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EMT Key Points > Ch14: BLS Resuscitation > Flashcards

Ch14: BLS Resuscitation Flashcards

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1
Q

what is BLS?

A

basic-life support are non-invasive emergency techniques to treat different conditions like airway obstruction, respiratory arrest and cardiac arrest.

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2
Q

likelihoods of brain damage with time

A

0-4 mins = not likely
4-6 mins = possible
6-10 mins = likely
10+ = irreversible

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3
Q

2 steps of CPR (cardiopulmonary resuscitation)

A

1) 30 chest compressions at depth of 2 inches (5 cm). at least 100 per minute but no more than 120
2) head tilt-chin life maneuver or jaw thrust maneuver with assisted ventilation using bag mask device

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3
Q

Six links in the chain of survival

A

Recognition & Activation of EMS
CPR
Rapid Defib
Basic and advanced emergency medical services
ALS and post-arrest care
Recovery

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3
Q

when do you assume a person is in cardiac arrest?

A

tap on shoulder and shout “are you okay”
no pulse for 10 seconds
not breathing or agonal gasps

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4
Q

whats the difference between BLS and ALS

A

ALS has more invasive procedures

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4
Q

return of spontaneous circulation (ROSC)

A

return of pulse and blood flow in a patient who was in cardiac arrest

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5
Q

ventricular fibrillation

A

electrical abnormality causing quivering of ventricles and inability of the heart to pump blood

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6
Q

ventricular tachycardia

A

rapid contraction of the ventricles that do not allow the ventricles to fill completely with blood

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7
Q

what age groups are considered infants, children and adults for BLS procedures

A

infants: below 1
children: 1-12/14 (before puberty)
adults: after puberty

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8
Q

AED for children and infants

A

use pediatric size pads and dose-attenuating system (energy reducer)

if not available, use adult-size pads: one anterior and one posterior. too much energy is better than none!

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9
Q

relationship between cardiac and respiratory arrest in infants and children

A

respiratory arrest usually comes first before cardiac arrest in infants and children so oxygenation and assisted ventilation is very important

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10
Q

relationship between cardiac and respiratory arrest in adults

A

cardiac arrest can lead to respiratory arrest

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11
Q

AED for patients with pacemakers or implanted defibs

A

put AED pad at least 1 inch (2.5 cm) away from pacemaker/implanted defib. putting it over the devices will reduce effectiveness of shock and can damage the devices

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12
Q

AED for patients with transdermal medicine patches

A

take off patch with gloves and wipe area to clear of any residue. attach AED as normal

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12
Q

AED for wet patients

A

get them out of water and wipe dry asap while doing CPR

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13
Q

what position is the most effective for CPR

A

supine

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14
Q

purpose of compressions in CPR

A

squeeze the heart, allowing it to circulate blood around the body to maintain perfusion

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15
Q

what fraction of the blood does CPR circulate compare to normal cardiac function

A

1/3

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16
Q

what is the proper way to perform chest compressions

A

1) positioning hands: one hand over lower half of sternum, heel of second hand over it and fingers interlocking onto the first hand
2) elbow straight, vertically above the hands
3) depress sternum 100-120 times per minute to a depth of 2 to 2.4 inches (5-6 cm)
4) switch person every 2 minutes to prevent fatigue and shallow compressions

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17
Q

complications from chest compressions

A

fractured ribs
fractured sternum
lacerated liver

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17
Q

advantages of recovery position

A

maintains open airway
allows vomit, blood and other fluids to drain

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17
Q

when do you put a patient into recovery position?

A

patient is breathing adequately on his/her own
no traumatic or suspected injuries to back, spine, neck
decreased LOC

18
Q

Process of Adult BLS Procedure

A

CAB!

Circulation:
assess pulse - carotid artery (none for 10 secs = compressions)
–> compression area: nipple line
–> compression depth: 5 - 6 cm (2-2.4 in)
–> compression rate: 100-120 per min
–> compression:ventilation ratio = 30:2

Airway:
foreign body obstruction
–> conscious: Heimlich maneuver
–> unconscious: chest compressions
airway positioning: HT-CL or jaw thrust maneuver

Breathing:
ventilations and assisted ventilation: 1 per 6 secs

19
Q

how do you ventilate with a stoma?

A

bag mask ventilation on top of stoma - use pediatric-sized mask

20
Q

risk of giving more breaths than 1 per 6 seconds or airway obstruction

A

gastric distention! which can cause vomiting
pressure causes esophagus to open and air to enter the stomach

20
Q

what to do if there is massive gastric distention

A

1) check ventilation!! if adequate, continue with SLOW ventilations
2) if ventilations are disrupted, contact medical control and prepare for suctioning vomit; if an ALS provider is present, they can insert a orogastric or nasogastric tube for decompression

21
Q

How to perform One-rescuer Adult CPR

A

1) assess pulse and breathing. If both are absent: do CPR
2) chest compressions: 30 (~17 seconds)
3) open airway based on suspected spinal injuries; ventilations with bag mask device: 2
–> E-C hold
–> 1 per 6 seconds
4) continue CPR until add’l personnel arrive or patient starts to move

22
Q

What can additional personnel do when arriving onto scene of one-rescuer adult CPR

A

1) insert airway adjuncts - oral airway, bag-mask device, suctioning
2) help with setting up and starting AED
3) swap doing chest compressions with the first rescuer to prevent fatigue

23
Q

what to do for a patient with an LVAD (left ventricular assist device) who is unresponsive, no breathing, pale skin color but the LVAD hum is heard

A

CPR

23
Q

How to perform Two-rescuer Adult CPR

A

1) assess patient pulse and breathing. if none = CPR
2) 15 chest compressions and 2 ventilations (rmb airway positioning). If AED is available, use immediately; one rescuer puts pads on chest while the other does chest compressions
3) reanalyze with AED every 2 mins and deliver shock if needed

*30:2 compression to ventilation ratio

24
Q

4-person team approach to CPR

A
  1. team leader
    2 and 3. alternate chest compressions
  2. AED
24
Q

how does the ITD impedance threshold device work?

