Basic life support

BASIC LIFE SUPPORT AND

ADVANCED TRAUMA LIFE SUPPORT

By-Hemam Shankar Singh

3rd Yr BDS

Basic life support• Cardiac arrest and respiratory arrest occurs when patients

heart suddenly stops beating, and there is cessation of respiration

• It leads to decreased – circulation of blood -- oxygen to important organs

• BLS is an attempt to restore respiratory and cardiac function.• Primary emphasis of BLS—

1. Removing upper airway obstruction and maintaining the patency of airway

2. Eliminating respiratory arrest3. Restoring circulation4. Procedure can be summarized as ABC of BLS

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ABC of BLSFirst and foremost is Positioning

Airway

Breathing

Circulation

Defibrillation (P-A-B-C-D)

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CHAIN OF SURVIVAL

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Assistance & PositionAirway

Breathing Circulation

Defibrillation

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--By ‘Shake and Shout’ maneuver

Shake shoulders gently

Ask “Are you all right?”

RecognitionAssistance & Position

Airway Breathing Circulation

Defibrillation

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Defibrillation

Summon assistanceMembers of the emergency team should report to the scene

Emergency drug kit Oxygen The AED

Positioning – supine positioni.e. head & chest parallel to floor, feet elevated slightly (10 degrees)

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Defibrillation

Head tilt & chin lift• to obtain a patent airwayJaw thrust

Assessment

Maintenance

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Defibrillation

Head tilt & chin lift• this stretch the tissues of the neck and lifting the tongue & epiglottis off the posterior wall of the pharynx

Assessment

Maintenance

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Defibrillation

• while maintaining the position, place your ear approx. 1 inch victims mouth and nose• look towards the chest of the victim• assess for 5-10 seconds

ASSESSMENT

Rescue breathing

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Defibrillation

• if respiratory arrest occurs or spontaneous ventilation is inadequate, then it is a must to ventilate the victim so that adequate oxygen is available to the brain•Three ways of artificial ventilation

1. Exhaled air ventilation2. Atmospheric (ambient) air

ventilation3. O₂ -enriched ventilation

Assessment

RESCUE BREATHING

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Defibrillation

Exhaled air ventilation• Exhaled air can

deliver 16-18 % inspired O₂, yielding an arterial PaO₂ of 88 Torr (normal- 75 to 100 Torr) at a tidal volume of 1000-1500mL

• Two basic types—i. Mouth-to-mouthii. Mouth-to-nose

• This technique do not need any adjunctive equipment

• Can be carried out in any situation

Assessment

RESCUE BREATHING

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Rescue breathing

Exhaled air ventilation• Head tilt-chin lift position• With mouth wide open, take a deep breath• Make a tight seal around the victims mouth• Blow into the mouth• Air should be rapidly & deeply inhaled & deliver immediately

• must be repeated once every 5 to 6 seconds for adult 3 seconds for infant or children

• Repeated for as long as necessary• Assessment of adequacy—

Feeling the escape of airSeeing the rise & fall of chest

• Risk –• Gastric aspiration • Limit movement of diaphragm due to

increase intraabdominal pressure thereby reduce the ability of the rescuer to ventilate

Mouth-to-mouth

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Rescue breathing

Exhaled air ventilation It is used when victim • Can’t open mouth• Can’t make a good seal• Severely injured mouth

•Head tilt-chin lift position • Seal the victims lips with the mandible• Seal your lips around the victims nose & blow until expansion of the victims lungs is felt & seen• Repeat 10-12 breaths per minute in adults & children• 20 breaths per minute for infant and young children i.e. once every 3 seconds

Mouth-to-nose

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Defibrillation

Atmospheric air ventilation• Provides 21% O₂• Bag-valve-mask devices

• Airway adjuncts

Assessment

RESCUE BREATHING

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Defibrillation

O₂ enriched ventilation

• Oxygen cylinder with demand-valve mask unit

Assessment

RESCUE BREATHING

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Defibrillation

• Determine whether the blood is circulated or not• Locate large artery–

carotid(preferred) or femoral• Palpate for 5-10 seconds

ASSESSMENT

Activation of EMS

Chest compression f

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Defibrillation

• After pulse check• Call emergency number of the locality

Assessment

ACTIVATION OF EMS

Chest compression f

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Defibrillation

• Rhythmicalapplication of pressure over the lower half of the sternum

• Create blood flow by increasingintrathoracic pressure & by direct compression

of the heart• Proper compression

can produced systolic arterial pressure

peaks of 60-80 mm of Hg, diastolic is

pressure is low

Assessment

Activation of EMS k

CHEST COMPRESSION

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Compression point• One heel of one hand on the middle of the sternum between the nipples & other

heel of other hand on top of the first so that they are overlapped & parallel• Fingers interlaced, with the fingers of the top hand pulling the fingers of the

lower hand upwardApplication of pressure• Shoulders should be located directly over the sternum• Elbow should be locked• If victim is—

• lying on the floor, rescuer kneels at the victims side, close enough to body• Dental chair, rescuer stands astride the victim, with the chair lower

• Downward compression should take 50% of the entire compression cycleRate of chest compression • 100 per minute & interruptions to no longer than 10 secondsCompression-ventilation ratio• 30:2• To increase compression and to reduce hyperventilation

