Presentation on theme: "Basic Life Support and Automated External Defibrillation"— Presentation transcript:
1Basic Life Support and Automated External Defibrillation
2ObjectivesAt the end of this course participants should be able to demonstrate:How to assess the collapsed casualty.How to perform Basic Life Support (BLS).How to place an unconscious breathing victim in the recovery position.Introduction to operating an automated external defibrillator (AED) safely.
3BackgroundIn the UK approximately 30,000 people sustain cardiac arrest outside hospital and are treated by emergency services each year.Bystander CPR and early Defibrillation are vital interventions before the arrival of emergency services.If defibrillation is delivered promptly, survival rates as high as 75% have been reported.The chances of successful defibrillation decline at a rate of about 10% with each minute of delay.The Resuscitation Council (UK) recommends strongly a policy of attemptingdefibrillation with the minimum of delay in victims of VF/VT cardiac arrest.
5On average only a person who receive CPR by an ambulance crew alone has a 2% chance of survival. A patient who receives “bystander” CPR prior to ambulance CPR, rises to 4% chance of survival. With the addition of an AED within the first 3-5 minutes the survival rate increases to 30%.2%4%30%
7Cardiac ConditionsCoronary heart disease is the UK's biggest killer, with 1 in every 4 men and 1 in every 6 women dying from the disease.In the UK, approximately 300,000 people have a heart attack each year.Angina affects about 1 in 50 people, and in the UK there are an estimated 1.2 million people with the condition. It affects men more than women, and your chances of being affected increase with age.
8Blood returning from upper body Oxygenated blood to upper bodyBlood to lungsBlood to lungsOxygenated blood from lungsOxygenated blood from lungsBlood returning from lower bodyOxygenated blood to lower body
9How many times does the human Heart beat in a day ? 100,800 beats per day(70 beats x 60 minutes x 24 hours = 100,800 beats)
12Suspected Heart Attack Pale, cold & clammy skinRapid weak pulseRapid shallow breathing-NauseaVomitingPain in chest possibly radiating into arm, back and/or jawSweatingImpending sense of doomSome or all of these symptoms may be present, no two Heart attacks are the same......
13Cardiac ConditionsAngina is a pain or discomfort felt in the chest caused by coronary heart disease.Typically presents as heaviness or tightness in the chestOften brought on by physical activity.Symptoms usually subside after a few mins.Angina Suffers usually carry GTN medication in the form of a spray or tablet
14Suspected Heart attack Dial 999 or 112 for AmbulanceRest in a comfortable positionReassureHelp casualty to take their own GTNBe prepared to resuscitateHave AED availableIf in any Doubt dial 999 or 112
15Primary SurveyPerforming CPRRecovery PositionBasic Life SUPPORT
16Initial assessment using the primary survey - D anger (Global overview)- R esponse- S hout for help- A irway - B reathing - C all 999/112 - commence CPREmphasise that patient assessment only takes place once the scene is safe.Stress that any life threatening problems identified during the primary survey should be treated immediately before moving on to the next component..
17Airway Management Airway Open Airway Closed Airway Obstructed An unconscious casualty has no control over their muscles, including the muscles that control the tongue.Slide demonstrates how the tongue will block the airway in an unconscious patient.Bottom picture shows how the air way is cleared by the head tilt chin lift position
18Approach safelyCheck responseShout for helpOpen airwayCheck breathingRecovery Position?Dial 999/112Monitor Patient
19APPROACH SAFELY! Rescuer Scene Victim Bystanders Check responseShout for helpOpen airwayCheck breathingRecovery PositionThe safety of both the rescuer and victim are paramount during a resuscitation attempt.Give example of Dangers and Hazards to you, the casualty, bystanders.Emphasise using an AED presents an additional danger, so must be used safelyDial 999/112Monitor
21Shake shoulders gently If he responds CHECK RESPONSEShake shoulders gently“Hello can you hear me?”If he respondsLeave as you find him.Find out what is wrong.Reassess regularly.If no response.....
