BLS & ACLS.pptx

PPT BLS

1. BLS Presented by: HARPREET KAUR M.Sc.(N) 2 nd year Critical C are Nursing

2. BLS (Basic Life Support)

3. DEFINITION Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and or cardiac arrest. Chest compresssions and pulmonary ventilation performed by anyone who knows how to do it, anywhere, immediately, without any other equipment . It is also called as CPR, (cardio pulmonary resuscitation).

4. It is the non-invasive assessment and intervention used to quickly identify and treat victims of respiratory, cardiovascular emergencies. It is a Combination of rescue breathing and chest compressions

5. INDICATIONS CARDIAC ARREST : sudden, unexpected loss of heart function, breathing and consciousness. In cardiac arrest, the heart abruptly stops beating without prompt intervention, it can result in person’s death.

6. HEART ATTACK : A blockage of the blood flow to the heart muscle. A Heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. without blood, tissue loses oxygen and dies.

7. RESPIRATORY ARREST : It is a state in which a patient stops breathing but maintains a pulse. Respiratory arrest can exist when breathing is ineffective, such as agonal gasping.

8. Survival from sudden cardiac arrest is optimized when the event is witnessed and CPR is initiated immediately Patient survival declines dramatically if basic CPR is not initiated within first four minutes

9. The Systematic Approach: The BLS Primary Survey Goal of BLS : To support and restore effective oxygenation Circulation with return of intact neurologic function ROSC (return of spontaneous circulation)

10. CPR : Timing is Everything <2% 2-8% 20% 30-50% 0 2 4 6 8 10 min Current Indian Scene Early BLS Early Defib Bystander

11. ADULT BLS

12. Chain of survival

13. Important Although BLS is taught as a sequence of distinct steps to enhance skills retention and clarify priorities, several actions should be accomplished simultaneously (begin CPR and activate emergency response system) when multiple rescuers are present. All adult arrest are cardiac in origin therefore 1 st step i.e. call for help is important because if AED is not available it can come on time.

14. BLS consists of………. Three main parts: Chest compressions (C) Airway (A) Breathing (B) Defibrillation (D) Previously sequence was ‘ABCD’ & Now it is ‘CABD’

15. Why change??? In ABCD, chest compressions were often delayed while the rescuer opened the airway to give mouth to mouth breaths, retrieved a barrier device or gathered ventilation equipment. With CABD, rescuer can start chest compressions sooner and likely to improve survival.

16. Contd… Every minute chances of success decreases to 10-15% but if we start CPR by the time AED is coming even in shockable rhythm, chances of success decreased to 3-4 from 10-15%.

17. Steps of BLS There are basically 4 steps in BLS: Assessment and scene safety Activate Emergency response system and Get an AED Check pulse Begin cycles of 30 chest compressions and 2 breaths if you do not definitely feel a pulse within 10sec and perform 5 cycles (30:2) with CAB sequence.

18. 1. Scene safety What should you do when you encounter a victim who is probably collapsed?

19. Ask yourself….. Is it safe for me to approach the victim? I may suffocate /get burnt/get hypothermic/get electric shock Is it safe for the victim to be attended to where he has collapsed? I need to take victim out of water / switch off the main switch to start CPR What other precautions should I take for my own safety? I should use barriers like handkerchief, gloves

20. Always make sure that the scene is safe for you and the victim

21. Assessment Tap the victim’s shoulder and shout, “Are you all right?” Check to see if the victim is breathing. If not breathing or not breathing normally (gasping), activate emergency response system.

22. ” HELP ! Is there anyone around?” Do not approach the victim from back or shake the victim hard since there is potential of exacerbating a possible cervical spine injury Ah! He is not responding, let me call for help

23. 2. Activate Emergency response system Ask him to call EMS (emergency medical services) Ask him to tell EMS about the place and about collapsed victim? While he activates the EMS, the rescuer should start CPR If someone approaches to help…. If no help available…… Call yourself before starting the CPR

24. 3. Pulse check Palpate carotid pulse. Feel for a pulse for atleast 5sec but no more than 10 sec. If you do not feel pulse within 10 seconds, start chest compressions (in CAB sequence)

25. 4. Begin CPR Assess C irculation and providing chest compression Opening A irway Assess B reathing and providing breath

