CPH LAB

BASIC LIFE SUPPORT SY 2019 - 2020

I. Introduction

Basic Life Support (BLS)

• care healthcare providers and public safety professionals provide to patients who are experiencing respiratory
arrest, cardiac arrest or airway obstruction
• utilized mainly by Emergency Medical Technicians (EMT), Paramedics, Triage nurses and anyone with BLS
Training

II. Procedure

1. Scene Size-Up
▪ Determine if the situation is safe, how many patients are involved and the nature of the illness/mechanism
of injury; gather an initial impression; and call for additional resources including any additional equipment
and providers as needed
▪ Check the scene by answering the following questions:
a. Is it safe?
i. Check for anything unsafe, such as traffic, fire, escaping steam, downed electrical lines,
smoke, extreme weather or even overly emotional bystanders that could become a
threat.
ii. Appropriate PPE and standard precautions must be followed
b. Is immediate danger involved?
c. What happened? What is the nature of the illness or mechanism of injury?
i. Look for clues to what may have caused the emergency and how the patient became ill
or injured, for example, a fallen ladder, broken glass or a spilled bottle of medication.
ii. Quickly ask bystanders what happened and use the information in determining what
happened.
d. How many patients are involved?
e. Is anyone else available to help?
f. What is your initial impressions?
2. Primary Assessment of the Unresponsive Adult Patient?
▪ Involves the following areas:
a. Level of Consciousness
i. Assess responsiveness of patient:
✓ A – alert → fully awake but may still be confused
✓ V – verbal → responds to verbal stimuli
✓ P – painful → responds to painful stimuli
✓ U – unresponsive → does not respond
b. Breathing
i. If the patient is alert and talking, the airway is open.
ii. For unresponsive patient, he or she must be in supine position. If the patient is face down,
roll patient onto his or her back.
iii. Two methods to open the airway:
✓ Head – tilt/ chin – lift technique
o Press down on the forehead while pulling up on the bony part of the chin
with two to three fingers of the other hand.
o For adults, tilt the head past a neutral position to open the airway while
avoiding hyperextension of the neck.
✓ Modified jaw – thrust maneuver
o Recommended if head, neck or spinal injury is suspected

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o Put one hand on each side of the patient’s head with the thumbs near
the corners of the mouth pointed toward the chin, using the elbows for
support.
o Slide the fingers into position under the angles of the patient’s jawbone
without moving the head or neck.
o Thrust the jaw upward without moving the head or neck to lift the jaw
and open the airway.
c. Circulation
i. Once the airway is open, simultaneously check for breathing and carotid pulse, for at least
5 but no more than 10 seconds.
ii. When checking for breathing, look to see if the patient’s chest rises and falls, listen for
escaping air and feel for it against the side of your cheek. Normal breathing is quiet,
regular and effortless.
iii. Agonal breaths - isolated or infrequent gasping that occurs in the absence of normal
breathing in an unconscious patient. This is considered as a sign of cardiac arrest.
iv. When checking the pulse on an adult patient, palpate the carotid artery by sliding two
fingers into the groove of the patient’s neck, being careful not to reach across the neck
and obstruct the airway.
▪ Primary Assessment Results:
a. Respiratory arrest
i. Patient is not breathing but with a definitive pulse
ii. Give ventilation to the patient
✓ Supplying oxygen to a patient
✓ 1 ventilation every 5 – 6 seconds for an adult patient, with each ventilation lasting
about 1 second
✓ Avoid overventilation and hyperventilation. Hyperventilation can result to gastric
distension, emesis, increased intrathoracic pressure and subsequent decrease in
coronary filling.
b. Cardiac arrest
i. Patient is not breathing, no pulse and unresponsive
ii. Follow the cardiac chain of survival
✓ Adult Cardiac chain of Survival
o Recognition of cardiac arrest and activation of the emergency response
system
o Early CPR to keep oxygen-rich blood flowing and to help delay brain
damage and death
o Early defibrillation with an automated external defibrillator (AED) to help
o restore an effective heart rhythm and significantly increase the patient’s
chance for survival
o Advanced life support using advanced medical personnel who can provide
the proper tools and medication needed to continue the lifesaving care
o Integrated post-cardiac arrest care to optimize ventilation and oxygenation
and treat hypertension immediately after the return of spontaneous
circulation
✓ Pediatric Cardiac Chain of Survival
o Prevention of arrest
o Early, high-quality CPR

