BASIC CARDIAC LIFE SUPPORT(BCLS)

PRESENTED BY
B.SC NURSING 3RD SEMESTER
BATCH-2022-26
 Index

S.NO TOPIC PAGE NO.

1 INTRODUCTION GENERAL CONCEPT OF

BLS
 Introduction of BCLS
 Definition of BCLS
 Purpose of BCLS
 Principle of BCLS

2 INTRODUCTION TO CPR
 Introduction
 Definition
 Purpose
 Principle
 Indication
 Contraindication
 Equipment of CPR
 Component of CPR
 Medication of CPR
 Initiating chain of Survival

3 BLS for Adults:

 Introduction
 Definition
 Principle
 Purpose
 Indication
 Contraindication
 Main component of CPR
 Algorithm
 One rescuer BCLS/CPR for Adults
 CPR steps
 Two rescuer BCLS /CPR for adults
 Adults mouth to mask ventilation
  Adult bag mask ventilation in two
rescuer

4 Automated external defebrilator (AED): -

 Introduction
 Definition
 Parts of AED
 Use of AED
 Steps of AED
 Acknowledgment
Acknowledgments enable you to
thank all those
who have had in carrying out the
research.
Carefull thought needs to be given
concerning those who
help should be acknowledge & in what
order.
The general advice is to express your
appreciation in a
concise manner & to avoid strong
emotive language..
Finally. I would like you thank our guider
Miss.Preeti Dubey
& our batchmets,without them this
project
could not be prepared…!!

THANKS….!!
Sai hospital
and college of nursing

Basic Cardiac
Life Support
and
Automated External
 Defibrillation
(BCLS+AED) Provider Course Manual

BCLS

INTRODUCTION TO BLS :- The cardiopulmonary resuscitation guideline

of Basic Cardiopulmonary Life Support (BCLS) for management of adult victims
with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise
approach for optimal outcome of the victims by trained medics and paramedics.
This guideline has been developed considering the need to have a universally
acceptable practice guideline for India and keeping in mind the infrastructural
limitations of some areas of the country. This guideline is based on evidence
elicited in the international and national literature. In the absence of data from
Indian population, the excerpts have been taken from international data, discussed
with Indian experts and thereafter modified to make them practically applicable
across India. The optimal outcome for a victim with cardiopulmonary arrest would
depend on core links of early recognition and activation; early high-quality
cardiopulmonary resuscitation, early defibrillation and early transfer to medical
facility. These links are elaborated in a stepwise manner in the BCLS algorithm.
The BCLS also emphasize on quality check for various steps of resuscitation.
DEFINITION of BCLS :-
 Basic Cardiac Life Support (BCLS) refers to the care healthcare providers and
public safety professional provide to patient who are experiencing respiratory
arrest, cardiac arrest or airway obstruction.
According to Wikipedia
 Basic Cardiac life support defines sequence of procedures performed to restore
the circulation of oxygenated blood after a sudden pulmonary or cardiac arrest
until they can be given full medical care of a hospital.

BCLS does not include the use of drug or invasive skill

According to AHA

Purposes :-
 To maintain an open and clear airway (A).
 To maintain breathing by external ventilation(B).
 To maintain blood circulation by external cardiac massages (C) .
 To save life of the patient.
 To provide basic Cardiaclife support till medical and advanced life support
arrives.

PRINCIPLE:-
2020 BCLS guidelines changes :
Approximately every five years the International Liaison Committee on Resuscitation
(ILCOR), updates the guidelines for CPR and ECC (Emergency Cardiac Care)

The content contained herein is based on the most recent ILCOR publications on BLS.
Recommendations for adult basic cardiac life support (BCLS) from the 2020 Guidelines
for CPR and ECC include the following:

 The importance of early initiation of CPR by lay rescuers has been re-
emphasized. The risk of harm to the patient is low if the patient is not in cardiac
arrest. Bystanders should not be afraid to start CPR even if they are not sure
whether the victim is breathing or in Cardiac Arrest.
 A sixth link, Recovery, was added to the Chains of Survival for both Pediatric
and Adults.
 Care of the patient after return of spontaneous circulation (ROSC) requires close
attention to oxygenation, blood pressure control, evaluation for percutaneous
coronary intervention, targeted temperature management, and multimodal
neuroprognostication
 Because recovery from cardiac arrest continues long after the initial
hospitalization, patients should have formal assessment and support for their
physical, cognitive, and psychosocial need
 After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-
based healthcare workers may be beneficial to support their mental health and
well-being.
 INTRODUCTION TO CPR

