East of England Ambulance Service NHS Trust Basic

East of England Ambulance Service NHS Trust Basic Life Support and Automated External Defibrillation 12/02/2015

OBJECTIVES BLS & AED • At the end of this course participants should be able to demonstrate: – How to assess the collapsed casualty. – How to perform Basic Life Support (BLS). – How to place an unconscious breathing victim in the recovery position. – Introduction to operating an automated external defibrillator (AED) safely. East of England Ambulance Service NHS Trust 2 Date 12/02/2015

BACKGROUND BLS & AED • In the UK approximately 30, 000 people sustain cardiac arrest outside hospital and are treated by emergency services each year. • Bystander CPR and early Defibrillation are vital interventions before the arrival of emergency services. • If defibrillation is delivered promptly, survival rates as high as 75% have been reported. • The chances of successful defibrillation decline at a rate of about 10% with each minute of delay. East of England Ambulance Service NHS Trust 3 Date 12/02/2015

BLS & AED ANYONE CAN DO IT? East of England Ambulance Service NHS Trust 4 Date 12/02/2015

BLS & AED 2% 4% 30% East of England Ambulance Service NHS Trust 5 Date 12/02/2015

BLS & AED Angina Suspected Heart Attack CARDIAC CONDITIONS East of England Ambulance Service NHS Trust 6 Date 12/02/2015

BLS & AED CARDIAC CONDITIONS • Coronary heart disease is the UK's biggest killer, with 1 in every 4 men and 1 in every 6 women dying from the disease. • In the UK, approximately 300, 000 people have a heart attack each year. • Angina affects about 1 in 50 people, and in the UK there an estimated 1. 2 million people with the condition. It affects men more than women, and your chances of being affected increase with age. East of England Ambulance Service NHS Trust 7 Date 12/02/2015

Blood returning from upper body BLS & AED Oxygenated blood to upper body Blood to lungs Oxygenated blood from lungs Blood returning from lower body Oxygenated blood to lower body East of England Ambulance Service NHS Trust 8 Date 12/02/2015

BLS & AED HOW MANY TIMES DOES THE HUMAN HEART BEAT IN A DAY ? 100, 800 beats per day (70 beats x 60 minutes x 24 hours = 100, 800 beats) East of England Ambulance Service NHS Trust 9 Date 12/02/2015

BLS & AED Suspected Heart Attack East of England Ambulance Service NHS Trust 10 Date 12/02/2015

Heart Attack BLS & AED East of England Ambulance Service NHS Trust 11 Date 12/02/2015

BLS & AED Suspected Heart Attack -Pale, cold & clammy skin -Rapid weak pulse -Rapid shallow breathing -Nausea -Vomiting -Pain in chest possibly radiating into arm, back and/or jaw -Sweating -Impending sense of doom Some or all of these symptoms may be present, no two Heart attacks are the same. . . East of England Ambulance Service NHS Trust 12 Date 12/02/2015

BLS & AED CARDIAC CONDITIONS • Angina is a pain or discomfort felt in the chest caused by coronary heart disease. • Typically presents as heaviness or tightness in the chest • Often brought on by physical activity. • Symptoms usually subside after a few mins. • Angina Suffers usually carry GTN medication in the form of a spray or tablet East of England Ambulance Service NHS Trust 13 Date 12/02/2015

BLS & AED Suspected Heart attack Dial 999 or 112 for Ambulance -Rest in a comfortable position -Reassure -Help casualty to take their own GTN -Be prepared to resuscitate -Have AED available If in any Doubt dial 999 or 112 East of England Ambulance Service NHS Trust 14 Date 12/02/2015

BLS & AED Primary Survey Performing CPR Recovery Position BASIC LIFE SUPPORT East of England Ambulance Service NHS Trust 15 Date 12/02/2015

BLS & AED PRIMARY SURVEY Initial assessment using the primary survey - D anger (Global overview) - R esponse - S hout for help - A irway - B reathing - C all 999/112 - commence CPR East of England Ambulance Service NHS Trust 16 Date 12/02/2015

BLS & AED Airway Management Airway Open Airway Closed Airway Obstructed • An unconscious casualty has no control over their muscles, including the muscles that control the tongue. East of England Ambulance Service NHS Trust 17 Date 12/02/2015

BLS & AED Approach safely Check response Shout for help Open airway Check breathing Recovery Position? Dial 999/112 Monitor Patient East of England Ambulance Service NHS Trust 18 Date 12/02/2015

