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1. Basic life Support

NES 1

2. Objectives
By the end of session learners will be able to:
•Review anatomy and physiology of heart and lungs.
•Discuss cardiac and respiratory arrest.
•Differentiate between cardiac arrest and Heart attack.
•Discuss Agonal breathing.
•Define BLS.
•List Indications of CPR.
•Recognize CAB of CPR.
•Differentiate adult, child and infant CPR.
•Explain airway obstruction types and care in adult ,child and
infants.
2

3. 3
Anatomy & Physiology
•Heart:
Heart is a hollow muscular organ about the size
of one’s fist.
•Location:
Heart is situated in the mediastinum
cavity between the two lungs.
•Function:
Its function is to propel blood throughout
the body.

4. 4
Circulatory System
Circulatory system comprises of:
•Arteries
Carry oxygenated blood
except for Pulmonary arteries.
•Veins
Carry deoxygenated blood except
for pulmonary veins.
•Capillaries
At the capillary level exchange
of gases takes place.

5. NES 5

6. 6
Respiratory Tract

7. 7

8. 8

9. Respiratory System
Function of the respiratory system
•It provides oxygen to and
remove carbon dioxide from the body.
•Atmosphere contain 21% of oxygen.
•4-5 % of oxygen is absorbed in the
body and rest 16-17 % of oxygen is exhaled
out from our body.
NES 9

10. 10
Respiratory Arrest
Respiratory arrest is the cessation of breathing. It
is a medical emergency.
Conditions that produce Respiratory arrest are:
• Airway obstruction
• Suffocation
• Smoke inhalation
Cardiac Arrest
Circulatory arrest indicates a sudden stop in effective and
normal blood circulation due to failure of the heart to pump
blood.
Conditions that produce Cardiac arrest are:
• Heart attack
• Electric shock

11. 11
Cardiac Arrest Heart Attack
1.Sudden cardiac arrest occurs
when the heart develops an
abnormal rhythm and can’t
pump blood.
A heart attack occurs when blood
flow to part of the heart muscle is
blocked by clot.
2.This abnormal rhythm causes
the heart to quiver so it can no
longer pump blood to the brain,
lungs and other organs.
If the blocked vessel is not
reopened quickly, the muscle
normally nourished by that vessel
begins to die.
3.Sudden cardiac arrest is often a
“rhythm” problem.
A heart attack is a “Clot” problem.

12. 12
Agonal Breathing
Agonal breaths or respirations are the
body's last-ditch effort to deliver oxygen to
the vital organs.
The victim in cardiac arrest
may demonstrate agonal
gasps.
Agonal gasps are not adequate breathing.

13. Basic Life Support
•BLS is the foundation for saving lives after cardiac arrest
and respiratory arrest.
 
13

14. 14
Indications For CPR
•Pulselessness
•Breathlessness

15. 15
Indications For CPR
Cardiac Arrest
When heart stops:
• Blood is not circulated
• Stored oxygen in the body will be depleted in few minutes.
This can also lead to respiratory arrest.
IF PROMPT CPR IS NOT INITIATED BRAIN DEATH
OCCUR IN 4 TO 6 MINUTES.

16. 16
Indications For CPR
Respiratory Arrest
When breathing stops it leads to respiratory
arrest.
Heart may continue to pump for several
minutes and use up the stored oxygen.
PROMPT RESCUE FROM THE RESPIRATORY
ARREST CAN PREVENT CARDIAC ARREST .

17. ABCD Of CPR
•Airway
Maintain victim’s airway (Head tilt chin lift)


NES 17

18. ABCD Of CPR
•Jaw thrust maneuver if head injury is present or suspected.
Jaw thrust

NES 18

19. ABCD Of CPR
•Breathing
Determine breathlessness,
(look listen and feel) Look-for
chest rising listen-for breath
sound feel-for exhaled breath.

