Mod D Tech 17 Adult and Paediatric BLS Flashcards
BLS
BLS
BLS
Primary Survey
DANGER
Response
Airway
- Head tilt/chin lift to check and clear the airway for obstruction
- Adjust to jaw thrust if c-spine injury is suspected
•
Note: the tongue is the
most likely obstruction
to the airway
Breathing and circulation
- Look, listen and feel for breathing (min 10 seconds)
- Check carotid pulse at the same time
•
•Assess breathing for:
–Rate
–Depth
–Adequacy
–•Assist ventilations if less than 10 or more than 30 breaths a minute
If the patient is not breathing normally:
•It may be difficult to be certain there is no pulse
•
•If there are no signs of life (lack of movement, normal breathing or coughing) or there is doubt, start chest compressions
Cardiopulmonary resuscitation (CPR)
- Commence chest compressions (30) followed by 2 rescue breaths
- •Continue at ratio of 30:2
- •Compress to a depth of 5-6 cm
- •Compress at a rate of 100-120/min
Maternal resuscitation
Special considerations
•Difficult airway management
–Engorged breasts
–Short obese neck
–Full dentition
•Difficult ventilation
–Spayed rib cage
–Raised diaphragm
•Reduced venous return
–Inferior vena cava compression
Special considerations
Maternal resuscitation
Management
- Don’t withhold or terminate pre-hospital resuscitation
- Consider I gel early in an attempt to protect the airway and reduce gastric insufflation
•
•Tilt the mother 15-30o laterally, using a wedge under the right-hand side
–Angle of tilt needs to allow high-quality chest compressions
–
•Treat as time-critical transfer, ensure pre-alert to hospital and ask for obstetrician to stand-by in A&E
Laryngectomy stoma patient
•Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx.
Tracheostomy/stoma
Basic Life Support
(Paediatric)
Chest Compressions
(Paediatric)
•Start chest compressions if:
“there are no signs of life, unless you are CERTAIN that you can feel a definite pulse of greater than 60/min”
•Depress the sternum by at least one-third the depth of the chest
•
•Compress at a rate of 100 – 120/min
•
•Push “hard and fast”
Considerations
Summary
Note incorrect placement of fingers. Avoid contact with soft tissues under chin as this may occlude the airway.
Ensure fingertip(s) placed on point of chin.
Note effect of large occiput on airway.
Pathways to Cardiac Arrest in Childhood
Paediatric Emergencies
- The outcome of cardiac arrest in children outside hospital is even worse than in adults
- •Children usually arrest because of hypoxia and acidosis due to respiratory or circulatory insufficiency
- Extensive cellular damage will take place before the heart actually stops
- The most important skill in managing paediatric emergencies is patient assessment
- Early recognition and management of developing respiratory distress or circulatory impairment or changed level of consciousness in a child will allow the clinician to rapidly transport the child to hospital for further urgent assessment and treatment
Pediatric Resuscitation
Newborn Basic Life Support
Pediatric Resuscitation
•Dry the baby
•
•Keep them warm
•
•Assess
Pediatric Resuscitation
Assess
Assess
- Colour
- •Tone
- •Breathing rate
- •Heart rate -
- Reassess every 30 seconds
Possible Presentations
- Healthy – blue (pink within 90 secs), breathing, crying, good tone, heart rate >100/min (120-150/min)
- Less Healthy - Inadequate respirations,
reduced tone, heart rate <100/min
•Ill - Inadequate respirations (or apnoeic), floppy, pale, heart rate <60/min or absent
Pediatric Resuscitation
What do the APGAR Scores mean in practice?
Normal APGAR score 7 – 10
Resuscitative measures might be needed APGAR 4-7
Immediate APGAR <4 resuscitation needed
Assess at 1min, 5 mins re-assess if resuscitative measures have been needed
•
You should, however, treat the baby not the score!
Post Cardiac Arrest
•ABCDE approach
•
• Controlled oxygenation and ventilation
•
• 12-lead ECG
•
• Treat precipitating cause
