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Activate the emergency response system in your setting. A, In-facility setting. B, Prehospital setting. Foundational Facts Emergency Response System Activation of the emergency response system may vary depending on your setting and local protocol. This will help you determine the next appropriate actions. To minimize delay in starting CPR, you may assess breathing at the same time as you check the pulse. This should take no more than 10 seconds. Check Pulse To perform a pulse check in an adult, palpate a carotid pulse Figure 7. If you do not definitely feel a pulse within 10 seconds, begin high-quality CPR, starting with chest compressions. In all scenarios, by the time cardiac arrest is identified, the emergency response system or backup must be activated and someone must be sent to retrieve the AED and emergency equipment. Figure 6. Check for breathing and pulse at the same time.

Caution Agonal Gasps Agonal gasps are not normal breathing. 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. Some time may pass between gasps because they 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 you do not definitely feel a pulse, begin CPR, starting with chest compressions. A B Figure 7. Finding the carotid pulse. A, Locate the trachea. B, Gently feel for the carotid pulse. Determine Next Actions Boxes 3a, 3b Determine next actions based on the presence or absence of normal breathing and pulse: If If the victim is breathing normally and a pulse is present Monitor the victim.

If the victim is not breathing normally but a pulse is present Provide rescue breathing see Rescue Breathing in Part 7. Be ready to perform high-quality CPR if you do not feel a pulse. Begin high-quality CPR see next step below. If the victim is not breathing normally or is only gasping and has no pulse, immediately begin high-quality CPR, starting with chest compressions see Critical Concepts: HighQuality CPR in Part 1 and the section Adult Chest Compressions below. This will also allow placement of the AED pads when the AED arrives. Resume High-Quality CPR Box 8 Immediately resume high-quality CPR, starting with chest compressions, when advised by the AED. Continue to provide CPR, and follow the AED prompts until advanced life support is available.

Adult Chest Compressions Importance of Chest Compressions Each time you stop chest compressions, the blood flow to the heart and brain decreases significantly. Once you resume compressions, it takes several compressions to increase blood flow to the heart and brain back to the levels present before the interruption. Thus, the more often chest compressions are interrupted and the longer the interruptions are, the lower the blood supply to the heart and brain is. High-Quality Chest Compressions If the victim is not breathing normally or is only gasping and has no pulse, begin CPR, starting with chest compressions. Single rescuers should use the compression-to-ventilation ratio of 30 compressions to 2 breaths when giving CPR to victims of any age.

When help arrives, the resuscitation team, based on local protocol, may choose to continue CPR at the scene or transport the victim to an appropriate facility while continuing rescue efforts. Foundational Facts The Importance of a Firm Surface Compressions pump the blood in the heart to the rest of the body. To make compressions as effective as possible, place the victim on a firm surface, such as the floor or a backboard. If the victim is on a soft surface, such as a mattress, the force used to compress the chest will simply push the body into the soft surface. A firm surface allows compression of the chest and heart to create blood flow. If the victim is lying facedown, carefully roll him faceup. If you suspect the victim has a head or neck injury, try to keep the head, neck, and torso in a line when rolling the victim to a faceup position.

A B Figure 8. A, Place the heel of your hand on the breastbone, in the center of the chest. B, Correct position of the rescuer during chest compressions. Foundational Facts Chest Recoil Chest recoil allows blood to flow into the heart. Incomplete chest recoil reduces the filling of the heart between compressions and reduces the blood flow created by chest compressions. Alternate Technique for Chest Compressions 20 If you have difficulty pushing deeply during compressions, put one hand on the breastbone to push on the chest. Grasp the wrist of that hand with your other hand to support the first hand as it pushes the chest Figure 9.

This technique may be helpful for rescuers with joint conditions, such as arthritis. BLS for Adults Figure 9. Alternate technique for giving chest compressions to an adult. Switch to a head tilt—chin lift maneuver if the jaw thrust does not open the airway. If multiple rescuers are available, one rescuer can perform a jaw thrust while another rescuer provides breaths with a bag-mask device. The third rescuer will give chest compressions. A B Figure The head tilt—chin lift relieves airway obstruction in an unresponsive victim.

