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Basic Life Support and Automated External Defibrillation

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1 Basic Life Support and Automated External Defibrillation

2 Objectives At 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.

3 Background In 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 attempting defibrillation with the minimum of delay in victims of VF/VT cardiac arrest.

4 Anyone can do it?

5 On 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%

6 Angina Suspected Heart Attack Cardiac conditions

7 Cardiac Conditions Coronary 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.

8 Blood returning from upper body
Oxygenated blood to upper body Blood to lungs Blood to lungs Oxygenated blood from lungs Oxygenated blood from lungs Blood returning from lower body Oxygenated blood to lower body

9 How 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)

10 Suspected Heart Attack

11 Heart Attack

12 Suspected Heart Attack
Pale, cold & clammy skin Rapid weak pulse Rapid shallow breathing -Nausea Vomiting Pain in chest possibly radiating into arm, back and/or jaw Sweating Impending sense of doom Some or all of these symptoms may be present, no two Heart attacks are the same......

13 Cardiac Conditions Angina is a pain or discomfort felt in the chest caused by coronary heart disease. Typically presents as heaviness or tightness in the chest Often 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

14 Suspected Heart attack
Dial 999 or 112 for Ambulance Rest in a comfortable position Reassure Help casualty to take their own GTN Be prepared to resuscitate Have AED available If in any Doubt dial 999 or 112

15 Primary Survey Performing CPR Recovery Position Basic Life SUPPORT

16 Initial assessment using the primary survey
- D anger (Global overview) - R esponse - S hout for help - A irway - B reathing - C all 999/112 - commence CPR Emphasise 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. .

17 Airway 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

18 Approach safely Check response Shout for help Open airway Check breathing Recovery Position? Dial 999/112 Monitor Patient

19 APPROACH SAFELY! Rescuer Scene Victim Bystanders
Check response Shout for help Open airway Check breathing Recovery Position The 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 safely Dial 999/112 Monitor

20 CHECK RESPONSE Dial 999/1123 Approach safely Check response
Shout for help Open airway Check breathing Recovery Position? Dial 999/1123 Monitor

21 Shake shoulders gently If he responds
CHECK RESPONSE Shake shoulders gently “Hello can you hear me?” If he responds Leave as you find him. Find out what is wrong. Reassess regularly. If no response.....

22 SHOUT FOR HELP Approach safely Check response Shout for help
Open airway Check breathing Recovery Position? Dial 999/112 Monitor

23 OPEN AIRWAY Approach safely Check response Shout for help Open airway
Check breathing Recovery Position Turn the victim onto his back and then open the airway using head tilt and chin 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 chin to open the airway. Dial 999/112 Monitor

24 CHECK BREATHING Look, listen and feel for NORMAL breathing for 10 sec
Do not confuse Agonal breathing with NORMAL breathing If you have any doubts act as if breathing is not normal Look, listen, and feel for no more than 10 s to determine if the victim is breathing normally. 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 taking infrequent, 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.

25 Not Breathing normally ?
No sign of Chest Movement No sounds of Breathing No feeling of breath against your ear Agonal Breathing Occurs shortly after the heart stops in up to 40% of cardiac arrests Described as barely, heavy, noisy or gasping breathing Recognised as a sign of cardiac arrest Agonal gasps Agonal 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.

26 Agonal Breathing

27 Approach safely Check response Shout for help Open airway If no help arrives and you are alone dial 999/112 After putting into recovery position. Check breathing Recovery Position Dial 999/112 Monitor

28 Recovery position 1 Kneel 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.

29 Recovery position 2                                                Grab and bend the person's far knee

30 Recovery position 3                                                  Protecting the head with one hand, gently roll the person toward you by pulling the far knee over and to the ground

31 30 CHEST COMPRESSIONS Approach safely Check response Shout for help
Open airway Check breathing Dial 999/112 30 chest compressions 2 rescue breaths 2 rescue breaths

32 Recovery position 4                                        Tilt 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

33 If Not Breathing Don’t Panic

34 CHEST COMPRESSIONS Place the heel of one hand in the centre of the chest Place other hand on top Interlock fingers Compress the chest Rate 100 to 120 Depth 5-6 cm Equal compression : relaxation When possible change CPR operator every 2 min 2010 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 not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the sternum. o Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum cm. o After each compression, release all the pressure on the chest without 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.

35 RESCUE BREATHS Approach safely Check response Shout for help
Open airway Check breathing Dial 999/112 Other variations to mention – Mouth-to-nose ventilation Mouth-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 to achieve. Mouth-to-tracheostomy ventilation Mouth-to-tracheostomy ventilation may be used for a victim with a tracheotomy tube or tracheal stoma who requires rescue breathing. 30 chest compressions 2 rescue breaths

36 RESCUE BREATHS Pinch the nose Take a normal breath
Place lips over mouth Blow until the chest rises Deliver rescue breath for 1 second Allow chest to fall Repeat This should not take longer than 5sec , then return to chest compressions without delay 2010 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 and thumb 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 sure that you have a good seal.  Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath.  Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.  Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. The two breaths should not take more than 5 s. Then return your hands without delay to the correct position on 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.

37 Combine Compressions and Rescue breaths at a ratio of 30:2
30 If there is more than one rescuer present, another should take over CPR about every 1-2 min to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers, and do not interrupt chest compressions.

