basic life support (2)

WELCOME

Presented By

Basil

Presented By

Basil

BASIC LIFE SUPPORTBASIC LIFE SUPPORT

INTRODUCTION

• Fundamental aspects of Basic Life Support (BLS) include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system (EMS), early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED).

• Dr. Peter Safar is considered as the father of modern day CPR

DEFINITION• Basic life support is an emergency

procedure that consists of recognising an arrest and initiating proper cardiopulmonary resuscitation techniques to maintain life without the use of drugs or specialist equipment until the victim either recovers or is transported to a medical facility where advance life support measures are available.

EMERGENCY ACTION PRINCIPLE

• In each emergency, we need to follow the emergency action principle so that we do not forget anything that might affect personal safety (yours and the victim’s) and the victim’s survival.

• Always follow the steps in order given

below.

• 1-survey the scene (to confirm the area is

safe for you as well as the victim),

• 2-do a primary survey of the victim,

• 3-activates the Emergency Medical Service

(EMS) system for help,

• 4-do a secondary survey of the victim.

ADULT BLS SEQUENCEA.H.A. ADULT CHAIN OF SURVIVAL

1. Immediate recognition of cardiac arrest and

activation of the emergency response system

2. Early CPR with an emphasis on chest

compressions

3. Rapid defibrillation

4. Effective advanced life support

5. Integrated post–cardiac arrest care

ENSURE SAFETY

• Survey the scene and make sure that the area is safe for the victim as well as to the rescuer.

• If a lone rescuer finds an unresponsive adult

(i.e., no movement or response to

stimulation) or witnesses an adult

who collapses,

• after ensuring that the scene is safe and

positioning the victim in supine on a firm

surface,

Immediate Recognition and Activation of the Emergency Response System

• The rescuer should check for a response

by tapping the victim on the shoulder and

shouting at the victim, “Are you all right?” If

the victim is responsive, he or she will

answer, move, or moan.

• The rescuer should also check for no breathing or no normal breathing (i.e., only gasping) while checking for responsiveness.

• if the healthcare provider finds the victim is unresponsive with no breathing or no normal breathing (i.e., only gasping), the rescuer should assume the victim is in cardiac arrest.

• And then, the rescuer should shout for help to activate the Emergency Response System (EMS) and to get an AED if available.

• The victim has occasional gasps, which can occur in the first minutes after Sudden Cardiac Arrest (SCA) and may be confused with adequate breathing.

• Occasional gasps do not necessarily result in adequate ventilation.

• The rescuer should treat the victim who has occasional gasps as if he or she is not breathing.

PULSE CHECKThe healthcare provider should take not more

than 10 seconds to check for a pulse; and if the rescuer does not definitely feel a pulse within that time, the rescuer should start chest compressions.

The carotid pulse can check while keeping the victims head tilted back with one hand on the forehead, use the other hand to find the pulse.

First, place your index or middle finger on the Adams apple.

• Then slide your finger toward in to the

groove between the windpipe and the

muscles at the side of the neck. This is

where the carotid pulse is located.

EARLY CPR

Sequence of cardiopulmonary resuscitation (CPR)

Compression – Airway- Breathing- Defibrillation

C-A-B-D

CHEST COMPRESSIONS

• Chest compressions consist of forceful

rhythmic applications of pressure over the

lower half of the sternum.

• These compressions create blood flow by

increasing intrathoracic pressure and

directly compressing the heart.

• This generates blood flow and oxygen delivery to the vital organs

• The rescuer should place the heel of the dominant hand on the centre (middle) of the victim's chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel

• Position yourself vertically above the victim's chest and, with your arms straight, the adult sternum should be depressed at least 2 inches (5 cm) with chest compression and chest recoil/relaxation times approximately equal.

• Allow the chest to completely recoil after each compression.

• To provide effective chest compressions,

push hard and push fast.

• healthcare providers should compress the

adult chest at a rate of at least 100

compressions per minute with a compression

depth of at least 2 inches/5 cm.

• Rescuers should allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression.

A compression-ventilation ratio of 30:2 is recommended.

To maximize the effectiveness of chest compressions, place the victim on a firm surface when possible, in a supine position with the rescuer kneeling beside the victim's chest.

Rescuers should attempt to minimize the frequency and duration of interruptions in compressions to maximize the number of compressions delivered per minute.

• Incomplete recoil during BLS, CPR is

associated with higher intrathoracic

pressures and significantly decreased

hemodynamics, including decreased

coronary perfusion, cardiac index,

myocardial blood flow, and cerebral

perfusion.

