This document provides information on cardiopulmonary resuscitation (CPR). It discusses the chain of survival, including early recognition of cardiac arrest, early activation of emergency services, early chest compressions, early defibrillation, and early advanced care. It reviews international CPR guidelines from 2005 and 2010. It also describes the techniques for performing CPR, including chest compressions, ventilations, use of an automated external defibrillator (AED), securing an airway, confirming device placement, identifying cardiac rhythms, defibrillation, pacing, establishing intravenous access, and administering rhythm-appropriate medications such as epinephrine, vasopressin, atropine, and amiodarone.
Basic life support,Cardi0-pulmonary resuscitationPinky Rathee
It refers to the care provided by healthcare providers and public safety professionals 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.
Basic life support,Cardi0-pulmonary resuscitationPinky Rathee
It refers to the care provided by healthcare providers and public safety professionals 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.
Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the end of normal circulation of the blood due to failure of the heart to contract effectively.
Also referred as a sudden cardiac arrest (SCA).
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early.
Unexpected cardiac arrest sometimes leads to death almost immediately; this is called sudden cardiac death (SCD).
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
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Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. “No initial intervention
can be delivered to the
victim of cardiac arrest
unless bystanders are
ready, willing, and able to
act”
2
3. Bad News Time Flies
Good News You are the Pilot
You take care of the Seconds
We take care of the Minutes
3
4. Cardiac Arrest
Cardiac arrest is the cessation of all cardiac
mechanical activity. It’s clinical diagnosis is
confirmed by
Unresponsiveness
Absence of detectable pulse
Apnea (or agonal respirations )
5. The Cardiac Arrest Rhythms
The four cardiac arrest rhythms are
Asystole
PEA ( Pulseless Electrical Activity )
Pulseless Ventricular Tachcardia (VT)
Ventricular Fibrillation (VF)
6. D. Differential Diagnosis
Review the most frequent causes
( the 6 H’s and 6 T’s )
Hypovolemia Tablets ( Toxins)
Hypoxia Tamponade - cardiac
Hydrogen ions – acidosis Tension pneumothorax
Hyper / hypokalemia Thrombosis - coronary
Hypothermia Trauma
Hypoglycemia Thrombosis - pulmonary
7. Cardio Pulmonary Cerebral Resuscitation
BLS : Basic life support
ACLS : Advance cardiac life support
Better chance of survival
Brain damage starts in 4-6 minutes
Brain damage is certain after 10 minutes
without CPR
What is treatment of cardiac arrest….?
8. How to do It- Chain of Survival
Early Recognition
(Sudden Cardiac Arrest))
Early Activation
(Emergency Medical Service)
Early Chest Compression
(Push Hard &Push Fast)
Early Shock
(Automated External
Defibrillator
Early Advanced care
9. Chain Of Survival – 4 links
Early Activation
of EMS
Early CPR
Early Defibrillation
Early Advanced
Care
BLS
15. BLS Algorithm
Step 1. Assess Responsiveness
Step 2. Activate the EMS and call for the defibrillator(AED)
Step 3. check for pulse in 10 sec.
Step 4. Start chest Compressions (30:2), minimize interruption
Beginning with 30 compressions rather than 2 ventilations l/t shorter
delays.
Step 5. Open airway
Step 6. Check breathing
Step 7. Give rescue breaths, avoid excessive ventilations
As soon as a AED is available attach and fallow
instructions
25. “Push hard and Push fast”
Minimise interruption of chest compression
• >100 /min.
• 30:2 ratio ( C:V )
• 5 cycles (2 minutes)
• 50% : 50 % ( C/R )
• minimum 5 cm sternal depression
• Arms Straight, elbows locked,
shoulder over hands
• Complete recoil of chest
26. • Rescuer fatigue may lead to inadequate
compression rates or depth.
• When 2 or more rescuers are available it is
reasonable to switch chest compressors
approximately every 2 minutes (or after
about 5 cycles of compressions and
ventilations at a ratio of 30:2) to prevent
decreases in the quality of compressions .
• Every effort should be made to accomplish
this switch in 5 seconds.
27. 5. Open the Airway
Head Tilt –Chin Lift Maneuver
32. Ventilation With Bag and Mask
• Rescuers can provide bag-mask ventilation
with room air or oxygen.
• This amount is usually sufficient to produce
visible chest rise and maintain oxygenation
and normocarbia in apneic patients (Class
IIa).
