BLS Lecture 1 Stage Nsg PDF

by: Maisam Hama Murad Majeed M.Sc. In Adult Nursing  What does this course teach? After successfully completing the BLS , you should be able to: Describe the importance of high-quality CPR and its impact on survival Elements of the Chains of Survival Recognize the...

by: Maisam Hama Murad Majeed M.Sc. In Adult Nursing  What does this course teach? After successfully completing the BLS , you should be able to: Describe the importance of high-quality CPR and its impact on survival Elements of the Chains of Survival Recognize the signs of someone needing CPR Perform high-quality CPR for an adult, a child, and an infant Describe the importance of early use of an automated external defibrillator (AED) Demonstrate the appropriate use of an AED Provide effective ventilation by using a barrier device 2 Keys for BLS: ► Quickly start the Chain of Survival. ► Deliver high-quality chest compressions to circulate oxygen to the brain and vital organs. ► Know when and how to use an Automated External Defibrillator (AED). ► Provide rescue breathing. ► Understand how to work with other rescuers as part of a team. 3  Basic Life Support ► Basic life support is a level of medical care which is used for patients with life-threatening illnesses or injuries(NO PULSE,NO BREATHING) until full medical care can be given by medical teams ► Basic Life Support (BLS) refers to a set of procedures that can be learnt to prolong survival in life-threatening situations, until more professional help is available. ► Providing cardio pulmonary resuscitation (CPR) until specialized advanced care providers arrive. 4  What are Life-Threatening Events? 1. Cardiac arrest: Cardiac arrest is defined as an abrupt cessation of heart function. Basically, in cardiac arrest, the heart stops beating. This means that ability to pump blood – both to the lungs, and to the rest of the body, is lost. 5  What are Life-Threatening Events? 2. Respiratory arrest: Respiratory arrest is a condition where the lungs shut down, cutting off the ability to breathe. In most cases, this occurs after cardiac arrest, because blood fails to reach the lungs for the oxygenation process. This can occur due to nerve or neuromuscular disorders, and drugs that inhibit respiratory drive (e.g., Opioids). It can also occur secondary to trauma, which may produce a crush injury to chest or cause upper or lower airway obstruction. 3. Airway obstruction: This condition is closely related to respiratory arrest. in airway obstruction, there is an anatomical (or physical) obstruction to the flow of air. This could be at any level from the nose, pharynx, larynx, or lower air passages. 6  Chain of survival The chain of survival shows the actions that must take place to give the cardiac arrest victim the best chance of survival. Each link is independent, yet connected, to the links before and after, if any link is broken, the chance for a good outcome decreases Actions in the Chain of Survival differ according to setting (in-hospital vs out-of-hospital) and age group. Here are the specific Chains of Survival : Pediatric in-hospital cardiac arrest Pediatric out-of-hospital cardiac arrest Adult in-hospital cardiac arrest 7 Adult out-of-hospital cardiac arrest  Chain of Survival Elements ▪ Although there are slight differences in the Chains of Survival based on the age of the victim and the location of the cardiac arrest, each includes the following elements: 1. Prevention and preparedness 2. Activating the emergency response system 3. High-quality CPR, including early defibrillation 4. Advanced resuscitation interventions 5. Post-cardiac arrest care 6. Recovery 8 AHA Chains of Survival for adult IHCA and OHCA. 9  AHA Chains of Survival for pediatric IHCA and OHCA. IHCA OHCA 10  Key Differences in Adult and Pediatric Chains of Survival ► In adults, cardiac arrest is often sudden and frequently results from a cardiac cause. In children, however, cardiac arrest is often secondary to respiratory failure or shock. Both respiratory failure and shock can be life-threatening. ► Prevention of cardiac arrest is the first link in the pediatric Chains of Survival. Early identification of respiratory or circulatory problems and appropriate treatment may prevent progression to cardiac arrest. Early identification also may maximize survival. ► Emergencies in children and infants are not usually caused by the heart. Children and infants most often have breathing problems that trigger cardiac arrest. The first and most important step of the Pediatric Chain of Survival is prevention 11 BLS for adult 12  Basic framework for CPR ► Anyone can be a lifesaving rescuer for a cardiac arrest victim. ► The particular CPR skills a rescuer uses depend on several variables, such as level of training, experience, and confidence Other variables are the type of victim (child vs adult), available equipment, and other rescuers. 