Final Pediatric Basic Life Support
pediatric pediatric basic life support...
pediatric bls Basic Life Support
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Supervisors Prof Mona el-samahy
Head of the fifth unit of Pediatric medicine
Assistant Prof Mervat Jamal
EDITED BY MOHAMED AHMED AED MOHAMED AHMED BADR MOHAMED AHMED BADAWY MOHAMED AHMED AMER MOHAMED AHMED ABAS MOHAMED AHMED ABD EL-HALEEM MOHAMED AHMED SAKR MOHAMED AHMED MOSA MOHAMED AHMED GHANEM MOHAMED AHMED F OUAD
841 842 843 845 846 847 848 850 851 852
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INDEX CALENDAR ACKNOWLEDGMENT TITLE OBJECTIVES DEFINITION INTRODUCTION THE BLS SEQUENCE FOR INFANTS AND CHILDREN SAFETY OF RESCUER AND VICTIM CHECK FOR RESPONSE AND ACTIVATE THE EMS SYSTEM POSITION THE VICTIM OPEN THE AIRWAY CHECK BREATHING PULSE CHECK CHEST COMPRESSIONS COORDINATE CHEST COMPRESSIONS AND BREATHING COMPRESSION ONLY CPR ACTIVATE THE EMS SYSTEM AND GET THE AED DEFIBRILLATION FOREIGN-BODY AIRWAY OBSTRUCTION (CHOKING ) SPECIAL RESUSCITATION SITUATIONS DIFFERENCES BETWEEN EUROPEAN AND AMERICAN GUIDELINES STATISTICS BLS RESULTS SUMMARY REFERENCES
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Calendar DAY 2-11-2009 5-11-2009 12-11-2009 14-11-2009 19-11-2009 20-11-2009 21-11-2009 23-11-2009
ACTION First meeting for discussion and choosing the subject. Choosing BLS. As a subject. Studying the American and UK guidelines. Practical learning BLS. Distribute responsibilities Discussing the questionnaire. Remolding of the questionnaire by dr. Mervat. Pre-teaching questionnaire distribution. Teaching our colleges. Post-teaching questionnaire distribution.
Acknowledgment We are grateful to Prof. Prof Mona el-samahy the Head of the fifth unit of Pediatric medicine, dr. Mervat Jamal who gives us a lot of her time, effort and patience, to our colleges whose were positive participant in practical part of the search and to all the members of the team.
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Title: Pediatric Basic life support
Objectives: • • •
Save lives. Filling our gap of knowledge about basic life support. Teaching our colleges BLS Technique: Successful participants will be able to: Demonstrate the ability to identify patients who require BLS. Demonstrate recognition of major life threatening situations including full arrest, respiratory arrest and foreign body airway obstruction. Demonstrate understanding of new BLS for Healthcare guideline changes and perform the guidelines in an emergency situation. Follow most recent guide lines in BLS.
Definition Basic life support (BLS) is a level of medical care which is used for patients with lifethreatening illness or injury until the patient can be given full medical care. It can be provided by trained medical personnel, including emergency medical technicians, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment.
Introduction BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced Life Support (ALS). Most laypersons can master BLS skills after attending a short course. Firefighters and police officers are often required to be BLS certified. BLS is also immensely useful for many other professions, such as daycare providers, teachers and security personnel. CPR provided in the field buys time for higher medical responders to arrive and provide ALS care. For this reason it is essential that any person starting CPR also obtains ALS support by calling for help via radio using agency policies and procedures and/or using an appropriate emergency telephone number. An important advance in providing BLS is the availability of the automated external defibrillator or AED, which can be used to defibrillation or delivery. This improves survival outcomes in cardiac arrest cases.
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Basic life support consists of a number of life-saving techniques focused on the medicine "ABC"s of pre-hospital emergency care: •
Airway: the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the outside of the body Breathing: inflation and deflation of the lungs (respiration) via the airway Circulation: providing an adequate blood supply to the body, especially critical organs, so as to deliver oxygen to all cells and remove carbon dioxide, via the perfusion of blood throughout the body,
Healthy people maintain the ABCs by themselves. In an emergency situation, due to illness (medical condition) or trauma, BLS helps the patient ensure his or her own ABCs, or assists in maintaining fir the patient who is unable to do so. For airways, this will include maintaining optimal angles or possible insertion of oral or nasal adjuncts, to keep the airway unblocked. For breathing, this may include artificial respiration, often assisted by emergency oxygen. For circulation, this may include bleeding control or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action. In each case, the BLS provider is trained to detect ABC problems and attempt to correct them. BLS also typically includes considerations of patient transport such as various forms immobilization to prevent additional injury, including cervical collars, splinting limbs, and full body splints (backboards).
