BLS & CPR

What is ARC?

-Assess -Recognize -Care

In multi-provider CPR, what does the team leader do?

-Assign team roles -Set clear expectations -Prioritize, direct, and act decisively -Monitor performance and provide support -Re-evaluate and summarize progress -Debrief

What is the difference between cardiac arrest and myocardial infarction?

-Cardiac arrest is caused by electrical dysfunction of the heart which causes bradycardia or the cessation of pumping -Myocardial Infarction (Heart Attack) is caused by heart tissue necrosis due to insufficient delivery of oxygenated blood to the heart

What is closed loop communication?

-Confirmation by receiver that message has been received and understood -Used to prevent misunderstandings -Ex. "Call the code team" --> "Got it, calling code team"

What are key things to remember when communicating with patient family?

-Credibility and empathy -Speaking in terms the family can understand -Be prepared to repeat information -Be open and honest about condition, minimize fears but do not give false hope -Reassure them that everything that can be done is being done

What is the proper compression technique?

-Hands centered on lower half of sternum -In an adult

What is the proper way to check for breathing and pulse in an infant?

-Open airway to neutral -Check for brachial pulse for at least 5 seconds, no more than 10

What is the proper way to check for breathing and pulse in adults?

-Open airway to past neutral -Check for carotid pulse for at least 5 seconds, no more than 10

What is the proper way to check for breathing and pulse in children?

-Open airway to slightly past-neutral -Check for carotid pulse for at least 5 seconds, no more than 10

You and two nurses have been performing CPR on a 72-year-old patient, Ben Phillips. When Mr. Phillips shows signs of ROSC, where should you perform the pulse check? a.) femoral or brachial b.) carotid or brachial c.) carotid or radial d.) carotid or femoral

d.) carotid or femoral

You suspect that an unresponsive patient has sustained a neck injury. Which technique should you use to open the patient's airway? a.) an oropharyngeal airway b.) head-tilt/chin-lift technique c.) a nasopharyngeal airway d.) modified jaw-thrust

d.) modified jaw-thrust

You are alone performing high-quality CPR when a second provider arrives to take over compressions. When switching roles, you should minimize interruptions in chest compressions to less than how many seconds? a.) 5 seconds b.) 10 seconds c.) 15 seconds d.) 20 seconds

b.) 10 seconds

You are preparing to deliver ventilations to an adult patient experiencing respiratory arrest. You should give 1 ventilation every: a.) 3-4 seconds b.) 5-6 seconds c.) 7-8 seconds d.) 9-10 seconds

b.) 5-6 seconds

The code team has arrived to take over resuscitative efforts. Among the members of the BLS team, whose role is it to communicate to the code team the patient's status and the care already provided? a.) timer/recorder b.) compressor c.) team member d.) team leader

d.) team leader

In multi-provider CPR, what do team members do?

-Provide care based on assigned role -Communicate effectively -Identify something people may have overlooked -Recognize dangerous situation and need for change of approach

What is crew resource management?

-Using all available resources to promote effective teamwork and reduce error during emergency response

How do you perform the jaw-thrust maneuver?

1) Keep head, neck, and spine aligned, moving patient as a unit until he is supine 2) Kneel at top of head. 3) Reach forward and place one hand on each side of the patient's lower jaw, at the angles of the jaw below the ears 4) Stabilize head with forearm 5) Using index fingers, push jaw forward (patient's forward, not your forward :) 6) Retract lower lip with thumb if necessary 7) Do not tilt or rotate head

What are the steps to "Care" an an illness or injury?

1. Call for EMS or other rapid response team as appropriate 2. Identify potential head, neck, spinal, or pelvic injury 3. If a patient has suspected head, neck, pelvic, or spinal injury, maintain current position. If no head, neck, pelvic, or spinal injuries are identified, place patient in recovery position 4. Do not leave patient until proper response team arrives

What are the steps to "Recognize" in a CPR event?

1. Determine if patient is in cardiac arrest, respiratory arrest, and/or experiencing opioid overdose 2. If experiencing any life-threatening event, get consent before performing care. Unless presented with a DNR, consent is implied if patient is unresponsive.

What are the steps to "Care" during opioid overdose?

