Basic Life Support and Automated External Defibrillation

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Basic Life Support and Automated External
Defibrillation
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Objectives

• At the end of this course participants should be
  able to demonstrate
• How to assess the collapsed casualty.
• How to perform Basic Life Support (BLS).
• How to place an unconscious breathing victim in
  the recovery position.
• Introduction to operating an automated external
  defibrillator (AED) safely.

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Background

• In the UK approximately 30,000 people sustain
  cardiac arrest outside hospital and are treated
  by emergency services each year.
• Bystander CPR and early Defibrillation are vital
  interventions before the arrival of emergency
  services.
• If defibrillation is delivered promptly, survival
  rates as high as 75 have been reported.
• The chances of successful defibrillation decline
  at a rate of about 10 with each minute of delay.

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Anyone can do it?
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2
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30
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Cardiac conditions

• Angina
• Suspected Heart Attack

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Cardiac Conditions

• Coronary heart disease is the UK's biggest
  killer, with 1 in every 4 men and 1 in every 6
  women dying from the disease.
• In the UK, approximately 300,000 people have a
  heart attack each year.
• Angina affects about 1 in 50 people, and in the
  UK there are an estimated 1.2 million people with
  the condition. It affects men more than women,
  and your chances of being affected increase with
  age.

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Blood returning from upper body
Oxygenated blood to upper body
Blood to lungs
Blood to lungs
Oxygenated blood from lungs
Oxygenated blood from lungs
Blood returning from lower body
Oxygenated blood to lower body
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How many times does the human Heart beat in a day
?

• 100,800 beats per day
• (70 beats x 60 minutes x 24 hours 100,800 beats)

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Suspected Heart Attack
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Heart Attack
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Suspected Heart Attack

• Pale, cold clammy skin
• Rapid weak pulse
• Rapid shallow breathing
• -Nausea
• Vomiting
• Pain in chest possibly radiating into arm, back
  and/or jaw
• Sweating
• Impending sense of doom
• Some or all of these symptoms may be present, no
  two Heart attacks are the same......

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Cardiac Conditions

• Angina is a pain or discomfort felt in the chest
  caused by coronary heart disease.
• Typically presents as heaviness or tightness in
  the chest
• Often brought on by physical activity.
• Symptoms usually subside after a few mins.
• Angina Suffers usually carry GTN medication in
  the form of a spray or tablet

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Suspected Heart attack

• Dial 999 or 112 for Ambulance
• Rest in a comfortable position
• Reassure
• Help casualty to take their own GTN
• Be prepared to resuscitate
• Have AED available
• If in any Doubt dial 999 or 112

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Basic Life SUPPORT

• Primary Survey
• Performing CPR
• Recovery Position

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Primary Survey

• Initial assessment using the primary survey
• - D anger (Global overview)
• - R esponse
• - S hout for help
• - A irway- B reathing- C all 999/112 -
  commence CPR

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Airway Management
Airway Open Airway
Closed Airway Obstructed

• An unconscious casualty has no control over their
  muscles, including the muscles that control the
  tongue.

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Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
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APPROACH SAFELY!
Approach safely

• Rescuer
• Scene
• Victim
• Bystanders

Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
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CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
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CHECK RESPONSE

• Shake shoulders gently
• Hello can you hear me?
• If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
• If no response.....

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SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
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OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
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CHECK BREATHING

• Look, listen and feel for NORMAL breathing for 10
  sec
• Do not confuse Agonal breathing with NORMAL
  breathing
• If you have any doubts act as if breathing is not
  normal

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Not Breathing normally ?

