Basic Life Support (BLS) refers to the care

healthcare providers and public safety

professionals provide to patients who are
experiencing respiratory arrest, cardiac arrest
or airway obstruction.

BLS includes psychomotor skills for

performing high-quality cardiopulmonary
resuscitation (CPR), using an automated
external defibrillator (AED) and relieving an
obstructed airway for patients of all ages.
 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.
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)
 BLS also focuses on the integration of the following key
skills to help rescuers achieve optimal patient outcomes:
Critical thinking: clear and rational thinking based on
facts presented and the learner’s experience and
expertise
Problem solving: identifying solutions to issues that
arise using readily available resources .
Communication: a closed-loop process involving a
sender, message and receiver
Team dynamics: integration and coordination of all
team members working together toward a common goal
 Primary Assessment of the Unresponsive
Adult:
Patient After completing the scene size-up and
determining that it is safe to approach the
patient, need to conduct a primary assessment.
This assessment involves three major areas:
=assessing the level of consciousness
=breathing and circulation.
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
 BLS & AED
Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor Patient
East of England Ambulance Service
NHS Trust

Date 12/02/2015
8
 BLS & AED

2% 4% 30%

East of England Ambulance Service

NHS Trust

Date 12/02/2015
9
 Level of Consciousness (LOC)
If the person is silent and not moving, he or
she may be unresponsive.

To check for responsiveness, tap the patient on

the shoulder and shout, “Are you okay?”

Use the person’s name if you know it. Speak

loudly.
CHECK RESPONSE

Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/1123
Monitor
 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.....
East of England Ambulance Service
NHS Trust

Date 12/02/2015
12
SHOUT FOR HELP

Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position?
Dial 999/112
Monitor
OPEN AIRWAY

Approach safely
Check response
Shout for help
Open airway
Check breathing
Recovery Position
Dial 999/112
Monitor
 Airway:
 Once assessed the patient’s level of
consciousness, evaluate the patient’s airway.

Remember, if the patient is alert and talking, the

airway is open. For a patient who is unresponsive,
make sure that he or she is in a supine (face-up)
position to effectively evaluate the airway.

If the patient is face-down, roll the patient onto

his or her back, taking care not to create or
worsen an injury.
If the patient is unresponsive and his or her
airway is not open, need to open the airway.

Two methods may be used:

= Head-tilt/chin-lift technique
=Modified jaw-thrust maneuver, if a head, neck
or spinal injury is suspected.
 Airway Management

Airway Open Airway Closed Airway Obstructed

•An unconscious casualty has no control over their

muscles, including the muscles that control the
tongue.
 Head-tilt/chin-lift technique

To perform the head-tilt/chin lift technique

on an adult:
=Press down on the forehead while pulling up
on the bony part of the chin with two to three
fingers of the other hand.

=For adults, tilt the head past a neutral position

to open the airway while avoiding
hyperextension of the neck.
 Modifi ed jaw-thrust maneuver:
 The modifi ed jaw-thrust maneuver is used to open the
airway when a patient is suspected of having a head,
neck or spinal injury.
 To perform this maneuver on an adult, kneel above the
patient’s head and: Put one hand on each side of the
patient’s head with the thumbs near the corners of the
mouth pointed toward the chin, using the elbows for
support.
 Slide the fingers into position under the angles of the
patient’s jawbone without moving the head or neck.
 Thrust the jaw upward without moving the head or
neck to lift the jaw and open the airway
 Simultaneous Breathing and Pulse Check:
Once the airway is open, simultaneously check for breathing
and a carotid pulse, for at least 5 but no more than 10
seconds.
When checking for breathing,
= look to see if the patient’s chest rises and falls,
= listen for escaping air and feel for it against the side of cheek.
Normal breathing is quiet, regular and effortless. Isolated or
infrequent gasping in the absence of other breathing in a
patient who is unresponsive may be agonal breaths.
= Feel for air on your cheek.
Agonal Breaths:
Agonal breaths are isolated or infrequent gasping that
occurs in the absence of normal breathing in an unconscious
patient. These breaths can occur after the heart has stopped
beating and are considered a sign of cardiac arrest.
Agonal breaths are NOT normal breathing. If the patient is
demonstrating agonal breaths, need to care for the patient as
if he or she is not breathing at all.
If Not Breathing

