BLSD: what is it? How should the manoeuvres be performed?

By Cristiano Antonino Last updated Jun 20, 2023

BLSD stands for Basic Life Support Defibrillator, i.e. first aid manoeuvres using a defibrillator

These are manoeuvres to be performed immediately in the event of a sudden cardiac arrest.

There are guidelines based on national and international standards designed to facilitate procedural methods of rescue.

BLSD Adult

A careful assessment of the safety of the scenario in which the victim finds himself or herself must be carried out, as rescue can only intervene if it is safe to do so.

Another careful assessment is the response of the victim whose attention should be drawn by asking loudly and repeatedly if he/she can hear.

It should be left in the position in which we found it and it should be ensured that there is no risk of further danger.

To ensure that there are no foreign bodies, or that there is no retroflexion of the tongue, it is useful to open the victim’s mouth in order to unblock the channel and the passage of oxygen.

Gently place your hand on the victim’s forehead and cautiously position the victim’s head backwards by opening the mouth from the tip of the chin in order to open the airway.

Breathing should be assessed using the Look, Listen, Feel technique, by standing next to the victim without blocking his or her airway; we should approach the victim’s mouth with our cheek, carefully observing his or her chest.

In the moments following cardiac arrest, the victim may breathe irregularly and in a slow and laboured manner; this is not to be confused with normal, regular breathing.

We need to observe whether there is expansion of the chest, noting whether the victim makes sounds during breathing and whether there is movement of air on our cheek for a time not exceeding 10 seconds to determine whether breathing is normal or not.

There may be a total absence of breathing or more or less severe alternation of breathing. In less than 10 seconds we can perform pulse and respiration checks simultaneously.

We should also activate and promptly call the 112 emergency service, staying if possible with the victim so as not to leave him/her alone, and activating the speakerphone for easy communication with the emergency services.

If we have any doubts about breathing, we must act as if there is no breathing and prepare to perform Cardio Pulmonary Resuscitation (CPR) again.

We need to start chest compressions by kneeling at the victim’s side and placing the hand near the wrist in the centre of the victim’s chest, i.e. in the middle of the sternum, placing the palm of the other hand on top of the first and interlocking the fingers making sure not to press on the victim’s ribs.

The arms must be straight and taut and we must position ourselves vertically on the victim’s chest by pressing down about 5 cm.

After each compression, we must totally release the pressure on the chest, never losing hand-forearm contact.

The manoeuvre should be repeated at a rate of 100-120/minute.

Chest compressions should be combined with ventilation.

After about 300 compressions we must again open the airway by hyperextending the head and lifting the chin.

By closing the nostrils with the thumb and forefinger of the hand on the victim’s forehead, trying to open the victim’s mouth while keeping the chin raised.

Breathing normally and placing the lips around the victim’s lips making sure there is a good fit, blow slowly and gradually into the victim’s mouth controlling the movement of the chest for a second or so as in a normal breath.

We must take another breath and blow into the victim’s mouth once more.

Chest compressions should not be interrupted for more than 10 seconds in order to proceed with the two ventilations.

The hands should be placed back in the correct position on the sternum and another 30 chest compressions should be performed.

Chest compressions and ventilations should be continued at a ratio of 30:2.

BLSD manoeuvres, defibrillator should be accessed and paddles applied following visual and voice commands

Paddles should be applied to the victim’s chest.

If there is more than one rescuer, Cardio Pulmonary Resuscitation should be continued while the pads are applied.

While the rhythm is being analysed by the defibrillator, no-one should touch the victim.

If there is no defibrillator available, CPR should be continued with chest compressions and 30:2 insufflations.

If the victim appears to be breathing normally but is still unconscious, he/she should be placed on his/her side and the airway kept clear, the so-called safety position.

We can tell whether the victim has been revived or not by the opening of the eyes, movement, regaining consciousness and breathing; however, we must remain alert in case the victim regresses.

For paediatric and infant BLSD, the procedures are the same as for adult BLSD, except that

In paediatric BLSD, chest compressions and insufflations should be performed in a ratio of 15:2 and the depth of compressions should be 1/3 of the chest diameter, slightly less than 5cm for adults.

In infant BLSD, cardiac arrest has an incidence of less than 1% of recorded cases.

Again, 15:2 compressions and insufflations should be performed, but cardiac massage should be performed with index and middle fingers placed just below the nipple line.

In the case of airway obstruction, we will have partial or total obstruction; the first is when the foreign body is positioned in such a way as to allow a reduced passage of air but allows the oxygenation of blood, the child is able to cough, cry and even speak.

The second is when the foreign body creates a real plug that totally prevents the passage of air, the child in this case is unable to cry, cough, speak or make any sound.

With total obstruction, there is an emergency that requires immediate intervention because, if action is not taken quickly, there will first be respiratory failure and in a few minutes cardiac arrest.