Basic life support (2)

INTRODUCTION
• Fundamental aspects of Basic Life Support
(BLS) include immediate recognition of
sudden cardiac arrest (SCA) and activation of
the emergency response system (EMS),
early cardiopulmonary resuscitation (CPR),
and rapid defibrillation with an automated
external defibrillator (AED).
• Dr. Peter Safar is considered as the father of
modern day CPR

DEFINITION
• Basic life support is an emergency
procedure that consists of recognising an
arrest and initiating proper
cardiopulmonary resuscitation techniques
to maintain life without the use of drugs
or specialist equipment until the victim
either recovers or is transported to a
medical facility where advance life
support measures are available.

EMERGENCY ACTION
PRINCIPLE
• In each emergency, we need to follow the
emergency action principle so that we do
not forget anything that might affect
personal safety (yours and the victim‟s) and
the victim‟s survival.

• Always follow the steps in order given
below.
• 1-survey the scene (to confirm the area is
safe 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 SEQUENCE
A.H.A. ADULT CHAIN OF SURVIVAL
1. Immediate recognition of cardiac arrest and
activation of the emergency response system
2. Early CPR with an emphasis on chest
compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post–cardiac arrest care

ENSURE SAFETY
• Survey the scene and make sure that
the area is safe for the victim as well as
to the rescuer.

• If a lone rescuer finds an unresponsive adult
(i.e., no movement or response to
stimulation) or witnesses an adult
who collapses,
• after ensuring that the scene is safe and
positioning the victim in supine on a firm
surface,

Immediate Recognition and Activation of
the Emergency Response System
• The rescuer should check for a response
by tapping the victim on the shoulder and
shouting at the victim, “Are you all right?” If
the victim is responsive, he or she will
answer, move, or moan.

• The rescuer should also check for no breathing
or no normal breathing (i.e., only gasping)
while checking for responsiveness.
• if the healthcare provider finds the victim is
unresponsive with no breathing or no normal
breathing (i.e., only gasping), the rescuer should
assume the victim is in cardiac arrest.
• And then, the rescuer should shout for help to
activate the Emergency Response System
(EMS) and to get an AED if available.

• The victim has occasional gasps, which can
occur in the first minutes after Sudden
Cardiac Arrest (SCA) and may be
confused with adequate breathing.
• Occasional gasps do not necessarily result
in adequate ventilation.
• The rescuer should treat the victim who has
occasional gasps as if he or she is not
breathing.

PULSE CHECK
The healthcare provider should take not more
than 10 seconds to check for a pulse; and if the
rescuer does not definitely feel a pulse within
that time, the rescuer should start chest
compressions.
The carotid pulse can check while keeping the
victims head tilted back with one hand on the
forehead, use the other hand to find the pulse.
 First, place your index or middle finger on the
Adams apple.

• Then slide your finger toward in to the
groove between the windpipe and the
muscles at the side of the neck. This is
where the carotid pulse is located.

EARLY CPR
Sequence of cardiopulmonary
resuscitation (CPR)
Compression – Airway- Breathing-
Defibrillation
C-A-B-D

CHEST COMPRESSIONS
• Chest compressions consist of forceful
rhythmic applications of pressure over the
lower half of the sternum.
• These compressions create blood flow by
increasing intrathoracic pressure and
directly compressing the heart.

• This generates blood flow and
oxygen delivery to the vital organs

• The rescuer should place the heel of the
dominant hand on the centre (middle) of the
victim's chest (which is the lower half of
the sternum) and the heel of the other hand on
top of the first so that the hands are overlapped
and parallel
• Position yourself vertically above the victim's
chest and, with your arms straight, the adult
sternum should be depressed at least 2 inches (5
cm) with chest compression and chest
recoil/relaxation times approximately equal.
• Allow the chest to completely recoil after each
compression.

• To provide effective chest compressions,
push hard and push fast.
• healthcare providers should compress the
adult chest at a rate of at least 100
compressions per minute with a compression
depth of at least 2 inches/5 cm.

• Rescuers should allow complete recoil of
the chest after each compression, to
allow the heart to fill completely before the
next compression.

A compression-ventilation ratio of 30:2 is
recommended.
To maximize the effectiveness of chest
compressions, place the victim on a firm
surface when possible, in a supine
position with the rescuer kneeling beside
the victim's chest.
Rescuers should attempt to minimize the
frequency and duration of interruptions in
compressions to maximize the number of
compressions delivered per minute.

• Incomplete recoil during BLS, CPR is
associated with higher intrathoracic
pressures and significantly decreased
hemodynamics, including decreased
coronary perfusion, cardiac index,
myocardial blood flow, and cerebral
perfusion.

