Bls & als rs mehta

Basic Life Support for Adults

Prof. Dr. Ram Sharan Mehta, MSND, CON

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OBJECTIVES

Participants should be able to demonstrate:

– How to assess the collapsed victim– How to perform chest compression and

rescue breathing– How to place an unconscious breathing

victim in the recovery position.

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HOW MANY TIMES DOES THE HUMAN HEART BEAT IN A DAY ?

1,00,800 beats per day

(70 beats x 60 minutes x 24 hours = 1,00,800 beats)

BRAIN TISSUE = ?HEART TISSUE =?KIDNEY TISSUE=?

CPR=CPCR CARDIO PULMONARY CEREBRAL RESUSCITATION

Death of Tissue after cutoff oxygen

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BLS ALS: steps

ABCD

DEFGHI

DEFINITIONS

CARDIAC ARREST: Abrupt cessation of cardiac pump function which may be reversible by a rapid intervention but will lead to death in its absence.

DEATH: Irreversible cessation of all biologic functions

Introduction:

Lack of resuscitation skills of nurses and doctors in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims.

The hypothesis was that nurses’ knowledge on BLS and ALS would be related to their professional background as well as their resuscitation training.

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Introduction...

Approximately 700,000 cardiac arrests per year in Europe

Survival to hospital discharge presently approximately 5-10%

Bystander CPR vital intervention before arrival of emergency services – double or triple survival from sudden cardiac arrest (SCA).

Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

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CHAIN OF SURVIVAL

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BASIC LIFE SUPPORT

Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest

Chest compressions and pulmonary ventilation performed by anyone who knows how to do it, anywhere, immediately, without any other equipment

Protective devices

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BLS Its Cardiopulmonary Resuscitation (CPR).Combines rescue breathing and chest

compressionsRevives heart (cardio) and lung

(pulmonary) functioning– Use when there is no breathing and no pulse

Provides O2 to the brain until ACLS arrives

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How CPR Works

Effective CPR provides 1/4 to 1/3 normal blood flow

Rescue breaths contain 16% oxygen (exhaled).

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Start CPR Immediately

Better chance of survivalBrain damage starts in 4-6

minutesBrain damage is certain after

10 minutes without CPR

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Do Not Move the Victim Until CPR is Given and Qualified Help Arrives…

unless the scene dictates otherwise– threat of fire or explosion– victim must be on a hard surface– Place victim level or head slightly

lower than body

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Even With Successful CPR, Most Won’t Survive Without ACLS

ACLS (Advanced Cardiac Life Support)

ACLS includes defibrillation, oxygen, drug therapy

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BLS = CPR = ABC?

Basic Life Support (BLS)ABCs - Airway, Breathing, Circulation

Steps to follow in BLS– Approach Safely– 1. Check the responsiveness of the victim– 2. Call for Help– 3. Position victim on his or her back– 4. Open the airway– 5. Assess breathing– 6. Assess circulation– 7. Stay with the victim until help arrives.

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Details of the Steps:

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APPROACH SAFELY!

Scene

Rescuer

Victim

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CHECK RESPONSE

– Shake shoulders gently

– Ask “Are you all right?”

– If he responds

• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

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SHOUT FOR HELP

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Open the airway with the head tilt-chin lift method to check for

breathing.

Check for Breathing

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OPEN AIRWAY

Head tilt and chin lift- lay rescuers- non-healthcare

rescuers

No need for finger sweep unless solid material can be

seen in the airway

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Look, listen and feel for breathing for not over 10 seconds.

Check for Breathing

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OPEN AIRWAY

Head tilt, chin lift + jaw thrust- healthcare professionals

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Head Tilt–Chin Lift Maneuver

Step 1 Step 2

Step 3 Step 4

Jaw-Thrust Maneuver

Step 1 Step 2

Step 3

Use a barrier device of some type while giving breaths.

Giving Breaths

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Give 2 breaths, each for about 1 second, watching the chest rise

and fall.

Giving Breaths

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RESCUE BREATHS

Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat

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RESCUE BREATHS

RECOMMENDATIONS:- Tidal volume 500 – 600 ml

- Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise

- Chest-compression-only

continuously at a rate of 100 min 31

Pocket mask vs bag-valve mask

•Easy to use and easily available

•One way valve

•Can give O2 up to 50%

Pocket mask

•Takes more skill and requires 2 people in most cases

•Can give O2 up to 85%

Bag-valve Mask

Give 30 chest compressions, hard and fast, positioning hand midway between breasts.

Giving Chest Compressions

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Use cycles of 2 breaths and 30 compressions.

