Teaching: Basic Life Support (BLS)

PLAB 2 CaseBank
1

Where are you:
You are an FY2 in Accident and Emergency Department.

Who is the Patient:
Alex Wilson is a 3rd year medical student who has not attended his Basic Life Support Class. He came today for you to learn about it now.

What you must do:
Talk with Alex and please demonstrate and teach him the BLS, explain him the steps of BLS.

Special Note:
Do not perform mouth to mouth breathing.

Introduce yourself:

  • Hello, are you Alex?
  • I’m Dr. XYZ, one of the junior doctors here.

Rapport :

  • I can see you come here today to learn.
  • That’s very good.
  • In which year, are you in?
  • How do you find your studies?
  • Very soon, you will be here teaching.
  • If you need any help, please let me know.
  • Best of luck in your exams.

Assess knowledge:

  • How much do you know about BLS?
  • Have you seen chest compression before?
  • That’s very good, you read before you came that shows how a good student you are!
  • Do you know why we do CPR?
  • When the heart or lung stops, we do CPR to restore their function. Simply it’s a lifesaving technique, so you need to know it exactly very well because you can save patient’s life.

Start teaching :

  • Before we go ahead, at any time, if you think I’m going too fast or I can’t express myself very well, You can stop me and I’ll be more than happy to explain it again.
  • Involve the student:
    – Are you following me?
    – Am I clear so far?
    – Do you know what we are looking for?

Steps of BLS

  1. Safety
  • Ensure the place is safe.
  • Not in work place, main road or wet area.
  1. Check response
  • Tapping on his shoulder
  • Hello, Are you alright?
    Note: If mannequin on its side, turn it on its
    back.
  1. Call for help
  • Assign anyone to be next to the patient during that time.

Airway

  • Head tilt chin lift to check for any foreign body
  • What to do if you find any foreign body?
  • Make sure that you make your little finger like a hook to remove the FB to pull it (not pushing).
  • If you suspect there is spinal cord injury then check the airway by Jaw Thrust method.

Breathing

  • Come close to his face to
    – Listen his breathing sounds
    – Look for his chest rise
    – Feel for his breathing touching your face
  • If no breathing → call 999 ( or use AED).
  • Start CPR immediately.
  • Checking for breathing should not last > 10 sec.

Circulation

  • Feel carotid pulse at same time of checking for breathing.

CPR

  • Make your arm straight.
  • Your shoulders are perpendicular to patient’s chest.
  • Place heel of your dominant hand on lower 1/3 of his chest but not on xiphi-sternum.
  • Interlock or cross your fingers of both hands.
  • Start to press
  • Depth should be 5-6 cm or 1/3 of the chest diameter.
  • Rate: 2 compressions / sec or 100-120 compressions /min
  • Do the chest compressions for 2 minutes and then reassess patient by checking his breathing\ and circulation but no more than 10 seconds
  • Then repeat compressions again and so on until no improvement or signs of life
    (30 compressions then giving 2 rescue breaths.
    – This is now obsolete according to the new NHS and WHO guidelines in adults)
  • Make sure you are not compressing xiphi-sternum , do you know why? Because, it can lead to a fracture.

chest cpr GIF

Important Notes

  1. If student asks you, when to stop ?
    – If ambulance arrives.
    – If you can see signs of life.
    – If you get tired.

  2. In paediatrics BLS → same as adult, Differences are:
    – Give 5 rescue breaths before starting CPR.
    – CPR rate = 15:2.
    – Use one hand if child is > 1 year.
    – if child is < 1 year , use 2 fingers.

  3. If the student start to yawning:
    – Are you ok ?
    – I can see you are yawning , are you tired ?
    – Should I carry on ?

  4. Assess student at CPR and rescue breaths:
    – Can you please show me how to do CPR ?

  5. If student asks you, could CPR cause rib fracture ?
    – Yes , it may happen , but the most important thing is to save his life.

  6. In any teaching station :
    – Use medical terms.
    – Check for understanding along the station.

10 Likes
2

Why 2 min for compression what about the 30:2 ratio

1 Like
3

30:2 (compression with breathing) for 2 minutes then assess for signs of life. and then continue back to 30: 2 (compression with breathing)
I hope that helps you understand that better.

8 Likes
4

Shall we say “Dr. XYZ” or just our name? I know we don’t use Dr. with our colleagues but in this scenario, we teach to a med student. Is that the reason why we use it?

1 Like
5

We believe here in NHS, most teaching sessions are preplanned. It’s not like you randomly start teaching a student about ALS. In this scenario, it’s a personal preference how you wanna introduce yourself, there is no right and wrong in using Dr as a title. You can also say, I’m Dr X YZ and you can call me X.

Hoping that answers your question.

4 Likes
6

Pediatrics bls

  1. Danger: check if child is in danger

  2. Response: check for response by tapping the child

  3. Shout for help in 3 directions

  4. Check Airway and see if it’s patent and has no secretions

  5. Check the Breathing
    6)Give 5 rescue breaths

  6. Count the carotid pulse for 5 seconds

  7. If there is a pulse > 60 , give only rescue breaths ie 1 breath every 3 seconds

  8. if pulse is <60,

  9. Do 4 cycles of cpr for 1 minute
    15 chest compressions and 2 rescue breath.

  10. Give 100-120 compressions 1cm above the xiphistentum and 5 cm depth
    12). Give 2 rescue breaths
    13). Repeat the cpr
    14). Call 222/999 ask for arrest team
    15). Continue cpr

2 Likes
7

Teaching Pediatric BLS

  1. Move patient to safety
  2. Check for response
  3. Call for help 3 times in 3 directions…left, front, right
  4. A-Assess airway. Head tilt and Chin lift and if cervical spine injury, do jaw thrust
  5. Breathing: bring your face close to patient’s face and listen for gush of air for 10seconds. Then give 5 rescue breaths
  6. C- circulation. Check carotid pulse for 10 seconds. Start CPR at a rate of 15 chest compressions to 2 rescue breaths. Do 4 cycles
  7. Then call the ambulance and let them know your ADDRESS, CONDITION OF PATIENT, WHAT YOU HAVE DONE FOR PATIENT AND WHY YOU NEED THE AMBULANCE URGENTLY. Ideally in the UK, ambulance will show up within 10minutes or as soon as possible
  8. While you wait for ambulance, reassess patient by checking for gushing of air for 5seconds, give 2 rescue breaths and check carotid pulse for 5seconds
  9. Continue CPR at a rate of 15 compressions :2 breaths till you become exhausted or the ambulance arrives.
    10-5-10 5-2-5
3 Likes
8

Is it carotid pulse or femoral pulse for pediatric bls

9

Please amend changes in the text too

10

Rescue breaths
If you are trained to do so, after 30 compressions, provide 2 rescue breaths.
Alternate between providing 30 compressions and 2 rescue breaths.
If you are unable or unwilling to provide ventilations, give continuous chest
compressions.

It is from the resuscitation UK council 2021.

There is no carotid pulse in UK BLS. Please enlighten me on the carotid pulse thing.

11

What’s with the Ambu bag in the examination
Any idea how to deal with that ??

2 Likes