INTRODUCTION• Fundamental aspects of Basic Life Support(BLS) include immediate recognition ofsudden cardiac arrest (SCA) and activation ofthe emergency response system (EMS),early cardiopulmonary resuscitation (CPR),and rapid defibrillation with an automatedexternal defibrillator (AED).• Dr. Peter Safar is considered as the father ofmodern day CPR
DEFINITION• Basic life support is an emergencyprocedure that consists of recognising anarrest and initiating propercardiopulmonary resuscitation techniquesto maintain life without the use of drugsor specialist equipment until the victimeither recovers or is transported to amedical facility where advance lifesupport measures are available.
EMERGENCY ACTIONPRINCIPLE• In each emergency, we need to follow theemergency action principle so that we donot forget anything that might affectpersonal safety (yours and the victim‟s) andthe victim‟s survival.
• Always follow the steps in order givenbelow.• 1-survey the scene (to confirm the area issafe for you as well as the victim),• 2-do a primary survey of the victim,• 3-activates the Emergency Medical Service(EMS) system for help,• 4-do a secondary survey of the victim.
ADULT BLS SEQUENCEA.H.A. ADULT CHAIN OF SURVIVAL1. Immediate recognition of cardiac arrest andactivation of the emergency response system2. Early CPR with an emphasis on chestcompressions3. Rapid defibrillation4. Effective advanced life support5. Integrated post–cardiac arrest care
ENSURE SAFETY• Survey the scene and make sure thatthe area is safe for the victim as well asto the rescuer.
• If a lone rescuer finds an unresponsive adult(i.e., no movement or response tostimulation) or witnesses an adultwho collapses,• after ensuring that the scene is safe andpositioning the victim in supine on a firmsurface,
Immediate Recognition and Activation ofthe Emergency Response System• The rescuer should check for a responseby tapping the victim on the shoulder andshouting at the victim, “Are you all right?” Ifthe victim is responsive, he or she willanswer, move, or moan.
• The rescuer should also check for no breathingor no normal breathing (i.e., only gasping)while checking for responsiveness.• if the healthcare provider finds the victim isunresponsive with no breathing or no normalbreathing (i.e., only gasping), the rescuer shouldassume the victim is in cardiac arrest.• And then, the rescuer should shout for help toactivate the Emergency Response System(EMS) and to get an AED if available.
• The victim has occasional gasps, which canoccur in the first minutes after SuddenCardiac Arrest (SCA) and may beconfused with adequate breathing.• Occasional gasps do not necessarily resultin adequate ventilation.• The rescuer should treat the victim who hasoccasional gasps as if he or she is notbreathing.
PULSE CHECKThe healthcare provider should take not morethan 10 seconds to check for a pulse; and if therescuer does not definitely feel a pulse withinthat time, the rescuer should start chestcompressions.The carotid pulse can check while keeping thevictims head tilted back with one hand on theforehead, use the other hand to find the pulse. First, place your index or middle finger on theAdams apple.
• Then slide your finger toward in to thegroove between the windpipe and themuscles at the side of the neck. This iswhere the carotid pulse is located.
EARLY CPRSequence of cardiopulmonaryresuscitation (CPR)Compression – Airway- Breathing-DefibrillationC-A-B-D
CHEST COMPRESSIONS• Chest compressions consist of forcefulrhythmic applications of pressure over thelower half of the sternum.• These compressions create blood flow byincreasing intrathoracic pressure anddirectly compressing the heart.
• This generates blood flow andoxygen delivery to the vital organs
• The rescuer should place the heel of thedominant hand on the centre (middle) of thevictims chest (which is the lower half ofthe sternum) and the heel of the other hand ontop of the first so that the hands are overlappedand parallel• Position yourself vertically above the victimschest and, with your arms straight, the adultsternum should be depressed at least 2 inches (5cm) with chest compression and chestrecoil/relaxation times approximately equal.• Allow the chest to completely recoil after eachcompression.
• To provide effective chest compressions,push hard and push fast.• healthcare providers should compress theadult chest at a rate of at least 100compressions per minute with a compressiondepth of at least 2 inches/5 cm.
• Rescuers should allow complete recoil ofthe chest after each compression, toallow the heart to fill completely before thenext compression.
A compression-ventilation ratio of 30:2 isrecommended.To maximize the effectiveness of chestcompressions, place the victim on a firmsurface when possible, in a supineposition with the rescuer kneeling besidethe victims chest.Rescuers should attempt to minimize thefrequency and duration of interruptions incompressions to maximize the number ofcompressions delivered per minute.
