Basic Life Support

BACKGROUND
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• Approximately 700,000 cardiac arrests per year in

Europe

• Survival to hospital discharge presently

approximately 5-10%

• Bystander CPR vital intervention before arrival of

emergency services – double or triple survival
from SCA (sudden cardiac arrest)

• Early resuscitation and prompt defibrillation

(within 1-2 minutes) can result in >60% survival
 Cardiac Arrest or Heart Attack

• People often use the terms cardiac

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arrest and heart attack

interchangeably, but they are not the
same.

• Sudden cardiac arrest occurs when

the heart develops an abnormal
rhythm and can’t pump blood

• A heart attack occurs when blood

flow to part of the heart muscle is
blocked
 Cardiac Arrest or Heart Attack
Basic Life Support
 Cardiac Arrest or Heart Attack
Basic Life Support
 Cardiac Arrest or Heart Attack
Basic Life Support
Basic Life Support

CHAIN OF SURVIVAL
 CHAIN OF SURVIVAL
• Most out-of-hospital adult
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cardiac arrests happen
unexpectedly and result
from underlying cardiac
problems.
• Successful outcome
depends on early bystander
CPR and rapid defibrillation
in the first few minutes after
the arrest
• Lay rescuers are expected to
recognize the victim’s distress, call for
help, start CPR, and initiate public-
access defibrillation until EMS arrives.
• EMS providers then take over
resuscitation efforts.
• Advanced care, such as administration
of medications, may be provided.
• EMS providers transport the cardiac
arrest victim to an emergency
department
or cardiac catheterization suite.
• Follow-up care by a team of
multidisciplinary specialists
continues in the ICU
 CHAIN OF SURVIVAL
Basic Life Support

The links in the Chain of Survival for an adult who has a cardiac arrest
outside the hospital are

• Immediate recognition of cardiac arrest and activation of the emergency

response system
• Early CPR with an emphasis on chest compressions
• Rapid defibrillation with an AED
• Effective advanced life support (including rapid stabilization and transport
to postcardiac arrest care)
• Multidisciplinary post-cardiac arrest care
 CHAIN OF SURVIVAL

• You must first recognize that the victim is

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in cardiac arrest based on

unresponsiveness, no breathing (or no
normal breathing or only gasping), and
no pulse

• Once you have recognized that the victim

is in cardiac arrest, activate the
emergency response system or ask
someone else to do it

• • The sooner you activate the emergency

response system, the sooner the next
level of care will arrive
 CHAIN OF SURVIVAL
• If the victim is in cardiac arrest, begin
high-quality CPR without delay
Basic Life Support

• High-quality CPR started immediately

after cardiac arrest can greatly improve
a victim’s chance of survival

• Bystanders who are not trained in CPR

are encouraged to at least provide
chest compressions. Chest
compressions can be performed by
those with no training and can be
guided by dispatchers over the
telephone.
 CHAIN OF SURVIVAL
• Rapid defibrillation in combination with
high-quality CPR can double or triple the
chances of survival. Provide defibrillation
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with a manual defibrillator or AED as

soon as the device is available

• The AED is a lightweight, portable device

that can identify lethal heart rhythms and
deliver a shock to terminate the abnormal
rhythm and allow the heart’s normal
rhythm to resume

• AEDs are simple to operate, allowing lay

rescuers and healthcare providers to
• attempt defibrillation safely
 CHAIN OF SURVIVAL

• Advanced life support (ALS) bridges

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the transition from BLS to more

advanced care
• ALS can occur in any setting (both out
of hospital and in hospital). Effective
ALS teams may provide the patient
with additional care if needed, such
as
• 12-lead electrocardiogram or
advanced cardiac monitoring
• Electrical therapy interventions (eg,
cardioversion)
• Obtaining vascular access
• Giving appropriate drugs
• Placing an advanced airway
 CHAIN OF SURVIVAL
• Once ROSC is achieved, the next
link is for the patient to receive post-
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cardiac arrest care

