The document summarizes the main changes in resuscitation guidelines from 2010 compared to 2005. Key changes include an increased focus on high-quality chest compressions with minimal interruptions, continuing compressions when charging a defibrillator to reduce delays, and removing recommendations for a specified period of CPR before defibrillation for unwitnessed arrests. The guidelines emphasize the importance of early defibrillation and avoiding long pause times both before and after shocks.
The document provides guidelines for basic and advanced life support from the European Resuscitation Council. It outlines the steps for assessing an unresponsive victim and providing CPR, including calling for help, checking breathing and pulse, opening the airway, delivering rescue breaths and chest compressions, using an AED if available, and treating reversible causes of cardiac arrest. It also describes treating shockable and non-shockable heart rhythms, minimizing interruptions to chest compressions, considering advanced airways and vascular access, and focusing on high-quality CPR when performing advanced life support.
The document outlines the universal algorithm for advanced life support. It begins with assessing if the patient is unresponsive and not breathing or only gasping occasionally. If so, call the resuscitation team and begin CPR with 30 chest compressions and 2 breaths. Attach a defibrillator/monitor and minimize interruptions. Assess the rhythm and if it is shockable (ventricular fibrillation or pulseless ventricular tachycardia), deliver one shock. If the rhythm is non-shockable (pulseless electrical activity or asystole), continue CPR for 2 minutes while minimizing interruptions. The algorithm then details steps to take during and after CPR, including treating reversible causes, providing oxygen, establishing vascular access
The 2010 AHA Guidelines for CPR and ECC updated several aspects of BLS and ACLS protocols based on the latest resuscitation science. Key changes included simplifying the treatment algorithms to focus on high-quality chest compressions, minimizing interruptions to provide continuous CPR, and optimizing post-cardiac arrest care through interventions like therapeutic hypothermia.
CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support
CPR with both compression & rescue breath is critical for victim in emergency situation
BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS
Performed by a medical professional or an ordinary citizen who trained on it
ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person
Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR). This presentation will provide you with an introduction to HP CPR for implementation in your EMS system.
The document calls for bystanders to provide hands-only CPR to adults experiencing out-of-hospital cardiac arrest. It recommends that bystanders push hard and fast in the center of the chest with minimal interruptions until emergency services arrive. Hands-only CPR eliminates rescue breaths and simplifies the process to improve the low rates of bystander CPR. While all cardiac arrest victims benefit from compressions, some may require additional interventions taught in a conventional CPR course.
The document provides guidelines for basic and advanced life support from the European Resuscitation Council. It outlines the steps for assessing an unresponsive victim and providing CPR, including calling for help, checking breathing and pulse, opening the airway, delivering rescue breaths and chest compressions, using an AED if available, and treating reversible causes of cardiac arrest. It also describes treating shockable and non-shockable heart rhythms, minimizing interruptions to chest compressions, considering advanced airways and vascular access, and focusing on high-quality CPR when performing advanced life support.
The document outlines the universal algorithm for advanced life support. It begins with assessing if the patient is unresponsive and not breathing or only gasping occasionally. If so, call the resuscitation team and begin CPR with 30 chest compressions and 2 breaths. Attach a defibrillator/monitor and minimize interruptions. Assess the rhythm and if it is shockable (ventricular fibrillation or pulseless ventricular tachycardia), deliver one shock. If the rhythm is non-shockable (pulseless electrical activity or asystole), continue CPR for 2 minutes while minimizing interruptions. The algorithm then details steps to take during and after CPR, including treating reversible causes, providing oxygen, establishing vascular access
The 2010 AHA Guidelines for CPR and ECC updated several aspects of BLS and ACLS protocols based on the latest resuscitation science. Key changes included simplifying the treatment algorithms to focus on high-quality chest compressions, minimizing interruptions to provide continuous CPR, and optimizing post-cardiac arrest care through interventions like therapeutic hypothermia.
CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support
CPR with both compression & rescue breath is critical for victim in emergency situation
BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS
Performed by a medical professional or an ordinary citizen who trained on it
ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person
Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR). This presentation will provide you with an introduction to HP CPR for implementation in your EMS system.
The document calls for bystanders to provide hands-only CPR to adults experiencing out-of-hospital cardiac arrest. It recommends that bystanders push hard and fast in the center of the chest with minimal interruptions until emergency services arrive. Hands-only CPR eliminates rescue breaths and simplifies the process to improve the low rates of bystander CPR. While all cardiac arrest victims benefit from compressions, some may require additional interventions taught in a conventional CPR course.
This document summarizes the key components of the hemostatic (blood clotting) system. It describes how platelets adhere to sites of injury via receptors like GpIb-IX-V and GpIa-IIa, become activated by collagen and thrombin binding receptors like GpVI and PARs, and aggregate together via GpIIb-IIIa receptors crosslinking with fibrinogen. This platelet plug formation is balanced by anti-coagulant factors. Inherited disorders of platelet adhesion, activation or secretion proteins can cause bleeding disorders. The coagulation cascade is initiated at sites of injury by tissue factor binding Factor VIIa and activating downstream coagulation factors X and IX. Ultimately thrombin is
1) New Thai HIV Treatment Guidelines 2010 reviews data on when to initiate antiretroviral therapy (ART) and notes that in developed countries the CD4 count threshold has stabilized around 150-200 cells/mm3 while in sub-Saharan Africa it has increased from 50-100 cells/mm3.
2) The development of ART in Thailand progressed from AZT mono-therapy in 1992 to triple therapy in 1997 to national ART programs in 2004-2006 that provided treatment according to CD4 count and clinical symptoms.
3) The 2010 Thai guidelines recommend starting ART for anyone with a CD4 count <200 cells/mm3 or AIDS-defining illnesses and monitoring but not treating those with CD4
Ryan Adams was born in 1974 in North Carolina and began playing guitar at age 14. He joined several local bands before dropping out of school to perform music full-time. Adams released his solo debut "Heartbreaker" in 2000 to critical acclaim but slow sales. His cover of "Wonderwall" increased his recognition, as did his songs being featured in television and film. Adams releases numerous albums each year on independent labels, changing his musical style frequently between alternative, country, and piano ballads.
