NCM 109 CARE OF MOTHER, & CHILD AT RISK

OR WITH PROBLEM (ACUTE OR CHRONIC) RLE

2M – Cardio-Pulmonary Resuscitation

CARDIO-PULMONARY RESUSCITATION
Cardio-Pulmonary Resuscitation (CPR) BLS VS ALS
• Cardiopulmonary resuscitation is an emergency Basic Life Support (BLS) is an emergency transport
procedure consisting of chest compressions provided by certified Emergency Medical Technicians
often combined with (EMTs). Advanced Life Support (ALS) is provided when a
artificial ventilation in patient is in more critical condition and a paramedic is
an effort to manually required to assist in the treatment of the patient before
preserve intact brain and/or during transport to the emergency facility. An
function until further ALS on can give basic treatment in case of cuts or
measures are taken injuries whereas a BLS person does not have the right to
to restore do it. Unlike the BLS unit, an ALS unit will be equipped
spontaneous blood with airway equipment, cardiac life support, cardiac
circulation and monitors and glucose testing device.
breathing in a person
who is in cardiac Cardiac Arrest
arrest. • Cardiac arrest, sometimes called sudden cardiac
arrest, means that your heart suddenly stops
Resuscitation beating.
• Resuscitation is the process of correcting Respiratory Arrest
physiological disorder such as lack of breathing • Respiratory arrest is caused by apnea or
or heartbeat) in an acutely ill patient respiratory dysfunction severe enough it will not
Airway sustain the body. Prolonged apnea refers to a
• The airway or breathing passage is the pathway patient who has stopped breathing for a long
through which air flows into your lungs. period of time
Artificial Respiration Crackles
• Artificial respiration is generally known as “the • Crackles occur if the small air sacs in the lungs
kiss of life” or “mouth-to-mouth resuscitation.” It fill with fluid and there's any air movement in
is the act of simulating respiration for a person the sacs, such as when you're breathing.
who is not breathing or not making sufficient Defibrillation
respiratory effort on his or her own. • Defibrillation is a treatment for life-threatening
Basic Life Support (BLS) cardiac dysrhythmias, specifically ventricular
• Basic life support is a level of medical care which fibrillation and non-perfusing ventricular
is used for victims of life-threatening illnesses or tachycardia.
injuries until they can be given full medical care
by advanced life support providers. It can be
provided by trained medical personnel, such as
emergency medical technicians, and by qualified
bystanders.

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External cardiac breathing out (expiration) or breathing in
compression (inspiration).
• External cardiac
compression is now THE GENERAL PRINCIPLES OF
the accepted CIRCULATION
method of treating
It consists of the heart and the blood vessels running
sudden cardiac
through the entire body.
arrest. The
technique is The circulatory system carries blood from the heart to
described, with the tissues of the body and returns the blood to the
particular emphasis heart. It allows for nutrient, waste, and gas exchange
on the steps which with the tissues as well as transport other substances
can cause serious (hormones, enzymes, etc.) through the body. Moreover,
trauma, if not the circulatory system regulates blood pressure and
properly performed. blood flow to the tissues.
Two types of Circulation:
Heimlich maneuver • Pulmonary Circulation - delivers blood from
• a first-aid procedure for the heart to the alveoli of the lungs for
dislodging an reoxygenation. It is through the alveoli that
obstruction from a carbon dioxide is exchanged for fresh oxygen
person's windpipe in • Systemic Circulation - delivers oxygenated
which a sudden strong blood from the heart to the periphery of the
pressure is applied on body through a vast network of blood vessels.
the abdomen, between Two types of Blood Vessels:
the navel and the rib • The Arteries carry blood away from the heart.
cage. The main artery (aorta) – branches into large
arteries, which lead to smaller and smaller
Jaw thrust technique vessels.
• It is performed by placing the index and middle • The Veins carry blood back to the heart. The
fingers to physically push the posterior aspects inferior vena cava, the largest vein, carries
of the lower jaw upwards while their thumbs deoxygenated blood to the heart.
push down on the chin to open the mouth. • Not all arteries carry oxygenated blood, and not
all veins carry deoxygenated blood:
o The Pulmonary Artery is the only artery
that carries DEOXYGENATED BLOOD
away from the heart
o The Pulmonary Vein is the only vein that
carries OXYGENATED BLOOD back to
the heart.

