HOLY CROSS COLLEGE OF NURSING

ADOOR

BLS /CPR FOR ADULTS

Cardio-
Pulmonary
Resuscitation

STUDENT MODULE
 ( According to American Heart Association 2021 )

BLS /CPR FOR ADULTS

BLS (Basic Life Support) /CPR ( Cardio Pulmonary Resuscitation) For Adults

Overview This section describes the basic steps of Basic Life Support ( BLS) or Cardiopulmonary Resuscitation for
adults. Adults include adolescents ( ie. After the onset of puberty).

CPR is the combination of chest compression and artificial breathing delivered to victims
of cardiac arres
Cardiac arrest is the abrupt cessation of the normal circulation
Indication for CPR: No response. No pulse and no respiration

Learning Objectives:

At the end of this section you will be able to

1  Tell the basic steps of CPR for adults

2  Demonstrate the basic steps of CPR with confidence

Understanding the Basic of BLS

1 Chest Compressions

2 Airway

3 Breathing
BLS consists of these main parts
4 Defibrillation

Basically if you memorize 5 alphabets you can easily remember the steps of

CPR. They are

1 A stands for Assessment

2 A Activate emergency medical service
3 C Chest Compressions
4 A Airway
5 B Breathing
6 D Defibrillation

CPR Performance
Make sure the environment is safe for rescuers and victim. Ensure no fire, no drowning
or vehicle accidents etc.
Step 1 Action: Assessment
A Assess Response: Shake on the Shoulder and
Shout, asking Are you all right?
Assess if patient is:
Unresponsive, No breathing or
only gasping (i.e,no normal
breathing)
If patient responds and breathing, place the patient
in recovery position

STEP 2 Action: Activate EMS

A
If no response and no breathing or gasping, Activate the
emergency medical service by using your mobile by dialing
112 and Get AED ( Code Blue if in hospital)

STEP 3 Action: Circulation Check Carotid Pulse

C
Check Carotid Pulse .
Locate trachea, using 2 or 3 fingers
Slide the fingers into the groove between the trachea and neck
muscles where carotid pulse can be felt.
Feel the pulse for 5-10 seconds. If pulse is not felt, give CPR
starting with Chest compressions in
C-A-B sequence Chest compression technique

1 Position at the victim’s side

2 Ensure the victim is in supine position on a flat and
firm surface.
3 Place the heel of one hand on the center of the
victim’s chest on the lower half of the sternum.
4 Place the heel of the other hand on the top of the
first hand
5 Straighten the arms and position shoulder directly
over the hands
6. Push hard and fast
Press down at least 2 inches (5cm) with each
compression (push hard). Ensure that the sternum
is pushed straight down with each compression
Give compressions at least 100/min as in a regular
heart beat
7. Each compression should allow the chest to recoil
or re-expand completely to allow blood flow to the
heart. If not blood flow will be reduced with
compressions.
8 Continue 5 cycles of compression with ventilation
(2 minutes)

If there are two rescuers Compression ventilation ratio is 30: Minimize interruptions in
chest compressions to less than 10 seconds.

Step 4 Action: Open Airway ( Head Tilt –Chin Lift)

A
Place one hand on the victim’s forehead and push with palm to tilt
the head back
Place the finger of the other hand under the bony part of the lower
jaw near the chin
Lift the jaw to bring the chin forward

Step 5 Action: Breathing or Ventilation with Mouth to

B Face Mask

Place the mask on the victim’s face, using the bridge of the nose as a
guide for correct Position
Seal the face mask against the face:
Place the index finger and thumb along the edge of the mask
Place the thumb of the second hand along the bottom edge of the
mask
Pace the remaining fingers of the second hand along the bony
margin of the jaw and lift the jaw
Perform a head tilt-chin lift to open the airway
Press the face mask firmly and completely against the face
Deliver air over 1 second to make the chest rise

See Directions below If Mouth to Mouth breathing is given

Place one Palm over the victim’s forehead and push the head back
Place the fingers of the other hand under the bony part of the lower
jaw near the chin
Lift the jaw with fingers to bring the chin forward
Place the mouth shield/ Gauze piece over the mouth
Pinch the nose with the hand on the forehead
Give 2 breaths – one second a breath.

