Presentation Basic life support procedure BLS.pptx

Presentation Basic life support procedure BLS

1. Basic Life Support

2. Individual skills of BLS Scene safety Assessing responsiveness Making emergency call Checking breathing and pulse Chest compression Airway opening and providing breath Using AED/Defibrillator

3. Skills of First Link Checking Scene safety Checking Responsiveness Making emergency call Assessing Breathing and pulse

4. Scene safety Person appears collapsed Is scene safe for victim? Is scene safe for rescuer? Personal protection

5. Verify scene safety

6. A ssessing Responsiveness & Making emergency call Face the victim Tap on his shoulder and shout “Are you all right?”

7. No response (answer, moan, groan) Shout for help If someone responds Ask to activate EMS (With AED)

8. If No one responds Activate EMS (102 in India) & ask to get AED. Provide dispatcher with the number of victims,age,gender, condition and location of emergency. Stay on line till told to hang up.

9. Perform gentle head tilt by placing one hand on victim’s forehead Locate thyroid cartilage on front of neck and slide the fingers into groove between trachea and sternocleidomastoid (on same side as provider) & simultaneously observe chest and abdomen. Palpate the carotid pulse for at least 5 seconds but not more than 10 seconds(One thousand one, one thousand two…….) Pulse check & Breathing

10. BREAK Divide into two groups- 8 each - One group for Resuscitation - One group for Surgical skill

11. Chain of survival

12. Scene safety Check responsiveness Call for help Check pulse and breathing Administer 30 chest compressions Open airway & give 2 rescue breaths Continue till sign of life or ACLS team arrives Pulse and breathing absent

13. Chest compressions

14. 1 2 3 Locate lower half of sternum Place heel of one hand , Just below intermammary line other hand on the top of first interlock fingers so that they are drawn up and heel of first hand remains on the chest of victim Keep elbows straight; Position shoulders directly above hands

15. Chest compressions Push hard (depth 5-6cm) Push fast (rate 100-120/min) Ensure full chest recoil after each compression Minimize interruptions (less than 10 seconds)

16. 1 st BREAK -Skill of chest compression -Scene safety to chest compression

17. Open Airway Deliver two breaths - Mouth to mouth - Mouth to mask - Bag and mask

18. Open the airway Head tilt-chin lift Put your palm on the person's forehead and gently tilt the head back With two fingers of the other hand, gently lift the chin

19. Head tilt-Chin lift

20. Place fingers posterior to the angle of the mandible A pply forward and upward pressure Hold mouth open using thumbs to displace chin anteriorly Jaw thrust Open the airway…. Concern for cervical spine

21. Two Rescue breaths Each rescue breath over 1 second Visible chest rise 30 compression: 2 breaths Attach O2 ASAP, no change in duration/number of breath delivered If 1 st breath ineffective , reposition then deliver second breath If 2 nd also ineffective go to ‘C’

22. Open the airway…… Give 2 rescue breaths Methods of delivering breaths Mouth to mouth Mouth to pocket mask Bag and Mask

23. Pinch nose Place and seal your lips over the victim´s mouth Blow until the chest rises Take s about 1 second Allow chest recoil Deliver the second breath Mouth to mouth 2 rescue breaths

24. Pocket mask

25. Mouth-To-Barrier device (POCKET MASK)

26. Single rescuer complete cycle

27. Scene safety Check responsiveness Call for help Pulse check Assess for breathing Administer 30 chest compressions Open airway & give 2 rescue breaths Continue till sign of life or ACLS team arrives Till signs of life appear ACLS team arrives Rescuer is tired

28. 2 nd BREAK FOR HANDS ON Demo : Skill of mouth to mask Single rescuer complete cycle

29. 1-rescuer Adult BLS -Revision The first rescuer who arrives at the side of a cardiac arrest victim should quickly perform boxes 1 &2

30. 1-rescuer Adult BLS CPR Next assess the victim for normal breathing and pulse Assess breathing at the same time as you check the pulse This should take no more than 10 seconds CPR

31. Scenario 1 Unresponsive but Pulse present and Breathing present Recovery position

32. Scenario 2 Unresponsive but Pulse present and Breathing Absent(no or agonal breathing) Immediately open the airway using the head-tilt/chin-lift maneuver and begin rescue breathing One breath every six seconds for 2 minutes Check pulse every 2 minutes

33. Bag And Mask Ventilation - Two rescuers Position yourself directly above patient’s head E_C clamp technique followed Place the mask placing the apex on the bridge of the nose and base over the groove over the chin Make “C” with thumb and index finger of one hand over the mask, compressing it over the face Use the remaining 3 fingers, to form “E ” to elevate the mandible to form the complete seal Perform head tilt S queeze the bag with other hand to give breaths to the patient

34. Two Rescuer Resuscitation Demonstration by Instructors

35. 2-rescuer Adult BLS Second rescuer to call EMS without leaving the person while you begin CPR. This second rescuer can also find an AED while you stay with the person. When the second rescuer returns, the CPR tasks can be shared The second rescuer prepares the AED for use. You begin chest compressions and count the compressions out loud. The second rescuer applies the AED pads. The second rescuer opens the person’s airway and gives rescue breaths. Switch roles after every five cycles of compressions and breaths. One cycle consists of 30 compressions and two breaths. Quickly switch between roles to minimize interruptions in delivering chest compressions.