• No sign of Chest Movement
• No sounds of Breathing
• No feeling of breath against your ear

• Agonal Breathing
• Occurs shortly after the heart stops in up to 40
  of cardiac arrests
• Described as barely, heavy, noisy or gasping
  breathing
• Recognised as a sign of cardiac arrest

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Agonal Breathing
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Approach safely
Check response
Shout for help
Open airway
If no help arrives and you are alone dial 999/112
After putting into recovery position.
Check breathing
Recovery Position
Dial 999/112
Monitor
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Recovery position 1

• Kneel next to the person. Place the arm closest
  to you straight out from the body. Position the
  far arm with the back of the hand against the
  near cheek.

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Recovery position 2

• Grab and bend the person's far knee

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Recovery position 3

• Protecting the head with one hand, gently roll
  the person toward you by pulling the far knee
  over and to the ground

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30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
2 rescue breaths
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Recovery position 4

• Tilt the head up slightly so that the airway
  remains open. Make sure that the hand is under
  the cheek, checking the airway and also for
  eventual wakening. Place a blanket or coat over
  the person (unless he or she has a heat illness
  or fever) and stay close until help arrives

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If Not Breathing
Dont Panic
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CHEST COMPRESSIONS

• Place the heel of one hand in the centre of the
  chest
• Place other hand on top
• Interlock fingers
• Compress the chest
• Rate 100 to 120
• Depth 5-6 cm
• Equal compression relaxation
• When possible change CPR operator every 2 min

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RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
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RESCUE BREATHS

• Pinch the nose
• Take a normal breath
• Place lips over mouth
• Blow until the chest rises
• Deliver rescue breath for 1 second
• Allow chest to fall
• Repeat
• This should not take longer than 5sec , then
  return to chest compressions without delay

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Combine Compressions and Rescue breaths at a
ratio of 302

• 30 2
• 30

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ANY QUESTIONS ?Time to practice.....
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Child CPR

• Many children do not receive resuscitation
  because potential rescuers fear causing harm.
• This fear is unfounded it is far better to use
  the adult BLS sequence for resuscitation of a
  child than to do nothing.
• Bystander resuscitation significantly improves
  outcome in children.
• Outcomes could be further improved if bystanders
  who would otherwise do nothing, were encouraged
  to begin resuscitation.

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Children and babies
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COMPRESSION only CPR
If a rescuer is unable or unwilling to perform
rescue breaths it is expectable to perform
compressions only CPR However, chest compression
combined with rescue breaths is the method of
choice for CPR by trained lay rescuers and
professionals.
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When to stop CPR

• Once CPR is started the rescuer should only stop
  CPR when the casualty shows signs of regaining
  conscious by
• Coughing
• Opening eyes
• Speaking or moving purposefully
• Starts to Breath NORMALLY again
• Or
• Qualified help arrives and takes over
• You become exhausted
• It is unsafe to continue

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Pocket Mask

• The pocket mask is an effective barrier device.
  It has a one-way valve which prevents the
  casualty's exhaled air being inhaled by the
  Rescuer.

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ANY QUESTIONS ?Time to practice.....
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Defibrillation

• Understanding Defibrillation
• Safe use of an AED

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Automated External Defibrillators

• An AED is an electric shock box used to stop
  the electrical activity of the heart when it is
  in a life threatening rhythm, this allows the
  Heart to re-establish an effective rhythm.
• The AED will
• analyse the presenting rhythm
• only advise a shock for a shockable rhythm
• advise the operator step-by-step what to do

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Automated External Defibrillators

• An AED can be used safely and effectively without
  previous training.
• Therefore, the use of an AED should not be
  restricted to trained rescuers.
• However, training should be encouraged to help
  improve the time to shock delivery and correct
  pad placement.

