American Red Cross Basic Life Support Course Vocabulary

Foundational Concepts in Basic Life Support

Critical Thinking and Problem Solving: These are essential healthcare skills for identifying connections between information and actions.
- Critical Thinking Definitions: Rational and clear thinking used to adapt to information logically and anticipate the effects of actions on a patient.
- Applications of Critical Thinking:
  - Performing rapid assessments to determine care.
  - Anticipating team roles based on patient presentation.
  - Re-evaluating situations based on changes in the patient's condition.
- Problem Solving Definition: Utilizing available resources to find solutions to challenges in emergency situations (e.g., equipment delay, equipment failure, or interference from bystanders).
Communication in Emergencies: Effective communication involves verbal and nonverbal cues (gestures and facial expressions).
- Closed-Loop Communication: A technique used to prevent misunderstandings through four components:
  - Sender: The person initiating communication.
  - Message: Clear and organized content understood by all.
  - Receiver: The person for whom the message is intended.
  - Feedback: Confirmation from the receiver that the message was understood.
- Familial Communication: Emergency situations cause stress; providers must build rapport, remain honest about patient conditions, and avoid false hope (e.g., avoid saying "Everything is going to be OK").
- Communication After Death: Must be honest, compassionate, and straightforward. Allow time for the grief process and offer to contact clergy or other family.
Teamwork and Leadership:
- Team Leader Responsibilities: Oversees the emergency, assigns roles, sets expectations, focuses on the "big picture," coaches the team, and leads debriefing.
- Team Member Responsibilities: Provides care within assigned roles, assists others when possible, and communicates if they lack specific skills or identify dangers.
- Crew Resource Management: A concept originally from aviation to reduce human error using all available resources (people, equipment, procedures). Focuses on mutual respect and open communication.
- Debriefing: A formal review post-resuscitation to identify improvements. The format includes:
  - Review: Recap of interventions.
  - Analyze: Review of objective data.
  - Reflect: Discussion of pros, cons, and reasoning.
  - Summarize: Takeaway points and action items.
Mental Health Referrals: Post-resuscitation stress should be managed by trained mental health professionals; seeking treatment is a coping strategy, not a weakness.

Systematic Approach to Assessing, Recognizing, and Caring for Adults

Scope and Duty to Act: Healthcare providers have a duty to act within healthcare facilities according to facility protocols and individual scopes of practice.
Assess, Recognize, and Care (ARC) Concept: A systematic, continuous approach for rapid assessment, re-assessment, and immediate care.
Rapid Assessment for Adults:
- Visual Survey (Scene Size-Up):
  - Safety: Check for gas, spills, or dangers. Move patient only if in immediate danger.
  - Number of Patients: Determine via a 360-degree view.
  - Mechanism of Injury/Nature of Illness: Look for clues like spilled medication or position.
  - Initial Impression: Does the patient look sick, pale, or cyanotic?
- Consent: Identify yourself, state training level, explain observations and plans, and ask for permission. Consent is implied for unresponsive adults.
- Checking Responsiveness: Use the shout-tap-shout sequence.
- Opening the Airway:
  - Head-Tilt/Chin-Lift: Tilt head to a past-neutral position.
  - Modified Jaw-Thrust: Used if head, neck, or spinal injury is suspected. Support jaw angles without moving the head.
- ABC Mnemonic: Airway (A), Breathing (B), and Circulation (C).
- Simultaneous Pulse and Breathing Check: Carotid pulse and breathing check (visual/auditory/tactile) should take no more than $10\, \text{seconds}$ .
Standard Precautions: Assume all body fluids are infectious. Utilize Personal Protective Equipment (PPE) like gloves, gowns, and face shields.

Basic Life Support for Adults

Respiratory Failure: Ineffective ventilation insufficient to sustain gas exchange.
Respiratory Arrest: No breathing but central pulse is present. Ventilation for an adult patient in respiratory arrest or failure should consist of 1 ventilation every 6 seconds.
Cardiac Arrest: An adult patient is in cardiac arrest when they are not breathing and the central pulse is absent.

Care: Deliver 1 ventilation every 6 seconds. Check pulse/breathing every 2 minutes.

Cardiac Arrest Management:

In-Hospital Cardiac Chain of Survival: Surveillance and Prevention, Recognition/Activation, Early High-Quality CPR, Early Defibrillation, Post-Cardiac Arrest Care, and Recovery.
Out-of-Hospital Cardiac Chain of Survival: Recognition/Activation, Early High-Quality CPR, Early Defibrillation, Advanced Life Support, Post-Cardiac Arrest Care, and Recovery.
High-Quality CPR Components (Adult):
- Compression Rate: $100\, \text{-- } 120\, \text{compressions/min}$ .
- Compression Depth: At least $2\, \text{inches}$ , maximum $2.4\, \text{inches}$ .
- Allow full chest recoil; avoid leaning.
- Minimize interruptions to $< 10\, \text{seconds}$ .
- Avoid excessive ventilation; deliver each over $1\, \text{second}$ .
- Compression-to-Ventilation Ratio: $30:2$ .
Myocardial Infarction (MI): Recognizing signs (chest pain radiating to arm/jaw, pale skin, nausea). Immediate care includes administering two to four low-dose ( $81\, \text{mg}$ ) or one ( $325\, \text{mg}$ ) adult aspirin (patient must chew it).

