Basic Life Support

 

What would you do if you were suddenly confronted with one of the following situations?

• During class, a student suddenly falls to the floor with no respiration or pulse.
• While sparring, a student is knocked out or is struck on the throat and the trachea is compressed obstructing the airway.
• A student runs to you grabbing his throat and indicating something is obstructing his airway.

A student's life may depend on your ability to perform immediate and adequate resuscitation. Airway obstruction is an emergency situation that must be recognized and treated immediately since inevitably leads to loss of consciousness, followed by heart arrest, and, once the heart stops beating, irreversible brain damage and death will follow within 4 to 6 minutes unless effective cardiopulmonary resuscitation (CPR) is administered. Of course, a cardiac arrest requires immediate attention and appropriate action to prevent death or brain damage.

Basic Adult CPR

When confronted with a medical emergency situation, remember following algorithm:

H-H-H-A-B-C-D (Hazards - Hello - Help - Airway - Breathing - Circulation - Defibrillation)

• Hazards. Move person to a save place and or remove hazardous material that may be dangerous to you or the person.
• Hello. Assess person's responsiveness by tapping on his or her shoulder and asking, "Hello, can you hear me?" or " What's your name?" If person responds, treat his or her basic needs, such as compression on a nosebleed, to keep person comfortable till help arrives.
• Help. If the person is unresponsive, SHOUT for help or ask a bystander to standby while you check for breathing.
• Airway. Open airway by placing palm of one hand on the person's forehead to tilt the head backward, while lifting the bony part of person's chin forward with the fingers of your other hand. If you suspect a neck injury, do not tilt the head backward, but just lift or pull the chin forward.
• Breathing. Keeping the airway open, determine if person is breathing by placing your ear over the mouth facing the chest and feel, listen, and look for any breathing or chest movement. Take up to 10 seconds for this important procedure.
  • Breathing present. If an unconscious person is breathing, turn person on his or her side and hold person's chin up to prevent tongue from falling back and obstructing the airway again and also to allow blood or secretions to drain from mouth. Turn person as a unit by placing person's hand closest to you under his or her face, place his or her opposite hand and leg across his or her body, grab person by the hip with one hand and roll person gently toward you as your other hand supports person's chin and face. This is called the "Recovery position." Cover person with a blanket and stay with him or her until help arrives, continuously checking person's breathing.
  • Breathing not present. With one hand holding the jaw, just open the mouth and look inside for any visible foreign objects. If nothing is visible, keep the mouth open, and with the other hand sweep a finger across the inside of the mouth being careful not to push any object down the airway. Remove mouth guard and put dentures back in place since they help in providing a proper seal for mouth-to-mouth breathing.
  • At this stage, you have an unconscious person that is not breathing and is going to need CPR. Ask your helper to call 911 immediately and to tell them what the emergency and give details about location and a telephone number. If there is no helper, call 911 yourself because the sooner trained staff with proper equipment arrive, the better chance for a successful resuscitation.
  • If you are alone or the person is a child (or a drowning victim), give CPR for one minute, before calling emergency personnel. Return immediately to your victim and start rescue breathing by placing the person on his or her back on a firm surface. Mouth-to-mouth breathing is done while tilting the forehead backward with the one hand and, with the same hand, pinching the soft part of the nostrils closed with the thumb and index fingers. Take a deep breath and place your mouth as a seal over the persons partially opened mouth that is hold in this position by your other hand. Administrate a slow full breath into the person's airway for approximately 1.5 seconds, making sure the chest moves as you breathe. If no movement of the chest is observed, tilt the head more and hold the chin more upward. Lift your mouth and, while keeping the airway open, turn your head toward the person's chest so as to feel the exhaled air against your cheek, while you inhale another full breath for the next cycle. Give 2 effective breaths while giving proper time for exhalation. Then check for evidence of circulation, movement, swallowing, or presence of a pulse.
    
