1
Q
infants
A
> 1 year
2
Q
children
A
before puberty (underarm hair, breast development)
3
Q
where are most out of. hosiptial cardiac arrests
A
at home
4
Q
common cause of cardiac arrest in children
A
respiratory failure, shock
5
Q
pediatric chain of survival in hospital
A
- early recognition + prevention
- activate emergency response
- High quality CPR
- advanced resuscitation (Defibrillator)
- Post-Cardiac arrest care
- Recovery
6
Q
Pediatric Out-of-Hospital Chain of Survival
A
- Prevention
- Activation of emergency response (911)
- High Quality CPR
- Advanced Resuscitation (Ambulance)
- Post-Cardiac Arrest Care
- Recovery
7
Q
Adult In-Hospital Chain of Survival
A
- Early Recognition and prevention
- Activation of Emergency Response
- High-Quality CPR
- Defibrillation
- Post Cardiac Arrest Care
- Recovery
8
Q
Adult Out-of-Hospital Chain of Survival
A
- Activation of Emergency Response
- High-Quality CPR
- Defibrillation
- Advanced Resuscitation
- Post-Cardiac Arrest Care
- Recovery
9
Q
Hands-Only CPR
A
Single rescuer with little training and no equipment
10
Q
30:2 CPR
A
BLS responder. 30 compressions to 2 breaths
11
Q
High-performance team
A
three emergency responders. 1st rescuer provides compressions, 2nd breaths with a bag mask, 3rd uses AED and CPR coach
12
Q
Main components of CPR
A
Chest compressions, airway, breathing
13
Q
Adult BLS algorithm for healthcare providers
A
- Verify Scene safety
- Check for responsiveness
- Assess breathing and pulse (>10 sec)
3a+3b.
~breathing normally and pulse felt, monitor victim
~ not breathing normally, but pulse felt
~provide resuce breathing (10/min)
~ check for pulse every 2 mins. CPR if no pulse
~If opioid use suspected, give narcan
~ not breathing or gasping and no pulse, begin CPR - Start CPR, 30 compressions followed by 2 breaths. use AED ASAP.
5 + 6: Use AED
7: If AED detects shockable rhythm, give 1 shock. resume CPR until prompted by AED to check rhythm ~2 mins. continue CPR and using AED until ALS takes over or victim breathes, moves or reacts
14
Q
Check Breathing
A
Scan for rise and fall in chest >10 sec.
If they are breathing: monitor
Not breathing/gasping: Be prepared to start CPR. sign of cardiac arrest. (agonal gasps)
15
Q
Feel for carotid pulse
A
If no def pulse in 10 sec, begin CPR
Carotid pulse:
1. Locate trachea using fingers.
2. Slider fingers into groove between trachea and muscles at side of neck.
3. Feel for 5-10 sec. Start CPR if no definite pulse
16
Q
Position victim
A
Faceup on a firm, flat surface.
17
Q
Compression Rate
A
100-120bpm
18
Q
Compression Depth
A
At least 2 in. Usually they are too shallow, so go harder than you think. No more than 2.4 in.
19
Q
Chest Recoil
A
Allow chest to completly recoil between compressions. This allows blood flow to the heart.
20
Q
Interruptions in Chest Compressions
A
minimize interruptions. CCF >60% increases likelihood of ROSC (return of spontaneous circulation), shock success, and survival to hospital. No not move victim during CPR, unless in dangerous circumstance.
21
Q
CCF
A
chest compression fraction. proportion of time that rescuers perform chest compressions.
22
Q
ROSC
A
return of spontaneous circulation.
23
Q
Chest compression Technique
A
- Position yourself at victim’s side.
a. Make sure vicitim is faceup on firm, flat surface. If neck or head injury suspected, keep body in line if needing to roll - Position your hands and body to perform compressions.
a. place heel of one hand in center of victim’s chest, on lower half of sternum
b. place other hand on top
c. straighten arms and position shoulders directly over hands - Give compressions 100-120bpm.
- press down 2-2.4”. push straight down.
- at end of each compression, allow recoil.
- minimize interruptions of compressions.
