BLS & CPR - Chapter 14

Basic Life Support

Noninvasive emergency life-saving care that is used to treat medical conditions, including airway obstruction, respiratory arrest, and cardiac arrest

Order of BLS

• Airway

• Breathing

• Circulation

Order of BLS of Pt in Cardiac Arrest

• Compressions

• Airway

• Breathing

Cardiopulmonary Resuscitation (CPR)

The combination of chest compressions and rescue breathing used to establish adequate ventilation and circulation in a patient who is not breathing and has no pulse

CPR Steps

1. Restore circulation by performing 30 chest compressions at a depth of 2 inches (5 cm) to circulate blood to the vital organs of the body. The rate should be at least 100 compressions per minute but no more than 120 per minute.

2. Open the airway with the jaw-thrust or head tilt–chin lift maneuver to restore breathing by providing rescue breaths (via bag-mask device). Administer two breaths, each over 1 second, while visualizing for chest rise. Repeat this sequence

Amount of chest compressions before a breath on an adult

30 chest compressions

Depth of Chest compression on an adult

2 inches

Advanced Life Support (ALS)

Advanced life-saving procedures, some of which are now being provided by the EMT

ALS Examples

• Cardiac monitoring

• IV fluids & meds

• advanced airway adjuncts

Successful Resuscitation Includes

• Return of Spontaneous Circulation

• Survival of patient to hospital discharge

Return of Spontaneous Circulation (ROSC)

The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest

Chain of Survival

1. Recognition and Activation of Emergency Response System

2. Immediate High Quality CPR

3. Rapid Defibrillation

4. Basic/advanced EMS

5. Advanced life support and post arrest care

6. Recovery

Before Staring CPR

• Rapid Primary Assessment

• Determine unresponsiveness

  • Ask: Are you okay?

• Take pulse for 10 seconds

Differences in CPR for Infants & Children

• Emergencies have different underlying Causes

• anatomic differences like smaller airway

Cardiac Arrest in Children

often results from respiratory Arrest

AED Usage in Children

• use peds pads

• apply after first 5 cycles of CPR

• Oxygenation + ventilation = very important

Using adult-size AED Pads

Adjust placement following manufacturer’s recommendation

Special AED Situations

• Pacemakers

• Defibrillators

• Wet patients

• Transdermal Meds

Pacemakers & Implanted Defibrillators

• Found in patients at high risk for cardiac dysrhythmias + cardiac arrest

• Recognizable by a hard lump beneath the skin

• Placed AED 1 inch from device

• if patient gets shocked by pacemaker wait 30/60 seconds before getting an AED shock

Wet Patients

• Pull patient out

• dry skin quickly

• still useable if patient is a little wet or in a puddle or snow

Transdermal Medication Patches

• can reduce AED effectiveness & burn skin

• Remove the patch and wipe way residue BEFORE placing AED pad

Positioning Patient for CPR

• Supine

• Placed on firm, flat surface

• Enough space for 2 EMTs

Complications from chest compressions

• broken ribs

• lacerated liver

• fractured sternum

Opening the Airway

• needed for rescue breaths

• Use:

  • Head-tilt-chin lift maneuver

  • Jaw-thrust maneuver

When to Place Patient in Recovery Position

• Breathing on their own

• no signs of injury to hip, spine, pelvis

Recovery Position

A side-lying position used to maintain a clear airway in unresponsive patients who are breathing adequately and do not have suspected injuries to the spine, hips, or pelvis

Hyperventilation

Rapid or deep breathing that lowers the blood carbon dioxide level below normal

Problems caused by hyperventilation

• reducing amount of blood returning to the heart

• hypotension

• increased intrathoracic pressure

Stoma Ventilation

ventilated with bag-mask device placed directly over the stoma

Gastric Distension

• A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation

• Occurs more easily in children

Preventing Gastric Distension

give slow gentle breaths

Problems caused by gastric distention

• vomit

• reduced lung volume via diaphragm elevation

When Gastric Dissension Occurs

• Check for adequate ventilation

• check the airway & reposition patient

• Have suction on standby

One Rescuer Adult CPR

1. Standard precautions

2. Postion supine on flat surface

3. check for breaths/pulse

4. Perform CPR until AED is available

5. Open airway & give ventilations

6. Repeat

Two Rescuer Adult CPR

1. Take standard precautions

2. Check for breathing & pulse

3. Begin CPR

4. Open airway and give ventilations

5. Switch after 5 cycles of CPR

Rounds before EMTs switch on compressions

5 rounds of CPR

Active Compression-Decompression CPR

• A technique that involves compressing the chest and then actively pulling it back up to its neutral position or beyond (decompression)

• may increase the amount of blood that returns to the heart and, thus, the amount of blood ejected from the heart during the compression phase

Impedance Threshold Device (ITD)

valve device placed between the endotracheal tube and a bag-mask device that limits the amount of air entering the lungs during the recoil phase between chest compressions

Mechanical Piston Device (Automated CPR)

A device that depresses the sternum via a compressed gas-powered or electric-powered plunger mounted on a backboard

Load-Distributing Band (Vest) CPR

A circumferential chest compression device composed of a constricting band and backboard that is either electrically or pneumatically driven to compress the heart by putting inward pressure on the thorax

Ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred

Pulse check for infants

brachial artery

Compression to ventilation ratio for infants/children with a partner

15:2

Determining Responsiveness (Infants & Children)

• Child = tap on shoulder

• Infant = tap the soles of the foot

Head Tilt-Chin Lift on a Child

1. Place one hand on the child’s forehead, and tilt the head back gently, with the neck slightly extended.

2. Place two or three fingers (not the thumb) of your other hand under the child’s chin, and lift the jaw upward and outward. Do not close the mouth or push under the chin; either move may obstruct rather than open the airway.

