BASIC-LIFE-SUPPORT-REV-2021(1).pptx

At the end of this module, the learner is expected to:
 understand the need for cardiopulmonary resuscitation (CPR);
 recognize an unconscious victim with
possible cardiopulmonary arrest; and
 learn how to perform adult basic life support (BLS) for
healthcare providers and application of an automated external
defibrillator (AED).
LEARNING OBJECTIVES

ADULT BASIC LIFE SUPPORT
Cardiac arrest is the sudden stop in effective blood
circulation due to failure of the heart to pump
blood, leading to compromised blood flow and
oxygen delivery to the entire body leading to loss
of function within minutes
Cardiac arrest can happen anytime, anywhere and
to anyone

 Cardiac Approximately half of cardiac deaths
occur as sudden cardiac arrest. Pre-existing
heart disease is a common cause, but it may
also strike people without any history of cardiac
problems.
 The most common arrhythmia in adult out-of-
hospital cardiac arrest victims is ventricular
fibrillation.

CPR “CARDIOPULMONARY RESUSCITATION”
Chest compressions – these manually force blood
to circulate to the brain and
Heart airway management and rescue breathing –
these inflate the lungs, facilitate oxygen delivery,
and open up pulmonary vasculature

CPR prolongs the time that the victim
is in ventricular fibrillation to buy time
for a shock to be delivered, via an
automated external defibrillator
(AED).

AEDs use voice and visual prompts to
guide rescuers to safely deliver shocks to
cardiac arrest victims.
The AED analyzes the victim’s rhythm
and will recommend shock delivery only
if the victim’s heart rhythm is one that a
shock can treat.

A shock delivered by the AED can temporarily
stun the heart’s disorganized activity, to allow
restoration to sinus rhythm and return of
cardiac function thereby promoting adequate
circulation of oxygenated blood throughout the
body.

Figure 1. 2020 American Heart Association Adult fChain of Survival for In-Hospital Cardiac Arrest
CHAIN OF SURVIVAL

CHAIN OF SURVIVAL
Figure 2. 2020 American Heart Association Adult Chain of Survival for Out-of-Hospital Cardiac Arrest

The key person in the early access is the
trained healthcare provider or even a well-
informed lay person who is able to recognize
the signs of a heart attack and respiratory
failure.

SYMPTOMS OF A HEART ATTACK
 Prolonged compressing pain
 Unusual discomfort in the center of the chest
 Radiate to the shoulder, arm, neck, or jaw, usually on the left
side
 Accompanied by sweating, nausea, vomiting and shortness of
breath

RESPIRATORY FAILURE
• Person is unable to speak, breathe, or cough
• The universal distress signal involves the victim clutching
his/her neck and may be accompanied by cyanosis or a
bluish discoloration of skin and lips due to lack of a patent
airway leading to lack of oxygen.

Lay rescuers and healthcare professionals should use the
combination of unresponsiveness and absent/abnormal
breathing to identify cardiac arrest.
 Agonal gasps, which are defined by short, labored, and
irregular breathing, are common during cardiac arrest.
Consider agonal gasps as NO BREATHING.

CPR before emergency medical service (EMS) arrival
has been shown to:
 Prevent ventricular fibrillation or pulseless ventricular
tachycardia from deteriorating to asystole;
 Increase the chance of defibrillation;
 Contribute to preservation of heart and brain function;
and,
 Improve overall survival.

SINGLE-RESCUER ADULT BASIC LIFE
SUPPORT

a. Head-tilt chin-lift maneuver (if with NO SUSPECTED cervical spine injury)
SUPPORT

b.Jaw thrust without head extension (if WITH SUSPECTED cervical spine injury)
SUPPORT

Perform high-quality CPR:
•Kneel facing the victim’s chest.
•Place the heel of the hand on the sternum at the
center of the chest between the nipples.
•Put your other hand on top of the first with fingers
interlaced.
•Your shoulders should be over your arms hands
that are perpendicular to the victim’s body, with
your elbows locked.
SUPPORT

