BLS Flashcards
What are the different oxygen masks?
Non-rebreather mask - 15L - delivers 85% inspired oxygen and one way valve means does not exhale into bag so only inhaling oxygen
Simple face mask - 10L delivers 40%
Venturi - draws in room air, useful for COPD
Nasal cannulae - 1-4L
Neb - salbutamol or ipratropium
When is ventilation required?
Breathing inadequately e.g. slow RR or irregular pattern of respiration
Shallow breathing
Not breathing at all
When does gastric distension happen?
High inflation - over inflating
Ventilating too fast
Partially obstructed airway - air going into stomach instead of lungs - can lead to aspiration
How do we use BVM?
Neck slightly flexed and head extended to sniffing position
Jaw thrust performed - decreases leaks as more of a seal
C shape with thumb/index finger on top of mask, gently squeeze bag enough to see chest rise (1 second)
Why do we always use a mask even if not connected to oxygen?
To prevent coming into contact with pt’s blood and secretions from mouth
What increases survival in cardiac arrests?
Early recognition and call for help
Early CPR
Early defib
Good ROSC care
Early transportation if cannot treat ONS
What are the four rhythms?
VF - rapid and disorganised
VT - wide-complex tachycardia, regular rhythm, may have pulse
Asystole - no electrical activity from heart
PEA - organised electrical activity without a pulse
What circumstances do you not shock pt?
Non-shockable rhythm
In contact with pt and wet surface/metal surfaces that conduct currents
Near explosives e.g. oxygen not removed
Pt wearing jewellery
What do we do for pregnant pt’s more than 20 weeks in CA?
Manually displace uterus to left or place pt on extrication board and tilt 15-30 degrees to left
Venous return restricted if not - cardiac output and uterine perfusion reduced
What do we do for pregnant pt’s more than 28 weeks in CA?
Have hands 2-3cm higher on sternum when doing CPR
Use anterior-posterior pad placement
What do we need to consider for pregnant pt’s in CA?
Early intubation as more likely to regurgitate stomach contents
Rapid transportation if no response to CPR within 5 minutes as baby could be saved with caesarean
Where do we transport pregnant pt’s in CA?
To closest ED and request obstetrician in ED in advance
What do we do if pt’s temp if less than 30 in CA?
Attempt to slowly warm pt - not dead till warm and dead
Can only give maximum of 3 shocks in VF or pulseless VT
No IV drugs can be administered
What do we do if pt’s temp if between 30-35 in CA?
Can use defib as usual
IV drug administration time doubles
What do we do if pt’s temp if over 35 in CA?
Resus is normal
What is the difference between penetrating trauma CA treatment and blunt trauma CA treatment?
Penetrating trauma to chest and epigastrium must be rapidly conveyed to ED - scoop and run
Blunt trauma resus can remain on scene
What do we do when we get ROSC?
Provide ventilation breaths at rate of 10-12 breaths/mins on high flow
Maintain capnography at 4.6-6
Check BM over 4
Keep core temp no higher than 36 - passively cool if higher - witnessed CA usually don’t need temp
Record 12 lead
Frequent BP checks - above 100mmHg, fluids 250ml required?
Transport - moving by 10 minutes - consider hospital with cardiac centre if believe caused by cardiac aetiology - stem showing on 12 lead)
Stop convulsions if occurring for more than 5 mins e.g. diazepam
Consider analgesia for management of pain
Head up 30 degrees when in back of ambulance as reduces cerebral pressure
ATMIST handover
What are signs of ROSC?
Rhythm compatible with cardiac output + central pulse
Breathing?
Purposeful movement?
Significant increase in end tidal?
What is considered good CPR?
Compress chest to depth of 5cm - no more than 6cm
Allow to recoil
Rate of 100-120 compressions/min
Swap over every 2 mins
In what cases do we not start CPR (unlikely to be successful?
At least 15 mins have gone since CA and no CPR was provided and no excluding factors - hypothermia, poisoning, pregnancy
ECG asystole for more than 30 seconds
Pt been submerged more than 90 mins
Injuries/condition unequivocally associated with death e.g. massive cranial destruction, split in two at waist, full thickness burns on 95% of total body surface area, hypostasis - pooling of blood in part of body, rigor mortis (stiffening of limbs), decomposition (tissue damage suggesting dead for days, weeks etc)
What do we do if an advance care plan states pt does not wish to be resuscitated?
