BLS : CPR by: Saba, yacoub, maen

Basic life support (BLS) What? A :is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. Who? A :can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training.emergency medical techniciansparamedicslaypersons When? A: generally used in pre-hospital setting, and can be provided w/o medical equipment.pre-hospital

CPR What? A :Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest.cardiac arrest Indication : those who are unresponsive with no breathing or abnormal breathing. Where? A : may be performed both in and outside of a hospital.

CPR Purpose CPR alone is unlikely to restart heart; its main purpose is to restore partial flow of oxygenated blood to the brain and heart.brainheart Objective?? 1)to delay tissue death andtissue death 2)to extend the brief window of opportunity for a successful resuscitation w/o permanent brain damage.brain damage

Cardiac arrest

= heart fails to contract effectively  cessation of normal blood circulation circulation also known as cardiopulmonary arrest or circulatory arrest Cardiac arrest is different from (but may be caused by) a heart attack (MI), where blood flow to the muscle of the heart is impaired.heart attack

Cardiac Arrest Character?? A : abrupt loss of heart function Main sign??: 1) loss of consciousness + 2) pulseless Resuscitate?? A : within few minutes (4-5m) if there is any initiation of rescue effort like CPR

Why cardiac arrest is dangerous? Following cardiac arrest : 1.Loss of consciousness at about seconds 2.Electro-encephalogram become flat after 30 seconds 3.Respiration arrest - may be in 30 second after cardiac arrest 4.Pupil dilates fully after 60 seconds 5.Brain damage take places within 4-6 minutes after cardiac arrest 6.Irreversible cerebral cortical damage occur within minutes after cardiac arrest

Cardiac diseaseRespiratory causes Ischaemic heart disease Hypoxia (usually causes asystole) Acute circulatory obstruction Hypercapnia Fixed output states Metabolic changes Cardiomyopathies Potassium disturbances Myocarditis Acute hypercalcaemia Trauma and tamponade Circulating catecholamines Direct myocardial stimulation Hypothermia Circulatory causesDrug effects Hypovolaemia Direct pharmacological actions Tension pneumothorax Secondary effects Air or pulmonary embolism Miscellaneous causes Vagal reflex mechanisms Electrocution Drowning Etiology of Cardiac Arrest

"Hs and Ts" is the name for a mnemonic used to aid in remembering the possible treatable or reversible causes of cardiac arrest. Hs 1.Hypovolemia - A lack of blood volumeHypovolemia 2.Hypoxia - A lack of oxygenHypoxiaoxygen 3.Hydrogen ions (Acidosis) - An abnormal pH in the bodyHydrogenAcidosis 4.Hyperkalemia or Hypokalemia - Both excess and inadequate potassium can be life-threatening.HyperkalemiaHypokalemia 5.Hypothermia - A low core body temperatureHypothermiacore body temperature 6.Hypoglycemia or Hyperglycemia - Low or high blood glucoseHypoglycemiaHyperglycemia Ts 1.Tablets or ToxinsTabletsToxins 2.Cardiac Tamponade - Fluid building around the heartCardiac Tamponade 3.Tension pneumothorax - A collapsed lungTension pneumothorax 4.Thrombosis (Myocardial infarction) - Heart attackThrombosisMyocardial infarction 5.Thromboembolism (Pulmonary embolism) - A blood clot in the lungThromboembolismPulmonary embolism 6.TraumaTrauma

Pathophysiology of Cardiac Arrest 3 basic mechanism : 1.Ventricular Fibrillation / Pulseless Ventricular Tachycardia 2.Asystole 3.Pulseless Electrical Activity

Ventricular Fibrillation Occur in 30% of in-hospital cardiac arrest More common in ischemic heart disease More likely to respond to treatment ECG : bizarre irregular waveform, random in both frequency and amplitude Shows disorganized electrical activity in myocardium The only effective treatment is early defibrillation

ASYSTOLE Occur in 25% of in-hospital cardiac arrest Occur 10% of out-side hospital cardiac arrest Characterized by ventricular standstill due to suppression of the cardiac peacemaker by myocardial disease, anoxia, electrolyte imbalance,or drugs ECG shows flat traces Often represent massive heart damage Survival less than 4%

Pulseless Electrical Activity (PEA) loss of palpable pulse in the presence of recordable cardiac electrical activity caused by the inability of cardiac muscle to generate a sufficient force despite an electrical depolarization due to global cardiac insult Rarely occur outside the hospital practise 5% of in-hospital cardiac arrest ECG : Regular complexes in presence of circulatory failure Poor prognosis

Treatment (1) Cardiopulmonary resuscitation(1) Cardiopulmonary resuscitation (CPR) : provide circulatory support, followed by (2) Defibrillation(2) Defibrillation if a shockable rhythm is present. If a shockable rhythm is not present after CPR and other interventions, clinical death is inevitable.

