AmericanHeartAssociation

BasicLifeSupport
for
HealthcareProviders

PrecourseReviewMaterials

RevisedApril2011
HuntsvilleHospitalTrainingCenter

Disclaimer:ThisdocumentissolelyproducedbyHuntsvilleHospitalbasedontheAmericanHeartAssociation2010Guidelines.
However,thisBLSreviewdoesnotwarrantorassumeanylegalliabilityorresponsibilityfortheaccuracy,completeness,or
usefulnessofanyinformation,orprocessdisclosed.

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BLSHealthcareProvider&RenewalCourse
PrecourseReview

THISISONLYFORHEALTHCAREPROVIDER&RENEWALPARTICIPANTSNOTHEARTSAVERCANDIDATES
AlllicensedProfessionalsMustTakeTheAHAHealthcareProviderClassnotaHeartsaverclass
Pleasereviewthisguidebeforecomingtoclass

_______________________________________________________________________________________________

FactstoKnow

YoumustbringacurrentHCPcardoracopytoarenewalclass.
Tabletopskillsareavailableifneeded
BooksareavailableforpurchaseatCorporateUniversity
Classsizeandlengthmayvary.Pleasebeontime,youwillnotbe
abletoparticipateiflate
YoumustpreregisterviaNetLearningafterapprovedbyyourNurse
Manager
Youmustbeontimefortheclassoryouwillhavetoreschedule

BLSCPRconsistsof3maincomponents:

Compressions
Airway
Breathing

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ADULT

AdultChainofSurvival:

Earlyaccess:EstablishUnresponsiveness/nobreathingthenactivateEMS/911,
EarlyCPR:ProvideBLS/CPRwithin4minutes
Earlydefibrillation:HaveanAEDonthemandshockingwithin5minutesofthearrest
Earlyadvancedcare:EMS/codeteamarrivingsoonthereafter

ChokingAdult
1. ConsciousChoking

Areyouchoking?
Canyouspeak?
CanIHELPyou?
ProvideinwardandupwardAbdominalthrust,justabovethenavel.

2. UnconsciousChoking:(NOBLINDFINGERSWEEPS)

Call911
Opentheairwayremovetheobjectifyouseeit,thenbeginCPR
(30compressionsto2breaths)
Everytimeyouopentheairwaytogivebreathslookfortheobject
ThencontinueCPR(30to2)

3. AdultRescuebreathing:
Itisdoneonlywhenthevictimisnotbreathingadequatelybuthasapulse.Rescuebreathingfortheadultis1breath
every56secondsor1012/min.AgonalGaspsareinadequatebreathsassociatedwithCardiacArrestnotChoking.

CPRAdult
1. Adult1rescuerCPR

DetermineUnresponsiveness(shakeandshout),ifnoresponse
Checkfornobreathingornormalbreathing(minimum5seconds;maximum10seconds)
ActivateemergencymedicalsystemandcallforanAED
Checkforcarotidpulsefor(minimum5seconds;maximum10seconds)
Ifthereisnodetectablepulse,startchestcompressionsatthecenterofthechest,atthenippleline,withtheheal
ofonehandontopoftheother,ataratioof:
30compressions(Acceptable<18secondsfor30compressions)
Give2breaths(1secondeach)
Deliversecondcycleof30compressionsatcorrecthandposition(Acceptable>23compressions)
Give2breaths(1secondeach)
ContinueCPRuntilhelparrives

PushHard,andPushFast:compressataminimumrateofatleast100compressionsper
minuteandadepthof2inches,andallowfullchestrecoilaftereachcompression.Minimize
interruptionsinchestcompressions.

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2. Adult2RescuerCPR:

Ratioof30compressionsto2breaths,Rate100/minuteor5cyclesin2minutes
(Ventilator)therescueratthehead,
(Compressor)therescueratthechest
Ventilatordeterminesresponsiveness,ifnoresponse
Ventilatorchecksfornobreathingornormalbreathing(minimum5seconds;maximum10seconds)
Compressororbystanderactivatesemergencymedicalsystem(call911)andcallforanAED
Ventilatorchecksforcirculation,carotidpulse(minimum5seconds;maximum10seconds)

Ifthevictimhascirculation(pulse)

Ifthevictimdoesnothavecirculation(nopulse)

Ventilatorwillrescuebreathforthem:
1breathevery56secondsforabout1012per
minute(eachbreathshouldbedeliveredover1
secondmakingthechestrise)

