BLS Skills Lecture

BASIC LIFE SUPPORT (BLS)

Franklin O. Que, BSN-RN

INTRODUCTION TO BLSKinds of Life Support1.BLS – an emergency procedure that

consists of recognizing respiratory or cardiac arrest or both and the proper application of CPR to maintain life until a victim recovers or advanced life support is available.

2.ACLS – the use of special equipment to maintain breathing and circulation for the victim of a cardiac emergency.

3.Prolonged Life Support – for post resuscitative and long term resuscitation

ADULT CHAIN OF SURVIVAL

ADULT CHAIN OF SURVIVAL1. Immediate recognition of cardiac

arrest and activation of the emergency response team

2. Early CPR with an emphasis on chest compressions

3. Rapid defibrillation4. Effective Advanced life Support5. Integrated post-cardiac arrest care

ADULT CHAIN OF SURVIVAL1. Immediate recognition of cardiac

arrest and activation of the emergency response team

Immediate recognition of cardiac arrest and activation of the emergency

response teamC - Circumstance (What is the

emergency)H - Help available / help givenA - Address (give a landmark) N - Name of caller / No. of victimsT - Telephone no.

ADULT CHAIN OF SURVIVAL2. Early CPR with an emphasis on chest

compressions

ADULT CHAIN OF SURVIVAL3. Rapid defibrillation

Automated External Defibrillator

ADULT CHAIN OF SURVIVAL4. Effective Advanced Life Support

ADULT CHAIN OF SURVIVAL5. Integrated post cardiac arrest

OVERVIEW OF THE BODY SYSTEMS

THE RESPIRATORY SYSTEM It delivers oxygen to the body, as well

as removes carbon dioxide from the body.

The passage of air into and out of the lungs is called respiration.

Breathing in is called inspiration or inhaling.

Breathing out is called expiration or exhaling.

THE CIRCULATORY SYSTEM It delivers oxygen and nutrients to the

body’s tissues and removes waste products.

It consists of the heart, blood vessels, and blood.

BREATHING & CIRCULATION1. Air that enters the lungs contains

about 21% oxygen and only a trace of carbon dioxide. Air that is exhaled from the lungs contains about 16% oxygen and 4% carbon dioxide.

2. The right side of the heart pumps blood to the lungs, where blood picks up oxygen and releases carbon dioxide.

3. The oxygenated blood then returns to the left side of the heart, where it is pumped to the tissues of the body.

BREATHING & CIRCULATION4. In the body tissues, blood releases

oxygen and takes up carbon dioxide after which it flows back to the right side of the heart.

5. All body tissues require oxygen, but the brain requires more than any other tissue.

6. When breathing and circulation stop is called CLINICAL DEATH. (0-4 mins = brain damage not likeley; 4-6 mins = brain damage probable.)

In all instances that the person is not breathing and/or does not have a pulse, you

should always start CPR.

BREATHING & CIRCULATION7. When the brain has been deprived of

oxygenated blood for a period of 6 minutes or more an irreversible damage probably occurred. This is called the BIOLOGICAL DEATH (6-10 mins = brain damage probable; over 10 minutes = brain damage is certain).

8. It is obvious from the above stated facts that both respiration and circulation are required to maintain life.

THE NERVOUS SYSTEM It is composed of the brain, spinal

cord and nerves. It has two major functions – communication and control.

It lets a person aware of and react to the env’t.

It coordinates the body’s responses to stimuli and keeps body systems working together.

SO WHAT DOES CPR STANDS

FOR???

Cardio = HEART

Pulmonary = LUNGS

Resuscitate = REVIVE

Cardio-Pulmonary Resuscitation (CPR)= Reviving the Heart and Lungs

Cardio = HEARTOur heart is a big, strong muscle that

expands and contracts more than 60 times a minute without you even thinking about it. It is automatically driven by electrical impulses and runs 24 hours a day, 7 days a week, with no vacation time. That's around 33 million beats a year! 

