Download to read offline
Basic Life Support NCORT KK Gemencheh 2024.pptx
- 1. UPDATE ON BASICLIFE SUPPORT BLS FOR HEALTHCARE PROVIDERS DR THULASI DEVI RAJU Basic Life Support Training Manual ,2nd Edition 2023
- 2. TOP MESSAGES • EARLYRECOGNITION OF CARDIAC ARREST • ALERT EMS/ 999 • EARLY HIGH QUALITY CPR • EARLY AED USAGE
- 3. Chain of survival Thekey observations are unresponsiveness and not breathing normally Defibrillation within 3–5 mins of collapse produce survival rates 50–70%.
- 4.
- 5. Ensure area is safefor yourself, patient, others and environment
- 6. Tap victim onthe shoulder Hello….are you ok? Can you hear me?
- 7. Call 999 Bring AED/ Emergency trolley
- 8. Open Airway Head tilt-chinlift Head tilt: place one hand on the forehead and not the eyes, to tilt the head back Chin lift: place fingers of the other hand on the bony part and not the soft tissue of the jaw, to lift the chin
- 9.
- 10. LOOK, LISTEN, FEEL FOR BREATHING , ANDPULSE PRESENCE <10 sec
- 11. Breathing Absent or abnormalbreathing < 10s - treat as sign of cardiac arrest start chest compression If in doubt --> treat as abnormal breathing start CPR PULSE +, ABNORMAL BREATHING -> RESCUE BREATH (1 BREATH EVERY 6 SEC)
- 12.
- 13. High quality CPR -Site: middle chest, lower half of sternum - Rate: 100 to 120 compressions per minute - Depth: at least 5 cm and not greater than 6 cm - Complete recoil of the chest - Minimize interruption on chest compression - Compression to ventilation ratio 30:2 - Ventilate adequately, each breath delivered over 1 second with visible chest rise
- 14. Figure 6 :Two hands technique (E-C clamp technique) Figure 5 : One hand technique (E-C clamp technique) • Each breath should be given over 1 second inspiratory • No BVM, CPR only BVM VENTILATION
- 16. • Once AEDor Defib machine available : Attach machine and check rhythm , shockable/ non shockable
- 17. AED, Defibrillator ARRIVES SHOCKABLERHYTHM? YES NO Give 1 shock Resume CPR For 5 cycles Resume CPR For 5 cycles and CHECK RHYTHM ; Cont. till ALS Provider take over, victims start to move
- 19. Reassessment during CPR After5 cycles / 2 minutes • Normal breathing check • Pulse check • Analyze rhythm
- 20. When to stopCPR 1) Victim recovers with normal breathing 2) HCW is exhausted 3) Assistance arrives to take over CPR 4) Safety of provider can no longer be sufficiently assured 5) Obvious mortal injury or irreversible death 6) Asystole for more than 20 minutes despite ongoing BLS in absence of reversible cause SIGNS OF RECOVERY : - WAKING UP/ MOVING/OPENING EYES/ NORMAL BREATHING
- 21.
- 22.
- 23. • If youare uncomfortable with intubation techniques required and ventilation is adequate • If patient’s condition improves during intubation attempts • If respiratory arrest is reversible with drugs • If patient has a deformity of the airway or neck but stable • If patient has a DNR order Guidelines on when NOT to intubate
- 25. TAKE AWAY MESSAGE •Recognise and start early high quality CPR • Minimise interuptions during CPR • Early AED usage • Intubate if skillful and decide if really in need • Suction <10sec • Epinephrine during the third CPR cycle, and every 3-5 min afterwards
- 26. NO RESPONSE /MOVEMENT CALL FOR HELP Get AED / Defibrillator Open AIRWAY, Check BREATHING If NO Breathing/ Gasping Give cycles of 30 compressions and 2 breath Until AED, Defib, ALS Provider take over, victims start to move Push HARD and FAST (100-120 /min) and release completely Minimise compression interruptions AED, Defibrillator ARRIVES SHOCKABLE RHYTHM? Give 1 shock Resume CPR For 5 cycles Resume CPR For 5 cycles and CHECK RHYTHM ; Continue till ALS Provider take over, victims start to move YES NO
- 28. Adult Foreign BodyAirway Obstruction • Definition: severe difficulty in breathing because of a constricted or obstructed throat or a lack of air
- 29. Recognize FBAO • Witnessepisode • Coughing or choking, gagging, stridor • Sudden onset respiratory distress • Recent history of playing with or eating small objects • Universal sign
- 30. Adult with FBAOAlgorithm
- 31. Effective Vs Ineffectivecough Effective cough • Crying or verbal response to questions • Loud cough • Able to take a breath before coughing • Fully responsive Ineffective cough • Unable to vocalize • Quiet or silent cough • Unable to breathe • Cyanosis • Decreasing level of consciousness
- 32. If cough isineffective, in conscious patient, give 5 back blows following with 5 abdomen thrust/chest thrust
- 33.
