Basic life support

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  • AED will analyze your heart rhythm
    AED will shock whoever is touching victim
  • PEA doesn’t necessarily mean there is no organized electrical activity. There could be any rhythm on the strip, and you can use that to narrow down your differential.
  • Basic life support

    1. 1. Your Logo Basic Life SupportBasic Life Support Iman HassanIman Hassan Assistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine Ain Shams UniversityAin Shams University E-mail: dr.imangalal@gmail.comE-mail: dr.imangalal@gmail.com
    2. 2.  Page 2 Basic Life SupportBasic Life Support Our GoalOur Goal Early Access Early CPR Early Defibrillation Early ACLSEarly Access Early CPR Early Defibrillation Early ACLS To “save hearts too good to die” while preserving cerebralTo “save hearts too good to die” while preserving cerebral viability.viability. To takeTo take RapidRapid decisions becausedecisions because IrreversibleIrreversible brainbrain damage may occur withindamage may occur within 4 minutes4 minutes of cardiac arrest.of cardiac arrest.
    3. 3.  Page 3 Basic Life SupportBasic Life Support Basic life support (BLS)Basic life support (BLS) is a specific level of pre-is a specific level of pre- hospital medical care provided by trained responders,hospital medical care provided by trained responders, including emergency medical technicians, in the absence ofincluding emergency medical technicians, in the absence of advanced medical care.advanced medical care. BLSBLS generally does not include the use of drugs or invasivegenerally does not include the use of drugs or invasive skills, and can be contrasted with the provision ofskills, and can be contrasted with the provision of Advanced cardiac life support (ACLS).Advanced cardiac life support (ACLS). CPR provided in the field buys time for higher medicalCPR provided in the field buys time for higher medical responders to arrive & provide ACLS.responders to arrive & provide ACLS.
    4. 4.  Page 4 Basic Life SupportBasic Life Support
    5. 5.  Page 5 Basic Life SupportBasic Life Support At the end of the lesson you should be able to state &At the end of the lesson you should be able to state & describe the Adult BLS Algorithm, focusing on Cardiacdescribe the Adult BLS Algorithm, focusing on Cardiac Arrest in aArrest in a non drowningnon drowning,, non traumaticnon traumatic,, non toxicnon toxic adult collapse.adult collapse. The guidelines are based on the document 2005The guidelines are based on the document 2005 International Consensus on CardiopulmonaryInternational Consensus on Cardiopulmonary Resuscitation & Emergency Cardiovascular Care Science.Resuscitation & Emergency Cardiovascular Care Science.
    6. 6.  Page 6 Basic Life SupportBasic Life Support BLS consists of the following sequence of actions:BLS consists of the following sequence of actions: Make sure the victim, any bystanders & you are safe.Make sure the victim, any bystanders & you are safe. Check the victim for a response.Check the victim for a response. Gently shake his shoulders and ask loudly, ‘Are you all right?’Gently shake his shoulders and ask loudly, ‘Are you all right?’ If he responds:If he responds: – Leave him in the position in which you find him providedLeave him in the position in which you find him provided there is no further danger.there is no further danger. – Try to find out what is wrong with him and get help ifTry to find out what is wrong with him and get help if needed.needed. – Reassess him regularly.Reassess him regularly. If he does not respond:If he does not respond: – Shout for help.Shout for help. – Turn the victim supine aligned position or stable sideTurn the victim supine aligned position or stable side position.position.
    7. 7.  Page 7 Basic Life SupportBasic Life Support
    8. 8.  Page 8 Basic Life SupportBasic Life Support Position on Back:Position on Back: All body parts rolled over at the same time. Always be aware of head & spinal cord injuries. Support neck & spinal column.
