The five links in the adult Chain of Survival
1- Immediate activation of EMS
2- Early CPR
3- Rapid defibrillation (not in peds)
4- Effective advanced life support
5- Integrated post-cardiac arrest care
The five links in the pediatric Chain of Survival
1- Prevention of arrest (only in peds)
2- Early CPR (2 in adults)
3- Rapid activation of the EMS (1 in adults)
4- Effective advanced life support
5- Integrated post-cardiac arrest care
The C in CAB stand for
Chest compressions
The A in CAB stand for
Airway
The B in CAB stand for
Breathing
For victims of all ages, begin CPR with
Compressions
If the victim is unresponsive and not breathing or only gasping, healthcare providers may take up to 10 seconds to
Feel for a pulse
For pediatric patients use a manual defibrillator. If not available the use of an AED equipped with .............. is preferred
an AED equipped with a pediatric dose attenuator
For pediatric patients if there is no pediatric AED available you may use an AED...
AED without a pediatric dose attenuator
BLS consists of these main parts
Chest compressions, Airway, Breathing and Defibrillation
If patient is not responding and not breathing or no normal breathing (only gasping), you should...
Shout for help
If the adult patient is not responding and not breathing and you are alone, you should...
Activate the emergency response system and get an AED and return to the patient
After you call for help on the non responsive, non breathing patient, you should...
Check the victim's pulse for 5 to 10 seconds
If you don't feel a pulse within 10 seconds, you should...
5 cycles of compressions and breaths
The ratio of compressions to breaths for one rescuer is...
30 compressions to 2 breaths
The first rescuer who arrives at the side of the victim must quickly be sure that
The scene is safe
Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest
Agonal gasps
In the adult patient you should check the ....... pulse
Palpate the carotid pulse
If you do not definitely feel a pulse within 10 seconds...
Start chest compressions
When you give chest compressions, push hard and fast at a rate of at least...
100 compressions per minute
When doing compressions make sure the victim is lying faceup on a firm, flat surface. If the victim is lying facedown...
Carefully roll him faceup
To do compressions put the heel of one hand on the ....of the victims chest on the....half of the breastbone
Center of the chest lower half of the breastbone
For adult compressions you should press down about...
2 inches (5 cm)
At the end of each compression, make sure you allow the chest to recoil. Chest recoil is necessary for...
Blood to flow into the heart to create blood flow
Incomplete chest recoil is harmful because it ........blood flow
Reduces
Chest compressions and chest recoil/relaxation times should be
Approximately equal
Only move the victim while CPR is in progress if
Dangerous environment
The two methods of opening the airway are
Head tilt-chin lift and jaw thrust
To open the airway using a jaw thrust and provide breaths with a bag-mask device, you need generally....
2 rescuers
If you suspect a head or neck injury, open the airway using
Jaw thrust
If the jaw trust does not open the airway, use
Head tilt chin lift maneuver
When a victim is unresponsive, the........can block the upper airway
Tongue can block the upper airway
When performing a head tilt-chin lift be careful not to
Press deeply into the soft tissue under the chin, do not use the thumb to lift the chin, do not close the victims mouth completely
The purpose of the one way valve when using a mask is to
Divert exhaled air, blood, or bodily fluids away from the rescuer
When using a mask to ventilate a patient, position yourself at the victim's side and open the airway using a
Head tilt chin lift maneuver
Deliver air over......to make the victims chest rise
1 second
Bag-mask ventilation technique requires instruction and practice and Is not recommended by
Lone rescuer during CPR
When using a Bag-Mask to ventilate a patient, position yourself ...
Above the victim's head
Use the.......technique to hold the mask in place when you lift the jaw to hold the airway open
E-C clamp technique
Squeeze the bag to give breaths and watch for...
Chest rise.
If you are using supplementary oxygen with a bag-mask device, you will deliver each breath over.......
Still over 1 second.
When a second rescuer is available to help, that second rescuer should
Activate the emergency response system and get the AED.
After the second rescuer returns, the rescuer should
Use the AED as soon as available
In 2 rescuer CPR the rescuers should switch roles
After every 5 cycles of CPR (about every 2 minutes)
During CPR try to limit interruptions in compressions for
Less than 10 seconds
In 2 rescuer adult CPR the compression ventilation ratio is
30:2
Switching roles should be done .........in seconds
Less than 5 seconds
When giving breaths you should
Watch for chest rise and avoid excessive ventilations
To reduce rescuer fatigue, switch compressor roles every
5 cycles (about 2 minutes)
When 2 rescuers use the bag-mask system, they can provide more effective ventilations by
One rescuer open the airway and holds the mask to the face while the other rescuer squeezes the bag
The jaw thrust is performed by lifting the jaw without tilting the head. Place one hand on each side of the victim's head, resting your elbows on the surface on which the victim is lying, then...
