Ch.14 Bls Resuscitation Flashcards
The principals of basic life support (bls) were introduced in
1960
The specific techniques for the management of cardiac arrest and the delivery of emergency and cardiac care have been reviewed and revised regularly. The updated guidelines are published in peer reviewed journals : __ in the United States and ___ in Europe
Circulation
Resuscitation
In normal situations, the risk of acquiring an infectious disease while performing CPR is very low. During a pandemic, this risk is escalated dramatically because both CPR and ventilation with a bag-mask device generate__ that can spread infectious disease.
aerosol particles
__ is noninvasive emergency life saving care that is used to treat medical conditions,including airway obstruction, respiratory arrest, and cardiac arrest
Basic life support (bls)
Permanent brain damage is possible after only __ to __ minutes without oxygen
4 to 6 minutes
Check for a pulse for no more than __ seconds,and, if no definite pulse is noted, assume the victim is in cardiac arrest
10 seconds
If breathing stops before the heart stops, then the patient may have enough oxygen in the lungs to stay alive for several minutes. When __ occurs first, the heart and brain stop receiving oxygen immediately
Cardiac arrest
__ is used to re establish circulation and artificial ventilation in a patient who is not breathing and has no pulse
Cardiopulmonary resuscitation (CPR)
Involves life saving procedures,such as cardiac monitoring,administration of intravenous (IV) fluids and medications, and the use of advanced airway adjuncts
Advanced life support (ALS)
According to the American heart association (AHA), 88% of sudden cardiac arrests occur__
in the home
Chest compressions create blood flow to the heart through filling of __
Coronary arteries
Everytime compressions are stopped,blood flow-and thus-___ - to the heart (and brain) drops to zero
Perfusion
It’s takes _ to _ compressions to reestablish effective blood flow to the heart after chest compressions are resumed.
5 to 10
If the patient is breathing adequately on his or her own and has no signs of injury to the spine ,hip,or pelvis,then place the patient in the __. This position helps to maintain a clear airway in a patient with a decreased level of consciousness who has not sustained traumatic injuries and is breathing adequately on his or her own
Recovery position
__ may cause increased intrathoracic pressure (pressure in the chest cavity) by putting pressure on the vena cava,thus reducing the amount of blood that returns to the heart. This increased intrathoracic pressure decreases the effectiveness of chest compressions and results in the heart and brain receiving decreased amounts of oxygen
Hyperventilation
Rapid or deep breathing that lowers the blood carbon dioxide level below normal; may lead to increased intrathoracic pressure,decreased venous return,and hypotension when associated with bag mask device use
Hyperventilation
Patients who have undergone a laryngectomy (surgical removal of the larynx) often have a permanent tracheal__ at the midline in the neck. In this case, a_ is an opening that connects the trachea directly to the skin (FIGURE 14*
15). Because it is at the midline, the _ is the only opening that will move air into the patient’s lungs. Patients with a _ should be ventilated with a bag-mask device placed directly over the __.
stoma
Artificial ventilation may result in the stomach becoming filled with air, a condition called
Gastric distention
If you ventilate too forcefully,or if the patients airway is not opened adequately,then the excess gas under pressure opens up the collapsible tube(the __) and allows air to enter the stomach
Esophagus
When CPR is in progress on a patient who has an advanced airway device in place (ie, ET tube, King LT supraglottic airway, i-gel supraglottic airway), stopping compressions to provide a breath is not necessary. Compressions should be continuous at a rate of 100 to 120 per minute and ventilations should occur at a rate of one breath every__ (10 breaths/min). Do not attempt to synchronize compressions and ventilations; do not pause between compressions to deliver breaths.
6 seconds (10 breaths/min)
After five cycles of CPR (about__ minutes), the rescuer providing compressions to the patient (the compressor) will begin to tire, and compression quality will decrease. Therefore, compressors should switch positions every___. If there are only two rescuers on scene, then the two rescuers will alternate positions. If additional rescuers are available, the compressor should rotate every__. During switches, every effort should be made to minimize the time that no compressions are being administered. It should take less than 10 seconds to switch compressors.
2 minutes
When performing CPR on pediatric patients,compress to a depth of at least ___ the anterior-posterior diameter of the chest, at a ratio of 30:2 compressions to ventilations (one rescuer) or 15:2 compressions to ventilations (two rescuers)
One-third
___CPR is a technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression). This technique 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. FIGURE 14-17 shows an active_____ CPR device. It features a suction cup that is placed in the center of the chest. After compressing the chest to the proper depth, the rescuer pulls up on the handle of the device to provide active decompression of the chest, thus ensuring that the chest returns to at least its neutral position or even beyond neutral.
Active compression-decompression
On occasion, you may encounter a patient who has a___. The__ is a mechanical pump that is implanted in the chest and helps pump blood from the left ventricle to the aorta. A tube from the device passes through the skin and is attached to an external power source that the patient wears on their belt or an over-the-shoulder harness. The__ is commonly implanted in patients with severe heart failure or in those who are awaiting a heart transplant.
left ventricular assist device (LVAD)
If the__ is working, then you will hear a humming sound when listening to the chest with a stethoscope. Blood flows continuously through the__, and the more assistance the__ is providing to the heart, the weaker the patient’s pulse will be. In some patients with an___, you may not feel a pulse at all, even though they are responsive and alert. If the patient is unresponsive with no breathing, poor skin color, and poor or no capillary refill, and the hum of the device is heard, CPR is indicated.
left ventricular assist device (LVAD)
An__ is a valve device placed between the ET tube and a bag-mask device, it may also be placed between the bag and mask if an ET tube is not in place. The__ is designed to limit the air entering the lungs during the recoil phase between chest compressions (FIGURE 14-18). This results in negative intrathoracic pressure that may draw more blood toward the heart, ultimately resulting in improved cardiac filling and circulation during each chest compression.
