BLS ppt.ppt FOR BASIC LIFE SUPPORT BY AHA

BLS ppt.ppt FOR BASIC LIFE SUPPORT BY AHA

1. Basic life support (BLS)

2. Introduction According to recent statistics sudden cardiac arrest is rapidly becoming the leading cause of death. Once the heart ceases to function, a healthy human brain may survive without oxygen for up to 4 minutes without suffering any permanent damage. Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes. It is during those critical minutes that CPR (Cardio Pulmonary Resuscitation) can provide oxygenated blood to the victim's brain and the heart, dramatically increasing his chance of survival and if properly instructed, almost anyone can learn and perform CPR.

3. What is BLS ?  Basic Life Support (BLS) refers to the care healthcare providers and public safety professionals provide to patients who are experiencing respiratory arrest, cardiac arrest or airway obstruction. BLS includes psychomotor skills for performing high-quality cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED) and relieving an obstructed airway for patients of all ages.

4. Timeline of CPR 0 to 4 minutes, unlikely development of brain damage  4 to 6 minutes, possibility of brain damage  6 to 10 minutes, high probability of brain damage  10 minutes and over, probable brain damage

5. Indications Road Traffic Accident Drowning Electric Shock Airway Obstruction Cardiac Arrest

6. Goals of Resuscitation To support and restore effective:- - oxygenation - ventilation - circulation with return of intact neurologic function ROSC (Return of spontaneous circulation) is an intermediate goal

7. CHAIN OF SURVIVAL

8. a.) For Adults

9. b.) For Pediatric Emergencies in children and infants are not usually caused by the heart. Children and infants most often have breathing problems that trigger cardiac arrest. The first and most important step of the Pediatric Chain of Survival is prevention

10. Contd..

11. Latest changes in AHA Guidelines (In 2015) Change in sequence to C-A-B from A-B-C Emphasis on high quality CPR No look, listen and feel No routine use of cricoid pressure during bag mask ventilation Continued de-emphasis on pulse check

12. CAUTION Use of cricoid Pressure The routine use of cricoid pressure in cardiac patients is not recommended. Cricoid pressure in nonarrest patients may offer some measure of protection to the airway from aspiration and gastric insufflation during bag and mask ventilation. However, it also may impede ventilation and interfere with placement of a supraglottic airway or intubation

13. In 2020 Guideline The importance of early initiation of CPR by lay rescuers has been re-emphasized. The risk of harm to the patient is low if the patient is not in cardiac arrest. Bystanders should not be afraid to start CPR even if they are not sure whether the victim is breathing or in Cardiac Arrest. A sixth link, Recovery, was added to the Chains of Survival for both Pediatric and Adults. Care of the patient after return of spontaneous circulation (ROSC) requires close attention to oxygenation, blood pressure control, evaluation for percutaneous coronary intervention, targeted temperature management, and multimodal neuroprognostication .

14. Contd.. Because recovery from cardiac arrest continues long after the initial hospitalization, patients should have formal assessment and support for their physical, cognitive, and psychosocial needs. After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers may be beneficial to support their mental health and well-being. Management of cardiac arrest in pregnancy focuses on maternal resuscitation, with preparation for early perimortem cesarean delivery if necessary to save the infant and improve the chances of successful resuscitation of the mother.

15. How to approach a patient ? Ans - A Systematic Approach is used

16. FOR UNCONCIOUS PATIENTS

17. BLS Assessment

18. Approach safely Check response Check the pulse Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help

19. APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Check response Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help

20. CHECK RESPONSE Approach safely Check response Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help

21. Shake shoulders gently Ask “Are you all right?” If he responds Leave as you find him. Find out what is wrong. Reassess regularly. Contd..

22. SHOUT FOR HELP Approach safely Shout for help Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check for response

23. CHECK THE PULSE Approach safely Check response Check the pulse Open airway Check breathing Call 977 30 chest compressions 2 rescue breaths Shout for help

24. OPEN AIRWAY Approach safely Check response Check the pulse Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Shout for help

25. Contd … Head tilt and chin lift - lay rescuers - non healthcare rescuers No need for finger sweep - unless solid material can be seen in the airway

26. Contd …

27. CHECK BREATHING Approach safely Check response Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse

28. Contd … Look, listen and feel for NORMAL breathing Do not confuse agonal breathing with NORMAL breathing

29. CAUTION Agonal gasps are not normal breathing. Agonal gaps may be present in the minutes after sudden cardiac arrest. Occurs shortly after the heart stops in up to 40% of cardiac arrests Described as barely, heavy, noisy or gasping breathing Recognise as a sign of cardiac arrest

