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BASIC LIFE SUPPORT - CPR

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Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsIntroduction to BLS Introduction to BLS -- CPRCPR

THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSSSAFETY SERVICESSAFETY SERVICES

1. BASIC Life Support (BLS)1. BASIC Life Support (BLS)An emergency procedure that consists of recognizing respiratory An emergency procedure that consists of recognizing respiratory or cardiac arrest or cardiac arrest or both and the proper application of CPR to maintain life untilor both and the proper application of CPR to maintain life until a victim recovers or a victim recovers or advanced life support is available. advanced life support is available.


2. Advanced Cardiac Life Support (ACLS) 2. Advanced Cardiac Life Support (ACLS)

3. Prolonged Life Support (PLS)3. Prolonged Life Support (PLS)

The use of special equipment to maintain breathing and circulatiThe use of special equipment to maintain breathing and circulation for the victim on for the victim of a cardiac emergency.of a cardiac emergency.

For post resuscitative and long term resuscitation.For post resuscitative and long term resuscitation.

Kinds of Life Support Kinds of Life Support

LIFE SUPPORTLIFE SUPPORT


1. The First Link: EARLY ACCESS1. The First Link: EARLY ACCESS

2. The Second Link: EARLY CPR 2. The Second Link: EARLY CPR

3. The Third Link: EARLY DEFIBRILLATION3. The Third Link: EARLY DEFIBRILLATION

It is the event initiated after the patientIt is the event initiated after the patient’’s collapse until the arrival of Emergency s collapse until the arrival of Emergency Medical Services personnel prepared to provide care.Medical Services personnel prepared to provide care.

It is most effective when started immediately after the victimIt is most effective when started immediately after the victim’’s collapse. The s collapse. The probability of survival approximately doubles when it is initiatprobability of survival approximately doubles when it is initiated before the arrival ed before the arrival of EMS.of EMS.

4. The Fourth Link: EARLY ACLS4. The Fourth Link: EARLY ACLS

It is most likely to improve survival. It is the key interventioIt is most likely to improve survival. It is the key intervention to increase the chances n to increase the chances of survival of patients with of survival of patients with ““outout--ofof--hospitalhospital”” cardiac arrest.cardiac arrest.

If provided by highly trained personnel like paramedics, provisiIf provided by highly trained personnel like paramedics, provision of advanced on of advanced care outside the hospital would be possible.care outside the hospital would be possible.


Four LinksFour Links

CHAIN OF SURVIVALCHAIN OF SURVIVAL


1. Medial (I)1. Medial (I)

2. Prone Position (C)2. Prone Position (C)3. Inferior (F)3. Inferior (F)4. Proximal (K)4. Proximal (K)

6. Distal (L) 6. Distal (L)

7. Posterior (H)7. Posterior (H)8. Lateral recumbent position (D)8. Lateral recumbent position (D)

9. Superior (E) 9. Superior (E) 10. Lateral (J)10. Lateral (J)

12. Anterior (G)12. Anterior (G)13. Supine position (B)13. Supine position (B)

15. Anatomical position (A)15. Anatomical position (A)

Anatomical TermsAnatomical Terms


16. Deep (N)16. Deep (N)

5. Internal (O)5. Internal (O)14. Superficial (M)14. Superficial (M)

11. External (Q)11. External (Q)

HUMAN BODYHUMAN BODY





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Body SystemsBody Systems

1. The Respiratory System1. The Respiratory System

It supply oxygen to the body, as well as removes It supply oxygen to the body, as well as removes carbon dioxide from the body. The passage of air into carbon dioxide from the body. The passage of air into and out of the lungs is called respiration. Breathing in and out of the lungs is called respiration. Breathing in is called inspiration or inhaling. Breathing out is called is called inspiration or inhaling. Breathing out is called expiration or exhaling.expiration or exhaling.



HUMAN BODY contHUMAN BODY cont……

Body SystemsBody Systems

2. 2. The Circulatory SystemThe Circulatory SystemIt delivers oxygen and nutrients to the bodyIt delivers oxygen and nutrients to the body’’s tissues s tissues and removes waste products. It consists of the heart, and removes waste products. It consists of the heart, blood vessels, and blood.blood vessels, and blood.




It is composed of the brain, spinal cord and nerves. It has two It is composed of the brain, spinal cord and nerves. It has two major functions major functions ––communication and control. It lets a person be aware of and reaccommunication and control. It lets a person be aware of and react to the t to the environment. It coordinates the bodyenvironment. It coordinates the body’’s responses to stimuli and keeps body systems s responses to stimuli and keeps body systems working together.working together.

3. The Nervous System3. The Nervous System

Body System cont...Body System cont...




Breathing and CirculationBreathing and Circulation•• Air that enters the lungs contains:Air that enters the lungs contains:

–– 21% O221% O2–– trace of CO2trace of CO2

•• Air exhaled from the lungs contains:Air exhaled from the lungs contains:–– 16% O216% O2–– 4% CO24% CO2


•• Clinical deathClinical death (0 (0 -- 4 min. 4 min. -- brain damage not brain damage not likely, 4 likely, 4 -- 6 min. 6 min. -- damage probable).damage probable).

•• Biological deathBiological death (6 (6 -- 10 min. 10 min. -- brain damage brain damage probable; over 10 min. probable; over 10 min. -- brain damage is certain).brain damage is certain).

Body System cont...Body System cont...



Body Substance IsolationBody Substance IsolationAre precautions taken to isolate or prevent risk of exposure froAre precautions taken to isolate or prevent risk of exposure from any other type of m any other type of bodily substance.bodily substance.

Basic Precautions and PracticesBasic Precautions and Practices

1. Personal Hygiene1. Personal Hygiene 2. Protective Equipment2. Protective Equipment 3. Equipment Cleaning3. Equipment Cleaning& Disinfecting& Disinfecting


PRECAUTIONS TO PREVENT PRECAUTIONS TO PREVENT DISEASE TRANSMISSIONDISEASE TRANSMISSION


Risk Factors for Cardiovascular Diseases Risk Factors for Cardiovascular Diseases

1. Risk factors that cannot be changed (Non1. Risk factors that cannot be changed (Non--modifiable) :modifiable) :

•• HeredityHeredity•• AgeAge•• GenderGender

2. Risk factors that can be changed (Modifiable) :2. Risk factors that can be changed (Modifiable) :•• Cigarette smoking.Cigarette smoking.

•• Elevated cholesterol and triglyceride levels.Elevated cholesterol and triglyceride levels.•• HypertensionHypertension

•• ObesityObesity•• StressStress

•• Lack of exercises.Lack of exercises.


