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Basic Life Support (BLS)

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Basic Life Support (BLS)

The aha’s bls course trains participants to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations and provide early use of an aed. reflects science and education from the american heart association guidelines update for cpr and emergency cardiovascular care (ecc). – powerpoint ppt presentation.

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Welcome to the Basic Life Support (BLS) algorithms and training by United Medical Education. Here we will discuss basic life saving interventions for patients in respiratory and cardiac distress and the importance of teamwork in a medical emergency. The life saving interventions of BLS are primarily for the purpose of maintaining circulation and oxygenation of the brain and other vital organs until Advanced Cardiac Life Support (ACLS) and other interventions can be initiated by trained healthcare providers.

Welcome to the free BLS algorithm page offered by  United Medical Education . Here you will be able to review critical interventions needed to save a life and earn your BLS provider card. Learn more about our  BLS certification  and build a free student account.

Need BLS Certification? It’s Trusted by Over 100,000+ Students

Register for bls certification, register for bls recertificaiton, cpr: for adults, cabd (circulation, airway, breathing, defibrillate).

There is a common acronym in BLS used to guide providers in the appropriate steps to assess and treat patients in respiratory and cardiac distress. This is CAB-D (Circulation, Airway, Breathing, Defibrillate). The following scenario will help guide you in performing CAB-D.

You find an adult lying on the ground.

Assess to make sure the scene is safe for you to respond to the down patient.

Assess Responsiveness: Stimulate and speak to the adult asking if they are ok. Look at the chest and torso for movement and normal breathing.

If unresponsive:

• (One provider) first call the emergency response team and bring an AED to the patient.
• (Two providers) Have someone near call the emergency response team and bring the AED.

Place patient supine on a hard flat surface.

Circulation

• Check the patient for a carotid pulse for 5-10 seconds. (Do not check for more than 10 seconds.)

If the patient has a pulse:

Move to the airway and rescue breathing portion of the algorithm:

• Provide 10 rescue breaths per minute (1 breath every 6 seconds).
• Recheck pulse every 2 minutes.

If the patient doesn’t have a pulse:

Begin 5 cycles of CPR (lasts approximately 2 minutes).

Start with chest compressions:

• Provide 100 to 120 compressions per minute. This is 30 compressions every 15 to 18 seconds.
• Place your palms midline, one over the other, on the lower 1/3 of the patient’s sternum between the nipples.
• lock your arms.
• Using two arms press to a depth of 2 to 2.4 inches (5-6cm) or more on the patient’s chest.
• Press hard and fast.
• Allow for full chest recoil with each compression.

1 cycle of adult CPR is 30 chest compressions to 2 rescue breaths.

If two providers are present: switch rolls between compressor and rescue breather every 5 cycles.

In the event of an unwitnessed collapse, drowning, or trauma:

Use the Jaw Thrust maneuver. (This maneuver is used when a cervical spine injury cannot be ruled out.):

• Place your fingers on the lower rami of the jaw.
• Provide anterior pressure to advance the jaw forward.

In the event of a witnessed collapse with no reason to assume a C-spine injury:

Use the Head Tilt-Chin Lift maneuver:

• place your palm on the patient’s forehead and apply pressure to tilt the head backward.
• place the fingers of your other hand under the mental protuberance of the chin and pull the chin forward and cephalic.

Scan the patients chest and torso for possible movement during the “assess unresponsiveness” portion of the algorithm. Watch for abnormal breathing or gasping.

If the patient is breathing adequately:

Continue to assess and maintain a patent airway and place the patient in the recovery position. (Only use the recovery position if its unlikely to worsen patient injury.)

If the patient is not breathing or is breathing inadequately:

• Commence rescue breaths immediately.

If the patient has no pulse:

• Begin CPR. (move to the “Circulation” portion of the algorithm.)
• Use a barrier device if available.
• Pinch the patient’s nose closed.
• Make a seal using your mouth over the mouth of the patient or use a pocket mask or bag mask.
• Each rescue breath should last approximately 1 second.
• Watch for chest rise.
• Allow time for the air to expel from the patient.

During normal CPR without an advanced airway:

• Provide approximately 6-8 rescue breaths per minute

During normal CPR with an advanced airway:

• Provide 10 rescue breaths per minute (don’t pause chest compressions for breaths).

If patient has a pulse and no CPR is required:

If there is a foreign body obstruction:

• Perform abdominal thrusts

Recovery position (lateral recumbent or 3/4 prone position):

This position is used to maintain a patent airway in the unconscious person.