1. The 2010 European Resuscitation Council guidelines include changes to basic and advanced life support protocols, with a strong emphasis on high-quality, minimally interrupted chest compressions.
2. For electrical therapies, the guidelines recommend minimizing pauses in chest compressions during defibrillation and resuming compressions immediately after shocks.
3. The advanced life support guidelines place increased focus on treating the underlying causes of cardiac arrest and managing patients after return of spontaneous circulation.
1. The 2010 European Resuscitation Council guidelines include changes to basic and advanced life support, as well as electrical therapies.
2. Key changes include an increased emphasis on high-quality, uninterrupted chest compressions and minimizing interruptions.
3. For electrical therapies, the guidelines recommend immediate resumption of chest compressions after defibrillation and continuing compressions while the defibrillator charges.
The document provides guidelines for basic and advanced life support from the European Resuscitation Council. For basic life support outside of a hospital, it recommends checking response and breathing, calling for emergency help, performing chest compressions and rescue breaths in a 30:2 ratio, and using an automated external defibrillator if available. For in-hospital resuscitation, it outlines assessing the patient and either calling a resuscitation team or starting CPR and defibrillation. It also provides algorithms for advanced life support, bradycardia, tachycardia, and newborn and pediatric life support.
This document provides guidance on performing basic life support (BLS) for adults and children. It outlines the steps of BLS, including assessing the scene and victim for safety, checking for response, opening the airway, checking for breathing and circulation, calling for help, performing chest compressions and rescue breaths. It emphasizes the importance of high-quality chest compressions and notes differences in performing CPR on children versus adults. The document also discusses complications of CPR, the recovery position, and hands-only or compression-only CPR. The goal of BLS is to provide oxygenated blood flow to vital organs until more advanced medical help arrives.
This document provides guidance on performing basic life support (BLS) for adults and children. It outlines the steps of BLS, including assessing the scene and victim for safety, checking for response, opening the airway, checking for breathing and circulation, calling for help, performing chest compressions and rescue breaths, and positioning an unconscious breathing victim. Key differences between adult and pediatric BLS are highlighted, such as using two fingers to perform chest compressions on children. The importance of early CPR and defibrillation for cardiac arrest survival is emphasized. Complications of CPR are also reviewed.
Basic life support (BLS) refers to emergency care provided to patients experiencing cardiac arrest, respiratory failure, or airway obstruction. It includes chest compressions, use of an automated external defibrillator, and relieving airway obstructions. The chain of survival emphasizes early CPR, early defibrillation, early advanced life support, and post-cardiac arrest care to maximize patient survival. BLS procedures include assessing the patient for responsiveness, activating emergency services, performing high-quality chest compressions, opening the airway, and providing rescue breaths. Defibrillation is key for shockable cardiac rhythms like ventricular fibrillation. BLS aims to provide oxygenated blood flow to vital organs until further medical help
Cardiopulmonary resuscitation (CPR) involves chest compressions and artificial ventilation to maintain blood flow and oxygen during cardiac arrest. CPR should be started immediately for anyone found unconscious and pulseless. The key steps of CPR include 30 chest compressions followed by 2 rescue breaths in a repeated cycle until a pulse returns or advanced care arrives. Defibrillation using an automated external defibrillator is critical for shockable rhythms like ventricular fibrillation to restore an effective heartbeat. Proper CPR technique is essential to optimize the chances of survival from cardiac arrest.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Basic life support is a course run by American Heart Association that teaches about handling cardiac arrest in Out of Hospital and In Hospital Situations. This Presentation covers important aspects of the same.
The document defines basic life support (BLS) and outlines the key steps and components of BLS. It explains that BLS includes performing high-quality CPR, using an automated external defibrillator (AED), and relieving an obstructed airway. The "chain of survival" is introduced as assessing response, activating emergency services, performing chest compressions, checking airway/breathing, defibrillating if needed, and continuing resuscitation until help arrives. Key BLS maneuvers like chest compressions, rescue breathing, and AED use are summarized.
The document discusses the learning objectives and key steps in performing adult and pediatric basic life support for healthcare providers. It covers topics such as recognizing cardiac arrest, performing high-quality chest compressions and rescue breathing, using an automated external defibrillator, and providing care for special circumstances like drowning and COVID-19 patients. The goal is for learners to understand how to effectively perform CPR and use an AED to support the cardiac chain of survival.
The document provides guidelines for cardiopulmonary resuscitation (CPR) published by the European Resuscitation Council in 2010. It highlights several main changes from the 2005 guidelines, including increased emphasis on high-quality, uninterrupted chest compressions; minimizing interruptions during defibrillation; and recognition of the potential harm of hyperoxaemia after return of spontaneous circulation. Other changes covered include updated treatment recommendations for acute coronary syndromes, greater use of capnography and therapeutic hypothermia, and revised pediatric CPR guidelines focusing on compression quality and automated external defibrillator use in children.
European resuscitation-council-guidelines-for-resuscitation-2010-section-1-ex...rojo1984
The document summarizes the key changes to the European Resuscitation Council Guidelines from 2010. Some of the main changes include:
1) Increased emphasis on high-quality chest compressions and minimizing interruptions during CPR.
2) Removal of the recommendation for a specified period of CPR before defibrillation for unwitnessed out-of-hospital cardiac arrests.
3) Continuation of chest compressions while the defibrillator is being charged to minimize pre-shock pauses.
4) For ventricular fibrillation/pulseless ventricular tachycardia, up to three quick successive shocks may be used in some settings, and adrenaline and amiodarone are recommended
The document summarizes the key changes to the European Resuscitation Council Guidelines from 2010. Some of the main changes include:
1) Increased emphasis on high-quality chest compressions and minimizing interruptions during CPR.
2) Removal of the recommendation for a specified period of CPR before defibrillation for unwitnessed out-of-hospital cardiac arrests.
3) Continuation of chest compressions while the defibrillator is being charged to minimize pre-shock pauses.
