BCLS REVIEW

1
BCLS REVIEW

• THE FOLLOWING SLIDES ARE A REVIEW FOR HEALTH CARE
  WORKERS WHO HAVE PREVIOUSLY TAKEN A BLS CLASS.
  THE SLIDES ARE DESIGNED TO HELP YOU PASS THE
  WRITTEN AND PRACTICAL TEST ON THE ADULT, CHILD
  AND INFANT MANNEQUINS. THIS IS THE CURRENT
  INFORMATION AS OF JANUARY 2004. THE RED SLIDES
  CONTAIN NEW AND IMPORTANT INFORMATION.

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CHAIN OF SURVIVALADULT

• EARLY ACCESS (CALL 911)
• EARLY CPR
• EARLY DEFIBRILLATION
• EARLY ADVANCES LIFE SUPPORT

3
CHAIN OF SURVIVALPEDIATRIC

• PREVENTION OF INJURIES AND CARDIAC ARREST
• EARLY CPR
• EARLY ACCESS (911)
• EARLY ADVANCED LIFE SUPPORT

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DEFINATIONS

• ABC
• AED
• FIBRILLATION

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ABC

• A AIRWAY
• OPEN THE AIRWAY
• CHECK FOR BREATHING
• B BREATHING
• GIVE 2 RESCUE BREATHS IF NOT BREATHING
• C CIRCULATION
• CHECK FOR PULSES
• BEGIN COMPRESSIONS IF ABSENT

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AED

• AUTOMATED EXTERNAL DEFIBRILLATOR
• UESD BY EMS PERSONNEL
• HOSPITALS
• TRAINED CIVILIANS
• PROVIDES DIAGNOSIS OF HEART FIBRILLATION AND
  DELIVERFS AN ELECTRIC SHOCK TO STOP FIBRILLATION
• BEST CHANCE OF SURVIVAL IF USED WITHIN 5 MINUTES
  OF COLLAPSE IN COMBINATION WITH CPR
• NOT FOR CHILDREN LESS THAN 8 YEARS OLD

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FIBRILLATION

• THE CAUSE OF MOST SUDDEN DEATHS
• CAUSES THE HEART MUSCLE TO QUIVER
• NO BLOOD IS CIRCULATED
• CAN BE COURSE OR FINE

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ACUTE CORONARY SYNDROME (ACS)

• AMI-ACUTE MYOCARDIAL INFARCTION
• NON-Q-WAVE AMI
• ACUTE UNSTABEL ANGINA
• TREATMENT
• FIBRINOLYTIC AGENTS (CLOT BUSTERS)
• ANGIOPLASTY
• STENT PLACEMENT

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RISK FACTORS

• SMOKING
• HIGH CHOLESTEROL
• HIGH BLOOD PRESSURE
• THESE COMBINED WILL INCREASE A PERSONS RISK OF A
  HEART ATTACK

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STROKE

• IMPORTANT RISK FACTOR
• HIGH BLOOD PRESSURE
• SIGNS
• INTENSE HEADACHE
• FACIAL WEAKNESS
• DOUBLE VISION
• WEAKNESS OF ONE SIDE OF THE BODY
• TROUBLE SPEEKING

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ANGINA

• USUALLY LAST 2 TO 15 MINUTES
• RELIEVED BY
• REST
• NITRO GLYCERIN

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HEART ATTACK

• USUALLY
• RADIATING CHEST PAIN
• SHORTNESS OF BREATH
• UNCOMFORTABLE FEELING
• DENIAL BY THE VICTIM

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ASSESSMENT

• ALWAYS DETERMINE UNRESPONSIVENESS
• CHECK FOR THE ABSENCE OF BREATHING
• LOOK FOR CHEST/ABD MOVEMENT
• LISTEN FOR AIR MOVEMENT
• FEEL AIR AGAINST YOUR CHEEK
• CHECK FOR THE ABSENCE OF A PULSE

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VICTIM SURVIVAL

• SURVIVAL IS BEST IF CPR IS STARTED WITHIN 4
  MINUTES OF THE ARREST
• EARLY DEFIBRILLATION WILL BE REQUIRED FOR
  SUCCESSFUL RESUSCITATION

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EMS SYSTEM

• ACTIVATE AFTER DETERMINING UNRESPONSIVENESS IN
  ADULTS
• OPEN THE AIRWAY/GIVE 2 BREATHS
• CHECK PULSE/BEGIN CPR
• MONITOR ALL VICTIMS
• ACTIVATE EMS AFTER 1 MINUTE OF CPR ON INFANTS AND
  CHILDREN
• EARLY ACTIVATION SAVES LIVES

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CRICOID PRESSURE

• USED IF
• VICTIM IS UNCONSCIOUS
• VICTIM IS RECEIVING RESCUE BREATHING
• AIRWAY IS NOT PROTECTED BY CUFFED ET TUBE
• DO NOT USE IF VICTIM IS VOMITING

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VENTILATION'S--ADULT

• 1-2 SECONDS LONG (SLOW)
• WITHOUT O2 - 700-1000 CC (2 SECONDS)
• WITH 02 - 400-600 CC (1-2 SECONDS)
• HEAD TILT, CHIN LIFT TO OPEN
• WATCH CHEST RISE
• IF UNSUCCESSFUL REPOSITION HEAD
• 8-10 BREATHS PER MINUTE
• 2 BREATHS INITIALLY
• 15 2 FOR 1 PERSON CPR
• 15 2 FOR 2 PERSON CPR

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VENTILATION'S--CHILD

• AGE 1 - 8 YEARS
• GIVE A VOLUME TO EXPAND THE CHEST ADEQUATELY
• BREATH EVERY 3 SECONDS
• 20 BREATHS PER MINUTE
• 5 1 RATIO COMPRESSION/VENT
• OPEN AIRWAY- JAW THRUST/SPINE IMMOBILIZATION WITH
  TRAUMA