Cardiopulmonary resuscitation (CPR)

Overview
Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in
many emergencies in which someone's breathing or heartbeat has stopped. For
example, when someone has a heart attack or nearly drowns. The American Heart
Association recommends starting CPR with hard and fast chest compressions. This
hands-only CPR recommendation applies to both untrained bystanders and first
responders.
CPR can keep oxygen-rich blood flowing to the brain and other organs until
emergency medical treatment can restore a typical heart rhythm. When the heart
stops, the body no longer gets oxygen-rich blood. The lack of oxygen-rich blood
can cause brain damage in only a few minutes

DEFINITION OF (CPR )Cardiopulmonary

Resuscitation
An emergency procedure used to restart a person’s heartbeat and breathing
after one or both have stopped. It involves giving strong, rapid pushes to the
chest to keep blood moving through the body. Usually, it also involves blowing
air into the person’s mouth to help with breathing and send oxygen to the
lungs. Also called cardiopulmonary resuscitation.
According to AHA
When to seek emergency help:-
If you are untrained and have immediate access to a phone, call 911 or your local
emergency number before beginning CPR. The dispatcher can tell you how to do the
proper procedures until help arrives. To learn CPR properly, take an accredited first-aid
training course, including CPR and how to use an automated external defibrillator (AED).
If you're afraid to do CPR or unsure how to perform CPR correctly, know that it's always
better to try than to do nothing at all. The difference between doing something and doing
nothing could be someone's life.

Treatment
Before starting CPR, check:

 Is the environment safe for the person?

 Is the person conscious or unconscious?
 If the person appears unconscious, tap or shake their shoulder and ask loudly,
"Are you OK?"
 If the person doesn't respond and you're with another person who can help,
have one person call 911 or the local emergency number and get the AED, if
one is available. Have the other person begin CPR.
 If you are alone and have immediate access to a telephone, call 911 or your
local emergency number before beginning CPR. Get the AED if one is
available.
 As soon as an AED is available, deliver one shock if instructed by the device,
then begin CPR.

Remember to spell C-A-B

The American Heart Association uses the letters C-A-B to help people remember
the order to perform the steps of CPR.

 C: compressions
 A: airway
 B: breathing
Compressions: Restore blood flow
Compressions means you use your hands to push down hard and fast in a specific
way on the person's chest. Compressions are the most important step in CPR.
Follow these steps for performing CPR compressions:

1. Put the person on their back on a firm surface.

2. Place the lower palm of your hand over the center of the person's chest,
between the nipples.

3. Place the lower palm of your hand over the center of the person's chest,
between the nipples.
4. Place your other hand on top of the first hand. Keep your elbows straight.
Place your shoulders directly above your hands
5. Push straight down on the chest at least 2 inches (5 centimeters) but no more
than 2.4 inches (6 centimeters). Use your entire body weight, not just your
arms, when doing compressions.
6. Push hard at a rate of 100 to 120 compressions a minute. The American Heart
Association suggests performing compressions to the beat of the song
"Stayin' Alive." Allow the chest to spring back after each push.
7. If you haven't been trained in CPR, continue chest compressions until there
are signs of movement or until emergency medical personnel take over. If
you have been trained in CPR, go on to opening the airway and rescue
breathing.
Airway: Open the airway

 If you're trained in CPR and you've performed 30 chest compressions, open the
person's airway using the head-tilt, chin-lift maneuver. Put your palm on the
person's forehead and gently tilt the head back. Then with the other hand,
gently lift the chin forward to open the airway.

. Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if

the mouth is seriously injured or can't be opened. Current recommendations
suggest performing rescue breathing using a bag-mask device with a high-
efficiency particulate air (HEPA) filter.

1. After opening the airway (using the head-tilt, chin-lift maneuver), pinch the
nostrils shut for mouth-to-mouth breathing and cover the person's mouth with
yours, making a seal.
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one
second — and watch to see if the chest rises.
3. If the chest rises, give a second breath.
4. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give
a second breath. Thirty chest compressions followed by two rescue breaths is
considered one cycle. Be careful not to provide too many breaths or to
breathe with too much force.
5. Continue chest compressions to restore blood flow.
6. As soon as an automated external defibrillator (AED) is available, apply it
and follow the prompts. Give one shock, then continue chest compressions
for two more minutes before giving a second shock. If you're not trained to
use an AED, a 911 operator or another emergency medical operator may be
able to give you instructions. If an AED isn't available, go to step 7 below.
7. Continue CPR until there are signs of movement or emergency medical
personnel take over