Ronchi
• A rattling or whistling respiratory sound
resembling snoring, caused by secretions in the
trachea or bronchi.
Ventilation
• The act of forcing air in and out of the lungs of a
person who cannot breathe easily on their own,
using a special machine called a ventilator.
Wheezing
• Wheezing is a high-pitched whistling sound
made while breathing. It's often associated with
difficulty breathing. Wheezing may occur during
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 SYSTEMIC CIRCULATION I. CIRCULATION
In the systemic circulation, the left ventricle pumps Check for:
oxygen-rich blood into the main artery (aorta). The • Signs for a heartbeat or pulse
blood travels from the main artery to larger and smaller o Pulse can be checked on the wrist or
arteries and into the capillary network. There, the blood neck
drops off oxygen, nutrients and other important • Skin appearance
substances and picks up carbon dioxide and waste • Movement & Coughing (however, the person
products. The blood, which is now low in oxygen, is could be unconscious)
collected in veins and travels to the right atrium and into Compressions must be done as this ensures vital blood
the right ventricle. flow to the heart, the brain, and other vital organs of the
body. Chest compressions are performed first if the
PULMONARY CIRCULATION person is unresponsive and not breathing or not
The right ventricle pumps low oxygen blood into the breathing properly.
pulmonary artery, which branches off into smaller and To perform:
smaller arteries and capillaries. The capillaries form a 1. Place the heel of your hand on the center of the
fine network around the pulmonary vesicles (grape-like person’s chest and place the heel of your other hand on
air sacs at the end of the airways). This is where carbon top of your hand that sits atop the person’s chest.
dioxide is released from the blood into the air inside the 2. Maintain straight arms and shoulders
pulmonary vesicles, and fresh oxygen enters the 3. Push hard and fast at least 2 inches (5 cm) in adults
bloodstream. When we breathe out, carbon dioxide and children and about 1 ½ inches (4 cm) in infants.
leaves our body. Oxygen-rich blood travels through the 4. Allow the chest to recoil after each push.
pulmonary veins and the left atrium into the left 5. 30 compressions must be done in approximately 18
ventricle. The next heartbeat starts a new cycle of seconds.
systemic circulation. 6. It is reasonable for the responder to deliver at least a
rate of 100 compressions per minute.
THE ABC OF BASIC
LIFE SUPPORT II. Airway
• Refers to Airway assessment must be done as well to make sure
simultaneously there is nothing obstructing the airway which mainly are
assessing the the nose and mouth.
person’s airway, To assess:
breathing, and 1. Assess for any visible obstructions in the airway
circulation. 2. Clear airway by removing any loose obstruction,
• Used as steps in (mucus, blood, foreign body) from mouth and pharynx
performing 3. In case of unconscious victim, tongue is the most
Cardiopulmonary common cause of airway obstruction
Resuscitation in 4. If the victim is still not breathing, then open airway by
adults, children, and head tilt and chin lift or jaw thrust
infants and these 5. If the mouth is not clear, place the person on their
stand for Airway, side and clear the contents.
Breathing, and Circulation. 6. Tilt the head back by placing one hand on the
• ABC to CAB (Chest Compressions, Airway, forehead and the other lifting the chin.
Breathing) 7. Once the airway is clear, proceed to perform rescue
o Compressions are done first to make breaths.
sure circulation is ongoing in the body
while only slightly delaying ventilation III. Breathing
o In the CAB sequence, the responder In the new CAB approach, ventilation is only minimally
initiates compressions first then delayed until the first cycle of chest compressions are
assessment of airway and breathing are done (30 compressions) in approximately 18 seconds.
followed • Delay will be reduced if 2 rescuers are present.
• After which the first cycle is done, 2 rescue
breaths are delivered and the cycle is repeated.
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 • Repeat the cycle 5 times in 2 minutes and stop trigger sudden cardiac arrest when these
only when help arrives or when the person abnormalities are present.
responds to the CPR performed. Recreational drug use
• This can occur in otherwise healthy people.

