Basic Life Support

THE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICES
Basic Life Support CPR Visual Aids Introduction to BLS - CPR
LIFE SUPPORT
Kinds of Life Support
1. BASIC Life Support (BLS) An emergency procedure that consists of recognizing respiratory or cardiac arrest or both and the proper application of CPR to maintain life until a victim recovers or advanced life support is available. 2. Advanced Cardiac Life Support (ACLS) The use of special equipment to maintain breathing and circulation circulation for the victim of a cardiac emergency. 3. Prolonged Life Support (PLS) For post resuscitative and long term resuscitation.
CHAIN OF SURVIVAL
Four Links
1. The First Link: EARLY ACCESS It is the event initiated after the patient patients collapse until the arrival of Emergency Medical Services personnel prepared to provide care. 2. The Second Link: EARLY CPR It is most effective when started immediately after the victim victims collapse. The probability of survival approximately doubles when it is initiated initiated before the arrival of EMS. 3. The Third Link: EARLY DEFIBRILLATION It is most likely to improve survival. It is the key intervention intervention to increase the chances of survival of patients with outout-ofof-hospital hospital cardiac arrest. 4. The Fourth Link: EARLY ACLS If provided by highly trained personnel like paramedics, provision provision of advanced care outside the hospital would be possible.
HUMAN BODY
Anatomical Terms
1. Medial (I) 2. Prone Position (C) 3. Inferior (F) 4. Proximal (K) 5. Internal (O) 6. Distal (L) 7. Posterior (H) 8. Lateral recumbent position (D) 9. Superior (E) 10. Lateral (J) 11. External (Q) 12. Anterior (G) 13. Supine position (B) 14. Superficial (M) 15. Anatomical position (A) 16. Deep (N)
HUMAN BODY cont cont Body Systems
HUMAN BODY cont cont
Body Systems
1. The Respiratory System

It supply oxygen to the body, as well as removes carbon dioxide from the body. The passage of air into and out of the lungs is called respiration. Breathing in is called inspiration or inhaling. Breathing out is called expiration or exhaling. 2. The Circulatory System It delivers oxygen and nutrients to the body bodys tissues and removes waste products. It consists of the heart, blood vessels, and blood.

Body System cont...
3. The Nervous System It is composed of the brain, spinal cord and nerves. It has two major functions communication and control. It lets a person be aware of and react react to the environment. It coordinates the body bodys responses to stimuli and keeps body systems working together.

Body System cont...
Breathing and Circulation Air that enters the lungs contains: 21% O2 trace of CO2 Air exhaled from the lungs contains: 16% O2 4% CO2 Clinical death (0 - 4 min. - brain damage not likely, 4 - 6 min. - damage probable). Biological death (6 - 10 min. - brain damage probable; over 10 min. - brain damage is certain).
PRECAUTIONS TO PREVENT DISEASE TRANSMISSION

Body Substance Isolation
Are precautions taken to isolate or prevent risk of exposure from from any other type of bodily substance.
CARDIOVASCULAR DISEASES
Risk Factors for Cardiovascular Diseases
1. Risk factors that cannot be changed (Non(Non-modifiable) : Heredity Age Gender 2. Risk factors that can be changed (Modifiable) : Cigarette smoking. Hypertension Elevated cholesterol and triglyceride levels. Lack of exercises. Obesity Stress Diabetes mellitus.
Basic Precautions and Practices
1. Personal Hygiene
2. Protective Equipment
3. Equipment Cleaning & Disinfecting
CARDIOVASCULAR DISEASES cont cont

HEART ATTACK ( Myocardial Infarction)
It occurs when the oxygen supply to the heart muscle (myocardium) (myocardium) is cutcut-off for a prolonged period of time. This cutcut-off results from a reduced blood supply due to severe narrowing or complete blockage of the diseased artery. The result is death (infarction) (infarction) of the affected part of the heart.
CARDIOVASCULAR DISEASES cont cont

