200S

AnA Gu|de||ne Changes
8LS for nea|thcare Þrov|ders
uomlnlc LŦ uel 8osarloţ 8n
Basic Life Support
&
Automated ExternaI
DefibriIIation Course
Basic Life Support
&
Automated ExternaI
DefibriIIation Course
ÞUkÞCSL CI 8LS CnANGLSť ÞUkÞCSL CI 8LS CnANGLSť
· @o lmprove survlval from cardlac arresL
by lncreaslng Lhe number of vlcLlms of
cardlac arresL who recelve ear|yţ h|ghŴ
qua||ty CÞk
!Ianned, practiced response
with C!#AEDs yieIds
survivaI rates of 49-74%
Even pros don't do good C!#
kLMLM8Lkť
· Larly resusclLaLlon and prompL
deflbrlllaLlon (wlLhln 1Ŵ2
mlnuLes) can resulL ln ƽ60Ʒ
survlvalŦ
· 8ysLander CÞ8 vlLal
lnLervenLlon before arrlval of
emergency servlcesŦ
uses fourŴllnk
CnAIN CI SUkVIVAL
Lo resusclLaLe Lhe vlcLlm
1. Activation
of Emergency
Medical Services
!hone First
C!# First"
2. Do not to delay
treatment until
arrival of Emergency
Medical Service
(EMS)
3. Early use of
a defibrillator/A
ED
4. Bystanders with
training in BLS can
perform the first 3 of
the 4 steps.
,@ nCn@ CnL
2003
· 8aslc llfe supporL conslsLs of a number of llfeŴsavlng Lechnlques
focused on Lhe medlclne ƍ8Cƍs
÷ A|rway ( 2 Ŷ C2 beLween lungs and aLmosphere )
÷ 8reath|ng (lnflaLlon and deflaLlon of lungs vla Lhe alrway)
÷ C|rcu|at|on ( provldlng adequaLe supply )
%'S ALL ABOU% BLOOD
FLOW
#escuers should ÌNÌTÌATE CHEST COMP#ESSÌONS before
giving rescue breaths C-A-B rather than A-B-C).
Beginning CP# with 30 compressions rather than 2 ventilations
leads to a shorter delay to first compression.
,@ nCn@ CnL
2003
· n Lhe Ŵ8ŴC sequence chest compress|ons are often de|ayed
whlle Lhe responder opens Lhe alrway Lo glve mouLhŴLoŴmouLh
breaLhs or reLrleves a barrler devlce or oLher venLllaLlon
equlpmenLŦ
· 8y changlng Lhe sequence Lo CŴŴ8ţ chesL compresslons wlll be
lnlLlaLed sooner and venLllaLlon only mlnlmally delayed unLll
compleLlon of Lhe flrsL cycle of chesL compresslons (30
compresslons should be accompllshed ln approxlmaLely 18
seconds)Ŧ
%'S ALL ABOU% BLOOD
FLOW
"push hard, push fast"
Compression rate is modified to at Ieast 100min from approximateIy 100min.
,@ nCn@ CnL
2003
· Lach shock from an Lu should be followed by 2 mlnuLes of
CÞ8 (3 cycles of 30ť2) sLarLlng wlLh compresslonsŦ
· Lach rescue breaLh should Lake one second and produce
vlslble chesL rlseŦ
· 8eafflrmaLlon LhaL Lus should be used for klds 1Ŵ8 year
oldŦ
%'S ALL ABOU% BLOOD
FLOW
CCMÞkLSSICNS AND VLN1ILA1ICNS
Why change compress|ons?
· Jhen compresslons sLopţ
|ood f|ow stops!
· Dnlversal compresslon raLlo
easler Lo learn/reLaln
· lgher raLlo ylelds more
blood flowŤ keeps pump
ºprlmed"
Why shorten reaths?
