Basic Life Support (BLS) refers to emergency care including CPR, use of an AED, and clearing obstructed airways. BLS aims to maintain circulation and breathing until emergency help arrives. It involves assessing for responsiveness, calling for help, providing chest compressions at 100-120 per minute and rescue breaths in a 30:2 ratio. An AED should be used as soon as available to analyze rhythms and deliver shocks if indicated. CPR techniques differ between adults and children, such as using two fingers to compress the chest of an infant or child. Foreign object airway obstructions are managed through back blows, chest thrusts and abdominal thrusts depending on responsiveness and age of the victim.

1. Basic Life Support (BLS)
By: Gebremeskel T(MSC, EMCCN)
1
12/3/2023

2. • Definition
• Steps in BLS
• High Quality CPR
• Mechanical CPR
• Automatic External Defibrilators
• Comparison of BLS in Adult and Children
• Choking
2
Outline

3. BLS Definition
• refers to the care healthcare providers and public safety professionals
provide to patients who are experiencing respiratory arrest, cardiac arrest or
airway obstruction.
• Includes psychomotor skills for performing
• high-quality cardiopulmonary resuscitation (CPR),
• using an automated external defibrillator (AED) and
• relieving an obstructed airway for patients of all ages.
3

4. Sudden CardiacArrest
• refer to the sudden cessation of cardiac mechanical activity with
hemodynamic collapse,
• most frequently due to sustained ventricular tachycardia/ventricular fibrillation.
• The most common etiology is Ischemic Cardiovascular Disease.
• Incidence: USA: 180,000 to >450,000 and Europe: ≈ 700,000 per year
• Survival to discharge in in-hospital setting is ≈ 17%
• Properly performed CPR improves outcomes.
4

5. save life with emergency response!
5
Early
Access
Early
CPR
Early
Defibrillation
Early
Advanced
Cardiac Care
The Chain of Survival
5
© 2002 Abertay Nationwide Training
12/3/2023

6. Steps in BLS

7. Scene Safety
• Before you can help an ill or injured patient, make sure that the scene is safe
for you and any bystanders
• Check for anything unsafe,
• Traffic, fire, escaping steam, downed electrical lines, smoke
• Are you wearing appropriate personal protection equipment (PPE)?
• Specialized clothing, equipment and supplies, such as gloves, CPR breathing barriers,
gowns, face shields, protective eyewear.
• If you see life-threatening bleeding, use any available resources to control the
hemorrhage.
7

8. 1. Establish Unresponsiveness
Tap the patient on the shoulder and shout, “Are you okay?”
• Responsive patient:
• Obtain the patient’s consent,
• Reassure him or her and try to find out what happened.
• Reassess regularly
• Unresponsive patient: …
8

9. 2. Call the Code/Get help
• Shout For Help
• Activate Emergency response System (Call 911)
• Get AED/defibrillator
9

10. 3. Simultaneous Breathing and Pulse Check
• Should not take more than 10 seconds.
10
• Checking for Pulse.
• Carotid: Slide your two
fingers into the groove of
the patient’s neck.
• Femoral: palpate the area
between the hip and groin
• useful when there are
multiple team members
• Checking for Breathing.
• See if the patient’s chest rises
and falls,
• Listen for escaping air and
feel for it against the side of
your cheek.
• Normal Breathing
Vs.
• Agonal Breathing

11. Normal Breathing + Has Pulse
11
Monitor the patient until Emergency responders arrive
Primary Assessment Results

12. 12
No normal Breathing + Has Pulse = Respiratory Arrest
Provide rescue breathing
Primary Assessment Results
 1 breath every 5 to 6 seconds
 About 10-12 breaths/minute
 Each breath lasts 1 second
 Allow chest to rise & fall
 Check pulse around Every 2 minutes

13. Ventilation
• Supply oxygen to a patient who is not breathing.
• May be given via several methods including:
• Mouth-to-mouth.
• Pocket mask.
• Bag-valve-mask (BVM) resuscitator
13

14. Mouth-to-Mouth Ventilation
• If a pocket mask or Bag-valve-mask are not available
• Open the airway past a neutral position
• use the head-tilt/chin-lift technique.
• Pinch the nose shut
• Make a complete seal over the patient’s mouth with your mouth
• Take a break between breaths
• by breaking the seal slightly between ventilations
• If unable to make a complete seal over a patient’s mouth, you may
need to use mouth-to-nose ventilations
14

