Basic life support

1. BASIC LIFE SUPPORT AND ADVANCED TRAUMA LIFE SUPPORT By- Hemam Shankar Singh 3 rd Yr BDS

2. Basic life support Cardiac arrest and respiratory arrest occurs when patients heart suddenly stops beating, and there is cessation of respiration It leads to decreased – circulation of blood -- oxygen to important organs BLS is an attempt to restore respiratory and cardiac function. Primary emphasis of BLS— Removing upper airway obstruction and maintaining the patency of airway Eliminating respiratory arrest Restoring circulation Procedure can be summarized as ABC of BLS BASIC LIFE SUPPORT

3. ABC of BLS First and foremost is Positioning A irway B reathing C irculation D efibrillation (P-A-B-C-D) BASIC LIFE SUPPORT

4. BASIC LIFE SUPPORT CHAIN OF SURVIVAL

5. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation

6. BASIC LIFE SUPPORT --By ‘Shake and Shout’ maneuver Shake shoulders gently Ask “Are you all right ?” Recognition Assistance & Position Airway Breathing Circulation Defibrillation

7. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Summon assistance Members of the emergency team should report to the scene Emergency drug kit Oxygen The AED Positioning – supine position i.e. head & chest parallel to floor, feet elevated slightly (10 degrees)

8. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Head tilt & chin lift to obtain a patent airway Jaw thrust Assessment Maintenance

9. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Head tilt & chin lift this stretch the tissues of the neck and lifting the tongue & epiglottis off the posterior wall of the pharynx Assessment Maintenance Campbell

10. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation while maintaining the position, place your ear approx. 1 inch victims mouth and nose look towards the chest of the victim assess for 5-10 seconds ASSESSMENT Rescue breathing

11. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation if respiratory arrest occurs or spontaneous ventilation is inadequate, then it is a must to ventilate the victim so that adequate oxygen is available to the brain Three ways of artificial ventilation Exhaled air ventilation Atmospheric (ambient) air ventilation O₂ -enriched ventilation Assessment RESCUE BREATHING

12. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Exhaled air ventilation Exhaled air can deliver 16-18 % inspired O₂, yielding an arterial PaO ₂ of 88 Torr (normal- 75 to 100 Torr ) at a tidal volume of 1000-1500mL Two basic types— Mouth-to-mouth Mouth-to-nose This technique do not need any adjunctive equipment Can be carried out in any situation Assessment RESCUE BREATHING

13. BASIC LIFE SUPPORT Rescue breathing Exhaled air ventilation Head tilt-chin lift position With mouth wide open, take a deep breath Make a tight seal around the victims mouth Blow into the mouth Air should be rapidly & deeply inhaled & deliver immediately must be repeated once every 5 to 6 seconds for adult 3 seconds for infant or children Repeated for as long as necessary Assessment of adequacy— Feeling the escape of air Seeing the rise & fall of chest Risk – Gastric aspiration Limit movement of diaphragm due to increase intraabdominal pressure thereby reduce the ability of the rescuer to ventilate Mouth-to-mouth

14. BASIC LIFE SUPPORT Rescue breathing Exhaled air ventilation It is used when victim Can’t open mouth Can’t make a good seal Severely injured mouth Head tilt-chin lift position Seal the victims lips with the mandible Seal your lips around the victims nose & blow until expansion of the victims lungs is felt & seen Repeat 10-12 breaths per minute in adults & children 20 breaths per minute for infant and young children i.e. once every 3 seconds Mouth-to-nose

15. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Atmospheric air ventilation Provides 21% O₂ Bag-valve-mask devices Airway adjuncts Assessment RESCUE BREATHING

16. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation O₂ enriched ventilation Oxygen cylinder with demand-valve mask unit Assessment RESCUE BREATHING

17. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Determine whether the blood is circulated or not Locate large artery– carotid(preferred) or femoral Palpate for 5-10 seconds ASSESSMENT Activation of EMS Chest compression f

18. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation After pulse check Call emergency number of the locality Assessment ACTIVATION OF EMS 108 Chest compression f

19. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation Rhythmical application of pressure over the lower half of the sternum Create blood flow by increasing intrathoracic pressure & by direct compression of the heart Proper compression can produced systolic arterial pressure peaks of 60-80 mm of Hg, diastolic is pressure is low Assessment Activation of EMS k CHEST COMPRESSION

20. BASIC LIFE SUPPORT Compression point One heel of one hand on the middle of the sternum between the nipples & other heel of other hand on top of the first so that they are overlapped & parallel Fingers interlaced, with the fingers of the top hand pulling the fingers of the lower hand upward Application of pressure Shoulders should be located directly over the sternum Elbow should be locked If victim is— lying on the floor, rescuer kneels at the victims side, close enough to body Dental chair, rescuer stands astride the victim, with the chair lower Downward compression should take 50% of the entire compression cycle Rate of chest compression 100 per minute & interruptions to no longer than 10 seconds Compression-ventilation ratio 30:2 To increase compression and to reduce hyperventilation CHEST COMPRESSION

21. BASIC LIFE SUPPORT CHEST COMPRESSION 30 2

22. BASIC LIFE SUPPORT Recognition Assistance & Position Airway Breathing Circulation Defibrillation It uses a device called AED (automated external defibrillator) AED is used only if the victim Does not respond Is not breathing Is pulseless AED 

23. BASIC LIFE SUPPORT DEFIBRILLATION attach pads to casualty’s bare chest analysing rhythm do not touch victim shock indicated CPR

24. BASIC LIFE SUPPORT CPR once started should be continued until one of the following occurs Recovery, demonstrating adequate spontaneous respiration and circulation and place in recovery position A physician arrives and assumes overall responsibility EMS personal arrive RECOVERY POSITION

25. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Objective Identify the correct sequence of priorities for assessment of a multiple injured pt. Apply the principles outlined in primary and secondary evaluation surveys of ATLS. Apply guidelines and techniques in the initial resuscitative and definitive care phases of treatment.

26. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey

27. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Initial assessment of the casualty Time interval Then proceed to the basic ATLS procedure i.e. (in short) ABCDE

28. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Breathing AIRWAY Circulation f Disability Environment & exposure Confirmation If patient talks normally, airway not compromised Hoarse voice or audible breathing, suspicious Assess the patient for airway obstruction (coma) Agitation--------------- hypoxia Cyanosis---------------- hypoxemia, secondary to inadequate oxygenation Hoarseness,----------- suspected laryngeal fracture s/c emphysema & palpable fracture

29. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Breathing AIRWAY Circulation f Disability Environment & exposure Established maintenance of airway through either of the two ---Head tilt-chin lift ---Jaw thrust JAW THRUST Rescuer fingers are placed behind the posterior border of the ramus of the mandible Displace the mandible forward, dislocating it while tilting the head backward Retract the lower lip with the thump JAW THRUST

30. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Breathing AIRWAY Circulation f Disability Environment & exposure If debris ( broken tooth, dentures) is present, remove it by—Finger sweep technique or --Yankauer suction or -- Magill’s forceps (for large object) If ---no foreign body is visible, endotracheal tube should be used to secure the established airway --- If the foreign body cannot be removed quickly or the vocal cords cannot be adequately visualized or endotracheal intubation is not possible, then cricothyroidotomy is indicated

31. ADVANCE TRAUMA LIFE SUPPORT Yankauer suction Magill’s forceps CRICOTHYROIDOTOMY ADVANCE TRAUMA LIFE SUPPORT

32. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Breathing AIRWAY Circulation f Disability Environment & exposure In patient sustaining significant blunt injury, should be assume to have cervical spine injury, until prove other-wise --- such pt. should have cervical spine immobilized with semi rigid cervical collar and bilateral sand bags or block joined with tapes or straps across the forehead

33. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT semi rigid cervical collar block joined with tapes or straps across the forehead

34. BREATHING Airway Circulation f Disability Environment & exposure ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Conditions that acutely compromised breathing are-- Tension pneumothorax Massive hemothorax Flail thorax accompanied by pulmonary contusion open pneumothorax compromise breathing Such condition can be diagnosed with physical examination & should be treated immediately It can be treated with endotracheal intubation, mechanical ventilation, needle thoracocentesis, or tube thoracostomy.

35. ADVANCE TRAUMA LIFE SUPPORT NEEDLE THORACOCENTESIS TUBE THORACOSTOMY ADVANCE TRAUMA LIFE SUPPORT

36. Breathing Airway CIRCULATION f Disability Environment & exposure ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Circulatory problems in trauma patients are usually caused by hemorrhage First action is to stop bleeding For --- Intra oral bleeding-----------------bite a cotton swap Tongue laceration------------------deep suture across the laceration Bleeding from fracture-----------manually reducing and brittle wiring of the fracture fragments mandible end Mobile maxilla---------------------rubber mouth gags Soft tissues of head & neck----direct pressure on the bleeding site Torrential bleeding from--------epistat tube with anterior and posterior balloons the nasopharynx region

37. Breathing Airway Circulation f DISABILITY Environment & exposure ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Assessment of the neurological status. The Glasgow coma score (GCS ) worst score is 3 points GCS can be caused by a focal brain injury Optimal oxygenation and circulation are important to prevent secondary injury to the brain Impaired consciousness can be caused by hypoxia or hypotension for which ABC stabilization is essential Patients who open their eyes spontaneously, obey commands, and are normally oriented score a total of 15 points

38. Breathing Airway CIRCULATION f Disability ENVIRONMENT & EXPOSURE ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Represent Hypothermia Burns , and Possible exposure to chemical and radioactive substance Should be evaluated and treated

39. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT Initial assessment Primary survey Secondary survey Under this the pt. is examined from head to toe Appropriate additional radiographs of the thoracic and lumbar spine and the extremities are performed when indicated. CT scans, when indicate Secondary survey mnemonics Head/skull Has Maxillofacial My Cervical Spine Critical Chest Care Abdomen Assessed Pelvis Patient's Perineum Priorities Orifices Or Neurological Next Musculoskeletal Management Diagnostic tests / Decision ? Definitive care

40. ADVANCE TRAUMA LIFE SUPPORT ADVANCE TRAUMA LIFE SUPPORT IF, DURING THE SECONDARY SURVEY, THE PATIENT'S CONDITION DETERIORATES, THE PRIMARY SURVEY SHOULD BE REPEATED BEGINNING WITH “A”.