Basic Life Support_part-2

7/27/2019 Basic Life Support_part-2

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WELCOME


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PresentedBy

Basil


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INTRODUCTION

Fundamental aspects of Basic Life Support(BLS) include immediate recognition ofsudden cardiac arrest (SCA) and activation ofthe emergency response system (EMS),early cardiopulmonary resuscitation ( CPR ),and rapid defibrillation with an automated

external defibrillator ( AED) . Dr. Peter Safar is considered as the father of

modern day CPR


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DEFINITION Basic life support is an emergency

procedure that consists of recognising anarrest and initiating propercardiopulmonary resuscitation techniques

to maintain life without the use of drugsor specialist equipment until the victimeither recovers or is transported to a

medical facility where advance lifesupport measures are available.


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EMERGENCY ACTION

PRINCIPLE In each emergency, we need to follow the

emergency action principle so that we donot forget anything that might affectpersonal safety (yours and the victims) andthe victims survival.


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Always follow the steps in order given

below.

1-survey the scene (to confirm the area is

safe for you as well as the victim), 2-do a primary survey of the victim,

3-activates the Emergency Medical Service(EMS) system for help,

4-do a secondary survey of the victim.


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ADULT BLS SEQUENCE A.H.A. ADULT CHAIN OF SURVIVAL

1. Immediate recognition of cardiac arrest andactivation of the emergency response system

2. Early CPR with an emphasis on chest

compressions

3. Rapid defibrillation

4. Effective advanced life support

5. Integrated post cardiac arrest care


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ENSURE SAFETY

Survey the scene and make sure thatthe area is safe for the victim as well asto the rescuer.


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If a lone rescuer finds an unresponsive adult

(i.e., no movement or response to

stimulation) or witnesses an adult

who collapses,

after ensuring that the scene is safe and

positioning the victim in supine on a firm

surface,


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Immediate Recognition and Activation of

the Emergency Response System The rescuer should check for a response

by tapping the victim on the shoulder and

shouting at the victim, Are you all right? If

the victim is responsive, he or she will

answer, move, or moan.


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The rescuer should also check for no breathingor no normal breathing (i.e., only gasping )

while checking for responsiveness. if the healthcare provider finds the victim isunresponsive with no breathing or no normalbreathing (i.e., only gasping), the rescuer should

assume the victim is in cardiac arrest. And then, the rescuer should shout for help to

activate the Emergency Response System(EMS) and to get an AED if available.


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The victim has occasional gasps, which canoccur in the first minutes after SuddenCardiac Arrest (SCA) and may beconfused with adequate breathing.

Occasional gasps do not necessarily resultin adequate ventilation.

The rescuer should treat the victim who has

occasional gasps as if he or she is notbreathing.


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PULSE CHECK

The healthcare provider should take not morethan 10 seconds to check for a pulse; and if therescuer does not definitely feel a pulse withinthat time, the rescuer should start chestcompressions.The carotid pulse can check while keeping thevictims head tilted back with one hand on the

forehead, use the other hand to find the pulse. First, place your index or middle finger on the

Adams apple.


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Then slide your finger toward in to the

groove between the windpipe and the

muscles at the side of the neck. This is

where the carotid pulse is located.


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EARLY CPR

Sequence of cardiopulmonaryresuscitation (CPR)

Compression Airway- Breathing-DefibrillationC-A-B-D


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CHEST COMPRESSIONS

Chest compressions consist of forceful

rhythmic applications of pressure over the

lower half of the sternum.

These compressions create blood flow by

increasing intrathoracic pressure anddirectly compressing the heart.


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This generates blood flow andoxygen delivery to the vital organs


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The rescuer should place the heel of thedominant hand on the centre (middle) of thevictim's chest (which is the lower half ofthe sternum ) and the heel of the other hand ontop of the first so that the hands are overlappedand parallel

Position yourself vertically above the victim'schest and, with your arms straight, the adultsternum should be depressed at least 2 inches (5cm) with chest compression and chest

recoil/relaxation times approximately equal. Allow the chest to completely recoil after each

compression.


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To provide effective chest compressions,

push hard and push fast. healthcare providers should compress the

adult chest at a rate of at least 100

compressions per minute with a compression

depth of at least 2 inches/5 cm.


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Rescuers should allow complete recoil ofthe chest after each compression, toallow the heart to fill completely before thenext compression.


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A compression-ventilation ratio of 30:2 isrecommended.To maximize the effectiveness of chestcompressions, place the victim on a firmsurface when possible, in a supineposition with the rescuer kneeling besidethe victim's chest.Rescuers should attempt to minimize the

frequency and duration of interruptions incompressions to maximize the number ofcompressions delivered per minute.


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Incomplete recoil during BLS, CPR is

associated with higher intrathoracic

pressures and significantly decreased

hemodynamics, including decreased

coronary perfusion, cardiac index,

myocardial blood flow, and cerebral

perfusion.


