This document provides information on basic life support (BLS). It defines BLS as procedures to restore circulation and oxygenated blood flow after cardiac or respiratory arrest. BLS involves chest compressions, rescue breathing, and defibrillation if needed, and can be performed by anyone without equipment. The key steps of BLS are to check for responsiveness, call for help, check pulse, and if no pulse, begin chest compressions at a rate of at least 100 per minute and depths of at least 2 inches, alternating with rescue breaths. An automated external defibrillator (AED) should be used as soon as available to attempt defibrillation if indicated. BLS is similar for children but uses a compression to ventilation

1. BLS
Presented by:
HARPREET KAUR
M.Sc.(N) 2nd year
Critical Care Nursing

2. BLS
(Basic Life Support)

3. DEFINITION
• Sequences of procedures performed to restore the
circulation of oxygenated blood after a sudden
pulmonary and or cardiac arrest.
• Chest compresssions and pulmonary ventilation
performed by anyone who knows how to do it,
anywhere, immediately, without any other
equipment.
• It is also called as CPR, (cardio pulmonary
resuscitation).

4. • It is the non-invasive assessment and
intervention used to quickly identify and
treat victims of respiratory, cardiovascular
emergencies.
• It is a Combination of rescue breathing and
chest compressions

5. INDICATIONS
• CARDIAC ARREST : sudden, unexpected loss of
heart function, breathing and consciousness.
In cardiac arrest, the heart abruptly stops
beating without prompt intervention, it can
result in person’s death.

6. • HEART ATTACK: A blockage of the blood flow
to the heart muscle.
• A Heart attack is a medical emergency. A heart
attack usually occurs when a blood clot blocks
blood flow to the heart. without blood, tissue
loses oxygen and dies.

7. • RESPIRATORY ARREST: It is a state in which a
patient stops breathing but maintains a pulse.
• Respiratory arrest can exist when breathing is
ineffective, such as agonal gasping.

8. • Survival from sudden cardiac arrest is
optimized when the event is witnessed
and CPR is initiated immediately
• Patient survival declines dramatically if
basic CPR is not initiated within first
four minutes

9. The Systematic Approach:
The BLS Primary Survey
Goal of BLS :
• To support and restore effective
 oxygenation
Circulation
 with return of intact neurologic function
• ROSC (return of spontaneous circulation)

10. CPR: Timing is Everything
<2%
2-8%
20%
30-50%
0 2 4 6 8 10 min
Current Indian Scene
Early BLS
Early Defib
Bystander

11. ADULT
BLS

12. Chain of survival

13. Important
• Although BLS is taught as a sequence of
distinct steps to enhance skills retention and
clarify priorities, several actions should be
accomplished simultaneously (begin CPR and
activate emergency response system) when
multiple rescuers are present.
• All adult arrest are cardiac in origin therefore
1st step i.e. call for help is important because if
AED is not available it can come on time.

14. BLS consists of……….
Three main parts:
• Chest compressions (C)
• Airway (A)
• Breathing (B)
• Defibrillation (D)
Previously
sequence
was ‘ABCD’
&
Now it is
‘CABD’

15. Why change???
• In ABCD, chest compressions were often
delayed while the rescuer opened the airway
to give mouth to mouth breaths, retrieved a
barrier device or gathered ventilation
equipment.
• With CABD, rescuer can start chest
compressions sooner and likely to improve
survival.

16. Contd…
• Every minute chances of success decreases to
10-15% but if we start CPR by the time AED is
coming even in shockable rhythm, chances of
success decreased to 3-4 from 10-15%.

17. Steps of BLS
There are basically 4 steps in BLS:
• Assessment and scene safety
• Activate Emergency response system and Get
an AED
• Check pulse
• Begin cycles of 30 chest compressions and 2
breaths if you do not definitely feel a pulse
within 10sec and perform 5 cycles (30:2) with
CAB sequence.

18. 1. Scene safety What should you do
when you encounter
a victim who is
probably collapsed?

