basic life support

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Basic Life Basic Life SupportSupport

Iman HassanIman HassanAssistant Professor Pulmonary Assistant Professor Pulmonary

MedicineMedicineAin Shams UniversityAin Shams University

E-mail: [email protected]: [email protected]

Basic Life SupportBasic Life Support

Our GoalOur Goal

Early Access Early CPR Early Defibrillation Early Early Access Early CPR Early Defibrillation Early ACLSACLS

To “save hearts too good to die” while preserving To “save hearts too good to die” while preserving cerebral viability.cerebral viability.

To take To take RapidRapid decisions because decisions because IrreversibleIrreversible brain damage may occur within brain damage may occur within 4 minutes4 minutes of of cardiac arrest.cardiac arrest.


Basic life support (BLS)Basic life support (BLS) is a specific level of pre- is a specific level of pre-

hospital medical care provided by trained hospital medical care provided by trained

responders, including emergency medical responders, including emergency medical

technicians, in the absence of advanced medical technicians, in the absence of advanced medical

care.care.

BLSBLS generally does not include the use of drugs or generally does not include the use of drugs or

invasive skills, and can be contrasted with the invasive skills, and can be contrasted with the

provision of provision of Advanced cardiac life support Advanced cardiac life support

(ACLS). (ACLS).

CPR provided in the field buys time for higher CPR provided in the field buys time for higher

medical responders to arrive & provide ACLS.medical responders to arrive & provide ACLS.


At the end of the lesson you should be able to state At the end of the lesson you should be able to state

& describe the Adult BLS Algorithm, focusing on & describe the Adult BLS Algorithm, focusing on

Cardiac Arrest in a Cardiac Arrest in a non drowningnon drowning, , non non

traumatictraumatic, , non toxicnon toxic adult collapse. adult collapse.

The guidelines are based on the document 2005 The guidelines are based on the document 2005

International Consensus on Cardiopulmonary International Consensus on Cardiopulmonary

Resuscitation & Emergency Cardiovascular Care Resuscitation & Emergency Cardiovascular Care

Science.Science.


BLS consists of the following sequence of BLS consists of the following sequence of actions:actions:

Make sure the victim, any bystanders & you are safe.Make sure the victim, any bystanders & you are safe.

Check the victim for a response.Check the victim for a response.

Gently shake his shoulders and ask loudly, ‘Are you all Gently shake his shoulders and ask loudly, ‘Are you all right?’right?’

If he responds:If he responds:– Leave him in the position in which you find him Leave him in the position in which you find him

provided there is no further danger.provided there is no further danger.– Try to find out what is wrong with him and get Try to find out what is wrong with him and get

help if needed.help if needed.– Reassess him regularly.Reassess him regularly.

If he does not respond:If he does not respond:– Shout for help.Shout for help.– Turn the victim supine aligned position or stable Turn the victim supine aligned position or stable

side position.side position.


Position on Back:Position on Back:All body parts rolled over at the

same time.

Always be aware of head &

spinal cord injuries.

Support neck & spinal column.

CARDIOPULMONARY CARDIOPULMONARY RESUSCITATION RESUSCITATION

IS AS EASY AS "A B C"IS AS EASY AS "A B C"

AAIRWAY:IRWAY: (Get it Open)(Get it Open)

Chin Lift Maneuver. Chin Lift Maneuver.

Jaw thrust maneuver. Jaw thrust maneuver.

Manual clearing of mouth & throat.Manual clearing of mouth & throat.

Endotracheal intubation & Tracheobronchial Endotracheal intubation & Tracheobronchial suctioning.suctioning.

Oropharyngeal & Nasopharyngeal airway.Oropharyngeal & Nasopharyngeal airway.

Cricothyrotomy - transtracheal OCricothyrotomy - transtracheal O2 2 jet insufflation jet insufflation

- Tracheotomy.- Tracheotomy.


Chin LiftChin Lift Jaw ThrustJaw Thrust


Head-Tilt/Chin LiftHead-Tilt/Chin Lift

maneuver in an maneuver in an

infant. infant.

Do not overextend Do not overextend

the head & neck.the head & neck.