• This advanced level of care is

provided by a multidisciplinary team
of healthcare providers. They focus
on preventing the return of cardiac
arrest and tailor specific therapies to
improve long-term survival

• • Post-cardiac arrest care may be

provided in the cardiac
catheterization suite and/or ICU
 BASIC LIFE SUPPORT
Basic Life Support

• SEQUENCES OF PROCEDURES PERFORMED TO

RESTORE THE CIRCULATION OF OXYGENATED BLOOD
AFTER A SUDDEN PULMONARY AND/OR CARDIAC
ARREST

• CHEST COMPRESSIONS AND PULMONARY

VENTILATION PERFORMED BY ANYONE WHO KNOWS
HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY
OTHER EQUIPMENT
 BLS for Adults
Basic Life Support

 Everyone can be a lifesaving rescuer for

a cardiac arrest victim

 Which CPR skills you use will depend on

your level of training, experience, and
confidence (ie, rescuer proficiency)

 The type of victim (child vs adult) as well

as the availability of equipment and other
rescuers to assist will determine CPR
efforts
 BLS for Adults
Basic Life Support

• Building blocks of CPR

 BLS for Adults
• Teamwork. Emergency responders who are
called to a scene to care for a cardiac arrest
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victim will perform multirescuer coordinated

CPR: one rescuer performs chest
compressions, a second rescuer gives
breaths with a bag-mask device, and a third
rescuer uses the defibrillator. With a team
approach, several lifesaving actions are
performed at the same time.

• 30:2 CPR. A lifeguard who rescues a

drowning young child or an adult in cardiac
arrest will provide both chest compressions
and breaths, using a ratio of 30 compressions
to 2 breaths

• Hands-Only CPR. A single rescuer with little

training and limited equipment who witnesses
a cardiac arrest in a middle-aged man might
provide only chest compressions until help
arrives.
 CPR
Basic Life Support

Cardiopulmonary resuscitation (CPR) is used in and out of the hospital

to save lives

CPR is performed when a person’s breathing or heart has stopped. Its

purpose is to move blood, and therefore oxygen, to the brain and heart
 CPR
Basic Life Support

 CPR is a lifesaving procedure for a victim who has signs

of cardiac arrest (ie, unresponsive, no normal breathing,
and no pulse)

 Components of CPR are chest compressions and

breaths
 CPR
Basic Life Support

CPR consists of these main components:

•Chest compressions
•Airway
•Breathing
 Why Perform CPR?
 CPR is performed to prevent brain damage and
death when a person is in cardiac arrest. The
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heart may stop because of heart disease, a motor

vehicle accident, drowning, or choking

 Anyone who has lost consciousness may need

CPR. Also, confusion, weakness, and chest pain
may signal that cardiac arrest is about to occur
and that CPR may be needed

 After the heart stops, even a few minutes’ delay in

starting CPR can mean the difference between life
and death

 Performing CPR supports the heart and brain with

oxygen until medical help arrives
Basic Life Support
BLS for Adults
 Initial steps for BLS for Adults
Basic Life Support
Basic Life Support

Verify that the scene

is safe for you and the
Rescuer victim
Scene
Victim  You do not want to
Bystanders
become a victim
yourself
Basic Life Support
 Check for Responsiveness
Basic Life Support

 Tap the victim’s shoulder and shout, “Are you OK?”