• place the patient close to a true lateral position with the head dependent to allow fluid to drain.
• Assure the position is stable.
• Avoid pressure of the chest that could impairs breathing.
• Position patient in such a way that it allows turning them onto their back easily.
• Take precautions to stabilize the neck in case of cervical spine injury.

Continue to assess and maintain access of airway. Avoid the recovery position if it will sustain injury to the patient.

Defibrillate

Arrival of the AED (Automated External Defibrillator)

• Turn AED On NOW! (early defibrillation is the single most important therapy for survival of cardiac arrest and should be done as soon as it arrives).
• Follow verbal AED prompts.

Attachment:

• Firmly place appropriate pads (adult/pediatric) to patient’s skin to the indicated locations (pad image).

A short pause in CPR is required to allow the AED to analyze the rhythm.

If the rhythm is not shockable:

• Initiate 5 cycles of CPR.
• Recheck the rhythm at the end of the 5 cycles of CPR.

If the shock is indicated:

• Assure no one is touching the patient or is in mutual contact of a good conductor of electricity by yelling “Clear, I’m Clear, you’re Clear!” prior to delivering a shock.
• Press the shock button when the providers are clear of the patient.
• Resume 5 cycles of CPR.

CPR: for infants 0-1 in age

An infant is found lying on the ground.

Assess Unresponsiveness: Lightly shake or tap the infant’s foot and say their name. Look at the chest and torso for movement and normal breathing.

If the infant is unresponsive:

• (One provider) If alone and collapse is un-witnessed: First perform 2 minutes of CPR then call the emergency response team and bring an AED to the patient.
• (One provider) If alone and collapse is witnessed: First call the emergency response team and bring an AED, then start CPR.
• (Two providers) Have someone near call the emergency response team and bring the AED and you start CPR.

Feel for either the brachial or femoral pulse (Do not check for more than 10 seconds).

If the infant has a pulse:

Move to the airway and rescue breathing portion of the algorithm.

• Give 12-20 breaths per minute.
• Recheck the pulse every 2 minutes.

If the infant doesn’t have a pulse:

Start with Chest Compressions:

• (One provider) Place two fingers on the sternum of the lower chest. One between the nipple line and the other 1cm below.
• (Two providers) Encircle the infant’s torso with both hands with both thumbs pointing cephalic positioned 1cm below the nipples over the sternum.
• Chest Compressions should be at least 1.5 inches or 1/3 the depth of infant’s chest.
• Allow for full chest recoil.
• Only allow minimal interruptions to the chest compressions.

(One Provider: 1 cycle is 30 chest compressions to 2 rescue breaths) (Two Providers: 1 cycle is 15 chest compressions to 2 rescue breaths)

If you have two providers: switch rolls between compressor and rescue breather every 2 minutes or 5 cycles of CPR.

Use the Jaw-Thrust maneuver. (This maneuver is used when cervical spine injury cannot be ruled out.):

• Place your thumbs on the upper cheek bones of the infant.

In the event of a witnessed collapse and there’s no reason to assume C-spine injury:

If the infant has adequate breathing:

• Continue to assess and maintain a patent airway and place the infant in the infant recovery position. (Only use the recovery position if its unlikely to worsen patient injury)

If the infant is not breathing or is inadequately breathing:

• commence rescue breaths immediately.
• begin CPR (go to Circulation portion of the algorithm).
• Make a seal using your mouth over the mouth and nose of the patient.
• Each rescue breath should be small and last approximately 1 second.
• Provide 12-20 rescue breaths per minute (do not stop chest compressions for rescue breaths).

If the patient has a pulse and no CPR is required:

• Provide 12-20 rescue breaths per minute.

Recovery position for infants

• Cradle the infant with the infant’s head tilted downward and slightly to the side to avoid choking or aspiration.
• Continually check the infants breathing, pulse, and temperature.

Arrival of AED (Automated External Defibrillator)

• Turn AED On NOW! (early defibrillation is the single most important therapy for survival of cardiac arrest. Begin use on patient as soon as it arrives).

If shock is indicated:

• Assure no one is touching the patient or in mutual contact of a good conductor of electricity by yelling “Clear, I’m Clear, you’re Clear!” prior to delivering a shock.

Manual defibrillators are preferred for infant use. If the manuals defibrillator is not available the next best option is an AED with a pediatric attenuator. An AED without a pediatric attenuator can also be used.

