Cognitive Objectives (1 of 4) Identify the need for basic life support, including the urgency surrounding its rapid application. List the EMT-B’s responsibilities in beginning and terminating CPR. Describe the proper way to position an adult patient to receive basic life support. Describe the proper way to position an infant and child to receive basic life support.

Cognitive Objectives (2 of 4) Describe three techniques for opening the airway in an infant, child, and adult. List the steps in providing artificial ventilations in an infant, child, and adult. Describe how gastric distention occurs. Define the recovery position. Describe infectious disease issues related to rescue breathing.

Cognitive Objectives (3 of 4) List the steps in providing chest compressions in an adult. List the steps in providing chest compressions in an infant and child. List the steps in providing one-rescuer CPR in an infant, child, and adult. List the steps in providing two-rescuer CPR in an infant, child, and adult.

Cognitive Objectives (4 of 4) Distinguish foreign body obstructions from other conditions that cause respiratory failure. Distinguish a complete airway obstruction from a partial airway obstruction. Describe the steps in removing a foreign body obstruction in an infant, child, and adult.

Affective Objectives Recognize and respect the feelings of the patient and family during basic life support. Explain the urgency surrounding the rapid initiation of basic life support measures. Explain the EMT-B’s responsibilities in starting and terminating CPR. Explain the rationale for removing a foreign body obstruction.

Psychomotor Objectives (1 of 2) Demonstrate how to position the patient to open the airway. Demonstrate how to perform the head tilt-chin lift maneuver in an infant, child, and adult. Demonstrate how to perform the jaw-thrust and modified jaw-thrust maneuvers in infants, children, and adults. Demonstrate how to place a patient in the recovery position.

Psychomotor Objectives (2 of 2) Demonstrate how to perform chest compressions in an adult. Demonstrate how to perform chest compressions in an infant and child. Demonstrate how to perform one-rescuer CPR in an infant, child, and adult. Demonstrate how to perform two-rescuer CPR in an infant, child, and adult. Demonstrate how to remove a foreign body obstruction in an infant, child, and adult.

BLS Review Airway Breathing Circulation

Elements of Basic Life Support

AED Use Consider use when medical cardiac arrest is suspected. Should not be used on children younger than 1 year of age. Pediatric pads and equipment should be used if available for children younger than 8 years.

Determine responsiveness. Initial Assessment Determine responsiveness. An alert and oriented patient does not need CPR. You may also suspect cervical spine injury. Protect the spine.

Age Guidelines Anyone younger than 1 year is considered an infant. A child is between 1 year and the onset of puberty. Adulthood is from the onset of puberty and older.

When BLS Should Not Be Started BLS should not be started if the following situations exist: Rigor mortis or stiffening of the body Dependent lividity Putrefaction or decomposition of the body Evidence of a nonsurvivable injury Existing DNR or no-CPR order

When Should CPR Be Stopped? S — Patient Starts breathing and has a pulse T — Patient is Transferred to another person O — You are Out of strength P — A Physician asks you to stop

Positioning the Patient Kneel beside the patient. First EMT-B: Place your hands behind the patient’s back, head, and neck. Second EMT-B: Place your hands on the distant shoulder and hip and turn the patient toward you. First EMT-B: Control the head and neck and place the patient in a supine position.

Opening the Airway (1 of 2) Head tilt–chin lift maneuver

Opening the Airway (2 of 2) Jaw-thrust maneuver

Opening the Child or Infant Airway

Recognizing an Obstruction

Removing a Foreign Body (1 of 4) If the patient is sitting or standing: Stand behind the patient. Make a fist with one hand. Press your fist into the patient’s abdomen. Repeat thrusts in sets of five.

Removing a Foreign Body (2 of 4) Chest thrusts Stand behind the patient. Wrap your arms around the patient’s chest. Make a fist with one hand; grasp the fist with the other hand. Press your fist into the patient’s chest with backward thrusts until the object is expelled or patient becomes unconscious.

Removing a Foreign Body (3 of 4) If the patient is unconscious: Place the patient in a supine position. Begin steps of CPR. If first ventilation does not produce visible chest rise, reposition the head. If both breaths fail to produce visible chest rise, perform 30 chest compressions then look in the mouth.

