency response system - Early ___(d)___ with an emphasis on chest compression - Rapid ___(e)___ - Multidisciplinary ___(f)____

a) prearrest conditions b) recognition c) activation d) CPR e) defibrillation f) post-cardiac arrest care

Pediatric cardiac Chain of Survival: - ___(a)___ of arrest - Early high-quality ___(b)___ - ___(c)___ of the emergency response system - Effective __(d)___ (including rapid stabilization and transport to post-cardiac arrest care) - Integrated ___(e)___

a) prevention b) bystander CPR c) rapid activation d) advanced life support e) post-cardiac arrest care

Links in Chain of Survival for an adult who has a cardiac arrest outside the hospital are: - Immediate ___(a)___ of cardiac arrest and ___(b)___ of the emergency response system - Early ___(c)___ with an emphasis on chest compressions - Rapid ___(d)___ with an AED - Effective ___(e)___ (including rapid stabilization and transport to post-cardiac arrest care) - Multidisciplinary ___(f)____

a) recognition b) activation c) CPR d) defibrillation e) advanced life support f) post-cardiac arrest care

Once the AED arrives, place on the ___(a)___ side, next to the ___(b)___ who will operate it.

a) victim's b) rescuer

Example of emergency response system in prehospital

activating EMS, paramedics, medic units, or advanced life support or calling for backup

Example of emergency response system in hospital

activating a specific hospital code, medical emergency team, or rapid response team

Naloxone

an agent that can reverse the effects of respiratory depression caused by opioids

Arrythmia

an irregular or abnormal heart beat

AP stands for...

anteroposterior

In 2-rescuer CPR, where is rescuer 1 (breaths) positioned?

at the victim's head

In 2-rescuer CPR, where is rescuer 1 (compressions) positioned?

at the victim's side

IHCA initial support depends on...

in-hospital system

If victim IS NOT breathing normally or is only gasping and has no pulse, then...

begin high-quality CPR

A firm surface allows compression of the chest and heart to create _______.

blood flow

Example of emergency response system in workplace/facility

calling 9-1-1 or activating specific Occupational Safety and Health Administration or workplace emergency response protocols

CPR stand for...

cardiopulmonary resuscitation

To perform a pulse check in a child, palpate a _________ or _________ pulse.

carotid, femoral

Hands-only CPR involves...

chest compressions

Provide high-quality CPR starting with _______.

chest compressions

For victims less than 8 years of age, use [child/adult] pads.

child

OHCA initial support depends on...

community & EMS providers

ED stands for...

emergency department

Chest compression and chest recoil/relaxation times should be about _______.

equal

To make compressions as effective as possible, place the victim on a ______ surface.

firm

Cardiac catherization suite or lab

group of procedure rooms in a hospital or clinic where specialized equipment is used to evaluate the heart and the blood vessels around the heart and in the lungs

(High quality CPR) Push ______, push _____

hard, fast

Multirescuer coordinated CPR involves...

high-performance team

Cardiac catheter procedure

involves insertion of a catheter through an artery or vein into the heart to study the heart and its surrounding structures and function

Gasping (is/is not) normal breathing. It is a sign of ___(a)___.

is not a) cardiac arrest

Definition of infants

less than 1 year of age (excluding newly born infants in the delivery room)

A manual defibrillator provides [lower/higher] energy doses that are often needed in infants.

lower

For infants, a [AED/manual] defibrillator is preferred.

manual

Opioid

medications used for pain relief

If victim is breathing normally and a pulse is present, then...

monitor the victim

Respiratory arrest occurs when...

normal breathing stops, preventing essential oxygen supply and carbon dioxide exchange

For mouth-to-mask breaths, use a _________.

pocket mask

In-house cardiac arrest (IHCA)

primary provider recognizes cardiac arrest --> immediate activation of resuscitation team --> early high-quality CPR & rapid defibrillation

If victim IS NOT breathing normally but a pulse is present, then...

provide rescue breaths - confirm emergency response system has been activated - continue rescue breathing, and check pulse about every 2 minutes - if opioid use is suspected, consider naloxone

PAD stands for...

public-access defibrillation

(AED) If the victim is in water, then...

pull victim out of water

(AED) If victim's chest is covered with water, then...

quickly wipe the chest before attaching the AED pads

To minimize delay in starting CPR, you may assess breathing at the _______ time as you check the pulse.

same

What action should you take when the AED is analyzing the heart rhythm?

stand clear of the victim

Sudden cardiac arrest occurs when...

the heart develops an abnormal rhythm and can't pump blood

(AED) If victim is lying on snow or in a small puddle, then...

use the AED after quickly wiping the chest

Do not use an AED in ________.

water

When is a jaw-thrust maneuver used?

when the head tilt-chin lift doesn't work or a spinal injury is suspected

(High quality CPR) When to begin compression?

within 10 seconds of recognition of cardiac arrest