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VENTILATION'S--INFANT

• UNDER 1 YEAR
• GIVE PUFFS OF AIR
• BREATH EVERY 3 SECONDS
• 20 PER MINUTE
• 5 1 RATIO COMPRESSION/VENT

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PULSE SITES

• ADULT
• CAROTID IN NECK
• RADIAL IN WRIST
• CHILD
• CAROTID IN NECK
• BRACHIAL IN ARM
• INFANT
• -BRACHIAL IN ARM
• FEMORAL IN GROIN

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PULSE CHECKS

• BE SURE PULSE IS ABSENT AND BEGIN CPR
• ADULT-AFTER 1 MINUTE OR 4 CYCLES OF 1 OR 2 MAN
  CPR
• CHILD INFANT-AFTER 1 MINUTE OR 20 CYCLES
• AND EVERY FEW MINUTES

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COMPRESSION'S--ADULT

• COMPRESS 1 1/2 - 2 INCHES
• GIVE 100 COMPRESSION'S PER MINUTE FOR 1 OR 2 MAN
  CPR
• USE 2 HANDS ON LOWER HALF OF STERNUM
• CHECK CAROTID PULSE AFTER 1 MINUTE OF CPR
• CHECK CAROTID PULSE DURING 2 MAN CPR

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COMPRESSION'S--CHILD

• COMPRESS 1/3 TO1/2 DEPTH OF CHEST
• GIVE 100 COMPRESSION'S PER MINUTE
• USE THE HEAL OF 1 HAND ON THE LOWER HALF OF THE
  STERNUM

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COMPRESSION'S--INFANT

• COMPRESS 1/3 TO 1/2 DEPTH OF CHEST
• USE 2 THUMBS AROUND THE CHEST
• GIVE 100 COMPRESSION'S PER MINUTE
• USE 2 FINGERS 1 FINGER BELOW THE NIPPLE LINE

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COMPRESSION RATIOS

• ADULT
• 15 2 FOR 2 RESCUERS
• 15 2 FOR 1 RESCUER
• CHILD
• 5 1 RATIO
• INFANT
• 5 1 RATIO

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OBSTRUCTED AIRWAY

• ADULT
• NO AIR MOVEMENT
• HANDS TO THROAT
• CHILD/INFANT
• PARTIALLY/ COMPLETELY OBSTRUCTED
• HIGH PITCHED NOISES
• BLUISH COLOR
• INEFFECTIVE COUGH

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HEIMLICK MANEUVERADULT

• PERFORM TONGUE-JAW LIFT AND FINGER SWEEP
• LOOK, LISTEN, FEEL FOR AIR MOVEMENT
• ATTEMPT BREATH
• GIVE 5 ABDOMINAL THRUST STANDING OR LYING ON
  FLOOR
• PERFORM FINGER SWEEP EACH TIME
• REPEAT UNTIL OBJECT REMOVED

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HEIMLICK MANEUVER CHILD

• 5 ABDOMINAL THRUST STANDING OR LYING
• NO FINGER SWEEP -LOOK ONLY FOR OBJECT-REMOVE ONLY
  IF SEEN
• REPEAT AS NEEDED

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HEIMLICK MANEUVER INFANT

• 4 BACK BLOWS AND
• 4 CHEST THRUST
• NO FINGER SWEEP -LOOK ONLY FOR OBJECT-REMOVE ONLY
  IF SEEN
• REPEAT AS NEEDED

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INFANT CHILD EMERGENCIES

• PREVENTABLE INJURIES ARE A MAJOR CAUSE
• PREVENTED BY
• TEACHING RESPECT FOR MATCHES
• PROVIDING A SAFE HOME ENVIRONMENT
• USING INFANT SEATS AND SEAT BELTS

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INFANT/CHILD CARDIAC ARREST

• USUALLY CAUSED BY
• SEVERE AIRWAY AND BREATHING PROBLEMS THAT GET
  WORSE
• RESPIRATORY ARREST
• MAY SEE PRIMARY CARDIAC ARREST WITH HEART DEFECTS

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COMPLICATIONS OF CPR

• PUNCTURED LUNG
• LIVER LACERATION
• FRACTURED RIBS/STERNUM
• GASTRIC DISTENTION
• GIVE SLOW EVEN BREATHS
• PROPER HAND POSITION TO MINIMIZE RIB FRACTURES

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POSITIONING

• ON BACK MAY CAUSE THE TONGUE TO FALL BACK AND
  OBSTRUCT THE AIRWAY
• TURN THE PATIENT ON HIS SIDE WHEN LEFT ALONE

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COMMUNICABLE DISEASE EXPOSURE

• TO PREVENT EXPOSURE TO COMMUNICABLE DISEASES
  DURING MOUTH-TO-MOUTH BREATHING USE A BARRIER
  DEVICE AND FOLLOW OSHA UNIVERSAL PRECAUTIONS,
  WEARING GLOVES WILL ALSO CUT DOWN ON EXPOSURE

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BLS TEST

• THE NEXT 25 SLIDES CONTAIN AN OLD VERSION OF THE
  BLS TEST. THIS IS A REVIEW OF THE INFORMATION
  ONLY. THE SLIDES AFTER THIS TEST CONTAIN
  VERSIONS A B OF THE CURRENT TEST. YOU MAY
  TAKE EITHER TEST. MARK YOUR ANSWER SHEET WITH
  THE CORRECT VERSION ON THE TOP. THE BLS CARD WILL
  COST YOU 1.00.

