BASIC SUPPORT BLSLIFE for HCP for LAY RESCUER

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Module 1:
Introduction to BLS

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THREE KINDS OF LIFE SUPPORT

1. BASIC LIFE SUPPORT (BLS)
A set of emergency procedures that consist of recognizing respiratory or cardiac arrest and the proper application of Artificial Respiration (AR)/Rescue Breathing (RB) or Cardio-Pulmonary Resuscitation (CPR) to maintain life until a victim recovers or advanced life support is available.

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THREE KINDS OF LIFE SUPPORT

2. ADVANCED CARDIAC LIFE SUPPORT (ACLS)
A set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening emergencies, as well as the knowledge and skills to deploy those interventions.

3. PROLONGED LIFE SUPPORT (PLS)

For post resuscitative and long term resuscitation with the use of adjunctive equipment such as ventilator, cardiac monitor, pulse oximeter etc.

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Chain of Survival

Early Access

Early CPR

Early Defibrillation

Early Advanced Care

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FOUR LINKS
1. The First Link: EARLY ACCESS
It is the event initiated after the patients collapse until the arrival of Emergency Medical Services personnel prepared to provide care.

2. The Second Link: EARLY CPR

It is most effective when started immediately after the victims collapse. The probability of survival approximately doubles when it is initiated before the arrival of EMS.
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FOUR LINKS
3. The Third Link: EARLY DEFIBRILLATION
It is most likely to improve survival. It is the key intervention to increase the chances of survival of patients with out-of-hospital cardiac arrest.

4. The Fourth Link: EARLY ACLS

Provided by highly trained personnel like paramedics.

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ANATOMICAL TERMS
(Position, direction and location)

Supine Position

Prone Position

Lateral Recumbent/ Recovery Position

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ANATOMY AND PHYSIOLOGY

Air that enters the lungs contains: 21% O2 trace of CO2 Air exhaled from the lungs contains: 16% O2 4% CO2

Breathing

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ANATOMY AND PHYSIOLOGY

Circulation

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ANATOMY AND PHYSIOLOGY

Clinical death 0 - 1 min. cardiac irritability 1 - 4 min. brain damaged not likely 4 - 6 min. - brain damage possible
Biological death 6 - 10 min. - brain damaged very likely over 10 min. - irreversible brain damaged

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BODY SUBSTANCE ISOLATION Are precautions taken to isolate or prevent risk of exposure from any other type of bodily substance. BASIC PRECAUTIONS AND PRACTICES AFTER MANAGING THE PATIENT

1. Personal Hygiene

2.Personal Protective Equipment (PPE)

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3. Equipment Cleaning & Disinfecting

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1. Risk Factors that cannot be changed:

Heredity Age Gender

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2 . Risk Factors that can be changed:

Cigarette smoking Hypertension

Elevated cholesterol and triglyceride levels Lack of exercises Obesity Stress Diabetes mellitus
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HEART ATTACK ( Myocardial Infarction)

It occurs when the oxygen supply to the heart muscle (myocardium) is cut-off for a prolonged period of time. This cut-off results from a reduced blood supply due to severe narrowing or complete blockage of the diseased artery. The result is death (infarction) of the affected part of the heart.
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SIGNS AND SYMPTOMS OF HEART ATTACK

1. 2. 3. 4. 5. Chest Discomfort Sweating Nausea Shortness of Breath Pain radiating to the lower jaw, arms, epigastric area, or back 6. Sudden fainting

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EMERGENCY MANAGEMENT OF HEART ATTACK

1. Recognized the signs and symptoms of heart attack and take action. 2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortable position. Do not let the patient move around. 3. Have someone call the physician or ambulance for help.

4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.
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Module 2:
Steps in Giving Emergency Care

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1. PLANNING
Emergency plan should be established based on anticipated needs and available resources.

2. PROVISION OF LOGISTICS

The emergency response begins with the preparation of equipment and personnel before any emergency occurs.

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3. INITIAL RESPONSE
a. Ask for HELP. b. Intervene c. Do no further harm.

