Basic Life Support

1. Basic Life Support

2. Introduction
• 2005 Consensus Conference of cardiologists and
Emergency medicine specialists
• Simplification of BLS sequences, particularly for
lay rescuers
• Universal compression-ventilation ratio is
recommended for all single rescuers of infant,
child and adult victims

3. Chain of Survival
• Early recognition of the emergency and activation of the
EMS or local emergency response
• Early bystander CPR
• Early delivery of a shock with a defibrillator
• Early advanced life support followed by postresuscitation
care delivered by healthcare providers

5. Check for Response
• Ensure that the scene is safe before checking for
patient’s response
• Tap the patient on the shoulder and ask, “Are you
alright?”
• If the victim responds but is injured or needs
medical assistance leave the patient and call for
help

6. Activate the EMS System
• One rescuer
– Call for help
– Get an AED (if available)
– Provide CPR and defibrillation
• 2 or more
– One should begin the steps in CPR
– Second calls for help
• In a facility
– Activate CODE BLUE

7. Adult Priorities
• Once LOC has been established, the resuscitation
priority for the adult in most cases is to activate the
code team or EMS.
• Exceptions to this include near drowning, drug
overdose, & respiratory arrest for which 1 minute
of CPR should be performed before activating the
EMS

8. Child Priorities
• Because the underlying cause of arrest in an infant
or child is usually respiratory, the priority is to
begin CPR and then activate the EMS after 2
minutes of CPR or 5 cycles.

9. The ABCD’s of CPR
1.Airway: maintain an open airway
2.Breathing: providing artificial
ventilation by rescue breathing
3.Circulation: promoting artificial
circulation by external cardiac
compression
4.Defibrillation: restoring the heartbeat

10. The ABCD’s of CPR
• If the patient shows ventricular tachycardia
or ventricular fibrillation on the ECG
monitor, defibrillation rather than CPR is the
treatment of choice.
• In this scenario, CPR is performed initially
only if the defibrillator is not immediately
available.
• SR  by 10% for every minute that
defibrillation is delayed.

11. Open the Airway
• To prepare for CPR, place
patient on hard surface on a
supine position
• Lay rescuer: Head-tilt-chin-
lift maneuver for both injured
and noninjured victim
• HCP: Head-tlit-chin-lift
maneuver without evidence
of head and neck trauma
– Jaw thrust if suspected with
spinal cord injury

12. Check Breathing
• Look, listen and feel for
breathing
• Observe for not more than 10
seconds
• Gasping is considered as no
breathing
• Give 2 rescue breaths for no
breathing or if unsure

13. Give Rescue Breaths
• Give 2 rescue breaths, each
over 1 second with enough
volume to produce visible
chest rise
• Applies to all forms of
ventilation with or without
oxygen

14. Give Rescue Breaths
• Avoid giving too large or too forceful
• An oropharyngeal airway is inserted if
available
• ET intubation is performed, and confirmed
by visualization of the tube through the vocal
cords, auscultation of breath sounds, or
bilateral chest expansion.

15. • After performing
ventilation, the carotid
pulse is assessed for not
more than 10 seconds
• CPR is provided when
no pulse is detected.
• If a defibrillator isn’t
yet available, chest
compressions are
initiated.
Pulse Check

16. Chest Compressions
• Rhythmic applications of pressure over the lower
half of the sternum
• Create blood flow by increasing intrathoracic
pressure and directly compressing the heart
• “push hard and push fast”

17. Chest Compressions: Technique
• Lie supine on a backboard or floor
• Rescuer kneeling beside the victim’s thorax
• Compress the lower half of the victim’s sternum in
the center of the chest between the nipples
• The heel of one hand should be on the chest and
the other on top of the first, overlapped and parallel

18. Chest Compressions: Technique
• Depress the sternum
approximately 1 ½ to 2
inches
• Allow the chest to return
to normal position
• Provide 100
compressions per minute

19. Chest Compressions

20. Chest Compressions

21. CPR for Children (Ages 1-8)
• Press the sternum approximately one-
third the depth of the chest

22. CPR for Children (Ages 1-8)

23. Infant CPR
1. Shout and tap the child on the shoulder. If there is no
response, position the infant on his or her back.

