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Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
Basic life support
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Basic life support

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  • 1. BASIC LIFE SUPPORT - CPR 1 Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES 1. BASIC Life Support (BLS)1. BASIC Life Support (BLS) An emergency procedure that consists of recognizing respiratoryAn emergency procedure that consists of recognizing respiratory or cardiac arrestor cardiac arrest or both and the proper application of CPR to maintain life untilor both and the proper application of CPR to maintain life until a victim recovers ora victim recovers or advanced life support is available.advanced life support is available. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR 2. Advanced Cardiac Life Support (ACLS)2. Advanced Cardiac Life Support (ACLS) 3. Prolonged Life Support (PLS)3. Prolonged Life Support (PLS) The use of special equipment to maintain breathing and circulatiThe use of special equipment to maintain breathing and circulation for the victimon for the victim of a cardiac emergency.of a cardiac emergency. For post resuscitative and long term resuscitation.For post resuscitative and long term resuscitation. Kinds of Life SupportKinds of Life Support LIFE SUPPORTLIFE SUPPORT THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES 1. The First Link: EARLY ACCESS1. The First Link: EARLY ACCESS 2. The Second Link: EARLY CPR2. The Second Link: EARLY CPR 3. The Third Link: EARLY DEFIBRILLATION3. The Third Link: EARLY DEFIBRILLATION It is the event initiated after the patientIt is the event initiated after the patient’’s collapse until the arrival of Emergencys collapse until the arrival of Emergency Medical Services personnel prepared to provide care.Medical Services personnel prepared to provide care. It is most effective when started immediately after the victimIt is most effective when started immediately after the victim’’s collapse. Thes collapse. The probability of survival approximately doubles when it is initiatprobability of survival approximately doubles when it is initiated before the arrivaled before the arrival of EMS.of EMS. 4. The Fourth Link: EARLY ACLS4. The Fourth Link: EARLY ACLS It is most likely to improve survival. It is the key interventioIt is most likely to improve survival. It is the key intervention to increase the chancesn to increase the chances of survival of patients withof survival of patients with ““outout--ofof--hospitalhospital”” cardiac arrest.cardiac arrest. If provided by highly trained personnel like paramedics, provisiIf provided by highly trained personnel like paramedics, provision of advancedon of advanced care outside the hospital would be possible.care outside the hospital would be possible. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR Four LinksFour Links CHAIN OF SURVIVALCHAIN OF SURVIVAL THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES 1. Medial (I)1. Medial (I) 2. Prone Position (C)2. Prone Position (C) 3. Inferior (F)3. Inferior (F) 4. Proximal (K)4. Proximal (K) 6. Distal (L)6. Distal (L) 7. Posterior (H)7. Posterior (H) 8. Lateral recumbent position (D)8. Lateral recumbent position (D) 9. Superior (E)9. Superior (E) 10. Lateral (J)10. Lateral (J) 12. Anterior (G)12. Anterior (G) 13. Supine position (B)13. Supine position (B) 15. Anatomical position (A)15. Anatomical position (A) Anatomical TermsAnatomical Terms Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR 16. Deep (N)16. Deep (N) 5. Internal (O)5. Internal (O) 14. Superficial (M)14. Superficial (M) 11. External (Q)11. External (Q) HUMAN BODYHUMAN BODY THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES
  • 2. BASIC LIFE SUPPORT - CPR 2 Body SystemsBody Systems 1. The Respiratory System1. The Respiratory System It supply oxygen to the body, as well as removesIt supply oxygen to the body, as well as removes carbon dioxide from the body. The passage of air intocarbon dioxide from the body. The passage of air into and out of the lungs is called respiration. Breathing inand out of the lungs is called respiration. Breathing in is called inspiration or inhaling. Breathing out is calledis called inspiration or inhaling. Breathing out is called expiration or exhaling.expiration or exhaling. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES HUMAN BODY contHUMAN BODY cont…… Body SystemsBody Systems 2.2. The Circulatory SystemThe Circulatory System It delivers oxygen and nutrients to the bodyIt delivers oxygen and nutrients to the body’’s tissuess tissues and removes waste products. It consists of the heart,and removes waste products. It consists of the heart, blood vessels, and blood.blood vessels, and blood. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES HUMAN BODY contHUMAN BODY cont…… It is composed of the brain, spinal cord and nerves. It has twoIt is composed of the brain, spinal cord and nerves. It has two major functionsmajor functions –– communication and control. It lets a person be aware of and reaccommunication and control. It lets a person be aware of and react to thet to the environment. It coordinates the bodyenvironment. It coordinates the body’’s responses to stimuli and keeps body systemss responses to stimuli and keeps body systems working together.working together. 3. The Nervous System3. The Nervous System Body System cont...Body System cont... Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES HUMAN BODY contHUMAN BODY cont…… Breathing and CirculationBreathing and Circulation •• Air that enters the lungs contains:Air that enters the lungs contains: –– 21% O221% O2 –– trace of CO2trace of CO2 •• Air exhaled from the lungs contains:Air exhaled from the lungs contains: –– 16% O216% O2 –– 4% CO24% CO2 Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR •• Clinical deathClinical death (0(0 -- 4 min.4 min. -- brain damage notbrain damage not likely, 4likely, 4 -- 6 min.6 min. -- damage probable).damage probable). •• Biological deathBiological death (6(6 -- 10 min.10 min. -- brain damagebrain damage probable; over 10 min.probable; over 10 min. -- brain damage is certain).brain damage is certain). Body System cont...Body System cont... THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES HUMAN BODY contHUMAN BODY cont…… Body Substance IsolationBody Substance Isolation Are precautions taken to isolate or prevent risk of exposure froAre precautions taken to isolate or prevent risk of exposure from any other type ofm any other type of bodily substance.bodily substance. Basic Precautions and PracticesBasic Precautions and Practices 1. Personal Hygiene1. Personal Hygiene 2. Protective Equipment2. Protective Equipment 3. Equipment Cleaning3. Equipment Cleaning & Disinfecting& Disinfecting Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR PRECAUTIONS TO PREVENTPRECAUTIONS TO PREVENT DISEASE TRANSMISSIONDISEASE TRANSMISSION THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES Risk Factors for Cardiovascular DiseasesRisk Factors for Cardiovascular Diseases 1. Risk factors that cannot be changed (Non1. Risk factors that cannot be changed (Non--modifiable) :modifiable) : •• HeredityHeredity •• AgeAge •• GenderGender 2. Risk factors that can be changed (Modifiable) :2. Risk factors that can be changed (Modifiable) : •• Cigarette smoking.Cigarette smoking. •• Elevated cholesterol and triglyceride levels.Elevated cholesterol and triglyceride levels. •• HypertensionHypertension •• ObesityObesity •• StressStress •• Lack of exercises.Lack of exercises. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR •• Diabetes mellitus.Diabetes mellitus. CARDIOVASCULAR DISEASESCARDIOVASCULAR DISEASES THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES
  • 3. BASIC LIFE SUPPORT - CPR 3 HEART ATTACK ( Myocardial Infarction)HEART ATTACK ( Myocardial Infarction) It occurs when the oxygen supply to the heart muscle (myocardiumIt occurs when the oxygen supply to the heart muscle (myocardium) is cut) is cut--off for a prolongedoff for a prolonged period of time. This cutperiod of time. This cut--off results from a reduced blood supply due to severe narrowingoff results from a reduced blood supply due to severe narrowing oror complete blockage of the diseased artery. The result is death (icomplete blockage of the diseased artery. The result is death (infarction) of the affected partnfarction) of the affected part of the heart.of the heart. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont…… Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Introduction to BLSIntroduction to BLS -- CPRCPR First Aid Management of Heart AttackFirst Aid Management of Heart Attack 1. Recognized the signals of heart attack and take action.1. Recognized the signals of heart attack and take action. 2. Have patient stop what he or she is doing and sit or lie him/2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortableher down in a comfortable position. Do not let the patient move around.position. Do not let the patient move around. 3. Have someone call the physician or ambulance for help.3. Have someone call the physician or ambulance for help. 4. If patient is under medical care, assist him/her in taking hi4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.s/her prescribed medicine/s. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont…… Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care After completing this module, participants will be able toAfter completing this module, participants will be able to-- •• Demonstrate how to do a primary survey.Demonstrate how to do a primary survey. 1. Explain the need of preparation to a proper emergency care.1. Explain the need of preparation to a proper emergency care. 2. Describe the four emergency action principles2. Describe the four emergency action principles 3. Enumerate the golden rules in giving emergency care.3. Enumerate the golden rules in giving emergency care. TR 2TR 2--11 KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES: SKILL OBJECTIVES:SKILL OBJECTIVES: THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES 1. Plan of Action1. Plan of Action 2. Gathering of Needed Materials2. Gathering of Needed Materials 3. Initial Response:3. Initial Response: Emergency plans should be established based on anticipated needsEmergency plans should be established based on anticipated needs andand available resources.available resources. The emergency response begins with the preparation of equipmentThe emergency response begins with the preparation of equipment and personneland personnel before any emergency occurs.before any emergency occurs. •• Ask for HELP.Ask for HELP. •• InterveneIntervene •• Do not further harm.Do not further harm. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care TR 2TR 2--22 4. Instruction to Helper/s4. Instruction to Helper/s Proper information and instruction to a helper/s would provide oProper information and instruction to a helper/s would provide organized first aidrganized first aid care.care. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES GETTING STARTEDGETTING STARTED Elements of the Survey the SceneElements of the Survey the Scene •• Scene safety.Scene safety. •• Mechanism of injury or nature of illness.Mechanism of injury or nature of illness. •• Determine the number of patients andDetermine the number of patients and additional resources.additional resources. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care TR 2TR 2--33 1. Survey the Scene1. Survey the Scene Once you recognized that an emergency has occurred and decide toOnce you recognized that an emergency has occurred and decide to act, youact, you must make sure the scene of the emergency is safe for you, the vmust make sure the scene of the emergency is safe for you, the victim/s, andictim/s, and any bystander/s.any bystander/s. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES EMERGENCY ACTION PRINCIPLESEMERGENCY ACTION PRINCIPLES Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care TR 2TR 2--44 Phone First and Phone FastPhone First and Phone Fast Both trained and untrained bystanders shouldBoth trained and untrained bystanders should be instructed to Activate Medical Assistance asbe instructed to Activate Medical Assistance as soon as they have determined that an adultsoon as they have determined that an adult victim requires emergency carevictim requires emergency care ““Phone FirstPhone First””.. While for infant and children aWhile for infant and children a ““Phone FastPhone Fast”” approach is recommended.approach is recommended. 2. Activate Medical Assistance and Transfer Facility2. Activate Medical Assistance and Transfer Facility In some emergency, you will have enough time to call for specifiIn some emergency, you will have enough time to call for specific medical advicec medical advice before administering first aid. But in some situations, you willbefore administering first aid. But in some situations, you will need to attend toneed to attend to the victim first.the victim first. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES EMERGENCY ACTION PRINCIPLES contEMERGENCY ACTION PRINCIPLES cont……
  • 4. BASIC LIFE SUPPORT - CPR 4 Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care TR 2TR 2--55 1. Check for Consciousness1. Check for Consciousness 3. Do a Primary Survey of the Victim3. Do a Primary Survey of the Victim In every emergency situation, you must first find out if there aIn every emergency situation, you must first find out if there are conditions thatre conditions that are an immediate threat to the victimare an immediate threat to the victim’’s life.s life. 2. Check for Airway2. Check for Airway 3. Check for Breathing3. Check for Breathing 4. Check for Circulation4. Check for Circulation THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES EMERGENCY ACTION PRINCIPLES contEMERGENCY ACTION PRINCIPLES cont…… Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care TR 2TR 2--66 1. Interview the victim.1. Interview the victim. 4. Do a Secondary Survey of the Victim4. Do a Secondary Survey of the Victim It is a systematic method of gathering additional information abIt is a systematic method of gathering additional information aboutout injuries or conditions that may need care.injuries or conditions that may need care. 2. Check vital signs.2. Check vital signs. 3. Perform head3. Perform head--toto--toe examination.toe examination. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES EMERGENCY ACTION PRINCIPLES contEMERGENCY ACTION PRINCIPLES cont…… Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing After completing this module, participants will be able toAfter completing this module, participants will be able to-- •• Demonstrate how to provide rescue breathing for an adult, child,Demonstrate how to provide rescue breathing for an adult, child, & infant& infant who shows signs of circulation but not breathing or inadequate.who shows signs of circulation but not breathing or inadequate. 1. Describe what is respiratory arrest.1. Describe what is respiratory arrest. 3. Describe the ways in ventilating the lungs.3. Describe the ways in ventilating the lungs. TR 3TR 3--11 KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES: SKILL OBJECTIVES:SKILL OBJECTIVES: 2. Identify the causes of respiratory arrest.2. Identify the causes of respiratory arrest. After completing this sessions, participants will be able toAfter completing this sessions, participants will be able to-- THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES Is the condition in which breathing stops or inadequate.Is the condition in which breathing stops or inadequate. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing Is a technique of breathing air into a person lungs to supply hiIs a technique of breathing air into a person lungs to supply him or her with them or her with the oxygen needed to survive.oxygen needed to survive. RESPIRATORY ARRESTRESPIRATORY ARREST RESCUE BREATHINGRESCUE BREATHING THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing 1. Mouth1. Mouth--toto-- MouthMouth 4. Mouth4. Mouth--toto-- StomaStoma 3. Mouth3. Mouth--toto--MouthMouth and Noseand Nose 2. Mouth2. Mouth-- toto--NoseNose WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES 5. Mouth5. Mouth--toto-- Face ShieldFace Shield 6. Mouth6. Mouth--toto-- MaskMask 7. Bag Mask7. Bag Mask DeviceDevice Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS
  • 5. BASIC LIFE SUPPORT - CPR 5 Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES Face mask Bag mask Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Foreign Airway Obstruction ManagementForeign Airway Obstruction Management After completing this module, participants will be able toAfter completing this module, participants will be able to-- •• Demonstrate how to provide Heimlich maneuver to an adult, childDemonstrate how to provide Heimlich maneuver to an adult, child & infant& infant who have obstructed airway.who have obstructed airway. 1. Identify the causes, types, and classification of obstruction1. Identify the causes, types, and classification of obstruction.. 2. Describe Heimlich maneuver.2. Describe Heimlich maneuver. TR 4TR 4--11 KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES: SKILL OBJECTIVES:SKILL OBJECTIVES: After completing this session, participants will be able toAfter completing this session, participants will be able to-- THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES It happens when the tongue drops back andIt happens when the tongue drops back and obstruct the throat. Other causes are acuteobstruct the throat. Other causes are acute asthma, croup, diphtheria, swelling, and coughasthma, croup, diphtheria, swelling, and cough (whooping).(whooping). Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Foreign Body Airway Obstruction ManagementForeign Body Airway Obstruction Management 1. Anatomical Obstruction1. Anatomical Obstruction 2. Mechanical Obstruction2. Mechanical Obstruction When foreign objects lodge in the pharynx orWhen foreign objects lodge in the pharynx or airways; fluids accumulate in the back of theairways; fluids accumulate in the back of the throat.throat. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES TWO TYPES OF OBSTRUCTIONTWO TYPES OF OBSTRUCTION Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Foreign Body Airway Obstruction ManagementForeign Body Airway Obstruction Management 1. Partial obstruction with good air exchange.1. Partial obstruction with good air exchange. 2. Partial obstruction with poor air exchange.2. Partial obstruction with poor air exchange. 3. Complete or total obstruction.3. Complete or total obstruction. The victim is responsive and can cough forcefully, although freqThe victim is responsive and can cough forcefully, although frequently thereuently there is wheezing between coughs.is wheezing between coughs. The victim has a weak, ineffective cough, highThe victim has a weak, ineffective cough, high--pitched noise while inhaling,pitched noise while inhaling, increased respiratory difficulty, and possibly cyanosis.increased respiratory difficulty, and possibly cyanosis. The victim is unable to speak, breathe, or cough and may clutchThe victim is unable to speak, breathe, or cough and may clutch the neck withthe neck with the thumb and fingers. Movement of air is absent.the thumb and fingers. Movement of air is absent. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES CLASSIFICATION OF OBSTRUCTIONCLASSIFICATION OF OBSTRUCTION Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Foreign Body Airway Obstruction ManagementForeign Body Airway Obstruction Management Heimlich maneuver or abdominal thrusts is recommended for relievHeimlich maneuver or abdominal thrusts is recommended for relieving foreign bodying foreign body airway obstruction.airway obstruction. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES HEIMLICH MANEUVERHEIMLICH MANEUVER Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation After completing this module, participants will be able toAfter completing this module, participants will be able to-- •• Demonstrate how to provide Cardiopulmonary Resuscitation to an aDemonstrate how to provide Cardiopulmonary Resuscitation to an adult,dult, child & infant who have cardiac arrest.child & infant who have cardiac arrest. 1. Describe cardiac arrest.1. Describe cardiac arrest. 2. Enumerate the three conditions of cardiac arrest.2. Enumerate the three conditions of cardiac arrest. TR 5TR 5--11 KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES: SKILL OBJECTIVES:SKILL OBJECTIVES: 3. Enumerate the criteria for not starting CPR and when to STOP3. Enumerate the criteria for not starting CPR and when to STOP CPR.CPR. After completing the class, participants will be able toAfter completing the class, participants will be able to-- THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES
  • 6. BASIC LIFE SUPPORT - CPR 6 Is the condition in which circulation ceases andIs the condition in which circulation ceases and vital organs are deprived of oxygen.vital organs are deprived of oxygen. Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation TR 5TR 5--22 THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES CARDIAC ARRESTCARDIAC ARREST 1.1. Cardio Vascular CollapseCardio Vascular Collapse 2.2. Ventricular FibrillationVentricular Fibrillation 3.3. Cardiac Stand StillCardiac Stand Still THREE CONDITONS OF CARDIAC ARRESTTHREE CONDITONS OF CARDIAC ARREST Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES This is a combination of chest compressionThis is a combination of chest compression and rescue breathing. This must be combinedand rescue breathing. This must be combined for effective resuscitation of the victim offor effective resuscitation of the victim of cardiac arrest.cardiac arrest. CARDIOPULMONARYCARDIOPULMONARY RESUSCITATION (CPR)RESUSCITATION (CPR) CoughCough -- CPRCPR Compression OnlyCompression Only -- CPRCPR Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation TR 5TR 5--33 1. SPONTANEOUS1. SPONTANEOUS signs of circulation are restored.signs of circulation are restored. 2. TURNED2. TURNED over to medical services or properly trained and authorizedover to medical services or properly trained and authorized personnel.personnel. 3. OPERATOR3. OPERATOR is already exhausted and cannot continue CPR.is already exhausted and cannot continue CPR. 4. PHYSICIAN4. PHYSICIAN assumes responsibility (declares death, take over, etc.).assumes responsibility (declares death, take over, etc.). THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES WHEN TO S.T.O.P. CPRWHEN TO S.T.O.P. CPR Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation TR 5TR 5--44 Survey the Scene.Survey the Scene. ““The Scene is SafeThe Scene is Safe””.. ““Activate Medical Assistance & Transfer FacilityActivate Medical Assistance & Transfer Facility””.. Check Responsiveness,Check Responsiveness, ““HeyHey MamMam/Sir are you OK? Victim Unresponsive/Sir are you OK? Victim Unresponsive””.. Open Airway (HeadOpen Airway (Head--TiltTilt--Chin Lift) Check AirwayChin Lift) Check Airway Check Breathing (Look, Listen & Feel) for 5 seconds.Check Breathing (Look, Listen & Feel) for 5 seconds. ““Victim is BreathlessVictim is Breathless””.. Give 2 Initial Ventilatory Maneuver (2 breaths).Give 2 Initial Ventilatory Maneuver (2 breaths). Check for Signs of Circulation for at least 10 seconds.Check for Signs of Circulation for at least 10 seconds. ““Victim has no signs of Circulation IVictim has no signs of Circulation I’’ll perform CPRll perform CPR””.. ““Victim has inadequate/no breathing but with Signs of CirculationVictim has inadequate/no breathing but with Signs of Circulation II’’ll performll perform Rescue BreathingRescue Breathing””.. THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICESSAFETY SERVICES SEQUENCE IN PERFORMING CPR & RBSEQUENCE IN PERFORMING CPR & RB ACLS APPROACHACLS APPROACH OBJECTIVESOBJECTIVES 1.1. Describe the 8 steps of the ACLSDescribe the 8 steps of the ACLS approachapproach 2. For each step of the ACLS Approach2. For each step of the ACLS Approach describe 2 acts of assessment anddescribe 2 acts of assessment and managementmanagement 3. Describe how you can apply this3. Describe how you can apply this approach to almost all cardiovascularapproach to almost all cardiovascular emergenciesemergencies
  • 7. BASIC LIFE SUPPORT - CPR 7 8 Things to Recall in an Emergency8 Things to Recall in an Emergency Airway: Is the airway open? Breathing: Is the victim moving air adequately? Circulation: Is there a pulse? If not, is CPR being performed effectively? Defibrillation: if no pulse, has someone checked whether rhythm is VF? Is a defibrillator on the way? Is it ready to deliver a shock? Airway: open the airway Breathing: provide positive- pressure Ventilations Circulation: give chest compressions Defibrllation: shock VF/pulseless VT Primary ABCD Survey (ACLS Questions to Ask) Primary Survey: ABCD (Basic Steps) 8 Things to Recall in an Emergency8 Things to Recall in an Emergency Airway: •provide advanced airway management •tracheal intubation, laryngeal mask airway, Combitube Secondary Survey: ABCD (Basic Steps) Airway: • Is advanced airway needed now? •If yes, intubate victim with laryngeal mask airway, Combitube, or tracheal tube Secondary Survey: ABCD Survey (Basic Steps) 8 Things to Recall in an Emergency8 Things to Recall in an Emergency Breathing: confirm tube placement primarily (physical examination), secondarily (check end-tidal CO2 and esophageal placement), check for adequate oxygenation and ventilation Secondary Survey: ABCD (Basic Steps) Breathing: Primary confirmation (physical examination) of proper placement of airway device Breathing: Secondary confirmation (end-tidal CO2 detectors, esophageal detector devices) of proper device placement Breathing: Adequate oxygenation and ventilation? Is it possible to provide continuous/intermittent monitoring of CO2 and oxygen levels Breathing: Is tube secured to prevent dislodgment? Is commercial tube holder being used or tape-and-tie techniques? Is proper tube placement reconfirmed frequently Secondary Survey: ABCD Survey(Basic Steps) 8 Things to Recall in an Emergency8 Things to Recall in an Emergency Circulation: obtain IV access, determine rhythm, give medications appropriate for rhythm and vital signs Secondary Survey: ABCD (Basic Steps) Circulation: What was the initial cardiac rhythm? What is current cardiac rhythm? Circulation:has someone obtained access to the venous circulation? Can fluids and medication now be given? Have all medications and interventions been providedas indicated for this rhythm and overall clinical condition? Secondary Survey: ABCD Survey(Basic Steps) 8 Things to Recall in an Emergency8 Things to Recall in an Emergency Differential Diagnosis: search for, find, and treat reversible cause Secondary Survey: ABCD (Basic Steps) Differential Diagnosis: Now… what is wrong with this patient? Why did adequate respirations and heartbeat stop? Why did the patient go into an arrest?What do we see, hear, smell, know or quickly learn that might help us identify a reversible cause of the arrest? Secondary Survey: ABCD Survey(Basic Steps)
  • 8. BASIC LIFE SUPPORT - CPR 8 Initial ResponsesInitial Responses The initial responses also include:The initial responses also include: •• Assess responsivenessAssess responsiveness •• Call fastCall fast •• Appropriately position the patientAppropriately position the patient •• Appropriately position yourself as theAppropriately position yourself as the rescuerrescuer Assessment processAssessment process •• Person CollapsesPerson Collapses •• Possible Cardiac ArrestPossible Cardiac Arrest •• Assess ResponsivenessAssess Responsiveness Assess ResponsivenessAssess Responsiveness •• Always assume that the victim is in cardiacAlways assume that the victim is in cardiac respiratory arrest or both unless provenrespiratory arrest or both unless proven otherwiseotherwise •• Establish unresponsiveness with theEstablish unresponsiveness with the traditionaltraditional ““shake and shoutshake and shout”” step:tapstep:tap andand gently shake the victim and shoutgently shake the victim and shout ““AreAre you OKyou OK”” call for helpcall for help •• Advance care, in the form of electricalAdvance care, in the form of electrical defibrillation, advanced airwaydefibrillation, advanced airway management, and IV medications, mustmanagement, and IV medications, must be on the way to the patient as soon asbe on the way to the patient as soon as possiblepossible Q? to Assess ResponsivenessQ? to Assess Responsiveness •• Did the victim fall from a height?Did the victim fall from a height? •• Or collapse with great force?Or collapse with great force? •• Or dive head first?Or dive head first? •• Or experience a motor vehicle crash?Or experience a motor vehicle crash? •• Activate emergency responseActivate emergency response •• Call for defibrillatorCall for defibrillator Begin Primary ABCD SurveyBegin Primary ABCD Survey AA Assess breathing (open airway, look,Assess breathing (open airway, look, listen, and feel)listen, and feel)
