ACLS for Healthcare Providers in US & Canada

What is the difference between ACLS and BLS?

Wed, 13 May 2026 22:37:15 +0000

Definition snapshot

BLS teaches immediate, foundational resuscitation skills: high-quality CPR, ventilations, and early AED use in prehospital and in-facility settings. See the AHA BLS course description.
ACLS builds on that foundation with advanced assessment and interventions, with a strong emphasis on high-performance teams and managing cardiac arrest and related emergencies. See the AHA ACLS course description.

You may also see ACLS referred to as ALS (advanced life support). Naming varies by employer and training system, so match the exact card name your organization requires.

Introduction

Two critical certifications in emergency medical care are BLS and ACLS. Both help healthcare providers save lives during cardiovascular emergencies, but they differ significantly in scope, complexity, and application.

Key point: The ACLS course entirely includes the BLS course concepts. Many companies require staff to do ACLS and BLS certifications, which can seem redundant.

flowchart
  subgraph ACLS["ACLS certification"]
    direction LR
    E[Advanced airway management]
    F[Pharmacology]
    G[Cardiac monitoring]
    H[Team dynamics]
    subgraph BLS["BLS certification"]
      A[Chest compressions]
      B[Airway management]
      C[Rescue breathing]
      D[AED use]
    end
  end

What happens in a real emergency

When a cardiac emergency occurs, the first responder immediately begins BLS actions: high-quality chest compressions, rescue breaths, and early defibrillation with an AED. These foundational steps maintain blood flow and oxygenation while the responder calls for advanced help. Once an ACLS-trained team arrives, they take over with advanced interventions—establishing an advanced airway, administering medications, interpreting cardiac rhythms, and coordinating team roles. BLS does not stop when ACLS begins; instead, the two work together, with BLS skills forming the continuous foundation that ACLS builds upon in real time.

Good news: If you do your BLS with Pacific Medical Training BLS, we manage to get you up to 8 CE credit hours for it.

Basic life support (BLS)

Definition and purpose (BLS)

Basic Life Support (BLS) provides the foundational skills necessary for responding to life-threatening emergencies. BLS focuses on immediate actions to support breathing and circulation in victims of cardiac arrest and other emergencies until advanced medical care can be provided.

Key components (BLS)

Chest compressions: High-quality compressions at a rate of 100–120 per minute to maintain blood circulation.
Airway management: Techniques to keep the airway open, such as head tilt–chin lift.
Rescue breathing: Providing breaths to ensure oxygenation, often using a bag-valve-mask (BVM).
Automated external defibrillator (AED): Using an AED to deliver shocks to restore a normal heart rhythm.

Training and certification (BLS)

BLS certification is designed primarily for healthcare professionals such as physicians, nurses, paramedics, and medical students. Lay rescuers and workplace responders typically take CPR/AED or CPR/first aid/AED courses instead. The training typically takes a few hours and includes hands-on practice to ensure competency in performing CPR and using an AED.

Advanced cardiovascular life support (ACLS)

Definition and purpose (ACLS)

Advanced Cardiovascular Life Support (ACLS) builds upon the skills learned in BLS, adding advanced interventions to treat cardiac arrest, stroke, and other cardiovascular emergencies. ACLS is intended for healthcare professionals involved in the management of these critical situations.

Key components (ACLS)

Advanced airway management: Techniques such as endotracheal intubation and the use of supraglottic airway devices.
Pharmacology: Administration of emergency drugs like epinephrine, amiodarone, and atropine.
Cardiac monitoring: Interpretation of ECGs to identify and treat arrhythmias.
Team dynamics and leadership: Coordination and effective communication among team members during resuscitation efforts.

Training and certification (ACLS)

ACLS certification is more intensive and longer than BLS, with case-based scenarios and assessment. It covers advanced skill practice, ECG interpretation, pharmacology, and team dynamics. It is designed for healthcare professionals such as physicians, nurses, and paramedics.

Key differences between ACLS and BLS

First, how to pick?

flowchart LR
  B{Are you a healthcare professional?}
  B -->|No| C[BLS certification]
  B -->|Yes| D{Working in ER, ICU, or transport?}
  D -->|Yes| E[ACLS certification]
  D -->|No| F{Does your employer require ACLS?}
  F -->|Yes| E
  F -->|No| C

Scope of practice

BLS: Focuses on basic interventions like chest compressions, rescue breathing, and AED use.
ACLS: Includes advanced interventions such as drug administration, advanced airway management, and cardiac monitoring.

Target audience

BLS: Designed for healthcare professionals such as physicians, nurses, EMTs, paramedics, and medical students. Lay rescuers typically take CPR/AED courses instead.
ACLS: Intended for healthcare professionals with a higher level of training and responsibility, such as doctors, nurses, and paramedics.

Level of training

BLS: Shorter training duration, focusing on foundational skills.
ACLS: More intensive training with case-based scenarios, covering complex medical procedures and advanced techniques.

You can find more about the differences between our BLS and CPR courses on the BLS, CPR and CPA/FA/AED page.

Situational application

BLS: Used in various settings, including community, workplace, and hospital environments for immediate, life-saving interventions.
ACLS: Applied in clinical settings such as emergency rooms, intensive care units, and during patient transport, where advanced care is necessary.

flowchart LR
  A[Cardiac emergency occurs] --> B[BLS response]
  B --> C[CPR and AED]
  C --> D{Advanced team available?}
  D -->|Yes| E[ACLS interventions]
  D -->|No| F[Continue BLS until help arrives]

Which one do you need?

If your requirement mentions ICU, ER, critical care, code team, or advanced rhythm management, you likely need ACLS (and you will still need BLS skills, since ACLS builds on them).
If your requirement mentions “healthcare provider CPR” or “BLS for healthcare providers”, you need BLS.
If you are unsure, ask your employer or school for the exact card name they accept.

Do I need BLS before ACLS?

Our ACLS course entirely includes BLS course concepts, so completing ACLS demonstrates BLS-level competency. However, many employers require both certifications separately. Check with your employer before assuming one covers the other.

Frequently asked questions

Can I take ACLS without having BLS first? Yes, our ACLS course covers BLS concepts as part of the curriculum. However, having prior BLS knowledge makes the ACLS material easier to learn.
Which course does my employer accept? Check our accreditations page for state-specific approvals, or ask your employer for the exact card name they require.
Is skills testing included? Both courses include a skills test form. We also offer skills testing services for an additional fee—contact us if you need help finding an instructor.
What about CPR and CPRFAAED courses? If you are not a healthcare provider, or if you need first aid training, see our BLS vs CPR vs CPRFAAED comparison.
Do nurses need ACLS certification? Many hospitals require ACLS certification for nurses who work in emergency departments, intensive care units, telemetry units, or other areas where cardiac emergencies occur. Nurses in outpatient or non-critical settings may only be required to maintain BLS certification.

References

American Heart Association. Basic Life Support (BLS) training. Course description and objectives.
American Heart Association. Advanced Cardiovascular Life Support (ACLS). Course description and objectives.
American Red Cross. ACLS/ALS vs. BLS: what’s the difference? Overview of the two certifications.
American Heart Association. 2020 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. 2020.
American Heart Association. (2025). BLS Provider Manual.
American Heart Association. (2025). ACLS Provider Manual.
Field, J. M., Hazinski, M. F., & Sayre, M. R. (2010). Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(18_suppl_3), S640-S656.
Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J., … & Hazinski, M. F. (2015). Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132(18_suppl_2), S414-S435.
Pacific Medical Training. (2024). ACLS Syllabus. Retrieved from /acls
Pacific Medical Training. (2024). BLS Syllabus. Retrieved from /bls

Acute bronchitis

Wed, 13 May 2026 22:37:15 +0000

Bronchitis is the inflammation of the respiratory tubes, which are known as bronchi. This inflammation causes increased mucus production and various other alterations in the airways. Bronchitis comes in several types, with acute and chronic being the most common. Acute bronchitis typically resolves in less than three weeks, whereas chronic bronchitis can persist for an extended period. Individuals who smoke are at a higher risk of developing bronchitis.

Causes

Acute bronchitis commonly stems from viral infections, often associated with colds or the flu. Additionally, bacterial infections or exposure to various physical or chemical agents, frequently inhaled, can trigger bronchitis. These agents may include dust, potent fumes, and allergens, with chemical cleaning compounds and tobacco smoke also posing risks.

