BLS Guide for Cardiac Arrest

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Basic Life SupportBasic Life Support
Iman HassanIman Hassan
Assistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine
Ain Shams UniversityAin Shams University
E-mail: dr.imangalal@gmail.comE-mail: dr.imangalal@gmail.com

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Our GoalOur Goal
Early Access Early CPR Early Defibrillation Early ACLSEarly Access Early CPR Early Defibrillation Early ACLS
To “save hearts too good to die” while preserving cerebralTo “save hearts too good to die” while preserving cerebral
viability.viability.
To takeTo take RapidRapid decisions becausedecisions because IrreversibleIrreversible brainbrain
damage may occur withindamage may occur within 4 minutes4 minutes of cardiac arrest.of cardiac arrest.

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Basic life support (BLS)Basic life support (BLS) is a specific level of pre-is a specific level of pre-
hospital medical care provided by trained responders,hospital medical care provided by trained responders,
including emergency medical technicians, in the absence ofincluding emergency medical technicians, in the absence of
advanced medical care.advanced medical care.
BLSBLS generally does not include the use of drugs or invasivegenerally does not include the use of drugs or invasive
skills, and can be contrasted with the provision ofskills, and can be contrasted with the provision of
Advanced cardiac life support (ACLS).Advanced cardiac life support (ACLS).
CPR provided in the field buys time for higher medicalCPR provided in the field buys time for higher medical
responders to arrive & provide ACLS.responders to arrive & provide ACLS.

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At the end of the lesson you should be able to state &At the end of the lesson you should be able to state &
describe the Adult BLS Algorithm, focusing on Cardiacdescribe the Adult BLS Algorithm, focusing on Cardiac
Arrest in aArrest in a non drowningnon drowning,, non traumaticnon traumatic,, non toxicnon toxic
adult collapse.adult collapse.
The guidelines are based on the document 2005The guidelines are based on the document 2005
International Consensus on CardiopulmonaryInternational Consensus on Cardiopulmonary
Resuscitation & Emergency Cardiovascular Care Science.Resuscitation & Emergency Cardiovascular Care Science.

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BLS consists of the following sequence of actions:BLS consists of the following sequence of actions:
Make sure the victim, any bystanders & you are safe.Make sure the victim, any bystanders & you are safe.
Check the victim for a response.Check the victim for a response.
Gently shake his shoulders and ask loudly, ‘Are you all right?’Gently shake his shoulders and ask loudly, ‘Are you all right?’
If he responds:If he responds:
– Leave him in the position in which you find him providedLeave him in the position in which you find him provided
there is no further danger.there is no further danger.
– Try to find out what is wrong with him and get help ifTry to find out what is wrong with him and get help if
needed.needed.
– Reassess him regularly.Reassess him regularly.
If he does not respond:If he does not respond:
– Shout for help.Shout for help.
– Turn the victim supine aligned position or stable sideTurn the victim supine aligned position or stable side
position.position.

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Position on Back:Position on Back:
All body parts rolled over at the
same time.
Always be aware of head &
spinal cord injuries.
Support neck & spinal column.

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CARDIOPULMONARY RESUSCITATIONCARDIOPULMONARY RESUSCITATION
IS AS EASY AS "A B C"IS AS EASY AS "A B C"

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AAIRWAY:IRWAY: (Get it Open)(Get it Open)
Chin Lift Maneuver.Chin Lift Maneuver.
Jaw thrust maneuver.Jaw thrust maneuver.
Manual clearing of mouth & throat.Manual clearing of mouth & throat.
Endotracheal intubation & Tracheobronchial suctioning.Endotracheal intubation & Tracheobronchial suctioning.
Oropharyngeal & Nasopharyngeal airway.Oropharyngeal & Nasopharyngeal airway.
Cricothyrotomy - transtracheal OCricothyrotomy - transtracheal O22 jet insufflation -jet insufflation -
Tracheotomy.Tracheotomy.

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Chin LiftChin Lift Jaw ThrustJaw Thrust

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Head-Tilt/Chin LiftHead-Tilt/Chin Lift
maneuver in an infant.maneuver in an infant.
Do not overextendDo not overextend
the head & neck.the head & neck.

