Basic Life Support Adult

Single Operator BLS Safety Check responsiveness Responsive patient – history & assessment Unresponsive patient: Obtain help Place pt. in supine position Look in mouth to ensure clear; clear if not Head tilt chin lift – consider c-spine Check breathing Task: Demonstrate each action on a mannequin Safety – ensure that you, the patient and any bystanders are safe Responsiveness – gently shake the patient by the shoulders and ask loudly “are you alright” or “hello can you hear me” Obtain help if appropriate Supine position – consider injuries but airway is priority Look in mouth, at this point is out of sequence with jrcalc but don’t want anything sent down trachea Head tilt, but if trauma use jaw thrust or chin lift with manual in-line stabilisation. If airway obstruction persists add head tilt a small amount at a time until airway open Check breathing – look, listen, feel for no more than 10 secs; if in doubt whether breathing is normal, act as if it is not normal

Single Operator continued… Breathing normally – recovery position; re- assess Breathing abnormally Ascertain if there is a pulse or signs of life No pulse/signs of life Start compressions x 100 per min. After 30 compressions provide 2 ventilations (supplemental oxygen as soon as possible) Continue cycle until pt. recovers or ALS applied Pulse check – may be difficult to be certain about a pulse, if no signs of life start CPR “looks like a duck; walks like a duck; quacks like a duck; it’s a duck……” “looks dead is dead” Compressions as deep as can press (4-5cm) Ventilations with the most appropriate equipment available – inspiratory time of 1 second with adequate volume to expand chest normally

Practical demonstration Danger D Scene assessment Response R Patient assessment Airway A Maintaining Airway + c spine control Airway sweep Head tilt chin lift Jaw thrust OPA Breathing B Bag Valve Mask + supplementary O2 Circulation C Chest compressions

Automated external defibrillation PRACTICAL EXERCISE prepare and use of an Automated External Defibrillator (AED) Emphasise the importance of recognising quickly that the patient is suffering a cardiac arrest. Stress the importance of safety when using an AED - as per 1.6 p6. Explain what an AED does - analyses the heart rhythm - advises if a shock is indicated - delivers a pre-set shock when activated by the Provider Demonstrate the preparation of the chest, application of pads and use of an AED. Demonstrate the procedure when a shock is indicated. Also demonstrate the procedure, including performance of CPR, where no shock is advised. Outline the management of a patient who responds to defibrillation.

Figure 1.6.6

Figure 1.6.7

Figure 1.6.8

Summary Adult BLS + AED

Basic Life Support Paediatric

Cardiac arrest in children is an extremely rare event Introduction Cardiac arrest in children is an extremely rare event Invariably it is secondary to another problem Hypoxia is the most likely cause Prognosis is poor The Guidelines have been simplified in 2005 to hopefully empower better patient care Guidelines simplified – new scientific evidence, assist teaching & retention Experimental work and taken from adult data – cant practice on kids

Age Ranges An infant is a child under 1 year A child is between 1 year and puberty Size matters! Treat for the child’s size/weight rather than age

The Algorithm The PLS algorithm has changed to more closely reflect the adult algorithm There is clear evidence to show that doing ANYTHING in a paediatric cardiac arrest is significantly better than doing nothing Don’t get distracted by fear of doing things wrong Do the simple things well Practice practice practice !!!!!

5 initial rescue breaths If on own do 1 min CPR before going for help Compress chest 1/3 rd of its depth Ensure own safety Check responsiveness – do not shake if suspect cervical spine injury If responds – primary survey – load & go If no response – open airway Look listen feel – no more than 10 secs If no breaths – remove obvious FB 5 rescue breaths Check for pulse – no more than 10 secs If pulse – continue rescue breaths If no pulse, slow pulse < 60 or if not sure start compressions

Rescue breaths Infant Neutral position Apply chin lift / jaw thrust Child Ensure head tilt & chin lift / jaw thrust Suitable size bag & mask Inflate chest over 1-1.5 sec Observe rise & fall of chest OPA Measure OPA Centre of the incisors to the angle of the jaw Insert OPA Concave side up – small child

Compressions Infant – tips of 2 fingers Child – 1 or 2 hands Lower 1/3 rd of sternum Sufficient to compress the chest by 1/3rd Rate – 100 / min Circulation check Infant – brachial pulse Child – carotid pulse

Summary Paediatric cardiac arrest is rare Invariably it is secondary to another problem Manage problems early to prevent cardiac arrest Normal presentation is asystole Emphasis should be on good airway management and chest compressions

Summary Paed BLS