Chapter 13: BLS Resuscitation

Explain the steps in providing two-rescuer adult CPR, including the method for switching positions during the process. (P 526)

Less tiring and it facilitates effective chest compressions. Before assisting with CPR, a second rescuer should apply the AED and then set up airway adjuncts 1. Take standard precautions and establish unresponsiveness 2. Check for breathing and a carotid pulse 3. Begin CPR, starting with chest compressions, give 30 chest compressions at a rate of 100 to 120 per minute. If an AED is available apply it 4. Open the airway according to your suspicion of spinal injury. 5. Give two ventilations of 1 second each and observe for visible chest rise. Continue cycle of 30 chest compressions and 2 ventilations until ALS providers take over.

Removing a Foreign Body Airway Obstruction from an Unresponsive Child

1. Take standard precautions, place child on a firm flat surface 2. Perform chest compressions using the same landmark as you would for CPR 3. Open airway and look inside the mouth 4. If object is visible and can be easily removed, then remove it with your fingers and attempt rescue breathing 5. Resume chest compressions if you can't see object, continue until ALS providers take over.

Discuss guidelines for circumstances that require the use of an automated external defibrillator (AED) on both adult and pediatric patients experiencing cardiac arrest. (P 517-518)

AEDs can be safely be used on children using the pediatric-sized pads and a dose-attenuating system (energy reducer) Apply AEDs after first five cycles of CPR has been completed Cardiac arrest in children is usually the result of respiratory failure, therefore, oxygenation and ventilation are vitally important If the patient is an infant a manual defibrillator is preferred

Describe the different mechanical devices that are available to assist emergency care providers in delivering improved circulatory efforts during CPR. (P 529, 531-533)

Active Compression-Decompression CPR: Involves compressing the chest and then pulls it back to its neutral position. Placed on center of chest Impedance Threshold Device (ITD): a valve device placed between the ET tube and a BVM, limit the air entering the lungs Mechanical Piston Device: device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard. Load-Distributing Band (LDB): circumferential chest compression device composed of a constricting band and backboard. Frees the rescuer to complete other tasks

Explain common causes of foreign body airway obstruction in both children and adults and how to distinguish mild or partial airway obstruction from complete airway obstruction. (P 541-542)

Airway obstruction may be caused by: Relaxation of throat muscles in an unresponsive patient, vomited, blood, damaged tissue, dentures, foreign bodies. Large objects that are visible and cannot be removed with suction should be swept forward and out with gloved index finger.

Explain the elements of basic life support (BLS), how it differs from advanced life support (ALS), and why BLS must be applied rapidly. (P 514-515)

Basic Life Support (BLS): is noninvasive emergency lifesaving care that is used to treat medical conditions, including airway obstruction, respiratory arrest, and cardiac arrest. BLS can maintain life for a short time, until ALS measures can be started Focus on: Airway (Obstruction) Breathing (Respiratory Arrest) Circulation (Cardiac Arrest) Advanced Life Support (ALS): involves advanced lifesaving procedures such as cardiac monitoring, administration of intravenous (IV) fluids and medications, and the use of advanced airway adjuncts

Describe the different possible causes of cardiopulmonary arrest in children. (P 533-534)

Cardiac arrest in infants and children follows respiratory arrest, which triggers hypoxia and ischemia of the heart Leading causes: Injury, infections of the respiratory tract, foreign body in the airway, submersion, electrocution, poisoning, (SIDS)

Describe the purpose of external chest compressions. (P 519)

Compressions squeeze the heart, acting as a pump to circulate blood, enhances blood return to the heart.

Describe the different methods for removing a foreign body airway obstruction in an infant, child, and adult, including the procedure for a patient with an obstruction who becomes unresponsive. (P 541-548)

Heimlich maneuver (abdominal-thrust maneuver): stand behind patients, make a fist with one hand, press fist into patient's abdomen until object is expelled Chest Thrusts: for woman in advanced stages, stand behind patient with arms directly under patient's armpits, make a fist with one hand and press against the sternum. Perform an abdominal-thrust maneuver in a responsive child If child is unresponsive, perform CPR if they still have no spontaneous breathing or circulation

Discuss how to provide grief support for a patient's family members and loved ones after resuscitation has ended. (P 548-550)

Most protocols suggest discontinuing resuscitative efforts if patient hasn't responded after 20 to 30 minutes. Be compassionate and sensitive approach, make family members aware that the patient is not responding to treatment, be concise and clear

Describe the proper way to position an adult patient to receive BLS care. (P 519)

Move to a supine position Protect the patient's neck and move him as a unit to prevent further spinal injury Move patient to floor if on a bed Assess to determine whether CPR and defibrillation are necessary

Explain the steps in providing single-rescuer adult CPR. (P 526)

Must provide continuous cycle of 30 chest compressions followed by 2 artificial ventilations (ratio of 30:3) 1. Take standard precautions and establish unresponsiveness and call for help 2. Check for breathing and a carotid pulse for no more than 10 seconds 3. If breathing and pulse is absent, then perform CPR until an AED is available. GIve 30 chest compressions at a rate of 100-120 per minutes 4. Open the airway according to your suspicion of spinal injury 5. Give two ventilations of 1 second each and observe for visible chest rise.