•• Diabetes mellitus.Diabetes mellitus.

CARDIOVASCULAR DISEASESCARDIOVASCULAR DISEASES



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HEART ATTACK ( Myocardial Infarction)HEART ATTACK ( Myocardial Infarction)It occurs when the oxygen supply to the heart muscle (myocardiumIt occurs when the oxygen supply to the heart muscle (myocardium) is cut) is cut--off for a prolonged off for a prolonged period of time. This cutperiod of time. This cut--off results from a reduced blood supply due to severe narrowing off results from a reduced blood supply due to severe narrowing or or complete blockage of the diseased artery. The result is death (icomplete blockage of the diseased artery. The result is death (infarction) of the affected part nfarction) of the affected part of the heart.of the heart.



CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont……


First Aid Management of Heart AttackFirst Aid Management of Heart Attack1. Recognized the signals of heart attack and take action.1. Recognized the signals of heart attack and take action.

2. Have patient stop what he or she is doing and sit or lie him/2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortable her down in a comfortable position. Do not let the patient move around.position. Do not let the patient move around.

3. Have someone call the physician or ambulance for help.3. Have someone call the physician or ambulance for help.

4. If patient is under medical care, assist him/her in taking hi4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.s/her prescribed medicine/s.


CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont……

Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsGuidelines in Giving Emergency CareGuidelines in Giving Emergency Care

After completing this module, participants will be able toAfter completing this module, participants will be able to--

•• Demonstrate how to do a primary survey. Demonstrate how to do a primary survey.

1. Explain the need of preparation to a proper emergency care. 1. Explain the need of preparation to a proper emergency care. 2. Describe the four emergency action principles 2. Describe the four emergency action principles 3. Enumerate the golden rules in giving emergency care.3. Enumerate the golden rules in giving emergency care.

TR 2TR 2--11

KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES:

SKILL OBJECTIVES:SKILL OBJECTIVES:


1. Plan of Action1. Plan of Action

2. Gathering of Needed Materials 2. Gathering of Needed Materials

3. Initial Response:3. Initial Response:

Emergency plans should be established based on anticipated needsEmergency plans should be established based on anticipated needs and and available resources.available resources.

The emergency response begins with the preparation of equipment The emergency response begins with the preparation of equipment and personnel and personnel before any emergency occurs.before any emergency occurs.

•• Ask for HELP.Ask for HELP.•• InterveneIntervene•• Do not further harm.Do not further harm.


TR 2TR 2--22

4. Instruction to Helper/s 4. Instruction to Helper/s Proper information and instruction to a helper/s would provide oProper information and instruction to a helper/s would provide organized first aid rganized first aid care.care.


GETTING STARTEDGETTING STARTED

Elements of the Survey the SceneElements of the Survey the Scene•• Scene safety.Scene safety.•• Mechanism of injury or nature of illness.Mechanism of injury or nature of illness.•• Determine the number of patients and Determine the number of patients and additional resources.additional resources.


TR 2TR 2--33

1. Survey the Scene1. Survey the SceneOnce you recognized that an emergency has occurred and decide toOnce you recognized that an emergency has occurred and decide to act, you act, you must make sure the scene of the emergency is safe for you, the vmust make sure the scene of the emergency is safe for you, the victim/s, and ictim/s, and any bystander/s.any bystander/s.


EMERGENCY ACTION PRINCIPLESEMERGENCY ACTION PRINCIPLES


TR 2TR 2--44

Phone First and Phone FastPhone First and Phone FastBoth trained and untrained bystanders should Both trained and untrained bystanders should be instructed to Activate Medical Assistance as be instructed to Activate Medical Assistance as soon as they have determined that an adult soon as they have determined that an adult victim requires emergency care victim requires emergency care ““Phone FirstPhone First””. . While for infant and children a While for infant and children a ““Phone FastPhone Fast””approach is recommended.approach is recommended.

2. Activate Medical Assistance and Transfer Facility2. Activate Medical Assistance and Transfer Facility

In some emergency, you will have enough time to call for specifiIn some emergency, you will have enough time to call for specific medical advice c medical advice before administering first aid. But in some situations, you willbefore administering first aid. But in some situations, you will need to attend to need to attend to the victim first.the victim first.


EMERGENCY ACTION PRINCIPLES contEMERGENCY ACTION PRINCIPLES cont……


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TR 2TR 2--55

1. Check for Consciousness1. Check for Consciousness

3. Do a Primary Survey of the Victim3. Do a Primary Survey of the VictimIn every emergency situation, you must first find out if there aIn every emergency situation, you must first find out if there are conditions that re conditions that are an immediate threat to the victimare an immediate threat to the victim’’s life.s life.

2. Check for Airway2. Check for Airway

3. Check for Breathing3. Check for Breathing

4. Check for Circulation4. Check for Circulation




TR 2TR 2--66

1. Interview the victim.1. Interview the victim.

4. Do a Secondary Survey of the Victim4. Do a Secondary Survey of the VictimIt is a systematic method of gathering additional information abIt is a systematic method of gathering additional information about out injuries or conditions that may need care.injuries or conditions that may need care.

2. Check vital signs.2. Check vital signs.

3. Perform head3. Perform head--toto--toe examination.toe examination.



Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsRespiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing


•• Demonstrate how to provide rescue breathing for an adult, child,Demonstrate how to provide rescue breathing for an adult, child, & infant & infant who shows signs of circulation but not breathing or inadequate.who shows signs of circulation but not breathing or inadequate.

1. Describe what is respiratory arrest. 1. Describe what is respiratory arrest.

3. Describe the ways in ventilating the lungs. 3. Describe the ways in ventilating the lungs.

TR 3TR 3--11


SKILL OBJECTIVES:SKILL OBJECTIVES:

2. Identify the causes of respiratory arrest. 2. Identify the causes of respiratory arrest.

After completing this sessions, participants will be able toAfter completing this sessions, participants will be able to--


Is the condition in which breathing stops or inadequate.Is the condition in which breathing stops or inadequate.


Is a technique of breathing air into a person lungs to supply hiIs a technique of breathing air into a person lungs to supply him or her with the m or her with the oxygen needed to survive.oxygen needed to survive.

RESPIRATORY ARRESTRESPIRATORY ARREST

RESCUE BREATHINGRESCUE BREATHING



1. Mouth1. Mouth--toto--MouthMouth

4. Mouth4. Mouth--toto--StomaStoma

3. Mouth3. Mouth--toto--Mouth Mouth and Noseand Nose

2. Mouth2. Mouth--toto--NoseNose

WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS


5. Mouth5. Mouth--toto--Face ShieldFace Shield

6. Mouth6. Mouth--toto--MaskMask

7. Bag Mask 7. Bag Mask DeviceDevice



WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS


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Face mask

Bag mask

Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsForeign Airway Obstruction ManagementForeign Airway Obstruction Management


•• Demonstrate how to provide Heimlich maneuver to an adult, child Demonstrate how to provide Heimlich maneuver to an adult, child & infant & infant who have obstructed airway.who have obstructed airway.