Use the Use the Jaw ThrustJaw Thrust

to open your to open your

patient's airway if patient's airway if

you suspect a you suspect a

cervical spine cervical spine

injury.injury.

RECOVERY POSITIONRECOVERY POSITION


SuctionSuction fluids from fluids from

your patient’s your patient’s

airway.airway.


OropharyngealOropharyngealAirwayAirway

NasopharyngealNasopharyngealAirwayAirway


Oropharyngeal AirwayOropharyngeal Airway


BBREATHING:REATHING: (Get it Started)(Get it Started)

Position your cheek close to victim's nose & mouth, Position your cheek close to victim's nose & mouth, look toward victim's chest, & look toward victim's chest, & "Look, Listen & "Look, Listen & Feel"Feel" for breathing for breathing (5-10 seconds).(5-10 seconds).

If If Not BreathingNot Breathing, pinch victim's nose closed and , pinch victim's nose closed and give give 22 full breaths into victim's mouth (use a full breaths into victim's mouth (use a microshield or similar barrier). microshield or similar barrier).

If your rescue breaths won't go in, reposition the If your rescue breaths won't go in, reposition the head & try again to give breaths.head & try again to give breaths.

If still blocked, suspect chocking & perform If still blocked, suspect chocking & perform abdominal thrusts (Heimlich maneuver).abdominal thrusts (Heimlich maneuver).



LookLook,, Listen Listen && FeelFeel for breathing forfor breathing for NoNo longer thanlonger than 1010 secondsseconds

LookLook for chest for chest movement.movement.

ListenListen at the victim's at the victim's mouth for breath mouth for breath sounds.sounds.

FeelFeel for air on your for air on your cheek.cheek.

BBreathing support:reathing support:

Mouth-to-mouth (nose) ventilation.

Mouth-to-adjunct with or without O2

Manual bag-mask (tube) ventilation with or

without O2

Hand-triggered O2 ventilation.

Mechanical ventilation.



If the victim is not breathing, give 2 breaths (1 second or longer)

• Pinch the nose• Seal the mouth with

yours.

If the first 2 don’t go in, re-tilt & give 2 more breaths (if breaths still do not go in, suspect choking)


BBreathing:reathing: Mouth To NoseMouth To Nose (when to use?) (when to use?)

Can’t open mouthCan’t open mouth

Can’t make a good sealCan’t make a good seal

Severely injured mouthSeverely injured mouth

CCIRCULATION:IRCULATION: (Get the Blood to the Brain)(Get the Blood to the Brain)

Check for Check for CarotidCarotid pulse by feeling for pulse by feeling for 5-10 5-10

secondsseconds at side of victims' neck. at side of victims' neck.

If there is If there is PulsePulse but victim is but victim is Not Not

BreathingBreathing, give rescue breathing at rate of , give rescue breathing at rate of 11

breath breath every 5 secondsevery 5 seconds or or 1212 breaths breaths per per

minute.minute.


If there isIf there is No PulseNo Pulse, , begin chest compressions as begin chest compressions as

follows:follows:

Place the heel of one hand on lower part of victim's Place the heel of one hand on lower part of victim's

sternum.sternum.

With your other hand directly on top of first hand and With your other hand directly on top of first hand and

arms locked straight, depress sternum arms locked straight, depress sternum 4 - 5 cms.4 - 5 cms.

Perform Perform 3030 compressions to every compressions to every 2 breaths.2 breaths.

Check for return of pulse Check for return of pulse every minute.every minute.


ContinueContinue UNINTERRUPTEDUNINTERRUPTED untiluntil ADVANCED ADVANCED

LIFE SUPPORTLIFE SUPPORT isis Available. Available.


Chest compression Only CPR:Chest compression Only CPR:

If you are not able, or are unwilling, to give If you are not able, or are unwilling, to give

rescue breaths, give chest compressions only.rescue breaths, give chest compressions only.

If chest compressions only are given, these If chest compressions only are given, these

should be continuous at a rate of should be continuous at a rate of 100/minute.100/minute.

