Basic Life Support
Core CPD
These BLS guidelines have been produced in association with the Resuscitation Council (UK) the guidelines were last updated 2010. Basic life support refers to maintaining airway patency and supporting breathing and the circulation without the use of equipment other than a protective device. It is important that those who may be present at the scene of a cardiac arrest, particularly lay bystanders, should have learnt the appropriate resuscitation skills and be able to put them into practice. Simplification of the BLS sequence continues to be a feature of these guidelines, but, in addition, there is now advice on who should be taught what skills, particularly chest-compression-only or chest compression and ventilation.
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Professor Tooth's Learning Activities
On average how many medical emergencies will a dental practitioner see in a normal working lifetime?
Adult basic life support sequence
Professor Tooth's Learning Activities
In the adult basic life support sequence how do you check the victim for a response?
Basic life support consists of the following sequence of actions:
1. Make sure the victim, any bystanders, and you are safe.
2. Check the victim for a response.
2.1 Shake and Shout - Gently shake his shoulders and ask loudly, ‘Are you all right?’Figure 4
2.2 Assess ABCDE, recognise and treat using algorithms as below:
ABCDE
A - Airway
- Check consciousness
- Assess ability to take a deep breath
- Assess ability to speak in a full sentence – can the patient speak a full sentences, juse phrases, single words, or not at all
- Assess if the airway is clear
B - Breathing
- Look, listen and feel for the movement of air
- Assess the adequacy of the breathing process – is their sufficient rate and volume of air being moved?
- Assess work of breathing (patient effort versus efficacy)
C - Circulation
- Examine for life- threatening haemorrhage
- Assess perfusion (level of consciousness, skin colour, pulse rate and blood preasure
- Assess the pule mannually – is it regular or irregular, what is the rate (15 seconds x 4), skin colour, temperature.
D - Disability
- Measure level of consciousness (AVPU – Patient is Alert, responding to verbal stimuli, responds to pain, unconscious; GCS: Glascow Coma Score)
- Check pupil size and functioning response (make sure you document pupil size)
- Assess motor and sensory responses to all four limbs.
- Assess ability to walk
- Assess ability to smile
E - Exposure
- Expose the patient (while maintaining their dignity) so that you can see any injuries, watch breathing, etc.
- Look for a rash, wounds, contusions
- Check temperature
3. If he responds:
3.1 Leave him in the position in which you find him provided there is no further danger.
3.2 Try to find out what is wrong with him and get help if needed.
3.3 Reassess him regularly.
4. If he does not respond:
4.1 Shout for help.Figure 5
4.2 Turn the victim onto his back and then open the airway using head tilt and chin lift:Figure 6
4.2.1 Place your hand on his forehead and gently tilt his head back.
4.2.2 With your fingertips under the point of the victim's chin, lift the chin to open the airway.
5. Keeping the airway open, look, listen, and feel for normal breathing.
5.1 Look for chest movement.Figure 7
5.2 Listen at the victim's mouth for breath sounds.
5.3 Feel for air on your cheek.
In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking infrequent, noisy, gasps. This is often termed agonal breathing and must not be confused with normal breathing.
Look, listen, and feel for no more than 10 seconds to determine if the victim is breathing normally. If you have any doubt whether breathing is normal, act as if it is not normal.
6. If he is breathing normally:
6.1 Turn him into the recovery position (see below).
6.2 Summon help from the ambulance service by mobile phone. If this is not possible, send a bystander. Leave the victim only if no other way of obtaining help is possible.
6.3 Continue to assess that breathing remains normal. If there is any doubt about the presence of normal breathing, start CPR
7. If he is not breathing normally:
7.1 Ask someone to call for an ambulance and bring an Automated External Defibrillator (AED) if available (see AED module). If you are on your own, use your mobile phone to call for an ambulance. Leave the victim only when no other option exists for getting help.
7.2 Start chest compression as follows:
7.3 Kneel by the side of the victim.
7.4 Place the heel of one hand in the centre of the victim’s chest (which is the lower half of the victim’s sternum (breastbone).Figure 8
7.5 Place the heel of your other hand on top of the first hand.Figure 9
7.6 Interlock the fingers of your hands and ensure that pressure is not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the sternum.Figure 10
7.7 Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum 5 - 6 cm.Figure 11
7.8 After each compression, release all the pressure on the chest without losing contact between your hands and the sternum. Repeat at a rate of 100 - 120 min.
7.9 Compression and release should take an equal amount of time.
8. Combine chest compression with rescue breaths:
8.1 After 30 compressions open the airway again using head tilt and chin lift.
8.2 Pinch the soft part of the victim’s nose closed, using the index finger and thumb of your hand on his forehead.
8.3 Allow his mouth to open, but maintain chin lift.
8.4Take a normal breath and place your lips around his mouth, making sure that you have a good seal.