It can manifest following a common cold or other viral infections affecting the upper respiratory tract. Moreover, individuals with chronic sinusitis, allergies, or enlarged tonsils and adenoids are prone to bronchitis. In those with underlying lung or heart conditions, bronchitis can escalate into a serious ailment. Left untreated, bronchitis can lead to severe complications such as pneumonia.

Symptoms

Symptoms of acute bronchitis can vary from person to person, but the following are typically the most common:

Production of sputum (mucus made in lungs), which can be clear, green, yellowish-gray, or white in color. At times it may be streaked with blood
Cough, i.e., first dry (non-productive), later a lot of mucus is produced
Back and muscle pain
Chills
Chest soreness
Headache
Runny nose
Feeling tired and achy
Slight fever
Shortness of breath
Sore throat
Wheezing
Watery eyes

Risk factors

Several factors can elevate the risk of bronchitis:

Low resistance: Older adults, infants, and young children are more susceptible to infections, which can also be exacerbated by other acute illnesses like colds or chronic conditions impacting the immune system.
Cigarette smoke: Individuals who smoke or are frequently exposed to secondhand smoke face an increased risk of both acute and chronic bronchitis.
Gastric reflux: Chronic heartburn episodes can irritate the throat, heightening vulnerability to bronchitis.
Occupational exposure to irritants: Those working in environments with lung irritants such as textiles, grains, or chemical fumes are at a heightened risk of developing bronchitis.

Diagnosis

A doctor typically diagnoses acute bronchitis through a physical examination and medical history review. Additional tests may be conducted to rule out other conditions such as asthma or pneumonia. The following tests aid in ensuring an accurate diagnosis:

Chest X-rays: This imaging test uses radiation beams to generate images of bones, internal tissues, lungs, and other organs.
Arterial blood gas: This blood test determines the levels of oxygen and carbon dioxide in the blood.
Pulse oximetry: A small device called an oximeter measures oxygen levels in the blood by placing a sensor on a patient’s finger, toe, or forehead. The process is painless, and a red light indicates the measurement without generating heat.
Cultures of nasal discharge and sputum: Samples of sputum coughed up or swabs from the nose are examined to identify the microorganism causing the infection.
Pulmonary function tests: These tests assess lung function by measuring the ability to inhale and exhale air using specialized machines.

Treatment

Acute bronchitis typically presents as a mild condition with few complications. Symptoms tend to subside on their own as the lungs regain normal function.

Antibiotics are generally unnecessary for treating acute bronchitis since viral infections are the primary cause, and antibiotics are ineffective against viruses. However, if the condition advances to pneumonia, antibiotics may be prescribed.

Treatment for symptom management may involve:

Avoiding exposure to secondhand smoke
Cough medicine
Humidifying the air
Increased fluid intake
Pain relievers and fever reducers
Quitting smoking
Avoid antihistamines as they dry up the secretions and can worsen the cough

Prevention

Acute bronchitis can be prevented by taking the following safety precautions:

Hand washing
Get vaccinated as recommended by your health physician, such as the flu vaccine
Quit smoking and avoid secondhand smoke
Remember to cover your mouth when you sneeze or cough

Things that help

Here are some strategies to help alleviate symptoms while combatting bronchitis:

Stay hydrated by drinking plenty of fluids.
Ensure you get ample rest.
Use saline nasal drops or sprays to relieve nasal congestion.
Employ a clean humidifier to moisten the air.
Clear mucus in young children with a rubber suction bulb.
Inhale steam from a container of hot water while showering.
Soothe your throat with lozenges; however, avoid giving them to children under four years old.
Adults and children aged one year or older can use honey to alleviate cough.
Consult your pharmacist or doctor for advice on over-the-counter medications that may provide relief. Follow the instructions carefully, as these medicines offer temporary relief but are not a cure for the illness.

Works cited

Antibiotic Prescribing and Use, 2021. Center for Disease Control. Chest Cold (Acute Bronchitis). Antibiotic Use. CDC
Acute Bronchitis, 2024. Hopkinsmedicine.org. Acute Bronchitis. Johns Hopkins Medicine
Bronchitis, 2017. Mayoclinic.org. Bronchitis - Symptoms and causes - Mayo Clinic

AHA resuscitation guideline update schedule

Wed, 13 May 2026 22:37:15 +0000

Update schedule {#update-schedule}

Guideline version	Release / publication date	Notes
2030 Guidelines	Expected October or November, 2030	Estimated based on five-year update cycle. Course rollout would follow over several months in 2031.
2025 Guidelines	Online November 2025	Full revision across all disciplines. Final searches executed through December 2024. Course materials expected to roll out through 2026.
2020 Guidelines	Online Oct 21, 2020; print Nov 4, 2020	Full revision. Updates across ACLS, BLS, PALS. Instructors required science update by Feb 2021.
2016 Course release (2015 Guidelines)	January–August 2016	Rolling release of instructor updates and course materials for BLS, ACLS, Heartsaver®, and PALS.
2010 Guidelines	Nov 2, 2010 (Circulation)	Major changes: C–A–B sequence (compressions first), stronger emphasis on high-quality CPR.
2005 Guidelines	Dec 13, 2005 (Epub Nov 28)	Compression-to-ventilation ratio set at 30:2, AED use emphasized, simplified BLS steps.
2000 Guidelines	Published 2000 (Circulation supplement)	“International Guidelines 2000 for CPR and ECC.” Global standardization; included ACLS, BLS, PALS.

Use this timeline to plan instructor refreshers, align learning materials, and communicate expectations to your training sites.

2025 guidelines update

The 2025 guidelines represent the latest comprehensive update to CPR and Emergency Cardiovascular Care science:

Published online November 2025 in Circulation
Evidence reviews executed through December 2024
Full revision across all resuscitation disciplines
Enhanced focus on special circumstances including updated drowning protocols, expanded toxicology guidance, and refined high-consequence pathogen management
Course materials and instructor updates expected to roll out progressively through 2026
Training centers should prepare for transition period and updated certification requirements

2020 guidelines update

Summary of changes:

Released online October 21, 2020; print version November 4, 2020.
Full revision across all disciplines: ACLS, BLS, PALS.
Expanded guidance on opioid-associated emergencies.
Refined BLS ventilation strategies.
Introduced pediatric airway changes.

2016 course release timeline (2015 guidelines)

The 2015 guidelines reshaped course delivery throughout 2016. Science content was published on schedule in October 2015, but supporting materials and instructor updates arrived in stages. Training centers had to keep a close eye on release announcements to stay compliant.

Instructor updates (January–February 2016)

Online updates for each discipline launched in late January.
Instructors certified in first aid, Heartsaver®, BLS, ACLS, or PEARS needed to complete six modules—one per discipline—by February 15, 2016.
Failure to finish the updates triggered full recertification requirements.

BLS releases (February 16, 2016)

Instructor and student manuals, updated videos, and algorithm cards shipped from distributors.
New online modules and blended options supported remote delivery.

March–April 2016 releases

ACLS: revised manuals, videos, posters, algorithm cards, and updated online/manikin-synthesizer formats.
Family & Friends® CPR Anytime kits with self-directed inflatables and videos.
Heartsaver® CPR AED and Heartsaver® First Aid packages with refreshed manuals, instructor guides, and video assets.

April–May 2016 releases

Family & Friends® CPR booklets and participation cards.
Heartsaver® Bloodborne Pathogens manuals and detachable certification cards.
Heartsaver® Pediatric First Aid CPR AED sets, including wall posters and instructor media.

July–August 2016 releases

Pediatric advanced life support (PALS) and Pediatric emergency assessment, recognition, and stabilization (PEARS) course materials closed out the cycle.

Keeping a dated inventory checklist during 2016 helped training sites swap out pre-2015 items, update LMS courseware, and brief instructors on each newly arriving resource.

The final course release is scheduled for July — August 2016. A specific date for the release has not been announced.

Pediatric advanced life support (PALS)
1. PALS student manual (including access to mandatory pretest online)
2. PALS instructor manual
3. PALS videos (DVD format)
4. PALS posters
5. PALS algorithm cards (assumed to have one set included with manual)
6. PALS mixed format online course (didactics online — skills with PALS instructor)
7. PALS online with maniken synthesizer (didactics online and practice and testing done with computerized manikin)
8. PALS certification cards (can be purchased only by community training center coordinators with secret number)
Pediatric emergency assessment, recognition and stabilization (PEARS)
1. PEARS student manual (including access to mandatory pretest online)
2. PEARS instructor manual
3. PEARS videos (DVD format)
4. PEARS posters
5. PEARS algorithm cards (assumed to have one set included with manual)
6. PEARS mixed format online course (didactics online — skills with PALS instructor)
7. PEARS online with maniken synthesizer (didactics online and practice and testing done with computerized manikin)
8. ACLS certification cards (can be purchased only by community training center coordinators with secret number)

That ends the scheduled releases for 2016. Going forward the AHA has said that they will update guidelines online as they become available rather than waiting for a conglomerate release every five years. How they are going to update course materials to match ongoing changes is still unknown.