Compressorwillstartchestcompressions,withtheheeloftwo
handsataratioof:
30compressionsbythecompressorto2ventilationsbythe
ventilatoratarateofatleast100perminuteandadepth
of2ordeeperforlargerperson
Theventilatorcancheckforapulseduringcompressionsto
makesuretheyareeffectivebyfeelingapulseevery
compression.
Afterevery5cyclesor2minutesofCPRswitchtomaintain
effectiveCPR

3. Advanceairway(ETT,combytube,etc.):
OncetheadvancedairwayisinplacedoNOTstopcompressionsforbreathsjustDOCONTINUOUSCOMPRESSIONSAND
PERFORM8TO10BREATHSPERMINUTE(every6to8seconds),switchpositionsevery2minutesor150compressions.

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CHILDANDINFANT
Pediatrics
PediatricsChainofSurvival:
Preventionis#1
EarlyandeffectivebystanderCPR,fortwominutesifalone
RapidactivationofEMSorCall911
EarlyandeffectiveadvancedLifesupport(EMS)(includesrapidstabilizationandtransporttodefinitivecareandrehabilitation)

Child(1yearofagetopuberty)
Pubertylookfor:maleschestfacialunderarmhair,femalesbreastbudding

ChokingChild
1. ConsciousChoking:

Areyouchoking?
Canyouspeak?
CanIHELPyou?(asktheparentifyoucanhelptheirchild)
Provideinwardandupwardabdominalthrust,justabovethenaveltorelivetheobstruction.

2. UnconsciousChoking:NOBLINDFINGERSWEEPS

Callforhelp,sendbystandertocall911oractivateEMS
Opentheairway,removetheobjectifyouseeit,thenbeginCPR,witharatioof30compressionsto2breaths
Everytimeyouopentheairwaytogivebreathslookfortheobject
ThencontinueCPRwitharatioof30compressionsto2breaths
Ifnoonecametocall911oractivateEMS,youcallafter2minutesofCPR

3. RescueBreathing:
1breatheevery3to5secondsor12to20/min(onlyenoughairtomakethechestriseover1secondeach)

CPRChild
1. Child1rescuerCPR:

Determineunresponsiveness
Checkfornobreathingornormalbreathing(minimum5seconds;maximum10seconds)
Callforhelpsendbystandertocall911oractivateEMS.IfnoonecomesyoubeginCPRandafter5cyclesortwo
minutes,youshouldactivate911/EMS.
Checkforcirculationatthecarotidarteryfor5secondsminimum;10secondsmaximum
Ifthereisnodetectablepulse,orpulseislessthan60beats/min.,startchestcompressionsatthecenterofthe
chest,atthenippleline,withthehealofonehandontopoftheother,atthedepthof1/3ofthechildsbodyor2
depth:
30compressions(Acceptable<18secondsfor30compressions)
Give2breaths(1secondeach)
Deliversecondcycleofcompressionsatcorrecthandposition(Acceptable>23compressions)
Give2breaths(1secondeach)
ContinueCPRataratioof30to2untilhelparrives

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PushHard,andPushFast:compressataminimumrateof100compressionsperminute
Allowfullchestrecoilaftereachcompression.Minimizeinterruptionsinchestcompressions.

2. Child2rescuer:
CPRRatio=15compressions:2breaths,Rate=100/min,5cyclesperminute
(Ventilator)therescueratthehead,(Compressor)therescueratthechest
Ventilatordeterminesresponsiveness,ifnoresponse
Checkfornobreathingornormalbreathing(minimum5seconds;maximum10seconds)
Compressororbystandercalls911oractivatesEMSnumber
Ventilatorchecksforcirculation,carotidpulse>60beats/min.within510seconds

Ifthevictimhascirculation
(pulse>60beats/min.)

Ventilatorwillrescuebreathforthem:
- 1breathevery35secondsforabout1220per
minute(eachbreathshouldbedeliveredover1
secondmakingthechestrise)
- Recheckpulseevery2minutes

Ifthevictimdoesnothavecirculation
(pulse<60beats/min.)

