American Red Cross Basic Life Support

If using a feedback device, make sure the compressions are no more than _____________ deep.

2.4 inches

ROSC (return of spontaneous circulation)

After return of spontaneous circulation (ROSC), survival outcomes are improved when providers work to stabilize the patient, minimize complications and diagnose and treat the underlying cause.

What do you do for a patient in respiratory arrest?

Deliver ventilations, no compressions. (when has pulse as well)

Modified jaw-thrust maneuver

When patient as an expected neck or head injury.

Proper rate for compressions for adults

100 to 120 compressions 30:2 ratio 30 compressions 2 breaths

The room is safe to enter. As you approach Mrs. Bailey you do not see any signs of life-threatening bleeding, but she appears unresponsive. Which action should you perform next?

Use the shoot-tap-shoot sequence to determine responsiveness.

To perform compressions on Maggie, you use the two-finger technique (i.e., two fingers centered on the sternum just below the nipple line.)

False (too old)

Ventilations for respiratory arrest on children and infants

1 ventilation every 3 to 5 seconds

With BVM, what happens for respiratory arrest?

1 ventilation every 6 seconds

Rapid assessment of Mrs. Bailey's breathing reveals irregular, gasping breaths. You correctly identify this pattern of breathing as:

Agonal Breaths

What do you do for a patient in cardiac arrest?

Start 30 compressions within 10 seconds of identification. Get AED and activate response team.

Shoot-tap-shoot

Used to check for patient responsiveness. On an adult or child, you tap the shoulder. On infant, you tap bottom of the foot.

When is AED not safe?

Water or combustible materials

What should you do to perform high quality CPR on adults?

100-120 compressions let chest fully recoil after each compression Depth of at least 2 inches no more than 2.4 inches Minimize interruptions to less than 10 seconds

What should you do with the AED when there is chest hair, jewelry, transdermal patch, or pacemaker present?

Chest hair: quickly shave the areas. Jewelry: avoid placing AED patches on the jewelry or piercings. Transdermal Patch: remove the patch and wipe away remaining medication on skin. Pacemaker: Avoid placing patches near them.

High Quality CPR

Conduct rapid assessment Place the patient on a firm, flat surface Position hands correctly Position your body effectively Provide 30 chest compressions Seal the mask and open the airway Provide 2 ventilations Switch positions every 2 minutes Continue providing CPR cycles

When the patient responds after administering naloxone

If the patient begins to breathe normally, check responsiveness and assess for breathing and a pulse. Then place them in a recovery position providing you do not suspect a head, neck, spinal, hip or pelvic injury. Monitor them until EMS, the rapid response team or the resuscitation team arrives. If the patient stops responding, begin ventilations or CPR as appropriate and repeat naloxone.

Aaliyah is 11 years old and weighs 97 lbs. She shows signs of puberty including breast development. You provide chest compressions at a depth of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm).

True

Objective assessments for opioid overdose

When assessing a patient with suspected or known opioid overdose, consider the use of more objective assessments to assess breathing, such as capnography. A normal ETCO2 value rules out respiratory depression.

Adolescent

Puberty through adulthood

Capnography

Measures the end tidal carbon dioxide level

Responsive Chocking Child

Same as adult 5 back blows and 5 abdominal thrust

How long can you wait before administering a second dosage of naloxone?

4 minutes

You are alone providing care for an unresponsive infant with an obstructed airway. You must look in the infant's mouth for the object that is obstructing the airway, and remove it with your pinky if you can see it. When is the appropriate time to perform this step?

After completing 30 compressions

Team Leader Responsibilities

Assigns and understands team roles. Sets clear expectations. Prioritizes, directs and acts decisively. Encourages and allows team input and interaction. Focuses on the big picture. Monitors performance while providing support. Acts as a role model. Coaches the team. Re-evaluates and summarizes progress. Leads a debriefing session.

How do you check an adult and child's pulse?

