Cardio pulmonary resuscitation or BLS

1. Muhammed Anwar V P M
MSN, PGDHHA, RN
Govt. School Of nursing
Kanhangad

4. • Cardio Pulmonary Resuscitation is a sequences
of procedures performed to restore the
circulation of oxygenated blood to the vital
organs(especially brain) after a sudden cardiac
and/or pulmonary arrest, until appropriate,
definitive medical treatment can restore normal
heart and ventilatory action.

5. • To maintain Blood circulation by external
cardiac massages (C).
• To maintain an open and clear airway
(A).
• To maintain breathing by external
ventilation (B).
• To save life of the Patient.
• To provide basic life support till medical
and advanced life support arrives.

6. Causes of cardio-
pulmonary arrest
cardiac
extracardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors
all cases accompanied
with hypoxia

7. Cardiac
• Ischemic heart disease
(myocardial infarction)
• Arrhythmias of different
origin and character
• Electrolytic disorders
• Valvular disease
• Cardiac tamponade
• Pulmonary artery
thromboembolism
• Ruptured aneurysm of
aorta
Extracardiac
• acute respiratory failure
• shock
• drug overdose
• electrocution
• Poisoning
• Drowning
• Stroke
• Foreign body in throat
• Smoke inhalation
• Suffocation
• Accident, injury

8.  Page 8
Differential Diagnosis:
• Hypovolemia
• Hypoxia
• Hydrogen ions (acidosis)
• Hyper/ hypokalemia
• Hypothermia
• Hypoglycemia
• Toxins
• Tamponade
• Tension PTX
• Thrombosis (coronary)
• Thrombosis (pulmonary)
• Trauma
6 Hs & 6 Ts

9.  Page 9
Basic Life Support
Our Goal
Early Access Early CPR Early Defibrillation Early ACLS
To take Rapid decisions because Irreversible brain
damage may occur within 4 minutes of cardiac arrest.

10.  Page 10
Basic Life Support

11. Resuscitation Update 2015

12. PERFORMED BY ANYONE WHO KNOWS
HOW TO DO IT, ANYWHERE, IMMEDIATELY,
WITHOUT ANY OTHER EQUIPMENT

13. New Chains of Survival

14. Five Links in the Adult Chain of Survival
Copyright © Texas Education Agency, 2014. All rights reserved.
Integrated
post-cardiac
arrest care
Effective
advanced life
support
Rapid
defibrillation
Early CPR
with an
emphasis on
chest
compressions
Immediate
recognition of
cardiac arrest
and activation of
the emergency
response
system
Photo Source: American Heart Association

15. CHAIN OF SURVIVAL

16. Basic Life Support
BLS consists of the following sequence of actions:
Make sure the victim, any bystanders & you are safe.
Check the victim for a response.
Gently shake his shoulders and ask loudly, ‘Are you all right?’
If he responds:
– Leave him in the position in which you find him provided
there is no further danger.
– Try to find out what is wrong with him and get help if
needed.
– Reassess him regularly.
If he does not respond:
– Shout for help.
– Turn the victim supine aligned position or stable side
position.

19. CHECK BREATHING
• Look for NORMAL
breathing
• Do not confuse
agonal breathing with
NORMAL breathing

20. Diagnosis of cardiac arrest
Symptoms of cardiac arrest
 absence of pulse on carotid arteries – a
pathognomonic symptom
 respiration arrest – may be in 30 seconds after
cardiac arrest
 enlargement of pupils – may be in 90 seconds after
cardiac arrest
Blood pressure measurement

Taking the pulse on peripheral arteries

Auscultation of cardiac tones
Loss of time !!!

21.  Page 21
If there is No Pulse, begin chest compressions
Basic Life Support
Continue UNINTERRUPTED until ADVANCED LIFE
SUPPORT is Available.

22. New CPR Sequence

23. Basic Life Support
CHEST COMPRESSIONS
• Emphasis on maximizing compressions
• Ensuring chest compressions of adequate rate
• Ensuring chest compressions of adequate depth
• Allowing full chest recoil between compressions
• Minimizing interruptions in chest compressions
• Avoiding excessive ventilation

24. • Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 - 120 min-1
– Depth atleast 5 cm (2
inches) not more than 6 cm
(2.4 inch)
CHEST COMPRESSIONS

26.  Page 26
AIRWAY: (Get it Open)
Manual clearing of mouth & throat.
Head tilt-Chin Lift Maneuver.
Jaw thrust maneuver.
Basic Life Support

27. Open the Airway

28. AIRWAY OPENING BY NECK EXTENSION

29.  Page 29
Basic Life Support
Use the Jaw Thrust
to open your patient's
airway if you suspect a
cervical spine injury.

30.  Page 30
Breathing support:
Mouth-to-mouth (nose) ventilation.
Mouth-to-adjunct with or without O2
Manual bag-mask ventilation with or without O2
Basic Life Support

31.  Page 31
Basic Life Support
If the victim is not
breathing, give 2
breaths (1 second or
longer)
• Pinch the nose
• Seal the mouth with
yours.

