Basic life support

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Basic life support

  1. 1. Basic Life Support
  2. 2. BLS: Definition • level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training.
  3. 3. Adult Chain of Survival 1.Early intervention 2.Immediate recognition of cardiac arrest and activation of the emergency response system (EMS) 3. Early CPR with an emphasis on chest compressions 4. Rapid defibrillation 5. Effective advanced life support 6. Integrated post–cardiac arrest care
  4. 4. Adult Chain of Survival
  5. 5. TIME IS GOLD!!!
  6. 6. Call First or CPR First? Call First 1. Activate EMS 2. Return to victim 3. Provide CPR CPR First 1. Give 5 cycles (2 minutes) of CPR 2. Leave victim 3. Activate EMS
  7. 7. Call First or CPR First? Call First!!! • Sudden collapse in adult or child • Collapse likely cardiac in origin CPR First!!! • Drowning victim • Asphyxial (primary respiratory) arrest in any age
  8. 8. When to CPR? • In the absence of breathing and pulse in an unresponsive victim • If the victim has agonal gasps • If victim is in cardiac arrest
  9. 9. How to approach victim? • *HAZARD • *HELLO • *HELP • *CIRCULATION/ COMPRESSION • *AIRWAY • *BREATHING • *DEFIBRILLATION
  10. 10. HIGH QUALITY CPR • A compression rate of at least 100/min (a change from “approximately” 100/min) • A compression depth of at least 2 inches (5 cm) in adults and a compression depth of at least one third of the anterior-posterior diameter of the chest in infants and children(approximately 1.5 inches [4 cm] in infants and 2 inches [5 cm] in children). Note that the range of 1. to 2 inches is no longer used for adults, and the absolute depth specified for children and infants is deeper than in previous versions of AHA Guidelines for CPR and ECC • Allowing for complete chest recoil after each compression • Minimizing interruptions in chest compressions • Avoiding excessive ventilation
  11. 11. HIGH QUALITY CPR There has been no change in the recommendation for a compression-to-ventilation ratio of 30:2 for single rescuers of adults, children, and infants (excluding newly born infants). The 2010 AHA Guidelines for CPR and ECC continue to recommend that rescue breaths be given in approximately 1 second. Once an advanced airway is in place, chest compressions can be continuous (at a rate of at least 100/min) and no longer cycled with ventilations. Rescue breaths can then be provided at about 1 breath every 6 to 8 seconds (about 8 to 10 breaths per minute). Excessive ventilation should be avoided.
  12. 12. Key issues: LR’s Adult CPR • The simplified universal adult BLS algorithm has been created • Refinements have been made to recommendations for immediate recognition and activation of the emergency response system based on signs of unresponsiveness, as well as initiation of CPR if the victim is unresponsive with no breathing or no normal breathing (ie, victim is only gasping). • Continued emphasis has been placed on highquality CPR (with chest compressions of adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation).
  13. 13. Key issues: LR’s Adult CPR • “Look, listen, and feel for breathing” has been removed from the algorithm. • There has been a change in the recommended sequence for the lone rescuer to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). The lone rescuer should begin CPR with 30 compressions rather than 2 ventilations to reduce delay to first compression. • Compression rate should be at least 100/min (rather than “approximately” 100/min). • Compression depth for adults has been changed from the range of 1. to 2 inches to at least 2 inches (5 cm).
  14. 14. Key issues: HCP BLS • Because cardiac arrest victims may present with a short period of seizure-like activity or agonal gasps that may confuse potential rescuers, dispatchers should be specifically trained to identify these presentations of cardiac arrest to improve cardiac arrest recognition. • Dispatchers should instruct untrained lay rescuers to provide Hands-Only CPR for adults with sudden cardiac arrest. • Refinements have been made to recommendations for immediate recognition and activation of the emergency response system once the healthcare provider identifies the adult victim who is
  15. 15. Key issues: HCP BLS unresponsive with no breathing or no normal breathing (ie, only gasping). The healthcare provider briefly checks for no breathing or no normal breathing (ie, no breathing or only gasping) when the provider checks responsiveness. The provider then activates the emergency response system and retrieves the AED (or sends someone to do so). The healthcare provider should not spend more than 10 seconds checking for a pulse, and if a pulse is not definitely felt within 10 seconds, should begin CPR and use the AED when available.
