bls ( bantuan hidup dasar )

BLS { Basic Life Support } Bantuan Hidup Dasar

Pak Broto

General Purpose * Identify signs and symtom, causes of

cardiopulmonary emergency cases * Know principles and how to prepare and perform

CPR, * Emergency team, as immediate response

cardiopulmonary emergency

Spesific purpose * Decrease morbidity and mortality of

cardiopulmonary emergency

Pathophysiologi

• Arrested blood circulation prevents deliveryof oxygen to the body.

• Lack of oxygen to the brain causes loss of consciousness result in abnormal or absent breathing

• Brain injury is likely to happen if cardiac arrest goes untreated for more than 5 minutes

* Correctly perform of Resucitation ( chest compression, open airway, breathing)

* No pulses, no breathing, no respon CPR started * Asking for help/ another rescuer * How to manage cardiac arrest? * Stage I, A,B,C ( Basic Life Support ) * Stage II, D,E,F ( Advanced Life Support ) * Stage III, G,H I ( Prolong Life Support )

Cardiac Arrest / Cardio pulmonary arrest

• Also known as cardiopulmonary arrest or circulatory arrest is the cessation of normal circulation of the blood due to failure of the heart to contract efectivelly

• Cardiac arrest is medical Emergency that in certain situations, is potentially reversible if treated EARLY

• Types:• Shockable and non shockable determined by the

ECG rhythm

Sign and symtom

• Due to inadequate cerebral perfusion patient will be:

• Unconscious and will stop breathing• No heartbeat or pulse can be felt• Some people may have a racing heartbeat• Feel dizzy or light headed just before they

faint• Chest pain, shorthness of breath, nausea

or vomiting

Inadequate cerebral perfusion factors : 1. Cerebral blood flow 2. Blood Oxygen concentration ( PaO2 )

lowCerebral injury factors 1. Decrease of cardiac output 2. PaO2 <50 mmHg , arytmia

Symptom and sign

a. Fainting b. ECG pattern VES 6 beat/

minute c. Lack/ abnormal Pupillary

light reflex a. Pulseless( main artery) b. Unconscious c. No breathing caused by

airway obstruction

Causes….

1. Cardiac• Decrease of cardiac output( bleeding,pulmo

embolus paru, valves tamponade,) • Coronary heart disease ( atherosclerotic<

coronary emboli, spasme koroner, vascular emboli )

• Decrease function of miocard ( Coronary acute syndrome, hipoksemia,asidotic, anesthesiology drugs,electrolyte imbalance, miocardytic )

• Anafilaktik, miokarditis, block, electrolyte imbalance, shock, hipercapneu, vagal refleks, hipotermia induce arytmia

2. Non Cardiac• Drugs 1. Anesthesia 2. Non anesthesia ( digitalis, kuinidin, proca- inamide, diagnostic contrast )

Vasovagal reflek

1. Vasovagal reflex : induced by stimulation of pharynx, glotic, bronchus, rectum/sfingter ani ,serviks , mesenterium, eyes

2. Electrolyte imbalance 3. Hypercapneu and hypoksemic 4. Air embolus 5. Bleeding more than > 30 % of blood volume 6. Hypotermia

Abnormal breathing factors:

1. AIRWAY( aspiration, tongue obstruction, fold ETT,glotis oedema, regurgitation, maksilofacial fractur)

2. Respiratory depression• Central : drugs intoxication, post cardiac arrest,

brain tumor, tenggelam )• Perifer : muscle relaxant drug, myastenic,

acethylcholine crisis, polyo mielitis

Sign of sudden cardiac arrest 1. Loss of consciousness( ussualy 15 second after heart

stop beating )

2. At the same time no heartbeat or pulse can be felt( carotis)

3. Sistolic blood pressure 50 mmHg ( NIBP ) 4. Gasping /shortness of breath 5. Pale/ pallor 6. ECG : VT,VF,PEA, Asistole 7. Midriatic pupil, negative light refleks

ECG

Cardiopulmonary resuscitation

• CPR is a critical part of the management of cardiac arrest

• It should be started as soon as posible and interrupted as little as possible

• The objective is to delay tissue death and to extend the brief window of opportunity for a succesfull resuscitation without PERMANEN BRAIN DAMAGE

When do we start rescucitation?• As soon as there is a sign of pulseless• Find out another environment factors (danger)• Chest compression ( C )• Patient respons• Airway( A ) • Breathing• 5 cycles of compressions in 2 minutes• Check carotid pulse maksimum 10 second

Basic life Support / ABC * A ( Airway ), Open Airway - ( chin lift, head tilt, jaw thrust )

AIRWAY TOOLS

Oro/nasopharynx pipe Tracheal Intubation Krikotirotomi needle

Trachea intubation

Checklist

Breathing support

Rescue Breathing :• Adult 10 - 12 beat / menit• Child /baby 12 - 20 beat/ menit• Tidal volume 6 10 ml per kg bb• Inspirasi Ekspirasi 1 3

• oksigen 50 % Oksigen 100 %

Oxygenation

Circulation

CPR should be performed immediately on any person who has become unconscious and is found to be PULSELESS

CPR

• CPR is a critical part of the management of cardiac arrest

• It should be started as soon as possible and interruped as little as possible

• Early CPR improves the flow of blood and oxygen to vital organs

CPR

• Indications • Ventricular fibrillation• Pulseless ventricular tachycardia (VT)• Pulseless electrical activity (PEA)• Asystole• Pulseless bradycardia

When do we start resuscitation?* It is indicated in those who are unresponsive with

no breathing and pulseless* Ask for help, another rescuer * Chest compressions ( C ) rate and deep * Patient response * Open airway ( A ) * Breathing ( B ) * 5 cycle

Chain Chain of survival (AHA) 2010

Chest Compression• Place the heel of you hand on

the Center of chest (just below midline nipple)

• Put your other hand on top of the first with your fingers interlaced

CPR technique

How deep should the rescuer compress on?

Adult : 4 - 5 cm Child : 2 - 3 cm Baby : 1 - 2 cm

CPR, AHA 2010• Optimal chest compression to ventilation

ratio• Baby/ child:

• 1 rescuer >>> 30 : 2• 2 rescuer >>> 15 : 2

• Adult: >>> 30 : 2

• After endotracheal tube inserted into the airway,

Breath 8 -10 beat perminute Chest compression minimum 100 beat

perminute

When we stop performing CPR?

Once you begin CPR, do not stop unless:• You see an obvious sign of life

(breathing)• An AED is available and ready to use• Another trained responder or EMS

personnel take over• You are too exhausted to continue• DEATH

5 Chance of Survival (AHA, 2010)1. Immediate recognition of cardiac arrest and activation of the emergency response system2. Early CPR with an emphasis on chest compressions3. Rapid defibrillation4. Effective advanced life support5. Integrated post–cardiac arrest care

Key changes point of emphasis from 2005 BLS guidelines:

• Look, listen, and feel removed from the BLS algorithm

• Encouraging hands only (chest compression only) CPR for untrained lay rescuer, (continous chest compression over the middle of the chest)

• Sequence change to chest compression before rescue breath (CAB rather than ABC)

• To provide effective chest compressions, push hard and push fast

• 100 compressions perminute, with compression depth at least 2 inches/5 cm

• Minimize the frequency and duration of interruptions in compression

• A compression – ventilation ratio 30:2 is recomended

• Cricoid pressure during ventilation is not recommended

• Rapid defibrilation if indicated

THANK YOU