BASIC LIFE SUPPORT - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

LIFE SUPPORT CHAIN OF SURVIVAL

Four Links
1. The First Link: EARLY ACCESS
Kinds of Life Support It is the event initiated after the patient’
patient’s collapse until the arrival of Emergency
Medical Services personnel prepared to provide care.
1. BASIC Life Support (BLS)
2. The Second Link: EARLY CPR
An emergency procedure that consists of recognizing respiratory or cardiac arrest
It is most effective when started immediately after the victim’
victim’s collapse. The
or both and the proper application of CPR to maintain life until a victim recovers or
probability of survival approximately doubles when it is initiated
initiated before the arrival
advanced life support is available.
of EMS.
2. Advanced Cardiac Life Support (ACLS) 3. The Third Link: EARLY DEFIBRILLATION
The use of special equipment to maintain breathing and circulation
circulation for the victim It is most likely to improve survival. It is the key intervention
intervention to increase the chances
of a cardiac emergency. of survival of patients with “out-
out-of-
of-hospital”
hospital” cardiac arrest.
3. Prolonged Life Support (PLS) 4. The Fourth Link: EARLY ACLS
For post resuscitative and long term resuscitation. If provided by highly trained personnel like paramedics, provision
provision of advanced
care outside the hospital would be possible.

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

HUMAN BODY

Anatomical Terms

1. Medial (I) 9. Superior (E)

2. Prone Position (C) 10. Lateral (J)
3. Inferior (F) 11. External (Q)
4. Proximal (K) 12. Anterior (G)
5. Internal (O) 13. Supine position (B)
6. Distal (L) 14. Superficial (M)
7. Posterior (H) 15. Anatomical position (A)
8. Lateral recumbent position (D) 16. Deep (N)

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BASIC LIFE SUPPORT - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

HUMAN BODY cont…

cont… HUMAN BODY cont…
cont…

Body Systems Body Systems

1. The Respiratory System

2. The Circulatory System
It supply oxygen to the body, as well as removes
carbon dioxide from the body. The passage of air into It delivers oxygen and nutrients to the body’
body’s tissues
and out of the lungs is called respiration. Breathing in and removes waste products. It consists of the heart,
is called inspiration or inhaling. Breathing out is called blood vessels, and blood.
expiration or exhaling.

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

HUMAN BODY cont…

cont… HUMAN BODY cont…
cont…
Body System cont... Body System cont...
3. The Nervous System
Breathing and Circulation
It is composed of the brain, spinal cord and nerves. It has two major functions –
communication and control. It lets a person be aware of and react react to the • Air that enters the lungs contains:
environment. It coordinates the body’
body’s responses to stimuli and keeps body systems – 21% O2
working together. – trace of CO2
• Air exhaled from the lungs contains:
– 16% O2
– 4% CO2
• Clinical death (0 - 4 min. - brain damage not
likely, 4 - 6 min. - damage probable).

• Biological death (6 - 10 min. - brain damage

probable; over 10 min. - brain damage is certain).

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

PRECAUTIONS TO PREVENT CARDIOVASCULAR DISEASES

DISEASE TRANSMISSION
Body Substance Isolation
Are precautions taken to isolate or prevent risk of exposure from
bodily substance.
Basic Precautions and Practices
1. Personal Hygiene
from any other type of
2. Protective Equipment
Risk Factors for Cardiovascular Diseases
1. Risk factors that cannot be changed (Non-
(Non-modifiable) :
• Heredity
• Age
• Gender
2. Risk factors that can be changed (Modifiable) :
• Cigarette smoking.
• Hypertension
• Elevated cholesterol and triglyceride levels.
• Lack of exercises.
• Obesity
• Stress
3. Equipment Cleaning • Diabetes mellitus.
& Disinfecting

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SAFETY SERVICES Introduction to BLS - CPR SAFETY SERVICES Introduction to BLS - CPR

CARDIOVASCULAR DISEASES cont…

cont… CARDIOVASCULAR DISEASES cont…
cont…
HEART ATTACK ( Myocardial Infarction) First Aid Management of Heart Attack
It occurs when the oxygen supply to the heart muscle (myocardium)
(myocardium) is cut-
cut-off for a prolonged 1. Recognized the signals of heart attack and take action.
period of time. This cut-
cut-off results from a reduced blood supply due to severe narrowing or
complete blockage of the diseased artery. The result is death (infarction)
(infarction) of the affected part 2. Have patient stop what he or she is doing and sit or lie him/her
him/her down in a comfortable
of the heart. position. Do not let the patient move around.
3. Have someone call the physician or ambulance for help.
4. If patient is under medical care, assist him/her in taking his/her
his/her prescribed medicine/s.