  16. 16. Key issues: HCP BLS • “Look, listen, and feel for breathing” has been removed from the algorithm. • Increased emphasis has been placed on highquality CPR (compressions of adequate rate and depth, allowing complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation). • Use of cricoid pressure during ventilations is generally not recommended. • Rescuers should initiate chest compressions before giving rescue breaths. Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression.
  17. 17. Key issues: HCP BLS • Compression rate is modified to at least 100/min from approximately 100/min. • Compression depth for adults has been slightly altered to at least 2 inches (about 5 cm) from the previous recommended range of about 1. to 2 inches (4 to 5 cm). • Continued emphasis has been placed on the need to reduce the time between the last compression and shock delivery and the time between shock delivery and resumption of compressions immediately after shock delivery. • There is an increased focus on using a team approach during CPR.
  18. 18. The ABC’s of CPR (2005 AHA) A irway Does the victim have an open airway? B reathing Is the victim breathing? C irculation/ C ompression - Ventilation Is the victim’s heart beating? Is the victim bleeding severely? D efibrillation
  19. 19. The CAB’s of CPR (2010 AHA) C irculation/ C ompression Is the victim’s heart beating? Is the victim bleeding severely? A irway Does the victim have an open airway? B reathing Is the victim breathing? D efibrillation
  20. 20. Badger County/Mayo Clinic H azard H ello H elp!!! C irculation Check C ompression for 2 minutes (200 compressions)
  21. 21. Position the Victim / Rescuer • Supine and on a firm surface • Head & neck should be in the same plane • Rescuer kneeling at victim’s thorax to perform both rescue breathing & chest compression
  22. 22. CIRCULATION
  23. 23. Adult BLS Sequence • Pulse check • Take at least 5 seconds & NOT more that 10 seconds
  24. 24. The way of finding the position of the heart massage The two finger upper side from the xiphisternal tip
  25. 25. The way of crossing a hand and the way of the oppression
  26. 26. Put hand(s) in correct position for chest compressions
  27. 27. Give 30 chest compressions at rate of 100 per minute Then give 2 ventilations
  28. 28. Chest Compressions Alert • Be careful with your hand position • For adults/children, keep your fingers off patient’s chest • Do not give compressions over bottom tip of breastbone
  29. 29. Chest Compressions Alert • When compressing, keep elbows straight and hands in contact with patient’s chest at all times
  30. 30. Chest Compressions Alert • Compress chest hard and fast, but let chest recoil completely between compressions. Minimize amount of time used giving ventilations between sets of compressions.
  31. 31. Locating hand position for chest compressions • Place heel of hand in the center of the chest with the heel of the other hand on top • Interlace your fingers or lift them off the victim’s chest
  32. 32. Chest compressions • Position your body directly over your hands • Shoulders should be above the hands • Elbows should be straight • Look down on your hands
  33. 33. Chest compressions • Push hard & push fast • Depress sternum to 2 inches (5 cm) at a rate of 100 compressions per minute
  34. 34. Chest compressions • Allow chest wall to recoil completely • No interruption with the compression
  35. 35. Roles of Each Rescuer Rescuer Location Actions Rescuer 1 At the victim’s side - Performs chest compressions - Counts out loud - Switches duties with Rescuer 2 every 5 cycles or 2 minutes, taking less than 5 seconds to switch Rescuer 2 At the victim’s head - Maintains an open airway - Gives breaths, watching for chest rise & avoiding hyperventilation - Encourages Rescuer 1 to perform compressions that are fast & deep enough & to allow full chest recoil between compressions - Switches duties with Rescuer 1 every 5 cycles of 2 minutes, taking less than 5 seconds to switch
  36. 36. AIRWAY • First thing to check in initial assessment • You may need to open airway, maintain its patency, or clear it when it is compromised