CHEST COMPRESSION

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CHEST COMPRESSION

30 2

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Defibrillation

• It uses a device called AED (automated external defibrillator)

• AED is used only if the victim• Does not respond• Is not breathing• Is pulseless

AED

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DEFIBRILLATION

• attach pads to casualty’s bare chest

analysing rhythm do not touch victim

shock indicated

CPR

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CPR once started should be continued until one of the following occurs1. Recovery, demonstrating adequate spontaneous respiration and

circulation and place in recovery position2. A physician arrives and assumes overall responsibility3. EMS personal arrive

RECOVERY POSITION

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ADVANCE TRAUMA LIFE SUPPORT

Objective• Identify the correct sequence of priorities for assessment of a multiple injured pt.• Apply the principles outlined in primary and secondary evaluation surveys of ATLS.• Apply guidelines and techniques in the initial resuscitative and definitive care phases of treatment.

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Initial assessmentPrimary survey

Secondary survey

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Initial assessmentPrimary survey

Secondary survey

• Initial assessment of the casualty• Time interval• Then proceed to the basic ATLS procedure i.e. (in short) ABCDE

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ADVANCE TRAUMA LIFE SUPPORT Initial assessmentPrimary survey

Secondary surveyBreathing

AIRWAY

Circulation f

Disability

Environment & exposure

•Confirmation • If patient

talks normally, airway not compromised

• Hoarse voice or audible breathing, suspicious

Assess the patient for airway obstruction (coma) Agitation--------------- hypoxia Cyanosis---------------- hypoxemia, secondary to inadequate oxygenation Hoarseness,----------- suspected laryngeal fracture

s/c emphysema& palpable fracture

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AIRWAY

Circulation f

Disability


• Established maintenance of airway through either of the two---Head tilt-chin lift---Jaw thrust

JAW THRUST •Rescuer fingers are placed behind the posterior border of the ramus of the mandible•Displace the mandible forward, dislocating it while tilting the head backward•Retract the lower lip with the thump

JAW THRUST

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AIRWAY

Circulation f

Disability


• If debris ( broken tooth, dentures) is present, remove it by—Finger sweep technique or --Yankauer suction or -- Magill’s forceps (for large object)

• If ---no foreign body is visible, endotracheal tube should be used to secure the established airway --- If the foreign body cannot be removed quickly or the vocal cords cannot be adequately visualized or endotracheal intubation is not possible, then cricothyroidotomy is indicated•

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Yankauer suction

Magill’s forceps

CRICOTHYROIDOTOMY


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AIRWAY

Circulation f

Disability


• In patient sustaining significant blunt injury, should be assume to have cervical spine injury, until prove other-wise•--- such pt. should have cervical spineimmobilized with semi rigid cervical collar and bilateral sand bags or block joined with tapes or straps across the forehead

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semi rigid cervical collar

block joined with tapes or straps across the forehead

BREATHING

Airway

Circulation f

Disability


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Secondary survey

•Conditions that acutely compromised breathing are--• Tension

pneumothorax• Massive

hemothorax• Flail thorax

accompanied bypulmonary contusion

• open pneumothorax compromise breathing •Such condition can be diagnosed with physical examination & should be treated immediately•It can be treated with endotracheal intubation, mechanical ventilation, needle thoracocentesis, or tube thoracostomy.

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NEEDLE THORACOCENTESIS

TUBE THORACOSTOMY


Breathing

Airway

CIRCULATION f

Disability


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Secondary survey

•Circulatory problems in trauma patients are usually caused by hemorrhage•First action is to stop bleeding

•For --- Intra oral bleeding-----------------bite a cotton swap Tongue laceration------------------deep suture across the laceration Bleeding from fracture-----------manually reducing and brittle wiring of the fracture fragments

mandible end Mobile maxilla---------------------rubber mouth gags Soft tissues of head & neck----direct pressure on the bleeding site Torrential bleeding from--------epistat tube with anterior and posterior balloons

the nasopharynx region

Breathing

Airway

Circulation f

DISABILITY


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Secondary survey

• Assessment of the neurological status. The Glasgow coma score (GCS)

• worst score is 3 points• GCS can be caused by a focal brain injury• Optimal oxygenation and circulation are important to prevent secondary injury to the brain • Impaired consciousness can be caused by hypoxia or hypotension for which ABC stabilization is essential

•Patients who open their eyes spontaneously, obey commands, and are normally oriented score a total of 15 points

Breathing

Airway

CIRCULATION f

Disability

ENVIRONMENT & EXPOSURE

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Secondary survey

• Represent Hypothermia Burns, and Possible exposure to

chemical and radioactive substance

Should be evaluated and treated

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Secondary survey

• Under this the pt. is examined from head to toe• Appropriate additional radiographs of the thoracic and lumbar spine and the extremities are performed when indicated. • CT scans, when indicate•Secondary survey mnemonics • Head/skull Has • Maxillofacial My • Cervical Spine Critical • Chest Care• Abdomen Assessed • Pelvis Patient's • Perineum Priorities • Orifices Or• Neurological Next • Musculoskeletal Management • Diagnostic tests/ Decision?

Definitive care

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IF, DURING THE SECONDARY SURVEY, THE PATIENT'S CONDITION DETERIORATES, THE PRIMARY SURVEY SHOULD BE REPEATED

BEGINNING WITH “A”.

Health & Medicine

Basic life support