dr.dhananjaya bulathwatta. importance importance cpr time line 0-4 mins. brain damage unlikely 4-6...
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CARDIAC LIFE SUPPORT
Dr.Dhananjaya Bulathwatta
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BLS
ALS
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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.
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Importance
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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
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Urgency60%
40%
20%
0%
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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
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ADULT BLS SEQUENCE
Check for Response - “touch and talk” Shout – “HELP” Call Emergency No.[s] Airway Breathing Circulation Disability
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AIRWAY
Head tilt- Chin lift
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Jaw Thrust with Support
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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
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BREATHING….
2 Resque breaths within 2-4 seconds
Make the chest rise
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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
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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.
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DISABILITY PREVENTION
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ADULT CHOKING SEQUENCE
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CHILD CPR DEFERENCES Pulse less than 60 bpm
2 Rescuer CPR
-Concider as poor perfusion
-15 : 2
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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
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ALS
Intubation
Cardiac Monitor
Precordial Thumb
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ALS… Pulseless VT
Asystole
VF
E.M.D.
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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.
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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
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E.M.D. CPR Give further adrenaline 1 mg IV every 3-5 min
(alternate loops)
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ENSURE YOUR SKILLS ARE
UPDATED EACH YEAR
THANK YOU
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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]