![BASIC LIFE
SUPPORT[BLS]
DR. ADELEYE G.T.C,
SURGICAL RESIDENT
DEPT. OF ACCIDENT AND
EMERGENCY(FETH, IDO EKITI)
20th
NOVEMBER, 2024.](https://image.slidesharecdn.com/basiclifesupport062757-250629130746-4fe3221d/85/BASIC-LIFE-SUPPORT-powerpoint-presentation-1-320.jpg)
BASIC LIFE SUPPORT powerpoint presentation
- 1. BASIC LIFE SUPPORT[BLS] DR. ADELEYE G.T.C, SURGICAL RESIDENT DEPT. OF ACCIDENT AND EMERGENCY(FETH, IDO EKITI) 20th NOVEMBER, 2024.
- 2. WORLD RESTART A HEART DAY
- 3. OUTLINE • Introduction • Indication • CAB- Approach • BLS technique and action • BLS for children • CPR technique • Automated external defibrillator(AED) • Post resuscitation care • Foreign body airway obstruction relief • Ethical issues • Complications of CPR • Summary • References
- 4. Introduction WHAT IS BASIC LIFE SUPPORT ? • Basic Life Support (BLS) defines Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary or cardiac arrest in an individual until they can be given full medical care at a hospital. • BLS does not include the use of drugs or invasive skills.
- 5. BASIC LIFE SUPPORT • GLOBAL BURDEN OF SUDDEN CARDIAC ARREST • Approximately 700,000 cardiac arrests per year. • Bystander CPR before arrival of emergency services – doubles survival from sudden cardiac arrest. • Early resuscitation can result in >60 % survival.
- 6. BASIC LIFE SUPPORT BASIC LIFE SUPPORT • It can be provided by trained medical personnel, including paramedics, and by anyone who knows, how to do it, anywhere, immediately, without any other equipment.
- 7. PURPOSES OF CPR • Maintaining circulation and • Oxygenation in order to maintain a cardiac output to keep vital organs alive.
- 8. INDICATIONS OF CPR • CARDIAC ARREST • RESPIRATORY ARREST • COMBINATION OF BOTH
- 9. CARDIAC ARREST • Cardiac arrest is when the heart ceases to beat; sudden cardiac arrest (SCA) cessation of cardiac mechanical activity which is confirmed by apnea or agonal respiration and absence of detectable pulse in person not expected to die at that time
- 10. CAUSES OF SUDDEN CARDIAC ARREST 5HS • Hypoxia • Hypovolemia • Hypo/Hyperkalemia • Hypothermia • Hydrogen Ions(Acidosis) 5TS • Tension pneumothorax • Tamponade (cardiac) • Thrombosis(pulmonary or Coronary) • Toxins(poisoning) • Tablets(drug overdose etc)
- 11. CAB-APPROACH • WHAT IS CAB APPROACH ? • There is a common acronym in BLS used to guide providers in the appropriate steps to assess and treat patients in respiratory and cardiac distress. This is CAB-D (Circulation, Airway, Breathing, Defibrillate)
- 12. CAB –Circulation Airway Breathing
- 13. SUMMARY OF BASIC AND ADVANCED LIFE SUPPORT GUIDELINES
- 15. CHAIN OF SURVIVAL • CHAIN OF SURVIVAL FIVE LINKS OF ADULT CHAIN OF SURVIVAL- •Early recognition of cardiac arrest. •Activation of the Emergency Response System. •Early CPR, to provide blood supply to vital organs. •Early defibrillation to restart the heart. •Comprehensive post-cardiac arrest care to restore quality of life.
- 16. BASIC LIFE SUPPORT • ACTIONS FOR PERFORMING ADULT CPR 1. Assess scene safety. 2 .Determine responsiveness 3 .Check carotid pulse 4 .Perform chest compressions 5 .Open Airway 6 .Check Breathing and deliver breath.
- 17. Establish Unresponsiveness • Ensure scene safety for both you and patient • Is patient responsive? Tap patient 'shoulder. Shout ‘are you alright?’ • Is he/she breathing? Agonal breathing(gasp) seen in the first several minutes of cardiac arrest.
- 18. Lone rescuer • Shout for help. If no response • Activate emergency response system • Retrieve an AED • Do a quick pulse check • Start CPR • Do not delay starting CPR
- 19. Two or more Rescuers • Switch roles every 2 mins or 5 cycles of CPR to minimize responder fatigue • First responder stays with the patient, while the second activates emergency response and obtains AED • Additional team members help with ventilation with self inflating bags
- 20. Two or more Rescuers • Place AED beside patient on same side as rescue operator • Turn on the AED device to activate voice prompts • Attach pads to patient’s chest and dry if wet • Device determines if shock is needed • AED is to be used by both healthcare professionals and lay people, to analyze electrical cardiac rhythms and deliver shock
- 21. BLS for Children • Compression: ventilation ratio for lone rescuer CPR is 30:2, for two rescuer CPR is 15:2. • Compress at least 1/3 the distance between the front and back of the chest
- 22. CHEST COMPRESSION IN AN INFANT
- 23. SCENE 1- YOU FIND AN ADULT LYING ON GROUND
- 24. ASSESS SCENE SAFETY Assess to make sure the scene is safe for you to respond to the down patient.
