TEACHING BASIC LIFE SUPPORT

(& ALS)

Anton Koželj, R.N., B. Sc.,

lecturer

Faculty of Health Sciences,

University of Maribor

Žitna ulica 15, 2000 Maribor,

Slovenia

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Fact´s

To know-how to perform basic life support can

save a life’s !!

As a health care workers we should know how,

and be able to implement this knowledge in

real situation.

(Without excuse !?)

How do we really know perform CPR?

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Students of Faculty of Health Sciences, should get

good knowledge, during the study, and as soon

as possible.

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For that reason all our students have course to

learn how to perform CPR (BLS) in first year of

study.

They have additional, extensive class in last year (BLS,

ALS, ATLS, APLS).

General idea is, that all health care workers should

have courses to refresh their knowledge every year.

Can this be achieved?

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Because of all this facts Faculty of Health Sciences,

University of Maribor assure funds and open

contemporary Simulation centre:

Field of education:

• emergency medicine, (trauma, surgery

emergency, paediatric emergency, intensive

medicine and nursing, etc.)

• anaesthesia,

• reanimathology.

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General idea: to get knowledge, perform skill’s

and go to the patience prepared (100 %).

• Tell me and I forget

• Show me and I remember

• Involve me and I understand.

(Confucius )

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Cardiac Arrest

Precordial Thump if appropriate

BLS if appropriate

Attach Defib-Monitor

Assess

Rhythm

+/- Check Pulse VF/VT Non-VF/VT

1 Shock

150-360 J biphasic

or 360 J monophasic

Immediately resume

CPR 30:2

for 2 min

Immediately resume

CPR 30:2

for 2 min

During CPR:

Correct reversible causes

Check electrode position and

contact

Attempt / verify:

IV access

airway and oxygen

Give uninterrupted

compressions when airway secure

Give adrenaline every 3-5 min

Consider: amiodarone, atropine,

Potential reversible causes:

•Hypoxia Tension pneumothorax

•Hypovolaemia Tamponade

•Hypo/hyperkalaemia & metabolic disorders Toxic/therapeutic disorders

•Hypothermia Thrombo-embolic & mechanical

obstruction

Universal ALS

Algorithm

r: ERC

Open Airway

Look for signs of life

Call for help

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Airway, ventilation and chest compression

• Secure airway:

tracheal tube

LMA

Combitube

• Once airway secured, do not interrupt chest

compressions for ventilation

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Recognising the sick patient and

preventing cardiac arrest

Objectives:

To understand:

• The causes of cardiorespiratory arrest in adults

• How to identify patients at risk

• The role of a Medical Emergency Team

• The initial management of patients at risk of a

cardiorespiratory arrest

r: ERC

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• Most arrests are predictable

• Deterioration prior to

50 - 80% of cardiac arrests

• Hypoxia and hypotension are common

antecedents

• Delays in referral to higher levels of care

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Recognition of critically ill patients

Modified Early Warning System (MEWS)

U P V A CNS

> 37.5 36.6-37.4 35.1-36.5 < 35 Temp °C

> 30 21-29 15-20 9 -14 < 8 Respiratory

Rate

> 200 101-199 81-100 71-80 < 70 Systolic BP mmHg

> 130 111-130 101-110 51-100 41-50 < 40 Pulse

3 2 1 0 1 2 3

Track score - a score of > 4 triggers a review by doctor

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Medical Emergency Team (MET)

Calling Criteria

1. Airway –threatened:

2. Breathing:

- Respiratory arrest

- RR < 5 or RR >36

3. Circulation:

- cardiac arrest

- pulse < 40 or >140

- systolic BP < 90 mmHg

4. Neurology:

- sudden fall in GCS > 2

- (AVPU is P od U)

5. Any other worries

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The ABCDE approach to the

critically ill patient

A…airway

B…breathing

C…circulation

D…disability

E…exposure

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• Complete initial assessment

