You could save a life

By Smriti Daniel

Someone collapses in front of you - you know the next few minutes are critical, but do you know what to do? Basic Life Support or BLS consists of life saving techniques that can be applied by anyone with basic training, without any sophisticated equipment or drugs, says Dr. Senaka Rajapakse, Consultant Physician and Senior Lecturer in Medicine at the Faculty of Medicine.

BLS recovery positions

This week, he shares some basic instructions with MediScene, along with the do's and don'ts of life support.

The ABC's of life support:

Applying BLS correctly can help save the life of someone who has collapsed and is unresponsive. When someone collapses, it could be because he is not breathing, his heart is not beating, or both. In essence, basic life support focuses on providing the basic ABCs:

A for Airway: to protect and maintain an open airway
B for Breathing: the actual flow of air through respiration, natural or artificial respiration
C for Circulation: the movement of blood through the beating of the heart or manual compression of the heart

As you can imagine, time is of critical importance. The faster you initiate basic life support, the better the person's chances of survival. In developed countries, emergency care is provided by trained personnel, supported by a system that allows them to respond rapidly. However, even a trained lay person can provide adequate basic life support. It is important to follow the standard protocol which has been laid according to standard guidelines. This is detailed below.

Basic life support consists of the following sequence of actions:

Someone collapses. You rush to his or her side.Don't panic. Stay calm, and do things in sequence.

• Make sure the victim, any bystanders, and you are safe. Do not attempt to move the victim, even if a hospital or doctor’s clinic is close at hand.
• Check the victim for a response.
• Gently shake his shoulders and ask loudly, 'Are you all right?'

If he responds:

• Try to find out what is wrong with him and get help if needed.
• Leave him in the position in which you find him provided there is no further danger. (for example, from falling debris or passing vehicles)
• Check on him regularly to ascertain that he is still alright.

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: To do this, place your hand on his forehead and gently tilt his head back. With your fingertips under the point of the victim's chin, lift the chin to open the airway.

Keeping the airway open, look, listen, and feel for normal breathing. How do you determine if he has 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 (where the heart has stopped), a victim may be barely breathing, or taking infrequent, noisy, gasps. Do not confuse this with normal breathing. Look, listen, and feel for no more than 10 seconds to determine if the victim is breathing normally. If you have any doubt whether breathing is normal, act as if it is not normal.

If he is breathing normally:

Turn him into the recovery position. There are several variations of the recovery position, each with its own advantages. No single position is perfect for all victims. The position should be stable, near a true lateral position with the head dependent, and with no pressure on the chest to impair breathing.

To place a victim in the recovery position:

• Remove the victim's spectacles (if he's wearing them)
• Kneel beside the victim and make sure that both his legs are straight.
• Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost.
• Bring the far arm across the chest, and hold the back of the hand against the victim's cheek nearest to you.
• With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.
• Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you onto his side.
• Adjust the upper leg so that both the hip and knee are bent at right angles.
• Tilt the head back to make sure the airway remains open.
• Adjust the hand under the cheek, if necessary, to keep the head tilted.
• Check breathing regularly.
• If the victim has to be kept in the recovery position for more than 30 minutes turn him to the opposite side to relieve the pressure on the lower arm.
• Send or go for help, or call for an ambulance.
• Check for continued breathing.

If he is not breathing normally:

• Ask someone to call for help or an ambulance. If you are alone, do this yourself.
  Start chest compression as follows:
• Kneel by the side of the victim.
• Place the heel of one hand in the centre of the victim's chest.
• Place the heel of your other hand on top of the first hand.
• Interlock the fingers of your hands and ensure that pressure is not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
• Position yourself vertically above the victim's chest and, with your arms straight, press down on the sternum 4 - 5 cm.
• After each compression, release all the pressure on the chest without losing contact between your hands and the sternum.
• Repeat at a rate of about 100 times a minute (a little less than 2 compressions a second). Compression and release should take an equal amount of time.

Combine chest compression with rescue breaths.

• After 30 compressions open the airway again using head tilt and chin lift.
• Pinch the soft part of the victim's nose closed, using the index finger and thumb of your hand on his forehead. Allow his mouth to open, but maintain chin lift.
• Take a normal breath and place your lips around his mouth, making sure that you have a good seal. Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath. 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 normal breath and blow into the victim's mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions.
  Continue with chest compressions and rescue breaths in a ratio of 30:2.
  Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation. If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt:
• Check the victim's mouth and remove any visible obstruction.
• Recheck to make certain that there is adequate head tilt and chin lift.

Do not attempt more than two breaths each time before returning to chest compressions. Giving mouth to mouth is not something many people are comfortable with. Most are concerned that they may catch an infection from the victim. While there have been a few instances of transmission of infections like TB and SARS, HIV infection has never been reported.

If there is more than one rescuer present, another should take over CPR about every 2 min to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers.

If you are not able to, or reluctant to give rescue breaths, continue chest compressions as this reduces the chance of brain damage. They should be given at a continuous rate of 100 per minute. Chest compressions only have been shown to be effective in maintaining blood circulation.

Continue resuscitation until:

• qualified help arrives and takes over,
• the victim starts breathing normally, or
• you become exhausted.

If the patient starts breathing normally, then turn him to the recovery position, and check regularly.