BLS Healthcare Provider Algorithm

(VF and Pulseless VT)

Using the BLS Healthcare Provider Algorithm for
Managing VF and Pulseless VT
Before proceeding, it is a good idea to view our terms.

If you would like to go to the main algorithms page, click here.

The BLS (basic life support) Primary Survey is used in all cases of cardiac arrest. For any
emergency, you first see if the patient is responsive, call EMS, and find an AED. Next you go
through the ABCDs. For this case, you assess a person without a pulse; you do not have an
emergency care team to work with you.

Initial Assessment:

Make sure the scene is safe.

Tap shoulder and ask, "Are you all right?"

If the patient does not respond, call for help. Activate EMS

Get the automated external defibrillator (AED) or send someone for it, if someone is
available.

Perform the ABCDs in the primary survey:

Watch for the patient's chest to rise and

fall.
Listen for air escaping.
Airway Feel for expired air against your cheek.
Open patient's airway using the head-tilt,
chin-lift or jaw thrust (if trauma is
suspected)
Breathing Check breathing (take at least 5 seconds
but not more than 10 seconds).
Patient is not breathing. Give 2 rescue
breaths.

Circulation
Defibrillation using and AED
Use a barrier device if you have
one.
Give each breath over 1 second.
Each breath should make the chest
rise. Be careful not to hyperventilate
the patient (rate too fast or volume too
much).
Check the patient's carotid pulse (take at
least 5 seconds but not more than 10
seconds).
No definite pulse? Start cycles of 30 chest
compressions and 2 breaths until the AED
arrives.
Push hard and fast (100/min) and
release completely.
Perform compressions at a depth of
1.5 to 2 inches.
Let the chest to completely recoil.
Minimize interruptions.
After the AED arrives, attach AED pads to
the patient's chest (see AED section for
details).
Turn on the AED.
Follow prompts.
Check rhythm.
Is the rhythm shockable?
If the AED advises a shock, make
sure bystanders or other helpers stay
clear.
Give one shock.
Resume CPR immediately for 5 cycles
(approximately 2 minutes). Check rhythm
again. Give one shock. Repeat cycle of
CPR.
If rhythm is not shockable, resume CPR
immediately for 5 cycles.
Check rhythm every 5 cycles.
 Continue until ALS providers take over or
the patient starts to move.

Unclear if the patient has a pulse?

Begin CPR immediately. Do not waste time trying to be certain about a pulse. It is better to
begin CPR that is unnecessary than to neglect compressions when they are needed. Applying
CPR to a patient with a pulse is not harmful. However, delaying CPR for a pulseless patient
reduces the patient's chances of being successfully resuscitated.

ACLS Secondary Survey (Respiratory

Arrest)
Using the ACLS Primary Survey for a Patient in
Respiratory Arrest
Before proceeding, it is a good idea to view our terms.
If you would like to go to the main algorithms page, click here.
The ACLS Secondary Survey takes you through the advanced assessments and actions you
need to accomplish for a patient in respiratory arrest (see Figure 1). Placing an advanced
airway interrupts chest compressions and takes many seconds. You decide if an advanced
airway is necessary for the patient to maintain respirations. Your assessments guide you in
finding answers and taking appropriate next steps.

The assessments follow the ABCD format of the primary survey:

Airway

Breathing

Circulation

Differential diagnosis

Figure 1. Advanced Cardiac Life Support Secondary

Survey
Assessment Action
To open the
airway for
unconscious
patients, use the
head-tilt, chin
lift.
Insert an
Is the patient's airway obstructed? oropharyngeal If
airway (OPA) or the
a
nasopharyngeal
airway (NPA) if
needed to keep
the airway
open.
If yes, use an
LMA,
Combitube, or
Does the patient need an advanced airway?
endotracheal
intubation,
among others.
Give bag-mask
ventilations
every 5 to 6
seconds (about
Is the patient breathing?
10 to 12 breaths
per minute
without chest
compressions).
No.
If bag-mask
ventilation is
adequate, defer
the insertion of
an advanced
airway until it
becomes
essential
Is an advanced airway indicated? (patient fails to
respond to
initial CPR or
until
spontaneous
circulation
returns).
Yes. Insert an
advanced
airway device.
Confirm correct
placement of
advanced
airway device
by a observing
the patient and
Is the advanced airway device placed properly? using a
confirmation
device, such as
an exhaled CO2
detector or an
esophageal