Removing a Foreign Body (4 of 4) If an object is visible, attempt to remove it. Do not perform blind finger sweeps. Reattempt to ventilate. Continue chest compressions, opening the airway and looking inside the mouth, and attempts to ventilate until the airway is clear or ALS help arrives.

Manual Removal

Mild Airway Obstruction Breathing is noisy. Patient may be coughing. Encourage patient to cough. Give 100% oxygen using a nonrebreathing mask. Provide prompt transport.

Removing Foreign Bodies in Children

Removing Foreign Bodies in Infants Place one hand on infant’s back and neck. Deliver five quick back slaps. Turn infant face up. Give five quick chest thrusts on the sternum.

Assessing for Breathing Open airway. Look. Listen. Feel.

Ventilations Use a barrier device. Open the airway. Pinch patient’s nostrils together. Take a deep breath. Give slow rescue breaths (1 second each). Rate of 10-12 breaths/min for adults

Stoma Ventilations

Gastric Distention Gastric distention is most likely to occur if: You blow too hard as you ventilate. You give breaths too rapidly. The patient’s airway is obstructed.

Pediatric Needs If the child is breathing, let the child maintain his or her position. Ventilate infants using mouth-to-nose-and-mouth ventilations. Ventilate once every 3 seconds or 20 times per minute. If air does not enter freely, check the airway for obstruction.

Recovery Position

Assess Circulation Assess after delivering rescue breaths. Feel for palpable pulse in the carotid artery.

Chest Compressions You can provide artificial circulation by applying rhythmic pressure and relaxation to the lower half of the sternum. External chest compressions only provide 25% to 33% of the blood normally pumped. Chest compressions must be accompanied by artificial ventilation.

Hand Position

Performing Chest Compressions

One-rescuer Adult CPR Perform initial assessment. Determine whether the patient is breathing. Determine whether the patient has a pulse. Place your hands on the chest. Give 30 compressions, followed by two ventilations.

Two-rescuer Adult CPR First EMT-B is positioned at patient’s head. Second EMT-B is positioned at patient’s side. First EMT-B delivers two rescue breaths. Second EMT-B begins chest compressions at a ratio of 30 compressions to two breaths. After 2 minutes, the first EMT-B reassesses breathing and pulse.

Switching Positions Switch during pulse checks. First EMT-B moves into position to deliver compressions after giving two breaths. Second EMT-B delivers 30th compression then moves to patient’s head. Second EMT-B checks pulse.

Pediatric Needs Opening the airway is your top priority. Assess circulation using the brachial artery in infants.

Pediatric Hand Positions

Pediatric Compressions Deliver at a rate of 100 per minute. Compress the infant or child’s chest 1/3 to 1/2 the depth of the chest. Give two breaths every 30 compressions for one rescuer, and two breaths every 15 compressions for two rescuers.

Interrupting CPR CPR is an important holding action. Transport immediately if ALS is not available at the scene. Try not to interrupt CPR for more than a few seconds. Do not move the patient until transport arrangements are made.

Review You respond to the library where a 75-year-old woman has collapsed and is unconscious. As you approach her, you can see that she is breathing inadequately. You should: A. attach an AED. B. open her airway. C. begin rescue breathing. D. assess for a carotid pulse.

Review Answer: B Rationale: The FIRST step in airway management is to open the airway. Sometimes a simple maneuver, such as the head tilt-chin lift, can restore adequate breathing. If manual head positioning does not restore adequate breathing, begin rescue breathing and assess for a pulse.

Review You respond to the library where a 75-year-old woman has collapsed and is unconscious. As you approach her, you can see that she is breathing inadequately. You should: attach an AED. Rationale: Only attach an AED after determining that the patient is pulseless and apneic. B. open her airway. Rationale: Correct answer C. begin rescue breathing. Rationale: You must open the airway first. D. assess for a carotid pulse. Rationale: Assess for a pulse only after opening the airway and providing rescue breathing.

Review 2. Early, effective basic life support measures are NOT likely to resuscitate a patient who has: A. dependent lividity. B. been struck by lightning. C. a severe airway obstruction. D. had a near-drowning accident.

Review Answer: A Rationale: Dependent lividity—pooling of blood in dependent parts of the body—is a sign of obvious death, and indicates that a person has been dead for a prolonged period of time. Resuscitation is not indicated for patients with lividity.

