Chapter 13: BLS Resuscitation
basic life support (BLS) -
Noninvasive emergency lifesaving care that is used to treat medical conditions, including
airway obstruction, respiratory arrest, and cardiac arrest.
if patient is not breathing adequately or at all you.... -
may be able to restore normal breathing simply by opening the airway. However, if the
patient has no pulse, then you must combine artificial ventilation with artificial circulation (chest
compressions). If breathing stops before the heart stops, then the patient may have enough oxygen
in the lungs to stay alive for several minutes. But when cardiac arrest occurs first, the heart and brain
stop receiving oxygen immediately
cardiopulmonary resuscitation (CPR) -
is used to establish circulation and artificial ventilation in a patient who is not breathing and
has no pulse. The steps for CPR include the following:
First, restore circulation by performing chest compressions to circulate blood to the vital organs of
the body.
Next, perform 30 high-quality compressions to a depth of 2 inches to 2.4 inches (5 cm to 6 cm) in an
adult at the rate
of 100 to 120 per minute. Next, open the airway with the jaw-thrust or head tilt-chin lift maneuver.
Last, restore breathing by providing rescue breaths (via mouth-to-mask ventilation or a bag-valve
mask [BVM]). Administer 2 breaths, each over 1 second, while visualizing for chest rise.
if the brain is deprived of oxygen for 4 to 6 minutes.... -
brain damage is possible
advanced life support (ALS) -
which involves advanced lifesaving procedures, such as cardiac monitoring, administration of
intravenous (IV) fluids and medications, and the use of advanced airway adjuncts. However, when
done correctly, BLS care can maintain life for a short time until ALS measures can be started. In some
cases, such as choking, near drowning, or lightning injuries, early BLS measures may be all that is
needed to restore a patient's pulse and breathing. Of course, these patients still require transport to
the emergency department (ED) for evaluation.
1|Page
,return of spontaneous circulation (ROSC) -
The return of a pulse and effective blood flow to the body in a patient who previously was in
cardiac arrest.
chain of survival step 1: Recognition and activation of the emergency response system. -
The first step in the chain of survival requires public education and awareness. Laypeople
must learn to recognize the early warning signs of a cardiac emergency and immediately activate
EMS by calling 9-1-1. This step ensures that emergency responders are dispatched to the scene
quickly, thus allowing the other links of the chain to be more effective. In modern EMS systems, the
9-1-1 dispatcher can provide prearrival instructions and direct the caller to provide CPR if needed.
chain of survival step 2: Immediate, high-quality CPR. -
The initiation of immediate CPR by a bystander is essential for successful resuscitation of a
person in cardiac arrest. CPR will keep blood, and therefore oxygen, flowing to the vital organs to
keep the patient alive until the other components of the chain are available. The more people
trained in CPR in the community, the better the chances of CPR being administered quickly to a
person in cardiac arrest. Immediate, high- quality CPR markedly increases the patient's chance of
survival, whereas a delay in CPR leads to poor patient outcomes. The lay public as well as emergency
responders should all be trained in CPR. Unfortunately, many bystanders are hesitant to perform CPR
on a stranger for fear of contracting a disease from mouth-to-mouth breathing, or out of fear of
liability. A perception that bystander CPR involves both mouth-to-mouth breathing and chest
compressions persists. Laypeople should be educated in performing compression-only (hands-only)
CPR.
For chest compressions to be most effective, they must be given hard and fast. The AHA
recommends that compressions be started as quickly as possible after onset of cardiac arrest.
Compressions should be between 2 and 2.4 inches in depth (5 to 6 cm) and given at a rate of 100 to
120 per minute. The chest should completely recoil between each compression to maximize blood
return to the heart. The rescuer should never lean on the chest between compressions. Interruptions
between compressions for any reason should be minimized.
chain of survival step 3: Rapid defibrillation -
Provided that immediate, high-quality CPR with minimal interruption is performed, early
defibrillation offers the best opportunity to achieve a successful patient outcome. Automated
external defibrillators (AEDs) have become readily available in many schools, fitness clubs, concert
venues, sports arenas, government buildings, and other mass gathering places. The simple design of
the AED makes it easy for emergency medical providers and laypeople to use with very little training.