A, Obstruction by the tongue. When a victim is unresponsive, the tongue can block the upper airway. B, The head tilt—chin lift maneuver lifts the tongue, relieving the airway obstruction. Rescuers may perform a jaw thrust to open the airway in a victim with a head or neck injury if a spinal injury is suspected Figure If the jaw thrust does not open the airway, use a head tilt—chin lift. Figure Jaw thrust. You may rest your elbows on the surface on which the victim is lying. BLS for Adults Barrier Devices Introduction Foundational Facts Standard precautions include using barrier devices, such as a pocket mask, when giving breaths. Rescuers should replace face shields with a pocket mask at the first opportunity. Low Infection Risk The risk of infection from CPR is extremely low and limited to a few case reports. However, the US Occupational Safety and Health Administration OSHA requires that healthcare workers use standard precautions in the workplace, including during CPR.

Pocket Mask For mouth-to-mask breaths, use a pocket mask Figure Pocket masks usually have a 1-way valve, which diverts exhaled air, blood, or bodily fluids away from the rescuer. Some pocket masks have an oxygen inlet that allows you to administer supplementary oxygen. Pocket masks are available in different sizes for adults, children, and infants Figure Effective use of the pocket mask barrier device requires instruction and practice. Adult, child, and infant pocket masks. This position is ideal when performing 1-rescuer CPR because you can give breaths and perform chest compressions without repositioning yourself every time you change from compressions to giving breaths. continued 23 P a r t 2 continued Step 3 Action Seal the pocket mask against the face. Perform a head tilt—chin lift to open the airway Figure One rescuer using a pocket mask. Because we use a relatively small amount of the oxygen we breathe, the air that the rescuer breathes out provides the victim with much-needed oxygen.

It consists of a bag attached to a face mask. If the bag is self-inflating, a bag-mask device may be used with or without an oxygen supply. Some bag-mask devices include a 1-way valve. The type of valve may vary from one device to another. Face masks are available in a variety of sizes. Common sizes are infant small , child medium , and adult large. The mask should extend from the bridge of the nose to the cleft of the chin. It should cover the nose and mouth but not compress the eyes Figure The mask contains a cup that should provide an airtight seal.

If the seal is not airtight, ventilation will be ineffective. All BLS providers should be able to use a bag-mask device. Proficiency in the bag-mask ventilation technique requires practice. During CPR, 2 rescuers are recommended to deliver effective ventilation. One rescuer opens the airway and seals the mask against the face, while the other squeezes the bag. Bag-mask device. Proper area of the face for face mask application. Note that no pressure is applied to the eyes. Deliver each breath over 1 second, whether or not you use supplementary oxygen. E-C clamp technique of holding the mask while lifting the jaw. When 2 rescuers use the bag-mask device, 1 rescuer opens the airway with a head tilt—chin lift or jaw thrust and holds the mask to the face while the other rescuer squeezes the bag Figure BLS for Adults Figure Two-rescuer bag-mask ventilation.

Critical Concepts Two Rescuers for Jaw Thrust and Bag-Mask Ventilation During CPR, jaw thrust and bag-mask ventilation are more efficiently performed when 2 or more rescuers are providing ventilation. Adult 2-Rescuer BLS Sequence Introduction If the rescuer encounters an unresponsive adult and other rescuers are available, follow the steps outlined in the BLS Healthcare Provider Adult Cardiac Arrest Algorithm Figure 4. Verify Scene Safety, Check for Responsiveness, and Get Help Algorithm Boxes 1, 2 The first rescuer who arrives at the side of a potential cardiac arrest victim should quickly perform the following steps. As more rescuers arrive, assign tasks Table 3. When more rescuers are available for a resuscitation attempt, more tasks can be performed simultaneously. Step Action 1 Verify that the scene is safe for the rescuers and the victim.

