Introduction to BLS for Healthcare Providers
Basic Life Support (BLS) refers to a set of interventions used to sustain life in the event of cardiac arrest or respiratory failure. BLS skills are considered essential for healthcare professionals, as they are usually the first responders in medical emergencies. Having proper training and knowledge of BLS techniques can mean the difference between life and death for a patient.
The BLS for Healthcare Providers course is designed to teach critical skills to recognize and respond to cardiovascular, respiratory, and other emergencies in adults, children, and infants. The techniques covered include cardiopulmonary resuscitation (CPR), automated external defibrillator usage (AED), relieving choking, and other life-saving interventions.
The target audience for this course is anyone who needs to obtain or renew BLS certification, including doctors, nurses, emergency medical personnel, and other allied healthcare workers. The certification is valid for two years and must be renewed to stay current.
The course utilizes a combination of video instruction, live instructor demonstrations, and hands-on practice to ensure proficiency in all skills. Skills are practiced in various simulated emergency scenarios with feedback from the instructor. Upon successful completion of skills testing, participants receive BLS certification from the American Heart Association.
Having a large workforce of medical personnel certified in BLS greatly improves survival from cardiac arrest and other medical crises. The techniques learned in this course allow rapid recognition, early CPR, and defibrillation, which are crucial for positive outcomes. This course provides the necessary knowledge and training for healthcare providers to competently perform BLS in any medical emergency.
Assessing the Scene and Patient
- Ensure the scene is safe before approaching the patient. Look for potential dangers like electrical wires, traffic, fire or gas leaks.
- Call out for nearby help. Yell “Help!” or “Call 911!” Ensure emergency medical services are activated as soon as possible.
- Determine if the patient is responsive. Gently tap the patient’s shoulder and shout “Are you okay?” See if the patient responds verbally or physically.
- Check for severe life threats. Look to see if the patient is breathing normally and has a pulse. Watch for severe bleeding, choking, or other threats.
- Position the patient appropriately. If the patient is unresponsive, roll the patient onto their back while supporting the head and neck. If breathing but unresponsive, place in the recovery position.
- Gather information for EMS. Note any medications, medical history or events leading up to unresponsiveness. Pass along key details.
- Provide ongoing care until EMS takes over. Continue cycles of CPR and defibrillation if needed. Keep monitoring vitals and watching for changes.
Adult CPR
Adult CPR involves performing chest compressions and rescue breaths. The key steps are:
- Assess the scene and the victim. Check for responsiveness by tapping the shoulders and shouting, “Are you ok?”.
- If no response, ask a bystander to call 911 and get an AED if available.
- Place the victim flat on their back on a firm, hard surface.
- Kneel by the victim’s side. Place the heel of one hand on the center of the chest. Place your other hand directly on top.
- Perform chest compressions by pushing hard and fast in the center of the chest at a rate of 100-120 compressions per minute. Compress the chest at least 2 inches deep on each compression.
- After each set of 30 compressions, open the airway using a head tilt-chin lift. Pinch the nose closed and make a complete seal over the victim’s mouth.
- Give 2 rescue breaths, each lasting 1 second long enough to make the chest rise.
- Continue cycles of 30 compressions and 2 breaths until emergency medical services arrive or an AED is brought to the scene.
- If an AED becomes available, stop CPR and attach the pads according to the diagram on the pads. Follow the voice prompts of the AED for analyzing rhythm and delivering a shock if advised.
- Resume CPR starting with chest compressions after delivering a shock. Perform 2 minutes of CPR before pausing to reanalyze the heart rhythm.
Proper hand placement, compression depth, and allowing full chest recoil after each compression are key for high-quality CPR. Using an AED as soon as possible along with CPR can greatly improve survival from cardiac arrest.
Child CPR
When performing CPR on a child aged 1 year to puberty, several modifications should be made compared to adult CPR:
- Compression depth: For a child, compressions should be at least one third the depth of the chest, about 2 inches (5 cm). This is deeper than for infants but shallower than for adults.
- Compression rate: Use a rate of 100-120 compressions per minute, which is the same rate as for adults.
