ADULT BASIC LIFE SUPPORT

(BLS)


1
OBJECTIVES
Students should be able to demonstrate:

How to assess the collapsed victim
How to perform chest compression and
rescue breathing
How to place an unconscious breathing
victim in the recovery position.
2
BACKGROUND

Survival to hospital discharge presently
approximately 5-10%

Bystander CPR vital intervention before
arrival of emergency services double or
triple survival from SCA (sudden cardiac
arrest)

Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60%
survival

3
CHAIN OF SURVIVAL
The 5 links in the adult Chain of
Survival are
Immediate recognition of cardiac arrest
and activation of the emergency
response system
Early cardiopulmonary resuscitation
(CPR) with an emphasis on chest
compressions
Rapid defibrillation
Effective advanced life support
Integrated post-cardiac arrest care
4
CPR
Cardio-pulmonary resuscitation
(CPR) is a means to provide
temporary support to the
coronary and cerebral circulation,
till normal cardiac output is
restored

5
What are the functions of CPR?
A. As basic life support to maintain a
viable (living) victim for advanced life
support.
B. To minimize the occurrence of panic
during times of emergency.
C. For early diagnosis and detection of
the symptoms of heart attack.
6
What does CPR stand for?

C = Cardio (heart)

P = Pulmonary (lungs)

R = Resuscitation (recover)
Oxygen is the basic requirement for breathing and every
Living cell in the body
7
What types of situations might
cause a victim to need CPR?
Heart attack
Electrocution
Drug overdose
Accidents
Stroke
Diabetes
Choking
Poisoning
Smoke Inhalation
Epilepsy
Suffocation
Drowning
8
Emergency Situations Requiring CPR
and Emergency First Aid
Alcohol Overdose - Alcohol Poisoning
Drug or Medicine Overdose
Choking Airway Obstruction
Auto Accident
Electrical Shock
Gun Shot
Stabbing/Knife Wound
Smoke Inhalation
Drowning
Poisoning
Heat Exhaustion
Over Exposure to
Cold Temperatures
9
Definitions
Coronary Heart Disease the blood supply to
a part of the heart is blocked; that part of the
heart not receiving oxygen begins to die.
Respiratory Arrest breathing stops
Cardiac Arrest the heart has stopped
Stroke the blood supply to a part of the brain
is blocked; those brain cells not receiving
oxygen begin to die.
Clinical Death means the heart and
breathing have stopped.
Heart attack A sudden severe instance of
abnormal heart function.

10
Definitions Continued
Brain Death Occurs 4-6 minutes after
clinical death when the cells of the brain
begin to die.
Biological death- all systems cease to
function. Organ systems have shut down
and are no longer working
11
DEFINITIONS
CARDIAC ARREST: Abrupt
cessation of cardiac pump function
which may be reversible by a
rapid intervention but will lead to
death in its absence.
DEATH: Irreversible cessation of
all biologic functions

12
13
DEFINITIONS
Basic life support: sequences of
procedures performed to restore the
circulation of oxygenated blood after
a sudden pulmonary and/or cardiac
arrest
Chest compressions and pulmonary
ventilation performed by anyone who
knows how to do it, anywhere,
immediately, without any other
equipment

14
Decision to start CPR:
Decision to start CPR is made if a
victim is unresponsive and not
breathing normally.
Pulse check is no longer required, and
is NOT recommended for lay persons.
Pulse check has been shown to be
unreliable, with unacceptably high
rates of false positives and negatives.
15
Adult Basic Life Support
PERSON
COLLAPSES
Check if he is
unresponsive.
Call Emergency
number.
Get AED (automatic
Electric Defibrillator)
Begin the ABCDs
16
Approach safely
30 chest compressions
Open Airway
Defibrillate
2 rescue breaths
Check response
Shout for help Get AED
Check Pulse
APPROACH SAFELY!

