What is the primary reason for immediate bystander CPR?
Improve a victim's chance for survival by providing a flow of oxygen rich blood to the heart and brain before defibrillation is started. This buys time for the victim's survival.
What are the 6 critical concepts of high-quality CPR, which are most likely to positively impact the victim's survival?
1. Start compressions within 10 seconds of cardiac arrest.
2. Push hard, push fast: compress at rate of 100-120 compressions per minute at a depth of at least 2" for adults (adolescents to adults); 1/3 of depth of chest, about 2" for children (1 year old
What are the 5 links of the Adult Chain of Survival?
1. Immediate recognition of cardiac arrest and activation of the emergency response system.
2. Early CPR with emphasis on chest compressions.
3. Rapid defibrillation with an AED (can eliminate abnormal heart rhythm)
4. Effective advanced life support.
5.
What are the 5 links of the Pediatric Chain of Survival?
1. Prevention of arrest.
2. Early high-quality bystander CPR.
3. Rapid activation of the emergency response system.
4. Effective advanced life support.
5. Post-cardiac arrest care.
Why is there a difference between the adult and pediatric chains of survival?
In adults cardiac arrest is often sudden and results from a cardiac (heart) cause. In children, cardiac arrest is often secondary to respiratory failure and shock (example in a child-- asthma or allergic reaction)
*Note: In a child in respiratory distress
What is the current BLS sequence of steps?
Chest Compressions, Airway, Breathing
Can you check for responsiveness and breathing at the same time?
Yes, and this is important to save time. (Check for responsiveness by tapping shoulder and asking, are you okay?) (Check for breathing by looking for chest rise)
When do you need to do CPR?
When the victim is unresponsive, not breathing or not breathing normally, and has no pulse.
When do you first access a scene for safety?
As soon as you are at the scene of the emergency.
If you are alone with an adult victim, when do you activate the emergency response system?
After you have assessed the scene to be safe and checked for unresponsiveness.
How long do you check for a pulse if alone?
For at least 5 seconds but no more than 10 seconds.
When do you check for a pulse if alone?
After you have assessed the scene for safety, checked for unresponsiveness, called for help, then you would check for breathing and the pulse at the same time.
What is the ratio of compressions to breaths for one rescuer for any victim?
30 chest compressions followed by 2 breaths.
What are agonal gasps?
Sign of cardiac arrest; not normal breathing; may sound like a snort, snore, or gasp.
What do you do if the victim is unresponsive and having agonal gasps?
Because the victim is in cardiac arrest, you must start CPR, starting with chest compressions.
Where do you check the pulse on an adult victim?
Palpate the carotid artery on the side of the neck closest to you.
What do you do if you are not sure you feel a pulse after 10 seconds?
Start chest compressions.
After you have completed 2 minutes of 5 cycles of compressions and breaths, what do you do next?
Check the pulse again and if no pulse, go back to chest compressions.
When can you stop CPR?
When EMS arrives and takes over or if the environment becomes dangerous (fire, building collapse) or if you cannot perform high quality CPR in the position you are in (inside a vehicle) or if you need to reach another victim that needs care quicker.
When giving breaths, how long should each breath last?
About one second.
What is the location of the hands for compressions for adult victims?
The heel of one hand in the center of the chest on the lower half of the breastbone (sternum). Put the heel of the other hand on top of the first hand and grasp the fingers together. As an alternative-- the heel of one hand in the correct position on the
How is the airway opened to provide breaths?
Head-tilt chin-lift. Place one hand on the victim's forehead and tilt the head back and at the same time, lift the chin with the fingers of the other hand.
What do you do if the victim vomits?
Roll the victim in one motion onto their side and away from you. Clean out the vomit by wiping out the mouth with protected fingers. When the vomit is out, roll the victim back and proceed with breaths.
You should start compressions within how many seconds after identifying an unresponsive victim with no normal breathing or pulse?
Within 10 seconds.
When is it acceptable to only do chest compressions with no breaths (hands only CPR)?
When no barrier is available, and the victim is an adult. Note-- Not acceptable for infants or children.
What is the maximum amount of time you can interrupt chest compressions?
No more than 10 seconds,
What are the signs of cardiac arrest?
Unresponsiveness, no breathing or normal breathing, no pulse.
What is the difference between a heart attack and sudden cardiac arrest?
A heart attack occurs when blood flow to part of the heart muscle is blocked and a sudden cardiac arrest occurs when the heart develops an abnormal rhythm and cannot pump blood.
When is the jaw-thrust used to open the airway?
When the victim has a suspected spinal injury(vehicle crashes, falls fro heights) or when the head-tilt chin-lift doesn't work. Only attempt the jaw-thrust maneuver once and then go to the head-tilt chin-lift. Also use this with cervical spine immobilizat
What is a bag mask and name 3 things to remember when using a bag mask?
