ADULT BASIC LIFE SUPPORT AND ADVANCED CARDIAC LIFE SUPPORT

By: Chandra Kusuma

ADULT BASIC LIFE SUPPORT

2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

CHAIN OF SURVIVAL Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post cardiac arrest care

Emergency systems that can effectively implement these links can achieve witnessed VF cardiac arrest survival of almost 50%.

CPR SEQUENCE

A B C
2005

C A B
2010

Recognition and Activation of Emergency Response

A cardiac arrest victim is not responsive. Breathing is absent or is not normal (agonal gasps) Pulse detection alone is often unreliable Consequently, rescuers should start CPR immediately if the adult victim is unresponsive and not breathing or not breathing normally (ie, only gasping). The directive to look, listen, and feel for breathing to aid recognition is no longer recommended.

Recognition and Activation of Emergency Response

Chest Compressions Providing chest compressions of adequate rate (at least 100/minute) Providing chest compressions of adequate depth adults: a compression depth of at least 5 cm infants and children: a depth of least 1/3 AP diameter of the chest or about 4 cm in infants and about 5 cm in children Allowing complete chest recoil Minimizing interruptions in compressions When possible change CPR operator every 2 min

Chest Compressions

Airway Opening the airway with a head tilt chin lift or jaw thrust

HEAD TILT, CHIN LIFT

JAW THRUST

Rescue Breathing Deliver each rescue breath over 1 second Give a sufficient tidal volume to produce visible chest rise (500 600 ml) Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations. When an advanced airway (ETT or laryngeal mask airway [LMA]) is in place during 2-person CPR, give 1 breath every 6 to 8 seconds (8 to 10 breaths/minute). There should be no pause in chest compressions for delivery of ventilations

Rescue Breathing

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

DEFIBRILLATION

DEFIBRILLATION

BIPHASIC 120 200J

MONOPHASIC 360J

MANUAL DEFIBRILLATION
1. Verify patient is in cardiac arrest, with no pulse or respiration. Have someone provide CPR, if possible, while the defibrillator is obtained and placed next to the patient. 2. Turn on defibrillator; verify all cables are connected. 3. Turn lead select to paddles or defibrillator. 4. Select initial energy level for an adult to 200 J. 5. Paddles: Use conducting gel and place on apex (lower left chest, midaxillary) and sternum (right of sternum, midclavicular). Pads: Place in same locations as you would put paddles. 6. Verify rhythm as VF or pulseless VT. 7. Say, Charging defibrillator, stand clear! 8. Charge defibrillator. 9. Say, Im going to shock on three. One, Im clear; two, youre clear; three, everybodys clear. Perform visual sweep to assure all rescue personnel are clear of patient, bed, and equipment. 10. Discharge defibrillator, reassess rhythm, and refer to appropriate treatment algorithm for resulting rhythm.

MANUAL DEFIBRILLATION

RECOVERY POSITION

RECOVERY POSITION

ADVANCED CARDIAC LIFE SUPPORT

2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care