  • 9. BASIC LIFE SUPPORT - CPR 9 A: Assess the AirwayA: Assess the Airway •• Begin with an assessment of the airway,Begin with an assessment of the airway, first opening the airway and checking forfirst opening the airway and checking for spontaneous breathingspontaneous breathing •• The basic techniques for opening theThe basic techniques for opening the airway are the head tiltairway are the head tilt--chin maneuverchin maneuver and the jawand the jaw--thrust maneuverthrust maneuver Head TiltHead Tilt--chin Liftchin Lift This maneuver pulls the base of the tongueThis maneuver pulls the base of the tongue away from the back of the throat, thusaway from the back of the throat, thus maintaining a more open airway:maintaining a more open airway: •• Open the mouth, inspect the upper airwayOpen the mouth, inspect the upper airway for foreign objects, vomitus, or blood. If afor foreign objects, vomitus, or blood. If a foreign object is present, remove it withforeign object is present, remove it with your fingers covered with a piece of cloth.your fingers covered with a piece of cloth. Head TiltHead Tilt--chin Liftchin Lift If there is no possibility of a cervical spineIf there is no possibility of a cervical spine Injury, remove material obstructing theInjury, remove material obstructing the airway by turning the patient on his or herairway by turning the patient on his or her sideside •• Place the edge of one hand on the victimPlace the edge of one hand on the victim’’ss forehead. Begin to gently tilt the headforehead. Begin to gently tilt the head back. At the same time place 2 fingers ofback. At the same time place 2 fingers of the other hand under the chin and liftthe other hand under the chin and lift upward, tilting the head backupward, tilting the head back JawJaw--Thrust ManeuverThrust Maneuver The jaw thrust maintains the neutralThe jaw thrust maintains the neutral positionofpositionof the cervical spine whilethe cervical spine while resuscitative efforts continue. Use the jawresuscitative efforts continue. Use the jaw thrust when you encounter patients with thethrust when you encounter patients with the combination of possible cervical spinecombination of possible cervical spine injuries and respiratory compromise orinjuries and respiratory compromise or victims of trauma.victims of trauma. The Advanced ACLS SkillsThe Advanced ACLS Skills OverviewOverview 2 Basic ACLS Skills2 Basic ACLS Skills 1.1. CPRCPR 2.2. AED (Automated External Defibrillators)AED (Automated External Defibrillators)
  • 10. BASIC LIFE SUPPORT - CPR 10 Advanced ACLS SkillsAdvanced ACLS Skills 1.1. Care of the airwayCare of the airway 2.2. Recognition of rhythmRecognition of rhythm 3.3. Electrical therapy I (defibrillation)Electrical therapy I (defibrillation) 4.4. Electrical therapy II (Electrical therapy II (cardioversioncardioversion)) 5.5. Electrical therapy III (Electrical therapy III (transcutaneoustranscutaneous pacing)pacing) 6.6. IVIV accesacces to circulationto circulation 7.7. Selection of appropriate resuscitationSelection of appropriate resuscitation medicationmedication Secondary (Advanced) ABCD SurveySecondary (Advanced) ABCD Survey A.A. Secondary ASecondary A –– establish an airway withestablish an airway with (1) tracheal(1) tracheal intubationintubation B. Secondary BB. Secondary B -- provide ventilation (breathing) with properlyprovide ventilation (breathing) with properly placed tracheal tubes and airway ductsplaced tracheal tubes and airway ducts C. Secondary CC. Secondary C –– Restore circulation with:Restore circulation with: (2) Defibrillation(2) Defibrillation (3)(3) CardioversionCardioversion (4)(4) TranscutaneousTranscutaneous pacingpacing (5) Recognition of the rhythm(5) Recognition of the rhythm (6) Initiation of IV access(6) Initiation of IV access (7) IV medications(7) IV medications D. Secondary DD. Secondary D –– Perform a differential diagnosisPerform a differential diagnosis ACLS Skill 1:ACLS Skill 1: Take care of the airwayTake care of the airway 1.1. Provide supplemental oxygenProvide supplemental oxygen –– without respiratory distresswithout respiratory distress •• 22 lpmlpm thru nasalthru nasal cannulacannula –– mild respiratory distressmild respiratory distress •• 5 to 65 to 6 lpmlpm thru nasalthru nasal cannulacannula –– severe respiratory distress, acute congestivesevere respiratory distress, acute congestive heart failure, cardiac arrestheart failure, cardiac arrest •• Use a system that provides a high inspiredUse a system that provides a high inspired oxygen concentration (preferably 100%)oxygen concentration (preferably 100%) –– COPD, who may be dependent on hypoxiaCOPD, who may be dependent on hypoxia drvendrven ventilationventilation •• Low dose supplemental oxygen via a 24%Low dose supplemental oxygen via a 24% VenturiVenturi maskmask –– Most serious casesMost serious cases •• Move quickly to advanced airway devices,Move quickly to advanced airway devices, intubationintubation and 100% oxygenand 100% oxygen
  • 11. BASIC LIFE SUPPORT - CPR 11 •• Devices used to administer supplementalDevices used to administer supplemental oxygenoxygen –– Oxygen supplyOxygen supply –– NasalNasal cannulacannula •• Starting deviceStarting device •• Up to 44% oxygenUp to 44% oxygen –– 1 L/min: 24%1 L/min: 24% 2 L/min: 28%2 L/min: 28% –– 3 L/min: 32%3 L/min: 32% 4 L/min: 36%4 L/min: 36% –– 5 L/min: 40%5 L/min: 40% 6 L/min: 44%6 L/min: 44% –– Face maskFace mask –– Up to 60% oxygenUp to 60% oxygen –– 6 to 10 L/min6 to 10 L/min –– Face mask with oxygen reservoirFace mask with oxygen reservoir ••up to 90up to 90 –– 100 % oxygen100 % oxygen –– 6 L/min: 60%6 L/min: 60% –– 7 L/min: 70%7 L/min: 70% –– 8 L/min: 80%8 L/min: 80% –– 9 L/min: 90%9 L/min: 90% –– 10 L/min: almost 100%10 L/min: almost 100% ••for use on patients who:for use on patients who: –– Seriously ill, responsive, spontaneouslySeriously ill, responsive, spontaneously breathing, require high oxygen concentrationbreathing, require high oxygen concentration –– May avoid trachealMay avoid tracheal intubationintubation if acuteif acute interventions produce a rapid clinical effectinterventions produce a rapid clinical effect –– Have relative indications for trachealHave relative indications for tracheal intubationintubation but maintain a gag reflexbut maintain a gag reflex –– Have relative indications forHave relative indications for intubationintubation butbut have clenched teeth or other physical barriershave clenched teeth or other physical barriers to immediateto immediate intubationintubation 2. Open the airway: recognize airway2. Open the airway: recognize airway obstructionobstruction –– Head and Jaw position:Head and Jaw position: •• Loss of tone in throat muscles (most common)Loss of tone in throat muscles (most common) –– Basic Opening TechniquesBasic Opening Techniques •• Head tiltHead tilt •• Jaw ThrustJaw Thrust 3. Maintain the open airway using3. Maintain the open airway using airway adjunctsairway adjuncts –– Assume that obstruction is produced by eitherAssume that obstruction is produced by either the tongue or relaxed throat musclesthe tongue or relaxed throat muscles –– Insert anInsert an oropharyngealoropharyngeal or nasopharyngealor nasopharyngeal airwayairway •• Manage foreignManage foreign--body airway obstructionbody airway obstruction with the BLS technique ofwith the BLS technique of subdiaphragmaticsubdiaphragmatic abdominal thrusts andabdominal thrusts and the advanced technique of directthe advanced technique of direct laryngoscopylaryngoscopy •• Use forceps to grasp and remove theUse forceps to grasp and remove the foreign bodyforeign body
