ADULTBASIC LIFE SUPPORT

Dr Subhankar ChatterjeeInstructor of BLS & ACLS, American Heart AssociationAssociate In-Charge of CCU, Calcutta Heart Clinic & Hospital

Sudden, unexpected cessation of respiration and functional circulation.

May be reversible

but will progress to DEATH without prompt intervention.

The Brain mattersCardiopulmonary arrest results in a rapid decline in oxygen delivery to the brainPermanent disability or death results if the period of cerebral hypoxia lasts longer than 6 minutes

During cardiac arrest a victim loses consciousness, stops normal breathing and loses pulse and blood pressure Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives

A patient who is :

unconscious,apneic, andpulseless

fulfills the cardiac arrest diagnosis criteria

5 HHypoxiaHypovolemiaHydrogen ion( Acidosis)Hypo/hyper kalemiaHypothermia5 TTension pneumothoraxTamponade, cardiacToxinsThrombosis,pulmonaryThrombosis,coronary

Coronary artery diseasewith myocardial infarction is the most common structural heart disease predisposingto cardiac arrest

Brain can withstand anoxia up to 6 minutes Then permanent brain damage ensues. So, time is brain.

Cardio Having to do with the heart

Pulmonary - Having to do with the lungs

Resuscitation - The act of reviving a person and returning them to consciousness

No breathingNo pulseUnconscious

Less than 4% of Indian health care providers have formal training in standardized CPR

*C - CirculationA - AirwayB - Breathing D- Defibrillation BLSDrugsShockAdvanced airway

Identify the victim has Cardiac Arrest

Assess Danger:

Check the scene is safe for the victim and the rescuerMove the victim to a safe place and start CPR

Shake shoulders gentlyAsk Are you all right?If he responds Leave as you find him. Find out what is wrong. Reassess regularly.

While assessing responsiveness look for absent or gasping breathing

urgently call for helpAnybody present in the same ward will rush leaving all routine job

Check for presence / absence for

PRESENTABSENTPlace the victim on recovery position check pulse every 2 minsProvide rescue breathMonitor closelyStart 30 chest compression followed by 2 breaths

A compression is the act of pushing on the chestPeople often dont push hard enough because theyre afraid of hurting the victimAn injury is unlikely, but it is better than deathIt is better to push too hard than not hard enough

Your breaths need to make the chest riseWhen the chest rises, you know the person has taken in enough air

Adult 30:2 Single or two rescuerChildren or Infant:1 Rescuer30:22 or more rescuer 15:2

Push hard 2 inchesPush fast @ 100/minAllow elastic chest recoilMinimize interruptionAvoid hyper-ventilationChange rescuer every 2 mins

It ensures the tongue is held in forward position It reduces the chance of inhalation of any expelled gastric contents

Simplified adult BLS algorithm.Berg R et al. Circulation 2010;122:S685-S705Copyright American Heart Association, Inc. All rights reserved.

BLS healthcare provider algorithm.Berg R et al. Circulation 2010;122:S685-S705Copyright American Heart Association, Inc. All rights reserved.

ITS ALL ABOUT BLOOD FLOW

If chest not allowed to recoil:1. venous return2. filling of heart3. 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

02040608010013579103050709008642Chances of survival reduced 7% to 10% each minuteTime (minutes)% Suvival

PLEASE DONT FORGET

ITS A TEAM EFFORT THAT SAVES LIFE

Victim revivesTrained help arrivesToo exhausted to continueUnsafe scenePhysician directed (do not resuscitate orders)

Delay in startingImproper procedures (ex. Forget to pinch nose)No ACLS follow-up and delay in defibrillationOnly 15% who receive CPR live to go homeImproper techniquesTerminal disease or unmanageable disease (e.g massive heart attack)

********As you may know, the American Heart Association came out with the new guidelines for CPR & Emergency Cardiovascular Care in October 2010. The biggest change is the new sequence for CPR. The sequence for CPR has changed from A-B-C to C-A-B. You may be asking yourself why the change? Because of delays in compressions associated with time needed to open the airway and give breathsThe new sequence allows chest compressions to begin soonerFor adults with a witnessed cardiac arrest and ventricular fibrillation, chest compressions and early defibrillation are criticalMost victims receive no bystander CPR, which may be due to the A-B-C sequence, which started with the most difficult task

CPR has 2 main parts: compressions and giving breaths. Pushing hard and fast on the chest is the most important part of CPR. Whenyou push on the chest, you pump blood to the brain and heart. A compression is the act of pushing on the chest. People often dont push hard enough because theyre afraid of hurting the victim. An injury is unlikely, but it is better than death. Its better to push too hard than not hard enough.*These are the actions you should take when giving CPR:Make sure the person is lying on theyre back on a firm, flat surface.Move clothes out of the way.Put the heel of 1 hand on the lower half of the breastbone. Put the heel of your other hand on top of the first hand.Push straight down at least 2 inches at a rate of at least 100 compressions a minute.After each compression, let the chest come back up to its normal position

Compressions are very important and doing them correctly is tiring. The more tired you are, the less effective your compressions are. If someone else knows CPR, take turns. Switch about every 2 minutes, moving quickly to keep the pause between compressions as short as possible. Remind each other to push down at least 2 inches, push at a rate of at least 100 compressions a minute, and let the chest come back up to its normal position after each compression.*Before giving breaths, open the airway. Follow these steps to open the airway:

Put 1 hand on the forehead and the fingers of your other on the bony part of the chin.Tilt the head back and lift the chin as seen on this image.

You should avoid pressing on the soft part of the neck or under the chin.*To give breaths:

Hold the airway open, pinch the nose closedTake a breath. Cover the persons mouth with your mouth.Give 2 breaths (blow for 1 second each). Watch for the chest to begin to rise as you give each breath.

If you give someone a breath and the chest doesnt rise, allow the head to go back to its normal position. Then open the airway again by tilting the head and lifting the chin. Then give another breath. Make sure the chest rises. Dont interrupt compressions for more than 10 seconds to give breaths. If the chest doesnt rise within 10 seconds, begin pushing hard and fast on the chest again.

During CPR, there is very little chance you can catch a disease. Some workplaces require rescuers to have masks. Masks are made of firm plastic and fit over the ill or injured persons mouth or mouth and nose. You may need to put the mask together before you use it.*Compressions are the most important part of CPR. If youre also able to give breaths, you will help even more. Your breaths need to make the chest rise. When the chest rises, you know the person has taken in enough air.***Simplified adult BLS algorithm.BLS healthcare provider algorithm.**For every minute that a patient is in sudden cardiac arrest, their chance of successful resuscitation drops by 10%. You have 10 minutes max, from collapse to that defibrillation shock.*