Imagine someone collapsing right in front of you. Would you know what to do in those first critical moments?
Basic Life Support (BLS) is a set of simple, but lifesaving skills designed to keep oxygen moving to the brain and vital organs when breathing or circulation stops. The goal is not only survival, but survival with the best possible neurological outcome until advanced medical care arrives.
Recognizing the Emergency
Medical emergencies can happen anywhere—at the grocery store, in church, on a sidewalk, or while hiking.
The goal is simple: keep oxygen moving into the body and keep blood circulating to the brain and other vital organs.
The first step is to check for responsiveness. Is the person conscious or unconscious?
How to Check for Consciousness
You check for consciousness by tapping the patient with good pressure and asking:
Are you okay??!
A responsive person may not always be fully alert. Responses can include:
- awake and able to answer questions
- unable to speak but able to respond with purposeful movements, nodding, or blinking
- it is not uncommon for patients to be conscious and confused
Ideally someone else is nearby to contact advanced medical professionals (911) and find an Automated External defibrillator (AED) if available. Your goal is to increase the chance of survival by supporting breathing, circulation and/or defibrillation until they get there.
If the person is conscious, that’s encouraging news. A conscious person is breathing and has enough circulation to maintain brain function. Let us consider the unconscious patient.
The Unconscious Patient
Scenario 1:
In the best-case scenario, your patient is unconscious BUT they have a pulse AND they are breathing normally.
This would include situations like fainting, concussions, symptomatic severe hypoglycemia, serious trauma and severe intoxication.
All of these are also serious medical emergencies, but it is obviously always better when your patient has a pulse and is able to breathe.
In this scenario the appropriate response will vary based on the specific cause. Monitor the patient until emergency services arrive.
Scenario 2:
The second-best scenario is where your patient is unconscious AND has a pulse BUT is not breathing normally or not breathing at all.
A pulse means the heart is still pumping blood, but without breathing, oxygen levels will
quickly fall.
This would include situations like drowning where water in the lungs prevents normal breathing, choking, severe trauma to the chest and respiratory depression from narcotic overdose.
An unconscious person with a pulse but not able to breathe is in respiratory arrest.
Without intervention, respiratory arrest can progress to cardiac arrest.
In respiratory arrest give 1 breath every 6 seconds and check for a pulse about every 2 minutes until advanced medical help arrives.
Scenario 3:
The most critical scenario is a patient with NO pulse. Without a pulse your heart is not pumping blood.
Within seconds blood flow to the brain drops which will automatically result in a loss of consciousness.
The brain also controls the ability to breathe, and loss of respiratory function soon follows.
No pulse = no circulation + no consciousness + no breathing
A person with no pulse is in cardiac arrest.
In cardiac arrest we start CPR.
CPR
Start CPR immediately with compressions. Push hard and push fast. High-quality compressions will provide 100 –120 compressions per minute with a depth of atleast 2 inches for adults.
Common Pitfalls of CPR:
1. Not allowing the chest to completely recoil after each compression:
Allowing the chest to fully recoil between compressions lets the heart refill with blood before the next compression. This will result in more blood being pumped to vital organs with the next compression.
2. Over- ventilating:
Breaths during CPR should be given over 1 second. Just enough to see the chest rise. Blowing in too much air increases the pressure within the chest which decreases blood flow to the heart and subsequently to vital organs with the next compression.
3. Excessive interruptions
During CPR any interruption greater than 10 seconds is considered excessive.
Compression is the surrogate pulse for patients in cardiac arrest; it is the only source of blood flow to the brain and vital organs.
When compressions are paused blood flow/oxygenation to vital organs stops almost immediately.
Brain tissue is extremely sensitive to oxygen deprivation and will begin to deteriorate in about 5 minutes.
The 10 second rule applies for all interventions during CPR including checking for a pulse. If you cannot confirm a pulse within 10 seconds, start CPR.
Defibrillation/AED
If an AED is available turn it on and follow the audio and visual instructions on screen to
correctly attach the pads. The device analyzes the heart’s rhythm and tells you whether a shock is needed. Follow each shock immediately with CPR, beginning with compressions.
When attaching the defibrillator the 10 second rule still applies.
Conclusion
Basic life support can save lives with no advanced equipment. Stay calm, check for breathing and pulse, provide the support needed: breaths, compressions and/or defibrillation.
What to test how well you can apply this information in real clinical scenarios? Take the BLS quiz!