Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway.

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BASIC LIFE SUPPORT
Be prepared for trouble.
Don’t fall apart when trouble strikes.
-Carl Sommer

2. GENERAL CONCEPT
This Module booklet explains about Basic Life Support. BLS is the foundation for saving lives after cardiac
arrest. You will learn the skills of high-quality cardiopulmonary resuscitation (CPR) for victims of adult both
as a single rescuer and as a member of a multirescuer team. The knowledge you learn in this booklet will
enable you to recognize cardiac arrest, activate the emergency response system early and respond quickly and
confidently.
Why do we do what we do?
Life is why.
Life is a celebration of life. A simple yet powerful answer to the question of why
we should all be healthy in heart and mind.
I encourage you to discover your Why and share it with others. Ask yourself;
what are the moments, people and experiences I live for? What makes me joy,
wonder, and happiness? Why am I saves lives? Why is cardiovascular care
important to me? The answer to these questions is your Why.
Through informational Booklet you will find information that correlates with the
importance of cardiovascular care.
Module Booklet content:
 Basic Life Support
 Introduction of heart………..
 Location and surface projection, Layers of heart wall, Chambers of heart, Valves of
heart, Normal heart sound, Coronary circulation, Cardiac conduction system
 Cardiac Arrest………….
 Definition, Cause, Symptom, Diagnosis, Management
 Basic life support………..
 Definition, American Heart Association 2020 guideline, Basic Steps Assessment , High
quality CPR components for BLS providers, BLS Algorithm, Choking relief for adult
 Nurses Responsibility…………

3. BASIC LIFE SUPPORT
INTRODUCTION OF HEART
Heart is the vital organ in the circulatory system, primarily responsible for delivering the circulation of blood
and transportation of oxygen and nutrients, as well as assisting in the removal of metabolic wastes in all parts
of the body. The heart is usually beating about 60 to 100 times per minute.
LOCATION AND SURFACE PROJECTION
• The heart is the hollow, cone shaped about the size of closed fist
• The heart is specifically located in thoracic cavity. It lies in the mediastinum between the lungs and
rests upon the diaphragm.
• The heart lies within a fluid filled cavity called pericardial cavity.
• The heart weighs about 250- 350 gms.
LAYERS OF HEART WALLS
• Layers of heart: Pericardium/ Epicardium, myocardium, endocardium.
1. PERICARDUIM/ EPICARDUIM:
It is the layer immediately outside of the heart muscle proper (the myocardium). The epicardium is
largely made of connective tissue and functions as a protective layer.
Pericardium is the membrane (sac) that surrounds and protects the heart by the help of two layers.

4. BASIC LIFE SUPPORT
a. Fibrous pericardium- superficial layer, tough, inelastic, prevents overstretching, provide protection
and anchors the heart in place.
b. Serous pericardium-
1. Parietal layer- fused to the fibrous pericardium
2. Visceral layer or epicardium- adheres to the heart itself
c. Pericardial cavity – Present between two layers is filled with pericardial fluids which reduce friction.
2. MYOCARDUIM
The myocardium of the left ventricle is the thickest, as this ventricle is responsible for generating the power
needed to pump oxygenated blood from the heart to the rest of the body.
3. ENDOCARDUIM
Endocardium (endo-cardium) is the thin inner layer of the heart wall. This layer lines the inner heart
chambers, covers heart valves, and is continuous with the endothelium of large blood vessels. The
endocardium of heart atria consists of smooth muscle, as well as elastic fibers.
CHAMBERS OF HEART
There are four chambers of heart:
• Right Atrium
• Right Ventricle
• Left atrium
• Left ventricle
VALVE OF HEART:
• The four valves are the mitral valve, tricuspid valve, pulmonary valve and aortic valve.

5. BASIC LIFE SUPPORT
NORMAL HEART SOUNDS:
• Normal heart sounds are Lubb and Dubb.
CORONARY CIRCULATION
• It is the circulation of blood in the blood vessels of the heart muscle. The vessels that deliver oxygen-
rich (oxygenated) blood to the myocardium are known as coronary arteries. The vessels that remove
the deoxygenated blood from the heart muscle are known as cardiac veins.
CARDIC CONDUCTION SYSTEM
• The cardiac conduction system involves the spread of electrical activity from the sinoatrial node, to
the atrioventricular node, down the bundle of His and along the Purkinje fibres. As the electrical
activity spreads along the heart’s conduction system it initiates myocardial contraction in the
surrounding myocardial tissue.

