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- 1. BASIC LIFE SUPPORT Dr. SUBHANKAR CHATTERJEE CCU in charge Calcutta Heart Clinic & Hospital
- 2. Basic Life Support Relation of vital organs Brain Lung Heart
- 3. Basic Life Support Cardiopulmonary arrest Sudden, unexpected cessation of respiration and functional circulation.
- 4. Basic Life Support Cardiac arrest not means death always… During respiratory and cardiac arrest, CPR may be successful…. ….. if performed before biological death of vital tissue develops
- 5. Basic Life Support BACKGROUND Approximately 700,000 cardiac arrests per year in Europe Survival to hospital discharge presently approximately 5-10% Bystander CPR vital intervention before arrival of emergency services – double / triple survival from SCA (sudden cardiac arrest) Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival
- 6. Basic Life Support Please DON’T FORGET Brain can withstand anoxia up to 6 minutes Then permanent brain damage ensues. So, time is brain.
- 7. Basic Life Support Approach BLS ( Basic Life Support) Primary survey. ACLS (Advanced Cardiovascular Life Support) Secondary survey Goal Return of Spontaneous Circulation ( ROSC) with preserved cerebral function
- 8. Basic Life Support Cardiopulmonary Resuscitation 8 C - Circulation A - Airway B - Breathing D- Defibrillation BLS Drugs
- 10. Basic Life Support BLS Primary Survey.components Assess Action Breathing Yes/ adequate?..... If no or agonal/ gasping breathing 2 Breaths using a barrier device, Each over 1 sec, visible chest rise. Defibrillation AED/ Shockable rhythm Shock as indicated. Resume CPR with compressions. Circulation Pulse present?...Carotid 5- 10 sec. CPR until AED arrives. C:V -30:2 5 cycles over 2 min. Airway Open? Head tilt- chin lift or jaw thrust
- 11. Basic Life Support Current Steps of BLS survey Step 1 : Ensure the place is safe for the victim & rescuer Step 2 Turn the victim onto his back if he is not already in that position Place the victim on a hard surface
- 12. Basic Life Support Shake shoulders gently Ask “Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly. Step 3 Check RESPONSE, CAROTID PULSE & BREATHING
- 13. Basic Life Support Carotid pulse • Look for no breathing or only gasping and • Check pulse (simultaneously). The pulse is definitely felt within 10 seconds.
- 14. Basic Life Support IDENTIFY AGONAL or GASPING BREATHING 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 Erroneous information can result in withholding CPR from cardiac arrest victim
- 15. Basic Life Support Step 4 SHOUT FOR HELP urgently call for help Anybody present in the same ward will rush leaving all routine job
- 16. Basic Life Support • Compress the chest –Push hard, push fast – Rate : 100 -120/min – Depth : minimum 2 inches (but not>2.4inches) – Allow full chest recoil after each compression – Minimize interruptions • change CPR operator every
- 18. Basic Life Support STEP 6 -OPEN AIRWAY Head tilt and chin lift - lay rescuers - non-healthcare rescuers Jaw Thrust -Patient with neck injury
- 19. Basic Life Support STEP 7- RESCUE BREATHS 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
- 20. Basic Life Support Bag-valve-mask ventilation AMBU(Artificial Manual Breathing Unit) This is the technique used to aid ventilation. • A tight seal around the face is required with ‘E-C Technique’ • Need a second hand to squeeze the self-inflating bag. • Expose the chest to observe chest wall excursion Chest compression: ventilation – 30:2
- 21. Step 8 Use AED(Automated External Defibrillator)/ Defibrillation as soon as available SHOCK
- 22. Basic Life Support STEP 9- IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION • It ensures the tongue is held in forward position • It reduces the chance of inhalation of any expelled gastric contents
- 23. Basic Life Support BLS Healthcare Provider Adult Cardiac Arrest Algorithm — 2015 Update
- 26. Basic Life Support Chest Compression IT’S ALL ABOUT BLOOD FLOW If chest not allowed to recoil: 1. venous return 2. filling of heart 3. CO in subsequent chest compressions When compressions interrupted, blood flow stops & Coronary Artery Perfusion Pressure falls If advanced airway in place do not pause for ventilation
- 27. Basic Life Support Only compressions Can maintain flow in cardiac arrest Can sustain life 60 min or more Always make an important difference Are a critical determinant of survival But unfortunately……
- 28. Basic Life Support High quality CPR Push Hard, push fast Ensure relaxation after each compression Avoid hyperventilation Minimize interruption Change rescuer every 2 mins
- 30. CoronaryArtery Perfusion Pressure Improves With Longer Series of Chest Compressions inAdult Victims Coronary Artery Pressure at 15:2 ratio Pressure at 30:2 ratio
- 31. Basic Life Support The time from collapse to defibrillation is the greatest determinant to survival
- 32. 0 20 40 60 80 100 1 3 5 7 9 10 30 50 70 90 0 8 6 4 2 Chances of success reduced 7% to 10% each minute Why “Early” Treatment? Time (minutes) % Success
- 34. Basic Life Support When Can I Stop 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 (controversial)
- 35. Basic Life Support Why CPR May Fail Delay in starting Improper procedures (ex. Forget to pinch nose) No ACLS follow-up and delay in defibrillation Only 15% who receive CPR live to go home Improper techniques Terminal disease or unmanageable disease (massive heart attack)
- 36. Basic Life Support Injuries Related to CPR Rib fractures Laceration related to the tip of the sternum Liver, lung, spleen
- 37. Basic Life Support Complications of CPR Vomiting Place victim on left side AspirationWipe vomit from mouth with fingers wrapped in a cloth Reposition and resume CPR
- 38. Reversible Causes of cardio-respiratory arrest- 5 H Hypoxia Hypovolemia Hydrogen ion ( Acidosis) Hypo/hyper kalemia Hypothermia 5T Tension pneumothorax Tamponade, cardiac Toxins Thrombosis,pulmona ry Thrombosis,coronary
- 39. Basic Life Support Few important facts In hospital cardiac arrest is commonly preceded by physiological changes. In one study nearly 80% of hospitalized patients with cardio-respiratory arrest had abnormal vital signs documented for upto 8 hours before arrest.
- 40. Basic Life Support Few important facts Cardiac arrest teams traditionally focus after arrest. Unfortunately the mortality of arrest 80%. So, best way to improve a patient’s chance of survival from arrest is to prevent it from happening. Rapid assessment and interventions for many physiologic variables can decrease the number of arrest occurring in the hospital
- 41. Basic Life Support The following criteria is applicable: 1. Threatened airway 2. Respiratory rate <10 to >30 /min 3. Heart rate <40 to >120/min 4. Systolic BP-<90 to >180 5. Unexpected decrease in level of consciousness 6. Unexplained agitation 7. Seizure 8. Significant drop in urine output 9. Subjective concern about the patient
- 42. Basic Life Support So, Target the patient before arrest if you want to decrease mortality.