Chapter 13 Flashcards by Gail I

BLS is … emergency lifesaving care that is used to treat medical conditions such as airway obstruction, respiratory arrest, cardiac arrest

noninvasive

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if the patient is in cardiac arrest, then a … sequence is used because chest compressions are essential and must be started as quickly as possible
only … should pass between the time you recognize a patient needs BLS and the start of treatment–> … is possible if brain is without oxygen for more than 4 to 6 mins

CAB: seconds; permanent brain damage

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cardiopulmonary resuscitation (CPR): establishes … and … in a patient who is not breathing and has no pulse
CPR steps:
restore circulation by
1. performing … high-quality compressions to circulate the blood
2. …
3. restore breathing by providing rescue breathing–> administer .. .breaths while visualizing for chest rise

circulation; artificial ventilation; 30; open airway; 2

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BLS differs from ALS
ALS involves: 
- cardiac ...
- ... and ...
- advanced ...

monitoring
intravenous fluids; meds;
airway adjuncts

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AHA’s chain of survival:
recognition and activation of the … system
immediate, high-quality …
rapid …
… and .. emergency medical services
advanced … and … care
if any one of the links in the chain is absent, the patient is more likely to die

emergency response
CPR
defibrillation 
basic; advanced;
life support; post-arrest

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Determining responsiveness should take no more than …seconds
an unresponsive patient may or may not need CPR

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although .. arrest in adults usually occurs before … arrest, the reverse is true for infants and children

cardiac; respiratory

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automated external defibrillation–> vital link in the chain of survival
AED should be applied to cardiac arrest patients as soon as available
if you witness cardiac arrest, begin CPR and apply AED as soon as available. For children:
- apply after the first … cycles of CPR
- for children 1 month to 1 yr of age, a … is preferred; if not available, use … pads and dose-attenuating system; if neither is available, then use an AED with … with … placement

five; manual defibrillator; pediatric-sized pads; adult-sized pads; anterior-posterior

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special situations for AED use: ‘

pacemakers and implanted defibs–> place electrodes at least … inch away from the device
wet patients: if the patient is in water, pull the patient out and … the skin before attaching the AED pads; if the patient is in a small puddle of water/in snow, the AED can be used, but the patient’s chest should be dried as much as possible
transdermal medication patches–> .. the patch and … the skin to remove any residue prior to attaching AED pad

1; dry; remove; wipe

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for CPR to be effective, patient must be … on firm, flat surface
must be enough space around the patient for two rescuers to perform CPR
.. patient onto long backboard

supine; log roll

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quickly check for breathing and a pulse: these assessments can occur simultaneously and take no longer than … second total–> visualize the chest for signs of breathing, palpate for a .. pulse

10; carotid

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provide external chest compressions:
apply … pressure and … to lower half of sternum
compressions .. heart, acting as a pump to circulate blood
avoid … in between compressions
proper hand positioning is crucial
injuries can be minimized by proper technique and hand placement

rhythmic; relaxation; squeeze; leaning on the chest

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if you determine that 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

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the combination of lack of oxygen and too much carbon dioxide in the blood is lethal–> provide slow, deliberate ventilations that last …
if patient is not breathing, ventilations can be given by one or two EMS providers–> use a …

1 second; barrier device

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For a patient with a stoma, place a … or … device directly over the stoma
… may result in …
have a suction unit available in case patient vomits

BVM; pocket mask; artificial ventilation; gastric distension

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single rescuer gives both … and …

ratio of compressions to ventilations is …

chest compressions; artificial ventilations; 30:2

two-rescuer CPR is always preferable to one-rescuer CPR: the rescuer who is doing the compressions can be switched
switching rescuers during CPR is critical to maintain high-quality compressions: recommend to switch positions every …

2 minutes

devices and techniques to assist circulation for two-rescuer adult CPR: 
... CPR 
... device (ITD)
mechanical ... device 
... CPR or ... CPR
... remain the standard of care

active compression-decompression 
impedance threshold
piston
load-distributing band; vest 
manual chest compressions

in most cases, cardiac arrests in infants and children follows respiratory arrest, which triggers … and … of the heart–> airway and breathing are the focus of pediatric BLS

hypoxia; ischemia

determining responsiveness: gently tap child on… and …–> if you find an unresponsive, apneic, pulseless child, while alone off duty, perform CPR for … cycles (about … mins) and then call the EMS system

shoulder; speak loudly; 5; 2

check for breathing and a pulse:
the child must be lying on a hard, flat surface for effective chest compressions
only use … fingers to compress an infant’s chest
if two rescuers are performing CPR on an infant, use the two-thumb-encircling-hands technique to deliver chest compressions
in children, especially those older than 8 years, you can use the … of one or both hands to compress the chest

two; heel

… is common in children. place an unresponsive, breathing child in the … position
the techniques for opening the airway are modified for pediatric patients
place a wedge of padding under the … and … when supine

foreign body obstruction; recovery; upper chest; shoulders

if the child is not breathing but has a pulse, then open the airway and deliver one breath every … to … seconds (12 to 20 breaths/min)
if the child is not breathing and does not have a pulse, then deliver .. rescue breaths after every 30 chest compressions
if an infant or small child is breathing, then provide prompt transport. allow the child to stay in whatever position is most comfortable.
in a child with a tracheostomy tube in the neck, remove the mask from the BVM and connect it directly to the tracheostomy tube to ventilate the child–> a face mask with one-way valve or other barrier device over the tracheostomy site can be used

