basic lifes support

1. BASIC LIFE SUPPORT (BSL)
Dr. Alok Kumar Verma
PhD Shalya Tantra
NEIAH, Shillong

2. OBJECTIVES
At the end of this presentation you all may be able to know:
• How to assess the collapsed victim.
• How to perform chest compression and rescue breathing.
• How to place an unconscious breathing victim in the
recovery position.
• How to operate an automated external defibrillator safely.

3. BACKGROUND
• Approximately 700,000 cardiac arrests per year in Europe.
• About 10% of the deaths in India is due to sudden cardiac arrest which is also the
most common factor of death in the world
• Survival to hospital discharge presently approximately 5-10
• Bystander CPR is vital intervention before arrival of emergency services
• Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in to
survival

4. CARDIO PULMONARY RESUSCITATION (CPR)
• Combines rescue breathing and chest compressions
• Revives heart (cardio) and lung (pulmonary)
functioning
• Use when there is no breathing and no pulse
• Provides O2 to the brain until ACLS arrives

5. IMPORTANCE OF CPR
• Start CPR Immediately Better chance of
survival
• Brain damage may begin in 4-6 minutes
• Brain damage is certain after 10 minutes
without CPR

6. PRECAUTIONS
• Do Not Move the Victim Until CPR is Given and Qualified Help Arrives
unless the scene dictates otherwise, threat of fire or explosion
• Victim must be on a hard surface
• Place victim level or head slightly lower than body

7. CHAIN OF SURVIVAL
• The sequence of actions that will
maximize survival after cardio-
respiratory emergencies.
• If any of the links is missing or
weak (action delayed or not
performed correctly), the victims
outcome is likely to be poor.
• The Chain of Survival applies to
all victims of cardiac and
respiratory emergencies and
stroke.

8. SURVEY THE SCENE THEN……RAP
• R -Responsiveness
• R - Responsiveness
• Tap shoulder and shout Are you ok?
• Check pulse
• A- A activate EMS
• Activate EMS ( if unresponsive)
• Order someone YOU - call 108/555 come back and let me know what they said (another can stay
by the phone) in case of indore patient.
• You may have to make the call
• P - Position on back
• All body parts rolled over at the same time
• Always be aware of head and spinal cord injuries
• Support neck and spinal column

9. APPROACH TO UNCONSIOUS
• D
• R
• S & P
• A
• B
• C
• D

10. DANGER
Look around and identify if there any danger like
• Fire
• Electricity
• Water road
• Etc.
• We must remove patients from danger zone.

11. CHECK RESPONSE
• Shake shoulders gently
• Ask Are you all right?
• If victim responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly

12. SHOUT FOR HELP
• If victim is non-responsve
• Call someone for help.
• Call from name.
• Ask to activate code blue in side hospital
• Call 108/555.

13. CHECK PULSE
• Check for pulse
• Feel carotid pulse in adults
• In child and infants find pulse in axilla
or thigh
• Do not wait for pulse more than 10
seconds
• If not found start CPR

14. OPEN AIRWAY
• To open air way lift the chin and tilt the
head.
• Make sure victim not having cervical
spine injury before manipulating .
• Secure with cervical color.
• Look for any foreign body inside mouth.

15. CHECK BREATHING
• Look, listen and feel for NORMAL
breathing
• Do not confuse agonal breathing with
NORMAL breathing

16. AGONAL BREATHING
• Occurs shortly after the heart stops
• Present in up to 40 out of 100 cardiac arrests
• Described as barely, heavy, noisy or gasping
breathing
• Recognize as a sign of cardiac arrest.

17. CHEST COMPRESSIONS
• Place the heel of one hand in the center of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
• Rate 100-120 per min-1
• Depth 4-5 cm
• Equal compression relaxation
• When possible change CPR operator every 2 min

18. How to do compression……?
• Place the victim against hard surface
• Sit on right side
• Lock your hands
• Place over middle of chest
• Extend your elbow
• During compression applied pressure from hip

19. COMPRESSION
• Count the compression loudly
• Compression should be deep enough
approx. 5 cm
• Push hard push fast
• Give the time to recoil the chest
• Minimal interval

20. RESCUE BREATHS
• Make sure airways is clear.
• Pinch the nose
• Take a normal breath
• Place lips over mouth
• Blow until the chest rises
• Take about 1 second
• In hospital Ambu bag can be used for
breathing
• Allow chest to fall
• Repeat 2 times

21. Compression and Breathing
• Give 30 compression follows by two breath up to 5 cycle
• Change over if you have partner
• Count loudly so that partner will be ready for change
over
• Ask the Partner to check for pulse simultaneously
• In adult ratio should be 30:2
• In infants ratio should be 15:2

22. Characteristics of CPR
• Push fast push hard
• Minimum interruption
• Minimum 100-120 compression per minute
• Allow chest to recoil

23. When Can I Stop CPR?
• Victim revives
• Trained help arrives
• Too exhausted to continue
• Unsafe scene
• Physician directed (do not resuscitate orders)
• Cardiac arrest of longer than 30 minutes (controversial)

24. Checking for CPR Effectiveness
• Does chest rise and fall with rescue breaths?
• Have a second rescuer check pulse while you give
compressions.
• What if pulse is present but breathing is absent.
• Stop compression but continue breathing at every
5 seconds.
• Second rescuer will explain the situation to ACLS
team.