IF NO BREATHING, GIVE 2
RESCUE BREATHS
NES 19

20. ABCD Of CPR
•Circulation
Determine pulselessness,
no pulse-start cardiac
compression.
NES 20

21. ABCD Of CPR
Defibrillation
Automated external defibrilator(AED).
How to use AED
•Power on the AED
•Attached the AED (select correct pads
for victim’s size and age)
•Clear the victim and allow
the AED to analyze
•Clear the victim and deliver the shock
if needed.
THE EARLIER THE DEFIBRILATION OCCURS,
THE HIGHER THE SURVIVAL RATE.
NES 21

22. 22

23. Special Consideration For AED
Following condition require the operator to take additional actions
before using AED
•The victim is immersed in water
•The victim has an implanted pacemaker
•A Transdermal medication patch or
other object is located on the surface of victim’s chest.
•The victim has a Hairy chest.
NES 23

24. CAB(Compression,Airway,
Breathing)
Change from A-B-C to C-A-B. the 2010 AHA
Guidelines for CPR And ECG Recommend a
change in the BLS sequence of steps from A-
B-C to C-A-B.
24

25. 25
Adult CPR
•Check scene safety.
•Check the victim for responsiveness.
•Tap the victim’s shoulder and shout " Are
you OK?"
•If there is no response, shout for nearby
help.
•Immediately activate EMS.
•Get AED and emergency equipment.
(or send someone to do so).

26. Circulation
If the victim remains unresponsive
Look, listen and feel for breathing and check his Carotid pulse within
10seconds.
If no pulse and no breathing or only gasping, remove or move the clothing
covering of victims chest so that you can locate appropriate hand placement
for compression and start CPR.
If normal breathing and has pulse Monitor
until emergency responders Arrive.
If no normal breathing, has pulse
Provide rescue breath every 5-6 seconds,
Or about 10-12 breaths/min.
Continue rescue breathing and check Pulse every 2 minutes.
26

27. 27
Chest compression for Adults
•Landmark-Center of the
breastbone between nipples.
•Push hard push fast, compress at a rate
of 100 to 120/min with a depth of at
least 5cm or 2inches.
•Allow complete chest recoil after each
compression.
•Minimize interruptions in
Compression.
•Use AED as soon as it is available.
•Immediately resume high quality
CPR, starting from chest compression,
when advised by the AED.

28. Maintain airway
Head tilt chin lift, if head injury suspected
then jaw thrust Maneuver.
28

29. 29
Breathing
Mouth to mouth breath
•Pinch nose with your
fingertips to prevent air
escaping
•place your mouth
over the victim's mouth
creating a tight seal.
•Give effective breaths that make the
chest rise.
Barrier devices:
•Use Pocket mask or bag-mask device
for breath.

30. C & E Technique
30

31. Bag-mask device
31

32. 32
Adult CPR
•Perform 5 cycles (30:2) then reassess
victim (check pulse)
•No pulse-continue CPR
•Pulse present check breathing.
•No breathing-give 1 breath
after every 5 to 6 seconds
(10-12 breath/min)
•Breathing and pulse present-place
victim in RECOVERY POSITION.

33. Child CPR
01
Verify the scene
02 Check for responsiveness tap the Child shoulder “ARE
YOU OK ?
03
Check pulse by palpating carotid or femoral pulse , check
breathing at a same time within 10seconds.
04
If the victim is not responsive activate the emergency
response system and start CPR.
NES 33

34. Child CPR
•Chest Compression
The rule to remember
is 1 hand.
• Open airway
• Give 2 Breath
•1rescuer : Complete 5 cycles (30:2)
•2 rescuer: complete 5 cycles (15:2)
•Then reassess victim
NES 34

35. 35
Infant CPR
•Check responsiveness

By patting feet, if no
crying, immediately check
Circulation.
•Circulation
An infant's pulse is checked
at the brachial artery.

36. 36
Infant CPR
•Place the infant on a firm, flat surface..
• Place 2 fingers in the center of the
infant's chest, just below the nipple line,
on the lower half of the breastbone.
•Do not press the tip of the breastbone.
•Compress at least one third the AP
diameter of the infant's chest(4cm)
•If two Rescuer then use 2 thumb-
encircling hand technique.
•Compress at the rate of 100 to 120/min.

37. 37
Open airway

• Head tilt chin lift
Breathing
•Cover the infant's mouth
and nose with your mouth
creating a seal, and give a
quick rescue breath

38. Cont….
•Complete 5 cycles (30:2) then activate EMS
and retrieved AED, if alone.
•If One rescuer (30:2)
•If Two rescuer (15:2)
•If two rescuer then switch roles after every 5
cycles.
38

39. 39
Cont…
•Check brachial pulse if no pulse
continue CPR
•If at any point the infant regains a
pulse but still does not breathe on his
own.
•give him one rescue breath every 3-5
seconds.

