Chapter 13: BLS Resuscitation

16. Demonstrate how to perform rescue breathing on a child. (p 538)

-If the child is not breathing but has a pulse, open the airway and deliver one breath every 3 to 5 seconds (12 to 20 breaths/min). -If the child is not breathing and does not have a pulse, deliver 2 rescue breaths after every 30 chest compressions (15 chest compressions if 2 rescuers are present).

7. Describe the purpose of external chest compressions. (p 519)

-compressions squeeze the heart, acting as a pump to circulate blood -When artificial ventilation is provided, the blood that is circulated through the lungs during chest compressions is likely to receive adequate oxygen to maintain tissue perfusion.

8. 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. (pp 522-523)

-if no indication of spinal injury, use head tilt chin lift -if spinal injury is suspected, use the jaw-thrust maneuver

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

-most cardiac arrests in the home results from sudden cardiac rhythm disturbance (dysrhythmia) such as V-fib or V-tach. -AEDs can be used in children with the pediatric pads. -Apply the AED to infants or children after the first five cycles of CPR have been completed. -cardiac arrest in children is usually due to resp. failure, so oxygenation and ventilation are the most important. -for infants, a manual defibrillator is preferred

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

-practice on high- fidelity manikins more frequently than the training that happens every 2 years.

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

-use a compassionate and sensitive approach -When death appears imminent and resuscitative efforts are unsuccessful, make the family members aware the patient is not responding to treatment. -Discuss with them what is happening so they may be better prepared. Keep the family informed throughout the resuscitation process because it may also help them feel more in control. -be confident and clear -avoid euphemisms like "passed away" -one provider should deliver the news of death -Take the family to a quiet, private place. Introduce yourself and anyone with you. -Use clear language and speak in a warm, sensitive, and caring manner. -Try to exhibit calm, reassuring authority. -Use the patient's name. -Use eye contact and appropriate touch.

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

-when in doubt, give too much care, vs. too little care do not start CPR if: 1. scene is unsafe 2. obvious signs of death including an absence of pulse and breathing, along with rigor mortis, dependent lividity, putrefaction, evidence of a nonsurvivable injury like decapitation. 3. Do not start CPR if the patient and his or her physician have previously agreed on a do not resuscitate (DNR) order or no-CPR order. Safest route is to begin CPR under implied consent -If a valid DNR document or living will is produced, resuscitative efforts may be withheld.

removing a foreign body airway obstruction in infants

1. Hold the infant facedown, with the body resting on your forearm. Support the infant's jaw and face with your hand, and keep the head lower than the rest of the body. 2. Deliver five back slaps between the shoulder blades, using the heel of your hand. 3. Place your free hand behind the infant's head and back, and turn the infant face up on your other forearm and thigh, sandwiching the infant's body between your two hands and arms. The infant's head should remain below the level of the body. 4. Give five quick chest thrusts in the same location and manner as chest compressions, using two fingers placed on the lower half of the sternum. For larger infants, or if you have small hands, you can perform this step by placing the infant in your lap and turning the infant's whole body as a unit between back slaps and chest thrusts. 5. Check the airway. If you can see the foreign body, then remove it. If not, then repeat the cycle as often as necessary. -If the infant becomes unresponsive, begin CPR and follow the same sequence as for a child and adult. -Do not check for a pulse before starting compressions. -If you see an object that can easily be removed, remove it with your finger and attempt to ventilate. -If you do not see an object, resume chest compressions. Continue the sequence until the obstruction is relieved or ALS providers take over.

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

1. If the child is unresponsive, apneic, and pulseless and you did not witness the child's collapse, perform CPR beginning with chest compressions for approximately five cycles (about 2 minutes), and then stop to call 9-1-1 and retrieve an AED. 2. Check for breathing and a pulse

steps for managing an airway in a child

1. Kneel on one knee behind the child, and circle both of your arms around the child's body. Prepare to give abdominal thrusts by placing your fist just above the patient's umbilicus and well below the xiphoid process. Place your other hand over that fist. 2. Give the child abdominal thrusts in an upward direction. Avoid applying force to the lower rib cage or sternum. 3. Repeat until the child expels the foreign body or becomes unresponsive. If the child becomes 4. unresponsive, position the child on a hard surface and immediately call for help (or send someone to call for help). 5. Perform 30 chest compressions (15 compressions if 2 rescuers are present), using the same landmark as you would for CPR. Do not check for a pulse before performing chest compressions. 6. Open the airway and look inside the mouth. If you see an object that can easily be removed, then remove it with your fingers and attempt to ventilate. If you do not see an object, then resume chest compressions. 7. Repeat steps 5 and 6 until the obstruction is relieved or ALS providers take over. -If you manage to clear the airway obstruction in an unresponsive child but he or she still has no spontaneous breathing or circulation, perform CPR (compressions and ventilations) and apply the AED as soon as it is available.