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AIR WAY


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OPEN THE AIRWAY:

The common cause of airway obstructionis back of the tongue blocking the air way.

A healthcare provider should use the headtilt chin lift maneuver to open the airway ofa victim with no evidence of head or necktrauma.

If healthcare providers suspect a cervicalspine injury, they should open the airwayusing a jaw thrust without head extension.


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Because maintaining a patent airwayand providing adequate ventilation arepriorities in CPR, use the head tilt chin liftmaneuver if the jaw thrust does notadequately open the airway.


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Jaw thrust

The practitioner uses their thumbs tophysically push the posterior (back)

aspects of the mandible upwards Whenthe mandible is displaced forward, itpulls the tongue forward and prevents it

from occluding (blocking) the entranceto the trachea, helping to ensure apatent (secure) airway.


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RESCUE BREATHING

During CPR, the primary purpose ofassisted ventilation is to maintain

adequate oxygenation; the secondary purpose is to

eliminate CO2.


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1) MOUTH-TO-MOUTHRESCUE BREATHING

Mouth-to-mouth rescue breathing providesoxygen and ventilation to the victim.To provide mouth-to-mouth rescuebreaths, open the victim's airway, pinch thevictim's nose, and create an airtight mouth-to-mouth seal.Give 1 breath over 1 second. take a "regular" (not a deep) breathe , andgive rescue breath over 1 second.


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Taking a regular rather than a deepbreath prevents the rescuer from gettingdizzy or lightheaded and prevents overinflation of the victim's lungs.

The most common cause of ventilationdifficulty is an improperly openedairway, so if the victim's chest does notrise with the first rescue breath.

Reposition the head by performingthe head tilt chin lift again and then givethe second rescue breath.


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If an adult victim with spontaneouscirculation (ie, strong and easily

palpable pulses) requires support ofventilation, the healthcare providershould give rescue breaths at a rate ofabout 1 breath every 5 to 6 seconds, orabout 10 to 12 breaths per minute.

Each breath should be given over 1second regardless of whether anadvanced airway is in place.

Each breath should cause visible chestrise.


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Use a compression to ventilation ratio of30 chest compressions to 2 ventilations


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More important, excessive ventilation canbe harmful because it increasesintrathoracic pressure, decreases venousreturn to the heart, and diminishescardiac output and survival.

2) MOUTH TO BARRIER


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2) MOUTH-TO BARRIERDEVICE BREATHING.

Some healthcare providers mayhesitate to give mouth-to-mouth rescuebreathing and prefer to use a barrier

device. The risk of disease

transmission through mouth-to-barrier

ventilation is very low. When using a barrier device the rescuer

should not delay chest compressions

while setting up the device.


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- -


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MOUTH-TO-STOMA

VENTILATION Mouth-to-nose ventilation is recommendedif ventilation through the victim's mouth isimpossible (eg, the mouth isseriously injured), the mouth cannot beopened, the victim is in water, or a mouth-to-mouth seal is difficult to achieve.

A case series suggests that mouth-to-noseventilation in adults is feasible, safe, andeffective


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AED, DEFIBRILLATION

An Automated External Defibrillator (AED)is used when the heart stops beatingnormally and needs to be reset by anelectric shock.

AEDs are designed for adults but most canbe adapted for children with paediatricpads down to 1 year of age.

Provide 5 cycles of CPR, 30 compressionsto 2 breaths, for 2 minutes before using an

AED on a child from 1 year to puberty


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SEQUENCE OF ACTIONS WHENUSING AN AUTOMATED EXTERNAL

DEFIBRILLATOR The following sequence applies to the

use of both semi-automatic andautomatic AEDs in a victim who is foundto be unconscious and not breathingnormally.

1. Follow the adult BLS sequence asdescribed. Do not delay starting CPRunless the AED is available

Immediately.


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2. AS SOON AS THE AED

ARRIVES: If more than one rescuer is present, continueCPR while the AED is switched on.

If you are alone, stop CPR and switch on the

AED. Follow the voice / visual prompts. Attach the

electrode pads to the patients bare chest.

Ensure that nobody touches the victim while the AED is analysing the rhythm.


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Placement of AED pads Place one AED pad to the right of thesternum, below the clavicle. Place theother pad in the left mid-axillary line,approximately over the position of theV6 ECG electrode. It is important thatthis pad is placed sufficiently laterallyand that it is clear of any breast tissue.


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3A. If a shock is indicated:

Ensure that nobody touches the victim. Push the shock button as directed (fully

automatic AEDs will deliver the shock

automatically). Continue as directed by the voice / visual

prompts.

Minimise, as far as possible interruptionsin chest compression.


