What happens when chest compressions stop?
Blood flow decreases significantly
You are using a bag-mask device to ventilate a 16- year-old in cardiac arrest who suddenly collapsed. An endotracheal tube has been placed by an advanced life support provider on the resuscitation team. Proper provider on the resuscitation team. Proper ventilation technique in the situation requires that you
Squeeze the bag to deliver 1 breath every 6 seconds
What technique may be useful for larger infants or when the BLS provider has difficulty compressing the appropriate depth?
Heel of the one hand technique
You are the only BLS provider responding to witnessing the collapse of an 11 year old child during a softball game. The scene is safe, and you have taken standard precautions. The patient is unresponsive and gasping occasionally. You do not feel a carotid pulse and an AED is within sight. You should ...
Activate EMS or ur occupational emergency action plan and get the AED
The link in the out-of-hospital- adult chain of survival is critical to survival when a patient's heart is at an abnormal rhythm like pulseless ventricular tachycardia (VT) and Ventricular fibrillation (VF) ...is defibrillation
Recovery def
supporting a patients physical and emotional needs that are ongoing after hospital discharge that's part of allowing the patient to survive
when ur adult patient is making abnormal gasping snoring sounds, and there is definitely a carotid pulse what should you do?
provide rescue breathing or bag mask ventilation
when assessing an unresponsive adult, child, or infant, you should take no longer than _________ to simultaneously assess breathing and pulse.
1.5 seconds
When ventilating a child with a bag-mask device, give 1 breath every 2-3 seconds. how long should each breathe be delivered for?
1 second, while watching the chest rise
You are the only BLS provider responding to "baby not breathing." The scene is safe, and you have taken standard precautions. The infant is unresponsive. You have activated EMS or your occupational emergency action plan. Other providers are on the way with an AED. You do not feel a brachial pulse. what should you do?
Immediately start high-quality CPR, beginning with chest compressions.
You and another BLS provider have responded to a call for a 5-month-old infant with trouble breathing. The scene is safe. You have taken standard precautions. The infant is unresponsive and gasping. You have activated EMS or your occupational emergency action plan. A weak brachial pulse at about 40 beats per minute is felt. The infant's skin is mottled, and the hands and feet are cool to touch. Other BLS providers are a few minutes away with an AED. what should you do?
Start high-quality CPR
You are attempting to resuscitate an unresponsive 25-year-old who overdosed on fentanyl. The scene is safe. You have taken standard precautions. EMS or your occupational emergency action plan has been activated. The patient is making snorting sounds. The carotid pulse is definitely felt. You have a bag-mask device, AED, and Narcan Nasal Spray. what should you do?
Ventilate the patient and give naloxone per local medical protocol.
You are a lone BLS provider responding to a possible cardiac arrest. The scene is safe, and you have taken standard precautions. The patient is unresponsive. You have activated EMS or your occupational emergency action plan. Other providers are on the way and you have an AED. The patient is occasionally gasping. You do not feel a carotid pulse. what should you do?
Power on the AED. Apply adult pads to the patient's bare chest.
You are providing CPR to a child under 8 years of age when the AED arrives, but there are no child AED pads available. what should you do?
Use the adult AED pads
When using an AED on a pediatric patient, what may be necessary to do?
Activate the button or "key" to adjust the shock level lower.
You are working as part of a high-performance resuscitation team. The BLS provider ventilating an infant with a bag-mask device should:
Encourage the compressor to perform high quality compressions.
Teamwork in high-performance resuscitation requires what?
use of effective communication
Four BLS providers have been performing CPR on a cardiac arrest patient for 18 minutes. The last switch in roles was only about a minute ago, but the compressor says, "I'm exhausted." what should they do?
Coordinate to switch out the compressor.
A teenager nearby is eating and laughing with friends when suddenly he begins coughing. Then his coughing stops, and he stands, holding his hands to his throat. The scene is safe, and you have taken standard precautions. what should you do?
Have someone activate EMS or your EAP while you begin abdominal thrusts.
A 6-year-old who was eating suddenly begins coughing loudly. The scene is safe, and you have taken standard precautions. You approach and the child says, "I choked... on my crackers." what should you do?
Kneel behind the child and begin abdominal thrusts.
You are attempting to relieve a severe airway obstruction in a responsive pregnant patient. what should you do?
Use chest thrusts instead of abdominal thrusts.
ASHI (BLS) Practice Questions and Answers
defibrillation -
(A controlled electrical shock is sent through the heart to stop ventricular fibrillation, allowing the heart's normal electrical activity to return and restore the normal pumping action of the heart.)
The most effective way to end ventricular fibrillation is __________.
