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{{Short description|Emergency medical care by first responder }}
{{howto|date=January 2011}}
{{for|techniques and equipment for keeping a patient alive longer term|life support}}
{{for|techniques and equipment for keeping a patient alive longer term|life support}}
{{More citations needed|date=April 2020}}
'''Basic life support''' ('''BLS''') is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by [[advanced life support]] providers (paramedics, nurses, physicians or any trained general personnel). It can be provided by trained medical personnel, such as [[emergency medical technician]]s, qualified bystanders and anybody who is trained for providing BLS and/or ACLS .


==Background==
'''Basic life support''' (BLS) is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including [[emergency medical technician]]s, [[paramedic]]s, and by [[layperson]]s who have received BLS training. BLS is generally used in the [[pre-hospital]] setting, and can be provided without medical equipment.
The [[International Liaison Committee on Resuscitation]] (ILCOR) was formed in 1992 to coordinate the efforts of resuscitation worldwide. The ILCOR representatives come from various countries such as the United States, Canada, Australia, New Zealand, and from the European, Asian, and African continents. In 2000, the committee published the first resuscitation guideline. In 2005, the committee published International Consensus on [[Cardiopulmonary resuscitation]] (CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations. Since 2010, the committee has provided materials for regional resuscitation providers such as [[European Resuscitation Council]] and [[American Heart Association]] to write their own guidelines.<ref>{{cite web |title=About ILCOR |url=https://www.ilcor.org/about-ilcor/about-ilcor/ |publisher=International Liaison Committee on Resuscitation |access-date=27 June 2019 |archive-url=https://web.archive.org/web/20180814171932/https://www.ilcor.org/about-ilcor/about-ilcor/ |archive-date=14 August 2018}}</ref> Since 2015, ILCOR has used a new methodology called Consensus on Science with Treatment Recommendations (COSTR) to evaluate the quality of latest evidence available and to reach a conclusion on the best treatments available in resuscitation.<ref>{{cite web |title=About CoSTR - Continuous Evidence Evaluation (CEE) and Consensus on Science with Treatment Recommendations (CoSTRs) |url=https://costr.ilcor.org/about |publisher=International Liaison Committee on Resuscitation |access-date=28 June 2019 |archive-url=https://web.archive.org/web/20190331083324/https://costr.ilcor.org/about |archive-date=31 March 2019}}</ref> Using the COSTR methodology, ILCOR also started to conduct yearly reviews and published updates on the latest evidence in resuscitation, changing it from the previous 5-yearly review on resuscitation.<ref>{{cite web |title=Frequently Asked Questions- What is a CoSTR? |url=https://costr.ilcor.org/faq |publisher=International Liaison Committee on Resuscitation |access-date=28 June 2019 |archive-url=https://web.archive.org/web/20190331230129/https://costr.ilcor.org/faq |archive-date=31 March 2019}}</ref>


[[CPR]] provided in the field increases the time available for higher medical responders to arrive and provide [[Advanced life support|ALS]] care. An important advance in providing BLS is the availability of the [[automated external defibrillator]] or AED. This improves survival outcomes in [[cardiac arrest]] cases.<ref>{{cite journal |title= Public-access defibrillation and survival after out-of-hospital cardiac arrest |journal= [[The New England Journal of Medicine]] |volume= 351 |issue= 7 |year= 2004 |pages= 637–46 |pmid= 15306665 |doi= 10.1056/NEJMoa040566 |last1= Hallstrom |first1= A. P. |last2= Ornato |first2= J. P. |last3= Weisfeldt |first3= M.|author-link3=Myron L. Weisfeldt|last4= Travers |first4= A. |last5= Christenson |first5= J. |last6= McBurnie |first6= M. A. |last7= Zalenski |first7= R. |last8= Becker |first8= L. B. |last9= Schron |first9= E. B. |last10= Proschan |first10= M. |author11= Public Access Defibrillation Trial Investigators |url= https://repository.upenn.edu/nrs/57 |doi-access= free }}</ref>
Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. The guidelines outline algorithms for the management of a number of conditions, such as Cardiac arrest, choking and drowning. BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of [[Advanced Life Support]] (ALS). Most laypersons can master BLS skills after attending a short course. [[Firefighter]]s and [[police officers]] are often required to be BLS certified. BLS is also immensely useful for many other professions, such as [[daycare]] providers, [[teachers]] and [[Security guard|security personnel]]. [[Emergency medical technician]]s also provide BLS, but at an advanced level. This can include:
* patient assessment
*[[patient transport]]
* preventative immobilization, using [[cervical collar]]s and [[long spine board]]s
* splinting limbs and/or full body [[splint]]s
* administration of select medication
* [[oxygen therapy]]
* [[nasal cannula]]s
* [[combitube]]s
* [[Bag valve mask|BVM]]s.


== Method ==
[[CPR]] provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of the [[automated external defibrillator]] or AED. This improves survival outcomes in [[cardiac arrest]] cases.


=== D - Danger ===
Basic life support consists of a number of life-saving techniques focused on the medicine "[[ABC (medicine)|ABC]]"s of pre-hospital emergency care:
One of the first checks done in emergency response is to assess the situation for any danger. If the person does not remove themselves or others from the danger then they are liable to become a patient and require emergency assistance themselves or become unable to render assistance for the other patient. Examples of dangerous situations which should cease before BLS is administered are electrocution, assault, drowning, burning etc.


=== R - Response ===
* '''[[Airway]]''': the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the atmosphere.
Checking for response is the next step in emergency situations as continuing with other forceful methods of BLS could exacerbate the patient's condition and can be seen as assault. [[AVPU]] (Alert, Verbal, Pain, Unconscious) is the commonly used acronym for quickly assessing the level of consciousness in a patient. [[Pain stimulus]] in particular should be used with caution as many methods if done incorrectly can leave bruises (sternal rub for example) commonly used methods for central stimulus are the trapezius squeeze and for peripheral stimulus it is squeezing the side of the finger.
* '''[[Breathing]]''': inflation and deflation of the lungs (respiration) via the airway
* '''[[Circulatory system|Circulation]]''': providing an adequate blood supply to tissue, especially critical organs, so as to deliver oxygen to all cells and remove metabolic waste, via the perfusion of blood throughout the body.


