State University of Medicine and Pharmacy “N.

Testemitanu”
BASIC LIFE SUPPORT
Gh. Ciobanu
Head of the Departament of Emergency Medicine,
PhD, professor

OBJECTIVES
INTRODUCTION
ADULT CHAIN OF SURVIVL
BASIC LIFE SUPPORT
A.AIRWAY
B.BREATHING
C.CIRCULATION
FOREING BODY AIRWAY OBSTRUCTION MANAGEMENT
AUTOMATED EXTERNAL DEFIBRILLATOR FOR ADULT
EARLY HIGH- QUALITY CPR FOR AN ADULT
CONCLUSIONS
BIBLIOGRAPHY
History of Modern CPR has been based on ideas discovered many years
ago,these include:
Vesalius A., 1543 - Intermittent positive pressure artificial ventilation
Tossach W.A., 1771 -Mouth- to – mouth breathing
Heiberg J., 1874, Esmarch JF., 1878 Jaw – thrust
Boehm R., 1878, Schiff M.,1882 – Open chest cardiac resuscitation
Prevost J.L., 1899, Wiggers 1940 Internal defibrillation
Kuhn F., 1911, Machintosh RR., 1920 Tracheal intubation
Maass 1892 , External CPR
Gurvitch NL., 1946 External defibrillation with direct current
Negovsly V.A., Pathophysiologic research on dying and resuscitation
Elam J.O., 1954 – proof that ventilation with the operator`s exhaled air is
physiologically sound
Safar P., 1958 - studies showing why obstruction of the upper airway in
unconscious patients coud be prevented or corrected by backward tilt of the head,
forward displacement of the mandible,and opening of the mouth.
Kouwenhoven W.B., 1960 – rediscovery and development of external cardiac
compression
Safar P., 1961 – demonstration of the need to combine positive pressure
ventilation with external cardiac compression
Zoll P., 1956 – external electric defibrillation of the heart in human patients
Sudden Cardiac Death (Cardiac arrest)
Despite important advances in prevention, sudden cardiac arrest remains a leading
cause of death.
Seventy percent of out-of- hospital cardiac arrest occur in the houm.Outcome from
out-of-hospital cardiac arrest remains poor
SCD (sudden cardiac death) is one of the greatest public health problems especially
in view of the fact that approximately 50% of all cardiac deaths are sudden and
unexpected.
In Europe SCD leads to the death of approximately 700,000 people per year.
OUT- OF-HOSPITAL CARDIOPULMONARY ARRESTS (OHCA) BY AETIOLOGY

Aetiology N(%) (n=21 175)

Presumed cardiac disease 17 451 (82.4%)

Non-cardiac internal aetiologies 1814 (8.6%)

Lung disease 901 (4.3%)

 Cerebrovascular disease 407 (2.2%)

Gastrointestinal haemorrage 71 (0.3%)

Obstetric/pediatric 50 (0.2%)

Pulmonary embolism 38 (0.2%)

Epilepsy 36 (0.2%)

Diabetes mellitus 30 (0.1%)

Renal disease 23 (0.1%)

Non-cardiac external aetiologies 1910 (9.0%)

Trauma 657 (3.1%)

Asfixia,drug overdose,drowning,electric 1253 ( 5.8%)

shock/lightning,other suicide, other external

Definitions and Terminology

Basic Life Support (BLS). - BLS is the phase of ECC that includes recognition of
cardiac arrest, access to the EMS system, and basic CPR.
Cardiopulmonary resuscitation (CPR). - In its broadest sense CPR refers to
attempting any of the maneuvers and techniques used to restore spontaneous
circulation.
Basic CPR. - Basic CPR is the attempt to restore spontaneous circulation using the
techniques of chest wall compressions and pulmonary ventilation.
Adult Basic Life Support (BLS)
BLS consists of three steps
Step A: Airway Control
Step B: Breathing support, emergency artificial ventilation and oxygenation of the
lung
Step C: Circulation support, recognition of pulselessness and establishment of
artificial circulation by cardiac compressions, control of hemorrhage and positioning
for shock
Sudden Cardiac Death (Cardiac arrest)
Sudden Cardiac Arrest (Cardiac arrest) is clinically diagnosed when the following
four conditions coexist:
1. Unconsciousness
2. Apnea or gasping respiration
3. Pulselessness in large arteries (carotid)
4. Death-like appearance
Successful resuscitation following cardiac arrest requires an integrated set of
coordinated actions represented by the links in the adult Chain of Survival.
The Adult Chain of Survival
The links include the following:
• Immediate recognition of cardiac arrest and activation of the
emergency response system
• Immediate high-quality CPR
• Rapid defibrillation
• Basic and advanced emergency medical services
• Advanced life support and postarrest care
Cardiac Arrest and the Chain of Survival IHCA

