Basic life support (BLS) is an essential skill for every healthcare provider. BLS is essentially cardiopulmonary resuscitation (CPR).
All too often this topic is glossed over in favor of larger, or more advanced topics, when really, BLS is critical to much of the medical support that is supplied in emergency scenarios.
For healthcare providers, it can be difficult to focus on BLS in an emergency as you are often distracted by the need to start advanced techniques. This distraction may cause providers to drop the ball on the basics.
Essentially, we want to refocus so that you are able to perform the basics perfectly in an advanced way!
Understanding Basic Life Support
Basic life support measures are performed on deceased patients. Their hearts have stopped beating and CPR is used as an attempt to bring them back from death.
Perfusion is necessary for survival. That is, bringing oxygenated fluids to the tissues of the body, in particular, the heart.
When the heart stops, it cannot move oxygenated blood throughout the body. We are all aware of the damage caused by lack of oxygen which tends to make people focus on the breath part of CPR over the compressions.
However, over the last fifteen to twenty years, we’ve come to understand that hemoglobin (the cells in the blood that hold oxygen) has about four times the oxygen-carrying capacity than we had previously believed.
When the heart stops beating and you die, you still have oxygenated blood in the body. If we can cycle that blood through the body using chest compressions, it will be 8-10 minutes before the cells have offloaded all that oxygen. And because chest compressions create negative pressure in the lungs, the body will be passively pulling in air even without mouth to mouth.
The oxygen already in the body and the passive intake will not be enough to sustain life without also doing breathing techniques, but it does underscore how important the compressions are in basic life support.
In fact, many CPR training programs for laypersons focus on compressions alone with the expectation of EMS arrival in 8-10 minutes. Chest compressions make the largest impact.
What Is Happening When You Do Compressions?
The heart is a pump. Chest compressions help to build pressure in the system.
Chest compressions should be performed at the center of the sternum, right at the nipple line. The sternum pushes the rib cage into the heart, compressing it, and building up pressure.
Typically, it takes about 12 to 15 compressions to get the blood moving.
It is worth noting that this is not a pleasant process. CPR is hard on both the person receiving it and on the person performing it. You will hear pops and cracks. While people often worry that this means they have broken the ribs, in all likelihood it is simply the cartilage moving.
Do not let the fear of broken ribs prevent you from doing chest compressions. Even if the ribs do break, broken bones are better than death!
The compressions need to be deep enough to activate the heart. As such chest recoil is important. The heart pumps blood, but it must also have blood. When you push down on the heart, the coronary vessels that feed the heart constrict. When the heart relaxes, these vessels fill with blood and oxygen. A full chest recoil means you are allowing the heart to relax and feed itself.
The Basics of Basic Life Support
There are several basic steps to follow when supplying basic life support. All healthcare providers should keep these basic principles in mind, no matter how complex the care they typically provide.
- Make sure the scene is safe and that you are wearing proper personal protective equipment.
- Assess whether or not the person down is in need of CPR. Tap the individual and shout “Are you okay?” If they don’t respond, check for a pulse.
- If after roughly 10 seconds you do not detect a pulse, begin chest compressions and tell someone to call 911 and get an AED.
- If you are alone, begin chest compressions. Use your cell phone on speaker mode to contact 911.
- The rate of compressions to breath should be 30 to 2 if you don’t have an advanced airway in place. Make sure you do not stop the chest compressions for more than 10 seconds.
- After 2 minutes, check for pulse again.
- If there is a pulse, turn the person on their side in case they begin to vomit. Continue to monitor pulse.
- If no pulse, continue CPR until EMS responds.
What About AEDs?
An automated external defibrillator (AED) can be a valuable tool in basic life support.
AEDs are designed to read the electrical rhythm of the heart and tell you whether or not a shock is advised.
A “shock not advised” reading does not mean that the patient has a pulse. AEDs do not check for a pulse. When a shock is not advised, the AED will tell you to continue CPR which is exactly what you should do. Continue compressions and then have it analyze the patient again.
It is important to hold compressions when the AED is analyzing as it will read the rhythm you are generating through the compressions or it might read your heart rhythm.
If a shock is advised, resume compressions while the AED charges. The AED will never automatically deliver a shock. AEDs automatically analyze the heart rhythm, they do not automatically shock.
What’s the Difference Between BLS and ACLS?
Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) are different in their scope and complexity of care during medical emergencies. BLS focuses on the essential skills needed to respond immediately to life-threatening situations like cardiac or respiratory arrest. It emphasizes high-quality CPR, rescue breathing, and the use of an Automated External Defibrillator (AED).
BLS ensures first responders can maintain circulation and manage the airway until advanced help arrives. It involves minimal equipment and straightforward techniques that prioritize chest compressions and basic airway management.
ACLS builds on the fundamentals of BLS and introduces more advanced interventions for healthcare providers. In addition to CPR and defibrillation, ACLS includes intubation, IV drug administration, and EKG interpretation to identify and treat complex arrhythmias.
ACLS-trained professionals follow specific algorithms to handle cardiac emergencies like ventricular fibrillation or post-cardiac arrest care. The goal is to stabilize the patient and address underlying causes using more specialized tools and medications.
Conclusion
Basic life support can make all the difference in an emergency. By performing CPR immediately and consistently, the odds of resuscitating a patient significantly increase.
By understanding the very basics of the actions and mechanisms at work, we can empower healthcare providers and laypersons alike to focus their efforts in the right direction and potentially improve patient outcomes.
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