=== S - Send for help ===
Healthy people maintain the ABCs by themselves. In an emergency situation, due to illness ([[medical emergency]]) or [[Trauma (medicine)|trauma]], BLS helps the patient ensure his or her own ABCs, or assists in maintaining for the patient who is unable to do so. For airways, this will include manually opening the patients airway ([[Head tilt/Chin lift]] or [[jaw thrust]]) or possible insertion of oral ([[Oropharyngeal airway]]) or nasal ([[Nasopharyngeal airway]]) adjuncts, to keep the airway unblocked ([[patency|patent]]). For breathing, this may include [[artificial respiration]], often assisted by emergency [[oxygen]]. For circulation, this may include [[Emergency bleeding control|bleeding control]] or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.
Sending for help allows much more assistance to be rendered upon the patient and increases their chances of receiving ALS.


==BLS in the United States==
=== A - Airway ===
Opening of the airway via the [[jaw-thrust maneuver]] is the preferred method as the head-tilt maneuver is thought to be more risky for people with suspected spinal injury or inconveniency. If the person is in danger of [[pulmonary aspiration]] then they should be placed in the recovery position or more [[advanced airway management]] should be used.
BLS in the United States is generally identified with Emergency Medical Technicians-Basic ([[EMT-B]]). However, the [[American Heart Association]]'s BLS protocol is designed for use by laypeople, [[certified first responder]], EMT-B, and to some extent, higher medical functions. It includes [[cardiac arrest]], [[respiratory arrest]], [[drowning]], and foreign body airway obstruction (FBAO, or [[choking]]). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the [[Advanced Life Support]] (ALS) protocols, in addition to BLS protocols.


=== B - Breathing ===
The [[Medical algorithm|algorithm]] for providing basic life support to adults in the USA was published in 2005 in the journal [[Circulation (journal)|''Circulation'']] by the [[American Heart Association]] (AHA).<ref name="AHA2005"/><ref>[http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-19 Circulation. 2005;112:IV-19-IV-34 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care]</ref>
Once the airway has been opened checking for breathing should begin, if the respiratory rate is below 12-20 breaths per minute then CPR should begin, however if the patient is breathing normally then the rescuer should place them in the recovery position and summon an ambulance.


=== C - CPR ===
The AHA uses four-link "[[Chain of Survival]]" to illustrate the steps needed to resuscitate a collapsed victim:
{{Main|Cardiopulmonary resuscitation}}


=== D - Defibrillation ===
* Early recognition of the emergency and activation of [[emergency medical service]]s
Once an automated external defibrillator (AED) has been acquired the rescuer should then finish the round of CPR, use the AED and then begin another round of CPR. However the AED will usually notify the rescuer of any impediments to continued CPR (such as a [[sinus rhythm]] or [[asystole]]) in which case the rescuer may be prompted to cease CPR.
* Early [[bystander]] [[CPR]], so as not to delay treatment until arrival of EMS
* Early use of a [[defibrillator]]
* Early [[advanced life support]] and post-resuscitation care


== Indications ==
Bystanders with training in BLS can perform the first 3 of the 4 steps.
=== Cardiac arrest ===
Cardiac arrest occurs when the heart stops pumping in a regular rhythm. In this situation, early defibrillation is the key to returning the patient's heart back to a normal rhythm. When a defibrillator is not readily available, a rescuer or bystander should keep the blood flowing by performing chest compressions and rescue breaths at an age-appropriate rate until it is.


===Adult BLS sequence===
=== Respiratory Arrest ===
Respiratory arrest is when there is no measurable breathing in a patient. It tends to occur in conjunction with cardiac arrest, but this is not always the case. Respiratory arrest is the most common indication of BLS in infants and toddlers. The most critical factor in restoring breathing in the patient is to provide high quality rescue breaths.
* Ensure that the scene is safe.
* Assess the victim's [[level of consciousness]] by asking loudly "Are you okay?" and by checking for the victim's responsiveness to pain ([[AVPU]]).
* Activate the local [[Emergency Medical Services|EMS]] system by instructing someone to call [[9-1-1]]. If an [[Automated external defibrillator|AED]] is available, it should be retrieved and prepared.
* If the victim has no suspected [[cervical spine]] trauma, open the airway using the [[Airway_management#Head_tilt.2FChin_lift|head-tilt/chin-lift]] maneuver; if the victim has suspected neck trauma, the airway should be opened with the [[Airway_management#Jaw_thrust|jaw-thrust]] technique. If the jaw-thrust is ineffective at opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
* Assess the airway for foreign object obstructions, and if any are visible, remove them using the [[Choking#Finger_sweeping|finger-sweep technique]]. Blind finger-sweeps should never be performed, as they may push foreign objects deeper into the airway.
* Look, listen, and feel for breathing for at least 5 seconds and no more than 10 seconds.
* If the patient is breathing normally, then the patient should be placed in the [[recovery position]] and monitored and transported; do not continue the BLS sequence.
* If patient is not breathing normally, and the arrest was witnessed immediately before assessment, then immediate defibrillation is the treatment of choice.<ref name="AHA2005">{{Cite web |url=http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-19 |title=Circulation}}</ref>
* Attempt to administer two artificial ventilation's using the [[mouth-to-mask]] technique, or a [[Bag Valve Mask|bag-valve-mask]] (BVM). The [[Mouth_to_mouth_resuscitation|mouth-to-mouth]] technique is no longer recommended, unless a face shield is present. Verify that the chest rises and falls; if it does not, reposition (i.e. re-open) the airway using the appropriate technique and try again. If ventilation is still unsuccessful, and the victim is unconscious, it is possible that they have a foreign body in their airway. Begin chest compressions, stopping every 30 compressions, re-checking the airway for obstructions, removing any found, and re-attempting ventilation.
* If the ventilation's are successful, assess for the presence of a [[pulse]] at the [[carotid artery]]. If a pulse is detected, then the patient should continue to receive artificial ventilation's at an appropriate [[Respiratory rate|rate]] and transported immediately. Otherwise, begin CPR at a ratio of 30:2 compressions to ventilation's at 100 compressions/minute for 5 cycles.
* After 5 cycles of CPR, the BLS protocol should be repeated from the beginning, assessing the patient's airway, checking for spontaneous breathing, and checking for a spontaneous pulse. Laypersons are commonly instructed not to perform re-assessment, but this step is always performed by healthcare professionals (HCPs). If an AED is available after 5 cycles of CPR, it should be attached, activated, and (if indicated) defibrillation should be performed. If defibrillation is performed, 5 more cycles of CPR should be immediately repeated before re-assessment.
* BLS protocols continue until (1) the patient regains a pulse, (2) the rescuer is relieved by another rescuer of equivalent or higher training (See [[Abandonment#Abandonment of a Patient|Abandonment]]), (3) the rescuer is too physically [[tired]] to continue CPR, or (4) the patient is pronounced dead by a [[medical doctor]].<ref name="AHA2005"/>
* At the end of five cycles of CPR, always perform assessment via the AED for a shockable rhythm, and if indicated, defibrillation, and repeat assessment before doing another five cycles.
* The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilation's or breaths). Note CPR for '''infants and children''' uses a 15:2 cycle when '''two''' rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer). Two person CPR for an infant also requires the "two hands encircling thumbs" technique for the rescuer performing compressions.


