BLS

You suspect that an unresponsive patient has sustained a neck injury. Which technique should you use to open the patient's airway?

Modified Jaw thrust

After determining an 8-year-old child is unresponsive, what is the best site to check for a pulse?

Carotid (neck)

After administering naloxone, Jamal should check for responsiveness and assess for breathing and a pulse. True or false?

true

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?

Team Leader

For opioid overdose, in addition to EMS, you immediately request which resources?

AED Resuscitation equipment Naloxone

Mrs. Bailey is unresponsive. You suspect she may have a head injury. Which technique should you use to open Mrs. Bailey's airway?

Modified Jaw Thrust maneuver

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?

"I'll go get the AED."

Compression rate

100-120/min

You and another provider are performing CPR on an infant who is in cardiac arrest. He does not have an advanced airway in place. You demonstrate appropriate technique for high-quality CPR by performing _____ compressions and 2 ventilations.

15

A well-organized team response when performing high-quality CPR includes ensuring that providers switch off performing compressions every _____ minutes.

2

What is the correct volume of air to deliver during BVM ventilations?

400-700 mL

Which statement about bag-valve-mask (BVM) resuscitators is true?

A two-person technique is the preferred methodology for bag-valve-mask (BVM) ventilations as it provides better seal and ventilation volume.

Compression depth for adults

At least 2 inches (5 cm) and no more than 2.4 inches (6cm)

You initiate CPR on a 15-month-old patient. Which CPR/AED guideline should you follow?

Child

The nurse assesses a responsive adult and determines she is choking. Which intervention should the nurse implement?

Cycles of 5 back blows and 5 abdominal thrusts

AED children and Infants

Infants up to 1 -Pediatric AED pads if available, okay to use adult if not -Anterior posterior pad placement (center of chest on sternum & back between scapula) Child 8 or younger under 55 lbs -Pediatric AED pads if available, okay to use adult if not - right of the sternum below right clavicle, left side of chest mid axillary line a few inches below arm pit. If they would touch each other use infant placement Child over 8 or over 55 lbs - adult pads right of the sternum below right clavicle, left side of chest mid axillary line a few inches below arm pit.

A patient is suspected of an opioid overdose. Which findings would most likely support this suspicion?

Pinpoint pupilsUnconsciousnessRespiratory depression

You are alone and caring for a 9-month-old infant with an obstructed airway who becomes unresponsive. Which action should you perform first?

Provide 30 chest compressions.

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?

Standing or kneeling at the side of the infant with your hips at a slight angle, provide chest compressions using the encircling thumbs technique and deliver ventilations with a pocket mask or face shield.

You are providing care for Mrs. Bove, who has an endotracheal tube in place. How does this affect compressions and ventilations?

The team should provide ventilations at a rate of 1 ventilation every 6 seconds without pausing compressions.

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?

Use the adult AED pads

What is the correct way to perform back blows?

Using the heel of your hand, firmly strike between the scapulae.

An adult patient with a suspected opioid overdose is in respiratory arrest. Which of the following actions are most appropriate?

-Administer naloxone, if your facility's protocol allows. -Check the pulse and breathing about every 2 minutes. -Provide 1 ventilation every 5 to 6 seconds.

High quality CPR adult having heart attack

-Provide smooth compressions at a rate of at least 100 to 120 per minute and a depth of at least 2 inches. -Allow the chest to fully recoil after each compression; compression and recoil times should be approximately equal. -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; allow the air to exit before delivering next ventilation. -Avoid excessive ventilations.

The Cardiac Chain of Survival describes six actions that, when performed in rapid succession, increase the patient's likelihood of surviving sudden cardiac arrest. Place the links of the In-Hospital Adult Cardiac Chain of Survival in the correct order.

-Surveillance and prevention -Recognition of cardiac arrest and activation of the emergency response system -Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions -Rapid defibrillation -Post-cardiac arrest care -Recovery (including additional treatment, observation, rehabilitation, and psychological support)

CPR for Infants

1. Crib at appropriate working height 2. Obtain CPR board or use cpr ready crib/bed or stable surface such as table 3. Encircling thumbs technique place thumbs just below nipple line 4. Press down about 1 1/2 inches deep at rate of at least 100 but no more than 120 per minute 5. Allow for complete chest recoil 2 finger technique- two fingers of hand closest to infants feet center of chest just below nipple line on sternum. press 1.5 inches deep at rate of at least 100 but no more than 120 bpm Ventilations 1. place infant resuscitation mask over nose and mouth 2. place fingers on bony part of chin to open airway 3. 2 ventilations about 1 sec each making chest rise CPR cycle (one provider) 30:2 Multiple providers 15:2 -encircling thumbs technique -switch positions every 2 minutes (compressor calls out loud)

You and another provider have recognized that an adult patient is in cardiac arrest. An advanced airway is not in place. Which actions demonstrate appropriate care?

