2. Basic life support
• Cardiac arrest and respiratory arrest occurs when patients
heart suddenly stops beating, and there is cessation of
respiration
• It leads to decreased – circulation of blood
-- oxygen to important organs
• BLS is an attempt to restore respiratory and cardiac function.
• Primary emphasis of BLS—
1. Removing upper airway obstruction and maintaining the patency of
airway
2. Eliminating respiratory arrest
3. Restoring circulation
4. Procedure can be summarized as ABC of BLS
BASICLIFESUPPORT
3. ABC of BLS
First and foremost is Positioning
Airway
Breathing
Circulation
Defibrillation (P-A-B-C-D)
BASICLIFESUPPORT
6. BASICLIFESUPPORT
--By ‘Shake and Shout’ maneuver
Shake shoulders gently
Ask “Are you all right?”
Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
7. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
Summon assistance
Members of the emergency team
should report to the scene
Emergency drug kit
Oxygen
The AED
Positioning – supine position
i.e. head & chest parallel to floor,
feet elevated slightly (10 degrees)
8. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
Head tilt & chin lift
• to obtain a patent
airway
Jaw thrust
Assessment
Maintenance
9. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
Head tilt & chin lift
• this stretch the tissues of the neck and
lifting the tongue & epiglottis off the
posterior wall of the pharynx
Assessment
Maintenance
Campbell
10. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• while maintaining
the position, place
your ear approx.
1 inch victims mouth and nose
• look towards the chest of the victim
• assess for 5-10 seconds
ASSESSMENT
Rescue breathing
11. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• if respiratory
arrest occurs or
spontaneous
ventilation is inadequate, then it is a
must to ventilate the victim so that
adequate oxygen is available to the
brain
•Three ways of artificial ventilation
1. Exhaled air ventilation
2. Atmospheric (ambient) air
ventilation
3. O₂ -enriched ventilation
Assessment
RESCUE BREATHING
12. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
Exhaled air
ventilation
• Exhaled air can
deliver 16-18 % inspired O₂,
yielding an arterial PaO₂ of 88 Torr
(normal- 75 to 100 Torr) at a tidal
volume of 1000-1500mL
• Two basic types—
i. Mouth-to-mouth
ii. Mouth-to-nose
• This technique do not need any
adjunctive equipment
• Can be carried out in any situation
Assessment
RESCUE BREATHING
13. BASICLIFESUPPORT Rescue breathing
Exhaled air ventilation
• Head tilt-chin lift position
• With mouth wide open, take a deep breath
• Make a tight seal around the victims mouth
• Blow into the mouth
• Air should be rapidly & deeply inhaled & deliver immediately
• must be repeated once every
5 to 6 seconds for adult
3 seconds for infant or children
• Repeated for as long as necessary
•Assessment of adequacy—
Feeling the escape of air
Seeing the rise & fall of chest
•Risk –
• Gastric aspiration
• Limit movement of diaphragm due to
increase intraabdominal pressure thereby
reduce the ability of the rescuer to
ventilate
Mouth-to-mouth
14. BASICLIFESUPPORT Rescue breathing
Exhaled air ventilation It is used when victim
• Can’t open mouth
• Can’t make a good seal
• Severely injured mouth
•Head tilt-chin lift position
• Seal the victims lips with the mandible
• Seal your lips around the victims nose &
blow until expansion of the victims lungs is
felt & seen
• Repeat 10-12 breaths per minute in
adults & children
• 20 breaths per minute for infant and
young children i.e. once every 3 seconds
Mouth-to-nose
16. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
O₂ enriched
ventilation
• Oxygen cylinder with demand-
valve mask unit
Assessment
RESCUE BREATHING
17. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• Determine
whether the blood
is circulated or not
• Locate large artery–
carotid(preferred) or femoral
• Palpate for 5-10 seconds
ASSESSMENT
Activation of EMS
Chest compression f
18. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• After pulse check
• Call emergency
number of the
locality
Assessment
ACTIVATION OF EMS
Chest compression f
19. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• Rhythmical
application of
pressure over the
lower half of the
sternum
• Create blood flow by increasing
intrathoracic pressure &
by direct compression
of the heart
• Proper compression
can produced systolic
arterial pressure
peaks of 60-80 mm
of Hg, diastolic is
pressure is low
Assessment
Activation of EMS k
CHEST COMPRESSION
20. BASICLIFESUPPORT
Compression point
• One heel of one hand on the middle of the sternum between the nipples & other
heel of other hand on top of the first so that they are overlapped & parallel
• Fingers interlaced, with the fingers of the top hand pulling the fingers of the
lower hand upward
Application of pressure
• Shoulders should be located directly over the sternum
• Elbow should be locked
• If victim is—
• lying on the floor, rescuer kneels at the victims side, close enough to body
• Dental chair, rescuer stands astride the victim, with the chair lower
• Downward compression should take 50% of the entire compression cycle
Rate of chest compression
• 100 per minute & interruptions to no longer than 10 seconds
Compression-ventilation ratio
• 30:2
• To increase compression and to reduce hyperventilation
CHEST COMPRESSION
22. BASICLIFESUPPORT Recognition
Assistance & Position
Airway
Breathing
Circulation
Defibrillation
• It uses a device called AED
(automated external defibrillator)
• AED is used only if the victim
• Does not respond
• Is not breathing
• Is pulseless
AED
24. BASICLIFESUPPORT
CPR once started should be continued until one of the following occurs
1. Recovery, demonstrating adequate spontaneous respiration and
circulation and place in recovery position
2. A physician arrives and assumes overall responsibility
3. EMS personal arrive
RECOVERY POSITION
25. ADVANCETRAUMALIFESUPPORT ADVANCE TRAUMA LIFE SUPPORT
Objective
• Identify the correct sequence of priorities for assessment of a
multiple injured pt.