4. INSTRUCTION TO BY-STANDERS
Proper information and instruction to bystander/s would provide organized first aid care.

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1. SURVEY THE SCENE

2. ACTIVATE MEDICAL ASSISTANCE 3. INITIAL /PRIMARY ASSESSMENT OF THE VICTIM 4. SECONDARY ASSESSMENT OF THE VICTIM 5. REFERRAL FOR FURTHER EVALUATION AND MANAGEMENT

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SURVEY THE SCENE

Once you recognize that an emergency has occurred and decide to act, you must make sure the scene of the emergency is safe for you, the victim/s, and any bystander/s.
Elements of the Survey the Scene Scene safety.
Mechanism of injury or nature of illness. Determine the number of patients and additional resources.

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ACTIVATE MEDICAL ASSISTANCE (AMA) OR TRANSFER FACILITY

In some emergency, you will have enough time to call for specific medical advice before administering first aid. But in some situations, you will need to attend to the victim first.

Call First and CPR First

Bystanders should be instructed to Activate Medical Assistance ( 117/161/168 or the nearest hospital ) as soon as they have determined that an adult victim requires emergency care Call First. While for infants and children a CPR First approach is recommended.
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For sudden collapse in victims of all ages, the lone HCP should telephone the emergency response number( 161, 117, 168 or nearest hospital ) and get an AED ( when readily available) and return to the victim to begin CPR (and use the AED ). For unresponsive victim of all ages with likely asphyxial arrest (e.g. drowning) the HCP should deliver about 5 cycles ( about 2 min.) of CPR before leaving the victim to telephone the response number and get an AED if available).

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3. INITIAL/ PRIMARY ASSESSMENT OF THE VICTIM

In every emergency situation, you must first find out if there are conditions that are an immediate threat to the victims life.

Check for Responsiveness

Check for Airway

Check for Circulation

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Check for Breathing

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4. SECONDARY ASSESSMENT OF THE VICTIM

It is a systematic method of gathering additional information about injuries or conditions that may need care.
a. Interview the victim.S- signs and symptoms A- allergies M- medications

P-past medical history L- last meal taken E- events prior to injury or incident

b. Check vital signs.- every 15 minutes if stable condition, and every 5 minutes if unstable

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Cont. SECONDARY ASSESSMENT OF THE VICTIM c. Perform head to toe examination:

D- deformity C- contusion A- abrasion P- punctures B- burn T- tenderness L- laceration S- swelling
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5. REFERRAL OF THE VICTIM FOR FURTHER EVALUATION AND MANAGEMENT

It refers to the transfer of a victim to hospital or health care facility if necessary for a definitive treatment.

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DOs

1. Do identify yourself 2. Do obtain consent when possible 3. Do think of the worst 4. Do provide comfort and emotional support 5. Do respect the victim( modesty and privacy) 6. Do be as calm and direct as possible 7. Do care for the most serious injuries first 8. Do assist the victim on medication 9. Do keep on lookers away from the injured person 10. Do handle the victim to a minimum 11. Do loosen tight clothing
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DONTS

1. Do not let the victim see his/her injuries 2. Do not leave the victim alone except to get help 3. Do not assume that the victims obvious injuries are the only one 4. Do not make any unrealistic promises 5. Do not trust the judgment of a confused person

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Module 3:
Cardiac Arrest and

Cardiopulmonary Resuscitation

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Is the condition in which circulation ceases and vital organs are deprived of oxygen.

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Is the condition in which circulation ceases and vital organs are deprived of oxygen.

1. Cardiovascular Collapse Heart is still beating but its action is so weak that blood is not being circulated through the vascular system to the brain body tissues.

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2. Ventricular Fibrillation

Occurs when the individual fascicles of the heart beat

independently rather than coordinated, synchronized manner that produce rhythmic heart beat. 3. Cardiac Standstill Means that the heart has stopped beating.

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This is a combination of chest compressions and rescue breathing. These must be combined for effective resuscitation of the victim of cardiac arrest.

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Chest Compressions

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Give TWO Full Breaths

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1. Cough CPR
Is a self initiated CPR which is possible and is limited to patient with monitored cardiac arrest and the arrest was recognized before the patient losses consciousness.

2. Compression only CPR

If a person is unwilling or unable to perform mouth-to-mouth ventilation for an adult victim, chest compression-only CPR should be provided rather than no attempt of CPR being made.

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1. The patient has a valid : DO NOT RESUSCITATE order 2. The patient has signs of irreversible death a. Rigor mortis- rigid stiffening of heart and skeletal muscles after death. b. Dependent lividity

c.