Assess for Breathing and Pulse Box 3 For details on assessing the victim for normal breathing and a pulse, see Adult 1-Rescuer BLS Sequence earlier in Part 2. Resume High-Quality CPR Box 8 28 After shock delivery or if no shock is advised, immediately resume high-quality CPR, starting with chest compressions. Continue to provide CPR and follow the AED prompts until advanced life support providers take over or the victim starts to breathe, move, or otherwise react. BLS for Adults Critical Concepts High-Performance Teams When giving compressions, rescuers should switch compressors after every 5 cycles of CPR about every 2 minutes , or sooner if fatigued. As additional rescuers arrive, they can help with bag-mask ventilation, compressions, and use of the AED and other emergency equipment Figure Multiple rescuers can perform simultaneous tasks during a resuscitation attempt.

Team Roles and Duties for 2-Rescuer CPR Rescuer Tasks In 2-rescuer CPR Figure 20 , each rescuer has specific tasks. Two-rescuer CPR. Take less than 5 seconds to switch. Effective Team Performance to Minimize Interruptions in Compressions Effective teams communicate continuously. If the compressor counts out loud, the rescuer providing breaths can anticipate when breaths will be given. This will help the rescuer prepare to give breaths efficiently and minimize interruptions in compressions. Also, the count will alert both rescuers when the time for a switch is approaching. It is hard work to deliver effective chest compressions. To reduce rescuer fatigue, switch compressors about every 5 cycles or every 2 minutes or sooner if needed.

To minimize interruptions, perform the switch when the AED is analyzing the rhythm. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. Which is the first action you should take in this situation? Activate the emergency response system b. Start high-quality CPR, beginning with chest compressions c. Start providing rescue breaths d. Verify that the scene is safe for you and the victim 2. Check his pulse b. Start high-quality CPR c. Shout for nearby help 3. Several rescuers respond, and you ask them to activate the emergency response and retrieve the AED and emergency equipment. You do not feel a pulse. What is your best next action? Start high-quality CPR, beginning with chest compressions b. Monitor the victim until additional, more experienced help arrives c. Provide rescue breathing by delivering 1 breath every 5 to 6 seconds d. Find someone to help by retrieving the nearest AED 4.

What is the ratio of chest compressions to breaths when providing CPR to an adult? What are the rate and depth for chest compressions on an adult? A rate rate rate rate of of of of 60 to 80 compressions per minute and a depth of about 1 inch 80 to compressions per minute and a depth of about 1½ inches to compressions per minute and a depth of about 2½ inches to compressions per minute and a depth of at least 2 inches 6. What action should you take when more rescuers arrive? Assign tasks to other rescuers and rotate compressors every 2 minutes or more frequently if needed to avoid fatigue b.

Continue CPR while the AED is attached even if you are fatigued c. Wait for the most experienced rescuer to provide direction to the team d. Direct the team to assign a team leader and roles while you continue CPR 7. If you suspect that an unresponsive victim has head or neck trauma, what is the preferred method for opening the airway? Head tilt—chin lift b. Jaw thrust c. Head tilt—neck lift d. Avoid opening the airway See Answers to Review Questions in the Appendix. AEDs are simple to operate, allowing laypersons and healthcare providers to attempt defibrillation safely. Public-Access Defibrillation To make early defibrillation possible, an AED or defibrillator should be immediately available to BLS providers responding to a cardiac arrest.

Public-access defibrillation PAD means having trained rescuers and AEDs available in public places where large numbers of people gather or where there is reasonable likelihood of witnessed cardiac arrests. Examples include airports, convention centers, sports facilities, industrial buildings, offices, fitness facilities, shopping malls, apartments, and healthcare facilities. This position provides ready access to AED controls and easy placement of AED pads. It also allows a second rescuer to perform high-quality CPR from the opposite side of the victim without interfering with AED operation. Importance of Minimizing Time Between Last Compression and Shock Delivery Research has shown that if rescuers minimize the interval between the last compression and shock delivery, the shock is much more likely to be effective ie, eliminating ventricular fibrillation and increasing the chances of return of spontaneous circulation.