Carotid

Mouth-to-Nose Ventilations

If you are unable to make a complete seal over the patient's mouth, you may need to use mouth-to-nose ventilations instead. With the patient's head tilted back, close the mouth by pushing up on the chin. Seal your mouth around the patient's nose and breathe into the nose. If possible, open the patient's mouth between ventilations to allow air to escape.

Child

Someone from the age of 1 to the onset of puberty

Sadie is a 2.5-year-old child weighing 28 pounds. To perform high-quality chest compressions, you may need to use a one-hand technique.

True. For a smaller child, you may need to use a one-hand technique to perform high-quality chest compressions. When using a one-hand technique, be sure you are able to compress the chest about 2 inches.

Ventilations for adult in cardiac arrest

deliver 2 ventilations that last about 1 second each and make the chest begin to rise.

For infant, how do you open their airway?

neutral position

What can providers do with hands when switching positions during AED use?

Hover them above patients body in preparation of CPR when ready.

Care

Provide care and Reassess and document

If the patient with an obstructed airway is a child or shorter than you, it may be better to kneel behind them rather than stand to perform abdominal thrusts.

True

When is consent to give care implied for a responsive choking child?

When a parent or guardian is not available to give consent

Respiratory arrest and opioid overdose

If the patient is in respiratory arrest, deliver 1 ventilation every 5 to 6 seconds for an adult and every 3 to 5 seconds for children and infants. Each ventilation should last about 1 second and make the chest begin to rise. Then, if your facility protocol allows, administer naloxone as soon as it is available. Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR or use an AED if one is available and ready to use. Remember, delivering ventilations is the priority over administering naloxone during respiratory arrest.

Unresponsive choking infant

Provide care as you would for an unresponsive adult or child who is choking. Use pinky to remove an object if you see it

AED placement for adults

Patient's upper right chest, below the right clavicle to the right of the sternum Patient's lower left chest along the midaxillary line, a few inches below the left armpit

Responsive chocking adult

Abdominal Thrust (middle of the abdomen, just above the navel) Back Blows (between the scapulae- heel of hand) 5 back blows and 5 abdominal thrust

Unresponsive chocking adult and child

After each set of compressions, open the patient's mouth and look for the object before attempting ventilations. If you see the object in the patient's mouth, remove it using a finger sweep. If you do not see the object, do not perform a blind finger sweep. Next, attempt 2 ventilations. Never try more than 2 ventilations during one cycle of CPR, even if the chest does not rise. Continue performing CPR cycles, checking for an object before each set of ventilations.

Valerie has established that Mr. Goodman does not have a pulse and is not breathing, and she has exposed the chest. She must immediately begin CPR while Joanne retrieves and sets up the AED. Which actions should the team take to ensure that they are providing high-quality CPR?

Avoid excessive ventilations. Provide smooth compressions at a rate of 100 to 120 compressions per minute and a depth of at least 2 inches Allow the chest to fully recoil after each compression

Responsive choking infant

Back blows (baby rests on forearm, cradling the head, heal of your hand, delivering between the scapulae, keep fingers to avoid hitting head or neck) Chest Thrusts (infant faces up between forearms, lower infant on thigh, place two fingers in the center of infant's chest, just below nipple line, depth is 1 1/2 inches) 5 back blows and 5 chest thrusts

Cardiac Arrest and opioid overdose

Begin CPR within 10 seconds of recognizing the patient is in cardiac arrest. As soon as available, use the AED and, if your facility protocol allows, administer naloxone. If you are alone and do not have a mobile device available, perform CPR for about 2 minutes before leaving to call for additional resources. Remember, providing high-quality CPR is the priority over administering naloxone during cardiac arrest.

How do you check an infants pulse?

Brachial

Other indicators of opioid overdose

Cyanosis. Track marks from intravenous drug use. Prescription pill bottles, pipes, needles, syringes, pill powder or other drug-related items. History of opioid drug abuse.