- Compression to breathing ratio: Use a ratio of 30 compressions to 2 breaths. After 30 compressions, tilt the head back, lift the chin, pinch the nose closed, and give 2 breaths. Each breath should be 1 second long and make the chest rise visibly.
- Use child-sized equipment if available: Child-sized pads should be used for AEDs. Child CPR masks or shields are also available to help ensure an effective seal when giving rescue breaths.
- Two rescuers: If two rescuers are present, one can provide continuous compressions while the other provides breaths in a 15:2 ratio.
Proper hand placement is also important for child CPR. For children, compressions should be performed with one or two hands on the lower half of the breastbone, avoiding the tip. Using the proper techniques for children helps provide effective CPR to circulate blood until advanced care arrives.
Infant CPR
Infant CPR involves some key modifications compared to adult and child CPR to account for an infant’s smaller body size. The most important modifications are in compression depth and hand placement.
For infants, compressions should be performed to a depth of about 1.5 inches or 4 cm. This is slightly shallower than the 2-inch depth used for children and adults. Using the correct reduced depth helps avoid injuries to an infant’s smaller chest.
Hand placement also differs for infant CPR. For an infant, rescuers should use 2 fingers to perform chest compressions rather than the heel of 1 or 2 hands. The 2 finger technique provides enough force to compress an infant’s chest the proper amount. The fingers should be placed just below the nipple line, on the lower half of the breastbone.
Using the proper hand placement and reduced compression depth helps provide effective CPR to infants while minimizing the risk of injury. Rescuers who know the right modifications to technique can help provide high-quality CPR to infants in an emergency.
Choking
Choking occurs when a foreign object lodges in the throat or windpipe, blocking the flow of air. It is a medical emergency that requires rapid first aid response. Healthcare providers must be able to quickly identify the signs of choking and perform appropriate interventions.
Identifying Choking
- The universal sign of choking is hands clutched to the throat. However, choking victims may not always demonstrate this sign.
- Look for signs that the victim cannot breathe, such as clutching the neck, inability to talk, difficulty breathing, inability to cough forcefully, or skin, lips and nails turning blue.
- Determine if the choking is mild or severe. In mild choking, the victim will be able to speak, cough forcefully, and breathe, although with difficulty. In severe choking, the victim will not be able to speak, cough, or breathe at all.
First Aid for Mild Choking
- Encourage the victim to continue coughing to try to expel the object. Do not interfere with coughing efforts if the victim can still breathe, speak or cough forcefully.
- Monitor the victim’s condition. If symptoms worsen, care for severe choking.
First Aid for Severe Choking
Conscious Victim
- Perform abdominal thrusts (Heimlich maneuver): stand behind the victim, make a fist, and place it thumb side in against the abdomen, above navel and below the rib cage. Grab fist with the other hand and pull it forcefully inwards and upwards. Repeat until object is expelled.
- If abdominal thrusts are ineffective, continue with cycles of 5 back blows (between shoulder blades with heel of hand) followed by 5 abdominal thrusts.
Unconscious Victim
- Call emergency medical services immediately.
- Begin CPR, starting with chest compressions.
- After 30 compressions, open airway and look for foreign object. If seen, remove it.
- Do not perform blind finger sweeps – only remove object you can see.
- Return to chest compressions. Do not stop CPR unless victim revives or EMS arrives.
Proper training and frequent practice on manikins is essential for healthcare providers to quickly identify choking and perform appropriate interventions in an emergency. Timely first aid response can save lives.
Defibrillation
The most effective treatment for cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia is defibrillation. Defibrillation delivers an electric shock to the heart to try to restore a normal heart rhythm.
An automated external defibrillator (AED) allows defibrillation to be done by non-medical personnel. AEDs provide voice and visual prompts to guide the rescuer. As soon as the AED is turned on, it will instruct you to attach the pads to the patient’s bare chest. The AED analyzes the heart rhythm and determines if a shock is needed. If a shock is indicated, the AED will instruct you to ensure no one is touching the patient, and then will deliver the shock automatically.
After each shock, or if no shock is advised, immediately resume CPR starting with chest compressions. Allow the AED to analyze the rhythm every 2 minutes. Continue CPR and use of the AED until advanced life support providers arrive.