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REVIEW TEST
43
1. You respond to someone who has just
collapsed (you witnessed the collapse). After
you make sure that the scene is safe, what is the
next thing you should do? A. Check the
victims mouth for foreign bodiesB. Check to
see if the victim is responsiveC. Perform the
Heimlick maneuverD. Give 2 slow mouth-to-mouth
breaths
44
1. You respond to someone who has just
collapsed (you witnessed the collapse). After
you make sure that the scene is safe, what is the
next thing you should do? B. Check to see if
the victim is responsive
45
2. Your neighbor is an overweight 55-year old
man. While mowing his lawn he begins to complain
of sudden, severe, crushing pain under his
breastbone in the center of his chest. The pain
has lasted more than 5 minutes. What problem
should you think of right away and what should
you do?A. Heartburn tell your neighbor to
take an antacid.B. Food is stuck in the mans
throat tell him to drink water.C. Heart
attack you should phone 911.D. Panic attack
tell your neighbor to rest quietly
46
2. Your neighbor is an overweight 55-year old
man. While mowing his lawn he begins to complain
of sudden, severe, crushing pain under his
breastbone in the center of his chest. The pain
has lasted more than 5 minutes. What problem
should you think of right away and what should
you do?C. Heart attack you should phone
911.
47
3. A person with acute heart attack pain will
often wait hours after the start of symptoms
before going to the Emergency Department.
Why?A. Someone experiencing symptoms will
often deny that the symptoms might
be due to a heart attack.B. Symptoms of a
heart attack come and go, so waiting is
prudent.C. If family members are trained in
CPR there is no need to hurry to the
hospital.D. Heart attack pain is typically
mild and last only 1 or 2 minutes
48
3. A person with acute heart attack pain will
often wait hours after the start of symptoms
before going to the Emergency Department.
Why?A. Someone experiencing symptoms will
often deny that the symptoms might
be due to a heart attack.
49
4. Which of the following risk factors for
stroke can be controlled?A. Prior history of
stroke.B. Heredity (family history).C.
Gender.D. Untreated high blood pressure
(hypertension)
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4. Which of the following risk factors for
stroke can be controlled?D. Untreated high
blood pressure (hypertension)
51
5. You pull a 3-year-old from the bottom of the
shallow end of a pool. You find that she is limp
and unresponsive. You are alone, and no one
responds to your shut for help. You are ready to
begin the steps of CPR, but when should you phone
911?A. After you have given the child 1 minute
of CPR.B. As soon as you get the child out of
the pool and find she is unresponsive.C. When
you see that after several minutes of CPR there
is no response.D. After giving a few
ventilations and before beginning chest
compressions.
52
5. You pull s 3-year-old from the bottom of the
shallow end of a pool. You find that she is limp
and unresponsive. You are alone, and no one
responds to your shut for help. You are ready to
begin the steps of CPR, but when should you phone
911?A. After you have given the child 1 minute
of CPR.
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6. You have found an unresponsive coworker,
phoned 911, opened the victims airway, checked
for breathing, provided 2 rescue breath, checked
for signs of circulation (no signs present)
turned on the AED, and attached it to the victim.
The AED provides a no shock indicated message,
and there are still no signs of circulation.
Which of the following should be your next
action?A. Press the AED ON button.B.
Check the electrode pads.C. Start CPR
immediately.D. Push the shock button.
54
6. You have found an unresponsive coworker,
phoned 911, opened the victims airway, checked
for breathing, provided 2 rescue breath, checked
for signs of circulation (no signs present)
turned on the AED, and attached it to the victim.
The AED provides a no shock indicated message,
and there are still no signs of circulation.
Which of the following should be your next
action?C. Start CPR immediately..
55
7. You have found an unresponsive child. You
open the airway and see that the child in not
breathing. You attempt to deliver rescue
breaths, but the chest does not rise. You know
this means that you are not delivering effective
rescue breath. What is the most common
explanation for lack of chest rise?A. The child
has an advanced lung infection.B. You probably
failed to open the airway properly.C. The
child has serious airway spasm.D. You are
actually delivering effective breath even if the
chest does not rise.
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7. You have found an unresponsive child. You
open the airway and see that the child in not
breathing. You attempt to deliver rescue
breaths, but the chest does not rise. You know
this means that you are not delivering effective
rescue breath. What is the most common
explanation for lack of chest rise?B. You
probably failed to open the airway properly.
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8. After 2 shocks from the AED, you receive a
no shock indicated message from the AED. The
victim has signs of circulation and normal
breathing and no signs of injury. Your next
actions should be toA. Perform 1-rescuer
CPR.B. Turn off and remove the AED from the
victim.C. Check the AED electrode pads and
press the AED ON button.D. Leave the AED
attached and place the victim in a recovery
position.
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8. After 2 shocks from the AED, you receive a
no shock indicated message from the AED. The
victim has signs of circulation and normal
breathing and no signs of injury. Your next
actions should be toD. Leave the AED attached
and place the victim in a recovery position.
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9. When you check to see if someone is
breathing, you LOOK, LISTEN, and FEEL. What
are you looking for?A. Any movement of the
persons body.B. Any twitches or spasms in the
person.C. Foreign bodies in the persons
mouth.D. Rise and fall of the chest.
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9. When you check to see if someone is
breathing, you LOOK, LISTEN, and FEEL. What
are you looking for?D. Rise and fall of the
chest.
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10. A young man has collapsed. You determine
that he is not breathing, but he shows other
signs of circulation (occasional movement). You
want to provide rescue breathing. How often
should you provide these rescue breaths?A.
About 6 breath per minute (1 breath every 10
seconds).B. About 20 breaths per minute (1
breath every 3 seconds).C. About 10-12 breaths
per minute (1 breath every 5 seconds).D. He
does not need rescue breathing because he shows
signs of circulation.
62
10. A young man has collapsed. You determine
that he is not breathing, but he shows other
signs of circulation (occasional movement). You
want to provide rescue breathing. How often
should you provide these rescue breaths?C.
About 10-12 breaths per minute (1 breath every 5
seconds).
63
11. The amount of air (ventilation volume)
during rescue breathing that you give to a
6-year-old child isA. Half the amount that
you give an adult.B. As much as possible.C.
Just enough air to cause the childs chest to
rise.D. Based on the childs weight.