Don’t Panic
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
 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
East of England Ambulance Service
NHS Trust

Date 12/02/2015
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Agonal Breathing
Ventilation with advanced airway every 6-8
seconds asynchronous with compressions.
Rescue breathing ever 5-6 seconds.
Deliver at about 1 second/breath.
Watch for visible chest rise.
 Approach safely
Check response
Shout for help
Open airway
If no help arrives and
you are alone dial Check breathing
999/112 After putting Recovery Position
into recovery position.
Dial 999/112
Monitor
 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.
 Recovery position 2

 
• Grab and bend the person's far knee
                                             
 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
 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
Recovery Position
 CPR
Cardiopulmonary resuscitation circulates blood
that contains oxygen to the vital organs of a
patient in cardiac arrest when the heart and
breathing have stopped.
It includes chest compressions and ventilations
as well as the use of an automated external
defibrillator.
 Compressions :
One component of CPR is chest compressions. To ensure
optimal patient outcomes, high-quality CPR must be
performed if the victim has no pulse.
Ensure high-quality CPR by providing high-quality chest
compressions, making sure that the:
= Patient is on a firm, flat surface to allow for adequate
compression.
= In a non-healthcare setting this would typically be on the
floor or ground, while in a healthcare setting this may be on
a stretcher or bed with a CPR board or CPR feature applied.
= The chest is exposed to ensure proper hand placement and
the ability to visualize chest recoil.
Hands are correctly positioned with the heel of
one hand in the center of the chest on the lower
half of sternum with the other hand on top.

Most rescuers find that interlacing their fingers

makes it easier to provide compressions while
keeping the fingers off the chest.

Arms are as straight as possible, with the

shoulders directly over the hands to promote
effective compressions. Locking elbows will help
maintain straight arms.
Compressions are given at the correct rate of at
least 100 per minute to a maximum of 100-120 per
minute, and at the proper depth of at least 2
inches (4-5cm)for an adult to promote adequate
circulation.

The chest must be allowed to fully recoil between

each compression to allow blood to flow back into
the heart following the compression.

For adult patients, CPR consists of 30 chest

compressions followed by 2 ventilations.
Body Alignment
  Ventilations:
 Ventilations supply oxygen to a patient who is not
breathing.
They may be given via several methods including:
=Mouth-to-mouth.
= Pocket mask.
= Bag-valve-mask (BVM) resuscitator.

During adult CPR, give 2 ventilations that last

approximately 1 second each and make the chest rise.
 Breathing
Mouth-to-Mouth Ventilation Children and Adults
Steps to follow in Mouth-to-Mouth
1. Place victim on their back
2. Open the airway
3. Check the victim’s breathing
4. If no breathing, start artificial ventilation
5. If chest doesn’t rise, airway may be blocked
6. Take 5-10 seconds to check for a pulse
7. If breathing is restored, remain in position
30 CHEST COMPRESSIONS:

Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
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 4-5 cm
– Equal compression : relaxation
• When possible change CPR
operator every 2 min.
RESCUE BREATHS

Approach safely
Check response
Shout for help
Open airway
Check breathing
Dial 999/112
30 chest compressions
2 rescue breaths
 Pinch the nose
RESCUE BREATHS 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
 BLS & AED
Combine Compressions and Rescue breaths
at a ratio of 30:2
30 2

30

East of England Ambulance Service

NHS Trust

Date 12/02/2015
44
 CPR Ratio 30:2
30 chest compressions  = 1 cycle
2 breaths
 Using an AED:
 For an AED to be effective, MUST use it
properly by doing the following:
= Turn it on first.
= Make sure the patient’s chest is clearly exposed
and dry.
= Remove any medication patches with a gloved
hand.
= If necessary, remove or cut any undergarments
that may be in the way.
= The pads need to be adhered to the skin for the
shock to be delivered to the heart.
Apply the appropriate-sized pads for the
patient’s age in the proper location on the bare
chest. - Use adult pads for adults and children
over the age of 8 years.