· arge volume breaLhs lncrease
@Þ (nLra @horaclc Þressure)Ť
decrease venous reLurn Lo hearL
· ong breaLhs lnLerrupL
compresslons
· ypervenLllaLlon decreases
coronary and cerebral perfuslon
pressures
· verŴvenLllaLlon lncreases alr ln
sLomachŤ regurglLaLlon/asplraLlon
CL@ C,Þ8Ln
NLW (200S)
÷ Þush hardţ fastţ rate of 100
per m|nute
÷ A||ow fu|| chest reco|| after
each compress|on (
|ncrease |ood venous return)
÷ M|n|m|ze |nterrupt|ons (no
more than 10 seconds at a
t|me) except for spec|f|c
|ntervent|ons (advanced
a|rway]ALD)
CLD (2000)
% Less emphas|s was g|ven to
need for adequate depthţ
comp|ete chest reco||ţ and
m|n|m|z|ng |nterrupt|ons
CL@ C,Þ8Ln
Study of CÞk performed y hea|thcare
prov|ders found thatť
· * of chesL compresslons too sha||ow
· no compresslons provlded durlng 24Ʒ
Lo 49Ʒ of CÞ8 Llme
CnL C,Þ8L8
LvL8? 2 ,nD@L
NLW (200S)
÷ f more Lhan 1 rescuer
presenLţ change
ºcompressor" roles every 2
mlnuLes
CLD (200S)
% 8escuers changed when
faLlguedŴusually dld noL
reporL feellng faLlgued unLll
3mlnŦ or more
Why:
Ìn manikin studies, rescuer
fatigue developed in as little
as 1-2minutes(as
demonstrated by inadequate
chest compressions)
kLSCUL 8kLA1nING WI1nCU1
CCMÞkLSSICNS
NLW (200S)
÷ 10Ŵ12 breaLhs per mlnuLe
(adulLs) 1 every 3Ŵ6 seconds
÷ 12Ŵ20 breaLhs per mlnuLe for
lnfanL or chlld 1 every 3Ŵ3
seconds
CLD (2000)
÷ 10 Ŵ12 breaLhs for adulLs
÷ 20 breaLhs for lnfanL or chlld
Why:
ider range of acceptable breaths for infant and child
will allow the provider to tailor support to patient
Note: Ìf you are assisting lay rescuer-they are not
taught to deliver rescue breaths without chest
compression
kLSCUL 8kLA1nING WI1n
CCMÞkLSSICNS
NLW (200S)
÷ Lach rescue reath shou|d e
g|ven over 1 second and
produce v|s||e chest r|se
÷ Avo|d reaths that are too
|arge or too forcefu|
÷ Man|k|ns conf|gured so that
v|s||e chest r|se occurs at
S00Ŵ600m|
CLD (2000)
÷ kescue reaths over 1Ŵ2
seconds
÷ kecommended t|da| vo|ume
for adu|t rescue reaths was
700m|Ŵ1000m|
Why:
Oxygen Delivery
-During first minutes of CP# for VF SCA, initial oxygen content in
blood adequate/ cardiac output is reduced
-Effective chest compressions more important than rescue breaths
immediately after VF SCA (sudden cardiac arrest)
-During CP# , blood flow to lungs is about 25-33% of normal
-Less ventilations needed during cardiac arrest than when patient
has perfusing rhythm
n¥ÞLkVLN1ILA1ICN LLADS 1Cť
· ncreased poslLlve pressure ln Lhe chesL
· uecreased venous reLurn Lo Lhe hearL
· lmlLed refllllng of hearL
· uecreased cardlac ouLpuL durlng
subsequenL compresslons
· asLrlc dlsLenLlon/vomlLlng
2 kLSCULk CÞk WI1n ADVANCLD
AIkWA¥
NLW (200S)
÷ no pause for venLllaLlon
when Lhere ls an advanced
alrway ln place
÷ 8Ŵ10 breaLhs per mlnuLe
CLD (2000)
÷ 8ecommended
ºasynchronous" compresslons
and venLllaLlons
÷ venLllaLlon raLe of 12Ŵ13 per
mlnuLe
÷ 8escuers LaughL Lo reŴcheck
for slgns of clrculaLlon ºevery
few mlnuLes"
Why:
-Ventilations can be delivered during
compressions
-Avoid excessive number of breaths
-During CP#, blood flow to lungs
decreased, so lower than normal
respiratory rate will maintain adequate
oxygenation.