1. Identify the causes, types, and classification of obstruction1. Identify the causes, types, and classification of obstruction..2. Describe Heimlich maneuver. 2. Describe Heimlich maneuver.

TR 4TR 4--11


SKILL OBJECTIVES:SKILL OBJECTIVES:After completing this session, participants will be able toAfter completing this session, participants will be able to--


It happens when the tongue drops back and It happens when the tongue drops back and obstruct the throat. Other causes are acute obstruct the throat. Other causes are acute asthma, croup, diphtheria, swelling, and cough asthma, croup, diphtheria, swelling, and cough (whooping).(whooping).

Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsForeign Body Airway Obstruction ManagementForeign Body Airway Obstruction Management

1. Anatomical Obstruction1. Anatomical Obstruction

2. Mechanical Obstruction2. Mechanical ObstructionWhen foreign objects lodge in the pharynx or When foreign objects lodge in the pharynx or airways; fluids accumulate in the back of the airways; fluids accumulate in the back of the throat.throat.


TWO TYPES OF OBSTRUCTIONTWO TYPES OF OBSTRUCTION


1. Partial obstruction with good air exchange.1. Partial obstruction with good air exchange.

2. Partial obstruction with poor air exchange.2. Partial obstruction with poor air exchange.

3. Complete or total obstruction. 3. Complete or total obstruction.

The victim is responsive and can cough forcefully, although freqThe victim is responsive and can cough forcefully, although frequently there uently there is wheezing between coughs.is wheezing between coughs.

The victim has a weak, ineffective cough, highThe victim has a weak, ineffective cough, high--pitched noise while inhaling, pitched noise while inhaling, increased respiratory difficulty, and possibly cyanosis.increased respiratory difficulty, and possibly cyanosis.

The victim is unable to speak, breathe, or cough and may clutch The victim is unable to speak, breathe, or cough and may clutch the neck withthe neck withthe thumb and fingers. Movement of air is absent.the thumb and fingers. Movement of air is absent.


CLASSIFICATION OF OBSTRUCTIONCLASSIFICATION OF OBSTRUCTION


Heimlich maneuver or abdominal thrusts is recommended for relievHeimlich maneuver or abdominal thrusts is recommended for relieving foreign body ing foreign body airway obstruction.airway obstruction.


HEIMLICH MANEUVERHEIMLICH MANEUVER

Basic Life Support Basic Life Support –– CPR Visual AidsCPR Visual AidsCardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation


•• Demonstrate how to provide Cardiopulmonary Resuscitation to an aDemonstrate how to provide Cardiopulmonary Resuscitation to an adult, dult, child & infant who have cardiac arrest.child & infant who have cardiac arrest.

1. Describe cardiac arrest. 1. Describe cardiac arrest. 2. Enumerate the three conditions of cardiac arrest. 2. Enumerate the three conditions of cardiac arrest.

TR 5TR 5--11


SKILL OBJECTIVES:SKILL OBJECTIVES:3. Enumerate the criteria for not starting CPR and when to STOP 3. Enumerate the criteria for not starting CPR and when to STOP CPR. CPR.

After completing the class, participants will be able toAfter completing the class, participants will be able to--



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Is the condition in which circulation ceases and Is the condition in which circulation ceases and vital organs are deprived of oxygen.vital organs are deprived of oxygen.


TR 5TR 5--22


CARDIAC ARRESTCARDIAC ARREST

1.1. Cardio Vascular Collapse Cardio Vascular Collapse 2.2. Ventricular FibrillationVentricular Fibrillation3.3. Cardiac Stand StillCardiac Stand Still

THREE CONDITONS OF CARDIAC ARRESTTHREE CONDITONS OF CARDIAC ARREST



This is a combination of chest compression This is a combination of chest compression and rescue breathing. This must be combined and rescue breathing. This must be combined for effective resuscitation of the victim of for effective resuscitation of the victim of cardiac arrest.cardiac arrest.

CARDIOPULMONARYCARDIOPULMONARYRESUSCITATION (CPR)RESUSCITATION (CPR)

Cough Cough -- CPR CPR

Compression Only Compression Only -- CPRCPR


TR 5TR 5--33

1. SPONTANEOUS1. SPONTANEOUS signs of circulation are restored.signs of circulation are restored.

2. TURNED2. TURNED over to medical services or properly trained and authorized over to medical services or properly trained and authorized personnel.personnel.

3. OPERATOR3. OPERATOR is already exhausted and cannot continue CPR.is already exhausted and cannot continue CPR.

4. PHYSICIAN4. PHYSICIAN assumes responsibility (declares death, take over, etc.).assumes responsibility (declares death, take over, etc.).


WHEN TO S.T.O.P. CPRWHEN TO S.T.O.P. CPR


TR 5TR 5--44

Survey the Scene.Survey the Scene.

““The Scene is SafeThe Scene is Safe””..““Activate Medical Assistance & Transfer FacilityActivate Medical Assistance & Transfer Facility””..

Check Responsiveness, Check Responsiveness,

““Hey Hey MamMam/Sir are you OK? Victim Unresponsive/Sir are you OK? Victim Unresponsive””. .

Open Airway (HeadOpen Airway (Head--TiltTilt--Chin Lift) Check AirwayChin Lift) Check AirwayCheck Breathing (Look, Listen & Feel) for 5 seconds. Check Breathing (Look, Listen & Feel) for 5 seconds.

““Victim is BreathlessVictim is Breathless””. .

Give 2 Initial Ventilatory Maneuver (2 breaths).Give 2 Initial Ventilatory Maneuver (2 breaths).Check for Signs of Circulation for at least 10 seconds.Check for Signs of Circulation for at least 10 seconds.

““Victim has no signs of Circulation IVictim has no signs of Circulation I’’ll perform CPRll perform CPR””..““Victim has inadequate/no breathing but with Signs of CirculationVictim has inadequate/no breathing but with Signs of Circulation II’’ll performll perform

Rescue BreathingRescue Breathing””. .


