BASIC LIFE SUPPORT
CARDIO PULMONARY RESUSCITATION DR.AHMAD ZAINI BIN MOHD SALLEH KMN AMK
Senior Consultant and Head of Department
Department of Anesthesiology and Intensive Care
Hospital Sultan Abdul Halim
DEFINITION
• • level of medical care which is used for level of medical care which is used for victims of life victims of life - - threatening illnesses or threatening illnesses or injuries until they can be given full injuries until they can be given full medical care at a hospital. It can be medical care at a hospital. It can be provided by trained medical personnel, provided by trained medical personnel, including emergency medical including emergency medical technicians, paramedics, and by technicians, paramedics, and by laypersons who have received BLS laypersons who have received BLS training. training.
OBJECTIVES
• How to assess the collapsed victim
• How to perform chest compression and rescue breathing
• How to place an unconscious breathing victim in the recovery position.
• How to relieve foreign body obstruction
THE ABC of CPR (2005 AHA)
A irway
Does the victim have an open airway?
B reathing
Is the victim breathing?
C irculation/ C ompression - Ventilation
Is the victim ’ s heart beating?
Is the victim bleeding severely?
D efibrillation
THE CAB of CPR (2010 AHA)
C irculation/ C ompression
Is the victim’s heart beating?
Is the victim bleeding severely?
A irway
Does the victim have an open airway?
B reathing
Is the victim breathing?
D efibrillation
CHAIN OF SURVIVAL
1.Immediate recognition of cardiac arrest and activation of the emergency response system (EMS)
2. Early CPR with an emphasis on chest compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post–cardiac arrest care
BASIC LIFE SUPPORT
SEQUENCE OF PROCEDURES PERFORMED TO RESTORE THE CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY AND/OR CARDIAC ARREST
CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER EQUIPMENT
BASIC LIFE SUPPORT
When to CPR?• In the absence of
breathing and pulse in an unresponsive victim
• If the victim has agonal gasps
• If victim is in cardiac arrest
BASIC LIFE SUPPORT
• .
Call First or CPR First?
Call First
1. Activate EMS
2. Return to victim
3. Provide CPR
CPR First
1. Give 5 cycles (2 minutes) of CPR
2. Leave victim
3. Activate EMS
BASIC LIFE SUPPORT
• .
Call First or CPR First?
Call First!!!
• Sudden collapse in adult or child
• Collapse likely cardiac in origin
CPR First!!!
• Drowning victim
• Asphyxial (primary respiratory) arrest in any age
WHAT TO DO…
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
APPROACH SAFETY
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
• SCENE
• VICTIM
• RESCUER
• BYSTANDER
CHECK RESPONSE
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
CHECK RESPONSE
Shake shoulders gently
Ask “Are you all right?”
If he responds,
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
SHOUT FOR HELP
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
OPEN AIRWAY
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
OPEN AIRWAY
Head tilt and chin lift
- lay rescuers
- non-healthcare rescuers
NO NEED FOR FINGER SWEEP
UNLESS SOLID MATERIAL IS
FOUND IN THE MOUTH
CHECK BREATHING
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
CHECK BREATHING
• LOOK, LISTEN AND FEEL FOR NORMAL BREATHING
• DO NOT MISTAKE AGONAL BREATHING FOR NORMAL
30 CHEST COMPRESSIONS
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
CHEST COMPRESSIONS
• Place the heel of one hand in the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
• Rate 100 min-1
• Depth 4-5 cm
• Equal compression : relaxation
• When possible change CPR operator every 2 min
2 RESCUE BREATHS
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
RESCUE BREATHS
• Pinch the nose
• Take a normal breath
• Place lips over mouth
• Blow until the chest rises
• Take about 1 second
• Allow chest to fall
• Repeat
RESCUE BREATHS
RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1sec with enough
volume to make the victim’s chest rise
- Chest-compression-only
continuously at a rate of 100 min
APPROACH SAFETY
CHECK RESPONSE
SHOUT FOR HELP
OPEN AIRWAY
CHECK BREATHING
30 CHEST COMPRESSIONS
2 RESCUE BREATHS
WHEN CAN I STOP CPR ?
• VICTIM REVIVES AND STARTS BREATHING
• TRAINED HELP ARRIVES
• TOO EXHAUSTED TO CONTINUE
• UNSAFE SCENE
• PHYSICIAN DIRECTED
• CARDIAC ARREST FOR MORE THAN 30 MINUTES
Why CPR May Fail ?
• Delay in starting
• Improper procedures (ex. Forget to pinch nose)
• No ACLS follow-up and delay in defibrillation
• Only 15% who receive CPR live to go home
• Improper techniques
• Terminal disease or unmanageable disease (massive heart attack)
• Poor quality CPR
HIGH QUALITY CPR
o Push hard and fast (at least 100 per minute).
o Allow complete chest recoil after each compression.
o Minimize interruptions.
o Compression depth of 2in (5cm) in adults,
1/3 AP diameter of the chest wall in infants (1.5in or
4cm) and children (2in or 5cm).
o Avoid hyperventilation
Complications of CPR
1. Vomiting-difficult to ventilate and risk of aspiration
2. Gastric distension
3. Punctured lungs, lacerated liver and fractured ribs and sternum
4. Disease transmission-HIV, hepatitis, herpes, influenza, TB, mononucleosis, Staphylococcus infection
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