BASIC LIFE SUPPORT

BLS for HCP

(Based on AHA 2010 Guidelines)

REFRESHER COURSE

AGUSTIN D. AGOS, JR., M.D., FPSGS, FPCS, Ph.D. OD

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3. DO A PRIMARY SURVEY OF THE VICTIM

In every emergency situation, you must first find out if there are conditions that are
an immediate threat to the victims life. R C A - B

Perform Chest Compressions

Check for Responsiveness

Perform Rescue Breathing

Open the Airway

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4. DO A SECONDARY ASSESMENT OF THE VICTIM

It is a systematic method of gathering additional information about injuries or
conditions that may need care.

a. Interview the victim

S - signs and symptoms
A - allergies
M - medications
P - past medical history
L - last meal taken
E - events prior to injury or incident
b. Check vital signs- every 15 minutes if stable
condition, and
every 5 minutes if unstable

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c. Head to toe examination

D- deformity
C - contusion
A - abrasion
P - punctures
B - burn
T - tenderness
L - laceration
S - swelling
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5. REFERRAL OF THE VICTIM FOR FURTHER

EVALUATION AND MANAGEMENT
It refers to the transfer of a victim to hospital or
health care facility if necessary for a definitive
treatment.

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BODY SUBSTANCE ISOLATION (BSI)

Are precautions taken to isolate or prevent risk
of exposure from any other type of bodily substance
using personal protective equipment (PPE).

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Basic Precautions and Practices

1. Personal Hygiene

2. Protective Equipment

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3. Equipment Cleaning
& Disinfecting

Adult Chain of Survival

Recognition
Activation
cardiac

Early
CPR

Rapid

Effective Integrated

Defibrillation ACLS

PostCare

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Pediatric Chain of Survival

Prevention

Early

Rapid access

Rapid PALS

of Arrest

CPR

to EMS

Support

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Integrated
Post-cardiac
Arrest Care

ANATOMY AND PHYSIOLOGY

When blood lacks oxygen

*Clinical death
0 - 1 min. - cardiac irritability
1 - 4 min. - brain damaged not likely
4 - 6 min. - brain damage possible
*Biological death
6 - 10 min. - brain damaged very likely
over 10 min. - irreversible brain damaged

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CARDIOPULMONARY
RESUSCITATION (CPR)
is series of assessments and interventions
using techniques and maneuvers made to
bring victims of cardiac arrest back to life.
Cardiac Arrest: No Circulation, No Pulse!
CPR = Chest Compressions + Rescue Breathing
- Intervention for Cardiac Arrest

C- CIRCULATION
CIRCULATION represents a heart that is
actively pumping blood, most often
recognized by the presence of a pulse
NO PULSE = NO CIRCULATION
Also assume NO CIRCULATION if:
Unresponsive,
Not breathing,
Not moving
Poor skin color
Basic Life Support ebec
2009

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WHEN NOT TO START CPR

All victims of cardiac arrest should receive CPR unless:
1. Patient has a valid DNAR (Do Not Attempt
Resuscitation) order.
2. Patient has signs of irreversible death (Rigor Mortis,
Decapitation, Dependent Lividity).
3. No physiological benefit can be expected because
the vital functions have deteriorated as in septic or
cardiogenic shock.

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WHEN NOT TO START CPR

All victims of cardiac arrest should receive CPR unless:
4. Confirmed gestation of < 23 weeks or birth weight <
400 grams, anencephaly.
5. Attempts to perform CPR would place the rescuer
at risk of physical injury.

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When to Stop CPR?

S - SPONTANEOUS signs of circulation are
restored
T -TURNED over to medical services or properly
trained and authorized personnel
O - OPERATOR is already exhausted and cannot
continue CPR
P - PHYSICIAN assumes responsibility (declares
death, takes over, etc.)
S SCENE becomes unsafe (such as traffic,
impending or ongoing violencegun fires, etc)
S SIGNED waiver to stop CPR

Alternative CPR
Compression- only CPR:
Outcome is better than outcome of NO CPR
Lay rescuers should do compression-only if
they are unwilling or unable to provide rescue
breaths

1. Mouth-to-Mouth
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2. Mouth-to-Nose
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3. Mouth-to-Mouth and Nose

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4. Mouth-to-Stoma
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5. Mouth-to-Face Shield
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6. Mouth-to-Mask
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7. Bag Valve Mask Device