OPEN THE AIRWAY:
• The common cause of airway obstruction
is back of the tongue blocking the air way.
• A healthcare provider should use the head
tilt–chin lift maneuver to open the airway of
a victim with no evidence of head or neck
trauma.
• If healthcare providers suspect a cervical
spine injury, they should open the airway
using a jaw thrust without head extension.

• Because maintaining a patent airway
and providing adequate ventilation are
priorities in CPR, use the head tilt–chin lift
maneuver if the jaw thrust does not
adequately open the airway.

Jaw thrust
• The practitioner uses their thumbs to
physically push the posterior (back)
aspects of the mandible upwards When
the mandible is displaced forward, it
pulls the tongue forward and prevents it
from occluding (blocking) the entrance
to the trachea, helping to ensure a
patent (secure) airway.

RESCUE BREATHING
• During CPR, the primary purpose of
assisted ventilation is to maintain
adequate oxygenation;
• the secondary purpose is to
eliminate CO2.

1) MOUTH-TO-MOUTH
RESCUE BREATHING
Mouth-to-mouth rescue breathing provides
oxygen and ventilation to the victim.
To provide mouth-to-mouth rescue
breaths, open the victim's airway, pinch the
victim's nose, and create an airtight mouth-
to-mouth seal.
Give 1 breath over 1 second.
 take a "regular" (not a deep) breathe, and
give rescue breath over 1 second.

• Taking a regular rather than a deep
breath prevents the rescuer from getting
dizzy or lightheaded and prevents over
inflation of the victim's lungs.
• The most common cause of ventilation
difficulty is an improperly opened
airway, so if the victim's chest does not
rise with the first rescue breath.
• Reposition the head by performing
the head tilt–chin lift again and then give
the second rescue breath.

• If an adult victim with spontaneous
circulation (ie, strong and easily
palpable pulses) requires support of
ventilation, the healthcare provider
should give rescue breaths at a rate of
about 1 breath every 5 to 6 seconds, or
about 10 to 12 breaths per minute.
• Each breath should be given over 1
second regardless of whether an
advanced airway is in place.
• Each breath should cause visible chest
rise.

• Use a compression to ventilation ratio of
30 chest compressions to 2 ventilations

• More important, excessive ventilation can
be harmful because it increases
intrathoracic pressure, decreases venous
return to the heart, and diminishes
cardiac output and survival.

2) MOUTH-TO–BARRIER
DEVICE BREATHING.
• Some healthcare providers may
hesitate to give mouth-to-mouth rescue
breathing and prefer to use a barrier
device.
• The risk of disease
transmission through mouth-to-barrier
ventilation is very low.
• When using a barrier device the rescuer
should not delay chest compressions
while setting up the device.

3) MOUTH-TO-NOSE AND
MOUTH-TO-STOMA
VENTILATION
• Mouth-to-nose ventilation is recommended
if ventilation through the victim's mouth is
impossible (eg, the mouth is
seriously injured), the mouth cannot be
opened, the victim is in water, or a mouth-
to-mouth seal is difficult to achieve.
• A case series suggests that mouth-to-nose
ventilation in adults is feasible, safe, and
effective

AED, DEFIBRILLATION
• An Automated External Defibrillator (AED)
is used when the heart stops beating
normally and needs to be reset by an
electric shock.
• AEDs are designed for adults but most can
be adapted for children with paediatric
pads down to 1 year of age.
• Provide 5 cycles of CPR, 30 compressions
to 2 breaths, for 2 minutes before using an
AED on a child from 1 year to puberty

SEQUENCE OF ACTIONS WHEN
USING AN AUTOMATED EXTERNAL
DEFIBRILLATOR
• The following sequence applies to the
use of both semi-automatic and
automatic AEDs in a victim who is found
to be unconscious and not breathing
normally.
• 1. Follow the adult BLS sequence as
described. Do not delay starting CPR
unless the AED is available
Immediately.

2. AS SOON AS THE AED
ARRIVES:
• If more than one rescuer is present, continue
CPR while the AED is switched on.
• If you are alone, stop CPR and switch on the
AED.
• Follow the voice / visual prompts. Attach the
electrode pads to the patient‟s bare chest.
• Ensure that nobody touches the victim while the
AED is analysing the rhythm.

Placement of AED pads• Place one AED pad to the right of the
sternum, below the clavicle. Place the
other pad in the left mid-axillary line,
approximately over the position of the
V6 ECG electrode. It is important that
this pad is placed sufficiently laterally
and 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 (fully
automatic AEDs will deliver the shock
automatically).
• Continue as directed by the voice / visual
prompts.
• Minimise, as far as possible interruptions
in chest compression.