19. Ask yourself…..
• Is it safe for me to approach the victim?
I may suffocate /get burnt/get hypothermic/get
electric shock
• Is it safe for the victim to be attended
to where he has collapsed?
I need to take victim out of water / switch off the
main switch to start CPR
• What other precautions should I take for
my own safety?
I should use barriers like handkerchief,
gloves

20. Always make sure
that the scene is safe
for you and the victim

21. Assessment
• Tap the victim’s shoulder and shout,
“Are you all right?”
• Check to see if the victim is breathing.
• If not breathing or not breathing normally
(gasping), activate emergency response
system.

22. ”HELP ! Is there
anyone
around?”
Do not approach the victim from
back or shake the victim hard
since there is potential of
exacerbating a possible cervical
spine injury
Ah! He is not
responding, let
me call for help

23. 2. Activate Emergency response
system
• Ask him to call EMS
(emergency medical services)
• Ask him to tell EMS about the
place and about collapsed
victim?
• While he activates the EMS,
the rescuer should start CPR
If someone approaches to help…. If no help available……
• Call yourself
before starting the
CPR

24. 3. Pulse check
• Palpate carotid pulse.
• Feel for a pulse for atleast
5sec but no more than 10
sec.
• If you do not feel pulse
within 10 seconds, start
chest compressions (in
CAB sequence)

25. 4. Begin CPR
1. Assess Circulation and providing
chest compression
2. Opening Airway
3. Assess Breathing and providing
breath

26. Revision
4 main steps of BLS:
1. Scene safety and Assessment
2. Call EMS
3. Check pulse
4. Start CPR (in CABD sequence)

27. CIRCULATION

28. Circulation
• After palpating pulse for atleast 10sec
start with CPR if no definite pulse is
palpable.
 Mechanism: Increase of intrathoracic
pressure and direct compression of the
heart
 Recommended compression rate: atleast
100 /min(100-120/min)

29. Changed from
approximately
100/min to atleast
100/min -120/min

30. Contd…
 Depth of compression should be atleast
2inches (5cm).
 Compression : ventilation
30 : 2 when one rescuer
30 : 2 when 2 rescuers
Changed from
approximately
2 inches to
atleast 2
inches

31. Effective chest compressions
• Start compressions within
10 seconds of recognition of cardiac
arrest.
• Push hard, push fast: Compress at a rate of
atleast 100/min with depth of atleast 2inches
(5cm).
• Allow complete chest recoil after each
compression.
• Minimize interruptions in compression (try to
limit interruptions to < 10 sec)

32. Process of CPR
• Position yourself at the victim’s side.
• Make sure that victim lies on the firm, hard
surface.
• Put the heel of the hand on the center of the
victim’s chest on the lower half of the
breastbone.
• Put the heel of your other hand on the top of
first hand.

33. Placement of hands during CPR
Inter-mammary line

35. • Straighten your arm with knees locked and
position your shoulder directly over the
hands.
• Push hard and fast
 Press down atleast 2 inches (5cm) with
each compression.
 Deliver compressions in a smooth fashion
at a rate of atleast 100/min.
• At the end of each compression, make sure to
allow complete chest recoil after each
compression.

36.  Adjust position that your shoulders are on
top of the victim and in line with hands

37.  Provide cycles of compressions and
breathing.
 30 compressions with 2 breaths is one
cycle
 30 : 2 in adults (with one or two rescuer)
 30 : 2 in infant and children (with one
rescuer)
 15 : 2 in infant and children (with two
rescuer)
 Complete 5 cycles and then check carotid
pulse

38. AIRWAY

39. Open the airway for breaths
2 methods are there to open the airway:
• Head tilt- chin lift
• Jaw thrust
*Jaw thrust is used with 2 rescuers as two persons
are needed to provide breaths.
*Head lilt-chin lift should be used until head or neck
injury is suspected as it reduces neck and spine
movement.

40. Head tilt- chin lift

41. Jaw thrust

42. Caution
• Do not press into the soft tissue under the
chin because this might block the airway.
• Do not use thumb to lift the chin.
• Do not close the victim’s mouth
completely.

