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![Contd..
• Monitor CPR quality
- Quantitative waveform capnography (if PETCO₂ is less than 10 mm Hg, atte
to improve CPR quality)
- Intra-arterial pressure (if relaxation phase [diastolic] pressure is less than
20 mm Hg, attempt to improve CPR quality)
• Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms
(eg, tricular fibrillation [VF], pulseless ventricular tachycardia [PVT], asystole,
pulse electrical activity [PEA])
• Provide defibrillation/cardioversion](https://image.slidesharecdn.com/blsppt-251008164133-a1be3774/85/BLS-ppt-ppt-FOR-BASIC-LIFE-SUPPORT-BY-AHA-78-320.jpg)
BLS ppt.ppt FOR BASIC LIFE SUPPORT BY AHA
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- 2. Introduction • According torecent statistics sudden cardiac arrest is rapidly becoming the leading cause of death. • Once the heart ceases to function, a healthy human brain may survive without oxygen for up to 4 minutes without suffering any permanent damage. Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes. • It is during those critical minutes that CPR (Cardio Pulmonary Resuscitation) can provide oxygenated blood to the victim's brain and the heart, dramatically increasing his chance of survival and if properly instructed, almost anyone can learn and perform CPR.
- 3. What is BLS? • Basic Life Support (BLS) refers to the care healthcare providers and public safety professionals provide to patients who are experiencing respiratory arrest, cardiac arrest or airway obstruction. • BLS includes psychomotor skills for performing high-quality cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED) and relieving an obstructed airway for patients of all ages.
- 4. Timeline of CPR •0 to 4 minutes, unlikely development of brain damage • 4 to 6 minutes, possibility of brain damage • 6 to 10 minutes, high probability of brain damage • 10 minutes and over, probable brain damage
- 5. Indications • Road TrafficAccident • Drowning • Electric Shock • Airway Obstruction • Cardiac Arrest
- 6. Goals of Resuscitation •To support and restore effective:- - oxygenation - ventilation - circulation with return of intact neurologic function • ROSC (Return of spontaneous circulation) is an intermediate goal
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- 9. b.) For Pediatric •Emergencies in children and infants are not usually caused by the heart. Children and infants most often have breathing problems that trigger cardiac arrest. The first and most important step of the Pediatric Chain of Survival is prevention
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- 11. CAUTION Use of cricoidPressure • The routine use of cricoid pressure in cardiac patients is not recommended. • Cricoid pressure in nonarrest patients may offer some measure of protection to the airway from aspiration and gastric insufflation during bag and mask ventilation. However, it also may impede ventilation and interfere with placement of a supraglottic airway or intubation
- 12. In 2020 Guideline •The importance of early initiation of CPR by lay rescuers has been re- emphasized. The risk of harm to the patient is low if the patient is not in cardiac arrest. Bystanders should not be afraid to start CPR even if they are not sure whether the victim is breathing or in Cardiac Arrest. • A sixth link, Recovery, was added to the Chains of Survival for both Pediatric and Adults. • Care of the patient after return of spontaneous circulation (ROSC) requires close attention to oxygenation, blood pressure control, evaluation for percutaneous coronary intervention, targeted temperature management, and multimodal neuroprognostication.
- 13. How to approacha patient ? Ans- A Systematic Approach is used
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- 16. Approach safely Check response Checkthe pulse Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help
- 17. APPROACH SAFELY! • Scene •Rescuer • Victim • Bystanders Approach safely Check response Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help
- 18. CHECK RESPONSE Approach safely Checkresponse Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help
- 19. Shake shoulders gently Ask“Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly. Contd..
