BASIC LIFE SUPPORT (BLS)

A presentation used to train medical professionals to perform BLS in emergency condition. it will provide a better understanding about the steps of BLS and the order in which it should be perfomed.

1. By- Dr. ASHWINI KUMAR ( MS Surgery) NMCH, PATNA

2. Objectives Define BLS Explain steps & components of BLS Explain Chain of survival

3. What is BLS ? Basic life support refers to sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest by chest compressions and pulmonary ventilation performed by anyone who knows how to do it, anywhere, immediately, without any other equipment.

4. COMPONENTS Ensure safety Check for response Activate EMS(102/ 108 /112) Chest compressions Check airway and ventilate Defibrillate

5. STEPS OF BLS

6. 1. ENSURE SAFETY Safety of SELF Safety of PATIENT Movement of TRAUMA victim only when absolutely necessary. [unstable cervical spine, injured spinal cord]

7. 2. ASSESS RESPONSE Ask the person “ Are you ok ?” Tap and shout Look the chest for movement and breathing. If the victim responds- leave the client and call for help . Return as quick as possible and reassess the condition of the person. Are you ok ?

8. If the victim is unresponsive- HELP ,HELP, HELP !!!

9. 3. Activate ems Call 108 / 102 Describe the emergency to the operator: -includes where you are (address and location) -condition of patient

10. CHANGE FROM A-B-C TO C-A-B The ABC regime is used now exclusively for victims of TRAUMA. The vast majority of cardiac arrests occur in adults. In these patients, the critical initial elements of BLS are chest compressions and early defibrillation. In the A-B-C sequence, chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths , retrieves a barrier device, or gathers and assembles ventilation equipment.

11. C. CIRCULATION Position of victim : Must be supine on a firm flat surface for CPR to be effective Victim lying facing down – logroll the victim (Attempt to roll the victim as a single unit by grasping the opposite shoulder and opposite hip, rolling the victim towards you.)

12. Check the patient for a carotid pulse for 5-10 seconds . (Do not check for more than 10 seconds.) If the patient has a pulse: Move to the airway and rescue Breathing portion of the algorithm. Provide 10 rescue breaths per minute (1 breath every 6 seconds). Recheck pulse every 2 minutes. 2. If the patient doesn’t have a pulse : Begin 5 cycles of CPR (lasts approx. 2 minutes).

13. 4. CHEST COMPRESSIONS POSTION OF THE RESCUER Kneel beside victim’s chest or stand beside bed Heel of one hand on inter-mammary line( lower half of the sternum) in midline. Heel of other hand on top of the first so that the hands are overlapped and parallel Lock elbows 1,2,3,4,5,6,…….29,30

14. Good compressions “ Push hard push fast ”. Push at a rate of 100-120/min. Compression depth- at least 2 inches(5cm) (not more than2.5 inches) Release completely to allow the chest to fully recoil. A compression-ventilation ratio of 30:2 . Do not bounce your hands up and down on the victim’s chest. Never use the palm of your hand, use the heel of your hand. If two rescuers are present: switch rolls between compressor and rescue breather every 5 cycles.

15. A. AIRWAY OPEN AIRWAY In the event of an unwitnessed collapse, drowning or trauma: Use the “ Jaw Thrust maneuver ” . (This maneuver is used when a cervical spine injury cannot be ruled out.) Place your fingers on the lower rami of the jaw behind the angles. Provide anterior pressure to advance the jaw forward using your thumb.

16. In the event of a witnessed collapse with no reason to assume a C-spine injury: Use the “ Head Tilt-Chin Lift maneuver ” : place your palm on the patient’s forehead and apply pressure to tilt the head backward. place the fingers of your other hand under the mental protuberance of the chin and pull the chin forward and cephalic.

17. B. BREATHING Scan the patients chest and torso for possible movement during the “ assess unresponsiveness ” portion of the algorithm. Watch for abnormal breathing or gasping. Breathing check should take no longer than10 seconds. If no breath is detected, CPR should not be delayed.

