INSTRUCTOR REFRESHER MATERIALS BASED ON NCORT

1. D R L E E O I W A H
P E G A W A I K E S I H A T A N K A W A S A N I I
P E J A B A T K E S I H A T A N K A W A S A N T A W A U
ADULT BLS
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2. • Basic life support (BLS) includes:
1. airway,
2. breathing
3. circulation
4. automated external defibrillator (AED)
5. management of choking or foreign body
airway obstruction (FBAO).
INTRODUCTION
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3. Early access Early CPR Early Defibrillation Early ALS and
Post
Resuscitation
Care
Adapted from ERC Guideline 2015
CHAIN OF SURVIVAL
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4. SUDDEN CARDIAC ARREST
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5. • Sudden cardiac arrest (SCA) is a condition in
which the heart suddenly and unexpectedly
stops beating.
• If this happens, blood stops flowing to the brain
and other vital organs.
• SCA causes death if it's not treated within
minutes.
• In adults, the most common cause is cardiac in
origin.
SUDDEN CARDIAC ARREST
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6. SUDDEN CARDIAC ARREST
• Signs and symptoms of cardiac arrest:
1. Unresponsiveness
2. No breathing
3. Abnormal breathing/ agonal breathing
4. Seizure
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7. 10%
Every 1 minute goes
(after cardiac arrest)……
CARDIAC ARREST
CPR 31/12/2018
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8. The main components of the heart
are :
1.Heart muscles - contract to pump
blood
2.Heart chambers - collect and
channel blood flow
3.Heart valves - allows only one way
flow of blood
4.Conduction system - coordinate
heart muscle contraction
5.Coronary blood vessels - supply
blood to the heart
ANATOMY & PHYSIOLOGY OF CVS
1. The heart is a muscular organ which pumps a continuous flow of blood
through the blood vessels of the circulatory system.
2. The cardiovascular system maintains blood flow to deliver oxygen and
nutrients to every cell and removes the carbon dioxide and waste products
made by those cells.
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9. • Effective external chest compressions pushes
blood out of heart chambers thus maintain
blood flow and oxygen delivery to vital organs.
• The recommended maximum rate of chest
compression is 120/min and full chest recoil is
important to allow for adequate perfusion to
the heart muscles and blood filling of the heart
chambers during the relaxation (diastole)
phase.
PHYSIOLOGY OF CHEST
COMPRESSION
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10. ANATOMY OF RESPIRATORY
SYSTEM
• The tongue may occlude the upper airway
in an unconscious patient. Thus, opening
the airway is essential.
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11. ANATOMY OF RESPIRATORY
SYSTEM
• However, due to anatomical differences between an adult, children and
neonate airway, head-tilt- chin lift maneuver may differ slightly.
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12. Room air -21% oxygen. Rescue breathing -16% oxygen
PHYSIOLOGY OF RESPIRATORY
SYSTEM
• During cardiac arrest, the body’s metabolic demand for oxygen is decreased.
Therefore a smaller amount of air is needed. When giving ventilation, a visible
chest rise indicates adequate volume of air has been given.
The harm of over or hyperventilation:
• decrease in atrial & ventricular filling
• reduction in coronary perfusion pressure
• distension of the stomach leading to regurgitation & aspiration
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13. AGE GROUP
Adult Children Infant
After the
onset of
puberty
1 year to
puberty
1 month to 12
months
TERMINOLOGY
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16. CARDIO PULMONARY
RESUSCITATION
D - DANGER
R - RESPONSE
S - SHOUT
A - AIRWAY
B - BREATHING
C - CIRCULATION
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19. S: SHOUT FOR HELP
Consider 3 situations :
1. Help available
2. Alone with mobile phone available
3. Alone without mobile phone available
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20. A: AIRWAY
Consider 3 techniques :
1. Head tilt-chin lift
2. Jaw thrust
3. Gentle chin lift
Suspected cervica l
trauma
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21. AIRWAY ADJUNCT
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 Nasopharyngeal airway (NPA)
 Oropharyngeal airway (OPA)
 Endotracheal intubation
 Laryngeal Mask Airway (LMA)
How to measure ?

22. B: BREATHING
Stress on :
1. Look
2. Listen
3. Feel
NOT MORE THAN 10 SEC
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23. VENTILATION
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Techniques for :
1. Mouth to mouth
2. Mouth to mask
3. Bag-Valve-Mask (single person vs 2 persons)

24. C : HIGH QUALITY CPR
The rule of 5 :
1. Location : middle of chest , lower ½ of sternum
2. Depth 5-6 cm
3. Rate : 100-120/min
4. Minimize interruption
5. Allow full chest recoil
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25. REASSESSMENT
Stress on :
1. When to check
2. Where to check
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1 CYCLE = 30
COMPRESSIONS + 2
VENTILATION

26. TERMINATION OF CPR
The rule of 4 :
1. Danger to rescuer
2. Victim/patients acheives ROSC
3. Help arrive
4. Rescuer exhaustion
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27. ADULT 2-MAN CPR
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RESCUER 1
 At the victim’s side
 Perform high quality CPR
 Switch duties with Rescuer
2 every 5 cycles or 2
minutes
 Each switch must < 5
seconds
RESCUER 1
 At the victim’s head
 Maintain airway
 Give ventilation
 Switch duties with Rescuer
2 every 5 cycles or 2
minutes
 Each switch must < 5
seconds

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CHECKLIST CPR

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30. Automated
External
Defibrillator
AED
Chances of survival
with defibrillation
30 -70 %

31. DEFIBRILLATION
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1. Switch on the AED
2. Attach the electrode pads on the victim’s bare chest
 If more than one HCW is present,CPR should be continued while electrode
pads attached to the chest
 Follow the spoken/visual directions
3. Ensure that nobody is touching the victim while the AED is analysing the
rhythm.
4a . If a shock is advised, deliver shock within 5 seconds
5. Ensure that nobody is touching the victim with clear CHANT “I am clear, you
are clear, everyone is clear…”
6. Push shock button as directed (fully automatic AEDs will deliver the
shock automatically)
7. Immediately restart CPR at the compressions:ventilation ratio of
30:2
8. Continue as directed by the voice/visual prompts

32. DEFIBRILLATION
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4b . If no shock is advised ;
continue CPR as directed by the voice/visual prompts.

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CHECKLIST AED

34. RECOVERY POSITION
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36. RECOGNITION OF CHOKING
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 History of eating or drinking
 People at higher risk of choking –
i. reduced conciousness
ii. intoxication (alcohol / drug)
iii. neurological impairment (stroke /Parkinson)
iv. older age
v . poor dentition

37. The victim will
clutch the neck
with the thumb
& fingers and
attempt to
cough
out the foreign
body
UNIVERSAL SIGN OF CHOKING

38. SIGN MILD
OBSTRUCTION
SEVERE
OBSTRUCTION
“Are you
choking”
“Yes” Unable to speak, may nod
head
Other signs Can speak, cough,
breathe
Cannot breathe / wheezy
breathing / silent attempts to
cough / unconsciousness
SEVERITY OF CHOKING

39. ADULT FBAO ALGORHYTHM

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 Technique to deliver back blows and abdominal thrust (correct body
mechanics)
 When to use chest thrust
CONCIOUS CHOKING

42. UNCONCIOUS CHOKING
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 As you open the airway to give ventilations, look in the person’s mouth
for any visible object. If you can see it, use a finger sweep motion to
remove it. If you don’t see the object, do not perform a blind finger
sweep, but continue CPR.
 Remember to never try more than 2 ventilations during one cycle of
CPR, even if the chest does not rise.

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CHECKLIST ADULT CHOKING