9781284243796_SLID_CH14.pptx

CHAPTER 14 BLS Resuscitation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies Applies a fundamental knowledge of the causes, pathophysiology, and management of shock, respiratory failure or arrest, cardiac...

CHAPTER 14 BLS Resuscitation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies Applies a fundamental knowledge of the causes, pathophysiology, and management of shock, respiratory failure or arrest, cardiac failure or arrest, and postresuscitation management. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Shock and Resuscitation Introduction  The most recent review (2020) was conducted by the International Liaison Committee on Resuscitation (ILCOR). Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The principles of basic life support (BLS) were introduced in 1960.  Specific techniques have been reviewed and revised regularly. Elements of BLS (1 of 8)  Airway obstruction  Respiratory arrest  Cardiac arrest Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Noninvasive emergency life-saving care  Used to treat medical conditions including: Elements of BLS (2 of 8)  Airway (obstruction)  Breathing (respiratory arrest)  Circulation (cardiac arrest or severe bleeding) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Focus is on the ABCs. Elements of BLS (3 of 8)  Permanent brain damage is possible if brain is without oxygen for 4 to 6 minutes. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ideally, only seconds should pass between the time you recognize a patient needs BLS and the start of treatment. Elements of BLS (4 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-2 Time is critical for patients who are not breathing. If the brain is deprived of oxygen for 4 to 6 minutes, brain damage is possible. © Jones & Bartlett Learning. Elements of BLS (5 of 8)  Reestablishes circulation and artificial ventilation in a patient who is not breathing and has no pulse Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Cardiopulmonary resuscitation (CPR) Elements of BLS (6 of 8) 1. Restore circulation (perform chest compressions). 2. Open the airway. 3. Restore breathing (provide rescue breathing). Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  CPR steps Elements of BLS (7 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-3 You must quickly identify patients in respiratory and/or cardiac arrest so that BLS © Jones & Bartlett Learning. of MIEMSS. measures can Courtesy begin immediately. Elements of BLS (8 of 8)  Cardiac monitoring  Intravenous fluids and medications  Advanced airway adjuncts Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  BLS differs from advanced life support (ALS).  ALS involves: The System Components of CPR (1 of 2) Data from the American Heart Association. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-4 The six links of the chain of survival. The System Components of CPR (2 of 2)  Recognition and activation of the emergency response system  Immediate, high-quality CPR  Rapid defibrillation  Basic and advanced emergency medical services  ALS and post-arrest care  Recovery Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  AHA chain of survival Assessing the Need for BLS (1 of 3)  Evaluate ABCs.  Determine unresponsiveness.  Should take less than 10 seconds Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Always begin by surveying the scene.  Complete primary assessment as soon as possible. Assessing the Need for BLS (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Basic principles of BLS are same for infants, children, and adults.  Although cardiac arrest in adults usually occurs before respiratory arrest, the reverse is true for infants and children. Assessing the Need for BLS (3 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-5 Assess an unresponsive patient by first attempting to rouse him or her by tapping on © Jonesshoulder. & Bartlett Learning. Courtesy of MIEMSS. the Automated External Defibrillation (1 of 3)  If you witness cardiac arrest, begin CPR and apply the AED as soon as it is available. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Vital link in the chain of survival  Should be applied to cardiac arrest patients as soon as available Automated External Defibrillation (2 of 3)  Children  If neither is available, then use an AED with adult-sized pads with anteriorposterior placement. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Apply after first five cycles of CPR.  Use pediatric-sized pads and dose-attenuating system. Automated External Defibrillation  Pacemakers and implanted defibrillators  Wet patients  Transdermal medication patches Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Special situations (3 of 3) Positioning the Patient  Log roll patient onto long backboard. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  For CPR to be effective, patient must be supine on firm, flat surface.  Must be enough space for two rescuers to perform CPR Check for Breathing and a Pulse (1 of 5)  Visualize the chest for signs of breathing.  Palpate for a carotid pulse. FIGURE 14-6 Feel for the carotid artery by locating the larynx, then slide your index and middle fingers toward one side. You can feel the pulse in the groove between the larynx and sternocleidomastoid © Jones & Bartlett Learning. Courtesy of MIEMSS. muscle. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Quickly check for breathing and a pulse. Check for Breathing and a Pulse (2 of 5)  Apply rhythmic pressure and relaxation to lower half of sternum.  Compressions squeeze heart, acting as a pump to circulate blood.  Avoid leaning on the chest in between compressions. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Provide external chest compressions. Check for Breathing and a Pulse (3 of 5)  Allow the chest to completely recoil between compressions.  Proper hand positioning is crucial.  Injuries can be minimized by proper technique and hand placement. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Administer chest compressions (cont’d) Check for Breathing and a Pulse (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-7 The heart lies slightly to the left of the middle ofLearning. the chest between the sternum and © Jones & Bartlett spine. Check for Breathing and a Pulse (5 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-8 A. Compression and relaxation should be rhythmic and of equal duration (a 1:1 ratio). B. Pressure on the sternum must be released so that the sternum can return to its normal resting position between A, B: © Jones & Bartlett Learning. Courtesy of MIEMSS. compressions. Opening the Airway and Providing Artificial Ventilation (1 of 7) Head tilt–chin lift maneuver FIGURE 14-12 To perform the jaw-thrust maneuver, maintain the head in neutral alignment and place your fingers behind the angles of the lower jaw, and move the upward. © Jonesjaw & Bartlett Learning. Courtesy of MIEMSS. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-11 To perform the head tilt– chin lift maneuver, place one hand on the patient’s forehead and apply firm backward pressure with your palm to tilt the head back. Next, place the tips of the index and middle fingers of your other hand under the lower jaw near the bony part of the chin. Lift the chin upward, © Jones & Bartlettthe Learning. bringing entire lower jaw Jaw-thrust maneuver Opening the Airway and Providing Artificial Ventilation (2 of 7)  Maintains clear airway  Allows vomitus to drain from mouth  Roll the patient as a unit. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If the patient is adequately breathing, and there are no signs injury to the head, spine, hip, or pelvis, place the patient in the recovery position. Opening the Airway and Providing Artificial Ventilation (3 of 7) Recovery position Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-13 The recovery position is used to maintain an open airway in an adequately breathing patient with a decreased level of consciousness who has no spinal injury. © Jones & Bartlett Learning. Courtesy of MIEMSS. It allows vomitus, blood, and any other secretions Opening the Airway and Providing Artificial Ventilation (4 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The combination of lack of oxygen and too much carbon dioxide in the blood is lethal.  If patient is not breathing, ventilations can be given by one or two EMS providers.  Use a barrier device. Opening the Airway and Providing Artificial Ventilation (5 of 7) © Jones & Bartlett Learning. Courtesy of MIEMSS. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-14 When you provide ventilations, use a bag-mask device. Opening the Airway and Providing Artificial Ventilation (6 of 7)  Have a suction unit available in case patient vomits. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  For a patient with a stoma, place a bag-mask device or pocket mask device directly over the stoma.  Artificial ventilation may result in gastric distention. Opening the Airway and Providing Artificial Ventilation (7 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-15 A. This stoma connects the trachea directly to the skin. B. Use a bag-mask device to ventilate a patient with a stoma. A, B: © Jones & Bartlett Learning. Courtesy of MIEMSS. One-Rescuer Adult CPR Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Single rescuer gives both chest compressions and artificial ventilations.  Ratio of compressions to ventilations is 30:2. Two-Rescuer Adult CPR  Less tiring  Facilitates effective chest compressions  Switching rescuers during CPR is critical to maintain high-quality compressions.  Recommended to switch positions every 2 minutes Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Always preferable to one-rescuer CPR Devices and Techniques to Assist Circulation (1 of 4)  Involves compressing the chest and then actively pulling it back up to its neutral position  Impedance threshold device (ITD)  Limits air entering lungs during recoil phase between chest compressions Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Active compression-decompression CPR Devices and Techniques to Assist Circulation FIGURE 14-18 An impedance threshold device Courtesy of Advanced Circulatory Systems, Inc. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-17 An active compression-decompression Provided device. with permission by ZOLL Medical CPR (2 of 4) Devices and Techniques to Assist Circulation (3 of 4)  Allows rescuer to configure the depth and rate of compression  Load-distributing band CPR or vest CPR  A circumferential chest compression device composed of constricting band and backboard  Manual chest compressions remain the standard of care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mechanical piston device Devices and Techniques to Assist Circulation Provided with permission by ZOLL Medical. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-20 A load-distributing band. (4 of 4) Infant and Child CPR (1 of 5)  Cardiac arrest in infants and children follows respiratory arrest. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Airway and breathing are the focus of pediatric BLS. Infant and Child CPR (2 of 5)  Causes of child respiratory problems:  Foreign body  Submersion  Electrocution  Poisoning/overdose  SIDS Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Injury  Infections Infant and Child CPR (3 of 5)  Determine unresponsiveness.  