Академический Документы
Профессиональный Документы
Культура Документы
Life Suppport
The steps of basic life support (BLS) consist of a series of actions and skills
performed by the rescuer(s) based on assessment findings. The first action
performed by the rescuer upon finding an adult victim is to assess for
responsiveness. This is accomplished by tapping or gently shaking the
victim's shoulder and asking, Are you all right? If the victim does not
respond and the rescuer is alone, the rescuer should activate emergency
medical services (EMS), get an automatic external defibrillator (AED) (if
available), return to the victim, and begin cardiopulmonary resuscitation
(CPR) and defibrillation if necessary.1
The American Heart Association includes training in the use of AEDs with
instruction of health care personnel and laypersons in BLS. Survival from
cardiac arrest is the highest when immediate CPR is provided and
defibrillation occurs within 3 to 5 minutes.1 AEDs now can be found in many
out-of-hospital, public settings (Fig. A-1).
FIG. A-1 Automatic external defibrillator (AED)
located in an airport.
Airway
The next step in BLS is to assess the victim's airway to confirm the
absence of breathing and to establish a patent airway. Fig. A-2
demonstrates opening the airway and performing mouth-to-mouth
ventilation. An adult's airway is opened by hyperextending the head. The
head tiltchin lift maneuver is used and involves tilting the head back with
one hand and lifting the chin forward with the fingers of the other hand. If
the victim is gasping occasionally or not breathing, the rescuer attempts
to ventilate the victim with mouth-to-barrier (recommended) or mouth-to-
mouth resuscitation.1
FIG. A-2 The head tiltchin lift maneuver is used to
open the victim's airway to give mouth-to-mouth
resuscitation. A, Rescuer places one hand on the
victim's forehead and applies firm, backward pressure
with the palm to tilt the head back. The chin is lifted
and brought forward with the fingers of the other
hand. B, Rescuer pinches the victim's nostrils, seals
mouth over victim's mouth, and delivers a regular
breath. Rescuer should observe for a rise in the
victim's chest (arrow).
TABLE A-1 Management of Foreign Body Airway
Obstruction (FBAO)
Conscious Adult Victim
Inability to speak
Silent cough
Cyanosis
Assessment
If rescuer sees victim collapse and knows that FBAO is the cause:
b. Reopen airway.
c. Reattempt to ventilate.
If airflow is obstructed, the rescuer should reposition the head and repeat
the attempt to ventilate. If the victim cannot be ventilated after
repositioning the head, the rescuer should proceed with CPR. When
providing rescue breaths, the rescuer should look for any foreign objects
in the victim's mouth and remove them if visible (Table A-1).
In those rare instances when airway obstruction is not relieved, additional
procedures are necessary. These include transtracheal catheter
ventilation and cricothyroidotomy, which should only be attempted by
health care professionals experienced in these procedures. 1
Cardiac Compressions
Cardiac arrest is characterized by the absence of a pulse in the large
arteries of an unconscious victim who is not breathing. Health care
providers are instructed to perform a pulse check in victims that are
unresponsive and not breathing. Lay rescuers are not taught this skill.
Instead they are instructed to begin chest compressions immediately after
delivering two rescue breaths.
It is preferable to have two persons performing CPR (see Table A-3). One
person, positioned at the victim's side, performs chest compressions while
the other rescuer, positioned at the victim's head, maintains an open
airway and performs ventilations. In order to maintain the quality and rate
of compressions, rescuers should change roles approximately every 2
minutes.1
FIG. A-5 Cardiopulmonary resuscitation (CPR). A,
Position of the hands during application of cardiac
compressions. B, When pressure is applied, the lower
portion of the sternum is displaced posteriorly with the
palm of the hand. C, To apply maximum downward
pressure, the rescuer leans forward so that both arms
are at right angles to the patient's sternum and the
elbows are locked.
ACLS involves the use of detailed medical algorithms for the provision of
lifesaving cardiac care in settings ranging from the pre-hospital
environment to the hospital setting. Nurses are often required to obtain
ACLS certification in addition to BLS depending on their area of practice.
Determine unresponsiveness:
Activate EMS system by calling 911 and get the AED (if available)
(outside of hospital).
Call a code and ask for the AED or crash cart (in the hospital).
Airway
Breathing
c. Reattempt to ventilate.
Circulation
Lay Rescuer
Compression/Ventilation
Compression-Ventilation Cycle
Begin Compressions
4. Begin compressions:
Provide Ventilation
5. Restart compressions.
Defibrillation
If rhythm is shockable, deliver one shock, then resume CPR for five
cycles before rechecking rhythm.
Continuation of CPR
One Rescuer
Determine unresponsiveness:
Other Rescuer
Activate EMS system by calling 911 and get the AED (if available)
(outside of hospital).
Call a code and ask for the AED or crash cart (in hospital).
Airway
Breathing
c. Reattempt to ventilate.
Circulation
Lay Rescuers
Compression/Ventilation
Compression-Ventilation Cycle
One Rescuer/Compressor
4. Begin compressions:
Other Rescuer/Ventilator
Switching
Defibrillation
If rhythm is shockable, deliver one shock, then resume CPR for five
cycles before rechecking rhythm.
Continuation of CPR
REFERENCE
1. 2005 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care, Part 4: Adult Basic
Life Support. Circulation. 112, 2005, IV,19.