basic life support for emergency cases

1. Basic Life Support (BLS)
By: Gebremeskel T(MSC, EMCCN)
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12/3/2023

2. • Definition
• Steps in BLS
• High Quality CPR
• Mechanical CPR
• Automatic External Defibrilators
• Comparison of BLS in Adult and Children
• Choking
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Outline

3. BLS Definition
• refers to the care healthcare providers and public safety professionals
provide to patients who are experiencing respiratory arrest, cardiac arrest or
airway obstruction.
• Includes psychomotor skills for performing
• high-quality cardiopulmonary resuscitation (CPR),
• using an automated external defibrillator (AED) and
• relieving an obstructed airway for patients of all ages.
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4. Sudden CardiacArrest
• refer to the sudden cessation of cardiac mechanical activity with
hemodynamic collapse,
• most frequently due to sustained ventricular tachycardia/ventricular fibrillation.
• The most common etiology is Ischemic Cardiovascular Disease.
• Incidence: USA: 180,000 to >450,000 and Europe: ≈ 700,000 per year
• Survival to discharge in in-hospital setting is ≈ 17%
• Properly performed CPR improves outcomes.
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5. save life with emergency response!
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Early
Access
Early
CPR
Early
Defibrillation
Early
Advanced
Cardiac Care
The Chain of Survival
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© 2002 Abertay Nationwide Training
12/3/2023

6. Steps in BLS

7. Scene Safety
• Before you can help an ill or injured patient, make sure that the scene is safe
for you and any bystanders
• Check for anything unsafe,
• Traffic, fire, escaping steam, downed electrical lines, smoke
• Are you wearing appropriate personal protection equipment (PPE)?
• Specialized clothing, equipment and supplies, such as gloves, CPR breathing barriers,
gowns, face shields, protective eyewear.
• If you see life-threatening bleeding, use any available resources to control the
hemorrhage.
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8. 1. Establish Unresponsiveness
Tap the patient on the shoulder and shout, “Are you okay?”
• Responsive patient:
• Obtain the patient’s consent,
• Reassure him or her and try to find out what happened.
• Reassess regularly
• Unresponsive patient: …
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9. 2. Call the Code/Get help
• Shout For Help
• Activate Emergency response System (Call 911)
• Get AED/defibrillator
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10. 3. Simultaneous Breathing and Pulse Check
• Should not take more than 10 seconds.
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• Checking for Pulse.
• Carotid: Slide your two
fingers into the groove of
the patient’s neck.
• Femoral: palpate the area
between the hip and groin
• useful when there are
multiple team members
• Checking for Breathing.
• See if the patient’s chest rises
and falls,
• Listen for escaping air and
feel for it against the side of
your cheek.
• Normal Breathing
Vs.
• Agonal Breathing

11. Normal Breathing + Has Pulse
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Monitor the patient until Emergency responders arrive
Primary Assessment Results

12. 12
No normal Breathing + Has Pulse = Respiratory Arrest
Provide rescue breathing
Primary Assessment Results
 1 breath every 5 to 6 seconds
 About 10-12 breaths/minute
 Each breath lasts 1 second
 Allow chest to rise & fall
 Check pulse around Every 2 minutes