Ventilatorwillstartchestcompressions,withthehealof
onehandortwoataratioof:15compressionsbythe
ventilatorandto2ventilationsbythebystanderatarate
of:100perminuteandadepthof1/3ofthechildsbody
depthor2switch/reassessafter5cycles

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INFANT(01YEAROFAGE)
ChokingInfant

1. InfantConsciousChoking:

Lookforchokingsigns,likebluishskin,lipsornose,highpitchednoise
Pickuptheinfantandgive5backblowsbetweentheshoulderblades,withtheheadsupportedandwiththehead
lowerthentheinfantsbottom
Thenfliptheinfantandprovide5chestthrustsjustbelowthenippleline,keepingtheheadlowerthattheinfants
bottom
Repeatuntilinfantsabletocryorbecomesunconscious

2. UnconsciousChoking:NOBLINDFINGERSWEEPS

Callforhelp,sendbystandertocall911oractivateEMS
Opentheairway,removetheobjectifyousee,beginCPRataratioof30to2
Everytimeyouopentheairwaytogivebreathslookfortheobject
ThencontinueCPRataratioof30to2
Ifnoonecametocall911oractivateEMS,youcallafter2minutesor5cyclesofCPR

3. InfantRescueBreathing:
1breathevery3to5secondsor12to20/min(onlyenoughairtomakethechestrise,eachbreathover1second)

CPRInfant
1. Infant1rescuerCPR

Determineunresponsiveness,ifnoresponsenobreathing
Callsforhelpifabystanderispresentsendthemtocall911oractivateEMS.Ifnobystandersrespondorpresent
precedeto:
Checkforcirculationfor510seconds:pulse(brachialorfemoral)>60beats/min.

Ifthevictimhascirculation
(pulse>60beats/min.)

Ifthevictimdoesnothavecirculation
(pulse<60beats/min.)
-

Rescuebreathforthem:
- 1breathevery35secondsforabout1220per
minute(eachbreathshouldbedeliveredover1
secondmakingthechestrise)
- Recheckpulseevery2minutes
- YouactivatetheEMSorcall911ifnooneisaround

Startchestcompressions,2fingersonefingerwidth
belowthenippleline,ataratioof30compressions
to2ventilationsatarateofatleast100perminute
andadepthof1/3oftheinfantsbodydepthor1
Reassessafter5cyclesof30to2
YouactivatetheEMSorcall911ifnooneisaround
afterthefirst5cycles
Thenreturntotheinfant&provideCPR

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2. Infant2rescuerCPR:
CPRRatio=15:2,Rate=100/min,5cyclesperminute
(Ventilator)therescueratthehead,(Compressor)therescueratthechest
Ventilatordeterminesresponsiveness,ifnoresponse
Ventilatorchecksfornobreathingornormalbreathing(minimum5seconds;maximum10seconds)
Compressororbystandercalls911oractivatesEMS
Ventilatorchecksforcirculationfor510sec:pulse(brachialorfemoral)>60beats/min.

Ifthevictimhascirculation
(pulse>60beats/min.)

Ifthevictimdoesnothavecirculation
(pulse<60beats/min.)

Ventilatorwillrescuebreathforthem:
- 1breathevery35secondsforabout1220
perminute(eachbreathshouldbedelivered
over1secondmakingthechestrise)
- Recheckpulseevery2minutes

Ventilatorwillstartchestcompressions,withthumb
encirclingtechniqueataratioof15compressionsbythe
bystandersto2ventilationsatarateofatleast100per
minuteandadepthof1/3oftheinfantsbodydepthor1
,switchafter5cycles

PushHard,andPushFast:compressataminimumrateof100compressionsperminute.
Allowfullchestrecoilaftereachcompression.Minimizeinterruptionsinchestcompressions.

AEDUSE

AnAutomatedExternalDefibrillator(AED)isusedwhentheheartstopsbeatingnormallyandneedstoberesetbyanelectricshock.
Thesoonertheshockisdeliveredthebetter,sincetheprobabilityofsuccessfuldefibrillationdiminishesrapidlyovertime.AEDsare
designedforadultsbutmostcanbeadaptedforchildrenandinfantswithpediatricpads.
Provide5cyclesofCPR,30compressionto2breaths,for2minutesbeforeusinganAEDonachildfrom1yearto8oronaninfant1<
ofage.

SpecialConsiderations:

Hairychestremoveenoughhairtogetgoodcontactwiththeskin.
Drychestifvisiblywet.
Implanteddeviceplacepadatleast1inchawayfromimplant,neverplacepadontopofdevice.
Medicationpatchremoveitandwipeareabeforepadplacement.

FYI:AEDsandInfants

Forinfants(<1yearofage),amanualdefibrillatorispreferred.Ifamanualdefibrillatorisnotavailable,anAEDwitha
pediatricdoseattenuatorisdesirable.Ifneitherareavailable,anAEDwithoutadoseattenuatormaybeused.

