basic life support

By
Dr sonal gabhiye (rahud)
md paediatrics

Purpose
 Initiating chain of survival
 Performing promt, high quality chest compression for
adult, child, infant victim
 Initiating early use of an AED
 Pacticing 2-rescuer team CPR
 Relieving choking

2010 AHA guidelines for CPR
 Change from A-B-C to C-A-B
 Emphasis of high quality CPR
 No look listen feel
 Routine use of cricoid pressure is not recommended
 Continued de-emphasis of pulse check
 Use of AED in infants

HIGH QUALITY CPR
 Start compressions within 10 seconds of recognition of cardiac
arrest
 Push hard, push fast ATLEAST 100/min with depth
 2 inches (5 cm) for adults,
 2 inches (5cm) for children,
 1 ½ inches (4 cm) for infants.
 Allow complete chest recoil after each compression
 Minimize interruptions in comprssions (< 10 sec)
 Avoid excessive ventilation.

What to do…
Scene saftey
Shout for help
Activate ERS and Get AED
Check pulse
30 compression
Check response & breathing
2 breaths

Approach safely
Safe scene
Rescuer
Victim
Scene saftey
Shout for help
Check pulse
30 compression
2 breaths

CHECK RESPONSE
Scene saftey
Shout for help
Check pulse
30 compression
2 breaths

CHECK RESPONSE
Tap the shoulders and
shout
“Are you all right ?”

CHECK BREATHING
 Look breathing
 non breathing
 Normal breathing
 Abnormal breathing- gasping
 DO NOT CONFUSE AGONAL
BREATHING WITH NORMAL
BREATHING

AGONAL BREATHING
 Present in first minutes after sudden cardiac arrest
 Mouth may be open & the jaw, head or neck may move with
gasps.
 May sound like a snort, snore or groan
 Recognise as a sign of cardiac arrest

Scene saftey
Shout for help
Check pulse
30 compression
Check response
2 breaths

 If another rescuer responds,
send him/ her to activate ERS
and get AED
 If no one responds, activate the
ERS and get AED
 Return to victim

 Locate trachea using 2 or 3 fingers
 Slides finges into groove between
trachea and muscle at the side of
neck
 Feel carotid pulses
 Atleast 5 seconds but not more than
10 seconds
 Do not feel pulse- start CPR (C-A-B)

 Place the heel of one hand on the
center of the chest on lower half
of sternum
 Put other hand on top
 Interlock fingers
 Straighten arms and position
your shoulders directly over
hands

Chest compression
Atleast 2 inches (5cm) down
Rate 100/ min
Compression: relaxation
Minimize interruptions
Count loudly
5 cycles (30:2)

Precautions
 Surface should be firm
 Rescuers with arthritis- put one hand on sternum to
push, grasp the wrist with other hand
 Do not move victim while CPR unless in dangerous
environment

Head tilt chin lift Jaw thurst

 Place on hand on victim’s forehead and
push with your palm to tilt the head back
 Place the fingers of the other hand under
the bony part of the lower jaw near the
chin.
 Lift the jaw to bring the chin forward

Head tilt chin lift
Precautions
 Donot press deep to soft tissue
as it may obstruct the airways
 Do not use thumb to lift the chin
 Do not close the victims mouth
completely

Mouth to mouth breaths
 Open airway
 Pinch nose Take regular breath,
 blow for 1 second , watch chest rise
 If no chest rise, repeat method
 If unable to ventilate after 2
attempts, return to chest
compression
 Precaution: gastic inflation

Mouth to mask breaths
 Position yourselfs
 Place mask
 Seal mask- hand closer to head- index finger
and thumb along the edge
 Thumb of 2nd hand along the bottom edge,
remaining fingers- bony, margin of jaw
 Head tilt chin lift to open airway
 Deliver air over 1 second to make the
victim’s chest rise

2 – resceuer Adult CPR
sequence

Jaw thurst
 Head, neck injury, you suspect spine
injury
 2 rescue
 Place on hand on each side of victims
head
 Resting elbows on the surface on which
victim is lying
 place fingers under angle of Lower jaw,
lift with both hands, displace jaw
forward
 Use thumbs to open lips

