1. Dept. of Anaesthesiology. K.G.M.C.H. BASIC LIFE SUPPORT GUIDELINES

2. RESUSCITATION RESUSCITATION Means Cardiopulmonary resuscitations Means Cardiopulmonary resuscitations Anywhere Anybody can do Anywhere Anybody can do

3. CPR… Considered when an individual Considered when an individual cannot adequately breathe and maintain circulation to vital organs.

4. WHY& WHEN TO DO IT ? Without CPR, irreversible brain damage occurs within Without CPR, irreversible brain damage occurs within 3-4 minutes Should be done immediately by a bystander Should be done immediately by a bystander TIME is the crucial factor here to decide the survival TIME is the crucial factor here to decide the survival

5. Minutes counts... Minutes counts... when the heart stops, damage occurs to the Brain within < 5 minutes when the heart stops, damage occurs to the Brain within < 5 minutes start BLS early start BLS early

6. CPR… CPR… BLS BLSACLS ALS ALSANLS CPCR – Cardio Pulmonary Cerebral resuscitation CPCR – Cardio Pulmonary Cerebral resuscitation

7. CPR… ABCDEF How ? Airway Airway Breathing BLS Breathing BLS Circulation Circulation Drugs Drugs ECG ACLS ECG ACLS Fibrillation Fibrillation

8. The Sequence of BLS Establish Unresponsiveness Establish Unresponsiveness If no response call for help If no response call for help Start BLS------- A- Airway Start BLS------- A- Airway B- Breathing B- Breathing C- Circulation C- Circulation

9. CPR… RECOGNITION Is crucial in BLS Determine Unresponsiveness Unresponsiveness Breathlessness Breathlessness Pulselessness Pulselessness

10. No victim should undergo CPR until the need for resuscitation is established.

12. 2. Check the Victim and see if he responds Gently SHAKE his shoulder Gently SHAKE his shoulder Ask loudly “Are you all right?” Ask loudly “Are you all right?”

14. 3A. Responds by answering or moving Leave him in the position. Leave him in the position. Reassess him regularly. Reassess him regularly.

15. 3B. If no response 3B. If no response SHOUT for help (Call for defibrillator) SHOUT for help (Call for defibrillator) Turn to his back and open airway. Turn to his back and open airway. HEAD TILT  Hand on forehead. HEAD TILT  Hand on forehead. Remove any visible obstruction. Remove any visible obstruction. CHIN LIFT  finger tips under the point of chin. CHIN LIFT  finger tips under the point of chin. Avoid head tilt in Trauma

16. CPR… CPR… Activation of EMS Activation of EMS Call for help Call for help Call for ambulance services Call for ambulance services Emergency

17. BLS ALGORHYTHM CHECK RESPONSIVENESS OPEN AIRWAY CHECK BREATHING ventilation A B CIRCULATION C

18. CPR… Airway - First basic skill Head tilt Head tilt Chin lift Chin lift Jaw thrust Jaw thrust Airways Airways ET intubation ET intubation Newer airways Newer airways

19. CPR… AIRWAY Head tilt Jaw thrust Chin lift

20. CPR… Breathing – Second basic skill LOOK for chest movement LOOK for chest movement LISTEN for breath sounds LISTEN for breath sounds FEEL for air on your cheek FEEL for air on your cheek 2 slow effective rescue breathing 2 slow effective rescue breathing

21. LOOK, LISTEN AND FEEL LOOK LISTEN FEEL

22. 5A. Breathing Normally Turn him into recovery Position. Turn him into recovery Position. Send or go for help. Send or go for help. Check for continued breathing. Check for continued breathing.

23. Recovery position. To maintain a good airway To minimize the risk of aspiration

24. Recovery Position To Maintain a good airway. To Maintain a good airway. To Minimize the risk of aspiration. To Minimize the risk of aspiration.

25. 5B. Not Breathing Rescue breathing Ensure head tilt and chin lift. Ensure head tilt and chin lift. Pinch the Nose. Pinch the Nose. Two Slow effective breaths. Two Slow effective breaths. Rise and fall of the Chest

26. Rescue Breathing  Required if breathing is absent or inadequate  Give 2 slow breaths sufficient to make the chest rise  Adult: Over 2 seconds  Child & Infant: Over 1 – 1 ½ seconds

27. Rescue Breathing Techniques Mouth-to-Mouth Mouth-to-Mouth Mouth-to-Barrier Mouth-to-Barrier Mouth-to-Nose Mouth-to-Nose Mouth-to Mask Mouth-to Mask Bag-mask device Bag-mask device

28. Any difficulty achieving an effective breath. Recheck Victims mouth. Recheck Victims mouth. Recheck head tilt and chin lift. Recheck head tilt and chin lift. Make up to 5 attempts. Make up to 5 attempts. Even in unsuccessful, move on to assessment of circulation. Even in unsuccessful, move on to assessment of circulation.

