Basic life support NCORT(old version).pptx

Basic life support for health care

1. NCORT Guidelines Basic Life Support Training for Trainer Basic Life Support Sarawak State 4-6 March 2015

2. NCORT National Committee for Resuscitation Training Created by Ministry Of Health Malaysia in 2006

3. NCORT Published in 2007 Committee from Anaesthesia and intensive care Emergency and traumatology Cardiology Peadiatrics General medicine

4. Created the Guidelines on Resuscitation Training on MOH Hospitals and Health Care Facilities 2011 Based on ILCOR 2010 Suited for local cultural, economic, system differences in practice and resources, and for ease of training

5. NCORT Guidelines Adult Basic Life Support Based on ILCOR part 5 and 7 Paediatric Basic Life Support Based on ILCOR part 5 and 10

6. ILCOR The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide an opportunity for the major organizations in resuscitation to work together on CPR (Cardiopulmonary Resuscitation) and ECC (Emergency Cardiovascular Care) protocols. The name was chosen in 1996 to be a deliberate play on words relating to the treatment of sick hearts - "ill cor " ( cor is latin for heart ).

7. NCORT Guideline

8. Highlights

9. 1.DANGER Assessing Danger and Safety to Rescuer prior to resuscitation Protect self from danger including: Wearing PPE; mask apron, and gloves Avoiding spills of body fluid, sharps and electrical wires at bedside Determining unstable beds and trolleys

10. 2.RESPONSIVENESS Assess by tapping both shoulders twice and calling “ Hello, hello are you OK?”

11. 2.RESPONSIVENESS - CHILD Gently stimulate the child and ask loudly “Are you alright?” If child responds by answering or moving, leave the child in the position found (provided safe), check condition and seek help. Reassess regularly If no response – Proceed to Shout!

12. 3 .SHOUT! Shout (Call) for help “Emergency! Emergency! Bring the resuscitation trolley and defibrillator”

13. 4 .Positioning of Patient Victims found on floor should initially managed on the floor Face down victims shall be rolled over to supine position Air filled mattress should be deflated during CPR Backboard not recommended – delays in initiation of chest compression, interrupting compressions, dislodging tubes or catheters

14. 5.Airway Open using Head Tilt and Chin Lift maneuver

15. 6.BREATHING – Adult Assessment of breathing Look for evidence of abnormal breathing or gasping Not more than 10 seconds Not for giving rescue breaths Not for LOOK, LISTEN and FEEL

16. 6.BREATHING - Adult LOOK at chest, neck and face Absence of breathing or presence of abnormal = cardiac arrest Agonal gasp = cardiac arrest Start Compression in absence of normal breathing

17. 6.BREATHING - Peads Keep airway open, LOOK, LISTEN and FEEL for normal breathing Not more than 10 Seconds If breathing normally – put in recovery position, send for help. Check for continued breathing. If breathing not normal or absent, give 5 effective breaths Listen Feel

18. 7.PULSE CHECK - Adult NOT RECOMMENDED prior to initiation of first chest compression

19. 7.PULSE CHECK - Peads Check pulse for I nfant and Child Not more than 10 seconds Infant – Brachial pulse Child – Carotid pulse Femoral Pulse – both Infant and Child INFANT INFANT CHILD CHILD

20. 7.PULSE CHECK - Peads If Pulse is ≥ 60 /min but inadequate breathing – continue rescue breaths at 12 – 20 breaths per min until child breathing effectively on his/her own If pulse is < 60 /min and signs of poor perfusion, start chest compression

21. 8.CHEST COMPRESSION High Quality chest compression Location: Lower half of sternum No longer using inter nipple line landmark Heel of hand at center of chest with other hand on top Rate: At least 100 compression per minute

22. 8.CHEST COMPRESSION Depth: At least 5 cm Recoil: Complete recoil of chest after each compression Interruption of chest compression: Shall be minimized during entire resuscitation attempt

23. 8.CHEST COMPRESSION - Peads Techniques One rescuer CPR Infant – tips of 2 fingers Two rescuer CPR Infant – 2 thumb chest compression Child > 1 year – heel of one hand at lower sternum, larger child – 2 hands interlocking fingers 1 Rescuer 2 Rescuer Child >1 year INFANT

24. 8.CHEST COMPRESSION - Peads Site Compression Infant – lower half of the sternum Child – lower half of the sternum Depth Infant – at least 1/3 depth of chest or 4 cm Child – at least 1/3 depth of chest or 5 cm Rate – 100/min but not more than 120/min