Our heart has a simple, but important job. It pumps oxygen-rich blood from the lungs out to the rest of your body. If your heart stops pumping, oxygen does not reach vital organs and they stop working. That's when you get in trouble.

Pulmonary = LUNGSWe breathe about 12 to 20 times each

minute and every breath you take brings oxygen into your lungs and gets rid of carbon dioxide. Your lungs function automatically just like your heart - you don't have to think about breathing, it just happens. Oxygen is important to your body because it gets combined with sugar to burn as fuel. There is very little oxygen stored in your body's tissues so it needs to be replenished often. (There is a big supply of sugar so you can go a long time without eating.)

Pulmonary = LUNGSIf your body stops bringing air with

oxygen in it into your lungs or your heart stops circulating the oxygen-rich blood to your organs, then bad things start to have real fast. When the oxygen runs out, the body only has a few minutes in an anaerobic state before cells start to die and brain damage results.

PRECAUTIONS TO PREVENT DISEASE TRANSMISSION

Body Substance Isolation are precautions taken to isolate or prevent the risk of exposure from any other type of bodily substance.

BASIC PRECAUTIONS & PRCATICES

1. Personal Hygiene2. Protective Equipment3. Equipment Cleaning & Disinfecting

CARDIOVASCULAR DISEASERISK FACTORS for Cardiovascular

disease:1. Non-modifiable – heredity, age,

gender2. Modifiable – cigarette smoking, lack of

exercise, stress, hypertension, obesity, DM, elevated cholesterol and triglycerides levels.

MYOCARDIAL INFARCTIONIt occurs when the oxygen supply to

the heart muscle is cut –off for a prolonged period of time.

This cut-off results from a reduced blood supply due to severe narrowing or complete blockage of the diseased artery.

The result is death (infarction) of the affected part of the heart.

Warning signalsChest discomfort characterized by:

uncomfortable pressure, squeezing, fullness or tightness, aching, crushing, constricting, oppressive or heavy.

SweatingNauseaShortness of breathe

First Aid ManagementRecognize the signals of heart attack

and take action.Have pt. stop what he or she is doing

and have him/her sit or lie down in a comfortable position. Do not let the pt. move around.

Have someone call the physician or ambulance for help.

If pt. is under medical care, assist him/ her in taking his/ her prescribed meds.

GUIDELINES IN GIVING EMERGENCY CARE

GETTING STARTED1.Planning of Action2.Gathering of needed materials3.Remember the initial response as

follows:A – I – D

4. Instruction to helper/s

RESPIRATORY ARREST & RESCUE

BREATHING

RESPIRATORY ARREST & RESCUE BREATHING

Respiratory Arrest – is the condition in which breathing stops or inadequate.Causes:

1.Obstruction2.Diseases3.Other causes of respiratory arrest

RESCUE BREATHINGIs a technique of breathing air

into a person’s lungs to supply him or her with the oxygen needed to survive.

WAYS TO VENTILATE THE LUNGS1. Mouth-to-mouth2. Mouth-to-nose3. Mouth-to-mouth and nose4. Mouth-to-stoma5. Mouth-to-face shield6. Mouth-to-mask7. Bag mask device

FOREIGN BODY AIRWAY

OBSTRUCTION MANAGEMENT

FOREIGN BODY AIRWAY OBSTRUCTION MANAGEMENTCauses of Obstruction:1.Improper chewing of large pieces of food.2.Excessive intake of alcohol3.The presence of loose upper and lower

dentures4.For children – running while eating5.For smaller children of hand-to-mouth

stage left unattended.

Two types of Obstruction1. Anatomical Obstruction 2. Mechanical Obstruction

Classification of Obstruction1. Partial obstruction with good air

exchange2. Partial obstruction with poor air

exchange3. Complete or total obstruction

Intervention:CONCIOUS PATIENT:

ask the victim, “are you choking?” if the victim’s airway is obstructed partially, a crowing

sound is audible; encourage the victim to cough. relieve the obstruction by Heimlich maneuver Heimlich maneuver:

stand behind the victim place arms around the victim’s waist make a fist place the thumb side of the fist just above the

umbilicus and well below the xyphoid process. Perform 5 quick in and up thrusts.

