1) The document provides instructions on performing basic life support (BLS) including assessing the scene and victim's responsiveness, activating emergency services, performing chest compressions and rescue breathing, using an automated external defibrillator, and placing the victim in the recovery position. 2) Key steps of BLS are ensuring safety, checking for response, calling for help, opening the airway, checking breathing, activating emergency services, performing chest compressions and rescue breaths. 3) Chest compressions should be provided at a rate of 100-120 per minute to a depth of at least 2 inches, and compressions should be paired with rescue breaths at a 30:2 ratio.

1. By-
Dr. ASHWINI KUMAR
(MS Surgery)
NMCH, PATNA

2. After an accident, immediately move the
victim to a comfortable position.
If a person is bleeding, use a tourniquet.
Signs of a heart attack include shortness
of breath, anxiety, and perspiration.
All burns can be treated with first aid
alone; no emergency medical attention
is necessary.
Prequiz:
True or False?

3. OBJECTIVES
◾Define BLS
◾Explain steps & components of
BLS

4. WHAT IS BLS ?
◾Basic life support refers to sequences of
procedures performed to restore the circulation
of oxygenated blood after a sudden pulmonary
and/or cardiac arrest by chest compressions
and pulmonary ventilation performed by anyone
who knows how to do it, anywhere, immediately,
without any other equipment.

5. COMPONENTS
◾Ensure safety
◾Check for response
◾Activate EMS(102)
◾Chest compressions
◾Check airway and ventilate
◾Defibrillate

6. STEPS OF BLS

7. 1. ENSURE SAFETY
◾Safety of SELF
◾Safety of PATIENT
◾Movement of TRAUMA
victim only when
absolutely necessary.
[unstable cervical spine,
injured spinal cord]

8. 2. ASSESS RESPONSE (AVPU)
◾Ask the person “Are you ok ?”
◾Tap and shout
◾Look the chest for movement and
breathing.
◾If the victim responds-
leave the client and call for help .
Return as quick as possible and reassess
the condition of the person.
Are you ok ?

9. If the victim is unresponsive- HELP ,HELP,
HELP !!!

10. 3. ACTIVATE EMS
◾Call 102
◾ Describe the emergency to the operator:
-includes where you are (address and
location)
-condition of patient

11. CHANGE FROM A-B-C TO C-A-B
 The ABC regime is used now exclusively for
victims of TRAUMA.
 The vast majority of cardiac arrests occur in
adults. In these patients, the critical initial
elements of BLS are chest compressions
and early defibrillation.
 In the A-B-C sequence, chest compressions
are often delayed while the responder opens
the airway to give mouth-to-mouth breaths ,
retrieves a barrier device, or gathers and
assembles ventilation equipment.

12. C. CIRCULATION
◾Position of victim :
• Must be supine on a firm flat surface for
CPR to be effective

13. Check the patient for a carotid pulse for 5-10 seconds. (Do not check
for more than 10 seconds.)
1. If the patient has a pulse:
• Move to the airway and rescue Breathing portion of the algorithm.
• Provide 10 rescue breaths per minute (1 breath every 6 seconds).
• Recheck pulse every 2 minutes.
2. If the patient doesn’t have a pulse:
• Begin CPR (lasts approx. 2 minutes).

14. 4. CHEST COMPRESSIONS
◾POSTION OF THE RESCUER
1. Kneel beside victim’s chest or stand beside bed
line.
parallel
2. Heel of one hand on inter-mammary line( lower half of the sternum) in mid
3. Heel of other hand on top of the first so that the hands are overlapped and
4. Lock elbows
1,2,3,4,5,6,……
.29,30

15. GOOD COMPRESSIONS
“Push hard push fast”. Push at a rate of 100-120/min.
Compression depth- at least 2 inches(5cm)(not more than2.5
inches)
Release completely to allow the chest to fully recoil.
 A compression-ventilation ratio of 30:2 .
◾Do not bounce your hands up and down on the victim’s chest.
◾Never use the palm of your hand, use the heel of your hand.
◾If two rescuers are present: switch rolls between compressor and
rescue breather every 5 cycles.

16. A. AIRWAY
OPEN AIRWAY
 In the event of an unwitnessed collapse,
drowning or trauma:
Use the “Jaw Thrust maneuver”. (This maneuver
is used when a cervical spine injury cannot be
ruled out.)
a. Place your fingers on the lower rami of the
jaw behind the angles.
b. Provide anterior pressure to advance the
jaw forward using your thumb.

17.  In the event of a witnessed collapse with no
reason to assume a C-spine injury:
Use the “Head Tilt-Chin Lift maneuver” :
a. place your palm on the patient’s forehead
and apply pressure to tilt the head
backward.
b. place the fingers of your other hand under
the mental protuberance of the chin and
pull the chin forward and cephalic.

18. B. BREATHING
◾Scan the patients chest and torso for
possible movement during the “assess
unresponsiveness” portion of the
algorithm. Watch for abnormal
breathing or gasping.
◾Breathing check should take no longer
than10 seconds. If no breath is
detected, CPR should not be delayed.