===[[Drowning]]===
=== Shock ===
[[Shock (circulatory)|Shock]], also known as Inadequate Tissue Perfusion, is a life-threatening condition that occurs as a result of the disruption to 3 major components of the [[Circulatory system|cardiovascular system]]: Heart Function, Blood Vessel Function, and Blood Volume. [[Perfusion]] describes the process of adequate blood flow to the organs, where the waste and reactants that are involved in [[cellular respiration]] are removed or transported throughout the 3 parts of the cardiovascular system for [[metabolism]] to be processed effectively.<ref>{{Cite book |last=Surgeons |first=American Academy of Orthopaedic |title=Emergency Care and Transportation of the Sick and Injured Essentials Package |date=2021-02-24 |publisher=Jones & Bartlett Learning |isbn=978-1-284-22722-2 |edition=12th |language=English}}</ref> However, if one part were to fail, important resources for cellular respiration such as [[oxygen]] would not be able to reach the organs that needs it function.<ref>{{Cite web |title=Shock |url=https://medlineplus.gov/shock.html |access-date=2024-04-29 |website=medlineplus.gov}}</ref> In an attempt to compensate, the body diverts blood to organs that cannot tolerate the lack of blood, such as the heart and the brain, resulting in widespread [[vasoconstriction]], or thinning of the blood vessels.<ref>{{Cite web |last=Services |first=Department of Health & Human |title=Shock |url=http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/shock |access-date=2024-04-29 |website=www.betterhealth.vic.gov.au |language=en}}</ref> Consequently, blood is prevented from reaching organs that can tolerate the lack of perfusion, or hypoperfusion, in organs such as the skin, resulting in the typical presentation of pale and clammy skin conditions during [[Shock (circulatory)|shock]]. Moreover, disruptions may present specifically to each component or multiple systems may be affected at the same time, which generally results in the 3 designated types of shock: [[Obstructive shock|Obstructive]], [[Distributive shock|Distributive]], [[Hypovolemic shock|Hypovolemic]].<ref>{{Cite journal |last1=Patel |first1=Samir |last2=Holden |first2=Kyle |last3=Calvin |first3=Bob |last4=DiSilvio |first4=Briana |last5=Dumont |first5=Tiffany |date=July–September 2022 |title=Shock |url=https://journals.lww.com/ccnq/abstract/2022/07000/shock.4.aspx |journal=Critical Care Nursing Quarterly |language=en-US |volume=45 |issue=3 |pages=225 |doi=10.1097/CNQ.0000000000000407 |pmid=35617089 |issn=0887-9303}}</ref> Typically, patients would have a presentation of shock at the [[Cryptic shock|Compensated]], Decompensated, and Irreversible Stage.<ref>{{Citation |last1=Haseer Koya |first1=Hayas |title=Shock |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK531492/ |access-date=2024-04-29 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30285387 |last2=Paul |first2=Manju}}</ref>


=== Drowning ===
Rescuers should provide CPR as soon as an unresponsive victim is removed from the water. In particular, rescue breathing is important in this situation.
In cases of drowning, rescuers should provide CPR as soon as an unresponsive patient is removed from the water. In particular, rescue breathing is important in this situation. A lone rescuer is typically advised to give CPR for a short time before leaving the patient to call emergency medical services. Since the primary cause of cardiac arrest and death in drowning and choking patients is hypoxemia, it is recommended to start with rescue breaths before proceeding to chest compressions (if pulseless). If the patient presents in a shockable rhythm, early defibrillation is still recommended.


=== Choking ===
A lone rescuer is typically advised to give CPR for a short time before leaving the victim to call emergency medical services.
{{See also|Choking#Treatment}}
Choking occurs when a foreign body obstructs the trachea. Rescuers should only intervene in patients who show signs of severe airway obstruction, such as a silent cough, cyanosis, or inability to speak or breathe. If a patient is coughing forcefully, rescuers should not interfere with this process and encourage the patient to keep coughing. If a patient shows signs of severe airway obstruction, anti-choking maneuvers such as back slaps or in the most severe cases [[abdominal thrusts]] should be applied until the obstruction is relieved. If a patient becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove with a finger sweep it if it is evident however many organisations state that the rescuer should not try to remove the foreign object as they might worsen the situation (either pushing it further down the trachea or initiating vomiting).{{citation needed|date=March 2020}}


== Technique ==
Since the primary cause of cardiac arrest and death in drowning and choking victims is hypoxia, it is more important to provide rescue breathing as quickly as possible in these situations, whereas for victims of VF cardiac arrest chest compressions and defibrillation are more important.


