BLS Study Guide. American Heart Association 2015 Guidelines

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1 BLS Study Guide American Heart Association 2015 Guidelines Allina Health Learning & Development Emergency Medicine Education 2925 Chicago Avenue Minneapolis, MN The American Heart Association strongly promotes knowledge and proficiency in AHA courses and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not represent income to the AHA. Special Needs The sponsors of this course are fully committed to accommodating the special needs of participants and will do everything possible to do so for requests received in writing 14 business days in advance of the activity. Accommodations or special needs requested after that date cannot be guaranteed.

2 Basic Life Support American Heart Association Guidelines for and ECC 1) Chain of Survival: How to perform BLS in a wide variety of in-and-out of hospital settings. i) In-Hospital Cardiac Arrest (prearrest recognition & activation defibrillation post-cardiac arrest care) ii) Out-of-Hospital Cardiac Arrest (recognition & activation defibrillation advanced life support postcardiac arrest care) b) When to start, when to give breaths, including barrier devices, when to check for pulse c) Performing prompt, high-quality chest compressions for adult, child and infant victims with full chest recoil d) Perform as an effective team member during a multi-rescuer resuscitation. e) Initiating early use of an AED (Automated External Defibrillator) to eliminate the abnormal heart rhythm. f) Providing appropriate rescue breaths g) Choking relief in a responsive & unresponsive adult, child and infant. 2) High-quality is most likely to positively impact the victim s survival. a) Start compressions within 10 seconds of the recognition of cardiac arrest. b) Push hard, push fast: A rate of at least compressions per minute. c) Allow complete chest recoil after each compression to allow the heart to adequately refill between compressions. d) Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds). e) Give effective breaths that make the chest rise and avoid excessive ventilation. 3) Skills: a) Giving breaths for adult, child, and infant victims and observing chest rise with breaths i) Mouth-to-mask ventilation ii) Bag-mask ventilation during 2-rescuer only or when doing rescue breathing b) Giving high-quality chest compressions for adult, child, and infant victims c) Performing 1-rescurer and 2-rescuer for adult, child and infant victims d) Demonstrating effective team dynamics e) Universal steps for operating an AED f) Choking Relief in the Responsive and the Unresponsive victim of any age adult, child, infant Important BLS Definitions: Agonal Gasps---Gasps are not normal breathing. You should start. Agonal gasps may be present in the first minutes after sudden cardiac arrest. A person who gasps usually looks like he is drawing air in very quickly. The mouth may be open and the jaw, head or neck may move with gasps. Gasps may appear forceful or weak, and some time may pass between gasps because they will usually happen at a slow rate. The gasp may sound like a snort, snore or groan. Gasping is not normal breathing. It is a sign of cardiac arrest. If there is no normal breathing (gasping), check the pulse, activate emergency response system (EMS), and start. Basic Life Support (BLS) Portion of Emergency Cardiovascular Care (ECC) that prevents respiratory and/or circulatory dysfunction through prompt recognition, intervention and early entry into the EMS system, or externally supports respiratory and/or circulatory system(s) through Cardiopulmonary Resuscitation (). Cardiac Arrest---The heart stops pumping blood. It is a clinical diagnosis, confirmed by unresponsive, apnea (or agonal respiration), and the absence of a pulse. Compressions should be initiated within 10 seconds of recognition of the arrest. A heart attack is not the same. A heart attack occurs when blood flow to part of the heart muscle is blocked. Child: for healthcare provider a child is defined as age 1 year to onset of puberty. Signs of puberty include chest or underarm hair on males and any breast development in females. Rates: Adult: minimum compression rate of 100/minute to a maximum compression rate of 120/minute. Child: minimum compression rate of 100/minute to a maximum compression rate of 120/minute. Infant: minimum compression rate of 100/minute to a maximum compression rate of 120/minute. Ratios: Adult - 1-rescurer and 2-rescuer: 30:2 Infant and Child - Single rescuer 30:2 Infant and Child two rescuer 15:2 Defibrillation (using an AED) is important because it can restore a regular heart rhythm. Early defibrillation is important in survival from sudden cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia.

