Dr. Cristian BLS - Medical Training. First Aid

7/27/2019 Dr. Cristian BLS - Medical Training. First Aid

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Medical TrainingB.L.S. Training Package

Dr. Cristian Remus Harsan

Emergency Physician

UK - GMC Registration Number: 7097484



Introduction

Basic Life Support comprises theelements:

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 maintainadequate ventilation and circulationuntil the underlying cause can bereversed.

Do not start CPR to a patient whodoesn’t need it.

How you decide if the patient needCPR 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 andnecrosis (death tissue) and death (exitus).

The neuron (brain cell) is dependent of

oxygen and glucoses. They can notregenerate 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 chestcompressions with 2 breaths on cycles of 2minutes. Press on the right spot avoiding theribs fractures.

Switch the person who provide CPR avoidingextenuation.

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 canmake the difference for patient life.



The elements of basic life support.

Remembered this :

Airway

BreathingCirculation

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 airwayis 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 mostmedics 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 patientsnose 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 2seconds, 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 PULSEfor less than

10 seconds



If there are no signs of circulation and the

patient is not respondingSTART CHEST

COMPRESSIONS.



Place the other hand on top of the

first and interlock

the fingers

Lift the fingers off

the chest wall



Position yourself vertically above the

victim’s chest and use

your weight tocompress.

Keep your arms straightand provide a high

quality of CPR.



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 30compressions

reopen the airway

and give 2 EFFECTIVE breaths

Repeat



Continue resuscitation until:

The victim shows signs

of lifeMedical aid arrives

You becomeexhausted



FIELD NOTE

If you have continued CPR for longer than 30minutes with no signs of recovery it is unlikelythat the patient will survive unless he ishypothermic. You would be right to stop at

this point.IT’S 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, fallowingthe ACLS protocols in conformity with AHA.

Pharmacological effects: Central vasoconstrictor.

Epinephrine is a human natural hormone

secreted by suprarenal glands specially in stressconditions which make the body and brain to be

alert, vigilant and increase the HR for short time.

At i lk l id t t d b l t d



Atropine – alkaloid extracted by a plant named,,Atropa belladona,, which in translation means -,,beautiful lady,,

Indications: severe bradicardia, can be consideratein asystole; ophthalmoscopy examination (dropsin the eye), gastric surgery for stopping thesecretions and vagal nerve inhibition.

Side effects: Midriazis (dilated pupils), increase the

heart rate, dry mouth, lethargy, confusion, comaor cerebral death.

Dosage: Ampoules of 1ml. Can be used 0,5 - 1mlIV and repeat every 3-5 minutes.

Antidote: in case of intoxication with atropine theantidote is Pilocarpine extracted by a plantnamed ,,Pilocarpus Jabolandi,,

A i d (C d ) A l f



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 cardiacmonitor and oxygen.

Chemical cardioversion can be fallowed by

electrical cardioversion fallowing the ACLSprotocols in conformity with AHA

algorithms.

M hi d i t f th G d f



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 plantnamed ,,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); don’t use in tachycardia,breathing problems (decreasing the respiration

rate); liver and kidney failures.

ATENTION: HIGHLY ADICTED DRUG.

D i t l b i h i l di t



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 ,,Parkinson’sdisease,,.

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.

M it l l ti i di t d i b l



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.

Documents

Dr. Cristian BLS - Medical Training. First Aid