BLS Assessment

The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses early CPR with basic airwav management and defibrillation but not advanced airwav techniques or drug administration. By using the BLS Assessment, any healthcare provider can support or restore effective oxygenation, ventilation, and circulation until the patient achieves ROSC or advanced providers intervene. Performing the BLS Assessment substantially improves a patient’s chance of survival and a good neurologic outcome

Remember to assess first, and then perform the appropriate action

Although the BLS Assessment requires no advanced equipment, you can use readily available supplies, such as a bag-mask ventilation device if it is available. Whenever possible, place the patient faceup on a firm, flat surface to maximize the effectiveness of chest compressions. Table 2 is an overview of the BLS Assessment, and Figures & through 12 illustrate the steps needed during the BLS

Check responsiveness

  • Tap and shout, “Are you OK?”

Shout for nearby help/activate the emergency response system and get the AED/defibrillator.

  • Shout for nearby help.
  • Activate the emergency response system
  • Get an AED if one is available, or send someone to activate the emergency response system and get an AED or defibrillator.

Check for breathing and pulse.

  • To check for absent or abnormal breathing (no breathing or only gasping) scan the chest for rise and fall for at least 5 but no more than 10 seconds
  • Feel for a pulse for at least 5 but no more than 10 seconds.
  • Perform the pulse check simullaneously with the breathing check within 10 seconds to minimize delaying CPR.
  • If you find no breathing and no pulse within 10 seconds, start CPR, beginning with chest compressions.
  • If you find a pulse, start rescue breathing at 1 breath every 6 seconds. Check pulse about every 2 minutes.

Defibrillate

  • If pulse is not fell, check for a shockable thythm with an AED/defibrillator as soon as it arrives.
  • Provide shocks as indicated
  • Follow each shock immediately with CPR, beginning with compressions

Critical Concepts: High-Quality CPR

  • To perform high-quality CPR, rescuers should
  • Compress the chest hard and fast at least 2 inches (5 cm) at a rate of 100 to 120/min (30:2 or another advanced protocol that maximizes CCF).
  • Allow the chest to completely recoil after each compression.
  • Switch compressors about every 2 minutes or earlier if fatigued the switch should only take about 5 seconds.
  • Minimize interruptions in compressions to 10 seconds or less (high CCF).
  • Avoid excessive ventilation.

 

Primary Assessment

In the Primary Assessment, you continue to assess the patient and perform appropriate actions until the patient is transferred to the next level of care. Members of a high-performance team often perform assessments and actions in ACLS simultaneously.

For unconscious patients in arrest (cardiac or respiratory), complete the BLS Assessment before the Primary Assessment. For conscious patients who may need more advanced assessment and management, conduct the Primary Assessment first. Table 3 provides an overview of the Primary Assessment.

Remember to assess first, and then perform the appropriate action.

 

Secondary Assessment

The Secondary Assessment involves the differential diagnosis. including a focused medical history and searching for and treating underlying causes (H’s and T’s). Gather a focused history of the patient, if possible. Ask specific questions related to the patient’s presentation

SAMPLE

  • Signs and symptoms
    • Breathing difficulty
    • Tachypnea, tachycardia
    • Fever, headache
    • Fever, headache
    • Abdominal main
    • Bleeding
  • Allergies
    • Medications, foods, latex, etc
    • Associated reactions
  • Medications (including the last dose taken)
    • Patient medications, including over-the-counter, vitamins, inhalers, and herbal supplements
    • Last dose and time of recent medications
    • Medications that can be found in the patient’s home
  • Past medical nistory (especiallv relatino to the current illness).
    • Health history (eg, previous illnesses, hospitalizations)
      Family health history (in cases of ACS or stroke)
      Significant underlying medical problems.
      Past surgeries
    • Immunization status
  • Last meal consumed
    • Time and nature of last intake of liquid or food
  • Events
    • Events leading to current illness or injury (eg, onset sudden or gradual type of iniury)
    • Hazards at scene
    • Treatment during interval from onset of disease or injury until evaluation
    • Estimated time of onset (if out-of-hospital onset)

The answers to these questions can help you quickly identify likely or suspected diagnoses. Look for and treat the underlying cause by considering the His and T’s to ensure that you are not overlooking common possibilities. The H’s and T’s create a guide for possible diagnoses and interventions for your patient.

H’s and T’s

The H’s and T’s are a memory aid for potential reversible causes of cardiac arrest and emergency cardiopulmonary conditions

The ACLS cases provide details on these components:

H’s

  • Hypovolemia
  • Нурохіа
  • Hydrogen ion (acidosis)
  • Hypo-/nyperkalemia
  • Hypothermia

T’s

  • Tension pneumothorax
  • Tamponade (cardiac)
  • Toxins
  • Thrombosis (pulmonary)
  • Thrombosis (coronary)