BASIC LIFE SUPPORT

by
KYAMUSOKE Borauzima
 ADULT
BASIC LIFE SUPPORT
(BLS)
 OBJECTIVES

Students should be able to demonstrate:

– How to assess the collapsed victim

– How to perform chest compression and rescue
breathing
– How to place an unconscious breathing victim in
the recovery position.
CHAIN OF SURVIVAL
 BASIC LIFE SUPPORT

SEQUENCES OF PROCEDURES PERFORMED TO RESTORE THE

CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY
AND/OR CARDIAC ARREST

CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY

ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY,
WITHOUT ANY OTHER EQUIPMENT
 Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
 APPROACH SAFELY!

Approach safely
Scene Check response
Shout for help
Rescuer
Open airway
Victim Check breathing
Call emergency services
Bystanders 30 chest compressions
2 rescue breaths
CHECK RESPONSE

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
CHECK RESPONSE

Shake shoulders gently

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

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
OPEN AIRWAY

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
OPEN AIRWAY

Head tilt and chin lift

- lay rescuers
- non-healthcare rescuers

No need for finger sweep

unless solid material can be seen
in the airway
 OPEN AIRWAY

Head tilt, chin lift + jaw thrust

- healthcare professionals
CHECK BREATHING

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
CHECK BREATHING

• Look, listen and feel for

NORMAL breathing

• Do not confuse agonal

breathing with
NORMAL breathing
 AGONAL BREATHING

• Occurs shortly after the heart stops

in up to 40% of cardiac arrests

• Described as barely, heavy, noisy or gasping

breathing

• Recognise as a sign of cardiac arrest

Erroneous information can result in withholding CPR from cardiac arrest victim
 Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
 FOREIGN-BODY AIRWAY
OBSTRUCTION (FBAO)

Approximately 16 000 adults and children receive treatment for FBAO in

the UK yearly

SIGNS MILD obstruction SEVERE obstruction

“Are you choking?” “YES” Unable to speak,

may nod
Other signs Can speak, cough, Can not
breathe breathe/wheezy
breathing/silent
attempts to cough/
unconsciousness
ADULT FBAO TREATMENT
BACK BLOWS
ABDOMINAL THRUSTS
30 CHEST COMPRESSIONS

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services

30 chest compressions
2 rescue breaths
CHEST COMPRESSIONS

• Place the heel of one hand in

the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
RESCUE BREATHS

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
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
 RESCUE BREATHS

RECOMMENDATIONS:
- Tidal volume
500 – 600 ml

- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise

- Chest-compression-only
continuously at a rate of 100 min
 Airway Control and Ventilation
• During low blood flow states such as CPR,
oxygen delivery to the heart and brain is
limited by blood flow rather than by arterial
oxygen content.
• Advanced airway placement in cardiac arrest
should not delay initial CPR and defibrillation
• Empirical use of 100% inspired oxygen during
CPR optimizes arterial oxyhemoglobin content
and in turn oxygen delivery.
 Airway and Ventilations
• Opening the airway (with a head tilt–chin lift
or jaw thrust) followed by rescue breaths
• Untrained rescuer will provide Hands-Only
(compression-only) CPR and the lone rescuer
who is able, should open the airway and give
rescue breaths with chest compressions.
• Ventilations should be provided if the victim
has a high likelihood of an asphyxial cause of
the arrest.
 Mouth-to-Mouth Rescue Breathing

• Open the victim’s airway, pinch the victim’s

nose
• Create an airtight mouth-to-mouth seal.
• Give 1 breath over 1 second, take a “regular”
(not a deep) breath
• A second rescue breath over next 1 second
 Ventilation With Bag and Mask

• With room air or oxygen.

