abdominal thrusts: the procedure used to help clear an upper airway obstruction in a choking individual who is awake but unable to make sounds.
agonal gasps: also called agonal respirations, an abnormal respiratory pattern characterized by gasping or struggling to breathe due to reduced oxygen circulating in the blood.
airway obstruction: a partial or complete blockage of any of the breathing passages that lead to the lungs. Airway obstruction is usually classified as an upper or lower obstruction and is caused by mechanical or disease-specific mechanisms.
apnea: a temporary cessation of breathing that results in no movement of air into or out of the lungs.
arrhythmia: a medical condition in which the heart beats in an abnormal rhythm.
asystole: also called cardiac standstill or flatline. In this state, the heart has stopped beating, and the patient has no cardiac output or heart muscle activity.
automated external defibrillator (AED): a portable device that evaluates the heart rhythm and delivers an appropriate electrical shock to the heart when a shockable rhythm is detected.
bag-mask ventilation: a hand-held device that allows a rescuer to provide breaths to patients who have inadequate or absent breathing. Healthcare providers should be trained to use this essential part of the resuscitation standard equipment. The bag-mask can be used without additional oxygen, but if higher oxygen concentrations are required, supplemental oxygen is given.
basic life support (BLS): the most basic level of medical care that can be used by field personnel or trained bystanders to support the injured or ill patient until definitive treatment can be delivered at a hospital.
bradycardia: an abnormally slow heart rate for the individual’s age. In the adult population, the normal heart rate is 60–100 beats per minute, but the heart rate normally varies with activity.
C-A-B sequence: the current and preferred CPR sequence that teaches chest compressions, airway management, and breathing. The rationale for this order is that the individual cannot survive without circulation but can survive for a short time without additional oxygen entering the circulation.
cardiac arrest: the sudden cessation of heart function. In the pediatric population, a cardiac arrest is rarely a primary event. Instead, it is usually the result of deteriorating respiratory function leading to respiratory failure and, ultimately, to cardiac arrest. This condition is often called cardiopulmonary arrest or failure.
cardiac output: the volume of blood pumped by the ventricle each minute. The cardiac output is calculated by multiplying heart rate and stroke volume (HR x SV). The pediatric population has a higher normal cardiac output than adults because pediatric patients normally have a higher normal heart rate.
closed-loop communication: a communication technique that involves the sender giving a message that is repeated back by the individual receiving the message. If the repeated message is correct, the original sender responds with a “yes” message.
compression-only CPR: CPR performed without delivering rescue breaths. Lay rescuers who are not trained in full CPR or who feel uncomfortable with the process are encouraged to learn compressions-only CPR to maintain enough circulation until definitive assistance arrives.
compression-ventilation ratio: the relationship between the number of chest compressions and breaths given during cardiopulmonary resuscitation. For single-rescuer situations, the ratio is 30 compressions to 2 ventilations for all ages. When two rescuers are available, the compression-ventilation ratio remains at 30 to 2 for adults but changes to 15 compressions to 2 ventilations for the pediatric population.
cyanosis: bluish or purplish discoloration of the skin due to decreased oxygen in the blood. See acrocyanosis and central cyanosis.
defibrillation: the definitive treatment for ventricular tachycardia or fibrillation that consists of delivering an unsynchronized shock to the cardiac muscle using a defibrillator.
