Life Support Education
Delivery of rescue breaths, defibrillation shocks, ventilations and rhythm analysis lead to pauses in chest compressions. Leaning on the chest preventing full chest wall recoil is common during CPR. The proportion of a chest compression spent in compression compared to relaxation is referred to as the duty cycle.
CPR feedback and prompt devices e. Their use during clinical practice should be integrated with comprehensive CPR quality improvement initiatives rather than as an isolated intervention. Chest compression depth can decrease as soon as two minutes after starting chest compressions. If there are sufficient trained CPR providers, they should change over approximately every two minutes to prevent a decrease in compression quality. Changing CPR providers should not interrupt chest compressions. Avoid rapid or forceful breaths. The maximum interruption in chest compression to give two breaths should not exceed 10 seconds.
Mouth-to-nose ventilation is an acceptable alternative to mouth-to-mouth ventilation. Mouth-to-tracheostomy ventilation may be used for a victim with a tracheostomy tube or tracheal stoma who requires rescue breathing. Barrier devices decrease transmission of bacteria during rescue breathing in controlled laboratory settings. Their effectiveness in clinical practice is unknown.
If a barrier device is used, care should be taken to avoid unnecessary interruptions in CPR. Manikin studies indicate that the quality of CPR is improved when a pocket mask is used, compared to a bag-mask or simple face shield during basic life support. AEDs are safe and effective when used by laypeople, including if they have had minimal or no training.
CPR providers should concentrate on following the voice prompts, particularly when instructed to resume CPR, and minimising interruptions in chest compression. It is extremely rare for bystander CPR to cause serious harm in victims who are eventually found not to be in cardiac arrest. Those who are in cardiac arrest and exposed to longer durations of CPR are likely to sustain rib and sternal fractures. Damage to internal organs can occur but is rare. CPR providers should not, therefore, be reluctant to start CPR because of the concern of causing harm.
Choking is an uncommon but potentially treatable cause of accidental death. As most choking events are associated with eating, they are commonly witnessed. As victims are initially conscious and responsive, early interventions can be life-saving. Recognition of airway obstruction is the key to successful outcome, so do not confuse this emergency with fainting, myocardial infarction, seizure or other conditions that may cause sudden respiratory distress, cyanosis or loss of consciousness. Choking usually occurs while the victim is eating or drinking.
Foreign bodies may cause either mild or severe airway obstruction. The victim that is unable to speak, has a weakening cough, is struggling or unable to breathe, has severe airway obstruction. Coughing generates high and sustained airway pressures and may expel the foreign body.
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Aggressive treatment with back blows, abdominal thrusts and chest compressions at this stage may cause harm and can worsen the airway obstruction. These treatments are reserved for victims who have signs of severe airway obstruction. Victims with mild airway obstruction should remain under continuous observation until they improve, as severe airway obstruction may subsequently develop. The clinical data on choking are largely retrospective and anecdotal.
Approximately half of cases of airway obstruction are not relieved by a single technique. The likelihood of success is increased when combinations of back blows or slaps, and abdominal and chest thrusts are used. Higher airway pressures can be generated using chest thrusts compared with abdominal thrusts. Bystander initiation of chest compressions for unresponsive or unconscious victims of choking is associated with improved outcomes.
Therefore, start chest compressions promptly if the victim becomes unresponsive or unconscious. After 30 compressions, attempt 2 rescue breaths, and continue CPR until the victim recovers and starts to breathe normally. Search our Site Keywords. Guidelines and guidance Introduction Adult basic life support and automated external defibrillation Adult advanced life support Paediatric basic life support Paediatric advanced life support Resuscitation and support of transition of babies at birth Prehospital resuscitation In-hospital resuscitation Post-resuscitation care Prevention of cardiac arrest and decisions about CPR Peri-arrest arrhythmias Education and implementation of resuscitation Contributors and conflict of interest G video summaries ABCDE approach.
Adult advanced life support Adult basic life support and automated external defibrillation Education and implementation of resuscitation In-hospital resuscitation Paediatric advanced life support Paediatric basic life support Peri-arrest arrhythmias Post-resuscitation care Prehospital resuscitation Prevention of cardiac arrest and decisions about CPR Resuscitation and support of transition of babies at birth.
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Adult Life Support. Paediatric Life Support. Newborn Life support. Free publications. Newsletter - Issue Course publications. Apply for membership FAQs Members' shop. Add to My Basket. Adult basic life support and automated external defibrillation. The guidelines process includes: Systematic reviews with grading of the quality of evidence and strength of recommendations.
Summary of changes in basic life support and automated external defibrillation since the Guidelines Guidelines highlights the critical importance of the interactions between the emergency medical dispatcher, the bystander who provides cardiopulmonary resuscitation CPR and the timely deployment of an automated external defibrillator AED.
An effective, co-ordinated community response that draws these elements together is key to improving survival from out-of-hospital cardiac arrest. The emergency medical dispatcher plays an important role in the early diagnosis of cardiac arrest, the provision of dispatcher-assisted CPR also known as telephone CPR , and the location and dispatch of an AED. The sooner the emergency services are called, the earlier appropriate treatment can be initiated and supported.
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The knowledge, skills and confidence of bystanders will vary according to the circumstances, of the arrest, level of training and prior experience. The bystander who is trained and able should assess the collapsed victim rapidly to determine if the victim is unresponsive and not breathing normally and then immediately alert the emergency services. Whenever possible, alert the emergency services without leaving the victim. The victim who is unresponsive and not breathing normally is in cardiac arrest and requires CPR.
Immediately following cardiac arrest blood flow to the brain is reduced to virtually zero, which may cause seizure-like episodes that may be confused with epilepsy. Bystanders and emergency medical dispatchers should be suspicious of cardiac arrest in any patient presenting with seizures and carefully assess whether the victim is breathing normally. Introduction The community response to cardiac arrest is critical to saving lives.
Once cardiac arrest has occurred, early recognition is critical to enable rapid activation of the ambulance service and prompt initiation of bystander CPR. Figure 1. The Chain of Survival.
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Everyone who is able to should learn CPR. Defibrillators are available in places where there are large numbers of people e.
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Owners of defibrillators should register the location and availability of devices with their local ambulance services. Systems are implemented to enable ambulance services to identify and deploy the nearest available defibrillator to the scene of a suspected cardiac arrest. All out-of-hospital cardiac arrest resuscitation attempts are reported to the National Out-of-Hospital Cardiac Arrest Audit. Key messages from Guidelines Ensure it is safe to approach the victim. Promptly assess the unresponsive victim to determine if they are breathing normally.
Be suspicious of cardiac arrest in any patient presenting with seizures and carefully assess whether the victim is breathing normally. For the victim who is unresponsive and not breathing normally: Dial and ask for an ambulance.
If possible stay with the victim and get someone else to make the emergency call. If trained and able, combine chest compressions and rescue breaths, otherwise provide compression-only CPR. If an AED arrives, switch it on and follow the instructions. Do not stop CPR unless you are certain the victim has recovered and is breathing normally or a health professional tells you to stop Treat the victim who is choking by encouraging them to cough. If the victim deteriorates give up to 5 back slaps followed by up to 5 abdominal thrusts.
If the victim becomes unconscious — start CPR. The same steps can be followed for resuscitation of children by those who are not specifically trained in resuscitation for children — it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing. Adult BLS sequence The sequence of steps for the initial assessment and treatment of the unresponsive victim are summarised in Figure 2.