EMS Chapter 13 - BLS Resuscitation

advanced life support (ALS)

Advanced lifesaving procedures used to treat medical conditions, such as cardiac monitoring, administration of intravenous fluids and medications, and the use of advanced airway adjuncts. EMTs may be trained in some of these areas.

dependent lividity

Blood settling to the lowest point of the body, causing discoloration of the skin; a definitive sign of death.

When assessing the pulse of an unresponsive infant, you should palpate the ________ artery. Select one: A. radial B. femoral C. brachial D. carotid

C. brachial

What is the proper compression-to-ventilation ratio for adult two-rescuer CPR? 15:2 30:2 50:2 60:2

30:2 is the proper compression-to-ventilation ratio.

Ventilation

Exchange of air between the lungs and the environment, spontaneously by the patient or with assistance from another person, such as an EMT.

Cardiac arrest occurs in children and adults for the same reasons. T/F

False: Correct. Cardiac arrest in children is usually the result of respiratory failure, whereas a sudden cardiac rhythm disturbance is the primary cause of cardiac arrest in adults.

A(n) ________ is designed to limit the air entering the lungs during the recoil phase between chest compressions, resulting in negative intrathoracic pressure. Active compression-decompression CPR Impedance threshold device (ITD) Mechanical piston device Load-distributing band (LDB)

Impedance threshold device (ITD) Correct. An ITD is designed to limit the air entering the lungs during the recoil phase between chest compressions, resulting in negative intrathoracic pressure.

rigor mortis

Stiffening of the body muscles; a definitive sign of death.

jaw-thrust maneuver

Technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward; used for patients who may have a cervical spine injury.

If you witness a patient's cardiac arrest and an AED is available, deploy the AED immediately and then begin CPR. T/F

True: Correct. If you witness a patient's cardiac arrest and an AED is available, deploy the AED immediately and then begin CPR. If you did not witness the cardiac arrest, start with CPR followed by the AED.

Hyperventilation

Rapid or deep breathing that lowers the blood carbon dioxide level below normal; may lead to increased intrathoracic pressure, decreased venous return, and hypotension when associated with BVM use.

Initial treatment to dislodge a severe foreign body airway obstruction in a responsive infant involves: Select one: A. bag-valve mask ventilation. B. blind finger sweeps. C. abdominal thrusts. D. back slaps.

D. back slaps.

What is the maximum amount of time that should be spent checking for spontaneous breathing in an unresponsive child? 5 seconds 10 seconds 15 seconds 20 seconds

10 seconds As with an adult, assessing for spontaneous breathing should take no longer than 10 seconds.

When performing CPR on an adult, you should compress the chest to what depth and at what a rate of compressions per minute? 1 to 1.4 inches (2.5 to 3.5 cm); 80 to 100 compressions per minute 2 to 2.4 inches (5 to 6 cm); 80 to 100 compressions per minute 1 to 1.4 inches (2.5 to 3.5 cm); 100 to 120 compressions per minute 2 to 2.4 inches (5 to 6 cm); 100 to 120 compressions per minute

2 to 2.4 inches (5 to 6 cm); 100 to 120 compressions per minute

load-distributing band (LDB)

A circumferential chest compression device composed of a constricting band and backboard that is either electrically or pneumatically driven to compress the heart by putting inward pressure on the thorax.

head tilt-chin lift maneuver

A combination of two movements to open the airway by tilting the forehead back and lifting the chin; not used for trauma patients.

gastric distention

A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation.

mechanical piston device

A device that depresses the sternum via a compressed gas-powered plunger mounted on a backboard.

stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

Ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.

recovery position

A side-lying position used to maintain a clear airway in unconscious patients without injuries who are breathing adequately and do not have suspected injuries to the spine, hips or pelvis.

active compression-decompression CPR

A technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression); may increase the amount of blood that returns to the heart, and thus, the amount of blood ejected from the heart during the compression phase.

impedance threshold device (ITD)

A valve device placed between the endotracheal tube and a bag-mask device that limits the amount of air entering the lungs during the recoil phase between chest compressions.

While rescuer one is finishing his or her fifth cycle of 30 compressions, rescuer two should: Select one: A. move to the opposite side of the patient's chest. B. assess for a carotid pulse for 15 seconds. C. give two breaths and prepare to start compressions. D. suction the patient's mouth and give two more ventilations.

