Chapter 14: Basic Life Support (BLS) Resuscitation

Historical Context

• BLS principles introduced in early 1960s.
• CPR as known today has been regularly reviewed and improved since its inception.
• American Heart Association guidelines are typically reviewed every 5 years, most recently in 2020.

Basic Life Support (BLS) Overview

• Non-invasive emergency life care.
• Used to treat airway obstruction, respiratory arrest, and cardiac arrest.
• Focus: Airway, Breathing, and Circulation (ABCs).
• Critical to initiate BLS within 4-6 minutes to prevent irreversible brain damage.

Cardiopulmonary Resuscitation (CPR)

• Aim: Re-establish circulation and provide artificial ventilation.
• Key components:
  • Chest compressions to restore circulation.
  • Open airway and restore breathing via rescue breathing.
• Use of Bag Valve Mask (BVM) with oxygen during rescue breathing.

BLS vs Advanced Life Support (ALS)

• BLS is basic, non-invasive.
• ALS involves advanced interventions like cardiac monitoring, IVs, and medication administration.

Chain of Survival

• Key components:
  1. Early recognition and activation of EMS.
  2. High-quality CPR.
  3. Early defibrillation.
  4. Basic and advanced EMS and ALS.
  5. Post-arrest and recovery phase.

BLS for Different Age Groups

• Same principles apply to infants, children, and adults.
• CPR algorithm differs slightly:
  • Adults typically have cardiac issues; children typically have respiratory issues.
  • Use pediatric pads for children in AED.

Special Situations

• Pacemakers and defibrillators: Avoid placing defibrillation pads over these devices.
• Wet patients: Dry before applying defib pads.
• Transdermal medication patches: Remove before pad application.

CPR Steps

1. Scene Safety: Always survey the scene first.
2. Assessment: Evaluate ABCs quickly (within 10 seconds).
3. CPR Initiation: Start CPR if no pulse and no breathing.
4. AED Usage: Apply AED as soon as available, especially in adult cardiac arrest.

CPR Techniques

• Hand placement: Lower half of the sternum.
• Ensure full chest recoil between compressions.
• Maintain proper compression depth and rate.

Airway Management

• Head tilt-chin lift for airway opening.
• Jaw thrust maneuver in case of suspected spinal injury.
• Recovery position for breathing individuals without suspected injuries.

Ventilation and Rescue Breathing

• Use barrier devices or BVM.
• Avoid excessive ventilation to prevent gastric distension.

CPR Devices

• Impedance Threshold Device: Limits lung inflation, aids heart efficiency.
• Mechanical Devices (e.g., Lucas, vest devices): Provide consistent, quality compressions.

CPR in Children and Infants

• Causes: Trauma, infections, choking, etc.
• CPR focus: High-quality compressions.
• Adjust techniques for anatomical differences (e.g., head support).

Special Considerations

• Opioid overdose: Naloxone can be used during CPR.
• Pregnancy: Position adjustments for effective CPR.

Legal and Ethical Considerations

• DNR (Do Not Resuscitate) orders must be respected.
• CPR discontinuation guidelines: Transfer, strength, physician's order.

Practice and Skills Maintenance

• Regular practice on mannequins recommended.
• CPR certification renewals typically every two years.

Emotional Support and Communication

• Provide clear communication to family members during resuscitation.
• Use simple language; involve family in the process.

Summary of Key Points

• CPR should be performed on a firm, supine surface.
• Pulse check: 5-10 seconds duration.
• Gastric inflation may occur with improper ventilation.
• Ensure comprehensive understanding of the BLS protocol and practice regularly.