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Guidelines in Giving Emergency Care SAFETY SERVICES Guidelines in Giving Emergency Care

GETTING STARTED
1. Plan of Action
Emergency plans should be established based on anticipated needs and
available resources.
2. Gathering of Needed Materials
The emergency response begins with the preparation of equipment and personnel
KNOWLEDGE OBJECTIVES: before any emergency occurs.
After completing this module, participants will be able to-
to- 3. Initial Response:
1. Explain the need of preparation to a proper emergency care.
• Ask for HELP.
2. Describe the four emergency action principles • Intervene
3. Enumerate the golden rules in giving emergency care. • Do not further harm.
4. Instruction to Helper/s
SKILL OBJECTIVES:
Proper information and instruction to a helper/s would provide organized
organized first aid
• Demonstrate how to do a primary survey. care.

TR 2-
2-1 TR 2-
2-2

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SAFETY SERVICES Guidelines in Giving Emergency Care SAFETY SERVICES Guidelines in Giving Emergency Care

EMERGENCY ACTION PRINCIPLES EMERGENCY ACTION PRINCIPLES cont…

cont…
2. Activate Medical Assistance and Transfer Facility
1. Survey the Scene
Once you recognized that an emergency has occurred and decide to act, you In some emergency, you will have enough time to call for specific
specific medical advice
must make sure the scene of the emergency is safe for you, the victim/s,
victim/s, and before administering first aid. But in some situations, you will need to attend to
any bystander/s. the victim first.

Elements of the Survey the Scene Phone First and Phone Fast
• Scene safety. Both trained and untrained bystanders should
• Mechanism of injury or nature of illness. be instructed to Activate Medical Assistance as
• Determine the number of patients and soon as they have determined that an adult
additional resources. victim requires emergency care “Phone First”
First”.
While for infant and children a “Phone Fast”
Fast”
approach is recommended.

TR 2-
2-3 TR 2-
2-4

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BASIC LIFE SUPPORT - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Guidelines in Giving Emergency Care SAFETY SERVICES Guidelines in Giving Emergency Care

EMERGENCY ACTION PRINCIPLES cont…

cont… EMERGENCY ACTION PRINCIPLES cont…
cont…

3. Do a Primary Survey of the Victim

4. Do a Secondary Survey of the Victim
In every emergency situation, you must first find out if there are
are conditions that
are an immediate threat to the victim’
victim’s life. It is a systematic method of gathering additional information about
about
injuries or conditions that may need care.
1. Check for Consciousness
1. Interview the victim.
2. Check for Airway
3. Check for Breathing 2. Check vital signs.

4. Check for Circulation 3. Perform head-

head-to-
to-toe examination.

TR 2-
2-5 TR 2-
2-6

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Respiratory Arrest & Rescue Breathing SAFETY SERVICES Respiratory Arrest & Rescue Breathing

RESPIRATORY ARREST
Is the condition in which breathing stops or inadequate.

KNOWLEDGE OBJECTIVES: RESCUE BREATHING

After completing this module, participants will be able to-
to-
Is a technique of breathing air into a person lungs to supply him
him or her with the
1. Describe what is respiratory arrest. oxygen needed to survive.
2. Identify the causes of respiratory arrest.
3. Describe the ways in ventilating the lungs.
SKILL OBJECTIVES:
After completing this sessions, participants will be able to-
to-
• Demonstrate how to provide rescue breathing for an adult, child, & infant
who shows signs of circulation but not breathing or inadequate.

