BLS Guidelines 2015

BLS Adult Basic Life Support Algorithm
Nov 3, 2015
Adult Basic Life Support Algorithm for Healthcare

Providers
In the algorithm for adult basic life support, emphasis is placed upon immediate recognition
of sudden cardiac arrest and rapid defibrillation with an AED (Automated External
Defibrillator.) To immediately recognize sudden cardiac arrest, the healthcare provider is
trained to assess for unresponsiveness and/or an absence of breathing or presence of
abnormal breath sounds. Look, listen and feel is no longer a part of Basic Life Support.
Untrained providers should be instructed to use hands-only CPR. This approach calls for
continuous compression on the sternum.
There has been a significant change in sequence in the 2010 guidelines for Basic Life
Support (BLS). The sequence of A-B-C (Airway, Breathing, Compression) has been
replaced with the new sequence of C-A-B (Compression, Airway, Breathing.)
CPR should be continued by a healthcare provider until return of spontaneous circulation
(ROSC) or until termination of efforts. High quality CPR emphasizes adequate depth and
number of chest compressions.
The pulse check has been deemphasized, and the guidelines recommend a pulse check for no
less than 5 seconds and no more than 10 seconds. An integrated team approach includes
simultaneous compressions and rescue breathing. Rhythm detection should take place as
soon as an AED or defibrillator is available, with subsequent shock, as indicated, as the
survival rate from ventricular fibrillation and pulseless ventricular tachycardia ranges from 5
to 50%, and decreases with an increase in the length of time to the first shock.
When a victim is unresponsive to a tap on the chest (ask Are you ok?) then the healthcare
provider should observe the victim for breathing for 5 to 10 seconds. If respirations are
present, the victim should be attached to a cardiac monitor. Otherwise, the HCP
should activate EMS and retrieve the AED by himself or by sending a second rescuer.
The pulse check is the third step in the algorithm. The pulse should be checked for no less
than 5 seconds and no more than 10 seconds. If there is a definite pulse, then rescue
breathing should be done for one second every five to six seconds with a recheck every 2
minutes.
If the victim does not have a pulse, then compressions should be initiated at the rate of
30:2, with 2 breaths every 30 compressions. When the AED or defibrillator is available, then
the HCP should check the victims rhythm. If it is shockable, then 1 shock should be
given with immediate CPR instituted for 2 minutes, beginning rapidly (within seconds) of the
shock.
If the rhythm is not shockable, then the HCP should administer CPR for 2 minutes and
recheck the rhythm every 2 minutes. Continue CPR until ALS is available.
High quality chest compressions:
Position patient on hard surface in supine position
Minimal interruptions for ventilation
18 seconds per cycle
Adequate number of compressions: >100/minute
Adequate depth of compressions: 2 or 5 cm.
Allow complete recoil of chest
Do not overventilate
Breathing devices include a ONE WAY VALVE FACE MASK. Deliver breath over one
second. Watch the chest rise.
A BAG VALVE MASK is an additional device to deliver breaths. Hold the mask in place
with the EC clamp technique and lift the jaw to open the airway. Squeeze the bag for one
second while watching for the rise and fall of the chest.
BLS Simplified Algorithm

Nov 3, 2015
For laypersons or other non-HCP personnel

The simplified ADULT BASIC LIFE SUPPORT algorithm includes five steps. The algorithm
diagram provided by the American Heart Association emphasizes the following:
1. Assess the victim's responsiveness. If a victim is not breathing, or is not breathing
normally (i.e., gasping), initiate CPR. Health care professionals should be trained to
recognize cardiac arrest that presents as seizure-like activity or with ago all respirations.
2. Activate EMS (Emergency Medical Response) by calling 911.
3. Retrieve a defibrillator, usually an automatic external defibrillator (AED).
4. The algorithm proceeds in a loop of CPR and rhythm checks with defibrillation.
5. Check PULSE before chest compressions for at least five seconds and no more than ten
seconds.
6. CPR: push hard and fast. Begin chest compressions before ventilation. Chest
compressions allow blood flow to the heart and brain. Delays in chest compressions result in
diminished survival.
7. For effective breathing, watch for chest rise and avoid excessive ventilation. 10 to 12
BREATHS should be delivered each minute, or one breath every five to six seconds.Each
breath should be delivered over 1 second. Observe visible chest rise.
Avoid gastric inflation, as it may result in aspiration, pneumonia or vomiting.
8. The ratio of chest compressions to breaths is 30 to 2.
9. Recheck the patient every five cycles (of 30:2).
10. After the defibrillator becomes available, check rhythm. USE THE AED WHEN
INDICATED AND AVAILABLE. The victim should receive a shock that is repeated
every two minutes or 5 cycles.
"Look, listen, and feel" is no longer part of the BLS algorithm. The emphasis is on high
quality CPR.
BLS Pediatric Algorithm