If there are two rescuers, one will give chest compression and the other will give artificial
Ventilation taking turns without interruption in chest compressions

See Directions below If Mouth to Bag Mask breathing is given for 2 rescuers only

Using Bag Mask- E C Technique

Place the mask on the victim’s face, using the bridge of the
nose as a guide for correct position
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 tilt the angles of the jaw -3
fingers form an “E”
Open the airway, and press the face to mask
Squeeze the bag to give breaths (1 second each) watching
the chest rise

2- Rescuer Adult BLS/CPR Sequence

Rescuers Activities
Rescuer 1 Perform chest compression - Compress the chest at least 2 inches (5cm)
At the - Compress at a rate of at least 100/min
Victim’ s side - allow the chest to recoil completely after each compression
- Minimize interruptions in compressions t0 < 10 seconds
- Use a compressions to breaths ration of 30:2
- Count compressions aloud
- Switch duties with the second rescuer every 5 cycles or about 2 minutes,
taking < 5 seconds to switch
Rescuer 2 Maintain an open airway using either
At the - Health tilt- Chin lift
Victim’s head - Jaw thrust
- Give breaths, watching for chest rise and avoiding excessive ventilation
- Encourage the first rescuer to perform compressions that are deep enough
and fast enough and to allow complete chest recoil between compression
- Switch duties with the first rescuer every 5 cycles or about 2 mounts, taking
< 5seconds to switch.

The rescuers will give compressions and breaths but should switch roles after every 5 cycles of
CPR (about every 2 minutes)
 2 rescuers using the Bag-Mask

Two-rescuer bag-mask ventilation. The rescuer at the victim’s head tilts the victim’s head and seals
the mask against the victim’s face with the thumb and first finger of each hand, creating a “C” to
provide a complete seal around the edges of the mask. The rescuer uses the remaining 3 fingers (the
“E”) to lift the jaw (this holds the airway open) and hold the face up against the mask. The second
rescuer slowly squeezes the bag (over 1 second) until the chest rises. Both rescuers should watch for
chest rise.

Opening the Airway for Breaths: Jaw Thrust

If the victim has head or neck injury and you suspect a spine injury, 2 rescuers may use another
method to open the airway: a jaw thrust.

Follow these steps to perform a jaw thrust:

Step Action
1 Place one hand on each side of the victim’s head, resting your elbows on the surface
on which the victim is lying
2 Place your fingers under the angels of the victim’s lower jaw and lift with both hands,
displacing the jaw forward
3 If the lips close, push the lower lip with your thumb to open the lips.

AED- Automated External Defibrillator for Adults ( and Children above 8 years)

Step Action
1 POWER ON the AED ( the AED will then guide you through the next steps).
 Open the carrying case or the top of the AED.
 Turn the power on (some devices will “power on” automatically when
you open the lid or case).
2 ATTACH AED pad to the victim’s bare chest.
 Choose adult pads (not child pads or a child system) for victims 8 years of
age and older.
 Peel the backing away from the AED pads.
 Attach the adhesive AED pads to the victim’s bare chest.
- Place one AED pad on the victim’s upper-right chest (directly below
the 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 (Figure 15).
  Attach the AED connecting cables to the AED box (some are
preconnected).
3 “Clear” the victim and ANALYZE the rhythm.
 If 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; other will do that automatically. The AED
may take about 5to 15seconds to analyze.
 The AED then tells you if a shock is needs.
4 If the AED advises a shock, it will tell you to clear the victim.
 Clear the victim before delivering the shock: be sure no one is touching
the victim.
 Loudly state a “clear the victim” message, such as “Everybody clear” or
simply “Clear.”
 Look to be sure no one is in contact with the victim.
 Press the SHOCK button.
 The shock will produce a sudden contraction of the victim’s muscles.
5 If no shock is needed, and after any shock delivery, immediately resume CPR,
starting with chest compressions.
6 After 5 cycles or about 2 minutes of CPR, the AED will prompt you to repeat
steps 3 and 4.

If “no shock advised,” immediately restart CPR beginning with chest

compressions.

Summary of High Quality

Cardio Pulmonary Resuscitation (CPR)
American Heart Association
Components for Basic Life Support (BLS)
COMPONENTS ADULTS AND CHILDTEN INFANTS
ASOLESCENTS ( AGE 1- PUBERTY) (AGE LESS THAN 1 YEAR
EXCLUDING NEW BORNS)
Verifying scene safety Make sure the environment is safe for rescuers and victim
Recognizing cardiac arrest Check for responsiveness
No breathing or only gasping (i.e,no normal breathing)
No definite pulse felt within 10 seconds
(Breathing and pulse check can be performed simultaneously in less than 10 seconds)
Activating emergency If a mobile device is available,
If a mobile
phonedevice
emergency
is available,
servicesphone
(100)emergency services (9·1·1)
response system
 If you are alone with no WitnessedWitnessed
collapsecollapse
mobile phone, leave Follow steps for adults and adolescents on the left the v
the victim to activate emergency Follow steps for adults and adolescents on the left
response Give 2 minutes ofcollapse
Unwitnessed CPR
system and get the AED Give 2 minutes of CPR
before beginning CPR Otherwise, send Leave the victim to activate the
Someone and begin CPR immediately. emergency response system and get the AED
Use the AED as soon as It Is available
Return to the child or infant and resume CPR;
Use the AED as soon as it is available

