BLS Course Training Materials

Last updated: April 8, 2021

BLS Algorithm page

BLS Algorithm page

These algorithms are the latest 2020 version from the American Heart Association. Our BLS course follows 2020 American Heart Association® Guidelines for CPR and ECC.

Panel One:

The first key concept of Basic Life Support (BLS) is the order of actions that are performed. It is helpful to remember C - A - B.

“C” stands for CIRCULATION. Circulation is maintained to the brain and heart by performing proper Chest Compressions. “A” stands for airway. Check and maintain patency. “B” stands for Breathing. This ensures proper oxygen delivery to the brain and other tissues.

Panel two

It is important to understand the rationale behind the actions taken. The following is a synopsis of key concepts of Basic Life Support.

Crucial concepts

Rationale

Start compressions within 10 seconds of identification of cardiac arrest.

The brain and heart are both extremely sensitive to loss of oxygenation. Restoring blood flow to them as soon as possible is directly related to the possibility of survival..

Push hard, push fast.

Adequate depth and rate of compressions assures that blood flow is adequate to oxygenate tissues

Allow compete chest recoil after each compression

Chest recoil is the diastolic (resting) phase of circulation. This is when the brain and heart (as well as other vital organs) are supplied with blood. In addition, releasing the chest completely permits the heart to fill with blood prior to the next compression.

Minimize interruptions (less than 10 seconds)

Each time compressions are paused, pressures in the body that are responsible for supply blood to the brain and heart fall to zero. It takes many compressions to build back up to an acceptable pressure. (coronary perfusion pressure)

Give effective breaths to ensure chest rise

Seeing the chest rise ensures that you have delivered enough air to the lungs to cause them to inflate adequately to supply oxygen for circulation.

Avoid excessive ventilation.

Excessive ventilation causes the lungs to be filled with air continuously. This increases the pressure in the chest and prevents blood from flowing into the ventricles during the diastolic (relaxation) phase. Therefore, there is not blood available for circulation with compressions.

Panel three

Five Simple Steps to Save a Life

  1. Assess the patient for the presence of absence of NORMAL breathing. Small intermittent breaths (agonal respirations) do not count as normal breathing. The healthcare provider can take 5–10 seconds to check for the presence of a carotid pulse.
  2. Activate 911 if outside the hospital or the emergency response team within a facility. They should bring the defibrillator or Automated External Defibrillator (AED) with them.
  3. If breathing and pulse are absent, compressions should be started without delay. If the patient is not breathing but has a pulse, rescue breathing should be started.
  4. The AED or defibrillator should be placed on the patient as soon as it is available. Defibrillation should be completed as indicated by the cardiac rhythm or in the case of an AED, as directed by the AED.

Panel four

Rationale behind resuscitation steps

No.

Step

Notes

1

Assess the patient

Fast assessment is important to avoid delays in beginning resuscitation.

2

Activate the Emergency Response System.

Both in and out of the hospital help is require to provide adequate resuscitation. In adult cardiac arrest 95% require defibrillation in the first few minutes following cardiac arrest. Early activation gets the AED or defibrillator to the patient sooner.

3

Pulse Check

Healthcare providers can check for the presence of a carotid pulse. It should take no longer than 5–10 seconds. If there is doubt as to whether a pulse is present, compression should be started.

4

Start CPR

CPR should be started on all patients without a pulse or in the absence of normal breathing if the presence of a pulse cannot be determined.

5

Use the AED or Defibrillator when it arrives

Defibrillation is the definitive care for the most common arresting rhythm; ventricular fibrillation. If an AED is utilized, it should be changed to a manual defibrillator as soon as one arrives with personnel capable of interpreting the rhythm.

Panel five

Pediatric Basic Life support

Although similar, there are key differences to the resuscitation of pediatric patients. (Patients who are pre-puberty or less than 8 years of age) The cause of arrest is very different from adults. Their arrest is almost always secondary to a cause other than cardiac such as respiratory failure or hypovolemia. For this reason, oxygenation is of paramount importance in pediatric resuscitation.

No.

Step

Notes

1

Assess the patient for breathing and presence or absence of a pulse simultaneously

Assessing for breathing and pulse at the same time saves precious seconds and provides the information needed to make the decision to begin resuscitation.

2

Activate the emergency response team

If alone and without a phone, CPR should be started for 2 minutes prior to leaving the patient to get help. This ensures that the patient is oxygenated adequately.

3

Start CPR with compressions

Begin CPR if the patient has no pulse or if the pulse rate is less than 60 and the patient is unconscious. Bradycardia (heart rate less than 60) during pediatric resuscitation is a terminal event and should be treated with compressions and ventilation.

4

Compressions

Compress the chest half of its depth (1.5 inches in infants and 2 inches in children) at a rate of 100–120 beats per minute. If two Healthcare providers are present, a ratio of 15:2 rather than 30:2 may be utilized.

5

Ventilations

If the child has a pulse, or has an advanced airway in place, ventilations should be done at a rate of 20–30 a minute. The smaller the child the higher the rate. This is one breath every 2–3 seconds.

6

AED

The defibrillator should be attached and utilized as soon as available.

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