BASIC LIFE SUPPORT_2.ppt

BASIC LIFE SUPPORT PAUL WAMBUGU Age definitions  intro Bls course focuses on training the students to offer high quality resuscitation CPR is a skill offered to patients who have signs of cardiac arrest. Components of CPR are chest compressions and breaths What...

BASIC LIFE SUPPORT PAUL WAMBUGU Age definitions  intro Bls course focuses on training the students to offer high quality resuscitation CPR is a skill offered to patients who have signs of cardiac arrest. Components of CPR are chest compressions and breaths What is cardiac arrest? Cardiac arrest vs heart attack  Signs of cardiac arrest Unresponsiveness Abnormal breathing No pulse Characteristics of high quality CPR  CAUTION ! Compression depth of more than 2.4 inches (6 cm) in adults can cause injuries  Chain of survival Chain of survival denotes a metaphor for the elements of emergency cardiovascular care Cardiac arrest can occur anywhere forming In hospitals chain of survival & Out of hospital chain of survival There are adult and pediatric chain of survival Chains of survival  Adult out of hospital chain of survival 1. Immediate recognition of cardiac arrest and activation of the emergency response system 2. Early CPR with an emphasis on chest compressions 3. Rapid defibrillation with an AED 4. Effective advanced life support (including rapid stabilization and transport to post– cardiac arrest care) 5. Multidisciplinary post–cardiac arrest care 6. Recovery  Adult in- hospital chain of survival 1. Surveillance, prevention, and treatment of prearrest conditions 2. Immediate recognition of cardiac arrest and activation of the emergency response system 3. Early CPR with an emphasis on chest compressions 4. Rapid defibrillation 5. Multidisciplinary post–cardiac arrest care  Pediatric chain of survival In children, cardiac arrest is often secondary to respiratory failure and shock. Identifying children with these problems is essential to reduce the likelihood of pediatric cardiac arrest and maximize survival and recovery. Therefore, a prevention link is added in the pediatric Chain of Survival  Pediatric chain of survival 1. Prevention of arrest 2. Early high-quality bystander CPR 3. Rapid activation of the emergency response system 4. Effective advanced life support (including rapid stabilization and transport to post– cardiac arrest care) 5. Integrated post–cardiac arrest care  Adult BLS Chest compressions only - can be done by rescuers with minimal training Chest compression and ventillation. 30 compressions: 2 breaths Team work for better outcomes  Main components of cpr Chest compressions Airway breathing  Adult 1-Rescuer BLS Sequence Verify Scene Safety, Check for Responsiveness, and Get Help (Algorithm Boxes 1, 2)  Assess for Breathing and PULSE (Box 3) Breathing To check for breathing, scan the victim’s chest for rise and fall for no more than 10 seconds. If the victim is breathing, monitor the victim until additional help arrives. If the victim is not breathing or is only gasping, this is not considered normal breathing and is a sign of cardiac arrest  Assess for Breathing and PULSE Pulse (Box 3) To perform a pulse check in an adult, palpate a carotid pulse. If you do not definitely feel a pulse within 10 seconds, begin high-quality CPR, starting with chest compressions. In all scenarios, by the time cardiac arrest is identified, the emergency response system or backup must be activated and someone must be sent to retrieve the AED and emergency equipment. Locating the carotid pulse Determine Next Actions (Boxes 3a, 3b) Begin HIGH-QUALITY CPR, Starting With Chest Compressions (Box 4) If the victim is not breathing normally or is only gasping and has no pulse, immediately begin high-quality CPR, starting with chest compressions. Remove or move the clothing covering the victim’s chest so that you can locate appropriate hand placement for compression. This will also allow placement of the AED pads when the AED arrives.  Attempt Defibrillation With the AED (Boxes 5, 6, 7) Use the AED as soon as it is available, and follow the prompts ( Automated External Defibrillator for Adults and Children 8 Years of Age and Older”). Chest compression technique  Importance of Chest Compressions Each time you stop chest compressions, the blood flow to the heart and brain decreases significantly. Once you resume compressions, it takes several compressions to increase blood flow to the heart and brain back to the levels present before the interruption. Thus, the more often chest compressions are interrupted and the longer the interruptions are, the lower the blood supply to the heart and brain is.  HIGH-QUALITY Chest Compressions Single rescuers should use the compression-to-ventilation ratio of 30 compressions to 2 breaths when giving CPR to victims of any age. Compress at a rate of 100 to 120/min. Compress the chest at least 2 inches (5 cm). Allow the chest to recoil (re-expand) completely after each compression.  The Importance of a Firm Surface Compressions pump the blood in the heart to the rest of the body. To make compressions as effective as possible, place the victim on a firm surface, such as the floor or a backboard. If the victim is on a soft surface, such as a mattress, the force used to compress the chest will simply push the body into the soft surface. A firm surface allows compression of the chest and heart to create blood flow  ADULT BREATHS Opening the Airway INTRODUCTION For breaths to be effective, the victim’s airway must be open. Two methods for opening the airway are  Head tilt–chin lift  Jaw thrust  Adult breaths cont. If a head or neck injury is suspected, use the jaw-thrust maneuver to reduce neck and spine movement. Switch to a head tilt–chin lift maneuver if the jaw thrust does not open the airway. If multiple rescuers are available, one rescuer can perform a jaw thrust while another rescuer provides breaths with a bag-mask device. The third rescuer will give chest compressions. Head tilt chin lift technique  Jaw thrust technique 1. Place one hand on each side of the victim’s head. You may rest your elbows on the surface on which the victim is lying. 