24
Q
Compressions for Pregnant women.
A
Uterus compresses large blood vessels in abdomen and interferes with blood flow to heart. Manual Lateral Uterine Displacement (LUD) move uterus to pateints left to relieve pressure on large blood vessels. if revived, place her on left side.
25
Opening Airway
head tilt-chin lift, jaw thrust
26
Head tilt-chin lift
1. Place one hand on victim's forehead and push with palm to tilt head back.
2. Place fingers of other hand under bony part of the jaw, near the chin
3. lift jaw to bring chin forward.
DO NOT:
1. press deeply into soft tissue under chin because might block airway.
2. do not close mouth completely
27
Jaw thrust
When head tilt-chin lift does not work, or when you suspect spinal injury, use jaw thrust maneuver
1. Position yourself at victims head
2. Place one hand on each side of the victims head. Rest elbows on surface where victim is lying.
3. Place fingers under angle of victims lower jaw and lift with both hands, displacing jaw forward.
4. If lips close, push lower lip with thumbs to open lips.
28
Pocket masks
diverts air and blood away from rescuer.
1. position yourself at victims side
2. place pocket mask on victims face, using bridge of nose as a guide for correct positioning.
3. seal pocket mask against face
a. using hand that is closer to top of victims head, place index finger and thumb along top edge of mask.
b. place thumb of other hand along bottom edge of mask.
c. place fingers of second hand along bony margin of jaw and lift jaw. perform head tilt chin lift to open airway.
d. while you lift jaw, press firmly and completly along outside edge of mask to seal pocket mask against face.
4. deliver each breath over 1 second, enough to make vicitms chest rise.
5. resume compressions in less than 10 seconds.
29
bag mask device
Use bag if available. can be self inflating and can be used with an oxygen supply. it should extend from bridge of the nose to just above lower edge of the chin. cover nose and mouth and make sure mask does not apply pressure to eyes.
1. position yourself directly above victim's head
2. place mask on victims face, using bridge of nose as a guide for correct positioning.
a. perform head tilt
b. place mask on face with narrow portion at bridge of nose.
c. use thumb and index fingerof one hand to make a C on side of the mask, pressing edges of mask to the face.
d. Use the remaining fingers to lift angles of the jaw, (3 fingers form an E). open the airwaym and press face to the mask.
3. Squeeze bag to give breaths while watching for chest rise. deliver each breath over 1 second with or without o2
30
bag mask ventilation with 2+ rescuers
1. Rescuer 1, positioned directly above the victim, opens the airway and positions bag-mask device.
a. rescuer should be careful not to press too hard on the mask, because it could push jaw down and block airway.
2. Rescuer 2, at victims side squeezes bag.
31
Ventilation for Victim With a Stoma or Tracheostomy Tube
Position mask over stoma or tube. pediatric mask may be more effective. If the chest doesn't rise, connect bag mask device directly to the tube.. If still doesn't rise, close victims mouth while providing breaths over stoma or tube.
32
When to switch compressors
After ever 5 cycles of CPR (2 minutes) or sooner if tired
33
Arrhythmia
electrical impulses cause heart to beat too quickly, too slowly, or erratically.
34
pVT
lower chambers of heart (ventricles) contract at a very fast pace (ventricular tachycardia). they pump so quickly and efficiently that there is no detectable pulse. no o2 flow.
35
ventricular fibrulation
chaotic electrical activity. quiver in fast, unsynchronized way.
36
Operating AED
1. open case
2. attach AED pads to bare skin.
3. Clear victim and allow AED to analyze rhythm.
4. If AED advises shock, it will tell you to clear and then deliver a shock.
37
AED Anterolateral Placement
Place one AED pad directly below right collarbone. Place other pad on side of left nipple, with top edge below armpit
38
AED AP Placement
one pad in center of bictims chest (anterior) and other on center of victims back (posterior)
or
one on left side of chest and left side of back.
39
AED with Hairy Chest
use a razor or use first set of pads to remove hair then put a second set of pads
40
AED with presence of Water or Other Liquids
Do not use an AED in water because it can conduct electricity. pull victim out of water. wipe the chest.
