Basic life support, Cardiopulmonary resuscitation ,cardiac failure ,chest compressions ,rescue breaths ,defibrillator ,aed ,nurses role ,lone rescuer ,two rescuers ,infant cpr ,heimlich maneuver ,head tilt chin lift ,jaw thrust, airway management, acls

1. BASIC LIFE
SUPPORT
PRESENTED BY:
DR. AKASH BHATT
PG RESIDENT
OMFS

2. CONTENTS
• Cardiac arrest
• BLS Introduction
• ABC to CAB
• Chest compressions
• Rescue breaths
• Defibrillation
• ACLS

3. CARDIAC ARREST
➢ Cessationof normal circulation of blood due to
failure of heart to contracteffectively.
➢ Suddencessationof mechanicalactivity of
heart with some or no electrical activity.
➢ May be reversible by a rapid intervention but
will lead to death in its absence.

4. ❖ M.I.
❖ Arrhythmia
❖ Low C.O.,failure,shock
❖ Cardiomyopathy
❖ Myocarditis
❖ Massive pulmonary
emboli
CARDIAC OTHERS
❖ Coronary artery disease❖ Severe anaphylaxis
❖ Suffocation
❖ Electrocution
❖ Trauma
❖ Stroke
❖ Exsanguination
(severe loss of
blood)
❖ Drowning
CAUSES OF CARDIAC ARREST

5. REVERSIBLE CAUSES OF CARDIAC ARREST
•5 Ts:
❑ Pulmonary
thromboembolism
❑ Tension
pneumothorax
❑ Cardiac Tamponade
❑ Toxins (TCAs, ß-blockers,
Ca channel blocker, Digoxin)
❑ Coronary thrombosis
5 Hs:
❑ Hypoxia
❑ Hypovolemia
❑ Hypo/hyperkalemia
❑ Hydrogen ions
❑ Hypothermia

6. INTRODUCTION
⚫ Approx. 700,000 cardiac arrests per year in
Europe.
⚫ Survival to hospital discharge presently
approx. 5-10%.
⚫ Bystander CPR vital intervention before arrival
of emergency services – double or triple
survival chances from sudden cardiac arrest.
⚫ Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60%
survival.

7. BLS
⚫ Lack of resuscitation skills of nurses and doctors has been
identified as a contributing factor to poor outcomes of cardiac
arrest victims.
⚫ It combines rescue breathing and chest
compressions.
⚫ It requires knowledge and skill to perform CPR and how to
operate AED / defibrillator.

8. ➢ These are sequences of procedure performed to
restore 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.

9. CHAIN OF SURVIVAL

10. ABCTO CAB
➢ Vast majority of cardiac arrests occur in adults, and
highest survival rates from cardiac arrest are reported
among all ages .
➢ In these patients, the critical initial elements of BLS are
chest compressions and early defibrillation.
➢ In the A-B-C sequence, chest compressions are often
delayed while the responder opens the airway to give
mouth-to-mouth breaths, retrieves a barrier device, or
gathers and assembles ventilation equipment.

11. ABC TO CAB

12. BASIC LIFE SUPPORT
⚫ Steps to follow in BLS
– Approach Safely
– 1. Check the responsiveness of the victim
– 2. Call for Help
– 3. Position victim on his or her back
– 4. Open the airway
– 5. Assess breathing
– 6. Assess circulation
– 7. Stay with the victim until help arrives.

13. STEPS OF BLS
▪ Assessment and scene safety
1. Scene is safe??
2. Asses the patient
3. Check breathing

14. ASSESS THE PATIENT
❑ Shake shoulders gently
❑ Ask “Are you all right?”
❑ If he responds.
❑ Find out what is wrong.
❑ Reassess regularly.

15. CHECK FOR PULSE: NO
MORE THAN 10 SEC
Feel the pulse
Feel the pulse at least for 5 seconds
Slide the finger laterally
Into the groove between trachea and muscle
Locate the trachea
Using 2 or 3 fingers

16. SHOUT FOR HELP

17. ➢ Look Listen Feel
➢ Do not confuse agonal breathing with normal
breathing.
CHECK FOR
BREATHING

18. OPEN AIRWAY
Head tilt and chin lift
- lay rescuers.
- non-healthcare rescuers.
No need for finger sweep
unless solid material can
be in the airway.
Head tilt, Chin lift + Jaw
thrust.

