CPR/BLS

Rate of compressions

100-120 per minute

The recommended adult dose is

2 mg intranasal or 0.4 mg intramuscular. You may repeat after 4 minutes. Follow facility protocols to determine dosing and timing of naloxone administration.

2 people CPR- switch positions every: take no more than:

2 minutes 10 seconds to switch

Although naloxone is typically administered

intravenously in the healthcare facility setting, it can be administered intranasally or intramuscularly.

check baby pulse

is at the brachial artery in the arm

A myocardial infarction (MI), or heart attack, refers to

the necrosis (death) of heart tissue as a result of insufficient delivery of oxygenated blood to the heart. The sooner the signs and symptoms are recognized and treated, the lesser the degree of damage to the heart. Even patients who have had an MI before may not recognize the signs because each MI may present differently.

For adult patients, high-quality CPR includes

30 chest compressions followed by 2 ventilations. Remember, when an advanced airway is in place, the 30:2 ratio does not apply.

Multiple providers

30:2 30 compressions 2 ventilations

Single provider

30:2 30 compressions 2 ventilations

How long should you wait before administering it?

4 minutes

refusal of care

A competent patient's refusal of care from a healthcare provider. Refusal of care must be honored, even if the patient is seriously injured or ill or desperately needs assistance. A patient can refuse some or all care. If a witness is available, have the witness listen to any refusal of care, and document it in writing.

capnography

procedure to record carbon dioxide levels

Check for Responsiveness

If the patient appears unresponsive during the initial impression, immediately check for responsiveness using the shout-tap-shout sequence.

Conduct a rapid assessment, which includes

performing a quick visual survey and checking for responsiveness, opening the patient's airway and simultaneously checking for breathing and a pulse. Then if an unresponsive patient isn't breathing normally and doesn't have a pulse, begin CPR.

CPR (cardiopulmonary resuscitation)

refers to medical procedures used when a person's heart and lungs have stopped working

CPR keeps

Blood and oxygen flowing to the beain

Shout tape shout

To check for responsiveness

intramuscularly

into muscles

cardiac arrest

complete stopping of heart activity

CPP>mmHg=

improved outcomes

child for two people

15:2

What is the correct ventilation rate for an adult patient in respiratory arrest?

1 ventilation every 5 to 6 seconds

Cardiac chain of survival performed in rapid succession to increase the likelihood of surviving cardiac arrest

1. Surveillance and prevention 2. Activation of the emergency response system 3. Early CPR 4. Early defibrillation 5. Integrated post cardiac arrest care

Pediatric Cardiac Chain of Survival

1. prevention 2. early CPR 3. activation of EMS 4. early advanced life support 5. integrated post cardiac arrest care

An adult patient who has collapsed is unresponsive. When conducting a rapid assessment of the patient, you simultaneously check breathing and a carotid pulse for at least 5 seconds, but no more than ______.

10

Reassess & Document

After providing care, it is important to reassess the patient and the effectiveness of your interventions to determine next steps based on your findings. Always document to establish a record of the events that took place, the care you provided and the facts you discovered.

AED Pad Placement child

Anterior/lateral placement: Upper right chest below right clavicle to right of sternum Left side of chest several inches below left armpit on midaxillary line Anterior/posterior placement: If pads risk touching each other or the AED model uses this type of pad placement

AED Pad Placement infant

Anterior/posterior placement: Middle of chest Back between scapulae

OD with cardiac arrest

Begin CPR within 10 seconds of recognizing the patient is in cardiac arrest. As soon as available, use the AED and, if your facility protocol allows, administer naloxone. If you are alone and do not have a mobile device available, perform CPR for about 2 minutes before leaving to call for additional resources. Remember, providing high-quality CPR is the priority over administering naloxone during cardiac arrest.

How soon after recognizing cardiac arrest should you begin compressions?

Begin chest compressions within 10 seconds.

cyanotic

Bluish skin color due to lack of Oxygen

Review the steps involved in performing CPR for adults as a single provider and with multiple providers.

Conduct a rapid assessment Place the patient on a firm, flat surface Position your hands correctly Position your body effectively Provide 30 chest compressions Seal the mask and Open airway Provide 2 ventilations Switch positions every 2 minutes Continue providing CPR cycles

For a patient in respiratory arrest, follow these steps:

Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR.

OD with respiratory arrest

If the patient is in respiratory arrest, deliver 1 ventilation every 5 to 6 seconds for an adult and every 3 to 5 seconds for children and infants. Each ventilation should last about 1 second and make the chest begin to rise. Then, if your facility protocol allows, administer naloxone as soon as it is available. Check the pulse and breathing about every 2 minutes. If you find no pulse, begin CPR or use an AED if one is available and ready to use. Remember, delivering ventilations is the priority over administering naloxone during respiratory arrest.