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3B If no shock is indicated:


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3B. If no shock is indicated:

Resume CPR immediately using a ratio of30 compressions to 2 rescue breaths.Continue as directed by the voice / visualprompts


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FOREIGN BODY AIRWAY


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OBSTRUCTION (FBAO)

(CHOKING) The rescuer should intervene if thechoking victim shows signs of severeairway obstruction.

These include signs of poor air exchangeand increased breathing difficulty, such asa silent cough, cyanosis, or inability to

speak or breathe. The victim may clutch the neck,

demonstrating the universal choking sign.


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Quickly ask, "Are you choking?" If the

victim indicates "yes" by nodding his head

without speaking, this will verify that the

victim has severe airway obstruction.

RELIEF OF FOREIGN BODY


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RELIEF OF FOREIGN-BODY

AIRWAY OBSTRUCTION If mild obstruction is present and the victimis coughing forcefully, do not interfere withthe patient's spontaneous coughing andbreathing efforts .

Attempt to relieve the obstruction, only ifsigns of severe obstruction develop: thecough becomes silent, respiratory difficultyincreases and is accompanied by stridor,or the victim becomes unresponsive.


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Activate the EMS system quickly if thepatient is having difficulty breathing.

ABDOMINAL THRUSTS


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ABDOMINAL THRUSTS(HEIMLICH MANEUVER)

Stand behind the victim.

The victim may be either standing or

sitting.

Wrap your arms around his or her waist.

Make a fist with one hand.


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Place the thumb side of your fist againstthe middle of the victims abdomen, justabove the naval and well below the lower

tip of sternum.

G fi i h h h d


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Grasp your fist with your other hand.

Keeping your elbows out from the victim,press your fist in to the persons abdomen

with a quick upward thrust.

Think of each thrust as a separate and

distinct attempt to dislodge the object.

Repeat the thrusts until the obstruction is

cleared.


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CHEST THRUSTS


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CHEST THRUSTS

Chest thrusts should be used for obese

patients if the rescuer is unable to encircle

the victim's abdomen.

If the choking victim is in the late stages of

pregnancy, the rescuer should usechest thrusts instead of abdominal thrusts.


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To do chest thrusts with the person either

standing or sitting, stand behind the

person and place your arms under the

persons armpit and around the chest.

Place the thumb side of your fist on the

middle of the sternum.


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Grasp your fist with your other hand and

give backward thrusts.

Give thrust until obstruction is cleared.

Each thrust should be a separate and

distinct attempt to dislodge the object


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ABDOMINAL THRUSTS FOR


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ABDOMINAL THRUSTS FOR

AN UNCONSCIOUS VICTIM If the adult victim with Foreign-Body AirwayObstruction becomes unresponsive, therescuer should carefully support the patient to

the ground. Immediately activate (or send someone to

activate) EMS, and then begin CPR. The healthcare provider should carefully lower

the victim to the ground, send someone toactivate the emergency response system andbegin CPR (without a pulse check).

After 2 minutes, if someone has not


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already done so, the healthcareprovider should activate the emergencyresponse system.

Each time the airway is opened duringCPR, the rescuer should look for anobject in the victim's mouth and if found,remove it.

Straddle the victims thighs. Place theheel of one hand against the middle ofthe victims abdomen, just above theumbilicus and well below the lower tip of

the sternum


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Place your other hand directly on the top of

the first hand with your fingers pointedtowards the victims head

Press into abdomen with a quick upward

thrust. Give 6-10 thrusts. Be sure that your

hands are directly on the middle of the

abdomen when you press. After 6-10, thrusts

do a finger sweep.


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FOREIGN-BODY AIRWAY


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FOREIGN-BODY AIRWAY

OBSTRUCTION IN INFANT Give 5 back blows as follows Hold the infants jaw between thumb and

fingers. Slide your other hand behind the

infants shoulder blade closest to you so

that your finger supports the back of theinfants head and neck. Turn the infant over so that he is face

down on your forearm


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Support infants head and neck with your

hand by firmly holding the jaw between your

thumb and fingers.

Lower your arm on to your thigh. The infants

head should be lower than his chest.

Give 5 back blows forcefully between theinfants shoulder blades with the heel of your

hand


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GIVE 5 CHEST THRUSTS AS


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GIVE 5 CHEST THRUSTS AS

FOLLOWS Place your free hand and forearm alonginfants head and back so that the infant issandwiched between your tow hand and

forearms. Support the back of the infants head and

neck with your fingers.

Support the infants neck, jaw, and chestfrom the front with one hand while yousupport the infants back with your other

hand and forearm


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Turn the infant in to his back.


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Lower your arm that is supporting the

infants back onto your thigh. The infants head should be lower than his

chest.

Use your other hand that is on the infantschest to locate the correct place to givechest thrusts.

