Education

1. BASIC LIFE SUPPORT
(BLS)
‘save lives following cardiac arrest’

2. Chain of survival

3. Chain of survival

4. History contd…
–Prone position inadequate
–Expired air did provide sufficient O2
–Head tilt, chin lift kept patent airway

6. APPROACH SAFELY!
Scene
Rescuer
Victim
Bystanders

7. Response
Ask, “are u all right”?
no response
Tap or squeeze shoulders – gently
no response
activate Emergency medical services
• Check for no breathing or no normal breathing (i.e.,
gasping)
• Gasping without eye opening - failure to respond –
manage as unconscious

8. Pulse check
• The lay rescuer should not check for a pulse
• The healthcare provider should take no more than
10 seconds. If no pulse or doubtful, proceed with CC
- Children and adults – carotid
- Infants - brachial or femoral
• Use two fingers and large surface area to feel over
carotid or femoral

10. Carotid pulse

11. Chest compressions
• victim on flat surface
• “push hard and push fast”
• Rate: 100 compressions/min
• Compression depth : 4-5 cm in adults,
: 1/2 - 1/3 of chest in infants
• Landmark:
- lower 1/2 of sternum , between nipples in
children & adults
- just below nipple line in infants

14. Chest compressions
• Allow complete recoil of chest after each
compression
• Minimize interruptions in chest compressions
• Swap rescuers every 2 minutes (6-8 cycles) to
avoid exhaustion
• Compressions should be paused for ventilations
till airway is secured

15. Ventilation
• Head tilt and chin lift to open airway unless cervical
injury is suspected
• Rescue breaths

18. Rescue breathing
• Give 2 breaths each over 1 second
• Sufficient tidal volume to produce visible chest
rise
• Low minute ventilation can maintain effective
oxygenation during CPR
• Avoid rapid or forceful breath

19. Rescue breathing
• Mouth to mouth breathing
- open victim’s airway
- pinch the nose , airtight mouth-mouth seal
give 1 breath over 1 second
- take regular (not a deep ) breath
• Mouth to barrier device
• Bag and mask
• Ventilation with advanced airway
“No pause in compressions for ventilation if
advanced airway is placed”

20. Mask ventilation

23. • IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN
RECOVERY POSITION

26. Scenarios

27. Rescue breathing without CC
• Pulse is felt but no breath then
give breath
children/adults : 10-12
breaths/min
infants : 12-20
breath/min.
• Reassess the pulse every 2 min
• No more than 10 seconds in
doing so

28. Compressions only CPR
• If you are not able or are unwilling to give
rescue breaths, give chest compressions only
• If patient is gasping immediately start
compressions Intra-thoracic pressure won’t
increase and RR also will become low
• Should be continuous, at a rate of 100 /min
• Stop to recheck the victim only if he starts
breathing normally

29. Phone first or CPR first?
• This confusion occurs when rescuer is single
• Adult collapsing suddenly - mostly cardiac
arrest----call first then start CPR
• If the likely cause of unconsciousness is a
breathing problem e.g., drowning, trauma,
chocking, intoxication or victim is an infant
then do CPR for 2 mins or 5 cycles then call for
help

30. When to Stop CPR ???
CPR should be continued till :
• Qualified help arrives and takes over
• Return of spontaneous circulation (ROSC)
• The patient recovers
• An authorised person pronounces life extinct
• Rescuer becomes exhausted

31. Special occasion - Pregnancy
• CPR in pregnant victim:
- In pregnant woman the uterus causes pressure
on the major abdominal organs when she lies
flat, reducing the venous return to the heart
- give pelvic tilt to left using pillow/wedge as
blood supply to fetus should not be jeopardized

32. Special occasion - chocking
• Responsive Adult/Child
Abdominal thrusts until object is removed
or victim becomes unresponsive
• Unresponsive Adult/Child
Lower them to the ground and begin the
steps of CPR
Look in the mouth before each breath
If you see the object, you can remove it

34. Early defibrillation
• Early defibrillation implies that defibrillation
carried out within 5 mins of cardiac arrest
• Survival decreases by 10% for every minute that
passes without defibrillation

35. Defib….

36. AED
(Automated External Defibrillator)
• AEDs are computerized devices that allow
laypersons to attempt defibrillation safely.
• AEDs are recommended for all ages >1 yr
• AHA has approved low energy defibrillation
with biphasic waveform AED for VT/VF
• AEDs are highly accurate in rhythm detection
• It delivers fixed three shock sequence of 150
or 200j

37. AED contd…
• Power on the AED
• Apply pads to the victim's bare chest
• Plug the pads into the AED
• "Clear" the victim and allow it to analyze
• If a shock is advised, "clear" the victim again
and press the shock button

38. ATTACH PADS TO CASUALTY’S BARE CHEST

39. ANALYSING RHYTHM
DO NOT TOUCH VICTIM

40. SHOCK INDICATED
• Stand clear
• Deliver shock

41. SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

42. Take home message
– Compressions are vital
– Minimal interruption of chest compressions
– Push hard and fast
– 8-10 breaths per minute
– Delivered over one second duration
– 30/2 compression ventilation ratio
– Compressions immediately after
defibrillation

43. Cough CPR/ Prone CPR
• Cough cpr-Recommended only for awake
monitored victim getting VF/VT
• Prone cpr – when supine position cannot
be given
blood pressure is raised in
prone CPR than supine CPR.