BLS

BLS
(Basic Life Support)
 Definition
• It is also called as CPR.
• It is the non-invasive assessment and
intervention used to quickly identify and
treat victims of respiratory, cardiovascular
emergencies.
 Cardiac Arrest : An Overview
• Sudden Cardiac arrest is a leading cause of
death
• Cardiac arrest is not a single problem
• Majority of Sudden Cardiac arrest are due
to coronary artery disease
• Other causes are asphyxia, as in drowning,
choking or drug overdose
 Cardiac arrest : CPR
• Survival from sudden cardiac arrest is
optimized when the event is witnessed
and CPR is initiated immediately

• Patient survival declines dramatically if

basic CPR is not initiated within first
four minutes
 The Systematic Approach:
The BLS Primary Survey
Goal of BLS :
• To support and restore effective
 oxygenation
Circulation
 with return of intact neurologic function

• ROSC (return of spontaneous circulation)

 CPR: Timing is Everything

Current Indian Scene <2%

Early BLS
2-8%
Early Defib 20%
Bystander 30-50%
0 2 4 6 8 10 min
ADULT
BLS
Chain of survival
 Important
• Although BLS is taught as a sequence of
distinct steps to enhance skills retention and
clarify priorities, several actions should be
accomplished simultaneously (begin CPR and
activate emergency response system) when
multiple rescuers are present.
• All adult arrest are cardiac in origin therefore
1st step i.e. call for help is important because if
AED is not available it can come on time.
BLS consists of……….
Three main parts:
• Chest compressions (C) Previously
• Airway (A) sequence was
• Breathing (B) ‘ABCD’ &
• Defibrillation (D) Now it is
‘CABD’
 Why change???
• In ABCD, chest compressions were often
delayed while the rescuer opened the airway
to give mouth to mouth breaths, retrieved a
barrier device or gathered ventilation
equipment.
• With CABD, rescuer can start chest
compressions sooner and likely to improve
survival.
 Contd…
• Every minute chances of success decreases to
10-15% but if we start CPR by the time AED is
coming even in shockable rhythm, chances of
success decreased to 3-4 from 10-15%.
 Steps of BLS
There are basically 4 steps in BLS:
• Assessment and scene safety
• Activate Emergency response system and Get
an AED
• Check pulse
• Begin cycles of 30 chest compressions and 2
breaths if you do not definitely feel a pulse
within 10sec and perform 5 cycles (30:2) with
CAB sequence.
1. Scene safety What should you do
when you encounter a
victim who is
probably collapsed?
 Ask yourself…..
• Is it safe for me to approach the victim?
I may suffocate /get burnt/get hypothermic/get
electric shock
• Is it safe for the victim to be attended
to where he has collapsed?
I need to take victim out of water / switch off the
main switch to start CPR
• What other precautions should I take for
my own safety?
I should use barriers like handkerchief,
gloves
 Always make sure
that the scene is safe
for you and the victim
Assessment
• Tap the victim’s shoulder and shout,

“Are you all right?”

• Check to see if the victim is breathing.
• If not breathing or not breathing normally
(gasping), activate emergency response
system.
 Ah! He is not
responding, let
me call for help

”HELP ! Is there
anyone
around?”

Do not approach the victim from

back or shake the victim hard
since there is potential of
exacerbating a possible cervical
spine injury
2. Activate Emergency response
system
If someone approaches to help….
If no help available……

• Ask him to call EMS

(emergency medical services) • Call yourself
• Ask him to tell EMS about the before starting the
place and about collapsed CPR
victim?
• While he activates the EMS ,
the rescuer should start CPR
3. Pulse check
• Palpate carotid pulse.
• Feel for a pulse for atleast
5sec but no more than 10
sec.
• If you do not feel pulse
within 10 seconds, start
chest compressions (in
CAB sequence)
4. Begin CPR
1. Assess Circulation and providing
chest compression
2. Opening Airway
3. Assess Breathing and providing
breath
 Revision
4 main steps of BLS:
1. Scene safety and Assessment
2. Call EMS
3. Check pulse
4. Start CPR ( in CABD sequence)
CIRCULATION
 Circulation
• After palpating pulse for atleast 10sec
start with CPR if no definite pulse is
palpable.
 Mechanism: Increase
Changed
of from
intrathoracic
approximately
pressure and direct compression of the
heart 100/min to atleast
100/min
 Recommended compression rate: atleast
100 /min
Depth of compression should be atleast
2inches (5cm). Contd…
Compression : ventilation
30 : 2 when lone rescuer
30 : 2 when 2 rescuers
15 : 2 when 2 rescuers (infants and
children)
Changed
from
approxim
ately 2
inches to
atleast 2
inches
Effective chest compressions
• Start compressions within
10 seconds of recognition of cardiac
arrest.
• Push hard, push fast: Compress at a rate of
atleast 100/min with depth of atleast 2inches
(5cm).
• Allow complete chest recoil after each
compression.
• Minimize interruptions in compression (try to
limit interruptions to < 10 sec)
 Process of CPR
• Position yourself at the victim’s side.
• Make sure that victim lies on the firm, hard
surface.
• Put the heel of the hand on the center of the
victim’s chest on the lower half of the
breastbone.
• Put the heel of your other hand on the top of
first hand.
Placement of hands during CPR