Check for breathing and a pulse.  Assessment occurs simultaneously.  Should take no longer than 10 seconds Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Gently tap on the shoulder and speak loudly. Infant and Child CPR (4 of 5)  Foreign body obstruction in children is common.  The techniques for opening the airway are modified for pediatric patients.  Place a wedge under the upper chest and shoulders when supine. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Place an unresponsive, breathing child in the recovery position. Infant and Child CPR (5 of 5)  Provide rescue breathing.  1 breath every 2 to 3 seconds  Not breathing and no pulse:  2 breaths after every 30 compressions Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Not breathing and has a pulse: Interrupting CPR (1 of 2)  Provide transport per local protocols.  Consider requesting ALS rendezvous en route to hospital. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  CPR is a crucial, life-saving procedure.  If no ALS available at scene: Interrupting CPR (2 of 2)  The total percentage of time during a resuscitation attempt in which chest compressions are being performed  Should be at least 80% (the higher the better) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Try not to interrupt CPR for more than a few seconds.  Chest compression fraction When Not to Start CPR (1 of 3)  Rigor mortis (stiffening of body)  Dependent lividity (livor mortis)  Putrefaction or decomposition of body  Evidence of nonsurvivable injury Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If the scene is not safe  If the patient has obvious signs of death When Not to Start CPR (2 of 3) Dependent lividity Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-25 Dependent lividity is an obvious sign of death, caused by blood settling to the areas of the body not in firm contact with the ground. The lividity in this figure is seen as purple discoloration of the back, except in areas that are in firm contact with the ground (scapula and buttock). © American Academy of Orthopaedic Surgeons. When Not to Start CPR (3 of 3)  When in doubt, begin CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If the patient and physician have previously agreed on do not resuscitate (DNR) orders: When to Stop CPR  S Patient Starts breathing and has a pulse.  T Patient is Transferred to another provider of equal or higher-level training.  O You are Out of strength.  P Physician directs to discontinue. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Once you begin CPR, continue until: Foreign Body Airway Obstruction in Adults  Relaxation of throat muscles  Vomited or regurgitated stomach contents  Blood  Damaged tissue  Dentures  Foreign bodies Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Airway obstruction may be caused by: (1 of 7) Foreign Body Airway Obstruction in Adults (2 of 7)  Patient with mild airway obstruction is able to exchange air but with signs of respiratory distress. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  In adults, usually occurs during a meal  In children, usually occurs during a meal or at play Foreign Body Airway Obstruction in Adults (3 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Sudden, severe obstruction is usually easy to recognize in responsive patients.  In unresponsive patients, suspect obstruction if maneuvers to open airway and ventilate are ineffective.  Abdominal-thrust maneuver (Heimlich) is recommended in responsive adults and children older than 1 year. Foreign Body Airway Obstruction in Adults (4 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-28 The abdominal thrust maneuver in a responsive adult. Stand behind the patient and wrap your arms around the patient’s abdomen. Place the thumb side of one fistLearning. against patient’s abdomen while © Jones & Bartlett Courtesythe of MIEMSS. Foreign Body Airway Obstruction in Adults (5 of 7)  Women in advanced stages of pregnancy  Obese patients Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Instead of abdominal-thrust maneuver, use chest thrusts for the following responsive patients: Foreign Body Airway Obstruction in Adults Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-29 Removal of a foreign body obstruction in a responsive adult using chest thrusts. Stand behind the patient and wrap your arms around the patient’s chest. Place the Learning. thumb side of one fist against the © Jones & Bartlett Courtesy of MIEMSS. chest while (6 of 7) Foreign Body Airway Obstruction in Adults (7 of 7)  Determine unresponsiveness.  Check for breathing and a pulse.  If pulse is present and breathing is absent, attempt ventilation.  If two attempts do not produce visible chest rise, perform 30 compressions, open airway, and look in mouth.  Attempt to carefully remove any visible object. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Unresponsive patients: Foreign Body Airway Obstruction in Infants and Children (1 of 5)  Common problem  On responsive, standing or sitting child, perform Heimlich maneuver.  On unresponsive child older than 1 year, manage in the same manner as an adult. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If there are signs and symptoms of airway obstruction, do not waste time trying to dislodge a foreign body. Foreign Body Airway Obstruction in Infants and Children (2 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-31 To perform the abdominal thrust maneuver on a child, kneel behind the child on one knee, wrap your arms around the child’s body, and place your fist © Jones & Bartlett Learning. Courtesy of MIEMSS. just above Foreign Body Airway Obstruction in Infants and Children (3 of 5)  Do not use abdominal thrusts.  