 Call out loudly. The person may be asleep or hard of hearing

 If the person answers, ask how you can help

 If there is no answer, gently tap the person’s shoulder (or feet in an infant)
 Get Help
 Shout for nearby help
Basic Life Support

 If there is still no response, activate

the emergency response system as
appropriate in your setting (via
mobile, etc)

 Get an AED if one is available, or

send someone to activate the
emergency response system and get
an AED or defibrillator

 If you are alone, get the

AED/defibrillator and emergency
equipment. If someone else is
available, send that person to get it
 Check breathing and pulse
Basic Life Support

 Check for absent or abnormal breathing (no breathing or only

gasping) by looking at or scanning the chest for movement for
about 5 to 10 seconds

 If the victim is breathing, monitor the victim until additional help arrives

 If the victim is not breathing or is only gasping, this is not

considered normal breathing and is a sign of cardiac arrest
 Check breathing and pulse
Basic Life Support

Check Pulse
To perform a pulse check in an
adult, palpate a carotid pulse

If you do not definitely feel a

pulse within 10 seconds, begin
high-quality CPR, starting with
chest compressions
 Check breathing and pulse
Basic Life Support

Ideally, the pulse check is performed

simultaneously with the breathing check to
minimize delay in detection of cardiac
arrest and initiation of CPR
 Normal breathing, has pulse
Basic Life Support
 No normal breathing, has pulse
Basic Life Support

 Check pulse
about every 2
minutes
 No normal breathing, no pulse
Basic Life Support
 Adult Chest Compressions
Position your hands and body to perform chest compressions:
Basic Life Support

•Put the heel of one hand in the center of the victim’s chest, on the
lower half of the breastbone (sternum)
 Adult Chest Compressions
Position your hands and body to perform
chest compressions:
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Put the heel of your other hand on top

of the first hand

If you have difficulty pushing deeply

during compressions, put one hand on
the breastbone to push on the chest
Grasp the wrist of that hand with your
other hand to support the first hand as it
pushes the chest
 Adult Chest Compressions
Basic Life Support

Position your hands and body to

perform chest compressions:

Straighten your arms and

position your shoulders directly
over your hands

Keep your arm(s) straight and

locked at the elbows
 Correct CPR position
Basic Life Support
 Adult Chest Compressions
When you give chest compressions, it is
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important to

Compress at a rate of 100 to 120/min

Compress the chest at least 2 inches

(5 cm)

Allow the chest to recoil (reexpand)

completely after each compression

Minimize interruptions in
compressions
 Adult Breaths
 If the person is not breathing, begin rescue
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breaths

 Rescue breathing delivers oxygen to the

victim’s lungs

 The most common technique for single-

rescuer breathing is a face mask or face
shield

 Use a bag-mask device when performing

two-rescuer CPR
 Adult Breaths
 For breaths to be effective, the victim’s airway must be open
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 Obstruction by the tongue. When a victim is unresponsive, the

tongue can block the upper airway
 Adult Breaths
2 methods for opening
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the airway

Head tilt-chin lift

Jaw thrust
 Head tilt–chin lift
Basic Life Support

Place the person face up on a hard, flat

surface

Lift the chin with one hand while pushing

down on the forehead with the other hand.
This aligns the airway structures

Do not press deeply into the soft tissue

under the chin because this might block the
airway

Do not close the victim’s mouth completely

 Jaw-thrust maneuver
Basic Life Support

The jaw-thrust maneuver is used when

the head tilt-chin lift doesn’t work or a
spinal injury is suspected
Place the person face up on a hard,
flat surface

Place the fingers of both your hands

on each side of the person’s jaw

Lift the jaw with both hands. The jaw

will be displaced forward, opening the
airway
 Barrier Devices
 The risk of infection from CPR is extremely low
and limited to a few case reports
Basic Life Support

 However, the US Occupational Safety and

Health Administration (OSHA) requires that
healthcare workers use standard precautions in
the workplace, including during CPR

 Standard precautions include using barrier

devices, such as a pocket mask, when giving
breaths

 Rescuers should replace face shields with a

pocket mask at the first opportunity
 Adult Breaths
Remember the following when interrupting chest compressions to
give 2 breaths with a barrier device:
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Deliver each breath over 1 second.

Note visible chest rise with each breath.
Resume chest compressions in less than 10 seconds
 Bag-mask
 A bag-mask device is used to
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provide positive-pressure
ventilation to a victim who is not
breathing or not breathing
normally.

