BLS Exam
Safety Precautions
safety measures to prevent disease transmission based on the assumption that all body fluids may be infectious
Rescue breathing for: Adult [>puberty] Children [1-puberty] Infants [<1]
-10-12 breaths/min recheck pulse every 2 minutes -12-20 breaths/min recheck pulse every 2 minutes -12-20 breaths/min recheck pulse every 2 minutes
Explain the Head-Tilt/Chin-Lift Technique (on an adult)
1. Press down on the forehead with one hand while pulling up on the bony underside of the chin with two to three fingers of the other hand. 2. Tilt the head to a past-neutral position to open the airway
Steps to the debriefing session
1. Review: The team leader provides a brief recap of the emergency and the interventions that were used. 2. Analyze: The team reviews and evaluates the objective data obtained during the resuscitation effort. 3. Reflect: The team reflects on the actions they took and why, discusses the pros and cons of those actions and identifies changes that could be made to improve future outcomes. 4. Summarize: The team recaps the main takeaway points and develops a list of action items.
List the four key components of close-loop communication
1. Sender: The person initiating the communication 2. Message: The content of the communication; must be expressed clearly so that everyone involved knows exactly what the message is 3. Receiver: The person for whom the message is intended 4. Feedback: The confirmation by the receiver that the message is received and understood; an essential element of closed-loop communication
Rate of compressions per minute for: Adult [>puberty] Children [1-puberty] Infants [<1]
100-120/min 100-120/min 100-120/min
Compression depth: Adult [>puberty] Children [1-puberty] Infants [<1]
2-2.4 inches At least 1/3 depth of chest 2 inches At least 1/3 depth of chest 1 ½ inches
Ratio of compressions to breaths *Once an advanced airway is placed ventilations will be 1 every 6 sec. with continual compressions.*: Adult [>puberty] Children [1-puberty] Infants [<1]
30:2-Change compressors and reevaluate every 2 min 30:2/15:2 if 2 rescuer-Change compressors and reevaluate every 2 min 30:2/15:2 if 2 rescuer-Change compressors and reevaluate every 2 min
Teamwork
A group of people with well-defined roles and responsibilities making a coordinated effort to achieve a common goa
Bag-Valve-Mask (BVM) resuscitator
A handheld device used to ventilate patients during respiratory arrest or multiple-provider CPR It delivers ambient air rather than the provider's exhaled air
19. While assisting with a cardiac arrest, you are instructed to take over bag valve mask ventilations. You repeat back " you would like for me to take over bag valve mask ventilations." In team dynamics, what is this called? A. Closed loop communications B. Knowing your limitations C. Knowledge sharing D. Mutual respect
A. Closed loop communications
20. A person is found lying next to an electrical line, unresponsive. You assure that the power is disconnected before you attempt resuscitation. In this case, you identified the information you saw, and took appropriate action. This concept of taking action based on information gathered is called? A. Critical thinking. B. Unified team approach. C. Problem identification. D. Solving issues.
A. Critical thinking
4. Opioids are medications that are used to treat pain but have a high potential for abuse. Addiction rate to the medications is a growing problem and they can cause respiratory and or cardiac arrests. While the first and most important step is to perform CPR, what is the name of the medication that is utilized to reverse the effects of respiratory depression? A. Naloxone. B. Ativan. C. Lasix. D. Magnesium Sulfate.
A. Naloxone.
17. When is the two thumb encircling technique is used? A. On an infant when two rescuers are available. B. When the infant is choking. C. When performing CPR on a pediatric victim. D. When performing one rescuer CPR on an infant and you become tired.
A. On an infant when two rescuers are available.
25. While at a school event, a teacher chokes on gum. He runs towards the office before falling unconscious. Immediately after performing 30 compressions, the next step is? A. Open the airway and look into the mouth before ventilating B. Perform a finger sweep and attempt breaths C. Readjust the airway with a jaw thrust maneuver D. Check pulse for no more than 10 seconds
A. Open the airway and look into the mouth before ventilating
13. What is the purpose of defibrillation? A. To stop a chaotic rhythm and restore the heart's normal rhythm. B. To increase the rate of complete heart block. C. To provide a blood pressure. D. To treat cardiac standstill.
