Basic Life Support

OSPITAL NG MAKATI

Department of Emergency Medicine

Introduction
Elements of Basic Life Support (BLS)
initial assessment Chest compression airway maintenance expired air ventilation

How does CPR work?

All living cells of our body need a steady
supply of oxygen to keep us alive. Breathe air into the victims lungs to provide oxygen into the blood. Press on the chest to move oxygencarrying blood through the body.

Failure of the circulation for 3-4 min will lead to irreversible cerebral damage

No CPR

Key guidelines for 2010 Adult Basic Life Support

Immediate recognition of sudden cardiac
arrest (SCA) on assessing responsiveness and absence of normal breathing Look, Listen and Feel was removed Encourage Hands only CPR for untrained lay rescuer Sequence change to C-A-B

Key guidelines to Adult BLS 2010

Increase focus in methods to ensure high
quality CPR is performed Simplified adult BLS algorithm is introduced Continued de-emphasis on pulse check Team approach is encouraged

Chain of survival

Chain of Survival Concept

IMPROVE THE OUTCOME FOR THE VICTIMS OF CARDIOPULMONARY ARREST

Early Access
The bystander could be any of us.
A well informed and properly educated lay person is the key in the early The Bystander access link. The Bystander must be able to recognize the emergency. As soon as an emergency is recognized, the bystander must make a telephone call to activate the EMS system. CALL 117

Early Access
By calling first, you join a team of Emergency Service dispatchers and responders.

The Bystander

Each member has a vital role.

The Dispatcher The EMS Responders

Early warning signs of heart attack

WHAT? WHERE? Uncomfortable pressure, fullness, squeezing or pain In the center of the chest, behind the breastbone. It may spread to, or occasionally originate in, either, shoulder, the neck, the lower jaw, or either arm Lasts longer than few minutes

HOW LONG?

Other signs of heart attack

chest discomfort or lightheadedness fainting sweating nausea shortness of breath

Early warning signs of respiratory failure

Inability to speak, breathe or cough clutches neck (universal distress
signal) bluish color of skin and lips

Early Access
Adult CP arrest CARDIAC

DEFIBRILLATOR

PHONE FIRST

Early Access
Infant/Child CP arrest RESPIRATORY

RESCUE BREATHING

PHONE FAST

Early Access
EXCEPTIONS to the PHONE FIRST/PHONE FAST Submersion/Near-drowning (phone fast)

Arrest associated with trauma (phone fast)

Drug overdoses (phone fast) Cardiac arrest in children known to be at high risk for arrhythmias (phone first)

Early CPR
Cardiopulmonary resuscitation keeps oxygenated blood flowing to the brain until additional help can arrive. Giving CPR promptly will help more

One-Rescuer CPR: Adult

Ensure safety of rescuer and victim.

You find a person lying on the ground, not moving. You should survey the scene to see if it is safe. Get some idea of what happened.

Then begin doing a primary survey.

Check for responsiveness.

Tap or gently shake the victim Rescuer shouts ARE YOU OK? and ARE YOU ALRIGHT? Scan the chest for any movement

Call for help.

If the victim is unconscious, rescuer shouts HELP He should activate EMS system if available in the locality by calling 117

No Pulse Check for Lay Rescuers

Check for SIGNS of circulation: normal breathing coughing movement in response to rescue breaths

Chest Compression:anatomical landmarks

Subcostal margin (rib cage) Xiphoid process (notch at the lower end of breastbone) Sternum (Breastbone)

Start chest compression.

Compress breastbone at least 2 inches, at least a rate of 100 compressions per minute.
Quality chest compression push hard push fast

Chest Compression
Place heel of other hand on breast bone between the imaginary nipple area

Place other hand above and interlock with the hand on top of the bony part of the sternum.

Chest Compression

Upstroke Downstroke At least 2 inches

Fulcrum (hip joints)

Position shoulders over hands with elbows lock and arms straight. Arms should be perpendicular to the victims body.