Simultaneously Check for Breathing and Pulse

If you determine the patient is indeed unresponsive, open the airway and simultaneously check breathing and a carotid pulse for at least 5 seconds but no more than 10.

If a pocket mask or BVM is not available, you may need to provide mouth-to-mouth ventilations:

Open the airway to a past-neutral position (for an adult). Pinch the patient's nose shut. Take a normal breath, make a complete seal over the patient's mouth with your mouth and blow into the patient's mouth to deliver 1 ventilation over 1 second until you see the chest begin to rise. After each ventilation, break the seal and take a breath before resealing your mouth over the patient's mouth. Then deliver the next ventilation.

Opioid Overdose Triad To quickly assess for an opioid overdose, use the opioid overdose triad:

Pinpoint pupils Respiratory depression Unconsciousness or severe sleepiness

To provide ventilations, you can use the following methods:

Pocket mask ventilations Bag-valve-mask resuscitator ventilations Mouth-to-mouth ventilations Mouth-to-nose ventilations Additionally, adjuncts to ventilations include supplemental oxygen, basic airways and advanced airways.

Crew resource management

Practice used to prevent errors. Centers around team leader, who coordinates actions actively and effectively. Guides the team members to communicate directly and openly during time critical situations

Taking advantage of readily available resource to find a solution is an example of

Problem solving (asking a family member to sit down with to get wife out of room)

ROSC

Return of spontaneous circulation

Duty to Act

The duty to respond to an emergency and provide care. Failure to fulfill these duties could result in legal action.

What is a reason you would choose to perform chest thrusts instead of abdominal thrusts for an adult with an obstructed airway?

The patient is in a wheelchair.

Critical thinking

Thinning clearly and rationally to identify the connection between information and actions

intravenously

directly into a vein

If Theo (6 yr old) were unresponsive and not breathing normally (or only gasping) but had a pulse ≤ 60 bpm with signs of poor perfusion, she would tell Joe get

help and an AED. Then, she would begin CPR. She would continue compressions and ventilations checking the pulse and breathing about every 2 minutes. If during pulse checks Theo's pulse increased to greater than 60 bpm, Amy would stop chest compressions but continue providing 1 ventilation every 3 to 5 seconds as long as Theo remained in respiratory arrest. If she did not find a pulse, she would continue CPR.

intranasally

nose

When performing abdominal thrusts, place the

thumb side of your fist on the middle of the abdomen, just above the navel.

respiratory arrest

If the patient is unresponsive, is not breathing normally (or only gasping) but has a pulse, they are in respiratory arrest. Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. See Lesson 3 for more information.

naloxone

opioid antagonist

battery

The unlawful, harmful or offensive touching of a patient without the patient's consent.

Perform Visual Survey

The visual survey includes assessing for safety, obtaining an initial impression of the patient and determining the need for additional resources.

Baby CPR

use hand-encircling technique or 2 finger technique; bvm ventilation is performed during a pause after every 3rd compression; the compression to ventilation ratio should be 3 to 1 (this will yield a total of 120 actions per minute or 90 compressions and 30 ventilations); if the newborns cardiac arrest is believed to be of cardiac origin then consider a 15 to 2 ratio of compression to ventilation (if you are doing CPR on a baby, transport them to a level III neonatal intensive care unit)

obstructed airway

If the patient is responsive but cannot cough, speak or breathe, they are choking. Obtain consent and immediately begin care for an obstructed airway. See Lesson 5 for more information.

If the patient is unresponsive, not breathing normally (or only gasping) but has a pulse, they are in

respiratory arrest

mouth-to-nose ventilations instead.

With the patient's head tilted back, close the mouth by pushing up on the chin. Seal your mouth around the patient's nose and breathe into the nose. If possible, open the patient's mouth between ventilations to allow air to escape.

A heart attack is when and sudden cardiac arrest is when

-blood flow to the heart is blocked, -the heart malfunctions and suddenly stops beating unexpectedly

When capnography is in use, an ETCO2 below

10 mmHg indicates that there could be a problem with the quality of chest compressions.

child-

100-120 2 inches recoil (smaller children, use one hand)

A R C

Assess Recognize Care

Use of an AED may restore

an effective heart rhythm, increasing the patient's chance for survival.

automated external defibrillator (AED)

A device that detects treatable life-threatening cardiac arrhythmias (ventricular fibrillation and ventricular tachycardia) and delivers the appropriate electrical shock to the patient.

scene size-up

A step within the patient assessment process that involves a quick assessment of the scene and the surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care.

Rapid assessment of Mrs. Bailey's breathing reveals irregular, gasping breaths. You correctly identify this pattern of breathing as:

Agonal breaths are isolated or infrequent gasps that occur in the absence of normal breathing in an unconscious patient. These breaths can occur after the heart has stopped beating and are considered a sign of cardiac arrest. Agonal breaths are not normal breathing. If the patient is demonstrating agonal breaths, you need to care for the patient as if they are not breathing at all.

