Basic Life Support

1. Safe environment
2. Responsiveness:
a. Ask patient “are you ok”
b. This asseses consciousness airway and breathing
c. Means that there are not in sever cardiopulmonary distress
d. Look at chest and abdomen for signs of breathing whi,e asking the
patient if they are ok
3. If unresponsive
a. Check breathing if not breathing then:
4. Call for help (AED – automated external defribillator)
5. Check central pulses for at least 5 secs and no more than 10 secs
i. Carotid ; braichal (infant)
ii. If no pulses then move to next step:
CAB
6. Circulation: Chest compressions
a. Perfusion is most important and there should be good compressions
b. Technique:
i. Directly over the sternum in the internipple line or 2 fingers
breath above the xiphysternum
ii. Lock both hands together with elbows locked and use the heel
of your hand.
c. Quality Chest compression:
i. Rate of compression: at least 100 per min to go into tachycardic
state
ii. Depth 4-5cm or a min of 2 inches.
1. For paeds 1/3 of the ap diameter of the chest. Rate is the
same. (1 hand small children)
iii. Adequate recoil
iv. When stopping compressions should be 10 secs or less to give
breaths.
d. Complication: rib fractures
e. 30 compression: 2 breaths
i. for paediatrics if it is a one person cpr then still do 30:2 but if
there are 2 ppl resent to do cpr then one does breath and the
other does compression the ration should be 15:2
ii. surface underneath should be flat and firm
failure to release between compressions:• prevents venous return and filling of
the heart…open chest compression 2-3 X better both cerebral and coronary.
Indications penetrating trauma, closed chest not sufficient (severe
emphysema_, rigid chest wall, severe VHD, recent sternotomy.

7. Airway
a. Head - chin lift or jaw thrust- reduced tone in muscles of the tongue, jaw and neck
allows the tongue to fall against the posterior pharyngeal wall. hand nearest the head
is placed on the forehead, gently extending the head backwards. Chin lifted using the
index and middle fingers. If the mouth closes, the lower lip should be retracted
downwards by the thumb.

• Jawthrust- head chin left fails to create an airway, or there is a suspcion that the
cervical spine may have been injured. The patient’s jaw is ‘thrust’ upwards (forwards)
by the rescuer applying pressure behind the angles of the mandible.

i. Laryngeal mask airway

ii. Nasopharyngeal tube
iii. Oropharyngeal tube
iv. Endotracheal tube
v. Tracheostomy
vi. Clears tongue which obstructs the airway
vii. Do not do head tilt if spinal injury is suspected
b. Manual in line stabilization (done with an assistant)
i. One holds head and neck firmly then other person use jaw
thurst to do breaths
c. Breaths
i. Mouth to mouth, mouth to mask (ambu bag/self inflating bag),
bag and mask
ii. Close off nostrils
iii. Room air 6% and oxygen 21%
Inadequate ventilation causes: obstruction , leaks , failure to maintain head tilt chin
lift . Exhaling too hard: trying to overcome an obstructed airway, resulting in gastric
distension

d. Reasses
i. After 5 cycles check pulses again if no pluse then repeat all
steps until help comes
e. If AED is available:
i. 1 clear: person
ii. 2 clear by standers
iii. 3 everyone clear and not touching wat ptn is touching
iv. do not reassess go str8 back to chest compressions

recovery position- supine, legs extended, open airway. victim’s closest arm is
abducted to lie at 90° so that the palm lies facing upwards. far arm brought to lie
across chest, so back of the hand against the cheek. far leg is then flexed at the hip and
knee, keeping the foot on the ground.• The far shoulder is grasped.• The victim is then
rolled. The shoulder is pulled towards the rescuer whilst at the same time the flexed
leg is rotated over the lower leg using a combination of pulling on the thigh and gentle
down- ward pressure. The upper leg is adjusted so that the hip and knee are flexed and
the hand under the cheek is adjusted to help maintain the head tilt
Cardiac Life Support
ALCS- identify and reverse the underlying cause of the cardiac arrest using a
defibrillator, airway devices, oxygen, intravenous cannulation and drugs, correcting
reversible causes.

Cardiac arrest:Cessation of mechanical cardiac activity with no cardiac output

Aetiology:
Hypovolemia, Hypoxia, Hypo and hyperkalemia, Hypothermia, hypoglycemia
Acidosis
Cardiac tamponade, Tension pneumothorax, Coronary Thrombosis, Toxins/Tablets,
Trauma

Rhythms:
• Shockable: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT).

