The document outlines the historical perspective and modern approaches to basic life support (BLS) and emergency cardiovascular care (ECC), highlighting key interventions and survival statistics for cardiac arrest. It emphasizes the importance of early recognition, immediate BLS, and advanced life support, as well as the role of bystanders in initiating these life-saving measures. Additionally, it discusses the use and operation of automated external defibrillators (AEDs) for effective emergency response.

1. Basic life support

3. Historical Perspective

6. The First Ever Guidelines
1. Warming the victim (which sometimes required transporting the body to a different location) by lighting a
fire near the victim, burying him in warm sand, placing the body in a warm bath, or placing in a bed with one
or two volunteers
2. Removing swallowed or aspirated water by positioning the victim's head lower than feet
3. Applying manual pressure to the abdomen
4. Respirations in to the victim's mouth, either using a bellows or with a mouth to mouth method (mouth to
mouth or mouth to nostril respiration is described including the advice that “a cloth or handkerchief may be
used to render the operation less indelicate”)
5. Tickling the victim's throat with a feather to induce vomiting
6. ‘Stimulating’ the victim by such means as rectal and oral fumigation with tobacco smoke. This may seem
very unusual in modern times; however it may have been that the nicotine was enough of a stimulant to
engender a response in the “almost” dead
7. Bloodletting

18. AHA

19. CPR

20.  Approximately 700,000 cardiac arrests per year in Europe.
 Survival to hospital discharge presently approximately 5-10%.
 Bystander CPR vital intervention before arrival of emergency
services.
 Early resuscitation and prompt defibrillation (within 1-2
minutes) can result in >60% survival.
 Heart attack is the leading cause of arrest in Europe.

21. • EARLY recognition and management is key to survival
• Survival from In- Hospital respiratory arrest 90%
• Survival from In- Hospital cardiac arrest 11%
• Survival from Out of Hospital cardiac arrest 7%
• Less than1 in 1,000 survive – & the key factor is the brain.

22. Emergency Cardiovascular Care ECC
 Recognition of early warning signs of heart attack and stroke, efforts to
prevent complications, reassurance of the victim, and prompt availability
of monitoring equipment
 Provision of immediate BLS at the scene when needed
 Provision of ACLS at the scene as quickly as possible to defibrillate if
necessary and stabilize the victim before transportation

23. Emergency Cardiovascular Care
 Transfer of the stabilized victim to a hospital where definitive cardiac care
can be provided
 The most important link in the ECC system in the community is the
layperson. Successful ECC depends on laypersons’ understanding of the
importance of early activation of the EMS system, their willingness and
ability to initiate effective CPR promptly, and their training in and safe
use of AEDs. Accordingly, providing lifesaving BLS at this level can be
considered primarily a public, community responsibility.

24. Emergency Cardiovascular Care
 ACLS includes the use of adjunctive equipment in supporting ventilation,
the establishment of intravenous access, the administration of drugs,
cardiac monitoring, defibrillation or other control of arrhythmias, and
care after resuscitation. In virtually every EMS system in the world a
medical physician must be involved to supervise and direct ACLS efforts
(1) in person at the scene, (2) by direct voice communication, or (3) by
the widely used mechanism of “standing orders.” These are a set of
written, condition-specific orders that instruct the nonphysician
responders.

25. Core Objectives of BLS Training
 1. Recognize unresponsiveness or other emergency situations when
resuscitation is appropriate (eg, the victim does not have a “do not
attempt resuscitation” order)
 2. Phone the EMS number at the appropriate time within the BLS
sequence
 3. Provide an open airway using the head tilt–chin lift or jaw-thrust
technique
 4. Provide effective rescuer ventilations (breathing) that make the chest
rise using the mouth-to-mouth, mouth-to-mask, or mouth-to–barrier
device technique

26.  5. Recognize and relieve FBAO in conscious victim as a part of the core
breathing step (lay providers are not required to perform this step in
unconscious victims)
 6. Provide proper chest compressions sufficient to generate a palpable
carotid pulse
 7. Perform all skills in a manner that is safe for the rescuer, victim, and
bystanders
 If use of an AED is taught as part of the course, an additional core
objective is to
 8. Use an AED safely, correctly, and in the appropriate sequence

27. When Not to Do CPR
 The patient has a valid DNAR order.
 The patient has signs of irreversible death: rigor mortis, decapitation, or
dependent lividity.
 No physiological benefit can be expected because the vital functions have
deteriorated despite maximal therapy for such conditions as progressive
septic or cardiogenic shock.
 Withholding attempts to resuscitate in the delivery room is appropriate for
newly born infants with —Confirmed gestation <23 weeks or birthweight
<400 g —Anencephaly —Confirmed trisomy 13 or 18

