- 28 فبراير 2018
Adult Basic Life Support (BLS)
Verify scene safety & Place patient supine on a hard flat surface.
1-Assess Responsiveness: Stimulate and speak to the adult asking if they are ok. Look at the chest and Assess for breathing.
- (One provider) first call the emergency response team and bring an AED.
- (Two providers) Have someone near call the emergency response team and bring the AED.
a-If normal breathing and pulse definitely present, monitor until additional help arrives.
b-If pulse is present and breathing absent (No breathing or only gasping), begin ventilation at a rate of 10 per minute or once every 6 seconds using mouth to mouth or bag valve mask.
Recheck pulse every 2 minutes; if no pulse, begin CPR.
If possible opioid overdose, administer naloxone. ( 2 mg intranasal or 0.4 mg intramuscular)
c-If the patient doesn’t have a pulse:
Begin 5 cycles of CPR (lasts approximately 2 minutes).
Start with chest compressions:
- Provide 100 to 120 compressions per minute. This is 30 compressions every 15 to 18 seconds.
- Place your palms midline, one over the other, on the lower 1/3 of the patient’s sternum between the nipples.
- lock your arms.
- Using two arms press to a depth of 2 to 2.4 inches (5-6cm) on the patient’s chest.
- Press hard and fast.
- Allow for full chest recoil with each compression.
1 cycle of adult CPR is 30 chest compressions to 2 rescue breaths.
changing rescuers every 2 minutes improves a victim’s chance of survival.
4- Attach and use AED as soon as available.
When the AED arrives, place it on the patient and follow the prompts
With AED attached, assess for shockable rhythm, as follows:
- If shockable, defibrillate and then immediately start CPR for about 2 minutes.
- If nonshockable, resume CPR for about 2 minutes and reassess for pulse and shockable rhythm.
- but is not required for respiratory arrest as the patient has a pulse for this case.
- NB, every 2 minutes, check pulse, check rhythm, and switch compressors.
The characteristics of high-quality CPR:
Adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation.
-The recommended chest compression rate is 100 to 120/min (updated from at least 100/min).
-The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm).
-Chest recoil Allow full recoil of chest after each compression; do not lean on the chest after each compression
-Minimizing interruptions Limit interruptions in chest compressions to less than 10 seconds
-Ventilate adequately (2 breaths after 30 compressions, each breath delivered over 1 second, each causing chest rise)
1-Head tilt-chin lift
place your palm on the patient’s forehead and apply pressure to tilt the head backward & place the fingers of your other hand under the mental protuberance of the chin and pull the chin forward and cephalic.
2-Jaw thrust (if trauma suspected)
Place your fingers on the lower rami of the jaw. Provide anterior pressure to advance the jaw forward.
(lateral recumbent or 3/4 prone position):
This position is designed to maintain a patent airway and reduce the risk of airway obstruction and aspiration. lateral position with the head dependent to allow fluid to drain.
- Assure the position is stable.
- Avoid pressure of the chest that could impairs breathing.
- Position patient in such a way that it allows turning them onto their back easily.
- Take precautions to stabilize the neck in case of cervical spine injury.
Continue to assess and maintain access of airway. Avoid the recovery position if it will sustain injury to the patient.
Post cardiac arrest care
Ventilation: CXR, monitor ETCO2, O2 saturation
- Keep ETCO2 35-40 mmHg (PaCO2 40-45 mmHg)
- Keep O2 sat > 94% (PaO2 100 mmHg); minimize FiO2
- Ventilator TV 6-8 ml/kg, plateau pressure < 30 cmH2O
- MAP > 65 mmHg SBP > 90 mmHg
- Correct hypotension: fluid bolus (1-2 L NS or LR), dopamine 5-10 mcg/kg/min, NE 0.1-0.5 mcg/kg/min, epinephrine 0.1-0.5 mcg/kg/min
Cardiovascular: Echocardiography, ECG, monitor ECG
Neurological: EEG monitoring, core temperature monitoring
temperature between 32°C and 36°C selected and achieved, then maintained constantly for at least 24 hours.
Metabolic: lactate, Cr, K, glucose; Urine output
- Serial lactate
- Keep K > 3.5 mEq/L
- Maintain euvolemia; RRT
- Glucose control (108-144 mg/dL)