BASIC LIFE

SUPPORT (BLS)
Franklin O. Que, BSN-RN
INTRODUCTION TO BLS
Kinds of Life Support
1.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.ACLS – the use of special equipment to
maintain breathing and circulation for the
victim of a cardiac emergency.
3.Prolonged Life Support – for post
resuscitative and long term resuscitation
ADULT CHAIN OF SURVIVAL
ADULT CHAIN OF SURVIVAL
1. Immediate recognition of cardiac
arrest and activation of the
emergency response team
2. Early CPR with an emphasis on chest
compressions
3. Rapid defibrillation
4. Effective Advanced life Support
5. Integrated post-cardiac arrest care
 ADULT CHAIN OF SURVIVAL
1. Immediate recognition of cardiac
arrest and activation of the
emergency response team
 Immediate recognition of cardiac
arrest and activation of the emergency
response team
C - Circumstance (What is the
emergency)
H - Help available / help given
A - Address (give a landmark)
N - Name of caller / No. of victims
T - Telephone no.
 ADULT CHAIN OF SURVIVAL
2. Early CPR with an emphasis on chest
compressions
 ADULT CHAIN OF SURVIVAL
3. Rapid defibrillation
Automated External Defibrillator
 ADULT CHAIN OF SURVIVAL
4. Effective Advanced Life Support
 ADULT CHAIN OF SURVIVAL
5. Integrated post cardiac arrest
OVERVIEW OF THE
BODY SYSTEMS
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.
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 & CIRCULATION
1. Air that enters the lungs contains
about 21% oxygen and only a trace of
carbon dioxide. Air that is exhaled
from the lungs contains about 16%
oxygen and 4% carbon dioxide.
2. The right side of the heart pumps
blood to the lungs, where blood picks
up oxygen and releases carbon
dioxide.
3. The oxygenated blood then returns to
the left side of the heart, where it is
pumped to the tissues of the body.
BREATHING & CIRCULATION
4. In the body tissues, blood releases
oxygen and takes up carbon dioxide
after which it flows back to the right
side of the heart.
5. All body tissues require oxygen, but
the brain requires more than any
other tissue.
6. When breathing and circulation stop is
called CLINICAL DEATH. (0-4 mins =
brain damage not likeley; 4-6 mins =
brain damage probable.)
 In all instances that the person is not
breathing and/or does not have a pulse, you
should always start CPR.
BREATHING & CIRCULATION
7. When the brain has been deprived of
oxygenated blood for a period of 6
minutes or more an irreversible
damage probably occurred. This is
called the BIOLOGICAL DEATH (6-10
mins = brain damage probable; over
10 minutes = brain damage is
certain).
8. It is obvious from the above stated
facts that both respiration and
circulation are required to maintain
life.
THE NERVOUS SYSTEM
 It is composed of the brain, spinal
cord and nerves. It has two major
functions – communication and
control.
 It lets a person aware of and react to
the env’t.
 It coordinates the body’s responses to
stimuli and keeps body systems
working together.
SO WHAT DOES
CPR STANDS
FOR???
Cardio = HEART