18. Maintain airway and place your ear over casualty’s mouth and nose, looking toward their abdomen.

19. If the patient is breathing adequately: Continue to assess and maintain a patent airway and place the patient in the “ recovery position ”. (Only use the recovery position if its unlikely to worsen patient injury.) If the patient is not breathing or is breathing INADEQUATELY : If the patient has a pulse Commence rescue breaths immediately. Provide 10 rescue breaths per minute (1 breath every 6 seconds). Recheck pulse every 2 minutes. If the patient has NO pulse Begin CPR. (move to the “Circulation” portion of the algorithm) along with rescue breaths.

20. An  advanced airway  (supraglottic  airway , laryngeal mask  airway , or endotracheal tube) provides a more stable way of providing breaths and should, therefore, be inserted as early as possible in a resuscitation effort. During normal CPR without an advanced airway : approximately 6-8 rescue breaths per minute During normal CPR with an advanced airway : 10 rescue breaths per minute (don’t pause chest compressions for breaths).

21. RESCUE BREATHS Use a barrier device if available. Pinch the patient’s nose closed. Make a seal using your mouth over the mouth of the patient or use a pocket mask or bag mask. Each rescue breath should last approximately 1 second. Watch for chest rise. Allow time for the air to expel from the patient.

22. HOW TO APPLY A SEAL USING A MASK

23. FOREIGN BODY OBSTRUCTION (choking) Universal signal for choking : patient has both hands wrapped around the base of their throat. With complete airway obstruction , the victim is unable to speak, cry, or provide any sounds of respiration. The patient may be confused, weak, obtunded , or cyanotic. Partial airway obstruction may result in stridor or a high-pitched audible noise during respiration. Partial airway obstruction may allow for a productive cough or allow the patient to speak. Get the patient’s attention and ask them if they are choking. Assess for signs and symptoms of airway obstruction.

24. If partial airway obstruction : Do not attempt Heimlich maneuver . If complete airway obstruction : (one provider) immediately call the emergency response team. (one provider) Attempt Heimlich maneuver (two provider) Send someone to call the emergency response team, while you attempt the Heimlich maneuver . If patient becomes unconscious : Initiate CPR.

25. Heimlich maneuver

26. Infant Under 1 Year Old If you are alone

27. D. DEFIBRILLATE AED – Automatic external Defibrillator A battery operated device which on applying to victim detects and assesses cardiac rhythm and prompts the user for further action. Components: On/Off switch Plug with flashing light near it Shock delivery button(orange) Speaker & volume control for voice prompt. Two self sticking pads with cables & connectors

28. POWER : Turn AED On NOW! (early defibrillation is the single most important therapy for survival of cardiac arrest and should be done as soon as it arrives).Follow verbal AED prompts. ATTACHMENT : Firmly place appropriate pads (adult/ pediatric ) to patient’s skin to the indicated locations (pad image). ANALYSE: A short pause in CPR is required to allow the AED to analyze the rhythm.

29. If the rhythm is not shockable : Initiate 5 cycles of CPR 30:2 .Recheck the rhythm at the end of the 5 cycles of CPR. If the shock is indicated : Assure no one is touching the patient or is in mutual contact of a good conductor of electricity by yelling “Clear, I’m Clear, you’re Clear!” prior to delivering a shock . Press the shock button when the providers are clear of the patient. Resume 5 cycles of CPR. Clear, I’m Clear, you’re Clear!

30. RECOVERY POSITION ( Lateral recumbent or 3/4 prone position) If the victim responds, position him in the recovery position and monitor breathing until help arrives. This position is used to maintain a patent airway in the unconscious person. Place the patient close to a true lateral position with the head dependent to allow fluid to drain. Avoid pressure of the chest that could impairs breathing. Position patient in such a way that it allows turning them onto their back easily.

31. 1 2 3 4

32. CONTINUE RESUSCITATION UNTIL – Qualified help arrives and takes over – The victim starts breathing normally – Rescuer becomes exhausted

33. THANK YOU