AIkWA¥]1kAUMA
VIC1IMS
NLW (200S)
÷ n paLlenLs wlLh suspecLed
cervlcal splne ln[urlesŴlf
unable Lo open alrway uslng
Lhe [aw LhrusLţ use Lhe headŴ
LllL chln llfL
CLD (2000)
÷ aw LhrusL wlLhouL head LllL
LaughL Lo boLh lay rescuers
and healLhcare provlders
Why:
aw thrust difficult maneuver to learn may not effectively
open airway and it can cause spinal movement
Opening the airway is a priority in an unresponsive trauma
victim
Manual stabilization preferred over immobilization devices
during CP#
LCNL nLAL1nCAkL ÞkCVIDLk
"phone f|rst" vsŦ "CÞk f|rst"
NLW (200S)
÷ 1a||or sequence to most
||ke|y cause of card|ac arrest
· "Þhone I|rst" Sudden
w|tnessed co||apse (adulL or
chlld)Ŵllkely Lo be cardlac ln
orlglnŦ Call 9Ŵ1Ŵ1 and geL Lhe
Lu
· "CÞk I|rst" nypox|c Arrest
(adulL or chlld)Ŵ glve 3 cycles
or abouL 2 mlnuLes of CÞ8
before leavlng vlcLlm Lo call
9Ŵ1Ŵ1 and geL Lhe Lu
CLD (2000)
÷ @allorlng response Lo llkely
cause of arresL was noL
emphaslzed ln Lralnlng
÷ C 8@ and C8L 8@
Why:
-Sudden collapse-likely cardiac and early
CP# and defibrillation needed
-Victims of hypoxic arrest need immediate
CP#
"CnILD" 8LS GUIDLLINLS
NLW (200S)
÷ Chlld CÞ8 guldellnes for
healLhcare provlders apply Lo
vlcLlms from 1 year of age Lo
onseL puberLy (abouL 12Ŵ14
years old)
CLD (2000)
÷ Chlld CÞ8 age 1Ŵ8
Why:
-No single anatomic or physiologic
characteristic that distinguishes a
"child¨ victim from an "adult¨ victim
-No scientific evidence that
identifies a precise age to begin
adult techniques
S¥MÞ1CMA1IC 8kAD¥CAkDIA
INIAN1S]CnILDkLN
NLW (200S)
÷ ChesL compresslons
lndlcaLed lf 8 Ƽ60 and
slgns of poor perfuslonţ
desplLe adequaLe
venLllaLlon
CLD (2000)
÷ ame recommendaLlon
ln 2000 guldellnes buL lL
was not lncorporaLed
lnLo Lhe 8 Lralnlng
Why:
Bradycardia is common terminal rhythm in infants and
children
- Do not want to wait for development of pulseless arrest
to begin chest compressions if there are signs of poor
perfusion and no improvement with 02 and ventilatory
support.
CnILD CnLS1 CCMÞkLSSICNS
NLW (200S)
÷ Dse heel of 1 or 2
hands
CLD (2000)
÷ Dse heel of 1 hand
Why:
Child manikin study showed that
rescuers performed better chest
compressions using the "adult¨
technique
INIAN1 CnLS1 CCMÞkLSSICNS
NLW (200S)
÷ Dse Lhe 2 LhumbŴ
enclrcllng LechnlqueŴ
sLernum compressed
wlLh Lhumbs and use
flngers Lo squeeze Lhorax
CLD (2000)
÷ Dse of flngers Lo
compress chesL wall was
noL descrlbed
Why:
This technique results in higher
coronary artery perfusion pressure
CCMÞkLSSICN 1C VLN1ILA1ICN kA1ICS
INIAN1S]CnILDkLN
NLW (200S)
÷ Lone rescuerť
Compresslon Lo venLllaLlon raLlo
30ť2 for lnfanLsţ chlldren and
adulLs for
÷ 2 kescuer CÞkť
13ť2 raLlo for lnfanLs and
chlldren
CLD (2000)
÷ 13ť2 adulLs
÷ 3ť1 lnfanLs/chlldren
Why:
-Simplify training
-#educe interruptions in chest
compressions
-15:2 ratio for 2 rescuer CP# for
infants/children will provide additional
ventilations
ICkLIGN 8CD¥ AIkWA¥ C8S1kUC1ICN
NLW (200S)
÷ lrway obsLrucLlons classlfled as
mlld or severe
÷ kescuers shou|d act on|y |f s|gns
of severe ostruct|on present
· poor alr exchange
· ncreased resplraLory
dlsLress
· llenL cough
· Cyanosls
· nablllLy Lo speak or breaLh
CLD (2000)
÷ 8escuers LaughL Lo recognlze
· ÞarLlal obsLrucLlon wlLh good
alr exchange
· ÞarLlal obsLrucLlon wlLh poor
alr exchange
· CompleLe alrway obsLrucLlon
÷ 8escuers LaughL Lo ask 2
quesLlons
· re you choklng?
· Can you speak?
