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BLS 2015 BLS for Infants and Children (Part 1)

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echoecho's version from 2016-06-16 06:21

Section

Question Answer
List the algorithm for BLS for Infants and Children?1) verify scene safety 2) victim is unreponsive. Shout for nearby help. Activate emergency response system via mobile device (if appropriate) 3) look for no breathing or only gasping and check pulse (simultaneously). Is pulse definitely felt within 10 seconds? If normal breathing with pulse, activate emergency response system (if not already done). Return to victim and monitor until emergency responders arrive. If NO normal breathing and WITH pulse, provide rescue breathing: 1 breath every 3-5 seconds, or about 12-20 breaths/min. (Add compessions if pulse remains < 60 /min with signs of poor perfusion. Activate emergency response system (if not already done) after 2 minutes. Continue rescue breathing; check pulse about every 2 minutes. If NO pulse, begin CPR 4) witnessed sudden collapse, if so activate emergency response system (if not already done), and retrieve AED/defibrillator. If no witnessed sudden collapse, go to CPR 5) CPR (1 rescuer = begin cycles of 30 compressions and 2 breaths)(Use 15:2 ratio if second rescuer arrives)(Use AED as soon as it is available) 6) after about 2 minutes, if still alone, activate emergency response system and retrieve AED (if not already done) 7) AED analyzes rhythm. Shockable rhythm? If yes, shockable (give 1 shock. Resume CPR immediately for about 2 minutes until prompted by AED to allow rhythm check. Contineu until ALS providers take over or victim starts to move). If NO shockable rhythmn. Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check). Continue until ALS providers take over or victim starts to move
List the signs of poor perfusion?1) cool extremities 2) decrease in responsiveness 3) weak pulses 4) paleness 5) mottling (patchy skin appearance), and cyanosis
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INFANT AND CHILD 1 RESCUER BLS SEQUENCE
VERIFY SCENE SAFETY, CHECK FOR RESPONSIVENESS, AND GET HELP (ALGORITHM BOXES 1, 2, 4)
Question Answer
The first rescuer who arrives at the side of an unresponsive infant or child should quickly do what steps?1) verify that the scene is safe for you and the victim. You don't want to become a victim yourself 2) check for reponsiveness. Tap the child's shoulder or the heel of the infant's foot and shout, "Are you OK?" 3) if the victim is not responsive, shout for nearby help. Activate the emergency response system via mobile device (if possible)
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ASSESS FOR BREATHING AND PULSE (BOX 3)
Question Answer
Next asses what?for normal breathing and pulse
To minimize delay in starting CPR, you may assess breathing at the same time as you check for the pulse. This should take non more than ____ seconds?10
To check breathing, scan the victim's hest for rise and fall for no more than ____ seconds?10
If the victim is breathing, what should be done?monitor the victim until additional help arrives
If the victim is not breathing or is only gasping, the victim has respirator or (if no pulse is felt) cardiac arrest. Is gasping considered normal breathing? Is gasping a sign of cardiac arrest?no; yes
If you don't feel a pulse w/in 10 seconds, do what?start CPR beginning with chest compressions
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INFANT= LOCATING THE BRACHIAL ARTERY PULSE
Question Answer
To perform a pulse check in an infant, palpate for a ______ pulse?brachial
List the steps to palpate brachial pulse?1) place 2 or fingers on the inside of the upper arm, midway between the infant's elbow and shoulder 2) then press the fingers to attempt to feel the pulse for at least 5 but no more than 10 seconds
If you do not feel a pulse within 10 seconds, do what?begin high-quality CPR, starting with chest compressions
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CHILD = LOCATING THE FEMORAL ARTERY PULSE
Question Answer
To perform a pulse check in a child, palpate a _____ or _____ pulse. If you do not definitely feel a pulse within ____ seconds, begin high quality CPR and start with chest _______?carotid, femoral, 10, compressions
List the steps to locate the femoral artery pulse?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. If you do not definitely feel a pulse, begin high-quality CPR, starting with chest compressions
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DETERMINE NEXT ACTIONS (BOXES 3a, 3b)
Question Answer
If the victim is breathing normally and a pulse is present, what should you do?monitor the victim
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If the victim is NOT breathing normally but a pulse is present? 1) provide rescue breathing 2) add compressions if pulse remains 60/min or less with signs of poor perfusion 3) confirm that the emergency response system has been activated 4) continue rescue breathing and check pulse about every 2 minutes. Be ready to perform high-quality CPR if you do not feel a pulse or if there is a heart rate < 60 /min with signs of poor perfusion
If the victim is NOT breathing normally, or is only gasping and has no pulse? if you are alone and the arrest was sudden and witnessed If you are alone and the arrest was not sudden and witnessed
If the victim is not breathing normally or is only gasping and has no pulse (if you are alone and the arrest was not considered witnessed? 1) if you are alone and the arrest was sudden and witnessed, you should leave the victim to activate the emergency response system in your setting (call 911 from your phone, mobilize the code team, or notify advanced life support. Get the AED and emergency equipment. If someone else is available send that person to get it. 2) if you are alone and the arrest was NOT sudden and witnessed, continue to the next step and begin high-quality CPR for 2 minutes
WAS THE COLLAPSE SUDDEN (BOXES 4 and 4a)
Question Answer
If the victim is NOT breathing or only gasping and has NO pulse, and the collapse was sudden and witnessed, what should you do?leave the victim to activate the emergency response system (unless you have already done so by mobile device) and retrieve the AED. If others arrive, send them to activate the system (if not already done) and retrieve the AED while you remain with the child to begin CPR.