Note:AdultAEDpadscanbeusedonchildrenandinfantsbutpediatricpadsarepreferred.Pediatricpadscannotbeusedonadults.

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BLSHCPReviewQuestions:

1.

2.

3.

4.

5.

6.

7.

8.
9.

10.

11.

12.

13.

14.

Whatare2waystoopenthevictimsairway?
A.[Headtiltchinliftandjawthrust]

WhatistheRATEofcompressionsforAdults,ChildrenandInfants?
A.[Atleast100/minute]

WhatarethecommonsignsofSTROKE?
A.[Weaknessononesideofthebody,troublespeaking,ordizziness]

Whatarethesignsofaheartattack?
A.[Crushingpaininthecenterofthechest,thepainmaystartradiatingtooneside,back,neck,orthejaw,sweatingand
nausea]

Whatishappeningwhenyounoticetheabdomenrisingonyourvictimasyoubreath?
A.[youaregivingtoomuchvolumeortooforcefulrescuebreaths][thegoalistohaveagentleriseandfallofthechest
duringventilationover1second]

Ifthechestdoesnotrisewhenyougiveabreath,whatshouldyoudo?
A.[repositiontheheadandtryagain]

Ifyoususpectaninjury,howdoyouopenthevictimsairway?
A.[jawthrust]

WheredoyoucheckforthepulseonaCHILD?[carotid,intheneck]

Whatisthepurposeof1secondbreathsjustmakingthechestrisewhenventilatingavictim?
A.[decreasegastricinflation]

Wheredoyouplaceyourhandswhendoingchestcompressionsonachildandadult
A.[centerofthevictimsbarechestbetweenthenipples]

Areagonalgaspsadequatebreathing?
A.[No,youmustgiverescuebreaths]

WheredoyoucheckforthepulseonanINFANT?
A.[brachialartery,onthepalmsideofthearmnearyoumidwaybetweentheelbowandtheshoulderorthefemoral
artery]

CanyouuseadultAEDpadsonachildorinfant?
A.[yes,ifyoudonothavechildpads]

WhendoyoushockachildorinfantwithanAED?
A.[AssoonastheAEDisavailable.]

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Reviewofsomekeyconceptsandskills:

1.

RecoveryPositioncanbeusedifvictimhasadequatebreathing,adequatecirculationandnosuspectedspinalinjury

2.

Gastricinflationoccurswhenbreathsaregivenwithtoomuchvolume,toorapidlyand/ortooforcefullyandtheextrabreath
entersthestomach,ifthisdoesstart,justreducetheamountofbreathyouaregivingtothevictim.Thegoalisagentlerise
andfallofchestsaysyouhavegivenadequatevolumeforbreathsover1second

3.

Hypertensioniselevatedbloodpressure

4.

C,A,B/DofBLS/CPRare:

CompressionPushingonthechest,hardandfasttocirculatebloodtotheheartandbrain

AirwayPerformingtheHead/Tilt,ChinLifttoprepareforbreathing
BreathingGivetwobreathsabout1secondeach,justenoughtomakethechestrise

DefibrillationUseanAEDtoshockorrestarttheheart
5.

Braindeathstartsafterabout4minutesifnohelpisprovidedandthevictimisnothypothermicthenbraindeathisusually
completeafter10minuteswithoutoxygen

6.

Heartattacksareusuallydenied,ifdiscomfortlastslongerthan1520minutesandisnotrelievebyrestornitroglycerin,
activateEMS.Remembersomepeopledonotpresentwiththeusualsymptomsofchestpain.

7.

MildAirwayObstructionisagoodairwayexchange,iftheycancoughforcefully.

8.

SevereairwayObstructionispoorornoairexchange,withaweakorineffectivecough.

9.

NoBlindfingersweepsonanyone.

10. Compressiontoventilationratiofor1rescuerCPRis30to2onallagesandchangesto15to2on2rescuerCPRONLYfor
CHILDorINFANT.
11. PUSHHARDANDPUSHFAST:Compressataminimumrateof100compressions/minuteforallages.

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SkillsChecklistsforReview

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SkillsChecklistsforReview

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 BLSforHealthcareProvidersStudentManual
ComparisonChart

BLSChanges

New

Old

Rationale

CPR

Chestcompressions,Airway,Breathing
(CAB)
Newscienceindicatesthefollowingorder:

1.Checkthepatientforresponsiveness.
2.Checkfornobreathingornonormalbreathing.
3.Callforhelp.
4.Checkthepulsefornolongerthan10seconds.
5.Give30compressions.
6.Opentheairwayandgive2breaths.
7.Resumecompressions.

