BLS Course
when using a pocket mask, where should the rescuer be positioned?
at the side of the victim
AED
automated external defibrillator -a device that analyzes the heart rhythm to identify the presence of an arrhythmia that can be corrected by a shock -lightweight, portable device -simple to operate -uses voice prompts, lights, and on-screen messages
critical components of chest compressions: adults
-Place the victim on a firm, flat surface, such as floor or backboard. -RATE: 100-120/min -DEPTH: at least 2 inches (5 cm) -HAND PLACEMENT: 2 hands on the lower half of the breastbone -CHEST RECOIL: allow complete recoil; do not lean on the chest -MINIMIZING INTERRUPTIONS: limit interruptions to less than 10 seconds
how to use a bag-mask device
-Position yourself directly above the victim's head 1. place the mask on the victim's face, using the bridge of the nose as a guide for correct position. 2. Use the E-C clamp technique -Perform a head tilt. -Place the mask on the face with the narrow portion at the bridge of the nose. -Use the thumb and index finger of one hand to make a "C" on the side of the mask, pressuring the edges of the mask to the face. -Use the remaining fingers to lift the angles of the jaw, open the airway, and press the face to the mask. 3. Squeeze the bag to give breaths while watching for chest rise. Deliver each breath over 1 second. If there are 2 rescuers: -Rescuer 1: Positioned directly above the victim, opens the airway and positions the bag-mask device. -Rescuer 2: Positioned at the victim's side, squeezes the bag.
critical components of chest compressions: children
-RATE: 100-120/min -DEPTH: approximately 2 inches (5 cm) -HAND PLACEMENT: 2 hands or 1 hand on the lower half of the breastbone -CHEST RECOIL: allow complete recoil; do not lean on the chest -MINIMIZING INTERRUPTIONS: limit interruptions to less than 10 seconds
Adult BLS Algorithm for healthcare providers
-Verify scene safety -Check for responsiveness. ----Tap the victim's shoulders and shout, "Are you OK?" ----If the victim is not responsive, shout for nearby help ----Activate the emergency response system via mobile device. ----Get the AED or send someone to do so. -Look for no breathing or only gasping and checks the pulse (simultaneously). Is a pulse definitely felt within 10 seconds? -Normal breathing, pulse felt ----Monitor until emergency responders arrive. -No normal breathing, pulse felt ----1 breathe every 6 seconds or 10 breaths/min. ----Check the pulse every 2 minutes ----If no pulse, start CPR ----If possible opioid overdose, administer naloxone if available per, protocol. -No normal breathing or only gasping, pulse not felt ----Start CPR ----Perform cycles of 30 compressions and 2 breaths ----Use AED as soon as it is available -Once the AED arrives, check the rhythm: --Shockable rhythm ----Give 1 shock and resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check). --Nonshockable rhythm ----Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check). -Continue CPR until ALS providers take over or the victim starts to move.
Pediatric BLS Algorithm for healthcare providers - single rescuer
-Verify scene safety -Check for responsiveness. ----Tap the victim's shoulders and shout, "Are you OK?" ----If the victim is not responsive, shout for nearby help ----Activate the emergency response system via mobile device. -Look for no breathing or only gasping and checks the pulse (simultaneously). Is a pulse definitely felt within 10 seconds? -Normal breathing, pulse felt ----Monitor until emergency responders arrive. -No normal breathing, pulse felt ----give rescue breaths every 2-3 seconds (20-30 breaths per minute) ----Assess pulse rate for no more than 10 seconds -Heart rate <60/min with signs of poor perfusion ---start CPR -Heart rate >60/min ---continue rescue breathing ---check pulse every 2 minutes ---if no pulse, start CPR -No breathing or only gasping, pulse not felt ---witnessed: activate the emergency response system, retrieve the AED and begin CPR ---unwitnessed: begin CPR immediately -CPR ----Perform cycles of 30 compressions and 2 breaths ----when a second rescuer arrives, perform cycles of 15 compressions and 2 breaths ----Use AED as soon as it is available -After about 2 minutes, if still alone, activate the emergency response system and retrieve the AED (if not already done) -Once the AED arrives, check the rhythm: --Shockable rhythm ----Give 1 shock and resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check). --Nonshockable rhythm ----Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check). -Continue CPR until ALS providers take over or the child starts to move.
what are the special considerations for defibrillation in children less than 8 years of age?