4) For ventricular fibrillation/pulseless ventricular tachycardia, up to three quick successive shocks may be used in some settings, and adrenaline and amiodarone are recommended
This document summarizes the key components of the hemostatic (blood clotting) system. It describes how platelets adhere to sites of injury via receptors like GpIb-IX-V and GpIa-IIa, become activated by collagen and thrombin binding receptors like GpVI and PARs, and aggregate together via GpIIb-IIIa receptors crosslinking with fibrinogen. This platelet plug formation is balanced by anti-coagulant factors. Inherited disorders of platelet adhesion, activation or secretion proteins can cause bleeding disorders. The coagulation cascade is initiated at sites of injury by tissue factor binding Factor VIIa and activating downstream coagulation factors X and IX. Ultimately thrombin is
1) New Thai HIV Treatment Guidelines 2010 reviews data on when to initiate antiretroviral therapy (ART) and notes that in developed countries the CD4 count threshold has stabilized around 150-200 cells/mm3 while in sub-Saharan Africa it has increased from 50-100 cells/mm3.
2) The development of ART in Thailand progressed from AZT mono-therapy in 1992 to triple therapy in 1997 to national ART programs in 2004-2006 that provided treatment according to CD4 count and clinical symptoms.
3) The 2010 Thai guidelines recommend starting ART for anyone with a CD4 count <200 cells/mm3 or AIDS-defining illnesses and monitoring but not treating those with CD4
Ryan Adams was born in 1974 in North Carolina and began playing guitar at age 14. He joined several local bands before dropping out of school to perform music full-time. Adams released his solo debut "Heartbreaker" in 2000 to critical acclaim but slow sales. His cover of "Wonderwall" increased his recognition, as did his songs being featured in television and film. Adams releases numerous albums each year on independent labels, changing his musical style frequently between alternative, country, and piano ballads.
1. The 2010 European Resuscitation Council guidelines include changes to basic and advanced life support protocols, with a strong emphasis on high-quality, minimally interrupted chest compressions.
2. For electrical therapies, the guidelines recommend minimizing pauses in chest compressions during defibrillation and resuming compressions immediately after shocks.
3. The advanced life support guidelines place increased focus on treating the underlying causes of cardiac arrest and managing patients after return of spontaneous circulation.
1. The 2010 European Resuscitation Council guidelines include changes to basic and advanced life support, as well as electrical therapies.
2. Key changes include an increased emphasis on high-quality, uninterrupted chest compressions and minimizing interruptions.
3. For electrical therapies, the guidelines recommend immediate resumption of chest compressions after defibrillation and continuing compressions while the defibrillator charges.
The document provides guidelines for basic and advanced life support from the European Resuscitation Council. For basic life support outside of a hospital, it recommends checking response and breathing, calling for emergency help, performing chest compressions and rescue breaths in a 30:2 ratio, and using an automated external defibrillator if available. For in-hospital resuscitation, it outlines assessing the patient and either calling a resuscitation team or starting CPR and defibrillation. It also provides algorithms for advanced life support, bradycardia, tachycardia, and newborn and pediatric life support.
This document provides guidance on performing basic life support (BLS) for adults and children. It outlines the steps of BLS, including assessing the scene and victim for safety, checking for response, opening the airway, checking for breathing and circulation, calling for help, performing chest compressions and rescue breaths. It emphasizes the importance of high-quality chest compressions and notes differences in performing CPR on children versus adults. The document also discusses complications of CPR, the recovery position, and hands-only or compression-only CPR. The goal of BLS is to provide oxygenated blood flow to vital organs until more advanced medical help arrives.
This document provides guidance on performing basic life support (BLS) for adults and children. It outlines the steps of BLS, including assessing the scene and victim for safety, checking for response, opening the airway, checking for breathing and circulation, calling for help, performing chest compressions and rescue breaths, and positioning an unconscious breathing victim. Key differences between adult and pediatric BLS are highlighted, such as using two fingers to perform chest compressions on children. The importance of early CPR and defibrillation for cardiac arrest survival is emphasized. Complications of CPR are also reviewed.
Basic life support (BLS) refers to emergency care provided to patients experiencing cardiac arrest, respiratory failure, or airway obstruction. It includes chest compressions, use of an automated external defibrillator, and relieving airway obstructions. The chain of survival emphasizes early CPR, early defibrillation, early advanced life support, and post-cardiac arrest care to maximize patient survival. BLS procedures include assessing the patient for responsiveness, activating emergency services, performing high-quality chest compressions, opening the airway, and providing rescue breaths. Defibrillation is key for shockable cardiac rhythms like ventricular fibrillation. BLS aims to provide oxygenated blood flow to vital organs until further medical help
Cardiopulmonary resuscitation (CPR) involves chest compressions and artificial ventilation to maintain blood flow and oxygen during cardiac arrest. CPR should be started immediately for anyone found unconscious and pulseless. The key steps of CPR include 30 chest compressions followed by 2 rescue breaths in a repeated cycle until a pulse returns or advanced care arrives. Defibrillation using an automated external defibrillator is critical for shockable rhythms like ventricular fibrillation to restore an effective heartbeat. Proper CPR technique is essential to optimize the chances of survival from cardiac arrest.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Basic life support is a course run by American Heart Association that teaches about handling cardiac arrest in Out of Hospital and In Hospital Situations. This Presentation covers important aspects of the same.
The document defines basic life support (BLS) and outlines the key steps and components of BLS. It explains that BLS includes performing high-quality CPR, using an automated external defibrillator (AED), and relieving an obstructed airway. The "chain of survival" is introduced as assessing response, activating emergency services, performing chest compressions, checking airway/breathing, defibrillating if needed, and continuing resuscitation until help arrives. Key BLS maneuvers like chest compressions, rescue breathing, and AED use are summarized.
The document discusses the learning objectives and key steps in performing adult and pediatric basic life support for healthcare providers. It covers topics such as recognizing cardiac arrest, performing high-quality chest compressions and rescue breathing, using an automated external defibrillator, and providing care for special circumstances like drowning and COVID-19 patients. The goal is for learners to understand how to effectively perform CPR and use an AED to support the cardiac chain of survival.
