P.

E 1 BASIC LIFE SUPPORT (BLS) 1

SESSION I 5. Refer patient for further evaluation and management (if
PRINCIPLES OF EMERGENCY CARE necessary, depending on patient’s condition).
▣ GETTING STARTED GOLDEN RULES IN GIVING EMERGENCY CARE
1. PLANNING. Emergency plans should be established based on What to DO:
anticipated needs and available resources. ▣ Do remember to identify yourself to the victim.
2. PROVISION OF LOGISTICS. The emergency response begins ▣ Do obtain consent, when possible.
with the preparation of equipment and personnel before any ▣ Do think the worst. It’s best to administer first aid for the
emergency occurs. gravest possibility.
3. Remember the initial response as follows: ▣ Do provide comfort and emotional support.
• Ask for help ▣ Do respect the victim’s modesty and physical privacy.
• Intervene ▣ Do be as calm and as direct as possible.
• Do know further harm ▣ Do care for the most serious injuries first.
4. INSTRUCTION TO BY-STANDERS. Proper information and ▣ Do assist the victim with his or her prescription medication.
instruction to a helper/s would provide organized first aid care. ▣ Do keep onlookers away from the injured person.
▣ EMERGENCY ACTION PRINCIPLES ▣ Do handle the victim to a minimum.
1. SURVEY THE SCENE. Once you recognized that an emergency ▣ Do loosen tight clothing.
has occurred and decide to act, you must make sure that the What not to DO:
scene of the emergency is safe for you, the victim/s, and the ▣ Do not let the victim see his/her own injury.
bystander/s. ▣ Do not leave the victim alone except to get help.
Take time to survey the scene and answer these questions: ▣ Do not assume that the victim’s obvious injuries are the only
• Is the scene safe? ones.
• What happened? Nature of incident ▣ Do not make any unrealistic promises.
• How many people are injured? ▣ Do not trust the judgment of a confused victim and require
• Are there bystanders who can help? them to make decision.
• Then identify yourself as a trained first aider PRECAUATIONS TO PREVENT DISEASE TRANSMISSION
• Get consent to give care BODY SUBSTANCE ISOLATION (BSI) are precautions taken to
2. ACTIVATE MEDICAL ASSISTANCE (AMA) OR TRANSFER isolate or prevent risk of exposure from any other type of
FACILITY. In some emergencies, you will have enough time to bodily substance.
call for specific medical advise before administering first aid. BODY PRECAUTIONS AND PRACTICES
But in some situations, you will need to attend to the victim 1. PERSONAL HYGIENE. Maintaining these habits, such as
first. frequent hand washing and proper grooming, are two
▪ CALL FIRST AND CPR FIRST. Both trained and untrained important ways to prevent disease transmission regardless of
bystanders should be instructed to Activate Medical Assistance any personal protective equipment you might lose.
as soon as they have determined that an adult victim requires 2. PROTECTIVE EQUIPMENT. These are equipment and supplies
emergency care, “CALL FIRST”. While for infant and children, a that prevent you from making direct contact with infected
“CPR FIRST” approach is recommended. materials.
▪ Information to be remembered in activating medical 3. EQUIPMENT CLEANING AND DISINFECTING. This will
assistance: prevent infection or contamination or equipment and supplies
i. What happened? from spreading.
ii. Location?
iii. Number of persons injured? SESSION II
iv. Extent of injury and first aid given? INTRODUCTION TO BASIC LIFE SUPPORT
v. The telephone number from where you are calling? 1. BASIC LIFE SUPPORT (BLS). An emergency procedure that
vi. Person who activated medical assistance must identify consists of recognizing respiratory of cardiac arrest or both and
him/herself and drop the phone last the proper application of CPR to maintain life until a victim
3. DO A PRIMARY SURVEY OF THE VICTIM. In every emergency recovers or advanced life support is available.
situation, you must first find out if there are conditions that are 2. ADVANCED CARDIAC LIFE SUPPORT (ACLS). The use of
immediate threat to the victim’s life. Check for RESPONSIVENESS. special equipment to maintain breathing and circulation for the
4. DO A SECONDARY ASSESSMENT OF THE VICTIM. victim of a cardiac emergency.
It is a systematic method of gathering additional information 3. PROLONGED LIFE SUPPORT (PLS). For post resuscitation and
about the injuries or conditions that may need care. long term resuscitation
• Interview the victim
• S- signs and symptoms
• A- allergies
• M- medications
• P- past medical history
• L- last meal taken
• E- events prior to injury
▣ Check vital signs every 15 minutes if stable and every 5
minutes if unstable.