High quality CPR

Adequate rate of at least 100
compressions / minute Adequate depth:
Adult : at least 2 inches or 5 cm depth Child : about 2 inches or 5 cm depth Infant : 1 inches or 4 cm depth

High quality CPR

Allow chest recoil after each compression Minimize interruption of CPR Avoid excessive ventilation

Open airway
Head-tilt/chin-lift method
Place one hand on victims forehead Place fingers of other hand under bony part of lower jaw near chin Tilt head and lift jaw

Head tilt/chin-lift method

Tongue Epiglottis Tongue may fall back

Patient is not breathing:

Give rescue breaths.

Maintain an open airway. Pinch nostrils closed. Make a tight seal around victims mouth. Give 2 normal breaths. Observe chest rise and fall. Allow for exhalation between breaths.

Compression/Breathing Cycles
Continue cycles of 30 compressions followed by 2 normal breaths.
After 5 cycles of (30:2), check pulse. If still with no pulse, resume CPR, starting with chest compression Re-check pulse every two minutes

Hands only (compression only) CPR

Lay persons or rescuers who have not
trained in BLS All age group Employs high quality CPR Better than to NO CPR at all

Pulse returns but no breathing:

Give rescue breaths.

Give 1 rescue breath every 5 seconds.
12 rescue breaths per minute. Monitor the pulse. If there is breathing, place in recovery position.

10
A

Recovery position
Keep the airway open

10

Recovery position

Place hand under the thigh.

10

Recovery position

Position the arm and raise the leg.

10

Recovery position

Pull the thigh towards you.

10

Recovery position

Place the leg at right angle.

10

Recovery position

Keep the airway open. Monitor the casualty.

Pediatric chain of survival

One-Rescuer CPR: Child (1 to 8 years)

One-Rescuer CPR: Child (1 to 8 years)

CPR performed on young children is similar for adults and older children except for 4 differences

1
If the rescuer has no help, give about 2 minutes of CPR before activating the EMS system.

One-Rescuer CPR: Child (1 to 8 years)

CPR performed on young children is similar for adults and older children except for 3 differences

Use the heel of one hand or 2 hands in chest compressions at the lower of sternum

One-Rescuer CPR: Child (1 to 8 years)

CPR performed on young children is similar for adults and older children except for 3 differences

Depress the sternum one third AP diameter or about 2 inches or 5 cm depth

One-Rescuer CPR: Child (1 to 8 years)

Aside from the carotid pulse, you can also check the pulse using the femoral artery

One Rescuer CPR: Infant (<1year)

Check for responsiveness.

Tap or gently shake the shoulder. Flick soles of feet

Check for Pulse

Maintain an open airway.
Feel for the brachial pulse on the inside of the upper arm with 2 fingers of one hand for 10s.

Start chest compression.

Compress breastbone 11/2 inch or 4 cm depth at a rate of at least 100 compressions per minute.

Chest Compression
Imagine a line between the nipples and place your index finger below that line. Follow the line up to the sternum (breastbone). Use the middle and the ring fingers to compress the sternum.

Two rescuer chest compression

Open airway
Head-tilt/chin-lift method
Place one hand on victims forehead. Place fingers of other hand under bony part of lower jaw near chin Tilt head and lift jaw.

Patient is not breathing:

Give rescue breaths.

Maintain an open airway.
Give 2 gentle rescue breaths.

Observe chest rise and fall; listen and feel for escaping air.
Allow for exhalation between breaths.

Rescue breathing
Open your mouth wide.
Take a deep breath Make a tight seal around the infants mouth and nose. Each breath should be provided for 1 sec.

Compression/Breathing Cycles
Continue cycles of 30 compressions followed by 2 rescue breath.

Do 5 cycles of compressions and rescue breaths.

Check for pulse.

Activate EMS
After 5 cycles of compressions and rescue breaths.

Activate EMS. Call 117

Check the brachial pulse.

If still with no pulse, continue 30:2 cycles beginning with chest compression.

Pulse returns but no breathing:

Give rescue breaths.

Give 12 -20 breaths / minute
Monitor the pulse every 2 minutes. If there is breathing, place in recovery position.

