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AHA BLS

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AHA guideline of BLS. Very important and must learn. exPlained in a very basic.

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AHA BLS

  1. 1. DR. ANKIT GAJJAR MD, IDCCM, IFCCM, EDIC (CONSULTANT INTENSIVIST) TOPIC- BLS
  2. 2. WHAT IS CARDIAC ARREST  Cessation of normal circulation of blood due to failure of heart to contract effectively.  Sudden cessation of mechanical activity of heart with some or no electricalactivity.  May be reversible by a rapid intervention but will lead to death in its absence.
  3. 3. REVERSIBLE CAUSES OF CARDIAC ARREST 5 Ts:  Pulmonary thromboembolism Tension pneumothorax  Cardiac Tamponade Toxins (TCAs,b- blockers,ca channel blocker,digoxin) Coronary thrombosis 5 Hs:  Hypoxia  Hypovolemia  Hypo/hyperkalemia  Hydrogen ions  Hypothermia
  4. 4.  M.I.  Arrhythmia  Low C.O.,failure,shock  Cardiomyopathy  Myocarditis  Massive pulmonary emboli CARDIAC: OTHERS  Coronary artery disease  Severe anaphylaxis  Suffocation  Electrocution  Trauma  Stroke  Exsanguination (severe loss of blood)  Drowning CAUSES OF CARDIAC ARREST
  5. 5. BLS  Its Cardiopulmonary Resuscitation (CPR).  It Combines rescue breathing and chest compressions  It requires knowledge and skill to perform CPR and how to operate AED / defibrillartor.  These are Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest
  6. 6. ABC to CAB
  7. 7. Basics of BLS • Chest compressions • Airway • Breathing • Defibrillation
  8. 8. STEPS of BLS  Assessment and scene safety 1. Scene is safe?? 2. Asses the patient 3. Check breathing
  9. 9. Assesse the patient  Shake shoulders gently  Ask “Are you all right?”  If he responds  Find out what is wrong.  Reassess regularly.
  10. 10. Check for pulse: no more than 10 sec Feel the pulse Feel the pulse at least for 5 seconds Slide the finger laterally Into the groove between trachea and muscle Locate the trachea Using 2 or3 fingures
  11. 11. SHOUT FOR HELP
  12. 12. Start CPR  Ratio: 30:2  High quality CPR  Chest compression is foundation of CPR  Push hard and push fast  100-120/min  2.5-2-1.5 inch depth  Allow complete chest recoil  Avoid excessive ventilation  Minimize interruption  <10 seconds  Effective rescue breaths.
  13. 13. Chest Compressions  Position yourself at patient’sside  Victim should be laid on firm, flat surface  Remove the clothings of the patient.  Put the heel of one hand on the centre of chest (sternum) at the level of nipples and put your other hand on the top of the former hand.
  14. 14.  Strengthen arms and shoulders ditrectly over hands  Lockall joints ; movement is allowed only at hip joint  Pushhard and fast (100 - 120 times/ min)  At the end of each compression, chest is allowed torecoil completely  Avoid excessiveventilation  Then give next compression immediately
  15. 15. ChestCompressions
  16. 16. Mechanisms • CardiacPump– 1. Blood pumping is assured by compression of heartbetween sternum andspine 2. Between compressions, thoracic cageexpands and heart gets filled with blood.
  17. 17. Thoracic Pump
  18. 18. Opening the airway
  19. 19. Caution  Do not press deeply into the soft tissue  Don’t use thumb to lift the chin  Don’t close mouth completely
  20. 20. Jaw thrust
  21. 21. RESCUE BREATHS 26 RECOMMENDATIONS: - Tidal volume 500 – 600 ml - Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise
  22. 22. Types  Mouth to mouthbreathing  Mouth to barrier device breathing  Mouth to nose and mouth tostoma ventilation  Ventilation with bagandmask