▣ Perform head-to-toe examination
◼ D- deformity
◼ C- contusion
◼ A- abrasion
◼ P- puncture
◼ B- burn
◼ T- tenderness
◼ L- laceration ADULT CHAIN OF SURVIVAL
◼ S- swelling
P.E 1 BASIC LIFE SUPPORT (BLS) 2
▣ THE FRIST LINK: Immediate recognition and activation of 6. Distal. Means distant, or far away from the point of
EMS reference.
◼ It is the event initiated after the patient’s collapse to 7. Posterior. Means toward the back.
recognize that the victim has experienced a cardiac arrest until 8. Lateral recumbent position. The patient is lying on the left
the arrival of Emergency Medical Services personnel or right side.
prepared to provide care. 9. Superior. Means toward, or closer to the head.
▣ THE SECOND LINK: Early CPR 10. Lateral. Refers to the left or right of the midline.
◼ It started immediately after the victim’s collapse, the 11. External. Means outside of the body.
probability of survival approximately 12. Anterior. Means toward the front.
doubles when it is initiated before the arrival of EMS. 13. Supine position. The patient is lying face up on his or her
▣ THE THIRD LINK: Rapid defibrillation back.
◼ It is the cornerstone therapy for patients who have just 14. Superficial. Means near the surface.
suddenly collapsed probably due to ventricular fibrillation and 15. Anatomical position. A patient’s body stands erect with
pulse-less ventricular tachycardia. arms down at the sides, palm facing you.
▣ THE FOURTH LINK: Effective ACLS 16. Deep. Means remote, or far from the surface
◼ If provided by highly trained personnel like paramedics, BODY REGIONS
provision of advanced care outside the hospital would be 1. Cranial Cavity
possible. ◼ Brain
▣ THE FIFTH LINK: Integrated post- cardiac of care 2. Thoracic Cavity
◼ Post cardiac arrest care after return of spontaneous ◼ Lungs
circulation (ROSC) can improve the likelihood of patient survival ◼ Heart
with good quality of life. 3. Pelvic Cavity
◼ Bladder
◼ Rectum
◼ Reproduction organs
4. Spinal Cavity
◼ Spinal cord
5. Abdominal Cavity
◼ Liver
◼ Pancreas
◼ Intestines
◼ Stomach
◼ Kidney
◼ Spleen
PEDIATRIC CHAIN OF SURVIVAL BODY SYSTEMS
▣ THE FIRST LINK: Prevention of arrest ▣ The Respiratory System
◼ In, children the leading cause of death is injury, and ◼ It delivers oxygen to the body, as well as removes carbon
vehicular accidents are the most common causes of fatal dioxide from the body. The passage of air
childhood injuries and child passengers’ safety seats can reduce into and out of the lungs is called respiration. Breathing in is
the risk of death. called inspiration or inhaling. Breathing
▣ THE SECOND LINK: Early and effective bystander CPR out is called expiration or exhaling.
◼ It is the most effective when started immediately after the ▣ The Circulatory System
victims collapse. The probability of survival approximately ◼ It delivers oxygen and nutrients to the body tissues and
doubles when it is initiated before the arrival of EMS. It is removes waste products. It consists of the
associated with successful return of spontaneous circulation heart, blood vessels, and blood.
and neurologically intact survival in children. Breathing and Circulation
▣ THE THIRD LINK: Rapid access to EMS system 1. Air that enters the lungs contains about 21 % oxygen and
◼ It is the cornerstone therapy for patients who have just only a trace of carbon dioxide. Air that is exhaled from the
suddenly collapsed probably due to ventricular fibrillation and lungs contains about 16 % oxygen and 4 % carbon dioxide.
pulse-less ventricular tachycardia. 2. The right side of the heart pumps blood to the lungs, where
▣ THE FOURTH LINK: Early and effective life support blood picks up oxygen and releases carbon dioxide.