÷ equence for unresponslve
choklng vlcLlm was a compllcaLed
sequence/lncluded abdomlnal
LhrusLs
ICkLIGN 8CD¥ AIkWA¥ C8S1kUC1ICN
NLW (200S)
÷ If v|ct|m ecomes
unrespons|ve
· C@v@L 9Ŵ1Ŵ1 and begln
CÞ8
· Jhen alrway opened
durlng CÞ8ţ look ln mouLh
and remove ob[ecL lf seen
· no bllnd flnger sweeps
Why:
-Simplification
-Compressions during CP#
may increase intrathoracic
pressure more than
abdominal thrusts
-Blind finger sweeps may
injure victims mouth/throat or
rescuers finger
Heimlich Muneover Heimlich Muneover
SnCCk ]IMMLDIA1L CÞk
NLW (200S)
÷ uellvery of sinq/e shock for
v and pulseless v@ followed
by immediote cPk
÷ Þerform 2 mlnuLes of CÞ8
before checklng for slgns of
clrculaLlon
CLD (2000)
÷ 3 sLacked shocks
recommended
÷ lrsLť 200 [oules
÷ econdť 300 [oules
÷ @hlrdť 360 [oules
÷ Lach one was sLronger
because Lhe ablllLy of body
Llssues Lo conducL elecLrlclLy
geLs worse wlLh each shockŦ
Why:
-3 shocks were based on use of
monophasic waveforms
-Use of AED
-New biphasic defibrillators have a higher
first-shock success rate
-biphasic defibrillators (less 200 joules) vs
monophasic debifrillators
%he Iower energy IeveIs reduce the rates
of burns and myocardiaI damage that
were found in oIder modeIs.
USL CI ALD'S IN CnILDkLN
NLW (200S)
÷ 8ecommended use of Lu's
ln chlldren 1Ŵ8 years old
CLD (2000)
÷ nsufflclenL evldence Lo
recommend for or agalnsL use
of Lu's ln chlldren under 8
years old
Why:
Evidence published since
2000 shows AED's safe and
effective for use in infants
and children
CCMMUNI1¥]LA¥ kLSCULk ALD
ÞkCGkAMS
NLW (200S)
÷ CÞ8/Lu use by publlc safeLy
flrsL responders
recommended Lo lncrease
C survlval raLes
÷ nsufflclenL evldence Lo
recommend for or agalnsL
Lu's ln homes
CLD (2000)
÷ ey elemenLs of an Lu
program lncludedť
· Þhyslclan overslghL
· @ralnlng of rescuers
· nLegraLlon wlLh L,
· Þrocess of CC
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
Basic Life Support &
Automated ExternaI
DefibriIIation Course
AÞÞkCACn SAILL¥!
cene
8escuer
vlcLlm
8ysLanders
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
CnLCk kLSÞCNSL
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
Shake shoulders gently
Ask "Are you all right?¨
Ìf he responds
· Leave as you find him.
· Find out what is wrong.
· #eassess regularly.
CnLCk kLSÞCNSL
SnCU1 ICk nLLÞ!
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
CÞLN AIkWA¥
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
CnLCk 8kLA1nING
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
CnLCk 8kLA1nING
· ookţ llsLen and feel for
n8, breaLhlng
· uo noL confuse agonal
breaLhlng wlLh
n8, breaLhlng
AGCNAL 8kLA1nING
· ccurs shorLly afLer Lhe hearL sLops
ln up Lo 40Ʒ of cardlac arresLs
· uescrlbed as barelyţ heavyţ nolsy or gasplng
breaLhlng
· 8ecognlse as a slgn of cardlac arresL
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
0 CnLS1 CCMÞkLSSICNS
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
· Place the heel of one hand in
the centre of the chest
· Place other hand on top
· Ìnterlock fingers
· Compress the chest
÷ #ate 100 min
1
÷ Depth 4-5 cm
÷ Equal compression : relaxation
· Change CP# operator every
2 min
CnLS1 CCMÞkLSSICNS
%uble oI Compurison on %uble oI Compurison on
Curdiopolmonury Resoscitution Curdiopolmonury Resoscitution
{Adolt, Child, InIunt) {Adolt, Child, InIunt)
Adolt Adolt Child Child InIunt InIunt
Coonting Coonting
1, ±, ¿, q, g, 1, ±, ¿, q, g,
6, ,, S, q, 1o, 6, ,, S, q, 1o,
11, 1±, 1¿, 1q, 11, 1±, 1¿, 1q,
1g, 16, 1,, 1S, 1g, 16, 1,, 1S,
1q, ±o, 1, ±, 1q, ±o, 1, ±,
¿, q, g, 6, ,, ¿, q, g, 6, ,,
S, q und 1 S, q und 1
Breuthe Breuthe
breuthe breuthe
1, ±, ¿, q, g, 6, ,, S, q, 1, ±, ¿, q, g, 6, ,, S, q,
1o, 11, 1±, 1¿, 1q, 1g, 1o, 11, 1±, 1¿, 1q, 1g,
16, 1,, 1S, 1q, ±o, 1, ±, 16, 1,, 1S, 1q, ±o, 1, ±,
¿, q, g, 6, ,, S, q und 1 ¿, q, g, 6, ,, S, q und 1
Breuthe Breuthe
breuthe breuthe
%uble oI Compurison on %uble oI Compurison on
Curdiopolmonury Resoscitution Curdiopolmonury Resoscitution
{Adolt, Child, InIunt) {Adolt, Child, InIunt)
Adolt Adolt Child Child InIunt InIunt
Rute Rute
Approximutely Approximutely
1oo[min 1oo[min
Approximutely Approximutely
1oo[min 1oo[min
At leust At leust
1oo[min 1oo[min
Compression Compression
to Ventilution to Ventilution
rutio rutio
¿o:± ¿o:±
¿o ICC ¿o ICC--± Vent ± Vent
{ or ± rescoers) { or ± rescoers)
¿o:± ¿o:±
¿o ICC ¿o ICC--± Vent ± Vent
{1g:± Ior ± rescoers) {1g:± Ior ± rescoers)
Nomber oI Nomber oI
Cycle[min. Cycle[min.