- 25. ASSESS RESPONSIVENESS ASSESS RESPONSIVENESS Shake the shoulder and speak to the adult asking ARE YOU ALRIGHT? . Look at the chest and torso for movement and normal breathing simultaneously.
- 26. CHECK CIRCULATION Check the patient for a palpable carotid pulse for 5-10 seconds. (Do not check for more than 10 seconds.) Carotid pulse check
- 27. Event of : • IF THERE IS NO PULSE AND • NO/ABNORMAL BREATHING • START CPR
- 28. CARDIO-PULMONARY RESUSCITATION • To start CPR, place patient in supine position on a firm and flat surface. • Kneel down to the patient and locate the position for chest compression on person’s chest.
- 30. LOCATION OF CHEST COMPRESSIONS • Locate the lower 1/3 of the patient’s sternum between the nipples in the midline of body.
- 31. LOCATION OF CHEST COMPRESSIONS
- 32. HAND POSITIONING FOR CHEST COMPRESSIONS 1. Lock your arms. 2. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. 3. Keep your elbows straight and position your shoulders directly above your hands.
- 33. CPR DEMO
- 34. HAND POSITIONING FOR CHEST COMPRESSIONS • Use your upper body weight (not just your arms) as you push straight down on the chest at least 2 inches (approximately 5 centimeters) but not greater than 2.4 inches (approximately 6 centimeters).
- 35. CPR DEMO
- 36. GOOD QUALITY CHEST COMPRESSIONS • Press hard and fast. • Allow for full chest recoil with each compression. • Allow for only minimal interruptions to chest compressions. • Deliver 30 chest compressions initially. • Push hard at a rate of 100 -120 compressions per minute.
- 37. AIRWAY • After initial 30 chest compressions ,assess and establish airway. • Give 2 rescue breaths, each lasting for 1 seconds and assess for visible chest rise with each breath
- 38. RESCUE BREATH
- 39. AIRWAY :OPEN THE AIRWAY • After giving 30 chest compressions open victim’s airway. • There are two maneuvers to open the airway- HEAD- TILT CHIN-LIFT MANEUVER • (Or Jaw thrust maneuver if spinal cord injury is suspected). JAW THRUST MANEUVER
- 40. RESCUE BREATHING • A technique used to resuscitate a person who has stopped breathing, in which the rescuer forces air into the victim's lungs at intervals of several seconds.
- 41. METHODS OF RESCUE BREATHS • Mouth-to-Mouth Rescue Breathing • Mouth-to-Nose and Mouth-to-Stoma Ventilation • Ventilation With Bag and Mask • Ventilation With an Advanced Airway
- 42. METHODS OF RESCUE BREATHS Mouth-to-Mouth Rescue Breathing Mouth-to-Nose and Mouth-to- Stoma Ventilation
- 43. Ventilation With Bag and Mask
- 44. Mouth to Mouth Breathing • Use a barrier device if available pinch the nostrils for mouth-to-mouth breathing. • Make a seal using your mouth over the mouth of the patient or use a pocket mask or bag mask.
- 45. Mouth to Mouth Breathing
- 46. Bag and mask Ventilation: The one- hand E-C technique • Place the mask on the patient’s face before attaching the bag. • Using the non dominant hand, create a C- shape with the thumb and index finger over the top of the mask, and apply gentle downward pressure. • Hook the remaining fingers around the mandible, and lift it upward toward the mask, creating the E.
- 47. Bag and mask Ventilation: The one- hand E-C technique
- 48. The one-hand E-C technique • Cover the nose and the mouth with the mask • without extending it over the chin. Change the • size of the mask, as appropriate, to create a good • seal.
- 49. RESCUE BREATHING • Each rescue breath should last approximately 1 second. • Watch for chest rise. • Allow time for the air to expel from the patient.
- 50. Cardio-Pulmonary Resuscitation • 1 cycle of adult CPR is 30 chest compressions • to 2 rescue breaths. • Perform 5 cycles of CPR (lasts approximately • 2 minutes).