BLS & AED APPROACH SAFELY! Approach safely Rescuer Scene Victim Check response Shout for help Open airway Check breathing Recovery Position Bystanders East of England Ambulance Service NHS Trust 19 Dial 999/112 Monitor Date 12/02/2015

CHECK RESPONSE BLS & AED Approach safely Check response Shout for help Open airway Check breathing Recovery Position? Dial 999/1123 Monitor East of England Ambulance Service NHS Trust 20 Date 12/02/2015

BLS & AED CHECK RESPONSE Shake shoulders gently “Hello can you hear me? ” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly. • If no response. . . East of England Ambulance Service NHS Trust 21 Date 12/02/2015

BLS & AED SHOUT FOR HELP Approach safely Check response Shout for help Open airway Check breathing Recovery Position? Dial 999/112 Monitor East of England Ambulance Service NHS Trust 22 Date 12/02/2015

BLS & AED OPEN AIRWAY Approach safely Check response Shout for help Open airway Check breathing Recovery Position Dial 999/112 Monitor East of England Ambulance Service NHS Trust 23 Date 12/02/2015

BLS & AED CHECK BREATHING • Look, listen and feel for NORMAL breathing for 10 sec • Do not confuse Agonal breathing with NORMAL breathing • If you have any doubts act as if breathing is not normal East of England Ambulance Service NHS Trust 24 Date 12/02/2015

BLS & AED Not Breathing normally ? • No sign of Chest Movement • No sounds of Breathing • No feeling of breath against your ear Agonal Breathing • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing Recognised as a sign of cardiac arrest East of England Ambulance Service NHS Trust 25 Date 12/02/2015

BLS & AED AGONAL BREATHING East of England Ambulance Service NHS Trust 26 Date 12/02/2015

BLS & AED Approach safely Check response Shout for help If no help arrives and you are alone dial 999/112 After putting into recovery position. Open airway Check breathing Recovery Position Dial 999/112 Monitor East of England Ambulance Service NHS Trust 27 Date 12/02/2015

BLS & AED Recovery position 1 • Kneel next to the person. Place the arm closest to you straight out from the body. Position the far arm with the back of the hand against the near cheek. East of England Ambulance Service NHS Trust 28 Date 12/02/2015

BLS & AED Recovery position 2 • Grab and bend the person's far knee East of England Ambulance Service NHS Trust 29 Date 12/02/2015

BLS & AED Recovery position 3 • Protecting the head with one hand, gently roll the person toward you by pulling the far knee over and to the ground East of England Ambulance Service NHS Trust 30 Date 12/02/2015

BLS & AED 30 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airway Check breathing Dial 999/112 30 chest compressions East of England Ambulance Service 2 rescue breaths NHS Trust 31 Date 12/02/2015

BLS & AED Recovery position 4 • Tilt the head up slightly so that the airway remains open. Make sure that the hand is under the cheek, checking the airway and also for eventual wakening. Place a blanket or coat over the person (unless he or she has a heat illness or fever) and stay close until help arrives East of England Ambulance Service NHS Trust 32 Date 12/02/2015

BLS & AED If Not Breathing Don’t Panic East of England Ambulance Service NHS Trust 33 Date 12/02/2015

BLS & AED CHEST COMPRESSIONS • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest –Rate 100 to 120 –Depth 5 -6 cm –Equal compression : relaxation • When possible change CPR operator every 2 min East of England Ambulance Service NHS Trust 34 Date 12/02/2015

BLS & AED RESCUE BREATHS Approach safely Check response Shout for help Open airway Check breathing Dial 999/112 30 chest compressions 2 rescue breaths East of England Ambulance Service NHS Trust 35 Date 12/02/2015

BLS & AED RESCUE BREATHS • Pinch the nose • Take a normal breath • Place lips over mouth • Blow until the chest rises • Deliver rescue breath for 1 second • Allow chest to fall • Repeat • This should not take longer than 5 sec , then return to chest compressions without delay East of England Ambulance Service NHS Trust 36 Date 12/02/2015

BLS & AED Combine Compressions and Rescue breaths at a ratio of 30: 2 30 2 30 East of England Ambulance Service NHS Trust 37 Date 12/02/2015

BLS & AED ANY QUESTIONS ? TIME TO PRACTICE. . . East of England Ambulance Service NHS Trust 38 Date 12/02/2015