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Use theUse the Jaw ThrustJaw Thrust
to open your patient'sto open your patient's
airway if you suspect aairway if you suspect a
cervical spine injury.cervical spine injury.

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RECOVERY POSITIONRECOVERY POSITION

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SuctionSuction fluids fromfluids from
your patient’s airway.your patient’s airway.

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OropharyngealOropharyngeal
AirwayAirway
NasopharyngealNasopharyngeal
AirwayAirway

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Oropharyngeal AirwayOropharyngeal Airway

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BBREATHING:REATHING: (Get it Started)(Get it Started)
Position your cheek close to victim's nose & mouth, lookPosition your cheek close to victim's nose & mouth, look
toward victim's chest, &toward victim's chest, & "Look, Listen & Feel""Look, Listen & Feel" forfor
breathingbreathing (5-10 seconds).(5-10 seconds).
IfIf Not BreathingNot Breathing, pinch victim's nose closed and give, pinch victim's nose closed and give 22
full breaths into victim's mouth (use a microshield or similarfull breaths into victim's mouth (use a microshield or similar
barrier).barrier).
If your rescue breaths won't go in, reposition the head & tryIf your rescue breaths won't go in, reposition the head & try
again to give breaths.again to give breaths.
If still blocked, suspect chocking & perform abdominalIf still blocked, suspect chocking & perform abdominal
thrusts (Heimlich maneuver).thrusts (Heimlich maneuver).

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LookLook,, ListenListen && FeelFeel for breathing forfor breathing for NoNo longerlonger
thanthan 1010 secondsseconds
 LookLook for chest movement.for chest movement.
 ListenListen at the victim'sat the victim's
mouth for breath sounds.mouth for breath sounds.
 FeelFeel for air on your cheek.for air on your cheek.

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BBreathing support:reathing support:
Mouth-to-mouth (nose) ventilation.
Mouth-to-adjunct with or without O2
Manual bag-mask (tube) ventilation with or without O2
Hand-triggered O2ventilation.
Mechanical ventilation.

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If the victim is not
breathing, give 2
breaths (1 second or
longer)
• Pinch the nose
• Seal the mouth with
yours.
If the first 2 don’t go
in, re-tilt & give 2 more
breaths (if breaths still
do not go in, suspect
choking)

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BBreathing:reathing: Mouth To NoseMouth To Nose (when to use?)(when to use?)
Can’t open mouthCan’t open mouth
Can’t make a good sealCan’t make a good seal
Severely injured mouthSeverely injured mouth

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CCIRCULATION:IRCULATION: (Get the Blood to the Brain)(Get the Blood to the Brain)
Check forCheck for CarotidCarotid pulse by feeling forpulse by feeling for 5-105-10
secondsseconds at side of victims' neck.at side of victims' neck.
If there isIf there is PulsePulse but victim isbut victim is Not BreathingNot Breathing,,
give rescue breathing at rate ofgive rescue breathing at rate of 11 breathbreath every 5every 5
secondsseconds oror 1212 breathsbreaths per minute.per minute.

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If there isIf there is No PulseNo Pulse,, begin chest compressions as follows:begin chest compressions as follows:
Place the heel of one hand on lower part of victim's sternum.Place the heel of one hand on lower part of victim's sternum.
With your other hand directly on top of first hand and armsWith your other hand directly on top of first hand and arms
locked straight, depress sternumlocked straight, depress sternum 4 - 5 cms.4 - 5 cms.
PerformPerform 3030 compressions to everycompressions to every 2 breaths.2 breaths.
Check for return of pulseCheck for return of pulse every minute.every minute.
ContinueContinue UNINTERRUPTEDUNINTERRUPTED untiluntil ADVANCED LIFEADVANCED LIFE
SUPPORTSUPPORT isis Available.Available.

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Chest compression Only CPR:Chest compression Only CPR:
If you are not able, or are unwilling, to give rescueIf you are not able, or are unwilling, to give rescue
breaths, give chest compressions only.breaths, give chest compressions only.
If chest compressions only are given, these should beIf chest compressions only are given, these should be
continuous at a rate ofcontinuous at a rate of 100/minute.100/minute.
Stop to recheck the victim only if he starts breathingStop to recheck the victim only if he starts breathing
normallynormally; otherwise do not interrupt resuscitation.; otherwise do not interrupt resuscitation.