The document provides guidelines for cardiopulmonary resuscitation (CPR) published by the European Resuscitation Council in 2010. It highlights several main changes from the 2005 guidelines, including increased emphasis on high-quality, uninterrupted chest compressions; minimizing interruptions during defibrillation; and recognition of the potential harm of hyperoxaemia after return of spontaneous circulation. Other changes covered include updated treatment recommendations for acute coronary syndromes, greater use of capnography and therapeutic hypothermia, and revised pediatric CPR guidelines focusing on compression quality and automated external defibrillator use in children.
European resuscitation-council-guidelines-for-resuscitation-2010-section-1-ex...rojo1984
The document summarizes the key changes to the European Resuscitation Council Guidelines from 2010. Some of the main changes include:
1) Increased emphasis on high-quality chest compressions and minimizing interruptions during CPR.
2) Removal of the recommendation for a specified period of CPR before defibrillation for unwitnessed out-of-hospital cardiac arrests.
3) Continuation of chest compressions while the defibrillator is being charged to minimize pre-shock pauses.
4) For ventricular fibrillation/pulseless ventricular tachycardia, up to three quick successive shocks may be used in some settings, and adrenaline and amiodarone are recommended
The document summarizes the key changes to the European Resuscitation Council Guidelines from 2010. Some of the main changes include:
1) Increased emphasis on high-quality chest compressions and minimizing interruptions during CPR.
2) Removal of the recommendation for a specified period of CPR before defibrillation for unwitnessed out-of-hospital cardiac arrests.
3) Continuation of chest compressions while the defibrillator is being charged to minimize pre-shock pauses.
4) For ventricular fibrillation/pulseless ventricular tachycardia, up to three quick successive shocks may be used in some settings, and adrenaline and amiodarone are recommended
CPR involves maintaining circulation and respiration through chest compressions and rescue breathing. It is performed when someone experiences cardiac arrest and their heart stops beating. The key steps of CPR are compressing the chest at a rate of 100-120 times per minute and providing two rescue breaths after every 30 compressions. Regular practice of CPR and immediate response in emergencies can help sustain vital organ function until advanced medical help arrives.
This document discusses cardiopulmonary resuscitation (CPR) techniques and a study that found a combination of vasopressin, steroids, and epinephrine during CPR led to improved outcomes compared to epinephrine alone. It provides details on performing CPR, including chest compressions, ventilation, positioning, and guidelines for adults, children and infants. Videos are referenced to demonstrate CPR and use of an automated external defibrillator. Potential complications of CPR like rib fractures and gastric insufflation are also mentioned.
This guideline applies to all persons who are unresponsive and not breathing normally.
This guideline is for use by bystanders, first aiders or first aid providers, first responders and health professionals.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
3. 3
Summary of main changes since 2005 Guidelines
Basic life support improve the quality of CPR perform-
ance and provide feedback to pro-
Changes in basic life support (BLS) since fessional rescuers during debriefing
the 2005 guidelines include:
sessions.
♦♦ Dispatchers should be trained to
interrogate callers with strict protocols electrical therapies:
to elicit information. This information automated external defi-
should focus on the recognition of brillators, defibrillation,
unresponsiveness and the quality of cardioversion and pacing
breathing. In combination with unre-
sponsiveness, absence of breathing or The most important changes in the 2010
any abnormality of breathing should ERC Guidelines for electrical therapies
start a dispatch protocol for suspect- include:
ed cardiac arrest. The importance of
gasping as sign of cardiac arrest is
emphasised. ♦♦ The importance of early, uninter-
rupted chest compressions is empha-
sised throughout these guidelines.
♦♦ All rescuers, trained or not, should
provide chest compressions to victims
of cardiac arrest. A strong empha- ♦♦ Much greater emphasis on mini-
sis on delivering high quality chest mising the duration of the pre-shock
compressions remains essential. The and post-shock pauses; the continua-
aim should be to push to a depth of tion of compressions during charging
at least 5 cm at a rate of at least 100 of the defibrillator is recommended.
compressions min-1, to allow full chest
recoil, and to minimise interruptions
in chest compressions. Trained rescu- ♦♦ Immediate resumption of chest
ers should also provide ventilations compressions following defibrillation
with a compression–ventilation (CV) is also emphasised; in combination
ratio of 30:2. Telephone-guided chest with continuation of compressions
compression-only CPR is encouraged during defibrillator charging, the
for untrained rescuers. delivery of defibrillation should be
achievable with an interruption in
chest compressions of no more than 5
♦♦ The use of prompt/feedback devic- seconds.
es during CPR will enable immediate
feedback to rescuers and is encour-
aged. The data stored in rescue equip- ♦♦ Safety of the rescuer remains par-
ment can be used to monitor and amount, but there is recognition in
4. 4
Adult Basic Life Support
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 112*
30 chest compressions
2 rescue breaths
30 compressions
*or national emergency number
5. 5
Automated External Defibrillation
Unresponsive?
Call for help
Open airway
Not breathing normally
Send or go for AED
Call 112*
* or national emergency number
CPR 30:2
Until AED is attached
AED
assesses
rhythm
Shock No shock
advised advised
1 Shock
Immediately resume: Immediately resume:
CPR 30:2 CPR 30:2
for 2 min for 2 min
Continue until the victim starts
to wake up: to move, opens
eyes and to breathe normally
6. In Hospital Resuscitation
Collapsed/sick patient
Shout for HELP & assess patient
No Signs of life? Yes
Call resuscitation team
Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access
CPR 30:2
with oxygen and airway adjuncts
Call resuscitation team
Apply pads/monitor If appropriate
Attempt defibrillation if appropriate
Advanced Life Support Handover to resuscitation team
when resuscitation team arrives
6
7. 7
these guidelines that the risk of harm adult advanced life
to a rescuer from a defibrillator is very support
small, particularly if the rescuer is
The most important changes in the 2010
wearing gloves. The focus is now on a
ERC Advanced Life Support (ALS) Guide-
rapid safety check to minimise the pre- lines include:
shock pause.
