BASIC LIFE SUPPORT

• Sequence of BLS (Basic Life Support)


  1. Assessment

  2. EMS(Emergency Medical Services) activation

  3. ABC's of CPR (Airway, Breathing, Circulation)
• Assessment phases of BLS

  1. Determine unresponsiveness

  2. Determine breathlessness

  3. Determine pulselessness
• Activating the EMS system

  1. Call the local emergency telephone number

  2. Provide location of emergency

  3. Provide telephone number calling from

  4. Explain what happened

  5. State how many people need help

  6. Describe condition of victim(s)

  7. Explain what aid is being given
• Positioning the victim for CPR

  1. Kneel beside the victim at shoulder level

  2. Move victim's arm closer to you above their head

  3. Straighten victim's legs if necessary

  4. Place one hand behind victim's head and neck for support

  5. Grasp victim under the arm to brace shoulder and torso

  6. Roll victim towards you by pulling steadily at the shoulder while controlling the head and neck
• Positioning the victim who is lying down

  1. Kneel beside the victim at a distance approximately equal to the width of the victim's body and at a level of the victim's shoulders

  2. Move the victim's arm closer to you so that it is raised above the victim's head

  3. Straighten the victim's legs if necessary. They should be straight or bent slightly at the knees

  4. Place one hand behind the victim's head and neck for support

  5. With the other hand grasp the victim under the arm to brace the shoulder and torso

  6. Roll the victim toward you by pulling steadily and evenly at the shoulder while controlling the head and neck. The head and neck should remain in the same plane as the torso and the body should be moved as a unit
• The nonbreathing victim should be supine with the arms alongside the body. The victim is now appropriately positioned for the next step in CPR.
• Rescuer position


  The rescuer should be at the victim's side, positioned to easily perform both rescue breathing and chest compression
• Open the airway


  1. Place one hand on the victim's forehead and apply firm, backward pressure to tilt the head back

  2. Place the fingers of the other hand under the bony part of the chin. Lift the chin forward and support the jaw, helping to tilt the head back
• The fingers must not press deeply into the soft tissues under the chin, which might obstruct the airway. The thumb should not be used for lifting the chin. The mouth should not be closed.
• Breathing assessment


  1. Place your ear over the victim's mouth and nose while maintaining an open airway

  2. Look for the chest to rise and fall

  3. Listen for air escaping during exhalation

  4. Feel for the flow of air
• Recovery position


  Roll the victim onto his or her side so that the head, shoulders and torso move simultaneously without twisting
• If the victim has sustained trauma or trauma is suspected, the victim should not be moved.
• Mouth-to-mouth rescue breathing


  1. Keep the airway open by the head tilt-chin lift maneuver

  2. Gently pinch the nose closed with your thumb and index finger, thereby preventing air from escaping through the victim's nose

  3. Take a deep breath and seal your lips around the victim's mouth, creating an airtight seal

  4. Then give two slow breaths (1 1/2 to 2 seconds per breath)
• Mouth-to-nose rescue breathing


  1. Keep the victim's head tilted back with one hand on the forehead

  2. Use the other hand to lift the victim's lower jaw (as in head tilt-chin lift) and close the mouth

  3. Take a deep breath, seal your lips around the victim's nose, and blow

  4. Then stop rescue breathing and allow the victim to exhale passively
• Mouth-to-stoma rescue breathing


  1. Make an airtight seal around the stoma and blow slowly until the chest rises

  2. When rescue breathing is stopped, the victim exhales passively
• Mouth-to-barrier device


  Masks and face shields are two broad categories of devices available. Most masks have a one-way valve so that exhaled air does not enter the rescuer's mouth. Many face shields have no exhalation valve and often air leaks around the shield.
• Mouth-to-mask rescue breathing


  1. Place the mask around the patient's mouth and nose using the bridge of the nose as a guide for correct position

  2. Seal the mask by placing the heel and thumb of each hand along the border of the mask and compressing firmly to provide a tight seal around the margin of the mask

  3. Place your remaining fingers along the boney margin of the jaw and lift the jaw while performing a head tilt

  4. Give breaths in the same sequence and at the same rate as in rescue breathing, observing chest excursion
• Recommendations for rescue breathing

