Basic life support(BLS)

Prepared by Dr Melaku M(ECCM R-1)

moderator:Dr Yonas(assistant professor of ECCM)
BLS
 PREAMBLE
 In 2015, approximately 350 000 adults in the United States
experienced nontraumatic OHCA attended by EMS personnel.
Approximately 10.4% of patients with OHCA survive their
initial hospitalization,and 8.2% survive with good functional
status.
The key drivers of successful resuscitation from OHCA are
lay rescuer CPR and public use of AED.
 Despite recent gains, only 39.2% of adults receive layperson-
initiated CPR, and the general public applied an AED in only
11.9% of cases.
 cont..
 Approximately 1.2% of adults admitted to US hospitals
suffer IHCA
 Of these patients, 25.8% were discharged from the
hospital alive,
 82% of survivors have good functional status at the time
of discharge.
 Despite steady improvement in the rate of survival from
IHCA, much opportunity remains.
EPIDEMIOLOGY AND SURVIVAL
 Approximately 450,000 individuals suffer OHSCA in the United
States annually.
 Roughly half of these patients have resuscitation attempted by
emergency medical services.
 Despite the development of resuscitative technique over the past
50 years, survival rates for SCA remain low.
 Effective delivery of BLS interventions is linked to improved
survival and favorable recovery.
 Studies show that even trained health care providers consistently
fail to meet BLS guidelines.
 BLS
 BLS consists of:
 prompt recognition of cardiac arrest
 Activation of emergency response system
 Immediate delivery of high quality CPR
 Defibrillation using AED(if available).
 General concepts of BLS

 Quickly starting the Chain of Survival.

 Delivering high-quality chest compressions
 Knowing where to locate and how to use an AED
 Providing rescue breathing when appropriate.
 Understanding how to perform as a team.
 Knowing how to treat choking.
 Key concepts for BLS

Recognize
 sudden cardiac arrest (SCA) as soon as possible.
A lone responder should activate emergency services first,

then proceed to provide resuscitation.
Lay rescuers should not attempt to check for a pulse.

Instead, they should initiate CPR.
Health care providers may perform a carotid pulse check for

no longer than 10 seconds.
Perform excellent chest compressions: "push hard, push

fast.
 Cont’s

Lone
 responders or those untrained or uncomfortable
providing ventilation should provide compression-only CPR
Minimize interruptions in chest compressions .

Use an automated external defibrillator (AED) as soon as

one is available.
Patient survival depends primarily upon prompt recognition

of cardiac arrest, activation of emergency services, rapid
initiation of excellent CPR, and early defibrillation.
Adult Chain of Survival
 The primary focus of BLS providers is the optimization
of all critical steps required to improve outcomes.
 These include
• activation of the emergency response,
• provision of high-quality CPR and early defibrillation,
• ALS interventions, effective post-ROSC care.
 Cont’s
 Resuscitation causes, processes, and outcomes are very
different for OHCA and IHCA.
 In OHCA, the care of the victim depends on
community engagement and response.
 It is critical for community members to recognize
cardiac arrest, the local emergency response number,
perform CPR and use an AED.
 cont’s
 EMS personnel are then called to the scene, continue
resuscitation, and transport the patient for stabilization and
definitive management.
 In comparison, surveillance and prevention are critical
aspects of IHCA.
 When an arrest occurs in the hospital, a strong
multidisciplinary approach is involved
 Outcomes from IHCA are overall superior to those from
OHCA
BLS
Pediatric chain of survival
 BLS
 When a patient is found unconscious or
suspected to have cardiac arrest the following
steps should be followed:
 Assess scene safety
• Do not approach the patient before doing a scene size-
up.Foolish haste may subtract an emergency care
provider andadd a patient.
 BLS
 Determine un-responsiveness by touching and shouting
 Call for help
 Position the victim and start CPR
 Act as a team and have a team leader that guides the
quality of the CPR and for decision making
 STEPS OF BASIC CPR

 C-A-B (chest compressions, airway, breathing) is the

recommended sequence for a single rescuer.
 Provide chest compressions before giving rescue
breaths.
 Compression rate should be 100 to 120 per minute.
 Compression depth should be 2 to 2.5 in. (5 to 6 cm).
 Cont’s

 Do not lean hands on the chest between compressions

to allow complete recoil between compressions.
 continue compression-only CPR until arrival of
automated external defibrillator or rescuers with
additional training.
 If trained in rescue breathing, add rescue breaths after
30 compressions, using two breaths then and every 30
compressions until skilled help arrives
 Chest compressions
 Place the victim supine on a firm surface, with the rescuer at the
victim’s side.
 Place the heel of one hand midline on the lower half of the
sternum,
 Maintain the rate of chest compression at 100 to 120
compressions per minute.
 cont’s

 Compress the chest at least 5 cm (2 inches) but no more

than 6 cm (2.5 inches) with each downstroke .
 Allow
the chest to recoil completely after each
downstroke.
 Minimize the frequency and duration of any
interruptions
 High quality CPR

