Marikina City Disaster Risk Reduction &

Management Office

BASIC LIFE SUPPORT -

CPRAdministrative and Training Division

LIFE SUPPORT

1. BASIC LIFE SUPPORT (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. ADVANCE CARDIAC LIFE SUPPORT (ACLS)

- The use of special equipment to maintain breathing and circulation for the victim of a

cardiac emergency.

3. PROLONGED LIFE SUPPORT (PLS)

- For post resuscitative and long term resuscitation.

SUDDEN CARDIAC ARREST AND CPR AWARENESS

BACKGROUND

HEART DISEASES are the number 1 killer in our country,

accounting for close to 20% of all causes of death according

to the latest Department of Health statistics.

Approximately half of all deaths from cardiovascular occur

as Sudden Cardiac Arrest.

Sudden Cardiac Arrest

• Majority of cardiac arrests occur outside the hospital – at home, in the work place, in

public institutions.

• According to the American Heart Association (AHA), almost 80% of out of hospital

cardiac arrest occur at home and are witnessed by a family member.

• Unfortunately, less than 10 % of sudden cardiac arrest victims survive because majority

of those witnessing the arrest are people who do not know how to perform CPR.

Sudden Cardiac Arrest

• Can happen at anytime, to anyone, anywhere without warning

• Most common mode of death in patients with Coronary Artery Disease

• Although pre –existing heart disease is a common cause, it may strike people with no

history of cardiac disease or cardiac symptoms.

• In sudden cardiac arrest or sudden cardiac death, the heart usually goes into a fatal

arrythmiacalled “Ventricular Fibrillation” (VF) wherein it suddenly goes into very

irregular fast ineffective contractions, the heart stops beating, the victim loses

consciousness, and if untreated, dies.

THE CHAIN OF SURVIVAL

It is associated with low survival rate, and major long term severe mental impairment

due to delays in cardiopulmonary resuscitation (CPR) and treatment.

Pediatric Chain of Survival

RESPIRATION AND CIRCULATION

• This is a concept which aims to improve the outcome for victims of cardiopulmonary arrest.

• It involves a series of events which are interconnected to each other like the links of a chain.

Prevention Early Rapid access Rapid PALS Integrated of Arrest CPR to EMS Support Post-cardiac Arrest Care

1. 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.

2. 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 and Circulation

Air that enters the lungs contains:

21%

O2

trace

of CO2

Air

exhaled from the

lungs contains:

16% O2

4% CO2

• Clinical death

(0 - 4 min.- brain damage not likely,

4 - 6 min. - damage probable).

• Biological death

(6 - 10 min. - brain damage probable;

over 10 min. - brain damage is certain).

CARDIOVASCULAR DISEASE

RISK FACTORS:

1. Risk factors that cannot be changed (Non- modifiable):

Age

Heredity

Gender

2.Risk factors that can be changed (Modifiable):

Cigarette smoking Lack of exercise

Elevated blood cholesterol levels

2.Risk factors that can be changed (Modifiable):

Stress

HEART ATTACK ( Myocardial Infarction)

It occurs when the oxygen supply to the heart muscle

(myocardium) 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 Signals of Heart Attack First Aid Management of

Heart Attack

Obesity

Hypertension

Pressure at the center of chest

1. Recognized the signals of heart attack and take action

2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortable position. Do not let the patient move around.

3. Have someone call the physician or ambulance for help.

4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.

GUIDELINES IN GIVING EMERGENCY CARE

GETTING STARTED

1. Plan of Action

Emergency plans should be established based on anticipated needs and available resources

2. Gathering of Needed Materials

The emergency response begins with the preparation of equipment and personnel before any

emergency occurs.

Pain in shoulders, abdomen, neck or arms

Chest discomfort with fainting, sweating or nausea

If you see a person drop dead, or lose consciousness, with presumed sudden cardiac arrest.

Tap or gently shake the victim

Rescuer shouts “are you OK?”

Quick check for normal breathing

If the victim is unconscious,

rescuer call for help.

3. Initial Response:

A Ask for HELP

I Intervene

D Do no further HARM

4. Instruction to Helper/s

Proper information and instruction to a helper/s would provide organized first aid care.

EMERGENCY ACTION PRINCIPLES

1. CHECK AREA SAFETY 2. CHECK UNRESPOSIVENESS

Survey the scene

See if the scene is safe to do CPR.

Get an idea of what happened.

3. CALL FOR HELP: (AMBULANCE, EMERGENCY SERVICES, DOCTOR)

Information to be remembered in Activating Medical Assistance:

WHAT happened?

LOCATION?

NUMBER of Persons Injured?

EXTENT of Injury and First Aid given?

The TELEPHONE no. from where you are calling?

