2. Introduction
• According to recent statistics sudden cardiac arrest is rapidly becoming
the leading cause of death.
• Once the heart ceases to function, a healthy human brain may survive
without oxygen for up to 4 minutes without suffering any permanent
damage. Unfortunately, a typical EMS response may take 6, 8 or even 10
minutes.
• It is during those critical minutes that CPR (Cardio Pulmonary
Resuscitation) can provide oxygenated blood to the victim's brain and the
heart, dramatically increasing his chance of survival and if properly
By- Ahmed Sodha
3. What is BLS ?
• Basic Life Support (BLS) refers to the care healthcare providers and
public safety professionals provide to patients who are experiencing
respiratory arrest, cardiac arrest or airway obstruction.
• BLS includes psychomotor skills for performing high-quality
cardiopulmonary resuscitation (CPR), using an automated external
defibrillator (AED) and relieving an obstructed airway for patients of all
ages.
By- Ahmed Sodha
4. Timeline of CPR
• 0 to 4 minutes, unlikely development of brain damage
• 4 to 6 minutes, possibility of brain damage
• 6 to 10 minutes, high probability of brain damage
• 10 minutes and over, probable brain damage
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5. Indications
• Road Traffic Accident
• Drowning
• Electric Shock
• Airway Obstruction
• Cardiac Arrest
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6. Goals of Resuscitation
• To support and restore effective:-
- oxygenation
- ventilation
- circulation with return of intact neurologic function
• ROSC (Return of spontaneous circulation) is an intermediate
goal
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9. b.) For Pediatric
• Emergencies in children and infants are not usually caused
by the heart. Children and infants most often have
breathing problems that trigger cardiac arrest. The first
and most important step of the Pediatric Chain of Survival is
prevention
By- Ahmed Sodha
11. Latest changes in AHA Guidelines (In 2015)
• Change in sequence to C-A-B from A-B-C
• Emphasis on high quality CPR
• No look, listen and feel
• No routine use of cricoid pressure during bag mask ventilation
• Continued de-emphasis on pulse check
By- Ahmed Sodha
12. CAUTION
Use of cricoid Pressure
• The routine use of cricoid pressure in cardiac patients is not recommended.
• Cricoid pressure in nonarrest patients may offer some measure of protection to
the airway from aspiration and gastric insufflation during bag and mask
ventilation. However, it also may impede ventilation and interfere with
placement of a supraglottic airway or intubation
By- Ahmed Sodha
13. In 2020 Guideline
• The importance of early initiation of CPR by lay rescuers has been re-emphasized. The
risk of harm to the patient is low if the patient is not in cardiac arrest. Bystanders should
not be afraid to start CPR even if they are not sure whether the victim is breathing or in
Cardiac Arrest.
• A sixth link, Recovery, was added to the Chains of Survival for both Pediatric and
Adults.
• Care of the patient after return of spontaneous circulation (ROSC) requires close
attention to oxygenation, blood pressure control, evaluation for percutaneous coronary
intervention, targeted temperature management, and multimodal neuroprognostication.
By- Ahmed Sodha
14. Contd..
• Because recovery from cardiac arrest continues long after the initial
hospitalization, patients should have formal assessment and support for their
physical, cognitive, and psychosocial needs.
• After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-
based healthcare workers may be beneficial to support their mental health and
well-being.
• Management of cardiac arrest in pregnancy focuses on maternal resuscitation,
with preparation for early perimortem cesarean delivery if necessary to save the
infant and improve the chances of successful resuscitation of the mother.
By- Ahmed Sodha
15. How to approach a patient ?
Ans- A Systematic Approach is used
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20. APPROACH SAFELY!
• Scene
• Rescuer
• Victim
• Bystanders
Approach safely
Check response
Check the pulse
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Shout for help
By- Ahmed Sodha
21. CHECK RESPONSE
Approach safely
Check response
Check the pulse
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Shout for help
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22. Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
Contd..
23. SHOUT FOR HELP
Approach safely
Shout for help
Check the pulse
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Check for response
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24. CHECKTHE PULSE
Approach safely
Check response
Check the pulse
Open airway
Check breathing
Call 977
30 chest compressions
2 rescue breaths
Shout for help
By- Ahmed Sodha
25. OPEN AIRWAY
Approach safely
Check response
Check the pulse
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Shout for help
By- Ahmed Sodha
26. Contd…
• Head tilt and chin lift
- lay rescuers
- non healthcare rescuers
• No need for finger sweep
- unless solid material can be seen in the
airway
By- Ahmed Sodha
28. CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Check the pulse
By- Ahmed Sodha
29. Contd…
• Look, listen and feel for
NORMAL breathing
• Do not confuse agonal
breathing with NORMAL
breathing
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30. CAUTION
• Agonal gasps are not normal breathing. Agonal gaps may be present in the minutes
after sudden cardiac arrest.