AIR WAY

OPEN THE AIRWAY:

• The common cause of airway obstruction is back of the tongue blocking the air way.

• A healthcare provider should use the head tilt–chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma.

• If healthcare providers suspect a cervical spine injury, they should open the airway using a jaw thrust without head extension.

• Because maintaining a patent airway and providing adequate ventilation are priorities in CPR, use the head tilt–chin lift maneuver if the jaw thrust does not adequately open the airway.

Jaw thrust

• The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.

RESCUE BREATHING

• During CPR, the primary purpose of assisted ventilation is to maintain adequate oxygenation;

• the secondary purpose is to eliminate CO2.

1) MOUTH-TO-MOUTH RESCUE BREATHING

Mouth-to-mouth rescue breathing provides oxygen and ventilation to the victim. 

To provide mouth-to-mouth rescue breaths, open the victim's airway, pinch the victim's nose, and create an airtight mouth-to-mouth seal.

Give 1 breath over 1 second. take a "regular" (not a deep) breathe, and

give rescue breath over 1 second.

• Taking a regular rather than a deep breath prevents the rescuer from getting dizzy or lightheaded and prevents over inflation of the victim's lungs. 

• The most common cause of ventilation difficulty is an improperly opened airway, so if the victim's chest does not rise with the first rescue breath.

• Reposition the head by performing the head tilt–chin lift again and then give the second rescue breath.

• If an adult victim with spontaneous circulation (ie, strong and easily palpable pulses) requires support of ventilation, the healthcare provider should give rescue breaths at a rate of about 1 breath every 5 to 6 seconds, or about 10 to 12 breaths per minute.

• Each breath should be given over 1 second regardless of whether an advanced airway is in place. 

• Each breath should cause visible chest rise.

• Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations

• More important, excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival.

2) MOUTH-TO–BARRIER DEVICE BREATHING.

• Some healthcare providers may hesitate to give mouth-to-mouth rescue breathing and prefer to use a barrier device.

• The risk of disease transmission through mouth-to-barrier ventilation is very low. 

• When using a barrier device the rescuer should not delay chest compressions while setting up the device.

3) MOUTH-TO-NOSE AND MOUTH-TO-STOMA

VENTILATION• Mouth-to-nose ventilation is recommended

if ventilation through the victim's mouth is impossible (eg, the mouth is seriously injured), the mouth cannot be opened, the victim is in water, or a mouth-to-mouth seal is difficult to achieve.

• A case series suggests that mouth-to-nose ventilation in adults is feasible, safe, and effective

AED, DEFIBRILLATION• An Automated External Defibrillator (AED)

is used when the heart stops beating normally and needs to be reset by an electric shock.

• AEDs are designed for adults but most can be adapted for children with paediatric pads down to 1 year of age.

• Provide 5 cycles of CPR, 30 compressions to 2 breaths, for 2 minutes before using an AED on a child from 1 year to puberty

SEQUENCE OF ACTIONS WHEN USING AN AUTOMATED EXTERNAL

DEFIBRILLATOR

• The following sequence applies to the use of both semi-automatic and automatic AEDs in a victim who is found to be unconscious and not breathing normally.

• 1. Follow the adult BLS sequence as described. Do not delay starting CPR unless the AED is available Immediately.

2. AS SOON AS THE AED ARRIVES:

• If more than one rescuer is present, continue CPR while the AED is switched on.

• If you are alone, stop CPR and switch on the AED.

• Follow the voice / visual prompts. Attach the electrode pads to the patient’s bare chest.

• Ensure that nobody touches the victim while the AED is analysing the rhythm.

Placement of AED pads• Place one AED pad to the right of the sternum, below the clavicle. Place the other pad in the left mid-axillary line, approximately over the position of the V6 ECG electrode. It is important that this pad is placed sufficiently laterally and that it is clear of any breast tissue.

3A. If a shock is indicated:

• Ensure that nobody touches the victim. • Push the shock button as directed (fully

automatic AEDs will deliver the shock automatically).

• Continue as directed by the voice / visual prompts.

• Minimise, as far as possible interruptions in chest compression.

3B. If no shock is indicated:

• Resume CPR immediately using a ratio of 30 compressions to 2 rescue breaths. Continue as directed by the voice / visual prompts

FOREIGN-BODY AIRWAY FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

(CHOKING)• The rescuer should intervene if the choking victim shows signs of severe airway obstruction.