Some rapid response systems use specific physiologic criteria to determine when to
call the team.
 • Threatened airway
• Respiratory rate < 6 or > 30 breaths per minute
• Heart rate < 40/min or > 140/min
• Systolic blood pressure (SBP) < 90 mm Hg
• Symptomatic hypertension
• Unexpected decrease in level of consciousness
• Unexplained agitation
• Seizure
• Significant fall in urine output
• Subjective concern about the patient
Cardiac Arrest and the Chain of Survival OHCA

Early recognition and call for help – to prevent cardiac arrest

Early CPR – to buy time
Early defibrillation – to restart the heart
Post resuscitation care – to restore quality of life
Risks to EMS personnel:

All body fluids, not just blood, are potentially infectious

Protective equipment:
• Medical Gloves are considered standard protective equipment for all patient
contacts
• Protective glasses
• Surgical mask
• Gown
• High- visibility clothing
Disease transmission
• Tuberculosis (TB)
 • Severe Acute Respiratory Distress Syndrom (SARS)
• Hepatitis B virus or meningococcal meningitis
Transmission of HIV during CPR has never been reported

A-Airwai

Anatomy of the Respiratory System

The airway is composed of the following elements:
A. Upper Airway
• Nose and mouth
• Pharynx (behind the tongue)
• Larynx or voice box
B. Lower Airway
• Trachea or windpipe
• The right and the left primary bronchi
• The point where the trachea divide into the right and left primary
bronchi called the carina
• The right primary bronchus is straighter or less angled than the left.
Foreign bodies tend to make their way into the right primary bronchus
more often
• Bronchioles, branches of the bronchi that terminate in the alveoli
Upper Airway Obstruction

• Trauma to face and throat

• Unconscious – posterior displacement of the tongue caused by decreased
muscle tone
• Foreign body (e.g. tooth, food)
• Laryngeal spasm and oedema
• Epiglottitis
• Pharyngeal swelling (e.g. infection, oedema)
Lower Airway Obstruction

• Central nervous system depression

• Bronchospasm-causes narrowing of the small airways in the
lung
• Blocked tracheostomy
• Foreign body
Tracheobronchial aspiration of:
• Blood
• Vomitus
• Bronchial secretions
Airway Management Procedure
1. Triple Airway Maneuver Safar
• Head Tilt
• Jaw Thrust
• Mouth open
2. Head Tilt-Chin Lift
3. Jaw Thrust
• Jaw Thrust without Head Tilt
• Jaw Thrust with Head Tilt
4. Remove a visible foreign body by used Magill or Kocher forceps.
5. Insertions an oropharyngeal airway (oropharingeal tubes Guedel or Berman
types, S-tubes Safar)
6. Insertion an nasopharyngeal airway (Robertazy tubes)
7. Insertion an Esophageal Obturator Airway
8. Insertion an Laryngeal Mask Airway.
1.Triple Airway Maneuver Safar

• Head tilt
• Jaw Thrust (Esmarch-Heiberg)
• Mouth open
• Back ward tilt of the head.
• Grasp the ascending rami of patients mandible in front of his ear lobies using
fingers 2-5 of both hands and pull forwards, displacing the mandible so that
the lower teeth just out in front of the upper teeth.
• With your thumbs open the month.
The triple airway maneuver Safar is a technique for opening the airway of an
unresponsive patient without suspected cervical spine injury.
2.Head Tilt-Chin Lift Maneuver

Step Action

Place one hand on the victim's forehead and push with your palm to
1
tilt the head back.

Place the fingers of the other hand under the bony part of the lower
2
jaw near the chin.

3 Lift the jaw to bring the chin forward.

3.Jaw Thrust Maneuver

Jaw Thrust
• Jaw thrust without head till
• Jaw thrust with head till
 The Jaw thrust without head tilt maneuver is the technique that is
recommended for opening the airway when cervical spine injury is
suspected.Ensure that the patient is in a supine position while stabilizing the
patients head in a neutral position, grasp the angles of the patients lower jaw
with your finger tips. Displace the lower jaw forward.
5.Airway Adjuncts

Airway adjuncts prevent the tongue from falling back into the airway and
blocking the flow of air.

