Basic Life Support (BLS) refers to medical care of life threatening illness or injury in the hospital and pre-hospital setting. BLS provides a stopgap for patients before advanced life support (ALS) is initiated.
BLS procedures vary slightly between countries. This article draws on BLS procedures for the UK outlined in 2010 resuscitation council guidlines.
BLS sequence for adults
The following steps should be carried out when approaching a collapsed or unresponsive patient:
- Check patient’s response: Shake the patient gently by the shoulders and ask, “Are you alright?”. Give a command e.g. “open your eyes.
- If there is no response, immediately Shout for help and activate the bedside alarm
- Open the airway: turn the patient onto their back and use the Head tilt- chin lift manouvere Care should be taken in potential spinal injuries, where attempting to gently turn the head to a neutral position and a jaw thrust should be used
- Check for breathing and circulation: With your head close to the patient’s and looking down towards their feet: Look at the chest for breathing movements Listen for breath sounds and Feel for air on your cheek Check for normal breathing for no longer than 10 seconds whilst simultaneously feeling for a carotid pulse. Infrequent, noisy, gasps (agonal breathing) can occur in the first few minutes and is not normal breathing.
- Put out a crash call: If someone else is around, ask them to do this. If you are alone, do this yourself; you may need to leave the patient. dial 2222 (or local emergency number) and state 'crash call ward B4' and repeat once. If you have assisstance and are ILS/ALS trained you can request that the resus equipment is brought whilst compressions are commenced, it is vital that CPR starts as soon as possible and continues without delay until more advanced techniques can be employed, if you are alone you must start CPR and await the crash team.
- Commence chest compressions: These should be given at a rate of around 100 per minute (just less than two a second) many beds have a 'CPR mode' adding that can be activated on the control. Place the heel of one hand in the centre of the chest (take care to avoid giving abdominal compressions) then place your other hand other the top of the first one with the fingers interlocking. Press down on the sternum with elbows locked so it falls by 1/3rd of the chest depth. Compression and release should take an equal amount of time and it is important to allow the chest to fully recoil allowing the coronary circulation to be perfused.
- Introduce rescue breaths: once a resus mask is available (ask for one to be collected) compressions and rescue breaths should be undertake at a ratio of 30:2. breathe for one second and allow the chest to fall for 3-4 seconds, it is not necessary to blow forcefully. The chest should rise as if they are breathing normally indicating an effective rescue breath. If trained and an assistant is available this can be accomplished using a bag-valve mask. If two attempts have been unsuccessful continue compressions until an individual with advanced airway skills arrives
- Continue until more qualified help arrives: If you have help it may be appropriate to begin 2-person CPR and to switch individuals giving compression to maintain efficacy
BLS adult sequence
Usually the adult sequence can also be used for children. Some small modifications have shown to be an improvement when used on children. This reflects a respiratory cause of arrest being more likely in children
The first two modifications are also more effective in adults who are drowning victims, or show other obvious signs of asphyxiation (whereas the regular sequence is more effective in adults with cardiac arrest)
- Give five rescue breaths BEFORE starting chest compressions.
- If you are on your own, perform CPR for 1 minute BEFORE finding help
- The chest needs to be compressed by one third of it’s depth. Two achieve this, use two fingers in infants under one year old. Smaller children may require one handed compressions and both hands can be used if older.
Chest Compression Only CPR
This method of CPR, which as the title suggests omits the rescue breaths, can be used when the person giving CPR can't or doesn't want to give rescue breaths. Chest compressions should be given at the regular rate (100 per minute) and uninterupted unless the patient starts breathing normally.
The recovery position is usually used when you discover a patient who is unconsious but breathing normally.
The following steps should be followed:
- Remove the patients glasses or any objects in their pockets that may dig in
- Kneel next to the patient and make sure their legs are straight.
- Take the arm nearest to you and place it at right angles to their body, palm facing upwards.
- Take the patients hand that is furthest from you and place it against their opposite cheek (the one nearest to you). Thier palm should be facing you.
- Using your other hand, pull their opposite knee up, making sure their foot doesn't leave the ground.
- Pull the raised knee towards you so that the patient rolls onto their side
- Adjust the upper leg so that the knee and hip are both at right angles
- Tilt the patients head back to open the airway, adjusting the hand under the cheek if neccesary.
- Turn the patient onto their oppsite side after thirty minutes and recheck breathing regularily.
Choking is when the airway is obstructed by a foreign body, and usually occurs whilst eating. It is important to ask the question "Are you choking?" when you suspect someone is choking. The airway obstruction may be mild (patient can speak, cough and breathe) or severe (patient can't speak, patient can't breathe or breathing is wheezy, coughing is silent, pateint may become unconsious).
When treating a a mild obstruction, encourage the patient to cough, but do nothing else.
When treating a severe obstruction the following steps should be followed:
1. Five back blows: These are given by standing behind and slightly to the side of the patient. Support the patient's chest with one hand and make sure they are leaning foward. GIve five sharp blows inebtween the patient's shoulder blades with you other hand. Check the patient between each blow to see if the obstruction has been removed.
2. Five abdominal thrusts: These are given standing behind the patient. Place a clenched fist in between the patients umbilcus and the bottom of the strenum. Reach around the patient with your other hand so you can grab the first hand. Pull sharply inwards and upwards. Repeat up to five times or untill the obstruction is removed.
3. Repeat steps 1 and 2 untill the obstruction is removed. If the airway cannot be cleared a crash call must be put out asap, ideally by an assistant. Failure remove the obstruction cill cause the patient to fall unconsious in which case CPR should be commenced as descirbed above
If the obstruction is successfully removed:
Small amounts of the foreign body may still be stuck in the upper or lower respiratory tract and may go on to cause infections. Therefore be cautious of patients who experience difficulty swallowing, a persistant cough or a sensation that there is something still stuck in their throat.
Any patient that receives abdominal thrusts should be examined carefully to check for internal injuries.