Advanced Airways and Special Situations:
- If an advanced airway is used: Continuous compressions with $1\, \text{ventilation every } 6\, \text{seconds}$ ( $10\, \text{breaths/min}$ ).
- Drowning: Deliver $2\, \text{initial ventilations}$ before beginning CPR.
- Pregnancy: Focused resuscitation of the mother. If the fundus is at/above umbilicus (approx. $\ge 20\, \text{weeks}$ ), perform Left Uterine Displacement (LUD) to relieve pressure on the inferior vena cava.
  - BAACC TO LIFE Mnemonic: Causes of arrest (Bleeding, Anesthesia, Amniotic fluid embolism, Cardiovascular, Clot, Trauma, Overdose, Lung injury, Ions, Fever, Eclampsia).
  - Resuscitative Cesarean Delivery (RCD): Goal is performance within $5\, \text{minutes}$ of arrest if ROSC is not achieved.
Ventilation Techniques:
- Pocket Mask: Preferred for single-provider resuscitation to maintain proximity to chest.
- Bag-Valve-Mask (BVM): Preferred two-person technique. Use E-C hand position. Volume delivered: $400\, \text{-- } 700\, \text{mL}$ (depress bag halfway).
- Mouth-to-Mouth: Provides approx. $16\%\, \text{-- } 17\%\, \text{oxygen}$ .
Automated External Defibrillators (AED):
- Apply pads (Anterior/Lateral: upper right chest below clavicle and side of chest below left armpit).
- Clear the patient during analysis and shock. Compressor should "hover" hands to minimize interruptions.
- Safety: Safe on metal surfaces and in snow/rain (wipe chest dry). Avoid placing pads over medication patches or pacemakers.
Quality Measurement:
- Chest Compression Fraction (CCF): Goal is $80\%$ , minimum $60\%$ .
- Capnography (ETCO2): Measures cardiac output. Target $15\, \text{-- } 20\, \text{mmHg}$ during CPR. ROSC is indicated by a spike to $40\, \text{mmHg}$ .

Basic Life Support for Children and Infants

Age Definitions:
- Infant: Under $1\, \text{year}$ .
- Child: $1\, \text{year}$ to onset of puberty (breast/underarm hair development).
- Adolescent: Puberty to adulthood (follow adult guidelines).
Rapid Assessment Differences:
- Responsiveness: Tap shoulder for children; tap bottom of foot for infants.
- Pulse Check: Brachial artery for infants; carotid for children.
- Airway Opening: Slightly past-neutral for children; neutral position for infants.
- Call First vs. Care First:
  - Call First: Witnessed collapse or known heart condition.
  - Care First: Unwitnessed collapse; provide $2\, \text{minutes}$ of care before calling.
CPR Techniques (Children and Infants):
- Depth: Child approx. $2\, \text{inches}$ ; Infant approx. $1.5\, \text{inches}$ ( $1/3$ chest diameter).
- Ratio: $30:2$ for single provider; $15:2$ for multiple providers.
- Infant Compressions: Two-thumb encircling technique (at nipple line) is preferred for multiple providers. Single providers may use two-finger or two-thumb technique.
- Advanced Airway Ventilation Rate: $1\, \text{ventilation every } 2\, \text{-- } 3\, \text{seconds}$ ( $20\, \text{-- } 30\, \text{breaths/min}$ ).
- Pediatric AED Use: Use pediatric pads/settings for those $\le 8\, \text{years}$ or $\le 55\, \text{lbs } (25\, \text{kg})$ . If not available, use adult pads. Pad placement for infants must be Anterior/Posterior.

Obstructed Airway Management

Signs: Universal sign of choking (clutching throat), stridor (squeaking noise), panicked expression.
Responsive Adult/Child Care: $5\, \text{back blows}$ and $5\, \text{abdominal thrusts}$ (upward/inward) or $5\, \text{chest thrusts}$ (for pregnancy/obesity).
Responsive Infant Care: $5\, \text{back blows}$ (head down) and $5\, \text{chest thrusts}$ ( $1.5\, \text{inches}$ deep).
Unresponsive Patient Care:
- Perform CPR starting with compressions.
- Look for object in the mouth before ventilations. Use a finger sweep (adult/child) or pinky sweep (infant) only if the object is visible. Do not perform blind sweeps.

Opioid-Associated Emergencies

Opioid Crisis Data: In 2018, nearly $47,000$ overdose deaths occurred; $32\%$ involved prescription opioids.
Opioid Overdose Triad: Pinpoint pupils, respiratory depression, and unconsciousness/sleepiness.
Care:
- Activate EMS and get Naloxone.
- Prioritize CPR and ventilations over Naloxone administration.
- Naloxone: Administered via IV, IO, IM, subcutaneous, or intranasal (IN) routes. Dosage may be repeated every $2\, \text{-- } 3\, \text{minutes}$ .
Post-Care: Monitor patient for $4\, \text{-- } 6\, \text{hours}$ due to risk of recurrence as Naloxone wears off.