1. One provider focuses on rapid assessment and starting CPR immediately; the other calls for additional resources and gets the AED. 2. You use a compression-to-ventilation ratio of 30:2

CPR for children

1. firm flat surface 2. bed at appropriate working height 3. Expose chest, place heel of hand on center of chest on lower part of sternum interlace other hand 4. Shoulders directly over hands keep arms straight and lock elbows 5. Compress to a depth of approx. 2" 6. 100-120 compressions One provider: 30 compressions to 2 ventilations Multiple providers: 15:2 & BVM for ventilations Switch positions every 2 minutes If child shows signs of life stop CPR monitor airway breathing and pulse

Compression to Ventilation ratio

Adult: 30:2 for 1 and 2 responders Child & Infant: 30:2 for 1 responder. 15:2 for 2 responders

While on break in the cafeteria, a person sitting at a nearby table begins choking. The person looks panicked and frightened. You go over to help and note that the person is not able to breathe, speak or cough. You summon additional resources and obtain consent. Which action would you do next?

Perform a series of 5 back blows and 5 abdominal thrusts until the person can cough forcefully, speak, or breathe; or they become unresponsive.

You come upon a child who has collapsed. You determine they are in cardiac arrest. You are alone and have no immediate access to a phone or other form of communication. Which action would you do first?

Perform about 2 minutes of CPR, starting with chest compressions.

Ventilations CPR

Provide smooth, effortless ventilations that last about 1 second and make the chest begin to rise; allow the air to exit before delivering next ventilation. The two-person technique for BVM ventilations is the preferred methodology when providing multiple-provider CPR for adults, children and infants.

Chest thrusts were not effective. You should now attempt a series of 5 back blows and 5 chest thrusts to clear the airway. True or false?

True

For most infants and children up to the age of 17 years, you must obtain consent from the child's parent or legal guardian if they are present regardless of the child's level of consciousness. True or false?

True

When caring for a patient in cardiac arrest due to opioid overdose, you should prioritize high-quality CPR over naloxone administration. True or false?

True

When providing CPR to a child or infant with an advanced airway in place, one provider should deliver 1 ventilation every 2 to 3 seconds, while the other provider delivers continuous chest compressions without pausing for ventilations. True or false?

True

Recognize

You've gathered information about the patient and the emergency throughout the rapid assessment. Now, you'll use the results of your assessment to quickly recognize the emergency condition and determine your immediate course of action. For example, if you find the patient is not breathing (or has ineffective ventilation) and their central pulse is present, you will implement care for respiratory arrest or respiratory failure. If you find that the patient is not breathing (or only gasping) and their central pulse is absent, you will implement care for cardiac arrest. Other conditions requiring basic life support may include: -Life-threatening injury or illness -Obstructed airway -Opioid overdose

Once the airway is open.....

you simultaneously check for breathing, a pulse and life-threatening bleeding.

call vs care first

Call First For a child or an infant whom you witnessed suddenly collapse, or for an unresponsive child or infant with a known cardiac condition: Call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. Then, provide care based on the conditions found. Care First For an unresponsive infant or child whom you did not see collapse: Provide 2 minutes of care based on the conditions found. Then, call for help to activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. If drowning is suspected always provide 2 initial ventilations first

As you approach Mrs. Bailey you note that she appears unresponsive and you do not see signs of life-threatening bleeding. Which action should you perform next?

If the patient appears unresponsive, you need to check for responsiveness. If they are unresponsive, you should activate EMS, rapid response or resuscitation team. Then open the airway to a past-neutral position and check breathing and a pulse for no more than 10 seconds; and at the same time, scan the body for life-threatening bleeding. Finally, you should implement care based on your findings.

Shout Tap Shout - infant

Shout are you okay? tap the bottom of the foot then shout again.

You are caring for a child who is in respiratory arrest with a central pulse of 55 bpm and signs of poor perfusion. What should you do?

