A bit by bit approach for an efficient BLS practices in adults & Children.

1. BY
Kerolus E. Shehata
•PGY-III IM Resident, Ain Shams University
•ECFMG certified
If you can’t give a life, you can save a life!!

2. OBJECTIVES
1) How to assess the collapsed victim.
2) How to perform chest compression
and rescue breathing in adults.
3) What are the differences between
adult & paediatric BLS.
4) How to place an unconscious breathing
victim in the recovery position.

3. BACKGROUND
 Approximately 700,000 cardiac arrests
per year in Europe.
 Percentage of victims who survive till
hospital discharge is currently 5-10%.
 Bystander CPR is a vital intervention
before arrival of emergency services.
 Early resuscitation and prompt defibrillation
(within 1 - 2 minutes) can result in > 60 %

4. Q. What is the difference
between BLS & ACLS ?
Q. What is the difference
between BLS & ACLS ?
A: BLS implies that NO
equipment is employed other
than protective devices.
A: BLS implies that NO
equipment is employed other
than protective devices.

5. Why do we do CPR?
Do we need to learn
about CPR?
Every minute will make a lifetime of differenceEvery minute will make a lifetime of difference

6. How does CPR work?
 The brain may sustain damage after blood flow has been
stopped for about 4 min. and irreversible damage after
about 7 min.
 The heart also rapidly loses the ability to maintain a
normal rhythm.
 CPR is effective only if performed within 7 minutes of the
stoppage of blood flow.
 Effective CPR enables enough oxygen to reach the brain
to delay brain stem death, and allows the heart to
remain responsive to defibrillation attempts.

8. Will CPR restart the heart?
 Chances are very low. Compression can’t
reverse the causes e.g. Hypoxia in children
& arrhythmias in adults
 To restart, you need an electric shock by
AED.
 CPR pump a small amount of blood that is
barely sufficient to keep your brain alive.

9. Q. Is there
anything that
improve the
outcome??

10. CHAIN OF SURVIVAL

11. Q. What will you do if you find
this?

12. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
First & most important thing: Don’t Panic!!

13. APPROACH SAFELY
1. Scene
2. Rescuer
3. Victim
4. Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

14. Don’t start CPR in an unsafe environment…we don’t want a second victim

15. Risks To The Rescuer
 Aim to eliminate or minimize risks.
 Beware of environmental dangers e.g.
 Traffic
 Electricity
 Gas
 Water
 Radiation

16. Can I get an infection??
 15 documented cases of CPR related infection
mainly Neisseria meningitides.
 TB (only isolated reports).
 Not hepatitis B or C or CMV.
 transmission of HIV during CPR has never
been reported.

17. Check for a response
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

18. • Shake the shoulders gently.
• Shout loudly “Are you alright?”
How to check the victim’s response?

19. If the victim responds
1. Leave him/her as it is.
2. Activate the EMS (123)
3. Try to find out what is wrong.
4. Reassess regularly.

20. If there is NO response
SHOUT FOR HELP!!
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

21. Open the airway
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

22. How to Open The
Airway?
 Head tilt & Chin lift
 If cervical spine injury suspected: jaw thrust

23. Check for breathing & Circulation
Approach safely
Check response
Shout for help
Open airway
Confirm arrest
Call 123
30 chest compressions
2 rescue breaths

24. How to check for breathing &
circulation?
 Look, Listen and Feel for
NORMAL breathing.
 Check the Carotid pulse.
 Assess for not more than
10 sec. before deciding
absent breathing.
 Do not confuse agonal
breathing with normal
breathing.

25. AGONAL BREATHING
 Occurs shortly after the heart stops
in up to 40% of cardiac arrests.
 Brain stem reflex.
 Described as heavy, noisy or gasping
breathing.
 Recognise as a sign of cardiac arrest.

26. If the patient is breathing normally & you
can feel a pulse:
 Turn him into the recovery position (if applicable).
 Call for help.
 Reassess regularly till arrival of EMS.
If you can feel a pulse, but the patient is
not breathing:
 Give 1 rescue breath every 5 seconds.
 Recheck the pulse every 2 minutes.

27. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
If you confirm Cardiac arrest
Call 123 & Start CPR

28. Give 30 effective chest
compressions
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

29.  Place the heel of one hand on the lower half
of sternum (Sterno-xyphoid junction).
 Place other hand on top.
 Interlock your fingers.
 keep your arms straight and lock your elbows
so you can compress the chest fully using your
weight while conserving your energy.
 Compress the chest:
 Rate at least 100/min.
 Depth 5-6 cm (1/3 A-P diameter of chest)
 Allow chest recoil.
 When possible change CPR operator/5 cycles.
How to perform effective chest
compressions?

31. Give 2 effective rescue breaths
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths

32. How to deliver effective rescue breaths?
 Open the airway.
 Close the victim’s nose.
 Take a normal breath.
 Seal your lips over the
victim’s mouth.
 Blow until the chest rises.
 Pause for 1 second.
 Allow chest to fall.
 Repeat one more time.

33. Continue Chest compressions & Rescue
breaths at a rate of:
230

34. Continue resuscitation
until…
Qualified help arrives and takes
over with AED & ACLS protocol.
The victim shows signs of life.
You become exhausted.
The Victim has a DNR order.

35. New Guidelines for a high quality CPR
1. Sufficient rate and depth without excessively
ventilating.
2. few interruptions of chest compressions.
3. completely relaxing pressure between
compressions.
• The order of interventions was changed from ABC to CAB
EXCEPT in:
1. Newborn in whom hypoxia is MCC of cardiac arrest.
2. Those believed to be in a respiratory arrest (drowning, drug
overdose…etc.).

36. Complications of CPR
1. Most common: Rib fractures & sternal
fracture.
2. Pneumothorax
3. Bleeding: Hemopericardium, hemothorax
& anterior mediastinal bleeding.
4. Contusion of: Heart & Lung.
5. Lacerations of: Liver & Spleen.

37. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 123
30 chest compressions
2 rescue breaths
A quick Recap

38. Compression only (Hands only)
(Cardio-cerebral) resuscitation
• Chest compressions without artificial respiration.
• Easier: the method of choice for the untrained
rescuer
• In adults with out-of-hospital cardiac arrest,
compression-only CPR by the lay public has a
higher success rate than standard CPR.
• The exceptions: cases of drownings, drug
overdose (with respiratory arrest) and arrest in
children.
• Rate: the same as standard CPR (at least 100/min.)

39. CPR during pregnancy
• During pregnancy when a
woman is lying on her back, the
uterus may compress the
inferior vena cava and thus
decrease venous return. It is
therefore recommended that
the uterus be pushed to the
woman's left.
• If this is not effective, either roll
the woman 30° or healthcare
professionals should consider
emergency Caesarean section.

40. Pediatric BLS

41. Steps:

42. Open the airway

43. Check for Breathing
LOOK, LISTEN & FEEL

44. Check for Pulsation
Carotid, Brachial or Femoral

45. Chest compression
In children: If pulse < 60, start CPR to enhance the perfusion.

46. Give 15 effective chest compression
2 fingers technique 2 thumbs technique

47. 2 hands technique 1 hand technique

48. Give 2 effective Rescue Breaths
Mouth to mouth
& nose technique
Mouse to mouth
technique

49. If the victim starts to breathe
normally, Put him/her in the
Recovery Position

50. 1 2
3 4
Steps of positioning the victim in the Recovery position

51.  Aim of the Recovery Position.
1. Gravity assistance to the clearance of physical obstruction of the airway
by the tongue.
2. Gives a clear route by which fluid (e.g. vomitus) can drain from the
airway.
3. There is a room for the chest to rise and fall freely.
 All forms of the recovery position
share basic principles:
1) The mouth is downward so that fluid can drain from the patient's airway.
2) The chin is upward to keep the epiglottis opened.
3) Arms and legs are locked to stabilize the position of the patient.