Basic Life Support

&
Cardio Pulmonary
Resuscitation
FFR Preparation 2022
Heart Disease as leading cause of death – CDC
Over 600,000 death/every year .
 Guidelines for Basic Life Support – A Review of the Most
Recent Updates

October 2020
1. The ‘chain of survival’ has been modified, with a sixth link, Recovery,
being added for both adults and children

2. For children, the rate for assisted ventilation has been modified. The
current guidelines recommend delivery of one breath every 2 to 3
seconds, with 20 to 30 breaths per minute.
 Guidelines for Basic Life Support – A Review of the Most
Recent Updates

3. Specific algorithms have been suggested for opioid-associated

emergencies, for both adults and children. It is recommended that lay
rescuers receive training in administering naloxone

4. Emphasis has been placed on debriefing the rescuer – whether

lay rescuers, emergency personnel, or hospital workers
 Time is of the Essence in Basic Life Support:

• Two to three minutes

• Neuronal changes begin in the brain – long term loss of brain

function.
 High quality CPR
• Keep compression rate of at least 100-120 minute for all persons.

• Keep compression depth of between 2-2.4 inches for adults and children, and
about 1.5 inches for infants.
• Allow complete chest recoil after each compression.

• Minimize interruptions in CPR, except to use an AED or to change rescuer positions.

• Do not over ventilate.

• Provide CPR as a team when possible

Breakdown of Techniques Used in Basic Life Support
Algorithms:

Three essential components of CPR :

1. Chest compressions
2. Airway maintenance, and rescue breathing/ assisted ventilation .
3. The use of an Automated External defibrillator. AED
Chest compressions
Aim to deliver at least 100 compressions per minute. The ideal
rate is 100-120 compressions per minute
Factors that Improve the Efficacy of Chest
Compressions:
1. Depth
2. Chest recoil
3.Surface
4.Interruptions
 2. Management of the airway and rescue
breathing
1.When the patient is unresponsive, has a pulse, and is either gasping ineffectively
or not breathing at all.

2.In cardiac arrest patients after 13 minutes have passed or 400 compressions have
been completed.

3. When two rescuers are available on the scene immediately after cardiac arrest.
One rescuer can focus on chest compressions while the other carries out rescue
breathing.
 AIRWAY MANAGEMENT

• Head Tilt – Chin Lift maneuver

Jaw Thrust Maneuver
RESCUE
BREATHING
Use of Barrier Devices during Rescue
Breathing
Technique
• Stand or kneel by the patient’s side.

• Place the barrier device over the patient’s mouth and nose.

• Perform the head-tilt/chin-lift (or jaw thrust) manoeuvre to open the airway.

• Take a normal (not deep) breath. Exhale into the victim’s mouth, through the barrier device

• The amount of air delivered and time taken to deliver the air must be monitored

• While delivering the breath, ensure that the patient’s chest rises

• Continue performing chest compressions if the chest does not rise even after two breaths

• If you are administering rescue breathing to infants, mouth-to mouth/nose technique is preferred. Your
mouth should cover both the mouth and nose of the infant, creating a tight seal.
Ventilation using a Bag-Mask
E C CLAMP TECHNIQUE
 3. Automated external defibrillator – why
and how it is used

• Ventricular Fibrillation Shockable

• Pulseless Ventricular Tachycardia

• Asystole
• Pulseless Electrical Activity Not shockable
How the AED Works:
• Power on
• Identify the correct adhesive AED pads to be used. Usually, adult pads
must be used for patients greater than 8 years of age.
• Adhesive pad placement options : anterolateral / antero posterior .
• ‘Clear’ the patient so that the AED can analyse the rhythm.
• If the AED prompts to shock the patient, ensure once again that the
patient is ‘clear’, and that no one is in contact with the victim
• Press the required button to deliver the shock, if indicated.
• Immediately resume CPR
Technique of Using an AED:
 Just follow
the
instructions
!
 Factors to Consider while Using an AED

• Water
• Chest hair
• Implantable pacemakers or defibrillators
• Transdermal patches:
Time is of the Essence while Using an AED.
• 3 to 5 mins

