GAJE SINGH

American Heart Association

Instructor
 Course Objective

► The purpose of this course is to inform

healthcare professionals about current
guidelines for emergency cardiac care.
 Approach

► BLS ( Basic Life Support) Primary survey.

► ACLS (Advanced Cardiovascular Life Support)

Secondary survey
 Cardiopulmonary
Resuscitation

C - Circulation
A - Airway
B - Breathing
D- Defibrillation
 C-A-B Rather than A-B-C
Steps
► Change in the BLS sequence of steps from A-
B-C (Airway, Breathing, Chest compressions)
to C-A-B (Chest compressions, Airway,
Breathing).

► Initiate chest compressions before giving

rescue breaths (C-A-B rather than A-B-C).

► Why: Highest survival rates from cardiac

arrest due to sooner starts of chest
compression.
 What is CPR?
► CPR stands for Cardio Pulmonary
Resuscitation, i.e. to help restart the heart
(pulse) and lungs (breathing).

► CPR is performed when a person stops

breathing and/or the heart stops.
 Why is timing important?

► When the heart (pulse) and lungs (breathing)

stops, the victim has 5 minutes before
(gradual) brain death starts to occur, if no
CPR is performed.

► Brain damage is certain after 5 - 10 minutes

without CPR

► Therefore, it is very important to start CPR as

soon as possible for better chance of survival.
 Learning Objectives
► Use the principles of patient assessment to
guide treatment decisions.
► Describe the appropriate care of a patient in a
pulseless arrest.
► Relate factors to consider when evaluating a
patient with an arrhythmia.
► Justify the emphasis on rapid evaluation and
treatment of a patient with acute coronary
syndromes.
► Discuss how the physiological differences in
the phases of cardiac arrest drive the
appropriate treatments for each phase.
Why is it required to learn Basic Life Support ?
 What is Cardiac Arrest ?
► Sudden cardiac arrest occurs when electrical
impulses in the heart become rapid or
chaotic, which causes the heart to suddenly
stop beating.

► Cardiac arrests are more common than you

think, and they can happen to anyone at any
time even in healthy looking person.

► Nearly 383,000 out-of-hospital and 209,000

in hospital sudden cardiac arrests occur
annually.
 Cardiac Arrest (contd..)
► Associated with very poor survival rate,
● 9.5 % for out of hospital cardiac arrest and
● 23.9% for in hospital cardiac arrest.

► Early resuscitation and prompt defibrillation

(within 1-2 minutes) can result in >60%
survival.

► Basic life support - one of the most important

skills you will learn here in this session.
BASIC LIFE SUPPORT
(BLS)
 Objectives
► At the end of this session, participants should be
able to demonstrate:

● How to assess the collapsed victim.

● How to perform chest compression and rescue
breathing.
● How to operate an automated external defibrillator
safely.
● How to place an unconscious breathing victim in the
recovery position.
 Basic Life Support (BLS)
► BLS is the foundation for saving lives
following cardiac arrest.

► Fundamental aspects of adult BLS include

five links called Adult Chain of Survival.
 Chain of Survival

The 5 links in adult chain of survival are:

► Immediate recognition of cardiac arrest and activation
of the emergency response system.
► Early CPR with an emphasis on chest compressions.
► Rapid defibrillation.
► Effective advance life support.
► Integrated post-cardiac arrest care.
Basic Life Support (BLS)
Approach safely
Check response
Shout for help
Call for emergency
Chest Compression
Open Airway
2 rescue Breaths
Defibrillation
 APPROACH SAFELY!

Approach safely
Scene
Check response
Rescuer Shout for help
Call for emergency
Victim
Chest compression

Bystanders Open airway

2 rescue breaths
Defibrillation
CHECK RESPONSE

Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway
2 rescue breaths
Defibrillation
 CHECK RESPONSE

By Shake & Shout Method

Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.

