Medical Training

B.L.S. Training Package

Dr. Cristian Remus Harsan Emergency Physician UK - GMC Registration Number: 7097484

Introduction
Basic Life Support comprises the elements:
Initial

assessment Airway maintenance Chest compressions When all are combined the term Cardio Pulmonary Resuscitation is used (C.P.R.)

Introduction
The

purpose of BLS is to maintain adequate ventilation and circulation until the underlying cause can be reversed. Do not start CPR to a patient who doesnt need it. How you decide if the patient need CPR or not?

Introduction
First rule of medicine: Do not harm. Failure of the circulation for longer than 4-6 minutes will lead to irreversible brain damage cerebral hypoxia to brain ischemia and necrosis (death tissue) and death (exitus). The neuron (brain cell) is dependent of oxygen and glucoses. They can not regenerate after death.

EXTERNAL CARDIAC COMPRESSIONS

Push fast no less than 100 c/min. Push hard at least 4 cm. Permit to the chest to recoil. Do not stop CPR more than 10 seconds. Provide a high quality of CPR 30 chest compressions with 2 breaths on cycles of 2 minutes. Press on the right spot avoiding the ribs fractures. Switch the person who provide CPR avoiding extenuation. DISCUSSIONS

C.P.R.
CPR

is only a temporary measure until definitive treatment arrives. Patients in cardiac arrest require:

Defibrillation Advanced cardiac life support with drugs

CPR

cannot provide these but can make the difference for patient life.

The elements of basic life support. Remembered this :

Airway Breathing

Circulation
Disability

Assess the Patients Response

Place

one hand on the patients forehead Gently shake his shoulder Ask the patient a question (check for response):

Can you hear me? Can you tell me what happened?

If he does not respond;

Make

sure as is safe for you to help the casualty (electric, gas, oil, fire, etc). Turn off the gas, the electric power, etc. Get help and call emergency for help. Provide information about: when happened, how many victims are, location and type of injuries. Start BLS assessment. ABCD.

THE HEAD TILT CHIN LIFT

This method of opening the airway is used if there is no risk to the C spine.

JAW THRUST

The jaw thrust is used if there is a risk of C spine injury It is favoured by most medics as it allows you to open the airway whilst stabilising the C spine

LOOK - LISTEN - FEEL

LOOK - for the rise and fall of the chest LISTEN - for breath sounds at the patients nose and mouth FEEL - for air movement against your cheek. This procedure must take less than 10 seconds.

10

Seconds

If he is not breathing;
Obtain

help - return ASAP Reassess the airway Give 2 EFFECTIVE breaths over 2 seconds, observe if the chest rise and fall.
Oxygen is medicine Oxygen therapy Do not provide more or less than 4-6l/min if oxygen available on the mask. If Ruben balloon is used give 6-8 breaths/minute with gentile press of the balloon.

Assess the victim for signs of Circulation:

Look

for any movement, including swallowing or breathing Check for central pulse:

CAROTID and FEMURAL PULSE

for less than

10 seconds

If there are no signs of circulation and the patient is not responding START CHEST COMPRESSIONS.

the other hand on top of the first and interlock the fingers Lift the fingers off the chest wall

Place

yourself vertically above the victims chest and use your weight to compress. Keep your arms straight and provide a high quality of CPR.

Position

Press down on the sternum in medium 1/3 of the sternum bone. Depress the sternum between 4 - 5 cms Release the pressure and permit to the chest to recoil. Repeat at a ratio of at least100 times per minute.

 After

30 compressions reopen the airway and give 2 EFFECTIVE breaths

Repeat

Continue resuscitation until:

The

victim shows signs of life Medical aid arrives You become exhausted

FIELD NOTE

If you have continued CPR for longer than 30 minutes with no signs of recovery it is unlikely that the patient will survive unless he is hypothermic. You would be right to stop at this point. ITS YOUR CALL!!! If the patient is hypothermic continue

EMERGENCY DRUGS
Adrenaline (Epinephrine) Ampoules of 1ml. Short time effect no more than 3-4 minutes. Can be repeat every 3-5 minutes. Indications: Asystole (flat line on monitor), VF&VT, anaphylaxis, epiglottis severe edema, fallowing the ACLS protocols in conformity with AHA. Pharmacological effects: Central vasoconstrictor. Epinephrine is a human natural hormone secreted by suprarenal glands specially in stress conditions which make the body and brain to be alert, vigilant and increase the HR for short time.

Atropine alkaloid extracted by a plant named ,,Atropa belladona,, which in translation means ,,beautiful lady,, Indications: severe bradicardia, can be considerate in asystole; ophthalmoscopy examination (drops in the eye), gastric surgery for stopping the secretions and vagal nerve inhibition. Side effects: Midriazis (dilated pupils), increase the heart rate, dry mouth, lethargy, confusion, coma or cerebral death. Dosage: Ampoules of 1ml. Can be used 0,5 - 1ml IV and repeat every 3-5 minutes.

Antidote: in case of intoxication with atropine the antidote is Pilocarpine extracted by a plant named ,,Pilocarpus Jabolandi,,

 Amiodarone

(Cordarone) Ampoules of

150 mg. Indications: SVT (Supra Ventricular Tachycardia) - 300mg of amiodarone (2 ampoules) diluted in glucoses in a large syringe of 20ml. You must administrate it slowly (15-20 minutes) under cardiac monitor and oxygen. Chemical cardioversion can be fallowed by electrical cardioversion fallowing the ACLS protocols in conformity with AHA algorithms.

Morphine derivate name from the ,,God of dreams,, from Greeks named ,,Morpheus,,. Morphine is a synthetic drug extracted from Opium which is natural (alkaloid) extracted from a plant named ,,Pappaverum Album Somniferum,, the scientific name for poppy seals. Indications: Pain killer in severe pain like ACS, cancer pain, severe traumas, fractures, surgical interventions, etc. Contraindications: Do not use in HYPOTENSION (low blood pressure); dont use in tachycardia, breathing problems (decreasing the respiration rate); liver and kidney failures. ATENTION: HIGHLY ADICTED DRUG.

Dopamine natural brain chemical mediator secreted by the ganglia in the human brain. A low quantity of dopamine in the human brain will lead to ,,Parkinsons disease,,. Indication: in severe hypotension (collapse) associated with other drugs fallowing the ACLS protocols in conformity with AHA. Magnesium chloride sulfate the election drug for ,,Torsade de points,, administrated in emergency under ACLS protocols in conformity with AHA.

Mannitol solution indicated in cerebral edema and hypertensive encephalopathy associated with antihypertensive drugs.

Defibrillation and drug administration

Must be provided by a qualified doctor, medic, paramedic or nurse who can recognize the cardiac rhythms and knows the ACLS protocols and has completed the ACLS course in conformity with AHA. Indication of shock 200 J only in VF&VT as a first intention. Do not give shock in PEA, asystole, SVT or other cardiac rhythms.