Defibrillation

Defibrillation
Therapeutic use of large amount of
electric current over a brief period of time. Depolarizes (stuns) an irregularly beating heart allowing a more coordinated contractile activity to resume Defibrillator is the device that administers controlled electric shock Most important treatment for sudden cardiac arrest patients with Ventricular

Defibrillation

Defibrillation

Defibrillation
Upon recognition
of the situation, ASSESS the condition of the victim

Call for Help or Activate Medical assistance

Defibrillation
Exposed Chest
Check Pulse Check Consciousness

Defibrillation
Perform CPR

Defibrillation
Attached Pads

AED Power On

Defibrillation
Analyze & stay clear for delivery of shock (if indicated)

Defibrillation
Time is the key
determinant for the survival of patients with VFibrillation.

Defibrillation in children and infants

Sudden witnessed collapse Manual type defibrillator or AED with

pediatric attenuator 2-4 joules /kg Shock delivery should occur as soon as possible after compression

Respiratory Arrest and Rescue Breathing

Respiratory Arrest
Condition wherein there is cessation or
inadequate breathing to support life Causes:
Obstruction (mechanical or anatomical) Diseases (COPD, bronchitis, pneumonia) Others: electrocution, drowning, suffocation, external strangulation, etc.

Rescue Breathing
Technique to provide oxygen to a
breathless person Ways:
1. 2. 3. 4. 5. 6. Mouth to mouth Mouth to nose Mouth to mouth and nose Mouth to stoma Mouth to mask Bag-valve mask apparatus

Mouth to mouth

Mouth to nose

Mouth to Stoma

Mouth to Mask

Bag-valve mask apparatus

Legal and Ethical issues

Good samaritan. When to stop CPR:
victim recovers another trained person takes over you are too exhausted to continue a valid DNR order is presented to the rescuer

EM ER G EN CY

Foreign Body Airway Obstruction

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Foreign Body Airway Obstruction

Causes:

Choking usually occurs during eating Meat is the most common cause of obstruction in adults A variety of foods and foreign bodies have been the cause of obstruction in children

Adult Foreign-Body Airway Obstruction-Conscious

Determine if victim is choking.

Determine if victim is able to speak or cough. Victim may be using the universal distress signal of choking (clutching the neck between thumb and index finger). Rescuer can ask Are you choking?

Position the patient.

Stand behind victim Wrap your arms around the victims body. Grab the victims hand and put them down

Perform abdominal thrust.

Press fist into abdomen with quick inward and upward thrusts.

Victim becomes unconscious:

Position

the patient.

Open the airway.

Tap or gently shake the victim Rescuer shouts ARE YOU OK?

Check for foreign body.

Sweep deeply into mouth with hooked finger to remove foreign body

Give rescue breaths.

Attempt rescue breathing.

Try to give 2 breaths.

If needed, reposition the head. Try again.

Anatomical landmarks
Xiphoid process
Umbilicus

Perform abdominal thrusts.

Kneel astride the victims thighs. Place the heel of one hand on the victims abdomen. Place the second hand on top of the first.

Heimlich maneuver
Press into the abdomen with quick upward thrusts.

Repeat sequence until successful.

Alternate these maneuvers in rapid sequence:
Finger sweep

Rescue breathing
Abdominal thrusts

Obstructed Airway: Child (1 to 8 years)

Obstructed Airway: Child (1 to 8 years)

Perform first aid for choking in children 1 to 8 years old just as you would for adults and older children.

BUT do not perform blind finger sweeps.

Instead, look down into the airway, and use your finger to sweep the foreign body out only if you can actually see it.

Obstructed Airway: Conscious infant (<1 year)

Determine airway obstruction.

Observe breathing difficulties, ineffective cough, weak (or absent) cry, dusky color.

Perform tongue-jaw lift.

Do not perform a blind finger sweep Remove foreign body only if you can see it.

Position the infant.

Support the head and neck with one hand. Place infant face down over one arm Head lower than trunk Support with your forearm and thigh

Deliver back blows.

Deliver up to 5 back blows forcefully between the shoulder blades with the heel of one hand.