Bag mask device
 Require 2 rescuers
 Postion at head end of victim
 Place mask over face
 Use E-C clamp technique to hold mask
 Perform head lilt
 Place mask
 Thumb and index finger of 1 hand to make “C” on one side
 Remaining fingers (form an “E”) to lift angle of jaw, open airway, press
face to mask
 Squeeze bag to give beaths, watch chest rise

 2 resuers using the bag – mask- 3 or > 3 rescuers

BLS/CPR for CHILDREN from 1
year to puberty

Difference in CPR from adults
 Compression ventilation ration is 15:2 for 2 rescuer
 Compression depth – atleast 1/3rd chest/ 2 inches (5
cm)
 Compression technique- 1 or 2 handed chest
compression depending on size

Activation of ERS-
 If you didn’t witness arrest & alone- provide 2 min CPR
& then activate ERS & get AED
 If arrest is sudden & witnessed- leave child to activate
ERS and get AED, return to child

1-resuer BLS sequence for
child

1 rescue BLS for child
If witnessed arrest
Check pulse
30 compression
Shout for help
2 breaths
If not witnessed arrest
Check pulse
30 compression
Shout for help
2 breaths

Check pulse
Femoral artery
 Place 2 fingers in the inner
thigh, midway between the
hip bone & the pubic & just
below the crease (where
thigh meets abdomen)
If witnessed arrest
Check pulse
30 compression
Shout for help
2 breaths

Chest compression
 Start cycle of chest
compression and breths
(30:2)if……
 Within 10 seconds don’t feel
pulse OR
 Despite adequate oxygenation
and ventilation HR< 60/min
 With signs of poor perfusion
If witnessed arrest
Check pulse
30 compression
Shout for help
2 breaths

Chest compression
If witnessed arrest
Check pulse
30 compression
Shout for help
2 breaths

 After 5 cycles if some one has not already done so,
avctivate ERS and get AED

Check pulse
30 compression
2nd rescuer Activate ERS and Get AED
2 breaths
2nd rescuer comes
15 compression
2 breaths
Breaths are
important for
infants and
childen in cardiac
arrest !

Key differences for infant BLS
 Pulse check- brachial artery
 Technique of compression- 2 fingers for single rescuer, 2
thumb encircling hands technique for 2 rescuers
 Compression depth- 1 ½ inches (4cm)
 Rate & ratio of 2 rescuers- 15:2
 activation of ERS same as child

What to do…
Scene saftey
Shout for help
Check pulse
30 (15) compression/ 1 (2) rescue
2 breaths

Scene saftey
Shout for help
Check pulse
30 (15) compression/ 1 (2) rescuer
2 breaths

Chest compression
Scene saftey
Shout for help
Check pulse
30 (15) compression/ 1 (2) rescuer
2 breaths

 Compression depth a 1½ inches (4 cm)
 Rate 100/min; 30 : 2 for 1 rescue, 15:2 for 2 rescue
 2-finger chest compression technique- 2 fingers in
center of infant’s chest just below nipple line

Rescue breaths
Scene saftey
Shout for help
Check pulse
2 breaths
Neck- nutral position, External
Ear canal is level with top of
infant’s shoulder

Mouth to mouth and nose breath
 Prefered method
 Head tilt chin lift
 Place your mouth over infant’s mouth and nose and
make airtight seal
 Blow to make chest rise, give 2 breaths
 Repeat procedure if no chest rise

Mouth to mouth
 If can’t cover the nose and mouth with your mouth
 Head tilt chin lift
 Pinch victim’s nose
 Make mouth to mouth seal, give 2 breaths

2- rescuer infant CPR
 Place both thumb side by side in
center of the chest on the lower half
of sternum (thumbs may overlap in
small infants)
 Encircle the chest and support the
infant’s back with the fingers of both
hands
 Ratio 15:2, switching roles every 2
minutes

Shout for help
2 nd rescuer Activate ERS and Get AED
Check brachial pulse
2 breaths
Use AED as soon as available