• Perform high quality CPR at 100 to 120
compressions per minute at 5 to 6 cm (2.0 to 2.4
in) deep while keeping your hand in contact with
the chest at all times, and allowing for full chest
recoil.
SUPPORT

• Perform 1 cycle of 30 chest compressions
while counting out loud, “1, 2, 3,… 27, 28, 29,
and ONE.” (Instead of saying “30,” say “1” to
“5” to indicate how many cycles of 30 chest
compressions you have already completed.)
SUPPORT

• After 30 chest compressions, open the airway
using the head-tilt chin-lift maneuver, and
provide 2 full one-second breaths. Check for
chest rise in between breaths.
SUPPORT

Hook the patient to an automated external defibrillator
(AED) once available:
 Activate the AED by turning the power on.
Attach the electrode pads:
o Peel the backing away from the electrode
pads.
o Wipe the victim’s chest dry.
o Attach one electrode pad to the right of the
breast bone directly below the collarbone.
Attach the other pad to the left of the left
nipple, a few inches below the left armpit.
o Attach the AED cables to the AED box if
these are not pre-connected.
SUPPORT

 Evaluate the rhythm.
 Deliver shock if advised by the
voice prompt.
 Start or resume CPR.
Hook the patient to an automated external defibrillator
(AED) once available:
SUPPORT

 The first rescuer will perform the chest compressions, while the
second rescuer will deliver the rescue breaths.
 The second rescuer will be the one to operate the AED.
TWO-RESCUER ADULT BASIC LIFE SUPPORT

ADULT BASIC LIFE SUPPORT IN THE
COVID-19 PANDEMIC In-hospital
Cardiac Arrest for Suspected,
Probable, or Confirmed Cases of
COVID-19
Figure 3. Adult basic life support for in-hospital
cardiac arrest victims during the COVID-19
pandemic

OUT-OF-HOSPITAL CARDIAC ARREST
Figure 4. Adult basic life support for out-of-hospital cardiac arrest victims during the COVID-19
pandemic

Pediatric Basic Life
Support for Healthcare
Professionals

 Recognize common conditions causing cardiac arrest in
children; and
 Gain knowledge and skills in performing pediatric basic
life support and using automated external defibrillator.
LEARNING OBJECTIVES

PEDIATRIC BASIC LIFE SUPPORT
Figure 1. 2020 American Heart Association Pediatric Chain of Survival for In-Hospital Cardiac Arrest
PEDIATRIC CHAIN OF SURVIVAL
Figure 2. 2020 American Heart Association Pediatric Chain of Survival for Out-of-Hospital Cardiac Arrest

CAUSES OF PEDIATRIC
CARDIAC ARREST
Table 1. Causes of Pediatric Cardiac Arrest
More Common: Hypoxic- asphyxial
causes
Less Common: Primary
Arrhythmic Causes
 Sudden Infant Death Syndrome
• Hypertrophic Cardiomyopathy
• Anomalous Coronary Artery
 Airway and breathing problems • Channelopathies
 Traumatic injury or accident • Myocarditis
 Drowning • Commotio Cordis
 Electrocution
• Intentional/accidental
ingestion of drugs/substances