SEQUENCE IN PERFORMING CPR & RBSEQUENCE IN PERFORMING CPR & RB

ACLS APPROACHACLS APPROACH

OBJECTIVESOBJECTIVES

1.1. Describe the 8 steps of the ACLS Describe the 8 steps of the ACLS approachapproach

2. For each step of the ACLS Approach 2. For each step of the ACLS Approach describe 2 acts of assessment and describe 2 acts of assessment and managementmanagement

3. Describe how you can apply this 3. Describe how you can apply this approach to almost all cardiovascular approach to almost all cardiovascular emergenciesemergencies


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8 Things to Recall in an Emergency8 Things to Recall in an Emergency

Airway: Is the airway open?Breathing: Is the victim moving air

adequately?Circulation: Is there a pulse? If

not, is CPR being performed effectively?

Defibrillation: if no pulse, has someone checked whether rhythm is VF?

Is a defibrillator on the way?Is it ready to deliver a shock?

Airway: open the airwayBreathing: provide positive-

pressure VentilationsCirculation: give chest

compressionsDefibrllation: shock VF/pulseless

VT

Primary ABCD Survey(ACLS Questions to Ask)

Primary Survey: ABCD(Basic Steps)


Airway: •provide advanced airway management

•tracheal intubation, laryngeal mask airway, Combitube

Secondary Survey: ABCD(Basic Steps)

Airway:• Is advanced airway needed now?

•If yes, intubate victim with laryngeal mask airway, Combitube, or tracheal tube

Secondary Survey: ABCD Survey(Basic Steps)


Breathing: confirm tube placement primarily (physical examination), secondarily (check end-tidal CO2 and esophageal placement), check for adequate oxygenation and ventilation


Breathing: Primary confirmation (physical examination) of proper placement of airway deviceBreathing: Secondary confirmation (end-tidal CO2 detectors, esophageal detector devices) of proper device placementBreathing: Adequate oxygenation and ventilation? Is it possible to provide continuous/intermittent monitoring of CO2 and oxygen levelsBreathing: Is tube secured to prevent dislodgment? Is commercial tube holder being used or tape-and-tie techniques? Is proper tube placement reconfirmed frequently



Circulation: obtain IV access, determine rhythm, give medications appropriate for rhythm and vital signs


Circulation: What was the initial cardiac rhythm? What is current cardiac rhythm?

Circulation:has someone obtained access to the venous circulation? Can fluids and medication now be given? Have all medications and interventions been providedasindicated for this rhythm and overall clinical condition?



Differential Diagnosis:search for, find, and treat reversible cause


Differential Diagnosis: Now… what is wrong with this patient? Why did adequate respirations and heartbeat stop? Why did the patient go into an arrest?What do we see, hear, smell, know or quickly learn that might help us identify a reversible cause of the arrest?



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Initial ResponsesInitial Responses

The initial responses also include:The initial responses also include:•• Assess responsivenessAssess responsiveness•• Call fastCall fast•• Appropriately position the patientAppropriately position the patient•• Appropriately position yourself as the Appropriately position yourself as the

rescuerrescuer

Assessment processAssessment process

•• Person CollapsesPerson Collapses

•• Possible Cardiac ArrestPossible Cardiac Arrest

•• Assess ResponsivenessAssess Responsiveness

Assess ResponsivenessAssess Responsiveness

•• Always assume that the victim is in cardiac Always assume that the victim is in cardiac respiratory arrest or both unless proven respiratory arrest or both unless proven otherwiseotherwise

•• Establish unresponsiveness with the Establish unresponsiveness with the traditional traditional ““shake and shoutshake and shout”” step:tapstep:tap and and gently shake the victim and shout gently shake the victim and shout ““Are Are you OKyou OK””

call for helpcall for help

•• Advance care, in the form of electrical Advance care, in the form of electrical defibrillation, advanced airway defibrillation, advanced airway management, and IV medications, must management, and IV medications, must be on the way to the patient as soon as be on the way to the patient as soon as possiblepossible

Q? to Assess ResponsivenessQ? to Assess Responsiveness

•• Did the victim fall from a height?Did the victim fall from a height?•• Or collapse with great force? Or collapse with great force? •• Or dive head first? Or dive head first? •• Or experience a motor vehicle crash?Or experience a motor vehicle crash?

•• Activate emergency responseActivate emergency response•• Call for defibrillatorCall for defibrillator

Begin Primary ABCD SurveyBegin Primary ABCD SurveyA A Assess breathing (open airway, look, Assess breathing (open airway, look,

listen, and feel)listen, and feel)


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A: Assess the AirwayA: Assess the Airway

•• Begin with an assessment of the airway, Begin with an assessment of the airway, first opening the airway and checking for first opening the airway and checking for spontaneous breathingspontaneous breathing

•• The basic techniques for opening the The basic techniques for opening the airway are the head tiltairway are the head tilt--chin maneuver chin maneuver and the jawand the jaw--thrust maneuverthrust maneuver

Head TiltHead Tilt--chin Liftchin Lift

This maneuver pulls the base of the tongueThis maneuver pulls the base of the tongueaway from the back of the throat, thusaway from the back of the throat, thusmaintaining a more open airway:maintaining a more open airway:•• Open the mouth, inspect the upper airway Open the mouth, inspect the upper airway

for foreign objects, vomitus, or blood. If a for foreign objects, vomitus, or blood. If a foreign object is present, remove it with foreign object is present, remove it with your fingers covered with a piece of cloth.your fingers covered with a piece of cloth.

Head TiltHead Tilt--chin Liftchin Lift

If there is no possibility of a cervical spineIf there is no possibility of a cervical spineInjury, remove material obstructing theInjury, remove material obstructing theairway by turning the patient on his or herairway by turning the patient on his or hersideside•• Place the edge of one hand on the victimPlace the edge of one hand on the victim’’s s

forehead. Begin to gently tilt the head forehead. Begin to gently tilt the head back. At the same time place 2 fingers of back. At the same time place 2 fingers of the other hand under the chin and lift the other hand under the chin and lift upward, tilting the head backupward, tilting the head back

JawJaw--Thrust ManeuverThrust Maneuver

The jaw thrust maintains the neutralThe jaw thrust maintains the neutralpositionofpositionof the cervical spine whilethe cervical spine whileresuscitative efforts continue. Use the jaw resuscitative efforts continue. Use the jaw thrust when you encounter patients with thethrust when you encounter patients with thecombination of possible cervical spinecombination of possible cervical spineinjuries and respiratory compromise orinjuries and respiratory compromise orvictims of trauma.victims of trauma.

