Basic%20life%20support%20-%20adult Treatment

• If alone, get help or if available, send someone for help
• Continue to observe for breathing

If spinal injury is not suspected, turn victim to recovery position:

• Recovery position is for patients who have normal breathing & effective circulation
• Position should be stable, near a true lateral position, w/ the head dependent & w/o pressure on the chest that could impair breathing
  
  • Recovery position is designed to maintain a patent airway & prevent aspiration & airway obstruction

• Remove victim’s spectacles
• Kneel next to victim
• Make sure both legs of victim are straight
• Put victim’s arm nearest to you at right angles to his body & bend elbow w/ palm facing upwards
• Bring victim’s far arm across chest & place back of hand against his cheek closest to you
• Bend victim’s knee farthest from you while keeping his foot on floor
• Roll victim towards you
• Adjust victim’s upper leg so that hip & knee are both at right angles
• Tilt head back to keep airway open

Patients w/ suspected spine injury:

• Studies done among normal volunteers have demonstrated that recovery position for victims w/ known spinal injury can be done by extending the lower arm above the head & rolling the head onto the arm while bending both legs

If recovery position has to be maintained for >30 min, turn the victim to opposite side to relieve pressure on the lower arm

• Turn victim on to his back if not yet in this position

Start Compressions

• Place heel of one hand over center of victim’s chest, then place heel of other hand on top of first hand so that the hands are overlapping & parallel
• Rate should be at between 100-120/min w/ a depth of at least 2 in (5 cm)
  • Chest compression rate refers to the speed of compressions (not the actual number of compressions delivered per minute)
  • Chest compression depth should not exceed 2.4 in (6 cm)
  • Chest compression & chest recoil/relaxation times should approximately be equal

• Allow complete chest recoil after each compression, minimizing duration & frequency of interruptions in compressions
  • Leaning on the chest wall between compressions should be avoided to allow complete chest wall recoil

Administer Ventilation

Give 2 slow, effective breaths

• Perform head tilt & chin lift maneuver to open the airway
  • In cases of suspected cervical spine injury, open the airway using jaw thrust w/o head extension
  • When jaw thrust does not allow adequate opening of airway, use head tilt-chin lift maneuver

• Using your thumb & index finger of hand placed on forehead, pinch close the soft part of nose
• Open victim’s mouth slightly while maintaining chin lift
• Take a regular breath & place lips around victim’s mouth ensuring an airtight seal
• Rescue breaths through the nose is recommended if ventilation cannot be given through the mouth
• Blow steadily into victim’s mouth for about 1 sec
  • Chest should rise w/ each administered breath

• Keeping head tilt & chin lift, move your mouth away from the victim’s
  • Watch the chest fall as air passes out

• Risk of disease transmission through mouth to mouth ventilation is reportedly very low & it is thus reasonable to initiate rescue breathing w/ or w/o a barrier device

Chest Compression Fraction

• Refers to the measurement of the proportion of time that chest compressions were successful during a cardiac event
• Chest compression fraction of at least 60% is recommended in patients w/ an unprotected airway
• Should be maximized by avoiding interruptions during chest compressions
• A pause of <10 sec to administer rescue breaths is recommended

Compression-Ventilation Ratio

• A compression-ventilation ratio of 30:2 is recommended until an advanced airway is present
• After placing an advanced airway (eg endotracheal tube, Combitube or laryngeal mask airway), multiple rescuers can provide continuous, uninterrupted chest compressions at a rate of at least 100/min while giving ventilations (at a rate of 1 breath every 6 sec or 10 breaths/min)
  • Avoid excessive ventilation & minimize interruptions in chest compressions

• When multiple rescuers are available, it is reasonable to switch chest compressors every 2 min (or approx 5 cycles) of compressions & ventilations to avoid compromising quality of compressions
  • Fatigue among rescuers may occur after 1 minute of CPR, leading to shallow compressions
  • Switching between rescuers should be done in <5 sec

• When checking for return of spontaneous circulation (ROSC), interruptions in chest compressions for a pulse check should still be minimized

Special Circumstances

• Consider administration of Naloxone to patients w/ known or suspected of opioid overdose

• For witnessed sudden collapse wherein ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) is considered (also called “shockable rhythms”)
• Rapid defibrillation is the treatment of choice for VF of short duration (eg hospitalized patients whose heart rhythm is monitored, witnessed out-of-hospital cardiac arrests)
• For lone rescuers, AED is retrieved if available nearby after which CPR should be immediately performed
  • Resume chest compressions as soon as the shock is delivered

• For multiple rescuers, one should initiate chest compressions while the other acquires or sets up AED
  • CPR is started while checking the rhythm w/ an AED or an ECG & preparing for defibrillation
  • Defibrillation should be done as soon as an AED is obtained, except in monitored patients where shock delivery should be done in <3 min

• Single shocks followed immediately by CPR is recommended
  • Studies suggest that 1-shock protocol on VF cardiac arrest provides greater survival benefit compared w/ a 3-shock protocol
  • Incremental benefit from another shock is low, & resumption of CPR after initial shock is likely to confer a greater value than another immediate shock

• Defibrillation administered w/in 3-5 min of collapse & w/ ongoing CPR produces better survival outcome in patients w/ VF or pVT

• Every few minutes take <10 sec to confirm circulation
• If victim starts to breathe, but remains unconscious, place in recovery position & continue to monitor

Continue resuscitation until:

• Qualified help arrives & takes over
• Victim shows signs of recovery
• Rescuer fatigues

If unable to give effective breaths:

• If healthcare worker is still unsuccessful, he should attempt FBAO sequence
  • Aggressive treatment in FBAO sequence, including back blows, abdominal thrusts & chest compressions should be reserved for victims w/ severe airway obstruction as these measures may worsen the obstruction

Complete Airway Obstruction: Victim stops breathing or coughing

For complete airway obstruction, several techniques are used, check w/ local protocol:

• Abdominal thrusts used alone
• 5 back blows followed by 5 abdominal thrusts
• 5 back blows followed by 5 chest thrusts

Recommended Steps

• Administer 5 slaps midback between the shoulder blades
• If 5 back blows fail to remove foreign object, try 5 abdominal thrusts or 5 chest thrusts depending on local protocol

Abdominal thrusts

• Conscious victim
  • Stand behind victim w/ right leg positioned between victim’s legs
  • Make fist w/ one hand & place thumb side against the victim’s midline abdomen slightly above the navel, making sure to be well below the bottom tip of the sternum
  • Place other hand over fist & press into the abdomen w/ a quick inward & upward thrust
  • Continue until foreign object is removed or victim loses consciousness
  • Victim should seek medical attention after abdominal thrusts are performed to rule out any internal injury

Chest thrusts

• Conscious victim
  • May be used when abdominal thrusts are difficult to administer (eg in late stages of pregnancy or for an extremely obese victim)
  • Stand behind victim w/ right leg positioned between victim’s legs
  • Encircle victim w/ your arms directly under his armpits
  • Make a fist w/ one hand & place thumb side against the middle of the victim’s sternum
  • Grab fist w/ 2nd hand & perform backward thrusts using care not to put pressure on the ribs or the xiphoid process
  • Continue until foreign object is removed or victim loses consciousness

Chest compressions

• Unconscious victim
  • Follow steps for basic life support
  • Check mouth for foreign object before attempting each cycle of rescue breaths