BASIC LIFE SUPPORT 2013

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First Aid

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BASIC LIFE SUPPORT:

BASIC LIFE SUPPORT Cardiopulmonary Resuscitation

Basic Life Support:

Basic Life Support A set of emergency procedures involving the immediate recognition of signs of sudden cardiac arrest (SCA), heart attack, stroke, and foreign-body airway obstruction (FBAO); and the application of external chest compressions, rescue breathing, abdominal thrusts, as well as the defibrillation with the use of an AED to maintain life or until advanced life support is available.

Cardiopulmonary Resuscitation:

Cardiopulmonary Resuscitation Series of steps to help you save one’s life by manually providing blood flow to the heart, brain and lungs until further medical attention can be obtained Provided through quality chest compressions that is uninterrupted as possible and only for the shortest time needed NOTE: CPR itself does not completely save a life it does prolong it for a short period of time

CHAIN OF SURVIVAL :

CHAIN OF SURVIVAL A series of critical interventions which need to be performed on a patient for him or her to have a chance of surviving respiratory or cardiac arrest.

Chain of Survival :

Chain of Survival 2010 Guidelines Pediatric Chain of Survival

CPR Broken down:

CPR Broken down CARDIO = heart Muscle that contracts/expands more than 60-100 beats per minute Pumps oxygen-rich blood from the lungs out to the rest of the body

CPR Broken down:

CPR Broken down PULMONARY = lungs Breathe about 15-25 times per minute Brings oxygen into our lungs and gets rid of carbon dioxide Breathe in 21% oxygen and breathe out 16-18% oxygen

CPR Broken down:

CPR Broken down RESUSCITATE = Revive Mimics the function of the heart and lungs Prevents brain damage CPR slows down deterioration of patient’s chance of survival from 7-10% per minute to 3-4%

Immediate Recognition:

Immediate Recognition Unresponsiveness and absence of breathing or normal breathing should prompt the rescuer to call for emergency assistance Pulse checking is often unreliable even for trained healthcare professionals. Pulse checking should not take more than 10 seconds . When there are more than one rescuer, one should start CPR immediately while the other calls for help If alone one should call for help first before providing CPR except for infants and children

What is CPR?:

What is CPR? CARDIOPULMONARY RESUSCITATION = Reviving the heart and lungs Rescue breathing + chest compression Effective if commenced within 6 mins after the blood stops flowing When effective can provide only about 30% of the “normal” heart output

RESCUE BREATHING (RB):

RESCUE BREATHING (RB) Exhale air from your lungs into the victim’s mouth Breathe into a victim’s mouth and have their nose closed, and see the chest rise

CHEST COMPRESSION:

CHEST COMPRESSION Manually compress the heart by pressing the chest By compressing and allowing the heart to expand, the blood flows through it

WHEN TO START CPR:

WHEN TO START CPR All victims of cardiac arrest should receive CPR unless: Patient has a valid DNAR (Do Not Attempt Resuscitation) Patient has signs of irreversible death (Rigor Mortis, Decapitation, Dependent Lividity ) No physiological benefit can be expected because functions have deteriorated (terminally ill) Gestation of < 23 weeks or birth weight of <400g, anencephaly Attempts to perform CPR would place the rescuer at risk of physical injury

RULES IN GIVING EMERGENCY CARE:

RULES IN GIVING EMERGENCY CARE WHAT TO DO: Do obtain consent when possible Do remember to identify yourself to the victim Do provide comfort and emotional support Be calm and direct as possible Keep onlookers away from the injured person Do loosen tight clothing

1- SCENE SURVEY:

1- SCENE SURVEY OBTAIN AS MUCH INFORMATION AS POSSIBLE: Is the scene safe? What happened? How many people are injured? Are there any bystanders who can help? Identify yourself as a trained CPR provider Get consent to give care

2 – CHECK LEVEL OF RESPONSIVENESS:

2 – CHECK LEVEL OF RESPONSIVENESS Tap shoulders and shout “ are you ok?” to get a response. Someone who does not respond and lack normal breathing can be assumed unresponsive.

3 – CALL FOR HELP:

3 – CALL FOR HELP What happened? Exact location? Number of persons injured? Extent of injury/illness and first aid given? Person who activated medical assistance must identify him/herself and drop the phone last .

C - CIRCULATION:

C - CIRCULATION Check for carotid pulse for not more than 10 secs. Negative pulse = start compression Perform 30 compressions

C – CHEST COMPRESSION:

C – CHEST COMPRESSION Loosen tight clothing Place palm of one hand between the nipple line and over the breast bone (sternum), 2 fingers above the xyphoid process Place the other hand over the first and interlock fingers Your should be on your knees squarely at the patient’s side Lean slightly over the patient keeping your elbows locked and back straight.