28. When to Stop CPR
 Restoration of effective, spontaneous circulation and ventilation
 Care is transferred to a more senior level of emergency medical
professional who may determine unresponsiveness to
resuscitation
 Recognition of reliable criteria indicating irreversible death
 The rescuer is unable to continue resuscitation because
exhaustion, the presence of dangerous environmental hazards,
or continuation of resuscitation places other lives in jeopardy
 Presentation of a valid DNAR order to the rescuers

29. Asystole Persists
 Time to terminate resuscitative efforts?
 Are all BLS/ACLS interventions completed? (CPR, ventilation and
oxygenation, defibrillation, intravenous access obtained, and indicated
medications given?)
 Has asystole persisted for several minutes? (documented electrical silence;
no specific time criteria imposed, but default approach should be shorter
time requirements, not longer)
 Consider opposing family attitudes toward stopping efforts.

30. When should more efforts be made
Young age
Toxins or electrolyte abnormalities
Profound hypothermia
Drug overdose

31. Types of arrest
Shockable rhythm
Ventricular fibrillation
Pulseless ventricular tachycardia
Unshockable rhythm
Pulseless electrical activity
asystole

32. Correctable causes of arrest
 Hypoxia
 Hypothermia
 Hypovolemia
 Electrolyte imbalance and acidosis
 Thrombosis
 Cardiac tamponade
 Tension pneumothorax
 Toxins

33. Phases of CPR
 Electrical phase: it is first 5 minutes of arrest on shockable rhythm. Chest compression till
defibrillator is ready is crucial in survival.
 Haemodynamic phase: from 5 to 10 minutes from arrest availability of defibrillator is crucial
but if patient found in VF may 90 to 180 seconds of chest compression is needed
before defibrillator (controversial in AHA)
 Metabolic phase: after 10 min it depends mainly on post resuscitative care after recovering
of ROSC

34. CHAIN OF SURVIVAL
1. Immediate recognition of cardiac arrest and activation of the
emergency response system
2. Early cardiopulmonary resuscitation (CPR) with an emphasis on
chest compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post-cardiac arrest care

35. Recognition of cardiac arrest:
 Approach to unresponsive patient to check his
response by shaking his shoulders gently while asking
the patient are you ok?
 If no response activate emergency response.
 Open airway see listen and feel for breathing for 10
seconds after checking that airway is open.
 After 10 seconds no breathing begin CPR.
 Check carotid pulsation in adults and brachial pulsation
with minimal pressure in pediatric not to cause fracture
humerus.

36. CPR
 Early CPR with emphasis on chest compression.
 Begin by ratio 30 compression to 2 rescue breaths as
long as we are not on advanced airway if we had
advanced airway we do about 100-120 chest
compressions per minute to 8-10 rescue breathes per
minute.
 Cardiac output falls during CPR to approximately 25%
of normal cardiac out put and minute volume will be
around 6-8 liters per minute.

37. Rapid access to defibrillator
 Defibrillator should be available within 4 minutes from beginning
of CPR and according to AHA 3 minutes only.
 While doing basic life support automated defibrillator will be use.
 When begin advanced life support it is preferred to use biphasic
defibrillator than monophasic defibrillator which use higher
energy in delivering the shock.
 Defibrillation for ventricular fibrillation and pulseless ventricular
tachycardia.
 If arrest for 4 or 5 min before beginning CPR and its shokable
rhythm u may do CPR for 90 to 180 second before delivering the
shock.

38. Effective advanced life support
 Advanced life support should begin with in 8
minutes in a hospital.
 It begin by resuscitation team with advanced
airway with advanced medications as
Adrenaline, Amiodarone and Magnesium
sulphate.

39. Advance life support team:
1. Team leader: instruct during CPR
2. Airway responsible
3. Responsible for drugs
4. Defbrillator responsible
5. 2 for chest compression
6. One for documenting events

40. Basic airway management
 Bag mask ventilation is a cornerstone of basic airway
management.
 It is used when inadequate ventilation either by
hypoxia or hypoventilation or both. Or due to upper
airway obstruction.
 Classified into maneuvers like head tilt chin lift jaw
thrust and airway adjuncts by oropharyngeal or
nasopharyngeal.