Scene

Rescuer

Victim

Bystanders
Approach safely
Check response
Shout for help Get AED
Check Pulse
30 chest compressions
Open Airway
2 rescue breaths
Defibrillate
CHECK RESPONSE
Approach safely
Check response
Shake shoulders gently
Ask Are you all right?
If he responds
Leave as you find him.
Find out what is wrong.
Reassess regularly.
If he does not respond:
CHECK RESPONSE
If he does not respond:
Check to see if the
victim is breathing. If
not breathing or not
breathing normally:
CHECK RESPONSE
SHOUT FOR HELP
Approach safely
Check response
Shout for help/Get AED
SHOUT FOR HELP

Remind the person
to get AED
P - Position on back
All body parts
rolled over at the
same time
Always be aware of
head and spinal
cord injuries
Support neck and
spinal column

Check Pulse

Approach safely
30 chest compressions
Open Airway
Defibrillate
2 rescue breaths
Check response
Shout for help Get AED
Check Pulse
Check Pulse
Feel for pulse for
at least 5 but no
more than 10
seconds
If you do not feel a
definite pulse,
begin CPR, starting
with chest
compressions
30 CHEST COMPRESSIONS
Open Airway
Defibrillate
30 chest compressions
2 rescue breaths
Approach safely
Check response
Shout for help Get AED
Check Pulse
Place the heel of one hand in
the centre of the chest
Place other hand on top
Interlock fingers
Compress the chest
Rate 100 min
-1

Depth 4-5 cm
Equal compression : relaxation
When possible change CPR
operator every 2 min
CHEST COMPRESSIONS
OPEN AIRWAY
Approach safely
Check response
Shout for help Get AED
Check Pulse
30 chest compressions
Open Airway
2 rescue breaths
Defibrillate

OPEN AIRWAY
There are two
methods:
Head tilt chin lift
Jaw thrust
Head tilt chin lift
Place one hand on the
victims forehead and
push with your palm
to tilt the head back
Place the fingers of
the other hand under
the bony part of the
lower jaw near the
chin
Lift the jaw to bring
the chin forward






OPEN AIRWAY
Head tilt, chin lift + jaw thrust
- healthcare professionals
CHECK BREATHING
CHECK BREATHING
Look, listen and feel
for NORMAL
breathing

Do not confuse
agonal breathing
with NORMAL
breathing
AGONAL BREATHING
Occurs shortly after the heart stops
in up to 40% of cardiac arrests

Described as barely, heavy, noisy or
gasping breathing

Recognise as a sign of cardiac arrest
Erroneous information can result in withholding CPR from cardiac arrest victim

RESCUE BREATHS
Approach safely
Check response
Shout for help Get AED
Check Pulse
30 chest compressions
Open Airway
2 rescue breaths
Defibrillate
RESCUE BREATHS
Pinch the nose
Take a normal
breath
Place lips over mouth
Blow until the chest
rises
Take about 1 second
Allow chest to fall
Repeat



RESCUE BREATHS
RECOMMENDATIONS:
- Tidal volume
500 600 ml

- Respiratory rate
give each breaths over about 1s with enough
volume to make the victims chest rise

- Chest-compression-only
continuously at a rate of 100 min
CONTINUE CPR






30 2
Continue CPR until Automated External
Defibrillator arrives
DEFIBRILLATION
Defibrillation
Automated External
Defibrillators are
computerized devices
that can identify
cardiac rythms that
need a shock and they
can then deliver the
shock
Approach safely
Check response
Shout for help Get AED
Check Pulse
30 chest compressions
Open Airway
2 rescue breaths
Defibrillate
AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)
Some AEDs will
automatically switch
themselves on when
the lid is opened
ATTACH PADS TO
CASUALTYS BARE CHEST
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK INDICATED
Stand clear
Deliver shock
SHOCK DELIVERED
FOLLOW AED
INSTRUCTIONS
30 2
NO SHOCK ADVISED
FOLLOW AED
INSTRUCTIONS
30 2
IF VICTIM STARTS TO
BREATHE NORMALLY PLACE
IN RECOVERY POSITION

CONTINUE RESUSCITATION
UNTIL
Qualified help arrives and takes over

The victim starts breathing normally

Rescuer becomes exhausted
CHILD BLS
Paediatric Chain of Survival 2010
Injury prevention and safety
Early CPR with an emphasis on chest compressions
Early access to emergency care. In most communities,
phone 911 accesses the EMS system.
Early pediatric advanced life support.
Comprehensive post-arrest care.

