Basic Life Support (BLS)

CPRCPR(CPCR- cardio-pulmonary-cerebral resuscitation)

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The heart is too good to die !

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CPR

BLS

ACLSPOST CPR STABLIZATION OR ORGAN PROTECTION

TECHNIQUE OF CARDIOPULMONARY RESUSCITATION (CPR )

ACLS ( Advance Cardiovascular Life Support)

Focus: more advanced assessments and treatmentsFocus: more advanced assessments and treatments

BLS ( Basic Life Support)

Focus: basic CPR and defibrillation

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EARLY ACCESS

EARLY CPR

EARLY DEFIBRILLATION (AED )

EARLY ACLS

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EarlyACCESS

EarlyCPR

EarlyDEFIB

EarlyACLS

Chain of Survival

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American Heart Association : “Textbook of Advanced Cardiac Life Support”

Check for SAFETY

Check for RESPONSE

Gentle SHAKE & SHOUT

No Response? Shout for HELP

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Before initiating the BLS approach;

CABD instead of traditional ABC

C: CirculationA: AirwayB: Breathing

Check for central pulse (Not peripheral!)

If there is not pulse resume chest compression immediately.

Compression to breathing ratio? Difference between adults and

pediatrics?

Adults: 30:2 Pediatrics: 1 rescuer: 30:2 2 rescuers: 15:2 Infants: 5:1 Neonates: 3:1 Change rescuers after 5

cycles(2 min) since pulse checking.

Rate 100/min Depth 4-5 cm 50% compression,

50% relaxation

Systolic BP ~ 60-80 mmHgMAP < 40 mmHg

CO ~ 30% normal

CHEST COMPRESSIONS AND CORONARY PERFUSION PRESSURE

CPP at 5:1 Ratio

CPP at 30:2 Ratio

not intubated30 compression : 2 ventilation

intubated100/min compression : 8-10

ventilation /min Asynchronous

COMPRESSION RATIO FOR 1& 2 COMPRESSION RATIO FOR 1& 2 RESCUERRESCUER

Perfusing rhythm : 10-12 ventilation /min

COPD : 6-8 ventilation /min

FATIGUEFATIGUE

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• Hard and Fast• Release completely• Minimize interruptions

only interrupt for 1. ventilation (until an advanced airway is

placed)2. rhythm check3. shock delivery

• Rotate compression every 2 minutes with rhythm check

CHEST COMPRESSIONCHEST COMPRESSION

CHECK- Remove foreign body/debris

OPEN - Head tilt/chin lift or jaw thrust

(Consider Tracheostomy/Laryngectomy Patients)

Head-tilt Chin-lift Maneuver

BREATHING

Rescue Breathing: “Gas flows down the path of least

resistance”• Gas can flow to the lungs or stomach

• Distribution of gas depends on– Peak airway pressure

• Inspiratory time• Tidal volume

– Lower esophageal sphincter opening pressure

PROBLEMS WITH HYPERINFLATION

1. Gastric inflation --> aspiration

Solution: cricoid pressure

(Sellick maneuver)

2. In COPD- rapid CO2 wash out Alkalosis- auto PEEP (air trap)

intrathoracic pressureVenous returnBP (especially if

hypovolemic)

Problems with hyperinflation

How to Prevent Gastric Inflation

• Use a longer inspiratory time

– 1 to 2 seconds for bag-mask ventilation with oxygen– 2 seconds for mouth-to-mouth or bag-mask ventilation with air

• Use a smaller tidal volume

– Less tidal volume = lower peak airway pressure

ASSESS SEVERITYASSESS SEVERITY

SEVERE AIRWAYSEVERE AIRWAY

OSTRUCTIONOSTRUCTION

INEFFECTIVE COUGHINEFFECTIVE COUGH

MILD AIRWAYMILD AIRWAY

OBSTRUCTIONOBSTRUCTION

EFFECTIVE COUGHEFFECTIVE COUGH

UNCONCIOUS?UNCONCIOUS?

STARTSTART

CPRCPR

CONCIOUS?CONCIOUS?5 BACK BLOWS5 BACK BLOWS

5 ABDOMINAL THRUSTS5 ABDOMINAL THRUSTS

ENCOURAGE COUGHENCOURAGE COUGH

CHECK FOR DETERIORATIONCHECK FOR DETERIORATION

OR INEFFECTIVE COUGH OR OR INEFFECTIVE COUGH OR

RELIEF OF OBSTRUCTIONRELIEF OF OBSTRUCTION

Stand to one side and slightly behind

Lean casualty forward & support chest with one hand

Give up to 5 back blows

Stand behind casualty and lean them forwards

Place fist between navel and breastbone

Grasp with other hand, pull sharply inwards and upwards

Repeat up to 5 times

Pregnant victims Very obese patients

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AED

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AED