29. NO - Circulation Absent carotid pulse. Absent carotid pulse. Lay Rescuer. Lay Rescuer. Normal Breathing. coughing Movement. Sign of Cardiac arrest. No More than 10 Sec.

30. CAROTID PULSE Identify Adam’s apple (Thyroid Cartilage). Identify Adam’s apple (Thyroid Cartilage). Slide down to the groove. Slide down to the groove. Palpate pulse in the groove. Palpate pulse in the groove. Never Palpate on both sides simultaneously. Never Palpate on both sides simultaneously.

32. 7A. Circulation Present Continue rescue breathing. Continue rescue breathing. Recheck rescue breathing. Recheck rescue breathing. Normally breathing  Recovery Position. Normally breathing  Recovery Position.

33. 7B. No signs of Circulation Chest compressions. Chest compressions. Identity middle of Lower half of Sternum. Identity middle of Lower half of Sternum. compressions by heel of the hands. compressions by heel of the hands. After 15 Compressions tilt the head, lift the chin and give 2 effective breaths. After 15 Compressions tilt the head, lift the chin and give 2 effective breaths.

34. Chest Compressions No pulse present START CHESTCOMPRESSIONS START CHESTCOMPRESSIONS Compression Rate: Adult, Child, & Infant – 100/min Adult, Child, & Infant – 100/min

35. TECHNIQUE OF EXTERNAL CARDIAC COMPRESSION Rescuer to one side of the patient Rescuer to one side of the patient Patient’s chest exposed and xiphisternum identified Patient’s chest exposed and xiphisternum identified Xiphisternum –Bony prominence in the mid line at the junction of lower borders of the ribs Xiphisternum –Bony prominence in the mid line at the junction of lower borders of the ribs The index and middle fingers of the lower hand placed on the xiphisternum and heel of the other hand is placed adjacent to them on the sternum The index and middle fingers of the lower hand placed on the xiphisternum and heel of the other hand is placed adjacent to them on the sternum

36. Heel of the second hand placed on the back of the hand on the sternum Fingers may be interlocked Sternum depressed vertically4- 5cm and then released rapidly Repeated at a rate of 80- 100/minwith compression and relaxation each taking the same length of time

37. Locate rib cage

38. Position your hands over middle of lower half of sternum and fingers away from Chest

39. Compression of Chest Arms Vertical Arms Straight Press  Depress 4-5Cm

41. CPR 15 x 2 x Chest compressions Breathing One Rescuer

42. Two rescuers

43. Depth of Compression Depth of Compression Adult: 1 ½ - 2 inches or enough Adult: 1 ½ - 2 inches or enough to generate a pulse to generate a pulse Child & Infant: 1/3 – ½ the depth Child & Infant: 1/3 – ½ the depth of the chest or enough to generate of the chest or enough to generate a pulse a pulse

44. Continue Resuscitation Until Continue Resuscitation Until Qualified help arrives and takes over. Qualified help arrives and takes over. Victim shows signs of life. Victim shows signs of life. You become exhausted. You become exhausted.

45. Reassessment (10 seconds)  Should be performed after the first minute of CPR and every few minutes thereafter  If no pulse- resume CPR  If pulse and breathing present- place in recovery position  If pulse present but no breathing- provide rescue breathing

46. BLS Algorithm CHECK RESPONSIVENESS OPEN AIRWAY CHECK BREATHING BREATHE ACCESS CIRCULATION 10 seconds only CIRCULATION PRESENT Continue Rescue Breathing NO CIRCULATION Compress Chest Shake & Shout Head tilt / Chin lift Look, Listen and Feel 2 Effective Breaths Signs of a Circulation 100 Per Minute 15:2 RatioCheck Circulation every Minute

47. CPR… Nutshell Nutshell AdultPaediatric Breath rate 10 – 12 bpm 20 bpm Pulse check CarotidBrachial Compression rate 100/min>100/min Compression method Hands interlaced Two or three fingers or heel of one hand CV ratio 15 : 2 5 : 1 FB obstruction Heimlich maneuver Back blows and chest thrusts

48. ACLS Special equipments and techniques Special equipments and techniques ECG monitoring ECG monitoring Defibrillation Defibrillation iv access iv access Drug therapy Drug therapy Post resuscitation care Post resuscitation care

49. NOW HE IS SAFE IN HELPING HANDS