Treatment Guideline Chart
Basic life support (BLS) is the fundamental approach to saving lives following cardiac arrest.  Primary aspects of BLS include immediate recognition of sudden cardiac arrest and activation of the emergency response system, early cardiopulmonary resuscitation, and rapid defibrillation with an automated external defibrillator. Initial recognition and response to heart attack and stroke are also considered part of BLS.

Basic%20life%20support%20-%20adult Treatment

Recovery Position

  • If alone, get help or if available, send someone for help
  • Continue to observe for breathing

If spinal injury is not suspected, turn victim to recovery position:

  • Recovery position is for patients who have normal breathing & effective circulation
  • Position should be stable, near a true lateral position, w/ the head dependent & w/o pressure on the chest that could impair breathing
    • Recovery position is designed to maintain a patent airway & prevent aspiration & airway obstruction
  • Remove victim’s spectacles
  • Kneel next to victim
  • Make sure both legs of victim are straight
  • Put victim’s arm nearest to you at right angles to his body & bend elbow w/ palm facing upwards
  • Bring victim’s far arm across chest & place back of hand against his cheek closest to you
  • Bend victim’s knee farthest from you while keeping his foot on floor
  • Roll victim towards you
  • Adjust victim’s upper leg so that hip & knee are both at right angles
  • Tilt head back to keep airway open

Patients w/ suspected spine injury:

  • Studies done among normal volunteers have demonstrated that recovery position for victims w/ known spinal injury can be done by extending the lower arm above the head & rolling the head onto the arm while bending both legs

If recovery position has to be maintained for >30 min, turn the victim to opposite side to relieve pressure on the lower arm

Chest Compression & Ventilation

  • Turn victim on to his back if not yet in this position

Start Compressions

  • Place heel of one hand over center of victim’s chest, then place heel of other hand on top of first hand so that the hands are overlapping & parallel
  • Rate should be at between 100-120/min w/ a depth of at least 2 in (5 cm)
    • Chest compression rate refers to the speed of compressions (not the actual number of compressions delivered per minute)
    • Chest compression depth should not exceed 2.4 in (6 cm)
    • Chest compression & chest recoil/relaxation times should approximately be equal
  • Allow complete chest recoil after each compression, minimizing duration & frequency of interruptions in compressions
    • Leaning on the chest wall between compressions should be avoided to allow complete chest wall recoil

Administer Ventilation

Give 2 slow, effective breaths

  • Perform head tilt & chin lift maneuver to open the airway
    • In cases of suspected cervical spine injury, open the airway using jaw thrust w/o head extension
    • When jaw thrust does not allow adequate opening of airway, use head tilt-chin lift maneuver
  • Using your thumb & index finger of hand placed on forehead, pinch close the soft part of nose
  • Open victim’s mouth slightly while maintaining chin lift
  • Take a regular breath & place lips around victim’s mouth ensuring an airtight seal
  • Rescue breaths through the nose is recommended if ventilation cannot be given through the mouth
  • Blow steadily into victim’s mouth for about 1 sec
    • Chest should rise w/ each administered breath
  • Keeping head tilt & chin lift, move your mouth away from the victim’s
    • Watch the chest fall as air passes out
  • Risk of disease transmission through mouth to mouth ventilation is reportedly very low & it is thus reasonable to initiate rescue breathing w/ or w/o a barrier device

Chest Compression Fraction

  • Refers to the measurement of the proportion of time that chest compressions were successful during a cardiac event
  • Chest compression fraction of at least 60% is recommended in patients w/ an unprotected airway
  • Should be maximized by avoiding interruptions during chest compressions
  • A pause of <10 sec to administer rescue breaths is recommended

