BLS:

Safety of the rescuer is paramount, otherwise there could be more than one casualty.
Therefore the scene should first be assessed for safety, specifically for approaching
cars, water, electric cables etc.
Only approach the casualty once the situation is safe.

Once the situation has been established as safe to approach the casualty, the next
step is to find out whether they are unconscious or not.
An effective way to do this is to use the "Shake and Shout" method. The best way to
do this is to give the casualty a direct command, such as "Hello, can you hear me?
Can you open your eyes for me?" incase they are unable to speak. Then shake them
gently by the shoulders in case they cannot hear the command.
If there is a response, then provided there is no danger

Leave the casualty in the position they were found

Try to find out what is wrong and get the required help
Reassess regularly until help arrives

If there is no response then the next thing is to shout for help.

Shouting 'Help, help can I have some assistance please?' will alert passers-by who
maybe able to help by calling an ambulance or helping in rolling the casualty.

The most important action you can do for a casualty is to open and maintain their airway. This is
because while someone is unconscious, their tongue may fall backwards into the throat and
cause their airway to be blocked. By performing the Head tilt and Chin lift the airway will be
opened and allow the easy passage of air into the lungs.
To open the airway, first place the palm of your hand nearest their head onto their
forehead. Then tilt the head backwards. This will lift the tongue off the back of the
throat. This is called the Head Tilt.
Next you must place two fingers below the chin and lift it so the mouth opens. This
allows a view into the mouth to look in the airway for any obstructions. This is called
the Chin Lift. Care not to place your whole hand there as you may obstruct the
trachea (windpipe).
Once the airway has been opened, the next step is to determine whether the casualty is
breathing normally or not. This is done by the "Look, Listen and Feel" method for breaths.
Whilst maintaining the airway in the head tilt chin lift, you must hold your cheek near
to the casualty's mouth and nose, whilst looking down their body towards their feet
to look at their chest. This is so it is possible to see if the casualtys chest is rising
and falling, listen for any breath sounds and feel any breaths on your cheek. This
position is held for 10 seconds.

If the casualty is not breathing or is making gasping or laboured infrequent breaths,

known as agonal breathing, you MUST call an ambulance and start chest
compressions and basic life support.
Once it has been established that the casualty is not breathing, it is important to call
an ambulance for the next parts of the chain of survival.
Call 999 or 112 and provide the following information;

Your Name
Where you are
What you are wearing
The condition of the casualty (i.e that they are not breathing)
That you are trained in BLS
And im about to perform chest compressions

Remember, in most cases this casualty will have had a cardiac arrest and whilst CPR
will buy them time, early defibrillation is vital to their chances of survival.
Lastly, it is important that you find out how long the ambulance is likely to take. If
you have asked someone else to call for you, make sure that they ask this and come
back and tell you.

Chest
Compressions
Once you have established that the casualty is NOT breathing normally and you have
called an ambulance, you must immediately start chest compressions. These will buy
you time until you can use an AED or the ambulance arrives.
To begin chest compressions, you must first locate the centre of the chest. In most
men, this is directly between the nipples. Place your hand in the centre of the chest.
Then interlock your hands, straighten your arms and lock your elbows.
Lean right over the casualty and then push downwards onto the casualty's chest. You must
perform 30 chest compressions at the rate of 100 a minute and press to a depth of about 4-5 cms
or 1/3 of the chest
Once you have given 30 Chest Compressions you must deliver 2 Rescue breaths.
To do this, you must first reopen the airway with the head tilt chin lift. Once the airway
is open you must pinch the nose. This will make the air go into to the lungs and
prevent it escaping through the nose.
Once you have done this you must breathe into the patient for 1 second. This will
inflate the lungs. Watch for the chest to rise. Do not breathe in too forcefully or air will
go into the stomach.
Then you must allow the casualty to breathe out for 1 second. Watch for the chest to fall. You must

then wait 1 second before delivering the second breath. You must deliver 2 effective rescue
breaths.
If you fail to get any of these breaths in, you must go straight back onto the 30 chest
compressions. Do not attempt to get more breaths in until the next breaths in the
cycle. Remember to repeat the cycle of 30 chest compressions to 2 breaths until the
ambulance arrives.
Once you have decided to approach a casualty you have a Duty of Care to them. This means
that whilst they are unconscious you must act in their best interests and provide care for them to
the level that you have been trained. Therefore, once you have established a 'Duty of Care', you
must continue to care for that casualty.
In this case you must continue providing Basic Life Support and you may only stop if:

The ambulance arrives and someone else is able to take over

Another BLS Provider can take over from you
You become too exhausted to continue

Once you have decided that the casualty is not breathing normally, and you have an AED
available to you, you must DECIDE TO USE IT.
AED's can look different but all serve the same purpose and the algorithm is the
same;
decide to use it
turn it on
follow it's instructions

Before using the AED you must again reassess the situation of the casualty. This is
because some things, for example a GTN patch will burn the patient if they are left on
and then the AED is used or will hinder the connection of the pads, for example, a hairy
chest.
Problem
Casualty Lying in
Water
Sweat
Hairy Chest
GTN patch
Pacemaker

Solution
Remove if safe to do so
Wipe the Chest
Shave or use a Spare pad to wax
it off
Remove
Place Pads one hand width away

Once the AED has been switched on the instructions must be followed.
Firstly the pad must be placed on the patients chest. They should be placed to allow
the maximum voltage to pass through the heart.

The pads often have diagrams attached to show

where they should be placed. The right hand one
is often under the clavicle on the right. The left is
often wrapped around the chest wall around the
level of the 5th and 6th rib (apex of the heart).
Care must be taken for good adherence to the
skin for example shaving a hairy chest (see
previous page).
Once the pads are in place and AED has started
to analyse the rhythm they should not be moved.
Next the pads should be plugged into the AED.
The AED will then begin to analyse the heart rhythm. It is of paramount importance
that no-one touches the patient at this point as in will interfere will the electrical
signal to the AED and lead to sub-optimal treatment.
If the AED advises a shock, make sure no-one is touching the patient otherwise the
current will pass to them too. Use one hand to guard them off and look around whilst
administering the shock.
After the shock the AED will again analyse the heart rhythm. It will then give followon instructions. These maybe in the form of further shocks or to provide BLS (chest
compressions and rescue breaths 30:2). These should be carried out as explained in
the BLS part of this website.
The AED will continue to give instructions and these should be followed until help
arrives.

Recovery
Position
Being able to put someone into the recovery position is important, as it helps to keep their airway
open and if they happen to vomit, they are less likely to aspirate it. This simple manoeuvre may
save their life!
Remember "How to sleep with your leg over"
Check for Danger
Check Response
Shout for help
Open Airway
Check Breathing
Put casualty in recovery position
Call ambulance
Recheck casualty every minute

To put a casualty into the recovery position you must first have them lying on their
back with their legs straight and their arms by their sides.
You must then take the nearest arm of the patient and put it at right angles and
the forearm at right angles to the upper arm - i.e. into the "How position"

Then, using your hand nearer the head of the patient, interlock your thumb with
their thumb on their side furthest away from you. Pull the arm over to their cheek
nearer you and hold the back of their hand against their cheek. This is the "go to
sleep" part.

With your other hand pull their leg up, that is furthest away from you, so that their
foot is flat on the ground. Then, using their knee as a lever, roll the casualty
towards you, onto their side.

Reposition their upper leg so that the thigh is at right angles to their body. This
will help to prevent them rolling too far forward. This is "getting their leg over".

Lastly, you
head back and

must check that their airway is still open by tilting the

that they are still breathing.

If the
their
and

casualty stops breathing, you must roll them back onto

back, reassess the airway and recheck their breathing
follow the appropriate sequence.

You must only put someone into this position if you have found that they are
breathing normally. Once they are in the position, you must then call an ambulance
and check that they are still breathing every minute until the ambulance arrives.

Then you must call the ambulance.

-

name
where

trained in bls

wearing

unconscious but breathing patient

put them in the recovery position

ambulance please

Shock
Definition of Shock
Shock is defined as:
"A failure of the circulation to provide an adequate oxygen supply to the vital organs which are:

The brain
The heart
The kidneys."

You MUST know this definition for your exam.

Types of Shock
There are several reasons why the circulation fails and these are covered below:
Hypovolaemic Shock
This is literally "low volume of blood". The obvious cause for this type of shock is severe or longstanding bleeding. In these cases the blood pressure drops because there is not enough blood
and as blood pressure falls the oxygen supply is reduced.There are other causes for

hypovolaemic shock, all of which are as a result of rapid fluid loss. This includes severe vomiting
or diarrhoea, or serious burns.
Cardiogenic Shock
This type of shock is a result of a failure of the heart to maintain normal cardiac output. For
example, if a person has a heart attack, their heart may slow down and it may not contract as
efficiently, resulting in a drop in blood pressure. In this case, oxygen supply is again compromised,
but not as a result of low volume, but as a result of low pressure.
Distributive Shock
This is a different type of shock again, which is a problem in the distribution of the blood causing a
resultant drop in blood pressure. In this type of shock, however, there is no problem with the heart.

