EuropeanResuscitationCouncil Basic Life Support & Automated External Defibrillation Course EuropeanResuscitationCouncil OBJECTIVES • At the end of this course participants should be able to demonstrate: – How to assess the collapsed victim. – How to perform chest compression and rescue breathing. – How to operate an automated external defibrillator safely. EuropeanResuscitationCouncil BACKGROUND • Approximately 350 000 - 700,000 cardiac arrests per year in Europe • Survival to hospital discharge presently approximately 5-10% • Bystander CPR vital intervention before arrival of emergency services • The immediate initiation of CPR can double or quadruple survival from cardiac arrest. • Defibrillation within 3–5 min of collapse can produce survival rates as high as 50–70%. EuropeanResuscitationCouncil CHAIN OF SURVIVAL EuropeanResuscitationCouncil Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil CHECK RESPONSE Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil Shake shoulders gently Ask “Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly. CHECK RESPONSE EuropeanResuscitationCouncil SHOUT FOR HELP Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil OPEN AIRWAY Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil OPEN AIRWAY • Tilt the head back • Lift victim´s chin EuropeanResuscitationCouncil CHECK BREATHING Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil CHECK BREATHING • Look, listen and feel for NORMAL breathing • Do not confuse agonal breathing with NORMAL breathing EuropeanResuscitationCouncil AGONAL BREATHING • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing • Recognise a signs of cardiac arrest EuropeanResuscitationCouncil Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil Dispatcher assisted CPR • Reduce the time to first CPR • Increase the number of chest compressions delivered • Improve patient outcomes following out-of-hospital cardiac arrest (OHCA) • Dispatchers should provide telephone-CPR instructions in all cases of suspected cardiac arrest • Dispatchers should provide chest-compression-only CPR instructions where required EuropeanResuscitationCouncil 30 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest – Rate 100 - 120 min-1 – Depth 5-6 cm – Equal compression : relaxation • When possible change CPR operator every 2 min CHEST COMPRESSIONS EuropeanResuscitationCouncil RESCUE BREATHS Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil RESCUE BREATHS • Pinch the nose • Take a normal breath • Place lips over mouth • Blow until the chest rises • Take about 1 second • Allow chest to fall • Repeat EuropeanResuscitationCouncil CONTINUE CPR 30 2 EuropeanResuscitationCouncil Chest-compression-only • All CPR providers should perform chest compressions for all victims in cardiac arrest. • CPR providers trained and able to perform rescue breaths should combine chest compressions and rescue breaths. • The addition of rescue breaths may provide additional benefit for: children, asphyxial cardiac arrest. EuropeanResuscitationCouncil Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths EuropeanResuscitationCouncil DEFIBRILLATION EuropeanResuscitationCouncil Call 112 Approach safely Check response Shout for help Open airway Check breathing Attach AED Follow voice prompts EuropeanResuscitationCouncil EuropeanResuscitationCouncil SWITCH ON AED • Some AEDs will automatically switch themselves on when the lid is opened EuropeanResuscitationCouncil ATTACH PADS TO CASUALTY’S BARE CHEST EuropeanResuscitationCouncil ANALYSING RHYTHM - DO NOT TOUCH VICTIM EuropeanResuscitationCouncil SHOCK INDICATED • Stand clear • Deliver shock EuropeanResuscitationCouncil SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 2 EuropeanResuscitationCouncil NO SHOCK ADVISED FOLLOW AED INSTRUCTIONS 30 2 EuropeanResuscitationCouncil IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION EuropeanResuscitationCouncil EuropeanResuscitationCouncil CPR IN CHILDREN • Adult CPR techniques can be used on children • Compressions 1/3 of the depth of the chest EuropeanResuscitationCouncil AED IN CHILDREN • Age > 8 years • use adult AED • Age 1-8 years • use paediatric pads / settings if available (otherwise use adult mode) • Age < 1 year • use only if manufacturer instructions indicate it is safe EuropeanResuscitationCouncil ANY QUESTIONS? EuropeanResuscitationCouncil Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths Approach safely Check response Shout for help Open airway Check breathing Call 112 Attach AED Follow voice prompts EuropeanResuscitationCouncil Heimlich‘s maneuver Choking and Foreign Body Airway Obstruction (FBAO) EuropeanResuscitationCouncil FBAO algorithm EuropeanResuscitationCouncil Back Blows Abdominal thrusts: position of first hand Abdominal thrusts: position of second hand Choking EuropeanResuscitationCouncil Adult EuropeanResuscitationCouncil EuropeanResuscitationCouncil • Oropharyngeal airways – Better in comatose patients • Nasopharyngeal airways – Better tolerated by patient – Can cause nose bleed CAREFUL! Both can cause airway obstruction ! Airway adjuncts EuropeanResuscitationCouncil Insertion of oropharyngeal airway Airway adjuncts EuropeanResuscitationCouncil • Give oxygen whenever it is available Type of oxygenation Oxygen concentration Mouth to mouth 17 % Face mask Up to 50% Face mask with reservoir Up to 85% More O2 for brain Oxygen EuropeanResuscitationCouncil • High incidence of complications without adequate training and experience • Best technique depends on the circumstances and competence of the rescuer Alternative airway devices EuropeanResuscitationCouncil • Mouth to mouth • Mouth to nose • Mouth to protective device • Using self inflating bag or ventilator B - Breathing EuropeanResuscitationCouncil • Inspiration 1 sec • Volume : enough to make the chest rise – Larger volumes lead to gastric inflation Ventilation EuropeanResuscitationCouncil ANY QUESTIONS?