25. Why CPR May Fail ??
• Delay in starting
• Improper procedures (ex. Forget to pinch nose)
• No ACLS follow-up and delay in defibrillation, Only 15 who receive CPR
live to go home
• Improper techniques
• Terminal disease or unmanageable disease
(massive heart attack)

26. Injuries Related to CPR
• Rib fractures
• Pericardial tamponade due to aorta and cardiac
rupture,
• Internal bleeding due to liver and spleen lacerations
• Gastrointestinal bleedings

27. Complications of CPR
• Vomiting
• Aspiration (Place victim on left side)
• Wipe vomit from mouth with fingers wrapped in a
cloth
• Reposition and resume CPR

28. Stomach Distension
• Air in the stomach
• Creates pressure against the lungs
• Prevention of Stomach Distension
• Don’t blow too hard
• Slow rescue breathing
• Re-tilt the head to make sure the airway is open
• Use mouth to nose method

29. If You Are Afraid to Perform CPR
• Call EMS
• Activate code blue
• Open the airway
• Give chest compressions

30. CPR for Infants (Under 1 Year of Age)
• Same procedures (RAPAB) except
• Seal nose and mouth or nose only
• Give shallow puffs

31. CPR Infants
• RAPAB
• Give CPR
• Press sternum 1/2 to 1/3 depth of the chest
• Use middle and ring finger
• May use both hands if have a partner
• 15 compressions to 2 breath
• If alone, resuscitate for 2 minutes then call 108

32. CHOKING
• The tongue is the most common obstruction in the
unconscious victim (head tilt- chin lift)
• Vomit
• Foreign body
• Balloons
• Foods
• Swelling (allergic reactions/ irritants)
• Spasm (water is inhaled suddenly)

33. How To Recognize Choking ??
• Can you hear breathing or coughing sounds?
• High pitched breathing sounds?
• Is the cough strong or weak?
• Can’t speak, breathe or cough
• Universal distress signal (clutches neck)
• Turning blue

34. RECOGNIZING CHOKING
• A partial airway obstruction with poor air exchange should be
treated as if it were a complete airway blockage.
• If victim is coughing strongly, do not intervene

35. CONSCIOUS CHOKING
• In case of Adult Foreign Body Airway Obstruction Give 5
abdominal thrusts (Heimlich maneuver)
• Place fist just above the umbilicus (normal size)
• Give 5 upward and inward thrusts
• Pregnant or obese? 5 chest thrusts
• Fists on sternum
• If unsuccessful, support chest with one hand and give back
blows with the other
• Continue until successful or victim becomes unconscious

36. If Victim Becomes Unconscious After Giving
Thrusts
• Call 108
• Try to support victim with your knees while
lowering victim to the floor
• Assess the situation
• Begin CPR
• After chest compressions, check for object before
giving breaths

37. Choking Conscious Infants
• Position with head downward
• 5 back blows (check for
expelled object)
• 5 chest thrusts (check for
expelled object)
• Repeat

38. Choking Unconscious Infants
• If infant becomes unconscious
• RAPAB
• When the first breaths don’t go in, check for object in throat
then try 2 more breaths.
• If neither set of breaths goes in, suspect choking
• Begin 30 compressions
• Check for object in throat (no blind finger sweep)
• Give 2 breaths

39. You Enter An Empty Room And Find An Unconscious
Victim On The Floor… What do you do?
• Assess the victim (RAPABC)
• Give CPR if needed
• After giving compressions
• look for object in throat
• Then give breaths

40. AUTOMATED EXTERNAL DEFIBRILLATOR
• An automated external defibrillator (AED)
is a medical device designed to analyze
the heart rhythm and deliver an electric
shock to victims of ventricular
fibrillation to restore the heart rhythm
to normal.
• Ventricular fibrillation is the
uncoordinated heart rhythm most often
responsible for sudden cardiac arrest.

41. Steps to use
• Step 1: POWER ON the AED. The first step in operating an
AED is to turn the power on. ...
• Step 2: Attach electrode pads. ...
• Step 3: Analyze the rhythm. ...
• Step 4: Clear the victim and press the SHOCK button.

42. Manual defibrillator
• Used in hospital
• Before giving shock ,, must to shout
clear.
• Nobody should touch the patient
while giving shock
• Start the sinus node though strong
electric shock

44. Introduction to Shalya tantra department
•We are dealing with many surgical as well as non-
surgical conditions in department.
•There are two faculty members
•Dr. Alok Kumar (MS Ay, Ph.D.) Head of
department (I/C)
•Dr Junita K Swer (MS Ay)

45. Department infrastructure
•Department is equipped with skill lab, Kshara
Karma Lab and departmental library.
•In the hospital we are providing OPD and IPD
facility.
•We have Minor OT and major OT where we
perform surgeries.

46. Services provided by department
• We provide treatment to various surgical and non-
surgical conditions like , trauma, musculoskeletal
condition, abscess, cyst, lipoma, tumour, condition
related to kidney, anorectal problems like piles, fissure
, fistula and the different conditions of skin etc.
• Marma Therpay, Agnikarma , leech therapy and Sira-
vedhana etc.

47. Different surgical procedures performed in
department

48. Infected wound

49. Pilonidal sinus

50. Excision of Lipoma

51. Fistula in ano

52. Heamorrhoidectomy

53. Implantation dermoid

54. Heamangioma

55. Tumour

56. Piles operation

57. Drainage of perianal abscess

58. Dermoid cyst excision

59. Our Operation Theater

60. Minor OT

61. OPD

62. Thank You