This document provides guidelines and information about basic life support (BLS) in Pahang, Malaysia. It discusses the history and evolution of CPR, challenges in performing high-quality CPR, and guidelines for performing CPR on adults, children, and infants. Key points covered include the importance of chest compressions, minimizing interruptions, compression-ventilation ratios for different age groups, foreign body airway obstruction treatment, and use of automated external defibrillators. The document is intended as a reference for emergency physicians and medical professionals in Pahang involved in BLS training and treatment.

1. BLS PAHANG 1
PAHANG HOSPITALS

2. BASIC LIFE SUPPORT 2011-2015
(BLS)
PREPARED BY :
DR SAZWAN REEZAL BIN
SHAMSUDDIN
EMERGENCY PHYSICIAN & HEAD,
EMERGENCY & TRAUMA DEPT,
HOSPITAL SULTAN HAJI AHMAD
SHAH, TEMERLOH
PANELISTS:
DR KHAIRI BIN
KASSIM@HASHIM
EMERGENCY PHYSICIAN & HEAD,
EMERGENCY & TRAUMA DEPT,
HOSPITAL TUANKU AMPUAN
AFZAN, KUANTAN.
DR ZAINAL ABIDIN BIN
MOHAMED
EMERGENCY PHYSICIAN,
EMERGENCY & TRAUMA DEPT,
HOSPITAL TUANKU AMPUAN
AFZAN, KUANTAN.
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3. RISK FACTORS FOR ISCHAEMIC
HEART DISEASE (IHD)
• Age > 40
• Male
• Hypertensive
• Diabetes mellitus
• Hypercholestrolemia
• Smoker
• Family history of IHD
IHD
CARDIAC
ARREST
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4. CPR through the ages…..
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5. Some not so celebrated instances …
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6. CPR through the ages
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• 1956 James Elam and Peter Safar
Mouth-to-mouth resuscitation
• 1960 Dr Kouwenhowen and team
External chest compression
• 1963 AHA formally endorses CPR
• 1966 First conference on CPR Standardize training and
performance standards
• 1972 Mass citizen’s training in CPR
Over 100,000 trained over 2 years
• 1970’s More than 60% bystanders will
perform CPR

7. CPR in Malaysia…
• 1985 CPR training started in HKL
• 1986 1st ACLS conducted in Malaysia
• 2008 Formation of Malaysia
Resuscitation Council
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8. 8
Challenges today
• Too few people know CPR
• Too few people willing to perform CPR
• We are not training the most important group of
people
• Trained providers cannot remember how to
perform CPR
• We have forgotten the importance of time
• Our duty to train other
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9. 9
CPR according to Guidelines 2000
“ Things we all do ?wrongly ”
• Too many interruptions to chest compressions
(up to 48% of total time the heart was not beating)
• Rate too slow
(28% achieved rates of only 60 bpm)
• Compression too soft and shallow
(40% did not achieve desired depth)
• Hyperventilation
(almost all the time, up to 37 breaths per min)
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10. CPR Guidelines keep changing
• BLS Guideline 2000
• BLS Guideline 2005
• BLS Guideline 2010
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11. Malaysia Guideline
• NCORT (National COmmittee for Resuscitation
Training) for MOH Hospitals was formed in 2008.
• A policy booklet was published in February 2009
& circulated to all hospital.
• NCORT reviewed the ILCOR (International Liaison
Committee on Resuscitation) consensus
document & will be use for BLS training till 2016.
• Therefore National Guideline for BLS will be
available soon.
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12. Chain of Survival
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13. BLS
= recognition of sudden cardiac arrest
+ activation of the emergency response system
+ early cardiopulmonary resuscitation (CPR)
+ rapid defibrillation with an automated external
defibrillator (AED)
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14. DRSABCD
• D- danger.
• R-responsiveness
• S-shout
• A-airway
• B-breathing
• C-chest compression
• D-defibrillation
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15. Danger
• Wear PPE eg. Mask, apron & gloves
• Avoiding spills of body fluid, sharps and
electrical wires.
• Determine unstable beds & trolleys.
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16. Responsiveness
• Tapping both shoulder
twice & calling
`Hello,hello are you ok?’
or `Tuan/Puan ok?
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17. Shout
• Shout after suspecting cardiac arrest
`Kecemasan! Kecemasan! Bawa troli resusitasi &
defibrilator!’
`Emergency! Emergency! Bring the resuscitation
trolley & defibrillator!’
• Positioning of victim
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18. Airway
• Open airway after
shouting for help –
head tilt chin lift
manouver.
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19. Breathing
• Looking at chest, neck & face not more than
10 seconds.
• Absence of breathing or presence of abnormal
breathing (include agonal breathing)= cardiac
arrest.
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20. Chest compression
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21. • Chest compressions consist of forceful rhythmic
applications of pressure over the lower half of the
sternum or centre of chest.
• To provide effective chest compressions, push
hard and push fast.
• It is reasonable for laypersons and healthcare
providers to compress the adult chest :
at a rate of at least 100 compressions per minute
a compression depth of at least 2 inches/5 cm.
allow complete recoil of the chest after each
compression to allow the heart to fill completely
before the next compression
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22. 22BLS PAHANG