36. AED

37. "Chain of Survival."   Immediate recognition of cardiac arrest   and activation of the   emergency response system   Early CPR   that emphasizes chest compressions   Rapid defibrillation if   indicated   Effective advanced life support   Integrated post–cardiac   arrest care   38

38. Defibrillation Delivery of massive amount of current through chest and heart to depolarize myocardium Electrical silence SA node takes over and generates normal sinus rhythm 39

39. Why to defibrillate in BLS ? VF/pulseless VT most frequent initial rhythm in witnessed SCA Treatment defibrillation Immediate T/t very important VF Asystole within minutes Success of defib  as time passes ( 7-10 %  in success rate with every 1min elapsed) 40

40. Ventricular Fibrillation (V-fib) V-fib to Shock to Normal V-fib is common in SCA Heart overwhelmed by electrical activity Can be related to lack of oxygen Quickly lethal Victim unresponsive CPR won’t stop V-fib “ Defib ” is only treatment for “V-fib” 42 V-fib present in 90% of SCA cases

41. 43 AED; Automated External defibrillator Safe, simple to use & reliable computerized device used for defibrillation Can detect, analyze and correct VF and pulseless VT rhythm Audio and visual prompts available Safe and effective use even in the hands of a lay person.

42. What is an AED Automated External Defibrillator (AED) What it does… Uses voice and visual prompts Easily guides rescuers Analyzes heart rhythm Determines if shock is needed Restores normal rhythm Provides CPR reminders CPR/AED for Community Rescuers CPR Overview 44

43. 45 Pre-use daily checks for AED Check AED function including ECG analysis Battery status and function Inspection of electrode pads and their readiness for use Electrolyte gel availability Expiry date of electrode

44. 46 Steps of AED use Step 1 Power on AED Step 2: Place AED electrode on the chest Step 3: AED Analyses rhythm( stand clear) Step 4: If Shock advised Stand clear Step 5: Deliver single shock Step6: Resume CPR starting with C

45. 47 Arrange for AED Switch on Some AEDs will automatically switch themselves on when the lid is opened

46. 48 ATTACH PADS TO VICTIM’S BARE CHEST

47. 49 Electrode Placement Well Illustrated

48. 50 ANALYSING RHYTHM DO NOT TOUCH VICTIM

49. 51 Stand clear Deliver shock SHOCK INDICATED

50. Clear Victim and Shock Clear victim first Loudly state, “Clear!” Look up and down entire victim Ensure no one touching person or clothing Press shock button Some AEDs shock automatically (no button) AEDs announce when safe to resume compressions Using an AED 52 Do not touch victim or clothing during a shock

51. 53 30 2 SHOCK DELIVERED FOLLOW AED INSTRUCTIONS

52. AED Use on Children Children & infants require less electrical current Special equipment reduces amount of energy delivered Child/Infant Pads Energy reducer or attenuator Pediatric key or switch If pediatric equipment is not available, use standard equipment CPR/AED for Community Rescuers Using an AED 54 For AED use: A child is 1-8 years old. An infant is < 1 year old

53. For Smaller Children or Infants CPR/AED for Community Rescuers Using an AED 55 Use front-to-back AED pad placement if needed Pads should not touch or overlap Do not cut or fold pads to fit

54. 56 A utomated E xternal D efibrillators Some practical tips

55. 57 Safe use of oxygen! Oxygen enriched atmosphere: spark, burns Minimize the risk of spark Take off any oxygen mask or cannula; place it 1m away substitute ventilator tubing to vent bag; hold it 1m away.