There are several courses that are not being updated because they are unaffected by the guideline changes for 2015. They are:

Advanced cardiac life support for the experienced provider (ACLS — EP)
Airway management course
ECG and pharmacology course
STEMI course

AHA 2015 resuscitation updates

Release announcement

On October 1st, 2015 at exactly 12:01 a.m., the Emergency Cardiac Care Guidelines for 2015 were released in the Journal of Circulation. Because they are shrouded in such secrecy, they are always met with much anticipation. When they were published, the update included tweaks across basic life support, advanced cardiac life support, pediatric advanced life support, and first aid. There were no major clinical breakthroughs but several operational and training changes. The following is a concise summary of only the changes; it does not include unchanged recommendations or detailed scientific citations.

This document focuses on the updates that affect care for adults. To stay up-to-date with other breaking releases, please enter your email address on the bottom of this page.

Systems of care

Because the requirements and the availability of care differs significantly between cardiac arrest that occurs in the hospital and cardiac arrest outside of the hospital two different chains of command have been developed. The in-hospital cardiac (IHCA) arrest chain includes;

The in-hospital cardiac arrest (IHCA) chain includes

Surveillance and prevention
Recognition and activation of the emergency response system
Immediate high-quality CPR
Rapid defibrillation
Advanced life support and post-arrest care

The out of hospital cardiac arrest (OHCA) chain includes

Recognition and activation of the emergency response system
Immediate high-quality CPR
Rapid defibrillation
Basic and advanced emergency medical services
Advanced life support

Rapid response teams

The use of rapid response teams (RRT) or medical emergency teams (MET) to respond to deteriorating patients on general care wards for both adult and children hospitals are encouraged. Although they were in their infancy when the 2010 Guidelines were released, there is current scientific data to support their use to reduce the incidence of IHCA.

Adult basic life support changes for the lay rescuer

Dispatcher recognition of cardiac arrest
1. EMS dispatchers should be trained to inquire about agonal or absent respirations in all unresponsive patients
2. The assumption should be made that the patient is in cardiac arrest in the absence of consciousness and abnormal or absent breathing
3. Training should include the fact that brief seizure activity may be the first sign of cardiac arrest and should be recognized as such
4. All EMS dispatchers should be prepared to “talk the caller through the steps of CPR.”
5. Studies are being done to investigate the possible impact of utilizing social media to notify nearby potential rescuers to respond. This has been done in a limited way in a number of communities with success.
6. Lay rescuers are being encouraged to utilize their cell phones for 911 calls. When the dispatcher answers they are encouraged to put their cell phone on speaker, put it down, and begin compressions while speaking with the dispatcher.
Chest compressions
1. All laypersons should deliver Hands-Only CPR at a minimum. If they are trained and comfortable they may add ventilation at a ratio of 30:2
2. The rate of compressions has been increased from “at least 100” to between 100–120 compressions per minute.
3. Emphasize the importance of minimizing interruptions in order to maintain a high “compression fraction”
4. Compression fraction is the percentage of time compared to the total time that compressions are actually being done. The minimum goal should be 60%
5. Depth — should be at least 2 inches but no more than 2.4 inches. The most common error found was compressions that were too shallow. There was one small study that documented an increase in non-life-threatening injuries when compressions were done too deeply
Narcan administration
1. The guidelines support the use of Narcan either IM (autoinjector) or intranasal by trained lay responders in patients who are unresponsive and without normal breathing who are at risk of opioid overdose.

Adult basic life support for the healthcare provider

The main changes are in the way the patient is approached. The guidelines emphasize the ability to complete multiple steps simultaneously. For example, the rescuer is encouraged to check for normal breathing and a pulse at the same time rather than chronologically.
There is greater flexibility in the activationof the emergency response system to allow for the differences in environments of care.
There is also flexibility for the healthcare provider to tailor their response to the potential cause of arrest.
The emphasis is once again being placed on continuous compressions. The goal is a compression fraction of at least 60%.
The compression rate has been increased to 100–120 per minute.
Because the greatest emphasis is placed on a diastolic pressure (that’s when the arteries of the heart are filled) care must be taken not to lean on the chest wall preventing it from fully recoiling between compressions.
The recommended depth is unchanged. It is 2 inches, however, an upper limit has been added. It is 2.4 inches. In a relatively small study, some non-life-threatening injuries were caused by compressions that were too deep. Most errors in the delivery of compressions occurred when they were too shallow, not too deep.
AHA has accepted the application of passive ventilation and continuous chest compressions in groups of 200 as adopted by many EMS models.
If an advanced airway is in place, the ventilation rate has been changed from a range of 8–10 per minute to 10 a minute mainly to make it easier to teach.
The debate over shock first vs CPR first has been clarified. If a defibrillator or AED is immediately available it should be used. If it is not immediately available compressions should be performed until it is available. It should be utilized immediately after it arrives on the scene.
Feedback devices (including audiovisual prompting) have shown to be helpful in increasing the efficacy of CPR in a healthcare environment and are encouraged. However, there was no correlation between the use of compression devices and survival rates. The routine device of automated compression devices is not recommended. It may be reasonable to utilize a compression device in areas where high-quality compressions are hard to deliver, such as angiography suites or moving ambulances.
Delayed ventilation is acceptable in EMS systems that have a bundled response to cardiac arrest including up to 3 cycles of 200 continuous compressions with interposed shocks before active ventilation. Three studies of both urban and suburban systems have shown increased survival rates when this system was trained and used consistently within the system.
The routine use of impedance threshold devices (ITD) during CPR is not recommended.
If the cause of arrest is known and considered reversible, the use of extracorporeal techniques and invasive perfusion devices may be useful. The use of these devices routinely is not recommended.

Adult advanced cardiac life support

he combined use of vasopressin with epinephrine showed no advantage over the use of epinephrine alone. Therefore for the purpose of ease of teaching and limiting the number of pharmacological agents vasopressin has been removed from the cardiac arrest algorithm in the 2015 Guidelines.
End tidal C02 that remains low (less than 10mm) despite resuscitation is associated with a very low successful resuscitation rate. Therefore when used in conjunction with other indicators, a low end-tidal C02 after 20 minutes of resuscitation may help determine when to stop resuscitation.
There was an association of the administration of epinephrine earlier in arrest when treating a non-shockable rhythm with increased neuro intact discharge. Ideally, it should be administered within 1–3 minutes of arrest.
Post cardiac arrest there is no evidence to support the use of lidocaine infusion. However, there were no negative outcomes and therefore it is acceptable to consider its use.
Beta blockade post arrest — although there is no evidence to support the use of beta blockade in the immediate post-arrest period, it is acceptable practice to consider its use. Each patient should be evaluated individually as in some studies the use of beta-blockers post-arrest was associated with hemodynamic instability.

Post-cardiac arrest care — this is an area of great emphasis in the new guidelines as our goal is no longer return of spontaneous circulation but neuro intact survival. Neuro intact survival depends a lot on the level of care received in the immediate post-cardiac arrest phase of care.

Coronary angiography

Recommended emergently following cardiac arrest in the adult patient. It should not be delayed until the patient is stabilized or rewarmed. It should be done immediately upon return of spontaneous circulation. The vast majority of cardiac arrests are ischemic in nature. Angiography should be done whether or not the patient regains consciousness immediately post-cardiac arrest. The ramifications of leaving the vessel closed until a patient regains consciousness or if they regain consciousness is a very costly decision.
All adult patients without meaningful response to stimuli following cardiac arrest should have targeted temperature management (TTM). The targeted temperature for these patients is 32–36 degrees C and should be maintained for at least 24 hours.
Fever should be actively prevented following TTM.
The routine use of prehospital cooling for patients using infusions of cold IV fluids is not recommended. There was no documented advantage and potential complications were identified.
The goal blood pressure following cardiac arrest remains 90mmHg systolic or a mean arterial pressure of 65mmHG.
Determination of poor clinical outcome potential cannot be determined sooner than 72 hours after arrest in patients who have not been cooled. In patients who have been cooled, this must be extended to 72 hours after the patient has returned to normal temperature. This can also be elongated by the use of sedation or paralysis in the immediate post-cardiac arrest treatment phase.
All patients who progress to brain death following resuscitation should be considered potential organ donors. Patients who do not achieve ROSC should be considered for kidney and/or liver donations if a rapid recovery program exists in the area.