Stop to recheck the victim only if he starts Stop to recheck the victim only if he starts

breathing breathing normallynormally; otherwise do not ; otherwise do not

interrupt resuscitation.interrupt resuscitation.

Two-Rescuer CPR for Adults and Children

Minimizes time between rescue breaths and compressions- CPR becomes more effective

Can more quickly set up AED

Reduces rescuer fatigue


Single Rescuer Single Rescuer CPRCPR

Give 30 chest compressions at rate of 100 per minute

Then give 2 ventilations

Automated External DefibrillatorAutomated External Defibrillator(AED)(AED)

Automated External Defibrillator Automated External Defibrillator (AED)(AED)

AEDs are pre-programmed devices used to provide AEDs are pre-programmed devices used to provide

treatment/care for cardiac arrest (heart attack) victims.treatment/care for cardiac arrest (heart attack) victims.

AEDs provide an electric charge that interupts the AEDs provide an electric charge that interupts the

fibrillation, or rapid uncoordinated contractions of the fibrillation, or rapid uncoordinated contractions of the

heart & allows it to begin beating regularly again.heart & allows it to begin beating regularly again.

Immediate defibrillation carries the only hope of survival Immediate defibrillation carries the only hope of survival

in cardiac arrest victims.in cardiac arrest victims.

Automated External Defibrillator Automated External Defibrillator (AED)(AED)

When defibrillation is delivered within one minute, survival When defibrillation is delivered within one minute, survival

rates can be as high as 90%. rates can be as high as 90%.

If defibrillation is delivered in < 5 minutes, survival can be If defibrillation is delivered in < 5 minutes, survival can be

as high as 50%. as high as 50%.

For every minute that passes prior to receiving defibrillation, For every minute that passes prior to receiving defibrillation,

a victim's chance of survival declines by about 10%. a victim's chance of survival declines by about 10%.

After 10 minutes chances of survival are near zero. After 10 minutes chances of survival are near zero.

Defibrillation TechniqueDefibrillation Technique

Defibrillation Sequence

Action Announcements

1. Switch on.

2. Place coupling pads/gel in correct position

3. Apply paddles

4. Check ECG rhythm and confirm no pulse

5. Select non-synchronized (VF) setting

6. Charge to required energy level "Charging"

7. Ensure no-one is in contact with anything touching the patient

"Stand clear"

8. Press paddle buttons simultaneously "Shocking now"

9. Check ECG rhythm

10. Check for output if rhythm change "Check pulse"

11. Return to ALS algorithm for further steps

Safety Precautions When Using Safety Precautions When Using AED AED

Do not touch the victim while the AED is analyzing or while Do not touch the victim while the AED is analyzing or while defibrillating. defibrillating.

Do not touch the victim Dry victim’s chest before applying pads Do not touch the victim Dry victim’s chest before applying pads but do not use alcohol to wipe the victim’s chest dry.but do not use alcohol to wipe the victim’s chest dry.

Do not defibrillate someone around flammable materials or cell Do not defibrillate someone around flammable materials or cell phones.phones.

Do not use an AED in a moving vehicleDo not use an AED in a moving vehicle

Do not use an AED on a victim in contact with water or on metal Do not use an AED on a victim in contact with water or on metal surfacesurface

Do not use an AED on a victim wearing a nitroglycerin patch or Do not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest.other patch on the chest.

Do not use a mobile phone or conduct radio transmission within Do not use a mobile phone or conduct radio transmission within 6 feet of the AED.6 feet of the AED.

Do not place the pads directly over a pacemaker or other Do not place the pads directly over a pacemaker or other implanted device.implanted device.

Differential Diagnosis:Differential Diagnosis:

Hypovolemia Hypoxia Hydrogen ions (acidosis) Hyper/ hypokalemia Hypothermia Hypoglycemia

Toxins Tamponade Tension PTX Thrombosis (coronary) Thrombosis (pulmonary) Trauma

6 Hs & 6 Ts6 Hs & 6 Ts

Checking for CPR Effectiveness?Checking for CPR Effectiveness?

Does chest rise & fall with rescue breaths?Does chest rise & fall with rescue breaths?

