1. Basic Life Support for Adults
Prof. Dr. Ram Sharan Mehta, MSND, CON
1

2. OBJECTIVES
Participants 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.
2

3. How many times does the human
Heart beat in a day ?
1,00,800 beats per day
(70 beats x 60 minutes x 24
hours = 1,00,800 beats)

4. BRAIN TISSUE = ?
HEART TISSUE =?
KIDNEY TISSUE=?
CPR=CPCR
CARDIO PULMONARY CEREBRAL RESUSCITATION
Death of Tissue after cutoff oxygen
4

5. BLS ALS: steps
A
B
C
D
 D
 E
 F
 G
 H
 I

6. DEFINITIONS
 CARDIAC ARREST: Abrupt cessation
of cardiac pump function which may
be reversible by a rapid intervention
but will lead to death in its absence.
 DEATH: Irreversible cessation of all
biologic functions

7. Introduction:
 Lack of resuscitation skills of nurses and doctors
in basic life support (BLS) and advanced life
support (ALS) has been identified as a contributing
factor to poor outcomes of cardiac arrest victims.
 The hypothesis was that nurses’ knowledge on
BLS and ALS would be related to their
professional background as well as their
resuscitation training.
7

8. Introduction...
 Approximately 700,000 cardiac arrests per year
in Europe
 Survival to hospital discharge presently
approximately 5-10%
 Bystander CPR vital intervention before arrival of
emergency services – double or triple survival
from sudden cardiac arrest (SCA).
 Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60% survival
8

9. CHAIN OF SURVIVAL
9

10. 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
Protective devices
10

11. BLS
 Its Cardiopulmonary Resuscitation (CPR).
 Combines rescue breathing and chest
compressions
 Revives heart (cardio) and lung
(pulmonary) functioning
– Use when there is no breathing and no pulse
 Provides O2 to the brain until ACLS
arrives
11

12. How CPR Works
 Effective CPR provides 1/4 to
1/3 normal blood flow
 Rescue breaths contain 16%
oxygen (exhaled).
12

13. Start CPR Immediately
 Better chance of survival
 Brain damage starts in 4-6
minutes
 Brain damage is certain after
10 minutes without CPR
13

14. Do Not Move the Victim Until CPR is
Given and Qualified Help Arrives…
 unless the scene dictates
otherwise
– threat of fire or explosion
– victim must be on a hard surface
– Place victim level or head slightly
lower than body
14

15. Even With Successful CPR, Most
Won’t Survive Without ACLS
 ACLS (Advanced
Cardiac Life
Support)
 ACLS includes
defibrillation,
oxygen, drug
therapy
15

16. 16
BLS = CPR = ABC?

17. Basic Life Support (BLS)
ABCs - Airway, Breathing, Circulation
 Steps to follow in BLS
– Approach Safely
– 1. Check the responsiveness of the victim
– 2. Call for Help
– 3. Position victim on his or her back
– 4. Open the airway
– 5. Assess breathing
– 6. Assess circulation
– 7. Stay with the victim until help arrives.
17

18. Details of the Steps:
18

19. APPROACH SAFELY!
Scene
Rescuer
Victim
19

20. 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.
20

21. SHOUT FOR HELP
21

22. Open the airway with the head tilt-
chin lift method to check for
breathing.
Check for Breathing
22

23. 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
23

24. Look, listen and feel for breathing
for not over 10 seconds.
Check for Breathing
24

25. OPEN AIRWAY
Head tilt, chin lift + jaw thrust
- healthcare professionals
25

26. Head Tilt–Chin Lift Maneuver
Step 1 Step 2
Step 3 Step 4

27. Jaw-Thrust Maneuver
Step 1 Step 2
Step 3

28. Use a barrier device of some type
while giving breaths.
Giving Breaths
28

29. Give 2 breaths, each for about 1
second, watching the chest rise
and fall.
Giving Breaths
29

30. 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
30

31. 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
31

32. Pocket mask vs bag-valve mask
• Easy to use and
easily available
• One way valve
• Can give O2 up to
50%
Pocket
mask
• Takes more skill and
requires 2 people in
most cases
• Can give O2 up to
85%
Bag-
valve
Mask

33. Give 30 chest compressions, hard
and fast, positioning hand
midway between breasts.
Giving Chest Compressions
33

34. Use cycles of 2 breaths and 30
compressions.
Cycles of
Breaths/Compressions
2 breaths +
30 compressions
34

35. • 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
CHEST COMPRESSIONS
35

36. CONTINUE CPR
30 2
36

37. DEFIBRILLATION
37

38. Date
East of England Ambulance Service
NHS Trust
BLS & AED
12/02/201538
Understanding Defibrillation
 The heart’s pumping
action controlled by
electrical system
 Electrical rhythm normally
very organized
 Normal heart’s rhythm is
called “Sinus Rhythm”
 Normal heart rate of 60 -
100 beats per minute
Sinus Rhythm

39. Date
East of England Ambulance Service
NHS Trust
BLS & AED
12/02/201539
Understanding Defibrillation:
Ventricular Fibrillation (VF)
 VF is the most common
rhythm in Sudden
Cardiac Arrest (90%)
 Electrical Problem in
Nature
 Chaotic rhythm results in
“quivering of heart” and
results in loss of pulse
 VF will result in brain
damage within 5 minutes
and death in 10-15
minutes

40. Date
East of England Ambulance Service
NHS Trust
BLS & AED
12/02/201540
Understanding Defibrillation
 Defibrillation may correct VF
 Uses DC current delivered
across the heart
 A successful defibrillation
“depolarizes” the heart’s
cells
 Depolarization allows the
cells to “reorganize”
 Defibrillation is the ONLY
effective cure for VF!