Compression-Ventilation Ratio

  • A compression-ventilation ratio of 30:2 is recommended until an advanced airway is present
  • After placing an advanced airway (eg endotracheal tube, Combitube or laryngeal mask airway), multiple rescuers can provide continuous, uninterrupted chest compressions at a rate of at least 100/min while giving ventilations (at a rate of 1 breath every 6 sec or 10 breaths/min)
    • Avoid excessive ventilation & minimize interruptions in chest compressions
  • When multiple rescuers are available, it is reasonable to switch chest compressors every 2 min (or approx 5 cycles) of compressions & ventilations to avoid compromising quality of compressions
    • Fatigue among rescuers may occur after 1 minute of CPR, leading to shallow compressions
    • Switching between rescuers should be done in <5 sec
  • When checking for return of spontaneous circulation (ROSC), interruptions in chest compressions for a pulse check should still be minimized

Special Circumstances

  • Consider administration of Naloxone to patients w/ known or suspected of opioid overdose

Mobilize Automated External Defibrillator (AED)

  • For witnessed sudden collapse wherein ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) is considered (also called “shockable rhythms”)
  • Rapid defibrillation is the treatment of choice for VF of short duration (eg hospitalized patients whose heart rhythm is monitored, witnessed out-of-hospital cardiac arrests)
  • For lone rescuers, AED is retrieved if available nearby after which CPR should be immediately performed
    • Resume chest compressions as soon as the shock is delivered
  • For multiple rescuers, one should initiate chest compressions while the other acquires or sets up AED
    • CPR is started while checking the rhythm w/ an AED or an ECG & preparing for defibrillation
    • Defibrillation should be done as soon as an AED is obtained, except in monitored patients where shock delivery should be done in <3 min
  • Single shocks followed immediately by CPR is recommended
    • Studies suggest that 1-shock protocol on VF cardiac arrest provides greater survival benefit compared w/ a 3-shock protocol
    • Incremental benefit from another shock is low, & resumption of CPR after initial shock is likely to confer a greater value than another immediate shock
  • Defibrillation administered w/in 3-5 min of collapse & w/ ongoing CPR produces better survival outcome in patients w/ VF or pVT

Continue Resuscitation

  • Every few minutes take <10 sec to confirm circulation
  • If victim starts to breathe, but remains unconscious, place in recovery position & continue to monitor

Continue resuscitation until:

  • Qualified help arrives & takes over
  • Victim shows signs of recovery
  • Rescuer fatigues

Foreign Body Airway Obstruction (FBAO) Sequence

If unable to give effective breaths:

  • If healthcare worker is still unsuccessful, he should attempt FBAO sequence
    • Aggressive treatment in FBAO sequence, including back blows, abdominal thrusts & chest compressions should be reserved for victims w/ severe airway obstruction as these measures may worsen the obstruction

Complete Airway Obstruction: Victim stops breathing or coughing

For complete airway obstruction, several techniques are used, check w/ local protocol:

  • Abdominal thrusts used alone
  • 5 back blows followed by 5 abdominal thrusts
  • 5 back blows followed by 5 chest thrusts

Recommended Steps

  • Administer 5 slaps midback between the shoulder blades
  • If 5 back blows fail to remove foreign object, try 5 abdominal thrusts or 5 chest thrusts depending on local protocol

Abdominal thrusts

  • Conscious victim
    • Stand behind victim w/ right leg positioned between victim’s legs
    • Make fist w/ one hand & place thumb side against the victim’s midline abdomen slightly above the navel, making sure to be well below the bottom tip of the sternum
    • Place other hand over fist & press into the abdomen w/ a quick inward & upward thrust
    • Continue until foreign object is removed or victim loses consciousness
    • Victim should seek medical attention after abdominal thrusts are performed to rule out any internal injury

Chest thrusts

  • Conscious victim
    • May be used when abdominal thrusts are difficult to administer (eg in late stages of pregnancy or for an extremely obese victim)
    • Stand behind victim w/ right leg positioned between victim’s legs
    • Encircle victim w/ your arms directly under his armpits
    • Make a fist w/ one hand & place thumb side against the middle of the victim’s sternum
    • Grab fist w/ 2nd hand & perform backward thrusts using care not to put pressure on the ribs or the xiphoid process
    • Continue until foreign object is removed or victim loses consciousness

Chest compressions

  • Unconscious victim
    • Follow steps for basic life support
    • Check mouth for foreign object before attempting each cycle of rescue breaths
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