24. Infant CPR
2. Open the airway using a head tilt lifting of chin.
Don’t tilt the head too far back.

25. Infant CPR
3. Give 2 small gentle breaths if
the baby is NOT breathing.
Cover the baby's mouth &
nose with your mouth. Each
breath should be 1 sec. long.
Watch the chest rise with
each breath.

26. Infant CPR
4. Give 30 gentle chest
compressions at the
rate of 100/min. Use
2 or 3 fingers in the
center of the chest
just below the
nipples. Press down
approximately 1/3
the depth of the
chest.

27. 5. Repeat with
2 breaths
and 30
compression
s.

28. Infant CPR

29. Compression Ventilation Ratio
• One-man CPR, 30:2 compression-ventilation ratio
for all
• Advanced airway in place:
– No longer administers CPR with cycles
– Continuous chest compression at a rate of 100 per
minute without pauses for ventilation
– Ventilation of 8 to 10 breaths per minute
• Changing of roles every 2 minutes of 5 cycles

30. Restoring Circulation
• When the code team arrives, the patient is quickly
assessed to determine cardiac rhythm &
respiratory status, as well as possible causes of
cardiac arrest.
• If ventricular defibrillation is detected, the patient
will be defibrillated up to 3 times, and then CPR is
resumed.

31. • If asystole is detected on the monitor, CPR
is resumed immediately while trying to
identify the underlying cause (e.g.
hypovolemia, hypothermia, or hypoxia)
• CPR may be stopped when the patient
responds & begins to breathe, or the
rescuers are too exhausted or at risk to
continue, or signs of death are obvious.

32. Agents Used in CPR
• Oxygen (100%): improves tissue oxygenation &
corrects hypoxemia
• Epinephrine:
– α-adrenergic effects can increase coronary and cerebral
perfusion pressure by vasoconstriction
– β-adrenergic can increase myocardial contractility
– Given 1 mg per IV/IO every 3-5 minutes

33. Agents Used in CPR
• Dopamine:
– catecholamine-like agent and a chemical precursor of
norepinephrine that stimulates both α- and ß-adrenergic
receptors.
– Management of choice in postresuscitation hypotension
– Positive effects include increases in both cardiacoutput
and arterial perfusion pressure.
– The usual dose of dopamine ranges from 2 to 20 µg/kg
per minute.

34. Agents Used in CPR
• Atropine:
– Blocks parasympathetic action
–  SA node automaticity & AV conduction
– Given 1mg per IV every 3 to 5 minutes
• Sodium Bicarbonate:
– corrects metabolic acidosis (1 mEq/kg IV)
• Magnesium:
– promotes adequate functioning of the Na-K pump

35. Defibrillation
• process in which an electronic device gives an
electric shock to the heart.
• Used during emergency situations as treatment of
choice for ventricular fibrillation & pulseless
ventricular Tachycardia
• Depolarizes a critical mass of myocardial cells at
once
• This helps reestablish normal contraction rhythms
in a heart having dangerous arrhythmia or in
cardiac arrest.

36. Defibrillator

38. Nursing Interventions
• Use multifunction conduction pads with a
conducting agent between the paddles &
the skin
• Place the paddles or pads so that they do
not touch the patient’s clothing or bed linen
& are not near medication patches or direct
oxygen flow.

39. Nursing Interventions
• When cardioverting, make sure that the
leads are attached to the patient and that the
defibrillator is in sync mode.
• If defibrillating, make sure that the
defibrillator is not in sync mode.
• Do not charge the device until ready to
shock.

40. Nursing Interventions
• Keep thumbs and fingers off discharge
buttons until paddles or pads on the chest
are ready to deliver the electric charge.
• Call “clear” three times before pressing the
discharge button.
• Record the delivered energy & results;
inspect for burns.