CPR: for a child older than 1 year of age to puberty

You find a child lying on the ground.

Assess Unresponsiveness:

• Stimulate and speak to the child.
• Look at the chest and torso for movement and normal breathing.

(One provider) If alone and collapse is un-witnessed:

• Perform 2 minutes of CPR first then call the emergency response team and bring an AED to the patient.

If alone and collapse is witnessed:

• (one provider) Call the emergency response team and bring an AED first, then start CPR.
• (two providers) Have someone near call the emergency response team and bring the AED.
• (two providers) You start CPR.
• Check the patient for a carotid pulse for 5-10 seconds.

If no pulse:

Begin 5 cycles of CPR (lasts approximately 2 minutes)

• Use one or two arms.
• Place one or both of your palms midline, one over the other, on the lower sternum, between the nipples.
• Press at least to 1/3 the depth of patient’s chest or 2 inches.
• Allow for only minimal interruptions to chest compressions.

In the event of an unwitnessed collapse, drowning, or trauma:  Use the Jaw-Thrust maneuver. (this maneuver is used when cervical spine injury cannot be ruled out):

In the event of a witnessed collapse and there’s no reason to assume a C-spine injury:  Use the Head Tilt-Chin Lift maneuver.

Scan the patients chest and torso for possible movement during the “assess unresponsiveness” portion of the algorithm. Watch for abnormal breathing or gasping that will require additional ventilatory support.

If adequate breathing:

Continue to assess and maintain a patent airway and place the child in the recovery position. (Only use the recovery position if its unlikely to worsen patient injury)

If not or inadequate breathing: has a pulse:  Commence rescue breaths immediately. no pulse:  Begin CPR (go to Circulation portion of the algorithm).

• Make a seal using your mouth over the mouth of the patient.
• Allow time for the air to expel from patient.

During normal CPR without an advanced airway: (One provider)  Provide at least 6 rescue breaths per minute. (Two provider)  Provide at least 12 rescue breaths per minute.

• Provide 12 -20 rescue breaths per minute.

If foreign body obstruction:

• Perform abdominal thrusts.

Recovery position (lateral recumbent or 3/4 prone position)

• Continue to assess and maintain access of airway.
• Avoid the recovery position if it will sustain injury to the patient.

• Turn AED On NOW! (early defibrillation is the single most important therapy for survival of cardiac arrest. Use immediately upon its arrival to the scene).

If rhythm is not shockable:

An AED with a pediatric attenuator should be used in children under 8 years of age if available. An AED without a pediatric attenuator can also be used.

Choking: Adult to Child Over 1 Year Old

Signs and symptoms of a child/adult choking:

Universal signal for choking: patient has both hands wrapped around the base of their throat. With complete airway obstruction, the child is unable to speak, cry, or provide any sounds of respiration. The patient may be confused, weak, obtunded, or cyanotic.

Partial airway obstruction may result in stridor or a high-pitched audible noise during respiration. Partial airway obstruction may allow for a productive cough or allow the patient to speak.

Get the patient’s attention and ask them if they are choking. Assess for signs and symptoms of airway obstruction.

If partial airway obstruction:

• Do not attempt Heimlich maneuver.

If complete airway obstruction:

• (one provider) immediately call the emergency response team.
• (one provider) Attempt Heimlich maneuver
• (two provider) Send someone to call the emergency response team, while you attempt the Heimlich maneuver.

How to perform the Heimlich maneuver:

• Stand directly behind the child/adult.
• Place both of your arms around patient’s waist.
• Make a fist with one hand and grab the fist with opposite hand.
• Position the thumb end of the fisted hand immediately above the patient’s naval (ample distance away from the xiphoid process).
• Perform fast upward and inward diaphragmatic abdominal thrusts.
• Continue abdominal thrusts until the obstruction is removed.

If patient becomes unconscious:

• Initiate CPR.

Before attempting rescue breaths during normal CPR, assess the airway, removing any visually present obstruction. Do not use a blind finger sweep in an attempt to remove an obstruction.

Choking: Infant Under 1 Year Old

Signs and symptoms of an infant choking:

With complete airway obstruction, the infant is unable to speak, cry, or provide any sounds of respiration. The infant may be confused, weak, obtunded, or cyanotic.

Partial airway obstruction may result in stridor or a high-pitched audible noise during respiration. If the child has a partial airway obstruction, powerful cough, or strong audible cry, do not attempt the Heimlich maneuver.

