MEKELLE UNIVERSITY COLLEGE

OF HEALTH SCIENCE
Department of Medicine

Seminar on Basic Life Support

Moderator: Dr Merhawit
04/13/2011E.C
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 also focuses on the integration of ŸCritical
thinking with Problem solving , Communication ,
Team dynamics skill to help rescuers achieve
optimal patient outcomes:
 Primary Assessment of the
Unresponsive Adult Patient
• Level of Consciousness (LOC)

If the person is silent and not moving, he or she

may be unresponsive. To check for responsiveness,
tap the patient on the shoulder and shout, “Are you
okay?” Use the person’s name if you know it.
Speak loudly.
• Use the pneumonic AVPU to help you
determine the patient’s level of consciousness

Alert—fully awake, but may still be confused

Verbal—responds to verbal stimuli
Painful—responds to painful stimuli
Unresponsive—does not respond
 Airway
If the patient is unresponsive and his or her
airway is not open, you need to open the airway.
Two methods may be used:
[Link]-tilt/chin-lift technique
[Link] jaw-thrust maneuver, if a head, neck
or spinal injury is suspected
To perform the head-tilt/chin lift technique on
an adult:
• Press down on the forehead while pulling up
on the bony part of the chin with two to three
fingers of the other hand.
• For adults, tilt the head past a neutral position
to open the airway while avoiding
hyperextension of the neck
To perform The modified jaw-thrust maneuver
on an adult, kneel above the patient’s head and:
• Put one hand on each side of the patient’s
head with the thumbs near the corners of the
mouth pointed toward the chin.
• Slide the fingers into position under the
angles of the patient’s jawbone.
• Thrust the jaw upward without moving the
head or neck.
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, you must give ventilations.
• Give 1 ventilation every 5 to 6 seconds for an
adult patient, with each ventilation lasting
about 1 second and making the chest rise
 Once you begin giving ventilations, you must
continue until:

The patient begins to breathe on his or her

own.
Another trained rescuer takes over.
The patient has no pulse, in which case you
should begin CPR or use an AED if one is
available and ready to use.
 Cardiac arrest
• If there is no breathing, no pulse and the
patient is unresponsive, the patient is in
cardiac arrest.
The key to the patient’s survival is ensuring the
Cardiac Chain of Survival.
The Cardiac Chain of Survival for adults consists
of five links:
 early recognition
Early CPR to keep oxygen-rich blood flowing
and to help delay brain damage and death
Early defibrillation with an automated
external defibrillator (AED)
Advanced life support
Integrated post-cardiac arrest care to
optimize ventilation and oxygenation
 Providing CPR/AED
for Adults
• Cardiopulmonary resuscitation circulates
blood that contains oxygen to the vital organs
of a patient in cardiac arrest when the heart
and breathing have stopped.
• It includes chest compressions and
ventilations as well as the use of an
automated external defibrillator.
 Compressions
• One component of CPR is chest compressions.
• You can ensure high-quality CPR by providing
high-quality chest compressions, making sure
that the:
• ŸPatient is on a firm, flat surface to allow for
adequate compression
• The chest is exposed
 theory of blood flow during compressions

