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ACLS &BLS -2010 RULES & CHANGESACLS &BLS -2010 RULES & CHANGES
BY-Dr Avijit Kumar Prusty,2nd Yr PGT,S.C.B Medical College, Cuttack,GUIDE- Asst Prof Dr S S Routray
BLS Principles – DRS CABDBLS Principles – DRS CABD• No change to Dangers and Response
• S – Send for help
• C – perform 30 Compressions for victims who are unresponsive and not breathing normally, followed by 2 breaths
• A – open the Airway
• B – check Breathing but no need to deliver two rescue breaths
• C – perform 30 Compressions for victims who are unresponsive and not breathing normally, followed by 2 breaths
• D – attach an AED as soon as it is available
BLS Principles – DRS ABCDBLS Principles – DRS ABCD
• Compressions before 2 initial rescue breaths
• “Signs of life” changed to “unresponsive and not breathing normally”
• If unwilling / unable to perform rescue breathing, then perform compression only CPR
• New focus on maintenance of CPR quality – change rescuers every two minutes
• Pulse check downgraded for HCPs – “unreliable indicator of the need for resuscitation”
BLS – CompressionsBLS – Compressions
• One or two handed technique for children • Push to a depth of at least 5 cms at a rate of
at least 100 / min• Allow full recoil of chest between
compressions • 30 Compressions : 2 ventilations for all age
groups (1 or 2 rescuer)• Apply AED (if available) – now BLS skill
taught as part of CPR programs
BLS – Health Professional (Cont)BLS – Health Professional (Cont)
• CPR Rates:– Single Rescuer: 30 Compressions : 2
ventilations at a rate of > 100 per minute for all age groups (Approx 5 cycles every 2 minutes – <18 seconds/cycle)
– Two Rescuer: Adult – 30:2 at rate of 100 per minute
– Two Rescuer: Child (0-14) 15:2 at rate of 100 per minute (Approx 10 cycles every 2 minutes)
• Pause to allow ventilations (until intubated or LMA insitu)
BLS – Health Professional (Cont)BLS – Health Professional (Cont)
• AED - Apply and follow the prompts• Continue until signs of life – briefly check (?
pulse) every two minutes (don’t pause CPR for more than 10 seconds!!)
• Change compressor every 2 minutes to avoid fatigue
AEDAED
• AED - Single shock strategy
• 2 minutes CPR before reanalysis
• No need to reprogram energy levels – should follow those programmed by manufacturer for their specific device
• Reasonable to continue to utilise older devices until replaced as part of normal life cycle – any resuscitation is better than none
CPR Changes EmphasiseCPR Changes Emphasise
“Push hard, push fast, minimise interruptions; allow full chest
recoil, and don’t hyperventilate”
RationaleRationale
• Although ventilations are impt part of resuscitation, evidence shows that compressions are the critical element in adult resuscitation. In the A-B-C sequence, compressions are often delayed.
• If a pulse is not detected within 10 seconds, do start compressions without further delay.
RECOMMENDATIONS
COMPONENTS ADULTS CHILDREN INFANTS
RECOGNITION NO BREATHING/NO NORMAL BREATHING
NO BREATHING/ONLY GASPING
ADULTS CHILDREN INFANTS
RECOMMENDATIONS
CPR Sequence C-A-B
Compression Rate
Atleast 100/Min
Compression Depth
Atleast 2 Inches(5 cm)
Atleast 1/3 APDAbout 2 Inches(5 cm)
Atleast 1/3 APDAbout 1.5 Inches(5 cm)
Chest wall Recoil
Allow Complete recoil between compressionsHCPs rotate compression every 2 mins
Compression Interupptions
Minimize Interruptions in chest compressionsAttempt to limit interruptions to < 10 secs
ADULTS CHILDREN INFANTS
AIRWAY Head Tilt-Chin Lift
COMPRESSION/ VENTILATION RATIO
30:21 OR 2 Rescuers
30:2=Single Rescuer15:2=2 HCP Rescuers
VENTILATIONS:WHEN RESCUER UNTRAINED OR NOT PROFICIENT
Compression Only
VENTILATION WITH ADVANCED AIRWAY
1 Breath every 6-8 Seconds (8-10 breaths/min)Asynchronus with Chest CompressionsAbout 1 second per BreathVisible Chest Rise
DEFIBRILLATION Attach and use AED as soon as possible.Minimize interupptions in Chest Compressions before and after shock;resume CPR with compressions immedieately after each Shock
Seek Reversible CausesSeek Reversible Causes
• 5Hs• Hypoxia• Hypovolemia• Hyperacidosis• Hyperkalemia• Hypothemia
• 5Ts• Thrombus (MI)• Thrombus (PE)• Tension PTX• Toxins• Tamponade