Minimizing this interval will require practice and excellent team coordination, particularly between the compressor and the rescuer operating the AED. Foundational Facts Life-Threatening Arrhythmias An arrhythmia is an irregular or abnormal heart beat. Arrhythmias occur when the electrical impulses that cause the heart to beat happen too quickly, too slowly, or erratically. Arrhythmias can be life threatening. Two life-threatening arrhythmias that cause cardiac arrest are pulseless ventricular tachycardia pVT and ventricular fibrillation VF. In extremely severe cases, the ventricles pump so quickly and inefficiently that no pulse can be detected ie, pVT.

Body tissues and organs, especially the heart and brain, no longer receive oxygen. The heart muscles quiver in a fast, unsynchronized way so the heart does not pump blood. Rapid defibrillation, high-quality CPR, and all components of the Chain of Survival are needed to improve chances of survival from pulseless pVT and VF. If VF or pVT is identified, the device prompts the delivery of an electrical shock to the heart. If an organized rhythm returns and high-quality CPR continues, the heart muscle can begin to contract and pump blood effectively.

If circulation returns, a pulse is palpable, and this is called return of spontaneous circulation ROSC. Using the AED Be Familiar With the AED Equipment in Your Setting AED equipment varies according to the model and manufacturer. There are a few differences from model to model, but AEDs all operate in basically the same way. In this manual, we include the universal steps for operating an AED during a resuscitation attempt. However, you must be familiar with the AED used in your particular setting. For example, some AEDs must be powered on while others power on automatically when the lid is opened. Universal Steps for Operating an AED Table 4 explains the universal steps for operating an AED.

However, always turn on the AED and follow the AED prompts as displayed or heard during the resuscitation attempt. Table 4. Universal Steps for Operating an AED Step 1 Action Open the carrying case. Power on the AED Figure 21 if needed. Choose adult pads not child pads or a child system for victims 8 years of age and older. Follow the placement diagrams on the pad Figure See Critical Concepts: AED Pad Placement Options later in Part 3 for common placement options. Be sure that no one is touching the victim, not even the rescuer in charge of giving breaths. The AED may take a few seconds to analyze. continued 35 P a r t 3 continued Step Action 4 If the AED advises a shock, it will tell you to clear the victim Figure 24A and then deliver a shock.

Do Not Delay High-Quality CPR After AED Use 5 If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions. Continue until advanced life support providers take over or the victim begins to breathe, move, or otherwise react. Power on the AED. The rescuer attaches AED pads to the victim and then attaches the electrodes to the AED. The AED operator clears the victim before rhythm analysis. If needed, the AED operator then activates the analyze feature of the AED. A, The AED operator clears the victim before delivering a shock. B, When everyone is clear of the victim, the AED operator presses the shock button.

If no shock is indicated and immediately after any shock delivered, rescuers start CPR, beginning with chest compressions. The 2 common placements are anterolateral and anteroposterior. AED pad placement options on an adult victim. A, Anterolateral. B, Anteroposterior. Caution Child AED Pads Your AED may also include smaller pads that are designed for children under 8 years of age. However, you should not use the child pads for an adult. The shock dose delivered by child pads is too small for an adult and will likely not be successful. It is better to provide high-quality CPR than to attempt to shock an adult victim with child pads. Remember to note whether or not the victim has a hairy chest before you apply the pads. Then you can shave the area where you will place the pads by using the razor from the AED carrying case.

If you have a second set of pads, you can use the first set to remove the hair. Apply the first set of pads, press them down so they stick as much as possible, and quickly pull them off. Then apply the new second set of pads. Water Water is a good conductor of electricity. Do not use an AED in water. Implanted Defibrillators and Pacemakers Victims with a high risk for sudden cardiac arrest may have implanted defibrillators or pacemakers that automatically deliver shocks directly to the heart. If you place an AED pad directly over an implanted medical device, the implanted device may block delivery of the shock to the heart.

