Where does naloxone fit in the 2025 AHA BLS algorithm?
Medically reviewed by Asia, RN, BSN
Written by Justin Alcalde, AHA and American Red Cross instructor, CPR West Covina
Price and class details checked .
In the 2025 AHA healthcare provider BLS algorithm, naloxone appears in two boxes. If an adult has a pulse but is not breathing normally, give 1 breath every 6 seconds and give an opioid antagonist such as naloxone if available when you suspect an overdose. If there is no pulse, start CPR, use the AED as soon as it arrives, and consider naloxone. The pediatric charts and the steps for the public add naloxone too.
To drill these boxes before an exam or a shift, our SOS First Aid app is a pocket study guide for AHA BLS, ACLS and PALS built on the 2025 guidelines, with practice quizzes and exams.
Adult BLS for healthcare providers
- Check breathing and pulse at the same time.
Look for no breathing or only gasping while you feel for a pulse.
AHA 2025 - Pulse, but breathing is not normal: breathe for them.
Give 1 breath every 6 seconds, about 10 breaths a minute. Check the pulse every 2 minutes. If you suspect an opioid overdose, give an opioid antagonist such as naloxone if it is available.
AHA 2025 - No pulse: start CPR.
Cycles of 30 compressions and 2 breaths. Use the AED as soon as it is available. If you suspect an opioid overdose, consider an opioid antagonist.
AHA 2025 - Pulse lost while you give breaths: switch to CPR.
The pulse check every 2 minutes is what moves you from the breathing box to the CPR box.
AHA 2025
Pediatric BLS
The 2025 pediatric BLS charts, for one rescuer and for two or more, follow the same idea with a faster breath rate. A child or infant with a pulse but inadequate breathing gets 1 breath every 2 to 3 seconds, about 20 to 30 breaths a minute, and an opioid antagonist if available when overdose is suspected. The CPR box carries the same naloxone line.
AHA 2025Steps for the public
The AHA's 2025 lay rescuer steps have no pulse check. If a person is unresponsive and not breathing or only gasping, call for emergency help, get an AED and start compressions, pressing hard and fast. When the AED arrives, follow its prompts. If you suspect an opioid overdose, give a dose of naloxone if you have it, then go back to CPR.
AHA 2025The three charts side by side
| Chart | Pulse check | Breaths with a pulse | Naloxone |
|---|---|---|---|
| Adult BLS, healthcare provider | Yes, with the breathing check | 1 every 6 seconds | Give if available with a pulse; consider in CPR |
| Pediatric BLS, healthcare provider | Yes | 1 every 2 to 3 seconds | Give if available, with a pulse and in CPR |
| Lay rescuer steps | No | Not part of the chart | Give a dose if you have it, then resume CPR |
What the 2025 guidelines changed
- The healthcare provider BLS algorithm was updated to show opioid antagonists such as naloxone for suspected overdose, in both respiratory arrest and cardiac arrest.
- In respiratory arrest from a suspected opioid overdose, an opioid antagonist should be given, and the AHA says trained rescuers, lay rescuers and the general public can all give naloxone.
- In cardiac arrest from a suspected overdose, giving an opioid antagonist may be reasonable if it does not interfere with high-quality CPR with breaths. The AHA notes there are no clinical trials on this, and no known harm from naloxone in cardiac arrest.
- Public access to naloxone is now recommended alongside public access to defibrillation.
Where sources differ
Breaths or compressions. The healthcare provider chart puts breaths first when there is a pulse, and the AHA's adult BLS guideline says ventilation is essential in conditions such as opioid overdose. The lay rescuer chart shows compressions. The 2024 AHA and Red Cross first aid guideline says compressions plus breaths for a first aid provider. Each chart is written for a different rescuer.
ACLS and PALS charts. The text versions of the 2025 ACLS adult cardiac arrest and PALS cardiac arrest algorithms that we read do not mention opioids or naloxone. The naloxone lines live in the BLS charts.
Learn it before you need it
Our SOS First Aid app puts adult, child and infant CPR, AED use and opioid emergencies in one BLS section, and its AI assistant answers questions on rhythms and drug dosing based on the AHA 2025 guidelines. For the card, Red Cross BLS ($69) lists opioid overdoses, the AHA does not list an opioid topic for AHA BLS, and workplace teams can take Heartsaver First Aid CPR AED ($98).
Questions people ask
Do lay rescuers check for a pulse in a suspected overdose?
No. The AHA 2025 lay rescuer steps start from unresponsive and not breathing normally, then go to calling for help, the AED, compressions and naloxone if you have it. The pulse check is in the healthcare provider charts.
How fast are rescue breaths for a child with a pulse?
The 2025 pediatric BLS charts say 1 breath every 2 to 3 seconds, about 20 to 30 a minute. For adults the provider chart says 1 breath every 6 seconds.
Is naloxone in the ACLS algorithm?
Not in the text versions of the 2025 ACLS adult cardiac arrest and post-arrest algorithms that we read. The naloxone steps are in the adult and pediatric BLS charts.
Does naloxone help in cardiac arrest?
The AHA says it may be reasonable when it does not interfere with high-quality CPR with breaths. No clinical trials have tested it in cardiac arrest, and the AHA says there is no known harm from giving it.
Related guides
- Narcan or CPR first? What each authority says
- What to do if someone is overdosing on opioids
- A workplace plan for an opioid overdose
Sources
This page is education, not medical or legal advice. In an emergency, call 911 first.
- American Heart Association: 2025 CPR and ECC algorithms (adult and pediatric BLS, lay rescuer steps)
- American Heart Association: Highlights of the 2025 AHA Guidelines for CPR and ECC
- American Heart Association: 2025 Guidelines, Part 7, Adult Basic Life Support
- American Heart Association and American Red Cross: Highlights of the 2024 First Aid Guidelines
- American Red Cross: BLS training page
- American Heart Association: Heartsaver First Aid CPR AED course page
- American Heart Association: Heartsaver CPR AED course page