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11. The amount of air (ventilation volume)
during rescue breathing that you give to a
6-year-old child isC. Just enough air to
cause the childs chest to rise.
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12. A responsive 6-year-old is struggling to
breathe. She cannot cough forcefully or move
air. She is turning blue. Her mother says, I
think she swallowed a button. you ask the child
Are you choking? she nods yes. You ask, Can
you speak? and she shakes her head no. She is
holding her throat. What is the first thing you
should do?A. Give the child 5 back blows, then
5 chest thrust.B. Attempt a blind finger sweep
of the childs mouth.C. Administer 100
oxygen and monitor the child closely.D. Give
the child abdominal thrust until the button is
removed or the child becomes unresponsive.
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12. A responsive 6-year-old is struggling to
breathe. She cannot cough forcefully or move
air. She is turning blue. Her mother says, I
think she swallowed a button. you ask the child
Are you choking? she nods yes. You ask, Can
you speak? and she shakes her head no. She is
holding her throat. What is the first thing you
should do?D. Give the child abdominal thrust
until the button is removed or the child becomes
unresponsive.
67
13. You are providing rescue breathing for an
unresponsive child who is not breathing but has
signs of circulation. How often should you
ventilate the child?A. Approximately once
every 3 seconds (20 breaths per minute).B.
Approximately once every 5 seconds (12 breaths
per minute).C. Approximately once every 6
seconds (10 breaths per minute).D.
Approximately once every 10 seconds (6 breaths
per minute).
68
13. You are providing rescue breathing for an
unresponsive child who is not breathing but has
signs of circulation. How often should you
ventilate the child?A. Approximately once
every 3 seconds (20 breaths per minute).
69
14. A 7-year-old child is pulled from below the
water of a neighbors pool. The neighbors
children say the child did not fall or jump into
the water--she was swimming and suddenly slipped
under the water. You kneel beside the child and
find that she is unresponsive. You send someone
to phone 911 while you remain with the child.
What should you do next?A. Turn the childs
head down and perform the Heimlick maneuver to
drain water from the lungs.B. Give 5 back
blows, then do a finger sweep of the mouth.C.
Find the proper hand position and begin chest
compressions.D. Open the airway with the head
tilt-chin lift maneuver, look-listen-feel for
breathing, and if the child is not breathing
normally give 2 rescue breaths
70
14. A 7-year-old child is pulled from below the
water of a neighbors pool. The neighbors
children say the child did not fall or jump into
the water--she was swimming and suddenly slipped
under the water. You kneel beside the child and
find that she is unresponsive. You send someone
to phone 911 while you remain with the child.
What should you do next?D. Open the airway
with the head tilt-chin lift maneuver,
look-listen-feel for breathing, and if the child
is not breathing normally give 2 rescue breaths
71
15. You are providing mouth-to-mask breaths for
an unresponsive, non-breathing victim. Which of
the following phrases is the best explanation of
the primary benefits of rescue breathing?A.
Rescue breathing helps overcome any airway
obstruction that may be blocking the airway.B.
Rescue breathing may prevent a heart attack.C.
Rescue breathing might help defibrillate the
heart.D. Rescue breathing delivers oxygen to
the victims lungs and blood.
72
15. You are providing mouth-to-mask breaths for
an unresponsive, non-breathing victim. Which of
the following phrases is the best explanation of
the primary benefits of rescue breathing?D.
Rescue breathing delivers oxygen to the victims
lungs and blood.
73
16. You are preparing to perform chest
compressions on an adult victim who is
unresponsive with no breathing and no signs of
circulation after you deliver 2 rescue breaths.
Which of the following best describes where you
should place your hands to perform
compressions?A. Just below the neck over the
top half of the breastbone.B. Over the very
bottom of the breastbone the xyphoid.C. At the
center of the chest. between the nipples.D. On
the lower right side of the chest, directly over
the left nipple.
74
16. You are preparing to perform chest
compressions on an adult victim who is
unresponsive with no breathing and no signs of
circulation after you deliver 2 rescue breaths.
Which of the following best describes where you
should place your hands to perform
compressions?C. At the center or the chest.
between the nipples.
75
17. You are alone, performing CPR on an adult.
What ratio of compressions to ventilations should
you use?A. 15 to 2.B. 12 to 4.C. 5 to
1.D. 3 to 1.
76
17. You are alone, performing CPR on an adult.
What ratio of compressions to ventilation's
should you use?A. 15 to 2.
77
18. You are performing chest compressions for an
adult victim of cardiac arrest. Which of the
following is the correct rate of compressions for
adult CPR?A. A rate of 150 times a minute.B.
A rate of 100 times a minute.C. A rate of 80
times a minute.D. A rate of 60 times a minute.
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18. You are performing chest compressions for an
adult victim of cardiac arrest. Which of the
following is the correct rate of compressions for
adult CPR?B. A rate of 100 times a minute.
79
19. You are performing chest compressions for an
infant victim of cardiac arrest. Which of the
following is the correct rate of compressions for
infant CPR?A. A rate of 70-80 times per
minute.B. A rate of 80-90 times per
minute.C. A rate of 90-100 times per
minute.D. A rate of at least 100 times per
minute.
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19. You are performing chest compressions for an
infant victim of cardiac arrest. Which of the
following is the correct rate of compressions for
infant CPR?D. A rate of at least 100 times per
minute.
81
20. A 4-year-old child is found unresponsive on
the playground of a daycare center. You do not
know if the child is injured, so you open the
airway with a jaw thrust. You find that the
child is not breathing, so you deliver 2
effective breaths (both make the chest rise).
You then check for signs of circulation. The
child is not breathing normally. What else
should you do to check for other signs of
circulation?A. Call out the childs name
several times.B. Check for coughing and scan
the child for any signs of movement.C. Push on
the childs chest several times to see if he
responds.D. Tap the child again more
forcefully.
82
20. A 4-year-old child is found unresponsive on
the playground of a daycare center. You do not
know if the child is injured, so you open the
airway with a jaw thrust. You find that the
child is not breathing, so you deliver 2
effective breaths (both make the chest rise).
You then check for signs of circulation. The
child is not breathing normally. What else
should you do to check for other signs of
circulation?B. Check for coughing and scan the
child for any signs of movement.
83
21. You have begun the steps of CPR for an
unresponsive victim while a coworker phones 911.
After opening the airway, checking for normal
breathing, and giving 2 effective breaths (the
chest rises), you do not find any signs of
circulation. What should you do next?A. Begin
chest compressions.B. Deliver 5 abdominal