6. BASIC LIFE SUPPORT
• The sinoatrial (SA) node or sinus node is the heart's natural pacemaker. The sinoatrial (SA) node or
sinus node is the heart's natural pacemaker. The AV node serves as an electrical relay station, slowing
the electrical current sent by the sinoatrial (SA) node before the signal is permitted to pass down through
to the ventricles. The bundle of His is an important part of the electrical conduction system of the heart,
as it transmits impulses from the atrioventricular node, located at the anterior- inferior end of the
interatrial septum, to the ventricles of the heart. The left bundle branch further divides into the left
anterior and the left posterior fascicles. These bundles and fascicles give rise to thin filaments known
as Purkinje fibers.
CARDIAC ARREST
Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart to pump effectively.
Causes:
 Abnormal heart rhythm
 Ventricular fibrillation
 Arrhythmias develop in people with conditions such as:
 Heart attack- often due to coronary artery disease
 Cardiomyopathy
 Congenital heart disease
 Heart rhythm abnormalities
 Coronary heart disease
Symptoms:
Cardiac arrest does not show warning symptoms in nearly half the cases. The main symptoms are:
 Loss of consciousness

7. BASIC LIFE SUPPORT
 Collapse/fainting
 Absence of breathing
 No pulse
Sometimes, chest pain, light-headedness, palpitations or vomiting may be seen before the arrest.
DIAGNOSIS:
Clinical diagnosis is made when there is an absence of a pulse. The gold standard for diagnosis is a lack of
carotid pulse. Additional tests may include:
Common tests & procedures
Blood test: Check levels of potassium and magnesium and hormones.
Hormone test: To check the levels of hormones that may affect the ability of the heart to function.
Electrocardiogram (ECG or EKG): Detects abnormal electrical activity and reveals disturbances in heart
rhythm.
Echocardiogram: Produces images of the heart. Done to identify areas of the heart that has been damaged
by the heart attack.
Nuclear stress test: To identify problems related to blood flow to the heart.
MANAGEMEMT:
Cardiac arrest requires immediate action i.e. Basic Life Support.

8. BASIC LIFE SUPPORT
Medication
 Beta blockers: Drugs used to manage abnormal heart rhythm.
 Atenolol, Metoprolol, Thrombolytic agents, Calcium, sodium, bicarbonates.
 ACE inhibitors: Drugs used to treat hypertension and congestive heart failure.
 Enalapril, Fosinopril, Epinephrine, Vasopressor, Antiarrhythmic: Amiodarone, Magnesium, Atropine,
 Defibrillation, Tracheal Intubation, Targeted Temperature management
Surgical Procedure:
 Coronary angioplasty: Opens blocked coronary arteries.
 Coronary artery bypass graft (CABG): Vein or artery from other parts of the body (usually taken
from thigh, arm or mammary vein) is used to bypass a blocked or narrowed artery.
 Radiofrequency catheter ablation: Used to block a single abnormal electrical pathway.

9. BASIC LIFE SUPPORT
Dietary modification:
To be eaten To be avoided
 Variety of fruits and vegetables
 Low fat or fat-free dairy products
 Poultry
 Fish
 Whole grains such as oatmeal and whole-
wheat pasta
 Saturated and trans fat
 Excess salt and sugar
Self care practices:
 Quit smoking and alcohol.
 Monitor blood sugar and cholesterol levels.
 Monitor your blood pressure regularly.
 Manage stress.
 Maintain the recommended weight.

10. BASIC LIFE SUPPORT
BASIC LIFE SUPPORT
Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers
and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress
or an obstructed airway. It requires knowledge and skills in cardiopulmonary resuscitation (CPR), using
automated external defibrillators (AED) and relieving airway obstructions in patients of every age.
BLS includes: Airway, Breathing, Circulation, Automated External Defibrillator, and Management of
chocking and foreign body obstruction.
According to American Heart Association 2020 guideline:
Chain of survival:
The 5 links in the adult in-the-hospital Chain of Survival are:
Surveillance,
prevention, and
treatment of pre
arrest conditions.
Immediate
Recognition of
cardiac arrest and
activation of the
emergency
response system
Early cardiopul-
monary
resuscitati-on
with an emphasis
on chest
compressions
Rapid
defibrillati-
on.
Multidisciplin-
ary post-cardiac
arrest care.

11. BASIC LIFE SUPPORT
The 5 links in the adult out-the-hospital Chain of Survival are:
Recognition of
cardiac arrest
and activation
of the
emergency
response
system
Early
cardiopul-
monary
resuscitation
with an
emphasis on
chest
compressions
Rapid
defibrillation
.
Basic and
advanced
emergency
medical services.
Advanced
life support
and post-
cardiac arrest
care.
BASIC STEPS OF ASSESSMENT:
CIRCULA-
TION:
Check the patient
for a carotid pulse
for 5-10 seconds.
Do not check for
more than 10
seconds
AIRWAY:
Tilt the victim's
head back, and
lift the chin to
open the airway.
BREATH-ING:
Give mouth to
mouth rescue
breathing.
DEFIBRIL-
LATION:
They are used to
prevent or correct
an arrhythmia.

12. BASIC LIFE SUPPORT
HIGH QUALITY CPR COMPONENTS FOR BLS PROVIDERS
COMPONENT DESCRIPTION
Scene safety Make sure the environment is safe for the rescuers and victim
Recognition of
cardiac arrest
 Check for responsiveness.
 Tap the victim’s shoulder and shout, “Are you OK?"