First Aid Management of Heart Attack
1. Recognized the signals of heart attack and take action. 2. Have patient stop what he or she is doing and sit or lie him/her him/her down in a comfortable position. Do not let the patient move around. 3. Have someone call the physician or ambulance for help. 4. If patient is under medical care, assist him/her in taking his/her his/her prescribed medicine/s.
Basic Life Support CPR Visual Aids Guidelines in Giving Emergency Care
GETTING STARTED
1. Plan of Action Emergency plans should be established based on anticipated needs and available resources. 2. Gathering of Needed Materials The emergency response begins with the preparation of equipment and personnel before any emergency occurs. 3. Initial Response: Ask for HELP. Intervene Do not further harm. 4. Instruction to Helper/s Proper information and instruction to a helper/s would provide organized organized first aid care.
TR 22-1 TR 22-2
KNOWLEDGE OBJECTIVES:
After completing this module, participants will be able toto1. Explain the need of preparation to a proper emergency care. 2. Describe the four emergency action principles 3. Enumerate the golden rules in giving emergency care. SKILL OBJECTIVES: Demonstrate how to do a primary survey.
EMERGENCY ACTION PRINCIPLES

1. Survey the Scene Once you recognized that an emergency has occurred and decide to act, you must make sure the scene of the emergency is safe for you, the victim/s, victim/s, and any bystander/s. Elements of the Survey the Scene Scene safety. Mechanism of injury or nature of illness. Determine the number of patients and additional resources.
EMERGENCY ACTION PRINCIPLES cont cont

2. Activate Medical Assistance and Transfer Facility In some emergency, you will have enough time to call for specific specific medical advice before administering first aid. But in some situations, you will need to attend to the victim first. Phone First and Phone Fast Both trained and untrained bystanders should be instructed to Activate Medical Assistance as soon as they have determined that an adult victim requires emergency care Phone First. While for infant and children a Phone Fast approach is recommended.
TR 22-3 TR 22-4

3. Do a Primary Survey of the Victim In every emergency situation, you must first find out if there are are conditions that are an immediate threat to the victim victims life. 1. Check for Consciousness 2. Check for Airway 3. Check for Breathing 4. Check for Circulation

4. Do a Secondary Survey of the Victim It is a systematic method of gathering additional information about about injuries or conditions that may need care. 1. Interview the victim. 2. Check vital signs. 3. Perform headhead-toto-toe examination.
TR 22-5
TR 22-6
Basic Life Support CPR Visual Aids Respiratory Arrest & Rescue Breathing
RESPIRATORY ARREST
Is the condition in which breathing stops or inadequate.
After completing this module, participants will be able toto1. Describe what is respiratory arrest. 2. Identify the causes of respiratory arrest. 3. Describe the ways in ventilating the lungs. SKILL OBJECTIVES:
RESCUE BREATHING
Is a technique of breathing air into a person lungs to supply him him or her with the oxygen needed to survive.
After completing this sessions, participants will be able toto Demonstrate how to provide rescue breathing for an adult, child, & infant who shows signs of circulation but not breathing or inadequate.
TR 33-1
WAYS TO VENTILATE THE LUNGS

1. MouthMouth-totoMouth 2. MouthMouthtoto-Nose
WAYS TO VENTILATE THE LUNGS
5. MouthMouth-totoFace Shield
6. MouthMouth-totoMask
3. MouthMouth-toto-Mouth and Nose
4. MouthMouth-totoStoma 7. Bag Mask Device
Basic Life Support CPR Visual Aids Foreign Airway Obstruction Management
Face mask
After completing this module, participants will be able toto1. Identify the causes, types, and classification of obstruction. obstruction.
Bag mask
2. Describe Heimlich maneuver. SKILL OBJECTIVES:
After completing this session, participants will be able toto Demonstrate how to provide Heimlich maneuver to an adult, child & infant who have obstructed airway.
TR 44-1
Basic Life Support CPR Visual Aids Foreign Body Airway Obstruction Management
TWO TYPES OF OBSTRUCTION

1. Anatomical Obstruction
It happens when the tongue drops back and obstruct the throat. Other causes are acute asthma, croup, diphtheria, swelling, and cough (whooping).
CLASSIFICATION OF OBSTRUCTION
1. Partial obstruction with good air exchange.
The victim is responsive and can cough forcefully, although frequently frequently there is wheezing between coughs.
2. Partial obstruction with poor air exchange.

