Basic and Advanced Life Support

Dr. Nevine Abdel Fattah Lecturer in Chest Diseases Ain Shams University.

Adult Basic Life Support This lecture contains the guidelines for outof-hospital, single rescuer, adult basic life support (BLS). The guidelines are based on the document 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment recommendations.

Adult Basic Life Support

At the end of the lesson you should be able to state and describe the Adult BLS Algorithm, focusing on Cardiac Arrest in a non drowning, non traumatic, non toxic adult collapse. Basic life support (BLS) is a specific level of pre-hospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. BLS may also include considerations of patient transport such as the protection of the cervical spine and avoiding additional injuries through splinting and immobilization.

Adult Basic Life Support

Nervous system

Adult Basic Life Support

BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced cardiac life support (ACLS). CPR provided in the field buys time for higher medical responders to arrive and provide ACLS. For this reason it is essential that any person starting CPR also obtains ACLS support by calling for help via radio using agency policies and procedures and/or using an appropriate emergency telephone number. An important advance in providing BLS is the availability of the automated external defibrillator or AED, which can be used to deliver defibrillation. This improves survival outcomes in cardiac arrest cases, sometimes dramatically.

Adult Basic Life Support

PERSON COLLAPSES
Check if he is unresponsive. Call Emergency number. Get AED (automatic Electric Defibrillator) Begin the ABCDs

Adult Basic Life Support

Adult Basic Life Support

Basic life support consists of the following sequence of actions:
Make sure the victim, any bystanders, and you are safe. Check the victim for a response. Gently shake his shoulders and ask loudly, Are you all right? If 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. If he does not respond: Shout for help. Turn the victim supine aligned position or stable side position.

Adult Basic Life Support START THE ABCDs

Airway: Open Airway.
Check Breathing
Breathing Non Breathing Check Circulation Circulation:. Monitor and check Circulation the pulse. Arrest

Breathing:

(Look, Listen &Feel)

Adult Basic Life Support

Defibrillator: An important advance in providing BLS is the availability of AED, which can be used to deliver defibrillation. improving survival outcomes in cardiac arrest cases.

Adult Basic Life Support

Airway Control:
- Chin Lift Maneuver. - Jaw thrust maneuver. - Manual clearing of mouth & throat. - Pharyngeal suctioning. - Pharyngeal intubation.

Adult Basic Life Support

Adult Basic Life Support

Open airways

Adult Basic Life Support

Airway Control:
- Esophageal obturator airway insertion. - Endotracheal intubation &Tracheobronchial suctioning. - Cricothyrotomy - transtracheal O2 jet insufflation. - Tracheotomy, bronchoscopy bronchodilatation, pleural drainage.

Adult Basic Life Support

Breathing:
Keeping the airway open, look, listen, and feel for normal breathing. Look for chest movement. Listen at the victim's mouth for breath sounds. Feel for air on your cheek. In the first few minutes after cardiac arrest, a victim may be barely breathing, taking infrequent, noisy, gasps. Do not confuse this with normal breathing. Look, listen, and feel for no more than 10 sec to determine if the victim is breathing normally. If you have any doubt whether breathing is normal, act as if it is not normal.

Adult Basic Life Support

If he is breathing normally:
Turn him into the recovery position. Send or go for help, or call for an ambulance. Check for continued breathing.

If he is not breathing normally: Ask someone to call for an ambulance or, if you are on your own, do this yourself; you may need to leave the victim. Start chest compression as follows:
Kneel by the side of the victim. Place the heel of one hand in the centre of the victims chest.

Adult Basic Life Support

Place the heel of your other hand on top of the first hand. Interlock the fingers of your hands and ensure that pressure is

not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
Position yourself vertically above the victim's chest and, with

your arms straight, press down on the sternum 4 - 5 cm.

After each compression, release all the pressure on the chest

without losing contact between your hands and the sternum.

Repeat at a rate of about 100 times a minute (a little less than

2 compressions a second).
Compression and release should take an equal amount of time.

Adult Basic Life Support

RECOVERY POSITION

Adult Basic Life Support

Adult Basic Life Support

Breathing support:
- Mouth-to-mouth (nose) ventilation. - Mouth-to-adjunct with or without O2. - Manual bag-mask (tube) ventilation with or without O2. - Hand-triggered O2 ventilation - Mechanical ventilation

Adult Basic Life Support

Combine chest compression with rescue breaths:

After 30 compressions open the airway again using head tilt and chin lift. Pinch the soft part of the victims nose closed, using the index finger and thumb of your hand on his forehead. Allow his 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 his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath. Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.

Adult Basic Life Support

Take another normal breath and blow into the victims mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. Continue with chest compressions and rescue breaths in a ratio of 30:2. Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.