• Incomplete recoil during BLS, CPR isassociated with higher intrathoracicpressures and significantly decreasedhemodynamics, including decreasedcoronary perfusion, cardiac index,myocardial blood flow, and cerebralperfusion.
OPEN THE AIRWAY:• The common cause of airway obstructionis back of the tongue blocking the air way.• A healthcare provider should use the headtilt–chin lift maneuver to open the airway ofa victim with no evidence of head or necktrauma.• If healthcare providers suspect a cervicalspine injury, they should open the airwayusing a jaw thrust without head extension.
• Because maintaining a patent airwayand providing adequate ventilation arepriorities in CPR, use the head tilt–chin liftmaneuver if the jaw thrust does notadequately open the airway.
Jaw thrust• The practitioner uses their thumbs tophysically push the posterior (back)aspects of the mandible upwards Whenthe mandible is displaced forward, itpulls the tongue forward and prevents itfrom occluding (blocking) the entranceto the trachea, helping to ensure apatent (secure) airway.
RESCUE BREATHING• During CPR, the primary purpose ofassisted ventilation is to maintainadequate oxygenation;• the secondary purpose is toeliminate CO2.
1) MOUTH-TO-MOUTHRESCUE BREATHINGMouth-to-mouth rescue breathing providesoxygen and ventilation to the victim.To provide mouth-to-mouth rescuebreaths, open the victims airway, pinch thevictims nose, and create an airtight mouth-to-mouth seal.Give 1 breath over 1 second. take a "regular" (not a deep) breathe, andgive rescue breath over 1 second.
• Taking a regular rather than a deepbreath prevents the rescuer from gettingdizzy or lightheaded and prevents overinflation of the victims lungs.• The most common cause of ventilationdifficulty is an improperly openedairway, so if the victims chest does notrise with the first rescue breath.• Reposition the head by performingthe head tilt–chin lift again and then givethe second rescue breath.
• If an adult victim with spontaneouscirculation (ie, strong and easilypalpable pulses) requires support ofventilation, the healthcare providershould give rescue breaths at a rate ofabout 1 breath every 5 to 6 seconds, orabout 10 to 12 breaths per minute.• Each breath should be given over 1second regardless of whether anadvanced airway is in place.• Each breath should cause visible chestrise.
• Use a compression to ventilation ratio of30 chest compressions to 2 ventilations
• More important, excessive ventilation canbe harmful because it increasesintrathoracic pressure, decreases venousreturn to the heart, and diminishescardiac output and survival.
2) MOUTH-TO–BARRIERDEVICE BREATHING.• Some healthcare providers mayhesitate to give mouth-to-mouth rescuebreathing and prefer to use a barrierdevice.• The risk of diseasetransmission through mouth-to-barrierventilation is very low.• When using a barrier device the rescuershould not delay chest compressionswhile setting up the device.
3) MOUTH-TO-NOSE ANDMOUTH-TO-STOMAVENTILATION• Mouth-to-nose ventilation is recommendedif ventilation through the victims mouth isimpossible (eg, the mouth isseriously injured), the mouth cannot beopened, the victim is in water, or a mouth-to-mouth seal is difficult to achieve.• A case series suggests that mouth-to-noseventilation in adults is feasible, safe, andeffective
AED, DEFIBRILLATION• An Automated External Defibrillator (AED)is used when the heart stops beatingnormally and needs to be reset by anelectric shock.• AEDs are designed for adults but most canbe adapted for children with paediatricpads down to 1 year of age.• Provide 5 cycles of CPR, 30 compressionsto 2 breaths, for 2 minutes before using anAED on a child from 1 year to puberty
SEQUENCE OF ACTIONS WHENUSING AN AUTOMATED EXTERNALDEFIBRILLATOR• The following sequence applies to theuse of both semi-automatic andautomatic AEDs in a victim who is foundto be unconscious and not breathingnormally.• 1. Follow the adult BLS sequence asdescribed. Do not delay starting CPRunless the AED is availableImmediately.
2. AS SOON AS THE AEDARRIVES:• If more than one rescuer is present, continueCPR while the AED is switched on.• If you are alone, stop CPR and switch on theAED.• Follow the voice / visual prompts. Attach theelectrode pads to the patient‟s bare chest.• Ensure that nobody touches the victim while theAED is analysing the rhythm.
Placement of AED pads• Place one AED pad to the right of thesternum, below the clavicle. Place theother pad in the left mid-axillary line,approximately over the position of theV6 ECG electrode. It is important thatthis pad is placed sufficiently laterallyand that it is clear of any breast tissue.
3A. If a shock is indicated:• Ensure that nobody touches the victim.• Push the shock button as directed (fullyautomatic AEDs will deliver the shockautomatically).• Continue as directed by the voice / visualprompts.• Minimise, as far as possible interruptionsin chest compression.
