Basic

Life
Support

OSPITAL NG MAKATI

Department of
Emergency
Medicine
Introduction

Elements of Basic Life Support (BLS)

initial assessment
Chest compression
airway maintenance
expired air ventilation
How does CPR work?
• All living cells of our body need a steady
supply of oxygen to keep us alive.
• Breathe air into the victim’s lungs to
provide oxygen into the blood.
• Press on the chest to move oxygen-
carrying blood through the body.
Failure of the
circulation
for 3-4 min
will lead to
irreversible
cerebral
damage
No CPR
Key guidelines for 2010 Adult
Basic Life Support
• Immediate recognition of sudden cardiac
arrest (SCA) on assessing responsiveness
and absence of normal breathing
• “Look, Listen and Feel” was removed
• Encourage “Hands only CPR” for untrained
lay rescuer
• Sequence change to C-A-B
Key guidelines to Adult BLS
2010
• Increase focus in methods to ensure high
quality CPR is performed
• Simplified adult BLS algorithm is
introduced
• Continued de-emphasis on pulse check
• Team approach is encouraged
Chain of survival
Chain of Survival Concept

IMPROVE THE OUTCOME

FOR THE VICTIMS
OF
CARDIOPULMONARY
ARREST
Early Access
The bystander could be any of us.
A well informed and properly educated
lay person is the key in the early
access link. The
The Bystander
Bystander
The Bystander must be able to
recognize the emergency.
As soon as an emergency is
recognized, the bystander must make a
telephone call to activate the EMS
system. CALL 117
 Early Access

By calling first, you

join a team of The Bystander
Emergency Service
dispatchers and
responders.

Each member has

The Dispatcher
a vital role.
The EMS Responders
Early warning signs of heart
attack
WHAT? Uncomfortable pressure,
fullness, squeezing or pain
WHERE? In the center of the chest,
behind the breastbone. It may
spread to, or occasionally
originate in, either, shoulder, the
neck, the lower jaw, or either
arm
HOW LONG? Lasts longer than few minutes
Other signs of heart attack
• chest discomfort or lightheadedness
• fainting
• sweating
• nausea
• shortness of breath
Early warning signs of respiratory
failure
• Inability to speak, breathe or cough
• clutches neck (universal distress
signal)
• bluish color of skin and lips
 Early Access

Adult CP arrest
CARDIAC
DEFIBRILLATOR

“PHONE FIRST”
 Early Access

Infant/Child CP arrest
RESPIRATORY
RESCUE BREATHING

“PHONE FAST”
 Early Access

EXCEPTIONS to the “PHONE FIRST/PHONE FAST”

Submersion/Near-drowning (phone fast)
Arrest associated with trauma (phone fast)
Drug overdoses (phone fast)
Cardiac arrest in children known to be at high risk for
arrhythmias (phone first)
 Early CPR
Cardiopulmonary
resuscitation
keeps
oxygenated
blood flowing
to the brain
until additional
help can arrive.
Giving CPR
promptly will
help more
One-Rescuer CPR: Adult
 1 Ensure safety of rescuer
and victim.
•You find a person lying on
the ground, not moving.
•You should survey the scene
to see if it is safe.
•Get some idea of what
happened.
•Then begin doing a primary
survey.
2 Check for responsiveness.

•Tap or gently shake

the victim
•Rescuer shouts “ARE
YOU OK?” and “ARE
YOU ALRIGHT?”
•Scan the chest for
any movement
3 Call for help.

•If the victim is

unconscious,
rescuer shouts
“HELP”
•He should activate
EMS system if
available in the
locality by calling
117
Rescuers

Check for SIGNS of

circulation:
normal breathing
coughing
movement in response to
rescue
breaths
Chest Compression:anatomical
landmarks
•Subcostal margin
(rib cage)
•Xiphoid process
(notch at the
lower end of
breastbone)
•Sternum
(Breastbone)
5 Start chest compression.
•Compress breastbone
at least 2 inches, at
least a rate of 100
compressions per
minute.
•Quality chest
compression “push
hard – push fast”
Chest Compression

•Place heel of other hand

on breast bone between
the imaginary nipple area

•Place other hand

above and interlock
with the hand on top
of the bony part of
the sternum.
 Chest Compression
•Upstroke
•Downstroke
•At least 2 inches

•Position shoulders
over hands with
 elbows lock and
•Fulcrum arms straight.
(hip joints) •Arms should be
perpendicular to the
victim’s body.
High quality CPR
• Adequate rate of at least 100
compressions / minute
• Adequate depth:
– Adult : at least 2 inches or 5 cm depth
– Child : about 2 inches or 5 cm depth
– Infant : 1 ½ inches or 4 cm depth
High quality CPR
• Allow chest recoil after each compression
• Minimize interruption of CPR
• Avoid excessive ventilation
6 Open airway