1. A single rescuer with limited or no training or who has training but limited equipment can do Hands-Only CPR. 2. A rescuer with more training can do 30:2 CPR. 3. When several rescuers are present, they can perform multirescuer-coordinated CPR. 13 BLS for adult ► The main components of CPR are: C = Chest compression A = Airway B = Breathing 14 Assess for breathing and pulse To minimize delay in CPR, Check for breathing and a pulse at the same time, this should take at least 5 seconds but no more than 10 seconds Breathing: scan the victim’s chest for rise and fall Pulse: to perform a pulse on an adult, check for a carotid pulse (in case not definitely feel a pulse within 10 seconds, begin high quality CPR, starting with chest compression) 15 carotid pulse checking►►  chest compression high quality chest compression When a victim is not breathing normally or is only gasping and has no pulse, begin CPR, starting with chest compressions. The foundation of CPR is high quality chest compression: Position victim: position the victim face up on a firm, flat surface. Compression to Ventilation Ratio: 30 compressions: 2 rescue breaths Compression rate: Chest compressions are 100 to 120 per minute. Compression depth: Compression depth should be at least 2 inches in adults (5cm) Allow complete chest recoil (re-expansion of the chest): allows blood to flow into the heart minimize interruptions: less than 10 seconds (Switch compression team members every 2 minutes) 16  chest compression technique ► Stand or kneel by the side of the patient, bending slightly forward as comfortable. ► Place the heel of one hand (usually the non-dominant hand) ► firmly on the lower part of the breastbone (the xiphisternum). ► Place the heel of the other hand (usually the dominant hand) over the first hand ► Ensure that your arms are straight, and position your shoulders directly over the heels of your hands, so that you are kneeling or standing ‘over’ 17 the patient chest compression technique 18 chest compression technique correct position of rescuer 19  chest compression technique ► To give a compression, press directly down on the patient's breastbone, trying to achieve a depth of at least 5cm. Extend your hands straight and position shoulders over the hands►► ► Compression of the chest more than 6 cm(2.4inch)in adult may decrease effectiveness of compression and cause injury Depth of each compression►► 20  chest compression technique ► Ensure that the chest recoils completely before you begin the next compression. The chest must recoil after each compression► Recoil allows the heart to fill with blood between each compression.►► 21  Alternate technique chest compression ► If you have difficulty pushing deeply during compressions, do the following: 1. Put one hand on the breastbone to push on the chest. 2. Grasp the wrist of that hand with your other hand to support the first hand as you push down on the chest ► This technique May Be helpful for rescuers with joint conditions such as arthritis (joint pain and stiffness) 22  compression for a pregnant woman ► Do not delay providing chest compression for a pregnant woman in cardiac arrest high quality CPR including respiratory support and early medical intervention can increase the mothers and the infants chance of survival. ► Before chest compression should be perform LUD (lateral uterine displacement) by experienced rescuers (the uterus compresses the large blood vessels in the abdomen) ► LUD is manually moving the uterus to the patient left to relieve to the pressure on the large blood vessels) 23  Manual LUD during CPR. 1 handed technique 2 handed technique 24  MANAGEMENT OF THE AIRWAY AND RESCUE Head BREATHING Tilt – Chin Lift maneuver Jaw Thrust maneuver When performing a head tilt-chin lift, make certain that you: When the head tilt-chin lift doesn’t work or when you suspect a spinal injury, use the jaw Avoid pressing deeply into the soft tissue under the chin because this might block the airway thrust maneuver Do not close victims mouth completely 25  Jaw Thrust maneuver ► Follow these steps to perform a jaw thrust: 1. Position yourself at the victim's head. 2. Place one hand on each side of the victim's head. You may rest your elbows on the surface where the victim is lying. 