Ventilations for adults in respiratory arrest

Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR.

CPR on infant

Depth of about 1 1/2 inches Two finger technique (one provider)- center of chest below nipple line on the sternum 30:2 for one provider Thumbs, side by side on the center of the infant's chest below nipple line (multiple provider) 15:2 for multiple provider

CPR on child

Depth of about 2 inches 30:2 for one provider 15:2 for multiple provider Same placement and hand technique for compressions

When do providers switch positions during CPR? (no AED)

Every 2 minutes

When delivering ventilations to Jalen, you open his airway to a neutral position.

False. For children like Jalen, you should open the airway to a slightly past neutral position. If Jalen were an infant, you would open the airway to a neutral position.

Measures of high quality CPR

Feedback devices Chest compression factors Capnography EtCO2 levels

To perform chest thrusts, perform quick inward and upward thrusts.

For chest thrusts, pull straight back, performing quick inward thrusts into the patient's chest, as you would with abdominal thrusts. Do not thrust upward.

Single provider AED use

If you do not have an AED with you, call for help and begin CPR. If you have no way of calling for help, place the patient in the recovery position and get the AED. Turn on the AED and follow the prompts, then expose the patient's chest. Attach the AED pads using an anterior/lateral or anterior/posterior position according to the manufacturer's recommendation. If necessary, plug in the connector and push the analyze button. Tell everyone to "clear" while the AED analyzes. No one, including you, should be touching the patient. If the AED advises a shock, again tell everyone to "clear." Press the shock button to deliver the shock, then immediately begin CPR. You do not need to wait for the AED prompt. Continue for about 2 minutes until: The AED prompts that it is reanalyzing.The patient shows signs of return of spontaneous circulation. Other trained providers arrive and relieve you.

How can you administer naloxone?

Intravenously, intranasally, and intramuscularly

You are providing abdominal thrusts to an adult patient with an obstructed airway when she suddenly becomes unresponsive. Another team member has already left to get the AED and additional resources. Identify the proper steps of care for an unresponsive adult with an obstructed airway.

Lower the patient to a firm, flat surface Perform 30 compressions Look for an object and perform a finger sweep if an object is seen Deliver 2 ventilations Continue cycles of CPR, checking for an object before each set of ventilations

Mrs. Bailey is unresponsive. You suspect she may have a head injury. Which technique should you use to open Mrs. Bailey's airway?

Modified Jaw Thrust

What should you do if ROSC is achieved?

Monitor the patient until the advanced cardiac life support team takes over. Check for breathing and pulse. Stop CPR/AED use.

Multiple Provider AED use

One or more providers perform CPR while another provider prepares and operates the AED. Turn on the AED and follow the prompts. Attach the AED pads using an anterior/lateral or anterior/posterior position depending on the manufacturer's recommendation. The team provides cycles of CPR until the AED prompts to clear for analysis. As the AED analyzes, switch positions. The provider performing compressions should hover their hands above the patient's chest taking care not to touch the patient. After the AED delivers a shock or advises "no shock," immediately resume CPR starting with chest compressions. You don't need to wait for the AED to prompt you. Continue CPR for about 2 minutes until:The AED prompts that it is reanalyzing. The patient shows signs of return of spontaneous circulation. Other trained providers arrive and relieve you. Switch roles each time the AED analyzes the heart rhythm to relieve the compressor.

Mouth-to-Mouth Ventilations

Open the airway to a past-neutral position (for an adult). Pinch the patient's nose shut. Take a normal breath, make a complete seal over the patient's mouth with your mouth and blow into the patient's mouth to deliver 1 ventilation over 1 second until you see the chest begin to rise. After each ventilation, break the seal and take a breath before resealing your mouth over the patient's mouth. Then deliver the next ventilation.