Position the infant.

Support the head Sandwich the infant between your hands/arms Turn on his back Head lower than trunk

Deliver chest thrusts.

Deliver up to 5 thrusts in the midsternal region, using the same landmarks as those for chest compressions.

Infant becomes unconscious:

Call

for help.
If the infant becomes unconscious, rescuer shouts HELP

If a second rescuer is available, have him activate the EMS system.

Position infant on back

Start chest compression.

Compress breastbone 11/2 inch or 4 cm depth at a rate of at least 100 compressions per minute.

Patient is not breathing:

Give rescue breaths.

Maintain an open airway.
Give 2 gentle rescue breaths.

Observe chest rise

Allow for exhalation between breaths.

Repeat sequence until successful.

Any CPR is Better than No CPR

Definition
First Aid is a system of assessments and interventions that can be performed by a bystander (or by the victim) with minimal or no medical equipment. A first aid provider is defined as someone with formal training in first aid, emergency care, or medicine who provides first aid. One of the primary equipment in First Aid is the triangular bandage.

Cardinal Principle

Primum Non Nocere First, Do No Harm

Body Substance Isolation

If the fluid is not yours, avoid unprotected contact.

Personal Protective Equipment

EM ER G EN CY

Splinting

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Bandages

Broad-Fold Bandage

Open Triangular Bandage Narrow-Fold Bandage

Square Knot

First Aid for Broken Bones

SYMPTOMS:
Pain and tenderness Inability to use the injured extremity (arms, legs) Deformity, swelling

Bruising
Numbness Pale, bluish skin

Reasons for splinting

Minimize or prevent further neural, vascular and other soft tissue injury prevent a closed fracture from becoming an open fracture minimize pain and discomfort facilitate transport of patient prevent paralysis in the case of spine patients

General Rules of Splinting

Remove or cut away all clothing surrounding the injury Remove all jewelry assess pulse, motor function and sensation distal to the injury Cover all wounds with sterile dressing prior to splinting

General Rules of Splinting

Never intentionally replace protruding bone back into the skin Pad the splint apply splint before moving the patient immobilize the joint above and below the fracture when in doubt, splint the injury

Hazards of Improper Splinting

Compression of neurovascular structures Delay of transport Reduce circulation Aggravate the bone and joint injury

Splinting-Upper extremities

Arm sling and swathe

Splinting-Upper extremities

Upper arm (humerus)

Splinting-Upper extremities

Forearm (radium/ulna)

Splinting-Upper extremities

Fingers and hands (position of function)

Splinting-Elbow and Knee

Knee in bent position

Knee in straight position

Splinting-Elbow and Knee

Elbow in bent position

Elbow in straight position

Splinting-Lower Extremities
Ankle/foot

Splinting-Lower Extremities
Lower leg (tibia/fibula)

Splinting-Lower Extremities
Thigh (femur)

Splinting-Lower Extremities
Self-splint (leg)

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Bleeding

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External Bleeding
ARTERIAL blood spurts from the wound most serious type of bleeding less likely to clot blood flows steadily or gushes easier to control
blood oozes most common type of bleeding can be controlled easily

VENOUS

CAPILLARY

External Bleeding
Regardless of the type of bleeding, the first aid is the same
FIRST, AND MOST IMPORTANT, YOU MUST COINTROL THE BLEEDING

WHEN CONTROLLING BLEEDING

Do Not

Do NOT Touch a wound with your bare hands Do NOT Use direct pressure on an eye injury, a wound with an embedded object, or a skull fracture Do NOT Remove a blood-soaked dressing Do NOT Remove an impaled object Do NOT Apply a pressure bandage so tightly that it cuts off circulation Do NOT Use a torniquet

External Bleeding
Protect yourself against disease by wearing medical exam gloves. If not available, the following can be used as alternative: -several layers of gauze pads -plastic wrap -plastic bag -waterproof material

External Bleeding
Direct pressure stops most bleeding.

External Bleeding
A pressure bandage can free you to attend to other injuries or victims.