22SHOUT FOR HELP Approach safely Check response Shout for help Open airwayCheck breathingRecovery Position?Dial 999/112Monitor
23OPEN AIRWAY Approach safely Check response Shout for help Open airway Check breathingRecovery PositionTurn the victim onto his back and then open the airway using head tilt andchin lift:o Place your hand on his forehead and gently tilt his head back.o With your fingertips under the point of the victim's chin, lift the chinto open the airway.Dial 999/112Monitor
24CHECK BREATHING Look, listen and feel for NORMAL breathing for 10 sec Do not confuse Agonal breathing with NORMAL breathingIf you have any doubts act as if breathing is not normalLook, listen, and feel for no more than 10 s to determine if the victim is breathingnormally.The absence of normal breathing continues to be the main sign of cardiac arrest in a non-responsive victim.In the first few minutes after cardiac arrest, a victim may be barely breathing, or takinginfrequent, noisy, gasps.This is often termed agonal breathing and must not be confused with normal breathing.If you have any doubt whether breathing is normal, act as if it is not normal.Normal respiratory rate is Breaths per min.
25Not Breathing normally ? No sign of Chest MovementNo sounds of BreathingNo feeling of breath against your earAgonal BreathingOccurs shortly after the heart stops in up to 40% of cardiac arrestsDescribed as barely, heavy, noisy or gasping breathingRecognised as a sign of cardiac arrestAgonal gaspsAgonal gasps are present in up to 40% of cardiac arrest victims.10 Therefore laypeople should be taught to begin CPR if the victim is unconscious (unresponsive) and not breathing normally. It should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest; they are an indication for starting CPR immediately and should not be confused with normal breathing.
27Approach safelyCheck responseShout for helpOpen airwayIf no help arrives and you are alone dial 999/112 After putting into recovery position.Check breathingRecovery PositionDial 999/112Monitor
28Recovery position 1Kneel next to the person. Place the arm closest to you straight out from the body. Position the far arm with the back of the hand against the near cheek.
29Recovery position 2Grab and bend the person's far knee
30Recovery position 3Protecting the head with one hand, gently roll the person toward you by pulling the far knee over and to the ground
3130 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airwayCheck breathingDial 999/11230 chest compressions2 rescue breaths2 rescue breaths
32Recovery position 4Tilt the head up slightly so that the airway remains open. Make sure that the hand is under the cheek, checking the airway and also for eventual wakening. Place a blanket or coat over the person (unless he or she has a heat illness or fever) and stay close until help arrives
34CHEST COMPRESSIONSPlace the heel of one hand in the centre of the chestPlace other hand on topInterlock fingersCompress the chestRate 100 to 120Depth 5-6 cmEqual compression : relaxationWhen possible change CPR operator every 2 min2010 Guidline change - Compress the chest to a depth of 5-6 cm and at a rate of min-1.Start chest compression as follows:o Kneel by the side of the victim.o Place the heel of one hand in the centre of the victim’s chest(which is the lower half of the victim’s sternum (breastbone)).o Place the heel of your other hand on top of the first hand.o Interlock the fingers of your hands and ensure that pressure is notapplied over the victim's ribs. Do not apply any pressure over theupper abdomen or the bottom end of the sternum.o Position yourself vertically above the victim's chest and, with yourarms straight, press down on the sternum cm.o After each compression, release all the pressure on the chestwithout losing contact between your hands and the sternum.Repeat at a rate of min-1.o Compression and release should take an equal amount of time.
35RESCUE BREATHS Approach safely Check response Shout for help Open airwayCheck breathingDial 999/112Other variations to mention –Mouth-to-nose ventilationMouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It may be considered if the victim’s mouth is seriously injured or cannot be opened, if the rescuer is assisting a victim in the water, or if a mouth-to-mouth seal is difficult toachieve.Mouth-to-tracheostomy ventilationMouth-to-tracheostomy ventilation may be used for a victim with a tracheotomy tube or tracheal stoma who requires rescue breathing.30 chest compressions2 rescue breaths
36RESCUE BREATHS Pinch the nose Take a normal breath Place lips over mouthBlow until the chest risesDeliver rescue breath for 1 secondAllow chest to fallRepeatThis should not take longer than 5sec , then return to chest compressions without delay2010 Guidline change - Give each rescue breath over 1 s rather than 2 s.After 30 compressions open the airway again using head tilt and chin lift. Pinch the soft part of the victim’s nose closed, using the index finger andthumb of your hand on his forehead. Allow his mouth to open, but maintain chin lift. Take a normal breath and place your lips around his mouth, making surethat you have a good seal. Blow steadily into his mouth whilst watching for his chest to rise; take aboutone second to make his chest rise as in normal breathing; this is an effectiverescue breath. Maintaining head tilt and chin lift, take your mouth away from the victim andwatch for his chest to fall as air comes out. Take another normal breath and blow into the victim’s mouth once more togive a total of two effective rescue breaths. The two breaths should not takemore than 5 s. Then return your hands without delay to the correct positionon the sternum and give a further 30 chest compressions.If the initial rescue breath of each sequence does not make the chest rise as in normal breathing, then, before your next attempt: Check the victim's mouth and remove any visible obstruction. Recheck that there is adequate head tilt and chin lift. Do not attempt more than two breaths each time before returning to chest compressions.