Oral airway’s is also called an oropharyngeal airway (OPA) Indications for

insertion include patients who are unresponsive and have no gag reflex.
An OPA is a J-shaped plastic or rubber device that is used to create an air passage
between the patient’s mouth and the posterior wall of the pharynx when correctly
positioned the flange of the device rests on the patient’s lips or teeth.
The distal tip lies between the base of the tongue and the back of the throat
preventing the tongue from blocking the airway.
Air passes around and through the device .
Oral airway are available in a variety of sizes that range from 0 for neonates up to 6
for large adults.
S-tubes Safar
• S-shaped mouth –to-mouth airways
• Insert like regular oropharyngeal tubes

6.Nasopharyngeal Airway
Nasopharyngeal Airway Sise is determined by holding the device against the side of
the patient face and selecting an airway that extends from the tip of the nose to the
angle of the jaw or the tip of the ear.
7.Esophageal Obturator Airway (EOA)
Esophageal Obturator Airway is used to prevent gastric regurgitation and gastric
insufflation during artificial ventilation.
EOA is large tube a rounded closed tip distally a cuff to be inflated in the esophagus
and multiple opening at the hypopharyngeal level through which air or oxigen is
delivred into the larynx and trachea.
For insertion only into relaxed apneic adult patient by personal unable to perform
tracheal intubation.
Blind insertion via mouth into esophagus
For insertion keep neck slightly flexed
Laryngeal Mask Airway
An LMA is a device that functions intermediately between an OPA and a tracheal
tube and does not require direct visualization of the airway for insertion.
The LMA is available in sizes for neonates, infants, young children, older children,
and small, average, and large adults. The LMA consists of a tube fitted with an oval
mask and an inflatable rim.
8.Laryngeal Mask Airway
A. LMA placement into the pharynx
B. LMA placement using the index finger as a guide
C. LMA in place with cuff overlying pharyngs
D. Laryngeal mask airway (LMA) with the cuff inflated

B-Breathing

Providing Basic Ventilation

• Mouth-to-mouth ventilasion
• Mouth-to-nose ventilation
 • Mouth-to-barrier device ventilation
• Mouth-to-pocket mask ventilation
• Bag-mask ventilation
Check for Breathing

Look for the chest to rise and fall

Listen for air escaping during exhalation
Fell for flow of air against your cheek
The evaluation procedure should take at least 5 seconds but no more than 10
seconds
Mouth-to-Mouth Breathing.

Mouth-to-mouth breathing is a quick, effective way to provide oxygen to the victim.

The rescuer's exhaled air contains approximately 17% oxygen and 4% carbon
dioxide. This is enough oxygen to supply the victim's needs.
Follow these steps to give mouth-to-mouth breaths to the victim:
Steps Action

1 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 the
2
forehead).
Take a regular (not deep) breath and seal your lips around the victim's mouth,
3 creating an airtight seal.

Give 1 breath (blow for 1 second). Watch for the chest to rise as you give the
4
breath.

5 If the chest does not rise, repeat the head tilt-chin lift.
6 Give a second breath (blow for 1 second). Watch for the chest to rise.

Mouth – to – Nose Breathing

Mouth – to – nose ventilation is an effective alternative to mouth – to – mouth

ventilation
 If the victim’s mouth is seriously injured or cannot be open (trismus)
 The rescuer is assisting a victim in the water
 A mouth – to – mouth seal is difficult to achieve
Mouth-to-Barrier Device Ventilation

A barrier device is a thin film of material, usually plastic or silicone, that is placed
on the patient’s face and used to prevent direct contact with the patient’s mouth
during positive pressure ventilation. One common type of barrier device is a face
shield.
Step1.
Put on apropriate personal protective equipment. Open the patient’s airway and place
the barrier device over the patient’s mouth.
Step 2.
Place your mouth over the mouthpiece of the barrier device. Take a normal breath
and breathe into the device with enough force to cause the patient’s chest to rise
gently.
Mouth-to-Mask Ventilation

Steps Action

1 Position yourself at the victim's side.

 Place the mask on the victim's face, using the bridge of the nose as a guide
2
for correct position.

