Adult Basic Life Support (BLS) Algorithm

Ref. 2010 AHA Guidelines for CPR and ECC

Adult Basic Life Support Algorithm

Immediate Recognition & Activation of Emergency Response System If a lone rescuer finds an unresponsive adult or witnesses an adult who suddenly collapses, after ensuring that the scene is safe, the rescuer should check for response by tapping the victim on the shoulder and shouting at the victim. If the victim also has absent or abnormal breathing, the rescuer should assume the victim is in cardiac arrest. Pulse Check Healthcare Provider should not take more than 10 seconds to check for a pulse. The lay rescuer should not check for pulse and should assume the victim is in cardiac arrest. If unable to definitely feel a pulse within 10 seconds, the rescuer should start chest compressions. Early CPR Chest Compressions consist of forceful rhythmic application of pressure over lower half of the sternum. By increasing intrathoracic pressure and directly compressing the heart, these compressions create blood flow and oxygen delivery to heart & brain. To provide this effectively, Push Hard and Push Fast. Compress the adult chest at a rate of at least 100 per minute with a compression depth of at least 2 inches/5 cm. Rescuers should allow complete recoil of the chest after each compression to allow the heart to fill completely before next compression. Minimise the frequency and duration of interruptions in chest compressions. To maximise the effectiveness of chest compressions Place the victim on a firm surface when possible, in a supine position, with the rescuer kneeling beside the victim's chest. Place the heel of one hand on the centre of the victim's chest (lower of sternum) and the heel of the other hand on top of the first such that hands are overlapped and parallel. To minimise rescuer fatigue and thereby ineffectiveness, rotate with another rescuer every 2 minutes (or after about 5 cycles of compressions and ventilations at a ratio of 30:2)

Airway If there is no evidence of head/neck trauma, use the Head TiltChin Lift manoeuvre to open the airway. If head/neck trauma is suspected, open the airway using a jaw thrust without head extension. Spinal injury should be suspected if victim has a craniofacial injury and/or a Glasgow Coma Scale score of < 8. Rescue Breaths Once chest compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation. Deliver each rescue breath over 1 second. Give a sufficient tidal volume to produce visible chest rise. Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations. Once an advanced airway (Endotracheal Tube/Combitube/Laryngeal Mask Airway) is in place, 2 rescuers need no longer pause chest compressions for ventilations. The rescuer giving chest compressions does it at the rate of least 100 per minute, while the rescuer delivering ventilation can provide a breath every 6 to 8 seconds (i.e., 8 to 10 breaths per minute) Early Defibrillation with Defibrillator After activating the emergency response system, the lone rescuer should next retrieve an AED if nearby & accessible and return to the victim to attach & use it. If two or more rescuers are present, one rescuer should begin chest compressions while the second rescuer activates emergency alarm system and gets the AED. After turning on the AED, follow the prompts to use it. Resume chest compressions immediately after the shock (minimise interruptions). Recovery Position It is used for unresponsive adult victims who have normal breathing and effective circulation. The victim is place on his/her side with the lower arm in front of the body.

CPR Sequence CAB

Compressions
Push hard and fast on the centre of the victim's chest

Airway
Tilt the victim's head back and lift the chin to open the airway

Breathing
Give mouth-to-mouth rescue breaths

CPR Starts with Compression

Many adults with witnessed arrest have ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) and require Chest Compressions Early Defibrillation Chest Compressions to be started immediately Opening airway, providing ventilation may significantly delay other actions Ventilation delayed by 18 seconds or less

Primary Emphasis on Chest Compressions

All rescuers should, at a minimum, provide chest compressions If bystander not trained: Hands-Only CPR If bystander trained & able / Healthcare Provider: Chest Compressions and Ventilations at rate of 30:2

Chest Compression Depth

Compress at least 2 inches / 5 centimetres Why? Oxygen flow to brain and heart stops Drugs go nowhere Rescuers often do not "push hard" enough

Chest Compression Rate

Compression Rate at least 100 per minute Why? Absolute number of compressions/minute linked with survival Actual compression rate is often well below 100/min

Summary of Key BLS Components

Component Recognition CPR Sequence Compression Rate Compression Depth Chest wall recoil Compression interruptions Airway Compression-toVentilation Ratio (until Advanced Airway placed) Ventilations: when rescuer untrained Ventilations with Advanced Airway (HCP) Defibrillation Recommendations Adults Children Infants Unresponsive (for all ages) NO breathing NO breathing or only gasping NO pulse palpated within 10 seconds (Health Care Provider only) CAB At least 100/minute At least AP diameter; At least AP diameter; At least 2 inches (5 cm) about 2 inches (5 cm) about 1 inches (4cm) Allow complete recoil between compressions Health Care Providers rotate compressions every 2 minutes Minimise interruptions in chest compressions Attempt to limit interruptions to <10 seconds Head Tilt-Chin Lift (Suspected trauma: Jaw Thrust) 30:2 1 or 2 Rescuers Single Rescuer 30:2 2 Health Care Provider 15:2 Compressions only 1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions; about 1 second per breath. Visible chest rise Attach and use AED as soon as available. Minimise interruptions in chest compressions before and after shock; Resume CPR beginning with compressions immediately after each shock