01 Adult and Pediatric BLS - Choking Drowning - KKADAM.pdf

Adult and Pediatric Basic Life Support Koray KADAM, MD Near East University Emergency Medicine Specialist Head of the EM Department WHAT IS…? BASIC LIFE SUPPORT (BLS) ADVANCED CARDIAC LIFE SUPPORT (ACLS) DEFINITION: Supporting the respiratory an...

Adult and Pediatric Basic Life Support Koray KADAM, MD Near East University Emergency Medicine Specialist Head of the EM Department WHAT IS…? BASIC LIFE SUPPORT (BLS) ADVANCED CARDIAC LIFE SUPPORT (ACLS) DEFINITION: Supporting the respiratory and circulatory system by maintaining the airway opening and performing chest compressions Cardiopulmonary Resuscitation (CPR) PAST… Attempts to resuscitate patients have changed dramatically throughout history with each version developed in hope of saving lives. Today, cardiopulmonary resuscitation, also known by the acronym CPR, can double or triple a cardiac arrest victim’s chance of survival -- if it is given immediately. EARLY AGES - FLAGELLATION METHOD EARLY AGES - HEAT METHOD Rescuers whipped the victim with Warm ashes, hot water, burning dried stinging nettles or struck with their animal excreta - anything hot - applied to hands or wet cloth to stimulate a abdomen of victim was thought to restore response. heat and life to cold body.  1770 - INVERSION METHOD 1530 - BELLOWS METHOD Lowering body expelled air from Fireplace bellows first used by the lungs. Inspiration resulted when Swiss physician Paracelsus to pressure removed by lifting victim. introduce air into lungs. Variations Used in England, Europe and used in Europe for 300 years. America with success in drowning cases. 1773 - BARREL METHOD 1803 - RUSSIAN METHOD Barrel movement back caused Successful resuscitation by burial in compression of chest for expiration. snow. Modification was burying Barrel movement forward released victim upright with head and chest pressure for inspiration. Used exposed, water dashed on face. before 1767; may still be seen along waterfronts. 1812 - TROTTING HORSE METHOD 1829 - LEROY METHOD Body in contact with horse compressed First use of supine position. Pressure chest and forced air out. When bounced applied over chest and abdomen for off horse, chest expanded, air entered expiration. Release of pressure caused lungs. Used on European inland inspiration waterways in drowning cases. 1831 - DALRYMPLE METHOD 1926 - EISENMENGER METHOD Pulling cloth by two rescuers Air from electrically driven pump compressed chest to force air from went into pressure and suction lungs. Chest expanded when cloth vessels in dome on patient's body released for inspiration and induced breathing.  1932 - HOLGER NIELSON METHOD 1931 - POLE TOP METHOD With this back-pressure arm-lift (OESTERREICH) method, rescuer pushes down on For linemen suffering electric shock, victim's back for expiration. Rocks abdomen compressed inward and backward and lifts victim's arm upward for expiration. Release of toward self for inspiration. Method compression for inspiration. still in use.  1960 - CARDIOPULMONARY 1958 - MOUTH-TO-MOUTH RESUSCITATION RESUSCITATION Combination of chest compressions Rescuer blows into victim's mouth, and mouth-to-mouth resuscitation. keeping the head back and the nose Training required to perform pinched. effectively.  What is an emergency situation? ???? a. Arrest b. Anaphylaxis c. Foreign body aspiration d. Syncope e. Bleeding f. and more…  Emergency Anything can happen at any time! Intervention is required before the diagnosis is clear! Most emergencies can be overcome if some basic principles are remembered! Basic Life Support  WHY so important? Every individual, regardless of experience or education, can be a LIFE SAVER!  WHY so important? Early BLS and early DEFIBRILLATION (within 1-2 minutes) save more than 50% of patients. AHA 2020  Cardiac Arrest The first step is early recognition of the event. Rescuers may witness someone collapse, or they may find someone who appears to be dead. Before intervening, the rescuer must ensure the safety of the scene. BLS ACLS  NALOXONE In the BLS guidelines, There is a recommendation that NALOXONE can be administered IM or IN to unresponsive patients in case of suspected opiate overdose, even for non-healthcare providers (lay rescuers) (Class 2B recommendation). NALOXONE NALOXONE ?  