BASIC LIFE SUPPORT

Instructor: Dr. Nguyen Van Phu

AGENDA
1. 2. 3. 4. 5. 6. 7. Chain of survival Primary survey DR(S)CAB (D) Cardiopulmonary resuscitation (CPR) Automated external defibrillation (AED) Control severe bleeding Secondary survey Head to toe examination Unconsciousness Recovery position

1. CHAIN OF SURVIVAL

Early Recognition & Activation of EMS

Early CPR

Early Defibrillation

Early Advanced Care

1. Recognize an Emergency: recognize the emergency and call the EMS system in the area. 2. Early CPR: CPR is the critical link that buys time between the first link (call EMS) and the third link (use the AED). The earlier you give CPR to a person in cardiac or respiratory arrest, the greater their chance of survival. 3. Early Defibrillation: use the AED. The sooner you provide defibrillation with the AED, the better the victim's chances of survival. 4. Early Advanced Care: Transfer to Advanced Care.
1. Chain of Survival 3. Cardiopulmonary Resuscitation 5. Control Severe Bleeding 7. Recovery Position

2. Primary Survey

4. Automated External Defibrillation

6. Secondary Survey

2. PRIMARY SURVEY

D DANGER R RESPONSE S SEND SOMEONE TO CALL FOR HELP C CIRCULATION

A AIRWAY
B BREATHING D DEFIBRILLATION

1. Chain of Survival 2. Primary Survey

3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation

5. Control Severe Bleeding 6. Secondary Survey

7. Recovery Position

Danger

Detect dangers Protect yourself

Look, listen, smell to detect hazards Remove the hazards if possible If impossible, remove the victim immediately

From blood borne pathogens: cover wounds, PPE, face shield for CPR, hand washing, contaminated clothes disposal

EMSs assistance Yes / No

THE MOST CRITICAL THING IS YOUR SAFETY NEVER PUT YOURSELF IN DANGERS AND BECOME A NEXT CASUALTY

Response
The brain is the center of the body control and it requires a constant supply of oxygen and food (essential sugar).

Nerve tissue is sensitive and will be affected rapidly by lack of essential fuels, especially oxygen.
Brain damage starts in 4-6 minutes. Brain damage is certain after 10 minutes without CPR. Tap and shout. Is there any response? Look at the persons chest and face. Is the person breathing normally? (in less than 10 seconds).

Are you alright?

AVPU: Alert Voice Pain Unresponsive.

Conscious: assess any further injury (secondary survey) & seek medical help.

Unconscious: shout for help.

Send someone to call for help

Send someone to call and tell him to come back. The caller should give dispatch the patients location, what happened, how many people are injured, and what is being done. If alone and no one is available: CALL first for adults and get the AED. Return to start CPR and use AED. CARE first for children and infant by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number. CARE first for all age patients of hypoxic (asphyxia), arrest (drowning, injury, drug overdose) Newborn: up to one month year old

Infant: one month to one year old

Child: one year to puberty Adult: puberty on

Circulation

Check for the pulse in no more 10 seconds:

Adult and child carotid artery in the neck Infant brachial artery, inside of upper arm If the pulse present but no breathing, start rescue breathing. Each breath should last 1 second. Reassess pulse every 2 minutes.

Adult 1 breath every 5 seconds

Child 1 breath every 4 seconds Infant 1 breath every 3 seconds If the pulse is < 40 in adult or < 60 in child / infant >>> start chest compression If unsure a pulse is exist >>> start chest compression Do not waste more critical time searching for a pulse

Circulation
Give 30 chest compressions, at least 100 per minute for all ages.

Hand placement:

Adult Place heel of dominate hand on the center of chest between nipples. The second hand should be placed on the top. The deep is at least 2 inches # 5 cm.
Child Place heel of one hand in the center of chest between nipples. Compress at least 1/3 the depth of chest.

Infant Place 2 fingers on the center of chest between nipples. Compress at least 1/3 the depth of chest.

Airway When consciousness is lost, airway obstruction and oxygen deprivation may develop. Tongue is the most common reason of airway obstruction in an unconscious victim. Head Tilt Chin Lift method. Jaw Thrust method. If you see any foreign objects, sweep it out right away.

