Adult Basic Life Support

Mohammed AlHusseini Elwan

Assistant Lecturer of EM, Faculty of Medicine, Alexandria University

Objectives

• Recognize the importance of basic life support.

• Understand how to do high quality resuscitation until more experience and equipment arrive.

• Learn how to use an automated external defibrillator.

• Learn the management of foreign-body airway obstruction.

Chain of Survival

Chain of Survival

BLS: Where?!

• Paramedics

BLS: Where?!

• Lay rescuers

BLS: Where?!

• In-hospital

History

Isis gave the kiss of life to Osiris.

History

This was originally practiced in Egypt almost 3,500 years ago and became popular again in Europe.

History

History

History

The first report of an experimental tracheal intubation was probably by the great Muslim philosopher and physician Avicenna.

BLS algorithm

Check Response

Check Response

• Make sure you, the victim and any bystanders are safe.

• Check the victim for a response:

o gently shake his shoulders and ask loudly: “Are you all right?“

Check Response

• If he responds:

o leave him in the position in which you find him, provided there is no further danger;

o try to find out what is wrong with him and get help if needed;

o reassess him regularly.

Check Response

• If he does not respond:

o Shout for help

o Turn the victim onto his back and then open the airway using head; tilt and chin lift

o Place your hand on his forehead and gently tilt his head back;

oWith your fingertips under the point of the victim’s chin, lift the chin to open the airway

Check Response

Look, listen and feel

• Keeping the airway open, look, listen and feel for breathing:

o look for chest movement;

o listen at the victim’s mouth for breath sounds;

o feel for air on your cheek;

o decide if breathing is normal, not normal or absent.

Look, listen and feel

• Check breathing for no more than 10 seconds

• Do not confuse agonal gasps with breathing

• If you have any doubt whether breathing is normal, act as if it is not normal

“Checking the carotid pulse is an inaccurate method of confirming the presence or absence

of circulation, both for lay rescuers and for professionals”

_______________________________________• Bahr J, Klingler H, Panzer W, Rode H, Kettler D. Skills of lay people in checking the carotid

pulse. Resuscitation 1997;35:23–6.

• Nyman J, Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students. Resuscitation 2000;47:179–84.

• Tibballs J, Russell P. Reliability of pulse palpation by healthcare personnel

to diagnose paediatric cardiac arrest. Resuscitation 2009;80:61–4

Chest Compressions

Chest Compressions

• Kneel by the side of the victim• Place the heel of one hand in the centre of the

victim’s chest • Place the heel of your other hand on top of the

first hand• Interlock the fingers of your hands and ensure

that pressure is not applied over the victim’s ribs. • Keep your arms straight• Position yourself vertically above the victim’s

chest

Chest Compressions

• Press down on the sternum at least 5 cm.

• Full recoil without losing contact between your hands and the sternum.

• Repeat at a rate of at least 100/min.

• Compression and release should take equal amounts of time.

• Minimize interruptions.

Chest Compressions

“In adults needing CPR, the cardiac arrest is likely to have a primary cardiac cause. CPR

should start with chest compression rather than initial ventilations”

Rescue Breaths

Rescue Breaths

• After 30 compressions open the airway again using head tilt and chin lift.

• Pinch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead.

• Allow the mouth to open, but maintain chin lift.

• Take a normal breath and place your lips around his mouth, making sure that you have a good seal.

• Blow steadily into the mouth while watching for the chest to rise, taking about 1 s as in normal breathing; this is an effective rescue breath.

Rescue Breaths

Rescue Breaths

Rescue Breaths

• Maintaining head tilt and chin lift, take your mouth away from the victim and watch for the chest to fall as air comes out.

• Take another normal breath and blow into the victim’s mouth once more to achieve a total of two effective rescue breaths. The two breaths should not take more than 5 s in all.

• Continue with chest compressions and rescue breaths in a ratio of 30:2.

• Stop to recheck the victim only if he starts to wake up: to move, opens eyes and to breathe normally. Otherwise, do not interrupt resuscitation.

