GENERAL EMERGE RSUP DR. SARDJIT CARDIO PULMONARY ENCY LIFE SUPPORT TO -YOGYAKARTA Y RESUSCITATION 201
GENERAL EMERGENCY LIFE SUPPORT
RSUP DR. SARDJITO
CARDIO PULMONARY R
GENERAL EMERGENCY LIFE SUPPORT
RSUP DR. SARDJITO - YOGYAKARTA
RY RESUSCITATION 2010
Cardiopulmonary resuscitation (CPR): is a
of life saving actions of life saving actions
survival following cardiac arrest.
Optimal approach to
on the rescuer, the vic
fundamental challenges remains:
early and effective CPRearly and effective CPR
Cardiopulmonary resuscitation (CPR): is a series
of life saving actions that improve the chance oof life saving actions that improve the chance o
survival following cardiac arrest.
h to CPR may vary, depending
e victim and resources, still th
fundamental challenges remains: how to achiev
early and effective CPRearly and effective CPR
Cardiac arrest occurs: in and out of hospital
In US & Canada: 350.000 people/yr (half in
hospital) cardiac arrest and receive attempted hospital) cardiac arrest and receive attempted
resuscitation. Not includ
resuscitation.
Inappropriate resuscita(on →
years lost
in and out of hospital
In US & Canada: 350.000 people/yr (half in
hospital) cardiac arrest and receive attempted hospital) cardiac arrest and receive attempted
cluded without attempted
Inappropriate resuscita(on → many lives & life-
Successfull resuscitation requires an
integrated set of coor
Chain of survival
✓ immediate recognition and activation
✓ early CPR
rapid defibrilation✓ rapid defibrilation
✓ effective advance life support
✓ integrated post-
resuscitation requires an
coordinated ac(ons →
immediate recognition and activation
defibrilationdefibrilation
effective advance life support
-cardiac arrest care
BASIC LIFE SUPPORT
Basic Life Support (BLS) is t
lives following cardiac arrestlives following cardiac arrest
Fundamental aspects of BLS:
✓ immediate recognition of su
Activation of emergency response system
✓ Early cardiopulmonary resuscitation (CPR)
✓ rapid defibrillation with automated external defibrillator ✓ rapid defibrillation with automated external defibrillator
(AED)
The universal Adult Basic Li
framework for all levels of rescuers setting.
BASIC LIFE SUPPORT
) is the foundation for saving
lives following cardiac arrestlives following cardiac arrest
Fundamental aspects of BLS:
of sudden cardiac arrest (SCA) and
Activation of emergency response system
Early cardiopulmonary resuscitation (CPR)
rapid defibrillation with automated external defibrillator rapid defibrillation with automated external defibrillator
sic Life Support is a conceptual
framework for all levels of rescuers setting.
Early recognitio
Ensuring the scene is safe
Check unresponsivenessCheck unresponsiveness
no movement
no response on stimulation (shouting or tapping his shoulder)
activate the emergency response (call 911)
check breathing:
no breathing
abnormal breathing (
nition & activation
Ensuring the scene is safe
unresponsiveness: unresponsiveness:
no response on stimulation (shouting or tapping his shoulder)
activate the emergency response (call 911)
abnormal breathing (ie gasping)
check pulseFor:
✓ lay rescuer: shouldn
collapses/unresponsive, no/abnormal collapses/unresponsive, no/abnormal
breathing →assume cardiac
chest compression
✓ health provider: <10
compression
check pulse
shouldn’t check! suddenly
collapses/unresponsive, no/abnormal collapses/unresponsive, no/abnormal
breathing →assume cardiac arrrest → start
<10” !! more → start chest
Early CPR
CHEST COMPRESSIONCHEST COMPRESSION
- consist of forcefulthe lower half of the
- Create blood flowpressures & directly→blood flow &→blood flow &myocardium & brain
- effective chest compression
Early CPR
rhythmic of pressure overthe sternum
by increasing intrathoracicdirectly compressing the heart
& oxygen delivery to& oxygen delivery tobrain
compression are essential
How to do ches
✓ lower half of sternumlower half of sternum
✓ push hard, push fast
✓ at least 100 compression/minutes
✓ at least 2 inch or 5 cm depth
✓ allow complete recoil
compression✓ compression
✓ minimal compression
chest compression ?
lower half of sternumlower half of sternum
push hard, push fast
100 compression/minutes
2 inch or 5 cm depth
allow complete recoil
sion & ventilation ratio= 30:2sion & ventilation ratio= 30:2
compression interruption
It is recommended to switch
or after 5 cycles, and should <5 seconds
to check pulse after cycles,
rescuers (do not stop the chest compression). But, it
for health provider, and still <10 s.for health provider, and still <10 s.
interuption for health care provider
intubate and to defib.