15. Pocket Mask Ventilation
• Creates a barrier between your mouth and the patient’s
• Open the airway past a neutral position
• Place the mask over the mouth and nose of the patient
• Starting from the bridge of the nose, then place the bottom of the mask
below the mouth to the chin
• Seal the mask by placing the “webbing” between your index finger and
thumb on the top of the mask above the valve
• Place your thumb along the base of the mask while placing your bent index
finger under the patient’s chin, lifting the face into the mask
15

16. Bag-Valve-Mask Ventilation
• Can hold greater than 1000 milliliters of volume
• Two rescuers are needed to effectively operate
• Open the airway past a neutral position
• Use an E-C hand position (first rescuer)
• Provide ventilations (second rescuer):
• Depress the bag about halfway
• to deliver between 400 to 700 milliliters of volume to make the chest rise.
• Don’t deflate BVM completely when providing ventilations
16

17. When to Stop Ventilation
• Once you begin giving ventilations, you must continue until:
• The patient begins to breathe on his or her own.
• Another trained rescuer takes over.
• The patient has no pulse,
• Begin CPR or use an AED if one is available and ready to use.
• The scene becomes unsafe
17

18. 18
No Breathing/ Only Gasping + No Pulse = Cardiac Arrest
Start CPR Immediately
Primary Assessment Results

19. 19
High Quality CPR

20. Cardio-Pulmonary Resuscitation
• Aim is to maintain victim's circulation and
breathing until emergency aid arrives.
• Composed of
• Chest compressions and rescue breath.
• Use of an automated external defibrillator (AED).
20
• Is an emergency first-aid procedure that is used to maintain respiration
and blood circulation in a person, whose breathing and heartbeats have
suddenly stopped.

21. Chest Compression
• Propels blood out of the thorax by increasing intra-thoracic pressure
• Provide only 30% of normal perfusion
• results in critical blood flow and oxygen delivery to the heart and brain.
• Without perfusion & oxygenation, irreversible brain damage occurs after 3-5 mins.
• Start Compression within 10 sec. of recognition of cardiac arrest.
• Patient must be placed on a Firm, Flat Surface,
• Floor or ground,
• Stretcher or bed with a CPR board or CPR feature
21

22. Chest Compression
• Expose the chest to ensure proper hand placement and the ability to visualize chest recoil.
• Hand placement:
• Place the heel of one hand in the center of the chest
• Place other hand on top
• Interlock the fingers
• Arms are as straight as possible, Shoulders directly over the hands to
22

23. PUSH HARD, PUSH FAST
• Rate: at a at least 100 per minute to a maximum of 120 per minute,
• Depth: at least 2 inches (5 cm) for an adult
• Allow complete chest recoil after each compression
• to allow blood to flow back into the heart
• Minimize interruptions in compression(< 10 sec)
• Chest compression fraction of at least 80%
• When possible (2 or more rescuers) change
CPR operator every 2 min. to prevent fatigue
23

24. Ventilation during CPR
• Follows 30 chest compressions
• Give 2 ventilations that last approximately 1 second each & make the chest
rise.
24
30 : 2

25. Chest compression-only (Hands-only) CPR
• No Ventilation provided
• Similar survival rates compared to conventional CPR
• For Adults in OHCA,
• Untrained lay rescuers should provide chest compression–only CPR.
• For Children…
25

26. CPR for a Pregnant woman
• Requires 2 people, one of them helping to move the uterus to the left
• If the fundus height is at or above the level of the umbilicus,
• When calling for EMS ask for Obstetrician
• If nonsurvivable trauma or prolonged pulselessness,
• Post Mortem C/D - at 4 minutes after onset of maternal cardiac arrest or CPR
26

27. Mechanical CPR
• No benefit over manual chest compressions
• May be a reasonable alternatives in specific settings
• The delivery of high-quality manual compressions may be
challenging or dangerous for the provider. E.g.
• Limited rescuers available,
• Prolonged CPR,
• CPR in a moving ambulance,
• CPR in the angiography suite
27
LoadDistributing
Band
Mechanical
Piston