• Non-shockable: asystole and pulseless electrical activity (PEA).

VT: best prognosis can be shockable (pulseless v tach) and non shockable
Wide reular waves.
VF: patient will still be talking to you. Once diagnosis made defibrillation must be
done 1st ecept if preceeded by precordial thump. (sharp blow given with fist. Don’t
only if cardiac arrest witnessed/ monitored).

Falsely seen if patient is shaken (leads shake); irregular small waves. Shockable.

Asystole: electrical sandstill of heart; no contractility (ecg= undulating baseline). r/o

vf, equip malfun, leads misplacesd.

PEA (pulseless electrical activity): - complexes on ECG seen but pulseless. due to
sumn mechanically restricting cardiac filling outflow/contractility CPR to correct and
BLS

Defribillators
Biphasic
1 shock: 200j

Monophasic
1 shock: 360j

In trauma defibrillation (and cardioversion) depolarizes a critical mass of the

myocardium, allowing the natural pacemaker of the heart to take over and restore a
normal coordinated contraction. Paddles-ne to the right of the ster- num, just below
the clavicle; and the other over the apex, below and to the left of the nipple.

Don’t touch chestBurns, remove nitrate patch & high flow O2 to eliminate fire risk.

Synchronized defibrillation- can defibrillate at any wave pf VTF (unsynchronized

shock). But pulseless VT, coordinate shock with ‘r’ wave (synchronized) AKA
cardioversion. If done on t wave VF

one should do ABC not CAB as well as in other situations except in cardiac life
support.

Circulation
IV Access or Intraosseous needle, cvp, intratracheally (do not give a fluid bolus by
this route)
Fluid Bolus
2l in adults and 20ml/kg for paeds

Drugs:
Adrenaline- cathecholamine. Alpha agonist (vasoconstrictor)inc PVRdiverts bf
to vital organs.
After shock and AED then give adrenaline and continue a 5 cycle cpr then re assess.
1mg IV / 1ml of 1:1000 or 10ml of 1:10000…no IV acces give 2-3mg via tracheal
tube diluted with 10ml n/s
Shockable rhythms: give every 3-5 mins
Other drugs can be given such as vasopressin.
If adrenaline isn’t working then may proceeed to use amidorone

Adrenaline: as soon as iv available for asys and PEA Img

Vasporessin is used as a substitute for first or second dose of adrenaline

If vaso and adren fail use amidoranone

Amiodarone- indication is shock refractory VF or pulseless VT. 300mg (adult dilute
20ml).

Atropine –antiach act on M recvagus block @ S & AVN inc HR. 3mg IV
Discontinuation of CPR if:
ROSC – return of spontaneous circulation
20 mins
Arrival of ambucare more qualified help
Fatigue

6 – npo for solid food including oranges

4 – breast milk in infants
2 – clear fluids

Anxiety pre induction can cause MI, stroke and dysrhythmias.

Atopine not commonly used anymore due to induced tachycardia. Use of othe
cholinergics

A normal CO value for an adult is 2.5 to 3.5 L/min/m2, or 4 5 to 6.0 L/min in a 70 kg

adult.
CO = SV*HR
SV= preload, afterload, contractility
Preload= end diastolic stretch of left ventricle. (LVEDV)
Inc prld= inc lft vent work, CO, pressure, SV.
Inc LVEDP inc LVEDV
Excessive inc EDS  dec cardiac performance as vent overdistended.
Pulmonary capillary wedge pressure (PCWP) measured with a pulmonary artery
catheter estimates LVEDV.
Afterload-myocardial wall stress of the left ventricle during ejection. measure work
LV performs with contraction. depends on elasticity of large arteries and on the
systemic vascular resistance (SVR). SVR (mean arterial blood pressure, cardiac
output, and CVP)

Contractility -myocardium's intrinsic ability to perform work at any given level of

end-diastolic fiber length (preload). Determined by the availability of intracellular
calcium.

Drugs inc myocardial contractility incintracellular calcium.

Contractility inc with symp stimu. & inotropic drugs, such as digoxin. Hypoxia,
acidosis, beta blockers, calcium channel blockers, and myocardial ischemia or
infarction are common conditions that depress contractility.

Inc preload, heart rate, contractility or dec afterload, inc in cardiac output

vasopressors  inc bp but severely restrict bf to vital organs such as the bowel, liver
and kidney. Marked increases in peripheral vascular resistance produced by
vasopressors may precipitate cardiac failure