CAUSES OF RESPIRATORY ARREST

Smoking
• Inhaling toxic chemicals, smoke, or fumes can
also cause acute respiratory failure. These
chemicals may injure or damage the tissues of
your lungs, including the air sacs and capillaries
Obstruction
• When something lodges in your throat, you may
have trouble getting enough oxygen into your
lungs. Obstruction can also occur in people with
chronic obstructive pulmonary disease (COPD)
or asthma.
CAUSES OF CARDIAC ARREST Stroke
Scarring of the heart tissue • Patients with acute strokes may not be able to
• It may be the result of a prior heart attack or maintain adequate oxygenation and/or
another cause. A heart that’s scarred or ventilation in the absence of an acute
enlarged from any cause is prone to develop respiratory failure. In fact, respiratory arrest
life-threatening ventricular arrhythmias. represents a primary cause of death in the first
Thickened heart muscle (cardiomyopathy) few days after a stroke.
• Damage to the heart muscle can be the result of Drug or alcohol abuse
high blood pressure, heart valve disease or • If you overdose on drugs or drink too much
other causes. alcohol, you can impair brain function and
Congenital Heart Disease hinder your ability to breathe in or exhale.
• When sudden cardiac arrest occurs in children Infection
or adolescents, it can be due to congenital heart • Infections are a common cause of respiratory
disease. Adults who've had corrective surgery distress. Pneumonia in particular, may cause
for a congenital heart defect still have a higher respiratory failure, even in the absence of acute
risk of sudden cardiac arrest. respiratory distress syndrome (ARDS).
Heart medications Cystic Fibrosis
• Under certain conditions, some heart • A progressive, genetic disease that causes
medications can set the stage for arrhythmias persistent lung infections and limits the ability
that cause sudden cardiac arrest. to breathe over time. Cystic fibrosis affects the
Electrical abnormalities cells that produce mucus, sweat and digestive
• These are called primary heart rhythm juices
abnormalities and include conditions such as Spinal Cord Injuries
Wolff-Parkinson-White syndrome and Long QT • Respiratory dysfunction is a major cause of
syndrome that may cause sudden cardiac arrest morbidity and mortality in spinal cord injury
in children and young people (SCI), which causes impairment of respiratory
Blood vessel abnormalities muscles, reduced vital capacity, ineffective
• These rare cases occur particularly in the cough, reduction in lung and chest wall
coronary arteries and aorta. Adrenaline compliance, and excess oxygen cost of
released during intense physical activity can
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 breathing due to distortion of the respiratory People with low oxygen levels may experience:
system • An inability to breathe
Injury • Bluish coloration in the skin, fingertips, or lips
• An injury that impairs or compromises your
respiratory system can adversely affect the LIST THE METHODS OF ARTIFICIAL
amount of oxygen in your blood. For instance,
RESPIRATION
an injury to the spinal cord or brain can
immediately affect your breathing. Mouth-to-Mouth Resuscitation
This is one of the most effective artificial respiration
methods. The fundamental benefit of this approach is
SIGNS AND SYMPTOMS OF CARDIAC ARREST
that it provides expired air containing carbon dioxide,
3 Cardinal Signs:
which activates the patient's respiratory center,
1. No pulse
resulting in better breathing.
2. No breathing
• Rescuer must inhale somewhat deeper than
3. Dilated pupils
normal (700 to 1000 ml) and exhale directly into
the victim's mouth for 1 second, causing a
If you are in cardiac arrest, you may:
visible chest rise
• Experience heart palpitations
• For most adults, a tidal volume (VT) of 700 ml to
• Become dizzy
1000 ml is ideal.
• Feel fatigued or weak
• When chest compressions are being given, a VT
• Be short or breath
of 500 ml should be given.
• Vomit
• Children's volumes are correspondingly smaller.
Immediate emergency care is needed if you or someone
• Two breaths, each lasting one second, should
you are with experiences these symptoms:
be delivered to a victim of cardiac arrest during
• Not breathing/difficulty breathing
resuscitation.
• No pulse
• Excessive volumes (>500 mL) or a rapid
• Chest pain
inspiratory rate (>8 to 10 breaths/min) should
• Collapse be avoided since they can force air into the
• Loss of consciousness stomach, producing gastric inflation and raising
intrathoracic pressure.
o Increased intrathoracic pressure can
SIGNS AND SYMPTOMS OF RESPIRATORY ARREST decrease coronary and cerebral
People with acute failure of the lungs and low oxygen perfusion.
levels may experience: • In both children and adults, a visible chest rise
• Restlessness should be used to determine the amount of VT
• Anxiety needed.
• Sleepiness
• Loss of consciousness
• Rapid and shallow breathing
• Racing heart
• Irregular heartbeats (arrhythmias)
• Profuse sweating

