BASIC Life Support

10/14/2014 1:15:00 AM

DRS ABCD
WASH HANDS

DANGER

Check around patient/env for danger ex: Electrical wires

Safety of yourself, bystanders and casualty like fire or traffic
IF there is danger we dont go in
USE Personal protective gear esp if any body fluids/sharps?

RESPONSIVENESS

Gentle touching (shoulder grasp, sternal rub, tap clavicle) +

Loud Shouting
DO NOT SHAKE
COWS
o Can you hear me?
o Open your eyes
o Whats your name?
o Squeeze my hand
Failed response/Minor Response without eye opening
UNCONCSCIOUS

SEND FOR HELP! + NOTE THE TIME

POINT AT BYSTANDER, YOU! CALL 000!

If no one around and person looks like trauma victim /found him
like that - do ABCD for two minutes
If you saw he had a heart attack and no ones aroundI CALL
000 before ABCD

AIRWAY

Loose dentures? Remove

Open Mouth and Look for blockages + do not blindly remove with
finger swipe: Tongue Food Vomit if found TURN HEAD
o Clear any visible blockages using your fingers
If C spine suspected use PRECAUTION keep minimal movement
to head and neck + maybe use suction if available
Infant in neutral head position, child/adult in head tilt/chin lift

Open AIRWAY with head tilt (NOT NECK) chin lift if NO SPINE
injury
Jaw Thrust if risk of spine injury
o Place fingers behind mandible and pull the jaw upwards
and use thumbs to open the mouth slightly
DONT OPEN AIRWAY FIRST IF BLOCKS ARE FOUND WILL
MOVE BACK AND OBSTRUCT TRACHEA FURTHER

BREATHING

Roll onto back (gently back to neutral if C Spine injury

suspected)and CHECK FOR BREATHING (ABSENT or ABNORMAL)
Listen for up to 10 seconds whist maintaining head tilt/jaw
thrust

LOOK LISTEN FEEL for 10 seconds

LOOK for movements in chest wall

LISTEN for breath sounds
FEEL breath on your cheek/movement of chest
o If patient is breathing + UnconsciousRecovery!
Remove glasses
Move hand near to you away
Move furthest arm across and put hand on cheek
Lift furthest leg up and push on it
Patient turns over

Open airway (head tilt chin lift)

Keep closest knee ( that was first lifted and pushed

on) flexed to 90 degrees
If doubtful patient is breathing move them to their
back and check again

CPR
Begun if no breaths/not breathing normally!
30 compression before 2 Breaths take turns with trained helper (switch
every 2 min) or continue till you tire
30 Chest Compressions:
100-120/min to depth of 5-6cm
extend elbows, wrists and fingers
hands are palm down with fingers interlocked
carpal area over mid-sternum (not above/below)
allow for proper recoil
heel of hand in child, 2 fingers in infant but same Rate/Ratio
(30:2)
2 Rescue Breaths

occlude nostrils, head-tilt/chin lift seal around patients lips

breath a normal expiration of 1 second

pocket mask? press around face with index finger and thumb
on either side and pinkys thrusting the mandible out and preform
2 normal expirations- must have adequate seal over mouth
+ nose.
o Be at victims head and hold it + mask + jaw thrust
LOOK FOR CHEST RISE then allow for exhalation
No rise? Check Airway/seal by mask (MAINTAIN HEAD/JAW
method of opening the airway)

Cant do breaths? Just do compressions - 100/min

When engaging in chest compressions:
interruptions to compressions should be minimised
compressions should be fast and hard

over-ventilation should be avoided.

Allow for proper recoil

Defibrillator

Continue CPR while someone else operates AED

Pads across the chest (one in anterior and one in lateral) and
switch it ON
Ensure good contact between pad/skin (look for air bubbles and
shave hair and remove moisture )
o Do not put pads over jewelry/clothes/implanted devices
8cm away from implanted device!
o Do not put pads near things that reduces skin contact like
medication patches or ECG electrodes
o Dry skin first if wet before attaching pads

o REMOVE O2 mask by 1 m there is one

One pad to the right of the upper sternum below the
clavicle
Other below the left nipple with center of pad on midaxillary
CPR SHOULD NOT BE STOPPED while someone attaches
pads

Analyzing rhythm => STOP compressions + NO ONE

TOUCHES
o Is the rhythm shockable? No? Continue compressions
Shockable? STAND CLEAR EVERYBODY
o Bed or floor wet? No one touches these areas
o Shock delivered command will prompt now clear to
touch the patient
Back to 30 compressions : 2 breaths, leave machine on and in 2
minutes (ie after 5 cycles) it will reanalyze follow machines
commands ie repeat.

CONTINUE CPR / Defib UNTIL RESPONSIVE/NORMAL/next shock

cycle/till paramedic comes/too tired/ health care professional
says CPR should be ceased.

