Cpr Bls
Upcoming SlideShare
Loading in...5
×
 

Cpr Bls

on

  • 6,833 views

 

Statistics

Views

Total Views
6,833
Views on SlideShare
6,821
Embed Views
12

Actions

Likes
4
Downloads
2,062
Comments
0

1 Embed 12

http://www.slideshare.net 12

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Cpr Bls Cpr Bls Presentation Transcript

  • RDT HOSPITALS EVERY C ARING P ERSON’S R ESPONSIBILITY
      • American Heart Association (AHA)
      • European Resuscitation Council (ERC)
      • Heart and Stroke Foundation of Canada (HSFC)
      • Resuscitation Council of Southern Africa (RCSA)
      • Australia and New Zealand Council on Resuscitation (ANZCOR)
      • Anti-American Heart Foundation (IAHF)
      • Japan Resuscitation Council (JRC) – International observer to ILCOR
    International Liaison Committee on Resuscitation
    • At least two international experts from different organizations review each topic
    • Minimum database requirements for every search strategy, include:
      • Medline
      • EMBase
      • Cochrane Systematic Reviews. 
    • Every reviewer rates the level and quality of evidence using a standardized international evidence evaluation form. 
    • There are separate international task forces for each of the following areas: BLS, ALS, Pediatric, Neonatal, ACS/MI, and Stroke. 
    • An additional interdisciplinary task force addresses topics that affect all groups.
    International Liaison Committee on Resuscitation
  • HISTORY OF CPR
    • 3000 BC - first artificial mouth to mouth ventilation
    • 1780 – first attempt of newborn resuscitation by blowing
    • 1874 – first experimental direct cardiac massage
    • 1901 – first successful direct cardiac massage in man
    • 1946 – first experimental indirect cardiac massage and defibrillation
    • 1960 – indirect cardiac massage
    • 1980 – development of cardiopulmonary resuscitation due to the works of Peter Safar
  • FACTS AND STATISTICS
    • DEATH FROM SUDDEN CARDIAC ARREST IS NOT INEVITABLE. IF MORE PEOPLE KNEW CPR, MORE LIVES COULD BE SAVED.
    • ABOUT 75 PERCENT TO 80 PERCENT OF ALL OUT-OF-HOSPITAL CARDIAC ARRESTS HAPPEN AT HOME & 94% OF SUDDEN CARDIAC ARREST VICTIMS DIE BEFORE REACHING THE HOSPITAL
    • EFFECTIVE BYSTANDER CPR, PROVIDED IMMEDIATELY AFTER CARDIAC ARREST, CAN DOUBLE A VICTIM’S CHANCE OF SURVIVAL.
    • APPROXIMATELY 95 PERCENT OF SUDDEN CARDIAC ARREST VICTIMS DIE BEFORE REACHING THE HOSPITAL.
    • ONLY 27.4 PERCENT OF OUT-OF-HOSPITAL SUDDEN CARDIAC ARREST VICTIMS RECEIVE BYSTANDER CPR
    • CARDIAC ARREST OCCURS TWICE AS FREQUENTLY IN MEN COMPARED TO WOMEN.
    • THERE HAS NEVER BEEN A CASE OF HIV TRANSMITTED BY MOUTH-TO-MOUTH CPR.
    • IF CPR IS STARTED WITHIN 4 MINUTES OF COLLAPSE AND DEFIBRILLATION PROVIDED WITHIN 10 MINUTES A PERSON HAS A 40% CHANCE OF SURVIVAL.
    • SURVIVAL < 6% WORLDWIDE AVERAGE
  • CARDIAC ARREST
    • CAUSES OF
    • CARDIAC ARREST
    CARDIAC EXTRA-CARDIAC
  • DIAGNOSIS OF CARDIAC ARREST
