Slide 1: 20/07/2008 drdgm 1 Basic life support (BLS) for healthcare providers
Winter 2005-2006/7 issue of Currents in Emergency Cardiac Care
(vol16, no 4)
2005 American Heart Association Guidelines
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Circulation. 2005;112: IV-1–IV-211) Cardiac Arrest ? : 20/07/2008 drdgm 2 Cardiac Arrest ? Sudden stopping of the pumping action of the heart
Major pulse absent
SCA and VF- electrocution /MI
drowning / drug overdose in
majority of children Myocardial infarction
In hospital SCA
Out of hospital SCA
Unwitnessed arrest Purpose of BLS : 20/07/2008 drdgm 3 Purpose of BLS Holding operation
To maintain respiration and circulation till expert help arrives
Failure of circulation for 3 to 4 minutes leads to irreversible brain damage
Emphasis on rapid and high quality bls Golden minutes : 20/07/2008 drdgm 4 Golden minutes Immediate AED : 20/07/2008 drdgm 5 Immediate AED Chain of survival : 20/07/2008 drdgm 6 Chain of survival Basic life support (BLS)elements : 20/07/2008 drdgm 7 Basic life support (BLS)elements Initial assessment,
then airway maintenance,
expired air ventilation (rescue breathing),
and chest compression.
Basic life support
implies that no equipment is employed;
where a simple airway or facemask for mouth to mouth ventilation is used,
this is defined as
"basic life support with airway adjunct".
Defibrillation with Automated external defibrillator Adult Basic Life support : 20/07/2008 drdgm 8 USE AED
ASAP DEFIB Adult Basic Life support Slide 9: 20/07/2008 drdgm 9 CPR : 20/07/2008 drdgm 10 CPR Restoration
(ROSC) Perform Chest Compression (CC) Rescue Breathing (RB) Slide 11: 20/07/2008 drdgm 11 Slide 12: 20/07/2008 drdgm 12 Performance Pitfalls emergency circumstances
unanticipated nature History/Theory of CPR : 20/07/2008 drdgm 13 History/Theory of CPR First mouth to mouth Ventilation ?
First Medical success-1744 –Tossach
Closed chest cardiac massage-1960 Kouwenhoven, Jude, and Knickerbocker Slide 14: 20/07/2008 drdgm 14 JAMA,2005:293;299-304 Slide 15: 20/07/2008 drdgm 15 Hand Placement : 20/07/2008 drdgm 16 Hand Placement Hand Placement… : 20/07/2008 drdgm 17 Hand Placement… Slide 18: 20/07/2008 drdgm 18 CPR : 20/07/2008 drdgm 19 CPR Minimize the number and length of interruptions in chest compressions.
Try to limit interruptions to 10 seconds or less unless necessary for specific interventions such as advanced airway placement or defibrillation.
The compressor should allow for full chest recoil following each compression.
To reduce the chances of fatigue affecting the quality of compressions, the rescuers should change compressors frequently, about every 2 minutes when the rhythm is checked. Slide 20: 20/07/2008 drdgm 20 Slide 21: 20/07/2008 drdgm 21 Slide 22: 20/07/2008 drdgm 22 Slide 23: 20/07/2008 drdgm 23 Airway and Breathing : 20/07/2008 drdgm 24 Airway and Breathing General
Please do not Hyperventilate
Opening the airway priority for an unresponsive trauma victim
Breaths in all age groups should be delivered over 1 second and should produce visible chest rise.
When the victim has an advanced airway
(eg, endotracheal tube, LMA, Combitube) in place,
CPR is no longer performed as "cycles" of compressions with pauses for breaths.
The compressor gives continuous compressions.
The rescuer giving breaths should give 1 breath every
6 to 8 seconds (about 8 to 10 breaths/minute) Rescue breathing : 20/07/2008 drdgm 25 Rescue breathing Ensure head tilt and chin lift
Pinch the victim’s nose closed with the index finger and thumb of your hand on his forehead
Open his mouth a little,
but maintain chin lift
Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out Jaw thrust… : 20/07/2008 drdgm 26 Jaw thrust… Adult(RB..) : 20/07/2008 drdgm 27 Adult(RB..) When giving 2 breaths at the beginning of the CPR sequence or during cycles of compressions and breaths, if the chest does not rise after the first breath, the rescuer should try again to open the airway before giving the second breath.