3. Remove any visible foreign body or vomitus.

Jaw-thrust Maneuver on a Child

1. Place two or three fingers under each side of the angle of the lower jaw; lift the jaw upward and outward.

2. If the jaw thrust alone does not open the airway and cervical spine injury is not a consideration, then tilt the head slightly. If cervical spine injury is suspected, then use a second rescuer to immobilize the cervical spine.

Maximum time CPR can be interrupted

10 seconds

Chest compression fraction

The total percentage of time during a resuscitation attempt in which active chest compressions are being performed

Minimum chest compression fraction

80 %

When Not to Start CPR

• Scene unsafe

• Rigor Mortis

• Dependent lividity

• decomposition

• evidence of non survivable injury

• DNR order

When to STOP CPR

S: Patient starts breathing & has a pulse

T: transfer or care to a provider of equal/higher training

O: out of strength or too tired to continue CPR

P: Physician assumes responsibility for the present

Mild Airway Obstruction in Adults

• can exchange air but show respritory distress

• Nosity breathing

• Encourage patient to cough

Abdominal Thrust Maneuver

The preferred method to dislodge a severe airway obstruction in adults and children; also called the Heimlich maneuver

Abdominal Thrust Maneuver

1. Stand behind the patient, and wrap your arms around his or her abdomen. Straddle your legs outside the patient’s legs. This will allow you to easily slide the patient to the ground if he or she becomes unresponsive.

2. Make a fist with one hand; grasp the fist with the other hand. Place the thumb side of the fist against the patient’s abdomen just above the umbilicus and well below the xiphoid process.

3. Press your fist into the patient’s abdomen with a quick inward and upward thrust.

4. Continue abdominal thrusts until the object is expelled from the airway or the patient becomes unresponsive.

Removing Blockages for Pregnant/obsese people

Perform chest thrusts

Chest Thrust Technique

1. Stand behind the patient with your arms directly under the patient’s armpits and wrap your arms around the patient’s chest.

2. Make a fist with one hand; grasp the fist with the other hand. Place the thumb side of the fist against the patient’s sternum, avoiding the xiphoid process and the edges of the rib cage.

3. Press your fist into the patient’s chest with backward thrusts until the object is expelled or the patient becomes unresponsive.

4. If the patient becomes unresponsive, then begin CPR, starting with chest compressions

Patients who become unresponsive due to airway obstruction

1. Carefully support the patient to the ground and immediately call for help (or send someone to call for help).

2. Perform 30 chest compressions, using the same landmark as you would for CPR (center of the chest, between the nipples). Do not check for a pulse before performing chest compressions.

3. Open the airway and look in the mouth. If you see an object that can easily be removed, then remove it with your fingers and attempt to ventilate. If you do not see an object, then resume chest compressions.

4. Repeat steps 2 and 3 until the obstruction is relieved or ALS providers take over

Performing Heimlich on a Child

1. Kneel on one knee behind the child, and circle both of your arms around the child’s body. Prepare to give abdominal thrusts by placing your fist just above the patient’s umbilicus and well below the xiphoid process. Place your other hand over that fist.

2. Give the child abdominal thrusts in an upward direction. Avoid pplying force to the lower rib cage or sternum.

3. Repeat this technique until the child expels the foreign body or becomes unresponsive.

4. If the child becomes unresponsive, position the child on a hard surface and immediately call for help (or send someone to call for help).

5. Perform 30 chest compressions (15 compressions if two rescuers are present), using the same landmark as you would for CPR. Do not check for a pulse before performing chest compressions.

6. Open the airway and look inside the mouth. If you see an object that can easily be removed, then remove it with your fingers and attempt to ventilate. If you do not see an object, then resume chest compressions.

7. Repeat steps 5 and 6 until the obstruction is relieved or ALS providers take over.

Removing Foreign body from an Unresponsive child

1. Standard precautions

2. Preform 30/15 chest compressions

3. Open airway & look in mouth

4. remove object if possible and attempt to ventilate

5. Resume compressions if object is unseen

6. Repeat until removed or ALS providers take over

Infant Abdominal Thrusts

1. Hold the infant facedown, with the body resting on your forearm. Support the infant’s jaw and face with your hand and keep the headlower than the rest of the body.

2. Deliver five back blows between the shoulder blades, using the heel of your hand.

3. Flip the infant and perform 5 chest thrusts

4. Check airway & remove foreign body if possible

Opioid Overdose

causes respiratory & cardiac arrest

Pregnant Patients

perform manual displacement of the uterus to relieve artery compression