Basic life support (BLS) is a critical set of skills and techniques that the Emergency Medical System uses to support and sustain vital functions during a cardiac or respiratory arrest, where the first few minutes are critical for successful treatment outcomes. It is designed to help sustain and preserve life in emergency situations, in and out of hospital settings. BLS protocols focus on assessing and maintaining airway, breathing, and circulation while also providing early defibrillation when necessary.
I. Basic Life Support General Concepts
A. General Concepts of BLS
General Concepts of BLS refer to the fundamental principles and techniques used in Basic Life Support, which is the immediate care given to individuals who are experiencing a life-threatening emergency. BLS is designed to provide initial stabilization and support until more advanced medical care can be given. These general concepts of BLS are fundamental to providing immediate, lifesaving care to individuals in an emergency situation.
B. Initiating Chain of Survival
The Chain of Survival is a concept developed by the American Heart Association (AHA) that outlines the steps necessary to improve the survival rate of individuals experiencing cardiac arrest. The Chain of Survival consists of key components: Early recognition and activation of the emergency response system, Early CPR, Early defibrillation, and Advanced Life Support, Post cardiac care or advanced monitoring, and Recovery.
C. 2020 BLS Guideline Changes
In 2020, the American Heart Association updated the BLS guidelines. The changes include an emphasis on high-quality CPR, a shift from the traditional ABC (Airway, Breathing, Circulation) sequence to CAB (Circulation, Airway, Breathing), and modifications to the compression-to-ventilation ratio during Cardiopulmonary Resuscitation. Approximately every five years, the International Liaison Committee on Resuscitation (ILCOR), updates the guidelines for CPR and Emergency Cardiac Care.
II. BLS for Adults
A. BLS for Adults
Basic Life Support (BLS) for adults involves a series of steps designed to support and sustain vital functions during a cardiac or respiratory arrest. The steps include checking for responsiveness, opening the airway, checking for breathing, starting chest compressions, providing rescue breaths, and using an automated external defibrillator (AED) if available. The goal of BLS for adults is to maintain an open airway, adequate breathing, and circulation to vital organs until healthcare professionals can administer advanced medical care.
B. One Rescuer BLS/CPR for Adults
One rescuer BLS/CPR for adults is a technique used when only one person is available to perform BLS. The Cardiopulmonary Resuscitation steps are similar to those for BLS for adults but are performed by a single rescuer. The rescuer should start with chest compressions and provide rescue breaths as needed. It is important to avoid interruptions to chest compressions and to maintain a compression rate of 100-120 per minute.
C. Two-Rescuer BLS/CPR for Adults
Two-rescuer BLS/CPR for adults is a technique used when two people are available to perform BLS. One rescuer should perform chest compressions while the other provides rescue breaths. Coordinating and communicating effectively is important to avoid interruptions in chest compressions and maintain a compression rate of 100-120 per minute.
D. Adult Mouth-to-Mask and Bag-Mask Ventilation
Adult mouth-to-mask and bag-mask ventilation are techniques used to provide rescue breaths during BLS for adults. Mouth-to-mask ventilation involves the rescuer providing breaths by placing a mask over the patient's mouth and nose and delivering air through the mask. Bag-mask ventilation involves using a bag-mask device to deliver air to the patient. Both techniques require the rescuer to maintain an open airway and to provide breaths at a rate of 10-12 per minute.
E. Adult Basic Life Support (BLS) Algorithm
The Adult Basic Life Support (BLS) Algorithm is a step-by-step guide used to perform BLS for adults. The algorithm is designed to be followed in a logical and sequential manner to ensure that BLS is performed effectively and efficiently. The BLS algorithm should be used as a guide and can be modified based on the specific needs of the patient and the situation.
III. Use of Automated External Defibrillator
Use of Automated External Defibrillator (AED)
An Automated External Defibrillator (AED) is a portable device that analyzes a patient's heart rhythm and delivers an electric shock, if necessary, to restore normal rhythm. AEDs are often used in conjunction with Cardiopulmonary Resuscitation to increase the survival rate of individuals experiencing cardiac arrest.