37Combine Compressions and Rescue breaths at a ratio of 30:2 30If there is more than one rescuer present, another should take over CPR about every1-2 min to prevent fatigue.Ensure the minimum of delay during the changeover ofrescuers, and do not interrupt chest compressions.
38ANY QUESTIONS ? Time to practice..... Practise Primary surveyDangersResponseShoutAirwayBreathingCPR,Recovery positionUse CPR relay game as a method of assessing each candidates CPR skills
39Child CPRMany children do not receive resuscitation because potential rescuers fear causing harm.This fear is unfounded; it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing.Bystander resuscitation significantly improves outcome in children.Outcomes could be further improved if bystanders who would otherwise do nothing, were encouraged to begin resuscitation.
41COMPRESSION only CPRIf a rescuer is unable or unwilling to perform rescue breaths it is expectable to perform compressions only CPRHowever, chest compression combined with rescue breaths is the method of choice for CPR by trained lay rescuers and professionals.Compression-only CPR If you are not trained to, or are unwilling to give rescue breaths, give chestcompressions only. If chest compressions only are given, these should be continuous at a rate ofmin-1. Stop to recheck the victim only if he starts to show signs of regainingconsciousness, such as coughing, opening his eyes, speaking, or movingpurposefully AND starts to breathe normally; otherwise do not interruptresuscitation.Those with a Duty of care should be using both compressions and ventilations when doing CPR.
42When to stop CPR Coughing Opening eyes Speaking or moving purposefully Once CPR is started the rescuer should only stop CPR when the casualty shows signs of regaining conscious by :CoughingOpening eyesSpeaking or moving purposefullyStarts to Breath NORMALLY againOrQualified help arrives and takes overYou become exhaustedIt is unsafe to continue
43Pocket MaskThe pocket mask is an effective barrier device. It has a one-way valve which prevents the casualty's exhaled air being inhaled by the Rescuer.The safety of both the rescuer and victim are paramount during a resuscitation attempt.There have been few incidents of rescuers suffering adverse effects from undertakingCPR, with only isolated reports of infections such as tuberculosis (TB) and severe acuterespiratory distress syndrome (SARS). Transmission of HIV during CPR has never beenreported.There have been no human studies to address the effectiveness of barrier devicesduring CPR; however, laboratory studies have shown that certain filters, or barrierdevices with one-way valves, prevent transmission of oral bacteria from the victim to therescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safetyprecautions where feasible, especially if the victim is known to have a serious infection
45Understanding Defibrillation Safe use of an AEDDefibrillation
46Automated External Defibrillators An AED is an “electric shock box” used to stop the electrical activity of the heart when it is in a life threatening rhythm, this allows the Heart to re-establish an effective rhythm.The AED will;analyse the presenting rhythmonly advise a shock for a shockable rhythmadvise the operator step-by-step what to do46
47Automated External Defibrillators An AED can be used safely and effectively without previous training.Therefore, the use of an AED should not be restricted to trained rescuers.However, training should be encouraged to help improve the time to shock delivery and correct pad placement.People with no previous training have used AEDs safely and effectively.While it is highly desirable that those who may be called upon to use an AED should be trained in their use, andkeep their skills up to date, circumstances can dictate that no trained operator (or a trained operator whose certificate of training has expired) is present at the site of an emergency.Under these circumstances no inhibitions should be placed on any personwilling to use an AED.47
48Automatic- will deliver shock automatically There are 2 types of AED:Automatic- will deliver shock automaticallySemi Automatic – rescuer intervention required to deliver shock.Once you have completed this trainingyou will be able to use any make or modelAED’s can be found in many public buildings e.g. Sports centres, Railway stations, Shopping centres and SchoolsAEDs should be stored in locations that are immediately accessible to rescuers; theyshould not be stored in locked cabinets as this may delay deployment. Use of the UKstandardised AED sign is encouraged, to highlight the locationof an AED. (SEE TOP right corner of the screen)48
50Understanding Defibrillation The heart’s pumping action controlled by electrical systemElectrical rhythm normally very organizedNormal heart’s rhythm is called “Sinus Rhythm”Normal heart rate of beats per minute
51Understanding Defibrillation: Ventricular Fibrillation (VF) VF is the most common rhythm in Sudden Cardiac Arrest (90%)Electrical Problem in NatureChaotic rhythm results in “quivering of heart” and results in loss of pulseVF will result in brain damage within 5 minutes and death in minutes
52Understanding Defibrillation Defibrillation may correct VFUses DC current delivered across the heartA successful defibrillation “depolarizes” the heart’s cellsDepolarization allows the cells to “reorganize”Defibrillation is the ONLY effective cure for VF!
