Basic Cardiac Life

Support (BCLS)
Basic Cardiac Life Support (BCLS)

Basic Cardiac Life Support (BCLS) is the term for identifying sudden cardiac arrest calling
for help, supporting the circulation, maintaining the airway and supporting breathing without
the use of equipment other than personal protective devices

This is also commonly referred to as cardiopulmonary resuscitation (CPR). This skill could
be used by a layperson or a healthcare provider in both out-of-hospital and in-hospital
settings.
Basic Cardiac Life Support (BCLS) in neonates and
child
The CPR steps for children and infants are slightly different to the steps for
adults, as below.
 Step 1. Call 911 or give 2 minutes of If you are alone with the child and they are not
care responding, give them 2 minutes of care and then
call 911.
First, check the surrounding area for factors that
could put you in danger. If there is a bystander, ask them to call 911 while
you give 2 minutes of care
Next, check the child or infant to see whether they
need help.
If possible, ask a bystander to go and search for
For children, tap their shoulders and shout, “Are an AED machine.
you OK?”
For infants, flick the sole of their feet to see if
they respond.

If the child does respond, call 911 to report any

life-threatening conditions.
Step 2. Place them on their back and open
their airways

Place the child or infant carefully on their back and kneel

beside their chest. Tilt their head backward slightly by
lifting their chin.

Open their mouth. Check for any obstruction, such as

food or vomit. If it is loose, remove it. If it is not loose,
do not touch it, as this may push it farther into their
airways.
 Step 3. Check for breathing
Place your ear next to their mouth and listen for
around 10 seconds. If you do not hear breathing, or
you only hear occasional gasps, begin to
administer CPR.

Changes in an infant’s breathing patterns are

normal, as they usually have periodic breathing.

Keep monitoring their breathing and perform CPR

if they stop breathing.
 Step 4. Perform two rescue breaths
If the child or infant is not breathing, perform two
rescue breaths with their head tilted backward and their
chin raised.

For a child, pinch their nose shut and place your mouth
over theirs. Breathe into their mouth twice.

For an infant, place your mouth over their nose and

mouth and blow for 1 second to make their chest rise.
Then, deliver two rescue breaths.

If they are still unresponsive, begin chest compressions.

 Step 5. Perform 30 chest compressions
Kneel beside the child or infant.

For a child, use one of your hands. Place the heel

of the hand at their sternum, which is in the center
of the chest, between and slightly below their
nipples. Press down hard and fast around 2 inches
deep, or one-third the depth of the chest, at least
100 times per minute.

For an infant, use two fingers. Place your fingers

in the center of their chest, between and slightly
below the nipples. Perform 30 quick compressions
around 1.5 inches deep.
.

Step 6. Repeat

Repeat the cycle of rescue breaths and

chest compressions until the child starts
breathing or help arrives

recovery postion
 BCLS IN CHILD AND NEONATES

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Advance Cardiac
Life Support
(ACLS)
Advance Cardiac Life Support
(ACLS)
is an advanced training program designed to teach healthcare
professionals how to respond effectively to cardiovascular
emergencies.

The goal of ACLS is to provide timely and appropriate care to

patients suffering from cardiac arrest or other life-threatening
cardiovascular conditions.
 Step 2. 5 steps of
Step 1.
Preparation resuscitative
“WARM PASSdelivery
neonate, Ventilate then
Intubate, Compress LOW Rate,
get the right Avoid a cold fate”

people get the

Step 1: time 0-30 sec: warm,
right stuff position, suction,
stimulate, assess
dry off amniotic fluid
ASAP
 replace with warm suction only if:
blankets
meconium present and
the large volume of
secretions
deep suctioning can lead to vagal
stimulation stimulate by rubbing feet,
back, etc
position to achieve maximum air assess: in the first 30 seconds:
entry
baby’s response to warming,
drying, and stimulation
HR
if HR <100 or
apnea APGAR
scores
 Step 2: 60-120 sec: ventilation, indications for intubation:
oxygen, intubation ▪
need for tracheal suctioning
▪
ineffective BVM
any cyanosis or respiratory distress: ▪
CPR st art ed
start CPAP or PPV
first breaths need 30-40 mmHg,
▪

if there is any deterioration

subsequent need 20 mmHg post- intubation:
▪
RR 40 -60 breat hs/ min think through the DOPE list
▪

▪
if you bag for >2 mins, put in an (displacement, obstruction,
OG tube
pneumothorax, equipment failure)
▪
use room air initially ▪
revert to BVM or insert an LMA
▪
***know that the O2 sat.
doesn’t reach
>90% until more
than 10 mins
 Step 4: resuscitative
Step 3: 180 sec – onwards: medications medications are
chest compression indicated:
•bradycardia in a neonate is an indication of
bradycardia/ asyst ole
hypoxemia hemorrhage
30 seconds should get CPR
o rate: 9 0 bpm with 30 vents / min Oxygen
o ratio of 3:1 in general
Epinephrin
if it’s thought to be a cardiac cause then
▪

the 15:2 ratio can be e

used. indicati
use the encircling hands technique ons:
▪
compress ⅓ the AP depth 1. asyst
▪
reassess every 30-60 seconds ole
2. HR < 60 despit e ef f ect ive
ventilations with 100% O2
and CPR
ideally administered IV
Nalox
treatment:
one
any glucose < 3.5 IV glucose
Gluco
mmol/ L wit h D10W 2-5 ml/kg, with an infusion
se
symptoms should of D10W at 80-100 ml/kg/day
be treated: higher concentrations of
glucose should be avoided because
i
they are hyperosmolar
r
r volume
i expanders:
t indicated signs of acute
a bleeding or hypovolemia (cyanosis
b despite resuscitation, shock, CPR
i required)
l use O- PRBCs – 10
i ml/kg NS
t Ringer
y
dopamine Step 5: Therapeutic hypothermia

infused at 5-20 mcg/kg/min for early neonatal asphyxia:

symptoms: altered LOC,
Vascular access: seizures, hypovolemia,
hyporeflexia
Immediate access through
in mod-severe hypoxemic
the umbilical vein
encephalopathy: selective cerebral
femoral line hypothermia at 33.5-34.5 degrees in
IO access the neonatal population leads to
lower mortality and less
Medications that should
neurologic disability at 18
NOT be used
start cooling
months within 6 hours of
of age
routinely:
birth and continue for 72
albumin
hours.
dopamine
calcium
bicarbonat e
atropine
Neonatal Resuscitation
Algorithm
These guidelines apply primarily to newly born infants transitioning from
intrauterine to
extrauterine life. For purposes of these guidelines, the terms newborn and
neonate apply to any infant during the initial hospitalization. The term newly
born applies specifically to an infant at the time of birth
Newly born infants who do not require resuscitation can be generally identified
upon delivery by
rapidly assessing the answers to the following 3 questions:
• Term gestation?
• Good tone?
• Breathing or crying?
 Initial
actions in steps in stabilization (warm and maintain
sequence
normal temperature, position, clear secretions only
if copious and/or obstructing the airway, dry,
stimulate)
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