S L IDESHOW

Basic Life Support

BLS for Healthcare Providers and Professional Rescuers

Prepared By:
PRINCE RENER V. PERA, RN,EMT

We Make Protecting and Saving Lives Easy®

INDICATIONS FOR CPR
Sudden Cardiac Arrest (SCA)

Sudden cardiac arrest (SCA) can happen with little or no warning

• Victims unexpectedly collapse

- Breathing stops

• Occurs when electrical pulses in

heart become disorganized
- Ventricular fibrillation occurs
- Blood flow with oxygen it carries
stops
- Brain cell death starts

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Cardiopulmonary
Resuscitation (CPR)
CPR is the immediate treatment for a suspected cardiac arrest

• CPR can restore limited oxygen to brain and other vital organs through:
- Chest compressions
- Rescue breaths

• CPR alone is not enough

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Early Defibrillation

The most effective way to end fibrillation is defibrillation

• Shock is sent through heart to stop

ventricular fibrillation, allowing
normal activity to return

• Success dependent on how quickly

defibrillation occurs
- Each minute in cardiac arrest,
chance of survival declines by ~10%
- After as few as 10 minutes, survival
is unlikely

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Automated External
Defibrillator (AED)
A small, portable, computerized device that is simple to operate

• Push power button

• AED provides voice instructions to

guide attachment and use
automatically
- Analyzes heart rhythm
- Determines if shock is needed
- Operator pushes button to deliver
shock when prompted by AED

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Chain of Survival
(outside of a hospital)

The greatest chance for survival exists when all the links are strong:

1. Early recognition

2. Immediate & high-quality CPR

3. Rapid defibrillation or electrical

shock

4. Effective basic and advanced

EMS care and transport

5. Effective post-cardiac arrest care

at a hospital

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1. EARLY RECOGNITION & EMS ACTIVATION

1. CARDIAC ARREST OR
RESPIRATORY ARREST

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Calling for Help

Ways to activate responses for higher levels of care vary, typically defined
by emergency response protocol:
• May radio centralized
communication person or call EMS
directly

• May request advanced care

providers or inform other incoming
responders of situation details

• In hospital, floor nurse may call a

code to activate a resuscitation
team with appropriate equipment

• Understand local protocols to be

an effective BLS provider

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Chain of Survival
(outside of a hospital)

The greatest chance for survival exists when all the links are strong:

1. Early recognition

2. Immediate & high-quality CPR

3. Rapid defibrillation or electrical

shock

4. Effective basic and advanced

EMS care and transport

5. Effective post-cardiac arrest care

at a hospital

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High-Quality CPR Skills

Narrow the gap between perfect skills and what you can perform

• High-quality CPR skills:

- Begin CPR compressions within 10 seconds of determining cardiac arrest
- Compress fast, at a rate of 100 to 120 times per minute
- Compress hard, at least 2 inches for adult, and at least 1/3 depth of chest for
children/infants
- Allow for complete chest recoil at top of each compression
- Minimize interruptions to compressions
- Give effective rescue breaths that create a visible chest rise
- Avoid excessive air on rescue breaths

• CPR feedback devices that measure skill performance in real time can
be used to optimize CPR

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External Compression

Increases pressure inside chest and directly compresses heart, forcing

blood to move from chest to lungs, heart, brain, and the rest of the body
• Do not lean on the chest between compressions

• Allow chest wall to fully rebound at top of each compression

• Minimize interruptions when doing compressions

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Chain of Survival
(outside of a hospital)

The greatest chance for survival exists when all the links are strong:

1. Early recognition

2. Immediate & high-quality CPR

3. Rapid defibrillation or electrical

shock

4. Effective basic and advanced

EMS care and transport

5. Effective post-cardiac arrest care

at a hospital

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Automated External
Defibrillation (AED)

• Allow AED to analyze heart rhythm

- Most automatically analyze once
pads in place
- Stop CPR, movement interrupts
analysis
- Be certain no one is touching person
- If defibrillation advised, AED will
charge for shock delivery

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Automated External
Defibrillation (AED)

