blsd-active volunteers-v4 - new system.pdf

7/31/2019 BLSD-Active Volunteers-V4 - New System.pdf

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CPR and AED

CPR and AED

Basic Pre-Hospital Emergency Care Training Project

8: Patient Assessment

Basic Life Support

Adult CPR and AEDReminders and a Summary of changes for

ACTIVE volunteers


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CPR and AED

Outline

Introduction

BLSD Sequence Reminders and changes

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Automatic External Defibrillators (For stations NOT using an

AED yet)

Special situations


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CPR and AED

References

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Major changes in 2005

Sequence changes in November 2010

Priority to Chest Compressions


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CPR and AED

BLS AED and survival link

Time is Critical!


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BLSD sequence

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CPR and AED

Steps to perform BLSD

Scene safety

Responsiveness

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Positioning the patient

Circulation

Airway Breathing

Defibrillation


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CPR and AED

Steps to perform BLSD 2011

Scene safety: BSI, bystanders

Responsiveness: does the patient MOVE, TALK, or Respond inany way? Does he appear to be breathing?

Positioning the patient: on back on a hard surface

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Circulation: start compressions as soon as possible

Airway: checked after first 30 compressions or by secondrescuer

Breathing: slow breaths that make the chest rise, donthyperventilate

Defibrillation: as soon as AED is ready


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CPR and AED

C Assess Circulation

Feel for palpable pulse in the

carotid artery (5 to 10 sec)

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Check on ONE side

If in doubt, and patient is NOT

responsive, start CPR


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CPR and AED

C Chest CompressionsIf no pulse or in doubt start chest

compressions:

Hands in center of chest

Begins chest compressions as soon aspossible:

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Ratio of 30 compressions to 2 breaths Rate of compression: at least

100/min

Depth ofat least 5cm

30 compressions should takeless than 18 seconds

5 cycles (about 2 minutes)

Change persons doing compressions

every 2 minutes if possible


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C Performing Chest Compressions

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Compression depth should be at least 5cm

Allow chest to recoil!


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Remove any obstruction

Suction any liquid

A Opening the Airway (1 of 2)

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Managing the airway should

be performed without

interrupting the chestcompressions


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CPR and AED

A Opening the Airway (2 of 2) Head tiltchin lift maneuver

Insert canulla

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B Ventilations

Place mask on patients face (BVM use) . Squeeze bag to deliver ventilations.

Give 2 slow rescue breaths that make the chest

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.


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C & E Technique for Holding Mask

Trouble Shoot if Air Doesnt Enter

(without interrupting

compressions) 15


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Gastric Distention

Gastric distention is most likely to occur if: You blow too hard as you ventilate.

You give breaths too fast.

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The patients airway is obstructed.


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CPR and AED

Switching Positions

Switch every 2 minutes (5 cycles).

First EMT-B moves into position to delivercompressions after giving two breaths.

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Second EMT-B delivers 30th compression thenmoves to patients head.

Second EMT-B checks pulse while positioned at the

head


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Any questions?


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Key Messages

Dont delay compressions!

Push HARD (at least 5cm), and FAST (at least100/min) on center of chest

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Give breaths that make chest rise and donthyperventilate

Defibrillate as soon as possible

Switch every 2 minutes when possible

Minimize interruptions

Work and practice as a team


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Steps to perform BLSD

Scene safety

Responsiveness

Positionin the atient

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Circulation

Airway

Breathing

Defibrillation


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DEFIBRILLATION

The most common rhythm in cardiac arrest is

Ventricular fibrillation (VF) 40%

VF deteriorates to Asystole within 3 to 5 min if not

rea e

The most effective treatment for (VF) is

defibrillation

Defibrillation is also the most effective treatment for

Ventricular Tachycardia (VT)23


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Factors affecting AED analysis: Patient movement (agonal gasps)

AED Usage Information

Moving the patient

Vibrations (engine)

Mobile phones or electronic equipment

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CPR and AED

AED Risks and precautions

Do not defibrillate a patient lying in a pool of water.

Dry a soaking wet patients chest first.

Do not defibrillate a patient who is touching metal.

Remove nitroglycerin patches.

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Shave a hairy patients chest if needed (patches cant stick)

Do not touch patient during analysis or shock

Do not over-dramatize safety precautions. A Patient can be

shocked on the stretcher in the ambulance without any risk

if no one is touching the patient or stretcher


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D Using an AED

AED is prepared while 1st EMT is checking the

pulse Ideally 3rd person should prepare the AED

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CPR and AED

D Using an AED

Remove clothing from the patients chest area.

Apply patches to the chest. Turn on the AED (as soon as possible)

Connect patches to AED when ready

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.

State aloud, Clear the patient.


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D Using an AED

Push the analyze button, if there is one.

Wait for the computer. If shock is advised, make sure that no one is

touching the patient.(visual check and response)

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.


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D Using an AED

After the shock 5 cycles of CPR 30 compressions, 2 ventilations

After 5 cycles

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reanalyze patients rhythm. If the machine advises a shock

clear the patient and push shock button.

If no shock advised

check for pulse.


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CPR and AED

Transport Considerations

When to transport:

When patient regains pulse After delivering two analyzes (finishingup with a CPR cycle)

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Keep patches attached on the chest

Check pulse continuously

Stop ambulance to use an AED.

Drive carefully in a way that allows the

rescuers to perform efficient CPR


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CPR and AED

Special situations

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d


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CPR and AED

Cardiac Arrest During Transport

While monitoring the patients pulse.

If pulse is not present:

Stop the vehicle and turn off the engine

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Perform CPR until AED is available. Analyze rhythm. Deliver shock when advised Continue resuscitation according to local protocol.

CPR d AED


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CPR and AED

CPR for drowning victims should use the traditional

A-B-C approach in view of the hypoxic nature of the

arrest.

Cardiac Arrest Drowned Patient

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rescue breaths.

Use AED as soon as possible

Maintain spinal protection and immobilization during

extrication and treatment if there is any likelihood of

head or neck trauma.

CPR d AED


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CPR and AED

Interrupting CPR

CPR is a continuous action.

Try not to interrupt CPR for more than 10

seconds

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Do not move the patient until transport

arrangements are made.

When patient is ready to be moved, move to

ambulance without exceeding 90 seconds

without CPR

CPR d AED


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CPR and AED

When Should CPR Be Stopped?

S Patient Starts breathing and has a

pulse T Patient is Transferred to another

person

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O You are Out of strength

P A Physician asks you to stop

CPR and AED


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CPR and AED

When CPR Should Not Be Started

BLS should not be started if the following

situations exist:

Rigor mortis or stiffening of the body

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Evidence of a non-survivable injury

Existing no-CPR order

Dependent lividity


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Any questions?

blsd-active volunteers-v4 - new system.pdf

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