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Basic Life Support (BLS)
CPRCPR(CPCR- cardio-pulmonary-cerebral resuscitation)
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The heart is too good to die !
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CPR
BLS
ACLSPOST CPR STABLIZATION OR ORGAN PROTECTION
TECHNIQUE OF CARDIOPULMONARY RESUSCITATION (CPR )
ACLS ( Advance Cardiovascular Life Support)
Focus: more advanced assessments and treatmentsFocus: more advanced assessments and treatments
BLS ( Basic Life Support)
Focus: basic CPR and defibrillation
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EARLY ACCESS
EARLY CPR
EARLY DEFIBRILLATION (AED )
EARLY ACLS
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EarlyACCESS
EarlyCPR
EarlyDEFIB
EarlyACLS
Chain of Survival
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American Heart Association : “Textbook of Advanced Cardiac Life Support”
Check for SAFETY
Check for RESPONSE
Gentle SHAKE & SHOUT
No Response? Shout for HELP
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Before initiating the BLS approach;
CABD instead of traditional ABC
C: CirculationA: AirwayB: Breathing
Check for central pulse (Not peripheral!)
If there is not pulse resume chest compression immediately.
Compression to breathing ratio? Difference between adults and
pediatrics?
Adults: 30:2 Pediatrics: 1 rescuer: 30:2 2 rescuers: 15:2 Infants: 5:1 Neonates: 3:1 Change rescuers after 5
cycles(2 min) since pulse checking.
Rate 100/min Depth 4-5 cm 50% compression,
50% relaxation
Systolic BP ~ 60-80 mmHgMAP < 40 mmHg
CO ~ 30% normal
CHEST COMPRESSIONS AND CORONARY PERFUSION PRESSURE
CPP at 5:1 Ratio
CPP at 30:2 Ratio
not intubated30 compression : 2 ventilation
intubated100/min compression : 8-10
ventilation /min Asynchronous
COMPRESSION RATIO FOR 1& 2 COMPRESSION RATIO FOR 1& 2 RESCUERRESCUER
Perfusing rhythm : 10-12 ventilation /min
COPD : 6-8 ventilation /min
FATIGUEFATIGUE
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• Hard and Fast• Release completely• Minimize interruptions
only interrupt for 1. ventilation (until an advanced airway is
placed)2. rhythm check3. shock delivery
• Rotate compression every 2 minutes with rhythm check
CHEST COMPRESSIONCHEST COMPRESSION
CHECK- Remove foreign body/debris
OPEN - Head tilt/chin lift or jaw thrust
(Consider Tracheostomy/Laryngectomy Patients)
Head-tilt Chin-lift Maneuver
BREATHING
Rescue Breathing: “Gas flows down the path of least
resistance”• Gas can flow to the lungs or stomach
• Distribution of gas depends on– Peak airway pressure
• Inspiratory time• Tidal volume
– Lower esophageal sphincter opening pressure
PROBLEMS WITH HYPERINFLATION
1. Gastric inflation --> aspiration
Solution: cricoid pressure
(Sellick maneuver)
2. In COPD- rapid CO2 wash out Alkalosis- auto PEEP (air trap)
intrathoracic pressureVenous returnBP (especially if
hypovolemic)
Problems with hyperinflation
How to Prevent Gastric Inflation
• Use a longer inspiratory time
– 1 to 2 seconds for bag-mask ventilation with oxygen– 2 seconds for mouth-to-mouth or bag-mask ventilation with air
• Use a smaller tidal volume
– Less tidal volume = lower peak airway pressure
ASSESS SEVERITYASSESS SEVERITY
SEVERE AIRWAYSEVERE AIRWAY
OSTRUCTIONOSTRUCTION
INEFFECTIVE COUGHINEFFECTIVE COUGH
MILD AIRWAYMILD AIRWAY
OBSTRUCTIONOBSTRUCTION
EFFECTIVE COUGHEFFECTIVE COUGH
UNCONCIOUS?UNCONCIOUS?
STARTSTART
CPRCPR
CONCIOUS?CONCIOUS?5 BACK BLOWS5 BACK BLOWS
5 ABDOMINAL THRUSTS5 ABDOMINAL THRUSTS
ENCOURAGE COUGHENCOURAGE COUGH
CHECK FOR DETERIORATIONCHECK FOR DETERIORATION
OR INEFFECTIVE COUGH OR OR INEFFECTIVE COUGH OR
RELIEF OF OBSTRUCTIONRELIEF OF OBSTRUCTION
Stand to one side and slightly behind
Lean casualty forward & support chest with one hand
Give up to 5 back blows
Stand behind casualty and lean them forwards
Place fist between navel and breastbone
Grasp with other hand, pull sharply inwards and upwards
Repeat up to 5 times
Pregnant victims Very obese patients
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AED
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AED