1. If a patient has symptoms in the overdose triad (pinpoint pupils, respiratory depression, and unconsiousness) they are likely having an overdose 2. If possible, check ETCO2 levels to confirm respiratory depression 3. If displaying signs of respiratory arrest or cardiac arrest, provide care 4. Administer Naloxone if possible. 2mg intranasally, .4mg intramuscular every 4 minutes 5. Stop care if patient moves, vomits, or becomes disoriented

What are the steps to "Care" during Myocardial Infarction?

1. If patient displays chest pain lasting longer than 3-5 minutes, sweating, dizziness, nausea, or other crushing sensation in the upper body, they are having an MI 2. Immediately give 2-4 low dose (81mg) aspirin or one 325 mg aspirin 3. If necessary give oxygen supplementation

What are the steps to "Care" in respiratory arrest?

1. If patient has a pulse, but is unresponsive and not breathing, they are in respiratory arrest 2. Deliver 1 ventilation every 5-6 seconds, lasting one second. Ensure the chest rises with each ventilation 3. Check breathing and pulse every 2 minutes. If no change, continue with ventilation. If still not breathing and no pulse, immediately begin care for cardiac arrest

What are the steps to "Care" during cardiac arrest?

1. If patient is not breathing, has no pulse, and is unresponsive, the patient is in cardiac arrest 2. Within 10 seconds, give 30 chest compressions followed by 2 ventilations. 3. Check pulse and breathing every 2 minutes 4. Get an AED if possible

What are the steps to "Care" if a patient has an obstructed airway?

1. If patient is responsive, but cannot cough, speak, or breathe, they are choking 2. Check for signs of cyanosis, palor, or stridor 2. Encourage the patient to cough 3. If coughing does not work, obtain consent to provide care 4. In an adult, give 5 abdominal thrusts followed by 5 back blows/5 chest thrusts. In a child, give 5 chest thrusts followed by 5 backblows. In an infant, give 5 backblows followed by 5 chest thrusts

What are the steps to performing mouth to mouth?

1. Open airway to past-neutral position 2. Pinch nose shut, take normal breath, make a complete seal over the mouth to blow into patients mouth to deliver 1 ventilation per second until chest begins to rise 3. After each ventilation, take a breath to ensure high oxygen concentration and minimize CO2 concentration in ventilations

What are the steps to "Assess" in a CPR event?

1. Perform a visual survey 2. Check for responsiveness using shout-tap-shout 3. Simultaneously check for breathing and pulse

What are the steps to performing chest thrusts?

1. Position behind patient as you would for abdominal thrusts 2. Place thumb side on fist on center of patient chest, lower half of sternum 3. Cover fist with other hand and pull straight back

How do you perform the head-tilt/chin-lift maneuver?

1. Press down on forehead with one hand 2. Pull up on bony underside of chin with two or three fingers 3. Move head into past-neutral to open airway

What are the steps to notifying of patient death?

1. Provide info with honesty and empathy 2. Allow family to begin processing info 3. Allow time for family to begin grieving process, ask if they would like to have you contact anyone 4. Be prepared for all reactions 5. Wait and answer any questions the family may have

Name the steps to debriefing following a CPR event?

1. REVIEW 2. ANALYZE 3. REFLECT 4. SUMMARIZE

What are the steps to using a BVM?

1. Recommended during multi-provider CPR 2. Position self behind patient 3. Lower mask over nose and mouth, ensure it does not pass the chin 4. Seal mask using the "E-C" formation (make a "C" with the thumb and index finger around the valve and an "E" with the other three fingers 5. Seal by lifting jaw into mask in past-neutral position to ensure airway stays open 6. Press bag halfway every 1 second

What are the steps to using a PVM?

1. Recommended during single-provider CPR to limit interruptions in chest compressions 2. Place mask on the bridge of the patient's nose 3. Lower mask onto nose and mouth, ensure not passing chin 4. Seal mask by placing index finger and thumb on outside of valve and place thumb on end of mask to open the airway 5. Provide ventilations by blowing into the valve

What are the steps to performing abdominal thrusts?

1. Stand behind patient, with one foot in front of the other to provide stability 2. Place hands on patient's navel, make a fist with one hand just above the navel 3. Enclose fist with other hand 4. Push inward and upward

What are the steps to performing back blows?

1. Stand behind the patient 2. Support patient by placing one arm diagonally across the chest 3. Bend patient at the waist so upper body is parallel to the ground 4. Using heel of other hand, give five hard back blows

What are the steps to using an AED in an adult?