  37. 37. Check Airway for Patency • Open mouth with gloved hand • Listen for sounds indicating liquid in airway • Look inside for fluids, solids, or objects • Clear using finger sweep or suction
  38. 38. AIRWAY • Open the airway • Head-tilt chin lift • Jaw thrust WITHOUT head extension
  39. 39. Head Tilt-Chin Lift • Simple, safe, easily learned and effective • Choice unless trauma to neck is suspected
  40. 40. Head Tilt-Chin Lift • Place your hand on victim’s forehead • Gently tilt head back • With your fingertips under point of victim’s chin, lift chin to open airway
  41. 41. Jaw Thrust • For suspected trauma to the neck • Place one hand on each side of victim’s head • Rest elbows on the surface on which the victim is lying • Grasp angles of victim’s lower jaw & lift with both hands
  42. 42. BREATHING • Look for adequate breathing in adults • Look for presence or absence of breathing in children and infants
  43. 43. Face Masks • Resuscitation mask seals over mouth/nose with port through which you blow air to give ventilations • One-way valve allows your air through mouthpiece, patient’s exhaled air exits through different opening. • When using face mask, seal mask well to face while maintaining an open airway • Use bridge of nose as guide for correct placement
  44. 44. FACE MASKS
  45. 45. Position at Top of Victim’s Head: Head-tilt-chin-lift
  46. 46. Position at Top of Victim’s Head: Jaw Thrust
  47. 47. BREATHING
  48. 48. LLF • Check breathing • Look, listen, & feel • Evaluation should take at least 5 seconds & NOT last more than 10 seconds
  49. 49. Adult BLS Sequence If with adequate breathing • Put in Recovery Position
  50. 50. Adult BLS Sequence If adequate breathing is NOT detected within 10 seconds OR patient has occasional gasps • Give 2 rescue breaths; each over 1 sec • Enough volume to produce visible chest rise • Avoid rapid / forceful breaths
  51. 51. Mouth-to-Mouth Rescue Breathing Note: • Pinch nostrils closed • Make tight seal around victim’s mouth • Open nostrils after giving rescue breath
  52. 52. Mouth-to-Mouth Rescue Breathing • • • • • Open airway Create airtight mouth-to-mouth seal Give 1 breath over 1 second Take REGULAR (not deep) breath Give 2nd rescue breath over 1 second
  53. 53. Mouth-to-Mouth Rescue Breathing • Most common cause of ventilation difficulty is an improperly opened airway • If NO chest rise with first rescue breath: Perform head-tilt chin lift again then give 2nd rescue breath
  54. 54. Defibrillation
  55. 55. Ventricular Fibrillation • Most common rhythm found in adults with witnessed non-traumatic sudden cardiac death • Treatment of choice: DEFIBRILLATION • Higher survival rate if immediate bystander CPR plus defibrillation occurs within 3-5 minutes
  56. 56. Arrest NOT Witnessed • CPR x 2 minutes • Check rhythm • Give 1 shock if needed • Immediate CPR x 2 minutes • Recheck rhythm Witnessed or In-Hospital Arrest • Use defibrillator as soon as it is available • Check rhythm • Give 1 shock if needed • Immediate CPR x 2 minutes • Recheck rhythm
  57. 57. When do you STOP CPR? • Spontaneous breathing is present (ROSC) • The rescuer is exhausted • Orders from the Doctor/DNR Order is presented • Paramedics or advanced team arrives • Patient obviously dead
  58. 58. Severe Airway Obstruction • Victim is getting no air at all • Victim will soon become unresponsive • Heart will soon stop
  59. 59. Mild Airway Obstruction • Victim is still getting some air into lungs around object • Victim may be able to cough out object
  60. 60. Assessing An Airway Obstruction • Most cases in adults occur while eating • Most cases in infants and children occur while eating/playing • Often someone is present recognizing choking event while patient responsive
  61. 61. Mild Obstruction • Victim is coughing forcefully • Victim is getting some air • Wheezing or high pitched sounds with breath • Do not interrupt coughing or attempts to expel object
  62. 62. Severe Obstruction • Victim getting little air or none • Victim may look frantic and be clutching at throat • Victim may have pale or bluish coloring around mouth and nail beds • Victim may be coughing weakly and silently or not at all • Victim cannot speak
