Managing Threats to Life

Question 1

At what rate should rescuers do compressions in CPR?

Answer 1

100-120 compressions/minute

Question 2

At what depth should rescuers compress the chest in infant CPR?

Answer 2

About 1.5” OR 1/3 of Chest/Back Depth

Question 3

Describe the principles of effective rescue breathing.

Answer 3

• Slow breath.
• Look for chest to rise.
• Allow chest to fall before giving next breath.
• Give one breath every 6 seconds for an adult and every 2-3 seconds for a child/infant.

Question 4

Bag Valve Mask

Answer 4

A hand-held device used to provide positive pressure ventilations to patients.

Question 5

Describe how to do a head tilt – chin lift as if coaching someone else to do it.

Answer 5

Lift the chin while sliding the back of the head toward the feet. Make sure not to hyperextend (tilt too far).

Question 6

How often should rescuers check for pulse/breathing?

Answer 6

About every 2 minutes (~ 5 cycles).

Question 7

It is important to minimize interruptions to compressions. What is the maximum amount of time?

Answer 7

When we are not doing compressions, blood is not circulating and oxygen is not being delivered to the tissues. Limit interruptions to less than 10 seconds.

Question 8

Describe the interventions rescuers can do to treat volume shock caused by an external bleed. In other words, what are the steps rescuers should take to control external bleeding. Describe all interventions.

Answer 8

Well aimed direct pressure. Place fingers or palm (rescuer or patient) directly on wound and press firmly.

Apply a pressure dressing and wrap using the following principles:

• Should be rigid and bulky
• Wrap wide in the back and pinpoint at source (i.e., twist of wrap)

Apply a tourniquet if pressure dressing not working, if limb is amputated, or wound is in an area that can’t be accessed using the following principles:

• Apply 2-3” above the wound not over a joint or “high and tight”
• Material should be a couple inches wide.
• Make sure there is no pulse downstream.
• Note time of application.
• Continue to monitor for no pulse. If pulse present, tighten.
• Consider removing after ~ 1 hour to see if bleeding has stopped. When doing so, loosen slowly. If bleeding continues reapply and leave on.

Question 9

What is the compression to PPV ratio for multiple rescuer child and infant CPR?

Answer 9

15 compression : 2 breaths

Question 10

Basic Life Support

Answer 10

The generic process of supporting the functions of the Circulatory, Respiratory, and Nervous systems using CPR, bleeding control, and spine stabilization.

Question 11

Describe the treatment for a patient suffering from an opioid overdose.

Answer 11

Treat what you find (i.e., respiratory failure/arrest – protect airway/PPV)

Administer Naloxone
Be prepared for patient to be combative and have withdrawal symptoms post admin of Naloxone.

Question 12

Describe how to use an AED.

Answer 12

1. Turn on AED. Follow prompts.
2. Wipe bare chest dry. Remove any medication patches with gloved hand.
3. Attach pads (look at pictures on pads). Remove excessive hair by attaching/removing pad. Hair removal can also be accomplished with duct tape.[BD1] Get a new set of pads if removing hair. Pads should not touch and should sandwich the heart.
4. Plug in connector, if necessary.
5. Stand clear while AED is analyzing patient. Make sure no one is touching patient or any part of the AED.
6. Deliver shock if shock advised by pressing “shock” button. Make sure no one is touching the patient during this process.
7. Continue CPR and keep following prompts.

Question 13

Describe how to differentiate between a partial and complete obstruction.

Answer 13

Partial – can still hear some air movement. Noise.

Complete – can no longer hear air movement. Silence.

Question 14

What is the compression to PPV ratio for single rescuer CPR?

Answer 14

30 compression : 2 breaths

Question 15

What is the compression to PPV ratio for multiple rescuer adult CPR?

Answer 15

30 compression : 2 breaths

Question 16

Why is allowing for full recoil crucial in high quality CPR?

Answer 16

The heart needs to be allowed to expand and refill with blood coming from the body for two reasons:

• To receive oxygenated blood.
• To be able to pump out blood on the next compression.

Question 17

Describe how to do a jaw thrust as if coaching someone else to do it.

Answer 17

Place thumbs over each side of the mask thumbs pointing toward chest. Use fingers (i.e., middle finger) to find notch behind lower jaw. Lift lower jaw into the mask.

Question 18

List four other tools that help with airway management that WFRs may encounter when other professional rescuers arrive on scene (i.e., EMTs/Paramedics).

Answer 18

• BVM
• Supplemental Oxygen
• Oropharyngeal Airway Adjunct
• Nasopharyngeal Airway Adjunct

Question 19

Describe the proper sequence of actions for a patient in cardiac arrest.

Answer 19

1. Assess scene safety/protect yourself (BSI)
2. Primary assessment
3. 30 chest compressions followed by 2 breaths allowing for chest to rise/fall each breath. See chart below.
4. Repeat
5. Reassess pulse every couple minutes (~ 5 cycles).
6. If AED is available turn on machine and listen/follow instructions.
7. Switch compressors often (at least every 2 minutes).

Question 20

Describe how to properly use a pocket mask.