• Circulation. Feel for the presence of the carotid artery pulsation at the side of the neck. Keep the head tilted backward and place the fingertips of the other hand on the front of the persons neck at the level of the Adams apple. Gently slide the fingers back till they slide into the groove between the trachea and the strap muscles of the neck. Take up to 10 seconds to perform this very important procedure.
  • Circulation present. Continue with mouth-to-mouth breathing at a rate of 1 breath every 5 seconds, checking circulation after one minute (10 -12 rescue breaths). If breathing returns, place person on his or her side and monitor until the paramedics arrive.
  • Circulation not present. If there is no evidence of circulation within 10 seconds, start chest compressions. Place person on a firm horizontal surface. Locate lower end of the sternum with one hand, then place the heel of your other hand on the lower end on the mid line of the sternum. Place your hand nearest to the person's legs on top of the hand already on the sternum so that your fingers point away from you, keeping them of the chest wall. With your arms straight, compress the chest 15 times to a depth of 4-5 cm at a rate of 100 per minute.
  • No pressure must be exerted between compressions, but do not remove your hands from the sternum so that you do not waste time repositioning your hands. Count out loud every compression, and keep them as rhythmically and smooth as possible. After 15 compressions, immediately reopen the airway and administer 2 effective breaths, followed by checking hand positioning on the sternum and administering 15 compressions. After one minute of CPR, check for a pulse. Continue the airway-breathing-compression cycle until movement and spontaneous breathing starts or until medical help arrives.
  • When can you stop CPR. If any sign of life is detected, check for a pulse. If a pulse is detected but the person is not breathing, continue with rescue breathing at 12 breaths per minute. Once person starts breathing spontaneously, turn him or her as a unit on his or her side and monitor pulse and breathing until medical help arrives.
• Defibrillation. This is the procedure where the medics "shock" the person's heart back to a normal rhythm. Most cardiac arrests or sudden deaths are due to fibrillation (an abnormal ineffective contraction of the heart). The only way to get the person back to life is to defibrillate them but lives may still be saved if we can keep a person's circulation and respiration going until help arrives. Some locations may have a portable defibrillator present that may be used by civilians.
  

Points to remember

• Most people will start breathing by just opening their airway, and/or removing objects from the mouth, followed by 2 effective breaths.
• With proper compression of the chest, only 30 % of blood circulation is possible, so do not waste time between rescue breathing and compressions (15/2).
• The ultimate goal is to bring the person back to life again, if person's heart is fibrillating only the paramedics can save him or her. Your job is to keep the person alive till help arrives with a defibrillator.
• It becomes futile to keep doing CPR after 10 minutes, but to justify to yourself that you did your best, keep going as long as you can or until help arrives.
  

Airway Obstruction

Any object that obstructs the flow of air into the lungs may result in respiratory distress or death so rapid removal of such an obstruction is absolute. Numerous objects may cause an obstruction, such as teeth or a mouth guard. Any swelling of soft tissues in and around the upper airway or the tongue may cause obstruction by falling backward in the throat of an unconscious person lying on his or her back or side. Obstruction may be partial and person can still get some air into the lungs or it may be complete with a total obstruction.

Partial Obstruction. Swelling of the soft tissue in and around the neck, or compression of the trachea, usually causes this type of obstruction. A foreign object may also be responsible. The person will be in distress with wheezing and strong efforts to breath. Allow the person to sit up if he or he wants to. Encourage person to cough forcefully in an attempt to dislodge the object and give oxygen if available. Performing a Heimlich Maneuver (see below) on the person may clear the object from the airway. Have person transported as soon as possible to a hospital for more immediate and definitive treatment.

• Complete Obstruction. With this type of obstruction, the person usually grasps his throat with his fingers and thumbs and will not be able to breath, talk, or cough. Without help, the person he will soon lose consciousness and die.
  • What do you do when you are confronted with this situation?
  • Ask person "ARE YOU CHOKING?" If person cannot answer, it means he or she cannot talk. Perform the Heimlich Maneuver on the person. Move behind the person and place your arms around his or her waist. Form a fist with one hand so that its thumb rests in person's abdomen just above the navel, but well below the ribcage. Grab your fist with your other hand and perform a sudden inward and upward abdominal thrust. If the obstruction is not immediately relieved, perform up to five such thrusts until the obstruction is cleared or the person become unconscious.
• For an Unconscious Obstructed Airway Person
  • An unconscious person lying on his or her back cannot control his or her neck position and most of the time the neck is flexed and causing the tongue to falling back, blocking the throat. Therefore, the first thing to do when attending to an unconscious, unresponsive person is to tilt the head backward. Make 5 attempts at rescue breathing to ventilate the person. If unsuccessful, kneel astride (straddle position) the person's thighs and place the palm of one hand in the midline of person's abdomen just above the navel, but well below the ribcage. Place your other palm on top of the other hand and administrate a quick inward and upward thrust. These thrusts must be rapid and distinct, with the purpose of dislodging the obstruction. Repeat these thrusts up to 5 times before you open person's mouth to check for dislodgment of an object and then lifting the chin to check for breathing. Once the obstruction is relieved if no pulse is present, start rescue breathing and chest compressions. If you are alone, go for help if the obstruction has not been relieved after one minute.
    

Points to remember

Never put your finger blindly into a throat or you may push the obstructing object deeper. First, open the mouth and look inside.

A general reaction to a choking person is to slap him or her on the back. This technique may be used, and up to 5 slabs on the back between the shoulder blades may be given, only when the person can bend his or her head lower than the chest. Slapping a person on the back in an upright position causes the head to extend backwards opening the airway and may cause the obstructing object to be sucked deeper as the person attempts to inhale.

If the victim happens to be yourself, you may try a modified Heimlich on yourself, throw yourself against a firm edge such as the side of a table or the back of a chair so that the edge strikes you just above the navel or belt level.

Sources

Jacobs, J. Basic Life Support - essential guidelines for instructors