Adult basic life support sequence

Basic life support consists of the following sequence of actions:

1. Make sure the victim, any bystanders, and you are safe.

2. Check the victim for a response.
• Gently shake his shoulders and ask loudly, ‘Are you all right?’

3A. If he responds:
• Leave him in the position in which you find him provided there is no further
danger.
• Try to find out what is wrong with him and get help if needed.
•Reassess him regularly.

3B. If he does not respond:
• Shout for help.
• Turn the victim onto his back and then open the airway using head tilt and
chin lift:
o Place your hand on his forehead and gently tilt his head back.
o With your fingertips under the point of the victim’s chin, lift the chin
to open the airway.

4. Keeping the airway open, look, listen, and feel for normal breathing.
• Look for chest movement.
• Listen at the victim’s mouth for breath sounds.
• Feel for air on your cheek.

In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking
infrequent, noisy, gasps. This is often termed agonal breathing and must not be
confused with normal breathing.

Look, listen, and feel for no more than 10 s to determine if the victim is breathing
normally. If you have any doubt whether breathing is normal, act as if it is not normal.

5A. If he is breathing normally:
• Turn him into the recovery position (see below).
• Summon help from the ambulance service by mobile phone. If this is not
possible, send a bystander. Leave the victim only if no other way of obtaining
help is possible.
• Continue to assess that breathing remains normal. If there is any doubt
about the presence of normal breathing, start CPR (5B).

Initial rescue breaths
During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content
remains high. Therefore, ventilation is less important than chest compression at this
time.

It is well recognised that skill acquisition and retention are aided by simplification of the
BLS sequence of actions.
It is also recognised that rescuers are frequently unwilling to
carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection
and distaste for the procedure.
For these reasons, and to emphasise the priority of
chest compressions, it is recommended that, in adults, CPR should start with chest
compressions rather than initial ventilations.

Compression-only CPR

Studies have shown that compression-only CPR may be as effective as combined
ventilation and compression in the first few minutes after non-asphyxial arrest.
However,
chest compression combined with rescue breaths is the method of choice for CPR by
trained lay rescuers and professionals and should be the basis for lay-rescuer
education.
Lay rescuers who are unable or unwilling to provide rescue breaths, should
be encouraged to give chest compressions alone. When advising untrained laypeople
by telephone, use only compression only CPR.

Chest compression

In most circumstances it will be possible to identify the correct hand position for chest
compression without removing the victim’s clothes. If in any doubt, remove outer
clothing.

Each time compressions are resumed on an adult, the rescuer should place his hands
on the lower half of the sternum. It is recommended that this location be taught in a
simple way, such as ‘place the heel of your hand in the centre of the chest with the
other hand on top.’ This teaching should be accompanied by a demonstration of placing
the hands on the lower half of the sternum.
Use of the internipple line as a landmark
for hand placement is not reliable.

Performing chest compression:

a. Compress the chest at a rate of 100-120/ min.
b. Each time compressions are resumed, place your hands without delay ‘in the
centre of the chest’
c. Pay attention to achieving the full compression depth of 5-6 cm (for an
adult).
d. Allow the chest to recoil completely after each compression.
e. Take approximately the same amount of time for compression and
relaxation.
f. Minimise interruptions in chest compression.
g. Do not rely on a palpable carotid or femoral pulse as a gauge of effective
arterial flow.
h. ‘Compression rate’ refers to the speed at which compressions are given, not
the total number delivered in each minute.

Dr G Mohan- Trainer Advanced Life Support.