The Advanced ACLS SkillsThe Advanced ACLS Skills

OverviewOverview2 Basic ACLS Skills2 Basic ACLS Skills

1.1. CPRCPR2.2. AED (Automated External Defibrillators)AED (Automated External Defibrillators)


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Advanced ACLS SkillsAdvanced ACLS Skills1.1. Care of the airwayCare of the airway2.2. Recognition of rhythmRecognition of rhythm3.3. Electrical therapy I (defibrillation)Electrical therapy I (defibrillation)4.4. Electrical therapy II (Electrical therapy II (cardioversioncardioversion))5.5. Electrical therapy III (Electrical therapy III (transcutaneoustranscutaneous

pacing)pacing)6.6. IV IV accesacces to circulationto circulation7.7. Selection of appropriate resuscitation Selection of appropriate resuscitation

medicationmedication

Secondary (Advanced) ABCD SurveySecondary (Advanced) ABCD SurveyA.A. Secondary ASecondary A

–– establish an airway with establish an airway with (1) tracheal (1) tracheal intubationintubation

B. Secondary BB. Secondary B-- provide ventilation (breathing) with properly provide ventilation (breathing) with properly

placed tracheal tubes and airway ductsplaced tracheal tubes and airway ducts

C. Secondary CC. Secondary C–– Restore circulation with:Restore circulation with:(2) Defibrillation(2) Defibrillation(3) (3) CardioversionCardioversion(4) (4) TranscutaneousTranscutaneous pacingpacing(5) Recognition of the rhythm(5) Recognition of the rhythm(6) Initiation of IV access(6) Initiation of IV access(7) IV medications(7) IV medications

D. Secondary DD. Secondary D–– Perform a differential diagnosisPerform a differential diagnosis

ACLS Skill 1:ACLS Skill 1:Take care of the airwayTake care of the airway

1.1. Provide supplemental oxygenProvide supplemental oxygen–– without respiratory distresswithout respiratory distress

•• 2 2 lpmlpm thru nasal thru nasal cannulacannula

–– mild respiratory distressmild respiratory distress•• 5 to 6 5 to 6 lpmlpm thru nasal thru nasal cannulacannula

–– severe respiratory distress, acute congestive severe respiratory distress, acute congestive heart failure, cardiac arrestheart failure, cardiac arrest•• Use a system that provides a high inspired Use a system that provides a high inspired

oxygen concentration (preferably 100%)oxygen concentration (preferably 100%)

–– COPD, who may be dependent on hypoxia COPD, who may be dependent on hypoxia drvendrven ventilationventilation•• Low dose supplemental oxygen via a 24% Low dose supplemental oxygen via a 24% VenturiVenturi

maskmask

–– Most serious casesMost serious cases•• Move quickly to advanced airway devices, Move quickly to advanced airway devices,

intubationintubation and 100% oxygenand 100% oxygen


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•• Devices used to administer supplemental Devices used to administer supplemental oxygenoxygen–– Oxygen supplyOxygen supply–– Nasal Nasal cannulacannula

•• Starting deviceStarting device•• Up to 44% oxygenUp to 44% oxygen

–– 1 L/min: 24%1 L/min: 24% 2 L/min: 28%2 L/min: 28%–– 3 L/min: 32%3 L/min: 32% 4 L/min: 36%4 L/min: 36%–– 5 L/min: 40%5 L/min: 40% 6 L/min: 44%6 L/min: 44%

–– Face maskFace mask–– Up to 60% oxygenUp to 60% oxygen–– 6 to 10 L/min6 to 10 L/min

–– Face mask with oxygen reservoirFace mask with oxygen reservoir••up to 90 up to 90 –– 100 % oxygen100 % oxygen

–– 6 L/min: 60%6 L/min: 60%–– 7 L/min: 70%7 L/min: 70%–– 8 L/min: 80%8 L/min: 80%–– 9 L/min: 90%9 L/min: 90%–– 10 L/min: almost 100%10 L/min: almost 100%

•• for use on patients who:for use on patients who:–– Seriously ill, responsive, spontaneously Seriously ill, responsive, spontaneously

breathing, require high oxygen concentrationbreathing, require high oxygen concentration–– May avoid tracheal May avoid tracheal intubationintubation if acute if acute

interventions produce a rapid clinical effectinterventions produce a rapid clinical effect–– Have relative indications for tracheal Have relative indications for tracheal intubationintubation

but maintain a gag reflexbut maintain a gag reflex–– Have relative indications for Have relative indications for intubationintubation but but

have clenched teeth or other physical barriers have clenched teeth or other physical barriers to immediate to immediate intubationintubation

2. Open the airway: recognize airway 2. Open the airway: recognize airway obstructionobstruction–– Head and Jaw position: Head and Jaw position:

•• Loss of tone in throat muscles (most common)Loss of tone in throat muscles (most common)

–– Basic Opening TechniquesBasic Opening Techniques•• Head tiltHead tilt•• Jaw ThrustJaw Thrust

3. Maintain the open airway using 3. Maintain the open airway using airway adjunctsairway adjuncts–– Assume that obstruction is produced by either Assume that obstruction is produced by either

the tongue or relaxed throat musclesthe tongue or relaxed throat muscles–– Insert an Insert an oropharyngealoropharyngeal or nasopharyngeal or nasopharyngeal

airwayairway

•• Manage foreignManage foreign--body airway obstruction body airway obstruction with the BLS technique of with the BLS technique of subdiaphragmaticsubdiaphragmatic abdominal thrusts and abdominal thrusts and the advanced technique of direct the advanced technique of direct laryngoscopylaryngoscopy

•• Use forceps to grasp and remove the Use forceps to grasp and remove the foreign bodyforeign body


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OROPHARYNGEAL AIRWAYSOROPHARYNGEAL AIRWAYS–– Devices that hold the tongue away from the Devices that hold the tongue away from the

posterior wall of the pharynxposterior wall of the pharynx–– Useful in spontaneous breathers who are Useful in spontaneous breathers who are

unconscious or semiconscious with no cough unconscious or semiconscious with no cough or gag reflexor gag reflex

–– At risk of occluding the airway via tongue and At risk of occluding the airway via tongue and phanryngealphanryngeal relaxationrelaxation

–– Keep the airway open during bagKeep the airway open during bag--mask mask ventilationventilation

–– Helps in mouth suction and prevents occlusion Helps in mouth suction and prevents occlusion of tracheal tubeof tracheal tube

Technique:Technique:•• Clear the mouth and pharynxClear the mouth and pharynx•• Place the airway backwardsPlace the airway backwards•• Rotate the airway 180Rotate the airway 180˚̊ as it passes through as it passes through

the oral cavity and approaches the the oral cavity and approaches the prosteriorprosteriorpharynxpharynx

•• Make sure that you have clear breath sounds Make sure that you have clear breath sounds upon placement of airwayupon placement of airway