3B. If no shock is indicated:
• Resume CPR immediately using a ratio of
30 compressions to 2 rescue breaths.
Continue as directed by the voice / visual
prompts

FOREIGN BODY AIRWAY
OBSTRUCTION (FBAO)
(CHOKING)• The rescuer should intervene if the
choking victim shows signs of severe
airway obstruction.
• These include signs of poor air exchange
and increased breathing difficulty, such as
a silent cough, cyanosis, or inability to
speak or breathe.
• The victim may clutch the neck,
demonstrating the universal choking sign.

• Quickly ask, "Are you choking?" If the
victim indicates "yes" by nodding his head
without speaking, this will verify that the
victim has severe airway obstruction.

RELIEF OF FOREIGN-BODY
AIRWAY OBSTRUCTION
• If mild obstruction is present and the victim
is coughing forcefully, do not interfere with
the patient's spontaneous coughing and
breathing efforts.
• Attempt to relieve the obstruction, only if
signs of severe obstruction develop: the
cough becomes silent, respiratory difficulty
increases and is accompanied by stridor,
or the victim becomes unresponsive.

• Activate the EMS system quickly if the
patient is having difficulty breathing.

ABDOMINAL THRUSTS
(HEIMLICH MANEUVER)
• Stand behind the victim.
• The victim may be either standing or
sitting.
• Wrap your arms around his or her waist.
Make a fist with one hand.

• Place the thumb side of your fist against
the middle of the victim‟s abdomen, just
above the naval and well below the lower
tip of sternum.

• Grasp your fist with your other hand.
Keeping your elbows out from the victim,
press your fist in to the persons abdomen
with a quick upward thrust.
• Think of each thrust as a separate and
distinct attempt to dislodge the object.
Repeat the thrusts until the obstruction is
cleared.

CHEST THRUSTS
• Chest thrusts should be used for obese
patients if the rescuer is unable to encircle
the victim's abdomen.
• If the choking victim is in the late stages of
pregnancy, the rescuer should use
chest thrusts instead of abdominal thrusts.

• To do chest thrusts with the person either
standing or sitting, stand behind the
person and place your arms under the
person‟s armpit and around the chest.
Place the thumb side of your fist on the
middle of the sternum.

• Grasp your fist with your other hand and
give backward thrusts.
• Give thrust until obstruction is cleared.
• Each thrust should be a separate and
distinct attempt to dislodge the object

ABDOMINAL THRUSTS FOR
AN UNCONSCIOUS VICTIM
• If the adult victim with Foreign-Body Airway
Obstruction becomes unresponsive, the
rescuer should carefully support the patient to
the ground.
• Immediately activate (or send someone to
activate) EMS, and then begin CPR.
• The healthcare provider should carefully lower
the victim to the ground, send someone to
activate the emergency response system and
begin CPR (without a pulse check).

• After 2 minutes, if someone has not
already done so, the healthcare
provider should activate the emergency
response system.
• Each time the airway is opened during
CPR, the rescuer should look for an
object in the victim's mouth and if found,
remove it.
• Straddle the victim‟s thighs. Place the
heel of one hand against the middle of
the victim‟s abdomen, just above the
umbilicus and well below the lower tip of
the sternum.

• Place your other hand directly on the top of
the first hand with your fingers pointed
towards the victims head
• Press into abdomen with a quick upward
thrust. Give 6-10 thrusts. Be sure that your
hands are directly on the middle of the
abdomen when you press. After 6-10, thrusts
do a finger sweep.

FOREIGN-BODY AIRWAY
OBSTRUCTION IN INFANT
• Give 5 back blows as follows
• Hold the infants jaw between thumb and
fingers.
• Slide your other hand behind the
infant‟s shoulder blade closest to you so
that your finger supports the back of the
infants head and neck.
• Turn the infant over so that he is face
down on your forearm.

• Support infants head and neck with your
hand by firmly holding the jaw between your
thumb and fingers.
• Lower your arm on to your thigh. The infants
head should be lower than his chest.
• Give 5 back blows forcefully between the
infants shoulder blades with the heel of your
hand

GIVE 5 CHEST THRUSTS AS
FOLLOWS
• Place your free hand and forearm along
infants head and back so that the infant is
sandwiched between your tow hand and
forearms.
• Support the back of the infants head and
neck with your fingers.
• Support the infant‟s neck, jaw, and chest
from the front with one hand while you
support the infants back with your other
hand and forearm.

