Basic Life Support

surveillance, prevention, and treatment of pre-arrest conditions

* for adult patients who are in the hospital, cardiac arrest usually happens as a result of serious respiratory or circulatory conditions that get worse. * Many arrests can be predicted and prevented by careful observation, prevention and early treatment of pre-arrest conditions.

Activation of emergency response system

**Adults & Adolescents** -If you are alone w/ no mobile phone, leave the victim to activate the emergency response system and get the AED before beginning CPR. - Otherwise, send someone and begin CPR immediately; use the AED as soon as it is available. **Children and Infants** - Witnessed collapse: Follow steps for adults and adolescents on the left. - Unwittnessed collapse: Leave the victim to activate the emergency response system and get the AED - Return the child or infant and resume CPR; use the AED as soon as it is available.

Hand placement for CPR for an: Adult, Child, Infant

**Adults** -2 hands on the lower 1/2 of the breast bone (Sternum) **child** - 2 hands or 1 hand (optional for very small child) on the lower half of the breast bone (sternum) **Infant** - 1 rescuer: 2 fingers in the center of the chest, just below the nipple line. -2 or more rescuers: thumb-encircling hands in the center of the chest, just below the nipple line.

IHCA Chain of Survival

**Initial support** in hospital appropriate surveillance, monitoring, prevention, responsive primary provider. **Resuscitation Teams** various departments, multidisciplinary team of prof. providers **Available resources** multidisciplinary teams, ED, Cardiac catheterization laboratory and ICU. **Resuscitation Constraints** crowd control, family presence, space constraints, resources, training, transportation and device failures **Level of complexity** complex

OHCA Chain of Survival

**Initial support**community and EMS providers **Resuscitation teams**Lay rescuers, EMS providers, ED and/or cardiac catheterization laboratory, ICU **Available Resources** AED, public-access, defibrillation system, emergency or first aid equipment, and dispatch assisted guidance, EMS may find themselves alone w/ no resources accept those they brought with them, additional backup resources. **resuscitation constraints** crowd control, family presence, space constraints, resources, training, transportation, device failuer **level of complexity** complex

Early CPR with an emphasis on chest compressions

*If the victim is in cardiac arrest, begin high-quality CPR without delay. *High-Quality CPR started immediately after cardiac arrest can greatly improve a victim's chance of survival. *Bystanders who are not trained in CPR are encouraged to at least provide chest compressions. Chest compressions can be performed by those with no training and can be guided by dispatchers over the phone.

Multidisciplinary postcardiac arrest care

*Once ROSC is achieved, the next link is for the patient to receive post-cardiac arrest care. *This advanced level of care is provided by a multidisciplinary team of healthcare providers. They focus on preventing the return of cardiac arrest and tailor specific therapies to improve long-term survival. *post-cardiac arrest care may be provided in the cardiac catheterization suite and/or ICU.

Rapid defibrillation

*Rapid defibrilation in combination with high-quality CPRcan double or triple the chances of survival. Provide defibrillation with a manual defibrillator or AED as soon as the device is available. -The AED is a lightweight, portable device that can identify lethal heart rhythms and deliver a shock to terminate the abnormal rhythm and allow the heart's normal rhythm to resume. - AED's are simple to oberate, allowing lay rescuers and health care providers to attempt defibrillation safely.

B) jaw-thrust maneuver

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. If you suspect that an unresponsive victim has head or neck trauma, what is the preferred method for opening the airway. a) Head tilt-chin lift b) Jaw thrust c) Head tilt-neck lift d) Avoid opening the airway.

Resumes compressions

-Ensures compressions are resumed immediately after shock delivery. -student directs instructor to resume compressions or -Student resumes compressions

Adult compressions

-Perform high-quality compressions -Hand placement on lower half of sternum -30 compressions in no less than 15 and no more than 18 seconds -compresses at least 2 inches (5cm) -complete recoil after each compression

AED (follows prompts of AED)

-Power on AED -Correctly attaches pads -clears for analysis -clears to safely deliver a shock -safely delivers a shock

Personal Protective Equipment (PPE)

-medical gloves -eye protection -full body coverage -high-visability clothing -safety footwear -safety helments

children

1 year of age to puberty

Compression depth for adults

At least 2 inches (5 cm)

Compression depth for infants

At least 1/3 AP diameter (about 1 1/2 inches or 4 cm)

Compression depth for children

At least 1/3 AP diameter (about 2 inches or 5 cm)

d) no breathing and a pulse

Which victim would need only rescue breathing? a) Agonal gasping with no pulse b) Breathing with a weak pulse c) No breathing and no pulse d) No breathing and a pulse

d) An infant younger than 1 year

For what age victim is the thumb -encircling hands technique recommended when 2 or more rescuers are present? a) A child younger than 3 years b) A child older than 3 years c) An infant older than 1 year d) An infant younger than 1 year