13. Ventilation
• Supply oxygen to a patient who is not breathing.
• May be given via several methods including:
• Mouth-to-mouth.
• Pocket mask.
• Bag-valve-mask (BVM) resuscitator
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14. Mouth-to-Mouth Ventilation
• If a pocket mask or Bag-valve-mask are not available
• Open the airway past a neutral position
• use the head-tilt/chin-lift technique.
• Pinch the nose shut
• Make a complete seal over the patient’s mouth with your mouth
• Take a break between breaths
• by breaking the seal slightly between ventilations
• If unable to make a complete seal over a patient’s mouth, you may
need to use mouth-to-nose ventilations
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15. Pocket Mask Ventilation
• Creates a barrier between your mouth and the patient’s
• Open the airway past a neutral position
• Place the mask over the mouth and nose of the patient
• Starting from the bridge of the nose, then place the bottom of the mask
below the mouth to the chin
• Seal the mask by placing the “webbing” between your index finger and
thumb on the top of the mask above the valve
• Place your thumb along the base of the mask while placing your bent index
finger under the patient’s chin, lifting the face into the mask
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16. Bag-Valve-Mask Ventilation
• Can hold greater than 1000 milliliters of volume
• Two rescuers are needed to effectively operate
• Open the airway past a neutral position
• Use an E-C hand position (first rescuer)
• Provide ventilations (second rescuer):
• Depress the bag about halfway
• to deliver between 400 to 700 milliliters of volume to make the chest rise.
• Don’t deflate BVM completely when providing ventilations
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17. When to Stop Ventilation
• Once you begin giving ventilations, you must continue until:
• The patient begins to breathe on his or her own.
• Another trained rescuer takes over.
• The patient has no pulse,
• Begin CPR or use an AED if one is available and ready to use.
• The scene becomes unsafe
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18. 18
No Breathing/ Only Gasping + No Pulse = Cardiac Arrest
Start CPR Immediately
Primary Assessment Results

19. 19
High Quality CPR

20. Cardio-Pulmonary Resuscitation
• Aim is to maintain victim's circulation and
breathing until emergency aid arrives.
• Composed of
• Chest compressions and rescue breath.
• Use of an automated external defibrillator (AED).
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• Is an emergency first-aid procedure that is used to maintain respiration
and blood circulation in a person, whose breathing and heartbeats have
suddenly stopped.

21. Chest Compression
• Propels blood out of the thorax by increasing intra-thoracic pressure
• Provide only 30% of normal perfusion
• results in critical blood flow and oxygen delivery to the heart and brain.
• Without perfusion & oxygenation, irreversible brain damage occurs after 3-5 mins.
• Start Compression within 10 sec. of recognition of cardiac arrest.
• Patient must be placed on a Firm, Flat Surface,
• Floor or ground,
• Stretcher or bed with a CPR board or CPR feature
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22. Chest Compression
• Expose the chest to ensure proper hand placement and the ability to visualize chest recoil.
• Hand placement:
• Place the heel of one hand in the center of the chest
• Place other hand on top
• Interlock the fingers
• Arms are as straight as possible, Shoulders directly over the hands to
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23. PUSH HARD, PUSH FAST
• Rate: at a at least 100 per minute to a maximum of 120 per minute,
• Depth: at least 2 inches (5 cm) for an adult
• Allow complete chest recoil after each compression
• to allow blood to flow back into the heart
• Minimize interruptions in compression(< 10 sec)
• Chest compression fraction of at least 80%
• When possible (2 or more rescuers) change
CPR operator every 2 min. to prevent fatigue
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24. Ventilation during CPR
• Follows 30 chest compressions
• Give 2 ventilations that last approximately 1 second each & make the chest
rise.
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30 : 2

25. Chest compression-only (Hands-only) CPR
• No Ventilation provided
• Similar survival rates compared to conventional CPR
• For Adults in OHCA,
• Untrained lay rescuers should provide chest compression–only CPR.
• For Children…
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26. CPR for a Pregnant woman
• Requires 2 people, one of them helping to move the uterus to the left
• If the fundus height is at or above the level of the umbilicus,
• When calling for EMS ask for Obstetrician
• If nonsurvivable trauma or prolonged pulselessness,
• Post Mortem C/D - at 4 minutes after onset of maternal cardiac arrest or CPR
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27. Mechanical CPR
• No benefit over manual chest compressions
• May be a reasonable alternatives in specific settings
• The delivery of high-quality manual compressions may be
challenging or dangerous for the provider. E.g.
• Limited rescuers available,
• Prolonged CPR,
• CPR in a moving ambulance,
• CPR in the angiography suite
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LoadDistributing
Band
Mechanical
Piston