If signs and symptoms of choking are present and infant is conscious:

• (one provider) Assess the airway for any visually present obstruction and manually remove it if possible.
• (two provider) Send someone to call the emergency response team while you assess the airway.
• Never use a blind finger sweep.

Position the patient:

• Lay infant’s face and torso down on forearm (prone) with chest being supported by your palm and their head and neck by your fingers.
• Tilt the infant’s body at a 30 degree angle, head downward (trandelenburg).
• Use your thigh or other object for support.

Interventional Back Blows:

• Provide 5 rapid forceful blows using a flat palm on the infant’s back between the two scapula.

Reposition the patient:

• Rotate the infant face up (supine), head downward (trandelenburg) by switching the infant to the opposite arm.

Interventional Chest Thrusts:

• Place your two fingers on the center of the infant’s sternum immediately below the nipple line.
• Provide 5 rapid compressions, with thrusts equaling 1/3 to 1/2 the total depth of the chest.
• Continue cycling back and forth between interventional back blows and chest thrusts until the obstruction is removed or until consciousness is lost.

If becomes unconscious:

• Before attempting rescue breaths during normal CPR, assess the airway, removing any visually present obstruction.
• Do not use a blind finger sweep in an attempt to remove an obstruction.

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Basic Life support

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The European Resuscitation Council (ERC) last issued guidelines for the resuscitation of the newly born infant in 1999 [1]. This was an "Advisory Statement" of the International Liaison Committee on Resuscitation (ILCOR). Following this, the American Heart Association and the Neonatal Resuscitation Programme Steering Committee of the American Academy of Paediatrics and representatives of the World Health Organisation, together with representatives from ILCOR, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [2,3]. The Paediatric Life Support Working Party of the European Resuscitation Council has considered this document and the supporting scientific literature and presents the ERC Newly Born Guidelines in this paper. Readers will find few changes to the ILCOR Advisory Statement recommendations as the new evidence that has emerged since its publication in 1999 has been confirmatory of the ILCOR recommendations.

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• 2021 Resuscitation Guidelines

Adult basic life support Guidelines

• There are no major changes in the 2021 Basic Life Support Guidelines.
• Cardiac arrest recognition remains a key priority as it is the first step in triggering the emergency response to cardiac arrest.
• Recognise cardiac arrest has occurred in any unresponsive person with absent or abnormal breathing.
• The ambulance call handler will assist with instructions for confirming cardiac arrest, starting compression-only CPR, and locating, retrieving and using an AED.
• Provide chest compressions as soon as possible after cardiac arrest is confirmed.
• Send someone to fetch an AED and bring it to the scene of the cardiac arrest. The British Heart Foundation database, “The Circuit” serves as a national resource for the location of AEDs.
• Use the recovery position, only if a person’s conscious level is reduced and they do not meet the criteria for starting CPR.

Introduction

Guidelines 2021 are based on the International Liaison Committee on Resuscitation 2020 Consensus on Science and Treatment Recommendations for Basic Life Support and Automated External Defibrillation and the European Resuscitation Council Guidelines for Resuscitation (2021) Adult Basic Life Support. Refer to the ERC guidelines publications for supporting reference material.

Guidelines 2021 prioritises supporting members of our communities to have the confidence, knowledge and skills to act when someone sustains an out of hospital cardiac arrest. Few major changes have been introduced as the principles of CPR remain unchanged. The guidelines emphasise that it is more important that people feel able to do something to help than they become focused on small details or concerned about causing harm. No greater harm can occur than failing to act when someone requires CPR and defibrillation.

The community response to cardiac arrest remains critical to saving lives. Bystander cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) increase the chances of survival by two to four-fold and are a critical part of UK government’s strategies to improving survival from cardiac arrest.

These guidelines are intended to support members of our communities who may be called upon to act in an emergency and to help saves someone’s life. This includes members of the public, children and family members, first responders, and those with a duty to respond (e.g. lifeguards, first aiders). They complement the Resuscitation Council UK Quality Standards for Cardiopulmonary Resuscitation and Automated External Defibrillation Training in the Community which describe that when cardiac arrest occurs, systems and education should be in place to ensure that:

• cardiac arrest is recognised early
• help is sought – shout for nearby help and dial 999
• CPR is promptly started according to current guidelines
• an AED is located, retrieved and used as early as possible.

Management of cardiac arrest in patients with known or suspected COVID-19 is not specifically included in these guidelines, but is covered within the separate COVID-19 guidance which is accessible from the RCUK website.