thrust.C. Check for signs of circulation
again.D. Reposition the airway and look,
listen, and feel for breathing.
84
21. You have begun the steps of CPR for an
unresponsive victim while a coworker phones 911.
After opening the airway, checking for normal
breathing, and giving 2 effective breaths (the
chest rises), you do not find any signs of
circulation. What should you do next?A. Begin
chest compressions.
85
22. You have been called to the side of an
unresponsive victim. You have opened the airway
and assessed for breathing, delivered 2 rescue
breaths, and checked for signs of circulation
(none present). You attach the AED. The machine
charges and advises a shock. Before pressing the
AED SHOCK button, which of the following
actions would be most appropriate?A. Yell
clear, make sure no one is touching the victim,
and push the SHOCK button.B. Perform 1 minute
of CPR and reassess the victim.C. Recheck
signs of circulation and then shock the
victim.D. Confirm pad position and then shock
the victim.
86
22. You have been called to the side of an
unresponsive victim. You have opened the airway
and assessed for breathing, delivered 2 rescue
breaths, and checked for signs of circulation
(none present). You attach the AED. The machine
charges and advises a shock. Before pressing the
AED SHOCK button, which of the following
actions would be most appropriate?A. Yell
clear, make sure no one is touching the victim,
and push the SHOCK button.
87
23. After 3 shocks from the AED, the AED prompts
no shock advised. You check for signs of
circulation and find there are no signs of
circulation. What should your next action
be?A. Perform CPR for 1 minute and
reanalyze.B. Turn off and remove the AED from
the victim.C. Immediately press the AED ON
button.D. Leave the AED attached and place the
victim in a recovery position.
88
23. After 3 shocks from the AED, the AED prompts
no shock advised. You check for signs of
circulation and find there are no signs of
circulation. What should your next action
be?A. Perform CPR for 1 minute and reanalyze.
89
24. Which of the following statements best
describes the effects of chest compressions and
ventilation's during adult CPR?A. They
decrease the need for coronary artery bypass.B.
They shock the heart in VF (ventricular
fibrillation) back to normal heart rhythm.C.
They constrict the pupils to help preserve
vision.D. They provide a flow of oxygen to the
heart and brain.
90
24. Which of the following statements best
describes the effects of chest compressions and
ventilation's during adult CPR?D. They provide
a flow of oxygen to the heart and brain.
91
25. After one shock from the AED, you receive a
shock indicated message from the AED. What
should your next action be?A. Perform
1-rescuer CPR.B. Turn off and remove the AED
from the victim.C. Yell clear, make sure no
one is touching the victim, and push the shock
button.D. Leave the AED attached and place the
victim in a recovery position.
92
25. After one shock from the AED, you receive a
shock indicated message from the AED. What
should your next action be?C. Yell clear,
make sure no one is touching the victim, and push
the shock button.
93
THATS ALL. NOW CONTINUE ON TO THE NEXT SET OF
SLIDES AND TAKE THE WRITTEN TEST. REMEMBER TO
MARK VERSION A OR B ON YOUR ANSWER SHEET. RETURN
THE TEST TO YOUR INSTRUCTOR.
94
REMEMBER YOU ONLY NEED TO TAKE TEST VERSION A
OR B, NOT BOTH
95
TEST VERSIONA
96
1. Which of the following is the most powerful
modifiable risk factors for stroke? A. High
blood pressure B. High blood potassium C.
High blood sodium D. Untreated high blood
pressure
97
2. You are caring for a 60-year-old man after
surgery and have observed him continuously.
Earlier he was alert and speaking normally, but
now he complains of a sudden weakness on one side
of his face and in one arm. He is also having
trouble speaking. What is the most likely cause
of these problems? A. A seizure B. A heart
attack C. A stroke D. A diabetic coma
98
3. Your tennis partner, a healthy 52-year-old
woman with no history of heart disease, began
complaining of a vague but severe pressure in
the middle of her chest. Now the discomfort is
worse and includes pain in her back. She feels
nauseated, dizzy, and sweaty but denies that she
is having a heart attack. What should you
do? A. Give her 1 aspirin, then have her rest
for an hour B. Have her lie down, then call her
personal physician C. Let her walk outside to
breathe fresh air D. Tell her to lie down or sit
quietly then you phone 911 immediately.
99
4. You are responding to an emergency call to
the room of a 68-year-old man who is unresponsive
and has no evidence of trauma. What is the best
way to open this victims airway? A. Give
abdominal thrusts and then sweep out the
mouth B. Use the head tilt-chin lift C. Use a
mask while ventilating the victim D. Grab and
tilt the chin
100
5. Which of the following gives an adult in
sudden cardiac arrest the best chance of
survival? A. CPR performed by EMS personnel
immediately upon their arrival at the
victims side B. Immediate CPR and
defibrillation within no more than 3 to 5
minutes C. Defibrillation in 10 minutes with or
without CPR D. Immediate CPR with
defibrillation in 10 minutes
101
6. Before giving rescue breaths to and
unresponsive patient, you must check for normal
breathing. You do this by listening and feeling
for airflow through the victims nose or mouth.
What other sign should you assess? A. Look
into the patients mouth to see if anything is
blocking the airway B. Gently shake the
patients shoulders C. Check the patients
pupils and look for constrictive response
to light D. Look to see if the patients chest
rises and falls when the patient breaths
102
7. Which of the following describes the best
method of delivering rescue breaths with a pocket
mask but no additional oxygen? A. Reduce the
volume and duration of breaths from the volume
and duration you would provide with
mouth-to-mouth ventilation B. Provide
approximately the same volume as you would with
mouth-to-mouth ventilation (with a volumes
sufficient to make the chest rise), and
deliver the breaths over 2 seconds C. Increase
your air volume and duration of breaths D. Give
3 breaths between series of compressions
103
8. You are assisting in 2-rescuer adult CPR by
providing bag-mask ventilations with oxygen.
Each breath is making the chest rise very
noticeably bilaterally, and the patient exhales
completely. Your partner is performing chest
compressions at the center of the chest between
the nipples. You notice that the patients
stomach is inflating (swelling). What is the
probable cause of this inflation? A. You are
delivering ventilations to quickly and to
forcefully B. You are not giving the victim
time to exhale C. The patients stomach is
probably full from a large meal D. Your partner
is performing compressions in a location too
low on the breastbone (sternum), and the
compressions are probably too forceful
104
9. What is the best location for performing a
pulse check on a 48-year-old man who is
unconscious and not breathing? A. At the
radial artery of the wrist B. At the brachial
artery of the arm C. At the carotid artery of
the neck D. On the chest directly over the heart
105
10. You are walking with a female patient in the
hospital hallway. She suddenly collapses against
you. She is unresponsive. You gently lower her
to the ground and ask a colleague to activate the
emergency response system and get the AED. When
should you first check the victim for signs of