40. 40
Component Adult and
Adolescents
Children
(Age 1 year to
Puberty)
Infants( Age less then
1 year, Excluding
newborns)
Scene safety Make sure the environment is safe for rescuers and victim.
Recognition of cardiac
arrest
Check for responsiveness
No breathing or only gasping
No definite pulse felt within 10 seconds
(Breathing and pulse check can be performed simultaneously in less
than 10 seconds)
Activation of EMS If you are alone with
no mobile phone,
leave the victim to
Activate the EMS and
get AED.
Other wise, send
some one and begin
CPR Immediately.
Witnessed collapse
Follow steps for adults and adolescents on
the left.
Unwitnessed collapse
Give 2 minutes of CPR, Leave the victim to
activate the EMS get the AED, Return and
resume CPR.
Summary of High-Quality CPR Components for BLS Providers

41. 41
Component Adult and
Adolescents
Children
(Age 1 year to
Puberty)
Infants( Age less then
1 year, Excluding
newborns)
Compression-
ventilation ratio
without advanced
airway
1 or 2 Rescuers
30:2
1 Rescuer
30:2
2 Rescuers
15:2
Compression-
ventilation ration with
advanced airway
Continuous compressions at a rate of 100-120/min
Give 1 breath every 6 seconds (10 breath/min)
Compression depth At least 5cm * At least one third AP
diameter of chest
About 5cm *
At least one AP
diameter of chest
About 4cm *
Hand placement 2 hands on the lower
half of the breastbone
(sternum)
2 hands or 1 hand
(optional for very
small child) on the
lower half of the
breast bone(sternum).
1 Rescuer
2 fingers in the center
of the chest, just
below the nipple line.
2 or more rescuers
2 thumb encircling
hand in the centre of
the chest, just below
the nipple

42. 42
Component Adult and
Adolescents
Children
(Age 1 year to
Puberty)
Infants( Age less
then 1 year,
Excluding newborns)
Compression rate 100-120/min
Chest recoil Allow full recoil of chest after each compression
Do not lean on the chest after each compression
Minimizing
interruptions
Limit interruption in chest compressions to less than 10 seconds
Compression depth should be no more than 6cm.

43. 43
Complications OF CPR
•Laceration (heart, lungs, liver and
stomach)
•Fracture (ribs, sternum)
•Gastric Distention (if airway not
opened properly)

44. 44
When To Stop CPR
•When pulse returns
•When rescuer gets
exhausted
•When the doctor
announces death

45. 45

46. 46
Partial Airway Obstruction
Partial obstruction with
Good air exchange
•Victim can cough
•Can speak
•Can breath
•Can cry (infant/child)
Partial obstruction with
Poor air exchange
•Victim is unable to speak
•Weak and ineffective cough
•Difficulty breathing
•Weak and ineffective cry
(infant/child)
For adult victim
Heimlich maneuver
For infant
5 back blows and 5 chest
thrust

47. 47
Complete Airway Obstruction
•Victim is unable to speak
•Cannot cough
•May appear cyanosed
•May become unconscious.

48. Choking relief in pregnant and obese
victims
•If the victim is pregnant or obese person chest
thrust instead of abdominal thrust
NES 48

49. Management Of Partial Airway
obstruction
INFANT
•5 back blows
•5 chest thrust (5 cycles)
•Check for object, if present -remove
•If not, then continue same cycle
CHILD/ADULT
•Heimlich maneuver
49

50. Management Of Complete Airway
obstruction
If ADULT victim is unresponsive after chocking:
•Activate EMS
•Open Airway
•Remove object if you see it.
•Begin CPR
If CHILD victim is unresponsive after chocking:=
•Open Airway
•Remove object if you see it.
•Begin CPR (complete 5 cycle of 30:2)
•Activate EMS
50

51. For Child and Adult Victims
Every time when you open the Airway to
give breaths
•Open victim’s mouth wide and Look for the object.
•Keep doing CPR
51

52. To Relieve Choking In An Unresponsive
Infant
•Place the infant on a firm, flat surface.
•Open infant’s airway
•look for an object
•If an object is visible, remove it. Do not perform a blind finger
sweep.
•Begin CPR.
•Each time when you open the Airway, look for the obstructing
object if you see it, remove it.
•After approximately 5 cycles of CPR
•Activate EMS.
52

53. 53
Reference
•American Heart Association(2008). Basic life support for
health care provider. (2
nd
ed) Edward r. Stapleton, Tom P.
Aufderheide, Mary Fran Hazinkiski.

54. 54