TR 3-
3-1

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Respiratory Arrest & Rescue Breathing SAFETY SERVICES Respiratory Arrest & Rescue Breathing

WAYS TO VENTILATE THE LUNGS WAYS TO VENTILATE THE LUNGS

1. Mouth-
Mouth-to-
to-
2. Mouth-
Mouth-
Mouth
to-
to-Nose
5. Mouth-
Mouth-to-
to- 6. Mouth-
Mouth-to-
to-
Face Shield Mask

3. Mouth-
Mouth-to-
to-Mouth 4. Mouth-
Mouth-to-
to-
and Nose Stoma

7. Bag Mask
Device

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BASIC LIFE SUPPORT - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Respiratory Arrest & Rescue Breathing SAFETY SERVICES Foreign Airway Obstruction Management

Face mask

KNOWLEDGE OBJECTIVES:
After completing this module, participants will be able to-
to-
1. Identify the causes, types, and classification of obstruction.
obstruction.
2. Describe Heimlich maneuver.
Bag mask
SKILL OBJECTIVES:
After completing this session, participants will be able to-
to-
• Demonstrate how to provide Heimlich maneuver to an adult, child & infant
who have obstructed airway.

TR 4-
4-1

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Foreign Body Airway Obstruction Management SAFETY SERVICES Foreign Body Airway Obstruction Management

TWO TYPES OF OBSTRUCTION CLASSIFICATION OF OBSTRUCTION

1. Anatomical Obstruction 1. Partial obstruction with good air exchange.

It happens when the tongue drops back and The victim is responsive and can cough forcefully, although frequently
frequently there
obstruct the throat. Other causes are acute is wheezing between coughs.
asthma, croup, diphtheria, swelling, and cough
(whooping). 2. Partial obstruction with poor air exchange.
The victim has a weak, ineffective cough, high-
high-pitched noise while inhaling,
increased respiratory difficulty, and possibly cyanosis.
2. Mechanical Obstruction
3. Complete or total obstruction.
When foreign objects lodge in the pharynx or The victim is unable to speak, breathe, or cough and may clutch the neck with
airways; fluids accumulate in the back of the the thumb and fingers. Movement of air is absent.
throat.

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Foreign Body Airway Obstruction Management SAFETY SERVICES Cardiac Arrest & Cardiopulmonary Resuscitation

HEIMLICH MANEUVER
Heimlich maneuver or abdominal thrusts is recommended for relieving
relieving foreign body
airway obstruction.

KNOWLEDGE OBJECTIVES:
After completing this module, participants will be able to-
to-
1. Describe cardiac arrest.
2. Enumerate the three conditions of cardiac arrest.
3. Enumerate the criteria for not starting CPR and when to STOP CPR.
SKILL OBJECTIVES:
After completing the class, participants will be able to-
to-
• Demonstrate how to provide Cardiopulmonary Resuscitation to an adult,
adult,
child & infant who have cardiac arrest.

TR 5-
5-1

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BASIC LIFE SUPPORT - CPR

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Cardiac Arrest & Cardiopulmonary Resuscitation SAFETY SERVICES Cardiac Arrest & Cardiopulmonary Resuscitation

CARDIOPULMONARY
CARDIAC ARREST RESUSCITATION (CPR)
Is the condition in which circulation ceases and This is a combination of chest compression
vital organs are deprived of oxygen. and rescue breathing. This must be combined
for effective resuscitation of the victim of
cardiac arrest.

THREE CONDITONS OF CARDIAC ARREST Cough - CPR

1. Cardio Vascular Collapse
2. Ventricular Fibrillation
3. Cardiac Stand Still
Compression Only - CPR

TR 5-
5-2

THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids THE PHILIPPINE NATIONAL RED CROSS Basic Life Support – CPR Visual Aids
SAFETY SERVICES Cardiac Arrest & Cardiopulmonary Resuscitation SAFETY SERVICES Cardiac Arrest & Cardiopulmonary Resuscitation