Inter-mammary line
• Straighten your arm with knees locked and
position your shoulder directly over the hands.
• Push hard and fast
 Press down atleast 2 inches (5cm) with
each compression.
 Deliver compressions in a smooth fashion
at a rate of atleast 100/min.
• At the end of each compression, make sure to
allow complete chest recoil after each
compression.
 Adjust position that your shoulders are on
top of the victim and in line with hands
 Provide cycles of compressions and
breathing.
 30 compressions with 2 breaths is one
cycle
 30 : 2 in adults (with one or two rescuer)
 30 : 2 in infant and children (with one
rescuer)
 15 : 2 in infant and children (with two
rescuer)
 Complete 5 cycles and then check carotid
pulse
AIRWAY
 Open the airway for breaths
2 methods are there to open the airway:
• Head tilt- chin lift
• Jaw thrust

*Jaw thrust is used with 2 rescuers as two persons

are needed to provide breaths.
*Head lilt-chin lift should be used until head or neck
injury is suspected as it reduces neck and spine
movement.
Head tilt- chin lift
Jaw thrust
 Caution
• Do not press into the soft tissue under the
chin because this might block the airway.
• Do not use thumb to lift the chin.
• Do not close the victim’s mouth
completely.
BREATHING
 Provide breaths
 Mouth to mouth breaths
 Mouth to mask breaths
 Bag to mask breaths
Mouth to mouth breaths
• Hold the victim’s airway open with a head tilt –
chin lift.
• Pinch the nose closed with your thumb and index
finger (using the hand on forehead)
• Take a regular (not deep) breath and seal your
lips around the victim’s mouth, creating an
airtight seal.
• Give 1 breath (blow for 1sec). Watch for the chest
rise.
• Give a second breath.
• If you are unable to ventilate the victim after 2
attempts, promptly return to chest compressions.
 Face mask
• Standard precautions include using face
mask or a bag mask ventilation when giving
breaths.
• Mask usually have a 1-way valve that diverts
exhaled air, blood or bodily fluids away from
the rescuer.
Mouth to mask breaths
• Position yourself at the victim’s side.
• Place the mask on the victim’s face, using the
bridge of the nose as a guide for correct
position.
• Seal the mask against the face:
 Using the hand that is closer to the top
of the victim’s head, place your index
finger and thumb along the edge of the
mask.
 Place the thumb of your second hand
along the bottom edge of the mask.
 Contd….
• Place the remaining fingers of your second
hand along the bony margin of the jaw and lift
the jaw
• While you lift the jaw, press firmly and
completely around the outside edge of the
mask to seal the mask against the face.
• Deliver air over 1 second to make the
victim’s chest rise.
• WORKSHOP 2010\Breaths with Mask.mpg
Bag to mask breaths
• Position yourself directly above the victim’s
head.
• Place the mask on the victim’s face, using the
bridge of the nose as a guide for correct
position.
• Use the E-C clamp technique to hold the mask
in place while you lift the jaw to hold the
airway open
• Squeeze the mask to give breaths (1second
each) while watching the chest rise.
E – C technique
1 rescuer
2 rescuer
2 rescuer CPR
2
When a second rescuer is available to
help, that second rescuer should
activate the emergency response
system and can get the AED.

The first will remain with the

victim to start CPR immediately
 Contd…
• The rescuers will then give compressions and
breaths but should switch roles after every 5
cycles of CPR (about every 2min)
Rescuer 1: At victim’s side
Switc
h
duties
with
the
secon
d
rescu
er
every
5
cycles
or
about
2minu
tes,
taking
less
than 5
sec to
switch
Rescuer 2: At victim’s head
Maintai Switc
n an h
open
airway
duties
Give with
breaths the
watchi secon
ng for d
chest
rise
rescu
and er
avoidin every
g 5
excessi cycles
ve
ventila
or
tion. about
Correct 2minu
the tes,
rescuer taking
1 to
perfor
less
m than 5
adequa sec to
te CPR. switch
DEFIBRILLATION
 AED (Automated External
Defibrillators)
• Automated external defibrillators (AEDs)
are computerized devices that can identify
cardiac rhythms that need a shock and
these can deliver shock.
• When VT is present, the heart muscle
fibres quiver and do not contract together
to pump blood.
 Contd…
• This delivers shock to stop the quivering of the
heart fibres and allows the muscle fibres of
the heart to ‘reset’ so that they can begin to
contract at same time.
• Once an organized rhythm occurs, the heart
muscle may begin to contract effectively and
begin to generate a pulse (called ROSC)
Parts of AED