The process used to produce the Resuscitation Council UK Guidelines 2021 is accredited by the National Institute for Health and Care Excellence (NICE). The guidelines process includes:

• systematic reviews with grading of the certainty of evidence and strength of recommendations
• Consensus on Science with Treatment Recommendations, led by the International Liaison Committee on Resuscitation (ILCOR)
• the involvement of stakeholders from around the world including members of the public and cardiac arrest survivors. 
• Details of the guidelines development process can be found in the Resuscitation Council UK  Guidelines Development Process Manual.  

How to recognise cardiac arrest

• Start CPR in any unresponsive person with absent or abnormal breathing.
• Slow, laboured breathing (agonal breathing) should be considered a sign of cardiac arrest.
• A short period of seizure-like movements can occur at the start of cardiac arrest. Assess the person after the seizure has stopped: if unresponsive and with absent or abnormal breathing, start CPR.

How to alert the emergency services

Alert the emergency medical services (EMS) immediately by dialling 999 on your phone, if a person is unconscious with absent or abnormal breathing.

• A lone bystander with a mobile phone should dial 999, activate the speaker or another hands-free option on the mobile phone and immediately start CPR assisted by the dispatcher.
• If you are a lone rescuer and you have to leave a victim to ring the ambulance service, alert the ambulance service first and then start CPR.

High-quality chest compressions

• Start chest compressions as soon as possible.
• Deliver compressions on the lower half of the sternum (‘in the centre of the chest’).
• Compress to a depth of at least 5 cm but not more than 6 cm.
• Compress the chest at a rate of 100–120 min −1 with as few interruptions as possible.
• Allow the chest to recoil completely after each compression; do not lean on the chest.
• Perform chest compressions on a firm surface whenever feasible.

Rescue breaths

• If you are trained to do so, after 30 compressions, provide 2 rescue breaths.
• Alternate between providing 30 compressions and 2 rescue breaths.
• If you are unable or unwilling to provide ventilations, give continuous chest compressions.

How to find an AED

• The location of an AED should be indicated by clear signage .
• Ambulance services should have available up to date information on defibrillator locations, either through regional databases or national databases such as the Circuit . There are a number of apps available for the public that list defibrillator locations.

When and how to use an AED

• As soon as the AED arrives, or if one is already available at the site of the cardiac arrest, switch it on.
• Attach the electrode pads to the person's (who has sustained cardiac arrest) bare chest according to the position shown on the AED or on the pads.
• If more than one rescuer is present, continue CPR whilst the pads are being attached.
• Follow the spoken (and/or visual) prompts from the AED.
• Ensure that nobody is touching the person whilst the AED is analysing the heart rhythm.
• If a shock is indicated, ensure that nobody is touching the person. Push the shock button as prompted. Immediately restart CPR with 30 compressions. If no shock is indicated, immediately restart CPR with 30 compressions.
• In either case, continue with CPR as prompted by the AED. There will be a period of CPR (commonly 2 minutes) before the AED prompts for a further pause in CPR for rhythm analysis.

Compressions before defibrillation

• Continue CPR until an AED (or other type of defibrillator) arrives on site and is switched on and attached to the person.
• Do not delay defibrillation to provide additional CPR once the defibrillator is ready.

Fully automatic AEDs

• If a shock is indicated, fully automatic AEDs are designed to deliver a shock without any further action by the rescuer. The safety of fully automatic AEDs has not been well studied.

Safety of AEDs

• Many studies of public access defibrillation have shown that AEDs can be used safely by bystanders and first responders. Although injury to the CPR provider from a shock by a defibrillator is extremely rare, do not continue chest compression during shock delivery.
• Make sure you, the person and any bystanders are safe.
• Members of the public should start CPR for presumed cardiac arrest without concerns of causing harm to those not in cardiac arrest.
• Members of the public may safely perform chest compressions and use an AED as the risk of infection during compressions and harm from accidental shock during AED use is very low.
• Separate guidelines have been developed for resuscitation of those with suspected or confirmed acute respiratory syndrome coronavirus 2 (SARS-CoV-2) .

How technology can help

• EMS systems should consider the use of technology such as smartphones, video communication, artificial intelligence and drones to assist in recognising cardiac arrest, to dispatch first responders, to communicate with bystanders, to provide dispatcher-assisted CPR and to deliver AEDs to the site of cardiac arrest.
• The GoodSAM app ( goodsamapp.org ) is an example of technology that is used widely in the UK and internationally.