Chain of Survival step 4: Basic and advanced emergency medical services. -
This link in the chain describes care provided by EMTs and ALS providers before the patient
arrives at the ED. Such care includes continuing high-quality CPR; basic airway management (ie, oral
2|Page
, airway insertion, BVM ventilation); advanced airway management (ie, endotracheal [ET] intubation
or use of supraglottic airway devices); manual defibrillation; vascular access; transcutaneous pacing;
and administration of medications. In addition to the care provided in the prehospital setting, be
familiar with the cardiac resuscitation centers in your service area. Your agency should implement a
process to ensure early notification and transport to the appropriate receiving facility.
chain of survival step 5: post cardiac arrest care -
After your team delivers the patient to the ED, further cardiopulmonary and neurologic
support is provided to improve the patient's recovery when indicated. This support can include
additional medication therapy to support blood pressure; targeted temperature management (ie,
therapeutic hypothermia); maintenance of blood glucose levels; cardiac catheterization; an
electroencephalogram to detect seizure activity; and admission to the intensive care unit for critical
care management.
Assessing the need for BLS -
1> survey the scene
2> complete primary assessment to evaluate the patients ABC's
3>begin CPR bac
basic principles of BLS -
The basic principles of BLS are the same for infants, children, and adults. For the purposes of
BLS, anyone younger than 1
Assessing the Need for BLS
year is considered an infant. A child is between 1 year of age and the onset of puberty
(approximately 12 to 14 years of age), as signified by breast development in girls and underarm,
chest, and facial hair in boys. Adulthood is from the onset of puberty and older. Children vary in size.
Some small children may best be treated as infants, some larger children as adults. There are two
basic differences in providing CPR for infants, children, and adults. The first is that the emergencies in
which infants and children require CPR usually have different underlying causes. The second is that
there are anatomic differences in adults, children, and infants, such as smaller airways in infants and
children than in adults.
Although cardiac arrest in adults usually occurs before respiratory arrest, the reverse is true in infants
and children. In most cases, cardiac arrest in children results from respiratory arrest. If untreated,
respiratory arrest will quickly lead to cardiac arrest and death. Respiratory arrest in infants and
children has a variety of causes, discussed later in this chapter.
AED -
3|Page
basic life support (BLS) -
Noninvasive emergency lifesaving care that is used to treat medical conditions, including
airway obstruction, respiratory arrest, and cardiac arrest.
if patient is not breathing adequately or at all you.... -
may be able to restore normal breathing simply by opening the airway. However, if the
patient has no pulse, then you must combine artificial ventilation with artificial circulation (chest
compressions). If breathing stops before the heart stops, then the patient may have enough oxygen
in the lungs to stay alive for several minutes. But when cardiac arrest occurs first, the heart and brain
stop receiving oxygen immediately
cardiopulmonary resuscitation (CPR) -
is used to establish circulation and artificial ventilation in a patient who is not breathing and
has no pulse. The steps for CPR include the following:
First, restore circulation by performing chest compressions to circulate blood to the vital organs of
the body.
Next, perform 30 high-quality compressions to a depth of 2 inches to 2.4 inches (5 cm to 6 cm) in an
adult at the rate
of 100 to 120 per minute. Next, open the airway with the jaw-thrust or head tilt-chin lift maneuver.
Last, restore breathing by providing rescue breaths (via mouth-to-mask ventilation or a bag-valve
mask [BVM]). Administer 2 breaths, each over 1 second, while visualizing for chest rise.
if the brain is deprived of oxygen for 4 to 6 minutes.... -
brain damage is possible
advanced life support (ALS) -
which involves advanced lifesaving procedures, such as cardiac monitoring, administration of
intravenous (IV) fluids and medications, and the use of advanced airway adjuncts. However, when
done correctly, BLS care can maintain life for a short time until ALS measures can be started. In some
cases, such as choking, near drowning, or lightning injuries, early BLS measures may be all that is
needed to restore a patient's pulse and breathing. Of course, these patients still require transport to
the emergency department (ED) for evaluation.