These devices are easy to identify because they create a hard lump beneath the skin of the upper chest or abdomen. The lump is about half the size of a deck of playing cards. Transdermal Medication Patches Do not place AED pads directly on top of a medication patch. The medication patch may block the transfer of energy from the AED pad to the heart and also cause small burns to the skin. Examples of medication patches are nitroglycerin, nicotine, pain medication, and hormone replacement therapy patches. If it does not delay delivery, remove the patch and wipe the area before attaching the AED pad. Remember to avoid delays as much as possible. Life Is Why Science Is Why Cardiovascular diseases claim more lives than all forms of cancer combined.

Review 1. Power on the AED b. Apply the pads c. Press the analyze button d. Press the shock button 2. Which step is one of the universal steps for operating an AED? Removing the victim from water d. If a victim of cardiac arrest has an implanted pacemaker or defibrillator, what special steps should be taken? Avoid placing the AED pad directly over the implanted device b. Avoid using the AED to prevent damage to the implanted device c. Turn off the implanted device before applying the AED pads d. Consider using pediatric pads to decrease the shock dose delivered 4. What action should you take when the AED is analyzing the heart rhythm? Check the pulse b. Continue chest compressions c. Give rescue breaths only d. Stand clear of the victim See Answers to Review Questions in the Appendix. Student Notes 40 Part 4 Team Dynamics General Concepts Overview Successful team dynamics are critical during a multirescuer resuscitation attempt, regardless of location.

Poor communication among team members can negatively affect performance. Effective team dynamics may increase the chance of a successful resuscitation. Whether you are a team member or team leader, it is important to understand not just what to do in a resuscitation attempt but how to communicate and perform effectively as part of a multirescuer team. Performing CPR with a chest compression fraction as high as possible is advisable to achieve this. The chest compression fraction is the proportion of time that chest compressions are performed during a cardiac arrest. Critical Concepts Effective Team Dynamics Successful multirescuer team members not only have medical expertise and mastery of resuscitation skills, but also practice good communication and effective team dynamics.

This enables rescuers to respond rapidly and effectively in an emergency situation. Effective multirescuer team dynamics help give victims the best chance of survival. When all team members know their jobs and responsibilities, the team functions more smoothly. Figure 27 shows an example of a team formation with assigned roles. No team member leaves the triangle except to protect his or her safety. Roles may be adapted to local protocol. Team diagram. Each team member should ask for assistance and advice early, not when the situation starts to get worse. Constructive Intervention Sometimes a team member or team leader may need to correct actions that are incorrect or inappropriate. What to Communicate Knowledge Sharing Knowledge sharing is important for effective team performance. Team leaders should ask frequently for observations and feedback. This includes good ideas for management and observations about possible oversights.

Clear Messages 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 is also calm and confident, helps keep all team members focused. Mutual Respect All team members should display mutual respect and a professional attitude to other team members, regardless of their skill level or training. Emotions can run high during a resuscitation attempt. Debriefing is the opportunity for team members to identify why certain actions were taken.

Life Is Why Education Is Why Heart disease is the No. After performing high-quality CPR for 5 minutes, the team leader frequently interrupts chest compressions to check for a pulse even though the victim has no organized rhythm when the AED analyzes the rhythm. Which action demonstrates constructive intervention? Ask another rescuer what he thinks should be done b. Say nothing that contradicts the team leader c. Suggest to resume chest compressions without delay d. Wait until the debriefing session afterward to discuss it 2. The team leader asks you to perform bag-mask ventilation during a resuscitation attempt, but you have not perfected that skill. What would be an appropriate action to acknowledge your limitations?