3; 5; 2;

CPR is a crucial, lifesaving procedure that provides minimal circulation and ventilation until the patient can receive .., …, and … at the ED
no matter how well performed, CPR alone is rarely enough to save a patient’s life

defibrillation, ALS treatment, definitive care

try not to interrupt CPR for more than a ... ...: the total percentage of time during a resuscitation attempt in which chest compressions are being performed, should be at least ..%

few seconds; chest compression fraction; 60

when not to start CPR: if the scene is unsafe if the patient has obvious signs of ..., which include an absence of pulse and breathing if the patient and physician have previously agreed on ... orders

death; do not resuscitate

once you begin CPR, continue until (STOP acronym): S: patient ... and has a .. T: patient is ...to another provider of equal/higher-level training O: you are ... P: ... directs to discontinue "out of strength" does not just mean tired, but physically unable to continue

starts breathing; pulse transferred out of strength physician

in adults, foreign body airway obstruction usually occurs during a .... in children, usually occurs during a ... or at ... patient with mild airway obstruction is able to ... but with signs of respiratory distress --> leave these patients able. observe for signs of a severe airway obstruction

during a meal; meal; play; exchange air

sudden, severe obstruction is usually easy to recognize in responsive patients--> the person is suddenly unable to speak/cough, grasps his/her throat, turns cyanotic, and makes exaggerated efforts to breathe; ... may be present in unresponsive patient, suspect obstruction if maneuvers to ... and ... are ineffective abdominal-thrust maneuver (Heimlich) is recommended in responsive adults and children older than ...--> creates an ...; if the patient with a severe airway obstruction is unresponsive, then perform chest compressions

stridor; open airway; ventilate; 1 year; artificial cough

instead of abdominal-thrust maneuver, use chest thrusts for the following responsive patients in: women in ... ... patients

advanced stages of pregnancy | obese

foreign body airway obstruction unresponsive patients: determine unresponsiveness check for breathing and a pulse if pulse is present and breathing is absent, attempt ... if two attempts do not produce visible chest rise, perform ..., open ..., and look in mouth--> attempt to carefully remove any visible object

ventilation; 30 compressions; airway

in patients who have signs and symptoms of an airway infection, do not waste time trying to ... a foreign body: administer supplemental oxygen and immediately transport on a responsive, standing, or sitting child, perform the Heimlich maneuver but with less ... than what would be used on an adult on unresponsive child older than 1 yr, manage in the same manner as an ...

dislodge; force; adult

for infants with foreign body obstruction, perform ... and ... instead

back slaps; chest thrusts

for infants with foreign body obstruction: in unresponsive infants, begin ..., beginning with chest compressions do not check for a ... before starting compressions open the airway and look in the mouth: if you see an object that can be easily removed, then remove it with your finger and attempt to ventilate. otherwise, resume compressions continue sequence of chest compressions, opening the airway, and looking inside the mouth until obstruction is relieved or ALS providers take over

CPR; pulse

opioid overdose: standard resuscitation measures take priority over ... administration cardiac arrest in pregnancy: priorities are to provide ... and relieve pressure off the ... and ...

naloxone; high-quality CPR; aorta; vena cava

if the pregnant patient is not in cardiac arrest, then position her on her ... side to relieve pressure on the great vessels. fi she is in cardiac arrest, and the top of the patient's uterus can be felt at/above the level of the umbilicus, perform ... of the uterus to the patient's left to relieve aortocaval compression while CPR is being performed

left; manual displacement

grief support: family members may experience a psychologic crisis that turns into a medical crisis family members and loved ones will remember this event in detail for the rest of their lives keep family informed throughout resuscitation process--> designate one provider to communicate the patient's ... to family members be concise and clear

status

after resuscitation has stopped, helpful measures for family include: take family to a .., ... place introduce yourself and anyone with you use clear language and speak in a ..,.., and ... manner exhibit calm, reassuring ... use the patient's ... use ... and appropriate ..

``` quiet; private; warm; sensitive; caring authority name eye contact; touch ```

after resuscitation has stopped, helpful measures include (contd): expect that the family members will show emotion as they begin the grieving process while you are still on scene, be .. but do not hover when you need to leave, turn the family over to someone else ensure that children are not ignored

supportive