43. BREATHING

44. Provide breaths
 Mouth to mouth breaths
 Mouth to mask breaths
 Bag to mask breaths

45. Mouth to mouth breaths

46. • Hold the victim’s airway open with a head tilt –
chin lift.
• Pinch the nose closed with your thumb and index
finger (using the hand on forehead)
• Take a regular (not deep) breath and seal your
lips around the victim’s mouth, creating an
airtight seal.
• Give 1 breath (blow for 1sec). Watch for the chest
rise.
• Give a second breath.
• If you are unable to ventilate the victim after 2
attempts, promptly return to chest compressions.

47. Face mask
• Standard precautions include using face
mask or a bag mask ventilation when giving
breaths.
• Mask usually have a 1-way valve that diverts
exhaled air, blood or bodily fluids away from
the rescuer.

50. Mouth to mask breaths

51. • Position yourself at the victim’s side.
• Place the mask on the victim’s face, using the
bridge of the nose as a guide for correct
position.
• Seal the mask against the face:
 Using the hand that is closer to the top of
the victim’s head, place your index finger
and thumb along the edge of the mask.
 Place the thumb of your second hand
along the bottom edge of the mask.

52. Contd….
• Place the remaining fingers of your second
hand along the bony margin of the jaw and lift
the jaw
• While you lift the jaw, press firmly and
completely around the outside edge of the
mask to seal the mask against the face.
• Deliver air over 1 second to make the
victim’s chest rise.

54. Bag to mask breaths

55. • Position yourself directly above the victim’s
head.
• Place the mask on the victim’s face, using the
bridge of the nose as a guide for correct
position.
• Use the E-C clamp technique to hold the mask
in place while you lift the jaw to hold the
airway open
• Squeeze the mask to give breaths (1second
each) while watching the chest rise.

56. E – C technique
1 rescuer

57. 2 rescuer
The E-C clamp technique of bag –mask
ventilations. Three fingers of one hand lift
the jaw ( they form the “E”) while the
thumb and index finger hold the mask to
the face (making a “C”)

58. 2 rescuer CPR

59. When a second rescuer is available to
help, that second rescuer should
activate the emergency response
system and can get the AED.
The first will remain with the
victim to start CPR immediately
2
1

60. Contd…
• The rescuers will then give compressions and
breaths but should switch roles after every 5
cycles of CPR (about every 2min)

61. Rescuer 1: At victim’s side
Perform chest
compressions
Switch duties
with the
second rescuer
every 5 cycles
or about
2minutes,
taking less
than 5 sec to
switch

62. Rescuer 2: At victim’s head
Maintain an open
airway
Give breaths
watching for chest
rise and avoiding
excessive
ventilation.
Correct the rescuer
1 to perform
adequate CPR.
Switch duties
with the
second rescuer
every 5 cycles
or about
2minutes,
taking less
than 5 sec to
switch

63. DEFIBRILLATION

64. AED (Automated External
Defibrillators)
• Automated external defibrillators (AEDs)
are computerized devices that can identify
cardiac rhythms that need a shock and
these can deliver shock.
• When VT is present, the heart muscle
fibres quiver and do not contract together
to pump blood.

65. Contd…
• This delivers shock to stop the quivering of the
heart fibres and allows the muscle fibres of
the heart to ‘reset’ so that they can begin to
contract at same time.
• Once an organized rhythm occurs, the heart
muscle may begin to contract effectively and
begin to generate a pulse (called ROSC)

66. Parts of AED
• Pads (self sticking)
• On/off switch
• Shock delivery
button
• Pad connector
• Battery

67. • Once the AED arrives, place it at the victim’s
side
• If multiple rescuers are present, one rescuer
should continue CPR while another rescuer
attaches AED pads.