8.5 Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath.Figure 12
8.6 Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.Figure 13
8.7 Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. The two breaths should not take more than 5s. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions.
8.8 Continue with chest compressions and rescue breaths in a ratio of 30:2.
8.9 Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally; otherwise do not interrupt resuscitation.
If the initial rescue breath of each sequence does not make the chest rise as in normal breathing, then, before your next attempt:
Check the victim's mouth and remove any visible obstruction.
Recheck that there is adequate head tilt and chin lift.
Do not attempt more than two breaths each time before returning to chest compressions.
If there is more than one rescuer present, another should take over CPR about every 1-2 min to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers, and do not interrupt chest compressions.
9.Compression-only CPR
9.1 If you are not trained to, or are unwilling to give rescue breaths, give chest compressions only.
9.2 If chest compressions only are given, these should be continuous at a rate of 100 - 120 min.
9.3 Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally; otherwise do not interrupt resuscitation.
10. Continue resuscitation until:
10.1 qualified help arrives and takes over
10.2 the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally,
OR
10.3 you become exhausted.
Professor Tooth's Learning Activities
When do you call emergency services?
Further points related to basic life support
Risks to the rescuer and victim
The safety of both the rescuer and victim are paramount during a resuscitation attempt. There have been few incidents of rescuers suffering adverse effects from undertaking CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute respiratory distress syndrome (SARS). Transmission of HIV during CPR has never been reported.
There have been no human studies to address the effectiveness of barrier devices during CPR; however, laboratory studies have shown that certain filters, or barrier devices with one-way valves, prevent transmission of oral bacteria from the victim to the rescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safety precautions where feasible, especially if the victim is known to have a serious infection such as TB or SARS. During an outbreak of a highly infectious condition (such as SARS), full protective precautions for the rescuer are essential.
Initial rescue breaths
- During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content remains high. Therefore, ventilation is less important than chest compression at this time.
- It is well recognised that skill acquisition and retention are aided by simplification of the BLS sequence of actions. It is also recognised that rescuers are frequently unwilling to carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection and distaste for the procedure.
- For these reasons, and to emphasise the priority of chest compressions, it is recommended that, in adults, CPR should start with chest compressions rather than initial ventilations.
Jaw thrust
The jaw thrust technique is not recommended for lay rescuers because it is difficult to learn and perform. Therefore, the lay rescuer should open the airway using a head-tilt chin-lift manoeuvre for both injured and non-injured victims.
Agonal gasps
Agonal gasps are present in up to 40% of cardiac arrest victims. Therefore laypeople should be taught to begin CPR if the victim is unconscious (unresponsive) and not breathing normally. It should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest; they are an indication for starting CPR immediately and should not be confused with normal breathing.
Use of oxygen during basic life support
There is no evidence that oxygen administration is of benefit during basic life support in the majority of cases of cardiac arrest before healthcare professionals are available with equipment to secure the airway. Its use may lead to interruption in chest compressions, and is not recommended, except in cases of drowning (see below).
Mouth-to-nose ventilation
Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It may be considered if the victim’s mouth is seriously injured or cannot be opened, if the rescuer is assisting a victim in the water, or if a mouth-to-mouth seal is difficult to achieve.
Mouth-to-tracheostomy ventilation
Mouth-to-tracheostomy ventilation may be used for a victim with a tracheostomy tube or tracheal stoma who requires rescue breathing.
Bag-mask ventilation
Considerable practice and skill are required to use a bag and mask for ventilation. The lone rescuer has to be able to open the airway with a jaw thrust whilst simultaneously holding the mask to the victim’s face. It is a technique that is appropriate only for lay rescuers who work in highly specialised areas, such as where there is a risk of cyanide poisoning or exposure to other toxic agents. There are other specific circumstances in which non-healthcare providers receive extended training in first aid, which could include training, and retraining, in the use of bag-mask ventilation. The same strict training that applies to healthcare professionals should be followed and the two-person technique is preferable.
Chest compression
In most circumstances it will be possible to identify the correct hand position for chest compression without removing the victim’s clothes. If in any doubt, remove outer clothing.
Each time compressions are resumed on an adult, the rescuer should place his hands on the lower half of the sternum. It is recommended that this location be taught in a simple way, such as ‘place the heel of your hand in the centre of the chest with the other hand on top.’ This teaching should be accompanied by a demonstration of placing the hands on the lower half of the sternum. Use of the inter nipple line as a landmark for hand placement is not reliable.
Performing chest compression:
a. Compress the chest at a rate of 100-120 min.
b. Each time compressions are resumed, place your hands without delay ‘in the centre of the chest’.
c. Pay attention to achieving the full compression depth of 5-6 cm (for an adult).
d. Allow the chest to recoil completely after each compression.
e. Take approximately the same amount of time for compression and relaxation.
f. Minimise interruptions in chest compression.
g. Do not rely on a palpable carotid or femoral pulse as a gauge of effective arterial flow.
h. ‘Compression rate’ refers to the speed at which compressions are given, not the total number delivered in each minute. The number delivered is determined not only by the rate, but also by the number of interruptions to open the airway, deliver rescue breaths, and allow AED analysis.
