docs_training on basic life support for nurses_bcls presentation

8/13/2019 Docs_Training on Basic Life Support for Nurses_BCLS Presentation

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Basic Cardiac Life SupportBasic Cardiac Life Supportfor Health Care Providerfor Health Care Provider

(AHA, HSF and ERC Guildline 2005)

Ruttonjee & Tang Shiu Kin HospitalA&E Training Centre

Last update for EBM: 19 April 2006


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Sudden Cardiac Arrest (SCA)

Hong Kong: approx 10,000 SCA-deaths per year!


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In Hospital CPR qualityAbella, B.S., Alvarado, J.P., Myklebust, H., Edelson, D.P., Barry, A.,

OHearn, N. et al. (2005). Quality of cardiopulmonary resuscitationduring in-hospital cardiac arrest. JAMA. 293 (3):305-310.

A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals,Chicago, Ill

28.1% chest compression rates were less than 90/min (Suggestion100/min)

37.4% Compression depth was too shallow (defined as


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Out Hospital CPR qualityWik, L., Kramer-Johansen, J., Myklebust, H., Sorebo, H., Syensson

L., Fellows, B. et al. (2005). Quality of cardiopulmonary resuscitationduring out-of-hospital cardiac arrest. JAMA. 293 (3):299-304.

176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London,England, and Akershus, Norway.Compression rate: 118-124/min28% (95% CI, 24%-32%) of the compressions had a depth of 38 mmto 51 mm (guidelines recommendation),

11 ventilations were given per minute.

61 patients (35%) had return of spontaneous circulation,5 (2%) patients discharged alive from the hospital had normal

neurological outcomes.


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Sudden Cardiac Arrest (SCA) HK data

Every year approx 10,000 people die of SCA!

HK Ambulance at scene within 12min, mostly too late for SCA!12 ,

HK Fire Service Ambulance attends to 300 SCA calls/month., 300 HK SCA-survival rates (outside hospital) = 1%!

1%! Time to defibrillation = the weakest link in the chain of survival

=

Calling 999 only = 1% chance of survival1%


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Use of ECG in Cardiac Arrest Patients

Not a must for Initial Diagnosis

Useful for : :diagnosis of underlying arrhythmiasmonitoring progress of CPR


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Non-traumatic Cardiac Arrest:Underlying

Cardiac Rhythms (1): (1)

Initial Rhythms for Arrest Outside Hospital :

:

Ventricular Fibrillation (VF) 60%Ventricular Tachycardia (VT) 10%

Pulseless Electrical Activity (PEA) 15%Asystole 15%


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Underlying Cardiac Rhythms:

Ventricular Tachycardia Ventricular Fibrillation


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Non-traumatic Cardiac Arrest:Underlying Arrthymias (2)

: (2)

In-hospital Cardiac Arrest ::

VT more common

Not yet deteriorated to VF due to shorter discovery time


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Principle of Treatment for CardiacArrest (1) (1)

(1) Basic Life Support (BLS)

Maintenance of airway, breathing & circulation without any ancillary

equipment,

A Airway B Breathing

C Circulation Aim: Produce an artificial cardiac output and maintain cerebral &

coronary oxygen supply while waiting for the definitive treatment

(ACLS) to start the heart again.:

( )


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Principle of Treatment for Cardiac Arrest (2)(2)

Advanced Cardiac Life Support (ACLS)

BLS with equipment + D Drugs

(advanced airways) E ECG evaluation

F Fibrillation Tx(Defibrillation)

BLS/ACLS distinction nowadays blurred

BLS providers do DF by automatic defibrillators

ACLS just the other end of resuscitation continuum


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Approach to ACLS

8 steps/blocks of problem assessment & management

Primary SurveyAirway (open )Breathing (Bag-valve-mask )C irculation (chest compression )Defibrillation (defibrillator/AED )

Secondary SurveyAirways (advanced airways )

Breathing ( placement & effectiveness confirmationC irculation (IV access & IV drugs )DDx (underlying problems )


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Principle of Treatment for Cardiac Arrest (3)

(3)The Brain:

CPR Initial Goal:* Restarting the heart

CPR Ultimate Goal:* Restoring neurological function

Therefore the term: Cardio-pulmonary-cerebral Resuscitation

The Patient & the Cause of Arrest:Must constantly returning to the overall view? Underlying causes forthe arrest


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Principle of Treatment for Cardiac Arrest (4)(4)

Time:Probability of survival & neurological recovery decline sharply withtimeProgressive death of brain cells starts 4 minutes after cardiac arrest

,

Post-resuscitation Care:

Patients condition may change rapidly, thus continuous assessment is a must.

