BLS (Basic Life Support) Provider Manual

1. High-Quality CPR is the Cornerstone of Survival

The BLS Course focuses on preparing students to perform CPR skills. CPR is a lifesaving procedure for a victim who has signs of cardiac arrest (i.e., unresponsive, no normal breathing, and no pulse).

CPR's Vital Role. Cardiopulmonary resuscitation (CPR) is the fundamental skill for saving lives after cardiac arrest. It involves chest compressions and breaths, and when performed correctly, significantly improves a victim's chances of survival. High-quality CPR is not just about performing the motions, but about doing them effectively and consistently.

Key Components of High-Quality CPR:

• Start compressions within 10 seconds of recognizing cardiac arrest.
• Push hard and fast: Compress at a rate of 100-120/min with adequate depth (at least 5 cm for adults, one-third the chest depth for children and infants).
• Allow complete chest recoil after each compression.
• Minimize interruptions in compressions (less than 10 seconds).
• Give effective breaths that make the chest rise.
• Avoid excessive ventilation.

Impact of Effective CPR: CPR provides crucial blood flow to the heart and brain, buying time until more advanced medical help arrives. The quality of CPR directly impacts the outcome, making it essential for all rescuers to master these skills.

2. The Chain of Survival: A Coordinated Response

The term Chain of Survival provides a useful metaphor for the elements of the ECC systems-of-care concept.

Interconnected Links. The Chain of Survival is a framework that outlines the critical steps needed to improve survival from cardiac arrest. Each link represents an action that is crucial for a successful outcome, and a break in any link reduces the chances of survival. The chain differs slightly for in-hospital and out-of-hospital cardiac arrests.

Adult Chain of Survival (Out-of-Hospital):

• Immediate recognition of cardiac arrest and activation of the emergency response system.
• Early CPR with an emphasis on chest compressions.
• Rapid defibrillation with an AED.
• Effective advanced life support.
• Multidisciplinary post-cardiac arrest care.

Adult Chain of Survival (In-Hospital):

• Surveillance, prevention, and treatment of pre-arrest conditions.
• Immediate recognition of cardiac arrest and activation of the emergency response system.
• Early CPR with an emphasis on chest compressions.
• Rapid defibrillation.
• Multidisciplinary post-cardiac arrest care.

Importance of Each Link: Each link is vital, from early recognition and activation of the emergency response system to post-cardiac arrest care. The chain emphasizes the need for a coordinated response involving both lay rescuers and healthcare professionals.

3. Adult CPR: Mastering the Basics

If the victim is not breathing normally or is only gasping and has no pulse, immediately begin high-quality CPR, starting with chest compressions.

Recognizing Cardiac Arrest. The first step in adult CPR is to recognize the signs of cardiac arrest: unresponsiveness, no normal breathing (or only gasping), and no pulse. Once recognized, it's crucial to activate the emergency response system and begin CPR immediately.

CPR Steps for Adults:

• Verify scene safety and check for responsiveness.
• Shout for help and activate the emergency response system.
• Assess for breathing and pulse (simultaneously, for no more than 10 seconds).
• If no normal breathing or pulse, begin chest compressions.
• Use a compression-to-ventilation ratio of 30:2.
• Compress the chest at a rate of 100-120/min and at least 5 cm (2 inches) deep.
• Allow complete chest recoil after each compression.
• Minimize interruptions in compressions.
• Open the airway using a head tilt-chin lift or jaw thrust.
• Give breaths using a barrier device (pocket mask or bag-mask device).

Importance of Chest Compressions: Chest compressions are the foundation of CPR, and they must be performed effectively to circulate blood to the vital organs. The quality of compressions directly impacts the victim's chances of survival.

4. AEDs: The Power of Early Defibrillation

The time between collapse and defibrillation is an important factor in survival from sudden cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia.

Early Defibrillation is Key. An automated external defibrillator (AED) is a portable device that can identify and correct life-threatening heart rhythms. Early defibrillation, combined with high-quality CPR, significantly increases the chances of survival from sudden cardiac arrest.

How AEDs Work: AEDs analyze the heart rhythm and deliver an electrical shock if needed to restore a normal rhythm. They are designed to be simple to use, allowing both lay rescuers and healthcare providers to attempt defibrillation safely.

Universal Steps for Operating an AED:

• Power on the AED.
• Attach AED pads to the victim's bare chest (adult pads for victims 8 years and older).
• "Clear" the victim and allow the AED to analyze the rhythm.
• If the AED advises a shock, clear the victim and deliver the shock.
• Immediately resume CPR after shock delivery or if no shock is advised.

