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BLS : CPR
by: Saba , yacoub , maen
Basic life support (BLS)
• What?
A :is the level of medical care which is used for patients with
life-threatening illnesses or injuries until the patient can be
given full medical care at a hospital.
• Who?
A :can be provided by trained medical personnel,
including emergency medical technicians, paramedics, and
by laypersons who have received BLS training.
• When?
A: generally used in pre-hospital setting, and can be provided
w/o medical equipment.
CPR
• What?
A :Cardiopulmonary resuscitation (CPR) is an emergency
procedure which is performed in an effort to manually
preserve intact brain function until further measures are
taken to restore spontaneous blood circulation and
breathing in a person in cardiac arrest.
• Indication : those who are unresponsive with no
breathing or abnormal breathing.
• Where?
A : may be performed both in and outside of a hospital.
CPR Purpose
• CPR alone is unlikely to restart heart; its main
purpose is to restore partial flow of
oxygenated blood to the brain and heart.
• Objective??
1) to delay tissue death and
2) to extend the brief window of opportunity
for a successful resuscitation w/o
permanent brain damage.
Cardiac arrest
Cardiac arrest
= heart fails to contract effectively  cessation of
normal blood circulation
• also known as cardiopulmonary
arrest or circulatory arrest
• Cardiac arrest is different from (but may be
caused by) a heart attack (MI), where blood
flow to the muscle of the heart is impaired.
Cardiac Arrest
• Character??
A : abrupt loss of heart function
• Main sign??:
1) loss of consciousness +
2) pulseless
• Resuscitate??
A : within few minutes (4-5m) if there is any
initiation of rescue effort like CPR
Why cardiac arrest is dangerous?
Following cardiac arrest :
1. Loss of consciousness at about 10-15 seconds
2. Electro-encephalogram become flat after 30 seconds
3. Respiration arrest - may be in 30 second after cardiac
arrest
4. Pupil dilates fully after 60 seconds
5. Brain damage take places within 4-6 minutes after
cardiac arrest
6. Irreversible cerebral cortical damage occur within 810 minutes after cardiac arrest
Etiology of Cardiac Arrest
Cardiac disease
Respiratory causes
•
Ischaemic heart disease
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Hypoxia (usually causes asystole)
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Acute circulatory obstruction
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Hypercapnia
•
Fixed output states
Metabolic changes
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Cardiomyopathies
Myocarditis
Trauma and tamponade
Direct myocardial stimulation
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•
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Potassium disturbances
Acute hypercalcaemia
Circulating catecholamines
Hypothermia
Circulatory causes
Drug effects
•
Hypovolaemia
•
Direct pharmacological actions
•
Tension pneumothorax
•
Secondary effects
•
Air or pulmonary embolism
Miscellaneous causes
•
Vagal reflex mechanisms
•
•
Electrocution
Drowning
• "Hs and Ts" is the name for a mnemonic used to aid in remembering the
possible treatable or reversible causes of cardiac arrest.
• Hs
1. Hypovolemia - A lack of blood volume
2. Hypoxia - A lack of oxygen
3. Hydrogen ions (Acidosis) - An abnormal pH in the body
4. Hyperkalemia or Hypokalemia - Both excess and inadequate potassium can be
life-threatening.
5. Hypothermia - A low core body temperature
6. Hypoglycemia or Hyperglycemia - Low or high blood glucose
• Ts
1. Tablets or Toxins
2. Cardiac Tamponade - Fluid building around the heart
3. Tension pneumothorax - A collapsed lung
4. Thrombosis (Myocardial infarction) - Heart attack
5. Thromboembolism (Pulmonary embolism) - A blood clot in the lung
6. Trauma
Pathophysiology of Cardiac Arrest
3 basic mechanism :
1. Ventricular Fibrillation / Pulseless
Ventricular Tachycardia
2. Asystole
3. Pulseless Electrical Activity
Ventricular Fibrillation
• Occur in 30% of in-hospital cardiac arrest
• More common in ischemic heart disease
• More likely to respond to treatment
• ECG : bizarre irregular waveform, random in both
frequency and amplitude
• Shows disorganized electrical activity in myocardium
• The only effective treatment is early defibrillation
ASYSTOLE
• Occur in 25% of in-hospital cardiac arrest
• Occur 10% of out-side hospital cardiac arrest
• Characterized by ventricular standstill due to
suppression of the cardiac peacemaker by
myocardial disease, anoxia, electrolyte imbalance,or
drugs
• ECG shows flat traces
• Often represent massive heart damage
• Survival less than 4%
Pulseless Electrical Activity (PEA)
•
loss of palpable pulse in the presence of recordable cardiac
electrical activity
• caused by the inability of cardiac muscle to generate a
sufficient force despite an electrical depolarization due to
global cardiac insult
• Rarely occur outside the hospital practise
• 5% of in-hospital cardiac arrest
• ECG : Regular complexes in presence of circulatory failure
• Poor prognosis
Treatment
(1) Cardiopulmonary resuscitation (CPR) : provide
circulatory support, followed by
(2) Defibrillation if a shockable rhythm is present.
• If a shockable rhythm is not present after CPR
and other interventions, clinical death is
inevitable.
Defibrillation
= Administration of an electric shock to the
heart .
• usually needed in order to restore a
viable or "perfusing" heart rhythm.