♦♦ Increased emphasis on the
♦♦ When treating out-of-hospital car- importance of minimally interrupt-
diac arrest, emergency medical serv- ed high-quality chest compressions
ices (EMS) personnel should provide throughout any ALS intervention:
good-quality CPR while a defibrillator chest compressions are paused briefly
is retrieved, applied and charged, but only to enable specific interventions.
routine delivery of a pre-specified peri-
od of CPR (e.g., two or three minutes)
before rhythm analysis and a shock is ♦♦ Increased emphasis on the use of
delivered is no longer recommended. ‘track and trigger systems’ to detect
For some EMS that have already fully the deteriorating patient and enable
implemented a pre-specified period of treatment to prevent in-hospital car-
chest compressions before defibrilla- diac arrest.
tion, given the lack of convincing data
either supporting or refuting this strat-
egy, it is reasonable for them to con- ♦♦ Increased awareness of the warn-
tinue this practice. ing signs associated with the poten-
tial risk of sudden cardiac death out of
hospital.
♦♦ The use of up to three-stacked
shocks may be considered if VF/VT
occurs during cardiac catheterisation ♦♦ Removal of the recommendation
or in the early post-operative period for a pre-specified period of cardiop-
following cardiac surgery. This three- ulmonary resuscitation (CPR) before
shock strategy may also be considered out-of-hospital defibrillation following
for an initial, witnessed VF/VT cardiac cardiac arrest unwitnessed by the EMS.
arrest when the patient is already con-
nected to a manual defibrillator.
♦♦ Continuation of chest compres-
sions while a defibrillator is charged -
♦♦ Further development of AED pro- this will minimise the pre-shock pause.
grammes is encouraged – there is a
need for further deployment of AEDs
in both public and residential areas. ♦♦ The role of the precordial thump is
de-emphasised.
8. 8
Advanced Life Support
Unresponsive?
Not breathing or only occasional
gasps
Call
Resuscitation Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock spontaneous
circulation
Immediately resume: Immediate post cardiac Immediately resume:
CPR for 2 min arrest treatment CPR for 2 min
• Use ABCDE approach
Minimise interruptions Minimise interruptions
• Controlled oxygenation and
ventilation
• 12-lead ECG
• Treat precipitating cause
•Temperature control / therapeu-
tic hypothermia
During CPR Reversible causes
• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Consider advanced airway and capnography • Hypothermia
• Continuous chest compressions when advanced airway in place
• Thrombosis
• Vascular access (intravenous, intraosseous)
• Tamponade - cardiac
• Give adrenaline every 3-5 min
• Toxins
• Correct reversible causes
• Tension pneumothorax
9. Tachycardia (with pulse)
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 ,record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Assess for evidence of adverse signs
Synchronised DC Shock* Unstable 1. Shock 2. Syncope Stable Is QRS narrow (< 0.12 sec)?
Up to 3 attempts
3. Myocardial ischaemia 4. Heart failure
Broad Narrow
• Amiodarone 300 mg IV over
10-20 min and repeat shock;
followed by:
• Amiodarone 900 mg over 24 h
Irregular Broad QRS Regular Regular Narrow QRS Irregular
Is QRS regular? Is rhythm regular?
Seek expert help Irregular Narrow Complex
• Use vagal manoeuvres
Tachycardia
• Adenosine 6 mg rapid IV bolus;
Probable atrial fibrillation
if unsuccessful give 12 mg;
Control rate with:
if unsuccessful give further 12 mg.
• ß-Blocker or diltiazem
• Monitor ECG continuously
• Consider digoxin or amiodarone if
evidence of heart failure
Anticoagulate if duration > 48h
If Ventricular Tachycardia Normal sinus rhythm restored? Seek expert help
Possibilities include: No
(or uncertain rhythm):
• AF with bundle branch block
• Amiodarone 300 mg IV over 20-60
treat as for narrow complex
min; then 900 mg over 24 h
• Pre-excited AF Yes
consider amiodarone
If previously confirmed
• Polymorphic VT
SVT with bundle branch block:
(e.g. torsades de pointes -
• Give adenosine as for regular
give magnesium 2 g over 10 min)
narrow complex tachycardia
Probable re-entry PSVT: Possible atrial flutter
• Record 12-lead ECG in sinus rhythm • Control rate (e.g. ß-Blocker)
• If recurs, give adenosine again &
*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia consider choice of anti-arrhythmic
9
prophylaxis
10. 10
Bradycardia
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 ,record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Assess for evidence of adverse signs:
1 Shock
Yes 2 Syncope No
3 Myocardial ischaemia
4 Heart failure
Atropine
500 mcg IV
Satisfactory
Yes
Response?
No Risk of asystole?
• Recent asystole
Yes • Möbitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s
Interim measures:
• Atropine 500 mcg IV repeat
to maximum of 3 mg
• Isoprenaline 5 mcg min-1
• Adrenaline 2-10 mcg min-1
• Alternative drugs* No
OR
• Transcutaneous pacing
Seek expert help Observe
Arrange transvenous pacing
* Alternatives include:
• Aminophylline
• Dopamine
• Glucagon (if beta-blocker or calcium channel
blocker overdose)
• Glycopyrrolate can be used instead of atropine
11. 11
♦♦ The use of up to three quick suc-
cessive (stacked) shocks for ventricular ♦♦ The potential role of ultrasound
fibrillation/pulseless ventricular tachy- imaging during ALS is recognised.
cardia (VF/VT) occurring in the cardiac
catheterisation laboratory or in the
immediate post-operative period fol- ♦♦ Recognition of the potential harm
lowing cardiac surgery. caused by hyperoxaemia after ROSC is
achieved: once ROSC has been estab-
lished and the oxygen saturation of
♦♦ Delivery of drugs via a tracheal tube arterial blood (SaO2) can be moni-
is no longer recommended – if intrave- tored reliably (by pulse oximetry and/
nous access cannot be achieved, drugs or arterial blood gas analysis), inspired
should be given by the intraosseous oxygen is titrated to achieve a SaO2 of
(IO) route. 94 – 98%.