Not legally binding so can use this when considering pt’s best interests - knowing their wishes and preferences
What do we do if the pt has an advance decision to refuse treatment at a CA?
Check if it says ‘even if life is at risk’, if it’s signed, dated, and witnessed.
If so then legally binding so must follow.
What do we do if the pt has a questionable DNAR at CA?
Can commence CPR is can justify actions
Not legally binding but do take into account pt’s best interests - DNAR usually in place as CPR unlikely to be successful or quality of life following CPR will not be in pt’s bests interests
Senior clinicians decision
What do we do if pt is terminally ill and does not have DNAR?
Consider if CPR would be successful and if in final stages of terminal illness - senior clinicians can justify stopping
What do we do if pt’s ROLED and death is suspicious?
Preserve scene as much as possible
Leave pt where they are and do not leave clinical equipment behind
Ask EOC to contact police
If outside and raining, cover body with foil blanket and not usual blanket
What do we do when a child unexpectedly dies (under 18) (SUDICA)?
Resuscitate all children unless signs unequivocally associated with death
Convey child and parent to ED - unless police want forensic evidence first
Support family - majority of cases due to natural causes
Use child’s name whenever you can when referring to them
Avoid placing infant in body bag
What are reversible causes in trauma CA?
Hypovolaemia - control external haemorrhage, splint pelvic fractures, IV/IO fluid, early TXA
Hypoxia - airway management, 100% oxygen
Tension pneumothorax - decompress check
Tamponade - consider enhanced skills/critical care intervention
What are the 4Hs and 4Ts?
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia + hypoglycaemia
Hypothermia
Toxins - check pupils/marks on skin indicating drug usage
Tension Pneumothorax
Thrombosis - coronary or pulmonary
Cardiac Tamponade
What do we do for pt who drowned in CA?
Start CPR if submerged for less than 90 mins for children and if in icy water - poor outcome past 25 mins
Find out if anymore pts
Consider c-spine injury in shallow water
Use capnography to confirm CA as pulse as sole indicator is unreliable
Early intubation
Hypothermic as well?
Dangerous rescue?
How do we know it’s CPR induced consciousness and not ROSC?
Absence of palpable pulses
Rapid deterioration in consciousness when chest compressions are stopped
Cardiac rhythm incompatible with life
What do we do with an agonal rhythm?
Can treat it as systole - can be terminated if persisted continuously for more than 30 mins.
What to do if ROLE pt and death expected?
Contact GP to certify death and issue certificate for medical cause of death
What to do if ROLE pt and death unexpected?
Refer to HM coroner’s office, possibly contact police.
How do we handle bystanders in CA, including children?
Acknowledge situation is difficult, answer what questions they had, give welfare advice, signpost to GP
Before leaving scene consider making GP referral for children - ask family if aware of death depending on age etc.
What checks need to be done before assessing ABCDE?
Danger ONS - anything preventing me from entering? Any fire, multiple unconscious pt’s (CBRN)? traffic? electricity? Do I require HART?
Response - hello, can you hear me in both ears? check pain
Background - unwitnessed? signs unequivocally associated with death?
Mechanism of injury - trauma or medical? Ladders fallen from?
Catastrophic haemorrhage?
What do we do after declaring CA?
Call for backup, commence CPR, place pads on in double crew
Pads on first, CPR after when single
Considerations? - feel cold? hypothermic? - pregnant? require bystander to move belly to left
Airway focus - positioning - mastoid process (behind ear) inline with sternal notch, adjuncts - OP and NP
What pt’s require transportation sooner than later?
Dialysis
Drug overdose
Pregnant
Unable to manage airway
Suspected PE
Asthma or anaphylaxis
What does our ATMIST handover involve?
Age and sex
Time of arrest, bystanders cpr time, LAS ONS/BLS commenced, time of ROSC
Medical complaint, CA
Information, presenting rhythm, prodomal symptoms - first sign of symptoms
S vital signs, best and current GCS
Treatment and trends, number of shocks, total adrenaline, any other medications
Allergies
Medications
Background history
Other info, family’s whereabouts, what they know
Safeguarding referral following arrest?
What do we do differently for child’s CA?
Pad placement, LP1000 first instead, 5 rescue breaths
