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basic life support (BLS)

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) 1) determine responsiveness a) gently shake patient b) do not shake head or neck if head or neck trauma is suspected 2) activate the EMS system 3) position the patient supine on a firm, flat surface, try to move the patient as a unit, avoiding tension on the neck 4) open airway & assess pulse & respirations (5-10 seconds) 5) begin chest compressions immediately (100-120/min) a) untrained bystanders should begin compression-only CPR [8] - compression-only CPR may also apply to BLS for healthcare providers [6] b) pediatric recommendations differ; see pediatric basic & advanced cardiopulmonary life support c) check for pulse & breathing simultaneously to reduce time to 1st chest compression [11] d) exception is drowning: give 2 respirations first [13] 6) 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) 7) basic life support: 30 compressions (100-120/min) followed by 2 respirations (1 sec/forced inspiration) [2] 8) stop basic life support at 2 minutes & each 2 minutes thereafter to assess for spontaneous pulse or respirations a) Red Cross recommends stopping CPR only for defibrillation or if the patient shows signs of life b) basic life support should not be withheld for more than 5-10 sec except for defibrillation or intubation c) attempts to intubate should not exceed 30 sec d) 2 minute cycles (about 5 cycles of 30 compressions with 2 repirations) e) change person delivering compressions every 2 minutes if feasible 9) 8-10 breaths/min for patients with endotracheal intubation or other advanced airway 10) rescue breathing (lower priority than chest compressions) a) open the patient's mouth, leave dentures in (they facilitate a good mouth-to-mouth seal) b) open patient's airway 1] head tilt-chin lift; lay rescuers should use the head tilt-chin lift in all unresponsive patients regardless of injury [4] 2] jaw thrust maneuver if neck injury suspected & rescuer is a professional proficient in this maneuver [4] c) 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] d) evaluate patient's respirations with airway open 1] look for chest movement 2] place ear over mouth & listen for respirations e) spontaneous respirations not present 1] gently pinch the nose with the index finger & thumb 2] make a tight seal over the patient's mouth & give 2 breaths 1 sec/breath 3] continue rescue breathing if signs of circulation f) palpate patient's carotid pulse for 5-10 sec, if pulse present continue rescue breathing @ 10-12/min

Related

airway obstruction cardiopulmonary arrest choking 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)

Useful

advanced cardiac life support (ACLS)

Specific

nasopharyngeal airway oral airway pediatric basic & advanced cardiopulmonary life support

General

cardiopulmonary resuscitation (CPR)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170-71
  2. 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: 16344388
  3. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
  4. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 http://www.americanheart.org/cpr
  5. Braga MS et al Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 2009 Jul; 124:e69 PMID: 19564271 http://dx.doi.org/10.1542/peds.2009-0153
  6. 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. 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: 22202708
  8. 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: 23230313
  9. 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: 25252721
  10. 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. 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
  12. 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. PMID: 29114008 http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000539.long
  13. 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: 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: 31411633 https://jamanetwork.com/journals/jamacardiology/article-abstract/2747603
  14. American Red Cross - Basic Life Support 2018