Cardiopulmonary

Question 1

What’s CPR?

Answer 1

CPR, or cardiopulmonary resuscitation, is a life-saving
attempt used when a patient does not have a pulse. We are
trying to…

1. Prolong the delivery of oxygen to the brain
2. Re-start the heart’s normal electrical activity

Question 2

What’s the difference between heart attack and cardiac arrest?

Answer 2

Heart Attack: myocardial infarction, can cause cardiac arrest.
Cardiac Arrest: Loss of heart function, no pulse

Question 3

What are the characteristics of a heart attack?

Answer 3

● AKA “myocardial infarction”
● Occurs because blood flow to the heart
is blocked
● The heart tissue dies because it lacks
oxygen and nutrients
● The heart does not usually stop beating
○ Unless the blockage is severe
enough that a massive section dies

● Can CAUSE cardiac arrest

Question 4

What are the characteristics of cardiac arrest?

Answer 4

● Loss of heart function
● The heart can no longer able to
coordinate its pumping
● Person will go unconscious and have no
pulse

Question 5

What can be a cause of cardiac arrest?

Answer 5

There may (or may not) be an electrical rhythm in the heart.
If there is an electrical rhythm, it’s an irregular one that can’t
coordinate myocardial contractions

Question 6

Ventricular fibrillation (v-fib)

Answer 6

● Quivering heart muscle because of uncoordinated contractions
○ It can’t produce a forceful pump
● The electricity traveling through the heart is completely disorganized
○ Ventricular tissue cells are firing at different times (tissue heterogeneity), normally because they
are stressed and structurally/electrically changed

● Cannot live with this; will likely lead to sudden cardiac death (SCD) within
minutes
● SHOCK

Question 7

Ventricular tachycardia (v-tach)

Answer 7

● Heart rate is organized but way too fast
○ Ventricles are contracting quicker than they’re supposed to
○ There’s no time for atrial blood to fill the ventricles!
● You can live with v-tach; someone in cardiac arrest will have pulseless v-tach
● Can develop into v-fib
● SHOCK

Question 8

Asystole

Answer 8

● No electrical activity to monitor on ECG
● Typically due to prolonged illness or cardiac arrest
● CAN’T SHOCK

Question 9

Pulseless electrical activity (PEA)

Answer 9

● Can appear like any rhythm
○ The rhythm should be producing a pulse but is not
● Heart muscle is not responding to the electrical signal that is present
○ Electrical-mechanical dissociation
● CAN’T SHOCK

Question 10

Why do we use the C-A-B algorithm?

Answer 10

1. Compressions
   ● Prioritize compressions because mechanically pumping the heart can push any
   residual oxygen in the blood to tissues while you set up other equipment
   ● This helps protect post-arrest quality of life
2. Airway
   ● Establish an airway using the head-tilt chin-lift technique to create a pathway for
   artificial ventilation
   ● Insert an airway adjunct, the tongue is a major airway obstruction
   ● Suction as needed
3. Breathing
   ● Use a BVM (preferably) to deliver oxygen
   ● Look for chest rise as a sign of good breaths

Question 11

When should you perform CPR before activating Emergency Response

Answer 11

…in infants/children
Perform 5 cycles of CPR then
go activate the emergency
response/get an AED

Question 12

Agonal respiration

Answer 12

Beware of agonal respirations, a last-ditch
attempt at breathing by the medulla oblongata.
This is not the same as normal breathing.

Question 13

Which pulses do you check for CPR

Answer 13

In adults, feel for a pulse at the carotid artery. In
infants, feel for a pulse at the brachial artery.
You should be checking for 5-10 seconds.

Question 14

How do you determine if a child/infant needs CPR?

Answer 14

In infants/children, if a pulse is above 60 beats per
minute and breathing is not adequate to sustain life,
begin giving rescue breaths. If a pulse is below 60
beats or absent, initiate CPR.

Question 15

How do you perform rescue breathing

Answer 15

Performed when a patient’s breathing is inadequate to sustain
life.

In adults, give a breath every 5-6 seconds.

In infants/children, give a breath every 3-5 seconds. In patients with
an advanced airway, regardless of age, give a breath every 6 seconds.

Reassess pulse every 2 minutes. Once it’s lost, initiate CPR.

Question 16

What is the compression to ventilation ratio

Answer 16

For adults, perform compressions and ventilations
in a 30:2 ratio.

For infants/children, perform compressions and
ventilations in a 30:2 ratio with 1 rescuer and 15:2
ratio with 2 rescuers.

For patients with an advanced airway,
compressions and ventilations are asynchronous.

Question 17

Commotio cordis

Answer 17

● Blunt trauma to the chest on the uprise of the T wave
causes instant v-fib
● The AED can reverse this fatal rhythm!

Question 18

What are some other circumstances to consider with CPR?

Answer 18

● Pad placement
○ Hairy chest? Shave them
○ Medicine patch? Remove it and wipe the area
○ Pacemaker? Place the pad below it
○ Patient is wet/in water? Pull them out and dry them off
● Hypothermia
○ Check pulse for 30-45 seconds
○ Shock a maximum of 3 times
● Left ventricular assist device (LVAD)
○ Use the AED but do not do compressions
■ You don’t want to dislodge it

Question 19

What forms do we honor a DNR

Answer 19

● DNRs should be honored in the form of...
○ Non-hospital DNR order
■ Signed and dated by a physician
■ Never expire
■ Some nursing homes/care centers use their own DNR form, which we also
honor
○ DNR bracelet
○ Bright pink, multi-page MOLST sheet
■ Can indicate wishes for a DNR

Question 20

What do you do if no one can produce a DNR?

Answer 20

● Proceed with resuscitative efforts until provided with an
adequate form of DNR
○ If you suspect the DNR has been altered or forged, you are
protected under good faith for continuing resuscitation

Question 21

When should you not start/continue CPR?

Answer 21

● DNR
● You’re physically exhausted
● Passing off to higher or equal level care
● Return of spontaneous circulation (ROSC)
● Scene becomes unsafe
● Obvious signs of death

Question 22

What are some obvious signs of death?

Answer 22

● In the case of cardiac arrest, respiratory arrest, and
neurological inactivity with…
○ Incineration
○ Transection
○ Rigor mortis
■ Long-term effect; extreme stiffness
○ Decapitation
○ Decomposition
○ Dependent lividity
■ Long-term effect; blood pooling in body
○ Massive crush injury to head, neck, or trunk
○ Penetrating or blunt injury causing evisceration of brain, heart, or lung

Question 23

Foreign Body Airway

Obstruction (FBAO)

Answer 23

Choking

Question 24

How do you address FBAO in adults?

Answer 24

If the patient is audibly coughing
▹ Encourage them to keep coughing
If the patient is silently choking and making the universal
choking sign
▹ Perform the Heimlich Maneuver

▸ Place one leg between theirs, wrap your arms around them,
and pull up in a J-shape from above their navel
▸ If patient is pregnant or overweight, do this around their chest

If the patient goes unresponsive
▹ Lower them to the ground and initiate compressions and ventilations

Question 25

How do you address FBAO in infants?

Answer 25

If the patient is audibly coughing
▹ Encourage them to keep coughing
▸ You can do this by mimicking a cough

If the patient is silently choking and flailing
▹ Perform cycles of 5 back slaps and 5 chest thrusts
If the patient goes unresponsive
▹ Initiate compressions and ventilations