The document discusses basic life support and airway management, noting that approximately 700,000 cardiac arrests occur in Europe each year with a survival rate of 5-14%, and that bystander CPR and early defibrillation within 1-2 minutes can result in over 60% survival. It provides details on assessing responsiveness, activating emergency services, performing chest compressions, giving rescue breaths, using an automated external defibrillator, and continuing or stopping CPR efforts based on guidelines. The causes and outcomes of cardiac arrest are also reviewed for adults and children.

1. Basic LifeSupport
Airway Management
KEIHAN Foundation
Clinical SkillsTraining Program
N. Rahim, MD.

2. Content
 Background
 Basic Life Support
 Airway Management

3. Background
 Approximately 700,000 cardiac arrests per year in
Europe
Outcome:
 Survival to hospital discharge presently approximately
5 - 14%
 Bystander CPR = vital intervention before arrival of
emergency services
 Early resuscitation and prompt defibrillation (within 1-2
minutes) can result in >60% survival

4. Chain of survival

5. Basic Life
Support
 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.

6. Respiratory arrest
 If the patient is not breathing, but has a definitive pulse, the patient is in respiratory arrest.
 To care for a patient, experiencing respiratory arrest, ventilations must be given.
Cardiac arrest
 If there is no breathing, no pulse and the patient is unresponsive, the patient is in cardiac
arrest.
 Cardiac arrest is a life-threatening situation, in which the electrical and/or mechanical
system of the heart malfunctions resulting in complete cessation of the heart’s ability to
function and circulate blood efficiently.

7. CardiacArrest
Most cardiac arrest victims have an electrical malfunction of the
heart  heart´s pumping function abruptly ceases, resulting in:
1. Asystole
2. Ventricular fibrillation
3. Pulseless ventricular tachycardia
Fast ventricular contractions without haemodynamic effect
Signs = identical!!!
Differential diagnosis: only with ECG!

8. Causes of
cardiac arrest
Cardiac Pulmonary
Myocardial infarction Respiratory failure
Heart failure Airway obstruction
Dysrythmia ARDS
Cardiac tamponade Pneumothorax
Pulmonary embolus
Electrolyte imbalance
Hyperkalemia Procedures
Hyper/hypocalcemia Cardiac catheterisation
Surgery
Others
Drugs toxicity

9. Causes of
cardiac arrest
Adults
• Ischemic heart disease - AMI- with/or ventricular fibrillation (> 80%)
Children
• Suffocation or choking with hypoxemia or asphyxia.
• Ventricular fibrillation is rare in children (only 5-8%)
• Trauma

10. Different approach to the emergency system
activation
Adults
 Electric defibrillator is necessary as soon as possible;
therefore, if telephone is available and you are alone:
 call for help, then
 start with CPR
Children
 start CPR immediately for 1 minute to provide
some tissue oxygenation
 then call for help

11. CPR not
indicated..
 Signs of definitive biological death
Witnessed cardiac arrest had happened 15 or more minutes before the
rescuer arrived (time assessment in the stressing situation is not precise)
Terminal stage of incurable disease
An evident trauma without chance to survive (catastrophic head injury)
 “living will” - only in countries when constitution accepts it
 DNR - “Do not attempt resuscitation” has been written in the file
(incurable disease after all available therapy failed)

12. CPR outcome
In first 4 minutes – brain damage is unlikely, if CPR started
 4 – 6 minutes – brain damage possible
 6 – 10 minutes – brain damage probable
 > 10 minutes – brain damage certain
 Cells of the brain cortex
 Most sensitive for the stop of the perfusion and oxygenation
 Without perfusion and oxygenation irreversibly damaged after 3-5
minutes

13. BLS
components
 Ensure safety
 Check for response
 Activate EMS (emergency medical services)
 Chest compressions
 Rescue breaths
 Defibrillation

14. Ensure safety!
 Safety Of Self
 Safety Of Patient
 Movement of a trauma victim – only when absolutely
necessary!! [unstable cervical spine – injured spinal
cord]

15. Assess
response
 Gently shake his shoulders and ask loudly: “Are you all
right?"
 If he responds:
 Leave him in the position in which you found him, provided
there is no further danger;
 Call for help
 Return as quick as possible and reassess the condition of the
person.

