Basic Life Support (BLS) is a set of emergency procedures used to maintain breathing and circulation in a person experiencing cardiac arrest or respiratory distress. It involves assessing the scene, calling for help, performing chest compressions, and possibly rescue breathing or using an AED (Automated External Defibrillator). BLS Procedure Steps: 1. Scene Safety and Activation: Assess the scene for safety and potential hazards. Call for emergency medical services (EMS). 2. Airway, Breathing, and Circulation (ABCs): Check for responsiveness. Open the airway by tilting the head and lifting the chin (unless suspected spinal injury). Check for breathing and pulse. 3. Chest Compressions and Rescue Breaths: If no pulse or breathing (or only gasping), begin high-quality CPR. Perform chest compressions at a rate of 100-120 per minute. For every 30 compressions, provide 2 rescue breaths. 4. AED Use: If an AED is available, use it according to its instructions. 5. Continue CPR: Continue CPR until the person begins to breathe or until medical help arrives. 6. Recovery Position: If the person starts breathing, place them in the recovery position on their side to help keep the airway open. Key Considerations: High-quality CPR: Maintain a proper compression depth, allow full chest recoil, and minimize interruptions. AED: Follow the AED's instructions for attaching pads, analyzing the heart rhythm, and delivering shocks. Airway Management: Ensure the airway is open and free of obstructions. Rescue Breathing: Deliver breaths effectively, ensuring the chest rises. Continuous Assessment: Recheck the person's pulse and breathing every 2 minutes.

1. BLS & ACLS
N. LEMUEL MATHEW
MSc. Cardiac Catheterization
& Interventional Technology

2. Basic Life Support(BLS)
- Basic Life Support (BLS) is performed to support the
patient’s circulation and respiration through the use of
cardiopulmonary resuscitation (CPR) until advanced life support
arrives.
- Victims who have had early and correct BLS intervention will be
better oxygenated and are more likely to respond to advanced
techniques to revive them, thereby increasing their chance of
survival.

3. BLS is the core of any resuscitation attempt, key
elements include:
- Prompt recognition of cardiac arrest
- Call for urgent medical assistance
- Early effective CPR with an emphasis on minimal disruptions to
compressions
- Early defibrillation
- Early advanced life support
- Integrated post-cardiac arrest care

4. Cardiopulmonary Resuscitation (CPR)
- CPR is a lifesaving technique.
- It aims to keep blood and oxygen flowing through the body when
a person’s heart and breathing have stopped.
- CPR is for people experiencing cardiac arrest.
- When the heart stops beating, cardiopulmonary resuscitation
(CPR) is used to save the patient's life.
- After a cardiac arrest, immediate CPR can double or triple the
possibilities of survival.

5. The steps involved in CPR are known as DRSABCD (or
‘doctors ABCD’)
• D – Danger
• R – Response
• S – Send for help
• A – Airway
• B – Breathing
• C – CPR
• D – Defibrillator

6. Types of CPR:
- Two types of CPR exist and both have a potentially life-saving impact. They
are:-
Hands-only CPR:- Involves calling for help and then pushing on the chest in a
rapid motion ie chest compressions.
- Hands-only CPR can prevent a delay in getting blood moving through the body.
Traditional CPR with breaths:- Also called CPR with breaths, this alternates
chest compressions with mouth-to-mouth breaths.
- This type of CPR can give the body more oxygen in the critical moments before
help arrives.

7. Compressions only CPR:
- Commenced when a victim/patient is unresponsive and not
breathing normally.
-Early compressions can improve outcomes by keeping
the brain and heart perfused with the oxygenated blood.
Rules for achieving effective chest compressions:
• 100 – 120 compressions per minute (for all ages)
• Push down firmly on the sternum to 1/3 of the depth of the chest
• Push in a regular rhythm, for example counting ‘1, 2, 3’
• Compression/relaxation ratio should be 50:50 with complete recoil of chest

8. • Frequent rotation of personnel should be taken after
approximately 200 compressions or every 2 mins
• Interruptions to chest compressions should be minimised
• Avoid compressions applied too high
• After each 30 compressions there is an interruption in chest
compressions for two (2) rescue breaths
Rhythm of compressions using these popular songs:
Staying alive’ by the Bee Gees
‘Row, row, row, your boat’
‘Baby shark’

9. Choking:
• Choking is a medical emergency that occurs when a foreign object
becomes stuck in the throat, blocking the airway and preventing the
person from breathing.
• This blockage cuts off the oxygen supply to the brain, and it can
be fatal.
Signs and Symptoms of Choking:
Facial expressions: Panicked, confused, or surprised look.
Hand gestures: Often, one or both hands are placed on the throat.
Coughing: The person may cough weakly or not at all.