Seal the mask against the face:

• Using your hand that is closer to the top of the victim's head,
3 place the index finger and thumb along the border of the mask.
• Place the thumb of your other hand along the lower margin of
the mask.
Place the remaining fingers of your hand closer to the victim's neck along
4 the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to
open the airway .

While you lift the jaw, press firmly and completely around the outside
5
margin of the mask to seal the mask against the face.

6 Deliver air over 1 second to make the victim's chest rise.

Bag-Mask Ventilation
A bag-mask device consists of a self-inflating bag; a nonrebreathing valve with an
adapter than can be attached to a mask, a tracheal tube, or another invasive airway
device; and an oxygen inlet valve.

C-Circulation
Check carotide puls
External cardiac compressions
Check carotide puls

Steps Action
 1 Maintain a head tilt with one hand on the victim’s forehead.
2 Locate the trachea, using 2or 3 fingers of the other hand
3 Slide these 2 or 3 fingers into the groove between the trachea and the
muscles at the side of the neck, where you can feel the carotid pulse

4 Palpate the artery for at least 5 seconds and no more than 10 seconds.

External Cardiac Compressions

a) Compression of chest between sternum and spine with heel of hand applied to
the sternum. Second hand applied on the top of the first hand.
b) Release of pressure to let chest fill. Compress and release for 50 percent of
each cycle. Maintain contact between hand and sternum.
The correct place for application of the hands-the lower half of the sternum.
Technique of external cardiac compressions.
Identification of correct point for external cardiac compressions, by feeling for
suprasternal notch and base of xiphoid, measuring one-half of this distance and
compressing the lower half of the sternum.
Alternative method for identifying the pressure point, i. e., feeling for the base of the
xiphoid, measuring two fingers cephalad, and applying heel of hand over lower half
of sternum.
Body and hand position for external cardiac compressions. Compress straight
downward, using part of body weight. Keep arms straight and hands off ribs. Inset:
alternative method for performing external cardiac compressions with heel of lower
hand, by locking fingers of both hands
CHEST COMPRESSION TECHNIQUE
One important part of CPR is chest compressions, which keep blood flowing to the
heart, brain, and other vital organs.
Steps Action
1 Position yourself at the victim's side.
Make sure the victim is lying on his back on a firm, flat surface. If the victim
2
is lying face down, carefully roll him onto his back.
Move or remove all clothing covering the victim's chest. You need to to see
3
the skin.
Put the heel of one hand on the center of the victim's bare chest between the
4
nipples
5 Put the heel of your other hand on top of the first hand.
6 Straighten your arms and position your shoulders directly over your hands.
Push hard and fast 100 to120/min. Press down 2 inches (5 cm) with each
7 compression. For each chest compression, make sure you push straight down
on the victim's breastbone
At the end of each compression, make sure you allow the chest to recoil or
re-expand completely. Full chest recoil allows more blood to refill the heart
8
between chest compressions. Incomplete chest recoil will reduce the blood
flow created by chest compressions.
Deliver compressions in a smooth fashion at a rate of 100 compressions per
9
minute.
Minimal Interruption of Chest Compressions
Chest compressions should ideally be interrupted only for a ventilation (unless an
advanced airway is placed), rhythm checks, and actual shock delivery. Perform a
pulse check if an organized rhythm is observed.
Each time you stop chest compressions,the blood flow to the heart and brain
dicreases significantly.Once you resume compressions,it takes several compressions
to increase blood flow to the heart and brain.Thus, the more often chest compressions
are interrupted and the longer the iterruptions are,the lower the blood supply to the
heart and brain is.
Relationship of quality CPR to coronary perfusion pressure (CPP)
demonstrating the need to minimize interruptions in compressions
Coronary perfusion pressure is aortic relaxation (-diastolic") pressure minus right
atrial relaxation ("diastolic") pressure. During CPR, CPP correlates with both
myocardial blood flow and ROSC.
If the arterial relaxation pressure is <20 mm Hg, it is reasonable to try to improve
chest compressions and vasopressor therapy.
Physiologic Monitoring During CPR
End-Tidal CO2
The main determinant of ETCO2 during CPR is blood delivery to the lungs.
Persistently low ETCO2 values <10 mm Hg during CPR in intubated patients
suggest that ROSC is unlikely. If PETCO2 abruptly increases to a normal value of
35 to 40 mm Hg, it is reasonable to consider this an indicator of ROSC.
If the ETCO2 is <10 mm Hg during CPR, it is reasonable to try to improve chest
compressions and vasopressor therapy.
Coronary Perfusion Pressure or Arterial Relaxation Pressure
Increased CPP correlates with both myocardial blood flow and ROSC. A reasonable
surrogate for CPP during CPR is arterial relaxation ("diastolic") pressure, which can
be measured by using an intraarterial catheter.
If the arterial relaxation pressure is <20 mm Hg , it is reasonable to try to improve
chest compressions and vasopressor therapy.
Central Venous Oxygen Saturation
If oxygen consumption, arterial oxygen saturation, and hemoglobin are constant,
changes in ScvO2 reflect changes in oxygen delivery due to changes in cardiac
output. ScvO2 can be measured continuously by using oximetric tipped central
venous catheters placed in the superior vena cava or pulmonary artery. Normal range
is 60% to 80%.
If the ScvO2 is <30%, it is reasonable to try to improve chest compressio