Answer 20

Use two hands. Make a C with both hands and place on either side of the mask or use thumb technique described for Jaw Thrust. Draw face into the mask instead of pushing down.

Question 21

Describe the complications associated with tourniquet use.

Answer 21

Ischemia - ≥ 2 hours could lead to permanent nerve injury, muscle injury, vascular injury, skin tissue death; ≥ 6 hours muscle damage is typically complete resulting in amputation.

Compartment Syndrome – arterial blood flow present and venous blood flow is impeded. Blood is trapped in limb, builds up, and puts pressure on tissues resulting in ischemia.

Reperfusion Injury – return of blood flow can cause inflammation and oxidative damage.

Volume depletion due to releasing tourniquet – multiple releases can lead to volume depletion/death

Question 22

At what depth should rescuers compress the chest in child CPR?

Answer 22

About 2” OR 1/3 of Chest/Back Depth

Question 23

Where should the hands be placed when performing CPR on an adult or child?

Answer 23

Two hands on center of chest. Consider using one hand on center of chest for a small child.

Question 24

Describe the treatment for a conscious patient suffering from a complete foreign body airway obstruction.

Answer 24

1. Get consent.
2. Give abdominal thrusts. From behind plant one foot between patient’s legs and one foot back. Get into an athletic stance with one leg behind the other. Encircle arms around patient. Form a fist and place palm of other hand over it. Thrust fist inward and upward just above belly button.
3. Continue until object is dislodged or patient becomes unresponsive.

Question 25

Describe the treatment for a conscious patient suffering from a partial foreign body airway obstruction (a.k.a. “cork”).

Answer 25

Encourage them to cough it out.

Question 26

Describe how to properly use a bag-valve-mask.

Answer 26

Choose the appropriate size BVM for the patient.

Connect a properly fitted mask to the BVM.

If attaching to supplemental oxygen, make sure the reservoir bag is inflated.

Two rescuers should be on the airway. One rescuer holds the mask in place and opens the airway (head tilt chin lift or jaw thrust) while the other rescuer squeezes the bag. The bag should only be squeezed about a third to half maximum (just enough to get the chest to rise).

Question 27

At what depth should rescuers compress the chest in adult CPR?

Answer 27

At least 2” OR 1/3 of Chest/Back Depth

Question 28

Describe the treatment for a patient that is not breathing adequately or not breathing at all but has a pulse.

Answer 28

Rescue breathing (a.k.a. PPV = Positive Pressure Ventilations). Give one breath every 6 seconds for an adult and every 2-3 seconds for a child/infant. Provide breaths slowly looking for the chest to rise.

Question 29

What does an AED do?

Answer 29

If the heart has an abnormal heart rhythm, it stops the heart completely and allows it to reboot itself.

Question 30

Describe how to properly seal the airway when using a barrier device that does not cover the nose.

Answer 30

Place device per instructions (either in the mouth or on top) and pinch nostrils.

Question 31

Automatic External Defibrillator (AED)

Answer 31

A portable electronic device that automatically diagnoses life-threatening cardiac arrhythmias. In the presence of these arrythmias, an AED applies electricity which stops the heart and allows the heart to reestablish an effective rhythm (a reboot).

Question 32

Describe the treatment for a choking patient when they become unresponsive.

Answer 32

1. Gently lower the patient to the ground protecting their head.
2. Give 30 chest compressions.
3. Look in mouth. If see something pull it out.
4. Give 2 breaths. If first breath does not go in re-tilt head.
5. Repeat.
6. Check pulse every couple minutes.

Question 33

What is the purpose of both the head tilt-chin lift and jaw thrust maneuvers?

Answer 33

To draw the tongue away from the throat.

Question 34

Where should the hands be placed when performing CPR on an infant?

Answer 34

2-3 fingers on center of chest (just below nipple line).

Question 35

What types of clues and signs/symptoms would lead a rescuer to believe that a patient is suffering from an opioid overdose?

Answer 35

Unresponsive

Respiratory Failure or Arrest

Pinpoint Fixed Pupils

Look for other clues: track marks arms, b/n toes/fingers, needles, pill bottles

Question 36

What is the PPV rate for adults? 1 breath every ____ seconds. Children/infants? 1 breath every ____ seconds.

Answer 36

One breath every 6 seconds for an adult.

One breath every 2-3 seconds for a child/infant.

Question 37

Describe various ways tourniquets can be utilized.

Answer 37

Scene Safety – use when scene safety is an issue. Apply “high and tight” and get to safety. Then, wipe down limb, slowly release tourniquet to find the source of the bleed, and apply a pressure dressing.

Find the Bleed – use when can’t find the source. Apply, wipe down limb, slowly release, identify site, and apply pressure dressing.

Pressure Dressing Not Working – apply 2”-3” above the wound, not over a joint. May consider releasing tourniquet after an hour to see if clot has formed to stop bleed.

Can’t Access Site – Apply 2”-3” above the wound not over a joint or “high and tight”, whichever is best

Need to address more critical life threats (i.e., respiratory arrest) – apply 2”-3” above wound or “high and tight”