dr.dhananjaya bulathwatta. importance importance cpr time line 0-4 mins. brain damage unlikely 4-6...

CARDIAC LIFE SUPPORT

Dr.Dhananjaya Bulathwatta

BLS

ALS

BLS

Defined

as “the preservation or restoration of life by the establishment and/or the maintenance of airway, breathing and circulation, and related emergency care.

Importance

Importance

CPR TIME LINE 0-4 mins. brain damage

unlikely 4-6 mins. brain damage

possible 6-10 mins. brain damage

probable >10 mins. probable

brain death

Urgency60%

40%

20%

0%

Background

The best chance of long term neurologically intact survival occurs if:

The victim’s collapse is witnessed CPR is commenced immediately The cardiac rhythm is VF or pulse less

VT

ADULT BLS SEQUENCE

Check for Response - “touch and talk” Shout – “HELP” Call Emergency No.[s] Airway Breathing Circulation Disability

AIRWAY

Head tilt- Chin lift

Jaw Thrust with Support

BREATHING

LOOK

LISTEN

FEEL

for rise and fall of the chest.

for breath sounds.

for the exhaled air

TAKE AT LEAST 5 BUT NOT MORE THAN 10 SECONDS

BREATHING….

2 Resque breaths within 2-4 seconds

Make the chest rise

CIRCULATION

Signs of Circulation Carotid pulse Cyanosis Cold peripheries

“There is reasonable evidence that rescuers are no more likely to be able to correctly determine if a pulse is present than simply tossing a coin” (ARC, 2006)

TAKE AT LEAST 5 BUT NOT MORE THAN 10 SECONDS

CIRCULATION…

Push down on the chest 11/2 to 2 inches 30 times right between the nipples.  Pump at the rate of 100/minute, faster than once per second.

Minimize interruptions to 10 seconds or less.

DISABILITY PREVENTION

ADULT CHOKING SEQUENCE

CHILD CPR DEFERENCES Pulse less than 60 bpm

2 Rescuer CPR

-Concider as poor perfusion

-15 : 2

INFANT CPR DIFFERENCES Brachial Pulse less

than 60 bpm

Just below the nipple line on breast bone

2 Rescuer CPR

-Consider as poor perfusion

-2 fingers

-15 : 2

ALS

Intubation

Cardiac Monitor

Precordial Thumb

ALS… Pulseless VT

Asystole

VF

E.M.D.

VT/VF Defibrillation (one shock - 150-200 J biphasic or 360 J

monophasic). Immediately resume chest compressions (30:2)

without reassessing the rhythm or feeling for a pulse. Continue CPR for 2 min, then pause briefly to check

the monitor. If VF/VT persists give adrenaline 1 mg IV [every 3-5

min] followed immediately by a shock.

ASYSTOLE CPR 30:2 till pt. becomes shockable Give adrenaline 1 mg IV as soon as intravascular

access is achieved and every 3-5 min (alternate loops).

Give atropine 3 mg IV

E.M.D. CPR Give further adrenaline 1 mg IV every 3-5 min

(alternate loops)

ENSURE YOUR SKILLS ARE

UPDATED EACH YEAR

THANK YOU

Adult Child Infant

1Response, Shout for help, Emergency Call

2Head tilt, Chin lift [Suspected trauma: Jaw thrust]

3Look, Listen, Feel for breathing 5-10 seconds

42 Rescue Breaths. [1 second each]

5No carotid Pulse No carotid Pulse No brachial Pulse

start CPR or <60 with signs or <60 with signs

of poor perfusion of poor perfusion

start CPR start CPR

6Center of the breast bone Just below the nipplebetween two nipples line on breast bone

7With both hands [interlaced fingers] 2 Fingers

81.5-2 Inches 1/3 - 1/2 of the depth of chest

9 100 per minute

1030 for 2 30 for2 [1 Resquer], 15 for 2 [2 Resquer]