26. Revision 4 main steps of BLS: Scene safety and Assessment Call EMS Check pulse Start CPR (in CABD sequence)

27. CIRCULATION

28. Circulation After palpating pulse for atleast 10sec start with CPR if no definite pulse is palpable. Mechanism: Increase of intrathoracic pressure and direct compression of the heart Recommended compression rate: atleast 100 /min(100-120/min)

29. Changed from approximately 100/min to atleast 100/min -120/min

30. Contd… Depth of compression should be atleast 2inches (5cm). Compression : ventilation 30 : 2 when one rescuer 30 : 2 when 2 rescuers Changed from approximately 2 inches to atleast 2 inches

31. Effective chest compressions Start compressions within 10 seconds of recognition of cardiac arrest. Push hard, push fast: Compress at a rate of atleast 100/min with depth of atleast 2inches (5cm). Allow complete chest recoil after each compression. Minimize interruptions in compression (try to limit interruptions to < 10 sec)

32. Process of CPR Position yourself at the victim’s side. Make sure that victim lies on the firm, hard surface. Put the heel of the hand on the center of the victim’s chest on the lower half of the breastbone. Put the heel of your other hand on the top of first hand.

33. Placement of hands during CPR Inter-mammary line

34. Straighten your arm with knees locked and position your shoulder directly over the hands. Push hard and fast Press down atleast 2 inches (5cm) with each compression. Deliver compressions in a smooth fashion at a rate of atleast 100/min. At the end of each compression, make sure to allow complete chest recoil after each compression.

35. Adjust position that your shoulders are on top of the victim and in line with hands

36. Provide cycles of compressions and breathing. 30 compressions with 2 breaths is one cycle 30 : 2 in adults (with one or two rescuer) 30 : 2 in infant and children (with one rescuer) 15 : 2 in infant and children (with two rescuer) Complete 5 cycles and then check carotid pulse

37. AIRWAY

38. Open the airway for breaths 2 methods are there to open the airway: Head tilt- chin lift Jaw thrust *Jaw thrust is used with 2 rescuers as two persons are needed to provide breaths. *Head lilt-chin lift should be used until head or neck injury is suspected as it reduces neck and spine movement.

39. Head tilt- chin lift

40. Jaw thrust

41. Caution Do not press into the soft tissue under the chin because this might block the airway. Do not use thumb to lift the chin. Do not close the victim’s mouth completely.

42. BREATHING

43. Provide breaths Mouth to mouth breaths Mouth to mask breaths Bag to mask breaths

44. Mouth to mouth breaths

45. Hold the victim’s airway open with a head tilt – chin lift. Pinch the nose closed with your thumb and index finger (using the hand on forehead) Take a regular (not deep) breath and seal your lips around the victim’s mouth, creating an airtight seal. Give 1 breath (blow for 1sec). Watch for the chest rise. Give a second breath. If you are unable to ventilate the victim after 2 attempts, promptly return to chest compressions.

46. Face mask Standard precautions include using face mask or a bag mask ventilation when giving breaths. Mask usually have a 1-way valve that diverts exhaled air, blood or bodily fluids away from the rescuer.

47. Mouth to mask breaths

48. Position yourself at the victim’s side. Place the mask on the victim’s face, using the bridge of the nose as a guide for correct position. Seal the mask against the face: Using the hand that is closer to the top of the victim’s head, place your index finger and thumb along the edge of the mask. Place the thumb of your second hand along the bottom edge of the mask.

49. Contd…. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the mask against the face. Deliver air over 1 second to make the victim’s chest rise.

50. Bag to mask breaths

51. Position yourself directly above the victim’s head. Place the mask on the victim’s face, using the bridge of the nose as a guide for correct position. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open Squeeze the mask to give breaths (1second each) while watching the chest rise.