Explain three special situations related to the use of an AED. (P 518)

Pacemakers and Implanted Defibrillators: used in patients at high risk for certain cardiac dysrhythmias and cardiac arrest. Hard lump beneath the skin, usually on the upper left side of chest, if AED pads are directly over the device it may damage the device. Wet Patients: AED should not be used in water because water conducts electricity, Make sure to dry the skin Transdermal Medical Patches: Patch could reduce the flow of the electrical current and may burn the skin, best bet is to remove the patch with gloved hands

Explain the components of CPR, the five links in the American Heart Association (AHA) chain of survival, and how each one relates to maximizing the survival of a patient. (P 515-516)

Recognition and Activation of the Emergency Response System: Learn to recognize early warning signs and immediately call 911 Immediate, high-quality CPR: Successful resuscitation of a person in cardiac arrest. Rapid defibrillation: offers best opportunity to achieve a successful patient outcome Basic and Advanced Emergency Medical Services: CPR, Basic airway management, Advanced airway management, Manual defibrillation, Vascular access, Transcutaneous pacing Advanced Life Support and Post Arrest Care:

Describe the recovery position and circumstances that would warrant its use as well as situations in which it would be contraindicated. (P 523-524)

Recovery position: helps to maintain a clear airway with a patient with a decreased level of consciousness who has not sustained traumatic injuries. Roll patient onto his side, place top hand under his cheek Never place a suspected patient with a spinal injury in the recovery position, because spine is not aligned

Explain the various factors involved in the decision to stop CPR after it has been started on a patient. (P 540-541)

S: patient STARTS breathing and has a pulse T: patient is TRANSFERRED to another provider O: when you are OUT of strength or too tired P: a PHYSICIAN who is present or providing medical direction assumes responsibility of the patient and directs you to discontinue CPR

Explain the goals of cardiopulmonary resuscitation (CPR) and when it should be performed on a patient. (P 515)

Steps for Cardiopulmonary Resuscitation (CPR): 1. Restore circulation by performing chest compressions to circulate blood 2. Perform 30 high-quality compressions to a depth of 2 to 2.4 inches at a rate of 100 to 120 per minute 3. Open the airway with jaw-thrust or head tilt-chin lift maneuver 4. Restore breathing by providing rescue breaths (Via mouth-to-mask ventilation or bag-valve mask) Administer 2 breaths, each over 1 second, while visualizing for chest rise.

Explain the four steps of pediatric BLS procedures and how they differ from BLS procedures used in an adult patient. (P 533-538)

Technique for chest compressions are different because of size of infants 1. Take standard precautions. Position infant on a firm surface while maintaining the airway. Place two fingers in the middle of the sternum with one finger below the nipple line. 2. Use two fingers to compress the chest at least one-third its depth at a rate of 100-120 per minute. Allow sternum to return to its normal position Performing CPR on a child: 1. Take standard precautions, place child on a firm surface, place heel of one or two hands in the center of chest in between the nipples, avoiding the xiphoid process 2. Compress the chest at a rate of 100-120, reassess for a pulse after 2 minutes 3. If child regains a pulse of greater than 60 beats/min and resumes effective breathing, then place him in recovery position.

Describe the ethical issues related to patient resuscitation, including examples of when not to start CPR on a patient. (P 539-540)

Three General Exceptions to Starting CPR: 1. Do not start CPR is the scene is unsafe 2. Do not start CPR if patient is obviously dead 3. Do not start CPR if patient has a (DNR) order or no-CPR order

Describe the process of providing artificial ventilations to an adult patient, ways to avoid gastric distention, and modifications required for a patient with a stoma. (P 524-526)

Ventilations can be given by one or two EMS providers Observe chest for visible rise to assess the effectiveness of your ventilations Hyperventilation: may cause increased intrathoracic pressure. Stoma Ventilation: hole that connects trachea directly to the skin, should be ventilated with a BVM, cover nose and mouth if it interferes with ventilation Gastric Distention: occurs more easily in children, important to give slow, gentle breaths to avoid hyperventilation. Can cause patient to vomit during CPR if there is excessive inflation of the stomach

Describe the two techniques EMTs may use to open an adult patient's airway and the circumstances that would determine when each technique would be used. (P 522-523)

With an Adult Patient: 1. Take standard precautions, place heel of one hand on the center of the chest (Lower half of sternum) 2. Place heel of your other hand over the first hand 3. With arms straight, lock elbows and position your shoulders directly over your hands. Depress sternum at a rate of 100-120 compressions per minute, and to a depth of 2 to 2.4 inches. Compressions and relaxation should be of equal duration

Discuss the importance of frequent CPR training for EMTs, as well as public education programs that teach compression-only CPR. (P 550)

he use of high-fidelity manikins for CPR training is encouraged. If this is not an option, CPR devices that provide corrective feedback are preferred over devices that only provide voice prompts.