Defibrillation = Administration of an electric shock to the heart. usually needed in order to restore a viable or "perfusing" heart rhythm.

Cardiac arrest patient receiving treatment

Defibrillation Defibrillation is only effective for certain heart rhythms: -Ventricular fibrillation Ventricular fibrillation -Pulseless ventricular tachycardia,Pulseless ventricular tachycardia Not : - Asystole orAsystole - Pulseless electrical activity.Pulseless electrical activity CPR is generally continued until the subject regains returnreturn of spontaneous circulation of spontaneous circulation (ROSC) or is declared dead.dead

CPR Definitions CPR: CardioPulmonary Resuscitation Newborn: birth through the 28th day of life Infant: 0-1 years of age Child:1-8 years of age Adult: older than 8 years of age BLS: Basic Life Support AED: Automated External Defibrillator

1. Immediate recognition of cardiac arrest and activation of the emergency response system 2. Early CPR with an emphasis on chest compressions 3. Rapid defibrillation 4. Effective advanced life support 5. Integrated post–cardiac arrest care Fundamental aspects of BLS are:

Step 1 : Immediate recognition of cardiac arrest and activation of the emergency response system Danger: Remember to ensure both your own safety and that of the patient. The safety of bystanders is also of important. Response: Place one hand on the patient’s forehead and shaking his/her shoulders gently with the other hand, whilst at the same time asking loudly ‘Are you alright?’ Always assume the patient may be deaf; ensure that he/she can see your lips move when assessing responsiveness.

Call for help: Activate the community emergency response system (eg: 911) The lay rescuer should phone the emergency response system once the rescuer finds that the victim is unresponsive. The healthcare provider can check for response and look for no breathing or no normal breathing (ie, only gasping) almost simultaneously before activating the emergency response system.

Step 2: Early CPR with an emphasis on chest compressions After activation of the emergency response system, all rescuers should immediately begin CPR for adult victims who are unresponsive with no breathing or no normal breathing (only gasping).

The new basic life support sequence of steps in C-A-B

Adult CPR: C : chest compressions Speed: Give 30 compressions in approximately 18 seconds (at least 100/min) Location: Middle of the chest Use: two hands Number: 30 compressions Frequency: all the compressions need to be delivered in 18 seconds Depth: 2 inches (5 cm)

Push hard and push fast Allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression. Minimize the frequency and duration of interruptions in compressions to maximize the number of compressions delivered per minute.

A compression-ventilation ratio of 30:2 is recommended. Rescuer fatigue may lead to inadequate compression rates or depth. When 2 or more rescuers are available it is reasonable to switch chest compressors approximately every 2 minutes (or after about 5 cycles of compressions and ventilations at a ratio of 30:2) to prevent decreases in the quality of compressions.

A: Open the airway Tilt the victim's head back and lift the chin to open the airway Apply a face shield protective mask

B: Rescue breathing - Mouth to mouth breathing: Cover the victim's mouth and nose with your mouth. Pinch the victim's nose if needed. Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations. Deliver each rescue breath over 1 second. Each breath should cause visible chest rise. If the victim's chest does not rise with the first rescue breath, reposition the head by performing the head tilt–chin lift again and then give the second rescue breath.

-Bag mask ventilation: It provides positive-pressure ventilation without an advanced airway. It is most effective when provided by 2 trained and experienced rescuers. One rescuer opens the airway and seals the mask to the face while the other squeezes the bag, both rescuers watch for visible chest rise. Masks should be made of transparent material to allow detection of regurgitation. They should be capable of creating a tight seal on the face, covering both mouth and nose.

Step 3: Use of a Defibrillator: Always read the machine's instructions first Turn the machine ON Place the age appropriate pads on the chest and the back of the victim The machine will detect the need for the shock If shock is advised, clear the victim Apply the shock, and turn the mashine OFF If victim doesn't recover, continue CPR until the paramedics arrive

If the victim recovers (is conscious again) leave him in the recovery positon The victim is placed on his or her side with the lower arm in front of the body.

designed to maintain a patent airway and reduce the risk of airway obstruction and aspiration. used for unresponsive adult victims who have normal breathing and effective circulation. Recovery position

Step 4: Effective advanced life support Step 5: Integrated post–cardiac arrest care

Children CPR: Location:middle of the chest Use:one hand Number:30 compressions Frequency: all the compressions need to be delivered in 18 seconds Depth: at least 1/3 AP diameter =2 inches=5cm

Infant CPR: Location: middle of the chest use: two fingers Number: 30 compressions Frequency: all the compressions need to be delivered in 18 seconds Depth: at least 1/3 AP diameter=one and half inches=4cm

High quality CPR is the cornerstone of a system of care that can optimize outcomes beyond return of spontaneous circulation(ROSC) Return to a prior quality of life and functional state of health is the ultimate goal of a resuscitation system of care

THANK YOU

References Highlights of the 2010 American Heart Association Guidelines for CPR and ECC