Adult Breaths

Give 2 breaths with a barrier device -each breath given over 1 second -visable chest rise with each breath - Resumes compressions in less than 10 seconds

c) 1 breath every 5-6 seconds

How often should rescue breaths be given in infants and children when a pulse is present? a) 1 breath every 2 to 3 seconds b) 1 breath every 3 to 5 seconds c) 1 breath every 5 to 6 seconds d) 1 breath every 8 to 10 seconds

d) stand clear of the victim

What action should you take when the AED is analyzing the heart rhythm? a) check the pulse b) continue chest compressions c) Give rescue breaths only d) stand clear of the victim

c) You may need to place 1 pad on the chest and 1 on the back, according to the diagrams on the pads.

What is important to remember about AED pad placement on infants? a) Ensure that pads overlap each other in very small infants b) Place 1 adult pad on the chest c) You may need to place 1 pad on the chest and 1 on the back, according to the diagrams on the pads d) If child AED pads are not available, do not use the AED.

d) Naloxone

What is not an example of an opioid? a) Heroin b) Hydrocodone c) Morphine d) Naloxone

a) repeat back to the team leader the task you were assigned.

What is the appropriate action to demonstrate close-loop communication when the team leader assigns you a task? a) Repeat back to the team leader the task you were assigned b) Nod your head as an acknowledgement of the assigned task c) Start performing the assigned tasks, but do not speak to minimize the noise d) wait for the team leader to address you by name before acknowledging the task.

b) At least 1/3 the depth of chest, or about 1 1/2 inches

What is the correct chest compression depth for a child? a) At least 1/4th the depth of chest , or about 1 inch b) At least 1/3 the depth of chest, or about 1 1/2 inches c) At least 1/3rd the depth of chest, or about 2 inches d) At least 1/2 the depth of chest, or about 3 inches

b) 15 compressions to 2 breaths

What is the correct compression -to-ventilation ratio for a 7 year old when 2 or more rescuers are present? a) 15 compressions to one breath b) 15 compressions to 2 breaths c) 20 compressions to 2 breaths d) 30 compressions to 2 breaths

d) 30 compressions to 2 breaths

What is the correct compression-to-ventilation ratio for a single rescuer of a 3 year old child? a) 15 compressions to 1 breath b) 15 compressions to 2 breaths c) 20 compressions to 2 breaths d) 30 compressions to 2 breaths

a) power on the AED

What is the most appropriate first step to take as soon as the AED arrives at the victims side? a) power on the AED b) apply the pads c) Press the analyze button d) Press the shock button

d) Rapid Defibrilation

What is the third link in the adult out-of hospital chain of survival? a) Advanced life support b) High-quality CPR c) Prevention d) Rapid defibrilation

c) Use adult AED pads if the Aed does not have child pads.

What should you do when using an AED on an infant or a child less than 8 years of age? a) Never use adult AED pads b) Use adult AED pads c) Use adult AEd pads if the AED does not have child pads d) Use adult AED pads, but cut the in half.

d) wheezing between coughs

Which is an example of a mild foreign body airway obstruction? a) cyanosis (turning blue) b) high-pitched noise while inhaling c) Inability to speak or cry d) wheezing between coughs

Respiratory failure or shock

Which is the most common cause of cardiac arrest in children? a) cardiac problem b) congenital or acquired heart defect c) Respiratory failure or shock d) Infection or sepsis

a) Mouth to mouth

Which is the preferred technique for giving rescue breaths to an infant? a) Mouth to mouth b) Mouth to mouth and nose c) Mouth to nose d) Any method is acceptable

d) when abnormal rhythm develops and the heart rate stops unexpectedly

Which statement best describes sudden cardiac arrest? a) When respiratory distress in adults occurs and the heart rate does not change? b) When the heart rate is 40 to 60/min. and respirations increase? c) When blood flow to the heart is blocked and heart rate increases? d) When abnormal rhythm develops and the heart rate stops unexpectedly?

a) placeing the pads on the victim's bare chest

Which step is one of the universal steps for operating an AED? a) placing the pads on the victim's bare chest b) Shaving the victim's hairy chest c) Removing the victim from water d) Finding the victim's implanted pacemaker

a) an average size 27 year old man

Which victim of a severe airway obstruction should receive abdominal thrusts? a) An average size 27 year old man b) A woman who is obviously pregnant c) An obese 50 year old man d) An average size month old infant

b) check for a pulse

You are performing abdominal thrusts on a 9 year old child when he suddenly becomes unresponsive. After you shout for nearby help, what is the most appropriate action to take next? a) Begin high-quality CPR, starting with chest compressions? b) check for a pulse c) continue performing abdominal thrusts d) Provide 5 back slaps followed by 5 chest thrusts

cycle 2 of CPR (Repeats Cycle 1)

compression Breaths Resumes compressions in 10 seconds

Life Is Why

early recognition and CPR are crucial for survival from cardiac arrest. By learning high quality CPR you'll have the ability to improve patient outcomes and save more lives.

