SEQUENCE FOR PERFORMING BLS:

Step 1: Verify scene safety.

 Ensure scene safety for both rescuer and victim, surrounding should be safe so that it
does not cause any harm.
 In case of Drowning the victim should be taken away from the water body.
 As a rescuer, you have to make sure that you stay fit to carry out the demands of
BLS/CPR.

Step 2: Check for responsiveness

 Tap the victim’s shoulder. shout, “Are you OK?” and Ask for help loudly.
 If the victim is not responsive, activate the emergency response system via mobile
device.
 Get the AED () or send someone to do so.

Step 3: Assess for breathing and a Pulse.

 Check for pulse to determine next actions.

 To minimize delay in starting CPR, you should assess breathing and pulse at the same
time. This should not take more than 10seconds.

Steps 3a and 3b: Determine next actions based on whether breathing is normal and if a
pulse is felt:

 If the victim is breathing normally and a pulse is felt, monitor the victim.
 If the victim is not breathing normally but a pulse is felt:
- Provide rescue breathing at a rate of 1 breath every 6 seconds, or 10 breaths
per minute.
- Check for a pulse about every 2 minutes. Perform high-quality CPR if you do
not feel a pulse.
 If the victim is not breathing properly or is only gasping and has no pulse, begin high
quality CPR

Step 4: Start high quality CPR,

 30 Chest compression and 2 breaths.

 Use an AED as soon as it is available.
 Steps 5 and 6: Use the AED as soon as it is available.

Follow the AED directions to check the rhythm.

Step 7: If the AED detects a shockable rhythm

 Give 1 shock. Resume CPR immediately until prompted by the AED to allow a
rhythm check, about, every 2 minutes
 Continue CPR and using the AED until advanced life support providers take over
or the victim begins to breathe,move,or otherwise react.

Step 8: If the AED detects a non-shockable rhythm

 Resume high-quality CPR until prompted by the AED to allow a rhythm

check, about every 2 minutes
 Continue CPR and using the AED until advanced life support providers take over
or the victim begins to breathe,move,or otherwise react.

 Assess the person’s consciousness by shaking or tapping

their shoulder hard and talking to him or her, ask loudly,
‘Are you all, right?
 Assess the person’s breathing patterns. Be aware of agonal
breathing, which is an interrupted breathing pattern that is not indicative of recovery.

Call EMS

 Do not leave the patient alone. Get someone else to call for
help or retrieve an AED.
 In the event that there are no other individuals in your
vicinity, proceed by checking the patient’s pulse and
 breathing while simultaneously contacting help. (The ILCOR points out that mobile
phones now come with built-in speakerphone capabilities, allowing rescuers to

simultaneously attend to the patient while calling for help.)

CPR

 Begin sets of compressions and rescue breaths.

Defibrillate

 Use the AED pads when available.

CPR STEPS

Sl.no Steps Illustration

1. The carotid pulse should be checked on the side of
the neck (Figure A). Don’t waste time feeling for a
pulse longer than 10 seconds. Even if you do not
feel the pulse, start a cycle of CPR with two breaths
and 30 chest compressions.
2. The heel of one hand should rest on the lower half
of the sternum (Figure B).

3. The other hand should be above the first (Figure C).

4. Straighten your arms and press down (Figure C).

Each compression should reach 2 to 2.4″ (5 to 6 cm)
into the patient’s chest, with a rate of 100 to 120
compressions per minute.
5. Between each compression, stop pressing and allow -
the chest wall to recoil naturally. Do not lean or rest
on the chest between compressions, as this prevents
 the heart from refilling between compressions,
making CPR less effective.
6. Tilt the head and lift the chin to open the airways
after 30 compressions (Figure D &E).

o Tilt the head back after putting your hand

on the patient’s forehead.
o Lift the jaw with your index and middle
fingers on the lower jaw.
o If the patient has a neck injury, do not tilt
the head; simply use the jaw thrust.
o In applying the jaw-thrust maneuver, hold
the lower jaw’s angles and lift with both
hands, moving the jaw forward from either
side. Open the lower lip with your thumb if
the patient’s lips are sealed (Figure F)

7. Watch the chest rise and give a breath. Do this again

-
while administering a second breath.
8. Chest compressions should then be resumed. Switch
between compressions and rescue breaths while -
minimizing interruptions in the compressions.

TWO RESCUER BLS FOR ADULTS:

In most situations, a second person is available to be a rescuer. The second rescuer must have
Emergency Medical Services (EMS) as you initiate CPR. The second rescuer can also help
by securing an AED while you help the person. After the second rescuer gets back, the
following CPR tasks can be shared:

1. The AED is prepared by the second rescuer.

2. Count the chest compressions out loud.
3. The AED pads can be applied by the second rescuer.
4. Rescue breaths and opening the person’s airway are done by the second rescuer.
 5. After every five cycles of compressions and breaths (30 compressions and two breaths
per cycle), switch roles.
6. Between each compression, stop pressing and allow the chest wall to recoil naturally.
Do not lean or rest on the chest between compressions, as this prevents the heart from
refilling between compressions, making CPR less effective. Switching roles helps
rescuers from becoming tired and leaning on the chest.
7. Minimize interruptions in compressions by switching roles quickly.
8. Minimize interruptions when the AED is connected by switching roles while the heart
rhythm is analysed by the AED. Minimize CPR interruptions if a shock is indicated,
and begin CPR again immediately.

ADULT MOUTH-TO-MASK VENTILATION

Breaths should be given with a pocket mask whenever available in one-rescuer CPR.

Sl.n
Steps Illustration
o
1. Deliver 30 high-quality chest compressions.