3 Depth of Compressions Adult heel of 2 hands compress on lower half of the breastbone should be compressed at least 2 inches (5cm) but should not exceed 2.4 inches (6cm). Child heel of hands (1 or 2 hands) on center of victim s chest should compress at least 1/3 of the anterior-posterior depth of the child s chest or, at least 2 inches (5cm). Infant 2 fingers compress at least 1/3 the anterior-posterior depth of the infant s chest, at least 1 ½ inches (4cm). BLS Sequence - for Adult, Child & Infant Check that the scene is safe. Assesses victim Check for responsiveness by tapping & shout, Are you OK? If there is no response, shout for help. Assess for normal breathing and a pulse. This should take no more than 10 seconds. Trained rescuers are encouraged to simultaneously check for breathing and pulse at the same time in an effort to reduce the time to the first chest compression. Check for a carotid pulse on adult and check carotid or femoral artery on a child. If there is a pulse in a child but it is less than 60 bpm (beats per minute) with signs of poor perfusion start. To perform a pulse check in an infant, palpate for a brachial pulse. If there is a pulse in an infant but it is less than 60 bpm (beats per minute) with signs of poor perfusion start. Activates Emergency Response System (EMS) Adult Call for help and activate the EMS system. If alone, get the AED and emergency equipment. Child & Infant If you are alone and the arrest was sudden and witnessed: Leave the victim (if no access to cell phone) to activate EMS get the AED and then return. If you are alone and the arrest was not sudden and witnessed: Begin high-quality for 2 minutes (5 cycles) before leaving (if no access to cell phone) the victim to activate EMS and get the AED. Compressions: Delivering high-quality Adult and child Put heel of one hand on the center of the victim s chest on lower half of the breast bone (between nipples). Put heel of other hand on top of first hand. Use 2 hands on an adult & 1 or 2 hands on a child. Infant Place 2 fingers in center of infant s chest just below the nipple line (two-finger chest compressions). Compression rate of at least 100 to 120/minute. Adequate depth of compressions are 2 inches (5 cm) for adults, at least 1/3 the depth of the chest, about 2 inches (5 cm) for a child and about 1/3 the depth of the chest, about 1 ½ inches (4 cm) for infants. Complete chest recoil after each compression allows the heart to adequately refill between compressions. Minimizes interruptions in compressions. Airway: Open the airway using the heat-tilt/chin-lift method. If neck injury is suspected use the jaw-thrust maneuver. Breathing: Give 2 breaths - delivering each breath over 1 second. The chest should rise with each breath. Avoids excessive ventilation. If unable to ventilate, first reposition the head and try again. If still unable to ventilate go to obstructed airway procedures. Spend no more than 10 seconds on breathing before returning to compressions. Infant and Child factoid Infants & children who develop cardiac arrest often have respiratory failure or shock that reduces the oxygen content in the blood even before the onset of the of the arrest. For this reason, it is important to give both compressions and breaths for infants and children during. 2-Rescuer BLS/ -- Team approach to (Rescuers can perform several actions simultaneously) Second rescuer comes in and takes over compressions while the first rescuer ventilates. Adults Use a 30:2 compression-to-breaths ratio in adults. Alternate the compressor role every 2 minutes about every 5 cycles of. Take no more than 5 seconds to switch. Child & Infant Use 15:2 compression-to-breaths ratio in children & infants. The 2 Thumb-Encircling Hands Technique is preferred if the hands can fit around the infant s chest. Alternate the compressor role every 2 minutes about every 10 cycles (15:2) of. Take no more than 5 seconds to switch. Elements of Effective Team Dynamics: The team functions smoothly when all team members have clear roles and responsibilities. Every member of the team should know his/her limitations and the team leader should be aware of them. Knowledge sharing for effective team performance. Team leaders should ask frequently for observations & feedback. Team leaders and team members should give clear messages. Using concise, clear language helps prevent misunderstandings. Speaking in a tone of voice that is loud enough to hear, but also calm & confident, helps keep all team members focused. All team leaders should display mutual respect and a professional attitude to other team members. Debriefing is an important part of every resuscitation attempt, both during & after the attempt. Debriefing has shown to help individual team members perform better and aid in identification of system strengths and deficiencies.