Drowning is a common cause of secondary cardiac arrest in which the heart becomes progressively weaker from the lack of oxygen. Immediate CPR with an emphasis on high-quality rescuer breaths may provide his only chance for survival.
A 34-year-old man has been pulled out of a lake after being submerged for several minutes. Bystanders describe that he appeared to become exhausted while swimming. Why are effective rescue breaths important if your BLS assessment indicates cardiac arrest?
Two main things that influence being able to treat this person in a high-performance manner are 1) high-quality CPR skills and 2) an integrated team approach, much like a pit crew in a car race.
You are part of a team of BLS providers who have responded to a person experiencing a cardiac arrest. Identify which two main things have an influence on being able to treat this person in a high-performance manner.
False
You are caring for a 5-year-old child who is not breathing. Because she is a child, it is not important to use a CPR mask or bag-mask device when giving rescue breaths.
In various ways, dependent on your emergency response protocol
What best describes the manner in which you, as a BLS provider, will activate a response for higher levels of care?
Head tilt-chin lift
a common single-provider technique that displaces the tongue and opens the airway.
jaw thrust
a convenient airway technique when working as a team or when using a bag-mask device.
bag-mask
allows providers to give breaths without blowing in the person's mouth
Jaw thrust without head tilt
can be used when the potential for neck injury exists
Perform CPR immediately, starting with compressions. Irregular gasping, snorting, or gurgling sounds do not provide oxygen and do not indicate normal breathing.
You have responded to someone complaining of severe pressure in the chest. As you are talking to the person, he suddenly slumps onto the floor. You kneel next to him, squeeze his shoulder, and loudly ask, "Are you all right?" He is unresponsive, so you look closely at the face and chest for breathing. At the same time, you feel for a carotid pulse. He makes a brief gasping snort, but then remains still. You cannot feel a pulse within 10 seconds. What do you do next?
Caring for Respiratory Arrest
A person in respiratory arrest has stopped breathing but still has a beating heart
If a BLS assessment indicates respiratory arrest, follow these basic steps.
Begin rescue breathing, delivering a single rescue breath every 5-6 seconds or about 10-12 breaths per minute.
Reassess pulse about every 2 minutes; if absent or unsure, begin CPR
If an opioid overdose is suspected, consider the use of naloxone as indicated by your local protocols
Children and Infants
To perform rescue breathing on a child or infant, deliver a single rescue breath every 3-5 seconds or about 12-20 breaths per minute
Perform CPR on an infant or child if the pulse rate is 60 beats per minute or lower, and it appears the heart is too weak to adequately move blood forward
Signs of poor perfusion include the following: Pale, mottled, or bluish skin. Weak pulse. Cool extremity temperature.
You respond to a teenager who was found unresponsive. Your BLS assessment indicates she is not breathing, but you can clearly feel her carotid pulse. Describe the care you will provide for her.
Provide a single rescue breath every 5 to 6 seconds, or about 10 to 12 breaths per minute. Monitor her pulse about every 2 minutes.
Caring for Cardiac Arrest
If a BLS assessment indicates cardiac arrest:
Begin CPR starting with compressions and deliver ongoing cycles of 30 compressions and 2 rescue breaths
When an AED arrives, use it immediately
Continue until another provider or EMS takes over, or you are too exhausted to continue
Minimize any interruptions to care to maintain high-quality CPR
Compression-Only CPR
Untrained bystanders are encouraged to provide compression-only CPR prior to the arrival of the next level of care
As a trained BLS provider, provide both compressions and breaths
Children and Infants
The steps of caring for cardiac arrest on a child or infant are the same as an adult
The ratio of chest compressions to rescue breaths for a child or infant is also 30:2
You responded to a man who collapsed. Your BLS assessment indicates cardiac arrest. You are with another BLS provider and have an AED with you. Place the following tasks in order of care.
Begin CPR starting with compressions. Perform ongoing cycles of 30 chest compressions and 2 rescue breaths. Stop CPR when the AED is attached and ready to analyze. Deliver a defibrillation shock if directed to by the AED.