  • 12. BASIC LIFE SUPPORT - CPR 12 OROPHARYNGEAL AIRWAYSOROPHARYNGEAL AIRWAYS –– Devices that hold the tongue away from theDevices that hold the tongue away from the posterior wall of the pharynxposterior wall of the pharynx –– Useful in spontaneous breathers who areUseful in spontaneous breathers who are unconscious or semiconscious with no coughunconscious or semiconscious with no cough or gag reflexor gag reflex –– At risk of occluding the airway via tongue andAt risk of occluding the airway via tongue and phanryngealphanryngeal relaxationrelaxation –– Keep the airway open during bagKeep the airway open during bag--maskmask ventilationventilation –– Helps in mouth suction and prevents occlusionHelps in mouth suction and prevents occlusion of tracheal tubeof tracheal tube Technique:Technique: •• Clear the mouth and pharynxClear the mouth and pharynx •• Place the airway backwardsPlace the airway backwards •• Rotate the airway 180Rotate the airway 180˚˚ as it passes throughas it passes through the oral cavity and approaches thethe oral cavity and approaches the prosteriorprosterior pharynxpharynx •• Make sure that you have clear breath soundsMake sure that you have clear breath sounds upon placement of airwayupon placement of airway •• Maintain proper head positionMaintain proper head position Hazards:Hazards: •• LongLong oropharyngealoropharyngeal airway may press theairway may press the epiglottis against the entrance of theepiglottis against the entrance of the larynxlarynx •• May push the tongueMay push the tongue posteriorlyposteriorly •• Prevent trauma: make sure tongue andPrevent trauma: make sure tongue and lips are note between the airway andlips are note between the airway and teethteeth •• Should only be used in unconscious orShould only be used in unconscious or semiconscious without cough or gag reflexsemiconscious without cough or gag reflex NASOPHARYNGEAL AIRWAYSNASOPHARYNGEAL AIRWAYS -- UncuffedUncuffed tubes made of soft rubber or plastictubes made of soft rubber or plastic -- For intoxicated or semiconscious who cannotFor intoxicated or semiconscious who cannot tolerate antolerate an oropharyngealoropharyngeal airwayairway -- Indicated when the insertion orIndicated when the insertion or oropharyngealoropharyngeal airway is technically difficult or impossibleairway is technically difficult or impossible •• TechniqueTechnique •• Proper sized airway is lubricated properlyProper sized airway is lubricated properly •• Inserted close to the midline along the floor ofInserted close to the midline along the floor of the nostrilthe nostril •• Continue inserting into the posterior pharynx,Continue inserting into the posterior pharynx, behind the tonguebehind the tongue •• Slight rotation may facilitate insertion if withSlight rotation may facilitate insertion if with resistanceresistance •• HazardsHazards •• May enter theMay enter the esophagusesophagus •• May precipitateMay precipitate laryngospasmlaryngospasm and vomitingand vomiting •• May injure nasal mucosa and cause bleedingMay injure nasal mucosa and cause bleeding •• Maintain proper head positionMaintain proper head position
  • 13. BASIC LIFE SUPPORT - CPR 13 PRECAUTIONSPRECAUTIONS –– Always check spontaneous respirationsAlways check spontaneous respirations immediately after insertion of airwayimmediately after insertion of airway –– If respirations are absent, start artificialIf respirations are absent, start artificial positive pressure ventilationpositive pressure ventilation –– If adjuncts are unavailable, use mouthIf adjuncts are unavailable, use mouth--toto-- mouth resuscitationmouth resuscitation 4. Ventilate the patient4. Ventilate the patient •• MouthMouth--toto--Mouth and MouthMouth and Mouth--toto--NoseNose VentilationVentilation –– Default methodDefault method –– Because a major mistake has been madeBecause a major mistake has been made –– Limitations:Limitations: •• RescuerRescuer’’s vital capacitys vital capacity •• Reduced concentration of exhaled airReduced concentration of exhaled air –– Professional rescuers should always have aProfessional rescuers should always have a barrier devicebarrier device •• Mouth to pocket face maskMouth to pocket face mask –– Must be transparentMust be transparent –– Tight fit in faceTight fit in face –– Has an oxygen inletHas an oxygen inlet –– Available in different sizesAvailable in different sizes –– AdvantageAdvantage •• Effective ventilation and oxygenationEffective ventilation and oxygenation •• EliminateEliminate’’ss direct contactdirect contact •• Possible supplemental oxygenPossible supplemental oxygen •• Eliminates exposure to victimEliminates exposure to victim’’s exhaled gasess exhaled gases •• Easy to teach and learnEasy to teach and learn •• Superior to bag mask techniqueSuperior to bag mask technique •• SelfSelf--inflating Ventilation Bags: Attached toinflating Ventilation Bags: Attached to Valves, Masks and Other Airway AdjunctsValves, Masks and Other Airway Adjuncts -- Mainstay of emergency ventilationMainstay of emergency ventilation -- Universal connectorsUniversal connectors -- One way valves to protect rescuerOne way valves to protect rescuer -- Oxygen portsOxygen ports -- Medication portsMedication ports -- Suction portsSuction ports -- Ports for quantitative sampling of end tidalPorts for quantitative sampling of end tidal CO2CO2 •• BagBag--Valve Masks: Adequate Seal andValve Masks: Adequate Seal and VolumeVolume –– Insert OP airwayInsert OP airway –– Recommended tidal volume: 10 to 15Recommended tidal volume: 10 to 15 mLmL/kg/kg –– 80 kg man: needs 800 to 120080 kg man: needs 800 to 1200 mLmL perper squeeze of bagsqueeze of bag –– Most bags: 1600Most bags: 1600 mLmL –– 1 handed squeeze: 50% of bag (8001 handed squeeze: 50% of bag (800 mLmL))
  • 14. BASIC LIFE SUPPORT - CPR 14 •• Good seal cannot be achieved when thereGood seal cannot be achieved when there is only one rescuer using the bagis only one rescuer using the bag--maskmask devicedevice •• Seal problems do not occur when the bagSeal problems do not occur when the bag is attached to the end of anis attached to the end of an EndotrachealEndotracheal tube or LMAtube or LMA •• Use a three second ventilation cycleUse a three second ventilation cycle •• Recommended features of bag masksRecommended features of bag masks –– Self refilling bag that is easily cleaned andSelf refilling bag that is easily cleaned and sterilizedsterilized –– Connections for delivery of high concentrationConnections for delivery of high concentration of oxygenof oxygen –– Capability to perform satisfactorily in allCapability to perform satisfactorily in all conditionsconditions –– Availability in different sizesAvailability in different sizes –– True nonTrue non rebreathingrebreathing valvevalve 5. Provide adequate ventilation5. Provide adequate ventilation •• TrachealTracheal intubationintubation –– Provides definitive airway managementProvides definitive airway management –– Should be provided by trained personnel asShould be provided by trained personnel as soon as possiblesoon as possible •• TrachealTracheal intubationintubation:: –– Keeps the airway patentKeeps the airway