Basic Life Support (BLS)

Basic life support, Cardiopulmonary resuscitation ,cardiac failure ,chest compressions ,rescue breaths ,defibrillator ,aed ,nurses role ,lone rescuer ,two rescuers ,infant cpr ,heimlich maneuver ,head tilt chin lift ,jaw thrust, airway management, acls

1. BASIC LIFE
SUPPORT
PRESENTED BY:
DR. AKASHBHATT
PGRESIDENT
OMFS

2. CONTENTS
•Cardiac arrest
•BLS Introduction
•ABC to CAB
•Chest compressions
•Rescue breaths
•Defibrillation
•ACLS

3. CARDIAC ARREST
➢Cessationofnormalcirculationofblooddueto
failure of heart to contracteffectively.
➢Suddencessationofmechanicalactivityof
heartwithsome or noelectricalactivity.
➢Maybe reversible by a rapidinterventionbut
will lead to death in itsabsence.

4. ❖M.I.
❖Arrhythmia
❖LowC.O.,failure,shock
❖Cardiomyopathy
❖Myocarditis
❖Massivepulmonary
emboli
CARDIAC OTHERS
❖Coronaryarterydisease❖Severeanaphylaxis
❖Suffocation
❖Electrocution
❖Trauma
❖Stroke
❖Exsanguination
(severe loss of
blood)
❖Drowning
CAUSES OF CARDIACARREST

5. REVERSIBLECAUSESOFCARDIAC ARREST
•5Ts:
❑Pulmonary
thromboembolism
❑Tension
pneumothorax
❑CardiacTamponade
❑Toxins (TCAs,ß-blockers,
Cachannel blocker,Digoxin)
❑Coronarythrombosis
5Hs:
❑Hypoxia
❑Hypovolemia
❑Hypo/hyperkalemia
❑Hydrogenions
❑Hypothermia

6. INTRODUCTION
⚫Approx. 700,000 cardiac arrests per year in
Europe.
⚫Survival to hospital discharge presently
approx.5-10%.
⚫Bystander CPR vital intervention before arrival
of emergency services –double or triple
survival chances from sudden cardiac arrest.
⚫Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60%
survival.

7. BLS
⚫Lack of resuscitation skills of nurses and doctorshas been
identified as a contributing factor to poor outcomes of cardiac
arrestvictims.
⚫It combines rescue breathing andchest
compressions.
⚫It requires knowledge and skill to perform CPR and how to
operate AED /defibrillator.

8. ➢These are sequences of procedure performedto
restorecirculation of oxygenated blood aftera
sudden pulmonary and/or cardiacarrest.
➢Chest compressions and pulmonary ventilation
performed by anyone who knows how to do it,
anywhere, immediately, without any other
equipment.

9. CHAIN OFSURVIVAL

10. ABCTO CAB
➢Vast majority of cardiac arrests occur in adults, and
highest survival rates from cardiac arrest are reported
among all ages .
➢In these patients, the critical initial elements of BLS are
chest compressions and earlydefibrillation.
➢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. ABC TOCAB

12. BASIC LIFE SUPPORT
⚫Steps to follow inBLS
–ApproachSafely
–1. Check the responsiveness of thevictim
–2.Call forHelp
–3.Position victim on his or herback
–4.Open theairway
–5.Assessbreathing
–6.Assesscirculation
–7.Stay with the victim until helparrives.

13. STEPSOFBLS
▪Assessment and scenesafety
1.Scene issafe??
2.Asses thepatient
3.Checkbreathing

14. ASSESS THEPATIENT
❑Shake shouldersgently
❑Ask “Are you allright?”
❑If heresponds.
❑Find out what iswrong.
❑Reassessregularly.

15. CHECK FOR PULSE: NO
MORE THAN10 SEC
Feel the pulse
Feel the pulse at least for 5seconds
Slide the fingerlaterally
Into the groove between trachea andmuscle
Locate thetrachea
Using 2 or3fingers

16. SHOUTFOR HELP

17. ➢Look Listen Feel
➢Do not confuse agonal breathing with normal
breathing.
CHECK FOR
BREATHING

18. OPENAIRWAY
Head tilt and chinlift
-layrescuers.
-non-healthcarerescuers.
No need for finger sweep
unless solid material can
be in theairway.
Head tilt, Chin lift + Jaw
thrust.