- 20. SHOUT FOR HELP Approachsafely Shout for help Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check for response
- 21. CHECK THE PULSE Approachsafely Check response Check the pulse Open airway Check breathing Call 977 30 chest compressions 2 rescue breaths Shout for help
- 22. OPEN AIRWAY Approach safely Checkresponse Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help
- 23. Contd… • Head tiltand chin lift - lay rescuers - non healthcare rescuers • No need for finger sweep - unless solid material can be seen in the airway
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- 25. CHECK BREATHING Approach safely Checkresponse Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse
- 26. Contd… • Look, listenand feel for NORMAL breathing • Do not confuse agonal breathing with NORMAL breathing
- 27. CAUTION • Agonal gaspsare not normal breathing. Agonal gaps may be present in the minutes after sudden cardiac arrest. • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing Recognise as a sign of cardiac arrest
- 29. Approach safely Check response Shoutfor help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse
- 30. 30 CHEST COMPRESSIONS Approachsafely Check response Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse
- 31. • Place theheel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest – Rate 100 -120 per min – Depth 4-5 cm – Equal compression : relaxation • When possible change CPR operator every 2 min • Allow complete chest recoil CHEST COMPRESSIONS
- 32. RESCUE BREATHS Approach safely Checkresponse Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse
- 33. Breathing- Mouth tomouth • Pinch the nose • Take a normal breath • Place lips over mouth • Blow until the chest rises • Take about 1 second • Allow chest to fall • Repeat
- 34. Breathing: Mouth ToNose (when to use) • Can’t open mouth •Can’t make a good seal • Severely injured mouth •Stomach distension Note- Mouth to stoma (tracheotomy)
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- 37. Activate EMS Approach safely Checkresponse Shout for help Open airway Check breathing Attach AED Follow voice prompts Check the pulse
- 38. AUTOMATED EXTERNAL DEFIBRILLATOR(AED) • Some AEDs will automatically switch themselves on when the lid is opened
- 39. ATTACH PADS TOCASUALTY’S BARE CHEST
- 40. ANALYSING RHYTHM DO NOTTOUCH VICTIM
- 41. SHOCK INDICATED • Standclear. • Do three checks - I clear - You clear - All clear • Deliver shock
- 42. SHOCK DELIVERED FOLLOWAED INSTRUCTIONS 30 : 2
- 43. NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS 30 :
- 44. IF VICTIM STARTSTO BREATHE NORMALLY PLACE IN RECOVERY POSITION
- 46. Approach safely Check response Shoutfor help Open airway Check breathing Call Emergency System 30 chest compressions 2 rescue breaths Check response Approach safely Shout for help Check the pulse Open airway Check breathing Call Emergency System Attach AED Follow voice prompts Check the pulse
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- 48. How to identifyobstruction ? • Patent Airway - If the patient responds in a normal voice. • Partial Obstruction- Signs of a partially obstructed airway include a changed voice, noisy breathing (eg, stridor), and an increased breathing effort. • Complete Airway obstruction- With a completely obstructed airway, there is no respiration despite great effort (ie, paradox respiration, or “see-saw” sign).
- 49. SIGNS MILD obstructionSEVERE obstruction “Are you choking?” “YES” Unable to speak, may nod Other signs Can speak, cough, breathe Can not breathe/wheezy breathing/silent attempts to cough/ unconsciousness Contd…
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- 57. Signs of HighQuality CPR • Start compression within 10 seconds of recognition of cardiac arrest • Push hard, Push fast: Compress at a rate of 100-120/min with a depth of : - At least 5cm for adults - At least one third the depth of the chest, about 5cm for children - At least one third of the chest, about 4cm, for infants • Allow complete chest recoil
- 58. Contd… • Minimize interruptionsin compression (try to limit interruptions to less than 10secs) • Give effective breaths that male chest rise • Avoid excessive ventilations
- 59. CONTINUE RESUSCITATION UNTIL •Qualified help arrives and takes over • The victim starts breathing normally • Rescuer becomes exhausted
- 60. When Can IStop CPR ? • Victim revives • Trained help arrives • Too exhausted to continue • Unsafe scene • Physician directed (do not resuscitate orders) • Cardiac arrest of longer than 30 minutes
- 61. Injuries Related toCPR • Rib fractures • Laceration related to the tip of the sternum, Liver, lung, spleen
- 62. Complications of CPR •Vomiting • Aspiration • Place victim on left side • Wipe vomit from mouth with fingers wrapped in a cloth • Reposition and resume CPR
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- 64. What to do? •Primary Assessment • Secondary Assessment
- 65. Assessment Primary Assessment SecondaryAssessment • A- AIRWAY • B- BREATHING • C- CIRCULATIONS • D- DISABILITY • E- EXPOSURE • Assessment involves differential diagnosis, focused medical history (memory aid- SAMPLE) • Searching for and treating underlying causes ( H’s and T’s)
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- 67. AIRWAY • Is theairway patent ? • Is an advanced airway indicated? • Is proper placement of airway device confirmed? • Is tube secured and placement confirmed frequently?
- 68. Is the airwaypatent ? • Maintain the airway patency in unconscious patients by use of the head tilt-chin lift , oropharyngeal airway or nasopharyngeal airway
- 69. Is an advancedairway indicated? • Use advanced airway management if needed (eg- laryngeal mask ,laryngeal tube , oesophageal –tracheal tube, endotracheal tube) NOTE:- Health care providers must weighs the benefit of advanced airway placement against adverse effects of interrupting chest compressions. If bag-mask ventilation is adequate, health care providers may defer insertion of advanced airway.