18. Demonstrate how to remove a foreign body airway obstruction in a responsive adult patient using abdominal thrusts (Heimlich maneuver). (p 543)

1. stand behind the patient, and wrap your arms around his or her abdomen. Straddle your legs outside the patient's legs. This will allow you to easily slide the patient to the ground if he or she becomes unresponsive 2. make a fist with one hand; grasp the fist with the other hand. Place the thumb side of the fist against the patient's abdomen just above the umbilicus and well below the xiphoid process. 3. press your fist into the patient's abdomen with a quick inward and upward thrust.

9. Demonstrate how to perform two-rescuer adult CPR. (pp 526, 528, Skill Drill 13-3)

1. take standard precautions. Establish unresponsiveness and take positions 2. check for breathing and carotid pulse 3. begin CPR, starting with chest compressions. Give 30 chest compressions at a rate of 100 to 120 per minute. If the AED is available, then apply it and follow the voice prompts 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 cycles of 30 chest compressions and 2 ventilations (switch roles every 5 cycles [2 minutes]) until ALS providers take over or the patient starts to move. Reanalyze the patient's cardiac rhythm with AED every 2 minutes and deliver a shock if indicated

13. Demonstrate how to perform CPR on a child who is between 1 year of age and the onset of puberty. (pp 535-537, Skill Drill 13-5)

1. take standard precautions. Place the child on a firm surface. Identify the location for hand placement. Place the heel of one or two hands in the center of the chest, in between the nipples, avoiding the xiphoid process. 2. Compress the chest at least one-third the anterior-posterior diameter of the chest at a rate of 100 to 120 times/minute. Coordinate compressions with ventilations in a 30:2 ratio (one rescuer) or 15:2 (two rescuers), pausing for two ventilations. Reassess for a pulse after 2 minutes. If there is no pulse and an AED is available, then resume CPR and apply the AED pads. 3. If a child regains a pulse of greater than 60 beats/min and resumes effective breathing, then place him or her in a position that allows for frequent reassessment of the airway and vital signs during transport.

12. Demonstrate how to perform external chest compressions on an infant. (p 535, Skill Drill 13-4)

1. take standard precautions. Position the infant on a firm surface while maintaining the airway. Place two fingers in the middle of the sternum with one finger just below the nipple line 2. use 2 fingers to compress the chest at least one-third its depth at a rate of 100 to 120 per minute. Allow the sternum to return to its normal position between compressions

11. Explain the steps in providing single-rescuer adult CPR. (pp p 526)

1. take standard precautions. establish unresponsiveness and call for help. use phone if needed. 2. check for breathing and a carotid pulse for no more than 10 seconds 3. if breathing and pulse are absent, then preform CPR until an AED is available. Give 30 chest compressions at a rate of 100 to 120 per minute 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 cycles of 30 chest compressions and 2 ventilations until additional personnel arrive or the patient starts to move.

8. Demonstrate how to perform one-rescuer adult CPR. (pp 526-527, Skill Drill 13-2)

1. take standard precautions. establish unresponsiveness and call for help. use phone if needed. 2. check for breathing and a carotid pulse for no more than 10 seconds 3. if breathing and pulse are absent, then preform CPR until an AED is available. Give 30 chest compressions at a rate of 100 to 120 per minute 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 cycles of 30 chest compressions and 2 ventilations until additional personnel arrive or the patient starts to move.