• Apply the principles outlined in primary and secondary
evaluation surveys of ATLS.
• Apply guidelines and techniques in the initial resuscitative and
definitive care phases of treatment.
27. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
• Initial assessment of the casualty
• Time interval
• Then proceed to the basic ATLS
procedure i.e. (in short) ABCDE
28. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
Breathing
AIRWAY
Circulation f
Disability
Environment &
exposure
•Confirmation
• If patient
talks normally,
airway not
compromised
• Hoarse voice
or audible
breathing,
suspicious
Assess the patient for airway obstruction (coma)
Agitation--------------- hypoxia
Cyanosis---------------- hypoxemia, secondary to inadequate oxygenation
Hoarseness,----------- suspected laryngeal fracture
s/c emphysema
& palpable
fracture
29. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
Breathing
AIRWAY
Circulation f
Disability
Environment &
exposure
• Established
maintenance of
airway through
either of the two
---Head tilt-chin lift
---Jaw thrust
JAW THRUST
•Rescuer fingers are placed behind the
posterior border of the ramus of the
mandible
•Displace the mandible forward,
dislocating it while tilting the head
backward
•Retract the lower lip with the thump
JAW THRUST
30. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
Breathing
AIRWAY
Circulation f
Disability
Environment &
exposure
• If debris ( broken
tooth, dentures) is
present, remove it
by—Finger sweep
technique or
--Yankauer suction or
-- Magill’s forceps (for
large object)
• If ---no foreign body is visible, endotracheal tube should be used to secure the
established airway
--- If the foreign body cannot be removed quickly or the vocal cords cannot be
adequately visualized or endotracheal intubation is not possible, then
cricothyroidotomy is indicated
•
32. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
Breathing
AIRWAY
Circulation f
Disability
Environment &
exposure
• In patient
sustaining
significant blunt
injury, should be
assume to have
cervical spine injury,
until prove other-
wise
•--- such pt. should
have cervical spine
immobilized with semi rigid cervical
collar and bilateral sand bags or block
joined with tapes or straps across the
forehead
34. BREATHING
Airway
Circulation f
Disability
Environment &
exposure
ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
•Conditions that
acutely compromised
breathing are--
• Tension
pneumothorax
• Massive
hemothorax
• Flail thorax
accompanied by
pulmonary contusion
• open pneumothorax compromise breathing
•Such condition can be diagnosed with physical examination & should be treated
immediately
•It can be treated with endotracheal intubation, mechanical ventilation, needle
thoracocentesis, or tube thoracostomy.
36. Breathing
Airway
CIRCULATION f
Disability
Environment &
exposure
ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
•Circulatory problems
in trauma patients are
usually caused by
hemorrhage
•First action is to stop
bleeding
•For ---
Intra oral bleeding-----------------bite a cotton swap
Tongue laceration------------------deep suture across the laceration
Bleeding from fracture-----------manually reducing and brittle wiring of the fracture fragments
mandible end
Mobile maxilla---------------------rubber mouth gags
Soft tissues of head & neck----direct pressure on the bleeding site
Torrential bleeding from--------epistat tube with anterior and posterior balloons
the nasopharynx region
37. Breathing
Airway
Circulation f
DISABILITY
Environment &
exposure
ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
• Assessment of the
neurological status.
The Glasgow coma
score (GCS)
• worst score is 3 points
• GCS can be caused by a focal brain injury
• Optimal oxygenation and circulation are important to prevent secondary injury to
the brain
• Impaired consciousness can be caused by hypoxia or hypotension for which ABC
stabilization is essential
•Patients who open
their eyes
spontaneously, obey
commands, and are
normally oriented score
a total of 15 points
39. ADVANCETRAUMALIFESUPPORTADVANCE TRAUMA LIFE SUPPORT
Initial assessment
Primary survey
Secondary survey
• Under this the pt. is examined from head to toe
• Appropriate additional radiographs of the
thoracic and lumbar spine and the extremities
are performed when indicated.
• CT scans, when indicate
•Secondary survey mnemonics
•Head/skull Has
•Maxillofacial My
•Cervical Spine Critical
•Chest Care
•Abdomen Assessed
•Pelvis Patient's
•Perineum Priorities
•Orifices Or
•Neurological Next
•Musculoskeletal Management
•Diagnostic tests/ Decision?
Definitive care
40. ADVANCETRAUMALIFESUPPORT ADVANCE TRAUMA LIFE SUPPORT
IF, DURING THE SECONDARY SURVEY, THE PATIENT'S CONDITION
DETERIORATES, THE PRIMARY SURVEY SHOULD BE REPEATED
BEGINNING WITH “A”.