Place one pad on the upper right chest below

the right clavicle to the right of the sternum;
place the other pad on the left side of the chest on
the mid-axillary line a few inches below the left
armpit.
Plug in the connector, and push the analyze
button, if necessary. (Most AEDs available today
have their pads pre-connected and will
automatically analyze once the pads are applied
to the chest. Make sure you understand how the
AED within organization operates.)

 Tell everyone to “clear” while the AED is

analyzing to ensure accurate analysis.Ensure no
one is touching the patient during the analysis or
shock.
When “clear” is announced, have the rescuer
performing the compressions stop compressions
and over a few inches above the chest, but remain
in position to resume compressions immediately
after a shock is delivered or the AED advises that
a shock is not indicated.
 Observe the AED analysis and prepare for a
shock to be delivered if advised.
 Ensure that everyone is clear of the patient
before the shock is delivered.
Remember that the AED delivers an electrical
current that could injure anyone in contact with
the patient.
After the shock is delivered, immediately start
compressions and perform about 2 minutes of
CPR (about 5 cycles of 30:2) until the AED
prompts that it is reanalyzing, the patient shows
signs of return of spontaneous circulation.

Do not wait for the AED to prompt to begin CPR

after a shock or no shock advised message.
Do’s and Don’ts for AED:
Do’s :
 Before shocking a patient with an AED, do make sure
that no one is touching or is in contact with the patient
or any resuscitation equipment.
Do use an AED if a patient is experiencing cardiac
arrest as a result of traumatic injuries.
Do use an AED for a patient who is pregnant.
Defibrillation shocks transfer no significant electrical
current to the fetus. The mother’s survival is paramount
to the infant’s survival.
Don’ts :
= Do not use alcohol to wipe the patient’s chest
dry. Alcohol is flammable.
= Do not touch the patient while the AED is
analyzing. Touching or moving the patient may
affect analysis.
= Do not touch the patient while the device is
defibrillating. You or someone else could be
shocked.
= Do not defibrillate someone when around
flammable or combustible materials, such as
gasoline or free-flowing oxygen.
ANY QUESTIONS ?

Time to practice.....
 Child CPR
Many children do not receive resuscitation because
potential rescuers fear is far better to use the adult
BLS sequence for resuscicausing harm.
This fear is unfounded; it tation 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.
Children and babies
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.
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
 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.
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 shock able rhythm.
• advise the operator step-by-step what to do.
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.
 • 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
 BLS & AED

2% 4% 30%

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NHS Trust

Date 12/02/2015
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 DEFIBRILLATION SAFETY !

THE PATIENT: THE AED:

 5 point check  In good working order
 Pacemaker  Do Not use in Heavy
 Jewellery
rain
 Do Not use if they lay in
 Hair on chest
a pool of water
 Damp/Wet skin
 Do Not use in an
 Patches (GTN)
explosive environment !
ATTACH PADS TO CASUALTY’S
BARE CHEST
 ANALYSING RHYTHM
DO NOT TOUCH PATIENT
SHOCK ADVISED

“Stand clear
Everyone” !
TOP
MIDDLE
BOTTOM
MYSELF
BEHIND YOU
DELIVER SHOCK
 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.
DEFIBRILLATION:
 SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
 COMMENCE CPR (2 Mins)
30 2

30 2
 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.
 Follow up – what to do after?
• If you have used an Automated External Defibrillator,
even by just attaching it to a patient, 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.
 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.
• Qualified help arrives and takes over.
• You become exhausted.
• It is unsafe to continue.