BLS Basics

Assess the Scene

Check the scene for safety hazards BEFORE providing care, it is important to ensure if you and the patient(s) are in a safe location, free of imminent danger or hazards.

Determine
  • If it is safe to help
  • number of patients
  • if you will need additional assistance from EMS
  • what personal protective devices are readily available to you

Assess the Patient

  • Check the person for responsiveness
    • Tap on patient’s shoulder and shout “Are you okay?”
    • Look at the person’s chest and face
    • Determine if the patient is breathing normally
      • Agonal breathing is not normal breathing and needs care
  • Call 911 or direct a bystander call 911 and return
    • Caller should give dispatcher patient’s location, details of emergency situation including how many patients are injured and what treatment is occurring
  • Check for pulse (about 10 seconds)
  • Request AED machine, if available
If you are alone:
Adults:
  • FIRST call 911
  • Retrieve AED, if available
  • Perform CPR cycle until EMS takes over or you are too tired to continue
Children and Infants:
  • FIRST complete five cycles (about 2 minutes) of CPR
  • Call 911
  • Perform CPR cycle until EMS takes over or you are too tired to continue
Always provide care first for unresponsive patients of hypoxia arrest (i.e. lack of oxygen to the brain due to drowning, injury, drug overdose, stroke, etc…).When assessing the scene, be sure to assess approximate age and size of the patient. Suggested guidelines for administering CPR are as follows:
  • Adult CPR: should be administered to patients who have reached the onset of puberty and older.
  • Child CPR: should be administered to patients who have not reached the onset of puberty and are not considered infants (approximately 1 year to the onset of puberty).
  • Infant CPR: should be administered to patients who are younger than toddler aged (approximately birth to 1 year).

Chain of Survival

 photo Chain of Survival_zpsa4tozpgt.png

The Chain of Survival is a common way of describing the order in which rescuers should provide care for a patient of cardiac arrest. Early action can improve the chance of a patient’s survival.

  • Link One: Early Access
    Rescuer recognizes early warning signs and immediately calls 911 to activate EMS (emergency medical services) to provide early access to care.

  • Link Two: Early CPR
    Rescuer immediately begins CPR cycle to continue minimal supply of blood to the patient’s heart and brain until defibrillator and EMS personnel take over.

  • Link Three: Early Defibrillation
    Rescuer utilizes AED (automated external defibrillator) to administer a shock to the patient which may restore the heartbeat in some instances.

  • Link Four: Early Advanced Care
    EMS arrives and provides advanced cardiac life support care to patient of sudden cardiac arrest. In addition, EMS may provide IV fluids, medications, and use advanced airway devices.

Compressions - Airway - Breathing

C-A-B (Compressions-Airway-Breathing) Order
  • Begin Compressions
  • Open Airway with head tilt–chin lift method
  • Check Breathing AT THE SAME TIME

Head Tilt-Chin Lift Method

Place one hand on the forehead to tilt the patient’s head back. AT THE SAME TIME place the other hand under the patient’s chin, lift the chin to open the airway and displace the tongue. Look into the patient’s mouth for an obstruction. If you see an obstruction, remove it immediately.

Rescue Breaths

Keep airway open with head tilt-chin lift method. Administer one rescue breath (1 second). Observe chest for rise and fall. If breath does not go in, re-tilt head and administer second rescue breath (1 second). Observe chest for rise and fall AT THE SAME TIME as administering rescue breaths.

Use one of the following methods to administer rescue breaths:
  • Mouth-to-barrier
  • Mouth-to-nose
  • Mouth-to-stoma

Chest compressions, which keep oxygen flowing to the brain, is the single most important factor in life saving procedures. Chest compressions should be administered immediately following rescue breaths that do or do not appear to go into lungs.

Chest Compressions

Chest compressions should be swift and consistent, at a rate of 100-120 per minute. Place the heel of the dominant hand at the correct location on the adult or child patient’s chest. Use two fingers in the correct location of the infant’s chest.

Use
  • Adult: Two hands (heel of dominant hand)
  • Child: One hand (heel of dominant hand)
  • Infant: Two fingers
Depth
  • Adult: At least 2 inches, but no more than 2.4"
  • Child: At least 1/3 depth of the body (or 2”)
  • Infant: At least 1/3 depth of the body (or 1 ½”)
Position
  • Adult and child: On the breastbone (sternum)
  • Infant: On the breastbone, just below nipple line
Rate
  • 100-120 compressions per minute

CPR Cycle

Perform 30 compressions then administer 2 rescue breaths
  • At a rate of 100-120 compressions per minute
  • Check for signs of breathing (rise/fall of chest)
Continue CPR cycles until:
  • AED becomes available
  • Patient shows signs of life
  • A second rescuer takes over
  • EMS takes over
  • You are too tired to continue

Identify Airway Obstruction

Partial air exchange
  • Mild: patient is able to produce forceful cough
  • Severe: patient is able to produce weak, ineffective cough
  • Complete blockage: patient is unable to breathe, cough or speak
Common causes for airway obstruction
  • Tongue, foreign object, vomit, allergic reaction, spasm, swelling

Caring for Airway Obstruction

Responsive adult or child: Heimlich Maneuver
  • Abdominal thrusts just above navel
  • Continue until object is removed or patient is unresponsive
  • Chest thrusts should be used for larger or pregnant patients
Responsive infant
  • Support infant’s head and lay face-down over your forearm
  • Support forearm with thigh
  • Give five back blows
  • Roll infant face up
  • Check for breathing
  • Continue until object is removed or patient is unresponsive
Unresponsive adult or child (if breath does NOT go in)
  • Re-tilt head
  • Reattempt breath
  • Begin CPR
  • Check airway
  • Remove object
Unresponsive infant (if breath does NOT go in)
  • Re-tilt head
  • Reattempt breath
  • Begin CPR
  • Check airway
  • Remove object