SEQUENCE IN PERFORMING CPR & RB

Survey the Scene.
WHEN TO S.T.O.P. CPR “The Scene is Safe”
Safe”.
“Activate Medical Assistance & Transfer Facility”
Facility”.
1. SPONTANEOUS signs of circulation are restored. Check Responsiveness,
“Hey Mam/Sir
Mam/Sir are you OK? Victim Unresponsive”
Unresponsive”.
2. TURNED over to medical services or properly trained and authorized
personnel. Open Airway (Head-
(Head-Tilt-
Tilt-Chin Lift) Check Airway
Check Breathing (Look, Listen & Feel) for 5 seconds.
3. OPERATOR is already exhausted and cannot continue CPR.
“Victim is Breathless”
Breathless”.
4. PHYSICIAN assumes responsibility (declares death, take over, etc.).
Give 2 Initial Ventilatory Maneuver (2 breaths).
Check for Signs of Circulation for at least 10 seconds.
“Victim has no signs of Circulation I’I’ll perform CPR”
CPR”.
“Victim has inadequate/no breathing but with Signs of Circulation I’ll perform
Rescue Breathing”
Breathing”.
TR 5-
5-3 TR 5-
5-4

OBJECTIVES

1. Describe the 8 steps of the ACLS

approach
ACLS APPROACH 2. For each step of the ACLS Approach
describe 2 acts of assessment and
management
3. Describe how you can apply this
approach to almost all cardiovascular
emergencies

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BASIC LIFE SUPPORT - CPR

8 Things to Recall in an Emergency 8 Things to Recall in an Emergency

Primary Survey: ABCD
(Basic Steps)
Airway: open the airway
Breathing: provide positive-
pressure Ventilations
Circulation: give chest
compressions
Defibrllation: shock VF/pulseless
VT
Primary ABCD Survey Secondary Survey: ABCD Secondary Survey:
(ACLS Questions to Ask) (Basic Steps) ABCD Survey
(Basic Steps)
Airway: Is the airway open? Airway: Airway:
Breathing: Is the victim moving air •provide advanced airway • Is advanced
adequately? management airway needed now?
Circulation: Is there a pulse? If
not, is CPR being performed •tracheal intubation, •If yes, intubate victim with laryngeal
effectively? laryngeal mask mask airway, Combitube, or tracheal
airway, Combitube tube
Defibrillation: if no pulse, has
someone checked whether
rhythm is VF?
Is a defibrillator on the way?
Is it ready to deliver a shock?

8 Things to Recall in an Emergency 8 Things to Recall in an Emergency

Secondary Survey: ABCD Secondary Survey: ABCD Secondary Survey: ABCD Secondary Survey: ABCD
(Basic Steps) Survey(Basic Steps) (Basic Steps) Survey(Basic Steps)

Breathing: confirm tube placement
primarily (physical examination),
secondarily (check end-tidal CO2 and
esophageal placement), check for
adequate oxygenation and ventilation
Breathing: Primary confirmation
(physical examination) of proper
placement of airway device
Breathing: Secondary confirmation
(end-tidal CO2 detectors, esophageal
detector devices) of proper device
placement
Breathing: Adequate oxygenation and
ventilation? Is it possible to provide
continuous/intermittent monitoring of
CO2 and oxygen levels
Breathing: Is tube secured to prevent
dislodgment? Is commercial tube
holder being used or tape-and-tie
techniques? Is proper tube placement
reconfirmed frequently
Circulation: obtain IV access,
determine rhythm, give medications
appropriate for rhythm and vital signs
Circulation: What was the initial
cardiac rhythm? What is current
cardiac rhythm?
Circulation:has someone obtained
access to the venous circulation? Can
fluids and medication now be given?
Have all medications and
interventions been providedas
indicated for this rhythm and overall
clinical condition?

8 Things to Recall in an Emergency

Secondary Survey: ABCD Secondary Survey: ABCD
(Basic Steps) Survey(Basic Steps)

Differential Diagnosis: Differential Diagnosis:

search for, find, and treat reversible
cause
Now… what is wrong with
this patient? Why did
adequate respirations and
heartbeat stop? Why did the
patient go into an
arrest?What do we see,
hear, smell, know or quickly
learn that might help us
identify a reversible cause
of the arrest?

