BASIC LIFE SUPPORT

BLS-ACLS TEAM
Division of Cardiology, Department of Internal Medicine
Dr Cipto Mangunkusumo General Hospital
Faculty of Medicine University of Indonesia
BLS-ACLS
TEAM :
Sally A Nasution, MD
Ika P Wijaya, MD
Tommy P Sibuea, MD
Ryan Ranitya, MD
Eka Ginanjar, MD
Muhadi, MD

Supervisor:
Irene Shiu (Hongkong)
Introduction
Sudden Cardiac Arrest (SCA) leading
cause of death in USA and Canada
CDCP USA = 330k annually die from
CHD before reaching a hospital or ER
250k of those deaths out of hospital
setting
The annual incidence of SCA in NA is
around 0.55 per 1000 population
How about INDONESIA..?
CPR Basics for Adults
Airway
Breathing
Circulation
Defibrillation
Lesson:
Chest Compression
Opening Airway and Giving Breaths
Compression-Ventilation
Compression-Ventilation-AED
CPR for infant and children
Relief of Chocking
Special Considerations
The AHA adult Chain of Survival
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation
Lesson 1: Chest Compression
1. Position yourself at the victims side
2. Make sure the victim is lying on his back on a firm, flat surface. If the
victim is lying facedown, carefully roll him onto his back
3. Move or remove all clothing covering the Victims chest.You need to be
able to see the skin
4. Put the heel of one hand on the center of the victims bare chest
between the nipples
5. Put the heel of one hand on top of the first hand
6. Straighten your arms and position your shoulders directly over your
hands
7. Push hard and fast. Press down 1 to 2 inches with each compression.
For each chest compression, make sure you push straight down on the
victims breastbone
8. At the end of each compression, make sure you allow the chest to
recoil or re-expand completely. Full chest recoil allows more blood to
refill the heart between chest compression. Incomplete chest recoil will
reduce the blood flow created by chest compression
9. Deliver compression in a smooth fashion at a rate of 100 compressions
per minute
Chest Compression
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation
Lesson 2: Opening the Airway and
Giving Breaths

Performing the Head Tilt-Chin Lift

Mouth-to-Mouth Breathing
Mouth-to-Barrier Device Breathing
Performing
the Head Tilt-Chin Lift
1. Place one hand on the victims forehead and
push with your palm to tilt the head back
2. Place the fingers of the other hand under the
bony part of the lower jaw near the chin
3. Lift the jaw to bring the chin forward
Mouth-to-Mouth Breathing
1. Hold the victims airway open with a head tilt-
chin lift
2. Pinch the nose closed with your thumb and
index finger (using the hand on the forehead)
3. Take a regular (not deep) breath and seal your
lips around the victims mouth, creating an
airtight seal
4. Give 1 breath (blow for 1 second). Watch for
the chest to rise as you give the breath
5. If the chest does not rise, repeat the head tilt-
chin lift
6. Give a second breath (blow for 1 second).
Watch for the chest to rise
Mouth-to-Mouth Breathing
Mouth-to-Barrier Device Breathing
1. Position yourself at the victims side
2. Place the mask on the victims face, using the bridge of
the nose as a guide for correct position
3. Seal the mask against the face:
Using your hand that closer to the top of the victims head,
place the index finger and thumb along the border of the
mask
Place the thumb of your other hand along the lower margin
of the mask
4. Place the remaining fingers of your hand closer to the
victims neck along the bony margin of the jaw and lift
the jaw. Perform a head tilt-chin lift to open the airway
5. While you lift the jaw, press firmly and completely
around the outside margin of the mask to seal the mask
against the face
6. Deliver air over 1 second to make the victims chest rise
Mouth-to-Barrier Device
Breathing
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation
Lesson 3:
Compression-Ventilation

1-Rescuer CPR
Step 1: Assessment
Step 2: Activate Emergency Response System
and Get an AED
Step 3: Open Airway and Check Breathing
Step 4: Give 2 Breaths
Step 5: Pulse Check
Step 6: Begin Cycles of 30 : 2

2-Rescuer CPR
Step 1: Assessment
1. Make sure the scene
is safe for you and the
victim
2. Tap the victims
shoulder and shout
Are you all right?

