BASIC LIFE SUPPORT

CARDIO PULMONARY RESUSCITATION

DR.AHMAD ZAINI BIN MOHD SALLEH
KMN AMK Senior Consultant and Head of Department Department of Anesthesiology and Intensive Care Hospital Sultan Abdul Halim

DEFINITION
level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training.

OBJECTIVES
How to assess the collapsed victim How to perform chest compression and rescue breathing How to place an unconscious breathing victim in the recovery position. How to relieve foreign body obstruction

THE ABC of CPR (2005 AHA)

A irway Does the victim have an open airway? B reathing Is the victim breathing? C irculation/ C ompression - Ventilation Is the victims heart beating? Is the victim bleeding severely? D efibrillation

THE CAB of CPR (2010 AHA)

C irculation/ C ompression Is the victims heart beating? Is the victim bleeding severely? A irway Does the victim have an open airway? B reathing Is the victim breathing? D efibrillation

CHAIN OF SURVIVAL

1.Immediate recognition of cardiac arrest and activation of the emergency response system (EMS) 2. Early CPR with an emphasis on chest compressions 3. Rapid defibrillation 4. Effective advanced life support 5. Integrated postcardiac arrest care

BASIC LIFE SUPPORT

SEQUENCE OF PROCEDURES PERFORMED TO RESTORE THE CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY AND/OR CARDIAC ARREST CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER EQUIPMENT

BASIC LIFE SUPPORT

When to CPR?
In the absence of breathing and pulse in an unresponsive victim If the victim has agonal gasps If victim is in cardiac arrest

BASIC LIFE SUPPORT

Call First or CPR First?

Call First 1. Activate EMS 2. Return to victim 3. Provide CPR

CPR First 1. Give 5 cycles (2 minutes) of CPR 2. Leave victim 3. Activate EMS

BASIC LIFE SUPPORT

Call First or CPR First?

CPR First!!! Call First!!! Sudden collapse in adult Drowning victim or child Asphyxial (primary respiratory) arrest in any Collapse likely cardiac in age origin

WHAT TO DO
APPROACH SAFETY
CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS

2 RESCUE BREATHS

APPROACH SAFETY
APPROACH SAFETY

SCENE VICTIM RESCUER BYSTANDER

CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

CHECK RESPONSE
APPROACH SAFETY CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

CHECK RESPONSE
Shake shoulders gently

Ask Are you all right?

If he responds,
Leave as you find him. Find out what is wrong. Reassess regularly.

SHOUT FOR HELP

APPROACH SAFETY CHECK RESPONSE SHOUT FOR HELP

OPEN AIRWAY
CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

OPEN AIRWAY
APPROACH SAFETY CHECK RESPONSE

SHOUT FOR HELP

OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

AIRWAY OPENING BY NECK EXTENSION

OPEN AIRWAY

Head tilt and chin lift - lay rescuers - non-healthcare rescuers

NO NEED FOR FINGER SWEEP UNLESS SOLID MATERIAL IS FOUND IN THE MOUTH

Head tilt, chin lift + jaw thrust

CHECK BREATHING
APPROACH SAFETY CHECK RESPONSE

SHOUT FOR HELP

OPEN AIRWAY CHECK BREATHING

30 CHEST COMPRESSIONS
2 RESCUE BREATHS

CHECK BREATHING

LOOK, LISTEN AND FEEL FOR NORMAL BREATHING DO NOT MISTAKE AGONAL BREATHING FOR NORMAL

FOREIGN-BODY AIRWAY OBSTRUCTION (FBAO)

BACK BLOWS

ABDOMINAL THRUSTS

30 CHEST COMPRESSIONS
APPROACH SAFETY CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

CHEST COMPRESSIONS
Place the heel of one hand in the centre of the chest Place other hand on top

Interlock fingers
Compress the chest Rate 100 min-1 Depth 4-5 cm

Equal compression : relaxation

When possible change CPR operator every 2 min

2 RESCUE BREATHS
APPROACH SAFETY CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS 2 RESCUE BREATHS

RESCUE BREATHS
Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat

RESCUE BREATHS
RECOMMENDATIONS: - Tidal volume
500 600 ml

- Respiratory rate
give each breaths over about 1sec with enough volume to make the victims chest rise - Chest-compression-only continuously at a rate of 100 min

APPROACH SAFETY CHECK RESPONSE SHOUT FOR HELP OPEN AIRWAY CHECK BREATHING 30 CHEST COMPRESSIONS

2 RESCUE BREATHS

IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

1.

2.

4. 3.

WHEN CAN I STOP CPR ?

VICTIM REVIVES AND STARTS BREATHING TRAINED HELP ARRIVES TOO EXHAUSTED TO CONTINUE UNSAFE SCENE PHYSICIAN DIRECTED CARDIAC ARREST FOR MORE THAN 30 MINUTES

Why CPR May Fail ?

Delay in starting Improper procedures (ex. Forget to pinch nose) No ACLS follow-up and delay in defibrillation Only 15% who receive CPR live to go home Improper techniques Terminal disease or unmanageable disease (massive heart attack) Poor quality CPR

HIGH QUALITY CPR

o o o o

Push hard and fast (at least 100 per minute). Allow complete chest recoil after each compression. Minimize interruptions. Compression depth of 2in (5cm) in adults, 1/3 AP diameter of the chest wall in infants (1.5in or 4cm) and children (2in or 5cm). Avoid hyperventilation

Complications of CPR

1. Vomiting-difficult to ventilate and risk of aspiration 2. Gastric distension 3. Punctured lungs, lacerated liver and fractured ribs and sternum 4. Disease transmission-HIV, hepatitis, herpes, influenza, TB, mononucleosis, Staphylococcus infection