3B. If no shock is indicated:• Resume CPR immediately using a ratio of30 compressions to 2 rescue breaths.Continue as directed by the voice / visualprompts
FOREIGN BODY AIRWAYOBSTRUCTION (FBAO)(CHOKING)• The rescuer should intervene if thechoking victim shows signs of severeairway obstruction.• These include signs of poor air exchangeand increased breathing difficulty, such asa silent cough, cyanosis, or inability tospeak or breathe.• The victim may clutch the neck,demonstrating the universal choking sign.
• Quickly ask, "Are you choking?" If thevictim indicates "yes" by nodding his headwithout speaking, this will verify that thevictim has severe airway obstruction.
RELIEF OF FOREIGN-BODYAIRWAY OBSTRUCTION• If mild obstruction is present and the victimis coughing forcefully, do not interfere withthe patients spontaneous coughing andbreathing efforts.• Attempt to relieve the obstruction, only ifsigns of severe obstruction develop: thecough becomes silent, respiratory difficultyincreases and is accompanied by stridor,or the victim becomes unresponsive.
• Activate the EMS system quickly if thepatient is having difficulty breathing.
ABDOMINAL THRUSTS(HEIMLICH MANEUVER)• Stand behind the victim.• The victim may be either standing orsitting.• Wrap your arms around his or her waist.Make a fist with one hand.
• Place the thumb side of your fist againstthe middle of the victim‟s abdomen, justabove the naval and well below the lowertip of sternum.
• Grasp your fist with your other hand.Keeping your elbows out from the victim,press your fist in to the persons abdomenwith a quick upward thrust.• Think of each thrust as a separate anddistinct attempt to dislodge the object.Repeat the thrusts until the obstruction iscleared.
CHEST THRUSTS• Chest thrusts should be used for obesepatients if the rescuer is unable to encirclethe victims abdomen.• If the choking victim is in the late stages ofpregnancy, the rescuer should usechest thrusts instead of abdominal thrusts.
• To do chest thrusts with the person eitherstanding or sitting, stand behind theperson and place your arms under theperson‟s armpit and around the chest.Place the thumb side of your fist on themiddle of the sternum.
• Grasp your fist with your other hand andgive backward thrusts.• Give thrust until obstruction is cleared.• Each thrust should be a separate anddistinct attempt to dislodge the object
ABDOMINAL THRUSTS FORAN UNCONSCIOUS VICTIM• If the adult victim with Foreign-Body AirwayObstruction becomes unresponsive, therescuer should carefully support the patient tothe ground.• Immediately activate (or send someone toactivate) EMS, and then begin CPR.• The healthcare provider should carefully lowerthe victim to the ground, send someone toactivate the emergency response system andbegin CPR (without a pulse check).
• After 2 minutes, if someone has notalready done so, the healthcareprovider should activate the emergencyresponse system.• Each time the airway is opened duringCPR, the rescuer should look for anobject in the victims mouth and if found,remove it.• Straddle the victim‟s thighs. Place theheel of one hand against the middle ofthe victim‟s abdomen, just above theumbilicus and well below the lower tip ofthe sternum.
• Place your other hand directly on the top ofthe first hand with your fingers pointedtowards the victims head• Press into abdomen with a quick upwardthrust. Give 6-10 thrusts. Be sure that yourhands are directly on the middle of theabdomen when you press. After 6-10, thrustsdo a finger sweep.
FOREIGN-BODY AIRWAYOBSTRUCTION IN INFANT• Give 5 back blows as follows• Hold the infants jaw between thumb andfingers.• Slide your other hand behind theinfant‟s shoulder blade closest to you sothat your finger supports the back of theinfants head and neck.• Turn the infant over so that he is facedown on your forearm.
• Support infants head and neck with yourhand by firmly holding the jaw between yourthumb and fingers.• Lower your arm on to your thigh. The infantshead should be lower than his chest.• Give 5 back blows forcefully between theinfants shoulder blades with the heel of yourhand
GIVE 5 CHEST THRUSTS ASFOLLOWS• Place your free hand and forearm alonginfants head and back so that the infant issandwiched between your tow hand andforearms.• Support the back of the infants head andneck with your fingers.• Support the infant‟s neck, jaw, and chestfrom the front with one hand while yousupport the infants back with your otherhand and forearm.
• Turn the infant in to his back.• Lower your arm that is supporting theinfants back onto your thigh.• The infants head should be lower than hischest.• Use your other hand that is on the infantschest to locate the correct place to givechest thrusts.• Imagine a line running across the infantschest between the nipples.• Place the pad of your ring finger onsternum just under the imaginary line.