A bag attached to a face mask that can provide ventilation to a victim who is not breathing or not breathing normally. When using the bag mask, remember to keep a tight seal against the face, keep the airway open, and provide enough air to make the chest
Why is a bag mask not recommended for the single rescuer?
It is most effective with two rescuers rather than the single rescuer because one rescuer can secure the mask to the face, while the other one gives breaths by squeezing the bag.
If the stomach inflates during bag mask use, what are you doing wrong?
Giving breaths too forcefully or too fast.
How do you minimize the risk of gastric inflation during the use of the bag mask?
Give only enough air to make the chest rise.
In adult 2-rescuer CPR, what is the job of the 1st rescuer? The second rescuer?
The first rescuer begins high quality CPR starting with chest compressions while the second rescuer maintains an open airway and gives breaths. The second rescuer can also get the AED and call 911.
When do the two rescuers change jobs?
They change jobs after about 5 cycles of chest compressions and breaths or about every 2 minutes or typically when the AED is analyzing the rhythm.
If the jaw thrust is not successful in opening the airway on the 1st attempt, what do you do next?
Go to head tilt, chin lift method.
When should an AED be implemented?
As soon as it is available at the scene of the emergency.
What is the first step in the use of an AED?
Power on the AED (push the button to turn it on)
What is meant by "clearing" the victim when using the AED?
By verbally addressing all around the victim to not touch because the AED is analyzing the rhythm and then again when the AED is ready to deliver the shock.
What should you do if the AED indicates that no shock is needed?
Immediately begin chest compressions.
How long will you give CPR before the AED again prompts you that it is reanalyzing the victim?
About 2 minutes or 5 cycles of chest compressions and breaths.
How should you handle a victim lying in water or covered with water when using an AED?
They must be moved from the water and then the chest must be quickly dried. If the victim is lying in a small puddle or in snow, you may use the AED without moving them but you still need to wipe the chest if any water is there.
Do you ever remove the AED pads from the victim?
No, this will be taken over by the ALS personnel.
Where do you attach the AED pads if the victim has an implanted pacemaker?
Never over the pacemaker but at least an inch away from it.
How do you attach the AED if the person has a hairy chest?
If the AED indicates "poor contact" after the pads have been attached, try to push them down further. If this is unsuccessful and you have another set of pads, pull the first set off quickly to remove the hair, and then attach the second set. If you have
What do you do about a transdermal medication patch when using an AED?
Remove the patch and quickly wipe the chest before attaching the AED pads. Use gloves to remove the patch.
If a second rescuer arrives with the AED while you are in the process of giving CPR, what do you do?
Continue with chest compressions and breaths while the second rescuer turns on the AED and prepares to use it.
After the AED detects ventricular fibrillation, what is the next step in using the AED?
Follow the prompts from the AED.
In effective team dynamics, what are the resuscitation triangle roles?
1. Compressor-- accesses the patient, does 5 cycles of chest compressions; alternates with AED/Monitor/Defibrillator every 5 cycles or two minutes.
2. AED/Monitor/Defibrillator-- brings and operates the AED; alternates with the compressor every 5 cycles o
What are the other members of a 6-person high performance team?
1. Team Leader-- assigns roles to team members, makes treatment decisions, provides feedback, assumes responsibility for roles not assigned.
2. Administer Medications-- an ALS provider role who administers medications.
3. Timer/Recorder-- records the time
Why is it important to know your limitations or boundaries in a team situation?
So inadequate techniques don't hamper the team operations which keeps the situation safe.
How is closed loop communications used in a team situation to keep members focused and understanding all instructions?
Team leaders calls team members by name; team leader assigns tasks to team members being sure they understand instructions; team members confirm they understand by verbally repeating them back to the team leader; team members tell team leader when they ar
If a lone rescuer comes on the scene with the AED, what should he do first?
Be sure to check the scene for safety, check the victim for responsiveness and breathing, and call 911, then he should power on the AED and put it into service for the victim.
Which size pads should be used on an adult victim?
Adult pads only can be used on adults. No other size pads will be strong enough to effectively issue the correct shock for the adult. If no adult pads are available, then the rescuer should go to chest compressions and breaths until ALS personnel arrive.
What is important about an AED in relation to a victim's chance of survival?
The use of the AED in light of ventricular fibrillation resets the electrical system of the heart to return of normal (organized) heart rhythm.
If you do not witness the cardiac arrest of a child, what should you do?
Check for responsiveness, shout for help, check for breathing and pulse, begin CPR. After 2 minutes or 5 cycles, activate emergency response system.
If you witness the cardiac arrest of a child, what should you do?
