OS 213: Human Disease and Treatment 3 (Circulation

and Respiration)
LEC 35: BASIC LIFE SUPPORT
Exam 1 | Dr. Paul M. Reganit | August 14, 2012
OUTLINE
I.
II.
III.
IV.
V.
VI.

Introduction
CPR and the Chain of Survival
Cardiopulmonary resuscitation (CPR)
Techniques and Steps in CPR
Hands-Only CPR
Summary for 2010 Guidelines

I.INTRODUCTION
Objectives

To increase awareness and knowledge of CPR

as a life-saving procedure for victims of sudden
cardiac arrest

To demonstrate the different steps and

techniques of CPR
The Burden: Heart diseases are the #1 cause of
death in the Philippines (DOH data 2004 +
2005)

Followed
by
vascular
system
disease,
malignant neoplasm, pneumonias, and accidents, in
that order

There has been a change in causes of mortality

(initially due to infectious diseases) now more due to
lifestyle-related causes such as stress
Sudden Cardiac Arrest (SCA) and Sudden Cardiac
Death (SCD)
Approximately 50% of deaths from cardiovascular
diseases occur as SCD
SCD is the most common mode of death in patients
with coronary artery disease
SCA reversible loss of cardiac function
SCD irreversible loss of all biologic function
Almost 80% of out-of-hospital cardiac arrests occur at
home and are witnessed by a family member.
Only 4-6 % of sudden cardiac arrest victims survive
because majority of those witnessing the arrest do
not know how to perform CPR.
It is unpredictable and can happen to anyone,
anywhere at anytime
Risk increases with age (especially individuals 60 y.o.
and above)
Pre-existing heart disease is a common cause
May strike people with no history of cardiac disease
or cardiac symptoms
Therefore: effective CPR done immediately after
cardiac arrest can double a victims chance of
survival prompt recognition of the problem and
swift action (management)
Rescue Breathing/CPR: Do what the patient isnt
o If not breathing, breathe for her
If sudden cardiac death occurs outside the hospital
setting, cardiopulmonary resuscitation (CPR) must
begin within 4-6 minutes and advanced life support
measures must begin within 8 minutes, to avoid
brain death

II. CPR AND THE CHAIN OF SURVIVAL

THE NEW CHAIN OF SURVIVAL:
1.Early access (immediate recognition and activation)
2.Early CPR
3.Early defibrillation
4.Early advanced care
5.Integrated post-cardiac arrest care

A. FIRST LINK: ACCESS

A well-informed lay person is THE key in the

early access link

JUSTIN, VINCEN, PIA

Recognition of signs of heart attack and

respiratory failure

Call for help immediately if needed

Activate the Emergency Medical System (EMS)

B. EARLY WARNING SIGNS OF HEART

ATTACK
Prolonged compressing pain or unusual discomfort in
the center of the chest
Pain may radiate to shoulder, arm, neck or jaw,
(usually left side)
Pain may be accompanied by sweating, nausea,
vomiting and shortness of breath.
Inferior wall infarct can have abdominal pain and
shortness of breath.

C. EARLY WARNING SIGNS OF

RESPIRATORY FAILURE

Unable to speak, breathe or cough

Clutches neck (universal distress signal)
Bluish color of skin and lips

D. SECOND LINK: EARLY CPR

Life saving technique for cardiac and respiratory

arrest

Rescue breathing and chest compressions

For lay persons and medical personnel alike

III. CARDIOPULMONARY RESUSCITATION

(CPR)
A. WHY IS EARLY CPR IMPORTANT?

CPR is the best treatment for cardiac arrest until

the arrival of an automated external defibrillator
(AED) and advanced cardiovascular (ACLS) care
Prevents ventricular fibrillation from deteriorating
into asystole
May increase the chance of defibrillation
Contributes to the preservation of heart and brain
function
Significantly improves survival
Prompt CPR is important: beyond 7 minutes with no
CPR, you are doomed to fail

B. HOW DOES CPR WORK?

All the living cells of out body need a steady supply

of oxygen to keep us alive
o
Important organs of concern during acute CPR:
lungs (pulmonary), brain (cerebral), heart (cardiac)
o
A clarification regarding the importance of
adrenals: by giving oxygen perfusion to the
adrenals, you can reactivate circulation of the
catecholamines (Norepinephrine and Epinephrine);
but in CPR, your immediate target organ includes
the lungs but not necessarily the adrenals

CPR works because you can breathe air into the

victims lungs to provide oxygen into the blood.