• Then place the pads of two finger next tothe ring finger just under nipple line.• Rise the ring finger if you feel the notchat the end of the infants sternum, moveyour finger up a little bit.• The pads of your finger should lie in thesame direction as the infants sternum.• Use the pads of two fingers to compressthe sternum.• Compress the sternum 1 inch and thenthe sternum return to its normal position.
• Keep your fingers in contact with thesternum.• Compress 5 times.• Keep giving back blows and chestcompression until the object is coughedup.
INFANT AND CHILD BASICLIFE SUPPORT• “If the victim is unresponsive and notbreathing (or only gasping), begin CPR.• Sometimes victims who require CPR willgasp, which may be misinterpreted asbreathing.• Treat the victim with gasps as thoughthere is no breathing and begin CPR.
• ” For an unresponsive child who is notbreathing or not breathing normally, beginCPR with 30 compressions followed byopening the airway and giving 2 rescuebreaths.• Repeat cycles of 30:2 (CAB method).
• For an infant, lone rescuers (whether layrescuers or healthcare providers) shouldcompress the sternum with 2 finger placedjust below the intermammary line.• Do not compress over the xiphoid or ribs.• Rescuers should compress at least one-third the depth of the chest, or about 4 cm(1.5 inches).
• Do not press on the xiphoid or the ribs.There are no data to determine if the 1- or2-hand method produces bettercompressions and better outcome.
• For a child, lay rescuers and healthcareproviders should compress the lower halfof the sternum at least one third of the APdimension of the chest or approximately 5cm (2 inches) with the heel of 1 or 2 hands.
• Push fast; push at a rate of at least 100compressions per minute.”• “Chest compressions of appropriate rate anddepth.• „Push fast‟: push at a rate of at least 100compressions per minute.
• Push hard‟: push with sufficient force todepress at least one third theanterior‐posterior (AP) diameter of thechest or approximately 1 ½ inches (4 cm)in infants and 2 inches (5 cm) in children
OPEN THE AIRWAY AND GIVEVENTILATIONS• For the lone rescuer a compression-to-ventilation ratio of 30:2 is recommended.• After the initial set of 30 compressions, openthe airway and give 2 breaths.• In an unresponsive infant or child, the tonguemay obstruct the airway and interfere withventilations.
• Open the airway using a head tilt–chin liftmaneuver for both injured and non-injuredvictims.• To give breaths to an infant, use a mouth-to-mouth-and-nose technique; to givebreaths to a child, use a mouth-to-mouthtechnique.
• Make sure the breaths are effective (ie,the chest rises).• Each breath should take about 1 second.If the chest does not rise, reposition thehead, make a better seal, and try again.• It may be necessary to move the childshead through a range of positions toprovide optimal airway patency andeffective rescue breathing
• In an infant, if you have difficulty makingan effective seal over the mouth and nose,try either mouth-to-mouth or mouth-to-nose ventilation.• If you use the mouth-to-mouth technique,pinch the nose closed.• If you use the mouth-to-nose technique,close the mouth.
• In either case make sure the chest riseswhen you give a breath.• If you are the only rescuer, provide 2effective ventilations using as short apause in chest compressions as possibleafter each set of 30 compressions.
DEFIBRILLATION• Ventricular fibrillation (VF) can be thecause of sudden collapse or maydevelop during resuscitation attempts.• Children with sudden witnessedcollapse (eg, a child collapsing duringan athletic event) are likely to have VFor pulseless ventricular tachycardia (VT)and need immediate CPR and rapiddefibrillation.
• VF and pulseless VT are referred to as"shockable rhythms" because theyrespond to electric shocks (defibrillation).• Many AEDs have high specificity inrecognizing paediatric shockable rhythms,and some are equipped to decrease (orattenuate) the delivered energy to makethem suitable for infants and children <8years of age• For infants a manual defibrillator ispreferred when a shockable rhythm isidentified by a trained healthcare provider.
• The recommended first energy dose fordefibrillation is 2 J/kg. If a second dose isrequired, it should be doubled to 4 J/kg.• If a manual defibrillator is not available, anAED equipped with a paediatric attenuatoris preferred for infants.• An AED with a paediatric attenuator is alsopreferred for children <8 year of age.
• If neither is available, an AED without adose attenuator may be used.• AEDs that deliver relatively high-energydoses have been successfully used ininfants with minimal myocardial damageand good neurological outcomes.
Neonatal CPR• Rubbing the back or flicking the sole ofthe feet to stimulate the baby• Compression to ventilation ratio is 3:1• Compression with 2 thumbs, withfingers encircling the chest andsupporting the back• 40- 60 breaths/ minute is advisable