♦♦ When treating VF/VT cardiac arrest, ♦♦ Much greater detail and emphasis
adrenaline 1 mg is given after the third on the treatment of the post-cardiac
shock once chest compressions have arrest syndrome.
restarted and then every 3-5 min-
utes (during alternate cycles of CPR).
Amiodarone 300 mg is also given after ♦♦ Recognition that implementation
the third shock. of a comprehensive, structured post
resuscitation treatment protocol may
improve survival in cardiac arrest vic-
♦♦ Atropine is no longer recommend- tims after ROSC.
ed for routine use in asystole or pulse-
less electrical activity (PEA).
♦♦ Increased emphasis on the use
of primary percutaneous coronary
♦♦ Reduced emphasis on early tra- intervention in appropriate (includ-
cheal intubation unless achieved by ing comatose) patients with sustained
highly skilled individuals with minimal ROSC after cardiac arrest.
interruption to chest compressions.
♦♦ Revision of the recommendation
♦♦ Increased emphasis on the use of for glucose control: in adults with sus-
capnography to confirm and continu- tained ROSC after cardiac arrest, blood
ally monitor tracheal tube placement, glucose values >10 mmol l-1 (>180 mg
quality of CPR and to provide an early dl-1) should be treated but hypoglycae-
indication of return of spontaneous mia must be avoided.
circulation (ROSC).
12. 12
ACS
Patient with clinical signs and symptoms of ACS
12 lead ECG
ST elevation
≥ 0.1 mV in ≥ 2 adjacent limb leads and/ Other ECG alterations
or ≥ 0.2 mV in ≥ adjacent chest leads (or normal ECG)
or (presumably) new LBBB
= NSTEMI if troponins = UAP if troponins
(T or I) positive remain negative
STEMI
non-STEMI-ACS
High risk
• dynamic ECG changes
• ST depression
• haemodynamic/rhythm instability
• diabetes mellitus
ECG
ECG
Pain relief Nitroglycerin sl if systolic BP > 90 mmHg
± Morphine (repeated doses) of 3-5 mg until pain free
Antiplatelet treatment 160-325mg Acetylsalicylic acid chewed tablet (or iv)
75 – 600 mg Clopidogrel according to strategy*
STEMI Non-STEMI-ACS
Thrombolysis preferred if PCI preferred if Early invasive strategy# Conservative
no contraindications and • timely and available in a high UFH or delayed invasive strategy#
inappropriate delay to PCI volume center
Enoxaparin or bivalirudin may be UFH (fondaparinux or bivalirudin
• contraindications for fibrinolysis
cardiogenic shock (or severe left considered may be considered in pts with high
Adjunctive therapy: ventricular failure) bleeding risk)
UFH, enoxaparin or fondaparinux Adjunctive therapy:
UFH, enoxaparin or bivalirudin may
be considered
# According to risk stratification
13. 13
♦♦ Use of therapeutic hypothermia to ♦♦ The role of chest pain observation
include comatose survivors of cardiac units (CPUs) is to identify, by using
arrest associated initially with non- repeated clinical examinations, ECG
shockable rhythms as well shockable and biomarker testing, those patients
rhythms. The lower level of evidence who require admission for invasive
for use after cardiac arrest from non- procedures. This may include provoca-
shockable rhythms is acknowledged. tive testing and, in selected patients,
imaging procedures such as cardiac
computed tomography, magnetic res-
♦♦ Recognition that many of the onance imaging etc.
accepted predictors of poor outcome
in comatose survivors of cardiac arrest
are unreliable, especially if the patient ♦♦ Non-steroidal anti-inflammatory
has been treated with therapeutic drugs (NSAIDs) should be avoided.
hypothermia.
♦♦ Nitrates should not be used for
initial management of diagnostic purposes.
acute coronary syndromes
Changes in the management of acute ♦♦ Supplementary oxygen is to be giv-
coronary syndrome since the 2005 en only to those patients with hypox-
guidelines include: aemia, breathlessness or pulmonary
congestion. Hyperoxaemia may be
♦♦ The term non-ST-elevation myo- harmful in uncomplicated infarction.
cardial infarction-acute coronary syn-
drome (non-STEMI-ACS) has been
introduced for both NSTEMI and ♦♦ Guidelines for treatment with
unstable angina pectoris because the acetyl salicylic acid (ASA) have been
differential diagnosis is dependent on made more liberal: ASA may now be
biomarkers that may be detectable given by bystanders with or without
only after several hours, whereas deci- EMS dispatcher assistance.
sions on treatment are dependent on
the clinical signs at presentation.
♦♦ Revised guidance for new anti-
platelet and anti-thrombin treatment
♦♦ History, clinical examinations, for patients with STEMI and non-STE-
biomarkers, ECG criteria and risk scores MI-ACS based on therapeutic strategy.
are unreliable for the identification of
patients who may be safely discharged
early.
14. 14
♦♦ Gp IIb/IIIa inhibitors before angiog- - Angiography and, if necessary, PCI
raphy/percutaneous coronary inter- may be reasonable in patients with
vention (PCI) are discouraged. return of spontaneous circulation
(ROSC) after cardiac arrest and may
be part of a standardised post-cardi-
♦♦ The reperfusion strategy in ac arrest protocol.
ST-elevation myocardial infarction has
been updated: - To achieve these goals, the creation
of networks including EMS, non PCI
- Primary PCI (PPCI) is the preferred capable hospitals and PCI hospitals
reperfusion strategy provided it is is useful.
performed in a timely manner by an
experienced team.
♦♦ Recommendations for the use
- A nearby hospital may be bypassed of beta-blockers are more restrict-
by emergency medical services ed: there is no evidence for routine
(EMS) provided PPCI can be achieved intravenous beta-blockers except in
without too much delay. specific circumstances such as for
the treatment of tachyarrhythmias.