• Positive-pressure ventilation without an
advanced airway
• Produce gastric inflation and its complications
• To deliver approximately 600mL tidal volume.
• Squeezing a 1-L adult bag about two thirds of
its volume or a 2-L adult bag about one third.
• Cycles of 30compressions and 2 breaths.
• Delivers ventilations during pauses in
compressions and each breath over 1 second.
• Can use supplementary oxygen
(O2concentration 40%, at a minimum flow
rate of 10 to 12 L/min) when available.
• When an advanced airway (ie, endotracheal tube,
combitube,or laryngeal mask airway [LMA]) is in
place during 2-person CPR,
• give 1 breath every 6 to 8 seconds without
attempting to synchronize breaths between
compressions
• This will result in delivery of 8 to 10
breaths/minute
• There should be no pause in chest compressions
for delivery of ventilations
 CONTINUE CPR

30 2
 Approach safely
Check response
Shout for help
Open airway
Check breathing
Call emergency services
30 chest compressions
2 rescue breaths
DEFIBRILLATION
AUTOMATED EXTERNAL DEFIBRILLATOR
(AED)

• Some AEDs will

automatically switch
themselves on when
the lid is opened
ATTACH PADS TO CASUALTY’S
BARE CHEST
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK INDICATED

• Stand clear
• Deliver shock
 SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

30 2
 NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

30 2
 CONTINUE RESUSCITATION UNTIL

– Qualified help arrives and takes over

– The victim starts breathing normally

– Rescuer becomes exhausted

Paediatric basic
life support
 Basic life support

A irway – airways opening

B
reathing – arteficial ventilation

C
irculation – recovery of circulation

CBA adults
 Paediatric basic life support
Age:
- An infant is a child under 1 year of age
- a child is between 1 year and puberty
25 kg, 8. years
 CPR IN CHILDREN

• Adult CPR techniques

can be used on children

• Compressions 1/3 of
the depth of the chest
30
3
0
 BASIC LIFE SUPPORT (BLS)

Approach safely
Check response
Shout for help
Open airway

head tilt
and chin lift,

Campbell
 BASIC LIFE SUPPORT (BLS)

Approach safely
Check response
Shout for help
Open airway
Check breathing

Look, listen and feel for NORMAL breathing

 Breathing
• Take a breath and cover the mouth and nasal apertures
of the infant with your mouth, making
sure you have a good seal

• Blow steadily into the infant’s

mouth and nose over 1—1.5 s,
sufficient to make the chest
visibly rise

• Take another breath and

repeat this sequence
five times
 Breathing
No effective breathing:
- the airway may be obstructed

• Open the child’s mouth and remove any

visible obstruction.

• Ensure that there is adequate head tilt

and chin lift,
try the jaw thrust method

• Make up to five attempts to achieve

effective breaths; if still unsuccessful,
move on to chest
compressions
 Breathing, circulation

• look for signs of a circulation

any movement, coughing
normal breathing=circulation is present
(not agonal gasps, which are infrequent, irregular breaths)
carotid pulse / CHILD brachial pulse / INFANT
 Basic life support

• Chest compressions
– To 1. year 2 fingers (2 thumbs circular)
– Over 1. yer one hand/two hands
– Low part of sternum
– Thumb over processus xiphoideus
– Compression by 1/3 of antero-posterior distance
– AED
– Children > 1 year
– Smaller size of pads for children to 8 years
– 50 – 75 J (4 J/kg)
Chest compression
 Chest compressions

• to depress the
sternum by
approximately one
third of the depth of
the chest

• and repeat at a rate of

about 100 min−1
Chest compressions : breaths
30:2
 AED IN CHILDREN

• Age > 8 years

• use adult AED

• Age 1-8 years

• use paediatric pads / settings
if available (otherwise use
adult mode)

• Age < 1 year

• use only if manufacturer
instructions indicate it is safe
AED DEFIBRILLATION
ATTACH PADS TO CASUALTY’S BARE CHEST
ANALYSING RHYTHM - DO NOT TOUCH VICTIM
SHOCK INDICATED

• Stand clear
• Deliver shock
SHOCK DELIVERED FOLLOW AED INSTRUCTIONS

30 2
CPR of newborn
 Newborn resuscitation
• Lungs distension- ambu- bag with face mask,
in term newborn f: 30-60/min
if bradycardia persists - increase oxygen concentration
• Mecónium – desuflation by weak newborns
• Compressions- breathing ratio 3:1
90 compressionsií and 30 breaths
• Adrenalín, if despite art. Vent.with O2 bradycardia <60/min
dose 0,01-0,03 mg/kg i.v., into ETT 5-7 x more
• Check HR every 30 sekúnd, STOP if HR > 60/min
• Circulation support evective only by lungs distension
• Temperature of body core maintenance
Foreign body airway obstruction