Pick up the bag-mask device and give it to another team member b. Pretend you did not hear the request and hope the team leader chooses someone else to do it c. Tell the team leader that you are not comfortable performing that task d. Try to do it as best you can and hope another team member will see you struggling and take over 3. What is the appropriate action to demonstrate closed-loop communication when the team leader assigns you a task? Repeat back to the team leader the task you were assigned b. Nod your head as an acknowledgment of the assigned task c. Start performing the assigned tasks, but do not speak, to minimize noise d. Wait for the team leader to address you by name before acknowledging the task See Answers to Review Questions in the Appendix. Student Notes 44 Part 5 BLS for Infants and Children General Concepts Overview This section describes BLS for infants and children. Signs of puberty include chest or underarm hair on males and any breast development in females.

Return to victim and monitor until emergency responders arrive. Normal breathing, has pulse 3 Look for no breathing or only gasping and check pulse simultaneously. No 5 6 CPR 1 rescuer: Begin cycles of 30 compressions and 2 breaths. Use ratio if second rescuer arrives. After about 2 minutes, if still alone, activate emergency response system and retrieve AED if not already done. No, nonshockable Yes, shockable 8 Give 1 shock. BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for the Single Rescuer. Verify Scene Safety, Check for Responsiveness, and Get Help Algorithm Boxes 1, 2, 4 The first rescuer who arrives at the side of an unresponsive infant or child should quickly perform the following steps: Assess for Breathing and Pulse Box 3 Step Action 1 Verify that the scene is safe for you and the victim. Activate the emergency response system via mobile device if possible.

Next, assess the infant or child for normal breathing and a pulse. Gasping is not considered normal breathing and is a sign of cardiac arrest. See Caution: Agonal Gasps in Part 2. It can be difficult for BLS providers to determine the presence or absence of a pulse in any victim, particularly in an infant or child. So if you do not definitely feel a pulse within 10 seconds, start CPR, beginning with chest compressions. A B C Figure Pulse check. To perform a pulse check in an infant, palpate a brachial pulse A. To perform a pulse check in a child, palpate a carotid B or femoral C pulse. Follow the steps below to locate the brachial artery and palpate the pulse. To perform a pulse check in a child, palpate a carotid or femoral pulse. Follow these steps to locate the femoral artery pulse: Step Determine Next Actions Boxes 3a, 3b Action 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 Figure 29C.

If you do not definitely feel a pulse, begin high-quality CPR, starting with chest compressions. Determine next actions based on the presence or absence of normal breathing and pulse: If Then If the victim is breathing normally and a pulse is present Monitor the victim. For example, call from your phone, mobilize the code team, or notify advanced life support. Boxes 4 and 4a If the victim is not breathing or only gasping and has no pulse, and the collapse was sudden and witnessed, 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. Begin High-Quality CPR, Starting With Chest Compressions Boxes 5, 6 If the victim is not breathing normally or is only gasping and has no pulse, begin highquality CPR, starting with chest compressions see Critical Concepts: High-Quality CPR in Part 1. This will also allow placement of AED pads when the AED arrives. Use the AED as soon as it is available. Attempt Defibrillation With the AED Boxes 7, 8, 9 Use the AED as soon as it is available and follow the prompts. Resume High-Quality CPR Boxes 8, 9 After shock delivery or if no shock is advised, immediately resume high-quality CPR, starting with chest compressions, when advised by the AED. Continue to provide CPR and follow the AED prompts until advanced life support providers take over or the child begins to breathe, move, or otherwise react.

The compression-to-ventilation ratio for single rescuers is the same in adults, children, and infants. If 2 rescuers are present for the resuscitation attempt of an infant or child, use a compression-to-ventilation ratio of For most children, the compression technique will be the same as for an adult: 2 hands heel of one hand with heel of other hand on top of the first hand. For a very small child, 1-handed compressions may be adequate to achieve the desired compression depth. Compress the chest at least one third the anteroposterior AP diameter of the chest about 2 inches, or 5 cm with each compression. For infants, single rescuers should use the 2-finger technique. If multiple rescuers are present, the 2 thumb—encircling hands technique is preferred. These techniques are described below. Infant 1 Rescuer : 2-Finger Technique Follow these steps to give chest compressions to an infant by using the 2-finger technique: Step Action 1 Place the infant on a firm, flat surface.