Decapitation

d. Decomposition

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3. No physiological benefit can be expected 4. Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants a. Confirmed gestation < 23 weeks or birth weight < 400gms. b. Anencephaly c. Confirmed Trisomy 13 or 18

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1. S - SPONTANEOUS signs of circulation are restored.

2. T -TURNED over to medical services or properly trained and authorized personnel. 3. O - OPERATOR is already exhausted and cannot continue CPR. 4. P - PHYSICIAN assumes responsibility (declares death, takes over, etc.). 5. S SCENE becomes unsafe. 6. S SIGNED waiver to stop CPR.

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Table of Comparison on Cardiopulmonary Resuscitation for Adult, Child and Infant

ADULT CHILD INFANT Center of the chest 1 finger width below the imaginary nipple line Approximately 1/3 to the depth of the chest 2 fingers (middle & ring fingertips) At least 100/min
Center of the chest along imaginary nipple line

Compression Area

Depth How to Compress Rate Compression/ Ventilation Ratio

Approximately 1 to 2 inches Heel of 1 hand, other hand on top

Approximately 1/3 to the depth of the chest Heel of 1 hand only .

Approximately 100/min

30 : :2 ( 1 rescuer );15:2 ( 2 rescuers) 5 cycles 1, & 2,& 3,& 4,& 5,& 6,& 7, & 8,& 9,&10, 11, 12, 13, 14,15, 16, 17,18, 19, 20, & 1,& 2,& 3,& 4,& 5,& 6, & 7,& 8,& 9, and 1 (cycle) breathe; breathe (up to 5 cycles)

Number of cycles per 2 minutes

Counting for standardization purposes

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Maneuver

Adult Lay Rescuer: 8yrs + HCP: Adolescent and older

Child Lay Rescuer: 1 8 yrs old HCP: 1 year to adolescent

Infant Under 1 year of age

Airway Breathing Initial

Head tilt chin lift (HCP: suspected trauma, use jaw thrust)

2 effective breaths at 1 second/breath HCP: Rescue breathing w/o chest compressions HCP: Rescue breaths for CPR with advanced airway Foreign-body airway obstruction 10 12 breaths per minute (approximate) 12 20 breaths per minute (approximate) 8 10 breaths per minute (approximately) Abdominal thrusts or chest thrusts (responsive) CPR (unresponsive) Carotid artery Lower half of sternum, between the nipples Back slaps and chest thrusts Brachial or Femoral artery Just below the nipple line (lower half of sternum) 2 or 3 fingers HCP (2 rescuers): 2 thumbs-encircling hand

Circulation HCP: Pulse check (10 sec. or less) Compression landmarks

Compression method Push hard and fast Allow complete recoil Compression rate Compression-ventilation ratio

Heel of one hand with the other hand on top

Heel of one hand or as for adult

Approximately 100 compressions per minute 30:2 (one rescuers) HCP: 15:2 (2 rescuers)

Defibrillation AED

Use adult pads Do not use child pads

Use AED after 5 cycles of CPR (out of hospital). Use pediatric system for children 1 8 years if available HCP: For sudden collapse (out-of-hospital) or in-hospital arrest use AED as soon as possible.

Not recommended for infants (< 1 year of age)

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Maneuver Airway Breathing Initial

Adult Lay Rescuer: 8yrs + HCP: Adolescent and older

Child Lay Rescuer: 1 8 yrs old HCP: 1 year to adolescent

Infant Under 1 year of age

Head tilt chin lift (HCP: suspected trauma, use jaw thrust) 2 effective breaths at 1 second/breath

HCP: Rescue breathing w/o chest compressions HCP: Rescue breaths for CPR with advanced airway

12 20 effective breaths per minute (approximate)

8 10 breaths per minute (approximately)

Foreign-body airway obstruction

Abdominal thrusts or chest thrusts (responsive) CPR (unresponsive)

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Back slaps and chest thrusts

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Circulation HCP: Pulse check (10 sec. or less)

Carotid artery

Brachial or Femoral artery

Compression landmarks

Lower half of sternum, between the nipples

Just below the nipple line (lower half of sternum)

2 or 3 fingers HCP (2 rescuers): 2 thumbsencircling hand

Compression method Push hard and fast Allow complete recoil Compression rate Compressionventilation ratio

Heel of one hand with the other hand on top

Heel of one hand or as for adult

Approximately 100 compressions per minute 30:2 (single rescuer) HCP: 15:2 (2 rescuers)
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