23. 23BLS PAHANG

24. • minimize interruptions in compressions
• compression-ventilation ratio of 30:2 is recommended.
Rescue breath
• Once chest compressions have been started, a trained rescuer
should deliver rescue breaths by mouth-to-mouth or bag-mask to
provide oxygenation and ventilation:
 A healthcare provider should use the head tilt– chin lift maneuver
to open the airway of a victim with no evidence of head or neck
trauma
 Deliver each rescue breath over 1 second
 Give a sufficient tidal volume to produce visible chest rise
(estimated about 500-600mls)
 1 breath every 6 to 8 seconds (8 to 10 ventilations per minute)
should be performed when advanced airway placed. (ETT, LMA)
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25. 25BLS PAHANG

26. 26
Chest Compressions is GOOD
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Good CPR produce one third (1/3) of cardiac output.

27. 27
The critical role of perfusion of the brain
• “Why is it that every time I press on his chest, he
opens his eyes, and every time I stop to breathe
for him, he goes back to sleep?”
• Maintenance of cerebral perfusion is vital to neurological
function.
• In the first 10 minutes, the most important determinant of
cerebral perfusion, is the arterial pressure generated
during chest compressions
Cardio-cerebral resuscitation, Ewy GA. Circulation 2005
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28. If chest compression not properly
perform may result in…..
• Puncture lungs.
• Lacerated liver.
• Fracture ribs & sternum.
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29. Defibrillation
1 rescuer : after activating the emergency
response system the lone rescuer should next
retrieve an AED (if nearby and easily
accessible) and then return to the victim to
attach and use the AED. The rescuer should
then provide high-quality CPR.
2 rescuers : one rescuer should begin chest
compressions while a second rescuer activates
the emergency response system and gets the
AED.
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30. Defibrillation Sequence
● Turn the AED on.
● Follow the AED prompts.
● Resume chest compressions immediately
after the shock (minimize interruptions).
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32. 32BLS PAHANG

33. Reassessment during CPR
• After every 5 cycles or 2 minutes of CPR,
rescuers should check for normal breathing.
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34. When to stop CPR?
• Victim recovers with normal breathing.
• Rescuer is exhausted
• Advanced life support assistance arrives.
• Rescuer shall be encourage to switch chest
compression every 5 cycles or 2 minutes to
avoid fatigue
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35. Recovery position
• No single position is perfect for all victims.
• The position should be stable, near a true
lateral position, with the head dependent and
with no pressure on the chest to impair
breathing.
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36. 36BLS PAHANG

37. DRSABCD
• D- danger.
• R-responsiveness
• S-shout
• A-airway
• B-breathing
• C-chest compression
• D-defibrillation
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38. Hands-only CPR
• Only about 20% to 30% of adults with out-of-
hospital cardiac arrests receive any bystander
• Hands-Only (compression-only) bystander CPR
substantially improves survival following adult
out-of-hospital cardiac arrests compared with no
bystander CPR.
• For the rescuer providing Hands-Only CPR, there
is insufficient evidence to recommend the use of
any specific passive airway (such as
hyperextending the neck to allow passive
ventilation
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39. PAEDIATRIC BASIC LIFE SUPPORT
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Prevention Early CPR Prompt access to
EMS
PALS
Intergrated post
cardiac care

