American Heart Association BLS/ACLS/PALS Update Janet Smith.

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Transcript of American Heart Association BLS/ACLS/PALS Update Janet Smith.

  • Slide 1
  • American Heart Association BLS/ACLS/PALS Update Janet Smith
  • Slide 2
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  • Forget everything you know
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  • Instructor Goals Incorporate the previous changes from 2001 & present 2005 revisions Less number of algorithms Review Acute Pulmonary Edema, Hypotension, & Shock combined algorithms, & Hypothermia algorithm Stroke algorithm less busy & ACS not much change
  • Slide 5
  • February 24, 2006 - Rollout First session BLS changes Second session ACLS & PALS update Begin new test revised 2005 Handbook of Emergency Cardiovascular Care includes Guidelines CPR/ECC 2005. Nice addition cardiac markers, Treatment w/ Non-ST-segment Elevation MI
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  • Instructor Objectives Fit the course to your needs Adult learners need positive reinforcement & deal well with scenarios Understand the exam (new & improved) What is your environment
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  • Student Objectives Discuss new basic life support guidelines Discuss patient assessment & survey Discuss the use of ACLS drugs Stations: Determine competency Discuss the ethical considerations in resuscitation
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  • What type of course do you need? Recertification versus full course Utilize your study guides or cheat sheets Review pretest written exam Provide scenarios
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  • ACLS goals Emphasis on trained & equipped Health Care Professional (HCP), but only in conjunction with trained lay rescuer & reduce time to CPR and shock delivery & obtain ultimate success Effective ACLS begins with high-quality CPR
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  • Drug changes 2005 Most drug doses are the same as those recommended in 2000 except use Atropine 0.5 mg IV for Bradycardia. May repeat to a total of 3 mg. Epinephrine or dopamine may be administered while waiting for a pacemaker
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  • Early intervention & effective CPR
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  • 5 major changes 2005 guidelines Emphasis on, & recommendations to improve, delivery of effective chest compressions A single compression-to-ventilation ratio for all single rescuers for all victims (except newborns)
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  • 5 major changes 2005 guidelines Recommendation that each rescue breath be given over 1 second & should produce visible chest rise A new recommendation that single shock, followed by immediate CPR, be used to attempt defibrillation for VF cardiac arrest. Rhythm checks should be performed every 2 minutes
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  • 5 major changes 2005 guidelines Endorsement of the 2003 ILCOR recommendations for use of AEDs in children 1 to 8 years old (and older); use a child dose-reduction system if available
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  • 5 major changes continued: AED teaching point Some AEDs have shown to be very accurate in recognizing pediatric shockable rhythms & may be used with regular adult pads
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  • Age Definition Child CPR guidelines apply to victims 1 year to the onset of puberty (about 12 14 years old) Chest compressions are recommended if the heart rate is less than 60 per minute with signs of poor perfusion
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  • Effective chest compressions push hard & push fast & chest compress the chest @ a rate of about 100 per minute (except newborns) Use 1 or 2 hands with a child (Use technique that gives best results) Allow the chest to recoil Limit interruptions in chest compression
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  • Effective chest compressions Chest compressions create a small amount of blood flow to vital organs the better the chest compressions (adequate rate, depth, & allowing for recoil) the more blood flow is produced
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  • Copyright 1996 American Heart Association Idris, A. H. et al. Circulation 1996;94:2324-2336 Arterial and central venous pressure waveforms during external closed chest compression
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  • Universal Compression-to- Ventilation all lone rescuers One universal compression-to- ventilation ratio for all lone rescuers: Single compression to ventilation ration of 30:2 for single rescuers of victims of all ages Teaching point: Simplify CPR & increase blood flow to the heart
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  • 1-Second breaths during all CPR All breaths should be given over 1 second w/ significant volume to achieve visible chest rise Teaching point: During CPR, blood flow to the lungs is much less than normal, so the victim needs less ventilation than normal
