Definition of "Life support"
Life support are emergency techniques performed support life after the failure of one or more vital organs.
Patient information
What is life support?It's where you try to "support life", after 1 or more of the vital organs fail.
What are the vital organs?
They are the 5 organs essential for survival. They're the brain, heart, kidneys, liver, and lungs.
- Basic life support (BLS, DRSABCD, aka first aid), is provided by bystanders before emergency services arrive. A✓B✓C✓ is shorthand for Airway, breathing and circulation are all normal. It includes:
- Check for Danger
- Assess for Response, verbalizing to patient, placing hand on their forehead, and shaking their arm
- Send for help, shout for help, emergency response button, or emergency response phone number (77)
- Open and clear Airways, using head tilt/chin lift in adults, or jaw thrust and in neutral position in children
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Patient information
Basic life support. Advanced life support. What's the difference?Basic life support is what the layperson can do. Advanced life support is what doctors do.
What is basic life support then?
DRSABCD. Watch out for any danger. Check for response. Send for help. Open and clear airways. Assess breathing. Assess circulation. And if things are going bad, start compressions. Attach the defibrillator as soon as you can.
How do you assess response?
Dry and stimulate bub. For adults, shake and pinch.
How do you open and clear airways?
Jaw thrust. Or chin lift and head tilt. Jaw thrust is where you place fingers under angle of lower jaw, and lift the jaw up, by the rear, at the jaw bone. You don't need to tilt the head up for that, which is useful if there's an injury, particularly of the spine. Chin lift and head tilt, is where you change the angle of the whole head, by lifting up the chin, and pushing the forehead back.
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- Assess Breathing, by placing face above infant, so that their ear is over nose, cheek over mouth, and eyes looking over chest, look (for movement, especially rise/fall of abdomen), listen (for life indicating sounds, e.g. breathing, swallowing), and feel (for breath on cheek) for 10 seconds. Also place palm on abdomen, to check for changes in pressure of abdomen against hand. If the Pt is unresponsive and not breathing, normally then give 2 rescue breaths w/ a bag and mask, mouth to mask, or mouth to mouth/nose, depending on availability. For mouth to mouth, the nose is pinched closed. Infants use a mouth to mouth and nose
- Assess Circulation, and commence Compressions (aka CPR) if Pt is unresponsive and not breathing normally, and pulse is not palpable within 10 seconds (at the femoral, brachial, or carotid) or <60 bpm (with poor perfusion). Compression rate is 100bpm, at a depth of 1/3rd of the chest wall, hand positioned at the lower half sternum, at a ventilation ratio of 15:2 (30:2 if alone), allowing for full chest recoil. You can compress using 2 fingers, 2 hands encircling (using 2 thumbs), 1 hand in older children, and 2 hand in even older kids and adults. With 2 hands, interlock fingers, and raise them, so pressure isn't applied to the ribs. Note that once a patient is secured with an endotracheal tube, there's no need to pause compressions for ventilation
- Attach a Defibrillator ASAP, whilst compressions are occurring
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Patient information
How do you check breathing?You look at the chest rising, listen for breath sounds, and feel if air is coming out of the mouth. If there's nothing, give just 2 rescue breaths. Huff and puff.
When do you decide to start compressions, and how do you compress?
You start compressions when the previous steps have all failed. So the patient doesn't respond. They're not breathing. And you can't detect a pulse within 10 secods. Or even if there is a pulse, it's slow, so below 60bpm. When you compress, you do so at 100bpm, and you push down 1/3rd of the chest wall, which is quite a bit if you think about it, placing your hands at the lower half of the sternum. For every 15 pumps, you give 2 huffs/puffs.
