Basic Life Support and Automated External Defibrillation: East of England Ambulance Service

East of England Ambulance Service
NHS Trust
Basic Life Support and

Automated External Defibrillation
12/02/2015
BLS & AED
Objectives
• At the end of this course participants should be able
to demonstrate:
– How to assess the collapsed casualty.
– How to perform Basic Life Support (BLS).
– How to place an unconscious breathing victim in
the recovery position.
– Introduction to operating an automated external
defibrillator (AED) safely.
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Date 12/02/2015
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BLS & AED
Background
• In the UK approximately 30,000 people sustain
cardiac arrest outside hospital and are treated by
emergency services each year.
• Bystander CPR and early Defibrillation are vital
interventions before the arrival of emergency
services.
• If defibrillation is delivered promptly, survival rates as
high as 75% have been reported.
• The chances of successful defibrillation decline at a
rate of about 10% with each minute of delay.
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Date 12/02/2015
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BLS & AED
Anyone can do it?

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Date 12/02/2015
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BLS & AED
2% 4% 30%

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BLS & AED
Angina
Suspected Heart Attack
CARDIAC CONDITIONS
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Date 12/02/2015
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BLS & AED
Cardiac Conditions
• Coronary heart disease is the UK's biggest killer, with
1 in every 4 men and 1 in every 6 women dying from
the disease.
• In the UK, approximately 300,000 people have a
heart attack each year.
• Angina affects about 1 in 50 people, and in the UK
there are an estimated 1.2 million people with the
condition. It affects men more than women, and
your chances of being affected increase with age.
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Date 12/02/2015
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Blood returning from
upper body
BLS & AED
Oxygenated blood to upper body
Blood to lungs
Blood to
lungs
Oxygenated Oxygenated blood from

blood from lungs lungs
Blood returning from lower body

Oxygenated blood to lower body

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Date 12/02/2015
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BLS & AED
How many times does the

human Heart beat in a day ?
100,800 beats per day

(70 beats x 60 minutes x 24 hours =
100,800 beats)
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Date 12/02/2015
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BLS & AED

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BLS & AED
Heart Attack

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Date 12/02/2015
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BLS & AED
-Pale, cold & clammy skin
-Rapid weak pulse
-Rapid shallow breathing
-Nausea
-Vomiting
-Pain in chest possibly radiating into arm, back and/or jaw
-Sweating
-Impending sense of doom
Some or all of these symptoms may be present, no two
Heart attacks are the same......
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Date 12/02/2015
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BLS & AED
Cardiac Conditions
• Angina is a pain or discomfort felt in the chest
caused by coronary heart disease.
• Typically presents as heaviness or tightness in the
chest
• Often brought on by physical activity.
• Symptoms usually subside after a few mins.
• Angina Suffers usually carry GTN medication in the
form of a spray or tablet

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Date 12/02/2015
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BLS & AED
Suspected Heart attack
Dial 999 or 112 for Ambulance
-Rest in a comfortable position
-Reassure
-Help casualty to take their own GTN
-Be prepared to resuscitate
-Have AED available
If in any Doubt dial 999 or 112

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Date 12/02/2015
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BLS & AED
Primary Survey
Performing CPR
Recovery Position
BASIC LIFE SUPPORT

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Date 12/02/2015
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BLS & AED
Primary Survey
Initial assessment using the primary survey
- D anger (Global overview)
- R esponse
- S hout for help
- A irway
- B reathing
- C all 999/112 - commence CPR
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Date 12/02/2015
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BLS & AED
Airway Management
Airway Open Airway Closed Airway Obstructed
•An unconscious casualty has no control over their muscles, including the
muscles that control the tongue.

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Date 12/02/2015
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BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
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Date 12/02/2015
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BLS & AED
APPROACH SAFELY!
Approach safely
Rescuer Check response
Shout for help
Scene
Open airway
Victim Check breathing

Recovery Position
Bystanders Dial 999/112
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Date 12/02/2015
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BLS & AED
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
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Date 12/02/2015
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BLS & AED
CHECK RESPONSE
Shake shoulders gently
“Hello can you hear me?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
•If no response.....
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Date 12/02/2015
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BLS & AED
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
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Date 12/02/2015
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BLS & AED
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
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Date 12/02/2015
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BLS & AED
CHECK BREATHING
•Look, listen and feel for
NORMAL breathing for 10
sec
•Do not confuse Agonal
breathing with NORMAL
breathing
•If you have any doubts
act as if breathing is not
normal
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BLS & AED
Not Breathing normally ?
• No sign of Chest Movement
• No sounds of Breathing
• No feeling of breath against your ear
Agonal Breathing
•Occurs shortly after the heart stops in up to 40% of cardiac
arrests
•Described as barely, heavy, noisy or gasping breathing
Recognised as a sign of cardiac arrest
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Date 12/02/2015
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BLS & AED
Agonal Breathing