People with a high carbon dioxide level may

experience:
• Rapid breathing
• Confusion

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 2. If the patient is a child between 1 year old and
1. Place the victim on his or her back on a hard, puberty, ventilate the victim’s lungs using the
flat surface. same technique as would be used for an adult.
2. Kneel at the patient’s side, and open and clear 3. Provide an initial breath (over 1 second)
the airway as previously described. Pinch the sufficient to cause a visible rise in the chest. In
victim’s nose with your thumb and index finger infants, small puffs of air from the rescuer’s
close to the nares to prevent air from escaping cheeks are usually sufficient to achieve
during ventilation. adequate ventilation.
3. Take a slightly deeper than normal breath and 4. Remove your mouth, and allow the victim to
deliver 500 ml over 1 second, while making a exhale passively. Provide a second breath after
seal over the victim’s mouth. A good seal over this deflation pause.
the patient’s mouth is essential. If a good seal 5. After successfully delivering two breaths,
cannot be obtained using this method, attempt immediately assess the pulse (less than 10
mouth-to-nose ventilation. seconds)
4. Remove your mouth from the patient’s mouth, 6. If the initial attempt to ventilate fails, reposition
and allow the victim to exhale passively. Provide the victim’s head and repeat the effort. A child’s
a second breath after exhalation is complete. head may need to be moved through a wide
5. After successfully delivering two breaths, range of positions to secure an open airway.
immediately assess the circulatory status. Hyperextension of a child’s neck can cause
6. Should the initial attempt to ventilate fail, obstruction and should be avoided. If a second
reposition the victim’s head and repeat the attempt at ventilation fails, the victim may have
effort. If a second attempt at ventilation fails, FBAO, and the appropriate procedures outlined
the victim may have foreign body airway elsewhere in this chapter should be followed.
obstruction (FBAO), and the procedures for 7. Assuming mouth-to-mouth ventilation is
handling such situations described elsewhere in successful and the child remains apneic,
this chapter should be followed. continue to provide one breath every 3 to 5
7. Assuming mouth-to-mouth ventilation is seconds to maintain a rate of 12 to 20
successful and the patient remains apneic, breaths/min.
continue the effort at a rate of one breath every
6 to 7 seconds to maintain the minimal adult Mouth-to-Nose Resuscitation
rate of 8 to 10 breaths/min. In some cases, such as trismus (involuntary contraction
of the jaw muscles, commonly known as lockjaw) and
The procedure for children and infants is as follows: traumatic jaw or mouth injury, mouth-to-mouth
resuscitation is not possible.

1. If the patient is an infant (less than 1 year old),

create an alright seal by placing your mouth 1. Place the victim on his or her back.
over the infant’s nose and mouth

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 2. Use the head-tilt/chin-lift maneuver to establish more effective in delivering the required tidal
the airway, taking care to close the mouth volume and also creates a better seal.
completely. 5. Ensure that the soft tissue around the neck is
3. Inhale slightly deeper than normal and exhale not compressed by the rescuer's fingers.
into the patient’s nose. Greater force may need
to be applied than would be used with mouth- Mouth-to-Mouth and Nose
to-mouth ventilation because the nasal Usually done with child under age 8 or on an Infant
passageways are smaller.
4. Remove your mouth from the victim’s nose to
allow the patient to exhale passively. If the
patient does not exhale through the nose
(because of nasopharyngeal obstruction from
the soft palate), open the victim’s mouth or
separate his or her lips to facilitate exhalation.
5. After successfully delivering two slow breaths,
immediately assess the circulatory status. 6. If
the victim remains apneic, maintain ventilation
at the rate appropriate for his or her age. 1. Place the child on a hard, flat surface.
2. Look into the mouth and throat to ensure that
Ambu-bag the airway is clear. If an object is present, try to
A bag valve mask (BVM), often known as an Ambu bag, sweep it out with your fingers. If unsuccessful
is a handleheld tool that delivers positive pressure and the object is blocking the airway, apply the
ventilation to anyone who has insufficient or ineffective Heimlich maneuver. If vomiting occurs, turn the
breathing. It consists of a self-inflating bag, one-way child onto his or her side and sweep out the
valve, mask, and an oxygen reservoir. mouth with two fingers.
1. An oropharyngeal airway may be inserted to 3. Tilt the head back slightly to open the airway.
prevent airway occlusion when the patient is 4. Place your mouth tightly over the nose and
supine. mouth. Blow two quick, shallow breaths
2. The rescuer should be at the patient’s head. A (smaller breaths than you would give to an
good seal must be achieved with the mask and adult). Watch for the chest to rise.
the face. The pointed end of the mask must be 5. Remove your mouth. Look for the chest to fall
over the nose, and the curved end just below as the child exhales.
the lower lip 6. Listen for the sounds of breathing. Feel for the
3. A one-person technique requires the "E-C seal" child's breath on your cheek. If breathing does
method where the first and second digits form a not start on its own, repeat the procedure.
"C" over the mask with the thumb pressing
down by the nasal bridge, the second digit over Mouth-to-Mask
the bottom of the mask by the mouth, and your It provides the same tidal volume as mouth-to-mouth
remaining three digits forming an "E" over the rescue breathing, and is easier to use and provides
mandible to hold the mask tight. There should larger tidal volumes than the bag-valve-mask technique,
be no gaps between the mask and the face. You since both hands of the rescuer can be used to maintain
can also perform the “head-tilt chin lift” airway patency and a secure mask fit.
maneuver or a “jaw-thrust” if indicated to
maintain airway patency.
4. In a two-person technique, the second rescuer
squeezes the bag while the first rescuer uses
the same E-C technique with both hands. This is

