basic life support ev-k2-cnr pyramid february 2007

BASIC LIFE SUPPORT

Ev-K2-CNR PYRAMID

February 2007

Objectives: basic life support

Criteria to BLS access: Valutation of unconscious patient

ABC: ABC valutation CPR (cardiopulmonary resuscitation)

Basic life support (BLS)

Chain of survivalChain of survival

Early recognition and call for help

Early recognition and call for help

Early CRPEarly CRP Early

defibrillation

Early

defibrillation

Post resuscitatio

n care

Post resuscitatio

n care

Aim of BLS

To prevent/reduce the hypoxic cerebral damage using the CPR techniques in subjects with cardiopulmonary arrest

To garantee an early access in synthomatic patients at high risk of cardiopulmonary complications (IMA/stroke) to hospital

SAFETY OF BOTH RESCUER AND VICTIM

SAFETY OF BOTH RESCUER AND VICTIM

1. MAKE SURE YOU; THE VICTIM AND ANY BYSTANDERS ARE SAFE.

2. USE RIGHT PROTECTION DEVICES.

3. TAKE CARE OF ANY ORGANIC SUBSTANCE.

1. MAKE SURE YOU; THE VICTIM AND ANY BYSTANDERS ARE SAFE.

2. USE RIGHT PROTECTION DEVICES.

3. TAKE CARE OF ANY ORGANIC SUBSTANCE.

IT’S THE FIRST THING TO DO.IT’S THE FIRST THING TO DO.

LEGAL ASPECTS of BLSLEGAL ASPECTS of BLSWhen don’t CRP start ?When don’t CRP start ?

EVIDENT SIGNS OF BIOLOGICAL DEATH

EVIDENT SIGNS OF BIOLOGICAL DEATH

• TISSUTAL DECOMPOSITION

• RIGOR MORTIS

• DECAPITATION

• FATAL TRAUMA

• TISSUTAL DECOMPOSITION

• RIGOR MORTIS

• DECAPITATION

• FATAL TRAUMA

LEGAL ASPECTS of BLSLEGAL ASPECTS of BLS

Start with CRP without thinking about:

Start with CRP without thinking about:

• AGE

• CADAVERIC APPEARANCE

• BODY TEMPERATURE

• MyDRIASIS

• AGE

• CADAVERIC APPEARANCE

• BODY TEMPERATURE

• MyDRIASIS

Access to BLS protocol

Access criteriaUnnconscious patients check AVPU

Unresponsive:Shout for helpTurn the victim onto his back and then open the airway BLS sequence

Responsive (V/P):Check ABC leaving him in the position in which you find him Try to find what is wrong with him and get help if neededReassess him regularly

Level of consciousness

A – Conscious (Alert)V – Responder to Verbal stimalationP – Responder to pain stimulation (Pain)U – Unresponsive

Primary ABC

Level of consciousness (AVPU) Airway Breathing Circulation

Steps of the BASIC LIFE SUPPORTSteps of the BASIC LIFE SUPPORT

RAPID EVALUATION of level of consciousness

RAPID EVALUATION of level of consciousness

Steps of the BASIC LIFE SUPPORTSteps of the BASIC LIFE SUPPORT

RAPID ACTIVATION OF THE EMERGENCY SYSTEM

RAPID ACTIVATION OF THE EMERGENCY SYSTEM

BASIC LIFE SUPPORTBASIC LIFE SUPPORT

Head tilt and chin lift Head tilt and chin lift

OPENING the AIRWAY OPENING the AIRWAY


ARTIFICIAL VENTILATIONARTIFICIAL VENTILATION

LookLook

ListeListenn

FeelFeel

LookLook

ListeListenn

FeelFeel


ARTIFICIAL VENTILATION

If he is breathing normally:

•Turn him into recovery position

•Call for help

•Check for continued breathig


If he is breathing normally:

•Turn him into recovery position

•Call for help

•Check for continued breathig



If he is not breathing normally:If he is not breathing normally:

•Send someone to call for helpSend someone to call for help

•Give 2 breths that makes chest riseGive 2 breths that makes chest rise

•Start chest compressionStart chest compression


If he is not breathing normally:If he is not breathing normally:

•Send someone to call for helpSend someone to call for help

•Give 2 breths that makes chest riseGive 2 breths that makes chest rise

•Start chest compressionStart chest compression

Positive Pressure Ventilation

Essential for an adeguate PPV, in order to prevent an inadeguate/insufficient ventilation are:

Good aderece between the device of PPV and patient’s mounth

Right volume/frequency og ventilations

NB: avoid rapid and forcefula breaths in order to prevent:

Gastric distension Lung injuries Haemodinamic problems

Mouth-to-mouth ventilation1. Using head tilt and chin lift picch the

soft part of the nose closed, using the index finger and thumb of your hand on the forehead. Allow the month to open, but mantaining chin lift.