===[[Hypothermia]]===
=== United States ===
Basic Life Support Emergency Medical Services in the United States are generally identified with Emergency Medical Technicians-Basic (EMT-B). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the Advanced Cardiac Life Support (ACLS) protocols, in addition to BLS protocols. However, the [[American Heart Association]]'s BLS protocol is designed for use by laypeople, as well as students and others [[certified first responder]], and to some extent, higher medical function personnel.


'''BLS for Healthcare Providers Course'''
* In unresponsive victims with [[hypothermia]], the breathing and pulse should be checked for 30 to 45 seconds as both breathing and heart rate can be very slow in this condition.
* If cardiac arrest is confirmed, CPR should be started immediately. Wet clothes should be removed, and the victim should be insulated from wind. CPR should be continued until the victim is assessed by advanced care providers.


According to the American Heart Association, in order to be certified in BLS, a student must take an online or in-person course. However, an online BLS course must be followed with an in-person skills session in order to obtain a certification issued by The American Heart Association.<ref>{{Cite web|url=http://savingchicagocpr.com/Chicago/bls-for-healthcare-providers/|title=HUT RI 73th|website=savingchicagocpr.com|access-date=2018-10-28|archive-date=2013-12-14|archive-url=https://web.archive.org/web/20131214214053/http://savingchicagocpr.com/Chicago/bls-for-healthcare-providers/|url-status=dead}}</ref>
===Foreign body airway obstruction ([[choking]])===


'''Chain of survival'''
* Rescuers should intervene in victims who show signs of severe airway obstruction, such as a silent cough, [[cyanosis]], or inability to speak or breathe.
* If a victim is coughing forcefully, rescuers should not interfere with this process.
* If a victim shows signs of severe airway obstruction, [[Choking#Abdominal thrusts|abdominal thrusts]] should be applied in rapid sequence until the obstruction is relieved. If this is not effective, [[Choking#Modified chest thrusts|chest thrusts]] can also be used. Chest thrusts can also be used in [[obese]] victims or victims in late [[pregnancy]]. Abdominal thrusts should not be used in [[infants]] under 1 year of age due to risk of causing injury.
* If a victim becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove it if it is evident.


The American Heart Association highlights the most important steps of BLS in a "five-link chain of survival."<ref>{{cite web | title = What is CPR? | publisher = American Heart Association | url = https://cpr.heart.org/en/resources/what-is-cpr}}</ref> The chain of survival includes early recognition of an ongoing emergency, early initiation of CPR by a bystander, early use of a defibrillator, and early advanced life support once more qualified medical help arrives. Qualified bystanders with training in BLS are encouraged to perform the first three steps of the five-link chain of survival.
==BLS in the United Kingdom==


'''High Quality CPR'''
Adult BLS guidelines in the [[United Kingdom]] were also published in 2005 by the Resuscitation Council (UK),<ref>[http://www.resus.org.uk/pages/bls.pdf Resuscitation Council (UK) Adult Basic Life Support (2005)]</ref> based on the ''2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR)'' published in November 2005.<ref>[http://www.erc.edu/index.php/guidelines_download_2005/en/ European Resuscitation Council guidelines and CoSTR documents]</ref>
{{See also|Cardiopulmonary resuscitation#Methods}}
High quality [[cardiopulmonary resuscitation]] (CPR) and early defibrillation using an [[automated external defibrillator]] (AED) are the most important aspects of BLS to ensure a patient survives. CPR involves a rescuer or bystander providing chest compressions to a patient in a [[supine position]] while also giving rescue breaths. The rescuer or bystander can also choose not to provide breaths and provide compression-only CPR. Depending on the age and circumstances of the patient, there can be variations in the compression to breath ratio given.


===Adult BLS sequence===
=== Europe ===


'''European Resuscitation Council'''
* Ensure the [[safety]] of the victim, the rescuer, and any bystanders.
* Check the victim for a response by gently shaking the victim's shoulders and asking loudly "Are you all right?"
* If the victim responds, leave him in the position in which he was found provided there is no further danger, try to find out what is wrong with him and get help if needed, and reassess him regularly.
* If the victim does not respond, turn him on to his back and open the airway using the [[Airway_management#Head_tilt.2FChin_lift|head-tilt/chin-lift]]. Shout for help.
* Look, listen and feel for normal breathing for no more than 10 seconds. If the victim is breathing normally, turn him into the [[recovery position]] and get help. Continue to check for breathing.
* If the victim is not breathing normally, call for an [[ambulance]].


According to 2015 guidelines published by [[European resuscitation council]], early initiation of resuscitation and coordination of lay people with medical personnel on helping an unconscious person is very helpful in increasing the chance of survival of the patient. When a person is unconscious and is not breathing normally, emergency services should be alerted and [[cardiopulmonary resuscitation]] (CPR) and [[mouth-to-mouth resuscitation]] (rescue breaths) should be initiated. High quality CPR is important. An adequate ratio of high quality chest compressions and rescue breaths are crucial. An [[automated external defibrillator]] (AED) machine is essential during resuscitation. [[Defibrillation]] during the first 3 to 5 minutes during resuscitation can produce survival rates as high as 50 to 70%. Placing AEDs in public places where there is one cardiac arrest in five years is cost-effective.<ref name="ERC 2015">{{cite journal |last1=Gavin D |first1=Perkins |last2=Anthony J |first2=Handley |last3=Rudolph W |first3=Koster |title=European Resuscitation Council Guidelines for Resuscitation 2015Section 2. Adult basic life support and automated external defibrillation |journal=Resuscitation |date=2015 |volume=95 |pages=81–99 |doi=10.1016/j.resuscitation.2015.07.015 |pmid=26477420|doi-access=free |hdl=10067/1302990151162165141 |hdl-access=free }}</ref>
These guidelines differ from previous versions in a number of ways:
Although the adult CPR sequence can be safely used in children, a modified sequence of basic life support that entails less forceful chest compression is even more suitable in children.