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 irreversible damage is done to the brain. If CPR
is immediately performed within the time frame
of six minutes after cardiac arrest, there is hope
that the person will survive without much brain
damage. If CPR is immediately performed within
the time frame of six minutes after cardiac
1. Give 30 high-quality chest compressions. arrest, there is hope that the person will survive
2. Seal the mask against the person’s face by without much brain damage.
placing four fingers of one hand across the top
of the mask and the thumb of the other hand Contraindications for CPR
along the bottom edge of the mask. • Obvious death
3. Using the fingers of your hand on the bottom of o Sometimes cardiac arrest is not
the mask, open the airway using the head-
witnessed and the victim is found
tilt/chin-lift. (Do not do this if you suspect the unresponsive after an unknown amount
person may have a neck injury). of time. It’s also possible that the
4. Press firmly around the edges of the mask and deceased may have non-viable injuries,
ventilate by delivering a breath over one second such as catastrophic brain trauma.
as you watch the person’s chest rise. When discovering an unresponsive
victim, one must assess the victim to
INDICATIONS AND CONTRAINDICATIONS OF CPR AND see if starting CPR is necessary. The
TECHNIQUES OF EXTERNAL CARDIAC COMPRESSION following are signs to look for:
Indications for CPR ▪ Cold to the Touch
CPR should be immediately performed on any ▪ Rigor Mortis
person/individual who has become unconscious and is ▪ Livor Mortis (Lividity)
found to be pulseless. ▪ Injuries Not Compatible with
• It is recommended to begin performing CPR if Life
the person is unconscious or unresponsive to • An AED is available and ready to use
prevent them losing control of their breathing. • Another trained responder or EMS personnel
When a person is not breathing normally or if they are take over
taking occasional gasping breaths • You are too exhausted to continue performing
• A person experiencing cardiac arrest may CPR
continue to breathe for a while. However, CPR • The scene becomes unsafe
compressions should be started immediately • An obvious sign of life can be seen, such as:
when they start gasping for breath. o Breathing
CPR is performed when someone’s heart has stopped o Purposeful movement. If the person
(cardiac arrest) moves their arm, lifts their head up,
• Begin performing CPR when the pulse is not felt. grimaces, etc
Oxygen can not get to the rest of the body if the o Making sounds. Listen for obvious
heart is not pumping. Chest compressions keep sounds such as moaning or speaking.
the blood flowing to the heart and brain until o Eye Movement. The opening of eyelids
the emergency responders can take over and is not enough reason to stop CPR. Look
try other methods of resuscitation. for eye movements from the victim
Perform CPR when someone is not breathing such as blinking, looking around, and/or
• If the person is not breathing, perform CPR to focusing on objects.
circulate oxygenated blood throughout the
body. The average person can only go without
oxygen for a total of six minutes before