Perform back slaps and chest thrusts (compressions). Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Responsive infants Foreign Body Airway Obstruction in Infants and Children (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 14-32 A. Hold the infant facedown with the body resting on your forearm. Support the jaw and face with your hand and keep the head lower than the rest of the body. Give the infant five back slaps between the shoulder blades, using the heel of your hand. B. Give the infant five quick chest thrusts, using two fingers placed the lower half of the sternum. A, B: © Jones on & Bartlett Learning. Foreign Body Airway Obstruction in Infants and Children (5 of 5)  Open the airway and look in the mouth.  Remove the object if seen.  Resume chest compressions if no object is seen. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  In unresponsive infants, begin CPR, beginning with chest compressions.  Do not check for a pulse before starting compressions. Special Resuscitation Circumstances  Opioid overdose  Cardiac arrest in pregnancy  Priorities are to provide high-quality CPR and relieve pressure off the aorta and vena cava. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Standard resuscitation measures take priority over naloxone administration. Grief Support for Family Members and Loved Ones (1 of 3)  Family members and loved ones will remember this event in detail for the rest of their lives.  Keep the family informed throughout the resuscitation process. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Family members may experience a psychologic crisis that turns into a medical crisis. Grief Support for Family Members and Loved Ones (2 of 3)  After resuscitation has stopped, helpful measures include: Take the family to a quiet, private place. Use clear language and speak in a warm, sensitive, and caring manner. Exhibit calm, reassuring authority. Use the patient’s name. Use eye contact and appropriate touch. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com      Grief Support for Family Members and Loved Ones (3 of 3)  After resuscitation has stopped, helpful measures include (cont’d):  Ensure that children are not ignored. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Expect emotion.  Be supportive but do not hover.  Ask if a friend or family member can be called. Education and Training for the EMT  CPR skills can deteriorate over time. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Practice often using manikin-based training.  CPR self-instruction through a video and/or computer-based modules with handson practice. Education and Training for the Public  You are a patient advocate. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  You must do your part to facilitate the training of laypeople in the critical skills of CPR and AED operation. Review A. B. C. D. 0–1 minutes. 0–4 minutes. 4–6 minutes. 6–10 minutes. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Brain damage is very likely in a brain that does not receive oxygen for: Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Permanent brain damage is very likely if the brain is without oxygen for 6 minutes or longer. After 10 minutes without oxygen, irreversible brain damage is likely. Review A. 0–1 minutes. Rationale: Cardiac irritability ensues at this stage. B. 0–4 minutes. Rationale: Brain damage is not likely at this stage. C. 4–6 minutes. Rationale: Brain damage is possible at this stage, but not likely. D. 6–10 minutes. Rationale: Correct answer Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Brain damage is very likely in a brain that does not receive oxygen for: Review A. Early access, integrated post-arrest care, early advanced care, early CPR, early defibrillation, recovery B. Early advanced care, early defibrillation, integrated post-arrest care, early CPR, early access C. Early access, early CPR, early defibrillation, early advanced care, integrated post-arrest care, recovery D. Early access, early riser, early CPR, early advanced care Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Which of the following sequences of events describes the AHA chain of survival? Review Rationale: The AHA has determined an ideal sequence of events that, if taken, can improve the chance of successful resuscitation of a patient who has an occurrence of sudden cardiac arrest: early access, early CPR, early defibrillation, early advanced care, integrated post-arrest care, and a recovery plan. If any one of the links in the chain is absent, the patient is more likely to die. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: C Review A. Early access, integrated post-arrest care, early advanced care, early CPR, early defibrillation, recovery Rationale: Early CPR and defibrillation come before advanced care. B. Early advanced care, early defibrillation, integrated post-arrest care, early CPR, early access Rationale: Chain is backwards. C. Early access, early CPR, early defibrillation, early advanced care, integrated postarrest care, recovery Rationale: Correct answer D. Early access, early riser, early CPR, early advanced care Rationale: Early riser is not in the chain of events. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Which of the following sequences of events describes the AHA chain of survival? Review A. B. C. D. Fowler prone supine recovery Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 3. For CPR to be effective, the patient must be on a firm surface, lying in the ______________ position. Review Rationale: For CPR to be effective, the patient must be lying supine on a firm surface, with enough clear space around the patient for two rescuers to perform CPR. If the patient is crumpled up or lying face down, you will need to reposition him or her. The few seconds that you spend repositioning the patient properly will greatly improve the delivery and effectiveness of CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: C Review A. Fowler Rationale: The patient is sitting up with knees bent in this position, making it nearly impossible to make effective chest compressions. B. prone Rationale: The patient is lying facedown in this position. C. supine Rationale: Correct answer D. recovery Rationale: The patient is lying facedown with one knee bent and the head slightly tilted. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 3. For CPR to be effective, the patient must be on a firm surface, lying in the ______________ position. Review A. B. C. D. 1 second. at least 1 second but no more than 5 seconds. at least 10 seconds. at least 5 seconds but no more than 10 seconds. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. The pulse check should take: Review Rationale: The pulse check should take at least 5 seconds but no more than 10 seconds. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: D Review A. 1 second. Rationale: One second is not long enough to detect a pulse. B. at least 1 second but no more than 5 seconds. Rationale: Five seconds may not be long enough to detect a pulse. C. at least 10 seconds. Rationale: Ten seconds is a long time in this situation. The brain should not be deprived of oxygen for longer than 6 minutes. Every second counts. D. at least 5 seconds but no more than 10 seconds. Rationale: Correct answer Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. The pulse check should take: Review A. B. C. D. gastric distention. vomitus. abdominal-thrust maneuver. acute abdomen. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 5. Artificial ventilation may result in the stomach becoming filled with air, a condition called: Review Rationale: Artificial ventilation may result in the stomach becoming filled with air, a condition called gastric distention. Gastric distention is likely to occur if you ventilate too fast, if you give too much air, or if the airway is not opened adequately. Therefore, it is important for you to give slow, gentle breaths. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: A Review A. gastric distention. Rationale: Correct answer B. vomitus. Rationale: Gastric distention may lead to vomitus. C. abdominal-thrust maneuver. Rationale: The abdominal-thrust maneuver is a method of removing a foreign obstruction from an airway. D. acute abdomen. Rationale: Acute abdomen is a medical term referring to the sudden onset of abdominal pain, generally associated with severe, progressive problems that require medical attention. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 5. Artificial ventilation may result in the stomach becoming filled with air, a condition called: Review A. B. C. D. mechanical piston device load-distributing band impedance threshold device cardiopulmonary resuscitation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. The ______________ is a circumferential chest compression device composed of a constricting band and backboard. Review Rationale: The load-distributing band is a circumferential chest compression device composed of a constricting band and backboard. The device is either electronically or pneumatically driven to compress the heart by putting inward pressure on the thorax. As with the mechanical piston device, use of the device frees the rescuer to complete other tasks. It is lighter and easier to apply than the mechanical piston device. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Review A. mechanical piston device Rationale: This device depresses the sternum via a compressed gas-powered plunger mounted on a backboard. B. load-distributing band Rationale: Correct answer C. impedance threshold device Rationale: This valve device is placed between the endotracheal tube and a bag-mask device. It is designed to limit the air entering the lungs during the recoil phase. D. cardiopulmonary resuscitation Rationale: This procedure is used to establish artificial ventilation and circulation in a patient who is not breathing and has no pulse. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. The ______________ is a circumferential chest compression device composed of a constricting band and backboard. Review A. A hysterical family member trying to gain access to the unconscious patient B. A vehicle honking its horn anxious to pass by the scene on a blocked road C. A small set of steps leading to the exit of the building, on the way to the ambulance D. Being tired from trying to resuscitate a patient Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Which of the following scenarios would warrant an interruption in CPR procedures? Review Rationale: Try not to interrupt CPR for more than a few seconds, except when it is absolutely necessary. For example, if you have to move a patient up or down stairs, you should continue CPR until you arrive at the head or foot of the stairs, interrupt CPR at an agreed-on signal, and move quickly to the next level where you can resume CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: C Review (1 of 2) A. A hysterical family member trying to gain access to the unconscious patient Rationale: Family members should be calmed down and reassured that the patient is in good hands. A hysterical family member does not warrant a break in CPR. B. A vehicle honking its horn anxious to pass by the scene on a blocked road Rationale: Your primary focus should be on the patient. Let the on-scene police and/or traffic control deal with upset motorists and blocked roadways. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Which of the following scenarios would warrant an interruption in CPR procedures? Review (2 of 2) C. A small set of steps leading to the exit of the building, on the way to the ambulance Rationale: Correct answer. D. Being out of breath while trying to resuscitate a patient Rationale: CPR should always be continued until the patient’s care is transferred to a physician in a hospital setting. Being “out of breath” does not mean being physically incapable of performing more CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Which of the following scenarios would warrant an interruption in CPR procedures? Review A. The patient stops breathing and has no pulse. B. The patient is transferred to another person who is trained in BLS, to ALS-trained personnel, or to another emergency medical responder. C. You are out of gas in the ambulance. D. A police officer assumes responsibility for the patient and gives direction to discontinue CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 8. Once you begin CPR in the field, you must continue until one of the following events occurs: Review Rationale: The “T” in the “STOP” mnemonic stands for patient transfer to another person who is trained in BLS, to ALS-trained personnel, or to another emergency medical responder. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Review A. The patient stops breathing and has no pulse Rationale: These are reasons to begin CPR. B. The patient is transferred to another person who is trained in BLS, to ALStrained personnel, or to another emergency medical responder Rationale: Correct answer C. You are out of gas in the ambulance Rationale: This is not a valid reason to stop CPR. You are out of strength or too tired to continue may be a valid reason. D. A police officer assumes responsibility for the patient and gives direction to discontinue CPR Rationale: A physician who is present or providing online medical direction should assume responsibility for the patient and give direction to discontinue CPR. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 8. Once you begin CPR in the field, you must continue until one of the following events occurs: Review A. B. C. D. chest thrusts Sellick maneuver basic life support DNR orders Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 9. Instead of the abdominal-thrust maneuver, use ___________ for women in advanced stages of pregnancy and patients who are obese. Review Rationale: You can perform the abdominal-thrust maneuver safely on all adults and children. However, for women in advanced stages of pregnancy and patients who are obese, you should use chest thrusts. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: A Review A. chest thrusts Rationale: Correct answer B. Sellick maneuver Rationale: This technique is used to prevent gastric distention in which pressure is applied to the cricoid cartilage; also referred to as cricoid pressure. C. basic life support Rationale: BLS is noninvasive emergency life-saving care that is used to treat medical conditions. Chest thrusts are a BLS tactic. D. DNR orders Rationale: Do not resuscitate orders are specific instructions not to perform lifesaving techniques on certain patients who may be suffering from terminal illnesses. DNR orders must be on hand and can be a complicated issue. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 9. Instead of the abdominal-thrust maneuver, use ___________ for women in advanced stages of pregnancy and patients who are obese. Review In infants who have signs and symptoms of an airway infection, you should not waste time trying to dislodge a foreign body. You should intervene only if signs of ____________ develop, such as a weak, ineffective cough; cyanosis; stridor; absent air movement; or a decreasing level of consciousness. A. sudden infant death syndrome B. child abuse C. bronchitis D. severe airway obstruction Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 10. Review Rationale: With a mild airway obstruction, the patient can cough forcefully, although there may be wheezing between coughs. As long as the patient can breathe, cough, or talk, you should not interfere with his or her attempts to expel the foreign body. As with an adult, encourage the child to continue coughing. Administer 100% oxygen with a nonrebreathing mask and provide transport to the emergency department. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: D Review (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 10. In infants who have signs and symptoms of an airway infection, you should not waste time trying to dislodge a foreign body. You should intervene only if signs of ____________ develop, such as a weak, ineffective cough, cyanosis, stridor, absent air movement, or a decreasing level of consciousness. A. sudden infant death syndrome Rationale: Death of an infant or young child that remains unexplained after a complete autopsy. B. child abuse Rationale: The obstruction may be the result of child abuse, but these signs are those of a severe airway obstruction. Review (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 10. In infants who have signs and symptoms of an airway infection, you should not waste time trying to dislodge a foreign body. You should intervene only if signs of ____________ develop, such as a weak, ineffective cough, cyanosis, stridor, absent air movement, or a decreasing level of consciousness. C. bronchitis Rationale: This is an inflammation of the lung. It is not the direct result of a foreign body lodged in the airway. D. severe airway obstruction Rationale: Correct answer