 No breathing or only gasping (i.e.) no normal breathing)
 Scan the victim’s chest for rise and fall.
 Check carotid pulse in between the trachea and the muscles at the side of the neck.
 Feel the pulse for at least 5sec but not more than 10 second.
Activation of
emergency
response system
 If alone with no mobile phone, leave the victim to activate the emergency response sytem
and get the AED before beginning CPR.
 Otherwise send someone and begin CPR immediately.
Compression-
ventilation ratio
without
advanced airway
 1 or 2 rescuers
 30:2
Compression-
ventilation ratio
with advanced
airway
 Continuous compressions at a rate of 100-120/min.
 Give 1 breath every 6 second (10 breaths/ min)
Compression
rate
 100-120/min
Compression
depth
 At least 5 cm
Continue CPR  Do not interrupt resuscitation until:
 A health professional tells you to stop
 You become exhausted
 The victim is definitely waking up, moving, opening eyes and breathing normally
 It is rare for CPR alone to restart the heart. Unless you are certain the person has
recovered, continue CPR
Hand placement  2 hands on the lower half of the breastbone (Lower portion of sternum)
Chest recoil  Allow full recoil of chest after each compression: do not lean on the chest after each
compression.
Minimizing
interruptions
 Limit interruptions in chest compressions to less than 10 seconds

13. BASIC LIFE SUPPORT
BLS ALGORITHM

14. BASIC LIFE SUPPORT
CHOKING RELIEF FOR ADULT
Early recognition of foreign-body airway obstruction is the key to successful outcome. It is important to
distinguish this emergency from fainting, stroke, heart attack, seizure, drug overdose, or other conditions that
may cause sudden respiratory distress but require different treatment.
Foreign bodies may cause a range of signs from mild to severe airway obstruction.
Signs Rescuer Actions
Mild airway
obstruction
 Good air exchange
 Can cough forcefully
 May wheeze between coughs
 As long as good air exchange continues,
encourage the victim to continue coughing.
 Do not interfere with the victim’s own attempts
to relieve the obstruction, but stay with victim and
monitor the condition.
 If mild airway obstruction continues or
progresses to signs of severe airway obstruction,
activate the emergency response system.
Severe airway
obstruction
 Clutching the throat with the
thumb and fingers, making the
universal choking sign.
 Unable to speak or cry
 Poor or no air exchange
 Weak, ineffective cough or no
cough at all.
 Increased respiratory difficulty
 Possible cyanosis (turning
blue)
 If the victim is an adult, asks him if he victim nods
“yes” and cannot talk, severe airway obstruction
is present.
 Take steps immediately to relieve the obstruction.
 If severe airway obstruction continues and the
victim becomes unresponsive, start CPR.
 If you are not alone, send someone to activate the
emergency response system. If you are alone,
provide about 2 minutes of CPR before leaving
to activate the emergency response
system.

15. BASIC LIFE SUPPORT
Choking relief in a Responsive Adult: With Victim sitting or standing
Step Action
1. Stand or kneel behind the victim and wrap your arms around the victim’s waist.
2. Make a fist with one hand.
3. Place the thumb side of your fist against the victim’s abdomen, in the midline, slightly
above the navel and well below the breastbone.
4. Grasp your fist with your other hand and press your fist into the victim’s abdomen with a
quick, forceful upward thrust.
5. Repeat thrusts until the object is expelled from the airway or the victim becomes
unresponsive.
6. Give each new thrust with a separate, distinct movement to relieve the obstruction.
Choking relief in an Unresponsive Adult: With Victim sitting or standing
Step Action
1. Shout for help. If someone else is available, send that person to activate the emergency
response system.
2. Gently lower the victim to the ground if you see that he is becoming unresponsive.
3. Begin CPR, starting with chest compressions. Do not check for a pulse.
4. Each time you open the airway to give breaths, open the victim’s mouth wide.
Look for object.
 If you see an object that can be easily removed, remove it with your fingers.
 If you see an object, continue CPR.
5. After about 5 cycles or 2 minutes of CPR, activate the emergency response system if
someone has not already done so.

16. BASIC LIFE SUPPORT
Nurses Responsibility
 Immediate management (Basic Life Support)
 Administer medications Such as (Anti- anginals)
 Administer supplemental Oxygen by nasal prongs or face mask as indicated
 Monitor Vital sign(pulse, blood pressure)
 Note heart sounds
 Monitor laboratory Status e.g BUN, Creatinine
 Measure cardiac output and other functional parameters
 Monitor closely ECG and Chest x-ray changes and electrolyte and nutrition
 Administer IV solution as prescribed
 Encourage rest, semi recumbent in bed or chair, Assist with physical care as indicated.
 Emotional Support Patient/client and family

17. Where to go for more information?
If you need more information, please go to
www.heart.org
www.international.heart.org
www.en.wikipedia.org/wiki/IndianHeartAssociation
For contacts:
+1 (800) 242-8721
+91 44 4202 6644
info@theproject.com