• If the airway is open and a good, tight seal is
established between face and mask.
• Avoid excessive ventilation (30:2 for bag &
mask and 8-10 breaths/min after intubation)
33. As long as the patient does not have an
advanced airway in place, the rescuers
should deliver cycles of 30 compressions and
2 breaths during CPR.
The rescuer delivers ventilations during
pauses in compressions and delivers each
breath over 1 second (Class IIa).
The healthcare provider should use
supplementary oxygen (O2 concentration
40%, at a minimum flow rate of 10 to 12
L/min) when available.
34. Ventilation With an Advanced Airway
When an advanced airway (ie, endotracheal
tube, Combitube, or laryngeal mask airway
[LMA]) is in place during 2-person CPR, give
1 breath every 6 to 8 seconds without
attempting to synchronize breaths between
compressions (this will result in delivery of 8
to 10 breaths/minute).
There should be no pause in chest
compressions for delivery of ventilations
(Class IIb).
36. D – Early Defibrillation
Automated External Defibrillator (AED)
Single greatest advance in CPR
The survival rate is 90% if
the patient is defibrillated
within 1 min. and only 10%
if it is delayed till 10mins
(Circulation 1984;69:943-8.)
Survival rate after cardiac
arrest has been reported to
go up from 30% to 49%
(Ann Emerg Med 1996;28:480-5.)
37.
38.
39. International Guidelines for CPR
2010 vs 2005
Team work
No look, listen, feel
ABC -CAB sequence Beginning with 30
compressions rather than 2 ventilations .
Chest compressions – >5 cm
Rescuer specific cpr strategy
Untrained: Hands only cpr
Pulse checks are only undertaken where
there are signs suggestive of ROSC.
40.
<10 sec. for intubation
Waveform capnography (Etco2 >10 mmhg)
Intra-arterial diastolic pressure >20 mmhg
Atropine no longer recommended in PEA /Asystole
and it remains for peri-arrest management.
Chronotrophic drug infusions used as alternative to
pacing.
Advanced airway: includes supraglottic airway
devices, capnography.
Interruption is allowed for only 5 sec.e.g.
Defibrillation, change over
The tracheal route of drug administration is not
recommended except in neonates following the
widespread introductionof intraosseous devices.
43. Biphasic vs Monophasic Defibrillation
Advantages
- greater efficacy
- low energy produces same effect
- less myocardial damage
- less incidence of S-T changes
( Ital Heart J Suppl. 2002 Jun;3(6):638-45 )
Energy
- Monophasic 360 J
- Biphasic 150/200 J
All AEDs are Biphasic
High first shock success of
Biphasic defibrillation (84%-95%)
45. A - Airway
Definitive airway should be secured as soon as possible
Tracheal intubation using cricoid pressure (by trained
personnel only)
Laryngeal Mask Airway (LMA) and Esophageal–tracheal
Combitube are accepted alternatives for others
Cricothyrotomy to be performed in an emergency
46. B. Breathing - Confirm device placement
Primary Confirmation
Direct Visualisation of ETT passing through cords
Chest expansion
5 point auscultation - L and R anterior,
- L and R mid-axillary
- Over stomach
Still in doubt –repeat laryngoscopy
Further confirmation - Exhaled CO2 detector (ETCO2)
- Oesophageal detector device
Inflate cuff and secure the tube
47. B. Breathing –
Confirm effective oxygenation and ventilation
No synchrony between ventilation and chest
compressions once definitive airway is secured
No longer 30 : 2 compression ventilation cycles
COMPRESSION @100/min
VENTILATION @ 6 – 8 breaths/min
48. C. Circulation
Identify the rhythm
Defibrillation /Pacing
Secure IV line-large easily accessible peripheral veins
Give rhythm appropriate medication
49. Recognition of Rhythm
Cardiac Arrest (lethal rhythms)
Shockable-VF,Pulseless VT
Non Shockable – Asystole.PEA
Non Cardiac Arrest (non lethal rhythm)
Rate too fast - >120/min
Rate too slow- <60/min
50. Defibrillation
For shockable rhythms – VF / Pulseless VT
Monophasic or Biphasic defibrillators (Biphasic preferred)
Monophasic 360 J ~ Biphasic 200 J
Steps of Defibrillation
- Mains plugged in or on battery, On Defib mode
- ECG size/gain maximum
- Set on leads: Only set on paddles if no leads
