BLS_

ACADEMIC SESSION: JUNIOR INTERNS Topic: Basic Life Support Lecturer: Teddy S. Fabila, MD Date: 04april09 Transcriber: cockroach! Sole Objective: To Maintain a constant supply of oxygen to the brain until the victim recovers or until help arrives Chain of Survival:     Responsibility is assumed by a more senior EMS profesional Criteria indicating irreversible death Rescuer exhaustion, scene is no longer safe Valid DNAR order ABC’s of Basic Life Support  Airway o Head tilt-chin lift maneuver Access American Heart Association:  Most adult victims of witnessed, non-traumatic cardiac arrest are found to be in ventricular fibrillation.  “time from collapse to defibrillation is the single greatest determinant of survival”  Activation of the local Emergency Medical System (EMS) or hospital, prior to any intervention o     Survival rates from witnessed VF SCA decrease 7 % to 10% every minute if no CPR is provided Survival rates are more gradual, and averages 3% to 4% decrease every minute from collapse to defibrillation, if CPR is provided. “Phone first” o Recommended to all witnessed collapse, nontraumatic, unresponsive adult victims “CPR first” o Infant, submersion or near drowning, cardiac arrest associated with trauma, and drug overdose Jaw thrust maneuver  Breathing o LLF position  Look: for the rise and fall of the chest  Listen: for air passing through the nose  Feel: for breathing through the mouth Cardiopulmonary Resuscitation  Criteria for NOT Starting CPR o Valid DNAR o Signs of Irreversible death o No physiologic benefit as in septic or cardiogenic shock o Confirmed gestation of < 23 weeks or birth weight < 400 grams, anencephaly, and confirmed trisomy 13 or 18  Criteria for Terminating Attempted CPR o Effective and spontaneous (normal) breathing and circulation has been restored Academic Session: Anesthesiology Page 2 of 5 If there are no signs of breathing give two initial rescue breaths   Do not bounce Deliver 100 per minute and 30 per cycle    Circulation o Motion o Temperature o Skin color o Pulse Assessment for pulse should not last for more than 10 seconds Pulse check, has been found to be only 65% accurate Compression-Ventilation Ratio and CPR cycle  Without advance airway o 30 compressions : 2 normal breaths / cycle o 5 cycles is roughly 2 minutes  With advance airway o Independent 100 compression per minute, and 8 -10 breaths per minute CPR Rescue Protocol 1. Establish scene safety 2. Establish yourself to the bystanders as capable of performing CPR and seek permission to help. 3. Check for unresponsiveness. “Hey, hey…are you OK?!” 4. If unresponsive, get someone to activate local EMS, or hospital. 5. Open victims Airway 6. Check for signs of breathing (5 seconds), if none give 2 rescue breaths. 7. Check for signs of Circulation (10 seconds), if none start CPR while preparing for the AED. 8. Attach AED, follow its instructions, and perform necessary action Operating an AED: 4 universal step  Step 1: Turn on the AED  Step 2 : Attach Electrode Pads  Step 3 : Analyze rhythm  Step 4 : Clear victim and deliver shock “I’m shocking in three…” One I’m clear, Two your clear, Three everybody clear?” Precaution/Reminders:  Place pads 1 inch away from implanted pacemaker or ICD.  Allow ICD to run its programmed shock  For submerged patient, dry the chest first, before the giving a shock.  For hairy patient, it is advised to shave the part where pads will be placed.  Remove all medication pads.  Chest compression o Hand placement  Place the heel of one hand over the sternum  Two fingers width above the xyphoid process Compressions  Lock elbows  Shoulders are directly over your hands  Depress the sternum 1 ½ to 2 inches with each compression 9. If signs of circulation return but the patient remains unconscious and breathing is inadequate, perform rescue breathing.  10 – 12 breaths per minute  1 breath every 4 – 5 seconds  one cycle (2 minutes) = 24 breaths  “If you are at anytime unsure whether the victim needs CPR or rescue breathing, GO TO CPR.” Academic Session: Anesthesiology Page 3 of 5 10. If signs of circulation are restored, but patient still remains unconscious, place the patient in the recovery position.     QRS: Normal looking Rate : less than 60 seconds Rhythm: Regular P wave: Upright in leads II, III, and AVF Advance Cardiac Life Support  Review of Basic Arrhythmia o Normal Sinus Rhythm o Brady-arrhythmia o Tachy-arrhythmia o Asystole  Atrioventricular Block o First Degree AV Block o Second Degree AV Block  Type I (Wenkebach)  Type II o Third Degree AV Block Atrioventricular block  1 degree AV block st Cardiac conduction 2 nd degree type 1 (Wenkebach) 2 nd degree type 2 Normal Sinus Review  P wave o 0.08 – 0.11 seconds o Upright in lead II, III, AVF o Inverted in AVR  PR interval o 0.12 – o. 20 seconds o Prolonged PR interval = bradycardia  Normal Sinus Review  QRS complex : 0.12 seconds  ST segment : - 0.5 to 1 mm from the baseline Brady-arrythmia  Sinus Bradycardia o Decrease in the rate of Atrial depolarization due to slowing of sinus node o ECG Criteria: 3 degree AV block Tachy-Arrythmias  Sinus Tachycardia  Ventricular Fibrillation  Wide Complex Tachycardia o Ventricular Tachycardia  Monomorphic  Polymorphic  Narrow Complex Tachycardia o Atrial Fibrillation o Atrial Flutter rd Academic Session: Anesthesiology Page 4 of 5 Sinus tachycardia Atrial flutter Ventricular fibrillation Practice: Wide complex tachycardia Atrial fibrillation 1 degree AV block st Torsades de pointes Monomorphic ventricular tachycardia Atrial fibrillation Atrial flutter Academic Session: Anesthesiology Page 5 of 5 Ventricular fibrillation