Basic Life Support Based on UK Resuscitation Guidelines (2010) Clinical Skills and Simulation Team With acknowledgements also to Basic Life Support Faculty - SoNMS PowerPoint content last updated 26/05/2015 10:44:49
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Aims & Outcomes Aims & Outcomes The aim of this module is to learn and practice adult basic life support in a safe environment. Learning Outcomes At the end of the session the student should be able to: Identify causes of cardio-respiratory arrest Define basic life support Discuss the adult basic life support algorithm Demonstrate adult basic life support using an adult manikin. Discuss the necessity of using a pocket face mask. Demonstrate the application and use of an automated external defibrillator Recognise and manage effectively a choking situation Evaluate own learning and recognise how improvements can be made.
Cardio-respiratory Arrest Cardio-respiratory Arrest Definition: A sudden interruption of cardiac output Dougherty and Lister 2004 If treated appropriately, cardio-respiratory arrest may be a reversible condition The main sign of cardio-respiratory arrest is the absence of normal breathing in a non-responsive individual.
Possible Causes of Cardio-respiratory Arrest Possible Causes of Cardio-respiratory Arrest H Hypoxia T Tension Pneumothorax H Hypovolaemia T Tamponade H Hypothermia T Toxins H Hyperkalaemia T Thromboembolism
Chain of Survival Chain of Survival EARLY Access EARLY CPR EARLY Defibrillation EARLY Advanced Life Support
Danger Responsiveness Shout Airway Breathing Circulation Basic Life Support Sequence of Basic Life Support DR.S. ABC D R S A B C THIS DOCTOR KNOWS HIS ABC S DO YOU
Environmental Dangers Electricity Falling Masonry Traffic Basic Life Support Safe Approach Danger
Responsiveness Responsiveness If you elicit a response If there is no response Leave the patient in the same position if in no other danger Turn the patient onto their back Find out what is wrong Reassess the patient regularly
Shout for Help Shout for Help You will tire quickly You will need help to continue resuscitation You will need to help to arrange / call for defibrillator and/or more advanced help
Assessing The Need For Resuscitation Airway What is wrong with this picture Head Tilt Chin Lift Jaw Thrust
Assessing The Need For Resuscitation Breathing Check breathing and signs of life for up to 10 SECONDS Look Listen and Feel for normal breathing Remember: Maintain head tilt and chin lift
If Not Breathing Normally If Not Breathing Normally Call 999 European Number: 112 State: Adult / Child Cardiac Arrest Location Trained in Basic Life Support
Start CPR (Cardiopulmonary Resuscitation) - Circulation Start CPR (Cardiopulmonary Resuscitation) - Circulation Hand Position: Place the heel of one hand in the middle of the lower half of the sternum Place the other hand on top of the first Rate: Approximately 100 120 compressions per minute Depth: 5 6 Centimetres
Breathing Breathing After 30 compressions, give 2 rescue breaths Take approximately 1 second per breath, allowing the chest to rise at each breath Allow the chest to fall between each ventilation Visualise the rise and fall of the chest
Continuation of CPR Continuation of CPR Continue with chest compressions and rescue breaths at a ratio of: Stop to recheck the patient only if they start to breath normally, otherwise DO NOT INTERUPT RESUSCITATION
No Chest Rise If the chest does not rise with rescue breaths: Before the next attempt: Check the patients mouth and remove visible obstruction Recheck that there is adequate head tilt and chin lift Do no attempt more than 2 breaths each time before returning to chest compressions NB: DO NOT put your fingers in the mouth but simply pull away anything immediately obvious. Otherwise, you may cause more problems by pushing an object further down, and risk losing a finger if the patient suddenly regained consciousness.
