Dept. of Anaesthesiology. K.G.M.C.H.

BASIC LIFE SUPPORT

GUIDELINES

RESUSCITATIONRESUSCITATION

Means Cardiopulmonary Means Cardiopulmonary

resuscitationsresuscitations

Anywhere Anybody can do Anywhere Anybody can do

CPR…CPR…

Considered when an individualConsidered when an individualcannot adequately breathe and cannot adequately breathe and maintain circulation to vital maintain circulation to vital organs.organs.

WHY& WHEN TO DO IT ?

Without Without CPR CPR , irreversible , irreversible brain damage occurs within brain damage occurs within

3-4 minutes3-4 minutes Should be done immediately Should be done immediately

by a bystander by a bystander TIME TIME is the crucial factor is the crucial factor

here to decide the survivalhere to decide the survival

Minutes counts...Minutes counts...

when the heart stops, when the heart stops, damage occurs to the damage occurs to the BrainBrain within < 5 within < 5 minutesminutes

startstart BLSBLS earlyearly

CPR…CPR…

BLSBLS

ACLSACLSALSALS

ANLSANLSCPCR – Cardio Pulmonary CPCR – Cardio Pulmonary

Cerebral resuscitationCerebral resuscitation

CPR… ABCDEFCPR… ABCDEF

How ?How ? AAirwayirway BBreathingreathing BLSBLS CCirculationirculation

DrugsDrugs EECG CG ACLSACLS FibrillationFibrillation

The Sequence of BLSThe Sequence of BLS

Establish UnresponsivenessEstablish Unresponsiveness

If no response If no response call for helpcall for help

Start BLS------- Start BLS------- A- A- AirwayAirway

B- B- BreathingBreathing

C- C- CirculationCirculation

CPR…CPR…

RECOGNITIONRECOGNITION

Is crucial in Is crucial in BLSBLS

DetermineDetermine UnresponsivenessUnresponsiveness BreathlessnessBreathlessness PulselessnessPulselessness

No victim should No victim should undergo undergo CPRCPR

until the need until the need

for resuscitationfor resuscitation

is established.is established.

2. 2. Check the Victim and see if he Check the Victim and see if he respondsresponds

GentlyGently SHAKE SHAKE his shoulderhis shoulder

Ask loudly “Are you all Ask loudly “Are you all

right?”right?”

3A. Responds by answering or 3A. Responds by answering or moving moving

Leave him in the position.Leave him in the position.

Reassess him regularly.Reassess him regularly.

3B. If no response3B. If no response

SHOUTSHOUT for help (Call for for help (Call for defibrillator) defibrillator)

Turn to his back and open airwayTurn to his back and open airway.. HEAD TILTHEAD TILT Hand on forehead. Hand on forehead. Remove any visible obstructionRemove any visible obstruction.. CHIN LIFTCHIN LIFT finger tips under the finger tips under the

point of chin.point of chin.

Avoid head tilt in Trauma

CPR…CPR…

Activation of EMS Activation of EMS

Call for helpCall for help

Call for ambulance Call for ambulance

servicesservices

Emergency

BLS ALGORHYTHM

CHECK RESPONSIVENESS

OPEN AIRWAY

CHECK BREATHING

ventilation

A

B

CIRCULATION C

CPR…CPR…

Airway - First basic skillAirway - First basic skillHead tiltHead tiltChin liftChin liftJaw thrust Jaw thrust

AirwaysAirwaysET intubationET intubationNewer airwaysNewer airways

CPR… CPR… AIRWAY AIRWAY

Head tiltHead tilt

Jaw thrustJaw thrust

Chin lift

CPRCPR……

Breathing – Second basic skillBreathing – Second basic skill LOOK LOOK for chest movementfor chest movement LISTENLISTEN for breath sounds for breath sounds FEEL FEEL for air on your cheekfor air on your cheek 2 slow effective rescue breathing2 slow effective rescue breathing

LOOK, LISTEN LOOK, LISTEN AND FEELAND FEEL

LOOKLOOK

LISTENLISTEN

FEELFEEL

5A. Breathing Normally5A. Breathing Normally

Turn him into recovery Position.Turn him into recovery Position.

Send or go for help.Send or go for help.

Check for continued breathingCheck for continued breathing..

Recovery position.Recovery position.

To maintain a good airwayTo maintain a good airway

To minimize the risk of aspirationTo minimize the risk of aspiration

Recovery PositionRecovery Position

To Maintain a good airway.To Maintain a good airway.

To Minimize the risk of aspirationTo Minimize the risk of aspiration. .

5B. Not Breathing5B. Not Breathing

Rescue breathingRescue breathing

Ensure head tilt and Ensure head tilt and

chin lift.chin lift.

Pinch the Nose.Pinch the Nose.

Two Slow effective Two Slow effective

breaths.breaths.

Rise and fall of the Chest

Rescue Breathing

Required if breathing is absent Required if breathing is absent or inadequateor inadequate

Give 2 slow breaths sufficient Give 2 slow breaths sufficient to make the chest riseto make the chest rise

Adult: Over 2 secondsAdult: Over 2 seconds Child & Infant: Over 1 – 1 ½ Child & Infant: Over 1 – 1 ½

secondsseconds

   

Rescue Breathing TechniquesRescue Breathing Techniques

Mouth-to-MouthMouth-to-Mouth

Mouth-to-BarrierMouth-to-Barrier

Mouth-to-NoseMouth-to-Nose         Mouth-to MaskMouth-to Mask

Bag-mask device Bag-mask device    

Any difficulty achieving an Any difficulty achieving an effective breath.effective breath.

