This document provides guidelines for adult basic life support (BLS). It outlines the objectives of BLS, which are to recognize its importance, understand how to perform high-quality resuscitation until more experienced help arrives, learn how to use an automated external defibrillator, and manage foreign-body airway obstructions. The guidelines describe the BLS algorithm, which involves checking for response, looking for breathing, providing chest compressions, rescue breaths, and using an AED. It emphasizes the importance of early defibrillation and provides historical context and evidence to support the recommended procedures.

1. Adult Basic Life Support
Mohammed AlHusseini Elwan
Assistant Lecturer of EM, Faculty of Medicine,
Alexandria University

2. Objectives
• Recognize the importance of basic life
support.
• Understand how to do high quality
resuscitation until more experience and
equipment arrive.
• Learn how to use an automated external
defibrillator.
• Learn the management of foreign-body airway
obstruction.

3. Chain of Survival

4. Chain of Survival

5. BLS: Where?!
• Paramedics

6. BLS: Where?!
• Lay rescuers

7. BLS: Where?!
• In-hospital

8. History
Isis gave the kiss of life to
Osiris.

9. History
This was originally
practiced in Egypt almost
3,500 years ago and
became popular again in
Europe.

10. History

11. History

12. History
The first report of an
experimental tracheal
intubation was probably
by the great Muslim
philosopher and physician
Avicenna.

13. BLS algorithm

15. Check Response

16. Check Response
• Make sure you, the victim and any bystanders
are safe.
• Check the victim for a response:
o gently shake his shoulders and ask loudly: “Are
you all right?“

17. Check Response
• If he responds:
o leave him in the position in which you find him,
provided there is no further danger;
o try to find out what is wrong with him and get
help if needed;
o reassess him regularly.

18. Check Response
• If he does not respond:
o Shout for help
o Turn the victim onto his back and then open the
airway using head; tilt and chin lift
o Place your hand on his forehead and gently tilt his
head back;
oWith your fingertips under the point of the
victim’s chin, lift the chin to open the airway

19. Check Response

20. Look, listen and feel
• Keeping the airway open, look, listen and feel
for breathing:
o look for chest movement;
o listen at the victim’s mouth for breath sounds;
o feel for air on your cheek;
o decide if breathing is normal, not normal or
absent.

21. Look, listen and feel

22. • Check breathing for no more than 10 seconds
• Do not confuse agonal gasps with breathing
• If you have any doubt whether breathing is
normal, act as if it is not normal

23. “Checking the carotid pulse is an inaccurate
method of confirming the presence or absence
of circulation, both for lay rescuers and for
professionals”
_______________________________________
• Bahr J, Klingler H, Panzer W, Rode H, Kettler D. Skills of lay people in checking the carotid
pulse. Resuscitation 1997;35:23–6.
• Nyman J, Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students.
Resuscitation 2000;47:179–84.
• Tibballs J, Russell P. Reliability of pulse palpation by healthcare personnel
to diagnose paediatric cardiac arrest. Resuscitation 2009;80:61–4

25. Chest Compressions

26. Chest Compressions
• Kneel by the side of the victim
• Place the heel of one hand in the centre of the
victim’s chest
• Place the heel of your other hand on top of the
first hand
• Interlock the fingers of your hands and ensure
that pressure is not applied over the victim’s ribs.
• Keep your arms straight
• Position yourself vertically above the victim’s
chest

27. Chest Compressions
• Press down on the sternum at least 5 cm.
• Full recoil without losing contact between
your hands and the sternum.
• Repeat at a rate of at least 100/min.
• Compression and release should take equal
amounts of time.
• Minimize interruptions.

28. Chest Compressions

29. “In adults needing CPR, the cardiac arrest is
likely to have a primary cardiac cause. CPR
should start with chest compression rather than
initial ventilations”

30. Rescue Breaths

31. Rescue Breaths
• After 30 compressions open the airway again using
head tilt and chin lift.
• Pinch the soft part of the nose closed, using the index
finger and thumb of your hand on the forehead.
• Allow the mouth to open, but maintain chin lift.
• Take a normal breath and place your lips around his
mouth, making sure that you have a good seal.
• Blow steadily into the mouth while watching for the
chest to rise, taking about 1 s as in normal breathing;
this is an effective rescue breath.

32. Rescue Breaths

33. Rescue Breaths

34. Rescue Breaths
• Maintaining head tilt and chin lift, take your mouth
away from the victim and watch for the chest to fall as
air comes out.
• Take another normal breath and blow into the victim’s
mouth once more to achieve a total of two effective
rescue breaths. The two breaths should not take more
than 5 s in all.
• Continue with chest compressions and rescue breaths
in a ratio of 30:2.
• Stop to recheck the victim only if he starts to wake up:
to move, opens eyes and to breathe normally.
Otherwise, do not interrupt resuscitation.