Step 2: Activate
Emergency Response
System and Get an
AED
Step 3: Open Airway
and Check Breathing
1. Open the victims airway
with head tilt-chin lift
manuver
2. Place your ear near the
victims mouth and nose
3. While observing the
victims chest:
Look
Listen
Feel

Step 4: Give 2 Breaths

(1 second each)
Step 5: Pulse Check
1. Maintain a head tilt with one hand on the victims
forehead
2. Locate the trachea, using 2 or 3 fingers of the other
hand
3. Slide these fingers into groove between the trachea
and the muscles at the side of the neck, where you
can feel the carotid pulse
4. Palpate yhe artery for at least 5 seconds and no
more 10 seconds
Step 6: Begin Cycles of 30 Chest
Compressions and 2 Breaths

30 2
30 2
2-Rescuer CPR
Rescuer 1 at the victims head
Perform chest compressions
Count out load
Switches duties with rescuer 2 every 5 cycles or 2
minutes, taking less than 5 seconds to switch
Rescuer 2 at the victims head
Maintains an open airway
Give breaths, watching for chest rise and avoiding
hyperventilation
Encourages rescuer 1 to perform compressions that are
fast and deep enough and to allow full chest recoil
between compressions
Switches duties with rescuer 1 every 5 cycles or 2
minutes, taking less than 5 second to switch
 2-Rescuer CPR
1. First Rescuer: performs bag-
mask ventilation using a
mask with supplementary
oxygen. The first rescuer
ensures that the chest rises
with each ventilation.
2. Second Rescuer performs
chest compressions.
3. The rescuers should change
positions for 5 cycles of CPR
(about every 2 minutes)
Mouth-to-mask E-C clamp technique of
holding mask while lifting the jaw.
Position your self at the victims head.
Circle the thumb and first finger around
the top of mask (forming a C) while
using the third, fourth, and fifth fingers
(forming an E) to lift the jaw

Two-rescuer use of bag mask. The rescuer

at the victims head tilts the victims head
and seals the mask against the victims face
with the thumb and first finger of each
hand creating a C to provide a complete
seal around the edges of the mask. The
rescuer uses the remaining 3 fingers
(theE) to lift the jaw (this holds the
airway open). The second rescuer slowly
squeezes the bag (over 1 second) until the
chest rises. Both rescuers should observe
chest rise.
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation
Lesson 4:
Compression-Ventilation-AED

Principles of Early Defibrillation

Automated External Defibrillator (AED)
2-Rescuer CPR Sequence With an AED
Principles of Early Defibrillation
The most common initial rhythm in
witnessed sudden cardiac arrest is
ventricular fibrillation (VF)
VF the heart quivers and does not
pump blood
The most effective treatment for VF is
electrical defibrillation
The probability of successful defibrillation
decreases quickly overtime
VF deteriorates to asystole if not treated
Automated External Defibrillator
(AED)
POWER ON the AED and follow the voice
prompts. Some devices will turn on when the AED lid
or carrying case is opened
ATTACH the AED
Select the correct pads (adult vs child)
Peel the backing from the pads
ATTACH the adhesive pads to bare skin of the victims
chest
Attach the electrode cable to the AED
Allow the AED to ANALYZE the victims rhythm
(clear the victim before analysis)
Deliver a SHOCK if needed (clear the victim before
shock)
If no shock is needed and after any shock delivery,
resume CPR beginning with chest compression
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation
Lesson 5:
CPR for Infant and Children
Infant : until 12 months year old A B C
Two-finger chest compression technique (1/3 to 1/2 the
depth of the chest compression)
Mouth to mouth and nose / Mouth to mouth
1-resuer 30 : 2 ; 2-rescuer 15: 2
Check pulse Brachial Artery
Children : 1 year until Puberty A B C D
1 or 2 hands for chest compression (1/3 to 1/2 the depth
of the chest compression)
HR < 60 start CPR
1 rescuer do 5 Cycles of CPR first than activate the
Emergency Response System
5 cycles first before use AED
1-resuer 30 : 2 ; 2-rescuer 15: 2
Lesson 6: Relief of Chocking
Lesson 7: Special Consideration
The AHA adult Chain of Survival
Critical Concepts.!!!

HIGH QUALITY AND EFFECTIVE CPR

Push hard, push fast: compress at a rate of 100

compressions per minute
Allow full chest recoil after each compression
Minimize interruptions in chest compressions: try
to keep interruptions to less than 10 seconds
Avoid hyperventilation