-if child pads are not included, use adult pads -a manual defibrillator is preferred for infants less than 1 year of age -use smaller-sized pads, if available
witnessed collapse of a child or infant
-if you are alone with no mobile phone, leave the victim to activate the emergency response system and get the AED before beginning CPR. Use the AED as soon as it is available -if you are not alone, send someone to get the AED and begin CPR immediately. Use the AED as soon as it is available
unwitnessed collapse of a child of infant
-if you are alone, start CPR with cycles of 30:2 -if you are not alone, send someone to get the AED and begin CPR immediately. Use the AED as soon as it is available -after about 20 minutes, if you are still alone, activate the emergency response system and get an AED if not already done
what are common administration routes for naloxone?
-intranasal -intravenous -intramuscular
critical components of chest compressions in adults
-place the victim on a firm, flat surface, such as a floor or backboard -rate: 100-120/min -depth: at least 2 inches (5 cm) -chest recoil: allow complete recoil -minimizing interruptions: limit interruptions to less than 10 seconds
bag-mask device
-provides positive-pressure ventilation to a victim who is not breathing normally -consists of a bag attached to a face mask -if the bag is self-inflating, it provides about 21% oxygen from air when not connected to supplemental oxygen -may include a 1-way valve
signs of choking: adults and children
-signs of poor air exchange and difficulty breathing -silent cough -inability to speak or breathe -cyanosis (turning blue) -adult or older child may clutch the neck with both hands, making the universal choking sign. if the victim nods that they are choking, you must act
how to check for responsiveness
-tap the victim's shoulders and shout "are you ok?" -if the victim is not responsive, active the emergency response system via mobile device -get the AED or send someone to do so
what are the correct actions to take for scene safety and assessment?
-verify scene safety -check for responsiveness -look for no breathing and only gasping and check pulse -activate the emergency response system and get an AED
what is recommended to minimize interruptions in compressions when using an AED?
-when 2 or more rescuers are present, 1 rescuer should continue chest compressions while the other prepares the AED -if no shock is advised and after any shock delivery, immediately resume high-quality CPR, starting with chest compressions -continue with high-quality CPR until an AED prompts to clear
when providing rescue breaths to an adult victim, you should give __ breath (s) every __ seconds
1 breath every 6 seconds
how are breaths delivered using a bag-mask device?
1 breath over 1 second, while watching for chest rise
compression-to-ventilation ratio: infants and children
1 rescuer: 30:2 2 or more rescuers: 15:2
What is the correct order of steps in the In-Hospital Chain of Survival for adults?
1) Early recognition and prevention 2) Activation of emergency response 3) High-quality CPR 4) Defibrillation 5) Post-cardiac arrest care 6) Recovery
Steps for Mouth-to-Mouth Breaths
1) Hold the victim's airway open with a head tilt-chin lift. Pinch the nose closed with your thumb and index finger 2) Take a regular breath and seal your lips around the victim's mouth, creating an airtight seal -give 1 breath and blow for 1 second -watch for the chest to rise as you give each breath 3) Give a second breath (blowing for about 1 second) while watching for chest rise
After positioning yourself directly above the victim's head, what is the correct order of steps for using a bag-mask device?
1) Place the mask on the victim's face, using the bridge of the nose as a guide for the correct position 2) Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open 3) Squeeze the bag to give breaths (1 second each) while watching for chest rise
how to find and feel for the carotid pulse
1) locate the trachea (on the side closest to you), using 2 or 3 fingers 2) slide those fingers into the groove between the trachea and muscles at the side of the neck, where you can feel the carotid pulse 3) feel for a pulse for at least 5 but no more than 10 seconds; if you do not definitely feel a pulse, begin CPR, starting with chest compressions.