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BEGIN HIGH-QUALITY CPR, STARTING WITH CHEST COMPRESSIONS (BOXES 5,6)
Question Answer
If the victim is NOT breathing normally or is only gasping and has NO pulse, begin what?1) start high quality CPR 2) remove or more the clothing covering the victim's chest so that you can locate appropriate hand or finger placement for compression. This will also allow placement of AED pads when the AED arrives
Single rescuers should use compression techniques. Explain what is the compressions for infants? for child?1) infant = 2 finger chest compressions 2) child = 1-2 hands (whatever is needed to provide compressions of adequate depth)
After 2 minutes of CPR, if you are still alone and were unable to activate the emergency response system (no mobile phone), what should you do?leave the victim to activate the emergency response system and get the AED. Use the AED as soon as it is available
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ATTEMPT DEFIBRILLATION WITH THE AED (BOXES 7, 8,9)
Question Answer
What should be done with the AED?use it as soon as it is available and follow the prompts
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RESUME HIGH-QUALITY CPR (BOXES 8,9)
Question Answer
What should be done immediately after shock delivery or if NO shock is advised?resume high-quality CPR starting with chest compressions when advised by the AED. Continue to provide CPR and follow the AED prompts until advanc
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SIGNS OF POOR PERFUSION
Question Answer
List the 4 signs of poor perfusion?1) temperature (cool extremities) 2) altered mental states (continued decline in consciousness / responsiveness 3) pulses (weak pulses) 4) skin (paleness, mottling like patchy appearance and later cyanosis)
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INFANT / CHILD CHEST COMPRESSIONS
COMPRESSION RATE AND COMPRESSION-TO-VENTILATION RATIO
Question Answer
The universal rate for compressions in all cardiac arrest victims is ____ to ____/min?100; 120
The compression-to-ventilation ratio for single rescuers is the same (__to__) in adults, children and infants?30; 2
If 2 rescuers are present for the resuscitation attempt of an infant or child, use a compression-to-ventilation ratio of (___to____)?15; 2
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CHEST COMPRESSION TECHNIQUE
Question Answer
For most children, either _________ or _________ hands can be used to compress the chest?1; 2
For most children, the compression technique will be the same as for an adult, which is what?heel of one hand with heel of other hand on top of the first hand
For a very small child, ___ handed compressions may be adequate to achieve the desired compression depth?one
Compress the chest at least ____ of the anteroposterior (AP) diameter of the chest (about ____ inches or ___ cm) with each compression?1/3; 2; 5
For infants, single rescuers should use the ____ ______ technique?2-finger
If multiple rescuers are present, what technique is preferred?2 thumb-encircling hands technique
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INFANT (1 RESCUER) = 2-FINGER TECHNIQUE
Question Answer
List the 8 steps to give chest compressions to an infant by using the 2-finger technique?1) place the infant on a firm, flat surface 2) place 2 fingers in the center of the infant's chest, just below the nipple line, on the lower half of the breastbone. Do not press the tip of the breastbone. 3) Give compressions at a rate of 100-120/min 4) compress at least one third the AP diameter of the infant's chest (about 1 1/2 inches or 4 cm) 5) At the end of each compression, make sure you allow the chest to fully recoil. Do not lean on the chest. Chest compression and chest recoil/ relaxation times should be about equal. Minimize interruptions in compressions (to give breaths) to < 10 seconds. 6) after each 30 compressions, open the airway with a head tilt-chin lift and give 2 breaths, each over 1 second. The chest should rise with each breath 7) After about 5 cycles or 2 minutes of CPR, if you are alone and the emergency response system has not been activated, leave the the infant (or carry the infant with you) to activate the emergency response system and retrieve the AED 8) continue compressions and breaths in the ratio of 30:2, and use the AED as soon as it is available. Continue until advanced providers take over or the infant begins to breathe, move, or otherwise react
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CHEST RECOIL
Question Answer
What does chest recoil allow?blood to flow into the heart