1. Turn on AED 2. Attach pads in anterior-lateral position (one pad on upper right chest below clavicle, to the right of the sternum, one pad on the left axillary border) 3. Continue CPR until AED is ready to analyze 4. Clear during shock delivery and analyzing 5. Once shock has been delivered, continue CPR

What are the steps to using an AED in a child/infant

1. Turn on AED 2. Use pediatric pads in a child less than 8 years or less than 55 pounds. If no pediatric pads available, use adult pads. 3. Attach pads in anterior-posterior position in an infant/small child (center of chest and between scapulae) to prevent pads touching. Use anterior-lateral position in an older child 4. Continue CPR until AED is ready to analyze 5. Clear during shock delivery and analyzing 6. Once shock has been delivered, continue CPR

How do you provide care for obstructed airway in an infant? 1. If infant is crying or forcefully choking, they may be choking 2. Obtain consent from parent to provide care, if not present, consent is implied 3. Perform back blows (a.) place forearm along infant back, cradle head with hand

How do you provide care for obstructed airway in an infant? 1. If infant is crying or forcefully choking, they may be choking 2. Obtain consent from parent to provide care, if not present, consent is implied 3. Perform back blows (a. place forearm along infant back, cradle head with hand b. place forearm along front, support jaw with thumb and fingers, c. perform back blows between the scapula) 4. If backblows are ineffective, perform 5 chest thrusts (a. position infant face up, using forearm to support head and neck, b. lower infant wit head lower than the chest c. place two fingers on center of chest, deliver 5 compressions 1.5 inches deep) 5. After each set, open mouth and look for object before performing ventilations 6. If patient becomes unresponsive, immediately begin CPR and check for object 7. If possible, remove object with pinky

While orienting a new medical assistant to the facility, you find a patient who is unresponsive in the exam room. You yell to the medical assistant, "Go get the AED!" Which response by the medical assistant demonstrates closed-loop communication? a.) "I'll go get the AED" b.) "I'll call 911" c.) "OK" d.) "Begin CPR, I'll gather equipment

a.) "I'll go get the AED"

A well-organized team response when performing high-quality CPR includes ensuring that providers switch off performing compressions every _____ minutes. a.) 2 b.) 4 c.) 5 d.) 10

a.) 2

You and another provider are caring for a patient who is in cardiac arrest. You suspect that your patient has overdosed on an opioid. When should you administer intranasal naloxone? a.) Ater initiating CPR b.) After an IV has been initiated c.) Before initiating CPR d.) After an opioid overdose has been confirmed

a.) After initiating CPR

You are providing high-quality CPR on a 6-year-old patient who weighs 44 pounds. The AED arrives. It does not have a pediatric setting and includes only adult AED pads. What should you do? a.) Use adult AED pads b.) Use only one pad c.) Do not use AED d.) Cut adult pads to fit

a.) Use adult AED pads

What is a reason you would choose to perform chest thrusts instead of abdominal thrusts for an adult with an obstructed airway? a.) patient is in wheelchair b.) patient is fragile c.) patient is coughing forcefully d.) patient is unresponsive

a.) patient is in wheelchair

ou are working in an OB/GYN office when your patient, Mrs. Tribble, suddenly goes into cardiac arrest. While preparing the AED, your colleague reminds you that Mrs. Tribble is 28 weeks pregnant. Which statement is true regarding the use of an AED on a pregnant patient? a.) AED settings should be adjusted to pediatric setting in pregnant patients b.) AED is safe to use on pregnant patients c.) AED use is not safe during third trimester d.) AED use is not safe at all in pregnant patients

b.) AED is safe to use on pregnant patients

Upon entering Mr. Cohen's room, you find him on the ground, unresponsive. After immediately initiating the emergency response system, what is your next action according to the Adult In-Hospital Cardiac Chain of Survival? a.) Injury prevention and safety b.) Early CPR c.) Early defibrillation d.) Integrated post-cardiac arrest care

b.) Early CPR

You are alone and caring for a 9-month-old infant with an obstructed airway who becomes unresponsive. Which action should you perform first? a.) Check for breathing and pulse b.) Provide 30 chest compressions c.) Look in mouth and remove object if you can see it d.) Provide 5 back blows

