Basic life support (BLS) is a level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including certified first responders, emergency medical technicians, and by qualified bystanders.
Background edit
The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to coordinate the efforts of resuscitation worldwide. The ILCOR representatives come from various countries such as the United States, Canada, Australia, Europe, New Zealand, and from the Asian and African continents. In 2000, the committee published the first resuscitation guideline. In 2005, the committee published International Consensus on Cardiopulmonary resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations. Since 2010, the committee has provided materials for regional resuscitation providers such as European Resuscitation Council and American Heart Association to write their own guidelines.[1] Since 2015, ILCOR has used a new methodology called Consensus on Science with Treatment Recommendations (COSTR) to evaluate the quality of latest evidence available and to reach a conclusion on the best treatments available in resuscitation.[2] Using the COSTR methodology, ILCOR also started to conduct yearly reviews and published updates on the latest evidence in resuscitation, changing it from the previous 5-yearly review on resuscitation.[3]
Indications edit
The American Heart Association's BLS protocol is designed for use by laypeople, as well as students and others certified first responder, and to some extent, higher medical function personnel. The protocol includes indications for cardiac arrest, respiratory arrest, drowning, and foreign body airway obstruction (FBAO, or choking).
Cardiac arrest edit
Cardiac arrest occurs when the heart stops pumping in a regular rhythm. In this situation, early defibrillation is the key to returning the victim's heart back to a normal rhythm. When a defibrillator is not readily available, a rescuer or bystander should keep the blood flowing by performing chest compressions and rescue breaths at an age-appropriate rate until it is.
Respiratory Arrest edit
Respiratory arrest is when there is no measurable breathing in a victim. It tends to occur in conjunction with cardiac arrest, but this is not always the case. Respiratory arrest is the most common indication of BLS in infants and toddlers. The most critical factor in restoring breathing in the victim is to provide high quality rescue breaths.
Drowning edit
In cases of drowning, rescuers should provide CPR as soon as an unresponsive victim is removed from the water. In particular, rescue breathing is important in this situation. A lone rescuer is typically advised to give CPR for a short time before leaving the victim to call emergency medical services. Since the primary cause of cardiac arrest and death in drowning and choking victims is hypoxemia, it is recommended to start with rescue breaths before proceeding to chest compressions (if pulseless). If the victim presents in a shockable rhythm, early defibrillation is still recommended.
Choking edit
Choking occurs when a foreign body obstructs the trachea. Rescuers should only intervene in victims who show signs of severe airway obstruction, such as a silent cough, cyanosis, or inability to speak or breathe. If a victim is coughing forcefully, rescuers should not interfere with this process and encourage the victim to keep coughing. If a victim shows signs of severe airway obstruction, anti-choking maneuvers such as Abdominal thrusts should be applied until the obstruction is relieved. If a victim becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove it if it is evident.
Technique edit
United States of America edit
Basic Life Support Emergency Medical Services in the United States is generally identified with Emergency Medical Technicians-Basic (EMT-B). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the Advanced Cardiac Life Support (ACLS) protocols, in addition to BLS protocols.
Chain of Survival
The American Heart Association highlights the most important steps of BLS in a "four-link chain of survival." The chain of survival includes early recognition of an ongoing emergency, early initiation of CPR by a bystander, early use of a defibrillator, and early advanced life support once more qualified medical help arrives. Qualified bystanders with training in BLS are encouraged to perform the first three steps of the four-link chain of survival.
High Quality CPR
High quality cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are the most important aspects of BLS to ensure a victim survives. CPR involves a rescuer or bystander providing chest compressions to a victim in a supine position while also giving rescue breaths. The rescuer or bystander can also choose not to provide breaths and provide compression-only CPR. Depending on the age and circumstances of the victim, there can be variations in the compression to breath ratio given.
These changes were introduced to simplify the algorithm, to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival.[1] It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.[2]
Special Populations edit
Pregnant women edit
To relieve choking, chest thrusts should be used when the victim is in late pregnancy.
Obese edit
If a victim of choking is obese and a rescuer cannot perform adequate abdominal thrusts, they are encouraged to instead perform chest thrusts.
Infants edit
To relieve choking, abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. A sequence of back slaps and chest compressions are used instead.
Other Countries edit
Europe edit
- ^ Eftestøl T, Sunde K, Steen PA (May 2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. doi:10.1161/01.cir.0000016362.42586.fe. PMID 12010909.
- ^ Hallstrom A, Cobb L, Johnson E, Copass M (May 2000). "Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation". N. Engl. J. Med. 342 (21): 1546–53. CiteSeerX 10.1.1.456.8789. doi:10.1056/NEJM200005253422101. PMID 10824072.