Page 1

Blackpool Teaching HospitalsNHS Foundation Trust

NHS

Basic Life Support

Page 2

Page 3

Introduction

Why do this course? Because it will help you save lives! It will help you: • Assessacollapsedvictim;• SeehowtoperformCPR(chestcompressionandrescuebreathing);• Seehowtoplaceanunconscious(butbreathing)victiminthe‘recoveryposition’;• Learnaboutthe‘chokingalgorithm’.

Should you save all victims?

It may sound callous at first, but some patients should NOT be resuscitated.

Likeotherhospitals,theTrusthasa‘DoNotAttemptResuscitation’(DNAR)policyanditistheconsultants’responsibilitytoenactthis.Haveatlookattheformweuse(ontheright):youcanseeitfullsizeontheL&DSharePointsite.

DNARisveryappropriateforsomepatients,andintheirbestinterestswhenithasbeendeterminedasthenecessarycourseofaction.Itdoesn’taltertheirroutinecare,anditalsosupports:• TheLiverpoolCarePathway;• TheNWEndofLifeCareModel

PS: For more information on End of Life Care please contact End of Life Co-ordinator, bleep 327

Fast action saves lives...

Ischaemicheartdiseaseistheleadingcauseofdeathworld-wide.InEurope,cardiovasculardiseaseaccountsforroughly40%ofalldeathsofpeopleunder75yearsold.YourFASTactioncouldhelpreducesomeofthesedeathsbecause:

• EachminutethatCPRisdelayedmeansthechancesofasuccessfuloutcomedecreasesby10-12%.

• Survivaltohospitaldischargeispresentlyjustover10%forallrhythms&justover21%forallVFarrests. [Source:RC(UK)6thEditionALSManual2011]

• Bystanderorin-hospitalCPRisavitalinterventionbeforethearrivalofAdvancedLifeSupport(ALS)or emergencyservices.

• Earlyresuscitationandpromptdefibrillationwithin1-2minutescanresultinabetterthan60%chance ofsurvival.

Page 4

Steps to Basic Life Support

Step1: Shout for help Step2: Eliminate Dangers Step3: Evaluate Response - Shout for help again, if necessary Step4: Airway Step5: Breathing Step6: Circulation

We use a mnemonic to summarise the steps you should take after the initial shout for help: ‘DR.ABC’ stands for:

Eliminate DANGERSEvaluate RESPONSEAIRWAYBREATHINGCIRCULATION

Step1:SHOUT FOR HELPShakethecasualty’sshouldersandshout“Areyoualright?”inbothears.

Step2:ELIMINATE DANGERSHelp the casualty – Don’t become one!

• Approachcarefully&safely• Thinkaboutmanualhandling• Don’tmovethepatientunlessyoureallyhaveto• Bewareanyenvironmentaldangers(roadtraffic,nearbyequipment,etc)• Avoidinfectionbyusingtheappropriateprotection(gloves,apron,facevisor,etc)• Ensuretheenvironmentisasafeonefortreatingthepatient

Step3:EVALUATE RESPONSIVENESSIfnecessary,ask“Areyoualright?”,againinbothears.

Note: In cases of trauma the neck and spine should be immobilised by placing one hand firmly on the forehead.

Isthepatientresponsive?

Yes? Great!Nowyoucan:• Checkforinjuries• AssessEarlyWarningScore(EWS)• Calculate&callforhelpasnecessary,followingthegradedresponsesystem• Seektheappropriatelevelofhelpneeded• Reassessregularly

No? Don’tpanic!ContinueontocheckA.B.C-Airway/Breathing/Circulation

Page 5

Step4: AIRWAY Getthepatientinpositionbyusingaheadtilt&chinlift:Isthereanyobstructionintheairway?Removeonlyvisibleobjectsusinganyrelevantequipmentavailable-forexample,suction,orMagill’sforceps(above)

Step5:BREATHING

• Look,listenandfeelfornormalbreathingfor no longer than 10 seconds.• BeawareofAGONALbreathing.• Considerasimultaneouscirculationcheck(ifyouareconfidentcheckingforacarotidpulse).

AGONALBREATHINGoccursshortlyaftertheheartstopsinupto40%ofcardiacarrests.Itcanbedescribedasbarelythere,heavy,noisy,orgasping,andmaybeinfrequent.Recognise this as a sign of cardiac arrest: DO NOT DELAY CPR!