Foreign body airway obstruction

• Suspect choking if someone is suddenly unable to speak or talk, particularly if eating.
• Encourage the person to cough.
• Lean the person forward.
• Apply blows between the shoulder blades using the heel of one hand.
• Stand behind the person and put both your arms around the upper part of their abdomen.
• Lean the person forwards.
• Clench your fist and place it between the umbilicus (navel) and the ribcage.
• Grasp your fist with the other hand and pull sharply inwards and upwards.
• If choking has not been relieved after 5 abdominal thrusts, continue alternating 5 back blows with 5 abdominal thrusts until it is relieved, or the person becomes unresponsive.
• If the person becomes unresponsive, start CPR.

Recovery Position

• Kneel beside the person and make sure that both legs are straight.
• Place the arm nearest to you out at right angles to the body with the hand palm uppermost.
• Bring the far arm across the chest, and hold the back of the hand against the person’s cheek nearest to you.
• With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.
• Keeping the hand pressed against the cheek, pull on the far leg to roll the person towards you onto their side.
• Adjust the upper leg so that both the hip and knee are bent at right angles.
• Tilt the head back to make sure the airway remains open.
• Adjust the hand under the cheek if necessary, to keep the head tilted and facing downwards to allow liquid material to drain from the mouth.
• Check regularly for normal breathing.
• Only leave the person unattended if absolutely necessary, for example to attend to other people.
• It is important to stress the importance of maintaining a close check on all unresponsive individuals until the EMS arrives to ensure that their breathing remains normal. In certain situations, such as resuscitation-related agonal respirations or trauma, it may not be appropriate to move the individual into a recovery position.

ERC Guidelines 2021:  https://cprguidelines.eu/

Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020;156:A35-A79.

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BASIC LIFE SUPPORT

Aug 25, 2014

980 likes | 1.88k Views

BASIC LIFE SUPPORT. Ev-K2-CNR PYRAMID February 2007. Objectives: basic life support. Criteria to BLS access: Valutation of unconscious patient ABC: ABC valutation CPR (cardiopulmonary resuscitation). Chain of survival. Early recognition and call for help. Early CRP. Early

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Presentation Transcript

BASIC LIFE SUPPORT Ev-K2-CNR PYRAMID February 2007

Objectives: basic life support • Criteria to BLS access: • Valutation of unconscious patient • ABC: • ABC valutation • CPR (cardiopulmonary resuscitation)

Chain of survival Early recognition and call for help Early CRP Early defibrillation Post resuscitation care

Aim of BLS • To prevent/reduce the hypoxic cerebral damage using the CPR techniques in subjects with cardiopulmonary arrest • To garantee an early access in synthomatic patients at high risk of cardiopulmonary complications (IMA/stroke) to hospital

SAFETY OF BOTH RESCUER AND VICTIM IT’S THE FIRST THING TO DO. • MAKE SURE YOU; THE VICTIM AND ANY BYSTANDERS ARE SAFE. • USE RIGHT PROTECTION DEVICES. • TAKE CARE OF ANY ORGANIC SUBSTANCE.

LEGAL ASPECTS of BLS Start with CRP without thinking about: • AGE • CADAVERIC APPEARANCE • BODY TEMPERATURE • MYDRIASIS

LEGAL ASPECTS of BLS When don’t CRP start ? EVIDENT SIGNS OF BIOLOGICAL DEATH • TISSUTAL DECOMPOSITION • RIGOR MORTIS • DECAPITATION • FATAL TRAUMA

ACCESS CRITERIA • Unnconscious patients  checkAVPU • Unresponsive: • Shout for help • Turn the victim onto his back and then open the airway  BLS sequence • Responsive (V/P): • Check ABC leaving him in the position in which you find him • Try to find what is wrong with him and get help if needed • Reassess him regularly

Access to BLS protocol

Primary ABC • Level of consciousness (AVPU) • Airway • Breathing • Circulation

LEVEL OF CONSCIOUSNESS • A– Conscious (Alert) • V– Responder to Verbal stimulation • P– Responder to pain stimulation (Pain) • U– Unresponsive

