Basic Life Support
Cardiopulmonary resuscitation
Objectives for CPR
Establish effective
circulation and ventilation as soon as possible.
Prevent irreversible cerebral
anoxic damage. (4 mins before irreversible brain damage)
Basic Life Support (BLS) means:-
Maintaining an airway and
supporting breathing of a victim of respiratory or cardiac arrest until further
help arrives
BLS is unlikely to
successfully revive someone - Advanced Life Support (ALS) or specific treatment
is needed. BLS "buys time"
During any resuscitation
attempt the priority must be to activate emergency medical services such as a
crash team or paramedics. They will have
the facilities/ability to provide ALS - the aim of which is to restore Sinus
rhythm and normal respirations.
Management of a situation
Safe approach
Shout for help
Approach with care
Free from danger
Evaluate the patient
Initial assessment
"Are you all
right?" - check responsiveness
Look, listen, feel -
check breathing
Further assessment
Feel for central pulse for 5
seconds - check circulation
Call emergency help
“Team” alerted
Start CPR:
Ventilation/compression ratio
1:5 with help
or 2:15 on your own.
Adequate breaths assessed by
chest movements
Airway opening manoeuvres
Head tilt
Chin lift
Finger sweep
Jaw thrust
Only the jaw thrust can be
used in a case with suspected trauma to the cervical spine.
Adequate breathes
Assessed by chest movements
Correct hand position
Correct body position
Correct rate
Correct depth
Adequate
compressions
Correct hand position
Correct body position
Correct rate
Correct depth
Key points in Chest Compression
Chest compression must be
given using vertical force in the midline - using interlocked hands.
Deliver downward pressure
with a rhythmic rather than a jerky action.
Use straight arms and the
heel of the hand on the lower half of the patient's sternum.
Depress to a depth of
1.5-2.0" (4-5 cms) in an adult.
The fingers should be kept
well away from chest wall.
Perfect compressions will
only result in about 20-25% of the normal output of the heart.
Remember - "Lock and
Rock"
Oxygen
Only drug used in BLS
Via mouth to mouth - 16%
Via bag valve mask system -
21%
Via bag, valve mask and
oxygen at 10 litres per minute - 40-50%
Via bag, valve mask, oxygen
and reservoir @ 10 litres per minute - 80-90%.
Key points in airway management and ventilation
Mouth to mouth breathing
provides adequate ventilation and requires no equipment.
Incorrect use of the
oropharyngeal airway may further occlude the airway.
A two-person technique is
preferred for effective bag-valve-face mask ventilation.
A patent and secure airway is
of paramount importance during cardiopulmonary resuscitation.
Flow Chart showing action plan for initial assessment
and management
of an apparently lifeless casualty
Resuscitation
The Cardiac Arrest Situation
What is the blood pressure in a cardiac arrest?
What effect does this have on cerebral and myocardial perfusion?
Causes
* after myocardial infarction
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Diagnosis
There are two components essential to clinical diagnosis
1. Absence of central pulse, for how long?
2. Unconsciousness
Other clinical indicators include;
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*
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Diagnosis on the Electrocardiograph
* Ventricular fibrillation
* Ventricular tachycardia sometimes
* Asystole
* Electromechanical disassociation
Treatment
Ask patient to cough
The pre - cordial thump is in
Cardio - chest compressions.
This works because of the valvular system in the heart and the compression of the heart between the thoracic vertebral column and the sternum
Pulmonary - regular lung inflations with 100% oxygen
Correction of the arrhythmia
Three essential criteria for defibrillation
All three must be present
Unconscious
Pulseless
VF or VT on the screen