A. To stop a chaotic rhythm and restore the heart's normal rhythm
Conscious choking: Adult Child Infants
Abdominal Thrusts (Red Cross Class - 5 Back Blows) Abdominal Thrusts (Red Cross Class - 5 Back Blows) 5 Back Blows/5 Chest Thrusts
10. The maximum amount of time that should be taken to check for a pulse or perform any procedure on an adult, infant or child in cardiac arrest is? A. 15 seconds B. 10 seconds C. 30 seconds D. 5 seconds
B. 10 seconds
5. Your middle age neighbor is mowing his grass when he clutches his chest and drops to the ground. He has no pulse or respirations. Your son calls 911 while you initiate chest CPR. How fast should the compression rate be? A. 100 compressions per minute. B. 100-120 compressions per minute. C. 80-100 compressions per minute D. 120-150 compressions per minute
B. 100-120 compressions per minute.
9. What is the correct ratio for compressions to ventilations in infant CPR with 2 rescuers present? A. 20 compressions to 4 breaths. B. 15 compressions to 2 breaths. C. The rate remains 30 compressions to 2 breaths. D. 15 compressions to 1 breath
B. 15 compressions to 2 breaths.
7. Which of the following situations will slightly delay AED usage while the situation is made safe for AED application? A. A person found lying on a metal floor inside a meat cooler. B. A person found submerged in a bathtub. C. A person who collapsed in snow. D. A person who has a transdermal nitro patch on their arm. E. The patient being in late stage pregnancy.
B. A person found submerged in a bathtub.
16. You begin your shift on the med/surg floor. You begin your rounds and when you walk into a patient's room, you notice the patient has agonal respirations. What should you do if following the concepts of resuscitation? A. Give the patient oxygen. (Airway, Revive, Care) B. Check a pulse, and begin compressions if indicated. (Assess, Recognize, Care) C. Do nothing, the patient is asleep. (Accept, Care, Revive) D. Begin the Heimlich maneuver. (Assess, Airway, Complete)
B. Check a pulse, and begin compressions if indicated. (Assess, Recognize, Care)
23. High quality CPR is the critical component to resuscitation, especially compressions; which concept is correct? A. Compression depth has a higher priority than recoil or relaxation B. Compression and recoil (refill) are equally important C. Ventilation is the priority for all victims D. 30 ventilations per minute are optimum for the best outcome
B. Compression and recoil (refill) are equally important
12. While providing CPR to a child or adult, an AED becomes available and a shock is indicated and administered. (Since it is OK to shock children with adult AED pads if necessary), what should you do next? A. Administer 2 more shocks; to total 3. B. Immediately restart CPR, starting with compressions. C. Give 2 breaths first then resume CPR. D. Check the carotid pulse for no longer than 10 seconds.
B. Immediately restart CPR, starting with compressions
What are the CAB's of CPR?
C = Circulation- Check for a pulse Max - 10 seconds. If pulse is not definite, begin compressions. A = Airway- Open airway (head tilt/chin lift) B = Breaths- Give 2 breaths then back to compressions [D=Defibrillator- Attach a manual defibrillator or AED]
29. The accepted ratio of compressions to ventilations for a 6 year old drowning victim when only 1 rescuer is available is? A. 15:1 B. 30:1 C. 30:2 D. 15:2
C. 30:2
11. You are watching a resuscitation attempt at a medical facility. You observe the hand placement of the person who is providing compressions to be incorrect. Your next step as a team member should be? A. Wait 10 seconds to see if the team leader notices. B. Tell the person doing compressions that you will take over. C. Alert the team leader for him/her to address. D. Tell another team member to take over.
C. Alert the team leader for him/her address
18. At the beginning of your work shift, your team leader assigns you the role of compressor during a cardiac arrest. This is known as: A. Mutual respect. B. Closed loop communications. C. Clear roles and responsibilities. D. Constructive intervention.
C. Clear roles and responsibilities.
26. The resuscitation team is made up of various professionals with different levels of license and skill sets. In order to function efficiently the team members must? A. Wait for a physician to order CPR and defibrillation B. Always be prepared to perform any skills, even if not licensed to C. Realize their strengths, abilities and limitations D. Decide if they feel CPR is worth the physical effort
C. Realize their strengths, abilities and limitations
1. An elderly woman collapses to the floor in a bingo hall. Your first action should be: A. Open the airway and give 2 breaths. (mouth to mouth rapid is best) B. Go grab the defibrillator off the wall in the hallway. C. Yell out/ call for help while simultaneously assessing for pulse and respirations. (carotid or femoral is best) D. Check for a carotid or radial pulse.