41. DC Shock: Joules
AED OR Defibrillation Machine
 150-360 Joules: Monophasic
 150-270 Joules: Biphasic
41

42. Use the AED as soon as it is
available and ready to use.
Use of an AED
Automated External Defibrillator42

43. Follow the AED prompts to give a
shock, then give CPR again
while the AED is analyzing the
victim’s rhythm.
Using AED and CPR
43

44. First turn it on.
Then simply follow instructions.
Using an AED
44

45. AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)
 Some AEDs will
automatically switch
themselves on when
the lid is opened
45

46. ATTACH PADS TO
CASUALTY’S BARE CHEST
46

47. ANALYSING RHYTHM
DO NOT TOUCH VICTIM
47

48. SHOCK INDICATED
 Stand clear
 Deliver shock
48

49. SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
30 249

50. NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS
30 250

51. IF VICTIM STARTS TO
BREATHE NORMALLY PLACE
IN RECOVERY POSITION
51

52. 52

53. DEFIBRILLATION SAFETY !
 THE PATIENT.
 5 point check
 Pacemaker
 Jewellery
 Hair on chest
 Damp/Wet skin
 Patches (GTN)
 THE AED.
 In good working order
 Do Not use in Heavy
rain
 Do Not use if they lay in
a pool of water
 Do Not use in an
explosive environment !

54. If the victim responds, position him
in the recovery position and
monitor breathing until help
arrives.
The Recovery Position
Infant Recovery Position
54

55. Complications of CPR
 Skeletal injuries especially rib#
 Visceral injuries- myocardial and pulmonary
contusions, blood in pericardial sac,
pneumothorax, liver and spleen rupture, gastric
perforation
 Airway injuries- tracheal & laryngeal injuries
 Skin and integument damage

56. Immediately after CPR…
 Laryngoscopy; 100% oxygen
 Urinary catheter
 NG tube
 establish or verify existing intravenous
access; start with NS
 Transfer to a special care unit for
continuous monitoring and therapy.

57. After CPR…
Complete exam including
– serial vitals
– urine output
– 12-lead ECG
– Chest x-ray
– Blood glucose
– Serum urea,
creatinine
– serum electrolytes
(+Mg++ and Ca++)
– Cardiac markers

58. Atropine, Adrenaline, CaCl2,
Digoxin
 Atropine: 5 amp (3 mg) single bolus dose to
increase heart rate
 Adrenaline: 1 ml=1mg, 1amp=1:1000 dilution,
1gm=1000mg, 1000mg=1000ml 1mg every 2-3
min till B P is maintained
 Cacl 2= 5-10 mmol
 Digoxin = 0.5 mg stat then 0.25 mg 6hrly

59. Factors contributing to cardiac arrest or complicating
resuscitation or post-resuscitation care
H’s
 Hypovolemia
 Hypoxia
 H+ (acidosis)
 hyper-/hypokalemia
 Hypoglycemia
 hypothermia
T’s
 Toxins
 tamponade (cardiac)
 tension pneumothorax
 thrombosis of coronary or
pulmonary vasculature
 trauma

60. Prognosis
5 clinical signs strongly predicting death or
poor neurological outcome:
No corneal reflex at 24 hours
No pupillary response at 24 hours
No withdrawal response to pain at 24hours
No motor response at 24 hours
No motor response at 72 hours

61.  Stroke (first 2 hours are critical)
 Asthma (check for inhalers)
 Fainting (look for injuries from fall)
 Seizures (check for medication)
 Diabetic emergencies
 Chocking
 Poisoning
First Aid Management for Common Problems:
61

62. CONTINUE RESUSCITATION UNTIL
– Qualified help arrives and takes over
– Victim revives: The victim starts
breathing normally
– Rescuer becomes exhausted
– Cardiac arrest of longer than 30 minutes
(controversial)
62

63. Summary
63

64. Simplified adult BLS algorithm.
Robert A. Berg et al. Circulation. 2010;122:S685-S705
Copyright © American Heart Association, Inc. All rights reserved.

65. BLS healthcare provider algorithm.
Robert A. Berg et al. Circulation. 2010;122:S685-S705
Copyright © American Heart Association, Inc. All rights reserved.

66. 66

67. Next Session: ALS
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68.  Circulation by cardiac compression
Airway management by equipments
 Breathing by advanced techniques
 Defibrillation by manual defibrillator
 Drugs.
68
ALS includes:

69. ALS ALGORITHM
69

70. Thank you
70
The woods are lovely dark and
deep but, I have promises to keep
and miles to go before I sleep and
miles to go before I sleep
-Robert Frost