ACLS Algorithm; Stroke ACLS Algorithm; Tachycardia ACLS Algorithm; Immediate Post-Cardiac Arrest Care ACLS Algorithm; Phamacology What is the most common cause of cardiac arrest in children? - respiratory failure or shock What is cardiac arrest? - occurs when the heart develops an abnormal rhythm and stops beating or beats too ineffectively to circulate blood to the brain and other vital organs What is heart attack? - A blockage of blood flow to the heart muscle. List the eight components of high quality CPR. - 1. Start compressions within 10 seconds of recognition of cardiac arrest. 2. Compress at a rate of 100-120/min with a depth of at least 2 inches in adults/children and 1 1/2 inches in infants. 3. Allow complete chest recoil after each compression. 4. Minimize interruptions in compressions (limit to 10 seconds). 5. Give effective breaths that make the chest visibly rise. 6. Switch compressors about every 2 minutes or earlier if fatigued. 7. Continue delivering chest compressions while the AED is charging. 8. Avoid prolonged rhythm analysis, frequent or inappropriate pulse checks, taking too long to give breaths to the patient, excessive ventilation, or unnecessarily moving the patient. What is the recommended compression depth for adults and children? - 2 inches What is the recommended compression depth for infants? - 1 1/2 inches What can result if a patient is ventilated too quickly? - hyperventilation - excessive intrathoracic pressure and gastric inflation - decreased venous return - decreased coronary and cerebral perfusion pressures - diminished cardiac output - decreased rates of survival What memory aid may be used when evaluating a patient's level of consciousness? - AVPU Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to: - simultaneously look for breathing and feel for a carotid pulse for no more than 10 seconds Upon finding an unresponsive child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to: - simultaneously look for breathing and feel for a carotid or femoral pulse for no more than 10 seconds Upon finding an unresponsive infant, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to: - simultaneously look for breathing and feel for a brachial pulse for no more than 10 seconds Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. Your next action should be to: - begin chest compressions; remove clothing; use AED as soon as it arrives Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is breathing normally and a pulse is present. Your next action should be to: - continue to monitor until additional help arrives. Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. The arrest was not sudden and not witnessed. Your next action should be to: - begin chest compressions 30:2 (1 rescuer), 15:2 (2 rescuer); if 2 rescuers are present, one rescuer begins CPR and the other activates the ERS; use the AED as soon as it arrives; after about 2 min of CPR, if you are still alone, activate the ERS and get the AED if not already done Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. The arrest was sudden and witnessed. Your next action should be to: - activate the emergency response system and retrieve the AED; begin chest compressions 30:2 (1 rescuer), 15:2 (2 rescuer) Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is breathing normally and a pulse is present. Your next action should be to: - activate ERS, return to victim and monitor until emergency responders arrive Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is not breathing normally but a pulse is present. Your next action should be to: - provide rescue breathing (one breath every 5-6 seconds) and recheck for a pulse every 2 minutes; be ready to perform high quality CPR if you do not feel a pulse; if opioid use is suspected, consider administering naloxone Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is not breathing normally but a pulse is present. Your next action should be to: - provide rescue breathing (one every 3-5 seconds); add compressions if pulse remains 60/min with signs of poor perfusion; activate ERS after 2 min; continue rescue breathing and check pulse about every 2 min (if no pulse begin CPR) What is the purpose of the primary survey? - to detect the presence of life-threatening problems that require rapid interventions What two cardiac arrest rhythms are shockable? - VF and pVT What two cardiac arrest rhythms are not shockable? - asystole and PEA During the primary survey, for what length of time should you assess for the presence of a pulse? - at least 5 seconds but no more than 10 seconds What is the importance of measuring coronary perfusion pressure during CPR? - represents myocardial blood flow during chest compressions and is a key determinant of the success of resuscitation What is an adequate coronary perfusion pressure (CPP)? - 15 mm Hg What is the importance of measuring waveform capnography (PETCO2) during CPR? - allows for evaluation of CPR quality, optimize chest compressions, detection of ROSC during chest compressions or when a rhythm check reveals an organized rhythm, ET tube placement What is an adequate waveform capnogrpahy (PETCO2) range? - 10-20 mm Hg When ROSC occurs, what happens to waveform capnography? - There will be a significant increase in the ETCO2. (35-45 mmHg) This increase represents a drastic improvement in blood flow (more CO2 being dumped in the lungs by the circulation) which indicates circulation. What is chest compression fraction? - the proportion of time that chest compressions are performed during a cardiac arrest What is the target goal of chest compression fraction during CPR? - 60-80% What is the appropriate tidal volume for adult cardiac arrest patients? - 500-600 mL (half a squeeze of an adult ventilation bag; enough to see visible chest rise) Single rescuers should use the compression-to-ventilation ratio of ____ compressions to ____ breaths when giving CPR to victims of any age. - 30:2 At what rate should compressions occur? - 100-120/min Interruptions in chest compressions should be limited to how many seconds? - 10 Rescuers should switch compressors how often? - every 5 cycles (2 min) or sooner if fatigued What method should be utilized when opening the airway of a patient who is suspected of having a head or neck injury? - jaw thrust When communicating with a team member, the team leader communicates by taking these steps: 1. The team leader gives a message, order, or assignment to a team member. 