The Basic Life Support Certification (BLS) can be very stressful whether you are taking the examination for the first time or renewing every 2 years. Here are some helpful tips in passing the BLS Certification Examination.
BASIC LIFE SUPPORT REVIEW
UNDERSTANDING BASIC LIFE SUPPORT
COMPRESSIONS, AIRWAY, BREATHING (CAB)
Understanding Basic Life Support in Adults
◦Check for responsiveness of the patient by tapping firmly on or above the collar bone
◦If no response, assess the environment for safety before beginning cardiopulmonary resuscitation
◦Activate emergency response system by shouting for help and have another person obtain the AED/Defibrillator
If a mobile device is available, activate emergency response system yourself immediately (2020 AHA Guidelines Update)
◦Check for breathing and pulse no more than 10 seconds
◦Begin CPR if no pulse is detected by starting with chest compressions
◦If pulse is present with agonal breathing, begin rescue breathing immediately
Chest Compressions (CAB)
◦Place palm of hand over the patient’s sternum just above the xiphoid process
◦Previous indicator was to place the palm of your hands on the mid-nipple line; however, due to the increase in obesity, the nipple line may no longer be the best indicator
◦Chest compressions are 100 to 120 per minute
◦Compression depth should be at least 2 inches in adults
◦Allow for full chest recoil between compression and minimize interruptions to less than 10 seconds
◦Switch compression team members every 2 minutes
Compression to Ventilation Ratio
30 compressions: 2 rescue breaths
Airway and Breathing (CAB)
◦Utilize the head tilt-chin lift or jaw thrust (trauma to the cervical spine)
◦Rescue breaths are 1 breath every 6 seconds for respiratory arrest with or without an advanced airway (2020 AHA Guidelines Update)
◦You want to see visible chest rise and fall with each rescue breath
◦Avoid excess ventilation
◦Potential reduction of cerebral blood flow rated to a decrease in PaCO2 levels
◦Risk of increased intrathoracic pressures which can lead to adverse hemodynamic effects
AED / Defibrillation
1.Turn on the AED and follow the AED prompts
2.Open or remove the person’s shirt, clearing any wet barrier or medication patches
3.Attach the AED pads to the right anterior chest and left midaxillary line per pad instructions and plug the pads into the connector
4.Stop chest compressions, confirm everyone is clear by saying “Stand Clear”
5.Push the analyze button and allow the AED to analyze the person’s heart rhythm
6.If a shock is recommended, make sure no one is touching the person and repeat “Stand Clear.” Once clear, press the shock button.
7.Begin CPR immediately following the shock or if no shock is advised. Perform 2 minutes of CPR and follow the AEDs prompts again.
Understanding Basic Life Support in Pediatrics
Definition of Neonate, Infant, Child, Adolescent
◦Neonate: 0 to 28 days
◦Infant: 28 days to 1 year old
◦Child: greater than 1 years old but has not reached puberty
◦Adolescent: Puberty is present either through arm pit hair or breast development
In Basic Life Support in Pediatrics, follow the CAB sequence for cardiopulmonary resuscitation. Compression – Airway – Breathing.
◦Verify the Scene Safety, Check for Responsiveness and Get Help
◦Verify that the scene is safe, so you don’t become a victim yourself.
◦Check for responsiveness of the child. Tap the shoulders or heel of the infant’s foot and shout “Are you OK?!”
◦If victim does not respond, should for help nearby and activate the emergency response system.
◦If no one responds, DO NOT LEAVE THE child. Perform one round of CPR prior to finding help.
◦Assess for Breathing
◦No more than 10 seconds – Check for rise and fall of chest and presence of pulse
◦Infant – palpate a brachial pulse
◦Child – palpate a carotid or femoral pulse
◦Unresponsive, no pulse, not breathing
◦Begin CPR Immediately
◦Infant – 2 finger chest compressions – center of chest at the nipple line
◦One-person rescuer is 30 chest compressions to 2 breaths
◦Two-person rescuer is 15 chest compressions to 2 breaths (better for coronary perfusion)
◦Child – 1 or 2 hands
Single rescuer CPR hand position now has options
2 fingers in the center of the infant’s chest, lower half of the breastbone
2 thumbs in the center of the infant’s chest, lower half of the breastbone
1 hand in the center of the infant’s chest, lower half of the breastbone
All options are based in the 2020 AHA Guidelines Update
◦Chest compression should be 1/3 the AP diameter of the chest
◦Infants – 1 ½ inches or 4 cm
◦Children – 2 inches or 5 cm
◦No compressions beyond 6 cm
◦100 to 120 chest compressions per minute in infants, children, and adolescents
◦After every 30 chest compressions, the provider should provide 2 breaths each over 1 second.
◦You want to see chest raise and fall for confirm appropriate rescue breaths
◦Patient should be placed in the sniffing position for optimization of rescue breaths. This requires the flexion and extension of the head and neck using the EC method with a bag-valve mask
◦If agonal breathing, with pulse – No CPR necessary
◦Give rescue breaths over 1 breath every 2 – 3 seconds (20 – 30/min) with or without an advanced airway (2020 AHA Guidelines Update)
◦IO access if the preferred access for cardiac arrest in pediatrics over IV access
AED Placement for Infants and Children
◦Under 8 years of age – Use child pads if available. If child pads are not available, you may use adult pads. Place pads so they do not touch each other. One pad is placed on the chest and the other pad is placed on the back. Pads should sandwich the heart when placed appropriately.
◦8 years of age and older – Use Adult pads. DO NOT USE CHILD PADS – they will likely give a shock dose that is too low.
Defibrillation is the treatment for immediate life-threatening arrhythmias with which the patient does not have a pulse such as ventricular fibrillation or pulseless ventricular tachycardia.
◦Initial Shock: 2-4 Joules/Kg
◦Second Shock: > OR = 4 Joules/Kg
◦Maximum Shock: 10 Joules/Kg
◦REMEMBER THIS MNEMONIC: 2, 4, 6, 8 THAT’S THE DOSE TO DEFIBRILLATE
Synchronized Cardioversion is the treatment that aims to convert an arrhythmia back to sinus rhythm such as atrial fibrillation or supraventricular tachycardia.
◦0.5 to 1 Joules/Kg
Foreign Body Airway Obstruction – Adult & Children
1.Ask “Are you choking?” If the victim nods “yes” and cannot talk, severe airway obstruction is present.
2.Give abdominal thrusts/Heimlich maneuvers or chest thrusts for pregnant or obese persons who is responsive
3.Repeat abdominal thrusts (or chest thrusts if pregnant or obese) until effective or the person becomes unresponsive
Foreign Body Airway Obstruction – Infant
1.If the victim cannot make any sounds or breathe, severe airway obstruction is present
2.Give up to 5 back slaps and up to 5 chest thrusts
3.Repeat step 2 until effective or the person becomes unresponsive
Foreign Body Airway Obstruction – Unresponsive
1.Activate the emergency response system through your mobile phone or send someone to do so. After 2 minutes of CPR, if you are alone with no mobile phone, leave the person to activate the emergency response system (if another person has not done so)
2.Lower the person to the floor. Begin CPR, starting with chest compression. Do not check for a pulse.
3.Before you deliver rescue breaths, investigate the mouth. If you see the foreign body that can be easily removed, remove it.