Basic Life Support Learner outcomes: ECA 8 BTM: Section 6 jrcalc: part 2 section 1

Group work List the signs of cardiac arrest

Adult Basic Life Support Objectives: ECA BTM: 6.2 jrcalc: part 2 section 1

BLS Definition: To maintain airway patency and support breathing and circulation without the use of equipment other than a BVM and airway adjunct (OPA). BLS is a prelude to defibrillation.

Single Operator BLS Safety Check responsiveness Responsive patient – history & assessment Unresponsive patient: Obtain help Place pt. in supine position Look in mouth to ensure clear; clear if not Head tilt chin lift – consider c-spine Check breathing

Single Operator continued… Breathing normally – recovery position; re- assess Breathing abnormally Ascertain if there is a pulse or signs of life No pulse/signs of life Start compressions x 100 per min. After 30 compressions provide 2 ventilations (supplemental oxygen as soon as possible) Continue cycle until pt. recovers or ALS applied

Practical demonstration DangerDScene assessment ResponseRPatient assessment AirwayAMaintaining Airway + c spine control Airway sweep Head tilt chin lift Jaw thrust OPA BreathingBBag Valve Mask + supplementary O2 Circulation CChest compressions

Key Points Agonal breathing is common in early arrest No signs of life start compressions Completely occluded airway - chocking protocol Over the head and straddle CPR are acceptable CPR continues until AED or LP12 arrives Do not rely on palpable pulse as gauge of effective arterial flow

Any Questions

Summary Adult BLS UNRESPONSIVE? Summon help if appropriate Clear & Open airway NOT BREATHING NORMALLY? 30 chest compressions 2 rescue breaths 30 chest compressions

Late stage pregnancy CPR ECA 8.4 Basic principles of CPR are the same CPR must continue till examined at hospital – even when survival seems improbable Anatomical changes make CPR difficult Otherwise fit and healthy mother can die from easily resuscitable cardiac arrest

Airway A Placed in supine position – causes pressure on inferior vena cava Incline lat 30 o putting wedge under right side Manually move uterus to left and towards the head Breathing B O2 consumption increased in pregnancy Become hypoxic quicker BLS asap CirculationC Maintain circulation may be more difficult if in supine position Managing patient as describe in Airway will help Late stage pregnancy CPR

Laryngectomy stoma patient Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx.

Air in and out Stoma anatomy

Paediatric Life Support

Cardiac arrest in children is an extremely rare event Invariably it is secondary to another problem Hypoxia is the most likely cause Prognosis is poor The Guidelines have been simplified in 2005 to hopefully empower better patient care Introduction

An infant is a child under 1 year A child is between 1 year and puberty Size matters! Treat for the child’s size/weight rather than age Age Ranges

The PLS algorithm has changed to more closely reflect the adult algorithm There is clear evidence to show that doing ANYTHING in a paediatric cardiac arrest is significantly better than doing nothing Don’t get distracted by fear of doing things wrong Do the simple things well Practice practice practice !!!!! The Algorithm

Rescue breaths Infant Neutral position Apply chin lift / jaw thrust Child Ensure head tilt & chin lift / jaw thrust Suitable size bag & mask Inflate chest over sec Observe rise & fall of chest OPA Measure OPA Centre of the incisors to the angle of the jaw Insert OPA Concave side up – small child

Circulation check Infant – brachial pulse Child – carotid pulse Compressions Infant – tips of 2 fingers Child – 1 or 2 hands Lower 1/3 rd of sternum Sufficient to compress the chest by 1/3rd Rate – 100 / min

Paediatric cardiac arrest is rare Invariably it is secondary to another problem Manage problems early to prevent cardiac arrest Normal presentation is asystole Emphasis should be on good airway management and chest compressions Summary

Summary Paed BLS UNRESPONSIVE? Summon help if appropriate Clear & Open airway NOT BREATHING NORMALLY? 5 rescue breaths ? still unresponsive 15 chest compressions 2 rescue breaths

Summary Neonatal BLS Birth Summon help if appropriate Term/gestation/amniotic fluid clear/breathing/crying/good muscle tone Evaluate breathing/heart rate colour & tone Apnoeic or HR <100 Positive Pressure ventilation Keep warm/dry/clear airway/assess colour Provide warmth / position/clear airway if necessary Dry stimulate reposition HR <60 Ensure effective lung inflation Then add chest compression Yes NO A B C

Foreign Body Airway Obstruction CHOKING

Choking

FBO choking algorithm Suitable for adults and children over 1 year old Substitute chest thrusts for child less than 1

Back blows Heel of one hand Middle of back between shoulder blades Chest thrusts Lower sternum Similar to chest compressions – sharper & slower Abdo thrust – Heimlich manoeuvre Stand behind child. Arms under childs arms, encircle torso Clench fist, place between umbilus & xiphisternum Grasp with other hand Pull sharply inwards & upwards