Basic Life Support
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1 PETER R. FIGUEROA, MD Department of Surgery UST Faculty of Medicine & Surgery OBJECTIVES Establish/maintain perfusion to brain & heart Provide adequate ven8la8on Technique Airway – head‐8lt, chin‐li@ or jaw‐thrust Finger‐sweep Breathing Mouth to mouth or mouth to nose Low 8dal volume – 500cc to 700cc Watch chest rise 2‐5 breaths ini8ally: 1 sec/breath With advance airway i.e. E‐T tube, laryngeal mask airway (LMP), give 8‐10 breathing/min. no interrup8on of compression while breathing Technique Compression Vic8m posi8on – supine firm surface/bed board or floor Rescuer posi8on – side of vic8m’s chest; kneeling, heel of dominant hand in the center of chest over the sternum between the nipples and then place the heel of the 2 nd on the top of first so that the hands overlapped and parallel Rate – 30:2 compression: ven8la8on with advance airway – 100/min. no interrup8on for ven8la8on Depth – 1 ½ ‐ 2 inches (4‐5 cms) or 1/3 the A‐P diameter of chest Decompression – allow complete chest recoil a@er each compression Duty cycle – ra8o between 8me spent compression and release = 50% Special Circumstances For rescuers not willing to give mouth to mouth breathing, con8nuous chest compression CPR (ccc) or minimally interrupted cardiac resuscita8on (MICR) are acceptable 200 chest compressions, then AED, then 200 more compressions and evaluate rhythm BLS in cervical spine injury – maintaining airway and adequate ven8la8on is the overriding priority in managing pa8ents with a suspected spinal injury. The head‐8lt chin‐ li@ or jaw thrust techniques are feasible and may be effec8ve albeit both techniques are associated with cervical spine movement. Use of manual in‐line stabiliza8on (MILS) to minimize head movement is reasonable if sufficient number of rescuers are available Special Circumstances Infant and pediatric basic life support: Most cardiac arrests in children are caused by asyphyxia unlike in adult where underlying etiology is usually VF or pulseless VT. Therefore in pediatrics, start CPR immediately then call to AED. For chest compression, in infants 2-two thumbs encircling hands is utilized for 2 rescuers. The 2-fingers technique for single rescuer. For children, both the 1-and 2-hand techniques are acceptable. Compress over the lower part of the staneum just below the nipple-line to a depth of approximately 1/3 the anterior=posterior diameter of chest
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Transcript of Basic Life Support
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PETER R. FIGUEROA, MD Department of Surgery
UST Faculty of Medicine & Surgery
OBJECTIVES
Establish/maintainperfusiontobrain&heart Provideadequateven8la8on
Technique
Airwayhead8lt,chinli@orjawthrust
Fingersweep Breathing
Mouthtomouthormouthtonose
Low8dalvolume500ccto700cc Watchchestrise
25breathsini8ally:1sec/breath Withadvanceairwayi.e.ETtube,laryngealmaskairway(LMP),give810breathing/min.nointerrup8onofcompressionwhilebreathing
Technique Compression
Vic8mposi8onsupinefirmsurface/bedboardorfloor Rescuerposi8onsideofvic8mschest;kneeling,heelofdominanthandinthecenterofchestoverthesternumbetweenthenipplesandthenplacetheheelofthe2ndonthetopoffirstsothatthehandsoverlappedandparallel
Rate30:2compression:ven8la8onwithadvanceairway100/min.nointerrup8onforven8la8on
Depth12inches(45cms)or1/3theAPdiameterofchest
Decompressionallowcompletechestrecoila@ereachcompression
Dutycyclera8obetween8mespentcompressionandrelease=50%
Special Circumstances Forrescuersnotwillingtogivemouthtomouthbreathing,con8nuouschestcompressionCPR(ccc)orminimallyinterruptedcardiacresuscita8on(MICR)areacceptable200chestcompressions,thenAED,then200morecompressionsandevaluaterhythm
BLSincervicalspineinjurymaintainingairwayandadequateven8la8onistheoverridingpriorityinmanagingpa8entswithasuspectedspinalinjury.Thehead8ltchinli@orjawthrusttechniquesarefeasibleandmaybeeffec8vealbeitbothtechniquesareassociatedwithcervicalspinemovement.Useofmanualinlinestabiliza8on(MILS)tominimizeheadmovementisreasonableifsufficientnumberofrescuersareavailable
Special Circumstances Infant and pediatric basic life support: Most cardiac
arrests in children are caused by asyphyxia unlike in adult where underlying etiology is usually VF or pulseless VT. Therefore in pediatrics, start CPR immediately then call to AED. For chest compression, in infants 2-two thumbs encircling hands is utilized for 2 rescuers. The 2-fingers technique for single rescuer. For children, both the 1-and 2-hand techniques are acceptable. Compress over the lower part of the staneum just below the nipple-line to a depth of approximately 1/3 the anterior=posterior diameter of chest
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Defibrillation (AED) Automated external defibrilllator (AED) is part
of BLS as well as ACLS One immediate precordial thump (closed fist
delivered from a height of 5-40 cms) after a monitored cardiac arrest if AED is not available
Principles:
A1to3minsperiodofCPRbeforeagemp8ngAEDwithoutofhospitalVForpulselessVTifresponseintervalismorethan45mins.
