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PAHANG HOSPITALS

BASIC LIFE SUPPORT 2011-2015(BLS)

PREPARED BY :DR SAZWAN REEZAL BIN

SHAMSUDDINEMERGENCY PHYSICIAN & HEAD,

EMERGENCY & TRAUMA DEPT,HOSPITAL SULTAN HAJI AHMAD

SHAH, TEMERLOH

PANELISTS:DR KHAIRI BIN KASSIM@HASHIM

EMERGENCY PHYSICIAN & HEAD,EMERGENCY & TRAUMA DEPT,HOSPITAL TUANKU AMPUAN

AFZAN, KUANTAN.

DR ZAINAL ABIDIN BIN MOHAMED

EMERGENCY PHYSICIAN,EMERGENCY & TRAUMA DEPT,HOSPITAL TUANKU AMPUAN

AFZAN, KUANTAN.

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RISK FACTORS FOR ISCHAEMIC HEART DISEASE (IHD)

• Age > 40• Male• Hypertensive• Diabetes mellitus• Hypercholestrolemia• Smoker• Family history of IHD

IHD

CARDIACARREST

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CPR through the ages…..

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Some not so celebrated instances …

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CPR through the ages

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• 1956 James Elam and Peter SafarMouth-to-mouth resuscitation

• 1960 Dr Kouwenhowen and team External chest compression

• 1963 AHA formally endorses CPR

• 1966 First conference on CPR Standardize training and performance standards

• 1972 Mass citizen’s training in CPROver 100,000 trained over 2 years

• 1970’s More than 60% bystanders will perform CPR

CPR in Malaysia…

• 1985 CPR training started in HKL

• 1986 1st ACLS conducted in Malaysia

• 2008 Formation of Malaysia Resuscitation Council

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Challenges today• Too few people know CPR

• Too few people willing to perform CPR

• We are not training the most important group of people

• Trained providers cannot remember how to perform CPR

• We have forgotten the importance of time

• Our duty to train other

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CPR according to Guidelines 2000“ Things we all do ?wrongly ”

• Too many interruptions to chest compressions(up to 48% of total time the heart was not beating)

• Rate too slow(28% achieved rates of only 60 bpm)

• Compression too soft and shallow (40% did not achieve desired depth)

• Hyperventilation (almost all the time, up to 37 breaths per min)

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CPR Guidelines keep changing

• BLS Guideline 2000• BLS Guideline 2005• BLS Guideline 2010

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Malaysia Guideline

• NCORT (National COmmittee for Resuscitation Training) for MOH Hospitals was formed in 2008.

• A policy booklet was published in February 2009 & circulated to all hospital.

• NCORT reviewed the ILCOR (International Liaison Committee on Resuscitation) consensus document & will be use for BLS training till 2016.

• Therefore National Guideline for BLS will be available soon.

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Chain of Survival

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BLS

= recognition of sudden cardiac arrest + activation of the emergency response system + early cardiopulmonary resuscitation (CPR) + rapid defibrillation with an automated external

defibrillator (AED)

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DRSABCD

• D- danger. • R-responsiveness• S-shout• A-airway• B-breathing• C-chest compression• D-defibrillation

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Danger

• Wear PPE eg. Mask, apron & gloves• Avoiding spills of body fluid, sharps and

electrical wires.• Determine unstable beds & trolleys.

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Responsiveness

• Tapping both shoulder twice & calling `Hello,hello are you ok?’ or `Tuan/Puan ok?

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Shout

• Shout after suspecting cardiac arrest`Kecemasan! Kecemasan! Bawa troli resusitasi &

defibrilator!’`Emergency! Emergency! Bring the resuscitation

trolley & defibrillator!’• Positioning of victim

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Airway

• Open airway after shouting for help –head tilt chin lift manouver.

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Breathing

• Looking at chest, neck & face not more than 10 seconds.

• Absence of breathing or presence of abnormal breathing (include agonal breathing)= cardiac arrest.

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Chest compression

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• Chest compressions consist of forceful rhythmic applications of pressure over the lower half of the sternum or centre of chest.

• To provide effective chest compressions, push hard and push fast.

• It is reasonable for laypersons and healthcare providers to compress the adult chest :

at a rate of at least 100 compressions per minute a compression depth of at least 2 inches/5 cm.allow complete recoil of the chest after each

compression to allow the heart to fill completely before the next compression

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• minimize interruptions in compressions• compression-ventilation ratio of 30:2 is recommended.

Rescue breath• Once chest compressions have been started, a trained rescuer

should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation:

A healthcare provider should use the head tilt– chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma

Deliver each rescue breath over 1 second Give a sufficient tidal volume to produce visible chest rise

(estimated about 500-600mls) 1 breath every 6 to 8 seconds (8 to 10 ventilations per minute)

should be performed when advanced airway placed. (ETT, LMA)

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Chest Compressions is GOOD

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Good CPR produce one third (1/3) of cardiac output.

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The critical role of perfusion of the brain

• “Why is it that every time I press on his chest, he opens his eyes, and every time I stop to breathe for him, he goes back to sleep?”

• Maintenance of cerebral perfusion is vital to neurological function.

• In the first 10 minutes, the most important determinant of cerebral perfusion, is the arterial pressure generated during chest compressions

Cardio-cerebral resuscitation, Ewy GA. Circulation 2005

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If chest compression not properly perform may result in…..