THE BLS SEQUENCE FOR INFANTS AND CHILDREN: S AFETY OF RESCUER AND VICTIM Always make sure that the area is safe for you and the victim. Move a victim only to ensure the victim’s safety. Although exposure to a victim while providing CPR carries a theoretical risk of infectious disease transmission, the risk is very low. (1) Check for Response and activate the EMS system: -Gently tap the victim and ask loudly, “Are you okay?” Call the child’s name if you know it. -Look for movement:
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(1) IF THE CHILD IS RESPONSIVE,
he or she will answer or move. Quickly check to see if the child has any injuries or needs medical assistance. If necessary, leave the child to phone EMS, but return quickly and recheck the child’s condition frequently. Children with respiratory distress often assume a position that maintains airway patency and optimizes ventilation. Allow the child with respiratory distress to remain in a position that is most comfortable. (2)IF
CHILD AND IS
MOVING, shout for help and start CPR. If you are alone, continue CPR for 5 cycles (about 2 minutes). One cycle of CPR for the lone rescuer is 30 compressions and 2 breaths then activate the EMS. If you are alone and there is no evidence of trauma, you may carry a small child with you to the telephone. The EMS dispatcher can guide you through the steps of CPR. If a second rescuer is present, that rescuer should immediately activate the EMS system and get an AED (if the child is 1 year of age or older) while you continue CPR. If you suspect trauma, the second rescuer may assist by stabilizing the child’s cervical spine . If the child must be moved for safety reasons, support the head and body to minimize turning, bending, or twisting of the head and neck.
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Position the Victim: If the victim is unresponsive, make sure that the victim is in a supine (face-up) position on a flat, hard surface such as a sturdy table, the floor, or the ground. If you must turn the victim, minimize turning or twisting of the head and neck. Open the Airway: LAY RESCUER: Open the airway using a head tilt-chin lift maneuver for both injured and non-injured victims. The jaw thrust is no longer recommended for lay rescuers because
• • •
IT is difficult to learned perform It is often not an effective way to open the airway may cause spinal movement
FOR HEALTH CARE P ROVIDER: A health care provider should use the head tilt-chin lift maneuver to open the airway of a victim without evidence of head or neck trauma. If there is cervical spine injury, open airway using jaw thrust without head tilt. (2, 3, 4) Check Breathing: While maintaining an open airway, take no more than 10 seconds to check whether the victim is breathing: • • •
Look for rhythmic chest and abdominal movement. Listen for exhaled breath sounds at the nose and mouth. Feel for exhaled air on your cheek. (5, 6)
If the child is breathing and there is no evidence of trauma: turn the child onto the side (recovery position) .This helps maintain a patent airway and Decreases risk of aspiration. GIVE RESCUE BREATHS: If the child is not breathing: maintain an open airway and give 2 breaths. Make sure that the breaths are effective (i.e. the chest rises) . In an infant, use a mouth-to-mouth-and-nose technique. In a child, use a mouth-to-mouth technique but pinch the nose closed to avoid passage of air outside from the nose. (7)
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BARRIER DEVICES: Some health care providers and lay rescuers may hesitate to give mouth-to-mouth Rescue breathing and prefer to use a barrier device (8-10). Barrier devices have not reduced the risk of transmission of infection, and some may increase resistance to air flow. If you use a barrier device, do not delay rescue breathing. BAG-MASK VENTILATION (HEALTH CARE PROVIDERS) Bag-mask ventilation can be as effective as end tracheal intubation and safer when providing ventilation for short period (11-14). But, bag-mask ventilation requires training and special skills. VENTILATION BAGS A self-inflating bag with a volume of at least 450 to 500 mL(15); smaller bags may not deliver an effective tidal volume(16). PRECAUTIONS :
HYPERVENTILATION; USE ONLY THE FORCE AND TIDAL VOLUME NECESSARY TO
MAKE THE CHEST RISE .
(2) DURING CPR FOR A VICTIM WITH AN ADVANCED AIRWAY (E. G., ENDOTRACHEAL TUBE, ESOPHAGEAL -TRACHEAL COMBITUBE OR LARYNGEAL MASK AIRWAY ) IN PLACE , RESCUERS SHOULD NO LONGER DELIVER “CYCLES ” OF CPR. THE COMPRESSING RESCUER SHOULD COMPRESS THE CHEST AT A RATE OF 100 TIMES PER MINUTE WITHOUT PAUSES FOR VENTILATIONS , AND THE RESCUER PROVIDING THE VENTILATION SHOULD DELIVER 8 TO 10 BREATHS PER MINUTE . TWO OR MORE RESCUERS SHOULD CHANGE THE COMPRESSOR ROLE APPROXIMATELY EVERY 2 MINUTES TO PREVENT COMPRESSOR FATIGUE AND DETERIORATION IN QUALITY AND RATE OF CHEST COMPRESSIONS . IF THE VICTIM HAS A PERUSING RHYTHM (I.E., PULSES ARE PRESENT) BUT NO BREATHING, GIVE 12 TO 20 BREATHS PER MINUTE (1 BREATH EVERY 3–5 SECONDS). OXYGEN SUPPLY: (1) Masks: Provide o2 concentration of 30% to 50% to a victim with spontaneous breathing. (2) Nasal cannulas: Concentration of delivered o2 depends on: child`s size, respiratory rate, respiratory effort (17)
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Two-finger chest compression technique in infant (1 rescuer). Two thumb-encircling hands chest compression in infant (2 rescuers). Pulse Check
Try to palpate pulse (brachial in infant or carotid and femoral in a child). No more than 10 seconds to start chest compression. Compression is recommended when pulse is