19. STARTCPR
➢Push hard andpush fast
➢100-120/min
➢2-2.5 inchdepth
➢Allow completechestrecoil.
➢Avoidexcessive ventilation
➢Minimizeinterruption
➢<10seconds
➢Effectiverescue breaths.
➢Ratio:30:2
➢High qualityCPR
➢Chest compression is
foundation ofCPR.

20. START CPRIMMEDIATELY
➢Better chance ofsurvival
➢Brain damage starts in 4-6 minutes.
➢Brain damage is certain after 10 minutes without
CPR.

21. Return to thevictim
CPR followedby
defibrillation
LoneRescuer
ACTIVATEEMS
Defibrillation
ActivateEMS
TwoRescuers
Begins CPR

22. DO NOT MOVE THE VICTIM UNTIL CPRIS
Given and Qualified HelpArrives…
⚫unless the scene dictates otherwise
–threat of fire orexplosion
–victim must be on a hardsurface
–Place victim level or headslightly lower thanbody
EVEN WITH SUCCESSFUL CPR,MOST
Won’t Survive WithoutACLS
⚫ACLS(Advanced Cardiac Life Support)
⚫ACLSincludesdefibrillation, oxygen,
drug therapy

23. PRONE CPR
❑Standard CPR is performed in supineposition.
❑Prone/reverse CPR performed on a person lying on
their chest, by turning the head to the side and
compressing the back. Due to the head's being
turned, the risk of vomiting and complications
caused by aspiration pneumonia may bereduced.
❑Location of compression –T7 at level of inferior
border of scapula.
❑The AHA's current guideline limits prone CPR to
situations where the patient cannot beturned and
not recommends for layperson.

24. ❑Pregnancy
❑When a woman is lying on her back, the uterus may
compress the inferior vena cava and thus decrease
venous return. It is recommended that uterus be
pushed to the woman's left; if this is not effective,
either roll the woman 30°or healthcare professionals
should consider emergency resuscitative
hysterotomy.
❑Cervical spinestabilization
❑Use cervical collar ifavailable
❑Any hard objects that restrict neckmovement
❑Firm surface(backboard orfloor)

25. CHESTCOMPRESSIONS
➢Position yourself at patient’sside.
➢Victim should be laid on firm, flatsurface.
➢Removetheclothingsofthepatient.
➢Put the heel of one hand on the centre of chest
(sternum)atthelevelofnipplesandputyourother
handonthetopoftheformerhand.

26. ➢Strengthenarmsandshoulders ditrectly over
hands.
➢Lockalljoints;movementisallowedonlyathip joint.
➢Pushhardandfast(100-120times/min)
➢Atendofeachcompression,chestisallowed
to recoilcompletely.
➢Avoid excessiveventilation.
➢Then give nextcompression immediately.
➢When possible change CPR operator every 2 min.

27. CHEST
COMPRESSIONS

28. HOW CPR WORKS
➢Effective CPR provides 1/4 to 1/3 normal
blood flow.
➢Rescue breaths contain 16% oxygen
(exhaled).

29. MECHANISMS
Cardiac Pump –
➢Blood pumping is assured by compression of heart
betweensternum and spine.
➢Between compressions, thoracic cage expands andheart
gets filled with blood.

30. THORACICPUMP

31. HEAD TILT–CHIN LIFTMANEUVER
➢Tilting head backwards in, lifts tongue away from
unconscious patients, often by applying pressure
to the forehead and the chin.
➢Head tilt stretches anterior neck muscles posterior
pharyngeal wall and epiglottis away from laryngeal
inlet.
➢Chin lift stretches structures more and pulls
mandible and tongue forward.
➢The maneuver is used in any patient in whom
cervical spine injury is not a concern
➢If neck injury is a concern the jaw-thrust maneuver
can be used instead.

32. OPENING THEAIRWAY
Caution-
➢Do not press
deeply into the
softtissue
➢Don’t use
thumb to lift the
chin
➢Don’t close
mouth
completely.

33. JAWTHRUST
➢An alternative to head tilt chin lift.
➢Used when cervical injury suspected.
➢Placing index and middle fingers to
physically push posterior aspects of
thelower jaw upwards and forwards
while their thumbs push down on the
chin to open the mouth.
➢When mandible is displaced forward, it
pulls tongue forward and prevents it
from obstructing the entrance to
trachea.