circulation? A. As soon as she collapses B.
You should open her airway, but do not check for
signs of circulation until you have
performed the complete sequence of CPR for
about 1 minute C. After opening her airway,
checking for normal breathing, and
providing 2 rescue breaths D. Immediately after
opening her airway
106
11. You are walking in the hallway at your
workplace. Ahead of you is an adult man who
suddenly slumps against the wall and slides to
the floor. No one is available to help. What
should you do next? A. Check for
responsiveness if the victim is unresponsive,
activate the emergency response system then
return to the victim to begin CPR B.
Activate the emergency response system wait in
an intersecting hallway to direct the
responders C. Place the victim in the recovery
position and await the arrival of
emergency responders with appropriate
equipment D. Perform CPR for 1 minute then
activate the emergency response system
107
12. You are part of a 2-rescuer team, and you are
performing chest compressions for an adult male
victim. Which of the following most accurately
represents the rate of compressions that you
should deliver for this man? A. A rate no
faster than 60 time per minute B. A rate of 80
times per minute C. A rate of about 100 times
per minute D. A rate of at least 120 times per
minute
108
13. A 24-year-old woman has swallowed an
overdose of prescription sleeping pills and is
now unresponsive. When you open her airway you
find that she takes only gasping breaths. You
provide 2 rescue breaths using a pocket mask and
check for signs of circulation, including a
pulse. Her pulse is rapid but weak. What should
you do next? A. Provide rescue breathing at a
rate of 1 breath every 5 seconds B. Begin chest
compressions because her pulse is weak C. Place
the victim in the recovery position D. Perform
CPR for 1 minute with chest compressions only
109
14. Your colleague is performing chest
compressions on an adult male patient who is on a
backboard. What is the best way to determine if
your colleague is compressing with enough force
and depth? A. Check for dilated pupils after 1
minute of CPR B. Check for pulse with each
chest compression C. Check the victims
breathing D. Note the victims color
110
15. You confirm that a responsive adult is
choking. While you perform abdominal thrusts on
the victim, he becomes limp and unresponsive.
What should you do next? A. Roll the person
over and give 5 back blows between the
shoulder blades B. Lower the victim to the
ground, open the victims airway, and
provide rapid and forceful mouth-to-mouth
breathing C. Lower the victim to the ground,
give 5 abdominal thrust, attempt rescue
breathing, and then alternate abdominal
thrust and attempts at rescue breathing D.
Lower the victim to the ground, open the airway
with a tongue-jaw lift to look for a
foreign object, perform a finger sweep to
remove any foreign objects that you can see,
open the airway and try to ventilate
111
16. Which of the following is the best
explanation you can give for the benefit of
immediate bystander CPR foe victims of sudden
cardiac arrest? A. Immediate CPR decreases the
need for coronary artery bypass B.
Immediate CPR forces the heart in ventricular
fibrillation to return to a normal
rhythm C. If defibrillation s performed within
6 to 10 minutes, bystander CPR is not
needed D. Immediate CPR provides a flow of
oxygen-rich blood to the heart and brain
and buys time until defibrillation
112
17. Which of the following statements best
describes the problems most commonly present in
infants and children whose condition deteriorates
to cardiac arrest? A. Most cardiac arrest in
children are sudden and are caused by an
inherited form of heart disease B. Most cardiac
arrest in children are preceded by severe
airway and breathing problems C. Most cardiac
arrest in infants and children are caused by
electric shock from appliances D. Most
cardiac arrest in infants and children are caused
by severe head injuries
113
18. You are babysitting your infant niece. You
are alone and find the infant unresponsive.
Which of the following is the best action? A.
Check for signs of circulation and if there are
none, phone 911 B. Phone 011 immediately
to ensure that advance life support is on
the way, and then return to the infant to begin
the ABC'S of CPR. C. Give 2 rescue
breaths if there is no response to the rescue
breaths, the phone 911 D. Begin the ABC'S
of CPR and then phone 911 after 1 minute
of rescue support
114
19. Which of the following is the correct ratio
of compressions to ventilations for infant or
child CPR? A. 10 to 2 B. 12 to2 C. 5 to
1 D. 15 to 2
115
20. Your neighbor runs to your house to ask you
to help a 6-year-old boy who has been struck by a
car near your home. You find that the child is
unresponsive. You send the neighbor to phone 911
while you remain with the child. How should you
open the childs airway? A. Head tilt-chin
lift with cervical spine immobilization B.
Tongue-jaw lift and blind finger sweep C. Head
tilt-chin lift without cervical spine
immobilization D. Jaw-thrust with cervical
spine immobilization
116
21. You are asked to provide rescue breathing
during the attempted resuscitation of a
6-year-old child. Which of the following
statements best describes the amount of air
(ventilation volume) that you sh7ld provide
during rescue breathing for this 6-year-old
child? A. The ventilation volume for this
child should be exactly half the volume
that you give an adult B. The ventilation
volume for this child should be twice the
volume you give a 3-year-old child C. The
ventilation volume should be enough to cause the
childs chest to rise D. You should
calculate the ventilation volume based on the
childs weight and deliver precisely that
volume during mouth-to-mouth,
mouth-to-mask, or bag-mask ventilation
117
22. You are providing rescue breathing for an
unresponsive, non-breathing child who has signs
of circulation. How often should you provide
rescue breaths for this child? A. Once every 3
seconds (20 breaths per minute) B. Once every 4
seconds (15 breath per minute) C. Once every 5
seconds (12 breath per minute) D. Once every 10
seconds (6 breaths per minute)
118
23. You are alone and providing CPR for a a
3-year-old child. Which of the following
describes the correct technique you should use to
perform chest compressions on this child? A.
Use both hands, one on top of the other B. Use
the heel of one hand C. Use the tips of 2
fingers D. Use the palm and fingers of one hand
119
24. You are alone and providing CPR for a
5-year-old child. Which of the following
directions most accurately describes compressions
for this child? A. Compress at a rate of about
100 times per minute B. Make sure to push the
breastbone (sternum) down at least 2
inches C. Use 2 fingers to compress the center
of the sternum D. Compress 15 times and then
give 2 quick breaths
120
25. A 2-year-old child eating at a table across
from yours begins coughing vigorously, but the
cough is becoming progressively weaker and less
effective, and she is making high-pitched noises
when she breaths in. The child seems to be in
respiratory distress and has bluish skin. What
is the most likely explanation for these
sighs? A. An acute asthma attack that has
caused a swelling of the airway B.
Severe or complete airway obstruction with
inadequate air exchange C. Development
of an upper airway infection D. A seizure from
a possible head injury
121
ANSWERS TO TEST VERSION A