The victim has a weak, ineffective cough, highhigh-pitched noise while inhaling, increased respiratory difficulty, and possibly cyanosis.
2. Mechanical Obstruction
When foreign objects lodge in the pharynx or airways; fluids accumulate in the back of the throat.
3. Complete or total obstruction.

The victim is unable to speak, breathe, or cough and may clutch the neck with the thumb and fingers. Movement of air is absent.
Basic Life Support CPR Visual Aids Cardiac Arrest & Cardiopulmonary Resuscitation
HEIMLICH MANEUVER
Heimlich maneuver or abdominal thrusts is recommended for relieving relieving foreign body airway obstruction.
After completing this module, participants will be able toto1. Describe cardiac arrest. 2. Enumerate the three conditions of cardiac arrest. 3. Enumerate the criteria for not starting CPR and when to STOP CPR. SKILL OBJECTIVES:
After completing the class, participants will be able toto-
Demonstrate how to provide Cardiopulmonary Resuscitation to an adult, adult, child & infant who have cardiac arrest.
TR 55-1
CARDIAC ARREST
Is the condition in which circulation ceases and vital organs are deprived of oxygen.
CARDIOPULMONARY RESUSCITATION (CPR)

This is a combination of chest compression and rescue breathing. This must be combined for effective resuscitation of the victim of cardiac arrest.
THREE CONDITONS OF CARDIAC ARREST

1. Cardio Vascular Collapse 2. Ventricular Fibrillation 3. Cardiac Stand Still
Cough - CPR Compression Only - CPR
TR 55-2
SEQUENCE IN PERFORMING CPR & RB

Survey the Scene.
WHEN TO S.T.O.P. CPR

1. SPONTANEOUS signs of circulation are restored. 2. TURNED over to medical services or properly trained and authorized personnel. 3. OPERATOR is already exhausted and cannot continue CPR. 4. PHYSICIAN assumes responsibility (declares death, take over, etc.).
The Scene is Safe Safe. Activate Medical Assistance & Transfer Facility Facility. Check Responsiveness, Hey Mam/Sir Mam/Sir are you OK? Victim Unresponsive Unresponsive. Open Airway (Head(Head-TiltTilt-Chin Lift) Check Airway Check Breathing (Look, Listen & Feel) for 5 seconds. Victim is Breathless Breathless. Give 2 Initial Ventilatory Maneuver (2 breaths). Check for Signs of Circulation for at least 10 seconds. Victim has no signs of Circulation I Ill perform CPR CPR. Victim has inadequate/no breathing but with Signs of Circulation Ill perform Rescue Breathing Breathing.
TR 55-3 TR 55-4
OBJECTIVES ACLS APPROACH

approach 2. For each step of the ACLS Approach describe 2 acts of assessment and management 3. Describe how you can apply this approach to almost all cardiovascular emergencies
1. Describe the 8 steps of the ACLS
8 Things to Recall in an Emergency

Primary Survey: ABCD (Basic Steps) Airway: open the airway Breathing: provide positivepressure Ventilations Circulation: give chest compressions Defibrllation: shock VF/pulseless VT Primary ABCD Survey (ACLS Questions to Ask) Airway: Is the airway open? Breathing: Is the victim moving air adequately? Circulation: Is there a pulse? If not, is CPR being performed effectively? Defibrillation: if no pulse, has someone checked whether rhythm is VF? Is a defibrillator on the way? Is it ready to deliver a shock?

