ACLS: BLS for Healthcare Providers

Special Note

[CPR sequence]

Info: recommended sequence is Circulation, Airway, Breathing; Defibrillate as soon as possible

Initial Response

[witnessed or unwitnessed collapse]

Sequence: verify scene safety; check for responsiveness; shout for nearby help and activate emergency response system via mobile device if appropriate; get defibrillator or AED; look for no breathing or only gasping; simultaneously check carotid pulse; if pulse not definitively felt within 10sec, start CPR; Info: perform actions simultaneously if 2 or more rescuers or rescue team

[primary asphyxial arrest only]

Sequence: verify scene safety; verify unresponsiveness with no or gasping respirations; shout for nearby help and activate emergency response system; get defibrillator or AED; if pulse present, start ventilations; if no pulse, start CPR; check pulse q2min; Info: perform actions simultaneously if 2 or more rescuers or rescue team

[suspected opioid overdose]

see ACLS: Opioid-Associated Life-Threatening Emergency in Adults table

1) Circulation

[chest compressions, non-pregnant patients]

Info: do 30 compressions BEFORE giving breaths; use 30:2 ratio compressions to ventilations; heels of both hands on lower half of sternum between nipples; perform 100-120 compressions/min at depth of 2-2.4 inches; avoid faster or deeper compressions; allow complete recoil; minimize compression interruptions; if advanced airway in place, ventilate 10 breaths/min (avoid hyperventilating), do not pause compressions for ventilations; if more than 1 rescuer, rotate compressor role q2min or 5 cycles of 30:2 or sooner if fatigued

[chest compressions, pregnant patients]

Info: perform chest compressions as above; perform continuous left lateral uterine displacement if uterus is at or above the umbilicus and 2 or more rescuers present

2) Airway

[head tilt-chin lift]

Info: if suspected cervical spine trauma, use jaw thrust without head extension; if jaw thrust inadequately opens airway, use head tilt-chin lift technique

3) Breathing

[rescue breaths only (pulse present)]

Info: ventilate 10 breaths/min, give each breath over 1sec with visible chest rise; alternate 5 back blows with 5 abdominal thrusts for foreign body obstruction; if patient becomes unresponsive, start CPR with 30:2 ratio compressions to ventilations and check mouth for foreign body before each set of two ventilations; recheck pulse q2min; use mouth to mouth, mouth-to-mask, or bag-mask ventilation

[rescue breaths + compressions]

Info: do 30 compressions BEFORE giving breaths; use 30:2 ratio compressions to ventilations; give each breath over 1sec with visible chest rise; use mouth to mouth, mouth-to-mask, or bag-mask ventilation

[rescue breaths with advanced airway + compressions]

Info: ventilate 10 breaths/min (avoid hyperventilating), give each breath over 1sec with visible chest rise; do not pause compressions for ventilations

4) Defibrillation

[settings]

AED: use default programming; Info: use adult pads

Biphasic manual defibrillators: use mfr recommended energy level (usually 120-200 J) or if unknown, use max setting; Info: use adult pads; subsequent shocks same energy level as 1st or consider higher levels; no pulse check after shock; resume CPR immediately, beginning with compressions

[sequence]

Info: begin/continue CPR while defibrillator or AED readied; check rhythm; do not hold shock for rescue breaths; deliver shock if indicated; begin/resume CPR immediately after 1 shock delivered or if rhythm not shockable; no pulse check after shock; check rhythm q2min; continue until ALS providers take over or victim starts to move