•• Maintain proper head positionMaintain proper head position

Hazards:Hazards:•• Long Long oropharyngealoropharyngeal airway may press the airway may press the

epiglottis against the entrance of the epiglottis against the entrance of the larynxlarynx

•• May push the tongue May push the tongue posteriorlyposteriorly•• Prevent trauma: make sure tongue and Prevent trauma: make sure tongue and

lips are note between the airway and lips are note between the airway and teethteeth

•• Should only be used in unconscious or Should only be used in unconscious or semiconscious without cough or gag reflexsemiconscious without cough or gag reflex

NASOPHARYNGEAL AIRWAYSNASOPHARYNGEAL AIRWAYS-- UncuffedUncuffed tubes made of soft rubber or plastictubes made of soft rubber or plastic-- For intoxicated or semiconscious who cannot For intoxicated or semiconscious who cannot

tolerate an tolerate an oropharyngealoropharyngeal airwayairway-- Indicated when the insertion or Indicated when the insertion or oropharyngealoropharyngeal

airway is technically difficult or impossibleairway is technically difficult or impossible

•• TechniqueTechnique•• Proper sized airway is lubricated properlyProper sized airway is lubricated properly•• Inserted close to the midline along the floor of Inserted close to the midline along the floor of

the nostrilthe nostril•• Continue inserting into the posterior pharynx, Continue inserting into the posterior pharynx,

behind the tonguebehind the tongue•• Slight rotation may facilitate insertion if with Slight rotation may facilitate insertion if with

resistanceresistance

•• HazardsHazards•• May enter the May enter the esophagusesophagus•• May precipitate May precipitate laryngospasmlaryngospasm and vomitingand vomiting•• May injure nasal mucosa and cause bleedingMay injure nasal mucosa and cause bleeding•• Maintain proper head positionMaintain proper head position


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PRECAUTIONSPRECAUTIONS–– Always check spontaneous respirations Always check spontaneous respirations

immediately after insertion of airwayimmediately after insertion of airway–– If respirations are absent, start artificial If respirations are absent, start artificial

positive pressure ventilationpositive pressure ventilation–– If adjuncts are unavailable, use mouthIf adjuncts are unavailable, use mouth--toto--

mouth resuscitationmouth resuscitation

4. Ventilate the patient4. Ventilate the patient•• MouthMouth--toto--Mouth and MouthMouth and Mouth--toto--Nose Nose

VentilationVentilation–– Default methodDefault method–– Because a major mistake has been madeBecause a major mistake has been made–– Limitations:Limitations:

•• RescuerRescuer’’s vital capacitys vital capacity•• Reduced concentration of exhaled airReduced concentration of exhaled air

–– Professional rescuers should always have a Professional rescuers should always have a barrier devicebarrier device

•• Mouth to pocket face maskMouth to pocket face mask–– Must be transparentMust be transparent–– Tight fit in faceTight fit in face–– Has an oxygen inletHas an oxygen inlet–– Available in different sizesAvailable in different sizes

–– AdvantageAdvantage•• Effective ventilation and oxygenationEffective ventilation and oxygenation•• EliminateEliminate’’ss direct contactdirect contact•• Possible supplemental oxygenPossible supplemental oxygen•• Eliminates exposure to victimEliminates exposure to victim’’s exhaled gasess exhaled gases•• Easy to teach and learnEasy to teach and learn•• Superior to bag mask techniqueSuperior to bag mask technique

•• SelfSelf--inflating Ventilation Bags: Attached to inflating Ventilation Bags: Attached to Valves, Masks and Other Airway AdjunctsValves, Masks and Other Airway Adjuncts-- Mainstay of emergency ventilationMainstay of emergency ventilation-- Universal connectorsUniversal connectors-- One way valves to protect rescuerOne way valves to protect rescuer-- Oxygen portsOxygen ports-- Medication portsMedication ports-- Suction portsSuction ports-- Ports for quantitative sampling of end tidal Ports for quantitative sampling of end tidal

CO2CO2

•• BagBag--Valve Masks: Adequate Seal and Valve Masks: Adequate Seal and VolumeVolume–– Insert OP airwayInsert OP airway–– Recommended tidal volume: 10 to 15 Recommended tidal volume: 10 to 15 mLmL/kg/kg–– 80 kg man: needs 800 to 1200 80 kg man: needs 800 to 1200 mLmL per per

squeeze of bagsqueeze of bag–– Most bags: 1600 Most bags: 1600 mLmL

–– 1 handed squeeze: 50% of bag (800 1 handed squeeze: 50% of bag (800 mLmL))


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•• Good seal cannot be achieved when there Good seal cannot be achieved when there is only one rescuer using the bagis only one rescuer using the bag--mask mask devicedevice

•• Seal problems do not occur when the bag Seal problems do not occur when the bag is attached to the end of an is attached to the end of an EndotrachealEndotrachealtube or LMAtube or LMA

•• Use a three second ventilation cycleUse a three second ventilation cycle

•• Recommended features of bag masksRecommended features of bag masks–– Self refilling bag that is easily cleaned and Self refilling bag that is easily cleaned and

sterilizedsterilized–– Connections for delivery of high concentration Connections for delivery of high concentration

of oxygenof oxygen–– Capability to perform satisfactorily in all Capability to perform satisfactorily in all

conditionsconditions–– Availability in different sizesAvailability in different sizes–– True non True non rebreathingrebreathing valvevalve

5. Provide adequate ventilation5. Provide adequate ventilation•• Tracheal Tracheal intubationintubation

–– Provides definitive airway managementProvides definitive airway management–– Should be provided by trained personnel as Should be provided by trained personnel as

soon as possiblesoon as possible

•• Tracheal Tracheal intubationintubation::–– Keeps the airway patentKeeps the airway patent–– Ensures delivery of high Ensures delivery of high concentratiojnconcentratiojn of O2of O2–– Ensures delivery of selected tidal volumeEnsures delivery of selected tidal volume–– Isolates and protects the airway from Isolates and protects the airway from

aspirationaspiration–– Permits effective suctioning of tracheaPermits effective suctioning of trachea–– Provides route for administration of other Provides route for administration of other

medicationsmedications

–– Indications:Indications:••Cardiac arrest with ongoing chest Cardiac arrest with ongoing chest

compressionscompressions••Inability of a conscious patient in Inability of a conscious patient in

respiratory compromise to breathe respiratory compromise to breathe adequatelyadequately

•• Inability of the patient to protect the airway Inability of the patient to protect the airway (coma, (coma, areflexiaareflexia, cardiac arrest), cardiac arrest)

•• Inability of the rescuer to ventilate the Inability of the rescuer to ventilate the unresponsive patient with conventional unresponsive patient with conventional methodsmethods

6. Provide definitive airway control6. Provide definitive airway control•• OverviewOverview

-- Prepare for Prepare for intubationintubation with necessary with necessary equipmentequipment

-- Ask second rescuer to apply Ask second rescuer to apply cricoidcricoid pressurepressure-- Prepare tracheal Prepare tracheal intubationintubation-- Inflate cuffInflate cuff-- Attach ventilation bagAttach ventilation bag-- Confirm placementConfirm placement


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•• CricoidCricoid Pressure Pressure ManeuverManeuver–– Why?Why?

