II basic life support (Basic Life Support, BLS) consists of procedures for cardiopulmonary resuscitation (CPR) needed to rescue a patient:
lost consciousness,
has an airway obstruction or is in a state of apnea for other reasons,
is in cardiac arrest.
The main goal of the BLS is the prevention of anoxic brain damage, and the procedures are aimed at:
prevent the progression to cardiac arrest in the case of airway obstruction or apnea,
to have breathing and circulation artificial in the case of circulatory arrest.
BLS procedures are standardized and recognized as valid by authoritative international organizations (American Heart Association, European Resuscitation Council, World Federation of Societies of Anaesthesiologists, etc..) That periodically provide a critical review and updated to reflect developments in knowledge.
This manual makes reference to international guidelines in 1992 on which date the ltalian Resuscitation Council gave a consensus (Consensus Methodology Meeting. BLS and Training, Monte Conero, Ancona, 24-25 June 1994).
The acquisition of "skills" of the BLS provides a course of practical-type behavior, so This manual is one of the teaching tools of the course and can not replace it.
warning signs of a heart attack
When one part of the heart muscle not receiving adequate blood flow for a prolonged period (20-30 minutes) manifests a clinical condition commonly called "heart attack", which may in some cases have myocardial infarction, namely the death of a number of cardiac cells.
During a heart attack you may experience the sudden cessation of pumping of the heart (cardiac arrest) in many cases due to ventricular fibrillation, in which case the present, if they are able to do so, they must promptly implement the procedures of the BLS, and activate the emergency system.
However, you should know the warning signs that may make us suspect that a cardiac arrest is imminent or even possible, in order to implement an early rescue, should know that the warning signs of a heart attack: pain or sense of tightness in the center of the chest or localized to the shoulders, neck, jaw or upper abdomen at the stomach only the symptoms can appear at any place and at any time, whether the patient is making an effort, whether it be at rest.
is defined as the sudden death sudden death sudden and unexpected cessation of circulatory and respiratory. It can occur without warning and be the first manifestation of coronary artery disease. It can also affect patients with known heart disease, especially during the first two hours after a heart attack. Represents 10% of deaths due to cardiovascular disease.
Anoxia BRAIN DAMAGE
The lack of oxygen to brain cells (anoxia brain) produces lesions that become irreversible after about 4-6 minutes of no circle. The implementation of procedures to maintain an oxygen signal can interrupt the progression to a state of irreversible tissue damage. If the circulation is restored, but the relief has been delayed or inadequate, prolonged I'anossia brain will manifest with varying amounts of outcomes: persistent coma, sensory or motor deficits, alterations in cognitive or affective, etc.. The possibility of preventing anoxic damage depends on the speed and effectiveness of emergency procedures, and in particular on the correct application of the "Chain of survival ".
The" chain of survival "
integrates survival after a cardiac arrest in the prehospital depends on the successful implementation of a series of interventions, the metaphor of the" chain "means that if one of the phases of the relief is missing, the chances of survival are slim.
the four links in the chain consist of:
early access to emergency system
early initiation of BLS procedures (with particular reference to the BLS implemented by those present)
early defibrillation, ie the early arrival of a team in place able to practice defibrillation
early initiation of intensive treatment.
THE BLS SEQUENCE
The sequence of procedures for the BLS is a series of actions alternate with phases of the evaluation. The actions are summarized mnemonic ABC:
A. Opening of the airways (Airway)
B. Mouth-to-mouth (Breathing)
C. Chest compressions (circulation).
Each step is preceded by a phase of evaluation: Evaluation of consciousness
==> A
Evaluation of the presence of respiratory ==> B
Evaluation of the presence of circulatory activity ==> C
Each assessment and each action is performed in the correct sequence and in the correct way.
ASSESSMENT OF THE STATE OF CONSCIOUSNESS
The first step in the rescue of a person apparently dead is to assess the state of consciousness:
call it out loud;
shake it gently.
The condition does not permit the operation of consciousness sequence of BLS:
calls for help and then activate the emergency system or the team of advanced resuscitation
places the victim on a hard floor or ground, aligning the head, trunk and limbs.
In the case of trauma, the victim can be moved if it is to maintain the axis of the neck and trunk.
A. Opening the airway
Loss of consciousness results in muscle relaxation, the jaw and the tongue falls backward is to obstruct the upper airways.
