BLS Flashcards
List the steps in BLS.
- Recognition
- Activation
- Pulse Check
- CPR
- Continue BLS Until Advanced Providers Arrive
- Defibrillation
How is the need for BLS recognized?
Patient is not responsive and not breathing or only gasping (i.e., not breathing normally)
What happens in the activation step?
Shout for nearby help.
Activate the emergency response system or resuscitation team via mobile device (if appropriate).
Get AED and emergency equipment or send someone to do so.
Check for a pulse for no more than ___. Which pulse should be check in adults vs. children vs. infants?
10 seconds
Adult: carotid
Child: carotid or femoral
Infant: brachial
If pulse is absent, what should be done next?
Provide CPR (start chest compressions and perform cycles of 30 compressions and 2 breaths) until an AED or ALS providers arrive. For 2 rescuers, the compression-ventilation ratio for infants and children (to the age of puberty) is 15:2.
If pulse is present but breathing is absent, what should be done next?
Open the airway and provide rescue breathing (1 breath every 5-6 seconds for an adult), every 3-5 seconds for an infant or child). Recheck the pulse about every 2 minutes.
If possible opioid overdose, administer naloxone if available per protocol.
In an infant or child with adequate oxygenation and ventilation if pulse is present but <60/min with poor perfusion, what should be done next?
Begin chest compressions with ventilations
What are the 3 aspects of CPR?
- Compressions: 30 chest compressions; if 2 rescuers for infant or child, provide 15 compressions
- Open airway: after chest compressions, open the airway with a head tilt-chin lift or jaw thrust
- Breathing: give 2 breaths that make the chest rise. Release completely; allow for exhalation between breaths. After 2 breaths, immediately resume chest compressions. Give each breath over 1 second.
What should be done when an AED is available?
Attach and use as soon as it is available. Minimize interruptions in chest compressions before and after shock. If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions.
Describe the high-quality components of CPR for BLS provider as it relates to scene safety.
Make sure the environment is safe for rescuers and victim
Describe the high-quality components of CPR for BLS provider as it relates to recognition of cardiac arrest.
Check for responsiveness.
Identify no breathing or only gasping (i.e., no normal breathing) and no definite pulse within 10 seconds
[Can perform these checks simultaneously]
Describe the high-quality components of CPR for BLS provider as it relates to activation of the emergency response system. How does this differ for children (to puberty) and infants?
If you are alone with no phone, leave the victim to activate the emergency response system and get the AED before beginning CPR. Otherwise, send someone and begin CPR immediately. Use the AED as soon as it is available.
If a witnessed collapse in children/infants, follow above steps.
If unwitnessed collapse in children/infants, give 2 minutes of CPR, then leave the victim to activate the emergency response system and get the AED. Return to the child or infant and resume CPR; use the AED as soon as it is available.
Describe the high-quality components of CPR for BLS provider as it relates to compression-ventilation ratio without an advanced airway.
Adults/adolescents: 30:2
Children/infants with 1 rescuer: 30:2
Children/infants with 2+ rescuers: 15:2
Describe the high-quality components of CPR for BLS provider as it relates to compression-ventilation ratio WITH an advanced airway.
Continuous compressions at a rate of 100-120/min
Give 1 breath every 6 seconds (10 breaths/min)
Describe the high-quality components of CPR for BLS provider as it relates to compression rate.
100-120/min
Describe the high-quality components of CPR for BLS provider as it relates to compression depth.
Adults: at least 2” (5 cm)
Children: At least 1/3 AP diameter of chest (about 2”/5cm)
Infants: At least 1/3 AP diameter of chest (About 1.5”/4cm)
Maximum: 2.4” (6cm)
Describe the high-quality components of CPR for BLS provider as it relates to hand placement.
Adults: 2 hands or the lower half of the sternum
Children: 2 hands or 1 hand (if very small child) on the lower half of the sternum
Infant: 2 fingers in the center of the chest, just below the nipple line (if 2+ rescuers, 2 thumb-encircling hands in the center of the chest just below the nipple line)
Describe the high-quality components of CPR for BLS provider as it relates to chest recail
Allow full recoil of chest after each compression; do not lean on the chest after each compression
Describe the high-quality components of CPR for BLS provider as it relates to minimizing interruptions
Limit to less than 10 seconds
Steps in relief of foreign-body airway obstruction (adults and children).
- Ask “Are you choking?” If the victim nods “yes” and cannot talk, severe airway obstruction is present. Take steps immediately to relieve the obstruction.