    9. 9.  Page 9 CARDIOPULMONARY RESUSCITATIONCARDIOPULMONARY RESUSCITATION IS AS EASY AS "A B C"IS AS EASY AS "A B C"
    10. 10.  Page 10 AAIRWAY:IRWAY: (Get it Open)(Get it Open) Chin Lift Maneuver.Chin Lift Maneuver. Jaw thrust maneuver.Jaw thrust maneuver. Manual clearing of mouth & throat.Manual clearing of mouth & throat. Endotracheal intubation & Tracheobronchial suctioning.Endotracheal intubation & Tracheobronchial suctioning. Oropharyngeal & Nasopharyngeal airway.Oropharyngeal & Nasopharyngeal airway. Cricothyrotomy - transtracheal OCricothyrotomy - transtracheal O22 jet insufflation -jet insufflation - Tracheotomy.Tracheotomy. Basic Life SupportBasic Life Support
    11. 11.  Page 11 Chin LiftChin Lift Jaw ThrustJaw Thrust Basic Life SupportBasic Life Support
    12. 12.  Page 12 Basic Life SupportBasic Life Support
    13. 13.  Page 13 Head-Tilt/Chin LiftHead-Tilt/Chin Lift maneuver in an infant.maneuver in an infant. Do not overextendDo not overextend the head & neck.the head & neck. Basic Life SupportBasic Life Support
    14. 14.  Page 14 Basic Life SupportBasic Life Support Use theUse the Jaw ThrustJaw Thrust to open your patient'sto open your patient's airway if you suspect aairway if you suspect a cervical spine injury.cervical spine injury.
    15. 15.  Page 15 RECOVERY POSITIONRECOVERY POSITION Basic Life SupportBasic Life Support
    16. 16.  Page 16 SuctionSuction fluids fromfluids from your patient’s airway.your patient’s airway. Basic Life SupportBasic Life Support
    17. 17.  Page 17 OropharyngealOropharyngeal AirwayAirway NasopharyngealNasopharyngeal AirwayAirway Basic Life SupportBasic Life Support
    18. 18.  Page 18 Oropharyngeal AirwayOropharyngeal Airway Basic Life SupportBasic Life Support
    19. 19.  Page 19 Basic Life SupportBasic Life Support
    20. 20.  Page 20 BBREATHING:REATHING: (Get it Started)(Get it Started) Position your cheek close to victim's nose & mouth, lookPosition your cheek close to victim's nose & mouth, look toward victim's chest, &toward victim's chest, & "Look, Listen & Feel""Look, Listen & Feel" forfor breathingbreathing (5-10 seconds).(5-10 seconds). IfIf Not BreathingNot Breathing, pinch victim's nose closed and give, pinch victim's nose closed and give 22 full breaths into victim's mouth (use a microshield or similarfull breaths into victim's mouth (use a microshield or similar barrier).barrier). If your rescue breaths won't go in, reposition the head & tryIf your rescue breaths won't go in, reposition the head & try again to give breaths.again to give breaths. If still blocked, suspect chocking & perform abdominalIf still blocked, suspect chocking & perform abdominal thrusts (Heimlich maneuver).thrusts (Heimlich maneuver). Basic Life SupportBasic Life Support
    21. 21.  Page 21 Basic Life SupportBasic Life Support LookLook,, ListenListen && FeelFeel for breathing forfor breathing for NoNo longerlonger thanthan 1010 secondsseconds  LookLook for chest movement.for chest movement.  ListenListen at the victim'sat the victim's mouth for breath sounds.mouth for breath sounds.  FeelFeel for air on your cheek.for air on your cheek.
