Author Topic: BLS Resuscitation Guidelines Guidelines 2010  (Read 1592 times)

adi

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BLS Resuscitation Guidelines Guidelines 2010
« on: September 28, 2013, 06:50:15 PM »
Right lets try to put this to bed.. Compression only CPR should only be used if cardiac arrest is witnessed and the patent is objectionable to you i.e. signs of drub use, covered in vomit. The ambulance service may tell you to do compression only CPR if you ring them and you are not first aid trained.

Resuscitation Council (UK)

2010 RESUSCITATION GUIDELINES 15

Adult   Basic Life Support


Introduction
This chapter contains the guidelines for out-of-hospital, single rescuer, adult basic life
support (BLS). Like the other guidelines in this publication, it is based on the document
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations (CoSTR), which was
published in October 2010. Basic life support refers to maintaining airway patency and
supporting breathing and the circulation without the use of equipment other than a
protective device.

It is important that those who may be present at the scene of a cardiac arrest,
particularly lay bystanders, should have learnt the appropriate resuscitation skills and be
able to put them into practice. Simplification of the BLS sequence continues to be a
feature of these guidelines, but, in addition, there is now advice on who should be
taught what skills, particularly chest-compression-only or chest compression and
ventilation. Within this advice, allowance has been made for the rescuer who is unable
or unwilling to perform rescue breathing, and for those who are untrained and receive
telephone advice from the ambulance service.

Guidelines 2000 introduced the concept of checking for ‘signs of a circulation’. This
change was made because of the evidence that relying on a check of the carotid pulse
to diagnose cardiac arrest is unreliable and time-consuming, mainly, but not exclusively,
when attempted by non-healthcare professionals.

 Subsequent studies have shown that
checking for breathing is also prone to error, particularly as agonal gasps are often
misdiagnosed as normal breathing.10 In Guidelines 2010 the absence of normal
breathing continues to be the main sign of cardiac arrest in a non-responsive victim.
Once cardiopulmonary resuscitation (CPR) has started, it is now recommended that the
rescuer should only stop CPR if the victim shows signs of regaining consciousness,
such as coughing, opening his eyes, speaking, or moving purposefully, as well as
breathing normally.

Guideline changes
It is well documented that interruptions in chest compression are common and are
associated with a reduced chance of survival.  The ‘perfect’ solution is to deliver
continuous compressions whilst giving ventilations independently. This is possible when
the victim has an advanced airway in place, and is discussed in the adult advanced life
support (ALS) chapter. Compression-only CPR is another way to increase the number
of compressions given and will, by definition, eliminate pauses. It is effective for limited period only (probably less than 5 min) and is not recommended as the
standard management of out-of-hospital cardiac arrest.


It is also known that chest compressions, both in hospital and outside, are often
undertaken with insufficient depth and at the wrong rate.

 The following changes in the BLS guidelines have been made to reflect the importance
placed on chest compression, particularly good quality compressions, and to attempt to
reduce the number and duration of pauses in chest compression:
1. When obtaining help, ask for an automated external defibrillator (AED), if
one is available.
2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1
.
3. Give each rescue breath over 1s rather than 2s.
4. Do not stop to check the victim or discontinue CPR unless the victim starts to
show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully AND starts to breathe normally.
5. Teach CPR to laypeople with an emphasis on chest compression, but
include ventilation as the standard, particularly for those with a duty of care.
In addition, advice has been added on the use of oxygen, and how to manage a victim
who regurgitates stomach contents during resuscitation. Resuscitation Council (UK)

Adult basic life support algorithm
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 999
30 chest compressions
2 rescue breaths
30 compressions

Adult basic life support sequence
Basic life support consists of the following sequence of actions:
1. Make sure the victim, any bystanders, and you are safe.
2. Check the victim for a response.
Gently shake his shoulders and ask loudly, ‘Are you all right?’
3A. If he responds:
Leave him in the position in which you find him provided there is no further
danger.
Try to find out what is wrong with him and get help if needed.
Reassess him regularly.
3B. If he does not respond:
Shout for help.
Turn the victim onto his back and then open the airway using head tilt and
chin lift:
Place your hand on his forehead and gently tilt his head back.
With your fingertips under the point of the victim's chin, lift the chin
to open the airway.

4. Keeping the airway open, look, listen, and feel for normal breathing.
Look for chest movement.
Listen at the victim's mouth for breath sounds.
Feel for air on your cheek.
In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking
infrequent, noisy, gasps. This is often termed agonal breathing and must not be
confused with normal breathing.
Look, listen, and feel for no more than 10s to determine if the victim is breathing
normally. If you have any doubt whether breathing is normal, act as if it is not normal.

5A. If he is breathing normally:
Turn him into the recovery position (see below).
Summon help from the ambulance service by mobile phone. If this is not
possible, send a bystander. Leave the victim only if no other way of obtaining
help is possible.
Continue to assess that breathing remains normal. If there is any doubt
about the presence of normal breathing, start CPR .

