Basic life support
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Basic Life Support (BLS) is a specific level of prehospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. Earlier guidelines used to focus on an 'ABC' sequence in which the BLS providers followed the sequence of airway protection, followed by breathing and cardiac compression. However, recent 2010 revised guidelines recommend certain changes based on the results of the randomized trials. The current guidelines support a CAB sequence (cardiac compression followed by airway protection, and breathing). Additionally, these guidelines de-emphasis continuous pulse checks, placement of cricoid pressure, and following the sequence of 'look, listen, and feel during breathing assessment.
General consideration
Basic Life Support consists of a number of life-saving techniques. It earlier focused on the "ABC"s sequence of prehospital emergency care which has been changed to CAB sequence in the recent 2010 guidelines. The key steps in BLS are:
- Airway: the protection and maintenance of patient airway including the use of airway adjuncts such as an oral or nasal airway
- Breathing: the actual flow of air through respiration, natural or artificial respiration, often assisted by emergency oxygen
- Circulation: the movement of blood through the beating of the heart or the emergency measure of CPR
- BLS may also include considerations of patient transport such as the protection of the cervical spine and avoiding additional injuries through splinting and immobilization.
- BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced cardiac life support (ACLS). Most laypersons can master BLS skill after attending a short course. Firefighters 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.
- CPR provided in the field buys time for higher medical responders to arrive and provide ACLS. For this reason it is essential that any person starting CPR also obtains ACLS support by calling for help via radio using agency policies and procedures and/or using an appropriate emergency telephone number.
- An important advance in providing BLS is the availability of the automated external defibrillator or AED, which can be used to deliver defibrillation. This improves survival outcomes in cardiac arrest cases, sometimes dramatically.
New BLS guidelines are published by the American Heart Association in December 2005 [3].
Revised AHA basic life support guidelines 2010
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The revised Basic life support guidelines have the following differences over the 2005 and 2008 guidelines:
- Change of the sequence from ABC (airway, breathing, and chest compression) to CAB (chest compression, airway, and breathing) in all age groups i.e. adults, children, and infants. This change was done as studies showed increased survival benefits with CAB sequence over the ABC sequence.
- Removal of 'Look, listen, and feel' for breathing- The new guidelines removed this step from assessment as sometimes the BLS providers delayed giving chest compression if they see agonal breathing (abnormal breathing, only gasping)
- The routine use of cricoid compression in cardiac arrest is not recommended. This was done as randomized studies found the following findings:
- Though it was thought to prevent regurgitation and aspiration, it made it difficult to put an advanced airway and block ventilation.
- Some degree of aspiration do occur even after placement of cricoid pressure.
- It was difficult technique to train and lacked uniformity among BLS providers
- De-emphasis on the continued pulse check
In other countries
The term BLS is also used in some non-English speaking countries (e.g. in Italy) for the education of first responders.
- Belgium: Aide médicale urgente ("emergency medical assistance")
- France]]: CFAPSE (certificat de formation aux activités des premiers secours en équipe, "education certificate for the team first responder activity")
- Germany]]: Erste Hilfe Schein (first aid certificate).
- Netherlands: EHBO (Eerste Hulp Bij Ongelukken, "first aid")
- Turkey: İlk Yardım Kursu
These courses do not include the use of drugs or of invasive techniques, but include the management of various traumas and casualty lifting and movement.
See also
- Advanced Life Support
- Emergency Medical Technician
- EMT Basic Skills
- Artificial respiration
- CPR
- Advanced cardiac life support
B.L.S. SIMULATOR
- BLS OnTheRoad [4] a multilanguage, interactive B.L.S. SIMULATOR, upgrade to Guide Lines IRC-2005, full version Freeware (4.81 Mb)
External links
- Single-Rescuer Adult Basic Life Support — An Advisory Statement From the Basic Life Support Working Group of the International Liaison Committee on Resuscitation, Circulation #95, pp 2174–2179, ed. American Heart Association, 1997
- Nozioni primo soccorso BLS (Italian), PDF document (12p, 912 Kb)
References
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