Head of Emergency Department, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
Presented algorithm accurately depicts the reality of situation in a patient with symptomatic bradycardia. It describes the wide variability of successful possibilities of solving the situation. Large amount of information gets the student again in justification of incorrect answers. Although this algorithm is presented in hospital facilities, therefore is considered to be an ALS, thanks to some mentioned steps student can manage similar situation of symptomatic bradycardia also under conditions of BLS.
Presented algorithm BLS in children depicts one of the most common causes leading to cardiac arrest in children, FBAO - Foreign Body Airway Obstruction. In this case a complete airway obstruction. The presented algorithm is based on the recommendations for CPR in children of the ERC from the year of 2010. What I consider to be very beneficial in this algorithm is that in addition to the procedure itself is aimed at key decision-making moments. I also very appreciate the amount of information what gets the student in justification of incorrect answers.
Students are introduced to the interactive presentation of CPR Basic Life Support algorithm, lay resuscitation without medical equipment (unless you count the automated external defibrillator and protective equipment of the rescuer). According to this algorithm must proceed each professional lifeguard off duty, if he or she gets into the role of witness of sudden cardiac arrest (SCA) and has no equipment. The situation of the patient with SCA is obviously very critical. Rescuer will definitely be in a large mental tension especially when the SCA occurs in a family member. If student perfectly manage this simple but very efficient algorithm how to deal with CPR, the chance of survival of the patient dramatically increases plus there is a chance of good recovery without significant neurologic deficits. The student must always keep in mind that during CPR procedure he or she should strictly act according to the algorithm ABCD and everything has its time. Between the main principles of CPR - BLS include the following:
1. Minimalize time between emergence of SCA and initiation of CPR.
2. Provide early defibrillation (EMS call, bringing AED).
3. Minimize interruptions of external chest compressions (max. 5 s, plan every step in advance)
4. If you have doubts about the presence of SCA, immediately initiate CPR (better to proceed CPR in patient with retained spontaneous circulation than do nothing in case of SCA).
5. Perform CPR until the arrival of EMS, restoration of spontaneous circulation (restoration of regular breathing and / or spontaneous movement of patient and / or return of consciousness), complete exhaustion of rescuer.
The presented scenario describes very clearly the various steps of the algorithm FBAO (Foreign-body airway obstruction) with a focus on severe (complete) airway obstruction. It deals with the variousn key moments when performing BLS (Basic Life Support). Since the described situation is by nature very dramatic and puts a huge strain on the psyche of a rescuer, he or she must be very well trained to provide assistance and act basically automatically. The way of processing of presented algorithm for the purpose of training is more than suitable for its quality and focus on the most important points in providing lay first aid to the patient with a complete airway obstruction by a foreign body.