Cardiac Arrest If a lone rescuer finds an unresponsive adult (ie, no movement or response to stimulation) or witnesses an adult who suddenly collapses, after ensuring that the scene is safe, the rescuer should check for a response by tapping the victim on the shoulder and shouting at the victim.  Cardiac Arrest If the victim also has absent or abnormal breathing (ie, only gasping), the rescuer should assume the victim is in cardiac arrest! The lay rescuer should phone the emergency response system once the rescuer finds that the victim is unresponsive  Chest Compressions The victim should be on a hard surface if possible in supine position The rescuer should be in a kneeling position  Chest Compressions Place the heel of one hand on the sternum and the other hand on top of the first, fingers interlaced Extend the elbows and the rescuer leans directly over the victim Press down, compressing the chest at least ….??? cm?  Chest Compressions Depth 5-6 cm / 100-120 per minute Release the chest and allow it to recoil completely!! Chest Compressions Chest Compressions Universal rhythm for compressions Bee Gees – Stayin’ Alive 90 120 100  Airway Fallen back tongue is the common cause for airway obstruction in an unresponsive victim.  Airway - Breathing Head tilt – chin lift Jaw thrust  Airway - Breathing Head tilt , Chin lift and Jaw thrust​ are the maneuvers used to overcome airway obstruction Head tilt is contraindicated in a trauma victim where Jaw thrust is the choice... Rescue Breaths  Rescue Breaths To perform the mouth-to-mouth technique, the provider does the following: Pinch the patient’s nostrils closed to assist with an airtight seal Put the mouth completely over the patient’s mouth After 30 chest compression, give 2 breaths ( 30:2 cycle of CPR) Give each breath for approximately 1 second with enough force to make the patient’s chest rise Failure to observe chest rise indicates an inadequate mouth seal or airway occlusion After giving the 2 breaths, resume the CPR cycle  Rescue Breaths Rescue breaths; – 1. Pediatric arrests – 2. Arrests due to asphyxia (drowning, drug overdose) – 3. Prolonged CPR should be performed by all trained rescuers. (Class IIa, LOE C)  Automated External Defibrillator Defibrillation is a process in which an electronic device gives an electrical shock to the heart. Defibrillation stops ventricular fibrillation by using an electrical shock and allows the return of a normal heart rhythm. A victim’s chance of survival decreases by 7 to 10 percent for every minute that passes without defibrillation.  Automated External Defibrillator In recent years, small portable defibrillators have become available. These devices are called automated external defibrillators, or AEDs. An AED is a device that analyzes a heart rhythm and prompts the user to deliver a shock when necessary. These devices only require the user to turn the AED on and follow the audio instructions when prompted. Automated External Defibrillator AED Public Access Defibrillators 2010 2020 Normal breathing, pulse felt  Recovery Position VIDEO Google drive link: – https://drive.google.com/file/d/1rA_5EkguGrec7z BN1bEDygn3E3dwsuoK/view?usp=sharing CHOKING  CHOKING Choking most often occurs during eating or drinking, when solid food lodges in the pharynx or larynx or when liquid is inhaled into the larynx and trachea. As a rule, the expulsive force of coughing is sufficient to remove the obstructions.  CHOKING The universal sign for choking is hands clutched to the throat!  CHOKING They’re: Unable to talk (or cry) Unable to breath (noisy breathing) Unable to cough (forcefully) Wide-eyed panicked look on face Loss of conscious Skin, lips, or nails turn blue or dusky Try to say “I’m choking!” CHOKING CHOKING CHOKING – Heimlich Maneuver Back Blows Heimlich Maneuver PEDIATRIC BLS  Checking Pulse (