BLS Basic life support (Latest 2020 AHA)

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Adult BLS

Adult breaths – methods of delivery

A normal human will be breathing the air in and out of lungs to help meet the oxygen demands of the body. When someone is not breathing adequately, body’s oxygen demands are not met. In such situations, rescuers will need to do some basic maneuvers to help the victim breathe well by opening the airway. Remember, these are done in case there’s breathing effort from the victim but you suspect airway obstruction preventing full entry of air into the lungs.

How to suspect airway obstruction?
You could hear snoring, gargling sounds or stridor while the victim is breathing.

Head-tilt-chin-lift and Jaw-thrust can help open the airway.

Head tilt – Chin lift

Notice the tongue blocking the airway, which got relieved with head tilt chin lift.
Notice the tongue blocking the airway, which got relieved with head tilt chin lift. Image credit: By Original art work by Vassia Atanassova (Spiritia), converted to vector by Offnfopt

AVOID this if it’s a case of trauma with possible neck bones fracture. (C-spine injury) You may use jaw thrust if needed.
Place a hand on the forehead, pushing it backwards and use the other hand fingers to elevate the chin. Make sure to place fingers on bony prominence of chin, not on soft tissue. If you press on soft tissue, the tongue will go back and obstruct the airway.

Jaw thrust

Jaw thrust to open the airway
Jaw thrust to open the airway By Randhillon – Own work, CC BY-SA 4.0

When someone is unconscious, the tongue falls back, blocking the airway. A simple jaw thrust could help pull the tongue forward and relieve the obstruction.
Stand at the head end of the patient. Using both hands on either side, pull the angles of the mandible forward, using cheek bones as support (fulcrum). Lips (mouth) should be open (See the image).

Breaths by rescuer

What if there is pulse but the breathing effort is lacking or inadequate?
Rescuer should provide breaths to victims using barrier devices or bag mask device.
Help the victim with a breath every 6 seconds – we call these The rescue breaths.
Breaths during CPR when there is no pulse
If the breaths are given during CPR, give 2 breaths every 30 compressions.
If there’s an advanced airway in place, give breaths every 6 seconds.

Each breath should be delivered over 1 second, then wait for the air to come out of lungs for another second before attempting the next breath.

Barrier device

barrier device
Barrier device usage. Source:

Instead of giving direct mouth-to-mouth breaths, using a barrier device such as a pocket mask with shield is preferred to reduce the chance of infection.
Some pocket masks have a provision to accept oxygen piping.
Most of the models have a 1-way valve which prevents the exhaled air or fluids from reaching the rescuer (inlet) port.
Place the mask over face covering both mouth and nose.
Rescuer should be located on the victim’s side.
Place the hand closest to head on the forehead (helps to do head tilt) and use the thumb and index finger to push the mask down to make a seal. Use the index and middle finger of other hand to do chin lift and use the thumb to push the mask down, sealing the lower end.
Take a deep breath and blow into the mask forcefully for 1 second till you see a visible chest rise.
After delivering a breath, move your face away and take another deep breath.
Repeat as needed.

Bag mask device

Bag mask ventilation
Bag mask ventilation By James Heilman, MD – Own work, CC BY-SA 4.0,

This is used from the head end. So, ideally, this is used when there are 2 people, one taking care of chest compressions and the other giving ventilations.
Connect the bag to an oxygen source if available.
Place the mask on the face, use your thumb and index finger on top of the mask like the alphabet “C”.
Use rest of the 3 finger like the alphabet “E” and elevate the angle of mandible (See the image).
Use the other hand to squeeze the bag till you see a chest rise.
Do not over ventilate – excess air you give will enter into stomach and might lead to regurgitation (vomit) of stomach contents leading to aspiration into lungs, which is dangerous.
Over ventilation also causes the chest pressures to increase and interferes with venous (blood) return to the heart.
If you have extra help available, one person can use both hands to secure the mask on either side and second person can squeeze the bag.