1|Page
,return of spontaneous circulation (ROSC) -
The return of a pulse and effective blood flow to the body in a patient who previously was in
cardiac arrest.
chain of survival step 1: Recognition and activation of the emergency response system. -
The first step in the chain of survival requires public education and awareness. Laypeople
must learn to recognize the early warning signs of a cardiac emergency and immediately activate
EMS by calling 9-1-1. This step ensures that emergency responders are dispatched to the scene
quickly, thus allowing the other links of the chain to be more effective. In modern EMS systems, the
9-1-1 dispatcher can provide prearrival instructions and direct the caller to provide CPR if needed.
chain of survival step 2: Immediate, high-quality CPR. -
The initiation of immediate CPR by a bystander is essential for successful resuscitation of a
person in cardiac arrest. CPR will keep blood, and therefore oxygen, flowing to the vital organs to
keep the patient alive until the other components of the chain are available. The more people
trained in CPR in the community, the better the chances of CPR being administered quickly to a
person in cardiac arrest. Immediate, high- quality CPR markedly increases the patient's chance of
survival, whereas a delay in CPR leads to poor patient outcomes. The lay public as well as emergency
responders should all be trained in CPR. Unfortunately, many bystanders are hesitant to perform CPR
on a stranger for fear of contracting a disease from mouth-to-mouth breathing, or out of fear of
liability. A perception that bystander CPR involves both mouth-to-mouth breathing and chest
compressions persists. Laypeople should be educated in performing compression-only (hands-only)
CPR.
For chest compressions to be most effective, they must be given hard and fast. The AHA
recommends that compressions be started as quickly as possible after onset of cardiac arrest.
Compressions should be between 2 and 2.4 inches in depth (5 to 6 cm) and given at a rate of 100 to
120 per minute. The chest should completely recoil between each compression to maximize blood
return to the heart. The rescuer should never lean on the chest between compressions. Interruptions
between compressions for any reason should be minimized.
chain of survival step 3: Rapid defibrillation -
Provided that immediate, high-quality CPR with minimal interruption is performed, early
defibrillation offers the best opportunity to achieve a successful patient outcome. Automated
external defibrillators (AEDs) have become readily available in many schools, fitness clubs, concert
venues, sports arenas, government buildings, and other mass gathering places. The simple design of
the AED makes it easy for emergency medical providers and laypeople to use with very little training.
Chain of Survival step 4: Basic and advanced emergency medical services. -
This link in the chain describes care provided by EMTs and ALS providers before the patient
arrives at the ED. Such care includes continuing high-quality CPR; basic airway management (ie, oral
2|Page
, airway insertion, BVM ventilation); advanced airway management (ie, endotracheal [ET] intubation
or use of supraglottic airway devices); manual defibrillation; vascular access; transcutaneous pacing;
and administration of medications. In addition to the care provided in the prehospital setting, be
familiar with the cardiac resuscitation centers in your service area. Your agency should implement a
process to ensure early notification and transport to the appropriate receiving facility.
chain of survival step 5: post cardiac arrest care -
After your team delivers the patient to the ED, further cardiopulmonary and neurologic
support is provided to improve the patient's recovery when indicated. This support can include
additional medication therapy to support blood pressure; targeted temperature management (ie,
therapeutic hypothermia); maintenance of blood glucose levels; cardiac catheterization; an
electroencephalogram to detect seizure activity; and admission to the intensive care unit for critical
care management.
Assessing the need for BLS -
1> survey the scene
2> complete primary assessment to evaluate the patients ABC's
3>begin CPR bac
basic principles of BLS -
The basic principles of BLS are the same for infants, children, and adults. For the purposes of
BLS, anyone younger than 1
Assessing the Need for BLS
year is considered an infant. A child is between 1 year of age and the onset of puberty
(approximately 12 to 14 years of age), as signified by breast development in girls and underarm,
chest, and facial hair in boys. Adulthood is from the onset of puberty and older. Children vary in size.
Some small children may best be treated as infants, some larger children as adults. There are two
basic differences in providing CPR for infants, children, and adults. The first is that the emergencies in
which infants and children require CPR usually have different underlying causes. The second is that
there are anatomic differences in adults, children, and infants, such as smaller airways in infants and
children than in adults.
Although cardiac arrest in adults usually occurs before respiratory arrest, the reverse is true in infants
and children. In most cases, cardiac arrest in children results from respiratory arrest. If untreated,
respiratory arrest will quickly lead to cardiac arrest and death. Respiratory arrest in infants and
children has a variety of causes, discussed later in this chapter.
AED -
3|Page