◼ Initial steps in stabilization provide warmth by placing baby 3. The oxygenated blood then returns to the left side of the
under a radiant heat source, position head in a “sniffing” heart, where it is pumped to the tissues of the body.
position to open the airway, clear airway with bulb syringe or 4. In the body tissues, blood releases oxygen and takes up
suction catheter, dry baby and stimulate breathing. carbon dioxide after which it flows back to the right side of the
▣ THE FIFTH LINK: Integrated post- cardiac arrest care heart.
◼ Post cardiac arrest care after return of spontaneous 5. All body tissues require oxygen, but the brain requires more
circulation (ROSC) can improve the likelihood of patient survival than any other tissue.
with good quality of life. 6. When breathing and circulation stop, this is called Clinical
death (0-4 minutes brain damage not likely, 4-6 minutes
HUMAN BODY damage probable).
ANATOMICAL TERMS 7. When the brain has been deprived of oxygenated blood for a
1. Medial. Means towards the midline, or center of the body. period of 6 minutes or more an irreversible damage probably
2. Prone position. The patient is lying face down on his or her occurred. This is called Biological death (6-10 minutes brain
stomach. damage probable; over 10 minutes brain damage is certain).
3. Inferior. Means toward, or closer to the feet, 8. It is obvious from the above stated- facts that both
4. Proximal. Means close, or near the point of reference. respiration and circulation are required to maintain life.
5. Internal. Means inside the body.
P.E 1 BASIC LIFE SUPPORT (BLS) 3
THE NERVOUS SYSTEM ▣ COMPRESSION ONLY – CPR
It is composed of the brain, spinal cord and nerves. It has two If a person cannot perform mouth-to-mouth ventilation for an
major functions – communication and control. It lets a person adult victim, chest compression only – CPR should be provided
be aware of and react to the environment. It coordinates the rather than no attempt of CPR being made.
body’s responses to stimuli and keeps body systems working Chest compression only – CPR is recommended only in the
together. following circumstances:
Myocardial infarction. It occurs when the oxygen supply to the 1. When a rescuer is unwilling or unable to perform mouth-to-
heart muscle (myocardium) is cut-off for a prolonged period of mouth rescue breathing, or
time. This cut-off results from a reduced blood supply due to 2. For use in dispatcher-assisted CPR instructions where the
severe narrowing or complete blockage of the diseased artery. simplicity of this modified technique allow untrained
The result is death (infarction) of the affected part of the heart. bystanders to rapidly intervene.
WARNING SIGNALS ▣ CRITERIA FOR NOT STARTING CPR
▣ Chest discomfort characterized by: All patients in cardiac arrest receive resuscitation unless:
◼ Uncomfortable pressure, Squeezing, Fullness or tightness, • The patient has a valid “Do Not Attempt Resuscitation”
Aching, Crushing, Constricting, (DNAR) order.
Oppressive, Heavy. • The patient has signs of irreversible death: rigor mortis,
◼ Sweating decapitation, or dependent lividity.
◼ Nausea • No physiological benefit can be expected because the vital
◼ Shortness of breath functions have deteriorated despite maximal therapy for such
FIRST AID MANAGEMENT conditions as progressive septic or cardiogenic shock.
• Recognize the signals of heart and take action. • Withholding attempts to resuscitate in the delivery room is
• Have patient stop what he or she is doing and have him/her appropriate for newly born infants with:
sit or lie down in a comfortable position. Do not let the patient • Confirm gestation <23 weeks or birth weight <400g.
move around. • Anencephaly.
• Have someone call the physician or ambulance for help. • Confirmed trisomy 13 or 18.
• If patient is under medical care, assist him/her in taking WHAT TO DO
his/her prescribe medicine/s. APPROACH SAFETY
CARDIOVASCULAR DISEASE ▣ SCENE
Risk factors for Cardiovascular Disease ▣ VICTIM
1. Risk factors that cannot be changed (non-modifiable): ▣ RESCUER
◼ Heredity ▣ BYSTANDER
◼ Age CHECK RESPONSE
◼ Gender Shake shoulders gently
2. Risk factors that can be changed or controlled (modifiable): Ask “ Are you all right?”If he responds
◼ Cigarette smoking •Leave as you find him.
