Bls

Front 1

BLS Primary Survey
Airway
Is the airway open?

Back 1

Open the airway using noninvasive techniques (head – tilt chin lift or jaw thrust without head extension if trauma is suspected.

Front 2

BLS Primary Survey
Breathing
Is the patient breathing and are respirations adequate?

Back 2

Look, listen, and feel for adequate breathing. Give 2 rescue breaths. Give each breath over 1 second. Each breath should make chest rise. Do not ventilate too fast (rate) or too much (volume).

Front 3

BLS Primary Survey
Circulation
Is a pulse present?

Back 3

Check carotid pulse for at least 5 seconds but no longer than 10 seconds. Perform high quality CPR until an AED arrives.

Front 4

BLS Primary Survey
Defibrillation
If no pulse, check for a shockable rhythm with a manual defibrillator or use AED.

Back 4

• Provide shocks as indicated.
• Follow each shock immediately with CPR, beginning with chest compressions.

Front 5

Minimize any interruptions in chest compressions
Avoid:

Back 5

• Prolonged rhythm analysis
• Frequent or inappropriate pulse checks
• Taking too long to give breaths to the patient
• Unnecessarily moving the patient

Front 6

ACLS Secondary survey
Airway
Is the airway patent?

Back 6

Maintain airway patency in unconscious patients by use of head tilt _ chin lift, Oropharngeal airway (OPA), or nasopharyngeal airway (NPA)

Front 7

ACLS Secondary survey
Airway
Is an advanced airway indicated?

Back 7

Use advanced airway management if needed (eg, LMA, Combitube, endotracheal intubation).

Front 8

ACLS Secondary survey
Breathing
Are oxygenation and ventilation adequate?

Back 8

Give supplementary oxygen.
Assess the adequacy of oxygenation and ventilation by
• Clinical criteria (chest rise)
• Oxygen saturation
• Capnometry or canography

Front 9

ACLS Secondary survey
Breathing
Is an advanced airway indicated?


Is tube placement reconfirmed frequently?

Back 9

The benefit of advanced airway placement is weighed against the adverse effect of interrupting chest compressions.

If bag – mask ventilation is adequate, insertion of an advanced airway may be deferred until the patient fails to respond to initial CPR and defibrillation or until spontaneous circulation returns

Front 10

ACLS Secondary survey
Breathing

Is tube secured and placement recon- firmed frequently?

Are exhaled CO2 and oxyhemoglobin saturation monitored?

Back 10

• If advanced airway devices are used:
• Confirm proper integration of CPR and ventilation
• Confirm proper placement of advanced airway devices by:
o Physical examination
o Measurement of exhaled CO2
o Use of esophageal detector device
• Secure the device to prevent dislodgment
• Continue exhaled CO2 measurement

Front 11

Respiratory arrest case
BLS Primary Survey
Scene safety

Back 11

Make sure the scene is safe for you and the victim. You do not want to become victim yourself

Front 12

Respiratory arrest case
BLS Primary Survey
Check response

Back 12

Tap the victims shoulder and shout, “Are you all right?

Front 13

Respiratory arrest case
BLS Primary Survey
Activate the emergency response system

Back 13

• If you are alone shout for help.
• If no one responds, activate the emergency response system, phone 911 or emergency number
• Get an AED if available
• Return to victim and begin CPR

Front 14

Respiratory arrest case
BLS Primary Survey
Airway

Back 14

Open the airway using non- invasive techniques:
Head tilt – chin lift
Jaws lift without head extension if trauma is present or suspected
While observing the patients chest:
• Look for the chest to rise and fall
• Listen for air escaping during exhalation
• Feel for flow of air against your cheek.

Front 15

Respiratory arrest case
BLS Primary Survey
Breathing

Back 15

If respirations are absent or inadequate:
Give 2 breaths. Use a barrier device if available
Each breath should take 1 second and cause visible chest rise.

Front 16

Respiratory arrest case
BLS Primary Survey
Circulation

Back 16

Feel the carotid pulse for at least 5 seconds but no more than 10 seconds.

Note: in this case the patient has a pulse, and chest compressions are not indicated

Front 17

Respiratory arrest case
BLS Primary Survey
Defibrillation

Back 17

If no pulse, attach an AED or manual defibrillator. Follow AED prompts or shock as indicated.

Note: in this case (respiratory arrest with a pulse) the AED is not attached.