  • Give two initial breaths of 1 1/2 to 2 seconds each
  • For both one-rescuer and two-rescuer CPR, deliver 10-20 breaths per minute
  • In one-rescuer CPR, pause for ventilation after every 15 chest compressions
  • In two-rescuer CPR, pause for ventilation after every 5 chest compressions
• Circulation assessment


  1. Check the pulse at the carotid artery; this should take no more than 5 to 10 seconds

  2. While maintaining head tilt with one hand on the forehead, locate the victim's larynx with two or three fingers of the other hand

  3. Place these fingers into the groove between the trachea and the muscles at the side of the neck, where the carotid pulse can be felt
• The pulse area must be pressed gently to avoid compressing the artery. This technique is more easily performed on the side nearer the rescuer.
• Locating and palpating a pulse will take 5 to 10 seconds. If a pulse is present but there is no breathing, rescue breathing should be initiated at a rate of 10 to 20 times per minute or once every 5 to 6 seconds. If there is no pulse, the victim is in cardiac arrest and chest compressions should be begun.
• Chest compressions


  1. Locate the lower margin of the victim's rib cage on the side next to the rescuer

  2. Move the fingers up the rib cage to the notch where the ribs meet the sternum in the center of the lower part of the chest

  3. Place the heel of one hand on the lower half of the sternum and place the other hand on top of the hand on the sternum so that the hands are parallel

  4. Your elbows should preferably be locked into position, your arms straightened, and your shoulders positioned directly over the hands so that the thrust for each chest compression is in a straight downward direction

  5. Depress the sternum approximately 1 1/2 to 2 inches (3.8 to 5.1 cm) for a normal-size adult

  6. Release chest compression pressure between each compression to allow blood to flow into the chest and heart
• Bouncing compressions, jerky movements, improper hand position and leaning on the chest can decrease effectiveness of resuscitation and are more likely to cause injuries. The chest compression rate should be a minimum of 80 to 100 per minute if possible and duration of chest compression should be 50% of the compression-release cycle.
• ACH chest compression


  • Straight downward direction
  • Torso has the tendency to roll
  • Part of the downward force is displaced
  • Chest compression may be less effective
• To achieve the most pressure with the least effort

  Lean forward until your shoulders are directly over your outstretched hands
• Sternum should be depressed


  Approximately 1 ½ to 2 inches (3.8 to 5.1 cm) for normal-size adult
• Release chest compression pressure between each compression

  To allow blood to flow into the chest and heart
• Do not lift the hands from the chest or change position, or correct position may be lost
• Bouncing compressions, jerky movements, improper hand position and leaning on the chest can decrease effectiveness of resuscitation and are more likely to cause injuries
• Chest compression rate


  Minimum of 80 to 100 per minute if possible
• Duration of chest compression

  50% of the compression – release cycle
• Upper airway obstruction can cause unconsciousness and cardiopulmonary arrest, but far more often unconsciousness and cardiopulmonary arrest cause upper airway obstruction
• An unconscious patient can develop airway obstruction when the tongue falls back into the pharynx, obstructing the upper airway
• Bleeding from head and facial injuries may also obstruct the upper airway, particularly if the patient is unconscious
• Foreign-body airway obstruction of the airway usually occurs during eating
• Common causes of obstruction in adults

  • Meat
  • Variety of other foods and foreign-bodies
• Common factors associated with choking on food

  • Large, poorly chewed pieces of food
  • Elevated alcohol levels
  • Dentures
• Ways to help prevent foreign-body airway obstruction

  • Cutting food into small pieces and chewing slowly and thoroughly, especially if wearing dentures
  • Avoid laughing and talking during chewing and swallowing
  • Avoid excessive intake of alcohol
  • Restricting children from walking, running, or playing when they have food in their mouths
  • Keep foreign objects (e.g. marbles, beads, thumbtacks) away from infants and children
  • Withholding peanuts, peanut butter, popcorn, hotdogs and other foods that must be thoroughly chewed from children unable to do so
• Early recognition of airway obstruction is the key to successful outcome
• Partial airway obstruction with good (adequate) air exchange

  Victim remains conscious and can cough forcefully, although frequently wheezing between coughs