32.  Page 32
Basic Life Support

34.  Page 34
Basic Life Support
Single Rescuer CPR

35.  Page 35
Give 30 chest compressions Then give 2
ventilations

36.  Page 36
Two-Rescuer
CPR

37. Basic Life Support
When the victim has an advanced airway in place during
CPR, rescuers no longer deliver cycles of 30 compressions
and 2 breaths. Instead, it may be reasonable for the
provider to deliver 1 breath every 6 seconds (10 breaths
per minute) while continuous chest compressions are
being performed

38. Basic Life Support
• For patients with known or suspected opioid
overdose who have a definite pulse but no normal
breathing or only gasping (ie, a respiratory arrest),
in addition to providing standard BLS care, it is
reasonable for appropriately trained BLS
healthcare providers to administer Inj naloxone

39.  Page 39
Automated External Defibrillator
(AED)

40.  Page 40
Automated External Defibrillator
(AED)
AEDs provide an electric charge that interrupts the
fibrillation, or rapid uncoordinated contractions of the
heart & allows it to begin beating regularly again.
Immediate defibrillation carries the only hope of survival in
cardiac arrest victims.

41.  Page 41
Automated External Defibrillator
(AED)
When defibrillation is delivered within one minute, survival
rates can be as high as 90%.
If defibrillation is delivered in < 5 minutes, survival can be
as high as 50%.
For every minute that passes prior to receiving
defibrillation, a victim's chance of survival declines by about
10%.
After 10 minutes chances of survival are near zero.

43. Actions based on AED Analysis:
Shockable rhythm – Give 1 shock and resume CPR immediately
for about 2 minutes or until prompted by the AED. Continue until
advanced life support providers take over or the victim starts to
move.
No shockable rhythm – Resume CPR immediately for about 2
minutes or until prompted by the AED. Continue until advanced life
support providers take over or the victim starts to move.
Basic Life Support
Pedia BLS ---rbt2016---

44. Rescue breathing
• If there is Pulse but victim is Not Breathing, give
rescue breathing at rate of 1 breath every 5 -6 seconds or
10-12 breaths per minute.

50. Compression
Pediatric Basic Life Support
Airway Opening Rescue Breaths
Pedia BLS ---rbt2016---

51. :
●The chest should be depressed at least one-third of its anterior-
posterior diameter with each compression:
- approximately 4 cm [1.5 inches] in most infants
- 5 cm [2 inches] in most children
- Compressions in adolescents should attain the recommended
adult depth of 5 to 6 cm, but should not exceed 6 cm (2.4 inches).
●The optimum rate of compressions is approximately 100 to 120 per
minute.
Pediatric Basic Life Support

52. Chest compressions for infants (younger than one year)
- may be performed with either two fingers (for single
rescuer) or with the two thumb-encircling hands (for
multiple rescuers)
Pediatric Basic Life Support
Pedia BLS ---rbt2016---

53. Two fingers technique for
infants’ chest compression
- Compressions are performed
with index and middle fingers,
placed on the sternum just
below the nipples.
Pediatric Basic Life Support
Pedia BLS ---rbt2016---

54. Two thumb-encircling hands
technique for infants’ chest
compression
- The thorax is encircled with both
hands and cardiac compressions
are performed with thumbs which
compress over the lower half of the
sternum, avoiding the xiphoid
process, while the fingers are
spread around the thorax.
Pediatric Basic Life Support
Pedia BLS ---rbt2016---

55. -Infants and children who require chest
compressions should receive 2 breaths per 30 chest
compressions for a lone rescuer and 2 breaths per
15 chest compressions for two or more rescuers.
Pediatric Basic Life Support
Pedia BLS ---rbt2016---

56. Pediatric
Basic
Life
Support
Pedia BLS ---rbt2016---

57. Choking
• Obstruction of the air way by foreign body( food ,
object….)

58. Signs of choking
 Poor or no air exchange
 Week, ineffective cough or no
cough at all
 High pitch noise while
inhaling or no noise at all
 Increased respiratory difficulty
 Possible cyanosis
 Unable to speak
 Clutching the neck with the
thump and fingers, making the
universal choking sign

59. Helping a Choking Adult

61. • Coronary vessel injury
• Diaphragm injury
• Hemopericardium
• Hemothorax
• Liver injury
• Myocardial injury
• Pneumothorax
• Rib fractures
• Spleen injury
• Sternal fracture

62. WHEN CAN I STOP CPR ?
• Victim revives
• Trained help arrives
• Too exhausted to continue
• Unsafe scene
• Physician directed
• Cardiac arrest for more than 30 minutes

63. Do not resuscitate (DNR),
Do not resuscitate (DNR), also known as no code or allow
natural death, is a legal order written either in the hospital or on a
legal form to withhold cardiopulmonary resuscitation (CPR)
or advanced cardiac life support(ACLS), in respect of the wishes of
a patient in case their heart were to stop or they were to stop
breathing.

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Basic Life Support
QUESTIONS

65. Thank
s…