16. Activate EMS
(call an
ambulance)
 Ask a helper to call if possible otherwise call them yourself
 Stay with the victim when making the call if possible
 Activate the speaker function on the phone to aid
communication with the ambulance service
 Describe the emergency to the operator:
 including where you are (address and location)
 condition of patient

17. Open airway
 Turn the victim onto his back
 HeadTilt & chin lift
 Place your hand on his forehead and gently tilt
his head back; with your fingertips under the
point of the victim's chin, lift the chin to open
the airway.
 Jaw thrust

18. Breathing
 Look, listen and feel for normal breathing for no more than 10 seconds
 In the first few minutes after cardiac arrest, a victim may be barely
breathing, or taking infrequent, slow and noisy gasps.
 Do not confuse gasping with normal breathing.
 In case of doubt, treat as apnoea!

19. Chest
compressions
• Kneel by the side of the victim
• Place the heel of one hand in the centre of the victim’s chest; (which is the
lower half of the victim’s sternum)
• Place the heel of your other hand on top of the first hand
• Interlock the fingers of your hands and ensure that pressure is not applied
over the victim's ribs
• Keep your arms straight
• Do not apply any pressure over the upper abdomen or the bottom end of
the bony sternum
• Position your shoulders vertically above the victim's chest and press down
on the sternum to a depth of 5–6 cm
• After each compression, release all the pressure on the chest without
losing contact between your hands and the sternum; Repeat at a rate of
100–120 min-1

20. Rescue breaths
Open the airway again using head tilt and chin lift and give 2
rescue breaths:
 Pinch the soft part of the nose closed, using the index finger and thumb of
your hand on the forehead
 Allow the mouth to open, but maintain chin lift
 Take a normal breath and place your lips around his mouth, making sure
that you have a good seal
 Blow steadily into the mouth while watching for the chest to rise, taking
about 1 second as in normal breathing; this is an effective rescue breath
 Maintaining head tilt and chin lift, take your mouth away from the victim
and watch for the chest to fall as air comes out
 Take another normal breath and blow into the victim’s mouth once more
to achieve a total of two effective rescue breaths. Do not interrupt
compressions by more than 10 seconds to deliver two breaths.

21. Expired air resuscitation - several techniques:
 Mouth-to-mouth breathing
 Mouth-to-nose breathing
 Mouth-to-mouth + nose breathing ( small children)
 Mouth-to the barrier device ( to protect the rescuer)
 Mouth to tracheostomy
Self-inflating bag

22. Oxygen content
 In atmospheric air - 21%
 In alveoli - 14,5%
Expired air – diluted by air from the airways (dead space)
 16 – 18 % O2
 Provided that there is an adequate amount of expired air
reaching the victim's lungs, oxygen delivery will be sufficient to
ensure that the victim's haemoglobin will be over 80%
saturated with oxygen.

24. AED
 Advanced computer technologies
 Ability to interpret heart (ECG) rhythm
 Ability to determine whether defibrillation is required
 Delivery of electric shock
 Guides the operator through every action
 Provides voice and message prompts

25. AEDs will automatically switch
themselves on when the lid is opened
Switch on AED

26. Attach pads to casualty’s bare chest
Attach pads to patient’s bare chest

27. Analyse rhythm – do not touch victimAnalyse rhythm – do not touch victim

28. Shock
indicated –
stand clear

29. Rescuer giving defibrillation shock
• is responsible for his safety
• is responsible for the safety of other people surrounding the
victim

30. Immediately
resumeCPR
30 : 2

31. Need new
picture
If victim starts to breathe normally place him in recovery position

32. Defebrillation
safety
Patient AED
Pacemaker In good working order
Jewellery Do Not use in Heavy rain
Hair on chest Do Not use if they lay in a pool of
water
Damp / wet skin Do Not use in an explosive
environment
Patches

33. StopCPR ..
 after 20 minutes
 without restoration of the spontaneous circulation
 before 20 minutes when:
 rescuer is physically exhausted
 when signs of biological death develop (post-mortal rigidity, post-
mortal cooling and gravity-dependent livid stains)

34. ContinueCPR..
Continue CPR after 20 minutes in case of:
 hypothermia
 persistent shockable rhythm

35. Airway
management