C. Yell out/ call for help while simultaneously assessing for pulse and respirations. (carotid or femoral is best)
Unconscious choking: Adult Child Infant
Call a "code" or call 911 Begin CAB's of CPR Before giving breaths: look in mouth for foreign body, remove object if it is seen. Repeat cycles of CPR if needed Begin CPR If second rescuer is present, send them to call a "code" or 911, otherwise, call after 2 min of CPR Before giving breaths: look in mouth for foreign body, remove object if it is seen. Repeat cycles of CPR if needed Begin CPR If second rescuer is present, send them to call a "code" or 911, otherwise, call after 2 min of CPR Before giving breaths: look in mouth for foreign body, remove object if it is seen. Repeat cycles of CPR if needed
Signs and Symptoms of a MI
Chest discomfort or pain that is severe, lasts longer than 3 to 5 minutes, goes away and comes back, or persists even during rest Discomfort, pressure or pain that is persistent and ranges from discomfort to an unbearable crushing sensation in the chest, possibly spreading to the shoulder, arm, neck, jaw, stomach or back, and usually not relieved by resting, changing position or taking medication Chest pain that comes and goes (such as angina pectoris) Difficulty breathing, such as at a faster rate than normal or noisy breathing Pale or ashen skin, especially around the face Sweating, especially on the face Dizziness or light-headedness Possible altered mental status or level of consciousness Nausea or vomiting
24. When performing compressions on a child for CPR or unconscious foreign body airway procedures the proper depth is? A. ½" or ½ the depth of the chest B. 1 ½ " to 2 1 ½ " inches C. Varies based on age and weight D. 2" or 1/3 the depth of the chest
D. 2" or 1/3 the depth of the chest
30. AED Pads require firm contact to the skin to be most effective, which of the following will negatively effect that contact? A. Water on the patients chest B. Suntan oil on the skin C. Hair on the chest D. All of the above
D. All of the above
6. Bystanders have pulled a young woman with a pulse but no respirations out of a lake. One of them is administering rescue breaths at a rate of one every 5-6 seconds while waiting for EMS to arrive. Which of the following is true about rescue breaths? A. Each breath should result in visible chest rise. B. Give each breath over 1 second. C. The pulse should be checked every 2 minutes. D. All of the above.
D. All of the above.
8. When utilizing a bag valve mask device it is important to remember: A. That this device requires training and is best suited for a 2-rescuer situation. B. The E-C clamp technique should be used while lifting the jaw to provide a good seal. C. To squeeze the bag for 1 second while watching the chest rise. D. All of the above.
D. All of the above.
27. A victim begins to choke, and you find them grabbing their throat and coughing uncontrollably, you should? A. Perform the Heimlich maneuver B. Perform the modified Heimlich maneuver C. Perform chest thrust if they are pregnant or obese D. Allow them to continue coughing
D. Allow them to continue coughing
21. You arrive to find a hospital maintenance worker lying on the ground, next to a ladder. He appears unconscious, your first action should be? A. Check for breathing and a pulse B. Shake and shout, check unresponsiveness C. Begin compressions at 30:2 D. Assure the area is safe for you to be in
D. Assure the area is safe for you to be in
22. After performing the choking procedure for a conscious victim who becomes unconscious, the next procedure is to? A. Perform a finger sweep B. Attempt ventilations C. Straddle the victim D. Begin CPR compressions
D. Begin CPR compressions
3. You are attending your nephew's birthday party when a 15-year-old suddenly starts choking on a hotdog. What should you do? A. Administer 2 rescue breaths using a barrier device. B. Perform a blind sweep of the victim's mouth using a soft cloth to keep him from biting. C. Deliver 2 back-slaps followed by looking into the mouth. D. Position yourself behind the child and administer abdominal thrusts or chest thrusts if warranted. (patient too large, pregnant or in a wheelchair)
D. Position yourself behind the child and administer abdominal thrusts or chest thrusts if warranted. (patient too large, pregnant or in a wheelchair)
28. You are assisting with a cardiac arrest at a surgi- center. Someone brings in an AED that you are not familiar with, in relation to utilizing this: A. Have an overhead page put out for someone familiar with the unit B. Perform 2 minutes of CPR, then apply the pads C. Wait for EMS or someone familiar with the AED before using D. Turn on the unit and follow the directions
D. Turn on the unit and follow the directions
2. You are performing 1 rescuer CPR on a 75-year-old female with a history of chest pain and diabetes. An AED has just been made available to you. What is the first action that you should take at this time? A. Finish the 5 cycles of chest compressions that you have started. B. Place the AED pads on the chest. C. Secure an electrical outlet to plug the AED into. D. Turn the AED on.
