Welcome back to the second part of our blog series on Basic Life Support (BLS). In the first blog, we discussed scene assessment, the ABC check (Airway, Breathing, and Circulation), and the proper use of CPR and AED. Now, in part two, we will delve into life-saving interventions and devices used within each step of the ABC check. Let's explore the crucial steps that can make a significant difference in saving lives.

Life Saving Interventions: Airway

Airway management is a critical component of Basic Life Support (BLS) and plays a crucial role in ensuring the patient's ability to breathe effectively. In addition to the manual maneuvers we discussed earlier, such as the head tilt-chin lift and jaw thrust, there are other devices that can be used to secure and protect the airway. Let's explore two commonly used devices: the Oropharyngeal Airway (OPA) and the Nasopharyngeal Airway (NPA).

1. Oropharyngeal Airway (OPA):

The oropharyngeal airway, is a curved plastic tube that is inserted into the patient's mouth to maintain the patency of the airway. It serves two main purposes:

a) Clearing Obstructions: The OPA helps to displace the tongue from the back of the throat, preventing it from obstructing the airway and impeding the passage of air. This is used for unconscious patients or those with decreased consciousness.

b) Facilitating Manual Stabilization: By providing a firm structure, the OPA allows rescuers to perform manual stabilization of the patient's head and neck, as it helps maintain the alignment of the airway.

When using an OPA, it is important to select the correct size for the patient to ensure proper placement and prevent complications. Insert the device upside down, rotating it 180 degrees as it reaches the back of the throat. Proper placement should allow the device to sit between the teeth or lips and the base of the tongue.

1. Nasopharyngeal Airway (NPA):

The nasopharyngeal airway, or nasal airway, is a flexible tube inserted through the nostril into the back of the throat. It is particularly useful in patients who have an intact gag reflex or clenched teeth, making oral insertion difficult or risky. The NPA has several advantages:

1) Improved Comfort: The NPA is generally better tolerated by conscious or semi-conscious patients as it avoids stimulation of the gag reflex.

2) Unobstructed Oral Access: By securing the airway through the nasal passage, the mouth remains free and accessible for other procedures, such as suctioning or oral medication administration.

To insert an NPA, select the appropriate size by measuring from the tip of the nostril to the earlobe or the angle of the jaw. Lubricate the device before gently inserting it along the floor of the nasal passage, aiming towards the back of the throat. Monitor for signs of discomfort or obstruction during insertion and adjust if necessary.

It is important to note that the use of OPAs and NPAs requires proper training and an understanding of the patient's anatomy and potential contraindications. Rescuers should be cautious and attentive to the patient's response while using these devices.

By employing manual maneuvers like the head tilt-chin lift and jaw thrust, along with the use of OPAs and NPAs, rescuers can effectively secure and maintain an open airway for patients in need of Basic Life Support. Remember, accurate assessment and regular practice are essential to ensure proper airway management in emergency situations.

Life Saving Interventions: Breathing

Various devices can be used to provide oxygenation and ventilation support. Let's explore the different devices commonly used in BLS:

1. Nasal Cannula:

The nasal cannula is a lightweight device that delivers supplemental oxygen through two small prongs inserted into the patient's nostrils. It provides a low to moderate flow rate of 1-4 liters per minute (LPM) with an oxygen concentration ranging from 25% to 45%. The nasal cannula is comfortable and allows patients to speak, and move freely while receiving oxygen.

Simple Face Mask:

The simple face mask is a mask that covers the patient's nose and mouth, delivering oxygen at a flow rate of 6-10 LPM. It provides a higher oxygen concentration compared to the nasal cannula, ranging from 40% to 60%. The simple face mask is commonly used in patients who require higher oxygen levels or when a more precise oxygen concentration is not required. However, it may impede communication and patient comfort.

Non-Rebreather:

The non-rebreather is a mask with a reservoir bag attached, ensuring the delivery of high concentrations of oxygen. It has one-way valves that prevent the patient from inhaling exhaled air and allow for a flow rate of 10-15 LPM. The non-rebreather mask can deliver an oxygen concentration of 90% or higher. It is particularly useful in patients with severe hypoxia or in cases where precise oxygen titration is necessary.

Bag-Valve-Mask (BVM):

The bag-valve-mask (BVM) device, is a manually operated resuscitator used to provide positive pressure ventilation. It consists of a self-inflating bag, a one-way valve, and a mask. The BVM is connected to an oxygen tank with a flow rate of 15 LPM, providing an oxygen concentration close to 100%. The BVM is often used in cases of respiratory distress or respiratory arrest, when the patient is not breathing adequately or requires assisted ventilation.

During assisted ventilation with a BVM, 1/3 of the bag should be compressed once every 5-6 seconds to achieve a target ventilation rate of 10-12 breaths per minute.

Newer BVM’s include a safety valve that makes a noise if you are compressing the bag too hard or fast, allowing for user friendly use.

As you provide assisted ventilation using a BVM, pay close attention to the patient's response. Look for chest rise and fall with each breath delivered. The presence of chest rise indicates that the ventilation is effectively reaching the patient's lungs.

Additionally, observe the patient's overall color. Effective ventilation should help improve the patient's skin color, with a return to a more normal or healthier appearance. If the patient's color improves, it is a positive sign that oxygenation and ventilation are being adequately supported.

It is important to note that when administering oxygen, the flow rate should be carefully adjusted based on the patient's condition and oxygen saturation levels. Oxygen therapy should be monitored closely.

Circulation assessment

Circulation assessment is a crucial step in Basic Life Support (BLS) to determine the adequacy of blood flow. While CPR remains the life-saving intervention when a pulse is not detected, let's explore other methods to assess circulation when a pulse is present.

1. Capillary Refill: To assess capillary refill, gently press down on the patient's nail bed or the tip of their finger. Upon releasing the pressure, observe how quickly the color returns to the area. A normal capillary refill time is around 2 seconds. If color returns within this timeframe, it indicates good capillary refill and suggests adequate peripheral circulation.

2. Extremity Warmth: Feeling the temperature of the patient's extremities, such as their hands and feet, can provide valuable information about circulation. Warm extremities indicate good blood flow, while cold extremities may suggest impaired circulation.

It's important to note that these assessments are complementary to the presence of a pulse. If there are concerns about circulation or any signs of poor perfusion, prompt medical attention should be sought.

1. Circulatory Obstruction: Major blood loss from an injury can obstruct circulation and pose a life-threatening situation. In such cases, immediate action is crucial. If the hemorrhage is external, apply direct pressure to the bleeding site using PPE always. Maintaining pressure helps control the bleeding and promotes clot formation, thereby restoring circulation. If available, consider the use of a tourniquet for severe hemorrhage that cannot be controlled by direct pressure alone.

Remember, it is important to prioritize personal safety and seek professional medical help as soon as possible in cases of significant bleeding or other circulatory emergencies. Timely intervention can make a significant difference in patient outcomes.

Training

Mastering Basic Life Support (BLS) is crucial for healthcare professionals, including nurses, doctors, dentists, firefighters, and other first responders. Understanding the key steps for assessing and applying critical interventions for airway, breathing, and circulation is essential to deliver timely and effective care during emergencies. At Delta, we recognize the importance of BLS training, as it is often required to be completed yearly for professionals in various fields. We are dedicated to providing frequent BLS courses to equip individuals with the life-saving skills they need. Enroll in our BLS courses today and stay prepared to make a difference when it matters most.