Basic Life Support (BLS)

Basic life support (BLS), also called basic cardiac life support (BCLS), includes
rapid entry into the EMS, performance of CPR, and use of techniques to clear
an obstructed airway.

CARDIAC ARREST

Cardiac arrest occurs when the heart stops beating or beats too ineffectively to
circulate blood to the brain and other vital organs. The beats, or contractions, of
the heart become ineffective if they are weak, irregular or uncoordinated,
because at that point the blood no longer flows through the arteries to the rest of
the body.

When the heart stops beating properly, the body cannot survive. Breathing will
soon stop, and the body’s organs will no longer receive the oxygen they need to
function. Without oxygen, brain damage can begin in about 4 to 6 minutes, and
the damage can become irreversible after about 10 minutes. A person in cardiac
arrest is unconscious, not breathing and has no heartbeat. The heart has either
stopped beating or is beating weakly and irregularly so that a pulse cannot be
detected.

Cardiovascular disease is the primary cause of cardiac arrest in adults. Cardiac

arrest also results from drowning, choking, drug abuse, severe injury, brain
damage and electrocution. Causes of cardiac arrest in children and infants
include airway and breathing problems, traumatic injury, a hard blow to the
chest, congenital heart disease and sudden infant death syndrome (SIDS).

Cardiac arrest can happen suddenly, without any of the warning signs usually
seen in a heart attack. This is known as sudden cardiac arrest or sudden cardiac
death and accounts for more than 300,000 deaths annually in the United States.
Sudden cardiac arrest is caused by abnormal, chaotic electrical activity of the

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heart (known as arrhythmias). The most common life-threatening abnormal
arrhythmia is ventricular fibrillation (V-fi b).

Cardiac Chain of Survival

CPR alone may not be enough to help someone survive cardiac arrest.
Advanced medical care is needed as soon as possible. A person in cardiac arrest
will have the greatest chance of survival if you follow the four links in the
Cardiac Chain of Survival:

1. Early recognition and early access to the emergency medical services

(EMS) system. The sooner someone calls help or the local emergency
number, the sooner EMS personnel will take over.
2. Early CPR. CPR helps supply blood containing oxygen to the brain and
other vital organs. This helps to keep the person alive until an AED is
used or advanced medical care is provided.
3. Early defibrillation. An electrical shock, called defibrillation, may help to
restore an effective heart rhythm
4. Early advanced medical care. EMS personnel provide more advanced
medical care and transport the person to a hospital.

For each minute that CPR and defibrillation are delayed, the chance for survival
is reduced by about 10 percent. In the Cardiac Chain of Survival, each link of
the chain depends on, and is connected to, the other links. Taking quick action
by calling 9-1-1 or the local emergency number, starting CPR immediately and
using an AED, if one is available, makes it more likely that a person in cardiac
arrest will survive. Remember, you first link in the Cardiac Chain of Survival.
By acting quickly, you can make a positive difference for someone experiencing
a cardiac emergency.

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What to Look for:

The main signals of cardiac arrest in an adult, a child and an infant are
unconsciousness and no breathing.

The presence of these signals means that no blood and oxygen are reaching the
person’s brain and other vital organs.

When to Call help or local emergency number

Call help or the local emergency number immediately if you suspect that a
person is in cardiac arrest or you witness someone suddenly collapse.

What to Do Until Help Arrives

Perform CPR until an AED is available and ready to use or advanced medical
personnel take over.

Early CPR and Defibrillation

A person in cardiac arrest needs immediate CPR and defibrillation. The cells of
the brain and other important organs continue to live for a short time—until all
of the oxygen in the blood is used.

CPR is a combination of chest compressions and rescue breaths. When the heart
is not beating, chest compressions are needed to circulate blood containing
oxygen. Given together, rescue breaths and chest compressions help to take
over for the heart and lungs. CPR increases the chances of survival for a person
in cardiac arrest.

In many cases, however, CPR alone cannot correct the underlying heart
problem: defibrillation delivered by an AED is needed. This shock disrupts the
heart’s electrical activity long enough to allow the heart to spontaneously
develop an effective rhythm on its own. Without early CPR and early
defibrillation, the chances of survival are greatly reduced.

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CPR for Adults

To determine if an unconscious adult needs CPR, follow the emergency action

steps:

 check the scene and the injured or ill person.

 Check for responsiveness by tapping the shoulder and shout, “Are you
okay?”
 Call for help or the local emergency number.
 check for breathing for no more than 10 seconds. Occasional gasps are
not breathing.
 Open the airway, by tilt head back slightly, lift chin manoeuvre
 If no breathing, give 2 rescue breaths.
 Quickly check for carotid pulse, if absent immediately begin chest
compression.
 If the person is not breathing, give care by beginning CPR.

For chest compressions to be the most effective, the person should be on his or
her back on a firm, flat surface. If the person is on a soft surface like a sofa or
bed, quickly move him or her to a firm, flat surface before you begin.