AED pad placement: adults and children 8 years and older
Anterolateral Placement -place 1 pad directly below the right collarbone -place the other pad to the side of the left nipple, with the top edge of the pad a few inches below the armpit Anteroposterior Placement -place 1 pad on the left side of the chest, halfway btwn the tip of the breastbone and left nipple -place the other pad on the left side of the victim's back, beneath the shoulder blade, next to the spine
advanced airways
A laryngeal mask airway, supraglottic airway device, and endotracheal tube are types of advanced airways. -when an advanced airway is in place: ---perform continuous compressions at 100 to 120/min ---give 1 breathe every 6 seconds for adults ---give 1 breath every 2 or 3 seconds for a child or infant ---no pauses in compressions to give breaths
cardiac arrest in a pregnant patient
High-quality CPR can increase the mother's and the infant's chance of survival -perform compressions and use an AED as you would for any cardiac arrest victim. Shock from the AED will not harm the infant -if additional rescuers are present and rescuers are trained, perform continuous lateral uterine displacement, in addition to high-quality BLS -if the woman is revived, place her on her left side. This may help improve blood flow to her heart and therefore, to the infant
minimizing interruptions while using an AED
When 2 or more rescuers are present: -One rescuer should continue chest compressions while the other operates the AED. Rescuers should continue high-quality CPR: -Until the AED delivers a prompt to clear the victim for analysis. If no shock is advised: -Immediately resume CPR, starting with chest compressions.
After an AED delivers a shock, what should the rescuers do next? a) clear the victim for another rhythm analysis b) complete a pulse check c) resume CPR, starting with chest compressions d) give 2 breaths and resume CPR
c) resume CPR, starting with chest compressions
when a choking infant becomes unresponsive, what is the one thing you need to do differently when performing CPR?
check the airway for the obstructing object
if a choking victim is too large for you to wrap your arms around the waist, you should perform ___ thrusts
chest
when should the rescuer operating the AED clear the victim?
during analysis and before shock delivery
to avoid fatigue, when should team roles alternate providing compressions?
every 5 cycles or 2 minutes
how do you open the airway for breaths if a single rescuer is present?
head tilt-chin lift
what is a sign of severe airway obstruction?
inability to speak
when performing high-quality CPR, when do pauses in compressions typically occur?
intubation, rhythm analysis, pulse checks, compressor switches, and defibrillation
Scene Safety
make sure the scene is safe for you and the victim
opioids
medications primarily used for pain relief -in high doses, this medication can cause a person to stop breathing or even cause death
how can you achieve a high chest compression fraction?
minimize pauses in chest compressions
how is CPR performed differently when an advanced airway is in place?
no pauses for ventilations
a bag-mask device is used to provide ____ to a victim who is not breathing or not breathing normally
positive-pressure ventilation
after an AED delivers a shock, what should the rescuers do next?
resume CPR, starting with chest compressions
Resuscitation Outcomes Consortium (ROC) trials
should that a 10% increase in CCF is roughly equal to an 11% increase in survival
how does CPR differ in an unresponsive adult choking victim?
the airway is checked for obstructing object
chest compression fraction (CCF)
the amount of time spent doing high-quality chest compressions during a cardiac arrest resuscitation attempt
when performing chest compressions for an infant in a 2-rescuer situation,, you should use 2 ____ in the center of the chest, on the lower half of the breastbone
thumbs
when performing abdominal thrusts on adults and children, in which direction should your thrusts be directed?
upward
2 life-threatening arrhythmias that can cause cardiac arrest are pulseless ventricular tachycardia and
ventricular fibrillation
AED Pad Placement: infants and children less than 8 years of age
Pad Choice -if your AED includes smaller-sized pads that are designed for children under 8 years of age, use them -if not, use the adult pads while making sure that they don't touch or overlap -do not use child pads for an adult. the shock dose is too small for an adult Pad Placement -some AED pads recommend placing 1 pad on the chest and 1 pad on the back for infants and children -follow the pictures on the pad packages for proper placement
team dynamics
Roles and Responsibilities -team members should ask for assistance and advice early, not when the situation deteriorates -a team member or the team leader may need to correct actions that are incorrect or inappropriate What to Communicate -knowledge sharing and summarizing information are critical components of effective team performance -team leaders should review what's happened and ask for ideas and observations from team members How to Communicate -closed-loop communication: the process of verifying that the message sent was received as intended; verifies that any assigned tasks have been completed -teams should use clear messaging to help prevent misunderstandings -teams need to communicate with respect and in a professional manner
choking in infants
Step 1: - First sit or kneel with the infant in your lap - Hold the infant facedown and resting on your forearm, with the head slightly lower than the chest - support the head and jaw with your hand Step 2: - Rest your forearm on thigh to provide support - Deliver up to 5 back slaps forcefully between the infant's shoulder blades, using the heel of your hand -- Deliver each slap with sufficient force to attempt to remove the foreign body Step 3: - Place your free hand on the infant's back, supporting the head with palm of your hand. This will cradle the infant as you turn the infant over faceup - Keep the infant's head lower than the chest, and deliver up to 5 quick downward chest thrusts -- Do this at a rate of about 1 per second, each with intention of creating enough force to dislodge the foreign body - Repeat the sequence until the object is removed or the infant becomes unresponsive
pediatric chain of survival
-Early Recognition and Prevention -Activation of Emergency Response -High-Quality CPR -Advanced Resuscitation -Post-Cardiac Arrest Care -Recovery
what is the preferred method for pulse check in an infant?