• 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
By- Ahmed Sodha
32. Approach safely
Check response
Shout for help
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Check the pulse
By- Ahmed Sodha
33. 30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Check the pulse
By- Ahmed Sodha
34. • Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 -120 per min
– Depth 4-5 cm
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
• Allow complete chest recoil
CHEST COMPRESSIONS
By- Ahmed Sodha
35. RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Activate EMS
30 chest compressions
2 rescue breaths
Check the pulse
By- Ahmed Sodha
36. Breathing- Mouth to mouth
• 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
By- Ahmed Sodha
37. Breathing: MouthTo Nose (when to use)
•Can’t open mouth
•Can’t make a good seal
•Severely injured mouth
•Stomach distension
Note- Mouth to stoma (tracheotomy)
By- Ahmed Sodha
40. Activate EMS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Attach AED
Follow voice prompts
Check the pulse
By- Ahmed Sodha
41. AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
• Some AEDs will
automatically switch
themselves on when the lid
is opened
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49. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call Emergency System
30 chest compressions
2 rescue breaths
Check response
Approach safely
Shout for help
Check the pulse
Open airway
Check breathing
Call Emergency System
Attach AED
Follow voice prompts
Check the pulse
By- Ahmed Sodha
51. How to identify obstruction ?
• Patent Airway - If the patient responds in a normal voice.
• Partial Obstruction- Signs of a partially obstructed airway include a changed
voice, noisy breathing (eg, stridor), and an increased breathing effort.
• Complete Airway obstruction- With a completely obstructed airway, there is
no respiration despite great effort (ie, paradox respiration, or “see-saw” sign).
By- Ahmed Sodha
52. SIGNS MILD obstruction SEVERE obstruction
“Are you choking?” “YES” Unable to speak,
may nod
Other signs Can speak, cough,
breathe
Can not
breathe/wheezy
breathing/silent
attempts to cough/
unconsciousness
Contd…
60. Signs of High Quality CPR
• Start compression within 10 seconds of recognition of cardiac arrest
• Push hard, Push fast: Compress at a rate of 100-120/min with a depth of :
- At least 5cm for adults
- At least one third the depth of the chest, about 5cm for children
- At least one third of the chest, about 4cm, for infants
• Allow complete chest recoil
By- Ahmed Sodha
61. Contd…
• Minimize interruptions in compression (try to limit interruptions to less than
10secs)
• Give effective breaths that male chest rise
• Avoid excessive ventilations
By- Ahmed Sodha
62. CONTINUE RESUSCITATION UNTIL
• Qualified help arrives and takes over
• The victim starts breathing normally
• Rescuer becomes exhausted
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63. When Can I Stop CPR ?
• Victim revives
• Trained help arrives
• Too exhausted to continue
• Unsafe scene
• Physician directed (do not resuscitate orders)
• Cardiac arrest of longer than 30 minutes
By- Ahmed Sodha
64. Injuries Related to CPR
• Rib fractures
• Laceration related to the tip of the sternum, Liver, lung, spleen
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65. Complications of CPR
• Vomiting
• Aspiration
• Place victim on left side
• Wipe vomit from mouth with fingers wrapped in a cloth
• Reposition and resume CPR
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70. AIRWAY
• Is the airway patent ?
• Is an advanced airway indicated?
• Is proper placement of airway device confirmed?
• Is tube secured and placement confirmed frequently?
By- Ahmed Sodha
71. Is the airway patent ?
• Maintain the airway patency in unconscious patients by use of the head
tilt-chin lift , oropharyngeal airway or nasopharyngeal airway
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72. Is an advanced airway indicated?
• Use advanced airway management if needed (eg- laryngeal mask ,laryngeal
tube , oesophageal –tracheal tube, endotracheal tube)
NOTE:- Health care providers must weighs the benefit of advanced airway
placement against adverse effects of interrupting chest compressions. If bag-mask
ventilation is adequate, health care providers may defer insertion of advanced
airway.
