8/30/20 American Heart Association BLS Recommendations COMPRESSIONS, AIRWAY, BREATHING (CAB) Understanding Basic Life Support in Adults ◦ Check for responsiveness of the patient by tapping firmly on or above How to Pass Your the collar bone BLS Like A Boss ◦ If no response, assess the environment for safety before beginning cardiopulmonary resuscitation 2020 ◦ Activate emergency response system by shouting for help and have another person obtain the AED/Defibrillator ◦ Check for breathing and pulse no more than 10 seconds Jennifer Cheung, M SN, RN, CCRN ◦ Begin CPR if no pulse is detected by starting with chest compressions ◦ If pulse is present with agonal breathing, begin rescue breathing immediately 1 2 American Heart Association BLS Recommendations American Heart Association BLS Recommendations Chest Compressions (CAB) Airway and Breathing (CAB) ◦ Place palm of hand over the patient’s sternum just above the xiphoid ◦ Utilize the head tilt-chin lift or jaw thrust (trauma to the cervical spine) process ◦ Rescue breaths are 1 breath every 5 to 6 seconds ◦ Previous indicator was to place the palm of your hands on the mid- ◦ You want to see visible chest rise and fall with each rescue breath nipple line; however, due to the increase in obesity, the nipple line may no longer be the best indicator ◦ Avoid excess ventilation ◦ Potential reduction of cerebral blood flow rated to a decrease in ◦ Chest compressions are 100 to 120 per minute PaCO2 levels ◦ Compression depth should be at least 2 inches in adults ◦ Risk of increased intrathoracic pressures which can lead to adverse ◦ Allow for full chest recoil between compression and minimize hemodynamic effects interruptions to less than 10 seconds ◦ Switch compression team members every 2 minutes Compression to Ventilation Ratio ◦ 30 compressions: 2 rescue breaths 3 4 American Heart Association BLS Recommendations American Heart Association BLS Recommendations AED / Defibrillation Understanding Basic Life Support in Pediatrics 1. Turn on the AED and follow the AED prompts 2. Open or remove the person’s shirt, clearing any wet barrier or Definition of Neonate, Infant, Child, Adolescent medication patches ◦ Neonate: 0 to 28 days 3. Attach the AED pads to the right anterior chest and left midaxillary ◦ Infant: 28 days to 1 year old line per pad instructions and plug the pads into the connector ◦ Child: greater than 1 years old but has not reached puberty 4. Stop chest compressions, confirm everyone is clear by saying “Stand ◦ Adolescent: Puberty is present either through arm pit hair or breast Clear” development 5. Push the analyze button and allow the AED to analyze the person’s heart rhythm 6. If a shock is recommended, make sure no one is touching the person and repeat “Stand Clear.” Once clear, press the shock button. 7. Begin CPR immediately following the shock or if no shock is advised. Perform 2 minutes of CPR and follow the AEDs prompts again. 5 6 1
8/30/20 American Heart Association BLS Recommendations American Heart Association BLS Recommendations Understanding Basic Life Support in Pediatrics Understanding Basic Life Support in Pediatrics In Basic Life Support in Pediatrics, follow the CAB sequence for ◦ Unresponsive, no pulse, not breathing cardiopulmonary resuscitation. Compression – Airway – Breathing. ◦ Begin CPR Immediately ◦ Infant – 2 finger chest compressions – center of chest at the ◦ Verify the Scene Safety, Check for Responsiveness and Get Help nipple line ◦ Verify that the scene is safe, so you don’t become a victim yourself. ◦ One-person rescuer is 30 chest compressions to 2 breaths ◦ Check for responsiveness of the child. Tap the shoulders or heel of ◦ Two-person rescuer is 15 chest compressions to 2 breaths the infant's foot and shout “Are you OK?!” (better for coronary perfusion) ◦ If victim does not respond, should for help nearby and activate ◦ Child – 1 or 2 hands the emergency response system. ◦ Chest compression should be 