Hand position for adult CPR

Other hand on top of the first one and fingers interlaced or hold them up. Shoulders directly over your hands with elbows locked

Behaviors of a patient who is choking

Panicked, confused or surprised facial expression Clutching the throat (the universal sign of choking) Running about Flailing the arms Trying to get attention Stridor (high-pitching squeaking noises) No noises at all Flushed, pale or cyanotic skin appearance

Recognize

Patient may be experiencing a life-threatening emergency. Injury, respiratory arrest, cardiac arrest, obstructed airway, or opioid overdose.

You use critical thinking when you:

Perform a rapid assessment and determine a course of action. Anticipate roles and functions as part of a team based on the patient's presentation and condition. Re-evaluate the situation for changes, interpret these changes and modify care accordingly.

Asses

Perform visual survey, check for responsiveness, and simultaneously check for breathing and pulse.

Opioid Overdose Triad

Pinpoint pupils, Respiratory depression, and unconsciousness or severe sleepiness

When is using an AED safe?

Pregnancy, Trauma, Pacemakers or ICDs, Transdermal Medication Patches, Chest Hair, Jewelry and Body piercings, Metal surfaces, and Inclement weather.

What are some examples of a patient for whom chest thrusts would be the alternative technique, instead of abdominal thrusts?

Pregnant woman Patient whom you may not be able to reach far enough around to deliver abdominal thrusts Patient in a bed or wheelchair Patient for whom abdominal thrusts are not effective

Pediatric Cardiac Chain of Survival

Prevention of arrest Early, high-quality CPR Rapid activation of the emergency medical service system or response team Effective, advanced life support Integrated post-cardiac arrest care

If the patient responds to the naloxone, you need to be prepared to perform which action(s) most immediately?

Protect yourselves against a possible violent reaction from Liz, clear the airway if needed and put Liz into a recovery position.

Proper dosage for naloxone

Recommended adult dose is 2 mg intranasal or 0.4 mg intramuscular.

You are about to start your morning rounds, when you hear a loud crash in Mrs. Bailey's room. When you enter her doorway, you see her lying on the floor with her walker tipped over next to her. You must first perform a visual survey. What actions should you take?

Scan the patient's room for any obvious hazards, determine whether any additional help is needed, and observe for any signs of illness or injury, including life-threatening bleeding.

Compressions for single and multiple providers

Single: 30:2 Multiple: 30:2

For children, how do you open their airway?

Slightly past neutral position

Chest Compression Fraction

Strive for 80% minimum of at least 60%

How long should you wait to check pulse and breathing?

every 2 minutes

Use pediatric AED pads on

infants and children less than 8 years old and weigh less than 55 lbs. If not present, adults pads are fine.

If capnography were in use, an ETCO2 level of ___ would indicate to the team that there could be a problem with the quality of chest compressions.

less than 10 mmHg

With a BVM when there is two providers, what happens? Cardiac arrest

1 ventilations every 6 seconds, compressions do not stop

When checking pulse and breathing, you check for at least 5 seconds but no more than

10 seconds

Tidal volume for adults

400 mL to 700 mL

Bag-Valve-Mask Resuscitator Ventilations

A BVM resuscitator is a handheld device used to ventilate patients during respiratory arrest or multiple-provider CPR. During single-provider CPR, use of a BVM resuscitator is not recommended because it will increase the time between sets of chest compressions resulting in poor outcomes. Unlike a pocket mask, a BVM resuscitator delivers ambient air rather than the provider's exhaled air. So, the patient receives a higher concentration of oxygen (approximately 20% to 21%) with BVM ventilations than with pocket mask or mouth-to-mouth (approximately 16% to 17%).

Closed-loop communication

A communication technique used to prevent misunderstandings; the receiver confirms that the message has been received and understood.

Location for hands during CPR on adults

Center of chest on the lower half of the sternum

What is the correct area of the chest to perform chest thrusts?