Acute coronary syndromes

Trained non-physicians are capable of obtaining and interpreting EKGs in the prehospital setting for evidence of ST-elevation MI (STEMI) and it should be a routine occurrence in EMS. 2.Direct transport to a facility capable of percutaneous coronary intervention is the preferred method of care for patients diagnosed in the field with STEMI.
Patients who receive fibrinolysis in hospitals not capable of PCI should be transported for angiography within 3–4 hours of administration.
Troponin alone should not be used to determine low risk and discharge. Troponin in conjunction with risk stratification must be utilized.
Complications of routine oxygen therapy have been well documented. Oxygen therapy should be withheld from acute coronary syndrome patients with normal oxygen saturations (94–99%).

Special resuscitation situations

Narcan — it is reasonable to administer Narcan to the patient who has abnormal breathing but a pulse who is at risk of opioid overdose. This training should have a first aid base rather than a healthcare provider base. Resuscitation should not be delayed while waiting for Narcan to work.
In pulseless patients, it may be reasonable to administer Narcan based on the fact that they may be in respiratory arrest with a very weak and possibly undetectable pulse. If pulseless arrest is definitive (i.e. obvious arrest, arterial monitoring) Narcan should not be administered and resuscitation should be performed according to the cardiac arrest algorithm.
Pregnancy — the priorities of resuscitation are high-quality CPR for the mother and relieving aortocaval compression. If the fundus height is at or above the umbilicus, manual left uterine displacement can be beneficial during compressions.
1. If maternal trauma makes arrest survival for the mom impossible, cesarean delivery should be done within 4 minutes of cardiac arrest. This decision is based on a number of factors including the environment and the level of training of those present.

update for cardiopulmonary resuscitation and emergency cardiovascular care. Retrieved from

https://www.cercp.org/wp-content/uploads/2015/10/Guidelines-RCP-AHA-2015-Full.pdf

2010 guidelines

The 2010 update marked a major pivot toward high-quality CPR. The sequence shifted to compressions–airway–breathing (C–A–B), prioritizing chest compressions with minimal interruptions. Emphasis on adequate depth, full recoil, and rate (at least 100 per minute) was coupled with a renewed focus on teamwork and post–cardiac arrest care bundles.

Implementation tips:

Reinforce compressor rotation every two minutes to avoid fatigue.
Integrate quantitative waveform capnography where available to guide resuscitation quality.
Pair algorithm refreshers with manikin practice to highlight the new cadence.

2005 guidelines

In 2005, the AHA simplified the public-facing message for lay rescuers and professionals alike. The compression-to-ventilation ratio standardized at 30:2 for single rescuers, early defibrillation received stronger emphasis, and automated external defibrillators (AEDs) were promoted for public access. New educational materials stressed minimizing pauses and providing clear, memorable steps.

For instructors, that meant revising slide decks, swapping out skill checklists, and adding AED practice scenarios to every certification pathway.

2000 guidelines

The “International Guidelines 2000 for CPR and Emergency Cardiovascular Care” represented a true global collaboration, harmonizing recommendations across ACLS, BLS, and PALS. For the first time, training centers worldwide could align to a unified standard instead of regional playbooks.

Training coordinators responded by updating policy manuals, translating courses, and building cross-border instructor networks—laying the groundwork for the rapid updates we manage today.

Airway management for obese patients

Wed, 13 May 2026 22:37:15 +0000

Obesity and its impact on airway management

Obesity is a growing global health concern, affecting both developed and developing nations. According to the World Health Organization (WHO), 43% of adults aged 18 and older are overweight, and 16% are classified as obese (WHO, 2024). Obesity is closely linked to cardiovascular diseases, including dyslipidemia, type 2 diabetes, hypertension, sleep disorders, and is a major risk factor for developing heart failure. (Powley et al, 2021)

Obesity is typically measured using body mass index (BMI); however, BMI alone does not account for fat distribution, a critical factor in cardiovascular risk.

Respiratory physiology of an obese patient

Obesity significantly alters respiratory physiology, impacting airway management and mechanical ventilation. Anatomically, increased cervical adipose tissue results in an enlarged neck circumference, strongly associated with upper airway obstruction and obstructive sleep apnea (Parker, 2019). Soft tissue deposition in the oropharynx further narrows the airway, while increased dorsocervical fat reduces neck extension, making airway management more challenging.

Obesity leads to a reduction in lung volumes, with the most significant decreases observed in functional residual capacity (FRC) and expiratory reserve volume (ERV). Notably, the greatest rates of decline in FRC and ERV occur in individuals who are overweight or have mild obesity. For instance, at a body mass index (BMI) of 30 kg/m², FRC and ERV are approximately 75% and 47%, respectively, of the values found in lean individuals with a BMI of 20 kg/m² (Jones, 2006). Among these, the reduction in FRC is most critical, as it predisposes patients to airway closure, increased airway resistance, atelectasis, and intrapulmonary shunting. Additionally, increased thoracic adipose tissue decreases chest wall compliance, further exacerbating respiratory difficulties, especially when the patient is in a supine position (Anozi, 2021).

Intubation in obese patients

Obese patients have a limited cardiopulmonary reserve and can experience rapid oxygen desaturation during intubation. Factors such as a short, thick neck, diabetes mellitus, and abnormal dentition contribute to difficult intubation (Parker et al., 2019). Anticipating airway difficulties, emergency personnel must optimize intubation conditions to minimize complications.

Preoxygenation strategies

Preoxygenation aims to maximize oxygen reserves by replacing nitrogen in the FRC with oxygen. Standard preoxygenation methods include:

Face mask (FM) with 100% FiO2
Bag-mask ventilation (BMV)
Noninvasive positive pressure ventilation (NIV)
High-flow nasal cannula (HFNC)

Optimal patient positioning

Proper positioning enhances both preoxygenation and intubation success. Due to their altered respiratory physiology, obese patients should be positioned:

Semirecumbent (head of the bed elevated to 25 degrees) or upright during preoxygenation to reduce air trapping and atelectasis while improving oxygen saturation.
Head-up or ramped position during intubation to optimize the laryngoscopic view. The patient’s sternal notch should be aligned with the external auditory meatus to ensure optimal airway access (Leiw et all, 2022).

Mechanical ventilation in obese patients

Ventilator mode

Both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are utilized in clinical practice. PCV may offer advantages in alveolar recruitment due to its decelerating inspiratory flow pattern.

Respiratory rate and PEEP

Obese patients often have reduced functional residual capacity (FRC) and are more prone to atelectasis. Applying higher positive end-expiratory pressure (PEEP) can help prevent airway closure and atelectasis.

Tidal volume

To minimize the risk of ventilator-induced lung injury, it’s recommended to calculate tidal volume based on ideal body weight, typically targeting 6–8 mL/kg.

Conclusion

Obese patients present unique challenges in emergency airway management due to altered respiratory physiology, difficult intubation, and rapid oxygen desaturation. Emergency providers must adapt their approach by employing appropriate preoxygenation techniques, optimal patient positioning, and individualized mechanical ventilation strategies. By implementing these evidence-based interventions, healthcare providers can reduce morbidity and mortality in this high-risk patient population.

Citations

Ball, L., Pelosi, P. How I ventilate an obese patient. Crit Care 23, 176 (2019). https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2466-x
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J. P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., St-Onge, M. P., & American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council (2021). Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation, 143(21), e984–e1010. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000973
Anozie, O., Zahid, B., Murali, S., & Author, G. (2021, July 2). Obesity and respiratory mechanics. CriticalCareNow. https://criticalcarenow.com/obesity-and-respiratory-mechanics/
Liew, W. J., Negar, A., & Singh, P. A. (2022). Airway management in patients suffering from morbid obesity. Saudi journal of anaesthesia, 16(3), 314–321. https://doi.org/10.4103/sja.sja_90_22
Parker, B. K., Manning, S., & Winters, M. E. (2019). The Crashing Obese Patient. The western journal of emergency medicine, 20(2), 323–330. https://escholarship.org/uc/item/4nd1w8r4
Lemyze, M., et al. (2013). “Pressure-controlled vs. volume-controlled ventilation in acute respiratory failure.” Critical Care, 17(1), R21.
Jones, R. L., & Nzekwu, M. M. (2006). The effects of body mass index on lung volumes. Chest, 130(3), 827–833. https://linkinghub.elsevier.com/retrieve/pii/S0012369215527980
Parker, B. K., Manning, S., & Winters, M. E. (2019, March). The crashing obese patient. The western journal of emergency medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6404698/
World Health Organization (WHO). (2024). “Obesity and Overweight.”