  63. 63. Assessing Airway Obstruction in Unresponsive Patient • If patient’s head is positioned to open airway but patient is not breathing, give 2 ventilations • If first breath doesn’t go in, try again and give a second breath • If it still does not go in, assume that there is obstructed airway
  64. 64. Care for FBAO • Depends on whether patient is responsive or unresponsive; whether the obstruction is mild or severe • For responsive, choking patient who is coughing, encourage coughing • For responsive, choking patient who cannot speak or cough forcefully, give abdominal thrusts • For unresponsive patient with an FBAO, if ventilations do not go in, ensure additional EMS personnel have been summoned and begin CPR
  65. 65. Management of Severe Airway Obstructions in Responsive Patients • Ask for consent, tell patient what you intend to do, and give abdominal thrusts • With child/someone much shorter than you, kneel behind patient • If patient is much taller than you, ask patient to kneel/sit
  66. 66. Management of Severe Airway Obstructions in Responsive Patients • Abdominal thrusts can cause internal injury, patient should be examined by a healthcare provider • When severe obstruction is not cleared, patient will become unresponsive within minutes
  67. 67. Skill: Body Severe Foreign Airway Obstruction (Responsive Adult or Child)
  68. 68. Stand behind victim. One leg between victim’s legs. Head to one side.
  69. 69. Abdominal Thrust • Stand behind victim & put both hands around upper part of abdomen • Lean victim forwards • Clench fist & place it thumb side against victim’s abdomen between the umbilicus & xiphoid
  70. 70. Abdominal Thrust • Grasp this hand with the other • Pull sharply inwards & upwards • Repeat until object is expelled or victim becomes unresponsive
  71. 71. Abdominal Thrust • If you find a CONSCIOUS choking victim lying on the ground, do abdominal thrusts in the supine position
  72. 72. Relief of FBAO • Do CHEST THRUSTS if: • Abdominal thrusts are NOT effective • Rescuer is unable to encircle obese victim’s abdomen • Victim is in late stages of pregnancy
  73. 73. Management of Airway Obstructions in Unresponsive Patients • Make sure additional EMS personnel have been called • Provide CPR • Begin by opening airway • When opening patient’s mouth, look first for an object in mouth • If you see an object in mouth, remove it with finger sweep • Then give 2 breaths and check for a pulse
  74. 74. CPR for Airway Obstructions in Unresponsive Patients • Chest compressions given in CPR may expel object • While giving CPR, each time you open mouth, check to see if object is visible, and remove it if so
  75. 75. Foreign Body Airway Obstructions in Infants/Children • Most child deaths from FBAOs occur under age 5, mostly in infants • Foreign bodies include: • Toys and other small objects • Pieces of popped balloons • Food such as hot dogs, round candies, nuts, and grapes
  76. 76. Foreign Body Airway Obstructions in Infants/Children • Suspect FBAO in an infant/child with onset of respiratory distress associated with coughing, gagging, stridor, or wheezing • If responsive infant can cry/cough, watch carefully to see if the object comes out
  77. 77. Responsive Choking Infant Who Cannot Cry/Cough • Ensure that additional EMS personnel have been summoned • Give alternating back slaps/chest thrusts to expel object • If Choking Infant Becomes Unresponsive • Give CPR, start with chest compressions • Check for object in mouth, remove any object you see
  78. 78. Unresponsive Infant when Encountered • Open airway; check for breathing • If not breathing, give 2 breaths • If first breath doesn’t go in, try again after repositioning head to open airway • If second breath doesn’t go in, assume an airway obstruction— provide CPR
  79. 79. Skill: Severe Foreign Body Airway Obstruction (Responsive Infant)
  80. 80. Severe Foreign Body Airway Obstruction in Responsive Infant • Check for expelled object • If not present, continue with next step
  81. 81. Give up to 5 back slaps between shoulder blades
  82. 82. Roll infant face up.
  83. 83. Check for expelled object. If not present, continue with next step.
  84. 84. Give 5 chest thrusts. Check mouth for expelled object. Repeat back slaps and chest thrusts as necessary.

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