BASIC LIFE SUPPORT

NCORT
(National Committee On Resuscitation Training)

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BASIC LIFE SUPPORT / HPD / ETD 2
 BASIC LIFE SUPPORT
NCORT(THE NATIONAL COMMITTEE ON RESUSCITATION TRAINING)

• It follows the simple concept of : D-R-S-A-B-C ( DANGER-RESPONSIVENESS-SHOUT FOR

HELP-AIRWAY-BREATHING AND CHEST COMPRESSION).

SIMPLE RULES TO FOLLOW:

1) Assessing DANGER and Safety to Rescuer and victim prior to Resuscitation.

All Health Care Workers (HCW) shall be taught to protect themselves from danger during CPR:
a) Wearing Personal Protective Equipment: (mask,apron,gloves)
b) Avoiding spills of body fluids,sharps and electrical wires at bed side.
c) If victim found at road side,pull the victim to safe area.(Pre Hospital Care)

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 Basic requirement : At least Mask and Glove

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 BLS
2)RESPONSEVENESS

Responsivenee shall be assesed by tapping both shoulders twice and calling

“Hello,hello are you ok”.

3) SHOUT FOR HELP

HCW(Health Care Worker) shall be taught to shout calling for help.eg: “Emergency!
Emergency! Bring the resuscitation trolly and defibrillator.” (in Hospital).
or
“Help please call 999/ambulance and get me an AED”
(Out of Hospital)

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 CHECK RESPONSIVENESS

SHOUT For Help

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 POSITIONING OF VICTIM
1. Victim found on the should be initially managed on the floor.

2. Faced down victims shall be rolled over to the supine position.

3. Air filled matress should be deflated during CPR.

4. Concern for protecting the neck should not hinder the evaluation process or
delayed life saving procedure.

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 BLS
4. AIRWAY:
For unresponsive adults and children the airway shall be opened using
‘Head Tilt Chin lift’. ( in non trauma case).

Tongue compressing airway

Jaw Thrust ( in Trauma case).

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 BLS
• 5. BREATHING

• The B shall stand for the assesment of breathing.In adult CPR it shall not refer to
giving 2 ventilations.
• The time taken to open the airway and check for breathing should not be more
than 10 sec.

1. Recommendation:
a. Breathing shall be assessed by looking at the chest , neck and face for not more
than 10 sec.
b. The absence of breathing or presence of abnormal breathing shall identify cardiac
arrest.
c. HCW shall be taught to recognize agonal gasph as a sign of cardiac arrest.
d. Chest compression shall begin with absence of normal breathing.

Pulse check is not recommended prior to First Chest Compression.

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6. CHEST COMPRESSION :
A high quality chest compression shall be emphasized in BLS training. The component include:
1) Location:
The lower half of the sternum shall be the site for hand placement. This taught as place the heel
of your hand in the centre of the chest with the other hand on the top.This instruction shall be
accompanied by the demonstration of placing the hands on the lower half of the sternum.
2) Rate:
At least 100 compressions per minute.
3) Depth: At least 5cm
4) Recoil:
Complete recoil of the chest must be allowed after each compression.
5) Minimize interruption.
Interruption must be minimize during entire resuscitation.

The compression-ventilation ratio : (30:2)

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7 ) DEFIBRILLATION :
1) Defibrillation (AED) training shall be part of BLS course content.
2) Rescuers shall be taught to attach the defibrillator as soon as it is available with
minimal interruptions to chest compression.
3) Chest compression should immediately resume after 1 shock.

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 AMBU BAG
(BAG VALVE MASK)

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• Reassesment During CPR.
After every 5 cycles or 2 minutes of CPR, rescuer shall check for normal breathing.
If no breathing then delivered rescue breathing every 5-6 sec ( 10- 12/min) for two minute.

It is reasonable to check pulse (Carotid or Femoral) if organized rhythm is seen from cardiac
monitoring.

1. ETHICAL ISSUE STOPPING CPR.

CPR CAN BE STOPPED IN FOLLOWING CIRCUMSTANCES:

a. Victim recovers with normal breathing.

b. Rescuer is exhausted.
c. Assistance arrives to take over CPR.

Recovery Position:
Recovery position is applied when victims resume normal breathing.
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 FOREIGN BODY AIRWAY OBSTRUCTION

1. Conscious Adult Foreign Body Airway Obstruction (FBAO):

i) Back blows or abdominal thrust shall be applied in rapid and continuous

sequence for a conscious adult with FBAO and poor oxygenation.
(Universal distress sign, ineffective cough , turning blue)

ii) Back blows or Chest thrusts shall be applied in rapid and continuous sequence
for a conscious adult who is pregnant or obese with FBAO and poor oxygenation.

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 UNIVERSAL SIGN

BACK BLOW

ABDOMINAL THRUST

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 CHEST THRUST

CHEST THRUST IN
PREGNANT

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 2.UNCONCIOUS ADULT FBAO (Foreign body airway obstruction)

1. The unconscious adult with FBAO shall be managed the same way as an
unresponsive victim in the BLS algorithm. (D-R-S-A-B-C-D).

2. The finger sweep shall only be performed if solid material is seen in the airway.

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 Cardiac Arrest Caused by Asthma ,Drowning and Drug
Overdose

 There is no change in treatment algorithm in cardiac arrest caused by

these condition.

