adult basic life support:
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Adult Basic Life Support
Adult Basic Life SupportMohammed AlHusseini ElwanAssistant Lecturer of EM, Faculty of Medicine, Alexandria University
ObjectivesRecognize the importance of basic life support.Understand how to do high quality resuscitation until more experience and equipment arrive.Learn how to use an automated external defibrillator.Learn the management of foreign-body airway obstruction.
Chain of Survival
Chain of Survival
BLS: Where?!Lay rescuers
HistoryIsis gave the kiss of life to Osiris.
HistoryThis was originally practiced in Egypt almost 3,500 years ago and became popular again in Europe.
HistoryThe first report of an experimental tracheal intubation was probably by the great Muslim philosopher and physician Avicenna.
Check ResponseMake sure you, the victim and any bystanders are safe.Check the victim for a response:gently shake his shoulders and ask loudly: Are you all right?
Check ResponseIf he responds:leave him in the position in which you find him, provided there is no further danger;try to find out what is wrong with him and get help if needed;reassess him regularly.Check ResponseIf he does not respond:Shout for helpTurn the victim onto his back and then open the airway using head; tilt and chin liftPlace your hand on his forehead and gently tilt his head back;With your fingertips under the point of the victims chin, lift the chin to open the airwayCheck Response
Look, listen and feelKeeping the airway open, look, listen and feel for breathing:look for chest movement;listen at the victims mouth for breath sounds;feel for air on your cheek;decide if breathing is normal, not normal or absent.Look, listen and feel
Check breathing for no more than 10 secondsDo not confuse agonal gasps with breathingIf you have any doubt whether breathing is normal, act as if it is not normal
Checking the carotid pulse is an inaccurate method of confirming the presence or absence of circulation, both for lay rescuers and for professionals_______________________________________Bahr J, Klingler H, Panzer W, Rode H, Kettler D. Skills of lay people in checking the carotid pulse. Resuscitation 1997;35:236. Nyman J, Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students. Resuscitation 2000;47:17984.Tibballs J, Russell P. Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest. Resuscitation 2009;80:614
Chest CompressionsKneel by the side of the victimPlace the heel of one hand in the centre of the victims chest Place the heel of your other hand on top of the first handInterlock the fingers of your hands and ensure that pressure is not applied over the victims ribs. Keep your arms straightPosition yourself vertically above the victims chestChest CompressionsPress down on the sternum at least 5 cm.Full recoil without losing contact between your hands and the sternum.Repeat at a rate of at least 100/min.Compression and release should take equal amounts of time.Minimize interruptions.Chest Compressions
In adults needing CPR, the cardiac arrest is likely to have a primary cardiac cause. CPR should start with chest compression rather than initial ventilations
Rescue BreathsAfter 30 compressions open the airway again using head tilt and chin lift.Pinch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead.Allow the mouth to open, but maintain chin lift.Take a normal breath and place your lips around his mouth, making sure that you have a good seal.Blow steadily into the mouth while watching for the chest to rise, taking about 1 s as in normal breathing; this is an effective rescue breath.
Rescue BreathsMaintaining head tilt and chin lift, take your mouth away from the victim and watch for the chest to fall as air comes out.Take another normal breath and blow into the victims mouth once more to achieve a total of two effective rescue breaths. The two breaths should not take more than 5 s in all. Continue with chest compressions and rescue breaths in a ratio of 30:2.Stop to recheck the victim only if he starts to wake up: to move, opens eyes and to breathe normally. Otherwise, do not interrupt resuscitation.Rescue BreathsIf your initial rescue breath does not make the chest rise as in normal breathing, then before your next attempt:Look into the victims mouth and remove any obstruction;Recheck that there is adequate head tilt and chin liftDo not attempt more than two breaths each time before returning to chest compressionsIf there is more than one rescuer present, another rescuer should take over delivering CPR every 2min to prevent fatigue
Chest-compression-only CPR may be used as follows:if you are not trained, or are unwilling to give rescue breaths;if only chest compressions are given, these should be continuous
Animal studies have shown that chest-compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest_______________________________________________________________Chandra NC, Gruben KG, Tsitlik JE, et al. Observations of ventilation during resuscitation in a canine model. Circulation 1994;90:30705.Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario. Circulation 2002;105: 6459.
Animal and mathematical model studies of chest compression only CPR have shown that arterial oxygen stores deplete in 24 min_______________________________________________________________Turner I, Turner S, Armstrong V. Does the compression to ventilation ratio affect the quality of CPR: a simulation study. Resuscitation 2002;52:5562.Dorph E,WikL, Stromme TA, Eriksen M, Steen PA. Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs. Resuscitation 2004;60:30918.
But, you should have this!
Mouth to mask ventilation
Do not interrupt resuscitation until:professional help arrives and takes over; orthe victim starts to wake up: to move, opens eyes and to breathe normally; oryou become exhausted
Automated External Defibrilator (AED)
AEDSend someone for help and to find and bring an AED if availableIf you are on your own, use your mobile phone to alert the ambulance service leave the victim only when there is no other option
AEDIf you are on your own and the AED is in your immediate vicinity, start with applying the AED
AEDSwitch on the AED and attach the electrode pads on the victims bare chest;If more than one rescuer is present, CPR should be continued while electrode pads are being attached to the chest;Follow the spoken/visual directions immediately;Ensure that nobody is touching the victim while the AED is analysing the rhythm.
AEDIf a shock is indicated:ensure that nobody is touching the victim;push shock button as directed;immediately restart CPR 30:2;continue as directed by the voice/visual prompts.AEDIf no shock is indicated:immediately resume CPR, using a ratio of 30 compressions to 2 rescue breaths;continue as directed by the voice/visual prompts.
AEDContinue to follow the AED prompts until:professional help arrives and takes over;the victim starts to wake up: moves, opens eyes and breathes normally;you become exhausted.
Lay rescuer AED programmes with very rapid response times, and uncontrolled studies using police officers as first responders,97,98 have achieved reported survival rates as high as 4974%.______________________________________________________________________White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2005;65:27983.Mosesso Jr VN, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med 1998;32:2007.
Two lower-level studies of adults with in-hospital cardiac arrest from shockable rhythms showed higher survival-to-hospital discharge rates when defibrillation was provided through an AED programme than with manual defibrillation alone______________________________________________________________________Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 2004;44:84652.Destro A, Marzaloni M, Sermasi S, Rossi F. Automatic external defibrillators in the hospital as well? Resuscitation 1996;31:3943.
Despite limited evidence, AEDs should be considered for the hospital setting as a way to facilitate early defibrillation (a goal of