BLS – Basic Life Support ppt for nursing

BASIC LIFE SUPPORT

1. BLS – Basic Life Support & ACLS- Advanced Cardiovascular Life Support DR. SUJITH H M

2. BASIC LIFE SUPPORT Anyone can be a lifesaving rescuer for a victim of cardiac arrest victim. Coordinated effort by several rescuers during CPR may increase the chances of successful resuscitation. The main components of Cardiopulmonary resuscitation ( CPR ) are: High quality chest compressions Airway Breathing

3. ADULT BLS ALGORITHM

4. ASSESSMENT: Assessment of responsiveness: Tap the patient's shoulders and ask “Are you okay?” Assess for Breathing : chest rise & Carotid Pulse simultaneously: MIN 5 sec, MAX 10 sec. Agonal gasps : sign of cardiac arrest.

5. C- COMPRESSIONS: High Quality CPR: Position patient on a hard surface 100-120 compressions / min – depth of atleast 5cm Allow for complete chest recoil- to enable filling of the heart Minimize interruptions in compressions - <10 seconds Pregnant woman: provide manual Left uterine displacement to relieve compression of the IVC by the uterus.

6. A- AIRWAY: Open the airway : Head tilt Chin lift Jaw thrust

7. B- BREATHING : 30 compressions: 2 breaths Each breath over 1 second Visible chest rise to be noted after each breath Pocket masks / bag mask devices can be used : Mask – bridge of nose – just above lower edge of chin C-E technique

8. AED- Automated External Defibrillator: Steps: Power on the AED and follow voice prompts. Attach the pads on the patient and electrodes to the AED - Place pads on patient's bare chest .- remove clothing/ water/ medication patches/hair One pad – just below the right collar bone Other- lateral to the L nipple , 7-8 cm below the armpit Paediatric – one on the front of the chest, one on the back Pacemaker- avoid placing the pad directly over the device

9. PLACEMENT OF AED PADS

10. AED: 3. DO NOT TOUCH the patient when AED is analyzing the rhythm 4. If SHOCKABLE rhythm +, no one should touch the patient. Say “ CLEAR ” loudly and ensure that everyone is clear of the patient and push the “SHOCK” button of the AED. 5 . Once shock is delivered immediately resume CPR. Check pulse, rhythm after 2 mins as the AED prompts. 6. Non- shockable rhythm – continue CPR until AED prompts again for a rhythm check in 2 mins .

11. ADULT BLS IN PREGNANCY ALGORITHM

12. PAEDIATRIC BLS ALGORITHM – SINGLE RESCUER

13. PEDIATRIC BLS – 2 OR MORE RESCUERS

14. PAEDIATRIC BLS Responsiveness : tap heel Pulse assessment : brachial > femoral Compressions: 1 rescuer : 2 fingers in the center of the chest , just below the nipple line 2 rescuers : 2 thumbs encircling the center of the chest , just below the nipple line Depth : 1/3 rd of chest AP diameter or approximately 4cm Single rescuer : 30 compressions: 2 breaths 2 or more rescuers : 15 compressions: 2 breaths

15. Foreign body obstruction

16. ACLS

17. ADULT CARDIAC ARREST ALGORITHM

18. CRP QUALITY Push hard (at least 2 inches (5 cms ) and fast (100-120/min) and allow complete chest recoil. Minimize interuptions in compressions. Avoid excessive ventilation. Change compressor every 2 minutes or sooner if fatigued. If no advanced airway 30:2 compression-ventilation-ventilation ratio. Quantitative waveform Capnography --if PETCO2 < 10mm Hg,attempt to improve CPR quality. Intra-arterial pressure ---If relaxation phase (diastolic) pressure < 20 mm Hg,attempt to improve CPR quality.

19. Shock Energy for Defibrillation Biphasic: Manufacturer recommendation ( eg,initial dose of 120-200 J):if unknown use maximum available. Second and subsequent doses should be equivalent and higher doses may be considered . Monophasic :360 J

20. DRUG Therapy Epinephrine IV/IO dose: 1 mg every 3-5 minutes. Amiodarone IV/IO dose: First dose 300mg bolus .Second dose 150mg. OR Lidocaine IV/IO dose : first dose : 1-1.5mg/Kg .Second dose :0.5-0.75 mg /Kg.

21. Advanced Airway Endotracheal intubation or supraglottic advanced airway . Waveform capnograpy or capnometry to confirm and monitor ET tube placement . Once advanced airway in place,give 1 breath every 6 seconds (10 breaths/minute) with continuous chest compression.

22. Return of Spontaneous circulation (ROSC) Pulse and blood pressure Abrupt sustained increase in PETCO2 (typically > 40 mm Hg) Spontaneous arterial pressure waves with intra-arterial monitoring

23. ADULT POST- CARDIAC ARREST CARE ALGORITHM

24. In-hospital Cardiac arrest in Pregnancy

25. PEDIATRIC CARDIAC ARREST ALGORITHM Shock : 2J/kg Second shock 4J /kg Max 10J/kg Epinephrine : 0.01mg/kg IV Amiodarone : 5mg/kg IV Lignocaine 1mg /kg IV

26. NORMAL ECG:

27. BRADYCARDIA:

28. Avoid using atropine for unstable bradycardia in heart transplant pts Treat with pacing and/ or dopamine OR Epinephrine Mobitz type II and type III unlikely to respond to atropine . Consider pacing or beta adrenergic infusion.

29. TACHYCARDIA:

30. SINUS TACHYCARDIA

31. ADULT TACHYCARDIA WITH A PULSE ALGORITHM 3 C’S FOR CARDIOVERSION: Consent Crash cart to be ready Consider sedation NEVER SHOCK A PATIENT WITH SINUS TACHYCARDIA For any rhythm on ECG, WITHOUT A PULSE, follow PEA algorithm

32. ACUTE CORONARY SYNDROME ALGORITHM

33. SUSPECTED STROKE ALGORITHM

34. SIGNS OF POSSIBLE STROKE: Sudden weakness/numbness of arm/leg or drooping of face Trouble speaking/ understanding Difficulty in seeing /walking/loss of balance, coordination Severe headache Sudden confusion

35. REFERENCES: 2020 AMERICAN HEART ASSOCIATION GUIDELINES

36. THANK YOU