BLS & AED

Basic Life Support for Healthcare Providers

Objectives

This BLS course focuses on what rescuers need to know to perform high-quality CPR.

Acting in an emergency is important and can make a difference to a victim of injury or illness.

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Before attempting CPR on someone

There are several things you must do. Make sure you and the patient aren’t in any danger. If possible, resolve the risk or move the patient out of harm’s way. If unable to do so for whatever reason, immediately call 911.
 

Check the patient to determine if they are conscious or not. Do not check for a pulse because time is of the essence and finding a pulse can take too long. Call out to the patient asking, “Are you okay?” Repeat if necessary. If the patient doesn't respond, immediately call 911 and then perform CPR—initiating Circulation, Airway and Breathing tasks (the C-A-B’s). Also, if possible, have someone nearby call 911 and begin CPR, immediately.

Understanding Duty to Act
 

Duty to act is the duty requiring a person to take necessary action in order to prevent harm to another person or to the general public. Whether you are required to follow through depends on the situation and the relationship between the parties. In some cases, breach of duty may put a party at liability for damages.

For laypersons, duty to act requires that you provide care if you have a legal duty. If you do not have a legal duty to provide care, you are not required to provide it.

Fear of providing care
 

There are a number of factors to weigh up when considering providing care. COVID-19 is an important concern, but the risk of contracting diseases can be reduced by wearing personal protective devices like masks, gloves, and gowns that limit exposure.
 

If you feel fear of providing care due to possible legal issues, know that rescuers who provide care without a legal duty and act in good faith are protected by Good Samaritan laws.
 

If the situation is actively unsafe, do not attempt care. If you or the victim are at risk, it is best to call EMS and wait for support to arrive

Fear of providing care
 

In some cases, you may be unable to save a victim. Rescuers should still attempt to provide the best care they are able to. A victim’s chances of survival can be improved by even basic efforts at life support. In accidents, victims who are clinically dead may still be helped when given care. Rescue efforts will not worsen their condition.
 

Following a traumatic situation in which you provided care, you may experience overwhelming emotions. If you continue to feel symptoms like depression, be sure to seek help from a professional source.

Out-of-Hospital Chain of Survival

This is the idea that every step in the out-of-hospital chain of survival is critical to a successful outcome, just as every link in a real chain is critical to its integrity. Additionally, a weak link in the out-of-hospital chain of survival also includes any delays in moving from one step to the next.

The earlier these steps take place in an emergency, the better the chance of a patient’s survival.

• Recognition and Activation of EMS
• High-Quality CPR
• Defibrillation
• Advanced Care
• Post Cardiac Arrest Care
• Recovery

Personal Protective Equipment

Putting On Gloves

Use disposable gloves when providing first aid care. If you have a latex allergy, use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged.
 

Removing Gloves

Remember to use skin to skin and glove to glove. Pinch the outside wrist of the other gloved hand. Pull the glove off turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside out trapping the other glove inside. Dispose of gloves properly.
 

Cardiovascular Disease

Cardiovascular disease is the number one killer in the United States. The Center for Disease Control reports that in the United States over 650,000 people die each year from cardiovascular disease.

Cardiovascular disease causes damage to the heart and blood vessels. Cardiovascular disease often leads to heart attack or stroke. The best way to survive a heart attack or stroke is to never have one. The key for cardiovascular disease is to focus on prevention.

Heart Attack

Signs and Symptoms may include

• Chest discomfort-pressure, tightness, that may radiate to jaw and arms.
• Nausea
• Sweating
• Shortness of breath
• Denial
• Feeling of weakness

Women present more with shortness of breath, extreme fatigue, or flu-like symptoms About a third of women experience no chest pain.

Treatment:

Recognize the signs and symptoms of a heart attack, activate EMS, have patient remain in a position of comfort, offer 1 adult dose aspirin, and keep the patient calm and quiet.

Stroke

Stroke is the 3rd leading cause of death in the United States. Strokes can be one of two types: ischemic– a clot in a blood vessel that restricts or obstructs blood flow to the brain; hemorrhagic- a blood vessel that ruptures and prevents blood flow to the brain. In either case, the brain is deprived of oxygen and tissue starts to die.