41
AED with Implanted Defibrillators and Pacemakers
Avoid placing AED directly over implanted device.
42
AED with Transdermal Medication Patch
Do not place AED directly on top. Can interfere with energy from AED to heart and cause burns. Examples are nitroglycerin, nicotine, pain meds, and hormone replacement therapy patches.
43
AED with Pregnant Women
Shocking will not harm baby. If woman is revived, place her on her left side.
44
AED with clothing and jewlery
Move bulky clothing. Remove clothes that cover the chest. no jewlery in contact with AED pads.
45
When AEd is analyzing heart rhythm
stand clear of victim.
46
Compressor role
~Assesses patient
~Performs compressions
~Rotates every 2 minutes
47
Monitor/Defibrillator/CPR Coach role
Operates AED
48
Airway role
~Opens airway
~Provides bag mask ventilation
~Inserts airway adjuncts as appropriate
49
Team Leader Role
~Must have a leader
~Assigns roles
~Makes treatment decisions
~Provides feedback
~Assumes responsibility for non defined roles
50
IV/IO/Meds role
~An ALS provider role
~Initiates IV/IO access
~Administers meds
51
Timer/Recorder Role
~Records time of interventions and medications and announces when they are next due
~Records frequency and duration of interruptions in compressions
52
What can ALS do that BLS cant
Administer medications and intubate
53
Pediatric BLS Algorithm for Healthcare Providers Single Rescuer
1: Verify Scene Safety
2: Check for responsiveness and get help.
3: Assess for breathing and a pulse (<10 secs)
3a + 3b:
~breathing normally and pulse felt: Activate emergency response system. and monitor victim
~not breathing normally but pulse felt: provide rescue breathing. 20-30 breaths per minute.
4, 4a, 4b: is heart rate <60bpm with signs of poor perfusion
~if yes, start CPR
~ If no, continue rescue breathing. Check for pulse every 2 min.
5, 5a: Was sudden collapse witnessed?
~ If yes, call 911 and get AED
6: If collapse was not witnessed:
~ Start CPR with 30 compressions and 2 breaths. use AED when available
7: After 2 minutes if alone, call 911 and get AED
8: use AED
9: If shockable, shock once.resume CPR and check rhythm every 2 mins. continue until victim breathes moves or reacts.
10: If non shockable, resume high quality CPR but keep checking every 2 mins for rhythm.
54
Pulse in infant
Feel for brachial artery pulse
1. Place fingers on inside of upper arm, midway between infant's elbow and shoulder. for 5-10 sec.
55
Pulse in child
Feel for carotid or femoral pulse. (carotid same technique as for adult)
Femoral artery pulse:
1: place fingers in inner thigh midway between hip bone and pubic bone and just below the crease where the leg meets the torso.
56
Signs of poor perfusion
Perfusion is flow of oxygenated blood from heart through arteries to body's tissues. signs of poor perfusion are
~ Temperature - cool extremities
~ Altered mental state: Continued decline in consciousness/responsiveness
~ Pulse: weak pulse
~Skin: Paleness, mottling (patchy appearance), and later, cyanosis (blue lips or skin)
57
Compression to ventilation ratio in children
for single rescuers, it is the same as adults 30:2
When 2 rescuers are there, they should use 15:2
58
Compression rate in children
100-120bpm
59
Compression depth in infant
compress at least 1/3 of AP diameter 1.5"
60
compression depth in children
1/3 of AP diameter 2"
61
How to perform Infant: 2-Finger technique
1. Place infant on firm, flat surface
2: place 2 fingers in center of infants chest, just below nipple line, on lower half of breastbone. do not press tip of breastbone.
3: compressions 100-120bpm
4: compress 1/3 AP diameter 1.5"
5: allow for complete chest recoil and minimize interruptions
6:after every 30 compressions, open airway with head tilt chin lift over 1 second.
7: after 5 cycles ~2 minutes of CPR and youre alone, stop CPR and call 911 and get AED
8: continue compressions 30:2 use AED
62
Why the Infant: 2 Thumb-Encircling Hands Technique
Preferred when 2 rescuers provide CPR.
