8/30/20 American Heart Association BLS Recommendations - - PDF document

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How to Pass Your BLS Like A Boss 2020

Jennifer Cheung, M SN, RN, CCRN

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American Heart Association BLS Recommendations

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

• 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

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American Heart Association BLS Recommendations

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

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American Heart Association BLS Recommendations

Airway and Breathing (CAB)

• Utilize the head tilt-chin lift or jaw thrust (trauma to the cervical spine)
• Rescue breaths are 1 breath every 5 to 6 seconds
• 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

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American Heart Association BLS Recommendations

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.

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American Heart Association BLS Recommendations

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

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics 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

• Pulse Checks
• Infant – palpate a brachial pulse
• Child – palpate a carotid or femoral pulse

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics

• 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
• 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

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics

• Rescue breaths
• 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

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics

• 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.

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics

• If agonal breathing, with pulse – No CPR necessary
• Give rescue breaths over 1 second every 3-5 seconds
• IV/IO Access
• IO access if the preferred access for cardiac arrest in pediatrics over IV

access

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American Heart Association BLS Recommendations

Understanding Basic Life Support in Pediatrics 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.

• Defibrillation
• 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.

• Synchronized Cardioversion
• 0.5 to 1 Joules/Kg

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American Heart Association BLS Recommendations

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

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American Heart Association BLS Recommendations

Foreign Body Airway Obstruction - Infant 1. If the victim cannot make any sounds or breathe, severe airway

• bstruction 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 Back Slaps Chest Thrusts

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American Heart Association BLS Recommendations

Foreign Body Airway Obstruction – Unresponsive 1. Activate the emergency response system through your mobile phone

• r 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. 4. Continue CPR until advanced providers arrive.

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