Adult Basic Life Support for the

Health Care Worker

Adult Basic Life Support for the

Health Care Worker

Philippine Heart Association, Inc.

Council on Cardio Pulmonary Resuscitation

- CPR

Philippine Heart Association, Inc.

Council on Cardio Pulmonary Resuscitation

- CPR

Chain of Survival ConceptChain of Survival Concept

The Links in the Chain of Survival The Links in the Chain of Survival Early accessEarly access Early CPREarly CPR Early defibrillationEarly defibrillation Early ACLSEarly ACLS

A A well-informed personwell-informed person - key in - key in the early access link.the early access link. Recognition of heart attack and Recognition of heart attack and

respiratory failure respiratory failure Call for help immediately if needed Call for help immediately if needed Activate the EMS SystemActivate the EMS System

The First Link--Early AccessThe First Link--Early Access

CPR - Cardio-Pulmonary ResuscitationCPR - Cardio-Pulmonary Resuscitation Life saving technique for cardiac &Life saving technique for cardiac & respiratory arrestrespiratory arrest Rescue breathing & chest compressionsRescue breathing & chest compressions Lay persons and medical personnelLay persons and medical personnel

Second Link - Early CPRSecond Link - Early CPR

Why The Need For CPR

Training?

CPR is the best treatment for cardiac arrest until the arrival of an AED and advanced cardiovascular (ACLS) care.

Why the need for early CPR?

prevents VF from deteriorating to asystole

may increase the chance of defibrillation

contributes to preservation of heart and brain function

significantly improves survival

BrainBrain(Cerebral)(Cerebral)

HeartHeart(Cardiac(Cardiac)

LungsLungs(Pulmonary/(Pulmonary/RespiratoryRespiratory)

NormalNormalAnatomyAnatomy NormalNormalAnatomyAnatomy

How does CPR work?How does CPR work?

All the living cells of our body All the living cells of our body need a steady supply of oxygen need a steady supply of oxygen to keep us alive.to keep us alive.

CPR works because you can CPR works because you can breathe air into the victim’s lungs breathe air into the victim’s lungs to provide oxygen into the blood. to provide oxygen into the blood. When you press on the chest, you When you press on the chest, you move oxygen - carrying blood move oxygen - carrying blood through the body.through the body.

When will you do When will you do CPR?CPR?

CPR must be started CPR must be started as soon asas soon as

possiblepossible after the heart stops beating after the heart stops beating

or if breathing either stops or is or if breathing either stops or is

ineffective. Any delay in starting CPR ineffective. Any delay in starting CPR

reduces the chances of survival. reduces the chances of survival.

In addition, the In addition, the brain cells begin to die brain cells begin to die

afterafter 4-6 minutes4-6 minutes without oxygen.without oxygen.

CARDIOVASCULAR RISK CARDIOVASCULAR RISK FACTORSFACTORS

Non-modifiableNon-modifiable HereditaryHereditary GenderGender RaceRace AgeAge

ModifiableModifiable Cigarette smokingCigarette smoking HypertensionHypertension Elevated Cholesterol & triglyceride levelsElevated Cholesterol & triglyceride levels Lack of exerciseLack of exercise ObesityObesity StressStress Diabetes mellitus Diabetes mellitus

EARLY WARNING SIGNS OFEARLY WARNING SIGNS OFHEART ATTACKHEART ATTACK

prolonged prolonged compressing paincompressing pain or unusual or unusual discomfort in the center of the chest, discomfort in the center of the chest, behind the breast bone behind the breast bone

pain may pain may radiateradiate to shoulder, arm, neck or to shoulder, arm, neck or jaw, usually on the left sidejaw, usually on the left side

may be may be accompanied byaccompanied by sweating, nausea, sweating, nausea, vomiting and shortness of breathvomiting and shortness of breath

EARLY WARNING SIGNS OFEARLY WARNING SIGNS OFRESPIRATORY FAILURERESPIRATORY FAILURE

unable to speak, unable to speak, breath or coughbreath or cough

clutches neck clutches neck (universal (universal distress signal) distress signal)

bluish color of bluish color of skin and lipsskin and lips

The ABC’s of CPRThe ABC’s of CPR

After After determining unconsciousnessdetermining unconsciousness, , you should evaluate the condition of you should evaluate the condition of the body’s two most vital systems-- the body’s two most vital systems-- respiratoryrespiratory and and circulatory system.circulatory system. This is done by checkingThis is done by checkingthe ABC’s.the ABC’s.

