CPR Online Portion Study Guide 2021 January
A bag-mask device is used to provide____to a victim who is not breathing or not breathing normally.
positive-pressure ventilation
You check the infant's pulse every 2 minutes and detect that the heart rate is less than 60 /min with signs of poor perfusion. While your colleague begins CPR, what action do you need to take?
power on the AED, follow the prompts, and use the child pads
The infant is not breathing normally but has a pulse. What do you need to do?
provide rescue breaths, with 1 breath every 2 or 3 seconds
Which team role makes treatment decisions and assigns roles?
team leader
how does CPR differ in an unresponsive adult chocking vicitm?
the airway is checked for the obstructing object
When performing chest compressions for an infant in a 2-rescuer situation, you should put 2 _____ in the center of the chest, on the lower half of the breastbone.
thumbs
Which team role keeps track of interruptions in compressions?
timer/recorder
Why is an AED needed?
to analyze the heart rhythm and provide a shock
when performing abdominal thrusts in adults and children, in which direction should your thrusts be directed
upward
After turning on the AED, you follow the prompts. You know to use child pads for infants and for children younger than 8 years, but the pediatric pads are unaviable. What should you do next?
use the adult pads
Two life-threatening arrhythmias that can cause cardiac arrest are pulseless ventricular tachycardia and __________
ventricular fibrillation
what are the special considerations when using an AED
water excessive chest hair implanted defibrillators/pacemakers transdermal medicine patches
What is the indication for mouth-to mouth- rescue breaths
when a barrier device is not aviable
AED pad placement: infants and children less than eight years of age
- Pad choice ---- if your aed include smaller size pads that are designed for children under 8 years of age use them ---- if not use the adult pads while making sure they do not touch or overlap ---- do not use the children's pads for an adult. The shock does is too small for an adult - replacement ---- some AED pads recommended placing one pad on the chest and one pad on the back of the infant and child ----follow the pictures on the pad packages for proper placement
AED OVERVIEW-Automated external defibrillator
-An AED is 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.
What are the recommended compression-to ventilation ratios for infants and children?
-1 rescuer: 30:2 -2 rescuers: 15:2
Which of the following are resuscitation triangle roles in a high-performance team?
-AED/Monitor/Defibrillator -Compressor -Airway
What does a chest compression feedback device monitor?
-Compression rate -Chest recoil -Compression depth
Pediatric Chain of Survival
-Early Recognition and Prevention -Activation of Emergency Response -High-Quality CPR -Advanced Resuscitation -Post-Cardiac Arrest Care -Recovery
What are the components of a pulse check in an unresponsive victim?
-Feel the pulse in the groove to the side of the trachea -Assess for a pulse for at least 5 but no more than 10 seconds -Use 2 or 3 fingers to locate the pulse
Scene Safety, responsiveness and assessment
-Make sure the scene is safe for you and the victim -Tap the victim's shoulder. Shout "Are you OK?" -If the victim is not responsive, activate the emergency response system via mobile devices. Get the AED or send someone to do so. -Assess breathing and breathing and a pulse --To minimize delay in starting CPR, you may assess breathing and pulse at the same time. This 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 is only gasping. Be prepared to begin high-quality CPR. Gasping is not normal breathing and is a sign of cardiac arrest. ---To perform a pulse check on an adult, feel for the carotid pulse: 1. Locate the trachea using 2 or 3 fingers 2. Slide fingers into the groove between the trachea and muscles at the side of the neck. 3. Feel for a pulse for at least 5 but no more than 10 seconds. If no pulse felt begin CPR, starting with chest compressions.
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 ot 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.
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.
What are the correct actions to take for scene safety and assessment?
-Verify scene safety -Look for no breathing and only gasping and check pulse -Check for responsiveness -Activate the emergency response system and get an AED -Begin CPR if no breathing or no gasping and no pulse felt
What are examples of effective team dynamics?
-clear roles and responsibilities -knowledge sharing -debriefing -constructive intervetion
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.
What is recommened to minimize interruption in compressions when using an 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 prompt to clear -when 2 or more rescuers are present, one rescuer should continue chest compressions while the other prepares the AED
While performing hig-quality CPR, when do pauses in compressions typically occur?
-intubation -compressor switches -defibrillation -rhythm analysis -pulse checks
Mouth-to-Mouth Breaths: adults, children, and infants
-mouth-to-mouth breathing is 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. 1. Hold the victim's airway open with a head tilt-chin lift. pinch the nose close with your thumb and index finger. 2. Take a regular breath and sugar lips around the victim's mouth creating an airtight seal. give one breath and blow for one second. Watch for the chest to rise as you give each breath. 3. Give a second breath (blowing for about 1 seconds) while watching for chest rise.
Your friend suddenly collapses at home and you determine she needs CPR. You being CPR starting with chest compressions and are about to deliver breaths by using mouth to mouth breaths. You open the airway with the head tilt-Chin lift. what is the sequence of your next position?
-pinch the nose and seal your lips around the victim's mouth -give one breath and blow for one second -watch for chest rise while giving the breath -give a second breath (blowing from about one second watching for chest rise)
what are the special considerations for defibrillation in children less than 8 years of age?