Steps of the BASIC LIFE SUPPORT RAPID EVALUATION of level of consciousness

Steps of the BASIC LIFE SUPPORT HELICOPTER RAPID ACTIVATION OF THE EMERGENCY SYSTEM

BASIC LIFE SUPPORT A OPENING the AIRWAY Head tilt and chin lift

BASIC LIFE SUPPORT B ARTIFICIAL VENTILATION Look Listen Feel 10 SECONDS

BASIC LIFE SUPPORT B • ARTIFICIAL VENTILATION • If he is breathing normally: • Turn him into recovery position • Call for help • Check for continued breathig

BASIC LIFE SUPPORT B • ARTIFICIAL VENTILATION • If he is not breathing normally: • Send someone to call for help • Give 2 breaths that makes chest rise • Start chest compressions

Positive Pressure Ventilation • Essential for an adeguate PPV, in order to prevent an inadeguate/insufficient ventilation are: • Good aderece between the device of PPV and patient’s mouth • Right volume/frequency of ventilations NB: avoid rapid and forceful breaths in order to prevent: • Gastric distension • Lung injuries • Haemodinamic problems

Positive Pressure Ventilation

Mouth-to-mouth ventilation • Using head tilt and chin lift pich the soft part of the nose closed, using the index finger and thumb of your hand on the forehead. Allow the mouth to open, but mantaining chin lift. • Take a normal breath and place your lift around his mouth, making sure that you have a good seal. • Blow steadly into the mouth while watching for the chest to rise, taking about 1s as in a normal breath. • Mantaining head tilt and chin lift, take your mouth away and watch for the chest to fall as air passes out.

Barrier devices Irway to insert in patient’s mouth

One way valve Filter Pocket-Mask Device

Oropharingeal cannula

Ventilation pocketmask-to-mouth • Advantages: • No direct contact, even if no case of trasmission of HIV with mouth-to-mouth ventilation • Good oxygenation if connected to O2 • Good for rescuer with small hands

Anoxic cerebral damage in acute heart arrest • Anoxic damage starts afeter 4-6 minutes without circulation • After abut 10 minutes there are irreversible cerebral lesions

Positive Pressure Ventilation Combine rescue breaths With chest compressions

BASIC LIFE SUPPORT C • CHEST COMPRESSION: • PLACE THE HEEL OF ONE HAND IN THE CENTRE OF THE VICTIM CHEST • INTERLOCK THE FINGER OF YOUR HANDS • PRESS DOWN ON THE STERNUM 4-5 cm

CPR Allow complete chest recoil Push hard Push fast Deep of compression: 4-5 cm Compression and release should take equal amount of time

BASIC LIFE SUPPORT C RITHM 30:2 RATE 100/MIN IF THERE IS MORE THAN ONE RESCUER PRESENT, ANOTHER SHOULD TAKE OVER CPR EVERY 1-2 MIN YO PREVENT FATIGUE. ENSURE THE MINIMUM OF DELAY DURING THE CHANGEOVER.

BASIC LIFE SUPPORT Continue with chest compressions and rescue breaths in a ratio of 30:2 with 5 cycles in 2 minutes

BASIC LIFE SUPPORT • Remember to continue resuscitation until: • Qualify help arrives and takes over • The victim starts breathing normally • You become exausted

Recovery position FOR UNRESPONSIVE VICTIMS WITH NORMAL BREATHING AND EFFECTIVE CIRCULATION The position shoul be stable, near a true lateral position with the head dependent and no pressure on the chest to impair breathing.

Recovery position Place the arm nearest to you at right angles of the body, elbow bent with the hand palm upper-most.

Recovery position Bring the far arm across the chest and hold the back of the hand against the victm’s cheek nearest to you.

Recovery position With your other hand, grasp the far leg just above the Knee and pull it up, keeping the foot on the ground.

Recovery position If the victims has to be kept in the recovery position for more than 30 minutes turn him to the opposite side.

FOREIGN-BODY AIRWAY OBSTRUCTION ADULT FBAO TREATMENT ASSESS SEVERITY SEVERE AIRWAY OBSTRUCTION (ineffective cough) MILD AIRWAY OBSTRUCTION (effective cough) Encourage cough Continue to check for deterioratin to ineffective cough or until obstruction relieve Conscious 5 back blows 5 abdominal trusts Unconscious Start CPR

He’s ablle to cough and talk FOREIGN-BODY AIRWAY OBSTRUCTION Cough..yes!! “Are you chocking?!” ENCOURAGE HIM TO CONTINUE COUGHING BUT DO NOTHING ELSE! MILD OBSTRUCION