If doesn't respond,
• Scan the chest & Check
pulse
 SHOUT FOR HELP

For Unresponsive Cardiac Arrest Patient

Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway
2 rescue breaths
Defibrillation
 CALL FOR EMERGENCY
For Unresponsive Cardiac Arrest Patient
Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway
2 rescue breaths
Defibrillation
CHEST COMPRESSION

Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway
2 rescue breaths
Defibrillation
CHEST COMPRESSION

By Good Hand Position

• Place the heel of one hand in the
centre of the chest on the lower
sternum.
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate - At least 100 min-1 100-120
compression /min
– Depth - At least 2 inches.(5-6 cm)
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
 COMPRESSIONS

► Quality: PUSH HARD, PUSH FAST, ALLOW

COMPLETE RECOIL AND MINIMIZE INTERRUPTIONS
► Site: Lower half of the sternum between nipples for
adult and child; Just below nipple line for infants
► Depth: at least 2 inches(5 cm) for adults; 5 cm for
children and 4 cm for infant
► Technique : two hand in adult and children, two
thumb, or two finger in infant
 OPEN AIRWAY

By Head Tilt Chin Lift Method

Approach safely
Check response
Shout for help

Call for emergency

Chest compression
Open airway
2 rescue breaths
Defibrillation
 Open The Airway

► Opening the airway by

head tilt chin lift
method.

► Placing one hand on

the victim’s forehead
with the other hand
on the chin and tilting
the head back.
RESCUE BREATHS

Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway

2 rescue breaths
Defibrillation
 BREATHING
► Give two rescue breaths 1 breath in
one sec.
► Three methods to give breathing

► mouth-to-mouth breathing
► mouth-to-mask breathing
► bag-valve-mask ventilation
RESCUE BREATHS
► Pinch the nose
► Take a normal breath

► Place lips over mouth

► Blow until the chest

rises
► Take about 1 second

► Allow chest to fall

► Repeat

► For infant cover nose

and Mouth by lip &
give rescue breath
 Rescue Breathing
Mouth to Mouth Method
► 2 rescue breaths after
30 compressions.

► Each breath should be

delivered over 1 Mouth to Mask Method
second with any
delivery method
available.

► A good breath will Bag-Mask Method

cause the chest to
rise.
 CONTINUE CPR

Compression To Ventilation Ratio

30 2
Five cycles of the 30:2 compressions/ventilations should be
delivered, which should take approximately 2 minutes. Only then
is the pulse check repeated.
 COMPRESSION VENTILATION RATIO

► For Adults its 30:2 (1 or 2 rescuers)

► For Children and Infants 30:2 (1
rescuer) and 15:2 (2 rescuers)
► One set of compressions and
ventilations form one cycle
► Five cycles of compression and
ventilation over 2 minutes
► Check pulse after five cycle if no pulse
start same at least 20 min
 How CPR Works?
► Compression of the chest during CPR raises
the intrathoracic pressure which forces the
blood out of the heart chambers.
► When the chest recoils, a negative
intrathoracic pressure is produced which
allows blood to return to the heart, feeding
the coronary arteries and filling the heart
chambers so that the next compression will be
even more effective - A cumulative effect.
► Successive compressions will continue to
increase coronary artery pressure and organ
perfusion.
 How CPR Works? (contd...)

► Effective CPR provides ¼ to 1/3 normal blood

flow.

► Rescue breaths contain 16 % Oxygen (out of

21 %)
► Tidal volume approx. 450 ml for effective
vantilation
AUTOMATED EXTERNAL
DEFIBRILLATORS

Approach safely
Check response
Shout for help
Call for emergency
Chest compression
Open airway

2 rescue breaths
Defibrillation
 AUTOMATED EXTERNAL
DEFIBRILLATORS
Attach pads to casualty’s bare chest

One pad - Left of the left nipple a Another pad on the upper-right
few inches below the left armpit. side of the patient’s bare chest
 AUTOMATED EXTERNAL
DEFIBRILLATORS
Analysing rhythm Shock indicated
Do not touch victim Deliver shock
 DEFIBRILLATION

Chest Compression - Shock Delivery (With in 5

seconds) - Chest compression Again

30 2
 Recovery Position

If he is breathing normally
• Turn him into the recovery position
• Send or go for help, or call for an ambulance.
• Check for continued breathing.
 RECOVERY POSITION

If victim starts to breath normally place

in recovery position
 When CPR Should Stop?

► Victim revives

► Trained help arrives

► To exhausted to continue

► Unsafe scene

► Physician directed

► Cardiac arrest for more than 20

minutes
 Complications of CPR

► Rib fractures (Most common)

► Vomiting and Aspiration

► Internal Injuries to vital organs like

lung & liver.

► Body Fluid Exposure - Risk of AIDS &

hepatitis like communicable diseases.

► Gastric Distention
Basic Life Support Algorithm