Secondary Survey: ABCD (Basic Steps)
Airway: provide advanced airway management tracheal intubation, laryngeal mask airway, Combitube
Secondary Survey: ABCD Survey (Basic Steps)

Airway: Is advanced airway needed now? If yes, intubate victim with laryngeal mask airway, Combitube, or tracheal tube

Breathing: confirm tube placement primarily (physical examination), secondarily (check end-tidal CO2 and esophageal placement), check for adequate oxygenation and ventilation

Circulation: obtain IV access, determine rhythm, give medications appropriate for rhythm and vital signs
Secondary Survey: ABCD Survey(Basic Steps)

Breathing: Primary confirmation (physical examination) of proper placement of airway device Breathing: Secondary confirmation (end-tidal CO2 detectors, esophageal detector devices) of proper device placement Breathing: Adequate oxygenation and ventilation? Is it possible to provide continuous/intermittent monitoring of CO2 and oxygen levels Breathing: Is tube secured to prevent dislodgment? Is commercial tube holder being used or tape-and-tie techniques? Is proper tube placement reconfirmed frequently

Circulation: What was the initial cardiac rhythm? What is current cardiac rhythm? Circulation:has someone obtained access to the venous circulation? Can fluids and medication now be given? Have all medications and interventions been providedas indicated for this rhythm and overall clinical condition?

Differential Diagnosis: search for, find, and treat reversible cause
Differential Diagnosis: Now what is wrong with this patient? Why did adequate respirations and heartbeat stop? Why did the patient go into an arrest?What do we see, hear, smell, know or quickly learn that might help us identify a reversible cause of the arrest?
Initial Responses
The initial responses also include: Assess responsiveness Call fast Appropriately position the patient Appropriately position yourself as the rescuer
Assessment process
Person Collapses Possible Cardiac Arrest Assess Responsiveness
Assess Responsiveness
Always assume that the victim is in cardiac
respiratory arrest or both unless proven otherwise Establish unresponsiveness with the traditional shake and shout shout step:tap and gently shake the victim and shout Are you OK OK
call for help
Advance care, in the form of electrical
defibrillation, advanced airway management, and IV medications, must be on the way to the patient as soon as possible
Q? to Assess Responsiveness
Did the victim fall from a height? Or collapse with great force? Or dive head first? Or experience a motor vehicle crash? Activate emergency response Call for defibrillator
Begin Primary ABCD Survey A Assess breathing (open airway, look, listen, and feel)
A: Assess the Airway

Begin with an assessment of the airway,
first opening the airway and checking for spontaneous breathing
Head Tilt-chin Lift

This maneuver pulls the base of the tongue away from the back of the throat, thus maintaining a more open airway: Open the mouth, inspect the upper airway for foreign objects, vomitus, or blood. If a foreign object is present, remove it with your fingers covered with a piece of cloth.
The basic techniques for opening the
airway are the head tilttilt-chin maneuver and the jawjaw-thrust maneuver
Head Tilt-chin Lift

If there is no possibility of a cervical spine Injury, remove material obstructing the airway by turning the patient on his or her side Place the edge of one hand on the victim victims forehead. Begin to gently tilt the head back. At the same time place 2 fingers of the other hand under the chin and lift upward, tilting the head back
Jaw-Thrust Maneuver
The jaw thrust maintains the neutral positionof the cervical spine while resuscitative efforts continue. Use the jaw thrust when you encounter patients with the combination of possible cervical spine injuries and respiratory compromise or victims of trauma.
Overview
2 Basic ACLS Skills
The Advanced ACLS Skills
1. CPR 2. AED (Automated External Defibrillators)
Advanced ACLS Skills

1. 2. 3. 4. 5. Care of the airway Recognition of rhythm Electrical therapy I (defibrillation) Electrical therapy II (cardioversion ) (cardioversion) Electrical therapy III (transcutaneous (transcutaneous pacing) 6. IV acces to circulation 7. Selection of appropriate resuscitation medication
Secondary (Advanced) ABCD Survey
A. Secondary A
intubation
establish an airway with (1) tracheal
B. Secondary B
provide ventilation (breathing) with properly placed tracheal tubes and airway ducts
C. Secondary C
Restore circulation with:
D. Secondary D
Perform a differential diagnosis
(2) Defibrillation (3) Cardioversion (4) Transcutaneous pacing (5) Recognition of the rhythm (6) Initiation of IV access (7) IV medications
ACLS Skill 1: Take care of the airway

