Understanding the Basic Life Support Algorithm

Adult BLS Algorithm Healthcare Providers

Step 1

Ensure the scene is safe. Your safety comes first.

Step 2

Next, assess the patient. Try to elicit a response by asking them a question or utilize a sternal rub. If the patient is unresponsive, get help and call the emergency medical services (EMS). You can’t work a code alone. Call a code if you are in the hospital or dial 9-1-1 on your cell phone if you are in the field.

Step 3

Check for a pulse and assess for breathing at the same time. You’ll feel for a carotid pulse while checking for a chest rise. Don’t spend more than 10 seconds on the assessment.

At this point, there are three patient algorithm scenarios.

Read: Difference Between ACLS and BLS

Step 4

First Scenario

In the first scenario, our assessment reveals the patient has adequate pulse and respirations. Continue to watch the patient and continually reassess them until EMS arrives. Make sure they have an airway and maintain it.

Second Scenario

In the second scenario, the patient has an adequate pulse but inadequate respirations. Provide a supplemental breath every five to six seconds. If a patient has an adequate pulse and abnormal breathing, it could be an opioid or heroin overdose, so make sure to assess for those and administer an antagonist such as naloxone (Narcan) if needed. 

Third Scenario

In the third scenario, the patient has no pulse and is not breathing. Patients with gasping respirations are not considered breathing, which may be confusing. Remember, while respirations may still occur during the initial moments of cardiac arrest, breathing consists of sustained, rhythmic ventilations every five to six seconds. 

Administer chest compressions at a ratio of 30 compressions to 2 ventilations. The rate for cardiac compressions is 100–120 compressions per minute. The chest compression depth is at least 2 inches deep without exceeding 2.4 inches.

Check for a pulse and assess for breathing at the same time. You’ll feel for a carotid pulse while checking for a chest rise. Don’t spend more than 10 seconds on the assessment.

At this point, there are three patient algorithm scenarios.

High-quality CPR involves adequate compression depth and compression rate.

Make sure your hand placement is correct. Place the heel of your hand on the lower third or lower half of the sternum, above the xiphoid process. If your hand is too high, the ribs will be too close together. You’ll have to maneuver them and won’t be able to get adequate depth. Make sure your hand’s heel is in the lower part of the sternum.

Place the heel of the hand in the lower half of the sternum.

Step 5

Step 5 is to assess the cardiac rhythm. Place the AED on the patient as soon as it arrives. Expose their upper body and place the pads anterolaterally on the chest. From the patient’s perspective, one pad is placed on the high right side of the chest and one on the low left side. Make sure the heart is in between the pads.

Proper pad placement is anterolateral. Notice that the heart is in between the pads.

Related Video – How to Use an Automated External Defibrillator (AED)

Step 6

In step 6, determine if the rhythm is shockable. If it is, proceed to step 8. If not, proceed to step 7.

Step 7

If the AED says no shock is advised, continue chest compressions and ventilations until professional help arrives.

Step 8

If the AED says the rhythm is shockable, administer one shock. Make sure you clear the patient before shocking them. Everyone must know you’re going to administer a charge. Scan the patient from head to toe, ensuring no one else is touching them. You don’t want to shock a bystander.

Right after the first defibrillation, resume chest compressions for two minutes, then reassess the rhythm. Some AEDs will prompt you to do something else. For example, some may say not to touch the patient after administering the shock because the AED is reassessing the rhythm to see if the shock was effective. But, according to the AHA algorithms, immediately resume chest compressions after defibrillation for two minutes before reassessing the rhythm.

Related Video – Basic Life Support for Healthcare Providers

Summary

ACLS only works if preceded by high-quality basic life support. There are several steps to effective BLS. You’ll assess the patient, checking to see if they’re responsive. Possible courses of action include a combination of chest compressions, AED charges, and monitoring depending on the patient’s pulse and respiratory ability.