bls edited 2012.ppt
TRANSCRIPT
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11
d
AHA ECC Chain of survival
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22 Resuscitation UpdateResuscitation Update Saturday, NovemberSaturday, November, 2!1", 2!1"
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ife Support System
#$y%enAtmospheric air 21 & #$y%en
E$haled air 1' & #$y%en (un%s e$tract " & #$y%en ##22
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ife Support System
(un%s E$chan%e of #$y%en and
carbon dio$ide
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ife Support System
Heart )o pump o$y%enated blood
to the rest of the body
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ife Support System
*rain *rain cells +ill start to die if
no o$y%en received for -'minutes
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FUNCTION OF THE HEART &
UNGS
BLOOD+ O2
O2
BLOOD - O2 BLOOD + O2
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Saturday, NovemberSaturday, November, 2!1", 2!1"
..
CPR through the ages
PR through the ages
ChallengesChallenges
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Saturday, NovemberSaturday, November, 2!1", 2!1"
//
Some !ot so "e#e$rate%
ome !ot so "e#e$rate%
i!sta!"es
!sta!"es
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Saturday, NovemberSaturday, November, 2!1", 2!1"
1!1!
19561956 James ElamJames Elamandand Peter SafarPeter Safar
0outh-to-mouth resuscitation0outh-to-mouth resuscitation
19601960 Dr KouwenhowenDr Kouwenhowenand teamand team
E$ternal chest compressionE$ternal chest compression
19631963 AHA formally endorses CRAHA formally endorses CR
19661966 irst conference on CRirst conference on CR
Standardi3e trainin% andStandardi3e trainin% and
performance standardsperformance standards
19721972 0ass citi3en4s trainin% in CR0ass citi3en4s trainin% in CR
#ver 1!!,!!! trained over 2 years#ver 1!!,!!! trained over 2 years
1970s1970s More than 60% !stan"ers w#llMore than 60% !stan"ers w#ll
$erform P&$erform P&
CPR i#esto!e
PR i#esto!e
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CPR i#esto!e
PR i#esto!e
1970s5 citi3en4s CR in US
19'5 5 0alaysian Society of Anesthesiolo%ists
6 0in7 #f Health 8AHA9
1997 5 Utstein style for reportin% of CR
2000 5 ne+ %uidelines on CR
2005 5 update on international %uidelines
2!1! 5 latest update on international %uidelines
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'H( CPR)
Help to save lives
0ost of the sudden
cardiopulmonaryarrest may be
successfully
resuscitated
rompt CR canprevent permanent
brain dama%e
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Cha##e!ges to%ay
)oo fe+ people :no+ CR
)oo fe+ people +illin% to perform CR
;e are not trainin% the most important %roup ofpeople
)rained providers cannot remember ho+ toperform CR
;e have for%otten the importance of time
#ur duty to train others
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CPR Pri!"ip#es
PR Pri!"ip#es
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Remem$er *********
emem$er *********
The human body may live forThe human body may live for
4 weeks without food;4 weeks without food;
4 days without water;4 days without water;
BUTBUT
Only 4 minutes withoutOnly 4 minutes withoutoxygenoxygen
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Dont waitDont wait
Call Call
!tart C"#"$"!tart C"#"$"
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Time of the esse!"e
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Saturday, NovemberSaturday, November, 2!1", 2!1"
1.1.
%very &'( minute )ass *after +ardia+ arrest,-
'. /
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&EMEM(E& )*+ *,-) ./E
M,+ES
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-oo4 out for"aner efore
!ou start P&
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Are you #
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/-/)S/-/)S/P/P .E M *,.E M *,
.E S.*+-DE&S.E S.*+-DE&S/,D /SK/,D /SK
.E M.E M /&E )*+ *K/&E )*+ *K
P*S*, M *, / ./&D S+&/E
S.*+
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0ook0ook
O)en airway maneuversO)en airway maneuvers
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Ope! the A r+ay
erform head tilt-chin lift to
open the air+ay
Head tilt5 place one hand
on the forehead and not
the eyes, to tilt the head
bac:
Chin lift5 place fin%ers of
the other hand on the bony
part and not the soft tissueof the >a+, to lift the chin
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OPEN AIR'A(
?a+ )hrust
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NOTOT
,REATHING
REATHING
or
r
GASPING)
ASPING)
""
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8#e :!:les of 30 :om$ress#ons to 2 reaths
+nt#l /ED; Def#; /-S Pro#"er ta4e oer;
or #:t#ms start to moe
Push ./&D an" /S
an" release :om$letel!
M#n#m#se :om$ress#on #nterru$t#ons
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Saturday, NovemberSaturday, November, 2!1", 2!1" @!@!
AE, efibrillator ARRBES
SH#C
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Re"o-ery positio!
e"o-ery positio!
0ain purpose50ain purpose5
)o maintain the)o maintain the patency of the air+ay 6patency of the air+ay 6
prevent aspirationprevent aspirationin a non-traumain a non-traumapatient +hile +aitin% for the ambulancepatient +hile +aitin% for the ambulance
after patient successfully resuscitatedafter patient successfully resuscitated
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@@@@
N# RES#NSE G 0#E0EN)N# RES#NSE G 0#E0EN)
CA(( #R HE(
et AE G efibrillator
#pen ABR;AD, Chec: *REA)HBN
ive cycles of @! compressions and 2 breath
Until AE, efib, A(S rovider ta:e over, victims start to move
ush HAR and AS) 81!!Gmin9 and release completely0inimise compression interruptions
AE, efibrillator ARRBES
SH#C
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Res"ue
es"ue
,reath
reath
1 res+ue breaths-- that make the +hest1 res+ue breaths-- that make the +hest
rise"rise"
%a+h res+ue breath should be given over '%a+h res+ue breath should be given over '
se+ond *Class 22a,"se+ond *Class 22a,"
This re+ommendation a))lies to all res+uers"This re+ommendation a))lies to all res+uers"
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Res"ue
es"ue
,reath
reath
ace shield
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Res"ue
es"ue
,reath
reath
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Res"ue
es"ue
,reath
reath
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3ealth )roviders
Che+k )ulse within '.se+safter 1 minutes 5 +y+lesof C#$
6on health +are)roviders 7 no need to+he+k for )ulses
Pu#se "he".
u#se "he".
