1. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
Liverpool Associates in Tropical Health
Airway, Breathing andAirway, Breathing and
CirculationCirculation

2. AimsAims
To understand the ABC and D approachTo understand the ABC and D approach
To develop and practise the skills ofTo develop and practise the skills of
cardiopulmonary resuscitation using the ABCcardiopulmonary resuscitation using the ABC
approachapproach
To achieve competence in those skillsTo achieve competence in those skills

3. Airway, Breathing and CirculationAirway, Breathing and Circulation
 Assessment of any sick patient begins with ABCAssessment of any sick patient begins with ABC
 Done in this order because airway and/orDone in this order because airway and/or
breathing problem will kill before a circulationbreathing problem will kill before a circulation
problemproblem
 You assess airway and breathing,You assess airway and breathing, and treatand treat,,
and then assess circulationand then assess circulation and treatand treat

4. Airway and BreathingAirway and Breathing
‘‘Hello how are you MrsHello how are you Mrs
Tilt?’Tilt?’
If no response:If no response:
 Assess if patient isAssess if patient is
breathing or notbreathing or not

5. Airway and BreathingAirway and Breathing
 LookLook for breathing byfor breathing by
looking for movementlooking for movement
of the chestof the chest
 ListenListen for breathingfor breathing
or noisy breathingor noisy breathing
 FeelFeel for breathingfor breathing

6. Airway and BreathingAirway and Breathing
If not breathing orIf not breathing or
difficult breathing:difficult breathing:
 Open airway byOpen airway by
head tilthead tilt andand chinchin
liftlift

7. Airway and BreathingAirway and Breathing
 Open airway byOpen airway by
jaw thrustjaw thrust

8. Airway and BreathingAirway and Breathing
 Gentle suctionGentle suction if necessary under direct visionif necessary under direct vision

9. Airway and BreathingAirway and Breathing
 If still not breathing:If still not breathing:
 place oropharyngeal airwayplace oropharyngeal airway

10. Airway and BreathingAirway and Breathing
If still not breathing:If still not breathing:
 give rescue breathsgive rescue breaths

11. Airway and BreathingAirway and Breathing
If breathing:If breathing:
 givegive oxygenoxygen
(if available)(if available)
 Sit patient upSit patient up (if alert)(if alert)
or place inor place in recoveryrecovery
positionposition

12. CirculationCirculation
How do we assess circulation?How do we assess circulation?

13. CirculationCirculation
 Colour-Colour-?pale ?greyish?pale ?greyish
 Skin-Skin-?cold, ?hot ?sweaty?cold, ?hot ?sweaty
 Mental State-Mental State- ? confused ?aggressive ?not alert? confused ?aggressive ?not alert
 Urine output-Urine output-?reduced?reduced
 Heart rateHeart rate- ? High ? low- ? High ? low
 Blood pressureBlood pressure-low-low
 Fetal heart RateFetal heart Rate - ? High ? low- ? High ? low

14. CirculationCirculation
 Pregnant uterus compresses vena cavaPregnant uterus compresses vena cava
causing BP to dropcausing BP to drop
 ‘‘Hello Mrs Tilt’……..Hello Mrs Tilt’……..

15. CirculationCirculation
 Place iv lines, take bloods, start iv fluidsPlace iv lines, take bloods, start iv fluids
 Why is there a circulation problem?Why is there a circulation problem?
 Stop bleedingStop bleeding
 Treat infectionTreat infection

16. Cardiopulmonary resuscitationCardiopulmonary resuscitation
(CPR)(CPR)
 This is the approach to an apparentlyThis is the approach to an apparently
lifeless patientlifeless patient
 It is a rapid assessment ofIt is a rapid assessment of
 AAirway andirway and BBreathing andreathing and CCirculationirculation
 starting treatment quicklystarting treatment quickly

17.  Ensure you are not putting yourself atEnsure you are not putting yourself at
risk!risk!
 Is it safe to approach?Is it safe to approach?

18. Shake and shoutShake and shout
 Hello how are you?Hello how are you?
 If no response, callIf no response, call
or send for helpor send for help
 Tilt to left lateralTilt to left lateral
position if greaterposition if greater
than 20 weeksthan 20 weeks
pregnantpregnant

19. Open the AirwayOpen the Airway
 Turn onto back andTurn onto back and
open airwayopen airway
 Head tilt or chin lift orHead tilt or chin lift or
jaw thrustjaw thrust
 Assess breathing andAssess breathing and
feel for a pulse for 10feel for a pulse for 10
secondsseconds
 Look, listen, feel
 Palpate carotid pulse
for 10 seconds

20. No breathing, No pulseNo breathing, No pulse
 Start chestStart chest
compressionscompressions

21. Chest compressionsChest compressions
 place heel of firstplace heel of first
hand on lower part ofhand on lower part of
sternumsternum
 place heel of secondplace heel of second
hand on top of firsthand on top of first
 interlock fingersinterlock fingers

22. Chest compressionsChest compressions
 Keep arms straightKeep arms straight
and depress sternumand depress sternum
4-5 cm at a rate of4-5 cm at a rate of
100 compressions per100 compressions per
minuteminute
 Change the personChange the person
delivering thedelivering the
compressions tocompressions to
avoid getting tiredavoid getting tired

23. Give 30 compressions:2 breathsGive 30 compressions:2 breaths
 Give 2 slow breathsGive 2 slow breaths
each lasting about 1each lasting about 1
secondsecond
 Watch for chest riseWatch for chest rise
 Give oxygen ifGive oxygen if
availableavailable

24. If breathingIf breathing
Turn into recovery positionTurn into recovery position
Check pulse, BP and FHCheck pulse, BP and FH
Regularly reassessRegularly reassess
AssessAssess DD, DISABILITY (level of consciousness), DISABILITY (level of consciousness)
AA-Alert,-Alert, VV-respond to voice,-respond to voice, PP-respond to pain,-respond to pain,
UU - Unresponsive- Unresponsive

25. Think of Reversible CausesThink of Reversible Causes
• 4 H’s, 4 T’s4 H’s, 4 T’s
HypovoleamiaHypovoleamia
HypothermiaHypothermia
Hypo/HyperkalaemiaHypo/Hyperkalaemia
HypoxiaHypoxia
Tension PneumothoraxTension Pneumothorax
TamponadeTamponade
ThromboembolismThromboembolism
ToxinsToxins

26. ??

27. AAirway beforeirway before BBreathing beforereathing before CCirculationirculation
OpenOpen AAirway and maintain, give oxygenirway and maintain, give oxygen
 Check forCheck for BBreathing, assist if necessaryreathing, assist if necessary
AssessAssess C and don’t forget left lateral tiltC and don’t forget left lateral tilt
TreatTreat CC problemproblem
RECAP-1RECAP-1

28. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
Liverpool Associates in Tropical Health
RECAP-2RECAP-2
The approach to an apparently lifeless
patient
Remember: CALL FOR HELP!
ABC approach
CPR 30:2
Left lateral tilt
Think about causes - 4 H’s, 4 T’s4 H’s, 4 T’s