BASIC LIFE SUPPORT

(BLS) & ADVANCED

CARDIAC LIFE SUPPORT
(ACLS)

Presented By : Dr. Mansi Shah,

MD Medicine
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Step 1: Identify

Identify unresponsiveness or absent, gasping, or abnormal

breathing at earliest possible time
If an adult is found unresponsive, there is no witness to
cardiac arrest, assume sudden cardiac arrest, until proven
otherwise

EMED Class day 1

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SCENARIO
•You find an unresponsive middle
aged man lying unresponsive on the
sidewalk.
•What’s your next best step?
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STEP 2
1. Verify scene safety
2. •Check for responsiveness
3. •Shout for nearby help
4. •Activate emergency response
5. •Get AED & emergency equipment
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STEP 3 : CHECK
Look for no breathing or only First Possibilty
Normal breathing &
gasping & check the pulse
Pulse felt =
simultaneously Monitor
For 5 to 10 seconds

Second Possibility
Third Possibility
No normal breathing
No breathing & pulse felt = Pulse felt
START CPR Rescue breaths 10/min
Check for pulse every 2 mins
(Naloxone?)
Ideal Chest Compressions
•golden rule - "push hard, push fast" on the centre of the chest
•Push hard = 5 – 6 cm
•Push fast = 100-120/min
•Centre of the chest = Heel of one hand in the centre of the chest over
the lower half of the sternum and the heel of their other hand atop the
first. The rescuer's own chest should be directly above their hands with
the elbows held in extension.
•Compression only if lone rescuer
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AIRWAY & BREATHING IN BLS
•When more trained rescuers are present - delivery of 30 chest compressions
1 followed by two rescue breaths (30:2) with each ventilation over no more than one
second.

•Provide only enough tidal volume to observe the chest rise (approximately 500 to
2 600 mL, or 6 to 7 mL/kg).

•Compressions are paused briefly for ventilation when using a bag-valve-mask

3 (BVM) (i.e.) without an advanced airway.
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START CPR
Chest compressions 100-120/min, 5 to 6 inch in depth
Airway Head tilt, chin lift
Breaths 2 rescue breaths 1 second each (30:2), enough to cause chest rise
C–A–B

When AED arrives

AED arrives. Resume CPR. Check pulse at 2 mins. Continue till ALS provider
arrive
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SHOULD WE CONTINUE?

Non-shockable initial cardiac arrhythmia (eg, asystole, pulseless electrical activity [PEA])
-No return of spontaneous circulation (ROSC) prior to administration of third 1 mg dose of epinephrine
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ENHANCE TO ACLS
•Enhance : C – A – B
•Cardiac monitor, blood pressure probes, oximetry
•IV access at least 2, large bore , Iv fluids
•12 lead ECG
•Consider possible hypoxic & toxicologic causes
•5H & 5T
•Hypoxia, Hypovolemia, Hypo- or Hyperkalaemia, Hypo- or
Hyperthermia, Hydrogen ions (acidosis)
•Tension pneumothorax, Tamponade, Thrombosis (MI),
Thromboembolism (PE), Toxins or Tablets (drug overdose)
•POCUS
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MONITOR QUALITY OF CHEST COMPRESSIONS
Larana University | 2024

Mechanical devices that provide real-time feedback of chest compression rate and
1 depth and of adequate chest recoil

End-tidal carbon dioxide (EtCO2) measurement, which reflects the quality of chest
2 compressions (see "Carbon dioxide monitoring (capnography)") targeting chest
compressions to an EtCO2 ≥20 mmHg may be useful

Arterial diastolic blood pressure measurement using invasive arterial pressure

3 monitoring if the line is already in place. A reasonable goal is to maintain an arterial
diastolic pressure above 20 mmHg. (Do not interrupt CPR for line placement)
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Airway
An advanced airway (eg, supraglottic device, endotracheal tube) can be placed
without interrupting CPR
•If intubation is to be performed during cardiac arrest, it must be done by a
trained provider, ideally require less than 10 seconds to complete

Breathing
•deliver breaths every 8 to 10 seconds.
•Bag & mask ventilation is preferred. (no need to squeeze the bag completely)
•Provide 100 percent oxygen during CPR.
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RHYTHM CHECK & DEFIBRILLATE
•Rhythm check 5 – 10 seconds
•Pad placement – Anterolateral or
anteroposterior
Avoid placement over pacemaker
•Shockable – Defibrillate – max charge (200 for
biphasic, 360J for monophasic)
•Check pulse after 2 mins of delivering shock due
to delay in restoration of effective ventricular
contraction, continue chest compressions till
then
 Continue CPR
Give Adrenaline 1 mg every 3 to 5
mins (Alternate CPR cycle)
MOA - alpha-1 agonism, increases
diastolic blood pressure and
coronary perfusion pressure.
Can be given for both shockable
(after 1st shock delivery) & non-
shockable.
Atropine is no longer recommended for the
treatment of asystole or PEA. Cardiac pacing is
ineffective for cardiac arrest and not
recommended
•After 3 shock delivered;
Consider anti arrhythmics amiodarone
or lidocaine
amiodarone (300 mg IV/IO bolus with a
repeat dose of 150 mg IV as indicated)
lidocaine (1 to 1.5 mg/kg IV/IO bolus,
then 0.5 to 0.75 mg/kg every 5 to 10
minutes)
Note – if rhythm looks like asystole,
increase the amplitude of the device to
unmask fine VF (a shockable rhythm)
with better prognosis.
 DECISION TO STOP 12

RESCUSCITATIVE OFFERS
-Duration of resuscitative effort >30 minutes without a sustained
perfusing rhythm
-Unwitnessed collapse with an initial ECG rhythm of asystole
-Prolonged interval between time of collapse and initiation of
cardiopulmonary resuscitation (CPR)
-Patient age, severe comorbid disease, or prior functional dependence
-A very low EtCO2 (<10 mmHg) following prolonged resuscitation (>20
minutes) is a sign of absent circulation and a strong predictor of acute
mortality always rule put misplaced tube or broken circuit
THANK YOU
Presented By : Dr. Mansi Shah