Basic Life Support (BLS)

CPR CPR (CPCR- cardio-pulmonary-cerebral resuscitation)

3 The heart is too good to die !

5 CPR BLS ACLS POST CPR STABLIZATION OR ORGAN PROTECTION TECHNIQUE OF CARDIOPULMONARY RESUSCITATION (CPR )

ACLS ( Advance Cardiovascular Life Support) Focus: more advanced assessments and treatments BLS ( Basic Life Support) Focus: basic CPR and defibrillation

7 EARLY ACCESS EARLY CPR EARLY DEFIBRILLATION (AED ) EARLY ACLS

8 Early ACCESS Early CPR Early DEFIB Early ACLS Chain of Survival

9 American Heart Association : “Textbook of Advanced Cardiac Life Support”

 Check for SAFETY  Check for RESPONSE  Gentle SHAKE & SHOUT No Response? Shout for HELP

11  Before initiating the BLS approach;

CABD instead of traditional ABC C: Circulation A: Airway B: Breathing

 Check for central pulse (Not peripheral!)  If there is not pulse resume chest compression immediately.  Compression to breathing ratio?  Difference between adults and pediatrics?

 Adults: 30:2  Pediatrics: 1 rescuer: 30:2 2 rescuers: 15:2  Infants: 5:1  Neonates: 3:1  Change rescuers after 5 cycles(2 min) since pulse checking.

 Rate 100/min  Depth 4-5 cm  50% compression, 50% relaxation  Systolic BP ~ mmHg MAP < 40 mmHg  CO ~ 30% normal

CHEST COMPRESSIONS AND CORONARY PERFUSION PRESSURE CPP at 5:1 Ratio CPP at 30:2 Ratio

 not intubated 30 compression : 2 ventilation  intubated 100/min compression : 8-10 ventilation /min Asynchronous COMPRESSION RATIO FOR 1& 2 RESCUER Perfusing rhythm : ventilation /min COPD : 6-8 ventilation /min

FATIGUE

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Hard and Fast Release completely Minimize interruptions only interrupt for 1. ventilation (until an advanced airway is placed) 2. rhythm check 3. shock delivery Rotate compression every 2 minutes with rhythm check CHEST COMPRESSION

 CHECK- Remove foreign body/debris  OPEN - Head tilt/chin lift or jaw thrust (Consider Tracheostomy/Laryngectomy Patients)

Head-tilt Chin-lift Maneuver

BREATHING

Rescue Breathing: “Gas flows down the path of least resistance” Gas can flow to the lungs or stomach Distribution of gas depends on – Peak airway pressure Inspiratory time Tidal volume – Lower esophageal sphincter opening pressure

PROBLEMS WITH HYPERINFLATION 1. Gastric inflation --> aspiration Solution: cricoid pressure (Sellick maneuver)

2. In COPD - rapid CO 2 wash out Alkalosis - auto PEEP (air trap) intrathoracic pressure Venous return BP (especially if hypovolemic) Problems with hyperinflation

How to Prevent Gastric Inflation Use a longer inspiratory time – 1 to 2 seconds for bag-mask ventilation with oxygen – 2 seconds for mouth-to-mouth or bag-mask ventilation with air Use a smaller tidal volume – Less tidal volume = lower peak airway pressure

ASSESS SEVERITY SEVERE AIRWAY OSTRUCTION INEFFECTIVE COUGH UNCONCIOUS?STARTCPRCONCIOUS? 5 BACK BLOWS 5 ABDOMINAL THRUSTS MILD AIRWAY OBSTRUCTION EFFECTIVE COUGH ENCOURAGE COUGH CHECK FOR DETERIORATION OR INEFFECTIVE COUGH OR RELIEF OF OBSTRUCTION

 Stand to one side and slightly behind  Lean casualty forward & support chest with one hand  Give up to 5 back blows

 Stand behind casualty and lean them forwards  Place fist between navel and breastbone  Grasp with other hand, pull sharply inwards and upwards  Repeat up to 5 times

 Pregnant victims  Very obese patients

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