1
Basic Life Support ( BLS )
Automated External Defibrillation
(AED )
2
Farhad HeydariEmergency Medicine Deprtment
Isfahan University Of Medical Sciences
3
At the end of this courseparticipants should be able to demonstrate:
How to assess the collapsed victim.
How to perform chest compression and rescue breathing.
How to place an unconscious breathing victim in the recovery position.
4
OBJECTIVES
Despite important advances in prevention, cardiac arrest
remains a substantial public health problem and a leading
cause of death in many parts of the world.
Cardiac arrest occurs both in and out of the hospital.
approximately 350 000 people/year (approximately half of them in-hospital) suffer a cardiac arrest and receive attempted resuscitation. 5
BACKGROUND
Survival to hospital discharge presently approximately 5-10%
Early resuscitation & prompt defibrillation
(within 1-2 minutes) can result in >60% survival
6
GUIDELINE 2010
CHAIN OF SURVIVAL
Immediate recognition and activation
Early CPR
Defibrillation,
Advanced life support
Integrated post-cardiac arrest care.
10
BLS 2005
ارزیابی سطح
هوشیاری
ارزیابی وضعیت تنفس
11
BLS 2005
ارزیابی سطح
هوشیاری
ارزیابی وضعیت تنفس
LOOK , LISTEN ,FEEL
12
13BLS 2010
همزمان ارزیابیتنفس و هوشیاری سطح
Start CPR When …… :
Unresponsiveness
AbnormalBreathing
Start CPR
ABC ???
A B C
SINCE 1960
C A B GIUDELINE 2010
16
Arterial Blood O2 Content(ABC)
Arrest
Resuscitation
RescueBreathes
ChestCompression
O2 Content
Time
Arterial Blood O2 Content(CAB)O2 Content
Time
Arrest
Resuscitation
ChestCompression
CAB vs ABCO2 Content
Time
CAB
ABC
* Approach safely
Check response Check breathing
Shout for help & Call 115
30 chest compressions
2 rescue breaths
21
BASIC LIFE SUPPORT
22
APPROACH SAFELY!Scene
Rescuer
Victim
Bystanders
Approach safely Check response Check breathing
Shout for help & Call 115
30 chest compressions
2 rescue breaths
23
CHECK RESPONSE - CHECK BREATHING
Approach safely
Check responseCheck breathing
Shout for help & Call 115 30 chest compressions
2 rescue breaths
24
CHECK RESPONSEShake shoulders gently
Ask “Are you all right?”
If he responds• Leave as you find
him.• Find out what is
wrong.• Reassess regularly.
Occurs shortly after the heart stops in up to 40% of cardiac arrests
Described as barely, heavy, noisy or gasping breathing
Recognise as a sign of cardiac arrest
25
AGONAL BREATHING & GASPING
26
SHOUT FOR HELPApproach safely
Check responseCheck breathing
Shout for help & Call 115
30 chest
compressions2 rescue breaths
27
Call 115Approach safelyCheck responseCheck breathingShout for help &
Call 115 30 chest
compressions2 rescue breaths
Call 115
How?
How many?
When?
Where?28
Once a cardiac arrest is identified, dispatchers can then give CPR instructions to a bystander over the phone until further help arrives.
Telephone instructions have been shown to increase the rates of bystander CPR and enhance outcomes.
Studies have also shown that the time to initiation of chest compressions is more rapid if the caller is given hands-only instructions (ie, no rescue breaths) rather than standard CPR instructions. (2012)
29
Feel within 1. definite pulse give 1 breath / q 5-6 s
2. recheck pulse q 2 min.
3. no pulse or suspicious pulse next step
30
10 sec
Check pulseOnly for healthcare provider
Chest compressions are the foundation of
CPR
All rescuers, regardless of training, should
provide chest compressions to all cardiac arrest victims.
Number of Compressions Delivered
The total number of compressions delivered during resuscitation
is an important determinant of survival from cardiac arrest.
rate and the compression fraction. (the portion of total CPR time during which compressions are
performed).32
Minimal Interruptions During Chest CompressionCardiac Output
Time2 min
Minimal Interruptions During Chest CompressionCardiac Output
Time2 min
Cardiac Output
Time2 min
With Interruptions
Without Interruptions
36
CHEST COMPRESSIONS
Approach safelyCheck responseCheck breathingShout for help &
Call 115 30 chest
compressions2 rescue breaths
Proper positioning of the patient and rescuer is fundamental to proper compression delivery.
The recommended position in out-of-hospital scenarios is to kneel perpendicular beside the patient’s torso.
For in-hospital cardiac arrest response, the rescuer
should stand beside the bed at the level of the patient’s torso. (2012)
CHEST COMPRESSIONS
37
38
CHEST COMPRESSIONS
• supine victim on a hard
surface
• Place the heel of one hand
in the centre of the chest
( lower half )
• Place other hand on top
• Interlock fingers
39
CONTINUE CPR
30 2
40
CHEST COMPRESSIONS
• Push hard and fast the chest:– Rate at least 100 /min– Depth 5 cm– Equal compression / relaxation– Minimize interruptions in chest
compressions.
• When possible change CPR operator every 2 min
Providers delivering chest compressions should rotate every 2 minutes to minimize the effects of rescuer fatigue, and the switch should take less than 5 seconds.