patent –– Ensures delivery of highEnsures delivery of high concentratiojnconcentratiojn of O2of O2 –– Ensures delivery of selected tidal volumeEnsures delivery of selected tidal volume –– Isolates and protects the airway fromIsolates and protects the airway from aspirationaspiration –– Permits effective suctioning of tracheaPermits effective suctioning of trachea –– Provides route for administration of otherProvides route for administration of other medicationsmedications –– Indications:Indications: ••Cardiac arrest with ongoing chestCardiac arrest with ongoing chest compressionscompressions ••Inability of a conscious patient inInability of a conscious patient in respiratory compromise to breatherespiratory compromise to breathe adequatelyadequately ••Inability of the patient to protect the airwayInability of the patient to protect the airway (coma,(coma, areflexiaareflexia, cardiac arrest), cardiac arrest) ••Inability of the rescuer to ventilate theInability of the rescuer to ventilate the unresponsive patient with conventionalunresponsive patient with conventional methodsmethods 6. Provide definitive airway control6. Provide definitive airway control •• OverviewOverview -- Prepare forPrepare for intubationintubation with necessarywith necessary equipmentequipment -- Ask second rescuer to applyAsk second rescuer to apply cricoidcricoid pressurepressure -- Prepare trachealPrepare tracheal intubationintubation -- Inflate cuffInflate cuff -- Attach ventilation bagAttach ventilation bag -- Confirm placementConfirm placement
  • 15. BASIC LIFE SUPPORT - CPR 15 •• CricoidCricoid PressurePressure ManeuverManeuver –– Why?Why? ••protects against regurgitation of gastricprotects against regurgitation of gastric contentscontents ••Helps ensure tube placementHelps ensure tube placement –– TechniqueTechnique ••Find the prominent thyroid cartilageFind the prominent thyroid cartilage ••Find the soft depression below the thyroidFind the soft depression below the thyroid cartilagecartilage ••Find the hard prominence just below thatFind the hard prominence just below that ••Apply firm pressure while pinching theApply firm pressure while pinching the thumb and index finger towards thethumb and index finger towards the victimvictim’’s back and somewhat towards thes back and somewhat towards the headhead ••Release pressure only when proper tubeRelease pressure only when proper tube placement is confirmed and the cuff isplacement is confirmed and the cuff is inflatedinflated 7. Provide primary and secondary7. Provide primary and secondary confirmation of tracheal tubeconfirmation of tracheal tube placementplacement PrimaryPrimary -- As the bag is squeezed, listen over theAs the bag is squeezed, listen over the epigastriumepigastrium and observe the chest wall forand observe the chest wall for movement.movement. -- If you hear stomach gurgling and no chestIf you hear stomach gurgling and no chest rise, you haverise, you have intubatedintubated thethe esophagusesophagus -- Stop ventilation and remove tubeStop ventilation and remove tube –– ReattemptReattempt intubationintubation afterafter reoxygenatingreoxygenating thethe victimvictim –– If the chest wall rises and no stomachIf the chest wall rises and no stomach gurgling listen to the lung fields withgurgling listen to the lung fields with 5 point5 point auscultationauscultation and document in medical recordand document in medical record ––Left and right anteriorLeft and right anterior –– left and rightleft and right mmiidaxillarydaxillary –– over the stomachover the stomach –– If there is any doubt, useIf there is any doubt, use laryngscopelaryngscope toto directly visualize (tube passing thru vocal cords)directly visualize (tube passing thru vocal cords) –– Secure the tubeSecure the tube –– Insert OP airwayInsert OP airway –– Look for moisture condensation inside the tubeLook for moisture condensation inside the tube SecondarySecondary -- Use of variety of electronic and mechanicalUse of variety of electronic and mechanical devicesdevices How to Ventilate With a Properly PlacedHow to Ventilate With a Properly Placed Tracheal TubeTracheal Tube –– tidal volume of 10tidal volume of 10--1515 mLmL/kg/kg –– 1 breath every 5 seconds1 breath every 5 seconds –– 2 seconds for each bag ventilation2 seconds for each bag ventilation –– Ventilate with 100% oxygenVentilate with 100% oxygen –– when O2 saturation measurements arewhen O2 saturation measurements are available respond accordingly when there is aavailable respond accordingly when there is a fall in the O2 saturationfall in the O2 saturation
  • 16. BASIC LIFE SUPPORT - CPR 16 •• Unprotected airwayUnprotected airway –– sets of 15 compressions at 100 per minutesets of 15 compressions at 100 per minute –– 2 ventilations at 2 seconds per ventilation2 ventilations at 2 seconds per ventilation •• Protected airwayProtected airway –– Continuous compression at 100 per minuteContinuous compression at 100 per minute –– Asynchronous with 1 ventilation at 2 secondsAsynchronous with 1 ventilation at 2 seconds per ventilation every 5 secondsper ventilation every 5 seconds •• Obtain a chest xObtain a chest x--ray as soon as possible toray as soon as possible to confirm position of tube within tracheaconfirm position of tube within trachea •• Never use a chestNever use a chest xrayxray to detectto detect inadvertentinadvertent esophagealesophageal insertion.insertion. ComplicationsComplications Insertion of Tube IntoInsertion of Tube Into EsophagusEsophagus •• Accidental insertion of tube intoAccidental insertion of tube into esophagusesophagus willwill result in no oxygenation or ventilationresult in no oxygenation or ventilation Tube Trauma and Adverse EffectsTube Trauma and Adverse Effects •• Lacerated lips or tongueLacerated lips or tongue •• Chipped teethChipped teeth •• Lacerated pharynx or tracheaLacerated pharynx or trachea •• Injury to the vocal cordsInjury to the vocal cords •• PharyngealPharyngeal--esophagealesophageal perforationperforation •• Vomiting and aspiration of the gastric contents intoVomiting and aspiration of the gastric contents into the lower airwaythe lower airway •• Release of high levels of epinephrine andRelease of high levels of epinephrine and norepinephinenorepinephine Insertion of Tracheal Tube Into 1 LungInsertion of Tracheal Tube Into 1 Lung •• Hypoxemia due toHypoxemia due to underinflationunderinflation of 1 lungof 1 lung Airway Control on Trauma PatientsAirway Control on Trauma Patients •• Assume that the patient with multiple trauma,Assume that the patient with multiple trauma, head injury or facial trauma has cervical spinehead injury or facial trauma has cervical spine injuryinjury Steps to follow in known or suspectedSteps to follow in known or suspected cervical spine traumacervical spine trauma –– Perform chin lift or Jaw thrust without head tiltPerform chin lift or Jaw thrust without head tilt –– Stabilize head in neutral positionStabilize head in neutral position –– OrotrachealOrotracheal intubationintubation in a patient with facialin a patient with facial fractures and fractures at the base of the skull,fractures and fractures at the base of the skull, another should provide spinal immobilizationanother should provide spinal immobilization –– Suction upper airwaySuction upper airway –– ConsiderConsider cricothyrotomycricothyrotomy oror tracheostomytracheostomy –– Use paralytic drugs in patients who cannot be inUse paralytic drugs in patients who cannot be in patients who cannot bepatients who cannot be intubatedintubated with thewith the above techniquesabove techniques Additional Techniques for InvasiveAdditional Techniques for Invasive Airway Control and VentilationAirway Control and Ventilation CricotyrotomyCricotyrotomy –– Allows rapid entrance into the airwayAllows rapid entrance into the airway –– CricothyroidCricothyroid membrane is opened with amembrane is opened with a scalpel and a tube is insertedscalpel and a tube is inserted
