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Basic Life Support ( BLS )

Automated External Defibrillation

(AED )

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Farhad HeydariEmergency Medicine Deprtment

Isfahan University Of Medical Sciences

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At the end of this courseparticipants should be able to demonstrate:

How to assess the collapsed victim.

How to perform chest compression and rescue breathing.

How to place an unconscious breathing victim in the recovery position.

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OBJECTIVES

Despite important advances in prevention, cardiac arrest

remains a substantial public health problem and a leading

cause of death in many parts of the world.

Cardiac arrest occurs both in and out of the hospital.

approximately 350 000 people/year (approximately half of them in-hospital) suffer a cardiac arrest and receive attempted resuscitation. 5

BACKGROUND

Survival to hospital discharge presently approximately 5-10%

Early resuscitation & prompt defibrillation

(within 1-2 minutes) can result in >60% survival

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GUIDELINE 2010

CHAIN OF SURVIVAL

Immediate recognition and activation

Early CPR

Defibrillation,

Advanced life support

Integrated post-cardiac arrest care.

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BLS 2005

ارزیابی سطح

هوشیاری

ارزیابی وضعیت تنفس

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BLS 2005

ارزیابی سطح

هوشیاری

ارزیابی وضعیت تنفس

LOOK , LISTEN ,FEEL

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13BLS 2010

همزمان ارزیابیتنفس و هوشیاری سطح

Start CPR When …… :

Unresponsiveness

AbnormalBreathing

Start CPR

ABC ???

A B C

SINCE 1960

C A B GIUDELINE 2010

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Arterial Blood O2 Content(ABC)

Arrest

Resuscitation

RescueBreathes

ChestCompression

O2 Content

Time

Arterial Blood O2 Content(CAB)O2 Content

Time

Arrest

Resuscitation

ChestCompression

CAB vs ABCO2 Content

Time

CAB

ABC

* Approach safely

Check response Check breathing

Shout for help & Call 115

30 chest compressions

2 rescue breaths

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BASIC LIFE SUPPORT

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APPROACH SAFELY!Scene

Rescuer

Victim

Bystanders

Approach safely Check response Check breathing

Shout for help & Call 115

30 chest compressions

2 rescue breaths

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CHECK RESPONSE - CHECK BREATHING

Approach safely

Check responseCheck breathing

Shout for help & Call 115 30 chest compressions

2 rescue breaths

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CHECK RESPONSEShake shoulders gently

Ask “Are you all right?”

If he responds• Leave as you find

him.• Find out what is

wrong.• Reassess regularly.

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

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AGONAL BREATHING & GASPING

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SHOUT FOR HELPApproach safely

Check responseCheck breathing

Shout for help & Call 115

30 chest

compressions2 rescue breaths

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Call 115Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

Call 115

How?

How many?

When?

Where?28

Once a cardiac arrest is identified, dispatchers can then give CPR instructions to a bystander over the phone until further help arrives.

Telephone instructions have been shown to increase the rates of bystander CPR and enhance outcomes.  

Studies have also shown that the time to initiation of chest compressions is more rapid if the caller is given hands-only instructions (ie, no rescue breaths) rather than standard CPR instructions. (2012)

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Feel within 1. definite pulse give 1 breath / q 5-6 s

2. recheck pulse q 2 min.

3. no pulse or suspicious pulse next step

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10 sec

Check pulseOnly for healthcare provider

Chest compressions are the foundation of

CPR

All rescuers, regardless of training, should

provide chest compressions to all cardiac arrest victims.

Number of Compressions Delivered

The total number of compressions delivered during resuscitation

is an important determinant of survival from cardiac arrest.

rate and the compression fraction. (the portion of total CPR time during which compressions are

performed).32

Minimal Interruptions During Chest CompressionCardiac Output

Time2 min

Minimal Interruptions During Chest CompressionCardiac Output

Time2 min

Cardiac Output

Time2 min

With Interruptions

Without Interruptions

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CHEST COMPRESSIONS

Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

Proper positioning of the patient and rescuer is fundamental to proper compression delivery.

The recommended position in out-of-hospital scenarios is to kneel perpendicular beside the patient’s torso.

For in-hospital cardiac arrest response, the rescuer

should stand beside the bed at the level of the patient’s torso. (2012)

CHEST COMPRESSIONS

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CHEST COMPRESSIONS

• supine victim on a hard

surface

• Place the heel of one hand

in the centre of the chest

( lower half )

• Place other hand on top

• Interlock fingers

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CONTINUE CPR

30 2

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CHEST COMPRESSIONS

• Push hard and fast the chest:– Rate at least 100 /min– Depth 5 cm– Equal compression / relaxation– Minimize interruptions in chest

compressions.

• When possible change CPR operator every 2 min

Providers delivering chest compressions should rotate every 2 minutes to minimize the effects of rescuer fatigue, and the switch should take less than 5 seconds.

