Basic Life Support ( BLS ) Automated External Defibrillation (AED )

1. Basic Life Support ( BLS ) Automated External Defibrillation (AED ) Reza Azizkhani Emergency Medicine Department Isfahan University Of Medical Sciences r_azizkhani@med.mui.ac.ir

3. OBJECTIVES • At the end of this course participants should be able to demonstrate: • How to assess the collapsed victim. • How to perform chest compression and rescue breathing. • How to place an unconscious breathing victim in the recovery position.

4. BACKGROUND • 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(46% in Iran). • Cardiac arrest occurs both in and out of the hospital. • approximately 350 000 people/year (approximately half of them in-hospital) suffer a cardiac arrest and receive attempted resuscitation.

5. Survival to hospital discharge presently approximately 5-10% • Early resuscitation & prompt defibrillation (within 1-2 minutes) can result in >60% survival

6. CHAIN OF SURVIVAL

9. ارزیابی سطح هوشیاری ارزیابی وضعیت تنفس BLS 2005

10. ارزیابی سطح هوشیاری ارزیابی وضعیت تنفس BLS 2005

11. LOOK , LISTEN ,FEEL

12. ارزیابی همزمان سطح هوشیاری و تنفس BLS 2010

13. BLS 2010

14. Start CPR When …… :

15. ABC ???

16. A B C SINCE 1960 C A B GIUDELINE 2010

17. Arterial Blood O2 Content(ABC) O2 Content Arrest Resuscitation Chest Compression Rescue Breathes Time

18. Arterial Blood O2 Content(CAB) O2 Content Arrest Resuscitation Chest Compression Time

19. CAB vs ABC O2 Content CAB ABC Time

21. Basic life support • * Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

22. APPROACH SAFELY! Scene Rescuer Victim Bystanders • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

23. CHECK RESPONSE - CHECK BREATHING • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

24. CHECK RESPONSE • Shake shoulders gently • Ask “Are you all right?” • If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly.

25. AGONAL BREATHING & GASPING • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing • Recognise as a sign of cardiac arrest

26. SHOUT FOR HELP • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

27. Call 115 • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

28. Check pulse Only for healthcare provider Feel within 1.definite pulse give 1 breath / q 5-6 s 2. recheck pulse q 2 min. 3.no pulse  next step 10 sec

29. Number of Compressions Delivered Affected by Compression Rate and by Interruptions. • The total number of compressions delivered during resuscitation is an important determinant of survival from cardiac arrest. The number of compressions delivered is affected by the compression rate and by the compression fraction. (the portion of total CPR time during which compressions are performed).

30. Chest compressions are the foundation of CPR • All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims.

31. Minimal Interruptions During Chest Compression Cardiac Output Time 2 min

32. Minimal Interruptions During Chest Compression Cardiac Output Time 2 min

33. Cardiac Output Without Interruptions With Interruptions Time 2 min

34. CHEST COMPRESSIONS • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

35. CHEST COMPRESSIONS • supine victim on a hard surface • Place the heel of one hand in the centre of the chest ( lower half ) • Place other hand on top • Interlock fingers

36. CONTINUE CPR 30 2

37. CHEST COMPRESSIONS • Push hard and fast the chest: • Rate at least 100 /min • Depth 5 cm • Equal compression / relaxation • Minimize interruptions in chest compressions. • When possible change CPR operator every 2 min

38. RESCUE BREATHS • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

39. OPEN AIRWAY (head tilt , chin lift -- jaw thrust ) • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

40. Give 2 BREATH ●Deliver each breath over 1 second • Give a sufficient tidal volume produce visible chest rise . ●Avoidrapid or forceful breaths.

41. Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat 2 RESCUE BREATHS

43. Basic life support • Approach safely • Check response • Check breathing • Shout for help & Call 115 • 30 chest compressions • 2 rescue breaths

45. Nature

47. Automated external defibrillator

48. In settings with 1-lay rescuer AED programs (AED on-site and available) 2-in-hospital environments 3-EMS rescuer witnesses the collapse, The rescuer should use the defibrillator as soon as ( within first 3-5 min) it is available for children and adults.

49. Out-of-hospital cardiac arrest not witnessed by EMS personnel EMS may initiate CPR while checking the rhythm with the AED or on the electrocardiogram (ECG) and preparing for defibrillation. In such instances, 1½ to 3 minutes of CPR may be considered before attempted defibrillation.

50. AED Use in Children Now Includes Infants 2010 (New) For infants (<1 year of age), defibrillator is preferred. If a manual defibrillator is not available, an AED with pediatric dose attenuation is desirable. If neither is available, an AED without a dose attenuator may be used.