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BASIC LIFE SUPPORT - CPR

Initial Responses Assessment process

The initial responses also include:

• Assess responsiveness • Person Collapses
• Call fast
• Appropriately position the patient • Possible Cardiac Arrest
• Appropriately position yourself as the
rescuer • Assess Responsiveness

call for help

Assess Responsiveness

• Always assume that the victim is in cardiac

respiratory arrest or both unless proven
otherwise
• Establish unresponsiveness with the
traditional “shake and shout”
shout” step:tap and
gently shake the victim and shout “Are
you OK”
OK”
• Advance care, in the form of electrical
defibrillation, advanced airway
management, and IV medications, must
be on the way to the patient as soon as
possible

Q? to Assess Responsiveness

• Did the victim fall from a height? • Activate emergency response

• Or collapse with great force?
• Or dive head first?
• Or experience a motor vehicle crash?
• Call for defibrillator
Begin Primary ABCD Survey
A Assess breathing (open airway, look,
listen, and feel)

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BASIC LIFE SUPPORT - CPR
A: Assess the Airway
• Begin with an assessment of the airway,
first opening the airway and checking for
spontaneous breathing
• The basic techniques for opening the
airway are the head tilt-
tilt-chin maneuver
and the jaw-
jaw-thrust maneuver
Head Tilt-chin Lift
If there is no possibility of a cervical spine
Injury, remove material obstructing the
airway by turning the patient on his or her
side
• Place the edge of one hand on the victim’
victim’s
forehead. Begin to gently tilt the head
back. At the same time place 2 fingers of
the other hand under the chin and lift
upward, tilting the head back
The Advanced ACLS Skills
Head Tilt-chin Lift
This maneuver pulls the base of the tongue
away from the back of the throat, thus
maintaining a more open airway:
• Open the mouth, inspect the upper airway
for foreign objects, vomitus, or blood. If a
foreign object is present, remove it with
your fingers covered with a piece of cloth.
Jaw-Thrust Maneuver
The jaw thrust maintains the neutral
positionof the cervical spine while
resuscitative efforts continue. Use the jaw
thrust when you encounter patients with the
combination of possible cervical spine
injuries and respiratory compromise or
victims of trauma.
Overview
2 Basic ACLS Skills
1. CPR
2. AED (Automated External Defibrillators)
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BASIC LIFE SUPPORT - CPR

Advanced ACLS Skills

1. Care of the airway
2. Recognition of rhythm
3. Electrical therapy I (defibrillation)
Secondary (Advanced) ABCD Survey
4. Electrical therapy II (cardioversion
(cardioversion)) A. Secondary A
5. Electrical therapy III (transcutaneous – establish an airway with (1) tracheal
(transcutaneous
pacing) intubation
6. IV acces to circulation B. Secondary B
7. Selection of appropriate resuscitation - provide ventilation (breathing) with properly
medication placed tracheal tubes and airway ducts

C. Secondary C D. Secondary D
– Restore circulation with: – Perform a differential diagnosis
(2) Defibrillation
(3) Cardioversion
(4) Transcutaneous pacing
(5) Recognition of the rhythm
(6) Initiation of IV access
(7) IV medications

ACLS Skill 1:
Take care of the airway
1. Provide supplemental oxygen – COPD, who may be dependent on hypoxia
– without respiratory distress drven ventilation
• 2 lpm thru nasal cannula • Low dose supplemental oxygen via a 24% Venturi
mask
– mild respiratory distress
– Most serious cases
• 5 to 6 lpm thru nasal cannula
• Move quickly to advanced airway devices,
– severe respiratory distress, acute congestive intubation and 100% oxygen
heart failure, cardiac arrest
• Use a system that provides a high inspired
oxygen concentration (preferably 100%)

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BASIC LIFE SUPPORT - CPR

• Devices used to administer supplemental

oxygen – Face mask with oxygen reservoir
– Oxygen supply • up to 90 – 100 % oxygen
– Nasal cannula – 6 L/min: 60%
• Starting device – 7 L/min: 70%
• Up to 44% oxygen – 8 L/min: 80%
– 1 L/min: 24% 2 L/min: 28%
– 9 L/min: 90%
– 3 L/min: 32% 4 L/min: 36%
– 5 L/min: 40% 6 L/min: 44%
– 10 L/min: almost 100%