'''United Kingdom'''
* They allow the rescuer to diagnose cardiac arrest if the victim is unresponsive and not breathing normally.
* Rescuers are taught to give chest compressions in the center of the chest, rather than measuring from the lower border of the sternum.
* Rescue breaths should be given over 1 second rather than 2 seconds.
* For an adult victim, the initial 2 rescue breaths should be omitted, so that 30 chest compressions are given immediately after a cardiac arrest has been diagnosed.


Adult BLS guidelines in the [[United Kingdom]] were published in 2015 by the Resuscitation Council (UK),<ref>{{Cite web|url=https://www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-automated-external-defibrillation/|title=British Resuscitation Council Basic Life Support Guidelines|website=Resuscitation Council UK}}</ref> based on the ''2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR)'' published in November 2005.<ref>{{cite web|url=https://www.phecit.ie//Images/PHECC/Clinical%20resources/ILCOR%202015/ILCOR%20Guidelines%202015%20for%20web.pdf|title=ILCOR Documents|website=erc.edu|url-status=dead|archive-url=https://web.archive.org/web/20171114104711/http://www.phecit.ie/Images/PHECC/Clinical%20resources/ILCOR%202015/ILCOR%20Guidelines%202015%20for%20web.pdf|archive-date=2017-11-14|access-date=2019-10-09}}</ref>
These changes were introduced to simplify the [[Medical algorithm|algorithm]], to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival.<ref>Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. ''Circulation'' 2002;105:2270-3</ref> It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.<ref>Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 2000;342:1546-53</ref>
The newest guidelines for adult BLS allow a rescuer to diagnose cardiac arrest if the patient is unresponsive and not breathing normally. The guidelines also changed the duration of rescue breaths and the placement of the hand on the chest when performing chest compressions. These changes were introduced to simplify the [[Medical algorithm|algorithm]], to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival.<ref>{{cite journal |vauthors=Eftestøl T, Sunde K, Steen PA |title=Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest |journal=Circulation |volume=105 |issue=19 |pages=2270–3 |date=May 2002 |pmid=12010909 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12010909 |doi=10.1161/01.cir.0000016362.42586.fe|s2cid=1092371 |doi-access= }}</ref> It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.<ref>{{cite journal |vauthors=Hallstrom A, Cobb L, Johnson E, Copass M |title=Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation |journal=N. Engl. J. Med. |volume=342 |issue=21 |pages=1546–53 |date=May 2000 |pmid=10824072 |doi=10.1056/NEJM200005253422101 |citeseerx=10.1.1.456.8789 }}</ref>
For choking, the guidelines in the United Kingdom first call for assessing the severity of the situation. If the patient is able to speak and cough effectively, the obstruction is mild. If the patient is unable to speak or cough effectively, or is unable to breathe or is breathing with a wheezy sound, the airway obstruction is severe. It is then recommended to perform back blows until the obstruction clears. If the patient becomes unresponsive, CPR is started.


===Adult choking sequence===
=== Other countries ===
The term BLS is also used in some non-English speaking countries (e.g. in [[Italy]]<ref>[http://www.vfv.it/tecnica/capitolo_4.pdf Nozioni primo soccorso BLS] {{webarchive |url=https://web.archive.org/web/20051028183115/http://www.vfv.it/tecnica/capitolo_4.pdf |date=October 28, 2005 }} ([[Italian language|Italian]]), [[portable document format|PDF]] document (12p, 912 Kb)</ref>) for the education of [[first responder]]s. Terms with similar meanings for similar skill sets are also common.
* Spain: SVB ([[:es:soporte vital básico|''soporte vital básico'']])
* Belgium: ''aide médicale urgente'' ("emergency medical assistance")/ EHBO (''eerste hulp bij ongelukken'', "first aid")
* Brazil: SBV (''Suporte básico de vida'')
* France: PSE 1 & PSE 2 (''Premiers Secours en Equipe niveaux 1 & 2''), "First Aid as part of a team", level 2 includes stretchering and teamwork, (former CFAPSE before 2007 ''Certificat de Formation aux Activités des Premiers Secours en Equipe'', "Training certificate for first aid teamwork")
* Poland: ''Podstawowe zabiegi resuscytacyjne''/ KPP (''Kwalifikowana pierwsza pomoc'')
* Portugal: SBV (''Suporte Básico de Vida'')
* Germany: ''Lebensrettende Sofortmaßnahmen'' (basic life support)
* Romania: SVB (''support vital de bază'')
* Netherlands: BLS ("first aid" is referred to as EHBO (''Eerste hulp bij ongelukken''))
* Turkey: TYD (''temel yaşam desteği'', "basic life support")


== Special Populations ==
* Assess the severity of airway obstruction. If the victim is able to speak and cough effectively, the obstruction is mild. If the victim is unable to speak or cough effectively, or is unable to breathe or is breathing with a wheezy sound, the airway obstruction is severe.
When performing BLS, laypeople and medical personnel are encouraged to remember that some groups of people have certain conditions that need to be taken into considerations.
* If the victim has signs of mild airway obstruction, encourage him to continue coughing; do nothing else.
* If the victim has signs of severe airway obstruction, and is conscious, give up to 5 back blows (sharp blows between the shoulder blades with the victim leaning well forwards). Check to see if the obstruction has cleared after each blow. If 5 back blows fail to relieve the obstruction, give up to 5 [[Choking#Abdominal thrusts|abdominal thrusts]], again checking if each attempt has relieved the obstruction.
* If the obstruction is still present, and the victim still conscious, continue alternating 5 back blows and 5 abdominal thrusts.
* If the victim becomes unconscious, lower him to the ground, call an ambulance, and begin [[CPR]].