Do not press the tip of the breastbone Figure Minimize interruptions in compressions eg, to give breaths to less than 10 seconds. The chest should rise with each breath. Continue until advanced providers take over or the infant begins to breathe, move, or otherwise react. Two-finger chest compression technique for an infant. Infant: 2 Thumb— Encircling Hands Technique The 2 thumb—encircling hands technique is the preferred 2-rescuer chest compression technique because it produces improved blood flow. Follow these steps to give chest compressions to an infant by using the 2 thumb— encircling hands technique: Step Action 1 Place the infant on a firm, flat surface. The thumbs may overlap in very small infants. The rescuer providing chest compressions should switch roles with another provider about every 5 cycles or 2 minutes to avoid fatigue so that chest compressions remain effective.

Continue CPR until the AED arrives, advanced providers take over, or the infant begins to breathe, move, or otherwise respond. Two thumb—encircling hands technique for an infant 2 rescuers. Two methods for opening the airway are the head tilt— chin lift and jaw-thrust maneuvers. As with adults, if a head or neck injury is suspected, use the jaw-thrust maneuver. If the jaw thrust does not open the airway, use the head tilt—chin lift. Why Breaths Are Important for Infants and Children in Cardiac Arrest 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. So delivering chest compressions is an effective way of distributing oxygen to the heart and brain. In contrast, 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 arrest. As a result, 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.

For this reason, it is very important to give both compressions and breaths for infants and children during high-quality CPR. Ventilation for an Infant or Child With a Barrier Device 52 Use a barrier device eg, pocket mask or a bag-mask device for delivering breaths to an infant or child. BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers Refer to the BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers as you read the steps below Figure BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers— Update 1 2 3a Monitor until emergency responders arrive.

First rescuer remains with victim. Second rescuer activates emergency response system and retrieves AED and emergency equipment. When second rescuer returns, use ratio compressions to breaths. BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers. The first rescuer who arrives at the side of an unresponsive infant or child should quickly perform the following steps. As more rescuers arrive, assign roles and responsibilities. Step Action 1 Verify that the scene is safe for you and the victim. If the arrest of an infant or child was sudden and witnessed, activate the emergency response system in your setting. Determine Next Actions Boxes 3a, 3b For details on determining next actions based on the presence or absence of breathing and pulse, see Infant and Child 1-Rescuer BLS Sequence earlier in Part 5. If CPR is indicated when the second rescuer is available to assist, use a compression-toventilation ratio of BLS for Infants and Children Begin High-Quality CPR, Starting With Chest Compressions Box 4 If the victim is not breathing normally or is only gasping and has no pulse, immediately do the following: Attempt Defibrillation With the AED Boxes 5, 6, 7 Use the AED as soon as it is available and follow the prompts.

Resume High-Quality CPR Boxes 6, 7 After shock delivery or if no shock is advised, immediately resume high-quality CPR, starting with chest compressions, when advised by the AED. Continue to provide CPR and follow the AED prompts until advanced life support providers take over or the victim starts to move. During 2-rescuer CPR, use the 2 thumb—encircling hands technique. What is the correct compression-to-ventilation ratio for a single rescuer of a 3-year-old child? What is the correct compression-to-ventilation ratio for a 7-year-old child when 2 or more rescuers are present? For what age victim is the 2 thumb—encircling hands technique recommended when 2 or more rescuers are present?

A child younger than 3 years b. A child older than 3 years c. An infant older than 1 year d. An infant younger than 1 year 55 P a r t 5 4. What is the correct chest compression depth for a child? At least least least least one one one one fourth the depth of the chest, or about 1 inch third the depth of the chest, or about 1½ inches third the depth of the chest, or about 2 inches half the depth of the chest, or about 3 inches 5. What is the correct chest compression depth for an infant? At least least least least one one one one fourth the depth of the chest, or about 1 inch third the depth of the chest, or about 1½ inches third the depth of the chest, or about 2 inches half the depth of the chest, or about 2½ inches See Answers to Review Questions in the Appendix.