Heart disease: angina pectoris

Wed, 13 May 2026 22:37:15 +0000

When the heart does not receive sufficient oxygen-rich blood flowing through it, discomfort and chest pain result. This chest pain is called “angina.” Some people describe angina as pressure or a tight chest squeeze. Angina is not a disease. Rather, angina is a symptom of other heart issues, such as coronary heart disease.

“Chest pain” by Sinclair.Sharon28 is licensed under CC BY 2.0

Different types of angina

Several types of angina exist, including stable angina, unstable angina, variant (Prinzmetal’s) angina, microvascular angina, and atypical angina. Different types of angina have different symptoms and different triggers that cause the symptoms.

Stable angina

Stable angina describes angina pectoris. This type of angina occurs in connection with coronary heart disease when the heart is deprived of sufficient amounts of blood. This situation typically occurs due to narrowing or blockages of coronary arteries. Blocked arteries may enable sufficient blood flow to the heart during periods of rest or light physical exertion. However, when the heart must pump faster to keep up with more physical exertion, the narrowed arteries will not allow enough blood to flow through them, and angina will occur.

Unstable angina

Unstable angina may also be called “acute coronary syndrome.” With unstable angina, chest pain occurs unexpectedly, even at rest. Atherosclerosis, fatty buildup in coronary arteries, may lead to a rupture. This could completely block blood flow to the heart. Unstable angina is an emergency situation that could lead to a heart attack.

Variant angina (Prinzmetal’s angina)

Variant or Prinzmetal’s angina is an uncommon type of angina, typically occurring in younger people. Variant angina usually happens while a person is sleeping during the overnight hours. This type of angina is exceedingly painful, and it occurs from a spasm of the coronary arteries.

Microvascular angina

Microvascular angina is often associated with coronary microvascular disease. This type of heart disease involves the smallest coronary artery blood vessels of the heart. When these tiny arterial blood vessels spasm, the flow of blood to the heart becomes restricted. This restriction causes angina symptoms.

Atypical angina

Some people experience angina that does not fit the normal symptom parameters. This type of angina is called atypical angina. Women usually experience atypical angina more than men do. Atypical angina symptoms include:

an indistinct discomfort in the chest,
nausea
fatigue
indigestion
shortness of breath
pain in the neck and back

What are the symptoms of angina?

Angina typically involves a group of symptoms centering on the heart in the upper body. If pain or pressure in the chest lasts more than a moment or two and does not subside with rest, get medical assistance immediately. Medical intervention, including CPR, can limit permanent damage from a heart attack. Anyone can perform CPR and restore blood flow to the heart muscle in the event of a heart attack.

The symptoms include

Sharp or indistinct chest pain
Pain in the shoulders, arms, neck, or jaw
Sweating
Nausea
Restlessness
Chest pressure
Burning or nagging indigestion
Shortness of breath
Fatigue
Dizziness

Learn more about symptoms and management of angina pectoris by our AHA ACLS renewal online.

Aggravating factors for angina pectoris

There are certain things that increase your risk of angina, particularly if your vessels are already blocked. Some of these situations that aggravate angina pectoris include:

Physical activity
Extreme heat or cold
Emotional stress
Large or rich meals
Drinking too much alcohol
Cigarette smoking

Diagnosis of angina pectoris

Electrocardiogram (EKG): An EKG records the electric rhythm of the heart, to evaluate any abnormal rhythms or damaged muscle.
Stress test: The test checks your heart’s ability to tolerate stress, like exercise. The heart can be evaluated by:
- EKG and treadmill
- Nuclear perfusion with a radioactive tracer detected by nuclear camera.
- Stress echocardiogram with an EKG and ultrasound of the heart.
Cardiac catheterization: A wire is passed into the coronary arteries and a contrast dye is injected into your artery. X-rays are taken to evaluate the vessels for narrowing, blockage, or any other signs of coronary artery disease.
Cardiac MRI or CT scan: A test to look at blood flow to the heart, and possibly calcium and plaque build-up.

Angina increases the risk of a cardiovascular event, like a heart attack. Angina pectoris means that your heart is not getting enough oxygen. Familiarizing yourself with basic life support (BLS) for cardiopulmonary resuscitation (CPR) can save lives.

“EKG” by mgstanton is licensed under CC BY-NC-ND 2.0

Treatment of angina pectoris

Treatment depends on your overall health and the severity of the pain. The goal is usually to treat it with a medication that improves blood flow to the heart.

The most common medication for angina is nitroglycerin, which is taken up to three times following the start of chest pain but cannot be taken in conjunction with erectile dysfunction medications.

Other medications also treat angina, like:

Beta-blockers: A drug that blocks a hormone that increases heart rate and blood pressure and relaxes the blood flow to improve blood flow.
Calcium channel blockers: A medication that helps to open coronary arteries.

Angina pectoris resources

Angina overview this web page presents information about angina symptoms, diagnosis, risk factors, and treatment.
Angina pectoris explore the different types of coronary artery disease and the classification of angina pectoris on this web page.
Angina/angina pectoris read a basic explanation of angina pectoris on this web page, including descriptions of the pain commonly experienced by people.
Chest pain of angina can be a symptom of coronary artery disease this web page presents comprehensive information about angina pectoris.
What is angina pectoris view a video or read a transcript that explains the causes of angina pectoris.
Angina pectoris treatment management the main goals of treatment in angina pectoris are to relieve the symptoms, slow the progression of the disease, and reduce the possibility of future events, especially MI and premature death.
Angina overview Cedars-Sinai presents information about angina, including symptoms, diagnosis, and treatment options.
Angina pectoris learn the difference between angina and a heart attack on this web page.
Signs and symptoms of coronary heart disease this web page presents an overview of coronary heart disease, explaining angina as the most frequent symptom of coronary heart disease.
Medication vs. stents for heart disease treatment explore different treatment options for patients with stable angina on this web page.
Exercise prescription heart disease learn about heart disease and how exercise can be beneficial for these patients on this web page.
Exercise for patients with coronary artery disease this report explains angina pectoris and how exercise can improve the health of patients.

In order to get details about heart diseases and angina pectoris checkout our ACLS certification and ACLS online recertification courses.

Aortic aneurysm

Wed, 13 May 2026 22:37:15 +0000

An aortic aneurysm is a condition in which the aorta, the main artery that carries blood from the heart to the chest and abdomen, bulges or balloons out. The part of the aorta that runs through the chest is called the thoracic aorta, while the segment that passes through the abdomen is known as the abdominal aorta.

Normally, the walls of the aorta are strong enough to withstand the force of blood flow. However, various medical conditions, genetic factors, or physical injuries can weaken or damage these walls. As a result, the pressure of blood flowing through weakened or damaged areas can cause an aneurysm to form.

Aortic aneurysms can lead to two critical complications:

Dissection: The force of blood flow can cause the layers of the artery wall to separate, resulting in blood leakage between them.
Rupture: The aneurysm may burst completely, causing internal bleeding.

Dissections and ruptures are the primary causes of most deaths associated with aortic aneurysms.

In 2019, aortic aneurysms or aortic dissections caused 9,904 deaths. Nearly 59% of these deaths among males were attributed to these conditions.

Types of aortic aneurysm

Abdominal aortic aneurysm

An abdominal aortic aneurysm is a condition where the aorta, the main blood vessel that supplies blood to the body, bulges or swells up in the abdomen area. It is more common than thoracic aneurysms. This condition usually affects men who are 65 years or older, and is more prevalent among white individuals than black individuals.

Atherosclerosis, which is the hardening of arteries, is the primary cause of abdominal aortic aneurysms. However, injury or infection can also contribute to their formation. In many cases, there are no symptoms of abdominal aortic aneurysms. However, if symptoms do appear, they may include:

Deep pain or throbbing sensations in the back or side.
Discomfort in the legs, groin, or buttocks.

Thoracic aortic aneurysm

A thoracic aneurysm is a condition that develops in the chest cavity and affects both men and women equally. This condition is more common in older individuals. Thoracic aortic aneurysms are usually caused by sudden injury or hypertension. People with inherited connective tissue disorders such as Ehlers-Danlos syndrome and Marfan syndrome are at a higher risk of developing thoracic aneurysms.

