Basic Life Support (BLS) PDF

BASIC LIFE SUPPORT Chain of Survival The 5 links in the adult out-of-hospital Chain of Survival are Recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Rapid defibrillation* Basic and advanced...

BASIC LIFE SUPPORT Chain of Survival The 5 links in the adult out-of-hospital Chain of Survival are Recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Rapid defibrillation* Basic and advanced emergency medical services Advanced life support and post-cardiac arrest care https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CPRFactsAndStats/UCM_475731_Out-of-hospital-Chain-of-Survival.jsp 10/1/2018 ASSOC.PROF.GULDAL IZBIRAK,MD 2 AIM is to inform the students about Basic Life Support and Chocking and convey them basic steps of both interventions. 10/1/2018 ASSOC.PROF.GULDAL IZBIRAK,MD 3 LEARNING OBJECTIVES At the end of this lecture the students should be able to; tell the definition of basic life support explain the basic principles of basic life support tell the the steps of basic life support regarding different age groups Understand the difference between partial and complete obstruction Tell the steps of Heimlich Maneuver 10/1/2018 ASSOC.PROF.GULDAL IZBIRAK,MD 4 Respiratory Arrest Complete respiratory arrest, absence of spontaneous ventilatory movement in an unconscious patient. Often with associated cyanosis, but it may develop acutely in a conscious victim secondary to foreign body obstruction. If respiratory arrest prolonged, cardiac arrest quickly follows because progressive hypoxemia impairs cardiac function. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 5 Respiratory Arrest Primary Respiratory Arrest Airway obstruction , partial or complete. Most common cause in an unconscious patient is upper airway obstruction due to posterior tongue displacement into the oropharynx secondary to a loss of muscular tone. Other causes: Blood, mucus, vomitus, foreign body, spasm or edema of the vocal cords. Secondary Respiratory Arrest Results from circulatory insufficiency. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 6 Cardiac Arrest No heart beat on an unconscious causalty. No breathing, not moving, and no response to any stimuli are signs for cardiac arrest. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 7 Time is very important when dealing with an unconscious person who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur in as little as 4 to 6 minutes later. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 8 Cardiopulmonary Resuscitation (CPR) Successful CPR depends on ◦ early Basic Life Support (BLS), prompt recognition and treatment of ventricular fibrillation (VF) if present and, ◦ advanced airway and rhythm control (ACLS) as necessary. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 9 BLS/Definition In the situation of respiratory/cardiac arrest; ◦ after opening the airway, ◦ chest compression to pump blood from the heart to peripheral tissues, ◦ performing rescue breathing to oxygenate the lungs, ◦ managing the causalty(ies) with available equipment, without using any medication and medical equipment to save life. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 10 Head tilt chin lift position for opening the airway Opens the airway by pushing the head back, pressing the forehead and lifting the chin so that the long edge of the chin bone builds an right angle with the floor; giving the patient/casualty head tilt chin lift position, 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 11 Head-tilt/chin-lift - open victims' airway by tilting their head back with one hand while lifting up their chin with your other hand. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 12 Look, listen, and feel Position your cheek close to victims' nose and mouth, look toward victims' chest, and Look, listen, and feel for breathing (10 seconds) 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 13 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 14 BLS IN ADULTS BLS/STEPS 1. Be sure about safety 2. Shake victim at the shoulders and shout "are you OK?" 3. If no response, tell someone to call 112 while you begin first aid. 4. Place victim flat on his/her back on a hard surface. 5. Knee beside the causalty 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 16 6. Open the shirts and ties which are tight on the neck and chest 7. Check the mouth, if a foreign body is seen, remove it 8. In order to open the airway, put one hand on the head of patient/casualty and the 2 fingers of the other hand on the chin. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 17 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 18 9. Give the patient/casualty head tilt chin lift position 10. Checks breathing using Look-Listen-Feel method for 10 seconds ⁻ ⁻ 1.10.2018 Looks for chest respiration movements, Bends down and gets closer to the mouth of the patient/casualty and listens to breathing sounds and puts his/her hand on the chest to feel the chest movements. GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 19 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 20 If there is no breathing, 11. If you are alone with the causalty, first call 112, then go on with 30 compressions / 2 breaths 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 21 In Adult BLS; Check consciousness, if unconscious assess quickly ; if not breathing … Neumar, R. W., Shuster, M., Callaway, C. W., Gent, L. M., Atkins, D. L., Bhanji, F.,... & Kleinman, M. E. (2015). Part 1: Executive Summary. Circulation, 132(18 suppl 2), S315-S367. Airway Breathing Compressions *ABC changed to CAB! Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality New Developments in Basic Life Support Science Since 2010 The 2010 Guidelines were most notable for the reorientation of the universal sequence from A-B-C (Airway, Breathing, Compressions) to C-A-B (Compressions, Airway, Breathing) to minimize time to initiation of chest compressions. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 22 C - COMPRESSİON If not breathing, begin chest compressions as follows: 12. In order to apply heart compressions, identify the lower and upper tip of the sternum and place the heel of one hand on the bottom half of the breast bone. 13. With your other hand directly on top of first hand. 14. Fingers of both hands interlock with each other. 15. Without touching the rib cage with the fingers of the hands and without bending the elbows, the arms should be straight perpendicular to the breast bone. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 23 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 24 16. Apply 30 heart compressions which are sufficient to depress the chest bone by 5 cms. (approximately one third of the depth of the chest from lateral view), *This process is adjusted so that the compression rate is 100 per minute The 2015 guideline defines the target depth for adult compressions to be between 2-2.4 inches. Compressions delivered beyond this depth may result in increased risk of resuscitation related injuries, such as rib fractures. 2.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 25 A - AIRWAY Opens the airway by pushing the head back, pressing the forehead and lifting the chin so that the long edge of the chin bone builds an right angle with the floor; giving the patient/casualty head tilt chin lift position, again 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 26 B – BREATHING 17. Use thumb and index finger of the hand which was placed over the forehead to close the patient/casualty's nostrils 18. Take a normal breath, place your mouth to cover the patient/casualty’s mouth while the patient/casualty is in head tilt chin lift position 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 27 20. Give two rescue breaths one second each to be able to rise the patient / casualty’s chest and give time to release the air back 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 28 In adults, if the rescuer does not feel the lungs expand or see the chest rise after opening the airway and applying rescue breathing, the airway is assumed to be still obstructed. The rescuer should reposition the head, make a firm mouth to mouth seal again, and repeat rescue breathing. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 29 20. Give 2 breaths after each 30 compressions to the patient/casualty (30: 2) 21. Continue to give basic life support without interruption until the medical help arrives or the vital reflexes returns. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 30 CPR must be continued until ◦the Cardiopulmonary System is stabilized – ROSC (Return of Spontaneous Circulation), ◦ resuscitation cannot be continued (termination of resuscitative efforts). 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 31 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 32 ADULT BLS IN THREE SIMPLE STEPS 1. CALL Check the victim for unresponsiveness. If there is no response tell someone for calling 112 and return to the victim. 2 PUMP Tilt the head back and listen for breathing. If the victim is not breathing normally, coughing or moving, begin chest compressions.* Push down on the chest 4 to 5 centimeters 30 times on the lower half of victim's sternum. Pump at the rate of 100/minute, faster than once per second. 3. BLOW Tilt the head back again, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second. * 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 34 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 35 BLS FOR CHILDREN ( Ages 1 – 8 ) 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 37 CPR for children is similar to adults. There are, however, 3 differences. ❑ First give 2 rescue breaths each one second, then go on with 30 compressions / 2 breaths * ❑ Use the heel of one hand for chest compressions (if the child’s body looks like an adult the heart compression is applied by using both hands like in adults), ❑ If there is one rescuer with the child, first give 2 rescue breathing, then go on with 30 compressions / 2 breaths; after five time of repeated cycles (30 compressions / 2 breaths) call 112 * ABC remains (Sequence of BLS) 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 38 BLS FOR INFANTS ( Ages 0-1) Shout and Tap Shout and gently tap the infant on the heel. If no response, tell someone to call 112 while you begin first aid. Open The Airway Open the airway using a head tilt lifting of chin. Do not tilt the head too far back. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 40 Look, Listen and Feel 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 41 Give 2 Gentle Breaths If the infant is NOT breathing take full-mouth breath and place your mouth to close both infant’s mouth and nose 2 small gentle breaths. Give two rescue breathing each of lasting 1 second enough to raise the chest of the infant and allows time between breaths to air comes back out 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 42 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 43 Give 30 Compressions Determine the center of chest (middle point of the line between two nipples) to begin heart compressions Place the middle and ring finger of one hand to 1 cm below this point 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 44 ❑Applies 30 heart compressions which are sufficient to depress the chest bone by 4 cms. (approximately one third of the depth of the chest from lateral view), this process is adjusted so that the compression rate is 100 per minute ❑Gives 2 breathing after 30 heart compressions to the patient/casualty (30:2) ❑If the first-aider is alone; after 5 cycles of 30:2 compressions calls 112 him/herself ❑Continues to give basic life support without interruption until the medical help arrives or the vital reflexes returns 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 45 Foreign Body Airway Obstruction (CHOKING) https://www.bing.com/videos/search?q=mrs+doubtfire+youtube+choki ng+scene&view=detail&mid=3EF48D12531C49A068293EF48D12531C4 9A06829&FORM=VIRE 2.