Start CPR immediately

You and another provider are performing CPR on a 6-month old infant. The provider performing chest compressions would use which technique?

encircling thumbs technique

You and a team of trained providers are performing CPR on an adult patient. One team member has gone to get additional resources and the AED. Which of the following statements are true about AED use?

1. After the shock is delivered, the team should immediately resume CPR. They do not need to wait for the AED prompt. 2. Team members should rotate roles every 2 minutes, which is generally during the AED analysis, to prevent compressor fatigue. 3. The compressor should continue providing compressions until the AED pads are applied and the AED prompts that it is analyzing

To ensure high-quality CPR, providers should switch off giving compressions every ___ minutes or sooner if the provider giving compressions is fatigued.

2

A young adult is brought into the emergency department by his mother. He is responsive but experiencing an altered level of consciousness with risk of progressing to a life-threatening condition due to an opioid overdose. Immediate care for this patient includes:

Consider naloxone administration.

A 4-year-old child is in respiratory failure. Her central pulse rate is 65 bpm. Which of the following actions are appropriate?

-Deliver 1 ventilation every 2 to 3 seconds Correct -Check the pulse and breathing about every 2 minutes

You are evaluating the quality of CPR provided by the BLS team. Which methods would you use for this evaluation?

1. Visual observation 2. Feedback device (depth: 2.4 inches) 3. Chest compression fraction 4. Capnography

You demonstrate high-quality CPR by keeping interruptions in CPR to less than _____ seconds.

10

You are preparing to deliver ventilations to an adult patient experiencing respiratory arrest. You should give 1 ventilation every:

6 sec

Compression depth for infant

About 1½ inches (3.8 cm) or one-third the anterior-posterior diameter of the chest

After the AED has delivered a shock, the EMT should:

After a shock is delivered, immediately resume CPR for 2 minutes before pausing compressions for the AED to analyze heart rhythm. However, based on the clinical situation, you may consider performing rhythm analysis after defibrillation, recognizing that this may not be possible on all AEDs.

What is the correct area of the chest to perform chest thrusts?

Center of the chest on the lower half of the sternum

You would use pediatric AED pads for which children?

Children 55 lbs and under

An infant has an obstructed airway but is responsive. Which technique should you use when administering back blows to the infant?

Heel of the hand between the scapulae

While simultaneously checking for breathing and a pulse, you correctly adhere to which amount of time?

No more than 10 sec

What should the team do after Jenna completes 30 chest compressions?

Open Mrs. Clark's mouth, look for an object and perform a finger sweep if an object is seen. if no object deliver 2 ventilations

A 32-year-old patient (30 weeks' gestation) goes into cardiac arrest. The fundus is above the umbilicus. How can team members maximize the effectiveness of chest compressions for this patient?

Team members can maximize the effectiveness of chest compressions for this patient by positioning the patient in the supine position and providing manual left uterine displacement.

An adult patient with an endotracheal tube (ET) in place experiences cardiac arrest and requires CPR. Which of the following statements are true when performing high-quality CPR with an ET tube in place?

the provider performs continuous compressions without pausing for ventilations and the provider delivers 1 ventilation every 6 seconds

An adult patient suffers cardiac arrest in bed and requires CPR. When compressing the patient's chest, which technique promotes high-quality CPR?

- Place down a CPR board or activate the system in the bed to ensure a firm CPR surface. - Adjust the bed or use a secure step or stool so you are at an appropriate working height. - Position yourself so your shoulders are directly over your hands. - Place one hand on top of the other and interlace your fingers or hold them up so that they are not resting on the patient's chest - Keep your arms straight and lock your elbows. Compress the chest using a straight down-and-up motion.

Compression depth for children

About 2 inches (5 cm) or one-third the anterior-posterior diameter of the chest

You note he is not breathing and has no central pulse. You do not see signs of life-threatening bleeding. What emergency condition is he experiencing?

Cardiac arrest

As you continue performing 5 back blows and 5 chest thrusts, Mrs. Clark becomes unresponsive.

Carefully lower Mrs. Clark to a firm, flat surface. Then immediately begin CPR, starting with chest compressions.

To provide care to an adult patient with a life-threatening injury or illness, follow these steps:

If you have not already done so, activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/initial interventions. Position patient as appropriate for clinical condition. If patient is lying down and does not have a suspected head, neck, spinal or pelvic injury, place them in a recovery position. Perform secondary assessment as patient condition allows. Reassess patient, recognize issues and provide care as needed.