Step6:CIRCULATION

Ifyouareconfidentaboutmakingcarotidpulseyoucouldbedoingthemwhilecheckingforbreathing(forupto10seconds).Ifyouarenotconfidentabouttakingapulse,lookforothersignsoflife,suchasmovement,colour,coughing,and/ortemperature.Checkthis(forupto10seconds)atthesametimeyoucheckforbreathing.

CPR (Cardio-Pulmonary Resuscitation)

Isthepatientbreathing?Orarethereothersignsoflife?

Yes?• Ifit’ssafetodoso,putthepatientintherecoveryposition.• Callforhelpon2222(attheBTH),(9)999(community)or112elsewhere.• ReassessA.B.C.atone-minuteintervals.• Considerassessingthepatient’sconditionthroughusingEWSorPOTTS.• Checkforsignsofagonalbreathing.

Isthepatientbreathing?Orarethereothersignsoflife?

No? • Iflocalhelpispresent,sendthemforadvancedhelpandemergencyequipment.• InouracuteTrustcalltheAdultCardiacArrestTeamon2222andstate‘AdultCardiacArrest’andyour location.• InaperipheralhospitalorintheNHScommunitysetting,call(9)999or112foranambulanceandsay “AdultCardiacArrestandwearedoingCPRrequestingparamediccrewanddefibrillator”.• Ifnohelpispresentleavethepatientandtelephoneforhelp.• ReturnandbeginCPR.

Remember to stay calm!

Page 6

Chest Compressions

• Placetheheelofonehandinthecentreofthechest• Placeotherhandontop• Interlockfingers• Compressthechest:• 30compressions• Rate:100-120bpm• Depth:5-6cm• Equalcompressiontorelaxationratio• WhenpossiblechangeCPRoperatorevery2minutes

Remember:Good, effective, chest compressions from the start can save a life!

• Mouth-to-mouthcanbeconsideredifapocketmaskisreadilyavailable.• Ifnomaskisavailable,andyouarenotpreparedtoperformmouth-to-mouth,performcontinuous chestcompressionsuntilequipmentarrives.• Eachventilationbreathshouldbegivenover1second.

Theformulatofollowis:

30compressions2breaths30compressions2breaths30compressions2breaths

&keepgoing!ContinueBLSuntil:

• Theadvancedemergencyteamarrivesandtakesover;• Thepatientshowssignsoflife;OR• Therescuerbecomestoophysicallyexhaustedtocarryon.

Page 7

The Recovery Position

Ifthepatientisunconscious,breathingnormally,hasanadequatecirculation,andthereisnosuspicionofcervicalspineinjury,thenconsiderusingtherecoverypositiontoensurefluidcandrainfreelyoutofthemouth:

Stage 1 Placethepatient'sarmnearesttoyouupwardsasiftheyareaskingaquestion:

Stage 2 Placethehandfurthestawayfromyouagainstthepatient'scheek:

Note:Ifyourpatientiswearingringswithstonesinthem,spintheringsaroundsothestoneisnotagainstthepatient'sface.

Stage 3Bendthekneefurthestawayfromyou:

Note:Checkthatyourpatienthasnoitemsinpocketsthatcouldcauseinjurywhenrolledontothem(suchasphones,orkeys).

Stage 4Rollthepatienttowardsyouandontotheirside:

Note: pregnant ladies should be placed on their LEFT side.

Page 8

General signs of choking• Attackoccurswhileeating• Victimmayclutchhisneck

Signs of mild airway obstructionResponsetoquestion‘Areyouchoking?’

• Victimspeaksandanswersyes

Othersigns• Victimisabletospeak,cough,andbreathe

Choking

5 Back Blows(checkthepatientaftereverybackblow)

followed by5 Abdominal Thrusts

(checkthepatientaftereveryabdominalthrust)If unconscious

Open airway, attempt to any remove visible object

And start CPR

Back Blows

Abdominal Thrusts

Back Blows Collapsed!

StartC.P.R

Signs of servere airway obstructionResponsetoquestion‘Areyouchoking?’