Key points about defibrillation:
- Start CPR until an AED is available. Apply AED as soon as possible.
- Ensure no one is touching the patient when the AED delivers a shock.
- Resume CPR immediately after each shock.
- Allow AED to analyze rhythm every 2 minutes.
- Continue until advanced life support providers arrive.
Proper use of an AED can greatly improve chances of survival for cardiac arrest victims. Knowing when and how to apply defibrillation is an essential skill for healthcare providers.
Special Situations
Certain emergency medical situations require modifications to standard BLS protocols. Healthcare providers should be prepared to adapt CPR techniques as needed.
CPR for Drowning
Drowning can cause cardiac arrest due to oxygen deprivation. If a drowning victim is unresponsive, immediately begin CPR. When providing breaths, be prepared for water in the airway. Turn the victim on their side and clear the airway following each set of 30 compressions.
Once advanced support is available, the victim may need suctioning of water, breathing support, or medication. Drowning victims have a high chance of survival if CPR is started quickly and correctly.
CPR for Opioid Overdose
Opioid overdoses can cause slowed or absent breathing that leads to cardiac arrest. Recognize the signs of overdose such as pinpoint pupils, slow shallow breaths, and unconsciousness.
Begin CPR if the victim stops breathing. Administer naloxone if available to reverse the effects of the overdose. Perform rescue breathing more frequently than the usual 30:2 ratio to provide oxygen.
When advanced support arrives, the victim will require continued monitoring and additional naloxone doses. With early administration of naloxone and proper CPR, many overdose victims can be resuscitated.
Post-Cardiac Arrest Care
After successful resuscitation and return of spontaneous circulation (ROSC), the focus shifts to post-cardiac arrest care. The goals are to stabilize the patient, prevent rearrest, restore oxygenation and ventilation, provide hemodynamic support, determine the cause of arrest, and facilitate transfer of care.
Several key steps should be taken:
- Monitor vital signs closely – Blood pressure, heart rate, oxygen saturation, respiratory rate. Be prepared to intervene if instability occurs. Titrate medications to maintain systolic BP >90.
- Ensure adequate oxygenation/ventilation – Use a bag valve mask, advanced airway if needed. Titrate FiO2 to SpO2 94-99%. Avoid hyperoxia.
- Start an IV/IO line – For medication administration and bloodwork.
- Obtain 12-lead ECG – Look for STEMI or arrhythmias requiring intervention.
- Targeted temperature management – Cool patient to 32-36°C to protect brain and vital organs.
- Control seizures – Give benzodiazepines for seizures.
- Treat precipitating causes – STEMI, stroke, exsanguination, hypoxia.
- Avoid hyperventilation – Can cause cerebral vasoconstriction.
- Optimize glucose – Titrate insulin to keep glucose <180 mg/dL.
Once the patient is stabilized, focus shifts to transferring care to a specialist unit for definitive care like percutaneous coronary intervention, hypothermia protocol, or neuroprotective strategies. Provide a clear handoff with details of arrest, resuscitation, and post-arrest care.
Skills Practice and Testing
CPR and first aid skills degrade quickly without continuing hands-on practice. That’s why BLS for Healthcare Providers courses focus on skills practice and testing scenarios. Participants will take part in practice sessions in order to gain muscle memory and confidence performing CPR and other lifesaving techniques. Manikins designed specifically for CPR practice are used so that students can receive feedback on their hand placement, compression depth, airway opening, and ventilation volumes.
At the end of the course, students must pass a skills test demonstrating competency in:
- Adult CPR and AED use
- Child CPR and AED use
- Infant CPR
- Relief of choking in adults, children and infants
Skills are tested by certified instructors who score students according to standard BLS checklists and guidelines. Testing scenarios aim to simulate real-life emergencies and require quick thinking. Only by passing the skills test can students receive BLS for Healthcare Providers certification. This certification is valid for two years, after which a recertification course and skills test must be completed.
The practice sessions and skills testing ensure healthcare providers have the confidence and ability to perform high-quality CPR and use an AED when the moment arises. Lives depend on healthcare providers maintaining competence in these basic but critical lifesaving skills.