– Face mask
– Up to 60% oxygen
– 6 to 10 L/min

2. Open the airway: recognize airway

• for use on patients who: obstruction
– Seriously ill, responsive, spontaneously – Head and Jaw position:
breathing, require high oxygen concentration • Loss of tone in throat muscles (most common)
– May avoid tracheal intubation if acute
– Basic Opening Techniques
interventions produce a rapid clinical effect
– Have relative indications for tracheal intubation
• Head tilt
but maintain a gag reflex • Jaw Thrust
– Have relative indications for intubation but
have clenched teeth or other physical barriers
to immediate intubation

3. Maintain the open airway using

airway adjuncts
– Assume that obstruction is produced by either • Manage foreign-
foreign-body airway obstruction
the tongue or relaxed throat muscles with the BLS technique of
– Insert an oropharyngeal or nasopharyngeal subdiaphragmatic abdominal thrusts and
airway the advanced technique of direct
laryngoscopy
• Use forceps to grasp and remove the
foreign body

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BASIC LIFE SUPPORT - CPR
OROPHARYNGEAL AIRWAYS
– Devices that hold the tongue away from the
posterior wall of the pharynx
– Useful in spontaneous breathers who are
unconscious or semiconscious with no cough
or gag reflex
– At risk of occluding the airway via tongue and
phanryngeal relaxation
– Keep the airway open during bag-
bag-mask
ventilation
– Helps in mouth suction and prevents occlusion
of tracheal tube
Hazards:
• Long oropharyngeal airway may press the
epiglottis against the entrance of the
larynx
• May push the tongue posteriorly
• Prevent trauma: make sure tongue and
lips are note between the airway and
teeth
• Should only be used in unconscious or
semiconscious without cough or gag reflex
• Technique
• Proper sized airway is lubricated properly
• Inserted close to the midline along the floor of
the nostril
• Continue inserting into the posterior pharynx,
behind the tongue
• Slight rotation may facilitate insertion if with
resistance
Technique:
• Clear the mouth and pharynx
• Place the airway backwards
• Rotate the airway 180˚
180˚ as it passes through
the oral cavity and approaches the prosterior
pharynx
• Make sure that you have clear breath sounds
upon placement of airway
• Maintain proper head position
NASOPHARYNGEAL AIRWAYS
- Uncuffed tubes made of soft rubber or plastic
- For intoxicated or semiconscious who cannot
tolerate an oropharyngeal airway
- Indicated when the insertion or oropharyngeal
airway is technically difficult or impossible
• Hazards
• May enter the esophagus
• May precipitate laryngospasm and vomiting
• May injure nasal mucosa and cause bleeding
• Maintain proper head position
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BASIC LIFE SUPPORT - CPR

PRECAUTIONS 4. Ventilate the patient

– Always check spontaneous respirations • Mouth-
Mouth-to-
to-Mouth and Mouth-
Mouth-to-
to-Nose
immediately after insertion of airway Ventilation
– If respirations are absent, start artificial – Default method
positive pressure ventilation
– Because a major mistake has been made
– If adjuncts are unavailable, use mouth-
mouth-to- to-
– Limitations:
mouth resuscitation
• Rescuer’
Rescuer’s vital capacity
• Reduced concentration of exhaled air
– Professional rescuers should always have a
barrier device

• Mouth to pocket face mask – Advantage

• Effective ventilation and oxygenation
– Must be transparent
• Eliminate’
Eliminate’s direct contact
– Tight fit in face • Possible supplemental oxygen
– Has an oxygen inlet • Eliminates exposure to victim’
victim’s exhaled gases
– Available in different sizes • Easy to teach and learn
• Superior to bag mask technique

• Self-
Self-inflating Ventilation Bags: Attached to • Bag-
Bag-Valve Masks: Adequate Seal and
Valves, Masks and Other Airway Adjuncts Volume
- Mainstay of emergency ventilation – Insert OP airway
- Universal connectors – Recommended tidal volume: 10 to 15 mL/kg
mL/kg
- One way valves to protect rescuer – 80 kg man: needs 800 to 1200 mL per
- Oxygen ports squeeze of bag
- Medication ports – Most bags: 1600 mL
– 1 handed squeeze: 50% of bag (800 mL)
mL)
- Suction ports
- Ports for quantitative sampling of end tidal
CO2

