lect 8 basic life support อ.อรรัตน์

7/26/2019 Lect 8 Basic life support .

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Basic Cardiac Life Support

Orarat Karnjanawanichkul


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Evidence based guideline

AHA Cardiac Life Support guideline

Retrospective studies Animal studies expert consensus

Few RCT in human

Recommendation : grade system


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survival rates 50% following witnessedout-ofhospital (VF) arrest


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Importance of CPR

CPR : increase coronary, cerebral blood

flow

: increase survival rate after

shock in 4-5 min

Increase survival in witness arrest 2-3time


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Copyright 2010 American Heart Association

Chain of Survival

Immediate recognition of cardiac arrest and activationof the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation

Effective advanced life support Integrated postcardiac arrest care


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Major changes

Basic life support 2005A = Airway

B = Breathing

C = CirculationD = Defibrillation :1

shock


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Immediate recognition

Lone rescuer

: check response by tapping the victim on theshoulder , shouting at the victim.

: absent or abnormal breathing (ie, only gasping)

: assume in cardiac arrest (Class I, LOE C)

: phone emergency response system(EMS)


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healthcare provider

: check response, look for no breathing or no

normal breathing (ie, only gasping) almostsimultaneously before activating the emergencyresponse system


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NO pulse check for lay rescuer

: assume cardiac arrest if not breathing normally

healthcare provider

: no more than 10 seconds: no definitely pulse >> start chest compressions

(Class IIa, LOE C)



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Health care provider



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Early CPR

All cardiac arrest should receive chestcompressions (Class I, LOE B)

Position: supine on a firm surface

Use backboard : avoid delays in initiation of CPR


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hand on center (middle)

of the chest

(lower half of sternum)

hands are overlapped and

parallel

(Class IIa, LOE B

Early CPR


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Effective chest compressions :

: rate 100 per minute (Class IIa, LOE B)

: depth 2 inches/ 5 cm (Class IIa,LOE B)

: allow complete recoil of the chest after each

compression (Class IIa, LOE B)

: minimize interruptions in compressions (ClassIIa, LOE B)

Early CPR


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A compression-ventilation ratio : 30:2

Early CPR

Push hard and fast


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Significant fatigue and shallow compressions :

after 1 minute of CPR

switch chest compressors approximately every 2minutes (or after about 5 cycles) (Class IIa, LOEB)

switch in 5 seconds.

Early CPR


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lay rescuers : not interrupt chest compressions

to palpate pulses or check for ROSC (Class IIa,

LOE C) Healthcare providers : infrequently interrupt

chest compressions as possible and limit to no

longer than 10 seconds, except for specific

interventions such as advanced airway ordefibrillator(Class IIa, LOE C).

Early CPR


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guideline CAB >ABC

&


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Airway

positioning head

achieving mouth-to-mouth or bag-maskapparatus

rescue breathing

takes time


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(head tilt-chin lift.)

Airway


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(Jaw thrust)

Airway


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trained lay rescuer

: use head tiltchin lift maneuver (Class IIa, LOEB)

healthcare provider

: use head tilt chin lift maneuver in victim withno evidence of head or neck trauma. (Class IIa,

LOE B).

Open the airway


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suspected spinal injury

use manual spinal motion restriction rather than

immobilization devices (Class IIb, LOE C).

devices (collar)

: interfere with maintaining a patent airway

: necessary during transport

Open the airway


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suspected spinal injury

Health care provider : use a jaw thrust without

head extension (Class IIb, LOE C) maintain patent airway and provide adequate

ventilation : priorities in CPR (Class I,LOE C)

head tiltchin lift maneuver if inadequate openairway by jaw thrust

Open the airway


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Rescue breaths


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Rescue breaths

Deliver each rescue breath over 1 second (ClassIIa, LOE C)

sufficient tidal volume to produce visible chestrise (Class IIa, LOE C)

tidal volume 6 - 7 mL/kg (Class IIa, LOE B) no pause in chest compressions for delivery of

ventilations after advanced airway (Class IIb,

LOE C)


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Excessive ventilation

: cause gastric inflation, regurgitation and

aspiration , decrease venous return and CO

avoid excessive ventilation (too many breaths or

too large a volume) during CPR (Class III, LOE

B)

Rescue breaths


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victim with spontaneous circulation

: 1 breath every 5 - 6 seconds, or 10 - 12breaths/minute (Class IIb, LOE C)

Rescue breaths


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cricoid

Rescue breaths


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Mouth-to-Mouth Rescue Breathing

: open the airway

: pinch the victims nose, and create an airtightmouth-to-mouth seal

: give 2 breaths :

: each regular (not a deep) breath over 1 second

(Class IIb, LOE C)

Rescue breaths


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Mouth-to-Nose Ventilation

injured mouth, mouth cannot be opened, in

water, difficult to achieve mouth-to-mouth seal(Class IIa, LOE C)

Rescue breaths


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Mouth-to-Nose and Mouth-to-StomaVentilation

create a tight seal over stoma with round,pediatric face mask

(Class IIb, LOE C)

Rescue breaths


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bag-mask

oxygen reservoir mask

40% flowrate 10 - 12

Rescue breaths


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: 100

: 8-10

2

Rescue breaths


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Untrained Lay Rescuer

Start and continue Hands-Only CPR until an

AED (ClassIIa, LOE B). Trained Lay Rescuer

minimum, provide chest compressions

add rescue breaths if capable continue CPR until an AED (Class I, LOE B)

Rescue breaths


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Healthcare Provider

provide chest compressions and rescue breathsfor cardiac arrest victims (Class IIa, LOE B)

tailor the sequence of rescue actions to the most

likely cause of arrest.

Rescue CPR strategies


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Early defibrillation


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Defibrillation

depolarize


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VF

electrical defibrillation

VF asystole



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2 or more rescuers one rescuer : begin chest compressions

second rescuer activates EMS and gets AED (or

a manual defibrillator in most hospitals) (Class

IIa, LOE C).



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Biphasic defibrillator

Manufaturers recommend dose :120-200 J

(class I,LOE B) Maximal dose (Class IIb, LOE C)

Subsequent shock: equivalent/ higher energylevels (Class IIb, LOE B)

Monophasic defibrillator: 360 J for all shocks

Early defibril lation


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(Conductive material)

(thoracic impedance)

Hairy chest : high impedance



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Electrodeantero-lateral posit ion(class IIa)

Sternum

: right border of sternum ,

under clavicle

Apex: 5th ICS & MAL

D : Defibril lation


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CPR 5 cycles 2 min. (Class IIa)

shockable AED (automated external defibrillator)shockable AED (automated external defibrillator)shockable AED (automated external defibrillator)


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AED (automated external defibrillator)

A t ti l t i l d fib ill t


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Automatic electrical defibrillator


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Travers, A. H. et al. Circulation 2010;122:S676-S684

the lone rescuer must firstrecognize that the victimhas experienced a cardiacarrest,based onunresponsivenessand lack of normalbreathing.

look, listen, and feel for breathingX

BLS healthcare provider algorithm


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Berg, R. A. et al. Circulation 2010;122:S685-S705


BLS h lth id l ith


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Berg, R. A. et al. Circulation 2010;122:S685-S705



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Thank You

lect 8 basic life support อ.อรรัตน์

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