2. OUTLINE
Part 1: General concept.
Part 2: The chain of survival.
Part 3: BLS for adults.
Part 4: Automated External Defibrillator (AED) for adults
Part 5: Team dynamics.
Part 6: Choking relief for Adults.
3. Part 1: General program concept.
• BLS is the foundation for saving lives after cardiac arrest. In this program
we will learn the skills of high – quality cardiopulmonary resuscitation
(CPR) for victims of adult.
• We will practice delivering these skills both as a single rescuer and as a
member of multirescuer team. The skill you learn in this program will
enable to
• Recognize cardiac arrest.
• Activate the emergency response system early.
• Respond quickly and confidently.
• Described and demonstrate the appropriate use of AED.
• Understand the importance of team as multirescuer resuscitation and
technique to relief from choking.
5. Part 2: The chain of survival.
• The term chain of survival provides a useful metaphor for
elements of emergency cardiovascular care system – of – care
concept.
• The chain of survival shows the actions that must take place
to give the cardiac arrest victim the best chance of survival.
• Each link is independent, yet connected to the links before
and after. If any link is broken the chance for a good outcome
is decreases.
6. CHAIN OF SURVIVAL ELEMENTS
1. Prevention and preparedness.
2. Activating the emergency response system.
3. High quality CPR, including early defibrillation.
4. Advanced resuscitation interventions.
5. Post – cardiac arrest care.
6. Recovery.
7.
8. 1. Prevention and preparedness
Out-of-hospital:
• Prevention and preparedness are foundation of early
recognition of cardiac arrest and rapid response.
• Prevention includes measures to improve the health of
individual and communities.
• Preparedness includes public awareness programs and training
to help people the signs of heart attack and cardiac arrest and
take effective action.
• Community CPR training and emergency response system
development are important.
9. Contd….
In hospital:
• In hospital setting preparedness includes early recognition and
rapid response to the patient who may need resuscitation.
• Health care providers can predict and prevent many of these
arrest by carefully observation, preventive care and early
treatment of pre arrest condition.
• Once the provider recognizes cardiac arrest, immediate
activation of emergency response system, early high – quality
CPR and rapid defibrillation are essential.
11. A. Activate the emergency response system out-of-hospital setting.
• Activating the emergency response system usually means
shouting for nearby help and phoning the local emergency
response number.
• Every employee should know how to activates the emergency
response system.
• The sooner the next level of care will arrive.
13. B. Activate the emergency response system in-hospital setting.
• Activation of the emergency response system in the hospital setting is
specific to each institute.
• A provider may activate a code, summon the rapid response team or
medical emergency team or ask someone else to do it.
• The sooner the provider activates the emergency response system, the
sooner the next level of care will arrive.
15. 3. High quality CPR, including early defibrillation:
• High quality CPR with minimal interruptions and early defibrillation are
the actions most closely related to good resuscitation outcomes.
• High quality CPR started immediately after cardiac arrest combined with
early defibrillation can double or triple the chances of survival.
• These time sensitive interventions can be provided both by members of the
public and by health care providers.
• Even without training, bystanders can perform chest compressions with the
guidance from emergency telecommunicators over the phone (T-CPR)
16. 4. Advanced resuscitation interventions:
Out-of-hospital In-hospital
• Lay rescuer provide high quality CPR and
defibrillation with an AED until a
multirescuer team take over the
resuscitation attempt.
• This high performance team will continue
high quality CPR and defibrillation and
may perform advanced interventions.
• The high performance team in a hospital may
include physicians, nurses, respiratory
therapies, pharmacist and others.
• In addition to advanced interventions,
extracorporeal CPR (ECPR) may be use in
certain resuscitation situation.
• N.B:- ECPR is a method of cardiopulmonary
resuscitation (CPR) that passes the patient's
blood through a machine in a process to
oxygenate the blood supply.
17. 5. Post cardiac arrest care
Out-of-hospital In-hospital
• After return of spontaneous circulation
(ROSC) all cardiac arrest victims receive
post-cardiac arrest care.
• Post cardiac arrest care includes routine
critical care support, such as artificial
ventilation and blood pressure
management.
• This care begins in the field and continues
during transport to a medical facility.
• A multidisciplinary provides this advanced
level of care.
• Provider focus on preventing the return of
cardiac arrest and tailor specific therapies to
improve long term survival.
• Post cardiac arrest care may occur in ED,
Cardiac catheterization lab (Cath lab). ICU
or Coronary care unit.
18. 6. Recovery
• Recovery from cardiac arrest continues long after hospital
discharge.
• Depending on the outcome the survivor of cardiac arrest may
need specific interventions.
• Some patient need rehabilitation focused on neurological
recovery.
20. Part 3: BLS for adults.
a. Basic framework for CPR.
b. High-Performance recue team.
c. Adult BLS Algorithm for health care providers.
d. High quality CPR skills: Adult.
e. Perform high quality chest compression technique.
f. Give breaths.
g. Barrier devices for giving breaths.
h. Pocket masks.
i. Bag-Mask Devices.
j. Adult 2-Rescuer BLS.
21. a. Basic framework for CPR.
• Anyone can be a lifesaving rescuer for cardiac arrest victim.
• The particular CPR skills a rescuer uses depend on several variables,
such as level of training, experience and confidence (ie, rescuer
proficiency).
