Basic life support

BLS

Airway

• Recommendations (ANZCOR)
  • In the unconscious patient, airway management take precedence over ALL other injuries
  • To assess airway and breathing, leave person in position they are in unless fluid/matter obstructs airway
  • To clear airway turn patient to side and downwards and allow to drain
  • For unresponsive adult or child (1-8yo), open airway with head tilt-chin lift
  • For infant (<1yo), open airway by placing head in neutral position and jaw thrust
  • Remove loose dentures but leave tight-fitting ones in place
  • Visible material can be moved with rescuers fingers but finger sweep not recommended
  • Most common causes of airway obstruction in unconscious pateint are occlusion of oropharynx by tongue and laxity of epiglottis

Airway

• Upper airway obstruction
  • Chest thrusts or back blows are effective in adults and children
    • 5, then change and 5 of the other, repeatedly
  • Chest thrusts at same point as for CPR but slower
  • Life-threatening complications of abdominal thrusts have been reported
  • If becomes unresponsive, can remove with fingers if visible but need to call for help and start CPR

Airway

Breathing

• Look, listen and feel (removed from American algorithms) – Start CPR immediately if unresponsive without respirations or with abnormal breathing
• Allow 1 second for each ventilation with volume to achieve chest rise
• 30:2
• Risk of disease transmission is very low but no human studies performed
• Lab-based studies show barrier devices reduce bacterial transmission

Circulation

• Minimise interruptions
• Palpation of pulse is unreliable and should NOT be performed (by anyone) to confirm the need for resuscitation
  • Base on unresponsiveness and absence of normal breathing
• Lower half of sternum
• Infants
  • Two-finger (lay rescuers) or two-thumb technique (health professionals)
• Place on firm surface
• 50%:50% compression:relaxation
• Allow complete recoil before each compression

Circulation

• If pregnant, start CPR and then put pad under right hip (15-30 degrees)
• 1/3 of depth of chest (>5cm in adults;5cm in children; 4cm in infants)
• No maximum compression depth as risk of inadequate depth outweighs risk of harm
• Rate of 100-120 for ALL AGES (total number will be less due to ventilations)
• Change rescuers at least every 2 minutes if feasible with minimal interruptions
• Hands off >5 seconds significantly decreases ROSC, etCO2 and diastolic arterial (coronary) pressure

Automated defibrillation

• AED should be applied as soon as available, irrespective of cycle
• Pad placement
  • Adults: Anterior-lateral or AP
  • Avoid placing over implantable device. At least 8cm away
  • Do not place over medication patch. Remove patch and wipe clean first
  • Children and infants: Standard adult approach if over 8yo
    • If <8yo and no paediatric setup available, use adult
    • Ensure pads do not touch each other on childs chest (might require AP placement)
• No reports of harm to rescuers in wet conditions
• In the presence of oxygen, no reports of fires if using adhesive pads
• Recommended to move patient to safe and dry area before delivering shock
• Not recommended to keep hands on as completely safety cannot be guaranteed

Cardiocerebral ‘compression-only’ resuscitation

• Similar 30 day and 1 year neurological outcomes
• Formal component of 2010 guidelines in America
• Rescue breathing during first 5 minutes may not be necessary based on animal studies
• Occasional gasps and chest recoil may provide adequate ventilation in situation where normal VQ ratio requires lower than normal minute ventilation
• Witholding airway interventions for 5-10 minutes may improve resuscitation rates and neurological survival
• Dunn – May be used in adult, witnessed OOHCA, with shockable rhythm, <4 minutes from time of arrest and low confidence of operator in ventilations

First aid for bleeding

• Manage as for life-threatening bleeding if:
  • Amputated or partially amputated limb above wrist or ankle
  • Shark attack/propeller cut or similar
  • Bleeding not controlled by local pressure
  • Bleeding with signs of shock
    • In these cases, control of haemorrhage takes precedence
• Apply direct pressure with 1-2 pads over precise bleeding point
• If not controlled by direct pressure, apply arterial tourniquet
• Can apply second tourniquet above first one if necessary
• If still not controlled, apply haemostatic dressing

First aid for burns

• Ensure safety
• Stop burning process
• ABC
• Cool running water for 20 minutes
• Remove all constricting materials/jewellery
• Cover with cling film
• Keep rest of victim warm
• Elevate burnt limb if able
• DO NOT remove adherent clothing, use ice, break blisters or apply powders/gels

First aid for chemical burns

• Remove chemical and any clothing/jewellery with chemical on them or on burnt limb
• Run cool water over area for one hour or until stinging ceases
• Apply non-adherent dressing
• If in eye, flush affected eye (keep below unaffected one to prevent spread of chemical)

Last Updated on October 13, 2020 by Andrew Crofton