Compression-only CPR
Studies have shown that compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest. However, chest compression combined with rescue breaths is the method of choice for CPR by trained lay rescuers and professionals and should be the basis for lay-rescuer education. Lay rescuers who are unable or unwilling to provide rescue breaths, should be encouraged to give chest compressions alone. When advising untrained laypeople by telephone, ambulance dispatchers should give instruction on compression-only CPR.
Regurgitation during CPR
Regurgitation of stomach contents is common during CPR, particularly in victims of drowning. If regurgitation occurs:
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Turn the victim away from you.
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Keep him on his side and prevent him from toppling on to his front.
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Ensure that his head is turned towards the floor and his mouth is open and at the lowest point, thus allowing vomit to drain away.
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Clear any residual debris from his mouth with your fingers; and immediately turn him on to his back, re-establish an airway, and continue rescue breathing and chest compressions at the recommended rate.
Teaching CPR
Compression-only CPR has potential advantages over chest compression and ventilation, particularly when the rescuer is an untrained or partially-trained layperson. However, there are situations where combining chest compressions with ventilation is better, for example in children, asphyxial arrests, and prolonged arrests. Therefore, CPR should remain standard care for healthcare professionals and the preferred target for laypeople, the emphasis always being on minimal interruption in compressions.
A simple, education-based approach is recommended:
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Ideally, full CPR skills should be taught to all citizens.
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Initial or limited-time training should always include chest compression.
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Subsequent training (which may follow immediately or at a later date) should include ventilation as well as chest compression.
CPR training for citizens should be promoted, but untrained lay people should be encouraged to give chest compressions only, when possible and appropriate with telephone advice from an ambulance dispatcher.
Those laypeople with a duty of care, such as first aid workers, lifeguards, and child minders, should be taught chest compression and ventilation.
Over-the-head CPR
Over-the-head CPR for a single rescuer and straddle CPR for two rescuers may be considered for resuscitation in confined spaces.
Recovery position
There are several variations of the recovery position, each with its own advantages. No single position is perfect for all victims. The position should be stable, near a true lateral position with the head dependent, and with no pressure on the chest to impair breathing.
The Resuscitation Council(UK) recommends the following sequence of actions to place a victim in the recovery position:
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Remove the victim’s glasses, if present.
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Kneel beside the victim and make sure that both his legs are straight.
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Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm-up.Figure 14
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Bring the far arm across the chest, and hold the back of the hand against the victim’s cheek nearest to you.Figure 15
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With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.Figure 16
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Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you on to his side.
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Adjust the upper leg so that both the hip and knee are bent at right angles.
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Tilt the head back to make sure that the airway remains open.
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If necessary, adjust the hand under the cheek to keep the head tilted and facing downwards to allow liquid material to drain from the mouth.
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Check breathing regularly.Figure 17
If the victim has to be kept in the recovery position for more than 30 min turn him to the opposite side to relieve the pressure on the lower arm.
Adult BLS algorithm test
Professor Tooth's Learning Activities
Please put the following into the correct order when discovering an unresponsive collapsed adult
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Paediatric BLS alogorithm test
Professor Tooth's Learning Activities
Please put the following into the correct order when discovering an unresponsive collapsed child
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Learning Activity Results
It is recommended that you take the Learning Activites above before you take your CPD test, if one is available.
Comments
This was very helpful.
very good, simple
Easy to understand
Very informative.All steps explained in great detail.
Article has been viewed 9026 times
- After reading this article, the reader should be able to:
- Explain the rationale of basic life support.
- Discuss the process of basic life support.
- Recognise further issues related to basic life support.
- Explain how to put someone in the recovery position.
Article gallery
Figure 1: In association with the Resuscitation Council (UK)
Figure 2: adult BLS algorithm
Figure 3: Paediatric BLS alogorithm
Figure 4: check victim for response
Figure 5: Shout for help
Figure 6: Head tilt and chin lift
Figure 7: Look listen and feel for normal breathing
Figure 8: Place the heal of one hand in the centre of the victims chest
Figure 9: Place the heel of your other hand on top of the first hand
Figure 10: Interlock the fingers of your hands. Keep your arms straight
Figure 11: Press down on the sternum at least 5cm
Figure 12: Blow steadily into his mouth whilst watching for his chest to rise
Figure 13: Take your mouth away from the victim and watch for his chest to fall as air comes out
Figure 14: Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost
Figure 15: Bring the far arm across the chest, and hold the back of the hand against the victim's cheek nearest to you
Figure 16: With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground
Figure 17: The recovery position completed
nice and straight forward
Posted by Vincent Davis - 11.32am 4th October 2012