Home | Index        BASIC LIFE SUPPORT: HEALTHCARE PROVIDER

 

INTRODUCTION   

Optimal patient care requires that the EMT-I be proficient in Basic Life Support according to American Heart Association (AHA) Healthcare Provider (HCP) standards, as well as be able to identify situations in which CPR can be withheld according to L.A. County guidelines.  The following topics will be discussed during this lesson:

 

·          Chain of Survival and the Role of the Healthcare Provider

·          Clinical Presentations and Treatment of Heart Disease and Stroke

·          Prudent Heart Living

·          Techniques for Adult and Pediatric CPR and Use of the AED

·          Pathophysiology, Treatment and Prevention of Foreign Body Airway Obstruction

·          Injury Prevention in the Pediatric Age Group

·          L.A. County guidelines for withholding CPR

 

LESSON OBJECTIVES 

At the end of this lesson the participants will be able to:

 

1.         Describe the links in the AHA Chain of Survival, including the importance of:

·          Activating the appropriate emergency response system (phoning 911 or other response system)

·          Performing CPR

·          Using a barrier device

·          Providing bag-mask ventilation

·          Providing early defibrillation

·          Ensuring the arrival of early advanced care by activating the appropriate emergency response system (phoning 911 or other response system)

 

2.         Describe the steps of CPR:

·          When to start CPR

·          When to start rescue breathing, including ventilation with a barrier device and bag-mask ventilation (with and without oxygen)

·          How to check for normal breathing or signs of circulation

·          The ABC sequence of CPR

·          When and how to use an AED

·          The signs of severe or complete FBAO

·          How to relieve FBAO in the responsive and unresponsive victim

 

3.         Describe the signs of 5 major emergencies in adults

·          Heart attack

·          Stroke

·          Cardiac arrest

·          Respiratory arrest

·          FBAO

4.         Describe strategies to prevent sudden infant death syndrome in infants and injuries in children.

 

5.         Using an adult, child, or infant manikin, demonstrate the following skills:

·          Activation of the emergency response system (phone 911 or other appropriate response system)

·          Rescue breathing using mouth-to mouth and bag-mask ventilation (with and without oxygen) for adult, child, and infant victims

·          1- and 2-rescuer CPR for adult, child, and infant victims

·          Use of an AED for victims ≥8 years of age (and approximately 25 kg or more)

·          Relief of FBAO in the responsive and unresponsive victim of any age

 

           

SKILLS 

            One Rescuer:  Adult, Child, and Infant CPR

            Two Rescuer: Adult CPR

            FBAO Conscious and Unconscious: Adult, Child, and Infant

            Bag-mask ventilation

 

KEY VOCABULARY 

The following terms will be used during this lesson:

 

·          Adult – Greater than eight years of age

 

·          Child - One year to eight years of age

 

·          Infant - Less than one year of age

 

·          Prudent Heat Living – a lifestyle that minimizes the risk of future heart disease.

 

·          Epigastrium - upper mid-portion of abdomen

 

·          Nitroglycerin - a medication that acts by dilating the coronary arteries, which increases blood flow to the heart muscle; and lowering the blood pressure and dilating the veins, which decreases the work of the heart and the heart muscle's need for oxygen.

 

·          Ventricular Fibrillation - a chaotic, uncoordinated quivering of the heart muscle, producing no heartbeat

 

·          Pneumothorax - collapsed lung

 

·          Hemothorax - blood in the pleural cavity

 

·          Fat Emboli - fat bubbles or particles circulating in blood stream as a result of long bone fractures

 

 

KEY CONCEPTS 

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

 

American Heart Association Statistics

 

·                 Cardiovascular disease is the leading cause of death in the U.S.

 

·                 Cardiovascular disease accounts for nearly one million deaths per year in the U.S.

 

·                 Approximately ½ million deaths are due to acute myocardial infarction; approximately 50% of these deaths are sudden and occur within the first hour of the onset of symptoms

 

·                 Stroke is the third leading cause of death in the U.S. and the leading cause of brain injury in adults

 

·                 Approximately ½ million suffer a stroke and nearly ¼ of these die annually

 

 

Emergency Cardiovascular Care (ECC)

 

·                 Includes all responses (prehospital and in-hospital) needed to stabilize the victim or patient who develops life-threatening events affecting the respiratory, cardiovascular, and cerebrovascular systems

 

·                 Ultimate goal is to maximize the outcome for all victim or patients

 

·                 Two components of ECC are BLS and ACLS

 

 

Basic Life Support (BLS)

·                 Includes interventions that can rapidly be performed by trained laypersons and healthcare providers to ensure recognition of common emergencies, access to ACLS, adequate airway, breathing, and oxygenation, and adequate circulation

 

·                 BLS skills include CPR, use of AED, and relief of foreign body airway obstruction

 

 

 

Advanced Cardiac Life Support

 

Includes BLS plus the use of adjunctive equipment to support ventilation, establishment of IV access, administration of drugs, use of cardiac monitoring, defibrillation or other control of arrhythmias, and care after resuscitation

 

 

CHAIN OF SURVIVAL

 

·                 Early Access

·                 Early CPR

·                 Early Defibrillation

·                 Early Advanced Care

 

 

First Link: Early Access

 

·                 Problem: Long 911 call-to-defibrillation intervals are common

·                 Key to effectiveness of this link: Recognition of early warning signs such as chest pain and shortness of breath so that 911 is called before collapse occurs

·                 Early identification of collapse can lead to rapid activation of the EMS system, rapid dispatching and arrival of first responders who can bring defibrillation and ACLS capabilities to the patient’s side

 

 

Second Link: Early CPR

 

·                 CPR is most effective when started immediately after collapse

·                 Bystander CPR has been consistently shown to have a significant positive effect on survival

·                 Bystander CPR is the best treatment that a cardiac arrest patient can receive until the arrival of defibrillation and ACLS care

 

 

Third Link: Early Defibrillation

 

·                 The link most likely to improve survival rates

·                 Time to defibrillation is the critical variable for successful conversion from VF to a normal rhythm

·                 Every minute that passes can reduce the chance for successful conversion by 7-10%

·                 Goal of early defibrillation: Within 5 minutes of EMS call receipt to shock

 

Fourth Link: Early Advanced Care

 

·                 Designed to prevent cardiac arrest through the use of advanced airway management, administration of medication, and other interventions

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