First check for responsiveness, breathing, and pulse. Then activate emergency response. Then begin CPR.
What is the compression ventilation ratio for 2 rescuers for a child? One rescuer?
15:2, 30:2.
What is the hand technique used to give compressions to a child?
The heel of one hand in the center of the chest, lower half of the breastbone or two hands as with the adult.
For a child victim, if no pulse is felt within 10 seconds or the heart rate is below 60 beats per minute, what should you do?
Start chest compressions immediately.
Why are breaths important for infant and children in cardiac arrest?
Because their cardiac arrest probably started with a respiratory event, there may be oxygen poor blood in the victim which requires the breaths.
Where is the pulse takes on a child?
The carotid artery at the side of the neck closest to the rescuer. Also the pulse could be taken at the femoral artery on the inside of the upper leg.
If a child has a heart rate greater than 60 beats per minute and is not breathing, what should you do?
The heart rate is adequate but you need to give rescue breathing at the rate of one breath every 3-5 seconds.
What is the best technique to give compressions to an infant when there are two rescuers?
The two-thumb encircling hands technique is preferred.
What is the compression to breaths ratio for an infant when there are two rescuers?
15:2
Where is the pulse taken on an infant?
On the brachial artery on the inside of the upper arm closest to the rescuer.
When do you activate EMS for an infant?
If unwitnessed, after 2 minutes of CPR. If witnessed, activate EMS and then begin CPR.
What is the proper position for the hands to give chest compressions to an infant with one rescuer?
Two fingers of one hand in the center of the chest below the nipple line on the lower half of the breastbone.
Why must you keep an infant's head in a neutral position when opening the airway?
This will open the airway correctly. If they head is tilted too far back, it could close the airway.
If an infant has a heart rate below 60 beats per minute, what should you do?
Begin chest compressions because this is an inadequate heart rate.
What are the preferences in the use of an AED for infants and children?
The AED can be used with infants and children in similar methods as for adults. A manual defibrillator is preferred but if that is not available, then a standard AED with either pediatric pads or adult pads if no pediatric pads can be used.
What must you do when using adult pads for infant of children victim?
Be sure the pads are not touching. They can be used in the same position as the adult pads or if the victim is small, then one pad could be placed on the front of the victim and one pad would be placed on the victim's back.
With an advanced airway, what is the rate of breaths?
One breath every 6 seconds without stopping compressions.
What is the proper technique for giving mouth-to-mouth breaths?
Hold the victim's airway open with a head tilt-chin lift; pinch the nose closed with your thumb and index finger (using the hand on the forehead); take a regular breath and seal your lips around the victim's mouth.
If the chest does not rise with your first attempt to give mouth-to-mouth breaths, what should you do?
Repeat the head tilt-chin lift.
What should you do if 2 attempts to give mouth-to-mouth breaths fail to make the chest rise?
Move to chest compressions quickly.
How long should each breath last in mouth-to-mouth breaths?
About one second.
What may cause gastric inflation during rescue breaths?
Giving breaths too hard (too forcefully) or too fast.
What is the proper way to give mouth-to-mouth rescue breaths to an infant?
Seal your mouth over the infant's mouth and nose.
What is the rate of rescue breathing for an adult? For infants and children?
One breath every 5-6 seconds (10-12 breaths per minute). One breath every 3-5 seconds (12-20 breaths per minute).
If a person who is chocking can still cough, speak, or breathe, what should you do?
Encourage the victim to keep coughing.
What are the signs of severe airway obstruction?
Clutching the throat with the thumb and fingers, unable to speak or cry, poor or no air exchange, high pitched noise while inhaling or no noise at all, increased respiratory difficulty, possible cyanosis (turning blue).
How is an airway obstruction relieved in a conscious adult or child?
With abdominal thrusts (Heimlich maneuver).
If a conscious chocking victim is obese or pregnant, what should you do?
So chest thrusts instead of abdominal thrusts.
If an adult or child chocking victim becomes unresponsive, what should you do?
Have someone call 911 and begin chest compressions immediately.
If you see an object, what would you do?
Sweep it out with the fingers in a hooking motion along the inside of the cheek.
If you don't see an object in a chocking victim, what do you do?
After giving chest compressions, you should open the airway and look for the object. If you don't see it, you should attempt 2 breaths and then go back to chest compressions.
When do you activate EMS for an adult or child chocking victim?
When they become unresponsive.
How do you relieve chocking in the conscious infant?
5 back slaps followed by 5 chest thrusts.
In what position do you hold the conscious infant to relieve chocking?
With its head lower than the rest of the body.
How do you relieve choking in the unconscious infant?
With chest compressions followed by a check for the object in the mouth and two breaths. Then return to chest compressions. Continue until the object is removed and the infant resumes breathing.