Chapter 14: BLS Resuscitation - Emergency Care and Transportation of the Sick and Injured

Introduction

• Review of Basic Life Support (BLS) for adults, infants, and children.
• BLS principles introduced in 1960, regularly revised; latest in 2020 by International Liaison Committee for Resuscitation.

Elements of BLS

• Non-invasive emergency life-saving care.
• Treats airway obstructions, respiratory rest, and cardiac arrest.
• Focus on ABCs:
  • Airway: Obstruction
  • Breathing: Respiratory arrest
  • Circulation: Cardiac arrest or severe bleeding
• CAB sequence used when cardiac arrest: Compressions, Airway, Breathing.
• Brain damage possible if deprived of oxygen for > 4-6 min.

CPR Basics

• Re-establishes circulation and artificial ventilation.
• Steps:
  1. High-quality chest compressions
  2. Open airway
  3. Restore breathing with rescue breaths
• Differs from Advanced Life Support (ALS) involving advanced procedures (e.g., cardiac monitoring).

Chain of Survival

• Recognition and activation of emergency response system
• Immediate high-quality CPR
• Rapid defibrillation
• Basic and advanced emergency services
• ALS and post-arrest care
• Recovery
• Absence of any link increases mortality.

Assessing Need for BLS

• Begin with scene survey and primary assessment.
• Determine responsiveness within 10 seconds.
• Differences in adults vs. children:
  • Adults: Cardiac arrest usually precedes respiratory.
  • Infants/Children: Respiratory issues often lead to cardiac arrest.

Automatic External Defibrillation (AED)

• Vital link in survival chain.
• Apply to cardiac arrest patients ASAP.
• Special situations:
  • Pacemakers: Place electrodes 1 inch away.
  • Wet patients: Dry skin before AED use.
  • Transdermal patches: Remove before AED pad application.

CPR Techniques

• Position: Supine on firm, flat surface.
• Check for breathing and pulse within 10 seconds.
• External chest compressions should allow full recoil.
• Two-rescuer CPR: Switch every 2 minutes.

Devices and Techniques

• Active Compression-Decompression CPR: Increases blood return to heart.
• Impedance Threshold Device (ITD): Limits air entering lungs during recoil.
• Mechanical Devices: Ensure correct depth/rate.
• Manual compressions remain standard.

Infant and Child CPR

• Focus: Airway and breathing due to common respiratory causes.
• Techniques differ:
  • Infants: Two-finger compressions or two-thumb encircling technique.
  • Children: Heel of one hand for compressions.
• Rescue breathing: Single breath every 2-3 seconds if pulse present.

Foreign Body Airway Obstruction

• Recognize and manage obstructions:
  • Mild: Observe; severe: Act quickly.
• Techniques:
  • Adults/Children >1yr: Abdominal thrusts (Heimlich Maneuver).
  • Infants: Back slaps and chest thrusts.
  • Unresponsive: Begin chest compressions.

Special Circumstances

• Opioid Overdose: Administer Narcan if allowed.
• Pregnancy: Position to relieve vessel pressure; manual uterine displacement if in arrest.

Grief Support

• Support family during and after resuscitation efforts.
• Communicate clearly and sensitively.

Education and Training

• Regular practice of CPR skills is crucial.
• Public education and training on CPR and AED operation encouraged.

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Conclusion: Review questions related to brain damage timelines, chain of survival events, CPR effectiveness, and scenarios requiring CPR interruption. Importance of practicing and training regularly emphasized for both professionals and the public.