Front 18

Respiratory arrest case
ACLS Secondary survey
Airway

Back 18

• Use advanced airway management if needed (eg, LMA, Combitube, endotracheal intubation).
• Maintain airway patency in unconscious patients by use of head tilt chin lift, Oropharngeal airway (OPA), or nasopharyngeal airway (NPA)

Front 19

Respiratory arrest case
ACLS Secondary survey
Breathing

Back 19

Give bag – mask ventilations every 5 – 6 seconds – about 10 breaths per minute (rescue breathing with out compressions
• If advanced airway devices are used:
• Confirm proper integration of CPR and ventilation
• Confirm proper placement of advanced airway devices by:
o Physical examination
o Measurement of exhaled CO2
o Use of esophageal detector device
• Secure the device to prevent dislodgment
Continue exhaled CO2 measurement

Front 20

Respiratory arrest case
ACLS Secondary survey
Circulation

Back 20

• Obtain IV/IO access
• Attach ECG leads
• Identify and monitor for arrhythmias
• Give fluids as indicated

Front 21

Respiratory arrest case
ACLS Secondary survey
Differential diagnosis

Back 21

Search for find, and treat reversible causes and contributing factors.

Front 22

Management of respiratory arrest

Back 22

• Giving supplementary oxygen
• Opening the airway
• Providing basic ventilation
• Using basic airway adjuncts (OPA and NPA)
• Suctioning
• Providing ventilation with advanced airways
• Patients with per fusing rhythm, deliver 1 breath every 5 – 6 seconds (10 – 12 breaths per minute).

Front 23

Critical concept:
Avoiding hyperventilation

Back 23

• Avoid deliver too much ventilation
• Increases intrathoracic pressure
• Decreases venous return to the heart
• Diminishes cardiac output
• Increase gastric inflation
• Predispose patient to vomiting

Front 24

Basic airway skills

Back 24

• Head tilt – chin lift
• Jaw thrust without head extension (suspected cervical spine trauma)
• Mouth to mouth ventilation
• Mouth to nose ventilation
• Moth to barrier device (using a pocket mask)
• Bag mask ventilation

Front 25

Bag mask ventilation

Back 25

• 1 way valves to prevent the patient from re-breathing exhaled air
• Oxygen ports for administering supplementary oxygen
• Medication ports for administering aerosolized and other medications
• Suction ports for clearing the airway
• Ports for quantitative sampling of end – tidal CO2

Front 26

Technique of Oropharngeal airway insertion

Back 26

1. Clear the mouth and pharynx
2. Select the proper size
3. Insert
4. As the OPA passes through the oral cavity and approaches the posterior wall of the pharynx, rotate it 180 degrees into proper position
An alternative method is to insert the OPA straight in while using a tongue depressor or similar device to hold the tongue on the floor of the mouth.

Front 27

Technique of nasopharyngeal airway insertion

Back 27

1. Select proper size
2. Lubricate the airway
3. Insert the airway

Front 28

Precautions for OPAs and NPAs

Back 28

• Always check spontaneous respirations immediately after insertion of either an OPA or NPA
• If respirations are absent or inadequate, start positive – pressure ventilations at once with an appropriate device
• If adjuncts are unavailable, use mouth to mask barrier ventilation

Front 29

Suctioning
Soft catheter

Back 29

• Aspiration of thin secretions from the oropharynx and nasopharynx
• Performing intratracheal suctioning
• Suction through an in – place airway ( i.e. NPA) to access the back of the pharynx in a patient with clenched teeth

Front 30

Suctioning
Rigid catheter

Back 30

1. Gently insert the suction catheter or device into the oropharynx beyond the tongue. Measure the catheter before suctioning, and do not insert it any further than the distance from the tip of the nose to the earlobe.
2. Apply suction by occluding the side opening while with drawing the catheter with a rotating or twisting motion
3. Limit suction attempts to 10 seconds or less

Front 31

Endotracheal tube suctioning

Back 31

1. Use sterile technique to reduce the likelihood of airway contamination
2. Gently insert the catheter into the ET tube. Be sure the side opening is not occluded during insertion
3. Apply suction by occluding the side opening only while withdrawing catheter with a rotating or twisting motion.

Front 32

VOMIT

Back 32

V - Vitals
O - O2
M – Monitor
I - IV
T - Treatment

Front 33

Vasopressors

Back 33

• Epinephrine
• Vasopressin

Front 34

Antiarrhythmics

Back 34

• Lidocaine
• Amiodarone
• Procainamide
• Magnesium sulfate

Front 35

Bradycardia/Tachycardia:

Back 35

• Atropine
• Adenosine
• Cardizem

Front 36

Acidosis:

Back 36

Sodium bicarbonate

Front 37

Acute coronary syndrome:

Back 37

Morphine sulfate
• Oxygen
• Nitroglycerine/NTG
• ASA

Front 38

Vasopressors infusions:

Back 38

• Dopamine
• Dobutamine
• Norepinephrine

Front 39

Epinephrine
Indications:

Back 39

Cardiac arrest
V – Fib
Pulseless V –Tach
Asystole
PEA

Front 40

Epinephrine
Cardiac arrest

Back 40

1mg q 3 – 5 min. 1:10,000 IV