Basic Life Support

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Contents 1 More Specific Terms 2 Introduction 3 Management 4 More General Terms 5 Additional Terms 6 References

More Specific Terms

• Airway, Breathing & Circulation (ABC)
• nasopharyngeal airway
• obstructed airway maneuver
• oral airway
• pediatric basic & advanced cardiopulmonary life support
• recovery position
• rescue breathing

Introduction

• The goal of basic life support is to provide oxygen to the brain & heart until ACLS can be delivered. ABCs, Airway, Breathing, & Circulation provide the cornerstone of BLS.

Management

• (guidelines)
• determine responsiveness

• gently shake patient
• do not shake head or neck if head or neck trauma is suspected

• activate the EMS system
• position the patient supine on a firm, flat surface, try to move the patient as a unit, avoiding tension on the neck
• begin chest compressions immediately (100/min)

• also applies to BLS for healthcare providers [6]
• untrained bystanders should begin compression-only CPR
• pediatric recommendations differ; see pediatric basic & advanced cardiopulmonary life support

• chest compressions

• heal of one hand on the back of another
• one inch above xiphoid
• shoulders above hands, elbows locked
• compress chest 1.5-2 inches (>= 5 cm) [7]
• for children, chest compression to a depth of 1/3 of the chest wall diameter [5]
• completely release pressure after each compression, but keep hands in contact with chest to maintain proper hand position
• rate = 100 compressions/minute, acceptable < 23 sec for 30 compressions
• assess adequacy of compressions by palpating carotid pulse (2 person CPR)

• basic life support: 30 compressions (100/min) followed by 2 respirations (1 sec/forced inspiration) [2]
• stop basic life support 2 minutes & each 2 minutes thereafter to assess for spontaneous pulse or respirations

• basic life support should not be withheld for more than 5-10 sec except for defibrillation or intubation
• attempts to intubate should not exceed 30 sec
• 2 minute cycles (about 5 cycles of 30 compressions with 2 repirations)
• change person delivering compressions every 2 minutes if feasible

• 8-10 breaths/min for patients with endotracheal intubation or other advanced airway
• rescue breathing (lower priority than chest compressions)

• open the patient's mouth, leave dentures in (they facilitate a good mouth-to-mouth seal)
• open patient's airway

• head tilt-chin lift; lay rescuers should use the head tilt-chin lift in all unresponsive patients regardless of injury [4]
• jaw thrust maneuver if neck injury suspected & rescuer is a professional proficient in this maneuver [4]

• sweep oral airway with hand to open airway
• evaluate patient's respirations with airway open

• look for chest movement
• place ear over mouth & listen for respirations

• spontaneous respirations not present

• gently pinch the nose with the index finger & thumb
• make a tight seal over the patient's mouth & give 2 breaths 1 sec/breath
• continue rescue breathing if signs of circulation

• palpate patient's carotid pulse for 5-10 sec, if pulse present continue rescue breathing @ 10-12/min

More General Terms

• cardiopulmonary resuscitation (CPR)

Additional Terms

• airway obstruction
• do not resuscitate (DNR)
• emergency medical system (EMS)
• head tilt-chin lift
• jaw thrust maneuver
• obstructed airway maneuver
• recovery position
• rescue breathing
• termination of cardiopulmonary resuscitation (CPR)

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170-71
2. ECC Committee, ECC Subcommittees, and ECC Task Forces; and Authors of Final Evidence Evaluation Worksheets 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations Conference. Circulation. 2005 Dec 13;112(24_suppl):b2-b5. No abstract available. PMID: [1]
3. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
4. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2005 [2]
5. Braga MS et al Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 2009 Jul; 124:e69 <PubMed> PMID: [3] <Internet> [4]
6. American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes [5]
7. Stiell IG et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012 Jan 5 PMID: [6]
8. National Guideline Clearinghouse Adult basic life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [7]

basic life support (BLS)