Symptoms of thoracic aortic aneurysm may include sudden, sharp chest or upper back pain, difficulty breathing or swallowing, and shortness of breath. If you experience any of these symptoms, it is important to seek medical attention immediately.

Other types of aneurysms

Aneurysms can develop not only in abdominal and thoracic aortas but also in other parts of the body. The rupture of a brain aneurysm can lead to a stroke, while peripheral aneurysms, found outside the aorta, can occur in the neck, groin or behind the knees. Although these types of aneurysms are less prone to rupture than aortic aneurysms, they can still cause blood clots to form. These clots can detach and obstruct blood flow within the artery.

Symptoms

Aortic aneurysms can occur without any noticeable symptoms. The symptoms primarily depend on the location of the aneurysm and how it affects nearby bodily structures. Symptoms may include:

Feeling full even after eating small amounts of food.
Hoarseness.
Painful or difficult swallowing if the aneurysm is pressing on the esophagus, which connects the mouth to the stomach.
Difficulty breathing if the aneurysm is compressing the trachea or windpipe.
Pain in the back, jaw, neck, chest, shoulder, or abdomen, depending on where the aneurysm is located.
Shortness of breath caused by lung compression.
Sensation of pulsing or throbbing in the abdomen.
Swelling of the neck, face, or arms if the aneurysm is compressing the superior vena cava, the main vein that returns blood from the upper body to the heart.

It is crucial to recognize the symptoms of a ruptured or burst aorta if you suspect an aortic aneurysm, as rapid intervention can be life-saving. Symptoms of a rupture may include:

Dizziness or lightheadedness.
Rapid heartbeat.
Sudden and severe pain in the chest, back, or abdomen.

Risk factors

Certain unhealthy habits and medical conditions can increase the chance of developing aortic aneurysms, which are a bulge in the wall of the aorta. Smoking cigarettes is the most common risk factor. Other factors that can contribute to aortic aneurysms include:

Genetic predisposition
Advancing age
Family medical history
Hypertension (high blood pressure)
Elevated levels of blood cholesterol
Atherosclerosis (hardening of the arteries)

Inherited connective tissue disorders like Ehlers-Danlos syndrome and Marfan syndrome can also increase the risk of aortic aneurysms. Similarly, if you have a family history of aortic aneurysms, you may be more likely to develop this condition.

Prevention

Making certain heart-healthy lifestyle changes can help prevent the development of an aneurysm. These changes might include:

Eating a heart-healthy diet
Avoiding stimulants like cocaine
Quitting smoking, as cigarette smoking is one of the leading risk factors for this condition
Managing stress, as it can help to avoid hypertension.

Treatment

Aortic aneurysms can grow and expand without any noticeable signs or symptoms. As they enlarge, they become a serious risk for rupturing or damaging the artery wall, which can cause life-threatening consequences. Timely diagnosis and intervention are crucial to manage this condition effectively and prevent serious harm.

The primary forms of treatment for aortic aneurysms are medications and surgical procedures. Medications are used to control high blood pressure and reduce the risk of aneurysm formation, while surgery is performed to replace or repair the affected segment of the aorta. Early intervention is essential to ensure the best possible outcomes and minimize the chances of severe complications.

Work cited

Aortic aneurysm. 2023. Mayoclinic.org. Aortic aneurysm - Symptoms and causes - Mayo Clinic
Aortic Aneurysm. 2021. CDC.gov. Aortic Aneurysm. cdc.gov
Aortic Aneurysm Symptoms. 2022. NHLBI.NIH.gov. Aortic Aneurysm - Symptoms. NHLBI, NIH
Aortic Aneurysm. 2022. My.Clevelandclinic.org. Aortic Aneurysm: Symptoms & Treatment

Atrial septal defect (ASD): causes and symptoms

Wed, 13 May 2026 22:37:15 +0000

The atrial septal defect (ASD) is a congenital cardiac disorder in which a hole in the wall (septum) divides the upper chambers (atria) of the heart. The hole can differ in size and may close on its own or need surgery. The atrial septal defect is a congenital cardiac defect that exists at the time of birth.

There is always an opening between the upper heart chambers of a baby at the time of birth called the foramen ovale. This opening allows fetal circulation to bypass the lungs until birth. This opening is no longer required and usually closes or becomes very small within some time after birth. However, if the opening is larger than normal, it may not close after birth.

If these openings do not close, a hole is left in the atria, and is called an atrial septal defect. The hole increases blood flow to the lungs and may damage the blood vessels in the lungs later on. Damage caused to the blood vessels in the lungs can lead to cardiac problems in adulthood, including pulmonary hypertension in the lungs, an arrhythmia (abnormal heartbeat), stroke, and cardiac arrest.

Atrial septal defects are among the most common types of congenital heart defects. These defects are often diagnosed in adulthood and found more commonly in females than males.

Causes

There are no known causes of atrial septal defects among most babies. Some babies have cardiac conditions due to genetic conditions. These types of cardiac defects may be caused due to a combination of genes and other risk factors, such as environmental conditions, food, and drugs.

Types

Atrial septal defects types include:

Secundum - This is the most commonly found type of atrial septal defect. It develops in the center of the wall between the upper heart chambers (atrial septum).
Primum - This type of atrial septal defect occurs in the lower part of the atrial septum. It can also occur with other congenital cardiac defects.
Sinus venosus - This type of atrial septal defect rarely occurs in the upper part of the wall separating the heart chambers. It can occur along with other heart structure changes present at the time of birth.
Coronary sinus - In this rare condition of the atrial septal defect, part of the wall between the coronary sinus, which is the vital part of the vein system of the heart, and the left upper heart chamber (left atrium) is not present.

Risk factors

The atrial septal defect occurs when the baby’s heart is in the process of developing during pregnancy. Some health conditions or medicines during pregnancy can increase a baby’s risk of ASD or other congenital cardiac defects.

The risk factors can include:

Diabetes
Lupus
Alcohol or tobacco use
Rubella (German measles) infection in the first few months of pregnancy
Illegal drug use, such as cocaine
Use of certain drugs, including some anti-seizure medicines for treating mood problems
Some types of congenital cardiac disorders are inherited.

If the patient’s family history includes a congenital cardiac disorder, such as an atrial septal defect, screening by a genetic counselor can help ascertain the risk of cardiac disorders in future babies.

Complications

A minor atrial septal defect doesn’t cause any concern, as these defects often close during infancy on their own.

Larger atrial septal defects can result in serious complications, which can include:

Stroke
Early death
Right-sided heart failure
Irregular heartbeats
Hypertension in the lungs and arteries (pulmonary hypertension)

Pulmonary high blood pressure can lead to permanent lung damage. This complication, called Eisenmenger syndrome, typically develops over time and can occur in untreated large atrial septal defects.

Prevention

As the exact cause of the atrial septal defect is unknown, prevention is currently impossible. However, getting proper prenatal care is important. Those planning to have a baby with an atrial septal defect should work closely with their health care provider.

Their visits should target:

Discussing present health conditions and medications under use. Certain health conditions, such as diabetes or lupus, are monitored during the entire pregnancy. Your health care provider can also suggest adjusting some medications before pregnancy.
Reviewing your family medical history. If you have a family medical history of congenital cardiac disorders or other genetic conditions, consult with a genetic advisor to determine your risk factors.
Prenatal screening, like testing for immunity to German measles (rubella). Rubella in the mother can lead to some types of congenital cardiac disorders in the baby. Ensure to get properly vaccinated before pregnancy if you’re not immune.

Treatment

Treatment for an atrial septal defect (ASD) depends on the size of the hole, the patient’s age, the number and severity of symptoms, and the presence of other cardiac conditions. Sometimes certain medicines are prescribed to help treat symptoms. Sometimes the hole is repaired via surgery. There are no specific medications that can help in repairing the hole.

If a baby is diagnosed with an atrial septal defect, the health care provider may monitor it for a certain period of time to see if the hole closes on its own. During this period, the health care provider will treat symptoms with medications. To prevent cardiac problems later in life, the health care provider can recommend the atrial septal defect be treated for a baby. Closure can also be recommended for an adult with severe or many symptoms. Closure of the hole may be done during heart catheterization or open-heart surgery. After completing these procedures, follow-up care will depend on the patient’s age, the size of the hole, and whether the patient has any other birth disorders.