One technique to minimize the interruption is to position a rescuer on either side of the patient for more seamless transitions. (2012)

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Interposed abdominal compression (IAC) is another strategy that has been proposed to increase cardio cerebral perfusion.

The first provider performs conventional chest compressions, while the second compresses the

abdomen with similar hand position and depth midway between the xiphoid process and umbilicus during chest wall recoil. The third provider delivers intermittent ventilation, typically via an advanced airway management device. (2012)

This technique could be considered for victims of in-hospital cardiac arrest if a sufficient number

of trained providers are present. (2012) 42

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RESCUE BREATHSApproach safelyCheck response

Check breathing

Shout for help & Call 115 30 chest

compressions2 rescue

breaths

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OPEN AIRWAY (head tilt , chin lift - jaw

thrust )

Approach safely

Check responseCheck breathing

Shout for help & Call 115

30 chest

compressions2 rescue breaths

● Deliver each breath over 1 second

• Give a sufficient tidal volume produce visible chest rise .

● Avoid rapid or forceful breaths.45

Give 2 BREATH

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2 RESCUE BREATHSPinch the nose

Take a normal breathPlace lips over mouthBlow until the chest

risesTake about 1 secondAllow chest to fallRepeat

However, an advanced airway device should be inserted and used to provide ventilations only after the patient has received 2 to 3 minutes of chest compressions

and attempted defibrillation, if appropriate. (2012)

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Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

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BASIC LIFE SUPPORT

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CCR aims to improve outcomes through refocusing certain interventions in CPR to maximize myocardial and cerebral perfusion.

In CCR, chest compressions are started immediately and continued for 200 continuous compressions. During

this time, oxygen is given via a noninvasive airway (ie, no endotracheal intubation), and defibrillator pads are placed on the patient. The rhythm is analyzed, and, when appropriate, a shock is given followed immediately by another interval of 200 compressions without pulse check. (2012)

cardiocerebral resuscitation(CCR)

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Epinephrine is given early, and endotracheal intubation is delayed until after 3 rounds of chest compressions are completed.

the first 3 years of this data was presented in percentages, CCR showed a survival to hospital discharge increase of 5.4% versus 1.8% . (2012)

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AUTOMATED EXTERNAL DEFIBRILLATOR

In settings with 1-lay rescuer AED programs (AED on-site and available) 2-in-hospital environments

3-EMS rescuer witnesses the collapse,

The rescuer should use the defibrillator as soon as( within first 3-5 min) it is available for children and adults.

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cardiac arrest not witnessed by EMS personnel

EMS may initiate CPR while

checking the rhythm with the AED or on the electrocardiogram

(ECG) and preparing for defibrillation.

In such instances, 1½ to 3 minutes of CPR may be considered

before attempted defibrillation.

CPR Before Defibrillation The rate of survival-to-hospital discharge is higher among patients who experienced an unwitnessed SCA and received 1.5 to 3 minutes of CPR followed by defibrillation.

In witnessed SCA, early defibrillation is imperative; CPR should be performed while the defibrillator is being prepared. (2012)

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AED Use in Children Now Includes Infants2010 (New)

For infants (<1 year of age),

defibrillator is preferred. If a manual defibrillator is not available,

an AED with pediatric dose attenuation is desirable. If neither is

available, an AED without a dose attenuator may be used.

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The precordial thump 2010 (New)

should not be used for unwitnessed out-of-hospital cardiac arrest.

1-for patients with witnessed monitored,

2-unstable VT (including pulse less VT)

3-if a defibrillator is not immediately ready for use,

but it should not delay CPR and shock delivery.

Percussion pacing, an extension of the precordial thump, is essentially rhythmic percussion of the chest wall with a fist to pace the myocardium.

Several case reports and small case series have documented successful resuscitation with this technique, but there is insufficient evidence to support its routine use. (2012)

The precordial thump

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*Approach safelyCheck responseCheck breathing

Shout for help and call 115, get AEDAttach AED

Follow voice prompts

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SWITCH ON AED

Some AEDs will automatically switch them-selves on when the lid is opened

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ATTACH PADS TO CASUALTY’S BARE CHEST

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ANALYSING RHYTHM

DO NOT TOUCH VICTIM

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SHOCK INDICATED

Stand clearDeliver shock

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NO SHOCK ADVISED

resume CPR immediately for 5

cycles

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studies have affirmed that it is extremely safe to continue compressions during defibrillation when a biphasic defibrillator is used with self-adhesive electrodes and the rescuer wears standard examination gloves.

The simulated rescuers in these studies perceived no electrical charge, despite voltage delivery during the compressions.

Therefore, uninterrupted manual chest compressions are feasible during shock delivery, without risk of harm to the rescuer.

The AHA did not adopt this practice until now (2012) 68

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Approach safely

Check responseCheck breathing

Shout for help & Call 115 30 chest

compressions2 rescue

breaths

Approach safely

Check responseCheck breathing

Shout for help and call 115,

get AEDAttach AEDFollow voice

prompts

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If victim starts to breathe normally place in recovery

position

Recovery position

1 2

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