PEDIATRIC BASIC
LIFE SUPPORT
Component 28 days to <1 year old (infants)
1 year to <8 years old
(children)
8 years old and above (children,
and adolescents)
Scene safety Make sure the environment is safe for the rescuer/s and the victim.
Recognition of
cardiac arrest
 Check for responsiveness.
 Check for pulse and breathing.
 If with no breathing (or only gasping), and with no definite pulse felt within 10seconds, proceed to
the next component.
Activation of
emergency
response system
 For WITNESSED COLLAPSE (more commonly VF in
etiology, and among victims 8 years old and above):
 Use the PHONE FIRST strategy:
o Follow the same steps as for victims 8 years old and
above.
 For UNWITNESSED COLLAPSE (more commonly
asphyxia in etiology, and among victims <8 years old):
 Use the PHONE FAST strategy:
o Give 2 minutes of CPR.
o Leave the victim to activate the EMS and get the
AED.
o Return to the child or infant and resume CPR.
o Use the AED as soon as it is available.
 If with only 1 RESCUER:
o Leave the victim to activate the
EMS and get the AED before
beginning CPR.
o Use the AED as soon as it is
available.
 If with >1 RESCUER:
o Send another rescuer to activate
the EMS and get the AED, while
you begin CPR immediately.
o Use the AED as soon as it is
available.
Compression-
ventilation ratio
without advanced
airway
If with only 1 RESCUER: 30:2
If with >1 RESCUER: 15:2 30:2
Compression rate 100 to 120 compressions per minute
Compression
depth
At least 1/3 of the AP diameter of the
chest
(about 1.5 inches or 4 cm)
At least 1/3 of the AP
diameter of the chest
(about
2 inches or 5 cm)
2 to 2.4 inches or 5 to 6 cm
Table 2. Summary of High-
quality CPR Components
in Pediatric Victims

PEDIATRIC BASIC
LIFE SUPPORT
Component 28 days to <1 year old
(infants)
1 year to <8
years old
(children)
8 years old and
above (children,
and
adolescents)
Hand placement
 If with only 1 RESCUER:
o 2 fingers at the
center of the chest,
just below the nipple
line
 If with >1 RESCUER:
o 2 thumb-encircling
hands at the center
of the chest, just
below the nipple line
2 hands or 1 hand
(optional for very
small child) on the
lower half of the
breastbone
(sternum)
2 hands on the lower
half of the
breastbone
(sternum)
Chest recoil  Allow full chest recoil of the chest after each compression.
 Do not lean on the chest after each compression.
Minimizing
interruptions  Limit interruptions in chest compressions to <10 seconds.

• Allow a child with respiratory distress (eg, a child who is bent
forward, in the tripod position, drooling, or appears toxic) to
remain in a position that is most comfortable for him/her.
• Where to check for pulse: o infants – brachial pulse
o children – carotid or femoral pulses

Victim with Pulse and No Breathing
 Perform rescue breathing:
 Open the airway using the head-tilt chin-lift or jaw thrust without head
extension.
 Select the appropriate route (eg, mouth-to-
mouth, mouth-to-nose-and-mouth, mouth-to-barrier, or bag-valve-mask).
 Provide 20-30 rescue breaths per minute (or 1 rescue breath every 2 to 3
seconds) for 2 minutes.

Victim with Pulse and No Breathing
 Reminders when performing rescue breathing: o Use a barrier
device.
 Deliver each breath over 1 second.
 Give sufficient tidal volume to produce visible chest rise.
 Avoid rapid or forceful breaths.

Victim with No Pulse and No Breathing
Perform CPR.
o Start chest compressions.
For Infants:
landmark: 1 finger below the inter-mammary or nipple line
hand position: two-thumb technique (preferred) or two-finger technique
For children:
landmark: lower half of the sternum
hand position: one-hand technique

Victim with No Pulse and No Breathing
o Open the airway.
Provide 2 one-second breaths after every 30 chest compressions.
Check for chest rise in between breaths.
o Perform rescue breathing.
compression-ventilation ratio if with only 1 RESCUER: 30:2
compression-ventilation ratio if with >1 RESCUER: 15:2

<8 years old, or ≥8 years old, or
<55 lbs (26 kg) ≥55 lbs (26 kg)
Choice of AED
pads
Placement of
AED pads
Use the AED as soon as it is available.
o Use of an AED with a pediatric
attenuator is preferable over an AED
without a pediatric attenuator.
Table 3. AED for Pediatric Victims

Victim with Pulse and Breathing
•Put the victim in the
recovery position
Figure 3. Recovery position in pediatric victims

RESUSCITATION
IN NEAR DROWNING

c
• Second leading cause of death among Filipino children aged 14
years and below.
• “About eight persons die everyday due to drowning and that more
were reported to be victims of near drowning (10 cases per day),”
World Conference on Drowning Prevention (WCDP) 2011
• “Children were found to be more prone to or at risk of drowning, “
Family Health Office, National Center for Disease
Prevention and Control, Department of Health (DOH)2011
RESUSCITATION IN NEAR DROWNING