PERSON who activated Medical Assistance must

identify him/herself and drop phone last….

PRIMARY SURVEY:

PULSE CHECK

Rescuer Activates the EMERGENCY MEDICAL SERVICES. GET AED OR DEFIBRILLATION

Both trained and untrained bystanders should be instructed to Call for Help as soon as they have determined that an adult victim requires emergency care “CALL FIRST”. While for infant and children a “CARE FIRST” approach is recommended.

After determining Unconsciousness:

C – COMPRESSION – Do Chest compression

A – AIRWAY – Does the victim have an open airway

(air passage that allows the victim to breathe?)

B – BREATHING – is the victim is breathing?

Palpate for

Carotid pulse (ADULT/CHILD),

Brachial (infant) with 10 seconds.

At the same time (check for Breathing)

Check for no longer than 10 seconds

(7 seconds better)

C – CHEST COMPRESSION

( TO ASSIST CIRCULATION)

After determining unconsciousness

and calling for help,

proceed immediately to do

CHEST

COMPRESSIONS!

Give 30 compressions

A - AIRWAY

Kneel facing victim’s chest

• Place the heel of your hand on the center of the victims chest. Put your other hand on top of the first with your fingers interlaced.

Give chest compressions at 100 per minute

Compress breastbone at least 2 inches deep

Compress at a rate of 100 per minute or more

Compress 30 times initially

Allow the chest to return to its normal position• Compress the breastbone at

least 2 inches

• (30 compressions should take

15-18secs)

• Count aloud “1, 2, 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25, 26, 27,28,29 and ONE!

• Minimize interruptions

• Allow recoil after each compressions

OPEN THE AIRWAY : use the head-tilt / chin-lift method

B - BREATHING

Place one hand on the victims forehead

Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw – avoid closing victims mouth

Give 2 : one –second breaths

Maintain airway

Pinch nose shut

Open your mouth wide, take a normal breath, and make a tight seal around outside of victim’s mouth

Give 2 full breaths (1 sec/breath)

Observe chest rise and fall, listen and feel for escaping air.

If with definite pulse but

No BREATHING

DO A SECONDARY ASSESSMENT TO THE VICTIM

It is a systematic method of gathering additional information about injuries or conditions that

may need care.

1. Interview the Victim

2. Checking for the vital signs

3. Perform head to toe assessment

FOREIGN BODY AIRWAY OBSTRUCTION

a life-threatening emergency which follows the lodgement of

a foreign object in the casualty's airway. In some instances,

MOUTH TO MOUTH BREATHING AND PULSE CHECK

As short as quick as possible

Pulse check no more than 10 seconds

If unsure, proceed directly to CHEST COMPRESSION

DO MOUTH TO MOUTH BREATHING

Give one breath every 5-6 secs

(about 12 breaths/min.)

Recheck pulse every 2 minutes

the object lodges at the epiglottis, the entry to the airway, but does not actually enter the

airway itself.

CAUSES OF OBSTRUCTION:

• Improper chewing of large pieces of food.

• Excessive intake of alcohol.

• The presence of loose upper and lower dentures.

• For children – running while eating.

• For smaller children of “hand to mouth” stage left unattended.

TWO TYPES OF OBSTRUCTION

1. Anatomical Obstruction

It happens when the tongue drops back and obstruct the throat. Other causes are acute

asthma, croup, diphtheria, swelling and cough (whooping).

2. Mechanical Obstruction

When foreign objects lodge in the pharynx or airways: fluids accumulate in the back of the

throat.

CLASSIFICATION OF OBSTRUCTION

unable to breathe, speak or cough

agitated and distressed

may grip the throat

bluish skin colour

rapid loss of consciousness

1. MILD/PARTIAL OBSTRUCTIONS 2. SEVERE/COMPLETE OBSTRUCTION

HEIMLICH MANEUVER

(abdominal thrusts)

The Heimlich maneuver is recommended for relieving foreign-body airway

obstruction. By elevating the diaphragm, the Heimlich maneuver can force air from the

lungs to create an artificial cough intended to expel a foreign body obstructing the airway.

Each individual thrust should be administered with the intent of relieving the

obstruction. It may be necessary to repeat the thrust several times to clear the airway. Five

thrusts per sequence is recommended.

difficulty in breathing

wheezing

snoring sound

persistent cough

cyanosis (blue skin colour)

in children and infants

flaring of the nostrils

in-drawing of the tissues above the sternum and in between the ribs

HEIMLICH MANEUVER (ADULT) HEIMLICH MANEUVER (INFANT)

PERFORMING THE ABDOMINAL THRUST UNDER SPECIAL CIRCUMSTANCES

OBVIOUSLY PREGNANT AND VERY OBESE PEOPLE

The main difference in performing the Abdominal Thrust on this group of people is in the placement of the fists.