Per ottenere la pervietà delle vie aeree:
solleva con due dita il mento;
spingi la testa all'indietro appoggiando l'altra mano sulla fronte.
Questa manovra impedisce la caduta indietro della lingua e permette il passaggio dell'aria. Tecnica alternativa: posizionandoti dietro la testa del paziente, solleva la mandibola agganciandone gli angoli con le due mani. In caso di sospetta lesione traumatica cervicale, solleva la mandibola senza estendere la testa. Controlla quindi se nella bocca della vittima sono presenti oggetti o residui di alimenti e se possibile cerca di asportarli.
Mezzo aggiuntivo: cannula faringea.
La cannula faringea facilita il mantenimento della pervietà delle vie aeree; posta tra la lingua and the rear wall of the pharynx guarantees the passage of air through the upper airway, and in cases of spontaneous breathing during mask ventilation {see below).
Warning: If you have the gag reflex, it is possible that the mechanical stimulus of the cannula causes vomiting, in which case the airway obstruction may be aggravated. It 'should therefore not use the tube if the subject reacts to the attempt of insertion.
The size of the cannula can be estimated by taking the distance between the earlobe and the angle of the mouth.
ASSESSMENT OF THE PRESENCE OF BUSINESS 'RESPIRATORY
Once effected the airway should be assessed if the respiratory activity is present:
keep the chin up and head extended;
approaching her cheek to his mouth and nose of the victim;
hear and feel the possible passage of air;
noted whether the chest rises and lower.
Currency for 10 seconds.
Attention: the presence of "agonal breathing" ("gasping") is equivalent to absence of breathing: It consists of contractions of the accessory respiratory muscles without being produced in an expansion of the chest is a breath ineffective.
recovery position
If the respiration is present and the victim remains unconscious, you can use the recovery position security, which allows you to:
keep the extension of the head (hence the airway);
prevent penetration into the airways of material present in the mouth (eg vomiting), which can drain outside, keep
stability (the body does not roll).
You can use this position in pending or other assistance if you need to get away.
is not indicated for traumatic events.
B. Mouth - mouth or mouth - nose
If respiration is absent, you should begin artificial respiration.
technique of mouth-mouth
positioned next to the victim, keep the head by placing his hand extended on the forehead and lift the chin with two fingers of the hand;
supports your mouth wide open mouth of the victim;
blow slowly twice into the airway of the victim in order to inflate his lungs;
insufflation notes that while the chest to get up;
between un'insufflazione and the other notes that the rib cage from falling.
II thumb and index finger on his forehead tighten the nose when insufflation.
If for some reason, the airflow through the mouth is blocked, you can blow through the nose while keeping the head extended with one hand and lifting his chin to close his mouth with the other. Inflations too harsh or inadequate extension head causes introduction of air into the stomach, gastric distension and vomiting.
VENTILATION WITH ADDITIONAL RESOURCES AND
'medical staff should use additional means of ventilation, avoiding, whenever possible, direct contact with the patient.
-mouth ventilation mask.
is practiced using a pocket mask (pocket mask) or traditional masks for resuscitation.
Technique:
positioned behind the head of the victim;
supports the mask on the face of the victim;
raises the mandible and extend his head with both hands, hold tight
the mask with your thumb and forefinger of both hands;
insufflation in mouthpiece of the mask.
The mouth-mask ventilation is very effective, easy to perform and can dispense a large volume to every note. Linking the mask to a source of oxygen is also possible to ventilate with oxygen enriched air.
bag-mask ventilation.
is using the system autoespansibile ball-mask and as soon as possible, oxygen. A one-way valve allows air to breath not covered by the ball and therefore not to be reinspirata. Oxygen enrichment can be obtained from various entities, depending on whether or not a second reservoir and the flow of oxygen used (approximate values \u200b\u200bin the table).
ball autoespansibile System / mask flow inspired O2 concentration of 10-12 l / min without reservoir 40-50% 10-12 l / min with 80-90% reservoir
Technique:
positioned behind the patient's head;
supports the mask, lift the jaw and extend head with his left hand;
compress the ball with his right hand.
Insufflations abrupt or made without an adequate airway can cause gastric distension. In the event that ventilation is not effective, you must switch immediately to another type of ventilation (mouth-mask or mouth-to-mouth).