28. Stopping CPR
• Continue CPR with 30 compressions followed by 2 ventilations until:
• You see signs of return of spontaneous circulation (ROSC) such as:
• Patient movement or breathing.
• An AED is ready to analyze the patient’s heart rhythm.
• Other trained rescuers take over and relieve you from responsibilities
• You are presented with a valid do not resuscitate (DNR) order.
• You are alone and too exhausted to continue.
• The scene becomes unsafe
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29. Complications during CPR
• Gastric distension –often in children
• Avoid overinflating the lungs
• Appropriate volume making the chest rise
• Rib fractures
• Correct hand´s position
• Do not remove hands from the chest wall
• Prevent “dancing on the chest“
• Gastric content (or other fluids) aspiration
• Prevent gastric distension
• Recovery position in unconscious victims
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30. Automated External Defibrillators (AED)
• Are portable electronic devices that are able to:
• Interpret heart (ECG) rhythm
• Determine whether defibrillation is required
• Deliver electric shock
• that may help the heart re-establish a perfusing rhythm
• Guides the operator through every action
• In cases of cardiac arrest, should be applied as soon as readily available
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31. Steps in usingAEDs
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Switch on AED Attach pads to casualty’s bare chest

32. Steps in usingAEDs
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Analyze rhythm -Do not touch victim Shock indicated – stand clear

33. UsingAEDs
• If CPR is in progress, continue CPR until
• AED is turned on, pads are applied and the AED is ready to analyze the heart rhythm.
• Resume compressions immediately
• After a shock is delivered or the AED advises that a shock is not indicated
• Perform about 2 minutes of CPR (about 5 cycles of 30:2) until
• The AED prompts that it is reanalyzing,
• The patient shows signs of return of spontaneous circulation (ROSC)
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34. AED Safety
• AEDs are very safe and built for almost any environment.
• Safe to be used on patients with pacemakers, ICDs or metal body piercings.
Precautions:
• In wet environment, make sure that the patient is as dry as possible
• Avoid getting the AED or AED pads wet
• Make sure that the pads are not touching the metal surface.
• Excessive chest hair, quickly shave the area before applying the AED
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35. AED Safety (Do’s and Don’ts)
Do’s Don’ts
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• Do use an AED if a patient is experiencing
cardiac arrest as a result of traumatic
injuries.
• Before shocking a patient with an AED, Do
make sure that no one is touching or is in
contact with the patient or any resuscitation
equipment.
• Do use an AED for a patient who is
pregnant.
• Do not use alcohol to wipe the patient’s
chest dry. Alcohol is flammable.
• Do not touch the patient while the AED is
analyzing.
• Do not touch the patient while the device
is defibrillating.
• Do not defibrillate someone when around
flammable or combustible materials, such
as gasoline or free-flowing oxygen.

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Differences b/nAdult and Pediatric BLS

37. 37
Differences b/nAdult and Pediatric BLS

38. Hand placement in Pediatric BLS
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1 rescuer:
2 fingers compression
≥ 2 rescuer:
2 thumbs compression
1 hand compression

39. 39
Adult

40. Choking
• Obstruction of the air way by foreign body (food , object….)
• The tongue is the most common obstruction in the unconscious victim
Signs of choking
 Poor or no air exchange
 Week, ineffective cough or no cough at all
 High pitch noise while inhaling or no noise at all
 Increased respiratory difficulty, Possible cyanosis
 Unable to speak
 Clutching the neck with the thumb and fingers,
 making the universal choking sign
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41. Choking on a Responsive Victim
• Adult or Child
• Ask “Are you choking?”
• Performing Abdominal thrusts
• Pregnant and obese victims
• Instead of abdominal thrusts Perform chest thrusts
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42. Choking on a Responsive Victim
• Infant:
• Confirm severe airway obstruction.
• Perform cycles of 5 back slaps and 5 chest thrusts
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43. Choking on a Un-responsive Victim
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• Immediately begin CPR when a choking victim becomes unresponsive
• Adult, Child, or Infant
• When you open the airway to give breaths,
• look for & remove the object (if seen) before giving breaths.
• NEVER perform a blind finger sweep

44. References
• 2015, AHA, Guidelines Update for CPR and ECC
• 2017, AHA, Focused Update on Adult BLS and CPR
• Rosen’s Emergency Medicine Concepts and Clinical Practice, 9th Ed.
• Tintinalli’s Emergency Medicine, 8th Ed.
• Uptodae.com/Basic life Support
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45. THANK YOU!!!