- 51. Rescue Breathing
- 52. RATE AND DEPTH OF CPR
- 53. During CPR • In course of CPR, an advanced airway(endotracheal tube or laryngeal mask airway) is placed. • Ventilations are delivered at a rate of 6-10per minute with no CPR interruptions for breath delivery • 100% oxygen is delivered
- 54. During CPR • Intravenous access is established for drugs administration • Also intraosseous access is established for drug administration • Waveform capnography is used ascertain correct airway placement, detect return of spontaneous circulation(ROSC), guide effectiveness of CPR
- 55. Medications in Cardiac Arrest Adrenaline • Is the vasopressor of choice- increases likelihood of ROSC and short- term survival • No definition of optimal dosing and timing of adrenaline • Adrenaline role in resuscitation protocol is based on consensus opinion
- 56. Medications in Cardiac Arrest Amiodarone • Improves rate of survival to hospital admission in out-of hospital cardiac arrest • Improves the response to defibrillation in shock refractory ventricular tachycardia or ventricular fibrillation
- 57. Ultrasound during cardiac arrest • Presence of a trained operator and equipment, bedside ultrasound is useful tool to help diagnose reversible cardiac and non- cardiac cause of cardiac arrest • Used to detect cardiac standstill, the presence of which is predictive of death and shows that further resuscitative efforts are futile
- 58. WHEN TO STOP RESUSCITATION CONTINUE RESUSCITATION UNTIL • Qualified help arrives and takes over • The victim starts breathing normally • Rescuer becomes exhausted
- 59. AUTOMATED EXTERNAL DEFIBRILLATOR • An AED, or automated external • defibrillator, is a device that has • the ability to detect irregular • heart rhythm and it automatically • delivers a defibrillation shock to • stop irregular heart beat and allow • a normal rhythm to resume. • AEDs are designed to be used by • any laypersons.
- 60. AUTOMATED EXTERNAL DEFIBRILLATOR • Biphasic defibrillator are recommended • Defibrillation is performed with minimal interruptions to chest compressions • Default energy setting is 200J for all shock in adults
- 61. ATTACH PADS TO CASUALTY’S BARE CHEST
- 62. DEFIBRILLATION
- 63. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION
- 64. Post-Resuscitation Care • This is done once ROSC is achieved. • Patient is re-evaluated; adequate oxygenation and ventilation MUST be confirmed • Urgent 12-lead ECG and chest X-ray should be considered • Reversible causes of cardiac arrest should be sought and arrested
- 65. Post-Resuscitation Care -Oxygenation Adequate oxygenation is maintained in this phase, preventing hypoxemia It is monitored by pulse oximetry or arterial blood gas Inspired oxygen is titrated to SaO2 94-98%
- 66. Post-Resuscitation Care -Temperature control therapeutic hypothermia helps in terms of intact long term neurological survival in comatose victims Recommended cooling to 32-34C for 12-24hrs it is of benefit after non- shockable rhythms and in hospital arrests Shivering which counteracts lowering of temperature is suppressed by neuromuscular blocking drugs
- 67. FOREIGN BODY AIRWAY OBSTRUCTION RELIEF
- 68. ABDOMINAL THRUST
- 69. BACK SLAPS AND CHEST THRUST IN INFANTS
- 70. Ethical Issues When not to start resuscitation • Resuscitation is not attempted when there is a Do-Not-Attempt-Resuscitation(DNAR) order. • Futility: resuscitation not attempted when there is no benefit of prolonging life
- 71. Ethical Issues When to stop resuscitation • A decision taken by the team leader after consultation with other team members • Medical history, prognosis, period between cardiac arrest and CPR onset, interval to defibrillation, period of advanced life support(ALS)with continuing asystole • When rescuer is exhausted
- 72. COMPLICATIONS OF CPR 1. Rib Fracture 2. Internal injuries to organs 3. Laceration related to the tip of the sternum 4. Vomiting and aspiration 5. Gastric distension.
- 73. Conclusion • Cornerstone in resuscitation is an effective chest compression with minimal interruptions • Taking the right action quickly and confidently make the difference between life and death for person dealing with cardiac arrest • Therefore, there is need for everyone to know how to perform each CPR skill effectively.
- 74. RECOMMENDATIONS • Educate the public: Teach laypeople how to recognize cardiac arrest, call for help, and perform chest compressions. • • Train medical professionals: Ensure medical personnel are trained in BLS, both in and out of the hospital. • • Provide medical oxygen: Ensure medical oxygen is available in ambulances and
- 75. References • WFSA ATOTW(tutorial 252); Dr Ray Siauw, Gosford Hospital, New South Wales, Australia • A-Z of Anaesthesia, Intensive Care and Perioperative Medicine. 6th Edition • Synopsis of Anaesthesia- Dr Queeneth Ndukwe Kalu • Anaesthesia Review for DNB student 2nd Edition
Editor's Notes
- #20: If shock is advice, no one touches patient and clear patient loudly by shouting ‘clear’ Press shock button , patient’s muscle will contract After delivering or deciding if shock is not needed, CPR continues immediately (30:2) After 2mins of CPR the device will prompt a repeat
- #21: Sole responder to a child who is unresponsive or gasping, administer 2 mins of CPR before leaving to activate the ERS and retrieve an AED
- #57: Examples pericardial effusion and tamponade, Rt ventricular dysfunction, absence of lung artifact in tension pneumothorax
- #60: After defibrillation, there should be no pause for rhythm analysis, chest compressions should be immediately recommenced after shock delivery and continue for two minutes prior to rhythm analysis Defibrillator should be charged during chest compressions to allow immediate defibrillation
- #66: Hypothermia is induced by rapid infusions of 30ml/kg of cold(4C) fluid which is either 0.9%saline or Hartmann’s solution) Alternatively ice packs is placed against patient’s neck, axillae and groin