• These include signs of poor air exchange and increased breathing difficulty, such as a silent cough, cyanosis, or inability to speak or breathe.

• The victim may clutch the neck, demonstrating the universal choking sign. 

• Quickly ask, "Are you choking?" If the

victim indicates "yes" by nodding his head

without speaking, this will verify that the

victim has severe airway obstruction.

RELIEF OF FOREIGN-BODY AIRWAY OBSTRUCTION

• If mild obstruction is present and the victim is coughing forcefully, do not interfere with the patient's spontaneous coughing and breathing efforts.

• Attempt to relieve the obstruction, only if signs of severe obstruction develop: the cough becomes silent, respiratory difficulty increases and is accompanied by stridor, or the victim becomes unresponsive. 

• Activate the EMS system quickly if the patient is having difficulty breathing.

ABDOMINAL THRUSTS (HEIMLICH MANEUVER)

• Stand behind the victim.

• The victim may be either standing or

sitting.

• Wrap your arms around his or her waist.

Make a fist with one hand.

• Place the thumb side of your fist against the middle of the victim’s abdomen, just above the naval and well below the lower tip of sternum.

• Grasp your fist with your other hand.

Keeping your elbows out from the victim,

press your fist in to the persons abdomen

with a quick upward thrust.

• Think of each thrust as a separate and

distinct attempt to dislodge the object.

Repeat the thrusts until the obstruction is

cleared.

CHEST THRUSTS

• Chest thrusts should be used for obese

patients if the rescuer is unable to encircle

the victim's abdomen.

• If the choking victim is in the late stages of

pregnancy, the rescuer should use

chest thrusts instead of abdominal thrusts.

• To do chest thrusts with the person either

standing or sitting, stand behind the

person and place your arms under the

person’s armpit and around the chest.

Place the thumb side of your fist on the

middle of the sternum.

• Grasp your fist with your other hand and

give backward thrusts.

• Give thrust until obstruction is cleared.

• Each thrust should be a separate and

distinct attempt to dislodge the object

ABDOMINAL THRUSTS FOR AN UNCONSCIOUS VICTIM

• If the adult victim with Foreign-Body Airway Obstruction becomes unresponsive, the rescuer should carefully support the patient to the ground.

• Immediately activate (or send someone to activate) EMS, and then begin CPR. 

• The healthcare provider should carefully lower the victim to the ground, send someone to activate the emergency response system and begin CPR (without a pulse check).

• After 2 minutes, if someone has not already done so, the healthcare provider should activate the emergency response system.

• Each time the airway is opened during CPR, the rescuer should look for an object in the victim's mouth and if found, remove it.

• Straddle the victim’s thighs. Place the heel of one hand against the middle of the victim’s abdomen, just above the umbilicus and well below the lower tip of the sternum.

• Place your other hand directly on the top of

the first hand with your fingers pointed

towards the victims head

• Press into abdomen with a quick upward

thrust. Give 6-10 thrusts. Be sure that your

hands are directly on the middle of the

abdomen when you press. After 6-10, thrusts

do a finger sweep.

FOREIGN-BODY AIRWAY OBSTRUCTION IN INFANT

• Give 5 back blows as follows • Hold the infants jaw between thumb and

fingers. • Slide your other hand behind the

infant’s shoulder blade closest to you so that your finger supports the back of the infants head and neck.

• Turn the infant over so that he is face down on your forearm.

• Support infants head and neck with your

hand by firmly holding the jaw between your

thumb and fingers.

• Lower your arm on to your thigh. The infants

head should be lower than his chest.

• Give 5 back blows forcefully between the

infants shoulder blades with the heel of your

hand

GIVE 5 CHEST THRUSTS AS FOLLOWS

• Place your free hand and forearm along infants head and back so that the infant is sandwiched between your tow hand and forearms.

• Support the back of the infants head and neck with your fingers.

• Support the infant’s neck, jaw, and chest from the front with one hand while you support the infants back with your other hand and forearm.

• Turn the infant in to his back. • Lower your arm that is supporting the

infants back onto your thigh. • The infants head should be lower than his

chest. • Use your other hand that is on the infants

chest to locate the correct place to give chest thrusts.

• Imagine a line running across the infants chest between the nipples.

• Place the pad of your ring finger on sternum just under the imaginary line.

• Then place the pads of two finger next to the ring finger just under nipple line.

• Rise the ring finger if you feel the notch at the end of the infants sternum, move your finger up a little bit.

• The pads of your finger should lie in the same direction as the infants sternum.

• Use the pads of two fingers to compress the sternum.

