Basic life support
Encyclopedia
Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technician
s, paramedic
s, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment.
Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. The guidelines outline algorithms for the management of a number of conditions, such as cardiac arrest
, choking
and drowning
. BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced Life Support
(ALS). Most laypersons can master BLS skills after attending a short course. Firefighter
, lifeguards, and police officers are often required to be BLS certified. BLS is also immensely useful for many other professions, such as daycare providers, teachers
and security personnel
and social workers especially working in the hospitals and ambulance drivers.
CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of the automated external defibrillator
or AED. This improves survival outcomes in cardiac arrest
cases.
Basic life support consists of a number of life-saving techniques focused on the medicine "CAB"s (previously known as ABC. was recently changed by the American Heart Association
) of pre-hospital emergency care:
Healthy people maintain the CABs by themselves. In an emergency situation, due to illness (medical emergency
) or trauma
, BLS helps the patient ensure his or her own CABs, or assists in maintaining for the patient who is unable to do so. For airways, this will include manually opening the patients airway (Head tilt/Chin lift or jaw thrust) or possible insertion of oral (Oropharyngeal airway
) or nasal (Nasopharyngeal airway
) adjuncts, to keep the airway unblocked (patent
). For breathing, this may include artificial respiration
, often assisted by emergency oxygen
. For circulation, this may include bleeding control
or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.
's BLS protocol is designed for use by laypeople, as well as students and others certified first responder
, and to some extent, higher medical function personel. It includes cardiac arrest
, respiratory arrest
, drowning
, and foreign body airway obstruction (FBAO, or choking
). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the Advanced Cardiac Life Support
(ACLS) protocols, in addition to BLS protocols.
The algorithm
for providing basic life support to adults in the USA was published in 2005 in the journal Circulation
by the American Heart Association
(AHA).
The AHA uses four-link "Chain of Survival
" to illustrate the steps needed to resuscitate a collapsed victim:
Bystanders with training in BLS can perform the first 3 of the 4 steps.
Basic Life Support 2011 Guideline
Steps in resuscitation are now DRS C-A-B in this sequence
- Check for Danger
- Check for Response
- ‘S’ has been added for Send for help
- ‘A’ directs rescuers to open the Airway
- ‘B’ directs rescuers to check Breathing but no need to deliver rescue breaths
- ‘C’ directs rescuers to perform 30 Compressions to patients who are unresponsive and not breathing normally, followed by 2 rescue breaths
- ‘D’ directs rescuers to attach an AED as soon as it is available and follow prompts
The major change is that in the patient who is unresponsive and not breathing CPR commences with chest compressions rather than rescue breaths.
If unwilling / unable to perform rescue breathing, then perform compression-only CPR, as any attempt at resuscitation is better than no attempt; and should be encouraged.
Assess:* If the patient is breathing normally, and pulse is present then the patient should be placed in the recovery position
and monitored. Transport if required, or wait for the EMS to arrive and take over.
If the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-lift maneuver; if the victim has suspected neck trauma, the airway should be opened with the jaw-thrust technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
Continue chest compression at a rate of 100 compressions per minute for all age groups, allowing chest to recoil in between. For adults push up to 5 cm and for child up to 4cm. For infants up to 3cm or 1/3 of the chest diameter antero-posteriorly.Keep counting aloud. Press hard and fast maintaining the rate of at about 100/minute.Allow recoil of chest fully between each compression.After every 30 chest compressions give two rescue breaths in adult and child victim, Continue for five cycles or two minutes before re-assessing pulse.
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If an AED is available it should be activated immediately and its directives followed and (if indicated), call for clearance before defibrillation/shock should be performed. If defibrillation is performed,begin chest compression immediately after shock.
Note CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer). Two person CPR for an infant also requires the "two hands encircling thumbs" technique for the rescuer performing compressions.
A lone rescuer is typically advised to give CPR for a short time before leaving the victim to call emergency medical services.
Since the primary cause of cardiac arrest and death in drowning and choking victims is hypoxia, it is more important to provide rescue breathing as quickly as possible in these situations, whereas for victims of VF cardiac arrest chest compressions and defibrillation are more important.
were also published in 2005 by the Resuscitation Council (UK), based on the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) published in November 2005.
