10.4 Basic Life Support (BLS) & Resuscitation Protocols

10.4 Basic Life Support (BLS) & Resuscitation Protocols

Basic Life Support (BLS) encompasses the fundamental clinical assessment and skills required to maintain airway, breathing, and systemic circulation in a patient experiencing cardiac or respiratory arrest. Registered nurses operating in the UK must adhere strictly to the Resuscitation Council UK (RCUK) adult BLS guidelines. Timely execution of effective BLS prevents irreversible hypoxic organ damage and significantly improves neurological outcomes following cardiac arrest.

---

Resuscitation Council UK Adult BLS Sequence

The adult BLS sequence follows a structured, step-by-step priority framework designed to identify cardiac arrest rapidly and initiate high-quality chest compressions without delay.

Safety -> Responsiveness -> Airway -> Breathing (up to 10s) -> Call 2222/999 -> 30 Compressions -> 2 Breaths

Step 1: Ensure Scene Safety

Before approaching the patient, the nurse must quickly assess the surrounding environment for potential hazards to themselves, the patient, or colleagues. Examples of hazards include electrical wires, toxic fumes, spilled fluids, or agitated bystanders. Safety is paramount; a responder who becomes incapacitated cannot deliver life-saving care.

Step 2: Check for Responsiveness

Gently shake the patient's shoulders and ask loudly in both ears, "Are you alright?"

• If the patient responds verbally or moves, keep them in the position found, re-evaluate their condition using the ABCDE approach, and call for clinical assistance.
• If the patient does not respond, they are classified as unresponsive.

Step 3: Open the Airway

Place the patient in a supine position (flat on their back). Open the airway using the head tilt-chin lift maneuver:

1. Place one hand on the patient's forehead and gently tilt the head backward.
2. Place the fingertips of the other hand under the point of the patient's chin and lift the chin upward to lift the tongue away from the posterior pharynx.
3. Special Consideration: If cervical spine injury is suspected (e.g., following trauma), perform a jaw thrust without neck extension to avoid spinal cord displacement.

Step 4: Assess Breathing (Up to 10 Seconds)

While maintaining an open airway, position your cheek near the patient's mouth and nose while looking down at their chest:

• Look for chest movement and chest expansion.
• Listen at the mouth for breath sounds.
• Feel for air movement against your cheek.

Perform this assessment for up to 10 seconds (noting that agonal gasps—infrequent, irregular, noisy gasps—are a sign of cardiac arrest and must NOT be mistaken for normal breathing). If the patient is not breathing normally or is only agonal gasping, treat the patient as being in cardiac arrest.

Step 5: Call for Emergency Help

• In-Hospital Setting: Immediately dial 2222 (the UK standardized hospital emergency number) to activate the Medical Emergency Team / Cardiac Arrest Team. State the exact location, ward, and nature of the emergency ("Adult Cardiac Arrest"). Bring the resuscitation trolley and Automated External Defibrillator (AED) to the bedside.
• Out-of-Hospital Setting: Call 999 or 112 for emergency medical services, request an ambulance, and send a bystander to retrieve the nearest AED.

Step 6: Perform High-Quality Chest Compressions (30 Compressions)

Initiate chest compressions immediately after calling for help:

• Positioning: Kneel beside the patient's chest. Place the heel of one hand on the center of the patient's chest (lower half of the sternum). Place the heel of the second hand on top of the first and interlock your fingers. Ensure pressure is applied directly through the sternum, avoiding the ribs, upper abdomen, or xiphoid process.
• Compression Depth: Compress the chest to a depth of 5 to 6 cm (2 to 2.5 inches) in adults.
• Compression Rate: Deliver compressions at a frequency of 100 to 120 compressions per minute (matching the rhythm of the song "Stayin' Alive").
• Chest Recoil: Allow the chest to recoil completely after each compression without removing your hands from the sternum ("leaning" on the chest impairs coronary artery perfusion pressure).
• Interruptions: Minimize interruptions to chest compressions; pause compressions only for essential interventions (e.g., AED rhythm analysis or airway placement).

Step 7: Deliver Rescue Breaths (2 Breaths)

Combine 30 chest compressions with 2 rescue breaths (30:2 ratio):

1. Re-open the airway using head tilt-chin lift.
2. Pinch the soft part of the patient's nose closed using your thumb and index finger.
3. Take a normal breath, place your lips around the patient's mouth (or pocket mask / bag-valve-mask device), ensuring an airtight seal.
4. Blow steadily into the mouth for 1 second, observing the chest rise.
5. Maintain airway opening, remove your mouth, and watch the chest fall completely as air exits.
6. Deliver a second rescue breath. The two breaths should take no longer than 5 seconds total.
7. Immediately return your hands to the lower sternum and deliver 30 compressions.

Note for Health Professionals: If unwilling or unable to give mouth-to-mouth resuscitation due to infection control concerns or lack of a barrier device, perform continuous compression-only CPR at 100–120 bpm.

---

Automated External Defibrillator (AED) & Defibrillation Protocols

Early defibrillation within 3 to 5 minutes of collapse can produce survival rates as high as 50–70%. When an AED arrives, turn it on immediately and follow the visual and voice prompts.

---

Choking Management (Foreign Body Airway Obstruction)

Foreign body airway obstruction (FBAO) requires rapid recognition to prevent complete respiratory and cardiac arrest. Signs of choking typically occur while eating or drinking.

Assess Severity -> Mild (Encourage Cough) OR Severe -> 5 Back Blows -> 5 Abdominal Thrusts -> Unconscious? Begin CPR

Differentiating Severity

• Mild Obstruction: Patient is conscious, able to speak, coughs effectively, and breathes. Intervention: Encourage continuous coughing; monitor closely for deterioration; do not intervene with physical blows.
• Severe Obstruction: Patient is unable to speak or answer, has an ineffective weak cough, cannot breathe, displays silent respiratory effort, or exhibits cyanosis and clutching of the neck (universal choking sign).

Management of Severe Choking in Conscious Adult

1. 5 Back Blows:
   • Stand to the side and slightly behind the patient.
   • Support the chest with one hand and lean the patient forward so that if an object is dislodged, it moves out of the mouth rather than further down the airway.
   • Deliver up to 5 sharp blows between the shoulder blades (scapulae) using the heel of your other hand.
   • Check after each blow to see if the obstruction has cleared.
2. 5 Abdominal Thrusts (Heimlich Manoeuvre):
   • If 5 back blows fail to clear the obstruction, stand behind the patient and put both arms around the upper part of their abdomen.
   • Lean the patient forward.
   • Clench your fist and place it between the umbilicus (navel) and the xiphoid process.
   • Grasp your fist with your other hand and pull sharply inwards and upwards.
   • Repeat up to 5 times; check after each thrust.
3. Continue Cycle: Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the patient becomes unconscious.

Unconscious Choking Patient

If the choking patient loses consciousness:

• Carefully lower the patient to the floor.
• Call 2222 (hospital) or 999 (community) immediately.
• Begin CPR starting with 30 chest compressions. Inspect the oral cavity prior to delivering rescue breaths; if a foreign body is clearly visible, remove it with a single finger sweep. Never perform blind finger sweeps, as this may push the object deeper into the pharynx.