ACLS &BLS -2010 RULES & CHANGESACLS &BLS -2010 RULES & CHANGES

BY-Dr Avijit Kumar Prusty,2nd Yr PGT,S.C.B Medical College, Cuttack,GUIDE- Asst Prof Dr S S Routray

BLSBLS

BLS Principles – DRS CABDBLS Principles – DRS CABD• No change to Dangers and Response

• S – Send for help

• C – perform 30 Compressions for victims who are unresponsive and not breathing normally, followed by 2 breaths

• A – open the Airway

• B – check Breathing but no need to deliver two rescue breaths

• C – perform 30 Compressions for victims who are unresponsive and not breathing normally, followed by 2 breaths

• D – attach an AED as soon as it is available

BLS Principles – DRS ABCDBLS Principles – DRS ABCD

• Compressions before 2 initial rescue breaths

• “Signs of life” changed to “unresponsive and not breathing normally”

• If unwilling / unable to perform rescue breathing, then perform compression only CPR

• New focus on maintenance of CPR quality – change rescuers every two minutes

• Pulse check downgraded for HCPs – “unreliable indicator of the need for resuscitation”

BLS – CompressionsBLS – Compressions

• One or two handed technique for children • Push to a depth of at least 5 cms at a rate of

at least 100 / min• Allow full recoil of chest between

compressions • 30 Compressions : 2 ventilations for all age

groups (1 or 2 rescuer)• Apply AED (if available) – now BLS skill

taught as part of CPR programs

BLS – Health Professional (Cont)BLS – Health Professional (Cont)

• CPR Rates:– Single Rescuer: 30 Compressions : 2

ventilations at a rate of > 100 per minute for all age groups (Approx 5 cycles every 2 minutes – <18 seconds/cycle)

– Two Rescuer: Adult – 30:2 at rate of 100 per minute

– Two Rescuer: Child (0-14) 15:2 at rate of 100 per minute (Approx 10 cycles every 2 minutes)

• Pause to allow ventilations (until intubated or LMA insitu)

BLS – Health Professional (Cont)BLS – Health Professional (Cont)

• AED - Apply and follow the prompts• Continue until signs of life – briefly check (?

pulse) every two minutes (don’t pause CPR for more than 10 seconds!!)

• Change compressor every 2 minutes to avoid fatigue

AEDAED

• AED - Single shock strategy

• 2 minutes CPR before reanalysis

• No need to reprogram energy levels – should follow those programmed by manufacturer for their specific device

• Reasonable to continue to utilise older devices until replaced as part of normal life cycle – any resuscitation is better than none

CPR Changes EmphasiseCPR Changes Emphasise

“Push hard, push fast, minimise interruptions; allow full chest

recoil, and don’t hyperventilate”

RationaleRationale

• Although ventilations are impt part of resuscitation, evidence shows that compressions are the critical element in adult resuscitation. In the A-B-C sequence, compressions are often delayed.

• If a pulse is not detected within 10 seconds, do start compressions without further delay.

•ACLS

RECOMMENDATIONS

COMPONENTS ADULTS CHILDREN INFANTS

RECOGNITION NO BREATHING/NO NORMAL BREATHING

NO BREATHING/ONLY GASPING

ADULTS CHILDREN INFANTS

RECOMMENDATIONS

CPR Sequence C-A-B

Compression Rate

Atleast 100/Min

Compression Depth

Atleast 2 Inches(5 cm)

Atleast 1/3 APDAbout 2 Inches(5 cm)

Atleast 1/3 APDAbout 1.5 Inches(5 cm)

Chest wall Recoil

Allow Complete recoil between compressionsHCPs rotate compression every 2 mins

Compression Interupptions

Minimize Interruptions in chest compressionsAttempt to limit interruptions to < 10 secs

ADULTS CHILDREN INFANTS

AIRWAY Head Tilt-Chin Lift

COMPRESSION/ VENTILATION RATIO

30:21 OR 2 Rescuers

30:2=Single Rescuer15:2=2 HCP Rescuers

VENTILATIONS:WHEN RESCUER UNTRAINED OR NOT PROFICIENT

Compression Only

VENTILATION WITH ADVANCED AIRWAY

1 Breath every 6-8 Seconds (8-10 breaths/min)Asynchronus with Chest CompressionsAbout 1 second per BreathVisible Chest Rise

DEFIBRILLATION Attach and use AED as soon as possible.Minimize interupptions in Chest Compressions before and after shock;resume CPR with compressions immedieately after each Shock

Seek Reversible CausesSeek Reversible Causes

• 5Hs• Hypoxia• Hypovolemia• Hyperacidosis• Hyperkalemia• Hypothemia

• 5Ts• Thrombus (MI)• Thrombus (PE)• Tension PTX• Toxins• Tamponade

REFFERENCES

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