These guidelines differ from previous versions in a number of ways:
These changes were introduced to simplify the algorithm
, to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival. It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.
) for the education of first responders.
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
s, paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
s, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment.
Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. The guidelines outline algorithms for the management of a number of conditions, such as cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
, choking
Choking
Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which...
and drowning
Drowning
Drowning is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia....
. BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced Life Support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
(ALS). Most laypersons can master BLS skills after attending a short course. Firefighter
Firefighter
Firefighters are rescuers extensively trained primarily to put out hazardous fires that threaten civilian populations and property, to rescue people from car incidents, collapsed and burning buildings and other such situations...
, lifeguards, and police officers are often required to be BLS certified. BLS is also immensely useful for many other professions, such as daycare providers, teachers
Teachers
Teachers may refer to:* Teachers, people who provide schooling for pupils and students* Teachers , one of the five Ascension Gift Ministries* Teachers , a British sitcom* Teachers Teachers may refer to:* Teachers, people who provide schooling for pupils and students* Teachers (ministry), one of the...
and security personnel
Security guard
A security guard is a person who is paid to protect property, assets, or people. Security guards are usually privately and formally employed personnel...
and social workers especially working in the hospitals and ambulance drivers.
CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of the automated external defibrillator
Automated external defibrillator
An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...
or AED. This improves survival outcomes in cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
cases.
Basic life support consists of a number of life-saving techniques focused on the medicine "CAB"s (previously known as ABC. was recently changed by the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
) of pre-hospital emergency care:
- CirculationCirculatory systemThe circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
: providing an adequate blood supply to tissue, especially critical organs, so as to deliver oxygen to all cells and remove metabolic waste, via the perfusion of blood throughout the body. - AirwayAirwayThe pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
: the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the atmosphere. - BreathingBreathingBreathing is the process that moves air in and out of the lungs. Aerobic organisms require oxygen to release energy via respiration, in the form of the metabolism of energy-rich molecules such as glucose. Breathing is only one process that delivers oxygen to where it is needed in the body and...
: inflation and deflation of the lungs (respiration) via the airway
Healthy people maintain the CABs by themselves. In an emergency situation, due to illness (medical emergency
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
) or trauma
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, BLS helps the patient ensure his or her own CABs, or assists in maintaining for the patient who is unable to do so. For airways, this will include manually opening the patients airway (Head tilt/Chin lift or jaw thrust) or possible insertion of oral (Oropharyngeal airway
Oropharyngeal airway
An oropharyngeal airway is a medical device called an airway adjunct used to maintain a patent airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing...
) or nasal (Nasopharyngeal airway
Nasopharyngeal airway
In medicine, a nasopharyngeal airway, also known as an NPA or a nasal trumpet because of its flared end, a type of airway adjunct, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw commonly relax...
) adjuncts, to keep the airway unblocked (patent
Patency
-Definition:The property of being open and unobstructed, with continuity of lumen .-Examples:* An obstructed coronary artery was treated by balloon angioplasty and patency was restored....
). For breathing, this may include artificial respiration
Artificial respiration
Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...
, often assisted by emergency oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
. For circulation, this may include bleeding control
Emergency bleeding control
Emergency bleeding control describes the steps or actions taken to control bleeding from a patient who has suffered a traumatic injury or who has a medical condition which has led to bleeding...
or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.
BLS in the United States
BLS in the United States is generally identified with Emergency Medical Technicians-Basic (EMT-B). However, the American Heart AssociationAmerican Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
's BLS protocol is designed for use by laypeople, as well as students and others certified first responder
Certified first responder
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency...
, and to some extent, higher medical function personel. It includes cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
, respiratory arrest
Respiratory arrest
Respiratory arrest is the cessation of breathing. It is a medical emergency and it usually is related to or coincides with a cardiac arrest. Causes include opiate overdose, head injury, anaesthesia, tetanus, or drowning...
, drowning
Drowning
Drowning is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia....
, and foreign body airway obstruction (FBAO, or choking
Choking
Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which...
). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the Advanced Cardiac Life Support
Advanced cardiac life support
Advanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...
(ACLS) protocols, in addition to BLS protocols.
The algorithm
Medical algorithm
A medical algorithm is any computation, formula, statistical survey, nomogram, or look-up table, useful in healthcare. Medical algorithms include decision tree approaches to healthcare treatment and also less clear-cut tools aimed at reducing or defining uncertainty.-Scope:Medical algorithms are...
for providing basic life support to adults in the USA was published in 2005 in the journal Circulation
Circulation (journal)
Circulation is a scientific journal published by Lippincott Williams & Wilkins for the American Heart Association. The journal publishes articles related to research in and the practice of cardiovascular diseases, including observational studies, clinical trials, epidemiology, health services and...
by the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
(AHA).
The AHA uses four-link "Chain of Survival
Chain of survival
The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link...
" to illustrate the steps needed to resuscitate a collapsed victim:
- Early recognition of the emergency and activation of emergency medical services
- Early bystander CPR, so as not to delay treatment until arrival of EMS
- Early use of a defibrillator
- Early advanced life supportAdvanced Life SupportAdvanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
and post-resuscitation care
Bystanders with training in BLS can perform the first 3 of the 4 steps.
Basic Life Support 2011 Guideline
Steps in resuscitation are now DRS C-A-B in this sequence
- Check for Danger
- Check for Response
- ‘S’ has been added for Send for help
- ‘A’ directs rescuers to open the Airway
- ‘B’ directs rescuers to check Breathing but no need to deliver rescue breaths
- ‘C’ directs rescuers to perform 30 Compressions to patients who are unresponsive and not breathing normally, followed by 2 rescue breaths
- ‘D’ directs rescuers to attach an AED as soon as it is available and follow prompts
The major change is that in the patient who is unresponsive and not breathing CPR commences with chest compressions rather than rescue breaths.
If unwilling / unable to perform rescue breathing, then perform compression-only CPR, as any attempt at resuscitation is better than no attempt; and should be encouraged.
Adult BLS sequence
- C-A-B is recommended in the new AHA EU guidelines.Keeping these facts as such follow the sequence introduced by AHA guidelines 2010 recommendations C-A-B should be followed in learning and teaching BLS.
- Ensure that the scene is safe.
- Assess the victim's level of consciousness by asking loudly and shaking at the shoulders "Are you okay?" and scan chest for breathing movement visually.If no response call for help by shouting for ambulance or EMS and ask for an AED( which is available in offices and building floors).
Assess:* If the patient is breathing normally, and pulse is present then the patient should be placed in the recovery position
Recovery position
The recovery position refers to one of a series of variations on a lateral recumbent or three-quarters prone position of the body, in to which an unconscious but breathing casualty can be placed as part of first aid treatment.An unconscious person The recovery position refers to one of a series of...
and monitored. Transport if required, or wait for the EMS to arrive and take over.
- If patient is not breathing assess pulse at the carotid on your side for an adult, at the brachial for a child and infant for 5 seconds and not more than 10 seconds; begin immediately with chest compressions at a rate of 30 chest compressions in 18 seconds followed by two rescue breaths in 5 seconds each lasting for 1 second.
If the victim has no suspected cervical spine trauma, open the airway using the head-tilt/chin-lift maneuver; if the victim has suspected neck trauma, the airway should be opened with the jaw-thrust technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
- Blind finger-sweeps should never be performed, as they may push foreign objects deeper into the airway.This procedure has been discarded as this may push the foreign body down the airway and increase chances of an obstruction.
Continue chest compression at a rate of 100 compressions per minute for all age groups, allowing chest to recoil in between. For adults push up to 5 cm and for child up to 4cm. For infants up to 3cm or 1/3 of the chest diameter antero-posteriorly.Keep counting aloud. Press hard and fast maintaining the rate of at about 100/minute.Allow recoil of chest fully between each compression.After every 30 chest compressions give two rescue breaths in adult and child victim, Continue for five cycles or two minutes before re-assessing pulse.