== In other countries ==
=== Pregnant women ===
To relieve choking, [[chest thrusts]] should be used instead of abdominal thrusts when the patient is in late pregnancy.{{citation needed|date=March 2020}}
The term BLS is also used in some non-English speaking countries (e.g. in [[Italy]]<ref>[http://www.vfv.it/tecnica/capitolo_4.pdf Nozioni primo soccorso BLS] ([[Italian language|Italian]]), [[portable document format|PDF]] document (12p, 912 Kb)</ref>) for the education of [[first responder]]s.


=== Obese ===
* [[Spain]]: SVB (''soporte vital básico'')
If a patient of choking is obese and a rescuer cannot perform adequate abdominal thrusts, they are encouraged to instead perform chest thrusts.{{citation needed|date=March 2020}}
* [[Belgium]]: ''aide médicale urgente'' ("emergency medical assistance")/ EHBO (''eerste hulp bij ongelukken'', "first aid")
* [[Brazil]]: SBV (''Suporte básico de vida'')
* [[France]]: PSE 2 (''premiers secours en équipe 2e niveau'', "team first aid 2nd level) = former CFAPSE (before 2007)(''certificat de formation aux activités des premiers secours en équipe'', "education certificate for the team first aid activity")
* [[Poland]]: ''Podstawowe zabiegi resuscytacyjne''
* [[Germany]]: ''Lebensrettende Sofortmaßnahmen'' (basic life support)
* [[Romania]]: SVB (''support vital de bază'')
* [[Netherlands]]: EHBO (''eerste hulp bij ongelukken'', "first aid")
* [[Turkey]]: TYD (''temel yaşam desteği'', "basic life support")


== See also ==
=== Infants ===
To relieve choking, abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. A sequence of back slaps and chest compressions are used instead.{{citation needed|date=March 2020}}
* [[Advanced life support]]
* [[Emergency medical technician]]
* [[Artificial respiration]]
* [[Cardiopulmonary resuscitation]] (CPR)
* [[Advanced cardiac life support]]


== References ==
==References==
{{reflist}}
{{reflist|2}}


{{Emergency medicine}}
{{Emergency medical services}}
{{Emergency medical services}}


[[Category:Emergency medical services]]
[[Category:Emergency medical services]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine courses]]
[[Category:Emergency life support]]

[[hr:Reanimatologija]]
[[it:Basic Life Support]]
[[nl:Reanimatie]]
[[ja:一次救命処置]]
[[no:Hjerte-lunge-redning]]
[[pl:Podstawowe zabiegi resuscytacyjne]]
[[pt:Suporte básico de vida]]
[[ro:Suport Vital de Bază]]
[[simple:Resuscitation]]

{{Emergency-services-stub}}

Latest revision as of 13:57, 17 October 2024

For techniques and equipment for keeping a patient alive longer term, see life support.

Basic life support (BLS) is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any trained general personnel). It can be provided by trained medical personnel, such as emergency medical technicians, qualified bystanders and anybody who is trained for providing BLS and/or ACLS .

Background

[edit]

The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to coordinate the efforts of resuscitation worldwide. The ILCOR representatives come from various countries such as the United States, Canada, Australia, New Zealand, and from the European, Asian, and African continents. In 2000, the committee published the first resuscitation guideline. In 2005, the committee published International Consensus on Cardiopulmonary resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations. Since 2010, the committee has provided materials for regional resuscitation providers such as European Resuscitation Council and American Heart Association to write their own guidelines.[1] Since 2015, ILCOR has used a new methodology called Consensus on Science with Treatment Recommendations (COSTR) to evaluate the quality of latest evidence available and to reach a conclusion on the best treatments available in resuscitation.[2] Using the COSTR methodology, ILCOR also started to conduct yearly reviews and published updates on the latest evidence in resuscitation, changing it from the previous 5-yearly review on resuscitation.[3]

CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of the automated external defibrillator or AED. This improves survival outcomes in cardiac arrest cases.[4]

Method

[edit]

D - Danger

[edit]

One of the first checks done in emergency response is to assess the situation for any danger. If the person does not remove themselves or others from the danger then they are liable to become a patient and require emergency assistance themselves or become unable to render assistance for the other patient. Examples of dangerous situations which should cease before BLS is administered are electrocution, assault, drowning, burning etc.

R - Response

[edit]

Checking for response is the next step in emergency situations as continuing with other forceful methods of BLS could exacerbate the patient's condition and can be seen as assault. AVPU (Alert, Verbal, Pain, Unconscious) is the commonly used acronym for quickly assessing the level of consciousness in a patient. Pain stimulus in particular should be used with caution as many methods if done incorrectly can leave bruises (sternal rub for example) commonly used methods for central stimulus are the trapezius squeeze and for peripheral stimulus it is squeezing the side of the finger.

S - Send for help

[edit]

Sending for help allows much more assistance to be rendered upon the patient and increases their chances of receiving ALS.

A - Airway

[edit]

Opening of the airway via the jaw-thrust maneuver is the preferred method as the head-tilt maneuver is thought to be more risky for people with suspected spinal injury or inconveniency. If the person is in danger of pulmonary aspiration then they should be placed in the recovery position or more advanced airway management should be used.

B - Breathing

[edit]

Once the airway has been opened checking for breathing should begin, if the respiratory rate is below 12-20 breaths per minute then CPR should begin, however if the patient is breathing normally then the rescuer should place them in the recovery position and summon an ambulance.

