BASIC LIFE SUPPORT (BLS)

Fremantle Hospital Staff Development

ANY ATTEMPT IS BETTER THAN NO ATTEMPT

Objectives
Chain of Survival Discuss legal and infection concerns Introduce cardiac anatomy and emergencies Introduce DRSABCD Describe Cardiopulmonary Resuscitation Describe differences between adult, child and infant resuscitation Describe the actions for someone choking Describe actions following a resuscitation

Chain of Survival
The chain of survival symbolises the best approach to the treatment of sudden cardiac arrest.

Early Recognition

Early CPR

Early Defibrillation

Post Resus Care

Good Samaritan Rule

A Good Samaritan is defined in legislation as a person acting without expecting financial or other reward for providing assistance. Volunteers acting as Good Samaritans are under no obligation to assist a fellow being. The Australian Resuscitation Council encourages the provision of assistance to any person in need.

Good Samaritan Rule

Having decided to assist, a standard of care appropriate to the volunteers level of training is expected. Do not need to fear litigation if coming to the aid of a fellow human in need. No Good Samaritan or volunteer has ever been successfully sued in Australia for consequences of rendering assistance to a person in need.

Infection Control
How infection can be passed on:
Contact blood or body fluids contact membranes of the mouth and eyes infected objects pierce the skin Breathing air borne infection risk is no greater than in normal social interaction Bites rare, usually only occur with fitting casualties

To Prevent Infection
Wash hands thoroughly before, if possible, and after Avoid direct contact with wounds and body fluids Have a pocket mask or disposable mask and gloves available Avoid direct contact with contaminated objects Avoid touching personal belongings Wash and disinfect all equipment used or dispose of correctly

Anatomy & Physiology

All cells need oxygen to function How do they get this? Breathe in air to our lungs Heart pumps blood through the lungs and around the body If lungs stop or heart stops = NO OXYGEN to organscells die

Possible Causes of Collapse

Heart attack (MI) Heart disease Airway diseases Poisoning Toxic fumes Smoke inhalation Drug overdoses Electrocution Chest injuries Crush injuries Head injury Blood loss Low/high blood sugar Feint

How do we help with CPR?

Open AIRWAY COMPRESSIONS to pump heart and circulate blood with oxygen Give BREATHS to add oxygen

Cardio Pulmonary Resuscitation

CPR is the technique of inflation of the lungs and compression of the heart It combines External Cardiac Compressions (ECC) and ventilation which may be delivered as Expired Air Resuscitation (EAR), commonly called Mouth to Mouth It may be referred to as Basic Life Support (BLS)

DRSABCD
Dangers? Responsive? Send for help Open Airway Normal Breathing? Start CPR Attach Defibrillator

Dangers?
To yourself and others may include: Electricity Poisonous gases Drowning/surf Envenomation Glass/road surfaces Vehicles

Responsive?
Determine if the casualty is

conscious or unconscious

Squeeze & shout Ask casualty for their name Give a simple command: squeeze my hand

Send for Help

RESPONSIVE CASUALTY Place in a comfortable position & reassess Send for HELP if appropriate UNRESPONSIVE CASUALTY Continue to assess Send for HELP!

Send for help

STAY CALM In the hospital dial 55 and state Code Blue and the patients location In the community dial 000 and answer questions asked by operator On a mobile - 112 or 000

Open Airway
Look into airway first Identify causes of an airway obstruction Clear the airway - suction or turn on side if the blockage is caused by secretion/vomit

Airway Opening
Open airway
head tilt & chin lift jaw thrust

Lateral Position
The lateral position can facilitate drainage but is only indicated if absolutely necessary to clear fluid from the airway

Normal Breathing?
Is the victim breathing normally? If you have any doubt whether breathing is normal, act as if it is not normal. Do not be mislead by abnormal breathing/gasping If NOT, commence Compressions immediately

Normal Breathing?

Yes
Place in lateral position Ensure help is coming Provide reassurance Monitor breathing

External Cardiac Compressions

Position Rate Depth Ergonomics All influence effectiveness of compressions

Position
Locate the middle of the chest Place heel of hand on the lower half of the sternum Cover first hand with other hand by interlocking fingers or support wrist if required

Rates - Compressions
Adults 100 compressions in a minute Children & Infants 100 compressions in a minute

Depth
Always one third of the depth of the chest
At least 5 cm in adults Requires 50 kg pressure on the average adult

Ergonomics
Patient should be on a firm flat surface

Position yourself between chest and head to decrease the amount of energy expended

Compression to Ventilation Ratio:

30:2

Administering Breaths
Pocket Mask Disposable face shield, e.g. key rings Bag and Mask If unable or unwilling to administer breathsdeliver continuous Chest Compressions

Complications -Rescue breaths

Abdominal distension Vomiting & aspiration No ventilation due to: Poor head position Obstruction Inadequate seal

Defibrillation
Attach defibrillator as soon as available Allows analysis of need to defibrillate Chances of successful defibrillation decrease rapidly with time Good CPR may increase likelihood of defib success

When To Stop CPR

Return of responsiveness or breathing Help arrives You are exhausted and physically unable to continue It has become unsafe to continue A doctor pronounces the patient dead

Special Circumstances
Children Choking Third Trimester of Pregnancy

CPR - Infants and Children

AGE AIRWAY POSITION Neutral neck Chin support BREATHING COMPRESSION TYPE INFANT < 12 months Small puff of cheeks Cover mouth & nose Two fingers Lower half sternum 1/3 the depth of the chest

CHILD 1- 8 years

Modified head tilt sniffing Chin support

Half a breath

Heal of one hand Lower half of sternum 1/3 the depth of the chest

Choking
Acute obstruction can be caused by an impacted foreign body!

If the person is responsive - encourage to cough.

Choking
If the victim has an ineffective/cannot cough: Open airway Deliver 5 back blows between shoulder blades with heel of hand If this fails deliver 5 chest thrusts - similar to chest compressions but sharper and more interspersed Continue alternating 5 back blows and 5 chest thrusts as necessary

Back Blows In An Infant

Choking if becomes unresponsive

If removal of foreign object is unsuccessful and the victim becomes unresponsive

BEGIN CPR

Third Trimester of Pregnancy

For the collapsed pregnant woman insert a wedge under the right buttock to enable slight pelvic tilt

This assists in shifting the uterus off the major abdominal veins to allow venous return

Recovery
Turn to stable lateral position Reassess DRSABCD Maintain airway Monitor breathing and responsiveness Ensure help is coming Protect from environment Treat injuries

Questions?

Summary
Discussed legal and infection concerns Reviewed anatomy and cardiac emergencies Reviewed DRSABCD Described differences between adult, child and infant resuscitation Described the actions for someone choking Described actions following a resuscitation

ANY ATTEMPT IS BETTER THAN NO ATTEMPT