basic life support (BLS)
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Introduction
The goal of basic life support is to provide oxygen to the brain & heart until ACLS can be delivered. ABCs, Airway, Breathing, & Circulation provide the cornerstone of BLS.
Management
(guidelines)
- determine responsiveness
- gently shake patient
- do not shake head or neck if head or neck trauma is suspected
- activate the EMS system
- position the patient supine on a firm, flat surface, try to move the patient as a unit, avoiding tension on the neck
- open airway & assess pulse & respirations (5-10 seconds)
- begin chest compressions immediately (100-120/min)
- untrained bystanders should begin compression-only CPR[8]
- pediatric recommendations differ; see pediatric basic & advanced cardiopulmonary life support
- check for pulse & breathing simultaneously to reduce time to 1st chest compression[11]
- exception is drowning: give 2 respirations first[13]
- chest compressions
- heal of one hand on the back of another
- one inch above xiphoid
- shoulders above hands, elbows locked
- compress chest 1.5-2 inches (>= 5 cm)[7]; 2-2.4 inches[14]
- survival is highest when chest compression depths are between 4.0 & 5.5 cm (adults)[9]
- 107 compressions per minute with a depth of 4.7 centimeters is optimal[13]
- American Heart Association guidelines recommend aiming for 80 to 100 compressions per minute with a compression depth of 4-6 cm.
- for children, chest compression to a depth of 1/3 of the anteroposterior chest wall diameter[5]
- completely release pressure after each compression, but keep hands in contact with chest to maintain proper hand position
- rate = 100-120 compressions/minute[11]
- acceptable < 23 sec for 30 compressions
- assess adequacy of compressions by palpating carotid pulse (2 person CPR)
- basic life support: 30 compressions (100-120/min) followed by 2 respirations (1 sec/forced inspiration)[2]
- stop basic life support at 2 minutes & each 2 minutes thereafter to assess for spontaneous pulse or respirations
- Red Cross recommends stoppng CPR only for defibrillation or if the patient shows signs of life
- basic life support should not be withheld for more than 5-10 sec except for defibrillation or intubation
- attempts to intubate should not exceed 30 sec
- 2 minute cycles (about 5 cycles of 30 compressions with 2 repirations)
- change person delivering compressions every 2 minutes if feasible
- 8-10 breaths/min for patients with endotracheal intubation or other advanced airway
- rescue breathing (lower priority than chest compressions)
- open the patient's mouth, leave dentures in (they facilitate a good mouth-to-mouth seal)
- open patient's airway
- head tilt-chin lift; lay rescuers should use the head tilt-chin lift in all unresponsive patients regardless of injury[4]
- jaw thrust maneuver if neck injury suspected & rescuer is a professional proficient in this maneuver[4]
- sweep oral airway with hand to open airway
- the AHA no longer recommends blind finger sweeping under any circumstances, as this may push foreign objects into the airway & cause an obstruction[10]
- evaluate patient's respirations with airway open
- look for chest movement
- place ear over mouth & listen for respirations
- spontaneous respirations not present
- gently pinch the nose with the index finger & thumb
- make a tight seal over the patient's mouth & give 2 breaths 1 sec/breath
- continue rescue breathing if signs of circulation
- palpate patient's carotid pulse for 5-10 sec, if pulse present continue rescue breathing @ 10-12/min
More general terms
More specific terms
Additional terms
- advanced cardiac life support (ACLS)
- airway obstruction
- cardiopulmonary arrest
- defibrillation (electrical cardioversion, automated external difibrillation, AED)
- do not resuscitate (DNR); do not attempt rescuscitation (DNAR)
- drowning
- emergency medical system (EMS)
- head tilt-chin lift
- jaw thrust maneuver
- obstructed airway maneuver
- recovery position
- rescue breathing
- respiratory arrest
- termination of cardiopulmonary resuscitation (CPR)
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170-71
- ↑ 2.0 2.1 ECC Committee, ECC Subcommittees, and ECC Task Forces; and Authors of Final Evidence Evaluation Worksheets 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations Conference. Circulation. 2005 Dec 13;112(24_suppl):b2-b5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16344388
- ↑ ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
- ↑ 4.0 4.1 4.2 ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 http://www.americanheart.org/cpr
- ↑ 5.0 5.1 Braga MS et al Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 2009 Jul; 124:e69 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19564271 <Internet> http://dx.doi.org/10.1542/peds.2009-0153
- ↑ 6.0 6.1 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317267.pdf
- ↑ 7.0 7.1 Stiell IG et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012 Jan 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22202708
- ↑ 8.0 8.1 Dumas F et al. Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 2013 Jan 29; 127:435. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23230313
- ↑ 9.0 9.1 Stiell IG et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation 2014 Sep 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25252721
- ↑ 10.0 10.1 Knowledge+ http://knowledgeplus.nejm.org/question-of-week
Link MS et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010 Oct 22; 122:S706.
American Red Cross. Step Three: Be Informed. Cardiac Arrest/AED Steps. 2007. https://www.redcross.org/flash/brr/English-html/AED.asp - ↑ 11.0 11.1 11.2 Physician's First Watch, Oct 20, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (in 15 parts, see Table of Contents) Circulation November 3, 2015, Volume 132, Issue 18 suppl 2 http://circ.ahajournals.org/content/132/18_suppl_2.toc - ↑ Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2017 Nov 6. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114008 <Internet> http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000539.long
- ↑ 13.0 13.1 13.2 Duval S, Pepe PE, Aufderheide TP et al Optimal Combination of Compression Rate and Depth During Cardiopulmonary Resuscitation for Functionally Favorable Survival. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411632 https://jamanetwork.com/journals/jamacardiology/fullarticle/2747606
Cone DC Push Hard, Push Fast, Do Not Stop - Optimal Chest Compression Rate and Depth. JAMA Cardiol. Published online August 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411633 https://jamanetwork.com/journals/jamacardiology/article-abstract/2747603 - ↑ 14.0 14.1 American Red Cross - Basic Life Support 2018