Nov 3, 2015
Pediatric Basic Life Support for Healthcare

Providers
In Pediatric Basic Life Support for Healthcare Providers (HCP), the rescuer should
first determine quickly if the victim is unresponsive. The provider should note if the
victim is not breathing or is only gasping.
If the victim is not breathing, only gasping, or is unresponsive, with sudden collapse, a lone
rescuer should activate the emergency medical response service and retrieve the
automated external defibrillator or defibrillator. If there is another rescuer, that person
should activate EMS and retrieve the AED or defibrillator.
Healthcare providers should check the victims pulse for at least 5 seconds but no longer than
10 seconds. In children aged one to adolescence, the pulse should be checked at the carotid
artery. In infants, the brachial pulse should be assessed.
If there is a palpable pulse within 10 seconds, then a rescue breath should be given every
3 seconds. Breaths should last one second and the chest should be observed for visible
rise. If the victim has an advanced airway, then the provider should administer breaths every
6 to 8 seconds, asynchronous with compressions.
If the pulse is less than 60/minutes, or if the victim has signs of poor perfusion after
adequate ventilation and oxygenation, the provider should begin chest compressions. In
the absence of a pulse, a long rescuer should begin CPR with 30 high quality
compressions followed by two breaths. If two rescuers are available, the cycle of
compressions to breaths should be 15:2 (pediatrics).
High quality compressions in CPR should be a minimum of 1/3 the AP diameter of the
chest, or approximately 1 inches in infants (4 cm) and 2 in children from age one to
adolescence. The rate of compressions should be at least 100 per minute. Chest recoil
should be complete between compressions.
Pediatric compression is performed with the head of one hand over the lower of the
sternum, between the nipples. In infants, use two fingers, or use the thumb encircling
technique if multiple providers are available.
After two minutes have passed, if EMS has not been notified, then they should be called. At
this time, if the AED is not yet available, the rescuer should retrieve it. When the AED is
available, the victims rhythm should be quickly assessed.
Shockable rhythms include ventricular fibrillation or pulseless ventricular tachycardia. One
shock should be given to the victim, with resumption of CPR immediately after the
shock. CPR should continue for 2 minutes. A dose attenuator should be used if available,
but if not, adult pads can be used.
If the rhythm is not shockable, CPR should be resumed immediately. The HCP
should check the rhythm once more after two minutes of CPR (5 cycles of 30:2). This
should until the victim moves or until advanced life support is available.
The airway in pediatrics should be opened with a head tilt/chin lift for children over the age
of one, and with the infant in the sniffing position. If trauma is suspected, then a jaw thrust
should be used to open the airway.
BLS CPR Algorithm

Nov 3, 2015
High quality cardiopulmonary resuscitation

HIGH QUALITY CPR is important in the provision of basic life support to an unresponsive
victim without a pulse. High quality CPR possesses the following important characteristics:
1. Compressions should begin within ten seconds of determination of cardiac arrest.
2. The rate of compression should be at least 100 per minute.
3. The depth of compression should be at least 2 for adults, approximately 2 for
children from age one to adolescence, and 1 (4 cm) for infants. The depth of
compression should be 1/3 the AP chest diameter for children and infants.
4. There should be complete recoil of the chest after each compression.
5. Interruptions in chest compression should be minimized. When giving shocks, the
interval between the last compression and the shock should be kept to less than 10
seconds, as should the interval between the shock and following compression.
6. Chest compressions should be initiated prior to rescue breathing. CPR should be
initiated with 30 compressions, in order to shorten any delay to the first compressions,
7. When giving breaths, effectiveness can be ascertained by watching the rise of the
chest.
8. All excessive ventilation should be avoided; excessive ventilation may result in
aspiration, vomitus or pneumonia.
BLS C-A-B Algorithm

Nov 3, 2015
Compressions-Airway-Breathing
The American Heart Association revised the Basic Life Support sequence in 2010. This
fundamental change reflects an international consensus after an extensive review of the
available resuscitation evidence. The current emphasis is on quality chest
compressions. This emphasis was present to a lesser degree in 2005. It stresses an adequate
rate and depth of compression.
The 2010 BLS guidelines include the following:
COMPRESSIONS
Compression rate of 100/ minute, pushing hard and fast in chest center
At least 100 compressions per minute
Minimum depth of at least 2" for adults
Children and infants: 1/3 depth of the chest (2 and 1.5)
Allow complete chest recoil between breaths.
AIRWAY
Head tilt/chin lift: tilt victim's head back and lift victim's chin to open the airway.
Infant airway can be opened by placing the head in the sniffing position.
BREATHING
Give rescue breathing, mouth to mouth, in the apneic patient with a pulse.
For effective breathing, watch for chest rise and avoid excessive ventilation. The ratio
of chest compressions to breaths is 30 to 2.
10 to 12 BREATHS should be delivered each minute, or one breath every five to six
seconds. Each breath should be delivered over 1 second. Observe visible chest rise.

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BLS Adult Basic Life Support Algorithm

Adult Basic Life Support Algorithm for Healthcare

High quality chest compressions:

Position patient on hard surface in supine position

Minimal interruptions for ventilation

18 seconds per cycle

Adequate number of compressions: >100/minute

Adequate depth of compressions: 2 or 5 cm.

Allow complete recoil of chest

BLS Simplified Algorithm

For laypersons or other non-HCP personnel

BLS Pediatric Algorithm

Pediatric Basic Life Support for Healthcare

BLS CPR Algorithm

High quality cardiopulmonary resuscitation

BLS C-A-B Algorithm

At least 100 compressions per minute

Minimum depth of at least 2" for adults

Children and infants: 1/3 depth of the chest (2 and 1.5)

Allow complete chest recoil between breaths.

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