Bcls Stikes

European Resuscitation Council
Basic Cardiac Life

Support
Sany R Siswardana, MD
OBJECTIVES
– How to assess the collapsed victim.

– How to perform chest compression and rescue

breathing.
– How to operate an automated external defibrillator
safely.
– How to place an unconscious breathing victim in the
recovery position.
BACKGROUND
• Approximately 700,000 cardiac arrests per year

in Europe
• Survival to hospital discharge presently

approximately 5-10%
• Bystander CPR vital intervention before arrival of

emergency services
• Early resuscitation and prompt defibrillation

(within 1-2 minutes) can result in >60% survival
CHAIN OF SURVIVAL
Lessons learned…
• CPR must be started ASAP to be effective
• Best results with lay rescuer CPR require
– Trained and motivated bystanders

– Short response times
– Readily available (AED) equipment
• Studies have shown that during asphyxial arrest chest
compressions alone are better than doing nothing
• Lay bystanders may be reluctant to perform CPR
– Feel it is too complicated
– Feel training is inadequate
– Fear the transmission of disease during mouth-to-mouth
resuscitation
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
APPROACH SAFELY!
Approach safely
Scene Check response

Shout for help
Rescuer
Open airway
Victim Check breathing
Call 112
Bystanders 30 chest compressions
2 rescue breaths
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
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.
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
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

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
CHEST COMPRESSIONS
• 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
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
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
30
CONTINUE CPR
2
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
2 rescue breaths
ELECTRICAL THERAPIES
DEFIBRILLATION
Passage across the myocardium of an electrical

current of sufficient magnitude to depolarise a
critical mass of myocardium and restoration of
coordinated electrical activity
USE OF DEFIBRILLATORS:
- Adults
- Children older than 8 years
- NO defibrillation in children less than 1 year
DEFIBRILLATION “WHAT
SHOULD KNOW?”
Sinus Rhythm
• Electrical Impulse
begins originates in
the atria
• P wave before every
QRS
• PR Interval .12 & .20
• QRS .8 & <.10
Sinus with PVC’s
• Underlying rhythm
originates in the
atria
• Aberrant beat
originating in the
ventricles
• QRS of the aberrant
beat is >.10
VT
• Electrical Impulse
originates in the
ventricles
• No P waves
• QRS > .10
VF
• Multiple stimulation
originating in the
ventricles
• Chaotic firing occurs
with no discernable
QRS noted
Asystole
• Lacks any form of

electrical conduction
• No discernable P
waves or QRS
• Commonly referred
to as flat line
Pulseless Electrical Activity
• Cardiac rhythm is
organized with
discernable P waves
and QRS
• Is not pulse
producing
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED
Follow voice prompts
“ABCD” – Simplified
• Airway • Universal ratio – 30:2

• Breathing – 30 compressions
• Circulation – 2 ventilations
• Defibrillation • No pulse check for lay

rescuers
• Key Message:
– Push hard, push fast,
full chest recoil,
minimize interruptions
in chest compressions
Adult BLS
1. Call for help and an AED
2. Open the victim's airway,
check for breathing, give two

breaths
3. Start CPR - 30 compressions
to 2 ventilations (100
compressions/minute)
4. On arrival of a defibrillator or
AED, check for a shockable
rhythm
5. Give one shock if indicated
then resume CPR for another
5 cycles
6. If no shock is indicated
continue another 5 cycles of
CPR
Note!
• Minimize pulse
checks
• Minimize interruptions
to compressions
Defibrillation
• No “stacked” shocks
• Single energy dose
• 200 Joules biphasic

defibrillator or 360 Joules
monophasic
• Witnessed collapse
– Immediate defibrillation
best
• Unwitnessed collapse
– May give CPR for 2
minutes first
– CPR may help with blood
flow to fibrillating heart
Defibrillation
• Apply AED or
Defibrillator
• Hunt for VF/VT
• Single shock
• Resume CPR
SWITCH ON AED
• Some AEDs will

automatically switch
themselves on when
the lid is opened
ATTACH PADS TO
CASUALTY’S 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
CPR IN CHILDREN
• Adult CPR
techniques can be
used on children
• Compressions 1/3 of
the depth of the chest
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
1. All breaths should be given over 1 second –
watch for chest rise
2. Neonatal resuscitation
• 100% oxygen or lower concentration
• Supplemental O2 should available if no
improvement in 90 seconds
Approach safely Approach safely
Check response Check response

Shout for help Shout for help
Open airway Open airway
Check breathing Check breathing
Call 112 Call 112
30 chest compressions Attach AED
2 rescue breaths Follow voice prompts
Secondary
ABCD
• IV or IO ASAP
• Medications
– Epinephrine
– Vasopressin
• Anti-dysrhythmics
– Amiodarone
– Lidocaine
• GOOD CPR!
IN-HOSPITAL RESUSCITATION
DRUGS AND FLUIDS
- DRUGS
Vasopressors
Adrenaline, Vasiopressin
Anti-arrhythmics
Amiodarone, Lidocaine
Other drugs
Atropine, Nabic
- INTRAVENOUS FLUIDS
Hartmann’s solution, Ringer’s solution
Intravenous fluid to flush peripherally injected drugs into the central

circulation
ANY QUESTIONS?

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European Resuscitation Council

Basic Cardiac Life

– How to assess the collapsed victim.

– How to perform chest compression and rescue

• Approximately 700,000 cardiac arrests per year

• Survival to hospital discharge presently

• Bystander CPR vital intervention before arrival of

• Early resuscitation and prompt defibrillation

– Trained and motivated bystanders

Scene Check response

Shake shoulders gently

• Look, listen and feel

• Occurs shortly after the heart stops

in up to 40% of cardiac arrests

• Described as barely, heavy, noisy or

• Recognise as a sign of cardiac arrest

• Place the heel of one hand in

• Place other hand on top

• Pinch the nose

Passage across the myocardium of an electrical

• Lacks any form of

• Airway • Universal ratio – 30:2

• Defibrillation • No pulse check for lay

check for breathing, give two

• 200 Joules biphasic

• Some AEDs will

• Age > 8 years

• Age 1-8 years

• Age < 1 year

Check response Check response

Intravenous fluid to flush peripherally injected drugs into the central

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