BASIC LIFE SUPPORT BLS)

1. BASIC LIFE SUPPORT(BLS)‘save lives following cardiac arrest’

2. Chain of survival

3. Chain of survival

4. History contd… • Prone position inadequate • Expired air did provide sufficient O2 • Head tilt, chin lift kept patent airway

6. APPROACH SAFELY! Scene Rescuer Victim Bystanders

7. Response Ask, “are u all right”? no response Tap or squeeze shoulders – gently no response activate Emergency medical services Check for no breathing or no normal breathing (i.e., gasping) Gasping without eye opening - failure to respond – manage as unconscious

8. Pulse check The lay rescuer should not check for a pulse The healthcare provider should take no more than 10 seconds. If no pulse or doubtful, proceed with CC - Children and adults – carotid - Infants - brachial or femoral Use two fingers and large surface area to feel over carotid or femoral

10. Carotid pulse

11. Chest compressions victim on flat surface “push hard and push fast” Rate: 100 compressions/min Compression depth : 4-5 cm in adults, : 1/2 - 1/3 of chest in infants Landmark: - lower 1/2 of sternum , between nipples in children & adults - just below nipple line in infants

14. Chest compressions Allow complete recoil of chest after each compression Minimize interruptions in chest compressions Swap rescuers every 2 minutes (6-8 cycles) to avoid exhaustion Compressions should be paused for ventilations till airway is secured

15. Ventilation Head tilt and chin lift to open airway unless cervical injury is suspected Rescue breaths

18. Rescue breathing Give 2 breaths each over 1 second Sufficient tidal volume to produce visible chest rise Low minute ventilation can maintain effective oxygenation during CPR Avoid rapid or forceful breath

19. Rescue breathing Mouth to mouth breathing - open victim’s airway - pinch the nose , airtight mouth-mouth seal give 1 breath over 1 second - take regular (not a deep ) breath Mouth to barrier device Bag and mask Ventilation with advanced airway “No pause in compressions for ventilation if advanced airway is placed”

20. Mask ventilation

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

26. Scenarios

27. Rescue breathing without CC Pulse is felt but no breath then give breath children/adults : 10-12 breaths/min infants : 12-20 breath/min. Reassess the pulse every 2 min No more than 10 seconds in doing so

28. Compressions only CPR If you are not able or are unwilling to give rescue breaths, give chest compressions only If patient is gasping immediately start compressions Intra-thoracic pressure won’t increase and RR also will become low Should be continuous, at a rate of 100 /min Stop to recheck the victim only if he starts breathing normally

29. Phone first or CPR first? This confusion occurs when rescuer is single Adult collapsing suddenly - mostly cardiac arrest----call first then start CPR If the likely cause of unconsciousness is a breathing problem e.g., drowning, trauma, chocking, intoxication or victim is an infant then do CPR for 2 mins or 5 cycles then call for help

30. When to Stop CPR ??? CPR should be continued till : Qualified help arrives and takes over Return of spontaneous circulation (ROSC) The patient recovers An authorised person pronounces life extinct Rescuer becomes exhausted

31. Special occasion - Pregnancy CPR in pregnant victim: - In pregnant woman the uterus causes pressure on the major abdominal organs when she lies flat, reducing the venous return to the heart - give pelvic tilt to left using pillow/wedge as blood supply to fetus should not be jeopardized

32. Special occasion - chocking Responsive Adult/Child Abdominal thrusts until object is removed or victim becomes unresponsive Unresponsive Adult/Child Lower them to the ground and begin the steps of CPR Look in the mouth before each breath If you see the object, you can remove it

34. Early defibrillation Early defibrillation implies that defibrillation carried out within 5 mins of cardiac arrest Survival decreases by 10% for every minute that passes without defibrillation

35. Defib….

36. AED(Automated External Defibrillator) AEDs are computerized devices that allow laypersons to attempt defibrillation safely. AEDs are recommended for all ages >1 yr AHA has approved low energy defibrillation with biphasic waveform AED for VT/VF AEDs are highly accurate in rhythm detection It delivers fixed three shock sequence of 150 or 200j

37. AED contd… Power on the AED Apply pads to the victim's bare chest Plug the pads into the AED "Clear" the victim and allow it to analyze If a shock is advised, "clear" the victim again and press the shock button

38. ATTACH PADS TO CASUALTY’S BARE CHEST

39. ANALYSING RHYTHMDO NOT TOUCH VICTIM

40. SHOCK INDICATED • Stand clear • Deliver shock

41. SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

42. Take home message • Compressions are vital • Minimal interruption of chest compressions • Push hard and fast • 8-10 breaths per minute • Delivered over one second duration • 30/2 compression ventilation ratio • Compressions immediately after defibrillation

43. Cough CPR/ Prone CPR Cough cpr-Recommended only for awake monitored victim getting VF/VT Prone cpr – when supine position cannot be given blood pressure is raised in prone CPR than supine CPR.