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• There are 2 types of AED
• Automatic- will deliver shock automatically
• Semi Automatic rescuer intervention required to
  deliver shock.
• Once you have completed this training
• you will be able to use any make or model

AEDs can be found in many public buildings e.g.
Sports centres, Railway stations, Shopping
centres and Schools
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2
4
30
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Understanding Defibrillation

• The hearts pumping action controlled by
  electrical system
• Electrical rhythm normally very organized
• Normal hearts rhythm is called Sinus Rhythm
• Normal heart rate of 60 - 100 beats per minute

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Understanding DefibrillationVentricular
Fibrillation (VF)

• VF is the most common rhythm in Sudden Cardiac
  Arrest (90)
• Electrical Problem in Nature
• Chaotic rhythm results in quivering of heart
  and results in loss of pulse
• VF will result in brain damage within 5 minutes
  and death in 10-15 minutes

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Understanding Defibrillation

• Defibrillation may correct VF
• Uses DC current delivered across the heart
• A successful defibrillation depolarizes the
  hearts cells
• Depolarization allows the cells to reorganize
• Defibrillation is the ONLY effective cure for VF!

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Single Rescuer
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112 get AED
Attach AED before CPR
Follow voice prompts
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Approach safely
Check response
2 or more Rescuers
Shout for help
Open airway
Check breathing
1st Rescuer commence CPR
2nd Rescuer Call 999 /112 gets AED and attaches
to Patient
Follow voice prompts
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Minimise interruptions in CPR

• If alone, attach AED before commencing CPR
• If 2 rescuers, provide good quality CPR while the
  AED is brought to the scene, is turned on, and
  pads attached
• Interrupt CPR only when it is necessary to
  analyse the rhythm and deliver a shock

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DEFIBRILLATION SAFETY !

• THE PATIENT.
• 5 point check
• Pacemaker
• Jewellery
• Hair on chest
• Damp/Wet skin
• Patches (GTN)

• THE AED.
• In good working order
• Do Not use in Heavy rain
• Do Not use if they lay in a pool of water
• Do Not use in an explosive environment !

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ATTACH PADS TO CASUALTYS BARE CHEST
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ANALYSING RHYTHM DO NOT TOUCH PATIENT
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SHOCK ADVISED

• Stand clear Everyone !
• TOP
• MIDDLE
• BOTTOM
• MYSELF
• BEHIND YOU
• DELIVER SHOCK

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DEFIBRILLATION SAFETY !

• REMEMBER.
• Always check that NO PERSON or ANIMALS are
  touching the patient prior to shocking.
• That you are not touching the patient in any way.

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DEFIBRILLATION
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SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

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COMMENCE CPR (2 Mins)

• 30 2
• 30 2

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NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS

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COMMENCE CPR (2 Mins)

• 30 2
• 30 2

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ANY QUESTIONS ?Time to practice.....
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Children and AEDs

• Standard AEDs are suitable for use on children of
  8 years and above.
• In children between 1 and 7 years paediatric pads
  or a paediatric mode should be used.
• Do not use an AED on an Infant less than 1 year.

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IPAD
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Follow up what to do after?

• If you have used an Automated External
  Defibrillator, even by just attaching it to a
  patient, you must
• Dispose of the pads used as clinical waste
• Replace the pads on the machine
• Inform named person that the Defibrillator has
  been used so that any data can be captured from
  the device
• Complete a Defibrillator Event Report Form
• If you require any equipment to be replaced, i.e.
  pads, pocket masks, razors etc. Please contact
  your named person as soon as possible.

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WHEN NOT TO RESUSCITATE

• Once CPR is started the rescuer should only stop
  CPR when the casualty shows signs or regaining
  conscious by
• Coughing
• Opening eyes
• Speaking or moving purposefully
• Starts to Breath NORMALLY again
• Or
• Qualified help arrives and takes over
• You become exhausted
• It is unsafe to continue

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OR IF YOU SEE THIS HAS OCCURRED !
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Oops ??
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ANY QUESTIONS ?
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Bleeding
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Bleeding

• Raise Limb
• Cover with clean dressing or cloth
• 999 or 112
• Reassure
• Lay down
• Raise legs
• Monitor

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Shock
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Shock
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Choking
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Choking
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Choking
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ANY QUESTIONS ?Time to practice.....
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