- Look, listen, and feel for breathing for at least 5 seconds and no more than 10 seconds.This is another step that has been discarded and considered loss of valuable time.
|url=http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-19 |title=Circulation}}
- Attempt to administer two artificial ventilations using the mouth-to-mouth technique, or a bag-valve-maskBag valve maskA bag valve mask is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew...
(BVM). The mouth-to-mouth technique is no longer recommended, unless a face shield is present. Verify that the chest rises and falls; if it does not, reposition (i.e. re-open) the airway using the appropriate technique and try again. If ventilation is still unsuccessful, and the victim is unconscious, it is possible that they have a foreign body in their airway. Begin chest compressions, stopping every 30 compressions, re-checking the airway for obstructions, removing any found, and re-attempting ventilation. - If the ventilations are successful, assess for the presence of a pulsePulseIn medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
at the carotid arteryCarotid arteryCarotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...
. If a pulse is detected, then the patient should continue to receive artificial ventilation's at an appropriate rateRespiratory rateRespiratory rate is also known by respiration rate, pulmonary ventilation rate, ventilation rate, or breathing frequency is the number of breaths taken within a set amount of time, typically 60 seconds....
and transported immediately. Otherwise, begin CPR at a ratio of 30:2 compressions to ventilation's at 100 compressions/minute for 5 cycles. - After 5 cycles of CPR, the BLS protocol should be repeated from the beginning, assessing the patient's airway, checking for spontaneous breathing, and checking for a spontaneous pulse as per new protocol sequence C-A-B. Laypersons are commonly instructed not to perform re-assessment, but this step is always performed by healthcare professionals (HCPs).
If an AED is available it should be activated immediately and its directives followed and (if indicated), call for clearance before defibrillation/shock should be performed. If defibrillation is performed,begin chest compression immediately after shock.
- BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by another rescuer of equivalent or higher training (See Abandonment), (3) the rescuer is too physically tiredTiredTired may refer to:* Fatigue , a feeling of exhaustion* "Tired", a song by Rollins Band on Weight from 1994* "Tired", a song by Willa Ford on Willa Was Here from 2001* "Tired", a song by LCD Soundsystem on LCD Soundsystem from 2005...
to continue CPR, or (4) the patient is pronounced dead by a medical doctor. - At the end of five cycles of CPR, always perform assessment via the AED for a shockable rhythm, and if indicated, defibrillate, and repeat assessment before doing another five cycles.
- The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilation's or breaths).
Note CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer). Two person CPR for an infant also requires the "two hands encircling thumbs" technique for the rescuer performing compressions.
Drowning
Rescuers should provide CPR as soon as an unresponsive victim is removed from the water. In particular, rescue breathing is important in this situation.A lone rescuer is typically advised to give CPR for a short time before leaving the victim to call emergency medical services.
Since the primary cause of cardiac arrest and death in drowning and choking victims is hypoxia, it is more important to provide rescue breathing as quickly as possible in these situations, whereas for victims of VF cardiac arrest chest compressions and defibrillation are more important.
Hypothermia
- In unresponsive victims with hypothermiaHypothermiaHypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
, the breathing and pulse should be checked for 30 to 45 seconds as both breathing and heart rate can be very slow in this condition. - If cardiac arrest is confirmed, CPR should be started immediately. Wet clothes should be removed, and the victim should be insulated from wind. CPR should be continued until the victim is assessed by advanced care providers.
Foreign body airway obstruction (choking)
- Rescuers should intervene in victims who show signs of severe airway obstruction, such as a silent cough, cyanosisCyanosisCyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
, or inability to speak or breathe. - If a victim is coughing forcefully, rescuers should not interfere with this process.
- If a victim shows signs of severe airway obstruction, abdominal thrusts should be applied in rapid sequence until the obstruction is relieved. If this is not effective, chest thrusts can also be used. Chest thrusts can also be used in obese victims or victims in late pregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
. Abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. - If a victim becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove it if it is evident.
BLS in the United Kingdom
Adult BLS guidelines in the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
were also published in 2005 by the Resuscitation Council (UK), based on the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) published in November 2005.
