BY

Kerolus E. Shehata•PGY-III IM Resident, Ain Shams University•ECFMG certified

If you can’t give a life, you can save a life!!

OBJECTIVES1) How to assess the collapsed victim.

2) How to perform chest compression and rescue breathing in adults.

3) What are the differences between adult & paediatric BLS.

4) How to place an unconscious breathing victim in the recovery position.

BACKGROUND

Approximately 700,000 cardiac arrests per year in Europe.

Percentage of victims who survive till hospital discharge is currently 5-10%.

Bystander CPR is a vital intervention before arrival of emergency services.

Early resuscitation and prompt defibrillation (within 1 - 2 minutes) can result in > 60 % survival and decrease in mortality rate.

Q. What is the difference between BLS & ACLS ?

A: BLS implies that NO equipment is employed other

than protective devices.

Why do we do CPR?Do we need to learn

about CPR?

Every minute will make a lifetime of difference

How does CPR work? The brain may sustain damage after blood flow has been

stopped for about 4 min. and irreversible damage after about 7 min.

The heart also rapidly loses the ability to maintain a normal rhythm.

CPR is effective only if performed within 7 minutes of the stoppage of blood flow.

Effective CPR enables enough oxygen to reach the brain to delay brain stem death, and allows the heart to remain responsive to defibrillation attempts.

Will CPR restart the heart? Chances are very low. Compression can’t

reverse the causes e.g. Hypoxia in children & arrhythmias in adults

To restart, you need an electric shock by AED.

CPR pump a small amount of blood that is barely sufficient to keep your brain alive.

Q. Is there anything that improve the

outcome??

CHAIN OF SURVIVAL

Q. What will you do if you find this?

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

First & most important thing: Don’t Panic!!

APPROACH SAFELY

1. Scene

2. Rescuer

3. Victim

4. Bystanders

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

Don’t start CPR in an unsafe environment…we don’t want a second victim

Risks To The Rescuer Aim to eliminate or minimize risks. Beware of environmental dangers e.g.

Traffic Electricity Gas Water Radiation

Can I get an infection??

15 documented cases of CPR related infection

mainly Neisseria meningitides.

TB (only isolated reports).

Not hepatitis B or C or CMV.

transmission of HIV during CPR has never

been reported.

Check for a responseApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

• Shake the shoulders gently.

• Shout loudly “Are you alright?”

How to check the victim’s response?

If the victim responds

1. Leave him/her as it is.2. Activate the EMS (123)3. Try to find out what is wrong.4. Reassess regularly.

If there is NO responseSHOUT FOR HELP!!

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

Open the airwayApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

How to Open The Airway?

Head tilt & Chin lift If cervical spine injury suspected: jaw thrust

Check for breathing & CirculationApproach safely

Check response

Shout for help

Open airway

Confirm arrest

Call 123

30 chest compressions

2 rescue breaths

How to check for breathing & circulation?

Look, Listen and Feel for NORMAL breathing.

Check the Carotid pulse. Assess for not more than

10 sec. before deciding absent breathing.

Do not confuse agonal breathing with normal breathing.

AGONAL BREATHING Occurs shortly after the heart stops

in up to 40% of cardiac arrests. Brain stem reflex. Described as heavy, noisy or gasping

breathing. Recognise as a sign of cardiac arrest.

If the patient is breathing normally & you can feel a pulse:

Turn him into the recovery position (if applicable).

Call for help. Reassess regularly till arrival of EMS.

If you can feel a pulse, but the patient is not breathing:

Give 1 rescue breath every 5 seconds. Recheck the pulse every 2 minutes.

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

If you confirm Cardiac arrestCall 123 & Start CPR

Give 30 effective chest compressionsApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

Place the heel of one hand on the lower half of sternum (Sterno-xyphoid junction).

Place other hand on top. Interlock your fingers. keep your arms straight and lock your elbows

so you can compress the chest fully using your weight while conserving your energy.

Compress the chest: Rate at least 100/min. Depth 5-6 cm (1/3 A-P diameter of chest) Allow chest recoil.

When possible change CPR operator/5 cycles.

How to perform effective chest compressions?

Give 2 effective rescue breathsApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

How to deliver effective rescue breaths ? Open the airway. Close the victim’s nose. Take a normal breath. Seal your lips over the

victim’s mouth. Blow until the chest rises. Pause for 1 second. Allow chest to fall. Repeat one more time.

Continue Chest compressions & Rescue breaths at a rate of:

2 30

Continue resuscitation until…

Qualified help arrives and takes over with AED & ACLS protocol.

The victim shows signs of life.You become exhausted.The Victim has a DNR order.

New Guidelines for a high quality CPR

1. Sufficient rate and depth without excessively ventilating.

2. few interruptions of chest compressions.3. completely relaxing pressure between

compressions.

• The order of interventions was changed from ABC to CABEXCEPT in:1. Newborn in whom hypoxia is MCC of cardiac arrest.2. Those believed to be in a respiratory arrest (drowning, drug

overdose…etc.).

Complications of CPR1. Most common: Rib fractures & sternal

fracture.2. Pneumothorax3. Bleeding: Hemopericardium, hemothorax

& anterior mediastinal bleeding.4. Contusion of: Heart & Lung.5. Lacerations of: Liver & Spleen.

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 123

30 chest compressions

2 rescue breaths

A quick Recap

Compression only (Hands only) (Cardio-cerebral) resuscitation

• Chest compressions without artificial respiration.• Easier: the method of choice for the untrained

rescuer• In adults with out-of-hospital cardiac arrest,

compression-only CPR by the lay public has a higher success rate than standard CPR.

• The exceptions: cases of drownings, drug overdose (with respiratory arrest) and arrest in children.

• Rate: the same as standard CPR (at least 100/min.)

CPR during pregnancy• During pregnancy when a

woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left.

• If this is not effective, either roll the woman 30° or healthcare professionals should consider emergency Caesarean section.

Pediatric BLS

Steps:

Open the airway

Check for Breathing

LOOK, LISTEN & FEEL

Check for Pulsation

Carotid, Brachial or Femoral

Chest compression

In children: If pulse < 60, start CPR to enhance the perfusion.

Give 15 effective chest compression

2 fingers technique 2 thumbs technique

2 hands technique 1 hand technique

Give 2 effective Rescue Breaths

Mouth to mouth & nose technique

Mouse to mouth technique

If the victim starts to breathe normally, Put him/her in the

Recovery Position

1 2

3 4

Steps of positioning the victim in the Recovery position

Aim of the Recovery Position.1. Gravity assistance to the clearance of physical obstruction of the airway

by the tongue. 2. Gives a clear route by which fluid (e.g. vomitus) can drain from the

airway.3. There is a room for the chest to rise and fall freely.

All forms of the recovery position share basic principles:

1) The mouth is downward so that fluid can drain from the patient's airway.2) The chin is upward to keep the epiglottis opened. 3) Arms and legs are locked to stabilize the position of the patient.