BLS Resuscitation Overview

Overview

This lecture covers the key concepts and protocols of Basic Life Support (BLS) resuscitation, including techniques for airway management, artificial ventilation, chest compressions, the chain of survival, special considerations, and the importance of ongoing training.

Introduction and Guidelines

• BLS is non-invasive emergency care for conditions like airway obstruction, respiratory arrest, and cardiac arrest.
• Guidelines are regularly updated to reflect current scientific evidence.
• BLS aims to maximize the chances of successful resuscitation and survival to hospital discharge.

BLS Fundamentals and Sequence

• BLS for adults emphasizes Airway, Breathing, and Circulation (ABC) or Compressions, Airway, Breathing (CAB) in cardiac arrest.
• Immediate action is critical; brain damage can occur in 4-6 minutes without oxygen.
• CPR for adults: 30 chest compressions (2-2.4 inches deep, 100-120/min) followed by 2 breaths.

Chain of Survival

• Five links: (1) Recognition/activation of EMS, (2) Immediate high-quality CPR, (3) Early defibrillation, (4) Basic/Advanced EMS, (5) Advanced life support/post-arrest care.
• Delay in any link decreases survival chances.

Adult CPR Procedures

• Assess scene safety and patient responsiveness.
• Check for breathing and pulse (≤10 seconds).
• Perform CPR if no pulse/breathing; use AED as soon as available.
• Two-rescuer CPR improves quality; switch compressors every 2 minutes.

Pediatric and Infant CPR Differences

• Pediatric arrest usually follows respiratory failure, not cardiac cause.
• Infants <1 year: use 2 fingers or two-thumb technique; compress 1.5 inches deep.
• Children: use heel of one or two hands; compress at least 2 inches deep.
• Ratio: 30:2 for one rescuer; 15:2 for two rescuers.

Airway Management and Artificial Ventilation

• Open airway with head tilt-chin lift (no trauma) or jaw thrust (suspected trauma).
• For stoma patients, ventilate directly over the stoma.
• Avoid hyperventilation and gastric distension.
• Place breathing, non-trauma patients in recovery position.

AED Use and Special Situations

• Use pediatric pads/attenuator for children if available; otherwise use adult pads.
• Avoid placing AED pads over pacemakers or medication patches.
• Dry the chest if wet; do not delay CPR for drying.

Foreign Body Airway Obstruction

• Encourage coughing if patient can breathe.
• For severe obstruction (unable to cough/talk): perform abdominal thrusts (adults/children), back slaps and chest thrusts (infants).
• For unresponsive patients: start compressions, check mouth, remove visible obstructions.

When to Start and Stop CPR

• Start CPR unless: scene is unsafe, obvious signs of death, or valid DNR is present.
• Stop CPR if: patient regains pulse/breathing, care is transferred, rescuer is exhausted, or ordered by a physician.

Special Resuscitation Circumstances

• Pregnancy: displace uterus leftward during compressions if uterus is above umbilicus.
• Opioid overdose: prioritize high-quality CPR.
• Family support: communicate clearly and compassionately during resuscitation and after.

Training and Education

• Regular practice and retraining are essential to maintain CPR skills.
• Public education in compression-only CPR increases survival rates.
• EMTs should advocate and assist in community CPR/AED training.

Key Terms & Definitions

• Basic Life Support (BLS) — Non-invasive emergency care for life-threatening conditions.
• Cardiopulmonary Resuscitation (CPR) — Technique combining chest compressions and ventilations to restore breathing/circulation.
• Automated External Defibrillator (AED) — Device that analyzes cardiac rhythm and delivers shocks.
• Chain of Survival — Series of critical actions that increase survival in cardiac arrest.
• Agonal Gasps — Abnormal, slow, or gasping breathing seen in cardiac arrest.
• Gastric Distension — Inflation of the stomach with air during ventilation.
• Impedance Threshold Device — Valve that enhances blood return during CPR.

Action Items / Next Steps

• Practice BLS and CPR skills regularly.
• Review local protocols for AED and advanced directives.
• Educate laypeople in compression-only CPR and AED use.
• Read related chapters: Workforce Safety, Human Body, Team Approach, Airway Management, Pediatric Emergencies.