41. The Standard 12 Lead ECG
• Prepare the equipment
and materials
• Explain the procedure to
the patient
• Clean with alcohol or
usual skin prep, if
necessary.
• If the patients are very
hairy – shave the
electrode areas.

43. 12 Leads
• Bipolar limb leads (frontal plane):
– Lead I: RA (-) to LA (+) (Right Left, or lateral)
– Lead II: RA (-) to LF (+) (Superior Inferior)
– Lead III: LA (-) to LF (+) (Superior Inferior)
• Augmented unipolar limb leads (frontal plane):
– Lead aVR: RA (+) to [LA & LF] (-) (Rightward)
– Lead aVL: LA (+) to [RA & LF] (-) (Leftward)
– Lead aVF: LF (+) to [RA & LA] (-) (Inferior)

44. 12 Leads
• Unipolar (+) chest leads (horizontal plane):
– V1: right 4th intercostal space
– V2: left 4th intercostal space
– V3: halfway between V2 and V4
– V4: left 5th intercostal space, mid-clavicular line
– V5: horizontal to V4, anterior axillary line
– V6: horizontal to V5, mid-axillary line

45. 12 Leads
• Two Basic Types of ECG Leads:
– Bipolar leads (standard limb leads)
• utilize a single positive and a single negative electrode
between which electrical potentials are measured.
– Unipolar leads (augmented leads and chest leads)
• have a single positive recording electrode and utilize a
combination of the other electrodes to serve as a composite
negative electrode.

46. Standard Limb Leads (Bipolar)
 Lead I
 positive electrode on the left
arm, and the negative on the
right
 measures the potential difference
between the two arms.
 Lead II
 positive electrode is on the left
leg and the negative is on the
right arm.
 Lead III
 positive electrode on the left leg
and the negative electrode on the
left arm.

47. Standard Limb Leads (Bipolar)
• lead I is said to be at zero degrees relative to the
heart (along the horizontal axis)
• lead II will be +60º relative to the heart
• lead III will be +120º relative to the heart

48. Augmented Limb Leads (Unipolar)
• Three augmented unipolar
limb leads
• Single positive electrode that
is referenced against a
combination of the other limb
electrodes.
• The positive electrodes:
– left arm (aVL) -30º
– right arm (aVR) -150º
– left leg (aVF) +90º

49. Chest Leads (Unipolar)
• Six positive electrodes
on the surface of the
chest over different
regions of the heart in
order to record electrical
activity horizontally
• Leads Ventricular
Region
– V1-V2 anteroseptal
– V3-V4 anteroapical
– V5-V6 anterolateral

50. Normal ECG Tracing

51. ECG Waves

52. ECG Interpretation
• P wave represents an electrical impulse starting
from the SA node & spreading through the atria
(atrial depolarization).
• QRS complex represents ventricular muscle
depolarization.
• T wave represents ventricular repolarization
(resting state).
• U wave represents repolarization of Purkinje fibers

53. ECG Interpretation
• PR interval (0.12-0.20 seconds) is the time
needed for SA node stimulation, atrial
depolarization, & conduction through the AV
node before ventricular depolarization
• ST segment represents early ventricular
repolarization; may be a sign of cardiac
ischemia if above or below the isoelectric line.
• QT interval (0.32-0.40 seconds) represents the
total time for ventricular depolarization and
repolarization

54. Atrial Fibrillation
• There are no P waves, only irregular or wavy
baseline.
• The QRSs are irregularly spaced.

55. Atrial Flutter
• Heart rate of 250-350 bpm and ventricles do not
beat as fast as the atria

56. Ventricular Fibrillation
• Uncoordinated contraction of the ventricles with a rate of
>350 bpm and wave forms are erratic and wavy

57. Ventricular Tachycardia
 Heart rate of 150-250 bpm and wide bizarre QRS