Instead of using abdominal thrusts, chest thrusts are used.

The fists are placed against the middle of the breastbone and do the chest thrust

HEIMLICH MANEUVER WITH VICTIM STANDING OR SITTING

HEIMLICH MANEUVER WITH VICTIM LYING DOWN

If the victim is unconscious, the chest thrusts are similar to those used in CPR.

RESPIRATORY ARREST

Is the condition in which breathing stops or inadequate.

RESCUE BREATHING

Is a technique of breathing air into a person lungs to supply him or her with the oxygen needed

to survive.

ARTIFICIAL RESPIRATION (ADULT) ARTIFICIAL

RESPIRATION (CHILD / INFANT)

Cardiopulmonary Resuscitation ( CPR )

This is a combination of chest compression and rescue breathing. This must be combined for

effective resuscitation of the victim of cardiac arrest.

Breath,

1, 1002, 1003, 1001, Breath,

1, 1002, 1003, 1002, Breath,

1, 1002, 1003, 1003, Breath,

1, 1002, 1003, 1004, Breath,

↓

1, 1002, 1003, 1024, Breath ,

Breath

1, 1001, Breath,

1, 1002, Breath,

1, 1003, Breath,

1, 1004, Breath,

1, 1005, Breath,

↓

1, 1040, Breath……

Check for breathing and pulse – 10 seconds

Check breathing and pulse for 10 seconds after each cycle.

It is a series of lifesaving actions that improve the chance of survival following cardiac arrest.

CPR

Adult / Child / Infant

PULSE CHECK

REPEAT 5 CYCLES OF

30 COMPRESSIONS AND 2 BREATHS

• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 1 – 2 breaths

• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 2 – 2 breaths

• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 3 – 2 breaths

• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 4 – 2 breaths

• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 5 – 2 breaths.

• Check for breathing and pulse – 10 seconds

• RECHECK PULSE EVERY 2 MINUTES

(equivalent to 5 cycles CPR)

• Very brief check pulse– should take less than 10 seconds (at the same time check for

normal breathing)

• In case there is any doubt about the presence or absence of pulse, CONTINUE CHEST

COMPRESSIONS

Continue CPR

Until…….

• HELP ARRIVES.

(Emergency Services, Ambulance, Doctor, AED)

• Person is REVIVED!

THE RECOVERY POSITION

COMPRESSION ONLY CPR

Maintain open airway and position the victim.

* The unresponsive victim with spontaneous respirations should be placed in the recovery

position if no cervical trauma is suspected.

* Placement in this position consists of rolling the victim into his or her side to help protect the airway

WHEN TO S.T.O.P. CPR Criteria for not starting CPR

SIMPLIFIED ADULT BLS ALGORITHM

If 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.

Is recommended only in the following circumstances:

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

For use in dispatcher-assisted CPR instruction.

-TURNED over to medical services or properly trained and authorized personnel

- SPONTANEOUS signs of circulation are restored

- OPERATOR is already exhausted and cannot continue CPR

- PHYSICIAN assumes responsibility (declares death, takes over, etc.)

- SCENE becomes unsafe (such as traffic, impending or ongoing violence—gun fires, etc)

- SIGNED waiver to stop CPR

Patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.

Signs of irreversible death: Rigor Mortis, Decapitation, or Dependent Lividity.

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

Don’ts in giving CPR

• Do not be a rocker

• Do not be a bender

• Do not be a massager

• Do not be a double crosser

• Do not be a bouncer

• Do not be a jerker

Memorize the Steps!

Survey the Scene.

(introduce yourself as a Trained First Aider.)

Check Responsiveness – Hey Hey are you OK?

Call for Help!.. Activate EMS

(Quick check pulse within 10secs of the same time check for breathing).. IF NO

BREATHING NO PULSE.

C – CHEST COMPRESSION: 30X 100/min; 2 inches deep; push hard and fast, COUNT 1,2,

3…..27,28,29 and 1.

A – AIRWAY: Head tilt-Chin lift

B – BREATHING: 2 BREATHS (1sec/breath)

Continue cycles 30:2 compression – ventilation., , COUNT 1,2, 3…..27,28,29 and 5.

(quick check pulse every 2 mins – approximately 5 cycles)

IF NO BREATHING NO PULSE. Do CPR.

If NO BREATHING BUT WITH PULSE. Do Artificial breathing.. Give 1 breath every 5

seconds. COUNT 1-2-3----1 Blow… up to 1-2-3--- 12blow (12cycles)

Until:

EMS arrives (AED, doctor ,ambulance)

Patient has signs of life.