Signs and Symptoms may include

• Numbness or weakness of the face, arm or leg, especially on one side of the body. The acronym FAST helps in assessing a stroke: F– facial droop, A– Arm drift, S– Speech, T– Time
• Confusion, trouble speaking or understanding
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause

Treatment:

Recognize the signs and symptoms of a stroke, activate EMS, give nothing to drink or eat, and keep the patient calm and quiet. Monitor patient and be prepared to start CPR if necessary.

Checking the Scene

Key Questions to ask:

• Is it safe for me to help?
• What happened?
• How many patients are there?
• Am I going to need assistance from
• EMS?
• Do I have my personal protective equipment ready to use?

Check the Patient

Tap and shout. Is there any response?

• While checking for responsiveness, look for normal breathing by looking at the person’s chest and face. Is the patient breathing normally?

• Agonal respirations are not normal breathing. They would be characterized as occasional gasps. The chest does not rise.

Activate EMS – Call 911

Send someone to call and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.

If you are alone and no one is available:

• PHONE FIRST for adults and get the AED. Return to start CPR and use the AED for all ages.

• CARE FIRST for children and infants by providing about 5 cycles or 2 minutes of CPR before activating the emergency response number.
  CARE FIRST for all age patients of hypoxic (asphyxial) arrest (ei., drowning, injury, drug overdose).

Compressions

If the victim is unconscious with no normal breathing, begin chest compressions.

Give 30 chest compressions at a rate of 100-120 compressions per minute for all ages.

Hand placement for compressions:

• Adult – Place heel of hand of the dominant hand on the center of the chest between the nipples. The second hand should be placed on top. Compress 2-2.4 inches deep.

• Child – Hand placement is the same as adult. You may choose to use only one hand in the center of the chest between the nipples for a very small child. Compress at least 1/3 the depth of the chest.

• Infant – Place two fingers on the center of the chest between the nipples. Compress at least 1/3 the depth of the chest.

Airway

Open Airway using head tilt chin lift. Look in the mouth to make sure the air- way is clear. If you see any foreign object, sweep it out right away.

Breathing

Give 2 breaths lasting 1 second each. Watch for chest rise and fall.

Note: If not using a rescue mask, make sure you make a seal over the mouth on an adult or child and pinch the nose closed each time you give a breath. On an infant, make sure to cover the mouth and nose with your mouth.

Continue cycles of 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, the patient shows signs of life, the scene becomes unsafe, or you are too exhausted to continue.

CPR Summary

• Check the Scene for Safety
• Check the person for responsiveness and normal breathing
• Call 911
• Give 30 Chest Compressions
  • (Adult rate of 100-120 per minute, 2-2.4 inches deep)
  • (Child or infant rate of 100-120 per minute, 1/3 depth of chest)
• Open the Airway
• Give 2 Breaths
• Continue cycles of 30 compressions to 2 breaths.

AEDs

AEDs are designed to shock the heart, in order for the heart to restart under a normal rhythm. The AED analyzes the heart’s rhythm, states whether a shock is advised and then powers up, the operator then pushes a button that will deliver the shock.

Each minute that defibrillation is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated. Early defibrillation increases survival rates to greater than 50%. Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready.

If you are giving CPR to a child or infant and the available AED does not have child pads or a way to deliver a smaller dose, it is still recommended to use the AED even with adult pads. With adult pads for a small child or infant, you would place one pad on the center of the chest and the other on the center of the back between the shoulder blades.

AED Considerations

• Remove a patient from standing water, such as in a puddle, before AED use. Rain, snow, or a damp surface is not a concern.

• Patient should be removed from a metal surface if possible.

• Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker.

• Remove medication patches found on the patient’s chest with a gloved hand.

• Never remove the pads from the patient or turn the machine off.

How to Use an AED

1. Turn the AED on and bare the chest. Dry the chest if it is wet. If there is excessive hair you may need to shave it off

2. Place the pads. Place one pad on the patient’s upper right chest above the nipple. Place the other pad on the patients lower left ribs below the armpit. **Follow the directions shown on the pads for the AED pad placement.

3. Quickly check the pads. Make sure pads are pressed down firmly.

4. Follow AED prompts.

5. Stand Clear. Do not touch the patient while the AED analyzes

6. If the AED says, “Shock advised, charging…,” shout, “Clear” and make sure no one is touching the patient. Push the shock button when the AED tells you to.