Use chest thrusts for the obese or for the advanced pregnancy victims.

continue abdominal thrusts until the object is dislodged or the victim becomes unconscious.

UNCONSCIOUS PATIENT: assess LOC call for help Do chest compression open airway using jaw thrust technique finger sweep to remove object attempt ventilation reposition the head if unsuccessful; reattempt ventilation relieve the obstruction by the Heimlich maneuver with five

thrust; then finger sweep the mouth reattempt ventilation repeat the sequence of jaw thrust, finger sweep, breaths and

Heimlich maneuver until successful be sure to assess the victim’s pulse and respirations

Choking child or infant: choking is suspected in infants and

children experiencing acute respiratory distress associated with coughing, gagging, or stridor.

allow the victim to continue to cough if the cough is forceful

if cough is ineffective or if increase respiratory difficulty is still noted, perform CPR

CARDIAC ARREST & CARDIOPULMONARY

RESUSCITATION

CARDIAC ARREST & CPRCardiac arrest – is the condition in

which circulation ceases and vital organs are deprived of oxygen.

Three Conditions of Cardiac Arrest1.Cardio Vascular Collapse2.Ventricular Fibrillation3.Cardiac Standstill

CARDIOPULMONARY RESUSCITATION (CPR)

CPR – this is a combination of chest compressions and rescue breathing. This must be combined for effective resuscitation of the victim of cardiac arrest.

COUGH CPR – it is a self-initiated CPR, which is possible.

CHEST COMPRESSION ONLY-CPR

HANDS-ONLY CPRIf a person is unwilling or unable

to perform mouth-to-mouth ventilation for an adult victim, chest compression only-CPR should be provided rather than no attempt of CPR being made.

Chest compression only-CPR is recommended only in the following circumstances:

1.When a rescuer is unwilling or unable to perform mouth-to-mouth rescue breathing, or

2.For use in dispatcher-assisted CPR instructions where the simplicity of this modified technique allow untrained bystanders to rapidly intervene.

CRITERIA FOR NOT STARTING CPRThe patient has a valid “Do not Attempt

Resuscitation” (DNAR) order.The patient has signs of irreversible death:

rigor mortis, decapitation, or dependent lividity, decomposition

No physiological benefit can be expected because the vital fxns have deteriorated despite maximal therapy for such conditions as progressive septic or cardiogenic shock

Spontaneous breathing

Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants with:

- Confirm gestation <23 weeks or birth weight <400grams

- Anencephaly- Confirmed trisomy 13 or 18

WHEN TO STOP CPRS – Spontaneous signs of circulation

restored.T – Turned over to medical services or

properly trained and authorized personnel

O – Operator is already too exhausted and cannot continue

P – Physician assumes responsibility (declares death)

S – Scene becomes unsafe

DONT’s while performing CPR

Double crosserRockerJerkingHead bangerBenderStar gazer

COMPLICATIONS OF CPR:RIB FRACTURE

STERNUM FRACTURE

LACERATION OF THE LIVER OR SPLEEN

PNEUMOTHORAX, HEMOTHORAX

LAY RESCUER ADULT CPR

Key issues and major changes for the 2010 AHA Guidelines for CPR and ECC recommendations for lay rescuer adult CPR are the following:

• The simplified universal adult BLS algorithm has been created.

• Refinements have been made to recommendations for immediate recognition and activation of the emergency response system based on signs of unresponsiveness, as well as initiation of CPR if the victim is unresponsive with no breathing or no normal breathing (ie, victim is only gasping).

• “Look, listen, and feel for breathing” has been removed from the algorithm.

• Continued emphasis has been placed on high-quality CPR (with chest compressions of adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation).

• There has been a change in the recommended sequence for the lone rescuer to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). The lone rescuer should begin CPR with 30 compressions rather than 2 ventilations to reduce delay to first compression.

• Compression rate should be at least 100/min (rather than “approximately” 100/min).