68. Attempted Defibrillation
Current Recommendation
• One shock
– Biphasic 150-200J
– Monophasic 360J
– Immediate CPR
– Rhythm check only
after 5 cycles (2
mins) of CPR

69. Using AED
• Switch it on
• Act according to voice prompt
• Apply pads to bare chest of victim ( one to the side of
the left nipple, with the top edge of the pad a few
inches below the armpit and other below right collar
bone)
• Connect pads to AED (some are preconnected)
• Let AED Analyze heart rhythm: do not touch the
victim (it will take 5 to 15 sec to analyze)

70. Contd…
• If the AED advices a shock; be sure no one is
touching the victim.
• Loudly state a “clear the victim” message, such as
“Everybody clear” or simply “clear”.
• Look to be sure no one is in contact with the
victim.
• Press shock button
• Shock delivered: immediately
resume with 5 cycles CPR begin with chest
compressions
• If “no shock advised”, immediately
restart CPR.

72. AED in special situations
• Age :
– Victim <1yr – AED not advised
– Victim 1-8yrs – use child pads and child AED
• Hairy chest:
– Press pads firmly, if not remove hairs by sticking
pads and removing hair along with them. Use
other set of pads now
– Use razor
• Wet chest:
– Clean victim’s chest dry

73. Contd….
• If patient is in water, do not use AED but if
patient is in snow; dry the chest first and then
AED can be used.
• Implanted device: Do not use AED

74. AED with 2 rescuer
• Check the response and check breathing
The first rescuer stays with the victim and
performs the next steps until the next rescuer
returns with AED.
The second rescuer activates the emergency
response system and gets the AED.
• Check for pulse
The first rescuer removes or moves clothing
covering the victim’s chest and then start CPR.

77. 2 Rescuer CPR Demo.mp4

78. PAEDIATRIC
BLS

79. Chain of survival

81. Prevention of arrest

82. Early high quality bystander CPR
• Rapid activation of the emergency response
system
• Effective advanced life support (including
rapid stabilization and transport to definitive
care and rehabilitation)
• Integrated post-cardiac arrest care

83. BLS in children from 1year of
age to puberty

84. Critical points
• Start compressions within 10sec of
recognition of cardiac arrest.
• Push hard, push fast : Compress at rate of
100/min with depth of approximately 2 inches
(5cm) or compress at least one third the depth
of the chest
• Allow complete chest recoil after each
compression

85. Contd…
• Compression: Ventilation ratio for:
2 rescuer CPR - 15: 2 ratio
1 rescuer- 30:2 ratio
• Compression technique: May use 1 or 2
handed chest compression for very small
children
• Complete 2min with 15:2 ratio, no number of
cycles is seen.
• Minimize interruptions in compressions (<
10sec)

86. Contd…
• Give effective breaths that make chest rise.
• Avoid excessive ventilation.

87. 1 rescuer BLS sequence
• Check the child for a response and check
breathing.
• Shout for help if there is no breathing or not
normal breathing (gasping)
• If someone responds, send that person to
activate emergency response system and get
the AED.

88. Contd…
[If the child collapsed suddenly and you are alone,
leave the child to activate emergency response
system and get the AED]
• Check the child’s pulse (take atleast 5 but not more
than 10sec). You can locate carotid or femoral pulse
in children
• If no pulse is felt, start with chest compressions at
rate of 30: 2 ratio.
• After 5 cycles, if someone has not already done so,
activate the emergency response system and get the
AED. Use AED as soon as available

89. Locating femoral pulse
• Place 2 fingers in the inner thigh, midway
between the hipbone and the pubic bone and
just below the crease where the leg meets the
abdomen.
• Feel the pulse for atleast 5 sec but not more
than 10sec.
• If you do not definitely feel a pulse, begin CPR,
starting with chest compressions (CAB
sequence)

91. 2 rescuer
• Check the child for a response and check
breathing.
• If there is no breathing or no normal
breathing, the second rescuer activates the
emergency response system
• Check the child’s pulse (take atleast 5 but not
more than 10sec). You can locate carotid or
femoral pulse in children

92. Contd…
• Start with chest compressions if no pulse is
palpable with 30: 2 ratio and when the second
rescuer arrives, use 15: 2 compression:
breaths ratio.