7. If no shock is advised give CPR if the patient is not moving and not breathing.

8. After the Shock, begin CPR. 

9. The AED will reanalyze every 2 minutes and prompt for a shock if needed.

Child and Infant AED Pad Placement

For children 8 years old and younger and infants, an AED with pediatric pads is preferred. If only a standard AED with adult pads is available, it should still be used for children and infants in cardiac arrest. When placing the pads on a child, the pads should not touch.

For a small child or infant, the pads should be placed one in the center of the chest and one in the center of the back between the shoulder blades.

Two Rescuer CPR

Check the Scene
 

Key questions to ask:

• Is it safe for me to help?

• What happened?

• How many patients are there?

• Do I have my personal protective equipment ready to use?

Check the patient

Tap and shout. Is there any response? Look at the person’s chest and face. Is the patient breathing normally?

Agonal respirations are not normal breathing. They would be characterized as occasional gasps with no chest rise.

Activate EMS – Call 911

Send someone to call and tell them to come back. The caller should give dispatch the patient’s location, what happened, how many people are injured, and what is being done.

Check Pulse

Check the pulse for no more than 10 seconds.

Adult and Child– Check the carotid artery in the neck.

Infant– Check the brachial artery on the inside of the upper arm.

Adult 2 Rescuer CPR

Give 30 compressions to 2 breaths.
 

• If starting together, the second rescuer can get into position to provide respirations while the primary rescuer begins compressions.
• If primary rescuer starts CPR alone, the second rescuer should take over compressions when or she arrives.
• After every 5 cycles of 30:2, or every 2 minutes, the compressor should call for a switch.
• Rescuer at the head should finish 2 breaths. Then, move into position and begin compressions. The switch should take less than 10 seconds.

Child and Infant 2 Rescuer CPR

Give 15 compressions to 2 breaths.

• If starting together, the second rescuer can get into position to provide respirations while the primary rescuer begins compressions. For a child (age 1 to approx. 12-14 years old) use 1 or 2 hands as needed for the size of child.
• If primary rescuer starts CPR alone, the second rescuer should take over compressions when or she arrives.
• After every 10 cycles of 15:2, or every 2 minutes, the compressor should call for a switch.
• Rescuer at the head should finish 2 breaths. Then, move into position and begin compressions. The switch should take less than 10 seconds.
• For infants, compressor should use the 2 thumbs hands encircling chest compression technique.

Team Approach CPR

In some rescue situations, there may only be one rescuer who can give care in the normal sequence of assessments and actions: check the scene, check the person, call 911, check pulse, give 30 compressions, give 2 breaths, prepare and use and AED.

In many situations, there is often more than one rescuer trained and willing to help. This is when the team approach should be used. This allows multiple rescuers to perform several actions simultaneously. One rescuer can be providing compressions, at the same time another is preparing the AED, at the same time another is getting ready to give breaths with a Bag Valve Mask. The primary or initial rescuer should take on the role as team leader and delegate the tasks that need to be done. With rescuers working together in this fashion, the most efficient and beneficial care will be given to the patient.

Bag Valve Mask

• If a bag-valve mask is available attach the bag-valve mask to a source of oxygen set at 12-15 L/min. If no O2 is available, remove the residual bag reservoir at the end of the bag-valve mask and use room air.

• Using the “C-E” method for sealing the bag-valve mask to the patient’s face, prepare to ventilate the patient. Please note that if for any reason the bag-valve ventilations are ineffective, revert to mouth-to-mask or face shield delivery method for rescue breaths.
   
• Ensure that thumb and forefinger are sealing the mask at the face of the patient. With middle, ring, and pinky fingers, grab the mandible (jaw) of the patient and pull the patient’s face into the mask seal. If the mask is sealed well, there should be minimum to no air leakage on ventilation. Squeeze the bag fully so that the patient’s chest rises. When the chest rises stop squeezing the bag so to avoid over-inflation which may force the air into the stomach.

Bag Valve Mask

• Ventilate at 1 breath every 5 seconds for and adult and 1 breath every 3 seconds for a child or infant, to perform rescue breathing. If an advanced airway is in place, perform 1 breath every 6-8 seconds. Take care not to hyperventilate the patient.
   
• A proper size infant mask should be used. However, if only an adult size mask is available, the infant will benefit from turning an adult sized mask upside down so that the small point (nose side) covers the patient’s chin and the broad part (chin side) of the mask is covering the mouth and nose.

