Basic Life Support
If a person collapses, the rescuer must assess the situation quickly, ensure the safety of the rescuer, victim and bystanders, call for help, and commence basic life support (BLS). When calling for help, the “phone first” approach is recommended because the vast majority of cardiac arrests are due to ventricular fibrillation, which is treatable by defibrillation. The level of consciousness is determined by the use of verbal and tactile stimuli. These stimuli should never reach a level that causes or aggravate an injury, and infants and small children should never be shaken. The shoulder should be firmly grasped and squeezed to elicit a response. Verbal stimuli should also be used. If conscious the person will respond. Allow the person to adopt a comfortable position, and observe him or her closely for any changes in condition. If there is no response to the stimuli, the person is unconscious and should be turned on their side. Help should be summoned. Anyone who fails to respond to touch or the spoken word is considered to be unconscious and more vigorous efforts to be obtain a response (such as painful stimuli) are not warranted.
The principles of BLS:
Airway Breathing Circulation AIRWAY The key to successful resuscitation is a clear airway. Current recommendations are to leave the person in the position found unless the airway is obstructed by fluid or vomit. The mouth should be open and turned slightly downwards to allow any foreign material expelled. Airway Management includes: o Clear the airway: Remove loose fitting dentures and any visible foreign material from the mouth. Allow fluids or vomitus to drain by turning the face slightly downwards. o Open the airway: Tilt the head backwards and support the jaw. If suspected that the person has injured their neck or back, the head should not be moved; the jaw thrust method to open the airway should be used. o Jaw thrust: pressure is applied behind the angle of the jaw to thrust it forwards. BREATHING Once the airway is open, the unconscious person’s breathing should be checked. With an ear placed over the person’s nose and mouth, the rescuer should: o Look and feel for movement of the chest or upper abdomen o Listen and feel for the passage of air into and out of the mouth and nose. o Check the head tilt and jaw support technique in order to prevent an air leak. o Ensure that the breaths delivered are full inflations.
turn the person on their side and observed closely for airway. o Reassess him regularly. If he is breathing normally: o Turn him into the recovery position (see below). as follows. breathing and circulation. Check the continued presence of the carotid pulse every two minutes. act as if it is not normal. and cardiac pulmonary resuscitation (CPR) should be initiated immediately. If breathing is re-established. and feel for no more than 10 s to determine if the victim is breathing normally. If the pulse is present continue rescue breathing at a rate of 1 breath every 5-6 seconds until breathing returns. Leave the victim only if no other way of obtaining help is possible. gasps. If he does not respond: o Shout for help. 4. any bystanders. listen. a cardiac arrest has occurred.CIRCULATION After delivering two initial breaths. feel for the carotid pulse while maintaining maximum head tilt. o Feel for air on your cheek. and feel for normal breathing.
Adult basic life support sequence
Basic life support consists of the following sequence of actions: 1. With your fingertips under the point of the victim's chin. If this is not possible. Look. noisy. o Begin external cardiac compression (ECC) by locating the middle of the lower half of the sternum. o Turn the victim onto his back and then open the airway using head tilt and chin lift: Place your hand on his forehead and gently tilt his head back. look. If he responds: o Leave him in the position in which you find him provided there is no further danger. This is often termed agonal breathing and must not be confused with normal breathing. ‘Are you all right?’ 3A. send a bystander. o Gently shake his shoulders and ask loudly. 2. or taking infrequent. listen.