Head Tilt Chin Lift

Jaw Thrust

Breathing

Give 2 effective breaths lasting 1 second each (chest rise and fall). Adult 1 breath every 5 seconds Child 1 breath every 4 seconds Infant 1 breath every 3 seconds Adult and child pinch nose, make sure good seal over mouth. Infant cover mouth and nose.

Defibrillation

Early defibrillation is very critical, especially in cardiac arrest. It is one of four actions in Chain of Survival.

The sooner you provide defibrillation with the AED, the better the victim's chances of survival.
It is totally automatic. We just follow the verbal instruction from the unit, that is all.

3. CARDIOPULMONARY RESUSCITATION

Continue cycles of 30 compressions to 2 breaths until AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene become unsafe, or we are too exhausted to continue. Every two minutes, check pulse and continue if needed.

1. Chain of Survival 2. Primary Survey

3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation

5. Control Severe Bleeding 6. Secondary Survey

7. Recovery Position

3. CARDIOPULMONARY RESUSCITATION

SUMMARY: Check Danger of the scene.

Check the Response and normal breathing.
Send someone to Call EMS. Check Circulation (pulse). Give 30 chest compressions. Open the Airway. Give 2 effective Breaths. Continue cycles of compressions to 2 breaths. 30

4. AUTOMATIC EXTERNAL DEFIBRILLATION (AED)

Defibrillators work by giving the heart a controlled electric shock, forcing all the heart muscles to contract at once, and, hopefully jolting it back into a regular rhythm AEDs allow trained rescuers to successfully deliver defibrillation even before EMS can arrive AEDs are safe, effective, lightweight, durable, low maintenance and easy to use

They are automated and wont let you administer a shock unless it is necessary. If a shock is not necessary you cant override it and shock anyway
All you do is place two electrodes on the casualtys chest and press one or two buttons then follow the verbal instruction
1. Chain of Survival 2. Primary Survey 3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation 5. Control Severe Bleeding 6. Secondary Survey 7. Recovery Position

5. COLTROL SERVERE BLEEDING

Introduction
Blood Volume in an adult is: 7% of their body weight 1 pump of cardiac output = 70 ml and the heart can circulate about 4.5 to 5 liter in a minute Much bleeding can cause death Bleeding from arteries: spurts under pressure, bright red Bleeding from veins: flows from a wound, dark red Bleeding from capillaries: oozes from a wound Classification: internal and external bleeding
a. External bleeding

Classification
Internal bleeding External bleeding
b. Internal bleeding
1. Chain of Survival 2. Primary Survey 3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation 5. Control Severe Bleeding 6. Secondary Survey 7. Recovery Position

5. COLTROL SERVERE BLEEDING

Control of bleeding
Protect yourself Direct pressure Elevation Pressure point control Pressure bandage Immobilization of the injured part Tourniquet Do not remove any impeded objects Always check pulse below the bandage to ensure circulation is not constricted

6. SECONDARY SURVEY
Formally begin this survey after completing the primary survey and after

starting the resuscitation phase. At this time, identify all injuries by conducting a thorough head-to-toe examination Monitor Vital Signs: Pulse; Respiratory rate; Blood pressure; Temperature; O2 saturations; Blood glucose; ECG Head: Skull for irregularity or scalp wounds; Ears (blood or CSF); Eyes for pupil size and reaction; Lips for color (cyanosed); Jaw for displacement; Mouth for loose or missing teeth or bitten tongue (Epilepsy); Skin color; texture and temperature (Flushed, Dry and Hot) etc Thorax: Clavicles for bruising and possible fractures; Sternum Bruising, Rib fractures; flail segments; bruising and abnormal breathing Abdomen: Rigidity and guarding; Pulsating masses; Bruising; Pelvis fractures or abnormal movement, bruising; Groin for dampness - Fitting patients commonly are incontinent during/after a seizure
1. Chain of Survival 2. Primary Survey 3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation 5. Control Severe Bleeding 6. Secondary Survey 7. Recovery Position