Rescue Breaths

• If your initial rescue breath does not make the chest rise as in normal breathing, then before your next attempt:

o Look into the victim’s mouth and remove any obstruction;

o Recheck that there is adequate head tilt and chin lift

o Do not attempt more than two breaths each time before returning to chest compressions

If there is more than one rescuer present, another rescuer should take over delivering CPR

every 2min to prevent fatigue

• Chest-compression-only CPR may be used as follows:

– if you are not trained, or are unwilling to give rescue breaths;

– if only chest compressions are given, these should be continuous

“Animal studies have shown that chest-compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest”

_______________________________________________________________

• Chandra NC, Gruben KG, Tsitlik JE, et al. Observations of ventilation during resuscitation in a canine model. Circulation 1994;90:3070–5.

• Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario. Circulation 2002;105: 645–9.

“Animal and mathematical model studies of chest compression only CPR have shown that

arterial oxygen stores deplete in 2–4 min”_______________________________________________________________

• Turner I, Turner S, Armstrong V. Does the compression to ventilation ratio affect the quality of CPR: a simulation study. Resuscitation 2002;52:55–62.

• Dorph E,WikL, Stromme TA, Eriksen M, Steen PA. Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs. Resuscitation 2004;60:309–18.

But, you should have this!

Mouth to mask ventilation

• Do not interrupt resuscitation until:

o professional help arrives and takes over; or

o the victim starts to wake up: to move, opens eyes and to breathe normally; or

o you become exhausted

Automated External Defibrilator(AED)

AED

• Send someone for help and to find and bring an AED if available

• If you are on your own, use your mobile phone to alert the ambulance service – leave the victim only when there is no other option

AED

• If you are on your own and the AED is in your immediate vicinity, start with applying the AED

AED

• Switch on the AED and attach the electrode pads on the victim’s bare chest;

• If more than one rescuer is present, CPR should be continued while electrode pads are being attached to the chest;

• Follow the spoken/visual directions immediately;

• Ensure that nobody is touching the victim while the AED is analysing the rhythm.

AED

AED

• If a shock is indicated:

o ensure that nobody is touching the victim;

o push shock button as directed;

o immediately restart CPR 30:2;

o continue as directed by the voice/visual prompts.

AED

• If no shock is indicated:

o immediately resume CPR, using a ratio of 30 compressions to 2 rescue breaths;

o continue as directed by the voice/visual prompts.

AED

• Continue to follow the AED prompts until:

o professional help arrives and takes over;

o the victim starts to wake up: moves, opens eyes and breathes normally;

o you become exhausted.

“Lay rescuer AED programmes with very rapid response times, and uncontrolled studies using

police officers as first responders,97,98 have achieved reported survival rates as high as 49–

74%.”______________________________________________________________________

• White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2005;65:279–83.

• Mosesso Jr VN, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med 1998;32:200–7.

“Two lower-level studies of adults with in-hospital cardiac arrest from shockable rhythms showed higher survival-to-hospital discharge

rates when defibrillation was provided through an AED programme than with manual

defibrillation alone”______________________________________________________________________

• Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol2004;44:846–52.

• Destro A, Marzaloni M, Sermasi S, Rossi F. Automatic external defibrillators

in the hospital as well? Resuscitation 1996;31:39–43.

“Despite limited evidence, AEDs should be considered for the hospital setting as a way to

facilitate early defibrillation (a goal of <3 min from collapse), especially in areas where healthcare providers have no rhythm recognition skills or where they use defibrillators infrequently. An

effective system for training and retraining should be in place”

______________________________________________________________________

• Spearpoint KG, Gruber PC, Brett SJ. Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: an observational

study over 6 years. Resuscitation 2009;80:638–43

Foreign-body airway obstruction

Foreign-body airway obstruction

Foreign-body airway obstruction (FBAO) is an uncommon but potentially treatable cause of accidental death.

Foreign-body airway obstruction

Foreign-body airway obstruction

Foreign-body airway obstruction

Foreign-body airway obstruction

Thank You!