BASIC LIFE SUPPORT

RC (UK)

Objectives
To understand: The risks to the rescuer during resuscitation How to perform BLS The differences between layperson and in-hospital BLS
RC (UK)

Risks to the rescuer

Eliminate or minimise risk Manual Handling Beware of environmental danger: traffic electricity gas water
RC (UK)

Risks to the rescuer: poisoning

Hydrogen cyanide or hydrogen sulphide gas mask and non-return Corrosive chemicals absorbed through skin and respiratory tract protective clothing
RC (UK)

Risks to the rescuer: infection

15 documented cases of CPR related infection - mainly Neisseria meningitidis Tuberculosis Not hepatitis B or C, or CMV 3 cases of HIV transmission from high-risk cutaneous exposure
RC (UK)

Risks to the rescuer: precautions against infection

Gloves and eye protection Sharps box Face-mask with one-way valves Manikins clean regularly
RC (UK)

Assessment
Ensure safety of rescuer and victim

RC (UK)

Shake and Shout

RC (UK)

Is the victim responsive? YES

Check for injuries Reassess Get help
RC (UK)

Is the victim responsive? NO

Shout for help Open their airway Check for breathing
RC (UK)

Opening the airway

Head tilt Chin lift If cervical spine injury suspected: jaw thrust

RC (UK)

Assess Breathing
Look for chest movement Listen for breath sounds Feel for expired air Assess for 10 seconds before deciding breathing is absent RC (UK)

Is the victim breathing? YES

If safe, use recovery position Telephone for help Reassess at intervals
RC (UK)

Recovery Position 1st Stage

RC (UK)

Recovery Position 2nd Stage

RC (UK)

Recovery Position 3rd Stage

RC (UK)

Recovery Position 4th Stage

RC (UK)

Is the victim breathing? NO

Telephone for help Give two slow effective rescue breaths Make up to 5 attempts
RC (UK)

Rescue breathing (Expired air ventilation)

Occlude victims nose Maintain chin lift Take a deep breath Ensure a good mouth-to-mouth seal
RC (UK)

Rescue breathing (Expired air ventilation)

Blow steadily (2 sec) into victims mouth Watch for chest rise Maintain chin lift, remove mouth Watch chest fall
RC (UK)

Watch for chest fall

RC (UK)

Finger sweep

RC (UK)

Assess Circulation
Look, listen and feel for normal breathing, coughing, or movement by the victim Check the carotid pulse (if trained) Take no more than 10 seconds

RC (UK)

Is a circulation present? YES

Continue with rescue breathing Reassess for signs of a circulation about every minute
RC (UK)

Is a circulation present? NO
Start chest compressions Continue with rescue breathing

RC (UK)

Identify costal margin

RC (UK)

Identify xiphisternum

RC (UK)

Identify hand position on sternum

RC (UK)

Chest compressions:
Depress sternum 4-5 cm Rate: 100 per minute

RC (UK)

Chest compressions

RC (UK)

One Person CPR

RC (UK)

Chest compression: breath ratio

15 compressions : 2 breaths for 1-person CPR 2-person CPR

RC (UK)

When to go for help?

Go for help immediately: More than one rescuer Single rescuer: adult with cardiac problem, once established that patient not breathing CPR for 1 minute first: Trauma Drowning Drug or alcohol intoxication Infant or child

RC (UK)

Continue resuscitation until:

Qualified help arrives and takes over The victim shows signs of life You become exhausted

RC (UK)

Mouth-to-nose ventilation
If mouth-to-mouth technically difficult If mouth seriously injured Rescue from water Resuscitation carried out by a child Aesthetic reasons
RC (UK)

Compression-only CPR
Reluctance to perform mouth-tomouth ventilation Chest compression alone better than no CPR If possible combine with head tilt Appropriate for telephone-CPR
RC (UK)

Cervical spine injury?

If possible, maintain alignment of head, neck and chest Minimum head tilt only Jaw thrust preferable Assistance often required

RC (UK)

Choking: Back Blows

RC (UK)

Abdominal Thrusts

RC (UK)

In-hospital Basic Life Support

Not responsive

Patient Collapsed

Shout for HELP and assess responsiveness Responsive

Definite Pulse and Breathing Present? No Call cardiac arrest team / Get defibrillator Start BLS if defibrillator not immediately available Apply pads / monitor Defibrillate if appropriate Ventilate with oxygen Chest compressions ALS on arrival of Cardiac Arrest Team Yes Call for medical assistance

Airway manoeuvres Oxygen, monitor, i.v.

Find notes Prepare handover RC (UK)

Any Questions?

RC (UK)

Summary
ABC of basic life support rescue breathing chest compressions modifications

RC (UK)