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KEY BLS COMPONENTS

ADULT
Recognition of Cardiac
Arrest

CHILD

INFANT

Unresponsive
No breathing / No normal breathing (i.e. only gasping)
No pulse

Activate
Emergency Response

Location for Pulse

Check (HCP only)
CPR Sequence
Compression Landmark
Hands Position

Compression Rate
Standard Counting of
Compressions/ 1 Cycle
in CPR

CALL FIRST: Activate when

unresponsive & ask for AED
Asphyxial arrest: Give 5
cycles (2 min) CPR before
CALL
Carotid Pulse

CARE FIRST: Activate after 5 cycles CPR

Sudden witnessed collapse: Activate after verifying
unresponsive & ask for AED

Carotid Pulse or Femoral

Pulse

Brachial Pulse or
Femoral Pulse

Compressions Airway Breathing (C A B)

HCPs rotate as compressors every 2 minutes
Lower half of sternum, between the nipples
2 Hands: Heel of 1 hand
with second on top

2 Hands: Heel of 1
hand with 2nd on top
or
1 Hand: Heel of 1
hand only

Just below the nipple line

(lower half of sternum)
Lone Rescuer: 2 finger
technique
2 HCP rescuers: 2-thumbs
hand encircling technique

At least 100/min
1 - 29 & (1,2,3,4,5 ) cycles (30 compressions within 18 seconds/cycle); 5 cycles
2 - rescuers : 1 - 14 & 1,2, 10 (cycles) for Pedia
CPR (15 compressions within 9 seconds)

KEY BLS COMPONENTS

ADULT
Compression Depth

CHILD

INFANT

At least 1/3 AP diameter

At least 2 inches (5 cm.)

At least 2 inches (5 cm)

Chest Wall Recoil

Allow complete chest recoil between compressions

HCPs rotate compressors every 2 minutes

Compression
Interruptions

Minimize interruptions in chest compressions

Limit interruptions to < 10 seconds

Head Tilt-Chin Lift

(HCP: If suspected spine injury perform Jaw thrust maneuver)

Opening of Airway

Method

Mouth-to-mouth / mouth-to-nose / Mouth to

mechanical barrier device

Amount of Breath
No. of breaths/1
Cycle in CPR
CPR
Compression:
Ventilation Ratio
Duration of Breath

At least 1-1/2 inches (4 cm)

Mouth-to-mouth and
nose/ Mouth to
mechanical barrier
device

Normal breath enough to make the chest rise

2 breaths/1 cycle in CPR

2 effective breaths/ 1 cycle in CPR

30:2

30:2

(1 rescuer)

1 or 2 rescuers

15:2

(2 HCP rescuers)

Chest compressions always preceed ventilations

1 sec /breath

1 sec /breath

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KEY BLS COMPONENTS

ADULT
H IGH QUALITY
CPR

CHILD

INFANT

Adequate Compression Rate/min & depth

Allow complete chest recoil after each compression
Minimize interruptions in chest compressions
Avoid excessive ventilation

Rate of Breath in
Artificial
Respiration

1 breath every 5 6 sec.

(10 -12 breaths/min)
then reassess Q 2 min.

Counting for
Standardization
Purposes

Breathe 1001,1002, 1003,

Breathe 1001,1002, 1003, breathe
1004, 1005, breathe

Ventilations with
Advanced airway
(HCP)
Foreign-body airway
obstruction

1 breath every 3 - 5 sec

(12 20 breaths/min)
then reassess Q 2 minutes

1 breath every 6 8 seconds (8 10 breaths/minute)

Asynchronous with chest compressions
About 1 second/breath
Visible chest rise
Responsive: Abdominal thrusts; chest thrusts (pregnant)
Unresponsive: Chest Compressions; CPR

Back slaps and chest

thrusts

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KEY BLS COMPONENTS

ADULT
Defibrillation:
Automated External
Defibrillation

CHILD

INFANT

Attach & use AED as soon as available. Minimize interruptions in chest compressions
before and after shock; resume CPR beginning with compressions immediately after
each shock
Use adult pads
Do not use child pads. For out
of hospital response may
provide 5 cycles/2min. of
CPR before shock if response
> 4 -5 min. & arrest not
witnessed

Use AED after 5 cycles of

CPR (out of hospital).
Use pediatric system for
children 1 8 years if
available
HCP: For sudden
collapse (out-of-hospital)
or in-hospital arrest use
AED as soon as possible.

Not recommended for

infants
(< 1 year of age)

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