Basic Life Support (BLS) in Adults

Basic Life Support (BLS) in Adults

• The information provided is a compilation from academic texts.
• It is not intended to replace any existing guidelines.
• This information is solely for academic purposes.

Guidelines Review

• Every give years, experts from the American Heart Association (AHA) and the European Resuscitation Council (ERC) systematically review and update resuscitation protocols based on scientific evidence.
• These revisions may include modifying, adding, or removing procedures for patients in cardiorespiratory arrest.
• The latest review and publication of resuscitation guidelines occurred in October of the previous year.
• This study guide references both the AHA's basic life support chapter and the ERC chapter.

Chain of Survival

• The chain of survival diagrams the steps that must be enacted in order to save a patient having a cardiorespiratory arrest (PCR).
• CPR may be necessary within a hospital setting or an out-of-hospital setting.
• For out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), the AHA has established varying survival chains due to protocol differences.

Out-of-Hospital Cardiac Arrest (OHCA)

• Those experiencing an OHCA depend on the initial assistance provided.
• It is critical to realize the state of cardiac arrest and activate emergency services.
• Cardiopulmonary resuscitation (CPR) alongside prompt defibrillation raises the chance of survival by 50% to 70% if performed in the first five minutes.
• Following initial procedures, medical services professionals must transport the patient to hospital facilities to receive post-arrest treatment.

In-Hospital Cardiac Arrest (IHCA)

• Patients who are in a hospital environment have surveillance and early warning systems that can forestall cardiac arrest.
• Interdisciplinary communication is necessary to provide effective and timely care when one goes into cardiac arrest.

Recognizing Cardiorespiratory Arrest

• The recommended sequence of recognizing such an arrest is to physically contact the patient while speaking to them.
• Determining proper breathing from agonizing or gasping breaths is essential.
• These sounds might be similar to moans or snores, however, they are commonly present within minutes of PCR
• It's imperative that these instances be recognized as indications for further and immediate action.
• Checking for respiration should entail looking for thoracic enlargement.
• No breathing indicates no breathing effort.
• Lay rescuers are not required to verify vitals, but signs of life.
• Qualified individuals should examine the carotid pulse for a max of 10 seconds.
• If there exists no response, no respiration, or any of the symptoms discussed, it can be concluded that the patient is suffering from a cardiac arrest.

OHCA Protocol

• The first responder must ensure the well-being of the scene.
• The patient must then be evaluated, checking for respitatory response and pulse.
• If they are unresponsive, not breathing, or have a non-palpable carotid pulse, then they must contact emergency services and have the AED retrieved.
• In Medellin, one must contact 123 and request an ambulance while sharing one's location.
• One should preferably be near the patient and use a mobile device, starting RCCP maneuvers until the AED or ambulance arrives.
• CAB pneumonic strategies need to be used to initiate chest compressions.
• Perform 30 chest compressions in the middle of the chest, alongside opening an airway.
• Be mindful of the clinical context, or administer two ventilations

Compressions-Ventilations

• Compressions should occur 30 to every two ventilations for two minutes, complete five cycles.
• Another type of ventilation would be asynchronous, using a BVM ventilator to deliver one breath every 6 seconds.
• 100-120 compressions should be administered a minute.

Clinical Context

• Ischemic cardiopathy is the most typical cause of such an attack being found in a patient suffering from a cardiac arrest
• Minimize the time until initial compression is provided.

SEM Notification (Emergency Medical Service)

• Managing cardiovascular events is a major public health and depends on rapid recognition and handling.
• Expert personnel that can perform prehospital and hospital management with appropriately trained personnel is required.
• Medical care requires technological and human resources, integrated with protocols that effectively delivers safe care to patients.
• The Medical Emergency System (SEM) is a chain that integrates all emergency resources from beginning to end to care of patients suffering from disease, arrest and traumas.
• Local law states regulations for emergency development and operation in Law 0926 of 2017, with the Emergency Regulation Center prioritizing conditions: cerebrovascular attacks, acute myocardial infractions, trauma and maternal support.