19. START CPR
➢ Push hard and push fast
➢ 100-120/min
➢ 2-2.5 inch depth
➢ Allow complete chest recoil.
➢ Avoid excessive ventilation
➢ Minimize interruption
➢ <10 seconds
➢ Effective rescue breaths.
➢ Ratio: 30:2
➢ High quality CPR
➢ Chest compression is
foundation of CPR.

20. START CPR IMMEDIATELY
➢ Better chance of survival
➢ Brain damage starts in 4-6 minutes.
➢ Brain damage is certain after 10 minutes without
CPR.

21. Return to the victim
CPR followed by
defibrillation
Lone Rescuer
ACTIVATE EMS
Defibrillation
Activate EMS
Two Rescuers
Begins CPR

22. DO NOT MOVE THE VICTIM UNTIL CPR IS
Given and Qualified Help Arrives…
⚫ unless the scene dictates otherwise
– threat of fire or explosion
– victim must be on a hard surface
– Place victim level or head slightly lower than body
EVEN WITH SUCCESSFUL CPR, MOST
Won’t Survive Without ACLS
⚫ ACLS (Advanced Cardiac Life Support)
⚫ ACLS includes defibrillation, oxygen,
drug therapy

23. PRONE CPR
❑ Standard CPR is performed in supine position.
❑ Prone/reverse CPR performed on a person lying on
their chest, by turning the head to the side and
compressing the back. Due to the head's being
turned, the risk of vomiting and complications
caused by aspiration pneumonia may be reduced.
❑ Location of compression – T7 at level of inferior
border of scapula.
❑ The AHA's current guideline limits prone CPR to
situations where the patient cannot be turned and
not recommends for layperson.

24. ❑ Pregnancy
❑ When a woman is lying on her back, the uterus may
compress the inferior vena cava and thus decrease
venous return. It is recommended that uterus be
pushed to the woman's left; if this is not effective,
either roll the woman 30° or healthcare professionals
should consider emergency resuscitative
hysterotomy.
❑ Cervical spine stabilization
❑ Use cervical collar if available
❑ Any hard objects that restrict neck movement
❑ Firm surface(backboard or floor)

25. CHESTCOMPRESSIONS
➢ Position yourself at patient’sside.
➢ Victim should be laid on firm, flat surface.
➢ Remove theclothings of the patient.
➢ Put the heel of one hand on the centre of chest
(sternum) at the level of nipples andput your other
hand on the top of the former hand.

26. ➢ Strengthen arms and shoulders ditrectly over
hands.
➢ Lockall joints ; movement is allowed only at hip joint.
➢ Pushhard and fast (100 - 120times/ min)
➢ At end of eachcompression,chestis allowed
to recoilcompletely.
➢ Avoid excessiveventilation.
➢ Then give next compression immediately.
➢ When possible change CPR operator every 2 min.

27. CHEST
COMPRESSIONS

28. HOW CPR WORKS
➢ Effective CPR provides 1/4 to 1/3 normal
blood flow.
➢ Rescue breaths contain 16% oxygen
(exhaled).

29. MECHANISMS
Cardiac Pump –
➢ Blood pumping is assured by compression of heart
between sternum and spine.
➢ Between compressions, thoracic cage expands and heart
gets filled with blood.

30. THORACICPUMP

31. HEAD TILT–CHIN LIFT MANEUVER
➢ Tilting head backwards in, lifts tongue away from
unconscious patients, often by applying pressure
to the forehead and the chin.
➢ Head tilt stretches anterior neck muscles posterior
pharyngeal wall and epiglottis away from laryngeal
inlet.
➢ Chin lift stretches structures more and pulls
mandible and tongue forward.
➢ The maneuver is used in any patient in whom
cervical spine injury is not a concern
➢ If neck injury is a concern the jaw-thrust maneuver
can be used instead.

32. OPENING THE AIRWAY
Caution -
➢ Do not press
deeply into the
soft tissue
➢ Don’t use
thumb to lift the
chin
➢ Don’t close
mouth
completely.

33. JAW THRUST
➢ An alternative to head tilt chin lift.
➢ Used when cervical injury suspected.
➢ Placing index and middle fingers to
physically push posterior aspects of
the lower jaw upwards and forwards
while their thumbs push down on the
chin to open the mouth.
➢ When mandible is displaced forward, it
pulls tongue forward and prevents it
from obstructing the entrance to
trachea.

