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.
Video Demonstration
BLS and ACLS – Quick Overview
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: Airway (A), Breathing (B), Chest compressions (C) 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 use 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 I. 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