• Compress the sternum 1 inch and then the sternum return to its normal position.

• Keep your fingers in contact with the sternum.

• Compress 5 times. • Keep giving back blows and chest

compression until the object is coughed up.

INFANT AND CHILD BASIC LIFE SUPPORT

• “If the victim is unresponsive and not breathing (or only gasping), begin CPR.

• Sometimes victims who require CPR will gasp, which may be misinterpreted as breathing.

• Treat the victim with gasps as though there is no breathing and begin CPR.

• ” For an unresponsive child who is not breathing or not breathing normally, begin CPR with 30 compressions followed by opening the airway and giving 2 rescue breaths.

• Repeat cycles of 30:2 (CAB method).

• For an infant, lone rescuers (whether lay

rescuers or healthcare providers) should

compress the sternum with 2 finger placed

just below the intermammary line.

• Do not compress over the xiphoid or ribs.

• Rescuers should compress at least one-

third the depth of the chest, or about 4 cm

(1.5 inches).

• Do not press on the xiphoid or the ribs.

There are no data to determine if the 1- or

2-hand method produces better

compressions and better outcome.

• For a child, lay rescuers and healthcare

providers should compress the lower half

of the sternum at least one third of the AP

dimension of the chest or approximately 5

cm (2 inches) with the heel of 1 or 2 hands.

• Push fast; push at a rate of at least 100

compressions per minute.”

• “Chest compressions of appropriate rate and

depth.

• ‘Push fast’: push at a rate of at least 100

compressions per minute.

• Push hard’: push with sufficient force to

depress at least one third the anterior‐

posterior (AP) diameter of the chest or

approximately 1 ½ inches (4 cm) in infants

and 2 inches (5 cm) in children

OPEN THE AIRWAY AND GIVE VENTILATIONS• For the lone rescuer a compression-to-

ventilation ratio of 30:2 is recommended.

• After the initial set of 30 compressions, open

the airway and give 2 breaths.

• In an unresponsive infant or child, the tongue

may obstruct the airway and interfere with

ventilations.

• Open the airway using a head tilt–chin lift

maneuver for both injured and non-injured

victims.

• To give breaths to an infant, use a mouth-

to-mouth-and-nose technique; to give

breaths to a child, use a mouth-to-mouth

technique.

• Make sure the breaths are effective (ie,

the chest rises).

• Each breath should take about 1 second.

If the chest does not rise, reposition the

head, make a better seal, and try again.

• It may be necessary to move the child's

head through a range of positions to

provide optimal airway patency and

effective rescue breathing

• In an infant, if you have difficulty making

an effective seal over the mouth and nose,

try either mouth-to-mouth or mouth-to-

nose ventilation.

• If you use the mouth-to-mouth technique,

pinch the nose closed.

• If you use the mouth-to-nose technique,

close the mouth.

• In either case make sure the chest rises

when you give a breath.

• If you are the only rescuer, provide 2

effective ventilations using as short a

pause in chest compressions as possible

after each set of 30 compressions.

DEFIBRILLATION

• Ventricular fibrillation (VF) can be the cause of sudden collapse or may develop during resuscitation attempts.

• Children with sudden witnessed collapse (eg, a child collapsing during an athletic event) are likely to have VF or pulseless ventricular tachycardia (VT) and need immediate CPR and rapid defibrillation.

• VF and pulseless VT are referred to as "shockable rhythms" because they respond to electric shocks (defibrillation).

• Many AEDs have high specificity in recognizing paediatric shockable rhythms, and some are equipped to decrease (or attenuate) the delivered energy to make them suitable for infants and children <8 years of age

• For infants a manual defibrillator is preferred when a shockable rhythm is identified by a trained healthcare provider.

• The recommended first energy dose for

defibrillation is 2 J/kg. If a second dose is

required, it should be doubled to 4 J/kg.

• If a manual defibrillator is not available, an

AED equipped with a paediatric attenuator

is preferred for infants.

• An AED with a paediatric attenuator is also

preferred for children <8 year of age.

• If neither is available, an AED without a

dose attenuator may be used.

• AEDs that deliver relatively high-energy

doses have been successfully used in

infants with minimal myocardial damage

and good neurological outcomes.

Neonatal CPR

• Rubbing the back or flicking the sole of the feet to stimulate the baby

• Compression to ventilation ratio is 3:1• Compression with 2 thumbs, with

fingers encircling the chest and supporting the back

• 40- 60 breaths/ minute is advisable

ANY QUESTIONS??????

`THANK YOU