Basic

Life
Support
Erwin Pradian
Bagian Anestesiologi dan Reanimasi
Fakultas Kedokteran Universitas Padjadjaran/ RS.
Dr. Hasan Sadikin Bandung

Introduction
The leading causes of preventable or reversible
sudden death resulting from heart attacks,
accidents, and other medical emergency

hypoxia or anoxia from:

airway obstr.
hypoventilation
apnea blood loss
pulselessness
brain injury

Irreversible brain damage may occur

when very low oxygen transport or no
oxygen transport lasts longer than a
few minutes.

Cardiopulmonary cerebral
Resuscitation
Phase I : Basic Life Support (BLS)
Emergency oxygenation. (A,B,C)
Phase II: Advanced Life Support (ALS)
Restoration of spontaneous circulation.
(D,E,F)
Phase III: Prolonged Life Support (PLS)
Cerebral resuscitation and post resuscitation intensive therapy. (G,H,I)

Basic Life Support

Airway control
Breathing support
Circulation support
With or without equipment

irway control

Airway control

Partial
Cause of airway obstruction: Complete
Base tongue and epiglottis fall to the
posterior pharyngeal wall.
the most common.
Foreign matter (vomitus, blood).
Laryngospasm.
in lightly comatous pasient.

Airway obstruction in comatous patients

 Complete: if one can not hear or feel air

flow at the mouth or nose.
- Spontaneous breathing
retraction (+) but chest expansion (-).
- Apnea
when PPV to inflate the lung difficult.
Partial: is recognized by noisy air flow

Patient Assessment
Level of consciousness
Spontaneous efforts vs.
apnea
Airway and cervical spine
injury
Chest expansion
Signs of airway obstruction
Breath sounds
Protective airway reflexes

Look, listen, and feel

Airway control (cont)

Without equipment:
Chin lift, jaw thrust, head tilt.
Lung inflation attempts
Manual clearing of mouth and throat.

Opening the Airway the Triple

Airway Maneuver
Slightly extend neck
(when cervical spine
injury not suspected)
Elevate mandible
Open mouth
Consider adjunctive
devices

Airway control (cont)

With equipment:

Pharyngeal suctioning.
Oro/Nasopharyngeal intubation.
Laryngeal Mask Airway (LMA).
Endotracheal/bronchial intubation.
Cricothyrotomy laringeal jet insufflation.
Tracheostomy.

Pharyngeal intubation

Endotracheal intubation - technique

Tracheostomy tube

Translaryngeal O2 jet
insufflation

reathing support

Breathing support
Goals: Emergency artificial ventilation and oxygenation.
Without equipment:
Mouth to mouth/nose ventilation.

With equipment: (with or without oxygen)

Mouth to adjunct.
Manual bag-mask (tube) ventilation.
Mechanical ventilation.

Breathing support (cont)

Position your cheek close to victims' nose and
mouth, look toward victims' chest.
Look, listen, and feel for breathing (5-10 seconds).
If not breathing, pinch victim's nose closed and give
2 full breaths into victim's mouth.
If breaths won't go in, reposition head and try again
to give breaths.

Manual Assisted Ventilation

Open the airway
Apply face mask and
obtain seal
Deliver optimal
minute ventilation
from resuscitation bag
Consider cricoid
pressure

Single-Handed Method
of Face Mask Application
Base of mask placed over
chin and mouth opened
Apex of mask over nose
Mandible elevated, neck
extended (if no cervical
spine injury), and
downward pressure by
mask hand

Two-Handed Method of
Face Mask Application
Helpful when mask
seal difficult
Fingers placed along
mandible on each
side
Assistant provides
ventilation

Inadequate Mask-to-Face Seal

Identify leak
Reposition face mask
Improve seal along cheek(s)
Change mask inflation or size
Slightly increase downward pressure
over face
Use two-handed technique

Cardiopulmonary
Resuscitation
Erwin Pradian
Bagian Anestesiologi dan Reanimasi Fakultas
Kedokteran Universitas Padjadjaran/ Perjan
RS. Dr. Hasan Sadikin Bandung

CPR Technique
Establish unresponsiveness
and activate the Emergency
Medical Services

Areyou
O.K.

Call for
help

Opening the Airway

Check for Breathing

Look/Listen/Feel

YesPlaceinrecoverypositionifunconscious
NoGive2fullbreaths

Check for signs of Circulation

Breathing,coughing,movement

YesContinuewithventilations
every5seconds

NoCommenceCPR

No Signs of Circulation
Locate position on sternum, place heel of hand,
taking care to keep the fingers raised.

No Signs of Circulation

45cms

CPR Rates
OneOperator15:2
TwoOperators15:2

AtaRATEof100
compressionspermin.

One and Two and Three .

Only stop CPR if victim shows signs of
circulation or spontaneous breathing
Do not interrupt CPR
If pulse returns continue ventilations at the
rate of approx. 10 breaths per minute

Complications
BlockedAirway
Cause - Tongue
Action - Head tilt/chin lift
Cause - Foreign Body
Action - Finger sweep
compressions

if

visible/Chest

Complications
BlockedAirway

Complications
Reason

MouthtoNose

Used in preference to Mouth to Mouth when

Victim is in water
Mouth is contaminated by blood or vomit
Mouth is damaged due to injury

Complications
MouthtoNose
Closethemouth
Blowthroughthenose

Complications
Cause

AirinStomach

Over pressurisation

Action
Modify technique less air/less forcefully
Allow 2 seconds for chest to rise in each rescue breath

Complications
Action

Vomiting

Turn victim on side away from rescuer and clean out mouth.
Assess breathing
Restart CPR

Children

CPRperformedlessforcefully

Children (1-8 years)

Less air for inflations
Mouth to mouth and nose (if possible)
One hand only for compressions
Depth of compressions
= one third the depth of the chest
100/minute
5 :1 only

Infants

CPRperformedfasterandlessforcefully

Infants (0-1 years)

Less air for inflations
Mouth to mouth and nose only
Two fingers for compressions
Depth of compressions
= one third the depth of the chest
100/minute
5 :1 only

Oxygen Enriched CPR

Benefits of O2
Higher concentration of oxygen to the
lungs
Improves blood and tissue oxygenation

Method
Pocket Mask with O2
Flow rate 15 litres per minute

Oxygen Enriched CPR

Onepersonoperation

Twopersonoperation

Recovery
Monitor rate of ventilations

supplement if

less than 10 breaths per minute

Recovery position
Give 100% O2 if available
Treat for shock - Reassure and keep warm
Watch victim at all times
Ensure early transportation to hospital

Recovery
RecoveryPosition