~ Produces better blood supply to heart
~ Helps ensure consistent depth and force of compressions
~Higher blood pressure
63
How to perform infant: 2 Thumb-Encircling Hands Technique
1. Place infant on firm, flat surface
2. Place both thumbs side by side in center of infant's chest on lower half of breastbone. with fingers of both hands, encircle infant's chest and support infant's back.
3. with hands encircling chest, use both thumbs to depress breastebone 100-120bpm
4. compress 1/3 AP 1.5"
5: Allow for chest recoil.
6: After each 15 compressions, have second rescuer to open airway with head tilt. give 2 breaths each over 1 second. minimize interruptions in compressions.
7: continue compressions 15:2 if there are 2 rescuers.
64
Are compressions enough to deliver o2 blood throughout body
many cardiac arrests are because of respiratory distress, so they need both compressions and breaths during CPR
65
Ventilation with a barrier device in pediatrics
use a barrier device to give breaths.
1: select bag and mask of appropriate size. mask must cover victims mouth and nose completely without covering eyes or extending below bottom edge of the chin.
2. Perform a head tilt to open airway. press mask to face as you lift the jaw to seal the mask
3. Connect to supplemental o2 when available.
66
Infant and Child 2-rescuer BLS
1: Verify scene safety.
2. Check responsiveness and get help.
3. asses breathing and pulse
3a, 3b.
~ breathing normally and pulse felt, call 911 and monitor
~ not breathing normall, pulse is felt, provide rescue breathing 20-30/min
4,4a,4b. is HR less than 60 bpm with signs of poor perfusion
~yes, start CPR
~no, continue rescue breathing. check pulse ~2min.
5. first rescuer starts CPR with 30:2. when second rescuer returns, continue cycles of 15:2 use AED asap.
6. follow AED directions
7. if AED detects shockable rhythm, give 1 shock. resume cpr utnil antother check.
8. if AED detects nonshockable resume high quality cpr and AED
67
How to reduce shock dose in AED
Attach pediatric dose attenuator (reduces by 2/3). these are connected to pediatric pads.
68
what to do if no child pads are available
Use adult pads, but do not touch them or overlap them. A high shock is better than no shock.
69
Where to place pediatric AED pads
Usually they will go AP. anteroposterior
70
What age to use adult pads`
8 years and older
71
AED use for children
~younger than 8 years
~use child pads
~switch to child shock dose
~place pads as illustrated on pad
~place directly on skin do not let them overlap
72
AED use in infants
manual defibrillator is preferred.
73
When to use mouth to mouth
unresponsive and not breathing but has a pulse and a bag mask device is not available.
74
Examples of Advanced Airways
Laryngeal mask, supraglottic airway device, endotracheal tube.
75
Ventilation technique when there is an advanced airway in place
~Compression rate 100-120bpm
~Continuous compressions without pauses for breaths
~ Ventilation:
- adult: 1 breath every 6 sec (10/min)
- child/infant: 1 breath every 2-3 seconds 20-30/min
76
When to Switch from Only Rescue Breathing to CPR in an Infant or Child
~Signs of poor perfusion despite effective ventilation and O2
~HR < 60/min with signs of poor perfusion
~No pulse felt
77
Risk of Gastric Inflation
Happens when you give breaths too quickly with too much force. Air can enter stomach instead of lungs.
~Do not give breaths too forecfully, too quickly, or with too much volume.
~Give breaths over 1 second.
~ Deliver just enough to make victim's chest rise.
78
Common opioids
Hydrocodone, morphine, fentanyl, heroin
79
Problematic Opioid use
~Takes more drug than perscribed (accident and on purpose)
~Takes an opioid perscribed for someone else
~Combines opioids with alcohol or other drugs (tranquilizers/sleeping pills)
~Has certain medical conditions, such as reduced liver function or sleep apnea
~Older than 65
80
What can too much opioid do
~Overwhelm brain
~Depress natural drive to breathe
81
Signs of opioid overdose
~Signs of injection in skin
~Medication bottles
~Slow, shallow, no breathing
~Choking or gurgling sounds
~Drowsiness or loss of consciousness
~Small, constricted pupils
~Blue skin, lips, or nails
82
Narcan
~Naloxone Autoinjector - IM
~Intranasal Naloxone - in nose, many mucus membranes
83
What to do for Opioid Emergency
1: Check for response, shout for help, 911, narcan, AED
2. breathing normally? -breathing normally -> step 3 and 4. not breathing normally ->step 5