The ABC’s of CPRThe ABC’s of CPR

A.A. Airway Airway Does the victim have an Does the victim have an open airway (air passage open airway (air passage that allows the victim to that allows the victim to breathe)?breathe)?

B.B. Breathing Breathing Is the victim breathing? Is the victim breathing?

C.C. CirculationCirculation Does the victim have a Does the victim have a pulse?pulse?

You find a person You find a person lying on the lying on the ground, not ground, not moving. You moving. You should should survey the scene to survey the scene to see if it is safesee if it is safe and and to get some to get some idea of what idea of what happened. Thenhappened. Thenbegin doing a begin doing a primary surveyprimary survey by by checking for checking for unresponsiveness.unresponsiveness.

TO CHECK FOR TO CHECK FOR UNRESPONSIVENESUNRESPONSIVENESSS Tap or gently shake Tap or gently shake

the victimthe victim Rescuer shouts Rescuer shouts

“Are you OK?”“Are you OK?” If the victim is If the victim is

unconscious, unconscious, rescuer shouts rescuer shouts “HELP”“HELP”

He should activate He should activate the EMS Systemthe EMS System

He then proceeds He then proceeds to do CPRto do CPR

Airway obstruction by epiglottis

A - AIRWAYA - AIRWAYOpen the Airway:Open the Airway: Use the head tilt/chin Use the head tilt/chin lift methodlift method

Place one hand on Place one hand on the victim’s foreheadthe victim’s forehead

Place fingers of other Place fingers of other hand under the bony hand under the bony part of lower jaw part of lower jaw near chinnear chin

Tilt head and lift Tilt head and lift jaw--avoid closing jaw--avoid closing victim’s mouth victim’s mouth

Jaw ThrustJaw Thrust

Jaw is lifted Jaw is lifted without tilting without tilting the head the head

Suspected Suspected victims of victims of cervical spine cervical spine injuryinjury

Check for Check for BreathlessnessBreathlessness Maintain open airwayMaintain open airway

Place your ear over Place your ear over victim’s mouth and victim’s mouth and nosenose

(LLF) Look(LLF) Look at chest, at chest, Listen Listen andand FeelFeel for for breathing for 10 sec. breathing for 10 sec.

Victims may either be Victims may either be breathing or not breathing or not

Counting Counting for 10 Sec.for 10 Sec.

thousand-one, 1002, 1003, thousand-one, 1002, 1003, 1004, 1005, 1006, 1007, 1004, 1005, 1006, 1007, 1008, 1009, thousand-ten 1008, 1009, thousand-ten

B - BREATHINGB - BREATHINGGive 2 full breathsGive 2 full breaths Maintain airwayMaintain airway Pinch nose shutPinch nose shut Open your mouth wide, Open your mouth wide,

take a deep breath, and take a deep breath, and make a tight seal around make a tight seal around outside of victim’s mouthoutside of victim’s mouth

Give 2 slow breaths (1 Give 2 slow breaths (1 1/2-2 sec/min)1/2-2 sec/min)

Observe chest rise & fall; Observe chest rise & fall; listen & feel for escaping listen & feel for escaping airair

C - CirculationC - Circulation Maintain open airwayMaintain open airway LLF: LookLLF: Look at chest, at chest,

Listen Listen andand FeelFeel for for breathing for 10 sec. breathing for 10 sec.

