BLS

Question 1

how has DRSABC changed in the covid update

Answer 1

the airway section has been removed

DRS BC

Question 2

What PPE should be worn for assessment / chest compressions / general contact with COVID-19 case

Answer 2

gloves
apron
mask

Question 3

what PPE must be worn for aerosol generating procedures / airway interventions and ventilations

Answer 3

full face shield / eye protection

FFP face mask

gloves

long sleeved fluid repellant gown

Question 4

is there any change to “danger”

Answer 4

no

still check before beginning

Question 5

how do you check for response

Answer 5

• Gently shake
• Speak loudly
• “hello can you hear me”

• Cover the victim’s nose and mouth with a surgical mask or a cloth

• The person helping must also wear basic PPE now
		○ Gloves
		○ Apron
		○ Mask 
		○ Visor

Question 6

what is “s” and how do you do it

Answer 6

shout

same as before
shout for help

Question 7

what has changed with checking the airway

Answer 7

DO NOT GO NEAR THE AIRWAY
Don’t do the head tilt chin lift / don’t open airway
Skip this step completely

Question 8

what is the new way to check for breathing and circulation

Answer 8

• Stay clear of the airway 
• Palpate a carotid pulse
	○ Circulation 
• Hand on the chest
	○ Looking / feeling for movements of breathing
• Simultaneously check for 10 seconds

Used to check this by doing look, listen, feel
Now you do not put your face near the victim’s face even if their nose and mouth is covered

Question 9

what is agonal breathing

Answer 9

• Infrequent noisy gasps
• Not normal
• Ignore these - this is not breathing

Question 10

when you dial 999 what should you say to the emergency services

Answer 10

• Cardiac arrest
• Not breathing
• Location
• Contact number
• COVID Status
○ This is the only difference when calling for help
○ If you know the victim is covid positive - tell them
○ If you do not know tell them the covid status is unknown

Question 11

how should chest compressions be done

Answer 11

• Interlock fingers
• Straight elbows
• Compress the sternum 5-6cms
• 100-120 compressions per minute
○ This will equal around 2 compressions per second
• Continue compressions until help arrives
• Patients face should remain covered

You should be wearing basic PPE at least

Question 12

how do you prepare the patient for the AED

Answer 12

• Scissors
○ Remove clothes on the chest
○ If there are no scissors available then pull the clothes up as high as you can to get access to the chest

• Dry
○ If the chest is wet, due to sweat or blood or something else it needs to be dried for the pads to stick

• Razor
○ Need to shave the chest if it is very hairy as the pads won’t stick properly / would be very painful to remove
○ Only need to shave the areas where the pads are

Question 13

how do you use the defib

Answer 13

• Attach pads to the patients chest
○ One 10cm below the armpit (left hand side)
○ One just below the clavicle (right hand side)

• Listen to the voice prompts of the AED

• Early defibrillation is a key intervention associated with improved neurological outcomes
○ Early intervention is the best thing
○ Quicker it is done = better outcomes

Apply AED as soon as available, even if only wearing droplet-precaution PPE

• Stand clear
• Do not touch the patient
• Do not touch equipment

Move the oxygen a metre away

Question 14

when can airway intervention / ventilation be done

Answer 14

only once full AGP PPE is put on

Question 15

how much oxygen is given

Answer 15

15L of 100% oxygen per minute

Question 16

what must be added to the bag valve mask

Answer 16

humidity moisture exchange filter (HME)

reduces the amount exhaled by the patient

Question 17

how should venilations be done

Answer 17

• Use a 2 person technique
○ Very important to create the best possible seal
○ Don’t want any droplets to come out of the mouth

• AGP PPE must be worn
• FFP3 mask for all staff before airway interventions commence

• One person does the head tilt chin lift and holds the mask in place creating a good seal over the nose and mouth - fingers on mandible
Second person is squeezing the balloon

○ Squeeze very gently
○ Allow the bag time to fill up
○ Watch the chest rise and fall

• Give 2 rescue breaths via Bag-Mask Ventilation (100% Oxygen)
○ Should not be done via mouth-to-mouth or mouth-to-mask

Question 18

what should be done if the chest does not rise and fall during the rescue breathes

Answer 18

check there is a good mask seal and that the head tile technique is correct

if these are good then use airway adjuncts / oropharyngeal airway (OPA)
[green usually female, male usually orange but always check first]

Question 19

how to insert OPA

Answer 19

Insert upside down
180 degree twist
measure it first

Question 20

what is ROSC

Answer 20

return of spontaneous circulation

Question 21

what should be done in post resuscitation care / ROSC

Answer 21

• Reassess breathing and circulation
• Reassure casualty (even if unconscious)
• Maintain airway

• Deliver oxygen via BVM
○ Patients respirations per minute will be very low initially
○ Whenever the patient breathes in squeeze the bag to give them extra oxygen
○ When they cannot tolerate this any more remove the BVM and replace with an oxygen mask delivering 15L

• Do not remove AED pads - Patient could still rearrest
• Cover up to maintain dignity of the patient and keep the patient warm
• The casualty could rearrest - be prepared to deliver CPR again
• Keep all emergency equipment to hand

Question 22

what is CPR

Answer 22

cardiopulmonary resuscitation

Question 23

What is BLS

Answer 23

basic life support

Question 24

what is AED

Answer 24

automated external defibrillator

Question 25

What is OHCA

Answer 25

out of hospital cardiac arrest

Question 26

what is VT

Answer 26

ventricular tachycardia

Question 27

what is VF

Answer 27

Ventricular fibrillation

Question 28

what is HME filter

Answer 28

humidity moisture exchange filter

Question 29

what is the full process of BLS and AED adapted for COVID-19

Answer 29

• patient unresponsive and not breathing normally
  (assess breathing visually, do not open airway or approach victim’s nose / mouth)
• call ALS team
  state COVID-19 status
• cover victim’s nose and mouth with a surgical mask or cloth
• apply AED as soon as available, even if only wearing droplet-precaution PPE
• don airbone precaution PPE
  consider optimal team size
• give 30 chest compressions
• give 2 rescue breaths via bag-mask ventilation (100% oxygen)
  not via mouth to mouth or mouth to mask

[use a 2 person technique; 1 to provide mask seal, the other 1 to provide compressions and also give ventilation][viral filter should be between the bag and mask]

• continue CPR 30:2
• switch rescuer every 2 minutes