  23. 23. Mouth-To-Mouth breath
  24. 24. Mouth-To-Nose breath  Given when mouth cant beopen  Good seal cant be made  Severeinjury present over area of mouth
  25. 25. Mouth-To-Barrier device
  26. 26. Bagand Mask ventilation  Position yourself directly above patient’shead o Perform headtilt o Make “C”with thumb and index finger to seal the mask o And other 3 fingers,forms“E” jawthurst o Chestrise is checked while squeezing the bagto give breaths to thepatient.
  27. 27. BagAnd Mask Ventilation
  28. 28.  Defibrillation is used for the treatment of tachydysrhythmias.  Defibrillation depolarises the critical mass of myocardial cell at once. It recaptures the SA node as its role as the pacemaker .  Is treatment of choice for pulseless VT/VF. Prof. Dr. RS Mehta, BPKIHS Defibrillation
  29. 29. DEFIBRILLATION
  30. 30. Ventricular tachycardia 35 Prof. Dr. RS Mehta, BPKIHS
  31. 31. Ventricular fibrillation 36 Prof. Dr. RS Mehta, BPKIHS
  32. 32. Defibrillators can be classified as : Monophasic(delivers current of one polarity only) Biphasic (deliver current of 2 polarity) Defibrillator 37 Prof. Dr. RS Mehta, BPKIHS
  33. 33. Position of defibrillator paddle:  1st paddle - on the right side of the chest just below the clavicle  2nd at precordial, region.  Paddle should be applied with pressure equivalent to 10 kg. 38 Prof. Dr. RS Mehta, BPKIHS
  34. 34.  Adult: 13cm  Children:8cm  Infants:4.5cm Latest Recommendation for shock protocol ; Previous recommendation of 3 successive shock (200,300,360J) Now a days only single shock is recommended .i.e. 360J by monophasic 150-200J by biphasic Paddle size 39
  35. 35.  Apply conducting jelly between the paddle and the skin.  Place the paddle so that they don't touch patient’s clothing and bed linen and aren't near medication and direct oxygen flow.  Ensure that defibrillator is not in synchronized mode.  Don't charge the device until ready to shock  keep the thumbs and fingers off discharge button until paddle are on Nurses role while performing defibrillation
  36. 36.  Before pressing the discharge button call “ all clear” 3 times 1st clear: Ensures" YOU” aren’t touching patient,bed, equipment 2nd clear: Ensures “no one" is touching patient, bed , equipment 3rd clear: Ensures “you and everyone" else are clear off the patient and anything touching the patient. Nurses role in defibrillation
  37. 37. Nurses role in defibrillation  Record the delivered energy and the results (cardiac rhythm and pulse).  After the event is complete inspect the skin under the pads and paddles for burns , and if any detected consult about the treatment. 42 Prof. Dr. RS Mehta, BPKIHS
  38. 38. First turn it on. Then simply follow instructions. Using an AED 43
  39. 39. AUTOMATED EXTERNAL DEFIBRILLATOR (AED)  Some AEDs will automatically switch themselves on when the lid is opened
  40. 40. ATTACH PADS TO CASUALTY’S BARE CHEST
  41. 41. ANALYSING RHYTHM DO NOT TOUCH VICTIM
  42. 42. SHOCK INDICATED  Stand clear  Deliver shock
  43. 43. SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 2
  44. 44. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION
  45. 45. 1. Adrenaline(all types of cardiac arrest)- 1mg every 3-5 mins 2. Amidarone(VF,VT)- 1st dose:300mg IV bolus, 2nd dose 150 mg 3. Lidocaine- ( 1 to 1.5 mg/kg) 4. Sodium bicarbonate(only if cardiac arrest is associated with hyperkalemia ) (2- 5 meq/kg) 5. Calcium gluconate- 10 mg iv slowly 6. Magnesium sulphate – 2 gms iv in 100 ml NS (refractory VT / VF) 51 DRUGS
  46. 46. THANK YOU FOR YOUR ATTENTION

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