01.01 CPR-BLS (Basic Life Support)

Today we’re going to talk about CPR-BLS.

CPR stands for Cardiopulmonary Resuscitation. What that means is we are performing chest compressions and rescue breathing for someone who is not doing it on their own during an emergency. The BLS stands for Basic Life Support. That’s what we are providing in emergencies without a crash cart. Pretty self-explanatory.

Before we start CPR we have to perform an assessment. This isn’t the head to toe kind of assessment we would perform in the hospital. Think about an accident that occurred. The most important thing you want to assess for is the safety of the scene. You don’t want to run out to help and there are hazards everywhere. Make sure it’s safe to approach the victim and to also touch the victim. Once you know the scene is clear and safe, you should check the person’s level of consciousness. If the person is unconscious you should tap or shake their shoulder and ask loudly “are you okay?”. You also want to check for signs of life. You don’t want to start compressing someone’s chest and all they did was pass out or fall asleep. If the victim is unresponsive and there are others around, you should delegate people to call 911 and to grab an AED if there’s one available, while you start CPR. If you are alone, you would call 911 and grab an AED, then start CPR. 

You should all be familiar with the ABC’s in nursing: Airway, Breathing, Circulation. CPR puts a little bit of a spin on it and uses the same letters but in a different order to help us remember what we are doing. CPR uses the CAB acronym for: Compressions, Airway, Breathing. How do we put that to use? Circulation requires the heart to pump. If it’s not pumping, we make it pump doing chest compressions. We are making sure the airway is open so the lungs can receive the rescue breaths we are giving as well. I’d like to assume the lady in the picture is using a barrier but I’ll save you some time and tell you, you should be!

When doing chest compressions hand placement and rate are everything. When doing CPR you should be kneeling next to the victim’s shoulders and neck. Place the heel of your hand over the center of the victim’s chest, right between the nipples. Put your other hand on top of that hand and interlock your fingers. When doing compressions, your elbows should stay straight at all times. In order to do this, your shoulders should be positioned directly over your hands. You’re essentially putting your upper body weight into the compressions. Once you’ve done this, you are ready to perform appropriately. Chest compressions should be 2 inches deep at a rate of 100-120 per minute. That equates to 30 compressions each cycle. To help with rhythm and to help pace yourself, you can sing “Stayin’ Alive”.

For airway and breathing, the first thing you have to make sure of is that the victim’s airway is open, otherwise you find yourself doing rescue breaths for no reason at all. To open the airway, you will perform the head tilt, chin lift.  Simply put the palm of your hand on the victim’s forehead and tilt the head back. At the same time you want to have your other hand underneath the chin and lifting. Be careful how much force you use doing this.  When you perform rescue breathing first and foremost use a barrier. Most CPR classes provide you with a pocket mask of some sort for you to keep in the event you need to use it. If you don’t have a barrier, continue with compressions. When you use the barrier, be sure it has a good seal, using your hands to hold it down. That seal along with the head tilt chin lift ensure you are getting those breaths in. 2 breaths should be given in 1 second intervals in each cycle, and you want to watch the chest for rise and fall. This lets you know air is getting in. If not, readjust both the head and the barrier seal and try again. Once both breaths are in, continue with compressions until the AED arrives and is in use, you are tired, or help arrives.  

The AED is an automated external defibrillator. It does exactly what the name implies. It analyzes heart rhythm and determines if an electric shock is needed to restart the heart or normalize its rhythm. The AED is great because step by step voice instructions make it super easy to use. It literally tells you what to do each step of the way so you’re never lost or confused and even tells you if you should continue CPR or if it will give a shock. For those who are hearing impaired, there are also visual aids.

AEDs are typically placed in common areas and are highly visible usually with bright colored displays. They can be mounted on the walls and sometimes they show up in kiosks. Wherever they are, they are clearly marked with the universal AED sign.

Just like any other medical equipment, AEDs have to be checked monthly. Someone is delegated for this job or it can rotate through staff depending on where it is. Where I work, it’s up to the nursing staff on the unit to keep track of the maintenance schedule and document when it’s done. Monthly testing includes battery testing, checking expiration dates on pads and other accessories and making sure they are in usable shape. We are looking for any wear and tear or defects and also making sure the pads are accurate sizes. If the AED has been used, we want to make sure everything is replaced as well. Just like any other battery operated technology, every now and again we also need to calibrate the AED to make sure it will work properly if we ever need to use it, so we let it cycle through minus giving the shock.We love you guys! Go out and be your best self today! And as always, Happy Nursing!