• Puncture lungs.• Lacerated liver.• Fracture ribs & sternum.

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Defibrillation

1 rescuer : after activating the emergency response system the lone rescuer should next retrieve an AED (if nearby and easily accessible) and then return to the victim to attach and use the AED. The rescuer should then provide high-quality CPR.

2 rescuers : one rescuer should begin chest compressions while a second rescuer activates the emergency response system and gets the AED.

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Defibrillation Sequence● Turn the AED on.● Follow the AED prompts.● Resume chest compressions immediately

after the shock (minimize interruptions).

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Reassessment during CPR

• After every 5 cycles or 2 minutes of CPR, rescuers should check for normal breathing.

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When to stop CPR?

• Victim recovers with normal breathing.• Rescuer is exhausted• Advanced life support assistance arrives.

• Rescuer shall be encourage to switch chest compression every 5 cycles or 2 minutes to avoid fatigue

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Recovery position

• No single position is perfect for all victims.• The position should be stable, near a true

lateral position, with the head dependent and with no pressure on the chest to impair breathing.

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DRSABCD

• D- danger. • R-responsiveness• S-shout• A-airway• B-breathing• C-chest compression• D-defibrillation

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Hands-only CPR

• Only about 20% to 30% of adults with out-of-hospital cardiac arrests receive any bystander

• Hands-Only (compression-only) bystander CPR substantially improves survival following adult out-of-hospital cardiac arrests compared with no bystander CPR.

• For the rescuer providing Hands-Only CPR, there is insufficient evidence to recommend the use of any specific passive airway (such as hyperextending the neck to allow passive ventilation

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PAEDIATRIC BASIC LIFE SUPPORT

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Prevention Early CPR Prompt access to EMS PALS

Intergrated post cardiac care

• Asphyxial cardiac arrest is the commonest cause of arrest in infants & children.

• Infants : < 1 year of age• Child : 1 year till puberty (~8 years old)

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• D - danger• R - responsiveness• S – shout for 999• A - airway• B - breathing• C – circulation (chest compression)• D - defibrillation

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Danger• Assess safety for rescuer

and victim.• Wear glove

Responsiveness

• Gently tap & asked loudly “ Hello. Are you okay?”

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Shout

• If child is unresponsive/gasping shout for help immediately.

2 rescuer : one start CPR & the other activate ERS.

Lone rescuer : call 999 without leave the victim. If not possible do 2 minutes CPR before activate ERS

Airway• Open airway- head tilt chin lift/jaw thrust.• Check for foreign body.

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Breathing

• Look for chest movement.

• Listen for breath sound.• Feel for air movement

on your cheek.• Should not more than

10 seconds.• If child has regular

breathing then put child in recovery position.

• Maintaining open airway, give 2 effective rescue breath.

• Make up 5 attempts to achieve effective breath.

• When giving rescue breath:• Each breath should take

about 1 second with sufficient chest rise.

• If chest doesn’t rise, reposition the head, make a better seal with mouth & try again.

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Circulation

• Absent sign of life.• Check pulse less than

10 second.• Infant : brachial/femoral

pulse.• Children : carotid pulse

• Chest compression.• Push hard & push fast.• Rate at least 100/min.• Depth : 1/3 AP diameter or

1 ½ inches (4 cm) infant & 2 inches (5 cm) in children.

• Allow complete chest recoil.• Minimize interuptions to

chest compression.• Avoid excessive ventilation.

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• Method:• Infant – lone rescuer :

compress the sternum with 2 fingers placed just below intermammary line.- 2 rescuer : 2-thumbs encircling technique.

• Child – using either 1 or 2 hands

• Chest compression: breathing ratio –

Lone rescuer – 30:2 every 2 minutes.

2 rescuer – 15:2 every2 minutes.

Only assess victim after at least 2 minutes.

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Chest compression technique

CPR ratio, breathing & depth

Adult

• 30:2 (5 cycles/2 Min)

• Once/ 6-8 seconds.(8-10x /min)

• Chest compression 2inc(5cm)

Child

• 30:2 (5 cycles)

• Once in 3 seconds (20 x /min)

• Chest compression 2inc(5cm) or 1/3 A-P diameter

Infant

• 30:2 (5 cycles)

• Once in 3 seconds

• Chest compression : 1.5 in(4cm) (20 x / min) or 1/3 A-P diameter

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FOREIGN BODY FOREIGN BODY

AIRWAYAIRWAY

OBSTRUCTIOOBSTRUCTION N

(FBAO)(FBAO)

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Adult choking

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Adult Foreign-body Airway Obstruction

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Adult choking (conscious)

• No finger sweep unless foreign body visible• In conscious pt, give 5 back slaps following

with 5 abdomen thrust/chest thrust • No abdominal thrust in unconscious pt but

CPR instead.

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Abdominal Thrust

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Chest Thrust

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Foreign-Body Airway Obstruction infant

• Conscious • Check serious difficulty in breathing • Ineffective cough • No strong cry • Dusky colour

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Foreign-Body Airway Obstruction infant

• Conscious – Give 5 back blows and 5 chest thrusts

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Foreign-Body Airway Obstruction infant

• If FBAO becomes Unconscious – Activate EMS – Open Airway ( if FB seen, remove it )– Start CPR

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