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o Rapid activation of the EMS system or response team to get help on the
way quickly—no matter the patient’s age
o Effective, advanced life support
o Integrated post-cardiac arrest care
iii. Provide Cardiopulmonary Resuscitation (CPR) or Automated External Defibrillators (AED)
✓ Cardiopulmonary Resuscitation (CPR)
o Circulates blood that contains oxygen to the vital organs of a patient in
cardiac arrest when the heart and breathing have stopped
o Includes chest compressions and ventilations
o Chest Compressions:
➢ Patient is on a firm, flat surface to allow for adequate compression.
In a non-healthcare setting this would typically be on the floor or
ground, while in a healthcare setting this may be on a stretcher or
bed with a CPR board or CPR feature applied.
➢ The chest is exposed to ensure proper hand placement and the
ability to visualize chest recoil.
➢ Hands are correctly positioned with the heel of one hand in the
center of the chest on the lower half of sternum with the other hand
on top. Most rescuers find that interlacing their fingers makes it
easier to provide compressions while keeping the fingers off the
chest.
➢ Arms are as straight as possible, with the shoulders directly over
the hands to promote effective compressions. Locking elbows will
help maintain straight arms.
➢ Compressions are given at the correct rate of at least 100 per
minute to a maximum of 120 per minute, and at the proper depth
of at least 2 inches for an adult to promote adequate circulation.
➢ The chest must be allowed to fully recoil between each
compression to allow blood to flow back into the heart following
the compression.
➢ For adults, CPR consists of 30 compressions followed by 2
ventilations
o Ventilations:
➢ Supply oxygen to the patient via mouth-to-mouth, pocket mask or
bag-valve-mask (BVM) resuscitator
 Mouth-to-Mouth Ventilation Steps:
1) Open the airway past a neutral position using the
head-tilt/chin-lift technique.
2) Pinch the nose shut and make a complete seal
over the patient’s mouth with your mouth.
3) Give ventilations by blowing into the patient’s
mouth. Ventilations should be given one at a time.
Take a break between breaths by breaking the
seal slightly between ventilations and then taking
a breath before re-sealing over the mouth.
 Pocket Mask Ventilation
❖Creates a barrier between your mouth and the
patient’s mouth and nose which protects you from
contact with a patient’s blood, vomitus and saliva,
and from breathing the air that the patient exhales
1) Assemble the mask and valve.

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2) Open the airway past the neutral position using

the head-tilt/chin-lift technique from the
patient’s side when alone.
3) Place the mask over the mouth and nose of the
patient starting from the bridge of the nose,
then place the bottom of the mask below the
mouth to the chin (the mask should not extend
past the chin).
4) Seal the mask by placing the “webbing”
between your index finger and thumb on the top
of the mask above the valve while placing your
remaining fingers on the side of the patient’s
face. With your other hand (the hand closest to
the patient’s chest), place your thumb along the
base of the mask while placing your bent index
finger under the patient’s chin, lifting the face
into the mask.
 Bag-Valve-Mask Resuscitator
❖Handheld device used to ventilate patients and
administer higher concentrations of oxygen than
a pocket mask
1)Assemble the BVM as needed.
2)Open the airway past neutral position while
positioned at the top of the patient’s head
(cephalic position).
3)Use an E-C hand position (first rescuer):
ŸPlace both hands around the mask, forming an
E with the last three fingers on each hand and a
C with the thumb and index finger around both
sides of the mask.
ŸSeal the mask completely around the patient’s
mouth and nose by lifting the jaw into the mask
while maintaining an open airway.
4)Provide ventilations (second rescuer):
ŸDepress the bag about halfway to deliver
between 400 to 700 milliliters of volume to make
the chest rise.
ŸGive smooth and effortless ventilations that last
about 1 second.
➢ For adults, two (2) ventilations that last approximately 1 second
each and make the chest rise must be given
✓ Automated External Defibrillators
o Portable electronic devices that automatically analyze the patient’s heart
rhythm and can provide defibrillation, an electrical shock that may help the
heart re-establish a perfusing rhythm
o How to use an AED:
1) Turn it on first.
2) Make sure the patient’s chest is clearly exposed and dry.
- Remove any medication patches with a gloved hand.
3) If necessary, remove or cut any undergarments that may be in the
way. The pads need to be adhered to the skin for the shock to be
delivered to the heart.

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4) Apply the appropriate-sized pads for the patient’s age in the proper
location on the bare chest.
- Use adult pads for adults and children over the age of 8 years or
over 55 pounds.
- Place one pad on the upper right chest below the right clavicle to
the right of the sternum; place the other pad on the left side of the
chest on the mid-axillary line a few inches below the left armpit.
5) Plug in the connector, and push the analyze button, if necessary.
(Most AEDs available today have their pads pre-connected and will
automatically analyze once the pads are applied to the chest. Make
sure you understand how the AED within your organization operates.)
6) Tell everyone to “clear” while the AED is analyzing to ensure accurate
analysis. Ensure no one is touching the patient during the analysis or
shock.
7) When “clear” is announced, have the rescuer performing the
compressions stop compressions and hover a few inches above the
chest, but remain in position to resume compressions immediately
after a shock is delivered or the AED advises that a shock is not
indicated.
8) Observe the AED analysis and prepare for a shock to be delivered if
advised.
- Ensure that everyone is clear of the patient before the shock is
delivered.
- Remember that the AED delivers an electrical current that could
injure anyone in contact with the patient.
- Have the rescuer in the hover position ready to resume
compressions immediately after a shock is delivered or the AED
advises that a shock is not indicated.
9) Deliver the shock by pressing the shock button, if indicated.
10) After the shock is delivered, immediately start compressions and
perform about 2 minutes of CPR (about 5 cycles of 30:2) until the AED
prompts that it is reanalyzing, the patient shows signs of return of
spontaneous circulation (ROSC), or you are instructed by the team
leader or more advanced personnel to stop.
11) Do not wait for the AED to prompt to begin CPR after a shock or no
shock advised message.

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***Note: When to stop CPR:

1) You see signs of return of spontaneous circulation (ROSC) such as patient
movement or breathing.
2) An AED is ready to analyze the patient’s heart rhythm.
3) Other trained rescuers take over and relieve you from compression or ventilation
responsibilities.
4) You are presented with a valid do not resuscitate (DNR) order.
5) You are alone and too exhausted to continue.
6) The scene becomes unsafe.

***Pediatric Considerations:

✓ Child - defined as the age of 1 to the onset of puberty as evidenced by

breast development in girls and underarm hair development in boys
✓ Infant – under the age of 1 year

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Reference:

American Red Cross Basic Life Support for Healthcare Providers Handbook

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