place 2 or 3 fingers on the inside of the upper arm, midway between the infant's elbow and shoulder
Why is an AED needed?
to analyze the heart rhythm and provide a shock
Pediatric BLS Algorithm for healthcare providers - 2 or more rescuers
-Verify scene safety -Check for responsiveness. ----Tap the victim's shoulders and shout, "Are you OK?" ----If the victim is not responsive, shout for nearby help ----first rescuer remains with the child ----second rescuer activates the emergency response system and gets the AED -Look for no breathing or only gasping and checks the pulse (simultaneously). Is a pulse definitely felt within 10 seconds? -Normal breathing, pulse felt ----Monitor until emergency responders arrive. -No normal breathing, pulse felt ----give rescue breaths every 2-3 seconds (20-30 breaths per minute) ----Assess pulse rate for no more than 10 seconds -Heart rate <60/min with signs of poor perfusion ---start CPR -Heart rate >60/min ---continue rescue breathing ---check pulse every 2 minutes ---if no pulse, start CPR -No breathing or only gasping, pulse not felt ---begin CPR ---first rescuer begins CPR with a 30:2 ratio -when the second rescuer returns, use a 15:2 ratio ----Use AED as soon as it is available -Once the AED arrives, check the rhythm: --Shockable rhythm ----Give 1 shock and resume CPR immediately --Nonshockable rhythm ----Resume CPR immediately for 2 minutes -Continue CPR with a ratio of 15:2 until ALS providers take over or the child starts to move.
which of the following are resuscitation triangle roles in a high-performance team?
-airway -AED/ monitor /defibrillator -compressor
how to assess for breathing and a pulse
-assess at the same time; should take no more than 10 seconds -to check for breathing, scan the victim's chest for rise and fall for no more than 10 seconds --if the victim is not breathing or only gasping, be prepared to begin high-quality CPR -to perform a pulse check on an adult, feel for a carotid pulse
what are the components of a pulse check in an unresponsive victim?
-assess for a pulse for at least 5 but not more than 10 seconds -use 2 or 3 fingers to locate the pulse -feel the pulse in the groove to the side of the trachea
where should AED pads be placed in the anterolateral placement for adults and children 8 years or older?
-below the right collarbone -side of the left nipple -below the left nipple
what does a chest compression feedback device monitor?
-compression depth -chest recoil -compression rate
achieving a high chest compression fraction (CCF)
-eliminate pauses during high-quality CPR -pauses typically occur during intubation, rhythm analysis, pulse checks, compressor switches, and defibrillation -Hover: whenever compressions are paused, compressors should hover their hands over the chest and be prepared to resume compressions -advanced providers check for a pulse, precharge the defibrillator, and prepare to deliver a shock about 15 seconds before pausing compressions at the end of each 2-minute cycle -when using an AED, the prompts will tell you when to pause -switch compressors with the 2nd compressor coming in from behind the 1st; for seamless transitions, switching between cycles every 2 minutes is best -if a compressor needs to switch due to fatigue, coordinate the switch to happen as fluidly as possible, such as while delivering breaths -best to use real-time feedback devices during CPR or a metronome to establish the proper rate
when performing chest compressions for an infant, you can use 2 thumbs or put 2 _____ in the center of the chest, just below the _______ line
-fingers -nipple
if an opioid-associated life-threatening emergency is suspected in a person who is unresponsive and not breathing normally but has a pulse:
-give 1 rescue breath every 6 seconds in an adult -give 1 rescue breath every 2-3 seconds in a child or infant -then, if local protocol allows, give naloxone. Don't delay breaths to give naloxone
AED special considerations
-hairy chest ----If your AED has 1 set of pads and razor quickly shave the area and then apply the pads ----If your AED has two sets of pads use the first set to remove the hair. Apply the first set of pads, press them down so they can stick as much as possible and quickly pull them off. Then apply the new second step pads. - Water ----If someone is lying in water quickly move the victim to a dry surface --------If the victim is lying in snow or small puddle use the AED ----If the chest is covered with water or sweat wipe the chest before attaching the pads -Transdermal medicine patch ----do not place the pad directly over medicine patch ----take the patch off and quickly wipe the chest before you put on the patch -Implanted defibrillator or pacemaker ----If you see a lump inside a device, avoid placing the pad directly over it -Defibrillation for infants less than one year of age ----A manual defibrillator is preferred weather than an AED. ----If a manual defibrillator is not available, an AED with a pediatric dose attenuator is preferred. ---If it is available you may use an AED without a pediatric dose alternator.
