adult basic life support cpr

Presented By:

Louis van RensburgPARAMEDIC

New CPR Guideline 2010

Adult Basic Life Support

TEAMWORK

What Is The Fundamental Aspects Of BLS ?


Immediate recognition of sudden cardiac arrest (SCA)

Activation of the emergency response system

Early cardiopulmonary resuscitation (CPR)

Rapid defibrillation With an automated external defibrillator (AED)

Initial recognition and response to heart attack and stroke are also considered part of BLS.


AdultBLS Sequence


Pulse CheckEarly CPR Chest compressions Rescue BreathsEarly Defibrillation With an AED


The lay rescuer should not check for a pulse and should assume that cardiac arrest is present

Healthcare providers also may take too long to check for a pulse

The healthcare provider should take no more than 10 seconds to check for a pulse and, if the rescuer does not definitely feel a pulse within that time period, the rescuer should start chest compressions .

Pulse Check

Early CPR Chest compressions Rescue Breaths


Effective chest compressions are essential for providing blood flow during CPR.

For this reason all patients in cardiac arrest should receive chest compressions (Class I).

To provide effective chest compressions, push hard and push fast.


Compress the adult chest at a rate of at least 100 compressions per minute (Class IIa) with a compression depth of at least 2 inches/5 cm (Class IIa).

Allow complete chest recoil after each compression.(Class IIa).


The rescuer should place the heel of one hand on the center (middle) of the victim’s chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel (Class IIa).

Chest compression and chest recoil/relaxation times approximately equal (Class IIb).


Minimize the frequency and duration of interruptions in compressions (Class IIa).

Once chest compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation.


Rescuer fatigue may lead to inadequate compression rates or depth.

When 2 or more rescuers are available it is reasonable to switch chest compressors approximately every 2 minutes (or after about 5 cycles of compressions and ventilations at a ratio of 30:2) to prevent decreases in the quality of compressions (Class IIa).

Every effort should be made to accomplish this switch in 5 seconds.


How can CPR be effective without rescue breathing/bvmr?

(Can it Be ????)


1. Initially during SCA with VF, rescue breaths are not as important as chest compressions because the oxygen level in the blood remains adequate for the first several minutes after cardiac arrest.

2. In addition, many cardiac arrest victims exhibit gasping or Agonal breaths, and gas exchange allows for some oxygenation and carbon dioxide (CO2) elimination.

3. If the airway is open, passive chest recoil during the relaxation phase of chest compressions can also provide some air exchange.


Managing the Airway A significant change in these guidelines is to

recommend the initiation of chest compressions before ventilations (CAB rather than ABC).

A healthcare provider should use the head tilt– chin lift maneuver to open the airway of a victim with no evidence of head or neck trauma .

If healthcare providers suspect a cervical spine injury, they should open the airway using a jaw thrust without head extension (Class IIb).


Head tilt chin lift & Head tilt jaw trust

Rescue Breathing● Deliver each rescue breath

over 1 second (Class IIa).● Give a sufficient tidal

volume to produce visible chest rise (Class IIa)

● Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations (Class IIa).


Adult Basic Life SupportPopulation Group

Ventilation Ratio (I:E)

BVMR Size Tidal Volume (6 – 8 ml/kg)

Adult1 Breath every 6-8 secs

Adult -/+ 600ml

Child1 Breath every 5-6 secs

Child Weight Dependant

Paed1 Breath every 3-4 secs

Neonatal Weight Dependant

Ventilation With Bag and Mask

Rescuers can provide bag-mask ventilation with room air or oxygen.

This amount is usually sufficient to produce visible chest rise and maintain oxygenation and normocarbia in apneic patients (Class IIa).

If the airway is open and a good, tight seal is established between face and mask.


As long as the patient does not have an advanced airway in place, the rescuers should deliver cycles of 30 compressions and 2 breaths during CPR.

The rescuer delivers ventilations during pauses in compressions and delivers each breath over 1 second (Class IIa).

The healthcare provider should use supplementary oxygen (O2 concentration 40%, at a minimum flow rate of 10 to 12 L/min) when available.


Ventilation With an Advanced Airway When an advanced airway (ie, endotracheal tube,

Combitube, or laryngeal mask airway [LMA]) is in place during 2-person CPR, give 1 breath every 6 to 8 seconds without attempting to synchronize breaths between compressions (this will result in delivery of 8 to 10 breaths/minute).

There should be no pause in chest compressions for delivery of ventilations (Class IIb).

Indicative of good proper CPR ? ETCO 2? Normal Ranges? CPR Range Shoot up? Drop Down?


Excessive ventilation is unnecessary and can cause gastric inflation and its resultant complications, such as regurgitation and aspiration (Class III).

Rescuers should avoid excessive ventilation (too many breaths or too large a volume) during CPR (Class III).


Cricoid Pressure Cricoid pressure might be used

in a few special circumstances (eg, to aid in viewing the vocal cords during tracheal intubation).

Routine use of cricoid pressure in adult cardiac arrest is not recommended (Class III).


Early Defibrillation With an AED


All BLS providers should be trained to provide defibrillation because VF is a common and treatable initial rhythm in adults with witnessed cardiac arrest.

For victims with VF, survival rates are highest when immediate bystander CPR is provided and defibrillation occurs within 3 to 5 minutes of collapse.