- The acceptable delay between start Otherwise, beta-blockers should be
of fibrinolysis and first balloon infla- started in low doses only after the
tion varies widely between about 45 patient is stabilised.
and 180 minutes depending on inf-
arct localisation, age of the patient,
and duration of symptoms. ♦♦ Guidelines on the use of prophy-
lactic anti-arrhythmics angiotensin,
- ‘Rescue PCI’ should be undertaken converting enzyme (ACE) inhibitors/
if fibrinolysis fails. angiotensin receptor blockers (ARBs)
and statins are unchanged.
- The strategy of routine PCI imme-
diately after fibrinolysis (‘facilitated
PCI’) is discouraged.
paediatric life support
- Patients with successful fibrinolysis
but not in a PCI-capable hospital Major changes in these new guidelines
should be transferred for angiog- for paediatric life support include:
raphy and eventual PCI, performed
optimally 6 – 24 hours after fibri- ♦♦ Recognition of cardiac arrest -
nolysis (the ‘pharmaco-invasive’ Healthcare providers cannot reliably
approach). determine the presence or absence
of a pulse in less than 10 seconds in
15. 15
infants or children. Healthcare provid- minimise no-flow time. Compress
ers should look for signs of life and if the chest to at least 1/3 of the ante-
they are confident in the technique, rior-posterior chest diameter in all
they may add pulse palpation for children (i.e., approximately 4 cm in
diagnosing cardiac arrest and decide infants and approximately 5 cm in chil-
whether they should begin chest com- dren). Subsequent complete release is
pressions or not. The decision to begin emphasised. For both infants and chil-
CPR must be taken in less than 10 dren, the compression rate should be
seconds. According to the child’s age, at least 100 but not greater than 120
carotid (children), brachial (infants) or min-1. The compression technique for
femoral pulse (children and infants) infants includes two-finger compres-
checks may be used. sion for single rescuers and the two-
thumb encircling technique for two
or more rescuers. For older children,
♦♦ The compression ventilation (CV) a one- or two-hand technique can be
ratio used for children should be based used, according to rescuer preference.
on whether one, or more than one
rescuer is present. Lay rescuers, who
usually learn only single-rescuer tech- ♦♦ Automated external defibrillators
niques, should be taught to use a ratio (AEDs) are safe and successful when
of 30 compressions to 2 ventilations, used in children older than one year
which is the same as the adult guide- of age. Purpose-made paediatric pads
lines and enables anyone trained in or software attenuate the output of
BLS to resuscitate children with mini- the machine to 50–75 J and these are
mal additional information. Rescuers recommended for children aged 1-8
with a duty to respond should learn years. If an attenuated shock or a man-
and use a 15:2 CV ratio; however, they ually adjustable machine is not avail-
can use the 30:2 ratio if they are alone, able, an unmodified adult AED may
particularly if they are not achieving be used in children older than 1 year.
an adequate number of compressions. There are case reports of successful
Ventilation remains a very important use of AEDs in children aged less than
component of CPR in asphyxial arrests. 1 year; in the rare case of a shockable
Rescuers who are unable or unwilling rhythm occurring in a child less than
to provide mouth-to-mouth ventila- 1 year, it is reasonable to use an AED
tion should be encouraged to perform (preferably with dose attenuator).
at least compression-only CPR.
♦♦ To reduce the no flow time, when
♦♦ The emphasis is on achieving using a manual defibrillator, chest
quality compressions of an adequate compressions are continued while
depth with minimal interruptions to applying and charging the paddles or
16. 16
Paediatric Basic Life Support
Health professionals with a duty to respond
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
5 rescue breaths
NO SIGNS OF LIFE?
15 chest compressions
2 rescue breaths
15 compressions
Call cardiac arrest team or Paediatric ALS team
17. 17
Paediatric Advanced Life Support
Unresponsive?
Not breathing or only occasional gasps
CPR (5 initial breaths then 15:2) Call Resuscitation
Attach defibrillator/monitor Team
Minimise interruptions (1 min CPR first, if alone)
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock 4 J/Kg spontaneous
circulation
Immediately resume: Immediate post cardiac Immediately resume:
CPR for 2 min arrest treatment CPR for 2 min
Minimise interruptions • Use ABCDE approach Minimise interruptions
• Controlled oxygenation and
ventilation
• Investigations
• Treat precipitating cause
• Temperature control
• Therapeutic hypothermia?
During CPR Reversible causes
• Hypoxia
• Ensure high-quality CPR: rate, depth, recoil
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Vascular access (intravenous, intraosseous) • Hypothermia
• Give adrenaline every 3-5 min
• Consider advanced airway and capnography • Tension pneumothorax
• Continuous chevvst compressions when advanced airway • Toxins
in place • Tamponade - cardiac
• Correct reversible causes • Thromboembolism
18. 18
Newborn Life Support
AT ALL STAGES ASK: DO YOU NEED HELP? Dry the baby Birth
Remove any wet towels and cover
Start the clock or note the time
Assess (tone), 30 sec
breathing and heart rate
If gasping or not breathing
Open the airway
Give 5 inflation breaths
Consider SpO2 monitoring 60 sec
Re-assess
If no increase in heart rate
Look for chest movement
Acceptable*
If chest not moving
pre-ductal SpO2
Recheck head position
Consider two-person airway control 2 min : 60%
or other airway manoeuvres 3 min : 70%
Repeat inflation breaths 4 min : 80%
Consider SpO2 monitoring
5 min : 85%
Look for a response
10 min : 90%
If no increase in heart rate
Look for chest movement
When the chest is moving
If the heart rate is not detectable or slow (< 60)
Start chest compressions
3 compressions to each breath
Reassess heart rate
every 30 seconds
If the heart rate is not detectable or slow (< 60)
Consider venous access and drugs
19. 19
self-adhesive pads (if the size of the ♦♦ Implementation of a rapid
child’s chest allows this). Chest com- response system in a paediatric in-
pressions are paused briefly once the patient setting may reduce rates of
defibrillator is charged to deliver the cardiac and respiratory arrest and in-
shock. For simplicity and consistency hospital mortality.
with adult BLS and ALS guidance, a
single-shock strategy using a non-
escalating dose of 4 J kg-1 (preferably ♦♦ New topics in the 2010 guidelines
biphasic, but monophasic is accepta- include channelopathies and several
ble) is recommended for defibrillation new special circumstances: trauma,
in children. single ventricle pre and post 1st stage
repair, post Fontan circulation, and
pulmonary hypertension.