Basic Life Support (BLS)

ABCD – Primary Survey
In the primary survey, focus on basic CPR and defibrillation Fist „A-B-C-D”
A - Airway: open the airway
B – Breathing: provide positive – pressure ventilation
C - Circulation: give chest compressions
D - Defibrillation: shock VF/pulseless VT
Adult Basic Life Support

Basic life support comprises the following sequence of actions

1. Make sure you and the victim are safe.
2. Check the victim for a response:
• gently shake his shoulders and ask loudly: "Are you all right?"
3a. If he responds:
• Leave him in the position in which you find him, provided there is no
further danger;
• Try to find out what is wrong with him and get help if needed:
• Reassess him regularly.
3b. If he does not respond:
• Shout for help
Turn the victim onto his back and then open the airway using head tilt and chin lift;
5A. If he is breathing normally:
• Turn him into the recovery position (see below);
 • Send or go for help - call 112 or local emergency number for an
ambulance (903);
• Continue to assess that breathing remains normal.
Recovery position
There are several variations of the recovery position, each with its own advantages.
No single position is perfect for all victims.
The position should be stable, near to a true lateral position with the head dependent,
and with no pressure on the chest to impair breathing.
Place your hand on his forehead and gently tilt his head back;
With your fingertips under the point of the victim's chin, lift the chin to open the
airway.
Recovery Position
A. Stable side position – for spontaneously breathing unconscious patient
• Flex leg closest to you
• Put hand closest to you under his buttocks
• Gently roll him onto his side
• Tilt his head backward and keep his face low. Put his upper hand under
his lower cheek to maintain head tilt and to prevent him from rolling
onto his face. The lowe arm behind his back prevents him from rolling
backward.
5B. If the breathing is not normal or absent:

Send someone for help and to find and bring an AED if available; or if you are on
your own, use your mobile phone to alert the ambulance service - leave the victim
only when there is no other option;
Start chest compression as follows: ;
Kneel by the side of the victim;
Place the heel of one hand in the centre of the victim's chest; (which is the lower
half of the victim's breastbone (sternum));
Place the heel of your other hand on top of the first hand;
Interlock the fingers of your hands and ensure that pressure is not applied over the
victim's ribs.
Keep your arms straight.
Do not apply any pressure over the upper abdomen or the bottom end of the sternum.
Position yourself vertically above the victim's chest and press down on the sternum
at least 5 cm (but not exceeding 6 cm); after each compression, release all the
pressure on the chest without losing contact between your hands and the sternum;
repeat at a rate of at least 100 min-1 (but not exceeding 120 min-1);
Compression and release should take equal amounts of time.
6A. Combine chest compression with rescue breaths.
After 30 compressions open the airway again using head tilt and chin lift.
Pinch the soft part of the nose closed, using the index finger and thumb of your hand
on the forehead.
Allow the mouth to open, but maintain chin lift.
Take a normal breath and place your lips around his mouth, making sure that you
have a good seal.
Blow steadily into the mouth while watching for the chest to rise, taking about 1 s
as in normal breathing; this is an effective rescue breath.
Maintaining head tilt and chin lift, take your mouth away from the victim and watch
for the chest to fall as air comes out.
Take another normal breath and blow into the victim's mouth once more to achieve
a total of two effective rescue breaths. The two breaths should not take more than 5
s. Then return your hands without delay to the correct position on the sternum and
give a further 30 chest compressions.
Continue with chest compressions and rescue breaths in a ratio of 30:2.
Stop to recheck the victim only if he starts to wake up: to move, opens eyes and to
breathe normally. Otherwise, do not interrupt resuscitation
If your initial rescue breath does not make the chest rise as in normal breathing, then
before your next attempt:
look into the victim's mouth and remove any obstruction;
• recheck that there is adequate head tilt and chin lift;
• do not attempt more than two breaths each time
• If there is more than one rescuer present, another rescuer should take over
delivering CPR every 2 min to prevent fatigue. Ensure that interruption of
chest compressions is minimal during the changeover of rescuers.
Do not interrupt resuscitation until:
• Professional help arrives and takes over;
• The victim starts to wake up: to move, opens eyes and to breathe
normally;
• You become exhausted.