team roles in high-performance teams
1) team leader: defined leader who assigns roles and makes treatment decisions; often at the foot of the victim but moves around to observe and evaluate the skills of the team and provide feedback when needed 2) administer medications 3) compressor: assesses the victim and stays next to the victim's chest to perform chest compressions; rescuers should switch every 5 cycles of CPR (~2 minutes) or sooner if tired 4) timer/recorder: keeps a record of the events that occur, including frequency and duration of interruptions in chest compressions, time of shock delivery, and medication administration 5) monitor/defibrillation / CPR coach: operates the AED; focus on team members' performance of high-quality CPR and provide feedback as needed during the resuscitation attempt 6) airway: positioned by the victim's head; maintains an open airway and delivers breaths while watching for chest rise and avoiding excessive ventilation
how to open the airway for breaths
1. Place one hand on the victim's forehead, and push with your palm to tilt the head back 2. Place fingers of the other hand under the bony part of the lower jaw, near the chin 3. Lift the jaw to bring the chin forward.
how to use an AED
1. Power on the AED if needed. Follow the prompts. 2. Choose adult pads for victims 8 years of age and older. Attach the adhesive AED pads to the victim's bare chest. 3. When the AED prompts you, clear the victim during analysis. Be sure that no one is touching the victim. Some AEDs will tell you to push a button to allow the AED to begin analyzing others will do that automatically. The AED may take a few seconds to analyze. 4. If the AED advises a shock: -It will charge and then tell you again to clear the victim. -Clear the victim before delivering the shock. -Press the shock button. -After any shock delivery, immediately resume CPR.
rescue breathing: adults, children, and infants
Adults -give one breath every 6 seconds (10 breaths/min) -Give each breath over 1 second and make sure there is visible chest rise with each breath -during rescue breathing, check the victim's pulse every 2 minutes Children and infants -give 1 breath every 2 or 3 seconds (20 to 30 breaths/min) -Give each breath over 1 second and make sure there is visible chest rise with each breath -during rescue breathing, check the victim's pulse every 2 minutes
pulse check: infants and children
Check the brachial artery pulse in an infant 1. Place 2 or 3 fingers on the inside of the upper arm, between the elbow and shoulder. 2. Then press the fingers to attempt to feel the pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse within 10 seconds, or the heart rate is 60/min or less, begin high-quality CPR, starting with chest compressions. Check the femoral artery pulse: 1. Place 2 or 3 fingers in the inner thigh, midway between the hip bone and the public bone and just below the crease where the leg meets the torso. 2. Feel for a pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse within 10 seconds, or the heart rate is 60/min or less begin high-quality CPR, starting with chest.
opioid-associated life-threatening emergency
a condition that can cause a person to stop breathing but still have a pulse
naloxone
a medication that can temporarily reverse the effects of opioid overdose -common routes of administration include intravenous, intramuscular, and intranasal
mouth-to-mouth breathing
a quick and effective way to provide oxygen to a victim when a barrier mask is not available -each breath you take contains 21% oxygen -when you provide a rescue breath, the air you breathe into a victim contains about 17% oxygen
You and your colleague respond to an adult victim who is unresponsive. After assessing that the victim is not breathing and has no pulse, what do you instruct your colleague to do?
activate the emergency response system and get the AED
what is the recommended depth of compressions in infants?
approximately 1.5 inches (4 cm)
what is the correct approach for AED pad placement for infants and children less than 8 years of age?
as indicated on the pad packages
