BLS Resuscitation Flashcards
Noninvasive emergency life-saving care that is used to treat medical conditions, including airway obstruction, respiratory arrest, and cardiac arrest
Basic Life Support
BLS sequence of events
ABCs
BLS sequence of events for cardiac arrest
CABs
Check for a pulse for no more than ___
10 seconds
Permanent brain damage is possible after only ___ without oxygen
4 - 6 minutes
If breathing stops before the heart stops, then they patient may have ___
Enough oxygen in the lungs to stay alive for several minutes
When cardiac arrest occurs before breathing stops, ___
The heart and brain stop receiving oxygen immediately
Used to re-establish circulation and artificial ventilation in a patient who is not breathing and has no pulse
CPR
CPR depth
2 - 2.4”
CPR rate
100 to 120 /min
Goal of CPR
Help restore spontaneous breathing and circulation
Timeline for oxygen deprivation in the brain
0-1 min: Cardiac irritability
0-4 min: Brain damage not likely
4-6 min: Brain damage possible
6-10 min: Brain damage very likely
10 min+: Irreversible brain damage
ALS differs from BLS by ___
Cardiac monitoring, administration of IV fluids and medications, and the use of advanced airway adjuncts
Some cases where BLS may be all that is needed to restore pulse and breathing
Choking, near-drowning, or lightning injuries
Chain of survival links
- Recognition/activation of EMS
- Immediate high-quality CPR
- Rapid defibrillation
- Basic and advanced EMS
- ALS and post-arrest care
- Recovery
Interruptions between compressions should be minimized and no longer than ___
10 seconds
Purpose of allowing the chest to fully recoil
Allow blood return to the heart
The first step when approaching a patient in need of CPR after determining if the scene is safe
Determine responsiveness
If a pulse cannot be felt definitively after 10 seconds, ___
Begin chest compressions
For BLS purposes, who is an infant, child, or adult?
Infant: younger than 1 year
Child: 1 year to about 12 to 14 (onset of puberty)
Adult: Onset of puberty and older
Determining puberty for BLS
Breast development in girls and underarm, chest, or facial hair in boys
Two basic differences in providing CPR for infants, children, and adults
- Emergencies in which infants and children require CPR usually have different underlying causes
- Anatomic differences in adults, children, and infants, such as smaller airways
Cardiac arrest in adults usually occurs ___ respiratory arrest
Before
Cardiac arrest in infants and children usually occurs ___ respiratory arrest
After
Most prehospital cardiac arrests occur as the result of a ___
Sudden cardiac rhythm disturbance
Sudden cardiac rhythm disturbance
Dysrhythmia
VF
Ventricular fibrillation
VT
Ventricular tachycardia
The normal heart rhythm is known as ___
Normal sinus rhythm
Disorganized quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest
VF
Rapid contraction of the ventricles that does not allow for normal filling of the heart
VT
If you witness a patient’s cardiac arrest and an AED is available, then ___
Deploy the AED immediately and then begin CPR
Apply the AED to infants or children after ___
The first 5 cycles of CPR have been completed
Cardiac arrest in children is usually the result of ___
Respiratory failure
AICD
Automated Implanted Cardioverter-Defibrillator
Deliver shock directly to the heart if necessary
AICD or pacemaker
How to recognize AICD or pacemaker
They create a hard lump beneath the skin, usually on the upper left side of the chest (just below the clavicle)
How to place AED pads with a pacemaker
At least 1” away from the device
If you observe a patient with a pacemaker’s muscles twitching as if they were just shocked, then ___
Continue CPR and wait 30 to 60 seconds before delivering a shock with the AED
If the patient is wet, ___ prior to attaching the AED pads
Dry the chest
If the patient has transdermal medication patches, ___ prior to attaching the AED pads
Remove the patch and wipe the skin to remove the residue
Positioning of a patient for CPR to be effective
Supine on a firm, flat surface, with enough space for two rescuer to perform CPR and use the AED
How to find carotid pulse
Locate the larynx and then slide two fingers toward the side closest to you. The pulse is felt in the groove between the larynx and the sternocleidomastoid muscle, with the pads of the index and middle fingers held side by side
CPR ratio of time devoted to compression vs relaxation
1:1
Complications of chest compressions
Fractured ribs, lacerated liver, and a fractured sternum
It takes ___ compressions to reestablish effective blood flow to the heart after chest compressions are resumed
5 to 10
Compression to ventilation ratio
30:2
Compression area
In the center of the chest, at the nipple line
Ventilation length
1 second
Hyperventilation may cause ___
Increased intrathoracic pressure by putting pressure on the vena cava, this reducing the amount of blood that returns to the heart
Use a ___ to ventilate through the stoma
Pediatric or infant mask
Stomach becomes filled with air
Gastric distention
Gastric distention occurs most commonly in ___
Children
How does gastric distention occur?
Ventilate too forcefully or if the patient’s airway is not opened adequately, the excess gas under pressure opens up the collapsible tube (esophagus) and allow air to enter the stomach
How does gastric distention become dangerous?
- Could vomit and block the airway
- Reduces lung volume by elevating the diaphragm
How can an ALS provide remedy gastric distention?
Insert an orogastric or nasogastric tube to decompress the stomach
Each set of 30 compressions should take about ___
17 seconds
Before assisting with CPR, a second rescuer should ___
Apply airway adjuncts, including a bag-mask device and suction, and insert an oropharyngeal airway
If CPR is in progress, then the second rescuer should ___
Enter the procedure after the AED and then cycle of 30 compressions and two ventilations
How often should the compressor and ventilator switch positions?