• Compression depth for adults has been changed from the range of 1 1/2 to 2 inches to at least 2 inches (5 cm). These changes are designed to simplify lay rescuer training and to continue to emphasize the need to provide early chest compressions for the victim of a sudden cardiac arrest

Emphasis on Chest Compressions*2010 (New): If a bystander is not trained in CPR, the

bystander should provide Hands-Only™ (compression-only) CPR for the adult victim who suddenly collapses, with an emphasis to “push hard and fast” on the center of the chest, or follow the directions of the EMS dispatcher. The rescuer should continue Hands-Only CPR until an AED arrives and is ready for use or EMS providers or other responders take over care of the victim. All trained lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest. In addition, if the trained lay rescuer is able to perform rescue breaths, compressions and breaths should be provided in a ratio of 30 compressions to 2 breaths. The rescuer should continue CPR until an AED arrives and is ready for use or EMS provider stake over care of the victim.

2005 (Old): The 2005 AHA Guidelines for CPR and ECC did not provide different recommendations for trained versus untrained rescuers but did recommend that dispatchers provide compression-only CPR instructions to untrained bystanders. The 2005 AHA Guidelines for CPR and ECC did note that if the rescuer was unwilling or unable to provide ventilations, the rescuer should provide chest compressions only.

Why: Hands-Only (compression-only) CPR is easier for an untrained rescuer to perform and can be more readily guided by dispatchers over the telephone. In addition, survival rates from cardiac arrests of cardiac etiology are similar with either Hands-Only CPR or CPR with both compressions and rescue breaths. However, for the trained lay rescuer who is able, the recommendation remains for the rescuer to perform both compressions and ventilations.

Change in CPR Sequence: C-A-B Rather Than A-B-C*2010 (New): Initiate chest

compressions before ventilations.2005 (Old): The sequence of adult

CPR began with opening of the airway, checking for normal breathing, and then delivery of 2 rescue breaths followed by cycles of 30 chest compressions and 2 breaths.

Why: starting CPR with 30 compressions rather than 2 ventilations leads to improved outcome, chest compressions provide vital blood flow to the heart and brain, and studies of out-of-hospital adult cardiac arrest showed that survival was higher when bystanders made some attempt rather than no attempt to provide CPR. Chest compressions can be started almost immediately, whereas positioning the head and achieving a seal for mouth-to-mouth or bag-mask rescue breathing all take time. The delay in initiation of compressions can be reduced if 2 rescuers are present: the first rescuer begins chest compressions, and the second rescuer opens the airway and is prepared to deliver breaths as soon as the first rescuer has completed the first set of 30 chest compressions. Whether 1 or more rescuers are present, initiation of CPR with chest compressions ensures that the victim receives this critical intervention early, and any delay in rescue breaths should be brief.

Elimination of “Look, Listen, and Feel for Breathing”*2010 (New): “Look, listen, and

feel” was removed from the CPR sequence. After delivery of 30 compressions, the lone rescuer opens the victim’s airway and delivers 2 breaths.

2005 (Old): “Look, listen, and feel” was used to assess breathing after the airway was opened.

Why: With the new “chest compressions first” sequence, CPR is performed if the adult is unresponsive and not breathing or not breathing normally (as noted above, lay rescuers will be taught to provide CPR if the unresponsive victim is “not breathing or only gasping”). The CPR sequence begins with compressions (C-A-B sequence). Therefore, breathing is briefly checked as part of a check for cardiac arrest; after the first set of chest compressions, the airway is opened, and the rescuer delivers 2 breaths.

Chest Compression Rate: At Least 100 per Minute*

2010 (New): It is reasonable for lay rescuers and healthcare providers to perform chest compressions at a rate of at least 100/min.

2005 (Old): Compress at a rate of about 100/min.

Why: The number of chest compressions delivered per minute during CPR is an important determinant of return of spontaneous circulation (ROSC) and survival with good neurologic function. The actual number of chest compressions delivered per minute is determined by the rate of chest compressions and the number and duration of interruptions in compressions (eg, to open the airway, deliver rescue breaths, or allow AED analysis). Provision of adequate chest compressions requires an emphasis not only on an adequate compression rate but also on minimizing interruptions to this critical component of CPR. An inadequate compression rate or frequent interruptions (or both) will reduce the total number of compressions delivered per minute.