• Victimunabletospeak• Victimmayrespondbynodding

Othersigns• Victimunabletobreathe• Breathingsoundswheezy• Attemptsatcouchingaresilent• Victimmaybeunconscious

Signs of Choking

ChokingAlgorithm

Page 9

BLS induction assessment

Please select only one answer to each question:

1. Whatdepthshouldchestcompressionsbemade to?

2. Howfastshouldchestcompressionsbe?

3. Inachokingpatient,howmanybackslapswould youperforminitially?

4. WhenwouldyouNOTstartCPRonapatient?

5. Whichnumberwouldyoudialforacardiacarrest atBlackpoolVictoriaHospital?

6. Ismouth-to-mouthventilationessentialifyou havenopocket-mask?

7. Ifyourpatienthasacardiacarrestonthefloor, wherewouldyoudeliverCPR?

8. Ifyourpatienthadacardiacarrestinachair, wherewouldyoudeliverCPR?

9. InadultCPR,whatdowebeginwith?

10.Whenplacingapregnantpatientintherecovery position,whichsidedoyourollthepatientto?

11.Whatisthecorrecthandpositionforexternal compressions?

12.WhatdoesEWSstandfor?

c3-4cmc4-5cmc5-6cm

c80-100bpmc100bpmc100-120bpm

c 3c5c7

c WhentheyhavebeendeadforawhilecWhenapatient’srelativeasksyounottocWhenanactiveDNARisinplace

c 2222c4444c(9)999

cYescNo

cBed cChaircFloor

cBed cChaircFloor

cChestcompressionscRescuebreaths

c LeftsidecRightsidecEither

c Lowerchestc UpperchestcCentreofchest

cEasyWeighingSystemcEarlyWarningScorecEarlyWasteSignal

Page 10

13.Whatprotectiveequipmentisavailabletoyou whenaddressinganinfectiouspatient?

14.WhatdoesDNARstandfor?

15.Iffacedwithachokingpatient,howmany abdominalthrustswouldyoudeliver?

16.WhatsystemdowefollowforBLS?

17.Whatequipmentcanweusetoremovea foreignbodyfromapatient’sairway?

18.Ifyouarestrugglingtoremoveaforeignbody fromapatient’sairway,whatshouldyoudo?

19.Ifyou’renotconfidentaboutdoingcarotid pulsechecks,whatshouldyoudo?

20.Isagonalbreathingasignofcardiacarrest?

21.Ifagonalbreathingwerepresent,wouldyou delayCPR?

22.Howlongwouldyoucheckforbreathing& circulation?

23.Ifnopocketmaskisavailable,andyou’re notpreparedtodelivermouth-to-mouth, what should you do?

cGloves cAproncVisorcAllofthese

cDoNotAttemptRescuecDoesn’tNeedAttemptedResuscitationcDoNotAttemptResuscitation

c3c5c7

c Danger,Response,Airway,Breathing, Circulationc Shoutforhelp,Danger,Response,Airway, Breathing,Circulationc Response,Airway,Breathing,Circulation, Shoutforhelp

c Magill’sforcepsc SuctioncBothwouldbeuseful

cSeekhelpc Keeptryingtoremoveitc Pretendyoudidn’tseeitandignoreit

c Nothingc CheckanywaycLookforsignsoflifeinstead

cYescNo

c YescNo

Upto:c5secsc8 secs c10secs

cNothingc ContinuouschestcompressionscStopafter30compressions

Page 11

c1secondc2secondsc3seconds

c Whenyourpatientshowssignoflifec Whentheemergencyteamarrivesandtakesoverc Whenyou’retoophysicallyexhaustedtocontinuecWhenthepatient’srelativeasksyou

c 30:2c15:2c15:1

c Fluidc Equipmentc Sharpsc Trafficc Allofthese

c Presstheshoulders&shoutinbothears?c Shoutatthepatient?c Shakethepatient?

24.Howlongshouldaventilationbreathlast?

25.WhenwouldyouNOTstopCPR?

26.WhatratioCPRshouldyouuse?

27.Whatshouldbeclassedas‘dangerous’onyour approachtothepatient?

28.Whenassessingtheresponsivenessofyour patient,doyou:

Page 12

Blackpool Teaching HospitalsNHS Foundation Trust

NHS

In acknowledgement to all staff whocontributed to the production of this work book