  •  
  • OBJECTIVES OF CPR
    • Provide oxygen to brain, heart, other vital organs until more expert/definitive medical treatment available.
    • Speed is critical
    • Highest discharge rate ……
    • CPR within 4 minutes of arrest
    • ACLS within 8 minutes.
    • Early bystander intervention
  • PHYSIOLOGY DURING CPR
    • 1. CIRCULATORY PHYSIOLOGY
    • A. BLOOD FLOW THEORIES
    • THORACIC PUMP THEORY
    • CARDIAC PUMP THEORY
    • CARDIAC OUTPUT
    • 2.
  • ELEMENTS OF BLS
    • A INITIAL ASSESSMENT,THEN AIRWAY MAINTENANCE
    • B EXPIRED AIR VENTILATION (RESCUE BREATHING)
    • C CHEST COMPRESSION.
    • D DEFIBRILLATION
  • CHAIN OF SURVIVAL
    • Early access to emergency services
    • Early CPR
    • Early defibrillation
    • Early advanced care
  • PRINCIPLES OF BLS
    • SHAKE
    • AND SHOUT
    • Check responsiveness
    • Call for help
  • BLS- HELLO + HELP
    • Determine if the patient is conscious by tapping and shouting &quot;Are you OK?&quot;
    • If no response have someone call for the crash cart
  • BLS- Airway
    • POSITION THE PATIENT ON HIS / HER BACK.
    • OPEN THE AIRWAY WITH A HEAD-TILT CHIN-LIFT OR
    • JAW THRUST
    • FINGER SWEEP
  • AIRWAY ADJUNCTS
    • AIRWAYS (NASAL & ORAL).
    • LARYNGEAL MASK AIRWAYS.
  • AIRWAY ADJUNCTS
    • COMBITUBES
    • ENDOTRACHEAL TUBES
  • B-BREATHING LOOK - for the chest to rise and fall LISTEN - for air escaping during exhalation FEEL - for the flow of air CHECK BREATHINGFOR NO LONGER THAN 10 SECS
  • B-BREATHING
    • IS THE VICTIM BREATHING?
    • YES
    • • IF SAFE, USE RECOVERY POSITION
    • • CALL FOR HELP
    • • REASSESS AT INTERVALS
  • RECOVERY POSITION
    • MAINTAIN A PATENT AIRWAY
    • REDUCE THE RISK OF AIRWAY OBSTRUCTION AND ASPIRATION
    • STABLE POSITION
    • NEAR A TRUE LATERAL POSITION
    • HEAD DEPENDENT
    • NO PRESSURE ON THE CHEST TO IMPAIR BREATHING
  • B-BREATHING
    • IS THE VICTIM BREATHING?
    • NO
    • • CALL FOR HELP
    • • GIVE TWO RESCUE BREATHS
  • BLS - BREATHING
    • RESCUE BREATHING
    • Give a sufficient tidal volume to produce visible chest rise
    • Avoid rapid or forceful breaths
    • Pinch the victim’s nose, and create an airtight mouth-to-mouth seal
    Take a normal breath prior to giving a rescue ventilation & ventilations that are approximately 1 second in length.
  • TYPES OF BREATHING
    • MOUTH TO MOUTH
    • MOUTH TO NOSE
    • MOUTH TO STOMA
    • BAG AND MASK
  • BLS- CIRCULATION ASSESSMENT Check for a pulse by palpating(feeling) the carotid artery. THE HEALTHCARE PROVIDER SHOULD TAKE NO MORE THAN 10 SECONDS CHECK FOR A PULSE
  • BLS- CIRCULATION
    • DO YOU DEFINITELY FEEL PULSE WITHIN 10 SECONDS?
    • YES
    • • CONTINUE WITH RESCUE BREATHING
    • • REASSESS FOR SIGNS OF A CIRCULATION ABOUT EVERY MINUTE
  • BLS- CIRCULATION
    • DO YOU DEFINITELY FEEL PULSE WITHIN
    • 10 SECONDS?
    • NO
    • • START CHEST COMPRESSIONS
    • • CONTINUE WITH RESCUE BREATHING
