BLS

Basic Life Support Teddy S. Fabila, MD Second Anesthesiologist Sole Objective: TO MAINTAIN A CONSTANT SUPPLY OF OXYGEN TO THE BRAIN UNTIL THE VICTIM RECOVERS OR UNTIL HELP ARRIVES The Chain of Survival 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 Access  Survival rates from witnessed VF SCA decrease 7 % to 10% every minute if no CPR is provided  Survival rates is more gradual, and averages 3% to 4% decrease every minute from collapse to defibrillation, if CPR is provided. Access  “phone first”  Recommended to all witnessed collapse, non- traumatic, unresponsive adult victims  “CPR first”  Infant, submersion or near drowning, cardiac arrest associated with trauma, and drug overdose Cardiopulmonary Resuscitation  Criteria for NOT Starting CPR  Valid DNAR  Signs of Irreversible death  No physiologic benefit as in septic or cardiogenic shock  Confirmed gestation of < 23 weeks or birth weight < 400 grams, anencephaly, and confirmed trisomy 13 or 18 Cardiopulmonary Resuscitation  Criteria for Terminating Attempted CPR  Effective and spontaneous (normal) breathing     and circulation has been restored 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  Head tilt-chin lift maneuver ABC’s of Basic Life Support  Jaw thrust maneuver ABC’s of Basic Life Support  Breathing  LLF position  Look: for the rise and fall of the chest  Listen: for air passing through the nose  Feel: for breathing through the mouth ABC’s of Basic Life Support  Breathing  If there are no signs of breathing give two initial rescue breaths ABC’s of Basic Life Support  Circulation  Motion  Temperature  Skin color  Pulse ABC’s of Basic Life Support  Assessment for pulse should not last for more than 10 seconds  Pulse check, has been found to be only 65% accurate Chest Compression  Chest compression  Hand placement 1. Place the heel of one hand over the sternum 2. Two fingers width above the xyphoid process Chest Compression  Compressions 1. Lock elbows 2. Shoulders are directly over your hands 3. Depress the sternum 1 ½ to 2 inches with each compression 4. Do not bounce 5. Deliver 100 per minute and 30 per cycle Chest Compression  Compression-Ventilation Ratio and CPR cycle  Without advance airway  30 compressions : 2 normal breaths / cycle  5 cycles is roughly 2 minutes  With advance airway  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. CPR Rescue Protocol 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 Operating an AED Step 1: Turn on the AED Operating an AED Step 2 : Attach Electrode Pads Operating an AED Step 3 : Analyze rhythm Operating an AED 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. CPR Rescue Protocol 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.” CPR Rescue Protocol 10.If signs of circulation are restored, but patient still remains unconscious, place the patient in the recovery position. CPR Rescue Protocol VIDEO PRESENTATION Advance Cardiac Life Support  Review of Basic Arrhythmia  Normal Sinus Rhythm  Brady-arrhythmia  Tachy-arrhythmia  Asystole Cardiac Conduction Normal Sinus Review  P wave  0.08 – 0.11 seconds  Upright in lead II, III, AVF  Inverted in AVR  PR interval  0.12 – o. 20 seconds  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  Decrease in the rate of Atrial depolarization due to slowing of sinus node  ECG Criteria:  QRS: Normal looking  Rate : less than 60 seconds  Rhythm: Regular  P wave: Upright in leads II, III, and AVF Brady-arrythmia  Atrioventricular Block  First Degree AV Block  Second Degree AV Block  Type I (Wenkebach)  Type II  Third Degree AV Block Atrioventricular Block First Degree AV Block Second Degree AV Block Type I (Wenkebach) Second Degree AV Block Type II Third Degree AV Block Tachy-Arrythmias  Sinus Tachycardia  Ventricular Fibrillation  Wide Complex Tachycardia  Ventricular Tachycardia  Monomorphic  Polymorphic  Narrow Complex Tachycardia  Atrial Fibrillation  Atrial Flutter Sinus Tachycardia Ventricular Fibrillation Wide Complex Tachycardia Torsades de Pointes Narrow Complex Atrial Fibrillation Atrial Flutter PRACTICE  Atrial fibrillation Identify  First degree AV block  Monomorphic Ventricular Tachycardia  Atrial Flutter  Ventricular Fibrillation DON’T WORRY Handouts will be provided Thank you!