,

Investigation : Arterial Blood Gases Assay, Serum Electrolytes & Cardiac Enzymes 12-Leads ECG Chest Radiograph Continuous BP, Pulse Oximeter Monitoring

Ryles Tube and Foley Catheter , End-Tidal CO 2 monitoring for patient transfer


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CHAIN OF SURVIVAL

HEALTHY CHOICES EARLY RECOGNITIONEARLY ACCESSEARLY CPREARLY DEFIBRILLATIONEARLY ADVANCED CARE ERALY

EARLY REHABILITATION


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HEALTHY CHOICESRISK FACTORS

- Cannot ControlAge

Gender

Family HistoryRace


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HEALTHY CHOICES (CONT)

( )Can Be Control

SmokingLack of ExerciseHigh Blood PressureHigh Blood CholesterolDiabetes

Drinking Too Much AlcoholStressBeing Overweight


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BE AWARE RISK FACTOR

Be Smoke-free

Be Physically Active

Control Blood Pressure

Eat Healthy

Maintain Healthy Body Weight


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BE AWARE RISK FACTORS (CONT)

( )Manage Diabetes

Limit Alcohol

Reduce Stress

Regularly Body Check-up

Post-menopause Female


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EARLY RECOGNITIONWarning Signs for Heart Disease & Stroke

Heart Disease PainShortness of Breath

NauseaSweating

Fear


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EARLY RECOGNITIONStroke

WeaknessTrouble Speaking

Vision Problems

HeadacheDizziness


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Early access

2min CPR (

2min CPR

,


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Early Access999 ( ) / 27353355 ( )

,

( )


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Early CPRCPR (Cardio- Pulmonary resuscitation)

Airway Clear Open

Maintain Breathing Look

Listen

Feel Circulation

Push hard and push fast


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AirwayClear

/

/ Magill forcep / (Suction)


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AirwayOpen

Head tilt chin lift

,Jaw Thrust

,


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AirwayMaintain

NPA ( Nasal Pharyngeal Airway ) OPA ( Oral Pharyngeal Airway )


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Breathing5-10 ( 10 )

: /

: ( Noisy Breathing )( ) :


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Breathing ,

(layman protocol )

1 ,500-600 (Tidal volume)

> > > > >


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Breathing

10-12 5-612-20 (3-5

12 :

1001 ( ), 1002 1003 1004 1005 ( )20 :1001 ( ), 1002 1003 ( )

EARLY CPR


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EARLY CPR

ResponsiveRestMedicationExperience Chest PainReassurance

UnresponsiveBegin CPR

Recovery PositionCPR


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( ), 30:2 CPR ( )

Push hard and push fast , 100

:

: 1 - 2,

2 ( 5 30:2)


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( ), 30:2 CPR ( ) 15:2 ( )

Push hard and push fast , 100

:: 1/3 1/2

,2 ( 5 30:2 / 8 15:2)


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( )

60 , , 30:2 CPR ( ) 15:2 ( )Push hard and push fast , 100

( ) ( ): ( ): 1/3 1/2

,2 ( 5 30:2 / 8 15:2)


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, ,


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D

R

A

B

2

2 C

, 0 -

12

2


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CPR,3- 4%

2- 3


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ACLSET Tube,

LMA, Combi tube CPR

8-101 ,

500-600 (Tidal volume)

Activate


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Activate 2min CPR 2min CPR

Airway Head tilt chin lift,

,

Breathing

10-12 5-6

12-20 (3-5

Circulation ( )

( )

1 to 2 1/3 1/2

10030:2 30:2 ( ) 15:2 ( )


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CPR AEDCPR


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CPR

( 75 )


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Timely access to AEDscan improve the chances of survival dramatically!, !