Hand Hygeine and Vital Signs

10/14/2014 1:15:00 AM

Hand Hygeine: total time = 40 60 with soap and 20-30 with gel

Remove Jewelry
Wet hands and wrist thoroughly and apply soap
Rub palm to palm
Rub back of hand and repeat with the other
Rub palm to palm with fingers interlaced
Rub back of fingers with hands clasped
Rub thumb
Rub Finger tips
Rub around the wrists

Rinse hands under water with fingers first and let water drain
towards the wrist
Pat hands with paper towel moving from fingers to wrist
Use paper towel to turn off taps

Vital Signs
Temp
PR
RR
BP
Others: O2 sat, Neuro obs, BSL, Urine
Changes with Age, RF, body position, smoking, exercise, food
1. Temperature
a. Normal is 36.6 to 37.2 in adults, 38 in child/infant
b. Temp changes 0.-1 during 24 hour period
c. Highes at 6PM
d. Core> Surface
e. Site: beneath tongue, tympanic, Axillary, Rectal
i. Age/Condition determines site
ii. Rectal + Tympanic = core but rectal more accurate
1. Avoid Tympanic: Hearing aid, newborns, ear
wax, ear trauma
2. Avoid Rectal: Diarrhea, Rectal Surgery, ICD
iii. Oral underestimates by 0.5 and Axillary by 1 =>
Surface Temp
1. Avoid Oral in: Face trauma, unccoperative,
epilepsy, shaking, infant
2. Avoid Axillary in uncooperative + takes a long
time

2. Pulse
a. Note the baseline
b. Strongest in arties closes to heart, palpable if close to surface
c. Adults use Radial (Located on lateral, flexor aspect of wrist
over the distal radius) /Carotid
d. Infants/Small children: Brachial (Located on the anteromedial
aspect of the cubital fossa medial to the biceps tendon)/Apex
(on MCL)
e. Neonate: Apex(before 4yo between MCL and Ant Axillary line
ie more lateral)
i. Apex gives you Rate and Rhythm on Auscultation
f. Done for 30 seconds (x2 for BPM), Full Minute if
Abnormal
g. Rate (BPM)
h. Volume (Amp/Strength thread/weak or strong/bounding)
i. Not heard when auscultating Apical Pulse
i. Rhythm
i. Regular intervals
ii. Pulses & Pauses at unequal intervals (Regularly
irregular)
iii. No pattern (Irregularly Irregular)
j. (ADULT)60-100 -110 -160 (NEONATE)
k. Tachy is >100 and Brady <60 in Adults
l. Brady can be normal in adults
3. Resp Rate
a. Note the baseline
b. Assessed over 30s, if irregular done for 60s
c. Do it during pulse measure position look at 1 cycle of breath
in breath out
d. Adults:16-25 -Neonate:30-40
e. Rate + use of accessory muscles or just diaphragmatic
f. Depth ~ Degree of Chest Wall Movement deep? Normal?
Shallow?
g. Rhythm: Irregular/Regular
h. Stridor on inspiration. Wheezing on expiration
i. Brady<8, tachy>25
j. Cheyne Stokes: shallow breaths increasing in depth and
rate then decrease and stop for 15- 30 seconds

k. Kussmauls: Abnormally deep and regular with increased RR

4. Blood Pressure
a. 120-130/80-84 is normal, mild >130/85 moderate
>140/90moderate II >160/100 Severe >180/110
b. Average of 3 sets of readings taken at weekly intervals
c. Neonates 70-90 >12 100-120
d. Normal BP<140/90
e. Hypertension >140/90
f. Hypotension is below normal range for age
g. Orthostatic drop in 15 of systolic when going supine to
standing.
h. Parts of Cuff I forget
i. Arterial line marker is placed OVER the Brachial Artery
ii. Clockwise valve knob to pump it up, anticlockwise to
iii.
i. Cuff
i.
ii.

release
Remove clothing from the arm
Sizes
Newborn to adult thigh, if too small, high reading, too
large low reading
When wrapping, make sure the INDEX line on the

arm is in the RANGE area that is going to wrap over it

iii. Palpate brachial artery so artery marker is over the
right area
iv. Cuff is 2.5-5cm above the Cubital Fossa
j. Measure BP
i. WASH HANDS before and after
ii. Confirm patient has not consumed/done in the last 30
MIN:
1. Food Tobacco Alcohol
2. Exercised
iii. Patient should not speak + 5 minutes to relax
o Brachial artery in line with heart and supported
iv. Difference of 10 between arms is normal
v. Popliteal is 20 higher than arms
k. Approximate the systolic by inflating cuff while palpating
radial pulse until it disappears then deflate slowly, 3-4 mmHg
per second until the radial pulse returns this is
observed systolic then rapidly deflate

l. Wait 30 seconds before using steth

m. Palpate Brachial artery and place Steth Diaphragm! Over the
brachial artery occluded by the BP Cuff
i. Diaphragm should not touch the cuff/clothing/tubing
ii. Cuff re inflated 30mmHG ABOVE at which radial
pulse reappears=> Avoid BP measurement during any
Auscul Gap
iii. Deflate at 3-4 mmHg/s
n. First K Sound is Systolic, 4th is a disappearing blowing sound
and is diastolic in Children, 5th sound of SILENCE is diastolic in
adults
o. RAPIDLY deflate, record BP to THE NEAREST 2 mmHg!!
p. WAIT 30 S BEFORE REPEATING ON THE SAME ARM
AND AVERAGE 2 READINGS!
q. HAND HYGEINE
i. Ascultatory Gap: Sound disappears after first K
temporarily for upto 40mmHg solved by inflating 30
mm above observed systolic
ii. If HOF/Peripheral VD in anemia or Aortic Insuff or preg
Silent 5th Sounds only when cuff fully deflated so use
phase 4 instead

Position Patient Properly

Palpate radial artery and count pulsation for 15 seconds then x4 = BPM
Count pulse for a full minute if abnormalities are detected
Do not tell the patient you are assessing their respirations
Count that for 30 seconds and x2

If abnormalities are detected count for a full minute

Blood Pressure
Cuff size
o Choose cuff appropriate for Pxs arm Size

10/14/2014 1:15:00 AM