Basic Life Support in Special Populations: Pediatrics, Geriatrics, and Pregnancy

Introduction:

Basic life support (BLS) is a way to help someone whose heart has stopped beating and who's not breathing. It involves doing CPR until advanced medical help arrives. When done correctly and quickly, BLS helps provide oxygen to the person's body, making them more likely to respond to further medical treatment and have a better chance of surviving. Special populations, including women who are pregnant, pediatrics, and the elderly, require additional considerations.

How Is Basic Life Support Provided for Pregnancy Patients?

• Airway: Ensure a clear airway by gently moving the head and jaw. Remove any obstructions from the mouth and insert an airway tube if needed.
• Breathing: If the person isn't breathing well, provide artificial ventilation until equipment is available. Due to pregnancy-related challenges, be cautious of regurgitation.
• Circulation: Check for a pulse, and if absent, perform chest compressions as usual, with adjustments for a pregnant woman's body. Ensure her position relieves pressure on the inferior vena cava to aid blood flow. Use various methods to achieve this.

Providing Advanced Life Support During Pregnancy:

Airway Management:

• Tracheal intubation is necessary but can be challenging in pregnant women due to anatomical changes.

• Specialized equipment and techniques may be needed.

• Maintaining proper head and neck positioning is crucial.

Ventilation and Intubation Difficulties:

• Obesity, full breasts, and a short, obese neck can hinder mouth-to-mouth or bag-mask ventilation.

• Laryngeal mask airway may be attempted if intubation fails.

• Cricoid pressure must be temporarily released during laryngeal mask airway placement.

Defibrillation and Drug Administration:

• Follow advanced life support guidelines for defibrillation and drug administration.

• Care is needed when using defibrillator paddles on a laterally positioned pregnant woman.

• Special care when using medications, considering the pregnant patient's condition.

Management of Eclampsia:

• Magnesium sulfate treats eclampsia, but calcium chloride may be administered if high magnesium levels contribute to cardiac arrest.

Cesarean Section:

• Cesarean section can play a critical role in resuscitating both the mother and fetus.

• It improves blood flow and lung function.

• It should be performed promptly if standard resuscitation measures fail.

• Continuous cardiopulmonary resuscitation during the procedure is essential.

Training and Preparedness:

• All healthcare providers involved in obstetric care should be trained in cardiopulmonary resuscitation to improve outcomes in emergencies.

How Is Resuscitation Done in Pregnant Women?

• Pregnant women may require special considerations during resuscitation due to their unique physiology.

• Maternal survival is the top priority, but the fetus's well-being should also be considered.

• Pregnancy increases blood volume, especially in the uterus, so stopping placental circulation during maternal collapse is crucial for maternal recovery.

• A perimortem cesarean section during maternal CPR without anesthesia may be necessary for visibly pregnant women to save the mother's life.

• The procedure involves rapid delivery of the fetus and placental circulation to improve the mother's blood volume and relieve pressure on major blood vessels.

• Preparation for this procedure should start within 3 minutes of resuscitation, with delivery ideally completed by 5 minutes.

• Specific equipment is used for this procedure and should be kept as sterile as possible.

• Maternal positioning during CPR involves manual left uterine displacement or a slight left tilt to prevent aorto-caval compression.

• Rapid restoration of the airway and breathing with 100 % oxygen is essential in pregnant patients.

• Specialized skills, like intubation, should be performed by senior medical staff to minimize apnea time.

• Identifying and treating the potential causes of cardiac arrest in pregnant women follows similar protocols as in the general population.

• Cardiovascular disease, non-obstetric bleeding, suicide, and sepsis are common causes of maternal death, and various conditions like thromboembolism and hypertensive disorders can directly lead to maternal death.

How Does Basic Life Support Help in Pediatric Patients?

In Babies:

The leading causes of infant death are birth defects, problems from being born too early, and Sudden Infant Death Syndrome (SIDS).

In Older Children:

Children over 1 year old are most likely to die from accidents. Car accidents are the most common cause of these accidents, but using child safety seats can help prevent deaths.

Find Safety Information:

One can find resources on preventing car-related injuries on the National Highway Traffic Safety Administration's website. The World Health Organization also has information on preventing injuries and violence.

CPR Sequence:

In the past, CPR was taught as "ABC" - airway, breathing, and chest compressions. But now, it is recommended as "CAB" - chest compressions, airway, breathing. Here is why:

• Chest Compressions First: High-quality chest compressions are vital during a cardiac arrest. Most CPR situations involve adults with a specific type of cardiac arrest where chest compressions are more important. Starting with chest compressions leads to faster help for them.
• Faster CPR: It is quicker to begin chest compressions than to position the head for breathing, especially in adults.
• For Kids: Children often experience cardiac arrest due to a lack of oxygen (asphyxial arrest). For them, a combination of breathing and chest compressions is best. Starting with breaths or compressions does not matter much, but starting with compressions makes training simpler and more consistent.