1. Provide supplemental oxygen
without respiratory distress 2 lpm thru nasal cannula mild respiratory distress 5 to 6 lpm thru nasal cannula severe respiratory distress, acute congestive heart failure, cardiac arrest Use a system that provides a high inspired
oxygen concentration (preferably 100%)
COPD, who may be dependent on hypoxia drven ventilation Low dose supplemental oxygen via a 24% Venturi
mask
Most serious cases Move quickly to advanced airway devices,

intubation and 100% oxygen
Devices used to administer supplemental

oxygen
Oxygen supply Nasal cannula Starting device Up to 44% oxygen
1 L/min: 24% 3 L/min: 32% 5 L/min: 40% 2 L/min: 28% 4 L/min: 36% 6 L/min: 44%
Face mask with oxygen reservoir
up to 90 100 % oxygen
6 L/min: 60% 7 L/min: 70% 8 L/min: 80% 9 L/min: 90% 10 L/min: almost 100%
Face mask
Up to 60% oxygen 6 to 10 L/min
for use on patients who:

Seriously ill, responsive, spontaneously breathing, require high oxygen concentration May avoid tracheal intubation if acute interventions produce a rapid clinical effect Have relative indications for tracheal intubation but maintain a gag reflex Have relative indications for intubation but have clenched teeth or other physical barriers to immediate intubation
2. Open the airway: recognize airway obstruction

Head and Jaw position: Loss of tone in throat muscles (most common) Basic Opening Techniques Head tilt Jaw Thrust
3. Maintain the open airway using airway adjuncts

Assume that obstruction is produced by either the tongue or relaxed throat muscles Insert an oropharyngeal or nasopharyngeal airway
Manage foreignforeign-body airway obstruction
with the BLS technique of subdiaphragmatic abdominal thrusts and the advanced technique of direct laryngoscopy Use forceps to grasp and remove the foreign body
OROPHARYNGEAL AIRWAYS
Devices that hold the tongue away from the posterior wall of the pharynx Useful in spontaneous breathers who are unconscious or semiconscious with no cough or gag reflex At risk of occluding the airway via tongue and phanryngeal relaxation Keep the airway open during bagbag-mask ventilation Helps in mouth suction and prevents occlusion of tracheal tube
Technique:
Clear the mouth and pharynx Place the airway backwards Rotate the airway 180 as it passes through the oral cavity and approaches the prosterior pharynx Make sure that you have clear breath sounds upon placement of airway Maintain proper head position
Hazards:
Long oropharyngeal airway may press the
NASOPHARYNGEAL AIRWAYS
- Uncuffed tubes made of soft rubber or plastic - For intoxicated or semiconscious who cannot tolerate an oropharyngeal airway - Indicated when the insertion or oropharyngeal airway is technically difficult or impossible
epiglottis against the entrance of the larynx May push the tongue posteriorly Prevent trauma: make sure tongue and lips are note between the airway and teeth Should only be used in unconscious or semiconscious without cough or gag reflex
Technique
Proper sized airway is lubricated properly Inserted close to the midline along the floor of the nostril Continue inserting into the posterior pharynx, behind the tongue Slight rotation may facilitate insertion if with resistance
Hazards
May enter the esophagus May precipitate laryngospasm and vomiting May injure nasal mucosa and cause bleeding Maintain proper head position
PRECAUTIONS
Always check spontaneous respirations immediately after insertion of airway If respirations are absent, start artificial positive pressure ventilation If adjuncts are unavailable, use mouthmouth-totomouth resuscitation
4. Ventilate the patient MouthMouth-toto-Mouth and MouthMouth-toto-Nose Ventilation

Default method Because a major mistake has been made Limitations: Rescuer Rescuers vital capacity Reduced concentration of exhaled air Professional rescuers should always have a barrier device
Mouth to pocket face mask

Must be transparent Tight fit in face Has an oxygen inlet Available in different sizes
Advantage Effective ventilation and oxygenation Eliminate Eliminates direct contact Possible supplemental oxygen Eliminates exposure to victim victims exhaled gases Easy to teach and learn Superior to bag mask technique
SelfSelf-inflating Ventilation Bags: Attached to