D. Turn the AED on.
AED Safety: Environmental Considerations
Flammable or combustible materials: Do not use an AED around flammable or combustible materials such as free-flowing oxygen. Metal surfaces: It is safe to use an AED when a patient is lying on a metal surface, as long as appropriate precautions are taken. Do not allow the AED pads to contact the metal surface, and ensure that no one is touching the patient when the shock is delivered. Water: If the patient is lying in a large puddle or submerged in water, remove them from the water before using an AED. However, if they are lying in a small puddle or wet surface, you do not need to remove them—providing you and the AED are not in the small puddle. Also, remove a patient's wet clothing from the chest and wipe the patient's chest dry before placing the AED pads. Avoid getting the AED or AED pads wet. Inclement weather: AEDs are safe to use in all weather conditions, including rain and snow. Provide a dry environment if possible, but do not delay defibrillation to do so. Remove a patient's wet clothing from the chest and wipe the patient's chest dry before placing the AED pads. Avoid getting the AED or AED pads wet.
Myocardial infarction (MI),
Heart Attack -the necrosis (death) of heart tissue as a result of insufficient delivery of oxygenated blood to the heart.
Compressions are performed with what?: Adult [>puberty] Children [1-puberty] Infants [<1]
Heel of 2 hands Heel of 1 or 2 hands 2 fingers OR 2 thumbs when using encircling hands technique
Agonal Breaths
Isolated or infrequent gasps, are not normal breathing.
Compression Landmark No pulse (or pulse <60 in infant or child with poor perfusion): Adult [>puberty] Children [1-puberty] Infants [<1]
Middle of the chest, between the nipples Middle of the chest, between the nipples 1 finger below nipple line
What happens in when two providers operate the BVM?
One provider maintains the mask seal and open airway with two hands in the E-C hand position, while the other provider depresses the bag halfway to deliver ventilations.
Rapid assessment
Performing a visual survey, checking responsiveness, opening the airway and simultaneously checking for breathing and a pulse.
E-C hand position (one provider operating the BVM
Placing one hand around the mask, forming an "E" with the last three fingers and a "C" with your thumb and index finger
Atypical signs and symptoms for a MI (women)
Shortness of breath Stomach, back or jaw pain Unexplained fatigue or malaise
Which position should the patient be in when opening their airway?
Supine
Problem Solving
The ability to use readily available resources to find solutions to challenging situations or issues that arise.
Responsibilities of Team Leader
To oversee the entire emergency situation and ensure that everyone works as a team to help promote the best possible outcome for the patient.
Critical Thinking
Thinking clearly and rationally to identify the connection between information and actions.
Responsibility of Crew Resource Management
To emphasize the use of all available resources, including people, equipment and procedures, to promote effective and efficient teamwork and reduce the likelihood of human error.
Why is debriefing important?
To improve performance and patient outcomes.
Responsibilities of Team Members
To provide care with skill and expertise
True or False: If an obstruction is found, remove it and attempt ventilations. Never perform a blind finger sweep.
True
What do you do next after you have made sure a scene is safe?
Use the shout-tap-shout sequence to obtain a response to a verbal or tactile stimulus
Capnography
a noninvasive way of obtaining an objective measure of compression quality with every ventilation which measures the end-tidal carbon dioxide (ETCO²) level
What is an AED (automated external defibrillator)? When should it be applied for patients experiencing cardiac arrest?
a portable electronic device that automatically analyzes the patient's heart rhythm and provides defibrillation as soon as it is readily available
Assess, Recognize and Care concept
a systematic, continuous approach for rapid assessment, accurate recognition and immediate care in emergency situations
Closed-Loop Communication
a technique used to prevent misunderstandings;
Defibrillation
an electrical shock that may help the heart re-establish a perfusing rhythm.
In any emergency, what is the first thing you do?
first make sure the environment is safe [for you, your team and anyone else there]