52. E – C technique 1 rescuer

53. 2 rescuer The E-C clamp technique of bag –mask ventilations. Three fingers of one hand lift the jaw ( they form the “E”) while the thumb and index finger hold the mask to the face (making a “C”)

54. 2 rescuer CPR

55. When a second rescuer is available to help, that second rescuer should activate the emergency response system and can get the AED. The first will remain with the victim to start CPR immediately 2 1

56. Contd… The rescuers will then give compressions and breaths but should switch roles after every 5 cycles of CPR (about every 2min)

57. Rescuer 1: At victim’s side

58. Rescuer 2: At victim’s head

59. DEFIBRILLATION

60. AED (Automated External D efibrillators) Automated external defibrillators (AEDs) are computerized devices that can identify cardiac rhythms that need a shock and these can deliver shock. When VT is present, the heart muscle fibres quiver and do not contract together to pump blood.

61. Contd… This delivers shock to stop the quivering of the heart fibres and allows the muscle fibres of the heart to ‘reset’ so that they can begin to contract at same time. Once an organized rhythm occurs, the heart muscle may begin to contract effectively and begin to generate a pulse (called ROSC)

62. Parts of AED Pads (self sticking) On/off switch Shock delivery button Pad connector Battery

63. Once the AED arrives, place it at the victim’s side If multiple rescuers are present, one rescuer should continue CPR while another rescuer attaches AED pads.

64. Attempted Defibrillation Current Recommendation One shock Biphasic 150-200J Monophasic 360J Immediate CPR Rhythm check only after 5 cycles (2 mins ) of CPR

65. Using AED Switch it on Act according to voice prompt Apply pads to bare chest of victim ( one to the side of the left nipple, with the top edge of the pad a few inches below the armpit and other below right collar bone) Connect pads to AED (some are preconnected) Let AED Analyze heart rhythm: do not touch the victim (it will take 5 to 15 sec to analyze)

66. Contd… If the AED advices a shock; be sure no one is touching the victim. Loudly state a “clear the victim” message, such as “Everybody clear” or simply “clear”. Look to be sure no one is in contact with the victim. Press shock button Shock delivered: immediately resume with 5 cycles CPR begin with chest compressions If “no shock advised”, immediately restart CPR.

67. AED in special situations Age : Victim <1yr – AED not advised Victim 1-8yrs – use child pads and child AED Hairy chest: Press pads firmly, if not remove hairs by sticking pads and removing hair along with them. Use other set of pads now Use razor Wet chest: Clean victim’s chest dry

68. Contd…. If patient is in water, do not use AED but if patient is in snow; dry the chest first and then AED can be used. Implanted device: Do not use AED

69. AED with 2 rescuer Check the response and check breathing The first rescuer stays with the victim and performs the next steps until the next rescuer returns with AED. The second rescuer activates the emergency response system and gets the AED. Check for pulse The first rescuer removes or moves clothing covering the victim’s chest and then start CPR.

70. 2 Rescuer CPR Demo.mp4

71. PAEDIATRIC BLS

72. Chain of survival

73. Prevention of arrest

74. Early high quality bystander CPR Rapid activation of the emergency response system Effective advanced life support (including rapid stabilization and transport to definitive care and rehabilitation) Integrated post-cardiac arrest care

75. BLS in children from 1year of age to puberty

76. Critical points Start compressions within 10sec of recognition of cardiac arrest. Push hard, push fast : Compress at rate of 100/min with depth of approximately 2 inches (5cm) or compress at least one third the depth of the chest Allow complete chest recoil after each compression

77. Contd… Compression: Ventilation ratio for: 2 rescuer CPR - 15: 2 ratio 1 rescuer- 30:2 ratio Compression technique: May use 1 or 2 handed chest compression for very small children Complete 2min with 15:2 ratio, no number of cycles is seen. Minimize interruptions in compressions (< 10sec)

78. Contd… Give effective breaths that make chest rise. Avoid excessive ventilation.

79. 1 rescuer BLS sequence Check the child for a response and check breathing. Shout for help if there is no breathing or not normal breathing (gasping) If someone responds, send that person to activate emergency response system and get the AED.

80. Contd… [If the child collapsed suddenly and you are alone, leave the child to activate emergency response system and get the AED] Check the child’s pulse (take atleast 5 but not more than 10sec). You can locate carotid or femoral pulse in children If no pulse is felt, start with chest compressions at rate of 30: 2 ratio. After 5 cycles, if someone has not already done so, activate the emergency response system and get the AED. Use AED as soon as available

81. Locating femoral pulse Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the abdomen. Feel the pulse for atleast 5 sec but not more than 10sec. If you do not definitely feel a pulse, begin CPR, starting with chest compressions (CAB sequence)

82. 2 rescuer Check the child for a response and check breathing. If there is no breathing or no normal breathing, the second rescuer activates the emergency response system Check the child’s pulse (take atleast 5 but not more than 10sec). You can locate carotid or femoral pulse in children

83. Contd… Start with chest compressions if no pulse is palpable with 30: 2 ratio and when the second rescuer arrives, use 15: 2 compression: breaths ratio.