2. To secure the mask on the patient’s face, place four fingers of

one hand along the mask’s top, with the other hand’s thumb
on the bottom edge (Figure A).

3. Use the head-tilt/chin-lift maneuver to open the airway, but

do not do this if the patient is suspected to have a neck injury
(Figure B).

4. Press the edges of the mask with strength and deliver a breath
that lasts over one second while observing the rise in the
patient’s chest (Figure C).

ADULT BAG-MASK VENTILATION IN TWO-RESCUER CPR

When the bag-mask device is available and two people are around, the second rescuer must
be at the patient’s head; the first rescuer delivers 30 high-quality chest compressions.
 Sl.no Steps Illustration
1. Count out loud while delivering the chest compressions to
avoid losing count (Figure A).

2. The first rescuer should open the airway by raising the

patient’s lower jaw, while the second rescuer secures the bag
mask by using his or her index finger and thumb and
shaping it in a “C” on a single side of the mask to properly
seal the mask and the face (Figure B).
3. The second rescuer then gives two breaths; each breath must
be over one second. Watch the victim’s chest rise (Figure
C).

4. The bag valve mask is crucial in creating a tight seal;

practice this technique.

NOTE: For ventilation for a victim with a stoma or tracheostomy tube position the mask
over the stoma or tube using the above technique. While providing breath check for chest
raise, if not happening then connect the bag-mask device directly to the tracheostomy tube if
still does not raise then close the victim’s mouth.

USE OF AUTOMATED EXTERNAL DEFIBRILLATOR (AED) – A STEP BY STEP

GUIDE

The automated external defibrillator (AED) is a device that can detect ventricular
fibrillation and other dysrhythmias, delivering electric shock appropriately. The AED has
become a regular fixture in many public establishments. The AED is an automated device
with room for few to no mistakes. It can be safely used by any individual. In cardiac events
where the victim observably collapses suddenly, the usual cause is ventricular fibrillation and
a defibrillator should be used to assess the person’s cardiac rhythm immediately.

AED STEPS
Sl.no Steps Illustration
1. Get the AED (Figure A).

a. Retrieve it from the case.

b. Turn on the device.

2. Keep the person’s chest exposed (Figure B).

a. Dry the chest if necessary.

b. Remove existing medication patches.

3. Peel off AED pads (Figure C).

a. Remove back covering.

b. Watch out for a pacemaker or internal defibrillator.

4. Place the pads onto strategic areas (Figure D).

a. Place one pad on the upper right chest above the breast.
b. Place the second pad on the lower left chest below the
armpit.

5. Check if the wires are connected to the AED box (Figure

E).

6. Keep a good distance between you and the person being

treated (Figure F).

a. Stop CPR.
b. Maintain distance from the person and make sure no one is
touching any part of the victim.

7. Allow AED to analyze the rhythm of the person’s heart.

 8. If the device reads “Check Electrodes,” proceed with the
following steps:

a. Check if the electrodes are in full contact with the body.

b. If the chest is hairy, peel off the pad and replace it with a
new one.

9. You’ll know it’s time to deliver the shocks when AED

reads “Shock.” Then, follow these steps:

a. Prohibit anyone from touching the person.

b. Press and hold the “shock” button until AED delivers the
shock (Figure G).

10. Continue with CPR for two minutes starting with chest
compressions (Figure H).

11. Repeat steps 1 to 10.

ALGORITHM FOR BLS

TREATMENT OF CHOKING FOR ADULTS

A common cause of cardiac arrest that is ultimately avoidable is

choking. The right reaction to a choking person is dependent on the
intensity of airway obstruction, whether or not the patient is responsive,
 and how old the patient is. Study the Table below for actionable responses for dealing with
choking adults and children. Figure 1

Choking In Adults

Degree of Person's Response Rescuers Action

Obstructio
n
Mild  Breathing but may also be wheezing  Stay with the person, try to
Obstructio  Coughing and making noise keep them calm
n  Encourage them to cough
 Call EMS if the person seems
to be getting worse

Severe  Clutching the neck (the universal  Use abdominal thrusts

Obstructio sign of choking; Figure 1) (Heimlich maneuver) to
n  Weak or no cough attempt to remove the
 Unable to make noise or talk; may obstruction
make a high-pitched noise  Call EMS
 Little or no breathing  Begin BLS if the person
 Appears cyanotic (blue around lips becomes unresponsive
and fingertips)

Abdominal Thrusts

People who are responsive or who are older than one year of age should be the exclusive
recipients of abdominal thrusts.

To successfully execute abdominal thrusts, complete the following steps:

Sl.no Steps Illustration

1. Place yourself behind the person. Place both arms around
the person’s waist and under the ribcage.
 2. Place the side of your fist above the person’s navel in the
middle of the belly. Refrain from pressing on the lower part
of the sternum (Figure A).

3. With your free hand, hold the first fist and press onto the
person’s abdomen and up toward their chest
forcefully (Figure B and C).

4. Continue executing the maneuver until the situation is

stabilized or until the person starts becoming unconscious.

OTHER EMERGENCIES

A number of other emergencies are also there like heart attack, stroke, drowning,
Anaphylaxis and opioid associated emergencies etc. Each and every emergency are dealt with
in a different manner with their own procedures.

RECOVERY POSITION
(lateral recumbent or 3/4 prone position):

This position is used to maintain a patent airway in the unconscious person.

 Place the patient close to a true lateral position with the head dependent to allow fluid
to drain.
 Assure the position is stable.
 Avoid pressure on the chest that could impair breathing.
 Position patients in such a way that it allows turning them onto their back easily.
 Take precautions to stabilize the neck in case of cervical spine injury. Continue to
assess and maintain access of airway.
Avoid the recovery position if it will
sustain injury to the patient.