1. BLS

2. EMERGENCY MEDICAL PROCEDURE BLS Primary survey ACLS Secondary survey
CPR
EMERGENCY MEDICAL PROCEDURE
BLS Primary survey
ACLS Secondary survey

3. BLS PRIMARY SURVEY Systematic approach to basic life support.
Includes early CPR and early defibrillation.
Until ROSC or ACLS intervention

4. TOOLS Mouth Hand If possible, Defibrillator &
Sincere desire to save a life

5. COMMON CAUSES
Half a million people die each year from CAD. 2/3 rd deaths outside the hospital , usually within 2 hours after onset of symptoms.
Drowning
Drug intoxication
Airway obstruction
Automobile accidents
Electrocution

6. HEALTHY HEART Controllable Risk factors Smoking Obesity Hypertension
Cholesterol
Diabetes
Stress

7. UNCONTROLLABLE RISK FACTORS
Age
Sex
Race
Heredity

8. Plan Healthier Life Styles
Diet
Exercise
Medications
Quit Smoking
Relaxed Life

9. Early Warning signs of MI
Pain : Indigestion
Uncomfortable pressure
Burning feeling lower chest
Squeeze in center of chest
Position : Chest
Back
Shoulder
Arms
Jaw
Upper abdomen

10. PAINLESS MI Other symptoms with or without pain Sweating
Nausea/Vomiting
Palpitations
Shortness of breath

11. VICTIM Weak Pale Feels Faint Sense of impending disaster
DENIAL BY PATIENT

12. STROKE RECOGNITION Headache Confusion
Weakness and Numbness of face/arm/leg
Dimness of vision
Speech difficulty
Loss of balance/falls
Many preceded by TIA’s

13. TIME IS CRITICAL Cardiac arrest = Victim clinically dead
Lack of Oxygen = Permanent damage in brain
Best chance of survival if EMS activated and CPR begun within 1st 4 minutes
Should be followed by defibrillation and ACLS within first 8 minutes
Permanent brain damage slower in near drowning especially in children/infants.

14. ASSESSMENT - ACTION Check breathing before giving rescue breaths
Check the pulse before starting chest compressions
Analyze for a shockable rhythm before delivering a shock

15. Defibrillation Airway Breathing Circulation Perform in ABCD order
Breathing is necessary to support circulation

16. Assess unresponsiveness
Gentle Tap and Shake victim’s shoulder and Shout loudly near his ear- Are you OK?
If unresponsive
Shout for help
Activate EMS
In Adults: Activate EMS, then do CPR(>8 yrs)
For Children: Two minutes CPR, then call EMS.

17. AIRWAY Head Tilt/ Chin Lift Maneuver Head Tilt = Head rotates back
Chin Lift = Jaw is raised

18. POSITIONING AIRWAY
Palm of hand on victim’s fore head and pressure - gentle for infants / more for child/ hyperextension for adults
Other hand’s fingers hooked under the bony part of lower jaw on side nearest to you.

19. BREATHING Look: Chest or belly movement
Listen: Air movement at nose and mouth
Feel: Air at mouth and nose

20. Inspiration - 20% oxygen used
MECHANISM OF RESCUE BREATHS
Inspiration - 20% oxygen used
Expiration - 80% exhaled(This is more than enough for the victim)

21. RESCUE BREATHING Mouth to mouth or mouth to nose
2 slow independent breaths
1 sec. delivery in adults
1 sec. delivery in children/infants
Allow time to exhale before second breath.

22. RESCUE BREATHS
Quick BreathsHigh airway pressure Air may enter stomach
Tight air sealfor both nose and mouth breathing
Infantsboth nose and mouth covered
Mask or face shield/after training

23. CIRCULATION - ASSESSMENT
Look for the carotid artery pulse
Maintain head tilt with one hand
Feel Adam's apple with other hand
Draw fingers back toward groove beside Adam's apple and press
Take 5-10 sec. to determine pulse

24. VICTIM’S POSITION Victim- over horizontal, firm surface
No pillow under head
Slightly elevate legs
Lower half of sternum
Never over Xiphoid

25. RESCUER’S POSITION One knee at victim’s shoulder and other at waist.
Contact with heel of one hand.
Interlock other hand over it.
Shoulders directly over victim’s sternum.
Straighten your arms.
Don’t let hands slip off.
Fingers must not press on ribs.

26. CHEST COMPRESSIONS-ADULT
Depress sternum 1.5”-2”.
Movement is at hips.
Don’t rock back and forth on knees.
Fully release pressure to allow chest to return to normal position.
Irregular,jabbing compressions should be avoided.

27. CHEST COMPRESSIONS
Even Best compressions result in ¼ to 1/3 of normal cardiac output.
So, it should be
Smooth
Regular
Uninterrupted
100/min.
Cycle should be 30:2
Reassessment- after 2 mins.

28. COMPLICATIONS OF CPR Sternal or Rib fracture
Separation of Costo Chondral Junction
Punctured Lung
Lacerated Liver
Bruises on Heart
Above reduced by good CPR technique.

29. CIRCULATION CHILDREN INFANTS Less than one year 1 – 8 year
Carotid artery
One hand
100/mt.
1-1.5 inches
INFANTS
Less than one year
Brachial artery
Two fingers
120/min.
0.5-1 inch

30. OBSTRUCTED AIRWAY Conscious adult may show universal sign of choking
Or ask “Are U Choking ?”
If coughing, encourage.
If there is ineffective cough, go to Heimlich’s Maneuver.

31. HEIMLICH’S MANEUVER If patient is standing, go behind the patient.
Wrap around victims waist.
Thumb side of fist on pt’s abdomen.
Midway between naval and Xiphoid.
Inward,upward thrust.
After five thrusts, reassess.

32. UNCONCIOUS ADULT Assess unresponsiveness
A and B. If unsuccessful, reposition and try again.
Even then unsuccessful, go to Heimlich’s maneuver.
Contd….

33. HEIMLICH’S MANEUVER Knee straddling thighs
Heel of hand in middle of abdomen
Not over Xiphoid
Press inward and upward along midline.
Not on either side.
Series of 5 thrusts in rapid succession

34. FB OBST. INFANT & CHILDREN
Less than one year
Support in arm with face down
Five back blows between shoulder blades
Five chest thrusts over mid sternum
CHILDREN
One to eight years
Only abdominal thrusts like adult with little pressure

35. FOREIGN BODY CHECK Tongue and jaw lift
Finger sweep if able to see the foreign body
Breathing attempt: If failure, reposition and try again.
If obstruction relieved
Give 2 rescue breaths
Feel pulse
If pulse absent, start CPR as 30:2
Contd……

36. FOREIGN BODY CHECK
In case of infants and children, sweeping should be done only if you see that.
Check for breathing and pulse as usual.

37. SUMMARY ADULT CHILD INFANT > 8 years 1-8 years <1 year 12 20
20/min
2 hands
1 hand
2 fingers
1.5-2 inch
1-1.5 inch
0.5-1 inch
100/min
120/min

38. Thank u