56. 58 Paddle force : 8Kg in adults & 5Kg in child Electrode size: 8-12cm for adults Electrode placement Traditional approach; 1st just below Rt. clavicle & 2 nd just outside Lt.nipple in midaxillary line Biaxillary position ; lat. Chest wall on right and left sides Lt. pad in standard apical position and other pad on right or left upper back

57. 59 Points to keep in mind with electrode placement Proper application of gel Keep electrode at least 1inch away from medically implantable device to protect them Do not place electrode directly over a transdermal medication patch, blocks delivery of current causing skin burns: remove it & wipe the area before placing electrode Victim wet or sweating: wipe before placing electrode Hairy chest Waxing trick Shaving

58. Very Hairy Chest A lot of chest hair limits contact between AED pad and victim’s skin AED may not be able to read heart rhythm If the first set of pads is not working Press pads firmly onto skin Remove with a quick motion Apply second set of pads CPR/AED for Community Rescuers Special Considerations - AED 60 If only 1 set of pads is available, quickly shave the areas of pad placement before applying pads

59. Implanted Devices Devices may include Pacemaker Automated Implantable Cardioverter -Defibrillator (AICD) Medication administration port Most implanted devices do not affect AED pad placement. Do not place pad directly over implanted device Adjust pad placement at least 1” from device s Special Considerations - AED 61 Device may appear as a small raised lump under skin

60. Medication Patches Do not place an AED pad over a medication patch Use a gloved hand to remove the patch Quickly wipe chest clean with a towel or cloth Apply pads after area is wiped clean Special Considerations - AED 62 Medication can be embedded in an adhesive patch applied to skin

61. Water AED Safety 63 Wipe chest dry before applying pads

62. What is Wrong With This Picture? CPR/AED for Community Rescuers AED Safety 64

63. Foreign body airway obstruction (choking )

64. Recognition of Severe Foreign Body Airway Obstruction Universal choking sign ( clutch the neck) Cannot breathe/ struggle to breath Inability to speak or make sound Cannot cry Very quiet or silent cough Feeling of impending doom Cyanosis Victim becomes unresponsive

65. Responsive victim Quickly ask, “Are you choking?” Victim indicates “yes” by nodding his head without speaking Activate EMS if someone is available Otherwise proceed to help Inform victim that you are going to help:: Perform abdominal thrusts (Heimlich maneuver ) Continue and repeat these abdominal thrusts till:- Object is expelled and victim can breathe/cough/talk OR Victim becomes unresponsive

66. Abdominal thrusts (Heimlich maneuver ) Stand firmly behind the patient Identify victim’s umbilicus Make fist with one hand Put thumb side slightly above umbilicus and well below xiphisternum Grasp fist with other hand Wrap your arms around victim Give quick backward and upward thrust into belly sufficient to lift victim off his feet Physiology: Elevates the diaphragm – increase in airway pressure & this forces air from the lungs- generates artificial cough

67. Unresponsive adult victim. Carefully lower the patient to ground, face up Confirm unresponsiveness Activate EMS through someone or yourself Ask for AED Open the victim’s airway with head tilt-chin lift Look inside mouth Remove foreign body, if seen ( Do not use blind finger sweeps ) Begin CPR (without pulse check) starting with 30 compressions After 30 compressions, open airway using head tilt –chin lift Look inside mouth Remove foreign body , if seen

68. Unresponsive adult victim. Attempt 2 breath after 30 compressions If first breath is not effective, Reposition head and neck of victim before attempting second breath Continue these cycles of compression , attempt of FB removal , giving breaths till FB is removed or visible chest rise After FB removal or visible chest rise, check carotid pulse X 5-10 sec PRESENT ABSENT Continue CPR starting chest compression Assess breathing for 5-10 sec and manage appropriately No foreign body seen

69. Pregnant or too obese victims Chest thrusts given Abdominal thrusts cannot be performed Press forcefully inwards on the lower half of the chest bone (avoiding xiphoid process) using fist of both hands In woman:: chest thrusts . If the first thrust doesn't relieve the choking Repeat several times OR till patient becomes unresponsive

70. Conscious child >1 year Back slaps Activate EMS Don’t leave child Bend child until head lower than chest Palm of hand to deliver firm blow between shoulder blades Repeat blow 5 times, checking between blows to see if obstruction is relieved If not cleared, try abdominal thrusts

71. Responsive infants Abdominal thrusts not recommended : liver injury 5 Back blows followed by 5 chest thrusts Support infant head with fingers on malar prominence on either side of face Flip infant prone Straddle over your arm Support arm over thigh Keep infant head-low Give 5 back slaps between scapula using heel of free hand Back blows:-

72. Responsive infants 5 Back blows followed by 5 chest thrusts Chest thrusts:: Support infant head with fingers on either side of occiput Turn infant face up Straddle over your arm Give 5 chest thrusts 2 fingers just below intermammary line Keep alternating 5 back slaps with 5 chest thrusts till :- Foreign body expelled OR infant becomes unresponsive

73. Unresponsive infant CPR adapted to babies Infant placed face up on a horizontal surface, with the head in straight position Alternating cycle of 30 chest compressions and 2 breaths After 30 compressions, looks into mouth for FB If FB visible, attempts to extract it (mainly using a finger sweeping) After extraction, continue CPR until the baby's breath is successfully recovered