3. prevent deterioration - tap and shout, open airway, narcan, hospital
4. Assess for responsiveness and breathing
5. Pulse? If yes, -> step 6. If no -> step 7
6. Support ventilation.
~Open and reposition airway before giving rescue breaths.
~ provide rescue breathing. can help prevent cardiac arrest. continue until normal breathing occurs. reassses pulse ~2 min, no pulse -> CPR
~narcan
7. Start CPR
~Narcan, but CPR is priority
84
What is a heart attack?
Blockage forms or severe spasm in a blood vessel that restricts flow of blood and O2 to heart. Heart typically continues to pump, but can trigger an abnormal rhythm and lead to arrest.
85
Signs of heart attack
~Chest discomfort - center in chest for more than a few minutes. may go and then return. pressure, squeezing, fullness, pain.
~ Discomfort in other areas in upper body. - left arm (commonly), both arms, upper back, neck, jaw, stomach
~Shortness of breath - with or without chest discomfort
~Cold sweat, nausea, vomiting, light-headedness
86
Heart attack vs sudden cardiac arrest
Heart attack - blood flow problem. blockage. cuts of bloodflow to heart -more common usually does not lead to arrest
Sudden cardiac arrest - rhythm problem, quiver or stop
87
If someone is having a heart attack
~Have victim sit and remain calm
~911, first aid kit and AED
~Take asprin because it is a blood thinner
~If they become unresponsive and stop breathing start CPR
88
Care for a Heart Attack
ASAP.
~Cardiac Cath Tab
~IV medication
89
What is a stroke
Occurs when blood stops flowing to a part of the brain. An artery in the brain is blocked (ischemic stroke) or a blood vessel bursts (hemorrhagic stroke). Brain cells die within minutes without blood and O2.
90
Warning signs of a stroke
~F - Face drooping. Ask person to smile
~A - Arm drift - raise both arms and close eyes
~S - Speech difficulty - is speech slurred
~T - When was the last time they were acting normal. 911
~Dizziness, trouble walking, loos balance and coordination
~Trouble seeing
~Severe headache
~Numbness
~Weakness
~Confusion or trouble understanding
91
Actions to help a stroke victim
~Evaluate quickly for signs of stroke
~911
~What time did stroke occur
~Remain with victim until someone with more advanced training arrives
~If victim becomes unresponsive and is not breathing normally, begin CPR
92
System of Care for stroke
~Meds within 3 hours of first symptom
~Recognize stroke
~Call 911
~EMS identification management and transport
~Triage -should be triaged to closest available stroke center
~Evaluation and management: Once they arrive at the ED should be processed immediately.
~Treatment decisions
~Therapy - Ischemic stroke: IV alteplase. or thrombectomy. invasive procedure that removes clot.
93
Help victim of Cardiac Arrest Due to Drowning
~Call for help - get victim out of the water
~Check for breathing and open airway. Rescue breaths and CPR.
~ do not clear airway of water or use abdominal thrusts
~Check for pulse after 2 breaths
~CPR 30:2. 5 cycles.
~AED once out of the water
~IF there is vomiting, put in recovery position. if spinal injury suspected, keep spine stabilized.
