BLS Flashcards
What is Respiratory Distress? Respiratory Failure? Respiratory Arrest?
Respiratory distress is a clinical state characterized by abnormal (increased or decreased) respiratory rate or effort. It encompasses a spectrum of signs from tachypnea with retractions to agonal gasps. Respiratory distress includes increased work of breathing, inadequate respiratory effort (e.g. hypoventilation or bradypnea), and irregular breathing.) These patients STILL HAVE A CENTRAL PULSE. Respiratory distress leads to respiratory failure.
Respiratory failure is a clinical state of inadequate oxygenation, ventilation, or both. That is, there is inadequate blood oxygenation, ventilation, or both to meet the metabolic demands of body tissues. The job of the lungs is to ventilate and oxygenate. When it doesn’t do any of that, it is failing. An adult patient is in respiratory arrest STILL HAS A CENTRAL PULSE.
Respiratory arrest simply means the absence of breathing. The patient isn’t breathing, but STILL HAS A CENTRAL PULSE.
To provide care to an adult patient 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 1 ventilation every 6 seconds; each ventilation should last about 1 second and make the chest begin to rise. If an advanced airway is in place, the rate remains the same.
Perform primary assessment (Airway, Breathing, Circulation, Disability, Exposure) and emergent/ initial interventions, if not already done.
Continue to check breathing and pulse every 2 minutes; if pulse becomes absent, start CPR immediately and use an AED when it’s available.
Position patient as appropriate for clinical condition.
Perform secondary assessment as patient condition allows.
Reassess patient, recognize issues and provide care as needed.
What is the correct rate of ventilation delivery for an adult in respiratory arrest or respiratory failure?
1 ventilation every 6 seconds
After 2 minutes of delivering ventilations to an adult patient in respiratory arrest, you reassess them for breathing and a pulse. What should you do if the patient’s pulse becomes absent?
Start CPR immediately and use an AED when it is available
An adult patient in respiratory failure may have some ventilation; however, this ventilation is insufficient to sustain needed gas exchange, oxygen and carbon dioxide. True or false?
TRUE
The majority of total cardiac arrests in the United States occur inside or outside the hospital?
Outside
There are more than 356,000 out-of-hospital cardiac arrests (OHCA) annually in the U.S., with a survival rate of 10%.
When a cardiac arrest occurs outside of the hospital, the patient relies on the members of the community, emergency medical services and healthcare providers to implement the Out-of-Hospital Cardiac Chain of Survival.
What two steps increase likelihood of survival for a patient in cardiac arrest?
1) High-quality CPR, starting with compressions, should be initiated immediately once cardiac arrest is recognized. If provided in the first few minutes of cardiac arrest, high-quality CPR can double or triple a patient’s chance of survival.
2) Early Defibrillation
Defibrillation may restore an effective heart rhythm, increasing the patient’s chance for survival.
For every 1 minute delay in CPR and defibrillation, the patient’s chance of survival is reduced by 7% to 10%.
What rate should you provide compressions for a patient in cardiac arrest?
100-120 compressions per minute
What four steps should you take to position a patient in cardiac arrest for CPR?
1) Patient should be completely supine (eg. decrease angle of bed, roll patient over, etc.)
2) Lower bed so that you can lean over patient, your waist should be well above the bed. The lower the better.
3) Place CPR board under patient if possible
4) Remove patient’s shirt including bras
How should you position yourself for CPR?
1) Palm on center of LOWER HALF of sternum, hand over hand, interlock fingers to lift bottom fingers so that they do not contact chest
2) Keep arms extended by locking your elbows
3) Ensure shoulders are directly over hands (may need to lower bed more)
Approximately what depth should you perform compressions?
> 2.0 inches, but no more than 2.5 inches
When performing compressions what is the most important thing to keep in mind?
Allow chest to fully recoil before each compression. Performing a compression before chest fully recoils will decrease venous return (VR) and subsequently cardiac output (CO). Compression and recoil times should be approximately equal.
It is important that chest compressions are not interrupted more than ________ seconds.
10 seconds
What are methods of providing ventilation to a patient in respiratory arrest or cardiac arrest?
- Mouth-to-mouth
- Mouth-to-nose
- Pocket mask
- Bag-valve-mask (BVM) or “bag mask”
Additionally, adjuncts to ventilations include supplemental oxygen, basic airways (eg. oropharyngeal airway, nasopharyngeal airway, laryngeal mask airway)
and advanced airways (e.g. endotracheal intubation, cricothyroidotomy, tracheostomy). You can insert an airway as long as it does not delay the administration of chest compressions, ventilations or defibrillation.
Why is overventilation a concern in patients in respiratory arrest or cardiac arrest?
When giving ventilations, the intrathoracic pressure increases, causing atrial and ventricular filling to decrease and reducing both cardiac output and the coronary perfusion pressure (CPP) (i.e., the difference between the pressure in the aorta and the pressure in the right atrium during diastole).
Overventilation further increases the intrathoracic pressure, which in turn further decreases atrial and ventricular filling and further reduces cardiac output and coronary perfusion pressures (CPP). In addition, overventilation without an advanced airway leads to gastric distension, which further raises intrathoracic pressure and can increase risks of aspiration.
CPP is a reflection of myocardial blood flow; maintaining adequate CPPs has been shown to increase the likelihood of return of spontaneous circulation (ROSC) and survival.
When is a BVM resuscitator not recommended?
During single-provider CPR, use of a BVM resuscitator is not recommended because it will increase the time between sets of chest compressions resulting in poor outcomes.
The two-person technique for operating the BVM is the preferred methodology for BVM ventilations during multiple-provider CPR as it provides a better seal and ventilation volume. If only one provider is available to deliver ventilations during multiple-provider CPR, the ventilator should consider using a pocket mask over a BVM resuscitator for a better seal and ventilation volume.
When using a BVM resuscitator how far should you compress the bag?
1/2 way
(to avoid overventilation)
To perform this technique, one provider seals the mask and maintains an open airway while the other provider delivers ventilations.
How can you ensure a patient is receiving each breath provided?
Visualize chest rise
Allow the air to exit before delivering next ventilation.
How do you perform proper mouth-to-mouth ventilation?
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.
When should you perform mouth-to-nose ventilation instead of mouth-to-mouth?
If the mouth is seriously injured, can’t be opened, or you are unable to make a complete seal over the patient’s mouth.
If the chest does not rise after the first breath what should you do?
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, assume the patient has an obstruction. Chest compressions are used to clear an obstruction, so 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.
How can you increase oxygen concentration when using a BVM resuscitator?
Ventilations using a BVM resuscitator deliver approximately 20% to 21% oxygen concentration to the patient.
Attaching high-concentration supplemental oxygen to a BVM resuscitator can increase the oxygen concentration to approximately 90% to 100% and is recommended as soon as it is available.
How is single-provider CPR performed?
During single-provider CPR, one provider performs chest compressions and delivers ventilations.
How is multiple-provider CPR performed?
During multiple-provider CPR, one provider performs chest compressions while one or two other providers manage the airway and deliver ventilations.
