Basic life support

1. DR NARAYANAN RAJARAM TAWKER MD PDCC
ASSOCIATE PROFESSOR, ANESTHESIOLOGY
G B PANT HOSPITAL & ANIIMS
PORT BLAIR

2. INTRODUCTION
 Sudden Cardiac Arrest claiming about 4,280 lives from
every 10 lakh of population annually
 BASIC LIFE SUPPORT is the support given to a person
who has sudden cardiac arrest outside a health care
center
 It works on the principle of artificially providing
circulation and ventilation till body recovers for an
acute insult

3. 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.

4. CHAIN OF SURVIVAL

5. “Thoracic pump theory“ -
the chest compression propels blood out of the thorax
by increasing intrathoracic pressure …
the time of the chest compression and
decompression should be equal
Pressure should be completaly released
Hands should remain in the contact with the chest

6. Theoretical background
Oxygene content
In atmospheric air - 21%
In alveoli - 14,5%
Expired air – diluted by air from the airways (dead space)
- 16 – 18 % O2
Provided that there is an adequate amount of expired air reaching
the victim's lungs, oxygen delivery will be sufficient to ensure that
the victim's haemoglobin will be over 80% saturated with oxygen.

7. Theoretical background
Cardiac arrest
1. Asystole
2. Ventricular fibrillation
Most cardiac arrest victims have an electrical
malfunction of the heart  heart´s pumping
function abruptly ceases
3. Pulseless ventricular tachycardia =
Fast ventricular contractions without
haemodynamc effect Signs of the both =
identical!!!
Differential dg: only ECG

8. Theoretical background
At best
chest compressions provide only 30% of normal perfusion
 brain + heart
Time! Time! Time! Time! Time! Time! Time! Time!
Failure of the circulation 3 - 5 minutes  irreversible
cerebral damage.
Chances of successful CPR - restoration of spontaneous
circulation (ROSC) decreases by 10% with each minute
following sudden cardiac arrest…

9. Adults
• Ischemic heart disease - AMI- with/or ventricular
fibrillation (> 80%)
Children
• Suffocation or choking with hypoxemia or asphyxia.
Ventricular fibrillation is rare in children (only 5-8%)
Trauma

10. Cause of cardiac arrest and emergency
system activation
different approach to the emergency system activation.
Adults
electric defibrillator is necessary as soon as possible; therefore,
if telephone is available and you are alone:
1. call for help, then
2. start with CPR
Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help

11.  to victims with unexpected cardiac arrest in
otherwise healthy individuals …
 to those, who can be described as having ”heart too
good to die”

12. • malignant arrhythmia
• acute myocardial infarction (AMI)
• pulmonary embolism
• intoxication
• electrocution
• drowning
• acute suffocation
• severe trauma
• stroke
Indication of CPR

13.  signs of definitive biological death
 witnessed information, that cardiac arrest had happened 15 or
more minutes before the rescuer arrived (time assessment in the
stressing situation is not precise)
 terminal stage of incurable disease (generalised malignant
disease…)
 an evident trauma without chance to survive (catastrophic head
injury)
 “living will” - only in countries when constitution accepts it
 DNR - “Do not attempt resuscitation” has been written in the
file (incurable disease after all available therapy failed)
execution
Age of the patient is not restriction of CPR

14. Ventricullar fibrilation – better than asystole
- in case of immediate CPR
Special emphasis

Soon defibrillation
 1 minute - survival - 90%,
 5 minutes - survival - 50%,
 7 minutes - survival - 30%
 10 - 12 minutes - survival - 2 – 5%.
Outcome after CPR

15. • In first 4 minutes – brain damage is unlikely, if
CPR started
• 4 – 6 minutes – brain damage possible
• 6 – 10 minutes – brain damage probable
• > 10 minutes – severe brain damage certain
Cells of the brain cortex
• Most sensitive for the cessation of perfusion and
oxygenation
Without perfusion and oxygenation
 irreversibly damaged after 3-5 minutes
CPR outcome

16. 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
Protective devices

17. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

18. APPROACH SAFELY!
Scene
Rescuer
Victim
Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

19. CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

20. Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE

21. SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

22. OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

23. OPEN AIRWAY
Head tilt and chin lift
- lay rescuers
- non-healthcare rescuers
No need for finger sweep
unless solid material can be seen
in the airway

24. OPEN AIRWAY
Head tilt, chin lift + jaw thrust
- healthcare professionals

25. CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

26. CHECK BREATHING
 Look, listen and feel
for NORMAL
breathing
 Do not confuse agonal
breathing with
NORMAL breathing

27. 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

28. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

29. FOREIGN-BODY AIRWAY
OBSTRUCTION (FBAO)
Approximately 16 000 adults and children receive treatment for FBAO
in the UK yearly
SIGNS MILD obstruction SEVERE obstruction
“Are you choking?” “YES” Unable to speak,
may nod
Other signs Can speak, cough,
breathe
Can not
breathe/wheezy
breathing/silent
attempts to cough/
unconsciousness

30. ADULT FBAO TREATMENT

31. BACK BLOWS

32. ABDOMINAL THRUSTS

33. 30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

34. • 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 4-6 cm
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
CHEST COMPRESSIONS

35. RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

36. 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

37. RESCUE BREATHS
RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise
- Chest-compression-only
continuously at a rate of 100 min

38. CONTINUE CPR
30 2

39. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths

40. DEFIBRILLATION

41. Call 102
Approach safely
Check response
Shout for help
Open airway
Check breathing
Attach AED
Follow voice prompts

42. AUTOMATED EXTERNAL DEFIBRILLATOR
(AED)
 Some AEDs will
automatically switch
themselves on when
the lid is opened

43. ATTACH PADS TO CASUALTY’S
BARE CHEST

44. ANALYSING RHYTHM
DO NOT TOUCH VICTIM

45. SHOCK INDICATED
 Stand clear
 Deliver shock

46. SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
30 2

47. NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS
30 2

48. IF VICTIM STARTS TO BREATHE
NORMALLY PLACE IN RECOVERY
POSITION

50. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
30 chest compressions
2 rescue breaths
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 102
Attach AED
Follow voice prompts

51. CONTINUE RESUSCITATION UNTIL
 Qualified help arrives and takes over
 The victim starts breathing normally
 Rescuer becomes exhausted

52. REPETITION
1. Name adult basic life support sequences of actions.
2. What is the manoeuvre for keeping the airway open
called?
3. What is the numeral combination of chest compression and
rescue breaths in adult basic life support?
4. Where do you place your hands while performing chest
compressions?
5. How would you describe „agonal breathing“?
6. What is the telephone number of emergency response system?
7. Name 2 techniques applied in severe airway obstruction?

53. Basic Life Support (BLS)
• Basic patient evaluation
• Vital signs and basic monitoring (noninvasive blood pressure,
Pulse oximetry, heart rate)
• Hemorrhage control via direct pressure or pressure dressing
• Cardiopulmonary resuscitation (CPR) (BLS level) with the use
of an automatic external defibrillator
• Bag-valve-mask ventilation
• Oral and nasal airway
• Oral suctioning
• Administration of oxygen
• Basic patient rescue, positioning, and transport skills
• Cervical spine stabilization
• Fracture splinting
• Assisting a patient taking prescribed medication (e.g., albuterol)

54. New resuscitation
alphabet – in adults
Algorithm of CPR
EKG
Circulation BLS
Airways ALS
Breathing
Drugs

59. THANK YOU