Introduction

Collapsed patients require assistance to maintain

their airway, breathing and circulation in order to prevent

further detoriation in their condition.

When this is achieved without the use of any

equipment, it is termed as Basic Life Support (BLS).

This must be continued whilst further help is

summoned to diagnose and treat the cause of collapse.

Resuscitation:• Means cardio pulmonary resuscitation

(CPR)

• Anywhere anybody can do

• All you need is a kind heart to help & the

basic skill to perform.

CPR:Considered when an individual cannot adequately

breathe and maintain circulation to vital organs.

Why & When to Do it?

• Without CPR, irreversible brain damage occurs

within 3-4 minutes.

• Should be done immediately by a bystander

• Time is the crucial factor here to decide the

survival.

CPR• BLS (Basic life Support)

• ALS (Advanced life support)

• CPCR - Cardio pulmonary cerebral Resuscitation

CPR . . . . ABCDEF

ACLS (Advanced cardiac life support

ANLS: (Advanced neurologic life support)

BASIC LIFE SUPPORT

How

• Airway

• Breathing BLS

• Circulation

• Drugs

• ECG ACLS

• Fibrillation

• Recognition

• BLS Algorhythm

• Airway

• Breathing

• Circulation

I. Recognition • Assessment phase is crucial in BLS.

• Determine - Unresponsiveness

Gently shake & Shout "Are you ok?"

Determine Breathlessness - Look, Listen, feel

Determine - Pulselessness - Carotid pulse ` `

Recognition• No victim should undergo CPR until the need for resuscitation is established

The sequence of BLS

II. BLS ALGORHYTHM

Shake Gently & Ask "Are you ok?" Check for

injuries

Leave him in the position

and reassess at intervals

Open airway Head tiltChin lift

Check breathing (Look, listen, feel)

SHOUT for help Activate EMS

Ventilate 2 breaths (exhaled air ventilation)

Check circulation (carotid pulse)

Start CPR

No circulation

CirculationPresent

Continue ventilation

Not breathing

Recovery Position

reassess at intervals

response

No response

Breathing

III. AIRWAY First basic skill to learn

• Position the victim

• Head lift

• Chin lift

• Jaw thrust

In unresponsive victim muscle tone is impaired resulting in obstruction of pharynx by tongue and soft tissues of pharynx.

HEAD TILT

Chin lift

Head tilt

The rescuer's hand nearest the head is

placed on the forehead, and apply firm backward

pressure to tilt the head back.

CHIN LIFT• Place fingers of other hand under the bony part of

the chin.

• Lift the chin forward and support the jaw helping to

tilt the head back.

Dont's• The fingers must not press deeply into the soft

tissue under the chin, which obstruct the air way.

• The thumb should not be used for lifting the chin.

• The mouth should not be closed.

JAW THRUST

• The jaw thrust technique without head tilt is the safest approach to opening airway of the victim with suspected neck injury.

• Grasp the angles of the victim lower jaw and lift with both hands, as on each side, displacing the mandible forward.

• If the lips close, retreat the lower lip with the thumb.

BREATHING

• Determine breathlessness • Recovery position • Rescue breathing

Determine breathlessness

• Place your ear over the victim's mouth and nose

while maintaining the open airway.• Look for the chest to raise and fall. • Listen for air escaping during exhalation. • Feel for the flow of air.

The evaluation procedures should be only 3-5 secs. Unresponsiveness No trauma Change to recovery position

Breathing

Recovery Position

To maintain a good airway

To minimisethe risk of aspiration

FEL

• Roll the victim on to his or her side so that the head,

shoulders and torso move simultaneously without

twisting

• If trauma suspected the victim should not be moved.

Position the victim

• To position the victim who is lying down, the

following sequence may be used.

• Kneel beside the victim at distance approximately

equal to the width of victim's body at the level of the

victim's shoulder.

• Move the arm closer to you so that it is raised above

the victim's head.

• Straighten the legs or bend slightly at the knees.

• Place the hand behind the victim's head & neck for

support.

• With the other hand grasp the victim under the arm

to brace the shoulder and torso.

• Roll the victim towards you by pulling steadily and

evenly at the shoulder while controlling the head

and neck. The head and neck should remain in the

same plane as the torso, and the body should be

moved as a single unit.

Rescue breathing - mouth to mouth- mouth to nose- mouth to stoma

Mouth to mouth

• The rescuer's exhaled air contains 16% oxygen to

supply victim's need.

• Keep the airway open by the head lift - chin lift

maneuver.

• Gently pinch the nose closed with your thumb and

index finger (of the hand on the forehead).

• Take a deep breath and seal your lips around the

victim's mouth, creating an airtight seal.

• Then give two slow breaths.

• Adequate time (11/2 - 2 seconds) should be allowed

for each breath to decrease the possibility of gastric

distention.

• Rescue breathing should be performed at a rate of

10-12 breaths per minute.

If attempts to ventilate the victim are unsuccessful It may be due to

• Improper chin and head positioning.

• FB airway obstruction - (proceed for airway

maneuvers).

Mouth to nose:

Useful in injuries of mouth.

• Keep the victim's head tilted back with one hand on

the forehead.

• Use the other hand to lift the victim's lower jaw and

close the mouth.

• Take of deep breath, seal your lips around the

victim's nose and blow.

• Then stop rescue breathing and allow the victim to

exhale passively.

In one rescuer CPR - pause for ventilation after every 15 chest compression In two rescuer CPR - pause for ventilation after every 5 chest compression.

V. CIRCULATION

Determine Pulselessness:

• Check the pulse at the carotid, this should take not

more than 5 -10 seconds.

