BLS Adult Basic Life Support AlgorithmNov 3, 2015

Adult Basic Life Support Algorithm for Healthcare ProvidersIn the algorithm for adult basic life support, emphasis is placed upon immediate recognition of sudden cardiac arrest and rapid defibrillation with an AED (Automated External Defibrillator.) To immediately recognize sudden cardiac arrest, the healthcare provider is trained to assess for unresponsiveness and/or an absence of breathing or presence of abnormal breath sounds. “Look, listen and feel” is no longer a part of Basic Life Support. Untrained providers should be instructed to use hands-only CPR. This approach calls for continuous compression on the sternum.

There has been a significant change in sequence in the 2010 guidelines for Basic Life Support (BLS). The sequence of A-B-C (Airway, Breathing, Compression) has been replaced with the new sequence of C-A-B (Compression, Airway, Breathing.)

CPR should be continued by a healthcare provider until return of spontaneous circulation (ROSC) or until termination of efforts. High quality CPR emphasizes adequate depth and number of chest compressions.

The pulse check has been deemphasized, and the guidelines recommend a pulse check for no less than 5 seconds and no more than 10 seconds. An integrated team approach includes simultaneous compressions and rescue breathing. Rhythm detection should take place as soon as an AED or defibrillator is available, with subsequent shock, as indicated, as the survival rate from ventricular fibrillation and pulseless ventricular tachycardia ranges from 5 to 50%, and decreases with an increase in the length of time to the first shock.

When a victim is unresponsive to a tap on the chest (ask “Are you ok?”) then the healthcare provider should observe the victim for breathing for 5 to 10 seconds. If respirations are present, the victim should be attached to a cardiac monitor. Otherwise, the HCP should activate EMS and retrieve the AED by himself or by sending a second rescuer.

The pulse check is the third step in the algorithm. The pulse should be checked for no less than 5 seconds and no more than 10 seconds. If there is a definite pulse, then rescue breathing should be done for one second every five to six seconds with a recheck every 2 minutes.

If the victim does not have a pulse, then compressions should be initiated at the rate of 30:2, with 2 breaths every 30 compressions. When the AED or defibrillator is available, then

the HCP should check the victim’s rhythm. If it is shockable, then 1 shock should be given with immediate CPR instituted for 2 minutes, beginning rapidly (within seconds) of the shock.

If the rhythm is not shockable, then the HCP should administer CPR for 2 minutes and recheck the rhythm every 2 minutes. Continue CPR until ALS is available.

High quality chest compressions:

Position patient on hard surface in supine position

Minimal interruptions for ventilation

18 seconds per cycle

Adequate number of compressions: >100/minute

Adequate depth of compressions: 2” or 5 cm.

Allow complete recoil of chest

Do not overventilate

Breathing devices include a ONE WAY VALVE FACE MASK. Deliver breath over one second. Watch the chest rise.

A BAG VALVE MASK is an additional device to deliver breaths. Hold the mask in place with the EC clamp technique and lift the jaw to open the airway. Squeeze the bag for one second while watching for the rise and fall of the chest.

BLS Simplified AlgorithmNov 3, 2015

For laypersons or other non-HCP personnelThe simplified ADULT BASIC LIFE SUPPORT algorithm includes five steps. The algorithm diagram provided by the American Heart Association emphasizes the following:

1. Assess the victim's responsiveness. If a victim is not breathing, or is not breathing normally (i.e., gasping), initiate CPR. Health care professionals should be trained to recognize cardiac arrest that presents as seizure-like activity or with ago all respirations.

2. Activate EMS (Emergency Medical Response) by calling 911.

3. Retrieve a defibrillator, usually an automatic external defibrillator (AED).

4. The algorithm proceeds in a loop of CPR and rhythm checks with defibrillation.

5. Check PULSE before chest compressions for at least five seconds and no more than ten seconds.

6.  CPR: push hard and fast. Begin chest compressions before ventilation. Chest compressions allow blood flow to the heart and brain. Delays in chest compressions result in diminished survival.

7. For effective breathing, watch for chest rise and avoid excessive ventilation. 10 to 12 BREATHS should be delivered each minute, or one breath every five to six seconds.Each breath should be delivered over 1 second. Observe visible chest rise.

Avoid gastric inflation, as it may result in aspiration, pneumonia or vomiting.

8. The ratio of chest compressions to breaths is 30 to 2.

9. Recheck the patient every five cycles (of 30:2).

10.   After the defibrillator becomes available, check rhythm. USE THE AED WHEN INDICATED AND AVAILABLE.  The victim should receive a shock that is repeated every two minutes or 5 cycles.

"Look, listen, and feel" is no longer part of the BLS algorithm. The emphasis is on high quality CPR.