-use smaller sized pas if available -a manual defibrillator is preferred for infants less than 1 year of age -if child pads are not included, use adult pads
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 and a pulse is felt ----Monitor until emergency responders arrive. -No normal breathing and a pulse is felt ----Give rescue breaths every 2 or 3 seconds (20 to 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 a pulse every two minutes ---If no pulse, start CPR -Once the AED Arrives, check the rhythm: -Shockable rhythm ----Give 1 shock. Resume CPR immediately for two minutes (until prompted by the AED to allow a rhythm check). -Nonshockable rhythm ----Resume CPR immediately for two minutes (until prompted by the AED to allow a rhythm check). -Continue CPR until ALS providers take over the child starts to move.
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 resuer remains with the child ---- The 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 and a pulse is felt ----Monitor until emergency responders arrive. -No normal breathing and a pulse is felt ----Give rescue breaths every 2 or 3 seconds (20 to 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 a pulse every two minutes ---If no pulse, start CPR -No breathing or only gasping, and no pulse is felt ----Begin CPR ----The first rescuer begins CPR with a 30:2 ratio ----When the second rescuer returns, use a 15:2 ratio -Use the AED as soon as it is avaible. --Once the AED Arrives, check the rhythm: -Shockable rhythm ----Give 1 shock and immediately resume CPR. -Nonshockable rhythm ----Immediately resume CPR for two minutes. -Continue CPR with a ratio of 15:2 until ALS providers take over or the vicitm starts to move.
After checking for breathing and a pulse, you verify that the child is not breathing normally but has a pulse. His airway is not obstructed. How do you deliver rescue breaths?
1 breath every 2 or 3 seconds, or about 20 to 30 breathers per minute
After checking for breathing and a pulse, you find that the patient is not breathing normally but had a pulse and needs rescue breathing. What is the correct ventilation rate?
1 breath every 6 seconds, or about 10 breaths per minute
How are breaths delivered using a bag-mask device?
1 breath over 1 second, while watching for chest rise
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
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.
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 techinque to hold the maks in place while you life the jaw to hold the airway open 3. Squeeze the bad to give breaths (1 second each) while watching for chest rise
How to Use a Pocket Mask
1. Position yourself at the victim's side. Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct positioning. 2.Seal the mask against the face. Using your hand that is closeaedr to the top of the victim's head, place your index finger and thumb along the top edges of the mask. Place the thumb of your other hand along the bottom edge of the masks. 3. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. 4.While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face. 5. Deliver each breath over 1 second. Enough to make the victim's chest rise.
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.
Mouth-to-mouth-and -nose breathing: infants
1. open the infant's airway with a head tilt-chin lift. 2. place your mouth over the infant's mouth and nose to create an airtight seal. 3. give one breath, blowing for about 1 second. Wacth for the chest to rise as you give the breath.
what is the correct sequence of actions for performing mouth to mouth and nose breaths for an infant
1. perform a head tilt-chin lift 2. place your mouth over the infant's mouth and nose to create an airtight seal 3. give on breath, blowing for one second, watching for chest rise
what is the correct order of steps of the pediatric out of hospital chain of survival
1. prevention 2. activation of emergency response system 3. high-quality CPR 4. advanced resuscitation 5. post-cardiac arrest care 6. recovery
During CPR on a child, interruptions to chest compressions should be limited to no more than ______ seconds
10
What is the correct chest compression rate for adults?
100 to 120/min
What is the target rate for chest compressions for children?
100 to 120/min
when providing rescue breaths to an adult vicitm, you should give _____ breaths every ____ seconds
1; 6
with an advancesd airway in place, rescue breaths should be given at a rate of ___ breaths every __ seconds for adults
1;6
when providing rescue breaths to a child or infant victim you should give 1 breath every ___ to ___ seconds
2;3
You should deliver ___ back slaps and ___ chest thrusts to a chocking infant who is responsive
5;5
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
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
AED Pad Placement: adults and Children 8 years and older
Anterolateral placement -Place one 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 one pad on the left side of the chest, halfway between 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
When performing high-quality CPR on a child, what is the correct depth of compressions?
Approximately 2 inches (5 cm)
Where should AED pads be placed in the anterolateral placement for adults and children 8 years or older?
Below the right collarbone and Side of the left nipple
You tap and shout to check for responsiveness, but the patient does not respond. What is your next step after calling for help?
Check for breathing and a pulse
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.
As you are providing CPR, your colleague arrives, turns on the AED, and follows the prompts. The AED analyzes the rhythm and does not advise a shcok. After you immediately resume CPR, how do you continute treating the patient?
Continue CPR until prompted by the AED to allow a rhythm check, the code team arrives, or the patient starts to move
When should the rescuer operating the AED clear the victim?
During analysis and before shock delivery
Chest Compression Feedback Device
Feedback devices can monitor CPR and provide real-time feedback for aspects such as -Rate -Depth -Recoil
The infant is unresponsive after you tape her foot and shout, "Are you OK?" She could be in cardiac arrest. What is your next step?