Recheck Victims mouth.Recheck Victims mouth.

Recheck head tilt and chin lift.Recheck head tilt and chin lift.

Make up to 5 attempts.Make up to 5 attempts.

Even in unsuccessful, move on Even in unsuccessful, move on

to assessment of circulationto assessment of circulation..

NO NO -- Circulation Circulation

Absent carotid pulse.Absent carotid pulse.

Lay Rescuer.Lay Rescuer. Normal Breathing.Normal Breathing. coughingcoughing Movement.Movement.

Sign of Cardiac Sign of Cardiac arrest.arrest.

No More than 10 Sec.No More than 10 Sec.

CAROTID PULSECAROTID PULSE

Identify Adam’s apple (Thyroid Identify Adam’s apple (Thyroid

Cartilage).Cartilage).

Slide down to the groove.Slide down to the groove.

Palpate pulse in the groove.Palpate pulse in the groove.

Never Palpate on both sides Never Palpate on both sides

simultaneously.simultaneously.

7A. Circulation Present7A. Circulation Present

Continue rescue breathing.Continue rescue breathing.

Recheck rescue breathing.Recheck rescue breathing.

Normally breathing Normally breathing Recovery Recovery

Position. Position.

7B. No signs of Circulation7B. No signs of Circulation

Chest compressions.Chest compressions.

Identity middle of Lower half of Identity middle of Lower half of

Sternum.Sternum.

compressions by heel of the hands.compressions by heel of the hands.

After 15 Compressions tilt the head, After 15 Compressions tilt the head,

lift the chin and give 2 effective lift the chin and give 2 effective

breaths.breaths.

Chest Compressions

No pulse presentNo pulse present

START CHESTCOMPRESSIONSSTART CHESTCOMPRESSIONS

Compression Rate:Compression Rate:

Adult, Child, & Infant – 100/minAdult, Child, & Infant – 100/min

   

TECHNIQUE OF EXTERNAL CARDIAC COMPRESSION

Rescuer to one side of the patientRescuer to one side of the patient Patient’s chest exposed and Patient’s chest exposed and

xiphisternum identifiedxiphisternum identified Xiphisternum –Bony prominence in Xiphisternum –Bony prominence in

the mid line at the junction of lower the mid line at the junction of lower borders of the ribsborders of the ribs

The index and middle fingers of the The index and middle fingers of the lower hand placed on the xiphisternum lower hand placed on the xiphisternum and heel of the other hand is placed and heel of the other hand is placed adjacent to them on the sternumadjacent to them on the sternum

Heel of the second hand placed on the back of the hand on the sternum

Fingers may be interlocked

Sternum depressed vertically4-5cm and then released rapidly

Repeated at a rate of 80-100/minwith compression and relaxation each taking the same length of time

Locate rib cageLocate rib cage

Position your hands over middle of lower Position your hands over middle of lower half of sternum and fingers away from half of sternum and fingers away from ChestChest

Compression of ChestCompression of Chest

Arms Vertical

Arms Straight

Press Depress

4-5Cm

CPRCPR

15 x 2 x

Chest compressions Breathing

One Rescuer

Two rescuersTwo rescuers

  Depth of CompressionDepth of Compression

Adult: 1 ½ - 2 inches or enough Adult: 1 ½ - 2 inches or enough

to generate a pulseto generate a pulse

Child & Infant: 1/3 – ½ the depthChild & Infant: 1/3 – ½ the depth

of the chest or enough to generateof the chest or enough to generate

a pulsea pulse

Continue Resuscitation Continue Resuscitation UntilUntil

Qualified help arrives and takes Qualified help arrives and takes

over.over.

Victim shows signs of life.Victim shows signs of life.

You become exhausted. You become exhausted.

Reassessment (10 seconds) Should be performed after the first Should be performed after the first

minute of CPR and every few minute of CPR and every few minutes thereafterminutes thereafter

  If no pulse- If no pulse- resume CPRresume CPR   If pulse and breathing present- If pulse and breathing present-

place in recovery positionplace in recovery position

  If pulse present but no breathing- If pulse present but no breathing- provide rescue breathingprovide rescue breathing

BLS AlgorithmBLS Algorithm

CHECK RESPONSIVENESS

OPEN AIRWAY

CHECK BREATHING

BREATHE

ACCESS CIRCULATION10 seconds only

CIRCULATION PRESENTContinue Rescue Breathing

NO CIRCULATIONCompress Chest

Shake & Shout

Head tilt / Chin lift

Look, Listen and Feel

2 Effective Breaths

Signs of a Circulation

100 Per Minute 15:2 RatioCheck Circulation every Minute

CPR…CPR… NutshellNutshell

AdultAdult PaediatricPaediatric

Breath rateBreath rate 10 – 12 10 – 12 bpmbpm

20 bpm20 bpm

Pulse checkPulse check CarotidCarotid BrachialBrachial

Compression Compression raterate

100/min100/min >100/min>100/min

Compression Compression methodmethod

Hands Hands interlacedinterlaced

Two or three Two or three fingers or heel fingers or heel of one handof one hand

CV ratioCV ratio 15 : 215 : 2 5 : 15 : 1

FB FB obstructionobstruction

Heimlich Heimlich maneuvermaneuver

Back blows Back blows and chest and chest thruststhrusts

ACLSACLS

Special equipments and Special equipments and techniquestechniques

ECG monitoringECG monitoring DefibrillationDefibrillation iv accessiv access Drug therapyDrug therapy Post resuscitation carePost resuscitation care

NOW HE IS SAFE IN HELPING NOW HE IS SAFE IN HELPING

HANDSHANDS