g cycles g cycles
{1 to ± rescoers) {1 to ± rescoers)
g cycles g cycles
{1 rescoer or ± rescoer ut 1o cycles) {1 rescoer or ± rescoer ut 1o cycles)
kLSCUL 8kLA1nS
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
kLSCUL 8kLA1nS
· Þlnch Lhe nose
· @ake a normal breaLh
· Þlace llps over mouLh
· 8low unLll Lhe chesL
rlses
· @ake abouL 1 second
· llow chesL Lo fall
· 8epeaL
uys to Ventilute the uys to Ventilute the
Longs Longs
Mooth to Mooth breuthing
Mooth to Nose breuthing
Mooth to Mooth und Nose
Mooth to Stomu
Mooth to Iuce Shield RB
Mooth to Musk Rescoe Breuthe
Bug-Musk Ðevice
%uble oI Compurison on Rescoe %uble oI Compurison on Rescoe
Breuthing Ior Adolt. Child, InIunt Breuthing Ior Adolt. Child, InIunt
Adolt Adolt Child Child InIunt InIunt
Breuths Breuths Ioll, slow
breuth
Ioll, slow
regoluted
breuth
Gentle,
slow breuth
Rute Rute 1o to 1±
breuths per
minote
±o breuths per minote
{1 breuth every ¿
seconds)
Coonting Coonting Breuth 1,
1oo±, 1oo¿,
1oo1±
breuth
Breuth 1, 1oo1, breuth 1,
1oo±, breuth op to 1,
1o±o, breuth
CCN1INUL CÞk
30 2
hen to hen to
Spontuneoos Spontuneoos signs oI circolution signs oI circolution
ure restored ure restored
%orned %orned over to medicul services over to medicul services
or properly truined und or properly truined und
uothorized personnel. uothorized personnel.
Operutor Operutor is ulreudy exhuosted und is ulreudy exhuosted und
cunnot continoe CPR. cunnot continoe CPR.
Physiciun Physiciun ussomes responsibility. ussomes responsibility.
{ { Ðeclures deuth, tuke over Ðeclures deuth, tuke over))
S%OP S%OP
CPR CPR
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
DLII8kILLA1ICN
CaII 112
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
Attach AED
FoIIow voice prompts
SWI1Cn CN ALD
· ome Lus wlll
auLomaLlcally swlLch
Lhemselves on when
Lhe lld ls opened
A11ACn ÞADS 1C CASUAL1¥'S
8AkL CnLS1
ANAL¥SING kn¥1nM
DC NC1 1CUCn VIC1IM
SnCCk INDICA1LD
· Land clear
· uellver shock
SnCCk DLLIVLkLD
ICLLCW ALD INS1kUC1ICNS
30 2
NC SnCCk ADVISLD
ICLLCW ALD INS1kUC1ICNS
30 2
II VIC1IM S1Ak1S 1C 8kLA1nL
NCkMALL¥ ÞLACL IN kLCCVLk¥
ÞCSI1ICN
CÞk IN CnILDkLN
· dulL CÞ8 Lechnlques
can be used on chlldren
· Compresslons 1/3 of
Lhe depLh of Lhe chesL
AED N CHLD#EN
· #ecommended use of
AED's in children 1-8 years
old
· Age < 1 year
· use only if
manufacturer
instructions indicate it
is safe
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
30 chest compressions
2 rescue breaths
Approach safeIy
Check response
Shout for heIp
Open airway
Check breathing
CaII 112
Attach AED
FoIIow voice prompts
1nANk ¥CU!!!

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