When you press on the chest, you move the

oxygen-carrying blood through the body.

C. WHEN WILL YOU DO CPR?

As soon as possible!
Brain cells begin to die after 4-6 minutes without
oxygen

D. WHO MAY LEARN CPR?

UPCM 2016 B: XVI, Walang
1 of 4
Kapantay!

OS 213: Human Disease and Treatment 3 (Circulation

and Respiration)
LEC 35: BASIC LIFE SUPPORT
Exam 1 | Dr. Paul M. Reganit | August 14, 2012

place the heel of the second hand on top of the

first so that the hands are overlapped and parallel.
4.
Position shoulders over hands with elbows
locked and arms straight.
5.
Compress
down
and
release
pressure
smoothly, keeping hand contact with chest at all
times.

Anyone; does not need to be a doctor, nurse,

med student, etc.

IV. TECHNIQUES AND STEPS IN CPR

WHAT TO DO WHEN YOU FIND A PERSON
UNCONSCIOUS IN THE GROUND
1.
Check area safety
Survey the scene
See if the scene is safe to do CPR
Get an Idea of what happened
2.

Check Unresponsiveness
Tap or gently shake the victim
Rescuer shouts: Are you okay?
Quick check for normal breathing
If the victim is unconscious, rescuer calls for help

3.
Call for Help: ambulance, emergency
services, doctor
Rescuer activates the emergency medical services
Get AED/Defibrillator
Non-responsive, no normal breathing = get a
defibrillator!

CHECK FOR CONSCIOUSNESS

1. PULSE CHECK

Palpate for carotid pulse within 10 seconds

At the same time check for breathing
For trained health care providers only!!!

2. MOUTH TO MOUTH BREATHING

Begin if there is a DEFINITE PULSE, but NO

BREATHING

Give one breath every 5-6 seconds (about 12

breaths per minute)

Recheck pulse every 2 minutes

Mouth to Mouth Breathing and Pulse Check:
Deemphasized in the new guidelines
For trained healthcare providers only
As short and quick as possible
Pulse check not more than 10 seconds
If unsure, proceed directly to chest compressions

Figure 1. Procedure for doing proper chest

compression.
Caveats:

Give chest compressions at a rate of AT LEAST

100/minute

Compress bone at least 2 inches deep

Compress 30 times initially (takes around 1518 seconds)

Minimize interruptions

Allow the chest to return to its normal position

(to provide sufficient diastolic filling for sufficient
CO; (compress = systole).

Slogan: Push hard, push fast.

AIRWAY

Open the airway by using the Head Tilt/Chin

Lift Method
o Place one hand on the victims forehead
o Place fingers of the other hand under the bony
part of the lower jaw near the chin
o Tilt head and lift jaw avoid closing the victims
mouth
o This maneuver prevents airway obstruction by the
epiglottis

If you are highly suspecting cervical spine

injury, do Jaw Thrust Method instead

3. PROCEED TO C-A-B

Compression: Do chest compressions first

Airway: does the victim have an open airway
(air passage that allow the victim to breathe)?

Breathing: is the victim breathing

START CPR (CA-B)

COMPRESSION

To assist circulation
After determining unconsciousness and calling
for help, proceed immediately to do chest
compressions

Procedure:
1.
Kneel facing the victims chest
2.
Place the heel of your hand on the center of
the victims chest. Put your other hand on top of
the first with our fingers interlaced.
o Note: Avoid the xiphoid cartilage!
3.
Place the heel of one hand on the sternum in
the center of the chest between the nipples then

JUSTIN, VINCEN, PIA

Figure 2. The Head-tilt or chin-lift maneuver

BREATHING
Procedure:
1.
Give 2 one-second breaths
2.
Maintain airway
3.
Pinch nose shut
4.
Open your mouth wide, take a normal breath,
and make a tight seal around outside of victims
mouth.
5.
Give 2 full breaths (1 second per breath)
6.
Observe chest rise and fall; listen and feel for
escaping air
7.
Repeat cycles of 30 compressions and 2
breaths (this will take about 2 minutes= 5 cycles!)
Pulse Check

Recheck pulse every 2 minutes (Equivalent to 5

cycles CPR)

UPCM 2016 B: XVI, Walang

Kapantay!

