Ch14: BLS Resuscitation Flashcards
what is BLS?
basic-life support are non-invasive emergency techniques to treat different conditions like airway obstruction, respiratory arrest and cardiac arrest.
likelihoods of brain damage with time
0-4 mins = not likely
4-6 mins = possible
6-10 mins = likely
10+ = irreversible
2 steps of CPR (cardiopulmonary resuscitation)
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
Six links in the chain of survival
Recognition & Activation of EMS
CPR
Rapid Defib
Basic and advanced emergency medical services
ALS and post-arrest care
Recovery
when do you assume a person is in cardiac arrest?
tap on shoulder and shout “are you okay”
no pulse for 10 seconds
not breathing or agonal gasps
whats the difference between BLS and ALS
ALS has more invasive procedures
return of spontaneous circulation (ROSC)
return of pulse and blood flow in a patient who was in cardiac arrest
ventricular fibrillation
electrical abnormality causing quivering of ventricles and inability of the heart to pump blood
ventricular tachycardia
rapid contraction of the ventricles that do not allow the ventricles to fill completely with blood
what age groups are considered infants, children and adults for BLS procedures
infants: below 1
children: 1-12/14 (before puberty)
adults: after puberty
AED for children and infants
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!
relationship between cardiac and respiratory arrest in infants and children
respiratory arrest usually comes first before cardiac arrest in infants and children so oxygenation and assisted ventilation is very important
relationship between cardiac and respiratory arrest in adults
cardiac arrest can lead to respiratory arrest
AED for patients with pacemakers or implanted defibs
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
AED for patients with transdermal medicine patches
take off patch with gloves and wipe area to clear of any residue. attach AED as normal
AED for wet patients
get them out of water and wipe dry asap while doing CPR
what position is the most effective for CPR
supine
purpose of compressions in CPR
squeeze the heart, allowing it to circulate blood around the body to maintain perfusion
what fraction of the blood does CPR circulate compare to normal cardiac function
1/3
what is the proper way to perform chest compressions
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
complications from chest compressions
fractured ribs
fractured sternum
lacerated liver
advantages of recovery position
maintains open airway
allows vomit, blood and other fluids to drain
when do you put a patient into recovery position?
patient is breathing adequately on his/her own
no traumatic or suspected injuries to back, spine, neck
decreased LOC
Process of Adult BLS Procedure
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
how do you ventilate with a stoma?
bag mask ventilation on top of stoma - use pediatric-sized mask
risk of giving more breaths than 1 per 6 seconds or airway obstruction
gastric distention! which can cause vomiting
pressure causes esophagus to open and air to enter the stomach
what to do if there is massive gastric distention
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
How to perform One-rescuer Adult CPR
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
What can additional personnel do when arriving onto scene of one-rescuer adult CPR
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
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
CPR
How to perform Two-rescuer Adult CPR
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
4-person team approach to CPR
- team leader
2 and 3. alternate chest compressions - AED
how does the ITD impedance threshold device work?
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
what is the active compression-decompression device
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
what is a mechanical piston device (MPD)?
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
what is a load-distributing band (LDB) or vest CPR
circumferential chest compression device secured to a backboard that puts pressure of thorax.
types of CPR-assisting devices
1) active compression-decompression device
2) impedance threshold device (ITD)
3) mechanical piston device (MPD)
4) load-distributing band (LDB)
what to do if you find an unresponsive, apneic and pulseless child off-duty?
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
BLS procedure for infants
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
Child BLS procedure
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
what to do if a child is unresponsive but breathing adequately?
put in recovery position to maintain open airway and allow drainage of blood, vomit and other secretions
How to perform PCR on child (1-14 yrs)
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
How to perform PCR on infant
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
contraindication for recovery position for unresponsive but breathing child
suspected spinal injury UNLESS child is secured to backboard that is tilted to the side
what to do if a child is responsive but has labored breathing?
supplemental oxygen + transport to hospital
what to do if child has a pulse but is not breathing?
assisted ventilation! with bag mask device
1 ventilation every 2-3 seconds
what to do if child has no pulse nor is breathing?
CPR
should a child with difficulty breathing be allowed to stay in whatever position is most comfortable?
yes
how to use bag mask device if child has a tracheostomy
remove mask of BM device and attach directly to tracheostomy
do not interrupt CPR for more than ___ seconds
10
when to STOP compressions
Starts breathing + pulse
Transfer of care to another provider of same or higher level
Out of breath, tired
Physician orders or medical control orders
chest compression fraction
total percentage of time during a resuscitation attempt where active chest compressions are being done.
the higher the better.
when NOT to start compressions
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
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?
manually displace uterus to her left with one/two hands and then continue compressions