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Two-Rescuer CPR for Adults and Children
 Minimizes time between
rescue breaths and
compressions
- CPR becomes more effective
 Can more quickly set up
AED
 Reduces rescuer fatigue

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Single Rescuer CPRSingle Rescuer CPR

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Give 30 chest compressions at rate of 100 per
minute
Then give 2 ventilations

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Automated External DefibrillatorAutomated External Defibrillator
(AED)(AED)

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(AED)(AED)
AEDs are pre-programmed devices used to provideAEDs are pre-programmed devices used to provide
treatment/care for cardiac arrest (heart attack) victims.treatment/care for cardiac arrest (heart attack) victims.
AEDs provide an electric charge that interupts theAEDs provide an electric charge that interupts the
fibrillation, or rapid uncoordinated contractions of the heartfibrillation, or rapid uncoordinated contractions of the heart
& allows it to begin beating regularly again.& allows it to begin beating regularly again.
Immediate defibrillation carries the only hope of survival inImmediate defibrillation carries the only hope of survival in
cardiac arrest victims.cardiac arrest victims.

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(AED)(AED)
When defibrillation is delivered within one minute, survivalWhen defibrillation is delivered within one minute, survival
rates can be as high as 90%.rates can be as high as 90%.
If defibrillation is delivered in < 5 minutes, survival can be asIf defibrillation is delivered in < 5 minutes, survival can be as
high as 50%.high as 50%.
For every minute that passes prior to receiving defibrillation,For every minute that passes prior to receiving defibrillation,
a victim's chance of survival declines by about 10%.a victim's chance of survival declines by about 10%.
After 10 minutes chances of survival are near zero.After 10 minutes chances of survival are near zero.

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Defibrillation TechniqueDefibrillation Technique
Defibrillation Sequence
Action Announcements
1. Switch on.
2. Place coupling pads/gel in correct position
3. Apply paddles
4. Check ECG rhythm and confirm no pulse
5. Select non-synchronized (VF) setting
6. Charge to required energy level "Charging"
7. Ensure no-one is in contact with anything touching the patient "Stand clear"
8. Press paddle buttons simultaneously "Shocking now"
9. Check ECG rhythm
10. Check for output if rhythm change "Check pulse"
11. Return to ALS algorithm for further steps

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Safety Precautions When Using AEDSafety Precautions When Using AED
Do not touch the victim while the AED is analyzing or whileDo not touch the victim while the AED is analyzing or while
defibrillating.defibrillating.
Do not touch the victim Dry victim’s chest before applying pads but doDo not touch the victim Dry victim’s chest before applying pads but do
not use alcohol to wipe the victim’s chest dry.not use alcohol to wipe the victim’s chest dry.
Do not defibrillate someone around flammable materials or cell phones.Do not defibrillate someone around flammable materials or cell phones.
Do not use an AED in a moving vehicleDo not use an AED in a moving vehicle
Do not use an AED on a victim in contact with water or on metal surfaceDo not use an AED on a victim in contact with water or on metal surface
Do not use an AED on a victim wearing a nitroglycerin patch or otherDo not use an AED on a victim wearing a nitroglycerin patch or other
patch on the chest.patch on the chest.
Do not use a mobile phone or conduct radio transmission within 6 feet ofDo not use a mobile phone or conduct radio transmission within 6 feet of
the AED.the AED.
Do not place the pads directly over a pacemaker or other implantedDo not place the pads directly over a pacemaker or other implanted
device.device.

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Differential Diagnosis:Differential Diagnosis:
 Hypovolemia
 Hypoxia
 Hydrogen ions (acidosis)
 Hyper/ hypokalemia
 Hypothermia
 Hypoglycemia
 Toxins
 Tamponade
 Tension PTX
 Thrombosis (coronary)
 Thrombosis (pulmonary)
 Trauma
6 Hs & 6 Ts6 Hs & 6 Ts

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Checking for CPR Effectiveness?Checking for CPR Effectiveness?
Does chest rise & fall with rescue breaths?Does chest rise & fall with rescue breaths?
Have a second rescuer check pulse while you giveHave a second rescuer check pulse while you give
compressions?compressions?