2. Take a normal breath and place your lift around his mouth, making sure that you have a good seal.

3. Blow steadly into the mouth while watching for the chest to ris, taking about 1s as in a normal breath.

4. Mantaining head tilt and chin lift,take your mouth away and watch for the chest to fall as air passes out.

Barrier devices

Irway to insert in patient’s mouth

Pocket-Mask Device

One way valve

Filter

Oropharingeal cannula

Ventilation pocketmask-to-mouth

Advantages: No direct contact,

even if no case of trasmission of HIV with mouth-to-mouth ventilation

Good oxygenation if connected to O2

Good for rescuer with small hands

Anoxic cerabral damage in acute heart arrest

Anoxic damage starts afeter 4-6 minutes without circulation

After abut 10 minutes there are irreversible cerebral lesions


Combine rescue breaths

With chest compressions

BASIC LIFE SUPPORTBASIC LIFE SUPPORTCHEST COMPRESSION:

1. PLACE THE HEEL OF ONE HAND IN THE CENTRE OF THE VICTIM CHEST

2. INTERLOCK THE FINGER OF YOUR HANDS

3. PRESS DOWN ON THE STERNUM 4-5 cm

CHEST COMPRESSION:

1. PLACE THE HEEL OF ONE HAND IN THE CENTRE OF THE VICTIM CHEST

2. INTERLOCK THE FINGER OF YOUR HANDS

3. PRESS DOWN ON THE STERNUM 4-5 cm

CPR

Allow complete

chest recoil

Push hardPush fast

Deep of compression: 4-5 cmCompression and release should take equal amount of time


RITHM 30:2RATE 100/MIN

IF THERE IS MORE THAN ONE RESCUER PRESENT, ANOTHER

SHOULD TAKE OVER CPR EVERY 1-2 MIN YO PREVENT FATIGUE.

ENSURE THE MINIMUM OF DELAY DURING THE

CHANGEOVER.

BASIC LIFE SUPPORT

Continue with chest compressions and rescue breaths in a ratio of

30:2

with 5 cycles in 2 minutes

BASIC LIFE SUPPORT

Remember to continue resuscitation until:

•Qualify help arrives and takes over•The victim starts breathing normally•You become exausted

Recovery position

FOR UNRESPONSIVE VICTIMS WITH NORMAL BREATHING AND EFFECTIVE CIRCULATION

The position shoul be stable, near a true lateral position with the head dependent

and no pressure on the chest to impair breathing.

Recovery position

Place the arm nearest to you at right angles of the body, elbow bent with the hand palm upper-most.

Recovery position

Bring the far arm across the chest and hold the back of the hand against

the victm’s cheek nearest to you.

Recovery position

With your other hand, grasp the far leg just above theKnee and pull it up, keeping the foot on the ground.

Recovery position

If the victims has to be kept in the recovery position formore than 30 minutes turn him to the opposite side.

FOREIGN-BODY AIRWAY OBSTRUCTION


ADULT FBAO TREATMENTASSESS SEVERITY

SEVERE AIRWAY OBSTRUCTION

(ineffective cough)

MILD AIRWAY OBSTRUCTION(effective cough)

Conscious

5 back blows5 abdominal trusts

Unconscious

Start CPR

Encourage coughContinue to check for

deterioratin to ineffective cough or until obstruction

relieve



ENCOURAGE HIM TO CONTINUE

COUGHING BUT DO NOTHING ELSE!

ENCOURAGE HIM TO CONTINUE

COUGHING BUT DO NOTHING ELSE!

He’s ablle to

cough and talk

He’s ablle to

cough and talk

MILD OBSTRUCION

“Are you chocking?!”

Cough..yes!!



UNCONSCIUOSNESS

WHEEZY BREATHING

SILENT ATTEMPTS TO COUGH

CYANOSIS

CANNOT SPEAK

CANNOT BREATH

UNCONSCIUOSNESS

WHEEZY BREATHING

SILENT ATTEMPTS TO COUGH

CYANOSIS

CANNOT SPEAK

CANNOT BREATH


“Are you choking?!”

…..

SAY “YES” BY NODDONG HIS HEAD WITHOUT SPEAKING!