A. move to the opposite side of the patient's chest.

If an object is visible in the unconscious patient's airway, you should __________. Select one: A. remove it B. place the patient on his or her side C. continue chest compressions D. leave it in place

A. remove it

A young male is unresponsive after overdosing on an opioid. He is not breathing and his pulse is weak. The EMT should immediately: Select one: A. ventilate with a BVM. B. administer naloxone. C. begin chest compressions. D. request an ALS ambulance.

A. ventilate with a BVM.

What is the preferred method of removing a foreign body in an unresponsive child? Back slaps Abdominal thrusts Chest compressions Manual removal

Abdominal thrusts You should treat a child older than 1 year as you would an adult: with abdominal thrusts.

You respond to a call in which a 6-year-old was hit by a car. She is responsive but struggling to breathe. What position should you place her in? Recovery Supine Fowler Any position of comfort

Any position of comfort Because the child is responsive, allow her to remain in whatever position is most comfortable.

When performing chest compressions on an adult, the EMT should compress: Select one: A. between 1 inch and 2 inches. B. at least 1 inch. C. more than 2.5 inches. D. at least 2 inches.

D. at least 2 inches.

Most prehospital cardiac arrests occur as the result of: Select one: A. severe blunt trauma. B. a cardiac dysrhythmia. C. an acute ischemic stroke. D. obstruction of the airway.

B. a cardiac dysrhythmia.

CPR should be initiated when: Select one: A. rigor mortis is obvious. B. a valid living will is unavailable. C. signs of putrefaction are present. D. the carotid pulse is very weak.

B. a valid living will is unavailable.

A 60-year-old man is found to be unresponsive, pulseless, and apneic. You should: Select one: A. start CPR and transport immediately. B. begin CPR until an AED is available. C. withhold CPR until he is defibrillated. D. determine if he has a valid living will.

B. begin CPR until an AED is available.

Several attempts to adequately open a trauma patient's airway with the jaw-thrust maneuver have been unsuccessful. You should: Select one: A. suction the airway and reattempt the jaw-thrust maneuver. B. carefully perform the head tilt-chin lift maneuver. C. tilt the head back while lifting up on the patient's neck. D. try opening the airway by lifting up on the chin.

B. carefully perform the head tilt-chin lift maneuver.

You should deliver chest compressions to an unresponsive adult patient in cardiac arrest by: Select one: A. placing the heel of your hand on the xiphoid. B. compressing the sternum between the nipples. C. depressing the sternum more than 2.5 inches in depth. D. compressing quickly and releasing slowly.

B. compressing the sternum between the nipples.

If gastric distention begins to make positive-pressure ventilation difficult, you should: Select one: A. increase the rate of ventilation. B. reposition the patient's airway. C. insert an oropharyngeal airway. D. suction the patient's oropharynx.

B. reposition the patient's airway.

Which of the following are effects of hyperventilation? Oxygen toxicity Gastric distention Increased intrathoracic pressure Increased blood flow to the heart

Correct. Both gastric distention and increased intrathoracic pressure are outcomes of hyperventilation.

When trying to clear a severe airway obstruction, who should get chest compressions instead of abdominal compressions? Women in late stages of pregnancy Obese patients Children under the age of 3 Geriatric patients (over 65)

Correct. You should perform chest thrusts on women in late stages of pregnancy and obese patients.

What is the correct ratio of compressions to ventilations when performing two-rescuer child CPR? Select one: A. 5:1 B. 3:1 C. 30:2 D. 15:2

D. 15:2

CPR is in progress on a pregnant woman. Shortly after manually displacing her uterus to the left, return of spontaneous circulation occurs. Which of the following would MOST likely explain this? Select one: A. Displacement of her uterus allowed her lungs to expand more fully, which restored her pulse. B. Increased blood flow to her heart caused her ventricles to stop fibrillating, which restored her pulse. C. Displacement of her uterus caused blood to flow backward, which increased blood flow to her heart. D. Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness.

D. Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness.

The MOST appropriate treatment for a patient with a mild upper airway obstruction includes: Select one: A. advising the patient not to make any attempts to cough. B. performing five back blows and five abdominal thrusts. C. visualizing the airway and removing the obstruction. D. administering oxygen and transporting immediately.