Place your fingers under the angles of the victim's jaw and lift with both hands, displacing the jaw forward
The AED stands for
Automated External Defibrillator
The AED are recommended for adults and
Children 8 years of age and older
When the heart muscle fibers quiver and do not contract together to pump blood, this is called...
Ventricular fibrillation
A defibrillator delivers an electric shock to
Stop the quivering of the heart
The 4 universal steps for operating an AED
Power on the AED - 2 Attach pads, 3 Clear to Analyze - 4 (if shock advised) Clear the victim and press the Shock button
After attaching the pads to the victims chest you should
Plug in connectors to AED box as needed
If no shock is needed, and after any shock delivery you should
Resume CPR starting with chest compressions
To place the pads on the victims bare chest, Place one pad on the upper-right chest (below the collarbone) and place the other pad
to the side of the left nipple, with the top edge of the pad a few inches below the armpit
When using the AED if multiple rescuers are present, one rescuer should continue chest compressions while another rescuer
Attaches the AED pads
If the heart muscle resets and initiates an organized rhythm this is called
ROSC return of spontaneous circulation
Keeping the time between the last compression and shock deliver to 10 seconds or less results in
The shock is much more likely to be effective
While transporting victim on a stretcher or in an ambulance you may leave the AED attached, you should never push...
Push the Analyze button... movement can interfere with rhythm analysis.
First bring vehicle to complete stop
If the AED the victim has a hairy chest and the AED is unable to analyze you should
Press down firmly on each pad, or pull off the pads to remove some hair, or shave the area and put new pads
If the victim is in water or the chest is covered with water, pull the victim out of the water.
Quickly wipe the chest before attaching the AED pads
If the victim is lying on snow or in a small puddle,
You may use the AED
If you identify an implanted defibrillator/pacemaker
Avoid placing the AED pad directly over the device
if patient has a medication patch in the area where the AED pad is to be attached
Remove the patch and wipe the area before attaching pad
For victims 8 years old and older only use.....pads
Adult pads
AHA considers a child to be
1 year old to puberty
Signs of puberty include
Chest or underarm hair on males and breast development in females
The compression ratio for one rescuer pediatric BLS is
30 compressions to 2 breaths
Compression-ventilation ratio for 2 rescuer pediatric CPR
15:2
Compressions depth for children
2 inches (5 cm) one third the depth of the chest
Compression technique for children
May use 1 or 2 handed compressions
If arrest was not witnessed the lone rescuer should first...
Provide 2 minutes of CPR before leaving the child to activate EMS and get the AED
If arrest is sudden and witnessed, you should first...
Leave the child to activate EMS and get AED, then return to child
Many infants and children develop....before they develop cardiac arrest.
Respiratory arrest and bradycardia
Recommended depth of compressions for children
At least one third of the anterior-posterior depth of the chest or approximately 2 in. (5 cm)
if the child is unresponsive and not breathing or just gasping you should
Shout for help...if someone responds, send them to activate EMS
Check the child's pulse may use the
Carotid or femoral pulse
If within 10 seconds you don't feel a pulse or if despite adequate oxygenation and ventilation, the heart rate is <60/min with sings of poor perfusion, you should
Perform cycles of compressions and breaths (30:2 ratio) starting with compressions
After 5 cycles of CPR on the child if someone has not already done so...
Activate EMS and get the AED
To find a femoral pulse you should
Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the abdomen.
The term infant refers to
Infants to 1 year of age
The location of pulse check in infant is
Brachial artery
The technique of delivering compressions on infants for one rescuer is
2 fingers
The technique of delivering compressions on infants for two rescuers
2 thumb-encircling hands technique
The compression depth for infant CPR
At least one third the chest depth, approximately 1 � in (4 cm)
The compression-ventilation ratio for one rescuer infant CPR
30:2
The compression-ventilation ratio for 2 rescuers infant CPR
15:2
If you did not witness the arrest on infant and are alone
Provide 2 minutes of CPR before leaving infant to activate EMS
If the arrest is sudden and witnessed
Leave the infant to phone 911 and get the AED then return to infant
To perform a pulse check in an infant, palpate the
Brachial pulse
If an infant is unresponsive and not breathing or only gasping and you do not feel a pulse within 10 seconds
Start CPR beginning with chest compressions
If the infant has no pulse or despite adequate oxygenation and ventilation, the heart rate is <60/min with signs of poor perfusion
Perform cycles of compressions and breaths
(30:2) starting with compressions
To give chest compressions to an infant using the 2 fingers technique. Place 2 fingers...