THIS TIME, FEEL FOR THIS TIME, FEEL FOR THE CAROTID PULSE THE CAROTID PULSE INSTEAD OF INSTEAD OF SUPPORTING THE SUPPORTING THE CHINCHIN

CountingCounting: : thousand-thousand-one, 1002, 1003, 1004, one, 1002, 1003, 1004, 1005, 1006, 1007, 1008, 1005, 1006, 1007, 1008, 1009, thousand-ten 1009, thousand-ten

Continue Rescue Continue Rescue BreathingBreathing

Give one breath Give one breath every 5 sec every 5 sec (about 12 (about 12 breaths/min) breaths/min)

Counting: Counting: (Blow) thousand-one, (Blow) thousand-one, 1002, 1003, 1004, 1002, 1003, 1004, TWO (2TWO (2ndnd blow) blow)

If with pulse but is If with pulse but is not breathingnot breathing

C - CirculationC - Circulation

Immediately begin Immediately begin chest compressionchest compression

If without signs of If without signs of circulation and circulation and normal breathingnormal breathing

C -C -CIRCULATIONCIRCULATIONLocate Locate Compression AreaCompression Area Kneel facing victim’s Kneel facing victim’s

chestchest With middle & index With middle & index

fingers of hand nearest fingers of hand nearest victim’s legs, locate victim’s legs, locate lower edge of victim’s lower edge of victim’s rib cage on side closest rib cage on side closest to youto you

Follow rib cage to Follow rib cage to “notch” at lower end of “notch” at lower end of breastbonebreastbone

. . PlacePlace heelheel of hand of hand nearest victim’s head nearest victim’s head on breastbone next to on breastbone next to index finger of hand index finger of hand used to find “notch”used to find “notch”

• Place heel of hand Place heel of hand used to locate used to locate “ “notch” notch” directly on directly on toptop of heel of other of heel of other handhand• Keep Keep fingers offfingers off victim’s chest victim’s chest

Position Position shoulders over shoulders over handshands with with elbows locked elbows locked and arms straightand arms straight

Give 30 CompressionsGive 30 Compressions Compress Compress

breastbone breastbone 1 1/2 to 1 1/2 to 2 in.2 in. (30 (30 compressions should compressions should take 15-20 sec)take 15-20 sec)

Count aloud Count aloud “1, 2, “1, 2, 3, 4, 3, 4, 5,6,7,8,9,10,11,12,15,6,7,8,9,10,11,12,13,14,15,16,17,18,19,3,14,15,16,17,18,19,20,21,22,23,24,25,2620,21,22,23,24,25,26,27,28,29, ONE ,27,28,29, ONE (Push (Push down as you say the down as you say the number and come up number and come up as you await chest as you await chest recoil)recoil)

Compress down Compress down and release and release pressure pressure smoothly, smoothly, keeping keeping hand hand contact with contact with chest at all timeschest at all times

If the victim is If the victim is breathingbreathing

the unresponsive victim with the unresponsive victim with spontaneous respirations should be spontaneous respirations should be placed in the recovery position placed in the recovery position if no if no cervical traumacervical trauma is suspected is suspected

placement in this position consists of placement in this position consists of rolling the victim onto his or her side rolling the victim onto his or her side to to help protect the airwayhelp protect the airway

Maintain open airway & Maintain open airway & position the victim position the victim

1. Survey the scene – the scene is SAFE2. Tap the shoulder. “Hey hey are you OK? PX IS UNRESPONSIVE

CALL FOR HELP– Help!”3. CHECK BREATHING:

LLF POSITION ”Thousand –one, 1002…10010”4. SCENARIO: (-)BREATHING

- I will give 2 full breaths – BREATHE 2X5. CHECK BREATHING AND PULSE: LLF and

pulse check – ”Thousand one…100106. SCENARIO: (-) BREATHING , (+) PULSE –

RESCUE BREATHING Breathe. 1001, 1002…….1004 – TWO (2ND breath) Breathe. 1001, 1002…….1004 – TWELVE (12TH Breath)

7. CHECK BREATHING & PULSE (same as #5)

8. SCENARIO: (-) BREATHING, (-) PULSE – I will do CPR (30:2) 1, 2, 3, 4, …….20, 1, 2….9 – ONE (1ST Breath 2X) 1, 2, 3, 4 …….. 20, 1, 2…9 – FIVE (5TH Breath 2X)

9. CHECK BREATHING & PULSE: (+) BREATHING, (+) PULSE – PX IS REVIVED

10. RECOVERY POSITION