Recommendations to Basic Life Support

7/31/2019 Recommendations to Basic Life Support

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Recommendation for Basic Life Support

NRC Guideline Conference 2011

Lim Swee HanMBBS (NUS), FRCS Ed (A&E), FAMS

Senior Consultant, Department of Emergency Medicine, Singapore General Hospital

Clinical Associate Professor, Yong Loo Lin School of Medicine, National University of Singapore

Co Chair Airway and CPR Adjunct, Member ALS Taskforce, ILCOR

Honorary Secretary, Resusciation Council of AsiaChairman, BCLS Subcommittee, National Resuscitation Council, Singapore


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BCLS Guidelines 2011

by NRC BCLS Subcommittee

Ng Ah Chee, AMK-THKH

Goh Teck Koon, CGH

Asmah Md Noor, NYP

Chew Jenny, NYP

Ho Soo Kim, IMH

Ler Ai Choo, ITE

Koh Gek Chee, KKWCH

Tan Siew King, KTPH

Shree Devi Gopal, NAP

Ismail Sheriff, NHC

Suresh Pillai, NUH

Lew Michelle, RCHMC

Kamsani, SCDF

Lim Swee Han, SGH (Chair)

Tan Boon Seng, SGH/Parkway College

Fong Celestine, SMA

Osman, SMM

Chee Tek Siong, St Johns Ambulance Association

Wee Fong Chi, TTSH


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BCLS

Recognition of Sudden Cardiac Arrest Call for help, activation of emergency

response system

Maintaining airway patency, supportingbreathing and the circulation without the

use of equipment other than personal

protective devices


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Goals of CPR Training:

Participants can do and will do CPR

Evidence based Resuscitation Guideline

Simplification


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Highlights of changes in BCLS guidelines

since 2005

Recognition of cardiac arrest Sequence of CPR Technique of chest compression

Landmark for chest compression Rate and depth of chest compression


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SENSIVITIY, SPECIFICITY, AND RELIABILITY OF PULSE CHECK:

PERFORMANCE OF PULSE CHECK AS A DIAGNOSTIC TEST

Pulse is Present Pulse is Absent Totals

Rescuer thinks pulse ispresent

81

(Sensitivity: correct positive

result of pulse check alltimes a pulse was actually

present)

a

6

b

87

(No. of times rescuer

thought pulse present=a +b)

Rescuer thinks pulse isabsent

66

c

53

(Specificity: correct

negative result of pulsecheck all times thereactually was no pulse)

d

119

(No. of times rescuer thought

pulse absent= c +d)

Totals 147

(Total number of studyopportunities where a pulsewas actually present= a +

c)

59

(Total number of studyopportunities where a pulsewas actually absent= b + d)

206

(total study opportunities= a+ b + c +d)


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Pulse check trained ( using appropriate mannikin) healthcare provider


8/31

An analysis of 1218 EMS-attended, witnessed, OHCA

Presence

of

gasping

(%)

(EMS arrival time)

39/119

(33%)

50/360

(14%)

73/363

(20%)

25/338

(7%)

Bobrow, JAMA, 2008

Phoenix Fire Department

Presumed cardiac origin


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Survival to Hospital Discharge

Gasped No Gasp Adjusted OR, 95%

CI54/191

(28%)

80/1027

(8%)

3.4, 95% CI, 2.2 to

5.2

Thosereceived

bystander

CPR

30/77

(39%)

38/404

(9%)

5.1, 95% CI, 2.7 to

9.4

Bobrow, JAMA, 2008

Recognition of Gaspining is NOT normal breathing


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42% 58%

16 secs


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bsCPR36%

bsCPR22%

Hpfl M, Lancet 2010


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NEJM

NEJM

NEJM

Hpfl M, Lancet 2010


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Percentage of 5170 Patients Aged 1 to 17

Surviving Neurologically Intact for 1 month

Postarrest

Origin No CPR

(n=2719

Bystander

CPR

(n=2439)

CPR vs

no CPR,

odds

ratio

(95% CI)

Compression-

only CPR

(n=888)

Conventional

CPR(n=1551)

Conventional

CPR vs

compression-

only, odds

ratio (95% CI)

Noncardiac

(n=3675)

1.5 5.1 4.17

(2.37-7.