28. Stopping CPR
• Continue CPR with 30 compressions followed by 2 ventilations until:
• You see signs of return of spontaneous circulation (ROSC) such as:
• Patient movement or breathing.
• An AED is ready to analyze the patient’s heart rhythm.
• Other trained rescuers take over and relieve you from responsibilities
• You are presented with a valid do not resuscitate (DNR) order.
• You are alone and too exhausted to continue.
• The scene becomes unsafe
28

29. Complications during CPR
• Gastric distension –often in children
• Avoid overinflating the lungs
• Appropriate volume making the chest rise
• Rib fractures
• Correct hand´s position
• Do not remove hands from the chest wall
• Prevent “dancing on the chest“
• Gastric content (or other fluids) aspiration
• Prevent gastric distension
• Recovery position in unconscious victims
29

30. Automated External Defibrillators (AED)
• Are portable electronic devices that are able to:
• Interpret heart (ECG) rhythm
• Determine whether defibrillation is required
• Deliver electric shock
• that may help the heart re-establish a perfusing rhythm
• Guides the operator through every action
• In cases of cardiac arrest, should be applied as soon as readily available
30

31. Steps in usingAEDs
31
Switch on AED Attach pads to casualty’s bare chest

32. Steps in usingAEDs
32
Analyze rhythm -Do not touch victim Shock indicated – stand clear

33. UsingAEDs
• If CPR is in progress, continue CPR until
• AED is turned on, pads are applied and the AED is ready to analyze the heart rhythm.
• Resume compressions immediately
• After a shock is delivered or the AED advises that a shock is not indicated
• Perform about 2 minutes of CPR (about 5 cycles of 30:2) until
• The AED prompts that it is reanalyzing,
• The patient shows signs of return of spontaneous circulation (ROSC)
33

34. AED Safety
• AEDs are very safe and built for almost any environment.
• Safe to be used on patients with pacemakers, ICDs or metal body piercings.
Precautions:
• In wet environment, make sure that the patient is as dry as possible
• Avoid getting the AED or AED pads wet
• Make sure that the pads are not touching the metal surface.
• Excessive chest hair, quickly shave the area before applying the AED
34

35. AED Safety (Do’s and Don’ts)
Do’s Don’ts
35
• Do use an AED if a patient is experiencing
cardiac arrest as a result of traumatic
injuries.
• Before shocking a patient with an AED, Do
make sure that no one is touching or is in
contact with the patient or any resuscitation
equipment.
• Do use an AED for a patient who is
pregnant.
• Do not use alcohol to wipe the patient’s
chest dry. Alcohol is flammable.
• Do not touch the patient while the AED is
analyzing.
• Do not touch the patient while the device
is defibrillating.
• Do not defibrillate someone when around
flammable or combustible materials, such
as gasoline or free-flowing oxygen.

36. 36
Differences b/nAdult and Pediatric BLS

37. 37
Differences b/nAdult and Pediatric BLS

38. Hand placement in Pediatric BLS
38
1 rescuer:
2 fingers compression
≥ 2 rescuer:
2 thumbs compression
1 hand compression

39. 39
Adult

40. Choking
• Obstruction of the air way by foreign body (food , object….)
• The tongue is the most common obstruction in the unconscious victim
Signs of choking
 Poor or no air exchange
 Week, ineffective cough or no cough at all
 High pitch noise while inhaling or no noise at all
 Increased respiratory difficulty, Possible cyanosis
 Unable to speak
 Clutching the neck with the thumb and fingers,
 making the universal choking sign
40

41. Choking on a Responsive Victim
• Adult or Child
• Ask “Are you choking?”
• Performing Abdominal thrusts
• Pregnant and obese victims
• Instead of abdominal thrusts Perform chest thrusts
41

42. Choking on a Responsive Victim
• Infant:
• Confirm severe airway obstruction.
• Perform cycles of 5 back slaps and 5 chest thrusts
42

43. Choking on a Un-responsive Victim
43
• Immediately begin CPR when a choking victim becomes unresponsive
• Adult, Child, or Infant
• When you open the airway to give breaths,
• look for & remove the object (if seen) before giving breaths.
• NEVER perform a blind finger sweep

44. References
• 2015, AHA, Guidelines Update for CPR and ECC
• 2017, AHA, Focused Update on Adult BLS and CPR
• Rosen’s Emergency Medicine Concepts and Clinical Practice, 9th Ed.
• Tintinalli’s Emergency Medicine, 8th Ed.
• Uptodae.com/Basic life Support
44

45. THANK YOU!!!