Adult Basic Life Support'

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For 1st year students of Medical Faculty
Adult Basic Life Support. Cardiopulmonary
Resuscitation.
Joel Starkopf TÜ Anestesioloogia ja
intensiivravi kliinik http//www.kliinikum.ee/aikl
iinik/
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• Major causes of the death

• Cardiovascular diseases
• Malignancy (cancer)
• Accidents

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Sudden death

• Unexpected death of the patient, who is in good
  general health condition. Appearance of the death
  within few hours from the onset of first symptoms
  of illness.
• Cardiac sudden death.
• Every tenth (third) of patients could be saved by
  proper life support.

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Life For normal functioning all cells of the
body require oxygen. If oxygen is not provided,
death of organism appears within 4..5 minutes.
Brain is the tissue most susceptible to anoxia
(absence of oxygen).
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• Process of the death
• Is not a momentary but stepwise process, which
  can take certain time.
• Three steps of the death
• Agony
• Clinical death (reversible injury)
• Biological death (irreversible injury)

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Agony is a stadium which preceeds to the death.
Function of vital organs is severly disturbed,
and conditions required for survival of organism
cannot be met.

• Unconsciousness
• Blood pressure is undetectable
• No pulse on arteries

Clinical death circulation stops completely and
that leads to the cessation of breathing and
nervous system activity.
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• Symptoms of clinical death
• No pulse on arteries
• Change of skin colour
• Unconsciousness
• Gasping, cessation of breathing
• Dilatation of eye pupils

Duration of clinical death is 3(5) minutes
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Biological death is irreversible condition.
Metabolism of and functioning of vital organs has
completely ceased. Organ damage is as extensive
that resuscitation of the body is impossible.

• Evident symptoms of the death
• Rigor mortis
• Death spots on the body
• Drop of body temperature to the level of the
  surrounding

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Sudden death
Cardiac arrest
Stop of breathing

• Closure of airway
• Unconscious patient
• Foreign body
• Trauma
• Inflammatory diseases of throat
• Drowning
• Electrical trauma
• Musculatory weakness
• Nervous system diseases
• Drug overdoses

• Rhytm disturbances
• Ventricular fibrillation
• Pulseless electrical activity
• Asystole
• Myocardial infarction
• Hypothermia
• Electrical trauma
• Blood (fluid) loss

Initially, during few minutes, pulse (heart
beating) is preserved. cardiac arrest can be
prevented by quick and effective first aid (open
the airway!)
Gasping (agonal breathing) can be continued for 5
minutes after cardiac arrest. In 4/5 cases the
cause of cardiac arrest is ventricular
fibrillation defibrillation (electric shock) is
the only treatment option! AED automatic
external defibrillators
Adults
Children
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Sudden death in Estonia 1999 2000

• Annually in Estonia
• 3000 cardiac sudden deaths
• 2300 deaths due to trauma
• 300 patients die from alcohol intoxication
• 920 out-of-hospital resuscitation attempts
• 72 adult men
• 26 adult women
• 2 infants and children
• Causes of the death
• 65 cardiac disease
• 10 intoxication
• 7 trauma

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Cardiopulmonary Resuscitation - CPR
BLS Basic life support Adult, pediatric A(C)LS Ad
vanced (Cardiac) Life Support Adult, pediatric
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Sequence of actions for adult basic life support
If You are alone and victim is adult (over 8
years old)

• Ensure safety of rescuer and victim
• 2. Check the victim and see if he responds
• 3.a. If he responds by answering and moving
• Check his condition and get help if needed
• Reassess him regularly
• 3.b. If he does not respond
• Shout for help
• Open the airway in position you find him
• If you cannot open the airway and assess the
  victim in initial position, turn him back and try
  again to open the airway

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• Keeping the airway open, look, listen and feel
  for normal breathing
• Look the chest movements
• Listen at victims mouth for breath sounds
• Feel for air with your cheek
• Use no more than 10 seconds to determine if
  victim is breathing normally (more than an
  occasional gasp or weak attempts at breathing)
• Try to avoid head tilt if trauma (injury) to
  the neck is suspected!

• 5.a. If he is breathing normally
• Turn him to the recovery position
• Send somebody for help, or leave the victim and
  go for help yourself
• Check for continued breathing

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• Recovery position
• Ensure removal of fluids from mouth
• Ensure stable position
• Avoid pressure to the chest, which can disturb
  breathing
• Check breathing regularly
• Be cautious about the injuries. If neck injury is
  suspected, recovery position cannot be used.

