AHA guideline of BLS. Very important and must learn. exPlained in a very basic.

1. DR. ANKIT
GAJJAR
MD, IDCCM, IFCCM, EDIC
(CONSULTANT
INTENSIVIST)
TOPIC- BLS

2. WHAT IS CARDIAC
ARREST
 Cessation of normal circulation of blood due to
failure of heart to contract effectively.
 Sudden cessation of mechanical activity of
heart with some or no electricalactivity.
 May be reversible by a rapid intervention
but will lead to death in its absence.

3. REVERSIBLE CAUSES OF CARDIAC
ARREST
5 Ts:
 Pulmonary
thromboembolism
Tension
pneumothorax
 Cardiac Tamponade
Toxins (TCAs,b-
blockers,ca channel
blocker,digoxin)
Coronary thrombosis
5 Hs:
 Hypoxia
 Hypovolemia
 Hypo/hyperkalemia
 Hydrogen ions
 Hypothermia

4.  M.I.
 Arrhythmia
 Low C.O.,failure,shock
 Cardiomyopathy
 Myocarditis
 Massive pulmonary
emboli
CARDIAC: OTHERS
 Coronary artery disease  Severe anaphylaxis
 Suffocation
 Electrocution
 Trauma
 Stroke
 Exsanguination
(severe loss of
blood)
 Drowning
CAUSES OF CARDIAC ARREST

5. BLS
 Its Cardiopulmonary Resuscitation (CPR).
 It Combines rescue breathing and chest
compressions
 It requires knowledge and skill to perform CPR
and how to operate AED / defibrillartor.
 These are Sequences of procedures performed to
restore the circulation of oxygenated blood
after a sudden pulmonary and/or cardiac arrest

6. ABC to CAB

7. Basics of BLS
• Chest compressions
• Airway
• Breathing
• Defibrillation

8. STEPS of BLS
 Assessment and scene safety
1. Scene is safe??
2. Asses the patient
3. Check breathing

9. Assesse the patient
 Shake shoulders gently
 Ask “Are you all right?”
 If he responds
 Find out what is wrong.
 Reassess regularly.

10. Check for pulse: no more than 10
sec
Feel the pulse
Feel the pulse at least for 5 seconds
Slide the finger laterally
Into the groove between trachea and muscle
Locate the trachea
Using 2 or3 fingures

11. SHOUT FOR
HELP

12. Start CPR
 Ratio: 30:2
 High quality CPR
 Chest compression
is foundation of CPR
 Push hard and push
fast
 100-120/min
 2.5-2-1.5 inch depth
 Allow complete chest
recoil
 Avoid excessive
ventilation
 Minimize interruption
 <10 seconds
 Effective rescue
breaths.

14. Chest Compressions
 Position yourself at patient’sside
 Victim should be laid on firm, flat surface
 Remove the clothings of the patient.
 Put the heel of one hand on the centre of chest
(sternum) at the level of nipples and put your other
hand on the top of the former hand.

15.  Strengthen arms and shoulders ditrectly over
hands
 Lockall joints ; movement is allowed only at hip
joint
 Pushhard and fast (100 - 120 times/ min)
 At the end of each compression, chest is allowed
torecoil completely
 Avoid excessiveventilation
 Then give next compression immediately

16. ChestCompressions

17. Mechanisms
• CardiacPump–
1. Blood pumping is assured by compression of
heartbetween sternum andspine
2. Between compressions, thoracic cageexpands and
heart gets filled with blood.

18. Thoracic Pump

19. Opening the airway

23. Caution
 Do not press deeply into the soft tissue
 Don’t use thumb to lift the chin
 Don’t close mouth completely

24. Jaw thrust

26. RESCUE BREATHS
26
RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise

27. Types
 Mouth to mouthbreathing
 Mouth to barrier device breathing
 Mouth to nose and mouth tostoma ventilation
 Ventilation with bagandmask

28. Mouth-To-Mouth breath

29. Mouth-To-Nose breath
 Given when mouth cant beopen
 Good seal cant be made
 Severeinjury present over area of mouth

30. Mouth-To-Barrier device

31. Bagand Mask ventilation
 Position yourself directly above patient’shead
o Perform headtilt
o Make “C”with thumb and index finger to seal the mask
o And other 3 fingers,forms“E” jawthurst
o Chestrise is checked while squeezing the bagto give
breaths to thepatient.

