Mod D Tech 17 Adult and Paediatric BLS

Question 1

BLS

Answer 1

Question 2

BLS

Answer 2

BLS

Question 3

Primary Survey

Answer 3

Question 4

DANGER

Answer 4

Question 5

Response

Answer 5

Question 6

Question 7

Airway

Answer 7

• Head tilt/chin lift to check and clear the airway for obstruction
• Adjust to jaw thrust if c-spine injury is suspected

•

Note: the tongue is the

most likely obstruction

to the airway

Question 8

Breathing and circulation

Answer 8

• Look, listen and feel for breathing (min 10 seconds)
• Check carotid pulse at the same time

•

•Assess breathing for:

–Rate

–Depth

–Adequacy

–•Assist ventilations if less than 10 or more than 30 breaths a minute

Question 9

If the patient is not breathing normally:

Answer 9

•It may be difficult to be certain there is no pulse

•

•If there are no signs of life (lack of movement, normal breathing or coughing) or there is doubt, start chest compressions

Question 10

Cardiopulmonary resuscitation (CPR)

Answer 10

• Commence chest compressions (30) followed by 2 rescue breaths
• •Continue at ratio of 30:2
• •Compress to a depth of 5-6 cm
• •Compress at a rate of 100-120/min

Question 11

Maternal resuscitation

Special considerations

•Difficult airway management

–Engorged breasts

–Short obese neck

–Full dentition

•Difficult ventilation

–Spayed rib cage

–Raised diaphragm

•Reduced venous return

–Inferior vena cava compression

Answer 11

Special considerations

Question 12

Maternal resuscitation

Management

Answer 12

• Don’t withhold or terminate pre-hospital resuscitation
• Consider I gel early in an attempt to protect the airway and reduce gastric insufflation

•

•Tilt the mother 15-30o laterally, using a wedge under the right-hand side

–Angle of tilt needs to allow high-quality chest compressions

–

•Treat as time-critical transfer, ensure pre-alert to hospital and ask for obstetrician to stand-by in A&E

Question 13

Laryngectomy stoma patient

Answer 13

•Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx.

Question 14

Tracheostomy/stoma

Answer 14

Question 15

Basic Life Support
(Paediatric)

Answer 15

Question 16

Chest Compressions

(Paediatric)

Answer 16

•Start chest compressions if:

“there are no signs of life, unless you are CERTAIN that you can feel a definite pulse of greater than 60/min”

•Depress the sternum by at least one-third the depth of the chest

•

•Compress at a rate of 100 – 120/min

•

•Push “hard and fast”

Question 17

Considerations

Answer 17

Summary

Note incorrect placement of fingers. Avoid contact with soft tissues under chin as this may occlude the airway.

Ensure fingertip(s) placed on point of chin.

Note effect of large occiput on airway.

Question 18

Pathways to Cardiac Arrest in Childhood

Answer 18

Question 19

Paediatric Emergencies

Answer 19

• The outcome of cardiac arrest in children outside hospital is even worse than in adults
• •Children usually arrest because of hypoxia and acidosis due to respiratory or circulatory insufficiency
• Extensive cellular damage will take place before the heart actually stops
• The most important skill in managing paediatric emergencies is patient assessment
• Early recognition and management of developing respiratory distress or circulatory impairment or changed level of consciousness in a child will allow the clinician to rapidly transport the child to hospital for further urgent assessment and treatment

Question 20

Pediatric Resuscitation

Newborn Basic Life Support

Answer 20

Question 21

Pediatric Resuscitation

Answer 21

•Dry the baby

•

•Keep them warm

•

•Assess

Question 22

Pediatric Resuscitation
Assess

Answer 22

Assess

• Colour
• •Tone
• •Breathing rate
• •Heart rate -
• Reassess every 30 seconds

Question 23

Possible Presentations

Answer 23

• Healthy – blue (pink within 90 secs), breathing, crying, good tone, heart rate >100/min (120-150/min)
• Less Healthy - Inadequate respirations,

reduced tone, heart rate <100/min

•Ill - Inadequate respirations (or apnoeic), floppy, pale, heart rate <60/min or absent

Answer 24

Pediatric Resuscitation

Question 25

What do the APGAR Scores mean in practice?

Answer 25

Normal APGAR score 7 – 10

Resuscitative measures might be needed APGAR 4-7

Immediate APGAR <4 resuscitation needed

Assess at 1min, 5 mins re-assess if resuscitative measures have been needed

•

You should, however, treat the baby not the score!

Question 26

Post Cardiac Arrest

Answer 26

•ABCDE approach

•

• Controlled oxygenation and ventilation

•

• 12-lead ECG

•

• Treat precipitating cause

Question 27