Rescue Breathing Without Chest Compressions: Give 1 breath every 5 to 6 seconds
(about 10 to 12 breaths/minute). Slide 28: 20/07/2008 drdgm 28 Child(RB..) When giving 2 breaths at the beginning of the CPR sequence or during cycles of compressions and breaths, if the chest does not rise after the first breath, the rescuer should try again to open the airway before giving the second breath. Healthcare providers may need to try "a couple of times" to open the airway and deliver effective breaths
breaths that produce visible chest rise
Rescue Breathing Without Chest Compressions:
Give 1 breath every 3 to 5 seconds
(about 12 to 20 breaths/minute) Slide 29: 20/07/2008 drdgm 29 Infant(RB..) : 20/07/2008 drdgm 30 Infant(RB..) Healthcare providers
30:2 compression-to-ventilation ratio for 1-rescuer CPR
15:2 compression-to-ventilation ratio for 2-rescuer CPR
if the heart rate is less than 60 per minute with signs of poor perfusion.
Give compressions just below the nipple line, over the lower half of the breastbone.
2-rescuer infant CPR
the healthcare provider who gives compressions should use the
2 thumb–encircling hands technique, including a thoracic squeeze.
If the healthcare provider is alone or cannot physically encircle the infant's chest, the rescuer should use 2 fingers to compress the breastbone. Un / Witnessed Collapse : 20/07/2008 drdgm 31 Un / Witnessed Collapse Unresponsive victims of likely asphyxial arrest
(drowning) of all ages (unwitnessed)
5 cycles (2 minutes)
Phone fast and get AED
Return for steps of cpr and use AED For Sudden collapse in victims of all ages
Phone First –ERS(witnessed)
Get AED( if available)
Return for CPR and use AED Slide 32: 20/07/2008 drdgm 32 Slide 33: 20/07/2008 drdgm 33 Adult BLS -SAFE Approach : 20/07/2008 drdgm 34 Adult BLS -SAFE Approach Slide 35: 20/07/2008 drdgm 35 SAFETY First
SHAKE on shoulders and SHOUT
Hey ?Are You all right? Sequence of
Action and (Re)/Assessment, Response, What is the response of the victim to your action? Airway Assessment : 20/07/2008 drdgm 36 Airway Assessment Keeping the airway open, look, listen, and feel for normal breathing-
Look for chest movement
Listen at the victim's mouth for breath sounds
Feel for air on your cheek Give 2 Rescue Breaths : 20/07/2008 drdgm 37 Give 2 Rescue Breaths Give 2 rescue breaths,
each over 1 second,
with enough volume
visible chest rise
to all forms
of ventilation during CPR,
bag-mask ventilation and ventilation through an advanced airway,
with and without supplementary oxygen (Class IIa) Response of victim : 20/07/2008 drdgm 38 Response of victim No response
Shout for help
turn the victim on to his back and then open the airway
With your fingertips under the point of the victim's chin, lift the chin to open the airway. If no visible chest rise on RB….? : 20/07/2008 drdgm 39 If no visible chest rise on RB….? Check the victim's mouth and remove any visible obstruction.
Recheck that there is adequate head tilt and chin lift.
Do not attempt more than two breaths each time before returning tochest compressions If you see a foreign body, remove it. Slide 40: 20/07/2008 drdgm 40 Slide 41: 20/07/2008 drdgm 41 Slide 42: 20/07/2008 drdgm 42 AED Use : 20/07/2008 drdgm 43 AED Use When using an AED, rescuers should deliver 1 shock (if advised) followed by immediate CPR, beginning with chest compressions. Immediately after shock delivery, healthcare providers should not check a pulse because that will delay the resumption of chest compressions; a pulse is unlikely to be present in the first seconds after shock delivery.
Rescuers should follow the AED voice prompts. Check with the device manufacturer regarding re-programming of the AED to be consistent with the 2005 AHA Guidelines. After re-programming by the manufacturer, the AED should prompt rescuers to allow the AED to analyze the victim's rhythm every 2 minutes.
The evidence is insufficient to recommend for or against the use of AEDs in infants under 1 year of age. Slide 44: 20/07/2008 drdgm 44 Slide 45: 20/07/2008 drdgm 45 No response
No pulse Slide 46: 20/07/2008 drdgm 46 Integration of CPR and AED : 20/07/2008 drdgm 47 Integration of CPR and AED How long the CPR ? : 20/07/2008 drdgm 48 How long the CPR ? Before and after shock delivery
Qualified help arrives and takes over
The victim starts breathing normally
Till rescuer becomes
Till defib Slide 49: 20/07/2008 drdgm 49 Future of CPR -- in You : 20/07/2008 drdgm 50 Future of CPR -- in You most important determinant of survival from sudden cardiac arrest
Presence of a trained rescuer who is
Ready, able, willing and equipped to act