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  • BLS For Healthcare Providers

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    جوهانسبرج جوهانسبرج
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    Basic Life Support by American Heart Association

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    BLS for Healthcare Providers

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    Basic Life Support by American Heart Association

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    © All Rights Reserved
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    2K Ansichten58 Seiten

    BLS For Healthcare Providers

    Hochgeladen von

    جوهانسبرج جوهانسبرج
    Basic Life Support by American Heart Association

    Copyright:

    © All Rights Reserved
    Als PDF herunterladen oder online auf Scribd lesen
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    von 58
    Gt American acr-a9 Pee BLS for Healthcare Providers eked Part 1 General Concepts Part 2 Introduction ‘The Purpose of This Manual The Chain of Survival Learning Objectives Introduction to the Adult Chain of Survival Introduction to the Pediatric Chain of Survival 2010 AHA Guidelines for CPR and ECC Science Update Overview Learning Objectives Change in Sequence: C-A-B, Not A-B-C. Emphasis on High-Quality CPR No Look, Listen, and Feel ‘Additional Changes. BLS/CPR for Adults oR ee Ooo MHKN ~“ BLSICPR Basics for Adults Overview Learning Objectives Understanding the Basics of BLS Overview of Initial BLS Steps Step 1: Assessment and Scene Safety Step 2: Activate the Emergency Response System and Get an AED Step 9: Pulse Check Step 4: Begin Cycles of 30 Chest Compressions and 2 Breaths (CPR) Chest Compression Technique Moving the Victim Only When Necessary Opening the Airway for Breaths: Head Tilt-Chin Lift ‘Adult Mouth-to-Barrier Device Breathing Giving Adult Mouth-to-Mask Breaths Bag-Mask Device Using the Bag-Mask During 2-Rescuer CPR eoaeernrn 410 410 2 2 18 “4 4 2-Rescuer Adult BLS/Team CPR Sequence Overview Learning Objectives When More Rescuers Arrive Duties for Each Rescuer 2 Rescuers Using the Bag-Mask (Opening the Airway for Breaths: Jaw Thrust Automated External Defibrillator for Adults 15 15 16 15 18 16 a and Children 8 Years of Age and Older 19 ‘Automated External Defibrillator for Adults and Children 8 Years of Age and Older 19 Overview 19 Learning Objectives 19 AED Arial 19 Special Situations 2 2-Rescuer BLS Sequence With an AED 4 2 Rescuers With an AED 24 4- and 2-Rescuer Adult BLS With AED Skills Testing Sheet ar 4- and 2-Rescuer Adult BLS with AED Skills Testing Criteria and Descriptors 28 BLS/CPR for Children From 1 Year of Age to Puberty 29 BLS/CPR Basics for Children From 1 Year of Age to Puberty 29 Overview 29 Learning Objectives 29 Child BLS 29 Compression Rate and Ratio for Lone Rescuer 29 +-Handed Chest Compressions 4-Rescuer Child BLS Sequence ‘2-Rescuer Child BLS Sequence Child Ventilation With Barrier Devices ‘Why Breaths Are Important for Infants and Children in Cardiac Arrest Part 5 BLS/CPR for Infants BLS/CPR Basics for Infants Overview Learning Objectives Infant BLS Compression Depth in Infants 1-Rescuer infant CPR ‘Compression Rate and Ratio for Lone Rescuer 4-Rescuer Infant BLS Sequence 2-Finger Chest Compression Technique Infant Ventilation With Barrier Devices Why Breaths Are Important for infants and Chitdren in Cardiac Arrest 2-Rescuer Infant CPR 2 Thumb-Encitcing Hands Chest Compression Technique 2-Rescuer Infant BLS Sequence 1- and 2-Rescuer Infant BLS Skills Testing Sheet 1- and 2-Rescuer Infant BLS Skills Testing Criteria and Descriptors Part 6 Automated External Defibrillator for Infants and for Children From 1 to 8 Years of Age sess esseee geese! |B & 41 Automated External Defibrillator for Infants and for Children From 1 to 8 Years of Ago Overview Learning Objectives Choosing the AED Pads or AED Child System Use of an AED for Infants and Children Use of an AED for infants Part 7 CPR With an Advanced Airway 4t at at 4a 4a at CPR With an Advanced Airway ‘Overview ‘Compression Rate and Ratio During 2-Rescuer CPR With and Without an Advanced Airway in Place aa |b Part 8 Mouth-to-Mouth Breaths ‘Mouth-to-Mouth Breaths Overview Leaming Objectives ‘Adult Mouth-to-Mouth Breathing Additional Techniques for Giving Breaths Infant Mouth-to-Mouth-and-Nose and Mouth-to-Mouth Breathing Part 9 Rescue Breathing Adult, Child, and Infant Rescue Breathing Overview Rescue Breathing Part 10 Relief of Choking Relief of Choking in Victims 1 Year of Age and Older Overview Leaming Objectives Recognizing Choking in a Responsive Adult or Child Relieving Choking in a Responsive Victim 1 Year of Age or Older Relieving Choking in an Unresponsive Victim 1 Year of Age or Older ‘Sequence of Actions After Relief of Choking Relief of Choking in