BASIC LIFE SUPPORT

Objectives:

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Enumerate the causes of sudden death Enumerate the requirements in BLS Enumerate the warning signs of life threatening emergencies

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Explain the importance of the chain of survival

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Explain the links in the chain of survival Explain how CPR works Describe the step-by-step procedure of doing one-rescuer CPR adult, child and infant

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Enumerate the reasons for stopping CPR.

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Chain of Survival:

Early access

Early CPR

Early Early Defibrillation Advanced Care

Chain of Survival Concept
- IMPROVE THE OUTCOME FOR THE VICTIMS OF CARDIOPULMONARY ARREST FIRST LINK: Early Access 117 SECOND LINK: Early CPR THIRD LINK: Early Defibrillation - To restart the heart FOURTH LINK: Early ACLS - To stabilize the heart

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How does CPR work? All living cells of our body need a steady supply of oxygen to keep us alive. Breathe air into the victim s lungs to provide oxygen into the blood. Press on the chest to move oxygen-carrying blood through the body.

Requirements: Hands Lungs Brain

SUDDEN CARDIAC ARREST
Number # 1 cause - Ventricular Fibrillation a. ELECTRIC SHOCK b. DROWNING c. DRUG ABUSE d. SUFFOCATION e. INSECT BITE TRAUMA f. STROKE

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either. It may spread to or occasionally originate in.How to Recognize Life-threatening Emergencies .Stroke .Heart attack . or either arm WHERE? HOW LONG? Lasts longer than few minutes Other signs of heart attack: Chest discomfort or lightheadedness Fainting Sweating Nausea Shortness of Breath 4 .Sudden Cardiac Arrest . behind the breastbone.Foreign Body Airway Obstruction (FBAO) Early warning signs of Heart Attack: CHEST PAIN WHAT? Uncomfortable pressure. the neck. lower jaw. shoulder. squeezing or pain In the center of the chest. fullness.

Facial Droop . breathe or cough .Sudden Loss of Consciousness o No Response o No Normal Breathing o No Signs of Circulation How to Recognize A Stroke .Arm Weakness .Clutches neck ( Universal Distress Signal) .How to recognize A Sudden Cardiac Arrest .Inability to speak.Speech Difficulties Early Warning Signs of Respiratory Failure .Bluish Color of Skin and Lips Early Access 1 PHONE FIRST VS CPR FIRST Early Access 2 CARDIAC DEFIBRILLATOR PHONE FIRST Early Access 3 RESPIRATORY RESCUE BREATHING Early Access 4 CPR FIRST Submersion / Near-Drowning 5 .

They must quickly reach the correct location carrying all the necessary equipment.Arrest associated with trauma Drug Overdoses Early Access 5 The dispatcher provides a critical Communication and coordination function. Early CPR a. Cardiopulmonary resuscitation keeps oxygenated blood flowing to the brain until additional help can arrive. What to tell the operator: Where the emergency is Telephone number you are calling from What happened? How many persons need help? Condition of the victims What is being done for the victims? Early Access 6 a. c. The EMS responders complete the Early Access Team. b. 6 . With their arrival. medical skills and knowledge are now available to help the victim.

One-Rescuer CPR: Adult HCP ADULT Puberty and up Child 1 to puberty Infant < 1Year Old LR > 8 years old 1 to 8 years old < 1 Year old 1. Giving CPR promptly will help more victims survive. . Check for responsiveness. Then begin doing a primary survey.Tap or gently shake the victim. not moving.Rescuer shouts ARE YOU OKAY? 7 . Ensure safety of rescuer and victim: You find a person lying on the ground. . 2.b. You should survey the scene to see if it is safe. Get some idea of what happened.

Open the Airway. if available - - 4.3. Call for help. If the victim is unconscious. Head Tilt-Chin lift method o Place one hand on the victim s forehead o Place Fingers of other hand under bony part of lower jaw near chin o Tilt head and lift jaw .Jaw Thrust Method o Should be used to open the airway when cervical spine injury is suspected o Use HTCL method if jaw thrust does not open the airway 8 . rescuer shouts HELP He should activate EMS system if available in the locality by calling 117 Get an AED.