Cardiac arrest patient receiving treatment
Defibrillation
• Defibrillation is only effective for certain heart rhythms:
- Ventricular fibrillation
- Pulseless ventricular tachycardia,
Not :
- Asystole or
- Pulseless electrical activity.
CPR is generally continued until the subject regains return
of spontaneous circulation (ROSC) or is declared dead.
CPR Definitions
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•
•
•
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CPR: CardioPulmonary Resuscitation
Newborn: birth through the 28th day of life
Infant: 0-1 years of age
Child:1-8 years of age
Adult: older than 8 years of age
BLS: Basic Life Support
AED: Automated External Defibrillator
Fundamental aspects of BLS are:
1. Immediate recognition of cardiac
arrest and activation of the
emergency response system
2. Early CPR with an emphasis on
chest compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post–cardiac arrest care
Step 1: Immediate recognition of cardiac arrest and activation
of the emergency response system
Danger:
• Remember to ensure both your own safety and that of the
patient.
• The safety of bystanders is also of important.
Response:
• Place one hand on the patient’s forehead and shaking his/her
shoulders gently with the other hand, whilst at the same time
asking loudly ‘Are you alright?’
• Always assume the patient may be deaf; ensure that he/she
can see your lips move when assessing responsiveness.
Call for help:
• Activate the community emergency response system (eg: 911)
• The lay rescuer should phone the emergency response system
once the rescuer finds that the victim is unresponsive.
• The healthcare provider can check for response and look for
no breathing or no normal breathing (ie, only gasping) almost
simultaneously before activating the emergency response
system.
Step 2: Early CPR with an emphasis on
chest compressions
• After activation of the emergency response
system, all rescuers should immediately begin
CPR for adult victims who are unresponsive
with no breathing or no normal breathing
(only gasping).
The new basic life support sequence of steps in C-A-B
Adult CPR:
C:chest compressions
• Speed: Give 30 compressions in
approximately 18 seconds (at least
100/min)
• Location: Middle of the chest
• Use: two hands
• Number: 30 compressions
• Frequency: all the compressions
need to be delivered in 18 seconds
• Depth: 2 inches (5 cm)
• Push hard and push fast
• Allow complete recoil of the chest after each
compression, to allow the heart to fill
completely before the next compression.
• Minimize the frequency and duration of
interruptions in compressions to maximize the
number of compressions delivered per
minute.
• A compression-ventilation ratio of 30:2 is
recommended .
• Rescuer fatigue may lead to inadequate
compression rates or depth.
• When 2 or more rescuers are available it is
reasonable to switch chest compressors
approximately every 2 minutes
(or after about 5 cycles of compressions and
ventilations at a ratio of 30:2) to prevent
decreases in the quality of compressions.
A: Open the airway
• Tilt the victim's head back and
lift the chin to open the airway
• Apply a face shield protective
mask
B:Rescue breathing
- Mouth to mouth breathing:
• Cover the victim's mouth and nose with
your mouth. Pinch the victim's nose if
needed.
• Use a compression to ventilation ratio of 30
chest compressions to 2 ventilations.
• Deliver each rescue breath over 1 second.
• Each breath should cause visible chest rise.
• If the victim's chest does not rise with the
first rescue breath, reposition the head by
performing the head tilt–chin lift again and
then give the second rescue breath.
-Bag mask ventilation:
• It provides positive-pressure ventilation
without an advanced airway.
• It is most effective when provided by 2
trained and experienced rescuers.
• One rescuer opens the airway and seals
the mask to the face while the other
squeezes the bag, both rescuers watch
for visible chest rise.
• Masks should be made of transparent
material to allow detection of
regurgitation. They should be capable
of creating a tight seal on the face,
covering both mouth and nose.
Step 3: Use of a Defibrillator:
• Always read the machine's instructions first
• Turn the machine ON
• Place the age appropriate pads on the chest
and the back of the victim
• The machine will detect the need for the
shock
• If shock is advised, clear the victim
• Apply the shock, and turn the mashine OFF
• If victim doesn't recover, continue CPR until
the paramedics arrive
If the victim recovers (is conscious again) leave him in the recovery positon
The victim is placed on his or her side with
the lower arm in front of the body.
used for
unresponsive
adult victims
who have
normal
breathing and
effective
circulation.
Recovery position
designed to
maintain a
patent airway
and reduce the
risk of airway
obstruction and
aspiration.
Step 4: Effective advanced life
support
Step 5: Integrated post–cardiac
arrest care
Children CPR:
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Location:middle of the chest
Use:one hand
Number:30 compressions
Frequency: all the compressions need to be
delivered in 18 seconds
• Depth: at least 1/3 AP diameter =2
inches=5cm
Infant CPR:
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•
•
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Location: middle of the chest
use: two fingers
Number: 30 compressions
Frequency: all the compressions
need to be delivered in 18
seconds
• Depth: at least 1/3 AP
diameter=one and half
inches=4cm
• High quality CPR is the cornerstone of a
system of care that can optimize outcomes
beyond return of spontaneous
circulation(ROSC)
• Return to a prior quality of life and functional
state of health is the ultimate goal of a
resuscitation system of care
THANK
YOU
References
• Highlights of the 2010 American Heart
Association Guidelines for CPR and ECC