Valves, Masks and Other Airway Adjuncts
Mainstay of emergency ventilation Universal connectors One way valves to protect rescuer Oxygen ports Medication ports Suction ports Ports for quantitative sampling of end tidal CO2
BagBag-Valve Masks: Adequate Seal and

Volume
Insert OP airway Recommended tidal volume: 10 to 15 mL/kg mL/kg 80 kg man: needs 800 to 1200 mL per squeeze of bag Most bags: 1600 mL
1 handed squeeze: 50% of bag (800 mL) mL)
Good seal cannot be achieved when there

is only one rescuer using the bagbag-mask device Seal problems do not occur when the bag is attached to the end of an Endotracheal tube or LMA Use a three second ventilation cycle
Recommended features of bag masks

Self refilling bag that is easily cleaned and sterilized Connections for delivery of high concentration of oxygen Capability to perform satisfactorily in all conditions Availability in different sizes True non rebreathing valve
5. Provide adequate ventilation Tracheal intubation

Provides definitive airway management Should be provided by trained personnel as soon as possible
Tracheal intubation: intubation:

Keeps the airway patent Ensures delivery of high concentratiojn of O2 Ensures delivery of selected tidal volume Isolates and protects the airway from aspiration Permits effective suctioning of trachea Provides route for administration of other medications
Indications:
Cardiac arrest with ongoing chest
compressions Inability of a conscious patient in respiratory compromise to breathe adequately Inability of the patient to protect the airway (coma, areflexia, areflexia, cardiac arrest) Inability of the rescuer to ventilate the unresponsive patient with conventional methods
6. Provide definitive airway control Overview

- Prepare for intubation with necessary equipment - Ask second rescuer to apply cricoid pressure - Prepare tracheal intubation - Inflate cuff - Attach ventilation bag - Confirm placement
Cricoid Pressure Maneuver

Why?
Technique
cartilage
protects against regurgitation of gastric

contents Helps ensure tube placement
Find the prominent thyroid cartilage Find the soft depression below the thyroid Find the hard prominence just below that Apply firm pressure while pinching the
thumb and index finger towards the victim victims back and somewhat towards the head Release pressure only when proper tube placement is confirmed and the cuff is inflated
7. Provide primary and secondary confirmation of tracheal tube placement

Primary
- As the bag is squeezed, listen over the epigastrium and observe the chest wall for movement. - If you hear stomach gurgling and no chest rise, you have intubated the esophagus - Stop ventilation and remove tube
Reattempt intubation after reoxygenating the victim If the chest wall rises and no stomach gurgling listen to the lung fields with 5 point auscultation and document in medical record Left and right anterior left and right midaxillary over the stomach
If there is any doubt, use laryngscope to directly visualize (tube passing thru vocal cords) Secure the tube Insert OP airway Look for moisture condensation inside the tube
How to Ventilate With a Properly Placed Tracheal Tube

tidal volume of 1010-15 mL/kg mL/kg 1 breath every 5 seconds 2 seconds for each bag ventilation Ventilate with 100% oxygen when O2 saturation measurements are available respond accordingly when there is a fall in the O2 saturation
Secondary
- Use of variety of electronic and mechanical devices
Unprotected airway
sets of 15 compressions at 100 per minute 2 ventilations at 2 seconds per ventilation
Obtain a chest xx-ray as soon as possible to

confirm position of tube within trachea inadvertent esophageal insertion.
Never use a chest xray to detect
Protected airway
Continuous compression at 100 per minute Asynchronous with 1 ventilation at 2 seconds per ventilation every 5 seconds
Complications Insertion of Tube Into Esophagus Accidental insertion of tube into esophagus will Tube Trauma and Adverse Effects Lacerated lips or tongue Chipped teeth Lacerated pharynx or trachea Injury to the vocal cords PharyngealPharyngeal-esophageal perforation Vomiting and aspiration of the gastric contents into
Release of high levels of epinephrine and
norepinephine the lower airway result in no oxygenation or ventilation
Insertion of Tracheal Tube Into 1 Lung Hypoxemia due to underinflation of 1 lung Airway Control on Trauma Patients Assume that the patient with multiple trauma,
head injury or facial trauma has cervical spine injury
Steps to follow in known or suspected cervical spine trauma