6. SECONDARY SURVEY
Limbs: Irregularity, deformity and fractures (compare limbs with each

other), shortening and rotation in legs; Flexion and extension without aggravating any injury; Signs of drug abuse (Needle marks); Identity bracelets; Capillary refill and distal pulses Back: Scapulae for fractures; Spine for irregularities Identity: If not done so already look for any form of identity, cards or bracelets; Any clues in pockets/bags e.g. medications; Do Not insert your bare hands into a patients pockets in case of sharps use a pen to peer into these areas if patient is unconscious or ask the patient to do it for you Before moving onto each section on the secondary survey go back and keep checking the patients CAB

Collate as much information as possible about the patient: Allergies; Medication; Previous medical history (Epilepsy, Diabetes); Last meal - This is relevant if a patient needs emergency surgery at hospital; Event - What has happened? Ask a passer by or the patient

7. RECOVERY POSITION
This position helps a semiconscious or unconscious person prevent the tongue falling back and block the airway. It also help them to breathe and permits fluids to drain from the nose and throat so they are not breathed in
Do not use the recovery position if the person has a major injury, such as a back or neck injury

1. Chain of Survival 2. Primary Survey

3. Cardiopulmonary Resuscitation 4. Automated External Defibrillation

5. Control Severe Bleeding 6. Secondary Survey

7. Recovery Position

RESCUE BREATHING
Instructor: Dr. Nguyen Van Phu

RESCUE BREATHING

D DANGER R RESPONSE S SEND SOMEONE TO CALL FOR HELP C CIRCULATION

A AIRWAY
B BREATHING D DEFIBRILLATION

RESCUE BREATHING
Universal Precaution:
Ambu bag Pocket mask Face shield / Mouth barrier

Hand gloves

RESCUE BREATHING

Technique:
First Aider kneels beside the casualty The casualty is supine Airway must be clear: Head tilt chin lift or

Jaw thrust
Use thumb and index finger to pinch the nose Take a deep breath Seal your mouth over the casualtys mouth

RESCUE BREATHING

Breathe into the victim slowly watch for the chest to rise Remove your mouth from the casualtys mouth Give 1 breath every 5 seconds

Reassess circulation every 2 minutes for no more than 10 seconds.

If unsure a pulse exist, start CPR. Do not waste more critical time searching for a pulse.

CARDIOPULMONARY RESUSCITATION
Instructor: Dr. Nguyen Van Phu

CARDIOPULMONARY RESUSCITATION

D DANGER R RESPONSE S SEND SOMEONE TO CALL FOR HELP C CIRCULATION

A AIRWAY
B BREATHING D DEFIBRILLATION

CARDIOPULMONARY RESUSCITATION
Untrained. If you are not trained in CPR, then provide hands only CPR. You do not need to try rescue breathing.

Trained, and ready to go. Start CPR with 30 chest compressions before checking the airway and giving rescue breathing.
Trained, but rusty. Just do chest compressions. The above advice applies to adults, children and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. A person may die within eight to 10 minutes.

CHEST COMPRESSION
Technique? Depth of compression: Adult at least 2 inches (5cm); Child / Infant at least 1/3 depth of chest. Rate at least 100 compressions / minute Compressions should be regular, smooth and uninterrupted. Avoid bouncing compressions

Do not lift your hands off the chest or change patients position between compressions

CHEST COMPRESSION
Positioning the patient External chest compressions can be effective on if the patient is supine on a firm surface. The patients head must be equal or lower the level of his heart. Elevate the lower extremities to promote the return of venous blood to heart. Fisrt Aiders position: Kneel beside the casualty. Place the heel of one hand on the breast bone, line of nipples. Place your other hand securely on top of the first hand. Fingers interlocked or extended. Keep fingers off the chest. Keep your shoulder vertically over the victims chest. Push harder and faster

CHOKING
Instructor: Dr. Nguyen Van Phu

CHOKING
The obstructed airway. It is often caused by foreign body lodged in the airway.

The recognition and proper management of choking is of the key importance to safety at homes, restaurants, and other public places.

