What is BLS?

Life-saving care starts with BLS, or Basic Life Support. They are the earliest medical instructions in an emergency intended to sustain life. 

Common in cardiac arrest, choking, and respiratory problems, the BLS techniques are widely applied.

Some core BLS components include:

• Chest compressions done in CPR.
• Air maintenance to make sure sufficient breathing.
• Use of AEDs upon their availability and immediate use.
Thus, in practice, BLS is the primary and direct intervention of a life threatening situation.

What is ACLS?

On this note, advanced cardiac life support (ACLS) takes things one step ahead. Whereas BLS provides the foundation, ACLS focuses on specific life saving measures. ACLS is specifically intended for healthcare professionals with extensive knowledge on complicating cardiac conditions, drugs, and other advanced therapies.

Key components of ACLS include:

• Reading and interpreting ECGs (electrocardiograms).
• Medications during cardiac emergencies.
• Strokes, acute coronary syndromes, and other acute cardiac care.
Unlike BLS that aims at resuscitation only until ACLS comes in.

ACLS vs BLS: The Core Differences

There are a few principal differences when considering ACLS vs BLS:

a. Target Audience: BLS training is typically geared towards a broader audience. Everyone from laypeople to healthcare professionals can benefit from BLS. ACLS, however, is primarily for healthcare providers like doctors, nurses, and paramedics who might need to make advanced medical decisions during emergencies.

b. Complexity: BLS procedures are relatively straightforward. They’re designed to be easy to remember and implement. ACLS, conversely, deals with more intricate procedures and requires deeper medical knowledge.

c. Scope: BLS is about stabilizing patients until they can receive advanced care. ACLS is that advanced care, focusing on identifying specific conditions and applying targeted treatments.

Image alt text: how to perform ACLS. A ventricular ACLS graphical illustration.

Author credit: By ProfBethRN – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=126316027

Why do they matter?

It is important that any person who is involved in emergency care understands the differentiation of ACLS vs BLS. Though BLS, is an instant and general response to life threatening conditions, ACLS is important in specialised medical facilities.

This, however, does not make one better than another, just a complementary effort. A trained professional on BLS, can manage a patient until they are helped by another person who is ACLS certified and will take over.

How to perform ACSL

Performing ACLS (Advanced Cardiac Life Support) requires comprehensive training and certification, which is typically geared towards healthcare professionals such as doctors, nurses, and paramedics.

ACLS encompasses a wide range of skills, from basic life support to advanced interventions. This overview provides a general outline, but it’s essential to seek formal training and hands-on practice to accurately and confidently know how to perform ACLS.

Scene Safety and Initial Response:

  • Ensure the scene is safe for both the patient and the responder.
  • Check the patient’s responsiveness. Tap and shout to see if they respond.
  • If unresponsive, shout for help and activate the emergency response system.

Check Breathing and Pulse:

  • Quickly assess if the patient is breathing normally. Agonal breathing (gasping) should not be considered normal.
  • Check the patient’s pulse simultaneously. If no pulse and no normal breathing, initiate CPR.

Start CPR:

  • Begin chest compressions at a rate of 100-120 per minute.
  • Ensure compressions are at least 2 inches deep but not more than 2.4 inches.
  • If trained, give 2 rescue breaths after every 30 compressions.
  • Use an AED as soon as it’s available.

Advanced Airway and Breathing:

  • If the patient’s airway is not secure, consider advanced airway management techniques, such as intubation.
  • Once an advanced airway is in place, give one breath every 6 seconds and continue chest compressions without pausing for breaths.

Monitor and Interpret:

  • Attach the patient to a cardiac monitor to identify any life-threatening arrhythmias.
  • For ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), deliver a first aid shock using a defibrillator.

6. Medication Administration:

  • Depending on the rhythm and situation, administer ACLS drugs like epinephrine, amiodarone, or others as trained.
  • Ensure you understand the indications, doses, and contraindications for each medication.

7. Rhythm Checks:

  • Every 2 minutes (or after each CPR cycle), check the cardiac rhythm. If a shockable rhythm (VF or pVT), give a defibrillation shock.

8. Post-Cardiac Arrest Care:

  • Once ROSC (Return Of Spontaneous Circulation) is achieved, focus on optimizing ventilation and oxygenation.
  • Monitor blood pressure and consider advanced hemodynamic monitoring.
  • Consider targeted temperature management.

9. Recognize and Treat Reversible Causes: Recall the “H’s and T’s” to help identify potential reversible causes of cardiac arrest:

  • Hypoxia
  • Hypovolemia
  • Hydrogen ion (acidosis)
  • Hypo/hyperkalemia (potassium imbalance)
  • Hypothermia
  • Toxins
  • Tamponade (cardiac)
  • Tension pneumothorax
  • Thrombosis (coronary or pulmonary)

10. Continuous Reevaluation:

  • Continuously reassess the patient’s airway, breathing, circulation, and neurological status.
  • Consider transport to a facility equipped to handle post-cardiac arrest patients.

Important Notes:

  • Always ensure you have a clear understanding of any equipment you’re using.
  • Communication is crucial, especially if working as part of a team.
  • Always debrief after a resuscitation attempt, regardless of the outcome. It’s an opportunity for learning and emotional support.

Commonly Asked Questions

  1. Can I skip BLS and go straight to ACLS training?

While technically possible, it’s recommended to have a strong foundation in BLS before moving to ACLS. BLS forms the base upon which ACLS builds.

  1. How often do I need to renew BLS and ACLS certification?

Both certifications typically require renewal every two years, though this can vary depending on the institution.

  1. Is BLS included in ACLS?

Many ACLS courses assume you already have a foundational knowledge from BLS, but some integrated courses might cover both.

  1. Who should take ACLS training?

Healthcare professionals like doctors, nurses, paramedics, and others involved in emergency medical care should consider ACLS.

  1. If I’m trained only in BLS, can I use an AED?

Absolutely! BLS courses often incorporate AED training as it’s a fundamental tool in cardiac emergency situations.

Conclusion

The debate of ACLS vs BLS isn’t about which is superior, but rather understanding their distinct roles in emergency medical care. BLS lays the groundwork for immediate response, while ACLS dives deeper into specialized care.

Whether you’re a layperson or a medical professional, having knowledge in either or both can make a significant difference in emergency situations. Remember, it’s not a competition; it’s a collaboration to save lives.