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European Resuscitation Council

Basic Cardiac Life


Support

Sany R Siswardana, MD
OBJECTIVES

– How to assess the collapsed victim.


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– How to perform chest compression and rescue


breathing.
– How to operate an automated external defibrillator
safely.
– How to place an unconscious breathing victim in the
recovery position.
BACKGROUND

• Approximately 700,000 cardiac arrests per year


in Europe
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• Survival to hospital discharge presently


approximately 5-10%

• Bystander CPR vital intervention before arrival of


emergency services

• Early resuscitation and prompt defibrillation


(within 1-2 minutes) can result in >60% survival
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CHAIN OF SURVIVAL
Lessons learned…
• CPR must be started ASAP to be effective
• Best results with lay rescuer CPR require
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– Trained and motivated bystanders


– Short response times
– Readily available (AED) equipment
• Studies have shown that during asphyxial arrest chest
compressions alone are better than doing nothing
• Lay bystanders may be reluctant to perform CPR
– Feel it is too complicated
– Feel training is inadequate
– Fear the transmission of disease during mouth-to-mouth
resuscitation
Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
APPROACH SAFELY!

Approach safely
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Scene Check response


Shout for help
Rescuer
Open airway
Victim Check breathing
Call 112
Bystanders 30 chest compressions
2 rescue breaths
CHECK RESPONSE

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHECK RESPONSE
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Shake shoulders gently


Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
SHOUT FOR HELP

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHECK BREATHING

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHECK BREATHING
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• Look, listen and feel


for NORMAL
breathing

• Do not confuse
agonal breathing with
NORMAL breathing
AGONAL BREATHING

• Occurs shortly after the heart stops


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in up to 40% of cardiac arrests

• Described as barely, heavy, noisy or


gasping breathing

• Recognise as a sign of cardiac arrest


Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
30 CHEST COMPRESSIONS

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
CHEST COMPRESSIONS

• Place the heel of one hand in


the centre of the chest
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• Place other hand on top


• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
RESCUE BREATHS

Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
RESCUE BREATHS
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• Pinch the nose


• Take a normal breath
• Place lips over mouth
• Blow until the chest
rises
• Take about 1 second
• Allow chest to fall
• Repeat
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30
CONTINUE CPR

2
Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
ELECTRICAL THERAPIES

DEFIBRILLATION
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Passage across the myocardium of an electrical


current of sufficient magnitude to depolarise a
critical mass of myocardium and restoration of
coordinated electrical activity

USE OF DEFIBRILLATORS:
- Adults
- Children older than 8 years
- NO defibrillation in children less than 1 year
DEFIBRILLATION “WHAT
SHOULD KNOW?”
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Sinus Rhythm
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• Electrical Impulse
begins originates in
the atria
• P wave before every
QRS
• PR Interval .12 & .20
• QRS .8 & <.10
Sinus with PVC’s
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• Underlying rhythm
originates in the
atria
• Aberrant beat
originating in the
ventricles
• QRS of the aberrant
beat is >.10
VT
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• Electrical Impulse
originates in the
ventricles
• No P waves
• QRS > .10
VF
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• Multiple stimulation
originating in the
ventricles
• Chaotic firing occurs
with no discernable
QRS noted
Asystole
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• Lacks any form of


electrical conduction
• No discernable P
waves or QRS
• Commonly referred
to as flat line
Pulseless Electrical Activity
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• Cardiac rhythm is
organized with
discernable P waves
and QRS
• Is not pulse
producing
Approach safely
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Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice prompts
“ABCD” – Simplified

• Airway • Universal ratio – 30:2


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• Breathing – 30 compressions
• Circulation – 2 ventilations

• Defibrillation • No pulse check for lay


rescuers
• Key Message:
– Push hard, push fast,
full chest recoil,
minimize interruptions
in chest compressions
Adult BLS
1. Call for help and an AED
2. Open the victim's airway,
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check for breathing, give two


breaths
3. Start CPR - 30 compressions
to 2 ventilations (100
compressions/minute)
4. On arrival of a defibrillator or
AED, check for a shockable
rhythm
5. Give one shock if indicated
then resume CPR for another
5 cycles
6. If no shock is indicated
continue another 5 cycles of
CPR
Note!

• Minimize pulse
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checks
• Minimize interruptions
to compressions
Defibrillation
• No “stacked” shocks
• Single energy dose
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• 200 Joules biphasic


defibrillator or 360 Joules
monophasic
• Witnessed collapse
– Immediate defibrillation
best
• Unwitnessed collapse
– May give CPR for 2
minutes first
– CPR may help with blood
flow to fibrillating heart
Defibrillation

• Apply AED or
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Defibrillator
• Hunt for VF/VT
• Single shock
• Resume CPR
SWITCH ON AED
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• Some AEDs will


automatically switch
themselves on when
the lid is opened
ATTACH PADS TO
CASUALTY’S BARE CHEST
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ANALYSING RHYTHM
DO NOT TOUCH VICTIM
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SHOCK INDICATED
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• Stand clear
• Deliver shock
SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
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30 2
NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS
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30 2
IF VICTIM STARTS TO
BREATHE NORMALLY PLACE
IN RECOVERY POSITION
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CPR IN CHILDREN
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• Adult CPR
techniques can be
used on children

• Compressions 1/3 of
the depth of the chest
AED IN CHILDREN

• Age > 8 years


• use adult AED
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• Age 1-8 years


• use paediatric pads /
settings if available
(otherwise use adult
mode)

• Age < 1 year


• use only if
manufacturer
instructions indicate it
is safe
1. All breaths should be given over 1 second –
watch for chest rise
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2. Neonatal resuscitation
• 100% oxygen or lower concentration
• Supplemental O2 should available if no
improvement in 90 seconds
Approach safely Approach safely
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Check response Check response


Shout for help Shout for help
Open airway Open airway
Check breathing Check breathing
Call 112 Call 112
30 chest compressions Attach AED
2 rescue breaths Follow voice prompts
Secondary
ABCD
• IV or IO ASAP
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• Medications
– Epinephrine
– Vasopressin
• Anti-dysrhythmics
– Amiodarone
– Lidocaine
• GOOD CPR!
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IN-HOSPITAL RESUSCITATION
DRUGS AND FLUIDS

- DRUGS
Vasopressors
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Adrenaline, Vasiopressin

Anti-arrhythmics
Amiodarone, Lidocaine

Other drugs
Atropine, Nabic

- INTRAVENOUS FLUIDS
Hartmann’s solution, Ringer’s solution

Intravenous fluid to flush peripherally injected drugs into the central


circulation
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ANY QUESTIONS?