– Combination of methods needed

– 5 hits back blows
– 5 chest compressions (till 1year) / abdominal thrusts over
1 year
– Horisontal rib´s position – abdominal organs damage risk
2010 American Heart Association
Guidelines for Cardiopulmonary
Resuscitation and Emergency
Cardiovascular Care
 New AHA Adult Chain of Survival

• New 5th link –post-cardiac arrest care

• Links in the new adult Chain of Survival:
• Immediate recognition and activation of
emergency response system
• Early CPR, w/emphasis on chest compressions
• Rapid defibrillation
• Effective advanced life support
• Integrated post-cardiac arrest care
 CPR Sequence

• Change: From A-B-C to C-A-B

• Initiate chest compressions
before ventilations

• Why? Goal: To reduce delay to

CPR, sequence begins with
skill that everyone can
perform
• Emphasize primary
importance of chest
compressions for professional
rescuers
 CPR Starts with Compressions
• Many adults with witnessed arrest have
ventricular fibrillation (VF)/pulseless ventricular
tachycardia (VT), and require
.chest compressions
.early defibrillation

• Chest compressions can be started immediately

(no equipment needed)
• Opening airway, providing ventilation may
significantly delay other actions
• Ventilation delayed by 18 seconds or less
 Primary Emphasis on Chest
Compressions

• All rescuers should, at a minimum, provide chest

compressions.
• If bystander not trained (adult arrest): Hands-Only CPR
• If bystander trained and able: perform compressions
and ventilations at rate of 30:2
• Healthcare provider: perform compressions and
ventilations at rate of 30:2
• For all pediatric arrest, compressions and ventilations
still recommended
Universal Algorithm for Adult CPR
Elimination of “Look, Listen, and Feel”
for Breathing

• Change: This action removed from the CPR sequence

• After delivery of 30 compressions, lone rescuer opens
airway and delivers 2 breaths.

• Why? Rescuer checks for response and “no breathing

or no normal breathing” in adult before beginning CPR
• Starting CPR with compressions minimizes delay to
action
 Healthcare Provider ADULT BLS
Sequence

• Recognize unresponsive adult with no breathing

or no normal breathing (ie, only agonal gasps)
• Activate emergency response, retrieve AED (or
send someone to do this)
• Check for pulse (no more than 10 seconds)
• If no pulse, begin sets of 30 chest compressions
and 2 breaths
• Use AED as soon as available
 Healthcare Provider CHILD BLS
Sequence

• Recognize unresponsive child with no breathing or

only agonal gasps
• Send someone to activate emergency response &
retrieve AED.
• Check for pulse (no more than 10 seconds)
• If no pulse, begin sets of 30 chest compressions and 2
breaths.
• Lone rescuer activates emergency response after 2
minutes of CPR.
• Use AED as soon as available
 Electrical Therapies

• Practice needed to minimize interruption in

chest compressions to deliver shock.
• In-hospital use of AEDs may facilitate early
defibrillation (goal: ≤ 3 minutes, monitor
results).
• AEDs can now be used in infants if a manual
defibrillator is not available.
• Defibrillation doses unchanged
 Pediatric Resuscitation

• Revised pediatric chain of survival

• New post-arrest care link
 Pediatric Basic Life Support

• Similarities in pediatric BLS and adult BLSC-A-B

rather than A-B-C sequence
• Continued emphasis on high-quality CPR
• Removal of “look, listen and feel”

• De-emphasis of pulse check for HCPs

• Use AEDs as soon as available
• AEDs may be used in infants, although manual
defibrillation preferred
 Pediatric Basic Life Support

• Some differences between pediatric BLS and

adult BLS
• Lone rescuer provides 2 minutes of CPR before
activating emergency response
• Two rescuers use 15:2 compression to ventilation
ratio
• Traditional CPR (compressions and ventilations)
by bystanders associated with higher survival
than chest compressions alone
 Neonatal Resuscitation
• For babies born at term, begin resuscitation with
room air rather than 100% oxygen.
• Any oxygen administered should be blended with
room air, titrated based on oxygen saturation
measured from right upper extremity.
• Suctioning after birth reserved for infants with
obvious airway obstruction, those requiring
ventilation or non-vigorous babies with
meconium
• Therapeutic hypothermia recommended for
babies near term with evolving moderate to
severe hypoxic-ischemic encephalopathy.