In the center of the chest just below the nipple line
When giving compression avoid pushing on
The bottom of the breastbone
Deliver compressions on the infant at a rate of at least
100/min
Infants and children who develop cardiac arrest often have
Respiratory failure or shock
When opening airway on an infant you should position the neck
In a neutral position (sniffing) position
after each compression, completely release the pressure on the breastbone and allow
The chest to recoil completely
Use the AED (or defibrillator)
As soon as it is available
If your AED includes a smaller size pad designed for children, use it. If not...
Use the standard pads, making sure they do not touch or overlap
When an advanced airway is in place the compression rate should be at least
100/min without pauses for breaths
The rescuer performing ventilations gives 1 breath every...
6 to 8 seconds (8 to 10/minute)
When an advanced airway is in place during 2-resucer CPR, do not stop compressions to....
Give breaths
When giving mouth to mouth the rescuer's exhaled air contains approximately......this is enough to meet the needs
17% oxygen and 4% carbon dioxide
When giving mouth to mouth you should,
take a regular breath and seal your lips around the victim's mouth.
Open victim's airway with head tilt-chin lift, pinch his/her nose closed, then...
Give 1 breath, watch for chest rise
When attempting to ventilate the chest doesn't rise, you should
Repeat the head tilt-chin lift give a second breath (1 sec)
If you are unable to ventilate the victim after 2 attempts
Return to chest compressions
If you give breaths too quickly or with too much force, air is likely to enter the stomach this causes
Gastric inflation
Rescuers can reduce the risk of gastric inflation by avoiding
giving breaths too rapidly, too forcefully, or with too much volume.
When ventilating an infant the preferred technique is
mouth to mouth and nose technique
When an adult, child, or infant have a pulse but is not breathing effectively, rescuers should
Give breaths without chest compressions
Rescue breathing for adults
1 breath every 5 to 6 seconds about (10 to 12 breaths per minute)
Rescue breathing for infants and children
1 breath every 3 to 5 seconds about (12 to 20 breaths per minute)
Give each breath in 1 second watching for
Chest rise
After about 2 minutes of rescue breathing you should
Check pulse
In infants and children if despite adequate oxygenation and ventilation, the pulse is <60 with signs of poor perfusion...
Start CPR
Respiratory arrest is...
The absence of respirations (apnea)
If choking victim has good air exchange, can cough forcefully or may wheeze between coughs you should
Encourage victim to continue coughing , do not interfere
If mild airway obstruction persists, you should
Activate EMS
Poor or no air exchange, weak, ineffective cough or no cough at all, high-pitched noise while inhaling or no noise at all, increased respiratory difficulty, possible cyanosis, unable to speak, clutching the neck with the thumb and fingers are signs of
Sever airway obstruction
If patient is showing signs of severe airway obstruction you should
Ask the victim if he is choking then try to help relieve obstruction
To relieve choking in a responsive victim 1 year or older
Use abdominal thrusts
To perform abdominal thrust position your hands
Around the victim's waist
Repeat abdominal thrusts until
The object is expelled or the victim becomes unresponsive
For conscious Pregnant and obese victims who is choking you should
Perform chest thrusts
If a choking victim becomes unresponsive
Activate EMS, begin CPR starting with compressions (do not check for a pulse)
Before giving breaths after 30 compressions you should
Open the mouth and look for the object
If you see the object and can easily be removed
Remove it with your fingers
If you do not see an object
Keep doing CPR activate EMS after 2 minutes if someone has not done it
Sometimes the choking victim may be unresponsive when you first encounter him. You probably will not know that an airway obstruction exists.
Activate EMS and start CPR (C-A-B sequence)
After you relieve choking in an unresponsive victim
Check response, breathing and pulse. Provide CPR or rescue breathing if needed
If an infant cannot make any sounds or breathe
Severe airway obstruction is present
To relieve choking in a responsive infant
Deliver up to 5 back slaps, and 5 chest thrust
You should repeat the sequence of up to 5 back slaps and 5 chest thrusts until
The object is removed or the infant becomes unresponsive
You should never perform ......on choking infants or children
Blind finger sweeps
If the choking infant becomes unresponsive
Begin CPR
Each time you open the airway, look for the obstructing object, if you see an object
Remove it
After approximately 2 minutes of CPR (C-A-B sequence), if no one has done so....
Activate EMS