Advanced cardiac life support basic life support.pptx

Advanced cardiac life support
Including BLC
basic life support
Medicine
Emergency life support skills

1. ACLS

2. INTRODUCTION ACLS : advanced cardiac life support is an orderly approach to providing advanced emergency care to a patient experiencing cardiac related problems Cardiac arrest : abrupt cessation of cardiac function resulting in loss of effective circulation Cardiovascular collapse : sudden loss of effective circulation due to cardiac and/or peripheral factors

3. CARDIAC ARREST Mechanical Stoppage of the heart.Sudden loss of consciousness with absent major pulses. There is no breathing and death is inevitable if not treated

4. Ventricular tachycardia R-R interval usually regular ,not always QRS complex is not preceded by p wave Wide and bizzare QRS difficult to find seperation between QRS and T wave

5. Ventricular fibrillation A severely abnormal heart rhythm that can be life threatening Not identifiable P,QRS or T wave

6. Asystole A state of no cardiac activity ,hence no contractions of the myocardium and no cardiac output or blood flow Rate, rhythm, p and QRS are absent

7. Pulseless electrical activity Unresponsiveness and no pulse palpable Some organized electrical activity It is previously known as electromechanical dissociation

8. CHAIN OF SURVIVAL

9. BASIC LIFE SUPPORT (BLS) Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.

10. CARDIAC ARREST DIAGNOSIS By assessing and confirming Unresponsiveness Apnea or inadequate breathing No palpable pulse What is the sequence of steps?

11. In cardiac arrest According to guidelines ABC- CAB Circulation is the priority In chest compression , pushing the blood to the brain,so that ischaemia doesn’t happen. 30 compressions ,2 ventilation – cycle of COR (2min)

12. RECOGNITION OF ARREST

13. CHECK RESPONSIVENESS

14. IF UNRESPONSIVE Call for help Activate E mergency medical services Retrieve AED if available

15. THEN CHECK BREATHING OR ONLY GASPING & PULSE

16. IF IN CARDIAC ARREST Start chest compressions Give 30 compressions

17. Depth of compression should be atleast 2 inch or 5 cm Allow the chest to recoil between the compressions But do not take your hand off the chest. Shoulders should be directly over the sternum Your elbows should not be bend In adults 30 compressions and 2 ventilatios Perform compressions at the rate of 100/ min Pust hard and push fast In hospitals, for ventilation ambu bag is used In hospitals ECG machine Defibrillator Cardiac medications

18. AFTER 30 CHEST COMPRESSIONS “AB” Open the airway and give 2 breaths

19. Respiratory Arrest Apneic or inadequately breathing patient with a pulse Management Open the airway and ventilate. One breath every 5 to 6 seconds for adults. One breath every 2 to 3 seconds for infants and children. Check pulse every 2 minutes Adjuncts like OPA, NPA, advanced airway.

20. CARDIAC ARREST AND THE D STEP The importance of the D step Saves patients Decides about continued care i.e. ACLS Cardioversion and defibrillation are both procedures that use electrical shocks to restore a normal heartbeat, but they differ in their timing and use

21. DEFIBRILLATION BIPHASIC WAVE FORM :120-200 J MONOPHASIC WAVE FORM:360J

22. HOW TO USE IF The patient is not intubated remove O2 delivery devices If intubated either leave bag valve resuscitator attached to et or remove it If available use self adhesive defibrillation pads Do not place over pacemakers Remove transdermal patches

23. PROCEDURE Place sternal paddle over right of the sternum below the clavicle Place apical paddle in mid axillary line in the 5 th IC space Switch on the defibrillator Charge the defibrillator to 200J or 360J Warn all other rescuers to stand clear-ARE YOU CLEAR Visually check all are clear Ensure yourself you are not touching patient or bed ‘I AM CLEAR’ deliver shock restart CPR w/o checking pulse

24. AUTOMATED EXTERNAL DEFIBRILLATOR Switch on AED Attach electrode pads Place electrodes as that of manual one Follow voice commands Make sure no one in contact with the patient Push shock button

25. Treatable causes of cardiac arrest 5H ‘ s Hypoxia Hypovolemia Hypo/ hyperkalemia Hypothermia Hydrogen ion T’s Toxins Tamponade Tension pneumothorax Pulmonary thrombosis Coronary thrombosis

26. PHARMACOTHERAPY

27. Amiodarone Indications : VT, VF IV dose : 300mg in 20-30 ml of NS Supplementary dose of 150 mg as same above Followed with continuous infusion of 1 mg /min for 6 hrs then ,5 mg /min to a max daily dose of 2g lidocaine IV dose: 1-1.5mg/kg bolus then continuous infusion of 2-4 mg /min, can be given down ET tube Signs of toxicity : slurred speech,seizures,altered conciousness

28. EPINEPHRINE Alpha beta 1 and beta 2 stimulation IV dose of 1 mg every 3-5 min It may increases ischaemia b/c of increased o2 demand by heart.

29. Cardiac arrest associated with pregnancy

30. Recommendations for CS When the gravid uterus is large enough to cause maternal haemodynamic changes due to aortocaval compression. Emergency CS Should be considered regardless of fetal viability

31. POST CARDIAC CARE

32. POST CARDIAC CARE