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When Can I Stop CPR?When Can I Stop CPR?
Victim revivesVictim revives
Trained help arrivesTrained help arrives
Too exhausted to continueToo exhausted to continue
Unsafe sceneUnsafe scene
Physician directed (do not resuscitate orders)Physician directed (do not resuscitate orders)
Cardiac arrest of longer than 30 minutesCardiac arrest of longer than 30 minutes (controversial)(controversial)

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Why CPR May Fail?Why CPR May Fail?
Delay in startingDelay in starting
Improper procedures (e.g., Forget to pinch nose)Improper procedures (e.g., Forget to pinch nose)
No ACLS follow-up & delay in defibrillationNo ACLS follow-up & delay in defibrillation
 Only 15% who receive CPR live to go homeOnly 15% who receive CPR live to go home
 Improper techniquesImproper techniques
Terminal disease (or) unmanageable disease (massiveTerminal disease (or) unmanageable disease (massive
heart attack)heart attack)

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Key Concepts in BLS?Key Concepts in BLS?
Avoid Hyperventilation (Do not ventilate too fast or tooAvoid Hyperventilation (Do not ventilate too fast or too
much volume).much volume).
Allow complete chest recoil, minimal interruptions.Allow complete chest recoil, minimal interruptions.
Compress chest depth of 1.5 to 2 inches at a rate of 100Compress chest depth of 1.5 to 2 inches at a rate of 100
compressions/minute.compressions/minute.
Resume CPR immediately after shock. Interruption in CPRResume CPR immediately after shock. Interruption in CPR
for rhythm check should not exceed 10 seconds.for rhythm check should not exceed 10 seconds.

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AAirway:irway: Open Airway.Open Airway.
BBreathing:reathing:
(Look, Listen &Feel)(Look, Listen &Feel)
CCirculation:irculation:
Monitor & check the pulseMonitor & check the pulse
Check BreathingCheck Breathing
BreathingBreathing
Non BreathingNon Breathing
Check CirculationCheck Circulation
CirculationCirculation
ArrestArrest
ABCD’sABCD’s

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Nursing Responsibilities in an ArrestNursing Responsibilities in an Arrest
Ensure there are enough staff to manage the situation.Ensure there are enough staff to manage the situation.
The nurse that scribes should ensure the following is documented:The nurse that scribes should ensure the following is documented:
1.1. Patient’s name.Patient’s name.
2.2. Time.Time.
3.3. Cardiac rhythm once chest leads in placeCardiac rhythm once chest leads in place
4.4. Defibrillations, joules delivered.Defibrillations, joules delivered.
5.5. All drugs delivered, including doses and routes.All drugs delivered, including doses and routes.
6.6. Observations.Observations.
7.7. Other comments e.g. IV fluids, intubation, bloods, CPR etc.Other comments e.g. IV fluids, intubation, bloods, CPR etc.
8.8. Staff attending the arrest.Staff attending the arrest.
9.9. Outcome / transferred to.Outcome / transferred to.
10.10. Time of death.Time of death.
11.11. Remember to ask if you are unclear as to what drugs have been given,Remember to ask if you are unclear as to what drugs have been given,
cardiac rhythm, defibrillation, etc.cardiac rhythm, defibrillation, etc.
For the Arrest Patient:For the Arrest Patient:

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Nursing Responsibilities in an ArrestNursing Responsibilities in an Arrest
For Other Patients & Visitors:For Other Patients & Visitors:
Curtain off the other patients bed areas.Curtain off the other patients bed areas.
Ask any visitors to either leave the room or stayAsk any visitors to either leave the room or stay
with the patient they have come to visit behindwith the patient they have come to visit behind
their curtains.their curtains.

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Complications of CPRComplications of CPR
Rib & sternal fracturesRib & sternal fractures
PneumothoraxPneumothorax
Pericardial tamponadePericardial tamponade
Pulmonary contusionPulmonary contusion
AspirationAspiration
Aortic lacerationAortic laceration

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Chain Of Survival Is Our GoalChain Of Survival Is Our Goal

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QUESTIONSQUESTIONS

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BLS Guide for Cardiac Arrest

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