b.) Provide 30 chest compressions

You and your co-worker Jake are operating a BVM during multiple-provider CPR for an adult. You manage the airway while Jake delivers ventilations. Which statement correctly describes the appropriate technique for operating the BVM? a.) Depress bag completely to deliver 1,000-2,000 mL oxygen b.) Seal mask with two hands using E-C technique c.) Stand behind patient, open airway to neutral d.) Deliver smooth, effortless ventilations that make chest rise fully over 1 to 2 seconds

b.) Seal mask with two hands using E-C technique

You are alone caring for a 4-month-old infant who has gone into cardiac arrest. Which is the most effective CPR technique to perform until help arrives? a.) Standing at infant's feet, provide chest compressions using encircling thumb technique and deliver ventilations with a BVM b.) Standing to side of infant, provide chest compressions using two-finger technique and deliver ventilations with a pocket mask c.) Standing to side of infant, provide hands-only CPR d.) Standing to side of infant, provide chest compressions using one hand technique and deliver ventilations with a pocket mask

b.) Standing to side of infant, provide chest compressions using two-finger technique and deliver ventilations with a pocket mask

The systematic and continuous approach to providing emergent patient care includes which three elements? a.) approach, respond, care b.) assess recognize, care c.) approach, recognize, care d.) assess, respond, care

b.) assess recognize, care

You are providing compressions on a 6-month-old who weighs 17 pounds. Which compression depth is appropriate for this patient? a.) 1/2 inch b.) 1 inch c.) 1.5 inches d.) 2 inches

c.) 1.5 inches

A 7-year-old patient goes into sudden cardiac arrest. You initiate CPR and correctly perform chest compressions at which rate? a.) At least 60 per minute b.) 80 to 100 per minute c.) 100 to 120 per minute d.) over 120 per minute

c.) 100-120 per minute

You and your colleagues are performing CPR on a 6-year-old child. What is the compression-to-ventilation ratio during multiple-provider CPR? a.) 15:1 b.) 30:2 c.) 15:2 d.) 30:1

c.) 15:2

How is a child defined in terms of CPR care? a.) Under age of 1 b.) Age of 1 month to 8 years c.) Age 1 to onset of puberty d.) 1-18 years

c.) Age 1 to onset of puberty

You and your colleagues have been providing high-quality CPR for and using the AED on Mr. Sauer. While providing ventilations, you notice that Mr. Sauer moves and appears to be breathing. What is the correct course of action? a.) Stop CPR and perform shout-tap-shout to check for responsiveness b.) wait for AED to analyze rhythm and follow AED c.) Stop CPR, check breathing and pulse, and monitor Mr. Sauer until advanced cardiac life support team takes over d.) continue cpr until advanced cardiac life support team takes over

c.) Stop CPR, check breathing and pulse, and monitor Mr. Sauer until advanced cardiac life support team takes over

You enter Ms. Evers's room and notice her lunch splattered on the floor. She is slumped over the bedside table and does not appear to be breathing. You perform a visual survey and determine that the scene is safe. Which is the next appropriate action? a.) check breathing and pulse b.) open airway c.) check for responsiveness d.) perform abdominal thrusts

c.) check for responsiveness

You perform a rapid assessment and determine that your patient is experiencing cardiac arrest. On the basis of your assessment findings, you begin CPR to improve the patient's chances of survival. Which term refers to clearly and rationally identifying the connection between information and actions? a.) communication b.) problem solving c.) critical thinking d.) teamwork

c.) critical thinking

You are providing care for Mrs. Bove, who has an endotracheal tube in place. How does this affect compressions and ventilations? a.) Team should provide ventilations every 10 seconds without pausing compressions b.) Compression ventilation ratio of 15:1 c.) Compression ventilation ratio of 30:2 d.) Team should provide ventilations every 6 seconds without pausing compressions

d.) Team should provide ventilations every 6 seconds without pausing compressions

During a resuscitation, the team leader assigns team roles and tasks to each member. You recognize that a task has been overlooked. Which is the most appropriate action? a.) do the task you were assigned, wait for team leader to realize what was overlooked b.) take on the responsibility of task, as long as you can maintain own responsibilities c.) assign overlooked task to other member d.) alert team leader and identify which task has been overlooked

d.) alert team leader and identify which task has been overlooked