CPR/AED Roles:

Airway Manager:This team member maintains an open airway and seals the mask. Ventilator: This team member is responsible for ventilations. Compressor: This team member is responsible for chest compressions. AED Operator: This team member manages the AED and relieves the compressor.

You enter an adult patient's room to provide routine care. Noticing the patient slumped over in the recliner, you perform a quick visual survey. This includes

Assessing for safety Determining the need for additional resources Obtaining an initial impression of the patient

Effective family communication

Demonstrated credibility confidence in empathy, built rapport and established trust, open and honest, minimized fears and false hopes, and reassured them

Abandonment

Discontinuing care once it has begun. You must continue care until someone with equal or more advanced training takes over.

Place the patient on a firm, flat surface

Ensure that the patient is on a firm, flat surface. In a healthcare setting, use a bed with a CPR feature, or place a CPR board under the patient to provide a firm, flat surface. In other settings, move the patient to the floor or ground before beginning CPR. Stand or kneel beside the patient. If the patient is in bed, make sure you are at a good working height.

Negligence

Failure to follow a reasonable standard of care, thereby causing or contributing to injury or damage.

opioid overdose

If the patient is unresponsive and shows signs and symptoms of opioid overdose (e.g., pinpoint pupils, respiratory depression, unconsciousness or severe sleepiness), follow these steps: If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED and naloxone. Provide care for the condition found. This will be similar to the care you must provide during any respiratory or cardiac arrest emergency. The primary differences are calling for and administering naloxone. See Lesson 6 for more information.

cardiact arrest

If the patient is unresponsive, is not breathing normally (or only gasping) and does not have a pulse, they are in cardiac arrest. Start CPR within 10 seconds of recognizing cardiac arrest and use an AED when it is available. See Lesson 3 for more information. Remember: Cardiac arrest is different from myocardial infarction (or heart attack); however, a myocardial infarction can lead to cardiac arrest.

infant cpr

If you are a single provider, use the two-finger technique: • Stand to the side of the infant. • Place the two fingers of your hand closest to the infant's feet in the center of the exposed chest just below the nipple line on the sternum. • Use your index and middle fingers or your middle and fourth fingers to provide compressions. Fingers that are more similar in length tend to make compressions easier to deliver.

Respiratory Arrest- Follow these steps:

If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate. Call for an AED. Deliver 1 ventilation every 5 to 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. Continue ventilations. Check the pulse and breathing about every 2 minutes. If you find no pulse, start CPR within 10 seconds following the steps outlined in the Care section.

Cardiac Arrest-Follow these steps:

If you have not already done so, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate. Call for an AED. Start CPR within 10 seconds following the steps outlined in the Care section

Recognition of a cardiac emergency and activation of the emergency response system

Immediate recognition of cardiac arrest and activation of the EMS system provides the patient with access to necessary personnel, equipment and interventions as soon after arrest as possible.

Provide Care

Implement appropriate care based on your understanding of the patient's condition. Proper care cannot be provided without effective assessment and accurate recognition of the patient's condition. The care you provide may include: Repositioning and monitoring an unresponsive patient who is breathing normally and has a pulse. Delivering ventilations to a patient in respiratory arrest. Performing CPR on a patient in cardiac arrest. Clearing an obstructed airway. Administering naloxone to a patient experiencing an opioid overdose.

adult patient is unresponsive. You have opened their airway and are simultaneously checking for breathing and a pulse. To check for normal breathing,

Look to see whether the chest rises and falls. Feel for breathing against the side of your cheek. Listen for escaping air.

BLS (basic life support)

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

If the patient is not breathing normally and has no pulse, you must perform single-provider CPR. What should you do?

Perform 30 chest compressions at a rate of 100 to 120 per minute. Then deliver 2 ventilations, each lasting about 1 second, with a pocket mask or mouth-to-mouth.

Valerie has established that Mr. Goodman does not have a pulse and is not breathing, and she has exposed the chest. She must immediately begin CPR while Joanne retrieves and sets up the AED. Which actions should the team take to ensure that they are providing high-quality CPR?

Provide smooth compressions at a rate of at least 100 to 120 per minute and a depth of at least 2 inches, allowing the chest to fully recoil after each compression. Minimize interruptions in chest compressions to less than 10 seconds. Provide smooth, effortless ventilations that last about 1 second each and make the chest begin to rise, avoiding excessive ventilations.

What should you do if ROSC is achieved?

Stop CPR/AED use. Check for breathing and pulse. Monitor the patient until the advanced cardiac life support team takes over.

Leadership/supportive roles:

Team Leader: The team leader assigns roles, sets clear expectations, prioritizes, directs, encourages team input and interaction, monitors the delivery of CPR/AED, makes adjustments in real time and focuses on the big picture. Recorder: This team member records and communicates key data during the resuscitation effort (for example, data related to interruptions to chest compressions).