Pulseless VT


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- Pulseless VT

150

Pulseless Ventricular Tachycardiac

- VF


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VFVentricular Fibrillation


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VT

120

+-

Polymorphic VT >

>

Monomorphic VT

> Amiodarone


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Cardiac SciencePowerheart AED

G3

Laerdal FR2

Laerdal Heartstart 3000

Medtronic CR Plus


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DefibrillationMonophasic

360J


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DefibrillationBiphasic dose

150-200J for truncatedexponential waveform(BTE)

120J forrectilinear biphasicwaveform (RLB)If unknown , 200J forANY biphasic

Automatic External Defibrillation


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VF 5min,AED

VF 5min, CPR2min(CPR AED)

CPR, AED

Automatic External Defibrillation


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(8 25 )AED

(


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AED Mode of HeartStart XL


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D


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R

A

B

C

D


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2

1

2

2

(CPR 2

ABC)

2


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( CPR2

ABC)

( AED 2 ABC)

EARLY ADVANCED CARE


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V C C

Ventilation

Set Up IVDrugs Apply

Cardiac Monitoring

Defibrillation

After Care

EBM CPR i H K


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EBM - CPR in Hong KongLau CL , Lai JCH, Hung CY ,Kam CW (2005). Cardiac arrest

(OHCA) to a regional hospital in Hong Kong. Hong Kong j.emerg. med, 12, 224-227.

1st Jan 2001 31 st Dec 2003 (2 year)A total of 876 cardiac arrests @ TMHRhythm

Asystole (n=795)VF / pulseless VT (n=45)

Pulseless electrical activity (n=22)Unknown (n=14)111/876 ( 12.7%) survived to hospital admission.4/876 (0.5%) survived to hospital discharge and at one year afterdischarge.

EBM CPR i H K


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EBM - CPR in Hong KongAKC Wai , P Cameron, CK Cheung , P Mak , TH Rainer Out-of-hospital cardiac arrest in a teaching hospital in Hong Kong:descriptive study using the Utstein style

( Hong Kong J.emerg.med. 2005;12:148-155)1 July 2002 and 31 December 2002.A total of 124 patients @ PWH(mean age 71.9 years).

The majority of cardiac arrests occurred in patients' home.The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3%(19/124).The overall survival was 0.8% (1/124),

The median defibrillation time was 14 minutes.The median prehospital time interval from collapse/recognition to arrival athospital was 33 minutes.

EBM CPR i H g K g


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EBM - CPR in Hong Kong

Leung LP, Wong TW, Tong HK, Lo CB, Kan PG (2001). Out of-hospital cardiacarrest in Hong Kong. Prehosp Emerg Care, 5(3):308-11.

out-of-hospital cardiac arrest treated in the three A&E of Hong Kong Islandfrom March 15, 1999, to October 15, 1999.320 patient @ RH, QMH, PYNEHThe majority of cardiac arrests occurred at patients' homes.In 57.5% of cases the arrest was not witnessed.The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%.The most common electrocardiographic (ECG) rhythm at scene was asystole.Ventricular fibrillation or pulseless ventricular tachycardia constituted 14.1%.

The average call to dispatch interval was 1.04 minutes.The average call to CPR interval was 9.82 minutes .The average total prehospital interval was 27.55 minutes.The overall immediate survival rate was 14.1%the rate of survival to hospital discharge was 1.25%.

EARLY REHABILITATION


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Healthy Lifestyle Choices

Ready to Face Second Attack


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( , / ,

: Abdominal thrusts: 30:2 CPR

(x ), .


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( , / ,

:(x )

,

Defibrillation protocol


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Defibrillation protocol

Guildline 2005


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Guildline 2005http:// www.americanheart.org/ presenter.jhtml?identifier=3035517

http:// ww2.heartandstroke.ca /Page.asp?PageID=33&ArticleID=4466&Src=heart&From=SubCategory

http:// www.erc.edu /index.php/guidelines_download_2005/en/?


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QUESTIONS?

docs_training on basic life support for nurses_bcls presentation

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