    22. 22.  Page 22 BBreathing support:reathing support: Mouth-to-mouth (nose) ventilation. Mouth-to-adjunct with or without O2 Manual bag-mask (tube) ventilation with or without O2 Hand-triggered O2ventilation. Mechanical ventilation. Basic Life SupportBasic Life Support
    23. 23.  Page 23 Basic Life SupportBasic Life Support If the victim is not breathing, give 2 breaths (1 second or longer) • Pinch the nose • Seal the mouth with yours. If the first 2 don’t go in, re-tilt & give 2 more breaths (if breaths still do not go in, suspect choking)
    24. 24.  Page 24 Basic Life SupportBasic Life Support
    25. 25.  Page 25 Basic Life SupportBasic Life Support BBreathing:reathing: Mouth To NoseMouth To Nose (when to use?)(when to use?) Can’t open mouthCan’t open mouth Can’t make a good sealCan’t make a good seal Severely injured mouthSeverely injured mouth
    26. 26.  Page 26 CCIRCULATION:IRCULATION: (Get the Blood to the Brain)(Get the Blood to the Brain) Check forCheck for CarotidCarotid pulse by feeling forpulse by feeling for 5-105-10 secondsseconds at side of victims' neck.at side of victims' neck. If there isIf there is PulsePulse but victim isbut victim is Not BreathingNot Breathing,, give rescue breathing at rate ofgive rescue breathing at rate of 11 breathbreath every 5every 5 secondsseconds oror 1212 breathsbreaths per minute.per minute. Basic Life SupportBasic Life Support
    27. 27.  Page 27 Basic Life SupportBasic Life Support
    28. 28.  Page 28 If there isIf there is No PulseNo Pulse,, begin chest compressions as follows:begin chest compressions as follows: Place the heel of one hand on lower part of victim's sternum.Place the heel of one hand on lower part of victim's sternum. With your other hand directly on top of first hand and armsWith your other hand directly on top of first hand and arms locked straight, depress sternumlocked straight, depress sternum 4 - 5 cms.4 - 5 cms. PerformPerform 3030 compressions to everycompressions to every 2 breaths.2 breaths. Check for return of pulseCheck for return of pulse every minute.every minute. Basic Life SupportBasic Life Support ContinueContinue UNINTERRUPTEDUNINTERRUPTED untiluntil ADVANCED LIFEADVANCED LIFE SUPPORTSUPPORT isis Available.Available.
    29. 29.  Page 29 Basic Life SupportBasic Life Support Chest compression Only CPR:Chest compression Only CPR: If you are not able, or are unwilling, to give rescueIf you are not able, or are unwilling, to give rescue breaths, give chest compressions only.breaths, give chest compressions only. If chest compressions only are given, these should beIf chest compressions only are given, these should be continuous at a rate ofcontinuous at a rate of 100/minute.100/minute. Stop to recheck the victim only if he starts breathingStop to recheck the victim only if he starts breathing normallynormally; otherwise do not interrupt resuscitation.; otherwise do not interrupt resuscitation.
    30. 30.  Page 30 Basic Life SupportBasic Life Support
    31. 31.  Page 31 Basic Life SupportBasic Life Support
    32. 32.  Page 32 Two-Rescuer CPR for Adults and Children  Minimizes time between rescue breaths and compressions - CPR becomes more effective  Can more quickly set up AED  Reduces rescuer fatigue
    33. 33.  Page 33 Basic Life SupportBasic Life Support Single Rescuer CPRSingle Rescuer CPR
    34. 34.  Page 34 Give 30 chest compressions at rate of 100 per minute Then give 2 ventilations
    35. 35.  Page 35 Automated External DefibrillatorAutomated External Defibrillator (AED)(AED)
    36. 36.  Page 36 Automated External DefibrillatorAutomated External Defibrillator (AED)(AED) AEDs are pre-programmed devices used to provideAEDs are pre-programmed devices used to provide treatment/care for cardiac arrest (heart attack) victims.treatment/care for cardiac arrest (heart attack) victims. AEDs provide an electric charge that interupts theAEDs provide an electric charge that interupts the fibrillation, or rapid uncoordinated contractions of the heartfibrillation, or rapid uncoordinated contractions of the heart & allows it to begin beating regularly again.& allows it to begin beating regularly again. Immediate defibrillation carries the only hope of survival inImmediate defibrillation carries the only hope of survival in cardiac arrest victims.cardiac arrest victims.