Head-tilt/chin-lift method
•Place one hand
on victim’s
forehead
•Place fingers of
other hand under
bony part of lower
jaw near chin
•Tilt head and lift
jaw
Head tilt/chin-lift method

•Tongue
•Epiglottis

Tongue may
fall back
7 Patient is not breathing:
Give rescue breaths.
•Maintain an open airway.
•Pinch nostrils closed.
•Make a tight seal around
victim’s mouth.
•Give 2 normal breaths.
•Observe chest rise and fall.

•Allow for exhalation between breaths.

8 Compression/Breathing
Cycles
•Continue cycles of 30
compressions followed
by 2 normal breaths.
•After 5 cycles of
(30:2), check pulse.
•If still with no pulse,
resume CPR, starting
with chest compression
•Re-check pulse every
two minutes
Hands only (compression only) CPR

• Lay persons or rescuers who have not

trained in BLS
• All age group
• Employs high quality CPR
• Better than to NO CPR at all
9 Pulse returns but no breathing:
Give rescue breaths.
•Give 1 rescue breath
every 5 seconds.
•12 rescue breaths per
minute.
•Monitor the pulse.
•If there is breathing,
place in recovery
position.
10 Recovery position

A
•Keep the airway open
10 Recovery position

•Place hand under the thigh.

B
10 Recovery position

•Position the arm and raise the leg.

C
10 Recovery position

•Pull the thigh towards you.

D
10 Recovery position

•Place the leg at right angle.

E
10 Recovery position
•Keep the airway open.
•Monitor the casualty.

F
Pediatric chain of survival
One-Rescuer CPR:
Child (1 to 8 years)
One-Rescuer CPR:
Child (1 to 8 years)
CPR performed on young children is similar for adults
and older children except for 4 differences

1
If the rescuer has
no help, give about
2 minutes of CPR
before activating
the EMS system.
One-Rescuer CPR:
Child (1 to 8 years)
CPR performed on young children is similar for adults
and older children except for 3 differences

2 Use the heel of one

hand or 2 hands in
chest compressions
at the lower ½ of
sternum
One-Rescuer CPR:
Child (1 to 8 years)
CPR performed on young children is similar for adults
and older children except for 3 differences

3 Depress the
sternum one third
AP diameter or
about 2 inches or
5 cm depth
One-Rescuer CPR:
Child (1 to 8 years)

Aside from the

carotid pulse, you
can also check the
pulse using the
femoral artery
One Rescuer CPR:
Infant (<1year)
1 Check for responsiveness.

•Tap or gently shake

the shoulder.
•Flick soles of feet
2 Check for Pulse

•Maintain an open
airway.
•Feel for the
brachial pulse on
the inside of the
upper arm with 2
fingers of one hand
for 10s.
3 Start chest compression.
•Compress breastbone
11/2 inch or 4 cm
depth at a rate of at
least 100 compressions
per minute.
Chest Compression

•Imagine a line between the

nipples and place your index
finger below that line.

•Follow the line up to

the sternum
(breastbone).

•Use the middle and the ring

fingers to compress the
sternum.
Two rescuer chest compression
4 Open airway
Head-tilt/chin-lift method
•Place one hand
on victim’s
forehead.
•Place fingers of
other hand under
bony part of lower
jaw near chin
•Tilt head and lift
jaw.
5 Patient is not breathing:
Give rescue breaths.
•Maintain an open airway.
•Give 2 gentle rescue
breaths.
•Observe chest rise and
fall; listen and feel for
escaping air.
•Allow for exhalation
between breaths.
Rescue breathing

•Open your mouth wide.

•Take a deep breath
•Make a tight seal around
the infant’s mouth and
nose.
•Each breath should be
provided for 1 sec.
6 Compression/Breathing
Cycles
•Continue cycles of 30
compressions followed by 2
rescue breath.
•Do 5 cycles of
compressions and rescue
breaths.

•Check for pulse.

7 Activate EMS
•After 5 cycles of
compressions and rescue
breaths.
•Activate EMS. Call 117
•Check the brachial
pulse.
•If still with no pulse,
continue 30:2 cycles
beginning with chest
compression.
8 Pulse returns but no breathing:
Give rescue breaths.
•Give 12 -20 breaths /
minute
•Monitor the pulse
every 2 minutes.
•If there is breathing,
place in recovery
position.