Basic life support
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Priyamvada Singh, M.B.B.S. [3]
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 'ABCD' 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 CABD sequence (cardiac compression followed by airway protection, breathing, and defibrillator). 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.
Revised AHA basic life support guidelines 2010
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Basic life support guidelines (Revised American heart association 2010 guidelines)
Steps of basic life support survey (Revised AHA 2010 guidelines)
- Step 1- Check for responsiveness
- Step 2- Activate the emergency response system and get an AED ([[Automated External Defibrillator]])
- Step 3- Check for circulation by palpating the carotid pulse. Don't spend more than 10 seconds for palpating the pulse. If a pulse is present give the patient 2 rescue breathings once every 5-6 seconds. If no pulse is palpated within 10 seconds start giving 30 chest compressions followed by two rescue breathings (ventilation)
- Step 4- Connect an Automated External Defibrillator and if indicated give a shock.
Similarities between basic life support guidelines 2005 and 2010
- The revised AHA basic life support guidelines 2010 have emphasized on high quality CPR (cardiopulmonary resuscitation) similar to the 2005 guidelines. A high quality CPR should include:
- Cardiac compression at a rate of atleast 100 chest compression/minutes.
- Compression depth of atleast 2 inches in adults
- Complete chest recoil between two compressions
- Minimizing interruptions in compression
- Changing rescuers every two minutes
- Avoiding excessive ventilation
Differences between basic life support guidelines 2005 and 2010
- Change of the sequence from ABCD (clearing airway, breathing, chest compression, and defibrillator) to CABD (chest compression, clearing airway, breathing, and defibrillator) in all age groups i.e. adults, children, and infants. This change was done as studies showed increased survival benefits with CABD sequence over the ABCD sequence. The reason being that most adults have a sudden cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia and have a better survival benefits if they received immediate chest compression or defibrillation. However, the health care provider should also take into consideration for the cause of unresponsiveness. For e.g. in cases of drowning hypoxia may be the primary cause for unresponsiveness so rescue breathing should be given before the chest compressions.
- Removal of 'Look, listen, and feel' for breathing and the two initial rescue breaths- 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)
- De-emphasis on the continued pulse check
- 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
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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