••protects against regurgitation of gastric protects against regurgitation of gastric contentscontents

••Helps ensure tube placementHelps ensure tube placement

–– TechniqueTechnique••Find the prominent thyroid cartilageFind the prominent thyroid cartilage••Find the soft depression below the thyroid Find the soft depression below the thyroid

cartilagecartilage••Find the hard prominence just below thatFind the hard prominence just below that••Apply firm pressure while pinching the Apply firm pressure while pinching the

thumb and index finger towards the thumb and index finger towards the victimvictim’’s back and somewhat towards the s back and somewhat towards the headhead

••Release pressure only when proper tube Release pressure only when proper tube placement is confirmed and the cuff is placement is confirmed and the cuff is inflatedinflated

7. Provide primary and secondary 7. Provide primary and secondary confirmation of tracheal tube confirmation of tracheal tube placementplacementPrimaryPrimary-- As the bag is squeezed, listen over the As the bag is squeezed, listen over the

epigastriumepigastrium and observe the chest wall for and observe the chest wall for movement.movement.

-- If you hear stomach gurgling and no chest If you hear stomach gurgling and no chest rise, you have rise, you have intubatedintubated the the esophagusesophagus

-- Stop ventilation and remove tubeStop ventilation and remove tube

–– Reattempt Reattempt intubationintubation after after reoxygenatingreoxygenating the the victimvictim

–– If the chest wall rises and no stomach If the chest wall rises and no stomach gurgling listen to the lung fields with gurgling listen to the lung fields with 5 point 5 point auscultationauscultation and document in medical recordand document in medical record

––Left and right anteriorLeft and right anterior

–– left and right left and right mmiidaxillarydaxillary–– over the stomachover the stomach

–– If there is any doubt, use If there is any doubt, use laryngscopelaryngscope to to directly visualize (tube passing thru vocal cords)directly visualize (tube passing thru vocal cords)

–– Secure the tubeSecure the tube–– Insert OP airwayInsert OP airway–– Look for moisture condensation inside the tubeLook for moisture condensation inside the tube

SecondarySecondary-- Use of variety of electronic and mechanical Use of variety of electronic and mechanical

devicesdevices

How to Ventilate With a Properly Placed How to Ventilate With a Properly Placed Tracheal TubeTracheal Tube–– tidal volume of 10tidal volume of 10--15 15 mLmL/kg/kg–– 1 breath every 5 seconds1 breath every 5 seconds–– 2 seconds for each bag ventilation2 seconds for each bag ventilation–– Ventilate with 100% oxygenVentilate with 100% oxygen–– when O2 saturation measurements are when O2 saturation measurements are

available respond accordingly when there is a available respond accordingly when there is a fall in the O2 saturationfall in the O2 saturation


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•• Unprotected airwayUnprotected airway–– sets of 15 compressions at 100 per minutesets of 15 compressions at 100 per minute–– 2 ventilations at 2 seconds per ventilation2 ventilations at 2 seconds per ventilation

•• Protected airwayProtected airway–– Continuous compression at 100 per minuteContinuous compression at 100 per minute–– Asynchronous with 1 ventilation at 2 seconds Asynchronous with 1 ventilation at 2 seconds

per ventilation every 5 secondsper ventilation every 5 seconds

•• Obtain a chest xObtain a chest x--ray as soon as possible to ray as soon as possible to confirm position of tube within tracheaconfirm position of tube within trachea

•• Never use a chest Never use a chest xrayxray to detect to detect inadvertent inadvertent esophagealesophageal insertion.insertion.

ComplicationsComplicationsInsertion of Tube Into Insertion of Tube Into EsophagusEsophagus

•• Accidental insertion of tube into Accidental insertion of tube into esophagusesophagus will will result in no oxygenation or ventilationresult in no oxygenation or ventilation

Tube Trauma and Adverse EffectsTube Trauma and Adverse Effects•• Lacerated lips or tongueLacerated lips or tongue•• Chipped teethChipped teeth•• Lacerated pharynx or tracheaLacerated pharynx or trachea•• Injury to the vocal cordsInjury to the vocal cords•• PharyngealPharyngeal--esophagealesophageal perforationperforation•• Vomiting and aspiration of the gastric contents into Vomiting and aspiration of the gastric contents into

the lower airwaythe lower airway•• Release of high levels of epinephrine and Release of high levels of epinephrine and

norepinephinenorepinephine

Insertion of Tracheal Tube Into 1 LungInsertion of Tracheal Tube Into 1 Lung•• Hypoxemia due to Hypoxemia due to underinflationunderinflation of 1 lungof 1 lung

Airway Control on Trauma PatientsAirway Control on Trauma Patients•• Assume that the patient with multiple trauma, Assume that the patient with multiple trauma,

head injury or facial trauma has cervical spine head injury or facial trauma has cervical spine injuryinjury

Steps to follow in known or suspected Steps to follow in known or suspected cervical spine traumacervical spine trauma–– Perform chin lift or Jaw thrust without head tiltPerform chin lift or Jaw thrust without head tilt–– Stabilize head in neutral positionStabilize head in neutral position–– OrotrachealOrotracheal intubationintubation in a patient with facial in a patient with facial

fractures and fractures at the base of the skull, fractures and fractures at the base of the skull, another should provide spinal immobilizationanother should provide spinal immobilization

–– Suction upper airwaySuction upper airway–– Consider Consider cricothyrotomycricothyrotomy or or tracheostomytracheostomy–– Use paralytic drugs in patients who cannot be in Use paralytic drugs in patients who cannot be in

patients who cannot be patients who cannot be intubatedintubated with the with the above techniquesabove techniques

Additional Techniques for Invasive Additional Techniques for Invasive Airway Control and VentilationAirway Control and VentilationCricotyrotomyCricotyrotomy–– Allows rapid entrance into the airwayAllows rapid entrance into the airway–– CricothyroidCricothyroid membrane is opened with a membrane is opened with a

scalpel and a tube is insertedscalpel and a tube is inserted


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TracheostomyTracheostomy–– Surgical opening of the trachea and insertion Surgical opening of the trachea and insertion

of of tracheostomytracheostomy tubetube–– Performed under controlled conditions in the Performed under controlled conditions in the