Septicaemia, infections in the blood cause widespread vasodilatation, so blood pools in

the peripheral parts of the body. This means that there is relatively too little blood for the
size of the circulation. This again causes a reduction in oxygen supply.
Anaphylactic Shock is similar to septic shock, in that the heart is working normally and
there is a normal amount of blood. However, as a result of allergic reaction, fluid from the
blood moves into the tissues very quickly and stays there as oedema. This causes a
reduced volume within the circulation so therefore a reduction in oxygen supply.

Obstructive Shock
In this type of shock, the flow of blood is obstructed. This 'blocks' circulation and can
result in circulatory arrest. Several conditions can cause this form of shock.

Cardiac Tamponade. Here there is blood in the pericardium and this hinders the flow of
blood into the heart (venous return).
Pulmonary Embolism is the result of a 'thromboembolic incident'. This can occur in the
blood vessels of the lung, preventing the return of blood to the heart.

Signs of Shock
Recognising shock is very important, especially as you can improve the situation through relatively
simple means. You need to learn the signs of shock as you may be asked about them in your
exam.

Casualty complains of feeling cold

Casualty looks pale and clammy
Casualty may be drowsy, confused or agitated
Their pulse will be fast
Their breathing may be fast and shallow
The casualty may be very thirsty.

Treating Shock
There are relatively simple things you can do to deal with shock whilst waiting for the ambulance.
These revolve around keeping the casualty comfortable as well as trying to raise their circulating

volume.
Below is a list of things you can do

Lie the casualty down (Helps keep blood supply to brain)

Cover the casualty with a blanket/coat (keeps casualty warm without overheating them)
Raise the legs above the heart (will return blood that had pooled in the legs to the body)
Moisten their lips with a little water
Attempt to stop any external bleeding

Keep talking and reassure the patient and call for an ambulance
Below is a list of things that you must NOT do to anyone you think may be in shock:

Do NOT warm the casualty with any hot object e.g. hot water bottle (this will encourage
blood flow to the periphery and reduce flow to the vital organs).

Do NOT give casualty anything to eat or drink (this will make anaesthetising
them more difficult and may cause them to vomit as the blood supply to the
gut will be reduced).

Bleeding
If you come across a casualty who is bleeding, it is important that you deal with the
wound quickly as this will help prevent the casualty from deteriorating. There are
several things you must do and in the event of a large bleed, you must remember to
treat the casualty for shock too.
Below is an algorithm for what you must do for a casualty who is bleeding:
Check for danger
Introduce yourself
Reassure the casualty
Put direct* pressure on wound
Elevate the affected limb
Put one dressing on
If seeps through
Put up to 2 dressings on wound

Call Ambulance and treat for shock

If bleeding through dressings, take off both and put up to 2 more on. Repeat as necessary
*Please remember that if there is an object sticking out of the wound, do not remove it and do not
put direct pressure in it. Leave the object where it is as it may be helping to stop blood flow and
put pressure on the areas around the wound, particularly above it and bandage around.

Choking
The protocol for Choking differs from most of the other situations where you approach
a casualty. This is because in most Choking situations the casualty will still be
conscious at first and may or may not have a completely obstructed airway.
Therefore, in situations where the casualty is still able to cough, you
must first introduce yourself to them and tell them you are trained in
First Aid and that you can help them. Then you must first encourage
them to cough, and in some situations this will clear the airway enough
for them to be able breathe.

If however, they become too exhausted to cough, or they

completely obstruct their airway, you must intervene. The first
step you must take is to lean them over, then
using one hand to support them, deliver a sharp
slap with the heel of your other hand between
their shoulder blades. After the back slap you
must check in their mouth as you may be able to
see the obstruction and you may be able to
remove it. You may repeat the back slaps up to 5
times.

If, however, the back slaps fail to clear the airway, you must deliver an abdominal
thrust. To do this you must stand behind the casualty, put your arms around their

abdomen, making a fist with one hand and clasping it in the other.

You must then pull in and up into the casualty (scooping action) at the
level of the navel. Once you have delivered each abdominal thrust, you
must again check in the casualty's mouth as you may be able to see
and remove the obstruction. If one abdominal thrust is not effective,
you may repeat it up to 5 times.

If you have delivered all 5 abdominal thrusts you may then repeat the sequence of up
to 5 back slaps then up to 5 abdominal thrusts until the obstruction is cleared or the
casualty falls unconscious.
If the casualty falls unconscious you must then phone the emergency services as you
would in any live casualty situation. Then you must start basic life support straight
away by doing 30 chest compressions at a rate of 100 a minute. Then try to deliver 2
effective rescue breaths. If the breaths do not go in go straight back to chest
compressions. Repeat this sequence until you clear the obstruction or help arrives.