BASIC LIFE SUPPORT Ev-K2-CNR PYRAMID February 2007
Objectives: basic life support • Criteria to BLS access: • Valutation of unconscious patient • ABC: • ABC valutation • CPR (cardiopulmonary resuscitation)
Chain of survival Early recognition and call for help Early CRP Early defibrillation Post resuscitation care
Aim of BLS • To prevent/reduce the hypoxic cerebral damage using the CPR techniques in subjects with cardiopulmonary arrest • To garantee an early access in synthomatic patients at high risk of cardiopulmonary complications (IMA/stroke) to hospital
SAFETY OF BOTH RESCUER AND VICTIM IT’S THE FIRST THING TO DO. • MAKE SURE YOU; THE VICTIM AND ANY BYSTANDERS ARE SAFE. • USE RIGHT PROTECTION DEVICES. • TAKE CARE OF ANY ORGANIC SUBSTANCE.
LEGAL ASPECTS of BLS When don’t CRP start ? EVIDENT SIGNS OF BIOLOGICAL DEATH • TISSUTAL DECOMPOSITION • RIGOR MORTIS • DECAPITATION • FATAL TRAUMA
LEGAL ASPECTS of BLS Start with CRP without thinking about: • AGE • CADAVERIC APPEARANCE • BODY TEMPERATURE • MyDRIASIS
Access criteria • Unnconscious patients checkAVPU • Unresponsive: • Shout for help • Turn the victim onto his back and then open the airway BLS sequence • Responsive (V/P): • Check ABC leaving him in the position in which you find him • Try to find what is wrong with him and get help if needed • Reassess him regularly
Level of consciousness • A– Conscious (Alert) • V– Responder to Verbal stimalation • P– Responder to pain stimulation (Pain) • U– Unresponsive
Primary ABC • Level of consciousness (AVPU) • Airway • Breathing • Circulation
Steps of the BASIC LIFE SUPPORT RAPID EVALUATION of level of consciousness
Steps of the BASIC LIFE SUPPORT HELICOPTER RAPID ACTIVATION OF THE EMERGENCY SYSTEM
BASIC LIFE SUPPORT A OPENING the AIRWAY Head tilt and chin lift
BASIC LIFE SUPPORT B ARTIFICIAL VENTILATION Look Listen Feel 10 SECONDS
BASIC LIFE SUPPORT B • ARTIFICIAL VENTILATION • If he is breathing normally: • Turn him into recovery position • Call for help • Check for continued breathig
BASIC LIFE SUPPORT B • ARTIFICIAL VENTILATION • If he is not breathing normally: • Send someone to call for help • Give 2 breths that makes chest rise • Start chest compression
Positive Pressure Ventilation • Essential for an adeguate PPV, in order to prevent an inadeguate/insufficient ventilation are: • Good aderece between the device of PPV and patient’s mounth • Right volume/frequency og ventilations NB: avoid rapid and forcefula breaths in order to prevent: • Gastric distension • Lung injuries • Haemodinamic problems
Mouth-to-mouth ventilation • Using head tilt and chin lift picch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead. Allow the month to open, but mantaining chin lift. • Take a normal breath and place your lift around his mouth, making sure that you have a good seal. • Blow steadly into the mouth while watching for the chest to ris, taking about 1s as in a normal breath. • Mantaining head tilt and chin lift,take your mouth away and watch for the chest to fall as air passes out.
Barrier devices Irway to insert in patient’s mouth
One way valve Filter Pocket-Mask Device
Ventilation pocketmask-to-mouth • Advantages: • No direct contact, even if no case of trasmission of HIV with mouth-to-mouth ventilation • Good oxygenation if connected to O2 • Good for rescuer with small hands
Anoxic cerabral damage in acute heart arrest • Anoxic damage starts afeter 4-6 minutes without circulation • After abut 10 minutes there are irreversible cerebral lesions
Positive Pressure Ventilation Combine rescue breaths With chest compressions
BASIC LIFE SUPPORT C • CHEST COMPRESSION: • PLACE THE HEEL OF ONE HAND IN THE CENTRE OF THE VICTIM CHEST • INTERLOCK THE FINGER OF YOUR HANDS • PRESS DOWN ON THE STERNUM 4-5 cm
CPR Allow complete chest recoil Push hard Push fast Deep of compression: 4-5 cm Compression and release should take equal amount of time
BASIC LIFE SUPPORT C RITHM 30:2 RATE 100/MIN IF THERE IS MORE THAN ONE RESCUER PRESENT, ANOTHER SHOULD TAKE OVER CPR EVERY 1-2 MIN YO PREVENT FATIGUE. ENSURE THE MINIMUM OF DELAY DURING THE CHANGEOVER.
BASIC LIFE SUPPORT Continue with chest compressions and rescue breaths in a ratio of 30:2 with 5 cycles in 2 minutes
BASIC LIFE SUPPORT • Remember to continue resuscitation until: • Qualify help arrives and takes over • The victim starts breathing normally • You become exausted
Recovery position FOR UNRESPONSIVE VICTIMS WITH NORMAL BREATHING AND EFFECTIVE CIRCULATION The position shoul be stable, near a true lateral position with the head dependent and no pressure on the chest to impair breathing.