SUSPECTED HEAD AND NECK INJURY HCP Jaw Trust LP HTCL HTCL 5.Give recue breaths o Maintain an open airway o Pinch nostrils closed o Make a tight seal around victim s mouth o Take a normal breath o Give 2 initial slow breaths Proper rescue breathing 9 . Check for adequate breathing Maintain an open airway Place your ear over victim s mouth and nose Look at chest for movement Listen for sounds of breathing Feel for breath o your check for 5-10s 6. Patient is not breathing .

Chest Compression 10 .Rescuer Technique 7. Start chest compression . Check Pulse Maintain an open airway Locate Adam s Apple with middle and index Fingers Slide fingers down into groove of neck on side closest to you Feel for carotid pulse for 10s - 8.o Deliver each recue breath over 1 second o Give a sufficient tidal volume to produce visible chest rise o Avoid rapid or forceful breaths - One Rescuer Technique Bag Valve-Mask Ventilation Two.

11 .5 2 Inches Rate: 100 per minute Count aloud 1 and 2 and 3 and 4 and 5 and 6 30 ( Push down as you say the number and come up as you say and ). Put the other hand on top of the other o o o o o . at the center of the chest between the 2 nipples.Chest Compression Position shoulders over hands with elbows lock and arms straight Arms should be perpendicular to the victim s body Depth: 1.o Place the heel of the pal.

. place in recovery position 11.9. resume CPR. Breathing Cycles .Give rescue breaths o Give 1 rescue breath every 5-6 seconds o 10 12 rescue breaths per minute o If there is breathing. Pulse returns but breathless . check pulse and signs of circulation. Recovery Position Extend the arm nearest to you Pull the patient on that side 12 .Re-check every 2 minutes 10. starting with chest compression .After 5 cycles of (30:2). Compression .If still with no pulse.Continue cycles of 30 compressions followed by 2 slow breaths .

End Point of Recovery Position . and review of the clinical history." 13 .No harm to the victim Pediatric CPR Causes of Cardiopulmonary Arrest in Children Injuries( motor vehicular accidents) Foreign Body Airway Obstruction Smoke inhalation Sudden infant death syndrome Poisoning Infections of throat and respiratory tract Congenital Heart Defect Sudden Infant Death Syndrome SIDS is "the sudden death of an infant under 1 year of age.Possible to turn the victim on the side .No pressure on the chest . examination of the death scene.Stable position .Airway accessible . including performance of a complete autopsy. which remains unexplained after a thorough case investigation.Near a true lateral position. head dependent .

7. 4. 3. 2.One Rescuer CPR: Child HCP LP 1 to Puberty 1 to 8 years old CPR performed to children is almost similar for adults except for the following differences If the rescuer has no help.5 inches Rate: 100 Compressions per minute If 1 Rescuer is available: 30 Compressions then 2 ventilations If 2 Rescuers are available: 15 compressions then 2 ventilations HCP: If the victim has pulse but still breathless provide rescue breaths at 12 to 20 breaths per minute (1 every 3 to 5 seconds) 1. you can also check the pulse using the femoral artery 14 . Aside from the carotid pulse. give about 2 minutes of CPR if before activating the EMS system if the cause of arrest is respiratory in nature Use the heel of 1-2 hands during chest compressions Depth: 1-1. 5. HCP COMPRESSION VENTILATION CYCLES LR After 5 Cycles Continue the cycle until: AED arrives HCP takes over patient moves Check again 8. 6.