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Date 12/02/2015
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BLS & AED
Approach safely
Check response
Shout for help
If no help arrives and you Open airway

are alone dial 999/112 Check breathing
After putting into Recovery Position
recovery position.
Dial 999/112
Monitor
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Date 12/02/2015
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BLS & AED
Recovery position 1
• Kneel next to the person. Place the arm

closest to you straight out from the body.
Position the far arm with the back of the
hand against the near cheek.

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Recovery position 2
• Grab and bend the person's far knee

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Recovery position 3
• Protecting the head with one hand, gently

roll the person toward you by pulling the
far knee over and to the ground

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BLS & AED
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions

2 rescue breaths
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Date 12/02/2015
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BLS & AED
Recovery position 4
• Tilt the head up slightly so that the airway remains open.
Make sure that the hand is under the cheek, checking the
airway and also for eventual wakening. Place a blanket or
coat over the person (unless he or she has a heat illness or
fever) and stay close until help arrives

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BLS & AED
If Not Breathing

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CHEST COMPRESSIONS
• Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
–Rate 100 to 120
–Depth 5-6 cm
–Equal compression : relaxation
• When possible change CPR
operator every 2 min
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BLS & AED
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
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Date 12/02/2015
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BLS & AED
RESCUE BREATHS
•Pinch the nose
•Take a normal breath
•Place lips over mouth
•Blow until the chest rises
•Deliver rescue breath for 1
second
•Allow chest to fall
•Repeat
•This should not take longer
than 5sec , then return to chest
compressions without delay
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Date 12/02/2015
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BLS & AED
Combine Compressions and Rescue breaths
at a ratio of 30:2
30 2
30
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Date 12/02/2015
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BLS & AED
ANY QUESTIONS ?
Time to practice.....
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Date 12/02/2015
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Child CPR
• Many children do not receive resuscitation because
potential rescuers fear causing harm.
• This fear is unfounded; it is far better to use the adult BLS
sequence for resuscitation of a child than to do nothing.
• Bystander resuscitation significantly improves outcome in
children.
• Outcomes could be further improved if bystanders who
would otherwise do nothing, were encouraged to begin
resuscitation.
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Children and babies

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COMPRESSION only CPR
If a rescuer is unable or
unwilling to perform rescue
breaths it is expectable to
perform compressions only CPR
However, chest compression

combined with rescue breaths is
the method of choice for CPR by
trained lay rescuers and
professionals.
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Date 12/02/2015
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BLS & AED
When to stop CPR
Once CPR is started the rescuer should
only stop CPR when the casualty shows
signs of regaining conscious by :
•Coughing
•Opening eyes
•Speaking or moving purposefully
•Starts to Breath NORMALLY again
Or
•Qualified help arrives and takes
over
•You become exhausted
•It is unsafe to continue
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Date 12/02/2015
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BLS & AED
Pocket Mask
The pocket mask is an effective barrier device.
It has a one-way valve which prevents the
casualty's exhaled air being inhaled by the
Rescuer.

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BLS & AED
ANY QUESTIONS ?
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BLS & AED
Understanding Defibrillation
Safe use of an AED
DEFIBRILLATION
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BLS & AED
Automated External Defibrillators
• An AED is an “electric shock box” used to stop
the electrical activity of the heart when it is in a
life threatening rhythm, this allows the Heart to
re-establish an effective rhythm.
• The AED will;
– analyse the presenting rhythm
– only advise a shock for a shockable rhythm
– advise the operator step-by-step what to do
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Date 12/02/2015
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BLS & AED
Automated External Defibrillators

• An AED can be used safely and effectively
without previous training.
• Therefore, the use of an AED should not be
restricted to trained rescuers.
• However, training should be encouraged to
help improve the time to shock delivery and
correct pad placement.
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Date 12/02/2015
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BLS & AED
•There are 2 types of AED:

Automatic- will deliver shock automatically
Semi Automatic – rescuer intervention
required to deliver shock.
•Once you have completed this training

you will be able to use any make or model
AED’s can be found in many public
buildings e.g. Sports centres, Railway
stations, Shopping centres and Schools
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BLS & AED
2% 4% 30%