Pulmonary = LUNGS

Resuscitate = REVIVE

Cardio-Pulmonary
Resuscitation (CPR)=
Reviving the Heart and Lungs
Cardio = HEART
Our heart is a big, strong muscle that expands
and contracts more than 60 times a minute
without you even thinking about it. It is
automatically driven by electrical impulses and
runs 24 hours a day, 7 days a week, with no
vacation time. That's around 33 million beats a
year! 
Our heart has a simple, but important job. It
pumps oxygen-rich blood from the lungs out to
the rest of your body. If your heart stops
pumping, oxygen does not reach vital organs and
they stop working. That's when you get in
trouble.
Pulmonary = LUNGS
We breathe about 12 to 20 times each
minute and every breath you take brings
oxygen into your lungs and gets rid of
carbon dioxide. Your lungs function
automatically just like your heart - you
don't have to think about breathing, it just
happens. 
Oxygen is important to your body because
it gets combined with sugar to burn as fuel.
There is very little oxygen stored in your
body's tissues so it needs to be replenished
often. (There is a big supply of sugar so
you can go a long time without eating.)
Pulmonary = LUNGS
If your body stops bringing air with
oxygen in it into your lungs or your
heart stops circulating the oxygen-rich
blood to your organs, then bad things
start to have real fast. When the oxygen
runs out, the body only has a few
minutes in an anaerobic state before
cells start to die and brain damage
results.
 PRECAUTIONS TO PREVENT
DISEASE TRANSMISSION
Body Substance Isolation are
precautions taken to isolate or
prevent the risk of exposure
from any other type of bodily
substance.
 BASIC PRECAUTIONS &
PRCATICES
1. Personal Hygiene
2. Protective Equipment
3. Equipment Cleaning & Disinfecting
 CARDIOVASCULAR DISEASE
RISK FACTORS for Cardiovascular
disease:
1. Non-modifiable – heredity, age,
gender
2. Modifiable – cigarette smoking, lack
of exercise, stress, hypertension,
obesity, DM, elevated cholesterol and
triglycerides levels.
 MYOCARDIAL INFARCTION
It occurs when the oxygen supply to
the heart muscle 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
Chest discomfort characterized by:
uncomfortable pressure, squeezing,
fullness or tightness, aching, crushing,
constricting, oppressive or heavy.
Sweating
Nausea
Shortness of breathe
 First Aid Management
Recognize the signals of heart attack
and take action.
Have pt. stop what he or she is doing
and have him/her sit or lie down in a
comfortable position. Do not let the pt.
move around.
Have someone call the physician or
ambulance for help.
If pt. is under medical care, assist him/
her in taking his/ her prescribed meds.
 GUIDELINES IN GIVING
EMERGENCY CARE
GETTING STARTED
1.Planning of Action
2.Gathering of needed materials
3.Remember the initial response as
follows:
A–I–D
4. Instruction to helper/s
 RESPIRATORY
ARREST & RESCUE
BREATHING
 RESPIRATORY ARREST &
RESCUE BREATHING
Respiratory Arrest – is the condition in
which breathing stops or inadequate.
Causes:
1.Obstruction
2.Diseases
3.Other causes of respiratory arrest
 RESCUE BREATHING
Is a technique of breathing air
into a person’s lungs to supply
him or her with the oxygen
needed to survive.
WAYS TO VENTILATE THE LUNGS
1. Mouth-to-mouth
2. Mouth-to-nose
3. Mouth-to-mouth and nose
4. Mouth-to-stoma
5. Mouth-to-face shield
6. Mouth-to-mask
7. Bag mask device
FOREIGN BODY
AIRWAY
OBSTRUCTION
MANAGEMENT
 FOREIGN BODY AIRWAY
OBSTRUCTION MANAGEMENT
Causes of Obstruction:
1.Improper chewing of large pieces of food.
2.Excessive intake of alcohol
3.The presence of loose upper and lower
dentures
4.For children – running while eating
5.For smaller children of hand-to-mouth
stage left unattended.
 Two types of Obstruction
1. Anatomical Obstruction
2. Mechanical Obstruction
 Classification of Obstruction
1. Partial obstruction with good air
exchange
2. Partial obstruction with poor air
exchange
3. Complete or total obstruction
Intervention:
CONCIOUS PATIENT:
 ask the victim, “are you choking?”
 if the victim’s airway is obstructed partially, a crowing
sound is audible; encourage the victim to cough.
 relieve the obstruction by Heimlich maneuver
 Heimlich maneuver:
 stand behind the victim
 place arms around the victim’s waist
 make a fist
 place the thumb side of the fist just above the
umbilicus and well below the xyphoid process. Perform
5 quick in and up thrusts.
 Use chest thrusts for the obese or for the advanced
pregnancy victims.
 continue abdominal thrusts until the object is dislodged or
the victim becomes unconscious.
 UNCONSCIOUS PATIENT:
 assess LOC

 call for help

 Do chest compression

 open airway using jaw thrust technique

 finger sweep to remove object

 attempt ventilation

 reposition the head if unsuccessful; reattempt ventilation

 relieve the obstruction by the Heimlich maneuver with five thrust;

