Basic Life Support

Life Saving Procedures

• BLS involves prompt recognition of breathing difficulties/cardiac arrest and emergency treatment

• skills included: how to clear an obstructed airway, perform CPR, use an AED

• all events and athletic sites should have EMergency Action Plans

• remember PPE whenever there is a potential for exposure to blood or other bodily fluids

CPR

• cardiopulmonary resuscitation

• combines rescue breathing and chest compressions

  • rescue breathing supplies oxygen to the lungs

  • chest compressions circulate blood throughout th body

• CPR completed whenever heart and lungs stop working

• when performed correctly, can maintain perfusion in a patient

• cardiac arrest=absence of a heartbeat

• clinical death=both respirations and pulse cease

• cells have residual oxygen supply and can survive a short time without new oxygen

• after 4-6 minutes without a pulse or respiration, brain does not receive oxygen that is vital to all body organs, brain cells begin to die

Sudden Cardiac Arrest

• when approaching an unknown emergency, maintain distance and call for help

• each minute a patient is in arrest, the chance of survival decreases by 10%

Chain of Survival

• chain of survival consists of five links:

  • early access to EMS

  • early high quality CPR

  • early defibrillation

  • early advanced care

  • multidisciplinary post-cardiac arrest care

• any weak link reduces a patient’s chance of survival

Prevention and Preparedness

• foundation of early recognition of cardiac arrest and rapid response

• out of hospital = unexpected, at a public setting or at home

  • successful outcomes depend on early high quality CPR and rapid defibrillation in the first few minutes after the arrest

  • organized community programs can prepare the public to respond quickly

• prevention = measures to improve the health of individuals and communities

• preparedness = public awareness programs and trainging to help people recognize the signs of a heart attack

  • community CPR training and emergency response system development

  • emergency telecommunication helps increase rates of bystander CPR (T-CPR)

• widespread AED availability supports early defibrillation

Activating the Emergency Response System

• out of hospital: shouting for nearby help, calling 911

High Quality CPR and Early Defibrillation

• when started immediately after cardiac arrest can double or triple the chances of survival

• Hands-Only CPR or T-CPR

Advanced Resuscitation Interventions

• performed by medically trained providers

• obtaining vascular access, giving medications, placing an advanced airway

• obtaining a 12-lead ECG or starting advanced cardiac monitoring

• lay rescuers provide CPR and defibrillation with an AED until a multi-rescuer team takes over

Post Cardiac Arrest Care

• all cardiac arrest victims receive post cardiac arrest care

• routine critical care support (artificial ventilation and BP management)

• begins in field, continues during transport

Recovery

• continues long after hospital discharge

• may address underlying cause of cardiac arrest or provide cardiac rehabilitation

• psychological support to the patient and family

SETUP

• Stop: pause and look for any obvious hazards

• Environment: account for any environmental barriers or dangers

• Traffic: be careful when providing first aid near a roadway

• Unknown hazards: be aware of unknown hazards that were not initially apparent

• Protect yourself and the patient: use of gloves and breathing barriers to prevent diseases that can be spread through open cuts and mucous membranes

Assess Responsiveness and Airway Patency

• introduce yourself

• tap and shout

• check airway- head tilt, chin lift

  • position one hand on the patient’s forehead while placing the fingertips of the other under the bony part of the chin to open the airway

  • apply firm, backward pressure on the patient’s forehead while lifting the chin upwards

  • once the airway is open, keep one hand on the forehead to maintain the airway

  • inspect the patient’s mouth, remove any visible foreign materials

Airway Management Suctioning Techniques

1. turn the unit on, attach a catheter, test for suction

2. position yourself at the patients head and turn the patients entire body to the side

3. open and clear the patients mouth

4. place the convex side of the rigid tip against the roof of the mouth, insert just to the base of the tongue

5. apply suction after rigid tip is in place, suction while withdrawing the tip

6. if using a flexible catheter, measure it from the patient’s earlobe to the corner of the mouth or from the center of the mouth to the angle of the jaw

Oropharyngeal Airway

1. ensure oropharyngeal airway is the correct size by checking it extends from the center of the mouth to the angle of the jaw or from the corner of the mouth to the tip of the earlobe

2. use crossed fingers technique to open the patient’s mouth

3. insert the airway with the tip pointing to the roof of the mouth

4. rotate it 180 degrees, flange should rest against the patient’s mouth

Nasopharyngeal Airway

1. measure from patients nostril to the tip of the earlobe or the angle of the jaw

2. apply water based lubricant before insertion

3. gently push the tip of the nose upward and insert airway with the beveled side towards the base of the nostril or towards the septum. insert airway until the flange rests against the nostril

   
   

Ventilations

1. place a shield over the patient’s mouth

2. take a normal breath, then press your mouth against the shield to create an airtight feel

