BLS

Compression Depth

Compress the chest at least 2 inches (5 cm).

Advanced airway in place (eg, laryngeal mask airway, supraglottic airway device, endotracheal tube)

Compression rate of 100-120/min Continuous compressions without pauses for breaths Ventilation: -Adult: 1 breath every 6 seconds -Infant and child: 1 breath every 2-3 seconds

Victim is not breathing normally and pulse is felt

- provide rescue breathing at a rate of 1 breath every 6 seconds (10 breaths per min) -Check for pulse about every 2 min, (perform CPR if no pulse is felt) -opiod use: give naloxone if available

Give Breaths, For breaths to be effective:

- the victim's airway must be open. Two methods for opening the airway are: Head tilt-chin lift Jaw thrust

chest compressions

-Compression-to-Ventilation Ratio: The compression-to-ventilation ratio for single rescuers is the same in adults, children, and infants: 30:2. --- 2 rescuers are attempting to resuscitate an infant or child, they should use a compression-to-ventilation ratio of 15:2. -Compression Rate: The universal rate for compressions in all cardiac arrest victims is 100 to 120/min. -Compression Depth: For an infant, compress at least one third the AP diameter of the infant's chest (approximately 1½ inches, or 4 cm). -----For a child, compress at least one third the AP diameter of the chest (approximately 2 inches, or 5 cm) with each compression. -Chest Recoil: During CPR, chest recoil (reexpansion of the chest) allows blood to flow into the heart. Incomplete chest recoil reduces the filling of the heart between compressions and reduces the blood flow that chest compressions create. To help ensure complete recoil, avoid leaning on the chest between compressions. Chest compression and chest recoil times should be about equal. -Interruptions in Chest Compressions: Minimize interruptions in chest compressions.

Rescue breathing for children

-Give 1 breath every 2 to 3 seconds. -Give each breath over 1 second. -Each breath should result in visible chest rise. -Check for a pulse about every 2 minutes.

Rescue breathing for adults

-Give 1 breath every 6 seconds. -Give each breath over 1 second. -Each breath should result in visible chest rise. -Check for a pulse about every 2 minutes.

AnteroPosterior Placement

-Place one AED pad on the left side of the chest, between the left side of the victim's breastbone and left nipple. -Place the other pad on the left side of the victim's back, next to the spine.

Infant 2 finger technique

-Place the infant on a firm, flat surface. -Place 2 fingers in the center of the infant's chest, just below the nipple line, on the lower half of the breastbone. -Give compressions at a rate of 100 to 120/min. -Compress at least one third the AP diameter of the infant's chest (approximately 1½ inches, or 4 cm). At the end of each compression, make sure you allow the chest to completely recoil (reexpand); do not lean on the chest. Chest compression and chest recoil times should be about equal. Minimize interruptions in compressions (eg, to give breaths) to less than 10 seconds. -After every 30 compressions, open the airway with a head tilt-chin lift and give 2 breaths, each over 1 second. The chest should rise with each breath. -After about 5 cycles or 2 minutes of CPR, if you are alone and no one has activated the emergency response system, leave the infant (or carry the infant with you) and activate the emergency response system and get the AED. -Continue compressions and breaths at a ratio of 30 compressions to 2 breaths. Use the AED as soon as it is available. Continue until advanced life support providers take over or the infant begins to breathe, move, or otherwise react.

Thumb-Encircling Hands Technique

-Place the infant on a firm, flat surface. -Place both thumbs side by side in the center of the infant's chest, on the lower half of the breastbone. Your thumbs may overlap on very small infants. With the fingers of both hands, encircle the infant's chest and support the infant's back. -With your hands encircling the chest, use both thumbs to depress the breastbone (Figure 30) at a rate of 100 to 120/min. -Compress at least one third the AP diameter of the infant's chest (approximately 1½ inches, or 4 cm). -After each compression, release all pressure on the breastbone and allow the chest to recoil completely. -After every 15 compressions, pause briefly for the second rescuer to open the airway with a head tilt-chin lift and give 2 breaths, each over 1 second. The chest should rise with each breath. Minimize interruptions in compressions (eg, to give breaths) to less than 10 seconds. -Continue compressions and breaths at a ratio of 15 compressions to 2 breaths (for 2 rescuers). The rescuer providing chest compressions should switch roles with another provider about every 2 minutes to avoid fatigue so that chest compressions remain effective. Continue CPR until the AED arrives, advanced life support providers take over, or the infant begins to breathe, move, or otherwise respond.

Critical concepts for chest compressions

-Use a ratio of 30 compressions to 2 breaths. -Compress at a rate of 100 to 120/min, with a depth of at least 2 inches (5 cm) for adults. -Allow complete chest recoil after each compression. Do not lean on the chest between compressions. -Minimize interruptions in chest compressions. Try to limit pauses in compressions to less than 10 seconds. -The goal is a CCF of at least 60%; with good teamwork, rescuers can often achieve 80% or higher.