• The artery lies is a groove created by the trachea

and the large strap muscles of the neck.

• While maintaining the head tilt with one hand on the

forehead, locate the victims larynx with two or three

fingers of the other hand

• Place these fingers into the groove between the

trachea and the muscles at the side of the neck,

where the carotid pulse can the felt.

• Never palpate simultaneously both carotid arteries.

Pulse present /No breathing -> continue rescue breathing 10-12 times/mtNo pulse / No breathing -> Activate EMS

Initiate chest compression Continue rescue breathing.

Chest compressions

Cardiac arrest is recognised by pulselessness in the large arteries of the unconscious, breathless victim.

• The patient must be in the horizontal, supine

position over hard surface during chest

compressions.

• Proper hand placement is established by identifying

the lower half of the sternum

• With your hand locate the lower margin of the

victim's ribcage on the side next to the rescuer

• Move the finger up the rib cage to the notch where

the ribs meet the sternum in the center of the lower

part of the chest.

• Place heel of the one hand on the lower half of the

sternum and place the other hand on top of the

hand on the sternum

• Fingers may be either extended on interlaced

• Your elbow should be locked into position

• Arms straightened

• Shoulder directly over the hands.

• Natural body weight falling forward provides the

force to depress the sternum.

• The sternum should be depressed approximately

11/2 - 2 inches (4-5cm) Children 1/3 - 1/2 inches (1-1.5 cm) depth.

• Release chest compression pressure between each compression to allow blood flow in to the chest and the heart

• Minimum chest compression rate is 80-100 per minute.

CONTINUE RESUSCITATION UNTIL• Qualified help arrives

• Victim shows signs of life

• You become exhausted

Reassement (10 seconds)• Should be performed after the first minute of CPR

and every minute thereafter.

• If no pulse - resume CPR

• If pulse and breathing present - place in recovery

position

• If pulse present no breathing - provide rescue

breathing

FB. suspects- Younger victims

- Suddenly stops breathing

- Cyanotic & loss of consciousness

Chocking:

FORIEGN BODY MANEUVER

With complete airway obstruction the victim is

unable to speak, breathe or cough and may clutch the

neck with the thumb and fingers.

Management:Hemlich, Maneuver. (Sub diaphragmatic abdominal

thrust)

Mechanism : by elevating the diaphragm the Hermlich

maneuver can force air from the lungs to create an artificial

cough intended to expel a FB obstructing the airway.

Hemlich with victim standing or Sitting

Hemlich Maneuver

Rescuer stands behind the victim, wraps his or her arms

around the victim's waist and proceeds as follows:

• Make a fist with one hand.

• Place the thumb side of the fist against victim's

abdomen in the midline above the navel and well

below the xiphoid process.

• Grasp the fist with the other hand and press the fist

in to the victim's abdomen with a quick upward

thrust.

• Repeat the thrust and continue until the object (FB)

is expelled.

Hemlich maneuver with victim lying down

• Place the victim in the supine position face up

• Kneel astride the victim's thighs and place the heel

of one hand against the victim's abdomen, in the

midline slightly above the navel and below the tip of

the xiphoid.

• Place the second hand directly on top of the first

• Press the abdomen with the quick upward thrust

Finger sweep

• Used only in the unconscious victim, never use it in seizure victim.

• With victim's face up, open the victim's mouth by

grasping both tongue and the lower jaw between the

thumb and fingers and lifting the mandible (tongue - jaw lift)

• Insert the index finger of the other hand down along

the inside of the cheek and deeply into the throat to

the base of the tongue.

• Use a hooking action to dislodge the FB and

maneuver it in to the mouth so that it can be

removed.

Chest Compression

Infants Children

Maneuver Infant (<1 y) Child (1 to 8 y)

Airway Head tilt-chin lift (if

trauma is present, use

jaw thrust)

Head tilt-chin lift (if

trauma is present, use

jaw thrust) Breathing Initial

Subsequent

Two breaths at 1 to

11/2 s/breath

20 breaths/min

(approximate)

Two breaths at 1 to

11/2 s/breath

20 breaths/min

(approximate)Circulation Pulse check

Compression area

Compression with

Depth

Brachial / femoral

Lower half of sternum

2 or 3 fingers

Approximately

One third

to one half the depth

of the chest

Carotid

Lower half of sternum

Heel of 1 hand

Approximately

one third

to one half the depth

of the chestRate At least 100/min 100/minCompression

ventilation ratio

5:1 (pause for

ventilation)

5:1 (pause for

ventilation)Foreign-body airway obstruction

Back blows / chest

thrusts

Heimlich maneuver

FOREIGN BODY AIRWAY OBSTRUCTION IN INFANTS

BACK BLOWS AND CHEST THRUST

BLS MANEUVERS IN INFANTS AND CHILDREN

• Hold the infant face down, resting on the forearm.

• Support the infant's head by firmly holding the jaw.

• Rest your forearm on your thigh to support the

infants.

• Infant head should be lower than the trunk.

• Deliver up to five back blows forcefully between the

infant's shoulder blades using heel of the hand.

• After delivering back blows, place your free hand on

the infant's back, holding infant's head. The infant is

effectively sandwiched between your hands and

arms one hand supports the heads and neck, jaw

and the chest while the other supports the back.

• Turn the infant while the head and neck are

carefully supported, and hold the infant in the supine

position, on the thigh.

• Give up to five quick downward chest thrusts in the

same location and manner as chest compression.

• Steps 1 - 5 should be repeated until the object is

expelled.