• Deliver shock if directed by AED

- No one in contact with person
- Press button to deliver shock
- Once shock delivered, immediately
resume CPR

• If shock not indicated, immediately

resume CPR

• If person responds, stop CPR and

place in recovery position
- Leave AED on and pads attached in
case cardiac arrest occurs again

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Chain of Survival
(outside of a hospital)

The greatest chance for survival exists when all the links are strong:

1. Early recognition

2. Immediate & high-quality CPR

3. Rapid defibrillation or electrical

shock

4. Effective basic and advanced

EMS care and transport

5. Effective post-cardiac arrest care

at a hospital

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BASIC & ADVANCED EMS TRANSPORT PROTOCOL

1. Red Cross

2. Municipal DRRMO

3. Provincial DRRMO

4. R2TMC

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Protecting Yourself

Your personal safety is the highest priority

• Putting yourself in danger to help

can make the situation worse

• Pause before approaching

• Look for obvious hazards

• Consider hidden dangers

• If not safe, do not enter until

hazards minimized or eliminated

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Standard Precautions

You can be exposed to blood or other potentially infectious body fluids

• Risk of contracting a disease is very low

• Must take simple measures to reduce exposure

• Common bloodborne diseases and pathogens

- Hepatitis B
- Hepatitis C
- STD's

• Standard precautions are protective practices used when providing care

whether or not an infection is suspected

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Personal Protective
Equipment (PPE)
Protective barriers worn to prevent exposure to infectious diseases

• Disposable gloves most common

- Make sure readily available
- Always use them

• CPR mask with a one-way valve or

a bag-mask device should be used
by emergency response personnel

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Basic BLS Skills
BLS Assessment

BLS assessment quickly identifies if resuscitation is required

• Ensure the scene is safe

- Pause and assess the scene for hazards
- If scene not safe, do not enter until hazards minimized or eliminated
- Take standard precautions to prevent contact with blood or other potentially
infectious materials

• Assess responsiveness
- If safe, check for responsiveness
- Tap or squeeze person’s shoulder and ask loudly, “Are you all right?”
- For an infant, tap the foot

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BLS Assessment

• Assess for breathing and pulse within 5-10 seconds

- If unresponsive, quickly look at person’s chest and face for signs of normal
breathing. At same time check for a pulse
- Normal breathing: effortless, quiet, and regular
- Agonal breaths: weak, irregular gasping, snorting, or gurgling sounds; provide
no usable oxygen. Not normal breathing
- Check carotid pulse in neck
- If unsure, assume they are absent

• Activate emergency response protocol for setting and get an AED

- If not already being done, tell another person to activate the protocol and get
an AED
- Relay what you have found so it can be passed on

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BLS Assessment

Your assessment will determine the care you provide

• If person is breathing normally, and uninjured, place him or her in a

side-lying recovery position

• If person is not breathing or only gasping, but definitely has a pulse, he

or she is in respiratory arrest
- Indicated care is rescue breathing

• If person is not breathing, or only gasping, and does not have a pulse,
he or she is in cardiac arrest
- Indicated care is CPR

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Chest Compressions - Adult

• Position face up on firm, flat surface.

Kneel close to chest. Place heel of 1
hand on center of chest, lower half of
breastbone. Place heel of other hand
on top of and parallel to first.

• Position shoulders directly above

hands, lock elbows. Bend at waist, use
upper body weight to push.

• Push deep, straight down at least 2

inches. Lift hands, allow chest to recoil.
Move into next compression.
Compress fast, 100-120 times per
minute.

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Chest Compressions - Child

• Position face up on firm, flat surface.

Kneel close to chest. Place heel of 1
hand on lower half of breastbone, just
above point where ribs meet.

• Position shoulder above your hand.

Lock elbow. Bend at waist, use upper
body weight to push.