• The alarming number of maritime disasters in the country has
contributed to drowning statistics.
• Ten of the 22 incidents from 1980 to 2003 were identified as major
maritime disasters in the Philippines which resulted to at least 3543
casualties, or an average of 10.5% of deaths from drowning for all
ages.
• “Moreover, the country is often visited by typhoons (average of 20-25
annually) causing floods, flooded areas, flash floods and turbulent
seas which undeniably cost the lives of Filipinos,”
Philippine report to the WCDP 2011
Drowning Statistics Philippine Data

Drowning Statistics Philippine Data
• In 2003 , there were 2,822 cases of deaths caused by drowning injuries. More
than one-third (35.6%) were children below 14 years old.
• Drowning rates were highest among boys and girls less than 5 years old
compared to other age groups and higher among females than males for all age
groups.
• Drowning rates were higher among males under 5 years and among those under
15 years compared to females of the same ages. This gender difference is
largest for male toddlers whose relative risk for drowning death is 1.5 times
higher than female toddlers.
Department’s National Epidemiology Center
from the UNICEF’s Philippine National Injury Survey (PNIS)

• Is CPR performed any differently for victims of drowning?”
The most important thing to remember is that for anyone
who is unresponsive and isn’t breathing, CPR needs to be
started immediately. Following the specific priorities
learned during your CPR training is the easiest way to get
CPR started for the drowning (or more accurately, near-
drowning) victim. Make sure to always call 911 first before
trying to rescue a victim and/or begin CPR. Rescuers must
also keep themselves safe during any rescue attempt.

• Near-drowning happens when a person is unable to breathe
due to extended submersion in water. Just as in other
respiratory-based issues, the body’s systems will shut down due
to the lack of oxygen, and can easily result in the rapid onset of
brain damage (this usually occurs faster in children than in
adults). Even if a near-drowning victim has been submerged for
a long period, CPR may still be effective – especially in cases
where the water is cold.

• One concern expressed is what to do about the water that has entered
the lungs, and how much the aspirated water will interfere with rescue
breaths. When water enters the airway both conscious and unconscious
victims will experience laryngospasm (the involuntary constriction of the
larynx), which will seal off the airway. This means that water will enter
into the stomach rather than the lungs. Around 7-10% of victims
maintain this seal up to the point of cardiac arrest. Therefore there is
usually no need to clear the airway of water, as only a small amount is
aspirated, and that which is aspirated will normally be absorbed into the
bloodstream.
• Cardiac arrest in near-drowning victims is caused by lack of oxygen and
physical changes to the blood.

•In salt water, osmosis pulls water out of the
bloodstream and into the lungs, making the blood
thicker and taxing the heart. In fresh water,
osmosis works in the opposite direction, diluting
the blood, destroying red blood cells, and altering
electrical activity in the heart. These can all result
in cardiac arrest.

• The current CPR guidelines indicate that CPR should begin with chest
compressions. Due to the conditions associated with near-drowning,
the AHA advises rescuers to deliver two rescue breaths first, and then
begin the cycles of compressions and breaths as directed. This
especially applies to BLS-trained EMS professionals, but is advised for
all rescuers. Breaths may be given mouth-to-nose if the rescuer and
victim are both still in the water, as mouth-to-mouth ventilations may
be difficult to perform.

• Victims of near-drowning who receive chest compressions might
vomit. A ten-year study showed that for the victims who received
compressions, 86% vomited. Rescuers should turn the victim on
his/her side and clear the airway with fingers or cloth.
• As stated, rescuers of near-drowning victims should always ensure
their own safety before attempting any rescue, especially an in-water
rescue. Even strong swimmers can find it difficult to swim with an
unconscious person.