Imagine a line running across the infantschest between the nipples. Place the pad of your ring finger on

sternum just under the imaginary line

Then place the pads of two finger next tothe ring finger just under nipple line


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the ring finger just under nipple line. Rise the ring finger if you feel the notch

at the end of the infants sternum, moveyour finger up a little bit.

The pads of your finger should lie in thesame direction as the infants sternum.

Use the pads of two fingers to compressthe sternum.

Compress the sternum 1 inch and thenthe sternum return to its normal position.


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Keep your fingers in contact with thesternum.

Compress 5 times.

Keep giving back blows and chestcompression until the object is coughedup.


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INFANT AND CHILD BASIC


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INFANT AND CHILD BASICLIFE SUPPORT

If the victim is unresponsive and notbreathing (or only gasping), begin CPR.

Sometimes victims who require CPR willgasp, which may be misinterpreted asbreathing.

Treat the victim with gasps as thoughthere is no breathing and begin CPR.


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For an unresponsive child who is notbreathing or not breathing normally, beginCPR with 30 compressions followed by

opening the airway and giving 2 rescuebreaths. Repeat cycles of 30:2 (CAB method).

For an infant, lone rescuers (whether lay


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rescuers or healthcare providers) should

compress the sternum with 2 finger placed

just below the intermammary line.

Do not compress over the xiphoid or ribs.

Rescuers should compress at least one-

third the depth of the chest, or about 4 cm

(1.5 inches).

Do not press on the xiphoid or the ribs.


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p p

There are no data to determine if the 1- or

2-hand method produces better

compressions and better outcome.

For a child, lay rescuers and healthcare


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providers should compress the lower half

of the sternum at least one third of the AP

dimension of the chest or approximately 5

cm (2 inches) with the heel of 1 or 2 hands.


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Push fast; push at a rate of at least 100


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compressions per minute.

Chest compressions of appropriate rate and

depth.

Push fast: push at a rate of at least 100

compressions per minute.

Push hard: push with sufficient force to


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Push hard : push with sufficient force to

depress at least one third the

anterior posterior (AP) diameter of the

chest or approximately 1 inches (4 cm)

in infants and 2 inches (5 cm) in children


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OPEN THE AIRWAY AND GIVEVENTILATIONS For the lone rescuer a compression-to-


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ventilation ratio of 30:2 is recommended.

After the initial set of 30 compressions, open

the airway and give 2 breaths.

In an unresponsive infant or child, the tongue

may obstruct the airway and interfere with

ventilations.

O th i i h d tilt hi lift


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Open the airway using a head tilt chin lift

maneuver for both injured and non-injured

victims.

To give breaths to an infant, use a mouth-

to-mouth-and-nose technique; to give

breaths to a child, use a mouth-to-mouthtechnique.

Make sure the breaths are effective (ie,

the chest rises)


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the chest rises).

Each breath should take about 1 second.

If the chest does not rise, reposition the

head, make a better seal, and try again.

It may be necessary to move the child's

head through a range of positions toprovide optimal airway patency and

effective rescue breathing


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In an infant, if you have difficulty making


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an effective seal over the mouth and nose,

try either mouth-to-mouth or mouth-to-

nose ventilation.

If you use the mouth-to-mouth technique,

pinch the nose closed.

If you use the mouth-to-nose technique,

close the mouth.


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In either case make sure the chest rises


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when you give a breath.

If you are the only rescuer, provide 2

effective ventilations using as short a

pause in chest compressions as possible

after each set of 30 compressions.


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DEFIBRILLATION


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Ventricular fibrillation (VF) can be thecause of sudden collapse or maydevelop during resuscitation attempts.

Children with sudden witnessedcollapse (eg, a child collapsing duringan athletic event) are likely to have VF

or pulseless ventricular tachycardia (VT)and need immediate CPR and rapiddefibrillation.

VF and pulseless VT are referred to as"shockable rhythms" because they


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y yrespond to electric shocks (defibrillation).

Many AEDs have high specificity inrecognizing paediatric shockable rhythms,and some are equipped to decrease (orattenuate) the delivered energy to makethem suitable for infants and children


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defibrillation is 2 J/kg. If a second dose is

required, it should be doubled to 4 J/kg.

If a manual defibrillator is not available, an

AED equipped with a paediatric attenuator

is preferred for infants.

An AED with a paediatric attenuator is also

preferred for children


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dose attenuator may be used.

AEDs that deliver relatively high-energy

doses have been successfully used in

infants with minimal myocardial damage

and good neurological outcomes.


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Neonatal CPR


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Neonatal CPR

Rubbing the back or flicking the sole ofthe feet to stimulate the baby

Compression to ventilation ratio is 3:1 Compression with 2 thumbs, with

fingers encircling the chest andsupporting the back

40- 60 breaths/ minute is advisable

ANY QUESTIONS??????


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ANY QUESTIONS??????


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`THANK YOU

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