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BASIC LIFE SUPPORT - CPR
• Good seal cannot be achieved when there
is only one rescuer using the bag-
bag-mask
device
• Seal problems do not occur when the bag
is attached to the end of an Endotracheal
tube or LMA
• Use a three second ventilation cycle
5. Provide adequate ventilation
• Tracheal intubation
– Provides definitive airway management
– Should be provided by trained personnel as
soon as possible
– Indications:
• Cardiac arrest with ongoing chest
compressions
• Inability of a conscious patient in
respiratory compromise to breathe
adequately
• Inability of the patient to protect the airway
(coma, areflexia,
areflexia, cardiac arrest)
• Inability of the rescuer to ventilate the
unresponsive patient with conventional
methods
• Recommended features of bag masks
– Self refilling bag that is easily cleaned and
sterilized
– Connections for delivery of high concentration
of oxygen
– Capability to perform satisfactorily in all
conditions
– Availability in different sizes
– True non rebreathing valve
• Tracheal intubation:
intubation:
– Keeps the airway patent
– Ensures delivery of high concentratiojn of O2
– Ensures delivery of selected tidal volume
– Isolates and protects the airway from
aspiration
– Permits effective suctioning of trachea
– Provides route for administration of other
medications
6. Provide definitive airway control
• Overview
- Prepare for intubation with necessary
equipment
- Ask second rescuer to apply cricoid pressure
- Prepare tracheal intubation
- Inflate cuff
- Attach ventilation bag
- Confirm placement
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BASIC LIFE SUPPORT - CPR

• Cricoid Pressure Maneuver – Technique

– Why? • Find the prominent thyroid cartilage
• protects against regurgitation of gastric • Find the soft depression below the thyroid
contents cartilage
• Helps ensure tube placement • Find the hard prominence just below that
• Apply firm pressure while pinching the
thumb and index finger towards the
victim’
victim’s back and somewhat towards the
head
• Release pressure only when proper tube
placement is confirmed and the cuff is
inflated

7. Provide primary and secondary – Reattempt intubation after reoxygenating the

confirmation of tracheal tube victim
placement – If the chest wall rises and no stomach
gurgling listen to the lung fields with 5 point
Primary
auscultation and document in medical record
- As the bag is squeezed, listen over the
– Left and right anterior
epigastrium and observe the chest wall for
movement. – left and right midaxillary
- If you hear stomach gurgling and no chest – over the stomach
rise, you have intubated the esophagus
- Stop ventilation and remove tube

– If there is any doubt, use laryngscope to How to Ventilate With a Properly Placed
directly visualize (tube passing thru vocal cords) Tracheal Tube
– Secure the tube – tidal volume of 10-
10-15 mL/kg
mL/kg
– Insert OP airway – 1 breath every 5 seconds
– Look for moisture condensation inside the tube – 2 seconds for each bag ventilation
– Ventilate with 100% oxygen
Secondary – when O2 saturation measurements are
- Use of variety of electronic and mechanical available respond accordingly when there is a
devices fall in the O2 saturation

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• Unprotected airway • Obtain a chest x-

x-ray as soon as possible to
– sets of 15 compressions at 100 per minute confirm position of tube within trachea
– 2 ventilations at 2 seconds per ventilation
• Never use a chest xray to detect
inadvertent esophageal insertion.
• Protected airway
– Continuous compression at 100 per minute
– Asynchronous with 1 ventilation at 2 seconds
per ventilation every 5 seconds

Complications Insertion of Tracheal Tube Into 1 Lung

Insertion of Tube Into Esophagus • Hypoxemia due to underinflation of 1 lung
• Accidental insertion of tube into esophagus will
result in no oxygenation or ventilation
Tube Trauma and Adverse Effects Airway Control on Trauma Patients
• Lacerated lips or tongue • Assume that the patient with multiple trauma,
• Chipped teeth head injury or facial trauma has cervical spine
• Lacerated pharynx or trachea injury
• Injury to the vocal cords
• Pharyngeal-
Pharyngeal-esophageal perforation
• Vomiting and aspiration of the gastric contents into
the lower airway
• Release of high levels of epinephrine and
norepinephine