UNCONSCIUOSNESS WHEEZY BREATHING SILENT ATTEMPTS TO COUGH CYANOSIS CANNOT SPEAK CANNOT BREATH FOREIGN-BODY AIRWAY OBSTRUCTION ….. “Are you choking?!” SAY “YES” BY NODDONG HIS HEAD WITHOUT SPEAKING! SEVERE AIRWAY OBSTRUCTION

“HEIMLICH” MANEUVER TREATMENT OF CONSCIOUS VICTIM, STANDING UP WITH SEVERE AIRWAY OBSTRUCTION • STAND BEHIND VICTIM • PUT BOTH HANDS ROUND THE UPPER PART OF THE ABDOMEN • LEAN THE VICTIM FORWARDS • CLENCH YOUR FIST AND PLACE BETWEEN THE UMBILICUS AND XIPHISTERNUM • GRASP THIS HAND WITH THE OTHER AND PULL SHARPLY INWARDS AND UPWARDS

“HEIMLICH” MANEUVER NOT RECCOMMENDED FOR CHILDREN UNDER 1 YEAR, OBESE VICTIMS AND PREGNACY WOMAN

If THE PATIENTS BECOMES UNCONSCIOUS IMMEDIATELY ACTIVATE EMS FOREIGN-BODY AIRWAY OBSTRUCTION CPR If while CPR, when you open the airway to give rescue breaths, YOU CAN SEE solid material: remove it!

RESUSCITATION OF CHILDREN The adult sequence can be used also in not responsive and not breathing children; Give 5 initial rescue breaths before starting chest compressions; A lone rescuer should perform CPR for approximately 1 min before going for help; Compress the chest by approximately 1/3 of depth; Use 2 fingers for an infant under 1 year.

FROSTBITE I DEGREE: PARTIAL THIKNESS SKIN FREEZING WITH EDEMA AND ERYTHEMA WITH STINGING OR BURNING PARESTHESIAS, NO BLISTERS. II DEGREE: TOTAL THIKNESS SKIN FREEZING WITH CLEAR BLISTERS THAT DESQUAMATE TO FORM BLACK, HARD ESCHAR WITH NUMBNESS AND ACHING. III DEGREE: DAMAGE TO SUBDERMAL PLEXUS WITH HEMORRHAGIC BLISTERS AND BLUE-GRAY SKIN. FEELING LIKE “BLOCK OF WOOD”. IV DEGREE: DAMAGE TO NERVE, BONE AND TENDOMS. NON EDEMA WITH NONBLANCHING CYANOSIS WITH DEEPER, ACHING, JOINT-TYPE PAIN.

FROSTBITE • BRING THE VICTIM IN A PROTECTED PLACE • TAKE OUT CLOTHES, IN PARTICULAR IF TIGHT OR WET • !! BE CAREFUL TO BOOTS • TAKE OUT RINGS • DRY THE DAMAGED PART CAREFULLY • WARM UP WITH THE BODY OF A FRIEND FOR 10 MIN • (AXILLA OR ABDOMEN) • GIVE WARM NOT ALCOHOLIC DRINKS • PUT ON BOOTS AND IF YOU CAN FEEL AGAIN • START WALKING

FROSTBITE • BRING IN A WARM PLACE • PUT IN WARM WATER (WITH AN ANTISEPHTIC AGENT) AT 37°C FOR 1 HOUR • DRY CAREFULLY • PUT COTTONS BETWEEN FINGERS • KEEP THE PART UP • REST • GIVE : -ASPIRIN 500-1000 mg • -IBUPROPHEN 400-800 mg

FROSTBITEDON’T DO • BRUSHING WITH HANDS, SNOW, ALCOHOL, • WOOL,… • PUT IN HOT WATER • EXPOSURE TO INTENSIVE HEAT (like fire…) • UNROOF BLISTERS • GIVE ALCOHOLIC DRINKS

Lassitude Headache Excessive fatigue Nausea, Vomiting Symptoms of acute mountain sickness

Peripheral edema • Orbital, hands, feeds • Lip cyanoses • Mental dysfunction • Ataxia Signs of acute mountain sickness

The Lake Louise consensus on definition of altitude illness • Acute mountain sickness (AMS) • Headache + • Gastrointestinal symptoms (anorexia, nausea, vomiting) • Fatigue or weakness • Dizziness or lightheadedness • Difficulty sleeping • "Endstage" of AMS = High altitude cerebral edema (HACE) • Changes in mental status and/or • Ataxia in the presence of AMS

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