2. By receiving a clear response and eye contact, the team leader confirms that the team member heard and understood the message. 3. The team leader listens for confirmation of task performance from the team member before assigning another task. What type of communication do these steps represent? - closed-loop communication Which pulse is palpated when performing a BLS assessment on an adult? - carotid What do agonal gasps represent? - not normal breathing; is a sign of cardiac arrest How does one palpate a carotid pulse? - locate the trachea; slide 2-3 fingers into the groove between the trachea and the muscles at the side of the neck; feel for at least 5 seconds but no more than 10 seconds When should the victim be moved during chest compressions? - never unless the victim is in a dangerous environment (such as a burning building) or if you believe you cannot perform CPR effectively in the victim's present position or location How does one properly perform chest compressions on an adult during resuscitation efforts? - 1. Make sure the victim is lying face-up on a firm surface. 2. Put the heel of one hand in the center of the victim's chest, on the lower half of the sternum. 3. Put the heel of your hand on top of the first hand. 4. Straighten your arms and position your shoulders directly over your hands. 5. Rate of 100-120/min. 6. Press down at least 2 in with each compression. 7. Allow for complete chest recoil. 8. Minimize interruptions in chest compressions. How does one properly perform the head tilt-chin lift technique? - 1. Place one hand on the victim's forehead and push with your palm to tilt the head back. 2. Place the fingers of the other hand under the bony part of the lower jaw near the chin. 3. Lift the jaw to bring the chin forward. How does one properly perform the jaw thrust maneuver? - 1. Place one hand on each side of the victim's head. You may rest your elbows on the surface on which the victim is lying. 2. Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward. 3. If the lips close, push the lower lip with your thumb to open the lips. How does one properly use a pocket mask to deliver breaths using the head tilt-chin lift technique? - 1. Position yourself at the victim's side. 2. Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct position. 3. Seal the pocket mask against the face. Using the hand that is closer to the top of the victim's head, place the index finger and thumb along the edge of the mask. Place the thumb of your other hand along the edge of the mask. 4. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. 5. While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face. 6. Deliver each breath over 1 second, enough to make the victim's chest rise. How does one properly use a bag mask device to deliver breaths? - 1. Position yourself directly above the victim's head. 2. Place the mask on the victim's face, using the bridge of the nose as a guide for correct position. 3. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open. 4. Squeeze the bag to give breaths (1 second each) while watching for chest rise. A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. What is the first action you should take in this situation? - verify that the scene is safe for you and the victim A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. The man doesn't respond when you touch his shoulder and shout, "Are you OK?" What is your best next action? - check for breathing and carotid pulse; shout for nearby help A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. Several rescuers respond, and you ask them to activate the emergency response and retrieve the AED and emergency equipment. As you check for a pulse and breathing, you notice that the man is gasping for air and making "snorting" sounds. You do not feel a pulse. What is your best next action? - start high-quality CPR, beginning with chest compressions How does one properly use an AED? - 1. Open the carrying case and power on the AED. 2. Attach AED pads to the victim's bare chest. 3. When the AED prompts you, clear the victim and allow the AED to analyze the rhythm. 4. Resume chest compressions while the AED is charging. 5. Clear the victim when delivering a shock; resume compressions after the shock has been delivered. 6. If no shock is needed, immediately resume CPR starting with chest compressions. What are the two correct methods for placement of AED pads? - Method 1. AKA Anterolateral Placement. Place one AED pad directly below the right collarbone. Place the other pad to the right side of the left nipple, with the top edge of the pad a few inches below the arm pit. Method 2. AKA Anteroposterior Placement. Place one AED pad on the left side of the chest, between the victim's left side of the breastbone and left nipple. Place the other pad on the left side of the victim's back, next to the spine. When placing AED pads on a patient with an implanted defibrillator or pacemaker, what precautions should be taken? - avoid placing AED pad directly over the implanted device What is the most appropriate first step to take as soon as the AED arrives at the victim's side? - power on the AED What action should you take when the AED is analyzing the heart rhythm? - stand clear of the victim How does one properly palpate a brachial pulse on an infant? - 1. Place 2-3 fingers on the inside of the upper arm, midway between the elbow and the shoulder. 2. Then press the fingers to attempt to feel the pulse for at least 5 seconds but no more than 10 seconds. How does one properly palpate a femoral pulse on a child? - 1. Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the torso. 2. Feel for a pulse for at least 5 but no more than 10 seconds. What pulse location should be palpated when assessing an unresponsive infant? - brachial What pulse location should be palpated when assessing an unresponsive child? - femoral or carotid What is the correct hand placement for performing high-quality chest compressions on a child? - 2 hands or 1 hand (optional for small child) on the lower half of the sternum What is the correct hand placement for performing high-quality chest compressions on an infant? - 1 rescuer: 2 fingers in the center of the chest, just below the nipple line 2 or more rescuers: 2 thumb-encircling hands in the center of the chest, just below the nipple line What are some signs of poor perfusion? - cool extremities, altered mental status, weak pulses, pale