BASIC LIFE SUPPORT

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 OBJECTIVES
2

➢At the end of this session, you will be able to:

✓Define BLS and ALS
✓Explain the epidemiology of SCA
✓Recognize symptoms of SCA
✓Manage patients with SCA
✓Manage patients with chocking

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DISCUSSION
➢A 40 year old man has abnormal breathing/gasping with pulse: how
do you approach?

➢A 50 year old woman has spontaneous breathing with pulse: how do

you approach?

➢A 65 year old man falling down and collapsed, no pulse no breathing:

how do you approach?

➢A 35 year old pregnant woman has been collapsed because of

heavy bleeding: do you do CPR? If so, how? If not, why?

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Introduction
❖BLS
➢Is an ABC assessment and provision of basic life saving management to a
sick or injured patient

➢Can be provided by both non medical person or medical worker until ALS
can be accessed.

➢Can be practiced at any place, any time, by any one who has the training,
with no equipments or with some basic equipments
❖ALS
➢Refers to advanced life-saving procedures such as
intravenous therapy, drug therapy, intubation, and
defibrillation

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 Introduction... 5

➢Sudden cardiac arrest is an emergency when-sudden collapse, no pulse, no breathing

➢Sudden cardiac arrest (SCA) remains a leading cause of death in the United States.

➢In 2015, approximately 350,000 adults in the United States experienced nontraumatic out-
of-hospital cardiac arrest

➢70% of out-of-hospital cardiac arrests (OHCAs) occur in the home, and approximately 50%
are unwitnessed.

➢Outcome from OHCA remains poor and only 10.8%

➢In-hospital cardiac arrest (IHCA) has a better outcome, with 22.3% to 25.5%

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 CAUSES: 6

➢Coronary artery disease

➢Heart attack
➢Enlarged heart/cardiomyopathy
➢Valvular heart disease
➢Congenital heart disease – in children
➢Drowning
➢Asphyxia
➢Blunt force trauma to the chest.
➢Electrical disturbance in the heart-e.g. QT

Ventricular Fibrillation
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WHEN TO CALL THE AMBULANCE

❖Call ambulance if you experience any of these signs and symptoms:

➢Chest pain or discomfort

➢Heart palpitations
➢Rapid or irregular heartbeats
➢Unexplained wheezing
➢Shortness of breath
➢Fainting or near fainting
➢Lightheadedness or dizziness

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Risk Factors of Sudden Cardiac Death (SCD)

➢Family history of coronary artery disease

➢Smoking
➢High blood pressure
➢High blood cholesterol
➢Obesity
➢Diabetes
➢An inactive lifestyle
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ARREST RHYTHMS

What are they?

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SHOCKABLE RHYTHMS

Ventricular Fibrillation Pulseless Ventricular Tachycardia

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NON SHOCKABLE RHYTHMS

Asystole Pulseless Electrical Activity(PEA)

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Treatment- Chain of survival

➢BLS is the foundation for saving lives after cardiac arrest.

➢ Fundamental aspects of adult BLS include (chain of survival):

✓ Immediate recognition of cardiac arrest and activation of the emergency response

system

✓ Early CPR that emphasizes chest compressions

✓ Rapid defibrillation if indicated (If VF)

✓ Effective advanced life support- not done by firs aider

✓ Integrated post– cardiac arrest care/ROSC- no done by first aider

✓ Recovery (added in 2020)

➢ When the links in the Chain of Survival are implemented in an effective way, survival can approach
50% for witnessed VF cardiac arrest out of hospital
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TIME IS GOLD!!!

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 HOW TO APPROACH VICTIM?
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FOLLOW DRS-CABD
➢HAZARD/danger
➢HELLO/response/COWS method
➢HELP/ send
➢CIRCULATION/
COMPRESSION
➢AIRWAY
➢BREATHING
➢DEFIBRILLATION
✓ Stay with the victim until help
arrives.

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 ADULT BLS SKILLS
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➢Verify Scene Safety

➢Recognition of Arrest –Updated and activate emergency

response
➢Pulse Present, Normal Breathing (closely monitor the patient)

➢Pulse Present, No Normal Breathing –Updated (IM or IN naloxone for

prehospital) and supportive ventilation for hospital setting

➢Pulse Absent, No Breathing or Only Gasping (initiate CPR and use an AED
as soon as possible).
➢ Site of CPR- lower half of the sternum

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Sudden Cardiac Arrest (SCA)

“Chain of Survival” First link – Early access

Call for Help !

Patient evaluation
➢ Determine if conscious or not, by placing
one hand on patient’s forehead and
shaking shoulders gently with another
hand.

➢ In case of SCA patient will not respond.