OROR–– Should be performed after the airway has Should be performed after the airway has

been secured by a tracheal tube or been secured by a tracheal tube or cricotyrotomycricotyrotomy

–– Not appropriate for urgent situations (airway Not appropriate for urgent situations (airway obstruction or cardiac arrest)obstruction or cardiac arrest)

ACLS Skill 2:ACLS Skill 2:Recognize the rhythmRecognize the rhythm

•• Ventricular fibrillationVentricular fibrillation•• PulselessPulseless ventricular tachycardiaventricular tachycardia•• PulselessPulseless electrical activityelectrical activity•• asystoleasystole

1.1. Cardiac Arrest (lethal) RhythmsCardiac Arrest (lethal) RhythmsA.A. ShockableShockable rhythms rhythms

a)a) VFVFb)b) pulselesspulseless VTVT

B.B. NonshockableNonshockable rhythmsrhythmsa)a) AsystoleAsystoleb)b) PulselessPulseless electrical activityelectrical activity

-- Includes rhythms that produce electrical activity on Includes rhythms that produce electrical activity on the monitor but no palpable pulsethe monitor but no palpable pulse

-- Electromechanical dissociation, Electromechanical dissociation, bradyasystolicbradyasystolicrhythms, rhythms, pulselessidioventricularpulselessidioventricular rhythmsrhythms

2. Non Cardiac Arrest (2. Non Cardiac Arrest (nonlethalnonlethal) Rhythms) RhythmsA.A. Rhythm too slow ( < 60 Rhythm too slow ( < 60 bpmbpm))B.B. Rhythm too fast ( > 120 Rhythm too fast ( > 120 bpmbpm))

ACLS Skill 3:ACLS Skill 3:DefibrillateDefibrillate

1.1. Turn on defibrillatorTurn on defibrillator2.2. Select energy level at 200 J for Select energy level at 200 J for

monophasicmonophasic defibrillatorsdefibrillators3.3. Set Set ““lead selectlead select”” switch on switch on ““paddlespaddles””4.4. Apple gel or conductor padsApple gel or conductor pads5.5. Position paddlesPosition paddles6.6. Visually check the monitor display and Visually check the monitor display and

assess rhythmassess rhythm

7.7. ““Charging Charging fibrillatorfibrillator –– Stand Clear!Stand Clear!””8.8. Press charge button on apex paddle or Press charge button on apex paddle or

defibrillator controlsdefibrillator controls9.9. When fully charged state firmly:When fully charged state firmly:

a)a) ““II’’m going to shock on three. One, Im going to shock on three. One, I’’m m clear.clear.””

b)b) ““Two, youTwo, you’’re clear.re clear.””c)c) ““Three, everybodyThree, everybody’’s clear.s clear.””

10.10.Apply 25lb of pressure on both paddlesApply 25lb of pressure on both paddles11.11.Press the 2 paddle Press the 2 paddle ““dischargedischarge”” button button

simultaneouslysimultaneously


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12.12.Check the monitorCheck the monitor13.13. Shock at 200 to 300 J, then at 360 JShock at 200 to 300 J, then at 360 J

ACLS Skill ACLS Skill 4:4:CardiovertCardiovert

ACLS Skill 5:ACLS Skill 5:TranscutaneousTranscutaneous PacingPacing

–– Delivers pacing impulses to the heart through Delivers pacing impulses to the heart through the skin via adhesive electrodesthe skin via adhesive electrodes

–– Use of Use of transcutaneoustranscutaneous pacing for pacing for asystoleasystole and and pulselesspulseless electrical activity has been electrical activity has been disappointingdisappointing

ACLS Skill 6:ACLS Skill 6:Gain IV Access to the Gain IV Access to the CirculationCirculation•• Administer drugs and fluidsAdminister drugs and fluids•• Obtain venous blood for laboratory Obtain venous blood for laboratory

determinationsdeterminations•• Insert catheters into the central circulationInsert catheters into the central circulation

•• Peripheral Peripheral venipuncturevenipuncture–– Arm vein (Arm vein (antecubitalantecubital or hand)or hand)–– External jugular veinExternal jugular vein

•• Central Central venipuncturevenipuncture–– Internal jugular veinInternal jugular vein–– SubclavianSubclavian veinvein–– Common femoral veinCommon femoral vein


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•• Peripheral linePeripheral line–– Procedure of choiceProcedure of choice–– Peripheral sites are compressiblePeripheral sites are compressible–– May collapse during low flow statesMay collapse during low flow states

•• Central lineCentral line–– Predictable locationPredictable location–– Allows for the use of large bore cathetersAllows for the use of large bore catheters–– Permits infusion of concentrated solutions Permits infusion of concentrated solutions

(greater flow)(greater flow)–– Damage to surrounding structuresDamage to surrounding structures

•• General PrinciplesGeneral Principles–– Speed is essentialSpeed is essential–– Strict aseptic technique may be impossibleStrict aseptic technique may be impossible–– After patient is stabilized After patient is stabilized cannulacannula should be should be

removed and replacedremoved and replaced–– During cardiac arrest follow all administered During cardiac arrest follow all administered

drugs by bolus administration of at least 20ml drugs by bolus administration of at least 20ml of IV salineof IV saline

ACLS Skill 7:ACLS Skill 7:Provide Appropriate Provide Appropriate Resuscitation MedicationsResuscitation Medications•• Medications are used to meet the following Medications are used to meet the following

major objectivesmajor objectives–– Correct hypoxemiaCorrect hypoxemia–– Restore spontaneous circulation at an adequate blood Restore spontaneous circulation at an adequate blood

pressurepressure–– Promote optimal cardiac functionPromote optimal cardiac function–– Prevent or suppress significant Prevent or suppress significant arrythmiasarrythmias–– Relieve painRelieve pain–– Correct electrolyte abnormalities, adjust acidosis, Correct electrolyte abnormalities, adjust acidosis,

counteract effects of excessive amounts of prescribed counteract effects of excessive amounts of prescribed medications or illegitimate agentsmedications or illegitimate agents

–– Treat congestive heart failureTreat congestive heart failure

SummarySummary

1.1. Airway managementAirway management2.2. Rhythm recognitionRhythm recognition3.3. Defibrillation Defibrillation 4.4. CardioversionCardioversion5.5. TranscutaneousTranscutaneous pacingpacing6.6. Direct circulation access though intravenous Direct circulation access though intravenous

catheterscatheters7.7. Administration of appropriate resuscitation Administration of appropriate resuscitation

medicationsmedications

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