34. AIRWAY OBSTRUCTION
The rescuer stands behind the victim and grasps his hands firmly over the
victim’s abdomen just below the rib cage. The position of the rescuer’s
hands and the direction of the thrust are shown.

35. FOR INFANTS

36. RESCUE BREATHS
RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise

37. TYPES
➢ Mouth to mouth breathing
➢ Mouth to barrier device breathing
➢ Mouth to nose or mouth to stomaventilation
➢ Ventilation with bagand mask

38. MOUTH-TO-MOUTH
BREATH

39. MOUTH-TO-NOSE
BREATH
❑ Givenwhen mouth cant beopen
❑ Goodsealcant bemade
❑ Severeinjury present over areaof mouth

40. MOUTH-TO-BARRIER DEVICE

41. BAG AND MASK VENTILATION
❑ Position yourself directly abovepatient’s
head
❑ Perform headtilt.
❑ Make“C”with thumb andindex finger to
seal the mask
❑ And other3 fingers,forms“E” jaw thurst
❑ Chestriseischeckedwhile squeezingthe
bagto give breaths to thepatient.

42. BAGAND MASKVENTILATION

43. CONTINUE CPR
30 2

44. 2 RESCUER
➢ With 2 rescuers breaths
should take approx. 5
seconds.
➢ Allows minimal interruption
to compressions.
Rate
➢ 30 chest compressions and
2 rescue breath for adults.
➢ 15 chest compressions and
2 rescue breath for infants
& children.
➢ Switching the role after
every 2 minutes or 10
cycles.

46. IF VICTIM STARTSTO BREATHE NORMALLY
PLACE IN RECOVERY POSITION
6 key principles for recovery position (ILCOR)
1. The casualty should be in as near a true lateral
position as possible with the head dependent to allow
free drainage of fluid.
2. The position should be stable.
3. Any pressure of the chest that impairs breathing
should be avoided.
4. It should be possible to turn the victim onto the side
and return to the back easily and safely, having
particular regard to the possibility of cervical spine
injury.
5. Good observation of and access to the airway should
be possible.
6. The position itself should not give rise to any injury to
the casualty.
https://en.wikipedia.org/wiki/Recovery_position

47. • Designed to prevent suffocation through
airway obstruction, which can occur in
unconscious supine patients.
• Two routes of obstruction:
• Mechanical obstruction: Physical object
obstructs airway. Own tongue leads to a loss of
control and muscle tone, causing tongue to fall
back and creating obstruction.
• Fluid obstruction: Fluids, usually vomit, can
collect in pharynx, causing person to drown.
Stomach contents flowing into throat,
causing regurgitation. Fluid collects in the back
of throat can also flow down into the lungs
causing aspiration pneumonia.
https://en.wikipedia.org/wiki/Recovery_position

48. IMMEDIATELY AFTER CPR…
Prof. Dr. RS Mehta, BPKIHS
⚫ Laryngoscopy; 100% oxygen
⚫ Urinary catheter
⚫ NG tube
⚫ Establish or verify existing i.v access; start with NS
⚫ Transfer to a special care unit for continuous
monitoring and therapy.

49. CONTINUE RESUSCITATION UNTIL
– Qualified help arrives and takes over
– Victim revives: The victim starts
breathing normally
– Rescuer becomes exhausted
– Cardiac arrest of longer than 30 minutes
(controversial)

50. AFTER CPR…
Prof. Dr. RS Mehta, BPKIHS
Complete exam including
– Serial vitals
– Urine output
– 12-lead ECG
– Chest X-ray
– Blood Glucose
– Serum Urea,
Creatinine
– Serum Electrolytes
(+Mg++ andCa++)
– Cardiac Markers

51. PROGNOSIS
5 clinical signs strongly predicting death or
poor neurological outcome:
No corneal reflex at 24 hours
No pupillary response at 24 hours
No withdrawal response to pain at 24hours
No motor response at 24 hours
No motor response at 72 hours

53. ⚫ Defibrillation is used for treatment
of tachydysrhythmias.
⚫ Depolarises the critical mass of
myocardial cell at once. It
recaptures the SA node as its
role as the pacemaker .
⚫ Is treatment of choice for
pulseless VT/VF.
DEFIBRILLATION