• Turn the infant in to his back.
• Lower your arm that is supporting the
infants back onto your thigh.
• The infants head should be lower than his
chest.
• Use your other hand that is on the infants
chest to locate the correct place to give
chest thrusts.
• Imagine a line running across the infants
chest between the nipples.
• Place the pad of your ring finger on
sternum just under the imaginary line.

• Then place the pads of two finger next to
the ring finger just under nipple line.
• Rise the ring finger if you feel the notch
at the end of the infants sternum, move
your finger up a little bit.
• The pads of your finger should lie in the
same direction as the infants sternum.
• Use the pads of two fingers to compress
the sternum.
• Compress the sternum 1 inch and then
the sternum return to its normal position.

• Keep your fingers in contact with the
sternum.
• Compress 5 times.
• Keep giving back blows and chest
compression until the object is coughed
up.

INFANT AND CHILD BASIC
LIFE SUPPORT
• “If the victim is unresponsive and not
breathing (or only gasping), begin CPR.
• Sometimes victims who require CPR will
gasp, which may be misinterpreted as
breathing.
• Treat the victim with gasps as though
there is no breathing and begin CPR.

• ” For an unresponsive child who is not
breathing or not breathing normally, begin
CPR with 30 compressions followed by
opening the airway and giving 2 rescue
breaths.
• Repeat cycles of 30:2 (CAB method).

• For an infant, lone rescuers (whether lay
rescuers or healthcare providers) should
compress the sternum with 2 finger placed
just 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- or
2-hand method produces better
compressions and better outcome.

• For a child, lay rescuers and healthcare
providers should compress the lower half
of the sternum at least one third of the AP
dimension of the chest or approximately 5
cm (2 inches) with the heel of 1 or 2 hands.

• Push fast; push at a rate of at least 100
compressions per minute.”
• “Chest compressions of appropriate rate and
depth.
• „Push fast‟: push at a rate of at least 100
compressions per minute.

• Push hard‟: push with sufficient force to
depress at least one third the
anterior‐posterior (AP) diameter of the
chest or approximately 1 ½ inches (4 cm)
in infants and 2 inches (5 cm) in children

OPEN THE AIRWAY AND GIVE
VENTILATIONS• For the lone rescuer a compression-to-
ventilation ratio of 30:2 is recommended.
• After the initial set of 30 compressions, open
the airway and give 2 breaths.
• In an unresponsive infant or child, the tongue
may obstruct the airway and interfere with
ventilations.

• Open the airway using a head tilt–chin lift
maneuver for both injured and non-injured
victims.
• To give breaths to an infant, use a mouth-
to-mouth-and-nose technique; to give
breaths to a child, use a mouth-to-mouth
technique.

• Make sure the breaths are effective (ie,
the chest rises).
• Each breath should take about 1 second.
If the chest does not rise, reposition the
head, make a better seal, and try again.
• It may be necessary to move the child's
head through a range of positions to
provide optimal airway patency and
effective rescue breathing

• In an infant, if you have difficulty making
an 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 rises
when you give a breath.
• If you are the only rescuer, provide 2
effective ventilations using as short a
pause in chest compressions as possible
after each set of 30 compressions.

DEFIBRILLATION
• Ventricular fibrillation (VF) can be the
cause of sudden collapse or may
develop during resuscitation attempts.
• Children with sudden witnessed
collapse (eg, a child collapsing during
an athletic event) are likely to have VF
or pulseless ventricular tachycardia (VT)
and need immediate CPR and rapid
defibrillation.

• VF and pulseless VT are referred to as
"shockable rhythms" because they
respond to electric shocks (defibrillation).
• Many AEDs have high specificity in
recognizing paediatric shockable rhythms,
and some are equipped to decrease (or
attenuate) the delivered energy to make
them suitable for infants and children <8
years of age
• For infants a manual defibrillator is
preferred when a shockable rhythm is
identified by a trained healthcare provider.

• The recommended first energy dose for
defibrillation is 2 J/kg. If a second dose is
required, it should be doubled to 4 J/kg.
• If a manual defibrillator is not available, an
AED equipped with a paediatric attenuator
is preferred for infants.
• An AED with a paediatric attenuator is also
preferred for children <8 year of age.

• If neither is available, an AED without a
dose attenuator may be used.
• AEDs that deliver relatively high-energy
doses have been successfully used in
infants with minimal myocardial damage
and good neurological outcomes.

Neonatal CPR
• Rubbing the back or flicking the sole of
the feet to stimulate the baby
• Compression to ventilation ratio is 3:1
• Compression with 2 thumbs, with
fingers encircling the chest and
supporting the back
• 40- 60 breaths/ minute is advisable

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