then finger sweep the mouth
 reattempt ventilation

 repeat the sequence of jaw thrust, finger sweep, breaths and

Heimlich maneuver until successful
 be sure to assess the victim’s pulse and respirations
 Choking child or infant:
 choking is suspected in infants and
children experiencing acute respiratory
distress associated with coughing,
gagging, or stridor.
 allow the victim to continue to cough if
the cough is forceful
 if cough is ineffective or if increase
respiratory difficulty is still noted,
perform CPR
 CARDIAC ARREST &
CARDIOPULMONARY
RESUSCITATION
 CARDIAC ARREST & CPR
Cardiac arrest – is the condition in
which circulation ceases and vital
organs are deprived of oxygen.
Three Conditions of Cardiac Arrest
1.Cardio Vascular Collapse
2.Ventricular Fibrillation
3.Cardiac Standstill
 CARDIOPULMONARY
RESUSCITATION (CPR)
CPR – this is a combination of
chest compressions and rescue
breathing. This must be combined
for effective resuscitation of the
victim of cardiac arrest.
COUGH CPR – it is a self-
initiated CPR, which is possible.
CHEST COMPRESSION ONLY-
CPR
HANDS-ONLY CPR
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.
Chest compression only-CPR is
recommended only in the following
circumstances:
1.When a rescuer is unwilling or unable
to perform mouth-to-mouth rescue
breathing, or
2.For use in dispatcher-assisted CPR
instructions where the simplicity of this
modified technique allow untrained
bystanders to rapidly intervene.
 CRITERIA FOR NOT STARTING CPR
The patient has a valid “Do not Attempt
Resuscitation” (DNAR) order.
The patient has signs of irreversible death:
rigor mortis, decapitation, or dependent
lividity, decomposition
No physiological benefit can be expected
because the vital fxns have deteriorated
despite maximal therapy for such
conditions as progressive septic or
cardiogenic shock
Spontaneous breathing
Withholding attempts to resuscitate in
the delivery room is appropriate for
newly born infants with:
- Confirm gestation <23 weeks or
birth weight <400grams
- Anencephaly
- Confirmed trisomy 13 or 18
 WHEN TO STOP CPR
S – Spontaneous signs of circulation
restored.
T – Turned over to medical services or
properly trained and authorized
personnel
O – Operator is already too exhausted
and cannot continue
P – Physician assumes responsibility
(declares death)
S – Scene becomes unsafe
 DONT’s while performing
CPR
Double crosser
Rocker
Jerking
Head banger
Bender
Star gazer
 COMPLICATIONS OF CPR:
RIB FRACTURE

STERNUM FRACTURE

LACERATION OF THE LIVER OR

SPLEEN

PNEUMOTHORAX, HEMOTHORAX
LAY RESCUER ADULT
CPR
Key issues and major changes for the 2010 AHA
Guidelines for CPR and ECC recommendations
for lay rescuer adult CPR are the following:

• The simplified universal adult BLS algorithm has

been created.

• Refinements have been made to recommendations

for immediate recognition and activation of the
emergency response system based on signs of
unresponsiveness, as well as initiation of CPR if the
victim is unresponsive with no breathing or no
normal breathing (ie, victim is only gasping).