CHILD CPR BLS & AED • Many children do not receive resuscitation because potential rescuers fear causing harm. • This fear is unfounded; it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing. • Bystander resuscitation significantly improves outcome in children. • Outcomes could be further improved if bystanders who would otherwise do nothing, were encouraged to begin resuscitation. East of England Ambulance Service NHS Trust 39 Date 12/02/2015

BLS & AED CHILDREN AND BABIES East of England Ambulance Service NHS Trust 40 Date 12/02/2015

BLS & AED COMPRESSION only CPR If a rescuer is unable or unwilling to perform rescue breaths it is expectable to perform compressions only CPR However, chest compression combined with rescue breaths is the method of choice for CPR by trained lay rescuers and professionals. East of England Ambulance Service NHS Trust 41 Date 12/02/2015

When to stop CPR BLS & AED Once CPR is started the rescuer should only stop CPR when the casualty shows signs of regaining conscious by : • Coughing • Opening eyes • Speaking or moving purposefully • Starts to Breath NORMALLY again Or East of England Ambulance Service • Qualified help arrives and takes over • You become exhausted • It is unsafe to continue NHS Trust 42 Date 12/02/2015

POCKET MASK BLS & AED The pocket mask is an effective barrier device. It has a one-way valve which prevents the casualty's exhaled air being inhaled by the Rescuer. East of England Ambulance Service NHS Trust 43 Date 12/02/2015

BLS & AED ANY QUESTIONS ? TIME TO PRACTICE. . . East of England Ambulance Service NHS Trust 44 Date 12/02/2015

BLS & AED Understanding Defibrillation Safe use of an AED DEFIBRILLATION East of England Ambulance Service NHS Trust 45 Date 12/02/2015

BLS & AED AUTOMATED EXTERNAL DEFIBRILLATORS • An AED is an “electric shock box” used to stop the electrical activity of the heart when it is in a life threatening rhythm, this allows the Heart to re-establish an effective rhythm. • The AED will; – analyse the presenting rhythm – only advise a shock for a shockable rhythm – advise the operator step-by-step what to do East of England Ambulance Service NHS Trust 46 Date 12/02/2015

BLS & AED AUTOMATED EXTERNAL DEFIBRILLATORS • An AED can be used safely and effectively without previous training. • Therefore, the use of an AED should not be restricted to trained rescuers. • However, training should be encouraged to help improve the time to shock delivery and correct pad placement. East of England Ambulance Service NHS Trust 47 Date 12/02/2015

BLS & AED • There are 2 types of AED: Automatic- will deliver shock automatically Semi Automatic – rescuer intervention required to deliver shock. • Once you have completed this training you will be able to use any make or model AED’s can be found in many public buildings e. g. Sports centres, Railway stations, Shopping centres and Schools East of England Ambulance Service NHS Trust 48 Date 12/02/2015

BLS & AED 2% 4% 30% East of England Ambulance Service NHS Trust 49 Date 12/02/2015

BLS & AED Understanding Defibrillation • The heart’s pumping action controlled by electrical system • Electrical rhythm normally very organized • Normal heart’s rhythm is called “Sinus Rhythm” • Normal heart rate of 60 - 100 beats per minute East of England Ambulance Service NHS Trust 50 Date 12/02/2015

BLS & AED Understanding Defibrillation: Ventricular Fibrillation (VF) • VF is the most common rhythm in Sudden Cardiac Arrest (90%) • Electrical Problem in Nature • Chaotic rhythm results in “quivering of heart” and results in loss of pulse • VF will result in brain damage within 5 minutes and death in 10 -15 minutes East of England Ambulance Service NHS Trust 51 Date 12/02/2015

BLS & AED Understanding Defibrillation • Defibrillation may correct VF • Uses DC current delivered across the heart • A successful defibrillation “depolarizes” the heart’s cells • Depolarization allows the cells to “reorganize” • Defibrillation is the ONLY effective cure for VF! East of England Ambulance Service NHS Trust 52 Date 12/02/2015

Single Rescuer BLS & AED Approach safely Check response Shout for help Open airway Check breathing Dial 999/112 – get AED Attach AED before CPR Follow voice prompts East of England Ambulance Service NHS Trust 53 Date 12/02/2015

Approach safely Check response Shout for help Open airway BLS & AED 2 or more Rescuers Check breathing 1 st Rescuer commence CPR 2 nd Rescuer Call 999 /112 gets AED and attaches to Patient Follow voice prompts East of England Ambulance Service NHS Trust 54 Date 12/02/2015