D. administering oxygen and transporting immediately.

Between each chest compression, you should __________. Select one: A. remove your hands from the chest B. administer a breath C. check for a pulse D. allow full chest recoil

D. allow full chest recoil

You are off duty at a park when you witness an apparently healthy 12-year-old child suddenly collapse. There are no bystanders around and your mobile phone is in your car. After confirming that the child is in cardiac arrest, you should: Select one: A. deliver five rescue breaths before starting chest compressions. B. perform chest compressions only until a bystander arrives. C. perform CPR for 2 minutes and then call 9-1-1. D. call 9-1-1 and then return to begin CPR on the child.

D. call 9-1-1 and then return to begin CPR on the child.

Without practice, your CPR skills will __________. Select one: A. become part of your muscle memory B. improve over time C. come back automatically when needed D. deteriorate over time

D. deteriorate over time

Your conscious patient has a mild partial airway obstruction. You should: Select one: A. perform abdominal thrusts. B. administer back blows. C. place the patient supine. D. encourage the patient to cough.

D. encourage the patient to cough.

The impedance threshold device (ITD) may improve circulation during active compression-decompression CPR by: Select one: A. maintaining increased intrathoracic pressure during the downward stroke of each chest compression, which forces more blood from both of the ventricles. B. drawing all of the air out of the lungs in between chest compressions, which causes positive intrathoracic pressure and a reduction of blood return to the right side of the heart. C. maximizing the amount of air in the lungs following chest recoil, which hyperinflates the lungs and forces more blood from the ventricle during each compression. D. limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling.

D. limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling.

You are off duty and you come across an unresponsive child lying on the ground at a playground. She does not have a pulse and no one witnessed the collapse. What should you do? Call 9-1-1 immediately, then return to the child and begin CPR. Do 5 cycles of chest compressions, and then call 9-1-1. Call for ALS backup immediately. Take the child to the nearest hospital in your vehicle.

Do 5 cycles of chest compressions, and then call 9-1-1. You should do 5 cycles of chest compressions (about 2 minutes), then call 9-1-1. Because cardiopulmonary arrest in children is most often the result of respiratory failure, it is critical that you restore oxygenation.

Which intervention(s) would have the MOST positive impact on the cardiac arrest patient's outcome? Cardiac medications Advanced airway management Early CPR and defibrillation IV fluid administration

Early CPR and defibrillation Early high-quality CPR and defibrillation are most likely to have a positive impact.

When you are performing CPR on an adult or child, approximately how often should you reassess the patient for return of respirations and/or circulation? Every minute Every 2 minutes Every 3 minutes Every 5 minutes

Every 2 minutes You should reassess after five cycles of chest compressions, or approximately every 2 minutes.

basic life support (BLS)

Noninvasive emergency lifesaving care that is used to treat medical conditions, including airway obstruction, respiratory arrest, and cardiac arrest.

When performing CPR on an infant, which of the following is correct? Place two fingers in the middle of the sternum, just below the nipple line. Place the heel of one hand on the lower half of the sternum and the other hand over the first hand. Place the heel of one or two hands in the center of the chest, in between the nipples, avoiding the xiphoid process. Use your index finger on the lower left half of the sternum.

Place two fingers in the middle of the sternum, just below the nipple line. Perform infant chest compressions using two fingers in the middle of the sternum, just below the nipple line.

The AED gives a "no shock" message to a patient who is in cardiac arrest. What should you do? Resume chest compressions. Check for a carotid pulse. Reanalyze the cardiac rhythm. Deliver two rescue breaths.

Resume chest compressions. In the case of "no shock," you should immediately resume CPR for approximately 2 minutes.

cardiopulmonary resuscitation (CPR)

The combination of rescue breathing and chest compressions used to establish adequate ventilation and circulation in a patient who is not breathing and has no pulse.

abdominal-thrust maneuver

The preferred method to dislodge a severe airway obstruction in adults and children; also called the Heimlich maneuver.

return of spontaneous circulation (ROSC)

The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.

chest compression fraction

The total percentage of time during a resuscitation attempt in which active chest compressions are being performed.

In adults, chest compressions should be between 2 and 2.4 inches (5 and 6 cm) in depth and given at a rate of 100 to 120 per minute. T/F

True: Correct. Compressions should be between 2 and 2.4 inches (5 and 6 cm) in depth and given at a rate of 100 to 120 per minute.