• Treat life-threatening problems

• Reassessment

• Assess effects of treatment/ interventions

• Call for help early e.g. Medical Emergency Team

• Personal safety

• Patient responsiveness

• Vital signs pulse, respiratory rate, BP, SpO2, ECG, temperature

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ABCDE approach

Airway

Recognition of airway obstruction

• Talking

• Difficulty breathing, distressed, choking

• Shortness of breath

• Noisy breathing stridor, wheeze, gurgling

• See-saw respiratory pattern, accessory muscles

Treatment of airway obstruction

• Airway opening

- i.e. head tilt, chin lift, jaw thrust

• Simple adjuncts • Advanced techniques

- e.g. LMA, tracheal tube

• Oxygen

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ABCDE approach

Breathing

Recognition of breathing problems

• Look respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity,

conscious level

• Listen noisy breathing, breath sounds

• Feel expansion, percussion, tracheal position

Treatment of breathing problems

• Airway

• Oxygen

• Treat underlying cause

- e.g. drain pneumothorax

• Support breathing if inadequate - e.g. ventilate with bag mask

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ABCDE approach

Circulation

Recognition of circulation problems

• Look at the patient

• Pulse – tachycardia, bradycardia

• Peripheral perfusion - capillary refill time

• Blood pressure

• Organ perfusion chest pain, mental state, urine output

• Bleeding, fluid losses

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Treatment of problems

• Airway, Breathing

• Oxygen

• IV access, take bloods

• Treat cause

• Fluid

• Haemodynamic monitoring

• Inotropes/vasopressors

• Oxygen/Aspirin/Nitrates/ Morphine for ACS

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ABCDE approach

Disability

• Recognition – AVPU or GCS, and pupils (P = GCS 8)

• Treatment - ABC

• Treat underlying cause

• Blood glucose

if < 3 mmol l-1 give glucose

• Consider lateral position

• Check drug chart

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ABCDE approach

Exposure

• Remove clothes to enable examination

- e.g. injuries, bleeding, rashes

• Avoid heat loss

• Maintain dignity

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DEFIBRILLATION

Early defibrillation !!

Why? Delay each minute: reduction of chances for 7-10%

Heart conduct system

ECG

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DEFIBRILLATION

• Shockable: (VF)

• Bizarre irregular waveform

• No recognisable QRS complexes

• Random frequency and amplitude

• Uncoordinated electrical activity

• Monomorphic: VT(no pulse) broad complex rhythm

rapid rate

constant QRS morphology

• Polymorphic VT

torsade de pointes (low potassium )

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VF/VT

1. Defibrilacija 150 – 200 –360J

2 min CPR 30: 2

2. Defibrilacija 200 – 360 J

VF/VT

2 min CPR 30: 2

VF/VT

3. Defibrilacija 200 – 360 J

Adrenalin 1 mg +

Amiodarone 300 mg

2 min CPR 30: 2

VF/VT

Amiodaron 300 mg

4. Defibrilacija 200 – 360 J

2 min CPR 30: 2

VF/VT

5. Defibrilacija 200 – 360 J

Adrenalin 1 mg +

Amiodarone 150 mg

2 min CPR 30: 2

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Non-shockable:

• Asystole

• EMD

Clinical / cardiac arrest

TH: Adrenaline 1 mg IV every 3-5 min

Atropine 3 mg if PEA with rate < 60 min-1

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PEA/asistolija

2min CPR 30:2

Adrenalin 1 mg + Atropin 3 mg / not in protocol any more

PEA/asistolija

2min CPR 30:2

PEA/asistolija

Adrenalin 1 mg

2min CPR 30:2

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Use of AED

What is AED?

When to use it?

Who should us it?

How to use it??

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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

Attach AED

Follow voice prompts

r: ERC

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This is not OK !!

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Summary

• Cardiovascular disease remains a major cause of cardiac arrest in adults

• Earlier recognition of patients ‘at risk’ may reduce the number of

cardiac arrests

• The ALS course teaches a standardised approach using several educational formats and assessment tools

(by patronage ERC)

Health care workers (starting with students) should know what to do and how to help !

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Conclusion

It is necessarily for health worker to know how to perform CPR because we are obligate to perform this procedure then they are needed.

(legal and moral obligation).

Our student are very satisfied with course in the first year and object in the last year.

(They estimate this topics as a indispensable knowledge)

We had course for all our teachers. (They share the same opinion as a students, and they express the need to have refreshing course every

year. )

Personally I totally agree, and I am happy that I can teach this topic,

that we have good conditions to teach and transmit my theoretically and practically knowledge to students and my

colleague.

r: ERC

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No need for CPR, just resting. But thanks for your care…!!!