No pulse check for LR 10.Get some idea of what happened .Flick the sole .Other options . have him activate the EMS system by calling 117 4.Maintain an open airway . Check for responsiveness .Then begin doing a primary survey 2. Open Airway Head-tilt / chin lift method .Tilt head and lift jaw 5. Check for breathlessness .If a second rescuer is available.You should survey the scene to see if it is safe .If the victim is unconscious.You find a baby lying on the crib. rescuer shouts HELP . Call for help .Place fingers of other hand under bony part of lower jaw near chin .Rub the baby s back 3. Recovery Position ONE RESCUER CPR: Infant (<1Year) 1.Place your ear over victim s mouth 15 .9.Place one hand in the victim s forehead . not moving .Tap or gently shake the shoulder . Ensure safety of rescuer and victim .

listen and feel for escaping air o Allow for exhalation between breaths .5 1 inch .Maintain an open airway . Check for Pulse .Depth: 0.Give rescue breaths o Maintain an open airway o Give 2 gentle rescue breaths (1 second per breath) o Observe chest rise and fall.Listen for breathing .Look at chest for movement .Rate: 100 Compressions per minute 16 .Feel for the brachial pulse on the inside of the upper arm with 2 fingers of one hand for 10s .Feel for breaths on your ear for 5 10s 6.Rescue breathing o Open your mouth wide o Take normal breath o Make a tight seal around the infant s mouth and nose o Each breath should provide for 1 second 7.2 fingers placed at the center of the chest just below the nipple line . lf patient is Pulse less Start Chest Compression Compression: anatomical landmarks .HCP may also check for femoral pulse 8.. Patient is not breathing .

Count aloud 1 and 2 and 3 and 4 and 5 and 6 30 ( Push down as you say the number and come up as you say and ). Compression / Breathing Cycles (HCP) .Continue cycles of 30 compressions followed by 2 rescue breaths .Check for pulse and signs of circulation .Check for pulse and signs of circulation .If there is breathing.Body in advanced stage decomposition .After 5 cycles of compressions and rescue breaths.A valid DNAR order is presented to rescuer When to start CPR .After 5 cycles. continue 30:2 cycles beginning with chest compression 11. Activate EMS . Pulse returns but no breathing: Give rescue breaths (HCP) .Another trained person takes over .You are too exhausted to continue .Give 1 rescue breath every 3-5 seconds .If still no pulse and signs of circulation. activate EMS call 117 .Victim recovers .Decapitation 17 - . check for pulse and breathing 10. 9. place in recovery position LEGAL and Ethical issues When to stop CPR (BLS) .12-20 rescue breaths per minute .

Any expression of a person s thoughts. a close relative or friend can become a surrogate decision maker for the patient .Can be based on conversations.Lividity Advance Directive .Most states have laws that designate the legal surrogate decision maker (guardian) for an incompetent patient who has not designated a decision maker through a durable power of attorney for health care 18 .Rigor Mortis .Constitutes clear evidence of the patient s wishes ..Written advance directives are more trustworthy than recollections of conversations Living Will - A patient s written direction to physicians about medical care the patient would approve if he or she becomes terminally ill and is unable to make decisions .In most areas it can be legally enforced Surrogate Decision Makers . or durable powers of attorney for health care . or preferences for his or her end-life care . written directives. living wills.When a patient has lost the capacity to make medical decisions. wishes.

Parent 4.Minimize interruptions in chest compressions 19 . Push Fast . Adult Child 3. Specialized care professional as defined by law Surrogates should base their decisions on: .Push hard.The Law recognizes the following order of priority for guardianship in the absence of a previously designated decision maker: 1. Any relative 5. Spouse 2.The patient s previously expressed preferences if known . Person nominated by the person for the incapacitated patient 6.Patient s best interest It s all about High Quality CPR .Allow full chest recoil .

crying. laughing or talking while food or foreign bodies are in the mouth Cut food into small pieces Chew slowly and thoroughly Avoid excessive intake of alcohol Avoid laughing and talking while chewing and swallowing 20 .CHOKING Foreign Body Airway Obstruction -About 3800 deaths are reported to be caused by FBAO ( Choking ) every year Causes: Risk factors Prevention Choking usually occurs during eating Meat is the most common cause of obstruction on adults A variety of foods and foreign bodies have been the cause of obstruction in children Large. poorly chewed pieces of food Elevated blood alcohol levels Dentures Playing.