steps for managing airway obstruction in an adult

1.Carefully support the patient to the ground and immediately call for help (or send someone to call for help). 2. Perform 30 chest compressions, using the same landmark as you would for CPR (center of the chest, between the nipples). Do not check for a pulse before performing chest compressions. 3. Open the airway and look in the mouth. If you see an object that can easily be removed, then remove it with your fingers and attempt to ventilate. If you do not see an object, then resume chest compressions. 4. Repeat steps 2 and 3 until the obstruction is relieved or ALS providers take over. If you are able to remove an object from the mouth, attempt to ventilate. -If ventilation produces chest rise, continue to ventilate and check for a pulse. -If a pulse is present but the patient is not breathing, continue rescue breathing and monitor the pulse. -If a pulse is absent, continue CPR (compressions and ventilations) and apply the AED as soon as it is available. When a patient is found unresponsive, begin CPR by determining unresponsiveness and checking for breathing and a pulse. 1. If a pulse is present but breathing is absent, open the airway and attempt to ventilate. 2. If the first ventilation does not produce visible chest rise, reposition the airway and reattempt to ventilate. 3. If both ventilation attempts do not produce visible chest rise, perform 30 chest compressions, and then open the airway and look in the mouth.

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

Active compression-decompression CPR is a technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression). -The device features a suction cup that is placed in the center of the chest. An impedance threshold device (ITD) is a valve device placed between the ET tube and a BVM -The ITD is designed to limit the air entering the lungs during the recoil phase between chest compressions. Results in negative intrathoracic pressure that may draw more blood toward the heart, ultimately resulting in improved cardiac filling and circulation during each chest compression A mechanical piston device is a device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard. A load-distributing band (LDB) is a circumferential chest compression device composed of a constricting band and backboard The device is either electrically or pneumatically driven to compress the heart by putting inward pressure on the thorax.

1. Explain the elements of basic life support (BLS), how it differs from advanced life support (ALS), and why BLS must be applied rapidly. (pp 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. focus on ABCs: -airway (obstruction) -breathing (resp. arrest) -circulation (cardiac arrest or severe bleeding) 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.

11. Demonstrate how to check for a pulse at the brachial artery in an unresponsive infant. (p 534)

Brachial artery is located on the inner side of the arm, midway between the elbow and shoulder. Place thumb on the outer surface of the arm between the elbow and shoulder. Then place the tips of your index and middle fingers on the inside of the biceps, and press lightly toward the bone.

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

Cardiac arrest in infants and children follows respiratory arrest, which triggers hypoxia and ischemia of the heart. Respiratory issues leading to cardiopulmonary arrest in children can have a number of causes, including: -Injury, both blunt and penetrating Infections of the respiratory -tract or another organ system (croup, epiglottitis) -A foreign body in the airway -Submersion (drowning) -Electrocution -Poisoning or drug overdose -Sudden infant death syndrome (SIDS)

18. 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. (pp 541-542)

Common causes of obstruction: -Relaxation of the throat muscles in an unresponsive -patient -Vomited or regurgitated stomach contents -Blood -Damaged tissue after an injury -Dentures -Foreign bodies such as food or small objects Mild airway obstruction - patients can exchange adequate amounts of air, but still have signs of resp. distress. - breathing may be noisy - patient can have a strong cough - prevent from being a complete airway obstruction. -encourage coughing. - don't interfere with patient's own attempts to expel the foreign body - give supplemental oxygen if needed to expel the foreign body -stridor A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway Unresponsive patients When you discover an unresponsive patient, your first step is to determine whether he or she is breathing and has a pulse. If the patient has a pulse, but is not breathing, make sure that the airway is open and unobstructed.

3. Demonstrate how to perform external chest compressions on an adult. (pp 520-521, Skill Drill 13-1)

For adults, position the heel of one hand on the sternum in the center of the chest 1. take standard precautions. place the heel of one hand on the center of the chest 2. place heel of other hand over the first hand 3. with arms straight, lock your elbows and position your shoulders directly over your hands. Depress the sternum at a rate of 100 to 120 compressions per minute, and to a depth of 2 to 2.4 inches using a downward movement. Allow chest to return to its normal position; do not lean on the chest between compressions. Compression and relaxation should be of equal duration..

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

Pacemakers and implanted defibrillators -AED pads should be placed at least 1 inch away from AICDs, or pacemakers -If you observe the patient's muscles twitching as if he or she was just shocked, continue CPR and wait 30 to 60 seconds before delivering a shock from the AED. Wet patients -water conducts elevtricity -dry skin before pad placement, but do not delay CPR Transdermal medical patches -If the medication patch interferes with AED pad placement, remove the patch with your gloved hands and wipe the skin to remove any residue prior to attaching the AED pad.