Every two minutes (5 cycles of 30:2)
Switch time between providers should take no longer than ___
5 seconds
The AED should analyze the cardiac rhythm every ___
2 minutes
A technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression)
Active compression-decompression CPR
Benefit of active compression-decompression CPR
May increase the amount of blood that returns to the heart, and thus, the amount of blood ejected from the heart during the compression phase
LVAD
Left Ventricle Assist Device
A mechanical pump that is implanted in the chest and help pump blood from the left ventricle to the aorta
LVAD
If the LVAD is working, you will hear ___
A humming sound when listening to the chest with a stethoscope
The more assistance the LVAD is providing to the heart, the ___ the patient’s pulse will be
Weaker
A valve device placed between the ET tube and a bag-mask device
Impedance threshold device
ITD
Impedance Threshold Device
The ITD may be placed ___ if an ET tube is not in place
Between the bag and mask
Designed to limit the air entering the lungs during the recoil phase between chest compressions
ITD
The result of using an ITD
Negative intrathoracic pressure that may draw more blood toward the heart, ultimately resulting in improved cardiac filling and circulation during each chest compression
ROSC
Return of spontaneous circulation
Use of an ITD is not recommended for use with ___
Conventional CPR
If ROSC occurs, the ITD should be ___
Removed
A device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard
Mechanical piston device
A circumferential chest compression device composed of a constricting band and backboard
Load-distributing band
LDB
Load-distributing band
Decreased oxygen supply
Ischemia
Children consume oxygen ___ than adults
2 to 3 times more rapidly
The focus of pediatric BLS
Airway and breathing
Respiratory issues leading to cardiopulmonary arrest in children causes
- Injury
- Infections of the respiratory tract or another organ system
- Foreign body in the airway
- Submersion
- Electrocution
- Poisoning or drug overdose
- SIDS
If you find an unresponsive, apneic, and pulseless child while alone and off duty, and you did not see the collapse, ___
Perform CPR for 2 minutes and then call for help and get an AED
The sudden collapse of an otherwise healthy child suggests a ___
Primary cardiac event that may respond to defibrillation
Pulse check for infant
Brachial artery
Pulse check for child
Carotid or femoral artery
Compression area for infant
Just below the nipple line
Compression area for child
In the center of the chest, in between the nipples
Compression width for infant
Two-finger technique (alone) or two-thumb-encircling-hands technique (two-rescuer)
Compression width for child
Heel of one or both hands
Compression depth for infant
At least 1/3 anterior-posterior diameter (about 1.5”)
Compression depth for child
At least 1/3 anterior-posterior diameter (about 2”)
Compression/ventilation ratio for infants or children
30:2 w/ one rescuer
15:2 w/ two rescuer
Foreign body obstruction response for responsive infants
Back slaps and chest thrusts
Foreign body obstruction response for responsive children
Abdominal thrusts
Ventilation rate for infants and children
1 breath every 2 to 3 seconds (20 to 30 breaths/min)
The total percentage of time during a high-quality resuscitation attempt in which chest compressions are being performed
Chest compression fraction
Chest compression fraction should be maintained greater than ___
80%
When to not start CPR
- Scene is unsafe
- Obvious signs of death
- If the patient and the patient’s physician have agreed on a DNR order or no-CPR order
Obvious signs of death
Absence of pulse and breathing with:
1. Rigor mortis
2. Dependent lividity
3. Putrefaction
4. Evidence of non-survivable injury (decapitation, dismemberment, or being burned beyond recognition)
If you are presented with a POLST or MOLST form, then ___
Contact medical control for guidance
When to stop providing CPR
S: the patient Starts breathing and has a pulse
T: the patient’s care is Transferred to another provider of equal or higher-level of training
O: you are Out of strength or too tired to continue CPR
P: a Physician who is present or providing online medical direction assumes responsibility for the patient and directs you to discontinue CPR
ALS providers under ___ may cease resuscitation efforts without online medical direction under specific situations
Termination of Resuscitation (TOR) protocols
TOR
Termination of Resuscitation
BLS criteria for TOR
- Unwitnessed by EMS
- No AED or shock delivered
- No ROSC
ALS criteria for TOR
- Same three rules from BLS
- Unwitnessed by bystander
- No bystander CPR
Creates an artificial cough by causing a sudden increase in intrathoracic pressure when thrusts are applied to the subdiaphragmatic region
Abdominal thrust maneuver
Hand placement for abdominal thrust
Fist, thumb side to abdomen just above the umbilicus and well below the diploid process
What technique should be used for a patient who is obese or in an advanced stage of pregnancy who have a severe airway obstruction?
Chest thrusts
Hand placement for chest thrusts
Fist, thumb side against the sternum, avoiding the xiphoid process and the edges of the rib cage
In infants who have signs and symptoms of ___, do not waste time trying to dislodge a foreign body
An airway infection
A previously health child who is eating or playing with small toys or an infant who is crawling around the house and who suddenly has difficulty breathing has probably ___
Aspirated a foreign body
If a child or infant has gone unconscious from choking, do not ___ before providing chest compressions
Check for a pulse
Priorities for a pregnant patient who is in cardiac arrest
Provide high-quality CPR and relieve pressure form the aorta and vena cava
When a pregnant patient lies supine, the uterus can ___
Compress the aorta and vena cava (aortocaval compression)
If a pregnant patient is not in cardiac arrest, then position them on their ___
Left side to relieve pressure on the great vessels
If a pregnant patients top of their uterus (fundus) can be felt at or above the level of the umbilicus, perform ___ while CPR is being performed
Manual displacement of the uterus to the patient’s left to relieve aortocaval compression