One technique to minimize the interruption is to position a rescuer on either side of the patient for more seamless transitions. (2012)
41
Interposed abdominal compression (IAC) is another strategy that has been proposed to increase cardio cerebral perfusion.
The first provider performs conventional chest compressions, while the second compresses the
abdomen with similar hand position and depth midway between the xiphoid process and umbilicus during chest wall recoil. The third provider delivers intermittent ventilation, typically via an advanced airway management device. (2012)
This technique could be considered for victims of in-hospital cardiac arrest if a sufficient number
of trained providers are present. (2012) 42
43
RESCUE BREATHSApproach safelyCheck response
Check breathing
Shout for help & Call 115 30 chest
compressions2 rescue
breaths
44
OPEN AIRWAY (head tilt , chin lift - jaw
thrust )
Approach safely
Check responseCheck breathing
Shout for help & Call 115
30 chest
compressions2 rescue breaths
● Deliver each breath over 1 second
• Give a sufficient tidal volume produce visible chest rise .
● Avoid rapid or forceful breaths.45
Give 2 BREATH
46
2 RESCUE BREATHSPinch the nose
Take a normal breathPlace lips over mouthBlow until the chest
risesTake about 1 secondAllow chest to fallRepeat
However, an advanced airway device should be inserted and used to provide ventilations only after the patient has received 2 to 3 minutes of chest compressions
and attempted defibrillation, if appropriate. (2012)
47
Approach safelyCheck responseCheck breathingShout for help &
Call 115 30 chest
compressions2 rescue breaths
49
BASIC LIFE SUPPORT
50
CCR aims to improve outcomes through refocusing certain interventions in CPR to maximize myocardial and cerebral perfusion.
In CCR, chest compressions are started immediately and continued for 200 continuous compressions. During
this time, oxygen is given via a noninvasive airway (ie, no endotracheal intubation), and defibrillator pads are placed on the patient. The rhythm is analyzed, and, when appropriate, a shock is given followed immediately by another interval of 200 compressions without pulse check. (2012)
cardiocerebral resuscitation(CCR)
51
Epinephrine is given early, and endotracheal intubation is delayed until after 3 rounds of chest compressions are completed.
the first 3 years of this data was presented in percentages, CCR showed a survival to hospital discharge increase of 5.4% versus 1.8% . (2012)
52
53
54
AUTOMATED EXTERNAL DEFIBRILLATOR
In settings with 1-lay rescuer AED programs (AED on-site and available) 2-in-hospital environments
3-EMS rescuer witnesses the collapse,
The rescuer should use the defibrillator as soon as( within first 3-5 min) it is available for children and adults.
56
cardiac arrest not witnessed by EMS personnel
EMS may initiate CPR while
checking the rhythm with the AED or on the electrocardiogram
(ECG) and preparing for defibrillation.
In such instances, 1½ to 3 minutes of CPR may be considered
before attempted defibrillation.
CPR Before Defibrillation The rate of survival-to-hospital discharge is higher among patients who experienced an unwitnessed SCA and received 1.5 to 3 minutes of CPR followed by defibrillation.
In witnessed SCA, early defibrillation is imperative; CPR should be performed while the defibrillator is being prepared. (2012)
57
58
AED Use in Children Now Includes Infants2010 (New)
For infants (<1 year of age),
defibrillator is preferred. If a manual defibrillator is not available,
an AED with pediatric dose attenuation is desirable. If neither is
available, an AED without a dose attenuator may be used.
59
The precordial thump 2010 (New)
should not be used for unwitnessed out-of-hospital cardiac arrest.
1-for patients with witnessed monitored,
2-unstable VT (including pulse less VT)
3-if a defibrillator is not immediately ready for use,
but it should not delay CPR and shock delivery.
Percussion pacing, an extension of the precordial thump, is essentially rhythmic percussion of the chest wall with a fist to pace the myocardium.
Several case reports and small case series have documented successful resuscitation with this technique, but there is insufficient evidence to support its routine use. (2012)
The precordial thump
60
*Approach safelyCheck responseCheck breathing
Shout for help and call 115, get AEDAttach AED
Follow voice prompts
61
62
63
SWITCH ON AED
Some AEDs will automatically switch them-selves on when the lid is opened
64
ATTACH PADS TO CASUALTY’S BARE CHEST
65
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
66
SHOCK INDICATED
Stand clearDeliver shock
67
NO SHOCK ADVISED
resume CPR immediately for 5
cycles
30 2
studies have affirmed that it is extremely safe to continue compressions during defibrillation when a biphasic defibrillator is used with self-adhesive electrodes and the rescuer wears standard examination gloves.
The simulated rescuers in these studies perceived no electrical charge, despite voltage delivery during the compressions.
Therefore, uninterrupted manual chest compressions are feasible during shock delivery, without risk of harm to the rescuer.
The AHA did not adopt this practice until now (2012) 68
69
Approach safely
Check responseCheck breathing
Shout for help & Call 115 30 chest
compressions2 rescue
breaths
Approach safely
Check responseCheck breathing
Shout for help and call 115,
get AEDAttach AEDFollow voice
prompts
70
If victim starts to breathe normally place in recovery
position
Recovery position
1 2
34
72
شما توجه ازسپاسگزارم