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Recovery position

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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Steps of Cardiopulmonary Resuscitation (CPR)

➢ Determine C-A-B of Basic Cardiac Life Support (BCLS).

✓ C- for Circulation/Compression
✓ A- for Airway.
✓ B- for Breathing.
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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Circulation

Feel - carotids

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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Once SCA is confirmed …………

➢Patient should be placed on hard surface.

➢Start CPR.

➢Give 30 compressions followed by 2 expired breaths

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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Cardiac compressions

➢ Locate correct chest compression site,

2 - fingers above xiphoid.
➢ Place heel of other hand on the lower end
of breast bone.
➢ Fingers off the chest wall.
➢ Continue till AED is available.
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 Give 30 chest compressions at rate of 100-120 per minute
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Then give 2 ventilations

30

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CONTINUE CPR

30 2
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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Mouth to mouth ventilation

➢Remove any obvious obstruction.

➢Open airway.

➢Pinch victims nose.

➢Give mouth to mouth ventilation.

➢Repeat
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CHARACTERISTICS OF HIGH QUALITY CPR

➢High-quality CPR improves survival from cardiac arrest,
including:

✓Rate: chest compressions of adequate rate(100-120/min)

✓Depth: chest compressions of adequate depth (5-6cm)

✓Allowing full chest recoil between compressions

✓Minimizing interruptions in chest compressions (<10sec)

✓Avoiding excessive ventilation (deliver each breath in 1 sec)

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Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

➢ CPR saves time

➢ The most common cause of SCA is VF, a lethal rhythm

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➢ The only effective treatment is defibrillation 6/4/2024
 DEFIBRILLATION
27

➢ Know your AED (Use for VF & VT)

➢ Universal steps:
1. Power ON
2. Attach electrode pads
3. Analyze the rhythm
4. Shock (if advised)
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 Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Safety First
➢ Attach AED only to someone not breathing and without a pulse or signs of circulation.

➢ Make sure no one is touching the victim.

➢ Be sure the electrodes are firmly adhered to victims chest.

➢ Move oxygen away from the rescue effort before defibrillation.

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ATTACH PADS TO CASUALTY’S BARE

CHEST

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ANALYSING RHYTHM
DO NOT TOUCH VICTIM

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SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

30 2
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NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

30 2
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CPR FOR PREGNANT

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CPR FOR PREGNANT...

➢Left lateral displacement of the uterus if GA >20 weeks;

➢Earlier definitive airway control;

➢Removal of fetal monitor to avoid electrical arcing during

defibrillation;

➢Defibrillation pads may be positioned in anterior and

posterior on the left side if apical is challenge;

➢Cesarean section delivery-within 3-4 minutes

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 WHEN DO YOU STOP CPR?
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➢Spontaneous breathing is present (ROSC)

➢The rescuer is exhausted

➢Orders from the Doctor/DNR Order is presented

➢Paramedics or advanced team arrives

➢Patient obviously dead

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 FBAO-SEVERE AIRWAY 36

OBSTRUCTION (CHOCKING)

➢Victim is getting no air at

all
➢Victim will soon become
unresponsive
➢Heart will soon stop

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FBAO (CHOCKING)

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 BACK BLOWS

➢Stand to one side and slightly

behind

➢Lean casualty forward & support

chest with one hand

➢Give up to 5 back blows

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 ABDOMINAL THRUSTS
➢Stand behind casualty and lean them forwards

➢Place fist between navel and breastbone

➢Grasp with other hand, pull sharply inwards and

upwards

➢Repeat up to 5 times

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RECOVERY POSITION

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 MANAGEMENT OF THE CHOKING 42

INFANT
➢Lay infant on your arm in head down position

➢Give 5 blows to the infants back with heel of hand

➢If obstruction persists turn over and give 5 chest thrusts with 2
fingers, 1 finger breadth below nipple level in midline

➢If obstruction persists check infants mouth for any object which
can be easily removed

➢If necessary repeat sequence with back slaps again

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 MANAGEMENT OF THE CHOKING 43

INFANT

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 MANAGEMENT OF CHOKING CHILD
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➢Give 5 blows to the child’s back with heel of hand with child sitting,
kneeling or lying

➢If obstruction persists, go behind the child and pass your arms around
the child’s body: form a fist with one had immediately below the
child’s sternum; place the other hand over the fist and pull upwards
into the abdomen; repeat this Heimlich manoeuvre 5 times

➢If the obstruction persists, check the child’s mouth for any obstruction
which can be removed

➢If necessary repeat sequence with back slaps again

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 MANAGEMENT OF CHOKING CHILD
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Thank you !

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REFERENCES

➢BLS 2015 / 2020 updates pdf

➢Tintinalli’s Emergency medicine 8th edition

➢Internets

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