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: -Delivering ventilations to a patient in respiratory arrest or respiratory failure. -Performing CPR on a patient in cardiac arrest. -Positioning and providing care as needed for a patient with a life-threatening injury or illness. -Clearing an obstructed airway. -Administering naloxone to a patient experiencing an opioid overdose.

Infant breathing, pulse, and life threatening bleeding check

Open the airway to a neutral position. Simultaneously check for breathing and a brachial pulse for no more than 10 seconds. At the same time, scan the body for life-threatening bleeding. To check brachial pulse place two fingers on the inside of exposed upper arm (no thumb)

Adult breathing, pulse, and life threatening bleeding check

Open the airway to a past-neutral position. Simultaneously check for breathing and a carotid pulse for no more than 10 seconds. At the same time, scan the body for life-threatening bleeding.

Infant compression technique

Single-Provider CPR: Position two thumbs centered on the sternum just below the nipple line with fingers encircling chest. Alternatively, you can use the two-finger technique. If the required depth cannot be achieved with either the encircling thumbs technique or the two-finger technique in infants, you may consider using a one-hand technique. Multiple-Provider CPR: Position two thumbs centered on the sternum just below the nipple line with fingers encircling chest.

A 5-year-old child experiences cardiac arrest and requires CPR. You ensure that high-quality CPR is administered when you compress the chest to which depth?

about 2"

Where are you applying the AED pads using the anterior/lateral pad placement.

one pad slightly below the collar bone on the persons right chest and one pad on the person's left side below the arm pit.

You have been performing multiple-provider CPR and using an AED on an adult patient in cardiac arrest. The patient is now showing signs of return of spontaneous circulation (ROSC). Which action(s) would the team perform?

1. Stop CPR.2. Check for breathing and pulse.3. Monitor the patient until the advanced cardiac life support team takes over.

An adult patient becomes unresponsive while you are attempting to clear their obstructed airway. After gently lowering them to the ground and providing 30 compressions, you open the patient's mouth and look for an object. If you do not see the object, which action should you attempt next?

2 ventilations

BVM

A two-person technique for bag-valve-mask (BVM) ventilations is the preferred methodology for multiple-provider CPR because it provides a better seal and ventilation volume. To perform this technique, one provider seals the mask and maintains an open airway while the other provider delivers ventilations. When there is only one provider to deliver ventilations during multiple-provider CPR, the ventilator may consider using a pocket mask over a BVM resuscitator for a better seal and ventilation volume. However, it is recognized that factors such as limited personnel or the need to perform other time critical interventions may preclude using two-person BVM technique. Also, BVM may be preferred to pocket mask for supplemental oxygen, positive end-expiratory pressure (PEEP) and infection control. In these situations, one-person BVM is acceptable.

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?

Alert the team leader immediately and identify for them what task has been overlooked.

You open Liz's airway and simultaneously check for breathing, a pulse and life-threatening bleeding. Liz is not breathing and has a central pulse of 68 bpm. Which action is the priority?

Provide care for respiratory arrest, starting with ventilations.

AED and pacemaker

When a patient has a pacemaker or ICD, adjust pad placement as necessary to avoid placing the AED pads directly over the device. Note: A pacemaker or ICD may be placed in the right upper chest near the clavicle or in the abdomen.

You are working with a BLS team performing CPR on a 62-year-old female patient. Which actions demonstrate high-quality CPR?

1. Deliver smooth ventilations that last about 1 second each and make the chest begin to rise 2. Allow for full chest recoil after each compression. 3. Compress the chest at a rate of 100 to 120.

You and another provider are delivering ventilations with a bag-valve-mask (BVM) resuscitator to an adult patient in cardiac arrest. Which of the following statements are correct?

1. Hold the mask in place with the E-C hand position 2. Ensure that the chest begins to rise. 3. Seal the mask and open the airway by lifting the jaw into the mask. 4. Bag-valve-mask (BVM) ventilations should be performed as a two-person technique to provide a better seal and ventilation volume.

An infant has an obstructed airway and back blows have been ineffective. You attempt chest thrusts. To about which depth would you perform the chest thrusts?

1.5"

What are the causes of cardiac arrest in a pregnant patient?