Slide20:

Compress at the depth of at least 2 inches and release pressure allowing the chest to recoil PUSH HARD, PUSH FAST at the rate of 100 compressions/minute RATIO: 30 compressions : 2 rescue breaths

A - AIRWAY:

A - AIRWAY Ensure open airway by performing the HEAD TILT, CHIN-LIFT Hyperextend the neck to ensure adequate passage of air\ Check and look for any obstructions. If you can’t see it, do not attempt to remove it

WHAT NOW?:

WHAT NOW? REPEAT STEPS C, A, B. Reassess the patient every 5 cycles

WHEN TO STOP CPR:

WHEN TO STOP CPR S pontaneous signs of life are restored (effective or normal breathing and circulation) T urnover to medical services or properly trained personnel (such as EMTs, physicians) O perator is exhausted P hysicians assumes responsibility S cene becomes unsafe

WHEN SIGNS OF LIFE APPEAR:

WHEN SIGNS OF LIFE APPEAR A patient who has circulation but does not breath adequately should be given RESCUE BREATHING 1 breath every 5 seconds 24 times (cycles) Reassess pulse after 24 cycles. A patient who has circulation and is adequately breather should be positioned to the RECOVERY POSITION

WHEN SIGNS OF LIFE APPEAR:

WHEN SIGNS OF LIFE APPEAR RECOVERY POSITION: * Lift left arm next to head, bend right leg up and pull them towards you. * this positions guards the patient from vomit and secretions

AUTOMATED EXTERNAL DEFIBRILLATOR:

AUTOMATED EXTERNAL DEFIBRILLATOR A device that provides electrical shocks to the body to restart the heart. This provides the rescue the advantage to provide more advanced care therefore increasing the patient’s chance of survival The Universal AED STEP 1: POWER ON the AED. STEP 2: Attach electrode pads. STEP 3: Analyze the rhythm. STEP 4: Clear the victim and press the SHOCK button .

Slide27:

Component Adults Children Infants Recognition Unresponsive (for all ages) No breathing, not breathing normally (e.g., only gasping) No breathing or only gasping No pulse palpated within 10 seconds (HCP Only) CPR Sequence CAB CAB CAB Compression Rate At least 100/min Compression Depth At least 2’ (5 cm) At least 1/3 AP depth, about 2’ (5 cm) At least 1/3 AP depth, about 1½’ (4 cm) Chest Wall Recoil Allow complete recoil between compressions. HCPs rotate compressors every 2 minutes. Compression Interruptions Minimize interruptions in chest compressions. Attempt to limit interruptions to less than 10 seconds. Airway Head tilt-chin lift (HCP suspected trauma: jaw thrust) Compression to ventilation ratio (until advanced airway placed) 30:2 (1 or 2 rescuers) 30:2 for single rescuer 15:2 for 2 HCP rescuers Ventilations: When rescuer untrained or not proficient Compressions only Ventilations with advanced airway (HCP) 1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Defibrillation Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume CPR beginning with compressions immediately after each shock.

BASIC LIFE SUPPORT:

BASIC LIFE SUPPORT FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

OBSTRUCTED AIRWAY:

OBSTRUCTED AIRWAY An event most likely witnessed Universal Choking Sign: hands around the neck SIGNS OF COMPLETELY OBSTRUCTED AIRWAY: Making high pitched wheezing noises Inability to speak or move any air

HEIMLICH MANUEVER:

HEIMLICH MANUEVER Discovered by Dr. Henry Heimlich Also known as the abdominal thrust Not for infants < 1 y.o.

HEIMLICH MANUEVER:

HEIMLICH MANUEVER Procedure: Ask the patient “Are you choking?” If they are unable to speak, stand behind them, place a closed fist (thumb first) above the belly button and place the other hand over the fist Deliver thrusts inward and then upward Do this until object is expelled or patient starts to become unresponsive If they lose consciousness, assist them gently to the floor and protect their head.

HEIMLICH MANUEVER:

HEIMLICH MANUEVER

Obstructed Airway: Unresponsive Patient:

Obstructed Airway: Unresponsive Patient Place patient on their back STEP 1: Start CPR with 30 chest compressions. STEP 2: Open mouth and inspect for obstruction. If the object is visible, remove it with your finger. Do not attempt to remove the obstruction if you can’t see it!

Obstructed Airway: Unresponsive Patient:

Obstructed Airway: Unresponsive Patient STEP 3: Attempt first ventilation. If chest doesn’t rise, reposition and give second ventilation. Repeat the Steps 1-3 in an attempt to relieve obstruction. If the obstruction persists, continue this modified CPR sequence until help arrives.

Pediatric FBAO:

Pediatric FBAO Child FBAO Kneel to be level with the child’s height. Just as in Adult FBAO Infant FBAO Five chest thrusts, as in CPR Five back slaps between the shoulder blades

Slide36:

1 - Scene Survey Scene Safety Identify and Consent 2 - Check Level Of Consciousness Tap Shout and Chest Rub 3 - Call for help (AED if available) C - Circulation Pulse check (not more than 10 secs ) – negative=compression A - Airway Head-tilt, chin-lift, Check for obstruction B - Breathing adult = 2 blows: 5secs: 24 cycles Infant = 2 blows: 3 secs : 40 cycles RESCUE BREATHING ADULT Blow, 1,1002,1003, 1001 ….. 24 INFANT Blow, 1,1001… 40

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