Infants Overview Leaming Objectives Recognizing Choking in a Responsive infant Relieving Choking in a Responsive Infant Relieving Choking in an Unresponsive Infant Appendix Healthcare Provider Summary of Steps of GPR for Adults, Children, and Infants Recommended Reading General Concepts Welcome to the BLS for Healthcare Providers Course. With the knowledge and skils you leam inthis course, you can save life. You wil lear the skis of CPR for victims of all ages and will practice CPR in a team setting, You will ear how to use an automated external defisrilator (AED) and how to relieve choking (foreign-body airway obstruction ‘The skis you learn in this course will enable you to recognize emergencies such as sud den cardiac arrest and know how to respond to ther. Despite important advances in prevention, cardiac arrest remains a substantial public health problem and a leading cause of death in many parts of the world, Cardiac arrest ‘occurs bath in and out of the hospital The Purpose of This manual focuses on what healthcare providers need to know to perform CPR in a wide This Manual variety of in- and out-of-hospital settings. The manual details the information and skils. you wil lar inthis class: «+ Initiating the Chain of Survival ++ Performing prompt, high-quality chest compressions for adult, infant victims Initiating early use of an AED * Providing appropriate rescue breaths * Practicing 2-rescuer team CPR * Relieving choking ena High-quality CPR improves a victim's chances of survival. The critical characteristics of high-quality CPR include * Start compressions within 10 seconds of recognition of cardiac arrest. * Push hard, push fast: Compress at a rate of at least 100/min with a depth of at least 5 om (2 inches) for adults, approximately 5 cm (2 inches) for children, and approximately 4 om (1% inches) for infants. * Allow complete chest recoil after each compression. * Minimize interruptions in compressions (ry to limit interuptions to <10 seconds). * Give effective breaths that make the chest rise. + Avoid excessive ventilation. The Chain of Survival Learning Objectives Introduction to the Adult Chain of Survival Introduction to the Pediatric Chain of Survival ‘After reading this section you will be able to name the links in the American Heart ‘Association (AHA) adult Chain of Survival and state the importance of each link. ‘The AHA has adopted, supported, and helped develop the concept of emergency cardiovascular care (ECC) systems for many years ‘The term Chain of Survival provides a useful metaphor forthe elements of the ECC ‘systems concept (Figure 1). The 5 links in the adult Chain of Survival are * Immediate recognition of carciac arest and activation ofthe emergency response system * Early cardiopulmonary resuscitation (CPR) with an emphasis on chest ‘compressions, * Rapid defibrilation * Effective advanced life support * Integrated post-cardiac arrest care Figure 4. the suit Chain f Survival, ‘Atthough basic ife support is taught as a sequence of distinct steps to enhance skils retention and clarify priotes, several actions should be accomplished simuttaneously (eg, begin CPR and activate the emergency response system) when multiple rescuers are present, Although in adults cardiac arrest is often sudden and results from a cardiae cause, in chien cardiac arestis often secondary to respiratory fallure and shock. Identifying chie ‘ren with these problems is essential to reduce the likelihood of pediatric carciac arrest and maximize survival and recovery. Therefore, a prevention link is added in the pediatric Chain of Survival Figure 2): + Prevention of arrest + Early high-quality bystander CPR * Rapid activation of the EMS (or other emergency response) system * Effective advanced life support (including rapid stabilization and transport to efintive care and rehabilitation) * Integrated post-cardiac arrest care Figure 2. the pediatic Cha of Survival 2010 AHA Guidelines for CPR and ECC Science Update Overview ‘The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommendations for healthcare providers include the following key changes and issues: * Changes in basic life support (BLS) sequence * Continued emphasis on high-quality CPR, with minor changes in compression rate and depth * Additional changes regarding cricoid pressure, pulse check, and AED use in infants Learning ‘After reading this section you will be able to name the major science updates in the Objectives 2010 AHA Guidelines for CPR and ECC. Change in ‘The 2010 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of Sequence: steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, C-A-B, Not A-B-C Airway, Breathing) for adults, children, and infants. This change in CPR sequence requires reeducation of everyone who has ever learned CPR, but the consensus of the authors and