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• 5.b. If he is not breathing, or is only making
  occasional gasps or weak attempts at breathing
• Send for help, if not already done
• Turn the victim onto his back
• Remove visible foreign body from mouth of the
  victim (loose false teeths)
• Give two slow, effective rescue breaths, each of
  which makes the chest rise and fall
• If You ar not succeed to provide effective
  breathing
• Recheck for the foreigh body
• Recheck that there is adequate head tilt and chin
  lift, change position of the head
• Make up to five attempts in all to achieve two
  effective breaths
• Even if unsuccessful, move on to check the
  circulation

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• 6. Check the victim for signs of circulation
• Look, listen and feel for normal breathing,
  coughing, or movement by the victim
• Only if you have been trained to do so, check the
  carotid pulse
• Take no more than 10 seconds to do this
• 7.a. If you are confident that you have detected
  signs of circulation
• Continue rescue breathing until the victim starts
  breathing on his own
• About every ten breaths (or about every minute)
  recheck for signs of circulation take no more
  than 10 s each time
• If the victim starts to breathe normally on his
  own but remains unconscious, turn him into the
  recovery position. Be ready to turn him ontohis
  back and restrat rescue breathing if he stops
  breathing.

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• 7.b. If there are no signs of a circulation, or
  you are at all unsure start chest compressions
• Position the hands on chest of the victim, follow
  correct technique
• Release all the pressure without losing contact
  between the hand and sternum, then repeat at a
  rate about 100 times a min (a little less than
  two compressions a second) it may be helpful to
  count out aloud. Compression and release should
  take an equal amount of time.
• Combine rescue breathing and compressions after
  15 compressions give 2 breathing, and continue in
  a ratio 152
• Only stop to recheck for signs of circulation if
  the victim makes a movement or takes a
  spontaneous breath otherwise resuscitation
  should not be interrupted.

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• 8. Continue resuscitation until
• Qualified help arrives and takes over
• The victim shows signs of recovery
• You become exhausted

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Resuscitation with two rescuers

• The first priority is to summon help
• It is preferable that the rescuers work from
  opposite sides of the victim
• A compressions/inflations ratio 152 should be
  used
• Chin lift and head tilt should be maintained at
  all times
• If the rescuers wish to change places, usually
  because the one giving compressions becomes
  tired, this should be undertaken as quikly and
  smoothly as possible

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Chest compressions

• Position yourself vertically above the victims
  chest
• Keep arms straight
• Press sternum down for 4-5 cm

• Firm back
• Middle of the lower half of sternum

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When to get help

• When more than one rescuer is available, one
  should start resuscitation while another rescuer
  goes for help immediately it has been established
  that the vistim is not breathing.
• If the victim is an adult, the single rescuer
  should normally assume that he has a heart
  problem and go for the help immediately it has
  been established that he is not breathing.
• If the likely cause of unconsciousness is a
  breathing problem, as in
• Trauma
• Drowning
• Choking
• Drug or alcohol intoxication
• Or if the victim is an infant or child
• the rescuer should perform resuscitation for
  about 1 min before going for help

Phone first, act fast
Act first, phone fast
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Shake and shout
Head tilt/Chin lift
If breathing Recovery position
Look, listen and feel
2 effective breaths
Signs of circulation
100 per minute 152 ratio
CIRCULATION PRESENT Continue rescue breathing
NO CIRCULATION Compress chest
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Chain of survival
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Drowning

• Submersion, near-drowning victim can be rescued
• Drowning a mortal event. Victim is pronounced
  dead at the scene of attempted resuscitation, in
  the ED, or in the hospital

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BLS for resuscitation from submersion

• Recovery from water
• Personal safety
• Possible spinal cord injury neck immobilisation
• Rescue breathing as quickly as possible
• Rescue breathing
• There is no need to clear the airway of aspirated
  water
• Heimlich maneuver only if there is suspect of
  foreign-body airway obstruction

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BLS for resuscitation from submersion

• Chest compressions
• If signs of circulation are not present, start
  chest compressions at once
• Vomiting
• Is likely to occur when chest compressions or
  rescue breathing is performed
• Turn the victim mouth to the side ande remove the
  vomitus with the finger sweep or use suction