BLS Pediatric AlgorithmNov 3, 2015

Pediatric Basic Life Support for Healthcare ProvidersIn Pediatric Basic Life Support for Healthcare Providers (HCP), the rescuer should first determine quickly if the victim is unresponsive. The provider should note if the victim is not breathing or is only gasping.

If the victim is not breathing, only gasping, or is unresponsive, with sudden collapse, a lone rescuer should activate the emergency medical response service and retrieve the automated external defibrillator or defibrillator. If there is another rescuer, that person should activate EMS and retrieve the AED or defibrillator.

Healthcare providers should check the victim’s pulse for at least 5 seconds but no longer than 10 seconds. In children aged one to adolescence, the pulse should be checked at the carotid artery. In infants, the brachial pulse should be assessed.

If there is a palpable pulse within 10 seconds, then a rescue breath should be given every 3 seconds. Breaths should last one second and the chest should be observed for visible rise. If the victim has an advanced airway, then the provider should administer breaths every 6 to 8 seconds, asynchronous with compressions.

If the pulse is less than 60/minutes, or if the victim has signs of poor perfusion after adequate ventilation and oxygenation, the provider should begin chest compressions. In the absence of a pulse, a long rescuer should begin CPR with 30 high quality compressions followed by two breaths. If two rescuers are available, the cycle of compressions to breaths should be 15:2 (pediatrics).

High quality compressions in CPR should be a minimum of 1/3 the AP diameter of the chest, or approximately 1 ½ inches in infants (4 cm) and 2” in children from age one to adolescence. The rate of compressions should be at least 100 per minute. Chest recoil should be complete between compressions.

Pediatric compression is performed with the head of one hand over the lower ½ of the sternum, between the nipples. In infants, use two fingers, or use the thumb encircling technique if multiple providers are available.

After two minutes have passed, if EMS has not been notified, then they should be called. At this time, if the AED is not yet available, the rescuer should retrieve it. When the AED is available, the victim’s rhythm should be quickly assessed.

Shockable rhythms include ventricular fibrillation or pulseless ventricular tachycardia. One shock should be given to the victim, with resumption of CPR immediately after the shock. CPR should continue for 2 minutes. A dose attenuator should be used if available, but if not, adult pads can be used.

If the rhythm is not shockable, CPR should be resumed immediately. The HCP should check the rhythm once more after two minutes of CPR (5 cycles of 30:2). This should until the victim moves or until advanced life support is available.

The airway in pediatrics should be opened with a head tilt/chin lift for children over the age of one, and with the infant in the sniffing position. If trauma is suspected, then a jaw thrust should be used to open the airway.

BLS CPR AlgorithmNov 3, 2015

High quality cardiopulmonary resuscitationHIGH QUALITY CPR is important in the provision of basic life support to an unresponsive victim without a pulse. High quality CPR possesses the following important characteristics:

1. Compressions should begin within ten seconds of determination of cardiac arrest.2. The rate of compression should be at least 100 per minute.3. The depth of compression should be at least 2” for adults, approximately 2” for

children from age one to adolescence, and 1 ½” (4 cm) for infants. The depth of compression should be 1/3 the AP chest diameter for children and infants.

4. There should be complete recoil of the chest after each compression.5. Interruptions in chest compression should be minimized. When giving shocks, the

interval between the last compression and the shock should be kept to less than 10 seconds, as should the interval between the shock and following compression.

6. Chest compressions should be initiated prior to rescue breathing. CPR should be initiated with 30 compressions, in order to shorten any delay to the first compressions,

7. When giving breaths, effectiveness can be ascertained by watching the rise of the chest.

8. All excessive ventilation should be avoided; excessive ventilation may result in aspiration, vomitus or pneumonia.

BLS C-A-B AlgorithmNov 3, 2015

Compressions-Airway-BreathingThe American Heart Association revised the Basic Life Support sequence in 2010. This fundamental change reflects an international consensus after an extensive review of the available resuscitation evidence. The current emphasis is on quality chest compressions. This emphasis was present to a lesser degree in 2005. It stresses an adequate rate and depth of compression.

The 2010 BLS guidelines include the following:

COMPRESSIONS

Compression rate of 100/ minute, pushing hard and fast in chest center At least 100 compressions per minute Minimum depth of at least 2" for adults Children and infants: 1/3 depth of the chest (2” and 1.5”) Allow complete chest recoil between breaths.

AIRWAY

Head tilt/chin lift: tilt victim's head back and lift victim's chin to open the airway. Infant airway can be opened by placing the head in the “sniffing position.”

BREATHING

Give rescue breathing, mouth to mouth, in the apneic patient with a pulse. For effective breathing, watch for chest rise and avoid excessive ventilation. The ratio

of chest compressions to breaths is 30 to 2. 10 to 12 BREATHS should be delivered each minute, or one breath every five to six

seconds. Each breath should be delivered over 1 second. Observe visible chest rise.