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.

carotid artery

The major artery that supplies blood to the head and brain. (neck)

recognize

The patient may be experiencing a life-threatening emergency. Use the findings collected during the rapid assessment to quickly recognize whether a life-threatening emergency is occurring and what condition the patient is experiencing. Emergencies requiring basic life support may include: Injury or illness. Respiratory arrest. Cardiac arrest. Obstructed airway. Opioid overdose.

Cerebral Perfusion Pressure (CPP)

The pressure of blood flow through the brain, is the difference between the MAP, and ICP. The minimum CCP should be 60.

Which is the correct technique for delivering ventilations to a patient in cardiac arrest?

The provider should deliver 2 ventilations that last about 1 second each and make the chest begin to rise

Providers are preparing to deliver ventilations to a patient in cardiac arrest. One provider seals the mask with both hands in the E-C hand position and simultaneously opens the airway to a past-neutral position. The other provider depresses the bag. How much volume should be administered?

The provider should supply 400-700 mL, depressing the bag halfway.

standard care

The public's expectation that personnel summoned to an emergency will provide care with a certain level of knowledge and skill.

scope of practice

The range of duties and skills you have acquired in training that you are authorized to perform by your certification to practice.

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.

consent

To obtain consent from an adult patient, follow these steps: Identify yourself to the patient or legal guardian. State your level of training. Explain what you observe. Explain what you plan to do. Ask for permission from the patient or legal guardian to provide care. If a patient is unresponsive, has an altered mental status, is mentally impaired or is unable to give consent verbally or through a gesture, then consent is implied.

After exposing the patient's chest, how should your hands be positioned?

Two hands, one on top of the other, fingers interlaced

Confidentiality

While providing care to a patient, you may learn details about the patient that are private and confidential. Do not share this information with anyone except personnel directly associated with the patient's medical care

advance directives

Written instructions that describe a patient's wishes (or the wishes of the parent or legal guardian) regarding medical treatment or healthcare decisions. Guidance for advance directives, including any required identification and verification process, is documented in state, regional or local laws, statutes and/or protocols, and must be followed. Advance directives include: Do Not Resuscitate (DNR) orders, also called Do Not Attempt Resuscitation (DNAR) orders. Physician Orders for Life-Sustaining Treatment (POLST).

depth

at least 2 inches (5 centimeters, no more than 2.6 inches, 6 centi)

AED

automated external defibrillator

If the patient is unresponsive, not breathing normally (or only gasping) and has no pulse, they are in

cardiac arrest

assess, recognize, and care

continuous approach for rapid assessment, accurate recognition, and immediate care in emergency situations. Because an acutely ill patient's condition can change rapidly (for better or for worse), you must continuously assess the patient, recognize what is happening with the patient and provide care accordingly.

Early CPR to keep oxygen-rich blood flowing and to help

delay brain damage and death

When drowning or other hypoxic event is suspected as the cause of cardiac arrest,

deliver two initial ventilations before starting CPR.

If an advanced airway is in place, one provider

delivers 1 ventilation every 6 seconds. At the same time, a second provider performs compressions at a rate of 100 to 120 per minute. In this case, the compression-to-ventilation ratio of 30:2 does not apply because compressions and ventilations are delivered continuously with no interruptions.

chest compressions

depressing the chest and allowing it to return to its normal position as part of CPR

myocardial infarction (MI)

heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery; usually caused by atherosclerosis; symptoms include pain in the chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea

As you check Mrs. Bailey's breathing, you look to see whether

her chest rises and falls, listen for escaping air and feel for breathing against the side of your cheek.

Correct adult AED pad placement

is upper right chest, below the right clavicle to the right of the sternum, and left side of the chest along the midaxillary line, a few inches below the armpit.

safety

make sure that the environment is safe for you and any individuals present during the emergency.

Ventilation

movement of air in and out of the lungs

airway obstruction

occurs when food or a foreign object blocks the airway and prevents air from entering or leaving the lungs

When delivering ventilations during CPR, if the chest does not rise after the first breath,

reopen the airway, make a seal and try a second ventilation. If the second ventilation is not successful, move directly back to compressions and check the airway for an obstruction before attempting subsequent ventilations. If an obstruction is found, remove it and attempt ventilations. Never perform a blind finger sweep

Be sure to check for anything unsafe or hazardous in the area, such as

the smell of gas, a chemical or biological spill, or any items that can threaten your or your patient's safety.

Open-ended communication

those that require more than a yes or no answer

closed loop communication

to repeat the message back to the speaker

AED pad placement

upper right, lower left

Avoid excessive

ventilation (Tidal Volume= 400mL-700mL, adults)

respiratory arrest

when breathing completely stops