CONTINUE CPR UNTIL... Basic Life Support Continue CPR Until Qualified help arrives and takes over The patient starts to breath normally You become exhausted If there are two persons involved in the rescue, then consider changing places every 2 3 minutes to maintain effectiveness of BLS
Upon Arrival of the Ambulance Upon Arrival of the Ambulance Give a brief history Give time e.g. I have been carrying out CPR for 5 minutes without response Remain to assist with equipment and help with CPR / BLS
Summary Adult CPR Algorithm Unresponsive Paediatric CPR Algorithm Unresponsive Shout for help Shout for help Open airway Open airway Not Breathing Normally Not Breathing Normally Call 999 5 rescue breaths 30 chest compressions No Signs of Life 15 chest compressions 2 rescue breaths 30 compressions 2 rescue breaths 15 compressions
Adult Automated External Defibrillation Adult Automated External Defibrillation The majority of cardiac arrests are due, at least initially, to an abnormal, fast, irregular beat of the heart known as ventricular fibrillation (VF) and it is long since established that delivering an electrical defibrillation is the only effective treatment. Survival rates as high as 75% have been recorded when a shock is delivered promptly. This figure decreases by 10% for every minute passed. Automated external defibrillators (AED) are sophisticated, portable electronic devices that analyse a victim s heart rhythm and ascertain if it is shockable (e.g. VF) or non-shockable (e.g. normal rhythm or one that would not respond to defibrillation). All AED devices can be used by laypeople or healthcare professionals, they use voice prompts to direct the user.
Using An AED Use of an AED consists of the following steps... Check for risks to the victim, any 1 6 Follow the AED voice prompts bystanders, and yourself 2 Assess the victim to be unresponsive and not breathing normally 7 Ensure nobody touches the victim whilst the rhythm is being analysed Send someone for the AED and to call 3 8 Safely deliver a shock to the victim for an ambulance 4 Start CPR, unless AED immediately available 9 Resume CPR immediately as guided by voice prompts, starting with chest compressions 5 Switch on AED and attached the AED pads as soon as it is available 10 Minimise interruptions in chest compressions 11 Continue as directed by voice / visual prompts
AED Algorithm AED Algorithm Unresponsive Open Airway Not breathing Normally CPR 30:2 Until AED is attached Call for help Send or go for AED Call 999 AED Assess Rhythm Shock Advised No Shock Advised 1 Shock Immediately resume CPR 30:2 for 2 min Immediately resume CPR 30:2 for 2 min Continue until the victim starts to wake up i.e. Moves, opens eyes and breathes normally
Choking Choking Recognition of choking is the key to successful treatment. Choking occurs when the airway is obstructed by a foreign body. Foreign bodies can cause either mild or severe airway obstruction. General Signs of Choking Attack occurs while eating Victim may clutch his/her neck Signs of SEVERE airway obstruction Response to question Are you choking Victim unable to speak Victim may respond by nodding Other signs Victim unable to breathe Breathing sounds wheezy Attempts at coughing are silent Victim may be unconscious Signs of MILD airway obstruction Response to question Are you choking Victims speaks and answers yes Other signs Victim is able to speak, cough, and breathe
Choking Algorithm Adult Choking Algorithm Assess severity Severe Airway obstruction (ineffective cough) Mild Airway obstruction (effective cough) Unconscious Start CPR Conscious 5 back blows 5 abdominal thrusts Encourage Cough Continue to check for deterioration to ineffective cough or until obstruction relived
Current Developments iresus iresus app for the iphone The Resuscitation Council (UK) now offers a unique medical app for the iphone iresus This provides rapid access to the latest resuscitation guideline algorithms, and is always up-to-date. The Resuscitation Council would like to see this guidance in the pockets of all doctors and healthcare professionals. Currently it is in the top ten medical apps. Resuscitation Council UK have recently updated the app to include the anaphylaxis treatment algorithm iresus is FREE to download and is available on the iphone App Store
Current Developments Resus Council Interactive Tool This link takes you to the excellent Resuscitation Council interactive tool which looks at CPR and Choking. The scenarios are very lifelike and you get to try your hand at some questions and tools that mimic CPR. (Opens in a new window) Web: https://life-saver.org.uk/ App Store: https://itunes.apple.com/gb/app/ lifesaver-mobile/id633999639 Google Play: http://bit.ly/2ndipwz
End End of module