Anterolateral Placement

-place both pads on the victim's bare chest. Place one AED pad directly below the right collarbone. -Place the other pad to the side of the left nipple, with the top edge of the pad a few inches below the armpit.

AED Pad Placement Options

1. Anterolateral Placement place both pads on the victim's bare chest. 2. AP Placement place one pad on the victim's bare chest (anterior) and the other pad on the victim's back (posterior).

Interuptions in chest compressions

Minimize interruptions in chest compressions. -Shorter duration of interruptions in chest compressions is associated with better outcome.

Chest compression technique

1. position yourself at the victims side Position yourself at the victim's side. Make sure the victim is lying faceup on a firm, flat surface. If the victim is facedown, carefully roll the person over. If you suspect a head or neck injury, try to keep the head, neck, and torso in a line when rolling the victim to a faceup position. It is best if someone can assist you in rolling the victim. Position your hands and body to perform chest compressions: Place the heel of one hand in the center of the victim's chest, on the lower half of the breastbone (sternum) (Figure 7A). Put the heel of your other hand on top of the first hand. Straighten your arms and position your shoulders directly over your hands. Give chest compressions at a rate of 100 to 120/min. Press down at least 2 inches (5 cm) with each compression; this requires hard work. For each chest compression, make sure you push straight down on the victim's breastbone (Figure 7B). At the end of each compression, always allow the chest to recoil completely. Avoid leaning on the chest between compressions. Minimize interruptions of chest compressions. (You will learn to combine compressions with ventilation next.)

critical concepts for ault breaths

30 chest compressions with 2 breaths with a barrier device -each breath over one second notice chest rise with each breath -ressume chest compressions in less than 10 seconds

If the victim is breathing normally and a pulse is felt:

Activate the emergency response system (if not already done). -Monitor the victim until emergency responders arrive.

No advanced airway in place

Adult: Compression rate of 100-120/min 30 compressions to 2 breaths Infant/child: Compression rate of 100-120/min 30 compressions to 2 breaths (1 rescuer) 15 compressions to 2 breaths (2 rescuers)

Chest Recoil

Allow the chest to recoil (reexpand) completely after each compression. To help ensure complete recoil, avoid leaning on the chest between compressions. Chest compression and chest recoil times should be about equal.

IN ADULTS first:

Assess the victim for normal breathing and a pulse

Perform chest compressions

CPR pumps blood from heart to the brain and then to the rest of the body

Compression rate

Compress at a rate of 100 to 120/min. This rate is the same for compressions in all cardiac arrest victims.

Barrier Device for giving breaths

Follow these steps to open the airway with a head tilt-chin lift and give breaths with a pocket mask: Position yourself at the victim's side. Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct positioning. Seal the pocket mask against the face. Using your hand that is closer to the top of the victim's head, place your index finger and thumb along the top edge of the mask. Place the thumb of your other hand along the bottom edge of the mask. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway (Figure 10). While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face (Figure 13). Deliver each breath over 1 second, enough to make the victim's chest rise.

When placing AED pads, you may need to take additional actions when the victim

Has a hairy chest Is immersed in water or has water or liquid covering the chest Has an implanted defibrillator or pacemaker Has a transdermal medication patch or other object on the surface of the skin where you need to place the AED pads Is a pregnant woman Is wearing jewelry or bulky clothing

Step 7 (If AED detects shockable rhythm)

If AED detects shockable rhythm- give one shock - resume CPR immediately until prompted by AED to allow a rhythm check -continue CPR and using the AED until advanced life support providers take over or the victim begins breathing

Was the sudden collapse witnessed?

If yes, activate the emergency response system (if not already done), and get the AED

Pulse

Infant: To perform a pulse check in an infant, feel for a brachial pulse (Figure 28A). Here is how to check the brachial artery pulse: Place 2 or 3 fingers on the inside of the upper arm, midway between the infant's elbow and shoulder. Press your fingers down and attempt to feel the pulse for at least 5 but no more than 10 seconds.

Mouth-to-Mouth Breathing for Adults and Children

Mouth-to-mouth breathing is a quick, effective technique to provide oxygen to an unresponsive adult or child. Follow these steps to give mouth-to-mouth breaths to adults and children: Hold the victim's airway open with a head tilt-chin lift. Pinch the nose closed with your thumb and index finger (using the hand on the forehead). Take a regular (not deep) breath and seal your lips around the victim's mouth, creating an airtight seal (Figure 36). Deliver 1 breath over 1 second. Watch for the chest to rise as you give the breath. If the chest does not rise, repeat the head tilt-chin lift. Give a second breath (blow for about 1 second). Watch for the chest to rise. If you are unable to ventilate the victim after 2 attempts, promptly return to chest compressions.