For 5 to 10 seconds, look for no breathing or only gasping while simultaneously checking the brachial pulse
You check the child's pulse after 2 minutes of providing rescue breaths and cannot feel a pulse. You immediately begin CPR. After performing CPR for 2 more minutes. the child still does not have a pulse and you are still alone. What is your next step?
Get and use an AED
How do you open the airway for breaths if a single rescuer is present?
Head tilt-chin lift
After 4 minutes of rescue breathing, no pulse is present during a pulse check. What immediate actions should be taken?
Immediately begin CPR and turn on the AED
Where should AED pads be placed in the anteroposterior placement for adults and children 8 years and older?
Left side of the back and Left side of the chest
During CPR on a child, you should place 1 or 2 hands over the ______ of the _____
Lower half; breastbone
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
Critical Components of Chest Compressions: Infants
RATE: 100 to 120/min DEPTH: Approximately 1.5 inches (4cm) HAND PLACEMENT: -1 rescuer places 2 fingers in the center of the chest, just below the nipple line -2 rescuers use the 2 thumb-encircling hands technique in the center of the chest, just below the nipple line. -1 rescuer may also use the 2 thumb-encircling hands technique or the heel of 1 hand. CHEST RECOIL: allow complete recoil; do not lean on the chest MINIMIZING INTERRUPTIONS: limit interruptions to less than 10 seconds
Critical Components of Chest Compressions: Children
RATE: 100 to 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 interruptionsto less than 10 seconds
Compression-to ventilation ratio: Infants and children
Ratio for 1 rescuer is 30;2 Ratio for 2 or more rescuers is 15;2
After an AED delivers a shock, what should the rescuers do next?
Resume CPR, starting with chest compressions
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: -Unitl the AED delivers a prompt to clear the victim for analysis. If no shock is advised: -Immediately resume CPR, starting with chest compressions.
Witnessed vs unwitnessed collapse: Children and Infants
Witnessed Collapse: -If you are along 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: -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 two minutes, if you are still along, activate the emergency response system and get an AED if not already done. -Use the AED as soon as it is available.
provides ventilation
airway
What is a correct approach for AED pad placement for infants and children learn than 8 years of age?
as indicated on the pad packages
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
when using a pocket mask, where should the rescuer be positioned?
at the side of the victim
you respond to a collapsed pregnant female as the only rescuer. you follow the BLS sequence that she is unresponsive, is not breathing, and has no pulse. she is visibly pregnant. you activate the emergency response system. What is your next action?
begin chest compressions
when a chocking 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 chocking victim is too large for you to wrap your arms around the waist, you should perform ____thrusts
chest
assigning your team members to individual roles and outlining what each member needs to do during the resuscitation attempt is an example of what element of high-performance team dynamics?
clear roles and responsibilities
You and your team have initiated compressions and ventilation. The AED was attached, and "no shock" was advised. Your team has continued CPR for 1 minute. You tell your team in a respectful, clear, and calm voice " Leslie, during the next analysis by the AED, I want you and Justin to switch positions and I want you to perform compressions for the next cycle" Lesli replies, " Got it. Next time the AED analyzes, I will switch with Justin and assume the role of the compressor." This is an example of which element of high-performance team dynamics?
closed-loop communication
The AED detects a shockable rhythm and advises a shock. After delivering 1 shock, you and your partner immediately resume CPR by using what ratio and which compressions technique?
complete cycles of 15 compressions and 2 breaths, and use the 2 thumb-encircling hands technique
assess the patient and provides compressions
compressor
as team leader you notice that your compressor is pushing too fast. It is important to correct actions that are incorrect, but it is also important to be tactful when delivering this correction to a colleague. This is an example of what element of team dynamics?
constructive intervention
You are still performing CPR as a single rescuer. The AED detects a shockable rhythm and advises a shock. After delivering 1 shock, you immediately resume CPR with what ratio of compressions to breaths?
cycles of 30 compressions and 2 breaths
What action can you take as a team during and after a resuscitation attempt that helps individual team members perform better and brings awareness to system strengths and deficiencies?
debriefing
To avoid fatigue, when should team roles alternate proving compressions?
every 5 cycles or 2 minutes
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
The child is unresponsive after you tape his shoulders and shout, "Are you OK?" She could be in cardiac arrest. What is your next step?
for 5 to 10 seconds, look for no breathing or only gasping while simultaneously checking the carotid pulse
A rescuer arrives at the side of an adult victim and suspects an opioid-associated life-threatening emergency. The victim is unresponsive and not breathing normally but has a pulse. what is the next action the rescuer should take?
give 1 rescue breath every 6 seconds
What is the sing ofo sever airway obstruction
inability to speak
what are common administration routes for naloxone?
intramuscular intravenous intranasal
you witnessed the collapse of a child. you are the only rescuer and do not have a mobile phone. after confirming no breathing and no pulse, what is your Next step?
leave the victim tp activate the emergency response system and get the AED
how cna you achieve a high chest compression fraction/
minimize pause in chest compression
operates the AED and alternates with the compressor after every 5 cycles or 2 minutes to avoid/farigue
monitor/defribillator
how is CPR performed differently when an advanced airway is in place
no pauses for ventilations