 It consists of a bag attached to a

face mask. If the bag is self-
inflating, a bag-mask device may
be used with or without an
oxygen supply
Basic Life Support

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call for help
30 chest compressions
2 rescue breaths
 DEFIBRILLATION
Basic Life Support

If no pulse, check for a

shockable rhythm with an
AED/defibrillator as soon as it
arrives

Provide shocks as indicated

Follow each shock
immediately with CPR,
beginning with compressions
Basic Life Support

Approach safely
Check response
Shout for help
Open airway
Check breathing
Call for help
Attach AED
Follow voice prompts
 AUTOMATED EXTERNAL DEFIBRILLATOR
(AED)
Basic Life Support

 An automated external defibrillator (AED) is

a lightweight, portable, computerized device
that can identify an abnormal heart rhythm
that needs a shock

 The AED can then deliver a shock that can

stop the abnormal rhythm (ventricular
fibrillation or pulseless ventricular
tachycardia) and allow the heart’s normal
rhythm to return

 AEDs are simple to operate, allowing

laypersons and healthcare providers to
attempt defibrillation safely
Basic Life Support
ATTACH PADS TO CASUALTY’S BARE CHEST

 If no pulse, check for a shockable rhythm with an

AED/defibrillator as soon as it arrives

 Provide shocks as indicated

 Follow each shock immediately with CPR, beginning with

compressions
 ANALYSING RHYTHM DO NOT TOUCH VICTIM
 “Clear” the victim and allow the AED to
analyze the rhythm
Basic Life Support

 When the AED prompts you, clear the

victim during analysis. Be sure that
no one is touching the victim, not even the
rescuer in charge of giving
breaths.

 Some AEDs will tell you to push a button

to allow the AED to begin analyzing the
heart rhythm; others will do that
automatically. The AED may take a few
seconds to analyze.

 The AED then tells you if a shock is

needed.
 DEFIBRILLATION
 “If the AED advises a shock, it will tell
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you to clear the victim and then

deliver a shock
 Clear the victim before delivering the
shock: be sure that no one is touching
the victim
 Loudly state a “clear the victim”
message, such as “Everybody clear”
or simply “Clear”
 Look to be sure that no one is in
contact with the victim
 Press the shock button
 The shock will produce a sudden
contraction of the victim’s muscles.
 If no shock is indicated and
immediately after any shock
delivered
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 rescuers start CPR, beginning with

chest compressions
Basic Life Support
BLS for Adults
 IF VICTIM STARTS TO BREATHE NORMALLY
PLACE IN
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RECOVERY POSITION
Basic Life Support
Basic Life Support

Approach safely Approach safely

Check response Check response
Shout for help Shout for help
Open airway Open airway
Check breathing Check breathing
Call Emergency System Call Emergency System
30 chest compressions Attach AED
2 rescue breaths Follow voice prompts
 CONTINUE RESUSCITATION UNTIL
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 Qualified help arrives and takes

over

 The victim starts breathing

normally

 Rescuer becomes exhausted

 When Can I Stop CPR?
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Victim revives
Trained help arrives
Too exhausted to continue
Unsafe scene
Physician directed (do not resuscitate
orders)
Cardiac arrest of longer than 30
minutes
– (controversial)
 Why CPR May Fail
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Delay in starting
Improper procedures (ex. Forget to pinch
nose)
No ACLS follow-up and delay in defibrillation
Only 15% who receive CPR live to go home
Improper techniques
Terminal disease or unmanageable disease
(massive heart attack)
 Injuries Related to CPR
Basic Life Support

• Rib fractures

• Laceration related to the tip of

the sternum
– Liver, lung, spleen
 Complications of CPR
Basic Life Support

• Vomiting
• Aspiration
• Place victim on left side
• Wipe vomit from mouth with
fingers wrapped in a cloth
• Reposition and resume CPR
Basic Life Support
THANK YOU