E-C technique: a one-handed technique for positioning and holding a face mask on the patient during ventilation. In this technique, the thumb and index finger form a C over the top and bottom of the mask, and the other three fingers form an E by holding the mandible. Unless the rescuer has large hands, this technique is less effective in adults than in children.
electrocardiogram (ECG): a noninvasive recording of the electrical activity of the heart. Electrodes are placed in specific locations on the individual’s skin to record activity in all areas of the heart.
endotracheal intubation: also called tracheal intubation, the placement of a plastic tube into the trachea to keep the individual’s airway open and provide ventilation during resuscitation.
endotracheal tube (ET tube): a plastic tube that is used in the endotracheal intubation procedure to keep the airway patent.
epinephrine: a naturally occurring hormone that aids in regulating the sympathetic autonomic nervous system. As a powerful vasopressor, epinephrine (or adrenaline) increases blood pressure, heart rate, and cardiac output. In resuscitation, epinephrine is used as a cardiac stimulant to treat persistent bradycardia, cardiac arrest rhythms, anaphylaxis, and hypotension.
foreign-body obstruction (FBO): obstruction of the upper airway due to aspiration of food or small objects.
gasping: abnormal respiratory effort in which the individual attempts to inhale or exhale with quick, ineffective breaths. The clinician should immediately intervene to provide effective ventilation.
head-tilt chin-lift maneuver: a technique for opening the airway in which the patient’s head is tilted and the chin is lifted, so the head is in the “sniffing” position. This technique should NOT be used in a suspected cervical spine injury. Instead, the team should use the jaw-thrust maneuver.
high-quality cardiopulmonary resuscitation: refers to the current American Heart Association (AHA) recommendations for a compression rate of 100–120 per minute for all ages, a compression depth of at least 2 inches for adults, and a depth of at least one-third of the anterior-posterior diameter of the chest for infants and children (usually 1.5 to 2 inches).
hypertension: a blood pressure higher than the normal expected range. In 2017, the American Heart Association and American College of Cardiology redefined the guidelines for blood pressure. In the new guidelines, the following categories apply:
Category | Definition |
---|---|
Normal | < 120/80 mm Hg |
Elevated | systolic BP 130–139 and diastolic BP < 80 mm Hg |
Stage 1 | systolic BP 130–139 or diastolic BP 80–89 mm Hg |
Stage 2 | systolic > 139 or diastolic at least 90 mm Hg |
Hypertensive crisis | systolic > 180 or diastolic > 120 mm Hg |
hypoxia: an inadequate oxygen supply at the tissue level to meet the body’s metabolic demands. Causes of hypoxia can include pulmonary disease, congenital heart disease, airway obstruction, or sepsis. Hypoxia will often lead to hyperventilation.
in-hospital cardiac arrest (IHCA): a cardiac arrest that occurs within the confines of an acute care hospital. Improved outcomes are associated with in-hospital arrest, but more importantly, with post-arrest care that occurs in the hospital setting.
jaw-thrust maneuver: a technique for opening a patient’s airway when a cervical spine injury is possible. The provider pushes the lower jaw forward while maintaining the neck in a neutral position.
laryngeal mask: a supraglottal airway that keeps the individual’s airway open. Easier to insert than an endotracheal tube, the laryngeal mask helps to ensure an airtight seal on top of the glottis.
myocardium: the heart muscle, which is the thick, middle layer of the heart wall that contains primarily contractile muscle cells.
naloxone: a medication that can be given to reverse respiratory depression caused by opioid overdose. Naloxone is often referred to by its brand name Narcan. Most emergency responders (police, fire, and EMS) now carry naloxone. It may also be given by a lay rescuer who has been trained to respond to patients with opioid overdose.
nasopharyngeal airway (NPA): an airway adjunct used in the management of less severe cases of airway obstruction. The NPA is inserted through the nose toward the base of the tongue to prevent the tongue from covering the epiglottis.
non-shockable rhythms: cardiac arrhythmias that will NOT respond to cardioversion or defibrillation, namely, PEA and asystole. They are considered nonshockable since they do not have an electrically identifiable spike.
normal sinus rhythm: the cardiac rhythm that results when the electrical impulse originates in the sinus node and travels through the normal conduction pathway to produce the characteristic rhythm of a healthy heart at rest.
oropharyngeal airway: an airway adjunct used to maintain an open airway by preventing the tongue from falling back over the epiglottis and causing airway obstruction.
