ADULT BASIC LIFE SUPPORT ( BLS ) Yangama Jokwiro BScNS MSc Physiology Cert IV Training and Assessment

1. ADULT BASIC LIFE SUPPORT (BLS) Yangama Jokwiro BScNS MSc Physiology Cert IV Training and Assessment

2. BASIC LIFE SUPPORT • Guidelines presents the latest in Consensus on Science (CoStar) • International Liaison Committee on Resuscitation (ILCOR) • Australian Resuscitation Council adopted in Feb 2006

3. OBJECTIVES Participants should be able to demonstrate: • How to assess the collapsed victim • How to manage an airway • How to perform chest compression and rescue breathing • How to place an unconscious breathing victim in the recovery position.

4. BASIC LIFE SUPPORT SEQUENCES OF PROCEDURES PERFORMED TO RESTORE THE CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY AND/OR CARDIAC ARREST CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER EQUIPMENT Protective devices and legal liability

5. Community nursing BLS challenges • Legal liability (usually arise if failure to diagnose or delay-in-diagnosis of a medical emergency) • Acting in the best interest of an incompetent adult vs family members (avoiding futile treatment and considering quality of life if treatment is given) • Lack of sufficient equipment (if unwilling to administer mouth to mouth commence compressions) C comes before A & B

6. LEADING GERIATRIC EMERGENCIES • AMI silent vague symptoms • Pulmonary embolism/pneumonia/pulmonary edema • Depression • CVA/ Seizures (mainly carcinogenic effects) • Falls • Dehydration • Abuse and Neglect

7. BACKGROUND • Survival to hospital discharge presently approximately 5-10% • Bystander CPR vital intervention before arrival of emergency services – double or triple survival from SCA (sudden cardiac arrest) • Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60%survival

8. Best chance of Survival (ARC guideline 11) • The victim is witnessed to collapse • CPR is commenced immediately and is effective • Cardiac rhythm is VT/VF • Defibrillation is performed as soon as possible REMEMBER TO PUSH HARD, PUSH FAST AND LIMIT INTERRUPTIONS

9. CHAIN OF SURVIVAL

10. New guide lines • Pulse checks not recommended for lay persons and de-emphasized for healthcare providers. (should take less than 10seconds) (Watch for a purposeful movement ) • Compressions only if mouth to mouth can not be delivered • Compression rate should come close 100bpm (2 per second) • Correct hand position (center of the chest lower half of the sternum) • FBAO (BACK BLOWS 5/ CHEST TRUSTS 5) no more Heimlich maneuver (ARC Guideline 4) • Recovery checks not recommended (ARC GUIDE 7) even after defib

11. SUMMARY OF TECHNIQUE

12. PUSH HARD PUSH FAST LIMIT INTERRUPTIONS

13. Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

14. APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

15. CHECK RESPONSE Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

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

17. SHOUT FOR HELP Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

18. OPEN AIRWAY Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

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

20. OPEN AIRWAY Head tilt, chin lift + jaw thrust - healthcare professionals

21. CHECK BREATHING Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

22. Look, listen and feel for NORMAL breathing Do not confuse agonal breathing with NORMAL breathing CHECK BREATHING

23. AGONAL BREATHING • 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 Erroneous information can result in withholding CPR from cardiac arrest victim

24. Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

25. FOREIGN-BODY AIRWAY OBSTRUCTION (FBAO) Approximately 16 000 adults and children receive treatment for FBAO yearly

26. ADULT FBAO TREATMENT

27. BACK BLOWS

28. ABDOMINAL THRUSTS

29. 30 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

30. CHEST COMPRESSIONS • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest • Rate 100 min-1 • Depth 4-5 cm • Equal compression : relaxation • When possible change CPR operator every 2 min

31. RESCUE BREATHS Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

32. 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 RESCUE BREATHS

33. RESCUE BREATHS RECOMMENDATIONS: - Tidal volume 500 – 600 ml - Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise - Chest-compression-only continuously at a rate of 100 min

34. CONTINUE CPR 30 2

35. Approach safely Check response Shout for help Open airway Check breathing Call 000 30 chest compressions 2 rescue breaths

36. DEFIBRILLATION

37. Approach safely Check response Shout for help Open airway Check breathing Call 000 Attach AED Follow voice prompts

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

39. ATTACH PADS TO CASUALTY’S BARE CHEST

40. ANALYSING RHYTHM DO NOT TOUCH VICTIM

41. Stand clear Deliver shock SHOCK INDICATED

42. SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS 30 2

43. NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS 30 2

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

46. Approach safely Approach safely Check response Check response Shout for help Shout for help Open airway Open airway Check breathing Check breathing Call 000 Call 000 30 chest compressions Attach AED 2 rescue breaths Follow voice prompts

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

48. REPETITION 1. Name adult basic life support sequences of actions. 2. What is the manoeuvre for keeping the airway open called? 3. What is the numeral combination of chest compression and rescue breaths in adult basic life support? 4. Where do you place your hands while performing chest compressions? 5. How would you describe „agonal breathing“? 6. What is the telephone number of emergency response system? 7. Name 2 techniques applied in severe airway obstruction?

49. Resus Failed? • If none of the above has worked, walk away casually and hope no-one recognises you.