3. if the patient is not breathing, provide two rescue breaths

4. each breath should be one second long and have sufficient volume to create a visible rise in the patients chest

5. remove your mouth and allow the patient to completely exhale while taking a fresh breath to provide the second ventilation (ventilate adult patient 10-12 times per minute and child 12-20 times per minute)

6. if pocket mask has oxygen inlet, provide supplemental oxygen

Circulation

• check for obvious signs of circulation (pulse in the neck, carotid pulse)

• indicate adequate blood flow

  • normal breathing, movement, pulse

• chest compressions

  • patient should have their back on flat, firm surface

  • rescuer places heels of the hands on the center of the sternum

  • place the other hand on top of the first while interlocking fingers

  • begin at a depth of 1 ½ to 2 inches at 30 compressions: 2 ventilations

  • about 100 times/minute

  • for newborns, encircle chest with fingers and overlap thumbs on the sternum

  • for average sized newborns, place thumbs side by side

  • for infants, place middle and ring fingers on sternum

Resuscitation Management

• when more rescuers are available for a resuscitation attempt, they can perform more tasks at the same time

• rescuer 1: provide compressions

  • switch compressors every 2 minutes, limit any interruptions to less than 10 seconds

• rescuer 2: provide breaths

  • position at victim’s head, maintain airway using head tilt, chin lift or jaw thrust

Automated External Defibrillator (AED)

• small, portable devices that can accurately identify whether defibrillation is needed

• analyzes heart rhythm, advises rescuer when shock is indicated, provides necessary shock to patients through electrode pads

• improve survival rates up to 50%

Cardiac Arrest Rhythms

• of the four arrhythmias implicated in cardiac arrest, defibrillation is indicated for two shockable rhythms

• Ventricular fibrillation: heart’s electrical impulses are disorganized, preventing heart from contracting normally

  • heart will appear to be quivering like a “bag of worms”

  • present in up to 50% of out-of-hospital cardiac arrest patients

• Ventricular Tachycardia: heartbeat is rapid and will not allow heart’s chambers to fill with enough blood between beats to produce blood flow sufficient to meet body’s needs

  • present in up to 10% of patients

• non shockable rhythms are where defibrillation is not effective

• Pulseless Electrical Activity: heart’s electrical rhythms remains relatively normal, but mechanical pumping activity fails to follow electrical activity

  • present in 15-20% of patients

• Asystole: heart has ceased generating electrical impulses, flatlining

  • 20-50%

Basic AED Operations

1. turn AED on

2. attach electrode pads to patient (one below patients right clivicle beside sternum other above patients left ribs)

3. allow AED to analyze heart’s rhythm

4. AED will charge automatically, press button to deliver shock

• patients chest must be dry

• after shock, start CPR immediately-stop if directed by AED, EMS provider, or patient moves

CPR Exceptions

• obvious mortal wounds: decapitation, incineration, severed body

• rigor mortis: stiffening of body and its limbs that occurs after death, within 4-10 hours

• line of lividity: red or purple skin discolouration that occurs when gravity causes blood to sink to the lowest parts of the body

  • indicates patient has been dead for more than 15 minutes unless they have been exposed to cold temperatures

• stillbirth: recognized by blisters on skin, soft head, strong odour

• stop CPR if:

  • arrest was not witnessed by EMS personnel or first responders

  • no return of spontaneous circulation after three rounds of CPR and rhythm checks with an AED

  • AED did not detect a shockable rhythm

Foreign Body Airway Obstructions

• an unconcious person can have an obstructed airway due to the positino of the airway

  • tongue or epiglottis, use head tilt, chin lift maneuver

• choking results from a partial or complete airway obstruction

  • if partial, patient will be able to cough and exchange some air-encourage coughing

  • if complete, patient cannot cough, speak, or breathe-will usually grasp neck

Obstructed Airway Maneuver

• stand behind conscious victim

• wrap hands around victims waist, make a fist with one hand

• place the thumb side of the fist against the victim’s abdomen directly above the navel

• grasp fist with other hand and attempt to knock the wind out of person

• continue in sets of 5 until obstruction is removed or victim becomes unconscious

• if victim is an infant: give up to 5 back blows and 5 chest thrusts

  • if unresponsive open airway and attempt to ventilate, then start CPR

  • when alone activate EMS system after 2 minutes

• if victim becomes unconscious: lay them in a supine position

  • place heel of one hand against victim’s abdomen above the navel

  • place other hand on top of the first and deliver upward abdominal thrusts five times

  • open mouth and do a finger sweep

• if victim is pregnant or obese: use alternate chest thrust

  • stand behind victim, place arms under victim’s armpits encircle the chest

  • place thumb side of your fist in the middle of the victim’s chest, grab other hand, quick backwards thrust

  • sets of 5