54. ➢ The heart’s pumping
action controlled by
electrical system.
➢ Electrical rhythm normally
very organized.
➢ Normal heart’s rhythm is
called “Sinus Rhythm”
➢ Normal heart rate of 60 -
100 beats per minute.
Sinus Rhythm
East of England AmbulanceService
NHS Trust
UNDERSTANDING DEFIBRILLATION

55. ➢ VF is the most common
rhythm in sudden cardiac
arrest (90%).
➢ Electrical problem in
nature.
➢ Chaotic rhythm results in
“quivering of heart” and
results in loss of pulse.
➢ VF will result in brain
damage within 5 minutes
and death in 10-15 mins.
East of England AmbulanceService
NHS Trust
UNDERSTANDING DEFIBRILLATION:
VENTRICULAR FIBRILLATION (VF)

56. ➢ Defibrillation may correct VF
➢ Uses DC current delivered across
the heart.
➢ A successful defibrillation
“depolarizes” the heart’s cells
➢ Depolarization allows the cells
to “reorganize”
➢ Defibrillation is the ONLY
effective cure for VF.
East of England AmbulanceService
NHS Trust
UNDERSTANDING DEFIBRILLATION

57. USE OF AN AED
➢ Use the AED as soon as it is available and ready to use.
➢ Follow the AED prompts to give a shock, then give CPR again
while the AED is analyzing victim’s rhythm.
➢ First turn it on.
➢ Then simply follow instructions.
➢ Some AEDs will automatically switch themselves on when the
lid is opened.

58. ATTACH PADSTO PATIENT’S BARE CHEST

59. ANALYSING RHYTHM DO NOTTOUCH VICTIM

60. SHOCK INDICATED
⚫ Stand clear
⚫ Deliver shock

61. SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
30 2

62. DEFIBRILLATION SAFETY !
▪ THE PATIENT.
▪ 5 point check
▪ Pacemaker
▪ Jewellery
▪ Hair on chest
▪ Damp/Wet skin
▪ Patches (GTN)
▪ THE AED.
▪ In good working order
▪ Do Not use in Heavy
rain
▪ Do Not use if they lay in
a pool of water
▪ Do Not use in an
explosive environment

63. Defibrillators can be classified as :
➢ Monophasic(delivers current of
one polarity only)
➢ Biphasic (deliver current of 2
polarity)
DEFIBRILLATOR
37

64. POSITION OF DEFIBRILLATOR PADDLE
✓ 1st paddle - on the right
side of the chest just
below the clavicle
✓ 2nd at precordial
region.
⚫ Paddle should be applied
with pressure equivalent
to 10 kg.
38

65. • Adult: 13cm
• Children:8cm
• Infants:4.5cm
• Previous recommendation of 3 successive
shock (200,300,360J)
• Now only single shock is recommended .i.e.
• 360 J by monophasic.
• 150-200J by biphasic.
PADDLE SIZE
39

66. ➢ Apply conducting jelly between the paddle and the skin.
➢ Place the paddle so that they don't touch patient’s
clothing and bed linen and aren't near medication and
direct oxygen flow.
➢ Ensure that defibrillator is not in synchronized mode.
➢ Don't charge the device until ready to shock
➢ Keep thumbs and fingers off discharge button until
paddle are on.
NURSES ROLEWHILE PERFORMING
DEFIBRILLATION

67. ⚫ Before pressing the discharge button call “ all
clear” 3 times
1st
2nd
NURSES ROLE IN DEFIBRILLATION
clear: Ensures" YOU” aren’t touching patient, bed, equipment
clear: Ensures “no one" is touching patient, bed , equipment
3rd clear: Ensures “you and everyone" else are clear off the
patient and anything touching the patient.

68. NURSES ROLE IN DEFIBRILLATION
⚫ Record the delivered energy and the results (cardiac
rhythm and pulse).
⚫ After the event is complete inspect the skin
under the pads and paddles for burns , and if
any detected consult about the treatment.
42

69. COMPLICATIONS OF CPR
⚫ Skeletal injuries especially rib #.
⚫ Visceral injuries- Myocardial and pulmonary
contusions, blood in pericardial sac,
pneumothorax, liver and spleen rupture, gastric
perforation.
⚫ Airway injuries- tracheal & laryngeal injuries.
⚫ Skin and integument damage