• A single rescuer with limited training or who has limited equipment
can do hands on only CPR.
• A rescuer with trained can do 30:2 CPR.
• When several rescuers are present, they can perform multirescuer-
coordinated CPR
23. b. High - Performance recue team
• Coordinated efforts by several rescuers during CPR may increase the
chances for the successful resuscitation.
• High performance team divide the task among team member during the
resuscitation attempt.
1. Compressor.
2. AED/Monitor/Defibrillator.
3. Airway.
4. Team leader.
5. IV/IO/Medications.
6. Timer/Recorder.
28. High Quality CPR Skills & Technique : ADULT
1. Assess for breathing and a pulse (5-10) seconds.
• If the victim is breathing: monitor the victim until additional help
arrives.
• If the victim is not breathing or is only gasping: Be prepared to begin
high-quality CPR. Gasping is not normal breathing and is a sign of
cardiac arrest.
29. 2. Perform high – quality chest compressions
a. Start compression within 10 seconds after recognizing cardiac arrest.
b. Position : supine, victim’s face up on firm, flat surface such as floor.
c. Push hard push fast: compress at the rate of 100 to 120 /min
d. Compression – to – Ventilation Ratio: 30:2
e. Compression depth: 5 cm.
f. Chest recoil: Chest recoil (re-expansions of the chest) allows blood to
flow into the heart.
g. Interruptions in chest compression:
• The proportion of time that rescuers perform chest compression during
CPR is called chest compression fraction (CCF).
• CCF 60% increases the likelihood of ROSC (return of spontaneous
circulation.
• With good teamwork and training can often achieve 80% or greater. This
should be the goal in all team resuscitation events.
37. Head tilt – chin lift.
1. Place one hand on the victim’s forehead and push with your palm to tilt the
head back.
2. Place the fingers of the other hand under the bony part of the lower jaw near to
the chin.
3. Lift the jaw to bring the chin forward.
38. Jaw thrust maneuver
• Used when victim is where this is concern about neck and spine injuries.
• Position yourself at the victim’s head.
• Place one hand on each side of the victim’s head. You may rest your elbows on
the surface where the victim is lying.
• Place your fingers under the angle of the victims lower jaw and lift with both
hands displacing the jaw forward.
47. Part 4: Operating Automated External Defibrillator (AED)
Universal steps
AED may be electronic voice prompts of digital screen prompts. To reduce the time
to shock delivery, try the following steps within 30 seconds after the AED arrives at
the victim’s side:
Step 1: P- POWER on the AED (Some device power on automatically).
Step 2: A- ATTACH the AED Pads on bare chest.
Step 3: A- “Clear” the victim and allow the AED to ANALYZE the rhythm.
Step 4: S- press shock button.
• Do not delay High – Quality CPR after AED use.
• After about 5 cycles or 2 minutes of CPR, the AED will prompt you Steps 3 & 4.
Continue until advanced life support providers take over or the victim begins to
breath, move.
48.
49.
50.
51.
52.
53. Concepts of AED Pad placement
Two common placement of AED pad:-
1. Anterolateral placement:-
Pads are place on the victim’s bare chest.
Place one AED pad directly below the right collarbone.
Place the other pad to the side of the left nipple, with the top
edge of the pad 7 to 8 cms below armpit
2. Anteroposterior (AP) Placement:
Place one pad in the center of the victim’s bare chest (anterior)
and the other pad in the center of the victim’s back (posterior).
56. Special circumstances when placing AED pads
When placing AED Pads, you may need to take additional actions when
the victim :-
Hairy chest.
Is immersed in water or has water or liquid covering the chest.
Has implanted pacemaker. (avoid placing AED directly over the implanted
device).
Has transdermal medication patch. (remove the patch, wipe it off and
apply pads).
Is pregnant women.
Is wearing jewelry or bulky clothing.
57. Part 5: Team dynamics.
• As BLS provider you may involved in a multirescuer resuscitation
attempt.
• Effective team dynamics increase chance of successful
resuscitation.
• Everyone on the team must understand not just what to do in
resuscitation attempt but how to communicate and perform
effective as a part of multirescuer team.
58.
59. ELEMENTS OF EFFECTIVE TEAM DYNAMICS
Team dynamics during a resuscitation attempt include 3 elements:
1. Roles and responsibilities.
2. Communication
3. Debriefing.
60. 1. Roles and responsibilities
1. Assign Roles and Responsibilities.
2. Know your limitations.
3. Offer constructive intervention.
2. Communication:
1. Share knowledge.
2. Summarize and reevaluation.
3. Use closed Loop communication. (repeating a message received from
sender)
4. Give clear message.
5. Show mutual respect.
61. 3. Debriefing:-
• Debriefing is very important in CPR, it will help to improve
performance of compression and ventilation and minimize
pauses in compressions.
• Helps individual team members perform better.
• Aid in identifying system strengths and deficiencies.
62. Part 6: Choking relief for Adults, children and infant.
Signs of chocking:
Unable to speak or cry.
Poor or no air.
Weak, ineffective cough or no cough.
May wheeze between cough.
High pitched noise while inhaling or no noise at all.
Increase respiratory difficulty.
Possible cyanosis.
63. Figure: The universal choking sign indicates the need for help when a victim
is choking.