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if 8%D or De9b ma+hine available : $hythm
+he+k on monitor every 1 minutes *together with)ulse +he+king,
!ho+kable De9b
Rhythm
hythm
"he".
he".
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Compressio! / 0e!ti#atio!
Ratios
uidelines 2!!! 1" 5 2 ratio for adultsF rate 1!! G min
cycles
uidelines 2!!" @! 5 2 ratio for all rescuers, all a%es a%e of 1 yr
Rate 1!! G minF push hard and push fast
" cycles in 2 minutes
No interruptions e$cept for defibrillation and rhythm analysisuidelines 2!1!
ChangesChanges
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22uideline 2!1!uideline 2!1!
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1efi$ri##atio! 2o!e3sho".
strategy4
E!ergy e-e#s use% for
0F50T
0anual defibrillation
0onophasic @'! ? for all shoc:s
*iphasic *)E 1"! to 2!! ? initial shoc:
Bf unsure +hich +aveform, use default 2!! ?
or second and subseIuent shoc:s, use same
or hi%her ener%ylevels
AE defibrillation
*iphasic evice specific
ChangesChanges
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1efi$ri##atio!
ChangesChanges
Attention must be paid to E)AB(S Reducin% interruptions to chest
compressions
roper techniIue
roper placement
roper eIuipment
roper ener%y levels
Resumin% chest compressions immediately
0a:e each shoc: countJJ
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Termi!ati!g a Resus"itatio!
i! a ,LS out3of3Hospita#SystemRescuers +ho start *(S should continue until one of
the follo+in% occurs5
17 Restoration of effective, spontaneous circulation
and ventilation7
27 Care is transferred to a more senior-level
emer%ency medical professional +ho may
determine that the patient is unresponsive to the
resuscitation attempt7
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@7 Reliable criteria indicatin% irreversible death
are present
7 )he rescuer is unable to continue because ofe$haustion or
"7 the presence of dan%erous environmental
ha3ards or because continuation of
resuscitative efforts places other lives in>eopardy7
'7 A valid NAR order is presented to rescuers7
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PAE1IATRIC CPR
ANER
P*SS(-E &EM*E .E S*+&E *
D/,8E& ?
*,-) &EM*E .E M /S / -/S
&ES*&
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PAE1IATRIC CPR
RES#NSE 8 entle tappin% or sha:in%
the shoulder7
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PAE1IATRIC CPR
Bf unresponsive , shout for HE( J
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PAE1IATRIC CPR
A - ABR;AD 8 head tilt chin lift or >a+
thrust 9
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PAE1IATRIC CPR
* K *reathin% 5 loo: , listen and feel L1!s
Absent =
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PAE1IATRIC CPR
* K *reathin% 8" initial rescue breaths9
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PAE1IATRIC CPR
C K Circulation 5L1! s
eel#n for the ra:h#al $ulse #n #nfant an" :arot#" $ulse #f the :h#l"
#s oer 1 !ear of ae?
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PAE1IATRIC CPR
Chest Compression 5 No ulse or ulseL '!Gmin
Child
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PAE1IATRIC CPR
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PAE1IATRIC CPR
Bnfant and children
one
res:uer
two
res:uer
ive cycle of 1" compressions and
2 breath for " cycle
ive cycle of @! compressions and 2
breath for " cycle
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Bf there is palpable pulse '!Gmin but inBf there is palpable pulse '!Gmin but in
adeIuate breathin% , to continue rescueadeIuate breathin% , to continue rescue
breaths 12-2!Gmin7breaths 12-2!Gmin7
Saturday, NovemberSaturday, November
, 2!1", 2!1"'!'!
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'1'1uideline 2!1!uideline 2!1!
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A%u#t Foreig!3$o%y
Air+ay O$stru"tio!
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A%u#t "ho.i!g
2"o!s"ious4
No fin%er s+eep unless forei%n body
visible
Bn conscious pt, %ive " bac:slapsfollo+in% +ith " abdomen thrustGchest
thrust
Noabdominal thrust in unconscious ptbut CR instead7
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A%u#t "ho.i!g
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A$%omi!a# Thrust
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Chest Thrust
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Foreig!3,o%y Air+ay
O$stru"tio! i!fa!t
Conscious 5 Serious si%ns Chec: serious difficulty in breathin%
Bneffective cou%h
No stron% cry
us:y colour
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Foreig!3,o%y Air+ay
O$stru"tio! i!fa!t
Conscious
ive " bac: blo+s and " chest thrusts
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Foreig!3,o%y Air+ay
O$stru"tio! i!fa!t
Bf *A# becomes Unconscious
Activate E0S
#pen Air+ay 8 if * seen, remove it 9 Start CR
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M hone fast or phone first for lone rescuerM aediatric chain of survival77M Assessment in conscious adult cho:in% victim by as:in%
Iuestion77
M Reference
M uidelines for Resuscitation )rainin% Bn 0inistry of Health
0alaysia Hospitals and Health Care acilities 2!12 - NC#R)
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