GENERAL EMERGENCY LIFE SUPPORT

RSUP DR. SARDJITO

CARDIO PULMONARY R

GENERAL EMERGENCY LIFE SUPPORT

RSUP DR. SARDJITO - YOGYAKARTA

RY RESUSCITATION 2010

Cardiopulmonary resuscitation (CPR): is a

of life saving actions of life saving actions

survival following cardiac arrest.

Optimal approach to

on the rescuer, the vic

fundamental challenges remains:

early and effective CPRearly and effective CPR

Cardiopulmonary resuscitation (CPR): is a series

of life saving actions that improve the chance oof life saving actions that improve the chance o

survival following cardiac arrest.

h to CPR may vary, depending

e victim and resources, still th

fundamental challenges remains: how to achiev

early and effective CPRearly and effective CPR

Cardiac arrest occurs: in and out of hospital

In US & Canada: 350.000 people/yr (half in

hospital) cardiac arrest and receive attempted hospital) cardiac arrest and receive attempted

resuscitation. Not includ

resuscitation.

Inappropriate resuscita(on →

years lost

in and out of hospital

In US & Canada: 350.000 people/yr (half in

hospital) cardiac arrest and receive attempted hospital) cardiac arrest and receive attempted

cluded without attempted

Inappropriate resuscita(on → many lives & life-

Successfull resuscitation requires an

integrated set of coor

Chain of survival

✓ immediate recognition and activation

✓ early CPR

rapid defibrilation✓ rapid defibrilation

✓ effective advance life support

✓ integrated post-

resuscitation requires an

coordinated ac(ons →

immediate recognition and activation

defibrilationdefibrilation

effective advance life support

-cardiac arrest care

BASIC LIFE SUPPORT

Basic Life Support (BLS) is t

lives following cardiac arrestlives following cardiac arrest

Fundamental aspects of BLS:

✓ immediate recognition of su

Activation of emergency response system

✓ Early cardiopulmonary resuscitation (CPR)

✓ rapid defibrillation with automated external defibrillator ✓ rapid defibrillation with automated external defibrillator

(AED)

The universal Adult Basic Li

framework for all levels of rescuers setting.

BASIC LIFE SUPPORT

) is the foundation for saving

lives following cardiac arrestlives following cardiac arrest

Fundamental aspects of BLS:

of sudden cardiac arrest (SCA) and

Activation of emergency response system

Early cardiopulmonary resuscitation (CPR)

rapid defibrillation with automated external defibrillator rapid defibrillation with automated external defibrillator

sic Life Support is a conceptual

framework for all levels of rescuers setting.

Early recognitio

Ensuring the scene is safe

Check unresponsivenessCheck unresponsiveness

no movement

no response on stimulation (shouting or tapping his shoulder)

activate the emergency response (call 911)

check breathing:

no breathing

abnormal breathing (

nition & activation

Ensuring the scene is safe

unresponsiveness: unresponsiveness:

no response on stimulation (shouting or tapping his shoulder)

activate the emergency response (call 911)

abnormal breathing (ie gasping)

check pulseFor:

✓ lay rescuer: shouldn

collapses/unresponsive, no/abnormal collapses/unresponsive, no/abnormal

breathing →assume cardiac

chest compression

✓ health provider: <10

compression

check pulse

shouldn’t check! suddenly

collapses/unresponsive, no/abnormal collapses/unresponsive, no/abnormal

breathing →assume cardiac arrrest → start

<10” !! more → start chest

Early CPR

CHEST COMPRESSIONCHEST COMPRESSION

- consist of forcefulthe lower half of the

- Create blood flowpressures & directly→blood flow &→blood flow &myocardium & brain

- effective chest compression

Early CPR

rhythmic of pressure overthe sternum

by increasing intrathoracicdirectly compressing the heart

& oxygen delivery to& oxygen delivery tobrain

compression are essential

How to do ches

✓ lower half of sternumlower half of sternum

✓ push hard, push fast

✓ at least 100 compression/minutes

✓ at least 2 inch or 5 cm depth

✓ allow complete recoil

compression✓ compression

✓ minimal compression

chest compression ?

lower half of sternumlower half of sternum

push hard, push fast

100 compression/minutes

2 inch or 5 cm depth

allow complete recoil

sion & ventilation ratio= 30:2sion & ventilation ratio= 30:2

compression interruption

It is recommended to switch

or after 5 cycles, and should <5 seconds

to check pulse after cycles,

rescuers (do not stop the chest compression). But, it

for health provider, and still <10 s.for health provider, and still <10 s.

interuption for health care provider

intubate and to defib.

switch chest compressors @2 mn

or after 5 cycles, and should <5 seconds

, NOT recommended for lay

rescuers (do not stop the chest compression). But, it’s o

for health provider, and still <10 s.for health provider, and still <10 s.

