BASIC LIFE SUPPORT
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Immediately after initial basic CPR training and for up to 2 years after, a rescuer should be able to:
1. Reduce the risk of the most common causes of injury and death.
2. Recognize unresponsiveness (or other emergency situations where resuscitation is appropriate).
3. Phone 911 in a timely fashion (or other emergency phone number, eg, in-hospital).
4. Provide an open airway (using head tilt-chin lift or jaw thrust techniques), including relieving foreign body airway obstruction.
5. Provide ventilations (breathing) that make the chest rise, using mouth-to-mouth or mouth-to-barrier device ventilations.
6. Provide chest compressions (using compression force that moves sternum down the appropriate depth for victim's age (lay rescuer) or that generates a palpable pulse (healthcare provider).
7. Perform all these skills in a manner that is safe for the rescuer, the patient and bystanders.
8. Show proficiency in bag-mask ventilation for victims of all ages and use of AEDs for victims 8 years of age or older (healthcare providers only).
WARNING SIGNS OF A HEART ATTACK:
People experiencing the early signs and symptoms of a heart attack often deny that they are having a heart attack. Delaying treatment continues to be a problem.
Signs and symptoms may include:
||In the chest, epigastric area, arms, neck or back. Sometimes described as pressure, tightness, indigestion, heaviness, crushing pain, etc. May move from original site to arms, shoulders, jaw, neck or back
||May become difficult
||May be pale, cool, clammy - patient may sweat excessively
||May be present - sometimes with vomiting
||May occur in some patients
If these symptoms occur and persist for 2 minutes - GET MEDICAL HELP by calling Emergency Medical Services (EMS).
- Call 911.
- Stay with the victim.
- Help the victim get comfortable. Be sure the victim is resting. Help the victim to a position that allows greatest ease of breathing.
- Be prepared to act promptly if the heart stops. KNOW CPR!
Angina is pain from myocardial ischemia (decreased blood flow and oxygen to the heart) that usually lasts less than 15-30 minutes and occurs with exertion or stress. If the pattern of angina changes or the pain lasts longer than usual or is not relieved by usual methods, call for help.
WARNING SIGNS OF A STROKE:
May include any/combination of the following:
- Unilateral paralysis - weakness, clumsiness or heaviness, usually involving one side of the body
- Unilateral numbness - sensory loss, tingling or abnormal sensation, usually involving one side of the body
- Language disturbance - trouble understanding or speaking (aphasia) or slurred speech (dysarthria)
- Monocular blindness - painless visual loss in one eye, often described as a curtain dropping
- Vertigo - sense of spinning or whirling that persists at rest. Isolated vertigo is also a common symptom of many nonvascular diseases; therefore, at least one other symptom of TIA or stroke should also be present.
- Ataxia - poor balance, stumbling gait, staggering, incoordination of one side of the body
- Headache - possibly severe
- Alterations in level of consciousness/mental status changes
The most important modifiable risk factor for stroke is hypertension (high blood pressure). Untreated or uncontrolled hypertension puts the patient at great risk for stroke.
CHAIN OF SURVIVAL
- Adult: early access to EMS, early CPR, early defibrillation, early advanced cardiovascular care
- Child: prevention cardiopulmonary arrest, early BLS, early access EMS, early pediatric advanced life support
CPR NEEDS TO BE STARTED IMMEDIATELY IF IT IS TO BE EFFECTIVE:
When the heart and lungs stop functioning, blood flow to the vital organs (most importantly the brain) stops. The brain generally cannot survive more than a few minutes without oxygen. If CPR is not started immediately the chance for recovery is greatly reduced. The risk of permanent, severe brain damage is greatly increased.
The most frequent initial heart rhythm in sudden cardiac arrest in the adult is ventricular fibrillation (VF). The only effective treatment for ventricular fibrillation is electrical defibrillation. The probability of successful defibrillation decreases rapidly over time. For most victims of cardiac arrest to be successfully resuscitated they require early defibrillation in addition to immediate CPR. By initiating CPR until a defibrillator is available vital organs can be provided with needed blood flow and oxygen. CPR can "buy time" until a defibrillator is available. Defibrillation must occur early if the patient is to survive VF.
As stated, early defibrillation saves lives. In order to facilitate early defibrillation, AEDs were developed. AED stands for Automated External Defibrillator. This equipment allows properly trained and authorized basic life support personnel to defibrillate.
AEDs incorporate a rhythm analysis system into the unit and thus are able to interpret a rhythm as well as deliver shocks. AEDs connect to the patient via two adhesive pads and a connecting cable. There are many different models available and the individual manufacturer's recommendations must be used. The following are general procedural steps:
||Check the patient for unresponsiveness and call 911.
||Open the airway and assess for absence of breathing. If patient is not breathing, give two rescue breaths.
||Assess for absence of pulse. If no pulse perform CPR until AED is available. As soon as AED is available, turn power on and attach cable and pads to patient. DO NOT CONNECT AED TO PATIENT UNTIL AFTER YOU ESTABLISH PATIENT IS PULSELESS.
||Cease all patient movement, including transport, whether in vehicle, on stretcher, whatever. Stop chest compressions. Patient must be STILL. There should be no radio transmissions in immediate vicinity of patient.
||Push "ANALYZE" button if required. (Some AEDs are programmed to immediately go into ANALYZE mode when POWER is turned on and you will not need to push the button.)
||Deliver "SHOCK" if recommended by unit. Be sure no one is touching patient or anything patient is touching prior to delivering shock. Be sure patient is on a dry surface. Do not touch any surfaces the patient may be lying on. Unit will advise up to three shocks if needed, which will take approximately 90 seconds. It is acceptable to interrupt CPR for up to 90 seconds in order for AED to deliver these three shocks if recommended by AED.
||After three shocks or anytime no shock is advised, check pulse and breathing. Do not turn AED power off. If no pulse, perform CPR for one minute and then repeat steps 4, 5& 6as indicated. The sequence is one minute of CPR, then up to 3 shocks if advised by AED. Continue to repeat this sequence as needed. If the patient is pulseless and no shocks are advised, perform CPR.