To perform CPR on an adult:

1) Position your body correctly by kneeling beside the person’s upper chest,
placing your hands in the correct position, and keeping your arms and
elbows as straight as possible so that your shoulders are directly over
your hands. Your body position is important when giving chest
compressions. Compressing the person’s chest straight down will help
you reach the necessary depth. Using the correct body position also will
be less tiring for you.
2) Locate the correct hand position by placing the heel of one hand on the
person’s sternum (breastbone) at the centre of his or her chest. Place your

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 other hand directly on top of the first hand and try to keep your fingers off
of the chest by interlacing them or holding them upward. If you feel the
notch at the end of the sternum, move your hands slightly toward the
person’s head. The person’s clothing should not interfere with finding the
proper hand position or your ability to give effective compressions. If it
does, loosen or remove enough clothing to allow deep compressions in
the centre of the person’s chest.
3) Give 30 chest compressions. Push hard, push fast at a rate of at least 100
compressions per minute. Note that the term “100 compressions per
minute” refers to the speed of compressions, not the number of
compressions given in a minute. As you give compressions, count out
loud, “One and two and three and four and five and six and…” up to 30.
Push down as you say the number and come up as you say “and.” This
will help you to keep a steady, even rhythm.
4) Give compressions by pushing the sternum down at least 2 inches. The
downward and upward movement should be smooth, not jerky. Push
straight down with the weight of your upper body, not with your arm
muscles. This way, the weight of your upper body will create the force
needed to compress the chest. Do not rock back and forth. Rocking
results in less-effective compressions and wastes much needed energy. If
your arms and shoulders tire quickly, you are not using the correct body
position.
5) After each compression, release the pressure on the chest without
removing your hands or changing hand position. Allow the chest to return
to its normal position before starting the next compression. Maintain a
steady down-and-up rhythm and do not pause between compressions.
Spend half of the time pushing down and half of the time coming up.
When you press down, the walls of the heart squeeze together, forcing the
blood to empty out of the heart. When you come up, you should release

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 all pressure on the chest, but do not take hands off the chest. This allows
the heart’s chambers to fill with blood between compressions.
6) Once you have given 30 compressions, open the airway using the head-
tilt/chin-lift technique and give 2 rescue breaths. Each rescue breath
should last about 1 second and make the chest clearly rise
a. Open the airway and give rescue breaths, one after the other.
b. Tilt the head back and lift the chin up
c. Pinch the nose shut then make a complete seal over the person’s
mouth.
d. Blow in for about 1 second to make the chest clearly rise.
7) Continue cycles of chest compressions and rescue breaths. Each cycle of
chest compressions and rescue breaths should take about 24 seconds.
Minimize the interruption of chest compressions.

If Two Responders Are Available

If two responders trained in CPR are at the scene, both should identify
themselves as being trained. One should call 9-1-1 or the local emergency
number for help while the other performs CPR. If the first responder is tired and
needs help:

 The first responder should tell the second responder to take over.
 The second responder should immediately take over CPR, beginning with
chest compressions.

When to Stop CPR

Once you begin CPR, do not stop except in one of these situations:

 You notice an obvious sign of life, such as breathing.

 An AED is available and ready to use
 Another trained responder or EMS personnel take over
 You are too exhausted to continue.

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  The scene becomes unsafe

If at any time you notice that the person is breathing, stop CPR. Keep his or her
airway open and continue to monitor the person’s breathing and for any changes
in the person’s condition until EMS personnel take over

Cardiac Emergencies in Children and Infants

It is rare for a child or an infant to initially suffer a cardiac emergency. Usually,

a child or an infant has a respiratory emergency first and then a cardiac
emergency develops.

Causes of cardiac arrest in children and infants include:

 Airway and breathing problems

 Traumatic injury or an accident (e.g., motor-vehicle collision, drowning,
electrocution or poisoning).
 A hard blow to the chest
 Congenital heart disease
 Sudden infant death syndrome (SIDS).

If you recognize that a child or an infant is not breathing, begin CPR.

CPR for a Child

If during the unconscious check, you find that the child is not breathing, place
the child face-up on a firm, flat surface. Begin CPR by following these steps:

1. Locate the proper hand position on the middle of the breastbone as you
would for an adult. If you feel the notch at the end of the sternum, move
your hands slightly toward the child’s head.
2. Position your body as you would for an adult, kneeling next to the child’s
upper chest, positioning your shoulders over your hands and keeping your
arms and elbows as straight as possible.

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 3. Give 30 chest compressions. Push hard, push fast to a depth of about 2
inches and at a rate of at least 100 compressions per minute. Lift up,
allowing the chest to fully return to its normal position, but keep contact
with the chest.
4. After giving 30 chest compressions, open the airway and give 2 rescue
breaths. Each rescue breath should last about 1 second and make the chest
clearly rise. Use the head-tilt/chin-lift technique to ensure that the child’s
airway is open.

Continue cycles of 30 chest compressions and 2 rescue breaths

CPR for an Infant

If during your check you find that the infant is not breathing, begin CPR by
following these steps:

1. Find the correct location for compressions. Keep one hand on the infant’s
forehead to maintain an open airway. Use the pads of two or three fingers
of your other hand to give chest compressions on the centre of the chest,
just below the nipple line. If you feel the notch at the end of the infant’s
sternum, move your fingers slightly toward the infant’s head.
2. Give 30 chest compressions using the pads of these fingers to compress
the chest. Compress the chest about 1½ inches. Push hard, push fast.
Your compressions should be smooth, not jerky. Keep a steady rhythm.
Do not pause between each compression. When your fingers are coming
up, release pressure on the infant’s chest completely but do not let your
fingers lose contact with the chest. Compress at a rate of at least 100
compressions per minute.
3. After giving 30 chest compressions, give 2 rescue breaths, covering the
infant’s mouth and nose with your mouth. Each rescue breath should last
about 1 second and make the chest clearly rise.

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Continue cycles of 30 chest compressions and 2 rescue breaths.