Multiple Provider Approach to CPR
It is common for multiple providers to respond to a cardiac arrest
High-performance CPR requires high-quality CPR skills but also relies on the efficiency of multiple providers working as a team
Splitting Compressions and Breaths
When 2 or more providers are available to perform CPR, split the compressions and breaths between providers
The compressor pauses to allow rescue breaths to be given
Switching
Compressions are tiring; switching compressors regularly helps to maintain CPR quality
Communicate switches ahead of time to prevent confusion
Before an AED is attached, switch compressors every 2 minutes after rescue breaths at the end of the CPR cycle
When an AED is attached, switch compressors during AED analysis, typically every 2 minutes
If a third provider is available, he or she can also relieve the compressor
Children and Infants
Use a 15-to-2 ratio of compressions to breaths when 2 or more providers are performing CPR on a child or infant
When doing 2-provider CPR compressions on an infant, encircle the sides of the chest with your hands and use your thumb tips to compress the lower third of the breastbone
When 2 or more providers are available to perform CPR (assuming others are available to handle priority things such as getting an AED), split the compressions and breaths between providers.
TRUE. When 2 more providers are available to perform CPR, compressions and breaths should be split between the providers.
Team Approach
When 2 or more BLS providers respond, orchestrating actions is necessary for high-performance resuscitation
Effective team communication is essential
Speak calmly and in simple terms
If asked to do something, repeat it back
Recognize the common roles identified for a team resuscitation and be ready to assume any one of them
Debriefing
After a resuscitation, a facilitated group discussion, or debriefing, lets team members reflect on the care provided
Changes based on debriefing can improve the overall standard of care for future resuscitations
Advanced Airways
An advanced airway device may be inserted into the throat during a resuscitation to protect and maintain an open airway. When in place, the bag-mask is attached directly to the device. Pauses in compressions for breaths are unnecessary
Uninterrupted compressions are given at a rate of 100-120 times per minute
A single rescue breath is given every 6 seconds
What is the most influential part of using a team approach that creates a higher performance of CPR?
The ability to orchestrate actions overall, much like a pit crew in a car race.
When two or more BLS providers respond in an emergency, orchestrating actions, much like a pit crew in a car race, is necessary for high-performance resuscitation.
Choking
Occurs when a solid object, such as a piece of food, enters a narrowed part of the airway and becomes stuck
Mild Obstruction
Some ability to inhale, an affected person can cough up the object on his or her own
Allow person to try and relieve obstruction without help
Severe Obstruction
Person cannot inhale air and create an effective cough
Repeated abdominal thrusts, given by standing behind someone and wrapping your arms around him or her, have shown to be extremely effective in relieving a severe foreign-body airway obstruction.
Thrusts should be repeated until the person can breathe normally
If the person becomes unresponsive, perform CPR and look for object in the mouth prior to giving sets of rescue breaths
When someone is clearly pregnant or obese, use chest thrusts
If you are alone and choking, press your abdomen quickly against a rigid surface, such as the back of a chair
Abdominal and chest thrusts can cause internal injury; anyone who has had these maneuvers used on him-or herself should be evaluated further to ensure there are no injuries
Children and Infants
Young children are particularly at risk for choking
The care for choking on a child is very similar to an adult
For infants, repeating cycles of 5 back blows and 5 chest thrusts is recommended
You are in the hospital cafeteria eating lunch with a coworker. He is laughing at something you said when he suddenly stops, grasps his throat with his hands, and stands up quickly. He clearly looks distressed so you stand up next to him and ask, "Are you choking?" He nods yes to you and is completely silent. Place the following tasks in order of care.
Stand behind him. Reach around and locate his navel with your finger. Make a fist with your other hand and place the thumb side against the abdomen, just above your finger and below his ribs. Grasp your fist with the other hand, and give a quick inward and upward thrust to expel the obstruction. Repeat thrusts until he can breathe normally.
ASHI CPR Practice Questions and Answers
Perform CPR and check the mouth for an object before rescue breaths.
You are alone with an adult man who is choking. Another person has gone to get more help. You are performing abdominal thrusts when he suddenly collapses. What should you do next?
Place her in the side-lying recovery position.
You are providing care to a 23-year-old female found unresponsive on a couch at a party. She is breathing normally and has a pulse. You should immediately do which of the following?
Start CPR; 30:2 compressions to ventilations.
You and another provider are attending to a 17-year-old boy found unresponsive with occasional gasps. You are not certain if a pulse is present. What should you do?
15:2 with 2 thumbs and the fingers encircling the chest
When two or more providers are performing CPR on an infant, the compression to ventilation ratio and preferred chest compression method is:
Clear the person and immediately deliver the shock.
A roofer was electrocuted when his aluminum ladder contacted an energized power line. The scene has been made safe and you have determined he is in cardiac arrest. The AED has analyzed the heart and is indicating a shock is advised. What should you do?
ventricular fibrillation; defibrillation
Sudden cardiac arrest in an adult is most likely caused by ________ and requires ________.
Send the friend to activate EMS and get an AED, then begin CPR yourself.
