Chapter 3 : BLS and ACLS – Quick Overview

Course II: BLS and ACLS – Quick Overview

Cardiopulmonary arrest or cardiac arrest occurs when the heart stops beating and blood circulation is terminated due to abnormalities of the heart. There are two approaches of resuscitation of a person in cardiac arrest; BLS and if needed the ACLS approach.

BLS

Basic life support is the initial response to a cardiac arrest and focuses on CPR and defibrillation. Advanced IV administration of drugs or advanced airway is not needed in BLS survey.
BLS has these components: Chest compressions (C), Airway (A), Breathing (B) and Defibrillation (D). The goal of BLS is to reinstate circulation, oxygenation and ventilation by focusing on CPR and defibrillation until the return of spontaneous circulation (ROSC). Before starting CPR, first always check if the scene is safe.

BLS Survey

STEPS	ASSESSMENT	TECHNIQUE/ACTION
1	Check for response	Tap and ask, “Are you all right?” Look for breathing by checking for movement of chest (5 to 10 seconds)
2	Activate the emergency response system and get AED	Activate the emergency response system (Call 911) and ask someone to get the AED if help is available
3	Circulation	Check carotid pulse (maximum of 10 seconds) If no pulse start CPR with 30 chest compressions and 2 breaths START WITH COMPRESSIONS FIRST! 100 compressions per minute Depth of 2 inches If there is a pulse, start rescue breathing at 1 breath every 5 to 6 seconds
4	Defibrillation	Check for shockable rhythm with AED Hook up the pads to the patients bare chest Give shock when needed – follow instructions on the AED After shock start CPR again beginning with chest compressions

The following is the Basic Life Support Algorithm:

ACLS

Once the BLS primary survey is conducted the patient is then moved to the next level of care which is the ACLS. Advanced Cardiac Life Support is used after ineffective BLS or if there is a conscious patient who needs advance medical attention. The main goal of ACLS is to provide a more invasive procedure, advance assessment, proper management techniques, and differential diagnosis for the overall health of the patient.

ACLS Survey

ASSESSMENT

TECHNIQUE/ACTION

Airway

Is the airway patent?
Is an advanced airway indicated?
Is placement of advanced airway confirmed?
Check if placement of airway is secure and check continuously

In an unconscious patient us the following to sustain airway patency:

Head tilt-chin life
Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA)

If needed use the following advanced airway management:

Laryngeal mask airway
Laryngeal tube
Esophageal-tracheal tube
Endotracheal tube

To minimize interruptions of CPR and ventilation, insert airway quickly
Ensure advanced airway is placed correctly by:

Physical examination
Quantitative waveform capnography

Ensure the device is stabilized

Use quantitative waveform capnography to

Ensure monitor is placed correctly

Breathing

Is oxygenation and ventilation sufficient?
Is there continuous monitoring of quantitative waveform capnography and oxyhemoglobin saturation?

Give supplementary oxygen when needed:

Patients who are in cardiac arrest, provide 100% oxygen
For everyone else, titrate oxygen administration to achieve oxygen saturation values of at least 94% (always confirm with pulse oximetry)
Monitor ventilation and oxygenation by

Clinical criteria (chest rise and cyanosis)
Quantitative waveform capnograpy
Oxygen saturation

Circulation

Are you providing adequate chest compressions?
Cardiac rhythm?
Is defibrillation or cadioversion needed?
IV/IO access obtained?
Is the patient with a pulse unstable?
Medications needed?
Need IV fluids?

Monitor quality CPR

Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms

Give defibrillation/cardioversion

Get IV/IO access

Administer appropriate drugs

Provide IV/IO fluids if needed

Differential Diagnosis

What caused the symptoms or arrest?
What are the reversible causes and can it be treated?

Look for and treat any reversible issues

Remember the H’s & T’s

THE H’S:

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper/hypokalemia, Hypothermia

THE T’S:

Toxins, Tamponade (cardiac), Tension pneumothorax, Thrombosis (coronary or pulmonary)

Learning Outcomes:

You have completed Course II. Now you should be able to:

Understand the basic BLS and ACLS survey
Explain the BLS survey in detail
Explain what initial steps you should take during a cardiac arrest situation

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Chapter 3 : BLS and ACLS – Quick Overview

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