Recognition of airway obstruction

Airway obstruction can be subtle and is often missed by healthcare professionals.
Recognition is best achieved by the look, listen and feel approach.
LOOK for chest and abdominal movements.
LISTEN and FEEL for airflow at the mouth and nose.
Partial Airway Obstruction, air entry is diminished and usually noisy.
Inspiratory stridor - caused by obstruction at the laryngeal level or above.
Expiratory wheeze - suggests obstruction of the lower airways, which tend to
collapse and obstruct during expiration.
Gurgling - suggests the presence of liquid or semisolid foreign material in the upper
airways.
Snoring - arises when the pharynx is partially occluded by the tongue or palate.
Crowing or stridor is the sound of laryngeal spasm or obstruction.
Complete airway obstruction in a patient who is making respiratory efforts causes
paradoxical chest and abdominal movement, described as 'see-saw breathing'. As the
patient attempts to breathe in, the chest is drawn in and the abdomen expands: the
opposite occurs in expiration. This is in contrast to the normal breathing pattern of
synchronous movement of the abdomen upwards and outwards (pushed down by the
diaphragm) with lifting of the chest wall.
During airway obstruction, accessory muscles of respiration are used - the neck and
the shoulder muscles contract to assist movement of the thoracic cage. There may
also be intercostal and subcostal recession and a tracheal tug.
Full examination of the neck, chest and abdomen should enable differentiation of
the movements associated with complete
Foreign-Body Airway Obstruction (choking)
Foreign-body airway obstruction (FBAO) is an uncommon but potentially treatable
cause of accidental death.
DIFFERENTIATION BETWEEN MILD AND SEVERE FBAO
General signs of FBAO
 Attack occurs while eating
 Victim may clutch his neck
 Signs of mild airway obstruction Signs of sever airway obstruction
Response to question Response to question
„Are you choking?” „Are you choking?”
 Victim speaks and answers yes  Victim unable to speak
Other signs: Other signs:
 Victim is able to speak, cough  Victim unable to breathe
and breathe  Breathing sounds wheezy
 Attempts at coughing are silent
 Victim may be unconscious