switch chest compressors @2 mn
or after 5 cycles, and should <5 seconds
, NOT recommended for lay
rescuers (do not stop the chest compression). But, it’s o
for health provider, and still <10 s.for health provider, and still <10 s.
for health care provider: to check pulse, to
Rescue breaths:
start immediately, after head positioning, but
compression
mouth to mouth or bag mask ventilationmouth to mouth or bag mask ventilation
each over 1 second
sufficient (dal volume → visible chest rise
» normal VT 8-10 ml/kg is sufficient
» in CPR patients (with CO 25
ratio with compression still 30:2
risk excessive ventilation:
» gastric inflation: regurgitation & aspiration
» ↑ intrathoracic pres
output→↓ survival
start immediately, after head positioning, but after chest
mouth to mouth or bag mask ventilationmouth to mouth or bag mask ventilation
sufficient (dal volume → visible chest rise
10 ml/kg is sufficient
in CPR patients (with CO 25-33%), VT 6-7 should be suffic
ratio with compression still 30:2
gastric inflation: regurgitation & aspiration
ressure→↓venous return→↓cardi
utput→↓ survival
Early defibrillation with an AED
VF is common & treatable initial rhythm in adults with witnessed cardiac arrestcardiac arrest
VF case, survival highest when CPR is provided & 3-5’ of collapse
Rapid defib is tx of choice for VF oout of hospital or hospitalized patient cardiac arrest.
AED should be used as rapidly as possible
Defibrillation sequence:
Turn on the AEDTurn on the AED
follow the AED prompts
Resume chest compression immediately after the shock (minimize interruptions)
Early defibrillation with an AED
VF is common & treatable initial rhythm in adults with witnessed
VF case, survival highest when CPR is provided & defib occurs within
F of short duration such as witnessed out of hospital or hospitalized patient cardiac arrest.
AED should be used as rapidly as possible
Resume chest compression immediately after the shock
Rescuers specif
Health care provider:
30:2 cycle until advanced airway is placed30:2 cycle until advanced airway is placed
after that, give ventilation, 1 breath: 6-8 second, or 8
Avoid excess ventilation
To activate EMS for lone provider:
- as seen the patient get collpase
- or ie in drowning or airway obstruction case, 5 CPR cycles first, then
ecific strategies:1. Untrained Lay rescuer:
Hand-only CPR until AED or health p
arrive.
push hard and push fast or by emergpush hard and push fast or by emerg
medical dispatcher’s direction
2. Trained Lay rescuer:
chest compression and breathing rat
do until EMS arrive or health care pr
take over
30:2 cycle until advanced airway is placed30:2 cycle until advanced airway is placed
8 second, or 8-10 x/mnt
in drowning or airway obstruction case, 5 CPR cycles first, then
managing the
for trained Lay rescuer who could do both
chin liftchin lift
for hands-only cpr → insufficient evidence
passive airway
for health care provider:
- no cervical spine injury → head (lt & chin liF
- susp cervical spine injury:✓ initially use manual spinal motion restriction (
side of patient’s head to hoside of patient’s head to ho✓ jaw thrust without head extention
• when advanced airway device is placed, no
• - chest compression: 100x/mnt
• - ventilation : every 6-8 second, or 8
the airway
both chest comp & ven(la(on → head (lt
ence to recommend them to use of any sp
no cervical spine injury → head (lt & chin liF
initially use manual spinal motion restriction (eg placing 1 hand on ei
hold it still) rather than immobilization devi hold it still) rather than immobilization devi
extention.
when advanced airway device is placed, no interuption anymore for ventilation
8 second, or 8-10 breaths/mnt
Recovery Position
is used for unresponsive patient who clearly have
normal breathing and effective circulationnormal breathing and effective circulation
Recovery Position
is used for unresponsive patient who clearly have
normal breathing and effective circulationnormal breathing and effective circulation
Key changes & con
emphasis from the 2005 BLS:
immediate recognition of SCA based onimmediate recognition of SCA based on
breathing
Look, Listen and Feel” removed from BLS
Hands-Only CPR for untrained lay-rescuer
Sequence ABC → CAB
Health care providers continue CPR untillHealth care providers continue CPR untill
termination of resuscitative efforts
Increased focus on methods to ensure
continued points of
emphasis from the 2005 BLS:
d on unresponsiveness & absence of nd on unresponsiveness & absence of n
from BLS
rescuer
untill return of spontaneous circulatiountill return of spontaneous circulatio
Increased focus on methods to ensure high quality CPR is performed
continued de-emphasis on pulse check
providers
*a simplified adult BLS algorithm
Recommendation of simultaneous, Recommendation of simultaneous,
for chest compression, airway management, rescue
breathing, rhythm detection, a
an integrated team of highly-tr
setting
emphasis on pulse check for health care
*a simplified adult BLS algorithm is introduced
simultaneous, choreographed approasimultaneous, choreographed approa
for chest compression, airway management, rescue
n, and shocks (if appropriate) b
trained rescuers in appropria