Basic and Advanced Life Support

1. Basic and Advanced Life Support Dr. Nevine Abdel Fattah Lecturer in Chest Diseases Ain Shams University.

2. Adult Basic Life Support • This lecture contains the guidelines for out-of-hospital, single rescuer, adult basic life support (BLS). • The guidelines are based on the document 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment recommendations.

3. Adult Basic Life Support • At the end of the lesson you should be able to state and describe the Adult BLS Algorithm, focusing on Cardiac Arrest in a non drowning, non traumatic, non toxic adult collapse. • Basic life support (BLS) is a specific level of pre-hospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. • BLS may also include considerations of patient transport such as the protection of the cervical spine and avoiding additional injuries through splinting and immobilization.

4. Adult Basic Life Support Nervous system

5. Adult Basic Life Support • BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced cardiac life support (ACLS). • CPR provided in the field buys time for higher medical responders to arrive and provide ACLS. For this reason it is essential that any person starting CPR also obtains ACLS support by calling for help via radio using agency policies and procedures and/or using an appropriate emergency telephone number. • An important advance in providing BLS is the availability of the automated external defibrillator or AED, which can be used to deliver defibrillation. This improves survival outcomes in cardiac arrest cases, sometimes dramatically.

6. Adult Basic Life Support • PERSON COLLAPSES • Check if he is unresponsive. • Call Emergency number. • Get AED (automatic Electric Defibrillator) • Begin the ABCD’s

7. Adult Basic Life Support

8. Adult Basic Life Support Basic life support consists of the following sequence of actions: • Make sure the victim, any bystanders, and you are safe. • Check the victim for a response. • Gently shake his shoulders and ask loudly, ‘Are you all right?’ If he responds: • Leave him in the position in which you find him provided there is no further danger. • Try to find out what is wrong with him and get help if needed. • Reassess him regularly. If he does not respond: • Shout for help. • Turn the victim supine aligned position or stable side position.

9. Adult Basic Life Support START THE ABCD’s Airway:Open Airway. Breathing: (Look, Listen &Feel) Circulation:. Monitor and check the pulse.

10. Adult Basic Life Support Defibrillator: An important advance in providing BLS is the availability of AED, which can be used to deliver defibrillation. improving survival outcomes in cardiac arrest cases.

11. Adult Basic Life Support Airway Control: - Chin Lift Maneuver. - Jaw thrust maneuver. - Manual clearing of mouth & throat. - Pharyngeal suctioning. - Pharyngeal intubation.

12. Adult Basic Life Support

13. Adult Basic Life Support Open airways

14. Adult Basic Life Support Airway Control: - Esophageal obturator airway insertion. - Endotracheal intubation &Tracheobronchial suctioning. - Cricothyrotomy - transtracheal O2 jet insufflation. - Tracheotomy, bronchoscopy bronchodilatation, pleural drainage.

15. Adult Basic Life Support Breathing: Keeping the airway open, look, listen, and feel for normal breathing. • Look for chest movement. • Listen at the victim's mouth for breath sounds. • Feel for air on your cheek. In the first few minutes after cardiac arrest, a victim may be barely breathing, taking infrequent, noisy, gasps. Do not confuse this with normal breathing. Look, listen, and feel for no more than 10 sec to determine if the victim is breathing normally. If you have any doubt whether breathing is normal, act as if it is not normal.

16. Adult Basic Life Support If he is breathing normally: • Turn him into the recovery position. • Send or go for help, or call for an ambulance. • Check for continued breathing. If he is not breathing normally: • Ask someone to call for an ambulance or, if you are on your own, do this yourself; you may need to leave the victim. • Start chest compression as follows: • Kneel by the side of the victim. • Place the heel of one hand in the centre of the victim’s chest.

17. Adult Basic Life Support • Place the heel of your other hand on top of the first hand. • Interlock the fingers of your hands and ensure that pressure is not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone). • Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum 4 - 5 cm. • After each compression, release all the pressure on the chest without losing contact between your hands and the sternum. • Repeat at a rate of about 100 times a minute (a little less than 2 compressions a second). • Compression and release should take an equal amount of time.