B A- anesthesia C C T O L I F- fever E- eclampsia

To minimize interruptions in chest compressions, what should Valerie do during the AED analysis and shock?

Clear the patient and prepare to resume CPR immediately after the shock is delivered or if no shock is advised.

You are working as part of a high-performance BLS team. Which roles would you and the other providers most likely fill?

1. Compressor 2. AED operator 3. Team leader 4. Airway manager/ventilator

You are performing CPR on an infant. A second provider prepares to apply the AED pads. Where should they place the pads?

-On the back between the scapulae -Middle of the infant's chest on the sternum

After performing a rapid assessment on an adult patient, you determine they are unresponsive, breathing and their pulse is present. You suspect they have a head and neck injury. What actions should you take?

-Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/initial interventions. -Perform secondary assessment as patient condition allows. -Reassess patient, recognize issues and provide care as needed.

Child not breathing with central pulse (respiratory failure)

Perform a primary assessment (Airway, Breathing, Circulation, Disability, Exposure). Continue to check breathing and pulse every 2 minutes.If at any time central pulse becomes absent, start CPR immediately and use an AED when it is available. Position patient as appropriate for clinical condition. Perform secondary assessment as patient condition allows. Reassess the patient, recognize issues and provide care as needed.

You note he is not breathing and has a central pulse. You do not see signs of life-threatening bleeding. What emergency condition is Mr. Henderson experiencing?

Respiratory arrest

A 9-year-old child is in cardiac arrest. You and another provider are present. The child's parents/legal guardians are not present. You stay with the child to begin CPR. Which actions would be appropriate for the second provider to do?

- Activate EMS, rapid response or resuscitation team. - Retrieve AED and resuscitation equipment.

You are caring for a pregnant patient (30 weeks gestation) in cardiac arrest. The patient's fundus is above the umbilicus. Which of the following steps are appropriate?

- Activate maternal and neonatal resuscitation teams. - Provide continuous high-quality CPR and left uterine displacement. - Make sure AED pads do not incorporate any breast tissue. - Perform resuscitative cesarean delivery (RCD), if trained, within 5 minutes from the time of arrest.

What is the correct ventilation rate for a pediatric patient in respiratory arrest?

1 ventilation every 2 to 3 seconds

You and your colleagues are performing CPR on a 6-year-old child. What is the compression-to-ventilation ratio during multiple-provider CPR?

15:2

Reassess and 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.

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

Agonal breaths: 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.

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?

At the carotid or femoral artery

You enter Ms. Evers's room and notice she is slumped over in her chair and appears unresponsive and cyanotic. You do not see signs of life-threatening bleeding. Which is the next appropriate action?

Check for Responsiveness

Quinn does not see an object. He delivers 2 ventilations but does not see the chest rise.

Continue performing cycles of 30 compressions and 2 ventilations, checking for an object before each set of ventilations.

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?

Critical Thinking

What action do you take for respiratory arrest

Deliver ventilations. Deliver 1 ventilation every 6 seconds for an adult patient, with each ventilation lasting about 1 second and making the chest rise. Do this for 2 minutes and recheck breath and pulse

Your adult patient is in respiratory arrest due to an opioid overdose. The team is delivering 1 ventilation every 6 seconds. You administered the recommended dose of naloxone. How often may this dose be repeated?

Every 2 to 3 minutes as needed.

You are working in an OB/GYN office when your patient, Mrs. Tribble, suddenly goes into cardiac arrest. She is 28 weeks pregnant and her fundus is above the umbilicus. Which statement is true regarding CPR and AED use for a pregnant patient?

High-quality CPR with continuous left uterine displacement (LUD) should be performed on a pregnant patient with a fundus at or above umbilicus or fetal age known to be ≥ 20 weeks. LUD is a technique used in a pregnant patient to move the gravid uterus up and toward the left to relieve pressure on the inferior vena cava and maximize the return of blood to the heart and cardiac output.

After the second dose of naloxone, Liz almost immediately makes some sudden movements. Jamal should perform which action(s)? Select all that apply.

Jamal should check for responsiveness and assess for breathing and a pulse. Then, he should place Liz in the recovery position and suction her airway, if she begins to vomit. It is important to reassess Liz for any changes in condition, recognize issues and provide care as needed. Naloxone temporarily reverses the effects of the opioid; If Liz stops responding, Jamal should check breathing and pulse, provide care as appropriate and re-administer naloxone, if needed.