Recognition of cardiac arrest

Check for responsiveness: No breathing or only gasping (ie, no normal breathing) No definite pulse felt within 10 minutes (Breathing and pulse check can be performed simultaneously in less then 10 seconds)

Know your limitations

Every member on the team should know his or her limitations, and the team leader should be aware of them. Each team member should ask for assistance and advice early, not when the situations starts to get worse.

ROSC

Return of Spontaneous Circulation: When a patient who is in cardiac arrest regains a pulse

Constructive Intervention

Sometimes a team member or team leader may need to correct actions that are incorrect or inappropriate. It is important to be tactful, especially if you have to correct someone who is about to make a mistake, whether it's a drug, dose, or intervention. Any person on the team should stop someone else from making a mistake, regardless of that person's role on the team.

Summarizing and Reevaluating

Summarizing information out loud is helpful during a resuscitation attempt for the following reasons: -Provides an ongoing record of treatment - Acts as a way to reevaluate the victims status, the interventions performed, and the teams's progress within the algorithm of care -Helps team members respond to the victim's changing condition.

Clear messages

Team leaders and team members should give clear messages. Using concise, clear languages helps prevent misunderstandings. Speaking in a tone of voice that is loud enough to hear, but is also calm and confident, helps keep all team members focused.

c) Tell the team leader that you are not comfortable performing the task

The team leader asks you to perform bag-mask ventilation during resuscitation attempt, but you have not perfected that skill. What would be an appropriate action to acknowledge your limitations? a) pick up the bag-mask device and give it to another team member b) pretend you did not hear the request and hope the team leader chooses someone else to do it c) Tell the team leader that you are not comfortable performing the task d) Try to do it as best you can and hope another team member will see you struggling and take over.

Compression rate

100-120/min

sudden cardiac arrest (SCA)

occurs when the heart develops an abnormal rhythm and can't pump blood.

a) start high quality CPR, beginning with chest compressions

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. Several rescuers respond, and you ask them to activate the emergency response and retrieve the AED and emergency equipment. As you check for a pulse and breathing, you notice that the man is gasping for air and making "snorting" sounds. You do not feel a pulse. What is your best next action? a) Start high-quality CPR, beginning with chest compressions. b) Monitor the victim until additional, more experienced help arrives. c) Provide rescue breathing by delivering 1 breath every 5 to 6 seconds. d) Find someone to help by retrieving the nearest AED

a) check his pulse

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. The man doesn't respond when you touch his shoulders and shout, "Are you ok?" What is your best next action? a) Check his pulse b) start high-quality CPR c) Start providing rescue breaths d) Shout for nearby help

a) Assign tasks to other rescuers and rotate compressors every 2 minutes or more frequently if needed to avoid fatigue.

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. What action should you take when more rescuers arrive? a) Assign tasks to other rescuers and rotate compressors every 2 minutes or more frequently if needed to avoid fatigue. b) Continue CPR while AED is attached even if you are fatigued. c) Wait for the most experienced rescuer to provide direction to the theam. d) Direct the team to assign a team leader and roles while you continue CPR.

d) A rate of 100 to 120 compressions per minute and a depth of at least 2 inches (5cm)

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. What are the rate and depth for chest compressions on an adult? a) A rate of 60 to 80 compressions per minute and a depth of about 1 inch. b) A rate of 80 to 100 compressions per minute and a depth of about 1 1/2 inches. c) A rate of 120 to 140 compressions per minute and a depth of about 2 1/2 inches d) A rate of 100 to 120 compressions per minute and a depth of at least 2 inches.

c) 30 compressions to 2 breaths

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. What is the ratio of chest compressions to breaths when providing CPR to an adult? a) 10 compressions to 2 breaths. b) 15 compressions to 2 breaths c) 30 compressions to 2 breaths d) 100 compressions to 2 breaths

d) Verify the scene is safe.

*Scenario: A 53 year old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. Which is the first action you should take in the situation? a) Activate the emergency response system b) start high-quality CPR, beginning w/ chest compressions c) start providing rescue breaths d) verify that the scene is safe for you and the victim.

Immediate recognition of cardiac arrest and activation of the emergency response system

*You must first recognize that the victim is in cardiac arrest based on unresponsiveness, no breathing (or no normal breathing or only gasping), and no pulse *The sooner you activate the emergency response system, the sooner the next level of care will arrive.