18. RECOVERY POSITION Adult Basic Life Support

19. Adult Basic Life Support

20. Adult Basic Life Support • Breathing support: - Mouth-to-mouth (nose) ventilation. - Mouth-to-adjunct with or without O2. - Manual bag-mask (tube) ventilation with or without O2. - Hand-triggered O2 ventilation - Mechanical ventilation

21. Adult Basic Life Support Combine chest compression with rescue breaths: • After 30 compressions open the airway again using head tilt and chin lift. • Pinch the soft part of the victim’s nose closed, using the index finger and thumb of your hand on his forehead. • Allow his mouth to open, but maintain chin lift. • Take a normal breath and place your lips around his mouth, making sure that you have a good seal. • Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath. • Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.

22. Adult Basic Life Support • Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. • Continue with chest compressions and rescue breaths in a ratio of 30:2. • Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.

23. Adult Basic Life Support • If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt: • Check the victim's mouth and remove any visible obstruction. • Recheck that there is adequate head tilt and chin lift. • Do not attempt more than two breaths each time before returning to chest compressions. • If there is more than one rescuer present, another should take over CPR about every 2 min to prevent fatigue. • Ensure the minimum of delay during the changeover of rescuers.

24. Adult Basic Life Support

25. Adult Basic Life Support • Circulation support: - Control of external hemorrhage. - Position of shock. - Pulse checking. - Mechanical chest compressions. - Open chest direct cardiac Compressions.

26. Adult Basic Life Support Chest-compression-only CPR: • If you are not able, or are unwilling, to give rescue breaths, give chest compressions only. • If chest compressions only are given, these should be continuous at a rate of 100 a minute. • Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.

27. Adult Basic Life Support

28. Adult Basic Life Support Continue resuscitation until: • Qualified help arrives and takes over, • The victim starts breathing normally, or • You become exhausted.

29. Adult Basic Life Support Algorithm Check Responsiveness Shake and Shout Open Airway Head tilt/chin lift Check Breathing Look, listen and feel 2 Effective Breaths Signs of circulation  Assess 10 seconds only Circulation Present Continue Rescue Breathing No Circulation Compress Chest Rate of 100 per second 30 compressions to 2 breaths (30:2)

30. Adult Advanced Cardiac Life Support • Advanced Cardiac Life support (ACLS) is a detailed medical protocol for the provision of lifesaving cardiac care in settings ranging from the pre-hospital environment to the hospital setting. • Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. • Only qualified health care providers (doctors, nurses, emergency medical responders) can provide ACLS.

31. Adult Advanced Cardiac Life Support • ACLS is an extension of BLS, especially now that the use of automated external defibrillators (AEDs) in out-of-hospital setting has become part of BLS. • The aim of this section is to review the Adult Advanced Life support Algorithm.

32. Adult Advanced Life Support Algorithm

33. Adult Advanced Life Support Algorithm Monitored or Witnessed Arrest! Within 30 seconds from time of arrest. Used once only.

34. Adult Advanced Life Support Algorithm

35. Adult Advanced Life Support Algorithm Chest free of Lead wiring. Lead positions; Ride Your Bike

36. Adult Advanced Life Support Algorithm

37. Adult Advanced Life Support Algorithm

38. Adult Advanced Life Support Algorithm Non VF/VT Any rhythm other than VF/VT

39. Adult Advanced Life Support Algorithm

40. Adult Advanced Life Support Algorithm

41. Adult Advanced Life Support Algorithm

42. Adult Advanced Life Support Algorithm • During CPR • Correct reversible causes • If not done already: • Check des, paddle position and contact. • Attempt / Verify: Airway and O2 • IV Access : Give Epinephrine every 3min. • Consider : Amiodarone, Atropine/ Pacing & Buffers.

43. Adult Advanced Life Support Algorithm • During CPR • Correct reversible causes • If not done already: • Check des, paddle position and contact. • Attempt / Verify: Airway and O2 • IV Access : Give Epinephrine every 3min. • Consider : Amiodarone, Atropine/ Pacing & Buffers.

44. Adult Advanced Life Support Algorithm • The H’s & T’s • Potential Reversible Causes • Hypoxia • Hpovolaemia • Hypo/Hyperkalaemia and Metabolic disorders • Hypothermia • Tension Pneumothorax • Tamponade • Toxic /Therapeutic Disorders • Thromboembolic and Mechanical obstruction.

45. Adult Advanced Life Support Algorithm Questions?

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