• 1. D
• 2. C
• 3. D
• 4. B
• 5. B
• 6. D
• 7. B
• 8. A
• 9. C
• 10. C
• 11. A
• 12. C
• 13. A

• 14. B
• 15. D
• 16. D
• 17. B
• 18. D
• 19. C
• 20. D
• 21. C
• 22. A
• 23. B
• 24. A
• 25. B

122
REMEMBER YOU ONLY NEED TO TAKE ONLY TEST VERSION
A OR B, NOT BOTH
123
TEST VERSIONB
124
1. You are at your neighborhood park. You see
an adult man collapse to his knees and then slump
to the ground. You are the first person to reach
the man, and no one has responded to your shuts
for help. What is the first thing you should
do? A. Activate the emergency response
system B. Check for responsiveness C. Place
the victim in the recovery position D. Give 2
slow mouth-to-mouth breaths
125
2. You are with an overweight 55-year-old man
who has no known history of heart disease. He
begins to complain of sudden, severe, crushing
pain under his breastbone, in the center of his
chest. The pain has lasted more than 5 minutes.
What should you do? A. Ask him if he has
heartburn, if he says he does, tell him to
take an antacid B. Tell him to lie down while
you call his personal physician and report
the problem C. Tell him to lie down or sit
quietly then you phone 911 (or the
emergency response system) immediately D. Offer
to drive him to the nearest Emergency Department
126
3. A person with acute heart attack pain often
delays phoning 911 (the EMS system). Which of
the following statements provides the most
accurate explanation for this behavior? A.
People often deny that their symptoms might be
due to a heart attack B. Symptoms of a
heart attack come and go, it is best to wait for
an hour to avoid a false alarm C. The
victim can wait and ask someone in the family to
provide transportation to the hospital if
the signs of heart attack persist D.
Transport to the hospital by ambulance takes
longer than if the victim drives to the
hospital
127
4. You are caring for a 68-year-old woman. She
was talking normally to you earlier, but now she
complains of a sudden numbness and weakness on
one side of her face and pins and needles in
her arm. You notice that one side of her face is
drooping and she is unable to speak clearly.
What is the most likely cause of these
problems? A. A seizure B. A heart attack C.
Cardiac arrest D. A stroke
128
5. You are the only person present when you
remove a 3-year-old from the bottom of the
shallow end of a swimming pool. When should you
phone 911? A. After you have given the child 1
minute of CPR (whatever steps are
needed) B. As soon as you remove the child form
the pool C. When you se that after several
minutes of CPR there is no response D.
After giving a few ventilations and before
beginning chest compressions
129
6. An adult is the victim of a sudden, witnessed
cardiac arrest. Which of the following would
give this victim the best chance of survival from
sudden out-of-hospital cardiac arrest? A.
Immediate CPR and defibrillation within 5
minutes B. CPR performed by EMS personnel upon
arrival at the victims side C.
Defibrillation in 10 minutes without CPR D.
Immediate CPR with defibrillation in 10 minutes
130
7. During your first attempt at rescue breathing
for a child who is unresponsive and not breathing
normally, you find that you cannot get air into
the victims lungs. What is the most common
cause of this problem? A. The child has an
advanced lung infection B. You probably did not
open the airway properly C. The child has a
serious airway spasm D. The child has severe
narrowing of the airway due to asthma
131
8. You are responding to an emergency call to
the room of a 68-year-old man who is lying in
bed, unresponsive, with no evidence of trauma.
What is the best way to open this victims
airway? A. Perform the head tilt-chin lift B.
Give abdominal thrusts and then sweep out the
mouth C. Use a mask while performing
ventilations for the victim D. Grab and lift
the chin
132
9. You must check for normal breathing before
giving rescue breaths to an unresponsive victim.
You do this by listening and feeling for airflow
through he victims nose or mouth. In addition,
what other sign should you assess? A. Look
into the victims mouth to see if anything is
blocking the airway B. Gently shake the
victims shoulders C. Check the pupils and look
for a constrictive response D. Look to see if
the chest rises and falls as the victim breaths
133
10. You are providing rescue breaths with a bag
and mask during 2-rescuer CPR. Why is it
important to deliver the breaths slowly? A.
Slow ventilations give more time for oxygen to
be in contact with the blood in the
lungs B. The rescuer does not become tired C.
Slow ventilations reduce the risk of gastric
inflation D. Slow delivery of ventilations
delivers less volume at a higher pressure
134
11. Which of the following statements best
describes the ventilation volume that you should
provide during rescue breathing for a 6-year-old
child? A. Ventilation volume for a child
should be exactly half that you give an
adult B. Ventilation volume for a child should
be twice the volume that you give a
3-year-old C. Ventilation volume should be
enough to cause the childs chest to
rise D. You should calculate the ventilation
volume based on the weight of the child
and deliver precisely that volume during
mouth-to-mouth, mouth-to-mask, or bag-mask
ventilation
135
12. A responsive 6-year-old is struggling to
breath and cannot talk, cough, or move air. She
is turning cyanotic, and she is clutching her
throat with her hands. Her mother says I think
she is choking on a button. You ask the child
if she is choking, and she nods yes. You ask