  • 17. BASIC LIFE SUPPORT - CPR 17 TracheostomyTracheostomy –– Surgical opening of the trachea and insertionSurgical opening of the trachea and insertion ofof tracheostomytracheostomy tubetube –– Performed under controlled conditions in thePerformed under controlled conditions in the OROR –– Should be performed after the airway hasShould be performed after the airway has been secured by a tracheal tube orbeen secured by a tracheal tube or cricotyrotomycricotyrotomy –– Not appropriate for urgent situations (airwayNot appropriate for urgent situations (airway obstruction or cardiac arrest)obstruction or cardiac arrest) ACLS Skill 2:ACLS Skill 2: Recognize the rhythmRecognize the rhythm •• Ventricular fibrillationVentricular fibrillation •• PulselessPulseless ventricular tachycardiaventricular tachycardia •• PulselessPulseless electrical activityelectrical activity •• asystoleasystole 1.1. Cardiac Arrest (lethal) RhythmsCardiac Arrest (lethal) Rhythms A.A. ShockableShockable rhythmsrhythms a)a) VFVF b)b) pulselesspulseless VTVT B.B. NonshockableNonshockable rhythmsrhythms a)a) AsystoleAsystole b)b) PulselessPulseless electrical activityelectrical activity -- Includes rhythms that produce electrical activity onIncludes rhythms that produce electrical activity on the monitor but no palpable pulsethe monitor but no palpable pulse -- Electromechanical dissociation,Electromechanical dissociation, bradyasystolicbradyasystolic rhythms,rhythms, pulselessidioventricularpulselessidioventricular rhythmsrhythms 2. Non Cardiac Arrest (2. Non Cardiac Arrest (nonlethalnonlethal) Rhythms) Rhythms A.A. Rhythm too slow ( < 60Rhythm too slow ( < 60 bpmbpm)) B.B. Rhythm too fast ( > 120Rhythm too fast ( > 120 bpmbpm)) ACLS Skill 3:ACLS Skill 3: DefibrillateDefibrillate 1.1. Turn on defibrillatorTurn on defibrillator 2.2. Select energy level at 200 J forSelect energy level at 200 J for monophasicmonophasic defibrillatorsdefibrillators 3.3. SetSet ““lead selectlead select”” switch onswitch on ““paddlespaddles”” 4.4. Apple gel or conductor padsApple gel or conductor pads 5.5. Position paddlesPosition paddles 6.6. Visually check the monitor display andVisually check the monitor display and assess rhythmassess rhythm 7.7. ““ChargingCharging fibrillatorfibrillator –– Stand Clear!Stand Clear!”” 8.8. Press charge button on apex paddle orPress charge button on apex paddle or defibrillator controlsdefibrillator controls 9.9. When fully charged state firmly:When fully charged state firmly: a)a) ““II’’m going to shock on three. One, Im going to shock on three. One, I’’mm clear.clear.”” b)b) ““Two, youTwo, you’’re clear.re clear.”” c)c) ““Three, everybodyThree, everybody’’s clear.s clear.”” 10.10.Apply 25lb of pressure on both paddlesApply 25lb of pressure on both paddles 11.11.Press the 2 paddlePress the 2 paddle ““dischargedischarge”” buttonbutton simultaneouslysimultaneously
  • 18. BASIC LIFE SUPPORT - CPR 18 12.12.Check the monitorCheck the monitor 13.13. Shock at 200 to 300 J, then at 360 JShock at 200 to 300 J, then at 360 J ACLS SkillACLS Skill 4:4: CardiovertCardiovert ACLS Skill 5:ACLS Skill 5: TranscutaneousTranscutaneous PacingPacing –– Delivers pacing impulses to the heart throughDelivers pacing impulses to the heart through the skin via adhesive electrodesthe skin via adhesive electrodes –– Use ofUse of transcutaneoustranscutaneous pacing forpacing for asystoleasystole andand pulselesspulseless electrical activity has beenelectrical activity has been disappointingdisappointing ACLS Skill 6:ACLS Skill 6: Gain IV Access to theGain IV Access to the CirculationCirculation •• Administer drugs and fluidsAdminister drugs and fluids •• Obtain venous blood for laboratoryObtain venous blood for laboratory determinationsdeterminations •• Insert catheters into the central circulationInsert catheters into the central circulation •• PeripheralPeripheral venipuncturevenipuncture –– Arm vein (Arm vein (antecubitalantecubital or hand)or hand) –– External jugular veinExternal jugular vein •• CentralCentral venipuncturevenipuncture –– Internal jugular veinInternal jugular vein –– SubclavianSubclavian veinvein –– Common femoral veinCommon femoral vein
  • 19. BASIC LIFE SUPPORT - CPR 19 •• Peripheral linePeripheral line –– Procedure of choiceProcedure of choice –– Peripheral sites are compressiblePeripheral sites are compressible –– May collapse during low flow statesMay collapse during low flow states •• Central lineCentral line –– Predictable locationPredictable location –– Allows for the use of large bore cathetersAllows for the use of large bore catheters –– Permits infusion of concentrated solutionsPermits infusion of concentrated solutions (greater flow)(greater flow) –– Damage to surrounding structuresDamage to surrounding structures •• General PrinciplesGeneral Principles –– Speed is essentialSpeed is essential –– Strict aseptic technique may be impossibleStrict aseptic technique may be impossible –– After patient is stabilizedAfter patient is stabilized cannulacannula should beshould be removed and replacedremoved and replaced –– During cardiac arrest follow all administeredDuring cardiac arrest follow all administered drugs by bolus administration of at least 20mldrugs by bolus administration of at least 20ml of IV salineof IV saline ACLS Skill 7:ACLS Skill 7: Provide AppropriateProvide Appropriate Resuscitation MedicationsResuscitation Medications •• Medications are used to meet the followingMedications are used to meet the following major objectivesmajor objectives –– Correct hypoxemiaCorrect hypoxemia –– Restore spontaneous circulation at an adequate bloodRestore spontaneous circulation at an adequate blood pressurepressure –– Promote optimal cardiac functionPromote optimal cardiac function –– Prevent or suppress significantPrevent or suppress significant arrythmiasarrythmias –– Relieve painRelieve pain –– Correct electrolyte abnormalities, adjust acidosis,Correct electrolyte abnormalities, adjust acidosis, counteract effects of excessive amounts of prescribedcounteract effects of excessive amounts of prescribed medications or illegitimate agentsmedications or illegitimate agents –– Treat congestive heart failureTreat congestive heart failure SummarySummary 1.1. Airway managementAirway management 2.2. Rhythm recognitionRhythm recognition 3.3. DefibrillationDefibrillation 4.4. CardioversionCardioversion 5.5. TranscutaneousTranscutaneous pacingpacing 6.6. Direct circulation access though intravenousDirect circulation access though intravenous catheterscatheters 7.7. Administration of appropriate resuscitationAdministration of appropriate resuscitation medicationsmedications

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