• Pads (self sticking)

• On/off switch
• Shock delivery
button
• Pad connector
• Battery
• Once the AED arrives, place it at the victim’s
side
• If multiple rescuers are present, one rescuer
should continue CPR while another rescuer
attaches AED pads.
Attempted Defibrillation
Current Recommendation
• One shock
– Biphasic 150-200J
– Monophasic 360J
– Immediate CPR
– Rhythm check only
after 5 cycles (2
mins) of CPR
 Using AED
• Switch it on
• Act according to voice prompt
• Apply pads to bare chest of victim ( one to the side of
the left nipple, with the top edge of the pad a few
inches below the armpit and other below right collar
bone)
• Connect pads to AED (some are preconnected)
• Let AED Analyze heart rhythm: do not touch the
victim (it will take 5 to 15 sec to analyze)
 Contd…
• If the AED advices a shock; be sure no one is
touching the victim.
• Loudly state a “clear the victim” message, such as
“Everybody clear” or simply “clear”.
• Look to be sure no one is in contact with the
victim.
• Press shock button
• Shock delivered: immediately
resume with 5 cycles CPR begin with chest
compressions
• If “no shock advised”, immediately
restart CPR.
 AED in special situations
• Age :
– Victim <1yr – AED not advised
– Victim 1-8yrs – use child pads and child AED
• Hairy chest:
– Press pads firmly, if not remove hairs by sticking
pads and removing hair along with them. Use
other set of pads now
– Use razor
• Wet chest:
– Clean victim’s chest dry
 Contd….
• If patient is in water, do not use AED but if
patient is in snow; dry the chest first and then
AED can be used.
• Implanted device: Do not use AED
 AED with 2 rescuer
• Check the response and check breathing
The first rescuer stays with the victim and
performs the next steps until the next rescuer
returns with AED.
The second rescuer activates the emergency
response system and gets the AED.
• Check for pulse
The first rescuer removes or moves clothing
covering the victim’s chest and then start CPR.
2 Rescuer CPR Demo.mp4
PAEDIATRIC
BLS
Chain of survival
• Prevention of arrest
• Early high quality bystander CPR
• Rapid activation of the emergency response
system
• Effective advanced life support (including rapid
stabilization and transport to definitive care
and rehabilitation)
• Integrated post-cardiac arrest care
BLS in children from 1year of
age to puberty
 Critical points
• Start compressions within 10sec of
recognition of cardiac arrest.
• Push hard, push fast : Compress at rate of
100/min with depth of approximately 2 inches
(5cm) or compress at least one third the depth
of the chest
• Allow complete chest recoil after each
compression
 Contd…
• Compression: Ventilation ratio for:
2 rescuer CPR - 15: 2 ratio
1 rescuer- 30:2 ratio
• Compression technique: May use 1 or 2
handed chest compression for very small
children
• Complete 2min with 15:2 ratio, no number of
cycles is seen.
• Minimize interruptions in compressions (<
10sec)
 Contd…
• Give effective breaths that make chest rise.
• Avoid excessive ventilation.
 1 rescuer BLS sequence

