Basic Life Support

Sadam John Eclipse Jeru Lising

Basic Life Support

Basic life support is providing oxygen to the brain, heart and other vital organs until help arrives It is also known as cardiopulmonary resuscitation

Key Principles in Resuscitation: Strengthening the Links in the Chain of Survival

Successful resuscitation following cardiac arrest requires an integrated set of coordinated actions represented by the links in the Chain of Survival

The links include the following:

Immediate recognition of cardiac arrest and

activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post cardiac arrest care

Conceptual Framework for CPR: Interaction of Rescuer(s) and Victim

The Rescuer: Everyone can be a rescuer. CPR skills and their application depends on the rescuers training, experience and confidence. Chest Compression: All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims. Because of their importance, chest compressions should be the initial CPR action for all victims regardless of age. Rescuers who are able should add ventilations to chest compressions. Highly trained rescuers working together should coordinate their care and perform chest compressions as well as ventilations in a teambased approach.

Conceptual Framework for CPR: Interaction of Rescuer(s) and Victim

Most cardiac arrests in adults are sudden, resulting from a primary cardiac cause; circulation produced by chest compressions is therefore paramount. In contrast, cardiac arrest in children is most often asphyxial, which requires both ventilations and chest compressions for optimal results. Thus rescue breathing may be more important for children than for adults in cardiac arrest

CPR Guidelines

A. Response
1.

2.

3.

Assessing the victim of sudden illness or accident for unconsciousness is the initial action. Gently tap the patient shoulder and ask Are you okay?. Be alert for potential head/neck injury Activate EMS when the victim is found unconscious; if asphyxial arrest is likely, call after 5 cycles of CPR

4.

5.

For an unresponsive infant or child, the HCP should perform 5 cycles of CPR then activate EMS . HCP must assess the most likely cause of the arrest. If the infant or child has a sudden witnessed collapse, the collapse is likely to be cardiac in origin (hypoxic cardiac arrest) ; in this situation, the HCP shall activate the EMS after verifying that the victim is unresponsive

A. Response
6.

Place the victim in a supine position on a flat firm surface (logroll the victim with spine precaution)

Circulation

Palpate the carotid artery to assess circulation. Always check for the absence of a pulse before beginning chest compression on the victim. If the victim is older than 1 yr, asses the circulation via the carotid or femoral pulse. If the victim is younger than 1 yr of age, assess via brachial or femoral

Circulation
If + pulse, continue to rescue breathing If no pulse, initiate CPR immediately: Landmark: Lower half of the sternum Method (Child) : Use two hands with the heel of one hand on the chest and second hand on top; or, use one hand only with the heel of the hand on chest of victim Method (Infant): Two fingers

Airway (Overview)
A change in the 2010 AHA Guidelines for CPR and ECC is to recommend the initiation of compressions before ventilations. While no published human or animal evidence demonstrates that starting CPR with 30 compressions rather than 2 ventilations leads to improved outcomes, it is clear that blood flow depends on chest compressions. Therefore, delays in, and interruptions of, chest compressions should be minimized throughout the entire resuscitation. Moreover, chest compressions can be started almost immediately, while positioning the head, achieving a seal for mouthto-mouth rescue breathing, and getting a bag-mask apparatus for rescue breathing all take time. Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression

How to open the airway?

Jaw Thrust Method Head tilt Chin Lift

Rescue Breaths
Deliver each rescue breath over 1 second Give a sufficient tidal volume to produce visible chest rise

Airway (Overview)

Techniques: Adult: Mouth to mouth, mouth to nose, mouth to stoma, Mouth to Barrier device Infant: Mouth to mouth and nose Deliver each rescue breath over 1 sec Compression to ventilation ratio is 30-2

When can we say that the patient is revived?

According to the PRC BLS-CPR training for HCP workbook, the patient is revived when there is positive pulse and the patient is breathing spontaneously

When to stop CPR?

