basic life support

1. Adapted from
2010
Department of Education, Training, and Research
PHILIPPINE HEART CENTER
BASIC LIFE SUPPORT
Adapted from
2010

2. PHC-DETR

3. PHC-DETR
INTRODUCTION
• Basic life support (BLS) is the foundation for saving lives
following cardiac arrest
• Fundamental aspects of BLS
• immediate recognition of sudden cardiac arrest (SCA) and
activation of the emergency response system
• early cardiopulmonary resuscitation (CPR)
• and rapid defibrillation with an automated external
defibrillator (AED).

4. PHC-DETR
CHAIN OF SURVIVAL
Immediate
recognitio
n of
cardiac
arrest and
activation
of EMS
Early
CPR
Rapid
Defibrillation
Effective
Advanced
Life
Support
Integrated
Post
Cardiac
Arrest
Care

5. PHC-DETR
ADULT BLS SEQUENCE
• Immediate recognition and
Activation of the Emergency
Response Sytem (EMS)
• Establish scene safety first
• Check for a response by
tapping the victim on the
shoulder and shouting at the
victim
• Simultaneously look for no
breathing or gasping
• Activate EMS

6. PHC-DETR
CHECK FOR RESPONSIVENESS
• ADULT and CHILD BLS
• Tap the shoulders to
check for
responsiveness
• INFANT BLS
• Tap the sole of the feet
to check for
responsiveness

7. PHC-DETR
ADULT BLS SEQUENCE
• Pulse Check
• Check pulse no more
than 10 seconds
• If there is no pulse start
CPR

8. PHC-DETR
PULSE CHECK
• Check for no longer than 10
seconds (7 seconds better)
• Adult BLS
• Check for Carotid Pulse
• Pedia BLS
• Child BLS
• Check for Carotid pulse
• Infant BLS
• Check for Brachial Pulse

9. PHC-DETR
ADULT BLS SEQUENCE
• Early CPR
• Chest Compressions
• Push Hard Push Fast
• Rate: at least 100/min
• should take 15-18 sec
• Depth: at least 2 inches or 5cm for
Adults
• Depth: at least 1/3 of the AP
diameter of the chest
• Infants: 1 ½ inches(4cm)
• Chilldren: 2 inches(5cm)
• Allow complete chest recoil
• Minimize interruptions

10. PHC-DETR
CHEST COMPRESSIONS
• Kneel facing the victim’s chest
• Place the heel of one hand on the
sternum in the center of the chest
between the nipples and then place the
heel of the second hand on top of the
first so that the hands are overlapped
and parallel.

11. PHC-DETR
CHEST COMPRESSIONS
• Position shoulders over
hands with elbows locked
and arms straight
• Compress down and
release pressure smoothly,
keeping hand contact with
chest at all times

12. PHC-DETR
ADULT BLS SEQUENCE
• Early CPR
• Rescue Breaths
• Deliver rescue breath
over 1 second
• Allow visible chest rise
• Compression:Ventilation
ratio of 30:2
• 5 cycles or 2 minutes

13. PHC-DETR
CHANGES OF BLS 2010 FROM BLS 2005
• “Look, Listen, and Feel” removed from the BLS algorithm
• Sequence change to chest compressions before rescue breaths
• CAB
• C : Circulation
• A : Airway
• B : Breathing
• rather than ABC

14. PHC-DETR
AIRWAY
• Open Airway
• Head Tilt Chin Lift Maneuver
• Jaw Thrust

15. PHC-DETR
BREATHING
• Maintain airway
• Pinch nose shut
• Open your mouth wide, take a
normal breath, and make a tight
seal around outside of victim’s
mouth
• Give 2 full breaths (1 sec/ breath)
• Observe chest rise

16. PHC-DETR
CPR
• Continue CPR until
• AED arrives and is ready for use
• EMS providers take over the care of the victim
• Cycles of 30 compressions:2 ventilations should be continued
until an advanced airway is placed
• Continuous compresions
• Ventilation rate of 1 breath every 6 to 8 seconds

17. PHC-DETR
ADULT BLS SEQUENCE
• Early Defibrillation with an AED
• Universal Steps of AED use
• POWER ON
• ATTACH electrodes
• ANALYZE rhythm
• SHOCK if advised

18. PHC-DETR
VENTRICULAR FIBRILLATION (VF)
• VF is a common and treatable initial rhythm in adults with
witnessed cardiac
• Survival rates are highest when immediate bystander CPR
is provided and defibrillation occurs within 3 to 5 minutes
of collapse
• Rapid defibrillation is the treatment of choice
• Rhythm causing ‘all’ sudden cardiac arrest
• Useless quivering of the heart  no blood flow
• Myocardium is depleted of oxygen & metabolic substrates

19. PHC-DETR

20. PHC-DETR
DEFIBRILLATION
• Shock success
• Termination of VF for at least 5 seconds following the shock
• VF frequently recurs after successful shocks & these recurrence
should not be equated to shock failure

21. PHC-DETR
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
• Machine that administers an
electric shock to the heart in an
attempt to convert an abnormal,
life threatening heart rhythm,
known as ventricular
fibrillation, into a normal
heartbeat.

