Melaka

Healthy Living

Carnival 2013

Basic Life Support

by DR. MOHD SAFIEE DAUD

Medical Officer Melaka Emergency & Traumatology

Department

CPR LECTURE

Hospital Melaka

Teori asas yang kita perlu tahu…

1. Anatomy dan physiology jantung dan paru2

2. Penyakit koronari, cara hidup sihat dan tindakkan kecemasan

3. ‘Choking’, pencegahan dan tindakkan.

4. Konsep ‘clinical/ biological death’

5. ‘Chain of survival’

6. DR. ABCD of CPR dan teori

Trauma

TLS

MTLS

ATLS

Paediatric

NRP

PALS

BLS

ALS

CPR

Lidah

Sebab2 penting kematian mengejut

Serangan jantung ‘Choking’ Stroke Drowning

Electric shock

Trauma (bleeding) Drug poisoning

Serangan

jantung

Atherosclerosis

BLOOD VESSEL DISEASE

Atherosclerosis

RISK

FACTORS

Kenali dan kawal

faktor risiko

Serangan jantung (Artherosclerosis) di sebabkan oleh

1. DIABETES

2. HYPERTENSION

3. MEROKOK

4. HYPERLIPIDEMIA

5. OBESITY

6. SEDENTARY LIFE STYLE

7. STRESS

Healthy life targets to achieve

RISK ALL AT RISK

SMOKING NO

DIABETES <6.5% (RBS/FBS/HBA1c)

HYPERTENSION <140/90 <130/80

T. CHOLESTEROL 5.4mmol/l <4.5

LDL-CHOLESTEROL 4.1mmol/l <2.6

HDL CHOLESTEROL 1.1mmol/l >1.1

AEROBIC EXERCISE 30 min, 3 X a week

OBESITY LOSE 5 % LOSE 10%

Simple advice

1. Aerobic exercise: at least 20min 3 X a week.

2. Avoid meat fat and chicken skin.

3. Reduce sugar, salt and oil intake. 4. Limit egg yolk, shelled sea food, fried foods.

5. Chose marjarine over butter.

6. Chose boiling, steaming, roasting and saute over frying and curry.

7. Relaxation and finding peace in our work and homes. Learning to say no and being positive.

8. No smoking

9. No alcohol or in moderation only.

Langkah kecemasaan untuk mangsa

disyaki mengalami serangan jantung

Kenali tanda serangan jantung

Duduk atau baring

Dapatkan Asprin 300mg, kunyah atau bancuh dengan air.

Satu biji GTN tablet di bawah lidah jika ada.

Ulangi setiap 5 minit jika perlu sebanyak tiga kali.

Panggil ambulan (999) ATAU bawa mangsa ke

Jabatan Kecemasan Hospital terdekat.

4 min brain death begins

10 min brain death certain

02 Room - 21%

Expired air - 16%

I want oxygen!

Chain of survival

Early

Access

Early

CPR

Early

Defibrillation

AED

Early

ALS

CHANGES IN NEW GUIDELINES 2010

1. Cardiac arrest will be recognized by unresponsiveness and absence of normal breathing

2. Gasping and agonal breaths will be highlighted as abnormal

breathing and indicators of cardiac arrest.

3. Carotid pulse check will not be performed prior to beginning

chest compressions.

4. Chest compressions will begin immediately after the absence

of normal breathing.

5. Chest compressions will resume immediately after delivery of

the first shock from a defibrillator.

DR S ABCD

1.D - DANGER

2.R - RESPONSIVENESS

3. S - SHOUT FOR HELP

4.A - AIRWAY

5. B - BREATHING

6.C - CIRCULATION

7. D - DEFIBRILLATION

DANGER

a. Wearing Personal Protective Equipment (PPE)

, eg: mask, apron, and gloves ( the availability

will be depend on the situation )

b. Avoiding spills of body fluids, sharps and

electrical wires (at bedside)

c. Determining unstable beds and trolleys

RESPONSIVENESS

Responsiveness will be assessed by tapping both shoulder twice and calling

‘ Hello are you OK ‘ or ‘ Tuan / Puan OK ‘

SHOUTING

shout the following words after suspecting a cardiac arrest or patient not responding to call .

“Emergency ! Emergency ! Bring the resuscitation trolley and defebrillator ! . / call 999 and get an AED !”

AIRWAY

Open the airway after shouting for help using the head tilt , chin lift manouver ,

BREATHING

-Assess by looking at the chest , neck and face for not more than 10 seconds.

-The absence breathing or presence of abnormal breathing will indentify cardiac arrest .

-Agonal gasp is a sign of cardiac arrest .

-Begin chest compression immediately with absence of normal breathing .

Checking pulse is not recommended prior to initiation of first chest compression.

CHEST COMPRESSION 1.Place the heel of your hand in the centre of the chest with other hand

on top .

1. A rate of at least 100-120 compression per minutes.

2. Depth at least 5 cm.

3. Complete recoil of the chest must be allowed after compression

4. Interruption of chest compression shall be minimized during the entire resuscitation attempt.

5. Ratio of chest compression to ventilation shall be 30 : 2

VENTILATION

a. Use personal protective devices where available

b. Each breath shall be given within 1 second inspiratory time until you observe a chest rise.

c. Mouth to mouth ventilation shall be taught for outside of the hospital and in hospital areas without bag-mask devices.

DEFIBRILLATION

Early defibrillation is an essential step in the chain of survival for victims of cardiac arrest.

Chest compression should immediately resume after 1 shock .

Reassessment during CPR

After every 5 cycles or 2 minutes of CPR , rescuers should

check for normal breathing.

When to do pulse check

For healthcare professionals it is reasonable to check a pulse if an organized rhythm is visible on the monitor at the next rhythm check.

When to stop CPR

a. When the victim recovers with normal breathing

b. Rescuers is exhausted

c. When advanced life support assistance arrive

Rescuers shall be encouraged to switch chest compression every 5 cycles or 2 minutes to avoid fatigue.

RECOVERY POSITION

Recovery when victims resume normal breathing but remain unresponsive .

The technique taught must ensure the following :

a. Victim in true lateral position

b. Position is stable

c. Position is safe and comfortable

d. Head in dependant position

Special situations

1. Vomiting

2. Neck injury

3. Dentures

4. Drowning

5. Refuse mouth to mouth ventilation

6. When to stop CPR

How do we count………..?

1. For determining time…one in a thousand, two in a thousand….

We count for not more than 10 seconds when assessing

for signs of breathing.

2. For chest compression…1, 2, 3, 4 … 13, 14, ..29,30

30 chest compressions and 2 ventilations..

THANK YOU