• Pulse less tachycardia / ventricular fibrillation asystole

TECHNIQUE MODIFICATIONS
FOR SPECIAL CATEGORIES
 Chest compressions in infants and
children:
• Chest Compressions in Children
 Chest Compressions in
Infants:
• Single rescuer : two finger technique

• Two rescuer :two thumb encircling hand technique

 Airway and rescue breathing in infants
and children:
• Head tilt in infants

Do not exceed neutral neck position

• Mask selection for children and adults

 Automated External Defibrillator in
children below 8 years of age
• Reduced dose

• Pediatric pads

• Adhesive position for infants

antero – posterior
Hospital Call Codes and numbers

CALL 222
Call Color

Adult Cardiac Arrest BLUE

Infant & Ped Cardiac Arrest PINK

Neonatal Emergency BROWN

Trauma YELLOW

Major Disaster ORANGE

Fire RED

Violence WHITE
BLS algorithm steps
• Adult versus child
• One rescuer versus two rescuer
 steps
• Phase 1 : Assessment of Environment
people

Phase 2: Assessment of victim

 Responsiveness
 Pulse and breathing

Less than 10 seconds

• Phase 3 : Definite phase
Scenario 1 : If the patient is breathing and a pulse can be detected:

Monitor the breathing and pulse periodically.

Scenario 2 : If a pulse is definitely detected, but breathing is absent:

Call Emergency Team – MDC
Get ambu bag

Start providing rescue breaths.

 One breath over one second every 5 to 6 seconds / 10- 12 breaths / minutes ( adults )

 One breath over 1 second, every 2 to 3 seconds / 20 to 30 breaths per minute.( children )

 Check for pulse in children periodically .

The pulse falls below 60 beats per minute. ( children )
signs of poor perfusion : cyanosis , cool extremities /pale

Start compressions .
30: 2 – single rescuer
15: 2 – two rescuers
• Scenario 3 : If both pulse and respiration are absent:
Activate Emergency Team – MDC and
Call 22
 Code Blue – adults
Code pink - children
Get ambu bag

Immediately start delivering chest compressions and rescue breathing

Component Compression Rescue breathing
Adults 30 2
Children and infants– 30 2
single rescuer
children and infants – two 15 2
rescuers

Once the AED is available, the second rescuer can attach the adhesive
pads and allow the AED to analyze the rhythm without stopping the
CPR
If prompted, the second rescuer must shock the patient (while others
stay clear). And immediately resume chest compressions
• Success of the two-rescuer protocol depends on effective
communication between both members of the team.
• Chest compressions must be counted out loud, so that the other
rescuer can correctly deliver rescue breaths at the end of 30
compressions.
• Clear communication is also essential while operating the AED,
and instructions to stand clear of the patient during rhythm analysis
and shock must be given in a loud, clear voice.

• Rescuer fatigue : decreases the efficiency of compressions

Switch roles every 5 cycles/ 2 minutes
• In children, rescue breathing plays a much more important role than
in adults. This is because the cause of cardiac arrest in children is
often shock or respiratory failure, which depletes the oxygen content
in blood even before cardiac arrest occurs. Therefore, unlike adults,
they do not have enough oxygen in their blood that can be circulated
through compressions.
 Relief of Choking
• Choking is the term used to describe the reaction that occurs when a
person is unable to breathe properly because of a physical
obstruction in their upper respiratory tract, usually at the level of the
laryngeal inlet.

• 4000 death / year – in United States

• One child every 5 days dies of choking alone in US
 RECOGNITION OF A CHOKING
VICTIM
• Prompt recognition will ensure prompt management.

Signs of Mild choking:

• Continuous cough in an attempt to expel the object

• A prominent wheeze between coughs

 Signs of Severe Choking
• Patient is unable to speak at all or cry

• There is weak cough or cough is absent

• High pitched noise may be produced while attempting to inhale

• Cyanosis due to insufficient oxygen exchange.

• Universal choking sign

This is an instinctive reaction and is considered the classical sign
of choking . The patient holds or clutches their throat with the
thumb and fingers of one or both hands.
 MANAGEMENT OF THE CHOKING
PATIENT
• Depends on 2 factors :
 Adult/ child/ infant
 Responsive (Conscious )/ Unresponsive
(unconscious )
 Responsive adult or child
Heimlich maneuver
• a series of controlled, upward abdominal thrusts.