  • BLS- CIRCULATION
    • COMPRESSIONS
    • Chest compressions consist of rhythmic applications of pressure over the lower half of the sternum
    • These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart
    • Chest compressions can produce systolic arterial pressure peaks of 60 to 80 mm Hg
  • BLS- CIRCULATION
    • PROPER HAND PLACEMENT
  • BLS- CIRCULATION The victim should lie supine on a hard surface(eg, backboard or floor), with the rescuer kneeling beside the victim’s thorax Correct compression technique and posture. Elbows straight, eyes looking at the top of your hands, counting each compression
  • COMPRESSION–VENTILLATION RATIO
    • A compression-ventilation ratio of 30:2 is recommended
    • Designed to
      • increase the number of compressions
      • reduce the likelihood of hyperventilation
      • minimize interruptions in chest compressions for ventilation
  • COMPRESSION–VENTILLATION RATIO
    • Once an advanced airway is in place, the compressing rescuer should give continuous chest compressions at a rate of 100 per minute without pauses for ventilation.
    • The rescuer delivering ventilation provides 8 to 10 breaths per minute.
    • NOTE: The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest
  • DEFIBRILLATION
    • All BLS providers should be trained to provide defibrillation because VF is the most common rhythm found in adults with witnessed, non traumatic SCA
    • Survival rates are highest when immediate bystander CPR is provided and defibrillation occurs within 3 to 5 minutes.
    • Unwitnessed cardiac arrest -rescuers may give a period of CPR (e.g., about 5 cycles or about 2 minutes) before checking the rhythm and attempting defibrillation.
  •  
  • MONOPHASIC Vs BIPHASIC
    • 1st-shock efficacy of monophasic < 1st-shock efficacy of biphasic
    • Goal: delivery of current through chest to the heart to depolarize myocardial cells and eliminate VF/VT
    • Monophasic:
      • delivers current of one polarity
      • 1-shock 360J
    • Biphasic :
      • <200J as safe and w/ higher efficacy than higher voltage in monophasic
      • 120J, 150J, 200J
  • SUMMARY OF BLS USE AED ASAP
  • PHASES OF CPR POSSIBLE THERAPEUTIC HYPOTHERMIA OR OTHER NEW CONCEPT AFTER ABOUT 10 TO 15 MIN METABOLIC PHASE 3 CPR BEFORE ELECTRICAL THERAPY ABOUT 5 MIN TO 10 OR 15 MIN AFTER ARREST CIRCULATORY (HEMODYNAMIC) PHASE 2 ELECTRICAL THERAPY FROM TIME OF ARREST TO ABOUT THE FIRST 5 MIN AFTER ARREST ELECTRICAL PHASE 1 IMPORTANT INTERVENTION TIME FROM VF ARREST PHASE NAME PHASE
  • ADULT BLS ALGORITHM NO RESPONSE
    • OPEN AIRWAY
    • CHECK BREATHING
    • PHONE 911
    • GET AED
    IF NOT BREATHING, GIVE 2 RESCUE BREATHS
  • IF NO RESPONSE CHECK PULSE
    • NO PULSE
    • GIVE CV CYCLES OF 30 : 2 UNTILL
    • AED / DEFIBRILLATOR ARRIVES
    • ACLS PROVIDER TAKES OVER
    • VICTIM STARTS TO MOVE
    • DEFINITE PULSE
    • GIVE 1 BREATH EVERY 5 SECS
    • RECHECK PULSE EVERY 2 MINS
  • AED / DEFIBRILLATOR ARRIVES