~Should be taken to ER
94
Signs of a Mild Allergic Reaction
~Stuffy nose
~Sneezing
~Itching around eyes
~Itching of skin or mucous membranes
~Hives
95
Actions of Mild Allergic Reactions
~Get help
~Remove victim from allergen (if known)
~Ask about history of allergy or anaphylaxis
~Consider antihistamine
96
Signs of a Severe Allergic Reaction
~Breathing - swelling of airway, trouble breathing, abnormal breathing sounds
~Skin - Hives, itching,flushing, swelling of lips, tongue, and face
~ Circulation - signs of poor perfusion (shock), very fast HR, changes in skin color, cool skin, not alert, low blood pressure
~Gastrointestinal - Stomach cramping, diarrhea
97
Criteria for Anaphylaxis
~Signs that come on quickly and get worse
~Skin changes such as flushing, itching, swelling of lips, tongue, face
~Life-threatening airway, breathing, or circulation problems
~Involvement of 2 or more body system
98
Actions to help someone with Severe Allergic Reactions
~911 and epi pen
~Give epi pen
~AED
~Second dose of epi if person has continued symptoms and advanced care will not arrive in 5-10 min
~If person becomes unresponsive and is not breathing, start CPR. may give epi during cardiac arrest
~Save sample of what caused reaction. Give to responders
99
How to use epipen
Do not use if solution is discolored or the clear window is red
~Do not touch either end. can give injection through clothes. open cap
~Hold leg firmly in place before and during injection.press tip of injector hard against side of person's thigh
~ hold injector in place for 3 seconds.
~Pull straight out and do not put fingers over the end that has touched the person's thigh
~rub spot for 10 seconds
~note time of injection and dispose injector
100
Signs of Milk airway obstruction
~Good air exchange
~Can cough forcefully
~May wheeze between coughs
101
Rescuer actions for Mild Airway Obstruction
~As long as good air exchange continues, allow victim to continue coughing.
~Do not interfere with victim's attemps to releive obstruction
~Stay with victim and monitor condition
~Continues or progresses, active emergency response system
102
Signs of Severe Airway Obstruction
~Clutching throat with thumb and fingers, making universal choking sign
~unable to speak or cry
~poor or no air exchange
~weak, ineffective cough or no cough
~High-pitched noise while inhaling or no noise at all
~Increased respiratory difficulty
~Possible cyanosis (blue lips or skin)
103
Rescuer Actions for Severe Airway Obstruction
~Ask if they are choking, if yes, then it is present
~take steps to remove
~if victim becomes unresponsive start CPR
~If you're not alone, sedn someone to call 911
104
Abdominal thrusts for choking
~in adults or children
~Stand or kneel behind victim and wrap arms around waist
~make a fist with one hand
~place thumb side of your fist against victim's abdomen, in midline, slightly above navel and well below breastbone
~grasp fist with other hand and press fist into victim's abdomen with quick forceful upward thrust
~ repeat thrusts until object is expelled from airway or victim is unresponsive
~Give each thrust with separate, distinct movement to relieve obstruction
105
Choking Relief in Pregnant and Obese Victims
Perform chest thrusts instead of abdominal thrusts.
106
Choking relief in an Unresponsive Adult or Child
~Shout for help. send them to activate emergency response system
~Lower victim to ground
~Begin CPR, starting with chest compressions. Do not check for pulse. Each time you open airway to give breaths, open mouth wide to look for object.
~ if easy to remove, remove with fingers
~ If no object visible, continue CPR
~After 5 cycles of CPR call 911 if not already done
107
Giving effective breaths when there is an airway obstruction
When they lose conciousness, the throat may relax and change to just a partial obstruction. Chest compressions can create as much force as abdominal thrusts so it can expel object.
108
Choking Relief in Infants
~Kneel or sit with infant in your lap
~Hold infant facedown with head lower than chest straddling
on your forearm.
~Support infant's head and jaw with your hand. Do nto compress soft tissues of infants throat.
~With heel of your hand, deliver up to 5 forceful back slaps between infants shoulder blades.
~After delivering slaps, place free hand on infants back and support back of infants head with palm of your hand. infant will be cradled in between forearms.
~Turn infant over while supporting head and neck. keep head lower than trunk.
~ Provide 5 quick downward chest thrusts in middle of chest. 1/sec.
~Continue until object dislodged or victim unresponsive.
109
Unresponsive Choking Infant
~HELP. 911.
~place infant on firm, flat surface
~Begin CPR, but when looking in airway, look for object and see if you can remove it
110
should you do blind finger sweeps
NO can push object further back in airway.
Nursing
flashcards
Decks in class (5)
# Cards