40. • Asphyxial cardiac arrest is the commonest
cause of arrest in infants & children.
• Infants : < 1 year of age
• Child : 1 year till puberty (~8 years old)
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41. • D - danger
• R - responsiveness
• S – shout for 999
• A - airway
• B - breathing
• C – circulation (chest compression)
• D - defibrillation
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42. Danger
• Assess safety for rescuer
and victim.
• Wear glove
Responsiveness
• Gently tap & asked loudly “
Hello. Are you okay?”
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Shout
• If child is unresponsive/gasping
shout for help immediately.
 2 rescuer : one start CPR & the
other activate ERS.
 Lone rescuer : call 999 without
leave the victim. If not possible
do 2 minutes CPR before
activate ERS

43. Airway
• Open airway- head tilt chin lift/jaw thrust.
• Check for foreign body.
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44. Breathing
• Look for chest
movement.
• Listen for breath sound.
• Feel for air movement
on your cheek.
• Should not more than
10 seconds.
• If child has regular
breathing then put child
in recovery position.
• Maintaining open airway,
give 2 effective rescue
breath.
• Make up 5 attempts to
achieve effective breath.
• When giving rescue breath:
• Each breath should take
about 1 second with
sufficient chest rise.
• If chest doesn’t rise,
reposition the head, make a
better seal with mouth &
try again.
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45. 45BLS PAHANG

46. Circulation
• Absent sign of life.
• Check pulse less than
10 second.
• Infant : brachial/femoral
pulse.
• Children : carotid pulse
• Chest compression.
• Push hard & push fast.
• Rate at least 100/min.
• Depth : 1/3 AP diameter or
1 ½ inches (4 cm) infant & 2
inches (5 cm) in children.
• Allow complete chest recoil.
• Minimize interuptions to
chest compression.
• Avoid excessive ventilation.
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47. 47BLS PAHANG

48. • Method:
• Infant – lone rescuer :
compress the sternum
with 2 fingers placed
just below
intermammary line.
- 2 rescuer : 2-thumbs
encircling technique.
• Child – using either 1 or
2 hands
• Chest compression:
breathing ratio –
Lone rescuer – 30:2 every
2 minutes.
2 rescuer – 15:2 every
2 minutes.
Only assess victim after at
least 2 minutes.
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49. BLS PAHANG 49
Chest compression
technique

50. CPR ratio, breathing & depth
Adult
• 30:2 (5 cycles/2
Min)
• Once/ 6-8
seconds.(8-10x
/min)
• Chest
compression
2inc(5cm)
Child
• 30:2 (5 cycles)
• Once in 3
seconds (20 x
/min)
• Chest
compression
2inc(5cm) or
1/3 A-P
diameter
Infant
• 30:2 (5 cycles)
• Once in 3
seconds
• Chest
compression :
1.5 in(4cm)
(20 x / min) or
1/3 A-P
diameter
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51. 51
FOREIGN BODYFOREIGN BODY
AIRWAYAIRWAY
OBSTRUCTIOOBSTRUCTIONN
(FBAO)(FBAO)
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52. Adult choking
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53. 53BLS PAHANG

54. Adult Foreign-body Airway
Obstruction
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55. Adult choking (conscious)
• No finger sweep unless foreign body visible
• In conscious pt, give 5 back slaps following
with 5 abdomen thrust/chest thrust
• No abdominal thrust in unconscious pt but
CPR instead.
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56. Abdominal Thrust
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57. Chest Thrust
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58. Foreign-Body Airway Obstruction
infant
• Conscious
• Check serious difficulty in breathing
• Ineffective cough
• No strong cry
• Dusky colour
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59. Foreign-Body Airway Obstruction
infant
• Conscious
– Give 5 back blows and 5 chest thrusts
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60. Foreign-Body Airway Obstruction
infant
• If FBAO becomes Unconscious
– Activate EMS
– Open Airway ( if FB seen, remove it )
– Start CPR
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61. 61BLS PAHANG