19.  Maintain airway and place your ear over casualty’s mouth and
nose, looking toward their abdomen.

20. 1. If the patient is breathing adequately: Continue to assess and maintain
a patent airway and place the patient in the “recovery position”. (Only
use the recovery position if its unlikely to worsen patient injury.)
2. If the patient is not breathing or is breathing INADEQUATELY:
• If the patient has a pulse
i. Commence rescue breaths immediately.
ii. Provide 10 rescue breaths per minute (1 breath every 6 seconds).
iii. Recheck pulse every 2 minutes.
• If the patient has NO pulse
Begin CPR. (move to the “Circulation” portion of the algorithm) along
with rescue breaths.

21.  An advanced airway (supraglottic airway, laryngeal mask airway,
or endotracheal tube) provides a more stable way of providing
breaths and should, therefore, be inserted as early as possible in a
resuscitation effort.
 During normal CPR without an advanced airway:
approximately 6-8 rescue breaths per minute
 During normal CPR with an advanced airway:
10 rescue breaths per minute
(don’t pause chest compressions for breaths).

22. RESCUE BREATHS
◾ Use a barrier device if available.
◾ Pinch the patient’s nose closed.
◾ Make a seal using your mouth over the
mouth of the patient or use a pocket mask
or bag mask.
◾ Each rescue breath should last
approximately 1 second.
◾ Watch for chest rise.
◾ Allow time for the air to expel from the
patient.

24. HOW TO APPLY A SEAL USING A MASK

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

26. 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

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

28. Shake shoulders gently
Ask “Are you all right?”
If he responds
 Find out what is wrong.
 Reassess regularly.
If he does not respond
CHECK RESPONSE

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

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

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

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

33. CHECK BREATHING
 Look, listen and feel
for NORMAL
breathing
 Do not confuse
AGONAL breathing
with normal breathing

34. 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

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

36. 30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call (102)
30 chest compressions
2 rescue breaths

37.  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 4-5 cm
Equal compression : relaxation
 When possible change CPR
operator every 2 min
CHEST COMPRESSIONS

38. 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

39. CONTINUE CPR
30 2

40. D. DEFIBRILLATE
◾AED – Automatic external Defibrillator
• A battery operated device which on applying to
victim detects and assesses cardiac rhythm and
prompts the user for further action.
Components:
• On/Off switch
• Plug with flashing light near it
• Shock delivery button(orange)
• Speaker & volume control for voice prompt.
• Two self sticking pads with cables & connectors

41.  If the rhythm is not shockable : Initiate 5 cycles of CPR 30:2 .Recheck the rhythm at
the end of the 5 cycles of CPR.
 If the shock is indicated: Assure no one is touching the patient or is in mutual contact
of a good conductor of electricity by yelling “Clear, I’m Clear, you’re Clear!” prior to
delivering a shock . Press the shock button when the providers are clear of the
patient.
Resume 5 cycles of CPR. Clear, I’m Clear,
you’re Clear!

42. RECOVERY POSITION
(LATERAL RECUMBENT OR 3/4 PRONE POSITION)
in.
 If the victim responds, position him in the recovery position and monitor
breathing until help arrives.
◾ This position is used to maintain a patent airway in the unconscious
person. Place the patient close to a true lateral position with the head
dependent to allow fluid to dra
 Avoid pressure of the chest
that could impairs
breathing.
 Position patient in such a
way that it allows turning
them onto their back easily.

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

45. CONTINUE RESUSCITATION UNTIL
Qualified help arrives and takes over
 Victim starts breathing normally
 Rescuer becomes exhausted

46. FOREIGN BODY OBSTRUCTION (CHOKING)
◾ Universal signal for choking : patient has both hands
wrapped around the base of their throat.
• With complete airway obstruction, the victim is unable to
speak, cry, or provide any sounds of respiration.
The patient may be confused, weak, obtunded, or cyanotic.
• Partial airway obstruction may result in stridor or a high-
pitched audible noise during respiration. Partial airway
obstruction may allow for a productive cough or allow the
patient to speak.
◾ Get the patient’s attention and ask them if they are choking.
Assess for signs and symptoms of airway obstruction.

47.  If partial airway obstruction:
Do not attempt Heimlich maneuver.
 If complete airway obstruction:
(one provider) immediately call the emergency response team.
(one provider) Attempt Heimlich maneuver
(two provider) Send someone to call the emergency response
team, while you attempt the Heimlich maneuver.
 If patient becomes unconscious : Initiate CPR.

48. HEIMLICH MANEUVER

49. Infant Under 1 Year Old If you are alone

50.  POWER: Turn AED On NOW! (early
defibrillation is the single most
important therapy for survival of
cardiac arrest and should be done
as soon as it arrives).Follow verbal
AED prompts.
 ATTACHMENT : Firmly place
appropriate pads (adult/pediatric)
to patient’s skin to the indicated
locations (pad image).
 ANALYSE: A short pause in CPR is
required to allow the AED to
analyze the rhythm.

52. 1
2
3
4

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

54. THANK YOU