out-of-hospital cardiac arrest (OHCA): a cardiac arrest that occurs in any location other than an acute care hospital. Differences in the availability of treatment modalities make the survival of an OHCA more unlikely than survival from an IHCA.
pneumothorax: a condition in which a lung is partially or completely collapsed. A common cause of pneumothorax is trauma to the chest and over-inflation of the lungs from aggressive ventilation that causes the alveoli to rupture.
positive pressure ventilation (PPV): a technique of artificial respiration using a mechanical ventilator or bag-valve mask device to force air into the lungs of the patient. PPV is used when spontaneous breathing is either inadequate or absent.
post-cardiac arrest care: care measures used to reduce morbidity and mortality after successful resuscitation. Most important during the period following ROSC is maintaining adequate blood pressure, running serial ECGs, therapeutic hypothermia, and monitoring oxygenation using waveform capnography as indicated.
preload: the end-diastolic volume of the ventricles just prior to contraction of the ventricles.
priority-based multiple-rescuer response: the protocol that designates which member of the team performs which functions and in what order. A resuscitation often begins with one rescuer, and other team members join the team as they are available. Facility protocol will designate what the essential duties are and who will accomplish each task in the context of the team.
pulseless electrical activity (PEA): a common arrhythmia during resuscitation in which the cardiac monitor shows electrical activity without palpable pulses. In this situation, defibrillation is not the treatment of choice. Instead, the team must continue CPR and use the Hs and Ts to quickly identify the cause of the arrest. The most common cause of PEA is hypoxemia.
recovery position: following the return of effective circulation and breathing, the rescuer should roll the patient onto the side, placing the head in a dependent position. This position helps to maintain a patent airway by decreasing pressure on the patient’s lungs and allows emesis to flow out from the mouth.
respiratory arrest: absent or extremely inadequate oxygenation and ventilation. This condition assumes that the patient has a palpable pulse and circulation.
respiratory distress: when a patient has trouble breathing and exhibits signs such as increased respiratory rate, retractions, accessory muscle use. This can be caused by lung disease, infection, or obstruction.
respiratory failure: a late stage of respiratory distress in which the gas exchange between the air and the blood cannot match the metabolic demands of the body. Signs and symptoms of respiratory failure include those of respiratory distress, such as tachypnea, tachycardia, hypertension, stridor, diminished breath sounds, paradoxical chest wall movement, and use of accessory muscles during respiration. However, impending respiratory failure is heralded by a slowed respiratory rate as the patient tires, bradycardia, and a decreasing level of consciousness.
shock: a life-threatening medical condition characterized by rapid breathing, cool skin, rapid and weak pulse, dizziness, faintness, and decreased blood pressure. Shock is categorized as compensated or decompensated and typed as anaphylactic, cardiogenic, distributive, hemorrhagic, hypovolemic, and septic.
shockable rhythm: an arrhythmia that can be interrupted by electrical shock. The two shockable rhythms are VF and pulseless VT.
supraglottic airway devices: adjunct airway devices such as LAM, King airway, and I-Gel that are used to manage the patient’s airway during resuscitation.
supraventricular tachycardia: a fast heart rhythm that originates above the ventricles. Signs and symptoms of SVT include chest pain, diaphoresis, shortness of breath, and dizziness.
synchronized cardioversion: an energy shock that is timed to be delivered at a particular point in the cardiac rhythm to avoid the relative refractory period. The purpose is to restore normal cardiac activity and to convert atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachycardia when medications have not been successful.
tragus: the small, pointed prominence in front of the opening on the outer ear.
upper airway obstruction: a blockage of the trachea, larynx, or throat that impairs air movement into the lungs.
ventricular fibrillation (VF): a cardiac arrhythmia characterized by fibrillation of the ventricles of the heart instead of effective contractions. In the pediatric population, this arrhythmia is uncommon and occurs mostly in the context of preexisting cardiomyopathy. It is one of the rhythms that an AED recognizes as shockable.