41. Airway obstruction
 It is diagnosed by increased respiratory effort cyanosis
work of accessory muscles of respiration and
adventitious sounds like snoring.
 Relieved by multiple techniques
1. Abdominal thrust by encircling abdomen by both hands and the
rescuer standing in the back it is contraindicated in pregnancy
sometimes it caused gastric rupture.
2. Chest thrust begin with it before abdominal if abdominal is
contraindicated
3. Back slaps sometimes relieve obstruction.
 Usually we need combination of these maneuveres to
releive obstruction.

44. Airway maneuvers
 Head-tilt chin-lift the
manoeuvre is done by
extending neck by one
hand of rescuer on
forehead other hand index
and middle fingers tip raise
chin anteriorly at the
mentum which lifts tongue
from posterior pharynx
head tilt can not be done if
cervical injury is a concern.

45.  Jaw-thrust maneuver With
the patient supine and the
clinician standing at the head
of the bed, it is performed by
placing the heels of both
hands on the parieto-occipital
areas on each side of the
patient's head, then grasping
the angles of the mandible
with the index and long
fingers, and displacing the
jaw anteriorly it is safe even if
there is cervical spine fracture

46. Bag mask ventilation
 Prior using bag mask ventilation use one of the airway opening
maneuvers.
 Used to buy time for the clinician to put a plan for definite airway
management.
 Success of bag mask ventilation depends on rate, volume and
sealing of mask on the face.
 Prior to mask placement bag should be removed from the mask
to make it more successful proper placement, nasal part of the
mask cover nasal bridge the rest of the mask cover maxillary
eminence and the mandibular alveolar ridge of the jaw but never
the eye as it may cause trauma or vagal stimulation.

47. Application of the mask
 One hand maneuver make a web between index
and thumb around the connector of the mask then
apply pressure by this web centrally on the mask the
rest of hand fingers will rest on the mandible making
chin lift maneuver.
 Double hand maneuver requires 2 persons first
care for airway by putting index and thumbs of both
hands simultaneous on superior and inferior ridges of
the mask and apply pressure and remaining 3 fingers
rest on the jaw doing chin lift jaw thrust maneuver.

48. Troubleshooting of bag mask
 Excessive facial hair may need KY jel
 Excessive facial oedema
 Down displaced lower lip
 Improper mask size
 Lack of airway adjuncts
 Inadequate airway maneuvers
 Inexperienced personnel

49. Ventilation through bag mask
 Tidal volume from 8-10 ml/kgm and in CPR 6-8
ml/kgm.
 Respiratory rate from 10-12 breaths per minute
 Inspiratory time should be around 1 second
 This tidal volume approximate to ambubagging
using single hand
Sellick’s maneuver
Press against cricoid cartilage to prevent over
distention of the stomach.

50. Automated external
defibrillator

51. Automated external defibrillator
The automated external defibrillator (AED) is a computerized
medical device. An AED can check a person’s heart rhythm. It
can recognize a rhythm that requires a shock. And it can
advise the rescuer when a shock is needed. The AED uses
voice prompts, lights and text messages to tell the rescuer
the steps to take.
AEDs are very accurate and easy to use. With a few hours of
training, anyone can learn to operate an AED safely.

52. How does it operate
 When turned on or opened, the AED will instruct the user
to connect the electrodes (pads) to the patient. Once the
pads are attached, everyone should avoid touching the
patient so as to avoid false readings by the unit. The pads
allow the AED to examine the electrical output from the
heart and determine if the patient is in a shockable rhythm
(either ventricular fibrillation or ventricular tachycardia). If
the device determines that a shock is warranted, it will use
the battery to charge its internal capacitor in preparation
to deliver the shock. This system is not only safer (charging
only when required), but also allows for a faster delivery of
the electrical current.

53.  When charged, the device instructs the user to ensure no
one is touching the patient and then to press a button to
deliver the shock; human intervention is usually required to
deliver the shock to the patient in order to avoid the
possibility of accidental injury to another person.
 Many AED units have an 'event memory' which store the
ECG of the patient along with details of the time the unit
was activated and the number and strength of any shocks
delivered. Some units also have voice recording abilities to
monitor the actions taken by the personnel in order to
ascertain if these had any impact on the survival outcome.

54.  The first commercially available AEDs were all of a
monophasic type, which gave a high-energy shock, up to
360 to 400 joules depending on the model.
 Now biphasic available deliver shock beginning with 200
the 300 then another 300 joules.
 Time of expiry is written on the defibrillator.
 Recommended class I to use with in 3 minutes of the
arrest according to AHA.

56. AED sign put on places
available

59. Chest recoil

66. Thank you