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Dept. of Anaesthesiology. K.G.M.C.H. BASIC LIFE SUPPORT GUIDELINES. RESUSCITATION. Means Cardiopulmonary resuscitations Anywhere Anybody can do. CPR…. Considered when an individual cannot adequately breathe and maintain circulation to vital organs. - PowerPoint PPT Presentation
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Dept. of Anaesthesiology. K.G.M.C.H.
BASIC LIFE SUPPORT
GUIDELINES
RESUSCITATIONRESUSCITATION
Means Cardiopulmonary Means Cardiopulmonary
resuscitationsresuscitations
Anywhere Anybody can do Anywhere Anybody can do
CPR…CPR…
Considered when an individualConsidered when an individualcannot adequately breathe and cannot adequately breathe and maintain circulation to vital maintain circulation to vital organs.organs.
WHY& WHEN TO DO IT ?
Without Without CPR CPR , irreversible , irreversible brain damage occurs within brain damage occurs within
3-4 minutes3-4 minutes Should be done immediately Should be done immediately
by a bystander by a bystander TIME TIME is the crucial factor is the crucial factor
here to decide the survivalhere to decide the survival
Minutes counts...Minutes counts...
when the heart stops, when the heart stops, damage occurs to the damage occurs to the BrainBrain within < 5 within < 5 minutesminutes
startstart BLSBLS earlyearly
CPR…CPR…
BLSBLS
ACLSACLSALSALS
ANLSANLSCPCR – Cardio Pulmonary CPCR – Cardio Pulmonary
Cerebral resuscitationCerebral resuscitation
CPR… ABCDEFCPR… ABCDEF
How ?How ? AAirwayirway BBreathingreathing BLSBLS CCirculationirculation
DrugsDrugs EECG CG ACLSACLS FibrillationFibrillation
The Sequence of BLSThe Sequence of BLS
Establish UnresponsivenessEstablish Unresponsiveness
If no response If no response call for helpcall for help
Start BLS------- Start BLS------- A- A- AirwayAirway
B- B- BreathingBreathing
C- C- CirculationCirculation
CPR…CPR…
RECOGNITIONRECOGNITION
Is crucial in Is crucial in BLSBLS
DetermineDetermine UnresponsivenessUnresponsiveness BreathlessnessBreathlessness PulselessnessPulselessness
No victim should No victim should undergo undergo CPRCPR
until the need until the need
for resuscitationfor resuscitation
is established.is established.
2. 2. Check the Victim and see if he Check the Victim and see if he respondsresponds
GentlyGently SHAKE SHAKE his shoulderhis shoulder
Ask loudly “Are you all Ask loudly “Are you all
right?”right?”
3A. Responds by answering or 3A. Responds by answering or moving moving
Leave him in the position.Leave him in the position.
Reassess him regularly.Reassess him regularly.
3B. If no response3B. If no response
SHOUTSHOUT for help (Call for for help (Call for defibrillator) defibrillator)
Turn to his back and open airwayTurn to his back and open airway.. HEAD TILTHEAD TILT Hand on forehead. Hand on forehead. Remove any visible obstructionRemove any visible obstruction.. CHIN LIFTCHIN LIFT finger tips under the finger tips under the
point of chin.point of chin.
Avoid head tilt in Trauma
CPR…CPR…
Activation of EMS Activation of EMS
Call for helpCall for help
Call for ambulance Call for ambulance
servicesservices
Emergency
BLS ALGORHYTHM
CHECK RESPONSIVENESS
OPEN AIRWAY
CHECK BREATHING
ventilation
A
B
CIRCULATION C
CPR…CPR…
Airway - First basic skillAirway - First basic skillHead tiltHead tiltChin liftChin liftJaw thrust Jaw thrust
AirwaysAirwaysET intubationET intubationNewer airwaysNewer airways
CPR… CPR… AIRWAY AIRWAY
Head tiltHead tilt
Jaw thrustJaw thrust
Chin lift
CPRCPR……
Breathing – Second basic skillBreathing – Second basic skill LOOK LOOK for chest movementfor chest movement LISTENLISTEN for breath sounds for breath sounds FEEL FEEL for air on your cheekfor air on your cheek 2 slow effective rescue breathing2 slow effective rescue breathing
LOOK, LISTEN LOOK, LISTEN AND FEELAND FEEL
LOOKLOOK
LISTENLISTEN
FEELFEEL
5A. Breathing Normally5A. Breathing Normally
Turn him into recovery Position.Turn him into recovery Position.
Send or go for help.Send or go for help.
Check for continued breathingCheck for continued breathing..
Recovery position.Recovery position.
To maintain a good airwayTo maintain a good airway
To minimize the risk of aspirationTo minimize the risk of aspiration
Recovery PositionRecovery Position
To Maintain a good airway.To Maintain a good airway.
To Minimize the risk of aspirationTo Minimize the risk of aspiration. .
5B. Not Breathing5B. Not Breathing
Rescue breathingRescue breathing
Ensure head tilt and Ensure head tilt and
chin lift.chin lift.
Pinch the Nose.Pinch the Nose.
Two Slow effective Two Slow effective
breaths.breaths.
Rise and fall of the Chest
Rescue Breathing
Required if breathing is absent Required if breathing is absent or inadequateor inadequate
Give 2 slow breaths sufficient Give 2 slow breaths sufficient to make the chest riseto make the chest rise
Adult: Over 2 secondsAdult: Over 2 seconds Child & Infant: Over 1 – 1 ½ Child & Infant: Over 1 – 1 ½
secondsseconds
Rescue Breathing TechniquesRescue Breathing Techniques
Mouth-to-MouthMouth-to-Mouth
Mouth-to-BarrierMouth-to-Barrier
Mouth-to-NoseMouth-to-Nose Mouth-to MaskMouth-to Mask
Bag-mask device Bag-mask device
Any difficulty achieving an Any difficulty achieving an effective breath.effective breath.