if she can speak, and she shakes her head no.
What should you do next? A. Give the child 5
back blows, then 5 chest thrust B. Attempt a
blind finger sweep of the childs mouth C.
Administer 100 oxygen and monitor the child
closely D. Give the child abdominal thrust
until the button is removed or the child
becomes unresponsive
136
13. You are providing rescue breathing for an
unresponsive, non-breathing child who has signs
of circulation. How often should you provide
rescue breaths for this child? A. Once every 3
seconds (20 breaths per minute) B. Once every 4
seconds (15 breaths per minute) C. Once every 5
seconds (12 breaths per minute) D. Once every
10 seconds (6 breaths per minute)
137
14. A 7-year-old child I pulled form the water
after witnesses saw her sink below the surface
(no trauma). You find that she is unresponsive.
You send someone to phone 911 for help. What
should you do next? A. Perform abdominal
thrust to drain water from the lungs B. Give 5
back blows, then do a finger sweep of the
mouth C. Find the proper hand position and
begin chest compressions with the heel of
one hand D. Open the airway with the head
tilt-chin lift maneuver and
look-listen-feel for normal breathing if there
is no normal breathing, give 2 rescue
breaths
138
15. Which of the following statements best
describes the benefit of rescue breathing? A.
Rescue breathing will help overcome any airway
obstruction that may be blocking the
airway B. Rescue breathing will maintain
completely normal oxygenation for the
victim C. Rescue breathing might defibrillate
the heart D. Rescue breathing is an effective
way to provide oxygen to the victim
139
16. Which of the following most accurately
represents the chest location where you should
perform compressions on an adult victim of
cardiac arrest? A. Just below the neck on the
top half of the breastbone B. On the left side
of the chest, over the left nipple C. On the
lower half of the breastbone, at the nipple line
in the center of the chest D. On the
very bottom of the breastbone, over the xyphoid
140
17. What is the ratio of chest compressions to
ventilations for and adult in cardiac
arrest? A. 15 to 2 B. 12 to 4 C. 5 to
1 D. 3 to 1
141
18. Which of the following is the rate of
compressions during adult CPR? A. A rate of 80
to 100 times per minute B. A rate of about 100
times per minute C. A rate of no faster then 60
times per minute D. A rate of at least 120
times per minute
142
19. How fast should your chest compressions be
during infant CPR? A. 70 to 80 times per
minute B. 80 to 100 times per minute C. At
fast as possible D. At least 100 times per
minute
143
20. Where should you check for a pulse on a
child? A. At the brachial artery of the
arm B. At the carotid artery of the neck C.
At the radial artery of the wrist D. Feel for a
pulse directly over the heart on the chest
144
21. You are performing CPR on an adult. Your
colleague has activated the emergency response
system and brought the AED to you. You opened
the mans airway, checked for breathing, and
discovered that he had agonal respirations. You
gave 2 successful breaths using a pocket mask.
You checked for signs of circulation, including a
pulse, and found none. What is the most
appropriate next step? A. Attach the AED and
determine if a shock is indicated B. Begin
chest compressions and ask your colleague to
perform rescue breathing with oxygen C.
Recheck for signs of circulation D. Reposition
the airway look, listen, and feel for breathing
and deliver rescue breaths with oxygen
145
22. You and a second rescuer are performing
2-rescuer CPR on an adult victim of cardiac
arrest. You are performing chest compressions
while you partner provides rescue breathing.
When should your partner check for signs of
circulation again? A. After 4 cycles of 15
compressions and 2 ventilations and every
few minutes thereafter B. After 5 minutes of
CPR, then every 5 minutes thereafter C. Do not
check again until EMS personnel arrive to
assess the victim D. Do not check again
until the patient begins to breath
146
23. You are performing CPR for an adult victim.
You recheck for signs of circulation after 1
minute. You find signs of circulation, but the
victim is not breathing normally. What should
you do next? A. Continue chest
compressions B. check signs of circulation
again C. Begin rescue breathing D. Place the
victim in the recovery position
147
24, which of the following is the best benefit
of immediate bystander CPR? A. Immediate CPR
decreases the need for coronary artery
bypass and improves survival B. Immediate CPR
forces the heart in ventricular fibrillation
to return to a normal rhythm C. If
defibrillation is performed within 6-10 minutes,
bystander CPR does not improve
survival D. Immediate CPR provides a flow of
oxygen-rich blood to the heart and brain,
buying time until defibrillation and
improving the victims chance of survival
148
25. Which statement about injuries in infants
and children is true? A. Most fatal injuries
are not preventable B. Injuries are the chief
cause of death in children and young
adults C. Bicycle helmets will not prevent
death from head injures D. School fires are the
leading cause of fatal childhood injures
149
ANSWERS TO TEST VERSION B

• 1. B
• 2. C
• 3. A
• 4. D
• 5. A
• 6. A
• 7. B
• 8. A
• 9. D
• 10. C
• 11. C
• 12. D
• 13. A

• 14. D
• 15. D
• 16. C
• 17. A
• 18. B
• 19. D
• 20. B
• 21. A
• 22. A
• 23. C
• 24. D
• 25. B

150
NOW THAT YOU ARE FINISHED, TURN YOUR ANSWER SHEET
INTO THE INSTRUCTOR FOR GRADING.