    • SHOCKABLE
    • GIVE 1 SHOCK
    • RESUME CPR IMMIDIATELY
    • FOR 5 CYLCLES
    CHECK RHYTHM ?
    • NOT SHOCKABLE
    • RESUME CPR IMMIDIATELY FOR 5 CYCLES
    • CHECK RHYTHM EVERY 5 CYCLES
    • CONTINUE UNTILL ALS TEAM TAKES
    • OVER OR VICTIM STARTS TO MOVE
  • FOREIGN BODY AIRWAY OBSTRUCTION
    • CAUSES FOR OBSTRUCTION ?
    • HOW TO RECOGNIZE ?
    • UNIVERSAL DISTRESS SIGNAL ?
    • HOW TO ASSESS AND TREAT ?
    • MILD OBSTRUCTION
    • VICTIM IS
    • CONCIOUS
    • COUGHING
    • WHEEZY BREATHING
    • ENCOURAGE COUGHING
    • DONOT INTERVENE
    FOREIGN BODY AIRWAY OBSTRUCTION
    • SEVERE OBSTRUCTION
    • VICTIM IS
    • CONCIOUS OR UNCONCIOUS
    • SEVERE COUGHING
    • RESPIRATORY DISTRESS
    • SILENT CHEST
    • CYANOSIS
    • HEIMLICH MANEUVER
    • CPR FOR UNRESPONSIVE VICTIMS
    • NO BLIND FINGER SWEEPS
    FOREIGN BODY AIRWAY OBSTRUCTION
    • HEIMLICH MANEUVER
    • OBDOMINAL THRUSTS
    • TECNIQUE
      • PLACE FIST JUST ABOVE THE UMBILICUS
      • GIVE 5 UPWARD AND INWARD THRUSTS
      • NOTE :PREGNANT OR OBESE?
        • CHEST THRUSTS WITH FISTS ON STERNUM
        • IF UNSUCCESSFUL, SUPPORT CHEST WITH ONE HAND AND GIVE BACK BLOWS WITH THE OTHER
  • PREGNANCY AND BLS
    • KEY POINTS
    • DURING RESUSCITATION THERE ARE TWO PATIENTS, MOTHER & FETUS
    • THE BEST HOPE OF FETAL SURVIVAL IS MATERNAL SURVIVAL
    • CONSIDER THE PHYSIOLOGIC CHANGES DUE TO PREGNANCY
  • PREGNANCY AND BLS
    • PLACEMENT OF A ROLLED BLANKET OR OTHER OBJECT UNDER THE RIGHT HIP
    • REDUCE THE VOLUME OF VENTILATION BECAUSE OF THE ELEVATED DIAPHRAGM
    • PERFORM CHEST COMPRESSIONS ABOVE CENTER OF THE STERNUM
    • TO ADJUST FOR THE ELEVATION OF DIAPHRAGM AND ABDOMINAL CONTENTS
    • THERE IS NO EVIDENCE THAT DEFIBRILLATION HAS ADVERSE EFFECT ON HEART OF THE FETUS
    • CONSIDER EMERGENCY LSCS IN THE NEAREST HOSPITAL
  • DROWNING AND BLS
    • MALES > FEMALES
    • 2 ND -3 RD LEADING CAUSE OF DEATH IN CHILDHOOD
    • DEFINITION
    • PROCESS RESULTING IN PRIMARY RESPIRATORY IMPAIRMENT
    • FROM SUBMERSION/IMMERSION IN A LIQUID MEDIUM
    • CLASSIFICATION
    • OUTCOME
  • DROWNING AND BLS
    • MODIFICATIONS IN BLS INCLUDE
    • RESCUE AND RECOVERY
      • RAPID AND CAUTIOUS RETRIEVAL FROM THE WATER
      • RESCUER MUST ALWAYS BE AWARE OF PERSONAL SAFETY
    • AIRWAY - MAINTAIN AIRWAY WITH C- SPINE PRECAUTIONS
    • - NO NEED TO CLEAR THE AIRWAY OF ASPIRATED WATER
    • BREATHING
    • - MOUTH TO MOUTH
    • - GIVE 2 RESCUE BREATHS
    • CIRCULATION
    • - FOLLOW BLS SEQUENCE
    • NOTE:
    • AVOID ABDOMINAL THRUSTS
    • 75% OF VICTIMS VOMIT DURING RESCUE BREATHING
  •  
  •  
  • BOXES BORDERED WITH DOTTED LINES INDICATE ACTIONS OR STEPS PERFORMED BY THE HEALTHCARE PROVIDER BUT NOT THE LAY RESCUER .
  • HIGH QUALITY CPR
    • RATE - PUSH HARD, PUSH FAST 100/MIN
    • DEPTH - 1.5 TO 2 inches
    • COMPLETE CHEST RECOIL
    • MINIMISE INTERRUPTIONS
    • CHANGE REGULARLY
    • COMPRESSION-VENTILATION RATIO OF 30:2 IS RECOMMENDED