◼ Hypertension •Find out what is wrong.
◼ Stress •Reassess regularly.
◼ Obesity SHOUT FOR HELP
◼ Diabetes mellitus OPEN AIRWAY
◼ Lack of exercise ▣ HEAD TILT / CHIN LIFT
◼ Elevated cholesterol and triglyceride level ◼ Lay rescuers
◼ Non- healthcare rescuers.
SESSION III ▣ NO NEED FOR FINGER
CARDIOPULMONARY RESUSCITATION (CPR) SWEEP UNLESS SOLID
▣ CARDIAC ARREST Is the condition in which circulation ceases MATERIAL IS FOUND IN THE MOUTH.
and vital HEAD TILT/CHIN LIFT AND JAW THRUST
organs are deprived of oxygen. CHECK BREATHING
THREE CONDITIONS OF CARDIAC ARREST ▣ LOOK, LISTEN AND FEEL FOR NORMAL BREATHING.
▣ CARDIAC VASCULAR COLLAPSE. The heart is still beating but ▣ DO NOT MISTAKE AGONAL BREATHING FOR NORMAL
its action is so weak that blood is not being circulated through 30 CHEST COMPRESSIONS
the vascular system to the brain body tissues. ▣ Place the heel of your dominant hand in the center of the
▣ VENTRICULAR FIBRILLATION. Occurs when the individual chest.
fascicles of the heart beat independently rather than the ▣ Place the non-dominant hand on top.
coordinated, synchronized manner that produce rhythmic ▣ Interlock fingers
heart beat. ▣ Compress the chest
▣ CARDIAC STANDSTILL. It means that the heart has stopped ◼ Rate 100 min^-1
beating. ◼ Depth 4-5 cm
▣ CPR. This is a combination of chest compression and rescue ◼ Equal compression: Relaxation
breathing. This must be combined for effective resuscitation of ▣ When possible change CPR operatory every 2 mins.
the victim of cardiac arrest. 2 RESCUE BREATHS
▣ WHEN TO STOP CPR ▣ Head tilt / chin lift
◼ S – Spontaneous signs of circulation are restored. ▣ Pinch the nose
◼ T – Turned over to medical services or properly trained and ▣ Take a normal breath
authorized personnel. ▣ Place lips over mouth
◼ O – Operator is already exhausted and cannot continue CPR. ▣ Blow until the chest rises
◼ P – Physician assumes responsibility (declares ▣ Take about 1 second
DEATH/takeover) ▣ Allow chest to fall
◼ S – Scene became unsafe. ▣ Repeat
◼ S – Signed waver to stop CPR ▣ Recommendation
P.E 1 BASIC LIFE SUPPORT (BLS) 4
◼ Tidal volume SESSION V:
� 500 – 600 ml AUTOMATED EXTERNAL DEFIBRILLATOR
◼ Respiratory rate ▣ AEDs are sophisticated computerized devices that can
� Give each breaths over about 1sec with enough analyze heart rhythms and generate high voltage electric
volume to make the victim’s chest rise. shocks.
IF VICTIM STARTS TO BREATHE NORMALLY, PLACE IN ▣ Indications and importance
RECOVEY POSITION ◼ Early defibrillation is critical for victims of sudden cardiac
CONTINUE RESUSCITATION UNTIL- arrest because:
▣ Qualified help arrives and takes over � The most frequent rhythm in sudden cardiac arrest is
▣ The victim starts breathing normally ventricular fibrillation(VF).
▣ Rescuer becomes exhausted � The most effective treatment for VF is defibrillation.
� Defibrillation is most likely to be successful if it occurs within
SESSION IV: minutes of collapse (cardiac arrest)
RESCUE BREATHING � Defibrillation may be ineffective if it is delayed.
▣ INTRODUCTION � VF deteriorates to asystole if not treated.
