WHEN TO HELP BLS UPDATE for EMDs

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WHEN TO HELP BLS UPDATE for EMDs

• 2011
• SILVER CROSS EMS
• EMD MARCH CE
• EMERGENCY MEDICAL DISPATCHER

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OBJECTIVES

• Review background information on BLS
• Provide information on DOAs
• Review updated information on CPR for the Adult,
  Child and Infant victims based on the AHA 2010
  Guidelines for Heartsaver
• Review procedures for assisting victims that are
  choking
• Troubleshoot possible complications encountered
  during BLS

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NO MATTER WHAT THE CAUSE

• When the heart has stopped and the victim is not
  breathing, CPR is the answer.
• Without a constant supply of blood, cells of the
  body will start to die. Brain damage begins
  within 4 to 6 minutes after cardiac arrest.
  Within 8 to 10 minutes, the damage may be
  irreversible. Cardiopulmonary resuscitation will
  help to circulate oxygenated blood until more
  advanced medical care can be performed.

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CPR

• CPR by itself cannot sustain life indefinitely.
• It should be started as soon as possible to give
  the patient the best chance for survival.
• Many patients will need defibrillation and
  medication to be successfully resuscitated.
• Its all part of the process.

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The Chain of Survival
Source American Heart Association
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The Chain of Survival

• The links in the Chain of Survival include
• Early recognition of cardiac arrest and
  activation of the 9-1-1 system
• Early bystander (or EMD assisted) CPR
• Early defibrillation by EMRs or other EMS
  personnel
• Early advanced care by paramedics and hospital
  personnel

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Possible DOA

• Signs of death
• Decapitation The head is separated from the rest
  of the body.
• Rigor mortis Temporary stiffening of muscles
  occurs several hours after death.
• Evidence of tissue decomposition Actual flesh
  decay occurs only after a person has been dead
  for more than one day.
• Dependent lividity Red or purple color occurs on
  the parts of the patients body that are closest
  to the ground.

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When to Start CPR

• CPR should be started on all non-breathing,
  pulseless patients, unless they are obviously
  dead or have a DNR order. (Responders will need
  to see a valid copy of the order to honor it.)
• It is better to start CPR on a person that is
  later declared dead by a physician than to
  withhold CPR from someone that could have been
  saved.
• When in Doubt, Resuscitate!

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When to Stop CPR (1 of 2)

• Discontinue CPR only when
• Effective spontaneous circulation and ventilation
  are restored.
• Resuscitation efforts are transferred to another
  trained person who continues CPR.
• A physician orders you to stop.
• The patient is transferred to properly trained
  EMS personnel.

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When to Stop CPR (2 of 2)

• Discontinue CPR only when (contd)
• Reliable criteria for death are recognized.
• You are too exhausted to continue resuscitation,
  environmental hazards endanger your safety, or
  continued resuscitation would place the lives of
  others at risk.

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It all starts with A-B-C

• A Airway
• B Breathing NO?
• C Circulation
• START COMPRESSIONS!

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New Sequence
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FOLLOW THIS LINK TO WATCH THE NEW GUIDELINES VIDEO

• http//www.youtube.com/watch?vO9T25SMyz3A

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AHA 2010 Recommendations

• Adult (HS 1 Rescuer)
• Unresponsive?
• Call for help AED
• Not breathing or only gasping (Agonal breaths)
• Start compressions in the center of the chest
  between the nipples, at a rate of 100/min and a
  depth of at least 2 inches, allowing for chest
  recoil

• 302 Ratio of compressions to breaths
• After 30 compressions, open the airway with a
  head tilt-chin lift and deliver 2 breaths
• When rescuers are untrained or not proficient,
  compressions only can be performed
• PUSH HARD FAST

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AHA 2010 Recommendations

• Children (HS 1 Rescuer)
• Unresponsive?
• Not breathing or only gasping
• Start compressions in the center of the chest
  between the nipples, at a rate of at least
  100/min
• and a depth of 2 inches or 1/3 chest diameter,
  allowing for chest recoil

• 302 Ratio of compressions to breaths
• After 30 compressions, open the airway with a
  head tilt-chin lift and deliver 2 breaths
• After 5 cycles or 2 minutes, call for help,
  continue cycles
• When rescuers are untrained or not proficient,
  compressions only can be performed
• PUSH HARD FAST