. Make sure the victim. o Try to find out what is wrong with him and get help if needed. If you have any doubt whether breathing is normal. 5A. a victim may be barely breathing. o Look for chest movement. If the pulse is absent. lift the chin to open the airway. 3B. o Summon help from the ambulance service by mobile phone. Keeping the airway open. Check the victim for a response. o Ensure the person is on a firm. and you are safe. o Listen at the victim's mouth for breath sounds. In the first few minutes after cardiac arrest. flat surface.
o Continue to assess that breathing remains normal. Leave the victim only when no other option exists for getting help. o Maintaining head tilt and chin lift.6 cm. with your arms straight. otherwise do not interrupt resuscitation. o Blow steadily into his mouth whilst watching for his chest to rise. After each compression. Combine chest compression with rescue breaths: After 30 compressions open the airway again using head tilt and chin lift. Repeat at a rate of 100 . such as coughing. o Stop to recheck the victim only if he starts to show signs of regaining consciousness. o Start chest compression as follows: Kneel by the side of the victim. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. take about one second to make his chest rise as in normal breathing. but maintain chin lift. take your mouth away from the victim and watch for his chest to fall as air comes out.
. making sure that you have a good seal. opening his eyes. Pinch the soft part of the victim’s nose closed. o Take a normal breath and place your lips around his mouth. Position yourself vertically above the victim's chest and. or moving purposefully AND starts to breathe normally. Place the heel of one hand in the centre of the victim’s chest (which is the lower half of the victim’s sternum (breastbone)). o Do not attempt more than two breaths each time before returning to chest compressions. Place the heel of your other hand on top of the first hand. start CPR (5B). Interlock the fingers of your hands and ensure that pressure is not applied over the victim's ribs. use your mobile phone to call for an ambulance. The two breaths should not take more than 5 s. then. speaking. o Continue with chest compressions and rescue breaths in a ratio of 30:2. If the initial rescue breath of each sequence does not make the chest rise as in normal breathing. o Allow his mouth to open. If you are on your own. RESUSCITATION GUIDELINES 2010 5B. this is an effective rescue breath. using the index finger and thumb of your hand on his forehead.120 min-1. release all the pressure on the chest without losing contact between your hands and the sternum. Compression and release should take an equal amount of time. press down on the sternum 5 . o Recheck that there is adequate head tilt and chin lift. before your next attempt: o Check the victim's mouth and remove any visible obstruction. If there is any doubt about the presence of normal breathing. o Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. If he is not breathing normally: o Ask someone to call for an ambulance and bring an AED if available. Do not apply any pressure over the upper abdomen or the bottom end of the sternum. 6A.
another should take over CPR about every 1-2 min to prevent fatigue. otherwise do not interrupt resuscitation. Do not rely on a palpable carotid or femoral pulse as a gauge of effective arterial flow. Compression-only CPR o If you are not trained to. speaking. Continue resuscitation until: o Qualified help arrives and takes over. or are unwilling to give rescue breaths.’ This teaching should be accompanied by a demonstration of placing the hands on the lower half of the sternum. the rescuer should place his hands on the lower half of the sternum. d. Take approximately the same amount of time for compression and relaxation. c. such as coughing. place your hands without delay ‘in the centre of the chest. opening his eyes. and do not interrupt chest compressions. these should be continuous at a rate of 100 120 min-1. o If chest compressions only are given. o Stop to recheck the victim only if he starts to show signs of regaining consciousness.If there is more than one rescuer present. such as coughing. opening his eyes. or moving purposefully and starts to breathe normally.
In most circumstances it will be possible to identify the correct hand position for chest compression without removing the victim’s clothes. Ensure the minimum of delay during the changeover of rescuers.17 Use of the internipple line as a landmark for hand placement is not reliable. or you become exhausted. g. speaking. e. Each time compressions are resumed on an adult. remove outer clothing. Pay attention to achieving the full compression depth of 5-6 cm (for an adult). The number delivered is determined not only by the rate. but also by the number of interruptions to open the airway deliver rescue breaths
. 6B. Minimize interruptions in chest compression. ‘Compression rate’ refers to the speed at which compressions are given. Performing chest compression: a. f. such as ‘place the heel of your hand in the centre of the chest with the other hand on top. or moving purposefully and starts to breathe normally. Compress the chest at a rate of 100-120 min-1. h. b. If in any doubt. give chest compressions only. 7. the victim starts to show signs of regaining consciousness. not the total number delivered in each minute. It is recommended that this location be taught in a simple way. Allow the chest to recoil completely after each compression. Each time compressions are resumed.