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 and press down by 5 to 6cm (2 to 2.5 inches) at
a steady rate of 100 to 120 compressions a
minute.
2. After every 30 chest compressions, give 2
rescue breaths.
3. Tilt the victim’s head gently and lift the chin up
with 2 fingers. Pinch the victim’s nose. Seal your
mouth over their mouth, and blow steadily and
firmly into their mouth for about 1 second.
Check that their chest rises. Give 2 rescue
Steps: breaths.
1. Place the heel of your hand on the breastbone 4. Continue with cycles of 30 chest compressions
at the center of the victim’s chest. Place your and 2 rescue breaths until they begin to recover
other hand on top of your first hand and or emergency help arrives.
interlock your fingers.
2. Position yourself with your shoulders above WAYS IN CHECKING THE EFFECTIVENESS
your hands. OF CPR
3. Using your body weight (not just your arms), Techniques of external cardiac compression
press straight down by 5 to 6cm (2 to 2.5 • Aim for 5 sets of 30 chest compressions to 2
inches) on their chest. breaths in about 2 minutes
4. Keeping your hands on their chest, release the • If you can’t do mouth-to-mouth, stick with
compression and allow the chest to return to its continuous compressions at a rate 100 per
original position. minute
5. Repeat these compressions at a rate of 100 to
120 times a minute until an ambulance arrives 1. A = Airways - open the person’s airways (nose,
or when you experience exhaustion. mouth and throat) and check they are clear.
Remove any blockage (such as vomit, blood,
CPR with Rescue Breaths food or loose teeth). Don’t spend too much
time doing this - CPR is the main priority
2. Make sure the person is in a neutral position
(such as on their back). Gently tilt their head
back and lift their chin.
3. B=Breathing - are they breathing normally? If
so, gently roll them onto their side (known as
recovery position)
4. If they are not breathing or breathing
abnormally (such as grunting or gasping for air)
you will need to give them CPR
5. C=CPR consist of 2 techniques - 30 chest
compressions and 2 breaths of mouth-mouth

Chest compression steps

Place the heel of one hand on the lower half of the
person's breastbone (in the middle of their chest).
Steps:
1. Place your other hand on top of your bottom
1. Place the heel of your hand on the centre of the
hand and grasp your wrist. Or you may like to
victim’s chest, then place the other hand on top

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 interlock your fingers - depending on what feels
comfortable
2. Keep your arms straight and press down on
their chest by one third of their chest depth
3. Release the pressure - this count as one
compression

CPR comparison between adult, child, infant, and pregnant woman as to:
CPR ADULT PREGNANT WOMAN CHILD INFANT
Head tilt-chin lift Head tilt-chin lift (do
not tilt head back too
Opening Airway far)

Carotid pulse (if no pulse, start CPR) Carotid pulse Brachial pulse
Checking of pulse
(if no pulse or (if no pulse of pulse <60
(at least 5 seconds
pulse <60 with with poor perfusion,
and no more than
poor perfusion, start CPR)
10 seconds)
start CPR)
2 hands 1 or 2 hands 2 fingers
Method (heel of 1, other (Middle and ring finger)
on top)
Give 2 breaths (1 second per breath)
Breaths

Center of chest between the nipples

Compression Area

1 ½ to 2 inches or 5 cm ½ depth of chest or 5 cm 1/3 depth of chest or 4 cm

Depth of
Compression

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 Place the heel of one Prior to performing Place the heel of one Place both thumbs
hand on the chest compressions, it hand in the center of (side-by-side) on the
breastbone, just is wise to manually the chest, with your center of the baby’s
below the nipples. move the uterus to other hand on top chest, just below the
Place the heel of your the left. While doing and your fingers nipple line.
other hand on top of this, place the victim interlaced and off
the first hand. Position in a comfortable the person’s chest. Use the other fingers
your body directly position- usually lying to encircle the
over your hands. Give on a flat surface. Position your baby’s chest toward
30 chest shoulders directly the back, providing
compressions. These Start with the over your hands and support.
compressions should compressions, without lock your elbows.
be FAST and hard. alternating the Using both thumbs
How to Compress Press down about 2 procedure with rescue Push down hard and at the same time,
inches into the chest. breathing. fast about 2 inches push hard down and
Each time, let the at a rate of 100 to fast about 1 ½ inches
chest rise completely Try to perform only 120 per minute. at a rate of 100 to
hands compressions 120 per minute
to ensure that the Allow the chest to
major veins have return to normal Allow the chest to
enough blood flow. position after each return to its normal
compression position after each
Continue to make 30 compression
compressions
followed by two
breaths until
exhaustion
100 - 120 per minute
Rate of External
Cardiac
Compression

