Basic life support. Goals. For health professionals. Identify the main causes of cardiac arrest. Roles and responsibilities of each individual

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1 Basic life support For health professionals Goals Identify the main causes of cardiac arrest Roles and responsibilities of each individual 1

2 Basic life support Chain of survival Each chain is vital to improve the survival rate New chain of survival 2

3 BLS in perspective Early access Ask for help Each minute makes a difference and reduce the chance of survival BLS in perspective Start CPR asap Maintain cerebral and myocardial perfusion Early CPR 3

BLS in perspective Early defibrilation Only

Most common cause of cardiac arrest Survival rate

perspective Early defibrillation 100 90 70 60 50

4 BLS in perspective Early defibrilation Only effective treatment for Ventricular fibrillation Most common cause of cardiac arrest Survival rate drops dramatically every minute BLS in perspective Early defibrillation % survival rate drops per minute 4

5 BLS in perspective Advance life Support Essential for survival of the patient Conclusion Like every chain breaks in the weaks link 5

6 Common causes of cardiac arrest Main cause of cardiac arrest Airway obstruction Cardiac (primary or secondary) 6

insuf Depression of resp center Alteration of thorax wall (Thorax trauma or neuro trauma)

7 Airway obstruction Blood, vómits, Foreign body Face and neck trauma GCS depression (airway not protected) Epiglottis, laryngospasm, laryngeal edema Bronchospasm and secretions Respiratory insuf Depression of resp center Alteration of thorax wall (Thorax trauma or neuro trauma) Alteration pulmonary parequimia (pneumothorax, ammonia, CPOD, pulmonary embolism, ARDS, restrictive diseases) 7

) Electrolytes or acid-base balance Electrocutions, Hipotermia Cardiac

8 Cardiac causes Isquemia Hypertensive Cardiopathy Miocardiopathy (valvular, hypertrophic, dilated) Drugs (anti-arrítmicos, anti-depressives, etc.) Electrolytes or acid-base balance Electrocutions, Hipotermia Cardiac Tamponade, cardiac rupture Other cardiac causes Hypoxemia Anemia Hypovolemia Sepsis... 8

9 The rescuer should not expose himself and others Safety Assess the safety 9

10 RISKS Infections Very little risks of contamination Tuberculosis Meningites herpes RISKS Hepatites HIV No cases reported Recomendação P.P.E. 10

11 P.P.E gloves mask goggles Pocket mask Unidirectional valve O2 connection 11

12 Pocket mask Barrier to protect the rescuer Basic life Support 12

13 Goals Describe BLS concept Understand each step Understand the sequence of actions Describe eventual problems LIMITATIONS OF THE BLS BLS its not enough to recovery a primary cardiac arrest Maintain 30% of perfusion needs of brain and heart Buy time for ALS to arrive and revert 13

14 BLS steps Primary survey Open airway- A Provide ventilation- B Chest compressions - C Check consciousness Are you ok? Tap the shoulders 14

15 Positive response Do not move the patient Try to understand what happened Look for wounds and bleedings ask for help Negative response Help!! Ask for help Check for breathing 15

16 Check breathing Check the mouth Open airway Unconsciousness Drop of the tongue Obstruction of airway Open airway Open airway 16

17 Airway - A Trauma patient Open airway Jaw thrust Check breathing 10 Seconds See Listen Feeling 17

18 Breaths present Recovery position ask for help re check often Absent breathing Ask for help Send someone looking for help 18

19 Exceptions Do not abandon the victim if Trauma Drowning Poisoning Children and babies Ventilation Mouth to mouth Mouth to mask 2 Breaths try up to 5 times if does not go in 19

Repeat after check compressions No pulse Start chest

20 Ventilation Thorax rise on each breath Slow breath (2 seconds) Maintain the open airway Let the air escape Repeat after check compressions No pulse Start chest compressions under nipple line and above xiphoidal appendix 20

21 Chest compressions 5 to 6 cm

22 C.P.R Do not stop until: ALS arrival Exhaustion Transport the victim 30:2 Airway obstruction Goals Early recognition of airway obstruction Be familiar with protocol 22

23 Clinica Girassol Obstructions Pharynx Tongue TRAUMA Vomit Blood Foreign body Larynx by edema (burn, anaphylaxis) Airway Obstruction Nose Mouth TRAQUEA. Anatomic. Mechanic. Pathologic Early recognition SEE - LISTEN - FEEL Airway obstruction. PARCIAL. COMPLETE Lost of L.O.C. 23

24 Airway obstruction protocol Ineffective Cough, not able to s p eak or breath Conscious Able to breath Encourage to cough Insist until No Release airway Yes X 5 X 5 No Release airway Yes Keep until become unconsciousness Airway obstruction protocol Unconsciuness Ask for help Se obstrução Recovery position Yes Breath No 30:2 Look for Foreign body B.L.S. If breath present 24

25 Conclusions BLS buy time for the patient A B C: A - Airway B - Breathing C - Circulation 25

26 HIOIDE Airway C. TIROIDE L. CRICO-TIROIDEU C. CRICOIDE 26

Clinica Girassol Open airway in trauma X

patient 1 Measurement 2 Place upside down If

27 Clinica Girassol Open airway in trauma X Avoid moving the cervical Head Till chin lift CERVICAL TRAUMA Do jaw thrust!! Oropharyngeal tube Only unresponsive patient 1 Measurement 2 Place upside down If too short do not open and secure the airway If too long cause vomits 27

Nasopharyngeal tube Indicated for more Reactive

$base of skull fracture Can cause vomit Can cause$ Mouth to Mouth, Mouth Mask B.L.S. LARINGEAL TUBE I.L.S ETT COMBITUBE A.

28 Nasopharyngeal tube Indicated for more Reactive patients Good for facial Trauma Contra indicated on base of skull fracture Can cause vomit Can cause Laringospasm Ventilation Techniques. Mouth to Mouth, Mouth Mask B.L.S. LARINGEAL TUBE I.L.S ETT COMBITUBE A.L.S. Oxygen 100% Patients may die without oxygen not without intubation 28

29 Mouth / Mask B.V.M. Oxygen supplement Mask and ETT 500 ml of O 2 Risk Hypoventilation with mask Gastric distention Vomits 2 slown breaths Check thorax distention Coordination with chest compressions 29

30 Máscara laríngea Menos treino Extensão cabeça Fiável Vários tamanhos Fármacos Não isola VA Não permite ventilar se pressões elevadas na VA Laringospasmo Obstrução VA Combitube 2 lúmens 2 cuffs Melhor isolamento VA Evita fuga ar pela boca Só tamanhos de adulto Uso único Abertura da boca Rotura cuffs Traumatismo tecidos 30

31 Defibrillators Manual Automatic 31

32 A.E.D. Automatic functions Recognize the cardiac rythm Select energy Charge Indicate if shock is indicated Rescuer Should recognize cardiac arrest Dry the patient/shave and expose chest Delivery the shock Start CPR A.E.D. 0 accidents in 20 years Impossible to deliver inappropriate shock 100% safe Deliver 1 shock without medical personnel Little amount training required 32

33 Conclusion Defibrillation its only way to re stablish cardiac output on VF Shock should be ASAP Pre cordial thumb If cardiac arrest its witness Unresponsive patient without ventricular activity Produce 2 joules of energy 33

AIRWAY MANAGEMENT AND VENTILATION

AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management D2 Basic