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AHA 2010 Recommendations

• Infant (HS 1 Rescuer)
• Unresponsive?
• Not breathing or only gasping
• Start compressions in the center of the chest
  between the nipples, at a rate of at least
  100/min
• and a depth of 1 1/2 inches or 1/3 chest
  diameter, allowing for chest recoil

• 302 Ratio of compressions to breaths
• After 30 compressions, open the airway with a
  head tilt-chin lift and deliver 2 breaths
• After 5 cycles or 2 minutes, call for help,
  continue cycles
• When rescuers are untrained or not proficient,
  compressions only can be performed
• PUSH HARD FAST

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GENERAL INFO

• Make sure victim is on a firm, flat surface
• Minimize interruptions to chest compressions, 1o
  seconds or less
• Watch for chest rise with breaths
• Attach AED as soon as it is available and follow
  the prompts
• Resume compressions immediately after
  administering a shock
• 30 compressions should be given over
  approximately 18 seconds (think of the tune
  Staying Alive)

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Recovery Position

• If the victim is unconscious but breathing
• Roll the patient onto one side, as you support
  the patients head.
• Place the patients face on his or her side so
  any secretions drain out of the mouth and the
  tongue wont block the airway.

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Is It Working?

• The victims color should improve
• The chest should be rising with each breath
• The compressions and breaths are delivered at the
  appropriate rate and depth

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Possible Complications

• Broken ribs
• Check hand placement and continue
• Gastric Distension (air in the stomach)
• Can happen if the airway is not open, re-tilt
  head
• Make sure breaths are not given too forcefully or
  too fast, give over 1 second each and allow for
  exhalation
• Give breaths only until the chest rises
• Be alert for vomiting and keep airway clear
• Chest does not rise
• Reposition head and try breath again. If its
  still not rising go right to compressions
• Victim breathes through a stoma (opening in the
  neck)
• If the chest does not rise with breaths, cover
  mouth and nose for possible air leakage

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Causes of Airway Obstruction

• The most common airway obstruction is the tongue.
• If the tongue is blocking the airway, the head
  tiltchin lift maneuver performed on the
  unconscious victim should open the airway.
• Food is the most common foreign object that
  causes an airway obstruction.
• If a foreign body is lodged in the air passage,
  you must use other techniques to remove it.

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Are you choking?

• Mild Obstruction
• Victim is able to cough or is gagging
• Victim is able to speak and breath
• Encourage victim to cough and monitor them in
  case the airway becomes blocked

• Severe Obstruction
• Victim has ineffective cough
• Victim is unable to speak or breath
• Victim is displaying the Universal Sign
• for choking
• Prepare to help victim

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Management of Foreign Body Airway Obstructions

• Airway obstruction in an adult or child
• If the victim is conscious, stand behind them and
  perform abdominal thrusts.
• If the victim is obese or pregnant, stand behind
  them and perform chest thrusts instead of
  abdominal thrusts.
• If the victim becomes unresponsive
• Ensure that the EMS system has been activated.
• Perform CPR, remembering to check the mouth for
  foreign objects before each breath.

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Steps for Managing Airway Obstruction in a
Conscious Adult or Child
1. Look for signs of choking.
2. Place your fist with the thumb side against
the patients abdomen, just above the navel.
3. Grasp the fist with your other hand and press
into the abdomen with quick inward and upward
thrusts.
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Management of Foreign Body Airway Obstructions
(continued)

• Airway obstruction in an infant
• Use a combination of 5 back slaps (with the heel
  of your hand between the shoulder blades) and 5
  chest thrusts (with 2 fingers between the nipples
  on the center of the chest), alternating, until
  the object is expelled or the victim becomes
  unconscious.
• If the infant becomes unresponsive
• Ensure that the EMS system has been activated.
• Begin CPR, remembering to check the mouth for the
  foreign object before each breath.

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FYI

• The flipcharts will be updated to reflect the new
  changes, in the near future. Until then, use the
  protocol that youre currently using.
• Your current CPR cards are good until the
  expiration dates printed on the card. Recommended
  renewal is every 2 years.
• You previously learned the same skills, the order
  has just changed to C-A-B.
• Hands Only CPR will be encouraged for the lay
  rescuer with no training or is not proficient in
  the skills
• For further information on CPR visit the American
  Heart Associations website www.heart.org/cpr

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Resources

• American Heart Associations Highlights of the
  2010 Guidelines for CPR ECC and other
  information provided on their website
• AAOS Emergency Medical Responder, 5th edition