BLS Cardiac Arrest Management

I. Anatomy and Physiology Review
A. Respiratory System
1. Passageway for fresh oxygen to enter the lungs and blood supply
2. Respiratory waste products to leave the blood and lungs
B. Cardiovascular System
1. Heart
a. Four chambers
b. Pumps blood to the lungs to pick up oxygen
c. Pumps blood around the body
i. to deliver oxygen and nutrients to the tissues
ii. to remove waste products from the tissues

2. Vascular System
a. Arteries carry blood to tissues
i. carotid pulse
ii. femoral pulse
iii. radial pulse
iv. brachial pulse
b. Veins carry blood to heart

II. Respiratory Failure
A. Pathophysiology
1. Constrictive
2. Obstructive
3. Destructive

B. Assessment
1. Pulmonary symptoms
2. Cardiovascular symptoms
3. Neurological symptoms
4. Other symptoms
C. Treatment
1. Oxygen therapy
2. Ventilatory support
a. Carbon dioxide clearance
b. Pharmacological therapy

III. Respiratory Arrest
A. Assessment
B. Treatment
1. Oxygen therapy
2. Ventilatory support
a. Carbon dioxide clearance
b. Advanced airways

IV. Cardiac Arrest
A. Pathophysiology
1. If the heart stops contracting, no blood will flow
2. The body cannot survive when the heart stops
a. Organ damage begins quickly after the heart stops
b. Brain damage begins 4-6 minutes after the patient suffers
cardiac arrest — damage becomes irreversible in 8-10 minutes

3. Cardio-pulmonary resuscitation (CPR)
a. Artificial ventilation — oxygenates the blood
b. External chest compressions — pushing on the chest squeezes
the heart and simulates a contraction
c. Oxygenated blood is circulated to the brain and other vital organs

B. General Reasons for the Heart to Stop Beating
1. Sudden death and heart disease
2. Breathing stops, especially in infants and children
3. Medical emergencies
4. Trauma
V. Resuscitation
A. System Components to Maximize Survival
1. Early access
a. Public education and awareness
i. rapid recognition of a cardiac emergency
ii. rapid notification before CPR starts — "phone first"
b. 911-pre- arrival instructions and dispatcher directed CPR

2. Early CPR
a. Lay public
i. family
ii. bystanders
b. Emergency Medical Responders
3. Early Defibrillation
4. Early Advanced Care
B. Basic Cardiac Life Support (Refer to the Current American Heart Association
Guidelines)
1. Adult CPR and foreign body airway obstruction
2. Child CPR and foreign body airway obstruction
3. Infant CPR and foreign body airway obstruction
C. Airway Control and Ventilation
1. Basic Airway adjuncts
2. Ventilation
a. Delivery of excessive rate or depth of ventilation reduces
blood return to the right side of the hear
b. Reduces the overall blood flow that can be generated with CPR

D. Chest Compressions
1. Factors which decrease effectiveness
a. Compression that are too shallow
b. Slow compression rate
c. Sub-maximum recoil
d. Frequent interruptions
2. Devices to assist circulation
a. Impedance Threshold Device
b. Mechanical Piston Device
c. Load-Distributing Band or Vest CPR

VI. Automated External Defibrillation (AED) (Refer to the current American Heart
Association guidelines)
A. Adult AED Use
B. Child AED Use
C. Infant AED Use
D. Special AED situations
1. Pacemaker
2. Wet patients
3. Transdermal medication patches

VII. Shock (Poor Perfusion)
A. Definition
1. Perfusion is the passage of blood and oxygen and other essential
nutrients to the body’s cells
2. While delivering these essentials to the body’s cells, the circulatory
system is also removing waste such as carbon dioxide from the
cells

3. Shock is a state of hypoperfusion, or inadequate perfusion of
blood through body tissues
4. Hypoperfusion can lead to death if not corrected
B. Anatomy and Physiology Review
1. Heart/Blood vessels
2. Physiology of respiration
a. Gas exchange
i. alveolar level
ii. tissue level
b. Circulation
i. pulmonary
ii. systemic