30:2 1 Rescuer – 30:2

Ratio: 2 Rescuer – 15:2
Compression and
Ventilation

BLS CHAIN OF SURVIVAL

ADULT PEDIATRIC
1. Survey the Scene 1. Survey the scene
2. Ask for Help 2. Ask for help
3. Assess the pt. 3. Assess the pt.
4. Activate EMS 4. 1 Cycle of CPR (30:2)
5. Chest Compression 5. Activate EMS
6. Rescue breathing 6. Chest Compression
7. Rescue breathing

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When to Stop? • If the person loses consciousness, start
Scene becomes unsafe cardiopulmonary resuscitation (CPR). Before
Turn over to the physician providing rescue breaths, examine inside the
Over exhaustion of the rescuer patient's mouth after each set of chest
Physician declared death compressions and remove any obvious
Spontaneous return of circulation and breathing
impediment that can be reached. Do not do
blind finger sweeps.

DIFFERENT MANEUVERS AND TECHNIQUES Abdominal thrusts (Heimlich maneuver):

DURING EMERGENCY GIVEN VARIOUS 1. Encircle the patient’s midsection with your arms
2. Clench one fist and place it midway between the
CLIENTS umbilical and xiphoid
Heimlich’s Maneuver 3. Grab the first with other hand
Indication: 4. Deliver a firm inward and upward thrust by
• Choking due to severe upper airway obstruction pulling with both arms sharply backward and
due to a foreign object (signaled by inability to upward
speak, cough, or breathe adequately). 5. Rapidly repeat the thrust 6-10 times or until the
object is expelled and the person can breathe or
Steps: cough on their own
Determine if there is severe airway obstruction
• Look for signs of difficulty speaking, coughing,
or breathing.
• Look for hands clutching the throat, which is the
Universal Distress Signal of severe airway
obstruction.
• Ask: “Are you choking?”
• Encourage the person to cough if they are able
to speak and breathe, but do not do any airway
clearance maneuvers; instead, schedule a
medical examination.
• If the choking person nods yes or cannot speak,
cough, or breathe adequately, that means that
the airway is blocked and airway clearance
procedures are required.
On a Pregnant Woman
• You should place your hand a little higher on a
Treat the choking conscious adult or child
pregnant woman's torso, around the
• Stand directly behind the choking adult or kneel
breastbone's base.
behind a child.
• Place the person on their back and try to clear
• Begin with abdominal thrusts for people who
the airway with your finger in a sweeping
are not pregnant or obese; do chest thrusts for
motion if they are unconscious.
obese patients and women in late pregnancy.
• Begin CPR if you are unable to dislodge the
• To remove the obstruction, alternate between
stuck object
sets of abdominal thrusts (Heimlich maneuver),
On an Infant
chest thrusts, and back blows as needed. • Hold the newborn on your forearm, which
• Continue until the obstruction has been should be resting on your thigh, while sitting
eliminated or sophisticated airway management down.
techniques have been developed. • With the heel of your hand, softly give five back
blows.
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 • If it does not work, place the infant on your 1. Kneel behind the patient’s head, keeping the
forearm and thigh with their head lower than head in a neutral position with the head, neck,
their body. and spine aligned.
• Place two fingers at the center of their 2. Make sure your fingertips are at the angle of
breastbone and perform five quick chest the jaw and your hands are on each side of the
compressions. face (mandible).
• The back blows and chest thrusts should be 3. Gently lift the jaw to open the airway. Take care
repeated until the object is removed and the not to tilt the neck.
infant is able to breathe or cough on their own. 4. The tongue is moved forward in the mouth by
On yourself: the movement of the jaw, which opens the
• Make a fist with your thumb side in and position airway.
it directly over your navel. 5. Do not put fingers in the mouth to assist the jaw
• With your other hand, grab the fist and drive it thrust.
inward and upward at the same time. Perform Guidelines:
five of these abdominal thrusts. 1. Place your palms on the patient's temples and
• Repeat until the object is expelled and you can your fingers beneath the mandibular rami while
breathe or cough on your own. standing at the head of the stretcher.
• You can also thrust your upper abdomen 2. Avoid extending the neck in patients who may
against a hard edge like the corner of a table or have a cervical spine injury.
counter, or back of a chair. 3. With your fingers, lift the mandible upward
until the lower incisors are higher than the
upper incisors. The tongue and mandible are
lifted together in this procedure, allowing the
upper airway to be cleared
4. Make sure you solely pull or push up on the
mandible's bony portions. The airway may be
obstructed by pressure on the neck's soft
tissues.