1/3 the AP diameter of the chest ◦ If no one responds, DO NOT LEAVE THE child. Perform one ◦ Infants – 1 ½ inches or 4 cm round of CPR prior to finding help. ◦ Children – 2 inches or 5 cm ◦ Assess for Breathing ◦ No compressions beyond 6 cm ◦ No more than 10 seconds – Check for rise and fall of chest and ◦ 100 to 120 chest compressions per minute in infants, children, presence of pulse and adolescents ◦ Pulse Checks ◦ Infant – palpate a brachial pulse ◦ Child – palpate a carotid or femoral pulse 7 8 American Heart Association BLS Recommendations American Heart Association BLS Recommendations Understanding Basic Life Support in Pediatrics Understanding Basic Life Support in Pediatrics ◦ Rescue breaths ◦ AED Placement for Infants and Children ◦ After every 30 chest compressions, the provider should provide 2 ◦ Under 8 years of age – Use child pads if available. If child pads are breaths each over 1 second. not available, you may use adult pads. Place pads so they do not touch each other. One pad is placed on the chest and the other pad is ◦ You want to see chest raise and fall for confirm appropriate placed on the back. Pads should sandwich the heart when placed rescue breaths appropriately. ◦ Patient should be placed in the sniffing position for optimization of ◦ 8 years of age and older – Use Adult pads. DO NOT USE CHILD PADS rescue breaths. This requires the flexion and extension of the head – they will likely give a shock dose that is too low. and neck using the EC method with a bag-valve mask 9 10 American Heart Association BLS Recommendations American Heart Association BLS Recommendations Understanding Basic Life Support in Pediatrics Understanding Basic Life Support in Pediatrics ◦ If agonal breathing, with pulse – No CPR necessary Defibrillation is the treatment for immediate life-threatening arrhythmias with which the patient does not have a pulse such as ◦ Give rescue breaths over 1 second every 3-5 seconds ventricular fibrillation or pulseless ventricular tachycardia. ◦ Defibrillation ◦ IV/IO Access ◦ Initial Shock: 2-4 Joules/Kg ◦ IO access if the preferred access for cardiac arrest in pediatrics over IV ◦ Second Shock: > OR = 4 Joules/Kg access ◦ Maximum Shock: 10 Joules/Kg ◦ REMEMBER THIS MNEMONIC: 2, 4, 6, 8 THAT’S THE DOSE TO DEFIBRILLATE Synchronized Cardioversion is the treatment that aims to convert an arrhythmia back to sinus rhythm such as atrial fibrillation or supraventricular tachycardia. ◦ Synchronized Cardioversion ◦ 0.5 to 1 Joules/Kg 11 12 2
8/30/20 American Heart Association BLS Recommendations American Heart Association BLS Recommendations Foreign Body Airway Obstruction – Adult & Children Foreign Body Airway Obstruction - Infant 1. Ask “Are you choking?” If the victim nods “yes” and cannot talk, 1. If the victim cannot make any sounds or breathe, severe airway severe airway obstruction is present. obstruction is present 2. Give abdominal thrusts/Heimlich maneuvers or chest thrusts for 2. Give up to 5 back slaps and up to 5 chest thrusts pregnant or obese persons who is responsive 3. Repeat step 2 until effective or the person becomes unresponsive 3. Repeat abdominal thrusts (or chest thrusts if pregnant or obese) until effective or the person becomes unresponsive Back Slaps Chest Thrusts 13 14 American Heart Association BLS Recommendations Foreign Body Airway Obstruction – Unresponsive 1. Activate the emergency response system through your mobile phone or send someone to do so. After 2 minutes of CPR, if you are alone with no mobile phone, leave the person to activate the emergency response system (if another person has not done so) 2. Lower the person to the floor. Begin CPR, starting with chest compression. Do not check for a pulse. 3. Before you deliver rescue breaths, investigate the mouth. If you see the foreign body that can be easily removed, remove it. 4. Continue CPR until advanced providers arrive. 15 3
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