Compressionsshouldbeinitiatedwithin10
secondsofrecognitionofthearrest.

Airway,Breathing,Chest
compressions
(ABC)
Previously,after
responsivenesswasassessed,
acallforhelpwasmade,the
airwaywasopened,the
patientwascheckedfor
breathing,and2breathswere
given,followedbyapulse
checkandcompressions.

Althoughventilationsareanimportant
partofresuscitation,evidenceshows
thatcompressionsarethecritical
elementinadultresuscitation.IntheA
BCsequence,compressionsareoften
delayed.

Compressionsweretobe
givenafterairwayand
breathingwereassessed,
ventilationsweregiven,and
pulseswerechecked.

Compressionsshouldbegivenatarateofatleast
100/min.Eachsetof30compressionsshould
takeapproximately18secondsorless.

Compressionsweretobe
givenatarateofabout
100/min.Eachcycleof30
compressionswastobe
completedin23secondsor
less.

Althoughventilationsareanimportant
partofresuscitation,evidenceshows
thatcompressionsarethecritical
elementinadultresuscitation.
Compressionsareoftendelayedwhile
providersopentheairwayanddeliver
breaths.

Compressionratesarecommonlyquite
slow,andcompressions>100/minresult
inbetterperfusionandbetteroutcomes.

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CPR

Compressiondepthsareasfollows:

Adults:atleast2inches(5cm)

Children:atleastonethirdthedepthofthe
chest,approximately2inches(5cm)

Infants:atleastonethirdthedepthofthe
chest,approximately1inches(4cm)

Airway&
Breathing

Cricoidpressureisnolongerroutinely
recommendedforusewithventilationsduring
cardiacarrest.

AEDUse

Compressiondepthswereas
follows:

Adults:1to2inches

Children:onethirdtoone
halfthediameterofthechest

Infants:onethirdtoone
halfthediameterofthechest

Ifanadequatenumberof
rescuerswereavailable,one
couldapplycricoidpressure.

Look,listen,andfeelforbreathinghasbeen
removedfromthesequenceforassessmentof
breathingafteropeningtheairway.Healthcare
providersbrieflycheckfornobreathingorno
normalbreathingwhencheckingresponsiveness
todetectsignsofcardiacarrest.Afterdeliveryof
30compressions,lonerescuersopenthevictims
airwayanddeliver2breaths.

Look,listen,andfeelfor
breathingwasusedtoassess
breathingaftertheairway
wasopened.

Forchildrenfrom1to8yearsofage,anAEDwith
apediatricdoseattenuatorsystemshouldbe
usedifavailable.IfanAEDwithadoseattenuator
isnotavailable,astandardAEDmaybeused.
Forinfants(<1yearofage),amanualdefibrillator
ispreferred.Ifamanualdefibrillatorisnot
available,anAEDwithapediatricdose
attenuatorisdesirable.Ifneitherisavailable,an
AEDwithoutadoseattenuatormaybeused.

Thisdoesnotrepresenta
changeforchildren.In2005
therewasnotsufficient
evidencetorecommendfor
oragainsttheuseofanAED
ininfants.

Deepercompressionsgeneratebetter
perfusionofthecoronaryandcerebral
arteries.

Randomizedstudieshavedemonstrated
thatcricoidpressurestillallowsfor
aspiration.Itisalsodifficulttoproperly
trainproviderstoperformthemaneuver
correctly.
Withthenewchestcompressionfirst
sequence,CPRisperformediftheadult
victimisunresponsiveandnotbreathingor
notbreathingnormally(ie,notbreathingor
onlygasping)andbeginswith
compressions(CABsequence).Therefore,
breathingisbrieflycheckedaspartofa
checkforcardiacarrest.Afterthefirstset
ofchestcompressions,theairwayis
openedandtherescuerdelivers2breaths.
Thelowestenergydoseforeffective
defibrillationininfantsandchildrenisnot
known.Theupperlimitforsafe
defibrillationisalsonotknown,butdoses
>4J/kg(ashighas9J/kg)haveprovided
effectivedefibrillationinchildrenand
animalmodelsofpediatricarrest,withno
significantadverseeffects.
AEDswithrelativelyhighenergydoses
havebeenusedsuccessfullyininfantsin
cardiacarrest,withnoclearadverseeffects

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