◼ Respiratory arrest can result from a number of causes, ▣ SEVERAL FACTORS CAN AFFECT AED ANALYSIS:
including submission/ near-drowning, ◼ Patient movement (eg: agonal gasp)
stroke, FBAO, smoke inhalation, epiglottis, drug ◼ Repositioning the patient.
overdose,electrocution, suffocation, injuries, ▣ USE AED ONLY WHEN VICTIM HAVE THE FOLLOWING 3
myocardial infarction, lightning strike, and coma from any CLINICAL
cause. When primary respiratory arrest occurs, the heart and FINDINGS:
lungs can continue to oxygenate. ◼ No response
▣ RESPIRATORY ARREST is the condition in which breathing ◼ No breathing
stops or inadequate. ◼ No pulse
▣ CAUSES OF Respiratory arrest ▣ NOTE: Defibrillation is also indicated for pulseless
1. Obstruction ventricular tachycardia (VT)
1. Anatomical Obstruction Critical Concepts:
2. Mechanical Obstruction The 4 Universal Steps of AED Operation
2. Diseases 1. POWER ON the AED
1. Bronchitis 2. ATTACH the electrodes pads to the victim’s chest.
2. Pneumonia 3. Clear the victim and ANALYZE the heart rhythm.
3. Chronic Obstructive Pulmonary Diseases (COPD) and 4. Clear the victim and deliver a SHOCK (if indicated)
other respiratory illnesses. ▣ DIFFERENT TYPES OF AED
3. Other causes of Respiratory Arrest 1. AED Trainer
1. Chest compression (by physical forces) � Not capable of delivering a shock
2. Circulatory collapse � Do not allow to be confused with real units
3. Drowning 2. Semi – Automated Defibrillator
4. Electrocution � Requires the user to press the button for analysis and shock
5. External strangulation 3. Fully Automated Defibrillator
6. Poisoning � No intervention required for analysis and shock
7. Suffocation � They are programmed to run self-test and they will indicate
RESCUE BREATHING is a technique of breathing air into the when maintenance is needed.
person lungs to supply him or her oxygen needed to survive. ▣ SPECIAL CONDITIONS THAT AFFECT THE USE OF AED
▣ WAYS TO VENTILATE THE LUNGS ◼ The victim is month old or less
1. MOUTH-TO-MOUTH is a quick, effective way to provide ◼ The victims has a hairy chest
oxygen and ventilation to the victim. ◼ The victim is lying in water, immersed in water, or water is
2. MOUTH-TO-NOSE is recommended when it is impossible to covering the victim’s chest.
ventilate through the victim’s mouth, the mouth cannot be ◼ The victim has implanted defibrillator, or pacemaker.
opened (trismus), the mouth is seriously injured, or a tight ◼ The victim has a transdermal medication patch or other
mouth-to-mouth seal is difficult to achieve. object on the surface of the skin where the AED electrode pads
3. MOUTH-TO-MOUTH AND NOSE. If the victim is an infant (1 are placed.
year old), this is the best way in delivering ventilation by HOW DOES DEFIBRILLATOR WORK?
placing your mouth over the infant’s mouth and nose to create ▣ A brief high voltage electrical shock.
a seal. ▣ Through the heart between pads on the chest.
4. MOUTH-TO-STOMA. It is used if the patient has a stoma; a ▣ Shock briefly stops electrical heart activity.
permanent opening that connects the trachea directly to the ▣ May restart beating with a normal rhythm.
front of the neck. These patients breathe only through ▣ But not everyone can be saved, even with defibrillation.
the stoma.
5. MOUTH-TO-FACE SHIELD. It could provide very low
resistance ventilations to a patient by using a thin and flexible
plastic.
6. MOUTH-TO-MASK. If could deliver ventilation to a patient by
using a pocket facemask with a one-way valve to form a seal
around the patient’s nose and mouth.
7. BAG VALVE MASK DEVICE. It could deliver ventilation to a
patient by using a hand-operated device consisting of a self-
inflating bag, one-way valve, facemask, and oxygen reservoir.
P.E 1 BASIC LIFE SUPPORT (BLS) 5
AED PROCEDURES 2. MECHANICAL OBSTRUCTION. When foreign objects lodge in
1. BLS until AED is available the pharynx or airways; fluids accumulate in the back of the
2. Diagnose cardiac arrest throat.
◼ Unresponsive ▣ CLASSIFICATION OF OBSTRUCTION
◼ Not breathing normally 1. MILD OBSTRUCTION. Has good air exchange, responsive and
3. Go for or send someone for AED can cough forcefully. May wheeze coughs and increases
◼ 30 compressions respiratory difficulty and possibly cyanosis.