Adult Basic Life Support

If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt:
Check the victim's mouth and remove any visible obstruction. Recheck that there is adequate head tilt and chin lift. Do not attempt more than two breaths each time before returning to chest compressions.

If there is more than one rescuer present, another should take over CPR about every 2 min to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers.

Adult Basic Life Support

Adult Basic Life Support

Circulation support:
- Control of external hemorrhage. - Position of shock. - Pulse checking. - Mechanical chest compressions. - Open chest direct cardiac Compressions.

Adult Basic Life Support

Chest-compression-only CPR: If you are not able, or are unwilling, to give rescue breaths, give chest compressions only. If chest compressions only are given, these should be continuous at a rate of 100 a minute. Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.

Adult Basic Life Support

Adult Basic Life Support

Continue resuscitation until:

Qualified help arrives and takes over, The victim starts breathing normally, or You become exhausted.

Adult Basic Life Support Algorithm

Check Responsiveness Shake and Shout

Open Airway Head tilt/chin lift

Check Breathing Look, listen and feel

2 Effective Breaths

Signs of circulation Assess 10 seconds only

Circulation Present Continue Rescue Breathing

No Circulation Compress Chest Rate of 100 per second 30 compressions to 2 breaths (30:2)

Adult Advanced Cardiac Life Support

Advanced Cardiac Life support (ACLS) is a detailed medical protocol for the provision of lifesaving cardiac care in settings ranging from the pre-hospital environment to the hospital setting.
Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Only qualified health care providers (doctors, nurses, emergency medical responders) can provide ACLS.

Adult Advanced Cardiac Life Support

ACLS is an extension of BLS, especially now that the use of automated external defibrillators (AEDs) in outof-hospital setting has become part of BLS. The aim of this section is to review the Adult Advanced Life support Algorithm.

Adult Advanced Life Support Algorithm

Adult Advanced Life Support Algorithm

Cardiac Arrest
Pericordial Thump if appropriate

Monitored or Witnessed Arrest!

Within 30 seconds from time of arrest. Used once only.

Adult Advanced Life Support Algorithm

Cardiac Arrest
Pericordial Thump if appropriate

BLS Algorithm if appropriate

Adult Advanced Life Support Algorithm

Cardiac Arrest
Pericordial Thump if appropriate

Lead positions;

BLS Algorithm if appropriate

Attach AED Monitor

Chest free of Lead wiring.

Ride Your Bike

Adult Advanced Life Support Algorithm

Cardiac Arrest
Pericordial Thump if appropriate
BLS Algorithm if appropriate

Attach AED Monitor

Assess Rhythm

+/- Check Pulse

VF/VT

Non VF/VT

Adult Advanced Life Support Algorithm

Adult Advanced Life Support Algorithm

Non VF/VT
Any rhythm other than VF/VT

Adult Advanced Life Support Algorithm

Cardiac Arrest
Pericordial Thump if appropriate

BLS Algorithm if appropriate

Attach AED Monitor

Assess Rhythm

+/- Check Pulse

VF/VT
Defibrillate x 3 As necessary

Non VF/VT

CPR immediately 1 min after AED

CPR 1 min

Adult Advanced Life Support Algorithm

Cardiac Arrest Assess Rhythm

VF/VT

Defibrillate x 3 As necessary

CPR 1 min

Adult Advanced Life Support Algorithm

Assess Rhythm +/- Check Pulse
Cardiac Arrest

Non VF/VT

CPR 3min 1 min immediately after AED

Adult Advanced Life Support Algorithm

CardiacRhythm Arrest Assess

+/- Check Pulse

VF/VT

During CPR
Correct reversible causes
If not done already:

Non VF/VT

Defibrillate x 3 As necessary

Check des, paddle position and contact. Attempt / Verify: Airway and O2 IV Access : Give Epinephrine every 3min. Consider : Amiodarone, Atropine/ Pacing & Buffers.

CPR immediately 1 min after AED

CPR 1 min

Adult Advanced Life Support Algorithm

During CPR
Correct reversible causes If not done already: Check des, paddle position and contact.

Attempt / Verify: Airway and O2

IV Access : Give Epinephrine every 3min.

Consider : Amiodarone, Atropine/ Pacing & Buffers.

Adult Advanced Life Support Algorithm

The Hs & Ts
Potential Reversible Causes Hypoxia Hpovolaemia Hypo/Hyperkalaemia and Metabolic disorders Hypothermia Tension Pneumothorax Tamponade Toxic /Therapeutic Disorders Thromboembolic and Mechanical obstruction.

Adult Advanced Life Support Algorithm

Questions?

THANK YOU