C - CPR

[edit]
Main article: Cardiopulmonary resuscitation

D - Defibrillation

[edit]

Once an automated external defibrillator (AED) has been acquired the rescuer should then finish the round of CPR, use the AED and then begin another round of CPR. However the AED will usually notify the rescuer of any impediments to continued CPR (such as a sinus rhythm or asystole) in which case the rescuer may be prompted to cease CPR.

Indications

[edit]

Cardiac arrest

[edit]

Cardiac arrest occurs when the heart stops pumping in a regular rhythm. In this situation, early defibrillation is the key to returning the patient's heart back to a normal rhythm. When a defibrillator is not readily available, a rescuer or bystander should keep the blood flowing by performing chest compressions and rescue breaths at an age-appropriate rate until it is.

Respiratory Arrest

[edit]

Respiratory arrest is when there is no measurable breathing in a patient. It tends to occur in conjunction with cardiac arrest, but this is not always the case. Respiratory arrest is the most common indication of BLS in infants and toddlers. The most critical factor in restoring breathing in the patient is to provide high quality rescue breaths.

Shock

[edit]

Shock, also known as Inadequate Tissue Perfusion, is a life-threatening condition that occurs as a result of the disruption to 3 major components of the cardiovascular system: Heart Function, Blood Vessel Function, and Blood Volume. Perfusion describes the process of adequate blood flow to the organs, where the waste and reactants that are involved in cellular respiration are removed or transported throughout the 3 parts of the cardiovascular system for metabolism to be processed effectively.[5] However, if one part were to fail, important resources for cellular respiration such as oxygen would not be able to reach the organs that needs it function.[6] In an attempt to compensate, the body diverts blood to organs that cannot tolerate the lack of blood, such as the heart and the brain, resulting in widespread vasoconstriction, or thinning of the blood vessels.[7] Consequently, blood is prevented from reaching organs that can tolerate the lack of perfusion, or hypoperfusion, in organs such as the skin, resulting in the typical presentation of pale and clammy skin conditions during shock. Moreover, disruptions may present specifically to each component or multiple systems may be affected at the same time, which generally results in the 3 designated types of shock: Obstructive, Distributive, Hypovolemic.[8] Typically, patients would have a presentation of shock at the Compensated, Decompensated, and Irreversible Stage.[9]

Drowning

[edit]

In cases of drowning, rescuers should provide CPR as soon as an unresponsive patient is removed from the water. In particular, rescue breathing is important in this situation. A lone rescuer is typically advised to give CPR for a short time before leaving the patient to call emergency medical services. Since the primary cause of cardiac arrest and death in drowning and choking patients is hypoxemia, it is recommended to start with rescue breaths before proceeding to chest compressions (if pulseless). If the patient presents in a shockable rhythm, early defibrillation is still recommended.

Choking

[edit]
See also: Choking § Treatment

Choking occurs when a foreign body obstructs the trachea. Rescuers should only intervene in patients who show signs of severe airway obstruction, such as a silent cough, cyanosis, or inability to speak or breathe. If a patient is coughing forcefully, rescuers should not interfere with this process and encourage the patient to keep coughing. If a patient shows signs of severe airway obstruction, anti-choking maneuvers such as back slaps or in the most severe cases abdominal thrusts should be applied until the obstruction is relieved. If a patient becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove with a finger sweep it if it is evident however many organisations state that the rescuer should not try to remove the foreign object as they might worsen the situation (either pushing it further down the trachea or initiating vomiting).[citation needed]

Technique

[edit]

United States

[edit]

Basic Life Support Emergency Medical Services in the United States are generally identified with Emergency Medical Technicians-Basic (EMT-B). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of the Advanced Cardiac Life Support (ACLS) protocols, in addition to BLS protocols. However, the American Heart Association's BLS protocol is designed for use by laypeople, as well as students and others certified first responder, and to some extent, higher medical function personnel.

BLS for Healthcare Providers Course

According to the American Heart Association, in order to be certified in BLS, a student must take an online or in-person course. However, an online BLS course must be followed with an in-person skills session in order to obtain a certification issued by The American Heart Association.[10]

Chain of survival

The American Heart Association highlights the most important steps of BLS in a "five-link chain of survival."[11] The chain of survival includes early recognition of an ongoing emergency, early initiation of CPR by a bystander, early use of a defibrillator, and early advanced life support once more qualified medical help arrives. Qualified bystanders with training in BLS are encouraged to perform the first three steps of the five-link chain of survival.

High Quality CPR

See also: Cardiopulmonary resuscitation § Methods

High quality cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are the most important aspects of BLS to ensure a patient survives. CPR involves a rescuer or bystander providing chest compressions to a patient in a supine position while also giving rescue breaths. The rescuer or bystander can also choose not to provide breaths and provide compression-only CPR. Depending on the age and circumstances of the patient, there can be variations in the compression to breath ratio given.

Europe

[edit]

European Resuscitation Council

According to 2015 guidelines published by European resuscitation council, early initiation of resuscitation and coordination of lay people with medical personnel on helping an unconscious person is very helpful in increasing the chance of survival of the patient. When a person is unconscious and is not breathing normally, emergency services should be alerted and cardiopulmonary resuscitation (CPR) and mouth-to-mouth resuscitation (rescue breaths) should be initiated. High quality CPR is important. An adequate ratio of high quality chest compressions and rescue breaths are crucial. An automated external defibrillator (AED) machine is essential during resuscitation. Defibrillation during the first 3 to 5 minutes during resuscitation can produce survival rates as high as 50 to 70%. Placing AEDs in public places where there is one cardiac arrest in five years is cost-effective.[12] Although the adult CPR sequence can be safely used in children, a modified sequence of basic life support that entails less forceful chest compression is even more suitable in children.