Center of the chest on the lower half of the sternum

Adult In-Hospital Cardiac Chain of Survival

Surveillance and prevention Recognition of a cardiac emergency and activation of the emergency response system Early CPR to keep oxygen-rich blood flowing and to help delay brain damage and death Early defibrillation to help restore an effective heart rhythm and significantly increase the patient's chance for survival. Integrated post-cardiac arrest care to optimize ventilation and oxygenation and treat hypotension immediately after the return of spontaneous circulation.

Which of these actions are appropriate ways to minimize interruptions in chest compressions?

Switch positions while the AED analyzes. Continue compressions while the AED pads are placed. Remain in position with the hands a few inches above the patient's chest during shock delivery.

Based on her rapid assessment findings, Amy recognized that Theo was in cardiac arrest and initiated CPR. If Theo were unresponsive and not breathing normally but had a pulse of ≤ 60 bpm with signs of poor perfusion, which action would Amy take?

Tell Joe to get help and an AED. Begin CPR. Continue compressions and ventilations. Check the pulse and breathing about every 2 minutes. If Theo were unresponsive and not breathing normally (or only gasping) but had a pulse ≤ 60 bpm with signs of poor perfusion, she would tell Joe get help and an AED. Then, she would begin CPR. She would continue compressions and ventilations checking the pulse and breathing about every 2 minutes. If during pulse checks Theo's pulse increased to greater than 60 bpm, Amy would stop chest compressions but continue providing 1 ventilation every 3 to 5 seconds as long as Theo remained in respiratory arrest. If she did not find a pulse, she would continue CPR.

After the resuscitation event, the BLS team conducted a debriefing session to ensure continuous CPR quality improvement. Which observation or data point suggests a need for improvement?

The chest compression fraction (CCF) was 58%

Providers are preparing to deliver ventilations to a patient in cardiac arrest. One provider seals the mask with both hands in the E-C hand position and simultaneously opens the airway to a past-neutral position. The other provider depresses the bag. How much volume should be administered?

The provider should supply 400-700 mL, depressing the bag halfway.

Open the airway

To check for breathing and a pulse, you must first open the patient's airway using either the head-tilt/chin-lift technique or the modified jaw-thrust maneuver.

After Ana-Lisa took over compressions, Joe and Amy worked together to operate the BVM. Joe maintained an open airway and sealed the mask with both hands in the E-C position, while Amy delivered ventilations. This is the recommended technique for operating the BVM when enough providers are available. True or false?

True

You recognize that Maggie is in cardiac arrest. You are alone and do not have a mobile phone or other form of communication. Although you called out for someone to help and get an AED, nobody responded. You did not witness Maggie collapse, so you provide 2 minutes of CPR before leaving Maggie to get help.

True

Pocket mask ventilations

Use of a pocket mask is recommended during single-provider CPR to limit interruptions in chest compressions. This allows you to remain at the side of the patient and limit unnecessary movement, which could delay your return to chest compressions.

As you check Mrs. Bailey's breathing, you look to see whether her chest rises and falls, listen for escaping air and feel for breathing against the side of your cheek. Is this the correct course of action?

Yes

You and the team delivered one shock to the patient, then performed about 2 minutes of CPR. You have been performing compressions and are starting to fatigue. What should you do?

You should anticipate a compressor change and verbalize the coordination plan to switch. You should switch off compressions when the AED analyzes again.

Myocardial Infarction (MI)

a heart attack; a condition where the heart muscle does not receive enough blood and lacks oxygen, causing damage or death to that area of the heart

AED use on infants

anterior/posterior pad placement (middle chest and on the back)

Depth of compressions for adults

at least 2 inches no more than 2.4 inches

Infant

someone under the age of 1

AED use on children 8 or older weighing more than 55 lbs

use adult pads anterior/lateral position (same as adults) If pads overlap, use anterior/posterior placement Never use pediatric AED pads or a pediatric electrical setting on a child older than 8 or weighing more than 55 lbs.