Perform chin lift or Jaw thrust without head tilt Stabilize head in neutral position Orotracheal intubation in a patient with facial fractures and fractures at the base of the skull, another should provide spinal immobilization Suction upper airway Consider cricothyrotomy or tracheostomy Use paralytic drugs in patients who cannot be in patients who cannot be intubated with the above techniques
Additional Techniques for Invasive Airway Control and Ventilation

Cricotyrotomy
Allows rapid entrance into the airway Cricothyroid membrane is opened with a scalpel and a tube is inserted
Tracheostomy
Surgical opening of the trachea and insertion of tracheostomy tube Performed under controlled conditions in the OR Should be performed after the airway has been secured by a tracheal tube or cricotyrotomy Not appropriate for urgent situations (airway obstruction or cardiac arrest)
ACLS Skill 2: Recognize the rhythm

Ventricular fibrillation Pulseless ventricular tachycardia Pulseless electrical activity asystole
1. Cardiac Arrest (lethal) Rhythms

A. Shockable rhythms a) VF b) pulseless VT B. Nonshockable rhythms a) Asystole b) Pulseless electrical activity
-
2. Non Cardiac Arrest (nonlethal ) Rhythms (nonlethal)

A. Rhythm too slow ( < 60 bpm) bpm) B. Rhythm too fast ( > 120 bpm) bpm)
Includes rhythms that produce electrical activity on the monitor but no palpable pulse Electromechanical dissociation, bradyasystolic rhythms, pulselessidioventricular rhythms
ACLS Skill 3: Defibrillate

1. Turn on defibrillator 2. Select energy level at 200 J for 3. 4. 5. 6.
7. Charging fibrillator Stand Clear! Clear! 8. Press charge button on apex paddle or
defibrillator controls 9. When fully charged state firmly:
a) Im going to shock on three. One, I Im clear. clear. b) Two, you youre clear. clear. c) Three, everybody everybodys clear. clear.
monophasic defibrillators Set lead select select switch on paddles paddles Apple gel or conductor pads Position paddles Visually check the monitor display and assess rhythm
10.Apply 25lb of pressure on both paddles 11.Press the 2 paddle discharge discharge button
simultaneously
12.Check the monitor 13. Shock at 200 to 300 J, then at 360 J
ACLS Skill 4: Cardiovert
ACLS Skill 5: Transcutaneous Pacing

Delivers pacing impulses to the heart through the skin via adhesive electrodes Use of transcutaneous pacing for asystole and pulseless electrical activity has been disappointing
ACLS Skill 6: Gain IV Access to the Circulation
Peripheral venipuncture
Arm vein (antecubital (antecubital or hand) External jugular vein
Administer drugs and fluids Obtain venous blood for laboratory
determinations Insert catheters into the central circulation
Central venipuncture
Internal jugular vein Subclavian vein Common femoral vein
Peripheral line
Procedure of choice Peripheral sites are compressible May collapse during low flow states
Central line
Predictable location Allows for the use of large bore catheters Permits infusion of concentrated solutions (greater flow) Damage to surrounding structures
General Principles
Speed is essential Strict aseptic technique may be impossible After patient is stabilized cannula should be removed and replaced During cardiac arrest follow all administered drugs by bolus administration of at least 20ml of IV saline
ACLS Skill 7: Provide Appropriate Resuscitation Medications

Medications are used to meet the following
major objectives
Correct hypoxemia Restore spontaneous circulation at an adequate blood pressure Promote optimal cardiac function Prevent or suppress significant arrythmias Relieve pain Correct electrolyte abnormalities, adjust acidosis, counteract effects of excessive amounts of prescribed medications or illegitimate agents Treat congestive heart failure
Summary
1. 2. 3. 4. 5. 6. 7.
Airway management Rhythm recognition Defibrillation Cardioversion Transcutaneous pacing Direct circulation access though intravenous catheters Administration of appropriate resuscitation medications

Basic Life Support

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THE PHILIPPINE NATIONAL RED CROSS SAFETY SERVICES