34. AIRWAY OBSTRUCTION
The rescuer stands behind the victim and grasps his hands firmly over the
victim’s abdomen just below the rib cage. The position of the rescuer’s
hands and the direction of the thrust are shown.

35. FOR INFANTS

36. RESCUEBREATHS
RECOMMENDATIONS :
-Tidalvolume
500 –600ml
-Respiratoryrate
give each breaths over about 1s withenough
volume to make the victim’s chestrise

37. TYPES
➢Mouth to mouthbreathing
➢Mouth to barrier devicebreathing
➢Mouthtonoseormouth to stomaventilation
➢Ventilationwithbagandmask

38. MOUTH-TO-MOUTH
BREATH

39. MOUTH-TO-NOSE
BREATH
❑Givenwhenmouthcantbeopen
❑Goodsealcantbemade
❑Severeinjury presentoverareaofmouth

40. MOUTH-TO-BARRIERDEVICE

41. BAGANDMASKVENTILATION
❑Positionyourselfdirectlyabovepatient’s
head
❑Perform headtilt.
❑Make“C”withthumbandindexfingerto
sealthemask
❑Andother3fingers,forms“E”jawthurst
❑Chestriseischeckedwhilesqueezingthe
bagtogivebreaths to thepatient.

42. BAGAND MASKVENTILATION

43. CONTINUECPR
30 2

44. 2 RESCUER
➢With 2 rescuers breaths
should take approx. 5
seconds.
➢Allows minimal interruption
to compressions.
Rate
➢30 chest compressions and
2 rescue breath for adults.
➢15 chest compressions and
2 rescue breath for infants
& children.
➢Switching the role after
every 2 minutes or 10
cycles.

46. IF VICTIMSTARTSTO BREATHE NORMALLY
PLACE INRECOVERY POSITION
6 key principles for recovery position (ILCOR)
1.The casualty should be in as near a true lateral
position as possible with the head dependent to allow
free drainage of fluid.
2.The position should be stable.
3.Any pressure of the chest that impairs breathing
should be avoided.
4.It should be possible to turn the victim onto the side
and return to the back easily and safely, having
particular regard to the possibility of cervical spine
injury.
5.Good observation of and access to the airway should
be possible.
6.The position itself should not give rise to any injury to
the casualty.
https://en.wikipedia.org/wiki/Recovery_position

47. •Designed to prevent suffocation through
airway obstruction, which can occur in
unconscioussupinepatients.
•Two routes of obstruction:
•Mechanical obstruction: Physical object
obstructs airway. Own tongue leads to a loss of
control andmuscle tone, causing tongue to fall
back and creating obstruction.
•Fluid obstruction: Fluids, usually vomit, can
collect in pharynx, causing person to drown.
Stomach contents flowing into throat,
causingregurgitation. Fluid collects in the back
of throat can also flow down into the lungs
causingaspiration pneumonia.
https://en.wikipedia.org/wiki/Recovery_position

48. IMMEDIATELY AFTER CPR…
Prof. Dr. RS Mehta,BPKIHS
⚫Laryngoscopy; 100% oxygen
⚫Urinary catheter
⚫NG tube
⚫Establish or verify existingi.vaccess; start with NS
⚫Transfer to a special care unit for continuous
monitoring and therapy.

49. CONTINUE RESUSCITATIONUNTIL
–Qualified help arrives and takesover
–Victim revives: The victimstarts
breathingnormally
–Rescuer becomesexhausted
–Cardiac arrest of longer than 30 minutes
(controversial)

50. AFTERCPR…
Prof. Dr. RS Mehta,BPKIHS
Complete examincluding
–Serialvitals
–Urineoutput
–12-leadECG
–ChestX-ray
–BloodGlucose
–SerumUrea,
Creatinine
–SerumElectrolytes
(+Mg
++ andCa
++)
–CardiacMarkers

51. PROGNOSIS
5 clinical signs strongly predicting death or
poor neurologicaloutcome:
No corneal reflex at 24hours
No pupillary response at 24hours
No withdrawal response to pain at 24hours
No motor response at 24hours
No motor response at 72hours

53. ⚫Defibrillation is used for treatment
oftachydysrhythmias.
⚫Depolarisesthecriticalmassof
myocardialcellatonce.It
recapturestheSAnodeasits
roleasthepacemaker.
⚫Is treatment of choicefor
pulselessVT/VF.
DEFIBRILLATION