Works cited

Centers for Disease Control and Prevention. Congenital Heart Defects- Facts about atrial septal defects. January 24, 2022. Accessed August 30, 2022. https://www.cdc.gov/heart-defects/about/atrial-septal-defect.html
Cleveland Clinic. Atrial septal defect. July 15, 2022. Accessed August 30, 2022. https://my.clevelandclinic.org/health/diseases/11622-atrial-septal-defect-asd
Mayo Clinic. Atrial septal defect (ASD). March 1, 2022. Accessed August 30, 2022. https://www.mayoclinic.org/diseases-conditions/atrial-septal-defect/symptoms-causes/syc-20369715

Bag valve mask ventilation: indications, equipment & techniques

Wed, 13 May 2026 22:37:15 +0000

Bag valve mask (BVM) ventilation is critical for medical professionals, especially in emergencies. Effective use of BVM ventilation requires deliberate practice and proper patient positioning. One of the most crucial aspects of this procedure is ensuring an open airway, as airway occlusion can occur due to the tongue falling back against the pharynx. Techniques such as the chin lift, head tilt, or jaw thrust maneuver can help maintain airway patency. The sniffing position, which aligns the external auditory meatus with the sternal notch through slight neck flexion and head extension, can optimize airway management and facilitate successful ventilation.
Many BVMs have features like one-way or pressure valves to regulate ventilation. A continuous oxygen supply is required to deliver oxygen effectively. Acronyms such as MOANS (Mask seal, Obesity, Aged patients, no teeth, Stiff lungs) and BONES (Beard, Obesity, no teeth, Elderly, Snoring/sleep apnea) help identify patients who may be difficult to ventilate. In cases where BVM ventilation is challenging, using supraglottic airway devices may improve success rates.

Indications

Bag valve mask ventilation is indicated in the following conditions:

Hypercapnic respiratory failure: Elevated carbon dioxide levels with reduced oxygenation.
Impaired airway protection: Due to altered mental status or loss of consciousness.
Apnea: Cessation of breathing.
Hypoxic respiratory failure: Low oxygen levels with near-normal carbon dioxide levels.
Anesthesia induction: Used during elective surgical procedures to support ventilation.

Equipment required

Essential equipment for BVM ventilation includes:

A bag valve mask.
An oxygen source with appropriate tubing.
Basic airway adjuncts such as a nasopharyngeal airway (NPA) or oropharyngeal airway (OPA).
A PEEP (Positive End-Expiratory Pressure) valve, if needed.

While one provider can perform BVM ventilation, a two-person technique is generally more effective, as one rescuer maintains the mask seal while the other squeezes the bag.

Preparing for bag valve mask ventilation

An oropharyngeal airway (OPA) is often used when the patient is unconscious to prevent airway occlusion due to the tongue falling back. The OPA can be inserted directly or rotated 90 to 180 degrees before positioning it behind the tongue. Nasopharyngeal airways (NPAs) can also be used in semi-conscious patients.
Positioning is critical for effective ventilation. The rescuer should stand at the head of the patient, ensuring the mask forms a tight seal over the nose and mouth. The pointed end of the mask should rest over the nasal bridge, and the curved end should cover the lower lip.

One-person BVM technique

If only one rescuer is available, the E-C seal technique is used:

The thumb and index finger form a “C” over the mask, pressing it firmly against the patient’s face.
The middle, ring, and little fingers form an “E,” applying pressure to the mandible to maintain an open airway.
If necessary, the head-tilt chin-lift or jaw-thrust maneuver can be used to further open the airway.

Two-person BVM technique

Research suggests that two-person BVM ventilation is more effective than the single-rescuer method. When two providers are available:

One rescuer maintains an effective mask seal using both hands.
The second rescuer squeezes the bag to deliver the appropriate tidal volume.
Replacing the standard E-C clamp with a thenar eminence grip can improve the mask seal and ventilation efficiency.

A BVM with a minimum oxygen flow of 15 liters per minute and a full reservoir bag can deliver nearly 100% oxygen. Care should be taken to avoid excessive ventilation, which can lead to gastric insufflation, vomiting, or barotrauma due to overdistension of the lungs. Low-volume, low-pressure ventilation strategies can help mitigate these risks.

Conclusion

Bag valve mask ventilation is a vital, life-saving technique used by EMS personnel, nurses, intensivists, and respiratory therapists. There are two primary methods: the one-person and two-person techniques, with the latter being more effective. Compared to intubation, BVM ventilation is simpler and faster to perform, making it an essential skill in emergency airway management.

Bucher, J. T. (2023, May 21). Bag-valve-mask ventilation. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK441924/
Bucher, J. T., Vashisht, R., Ladd, M., & Cooper, J. S. (2023). Bag-Valve-Mask Ventilation. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/28722953/
Davidovic, L., LaCovey, D., & Pitetti, R. D. (2005). Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children. Annals of emergency medicine, 46(1), 37–42. https://linkinghub.elsevier.com/retrieve/pii/S0196064405001435

Basic life support and emergency CPR

Wed, 13 May 2026 22:37:15 +0000

Cardiopulmonary resuscitation, commonly abbreviated as CPR, is a form of basic life support used during a life-threatening emergency. Situations that call for CPR include cardiac arrest, near-drowning incidents, suffocation, or any situation in which a person is unresponsive and not breathing normally (e.g., only gasping).

The goal of performing emergency CPR is to ensure the circulation of oxygen-rich blood to the brain. This action can help prevent brain damage or death from occurring. It is essential that both adults and children learn the basics of performing CPR.

Why is it important to learn CPR?

There are many reasons why learning CPR is important. Approximately 350,000 to 360,000 out-of-hospital cardiac arrests occur each year in the United States. A majority of those take place in a home; however, 70 percent of people in the U.S. don’t know CPR or have forgotten how to do it. All parents of infants and young children should also learn how to perform CPR so that they can take appropriate action if their child stops breathing. Acting swiftly often means the difference between life and death in any of these situations.

Learning how to do CPR

The best way to learn CPR is to take a course. Local hospitals and colleges may offer CPR classes to the public.

During these classes, people learn the guidelines for cardiopulmonary resuscitation and how to provide it adequately for adults, children, and infants. Qualified instructors teach these courses and use mannequins to demonstrate the correct steps.

Even if a person is unable to take a CPR course, he or she should learn hands-only CPR; this simple technique is illustrated on the American Heart Association’s website. Hands-only CPR is a simple-to-learn emergency CPR technique that can save the life of a loved one or anyone in need.

Important guidelines

There are a few guidelines for cardiopulmonary resuscitation that people should follow before attempting to administer help. The first instruction is to determine if the person is conscious. To do this, use a loud voice and ask if the person is okay while tapping them. It is okay to gently shake a person only if there is no risk of a back or neck injury.

Another essential rule before attempting emergency CPR or any other type of basic life support is to contact emergency services so that professional help arrives as quickly as possible. If an infant or a child who has not yet reached puberty needs CPR, the parent or guardian should contact emergency services after performing CPR for two minutes if they are alone.

If more than one person is present, one should call 911 while the other begins performing CPR. There are also guidelines on what type of CPR to perform. People who are not trained in CPR, or who are trained but not confident, should perform hands-only CPR for adults, while conventional CPR with compressions and rescue breaths is recommended for infants and children. If trained, a person should begin CPR using the CAB sequence: compressions, airway, and breaths.

To perform hands-only CPR on an adult or a teenager who suddenly collapsed, place your hands together with one on top of the other. The heel of the bottom hand should then be placed on the center of the unconscious person’s chest. The person must then straighten his or her arms, lock the elbows, and press down on the unconscious person’s chest repeatedly.

What to take into account when performing CPR

When performing CPR on a child, use one or two hands depending on the size of the child. For an infant, use two thumbs encircling the chest when two rescuers are present. The pressing motion should be relatively hard and fast, keeping the beat of the disco classic “Stayin’ Alive” from the movie Saturday Night Fever. The American Heart Association recommends the beat from this song because it accurately matches the rate that a person should push on the chest, which is 100–120 beats per minute. Continue this until help arrives.

When performing full CPR, a simple way to remember the three steps is to memorize the acronym CAB. CAB stands for compressions, airway, and breaths; this is the correct order to follow when providing CPR. Compressions are performed in the same manner as hands-only CPR.

Unlike the hands-only method, which continues with compressions until help arrives, 30 compressions should be performed before checking the airway. To open the airway, tilt the head back and lift the chin up. If the person is not breathing normally or not breathing at all, then emergency breaths are needed.