32. BagAnd Mask Ventilation

33.  Defibrillation is used for the treatment of
tachydysrhythmias.
 Defibrillation depolarises the critical mass of
myocardial cell at once. It recaptures the SA
node as its role as the pacemaker .
 Is treatment of choice for pulseless VT/VF.
Prof. Dr. RS Mehta, BPKIHS
Defibrillation

34. DEFIBRILLATION

35. Ventricular
tachycardia
35 Prof. Dr. RS Mehta, BPKIHS

36. Ventricular
fibrillation
36 Prof. Dr. RS Mehta, BPKIHS

37. Defibrillators can be classified as :
Monophasic(delivers current of
one polarity only)
Biphasic (deliver current of 2
polarity)
Defibrillator
37 Prof. Dr. RS Mehta, BPKIHS

38. Position of defibrillator paddle:
 1st paddle - on the right
side of the chest just
below the clavicle
 2nd at precordial,
region.
 Paddle should be applied
with pressure equivalent
to 10 kg.
38 Prof. Dr. RS Mehta, BPKIHS

39.  Adult: 13cm
 Children:8cm
 Infants:4.5cm
Latest Recommendation for shock protocol ;
Previous recommendation of 3 successive shock
(200,300,360J)
Now a days only single shock is recommended .i.e.
360J by monophasic
150-200J by biphasic
Paddle
size
39

40.  Apply conducting jelly between the
paddle and the skin.
 Place the paddle so that they don't
touch patient’s clothing and bed
linen and aren't near medication and
direct oxygen flow.
 Ensure that defibrillator is not in
synchronized mode.
 Don't charge the device until ready to
shock
 keep the thumbs and fingers off
discharge button until paddle are on
Nurses role while performing
defibrillation

41.  Before pressing the discharge button call “ all
clear” 3 times
1st clear: Ensures" YOU” aren’t touching
patient,bed, equipment
2nd clear: Ensures “no one" is touching patient, bed ,
equipment
3rd clear: Ensures “you and everyone" else are clear off
the patient and anything touching the patient.
Nurses role in
defibrillation

42. Nurses role in
defibrillation
 Record the delivered energy and the results (cardiac
rhythm and pulse).
 After the event is complete inspect the skin under
the pads and paddles for burns , and if any
detected consult about the treatment.
42 Prof. Dr. RS Mehta, BPKIHS

43. First turn it on.
Then simply follow
instructions.
Using an AED
43

44. AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)
 Some AEDs will
automatically switch
themselves on when
the lid is opened

45. ATTACH PADS TO
CASUALTY’S BARE CHEST

46. ANALYSING RHYTHM
DO NOT TOUCH VICTIM

47. SHOCK INDICATED
 Stand clear
 Deliver shock

48. SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
30 2

49. IF VICTIM STARTS TO BREATHE
NORMALLY PLACE IN RECOVERY
POSITION

51. 1. Adrenaline(all types of cardiac arrest)- 1mg
every 3-5 mins
2. Amidarone(VF,VT)- 1st dose:300mg IV bolus,
2nd dose 150 mg
3. Lidocaine- ( 1 to 1.5 mg/kg)
4. Sodium bicarbonate(only if cardiac arrest is
associated with hyperkalemia ) (2- 5 meq/kg)
5. Calcium gluconate- 10 mg iv slowly
6. Magnesium sulphate – 2 gms iv in 100 ml NS
(refractory VT / VF)
51
DRUGS

52. THANK YOU
FOR YOUR ATTENTION