3. Essential components for normal perfusion
a. Functioning pump/heart
i. pump delivers blood to the tissue
ii. pump collects blood from the body
iii. controlled by the autonomic nervous system during shock
b. Adequate volume
i. blood contains formed elements
a) RBCs transport oxygen
b) WBCs fight infection
c) platelets form blood clots
d) clots are very unstable and prone to rupture
ii. plasma is the fluid that transports the formed elements
c. Intact container/vessels
i. arteries surrounded by smooth muscle contract and dilate
to deliver blood to tissue
ii. capillary beds are the site where perfusion occurs
iii. veins are low pressure vessels responsible for
returning blood to the heart
iv. smooth muscle and sphincters controlled by the
autonomic nervous system to constrict or dilate
v. blood flow controlled by cellular tissue demands

C. Disruptions That Can Cause Shock
1. Inadequate fluid/blood – blood/water loss
2. Failing pump/heart
a. Disease or injury to conduction system
b. Damage to cardiac muscle
3. Leaky or dilated container/vessels
a. Loss of nervous control
b. Severe allergic reactions
c. Massive infection
d. Hypothermia

D. Categories of Shock
1. Compensated shock
2. Decompensated shock
3. Irreversible shock
E. Shock Due to Fluid Loss
1. Hypovolemic
a. Examples
b. Signs and symptoms
F. Shock Due to Pump Failure
1. Cardiogenic
a. Examples
b. Signs and symptoms
G. Shock Due to Container Failure
1. Anaphylaxis
a. Examples
b. Signs and symptoms
2. Neurogenic
a. Examples
b. Signs and symptoms
3. Sepsis
a. Examples
b. Signs and symptoms

H. Patient Assessment
1. Complete a scene size-up
2. Perform a primary assessment
3. Obtains a relevant history
4. Perform secondary assessment
5. Perform a reassessment
I. Management
1. Manual in-line spinal stabilization, as needed
2. Comfort, calm, and reassure the patient while awaiting additional
EMS resources
3. Do not give food or drink
4. Airway control – adjuncts, as needed
5. Breathing
a. Oxygen administration (high-flow/high- concentration)
b. Assist ventilation, as needed
6. Circulation
a. Attempt to control obvious uncontrolled external bleeding
b. Position patient appropriately for all ages
c. Keep patient warm – attempt to maintain normal body
temperature

7. Pneumatic anti-shock garment (PASG) application
8. Begin transport at the earliest possible moment
9. Treat any additional injuries that may be present

J. Age-related variations
1. Pediatrics
a. Common causes of shock
i. trauma
ii. fluid loss
iii. infection
iv. anaphylaxis
v. congenital heart disease
vi. chest wall injury
b. Presentation of Shock
i. cardiovascular
ii. skin signs
iii. CNS
iv. decreased fluid output
v. vital signs
c. Management
i. inline spinal stabilization, if indicated
ii. suction, as needed
iii. high oxygen concentration
iv. control bleeding
v. positioning
vi. maintain body temperature
vii. transport

2. Geriatrics
a. Assessment
i. body system changes affecting presentation of shock
a) CNS
b) cardiovascular
c) respiratory
d) skin
e) renal
f) GI
ii. vital signs changes
a) CNS
b) hypoxia
iii. airway
a) decreased cough reflex
b) cervical arthritis
c) loose dentures
iv. breathing
a) higher resting respiratory rate
b) lower tidal volume
c) less elasticity/compliance of chest wall

v. circulation
a) higher resting heart rate
b) irregular pulses
vi. skin
a) dry, less elastic
b) cold
c) fever, not common
d) hot
b. Management
i. inline spinal stabilization, if indicated
ii. suction, as needed
iii. high oxygen concentration
iv. control bleeding
v. positioning
vi. maintain body temperature
vii. transport

 

Content Creator: Ariel Wei

CAPCE Course Number:  18-EMTP-F3-7102

Total CE Hours: 2

Level: Basic

EMT-CE uses the NEMSES guidelines as the foundation for every course outline.