22. PHC-DETR
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
• designed to be easy to use and portable
• senses the heart rhythm of the victim through
two pads placed on the chest and analyses the
rhythm
• advises the most appropriate course of action

23. PHC-DETR
• Placed in areas of public access
• railway stations
• Airports
• Shopping centers
• Stored in:
• Secure display units
• Accessible to all trained rescuers
• Clearly marked
• Should always be stored ready to use with a fully charged battery
• Razors to shave the casualty’s chest should be stored with the defibrillator,
along with gloves in various sizes
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

24. PHC-DETR
• Different waveforms: success at different shock
energies:
• MONOPHASIC DEFIBRILLATORS
• 360 J
• BIPHASIC DEFIBRILLATORS
• 120-200 J
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

25. PHC-DETR
DEFIBRILLATORS
• MONOPHASIC
• Deliver current of one polarity
(direction of current flow)
1. MONOPHASIC DAMPED
SINUSOIDAL SYSTEM (MDS)
• Returns to ZERO gradually
• More common
2. MONOPHASIC TRUNCATED
EXPONENTIAL WAVEFORM (MTE)
• Abruptly returns to ZERO current
flow
• BIPHASIC
• Bipolar delivery of current
1. BIPHASIC TRUNCATED
EXPONENTIAL WAVEFORM
• 150-200J
2. RECTILINEAR BIPHASIC
WAVEFORM
• 120 J

26. PHC-DETR
IF YOU ARE NOT SURE ABOUT THE WAVEFORM OF YOUR
BIPHASIC DEFIBRILLATOR
200 JOULES

27. PHC-DETR
PRIMARY ABCD SURVEY
• Focus: Basic CPR and Defibrillation
1. Check for responsiveness
2. Activate Emergency Response System
3. Call for defibrillator
C = Circulation: Give chest compressions 30:2
A = Airway: Open airway
B = Breathing: Check breathing
Provide 2 positive pressure ventilations
D = Defibrillation: Assess for and Shock VF & Pulseless VT

28. PHC-DETR
AED DEFIBRILLATION
• Add AED Video here

29. PHC-DETR
AED SAFETY
• With every analysis and shock
NO ONE TOUCHES THE PATIENT!
• Verbal warning to bystanders:
• I am shocking on three
• 1- I’m clear!
• 2 -You’re clear!
• 3 - Everybody clear!
• Physical and hand gestures
• Only then press to SHOCK!

30. PHC-DETR
BLS HEALTHCARE PROVIDER ALGORITHM

31. PHC-DETR
BLS HEALTHCARE PROVIDER ALGORITHM

32. Maneuvers Adults Children
RECOGNITION UNRESPONSIVE
No breathing,
not breathing normally (eg. only gasping)
No breathing or only gasping
CPR Sequence CAB CAB
Compression Rate At least 100/min
Compression Depth At least 2 inches (5 cm) At least 1/3 AP depth; About 2
inches
Chest wall Recoil Allow complete recoil between compressions
HCPs rotate compressors every 2 minutes
Compression
interruptions
Minimize interruptions in chest compressions
Attempt to limit interruptions to less than 10 seconds
Airway Head tilt chin lift (HCP suspected trauma: jaw thrust)
Compression-Ventilation
ratio
30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)
Ventilations: when rescuer
untrained or trained and not
proficient
Compressions only Compressions only
Ventilations with
advanced airway (HCP)
1 breath every 6-8 seconds (8-10 breaths/min)
Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
DEFIBRILLATION ( AED ) Attach and use AED as soon as available. Minimize interruptions in chest
compressions before and after shock, resume CPR beginning with compressions
immediately after each shock
Summary of Key BLS Components for Adults and Children

33. PHC-DETR
• recognition of FBAO is the key to successful outcome
• clutch the neck, “Are you choking?”
• If the victim indicates “yes” by nodding  severe obstruction
• activate the EMS system quickly if the patient is having difficulty
breathing
• Adults and Children: Abdominal thrusts/Heimlich maneuver
• Pregnant or Obese: chest thrusts
• Infants: 5 back blows or “slaps” and 5 chest thrusts
SPECIAL RESUSCITATION SITUATIONS
FOREIGN-BODY AIRWAY OBSTRUCTION (CHOKING)

34. PHC-DETR
SPECIAL RESUSCITATION SITUATIONS
FOREIGN-BODY AIRWAY OBSTRUCTION (CHOKING)
• When the victim becomes unresponsive
• Activate EMS if someone is with you
• Lower the victim to the floor
• If the victim is unresponsive with no breathing or no normal
breathing (agonal gasp), begin CPR (no pulse check)
• Before delivering breaths, look into the mouth to look for and
remove foreign body
• Continue CPR for 5 cycles or 2 minutes

35. PHC-DETR
FOREIGN BODY AIRWAY OBSTRUCTION
• Add FBAO infant and adult video here

36. PHC-DETR
RECOVERY POSITION
• is used for unresponsive adult
victims who clearly have normal
breathing and effective circulation
• victim is placed on his or her side
with the lower arm in front of the
body
• extending the lower arm above the
head and rolling the head onto the
arm, while bending both legs (
known or suspected spinal injury)
Insert Recovery position video here

37. PHC-DETR
THANK YOU