BLS special situations

8/7/2019 BLS special situations

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Basic Life Support

Special Resuscitation Situations

Hannah Inyama

BSc. N, MSc.N (Critical Care Nursing)


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Overview

Special situations that can lead to cardio-

pulmonary arrest

May require changes in the sequence or

specific aspects of resuscitation


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OverviewHypothermia

Submersion (near-drowning)Trauma

Electric shock

Lightening strikePregnancy

Allergies


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Objectives

1. Describe BLS management of a cardiac

arrest victim who is hypothermic

2. Describe BLS management of a near-drowning victim who is in cardiac arrest

3. Describe BLS management of a trauma

victim who is in cardiac arrest


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Objectives cont..

4. Describe BLS management of a cardiac

arrest associated with electric shock or

lightening5. Describe BLS management of a

pregnant victim in cardiac arrest


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Hypothermia

Severe hypothermia (Temp below 30o C)

May make assessment difficult

Associated with;

- marked depression of cerebral blood

flow and oxygen requirement

- reduced cardiac output

- decreased arterial pressure


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Hypothermia

Slow respiratory rate

Slow pulse rate

Shallow breathing Peripheral vasoconstriction make pulses

difficult to feel.

assess breathing and later

circulation for30 to 45 sec


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Hypothermia

BLS Victims may appear to be clinically

dead (marked brain function depression)

Full recovery with intact brain possible, but

unusual.


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BLS principles forHypothermia

Remove all wet garments from the victim

Protect against heat loss and wind chill

Maintain the patient in a horizontal position

Avoid rough movement and excessive

activity ( may trigger arrthymia)

Allow 30-45 sec to assess breathing and

circulation


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BLS principles cont..

If no breathing, provide rescue breathing

If the victim is not in a cardiac arrest,

provide passive rewarming if available

If victim is in cardiac arrest, start chest

compressions


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Submersion / Near-Drowning


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Critical factor determining outcome

the duration of hypoxia


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Attempt to remove water by any means other

than suction is usually unnecessary and

dangerous

likely to eject gastric contents and cause

aspiration

Hemlich maneuver; thus not recommended for

routine resuscitation of submersion victims


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Vomiting and regurgitation are verycommon

- 86% in cases with chest compression

- 68% in cases with expired airresuscitation

Be prepared to manage airwayappropriately with suction or manualclearance


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BLS care for Submersion

Rescue the victim from water

Begin rescue breathing as soon as

possible If diving accident/head injury suspected,

maintain the neck in a neutral position,

protect the spine remember, remove

victim from the water


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BLS care for Submersion

Do not attempt chest compressions in the

water

Do not attempt to drain water from thelungs

Remove foreign bodies in the airway


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Trauma


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Trauma

Survival rate from pre-hospital cardiacarrest secondary to blunt trauma isuniformly low in children and adults

BLS is fundamentally the same as care ofthe patient with primary cardiac orrespiratory arrest

Structured approach

AcBCDE


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Electric shock


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Electric shock

Adults work related

Children home appliances

Wide spectrum of injury


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Electric shock


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Electric shock

Mechanism of cardiorespiratory arrest

Electrical current passing thro the brain

Inhibit respiratory centre Tetanic contractions of the diaphragm and

chest wall musculature

Prolonged paralysis of Resp Muscle

Hypoxia Cardiac arrest


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Lightening strike

Direct Current


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Pregnancy


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Pregnancy

CPR for pregnant mothers should be undertakenwithout modification except to a wedge pillowunder the right abd flank and hip.

Displace the uterus to the LT side of theabdomen

Keeps the uterus from interfering with venousreturn to the heart and cardiac output duringCPR


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Allergies

Severe allergic reactions are rare

W

hen they occur, they may belife-threatening

Initial inciting event;

- exposure to a known allergen

- a reaction to an insect bite


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Questions?


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Summary

Principles of BLS the same

Push hard, push fast

Allow complete chest recoil Avoid hyper-ventration

Ratio compression : ventration 30:2

Documents

BLS special situations