Page 3 Cardiology and Resuscitation Study Guide for the EMT test

Resuscitation

What is BLS?

Basic Life Support (BLS) includes the concept of recognizing and providing high-quality care for someone in need of CPR or someone in another life-threatening cardiovascular situation. There are standard scientific best practices established that are related to the actions and sequence of the steps of care.

Elements of BLS

Basic Life Support (BLS) consists of techniques aimed at sustaining life in an emergency relating to the airway, respiratory function, or cardiac arrest. The basic treatment elements of chest compressions and assisted breaths focus on airway (obstruction), breathing (respiratory arrest), and circulation (cardiac arrest or bleeding). In 2010, the American Heart Association updated CPR guidelines from the “ABC” (airway, breathing, chest compressions) to “CAB” (chest compressions, airway, breathing) model. This is because data has shown that those receiving little delay in chest compressions (i.e., chest compressions done first) have better outcomes.

The elements in Advanced Life Support (ALS) build on BLS concepts, but differ in that they also include monitoring, IV fluid, and/or medication administration.

Determining the Need for BLS

To determine if someone is in need of BLS that includes CPR, the EMT will assess for key elements. Establish that the patient is breathing and has a patent airway. Ensure there is adequate circulation via pulse palpation and no signs of bleeding.

Terms/Concepts to Know: basic elements of CPR, CAB, ABCs

CPR

Cardiopulmonary resuscitation is used to assist a person who presents with absent pulses and respirations. This technique was developed in the 1960s and has evolved to provide both healthcare and laypersons with ongoing current knowledge to assist in a cardiopulmonary or respiratory crisis.

Purpose of CPR

The main goal of CPR is to establish spontaneous breathing and circulation after the cessation of these functions. This happens through the use of artificial maneuvers by someone trained in them.

Terms/Concepts to Know: main goal of CPR

Steps in CPR

There are five critical steps for CPR. These steps include cooperation, collaboration, and communication between the emergency BLS, ALS, and ER teams.

Terms/Concepts to Know: critical CPR steps, chain of survival

CPR Guidelines

CPR is not an absolute treatment for every situation in which someone is unresponsive. Before beginning CPR, always assess for airway and pulse. Do not perform compressions on an unresponsive person who has a pulse. Do not attempt to provide artificial ventilations if the person has an open airway with adequate respirations.

When not to Start CPR

There are certain scenarios where CPR is not an appropriate intervention. If a person is not breathing but has a pulse, CPR should not be done, though appropriate respiratory support should be given. DNR orders and a patient with no signs of life should also not be given CPR.

Terms/Concepts to Know: non survivable injuries, rigor and livor mortis, examples of when not to begin CPR

When to Stop CPR

When CPR is initiated, the intent is to continue until the patient expires or more advanced interventions can be done. There are standard criteria for the cessation of CPR that can be remembered by the acronym STOP. They are:

S: Starts breathing

T: Transfer of Care

O: Out of Strength

P: Physician’s Order

Terms/Concepts to Know: STOP mnemonic

Interrupting CPR

CPR is intended to be a life-saving intervention. When CPR begins, interruption should be very minimal. Often, the absence of ALS on the scene will create the need for CPR to be performed in transport. The emergency team should perform continuous CPR except for minimal necessary interruptions, such as lifting the patient for transport. Interruptions to chest compressions should be no more than 10 seconds.

Terms/Concepts to Know: chest compression fraction

Patient Care

Care of the patient requires more than performing the technical maneuvers or use of equipment. When a patient is in an emergency or crisis situation, there are multiple things to consider. What preceded the event, is the scene safe, does the patient have other injuries, are there friends or family present, and what do witnesses know? The answers to these questions will help to frame a plan of care.

Positioning

A firm, flat surface and a supine position provide the best way to assess the patient and perform CPR. If possible, you should work to ensure enough space for two rescuers and equipment before the procedure is initiated. Use the recovery position for patients with no spinal injuries who are breathing on their own and may have decreased loc.

Terms/Concepts to Know: supine, prone, logroll, recovery position

Breathing and Pulse Check

Before beginning CPR on a patient who appears unresponsive, a basic CPR needs assessment should be done. Try to arouse the patient, and take 10 seconds to look, listen, and feel for breathing and pulses.

Terms/Concepts to Know: carotid artery location, how to palpate carotid pulse, how to assess for breathing and pulse

Chest Compressions

The initiation of chest compressions is important for quality CPR in patients without a pulse. The key to quality compressions is an appropriate technique that includes correct hand positioning and depth, depending on age of patient. In adults, the rescuer should kneel next to the patient, and the fingers should be laced together, one on top of the other, and placed over the tip of the patient’s breastbone. Compressions should be given at a rate of 100 a minute, at a depth of at least 2 inches. Two breaths should be given after 30 compressions, regardless if there are one or two rescuers present.

Terms/Concepts to Know: depth required for adult compressions, CPR hand and arm position for compressions

CPR in Children and Infants

In most cases, a pediatric patient does not have a cardiac arrest unless there is cardiac history or a respiratory condition that leads to cardiopulmonary complications. If CPR is initiated, appropriate breaths and hand placement is essential.

In children ages 1 to puberty, the rescuer should place one or two hands on the lower half of the patient’s breastbone, depending on hand and child size. Compression depth should be at least 2 inches and compressions should be delivered at a rate of 100 per minute. If one rescuer is present, the compression-ventilation ratio is 30:2. But if there are two rescuers, the rate should be changed to 15:2.

In infants 1 year or less, the compression rate of 100 per minute is the same, but the depth should be reduced to 1 1/2 inches. Hand placement and CPR ratios are different depending on how many rescuers are present. If only one rescuer is available, the rescuer should stay at the patient’s side, using 2 fingers to compress the chest just below the patient’s nipple line. The compression-ventilation ratio for single rescuer infant CPR is 30:2. In two person infant CPR, one rescuer should stay at the head and the other at the feet. The rescuer responsible for compressions should use both hands to encircle the chest, delivering 15 compressions for every two breaths.

Terms/Concepts to Know: ischemia, hypoxia, standard position, infant and child compression depth