PURPOSE OF CPR :-
1. To temporarily provide sufficient oxygenation to vital organs, especially
the brain and heart.
2. To stop the degenerative processes of ischemia and anoxia caused by
inadequate circulation and inadequate oxygenation.
3. To restore breathing and blood circulation.
4. To maintain perfusion of oxygenated blood to cells.
5. To prevent biological death until advanced cardiac life support measures can
be started

PRINCIPAL OF CPR:-
COMPONENTS Of CPR:-

INDICATION OF CPR:-
CONTRAINDICATION OF CPR:-

DRUG USED DURING CPR:-

FIRST LINE DRUGS

 Epinephrine 1mg every 3-5 min

 Vasopressin 40 units
 Atropine sulfate(bradycardia)
 Amiodarone( pulseless VT)

INITIATING CHAIN Of SURVIVAL

 BCLS FOR ADULTS
BCLS for adults focuses on doing several tasks simultaneously. In previous
versions of BCLS, the focus was primarily on one-rescuer CPR. In many
situations, more than one person is available to do CPR. This simultaneous and
choreographed method includes performing chest compressions, managing the
airway, delivering rescue breaths, and using the AED, all as a team. By
coordinating efforts, a team of rescuers can save valuable seconds when time lost
equals damage to the heart and brain .

Simple Adult BCLS Algorithm

ONE-RESCUER BCLS/CPR FOR ADULTS

Be Safe

• Make sure the scene is safe before proceeding.

• Move the person out of traffic.

• Move the person out of water and dry the person. (Drowning persons should be
removed from the water and dried off; they should also be removed from standing water,
such as puddles, pools, gutters, etc.)
• Be sure you do not become injured yourself.

Assess the Person

• Shake the person, tap their shoulder hard, and talk to them loudly.

• Check to see if the person is breathing. (Agonal breathing, which is occasional

gasping and is ineffective, does not count as breathing.)

Call EMS

• Send someone for help or to call your emergency number and to get an AED. • If
alone, call for help while assessing for breathing and pulse. (The ILCOR
emphasizes that cell phones are available everywhere now and most have a built-in
speakerphone. Call for help without leaving the person.)

CPR

• Begin sets of compressions and rescue breaths.

• Attach the AED pads when available.

CPR STEPS

 STEPS
CPR STEPS:-

TWO-RESCUER BCLS/CPR FOR ADULTS

Many times there will be a second person available that can act as a rescuer. The
ILCOR emphasizes that cell phones are available everywhere now and most have a
built-in speakerphone. Direct the second rescuer to call 112 or Emergency Medical
Services (EMS) without leaving the person while you begin CPR. This second
rescuer can also find an AED while you stay with the person. When the second
rescuer returns, the CPR tasks can be shared:

1. The second rescuer prepares the AED for use.

2. You begin chest compressions and count the compressions out loud.

3. The second rescuer applies the AED pads.

4. The second rescuer opens the person’s airway and gives rescue breaths.

5. Switch roles after every five cycles of compressions and breaths. One cycle
consists of 30 compressions and two breaths

. 6. Be sure that between each compression you completely stop pressing on the
chest and allow the chest wall to return to its natural position. Leaning or resting
on the chest between compressions can keep the heart from refilling in between
each compression and make CPR less effective. Rescuers who become tired may
tend to lean on the chest more during compressions; switching roles helps rescuers
perform high-quality compressions.

7. Quickly switch between roles to minimize interruptions in delivering chest

compressions.

8. When the AED is connected, minimize interruptions of CPR by switching

rescuers while the AED analyzes the heart rhythm
 ADULT MOUTH-TO-MASK VENTILATION

ADULT MOUTH-TO-MASK VENTILATION

In one-rescuer CPR, breaths should be supplied using a pocket mask, if available

. 1. Give 30 high-quality chest compressions.

 2. Seal the mask against the person’s face by placing four fingers of one hand
across the top of the mask and the thumb of the other hand along the bottom edge
of the mask (Figure 5a).

3. Using the fingers of your hand on the bottom of the mask, open the airway
using the head-tilt/chin-lift maneuver. (Do not do this if you suspect the person
may have a neck injury) (Figure 5b).

4. Press firmly around the edges of the mask and ventilate by delivering a breath
over one second as you watch the person’s chest rise.

ADULT BAG-MASK VENTILATION IN TWO-RESCUER CPR

If two people are present and a bag-mask device is available, the second rescuer is
positioned at the victim’s head while the other rescuer performs high-quality chest
compressions. Give 30 high-quality chest compressions.