WHEN CAN I STOP CPR ?
 VICTIM REVIVES
 TRAINED HELP ARRIVES
 TO EXHAUSTED TO CONTINUE

CPR with Advanced airway
Ventilaion technique Compression to
breaths (adult)
Compression to
breaths (infant+child)
NO advanced airway
(mouth to mouth, mouth
to mask, bag mask)
30:2
100/min
15:2
100/min
Advanced airway
(endotracheal
intubation, laryngeal
masl airway)
Compression Rate 100/min without pause for
breaths
1 breaths every 6 to 8 seconds (8 to 10 breaths per
minute)

Rescue breathing for adults
Rescue breathing for infants
and children
Give 1 breath every 5 to 6 sec
(10-12 /min)
Give 1 breath every 3 to 5 sec
(12-20/min)
 Give each breath in 1 sec
 Each breath should result in visible chest rise
 Check pulse very 2 minutes

Automated external defibrillator
for adult and children 8 years of
Age and older

Attach AED pads to the victim’s chest
“CLEAR” the victim
Analyze the rhythm
AED advises shock clear the victim
Power ON the AED
Press SHOCK button
Resume CPR

 Open top of AED
 Turn power on
Analyze the rhythm
Power ON the AED
Press SHOCK button
Resume CPR

 Attach pads to bare chest
 Choose adult pads for victim
age > 8 yrs
 Attach adhesive pads
 1 on upper right chest
(below clavicle)
 2nd on side of left nipple, top
edge of pad few inches below
axila
 Attach connection cables to
AED box
Analyze the rhythm
Power ON the AED
Press SHOCK button
Resume CPR

 If AED says “ clear the
victim” be sure no one
is touching victim
 AED will analyze the
heart rhythm and
take 5 to 15 seconds
 AED will tells you if
shock needed
Analyze the rhythm
Power ON the AED
Press SHOCK button
Resume CPR

 Loudly state “ CLEAR
the victim”
 Be sure that no one
is in contact with
victim
 Press SHOCK button
Analyze the rhythm
Power ON the AED
Press SHOCK button
Resume CPR

 If No shock needed
resume CPR
 Start 5 cycles / 2 min
CPR
 AED will prompt you
to repeat last two
step. If “no shock
advised” restart CPR
Analyze the rhythm
Power ON the AED
Press SHOCK button
Resume CPR

Precautions
 AED prompt- “check pads” or “check electrodes”
 Quickly pull off the pads, it remove a large amount of hairs & allow
pads to stick
 Victim has a hairy chest-shave the area with razor
 Victim is immersed in water- donot use AED in water, pull
out of victim out of water, quickly wipe the chest
 Transdermal patch- remove patch and wipe area before
attaching AED pads

AED for infants & for children from 1 to 8 years of
age
 Use smaller size
 If not available use standard size, making sure they do not touch/
overlap
 Manual defibrillator is preferred to an AED
 If manual D-fib not available AED with pediatric dose attenuator
 If neither available- use an AED without a pediatric dose
 Use adult dose is better than No attempt at Defibrillation

Choking in adult & child above 1 yr
SIGNS MILD OBSTRUCTION SEVERE obstruction
“Are you choking” “YES” Unable to speak,
May NOD
Other signs  Can speak,
 cough,
 breath,
 wheeze between
coughs
 Can’t breath,
 respiratory distress,
 attempt to cough but
NO sound,
 Can’t speak,
 Cyanosis
 Make choking signs
 unconsciousness

Relieving choking in responsive
adult / child >1 yr
 Heimlich maneuver (abdominal
thursts with victim standing)

Large person or pregnant
woman
 Chest thurst

Relieving choking in unresponsive
Shout for help
Begin CPR (Donot check pulse)
Open mouth wide & look for object
2 breaths

Choking in Infants
SIGNS MILD OBSTRUCTION SEVERE obstruction
 Can make sound,
 cough,
 breath,
 wheeze between
coughs
 Can’t breath,
 respiratory distress,
 attempt to cough but
NO sound,
 Can’t make sound,
 Cyanosis
 unconsciousness

Relieve choking in responsive infant
 Kneel/ sit with infant in your lap
 Deliver 5 back slaps and chest thursts

Relieve choking in unresponsive infant
Shout for help
Begin CPR (Donot check pulse)
Open mouth wide & look for object
2 breaths

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