Age Groups for CPR:

• Infant BLS: For babies under about 1 year old.
• Child BLS: For kids from about 1 year old until puberty.
• Adult BLS: For teenagers and adults.

CPR Steps for Regular People:

• CPR Safety: Before anything else, make sure the person needing help are safe. The risk of catching diseases while giving CPR is very low.
• Check If CPR Is Needed: If someone is unresponsive, not breathing, or only gasping, assume they need CPR.
• Check for a Response: Tap the person and ask if they are okay. If they respond or move, they do not need CPR. Check for injuries.
• Checking Breathing: If the person is breathing normally and has no injuries, put them on their side to keep their airway clear.
• No Breathing or Just Gasping: Start CPR if they are unresponsive and not breathing (or only gasping). Sometimes, gasping can be mistaken for breathing, so it is better to act even if unsure.
• Start Chest Compressions: If the person is unresponsive and not breathing, give 30 chest compressions immediately.

How Does Basic Life Support Help in Elderly Patients?

Step 1: Quick Access to Help

• Call emergency services right away.

Step 2: Early CPR

• Start CPR promptly.

Step 3: Early Defibrillation

• Use an AED (automated external defibrillator) to restore the heart's rhythm.

Step 4: Professional Help

• Allow healthcare professionals to take over.

Step 5: Quality Post-Care

• Ensure the person receives proper care after the emergency.

CPR for Seniors:

CPR Basics:

• CPR is crucial to keep blood flowing in someone whose heart has stopped.

• One can do hands-on CPR if they are not trained or uncomfortable with mouth-to-mouth.

Steps to Follow:

• Check Safety: Ensure the area is safe and the person in need.

• Check for Responsiveness: Try to wake the person by calling their name or gently tapping them.

• Call for Help: If the person is unresponsive and not breathing normally, call emergency or ask someone to fetch an AED.

• Start CPR (CAB): Begin chest compressions.

• Breathing: Observe chest movements and any breathing sounds.

CPR Technique for Untrained Rescuers:

• Place the hands on the person's chest.

• Use the body weight to push hard and deep (about 2 inches) on the chest.

• Allow the chest to recoil after each compression fully.

• Aim for a rate of 100 to 120 compressions per minute, similar to the beat of "Staying Alive."

Repeat until:

• The person regains consciousness normal breathing, and heart rate.

• An ambulance arrives.

• An AED arrives.

Using an AED (Automated External Defibrillator):

• An AED can help restore a normal heart rhythm during sudden cardiac arrest.

• AEDs come with simple instructions and are designed for use by untrained individuals.

Steps to Use an AED:

• Turn on the AED.

• Attach the pads to the person's chest.

• Let the AED analyze the heart rhythm.

• If advised, administer a shock. Ensure no one is touching the person.

Locating an AED:

• It's essential for the local EMS system to know where AEDs are placed in the community.

• Many AEDs have clear visual or spoken instructions.

• Remember to ensure no one is in contact with the person when delivering a shock.

In older patients, even minor or moderate injuries can be quite serious. Things like hip fractures or dislocated joints can even lead to death. When an elderly person seems mentally different, it's not always dementia; it could be due to a stroke, metabolic issue, or infection. So, it's important to check their blood sugar and look for signs of stroke, injury, or other problems if their mental state changes from what's usual for them.

General Considerations:

• Elderly patients often have multiple health issues, take many medications, and face various complications.

• Be aware of common causes of death in the elderly: heart and stroke diseases, cancer, falls, pneumonia, and drug-related issues.

• Know common causes of confusion in the elderly, including diseases, infections, malnutrition, etc.

• Elderly people are more vulnerable to heatstroke and hypothermia due to various factors.

• Confusion is often a sign of underlying problems, so do not assume it is due to age.

• Sudden weakness, shortness of breath, or confusion could indicate a heart attack, even if symptoms are unusual.

• Syncope (fainting) in the elderly can result from various serious issues, so treat it seriously.

Environmental Assessments:

• Assess their living conditions and potential signs of abuse or neglect.

• Look for evidence of medication use and alcohol abuse.

Conclusion:

In basic life support (BLS), the critical steps are immediate activation of emergency help, early CPR, and rapid defibrillation for ventricular fibrillation (VF). When an adult collapses, call for help and begin chest compressions right away, even if untrained. Trained individuals and healthcare providers should perform high-quality CPR with deep, uninterrupted chest compressions and controlled breaths. If an AED is available, use it without delaying compressions. These steps, if done promptly, save lives.