BLS

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ADULT BASIC LIFE SUPPORT (BLS)
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BASIC LIFE SUPPORT

• SEQUENCES OF PROCEDURES PERFORMED TO RESTORE THE
  CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN
  PULMONARY AND/OR CARDIAC ARREST
• involves
• CHEST COMPRESSIONS AND PULMONARY VENTILATION
  PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT,
  ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER
  EQUIPMENT

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• Healthcare institutions have an obligation to
  provide an effective resuscitation service
• Failure to provide an effective service is a
  failure in duty of care

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OBJECTIVES

• Rescuer 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.

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BACKGROUND

• Approximately 700,000 cardiac arrests per year in
  Europe . Indian statistics ?
• Survival to hospital discharge presently
  approximately 5-10
• Bystander CPR vital intervention before arrival
  of emergency services doubles survival from
  sudden cardiac arrest
• Early resuscitation and prompt defibrillation
  (within 1-2 minutes) can result in gt60 survival

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CHAIN OF SURVIVAL
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Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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APPROACH SAFELY!

• Scene
• Rescuer
• Victim
• Bystanders

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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CHECK RESPONSE

• Shake shoulders gently
• Ask Are you all right?
• If he responds
• Find out what is wrong.
• Reassess regularly.
• If he does not respond

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SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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OPEN AIRWAY

• Head tilt and chin lift
• lay rescuers
• No need for finger sweep
• unless solid material can be seen seen
  in airway

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OPEN AIRWAY
Head tilt, chin lift jaw thrust - For
healthcare professionals
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CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64(psg)
30 chest compressions
2 rescue breaths
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CHECK BREATHING

• Look, listen and feel for NORMAL breathing
• Do not confuse AGONAL breathing with normal
  breathing

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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

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Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 ( psg)
30 chest compressions
2 rescue breaths
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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

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RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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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

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RESCUE BREATHS

• RECOMMENDATIONS
• - Tidal volume
• 500 600 ml
• - Respiratory rate
• give each breaths over about 1s with enough
• volume to make the victims chest rise
• - Chest-compression-only
• continuously at a rate of 100 min

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CONTINUE CPR

• 30 2

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CONTINUE RESUSCITATION UNTIL

• Qualified help arrives and takes over
• Victim starts breathing normally
• Rescuer becomes exhausted

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Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108 / 64 (psg)
30 chest compressions
2 rescue breaths
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IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN
RECOVERY POSITION
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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, breathe Can not breathe/wheezy breathing/silent attempts to cough/ unconsciousness
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ADULT FBAO TREATMENT
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BACK BLOWS
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ABDOMINAL THRUSTS
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Guideline changes for BLS

• WHY? Simplifying guidelines to aid retention
  of BLS skills
• To reflect the greater importance placed on
  chest compression
• To reduce the number and duration of pauses
• Make a diagnosis of cardiac arrest if a victim is
  unresponsive and not breathing normally.
• 2) Teach rescuers to place their hands in the
  centre of the chest, rather than to spend more
  time using the rib margin method.
• 3) Give each rescue breath over 1 sec rather than
  2 sec.
• 4) Use a ratio of compressions to ventilations of
  302 for all adult victims of sudden cardiac
  arrest. Use this same ratio for children when
  attended by a lay rescuer.
• 5) For an adult victim, omit the initial 2 rescue
  breaths and give 30compressions immediately after
  cardiac arrest is established.

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Special circumstances

• Child
• needs expertise and training
• Ideally, pediatric resuscitation team
• knowledge of equipment doses for a child
• Trauma
• multidisciplinary trauma team
• skilled in RSI and intubation
• Pregnancy
• Early involvement of an obstetrician and
  neonatologist
• Possibility of Peri-mortem Caesarean section

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Training of Health Personnel

• regular resuscitation training
• should be able to
• recognize the arrest
• summon help
• start CPR using airway adjuncts, and attempt
  defibrillation within 3 minutes of collapse.
  This is the minimum standard.
• New staff should have resuscitation training as
  part of their induction programme.

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• THANK YOU