1. Deliver 30 high-quality chest compressions while counting out loud (Figure 6a).

2. The second rescuer holds the bag-mask with one hand using the thumb and
index finger in the shape of a “C” on one side of the mask to form a seal between
the mask and the face, while the other fingers open the airway by lifting the
person’s lower jaw (Figure 6b).
3. The second rescuer gives two breaths over one second each as you watch the
person’s chest rise (Figure 6c).

4. Practice using the bag-valve-mask; it is essential to forming a tight seal and

delivering effective breaths.

Adult BCLS Algorithm

 UNRESPONSIVE
USE OF WITHOUT NORMAL
RESPIRATION

AUTOMATED
EXTERNAL CALL 911 /EMS

GET AED
DEFIBRILLATOR /DEFEBRILATOR

______________________________________________

AED ARRIVES

INTRODUCTION The automated external defibrillator (AED) is a device

that recognizes ventricular fibrillation and other dysrhythmias and delivers an
electric shock at the right time. The AED has become a common sight in public
buildings. The AED is nearly foolproof and will not allow you to make a mistake.
It is safe for anyone to use. In a witnessed cardiac arrest, where the person is
observed to suddenly collapse, the most common cause is likely to be ventricular
fibrillation and a defibrillator should analyze the person’s cardiac rhythm as soon
as possible. Using the team concept, one rescuer should coordinate all available
rescuers so that one rescuer performs chest compressions while the second rescuer
prepares the AED for use. Although there are many different brands of AEDs, all
are utilized in a similar way. Be sure to move the person and yourself to a safe
place before using the AED. Electricity and water can be lethal when combined.
Ensure that the person is not wet (quickly wipe dry) or in close proximity to water
before using the AED. It is safe to use an AED if the person is lying in snow. If the
person has an implanted device, such as a pacemaker, you will see a bulge over
their chest. Place the defibrillator pads as close to the correct position as possible
without being directly over the device. For persons with medication patches,
remove the patch, wipe the skin dry, and apply the AED pad .

DEFINITION :-
An automated external defibrillator (AED) is a medical device designed to analyze
the heart rhythm and deliver an electric shock to victims of ventricular fibrillation
to restore the heart rhythm to normal. An automated external defibrillator (AED)
is a medical device designed to analyze the heart rhythm and deliver an electric
shock to victims of ventricular fibrillation to restore the heart rhythm to normal.

PARTS OF AED
 STEPS OF AED

AED STEPS

1. Retrieve the AED (Figure 8a).

a. Open the case.

b. Turn on the AED.

2. Expose the person’s chest (Figure 8b)

a. If wet, dry chest.

b. Remove medication patches.

3. Open the AED pads (Figure 8c).

a. Peel off backing

b. Check for pacemaker or internal defibrillator.

4. Apply the pads (Figure 8d).

a. Apply one pad on upper right chest above the breast.

 b. Apply the second pad on lower left chest below the armpit.

5. Ensure the wires are attached to the AED box (Figure 8e).

6. Move away from the person (Figure 8f).

a. Stop CPR.

b. Clear the person to make sure no one is touching any part of the victim

SUMMARY
Basic Cardiac Life Support (BCLS),such as
cardio pulmonary resuscitation(CPR) is a
non invasive series of emergency life saving
procedures to treat airway Obstruction,
Respiratory arrest & Cardiac arrest.

BIBLIOGRAPHY

1) Brar Kaur Navdeep, Rawat HC, Textbook of Advanced Nursing Practices,

first edition, Jaypee brothers, page no.497- 505.
 2) Nursing of college Achi Omayal, Manual of Nursing Procedures &
Practices, 2nd edition, Kluwer Wolters, page no.304-310,796-805.

3) Tarachand Sonali Jadhav, R. Rekha, Jacob Annamma, Clinical Nursing

Procedures, The Art of Nursing Practices, 3rd edition, Jaypee brothers, page
no. 662-624.
4) Garg Rakesh, Ahmed Syed Moied, Indian Journal of Anaesthesia, Volume
61, issue 11, November 2017, page no.18-26.

5) Perkins GD, Handley AJ, Koster RW, Castren M, Smyth MA, Olasveengen
T, e. tal. European Resuscitation Council Guidelines for Resuscitation
2015: Section 2. Adult basic life support and automated external
defibrillation. Resuscitation 2015; 95: 81-99.

Net Reference-

1. https://www.slideshare.net/resmgs/cpr-45003243
2. https://www.heart.org>files>answers-by-heart
3. https://www.mycprcertificationonline.com
BSC NURSING 3RD SEMESTER