3. Place your fingers under the angle of the victim's lower jaw and lift with both hands, displacing the jaw forward 4. If the victim's lips close, push the lower lip with your thumbs to open the lips. ❖If the jaw thrust does not open the airway, use a head tilt-chin 26 lift jaw thrust maneuver 27 Barrier Devices for giving breaths Pocket masks Face shield 28  Pocket masks ► This is a pear-shaped mask which can be placed directly over the patient’s nose and mouth to achieve a tight seal. ► For mouth-to-mask breaths, use a pocket mask. it usually have a 1-way valve that diverts exhaled air, blood, or bodily fluids away from the rescuer. The 1-way valve allows the rescuer's breath to enter the victim's mouth and nose and diverts the victim's exhaled air away from the rescuer. ► The American Heart Association believes that these are more 29 protective than face shields.  Bag-Mask Devices ► A bag-mask device (also known as an ambu-bag) is a device that delivers air under positive pressure into the lungs. ► If available, it must be preferred over mouth-to-mouth resuscitation. ► The bag-mask device delivers 21% oxygen, which is the normal oxygen level in room air. This is higher than 17% oxygen found in exhaled air and may be more beneficial to the patient. ► The name “Ambu” is an acronym for “artificial manual breathing 30 unit,”  Bag-Mask Devices ► All BLS providers should be able to use bag mask device, proficiency in this ventilation technique requires practice E-C technique of holding the mask 2 rescuers bag mask ventilation while lifting the jaw (single 31 rescuer) Bag-Mask Devices Proper area of the face for face mask application 32  RESCUE BREATHING ► If barrier device is not available, pinch the nose closed with one hand, and place your mouth firmly on the patient’s mouth, creating a tight seal, Exhale into the victim’s mouth. ► Delivering too much air, or too fast, can force the air into the esophagus and stomach rather than the lungs. This increases the risk of gastric inflation. Ideally, ensure that each breath is delivered over 1 second. ► While delivering the breath, ensure that the patient’s chest rises. This will indicate that the air is reaching the lungs. ► Repeat the procedure. Continue performing chest compressions if the chest does not rise even after two breaths. 33 RESCUE BREATHING 34  Key points (C-A-B) Provide compressions Provide breaths Make sure the victim is face-up on a Maintain an open airway by using firm, flat surface. either: head tilt-chin lift or jaw thrust Perform chest compressions In adults If the person is not breathing Compress at rate of 100-120/min but has a pulse, give 1 rescue breath every 6 seconds or 10 breaths per Compress at least 2 inches (5cm) minute. Allow complete chest recoil Give breaths, watching for chest rise Minimize interruptions (less than 10 and avoiding excessive ventilation seconds) Use a compression to ventilation ratio When only 2 rescuers are available, of 30:2 switch with the compressor about Count compressions out loud every 5 cycles or every 2 minutes, taking less than 10 seconds to switch Switch compressors about every 5 cycles or 2 minutes (more frequently if 35 fatigued), take less tan 10 seconds to switch  Adult BLS Algorithm This protocols that must be followed for various clinical scenarios. The adult algorithm described in this section is based on the latest recommendations made by the American heart Association (AHA) in 2020. 