Chest Compression Depth*

2010 (New): The adult sternum should be depressed at least 2 inches (5 cm).

2005 (Old): The adult sternum should be depressed approximately 1 1/2 to 2 inches (approximately 4 to 5 cm).

Why: Compressions create blood flow primarily by increasing intrathoracic pressure and directly compressing the heart. Compressions generate critical blood flow and oxygen and energy delivery to the heart and brain. Confusion may result when a range of depth is recommended, so 1 compression depth is now recommended. Rescuers often do not compress the chest enough despite recommendations to “push hard.” In addition, the available science suggests that compressions of at least 2 inches are more effective than compressions of 1 1/2 inches. For this reason the 2010 AHA Guidelines for CPR and ECC recommend a single minimum depth for compression of the adult chest.

HEALTHCARE PROVIDER CPR

Key issues and major changes in the 2010 AHA Guidelines for CPR and ECC recommendations for healthcare providers include the following:

• Because cardiac arrest victims may present with a short period of seizure-like activity or agonal gasps that may confuse potential rescuers, dispatchers should be specifically trained to identify these presentations of cardiac arrest to improve cardiac arrest recognition.

• Dispatchers should instruct untrained lay rescuers to provide Hands-Only CPR for adults with sudden cardiac arrest.

• Refinements have been made to recommendations for immediate recognition and activation of the emergency response system once the healthcare provider identifies the adult victim who is unresponsive with no breathing or no normal breathing (ie, only gasping). The healthcare provider briefly checks for no breathing or no normal breathing (ie, no breathing or only gasping) when the provider checks responsiveness. The provider then activates the emergency response system and retrieves the AED (or sends someone to do so). The healthcare provider should not spend more than 10 seconds checking for a pulse, and if a pulse is not definitely felt within 10 seconds, should begin CPR and use the AED when available.

• “Look, listen, and feel for breathing” has been removed from the algorithm.

Increased emphasis has been placed on high-quality CPR (compressions of adequate rate and depth, allowing complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation).

• Use of cricoid pressure during ventilations is generally not recommended.

• Rescuers should initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C). Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression.

• Compression rate is modified to at least 100/min from approximately 100/min.

• Compression depth for adults has been slightly altered to at least 2 inches (about 5 cm) from the previous recommended range of about 1. to 2 inches (4 to 5 cm).

• Continued emphasis has been placed on the need to reduce the time between the last compression and shock delivery and the time between shock delivery and resumption of compressions immediately after shock delivery.

• There is an increased focus on using a team approach during CPR.

Cricoid Pressure2010 (New): The routine use of

cricoid pressure in cardiac arrest is not recommended.

2005 (Old): Cricoid pressure should be used only if the victim is deeply unconscious, and it usually requires a third rescuer not involved in rescue breaths or compressions.

Why: Cricoid pressure is a technique of applying pressure to the victim’s cricoid cartilage to push the trachea posteriorly and compress the esophagus against the cervical vertebrae. Cricoid pressure can prevent gastric inflation and reduce the risk of regurgitation and aspiration during bag-mask ventilation, but it may also impede ventilation. Seven randomized studies showed that cricoid pressure can delay or prevent the placement of an advanced airway and that some aspiration can still occur despite application of cricoid pressure. In addition, it is difficult to appropriately train rescuers in use of the maneuver. Therefore, the routine use of cricoid pressure in cardiac arrest is not recommended.

Summary of Key BLS Components for Adults, Children, and Infants*

(see your copy)

RECOVERY POSITIONThe recovery position is used for

unresponsive adult victims who clearly have normal breathing and effective circulation.

This position is designed to maintain a patent airway and reduce the risk of airway obstruction and aspiration.

The victim is placed on his or her side with the lower arm in front of the body.

Any questions???

Thank you!!!