“HEIMLICH” MANEUVER “HEIMLICH” MANEUVERTREATMENT OF

CONSCIOUS VICTIM, STANDING UP WITH


TREATMENT OF CONSCIOUS VICTIM, STANDING UP WITH


1. STAND BEHIND VICTIM

2. PUT BOTH HANDS ROUND THE UPPER PART OF THE ABDOMEN

3. LEAN THE VICTIM FORWARDS

4. CLENCH YOUR FIST AND PLACE BETWEEN THE UMBILICUS AND XIPHISTERNUM

5. GRASP THIS HAND WITH THE OTHER AND PULL SHARPLY INWARDS AND UPWARDS

Not reccommended for children under 1 year, obese victims and pregnacy woman

1. STAND BEHIND VICTIM

2. PUT BOTH HANDS ROUND THE UPPER PART OF THE ABDOMEN

3. LEAN THE VICTIM FORWARDS

4. CLENCH YOUR FIST AND PLACE BETWEEN THE UMBILICUS AND XIPHISTERNUM

5. GRASP THIS HAND WITH THE OTHER AND PULL SHARPLY INWARDS AND UPWARDS

Not reccommended for children under 1 year, obese victims and pregnacy woman

“HEIMLICH” MANEUVER “HEIMLICH” MANEUVER

NOT RECCOMMENDED FOR CHILDREN UNDER 1 YEAR, OBESE VICTIMS AND PREGNACY

WOMAN

NOT RECCOMMENDED FOR CHILDREN UNDER 1 YEAR, OBESE VICTIMS AND PREGNACY

WOMAN



If THE PATIENTSBECOMES

UNCONSCIOUSIMMEDIATELYACTIVATE EMS

If THE PATIENTSBECOMES

UNCONSCIOUSIMMEDIATELYACTIVATE EMS

CPR

If while CPR, when you open the airway to give rescue breaths, YOU CAN SEE solid material: remove it!

RESUSCITATION OF CHILDREN

The adult sequence can be used also in not responsive and not breathing children;Give 5 initial rescue breaths before starting chest compressions;A lone rescuer should perform CPR for approximately 1 min before going for help;Compress the chest by approximately 1/3 of depth;Use 2 finders for an infant under 1 year.

CONGELAMENTOSTADIAZIONESEGNI E SINTOMI-EVOLUZIONE

1 PALLORE, CIANOSI, EDEMA, INTORPIDIMENTODOLORABILITA’ SPONTANEA, PARESTESIE RECUPERO

2a BOLLE CHIARE, IPOANESTESIA RECUPERO

2b BOLLE EMORRAGICHE, ANESTESIA ULCERE DISTROFICHE, CICATRICI DEFORMANTI RISCHIO AMPUTAZIONE

3 NECROSI, ANESTESIA TOTALE COINVOLGIMENTO MUSCOLARE, NERVOSO, OSSEO AMPUTAZIONE

FROSTBITES•BRING THE VICTIM IN A PROTECTED PLACE

•TAKE OUT CLOTHES, IN PARTICULAR IF TIGHT OR WET !! BE CAREFUL TO BOOTS

•TAKE OUT RINGS

•DRY THE DAMAGED PART CAREFULLY

•WARM UP WITH THE BODY OF A FRIEND FOR 10 MIN (AXILLA OR ABDOMEN)

•GIVE WARM NOT ALCHOLIC DRINKS

•PUT ON BOOTS AND IF YOU CAN FEEL AGAIN START WALKING

FROSTBITES

•BRING IN A WARM PLACE

•PUT IN WARM WATER (WITH AN ANTISEPHTIC AGENT) AT 37°C FOR 1 HOUR

•DRY CAREFULLY

•PUT COTTONS BETWEEN FINGERS

•KEEP THE PART UP

•REST

•GIVE -ASPIRINA 500-1000 mg.-IBUPROFENE 400-800 mg.

CONGELAMENTODA EVITARE

•FRIZIONARE LA PARTE LESA (con le mani, neve, alcool, pomate, lana, stoffa)

•IMMERGERE IN ACQUA CALDA

•ESPORRE LA PARTE LESA A FONTI DI CALORE

•BUCARE LE BOLLE

•SOMMINISTRARE BEVANDE ALCOOLICHE (se luogo non riscaldato)

CONGELAMENTOEVOLUZIONE

Il recupero della sensibilità dopo 10 min. di riscaldamentoè indice di congelamento superficiale

Se la circolazione non viene ripristinata entro 48 ore si rischia l’amputazione

•PERIODO DI PROGRESSIVA NECROSI 24-36 h

•PERIODO DI MUMMIFICAZIONE 16-21 gg.

basic life support ev-k2-cnr pyramid february 2007

Documents

airway slide

consciousness slide

hospital slide

time slide

basic life support bls

bls protocol slide

continued breathig slide

victim chest