basic life support procedures and guidelines:The health professionals must be aware of the basic life support (BLS) and develop skill in doing it. Basic life support refers to the maintenance of an airway and support for breathing without any specific equipment.
The three basic principles involved in BLS are: a) Airway, b) Breathing; and c) Circulation.
Procedure to give BLS
i) Assess the level of consciousness of the mother by shaking her shoulders and ask if she can hear.
ii) Call for assistance and remain with the mother.
iii) Remove pillows, and put her in flat position.
iv) Clear the airway of any mucus, vomits, remove dentures.
v) Open the airway by tilting the head backwards and lifting the chin upwards (Fig. 5).
vi) Observe the chest for respiratory effort and listen for the breath sounds. Feel for breath exhaled by the mouth and nose of the mother.
vii) Feel and check the carotid artery. This is felt in the neck at the side of the mother’s larynx.
viii)If no breathing is noticed, mouth to mouth ventilation is indicated. To do this, the Midwife uses her hand behind mother’s neck to maintain the head in a position of maximum backward tilt. She then pinches the mother’s nostrils together with a thumb and index finger of her other hand which also continues to exert pressure on the forehead to maintain the backward tilt. Midwife, then takes a deep breath and exhale the air into the mother’s mouth so that her chest can be seen to rise. Thereafter allow the air to escape. Continue to do this repeatedly. Use a Ambu Bag or a moulded face mask if available.
ix) If no pulse is felt a pre-cordial thump is delivered centrally to the sternum. Then, using the fist a short, sharp blow is administered on the sternum. The fist is then removed quickly, and the pulse rechecked to see whether the blow has been effective is restarting the heart beat. The blow should start from a height of 15 cms.
x) Give external cardiac massage is needed if the pre-cardial thump is not successful to start the heart beat. For giving external cardiac massage, locate the Xiphisternum, place the palm downwards on top of one another with the fingers inter-linked. Position, the heel of the lower hand on the lower two thirds of the sternum. With arms straight lean on the sternum depressing 4-5 cms. and release it slowly as the same rate as compression. Repeat this action at the rate of eighty times per minute. To suitably carry out this procedure you may need to kneel over the mother or stand on something. Moreover, in order to be successful make sure that the surface under the mother is firm and she is properly positioned.
xi) Continue Chest compression and ventilation until help arrives and until those who are experienced in resuscitation are able to take over. If one person is present, a rate of 15 chest compressions to; breaths are carried out and if two people are available then the rate is 5 compressions to one breath.
Summary of basic life support procedures and guidelines
1) Call for help
2) Check breathing
3) Check pulse
4) Cardiac Arrest — give pre-cordial thump to chest
5) Recheck the pulse
6) Give 2 breaths to 15 compressions
7) Continue the procedure till further help arrives.