1. Basic Life Support
Adult

2. 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

3. 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

4. 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

5. 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.

6. Figure 1.6.6

7. Figure 1.6.7

8. Figure 1.6.8

9. Summary Adult BLS + AED

10. Basic Life Support
Paediatric

11. 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

12. 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

13. 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 !!!!!

14. 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

15. 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 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

16. 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

17. 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

18. Summary Paed BLS