14. Demonstrate how to perform a head tilt-chin lift maneuver on a pediatric patient. (p 537)

Perform the head tilt-chin lift maneuver in a child in the following manner: 1. Place one hand on the child's forehead and tilt the head back gently, with the neck slightly extended. 2. Place two or three fingers (not the thumb) of your other hand under the child's chin and lift the jaw upward and outward. Do not close the mouth or push under the chin; either move may obstruct rather than open the airway. 3. Remove any visible foreign body or vomitus.

15. Demonstrate how to perform a jaw-thrust maneuver on a pediatric patient. (p 537)

Perform the jaw-thrust maneuver in a child in the following manner: 1. Place two or three fingers under each side of the angle of the lower jaw; lift the jaw upward and outward. 2. If the jaw thrust alone does not open the airway and cervical spine injury is not a consideration, tilt the head slightly.

3. 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. (pp 515-516)

Recognition and activation of the emergency response system -public attention and awareness -someone calls 911 Immediate, high-quality CPR -The initiation of immediate CPR by a bystander is essential for successful resuscitation of a person in cardiac arrest. -laypeople should know hands-only CPR -hard and fast compressions -2 to 2.4 inches in depth and rate of 100 to 120 per minute Rapid defibrillation -defibrillators offer best opportunity for survival -AEDs are available in many public places Basic and advanced emergency medical services -Care includes: Continuing high-quality CPR Basic airway management (ie, oral airway insertion, BVM ventilation) Advanced airway management (ie, endotracheal [ET] intubation or use of supraglottic airway devices) Manual defibrillation Vascular access Transcutaneous pacing Administration of medications Advanced life support and postarrest care -additional therapy to support BP -temp management -maintain blood glucose levels

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

The recovery position helps to maintain a clear airway in a patient with a decreased level of consciousness who has not sustained traumatic injuries and is breathing adequately on his or her own. -do not place a patient with a suspected spinal injury in the recovery position

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

The steps for cardiopulmonary resuscitation (CPR) include: -Restore circulation by performing chest compressions to circulate blood to the vital organs of the body. -Perform 30 high-quality compressions to a depth of 2 to 2.4 inches (5 to 6 cm) in an adult at the rate of 100 to 120 per minute. -Open the airway with the jaw-thrust or head tilt-chin lift maneuver. -Restore breathing by providing rescue breaths (via mouth-to-mask ventilation or a bag-valve mask [BVM]). --Administer 2 breaths, each over 1 second, while visualizing for chest rise

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

The switch between the two rescuers can be accomplished by doing the following: 1. Rescuer one (the first compressor) should finish the cycle of 30 compressions while the second rescuer moves to the opposite side of the chest and moves into position to begin compressions. 2. Rescuer one should deliver two rescue breaths and then rescuer two should take over compressions by administering 30 chest compressions. 3. Rescuer one will then deliver two ventilations and the CPR cycles will continue as needed until the next 2-minute mark (five cycles) is reached, at which time the process will be repeated. -during switching, it should take no more than 5 seconds that the patient doesn't have compressions

7. Demonstrate how to perform rescue breathing in an adult. (p 524)

Use a BVM or a pocket mask with one-way valve.

19. Demonstrate how to remove a foreign body airway obstruction in a responsive pregnant or obese patient using chest thrusts. (p 543)

Use chest thrusts: 1. stand behind the patient with your arms directly under the patient's armpits, and wrap your arms around the patient's chest. 2. make a fist with one hand; grasp the fist with the other hand. place the thumb side of the fist against the patient's sternum, avoiding the xiphoid process and the edges of the rib cage. 3. press your fist into the patient's chest with backward thrusts until the object is expelled or the patient becomes unresponsive. 4. if the patient becomes unresponsive, then begin CPR, starting with chest compressions