4 Automated External Defibrillator (AED) for Adults, Children and Infants: Assess the victim for response (shout Are you okay? & tap the victim). Shout for help! Simultaneously check for breathing or abnormal breathing (agonal gasps) and pulse at the same time. This should take no more than 10 seconds. Send someone to call EMS and get the AED or use your cell phone to activate EMS. If you are alone without access to a cell phone, leave the victim to activate the EMS and get an AED (or defibrillator) and return to the victim. First Step: Turn on the AED by either pushing the power button or on some models by lifting the lid. Apply the AED electrode pads. Patient must be apneic and pulseless before using the AED. Attach AED pads (electrodes) to bare chest. Place one AED pad on the victim s upper-right chest (directly below the collarbone. Place the other AED pad to the side of the left nipple, with the top edge of the pad a few inches below the armpit. Attach the AED connecting cables to the AED box (some are pre-connected). Follow the AED Prompts. Clear the victim and allow the AED to ANALYZE the rhythm. Analyze will begin when the AED senses a solid connection from the electrodes or in some models after pushing the analyze button as directed. Make sure no one is touching the patient. With 2-rescuer - switch roles when the AED is analyzing the victim. If shock is indicated AED will begin to charge. Loudly state to bystanders and rescuers that they should be All Clear, while checking from head to toe that no one is touching the patient. Press the shock button when all people are clear of patient. Begin starting with compressions until the patient regains consciousness or help arrives and takes over. If no shock advised is indicated immediately begin, starting with chest compressions. If pulse is present check for breathing, give rescue breathes if needed. AED s should be used on children ages 1-8 when the child remains breathless and pulseless after 5 cycles of or when rescuer witnesses a sudden collapse. An AED with a pediatric dose-attenuator system should be used if available. If an AED with a dose attenuator is not available, a standard AED may be used. For infants (<1year of age), a manual defibrillator is preferred. If a manual defibrillator is not available, an AED with a pediatric dose attenuator is desirable. If neither is available, an AED without a dose attenuator may be used. Remove all clothing that may get in the way of placing the electrodes. On a hairy chest, the pads may not stick & may fail to deliver the shock. Remove chest hair with razor, if available. Remove medication patches (using gloves) in the area where you are going to place the electrodes. If a person has been submerged in water, pull the victim out of the water and wipe the chest. With an Advanced Airway (laryngeal mask airway, supraglottic airway device, and endotracheal tube) Continuous compressions with a rate of /min without pauses for breaths. Give 1 breath every 6 seconds (10 breaths per minute) for adults, children, and infants. Rescue Breathing (for victims who have a pulse but are not breathing) Infant and Child - 1 ventilation every 3 to 5 seconds (12 to 20 per minute) Adult - 1 ventilation every 5 to 6 seconds (10 to 12 per minute) Breaths should be given at a rate of 1-breath per second and result in visible chest rise. Opioid-Associated Life-Threatening Emergencies Opioids are medications used primarily for pain relief. Example are hydrocodone, morphine and heroin (illegal in USA). If and opioid-associated life-threatening emergency is suspected: In patients who have a definite pulse, in addition to providing BLS care, it is reasonable for appropriately trained BLS healthcare providers (per protocol) to give naloxone to these patients. In a victim of a cardiac arrest, consider giving naloxone per local protocol after starting. Note that the effect of naloxone administration for victims of cardiac arrest from opioid overdose is unknown. Complications and trouble-shooting Trauma from (even when is properly performed) could result in fractures of the ribs and /or sternum, punctured lungs, abdominal injuries, heart contusion. Gastric inflation is most likely to occur if the rescuer gives breaths too quickly or with too much force. Turn the victim on their side if they start to vomit. Clear the mouth and return to. You may stop when the scene becomes unsafe, the victim responds begins to breathe, move or otherwise respond, you turn the care of the victim over to another responsible and qualified individual, you are exhausted and unable to continue or a physician tells you to stop. Spontaneous return of circulation is when the victim regains a pulse, continue to maintain an open airway and ventilate, if needed. Place victim in the recovery position if the victim is breathing and has a pulse continue to monitor the effectiveness of their breaths and circulation.