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BLS & AED
• The heart’s pumping action
controlled by electrical
system
Sinus Rhythm
• Electrical rhythm normally
very organized
• Normal heart’s rhythm is
called “Sinus Rhythm”
• Normal heart rate of 60 -
100 beats per minute

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Date 12/02/2015
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BLS & AED
Understanding Defibrillation:
Ventricular Fibrillation (VF)
• VF is the most common
rhythm in Sudden Cardiac
Arrest (90%)
• Electrical Problem in
Nature
• Chaotic rhythm results in
“quivering of heart” and
results in loss of pulse
• VF will result in brain
damage within 5 minutes
and death in 10-15 minutes
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Date 12/02/2015
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BLS & AED
• Defibrillation may correct VF
• Uses DC current delivered
across the heart
• A successful defibrillation
“depolarizes” the heart’s cells
• Depolarization allows the cells
to “reorganize”
• Defibrillation is the ONLY
effective cure for VF!

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Date 12/02/2015
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Single Rescuer BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112 – get AED
Attach AED before CPR
Follow voice prompts
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Date 12/02/2015
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BLS & AED
Approach safely
Check response
Shout for help 2 or more
Open airway Rescuers
Check breathing
1st Rescuer commence CPR
2nd Rescuer Call 999 /112
gets AED and attaches to
Patient
Follow voice prompts
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Date 12/02/2015
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BLS & AED
Minimise interruptions in
CPR
•If alone, attach AED before commencing CPR
•If 2 rescuers, provide good quality CPR while

the AED is brought to the scene, is turned on,
and pads attached
•Interrupt CPR only when it is necessary to

analyse the rhythm and deliver a shock

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Date 12/02/2015
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BLS & AED
DEFIBRILLATION SAFETY !
 THE PATIENT.  THE AED.
 5 point check  In good working order
 Pacemaker  Do Not use in Heavy rain
 Jewellery  Do Not use if they lay in a
 Hair on chest pool of water
 Damp/Wet skin  Do Not use in an
 Patches (GTN) explosive environment !

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BLS & AED
ATTACH PADS TO CASUALTY’S
BARE CHEST

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ANALYSING RHYTHM
DO NOT TOUCH PATIENT

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BLS & AED
SHOCK ADVISED
“Stand clear
Everyone” !
• TOP
• MIDDLE
• BOTTOM
• MYSELF
• BEHIND YOU
DELIVER SHOCK
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BLS & AED
DEFIBRILLATION SAFETY !
• REMEMBER.
• Always check that NO PERSON or ANIMALS
are touching the patient prior to shocking.
• That you are not touching the patient in any
way.

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DEFIBRILLATION

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SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

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COMMENCE CPR (2 Mins)

30 2
30 2
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BLS & AED
NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

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BLS & AED
COMMENCE CPR (2 Mins)
30 2
30 2
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ANY QUESTIONS ?
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Children and AED’s
• Standard AEDs are suitable for use on children
of 8 years and above.
• In children between 1 and 7 years paediatric
pads or a paediatric mode should be used.
• Do not use an AED on an Infant less than 1
year.

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Follow up – what to do after?
• If you have used an Automated External Defibrillator,
even by just attaching it to a patient, you must:
• Dispose of the pads used as clinical waste
• Replace the pads on the machine
• Inform named person that the Defibrillator has been
used so that any data can be captured from the device
• Complete a “Defibrillator Event Report Form”
• If you require any equipment to be replaced, i.e. pads,
pocket masks, razors etc. Please contact your named
person as soon as possible.
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Date 12/02/2015
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WHEN NOT TO RESUSCITATE
• Once CPR is started the rescuer should only stop CPR
when the casualty shows signs or regaining conscious by
• Coughing
• Opening eyes
• Speaking or moving purposefully
• Starts to Breath NORMALLY again
• Or
• Qualified help arrives and takes over

• You become exhausted
• It is unsafe to continue
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Date 12/02/2015
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BLS & AED
OR IF YOU SEE THIS HAS

OCCURRED !

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Oop’s ??

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ANY QUESTIONS ?

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Bleeding

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Bleeding
• Raise Limb
• Cover with clean dressing or cloth
• 999 or 112
• Reassure
• Lay down
• Raise legs
• Monitor
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BLS & AED
Shock

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Shock

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Choking

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Choking

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Choking

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ANY QUESTIONS ?
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BLS & AED

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Basic Life Support and Automated External Defibrillation: East of England Ambulance Service

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