Pulse

and respiration return EMS arrives Administration of AED Physician declares the victim dead Rescuer is exhausted

Lets do it!
Scan the area. If scene is safe, approach the victim. 2. Ask if theres any bystander who can help. 3. Assess for responsiveness 4. Activate EMS (see previous topic on guidelines for when to activate EMS) 5. Assess for signs of circulation for no longer than 10 seconds.
1.

6. 7. 8.

9.

If no breathing but with pulse, do rescue breathing. If no pulse and breathing, do CPR. Recheck for breathing and circulation not longer that 10 seconds after 5 CPR cycles. If respiration and circulation resumes. Place the patient in recovery position.

Defibrillation and Defibrillator

Defibrillation: Introduction

According to the AHA website Defibrillation is a process in which an electronic device gives an electric shock to the heart. This helps reestablish normal contraction rhythms in a heart having dangerous arrhythmia or in cardiac arrest. In recent years small portable defibrillators have become available. These are called automated external defibrillators or AEDs.

It's essential to integrate early defibrillation into an effective emergency cardiovascular care system. This means employing the fivepart "chain of survival" concept.
Immediate recognition of cardiac arrest and activation of the emergency response system quickly calling the Emergency Medical Services (9-1-1) system. Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions promptly giving cardiopulmonary resuscitation when needed. Order a CPR Anytime Kit.

Contd
Rapid defibrillation having proper equipment and being trained to use it when indicated. Effective advanced life support including airway management, ventilation support, and treatment of rhythm disorders. Integrated post-cardiac arrest care a comprehensive, structured, integrated, multidisciplinary system of care should be implemented in a consistent manner

All emergency personnel should be trained and allowed to use a properly maintained defibrillator if they're likely to respond to cardiac arrest victims. This includes all firstresponding emergency personnel, both hospital and non-hospital.

To make early defibrillation possible, a defibrillator must be immediately available to emergency personnel responding to a cardiac arrest. Thus, all emergency ambulances and other emergency vehicles that respond to or transport heart patients should have a defibrillator.

The American Heart Association recommends that AEDs be available wherever large numbers of people congregate. Such places include airports, convention centers, sports stadiums and arenas, large industrial buildings, high-rise offices, large health fitness facilities, etc.

Defibrillation
Treatment of choice for Vfib and pulseless Vtach Not used for patients with pulse and conscious Defibrillation depolarizes a critical mass of myocardial muscle all at once, when they repolarize, the SINUS NODE usually recaptures its role as pacemaker

Defibrillator
Classified into monophasic and biphasic Monophasic delivers current in only one direction and requires increased energy loads Biphasic defibrillators delivers the electrical charge to the positive paddles, which then reverses back to the originating paddle. This system requires lower possibly non-progressive energy levels

Defibrillator
The lower the energy emitted by the defibrillator, the lesser the myocardial damage If defibrillation is unsuccessful, CPR is initiated and other acls treatments are begun.

Automated External Defibrillator

Description
Device used to convert ventricular fibrillation into a perfusing rhythm The AED differentiates nonventricular from ventricular fibrillation rhythms and allows for early defibrillation by first responders. AED is not recommended for infant younger than 1 year

AED: For Adult

Use adult pads For out of hospital response: Provide 5 cycles of CPR before defibrillating if response time was longer that 5-5 minutes

AED: For Child

Child pad and child system are used for a child 1-8 years of age

AED: Interventions
Attach pads to the victim Turn on the AED and push button to activate the analyzer Follow instruction given for AED usually assess, stand back, shock, and reassess CPR guidelines to treat cardiac arrest associated with ventricular fibrillation or pulseless ventricular tachycardia recommend the delivery of single shocks by a period of CPR; interruption of chest compressions to check circulation should not be done until about five cycles or approximately 2 minutes of CPR have been providedafter the shock

References
Silvestri, L. (2008). Comprehensive Review for the NCLEX-RN Examination. Elsevier Singapore. American Heart Association (2010). Highlights of the 2010 American Heart Association Guidelines for CPR and ECC.