BASIC LIFE SUPPORT CPR: Introduction. Why & When to Do it? CPR... ABCDEF

Transcription

1 BASIC LIFE SUPPORT CPR: Considered when an individual cannot adequately breathe and maintain circulation to vital organs. Introduction Why & When to Do it? Collapsed patients require assistance to maintain their airway, breathing and circulation in order to prevent further detoriation in their condition. When this is achieved without the use of any equipment, it is termed as Basic Life Support (BLS). Without CPR, irreversible brain damage occurs within 3-4 minutes. Should be done immediately by a bystander Time is the crucial factor here to decide the survival. This must be continued whilst further help is summoned to diagnose and treat the cause of collapse. CPR Resuscitation: ACLS (Advanced cardiac life support BLS (Basic life Support) ALS (Advanced life support) CPCR - Cardio pulmonary cerebral Resuscitation Means cardio pulmonary resuscitation (CPR) Anywhere anybody can do All you need is a kind heart to help & the basic skill to perform. CPR.... ABCDEF ANLS: (Advanced neurologic life support)

2 How Airway Breathing Circulation Drugs ECG Fibrillation BLS ACLS The sequence of BLS Gently shake & Shout "Are you ok?" Recognition BLS Algorhythm Airway Breathing Circulation I. Recognition Assessment phase is crucial in BLS. Determine - Unresponsiveness Determine Breathlessness - Look, Listen, feel Determine - Pulselessness - Carotid pulse ` ` No victim should undergo CPR until the Recognition need for resuscitation is established II. BLS ALGORHYTHM

3 response Shake Gently & Ask "Are you ok?" Check for injuries No response Leave him in the position and reassess at intervals Open airway Head tilt Chin lift Breathing Check breathing (Look, listen, feel) Recovery Position Not breathing reassess at intervals SHOUT for help Activate EMS Ventilate 2 breaths (exhaled air ventilation) Check circulation (carotid pulse) Circulation Present No circulation Start CPR Continue ventilation

4 III. AIRWAY Head tilt First basic skill to learn Position the victim Head lift Chin lift Jaw thrust The rescuer's hand nearest the head is placed on the forehead, and apply firm backward pressure to tilt the head back. CHIN LIFT Place fingers of other hand under the bony part of the chin. Lift the chin forward and support the jaw helping to tilt the head back. Dont's In unresponsive victim muscle tone is impaired resulting in obstruction of pharynx by tongue and soft tissues of pharynx. HEAD TILT Chin lift The fingers must not press deeply into the soft tissue under the chin, which obstruct the air way. The thumb should not be used for lifting the chin. The mouth should not be closed. JAW THRUST

5 Breathing The jaw thrust technique without head tilt is the safest approach to opening airway of the victim with suspected neck injury. Grasp the angles of the victim lower jaw and lift with both hands, as on each side, displacing the mandible forward. If the lips close, retreat the lower lip with the thumb. Recovery Position BREATHING Determine breathlessness Recovery position Rescue breathing Determine breathlessness To maintain a good airway FEL Place your ear over the victim's mouth and nose while maintaining the open airway. Look for the chest to raise and fall. Listen for air escaping during exhalation. Feel for the flow of air. The evaluation procedures should be only 3-5 secs. Unresponsiveness No trauma Change to recovery position To minimise the risk of aspiration

6 Roll the victim on to his or her side so that the head, shoulders and torso move simultaneously without twisting support. If trauma suspected the victim should not be moved. With the other hand grasp the victim under the arm to brace the shoulder and torso. Position the victim Place the hand behind the victim's head & neck for Roll the victim towards you by pulling steadily and evenly at the shoulder while controlling the head and neck. The head and neck should remain in the same plane as the torso, and the body should be moved as a single unit. Rescue breathing To position the victim who is lying down, the following sequence may be used. Kneel beside the victim at distance approximately equal to the width of victim's body at the level of the victim's shoulder. Move the arm closer to you so that it is raised above the victim's head. Straighten the legs or bend slightly at the knees. - mouth to mouth - mouth to nose - mouth to stoma Mouth to mouth

7 The rescuer's exhaled air contains 16% oxygen to Mouth to nose: supply victim's need. Keep the airway open by the head lift - chin lift maneuver. Gently pinch the nose closed with your thumb and index finger (of the hand on the forehead). Useful in injuries of mouth. the forehead. Take a deep breath and seal your lips around the victim's mouth, creating an airtight seal. Then give two slow breaths. Adequate time (11/2-2 seconds) should be allowed for each breath to decrease the possibility of gastric Keep the victim's head tilted back with one hand on Use the other hand to lift the victim's lower jaw and close the mouth. Take of deep breath, seal your lips around the victim's nose and blow. Then stop rescue breathing and allow the victim to exhale passively. distention. Rescue breathing should be performed at a rate of In one rescuer CPR - pause for ventilation after breaths per minute. every 15 chest compression In two rescuer CPR - pause for ventilation after If attempts to ventilate the victim are unsuccessful It every 5 chest compression. may be due to Improper chin and head positioning. FB airway obstruction - (proceed for airway maneuvers). V. CIRCULATION

