BLS ( Basic Life Support/ Cardiopulmonary Resuscitation )

BLS

1. GAJE SINGH American Heart Association Instructor BASIC LIFE SUPPORT

2. Course Objective The purpose of this course is to inform healthcare professionals about current guidelines for emergency cardiac care.

3. Approach BLS ( Basic Life Support) Primary survey. ACLS (Advanced Cardiovascular Life Support) Secondary survey

4. Cardiopulmonary Resuscitation BLS ACLS PROLONGED LIFE SUPPORT A - Airway B - Breathing D- Defibrillation C - Circulation

5. C-A-B Rather than A-B-C Steps Change in the BLS sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing). Initiate chest compressions before giving rescue breaths ( C-A-B rather than A-B-C). Why: Highest survival rates from cardiac arrest due to sooner starts of chest compression.

6. What is CPR? CPR stands for Cardio Pulmonary Resuscitation, i.e. to help restart the heart (pulse) and lungs (breathing). CPR is performed when a person stops breathing and/or the heart stops.

7. Why is timing important?  When the heart (pulse) and lungs (breathing) stops, the victim has 5 minutes before (gradual) brain death starts to occur, if no CPR is performed. Brain damage is certain after 5 - 10 minutes without CPR Therefore, it is very important to start CPR as soon as possible for better chance of survival.

8. Learning Objectives Use the principles of patient assessment to guide treatment decisions. Describe the appropriate care of a patient in a pulseless arrest. Relate factors to consider when evaluating a patient with an arrhythmia. Justify the emphasis on rapid evaluation and treatment of a patient with acute coronary syndromes. Discuss how the physiological differences in the phases of cardiac arrest drive the appropriate treatments for each phase.

9. Why is it required to learn Basic Life Support ?

10. What is Cardiac Arrest ? Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. Cardiac arrests are more common than you think, and they can happen to anyone at any time even in healthy looking person. Nearly 383,000 out-of-hospital and 209,000 in hospital sudden cardiac arrests occur annually.

11. Cardiac Arrest (contd..) Associated with very poor survival rate, 9.5 % for out of hospital cardiac arrest and 23.9% for in hospital cardiac arrest. Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival. Basic life support - one of the most important skills you will learn here in this session.

12. BASIC LIFE SUPPORT (BLS)

13. Objectives At the end of this session , participants should be able to demonstrate: How to assess the collapsed victim. How to perform chest compression and rescue breathing. How to operate an automated external defibrillator safely. How to place an unconscious breathing victim in the recovery position.

14. Basic Life Support (BLS) BLS is the foundation for saving lives following cardiac arrest. Fundamental aspects of adult BLS include five links called Adult Chain of Survival.

15. Chain of Survival The 5 links in adult chain of survival are: Immediate recognition of cardiac arrest and activation of the emergency response system. Early CPR with an emphasis on chest compressions. Rapid defibrillation. Effective advance life support. Integrated post-cardiac arrest care.

16. Approach safely Open A irway Check response Shout for help 2 rescue B reaths Call for emergency Chest C ompression D efibrillation Basic Life Support (BLS)

17. APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Open airway 2 rescue breaths Defibrillation Check response Shout for help Call for emergency Chest compression

18. CHECK RESPONSE Approach safely Check response Shout for help Call for emergency Chest compression Open airway 2 rescue breaths Defibrillation

19. Shake shoulders gently Ask “Are you all right?” If he responds Leave as you find him. Find out what is wrong. Reassess regularly . If doesn't respond, Scan the chest & Check pulse CHECK RESPONSE By Shake & Shout Method

20. SHOUT FOR HELP Approach safely Check response Shout for help Call for emergency Chest compression Open airway 2 rescue breaths Defibrillation For Unresponsive Cardiac Arrest Patient

21. Approach safely Defibrillation Check response Shout for help Call for emergency Chest compression 2 rescue breaths Open airway CALL FOR EMERGENCY For Unresponsive Cardiac Arrest Patient

22. CHEST COMPRESSION Approach safely Defibrillation Check response Shout for help Call for emergency Chest compression Open airway 2 rescue breaths

