5 Simplified Universal Adult BLS Algorithm 729American Heart Association
6 CPRBsic life supportAdvanced cardiac life support
7 Elements of BLS Noninvasive emergency lifesaving care For any patient having cardiac arrest, the most important steps are(1) immediate recognition of unresponsiveness,(2) checking for lack of breathing or lack of normal breathing(3) activating an emergency response system and retrieving an automated external defibrillator (AED),(4) checking for a pulse (no more than 10 seconds), and(5) starting cycles of 30 chest compressions followed by 2 breaths
8 ResponsivenessPrior to approaching a victim, the rescuer should make sure that the scene is safe; then the victim is assessed for responsiveness by tapping or questioning (“Are you OK?”).
9 A quick check for presence of breathing or lack of normal breathing should occur simultaneouslythen the emergencyresponse system shouldbe activated,and an AED should bequickly retrieved.
10 CirculationThe health care provider should take no more than 10 seconds to check for a definitive pulse either at the carotid or femoral arteryIF the patient hasNo pulse,No signs of life,Or the rescuer is unsure,THEN compressions should be started immediately
11 METHODThe heel of the hand should be placed longitudinally on the lower half of the sternum, between the nipplesThe sternum should be depressed at least 5 cm (2 inches) at a rate of at least 100 compressions per minute.Complete chest recoil is necessary to allow for venous return and is important for effective CPRThe pattern should be 30 compressions to 2 breaths (30:2 equals 1 cycle of CPR), regardless of whether one or two rescuers are present.
13 “C-A-B” rather than “A-B-C” New for 2010Initiate chest compressions before ventilations.Why Change?Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression11-13 providing vital blood flow to the heart and brain.Chest compressions provides vital blood flow to the heart and brain, and studies of out-of-hospital adult cardiac arrest showed that survival was higher when bystanders made some attempt rather than no attempt to provide CPR.Animal data demonstrated that delays or interruptions in chest compressions reduced survival, so such delays or interruptions should be minimized throughout the entire resuscitation.- Chest compressions can be started almost immediately, whereas positioning the head and achieving a seal for mouth-to-mouth or bag-mask rescue breathing all take time. The delay ininitiation of compressions can be reduced if 2 rescuers are present: the first rescuer begins chest compressions, and the second rescuer opens the airway and is prepared to deliver breaths as soon as the first rescuer has completed the first set of 30 chest compressions. Whether 1 or more rescuers are present, initiation of CPR with chest compressions ensures that the patient receives this critical intervention early, and any delay in rescue breaths should be brief.
14 How can CPR be effective without rescue breathing? because the oxygen level in the blood remains adequate for the first several minutes after cardiac arrest.4Animal models suggest gasping do allow for some oxygenation and carbon dioxide (CO2)elimination.9-10If the airway is open, passive chest recoil during the relaxation phase of chest compressions can also provide some air exchange.19,110,111,119–122However, at some time during prolonged CPR, supplementary oxygen with assisted ventilation is necessary. The precise interval for which the performance of Hands-Only CPR is acceptable is not known at this time.110,111,119,123
15 AIR WAY openingOpening of the airway can be achieved by Simple head tilt–chin lift technique Oral or nasal airway Tracheal intubation Laryngeal mask
16 Breathingchest compression-alone CPR is not inferior to traditional compression-ventilation CPR, health care providers are still expected to provide assisted ventilationA lone rescuer, if not an expert in airway management, should not use a bag-mask for ventilation, but should use mouth-to-mouth or mouth-to-mask
19 NOTE Care should be taken to avoid rapid or forceful breaths Delivered tidal volumes are given over 1 second and should produce visible chest rise.Delivered tidal volumes are given over 1 second and should produce visible chest riseA lower than normal minute ventilation (cardiac output is much less than normal) should be the goal (CO2 and brain vasoconstriction and delay neurologic recovery.)
22 DefibrillationA defibrillator should be attached to the patient as soon as possible.Proper electrode pad placement on the chest wall should be to the right of the upper sternal border below the clavicle and to the left of the nipple with the center in the midaxillary lineAlternative locations include anteriorposterior, anterior-left infrascapular, and anterior-right infrascapular. Right anterior axillary to left anterior axillary is not recommended(718)
23 ENERGY USED FOR DEFIBRILLATION amount of energy (joules) delivered is dependent on type of defibrillator usedTwo major defibrillator typesmonophasic : deliver a unidirectional energy chargeBiphasic : deliver bidirectional energy charge more successful in terminating ventricular tachycardia (VT) and ventricular fibrillation(VF) In addition, biphasic waveform shocks require less energy than traditional monophasic waveform shocks (120 to 200 J versus 360 J, respectively) and may therefore cause less myocardial damage.
24 ChokingThe tongue is the most common obstruction in the unconscious victim (head tilt- chin lift)VomitForeign bodyBalloonsFoodsSwelling (allergic reactions/ irritants)Spasm (water is inhaled suddenly)
25 Conscious Choking (Adult Foreign Body Airway Obstruction) Give 5 abdominal thrusts (Heimlich maneuver)Place fist just above the umbilicus (normal size)Give 5 upward and inward thrustsPregnant or obese? 5 chest thrustsFists on sternumIf unsuccessful, support chest with one hand and give back blows with the other
26 If Victim Becomes Unconscious After Giving Thrusts Call 115Try to support victim with your knees while lowering victim to the floorAssessBegin CPRAfter chest compressions, check for object before giving breaths breaths
27 Choking: Conscious Infants Position with head downward5 back blows (check for expelled object)5 chest thrusts (check for expelled object)Repeat