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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 ASSESSMENTTECHNIQUE/ACTION 
1Check for response
  • Tap and ask, “Are you all right?”
  • Look for breathing by checking for movement of chest (5 to 10 seconds)
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2Activate 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
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3Circulation
  • 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
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4Defibrillation
  • 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
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The following is the Basic Life Support Algorithm:

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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

ASSESSMENTTECHNIQUE/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:

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