♦♦ Cuffed tracheal tubes can be used
safely in infants and young children.
The size should be selected by apply- Resuscitation of babies at
ing a validated formula. birth
The following are the main changes that
♦♦ The safety and value of using cricoid have been made to the guidelines for re-
pressure during tracheal intubation is suscitation at birth in 2010:
not clear. Therefore, the application of
cricoid pressure should be modified or ♦♦ For uncompromised babies, a
discontinued if it impedes ventilation delay in cord clamping of at least one
or the speed or ease of intubation. minute from the complete delivery of
the infant, is now recommended. As
yet there is insufficient evidence to
♦♦ Monitoring exhaled carbon diox- recommend an appropriate time for
ide (CO2), ideally by capnography, is clamping the cord in babies who are
helpful to confirm correct tracheal severely compromised at birth.
tube position and recommended dur-
ing CPR to help assess and optimise its
quality. ♦♦ For term infants, air should be used
for resuscitation at birth. If, despite
effective ventilation, oxygenation (ide-
♦♦ Once spontaneous circulation is ally guided by oximetry) remains unac-
restored, inspired oxygen should be ceptable, use of a higher concentration
titrated to limit the risk of hyperoxa- of oxygen should be considered.
emia.
20. 20
♦♦ Preterm babies less than 32 weeks start mask ventilation, particularly if
gestation may not reach the same there is persistent bradycardia.
transcutaneous oxygen saturations in
air as those achieved by term babies.
Therefore blended oxygen and air ♦♦ If adrenaline is given then the
should be given judiciously and its use intravenous route is recommended
guided by pulse oximetry. If a blend using a dose of 10-30 microgram kg-1.
of oxygen and air is not available use If the tracheal route is used, it is likely
what is available. that a dose of at least 50-100 micro-
gram kg-1 will be needed to achieve
a similar effect to 10 microgram kg-1
♦♦ Preterm babies of less than 28 intravenously.
weeks gestation should be completely
covered in a food-grade plastic wrap or
bag up to their necks, without drying, ♦♦ Detection of exhaled carbon diox-
immediately after birth. They should ide in addition to clinical assessment
then be nursed under a radiant heater is recommended as the most reliable
and stabilised. They should remain method to confirm placement of a tra-
wrapped until their temperature has cheal tube in neonates with spontane-
been checked after admission. For ous circulation.
these infants delivery room tempera-
tures should be at least 26°C.
♦♦ Newly born infants born at term or
near-term with evolving moderate to
♦♦ The recommended compression: severe hypoxic – ischaemic encepha-
ventilation ratio for CPR remains at 3:1 lopathy should, where possible, be
for newborn resuscitation. treated with therapeutic hypother-
mia. This does not affect immediate
resuscitation but is important for post-
♦♦ Attempts to aspirate meconium resuscitation care.
from the nose and mouth of the
unborn baby, while the head is still on
the perineum, are not recommended.
If presented with a floppy, apnoeic
baby born through meconium it is rea-
sonable to rapidly inspect the orophar-
ynx to remove potential obstructions.
If appropriate expertise is available,
tracheal intubation and suction may
be useful. However, if attempted intu-
bation is prolonged or unsuccessful,
21. 21
principles of education in ♦♦ Basic and advanced life support
resuscitation knowledge and skills deteriorate in as
little as three to six months. The use
The key issues identified by the Educa- of frequent assessments will identify
tion, Implementation and Teams (EIT)
those individuals who require refresh-
task force of the International Liaison
Committee on Resuscitation (ILCOR) er training to help maintain their
during the Guidelines 2010 evidence knowledge and skills.
evaluation process are:
♦♦ CPR prompt or feedback devices
♦♦ Educational interventions should improve CPR skill acquisition and
be evaluated to ensure that they retention and should be considered
reliably achieve the learning objec- during CPR training for laypeople and
tives. The aim is to ensure that learn- healthcare professionals.
ers acquire and retain the skills and
knowledge that will enable them to
act correctly in actual cardiac arrests ♦♦ An increased emphasis on non-
and improve patient outcomes. technical skills (NTS) such as leader-
ship, teamwork, task management
and structured communication will
♦♦ Short video/computer self-instruc- help improve the performance of CPR
tion courses, with minimal or no and patient care.
instructor coaching, combined with
hands-on practice can be considered
as an effective alternative to instruc- ♦♦ Team briefings to plan for resusci-
tor-led basic life support (CPR and tation attempts, and debriefings based
AED) courses. on performance during simulated or
actual resuscitation attempts should
be used to help improve resuscitation
♦♦ Ideally all citizens should be trained team and individual performance.
in standard CPR that includes com-
pressions and ventilations. There are
circumstances however where train- ♦♦ Research about the impact of
ing in compression-only CPR is appro- resuscitation training on actual patient
priate (e.g., opportunistic training outcomes is limited. Although manikin
with very limited time). Those trained studies are useful, researchers should
in compression-only CPR should be be encouraged to study and report the
encouraged to learn standard CPR. impact of educational interventions
on actual patient outcomes.
22. 22
Edited by Jerry Nolan
Authors
Jerry P. Nolan Charles Deakin
Jasmeet Soar Rudolph W. Koster
David A. Zideman Jonathan Wyllie
Dominique Biarent Bernd Böttiger
Leo L. Bossaert on behalf of the ERC Guidelines
Writing Group
Acknowledgements: The ERC staff members Annelies Pické, Christophe Bostyn,
Jeroen Janssens, Hilary Phelan and Bart Vissers for their administrative support. Het
Geel Punt bvba, Melkouwen 42a, 2590 Berlaar, Belgium (hgp@hetgeelpunt.be) for
creating the algorithms and Griet Demesmaeker (grietdemesmaeker@gmail.com)
for the cover design.
23. 23
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