IV. BLS for Children (1 to 8 years)
A. BLS for Children 1 – Puberty
BLS for children aged 1 to puberty involves similar steps to BLS for adults, but with some differences. The steps include checking for responsiveness, opening the airway, checking for breathing, starting chest compressions, providing rescue breaths, and using an automated external defibrillator (AED) if available. The compression depth should be one-third the depth of the chest, and compressions should be performed at a rate of 100-120 per minute. Rescue breaths should be delivered using a mask with a one-way valve, and the ventilation rate should be 10-12 breaths per minute.
B. One & Two Rescuer BLS for Children
One-rescuer BLS for children involves performing the same steps as BLS for adults or children with some modifications, such as using one hand to perform chest compressions for infants and two hands for children. Two-rescuer BLS for children involves one rescuer performing chest compressions while the other provides rescue breaths.
C. Pediatric BLS Algorithm
The Pediatric Basic Life Support (BLS) Algorithm is a step-by-step guide designed to help rescuers perform effective BLS on infants and children. The algorithm provides a clear and logical approach to assessing and treating pediatric cardiac arrest.
D. Child Ventilation
Child ventilation during BLS involves delivering rescue breaths using a mask with a one-way valve. The ventilation rate should be 10-12 breaths per minute, and it is important to avoid over-ventilation or under-ventilation. The rescuer should monitor the chest rise and fall to ensure adequate ventilation. If the child is not breathing, rescue breaths should be given before chest compressions.
V. BLS for Infants (0 to 12 months)
A. One Rescuer BLS for Infants (0 to 12 months old)
One Rescuer Basic Life Support (BLS) is a life-saving technique used for infants aged 0 to 12 months in emergency situations. The procedure involves a single rescuer performing chest compressions and rescue breaths to restore breathing and maintain circulation in the infant. The primary goal of one rescuer BLS for infants is to ensure that the infant's airway is open, breathing is restored, and circulation is maintained until professional help arrives. While performing BLS for infants can be challenging and stressful for the rescuer, it is critical to remain calm and follow the appropriate steps to increase the infant's chances of survival.
B. Two Rescuer BLS for Infants (0 to 12 months old)
Two rescuer BLS for infants aged 0 to 12 months involves two rescuers working together to provide care to the infant. The technique requires a different approach than that used for adults or older children, and it is important to know the appropriate steps to take in order to provide effective and efficient care. By working together, the two rescuers can provide care more effectively and efficiently, potentially increasing the infant's chances of survival. It is important for both rescuers to communicate effectively and work in a coordinated manner to ensure that the care provided is consistent and effective.
VI. AED for Children and Infants
Automated External Defibrillator (AED) Infants & Children
Following the appropriate guidelines and protocols is essential when using an AED on an infant or child. It is critical to ensure that the child is not in contact with any metal or water and that the pediatric pads are used instead of the adult pads. Additionally, it is important to ensure that the child is lying flat on their back and that the rescuer is not in contact with the child during the analysis and shock delivery.
VII. Airway Management
A. Airway Management
Airway management is an essential component of emergency care, and it involves the maintenance and restoration of a patient's airway to ensure that they are able to breathe adequately. One technique used in airway management is rescue breathing, also called mouth-to-mouth rescue breathing.
B. Mouth-to-Mouth Rescue Breathing
Mouth-to-mouth rescue breathing, or mouth-to-mouth resuscitation, is a basic life support technique used to provide oxygen to a patient who is not breathing. This technique is often used in emergencies, such as drowning or cardiac arrest, where prompt intervention can significantly affect the patient's outcome.
C. Rescue Breathing
Rescue breathing is a basic life support technique used to supply oxygen to a patient who is not breathing or has difficulty breathing. This technique involves the rescuer blowing air into the patient's lungs using their own mouth. Rescue breathing aims to provide oxygen to the patient and maintain their breathing until advanced medical care arrives.
VIII. Relief of Choking
Relief of Choking For Adults, Children, & Infants
Choking occurs when a foreign object, such as a piece of food, get lodged in the throat and blocks the airway. This can be a life-threatening emergency, as it can cause the affected person to suffocate. The relief of choking requires immediate action to remove the obstruction and restore normal breathing. The techniques used to relieve choking differ slightly between adults, children, and infants.