Recovery position Place the arm nearest to you at right angles of the body, elbow bent with the hand palm upper-most.
Recovery position Bring the far arm across the chest and hold the back of the hand against the victm’s cheek nearest to you.
Recovery position With your other hand, grasp the far leg just above the Knee and pull it up, keeping the foot on the ground.
Recovery position If the victims has to be kept in the recovery position for more than 30 minutes turn him to the opposite side.
FOREIGN-BODY AIRWAY OBSTRUCTION ADULT FBAO TREATMENT ASSESS SEVERITY SEVERE AIRWAY OBSTRUCTION (ineffective cough) MILD AIRWAY OBSTRUCTION (effective cough) Encourage cough Continue to check for deterioratin to ineffective cough or until obstruction relieve Conscious 5 back blows 5 abdominal trusts Unconscious Start CPR
He’s ablle to cough and talk FOREIGN-BODY AIRWAY OBSTRUCTION Cough..yes!! “Are you chocking?!” ENCOURAGE HIM TO CONTINUE COUGHING BUT DO NOTHING ELSE! MILD OBSTRUCION
UNCONSCIUOSNESS WHEEZY BREATHING SILENT ATTEMPTS TO COUGH CYANOSIS CANNOT SPEAK CANNOT BREATH FOREIGN-BODY AIRWAY OBSTRUCTION ….. “Are you choking?!” SAY “YES” BY NODDONG HIS HEAD WITHOUT SPEAKING! SEVERE AIRWAY OBSTRUCTION
“HEIMLICH” MANEUVER TREATMENT OF CONSCIOUS VICTIM, STANDING UP WITH SEVERE AIRWAY OBSTRUCTION • STAND BEHIND VICTIM • PUT BOTH HANDS ROUND THE UPPER PART OF THE ABDOMEN • LEAN THE VICTIM FORWARDS • CLENCH YOUR FIST AND PLACE BETWEEN THE UMBILICUS AND XIPHISTERNUM • GRASP THIS HAND WITH THE OTHER AND PULL SHARPLY INWARDS AND UPWARDS • Not reccommended for children under 1 year, obese victims and pregnacy woman
“HEIMLICH” MANEUVER NOT RECCOMMENDED FOR CHILDREN UNDER 1 YEAR, OBESE VICTIMS AND PREGNACY WOMAN
If THE PATIENTS BECOMES UNCONSCIOUS IMMEDIATELY ACTIVATE EMS FOREIGN-BODY AIRWAY OBSTRUCTION CPR If while CPR, when you open the airway to give rescue breaths, YOU CAN SEE solid material: remove it!
RESUSCITATION OF CHILDREN The adult sequence can be used also in not responsive and not breathing children; Give 5 initial rescue breaths before starting chest compressions; A lone rescuer should perform CPR for approximately 1 min before going for help; Compress the chest by approximately 1/3 of depth; Use 2 finders for an infant under 1 year.
CONGELAMENTOSTADIAZIONESEGNI E SINTOMI-EVOLUZIONE • PALLORE, CIANOSI, EDEMA, INTORPIDIMENTO • DOLORABILITA’ SPONTANEA, PARESTESIE • RECUPERO • 2a BOLLE CHIARE, IPOANESTESIA • RECUPERO • 2b BOLLE EMORRAGICHE, ANESTESIA • ULCERE DISTROFICHE, CICATRICI DEFORMANTI • RISCHIO AMPUTAZIONE • NECROSI, ANESTESIA TOTALE • COINVOLGIMENTO MUSCOLARE, NERVOSO, OSSEO • AMPUTAZIONE
FROSTBITES • BRING THE VICTIM IN A PROTECTED PLACE • TAKE OUT CLOTHES, IN PARTICULAR IF TIGHT OR WET • !! BE CAREFUL TO BOOTS • TAKE OUT RINGS • DRY THE DAMAGED PART CAREFULLY • WARM UP WITH THE BODY OF A FRIEND FOR 10 MIN • (AXILLA OR ABDOMEN) • GIVE WARM NOT ALCHOLIC DRINKS • PUT ON BOOTS AND IF YOU CAN FEEL AGAIN • START WALKING
FROSTBITES • BRING IN A WARM PLACE • PUT IN WARM WATER (WITH AN ANTISEPHTIC AGENT) AT 37°C FOR 1 HOUR • DRY CAREFULLY • PUT COTTONS BETWEEN FINGERS • KEEP THE PART UP • REST • GIVE • -ASPIRINA 500-1000 mg. • -IBUPROFENE 400-800 mg.
CONGELAMENTODA EVITARE • FRIZIONARE LA PARTE LESA (con le mani, neve, • alcool, pomate, lana, stoffa) • IMMERGERE IN ACQUA CALDA • ESPORRE LA PARTE LESA A FONTI DI CALORE • BUCARE LE BOLLE • SOMMINISTRARE BEVANDE ALCOOLICHE • (se luogo non riscaldato)
CONGELAMENTOEVOLUZIONE • Il recupero della sensibilità dopo 10 min. di riscaldamento • è indice di congelamento superficiale • Se la circolazione non viene ripristinata entro 48 ore • si rischia l’amputazione • PERIODO DI PROGRESSIVA NECROSI 24-36 h • PERIODO DI MUMMIFICAZIONE 16-21 gg.