Legal and Regulatory Appendices

Legal Considerations:
- Duty to Act: Responsibility to provide care.
- Scope of Practice: Authorized skills based on certification.
- Standard of Care: Public expectation of skill level.
- Negligence: Contributing to damage/injury by failing standard of care.
- Advance Directives: DNR (Do Not Resuscitate) or POLST (Physician Orders for Life-Sustaining Treatment).
- Battery: Touching without consent.
- Abandonment: Stopping care before a higher/equal power takes over.
- Confidentiality: Mandatory privacy regarding patient data.
Standard Precautions:
- Hand hygiene is the most effective infection prevention.
- Engineering controls (e.g., biohazard containers) and walk practice controls minimize exposure.
- Post-exposure: Flush eyes for $20\, \text{minutes}$ if splashed.

CPR Steps for Adults

Assess the Scene: Ensure the area is safe.
Check Responsiveness: Tap the person and shout.
Call for Help: If unresponsive, call 911 and get an AED.
Open the Airway: Use the head-tilt/chin-lift or jaw-thrust maneuver.
Check Breathing: Look, listen, and feel for breathing for no more than 10 seconds.
Start Compression:
- Compression Rate: 100-120 compressions/minute.
- Compression Depth: At least 2 inches.
- Compression-to-Ventilation Ratio: For adult CPR, it is 30:2.
Ventilation:
- Give 2 breaths after every 30 compressions. Each breath should last about 1 second.
- Ensure chest rises with each breath.
Continue CPR: Continue cycles of 30 compressions and 2 breaths until help arrives or the person shows signs of life.

CPR Steps for Children (1 Year to Puberty)

Assess the Scene: Ensure safety.
Check Responsiveness: Gently tap the child’s shoulder or foot.
Call for Help: If unresponsive, call 911 and get an AED.
Open the Airway: Use the head-tilt maneuver but keep the head in a neutral position.
Check Breathing: Look, listen, and feel for breathing for no more than 10 seconds.
Start Compression:
- Compression Rate: 100-120 compressions/minute.
- Compression Depth: About 2 inches.
- Compression-to-Ventilation Ratio: 30:2 for a single rescuer, 15:2 for multiple rescuers.
Ventilation:
- Give 2 breaths after every 30 compressions. Ensure chest rise with each breath.
Continue CPR: Keep alternating between compressions and breaths until emergency help arrives or the child shows signs of life.

CPR Steps for Infants (Under 1 Year)

Assess the Scene: Ensure safety.
Check Responsiveness: Gently tap the bottom of the foot.
Call for Help: If unresponsive, call 911 and get an AED (if available).
Open the Airway: Keep the head in a neutral position.
Check Breathing: Look, listen, and feel for breathing (no more than 10 seconds).
Start Compression:
- Compression Rate: 100-120 compressions/minute.
- Compression Depth: About 1.5 inches (1/3 the depth of the chest).
- Compression Technique: Use two fingers or the two-thumb encircling technique for multiple rescuers.
Ventilation:
- Give 2 breaths after every 30 compressions, ensuring that the chest rises with each breath.
Continue CPR: Alternate between compressions and breaths until help arrives or the infant shows signs of life.

The techniques used for airway management in Basic Life Support (BLS) are essential for ensuring an open airway and effective oxygen delivery to the patient.

Head-Tilt/Chin-Lift: This technique is used to open the airway by repositioning the head. In most patients, this method helps to lift the tongue away from the back of the throat, which can obstruct air passage, especially in unresponsive patients.
Modified Jaw-Thrust: This technique is particularly important for patients with suspected neck or spinal injuries. It allows the provider to maintain an open airway without flexing the neck, which could worsen an injury. By supporting the jaw angles and lifting the jaw upward, the airway is kept clear while minimizing movement to the spinal column.
Monitoring Pulse and Ventilations: If during airway management, the pulse decreases to <60 bpm with signs of poor perfusion despite adequate ventilations, we stop CPR to assess the situation. Delivering one ventilation every 2 to 3 seconds is crucial in this context as it ensures that the patient receives adequate oxygenation while we monitor their response. Effective ventilations help restore normal breathing patterns, supporting the patient's overall condition and potentially improving heart rate and perfusion.
ABC Mnemonic: This acronym emphasizes the essential order of assessment and intervention in emergencies, allowing responders to prioritize critical functions—Airway, Breathing, and Circulation.
Simultaneous Pulse and Breathing Check: This quick assessment ensures that vital signs are monitored efficiently, allowing healthcare providers to respond rapidly if the patient shows signs of respiratory failure or arrest. The aim is to quickly determine if further interventions are necessary while ensuring that no more than 10 seconds is spent checking for these signs.