Check for foreign body .Press fist abdomen with quick inward and upward thrusts 4.If needed.Determine if victim is able to speak or cough . Victim becomes unconscious: Position the Patient 5.Victim maybe using the Universal distress signal of Choking (clutching the neck between thumb and index finger) .Try to give 2 breaths .Rescuer shouts ARE YOU OKAY? 7.Tap or gently shake the victim .Stand behind victim .Adult Foreign Body Airway Obstruction Conscious 1. Determine if victim is choking . reposition head . Perform abdominal thrust .Rescuer can ask Are you choking? 2. Open the airway .Try again 21 .Sweep deeply into mouth with hooked finger to remove foreign body 6.Attempt rescue breathing .Grab the victims hand and put them down 3. Position the patient . Give recue breaths .Wrap your arms around the victim s body .

rescuer shouts HELP .Tap or gently shake the shoulder 2. Deliver Chest thrusts .Look at chest for movement . Patient is not breathing Give rescue breaths .Maintain an open airway . Deliver back blows . If necessary.Feel for breaths on your ear for 3-5s 6. Open the airway .Listen for breathing .Try to give rescue breaths 7.Deliver up to 5 blows forcefully between the shoulder blades with the heel of one hand 8.Head Tilt / Chin Lift Method 5. on a firm. Call for help . have him activated the EMS 3.If the victim is unconscious.If a second rescuer is available. Check for responsiveness .Deliver up to 5 thrusts in the mid sterna region.OBSTRUCTED AIRWAY: UNCONSCIOUS INFANT (<1 YEAR) 1. Position the infant . using the same landmarks as those for chest compressions. Determine breathlessness . hard surface while supporting the head and neck 4. 22 .Turn on Back.

Perform tongue jaw lift .9. listen and feel for escaping air .Reposition the head and try to give rescue breaths 11.If you are alone and your efforts are unsuccessful. Obstruction removed: Check for breathing and pulse. activate EMS after about 1 minute of efforts to clear the airway 13. 23 . Give rescue breaths .Remove foreign body only if you can see it. 10.Do not perform a blind finger sweep . Repeat sequence until successful 12.Try to give rescue breaths .Maintain an open airway . Unsuccessful resuscitation: Activate EMS system .Observe chest rise and fall.

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hives. Transport victim to hospital ± 7. Band should not be too restricting ± 6. Flush snakebite with water ± 4. Remove stinger with a flicking motion ± 3. skin swelling and itching Treatment ± 1. give artificial ventilation. Lie victim down and immobilize limb ± 2. treat for allergic react. Provide non-alcoholic liquid to victim Bites and Stings (Bees) ‡ Treatment ± 1. tongue. Contact Medical Help ± 2. If victim stops breathing. swollen lips.Allergic Reactions ‡ Signs of allergic reactions include difficulty breathing (wheezing). If victim shows signs. Keep victim quiet in a comfortable position ± 3. Bites and Stings (General) ‡ Treatment ± 1. and ears. 2 wide cloth to provide a band near bite ± 5. 25 ‡ . Cold application on all bites except snakes ± 3. Do not remove stinger with a tweezer ± 2.

All burns should be attended to by a physician Do not apply ointments. Should be placed between injury and heart Burns ‡ ‡ ‡ Object is to prevent shock and contamination. Raise bleeding part higher than rest of body Bleeding (Tourniquet) ‡ ‡ ‡ ‡ Use on arms or legs only Is usually not necessary Do not attempt to use unless you are specially trained.Bleeding ‡ Treatment ± 1. Apply direct pressure firmly with both hands ± 5. or baking soda Burns (Thermal) ‡ Treatment ± 1. Keep victim lying down ± 3. Keep victim lying down 26 . grease. Call for medical help ± 2. Place clean cloth over burned area ± 3. Cool quickly with water ± 2. Place pad directly over wound ± 4.

