BLS

(Basic Life Support)

Definition

Sequences of procedures performed to restore the circulation of oxygenated blood after a

Chest compressions and pulmonary ventilation performed by anyone who knows how to do
it, anywhere, immediately, without any other equipment.

CPR (Cardio pulmonary resuscitation) is the part of BLS. It is the non-invasive assessment
and intervention used to quickly identify and treat victims of respiratory, cardiovascular
emergencies.

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 persons’s death.

Heart attack to the heart muscle.

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,
tissues loses oxygen and dies.

Respiratory arrest

It is the state in which a patient stops breathing but maintains a pulse. Respiratory

Cardiac arrest : CPR

 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

The Systematic Approach:

Goal of BLS :

To support and restore effective

 oxygenation
  Circulation

 with return of intact neurologic function

ROSC (return of spontaneous circulation)

CPR: Timing is Everything

ADULT
BLS

Chain of survival

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.

BLS consists of……….

Three main parts:

Chest compressions (C)

Airway (A)

Breathing (B)

Defibrillation (D)

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.

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%.

Steps of BLS

There are basically 4 steps in BLS:

Assessment and scene safety

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.

1. Scene safety

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

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.

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

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)

4. Begin CPR

1. Assess Circulation and providing chest compression

2. Opening Airway

3. Assess Breathing and providing

breath

Revision

4 main steps of BLS:

1. Scene safety and Assessment

2. Call EMS

3. Check pulse

4. Start CPR ( in CABD sequence)

CIRCULATION

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

Contd…

 Depth of compression should be atleast 2inches (5cm).

 Compression : ventilation

30 : 2 when lone rescuer

30 : 2 when 2 rescuers

15 : 2 when 2 rescuers (infants and children)

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)

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.

Placement of hands during CPR

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.

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

 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

AIRWAY

Open the airway for breaths

2 methods are there to open the airway:

• 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.

Head tilt- chin lift

Jaw thrust

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.

BREATHING

Provide breaths

 Mouth to mouth breaths

 Mouth to mask breaths

 Bag to mask breaths

Mouth to mouth breaths

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.

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.
Mouth to mask breaths

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.

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.

WORKSHOP 2010\Breaths with Mask.mpg

Bag to mask breaths

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.

E – C technique

2 rescuer

2 rescuer CPR

Contd…

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

Rescuer 1: At victim’s side

DEFIBRILLATION

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.

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)

Parts of AED

• Pads (self sticking)

• On/off switch

• Shock delivery button

• Pad connector

• Battery

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.

Attempted Defibrillation

Current Recommendation

One shock

Biphasic 150-200J

Monophasic 360J

Immediate CPR

Rhythm check only after 5 cycles (2 mins) of CPR

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)

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.

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

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

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.