30. Approach safely Check response Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse

31. 30 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse

32. Place the heel of one hand in the centre of the chest Place other hand on top Interlock fingers Compress the chest Rate 100 -120 per min Depth 4-5 cm Equal compression : relaxation When possible change CPR operator every 2 min Allow complete chest recoil CHEST COMPRESSIONS

33. RESCUE BREATHS Approach safely Check response Shout for help Open airway Check breathing Activate EMS 30 chest compressions 2 rescue breaths Check the pulse

34. Breathing- Mouth to mouth 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

35. Breathing: Mouth To Nose (when to use) Can’t open mouth Can’t make a good seal Severely injured mouth Stomach distension Note- Mouth to stoma (tracheotomy )

36. CONTINUE CPR 30 : 2

37. DEFIBRILLATION

38. Activate EMS Approach safely Check response Shout for help Open airway Check breathing Attach AED Follow voice prompts Check the pulse

39. AUTOMATED EXTERNAL DEFIBRILLATOR ( AED ) Some AEDs will automatically switch themselves on when the lid is opened

40. ATTACH PADS TO CASUALTY’S BARE CHEST

41. ANALYSING RHYTHM DO NOT TOUCH VICTIM

42. SHOCK INDICATED Stand clear. Do three checks I clear You clear All clear Deliver shock

43. SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 : 2

44. NO SHOCK ADVISED FOLLOW AED INSTRUCTIONS 30 : 2

45. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

46. Approach safely Check response Shout for help Open airway Check breathing Call Emergency System 30 chest compressions 2 rescue breaths Check response Approach safely Shout for help Check the pulse Open airway Check breathing Call Emergency System Attach AED Follow voice prompts Check the pulse

47. Foreign Body obstruction

48. H ow to identify obstruction ? Patent Airway - If the patient responds in a normal voice. Partial Obstruction- Signs of a partially obstructed airway include a changed voice , noisy breathing ( eg , stridor), and an increased breathing effort. Complete Airway obstruction- With a completely obstructed airway, there is no respiration despite great effort ( ie , paradox respiration, or “see-saw” sign).

49. SIGNS MILD obstruction SEVERE obstruction “Are you choking?” “YES” Unable to speak, may nod Other signs Can speak, cough, breathe Can not breathe/wheezy breathing/silent attempts to cough/ unconsciousness Contd …

50. ADULT FBAO TREATMENT

51. Heimlich Maneuver

52. Pediatric Foreign Body obstruction

53. BLS Algorithm (2020)

54. Signs of High Quality CPR Start compression within 10 seconds of recognition of cardiac arrest Push hard, Push fast: Compress at a rate of 100-120/min with a depth of : - At least 5cm for adults - At least one third the depth of the chest, about 5cm for children - At least one third of the chest, about 4cm, for infants Allow complete chest recoil

55. Contd … Minimize interruptions in compression (try to limit interruptions to less than 10secs) Give effective breaths that male chest rise Avoid excessive ventilations

56. CONTINUE RESUSCITATION UNTIL Qualified help arrives and takes over The victim starts breathing normally Rescuer becomes exhausted

57. When Can I Stop CPR ? Victim revives Trained help arrives Too exhausted to continue Unsafe scene Physician directed (do not resuscitate orders) Cardiac arrest of longer than 30 minutes

58. Injuries Related to CPR Rib fractures Laceration related to the tip of the sternum, Liver, lung, spleen

59. Complications of CPR Vomiting Aspiration Place victim on left side Wipe vomit from mouth with fingers wrapped in a cloth Reposition and resume CPR

60. FOR CONSCIOUS PATIENTS

61. What to do? Primary Assessment Secondary Assessment

62. Assessment Primary Assessment Secondary Assessment A- AIRWAY B- BREATHING C- CIRCULATIONS D- DISABILITY E- EXPOSURE Assessment involves differential diagnosis, focused medical history (memory aid- SAMPLE) Searching for and treating underlying causes ( H’s and T’s)

63. PRIMARY ASSESSMENT

64. AIRWAY Is the airway patent ? Is an advanced airway indicated? Is proper placement of airway device confirmed? Is tube secured and placement confirmed frequently?