    37. 37.  Page 37 Automated External DefibrillatorAutomated External Defibrillator (AED)(AED) When defibrillation is delivered within one minute, survivalWhen defibrillation is delivered within one minute, survival rates can be as high as 90%.rates can be as high as 90%. If defibrillation is delivered in < 5 minutes, survival can be asIf defibrillation is delivered in < 5 minutes, survival can be as high as 50%.high as 50%. For every minute that passes prior to receiving defibrillation,For every minute that passes prior to receiving defibrillation, a victim's chance of survival declines by about 10%.a victim's chance of survival declines by about 10%. After 10 minutes chances of survival are near zero.After 10 minutes chances of survival are near zero.
    38. 38.  Page 38 Defibrillation TechniqueDefibrillation Technique Defibrillation Sequence Action Announcements 1. Switch on.   2. Place coupling pads/gel in correct position   3. Apply paddles   4. Check ECG rhythm and confirm no pulse   5. Select non-synchronized (VF) setting   6. Charge to required energy level "Charging" 7. Ensure no-one is in contact with anything touching the patient "Stand clear" 8. Press paddle buttons simultaneously "Shocking now" 9. Check ECG rhythm   10. Check for output if rhythm change "Check pulse" 11. Return to ALS algorithm for further steps  
    39. 39.  Page 39 Safety Precautions When Using AEDSafety Precautions When Using AED Do not touch the victim while the AED is analyzing or whileDo not touch the victim while the AED is analyzing or while defibrillating.defibrillating. Do not touch the victim Dry victim’s chest before applying pads but doDo not touch the victim Dry victim’s chest before applying pads but do not use alcohol to wipe the victim’s chest dry.not use alcohol to wipe the victim’s chest dry. Do not defibrillate someone around flammable materials or cell phones.Do not defibrillate someone around flammable materials or cell phones. Do not use an AED in a moving vehicleDo not use an AED in a moving vehicle Do not use an AED on a victim in contact with water or on metal surfaceDo not use an AED on a victim in contact with water or on metal surface Do not use an AED on a victim wearing a nitroglycerin patch or otherDo not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest.patch on the chest. Do not use a mobile phone or conduct radio transmission within 6 feet ofDo not use a mobile phone or conduct radio transmission within 6 feet of the AED.the AED. Do not place the pads directly over a pacemaker or other implantedDo not place the pads directly over a pacemaker or other implanted device.device.
    40. 40.  Page 40 Differential Diagnosis:Differential Diagnosis:  Hypovolemia  Hypoxia  Hydrogen ions (acidosis)  Hyper/ hypokalemia  Hypothermia  Hypoglycemia  Toxins  Tamponade  Tension PTX  Thrombosis (coronary)  Thrombosis (pulmonary)  Trauma 6 Hs & 6 Ts6 Hs & 6 Ts
    41. 41.  Page 41 Basic Life SupportBasic Life Support
    42. 42.  Page 42 Checking for CPR Effectiveness?Checking for CPR Effectiveness? Does chest rise & fall with rescue breaths?Does chest rise & fall with rescue breaths? Have a second rescuer check pulse while you giveHave a second rescuer check pulse while you give compressions?compressions? Basic Life SupportBasic Life Support
    43. 43.  Page 43 When Can I Stop CPR?When Can I Stop CPR? Victim revivesVictim revives Trained help arrivesTrained help arrives Too exhausted to continueToo exhausted to continue Unsafe sceneUnsafe scene Physician directed (do not resuscitate orders)Physician directed (do not resuscitate orders) Cardiac arrest of longer than 30 minutesCardiac arrest of longer than 30 minutes (controversial)(controversial) Basic Life SupportBasic Life Support
