BASIC CONCEPTS TO BASIC LIFE SUPPORT

What is basic life support ? It is an emergency treatment of a victim of cardiac or respiratory arrest through cardiopulmonary resuscitation and emergency cardiac care. It involves procedures such as rescue breathing, cardiopulmonary resuscitation, Heimlich maneuver, jaw-thrust technique, back blows, chest thrusts and finger sweep.

A. RESCUE BREATHING During respiratory arrest, you must provide oxygen within 4 to 6 minutes, or biological death will follow. You can restore the oxygen supply by exhaling into the victims mouth, nose, or tracheal stoma. These procedures can be used for any victim, with appropriate modification for the patients size, age, and respiratory rate.

METHODS OF ARTIFICIAL RESPIRATION OR RESCUE BREATHING

1. Mouth-to-Mouth Ventilation You can restore oxygenation through mouth-to-mouth ventilation by inflating the victims lungs with exhaled air. To do so, you double your tidal volume by taking deep breaths and exhale directly into the victims mouth. Exhaled air provides about 18% oxygen and 2% carbon dioxide, sufficient to achieve an artificial oxygen tension of between 50 to 60 torr. 2. Mouth-to-Nose Ventilation

These are situations in which mouth-to-mouth ventilation cannot be performed. These include trismus, or involuntary contractions of the jaw muscles, and traumatic jaw or mouth injury. There are also times when it is difficult to maintain a tight seal with the lips using the mouth-to-mouth method. In these situations, mouth-to-nose ventilation should be performed. 3. Mouth-to-Mouth and Nose Ventilation if the victrim is an infant, this is the best way in delivering ventilation by placing your mouth over the infants mouth and nose to create a seal. 4. Mouth-to-Stoma Ventilation You can ventilate patients with tracheostomies or laryngectomies directly through the stoma or tube. These patients can be identified by an obvious stoma, tracheostomy, or laryngectomy tube in place. Some patients wear a Medic Alert tag or bracelet that tells you a stoma is present. If no chest expansion occurs, you should look for prescence of the stoma. 5. Mouth-to-Mask Ventilation It could deliver ventilation to a patient by using a pocket facemask with a one way valve to form a seal around the patients mouth. 6. Mouth-to-Facesheild Ventilation It could provide very low resistance ventilations to a patient by using a thin and flexible plastic. 7. Bag Mask Device Ventilation

It could deliver ventilation to a patient by using a hand-operated device consisting of a self-inflating bag, one-way valve, facemask and oxygen reservoir.
B. External Cardiac Compressions

It is the action for treating sudden cardiac arrest. It consists of rhythmic administration of pressure on chest wall.

Depth of Compressions: Patient 1. Infant 2. Child 3. Adult Depth 1.5 inches About 2 inches At least 2 inches

Ratio of Compressions to Breathing: Two Man-Rescuer with AED 15:2 30:2 30:2

Patient 1. Infant 2. Child 3. Adult

One-Man Rescuer 30:2 30:2 30:2

CARDIOPULMONARY RESUSCITATION It is a basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac compressions. It is used in cases of cardiac arrest to establish effective circulation and ventilation to prevent irreversible cerebral

damage resulting from anoxia.

Indications of CPR People who are unconscious or have collapsed People with cardiac or respiratory arrest to help start or induce spontaneous breathing or heart beat that has been previously stopped. People with impaired gas exchange due to airway obstruction Failure of chest to rise and fall during respiration. Absence of pulse upon palpation of victims carotid artery People who have drowned and remain unconscious and unresponsive People who become unconscious from previously choking from anything that has obstructed their airway. Contraindications of CPR Patients with cervical injury to prevent the possibility of creating further damage to the fractures already present. Patients with fracture in sternum, ribs or thoracic bone to prevent puncturing or lacerating any of the visceral organs within the thoracic cavity or abdomen. Patients with spinal injury. If the physician has an order DNR (Do Not Resuscitate) for the patient who is unresponsive to avoid any legal implications and respect patient rights. Victims with severe crushing injuries to face and neck cannot have mechanical ventilation performed as it would further complicate any injuries that were already present. People who are conscious. When the patient is announced dead as noted or said by the physician present with indicators or evidence such findings as rigor mortis.

Types of CPR 1. Conventional CPR Combination of rescue breathing and external cardiac compressions

2. Compression-Only CPR Done when rescue is unwilling or unable to perform mouth-to-mouth rescue breathing or when untrained bystanders are allowed to intervene 3. Cough CPR Self-initiated CPR done before loss of consciousness

4. Prone CPR Done by performing compressions on the victims back

Wrong Gestures When Performing CPR 1. The Bender frequent flexing of the elbows 2. The Grasper unintentional grasping of the victims chest 3. The Head-Banger force concentrated on the head rather than the shoulders 4. The Jerker compressions given at an abnormally fast rate Criteria When To Not Start CPR 1. Patients with valid DNAR Order. 2. No physiological benefits can be expected. 3. Conditions such as <23 weeks of gestation, <400 grams of birthweight, anencephaly, trisomy 13 and 18

Signs When To Stop CPR S - Spontaneous circulation occurs in response to mechanical ventilation; breathing and pulse return T - Turn over to the physician O- Operator has gotten tired and exhausted P- Physician has declared the victim dead S- Scene becomes unsafe S- Signed the waiver to stop CPR Signs That Indicate Effective CPR The rescuer is able to see the victims chest rise during the interposed ventilations and feel a carotid pulse. Dilated pupils of the eyes will begin to constrict as an indication that the victims vision is focused. Skin color improves from its previous pale condition or will begin to return to its original tone. Heartbeat returns spontaneously Spontaneous gasping response is seen to facilitate the need to intake more air for the victim Victim becomes conscious Presence of a pulse is felt upon palpation of the victims carotid artery Respirations continue to occur

C. PROCEDURES FOR CHOKING

1. Heimlich Maneuver It is an emergency procedure of dislodging a bolus of food or other obstructions from the trachea to prevent asyphyxiation. The choking person is

grasped from behind by the rescuer, whose fist, with thumb side in, is placed just below the victims xiphoid process with the other hand placed firmly over the fist. The rescuer then pulls the fist firmly and abruptly upward into the epigastrium, forcing the obstruction up the trachea. Indications: Choking adults Choking children

2. Back Blows and Chest Thrusts Procedure which relieves patient from choking through forceful blows made in the back and thrusts on the chest area. Indications: Choking infants

3. Finger Sweep Act of manually dislodging the foreign object that can be seen in the mouth with the use of fingers. Indications: Choking adults Choking children Choking infants

D. SKILLS INVOLVED

1. For Opening the Airway 1.1 Head Tilt-Chin Lift - most common way for opening the airway 1.2 Jaw Thrust Technique

- alternative way of opening the airway applicable for victims with suspected or confirmed head or neck injury. 2. For Checking the Pulse 2.1 Carotid Pulse Palpation - for children and adults 2.2 Brachial Pulse Palpation - for infants