23. Place the heel of one hand in the centre of the chest on the lower sternum. Place other hand on top Interlock fingers Compress the chest Rate - At least 100 min -1 100-120 compression /min Depth - At least 2 inches.(5-6 cm) Equal compression : relaxation When possible change CPR operator every 2 min CHEST COMPRESSION By Good Hand Position

24. COMPRESSIONS Quality: PUSH HARD, PUSH FAST, ALLOW COMPLETE RECOIL AND MINIMIZE INTERRUPTIONS Site: Lower half of the sternum between nipples for adult and child; Just below nipple line for infants Depth: at least 2 inches(5 cm) for adults; 5 cm for children and 4 cm for infant Technique : two hand in adult and children, two thumb, or two finger in infant

25. OPEN AIRWAY Approach safely Defibrillation Check response Shout for help Chest compression Open airway 2 rescue breaths Call for emergency By Head Tilt Chin Lift Method

26. Open The Airway Opening the airway by head tilt chin lift method. Placing one hand on the victim’s forehead with the other hand on the chin and tilting the head back.

27. RESCUE BREATHS Approach safely Check response Shout for help Call for emergency Chest compression Open airway Defibrillation 2 rescue breaths

28. BREATHING Give two rescue breaths 1 breath in one sec. Three methods to give breathing mouth-to-mouth breathing mouth-to-mask breathing bag-valve-mask ventilation

29. Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat For infant cover nose and Mouth by lip & give rescue breath RESCUE BREATHS

30. Rescue Breathing 2 rescue breaths after 30 compressions. Each breath should be delivered over 1 second with any delivery method available. A good breath will cause the chest to rise. Mouth to Mouth Method Mouth to Mask Method Bag-Mask Method

31. CONTINUE CPR 30 2 Compression To Ventilation Ratio Five cycles of the 30:2 compressions/ventilations should be delivered, which should take approximately 2 minutes. Only then is the pulse check repeated .

32. COMPRESSION VENTILATION RATIO For Adults its 30:2 (1 or 2 rescuers) For Children and Infants 30:2 (1 rescuer) and 15:2 (2 rescuers) One set of compressions and ventilations form one cycle Five cycles of compression and ventilation over 2 minutes Check pulse after five cycle if no pulse start same at least 20 min

33. How CPR Works? Compression of the chest during CPR raises the intrathoracic pressure which forces the blood out of the heart chambers. When the chest recoils, a negative intrathoracic pressure is produced which allows blood to return to the heart, feeding the coronary arteries and filling the heart chambers so that the next compression will be even more effective - A cumulative effect. Successive compressions will continue to increase coronary artery pressure and organ perfusion.

34. How CPR Works? (contd...) Effective CPR provides ¼ to 1/3 normal blood flow. Rescue breaths contain 16 % Oxygen (out of 21 %) Tidal volume approx. 450 ml for effective vantilation

35. Approach safely Check response Shout for help Call for emergency Chest compression Open airway 2 rescue breaths AUTOMATED EXTERNAL DEFIBRILLATORS Defibrillation

36. Attach pads to casualty’s bare chest Another pad on the upper-right side of the patient’s bare chest  One pad - Left of the left nipple a few inches below the left armpit. AUTOMATED EXTERNAL DEFIBRILLATORS

37. Analysing rhythm Do not touch victim Shock indicated Deliver shock AUTOMATED EXTERNAL DEFIBRILLATORS

38. Chest Compression - Shock Delivery (With in 5 seconds) - Chest compression Again 30 2 DEFIBRILLATION

39. If he is breathing normally • Turn him into the recovery position • Send or go for help, or call for an ambulance. • Check for continued breathing. Recovery Position

40. If victim starts to breath normally place in recovery position RECOVERY POSITION

41. When CPR Should Stop? Victim revives Trained help arrives To exhausted to continue Unsafe scene Physician directed Cardiac arrest for more than 20 minutes

42. Complications of CPR Rib fractures (Most common) Vomiting and Aspiration Internal Injuries to vital organs like lung & liver. Body Fluid Exposure - Risk of AIDS & hepatitis like communicable diseases. Gastric Distention

43. Basic Life Support Algorithm