• puts pressure on the diaphragm, forcing it upwards into the chest

cavity.

• pushes air out of the patient’s lungs, forcing them to cough and
eventually, expel the object.
Steps in performing the
Heimlich maneuver
 Modifications of the Heimlich
Maneuver
• Performing the maneuver on a
Pregnant Patient
Chest Thrusts

 Combining abdominal thrusts with back

blows: ‘Five and five approach’
 UNRESPONSIVE ADULT OR CHILD:
CPR
• When a patient loses consciousness, it is indicative of oxygen
deprivation to the brain. Immediate steps must be taken.

• Immediately activate emergency team.

• Gently lower the victim to the ground or any available firm surface.
• Start CPR: it is not necessary to look for a pulse: 30: 2
• Modification of rescue breathing: after each cycle of compression-
look for the object .
• Continue 5 cycles of 30 compressions and 2 rescue breaths.
 Relief of choking in a responsive infant
• Abdominal thrusts must NEVER be used
in an infant.
• standard chest compressions, similar to
those described for infant CPR.

• American Heart Association recommends

the ‘five and five’ approach for responsive
infants
 Relief of choking in an unresponsive
infant
• If the infant becomes unresponsive, the rescuer must shift over to
CPR. As for adults, one must not waste time looking for a pulse.
 When to stop CPR?
CPR must only be stopped by rescuers if any one of the following end points
is reached:
An Advanced Life Support team takes over chest compressions and
rescue breathing, while transporting the patient to the hospital.

 The patient begins to regain consciousness and awareness.

The rescuer becomes fatigued to an extent that their own health may be at
risk if they continue. If this is the case, there would usually be other
rescuers on hand to take over.
Thank you for saving lives
Mass Casualty, START Triage and the
SMART Tag System
• What is a Mass Casualty Incident?

• ANY event that overwhelms the available resources.

• By available resources, this could mean that we don’t have enough
ambulances, enough personnel or enough hospital beds.

• It could be: Natural

Accidental or
Intentional event.
Triage
• what is Triage? 
Triage is the process of prioritizing or sorting of sick or injured people
for treatment according to the seriousness of the condition or injury.
Triage: Sorting of Patients
• You can’t commit to “one-on-one” care

• You have to be fast – 30 sec or less per patient

• Very limited treatment is provided
Manually open airways
 Clear airway with finger sweep 
 Control major bleeding
The “START” System of Triage
• Simple triage and rapid treatment (START )
• Triage Categories:
Red (1)= immediate - critical patient
Yellow (2)= delayed - serious patient that could wait until all reds
have been transported
Green(3) = ambulatory / hold – minor injuries (anyone who can walk
at the scene will be tagged GREEN.)
 Black = deceased/ Dead (expectant)
• BEGIN… Clear out all ambulatory patients – tag Green

• Rest of the patients require MORE triage –

• 3 steps: They will be either red, yellow or black.

 Respiratory effort
Pulses/perfusion
 Mental status
• Not breathing – manually open their airway
• If they start breathing - tag RED
• If they don’t start breathing – tag BLACK Breathing >30 or
START – Step 1 Respiratory Effort
Not breathing – manually open their airway
If they start breathing - tag RED
• If they don’t start breathing – tag BLACK

• Breathing >30 or < 10 - tag red

• Breathing normal 10-30 = go to next step
START – Step 2 Pulses/Perfusion
• Check for Radial pulse.
• Radial pulse absent = tag RED
• Radial pulse present =
Go to next step
START – Step 3 Mental Status
• Assess whether or not the person can follow a simple command.

“Squeeze my hand”
Can follow a simple command = tag YELLOW

Cannot follow a simple command = tag RED

Pediatric Modifications for START
• Respirations < 15 or > 45 tag RED

• Respirations 15-45 - go to next step (Pulse)

Face shield:
Technique for Performing Rescue
Breathing:
Protocols Used in Cardiopulmonary
Resuscitation
• Now that the individual components of cardiopulmonary resuscitation
have been mastered, one must learn to fit these into an appropriate
algorithm which can be followed when put into action.