experts involved in creating the 2010 AHA Guidelines for CPR and ECC is that the change is tkely to improve survival. In the A-B-C sequence, chest compressions were often delayed while the rescuer ‘opened the airway to give mouth-to-mouth breaths, retrieved a barrier device, or gathered and assembled ventilation equipment. By changing the sequence to C-A-B, rescuers can start chest compressions sooner, and the delay in giving breaths should be minimal (only the time required to deliver the frst cycle of 30 chest compressions, or approximately 18 seconds or less; for 2-rescuer infant or child CPR, the delay will be even shorter) Emphasis on High-Quality CPR No Look, Listen, and Feel ‘The 2010 AHA Guidelines for CPR and ECC once again emphasize the need for high- Quality CPR, inctuding * A Compression rate of atleast 100/min (this is a change from “approximately” *100/min). * A compression depth of atleast § cm (2 inches) in adults and a compression depth Of atleast one third ofthe anterior-posterior diameter of the chest in infants and children. Ths is approximately 4 cm (1¥ inches) in infants and 5 cm (2 inches) in Children. Note that the range of 4 to 5 om (1¥e to 2 inches) is no longer used for ‘dts, and the absolute depth specified for children and infants is deeper than in pre- vious versions of the AMA Guidelines for CPR and ECC. * Allowing complete chest recoil, minimizing interuptions in compressions, and avold- ing excessive ventlation continue to be important components of high-qualty CPR, To further strengthen the focus on high-quality CPR, the 2010 AHA Guidelines for CPA and ECO stress the importance of taining using a team approach to CPR. The steps in the BLS Algorithm have traditionally been presented as a sequence to help a single rescuer prioritize actions, ‘There is increased focus on providing CPR as a team because resusctations in most EMS and healthcare systems involve teams of rescuers, with rescuers performing several actions simultaneously. For example, one rescuer activates the emergency response system while a second begins chest compressions, a third is ether providing ventilation OF retrieving the bag-mask for rescue breathing, and a fourth is retrieving a defibrillator ‘and preparing to use it. ‘Another key change isthe removal of “ook, listen, and feel for breathing’ from the assessment step. This step was removed because bystanders often failed to start CPR inhen they observed agonal gasping. The healthcare provider should not delay activating {he emergency response system but should check the victim for 2 things simultaneously. response and breathing. With the new chest compression-first sequene, the rescuer ‘should activate the emergency response system and begin CPR if the adult victim is unre- Sponsive and not breathing or not breathing normally (only gasping) and has no pulse. For {he child or infant victim, CPR is performed ifthe victim is unresponsive and not breathing ‘r only gasping and has no pulse. For victims ofall ages (except newborns), begin CPR with compressions (C-A-B Sequence). After each set of chest compressions, open the airway and give 2 breaths, “There are several additional changes in the 2010 AHA Guidelines for CPR and ECC: Ce The routine use of cricoid pressure in cardiac arrest is not recommended ce ‘Athough cricoid pressure can prevent gastric ina tion and reduce the risk of regurgitation and aspira- tion during bag-mask ventilation, it may also block ventilation. ‘Several randomized studies have shown that cricoid pressure can delay or prevent the placement of ‘an advanced airway and that some aspiration can still occur despite the use of cricoid pressure. In ‘addition, itis dificult to appropriately train rescuers how to do this. ‘Therefore, the routine use of cticoid pressure in cardiac arrest is not recommended. Continued de-emphasis of the pulse check It can be diffeut to determine the presence or ‘absence of a pulse within 10 seconds, especially in ‘an emergency, and studies show that both health- ‘care providers and lay rescuers are unable to reliably detect a pulse. If the vietim is unresponsive and not breathing oF ‘only gasping, healthcare providers may take up to 10 seconds to attempt to feel for a pulse (brachial in ‘an infant and carotid or femoral in a child). within 10 seconds you don't feel a puise or are not ‘sure if you feel a puise, begin chest compressions. Use of an AED for infants For infants, a manual defibrilator is preferred to an [AED for defibrilation. Ia manual defibrilator is not available, an AED ‘equipped with a pediatric dose attenuator is preferred. {neither is available, you may use an AED without a pediatric dose attenuator. For more detailed information and references, read the 2010 AHA Guidelines for CPR ‘and ECC, including the Executive Summary, published online