Recheck Victims mouth.Recheck Victims mouth.
Recheck head tilt and chin lift.Recheck head tilt and chin lift.
Make up to 5 attempts.Make up to 5 attempts.
Even in unsuccessful, move on Even in unsuccessful, move on
to assessment of circulationto assessment of circulation..
NO NO -- Circulation Circulation
Absent carotid pulse.Absent carotid pulse.
Lay Rescuer.Lay Rescuer. Normal Breathing.Normal Breathing. coughingcoughing Movement.Movement.
Sign of Cardiac Sign of Cardiac arrest.arrest.
No More than 10 Sec.No More than 10 Sec.
CAROTID PULSECAROTID PULSE
Identify Adam’s apple (Thyroid Identify Adam’s apple (Thyroid
Cartilage).Cartilage).
Slide down to the groove.Slide down to the groove.
Palpate pulse in the groove.Palpate pulse in the groove.
Never Palpate on both sides Never Palpate on both sides
simultaneously.simultaneously.
7A. Circulation Present7A. Circulation Present
Continue rescue breathing.Continue rescue breathing.
Recheck rescue breathing.Recheck rescue breathing.
Normally breathing Normally breathing Recovery Recovery
Position. Position.
7B. No signs of Circulation7B. No signs of Circulation
Chest compressions.Chest compressions.
Identity middle of Lower half of Identity middle of Lower half of
Sternum.Sternum.
compressions by heel of the hands.compressions by heel of the hands.
After 15 Compressions tilt the head, After 15 Compressions tilt the head,
lift the chin and give 2 effective lift the chin and give 2 effective
breaths.breaths.
Chest Compressions
No pulse presentNo pulse present
START CHESTCOMPRESSIONSSTART CHESTCOMPRESSIONS
Compression Rate:Compression Rate:
Adult, Child, & Infant – 100/minAdult, Child, & Infant – 100/min
TECHNIQUE OF EXTERNAL CARDIAC COMPRESSION
Rescuer to one side of the patientRescuer to one side of the patient Patient’s chest exposed and Patient’s chest exposed and
xiphisternum identifiedxiphisternum identified Xiphisternum –Bony prominence in Xiphisternum –Bony prominence in
the mid line at the junction of lower the mid line at the junction of lower borders of the ribsborders of the ribs
The index and middle fingers of the The index and middle fingers of the lower hand placed on the xiphisternum lower hand placed on the xiphisternum and heel of the other hand is placed and heel of the other hand is placed adjacent to them on the sternumadjacent to them on the sternum
Heel of the second hand placed on the back of the hand on the sternum
Fingers may be interlocked
Sternum depressed vertically4-5cm and then released rapidly
Repeated at a rate of 80-100/minwith compression and relaxation each taking the same length of time
Locate rib cageLocate rib cage
Position your hands over middle of lower Position your hands over middle of lower half of sternum and fingers away from half of sternum and fingers away from ChestChest
Compression of ChestCompression of Chest
Arms Vertical
Arms Straight
Press Depress
4-5Cm
CPRCPR
15 x 2 x
Chest compressions Breathing
One Rescuer
Two rescuersTwo rescuers
Depth of CompressionDepth of Compression
Adult: 1 ½ - 2 inches or enough Adult: 1 ½ - 2 inches or enough
to generate a pulseto generate a pulse
Child & Infant: 1/3 – ½ the depthChild & Infant: 1/3 – ½ the depth
of the chest or enough to generateof the chest or enough to generate
a pulsea pulse
Continue Resuscitation Continue Resuscitation UntilUntil
Qualified help arrives and takes Qualified help arrives and takes
over.over.
Victim shows signs of life.Victim shows signs of life.
You become exhausted. You become exhausted.
Reassessment (10 seconds) Should be performed after the first Should be performed after the first
minute of CPR and every few minute of CPR and every few minutes thereafterminutes thereafter
If no pulse- If no pulse- resume CPRresume CPR If pulse and breathing present- If pulse and breathing present-
place in recovery positionplace in recovery position
If pulse present but no breathing- If pulse present but no breathing- provide rescue breathingprovide rescue breathing
BLS AlgorithmBLS Algorithm
CHECK RESPONSIVENESS
OPEN AIRWAY
CHECK BREATHING
BREATHE
ACCESS CIRCULATION10 seconds only
CIRCULATION PRESENTContinue Rescue Breathing
NO CIRCULATIONCompress Chest
Shake & Shout
Head tilt / Chin lift
Look, Listen and Feel
2 Effective Breaths
Signs of a Circulation
100 Per Minute 15:2 RatioCheck Circulation every Minute
CPR…CPR… NutshellNutshell
AdultAdult PaediatricPaediatric
Breath rateBreath rate 10 – 12 10 – 12 bpmbpm
20 bpm20 bpm
Pulse checkPulse check CarotidCarotid BrachialBrachial
Compression Compression raterate
100/min100/min >100/min>100/min
Compression Compression methodmethod
Hands Hands interlacedinterlaced
Two or three Two or three fingers or heel fingers or heel of one handof one hand
CV ratioCV ratio 15 : 215 : 2 5 : 15 : 1
FB FB obstructionobstruction
Heimlich Heimlich maneuvermaneuver
Back blows Back blows and chest and chest thruststhrusts
ACLSACLS
Special equipments and Special equipments and techniquestechniques
ECG monitoringECG monitoring DefibrillationDefibrillation iv accessiv access Drug therapyDrug therapy Post resuscitation carePost resuscitation care
NOW HE IS SAFE IN HELPING NOW HE IS SAFE IN HELPING
HANDSHANDS