PCIH Protocol

• In an intra-hospital environment, a patient that does not respond, experiences abnormal respiration or lacks a carotid pulse receives a 'code blue'.
• A 'code blue' is an alerting system signifying that a patient is undergoing a cardiorespiratory arrest and indicating the immediate movement of resuscitation teams to the patient's location.
• Following confirmation, a patient is transferred to a trauma room with a manual defibrillator.
• The team must be well prepared and have well established roles to limit errors with assistance to the patient.
• It is generally comprised of six people, but personnel may have several responsibilities when required
• The leader directs procedures correctly.
• The air passage assistant ensures air provision and ventilation.
• The massage assistant needs to provide appropriate compressions.
• The medication assistant conducts fluids requested.
• The circulating assistant connects electrodes and provides equipment.
• The clinical history assistant takes record of various procedures during resuscitation.

Carotid Pulse Technique

• When checking for one in adults, the trachea must be located with two or three fingers, sliding towards the neck to palpitate the carotid artery.
• Trained personal should take a measurement for ten seconds.
• When giving thoracic compressions to an adult, it is to pump blood to the body, especially to the brain.
• The patient must lay upward on a solid surface to facilitate better compressions.
• The reanimator must utilize the palm of their dominant hand to the middle of the chest and bottom portion of the sternum, and another palm overtop while interlacing them.
• Limbs need to be widened and shoulders need to be in a straight line with hands, compressing in a fast and hard manner.
• Compressions must reach between 100 and 120 per minute with a minimum of 5cm and up to 6cm of chest depth.
• The chest should gradually expand to refill with blood if performed adequately.
• Each 30 compressions should be followed by two ventilations to guarantee elevation.
• The reanimator can take two minute relief periods when applying chest compressions.

Maneuvers for Air Passage

• There are two types of maneuvers to do prior to doing ventilations.
• Subluxation/mandibular traction is ideal to reduce the movements of the neck and head.
• The other one is the extension of the head and lifting of the tip of the head and using it to curve the head back.
• The other hand should then be used to pull the bottom jaw.
• When performing the maneuver to relocate the jaw, one needs to position fingers below the bottom part and lift until the air passage is unlifted.
• Using two reanimators is recommended to perform two ventilations: one supports the jaw while the other facilitates breaths.

Mouth-to-Mouth Ventilation in Adults

• Mouth to mouth ventilations should be done when one lacks certain devices as barriers.
• The reanimator should close the nose, and give approximately 1 second of air, observing the chest.
• This is followed up by another ventilation.
• In a situation when the person is not able to assist ventilations, compression must be repeated for two minutes until assistance or DEA arrives.

Barrier Ventilation Device

• A face mask and a bag value mask (BVM) is required for these situations.
• It is obligatory to follow safety standards to prevent possible infection by all personnel assisting resuscitation.
• When using a facial mask, the facilitator must then proceed with administering the ventilations and performing compressions from the same position as shown.
• The reanimator must ensure the mask is tight against the patients face as they deliver breaths or compressions at a ratio of 30:2 seconds.
• To correct apply the BVM the facilitator needs to stand at the patients head and utilize CE clutching, squeezing the BVM with a one second interval between each chest rise.

Reanimation Guideline with COVID-19 during the pandemic

• Personal protective equipment should be implemented during situations such as a CPR.
• Cover the mouth and only make hand gestures.
• Minimize the surrounding personnel during these instances.
• First reanimator activating the system.
• the compressor fulfilling frequency parameters, minimizing disturbance and enabling expansion.
• the other to provide permeability of the airway.
• The teams must be in constant communication with each other.

Adults and AED's

• The window of time the patient is suffering from the collapse has significant impact on his revival and restoration.
• Each minute without defibrillator used can decrease restoration by 8 - 10%.
• Ventricular fibrillation is when the muscle contracts in a spasming manner, preventing blood flow.
• defibrillators are responsible for resetting this.

DEA Usage

• They must be operated by the second reanimator.
• the apparatus must be switched on
• The DEA can be adjected to the body, with one pad above the chest clavicle, and another under the arm.
• Other people have to be cleared away and not touching the defibrillator.
• if the system allows it, deliver and analyze the required shock.
• Then resume the the reanimation.
• Do the cycles 4 to 5 times.

Considerations

• It must properly contact the skin.
• Hair can be shaved appropriately.
• Water must be removed to prevent conductivity.
• Transdermal patches interfere with electricity.
• Defibrillators interfere with patches.

Airway Obstruction

• Rapid ID signs are needed; more often than not, patients tend to exhibit a universal sign of discomfort.
• Other examples can include wheezing but ultimately speaking and effectiveness of a potential cough.

Heimlich

1. Person must position behind patient.
2. Then the leg should be placed between the two with support.
3. Position the thumb, compressing until consciousness.
4. The individual must be under medical checkups.