25. 9.RATIO COMPRESSION TO VENTILATION Adult 30:2 Child One rescuer - 30:2 Two rescuer – 15:2

26. 10.VENTILATION Ventilate using Bag Valve Mask (BVM) Each breath given within one second inspiratory time until a chest rise observed Mouth to mouth in areas without BVM Protective devices for Mouth to mouth ventilation

27. 11.DEFIBRILLATION Essential step in chain of survival of cardiac arrest patients AED / Manual Defibrillation is part of BLS Attach AED as soon as it is available, minimizing interruption to chest compression Chest compression should immediately resume after 1 shock

28. 12.REASSESSMENT DURING CPR After every 5 cycle or 2 minutes of CPR, check for normal breathing

29. 13.PULSE CHECK If cardiac monitor is available, pulse shall be checked when an organized rhythm is seen Pulse check at Carotid and Femoral arteries

30. 14.STOPPING CPR CPR can be stopped in the following circumstances: Victims recovers with normal breathing Rescuer is exhausted Assistance arrives to take over CPR

31. 15.RECOVERY POSITION Recovery position is applied when victims resume normal breathing but remain unresponsive Recovery position True lateral position Head in dependent position Position is stable Position is safe and comfortable to patient

32. 16.BLS ALGORITHM D R S A B C D

33. Special Circumstances

34. SPECIAL CIRCUMSTANCES Cardiac Arrest caused by asthma, drowning and drug overdose No special consideration when starting BLS Pregnancy Manual Left Uterine Displacement shall be performed in Pregnancy associated with cardiac arrest

35. SPECIAL CIRCUMSTANCES Trauma Jaw thrust can be used instead of a head tilt-chin lift to establish a patent airway if multi-system trauma is present or in head and neck trauma; however this should not delay assessment and commencement of CPR.

36. CPR Techniques and devices Circulatory adjunct and techniques Eg : mechanical CPR Insufficient evidence to support or refute Cough CPR and pre cordeal Thump Not recommended Have the potential to delay chest compression and defibrillation

37. Foreign Body Airway Obstruction

38. CONSCIOUS ADULT FBAO Back blows and/or abdominal thrusts in rapid continuous sequence for a conscious adult with FBAO and poor oxygenation ( universal distress sign , ineffective cough, cyanosis) Back blows and/or chest thrusts in rapid continuous sequence for a conscious adult whom is pregnant or obese with FBAO and poor oxygenation (universal distress sign, ineffective cough, cyanosis)

39. Unconscious Adult FBAO Manage similarly as an unresponsive victims in BLS Algorithm Finger sweep shall only be performed is solid material is seen in the airway

40. Child FBAO If Mild, do not interfere – allow victim to clear airway by coughing, but observe for sign of severe FBAO Severe FBAO Child – perform back blows or abdominal thrusts , until expelled of child becomes unresponsive Infant – deliver repeated cycles of 5 back blows followed by 5 chest thrusts , until expelled or infant becomes unresponsive

41. Child FBAO Abdominal thrust-> Not recommended in infants – may cause liver injury If victims becomes unresponsive Start CPR After 30 compressions – open airway, if foreign body seen, remove it but do not perform blind finger sweeps Attempts 2 rescue breaths Continue with cycles of chest compressions and ventilations until object is expelled After 2 minutes, activates EMS if no one has done so

42. Summary

43. Adult BLS ALGORITHM D R S A B C D

44. DANGER Protect from danger during CPR

45. RESPONSE Tap Shoulder and say “Hello, hello are you OK?”

46. SHOUT! Shout (Calling) for Help “Emergency! Emergency! Bring the resus trolley and AED”

47. AIRWAY Open the airway Head Tilt and Chin Lift Maneouver

48. Breathing Assessment of breathing Look for evidence of abnormal breathing or gasping Not more than 10 seconds Not for giving rescue breaths Not for LOOK, LISTEN and FEEL

49. BREATHING

50. CIRCULATION High quality chest compression Middle of chest at lower sternum Depth : At least 5cm Rate: At least 100 compression per minute Recoil: Allow complete recoil Minimal interruptions Compression Ventilation ratio 30 : 2 Ventilation over 1 second, visible chest rise

51. DEFIBRILLATE Attach AED / Manual Defibrillator ASAP without interrupting chest compression Follow AED prompt For Manual defibrillator shock if VF or pulse less VT recognized Chest compression resumed after 1 shock

52. ALGORITHM Adult BLS

53. ALGORITHM Child BLS

54. Thank you