65. Is the airway patent ? Maintain the airway patency in unconscious patients by use of the head tilt-chin lift , oropharyngeal airway or nasopharyngeal airway

66. Is an advanced airway indicated? Use advanced airway management if needed ( eg - laryngeal mask ,laryngeal tube , oesophageal –tracheal tube, endotracheal tube) NOTE:- Health care providers must weighs the benefit of advanced airway placement against adverse effects of interrupting chest compressions. If bag-mask ventilation is adequate, health care providers may defer insertion of advanced airway.

67. Contd … If using advanced airway devices:- Confirm proper integration of CPR and ventilation Confirm proper placement of advanced airway devices by - Physical examination - Quantitative waveform capnography Secure the device to prevent dislodgement Monitor airway placement with continuous quantitative waveform capnography

68. Continuous waveform capnography Quantitative waveform capnography is the continuous, noninvasive measurement and graphical display of end-tidal carbon dioxide/ETCO2 (also called PetCO2). Capnography uses a sample chamber/sensor placed for optimum evaluation of expired CO2. The inhaled and exhaled carbon dioxide is graphically displayed as a waveform on the monitor along with its corresponding numerical measurement.

69. Contd.. Two very practical uses of waveform capnography in CPR are: 1.) evaluating the effectiveness of chest compressions, and 2.) identification of ROSC. Evaluating the effectiveness of chest compressions is accomplished in the following manner: Measurement of a low ETCO2 value (< 10 mmHg) during CPR in an intubated patient would indicate that the quality of chest compressions needs improvement. Normal ETCO2 in the adult patient should be 35-45 mmHg. High quality chest compressions are achieved when the ETCO2 value is at least 10-20 mmHg .

70. Contd.. When ROSC occurs, There will be a significant increase in the ETCO2. (35-45 mmHg) This increase represents a drastic improvement in blood flow (more CO2 being dumped in the lungs by the circulation) which indicates circulation.

71. Contd.. The 2020 AHA Guidelines for ACLS recommend using quantitative waveform capnography in intubated patients during CPR. Waveform capnography allows providers to monitor CPR quality, optimize chest compressions, and detect ROSC (return of spontaneous circulation) during chest compressions. Also, according to the AHA , continuous waveform capnography along with clinical assessment is th e most reliable method of confirming and monitoring correct placement of an ET tube.

72. BREATHING Are ventilation and oxygenation adequate? Are quantitative waveform capnography and oxyhemoglobin saturation monitored?

73. Contd.. Give supplementary oxygen when indicated - For cardiac arrest patients, administer 100% oxygen For others, titrate oxygen administration to achieve oxygen saturation of 94% or greater by pulse oximetry Monitor the adequacy of ventilation and oxygenation by - Clinical criteria( chest rise and cyanosis) - Quantitative waveform capnography oxygen saturation Avoid excessive ventilation

74. CIRCULATION Are chest compressions effective? What is the cardiac rhythm? Is defibrillation or cardioversion indicated? Has IV/IO access been established? Is ROSC present? Is the patient with a pulse unstable? Are medications needed for rhythm or blood pressure? Does the patient need volume (fluid) for resuscitation?

75. Contd.. Monitor CPR quality Quantitative waveform capnography (if PETCO₂ is less than 10 mm Hg, atte to improve CPR quality) Intra-arterial pressure (if relaxation phase [diastolic] pressure is less than 20 mm Hg, attempt to improve CPR quality) Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms ( eg , tricular fibrillation [VF], pulseless ventricular tachycardia [PVT], asystole, pulse electrical activity [PEA]) Provide defibrillation/cardioversion

76. Contd.. Obtain IV/IO access Give appropriate drugs to manage rhythm and blood pressure Give IV/IO fluids if needed Check glucose and temperature Check perfusion issues

77. DISABLITY Check for neurologic function Quickly assess for responsiveness, levels of consciousness, and pupil dilation Assess for AVPU A - Alert V - Voice P - Painful U- Unresponsive

78. EXPOSURE Remove clothing to perform a physical examination, looking for obvious signs of trauma, bleeding, burns, unusual markings, or medical alert bracelets

79. SECONDARY ASSESSMENT Secondary assessment involves the differential diagnosis, including a focused medical history and searching for and treating underlying causes (H;s and T;s) Ask specific question related to the patient's presentation consider using memory aid SAMPLE

80. POTENTIALLY REVERSIBLE CAUSES ( 5 H ’s & 5 T’s ) : T ension pneumothorax T amponade T oxic/therap. disturbances T hrombo sis coronary T hrombo sis pulmonary H ypoxia H ypovolemia H ypothermia H yper/ hypokalemia and metabolic disorders H + ions (acidosis)