By- Ahmed Sodha
73. Contd…
If using advanced airway devices:-
• Confirm proper integration of CPR and ventilation
• Confirm proper placement of advanced airway devices by
- Physical examination
- Quantitative waveform capnography
• Secure the device to prevent dislodgement
• Monitor airway placement with continuous quantitative waveform capnography
By- Ahmed Sodha
74. Continuous waveform capnography
• Quantitative waveform capnography is the continuous, noninvasive
measurement and graphical display of end-tidal carbon dioxide/ETCO2
(also called PetCO2). Capnography uses a sample chamber/sensor placed
for optimum evaluation of expired CO2.
• The inhaled and exhaled carbon dioxide is graphically displayed as a
waveform on the monitor along with its corresponding numerical
measurement.
By- Ahmed Sodha
75. Contd..
Two very practical uses of waveform capnography in CPR are:
1.) evaluating the effectiveness of chest compressions, and
2.) identification of ROSC. Evaluating the effectiveness of chest compressions
is accomplished in the following manner:
Measurement of a low ETCO2 value (< 10 mmHg) during CPR in an intubated
patient would indicate that the quality of chest compressions needs
improvement.
• Normal ETCO2 in the adult patient should be 35-45 mmHg.
• High quality chest compressions are achieved when the ETCO2 value is at least 10-
20 mmHg.
By- Ahmed Sodha
76. Contd..
• When ROSC occurs, There will be a significant increase in the ETCO2. (35-
45 mmHg) This increase represents a drastic improvement in blood flow
(more CO2 being dumped in the lungs by the circulation) which indicates
circulation.
By- Ahmed Sodha
77. Contd..
• The 2020 AHA Guidelines for ACLS recommend using quantitative
waveform capnography in intubated patients during CPR. Waveform
capnography allows providers to monitor CPR quality, optimize chest
compressions, and detect ROSC (return of spontaneous circulation) during
chest compressions.
• Also, according to the AHA, continuous waveform capnography along with
clinical assessment is the most reliable method of confirming and
monitoring correct placement of an ET tube.
By- Ahmed Sodha
78. BREATHING
• Are ventilation and oxygenation adequate?
• Are quantitative waveform capnography and oxyhemoglobin
saturation monitored?
By- Ahmed Sodha
79. Contd..
• Give supplementary oxygen when indicated
- For cardiac arrest patients, administer 100% oxygen
- For others, titrate oxygen administration to achieve oxygen saturation of 94% or greater
by pulse oximetry
• Monitor the adequacy of ventilation and oxygenation by
- Clinical criteria( chest rise and cyanosis)
- Quantitative waveform capnography
- oxygen saturation
• Avoid excessive ventilation
By- Ahmed Sodha
80. CIRCULATION
• Are chest compressions effective?
• What is the cardiac rhythm?
• Is defibrillation or cardioversion indicated?
• Has IV/IO access been established?
• Is ROSC present?
• Is the patient with a pulse unstable?
• Are medications needed for rhythm or blood pressure?
• Does the patient need volume (fluid) for resuscitation?
By- Ahmed Sodha
81. Contd..
• Monitor CPR quality
- Quantitative waveform capnography (if PETCO₂ is less than 10 mm Hg, atte to
improve CPR quality)
- Intra-arterial pressure (if relaxation phase [diastolic] pressure is less than 20 mm
Hg, attempt to improve CPR quality)
• Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms (eg, tricular
fibrillation [VF], pulseless ventricular tachycardia [PVT], asystole, pulse electrical
activity [PEA])
• Provide defibrillation/cardioversion
By- Ahmed Sodha
82. Contd..
• Obtain IV/IO access
• Give appropriate drugs to manage rhythm and blood pressure
• Give IV/IO fluids if needed
• Check glucose and temperature
• Check perfusion issues
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83. DISABLITY
• Check for neurologic function
• Quickly assess for responsiveness, levels of consciousness, and pupil
dilation
• Assess for AVPU
A - Alert
V - Voice
P - Painful
U- Unresponsive
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84. EXPOSURE
• Remove clothing to perform a physical examination, looking for obvious
signs of trauma, bleeding, burns, unusual markings, or medical alert
bracelets
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85. SECONDARY ASSESSMENT
• Secondary assessment involves the differential diagnosis, including a focused
medical history and searching for and treating underlying causes (H;s andT;s)
• Ask specific question related to the patient's presentation consider using
memory aid SAMPLE
By- Ahmed Sodha