2. Place your fingers under the angles of the victim’s lower jaw and lift with both hands, displacing the jaw forward (Figure 11). 3. If the lips close, push the lower lip with your thumb to open the lips. Barrier devices for ventilation  Pocket mask For mouth-to-mask breaths, use a pocket mask (Figure 12). Pocket masks usually have a 1-way valve, which 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. Some pocket masks have an oxygen inlet that allows you to administer supplementary oxygen.  How to use a pocket mask 1 Position yourself at the victim’s side. 2 Place the pocket mask on the victim’s face, using the bridge of the nose as a guide for correct position. 3. Seal the pocket mask against the face. Using your hand that is closer to the top of the victim’s head, place the index finger and thumb along the edge of the mask. Place the thumb of your other hand along the edge of the mask  How to use a pocket mask 4. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt–chin lift to open the airway (Figure 10). 5. While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face (Figure 13). 6. Deliver each breath over 1 second, enough to make the victim’s chest rise.  Adult breaths The air we breathe in contains about 21% oxygen. The air we breathe out contains about 17% oxygen Remember the following when interrupting chest compressions to give 2 breaths with a barrier device: Deliver each breath over 1 second. Note visible chest rise with each breath. Resume chest compressions in less than 10 seconds  Bag mask devices A bag-mask device is used to provide positive-pressure ventilation to a victim who is not breathing or not breathing normally. It consists of a bag attached to a face mask. If the bag is self-inflating, a bag-mask device may be used with or without an oxygen supply. If not attached to oxygen flow, it provides about 21% oxygen from room air. Some bag-mask devices include a 1-way valve. The type of valve may vary from one device to another Bag valve mask device positioning How to use a BVM Multiple rescuers  Automated External Defibrillator for Adults and Children 8 Years of Age and Older  Ventricular fibrillation An automated external defibrillator (AED) is a lightweight, portable, computerized device that can identify an abnormal heart rhythm that needs a shock. The AED can then deliver a shock that can stop the abnormal rhythm (ventricular fibrillation or pulseless ventricular tachycardia) and allow the heart’s normal rhythm to return.. Ventricular fibrillation Pulseless ventricular tachycardia  AED AEDs are simple to operate, allowing laypersons and healthcare providers to attempt defibrillation safely The time between collapse and defibrillation is an important factor in survival from sudden cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia  Universal steps 1. Open the carrying case. Power on the AED if needed. Some devices will “power on” automatically when you open the lid or case. Follow the AED prompts as a guide to next steps 2. Attach AED pads to the victim’s bare chest. Choose adult pads (not child pads or a child system) for victims 8 years of age and older. Peel the backing away from the AED pads. Attach the adhesive AED pads to the victim’s bare chest. Follow the placement diagrams on the pad. See Critical Concepts: AED Pad Placement Options later in Part 3 for common placement options. Attach the AED connecting cables to the AED device (some AED cables are already preconnected to the device). 3 “Clear” the victim and allow the AED to analyze the rhythm. When the AED prompts you, clear the victim during analysis. Be sure that no one is touching the victim, not even the rescuer in charge of giving breaths. Some AEDs will tell you to push a button to allow the AED to begin analyzing the heart rhythm; others will do that automatically. The AED may take a few seconds to analyze. The AED then tells you if a shock is needed. 4. If the AED advises a shock, it will tell you to clear the victim and then deliver a shock. Clear the victim before delivering the shock: be sure that no one is touching the victim. Loudly state a “clear the victim” message, such as “Everybody clear” or simply “Clear.” Look to be sure that no one is in contact with the victim. Press the shock button. The shock will produce a sudden contraction of the victim’s muscles 5. If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions. 6. After about 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 and 4. How to place the pads Pediatric basic life support  Signs of Poor Perfusion Assess the following to determine signs of poor perfusion: Temperature: Cool extremities Altered mental state: Continued decline in consciousness/responsiveness Pulses: Weak pulses Skin: Paleness, mottling (patchy appearance), and later cyanosis (turning blue)  Compression ventillation ratio in children and infants The universal rate for compressions in all cardiac arrest victims is 100 to 120/min. The compression-to-ventilation ratio for single rescuers is the same (30:2) in adults, children, and infants. If 2 rescuers are present for the resuscitation attempt of an infant or child, use a compression-to-ventilation ratio of 15:2.  Compression technique For most children, either 1 or 2 hands can be used to compress the chest. For most children, the compression technique will be the same as for an adult: 2 hands (heel of one hand with heel of other hand on top of the first hand). For a very small child, handed compressions may be adequate to achieve the desired compression depth..  Compress the chest at least one third the anteroposterior (AP) diameter of the chest (about 2 inches, or 5 cm) with each compression. For infants, single rescuers should use the 2-finger technique. If multiple rescuers are present, the 2 thumb– encircling hands technique is preferred. These techniques are described below