93. BLS/ CPR for infants

94. Critical points
• Location of pulse: Brachial artery in infants
• Technique of giving compressions: 2 fingers
for single rescuer and 2 thumb – encircling
hands technique for 2 rescuer.
• Compression depth: at least one third of the
chest depth or approximately 1.5 inches (4cm)
• Compression: Ventilation ratio-
30: 2 for 1 rescuer
15: 2 for 2 rescuer

95. Locating brachial pulse
• Place 2 or 3 fingers on the inside of the
upper arm, between the infant’s elbow and
shoulder.
• Press the index and middle fingers gently on
the inside of the upper arm for atleast 5 but
no more than 10 seconds when attempting
to feel pulse.

97. 1 rescuer
• Check the infant for a response and check
breathing.
• If there is no response and no breathing or not
normal breathing, despite of adequate
oxygenation and ventilation, heart rate (pulse)
is < 60/min with signs of poor perfusion,
perform cycles of compressions and breaths
(30:2 ratio). shout for help.
• Check the infant’s brachial pulse (take at least
5 but no more than 10 seconds)

98. Contd…
• If someone responds, send that person to
activate the emergency response system and
get the AED.
• If there is no pulse, start chest compressions
with 30: 2 ratio.
• After 5 cycles, if someone has already done so,
activate emergency response system and get
the AED.

99. 2-finger chest compression
• Place the infant on a firm, flat surface.
• Place 2 fingers in the center of the infant’s
chest just below the nipple line. Do not press
on the bottom of the breast bone.
• Push hard and fast. To give chest
compressions, press the infant’s breastbone
down atleast one third the depth of the chest
(app. 1.5 inches). Deliver compressions in a
smooth fashion at a rate of at least 100/min.

100. 2 fingers for Single rescuer

101. Contd…
• Make sure to allow complete chest recoil.
• Minimize interruptions in chest
compressions.

102. 2 rescuer
• Check the infant for a response and check
breathing.
• If there is no response and no breathing or not
normal breathing, send the second rescuer to
activate the emergency response system and
get the AED.
• Check the infant’s brachial pulse

103. Contd…
• If there is no pulse, despite of adequate
oxygenation and ventilation, heart rate (pulse)
is < 60/min with signs of poor perfusion,
perform cycles of compressions and breaths
(30:2 ratio).
• When the second rescuer arrives and can
perform CPR, use a compression- ventilation
ratio of 15: 2.

104. 2 Thumb encircling hands chest
compression technique
• Perform when 2 rescuer are present.
• The technique produces blood flow by
compressing the chest with both the thumbs.
• It produces more better flow, more
consistently results in appropriate depth or
force of compression, and may generate
higher blood pressures than the 2 finger
technique.

105. 2 thumb – encircling hands technique
for 2 rescuer

107. Pediatric BLS Algorithm.

108. Airway

109. Open the airway for breaths
2 methods are there to open the airway:
• Head tilt- chin lift
• Jaw thrust
*Jaw thrust is used with 2 rescuers as two persons
are needed to provide breaths.
*Head lilt-chin lift should be used until head or neck
injury is suspected as it reduces neck and spine
movement.

110. BREATHING

111. Provide breaths
 Mouth to mouth breaths
 Mouth to mask breaths
 Bag to mask breaths

112. Defibrillation

114. • Child CPR 2 rescuer.mp4

115. Comparison of 2005 and 2010
guidelines by AHA
2005 guidelines
• ABCD sequence
• Look listen feel
• Compression depth:
approximately 2 inches
(5cm)
• Pulse check for atleast
10sec
• C: V ratio is 30: 2 with 1
rescuer and 15: 2 with 2
rescuer in adults and paed.
2010 guidelines
• CABD sequence
• No Look listen feel
• Compression depth: atleast
2 inches (5cm)
• Pulse check for 5sec but not
more than 10sec
• C: V ratio is 30: 2 in adults,
paed (if 1 rescuer)

116. Summarization
• Best CPR generate 30% of the cardiac output
which is critical for cerebral and coronary
blood perfusion, therefore compressions
should come first.
• After surgeries even immediately after CABG,
we can give CPR.
• Almost all arrests in paed are respiratory
arrest so breaths are more important.

117. ANY QUERY????

118. THANK
‘U’