Steps to follow in known or suspected Additional Techniques for Invasive

cervical spine trauma Airway Control and Ventilation
– Perform chin lift or Jaw thrust without head tilt Cricotyrotomy
– Stabilize head in neutral position – Allows rapid entrance into the airway
– Orotracheal intubation in a patient with facial – Cricothyroid membrane is opened with a
fractures and fractures at the base of the skull,
scalpel and a tube is inserted
another should provide spinal immobilization
– Suction upper airway
– Consider cricothyrotomy or tracheostomy
– Use paralytic drugs in patients who cannot be in
patients who cannot be intubated with the
above techniques

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Tracheostomy ACLS Skill 2:

– Surgical opening of the trachea and insertion Recognize the rhythm
of tracheostomy tube
– Performed under controlled conditions in the
OR • Ventricular fibrillation
– Should be performed after the airway has • Pulseless ventricular tachycardia
been secured by a tracheal tube or
cricotyrotomy • Pulseless electrical activity
– Not appropriate for urgent situations (airway • asystole
obstruction or cardiac arrest)

1. Cardiac Arrest (lethal) Rhythms

A. Shockable rhythms
a) VF
b) pulseless VT 2. Non Cardiac Arrest (nonlethal
(nonlethal)) Rhythms
B. Nonshockable rhythms A. Rhythm too slow ( < 60 bpm)
bpm)
a) Asystole B. Rhythm too fast ( > 120 bpm)
bpm)
b) Pulseless electrical activity
- Includes rhythms that produce electrical activity on
the monitor but no palpable pulse
- Electromechanical dissociation, bradyasystolic
rhythms, pulselessidioventricular rhythms

ACLS Skill 3: 7. “Charging fibrillator – Stand Clear!”

Clear!”
Defibrillate 8. Press charge button on apex paddle or
defibrillator controls
1. Turn on defibrillator
9. When fully charged state firmly:
2. Select energy level at 200 J for a) “I’m going to shock on three. One, I’
I’m
monophasic defibrillators clear.”
clear.”
3. Set “lead select”
select” switch on “paddles”
paddles” b) “Two, you’
you’re clear.”
clear.”
4. Apple gel or conductor pads c) “Three, everybody’
everybody’s clear.”
clear.”
5. Position paddles 10.Apply 25lb of pressure on both paddles
6. Visually check the monitor display and 11.Press the 2 paddle “discharge”
discharge” button
assess rhythm simultaneously

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12.Check the monitor ACLS Skill

13. Shock at 200 to 300 J, then at 360 J 4:
Cardiovert

ACLS Skill 5:
Transcutaneous Pacing
– Delivers pacing impulses to the heart through
the skin via adhesive electrodes
– Use of transcutaneous pacing for asystole and
pulseless electrical activity has been
disappointing

ACLS Skill 6:
Gain IV Access to the • Peripheral venipuncture
Circulation – Arm vein (antecubital
(antecubital or hand)
• Administer drugs and fluids – External jugular vein
• Obtain venous blood for laboratory
determinations • Central venipuncture
• Insert catheters into the central circulation – Internal jugular vein
– Subclavian vein
– Common femoral vein

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• Peripheral line • Central line

– Procedure of choice
– Predictable location
– Peripheral sites are compressible
– Allows for the use of large bore catheters
– May collapse during low flow states
– Permits infusion of concentrated solutions
(greater flow)
– Damage to surrounding structures

• General Principles
– Speed is essential
– Strict aseptic technique may be impossible
– After patient is stabilized cannula should be
removed and replaced
– During cardiac arrest follow all administered
drugs by bolus administration of at least 20ml
of IV saline
ACLS Skill 7:
Provide Appropriate
Resuscitation Medications
• Medications are used to meet the following
major objectives
– Correct hypoxemia
– Restore spontaneous circulation at an adequate blood
pressure
– Promote optimal cardiac function
– Prevent or suppress significant arrythmias
– Relieve pain
– Correct electrolyte abnormalities, adjust acidosis,
counteract effects of excessive amounts of prescribed
medications or illegitimate agents
– Treat congestive heart failure

Summary
1. Airway management
2. Rhythm recognition
3. Defibrillation
4. Cardioversion
5. Transcutaneous pacing
6. Direct circulation access though intravenous
catheters
7. Administration of appropriate resuscitation
medications

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