Attach AED PAds

Peel the backing away from the AED pads. Attach the adhesive AED pads to the victim's bare chest. Follow the placement diagrams on the pad (Figure 21). See Critical Concepts: AED Pad Placement Options later in Part 4 for common placement options. Attach the AED connecting cables to the AED device (some AEDs have preconnected cables).

Head tilt-chin lift

Place one hand on the victim's forehead and push with your palm to tilt the head back. Place the fingers of the other hand under the bony part of the lower jaw, near the chin. Lift the jaw to bring the chin forward.

Position Victim

Position the victim faceup on a firm, flat surface, such as the floor or a backboard.

if head tilt doesn't work: Jaw thrust

Position yourself at the victim's head. Place one hand on each side of the victim's head. You may rest your elbows on the surface where the victim is lying. Place your fingers under the angle of the victim's lower jaw and lift with both hands, displacing the jaw forward (Figure 11). If the victim's lips close, push the lower lip with your thumbs to open the lips.

Bag mask ventilation

Position yourself directly above the victim's head. Place the mask on the victim's face, using the bridge of the nose as a guide for correct positioning. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open (Figure 16). Perform a head tilt. Place the mask on the face with the narrow portion at the bridge of the nose. Use the thumb and index finger of one hand to make a "C" on the side of the mask, pressing the edges of the mask to the face. Use the remaining fingers to lift the angles of the jaw (3 fingers form an "E"). Open the airway, and press the face to the mask. Squeeze the bag to give breaths while watching for chest rise. Deliver each breath over 1 second, with or without the use of supplemental oxygen.

Rescuer One Two

Provide compressions Provide Breaths

If the victim is not breathing normally but a pulse is felt:

Provide rescue breathing, with 1 breath every 2 to 3 seconds, or 20 to 30 breaths per minute. -Assess the pulse rate for 10 seconds

compression to ventilation ratio

Single rescuers should use the compression-to-ventilation ratio of 30 compressions to 2 breaths when giving CPR to victims of any age.

Open AED

Some devices power on automatically when you open the lid or case. Follow the AED prompts.

If not

Start CPR with cycles of 30 compressions and 2 breaths. Use an AED as soon as it is available.

A rescuer who arrives at the side of potential cardiac arrest victim (steps 1-3 are:)

Step 1.Verify scene safety Step 2. Check responsiveness: "Are you okay?" -if non responsive activate emergency response system via moble device -GET AED or send someone Step 3. Assess for breathing and a pulse - check pulse and determine next action

Infant and child resuce

Step 1: Verify scene safety. Make sure that the scene is safe for you and the victim. Step 2: Check for responsiveness and get help. Tap the child's shoulders. Shout, "Are you OK?" If the victim is not responsive, shout for help and activate the emergency response via mobile device if appropriate. The first rescuer remains with the victim while the second rescuer activates the emergency response system and retrieves the AED and emergency equipment. Step 3: Assess for breathing and a pulse. Check for a pulse to determine next actions. To minimize delay in starting CPR, you should assess breathing and pulse at the same time. This should take no more than 10 seconds. Steps 3a and 3b: Determine next actions based on whether breathing is normal and if a pulse is felt: If the victim is breathing normally and a pulse is felt, activate the emergency response system. Monitor the victim until emergency responders arrive. If the victim is not breathing normally but a pulse is felt: -Provide rescue breathing, with 1 breath every 2 to 3 seconds, or 20 to 30 breaths per minute. -Assess the pulse rate for 10 seconds. Steps 4, 4a, and 4b: Is the heart rate less than 60/min (less than 6 beats in 10 seconds) with signs of poor perfusion? If yes, start CPR. If no, continue rescue breathing. Check for a pulse about every 2 minutes. If no pulse, start CPR. Step 5: The first rescuer starts cycles of CPR with 30 compressions and 2 breaths. When the second rescuer returns, continue cycles of CPR with 15 compressions and 2 breaths. Use the AED as soon as it is available. Step 6: Follow the AED directions to check the rhythm. Step 7: If the AED detects a shockable rhythm, give 1 shock. Resume CPR immediately until prompted by the AED to allow a rhythm check, about every 2 minutes. Continue CPR and using the AED until advanced life support providers take over or the victim begins to breathe, move, or otherwise react. Step 8: If the AED detects a nonshockable rhythm, resume high-quality CPR until prompted by the AED to allow a rhythm check, about every 2 minutes. Continue CPR and using the AED until advanced providers take over or the victim begins to breathe, move, or otherwise react.