- 35.
Editor's Notes
- #1 SELAMAT PG KPD DR SURAIHAN, MOS, MAS DAN NURSES2. SAYA, DR THULASI AKAN MENYAMPAIKAN SEDIKIT REFRESHER ON BLS. I WILL BE USING BOTH MALAY AND ENGLISH TO ENSURE BETTER UNDERSTANDING ON THE TOPIC. THIS SLIDES ARE BASED ON BLS TRAINING MANUAL 2ND EDITION OF 2023. LATER ON , WE WILL HAVE PRACTICAL PART TO DO HANDS ON.
- #2 THE TOP MESSAGE ATAUPUN PERKARA YG PALING DISTRESSKAN DLM MANUAL ADALAH SAMA SEPERTI SEBELUM INI
- #3 the chain of survival summarizes the links for a successful resuscitation. Early recognition and call for help - recognise chest pain earlier before pt collapses due to MI. If cardiac arrest happen, faster initiate ERS - emergency response System (ERS)- how to recognise earlier- the key observations are not responsive, not breathing and no pulse - if already collapse- then start CPR immediately without wasting time, because within 4 minutes without oxygen, brain cells start to die req help and ask for AED, all done while initiating CPR (chest compression together with ventilation) - once AED arrive, utilise it as early as possible, because studies show higher rate of survival with earlier AED usage - Early advanced life support and post-resuscitation care to improve survival.
- #4 This is the sequence of steps for the initial assessment and treatment of the unresponsive victim wherenby the mnemonics of drs abcd. danger, response, shount and send, airway, breathing, circulation/cpr, defib make sure its safe to help check the vistim to response shout for help and AED open airway assess breathing- not more than 10 sec, agonal breath or no breathing.. strat compression - high quality once AED is there, assess for the need for shock
- #5 Make sure you, the victim and any bystanders are safe • Wear PPE (gloves, apron, mask) if available. • Look out for blood spills, sharps, electric wires, unsteady beds, trolley.
- #6 Check the victim for a response a. Gently tap his shoulders/collarbone and ask loudly: i. “Are you OK?”. ii. If no response proceed to next step (Shout for Help) b. If he responds, leave him in the position in which you find him, provided there is no further danger. Get help if needed and re-asses regularly.
- #7 Shout for help/activate Emergency Response System(ERS) • If alone, call for help VIA HANDS FREE OPTION- LIKE CALL IN SPEAKER PHONE while assessing for breathing and pulse without leaving the person. - send somebody to get AED
- #8 Open The Airway a. Head tilt chin lift • Place your hand on the forehead. Gently tilt the head back and with your fingertips under the point of the victim's chin, lift the chin to open the airway.
- #9 b. Jaw thrust- if suspected cervical injury • Use index and middle fingers to physically push the posterior aspects of the mandible upwards while your thumbs push down on the chin to open the mouth.
- #10 • Check pulse simultaneously with checking for breathing. Do not pause more than 10 seconds to check for breathing and pulse.
- #12 Start Chest Compressions a. Place the heel of one hand in the centre of the victim’s chest at the lower half of the sternum. b. Place the heel of your other hand on top of the first hand c. Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs d. Keep your arms straight e. Position your shoulders vertically above the victim’s chest and press down on the sternum with high quality CPR Switched the person applying chest compression every 5 cycles or 2 minutes to avoid fatigue. b. Optimal chest compression are best delivered with the patient on a firm surface:
- #13 High quality CPR • Rate: 100 to 120 compressions per minute • Depth: at least 5 cm and not greater than 6 cm (injuries are more common when compression depth is greater than 6 cm). • Complete Recoil of the chest (to allow adequate perfusion to heart muscle and fill chambers during diastole) - Do not lean on the chest. • Minimize interruption on chest compression - Delivery of rescue breaths, shocks, ventilations and rhythm analysis lead to pauses in chest compression - Pre-and post-shock pauses of less than 10s 1 person CPR, anotehr person give ventilation 1 in 5-6 sec
- #14 Bag-valve-mask (BVM) ventilation • Position yourself directly above the victim’s head. • Place the mask on the victim’s face, using the bridge of the nose as a guide for correct position. • Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open: - perform head tilt. - use the thumb and index finger of one hand to make a “C” on the side of the mask, pressing the edges of the mask to the face. - use remaining fingers to tilt angles of the jaw (3 fingers form an “E”). • Squeeze the bag to give breaths (1 second each) while watching for chest rise.
