ADULT BASIC LIFE SUPPORT Katarina Zadrazilova, FN Brno • Sudden cardiac arrest is a leading cause of death in Europe • 700 000 Europeans a year • 40 % of SCA victims have VF • Immediate CPR can double or triple survival CPR Succese rate 77 % ! ...Reality only 25% European resuscitation council guidelines for resuscitation 2010 • www.erc.edu • New guidelines every 5 years Overview • Adult BLS sequence • Foreign-body airway obstruction/choking • Airway management • Ventilation Basic life support Maintaining airway patency and supporting breathing and the circulation without the use of equipment other then a protective device Chain of survival • Early recognition • Early bystander CPR • Early defibrillation • Early Advanced life support Make sure the victim and bystanders are safe ARE YOU ALL RIGTH ? JSTE V POŘÁDKU ? HEAD TILT CHIN LIFT 10 SEC LOOK LISTEN AND FEEL • If breathing normally Turn to recovery position and get help EFFECTIVE RESCUE BREATHS ONTINUE CPR ATIO 30 : 2 When to stop CPR • Qualified help arrives and takes over • The victim starts to breath normally • You become exhausted News BLS 2010 • in the centre of the victim’s chest; (which is the lower half of the victim’s breastbone (sternum)) • position yourself vertically above the victim’s chest and press down on the sternum at least 5 cm (but not exceeding 6 cm); • after each compression, release all the pressure on the chest without losing contact between your hands and the sternum; • repeat at a rate of at least 100 min−1 (but not exceeding 120 min−1); News BLS 2010 If your initial rescue breath does not make the chest rise as in normal breathing, then before your next attempt: • look into the victim’s mouth and remove any obstruction; • recheck that there is adequate head tilt and chin lift; • do not attempt more than two breaths each time before Time should not be spent returning mouth compressions. checking the to chestfor foreign bodies unless attempted rescue breathing fails to make the chest rise. Foreign body airway obstruction (choking) Causes of choking • • adults: kids: fish, poultry sweets, peanuts Up to 5 sharp back blows Abdominal thrusts Up to 5 times, then alternate 5 back blows - 5 abdominal thrusts If unconscious – start CPR AIRWAY MANAGEMENT AND VENTILATION A for Airway • Patients with cardiorespiratory arrest often have an obstructed airway • Prompt control of the airway is essential to prevent secondary hypoxic damage to the brain and without oxygenation it may be impossible to restore spontaneous cardiac output Causes of the airway obstruction Recognition of airway obstruction LOOK, LISTEN AND FEEL Partial obstruction • • • • • Stridor Wheeze Gurgling Snoring Crowing obstruction above larynx lower airway semisolid/liquid FB soft palate/epiglotis laryngeal spasm Recognition of airway obstruction Complete obstruction • Look for paradoxical chest and abdominal movement –´see-saw breathing´ Basic airway management Head tilt chin lift Jaw trust Airway management with suspected cervical spine injury Manual in line stabilization Airway adjuncts • Oropharyngeal airways ▫ Better in comatose patients • Nasopharyngeal airways ▫ Better tolerated by patient ▫ Can cause nose bleed CAREFUL! Both can cause airway obstruction ! Airway adjuncts Insertion of oropharyngeal airway Oxygen • Give oxygen whenever it is available Type of oxygenation Mouth to mouth Face mask Type of oxygenation Oxygen concentration 17 % Up to 50% Oxygen concentration More O2 for brain Alternative airway devices • High incidence of complications without adequate training and experience • Best technique depends on the circumstances and competence of the rescuer Alternative airway devices • Laryngeal mask airway • Combitube • Tracheal intubation Laryngeal mask airway Combitube Gold standart – tracheal intubation Gold standart – tracheal intubation • Advantages: ▫ ▫ ▫ ▫ ▫ Maintainance of patent airway Protection from aspiration Ability to ventilate reliably Free the rescuers hands Route for giving drugs • Disadvantages ▫ Unrecognised misplaces tracheal tube ▫ Prolonged period without compressions B for breathing • Mouth to mouth • Mouth to nose • Mouth to protective device • Using self inflating bag or ventilator Ventilation • Inspiration 1 sec • Volume : enough to make the chest rise ▫ Larger volumes lead to gastric inflation • Once the tracheal tube is in place ventilate the lungs at a rate of 10 breaths/min and continue chest compressions without pausing during ventilation SUMMARY • Open the airway • Look listen and feel for breathing • Use airway adjuncts you’re familiar with to enable ventilation • Ventilation : chest compressions 2:30 Until airway protected, then 10 breaths / min and 100/min chest compressions Questions ?