External Bleeding
Do not remove a blood-soaked dressing. Add more dressings on top.

External Bleeding
Elevation of the injured extremity help reduce blood flow

External Bleeding
If bleeding still continues, apply pressure at a pressure point to slow blood flow

BURNS AND SCALDS

Skin Anatomy

Burns : results from dry heat, corrosive substances/friction Scalds: caused by wet heat General Principles:
own safety stop burning cover injury obtain medical aid

Classification of burns
thermal chemical electrical

First Degree Burn

Involves the epidermis Redness, mild swelling Tenderness, pain Ex. mild sunburn First aid relieve pain dec pain/infl moisturizer

Second Degree Burn

Dermis and epidermis Blister formation, looks raw Swelling ,severe pain First aid analgesic hospital cover Topical antibiotic

Third Degree Burn

Skin, fats, muscles Leathery,waxy charred No pain Hospital Cover Treat for shock

Extent of Burns

Estimating the body surface Rule of palm victims hand,it represents 1% for small of scattered burn Large burn, unburned subtract to 100%

Thermal Burn

Thermal Burns
Assess ABC`s Decide Severity of Burn (when in doubt choose more severe classification) Mild Burns apply cold compress for about 10-40 min until pain subsides then apply moisturizer, like aloe vera More Severe Burns cold compress (If small area), Remove jewelries and clothing from burn area (if stuck, do not pull off, CUT), cover with nonstick sterile dressing (preferably), seek medical consult

Pointers: seek medical attention for:

Burns of face, hands, feet and genital are more severe Circumferential burn Age( < 5 y/o,>55 y/o) Electrical injury Child abuse is suspected Surface of 2 degree >15% of BSA 3rd burn

Chemical Burn

Chemical burns:
caustic or corrosive substance alkalis ( drain cleaners) acids (battery acids) organic compounds(petroleum products)

First Aid:
Wash off for ATLEAST 20 min. (In cases of Dry Chemicals, Brush off Powder before washing off)

remove contaminated clothing sterile dressing hospital chemical burn to eye flush with water

Chemical Burns
Assess ABC`s Wash off for ATLEAST 20 min. (In cases of Dry Chemicals, Brush off Powder before washing off) Remove clothing and jewelries Seek medical Attention

Electrical Burn

Electrocution
Current of 1,000 volts or more high voltage Entrance and exit wound Disrupt normal heart rhythm First Aid: safety first, Shut off power to building if necesary check ABC Treat as Thermal Burns Treat for shock

Summary
Stop the burning and cool area Check ABC Depth and extent Determine other injuries Burn severity Seek medical attention

EPILEPSY
SIGNS & SYMPTOMS Sudden loss of consciousness, casualty may let out a strange cry Casualty may become rigid Convulsive jerking movements that may be violent At the end of the attack, the muscles relax and the casualty returns to normal

EPILEPSY
AIM To protect the casualty from injury To reassure the casualty when she recovers IMPORTANT Never try to hold someone down or stop the convulsions Never put anything in her mouth Never try to give the person anything to eat or drink during a fit

EPILEPSY
WHAT TO DO Ease the fall and keep onlookers well back Clear the area around the casualty Loosen tight clothing Place the casualty in a recovery position Remain with the casualty and reassure her Seek Medical Attention

POISONING
HOW TO RECOGNIZE POISONING There may be a container near the casualty that is known to have had a poisonous substance in it The casualty may have lost consciousness at any given time Convulsions/Seizures Damage to the lips Laboured breathing Upset stomach

POISONING
HOW POISONS ENTER THE BODY
Swallowed Inhaled Injected Absorption

POISONING
IMPORTANT
Take care not to get any poison on yourself If the casualty swallowed a corrosive poison, never try to force her to vomit Do not leave the casualty alone unless you have to call an ambulance Keep poisonous substances out of reach of children

POISONING
WHAT TO DO
Look out for danger Follow the ABC Call an ambulance Give details of the poison is known Give tablets or medicine to the ambulance crew Monitor the casualtys responses

It is better to know First Aid and not need it than to need it and not know it

Thank you