Review 2. Early, effective basic life support measures are NOT likely to resuscitate a patient who has: dependent lividity. Rationale: Correct answer B. been struck by lightning. Rationale: The patient has a good chance of surviving. C. a severe airway obstruction. D. had a near-drowning accident.

Review 3. You are performing one-rescuer CPR on a middle-aged man in cardiac arrest. What should you do when a second rescue arrives to assist you? A. switch to a compression to ventilation ratio of 15:2. B. apply the AED and deliver up to 3 shocks in a row. C. stop CPR and check for a pulse for up to 15 seconds. D. ensure that you switch rescuer roles every 2 minutes.

Review Answer: D Rationale: In order to avoid unrecognized rescuer fatigue, it is important to switch rescuer roles every 2 minutes (five cycles of 30 compressions and 2 breaths in the adult). All adult (one- and two-rescuer) and all one-rescuer CPR is performed at a compression to ventilation ratio of 30:2. If the AED advises a shock, deliver a single shock and immediately resume CPR. Pulse checks, if indicated, should not exceed 10 seconds.

Review 3. You are performing one-rescuer CPR on a middle-aged man in cardiac arrest. What should you do when a second rescue arrives to assist you? switch to a compression to ventilation ratio of 15:2. Rationale: Adult CPR is performed at a ratio of 30:2. B. apply the AED and deliver up to 3 shocks in a row. Rationale: An AED will deliver a single shock and then indicate to continue CPR. C. stop CPR and check for a pulse for up to 15 seconds. Rationale: Pulse checks should not exceed 10 seconds. D. ensure that you switch rescuer roles every 2 minutes. Rationale: Correct answer

Review 4. When attempting to relieve a severe foreign body airway obstruction in an unresponsive infant, you should: A. deliver 5 back slaps and 5 chest thrusts. B. sweep the mouth with your finger every 30 seconds. C. perform chest compressions and visualize the mouth. D. administer abdominal thrusts until the obstruction is relieved.

Review Answer: C Rationale: Proper treatment for an unresponsive infant with a severe (complete) foreign body airway obstruction involves performing chest compressions (30 if you are alone; 15 if two rescuers are present), opening the airway and visualizing the mouth, and attempting to ventilate. DO NOT perform blind finger sweeps on any patient—regardless of age. Back slaps and chest thrusts are appropriate for a responsive infant with a severe airway obstruction.

Review 4. When attempting to relieve a severe foreign body airway obstruction in an unresponsive infant, you should: deliver 5 back slaps and 5 chest thrusts. Rationale: This is only performed on a responsive infant. B. sweep the mouth with your finger every 30 seconds. Rationale: Do not perform blind finger sweeps, regardless of the patient’s age. C. perform chest compressions and visualize the mouth. Rationale: Correct answer D. administer abdominal thrusts until the obstruction is relieved. Rationale: Abdominal thrusts are not performed on infants. They are only performed on children and adults.

Review 5. Which of the following ventilation techniques should be used for a patient who has had a laryngectomy? A. Mouth-to-nose B. Mask-to-stoma C. Mouth-to-mask D. Mouth-to-mouth

Review Answer: B Rationale: Patients who have had a laryngectomy (surgical removal of the larynx) often have a permanent stoma (a hole in the center of the neck) through which they breathe; they do not breathe through the nose and mouth. Therefore, mask-to-stoma (preferred over mouth-to-stoma) ventilations would be necessary. If any of the other techniques listed were used, little or no air would reach the lungs.

Review 5. Which of the following ventilation techniques should be used for a patient who has had a laryngectomy? Mouth-to-nose Rationale: It will be ineffective since little or no air will reach the lungs. B. Mask-to-stoma Rationale: Correct answer C. Mouth-to-mask D. Mouth-to-mouth

Review 6. Gastric distention during rescue breathing can be minimized by: A. delivering each breath over 1 second. B. increasing the volume of each breath. C. delivering at least 24 breaths per minute. D. allowing partial exhalation in between breaths.

Review Answer: A Rationale: Gastric distention—inflation of the stomach with air—can cause regurgitation of stomach contents, which may be aspirated into the lungs. To minimize the incidence of gastric distention, deliver each rescue breath over a period of 1 second—just enough to produce visible chest rise—and allow for complete exhalation. For the adult, give one breath every 5 to 6 seconds (10 to 12 breaths/min). For the infant and child, give one breath every 3 to 5 seconds (12 to 20 breaths/min).