Emergency breaths involve pinching the nose and breathing into the mouth of the unconscious individual to force air into the lungs; this is done twice, with each breath lasting one full second. Thirty chest compressions follow the breaths. The cycle repeats until emergency responders arrive or the individual begins breathing on his or her own. When giving rescue breaths to an infant, a person should use their mouth to cover both the baby’s mouth and nose before delivering gentle puffs of air.

A person can never be sure when or if they will be in a situation where cardiopulmonary resuscitation is required. While everyone should know how to deliver CPR in an emergency situation, it is essential that mothers, fathers, or guardians of small children know how to react if a child is not breathing. Responding quickly and providing the necessary basic life support may save a life. Taking a class can help individuals learn practical facts about CPR, as well as the important steps for performing it safely and accurately on children, infants, and adults.

The following links provide further information about CPR.

How are BLS, CPR and CPRFAAED courses different?

Wed, 13 May 2026 22:37:15 +0000

BLS, CPR/AED, and CPR/first aid/AED certifications teach overlapping life-saving skills but are designed for different audiences and workplaces.

Which course should you take?

Choose CPRFAAED if you work in childcare, schools, coaching, or a non-medical workplace that asks for CPR, AED, and first aid.
Choose BLS if you are a healthcare provider or student who needs a healthcare-provider card and team-based resuscitation skills.
Choose CPRAED if you need a shorter CPR + AED option without first aid content (when accepted by your employer).

flowchart TD
  A[Which certification do you need?] --> B{Where will you use the training?}
  B -->|Hospital or healthcare job| C[BLS certification]
  B -->|School, workplace, childcare| D[CPR, first aid, AED certification]
  B -->|Not sure| E{Does the requirement mention first aid?}
  E -->|Yes| D
  E -->|No| F[CPR, AED certification]
  C --> G[Healthcare team response training]

Definitions used

The terms on this page follow nationally recognized training frameworks:

BLS teaches immediate, foundational resuscitation skills: high-quality CPR, ventilations, and early AED use, with an emphasis on team dynamics in clinical settings. See the AHA BLS course description.
CPR refers to the core skill of chest compressions and rescue breaths used to maintain circulation during cardiac arrest.
AED is a portable device that analyzes heart rhythm and delivers a shock to restore normal rhythm when needed.
First aid covers basic medical care for injuries, illnesses, choking, burns, and allergic reactions.

In most training systems, BLS focuses on high-quality CPR, ventilation skills, and early AED use in prehospital and in-facility settings. First aid is usually a separate course. Our catalog bundles these skills differently depending on the product you choose.

Three courses

We offer three courses that cover overlapping skills at different levels. These courses exist because different jobs require different levels of emergency response training. Healthcare providers work in teams and use specialized equipment, while workplace responders or teachers are usually individual rescuers who need simpler protocols.

Basic life support (BLS)

For healthcare providers

Cardiopulmonary resuscitation & automated external defibrillator (CPRAED)

CPR + AED without first aid

Adult, child, & infant CPR, first aid & AED (CPRFAAED)

For childcare, schools, and non-medical professionals

How the skills build on each other

flowchart BT
  A[CPR skills] --> B[BLS for healthcare providers]
  A --> C[CPR and AED training]
  C --> D[CPR, first aid, AED training]
  B --> E[Advanced cardiovascular life support]

Course comparison

Course feature	BLS	CPRAED	CPRFAAED
Who it is for	Healthcare providers	Individuals who need CPR + AED without first aid	Childcare, schools, non-medical workplaces
Setting	Clinical and prehospital	Clinical and prehospital	Community, workplace, school
CPR	✅	✅	✅
AED	✅	✅	✅
Breathing with a bag-mask (BVM)	✅	✅	❌
Team dynamics	✅	❌	❌
First aid	✅ (bundled in our course)	❌	✅
Typical requirement source	Employer (hospital, clinic, EMS)	Employer (healthcare)	Employer/school/OSHA
Skills check	Form provided; optional add-on	Form provided; optional add-on	Included in price

Full syllabi:

BLS syllabus — for healthcare providers
CPRAED syllabus — CPR + AED without first aid
CPRFAAED syllabus — for childcare, schools, and non-medical professionals

Which one should I enroll in?

If you work in a child care facility, school, or are a non-medical professional, you want the CPRFAAED course. This course is designed for teachers, coaches, camp counselors, and others who need OSHA-compliant training.
If you work in any medical setting (hospital, clinic, nursing home, EMS, etc.), you want the BLS course. This includes doctors, nurses, EMTs, paramedics, and other healthcare professionals.
For healthcare providers who want a fully online course without first aid, you want the CPRAED course. This is also for healthcare professionals but focuses on CPR and AED without the first aid component.

Or if you are enrolling a group of people, please use our group customer page.

What employers typically require

Hospitals, clinics, and EMS agencies almost always require BLS certification for all patient-facing staff.
Dental offices and pharmacies often accept either BLS or CPRAED depending on state regulations.
Schools, daycares, and camps typically require OSHA-compliant CPR/first aid/AED training, which is covered by CPRFAAED.
Corporate offices and general workplaces with OSHA requirements for designated first aid responders should use CPRFAAED.

If you are unsure, ask your employer or school for the exact card name they accept.

Renewal

Most CPR, BLS, and ACLS certifications are valid for two years from the date of issue, though exact requirements depend on the training organization and employer policies. We recommend starting your renewal course about 30 days before your expiration date to ensure continuous certification.

Conformance and approvals

Our courses have different accreditations, outlined here:

BLS	CPRAED	CPRFAAED
AMA, ANCC, ACPE, ADA, IPCE, 8 hours	AMA, ANCC, 3 hours	State approvals, no medical CE credit

And those are American Medical Association (AMA), American Nurses Credentialing Center (ANCC), Accreditation Council for Pharmacy Education (ACPE), American Dental Association (ADA) and Interprofessional Continuing Education (IPCE).

Our specific state/province, local, and federal approvals are extensive. See our accreditations page and click through to your state/province.

eCards

All options provide a verifiable eCard with an issue date and renew-by date (two years from issue).

Basic life support (BLS)

Cardiopulmonary resuscitation & automated external defibrillator (CPRAED)

Adult, child, & infant CPR, first aid & AED (CPRFAAED)

Each card shows your name, issue date, renew-by date, and a unique eCard code that anyone can use to verify your certification online.

Frequently asked questions

I’m a healthcare provider. Which course should I take? If you work in any medical setting, take the BLS course. If you want a shorter course without first aid, take the CPRAED course. Both are designed for healthcare providers.
I work in childcare/education/non-medical field. Which course should I take? You should take the CPRFAAED course, which is specifically designed for non-medical professionals and includes OSHA-compliant training.
Which course does my employer accept? Our courses carry accreditation from the AMA, ANCC, ACPE, ADA, and IPCE (varies by course). Check our accreditations page to verify acceptance in your state, or ask your employer for the exact card name they require.
Do I need both CPR and BLS certification? No. BLS certification includes CPR training. If your employer requires BLS, you do not need a separate CPR certification.
Why do some of the cards say CPR-C and others don’t? Both our BLS and CPRAED courses are designed for the CPR-C competency (healthcare provider). The CPRFAAED course is designed for the CPR-A competency (lay rescuer).
Is skills testing included? Our CPRFAAED course includes skills testing in the product price. The BLS and CPRAED courses include a skills test form that you can download and have completed by a certified instructor at your facility. We also offer skills testing services for an additional fee—contact us if you need help finding an instructor.
How long does each course take? BLS is 8 hours, CPRAED is 3 hours, and CPRFAAED varies by state approval, typically shorter for online formats.
Is BLS harder than CPR certification? BLS covers CPR and AED use but also includes additional clinical skills such as team-based resuscitation, airway management with a bag-valve mask, and coordinated response in healthcare settings. Because of this additional content, BLS training is generally more comprehensive than basic CPR/AED courses.
Why do the cards look different from each other? The color, wording, and logos on each card are driven by feedback from state governments during course approval. For example, OSHA expects the ANSI standardized “safety orange” color (ANSI Z535.1–1998) on workplace cards, while hospitals expect “AHA blue.” All our courses are OSHA compliant regardless of card color. See all our government approvals here.

References

American Heart Association. Basic Life Support (BLS) training. Course description and objectives.
American Heart Association. 2020 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. 2020.
American Heart Association. Highlights of the 2020 American Heart Association guidelines for CPR and emergency cardiovascular care. 2020.
Occupational Safety and Health Administration (OSHA). Best practices guide: fundamentals of a workplace first-aid program. OSHA 3317-06N, 2006.