• Push deep, straight down 1/3 depth of

chest, ~2”. Lift hand, allow chest to
recoil. Move into next compression.
Compress fast, at a rate of 100-120
times per minute.
- If needed, use 2 hands

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Chest Compressions - Infant

• Position face up on a firm, flat

surface. Place 2 fingertips on
breastbone just below nipple line

• Push deep, at least 1/3 depth of

chest, or about 1 ½ inches. Lift
fingers, allow chest to fully recoil.
Move into next compression.
Compress fast,100–120 times per
minute

• If 2 or more providers, encircle

sides of chest with your hands and
use your thumb tips to compress
lower third of breastbone

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Rescue Breaths

• Artificial breaths given to someone

not breathing by blowing air into
the mouth to inflate lungs
- Air you breathe contains about 21%
oxygen
- Exhaled air still contains 16% to17%
oxygen

• Exhaled oxygen is enough to

support someone’s life

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Establishing an Airway

• You need to make sure there is an open airway

• Unresponsive person can lose muscle tone

• If flat on his or her back, base of tongue can relax and obstruct the
airway

• The tongue is attached to the lower jaw

• Lifting the jaw forward pulls the tongue away from the back of the throat
and opens the airway

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Head Tilt-Chin Lift

You can open a person’s airway by using the head tilt-chin lift technique:

• Place one hand on forehead

• Place fingertips of your other hand

under bony part of chin

• Apply firm, backward pressure on

forehead while lifting chin upward,
will tilt head back and jaw forward

• Maintain head tilt with your hand

on forehead. Leave mouth slightly
open

• Avoid pressing into soft tissue of

chin, this can obstruct airway
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Using a CPR Mask

Use a protective barrier such as CPR mask or bag-mask device to

minimize exposure to infectious disease
• Each breath should be ~1 second
in length
- Only enough air to create a visible
rise of chest, but no more

• Remove mouth, let person exhale

between breaths
- Take a breath before delivering 2nd
breath
- Ensure airway is open for each
rescue breath

• If needed, reposition head further

back, try another breath
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Using a CPR Mask

Recommended to use appropriately sized pediatric CPR mask for

children and infants
• Infant airway may become blocked if head is tilted too far
- Position infant’s head in neutral position, ear openings level with infant’s
shoulders

• Special care should be taken not to give too much air in a single breath

• Provide only enough air to make the chest visibly rise, but no more

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Jaw Thrust

• A convenient airway technique

when:
- Working in a team
- Using a bag-mask device

• Provider is located above the

person’s head

• Uses 2 hands to tilt the head and

thrust the jaw upward

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Recovery Position

• Helps protect airway, uses gravity

to:
- Drain fluids from mouth
- Keep tongue from blocking airway

• Frequently assess and monitor the

person’s breathing

• Condition can quickly become

worse and require additional care

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BLS Assessment

Assess Scene
• Pause and assess scene
for safety
• If unsafe, or if it becomes
unsafe at any time, GET
OUT!
Check for Response
• Tap or squeeze shoulder
and ask loudly, “Are you all
right?”
• For an infant, tap the foot
• If alone, shout out for help
• Position person face-up on
a firm, flat surface
Check Breathing and
Pulse
• Look at face/chest for
normal breathing. If unsure,
assume not normal
• Weak, irregular gasping,
snorting, or gurgling is not
normal
• Check for a carotid pulse;
for infant, check brachial
pulse
• Take at least 5 and no
longer than 10 seconds to
check breathing/pulse
Provide Indicated Care
• If not already done, activate
emergency response
protocol and get AED
• No response, with normal
breathing and pulse? Place
in recovery position
• No response with breathing
absent and pulse present?
Begin rescue breathing
• No response with normal
breathing and pulse
absent? Begin CPR

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Recovery Position
Prepare
• Place arm nearest you up alongside
head
• Bring far arm across chest and place
back of hand against cheek
• Grasp far leg just above knee and pull
it up so foot is flat on ground
Roll
• Grasping shoulder and hip, roll person
toward you in a single motion, keeping
head, shoulders, and body from
twisting
• Roll far enough for face to be angled
toward ground
Stabilize
• Position elbow and legs to stabilize
head and body
• Ensure there is no pressure on chest
that restricts breathing
• Make sure head ends up resting on
extended arm and head, neck, and
body are aligned
• If person seriously injured, do not place
in a recovery position unless fluids in
airway, or need to leave to get help
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Automated External
Defibrillation (AED)
AEDs are simple to use; voice, lights, and screen instructions guide you