for health care provider: to check pulse, to

Rescue breaths:

start immediately, after head positioning, but

compression

mouth to mouth or bag mask ventilationmouth to mouth or bag mask ventilation

each over 1 second

sufficient (dal volume → visible chest rise

» normal VT 8-10 ml/kg is sufficient

» in CPR patients (with CO 25

ratio with compression still 30:2

risk excessive ventilation:

» gastric inflation: regurgitation & aspiration

» ↑ intrathoracic pres

output→↓ survival

start immediately, after head positioning, but after chest

mouth to mouth or bag mask ventilationmouth to mouth or bag mask ventilation

sufficient (dal volume → visible chest rise

10 ml/kg is sufficient

in CPR patients (with CO 25-33%), VT 6-7 should be suffic

ratio with compression still 30:2

gastric inflation: regurgitation & aspiration

ressure→↓venous return→↓cardi

utput→↓ survival

Early defibrillation with an AED

VF is common & treatable initial rhythm in adults with witnessed cardiac arrestcardiac arrest

VF case, survival highest when CPR is provided & 3-5’ of collapse

Rapid defib is tx of choice for VF oout of hospital or hospitalized patient cardiac arrest.

AED should be used as rapidly as possible

Defibrillation sequence:

Turn on the AEDTurn on the AED

follow the AED prompts

Resume chest compression immediately after the shock (minimize interruptions)

Early defibrillation with an AED

VF is common & treatable initial rhythm in adults with witnessed

VF case, survival highest when CPR is provided & defib occurs within

F of short duration such as witnessed out of hospital or hospitalized patient cardiac arrest.

AED should be used as rapidly as possible

Resume chest compression immediately after the shock

Rescuers specif

Health care provider:

30:2 cycle until advanced airway is placed30:2 cycle until advanced airway is placed

after that, give ventilation, 1 breath: 6-8 second, or 8

Avoid excess ventilation

To activate EMS for lone provider:

- as seen the patient get collpase

- or ie in drowning or airway obstruction case, 5 CPR cycles first, then

ecific strategies:1. Untrained Lay rescuer:

Hand-only CPR until AED or health p

arrive.

push hard and push fast or by emergpush hard and push fast or by emerg

medical dispatcher’s direction

2. Trained Lay rescuer:

chest compression and breathing rat

do until EMS arrive or health care pr

take over

30:2 cycle until advanced airway is placed30:2 cycle until advanced airway is placed

8 second, or 8-10 x/mnt

in drowning or airway obstruction case, 5 CPR cycles first, then

Adult BLS for

health care

provider

managing the

for trained Lay rescuer who could do both

chin liftchin lift

for hands-only cpr → insufficient evidence

passive airway

for health care provider:

- no cervical spine injury → head (lt & chin liF

- susp cervical spine injury:✓ initially use manual spinal motion restriction (

side of patient’s head to hoside of patient’s head to ho✓ jaw thrust without head extention

• when advanced airway device is placed, no

• - chest compression: 100x/mnt

• - ventilation : every 6-8 second, or 8

the airway

both chest comp & ven(la(on → head (lt

ence to recommend them to use of any sp

no cervical spine injury → head (lt & chin liF

initially use manual spinal motion restriction (eg placing 1 hand on ei

hold it still) rather than immobilization devi hold it still) rather than immobilization devi

extention.

when advanced airway device is placed, no interuption anymore for ventilation

8 second, or 8-10 breaths/mnt

Recovery Position

is used for unresponsive patient who clearly have

normal breathing and effective circulationnormal breathing and effective circulation

Recovery Position

is used for unresponsive patient who clearly have

normal breathing and effective circulationnormal breathing and effective circulation

Key changes & con

emphasis from the 2005 BLS:

immediate recognition of SCA based onimmediate recognition of SCA based on

breathing

Look, Listen and Feel” removed from BLS

Hands-Only CPR for untrained lay-rescuer

Sequence ABC → CAB

Health care providers continue CPR untillHealth care providers continue CPR untill

termination of resuscitative efforts

Increased focus on methods to ensure

continued points of

emphasis from the 2005 BLS:

d on unresponsiveness & absence of nd on unresponsiveness & absence of n

from BLS

rescuer

untill return of spontaneous circulatiountill return of spontaneous circulatio

Increased focus on methods to ensure high quality CPR is performed

continued de-emphasis on pulse check

providers

*a simplified adult BLS algorithm

Recommendation of simultaneous, Recommendation of simultaneous,

for chest compression, airway management, rescue

breathing, rhythm detection, a

an integrated team of highly-tr

setting

emphasis on pulse check for health care

*a simplified adult BLS algorithm is introduced

simultaneous, choreographed approasimultaneous, choreographed approa

for chest compression, airway management, rescue

n, and shocks (if appropriate) b

trained rescuers in appropria