The__ may be considered when used together with devices that provide active compression-decompression CPR. It is not currently recommended for use with conventional CPR. If ROSC occurs, then the__ should be removed. You should understand research trends regarding the effectiveness of the__!
impedance threshold device (ITD)
A__ is a device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard (FIGURE 14-19). The patient is positioned supine on the backboard, with the piston positioned on top of the patient with the plunger centered over the patient’s thorax in the same manner as with manual chest compressions. The device is then secured to the backboard.
mechanical piston device
The__ allows rescuers to configure the depth and rate of compressions, resulting in consistent delivery. This frees the rescuer to complete other tasks and eliminates rescuer fatigue that results from continuous delivery of manual chest compressions. These devices have been available for many years. The latest versions of these devices offer you the option of providing compressions using a battery instead of an oxygen tank or a compressed air system, thus eliminating the tanks and hoses.
mechanical piston device
The__ is a circumferential chest compression device composed of a constricting band and backboard (FIGURE 14-20). The device is either electrically or pneumatically driven to compress the heart by putting inward pressure on the thorax.
load-distributing band (LDB)
As with the mechanical piston device, use of the __ frees the rescuer to complete other tasks. The device weighs less
than the early-version mechanical piston devices and can be easier to apply.
Although a mechanical CPR device may be a reasonable alternative to conventional CPR in specific settings, manual chest compressions remain the standard of care. If your EMS service uses a mechanical CPR device, then it is critical to practice frequently to ensure that you can apply it rapidly. Remember to minimize interruptions to chest compressions while the device is being applied.
load-distributing band (LDB)
In most cases,__ in infants and children follows respiratory arrest, which triggers hypoxia and ischemia (decreased oxygen supply) of the heart. Children consume oxygen two to three times more rapidly than adults, so you must first focus on opening the airway and providing artificial ventilation. Often, this will be enough to allow the child to resume spontaneous breathing and, thus, prevent cardiac arrest. Therefore, airway and breathing are the focus of pediatric BLS
cardiac arrest
A lack of oxygen that deprives tissues of
necessary nutents, resulung from partial or complete blockage of blood flow; potentially reversible because permanent injury has not
yet occurred.
Ischemia
Which arterty do you check for infants (between age 1 month and 1 year)
Brachial artery
Which artery do you check for children(age 1 year to onset if puberty)
Carotid or femoral artery
CPR will be required if the infant or child is not breathing or is not breathing normally (agonal gasps),and a pulse is absent (or less than __beats/min)
60
The __ (immediately under the right side of the diaphragm) is relatively large and fragile, especially in infants.
liver
The_, on the left, is smaller and more fragile in children than in adults. These organs are easily injured if you are not careful in performing chest compressions, so be sure that your hand position is correct before you begin.
spleen
If the child is unresponsive but breathing adequately, then place him or her in the__ to maintain an open airway and allow drainage of saliva, vomitus, or other secretions from the mouth. Do not use this position if you suspect injury to the spine, hips, or pelvis unless you can secure the child to a backboard that can be tilted to the side.
recovery position
If the child is not breathing but has a pulse, then open the airway and deliver one breath every__ (20 to 30 breaths/min) (FIGURE 14-24). If the child is not breathing and does not have a pulse, then deliver two rescue breaths after every 30 chest compressions (15 chest compressions if two rescuers are present). Each ventilation should last about 1 second and should produce visible chest rise. Use the proper-size mask and ensure an adequate mask-to-face seal
2 to 3 seconds
__is the total percentage of time during a high-quality CPR resuscitation attempt in which chest compressions are being performed. Make every effort to maintain a __ greater than 80% (the higher the better). The more frequent the interruptions in chest compressions, the lower the__ will be.
Chest compression fraction
Stiffening of the body muscles;definitive sign of death
Rigor mortis
Blood settling to the lowest point of the body, causing discoloration of the skin; a definitive sign of death
Dependent lividity
The BLS criteria for TOR differ from the ALS criteria.
BLS criteria include the following three rules:
__
ALS criteria include the three BLS rules plus the following additional two rules:
• Unwitnessed by bystander
• No bystander CPR
• Unwitnessed by EMS
• No AED or shock delivered
• No ROSC
If vou determine a child older than 1 year has an airway obstruction, then __behind the child and provide abdominal thrusts in the same manner as an adult, but use less force, until the object is expelled or the child becomes unresponsive. If the child becomes unresponsive, then follow the same steps as for the unresponsive adult.
stand or kneel
An__ is a narcotic drug that, when taken in excess, depresses the central nervous system and causes respiratory arrest followed by cardiac arrest. Examples of opioids include heroin and oxycodone. Opioids are discussed further in Chapter 22 Toxicology.
opioid
If you encounter a __patient who is in cardiac arrest, then your priorities are to provide high-quality CPR and relieve pressure from the aorta and vena cava. When the patient lies supine, the pregnant uterus can compress the aorta and vena cava (aortocaval compression). Compression of the vena cava causes a significant decrease in blood return to the heart and, secondarily, in the forward flow of blood to the vital organs
pregnant patient
However, if she is in cardiac arrest, then this approach is impractical, because she must remain in a supine position to maximize the effectiveness of compressions. Therefore, if the top of the patient’s uterus (fundus) can be felt at or above the level of the umbilicus, perform manual displacement of the uterus to the patient’s__ to relieve aortocaval compression while CPR is being performed. This step will improve the effectiveness of compressions
Left