- Select joules (200,300 & all others 360)
- Charge, (“all clear”chant to count of 3 before discharge)
- Discharge
51. Pacing
Disappointing results for asystole, PEA
No benefit in post shock asystole
May be indicated for cardiac arrest with
narrow QRS complexes
Not useful during terminal wide complex
agonal rhythms
Extensive use in pre-arrest bradyarrhythmias
Transcutaneous or transvenous
52. C-Circulation
IV Access
Wide bore peripheral upper limb vein
Push each bolus with 20cc fluid
Raise extremity
Urgent central/femoral line only if peripheral
access impossible or difficult & taking a long time
to cannulate
53. C-Circulation
Other Drug Delivery Routes
Tracheal
- 2-3 times IV dose
- Dilute in 10 ml saline
- Preferably inject down a suction catheter which
is wedged deep into the bronchus
- Rapid bagging
Intracardiac route
- Not recommended
- Dangerous
can result in refractory VF or convert to
nonshockable rhythm
54. C - Circulation
Rhythm appropriate medications
Epinephrine
Indicated in all cardiac arrest rhythms
i.e. VF, Pulse less VT, Asystole and PEA
IV dose is 1mg administered every 3-5 minutes
followed by 20 ml IV saline flush
Adrenaline causes intense cardio-cerebral sparing
vasoconstriction CPR generates CO 25% of normal
Beneficial effects outweigh negative effects on the myocardium
55. Vasopressin
Antidiuretic hormone and a powerful vasoconstrictor
when used in the higher doses.
Positive effects of epinephrine with lesser adverse
effects . Effect lasts for 20 minutes
Dose - 40 IU
Drug of choice for all 4 rhythms
Pulseless VT , VF, Asystole and PEA
One dose of vasopressin may replace either the first
or the second dose of epinephrine
56. Atropine
First drug of choice in symptomatic bradycardia (class I )
Second drug after epinephrine for asystole and
bradycardic PEA ( class II b ).
Dose is 1mg IV push, repeat every 3-5 minutes up to a
maximum dose of 0.04 mg /kg .
57. Amiodarone
Persistent or recurrent VF or VT ( class II b )
Dose is 300 mg IV push (150 mg may be repeated after
3-5 minutes ) may be followed by a 24 hour infusion of
1mg / minute for 6 hours and then 0.5 mg/minute for the
remaining 18 hours.
Amiodarone preferred over Lignocaine (class
indeterminate ) in the treatment of persistent or
recurrent VF /VT.
58. Sodium Bicarbonate
Specific indications are as follows
class I if known pre-existing hyperkalemia
class II a if known bicarbonate responsive acidosis -
TCA overdose
class II b after prolonged resuscitation with
effective ventilation
class III hypercarbic acidosis
The dose is 1 meq/kg bolus, repeat half this dose every
10 minutes thereafter
59. Calcium
Detrimental effect on ischaemic myocardium
Impairs cerebral recovery
NOT TO BE USED ROUTINELY
Indicated in PEA due to
Hyperkalaemia
Hypocalcaemia
Ca channel blocker overdose
60. Magnesium sulphate
Shock refractory ventricular fibrillation in
pr of possible hypomagnesemia
Torsades de pointes
VT in pr of possible hypomagnesemia
Dose : 1 –2 g (4-8 mmol ) MgSO4 over 1-2
min,can be repeated after 10 –15 min
61. D. Differential Diagnosis
Review the most frequent causes
( the 5 H’s and 5 T’s )
Hypovolemia Tablets ( Toxins)
Hypoxia Tamponade - cardiac
Hydrogen ions – acidosis Tension pneumothorax
Hyper / hypokalemia Thrombosis - coronary
Hypothermia trauma
hypoglycemia Thrombosis - pulmonary
62. ACLS - Secondary ABCD
Survey
A Airway : place airway device as soon as possible
B Breathing : confirm airway device placement
by examination plus confirmation device
B Breathing : secure airway device
B Breathing : confirm effective oxygenation & ventilation
C Circulation : identify rhythm – monitor
C Circulation : Defibrillation/Pacing
C Circulation : establish IV access
C Circulation : give medications appropriate for rhythm and
condition
D Differential Diagnosis : search for and treat identified reversible
causes
63. Monitoring the Victim -
To assess effectiveness of rescue efforts
Monitor for signs of circulation and breathing
Check pulse during compression to assess
effectiveness of compression
To determine ROSC after 2 minutes of chest
compression check for pulse
ETCO2