ADULT BASIC LIFE SUPPORT (BLS)

Guideline 2015
revising
Guideline 2000
Guideline 2005
Guideline 2010

Pontisomaya Parami
Departemen/ SMF Anestesiologi & Terapi Intensif
FK UNUD-RSUP SANGLAH
 Fundamental Aspects of BLS

• Immediate recognition of SCA (sudden cardiac

arrest)& activation of emergency response
system

• Early CPR (cardiopulmonary resuscitation)

• Rapid defibrillation with AED (automated external

defibbrillator)
 SCA (sudden cardiac arrest)
• Many etiologies (cardiac or noncardiac)
• Many circumstances (witnessed or unwitnessed)
• Many setting (out-of-hospital or in-hospital)

→ No single approach for resuscitation

→ Universal strategy for successful resuscitation
→ This action are termed the link in the
“Chain of Survival”
Chain of Survival (for adult)
The links in this Chain are:
1. Immediate recognition and activation
of the emergency response system
2. Early CPR with an emphasis on chest compressions
3. Rapid defibrillation,
4. Effective advanced life support and
5. Integrated post-cardiac arrest care.

1 2 3 4 5
2015
 Simplified adult BLS algorithm

• To present the step of BLS in logical & concise

manner → easy for all type of rescuers to
learn, remember & perform.
• Traditionally been presented as a sequence to
help a single rescuers
• In-hospital involve teams who should perform
several action simultaneously
Simplified adult
BLS algorithm
2015
2015
2015
2015
2015
2015
Activate Emergency Medical Service

Call ambulance 118

Ward area:
Activate code blue /
shout for help for
lapor dokter…
 IMMEDIATE RECOGNITION & ACTIVATION OF
THE EMERGENCY RESPONSE SYSTEM

• Lone rescuer find :

Call ambulance
Unresponsive adult (no 118
movement, no response
) or witnesses a Ward area:
suddenly collapse adult Activate code
→Ensuring the scene is blue / shout for
safe help,
→Check for response lapor dokter
(tapping the victim on
shoulder, shouting)
 IMMEDIATE RECOGNITION & ACTIVATION OF
THE EMERGENCY RESPONSE SYSTEM

Victim also has absent or abnormal breathing

(ie, only gasping)

→Assume the victim is in cardiac arrest

→Phone emergency response system (call
emergency number)
IMMEDIATE RECOGNITION & ACTIVATION OF THE
EMERGENCY RESPONSE SYSTEM

• If there is trained or untrained bystander :

→Minimum activate the community
emergency response system (call emergency
number)

• After activating emergency response system

→Begin CPR (adult victim unresponsive with no
breathing or abnormal breathing)
 EARLY CPR
CHEST COMPRESSION
• Effective chest compression
→provide blood flow during CPR
• PUSH HARD AND PUSH FAST
→At least 100 x/minute
→depth at least 2 inches/5 cm
→allow complete recoil after each
• Minimize frequency & duration of interruption
• Compression-ventilation ratio 30:2
 EARLY CPR
CHEST COMPRESSION
 The hand position EARLY CPR
CHEST COMPRESSION

For adults receiving chest

compressions, it is reasonable for
rescuers to place their hands on
the lower half of the sternum.

It is reasonable to teach this

location in a simplified way,
such as:
“Place the heel of your hand in the
center of the chest
with the other hand on top.”
2010 ILCOR
 EARLY CPR
RESCUE BREATHS

• Once chest compression

have been started
• A trained rescuer should
deliver rescue breath
→ Each over 1 second
→ Produce visible chest
rise
→ Compression-
ventilation ratio 30:2
Building Blocks of CPR.
 CPR

• Untrained lay rescuer , not trained bystander

→Hands-only (chest compression only) CPR untill
AED arrive & ready to use or healthcare take care
over the victim.

• 2 or more rescuer
→Switch chest compression approximately every 2
minutes
 30 : 2
CPR
Chest Compression
& Rescue Breaths
 Early Defibrillation
With AED

• Lone rescuer, after activating emergency

response system
→Retrieve an AED (if nearby, accessible)
→ Attach to victim
→ Use the AED
→Then provide CPR
Early Defibrillation
With AED

A single shock is delivered

immediately followed by
two minutes
of uninterrupted CPR
 Early Defibrillation
With AED

• 2 or more rescuer,
→One begin chest compression
→The second activates emergency response
system & get AED
→ use AED as rapid as possible, both rescuer
provide CPR (chest compression & ventilations)
 AED Defibrillation
Public Area Defibrillation (PAD) programs

• Sophicticated, reliable computerized devices

that use voice & visual prompts to guide lay
rescuer & healthcare to safely defibrillate VF &
(pulseless) rapid VT (ventricular tachycardia)
SCA
• Extremely accurate for rhythm analysis
• For Out-hospital witnessed VF SCA
 Early Defibrillation
With AED

Defibrillation Sequence
• Turn the AED on
• Follow the AED prompts
• Resume chest compressions immediately after
the shock (minimize interruption)
Cardiac arrest = carotis pulse (-)
check ECG !

• VF / VT pulseless = specific wave

– shockable rhythm

• Asystole = ECG flat, no wave

– UN-shockable

• PEA = EMD = like normal ECG wave

– UN-shockable
 UN-shockable
Asystole
EKC = Flat
Tidak ada gelombang

P-ulseless
ROSC < 10% E-lectrical
( Recovery of A-ctivity
Spontaneous Circulation )
E-lectro
M-echanical
D-issociation
SHOCKABLE RHYTHMS
1. Ventriculer Fibrilation - VF

Coarse Ventricular Fibrillation

Fine Ventricular Fibrillation

BE CAREFULL!! UNshockable
2015
CHOCKING
Foreign-body Airway Obstruction
CHOKING

Back blows
or “slaps”

5 times back blows,

Between scapula

Conscious victim
 CHOKING

Heimlich
Abdominal thrust

Conscious victim
Not for infants < 1 year
Hipoxia then fall

Back blows
&
Heimlich Manouvre
 Heimlich Abdominal trust

x
Unconscious victim
x
Do CPR !!,
Not Heimlich Abdominal Trust
Infant (5 back blows 5 chest compression)
Children (heimlich )
 Foreign Body Airway Obstruction
(FBAO)
• MILD FBAO SEVERE FBAO
(cough+, sounds+)
Intefere – Heimlich (child, adult) / 5 back blows
5 chest compression (infant)
• SEVERE FBAO Untill unresponsive or expelled
(cough-,sounds-)
Start CPR
consciuos • (30 compression)
• Open airway (foreign body+,
remove, NOT blind finger sweep)
unconscious • 2 breath
• Continue CPR cycles (2min)

Activate Emergency Response System

 DROWNING

• Remove victims from water by the fastest

means → begin resuscitation as quickly as
possible
• Provide CPR, particularly 2 rescue breathing as
soon as unresponsive submersion victim
removed from water
• Lone healthcare provider
→5 cycles CPR before leaving for activating
EMS (emergency medical services)
THANK YOU