35. Rescue Breaths
• If your initial rescue breath does not make the
chest rise as in normal breathing, then before
your next attempt:
o Look into the victim’s mouth and remove any
obstruction;
o Recheck that there is adequate head tilt and chin
lift
o Do not attempt more than two breaths each time
before returning to chest compressions

36. If there is more than one rescuer present,
another rescuer should take over delivering CPR
every 2min to prevent fatigue

37. • Chest-compression-only CPR may be used as
follows:
– if you are not trained, or are unwilling to give
rescue breaths;
– if only chest compressions are given, these should
be continuous

38. “Animal studies have shown that chest-compression-
only CPR may be as effective as
combined ventilation and compression in the
first few minutes after non-asphyxial arrest”
_______________________________________________________________
• Chandra NC, Gruben KG, Tsitlik JE, et al. Observations of ventilation during
resuscitation in a canine model. Circulation 1994;90:3070–5.
• Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance of continuous chest
compressions during cardiopulmonary resuscitation: improved outcome during a
simulated single lay-rescuer scenario. Circulation 2002;105: 645–9.

39. “Animal and mathematical model studies of
chest compression only CPR have shown that
arterial oxygen stores deplete in 2–4 min”
_______________________________________________________________
• Turner I, Turner S, Armstrong V. Does the compression to ventilation ratio affect
the quality of CPR: a simulation study. Resuscitation 2002;52:55–62.
• Dorph E,WikL, Stromme TA, Eriksen M, Steen PA. Oxygen delivery and return of
spontaneous circulation with ventilation:compression ratio 2:30 versus chest
compressions only CPR in pigs. Resuscitation 2004;60:309–18.

40. But, you should have this!

41. Mouth to mask ventilation

42. • Do not interrupt
resuscitation until:
o professional help arrives
and takes over; or
o the victim starts to wake
up: to move, opens eyes
and to breathe normally;
or
o you become exhausted

43. Automated External Defibrilator
(AED)

44. AED
• Send someone for help
and to find and bring an
AED if available
• If you are on your own,
use your mobile phone
to alert the ambulance
service – leave the
victim only when there
is no other option

45. AED
• If you are on your own
and the AED is in your
immediate vicinity, start
with applying the AED

46. AED
• Switch on the AED and
attach the electrode pads
on the victim’s bare chest;
• If more than one rescuer is
present, CPR should be
continued while electrode
pads are being attached to
the chest;
• Follow the spoken/visual
directions immediately;
• Ensure that nobody is
touching the victim while
the AED is analysing the
rhythm.

47. AED

48. AED
• If a shock is indicated:
o ensure that nobody is touching the victim;
o push shock button as directed;
o immediately restart CPR 30:2;
o continue as directed by the voice/visual prompts.

49. AED
• If no shock is indicated:
o immediately resume CPR, using a ratio of 30
compressions to 2 rescue breaths;
o continue as directed by the voice/visual prompts.

50. AED
• Continue to follow the
AED prompts until:
o professional help arrives
and takes over;
o the victim starts to wake
up: moves, opens eyes
and breathes normally;
o you become exhausted.

51. “Lay rescuer AED programmes with very rapid
response times, and uncontrolled studies using
police officers as first responders,97,98 have
achieved reported survival rates as high as 49–
74%.”
______________________________________________________________________
• White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early
defibrillation programme experience over 13 years using police/fire personnel and
paramedics as responders. Resuscitation 2005;65:279–83.
• Mosesso Jr VN, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external
defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann
Emerg Med 1998;32:200–7.

52. “Two lower-level studies of adults with in-hospital
cardiac arrest from shockable rhythms
showed higher survival-to-hospital discharge
rates when defibrillation was provided through
an AED programme than with manual
defibrillation alone”
______________________________________________________________________
• Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation
results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol
2004;44:846–52.
• Destro A, Marzaloni M, Sermasi S, Rossi F. Automatic external defibrillators
in the hospital as well? Resuscitation 1996;31:39–43.

53. “Despite limited evidence, AEDs should be
considered for the hospital setting as a way to
facilitate early defibrillation (a goal of <3 min from
collapse), especially in areas where healthcare
providers have no rhythm recognition skills or
where they use defibrillators infrequently. An
effective system for training and retraining should
be in place”
______________________________________________________________________
• Spearpoint KG, Gruber PC, Brett SJ. Impact of the Immediate Life Support course on the
incidence and outcome of in-hospital cardiac arrest calls: an observational
study over 6 years. Resuscitation 2009;80:638–43

55. Foreign-body airway obstruction

56. Foreign-body airway obstruction
Foreign-body airway
obstruction (FBAO) is an
uncommon but potentially
treatable cause of
accidental death.

57. Foreign-body airway obstruction

58. Foreign-body airway obstruction

59. Foreign-body airway obstruction

60. Foreign-body airway obstruction

61. Thank
You!