5 Choking Relief for Adults, Children and Infants Foreign Body Airway Obstruction If an adult or child has a mild airway obstruction with adequate air exchange, encourage the victim to continue coughing. If the adult or child has a severe airway obstruction, take steps to relieve the obstruction. Abdominal thrusts (or Heimlich maneuver) should be done on a responsive choking adult or child victim. Place the thumb side of your fist against the victim s abdomen, in the midline, slightly above the navel and well below the breastbone. Grasp your fist with the other hand and press your fist into the victim s abdomen. Give quick, forceful upward thrusts (placement is the same for a child, using less force). Repeat thrusts until the object is expelled from the airway or the victim becomes unresponsive. Give each new thrust with a separate, distinct movement to relieve the obstruction. Chest thrusts should be used instead of abdominal thrusts on choking victims if they are markedly obese, history of recent abdominal surgery, or in the late stages of pregnancy. If the victim becomes unresponsive activate EMS then gently lower the victim to the ground. Start with compressions. Do not check for a pulse. Each time you open the airway to give breaths, open the victim s mouth wide and look for the object. If the object can be easily removed, remove it with your fingers. DO NOT do a blind finger sweep. Relieving choking in a responsive infant - Deliver 5 back slaps and 5 chest thrusts at a rate of 1 per second. Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the object is removed or the infant becomes unresponsive. When an infant becomes unresponsive - Perform (starting with compressions) each time you open the airway, look in the mouth for the obstructing object. If you see an object and can easily remove it, remove it. DO NOT do a blind finger sweep. After two minutes or 5 cycles of (C-A-B), activate EMS (if no one has done so). Signs of Severe Airway Obstruction are clutching neck with the thumb and fingers (making the universal choking sign), unable to speak or cry, poor or no air exchange, weak cough or no cough at all, high-pitched noise while inhaling or no noise at all, increased respiratory difficulty, possible cyanosis (turning blue). 604A.01 GOOD SAMARITAN LAW. Subdivision 1.Duty to assist. A person at the scene of an emergency who knows that another person is exposed to or has suffered grave physical harm shall, to the extent that the person can do so without danger or peril to self or others give reasonable assistance to the exposed person. Reasonable assistance may include obtaining or attempting to obtain aid from law enforcement or medical personnel. A person who violates this subdivision is guilty of a petty misdemeanor. Subd. 2. General immunity from liability. (a) A person who, without compensation or the expectation of compensation, renders emergency care, advice, or assistance at t he scene of an emergency or during transit to a location where professional medical care can be rendered, is not liable for any civil damages as a result of acts or omissions by that person in rendering the emergency care, advice, or assistance, unless the person acts in a willful and wanton or reckless manner in providing the car e, advice, or assistance. This subdivision does not apply to a person rendering emergency care, advice, or assistance during the course of regular employment, and receiving comp ensation or expecting to receive compensation for rendering the care, advice, or assistance. (b) For the purposes of this section, the scene of an emergency is an area outside the confines of a hospital or other institution that has hospital facilities, or an office of a person licensed to practice one or more of the healing arts under chapter 147, 147A, 148, 150A, or 153. The scene of an emergency includes areas threatened by or exposed to spillage, seepage, fire, explosion, or other release of hazardous materials, and includes ski areas and trails. (c) For the purposes of this section, "person" includes a public or private nonprofit volunteer firefighter, volunteer police officer, volunteer ambulance attendant, volunteer first provider of emergency medical services, volunteer ski patroller, and any partnership, corporation, association, or othe r entity. (d) For the purposes of this section, "compensation" does not include payments, reimbursement for expenses, or pension benefits paid to members of voluntee r organizations. (e) For purposes of this section, "emergency care" includes providing emergency medical care by using or providing an automatic external defibrillator, unless the person on whom the device is to be used objects; or unless the person is rendering this care during the course of regular employment, the person is receiving or expects to receive compensation for rendering this care, and the usual and regular duties of the person include the provision of emergency medical care. "Automatic external defibrillator" means a medical device heart monitor and defibrillator that: (1) has received approval of its premarket notification, filed pursuant to United States Code, title 21, section 360(k), from the United States Food and Drug Administration; (2) is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia, and is capable of determining, without intervention by an operator, whether defibrillation should be performed; and (3) upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individual's heart.

6 BLS Quick Guide Hand Placement for Compressions Depth Rate 1-Rescuer 2-Rescuer Advanced Airway Rescue Breathing Adult 2 hands on the Lower half of Breastbone At least 2 inches - no more than 2.4 inches /min 30:2 30:2 1 breath every 6 seconds with continuous 1 breath every 5-6 seconds Child 1 or 2 hands on the Lower half of Breastbone 1/3 Depth = 2 inches /min 30:2 15:2 1 breath every 6 seconds with continuous 1 breath every 3-5 seconds Infant 2 fingers just below nipple line 2-Rescuers = 2-thumbencircling hands technique 1/3 Depth = 1.5 Inches /min 30:2 15:2 1 breath every 6 seconds with continuous 1 breath every 3-5 seconds NOTES:

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