WitnessedinhospitalSCAwithVF/pulselessVT,useofAEDearlyinCPRisrecommended
Minimalinterrup8onofchestcompression 1shockprotocolpreferredversus3shocksequence Immediatecon8nua8onofchestcompressiona@er1schokdefibrilla8on
Principles: Use of 12cms electrodes (paddles) better than
8cms. Small paddles (4.3cms) harmful to the myocardium
Use 150J to 200J biphasic waveform; with monophasic = 360J. For pediatrics = 2J/kg 4J/kg
Place paddles antero-lateral position Defibrillation should not be attempted in an O2
enriched atmosphere. Turn off O2 supply momentarilly. Do not disconnect ET/respirator tubes.
Basic Life Support (BLS)
Recognition of sudden cardiac arrest (SCA)
Cardiopulmonary Resuscitation (CPR) Defibrillation (AED)
GOALS OF BLS
Preserve life Restore Health Limit disability
CRITERIA FOR WITHHOLDING CPR
Valid do not attempt resuscitation (DNAR) Signs of irreversible death (e.g. rigor
mortis, decapitation or dependent lividity) Medical futility (e.g. terminal septic shock
or cardiogenic shock) Attempts to perform CPR would place the
rescuer at risk of physical injury
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Maneuver Adult Child 1 yr. to 16 yrs.
Infant under 1 yr.
Airway Head Tilt-Chin Lift
Trauma-use jaw thrust
Breathing-initial with advance
2 breaths (1 breath/sec)
Airway FBAO
10-12breaths/min Abdominal
thrusts
12-20/mins Back slaps: chest thrust
SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS Maneuver Adult Child 1 yr. to
16 yrs. Infant under 1 yr.
Circulation- pulse check
< 10 sec. Compression
Carotid
Lower half of sternum-between
nipples
Brachial or femoral
just below nipple line lower half sternum
Method Heel of one hand: other on top
2 fingers or 2 thumbs encircling
SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS
Maneuver Adult Child 1 yr. to 16 yrs.
Infant under 1 yr.
Depth 1 to 2 inches 1/3 chest diameter
Rate C:V
100/min 30:2
1 or 2 rescuer
30:2 (single rescuer)
15:2 (2 rescuers)
Defibrillation AED
8-12 inches Adult pads
150J-200Joules
Pediatric pads
2J/kg :4J/kg For subsequent
No recommend-
dation
SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS ILCORUNIVERSALCARDIACARRESTALGORITHM
Unresponsive?SCA
OpenAirway:Lookforsignsoflife
Give25ini8albreathsIfnotbreathing
Give30chestcompressions2compressions/sec.followedby2breaths.Con8nueun8lAEDisagached
AssesrhythmShockable(VForVT)
Nonshockable(PEAorasystole)
Give1shock
ImmediatelyResumeCPR
30:2for5cycles
ACLSarrivesMaintainairwayVascularaccessVerifyelectrodes
Drugs
Shoutforhelp
CallEMS/CPRteam
ResumeCPR30:2for5cycles
Reasonabledura8onforBLS=20mins.IfnoROSC,terminateresuscita8onReasonabledura8onforACLS=40minutesto1hour
TERMINATION OF CPR IN BLS
Restoration of spontaneous circulation ( ROSC) and ventilation.
Reliable criteria indicating irreversible death are present. No ROSC after more than 10 minutes of intensive
resuscitative efforts. Exceptions are drug overdose, pre arrest hypothermia, recurring VF/VT and ROSC of any duration occurs.
Rescuer is unable to continue because of dangerous hazards or risks to other lives.
Care is transferred to a more senior level emergency medical professional.
Glossary: SCA Sudden cardiac arrest VF Ventricular fibrillation VT Ventricular tachycardia PEA Pulseless electrical activity AED Automated external defibrillation BLS Basic life support ACLS Advanced cardiovascular life support CCR Cardio-cerebral resuscitation MICR Minimally interrupted cardiac resuscitation PALS Pediatric advanced life support ACS Acute coronary syndrome ILCOR International Liasson Committee on Resuscitations ROSC Return of spontaneous circulation
References: Circulation supplement vol.112, No. 22, Nov. 29, 2005 Circulation supplement vol. 112, No. 24, Dec. 13, 2005 hrttp://circ.ahajournals.or
Prepared by: Peter R. Figueroa, MD Department of Surgery