• Open lid or press power to turn on

• Remove clothing, dry torso if wet

• Locate, pull out defibrillation pads

• Peel pads from backing and place

as shown in pictures
- One below right collarbone, above
nipple, beside breastbone
- Other pad lower on left side, over
ribs, and few inches below armpit

• Make sure pads adhere well by

pressing flat.
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Using an AED: Adult
Perform CPR When Available, Attach
AED Immediately
• If your BLS assessment
indicates cardiac arrest, • Turn on AED and bare
perform CPR person’s chest
• Peel first pad from backing
and place below right
collarbone, above nipple,
and beside breastbone
• Remove second pad from
backing and place on left
side, over ribs, and a few
inches below armpit
If Indicated, Deliver
Shock
• Allow AED to analyze
heart. Stop CPR. Do not
touch the person
• If shock is advised, clear
everyone and press button
to deliver shock
Resume CPR
• Quickly resume CPR, start
with chest compressions.
Follow any voice
instructions from AED
• Continue until another BLS
provider takes over, person
shows signs of life, or you
are too exhausted to
continue
• If person responds, stop
CPR and place in recovery
position. Leave AED on
and attached
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Using an AED:
Children and Infants
Perform CPR
• If your BLS assessment
indicates cardiac arrest,
perform CPR
When Available, Attach
AED Immediately
• Turn on AED and bare
child’s chest
• Peel first pad from backing
and place in center of chest
just below collarbones
• Roll child and place second
pad on center of back
between shoulder blades
If Indicated, Deliver
Shock
• Allow AED to analyze
heart. Stop CPR. Do not
touch the child
• If shock advised, clear
everyone and press button
to deliver shock
Resume CPR
• Quickly resume CPR
starting with chest
compressions. Follow voice
instructions from AED
• Continue until another BLS
provider takes over, child
shows signs of life, or you
are too exhausted to
continue
• If child responds, stop CPR
and place in recovery
position
• Leave AED on and
attached
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Recovery Position

• Helps protect airway, uses gravity

to:
- Drain fluids from mouth
- Keep tongue from blocking airway

• Frequently assess and monitor the

person’s breathing

• Condition can quickly become

worse and require additional care

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Caring for Cardiac Arrest

Immediate, high-quality CPR and defibrillation with AED can double or

triple chance for survival
• Combined chest compressions and
rescue breaths provide oxygen to
brain and vital organs

• CPR buys time for and helps make

heart receptive to defibrillation
- Ratio of chest compressions to
rescue breaths for an adult CPR
cycle is 30:2
- Cycles of compressions and breaths
are repeated non-stop
- Keep interruptions short. Take < 10
seconds to give rescue breaths

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Caring for Cardiac Arrest

Use AED immediately when it arrives

• Turn on AED, adhere pads to bare chest, allow AED to analyze heart

• If shock advised, make sure not touching person before delivering shock

• Immediately after shock, resume CPR starting with compressions

• Voice instructions and analysis by AED will guide you through care

• Don’t stop until person shows signs of life, another BLS provider takes
over, or you are too exhausted to continue

• If person begins to breathe, move, or respond, stop CPR and place in

the recovery position

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Caring for Cardiac Arrest

• Leave AED turned on and pads attached in case cardiac arrest reoccurs

• In cases where shock is not indicated by AED, immediately resume

CPR

• Continue to follow the AED’s instructions

• When performing CPR, do the best you can!