32)

1.6 7.2 5.54

(2.52-16.99)

Cardiac

(n=1495)

4.1 9.5 2.21

(1.08-4.54

8.9 9.9 1.2

(0.55-2.66)

Kitamura, Lancet 2010


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Victim

Adult VF Arrest / Cardiac cause Respond time < 5 min

Victim

Adult Asphyxia (non cardiac cause)drowning, trauma, intoxication Cardiac arrest 15 min

ChildrenRescuer Untrained Unable (or unwilling) to

perform mouth to moutheffectively, without long

interruption of chest

compression

Chest-compression only CPR

RescuerAble and willing to perform

mouth to mouth (effective)

Chest compression and mouth

to mouth ventilation


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Quality of CPR During In-

Hospital Cardiac Arrest Case series n=67 (Chicago) Outcome measure = G2000 standards Chest compressions were too slow 38% of the compressions were too shallow Ventilation rates were too high


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6 sec

1 sec

400 600 m/s

18 sec

ONE-MAN CPR STRIP INTERPRETATION

(at least 100 min)

5cm


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Kouwenhoven et al. JAMA 1960

>100

>5

mouth


19/31

Locate landmark for

chest compression

Hand Position for

Chest

Compression


20/31

S Kusunoki et al Resuscitation 80(2009)


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One hundred Japanese patients 12 male and 6 female anaesthsiologists D value was positive in 51 patients, no

significant diff between the genders

For 5 (10%) of the female patients, the heel ofthe rescuer extended beyond the xiphoidprocess to the epigastric region. This only

happened to the females

No significant correlation between D vale andpatient age, height, weight and BMI

S Kusunoki et al Resuscitation 80(2009)


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J Shin et al Resuscitation 75 (2007)

Intrathoraic structurebeneath the inter-nipple line

80% was a structure justcephalad to theLV ieascending aorta, root of the

aorta, or the left ventricularoutflow tract


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Adult Basic Life Support

CHECK DANGER

UNRESPONSIVE?

TAP SHOULDER FIRMLYASK LOUDLY

ACTIVATE EMERGENCY

RESPONSE SYSTEMGET AED

OPEN AIRWAY

HEAD TILT, CHIN LIFT

NOT BREATHING NORMALLY?

LOOK, LISTEN, FEEL 10 SEC

30 CHEST COMPRESSIONS

CENTRE OF CHEST / LOWER HALF OF STERNUMDEPTHAT LEAST 5 CM

RATEAT LEAST 100 PER MINALLOW COMPLETE CHEST RECOIL

CHECK PULSES

FOR HEALTHCARE PROVIDER ONLYDEFINE PULSE AND NORMAL BREATHING

WITHIN 10 SEC

DO A GREAT QUALITY CHEST COMPRESSIONS AT 100 / MINUTE,IF UNABLE / UNWILLING TO VENTILATE FOR ANY REASON

2 BREATHS 1 SEC PER BREATH

TIDAL VOLUME 500-600 CHEST RISE

OPEN AIRWAY

HEAD TILT, CHIN LIFT

RECHECK VICTIM ONLY

( IF HE STARTS TO WAKE UP/ MOVE / OPENEYES / BREATH NORMALLY OR EXPERT HELP /

DEFIBRILLATOR ARRIVES)


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CPR SequenceAdult and Older

Child

Child

(1-8 Years

of Age)

Infant

(Less than 1 Year of

Age)

Establish Unresponsiveness

Call 995, get AEDImmediately After 2 minutes CPR

Open Airway Head Tilt Chin Lift

Recognition of Cardiac

Arrest

Check for normal breathing (gasping is not normal

breathing)

Pulse Check

(for Trained Healthcare

Providers Only)

Carotid Brachial

Start Chest CompressionsIf no normal breathing or pulse check (by trained

healthcare providers only) within 10 seconds

Compression Landmarks Lower half of sternum

Lower half of sternum

(Just below

intermammary line)

Compression Method Heel of 1 hand, other on top 2 Fingers

Compression Depth At least 5 cm 5 cm 4 cm

Compression Rate At least 100 / minutes

Compression : Ventilation

Ratio30:2 (1 or 2 rescuers)

Breathing2 breaths at 1 second per breath. The two breaths should

not take more than 6 seconds.


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6 sec

1 sec400 600 m/s

18 sec

< 130 sec

ONE-MAN CPR STRIP INTERPRETATION

Passing Criteria: 1) NOT MORE THAN 30 Compressions & 5 Ventilations mistakes are allowed

2) IMMEDIATE FAILURE for wrong landmark location for chest compressions

i.e. outside the sternum (Exclamation mark appearing but correct hand position -> ignore


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Chest compression only CPR

Compression only CPR is instructedduring dispatcher CPR

Rescuers are unable or unwilling toprovide mouth to mouth ventilationsshould be encouraged to perform good

chest compressions


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2-men CPR

One of the rescuers to call 995 for activation ofemergency response system and get AED once

the victim is found to be unresponsive. The other

is to continue to check for breathing (and pulse

for trained healthcare providers only) and to starton chest compressions when needed.

Rescuers should take turns to perform CPRevery 2 min (5 cycles, 30 chest compressions : 2

ventilations) *

* Minimal interruption for chest compressions


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FBAO


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Abdominal Thrust /

Heimlich Manoeuvre Chest Thrusts


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Optional module for NRC BCLS course

Documents

Recommendations to Basic Life Support