Drowning Events

 recognize a patient with foreign body airway obstruction
and assess its severity; and
 o know the immediate steps to relieve the obstruction.
LEARNING OBJECTIVES

FOREIGN BODY OBSTRUCTION
APPROACH TO FOREIGN
BODY AIRWAY
OBSTRUCTION

Airway Obstruction
May occur when normal airway protective mechanisms that
prevent foreign bodies from entering the upper airway (eg,
glottal closure, expiration reflex, cough reflex) become
insufficient to prevent airway obstruction

Airway Obstruction
Possible causes:
 The most common cause of upper airway obstruction
is obstruction by the tongue during loss of
consciousness, or cardiopulmonary arrest.
 The tongue may fall backward into the pharynx
obstructing the upper airway.

Airway Obstruction
Possible causes:
 The epiglottis can block the entrance of the airway in
unconscious victims.
 Blood from head and facial injuries, or regurgitated
stomach contents may also obstruct the upper airway.

Airway Obstruction
• Inhalation of a foreign body, usually while eating,
can lodge along the upper airway.

EPIDEMIOLOGY OF FOREIGN BODY AIRWAY
OBSTRUCTION
• Foreign body airway obstruction (FBAO) is a
relatively uncommon but preventable cause of
cardiac arrest.

OBSTRUCTION
• Death from this cause is much less common (1.2 deaths
per 100,000 population) than death from other
emergencies:
 1.7 deaths per 100,000 population from drowning;
 16.5 deaths per 100,000 population from motor vehicle crashes;
 198 deaths per 100,000 from coronary heart disease.

OBSTRUCTION
• Eighty percent of FBAO cases occur in children below
three years old and occur more frequently in those 1 to 2
years of age.
• The high incidence of FBAO among mobile babies and
toddlers are primarily due to curdled milk and small round
objects.

OBSTRUCTION
• Among adults, common factors associated with choking
include attempts to swallow large, poorly chewed pieces of
food; elevated blood alcohol levels; and dentures.
• Elderly patients with dysphagia are also at risk for FBAO
and should take care while drinking and eating.

OBSTRUCTION
• In restaurants, choking emergencies have been mistaken
for a heart attack, giving rise to the term “café coronary.”

RECOGNITION OF
FOREIGN BODY AIRWAY
OBSTRUCTION

Partial Airway Obstruction
• The victim may still be capable of “good air exchange.”
• The victim is responsive, able to cough, with possible
wheezing in between.

Partial Airway Obstruction
• The rescuer should not interfere with the victim’s
own attempts to expel the foreign body, but should
stay with the victim and monitor these attempts. If
partial airway obstruction persists, activate the
emergency medical service EMS (EMS) system.

Complete Airway Obstruction
• The victim is unable to speak, breathe, or cough
and may clutch the neck with the thumb and
fingers.
• Movement of air is absent.

Complete Airway Obstruction
• If not relieved, the victim’s blood oxygen saturation
will fall rapidly because the obstructed airway
prevents air entry into the lungs. The victim will
become unresponsive, and death will follow rapidly.
• Complete airway obstruction is an emergency that
will result in death within minutes if not treated.

RELIEF OF FOREIGN BODY
AIRWAY OBSTRUCTION

Infants Up to 1 Year Old
Step 1: With a conscious infant, verify if he/she has a
complete airway obstruction with note of breathing difficulties,
ineffective cough, or absence of strong cry.
Step 2: Immediately position the infant face down over one of
your forearms, with the head lower than the body. Support
the infant’s head by holding the jaw with your hand.

Step 3: Deliver 5 back blows using the heel of your hand
between the infant’s shoulder blades.
Step 4: If still not relieved, turn over the infant and position
your middle and ring finger in the middle of the infant’s
sternum, just below the imaginary line in between the infant’s
nipples and deliver 5 chest thrusts. Repeat steps 2 to 4 until
effective or until infant becomes unconscious.

Step 5: If the infant becomes
unresponsive, begin CPR. After 30 chest
compressions, check the oral cavity for
any foreign body. Do not perform a blind
finger sweep. Continue with the steps of
pediatric BLS until help arrives or the
infant is revived.