(If you would like more detailed information on AEDs, please see "Study Guides for Nursing" in the Meditech Library.)
WHEN TO DO CPR?
Victims of SUDDEN UNEXPECTED death are candidates for CPR. If you don't know what caused the heart to stop, give the victim the benefit of the doubt and start CPR.
If a second rescuer is available when a victim of cardiac or respiratory arrest of any age is discovered, the first rescuer should begin CPR while the second rescuer activates the EMS system and retrieves the AED if appropriate.
IF YOU ARE ALONE (THE ONLY RESCUER):
PHONE FIRST: Immediately after establishing unconsciousness, call 911.
PHONE FAST: Do one minute of CPR, then call 911.
In an adult, call for help (911) first (PHONE FIRST), then begin CPR. (See exceptions below.) This is because most adult victims of cardiac arrest need immediate defibrillation and calling for help immediately should decrease the amount of time until defibrillation occurs.
In an infant or child, begin CPR first - for one minute, then be sure help has been called or call yourself (PHONE FAST). (See exception below.) In children and infants the most common causes of cardiopulmonary arrest are related to airway and ventilation problems rather than sudden cardiac arrest due to rhythm disturbances. Therefore rescue support, especially rescue breathing, is essential and should be attempted first.
In adults, PHONE FAST (do one minute of CPR, then call 911) if victim of drowning, trauma or drug intoxication.
Submersion/near drowning - PHONE FAST - all ages
Arrest associated with trauma - PHONE FAST - all ages
Drug overdoses - PHONE FAST - all ages
For all other adult victims or if unknown cause, PHONE FIRST!
In children, the exception to PHONE FAST (after one minute of CPR) would be in child known to be at high risk for arrhythmias. In this situation PHONE FIRST for all ages, including children!
STEPS OF CPR FOR ALL AGES:
Infant: 0 - 1 year of age
Child: 1 - 8 years of age
Adult: over 8 years of age
- Establish unresponsiveness. Tap or gently shake the victim and shout, "Are you OK?"
- Activate EMS system or appropriate resuscitation team.
- If needed, position victim. Turn onto back, supporting head and neck. If the victim has sustained trauma, move only if absolutely necessary. Improper movement may cause paralysis if the person has injury to the spine.
(Head tilt-chin lift is preferred method to open airway unless trauma suspected. If trauma is suspected the jaw thrust with spinal immobilization should be used.)
Check for breathing
(Look, listen and feel for no more than 10 seconds. Look for the chest to rise and fall, listen for air moving from the nose or mouth and feel for air movement from the mouth or nose.)
If victim is breathing or resumes effective breathing, place in the recovery position.
If victim is not breathing or has minimal respirations, give 2 SLOW breaths (each breath over 2 seconds for adult and over 1 1/2-2 seconds for child or infant) using pocket mask or bag-mask. During ventilation attempts, use appropriately sized mask or bag-mask as soon as available. If not available pinch nostrils in adult and child and cover mouth with your mouth to ventilate. In infants cover mouth and nose with your mouth to ventilate.
Correct volume for rescue breaths is volume needed to expand chest adequately. Watch for gentle rise and fall of chest. Volume required for mouth to mouth and mouth to mask without supplemental oxygen is the same.
Supplemental oxygen delivery should be immediately available and provided in the health care setting.
Allow for exhalation between breaths.
Be sure to deliver rescue breaths slowly as described. Delivering rescue breaths too quickly or forcefully causes gastric distention.
Observe for chest rise and fall. If unable to ventilate, reposition airway and attempt to ventilate again. If still unable to ventilate, see obstructed airway management.
Check for signs of circulation
(Breathing, coughing, movement), including pulse for no more than 10 seconds. (Carotid pulse in child and adult; brachial or femoral pulse in infant.)
If signs of circulation/pulse present but breathing is absent, provide rescue breathing (1 breath every 4 to 5 seconds for adult or 10-12/minute, 1 breath every 3 seconds for infant or child or 20/minute).
If signs of circulation/pulse absent, begin chest compressions interposed with breaths.
If signs of circulation/pulse present but <60 bpm in infant or child with poor perfusion, begin chest compressions.
Verify landmark check before initial hand placement. On adults and children, location is lower half of sternum. On infants, location is one finger's width below the intermammary line (imaginary line between nipples). Maintain proper hand placement throughout.
In adults, use both hands; heel of one hand on chest with other hand positioned over lower hand. In children use heel of one hand. In infants use 2 or 3 fingers or both thumbs encircling chest.
- In adults: 1 1/2 - 2 inches
- In children: 1 - 1 1/2 inches or approximately one third to one half the depth of the chest
- In infants: 1/2 - 1 inch or approximately one third to one half the depth of the chest
Compression speed all ages: Approximately 100/minute; infants at least 100/minute and newborns 120/minute.
Compression/ventilation ratio - Adult one rescuer or two rescuer 15:2 (Exception - after patient intubated give 5 compressions to 1 ventilation.). Child and infant 5:1
Use equal compression to relaxation cycle.
* Reassess after one minute of CPR and every few minutes thereafter.
If needed, defibrillate as soon as able and possible.
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