36 Adult BLS in pregnancy Algorithm 37 Automated external defibrillator (AED) for adult and children 8 years of age and above 38  Automated external defibrillator (AED) ► An automated external defibrillator (AED) is a portable electronic device that can identify an abnormal heart rhythm as shockable or non-shockable. ► Shockable heart rhythms are treated with defibrillation. Two life-threatening shockable arrhythmias that cause cardiac arrest are: 1. ventricular fibrillation (V-fib) 2. pulseless ventricular tachycardia(P-vt) 39 VT AND VF 40 Automated external defibrillator Operating and AED: Universal steps ► 1- Power on the AED 2- Attach the AED pads to the right anterior chest and left mid axillary line and plug the pads into the connector 3- Clear the victim and allow the AED to 41 analyze the rhythm  Automated external defibrillator Operating and AED: Universal steps 4- The AED operators clear the victim before delivering a shock 5- When everyone is clear of the victim, the AED operator presses the shock button ❖ After 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 &4 42  Do Not Delay High-Quality CPR After AED Use ► Immediately resume high-quality CPR, starting with chest compressions after either of the following: The AED operator delivers a shock The AED prompts, No shock advised" ► After about 5 cycles or 2 minutes of high-quality CPR, the AED will prompt you to repeat steps 3 & 4 ► Continue until advanced life support providers take over or the victim begins to breathe normally, move, or otherwise react. 43  AED pads placement options Anterolateral Antero-posterior 44 Automated external defibrillator Special considerations Hairy chest: use the razor to shave the area before place the pads In case the razor not available, use the first setoff pads and press down to stick as much as possible then quickly pull them off, then apply new set of pads 45  Automated external defibrillator Special considerations Presence of water or other liquids: Water and other liquids conduct electricity Do not use an AED in water If the victim is wet, or has been lying in snow or water, it is important to ensure that the chest is wiped dry before using the AED. 46  Automated external defibrillator Special considerations Implanted defibrillator and pacemaker: ► These devices may block the AED shock from reaching the heart. ► Such devices are easily palpable as hard masses beneath the skin. If present, avoid placing the AED directly over these devices.You may be able to place AED pads just below 47 implanted device  Automated external defibrillator Special considerations Transdermal patches: Pregnant woman: ► Several patients use transdermal patches for medications such ►as Shock from the AED will not harm the baby nitroglycerin, hormones, and nicotine. ► These patches may block delivery of electric current to the heart, and may also cause skin burns. ► If present, these patches must be removed, and the area must be wiped before adhesive pads are applied. 48 49 Basic life support For infants and children Infants are younger than 1 year of age Children range from 1 year of age to puberty 50  Basic life support assess pulse In a child feel for a carotid or In an infant feel for a brachial pulse femoral pulse If you do not definitely feel a pulse within 10 seconds, start high quality CPR, beginning with chest compressions 51 Basic life support assess breathing ► If the victim is breathing monitor the victim until additional help arrives ► If the victim is not breathing or is only gasping: start high quality CPR 52  Basic life support assess pulse and breathing ► If the patient is breathing and a pulse can be detected: Similar to adults, monitor the child or infant by continuing to check on pulse and respiration. ► If a pulse is definitely detected, but breathing is absent: Provide rescue breathing. Deliver rescue breaths over 1 second, every 2 to 3 seconds, totaling about 20 to 30 breaths per minute. Assess the pulse and perfusion. You may need to start chest compressions if: ► The pulse falls below 60 beats per minute. ► There are signs of poor perfusion So continue with rescue breathing and check the pulse rate every two minutes. If the pulse falls below 60 beats,.(less than 6 beats in 10 seconds) or is absent, start chest compressions immediately. 53  Signs of Poor Perfusion ► Perfusion is the flow of oxygenated blood from the heart through the arteries to the body's tissues. To identify signs of poor perfusion, assess the following: 1. Temperature: Cool extremities 2. Altered mental state: Continued decline in consciousness/responsiveness 3. Pulses: Weak pulses 4. Skin: Paleness, mottling (patchy appearance), and, later, cyanosis (blue lips or skin) 54  Basic life support assess pulse and breathing ► If both pulse and respiration are absent: ▪ The AHA advises two different recommendations based on whether the arrest was witnessed or not. If the arrest was witnessed, the AHA recommends that you leave the victim to activate emergency services and locate an AED. CPR may be