 Cardiac Arrest in Pregnancy.

AHA guidelines states It is reasonable to perform manual left uterine
displacement in supine position. If this is unsuccessful and an appropriate
wedge is readily available , then providers may consider placing the patient in
a left lateral tilt of 27 to 30 degree.

NCORT Recommended :
Manual left uterine displacement shall be performed in pregnancy associated
with cardiac arrest

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 MANUAL LEFT UTERINE DISPLACEMENT

OR

TWO HAND PULL TO LEFT ONE HAND PUSH TO THE LEFT

USING WEDGE SUPPORT TILT 30

TILT PT 30 DEGREE ON SPINAL

BOARD

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 Cardiac Arrest Associated with Trauma

• BLS for the trauma patient is fundamentally the same as that for the
patient with primary cardiac arrest. However, when multi system trauma is
present or trauma involves the head and neck , the cervical spine must be
stabilized.

• Jaw thrust are recommended instead of head tilt chin lift and there should
be no delay in assessment and commencing CPR.

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 CPR IN CHILDREN

It follows the same algorithm as in adults except when it comes to the sequence of BREATHING.
1. DANGER : The rescuer should ensure the external environment is safe and the child is not in
danger.

2. RESPONSIVENESS : Gently stimulate the child and ask loudly ‘ Are you alright’.

3. SHOUT FOR HELP : If the child does not respond shout for help by saying out loudly
‘Emergency ! Emergency! Bring the resuscitation trolley and defibrillator’
or Call 999/ambulance and get me an AED.
4. AIRWAY : Open airway by head tilt chin lift.

4. BREATHING : IF BREATHING IS NOT NORMAL OR ABSENT RESCUER SHOULD GIVE 5 (FIVE) RESCUE
BREATHS FIRST. ( In paediatric CPR especially cardiac arrest, often results from or is complicated by
asphyxia). Assesment of breathing should not exceed 10 second.

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6. CHECKING PULSE : The committee recommends checking the pulse for infant and child. Time
taken checking pulse not more than 10 second. For infant feel the Brachial pulse. For child feel
Carotid pulse.Femoral pulse maybe felt in both infant and child.

7.CHEST COMPRESSION: For ease of training and teaching, a compression-ventilation ratio of 30:2
is recommended for single rescuer. For two rescuer the ratio of 15:2 is recommended.

Recommendation :
1. Push Hard ( for infant : 1/3 the depth of chest or 4cm : For Child 5cm).
2. Push Fast ( Rate at least : 100- 120/min).
3. Ratio compression to ventilation : (one rescuer 30:2 two rescuer :15:2)
4. Allow full chest recoil.
5. Minimize interruptions.
6. Avoid excessive ventilation.

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• VENTILATION :
1. Use of bag mask device shall be taught to all HCW.
2. Mouth to mouth ventilation shall be taught for use outside and inside hospital without bag
mask devices.
3. Use of protective device such as pocket mask and face sheild shall be taught during BLS
course.

4. In peads if there is palpable pulse but there is inadequate breathing , continue rescue breath
at 12-20/min. Meaning delivering rescue breath of total 24 – 40 breath in two min.( every 5
or 3 sec provide rescue breath).For ease of training use every 3 sec for each ventilation.

DEFIBRILLATION :
1. Rescuer shall be taught to attach the defibrillator as soon as it is available with minimal
interruptions to chest compression.
2. Chest compression should immediately resume after 1 shock.

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DRS – A-B-C-D

OPEN AIRWAY (HEAD TILT CHIN LIFT)

DELIVER FIVE RESCUE BREATH

START CHEST COMPRESSION

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POSITION OF AED PAD IN INFANT AND CHILD

Position of pad can be :

1. RIGHT ANTERIOR AND LEFT LATERAL.
2. CENTRAL ANTERIOR AND CENTRAL
POSTERIOR

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 FOREIGN BODY AIRWAY OBSTRUCTION IN INFANT AND CHILD

If the FBAO is mild, do not interfere. Allow the victim to clear the airway by coughing
while you observe for signs of severe FBAO.

1. If the FBAO is severe (ie, the victim is unable to make a sound), you must act to
relieve the obstruction.

2. For a child, perform back blows or abdominal trusts until the object is expelled or
the child becomes unresponsive.

3. For an infant, deliver repeated cycles of 5 back blows (slaps) followed by 5 chest
thrusts until the object is expelled or the victim becomes unconscious.

4. Abdominal trusts are not recommended in infants as it may cause liver injury.

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If the victim becomes unresponsive:
1) Start CPR compressions.

2) After 30 compressions, open the airway. If you see a foreign body,

remove it but do not perform blind finger sweeps.

3) Attempt to give 2 rescue breaths.

4) Continue with cycles of chest compressions and ventilations until the

object is expelled.

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 BACK BLOW X5

CHEST THRUST X 5

FINGER SWEPT ONLY WHEN

OBJECT VISIBLE

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 REFERENCES

1) Guidelines For Resuscitation Training In Ministry of Health

Malaysia Hospitals and Healthcare Facilities
First published in Malaysia in January 2012 by
Medical Development Division
Ministry of Health, Malaysia
© The Ministry of Health Malaysia 2012 www.moh.gov.my

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