Compression. Ventilation 1 or 2 rescuers - 30:2 1 rescuer – 30:2 30:2

ratio without advanced 2 or more rescuers- 15:2
airway
Compression-ventilation Continuous compressions at a rate of Continuous compressions at a rate of 100 -120/min
ratio with advanced airway 100-120/min. Give 1 breath every 2·3 seconds (20·30 breaths/min)
Give 1 breath every
6 seconds (10 breaths/min)
Compression rate 100-120/min
Compression depth At least 2 inches (5 cm) At least one third AP At least one third AP
diameter of chest diameter of chest

Approximately 2 inches (5 Approximately 1.5 inches

cm) ( 4cm) Approximately 1
inch (4 cm)
Hand placement 2 hands or 1hand on the 1 rescuer
2 hands on the lower half of the Two
2 hands
fingers
or (index
1hand and 1 rescuer
lower half of the chest (sternum) middle)(optional
or two thumps
for everyon 2 fing
the center of the chest (sternum) 1 hand optional for small child the center of the chest
Just below the nipple line
2 or more rescuers
2 thumb encircling hands
in the center of the chest
just below the nipple line
If the rescuer is unable to
achieve the
recommended depth, it
may be reasonable to use
the heel of one hand
Chest recoil Allow complete recoil of chest after each compression;
Allow complete recoil of chest after each compression;
do not lean on the chest after each compression
Minimizing interruptions Limit interruptions
Limit
in chest
interruptions
compressions
in chesttocompressions
less than 10 seconds
to less than
with 10
a Chest
seconds
compression
with a CCFfraction
goal of
goal
80%of
80%
© 2020 American Heart Association

BLS Healthcare Provider Study Guide for Written Test

1. The ratio for 1rescuer infant CPR is 30 compressions to 2 breaths
2. If a victim is immersed in water, pull the victim out of the water and quickly wipe the
chest dry before attaching the AED
3. Two rescuers alternate giving high quality chest compressions
4. Two rescuers alternate the compressor role every 2 minutes to avoid fatigue
5. Agonal gasps are not considered normal breathing and are signs of cardiac arrest, you
should immediately begin CPR if there is no pulse
6. Defibrillation is important because it can restore a regular cardiac rhythm
7. As soon as an AED is available, the first step is to turn on the AED
8. After the AED pads are attached the next step is to follow the AED prompts
9. During a resuscitation attempt, clear roles and responsibilities should be defined as
soon as possible by the team leader this will help a team function more smoothly
10. Each team member should know their limits and ask for help before a resuscitation worsens
11. If a victim of a foreign body airway obstruction becomes unresponsive, the rescuer should
Start CPR,beginning with chest compressions
12. The depth of chest compressions for an adult is at least one third the depth of the chest,
about2 inches (Scm)
13. A victim who is unresponsive, is not breathing, and has no pulse requires high-quality
CPR to improve their chance of survival
14. The rate of performing chest compressions is 100 to 120 per minute
15. An AED can help eliminate an abnormal heart rhythm and restore a regular heart rhythm
16. AED pads may not stick to a hairy chest making it difficult to analyze and deliver a shock
17. If a victim has no pulse and not breathing normal, performing high-quality CPR has been
shown to improve a victim's chances of survival
18. The depth of chest compressions for a child is at least one third the depth of the chest,
about 2 inches (5cm)
19. Allowing complete chest recoil between compressions allows blood to flow into the
heart and refill between compressions
20. When performing CPR on an unresponsive choking victim you should look for the
obstructing object each time you open the airway
21. The best action to relieve severe choking in a responsive infant is to begin cycles of 5 back
slaps, followed by 5 chest thrusts
22. If a choking infant becomes unresponsive, stop giving back slaps and begin CPR, and look
in the mouth for the obstructing object each time you open the airway
23. In 2 rescuers CPR,the rescuers should switch positions about every 2 minutes to avoid
fatigue
24. If you notice the person giving chest compressions is not allowing complete chest recoil,
tell the compressor you notice decreased chest recoil and make corrective actions
25. Rescuers should observe the chest rise when providing effective breaths