HCP BLS for Special Populations

Certain patient populations require special considerations when performing BLS. As a healthcare provider, you must be able to adapt CPR and resuscitation techniques to accommodate specific needs.

—

1. BLS for Pregnant Patients

Performing CPR on a pregnant patient presents unique challenges due to the physiological changes during pregnancy.

Key Considerations

• Cardiac output and oxygen demand are higher during pregnancy.
• Compression depth remains the same as in non-pregnant adults (at least 2 inches or 5 cm).
• In late pregnancy (third trimester), the enlarged uterus can compress the inferior vena cava, reducing blood return to the heart.

Modifications for CPR in Pregnant Patients

• Perform manual left uterine displacement (LUD) by gently shifting the uterus to the left while providing compressions.
• If a backboard is available, tilt the patient slightly (15-30°) to the left to relieve pressure from the vena cava.
• Prioritize high-quality chest compressions—maternal survival is the best way to ensure fetal survival.

Emergency Cesarean Section (Perimortem C-Section)

• If maternal cardiac arrest occurs after 20 weeks of gestation, consider emergency delivery of the fetus if resuscitation is unsuccessful within 4-5 minutes.
• This should only be performed by trained personnel in a hospital setting.

—

2. BLS for Trauma Patients

Trauma patients present additional challenges due to potential spinal injuries, severe bleeding, or airway compromise.

Key Considerations

• Uncontrolled hemorrhage is a leading cause of preventable death—stop bleeding immediately.
• Patients with spinal trauma require careful handling to avoid worsening injuries.
• Patients with major chest trauma may have compromised ventilation (e.g., pneumothorax).

Modifications for Trauma CPR

• If a spinal injury is suspected, use the jaw thrust maneuver instead of head tilt-chin lift.
• Control severe bleeding using direct pressure, tourniquets (for limb injuries), or wound packing.
• For chest trauma, assess for signs of tension pneumothorax (distended neck veins, absent breath sounds).

—

3. BLS for Opioid Overdose

With the rise of opioid-related emergencies, healthcare providers must be prepared to recognize and treat opioid overdose.

Key Signs of Opioid Overdose

• Unresponsiveness
• Slow, shallow, or absent breathing (respiratory arrest)
• Pupillary constriction (“pinpoint pupils”)
• Cyanosis (bluish skin due to lack of oxygen)

Rescue Breathing for Opioid Overdose

• If the patient has a pulse but is not breathing, provide 1 breath every 5-6 seconds.
• Use a bag-mask device (BVM) with oxygen if available.

Naloxone (Narcan) Administration

• Naloxone is an opioid antagonist that reverses respiratory depression.
• Administer via:
  • Intranasal (IN): 2-4 mg per spray (repeat every 2-3 minutes as needed).
  • Intramuscular (IM): 0.4-2 mg (repeat every 2-3 minutes as needed).
• If no response after two doses of naloxone, continue CPR and ventilations—opioid overdose may not be the sole cause.

—

Summary: Adapting BLS for Special Populations

• Pregnant patients: Displace the uterus leftward, prioritize compressions, consider emergency C-section after 4-5 minutes.
• Trauma patients: Protect the airway (jaw thrust if spinal injury suspected), stop severe bleeding immediately.
• Opioid overdose: Recognize respiratory arrest, provide rescue breathing, administer naloxone.

BLS is not one-size-fits-all. Recognizing these special circumstances and adjusting your approach can make a life-saving difference.