Special Circumstances: Be aware of special circumstances such as hairy chests, water, implanted devices, and medication patches, and take appropriate actions to ensure effective AED use.

5. Team Dynamics: The Strength of Collaboration

Effective multirescuer team dynamics help give victims the best chance of survival.

Effective Teamwork. Successful resuscitation requires not only individual skills but also effective teamwork. Clear roles, responsibilities, and communication are essential for a coordinated response. High-performance teams divide tasks and work together seamlessly.

Elements of Effective Team Dynamics:

• Clear roles and responsibilities: Assign tasks based on skill level.
• Knowing your limitations: Ask for help early.
• Constructive intervention: Correct errors tactfully.
• Knowledge sharing: Share observations and feedback.
• Summarizing and reevaluating: Provide ongoing updates.
• Closed-loop communication: Confirm understanding of instructions.
• Clear messages: Use concise language.
• Mutual respect: Maintain a professional attitude.
• Debriefing: Review the resuscitation attempt to identify areas for improvement.

Importance of Communication: Effective communication is crucial for minimizing interruptions in chest compressions and ensuring a smooth, coordinated response. Team members should communicate continuously and anticipate each other's actions.

6. Pediatric CPR: Tailored Techniques for Young Lives

In children, cardiac arrest is often secondary to respiratory failure and shock.

Unique Needs of Children. Pediatric cardiac arrest often results from respiratory failure or shock, unlike adults where it's often cardiac-related. This difference necessitates a tailored approach to CPR for infants and children.

Key Differences in Pediatric CPR:

• Prevention is a crucial link in the pediatric Chain of Survival.
• Compression depth is adjusted for infants and children (one-third the chest depth).
• For infants, use the 2-finger technique (single rescuer) or the 2 thumb-encircling hands technique (2 rescuers).
• For children, use 1 or 2 hands, depending on the size of the child.
• Compression-to-ventilation ratio is 30:2 for single rescuers and 15:2 for 2 rescuers.
• Breaths are especially important for infants and children due to respiratory issues.

AED Use in Children: Use child pads if available for infants and children less than 8 years of age. If child pads are not available, use adult pads, ensuring they do not touch each other.

Importance of Early Intervention: Early recognition of respiratory distress and shock in children is crucial to prevent cardiac arrest and maximize survival.

7. Opioid Overdose: Recognizing and Reversing the Threat

Naloxone is an agent that can reverse the effects of respiratory depression caused by opioids. It should be given quickly.

Opioid Crisis. Opioid overdose is a growing public health crisis, causing respiratory and cardiac arrest. Recognizing the signs of an opioid-associated life-threatening emergency is crucial for timely intervention.

Signs of Opioid Overdose:

• Unresponsiveness
• Slow or absent breathing
• Pinpoint pupils
• Signs of injection or opioid use

Naloxone: The Antidote: Naloxone is a medication that can reverse the effects of opioids. It should be administered quickly to restore breathing and consciousness. It can be given intranasally, intramuscularly, or intravenously.

Opioid-Associated Life-Threatening Emergency Response:

• Verify scene safety and assess for potential opioid use.
• Check for responsiveness and activate the emergency response system.
• Assess breathing and pulse.
• If no normal breathing but a pulse is present, provide rescue breathing and administer naloxone if available.
• If no normal breathing and no pulse, begin CPR and administer naloxone if available.

Importance of Rapid Response: Quick action, including naloxone administration, can reverse the effects of opioid overdose and save lives.

8. Choking Relief: Swift Action Saves Lives

Early recognition of foreign-body airway obstruction is the key to successful outcome.

Recognizing Choking. Choking occurs when a foreign object blocks the airway. Early recognition of choking is crucial for a successful outcome. Signs range from mild to severe airway obstruction.

Signs of Choking:

• Mild obstruction: Good air exchange, forceful cough, may wheeze.
• Severe obstruction: Unable to speak or cry, poor or no air exchange, weak or no cough, high-pitched noise while inhaling.

Choking Relief Techniques:

• Responsive adult or child: Use abdominal thrusts (Heimlich maneuver). For pregnant or obese victims, use chest thrusts.
• Unresponsive adult or child: Begin CPR, look for the object in the mouth, and remove it if seen.
• Responsive infant: Use back slaps and chest thrusts.
• Unresponsive infant: Begin CPR, look for the object in the mouth, and remove it if seen.

Importance of Swift Action: Choking can quickly lead to respiratory arrest and death. Knowing how to recognize and relieve choking is a critical life-saving skill.

Last updated: January 19, 2025