When Joanne returns with the AED, what is her first step

turn on AED and follow the prompts

Child breathing, pulse, and life threatening bleeding check

Open the airway to a slightly past-neutral position. Simultaneously check for breathing and a carotid pulse for no more than 10 seconds. At the same time, scan the body for life-threatening bleeding.

Adult compression technique

Position one hand on top of the other with fingers interlaced and off the chest centered on lower half of the sternum.

Child compression technique

Position one hand on top of the other with fingers interlaced and off the chest centered on lower half of the sternum. For smaller children, use the one-hand technique.

Recovery Positions

To place a supine adult patient in a recovery position: Kneel at the patient's side. Lift the patient's arm closest to you up next to their head. Place the patient's arm farthest from you next to their side. Grasp their leg closest to you, flex it at the hip and bend the knee toward their head. Place one of your hands on the patient's shoulder and your other hand on their hip farthest from you. Using a smooth motion, roll the patient toward you by pulling their shoulder and hip with your hands. Make sure the patient's head remains in contact with their extended arm. Stop all movement when the patient is on their side. Place their knee on top of the other knee so that both knees are in a bent position. Place the patient's free hand under their chin to help support their head and airway.

When drowning is suspected as the cause of cardiac arrest in a child or infant, deliver 2 initial ventilations before starting CPR. You may also consider delivering 2 initial ventilations before starting CPR on a child or infant with a primary respiratory etiology. True or False?

True

opioid overdose triad:

coma, respiratory depression, pinpoint pupils Pinpoint pupils Respiratory depression Unconsciousness or severe sleepiness

You are about to start your morning rounds, when you hear a loud crash in Mrs. Bailey's room. When you enter her doorway, you see her lying on the floor with her walker tipped over next to her. You must first perform a visual survey. What actions should you take?

-Determine whether any additional help is needed -Observe for any signs of illness or injury Before you help an ill or injured patient, assess for any immediate dangers to make sure that the environment is safe for you and any individuals present during the event. Next, gather an initial impression of the patient's status, which includes looking for life-threatening bleeding. Your ability to quickly formulate an impression of the patient before performing any hands-on techniques helps you to assess whether the emergency is life-threatening. While the initial impression does not identify a specific emergency, it does provide important clues to what might be happening, and it may help determine whether a patient survives. Finally, quickly identify what additional resources you may need in the situation, such as a rapid response or resuscitation team or an advanced life support unit available to respond, or any additional equipment such as an AED.

You are caring for for a 6-month-old infant who is unresponsive, breathing and has a pulse. What should you do?

-Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/initial interventions. -Perform secondary assessment as patient condition allows. -Reassess patient, recognize issues and provide care as needed.

You are providing care for an adult patient in respiratory arrest. Which actions demonstrate appropriate care?

1. Deliver 1 ventilation every 6 seconds. 2. Continue to check breathing and pulse every 2 minutes. If pulse becomes absent, start CPR.

Pediatric Out-of-Hospital Cardiac Chain of Survival

1. Prevention Community prevention is key. As the most common causes of cardiac arrest in children and infants include respiratory emergencies, shock and preventable injury (e.g., trauma, drowning, choking or electrocution), efforts to reduce these events and manage them are key. In addition, establishing systems to respond, such as CPR education, public awareness of what to do in an emergency and telecommunicator CPR is important. 2. Recognition of Cardiac Emergency and Activation of Emergency Response System Immediate recognition of cardiac arrest and activation of EMS quickly gives the patient access to necessary personnel, equipment and interventions as soon as possible after arrest. 3. Early High-Quality CPR High-quality CPR should be initiated immediately after recognizing cardiac arrest. 4. Pediatric Advanced Life Support Effective, pediatric advanced life support gives the patient access to care delivered by specially trained professionals. 5. Integrated Post-Cardiac Arrest Care After return of spontaneous circulation (ROSC), survival outcomes are improved when providers work to stabilize the patient, minimize complications, and diagnose and treat the underlying cause. 6. Recovery A sixth link has been added to highlight the importance of recovery including continued follow-up during the recovery process in the form of rehabilitation, therapy and support from family and healthcare providers.

What are the steps of the In-Hospital Pediatric Cardiac Chain of Survival?