19. 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. (pp 541-548)

abdominal-thrust maneuver (also called the Heimlich maneuver). 1. Stand behind the patient and wrap your arms around his or her abdomen. Straddle your legs outside the patient's legs. This will allow you to easily slide the patient to the ground if he or she becomes unresponsive. 2. Make a fist with one hand; grasp the fist with the other hand. Place the thumb side of the fist against the patient's abdomen just above the umbilicus and well below the xiphoid process. 3. Press your fist into the patient's abdomen with a quick inward and upward thrust. 4. Continue abdominal thrusts until the object is expelled from the airway or the patient becomes unresponsive. -If the patient with a severe airway obstruction is unresponsive, perform chest compressions Chest thrusts are recommended for pregnant and obese patients: 1. Stand behind the patient with your arms directly under the patient's armpits, and wrap your arms around the patient's chest. 2. Make a fist with one hand; grasp the fist with the other hand. Place the thumb side of the fist against the patient's sternum, avoiding the xiphoid process and the edges of the rib cage. 3. Press your fist into the patient's chest with backward thrusts until the object is expelled or the patient becomes unresponsive.

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

always continue CPR until care is transferred. Or until: S: The patient Starts breathing and has a pulse. T: The patient's care is Transferred to another provider of equal or higher-level training. O: You are Out of strength or too tired to continue CPR.Out of strength does not mean merely weary; rather, it means that you are no longer physically able to perform CPR. P: A Physician who is present or providing online medical direction assumes responsibility for the patient and directs you to discontinue CPR.

2. Demonstrate how to check for a pulse at the carotid artery in an unresponsive child or adult. (p 519)

feel for the carotid artery by locating the larynx, then slide your index and middle fingers toward one side. You can feel the pulse in the groove between the larynx and sternocleidomastoid muscle.

20. Demonstrate how to remove a foreign body airway obstruction in a responsive child older than 1 year using abdominal thrusts (Heimlich maneuver). (pp 545-546)

kneel behind the patient on one knee, wrap your arms around his or her body, and place your fist just above the umbilicus and well below the lower tip of the sternum.

5. Demonstrate how to perform a jaw-thrust maneuver on an adult. (pp 522-523)

maintain the head in a neutral alignment and place your fingers behind the angles of the lower jaw, and move the jaw upward.

17. Demonstrate how to perform rescue breathing on an infant. (p 538)

open the airway and provide rescue breathing

4. Demonstrate how to perform a head tilt-chin lift maneuver on an adult. (pp 522-523)

place one hand on the patient's forehead and apply firm backward pressure with your palm to tilt the head back. Next, place the tips of the index and middle fingers of your other hand under th lower jaw near the bony part of the chin. Lift the chin upward, bringing the entire lower jaw with it, helping to tilt the head back.

6. Demonstrate how to place a patient in the recovery position. (pp 523-524)

roll the patient onto his or her side so that the head, shoulders, and torso move as a unit, without twisting Then place the top hand under his or her cheek.

21. Demonstrate how to remove a foreign body airway obstruction in an unresponsive child. (pp 546-547, Skill Drill 13-6)

same as an adult... 1. take standard precautions. position the child on a firm, flat surface 2. perform chest compressions using the same landmark as you would for CPR 3. open the airway and look inside the mouth 4. if an object is visible and can be easily removed, the remove it with your fingers and attempt rescue breathing 5. if you do not see an object in the mouth, then resume chest compressions. continue the sequence of chest compressions, opening the airway, and looking inside the mouth until the obstruction is relieved or ALS providers take over.

Skills Objectives 1. Demonstrate how to position an unresponsive adult for CPR. (p 519)

supine on a firm, flat surface. Protect patient's neck to prevent twisting -- you cannot rule out spinal injury if possible, log-roll onto backboard

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

supine on a hard flat surface -do not rule out spinal injury, so move as a unit -log roll onto a backboard for cpr asap

10. 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. (pp 524-526)

to provide artificial ventilations, use a barrier device, such as a pocket mask with a one-way valve, or a BVM. Give supplemental oxygen when possible. -observe chest for rise and fall -a stoma is an opening that connect the trachea to the skin. from the removal of the larynx -Patients with a stoma should be ventilated with a BVM or pocket mask device placed directly over the stoma. -If air leakage through the nose and mouth interferes with ventilation through the stoma, cover the nose and mouth with your hand to make a seal. gastric distention A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation. -likely to occur if you hyperventilate the patients -give slow and gentle breaths to prevent this -