• “Look, listen, and feel for breathing” has been

removed from the algorithm.
• Continued emphasis has been placed on high-
quality CPR (with chest compressions of
adequate rate and depth, allowing complete
chest recoil after each compression,
minimizing interruptions in compressions, and
avoiding excessive ventilation).
• There has been a change in the recommended
sequence for the lone rescuer to initiate chest
compressions before giving rescue breaths (C-
A-B rather than A-B-C). The lone rescuer
should begin CPR with 30 compressions rather
than 2 ventilations to reduce delay to first
compression.
• Compression rate should be at least
100/min (rather than “approximately”
100/min).
• Compression depth for adults has been
changed from the range of 1 1/2 to 2
inches to at least 2 inches (5 cm).
These changes are designed to simplify
lay rescuer training and to continue to
emphasize the need to provide early
chest compressions for the victim of a
sudden cardiac arrest
Emphasis on Chest Compressions*
2010 (New): If a bystander is not trained in CPR, the
bystander should provide Hands-Only™ (compression-
only) CPR for the adult victim who suddenly collapses,
with an emphasis to “push hard and fast” on the center
of the chest, or follow the directions of the EMS
dispatcher. The rescuer should continue Hands-Only CPR
until an AED arrives and is ready for use or EMS
providers or other responders take over care of the
victim. All trained lay rescuers should, at a minimum,
provide chest compressions for victims of cardiac arrest.
In addition, if the trained lay rescuer is able to perform
rescue breaths, compressions and breaths should be
provided in a ratio of 30 compressions to 2 breaths. The
rescuer should continue CPR until an AED arrives and is
ready for use or EMS provider stake over care of the
victim.
2005 (Old): The 2005 AHA Guidelines for
CPR and ECC did not provide different
recommendations for trained versus
untrained rescuers but did recommend that
dispatchers provide compression-only CPR
instructions to untrained bystanders. The
2005 AHA Guidelines for CPR and ECC did
note that if the rescuer was unwilling or
unable to provide ventilations, the rescuer
should provide chest compressions only.
Why: Hands-Only (compression-only)
CPR is easier for an untrained rescuer
to perform and can be more readily
guided by dispatchers over the
telephone. In addition, survival rates
from cardiac arrests of cardiac etiology
are similar with either Hands-Only CPR
or CPR with both compressions and
rescue breaths. However, for the
trained lay rescuer who is able, the
recommendation remains for the
rescuer to perform both compressions
and ventilations.
Change in CPR Sequence: C-A-B
Rather Than A-B-C*
2010 (New): Initiate chest
compressions before ventilations.
2005 (Old): The sequence of adult
CPR began with opening of the airway,
checking for normal breathing, and
then delivery of 2 rescue breaths
followed by cycles of 30 chest
compressions and 2 breaths.
Why: starting CPR with 30 compressions rather than 2
ventilations leads to improved outcome, chest
compressions provide vital blood flow to the heart and
brain, and studies of out-of-hospital adult cardiac arrest
showed that survival was higher when bystanders made
some attempt rather than no attempt to provide CPR.
Chest compressions can be started almost immediately,
whereas positioning the head and achieving a seal for
mouth-to-mouth or bag-mask rescue breathing all take
time. The delay in initiation of compressions can be
reduced if 2 rescuers are present: the first rescuer
begins chest compressions, and the second rescuer
opens the airway and is prepared to deliver breaths as
soon as the first rescuer has completed the first set of
30 chest compressions. Whether 1 or more rescuers are
present, initiation of CPR with chest compressions
ensures that the victim receives this critical intervention
early, and any delay in rescue breaths should be brief.
Elimination of “Look, Listen,
and Feel for Breathing”*
2010 (New): “Look, listen, and
feel” was removed from the CPR
sequence. After delivery of 30
compressions, the lone rescuer
opens the victim’s airway and
delivers 2 breaths.
2005 (Old): “Look, listen, and feel”
was used to assess breathing after
the airway was opened.
Why: With the new “chest compressions
first” sequence, CPR is performed if the
adult is unresponsive and not breathing or
not breathing normally (as noted above,
lay rescuers will be taught to provide CPR
if the unresponsive victim is “not
breathing or only gasping”). The CPR
sequence begins with compressions (C-A-
B sequence). Therefore, breathing is
briefly checked as part of a check for
cardiac arrest; after the first set of chest
compressions, the airway is opened, and
the rescuer delivers 2 breaths.
Chest Compression Rate: At
Least 100 per Minute*

2010 (New): It is reasonable for lay

rescuers and healthcare providers to
perform chest compressions at a rate
of at least 100/min.
2005 (Old): Compress at a rate of
about 100/min.
Why: The number of chest compressions delivered
per minute during CPR is an important determinant of
return of spontaneous circulation (ROSC) and survival
with good neurologic function. The actual number of
chest compressions delivered per minute is
determined by the rate of chest compressions and
the number and duration of interruptions in
compressions (eg, to open the airway, deliver rescue
breaths, or allow AED analysis). Provision of adequate
chest compressions requires an emphasis not only on
an adequate compression rate but also on minimizing
interruptions to this critical component of CPR. An
inadequate compression rate or frequent
interruptions (or both) will reduce the total number of
compressions delivered per minute.
 Chest Compression Depth*