A

It increases the negative pressure to bring more blood back to the heart in between chest compressions.
During compression, the ITD valve opens to allow air out of the thorax. But between compressions, when the chest returns to its neutral position, the ITD valve closes and does not let any air in. This maintains a higher negative pressure to allow blood to travel back to the heart

25
Q

what is the active compression-decompression device

A

device with a handhold and large suction cup.
suction cup goes on the patients chest. after compressing to the correct depth, the EMT can pull up to provide active decompression and return the chest to neutral position or further

26
Q

what is a mechanical piston device (MPD)?

A

device that depresses the sternum mechanically just like manual chest compressions. it is secured to a backboard.

allow control over consistency in depth and rate of compressions

27
Q

what is a load-distributing band (LDB) or vest CPR

A

circumferential chest compression device secured to a backboard that puts pressure of thorax.

28
Q

types of CPR-assisting devices

A

1) active compression-decompression device
2) impedance threshold device (ITD)
3) mechanical piston device (MPD)
4) load-distributing band (LDB)

29
Q

what to do if you find an unresponsive, apneic and pulseless child off-duty?

A

immediately do 5 sets of chest compressions (~2 minutes) before calling for additional help and getting an AED
*note: usually cardiopulmonary arrest in children occurs because of respiratory failure, not a cardiac event so oxygenation and perfusion are the main priorities

29
Q

BLS procedure for infants

A

CAB!

Circulation:
assess pulse - brachial artery
compression with two fingers or two-thumbs-encircling-hand technique
compression area - right below nipple line
compression depth - 1/3 of anterior-posterior diameter
compression rate - 100-120 per min
comp:ventilation ratio - 30:2 (one-rescuer), 15:2 (two-rescuer)

Airway:
foreign body obstruction:
–> responsive: back slaps or chest thrusts
–> unresponsive: CPR
same positioning - HT CL or jaw thrust man.

Breathing:
1 ventilation every 2-3 secs

30
Q

Child BLS procedure

A

CAB!

Circulation:
assess pulse - femoral or carotid artery
compression with heel of one hand or both hands
compression area: nipple line
compression depth: 1/3 of ant.-post. diameter = ~2 inches
compression rate: 100-120 per min
comp:ventilation ratio - 30:2 (one-rescuer), 15:2 (two-rescuer)

Airway:
foreign body obstruction
–> responsive: Heimlich man.
–> unresponsive: CPR
same positioning - HT CL man. or jaw thrust man.

Breathing:
1 ventilation per 2-3 secs

31
Q

what to do if a child is unresponsive but breathing adequately?

A

put in recovery position to maintain open airway and allow drainage of blood, vomit and other secretions

31
Q

How to perform PCR on child (1-14 yrs)

A

1) lay child on flat, hard surface
2) put heel of hand on the middle of nipple line and chest
3) same chest compressions and ventilation ratio
4) apply AED
5) if ROSC –> place in recovery position

32
Q

How to perform PCR on infant

A

1) lay infant on flat surface
2) one hand is gently pushing down on forehead to open airway like HT-CL maneuver
3) chest compressions (1/3 depth, 100-120 per min) with two fingers in the middle of the sternum right below the nipple line
4) 30:2 for one-rescuer and 15:2 for two-rescuer

33
Q

contraindication for recovery position for unresponsive but breathing child

A

suspected spinal injury UNLESS child is secured to backboard that is tilted to the side

34
Q

what to do if a child is responsive but has labored breathing?

A

supplemental oxygen + transport to hospital

35
Q

what to do if child has a pulse but is not breathing?

A

assisted ventilation! with bag mask device

1 ventilation every 2-3 seconds

36
Q

what to do if child has no pulse nor is breathing?

A

CPR

37
Q

should a child with difficulty breathing be allowed to stay in whatever position is most comfortable?

A

yes

38
Q

how to use bag mask device if child has a tracheostomy

A

remove mask of BM device and attach directly to tracheostomy

39
Q

do not interrupt CPR for more than ___ seconds

A

10

40
Q

when to STOP compressions

A

Starts breathing + pulse
Transfer of care to another provider of same or higher level
Out of breath, tired
Physician orders or medical control orders

40
Q

chest compression fraction

A

total percentage of time during a resuscitation attempt where active chest compressions are being done.

the higher the better.

41
Q

when NOT to start compressions

A

1) scene NOT SAFE
2) obvious signs of death e.g. dependent lividity, rigor mortis, putrefaction, serious trauma that indicates definitive death
3) valid DNR order

  • look for MOLST or POLST documents
42
Q

what to do if a pregnant patient is in cardiac arrest but her uterus compresses vena cava and disrupts blood flow when lying down supine?

A

manually displace uterus to her left with one/two hands and then continue compressions

43
Q
A
43
Q
A

EMT Key Points (21 decks)

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