Adult BLS sequence
- Ensure the safetySafetySafety is the state of being "safe" , the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be...
of the victim, the rescuer, and any bystanders. - Check the victim for a response by gently shaking the victim's shoulders and asking loudly "Are you all right?"
- If the victim responds, leave him in the position in which he was found provided there is no further danger, try to find out what is wrong with him and get help if needed, and reassess him regularly.
- If the victim does not respond, turn him on to his back and open the airway using the head-tilt/chin-lift. Shout for help.
- Look, listen and feel for normal breathing for no more than 10 seconds. If the victim is breathing normally, turn him into the recovery positionRecovery positionThe recovery position refers to one of a series of variations on a lateral recumbent or three-quarters prone position of the body, in to which an unconscious but breathing casualty can be placed as part of first aid treatment.An unconscious person The recovery position refers to one of a series of...
and get help. Continue to check for breathing. - If the victim is not breathing normally, call for an ambulanceAmbulanceAn ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
.
These guidelines differ from previous versions in a number of ways:
- They allow the rescuer to diagnose cardiac arrest if the victim is unresponsive and not breathing normally.
- Rescuers are taught to give chest compressions in the center of the chest, rather than measuring from the lower border of the sternum.
- Rescue breaths should be given over 1 second rather than 2 seconds.
- For an adult victim, the initial 2 rescue breaths should be omitted, so that 30 chest compressions are given immediately after a cardiac arrest has been diagnosed.
These changes were introduced to simplify the algorithm
Medical algorithm
A medical algorithm is any computation, formula, statistical survey, nomogram, or look-up table, useful in healthcare. Medical algorithms include decision tree approaches to healthcare treatment and also less clear-cut tools aimed at reducing or defining uncertainty.-Scope:Medical algorithms are...
, to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival. It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.
Adult choking sequence
- Assess the severity of airway obstruction. If the victim is able to speak and cough effectively, the obstruction is mild. If the victim is unable to speak or cough effectively, or is unable to breathe or is breathing with a wheezy sound, the airway obstruction is severe.
- If the victim has signs of mild airway obstruction, encourage him to continue coughing; do nothing else.
- If the victim has signs of severe airway obstruction, and is conscious, give up to 5 back blows (sharp blows between the shoulder blades with the victim leaning well forwards). Check to see if the obstruction has cleared after each blow. If 5 back blows fail to relieve the obstruction, give up to 5 abdominal thrusts, again checking if each attempt has relieved the obstruction.
- If the obstruction is still present, and the victim still conscious, continue alternating 5 back blows and 5 abdominal thrusts.
- If the victim becomes unconscious, lower him to the ground, call an ambulance, and begin CPR.
In other countries
The term BLS is also used in some non-English speaking countries (e.g. in ItalyItaly
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
) for the education of first responders.
- SpainSpainSpain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
: SVB (soporte vital básico) - BelgiumBelgiumBelgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...
: aide médicale urgente ("emergency medical assistance")/ EHBO (eerste hulp bij ongelukken, "first aid") - BrazilBrazilBrazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
: SBV (Suporte básico de vida) - FranceFranceThe French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
: PSE 2 (premiers secours en équipe 2e niveau, "team first aid 2nd level) = former CFAPSE (before 2007)(certificat de formation aux activités des premiers secours en équipe, "education certificate for the team first aid activity") - PolandPolandPoland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...
: Podstawowe zabiegi resuscytacyjne - GermanyGermanyGermany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
: Lebensrettende Sofortmaßnahmen (basic life support) - RomaniaRomaniaRomania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...
: SVB (support vital de bază) - NetherlandsNetherlandsThe Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
: EHBO (eerste hulp bij ongelukken, "first aid") - TurkeyTurkeyTurkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...
: TYD (temel yaşam desteği, "basic life support")
See also
- Advanced life supportAdvanced Life SupportAdvanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
- Emergency medical technicianEmergency medical technicianEmergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
- Artificial respirationArtificial respirationArtificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...
- Cardiopulmonary resuscitationCardiopulmonary resuscitationCardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
(CPR) - Advanced cardiac life supportAdvanced cardiac life supportAdvanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...