BLS for infants steps 1-3

Step 1: Verify scene safety. Make sure the scene is safe for you and the victim. Step 2: Check for responsiveness and get help. Tap the child's shoulders. Shout, "Are you OK?" If the victim is not responsive, shout for help and activate the emergency response system via mobile device if appropriate. Step 3: Assess for breathing and a pulse. Check for a pulse to determine next actions. To minimize delay in starting CPR, you should assess breathing and pulse at the same time. This should take no more than 10 seconds.

Adult 2 rescuers

The first rescuer who arrives at the side of a potential cardiac arrest victim should quickly assess the scene for safety and check the victim for responsiveness. -This rescuer should send another rescuer to activate the emergency response system and get the AED. -As more rescuers arrive, assign tasks. Additional rescuers can help with bag-mask ventilation, compressions, and using the AED (Figure 18).

Assess breathing and a pulse

To check for breathing: scan the victim's chest for rise and fall for no more than 10 seconds. If the victim is breathing: Monitor the victim until additional help arrives. If the victim is not breathing or is only gasping: The victim has respiratory arrest or (if no detectable pulse) cardiac arrest. (Gasping is not normal breathing and is a sign of cardiac arrest.

Checking for the carotid pulse of an adult

feel for carotid pulse: -Locate trachea (2-3 fingers) -slide those fingers into the groove to the side of the trachea -feel for 5-10 seconds, if you do not feel a pulse begin CPR starting with chest compressions -someone has activated ERS and gone to get AED

"Clear" the victim and allow the AED to analyze the rhythm (Figure 22).

When the AED prompts you, clear the victim during analysis. Be sure no one is touching the victim, not even the rescuer in charge of giving breaths. Some AEDs will tell you to push a button to allow the AED to begin analyzing the heart rhythm; others will analyze automatically. The AED may take a few seconds to analyze. The AED then tells you if the victim needs a shock.

if it doesnt

fesume high-quality CPR until prompted by the AED to allow a rhythm check, about every 2 minutes. Continue CPR and using the AED until advanced life support providers take over or the victim begins to breathe, move, or otherwise react.

When to Switch From Only Rescue Breathing to CPR in an Infant or a Child

When you are providing rescue breathing only, start CPR (compressions and breaths) if you see the following: Signs of poor perfusion in an infant despite effective oxygenation and ventilation provided by rescue breathing The infant's or child's heart rate is less than 60/min with signs of poor perfusion When a pulse is no longer felt

Child AED Pads

Your AED may include smaller pads designed specifically for children younger than 8 years of age.

AED

automated external defibrillator

If victim is not breathing normally or gasping and has no pulse

begin CPR (step 4)

If the AED detects a shockable rhythm,

give 1 shock. Resume CPR immediately until prompted by the AED to allow a rhythm check, about every 2 minutes. Continue CPR and using the AED until advanced life support providers take over or the victim begins to breathe, move, or otherwise react.

AED job

ightweight, portable, computerized device that can identify an abnormal heart rhythm that needs a shock. -The AED can then deliver a shock that can stop the abnormal rhythm and allow the heart's normal rhythm to return.

The victim is breathing normally and a pulse is felt

monitor victim

Once the AED arrives,

place it at the victim's side, near the rescuer who will operate it. This position provides ready access to AED controls and helps ensure easy placement of AED pads. It also allows a second rescuer to continue high-quality CPR from the opposite side of the victim without interfering with AED operation. Ensure that AED pads are placed directly on the skin and are not placed over clothing, medication patches, or implanted devices.

Check breathing:

scan victims chest for rise and fall (less than 10 seconds) -- if not breathing or is gasping CPR

Chest Compression Techniques: for infants

single rescuers can use either the 2-finger or 2 thumb-encircling hands technique. If multiple rescuers are present, the 2 thumb-encircling hands technique is preferred. If you cannot compress the necessary depth on an infant with your fingers, you can use the heel of one hand. These techniques are described below.

Step 4

start CPR with 30 chest compressions followed by 2 breaths -USE AED as soon as possible

Victim is not breathing normally and has no pulse

start chest compressions: -position victim -compression to ventilation ratio - compression rate -compression depth -chest recoil -interruptions in chest compressions -

Chest Compression Techniques for a child

use 1 or 2 hands. For most children, the compression technique is the same as for an adult: 2 hands (heel of one hand with heel of other hand on top of the first hand). For a small child, 1-handed compressions may be adequate to achieve the desired compression depth. Whether you use one hand or both hands, compress at least one third the AP diameter of the chest (approximately 2 inches, or 5 cm) with each compression.

Step 5-6

use aed as soon as available following AED directions to check the rhythm

If AED advises a shock: clear the victim

yell clear the vitim everbody clear Press the Shock button (Figure 23B). The shock will produce a sudden contraction of the victim's muscles. If the AED prompts that no shock is advised or after any shock is delivered, immediately resume CPR, starting with chest compressions (Figure 24). After about 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat Steps 3 and 4.