Review 6. Gastric distention during rescue breathing can be minimized by: delivering each breath over 1 second. Rationale: Correct answer B. increasing the volume of each breath. Rationale: Increasing the volume will increase the amount of gastric distention. C. delivering at least 24 breaths per minute. Rationale: Adults are 10 to 12 breaths/min, and children are 12 to 20 breaths/min. D. allowing partial exhalation in between breaths. Rationale: Exhalation is a passive process since the patient is not breathing, allow for complete exhalation.

Review 7. You assess a 56-year-old man and determine that he is apneic and pulseless. As you begin CPR, his wife presents you with a living will that appears to be valid. You should: A. continue CPR and contact medical control for advice. B. obtain a signed release from the wife and then stop CPR. C. stop CPR if the patient does not respond within 5 minutes. D. respect the patient's wishes and cease resuscitative efforts.

Review Answer: A Rationale: Advance directives, such as living wills, express the patient's wishes should he or she become incapacitated. If you are faced with a situation in which a cardiac arrest patient’s spouse or other family member presents you with what appears to be a valid living will, the safest course of action is to contact medical control, apprise him or her of the situation, and request guidance. In most cases, the physician will permit you to stop CPR if a valid document is presented.

Review 7. You assess a 56-year-old man and determine that he is apneic and pulseless. As you begin CPR, his wife presents you with a living will that appears to be valid. You should: continue CPR and contact medical control for advice. Rationale: Correct answer B. obtain a signed release from the wife and then stop CPR. Rationale: You should contact medical control, the spouse does not have to sign the release. C. stop CPR if the patient does not respond within 5 minutes. Rationale: Only stop CPR with a valid living will and if medical control authorizes you to discontinue. D. respect the patient's wishes and cease resuscitative efforts. Rationale: Cease resuscitative efforts only after authorization from medical control.

Review 8. After defibrillating a 60-year-old man with the AED, you should: A. assess for a carotid pulse. B. begin rescue breathing. C. reanalyze his cardiac rhythm. D. perform CPR for 2 minutes.

Review Answer: D Rationale: After defibrillating any patient with the AED, you should immediately begin or resume CPR, starting with chest compressions. After 2 minutes of CPR, reanalyze the patient’s cardiac rhythm and deliver another shock if indicated. If signs of life are present (ie, coughing, movement), assess for a carotid pulse.

Review 8. After defibrillating a 60-year-old man with the AED, you should: assess for a carotid pulse. Rationale: Assess only if there are signs of life (coughing, movement). B. begin rescue breathing. Rationale: CPR must be started at a ration of 30:2. C. reanalyze his cardiac rhythm. Rationale: Reanalyze the cardiac rhythm after 2 minutes of CPR. D. perform CPR for 2 minutes. Rationale: Correct answer

Review 9. Which of the following diseases poses the GREATEST threat to the EMT-B who performs mouth-to-mouth rescue breathing without a barrier device? A. HIV B. Hepatitis B C. Hepatitis C D. Tuberculosis

Review Answer: D Rationale: Tuberculosis (TB) is transmitted by the droplet route via aerosol transmission; therefore, it would pose the greatest threat to the EMT-B who performs mouth-to-mouth rescue breathing without a barrier device. HIV and hepatitis transmission could occur, but is much less likely as they are primarily transmitted via the blood.

Review 9. Which of the following diseases poses the GREATEST threat to the EMT-B who performs mouth-to-mouth rescue breathing without a barrier device? HIV Rationale: It is a bloodborne pathogen and exposure is minimal. B. Hepatitis B C. Hepatitis C D. Tuberculosis Rationale: Correct answer

Review 10. Which of the following is a basic life support (BLS) skill? A. Intubation B. IV therapy C. Sellick maneuver D. Manual defibrillation

Review Answer: C Rationale: All levels of EMS provider are trained to perform the Sellick maneuver (cricoid pressure)—a technique used to minimize gastric distention during rescue breathing. Intubation, IV therapy, and manual defibrillation are advanced life support skills. Defibrillation with the AED, however, is a BLS skill.

Review 10. Which of the following is a basic life support (BLS) skill? Intubation Rationale: This is an ALS skill. B. IV therapy C. Sellick maneuver Rationale: Correct answer D. Manual defibrillation Rationale: This is an ALS skill, while using an AED is a BLS skill.