    44. 44.  Page 44 Why CPR May Fail?Why CPR May Fail? Delay in startingDelay in starting Improper procedures (e.g., Forget to pinch nose)Improper procedures (e.g., Forget to pinch nose) No ACLS follow-up & delay in defibrillationNo ACLS follow-up & delay in defibrillation  Only 15% who receive CPR live to go homeOnly 15% who receive CPR live to go home  Improper techniquesImproper techniques Terminal disease (or) unmanageable disease (massiveTerminal disease (or) unmanageable disease (massive heart attack)heart attack) Basic Life SupportBasic Life Support
    45. 45.  Page 45 Key Concepts in BLS?Key Concepts in BLS? Avoid Hyperventilation (Do not ventilate too fast or tooAvoid Hyperventilation (Do not ventilate too fast or too much volume).much volume). Allow complete chest recoil, minimal interruptions.Allow complete chest recoil, minimal interruptions. Compress chest depth of 1.5 to 2 inches at a rate of 100Compress chest depth of 1.5 to 2 inches at a rate of 100 compressions/minute.compressions/minute. Resume CPR immediately after shock. Interruption in CPRResume CPR immediately after shock. Interruption in CPR for rhythm check should not exceed 10 seconds.for rhythm check should not exceed 10 seconds. Basic Life SupportBasic Life Support
    46. 46.  Page 46 Basic Life SupportBasic Life Support
    47. 47.  Page 47 Basic Life SupportBasic Life Support AAirway:irway: Open Airway.Open Airway. BBreathing:reathing: (Look, Listen &Feel)(Look, Listen &Feel) CCirculation:irculation: Monitor & check the pulseMonitor & check the pulse Check BreathingCheck Breathing BreathingBreathing Non BreathingNon Breathing Check CirculationCheck Circulation CirculationCirculation ArrestArrest ABCD’sABCD’s
    48. 48.  Page 48
    49. 49.  Page 49 Nursing Responsibilities in an ArrestNursing Responsibilities in an Arrest Ensure there are enough staff to manage the situation.Ensure there are enough staff to manage the situation. The nurse that scribes should ensure the following is documented:The nurse that scribes should ensure the following is documented: 1.1. Patient’s name.Patient’s name. 2.2. Time.Time. 3.3. Cardiac rhythm once chest leads in placeCardiac rhythm once chest leads in place 4.4. Defibrillations, joules delivered.Defibrillations, joules delivered. 5.5. All drugs delivered, including doses and routes.All drugs delivered, including doses and routes. 6.6. Observations.Observations. 7.7. Other comments e.g. IV fluids, intubation, bloods, CPR etc.Other comments e.g. IV fluids, intubation, bloods, CPR etc. 8.8. Staff attending the arrest.Staff attending the arrest. 9.9. Outcome / transferred to.Outcome / transferred to. 10.10. Time of death.Time of death. 11.11. Remember to ask if you are unclear as to what drugs have been given,Remember to ask if you are unclear as to what drugs have been given, cardiac rhythm, defibrillation, etc.cardiac rhythm, defibrillation, etc. For the Arrest Patient:For the Arrest Patient:
    50. 50.  Page 50 Nursing Responsibilities in an ArrestNursing Responsibilities in an Arrest For Other Patients & Visitors:For Other Patients & Visitors: Curtain off the other patients bed areas.Curtain off the other patients bed areas. Ask any visitors to either leave the room or stayAsk any visitors to either leave the room or stay with the patient they have come to visit behindwith the patient they have come to visit behind their curtains.their curtains.
    51. 51.  Page 51 Complications of CPRComplications of CPR Rib & sternal fracturesRib & sternal fractures PneumothoraxPneumothorax Pericardial tamponadePericardial tamponade Pulmonary contusionPulmonary contusion AspirationAspiration Aortic lacerationAortic laceration
    52. 52.  Page 52 Basic Life SupportBasic Life Support Chain Of Survival Is Our GoalChain Of Survival Is Our Goal
    53. 53.  Page 53 Basic Life SupportBasic Life Support QUESTIONSQUESTIONS
    54. 54.  Page 54 Basic Life SupportBasic Life Support
    55. 55.  Page 55 Basic Life SupportBasic Life Support
    56. 56.  Page 56 Basic Life SupportBasic Life Support
    57. 57. Your Logo Thank YouThank You

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