What does incomplete chest recoil reduce?1) reduces the filling of the heart between compressions 2) reduces the blood flow created by chest compressions
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INFANT = 2 THUMB-ENCIRCLING HANDS TECHNIQUE
Question Answer
Why is the 2 thumb-encircling hands technique preferred 2-rescuer chest compression technique?becasue it produces blood flow
List the steps for the 2 thumb-encircling hands technique?1) place the infant on a firm, flat surface 2) place both thumbs side by side in the center of the infat's chest, on the lower half of the breastbone. The thumbs may overlap in very small infants. Encircle the infant's chest and support the infant's back with fingers of both hands 3) with your hands encircling the chest, use both thumbs to depress the breastbone at a rate of 100-120/min 4) compress at least 1/3 the AP diameter of infant's chest (about 1 1/2 inches (4 cm) 5) after each compression, completely release the pressure on the breastbone and allow the chest to recoil completely 6) after every 15 compressions, pause briefly for the second rescuer to open the airway with a head tilt-chin lift and give 2 breaths, each over 1 second. The chest should rise with each breath. Minimize interruptions in compressions (e.g. to give breaths) to < 10 seconds 7) continue compressions and breaths in a ratio of 15:2 (for 2 rescuers). The rescuer providing chest compression should switch roles with another provider about every 5 cycles or 2 minutes to avoid fatigue so that chest compressions remain effective continue CCPR until the AED arrives, advanced providers take over, or the infant begins to breathe, move, or otherwise reported
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THE 2 THUMB-ENCIRCLING HANDS TECHNIQUE
List the 3 reasons why the 2 thumb-encircling hands technique is the recommended technique when CPR is provided by 2 rescuers. This technique is preferred over the 2-finger technique?: 1) produces better blood supply to the heart muscle 2) helps ensure consistent depth and force of chest compressions 3) may generate higher BP
COMPRESSION DEPTH IN ADULTS VS CHILDREN AND INFANTS
Question Answer
What is the compression depth for adults and adolescents? for children? in infants? 1) at least 2 inches (5 cm) 2) at least 1/3 the AP diameter of the chest or about 2 inches (5 cm) 3) at least 1/3 the AP diameter of the chest or about 1 1/2 inches (4 cm)
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INFANT/CHILD BREATHS
OPENING THE AIRWAY
Question Answer
List the 2 methods of opening the airway?1) head tilt chin lift 2) jaw-thrust
As with adults, if a head injury is suspected, use what maneuver?jaw-thrust
If the jaw thrust does not open the airway, use what manuever?head tilt-chin lift
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KEEP HEAD IN NEUTRAL POSITION
Question Answer
If you tilt (extend) an infant's head beyond what position, the infant's airway may be come blocked?sniffing
How can you maximize airway patency?positioning the infant with the neck in a neutral position (so the external ear canal is level with the top of the infant's shoulder)
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WHY BREATHS ARE IMPORTANT FOR INFANTS AND CHILDREN IN CARDIAC ARREST
Question Answer
Why is delivering chest compressions an effective way of distributing oxygen to the heart and brain?because when sudden cardiac arrest occurs, the oxygen content of the blood is typically adequate to meet oxygen demands of the body for the first few minutes after arrest
Why is it important to give BOTH compressions and breaths for infants and children during high-quality CPR?1) infants and 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 arrest 2) for most infants and children in cardiac arrest, chest compressions alone are NOT as effective as compressions and breaths for delivering oxygenated blood to the heart and brain
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VENTILATION FOR AN INFANT OR CHILD WITH A BARRIER DEVICE
Question Answer
What should be used for delivering breaths to an infant or child?pocket mask or a bag-mask device
List the steps when providing bag-mask ventilation for an infant or child?1) select a bag and mask of appropriate size. The mask must cover the victim's mouth and nose completely WITHOUT covering the eyes or overlapping the chin 2) perform a head tilt-chin lift to open the victim's airway. Press the mask to the face as you lift the jaw, making a seal between the child's face and the mask 3) connect supplementary oxygen when available
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