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Definition
Chest compressions and pulmonary ventilation performed by anyone who knows how to do
it, anywhere, immediately, without any other equipment.
CPR (Cardio pulmonary resuscitation) is the part of BLS. It is the non-invasive assessment
and intervention used to quickly identify and treat victims of respiratory, cardiovascular
emergencies.
Indications
Cardiac Arrest
Sudden, unexpected loss of heart function, breathing and consciousness. In cardiac arrest, the
heart abruptly stops beating without prompt intervention, it can result in persons’s death.
A blockage of the blood flow to the heart muscle. A heart attack is a medical emergency. A
heart attack usually occurs when a blood clot blocks blood flow to the heart, without blood,
tissues loses oxygen and dies.
Respiratory arrest
It is the state in which a patient stops breathing but maintains a pulse. Respiratory
Survival from sudden cardiac arrest is optimized when the event is witnessed and
CPR is initiated immediately
Patient survival declines dramatically if basic CPR is not initiated within first four
minutes
Goal of BLS :
oxygenation
Circulation
ADULT
BLS
Chain of survival
Important
Although BLS is taught as a sequence of distinct steps to enhance skills retention and clarify
priorities, several actions should be accomplished simultaneously (begin CPR and activate
emergency response system) when multiple rescuers are present.
All adult arrest are cardiac in origin therefore 1st step i.e. call for help is important because if
AED is not available it can come on time.
Airway (A)
Breathing (B)
Defibrillation (D)
Why change???
In ABCD, chest compressions were often delayed while the rescuer opened the airway to
give mouth to mouth breaths, retrieved a barrier device or gathered ventilation equipment.
With CABD, rescuer can start chest compressions sooner and likely to improve survival.
Contd…
Every minute chances of success decreases to 10-15% but if we start CPR by the time AED
is coming even in shockable rhythm, chances of success decreased to 3-4 from 10-15%.
Steps of BLS
Check pulse
Begin cycles of 30 chest compressions and 2 breaths if you do not definitely feel a pulse
within 10sec and perform 5 cycles (30:2) with CAB sequence.
1. Scene safety
Ask yourself…..
I need to take victim out of water / switch off the main switch to start CPR
my own safety?
gloves
Assessment
If not breathing or not breathing normally (gasping), activate emergency response system.
Ask him to tell EMS about the place and about collapsed victim?
3. Pulse check
Feel for a pulse for atleast 5sec but no more than 10 sec.
If you do not feel pulse within 10 seconds, start chest compressions (in CAB sequence)
4. Begin CPR
2. Opening Airway
breath
Revision
2. Call EMS
3. Check pulse
CIRCULATION
Circulation
After palpating pulse for atleast 10sec start with CPR if no definite pulse is palpable.
Contd…
Compression : ventilation
30 : 2 when 2 rescuers
arrest.
Push hard, push fast: Compress at a rate of atleast 100/min with depth of atleast 2inches
(5cm).
Process of CPR
Put the heel of the hand on the center of the victim’s chest on the lower half of the
breastbone.
Put the heel of your other hand on the top of first hand.
Straighten your arm with knees locked and position your shoulder directly over the hands.
At the end of each compression, make sure to allow complete chest recoil after
each compression.
Adjust position that your shoulders are on top of the victim and in line with hands
AIRWAY
• Jaw thrust
*Jaw thrust is used with 2 rescuers as two persons are needed to provide breaths.
*Head lilt-chin lift should be used until head or neck injury is suspected as it reduces
neck and spine movement.
Jaw thrust
Caution
Do not press into the soft tissue under the chin because this might block the airway.
BREATHING
Provide breaths
Hold the victim’s airway open with a head tilt – chin lift.
Pinch the nose closed with your thumb and index finger (using the hand on forehead)
Take a regular (not deep) breath and seal your lips around the victim’s mouth, creating an
airtight seal.
Give 1 breath (blow for 1sec). Watch for the chest rise.
If you are unable to ventilate the victim after 2 attempts, promptly return to chest
compressions.
Face mask
Standard precautions include using face mask or a bag mask ventilation when giving breaths.
Mask usually have a 1-way valve that diverts exhaled air, blood or bodily fluids away from
the rescuer.
Mouth to mask breaths
Place the mask on the victim’s face, using the bridge of the nose as a guide for correct
position.
Using the hand that is closer to the top of the victim’s head, place your
index finger and thumb along the edge of the mask.
Place the thumb of your second hand along the bottom edge of the
mask.
Contd….
• Place the remaining fingers of your second hand along the bony margin of the
jaw and lift the jaw
While you lift the jaw, press firmly and completely around the outside edge of the mask to
seal the mask against the face.
Place the mask on the victim’s face, using the bridge of the nose as a guide for correct
position.
Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the
airway open
Squeeze the mask to give breaths (1second each) while watching the chest rise.
E – C technique
2 rescuer
2 rescuer CPR
Contd…
The rescuers will then give compressions and breaths but should switch roles after every 5
cycles of CPR (about every 2min)
DEFIBRILLATION
Automated external defibrillators (AEDs) are computerized devices that can identify cardiac
rhythms that need a shock and these can deliver shock.
When VT is present, the heart muscle fibres quiver and do not contract together to pump
blood.
Contd…
This delivers shock to stop the quivering of the heart fibres and allows the muscle fibres of
the heart to ‘reset’ so that they can begin to contract at same time.
Once an organized rhythm occurs, the heart muscle may begin to contract effectively and
begin to generate a pulse (called ROSC)
Parts of AED
• On/off switch
• Pad connector
• Battery
If multiple rescuers are present, one rescuer should continue CPR while another rescuer
attaches AED pads.
Attempted Defibrillation
Current Recommendation
One shock
Biphasic 150-200J
Monophasic 360J
Immediate CPR
Using AED
Switch it on
Apply pads to bare chest of victim ( one to the side of the left nipple, with the top edge of the
pad a few inches below the armpit and other below right collar bone)
Let AED Analyze heart rhythm: do not touch the victim (it will take 5 to 15 sec to analyze)
Contd…
Loudly state a “clear the victim” message, such as “Everybody clear” or simply “clear”.
restart CPR.
Age :
Hairy chest:
Press pads firmly, if not remove hairs by sticking pads and removing hair along with them.
Use other set of pads now
Use razor
Wet chest:
Contd….
If patient is in water, do not use AED but if patient is in snow; dry the chest first and then
AED can be used.
Implanted device: Do not use AED
The first rescuer stays with the victim and performs the next steps until the next
rescuer returns with AED.
The second rescuer activates the emergency response system and gets the AED.
The first rescuer removes or moves clothing covering the victim’s chest and then start
CPR.