Compression- Ventilation ration without advanced Airway

-Continuous compressions at a rate of 100-120/min. -Give 1 breath every 6 seconds (10 breaths/min)

Assessment and activation

-check responsiveness -check breathing -shout for help/Activation of emergency response-AED -check pulse

Chest recoil

Allow full recoil of chest after each compression; do not lean on the chest after each compression

c) suggest to resume chest compressions without delay.

After performing high-quality CPR for 5 minutes, the team leader frequently interrupts chest compressions to check for a pulse even though the victim has no organized rhythm when the AED analyzes the rhythm. Which action demonstrates constructive intervention? a) ask another rescuer what he thinks should be done? b) Say nothing that contradicts the team leader c) Suggest to resume chest compressions without delay d) wait until the debreifing session afterward to discuss it.

Mutual Respect

All team members should display mutual respect and a professional attitude to other team members, regardless of their skill level or training. Emotions can run high during a resuscitation attempt. So its especially important for the team leader to speak in a friendly, controlled voice and avoid shouting or aggression.

chest compression depth

Child 1/3 chest = 2 inches, 5 cm Infant 1/3 chest = 1.5 inches, 4 cm

closed loop communication

Closed loop communication is important for both the team leader and team members. To practice closed loop communication the team leader and the team member should do the following: **Team Leader** -call each team member by name and make eye contact when giving instruction. - Don't assign additional tasks until you are sure that the team member understands the instruction. **Team members** -Confirm that you understand each task to which you are assigned by verbally acknowledging the task. -Tell the team leader when you have finished a task.

b) Use an AED equipped with a pediatric dose attenuator

If a manual defibrillator is not available for an infant victim, which action should you take? a) perform high-quality CPR b) Use an AED equipped with a pediatric dose attenuator c) Use an AED without a pediatric dose attenuator d) Wait for advanced care to arrive.

a) avoid placing the AED pad directly over the implanted device

If a victim of cardiac arrest has an implanted pacemaker or defibrillator, what special steps should be taken? a) Avoid placing the AED pad directly over the implanted device b) Avoid using the AED to prevent damage to the implanted device c) Turn off the implanted device before applying the AED pads. d) consider using pediatric pads to decrease the shock dose delivered.

Homes

In which locations do most out of the hospital cardiac arrests occur? a) healthcare clinics b) Homes c) Recreational facilities d)shopping centers

Knowledge sharing

Knowledge sharing is important for effective team performance. Team leaders should ask frequently for observations and feedback. This includes good ideas for management and observations about possible oversights.

Infants

Less than 1 year of age (excluding newly born infants in the delivery room)

Minimizing interruptions

Limit interruptions in chest compressions to less than 10 seconds

scene safety

Make sure the environment is safe for rescuers and victim

Heart Attack

Occurs when blood flow to part of the heart muscle is blocked.

b) Begin CPR, starting with chest compressions

You encounter an unresponsive 56 year old man who has been taking hydrocodone after a surgical procedure. He is not breathing and has no pulse. You notice that his medication bottle is empty. You suspect an opioid associated life threatening emergency. A colleague activates the emergency response system and is retrieving the AED and naloxone. What is the most appropriate action for you to take next? a) Wait for the naloxone to arrive before doing anything b) Begin CPR, starting with chest compressions c) Provide 1 rescue breath every 5 to 6 seconds until naloxone arrives. d) provide rapid defibrillation with the AED

c) Provide rescue breathing 1 breath every 5-6 seconds

Your 27 year old roommate uses opioids. You find him unresponsive with no breathing but a strong pulse. You suspect an opioid associated life threatening emergency. A friend is phoning 911 and is looking for the naloxone autoinjector. What action should you take? a) Remain with your roommate until the naloxone arrives and administer it immediately b) begin CPR, starting with chest compressions c) Provide rescue breathing 1 breath every 5-6 seconds d) provide rapid defibrillation with and AED.

High Quality CPR

a) start compressions within 10 seconds b) Push hard, push fast: compress at a rate of 100 to 120/min. with a depth of- -at least 2 inches (5cm) for adults - at least 1/3 depth of chest -2 inches**child** - at least 1/3 depth, 1 1/2 in. (4cm) **infant** c) allow complete chest recoil d) minimize interruptions e) give effective breaths f) avoid excessive ventilation

The chain of survival for a cardiac emergency (adult)

a) surveillance, prevention, and treatment of pre-arrest conditions b) immediate recognition of a cardiac arrest and activation of emergency response system c) Early CPR with an emphasis on chest compressions d) multidiscipline post-cardiac arrest care.

Adults

adolescents (after the onset of puberty) and older.