You find an 11-year-old child who is unresponsive and blue. She is not breathing normally and you cannot feel a carotid pulse. Her friend states that she collapsed and stopped moving after playing the "pass out" choking game. You are the only trained BLS provider. What do you need to do?
To follow a set of infection control practices used whether or not an infection is suspected
To observe standard precautions means:
Look at the face and chest for signs of breathing.
You have determined a 47-year-old man is unresponsive. In order to assess for normal breathing, what should you do?
High-quality CPR skills and an efficient team approach
High-performance CPR includes:
Change positions every 2 minutes.
Two providers are performing CPR. What should they do to prevent fatigue and maintain the quality of chest compressions?
Immediately resume CPR and follow any instructions given by the AED.
After delivering a shock with an AED, you should:
Adults outside a hospital
Early recognition of cardiac arrest and activation of an emergency response protocol; immediate high-quality CPR; rapid defibrillation; effective BLS and ALS care and transportation; and effective post-cardiac arrest care at a hospital are the links in which chain of survival?
Grasp the shoulder and hip and roll the child onto his side.
You are caring for a child who is unresponsive but breathing normally. No trauma is suspected, and the scene is safe. You want to protect the child's open airway. You have extended the arm nearest to you up alongside the head, brought the other arm across his chest, and have the back of his hand against his cheek. What is your next step?
Cut open or tear away the man's shirt and apply the pads to his bare chest
You are performing CPR on a 65-year-old man who suddenly collapsed. Another provider shows up with an AED. She turns on the device and the voice instructions begin. What is the next step?
Attach the AED quickly and follow the voice instructions.
You have been performing CPR on a 9-year-old child for about 4 minutes. An AED has just arrived. What should you do?
Perform CPR with effective rescue breaths.
You respond as an EMS provider to a 51-year-old man found collapsed near a car with its engine running inside a closed garage. Bystanders have dragged him outside onto the lawn. He is unresponsive and does not appear to be breathing normally. You cannot feel his carotid pulse. What is the indicated care?
Check her for breathing and pulse at the same time.
It's a hot day and you have responded as an EMS provider to a report of a woman suddenly collapsing to the floor at a grocery store. The scene is safe and she is unresponsive to your voice and touch. What is your next action?
Children and infants
Prevention of airway and breathing emergencies; early CPR with an emphasis on effective rescue breaths and, if needed, rapid defibrillation; early activation of the appropriate emergency response protocol; effective BLS and ALS care and transportation; and effective post-cardiac arrest care at a hospital are the links in which chain of survival?
Adults inside a hospital
Monitoring, prevention, and treatment of pre-arrest conditions; early recognition of cardiac arrest and activation of an emergency response protocol; immediate high-quality CPR; rapid defibrillation; and effective post-cardiac arrest care are the links in which chain of survival?
Immediately provide CPR.
You are attending to a 54-year-old man who collapsed suddenly and is unresponsive. He is not breathing normally and you cannot feel a pulse. There is no suspicion of trauma and your emergency response protocol is being activated. What is your next step?
Sudden cardiac arrest; CPR, defibrillation
You have responded to a report of an abrupt collapse of a middle-aged man at a local office building. Your BLS assessment shows the man is unresponsive, not breathing normally, and has no carotid pulse. This condition is most likely caused by and treated with:
Respiratory arrest
You are attending to a person who is unresponsive, not breathing normally, but you can clearly feel a carotid pulse. What is the determined problem?
Inspect the CPR mask to make sure a one-way valve is in place.
You are attending to a neighbor who is unresponsive, not breathing normally, and pulseless. Your spouse has left to activate EMS while you begin CPR. You have just given your first set of compressions and are ready to give your initial rescue breaths. What is your next step?
Ensure there is an open airway for rescue breaths.
When providing CPR on a child or infant:
Place the person in a side-lying recovery position.
You are attending to a person who is unresponsive and is breathing normally. You are alone and need to leave to activate EMS. Before leaving, what should you do?
Stay close and let her try to resolve the problem on her own.
In the hospital cafeteria, a hospital employee suddenly begins to cough loudly at her table. She appears to be trying to get something out of her throat. Her eyes are watering and she continues to cough forcefully. What should you do?
Perform abdominal thrusts.
While eating, an older woman suddenly grabs her throat and cannot make any sound. You ask, "Are you choking?" She nods yes. What should you do?
Use a CPR mask with a one-way valve.
You are performing CPR Exam on your uncle who collapsed at a family gathering where you are the only trained BLS provider. What is the recommended approach to deliver rescue breaths?
Assess scene safety; check response; check breathing and pulse; activate emergency response protocol
What are the basic steps of the BLS Assessment in the proper order?
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