performed immediately on returning. ► If the arrest was not witnessed, do not leave the victim. Instead, begin CPR immediately. After about 2 minutes, if you are still alone activate the emergency response system and get the an AED if not already done. 55 Basic life support airway management For airway management, as with adults use jaw thrust maneuver if suspect neck injury, if the jaw thrust does not open the airway use the head-tilt chin lift USE C/E technique when start ventilation with barrier device 56 Basic life support high quality chest compressions The compression to ventilation ratio for single rescuers is the same in adults children and infant (30:2) If there is 2 rescuers to resuscitate an infant and child they should use a compression to ventilation (15:2) Compression rate at 100 to 120 /min Compression depth for infant 1.5 inches or 4 cm, and for child 2 inches or 5 cm with each compressions Allow complete chest recoil Minimize interruptions in chest compressions 57  Basic life support high quality chest compressions Chest compressions technique for 1 hand technique child: Use one or 2 hands The compressions technique is the same as for an adults. For a small child 1-handed compressions may be adequate. Compress at least one third the AP diameter of the chest in depth 2 inches or 5 cm 58 2 hands technique►► 1 hand technique Chest compressions technique for child 59  Basic life support Chest compressions technique for Common considerations: infant: Two finger chest compression technique infant 1. Compressions at rate 100 – 120 /min 2. Compression depth 1.5 inches or 4 cm 3. Allow complete chest recoil 4. Minimize interruptions less than 10 seconds 2 fingers chest compressions for an infant, place 2 fingers in the center Of the chest below the nipple on the lower half of sternum 60 Two finger chest compression technique infant 61  Chest compressions technique for infant: ► 2 thumbs encircling hands technique for an infant (2 rescuers), place 2 thumb side by side in the center Of the chest, on the lower half of sternum 62 Basic life support high quality chest compressions 63  AIRWAY AND RESCUE BREATHING IN INFANTS AND ► CHILDREN The technique is almost the same as for adults, with a few modifications: ► In infants, the head-tilt must never exceed the neutral neck position. Excessive head tilt can cause airway compression. A good guide is the external ear canal, which must ideally be at the same level as the infant’s shoulder. 64  Caution: Risk of Gastric Inflation ► If you give breaths too quickly or with too much force, air is likely to enter the stomach rather than the lungs. This can cause gastric inflation (filling of the stomach with air). ► Gastric inflation frequently develops during mouth-to-mouth, mouth-to-mask, or bag-mask ventilation. It can result in serious complications. ► To reduce the risk of gastric inflation, avoid giving breaths too quickly, too forcefully, or with too much volume. But even if you give breaths correctly during high-quality CPR, gastric inflation may still develop. To reduce the risk of gastric inflation: 1. Deliver each breath over 1 second 2. Deliver just enough air to make the victim's chest rise 65  AED for infants and children younger than 8 years of ages ► Children: Use the AED as soon as it is available Use child pads if available. If not, you may use adult pads. Place the pads so that they do not touch each other. Turn on AED if a key or switch is present Place pads as illustrated on the pads Place pads directly on the skin. ► Infants: A manual defibrillator is preferred to an AED, however if not available, an AED equipped with a pediatric dose attenuator is preferred alternative If neither is available you may use an AED without attenuator. 66 Choosing and placing the AED pads AP AED pads placement on a child victim 67 pediatric BLS Algorithm for single and 2 rescuers 68 69 BLS summary 70 71  Reference ► English eBook edition ©2020 American heart association.ISBN 978-1-61669-799-0.20-3102 ► BASIC LIFE SUPPORT (BLS) PROVIDER MANUAL A Comprehensive Guide Covering the Latest Guidelines M. Mastenbjörk M.D. S. Meloni M.D. ► Basic Life Support Provider Handbook By Dr. Karl Disque , Version 2021.01 ► St John Ambulance, St Andrew’s First Aid, British Red Cross: FIRST AID MANUAL,ED10, 2014 ► Comprehensive Guide for First Aid & CPR contents:Fundamental Principles of the Red Cross 72 Any question ???? 73