54. ➢The heart’s pumping
action controlled by
electrical system.
➢Electrical rhythm normally
very organized.
➢Normal heart’s rhythm is
called “Sinus Rhythm”
➢Normal heart rate of 60 -
100 beats per minute.
SinusRhythm
East of England AmbulanceService
NHSTrust
UNDERSTANDING DEFIBRILLATION

55. ➢VF is the most common
rhythm in sudden cardiac
arrest (90%).
➢Electrical problem in
nature.
➢Chaotic rhythm results in
“quivering of heart” and
results in loss of pulse.
➢VF will result in brain
damage within 5 minutes
and death in 10-15 mins.
East of England AmbulanceService
NHSTrust
UNDERSTANDING DEFIBRILLATION:
VENTRICULAR FIBRILLATION (VF)

56. ➢Defibrillation may correct VF
➢Uses DC current delivered across
the heart.
➢A successful defibrillation
“depolarizes” the heart’s cells
➢Depolarization allows the cells
to “reorganize”
➢Defibrillation is the ONLY
effective cure for VF.
East of England AmbulanceService
NHSTrust
UNDERSTANDING DEFIBRILLATION

57. USE OF AN AED
➢Use the AED as soon as it is available and ready to use.
➢Follow the AED prompts to give a shock, then give CPR again
while the AED is analyzing victim’s rhythm.
➢First turn it on.
➢Then simply follow instructions.
➢Some AEDs will automatically switch themselves on when the
lid is opened.

58. ATTACH PADS TO PATIENT’SBARECHEST

59. ANALYSING RHYTHM DO NOT TOUCHVICTIM

60. SHOCKINDICATED
⚫Standclear
⚫Delivershock

61. SHOCKDELIVERED
FOLLOW AEDINSTRUCTIONS
30 2

62. DEFIBRILLATION SAFETY!
▪THEPATIENT.
▪5 pointcheck
▪Pacemaker
▪Jewellery
▪Hair onchest
▪Damp/Wetskin
▪Patches(GTN)
▪THEAED.
▪In good workingorder
▪Do Not use in Heavy
rain
▪Do Not use if they lay in
a pool ofwater
▪Do Not use in an
explosive environment

63. Defibrillators can be classified as:
➢Monophasic(deliverscurrentof
one polarityonly)
➢Biphasic (deliver current of2
polarity)
DEFIBRILLATOR
37

64. POSITION OF DEFIBRILLATORPADDLE
✓1
stpaddle-ontheright
side ofthechestjust
belowtheclavicle
✓2
nd atprecordial
region.
⚫Paddleshouldbeapplied
withpressureequivalent
to10kg.
38

65. •Adult:13cm
•Children:8cm
•Infants:4.5cm
•Previous recommendation of 3 successive
shock (200,300,360J)
•Nowonlysingleshockis recommended.i.e.
•360J bymonophasic.
•150-200J bybiphasic.
PADDLE SIZE
39

66. ➢Apply conducting jelly betweenthe paddle and theskin.
➢Place the paddle so that they don't touchpatient’s
clothing and bed linen and aren't near medicationand
direct oxygenflow.
➢Ensure that defibrillator is notin synchronizedmode.
➢Don't charge the device until readyto shock
➢Keepthumbs and fingers off discharge buttonuntil
paddle areon.
NURSES ROLE WHILEPERFORMING
DEFIBRILLATION

67. ⚫Beforepressingthedischargebuttoncall“all
clear” 3times
1
st
2
nd
NURSES ROLEIN DEFIBRILLATION
clear: Ensures" YOU” aren’ttouching patient, bed,equipment
clear: Ensures “no one" is touching patient, bed, equipment
3
rdclear: Ensures “you and everyone" else are clear off the
patient and anything touchingthepatient.

68. NURSES ROLEIN DEFIBRILLATION
⚫Record the delivered energyandtheresults(cardiac
rhythm andpulse).
⚫After the event iscomplete inspectthe skin
under the padsandpaddlesfor burns , and if
any detectedconsult about thetreatment.
42

69. COMPLICATIONS OFCPR
⚫Skeletal injuries especiallyrib#.
⚫Visceral injuries-Myocardial and pulmonary
contusions, blood in pericardial sac,
pneumothorax, liver and spleen rupture, gastric
perforation.
⚫Airway injuries-tracheal & laryngealinjuries.
⚫Skin and integumentdamage