- Give abdominal thrusts/Heimlich maneuver or chest thrusts for pregnant or obese victims. (Always abdominal thrusts in children)
- Repeat abdominal thrusts (or chest thrusts) until effective or the victim becomes unresponsive.
Steps in relief of foreign-body airway obstruction (infants).
- If the victim cannot make any sounds or breathe, severe airway obstruction is present.
- Give up to 5 back slaps and up to 5 chest thrusts.
- Repeat step 2 until effective or the victim becomes unresponsive.
If a chocking victim becomes unresponsive, what should be done?
- Activate the emergency response system or send someone to do so.
- Lower the victim to the floor. Begin CPR, starting with chest compressions. Do not check for a pulse.
- Before you deliver breaths, look into the mouth. If you see a foreign body that can be easily removed, remove it.
- Continue CPR until advanced providers arrive.
What are the important variations to the BLS algorithm for cardiac arrest in pregnancy out-of hospital?
- Notify EMS that the patient is pregnant (activates in-hospital maternal code team and maternal care pathway (minimum 4 EMS dispatched optimally)
- If uterus is at or above umbilicus, perform aortocaval decompression. If rescuer is available (ideaL) - manual left uterine displacement.
Alternative - if wedge available - left lateral tilt
How does the BLS algorithm change for opioid-associated life-threatening emergencies?
- Assess and activate - check for unresponsiveness and call for help. Send someone to call 9-1-1 and get the AED and naloxone. Observe for breathing vs. no breathing/only gasping.
- If unresponsive with no breathing/only gasping, begin CPR. If alone, perform CPR for 2 minutes before leaving to phone 9-1-1 and get naloxone and AED.
- Give naloxone as soon as available. 2 mg IN or 0.04 mg IM. May repeat after 4 minutes.
- If no response (aka, move purposefully, breathe regularly, moan, etc.), continue CPR and use the AED as soon as available. If yes, continue to check responsiveness and breathing until advanced help arrives. If they stop responding, begin CPR and repeat naloxone.
What are the 6 roles in team-based resuscitation?
- Compressor
- AED/Monitor/Defibrillator
- Airway
- Team Leader
- IV/IO/Medications
- Timer/Record
Why is excessive ventilation problematic?
Leads to increased intrathoracic pressure, decreased venous return, decreased cardiac output; can also cause gastric insufflation and aspiration of gastric contents
What are the 2 components of CPR that lead to best patient outcomes?
High-quality CPR and rapid defibrillation
What are the components of the systematic approach to ACLS?
Initial impression
If unconscious -> BLS assessment -> primary assessment
If conscious -> primary assessment -> secondary assessment
BLS assessment?
Check responsiveness.
Shout for help and activate the emergency response system/get an AED.
Check breathing and pulse. Ideally, check these simultaneously.
If no pulse within 10 seconds, start high-quality CPR with chest-compressions. If pulse but no breathing, ventilate once every 5-6 seconds.
Use a defibrillator.
Primary assessment?
Can be performed simultaneously
Airway - maintain patent airway and consider advanced airway device if unconscious; use waveform capnography to monitor effectiveness.
Breathing - provide 2 ventilations with BVM after every 30 chest compressions. Continue asynchronous ventilation once every 6 seconds if advanced airway. Use O2 if needed.
Circulation - EKG leads, IV/IO access, give appropriate drugs to manage abnormal rhythms and assess for perfusion issues (BP, HR, temperature, glucose levels)
Disability - neurological functioning; quickly assess for responsiveness, level of consciousness, and pupil dilation (AVPU - Alert, Voice, Painful, Unresponsive)
Exposure - remove clothing to perform a physical examination looking for obvious signs
Secondary Assessment?
Involves DDx
Focused medical history: SAMPLE - signs and symptoms, allergies, medications (last dose), PMHx, last meal, events (especially precipitating)
Searching for/treating reversible causes - H’s and T’s
Hypovolemia Hypoxia Hydrogen ion (acidosis) Hyperkalemia Hypokalemia Hypothermia (<95F/35C)
Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary, coronary)
What are the 2 types of airway adjuncts?
OPA (oropharyngeal) - unconscious only
NPA (nasopharyngeal) - conscious, semiconscious, or unconscious; with or without gag reflex
How can you check for adequate ventilation with an OPA/NPA?
Listen for breath sounds
Indications for advanced airway?
Difficult BMV
Airway compromise
Need to isolate the airway
