Cardio Pulmonary

Cerebral
Resuscitation
 Definition of Basic Life Support

BLS is a sequence of actions

1st few minutes of emergency

Prompt action for an unresponsive victim

 A Correct BLS
Prevent Cardiac Arrest by early CPR

Restore C-R function

Maintain Brain viability until ACLS is

provided
 Indications of BLS
Respiratory arrest: Respirations absent or
ineffective to maintain oxygenation and
ventilation.
Immediate establishment of the airway

Prevents Cardiac Arrest

 Indications of BLS
Cardiac Arrest:
- Circulation ceases
- Vital organs deprived of oxygen
Signs:
- Pulse
- Breathing ( gasping efforts or Agonal
breaths)
- Coughing
 Sequence of BLS
Assess responsiveness and scan the chest for
breathing
Activate EMS / Call for Help
Perform:
C-Circulation
A- Airway
B- Breathing
D-Defibrillation
 Assess Responsiveness
Safety of the victim and the rescuer

Tap at the shoulder and shout

Are You All Right
(in native language!)
 Activate EMS
Call the CAT on 1099/ 102

Give the following information:

Location of the emergency
Telephone no.
What happened
Condition of victim
Aid being given
 Circulation
Assessment to check for signs of circulation

breathing,
coughing
movements in response to rescue breaths

quick pulse check for carotids
 Chest Compressions
No signs of circulation start chest
compressions
Serial rhythmic application of pressure over
lower half of the sternum
Mechanism: Increase of intrathoracic
pressure and direct compression of the heart
Recommended at 100-120/min
Compression ventilation ratio of 30:2
 Airway

Victim should be lying supine

with an open airway
 Airway

Position of the victim :

Supine on a firm flat surface

Roll the patient as a unit without twisting

 Airway
Position of the rescuer :

Side of the victim to perform rescue

breathing and chest compressions
 Opening of the Airway

Tongue is the most common cause of

airway obstruction in unresponsive patient

HEAD TILT - CHIN LIFT maneuver lifts

the tongue and relieves obstruction
 Jaw Thrust Maneuver

Grasp the angles of the victims lower jaw

and lift with both the hands displacing the
mandible forward
When head or neck trauma is suspected
Jaw is lifted without tilting the head
 Breathing
Provide 2 rescue breaths if respirations
inadequate or absent
 Provide rescue breathing
The Rescuer inflates the victims lungs
adequately with each breath. The various
techniques are:
Mouth to mouth
Mouth to nose
Mouth to stoma
Mouth to barrier device
Bag and mask
 Self Inflating Bag

The self-inflating bags have a volume of

1600 ml
Can be used by single or two rescuers
Lower tidal volumes recommended
Squeeze the bag slowly over 1 seconds
Single rescuer bag and mask
Two rescuer Bag and Mask
 D

Defibrillation
Why Early Defibrillation

Most effective treatment is

defibrillation
VF is the most common initial rhythm
Success rapidly diminishes over time
EARLY DIFIBRILLATION
Survival rates after VF
arrest decrease approx.
7% to 10% with every
minute that defibrillation
is delayed

Larsen et al. Ann Emerg Med.

1993:222:1652-58
Guidelines

Early defibrillation (<5min) high

priority goal
Early defibrillation capability
available throughout hospitals
Collapse-to-shock interval < 3min
What is VF
Uncoordinated electrical activity
of the heart
Resulting in loss of output
Causes of VF
Ischaemic myocardium
Electrocution
Poisoning
Hypo or Hyperthermia
Drowning
Drugs tri cyclic antidepresssantss
How does defibrillator terminate VF
Electrical energy stored in the capacitor
Shock delievered to victim via paddles
Cardiac muscle depolarised
Natural pacemaker resumes control
Energy requirement

too much could damage the heart and too

little would be ineffective

200J 200J --- 360J

Safety Issues
stand clear
glyceryl trinitrate patches
Oxygen
Avoid contact with metallic objects
permanent pacemaker
Automatic external
defibrillators

hands-free defibrillation
Checking Equipment

Defibrillators should be checked discharged

and daily
Use checklists for daily check
Skilll maintenance practice drills every 3-6
months inn a simuullatted carrdiac arrest
scenarios
Service contract
 Recovery position
For victims who are unresponsive but
breathing with signs of circulation
Modified lateral position is used in which:
Head is dependent
Avoids any pressure on chest
Good observation and access to the airway
is possible
 Recovery position

The victim is waving goodbye while taking a nap

 Monitoring the Victim
Stop chest compressions for 5 seconds at the
end of first minute and then every few
minutes thereafter

Do not interrupt CPR

To be interrupted only when:
Tracheal intubation is being performed
Defibrillator being attached
Conclusion

Early defibrillation is a vital link in the

chain of survival since it is the single most
effective treatment of VF.
The speed with which defibrillation is
achieved has a direct effect on the eventual
outcome.
Conclusion

Defibrillation is a potentially dangerous

procedure and must be carried out safely.
All hospital personnel should be aware of
its use to be able to assist in an emergency