    • RESTORE CORONARY & CEREBRAL BLOOD FLOW
  • TYPES OF CPR
    • 1. CLOSED COMPRESSION CPR
    • 2. ACD – CPR
    • 3. IAP – CPR
    • 4. VEST – CPR
    • 5. INVASIVE CPR
  • HANDS – ONLY CPR
    • WHAT IS HANDS –ONLY CPR?
    • CPR WITHOUT MOUTH-TO-MOUTH BREATHS.
    • IT IS RECOMMENDED FOR “OUT-OF HOSPITAL” SETTING
    • IT CONSISTS OF TWO STEPS
      • CALL 911
      • PROVIDE HIGH-QUALITY COMPRESSIONS WITHOUT INTERRUPTIONS
    • WHO SHOULD RECEIVE ?
    • VICTIMS WHO SUDDENLY COLLAPSE
    • WHEN AN ADULT SUDDENLY COLLAPSES WITH CARDIAC ARREST, THEIR LUNGS AND BLOOD CONTAIN ENOUGH OXYGEN TO KEEP VITAL ORGANS HEALTHY FOR THE FIRST FEW MINUTES
    • IS HANDS ONLY CPR AS EFFECTIVE AS CONVENTIONAL CPR?
    • SHOWN TO BE AS EFFECTIVE AS CONVENTIONAL CPR (CPR THAT INCLUDES BREATHS) IN THE FIRST FEW MINUTES OF AN OUT-OF-HOSPITAL SUDDEN CARDIAC ARREST
    • . HAS AMERICAN HEART ASSOCIATION CHANGED ITS RECOMMENDATION FOR HEALTHCARE PROVIDERS? NO , IT HAS NOT CHANGED
    • IT IS RECOMMENDED FOR ONLY BY-STANDER CPR
  • END-POINTS OF CPR
    • ROSC: RESTORATION OF ADEQUATE CARDIAC FUNCTION
    • SUCCESSFUL RESUSCITATION: RESTORATION OF NORMAL BRAIN FUNCTION.
    • LIKELIHOOD OF ACHIEVING BOTH THESE GOALS DECREASES WITH EVERY MINUTE IN CARDIAC ARREST.
    • CARDIAC OUTPUT BY STANDARD CHEST COMPRESSION IS AT BEST <30% BASELINE; DECREASES PRECIPITOUSLY WITH TIME TO INITIATION AND DURATION OF CHEST COMPRESSION.
  • COMPLICATIONS OF CPR
    • INEVITABLE COMPLICATIONS RIB FRACTURE
    • STERNAL FRACTURE
    • CARDIAC CONTUSION
    • LUNG CONTUSION
    • DUE TO IMPROPER CHEST PNEUMOTHORAX
    • COMPRESSIONS LIVER / SPLEEN INJURIES
    • CARDIAC RUPTURE
    • AORTIC INJURIES
    • ESOPHAGUS / STOMACH INJURIES
    • DUE TO IMPROPER REGURGITATION OF STOMACH
    • VENTILLATION CONTENTS
    • VOMITTING
    • ASPIRATION
  • COMMON ELEMENTS OF SUCCESS
    • TRAINED RESCUERS
    • RAPID RECOGNITION
    • PROMPT CPR
    • DEFIBRILLATION < 5 MIN
  • CRITERIA FOR NOT STARTING CPR
    • PATIENTS IN CARDIAC ARREST SHOULD NOT RECEIVE RESUSCITATION IF
      • PATIENT HAS A VALID DO NOT ATTEMPT RESUSCITATION ORDER
      • PATIENT HAS SIGNS OF IRREVERSIBLE DEATH
      • NO PHYSIOLOGICAL BENEFIT CAN BE EXPECTED BECAUSE VITAL FUNCTIONS HAVE DETERIORATED DESPITE MAXIMAL THERAPY
  • WHY CPR MAY FAIL ?
    • DELAY IN STARTING
    • IMPROPER PROCEDURES (EX. FORGET TO PINCH NOSE)
    • NO ACLS FOLLOW-UP AND DELAY IN DEFIBRILLATION
      • ONLY 15% WHO RECEIVE CPR LIVE TO GO HOME
      • IMPROPER TECHNIQUES
    • TERMINAL DISEASE OR UNMANAGEABLE DISEASE
    • (MASSIVE HEART ATTACK)
  • WHY CPR MAY FAIL ? Rate too slow Depth too shallow Ventilation rate too high
  • WHEN CAN I STOP CPR?
    • VICTIM REVIVES
    • TRAINED HELP ARRIVES
    • TOO EXHAUSTED TO CONTINUE
    • UNSAFE SCENE
    • PHYSICIAN DIRECTED (DO NOT RESUSCITATE ORDERS)
    • CARDIAC ARREST OF LONGER THAN 30 MINUTES
      • (CONTROVERSIAL)
  • CPR VIDEO
  •  
  • Questions