Life support are emergency techniques performed support life after the failure of one or more vital organs.
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
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.
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
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
If shockable (VF, pulseless VT). This is done with the COACH approach, which includes:
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
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.