Transcript part1

BLS
CPR
EMERGENCY MEDICAL PROCEDURE
BLS Primary survey
ACLS Secondary survey
BLS PRIMARY SURVEY

Systematic approach to basic life support.

Includes early CPR and early defibrillation.
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Until ROSC or ACLS intervention
TOOLS
Mouth
Hand
If possible, Defibrillator
&
Sincere desire to save a life
COMMON CAUSES

Half a million people die each year from CAD. 2/3 rd
deaths outside the hospital , usually within 2
hours
after onset of
symptoms.
 Drowning
 Drug intoxication
 Airway obstruction
 Automobile accidents
 Electrocution
HEALTHY HEART
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Controllable Risk factors
Smoking
Obesity
Hypertension
Cholesterol
Diabetes
Stress
UNCONTROLLABLE RISK FACTORS
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Age
 Sex
 Race
 Heredity
Plan Healthier Life Styles
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Diet
Exercise
Medications
Quit Smoking
Relaxed Life
Early Warning signs of MI
Pain
:
Position :
Indigestion
Uncomfortable pressure
Burning feeling lower chest
Squeeze in center of chest
Chest
Back
Shoulder
Arms
Jaw
Upper abdomen
PAINLESS MI
Other symptoms with or without pain

Sweating
 Nausea/Vomiting
 Palpitations
 Shortness of breath
VICTIM

Weak
 Pale
 Feels Faint
 Sense of impending disaster
DENIAL BY PATIENT
STROKE RECOGNITION

Headache
 Confusion
 Weakness and Numbness of face/arm/leg
 Dimness of vision
 Speech difficulty
 Loss of balance/falls
Many preceded by TIA’s
TIME IS CRITICAL
Cardiac arrest = Victim clinically dead
Lack of Oxygen = Permanent damage in brain
Best chance of survival if EMS activated and CPR
begun within 1st 4 minutes
Should be followed by defibrillation and ACLS
within first 8 minutes
Permanent brain damage slower in near drowning
especially in children/infants.
ASSESSMENT - ACTION

Check breathing before giving rescue
breaths
 Check the pulse before starting chest
compressions
 Analyze for a shockable rhythm before
delivering a shock
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Airway
 Breathing
 Circulation
 Defibrillation
Perform in ABCD order
Breathing is necessary to support
circulation
Assess unresponsiveness

Gentle Tap and Shake victim’s shoulder
and Shout loudly near his ear- Are you
OK?
If unresponsive
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Shout for help
 Activate EMS
In Adults: Activate EMS, then do CPR(>8
yrs)
For Children: Two minutes CPR, then call
EMS.
AIRWAY
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Head Tilt/ Chin Lift Maneuver
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Head Tilt = Head rotates back
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Chin Lift = Jaw is raised
POSITIONING AIRWAY
 Palm
of hand on victim’s fore
head and pressure - gentle for
infants / more for child/
hyperextension for adults
 Other
hand’s fingers hooked
under the bony part of lower jaw
on side nearest to you.
BREATHING
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Look: Chest or belly movement
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Listen: Air movement at nose and mouth
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Feel: Air at mouth and nose
MECHANISM OF RESCUE BREATHS
•
Inspiration - 20% oxygen used
•
Expiration - 80% exhaled(This is
more than enough for the victim)
RESCUE BREATHING
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Mouth to mouth or mouth to nose
2 slow independent breaths
1 sec. delivery in adults
1 sec. delivery in children/infants
Allow time to exhale before second breath.
RESCUE BREATHS
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Quick BreathsHigh airway pressure
Air may enter stomach
 Tight air sealfor both nose and mouth
breathing
 Infantsboth nose and mouth covered
 Mask or face shield/after training
CIRCULATION - ASSESSMENT
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Look for the carotid artery pulse
Maintain head tilt with one hand
Feel Adam's apple with other hand
Draw fingers back toward groove beside
Adam's apple and press
Take 5-10 sec. to determine pulse
VICTIM’S POSITION
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Victim- over horizontal, firm surface
No pillow under head
Slightly elevate legs
Lower half of sternum
Never over Xiphoid
RESCUER’S POSITION
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One knee at victim’s shoulder and other at
waist.
Contact with heel of one hand.
Interlock other hand over it.
Shoulders directly over victim’s sternum.
Straighten your arms.
Don’t let hands slip off.
Fingers must not press on ribs.
CHEST COMPRESSIONS-ADULT
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Depress sternum 1.5”-2”.
Movement is at hips.
Don’t rock back and forth on knees.
Fully release pressure to allow chest to
return to normal position.
Irregular,jabbing compressions should be
avoided.
CHEST COMPRESSIONS
Even Best compressions result in ¼ to 1/3 of
normal cardiac output.
So, it should be
Smooth
Regular
Uninterrupted
100/min.
Cycle should be 30:2
Reassessment- after 2 mins.
COMPLICATIONS OF CPR
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Sternal or Rib fracture
Separation of Costo Chondral Junction
Punctured Lung
Lacerated Liver
Bruises on Heart
Above reduced by good CPR technique.
CIRCULATION
CHILDREN
1 – 8 year
Carotid artery
One hand
100/mt.
1-1.5 inches
INFANTS
Less than one year
Brachial artery
Two fingers
120/min.
0.5-1 inch
OBSTRUCTED AIRWAY
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Conscious adult may show universal sign of
choking
 Or ask “Are U Choking ?”
 If coughing, encourage.
 If there is ineffective cough, go to Heimlich’s
Maneuver.
HEIMLICH’S MANEUVER
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If patient is standing, go behind the patient.
Wrap around victims waist.
Thumb side of fist on pt’s abdomen.
Midway between naval and Xiphoid.
Inward,upward thrust.
After five thrusts, reassess.
UNCONCIOUS ADULT

Assess unresponsiveness
 A and B. If unsuccessful, reposition and try
again.
 Even then unsuccessful, go to Heimlich’s
maneuver.
Contd….
HEIMLICH’S MANEUVER
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Knee straddling thighs
Heel of hand in middle of abdomen
Not over Xiphoid
Press inward and upward along midline.
Not on either side.
Series of 5 thrusts in rapid succession
FB OBST. INFANT & CHILDREN
INFANT
Less than one year
Support in arm with
face down
Five back blows
between shoulder
blades
Five chest thrusts
over mid sternum
CHILDREN
One to eight years
Only abdominal thrusts
like adult with little
pressure
FOREIGN BODY CHECK

Tongue and jaw lift
 Finger sweep if able to see the foreign body
 Breathing attempt: If failure, reposition and
try again.
 If obstruction relieved
Give 2 rescue breaths
Feel pulse
If pulse absent, start CPR as 30:2
Contd……
FOREIGN BODY CHECK
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In case of infants and children, sweeping
should be done only if you see that.
 Check for breathing and pulse as usual.
SUMMARY
ADULT
CHILD
> 8 years
1-8 years
12
2 hands
1.5-2 inch
100/min
20
INFANT
<1 year
20/min
1 hand
2 fingers
1-1.5 inch
0.5-1 inch
100/min
120/min
Thank
u