70. BLS DIFFERENCES

71. BLS DIFFERENCES

72. Simplified adult BLSalgorithm.
Robert A. Berg et al. Circulation.2010;122:S685-S705

73. BLS healthcare provideralgorithm.
Robert A. Berg et al. Circulation.2010;122:S685-S705

74. ALGORITHM OF ACLS
2015

75. •“Look, listen, and feel for breathing” has been removed from
thealgorithm.
•Continued emphasis has been placed on high-quality CPR (with
chest compressions of adequate rate and depth, allowing
complete chest recoil after each compression minimizing
interruptions in compressions, and avoiding excessive
ventilation).
KEY ISSUES AND MAJORCHANGES

76. ⚫To initiate chest compressions before giving rescue breaths (C-A-B
rather thanA-B-C).
⚫Compression rate should be at least 100/min (rather than
“approximately”100/min).
⚫Compressiondepthforadultshasbeenchangedfromtherangeof1½to
2inchestoatleast2inches(5cm).
⚫BLSonlyprovides15to20%ofnormalcardiacoutputandshouldbe
regardedas“buyingtime”untilthecommencementofALS.
⚫Ifthereismorethanonerescuerpresent,anothershouldtakeoverthe
CPRevery1to2minutetopreventfatigue.

77. ❖Circulation by cardiaccompression
❖Airway management byequipments
❖Breathing by advancedtechniques
❖Defibrillation by manualdefibrillator
❖Drugs
ACLSINCLUDES:

78. Chest compression:
-Rate-100/min
-Place-Mid ofsternum
-Depth-At least 5cm (2inches)or 1/3
rd
of
AP diameter ofchest
-No synchrony withrespiration.
CIRCULATION

79. •Should not be used for unwitnessed out-of-
hospital cardiacarrest.
•Rapid treatment for witnessed and monitored VT.
•Used if a defibrillator is not immediately available.
•Consider giving single thump .
•Using ulnar edge tightly clenched fist, deliver a sharp
impact to the lower half of sternum from a height of
20cm.
•Converts VT to sinus rhythm.
PRECORDIALTHUMP

80. ❑Breathing can be accomplished by
1.Bag and mask ventilation
2.Ventilation by advancedmethod:
a.ET tube: Intubation is mostdefinitive and best method for
ventilation.
b.LMA
c.Tracheostomytube
3. Ventilation by automaticventilators.
BREATHING

81. 1) Oropharyngeal Airway
AIRWAYMANAGEMENT
➢Correct size chosen by measuring from
1
st
incisors to the angle of jaw.
➢Inserted into the person's mouth upside
down.
➢Once contact is made with the back of
the throat, the airway is rotated 180
degrees, allowing for easy insertion, and
assuring that the tongue is secured. An
alternative method for insertion.

82. 2) Laryngeal MaskAirways
Airwaymanagement
•Supraglottic airway device.
•Composed of airway tube that
connects to an elliptical mask with a
cuff which is inserted through patient's
mouth, down the windpipe, and once
deployed forms an airtight seal on top
the glottisallowing a secureairway to
be managed.

83. 3) Endotrachealtube
Airwaymanagement

84. ARTIFICIAL MANUALBREATHING
UNIT (AMBU)
Prof. Dr. RS Mehta,BPKIHS
➢Itconsistsofselfinflatingbagmadeupofrubberorsilicon,
connector,safetyvalve,mouthpiece.
➢100%oxygencanbedeliveredbyAMBUbagbyattachingoxygen
sourceandoxygenreservoir.

85. 1.Adrenaline(All types of cardiac arrest)–1mg
every 3-5mins
2.Amidarone(VF,VT)-1
st dose:300mg iv bolus,
2
nd dose 150mg.
3.Lidocaine-(1-1.5mg/kg)
4.Sodium Bicarbonate(only if cardiac arrest is
associated with hyperkalemia ) (2-5meq/kg)
5.Calcium Gluconate-10 mg ivslowly.
6.Magnesium Sulphate –2 gms iv in 100 ml NS
(Refractory VT /VF).
DRUGS

86. REFERENCES
❑American Heart Association Study Guide 2017 BLS for
Healthcare Providers
❑http://circ.ahajournals.org/content/122/18_suppl_3/S8
62
❑http://ajcc.aacnjournals.org/content/17/5/426.abstract
❑https://en.wikipedia.org/wiki/Recovery_position
❑http://en.wikipedia.org/wiki/Precordial_thump

87. THANKYOU