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    Basic Life Support (BLS) & G

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    Dhanush P

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    Basic Life Support (BLS) & G

    Uploaded by

    Dhanush P
    8 views20 pages

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    Basic Life Support (BLS) & g

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    © All Rights Reserved
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    8 views20 pages

    Basic Life Support (BLS) & G

    Uploaded by

    Dhanush P

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 20

    BASIC LIFE SUPPORT

    (BLS) & ADVANCED


    CARDIAC LIFE SUPPORT
    (ACLS)

    Presented By : Dr. Mansi Shah,


    MD Medicine
    1
    Step 1: Identify

    Identify unresponsiveness or absent, gasping, or abnormal


    breathing at earliest possible time
    If an adult is found unresponsive, there is no witness to
    cardiac arrest, assume sudden cardiac arrest, until proven
    otherwise

    EMED Class day 1


    2
    SCENARIO
    •You find an unresponsive middle
    aged man lying unresponsive on the
    sidewalk.
    •What’s your next best step?
    3
    STEP 2
    1. Verify scene safety
    2. •Check for responsiveness
    3. •Shout for nearby help
    4. •Activate emergency response
    5. •Get AED & emergency equipment
    4
    STEP 3 : CHECK
    Look for no breathing or only First Possibilty
    Normal breathing &
    gasping & check the pulse
    Pulse felt =
    simultaneously Monitor
    For 5 to 10 seconds

    Second Possibility
    Third Possibility
    No normal breathing
    No breathing & pulse felt = Pulse felt
    START CPR Rescue breaths 10/min
    Check for pulse every 2 mins
    (Naloxone?)
    Ideal Chest Compressions
    •golden rule - "push hard, push fast" on the centre of the chest
    •Push hard = 5 – 6 cm
    •Push fast = 100-120/min
    •Centre of the chest = Heel of one hand in the centre of the chest over
    the lower half of the sternum and the heel of their other hand atop the
    first. The rescuer's own chest should be directly above their hands with
    the elbows held in extension.
    •Compression only if lone rescuer
    5
    AIRWAY & BREATHING IN BLS
    •When more trained rescuers are present - delivery of 30 chest compressions
    1 followed by two rescue breaths (30:2) with each ventilation over no more than one
    second.

    •Provide only enough tidal volume to observe the chest rise (approximately 500 to
    2 600 mL, or 6 to 7 mL/kg).

    •Compressions are paused briefly for ventilation when using a bag-valve-mask


    3 (BVM) (i.e.) without an advanced airway.
    6
    START CPR
    Chest compressions 100-120/min, 5 to 6 inch in depth
    Airway Head tilt, chin lift
    Breaths 2 rescue breaths 1 second each (30:2), enough to cause chest rise
    C–A–B

    When AED arrives


    AED arrives. Resume CPR. Check pulse at 2 mins. Continue till ALS provider
    arrive
    7
    SHOULD WE CONTINUE?

    Non-shockable initial cardiac arrhythmia (eg, asystole, pulseless electrical activity [PEA])
    -No return of spontaneous circulation (ROSC) prior to administration of third 1 mg dose of epinephrine
    8
    ENHANCE TO ACLS
    •Enhance : C – A – B
    •Cardiac monitor, blood pressure probes, oximetry
    •IV access at least 2, large bore , Iv fluids
    •12 lead ECG
    •Consider possible hypoxic & toxicologic causes
    •5H & 5T
    •Hypoxia, Hypovolemia, Hypo- or Hyperkalaemia, Hypo- or
    Hyperthermia, Hydrogen ions (acidosis)
    •Tension pneumothorax, Tamponade, Thrombosis (MI),
    Thromboembolism (PE), Toxins or Tablets (drug overdose)
    •POCUS
    5
    MONITOR QUALITY OF CHEST COMPRESSIONS
    Larana University | 2024

    Mechanical devices that provide real-time feedback of chest compression rate and
    1 depth and of adequate chest recoil

    End-tidal carbon dioxide (EtCO2) measurement, which reflects the quality of chest
    2 compressions (see "Carbon dioxide monitoring (capnography)") targeting chest
    compressions to an EtCO2 ≥20 mmHg may be useful

    Arterial diastolic blood pressure measurement using invasive arterial pressure


    3 monitoring if the line is already in place. A reasonable goal is to maintain an arterial
    diastolic pressure above 20 mmHg. (Do not interrupt CPR for line placement)
    9

    Airway
    An advanced airway (eg, supraglottic device, endotracheal tube) can be placed
    without interrupting CPR
    •If intubation is to be performed during cardiac arrest, it must be done by a
    trained provider, ideally require less than 10 seconds to complete

    Breathing
    •deliver breaths every 8 to 10 seconds.
    •Bag & mask ventilation is preferred. (no need to squeeze the bag completely)
    •Provide 100 percent oxygen during CPR.
    10
    RHYTHM CHECK & DEFIBRILLATE
    •Rhythm check 5 – 10 seconds
    •Pad placement – Anterolateral or
    anteroposterior
    Avoid placement over pacemaker
    •Shockable – Defibrillate – max charge (200 for
    biphasic, 360J for monophasic)
    •Check pulse after 2 mins of delivering shock due
    to delay in restoration of effective ventricular
    contraction, continue chest compressions till
    then
    Continue CPR
    Give Adrenaline 1 mg every 3 to 5 •After 3 shock delivered;
    mins (Alternate CPR cycle) Consider anti arrhythmics amiodarone
    MOA - alpha-1 agonism, increases or lidocaine
    diastolic blood pressure and amiodarone (300 mg IV/IO bolus with a
    coronary perfusion pressure. repeat dose of 150 mg IV as indicated)
    Can be given for both shockable lidocaine (1 to 1.5 mg/kg IV/IO bolus,
    (after 1st shock delivery) & non- then 0.5 to 0.75 mg/kg every 5 to 10
    shockable. minutes)
    Note – if rhythm looks like asystole,
    Atropine is no longer recommended for the
    treatment of asystole or PEA. Cardiac pacing is increase the amplitude of the device to
    ineffective for cardiac arrest and not unmask fine VF (a shockable rhythm)
    recommended
    with better prognosis.
    DECISION TO STOP 12

    RESCUSCITATIVE OFFERS
    -Duration of resuscitative effort >30 minutes without a sustained
    perfusing rhythm
    -Unwitnessed collapse with an initial ECG rhythm of asystole
    -Prolonged interval between time of collapse and initiation of
    cardiopulmonary resuscitation (CPR)
    -Patient age, severe comorbid disease, or prior functional dependence
    -A very low EtCO2 (<10 mmHg) following prolonged resuscitation (>20
    minutes) is a sign of absent circulation and a strong predictor of acute
    mortality always rule put misplaced tube or broken circuit
    THANK YOU
    Presented By : Dr. Mansi Shah

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