70. BLS DIFFERENCES

71. BLS DIFFERENCES

72. Simplified adult BLS algorithm.
Robert A. Berg et al. Circulation. 2010;122:S685-S705

73. BLS healthcare provider algorithm.
Robert A. Berg et al. Circulation. 2010;122:S685-S705

74. ALGORITHM OF ACLS
2015

75. • “Look, listen, and feel for breathing” has been removed from
the algorithm.
• Continued emphasis has been placed on high - quality CPR (with
chest compressions of adequate rate and depth, allowing
complete chest recoil after each compression minimizing
interruptions in compressions, and avoiding excessive
ventilation).
KEY ISSUES AND MAJOR CHANGES

76. ⚫ To initiate chest compressions before giving rescue breaths (C-A-B
rather than A-B-C).
⚫ Compression rate should be at least 100/min (rather than
“approximately” 100/min).
⚫ Compression depth for adults has been changed from the range of 1½ to
2 inches to at least 2 inches (5 cm).
⚫ BLS only provides 15 to 20% of normal cardiac output and should be
regarded as “buying time” until the commencement of ALS.
⚫ If there is more than one rescuer present , another should take over the
CPR every 1 to 2 minute to prevent fatigue.

77. ❖ Circulation by cardiac compression
❖ Airway management by equipments
❖ Breathing by advanced techniques
❖ Defibrillation by manual defibrillator
❖ Drugs
ACLS INCLUDES:

78. Chest compression:
- Rate - 100/min
- Place - Mid of sternum
- Depth - At least 5 cm (2inches) or 1/3rd of
AP diameter ofchest
- No synchrony with respiration.
CIRCULATION

79. • Should not be used for unwitnessed out-of-
hospital cardiac arrest.
• Rapid treatment for witnessed and monitored VT.
• Used if a defibrillator is not immediately available.
• Consider giving single thump .
• Using ulnar edge tightly clenched fist, deliver a sharp
impact to the lower half of sternum from a height of
20cm.
• Converts VT to sinus rhythm.
PRECORDIAL THUMP

80. ❑ Breathing can be accomplished by
1. Bag and mask ventilation
2. Ventilation by advanced method:
a. ET tube : Intubation is most definitive and best method for
ventilation.
b. LMA
c. Tracheostomy tube
3. Ventilation by automatic ventilators.
BREATHING

81. 1) Oropharyngeal Airway
AIRWAY MANAGEMENT
➢ Correct size chosen by measuring from
1st incisors to the angle of jaw.
➢ Inserted into the person's mouth upside
down.
➢ Once contact is made with the back of
the throat, the airway is rotated 180
degrees, allowing for easy insertion, and
assuring that the tongue is secured. An
alternative method for insertion.

82. 2) Laryngeal Mask Airways
Airway management
• Supraglottic airway device.
• Composed of airway tube that
connects to an elliptical mask with a
cuff which is inserted through patient's
mouth, down the windpipe, and once
deployed forms an airtight seal on top
the glottis allowing a secure airway to
be managed.

83. 3) Endotracheal tube
Airway management

84. ARTIFICIAL MANUAL BREATHING
UNIT (AMBU)
Prof. Dr. RS Mehta, BPKIHS
➢ It consists of self inflating bag made up of rubber or silicon,
connector, safety valve, mouth piece.
➢ 100% oxygen can be delivered by AMBU bag by attaching oxygen
source and oxygen reservoir.

85. 1. Adrenaline (All types of cardiac arrest) – 1 mg
every 3-5 mins
2. Amidarone (VF, VT) - 1st dose : 300 mg iv bolus,
2nd dose 150 mg.
3. Lidocaine - (1-1.5 mg/kg)
4. Sodium Bicarbonate (only if cardiac arrest is
associated with hyperkalemia ) (2- 5 meq/kg)
5. Calcium Gluconate - 10 mg iv slowly.
6. Magnesium Sulphate – 2 gms iv in 100 ml NS
(Refractory VT / VF).
DRUGS

86. REFERENCES
❑ American Heart Association Study Guide 2017 BLS for
Healthcare Providers
❑ http://circ.ahajournals.org/content/122/18_suppl_3/S8
62
❑ http://ajcc.aacnjournals.org/content/17/5/426.abstract
❑ https://en.wikipedia.org/wiki/Recovery_position
❑ http://en.wikipedia.org/wiki/Precordial_thump

87. THANK YOU