2 of 4

OS 213: Human Disease and Treatment 3 (Circulation

and Respiration)
LEC 35: BASIC LIFE SUPPORT
Exam 1 | Dr. Paul M. Reganit | August 14, 2012

Very brief pulse check should take less than

10 seconds (at the same time check for normal
breathing)

In case there is any doubt about the presence

or absence of pulse continue chest compressions

This is for trained healthcare providers only

Continue CPR until

Help arrives (emergency services, ambulance,

doctor, AED)

Person is revived

o AED arrives
o EMS providers take over care of the victim

If trained in CPR, provide either conventional

CPR using 30:2 compression-to-ventilation ratio or
hands only CPR

VI. SUMMARY OF 2010 BLS GUIDELINES

KEY CHANGES:

CABV instead of ABC

If the Victim is Breathing, place him/her in the

Recovery Position

Maintain open airway and position the victim

The unresponsive victim with spontaneous

respirations should be placed in the recovery
position if no cervical trauma is suspected

Placement in this position consists of rolling the

victim onto his other side to help protect the
airway

Figure 3. The recovery position.

SUMMARY OF STEPS IN CPR

Survey the scene.

Check responsiveness Hey, are you ok?
Call for help! Activate EMS
[Quick check pulse within 10 secs]
C (Compression): 30x; 100/min; 2 inches deep;
push hard and fast
A (Airway): head tilt chin lift
B (Breathing): 2 breaths (1 second/breath)
Cycle 30:2 compression-ventilation
[Quick check pulse every 2 mins]
Continue until: EMS arrives, patient is revived/has
signs of life

V. HANDS-ONLY CPR
A. INDICATIONS

Not trained
Do not know mouth to mouth ventilation
Not sure about mouth to mouth ventilation
Hesitant to do mouth to mouth ventilation
Do not want to do mouth to mouth ventilation
You can do HANDS ONLY CPR: It only takes two
steps to save a life:
1.Call for help
2.Do chest compressions

Hands only CPR should only be used for adult

victims who have suddenly collapsed or become
unresponsive

B. RECOMMENDATIONS

All victims of cardiac arrest should receive

high-quality chest compressions

When an adult suddenly collapses, all

bystanders should activate their community EMS and
provide high quality chest compression, minimizing
interruptions (Class I)

If not trained in CPR, provide hands only CPR

(Class IIa) until

JUSTIN, VINCEN, PIA

Compress first

NO more Look, Listen and Feel

Harder minimum 2 inches (1.5-2 in for

elderly)

Faster minimum 100/min. (max 100/min for

elderly)

Deemphasize pulse checks

o For trained healthcare providers not more than
10 secs

Check for normal breathing together with

check for unresponsiveness

Hands only CPR for the untrained lay rescuer

IMPORTANT POINTS
There are no mistakes when you perform CPR
o The only harm is to delay responding
o Start chest compressions now viewed as the
most effective procedures
o All victims in cardiac arrest need chest
compressions
Dont stop pushing
o Keep pushing as long as you ca. Push until AED is
in place and ready to analyze the heart. When it is
time to do mouth to mouth, do it quick and get
right back on the chest
80-90% of cardiac emergencies occur at home
Training is now simpler and more accessible
(reduced steps and simplified)
Being trained to do CPR can save a loved one
Effective CPR done immediately after cardiac arrest
can double a victims chance of survival

UPCM 2016 B: XVI, Walang

Kapantay!

3 of 4

OS 213: Human Disease and Treatment 3 (Circulation

and Respiration)
LEC 35: BASIC LIFE SUPPORT
Exam 1 | Dr. Paul M. Reganit | August 14, 2012
END OF TRANSCRIPTION
Vincen: SIMPLIER. >:D Kelan lang walang coke na
hawak o katabi si Dr. Coke na nephrologist at nagtuturo
ng IDC 3-5PM? Sinong lecturer ang kamukha ni Peter
Griffin from Family Guy? (Clue: Hes just going to have
a one-sided conversation.) Hello to my great friends,
closest friends, friend-friends, old friends, new friends,
and potential friends. Panoorin ang Memento ,The
Squid and the Whale, at Requiem for a Dream this
weekend kung hindi pa napanood.
Justin: Happy birthday Chikki! <3 <3 <3 a million
times over.
Pia: Vincen and Justin are the best transmates ever.
Yeahboi(s)!

JUSTIN, VINCEN, PIA

UPCM 2016 B: XVI, Walang

Kapantay!

4 of 4