2010 (New): The adult sternum

should be depressed at least 2 inches
(5 cm).
2005 (Old): The adult sternum should
be depressed approximately 1 1/2 to 2
inches (approximately 4 to 5 cm).
Why: Compressions create blood flow
primarily by increasing intrathoracic pressure
and directly compressing the heart.
Compressions generate critical blood flow and
oxygen and energy delivery to the heart and
brain. Confusion may result when a range of
depth is recommended, so 1 compression
depth is now recommended. Rescuers often
do not compress the chest enough despite
recommendations to “push hard.” In addition,
the available science suggests that
compressions of at least 2 inches are more
effective than compressions of 1 1/2 inches.
For this reason the 2010 AHA Guidelines for
CPR and ECC recommend a single minimum
depth for compression of the adult chest.
 HEALTHCARE
PROVIDER CPR
Key issues and major changes in the 2010 AHA
Guidelines for CPR and ECC recommendations
for healthcare providers include the following:

• Because cardiac arrest victims may present with a

short period of seizure-like activity or agonal gasps
that may confuse potential rescuers, dispatchers
should be specifically trained to identify these
presentations of cardiac arrest to improve cardiac
arrest recognition.

• Dispatchers should instruct untrained lay rescuers

to provide Hands-Only CPR for adults with sudden
cardiac arrest.
• Refinements have been made to recommendations
for immediate recognition and activation of the
emergency response system once the healthcare
provider identifies the adult victim who is
unresponsive with no breathing or no normal
breathing (ie, only gasping). The healthcare
provider briefly checks for no breathing or no
normal breathing (ie, no breathing or only gasping)
when the provider checks responsiveness. The
provider then activates the emergency response
system and retrieves the AED (or sends someone to
do so). The healthcare provider should not spend
more than 10 seconds checking for a pulse, and if a
pulse is not definitely felt within 10 seconds, should
begin CPR and use the AED when available.
• “Look, listen, and feel for breathing” has been
removed from the algorithm.
Increased emphasis has been placed on high-
quality CPR (compressions of adequate rate and
depth, allowing complete chest recoil between
compressions, minimizing interruptions in
compressions, and avoiding excessive ventilation).

• Use of cricoid pressure during ventilations is

generally not recommended.

• Rescuers should initiate chest compressions before

giving rescue breaths (C-A-B rather than A-B-C).
Beginning CPR with 30 compressions rather than 2
ventilations leads to a shorter delay to first
compression.
• Compression rate is modified to at least 100/min
from approximately 100/min.

• Compression depth for adults has been slightly

altered to at least 2 inches (about 5 cm) from the
previous recommended range of about 1. to 2
inches (4 to 5 cm).

• Continued emphasis has been placed on the need

to reduce the time between the last compression
and shock delivery and the time between shock
delivery and resumption of compressions
immediately after shock delivery.

• There is an increased focus on using a team

approach during CPR.
Cricoid Pressure
2010 (New): The routine use of
cricoid pressure in cardiac arrest is not
recommended.
2005 (Old): Cricoid pressure should
be used only if the victim is deeply
unconscious, and it usually requires a
third rescuer not involved in rescue
breaths or compressions.
Why: Cricoid pressure is a technique of applying
pressure to the victim’s cricoid cartilage to push
the trachea posteriorly and compress the
esophagus against the cervical vertebrae. Cricoid
pressure can prevent gastric inflation and reduce
the risk of regurgitation and aspiration during bag-
mask ventilation, but it may also impede
ventilation. Seven randomized studies showed that
cricoid pressure can delay or prevent the
placement of an advanced airway and that some
aspiration can still occur despite application of
cricoid pressure. In addition, it is difficult to
appropriately train rescuers in use of the
maneuver. Therefore, the routine use of cricoid
pressure in cardiac arrest is not recommended.
 Summary of Key BLS
Components for Adults,
Children, and Infants*

(see your copy)

 RECOVERY POSITION
The recovery position is used for
unresponsive adult victims who clearly
have normal breathing and effective
circulation.
This position is designed to maintain a
patent airway and reduce the risk of
airway obstruction and aspiration.
The victim is placed on his or her side
with the lower arm in front of the body.
Any questions???
Thank you!!! 