Student Notes 56 Part 6 Automated External Defibrillator for Infants and Children Less Than 8 Years of Age AED for Infants and Children Overview This part discusses use of an AED in infants and children less than 8 years of age. You must be familiar with the AED used in your particular setting. Pediatric-Capable AEDs Some AED models are designed for both pediatric and adult use. These AEDs deliver a reduced shock dose when pediatric pads are used. Delivering a Pediatric Shock Dose The AED shock dose may be reduced by pediatric cables, an attenuator, or preprogramming in the device. One commonly used method for reducing a shock dose is a pediatric dose attenuator Figure When attached to an AED, it reduces the shock dose by about two thirds.

Typically, child pads are used to deliver the reduced shock dose. Example of a pediatric dose attenuator, which reduces the shock dose delivered by an AED. Child pads are also used with this attenuator. If child pads are not available, use adult pads. Make sure the pads do not touch each other or overlap. Adult pads deliver a higher shock dose, but a higher shock dose is preferred to no shock. Follow the instructions for pad placement provided by the AED manufacturer and the illustrations on the AED pads. Some AEDs require that child pads be placed in a front and back anteroposterior [AP] position Figure 35 , while others require right-left anterolateral placement. AP pad placement is commonly used for infants. See Critical Concepts: AED Pad Placement Options in Part 3. Anteroposterior AED pad placement on a child victim. Do not use child pads—they will likely give a shock dose that is too low.

If you do not have child pads, you may use adult pads. Place the pads so that they do not touch each other. Adult AED pads. Use of an AED for Infants Figure Child AED pads. For infants, a manual defibrillator is preferred to an AED for defibrillation. A manual defibrillator has more capabilities than an AED and can provide lower energy doses that are often needed in infants. Advanced training is required to use a manual defibrillator and will not be covered in this course. Pads may need to be placed anterior and posterior so that they do not touch each other or overlap. What should you do when using an AED on an infant or a child less than 8 years of age?

Never use adult AED pads b. Use adult AED pads c. Use adult AED pads if the AED does not have child pads d. Use adult AED pads, but cut them in half 2. If a manual defibrillator is not available for an infant victim, which action should you take? Perform high-quality CPR b. Use an AED equipped with a pediatric dose attenuator c. Use an AED without a pediatric dose attenuator d. Wait for advanced care to arrive 3. What is important to remember about AED pad placement on infants? Ensure that pads overlap each other in very small infants b. Place 1 adult pad on the chest c. You may need to place 1 pad on the chest and 1 on the back, according to the diagrams on the pads d. If child AED pads are not available, do not use the AED See Answers to Review Questions in the Appendix. Advanced airways prevent airway obstruction and can provide a route for more effective oxygenation and ventilation. Examples of advanced airways include laryngeal mask airway, supraglottic airway device, and endotracheal tube.

Table 5 summarizes the compression-to-ventilation ratio with and without an advanced airway for adults, children, and infants. Table 5. You may provide rescue breathing by using a barrier device eg, pocket mask or bag-mask device. If emergency equipment is not available, the rescuer may provide breaths by using the mouth-to-mouth or mouth-to-mouth-and-nose technique. Table 6 outlines how to provide rescue breathing for adults, children, and infants. Table 6. Critical Concepts Respiratory Arrest Respiratory arrest occurs when normal breathing stops, preventing essential oxygen supply and carbon dioxide exchange.

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What would be an appropriate action to acknowledge your limitations? Page 82 Signs of Choking Student Notes 70 Part 9 Choking Relief for Adults, Children, and Infants General Concepts Overview This section discusses choking foreign-body airway obstruction. EMS providers transport the cardiac arrest victim to an emergency department or cardiac catheterization suite. Featured All Images This Just In Flickr Commons Occupy Wall Street Flickr Cover Art USGS Maps. Page 79 Opioid-Associated Life-Threatening Emergency Response Sequence Potential complications from abdominal thrusts should be evaluated.

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