- A person without breathing or circulation will not survive without help
- Nothing you do can make the outcome worse

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Compression-Only CPR

Compression-only CPR encouraged for those who are not trained in CPR

• Limited approach to treating

cardiac arrest

• EMS dispatchers providing

instructions during emergency calls

• Rescue breaths are essential for

all cardiac arrests, especially for
secondary cardiac arrest

• As a trained BLS provider, perform

both compressions and breaths

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Two-Provider CPR

Coordination Preparing to Switch Switching More Than 2 Providers

Compressors
• One provider delivers • Compressor moves • If available, rotate extra
compressions while a 2nd • Compressions are tiring. towards person’s head providers into compressor
provider delivers rescue during rescue breaths and role instead of ventilator
• Switch out compressor
breaths prepares to become new
every 2 minutes ventilator
• Avoid positioning both
• Clearly communicate
providers on same side • Ventilator quickly moves to
ahead of time so everyone side of person’s chest and
• Compressor pauses to understands when switch
allow for rescue breaths. begins compressions within
will occur
5 seconds
Minimize pause as much
as possible. • New ventilator gives
rescue breaths at end of
CPR cycle

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BLS Carefor Respiratory
Arrest
Opioid Overdose

Opioids, taken in excess, can depress and stop breathing

• Naloxone
- Temporarily reverses life-threatening
effects of opioids
- Easy to administer with auto-injector
device or aerosol sprayed into nose

• Suspicion of opioid use may

present itself through questioning
of bystanders, or by observation of
person and location

• Initiate and establish BLS care

prior to using naloxone

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Caring for Respiratory Arrest

A person in respiratory arrest has stopped breathing but still has a beating
heart
• Without immediate intervention,
can quickly progress to cardiac
arrest
- For adult, provide1 high-quality
rescue breath every 5-6 seconds or
10-12 breaths per minute
- Reassess pulse every 2 minutes,
taking no longer than 10 seconds
- If pulse absent and tissue signs
indicate poor perfusion, or you are
unsure, perform CPR
- If opioid overdose suspected,
consider use of naloxone

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Children and Infants

• Rescue breathing for children and infants is 1 breath every 3 to 5

seconds, or about 12 to 20 breaths per minute

• When monitoring pulse of an infant, check for the brachial pulse

• Add compressions and perform CPR if pulse rate ≤ 60 beats per minute
and appears heart too weak to move blood forward

• Signs of poor blood perfusion include the following:

- Pale, mottled, or bluish skin
- Weak pulse
- Cool extremity temperature

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Caring for Respiratory Arrest:
Adult
Assess
• If safe, tap or squeeze shoulder. As
loudly, “Are you all right?”
No response!
• Check face and chest for normal
breathing. Check pulse at same time
Normal breathing absent! Pulse
present!
• Activate emergency response protocol
to get additional help and an AED
Establish an Airway
• Use head tilt-chin lift or jaw thrust to
open airway
• If you suspect neck injury, use jaw
thrust without head tilt
Give Rescue Breaths
• Provide 1 rescue breath every 5-6
seconds, or 10-12 times per minute
• Give each breath over 1 second; make
chest visibly rise with each breath, but
no more
• Reassess pulse every 2 minutes, take
no longer than 10 seconds
• Continue until another BLS provider
takes over, person shows signs of life,
or you are too exhausted to continue
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Caring for Respiratory Arrest:
Children and Infants
Assess Child or Infant
• If safe, tap or squeeze shoulder. Ask
loudly, “Are you all right?” For an infant,
tap the foot and shout loudly.
No response!
• Check face and chest for normal
breathing. Check pulse at same time.
For infant, check brachial pulse
Normal breathing absent! Pulse
present!
• Activate emergency response protocol
to get additional help and an AED
Establish an Airway
• Use head tilt-chin lift or jaw thrust to
open airway
• If you suspect neck injury, use jaw
thrust without head tilt
Give Rescue Breaths
• Provide 1 rescue breath every 3-5
seconds, or 12-20 times per minute
• Give each breath over 1 second; make
chest visibly rise with each breath, but
no more
• Reassess pulse every 2 minutes, take
no longer than 10 seconds
• Continue until another BLS provider
takes over, person shows signs of life,
or you are too exhausted to continue
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Advanced Airways

An advanced airway device may be inserted into throat during a

resuscitation to protect and maintain an open airway
• When in place, mask from bag-
mask is removed, bag is attached
directly to airway device
- Provide only enough air to make
chest visibly rise

