Basic Life Support ( BLS )

Automated External Defibrillation

(AED )

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Reza AzizkhaniEmergency Medicine Department

Isfahan University Of Medical Sciences

r_azizkhani@med.mui.ac.ir

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At the end of this courseparticipants should be able to demonstrate:

How to assess the collapsed victim.

How to perform chest compression and rescue breathing.

How to place an unconscious breathing victim in the recovery position.

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OBJECTIVES

Despite important advances in prevention, cardiac arrest

remains a substantial public health problem and a leading

cause of death in many parts of the world(46% in Iran).

Cardiac arrest occurs both in and out of the hospital.

approximately 350 000 people/year (approximately half of them in-hospital) suffer a cardiac arrest and receive attempted resuscitation. 4

BACKGROUND

Survival to hospital discharge presently approximately 5-10%

Early resuscitation & prompt defibrillation

(within 1-2 minutes) can result in >60% survival

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CHAIN OF SURVIVAL

Immediate recognition and activation

Early CPR

Defibrillation,

Advanced life support

Integrated post-cardiac arrest care.

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BLS 2005

ارزیابی سطح

هوشیاری

ارزیابی وضعیت تنفس

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BLS 2005

ارزیابی سطح

هوشیاری

ارزیابی وضعیت تنفس

LOOK , LISTEN ,FEEL

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12BLS 2010

همزمان ارزیابیتنفس و هوشیاری سطح

BLS 2010

Start CPR When …… :

UnresponsivenessAbnormalBreathing

OrNo breathing

Start CPR

ABC ???

A B C

SINCE 1960

C A B GIUDELINE 2010

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Arterial Blood O2 Content(ABC)

Arrest

Resuscitation

RescueBreathes

ChestCompression

O2 Content

Time

Arterial Blood O2 Content(CAB)O2 Content

Time

Arrest

Resuscitation

ChestCompression

CAB vs ABCO2 Content

Time

CAB

ABC

* Approach safely

Check response Check breathing

Shout for help & Call 115

30 chest compressions

2 rescue breaths

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BASIC LIFE SUPPORT

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APPROACH SAFELY!Scene

Rescuer

Victim

Bystanders

Approach safely Check response Check breathing

Shout for help & Call 115

30 chest compressions

2 rescue breaths

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CHECK RESPONSE - CHECK BREATHING

Approach safely

Check responseCheck breathing

Shout for help & Call 115 30 chest compressions

2 rescue breaths

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CHECK RESPONSEShake shoulders gently

Ask “Are you all right?”

If he responds• Leave as you find

him.• Find out what is

wrong.• Reassess regularly.

Occurs shortly after the heart stops in up to 40% of cardiac arrests

Described as barely, heavy, noisy or gasping breathing

Recognise as a sign of cardiac arrest

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AGONAL BREATHING & GASPING

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SHOUT FOR HELPApproach safely

Check responseCheck breathing

Shout for help & Call 115

30 chest

compressions2 rescue breaths

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Call 115Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

Feel within 1. definite pulse give 1 breath / q 5-6 s

2. recheck pulse q 2 min.

3. no pulse next step28

10 sec

Check pulseOnly for healthcare provider

Number of Compressions Delivered

Affected by Compression Rate and by Interruptions.

The total number of compressions delivered during resuscitation

is an important determinant of survival from cardiac arrest.

The number of compressions delivered is affected by the

compression rate and by the compression fraction.

(the portion of total CPR time during which compressions are

performed).

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Chest compressions are the foundation of

CPR

All rescuers, regardless of training, should

provide chest compressions to all cardiac arrest victims.

Minimal Interruptions During Chest CompressionCardiac Output

Time2 min

Minimal Interruptions During Chest CompressionCardiac Output

Time2 min

Cardiac Output

Time2 min

With Interruptions

Without Interruptions

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CHEST COMPRESSIONS

Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

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CHEST COMPRESSIONS

• supine victim on a hard

surface

• Place the heel of one hand

in the centre of the chest

( lower half )

• Place other hand on top

• Interlock fingers

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CONTINUE CPR

30 2

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CHEST COMPRESSIONS

• Push hard and fast the chest:– Rate at least 100 /min– Depth 5 cm– Equal compression / relaxation– Minimize interruptions in chest

compressions.

• When possible change CPR operator every 2 min

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RESCUE BREATHSApproach safelyCheck response

Check breathing

Shout for help & Call 115 30 chest

compressions2 rescue

breaths

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OPEN AIRWAY (head tilt , chin lift -- jaw

thrust )

Approach safely

Check responseCheck breathing

Shout for help & Call 115

30 chest

compressions2 rescue breaths

● Deliver each breath over 1 second

• Give a sufficient tidal volume produce visible chest rise .

● Avoid rapid or forceful breaths.40

Give 2 BREATH

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2 RESCUE BREATHSPinch the nose

Take a normal breathPlace lips over mouthBlow until the chest

risesTake about 1 secondAllow chest to fallRepeat

Approach safelyCheck responseCheck breathingShout for help &

Call 115 30 chest

compressions2 rescue breaths

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BASIC LIFE SUPPORT

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Nature

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AUTOMATED EXTERNAL DEFIBRILLATOR

In settings with 1-lay rescuer AED programs (AED on-site and available) 2-in-hospital environments

3-EMS rescuer witnesses the collapse,

The rescuer should use the defibrillator as soon as( within first 3-5 min) it is available for children and adults.

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Out-of-hospital cardiac arrest not witnessed by EMS personnel

EMS may initiate CPR while

checking the rhythm with the AED or on the electrocardiogram

(ECG) and preparing for defibrillation.

In such instances, 1½ to 3 minutes of CPR may be considered

before attempted defibrillation.

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AED Use in Children Now Includes Infants2010 (New)

For infants (<1 year of age),

defibrillator is preferred. If a manual defibrillator is not available,

an AED with pediatric dose attenuation is desirable. If neither is

available, an AED without a dose attenuator may be used.

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The precordial thump 2010 (New)

should not be used for unwitnessed out-of-hospital cardiac arrest.

1-for patients with witnessed monitored,

2-unstable VT (including pulseless VT)

3-if a defibrillator is not immediately ready for use,

but it should not delay CPR and shock delivery.

*Approach safelyCheck responseCheck breathing

Shout for help and call 115, get AEDAttach AED

Follow voice prompts

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SWITCH ON AED

Some AEDs will automatically switch them-selves on when the lid is opened

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ATTACH PADS TO CASUALTY’S BARE CHEST

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ANALYSING RHYTHM

DO NOT TOUCH VICTIM

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SHOCK INDICATED

Stand clearDeliver shock

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SHOCK DELIVEREDresume CPR

immediately for 5 cycles

30 2

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NO SHOCK ADVISED

resume CPR immediately for 5

cycles

30 2

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If victim starts to breathe normally place in recovery

position

Recovery position

1 2

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Approach safely

Check responseCheck breathing

Shout for help & Call 115 30 chest

compressions2 rescue

breaths

Approach safely

Check responseCheck breathing

Shout for help and call 115,

get AEDAttach AEDFollow voice

prompts

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