Adult Basic Life Support (BLS) Using DRSABCD
Published: 26 January 2021
Published: 26 January 2021
It’s essential that all healthcare workers know how to correctly perform BLS.
In all Australian healthcare service settings, basic life support is an aspect of patient care directly tied to Standard 8 of the National Safety and Quality Health Service: Recognising and Responding to Acute Deterioration (ACSQHC 2019).
Note: The information is this article applies to adult patients/residents only.
Basic life support (BLS) is a procedure used to achieve preliminary preservation or restoration of life until advanced life support (ALS) can be performed. It involves establishing and maintaining airway, breathing, circulation and related emergency care using CPR, in addition to using an automated external defibrillator (AED) (Carey 2014a; VIC DoH 2014).
BLS can only generate about 20 to 30% of normal cardiac output, so it should only be used as a temporary substitute for normal ventilation and circulation. However, early, correctly-performed BLS is associated with better oxygenation, an increased likelihood of successful defibrillation, an increased likelihood that the patient will respond to advanced techniques and consequently, a higher chance of survival (HCA 2016; VIC DoH 2014).
Advanced life support (ALS) describes interventions that are performed additionally alongside BLS to achieve airway management, ventilation and circulation. Interventions may include advanced airway management, vascular access/therapy and other actions (Carey 2014b).
BLS can be performed by first responders, healthcare professionals and bystanders. The Australian Resuscitation Council holds the belief that ‘any attempt at resuscitation is better than no attempt’ (American Red Cross 2019; ARC 2019).
The chain of survival summarises the series of crucial actions that should be taken to resuscitate someone who is experiencing cardiac arrest. These actions are vital for successful resuscitation and when performed quickly enough, can significantly increase the likelihood of survival (St John VIC 2016; ERC 2015).
The steps are:
It is crucial to recognise that an emergency is occurring. An ambulance should be called immediately to ensure the patient/resident receives defibrillation and life support as soon as possible (St John VIC 2016).
In order to maintain oxygenation of the brain and other crucial organs, cardiopulmonary resuscitation (CPR) should be commenced within four minutes of cardiac arrest (St John VIC 2016).
Survival rate can be significantly improved by applying an AED as soon as possible, ideally within two minutes (ANZCOR 2016b; Ambulance Victoria 2019).
Performing early defibrillation can increase the likelihood of survival by about 70%, but every minute without defibrillation decreases the chance of survival by 10% (St John VIC 2021).
The likelihood of survival can be further improved by interventions such as medication and stabilisation of the airway (St John VIC 2016).
DRSABCD is an acronym used to outline the steps of BLS. They are:
When performing BLS, your first priority is to check the scene for danger and identify any potential hazards or risks that may jeopardise the safety of you, the patient/resident or bystanders (HCA 2016).
Where there is more than one patient/resident in need of assistance, whoever is unconscious takes priority (ANZCOR 2016b).
Dangers generally fall into one of the following categories:
You should generally avoid moving the patient/resident, as this may cause their condition to deteriorate further. However, there are some situations where this cannot be avoided (HCA 2016). These include moving the patient/resident to:
Always follow best-practice manual handling principles if attempting to move a patient/resident (HCA 2016).
Assess whether the patient/resident will respond to verbal and tactile stimuli (this is known as ‘talk and touch'). Give them a simple command such as ‘open your eyes’ or ‘squeeze my hand’, then firmly grasp and squeeze their shoulders (ANZCOR 2016b).
A person that gives no response or only a minimal response (e.g. groaning without opening their eyes) should be treated as unconscious (ANZCOR 2016b).
Assess for signs of life. Lack of movement, unconsciousness, lack of breathing or abnormal breathing may indicate no signs of life (Ionmhain 2020).
Unconsciousness may be caused by:
Delegate someone to call emergency services and retrieve an AED if possible (Ionmhain 2020). If you are alone with the patient/resident, you may wait until after the first two minutes of CPR to send for help (HCA 2016).
As a healthcare professional, it is your responsibility to know:
Remember that the Australian Ambulance Service emergency phone number is 000.
