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OBJECTIVES
Establish/maintainperfusiontobrain&heart Provideadequateven8la8on

PETER R. FIGUEROA, MD
Department of Surgery UST Faculty of Medicine & Surgery

Technique

Technique
Compression

Airwayhead8lt,chinli@orjawthrust Fingersweep Breathing

Mouthtomouthormouthtonose Low8dalvolume500ccto700cc Watchchestrise 25breathsini8ally:1sec/breath Withadvanceairwayi.e.ETtube,laryngealmaskairway (LMP),give810breathing/min.nointerrup8onof compressionwhilebreathing

Vic8mposi8onsupinermsurface/bedboardoroor Rescuerposi8onsideofvic8mschest;kneeling,heelof dominanthandinthecenterofchestoverthesternum betweenthenipplesandthenplacetheheelofthe2ndon thetopofrstsothatthehandsoverlappedandparallel Rate30:2compression:ven8la8onwithadvanceairway 100/min.nointerrup8onforven8la8on Depth12inches(45cms)or1/3theAPdiameterof chest Decompressionallowcompletechestrecoila@ereach compression Dutycyclera8obetween8mespentcompressionand release=50%

Special Circumstances

Special Circumstances

Forrescuersnotwillingtogivemouthtomouthbreathing, con8nuouschestcompressionCPR(ccc)orminimally interruptedcardiacresuscita8on(MICR)areacceptable 200chestcompressions,thenAED,then200more compressionsandevaluaterhythm BLSincervicalspineinjurymaintainingairwayand adequateven8la8onistheoverridingpriorityinmanaging pa8entswithasuspectedspinalinjury.Thehead8ltchin li@orjawthrusttechniquesarefeasibleandmaybe eec8vealbeitbothtechniquesareassociatedwith cervicalspinemovement.Useofmanualinline stabiliza8on(MILS)tominimizeheadmovementis reasonableifsucientnumberofrescuersareavailable

Infant and pediatric basic life support: Most cardiac arrests in children are caused by asyphyxia unlike in adult where underlying etiology is usually VF or pulseless VT. Therefore in pediatrics, start CPR immediately then call to AED. For chest compression, in infants 2-two thumbs encircling hands is utilized for 2 rescuers. The 2-fingers technique for single rescuer. For children, both the 1-and 2-hand techniques are acceptable. Compress over the lower part of the staneum just below the nipple-line to a depth of approximately 1/3 the anterior=posterior diameter of chest

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Principles:

Defibrillation (AED)

Automated external defibrilllator (AED) is part of BLS as well as ACLS One immediate precordial thump (closed fist delivered from a height of 5-40 cms) after a monitored cardiac arrest if AED is not available

A1to3minsperiodofCPRbeforeagemp8ngAED withoutofhospitalVForpulselessVTifresponse intervalismorethan45mins. WitnessedinhospitalSCAwithVF/pulselessVT,use ofAEDearlyinCPRisrecommended Minimalinterrup8onofchestcompression 1shockprotocolpreferredversus3shocksequence Immediatecon8nua8onofchestcompressiona@er 1schokdebrilla8on

Principles:

Basic Life Support (BLS)

Recognition of sudden cardiac arrest (SCA) Cardiopulmonary Resuscitation (CPR) Defibrillation (AED)

Use of 12cms electrodes (paddles) better than 8cms. Small paddles (4.3cms) harmful to the myocardium Use 150J to 200J biphasic waveform; with monophasic = 360J. For pediatrics = 2J/kg 4J/ kg Place paddles antero-lateral position Defibrillation should not be attempted in an O2 enriched atmosphere. Turn off O2 supply momentarilly. Do not disconnect ET/respirator tubes.

GOALS OF BLS
Preserve life Restore Health Limit disability

CRITERIA FOR WITHHOLDING CPR

Valid do not attempt resuscitation (DNAR) Signs of irreversible death (e.g. rigor mortis, decapitation or dependent lividity) Medical futility (e.g. terminal septic shock or cardiogenic shock) Attempts to perform CPR would place the rescuer at risk of physical injury

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SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS

Maneuver Airway Breathinginitial with advance Airway FBAO Adult Head Tilt-Chin Lift 2 breaths (1 breath/sec) 10-12breaths/min Abdominal thrusts 12-20/mins Back slaps: chest thrust Child 1 yr. to 16 yrs. Trauma-use jaw thrust Infant under 1 yr.

SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS Maneuver Adult Child 1 yr. to 16 yrs.

Infant under 1 yr. Brachial or femoral just below nipple line lower half sternum 2 fingers or 2 thumbs encircling

Circulationpulse check < 10 sec. Compression

Carotid Lower half of sternum-between nipples Heel of one hand: other on top

Method

SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS

Maneuver Adult Child 1 yr. to 16 yrs. Infant under 1 yr.

ILCORUNIVERSALCARDIACARRESTALGORITHM
Unresponsive?SCA
Shoutforhelp

OpenAirway:Lookforsignsoflife
CallEMS/CPRteam

Depth

1 to 2 inches 1/3 chest diameter 100/min 30:2 1 or 2 rescuer

Rate C:V

Give25ini8albreaths Ifnotbreathing

Reasonabledura8onforBLS =20mins.IfnoROSC, terminateresuscita8on Reasonabledura8onforACLS =40minutesto1hour

30:2 (single rescuer) 15:2 (2 rescuers)

Give30chestcompressions2compressions/sec.followedby2breaths. Con8nueun8lAEDisagached Assesrhythm

Defibrillation AED

8-12 inches Adult pads 150J-200Joules

Pediatric pads 2J/kg :4J/kg For subsequent No recommenddation

Shockable (VForVT) Give1shock

Immediately ResumeCPR 30:2for5cycles

Nonshockable (PEAorasystole) ACLSarrives Maintainairway Vascularaccess Verifyelectrodes Drugs

ResumeCPR 30:2for5cycles

TERMINATION OF CPR IN BLS

Glossary:

Restoration of spontaneous circulation ( ROSC) and ventilation. Reliable criteria indicating irreversible death are present. No ROSC after more than 10 minutes of intensive resuscitative efforts. Exceptions are drug overdose, pre arrest hypothermia, recurring VF/VT and ROSC of any duration occurs. Rescuer is unable to continue because of dangerous hazards or risks to other lives. Care is transferred to a more senior level emergency medical professional.

SCA Sudden cardiac arrest VF Ventricular fibrillation VT Ventricular tachycardia PEA Pulseless electrical activity AED Automated external defibrillation BLS Basic life support ACLS Advanced cardiovascular life support CCR Cardio-cerebral resuscitation MICR Minimally interrupted cardiac resuscitation PALS Pediatric advanced life support ACS Acute coronary syndrome ILCOR International Liasson Committee on Resuscitations ROSC Return of spontaneous circulation

References: Circulation supplement vol.112, No. 22, Nov. 29, 2005 Circulation supplement vol. 112, No. 24, Dec. 13, 2005 hrttp://circ.ahajournals.or Prepared by: Peter R. Figueroa, MD
Department of Surgery