- #16 Early defibrillation is an essential step in the chain of survival for victims of cardiac arrest. Defibrillation should be on as soon as it is available in shockable rhythm. Before attach the pad, make sure shave if too hairy, the area in concern is dry, if pt has pacemaker, avoid attaching on top of it. Adult pad can be used for those 8 years and above
- #17 Once u have AED, turn on the power, chose pad (8 years and above- adult pad) and attach- one at right upper chest right below the clavicle and another one at the side of the heart’s apex. If a shock is advised, deliver shock within 5 seconds • Ensure that nobody is touching the victim with clear CHANT “I am clear, you are clear, everyone is clear…”. Make sure no free flow oxygen at the site. • Push shock button as directed (fully automatic AEDs will deliver the shock automatically) • Immediately restart CPR at the compressions:ventilation ratio of 30:2. • Continue as directed by the voice/visual prompts. If no shock is advised, continue CPR as directed by the voice/visual prompts.
- #18 shockable- VF , pulseless VT
- #19 Reassessment After every 5 cycles or 2 minutes of CPR, HCP shall check for normal breathing, less than 10 sec
- #21 If you are certain the victim is breathing normally but is still unresponsive, place the victim in the recovery position. • Remove the victim’s glasses, if worn. • Kneel beside the victim and make sure that both his legs are straight. • Place the arm nearest to you at right angles to his body, elbow bent with the hand palm-up. • Bring the far arm across the chest, and hold the back of the hand against the victim’s cheek nearest to you. • With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground. • Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you on to his side. • Adjust the upper leg so that both the hip and knees are bent at right angles. • Tilt the head back to make sure that the airway remains open. • If necessary, adjust the hand under the cheek to keep the head tilted and facing downwards to allow liquid material to drain from the mouth. • Check breathing regularly. Be prepared to restart CPR immediately if the victim deteriorates or stops breathing normally
- #22 A bit on airway- The basic airway adjuncts are oropharngeal and nasopharngeal airway OPA- use in unresponsive (no cough/gag), angle of mouth to angle of jaw NPA- can use in concious pt, not in facial trauma, tip of the nose to ear tragus Laryngeal mask airway- alternative for intubation, cannot prevent aspiration, are various sizes available. - rescue breath During CPR, the chest compression to ventilation rate for adults is 30:2. • If advanced airway is placed, do not interrupt chest compressions for breaths. Give one breath every 6 seconds with continuous chest compressions once advanced airway is introduced. And suction attempt should be less than 10sec
- #24 Early epinephrine found to have association with ROCS but not survival For patients with shockable rhythm, defibrillation and CPR is prioritize initially and giving epinephrine if initial attempts with CPR and defibrillation are not successful. GIve epi during the thrid cpr cycle, then every 3-5 min aftr • 1.0 mg (1:10,000) IV/IO or 1 ampule (1:1,000) in 10ml of normal saline
- #26 DRSabcd danger response shout for help airway breathing circulation defib
- #30 encourage coughing until expoel FB, and then until improve
- #31 No finger sweep unless foreign body visible If cough is effective, encourage the victims to cough until the obstruction is relieved
- #32 If cough becomes ineffective give up to 5 back blows • Give five sharp blows between the shoulder blades with the heel of your hand. If back blows are ineffective give up to 5 abdomina l thrust s • Clench your fist and place it between the umbilicus (navel) and the ribcage • Grasp this hand with your other hand and pull sharply inwards and upwards • Repeat up to five times • If the obstruction is still not relieved, continue alternating fiv e back blows with five abdominal thrusts If the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts If patient deteriorates to become unconscious, HCW should begin CPR.
- #33 WAER PROPER PPE, ESPECIALY N95 AND GOOGLES NO OPEN AIRWAY AND BREATHING ASSESSMENT NO MOUTH2MOUTH VENTILATIONJ ENSURE GOOD SEAL WITH BVM, USE TWO HANDS CLAMP EC.. CPR GUYS STOP AND SQUEEZE THE BAG