2. If the victim shows signs of severe airway obstruction:

If the victim is conscious:
Apply up to five back blows:
Stand to the side and slightly behind the victim.
Support the chest with one hand and lean the victim well forwards so that when the
obstructing object is dislodged it comes out of the mouth rather than goes further
down the airway.
Give up to five sharp blows between the shoulder blades with the heel of your other
hand.
Check to see if each back blow has relieved the airway obstruction. The aim is to
relieve the obstruction with each blow rather than necessarily to give all five.
If five back blows fail to relieve the airway obstruction give up to five abdominal
thrusts:
• Stand behind the victim and put both arms round the upper part of his
abdomen.
• Lean the victim forwards.
• Clench your fist and place it between the umbilicus and xiphisternum.
• Grasp this hand with your other hand and pull sharply inwards and
upwards.
 • Repeat up to five times.
If the obstruction is still not relieved continue alternating five back blows with five
abdominal thrusts.
Automated External Defibrillators
Automated external defibrillators (AEDs) are safe and effective when used by either
laypeople or healthcare professionals (in- or out-of-hospital).
Use of an AED by a layperson makes it possible to defibrillate many minutes before
professional help arrives.
Sequence for use of an AED
1. Make sure you, the victim, and any EMS personel are safe.
2. Follow the Adult BLS sequence:
• if the victim is unresponsive and not breathing normally, send someone
for help and to find and bring an AED if available;
• if you are on your own, use your mobile phone to alert the ambulance
service - leave the victim only when there is no other option.
3. Start CPR according to the adult BLS sequence. If you are on your own and the
AED is in your immediate vicinity, start with applying the AED.
There are 4 acceptable AED electrode pad positions:
• Anterolateral
• Anteroposterior
• Anterior-left infrascapular
• Anterior-right infrascapular
All 4 positions are equally effective in shock success and are reasonable for
defibrillation.
For ease of placement, anterolateral is a reasonable default electrode placement
4. As soon as the AED arrives:
 • switch on the AED and attach the electrode pads on the victim's bare
chest;
• if more than one rescuer is present, CPR should be continued while
electrode pads are being attached to the chest;
• follow the spoken/visual directions immediately;
• ensure that nobody is touching the victim while the AED is analyzing
the rhythm.
5a. If a shock is indicated:
• ensure that nobody is touching the victim;
• push shock button as directed;
• immediately restart CPR 30:2;
• continue as directed by the voice/visual prompts.
5b. If no shock is indicated:
• immediately resume CPR, using a ratio of 30
compressions to 2 rescue breaths;
• continue as directed by the voice/visual prompts.
6. Continue to follow the AED prompts until:
• professional help arrives and takes over;
• the victim starts to wake up: moves, opens eyes and breathes normally;
• you become exhausted.

SUMMARY OF BLS MANEUVERS FOR ADULT

Recommendations
Component

Recognition Unresponsive
 No breathing or no normal breathing (ie, only gasping)

No pulse palpated within 10 seconds

CPR Sequence C-A-B
Compression Rate At least 100/min
Compression Depth At least 2 inches (5 cm)
Chest Wall Recoil Allow complete recoil between compressions
Rotate compressors every 2 minutes
Compression Interruptions Minimize interruptions in chest compressions.
Attempt to limit interruptions to < 10 seconds.
Airway Head tilt-chin lift (suspected trauma: jaw trust)
Compression-to-Ventilation 30:2
Ratio 1 or 2 rescuers
(until advanced airway placed)
Ventilations with advanced 1 breath every 6-8 seconds (8-10 breaths/min)
airway Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
Defibrillation Attach and use AED as soon as available.
Minimize interruptions in chest compressions before and
after shock;
Resume CPR beginning with compressions immediately
after each shock.

HIGH QUALITY CPR

The critical characteristics of high-quality CPR include:
Start compressions within 10 seconds of recognition of
cardiac arrest
Push hard,push fast: Compress at a rate of 100 to 120/min
with a depth of:
-At least 5 cm(2 inches), for adults
-At least one third the depth of the chest,about 5 cm
(2 inches),for children
-At least one third the depth of the chest, about 4 cm
(1,5 inches), for infants
Allow complete chest recoil after each compression
Minimize interruptions in compressions(try to limit
interruptions to less than 10 seconds).
Give effective breaths that make the chest rise
Avoid excessive ventilation
CONCLUSIONS
Basic Life Support (BLS). - BLS is the phase of ECC that includes recognition of
cardiac arrest, access to the EMS system, and basic CPR. .BLS consists of three
steps:Step A: airway control ;Step B: breathing support, emergency artificial
ventilation and oxygenation of the lung
Step C: circulation support, recognition of pulselessness and establishment of
artificial circulation by cardiac compressions, control of hemorrhage and positioning
for shock.
The links the Adult Chain of Survival include the following:
• Immediate recognition of cardiac arrest and activation of the
emergency response system
• Immediate high-quality CPR
• Rapid defibrillation
• Basic and advanced emergency medical services
• Advanced life support and postarrest care

The critical characteristics of high-quality CPR include:

• Start compressions within 10 seconds of recognition of cardiac arrest.
• Push hard, push fast: Compress at rate of at least 100/min. with a depth of at
least 2 inches (5 cm) for adults.
• Allow complete chest recoil after each compression.
• Minimize interruptions in compressions (try to limit interruptions to <10
seconds).
• Give effective breaths that make the chest rise.
• Avoid excessive ventilation.
REFERENCES

1. American Heart Associatipn.BLS for Healthcare Providers 2016

2. European Resuscitation Council Guidelines for Resuscitation
2015,section 2
3. Gh.Ciobanu Resuscitarea Cardiorespiratorie și Cerebrală,2015, Vol.1-2