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BLS ????
CHAIN OF SURVIVAL IN
BLS
SEQUENCE OF BLS
C
A
B
D
CIRCULATION
AIRWAY
BREATHING
DEFIBRILLATION
Effective chest
compressions
Start compressions within
10
seconds of recognition of
cardiac
arrest.
Push hard, push fast: Compress at
a rate of atleast 100/min with
depth of atleast 2inches (5cm).
Allow complete chest recoil after
each compression.
Minimize
interruptions
in
Highlights of 2010
Contd
Encourage
Hands-Only
(compression only) CPR for the
untrained lay rescuer.
High-quality CPR
Healthcare provider training should
focus on building the team as each
member
arrives
or
quickly
delegating roles if multiple rescuers
are present.
ADULT
Lay rescuer
8yrs
HCP: Adolescent
& older
CHILD
INFANT
Lay rescuer :1- Under 1 yr of
8 yrs, HCP:
age
1yr-adolescent
RECOGNITION
UNRESPONSIVE (for all ages)
RESPONSIVENES
No Breathing
No breathing or only gasping
S
or no normal
BREATHING
breathing
CPR SEQUENCE
C-A-B SEQUENCE
COMPRESSION
RATE
COMPRESSION
DEPTH
At least 2
At least 1/3 AP dia
inches / 5cm AP dia
About 2 inches
inches
(5 cm)
At least 1/3
About 1.5
(4cm)
ADULT
Lay rescuer
8yrs
HCP: Adolescent
& older
CHILD
Lay rescuer :18 yrs
HCP: 1yradolescent
INFANT
Under 1 yr of
age
CHEST WALL
RECOIL
COMPRESSION
INTERRUPTIONS
Minimize interruptions
Attempt to limit interruptions to 10seconds
AIRWAY
COMPRESSION
to VENTILATION
RATIO
30:2
1 or 2 rescuers
ADULT
Lay rescuer
8yrs
HCP: Adolescent
& older
CHILD
Lay rescuer :18 yrs
HCP: 1yradolescent
INFANT
Under 1 yr of
age
VENTILATIONS
WITH ADVANCED
AIRWAY (HCP)
VENTILATIONS:
WHEN RESCUER
UNTRAINED
COMPRESSIONS ONLY
DEFIBRILLATION
RECOVERY POSITION
ACLS
(Advanced cardiac
life support)
ACLS
ACLS requires equipment and
particular skills.
It is designated
to provide
airway security, sophisticated
artificial
ventilation
and
circulatory
support
while
restoring
a
spontaneous
heartbeat and respiration.
ADULT
ACLS
Chain of survival
Integrated
post cardiac
arrest care
Postcardiac arrest
care has significant potential
to reduce early mortality caused by
hemodynamic instability and later morbidity and
mortality from multiorgan failure and brain injury
It includes:
Therapeutic hypothermia
Hemodynamic and ventilation
optimization
Immediate coronary reperfusion
Glycemic control
Neurologic care
Prognostication
Therapeutic
hypothermia
AHA
recommends
cooling
comatose adult patient with ROSC
after cardiac arrest to
Hemodynamic and
ventilation
optimization
Provide 100% oxygen during the
initial resuscitation.
Then titrate the inspired oxygen
during post cardiac arrest care to the
lowest level required to achieve an
arterial oxygen saturation of 94%.
Ventilation rates should be started
from 10-12breaths/min and then
titrate to achieve a PET CO2 of 3540mm Hg or a PaCo2 of 40-45mm
monitoring
correct
placement
of
endotracheal tube following insertion
and during transport.
As a tool to monitor :
CPR quality
Optimize chest compressions
Detect ROSC
Atropine
is now not
New Medication
recommended
for
Protocol
routine
use
in
the
management
of
PEA/Asystole.
Current evidence suggest
that they are unlikely to
have a therapeutic benefit
PULSE
OXIMETRY/ABG
CAPNOGRAPHY
CHEST X-RAY
Ventilation
MECHANICA
L
VENTILATIO
N
Contd
Frequent Blood
Pressure
Monitoring/Arterial-line
Treat
hypotension
Maintain perfusion
Fluid bolus if tolerated
Dopamine 510 mcg/kg per min
Nor
epinephrine
0.10.5
mcg/kg/per min
Epinephrine 0.10.5 mcg/kg/min
Hemodynamics
Echocardiogra
m
Treat acute
coronary
syndrome
12 lead
)
ECG/Troponin
Continuous
cardiac
monitoring
Cardiovascular
Rationale-exclude seizures
Anticonvulsants if seizing
Serial examinations define coma, brain injury
and prognosis
Response to verbal commands and physical
stimulation
Pupillary light and corneal reflex,
spontaneous eye movements
Gag ,cough, spontaneous breaths
EEG
monitoring
if
Core
comatosed
temperat
ure:
measure
ment if
comatose
Serial
neurolog
ical
exam
Neurological
Urine
output/seru
m
creatinine
Serum
potassium
Serial
lactate
Metabolic
May
increase
edema
including cerebral edema
Detect
hyperglycemia
and
hypoglycemia
Treat hypoglycemia (80 mg/dL)
with dextrose
Treat hyperglycemia to target
glucose 144180 mg/dL
Avoid
hypotonic
fluid
Serum
glucose
Contd.
DIFFERENT CASES
VF/ Pulseless VT
Pulseless Electrical activity
Asystole
Acute Coronary Syndrome (ACS)
Bradycardia
Unstable Tachycardia
Stable Tachycardia
Stroke
VF/ Pulseless VT
Pulseless Electrical
Activity
&
Asystole
Acute Coronary
Syndrome
Oxygen therapy
Aspirin
Nitroglycerin
Morphine
Fibrinolytic therapy
Heparin
- blockers
Adenosine diphosphate (ADP) antagonists
ACE inhibitors
HMG-CoA reductase inhibitors
Bradycardia
HR < 50/min
Chest discomfort
Shortness of breath
Decreased level of consciousness
Weakness
Fatigue
Lightheadedness
Dizziness
Presyncope or syncope
Tachycardia
HR>100/min
AF
Atrial flutter
SVT
Monomorphic VT
Polymorphic VT
Unstable
Stable
Unstable Tachycardia
Rate related cardiovascular
compromise
Hypotension
Altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
PROCEED TO IMMEDIATE
SYNCHRONIZED CARDIOVERSION
Stroke
Stroke
Out of hospital acute stroke
focuses on:
Rapid identification and
assessment of patient with stroke
Rapid transportation
Stroke
The 8 Ds of Stroke Care remain the
major steps in diagnosis and
treatment of stroke and identify the
key points at which delays can occur.
Detection: Rapid recognition of
stroke symptoms
Dispatch: Early activation and
dispatch of emergency medical
services (EMS) system by calling 911
Delivery: Rapid EMS identification,
management, and transport
Contd
Door: Appropriate triage to stroke
center
Data: Rapid triage, evaluation, and
management within the emergency
department (ED)
Decision: Stroke expertise and
therapy selection
Drug: Fibrinolytic therapy, intraarterial strategies
Disposition: Rapid admission to
stroke unit, critical-care unit
Time is Brain.
CHAIN OF SURVIVAL
FACIAL DROOP
ANY QUERY?????
THANK
U