in Circulation in October ‘2010, or the Highlights of the 2010 AHA Guidelines for CPR and ECC, avaiable at ‘www.heart.org/eceguidelines, You can also review the detailed summary of resuscita- tion science in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, published simuttaneousty in Circulation and Resuscitation. BLS/CPR for Adults BLS/CPR Basics for Adults lew This section describes the basic steps of CPR for adults, Adults include adolescents (, after the onset of puberty) Signs of puberty include chest or underarm hair in males and any breast development in females. ‘At the end of this section you will be able to * Tell the basic steps of CPR for adults + Show the basic steps of CPR for adults BLS consists of these main parts (Figure 3): + Chest compressions © Airway + Breathing * Defibrillation You will learn about each of these throughout this course. Distinct from the lone responder ‘approach, many workplaces and most EMS and in-hospital resusci- tations involve teams of providers, ‘who should perform several actions ‘simultaneously (eg, one rescuer activates the emergency response system while @ second rescuer begins chest compressions, a third 's elther providing ventiations or retrieving the bag-mask for rescue breathing, and a fourth is retrieving a defibritator and prepar- ing to use it). This course focuses on team-based CPR, Figure 3. The Simplied Adult BLS Algorithm for Healthcare Providers Overview of Initial Follow these intial BLS stops for adults: BLS Steps Step en 11 | Assess the victim for a response and look for normal or abnormal breath- ing. If there is no response and no breathing or no normal breathing (le, only gasping), shout for help. 2 | It you are alone, activate the emergency response system and get an AED (0¥ defibrilator it available and return to the vitim. 3 _| Check the victin’s pulse (take at least 6 but no more than 10 seconds). 4 | It you do not definitely feo! a pulse within 10 seconds, perform § cycles of compressions and breaths (30:2 ratio), starting with compressions (C-A-B sequence). Step 1: Assessment The fist rescuer who arrives atthe side ofthe victim must quickly be sur thatthe scene and Scene Safety is safe. The rescuer should then check the victim for a response: 11 | Make sure the scene is safe for you and the victim, You do not want to become a victim yourself, 2 | Tap the victim's shoulder and shout, “Are you all ight?" (Figure 4). '3_| Check to see ifthe victim is breathing. Ifa victim is not breathing or not breathing normaly e, only gasping), you must activate the emergency response system. ‘Agonal gasps are not normal breathing. Agonal gasps may be present in the fist min- tutes after sudden cardiac arrest. ‘A person who gasps usually looks lke he is drawing air in very quickly. The mouth may ‘be open and the jaw, head, or neck may move with gasps. Gasps may appear force- ful or weak, and some time may pass between gasps because they usually happen at a slow rate. The gasp may sound like a snort, snore, or groan. Gasping is not normal breathing. Iti @ sign of cardiac arrest in someone who doesn't respond, {fa victim is not breathing or there is no normal breathing ie, only agonal gasps), you ‘must activate the emergency response system, check the pulse, and start CPR. p 2: Activate Emergency nse System Get an AED lf you are alone and find an unresponsive vietim not breathing, shout for help. Ino one responds, activate the emergency response system, get an AED (or defibrilato) if avali- able, and then return to the victim to check a pulse and begin CPR (C-A-B sequence) Figure 4. Check fr response and breathing and activate the emergency response system (assess and ‘activate. A, Tap the vein’ shoulder and shout, "Ave you allright? At the same te, look for brsthing, B, I the acu victim does not respond and has no breathing or no normal breathing (eis only gasping), ‘shout or hep. another escver responds, send him or her to activate the emergency response systom ‘nl gt the AED (or defibilatoy It availaba. noone responds, actuate the emergency response system, {get the AED (or dafiilaton, and return to the victim to check a pulse and bagin CPR (C-A-B sequence) Healthcare providers should take no more than 10 seconds to check for a pulse. ‘To perform a pulse check in the adult, palpate a carotid pulse (Figure 8). f you do not definitely feel a pulse within 10 seconds, start chest compressions, Follow these steps to locate the carotid artery pulse: 1 _| Locate the trachea, using 2 or 3 fingers (Figure 5A). 2 _| Slide these 2 or 3 fingers into the groove between the trachea and the mus- les at the side of the neck, where you can feel the carotid pulse (Figure 5B) 3 | Fee! fora pulse for at least 5 but no more than 10 seconds. If you do not

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