10. Breathing sounds: High-pitched squeaks
Inability to speak: If airway is fully blocked, the person cannot
speak, cry, or cough.
Skin color: Initially flushed (red), turning pale or bluish as oxygen
is deprived.

11. Advanced Cardiac Life Support (ACLS): Adult
Cardiac Arrest
1. The initial evaluation is as follows:
- Activate emergency response system.
- Initiate adult basic life support (BLS) algorithm.
2. The initial intervention is as follows:
- Start high-quality cardiopulmonary resuscitation (CPR).
- Administer oxygen if hypoxemic.
- Attach monitor/defibrillator.
- Monitor blood pressure and oximetry; do not delay defibrillation.

12. 3. Check rhythm, as follows:
Shockable rhythm = Ventricular fibrillation or pulseless ventricular
tachycardia (VF/VT)
Non shockable rhythm = Asystole/pulseless activity (PEA)
Shockable Rhythm
1. Initial treatment of VT/VF is as follows:
- Defibrillate immediately.
- Continue CPR for 2 minutes.
- Obtain intravenous (IV)/intraosseous (IO) acess; IO access
- Consider advanced airway, end-tidal carbon dioxide tension.

13. 2. Administer vasopressor (epinephrine q3-5min)
3. Check pulse and rhythm every 2 minutes, as follows:
- If nonshockable, see Nonshockable Rhythm (below).
- If shockable, see Shockable Rhythm (above) and administer
amiodarone after second defibrillation attempt.
- Rotate chest compressors.
- Identify and treat reversible causes.
4. If return of spontaneous circulation (ROSC), see ACLS

14. Non-shockable Rhythm:
1. Initial treatment of asystole/PEA is as follows:
- Continue CPR for 2 minutes.
- Obtain intravenous (IV)/intraosseous (IO) access.
- Consider advanced airway, end-tidal carbon dioxide tension
2. Administer vasopressor (epinephrine q3-5min).
3. Check pulse and rhythm every 2 minutes, as follows:
- If nonshockable, see Nonshockable Rhythm (above).
- If shockable, see Shockable Rhythm (above).
- Rotate chest compressors.
- Identify and treat reversible causes.
4. If return of spontaneous circulation (ROSC), see ACLS:

15. CPR Quality:
CPR should proceed as follows
• Push hard and fast, at least 2 inches (5 cm) and 100-120
compressions per minute.
• Allow complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Rotate compressor every 2 minutes or if fatigued.
• Compression-to-ventilation ratio is 30:2.
• Continuous compressions if advanced airway present

16. Shock Energy:
- Shock energy should be as follows:
Biphasic: Manufacturer recommendation (eg, 120-200 J initial); if
unknown, use maximum available.
Monophasic: 360 J
Return of Spontaneous Circulation
Signs of ROSC include the following:
- Pulse and blood pressure present
- Abrupt sustained increase in PETCO2 (typically >40 mm Hg)
- Spontaneous arterial pressure waves with intra-arterial monitoring

17. Advanced Airway:
Advanced airway should be established as follows:
• Endotracheal tube (ETT) or supraglottic airway (SGA)
• Waveform capnography to confirm and monitor ET tube
placement
• Ventilation every 6 seconds asynchronous with compressions
• Stop CPR for no longer than 10 seconds for the placement of an
advanced airway.

18. Difference Between BLS & ACLS
Basic Life Support Advanced Cardiac Life Support
CPR Can provide all BLS skills plus
Artificial Ventilations EKG monitoring
Oxygen Administration Manual Defibrillator
Basic Airway Management Advanced Airway Management
Spinal Immobilization External Transcutaneous Pacing
Vital signs Fluid Therapy
Bandaging/Splinting Needle chest decompression
Obstetrics Administration of critical care medications
Blood Glucose Monitoring

19. THANK YOU