Have a second rescuer check pulse while Have a second rescuer check pulse while

you give compressions?you give compressions?


When Can I Stop CPR?When Can I Stop CPR?Victim revivesVictim revives

Trained help arrivesTrained help arrives

Too exhausted to continueToo exhausted to continue

Unsafe sceneUnsafe scene

Physician directed (do not resuscitate orders)Physician directed (do not resuscitate orders)

Cardiac arrest of longer than 30 minutes Cardiac arrest of longer than 30 minutes (controversial)(controversial)


Why CPR May Fail?Why CPR May Fail?Delay in startingDelay in starting

Improper procedures (e.g., Forget to pinch nose)Improper procedures (e.g., Forget to pinch nose)

No ACLS follow-up & delay in defibrillationNo ACLS follow-up & delay in defibrillation

Only 15% who receive CPR live to go homeOnly 15% who receive CPR live to go home

Improper techniquesImproper techniques

Terminal disease (or) unmanageable disease Terminal disease (or) unmanageable disease

(massive heart attack)(massive heart attack)


Key Concepts in BLS?Key Concepts in BLS?

Avoid Hyperventilation (Do not ventilate too fast or Avoid Hyperventilation (Do not ventilate too fast or

too much volume).too much volume).

Allow complete chest recoil, minimal interruptions.Allow complete chest recoil, minimal interruptions.

Compress chest depth of 1.5 to 2 inches at a rate of Compress chest depth of 1.5 to 2 inches at a rate of

100 compressions/minute.100 compressions/minute.

Resume CPR immediately after shock. Resume CPR immediately after shock.

Interruption in CPR for rhythm check should not Interruption in CPR for rhythm check should not

exceed 10 seconds.exceed 10 seconds.



AAirway:irway: Open Airway.Open Airway.

BBreathing:reathing:

(Look, Listen &Feel)(Look, Listen &Feel)

CCirculation:irculation:

Monitor & check the Monitor & check the pulsepulse

Check BreathingCheck Breathing

BreathingBreathing

Non BreathingNon Breathing

Check CirculationCheck Circulation

CirculationCirculation

ArrestArrest

ABCD’sABCD’s

Nursing Responsibilities in an ArrestNursing Responsibilities in an Arrest

Ensure there are enough staff to manage the situation.Ensure there are enough staff to manage the situation.The nurse that scribes should ensure the following is The nurse that scribes should ensure the following is documented:documented:

1.1. Patient’s name.Patient’s name.2.2. Time.Time.3.3. Cardiac rhythm once chest leads in placeCardiac rhythm once chest leads in place4.4. Defibrillations, joules delivered.Defibrillations, joules delivered.5.5. All drugs delivered, including doses and routes.All drugs delivered, including doses and routes.6.6. Observations.Observations.7.7. Other comments e.g. IV fluids, intubation, bloods, CPR etc.Other comments e.g. IV fluids, intubation, bloods, CPR etc.8.8. Staff attending the arrest.Staff attending the arrest.9.9. Outcome / transferred to.Outcome / transferred to.10.10.Time of death.Time of death.11.11.Remember to ask if you are unclear as to what drugs have Remember to ask if you are unclear as to what drugs have

been given, cardiac rhythm, defibrillation, etc.been given, cardiac rhythm, defibrillation, etc.

For the Arrest Patient:For the Arrest Patient:

Nursing Responsibilities in an Nursing Responsibilities in an ArrestArrest

For Other Patients & Visitors:For Other Patients & Visitors:

Curtain off the other patients bed areas.Curtain off the other patients bed areas.

Ask any visitors to either leave the room or Ask any visitors to either leave the room or

stay with the patient they have come to visit stay with the patient they have come to visit

behind their curtains.behind their curtains.

Complications of CPRComplications of CPR

Rib & sternal fracturesRib & sternal fractures

PneumothoraxPneumothorax

Pericardial tamponadePericardial tamponade

Pulmonary contusionPulmonary contusion

AspirationAspiration

Aortic lacerationAortic laceration


Chain Of Survival Is Our GoalChain Of Survival Is Our Goal


QUESTIONSQUESTIONS

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