CPR In Children
Modifications of CPR in Children include:
Amount of air for breaths
Depth of compressions (at least 1/3 the depth of
the chest or approximately 2 inches)
Chest compressions may be done with one hand
AED
2 person CPR in children the ratio becomes 15:2
In an unwitnessed arrest of a child perform CPR
for 2min. Or 5 cycles before calling 911
Gently tap the victim and ask loudly, If the child is
responsive, he or she will answer or move
If you are alone and the child is breathing, leave the
child to phone the emergency response system, but
return quickly and recheck the child's condition
frequently.
Children with respiratory distress often assume a
position that maintains airway patency and optimizes
ventilation.
Check for Breathing:-

If you see regular breathing, the victim does not need
CPR.

If the victim is unresponsive and not breathing (or
only gasping), shout for help and ask for AED
If the infant is unresponsive, check for
a brachial pulse
If there is no pulse, or the rate is less
than 60 with signs of poor perfusion,
begin chest compressions
When performing 2 rescuer CPR on an infant, the
rescuer has the option of using the 2 thumbs-
encircling hands technique.
This technique allows one rescuer to be at the infants
head for breaths and the other rescuer to be at the
feet for compressions.
In 2 person CPR in infants the ratio becomes 15:2
(10 cycles-2 person)
In an unwitnessed arrest of an infant perform 2
minutes or 5 cycles of CPR before calling 911 &
getting AED
Compression Techniques
Position:
for all ages: compress the lower third of the
sternum
Number of hands:
In infants: two thumbs or two fingers

in children: use one or two hands: depressing the
sternum by approximately one third of the depth of the
chest
59
Characteristics of high-quality
CPR
Chest

compressions of appropriate rate and
depth.
"Push fast":

push

at a rate of at least 100
compressions per minute.
"Push

hard":

push with sufficient force to depress
at least one third

the

anterior-posterior (AP)
diameter of the chest or approximately

1 inches
(4 cm) in infants and 2 inches (5 cm) in children.
Allow complete chest recoil

after each
compression to allow

the heart to refill with
blood.

Minimize interruptions of chest compressions.




Open the Airway and Give
Ventilations(A B)
For the lone rescuer a compression-
to-ventilation ratio of 30:2

is
recommended. After the initial set of
30 compressions, open

the airway and
give 2 breaths.
In an unresponsive infant or

child, the
tongue may obstruct the airway and
interfere with

ventilations, open the
airway using a head tiltchin

lift
maneuver.




- To give breaths to an infant, use a mouth
to mouth and nose

technique.

- To give breaths to a child, use a mouth-to-
mouth

technique. Make sure the breaths
are effective (i.e. the chest

rises).

Each breath should take about 1 second. If
the chest

does not rise, reposition the
head, make a better seal and

try again.


Coordinate Chest Compressions and
Breathing:-
-After giving 2 breaths, immediately give 30
compressions. The

lone rescuer should continue this
cycle of 30 compressions and

2 breaths for
approximately 2 minutes before

leaving the victim to
activate the emergency response system

and obtain
an automated external defibrillator (AED).
-Ratio of compression : ventilation 30:2 for one rescue,
and 15:2 for 2 rescue.



AED IN CHILDREN
Age > 8 years
use adult AED

Age 1-8 years
use paediatric pads /
settings if available
(otherwise use adult
mode)

Age < 1 year
use only if
manufacturer
instructions indicate it
is safe


The 2010 AHA Guidelines

for CPR and ECC
recommend CAB sequence.
(chest compressions- airway- breathing)













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