CH 14 BLS RESUSCITATION

• Focus on ABC's


  • Only seconds should pass between time you recognize patient's needs BLS and treatment
  • Permanent brain damage if brain is without oxygen for 4-6 minutes
• Minutes/Consequences


  1. 0-1: cardiac irritability

  2. 0-4: brain damage not likely

  3. 4-6: brain damage possible

  4. 6-10: brain damage very likely

  5. 10+: irreversible brain damage
• Cardiopulmonary Resuscitation (CPR)


  Establishes circulation and artificial ventilation in a patient who is not breathing and has no pulse
• CPR


  1. 2 - 2.4 inches depth, 100 - 120 rate, 30:2 (even with 2 EMS)

  2. Open airway: head tilt chin lift, jaw thrust

  3. Use BVM, 2 breaths over 1 second with adequate chest rise

  4. Optimizes preload

  5. Incomplete chest wall recoil: diminishes preload

  6. Responsive patient does not need CPR, but may need rescue breathing

  7. Cardiac arrest in adults occurs before respiratory arrest, children usually go into respiratory arrest before cardiac arrest

  8. If you witness cardiac arrest, call ALS and then begin compressions

  9. If you do not witness cardiac arrest, begin CPR for 2 min then call for help

  10. AED use in children: apply after first 5 cycles of CPR

  11. Manual defibrillation preferred for infants 1 month - one year

  12. AED with children: anterior-posterior placement

  13. Pacemakers/implanted defibrillators: Place electrodes 1 inch (2.5 cm) away from device

  14. Transdermal Medication Patches: Remove the patch and wipe skin

  15. Not breathing, yes pulse = rescue breaths

  16. Breathing adequately, no signs of injury to head, spine, hip, pelvis: place patient in recovery position

  17. Stoma = place BVM directly over stoma

  18. One rescuer adult CPR: 30:2, mouth-to-mask technique with one way valve

  19. Manual chest compressions remain standard of care

  20. Cardiac arrest in infants/children follows respiratory arrest, which triggers hypoxia and ischemia (decreased oxygen supply) of heart

  21. Infant/children CPR: Unresponsive, breathing child in recovery position, place wedge on padding under a child's upper chest and shoulders to avoid partially obstructing the airway

  22. Infant/children CPR: 1 breath every 3-5 seconds (12-20 breathing per minute)

  23. Tracheostomy tube in neck: remove mask from BVM, connect directly to the tracheostomy tube to ventilate the child

  24. If ALS not available: Provide transport, consider requesting ALS rendezvous on route to hospital

  25. Do not interrupt CPR for longer than 10 seconds

  26. Obvious signs of death: absence of pulse and breathing --> stop CPR
• STOP acronym: when to stop CPR


  • S: Patient Starts Breathing and has pulse
  • T: Transferred to another provider
  • O: Out of strength
  • P: Physician directs to discontinue
• Mild obstruction


  Still able to exchange air, but have signs of respiratory distress.. encourage them to cough/get things out of mouth. Do not do Heimlich on mild obstruction (coughing), only severe
• Chest thrusts


  Used instead of abdominal thrusts for women in advance stages of pregnancy + obese patients
• What to do when a patient is unresponsive:

  Determine responsiveness, check for breathing pulse, pulse present and breathing absent: attempt ventilation
• Infants


  1. Perform back slaps (5 slaps between shoulder blades using heel of hand)/ chest thrust

  2. Unresponsive infants: Begin CPR, begin with chest compressions.. do not check for pulse before starting compressions
• Opioid OD


  Standard resuscitation measures take priority over naloxone administration
• Cardiac arrest in pregnancy

  1. Priorities are to provide CPR and relieve pressure of aorta + vena cava

  2. Pregnant patient not in cardiac arrest: position on left side to relieve pressure

  3. Pregnant patient in cardiac arrest: If uterus can be felt at or above level of umbilicus (belly button), perform manual displacement of the uterus to patient's left to relieve pressure while CPR is being performed
• Designate one provider


  To communicate patient's status to family members
• ALS


  Cardiac monitor, IV/medications, Advanced airway adjuncts
• Five links of the chain of survival

  • Recognition/Activation of EMS
  • Immediate CPR
  • Rapid defibrillation (AED) --> should be applied asap
  • Basic and Advanced EMS
  • ALS and post-arrest care
• If any chain is broken, you decrease their chance of survival
• Transporting pregnant patient


  Transport on left side