- Advanced life support (ALS), provided by healthcare providers, involving:
- Attaching defibrillator/monitor. Rather than full LA, RA and LL placement, ECG monitoring may be more easily available through 2 patches, 1 on the patient's heart apex, and 1 on the patient's upper R chest. On an infant, you place the 2nd patch on their back, as it won't fit on the front
- Assess rhythm
- If shockable (VF, pulseless VT). This is done with the COACH approach, which includes:
- Compressions continue
- Oxygen away, removing free flowing oxygen
- All else clear, asking everyone to stand clear
- Charging, selecting the appropriate joules, selecting 4J/kg, and give adrenaline 10mcg/kg IV/IO with the next cycle, then amiodarone (diluted with dextrose) 5mg/kg IV/IO the next cycle, then adrenaline again every cycle. If rounding occurs, select the slightly higher joule setting
- Hands off, "I'm safe"
- Evaluate rhythm, that the patient is in shockable rhythm
- Defibrillation, or disarm and dump
- Recheck pulse for return of spontaneous circulation
- If not shockable (asystole, PEA), give adrenaline 10mcg/kg IV/IO immediately every 2nd cycle
- Recommence CPR for 2 mins
- Loop the ALS another time
- Continuously considering and correcting the 4 H's and 4 T's
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Patient information
What is a defibrillator used for, and when do you use it?It's where you give an electric shock to the heart, acting like a temporary pacemaker, to help depolarize the heart, hopefully restarting it. You use it if there's a "shockable" rhythm.
What's a shockable rhythm?
If there's ventral fibrillation or pulseless ventricular tachycardia, that's shockable. If there's asystole or PEA, that's not shockable.
What is VFib? Pulseless VTach? Asystole? PEA?
VFib is where there's uncoordinated contraction of the pumping portion of the heart, the ventricles. VTach is when there's a fast heart rate starting at the pumping portions, and although you might expect that there is therefore a high cardiac output, it is pulseless as there is actually the exact opposite - NO cardiac output. So both of those are shoackable. It's not shockable if there's asystole, which is where the heart doesn't beat anymore. And pulseless electrical activity is where an ECG reading shows that there should be a pulse, but because for some reason there is not enough cardiac output, there isn't.
What is adrenaline and amiodarone, and what do they do?
Adrenaline is responsible for the fight-or-flight response, increasing output of the heart. Amiodarone helps irregular heartbeats, as an antiarrhtyhmic, by prolonging phase 3 of the cardiac action potential.
Source: 2006-8239.pdf">Health NSW (page 3 and 4)
- DRSABCDEFG (aka primary survey) can be modified for assessment, replacing "D" defibrillation onwards, with:
- Airways, +suctioning
- Breathing, +supplemental oxygen
- Circulation, including:
- Obtaining IV/IO access
- Ordering appropriate blood tests
- Fluid resus
- Disability/neurological, including:
- Assess LOC, alertnes or arousal
- Assess pupil reaction
- Recovery position
- Seizure control
- Tx raised ICP
- Pain Mx
- Exposure, including:
- Temperature
- Rashes
- Fluids/electrolytes, including:
- Fluids in
- Fluids out
- Glucose, checking BGL's
- Secondary survey, is done when a patient is stable, and involves doing a top-to-bottom physical examination, including of the heads/face, neck, chest, abdomen, limbs, and back
- Tertiary survey, is a repetition of the secondary survey, and aims to pick up on missed injuries. It may occur on multiple occasions over days following the injury
- Cerebral hypoxia (i.e. shortage of oxygen to the brain due to heart or respiratory failure), most commonly
- Cardiac arrest
- Stroke
- Drowning
- Choking
- Accidental injuries
- Violence
- Severe allergic reactions
- Burns
- Hypothermia
- Birth complications
- Drug overdose
- Alcohol intoxication
- Pt's w/ cerebral hypoxia may die within 9 minutes w/o basic life support procedures
- Basic life support can be performed at the scene by any bystander before emergency arrives
- Advanced life support can be performed by healthcare professionals, which are certified to perform the procedures
- CPR is initiated by bystanders 25% of the time
- Basic life support techniques (e.g. performing CPR on a Pt w/ cardiac arrest) can double or even triple the Pt's chance of survival
- Basic life support is the lowest of emergency care, following by advanced life support, and critical care
- Emergency department
- Defibrillation
- Amyotrophic lateral sclerosis (another abbreviation for ALS)
- Trauma
- Neonatal resuscitation
- Cardiac arrest (includes causes, and the 4 H's and T's)
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