 A number of key components

 minimizing interruptions in chest compressions,
 providing compressions of adequate rate and depth,
 avoiding leaning on the chest between compressions,
 avoiding excessive ventilation.
Physiology of Closed Chest Compressions
 There are three basic theories for how pressure gradients
and flow are produced:
 cardiac pump theory:
 direct compression of the heart between the spine and
the sternum leads to increased pressure in the
ventricles.
 This causes closure of the mitral and tricuspid valves
 leading to blood flow into the aorta and the pulmonary
arteries.
Physiology of Closed Chest Compressions

 thoracic pump theory:

 postulates that compressions lead to an increase in pressure
throughout the thoracic cavity,
 leading to a pressure gradient from intrathoracic to
extrathoracic arteries.
 abdominal pump theory:
 increased arterial pressure caused by abdominal compressions of
aorta forces blood from the abdominal aorta against the closed
aortic valve.
Open Chest Cardiac Compressions

 Open chest cardiac massage is an alternative to standard

CPR
 improves blood flow in animal models.
 after penetrating chest trauma;
 in the perioperative period before or after cardiothoracic
surgery;
 Cont’s

 duringcardiac arrest caused by hypothermia, pulmonary

embolism, pericardial tamponade, or abdominal
hemorrhage;
 in cases of chest deformity in which closed chest CPR is
ineffective
cont’s
Cont’s
AIRWAY Opening AND RESCUE
BREATHING
 Determine airway patency
 positioning the individual supine on a flat, firm surface with the arms along
the sides of the body.
 Unless trauma can be definitely excluded, any movement of the victim should
consider the possibility of a spine injury.
 Cont’s

 stabilize the cervical spine by maintaining the head,

neck, and trunk in a straight line.
 If the neck is not already straight, then it should be
moved as little as possible to establish the airway.
 If the patient cannot be placed supine, the jaw thrust
maneuver can be applied with the rescuer at the victim’s
side.
AIRWAY Opening AND RESCUE
BREATHING
 After positioning the patient, inspect the mouth and oropharynx
for secretions, foreign objects, loose,or broken teeth.
 Assess, clear, and protect airway: jaw thrust/chin lift, suctioning.
 The presence of airway obstruction is indicated by snoring,
gurgling, stridor,or silence.
 Jaw Thrust Maneuver The jaw thrust is the safest method for
opening the airway if there is the possibility of cervical spine
injury.
 Head Tilt–Chin Lift Maneuver
Determine breathlessness
Jaw thrust maneuver
 Rescue Breathing

 Deliver each rescue breath over 1 second.

 Give a sufficient tidal volume (by mouth to mouth/mask
or bag mask with or without supplementary oxygen) to
produce visible chest rise.
 Avoid rapid or forceful breaths.
 Avoid hyperventilation.
Mouth-to-mouth rescue breathing.
Mouth-to-mask rescue breathing
Assess Breathing

 Ventilate with 100% oxygen; monitor oxygen

saturation.
 Auscultate for breath sounds.
 Inspect thorax and neck for deviated trachea, open chest
wounds, abnormal chest wall motion, and crepitus at
neck or chest.
 Consider immediate needle thoracostomy for suspected
tension pneumothorax.
 Consider tube thoracostomy for suspected
CIRCULATION AND HEMORRHAGE
CONTROL
 Assessment of the patient’s overall hemodynamic status
is critical.
 Assess for blood volume status: skin color, capillary
refill, radial/femoral/carotid pulse, and blood pressure.
 Place two large-bore peripheral IV catheters.
 Begin rapid infusion of warm crystalloid solution, if
indicated.
 Apply direct pressure to sites of brisk external bleeding.
CIRCULATION AND HEMORRHAGE
CONTROL
 Consider central venous or interosseous access if
peripheral sites are unavailable.
 Considerpericardiocentesis for suspected pericardial
tamponade.
 Considerleft lateral decubitus position in late-trimester
pregnancy.
 As part of the primary survey in the prehospital and
hospital settings, identify and control external
hemorrhage.
 Disability
 Perform screening neurologic and mental status examination,
assessing:
 Pupil size and reactivity.
 Limb strength and movement, grip strength.
 Orientation, Glasgow Coma Scale score.
 Consider measurement of capillary blood glucose level in patients
with altered mental status.
 persistent tGCS score of ≤8 generally suggests a poorer prognosis
secure a definitive airway to protect against aspiration or asphyxia.
 a score of 15 does not exclude the presence of traumatic brain
injury.
Expose injuries and protect from
Environment
 Completely disrobe the patient, and inspect for burns
and toxic exposures.
 Logroll patient, maintaining neutral position and in-line
neck stabilization, to inspect and palpate thoracic spine,
flank, back, and buttocks.
 Palpate the spinous processes of the thoracic and lumbar
spine for tenderness or deformity, and then carefully
logroll the patient back to a neutral position.
Referrences:

 Uptodate
 AHA and ACLS 2020
 Tintinally 9th edition
 ITLS 9th edition
THANK U

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