5B. If he is not breathing normally:
Ask someone to call for an ambulance and bring an AED if available. If you
are on your own, use your mobile phone to call for an ambulance. Leave the
victim only when no other option exists for getting help.
Start chest compression as follows:
Kneel by the side of the victim.
Place the heel of one hand in the centre of the victim’s chest
(which is the lower half of the victim’s sternum (breastbone)).
Place the heel of your other hand on top of the first hand.
Interlock the fingers of your hands and ensure that pressure is not
applied over the victim's ribs. Do not apply any pressure over the
upper abdomen or the bottom end of the sternum.
Position yourself vertically above the victim's chest and, with your
arms straight, press down on the sternum 5 - 6 cm.
After each compression, release all the pressure on the chest
without losing contact between your hands and the sternum.
Repeat at a rate of 100 - 120 min.
Compression and release should take an equal amount of time.

6A. Combine chest compression with rescue breaths:
After 30 compressions open the airway again using head tilt and chin lift.
Pinch the soft part of the victim’s nose closed, using the index finger and
thumb of your hand on his forehead.
Allow his mouth to open, but maintain chin lift.
Take a normal breath and place your lips around his mouth, making sure
that you have a good seal.
Blow steadily into his mouth whilst watching for his chest to rise; take about
one second to make his chest rise as in normal breathing; this is an effective
rescue breath.
Maintaining head tilt and chin lift, take your mouth away from the victim and
watch for his chest to fall as air comes out.
Take another normal breath and blow into the victim’s mouth once more to
give a total of two effective rescue breaths. The two breaths should not take
more than 5s. Then return your hands without delay to the correct position
on the sternum and give a further 30 chest compressions.
Continue with chest compressions and rescue breaths in a ratio of 30:2.
Stop to recheck the victim only if he starts to show signs of regaining
consciousness, such as coughing, opening his eyes, speaking, or moving
purposefully AND starts to breathe normally; otherwise do not interrupt
If the initial rescue breath of each sequence does not make the chest rise as in normal
breathing, then, before your next attempt:
Check the victim's mouth and remove any visible obstruction.
Recheck that there is adequate head tilt and chin lift.
Do not attempt more than two breaths each time before returning to chest
compressions.

If there is more than one rescuer present, another should take over CPR about every
1-2 min to prevent fatigue. Ensure the minimum of delay during the changeover of
rescuers, and do not interrupt chest compressions.

6B. Compression-only CPR
If you are not trained to, or are unwilling to give rescue breaths, give chest
compressions only.
If chest compressions only are given, these should be continuous at a rate of
100 - 120 min
.
Stop to recheck the victim only if he starts to show signs of regaining
consciousness, such as coughing, opening his eyes, speaking, or moving
purposefully AND starts to breathe normally; otherwise do not interrupt
resuscitation.

7. Continue resuscitation until:
qualified help arrives and takes over,
the victim starts to show signs of regaining consciousness, such as
coughing, opening his eyes, speaking, or moving purposefully AND starts to
breathe normally, OR
you become exhausted.
Further points related to basic life support
Risks to the rescuer and victim
The safety of both the rescuer and victim are paramount during a resuscitation attempt.
There have been few incidents of rescuers suffering adverse effects from undertaking
CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute
respiratory distress syndrome (SARS). Transmission of HIV during CPR has never been
reported.

There have been no human studies to address the effectiveness of barrier devices
during CPR; however, laboratory studies have shown that certain filters, or barrier
devices with one-way valves, prevent transmission of oral bacteria from the victim to the
rescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safety
precautions where feasible, especially if the victim is known to have a serious infection
such as TB or SARS. During an outbreak of a highly infectious condition (such as
SARS), full protective precautions for the rescuer are essential.
Initial rescue breaths
During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content
remains high. Therefore, ventilation is less important than chest compression at this
time.

It is well recognised that skill acquisition and retention are aided by simplification of the
BLS sequence of actions. It is also recognised that rescuers are frequently unwilling to
carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection
and distaste for the procedure. For these reasons, and to emphasise the priority of
chest compressions, it is recommended that, in adults, CPR should start with chest
compressions rather than initial ventilations.

Jaw thrust
The jaw thrust technique is not recommended for lay rescuers because it is difficult to
learn and perform. Therefore, the lay rescuer should open the airway using a head-tiltchin-lift manoeuvre for both injured and non-injured victims.

Agonal gasps
Agonal gasps are present in up to 40% of cardiac arrest victims.10 Therefore laypeople
should be taught to begin CPR if the victim is unconscious (unresponsive) and not
breathing normally. It should be emphasised during training that agonal gasps occur
commonly in the first few minutes after sudden cardiac arrest; they are an indication for
starting CPR immediately and should not be confused with normal breathing.
Use of oxygen during basic life support
There is no evidence that oxygen administration is of benefit during basic life support in
the majority of cases of cardiac arrest before healthcare professionals are available with
equipment to secure the airway. Its use may lead to interruption in chest compressions,
and is not recommended, except in cases of drowning (see below).

Mouth-to-nose ventilation
Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It
may be considered if the victim’s mouth is seriously injured or cannot be opened, if the
rescuer is assisting a victim in the water, or if a mouth-to-mouth seal is difficult to
achieve.

Link to complete protocols. Adult Basic Life Support is Section 2. On page 15. 
http://www.resus.org.uk/pages/guide.htm
« Last Edit: September 29, 2013, 09:15:21 PM by adi »
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