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  • Review of BLS guidelines Determine if you require BLS proof prior to your course
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  • Basic Life Support Teaching concepts Early bystander CPR can double or triple the victims survival from VF & Sudden cardiac arrest (SCA) CPR plus defibrillator within 3 5 minutes of collapse can produce survival rates as high as 49% to 75%
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  • Basic Life Support Calling for help Lone Healthcare provider: Sudden collapse Phone 911 & get an AED available & then return to victim to begin CPR Unresponsive victim w/ likely drowning deliver about 5 cycles (about 2 minutes) of CPR prior to phoning 911 to get the AED & then return to CPR
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  • Lone Healthcare Provider/CPR Scenario: Patient unresponsive & non- breathing the Lone Healthcare provider will give 2 rescue breaths & then feel a pulse for no more than 10 seconds. If no pulse begin compression Adult: 30:2 Child: 15:2 (two rescuers)
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  • HCP- Rescue breathing Deliver rescue breath over 1 second Rescue breathing for a victim w/pulse Adult: 10 to 12 breaths/minute Infant/child: 12 to 20 breaths/minute Teaching point: Less ventilation than normal & not as effective as compressions
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  • Chest compressions components Adult: Center chest & @ nipple line & 1 to 2 inches using heel of both hands & lower half of sternum Child: 1/3 to depth of chest & using heel of one hand Rate: 100 on all patients
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  • HCP Chest compressions Compression during CPR & NO advanced airway is present: Deliver cycles of compressions 30:2 Compression during CPR & advanced airway IS present: No longer use cycles or pausing for rescue breathing. Deliver 100 compressions/minute w/ 8- 10 breaths/minute
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  • Lay Rescuers CPR may include information with your course Lay rescuers should immediately begin cycles of chest compressions after delivering 2 rescue breaths in the unresponsive victim. Lay rescuers are not taught to assess for pulse or sings or circulation Research notes that the lay public has a difficult time locating the correct place for palpation
  • Slide 32
  • Defibrillation One shock followed by immediate CPR beginning w/ chest compressions & 5 cycles or 2 minutes Monophasic: 360 J Biphasic: 150 to 200 J
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  • AED Review Use the model for teaching & state the proper order - 4-Universal steps: Power AED Attach to victim Analyze rhythm Deliver shock if indicated
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  • Use of the AED Use adult pads on adults Use AED after 5 cycles of CPR (out of hospital) No recommendation for infants < 1 year of age Children 1 to 8 Use an AED with pediatric dose-attenuator
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  • Electrical Therapies Defibrillation involves delivery of current through the chest & to the heart to depolarize myocardial cells & eliminate VF Monophasic Deliver current to one polarity & higher energy level Biphasic Lower energy & are more in current use
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  • Management of Pulseless Arrest 5 cycles or 2 minutes or uninterrupted CPR & should resume immediately after deliver 1 shock Pulse & rhythm are NOT checked after shock
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  • Management of cardiac arrest Drug administration is of 2 nd importance NO IV access: Lidocaine, epinephrine, atropine, narcan, & vasopression are absorbed via the trachea w/typical dose 2 to 2 times the recommended IV dose & should dilute with water or NS Administer drugs during CPR
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  • HCP- Rescue breathing Deliver rescue breath over 1 second Rescue breathing for a victim w/pulse Adult: 10 to 12 breaths/minute Infant/child: 12 to 20 breaths/minute Teaching point: Less ventilation than normal & not as effective as compressions
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  • Airway management - review & observe student performance Demonstrate the BVM Intubation techniques Secondary confirmation techniques Securing the ETT C-Spine precautions & trauma 5-point chest exam
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  • Airway & C-spine management Use head tilt-chin lift technique to open the airway of trauma victim unless cervical spine injury is suspected Teaching point: Jaw thrust is a difficult maneuver & may not be an effective way to open the airway
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  • Airway station Use BVM Anyone providing prehospital care for adult, children, or infants should be trained to deliver effective oxygenation & ventilation The use of BVM should be considered to be the primary method of venilatory support, especially if t