The difficulty of maintaining a good grip on the form and to ensure a sufficient tidal volume require specific training to achieve a appropriate manual.
ASSESSMENT OF THE PRESENCE OF BUSINESS 'CIRCULATORY
After 2 rescue is necessary to assess whether this is the circulatory activity. To do this for the presence of the carotid pulse (carotid pulse): Hold
extended the victim's head with one hand
with the index and middle fingers of the other hand, find the Adam's apple;
you slide your finger from Adam's apple at you until you find a groove on the side of the neck;
feel for 10 seconds with your fingertips if there are pulses in this area, the pulse must be sought carefully to avoid crushing the artery.
The research is carried out from the side of the wrist where is the rescuer, you must ensure that the fingers are placed across the airways to not compress. Practice
perform this maneuver on yourself and others.
C. Chest compressions (external cardiac massage)
If the carotid pulse is absent, this means that absent an effective cardiac activity.
E 'need to provide artificial circulation by means of chest compressions and external cardiac massage.
The heart is located within the chest behind the sternum, the sternum by compressing the heart is crushed against the spine and this, together with increased pressure within the chest, allowing the blood contained in cardiac chambers and great vessels to be pushed in a circle by releasing the chest the heart is filled again.
Technique: Search
compression point and hand position:
slide the index and middle fingers along the bottom edge of the thoracic cavity and identify the meeting point of the last coast with the sternum;
supports the two fingers to above this point on the bone of the sternum;
supports the "heel" beside the two fingers of the other hand, this is the correct point to do the compressions;
supports the "heel" of the first hand above the other and interlace the fingers to make sure that they remain raised and not compress the coasts.
Implementation of massage Cardiac:
positioned so that your arms and shoulders are on the vertical compression of the area;
rhythmically compress the chest at a rate of 80-100/min, chest should go down by 4-5 cm; the
Compression and release should have the same duration;
keep your arms straight, using the weight of the trunk;
alternating 15 compressions to 2 breaths if you are alone;
if rescuers are two alternate 5 chest compressions to the inflation.
after 3-4 cycles, and every few minutes, please check the carotid pulse, if absent, continuous
never interrupt the BLS for more than five seconds. If the pulse reappears
, retrace your On the contrary
perform an injection about every 5 seconds, checking every 30 seconds around the wrist is always present;
reappears if the respiratory activity, continues to maintain a patent airway by lifting the chin and extending the head or, if indicated:
use the recovery position.
Summary
BLS SEQUENCE - AN EMERGENCY
1. Assess the state of consciousness;
if the victim does not respond:
2. Calls for help, positions, aligns
3. A. Airway: chin lift, head tilt, exploration of the oral cavity
4. Rate for 5 seconds, the presence of respiratory activity;
if absent:
5. B. 2 breaths
6. Rate for 5 s. the presence of carotid pulse, if absent
:
7. C. 80 chest compressions - 100/min. Alternative 2 breaths to 15 compressions
8. After the first minute and every few minutes then assess whether the pulse reappeared.
9. If pulse and breathing reappeared, retrace your steps backwards.
BLS ADMINISTERED BY TWO EMERGENCY
The BLS sequence is carried by two rescuers in a more effective and less tiring for operators.
separation of roles:
on 1 rescuer performs the steps of the BLS as described above to the evaluation of the presence of the circle, positioned behind the patient's head in case additional resources are used for ventilation (Pocket mask, bag-mask);
the 2nd rescuer helps in positioning on 1 of the victim and is preparing to perform chest compressions on the side of taking the patient's chest;
on 1 rescuer, found that no carotid pulse, announced on the 2nd, "is a cardiac arrest begins the massage"
the 2nd rescuer starts chest compressions by counting aloud to synchronize with the insufflation;
alternate compressions and I'insufflazione 5;
on 1 ° rescuer after the first minute (and every few minutes) calls on the 2nd to interrupt compressions for 5 seconds and re-evaluate the presence of the wrist.
exchange between the two rescuers.
When one is tired (more likely the 2nd) calls for an exchange of roles:
"at the end of this cycle, change"
ends the 5 compressions, the patient's head moves, to assess the presence of Ia 5s wrist, insufflation;
I'altro rescuer, after the partner has made the 5th compression, will move to the side of the chest, the research point compression and after the injection begins chest compressions
pain is not necessarily described as " sharp "at times can be moderate and be present difficulty breathing 
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