United Kingdom

Adult BLS guidelines in the United Kingdom were published in 2015 by the Resuscitation Council (UK),[13] based on the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) published in November 2005.[14] The newest guidelines for adult BLS allow a rescuer to diagnose cardiac arrest if the patient is unresponsive and not breathing normally. The guidelines also changed the duration of rescue breaths and the placement of the hand on the chest when performing chest compressions. These changes were introduced to simplify the algorithm, to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce the chance of survival.[15] It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes.[16] For choking, the guidelines in the United Kingdom first call for assessing the severity of the situation. If the patient is able to speak and cough effectively, the obstruction is mild. If the patient is unable to speak or cough effectively, or is unable to breathe or is breathing with a wheezy sound, the airway obstruction is severe. It is then recommended to perform back blows until the obstruction clears. If the patient becomes unresponsive, CPR is started.

Other countries

[edit]

The term BLS is also used in some non-English speaking countries (e.g. in Italy[17]) for the education of first responders. Terms with similar meanings for similar skill sets are also common.

  • Spain: SVB (soporte vital básico)
  • Belgium: aide médicale urgente ("emergency medical assistance")/ EHBO (eerste hulp bij ongelukken, "first aid")
  • Brazil: SBV (Suporte básico de vida)
  • France: PSE 1 & PSE 2 (Premiers Secours en Equipe niveaux 1 & 2), "First Aid as part of a team", level 2 includes stretchering and teamwork, (former CFAPSE before 2007 Certificat de Formation aux Activités des Premiers Secours en Equipe, "Training certificate for first aid teamwork")
  • Poland: Podstawowe zabiegi resuscytacyjne/ KPP (Kwalifikowana pierwsza pomoc)
  • Portugal: SBV (Suporte Básico de Vida)
  • Germany: Lebensrettende Sofortmaßnahmen (basic life support)
  • Romania: SVB (support vital de bază)
  • Netherlands: BLS ("first aid" is referred to as EHBO (Eerste hulp bij ongelukken))
  • Turkey: TYD (temel yaşam desteği, "basic life support")

Special Populations

[edit]

When performing BLS, laypeople and medical personnel are encouraged to remember that some groups of people have certain conditions that need to be taken into considerations.

Pregnant women

[edit]

To relieve choking, chest thrusts should be used instead of abdominal thrusts when the patient is in late pregnancy.[citation needed]

Obese

[edit]

If a patient of choking is obese and a rescuer cannot perform adequate abdominal thrusts, they are encouraged to instead perform chest thrusts.[citation needed]

Infants

[edit]

To relieve choking, abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. A sequence of back slaps and chest compressions are used instead.[citation needed]

References

[edit]
  1. ^ "About ILCOR". International Liaison Committee on Resuscitation. Archived from the original on 14 August 2018. Retrieved 27 June 2019.
  2. ^ "About CoSTR - Continuous Evidence Evaluation (CEE) and Consensus on Science with Treatment Recommendations (CoSTRs)". International Liaison Committee on Resuscitation. Archived from the original on 31 March 2019. Retrieved 28 June 2019.
  3. ^ "Frequently Asked Questions- What is a CoSTR?". International Liaison Committee on Resuscitation. Archived from the original on 31 March 2019. Retrieved 28 June 2019.
  4. ^ Hallstrom, A. P.; Ornato, J. P.; Weisfeldt, M.; Travers, A.; Christenson, J.; McBurnie, M. A.; Zalenski, R.; Becker, L. B.; Schron, E. B.; Proschan, M.; Public Access Defibrillation Trial Investigators (2004). "Public-access defibrillation and survival after out-of-hospital cardiac arrest". The New England Journal of Medicine. 351 (7): 637–46. doi:10.1056/NEJMoa040566. PMID 15306665.
  5. ^ Surgeons, American Academy of Orthopaedic (2021-02-24). Emergency Care and Transportation of the Sick and Injured Essentials Package (12th ed.). Jones & Bartlett Learning. ISBN 978-1-284-22722-2.
  6. ^ "Shock". medlineplus.gov. Retrieved 2024-04-29.
  7. ^ Services, Department of Health & Human. "Shock". www.betterhealth.vic.gov.au. Retrieved 2024-04-29.
  8. ^ Patel, Samir; Holden, Kyle; Calvin, Bob; DiSilvio, Briana; Dumont, Tiffany (July–September 2022). "Shock". Critical Care Nursing Quarterly. 45 (3): 225. doi:10.1097/CNQ.0000000000000407. ISSN 0887-9303. PMID 35617089.
  9. ^ Haseer Koya, Hayas; Paul, Manju (2024), "Shock", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30285387, retrieved 2024-04-29
  10. ^ "HUT RI 73th". savingchicagocpr.com. Archived from the original on 2013-12-14. Retrieved 2018-10-28.
  11. ^ "What is CPR?". American Heart Association.
  12. ^ Gavin D, Perkins; Anthony J, Handley; Rudolph W, Koster (2015). "European Resuscitation Council Guidelines for Resuscitation 2015Section 2. Adult basic life support and automated external defibrillation". Resuscitation. 95: 81–99. doi:10.1016/j.resuscitation.2015.07.015. hdl:10067/1302990151162165141. PMID 26477420.
  13. ^ "British Resuscitation Council Basic Life Support Guidelines". Resuscitation Council UK.
  14. ^ "ILCOR Documents" (PDF). erc.edu. Archived from the original (PDF) on 2017-11-14. Retrieved 2019-10-09.
  15. ^ Eftestøl T, Sunde K, Steen PA (May 2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. doi:10.1161/01.cir.0000016362.42586.fe. PMID 12010909. S2CID 1092371.
  16. ^ Hallstrom A, Cobb L, Johnson E, Copass M (May 2000). "Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation". N. Engl. J. Med. 342 (21): 1546–53. CiteSeerX 10.1.1.456.8789. doi:10.1056/NEJM200005253422101. PMID 10824072.
  17. ^ Nozioni primo soccorso BLS Archived October 28, 2005, at the Wayback Machine (Italian), PDF document (12p, 912 Kb)
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