± 4. Flush with plenty of water for 5 minutes ± 2. provide lots of liquids ± 6. Call for medical health ± 6. Raise legs if possible Burns (Chemical) ‡ Treatment ± 1. Place head and chest lower than rest of body ± 7. Remove clothes if needed ± 3. Continue to cover wound if bleeding persists 27 . Hold sterile pad firmly over wound ± 3. Lie victim down. Place clean material over burns ± 4. Place head and chest lower than rest of body ± 7. Raise legs if possible Cuts and Abrasions ‡ ‡ ‡ ‡ ‡ It s important to prevent infections Never put your mouth over a wound Don t breath on a wound Don t touch with dirty fingers or cloths Treatment ± 1. Give no fluids ± 5. Call for medical help ± 5. Cleanse wound with soap and water ± 2.

hold them in armpit ± Bring victim inside ± Place area in warm water (101-103 F) ± Don t use hot water. exercise ± Give them something warm to drink ± See a doctor 28 ‡ . numbness and cold. water bottle.Fractures ‡ ‡ ‡ First aid should do no more than prevent further injury A fracture should be assumed if body part does not have normal look and function Treatment ± 1. Treatment ± Cover area with warm hand of woolen material ± If hands. initial pain. Unless in danger. don t move victim ± 2. Leave the limb in the position you found it ± 3. or heat lamp ± Don t rub frostbitten area ± Let circulation reestablish naturally. Apply a splint Frostbite ‡ Signs include skin that is pink just before frostbite and changes to whit or grayish-yellow as it develops.

Heat Exhaustion ‡ Signs include pale and clammy skin. It usually ends in a few minutes. headache. cramps in abdomen and limbs. rapid pulse. Treatment ± Contact emergency medical help ± Have victim lie down. profuse perspiration. weak pulse. If it lasts more than 15 minutes. rapid. get medical help. weakness. nausea. but no alcohol Seizures and Convulsions ‡ A seizure is not a medical emergency. delays could be fatal ± Cool body by spraying or sponging with cool water ± Liquids. confusion and unconscious Treatment ± Get medical help. Treatment ± Remove objects that may injure a person ± Do not restrain victim ± Do not slap victim or douse with water 29 ‡ ‡ . elevate feet ± Move victim to shade or cool place ± Give victim diluted salt water Heat Stroke ‡ ‡ Signs include flushed hot and dry skin.

a cold feeling. take victim to comfortable area and allow them to sleep if they wish ± Shock ‡ Signs include cold. roll to their side. prevent choking ± Elevate victims legs ± Keep victim comfortable and warm ± Give water to the victim (unless abdominal) ± Reassure victim Spine or Neck Injuries ‡ ‡ ‡ ‡ ‡ Do not move victim unless needed Get medical help Do not move head except to keep airway open If victim vomits.Do not place finger or hard objects in the mouth ± When seizure ends. shaking chills. pale skin color. clammy skin with beads of perspiration on forehead and palms. nausea. rapid breathing Usually accompanies severe injury Treatment ± Get medical help ± Correct the cause of the shock ± Keep victim s airway open ± If victim vomits. shallow. Don t turn head Monitor breathing 30 ‡ ‡ . vomiting.

Sprains or Strains ‡ ‡ ‡ ‡ ‡ ‡ Treat as though it were a fracture Place injured part at rest Elevate injured part if possible Apply cold compress or ice to prevent swelling Contact a doctor Don t apply heat for at least 24 hours 31 .

Luke s Medical Center Compiled and Prepared by: Office of the Chief MSD: PSUPT RENEE BALAGOT PSUPT JANET HOMO PO1 Marco Angelo D Ignacio PO1 Melanie Ignacio 32 . St. Lung Center of the Philippines 5. 2.References: 1. Basic Life Support Provider Course. Philippine Heart Center 3. European Resuscitation Council. Philippine National Redcross 4.

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