1. Surveillance and Prevention This includes recognizing an emergency early and an efficient and rapid response. In children and infants, cardiac arrest most often arises from respiratory failure or shock. Although primary cardiac causes are rare in children, they more commonly contribute to in-hospital cardiac arrest. 2. Recognition of Cardiac Emergency and Activation of Emergency Response System Immediate recognition of cardiac arrest and activation of pediatric rapid response or pediatric resuscitation team quickly gives the patient access to necessary personnel, equipment and interventions as soon as possible after arrest. 3. Early High-Quality CPR High-quality CPR should be initiated immediately after recognizing cardiac arrest. 4. Pediatric Advanced Life Support Effective, pediatric advanced life support gives the patient access to emergency medical care delivered by specially trained professionals. 5. Integrated Post-Cardiac Arrest Care After return of spontaneous circulation (ROSC), survival outcomes are improved when providers work to stabilize the patient, minimize complications, and diagnose and treat the underlying cause. 6. Recovery A sixth link has been added to highlight the importance of recovery including continued follow-up during the recovery process in the form of rehabilitation, therapy and support from family and healthcare providers.

AED steps

1. turn on the AED and follow the prompts. 2. attach the AED pads to the patient's bare chest while other person continues CPR. Both providers should clear the patient during rhythm analysis and shock delivery. After delivering the shock, they should immediately resume CPR.

Identify the situations in which it is safe to use an AED.

Environmental Considerations -Do not use an AED near flammable or combustible materials (e.g. gasoline). -It is safe to use an AED when the person is lying on a metal surface, but don't allow the AED pads to contact the metal surface. -Do not use an AED if the person is in or near water. Avoid getting the AED wet.It is safe to use AEDs in all weather conditions. If possible, provide a dry environment before using AED. Remove the person's wet clothing and wipe the chest dry before placing the AED pads. Person-Specific Considerations -It is safe to use an AED on a pregnant woman.If the person has a pacemaker or ICD, adjust pad placement as necessary to avoid placing the AED pads directly over the device. Healthcare professionals should learn from their healthcare education how to determine if a person uses a pacemaker or ICD. -Remove any transdermal medication patches (e.g. nitroglycerin) that you see before using an AED. Wear gloves when removing these patches -If the person has thick chest hair that interferes with pad-to-skin contact, quickly shave the areas where the pads will be placed.

A child with an obstructed airway becomes unresponsive. Which action would be most appropriate to do first?

Gently lower the child to the ground and immediately begin CPR, starting with chest compressions.

Child pulse >60 BPM not breathing with central pulse (respiratory failure)

If their central pulse is > 60 bpm, deliver 1 ventilation every 2 to 3 seconds. If an advanced airway is in place, the rate remains the same. If at any time central pulse decreases to ≤ 60 bpm with poor perfusion despite adequate ventilations and oxygen, start CPR.

Child pulse ≤60 BPM not breathing with central pulse (respiratory failure)

If their central pulse is ≤ 60 bpm with signs of poor perfusion, start CPR. If at any time central pulse and perfusion improve, stop CPR and deliver 1 ventilation every 2 to 3 seconds until the patient is ventilating sufficiently.

A child or infant is in respiratory arrest if they are not breathing and have a central pulse. They are in respiratory failure if they have ineffective ventilation and a central pulse. Like an adult, a pediatric patient in respiratory failure may have some ventilation; however, this ventilation is insufficient to sustain needed gas exchange, oxygen and carbon dioxide. To provide care to a child or infant in respiratory arrest or respiratory failure, follow these steps.

If you have not already done so, activate EMS, the rapid response team or the resuscitation team, as appropriate, and call for an AED. Deliver ventilations; each ventilation should last about 1 second and make the chest begin to rise.

While the AED analyzes the victim's heart rhythm:

When the AED is analyzing the rhythm, pause compressions and ventilations, even when using devices with artifact-filtering algorithms.

A 28-year-old patient (27 weeks' gestation) was admitted to the intensive care unit for treatment of pneumonia-related sepsis. The patient goes into cardiac arrest. When should a trained provider perform resuscitative cesarean delivery (RCD)?

Within 5 minutes from the time of arrest

Chest Compression Fraction (CCF)

a CCF of at least 60% is needed to promote optimal outcomes, and the goal should be 80%.

You initiate CPR on an 11-year-old patient who shows signs of puberty, including breast development. Which CPR/AED guideline should you follow?

adult

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.