- 70. Contd… If using advancedairway devices:- • Confirm proper integration of CPR and ventilation • Confirm proper placement of advanced airway devices by - Physical examination - Quantitative waveform capnography • Secure the device to prevent dislodgement • Monitor airway placement with continuous quantitative waveform capnography
- 71. Continuous waveform capnography •Quantitative waveform capnography is the continuous, noninvasive measurement and graphical display of end-tidal carbon dioxide/ETCO2 (also called PetCO2). Capnography uses a sample chamber/sensor placed for optimum evaluation of expired CO2. • The inhaled and exhaled carbon dioxide is graphically displayed as a waveform on the monitor along with its corresponding numerical measurement.
- 72. Contd.. Two very practicaluses of waveform capnography in CPR are: 1.) evaluating the effectiveness of chest compressions, and 2.) identification of ROSC. Evaluating the effectiveness of chest compressions is accomplished in the following manner: Measurement of a low ETCO2 value (< 10 mmHg) during CPR in an intubated patient would indicate that the quality of chest compressions needs improvement. • Normal ETCO2 in the adult patient should be 35-45 mmHg. • High quality chest compressions are achieved when the ETCO2 value is at least 10- 20 mmHg.
- 73. Contd.. • When ROSCoccurs, There will be a significant increase in the ETCO2. (35-45 mmHg) This increase represents a drastic improvement in blood flow (more CO2 being dumped in the lungs by the circulation) which indicates circulation.
- 74. Contd.. • The 2020AHA Guidelines for ACLS recommend using quantitative waveform capnography in intubated patients during CPR. Waveform capnography allows providers to monitor CPR quality, optimize chest compressions, and detect ROSC (return of spontaneous circulation) during chest compressions. • Also, according to the AHA, continuous waveform capnography along with clinical assessment is the most reliable method of confirming and monitoring correct placement of an ET tube.
- 75. BREATHING • Are ventilationand oxygenation adequate? • Are quantitative waveform capnography and oxyhemoglobin saturation monitored?
- 76. Contd.. • Give supplementaryoxygen when indicated - For cardiac arrest patients, administer 100% oxygen - For others, titrate oxygen administration to achieve oxygen saturation of 94% or greater by pulse oximetry • Monitor the adequacy of ventilation and oxygenation by - Clinical criteria( chest rise and cyanosis) - Quantitative waveform capnography - oxygen saturation • Avoid excessive ventilation
- 77. CIRCULATION • Are chestcompressions effective? • What is the cardiac rhythm? • Is defibrillation or cardioversion indicated? • Has IV/IO access been established? • Is ROSC present? • Is the patient with a pulse unstable? • Are medications needed for rhythm or blood pressure? • Does the patient need volume (fluid) for resuscitation?
- 78. Contd.. • Monitor CPRquality - Quantitative waveform capnography (if PETCO₂ is less than 10 mm Hg, atte to improve CPR quality) - Intra-arterial pressure (if relaxation phase [diastolic] pressure is less than 20 mm Hg, attempt to improve CPR quality) • Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms (eg, tricular fibrillation [VF], pulseless ventricular tachycardia [PVT], asystole, pulse electrical activity [PEA]) • Provide defibrillation/cardioversion
- 79. Contd.. • Obtain IV/IOaccess • Give appropriate drugs to manage rhythm and blood pressure • Give IV/IO fluids if needed • Check glucose and temperature • Check perfusion issues
- 80. DISABLITY • Check forneurologic function • Quickly assess for responsiveness, levels of consciousness, and pupil dilation • Assess for AVPU A - Alert V - Voice P - Painful U- Unresponsive
- 81. EXPOSURE • Remove clothingto perform a physical examination, looking for obvious signs of trauma, bleeding, burns, unusual markings, or medical alert bracelets
- 82. SECONDARY ASSESSMENT • Secondaryassessment involves the differential diagnosis, including a focused medical history and searching for and treating underlying causes (H;s and T;s) • Ask specific question related to the patient's presentation consider using memory aid SAMPLE
- 84. POTENTIALLY REVERSIBLE CAUSES (5H’s & 5 T’s): • Tension pneumothorax • Tamponade • Toxic/therap. disturbances • Thrombosis coronary • Thrombosis pulmonary • Hypoxia • Hypovolemia • Hypothermia • Hyper/hypokalemia and metabolic disorders • H+ ions (acidosis)
Editor's Notes
- #2 According to recent stats, more than 70% SCA or Sudden Cardiac Arrests occur at home or similar private settings. 95% of Sudden Cardiac Arrest victims die prior to even reaching the hospital. Out of all these numbers, only 6% survive cardiac arrest. Effective CPR provided by a bystander in the first few minutes of cardiac arrest can increase the chances of survival by 2x or 3x. If a bystander does not perform CPR, the survival chances of a victim will decrease 7% in every single minute of delay.
- #20 Ensure cervical spine stability