53Single Rescuer Approach safely Check response Shout for help Open airwayCheck breathingDial 999/112 – get AEDTo minimise delays in CPR the AED should be attached before CPR is started.Once CPR is started it should only be stopped while the AED analyses the Patients rythmAttach AED before CPRFollow voice prompts
541st Rescuer commence CPR gets AED and attaches to Patient Approach safelyCheck response2 or moreRescuersShout for helpOpen airwayCheck breathing1st Rescuer commence CPR2nd Rescuer Call 999 /112gets AED and attaches to PatientProvide good quality CPR while the AED is brought to the scene. Continue CPR whilstthe AED is turned on, then follow the voice and visual prompts. Giving a specifiedperiod of CPR, as a routine before rhythm analysis and shock delivery, is notrecommended.Follow voice prompts
55Minimise interruptions in CPR If alone, attach AED before commencing CPRIf 2 rescuers, provide good quality CPR while the AED is brought to the scene, is turned on, and pads attachedInterrupt CPR only when it is necessary to analyse the rhythm and deliver a shock
56DEFIBRILLATION SAFETY ! THE PATIENT.5 point checkPacemakerJewelleryHair on chestDamp/Wet skinPatches (GTN)THE AED.In good working orderDo Not use in Heavy rainDo Not use if they lay in a pool of waterDo Not use in an explosive environment !Discuss each point.
57ATTACH PADS TO CASUALTY’S BARE CHEST Although most AED pads are labelled left and right, or carry a picture of their correctplacement, it does not matter if their positions are reversed. It is important to teach thatif this happens ‘in error’, the pads should not be removed and replaced because thiswastes time and they may not adhere adequately when re-attached.The victim’s chest must be sufficiently exposed to enable correct pad placement. Chesthair will prevent the pads adhering to the skin and will interfere with electrical contact.Shave the chest only if the hair is excessive, and even then spend as little time aspossible on this.Do not delay defibrillation if a razor is not immediately available.
58ANALYSING RHYTHM DO NOT TOUCH PATIENT Touching the Patient will interfere with the AED’s ability to assess the casualtys heart rythm by casuing interderence.....
59SHOCK ADVISED “Stand clear Everyone” ! TOP MIDDLE BOTTOM MYSELF BEHIND YOUDELIVER SHOCKDemonstrate saftey sweep with loud voice prompts
60DEFIBRILLATION SAFETY ! REMEMBER.Always check that NO PERSON or ANIMALS are touching the patient prior to shocking.That you are not touching the patient in any way.Discuss safety points, how to discharge defibrillator if necessary.
67Children and AED’sStandard AEDs are suitable for use on children of 8 years and above.In children between 1 and 7 years paediatric pads or a paediatric mode should be used.Do not use an AED on an Infant less than 1 year.Shockable rhythms are unusual in children under 1 year of age and the main focus of resuscitation should be on good-quality CPR.# An infant is a child under 1 year. A child is between 1 year and puberty.Pad placementIt is important that the Pads are not in contact with each other when placed on the patientIf using adult pads on a small child, place the pads front and backFront pad directly over center of the chest, back pad directly in lie with the first.
70Follow up – what to do after? If you have used an Automated External Defibrillator, even by just attaching it to a patient, you must:Dispose of the pads used as clinical wasteReplace the pads on the machineInform named person that the Defibrillator has been used so that any data can be captured from the deviceComplete a “Defibrillator Event Report Form”If you require any equipment to be replaced, i.e. pads, pocket masks, razors etc. Please contact your named person as soon as possible.
71WHEN NOT TO RESUSCITATE Once CPR is started the rescuer should only stop CPR when the casualty shows signs or regaining conscious byCoughingOpening eyesSpeaking or moving purposefullyStarts to Breath NORMALLY againOrQualified help arrives and takes overYou become exhaustedIt is unsafe to continue