 cardiac pump theory=increased pressure in the

ventricles.
 The thoracic pump theory = pressure gradient from
intra thoracic to extra thoracic arteries.
 abdominal pump theory
The arterial component postulates blood flow into the
peripheral arterial system from increased arterial
pressure caused by abdominal compressions that forces
blood from the abdominal aorta against the closed aortic
valve. The venous component leads to blood return via
the inferior vena cava from abdominal pressure.
• Hands are correctly positioned with the heel
of one hand in the center of the chest on the
lower half of sternum with the other hand on
top
• Arms are as straight as possible
• Compressions are given at the correct rate of
at least 100 per minute to a maximum of 120
per minute, and at the proper depth of at
least 2 inches(5cm) for an adult to promote
adequate circulation.
The rescuer providing compressions should count out
loud and raise the volume of his or her voice as he or
she nears the end of each cycle (… 21 … 22 … 23 … 24
… 25 … 26 … 27 … 28 … 29 … 30). The rescuer at the
chest will move to give ventilations while the
rescuer at the head will move to the chest to provide
compressions.
• The chest must be allowed to fully recoil
between each compression to allow blood to
flow back into the heart following the
compression.
• For adult patients, CPR consists of 30 chest
compressions followed by 2 ventilations.
 Ventilations
• Ventilations supply oxygen to a patient who is not
breathing. They may be given via several methods
including:
 ŸMouth-to-Mouth Ventilation With the airway
open, gently pinch the patient’s nose shut with
the thumb and index finger
Protective devices(face shields) decrease the risks
to the provider of contracting an infectious disease
 Mouth-to-Nose Ventilation as with severe
maxillofacial trauma, mouth-to-nose ventilation
may be effective.
Mouth-to-Stoma or Tracheostomy Ventilation
After laryngectomy or tracheotomy, the stoma
or tracheostomy becomes the patient’s
airway.
Mouth/ bag -to-Mask Ventilation
During adult CPR, you give 2 ventilations that
last approximately 1 second each and make the
chest rise. There should be no pause in chest
compressions for delivery of ventilations.
• In an adult with normal perfusion, 8 to 10
mL/kg tidal volume is required for adequate
oxygenation and ventilation.
• However, in the setting of CPR, where cardiac
output is only 25% to 33% of normal
Approximately 6 to 7 mL/kg will suffice.
 Stopping CPR
• Once started, continue CPR with 30
compressions followed by 2 ventilations (1
cycle = 30:2) until:
You see signs of return of spontaneous
circulation
An AED is ready to analyze the patient’s
heart rhythm.
Other trained rescuers take over .
 Recovery Positions

• Recovery position is very usefull to prevent

aspiration.
• Kneel at the side of the patient and roll the
patient toward the rescuer.
• Place the top leg on the other with both knees
in a bent position.
• Align the arm on top with the upper body.
Recovery
 Complication of CPR
• Ventilations= insufflation of the stomach, leading to regurgitation and
aspiration and possibly to gastric rupture.
• Closed chest compressions=
 fractures of the sternum or the ribs
 Pulmonary or myocardial contusion
 pneumothorax
 hemorrhagic pericardial effusions
 splenic or liver laceration.
• Late complications =
• Pulmonary edema
• GI hemorrhage
• pneumonia,
• recurrent cardiopulmonary
arrest.
Proper techniques can minimize these complications
but cannot totally prevent them.
 Defibrillation
• is the therapeutic use of electricity to
depolarize the myocardium so
coordinated contractions can occur. The
term defibrillation is usually applied to an
attempt to terminate a nonperfusing
rhythm (e.g., ventricular fibrillation or
pulseless ventricular tachycardia).
Indications for defibrillation include ventricular
fibrillation (VF) and pulseless ventricular
tachycardia (VT).
contraindicated for sinus rhythm, a conscious
patient with a pulse.
N.B If the patient is on a wet or conducting
surface, move the patient to a safe
area and dry the body before delivering the shock.
• Regarding placement of defibrillation paddles
or pads, there are several
alternative positions:
1. Antero-apical position
2. Anteroposterior position
3. Apex-posterior position
 COMPLICATIONS
 skin burns
 inadvertent electric shock
 defibrillation-induced myocardial damage.

However, these complications are minimal

compared to the ultimate complication of patient
death if defibrillation is unsuccessful or not
attempted.
 Cardioversion
• is the application of electricity to
terminate a still perfusing rhythm (e.g.,
ventricular tachycardia with a pulse,
supraventricular tachycardias including
atrial arrhythmias) to allow a normal
sinus rhythm to restart.
 Cardioversion indication
hemodynamically unstable patient
with VT
supraventricular tachycardia
atrial flutter or atrial fibrillation.
possibly after failed pharmacologic therapy for
the previously mentioned arrhythmias,
 References
1. Tintinallis Emergency Medicine A
Comprehensive Study Guide_8th-1
2. BLS by Dr karl Disque
 THANK
YOUBY ESTIFANOS AND BROOKEY

C3 2011/12
HAPPY
NEW
YEAR