Cognitive Objectives (1 of 4)

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. BLS Review • Airway • Breathing • Circulation

10. Elements of Basic Life Support

11. 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.

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

13. 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.

14. 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

15. 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

16. 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.

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

18. Opening the Airway (2 of 2) • Jaw-thrust maneuver

19. Opening the Child or Infant Airway

20. Recognizing an Obstruction

21. 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.

22. 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.

23. 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.

24. 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.

25. Manual Removal

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

27. Removing Foreign Bodies in Children

28. 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.

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

30. 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

31. Stoma Ventilations

32. 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.

33. 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.

34. Recovery Position

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

36. 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.

37. Hand Position

38. Performing Chest Compressions

39. 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.

40. 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.

41. 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.

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

43. Pediatric Hand Positions

44. 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.

45. 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.

46. 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.

47. 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.

48. 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.

49. 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.

50. 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.