8 Determine Pulselessness: Chest compressions Check the pulse at the carotid, this should take not more than 5-10 seconds. the large arteries of the unconscious, breathless The artery lies is a groove created by the trachea victim. and the large strap muscles of the neck. position forehead, locate the victims larynx with two or three compressions. Place these fingers into the groove between the trachea and the muscles at the side of the neck, Never palpate simultaneously over hard surface during chest Proper hand placement is established by identifying the lower half of the sternum where the carotid pulse can the felt. The patient must be in the horizontal, supine While maintaining the head tilt with one hand on the fingers of the other hand Cardiac arrest is recognised by pulselessness in With your hand locate the lower margin of the victim's ribcage on the side next to the rescuer both carotid arteries. Pulse present /No breathing -> continue rescue breathing times/mt No pulse / No breathing -> Activate EMS Initiate chest compression Continue rescue breathing. Move the finger up the rib cage to the notch where the ribs meet the sternum in the center of the lower part of the chest.

9 Fingers may be either extended on interlaced Your elbow should be locked into position Arms straightened Shoulder directly over the hands. Natural body weight falling forward provides the Place heel of the one hand on the lower half of the sternum and place the other hand on top of the hand on the sternum force to depress the sternum. The sternum should be depressed approximately 11/2-2 inches (4-5cm) Children 1/3-1/2 inches (1-1.5 cm) depth.

10 breathing FORIEGN BODY MANEUVER FB. suspects Release chest compression pressure between each compression to allow blood flow in to the chest and the heart Minimum chest compression rate is per minute. CONTINUE RESUSCITATION UNTIL Qualified help arrives Victim shows signs of life You become exhausted Reassement (10 seconds) Should be performed after the first minute of CPR and every minute thereafter. If no pulse - resume CPR If pulse and breathing present - place in recovery position If pulse present no breathing - provide rescue - Younger victims - Suddenly stops breathing - Cyanotic & loss of consciousness Chocking:

11 With complete airway obstruction the victim is unable to speak, breathe or cough and may clutch the neck with the thumb and fingers. Management: Hemlich, Maneuver. (Sub diaphragmatic abdominal thrust) Mechanism : by elevating the diaphragm the Hermlich maneuver can force air from the lungs to create an artificial cough intended to expel a FB obstructing the airway. Hemlich with victim standing or Sitting Hemlich Maneuver

12 Rescuer stands behind the victim, wraps his or her arms around the victim's waist and proceeds as follows: Place the victim in the supine position face up Kneel astride the victim's thighs and place the heel Make a fist with one hand. Place the thumb side of the fist against victim's of one hand against the victim's abdomen, in the abdomen in the midline above the navel and well midline slightly above the navel and below the tip of below the xiphoid process. the xiphoid. Grasp the fist with the other hand and press the fist Place the second hand directly on top of the first in to the victim's abdomen with a quick upward Press the abdomen with the quick upward thrust thrust. Repeat the thrust and continue until the object (FB) Finger sweep is expelled. Hemlich maneuver with victim lying down Used only in the unconscious victim, never use it in seizure victim. With victim's face up, open the victim's mouth by grasping both tongue and the lower jaw between the

13 thumb and fingers and lifting the mandible (tongue - Airway jaw lift) Insert the index finger of the other hand down along the inside of the cheek and deeply into the throat to Breathing Initial Subsequent the base of the tongue. Head tilt-chin lift (if Head tilt-chin lift (if trauma is present, use trauma is present, use jaw thrust) Two breaths at 1 to jaw thrust) Two breaths at 1 to 11/2 s/breath 20 breaths/min 11/2 s/breath 20 breaths/min (approximate) Use a hooking action to dislodge the FB and (approximate) Circulation Pulse check Brachial / femoral Carotid maneuver it in to the mouth so that it can be Compression area Lower half of sternum Lower half of sternum removed. Compression with 2 or 3 fingers Heel of 1 hand Depth Approximately Approximately BLS MANEUVERS IN INFANTS AND CHILDREN Chest Compression Infants One third one third to one half the depth to one half the depth Rate Compression of the chest At least 100/min 5:1 (pause for of the chest 100/min 5:1 (pause for ventilation ratio Foreign-body airway ventilation) Back blows / chest ventilation) Heimlich maneuver obstruction thrusts Children FOREIGN BODY AIRWAY OBSTRUCTION IN INFANTS Maneuver Infant (<1 y) Child (1 to 8 y) BACK BLOWS AND CHEST THRUST

14 After delivering back blows, place your free hand on the infant's back, holding infant's head. The infant is Hold the infant face down, resting on the forearm. effectively sandwiched between your hands and Support the infant's head by firmly holding the jaw. arms one hand supports the heads and neck, jaw Rest your forearm on your thigh to support the and the chest while the other supports the back. infants. Turn the infant while the head and neck are Infant head should be lower than the trunk. carefully supported, and hold the infant in the supine Deliver up to five back blows forcefully between the position, on the thigh. infant's shoulder blades using heel of the hand. Give up to five quick downward chest thrusts in the same location and manner as chest compression. Steps 1-5 should be repeated until the object is expelled.