84. BLS/ CPR for infants

85. Critical points Location of pulse : Brachial artery in infants Technique of giving compressions: 2 fingers for single rescuer and 2 thumb – encircling hands technique for 2 rescuer. Compression depth : at least one third of the chest depth or approximately 1.5 inches (4cm) Compression: Ventilation ratio- 30: 2 for 1 rescuer 15: 2 for 2 rescuer

86. Locating brachial pulse Place 2 or 3 fingers on the inside of the upper arm, between the infant’s elbow and shoulder. Press the index and middle fingers gently on the inside of the upper arm for atleast 5 but no more than 10 seconds when attempting to feel pulse.

87. 1 rescuer Check the infant for a response and check breathing. If there is no response and no breathing or not normal breathing, despite of adequate oxygenation and ventilation, heart rate (pulse) is < 60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio). shout for help. Check the infant’s brachial pulse (take at least 5 but no more than 10 seconds)

88. Contd… If someone responds, send that person to activate the emergency response system and get the AED. If there is no pulse, start chest compressions with 30: 2 ratio. After 5 cycles, if someone has already done so, activate emergency response system and get the AED.

89. 2-finger chest compression Place the infant on a firm, flat surface. Place 2 fingers in the center of the infant’s chest just below the nipple line. Do not press on the bottom of the breast bone. Push hard and fast. To give chest compressions, press the infant’s breastbone down atleast one third the depth of the chest (app. 1.5 inches). Deliver compressions in a smooth fashion at a rate of at least 100/min.

90. 2 fingers for Single rescuer

91. Contd… Make sure to allow complete chest recoil. Minimize interruptions in chest compressions.

92. 2 rescuer Check the infant for a response and check breathing. If there is no response and no breathing or not normal breathing, send the second rescuer to activate the emergency response system and get the AED. Check the infant’s brachial pulse

93. Contd… If there is no pulse, despite of adequate oxygenation and ventilation, heart rate (pulse) is < 60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio). When the second rescuer arrives and can perform CPR, use a compression- ventilation ratio of 15: 2.

94. 2 Thumb encircling hands chest compression technique Perform when 2 rescuer are present. The technique produces blood flow by compressing the chest with both the thumbs. It produces more better flow, more consistently results in appropriate depth or force of compression, and may generate higher blood pressures than the 2 finger technique.

95. 2 thumb – encircling hands technique for 2 rescuer

96. Pediatric BLS Algorithm.

97. Airway

98. Open the airway for breaths 2 methods are there to open the airway: Head tilt- chin lift Jaw thrust *Jaw thrust is used with 2 rescuers as two persons are needed to provide breaths. *Head lilt-chin lift should be used until head or neck injury is suspected as it reduces neck and spine movement.

99. BREATHING

100. Provide breaths Mouth to mouth breaths Mouth to mask breaths Bag to mask breaths

101. Defibrillation

102. Child CPR 2 rescuer.mp4

103. Comparison of 2005 and 2010 guidelines by AHA 2005 guidelines ABCD sequence Look listen feel Compression depth: approximately 2 inches (5cm) Pulse check for atleast 10sec C: V ratio is 30: 2 with 1 rescuer and 15: 2 with 2 rescuer in adults and paed . 2010 guidelines CABD sequence No Look listen feel Compression depth: atleast 2 inches (5cm) Pulse check for 5sec but not more than 10sec C: V ratio is 30: 2 in adults, paed (if 1 rescuer)

104. Summarization Best CPR generate 30% of the cardiac output which is critical for cerebral and coronary blood perfusion, therefore compressions should come first. After surgeries even immediately after CABG, we can give CPR. Almost all arrests in paed are respiratory arrest so breaths are more important.

105. ANY QUERY????

106. THANK ‘U’