PREVENTION OF CHOKING
1. Adults:
- Cut food into small pieces. - Chew food slowly and thoroughly., especially if wearing dentures. - Avoid laughing and talking during eating food. - Avoid excessive intake of alcohol before and during meals. 2. Infants and Children: - Keep marbles, beads and other small objects out of their reach. - Prevent them form walking, running or playing with food or toys in their mouths.

RECOGNIZATION OF OF CHOKING
Victim clutches at his neck, universal sign for choking.

If not sure of choking, ask victim loudly Are you choking? Can you talk? Can you breath? Can you cough?
Ask victim to cough as hard as his can.

If the chocking is getting worse, you will notice the victims coughing is becoming weak and ineffective.
- Victim is unable to breath. - Victim develops harsh noise while speaking. - Victim s face may become blue.

THE HEIMLICH MANEUVER

Adults and children: 1. Stay safe! Remember that victim may panic and inadvertently strike out. 2. Stand behind the victim with one foot in-between the victims feet and your other foot behind you. 3. Put your arms around the victims waist. 4. Make a fist with your right hand and place it just above the victims belly button. 5. Grab your fist with your left hand and thrust inwards and upwards forcefully. 6. Repeat thrust until the victim is able to breath again or until the victim becomes unconscious. 7. If the victim becomes unconscious, begin CPR. 8. If the patient is pregnant or too large to reach around, chest thrusts.

THE HEIMLICH MANEUVER

THE BACK BLOW CHEST THRUST

1. Infants: Support the infants face and place body on your forearm. Keep the infants head lower than the feet. Administer 5 back blows between the shoulders blades with palm of your hand. Support the infants head. Turn the baby over onto your other forearm. Give 5 chest thrusts. Continue back blows and chest thrusts until object comes out or infant becomes unconscious.

2.
3. 4. 5.

AUTOMATIC EXTERNAL DEFIBRILLATION

Instructor: Dr. Nguyen Van Phu

AUTOMATIC EXTERNAL DEFIBRILLATION (AED)

AEDs are designed to shock the heart, in order for the heart to restart under a normal rhythm. AEDs analyses the hearts rhythm, states whether a shock is advised and then powers up, the operator then push the button that will deliver the shock. Each minute that the defibrillation is delayed the chance of survival is reduced by 10%. After 10 minutes, few people are resuscitated. Early defibrillation increases survival rates to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AEDs as soon as it is available and ready. For a child or infant, if the child pads are not available, it is still recommended to use the adult pads.

AUTOMATIC EXTERNAL DEFIBRILLATION (AED)

AED considerations: Remove a patient from standing water, such as in a puddle, before AED use. Rain, snow, or a damp surface is not a concern.

Patient should be removed from a metal surface if possible.

Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker. Remove medication patches found on the patients chest with a gloved hand. Never remove the pads from the patient or turn the machine off.

AUTOMATIC EXTERNAL DEFIBRILLATION (AED)

1. Turn machine on. 4. Stand clear. Do not touch the patient when AED analyzes. 5. Push the shock button when AED advises. 6. Continue CPR 30:2 until signs of life detected.

2. Bare the chest. Dry it if wet. Shave it if there is excessive hair. 3. Follow directions shown on pads for placement.

AEDs will analyze every two minutes and prompt for a shock if needed.

AUTOMATIC EXTERNAL DEFIBRILLATION (AED)

For infants, it is preferable to use manual

defibrillator. AED with child pads can be used.

For children, an AED with child pads and a dose attenuator should be used. If only standard AED with adult pads is available, it should still be used for children and infants in cardiac arrest. Child pads are smaller than adults ones. Children, pads are in normal anteriorlateral position. A small child or infants, pads are in the anterior-posterior position.

BASIC LIFE SUPPORT PRACTICE 1. Cardio Pulmonary Resuscitation (CPR)

Four students do practice on one manikin. Each student does at least 3 cycles of 30:2 on the manikin.

2. Recovery Position
Each student performs Recovery position at least one on youre classmate.

2. Choking
Each student demonstrates Heimlich Maneuver on your classmate (Adult choking) and Back blow + Chest thrust on manikin (Infant choking).