Jaw Thrust for Spinal Injury

If you suspect a head, Neck or back injury, do not move the person unless it is necessary to provide care for life threatening conditions. A jaw thrust can be used to open the airway.

If you are not able to open the airway adequately with the jaw thrust, use a head-tilt chin-lift to open the airway. For an unconscious, non-breathing person it is more important to have an open airway rather than consideration of a potential spinal injury.

To perform a Jaw Thrust:

• Place hands firmly along the side of the victim’s face
• The fingers are placed on the bottom of the jawbone
• The thumbs are placed on the cheekbones
• To open the airway, lift up on the bottom of the jawbone while the thumbs stay firmly on the cheekbones

Recovery Position

• Used when a person is breathing and unconscious
• Helps keep airway open
• Allows fluid to drain from mouth
• Prevents aspiration

How to Place in Recovery Position

• Extend victim’s arm closest to you above victim’s head
• Place victim’s leg farthest from you, over his other leg.
• Support head and neck
• Place victim’s arm farthest from you across his chest
• Roll victim towards you
• Position victims top leg so the knee acts as a prop for the body
• Place victim’s hand under chin to keep airway open

Emergency Rescue Moves

In general, a rescuer should not move a person unless it is necessary to provide care or there is a direct danger to the person’s life. Remember to protect the head, neck and back.
 

• Clothing Drag – Grasp the shirt near the shoulders. Lift up and walk backwards dragging the patient.
• Blanket Drag – Place the patient on blanket or sheet. Grasp at head end, lift up and walk backwards or crawl while dragging the patient.
• Extremity drag – If necessary simply drag by holding the legs or forearms and pulling.

Conscious Choking

Ask, “Are you choking?

If a person is unable to cough, breath or speak, activate EMS

Adult and Child

• Stand behind the victim with one foot in-between the victims feet and your other foot behind you.
• Place the flat side of your fist just above the patients belly button. Grab the back of your fist with your other hand.
• Administer abdominal thrusts, pulling inward and upward, until the object comes out or the patient becomes unconscious.

Infant Choking

• Support the infant’s face and place body on your forearm.
• Keep the infant’s head lower than the feet.
• Administer 5 back blows between the shoulder blades with the palm of your hand.
• Support the infant’s head. Turn the baby over onto your other forearm. Give 5 chest thrusts.
• Continue back blows and chest thrusts until object comes out or infant becomes unconscious.

Special Circumstances for Choking:

• If the patient is pregnant or too large to reach around, give chest thrusts instead.

• If you are giving someone abdominal thrusts and the person goes unconscious, lower the patient safely to the ground
   
• Activate EMS, send someone to call 911

Unconscious Choking

• Give 30 chest compressions

• Open the airway and check the mouth for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.

• Attempt rescue breaths. If breaths do not make the chest rise, reposition head and reattempt rescue breaths.

• Give 30 more chest compressions

• Open the airway again and check the mouth for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.

• Give 2 more breaths.

• If breaths do not make the chest rise, reposition head and reattempt rescue breaths. Continue compressions, foreign body check, breathing attempts.

• If victim is still unresponsive and not breathing normally, continue CPR with cycles of 30 compressions to 2 breaths.

Opiates and opioids are central nervous system (CNS) depressants

Common Opiates and Opioids

• Heroin
• Morphine
• Codeine
• Methadone
• Hydrocodone (also known as Vicodin or Lortab)
• Oxycodone (also known as Percocet)

A Naloxone dose of two milligrams is recommended and typically takes three to five minutes for the full effect. Patients must be closely monitored for re-occurrence of problems requiring additional doses.

What are some signs of an Opioid Overdose?

• Unconsciousness
• Very small pupils
• Slow or shallow breathing
• Vomiting
• An inability to speak
• Faint heartbeat
• Limp arms and legs
• Pale skin
• Purple lips and fingernails

How to Administer Naloxone

1. Assemble the nasal atomizer.

2. Tilt the head back and briskly spray half of the Naloxone up one side of the nose with 1 cc.

3. Spray half up the other side of the nose with 1 cc.
    

Rescue breathing or CPR should continue while waiting for the Naloxone to take effect. If there’s no change in three to five minutes, administer another dose of Naloxone and continue CPR or rescue breathing. If the second dose of Naloxone doesn’t revive them, something else is wrong. Either there are no opioids in their system, or the opioids are unusually strong and require more Naloxone.

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