• Check the child for a response and check

breathing.
• Shout for help if there is no breathing or not
normal breathing (gasping)
• If someone responds, send that person to
activate emergency response system and get
the AED.
 Contd…
[If the child collapsed suddenly and you are alone,
leave the child to activate emergency response
system and get the AED]
• Check the child’s pulse (take atleast 5 but not more
than 10sec). You can locate carotid or femoral pulse
in children
• If no pulse is felt, start with chest compressions at
rate of 30: 2 ratio.
• After 5 cycles, if someone has not already done so,
activate the emergency response system and get the
AED. Use AED as soon as available
 Locating femoral pulse
• Place 2 fingers in the inner thigh, midway
between the hipbone and the pubic bone and
just below the crease where the leg meets the
abdomen.
• Feel the pulse for atleast 5 sec but not more
than 10sec.
• If you do not definitely feel a pulse, begin CPR,
starting with chest compressions (CAB
sequence)
 2 rescuer
• Check the child for a response and check
breathing.
• If there is no breathing or no normal
breathing, the second rescuer activates the
emergency response system
• Check the child’s pulse (take atleast 5 but not
more than 10sec). You can locate carotid or
femoral pulse in children
 Contd…
• Start with chest compressions if no pulse is
palpable with 30: 2 ratio and when the second
rescuer arrives, use 15: 2 compression:
breaths ratio.
BLS/ CPR for infants
 Critical points
• Location of pulse: Brachial artery in infants
• Technique of giving compressions: 2 fingers
for single rescuer and 2 thumb – encircling
hands technique for 2 rescuer.
• Compression depth: at least one third of the
chest depth or approximately 1.5 inches (4cm)
• Compression: Ventilation ratio-
30: 2 for 1 rescuer
15: 2 for 2 rescuer
 Locating brachial pulse
• Place 2 or 3 fingers on the inside of the
upper arm, between the infant’s elbow and
shoulder.
• Press the index and middle fingers gently on
the inside of the upper arm for atleast 5 but
no more than 10 seconds when attempting
to feel pulse.
 1 rescuer
• Check the infant for a response and check
breathing.
• If there is no response and no breathing or not
normal breathing, despite of adequate
oxygenation and ventilation, heart rate (pulse)
is < 60/min with signs of poor perfusion,
perform cycles of compressions and breaths
(30:2 ratio). shout for help.
• Check the infant’s brachial pulse (take at least
5 but no more than 10 seconds)
 Contd…
• If someone responds, send that person to
activate the emergency response system and
get the AED.
• If there is no pulse, start chest compressions
with 30: 2 ratio.
• After 5 cycles, if someone has already done so,
activate emergency response system and get
the AED.
 2-finger chest compression
• Place the infant on a firm, flat surface.
• Place 2 fingers in the center of the infant’s
chest just below the nipple line. Do not press
on the bottom of the breast bone.
• Push hard and fast. To give chest
compressions, press the infant’s breastbone
down atleast one third the depth of the chest
(app. 1.5 inches). Deliver compressions in a
smooth fashion at a rate of at least 100/min.
2 fingers for Single rescuer
 Contd…
• Make sure to allow complete chest recoil.
• Minimize interruptions in chest
compressions.
 2 rescuer
• Check the infant for a response and check
breathing.
• If there is no response and no breathing or not
normal breathing, send the second rescuer to
activate the emergency response system and
get the AED.
• Check the infant’s brachial pulse
 Contd…
• If there is no pulse, despite of adequate
oxygenation and ventilation, heart rate (pulse)
is < 60/min with signs of poor perfusion,
perform cycles of compressions and breaths
(30:2 ratio).
• When the second rescuer arrives and can
perform CPR, use a compression- ventilation
ratio of 15: 2.
 2 Thumb encircling hands chest
compression technique
• Perform when 2 rescuer are present.
• The technique produces blood flow by
compressing the chest with both the thumbs.
• It produces more better flow, more
consistently results in appropriate depth or
force of compression, and may generate
higher blood pressures than the 2 finger
technique.
2 thumb – encircling hands technique
for 2 rescuer
Pediatric BLS Algorithm.
Airway
 Open the airway for breaths
2 methods are there to open the airway:
• Head tilt- chin lift
• Jaw thrust

*Jaw thrust is used with 2 rescuers as two persons

are needed to provide breaths.
*Head lilt-chin lift should be used until head or neck
injury is suspected as it reduces neck and spine
movement.
BREATHING
 Provide breaths
 Mouth to mouth breaths
 Mouth to mask breaths
 Bag to mask breaths
Defibrillation
• Child CPR 2 rescuer.mp4
 Comparison of 2005 and 2010
guidelines by AHA
2005 guidelines
• ABCD sequence
• Look listen feel
• Compression depth:
approximately 2 inches
(5cm)
• Pulse check for atleast
10sec
• C: V ratio is 30: 2 with 1
rescuer and 15: 2 with 2
rescuer in adults and paed.
2010 guidelines
• CABD sequence
• No Look listen feel
• Compression depth: atleast
2 inches (5cm)
• Pulse check for 5sec but not
more than 10sec
• C: V ratio is 30: 2 in adults,
paed (if 1 rescuer)
 Summarization
• Best CPR generate 30% of the cardiac output
which is critical for cerebral and coronary
blood perfusion, therefore compressions
should come first.
• After surgeries even immediately after CABG,
we can give CPR.
• Almost all arrests in paed are respiratory
arrest so breaths are more important.
ANY QUERY????
THANK
‘U’