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 47 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 48 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 49 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 50 Definition A foreign body airway obstruction is a life-threatening emergency which follows the lodgment of a foreign object in the casualty’s airway. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 51 In some instances, the object lodges at the epiglottis, the entry to the airway, but does not actually enter the airway itself. Both situations cause initial coughing, which is the body’s reflex action to dislodge the object. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 52 PARTIAL/MILD OBSTRUCTION ❑difficulty in breathing ❑wheezing ❑snoring sound ❑persistent cough 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 53 CARE AND TREATMENT ❑encourage the casualty to keep coughing ❑if blockage has not been cleared call ‘112’ for an ambulance ❑Reassurance ❑stand behind the casualty ❑DO NOT slap the casualty with a partial obstruction on the back 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 54 COMPLETE/SEVERE OBSTRUCTION ❑unable to breathe, speak or cough ❑agitated and distressed ❑may grip the throat with hands ❑cyanosis (bluish skin colour) ❑rapid loss of consciousness 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 55 Universal sign for choking 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 56 CARE AND TREATMENT ❑ Conscious casualty ❑ Stand behind or near the casualty ❑ By supporting the chest with your hand let the causalty lean forward ❑ Give up to 5 quick, forceful blows between the causalty’s shoulder blades. Use the heel of your free hand. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 57 ❑ ❑ ❑ ❑ ❑ 1.10.2018 check mouth and clear any obstructions that may have come loose after Position yourself to perform Heimlich maneuver : stand behind the casualty press your clasped hands hard into the epigastrium give a sudden thrust to elevate the diaphragm. GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 58 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 59 Heimlich Maneuver on An Adult 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 60 ❑deliver up to five-seven abdominal thrusts. ❑check mouth and clear any obstructions that may have come loose after ❑repeat Heimlich maneuver if obstruction not relieved ❑Repeat these two maneuvers each 5 times rotatively 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 61 If the victim gets unconsciousness; ❑Check respiration ❑Call for medical help (112) ❑Perform BLS *if breathing does not support check mouth and clear any obstructions that may have come loose after 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 62 Heimlich Maneuver on Conscious Child Grasp your fist with the other hand. Give a quick upward thrust into the abdomen. This may cause the object to pop out. Use less force for a child. Repeat thrusts until the object pops out or the person loses consciousness. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 63 Heimlich Maneuver on Conscious Child 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 64 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 65 Choking First Aid CONSCIOUS INFANT Definition Choking is when an infant can't breathe because food, a toy, or other object is blocking the airway (throat or windpipe). Causes Choking in infants is usually caused by inhaling a small object that they have placed in their mouth, such as a button, coin, balloon, or watch battery. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 67 ❑Inability to cry or make much sound ❑Weak, ineffective coughing ❑Soft or high-pitched sounds while inhaling ❑Difficulty breathing - ribs and chest retract ❑Bluish skin color ❑Loss of consciousness if blockage is not cleared 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 68 Complete obstruction Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant's chest in your hand and jaw with your fingers. Point the infant's head downward, lower than the body. Give up to 5 quick, forceful blows between the infant's shoulder blades. Use the heel of your free hand. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 69 Lay the infant on his/her back Sweep your finger through the mouth to remove debris 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 70 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 71 Partial obstruction DO NOT perform these steps if the infant is coughing forcefully or has a strong cry a strong blow can dislodge the object ! 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 72 IF THE INFANT LOSES CONSCIOUSNESS If the child becomes unresponsive, stops breathing, or turns blue: ❑Shout for help. ❑Give infant BLS. ❑ If there is one rescuer, repeat with 2 breaths and 30 compressions. After five time of repeated cycles call 112 and continue giving breaths and compressions. *If you see something blocking the airway, try to remove it. 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 73 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 74 References 1. Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J.,... & Rea, T. (2015). Part 5: Adult basic life support and cardiopulmonary resuscitation quality. Circulation, 132(18 suppl 2), S414-S435. 2. Neumar, R. W., Shuster, M., Callaway, C. W., Gent, L. M., Atkins, D. L., Bhanji, F.,... & Kleinman, M. E. (2015). Part 1: Executive Summary. Circulation, 132(18 suppl 2), S315-S367. http://circ.ahajournals.org/content/132/18_suppl_2/S315 3. Health Department Istanbul / National First Aid Certification Program http://www.istanbulsaglik.gov.tr/w/sb/ash/ilkyardim.asp 1.10.2018 GÜLDAL İZBIRAK, MD, ASSOC.PROF OF FM 75