• Once in place, not necessary to

pause compressions for breaths
- Provide continuous compressions at
a rate of 100 to 120 per minute
- Regardless of age, provide single
breath every 6 seconds, or 10 times
per minute

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AIRWAY ADJUNCTS

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Supraglottic Airway Laryngopharyngeal Tube

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Additional Considerations
Choking

• A solid object enters narrowed part

of airway and becomes stuck

• On inhalation, object can be drawn

tighter into airway and block air

• A forceful thrust beneath ribs and

up into diaphragm can pressurize
air in chest and pop obstruction out

• Compression of chest over

breastbone can also create
enough pressure to expel an object

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Choking

Be able to recognize the difference between mild and severe blockage

• Mild Obstruction
- Person can speak, cough, or gag
- Typically cleared by affected person naturally through forceful coughing
- Allow person to try and resolve the problem on his/her own
- Stay close and be ready to take action if things worsen

• Severe Obstruction
- Person cannot take in enough air to dislodge the object
- Very little or no air exchange, lack of sound
- Inability to speak or cough forcefully
- May hold hands to throat while attempting to clear the obstruction

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Choking: Severe Obstruction

A person without air exchange requires your help to survive

• Repeated abdominal thrusts, while standing behind person can be
extremely effective

• When someone is clearly pregnant or obese, use chest thrusts instead

of abdominal thrusts
- Position yourself directly behind the person, reach under armpits and place
thumb side of fist on center of chest
- Grasp your fist with your other hand and thrust straight backward; try to not
put pressure on the ribs

• If choking and alone, try pressing abdomen quickly against a rigid

surface; otherwise, attempt abdominal thrusts on yourself

• Anyone who has had these maneuvers used on them should be

evaluated further to ensure there are no injuries
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Choking: Children & Infants

Young children are at risk for choking because of small air passages,
inexperience chewing, and tendency to put objects in mouths
• Might be easier to kneel behind a
choking child to deliver thrusts

• Use less force on your thrusts

• More difficult to recognize choking

in infants, sudden onset
differentiates it from other
breathing emergencies

• Signs include weak, ineffective

coughs, and lack of sound

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Choking: Adults and Children
Assess Person
• Ask, “Are you choking?”
• If nods yes, or is unable to
speak or cough, act quickly
• If available, have someone
activate your emergency
response protocol
Position Yourself Give Thrusts If Person Becomes
Unresponsive
• Stand behind person. If • Quickly thrust inward and
needed, kneel behind a upward into abdomen • Carefully lower person to
child • Repeat. Each thrust needs ground
• Reach around and locate to be given with intent of • Begin CPR, starting with
navel expelling object compressions
• Make fist with other hand • Continue until person can • Look in mouth for object
and place thumb side breathe normally before giving rescue
against abdomen, just breaths
above navel and below ribs • Remove any object seen
• Grasp fist with other hand • Continue until another BLS
provider takes over, person
shows signs of life, or you
are too exhausted to
continue
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Choking: Infants
Assess Infant
• Look at infant’s face
• If infant has weak,
ineffective coughs, or lack
of sound even when clearly
attempting to breathe, act
quickly!
• If available, have someone
activate emergency
response protocol
Give 5 Back Blows Give 5 Chest Thrusts
• Lay infant face down over • Sandwich infant between
your forearm with legs your forearms and turn
straddled and with head onto back
lower than the chest
• Place 2 fingertips on
• Support the head by breastbone just below
holding the jaw nipple line and give 5 chest
thrusts
• Using heel of other hand,
give 5 back blows between • Repeat back blows and
shoulder blades chest thrusts until infant
can breathe normally
If Infant Becomes
Unresponsive
• Gently place infant on firm
surface
• Begin CPR, starting with
compressions
• Look in mouth for object
before giving rescue breaths
• Remove any object seen
• Continue until another BLS
provider takes over, person
shows signs of life, or you
are too exhausted to
continue
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EMERGENCY
CRICHOTHYROTOMY

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