Managing the patient/resident’s airway must take priority over any other injury they have, including a spinal injury (ANZCOR 2016b).
If an unconscious patient/resident is lying on their back, their tongue may fall against the back wall of their throat and obstruct airflow (as unconsciousness causes the muscles to relax). This blockage may be further exacerbated by soft tissues in the airway. Furthermore, an unconscious person will be unable to swallow or cough out foreign bodies (ANZCOR 2016b).
Other potential causes of airway obstruction include:
(HCA 2016; ANZCOR 2016b)
In order to manage the patient/resident’s airway:
(ANZCOR 2016b; Ionmhain 2020)
If the patient/resident is unresponsive and gasping or breathing abnormally, they require resuscitation. Abnormal breathing may be caused by:
When assessing the patient/resident’s breathing:
If the patient/resident is unresponsive and breathing abnormally once the airway has been opened and cleared, you must commence chest compressions and rescue breathing (ANZCOR 2016b).
To perform CPR:
(ANZCOR 2016b; HCA 2016)
To perform a mouth-to-mouth rescue breath:
(ANZCOR 2016b; HCA 2016)
Consider using a barrier device if one is available. However, risk of disease transmission through rescue breaths is low so do not be deterred if a barrier device is unavailable (ANZCOR 2016b).
A bag-mask device or advanced airway is advised for airway management, however, anyone using such equipment should be adequately trained and competent (ANZCOR 2016b).
Automated external defibrillators (AEDs) are devices used to deliver controlled electrical shocks to people experiencing particular cardiac arrhythmias. AEDs are small and portable. They can be found in many public places, including supermarkets, workplaces and sporting facilities. It is your responsibility to know the location of AEDs in your workplace. AEDs must only be used alongside CPR (NSW DoH 2020a; St John VIC 2020).
The Ambulance Victoria AED Registry can be used to locate publicly accessible AEDs in Victoria.
In patients/residents who are unresponsive and breathing abnormally, prompt defibrillation is crucial. An AED should be retrieved as quickly as possible, as every minute in delay reduces the patient/resident’s chance of survival. Note that anyone, regardless of whether they are trained or not, can operate an AED if required (ANZCOR 2016b).
CPR should be performed until an AED is retrieved, turned on and attached. Once the AED is ready, follow the prompts (ANZCOR 2016b).
Proper pad placement is crucial to ensure the shock is delivered on an axis through the heart. Place one pad just below the collarbone on the patient/resident’s right chest and the second below the patient/resident’s left armpit. If the patient/resident is big-breasted, you can place the second pad lateral to the left breast instead. The chest must be exposed, and you may need to remove moisture or chest hair to ensure pad-to-skin contact. However, keep in mind that delays in defibrillation must be minimised (ANZCOR 2016b).
Other acceptable pad placements include anterior-posterior (where the anterior pad is placed over the praecordium or apex, and the posterior pad is placed on the back in the left or right infrascapular region) and apex-posterior (ANZCOR 2016b).
Anterior-posterior electrode placement may be considered if defibrillation electrodes are at risk of overlapping (paediatric patients) (CC: Queensland Ambulance Service, Clinical Practice Procedures: Resuscitation/Defibrillation 2019).
Always check safety before delivering a shock:
Remember that AED must only be used for unresponsive patients/residents who are breathing abnormally (ANZCOR 2016b).
If the defibrillation is successful, the patient/resident will have a return of spontaneous circulation (ROSC), become responsive and start to breathe independently. You should:
Note: There is a possibility that the patient/resident could deteriorate once again, which may require recommencement of CPR and further defibrillation as per AED if the patient/resident becomes unresponsive.
If the defibrillation is unsuccessful, continue CPR. Only stop if:
The New South Wales Department of Health has developed a refined version of the DRS ABCD guidelines to use for patients/residents who are confirmed or suspected to have COVID-19. This can be viewed here.
It is crucial that you continue to practise BLS so that when the time comes, you feel confident in your practice and clinical judgement.
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