Back Blows for Infants

Indications:
1. When someone cannot breathe because food, a
toy, or other object is blocking the throat or
windpipe (airway).
Jaw Thrust Technique 2. Create a strong vibration and pressure in the
Indications: airway, which is often enough to dislodge the
1. Patients who are obtunded or unresponsive blockage, allowing them to breathe again.
should have a treatment for suspected upper Support their head while you hold them in
airway obstruction. position.
2. Apnea or impending respiratory arrest is 3. If the person is able to cough forcefully, the
treated as part of the initial emergency care. 3 person should keep coughing. If the person is
3. Improvement of airway patency during BVM choking and can't talk, cry or laugh forcefully,
ventilation and sometimes during spontaneous the American Red Cross recommends a "five-
breathing. and-five" approach to delivering first aid
4. Patients who have apnea
Steps:
Steps: Give up to five back blows
• Lay the baby down on your forearm

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 • Hold the baby's mouth open with your fingers.
• Use the heel of your hand to give the baby a
firm back blow between the shoulder blades.
• Give up to five back blows.
• Check between each blow to see if the blockage
has cleared.
Give up to five chest thrusts:
• If the blockage hasn’t cleared, lay the baby on
their back.
• Put two fingers in the center of the chest, and
give up to five chest thrusts – like CPR Guidelines:
compressions but slower and sharper. Back blows for babies under 1 year
• Check to see if the blockage has cleared • Sit down and lay your baby face down along
between each thrust. your thigh or forearm, supporting their back
and head with your hand.
• Give up to 5 sharp back blows with the heel of 1
hand in the middle of the back between the
shoulder blades.
Back blows for children over 1 year
• Lay a small child face down on your lap as you
would a baby.
• If this isn't possible, support your child in a
forward-leaning position and give 5 back blows
If the blockage has come loose or been removed, from behind
remove the object with your little finger. Put the baby Unconscious child with choking
into the recovery position on their side with their head • If a choking child is, or becomes, unconscious,
tilted down. put them on a firm, flat surface and shout for
help.
• Call 911, putting the phone on speakerphone so
your hands are free.
• Don't leave the child at any stage.
• Open the child's mouth. If the object's clearly
visible and you can grasp it easily, remove it.
• Start CPR

Chest Thrust Technique

Indications:
If the baby is still choking, alternate five back blows and When the airway obstruction is severe and life is
five chest thrusts until emergency help arrives. If the endangered. If the choking person can speak, cough
baby becomes unconscious, start baby CPR. forcefully, or breathe adequately, no intervention is
required.

Steps:
• Encircle the
patient's
midsection with
your arms.
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 • Clench one fist and place it on the lower half of • Open the infant’s/child’s mouth. If an obvious
the sternum. object is seen, attempt to remove it with a
• Grab the fist with the other hand. single finger sweep. Blind or repeated finger
• Deliver a firm inward thrust by pulling both sweeps are not recommended because the
arms sharply backward. object could be pushed deeper into the
• Rapidly repeat the thrust 6 to 10 times as pharynx.
needed.

Guidelines:
Chest thrusts for children under 1 year
• Lay your baby face up along the length of your
thighs.
• Find the breastbone and place 2 fingers in the
middle.
• Give 5 sharp chest thrusts (pushes),
compressing the chest by about a third.
Indications:
• Running your finger through the choking
person’s mouth in an attempt to dislodge the
food or other object that is blocking the airway.
Steps:
1. With the victim’s
face up, open the
victim's mouth by
grasping both the
tongue and lower
jaw between the
thumb and fingers
and lifting the jaw.
This action draws
the tongue away
from the back of the
throat and away from a foreign body that may
be lodged there. This step alone may partially
relieve the obstruction.
2. Insert the index finger of the other hand down
along the inside of the cheek and deeply into
the throat to the base of the tongue
3. Use a hooking action to dislodge the foreign
body and maneuver it into the mouth so that it
can be removed.
Guidelines:
• Can be done quickly and require no special
equipment except a set of medical gloves
• A foreign body can be removed by performing a
“finger sweep.” This procedure, however, must
be performed on unconscious victims only
(though not on seizure victims).
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