basic life support, bit by bit approach
TRANSCRIPT
BY
Kerolus E. Shehata•PGY-III IM Resident, Ain Shams University•ECFMG certified
If you can’t give a life, you can save a life!!
OBJECTIVES1) How to assess the collapsed victim.
2) How to perform chest compression and rescue breathing in adults.
3) What are the differences between adult & paediatric BLS.
4) How to place an unconscious breathing victim in the recovery position.
BACKGROUND
Approximately 700,000 cardiac arrests per year in Europe.
Percentage of victims who survive till hospital discharge is currently 5-10%.
Bystander CPR is a vital intervention before arrival of emergency services.
Early resuscitation and prompt defibrillation (within 1 - 2 minutes) can result in > 60 % survival and decrease in mortality rate.
Q. What is the difference between BLS & ACLS ?
A: BLS implies that NO equipment is employed other
than protective devices.
Why do we do CPR?Do we need to learn
about CPR?
Every minute will make a lifetime of difference
How does CPR work? The brain may sustain damage after blood flow has been
stopped for about 4 min. and irreversible damage after about 7 min.
The heart also rapidly loses the ability to maintain a normal rhythm.
CPR is effective only if performed within 7 minutes of the stoppage of blood flow.
Effective CPR enables enough oxygen to reach the brain to delay brain stem death, and allows the heart to remain responsive to defibrillation attempts.
Will CPR restart the heart? Chances are very low. Compression can’t
reverse the causes e.g. Hypoxia in children & arrhythmias in adults
To restart, you need an electric shock by AED.
CPR pump a small amount of blood that is barely sufficient to keep your brain alive.
Q. Is there anything that improve the
outcome??
CHAIN OF SURVIVAL
Q. What will you do if you find this?
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
First & most important thing: Don’t Panic!!
APPROACH SAFELY
1. Scene
2. Rescuer
3. Victim
4. Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
Don’t start CPR in an unsafe environment…we don’t want a second victim
Risks To The Rescuer Aim to eliminate or minimize risks. Beware of environmental dangers e.g.
Traffic Electricity Gas Water Radiation
Can I get an infection??
15 documented cases of CPR related infection
mainly Neisseria meningitides.
TB (only isolated reports).
Not hepatitis B or C or CMV.
transmission of HIV during CPR has never
been reported.
Check for a responseApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
• Shake the shoulders gently.
• Shout loudly “Are you alright?”
How to check the victim’s response?
If the victim responds
1. Leave him/her as it is.2. Activate the EMS (123)3. Try to find out what is wrong.4. Reassess regularly.
If there is NO responseSHOUT FOR HELP!!
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
Open the airwayApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
How to Open The Airway?
Head tilt & Chin lift If cervical spine injury suspected: jaw thrust
Check for breathing & CirculationApproach safely
Check response
Shout for help
Open airway
Confirm arrest
Call 123
30 chest compressions
2 rescue breaths
How to check for breathing & circulation?
Look, Listen and Feel for NORMAL breathing.
Check the Carotid pulse. Assess for not more than
10 sec. before deciding absent breathing.
Do not confuse agonal breathing with normal breathing.
AGONAL BREATHING Occurs shortly after the heart stops
in up to 40% of cardiac arrests. Brain stem reflex. Described as heavy, noisy or gasping
breathing. Recognise as a sign of cardiac arrest.
If the patient is breathing normally & you can feel a pulse:
Turn him into the recovery position (if applicable).
Call for help. Reassess regularly till arrival of EMS.
If you can feel a pulse, but the patient is not breathing:
Give 1 rescue breath every 5 seconds. Recheck the pulse every 2 minutes.
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
If you confirm Cardiac arrestCall 123 & Start CPR
Give 30 effective chest compressionsApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
Place the heel of one hand on the lower half of sternum (Sterno-xyphoid junction).
Place other hand on top. Interlock your fingers. keep your arms straight and lock your elbows
so you can compress the chest fully using your weight while conserving your energy.
Compress the chest: Rate at least 100/min. Depth 5-6 cm (1/3 A-P diameter of chest) Allow chest recoil.
When possible change CPR operator/5 cycles.
How to perform effective chest compressions?
Give 2 effective rescue breathsApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
How to deliver effective rescue breaths ? Open the airway. Close the victim’s nose. Take a normal breath. Seal your lips over the
victim’s mouth. Blow until the chest rises. Pause for 1 second. Allow chest to fall. Repeat one more time.
Continue Chest compressions & Rescue breaths at a rate of:
2 30
Continue resuscitation until…
Qualified help arrives and takes over with AED & ACLS protocol.
The victim shows signs of life.You become exhausted.The Victim has a DNR order.
New Guidelines for a high quality CPR
1. Sufficient rate and depth without excessively ventilating.
2. few interruptions of chest compressions.3. completely relaxing pressure between
compressions.
• The order of interventions was changed from ABC to CABEXCEPT in:1. Newborn in whom hypoxia is MCC of cardiac arrest.2. Those believed to be in a respiratory arrest (drowning, drug
overdose…etc.).
Complications of CPR1. Most common: Rib fractures & sternal
fracture.2. Pneumothorax3. Bleeding: Hemopericardium, hemothorax
& anterior mediastinal bleeding.4. Contusion of: Heart & Lung.5. Lacerations of: Liver & Spleen.
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
A quick Recap
Compression only (Hands only) (Cardio-cerebral) resuscitation
• Chest compressions without artificial respiration.• Easier: the method of choice for the untrained
rescuer• In adults with out-of-hospital cardiac arrest,
compression-only CPR by the lay public has a higher success rate than standard CPR.
• The exceptions: cases of drownings, drug overdose (with respiratory arrest) and arrest in children.
• Rate: the same as standard CPR (at least 100/min.)
CPR during pregnancy• During pregnancy when a
woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left.
• If this is not effective, either roll the woman 30° or healthcare professionals should consider emergency Caesarean section.
Pediatric BLS
Steps:
Open the airway
Check for Breathing
LOOK, LISTEN & FEEL
Check for Pulsation
Carotid, Brachial or Femoral
Chest compression
In children: If pulse < 60, start CPR to enhance the perfusion.
Give 15 effective chest compression
2 fingers technique 2 thumbs technique
2 hands technique 1 hand technique
Give 2 effective Rescue Breaths
Mouth to mouth & nose technique
Mouse to mouth technique
If the victim starts to breathe normally, Put him/her in the
Recovery Position
1 2
3 4
Steps of positioning the victim in the Recovery position
Aim of the Recovery Position.1. Gravity assistance to the clearance of physical obstruction of the airway
by the tongue. 2. Gives a clear route by which fluid (e.g. vomitus) can drain from the
airway.3. There is a room for the chest to rise and fall freely.
All forms of the recovery position share basic principles:
1) The mouth is downward so that fluid can drain from the patient's airway.2) The chin is upward to keep the epiglottis opened. 3) Arms and legs are locked to stabilize the position of the patient.