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Prevention, First Aid and Emergency Care
 § Sequence of actions for adult Basic Life Support
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AMCI Basic Mountaineering Course (BMC) 2002

Sequence of actions for adult basic life support

Provided by Resuscitation Council (UK)
Resuscitation Guidelines 2000

For the purposes of these guidelines an adult is considered a person aged 8 years or over.

1. Ensure safety of rescuer and victim

2. Check the victim and see if he responds:
  • Gently shake his shoulders and ask loudly: "Are you all right?"
3. A. If he responds by answering or moving:
  • Leave him in the position in which you find him (provided he is not in further danger), check his condition and get assistance if needed
  • Reassess him regularly
B. If he does not respond:
  • Shout for help
  • Unless you can assess him fully in the position you find him, turn the victim on to his back and then open the airway:
    • Place your hand on his forehead and gently tilt his head back keeping your thumb and index finger free to close his nose if rescue breathing is required
    • Remove any visible obstruction from the victimís mouth, including dislodged dentures, but leave well fitting dentures in place
    • With your fingertips under the point of the victim's chin, lift the chin to open the airway
Try to avoid head tilt if trauma (injury) to the neck is suspected

4. Keeping the airway open, look, listen and feel for breathing (more than an occasional gasp or weak attempts at breathing):
  • Look for chest movement
  • Listen at the victim's mouth for breath sounds
  • Feel for air on your cheek
Look, listen and feel for no more than 10 seconds to determine if the victim is breathing normally

5. A. If he is breathing normally:
  • Turn him into the recovery position (Left Lateral Position)
  • Send or go for help
  • Check for continued breathing
B. If he is not breathing or is only making occasional gasps or weak attempts at breathing:
  • Send someone for help or, if you are on your own, leave the victim and go for help; return and start rescue breathing as below
  • Turn the victim onto his back if he is not already in this position
  • Give 2 slow, effective rescue breaths, each of which makes the chest rise and fall:
    • Ensure head tilt and chin lift
    • Pinch the soft part of his nose closed with the index finger and thumb of your hand on his forehead
    • Open his mouth a little, but maintain chin lift
    • Take a deep breath to fill your lungs with oxygen, and place your lips around his mouth, making sure that you have a good seal
    • Blow steadily into his mouth whilst watching his chest; take about 2 seconds to make his chest rise as in normal breathing
    • Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out
  • Take another breath and repeat the sequence as above to give 2 effective rescue breaths in all
  • If you have difficulty achieving an effective breath:
    • Recheck the victim's mouth and remove any obstruction
    • Recheck that there is adequate head tilt and chin lift
    • Make up to 5 attempts in all to achieve 2 effective breaths
    • Even if unsuccessful, move on to assessment of the circulation
6. Assess the victim for signs of a circulation:
  • Look, listen and feel for normal breathing, coughing or movement by the victim
  • Only if you have been trained to do so, check the carotid pulse
  • Take no more than 10 seconds to do this
7. A. If you are confident that you have detected signs of a circulation:
  • Continue rescue breathing until the victim starts breathing on his own
  • About every 10 breaths (or about every minute) recheck for signs of a circulation; take no more than 10 seconds each time
  • If the victim starts to breathe normally on his own but remains unconscious, turn him into the recovery position. Be ready to turn him on to his back and re-start rescue breathing if he stops breathing
B. If there are no signs of a circulation, or you are at all unsure, start chest compressions:
  • With your hand that is nearest the victim's feet, locate the lower half of the sternum (breastbone):
    • Using your index and middle fingers, identify the lower rib edge nearest to you. Keeping your fingers together, slide them upwards to the point where the ribs join the sternum. With your middle finger on this point, place your index finger on the sternum itself
    • Slide the heel of your other hand down the sternum until it reaches your index finger; this should be the middle of the lower half of the sternum
    • Place the heel of the other hand on top of the first
    • Extend or interlock the fingers of both hands and lift them to ensure that pressure is not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or bottom tip of the sternum
    • Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum to depress it between 4 - 5 cms
    • Release all the pressure without losing contact between the hand and sternum, then repeat at a rate of about 100 times a minute (a little less than 2 compressions a second); it may be helpful to count aloud. Compression and release should take an equal amount of time
  • Combine rescue breathing and chest compression:
    • After 15 compressions tilt the head, lift the chin, and give 2 effective breaths
    • Return your hands without delay to the correct position on the sternum and give 15 further compressions, continuing compressions and breaths in a ratio of 15:2
    • Only stop to recheck for signs of a circulation if the victim makes a movement or takes a spontaneous breath; otherwise resuscitation should not be interrupted
8. Continue resuscitation until:
  • Qualified help arrives and takes over;
  • The victim shows signs of life;
  • You become exhausted

Notes on techniques of BLS

Rescue Breathing

  1. Only a small amount of resistance to breathing should be felt during rescue breathing and each rescue breath should take 2 seconds.
  2. If inflation is too quick resistance will be greater and less air will get into the lungs.
  3. The tidal volume to be achieved is about 700 - 1000 ml in an adult, which is the amount normally required to produce visible lifting of the chest.
  4. The rescuer should wait for the chest to fall fully during expiration before giving another breath. This should normally take about 2 - 4 seconds; each sequence of 10 breaths will therefore take about 40 to 60 seconds to complete.
  5. The exact timing of expiration is not critical; the chest should be allowed to fall before another breath is given.

Chest compression

  1. In an adult the aim should be to press down approximately 4-5 centimetres and apply only enough pressure to achieve this.
  2. At all times the pressure should be firm, controlled and applied vertically. Erratic or violent action is dangerous.
  3. The recommended rate of compression is a rate and not the number of compressions which are to be given in a minute; this will depend upon interruptions for rescue breathing.
  4. About the same time should be spent in the compression phase as in the released phase.
  5. As the chances are remote that effective spontaneous cardiac action will be restored by BLS without other techniques of advanced life support (including defibrillation), time should not be wasted by further checks for the presence of a circulation. If, however, the victim makes a movement or takes a spontaneous breath, the rescuer should check for signs of a circulation; take no more than ten seconds to do this. Otherwise resuscitation SHOULD NOT BE INTERRUPTED.
  6. The presence of dilated pupils has in the past been variously used as a sign of cardiac arrest, failure of the circulation during resuscitation, and the presence of established brain damage. This sign is unreliable and should not be used to influence management decisions before, during, or after cardiopulmonary resuscitation.

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