Cycles of Breaths/Compressions

2 breaths + 30 compressions

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• Place the heel of one hand in the centre of the chest

• Place other hand on top • Interlock fingers• Compress the chest

– Rate 100 min-1

– Depth 4-5 cm– Equal compression : relaxation

• When possible change CPR operator every 2 min

CHEST COMPRESSIONS

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CONTINUE CPR

30 2

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DEFIBRILLATION

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Date

East of England Ambulance ServiceNHS Trust

BLS & AED

12/02/201538

Understanding Defibrillation

The heart’s pumping action controlled by electrical system

Electrical rhythm normally very organized

Normal heart’s rhythm is called “Sinus Rhythm”

Normal heart rate of 60 - 100 beats per minute

Sinus Rhythm

Date


BLS & AED

12/02/201539

Understanding Defibrillation:Ventricular Fibrillation (VF)

VF is the most common rhythm in Sudden Cardiac Arrest (90%)

Electrical Problem in Nature

Chaotic rhythm results in “quivering of heart” and results in loss of pulse

VF will result in brain damage within 5 minutes and death in 10-15 minutes

Date


BLS & AED

12/02/201540

Understanding Defibrillation Defibrillation may correct VF Uses DC current delivered

across the heart A successful defibrillation

“depolarizes” the heart’s cells

Depolarization allows the cells to “reorganize”

Defibrillation is the ONLY effective cure for VF!

DC Shock: Joules

AED OR Defibrillation Machine

150-360 Joules: Monophasic 150-270 Joules: Biphasic

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Use the AED as soon as it is available and ready to use.

Use of an AED

Automated External Defibrillator42

Follow the AED prompts to give a shock, then give CPR again

while the AED is analyzing the victim’s rhythm.

Using AED and CPR

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First turn it on.

Then simply follow instructions.

Using an AED

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AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

Some AEDs will automatically switch themselves on when the lid is opened

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ATTACH PADS TO CASUALTY’S BARE CHEST

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ANALYSING RHYTHM DO NOT TOUCH VICTIM

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SHOCK INDICATED

Stand clear Deliver shock

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SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

30 249

NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS

30 250

IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

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DEFIBRILLATION SAFETY !

THE PATIENT. 5 point check Pacemaker Jewellery Hair on chest Damp/Wet skin Patches (GTN)

THE AED. In good working order Do Not use in Heavy

rain Do Not use if they lay in

a pool of water Do Not use in an

explosive environment !

If the victim responds, position him in the recovery position and monitor breathing until help

arrives.

The Recovery Position

Infant Recovery Position54

http://upload.wikimedia.org/wikipedia/commons/3/34/Recovery_position.jpg

Complications of CPR

Skeletal injuries especially rib# Visceral injuries- myocardial and pulmonary

contusions, blood in pericardial sac, pneumothorax, liver and spleen rupture, gastric perforation

Airway injuries- tracheal & laryngeal injuries Skin and integument damage

Immediately after CPR…

Laryngoscopy; 100% oxygenUrinary catheterNG tubeestablish or verify existing intravenous

access; start with NSTransfer to a special care unit for

continuous monitoring and therapy.

After CPR…

Complete exam including– serial vitals– urine output– 12-lead ECG– Chest x-ray

– Blood glucose– Serum urea,

creatinine– serum electrolytes

(+Mg++ and Ca++)– Cardiac markers

Atropine, Adrenaline, CaCl2, Digoxin

Atropine: 5 amp (3 mg) single bolus dose to increase heart rate

Adrenaline: 1 ml=1mg, 1amp=1:1000 dilution, 1gm=1000mg, 1000mg=1000ml 1mg every 2-3 min till B P is maintained

Cacl 2= 5-10 mmol Digoxin = 0.5 mg stat then 0.25 mg 6hrly

Factors contributing to cardiac arrest or complicating resuscitation or post-resuscitation care

H’s

Hypovolemia Hypoxia H+ (acidosis) hyper-/hypokalemia Hypoglycemia hypothermia

T’s

Toxins tamponade (cardiac) tension pneumothorax thrombosis of coronary or

pulmonary vasculature trauma

Prognosis

5 clinical signs strongly predicting death or poor neurological outcome:

No corneal reflex at 24 hours

No pupillary response at 24 hours

No withdrawal response to pain at 24hours

No motor response at 24 hours

No motor response at 72 hours

Stroke (first 2 hours are critical)Asthma (check for inhalers)Fainting (look for injuries from fall)Seizures (check for medication)Diabetic emergencies ChockingPoisoning

First Aid Management for Common Problems:

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CONTINUE RESUSCITATION UNTIL

– Qualified help arrives and takes over– Victim revives: The victim starts

breathing normally– Rescuer becomes exhausted– Cardiac arrest of longer than 30 minutes

(controversial)

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Summary

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Next Session: ALS

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Circulation by cardiac compression Airway management by equipments Breathing by advanced techniques Defibrillation by manual defibrillator Drugs.

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ALS includes:

ALS ALGORITHM

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Thank you

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The woods are lovely dark and deep but, I have promises to keep and miles to go before I sleep and miles to go before I sleep

-Robert Frost

Bls & als rs mehta

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