◼ 2 rescue breaths 2. SEVERE OBSTRUCTION. Has poor or no air exchange, weak
◼ Continue 30:2 or ineffective cough or no cough at all, with high-pitched noise
◼ CC + RB = “CPR” while inhaling or no noise at all, increased respiratory difficulty
ATTACH AED and possible cyanosis.
1. Power on FBAO MANAGEMENT
2. Follow voice prompts 1. Determine scene safety.
3. Expose chest 2. Introduce yourself to patient, guardian and/or bystander.
4. Attach pads in victim’s bare chest 3. Determine level of breathing difficulty by checking:
5. Keep following voice prompts ◼ Infant- ineffective cough, weak or absence of cry. If so, tell
6. Clear the victim and press analyze button parents/guardian that you are there to help.
GIVING A SHOCK ◼ Child/Adult- by asking if the victim is choking. If so, tell the
1. Be sure no one is touching the victim victim that you are there to help.
2. Press Shock button if instructed 4. Properly position the patient.
3. Resume CPR immediately after giving 1 shock ◼ Infant- Support the infant on rescuer’s knee or lap.
4. Follow voice prompts ◼ Child/Adult- Assume straddle position behind.
5. Record events 5. Locate proper site:
LEGAL IMPLICATIONS ◼ Infant- give 5 back slaps and 5 chest trust using 2 finger
1. Obtain recognized training techniques.
2. Practice skills and remain up to date with current guidelines ◼ Child/Adult- for abdominal thrust, properly position balled
3. AED must be of a recommended standard fist on the patient . Properly perform abdominal thrust.
4. AED must be maintained in accordance with manufacturers’ 6. Carefully lay down unconscious patient.
Recommendations 7. Shout for help. Activate Medical Assistance (For adolescent
AED MAINTENANCE & Adult).
1. Become familiar with your AED and how it operates. 8. Locate CPR hand position.
2. Check the AED for visible problems such as signs of damage. 9. Properly perform 30 Chest Compression.
3. Check the “ready – for – use” indicator on your AED (if so 10. Check oral cavity for presence of obstruction. If foreign
equipped) daily. body is not visible.
4. Perform all user- based maintenance according to the 11. Properly administer first RB.
manufacturer’s recommendations. 12. If air bounce back, re-tilt patient’s head and try again.
5. Make sure the AED carrying case contains the following 13. Properly administer second RB.
supplies at all times: 14. Check oral cavity for presence of obstruction. If foreign
◼ 2 sets of extra electrode pads (3 sets total) body is visible. Perform finger sweep.
◼ 2 pocket face masks 15. Check patency of airway by giving two breaths, note for
◼ 1 extra battery (if appropriate for our AED); some AEDs have visible chest rise.
batteries that last for years. 16. After 2 mins, activate Emergency Response System if still
◼ 2 disposable razors unconscious (for infant & child). (if still unconscious give 30
◼ 5 to 10 alcohol wipes compressions and 2 rescue breaths then apply AED if available.)
◼ 5 sterile gauze pads (4x4 inches), individually wrapped 17. If patient has become conscious, properly place in recover
◼ 1 absorbent cloth towel position. (do log roll for child and adult)
Remember: AED malfunctions are rare. Most AED “problem”
are caused by operator error or failure to perform
recommended user-based maintenance.

SESSION VI:
FOREIGN BODY AIRWAY OBSTRUCTION
▣ FBAO is a condition when solid material like chunked foods,
coins, vomitus, small toys, etc. are blocking the airway.
▣ CAUSES OF OBSTRUCTION
1. Improper chewing of large pieces of food.
2. Excessive intake of alcohol.
3. The presence of loose upper and lower dentures.
4. For children- running while eating.
5. For smaller children of “hand-to-mouth” stage left
unattended.
▣ UNIVERSAL SIGN OF CHOKING is a sign wherein the victim is
clutching his/neck with one or both hands and gasping for
breath.
▣ TWO TYPES OF OBSTRUCTION
1. ANATOMICAL OBSTRUCTION. When tongue drops back and
obstruct the throat. Other causes are acute asthma, croup,
diphtheria, swelling, and cough (whooping).