Children 1 to 8 Years Old
Step 1: Determine if the child has a mild or severe airway obstruction.
 If obstruction is mild, the child can still cough or make some sounds.
Hence, do not interfere and allow the victim to clear the airway by
coughing. Closely observe the child for progression to severe
obstruction.
 If obstruction is severe, the child may be seen clutching his/her chest
or neck, and unable to speak, breathe, or cough.

Step 2: If obstruction is severe, immediately position yourself
behind the child. Give 5 back blows by hitting the victim firmly
on the back between the shoulder blades. If back blows do not
dislodge the foreign body, move to the next step.

Step 3: Perform 5 upright abdominal thrusts (also known as
Heimlich maneuver) by holding the child around the waist and
pulling upwards above their belly button.
o Upright abdominal thrusts elevate the diaphragm, forcing air
out from the lungs. This may be sufficient to create an artificial
cough and expel a foreign body from the airway.

• Repeat steps 2 and 3 until the foreign body is expelled, or
until the child becomes unconscious.
• If the child becomes unresponsive, immediately perform
CPR. After each 30 chest compressions, check the oral cavity
for the foreign body.

• If the foreign body can be seen, remove it. Do not perform a
blind finger sweep. Give 2 rescue breaths and continue with
pediatric BLS
• Repeat the cycle until the airway is cleared or until help
arrives.

A. B.

Children >8 Years Old and Adults
Step 1: For a conscious victim, first identify the universal distress signal
which is seen as a victim clutching his/her neck
Introduce yourself as a BLS provider who knows how to perform the
Heimlich maneuver.
If the victim is able to cough or speak, do not interfere and allow the
victim to clear his/her airway by coughing, while continuing to observe
for signs of progression to severe obstruction.

Step 2: If the obstruction becomes severe (eg, the victim is unable to
cough or speak), provide up to 5 back blows/slaps as the initial
maneuver, with the back slaps delivered between the shoulder blades
with the heel of the rescuer’s hand.
Step 3: If back slaps fail, perform 5 abdominal thrusts. Stand behind the
victim and allow the victim to lean forward. Put both arms around the
upper abdomen and clench one fist, grasp it with the other hand and pull
sharply inward and upward.

Repeat steps 2 and 3 until the foreign
body is expelled, or until the victim
becomes unconscious.

Step 4: If the victim becomes unconscious, position the victim supine
on a hard surface and call for help. If a second rescuer is available,
send the second rescuer to activate the EMS system while you begin
CPR.
Step 5: Perform CPR, and in addition, inspect the oral cavity for the
foreign body each time the airway is opened. If the foreign body is not
visible, proceed with CPR as previously instructed. If the foreign body
is visible, perform the tongue-jaw lift as follows, but only if you are a
healthcare provider.

• Insert the thumb of one hand into the
mouth and press on the tongue. The other
fingers of the same hand grasp on the
lower jaw.
Figure 6. Tongue-jaw lift

• The maneuvering hand lifts the mandible. Insert the index finger
of your other hand down along the inside of the cheek and
deeply into the victim’s throat to the base of the tongue to
sweep. Then use a hooking action to dislodge the foreign body
and maneuver it out of the mouth so that it can be removed. Be
careful to avoid forcing the object deeper into the airway.

Special Situations

Victims who are obese or in the late stages of
pregnancy
• Chest thrusts may be an alternative to abdominal thrusts.
• Stand behind the victim. Raise the victim’s arms, then make a
fist with your hand and position it on the victim’s sternum.

Victims who are obese or in the late stages of
pregnancy
• Grasp the fist with your other hand, then
pull sharply inward with a quick motion.
• Repeat 5 times until the foreign body is
expelled, or until the victim becomes
unconscious.
Figure 7. Chest thrust

Victim is YOU
• If you should find yourself with a foreign
body airway obstruction, immediately
thrust your upper abdomen against any
firm surface, such as the back of a
chair, side of a table, or porch railing
(self-administered Heimlich maneuver).
Repeat until the foreign body is
expelled.
Figure 8. Self-administered Heimlich maneuver

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