BLS & AED Minimise interruptions in CPR • If alone, attach AED before commencing CPR • If 2 rescuers, provide good quality CPR while the AED is brought to the scene, is turned on, and pads attached • Interrupt CPR only when it is necessary to analyse the rhythm and deliver a shock East of England Ambulance Service NHS Trust 55 Date 12/02/2015

BLS & AED DEFIBRILLATION SAFETY ! § § § § THE PATIENT. 5 point check Pacemaker Jewellery Hair on chest Damp/Wet skin Patches (GTN) THE AED. In good working order Do Not use in Heavy rain Do Not use if they lay in a pool of water § Do Not use in an explosive environment ! § § East of England Ambulance Service NHS Trust 56 Date 12/02/2015

BLS & AED ATTACH PADS TO CASUALTY’S BARE CHEST East of England Ambulance Service NHS Trust 57 Date 12/02/2015

BLS & AED ANALYSING RHYTHM DO NOT TOUCH PATIENT East of England Ambulance Service NHS Trust 58 Date 12/02/2015

BLS & AED SHOCK ADVISED East of England Ambulance Service “Stand clear Everyone” ! • TOP • MIDDLE • BOTTOM • MYSELF • BEHIND YOU DELIVER SHOCK NHS Trust 59 Date 12/02/2015

BLS & AED DEFIBRILLATION SAFETY ! • REMEMBER. • Always check that NO PERSON or ANIMALS are touching the patient prior to shocking. • That you are not touching the patient in any way. East of England Ambulance Service NHS Trust 60 Date 12/02/2015

BLS & AED DEFIBRILLATION East of England Ambulance Service NHS Trust 61 Date 12/02/2015

BLS & AED SHOCK DELIVERED FOLLOW AED INSTRUCTIONS East of England Ambulance Service 62 NHS Trust Date 12/02/2015

BLS & AED COMMENCE CPR (2 MINS) 30 2 30 2 East of England Ambulance Service NHS Trust 63 Date 12/02/2015

BLS & AED NO SHOCK ADVISED FOLLOW AED INSTRUCTIONS East of England Ambulance Service 64 NHS Trust Date 12/02/2015

BLS & AED COMMENCE CPR (2 MINS) 30 2 30 2 East of England Ambulance Service NHS Trust 65 Date 12/02/2015

BLS & AED ANY QUESTIONS ? TIME TO PRACTICE. . . East of England Ambulance Service NHS Trust 66 Date 12/02/2015

BLS & AED CHILDREN AND AED’S • Standard AEDs are suitable for use on children of 8 years and above. • In children between 1 and 7 years paediatric pads or a paediatric mode should be used. • Do not use an AED on an Infant less than 1 year. East of England Ambulance Service NHS Trust 67 Date 12/02/2015

BLS & AED East of England Ambulance Service NHS Trust 68 Date 12/02/2015

BLS & AED East of England Ambulance Service NHS Trust 69 Date 12/02/2015

• • • FOLLOW UP – WHAT TOBLS & AED DO AFTER? If you have used an Automated External Defibrillator, even by just attaching it to a patient, you must: Dispose of the pads used as clinical waste Replace the pads on the machine Inform named person that the Defibrillator has been used so that any data can be captured from the device Complete a “Defibrillator Event Report Form” If you require any equipment to be replaced, i. e. pads, pocket masks, razors etc. Please contact your named person as soon as possible. East of England Ambulance Service NHS Trust 70 Date 12/02/2015

BLS & AED WHEN NOT TO RESUSCITATE • Once CPR is started the rescuer should only stop CPR when the casualty shows signs or regaining conscious by • Coughing • Opening eyes • Speaking or moving purposefully • Starts to Breath NORMALLY again Or • • Qualified help arrives and takes over • You become exhausted • It is unsafe to continue East of England Ambulance Service NHS Trust 71 Date 12/02/2015

BLS & AED OR IF YOU SEE THIS HAS OCCURRED ! East of England Ambulance Service NHS Trust 72 Date 12/02/2015

OOP’S ? ? BLS & AED East of England Ambulance Service NHS Trust 73 Date 12/02/2015

BLS & AED ANY QUESTIONS ? East of England Ambulance Service NHS Trust 74 Date 12/02/2015

BLEEDING BLS & AED East of England Ambulance Service NHS Trust 75 Date 12/02/2015

BLEEDING • • BLS & AED Raise Limb Cover with clean dressing or cloth 999 or 112 Reassure Lay down Raise legs Monitor East of England Ambulance Service NHS Trust 76 Date 12/02/2015