38 ANY QUESTIONS ? Time to practice.....
Practise Primary survey Dangers Response Shout Airway Breathing CPR, Recovery position Use CPR relay game as a method of assessing each candidates CPR skills

39 Child CPR Many 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.

40 Children and babies

41 COMPRESSION only CPR If a rescuer is unable or unwilling to perform rescue breaths it is expectable to perform compressions only CPR However, 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 chest compressions only.  If chest compressions only are given, these should be continuous at a rate of min-1.  Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally; otherwise do not interrupt resuscitation. Those with a Duty of care should be using both compressions and ventilations when doing CPR.

42 When 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 : Coughing Opening eyes Speaking or moving purposefully Starts to Breath NORMALLY again Or Qualified help arrives and takes over You become exhausted It is unsafe to continue

43 Pocket Mask The 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 undertaking CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute respiratory distress syndrome (SARS). Transmission of HIV during CPR has never been reported. There have been no human studies to address the effectiveness of barrier devices during CPR; however, laboratory studies have shown that certain filters, or barrier devices with one-way valves, prevent transmission of oral bacteria from the victim to the rescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safety precautions where feasible, especially if the victim is known to have a serious infection

44 ANY QUESTIONS ? Time to practice.....

45 Understanding Defibrillation
Safe use of an AED Defibrillation

46 Automated 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 rhythm only advise a shock for a shockable rhythm advise the operator step-by-step what to do 46

47 Automated 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, and keep 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 person willing to use an AED. 47

48 Automatic- will deliver shock automatically
There are 2 types of AED: Automatic- will deliver shock automatically Semi Automatic – rescuer intervention required to deliver shock. Once you have completed this training you will be able to use any make or model AED’s can be found in many public buildings e.g. Sports centres, Railway stations, Shopping centres and Schools AEDs should be stored in locations that are immediately accessible to rescuers; they should not be stored in locked cabinets as this may delay deployment. Use of the UK standardised AED sign is encouraged, to highlight the location of an AED. (SEE TOP right corner of the screen) 48

49 2% 4% 30%

50 Understanding Defibrillation
The heart’s pumping action controlled by electrical system Electrical rhythm normally very organized Normal heart’s rhythm is called “Sinus Rhythm” Normal heart rate of beats per minute

51 Understanding Defibrillation: Ventricular Fibrillation (VF)
VF is the most common rhythm in Sudden Cardiac Arrest (90%) Electrical Problem in Nature Chaotic rhythm results in “quivering of heart” and results in loss of pulse VF will result in brain damage within 5 minutes and death in minutes

52 Understanding Defibrillation
Defibrillation may correct VF Uses DC current delivered across the heart A successful defibrillation “depolarizes” the heart’s cells Depolarization allows the cells to “reorganize” Defibrillation is the ONLY effective cure for VF!

53 Single Rescuer Approach safely Check response Shout for help
Open airway Check breathing Dial 999/112 – get AED To 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 rythm Attach AED before CPR Follow voice prompts

54 1st Rescuer commence CPR gets AED and attaches to Patient
Approach safely Check response 2 or more Rescuers Shout for help Open airway Check breathing 1st Rescuer commence CPR 2nd Rescuer Call 999 /112 gets AED and attaches to Patient Provide good quality CPR while the AED is brought to the scene. Continue CPR whilst the AED is turned on, then follow the voice and visual prompts. Giving a specified period of CPR, as a routine before rhythm analysis and shock delivery, is not recommended. Follow voice prompts

55 Minimise interruptions in CPR
If alone, attach AED before commencing CPR If 2 rescuers, provide good quality CPR while the AED is brought to the scene, is turned on, and pads attached Interrupt CPR only when it is necessary to analyse the rhythm and deliver a shock

THE PATIENT. 5 point check Pacemaker Jewellery Hair on chest Damp/Wet skin Patches (GTN) THE AED. In good working order Do Not use in Heavy rain Do Not use if they lay in a pool of water Do Not use in an explosive environment ! Discuss each point.

Although most AED pads are labelled left and right, or carry a picture of their correct placement, it does not matter if their positions are reversed. It is important to teach that if this happens ‘in error’, the pads should not be removed and replaced because this wastes time and they may not adhere adequately when re-attached. The victim’s chest must be sufficiently exposed to enable correct pad placement. Chest hair 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 as possible on this. Do not delay defibrillation if a razor is not immediately available.

Touching the Patient will interfere with the AED’s ability to assess the casualtys heart rythm by casuing interderence.....

BEHIND YOU DELIVER SHOCK Demonstrate saftey sweep with loud voice prompts

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.



63 COMMENCE CPR (2 Mins) Interrupt CPR only when it is necessary to analyse the rhythm and deliver a shock

Casualty may be in a non shockable Heart Rythm Give 2 min CPR, the rythm could change at any point, just because a shock is not required initally,

65 COMMENCE CPR (2 Mins)

66 ANY QUESTIONS ? Time to practice.....

67 Children and AED’s Standard 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 placement It is important that the Pads are not in contact with each other when placed on the patient If using adult pads on a small child, place the pads front and back Front pad directly over center of the chest, back pad directly in lie with the first.



70 Follow 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 waste Replace the pads on the machine Inform named person that the Defibrillator has been used so that any data can be captured from the device Complete 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.

Once CPR is started the rescuer should only stop CPR when the casualty shows signs or regaining conscious by Coughing Opening eyes Speaking or moving purposefully Starts to Breath NORMALLY again Or Qualified help arrives and takes over You become exhausted It is unsafe to continue


73 Oop’s ??


75 Bleeding

76 Bleeding Raise Limb Cover with clean dressing or cloth 999 or 112
Reassure Lay down Raise legs Monitor

77 Shock

78 Shock

79 Choking

80 Choking

81 Choking

82 ANY QUESTIONS ? Time to practice.....


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