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C R I T I C A L C A R E T R A I N I N G C E N T E R | C O P Y R I G H T 2 0 1 2

12/12/12

Course Overview
This study guide is an outline of content that will be taught in the American Heart Association
Accredited Basic Life Support (BLS) Course. It is intended to summarize important content, but
since all BLS content cannot possibly be absorbed in a class given every two years, it is expected
that the student will have the 2010 Updated ECC Handbook readily available for review as a
reference. The student is also required to have the AHA BLS Textbook available for reference
and study for more in depth content.
Evidence Based Updates
Approximately every 5 years the AHA updates the guidelines for CPR and Emergency
Cardiovascular Care. These updates are necessary to ensure that all AHA courses contain the
best information and recommendations that can be supported by current scientific evidence
experts from outside the United States and outside the AHA. The guidelines were then
classified as to the strength of evidence that supports
the recommendation.

Critical Concepts
High-quality CPR improves a victims chances
of survival. The critical characteristics of high-
quality CPR include.
Start Compressions within 10
seconds
Push Hard, Push Fast
Allow complete Chest recoil
Minimize interruptions
Give effective Breaths
Avoid Excessive Ventilations

2010 AHA Guidelines for CPR and ECC Science Update
The 2010 American Heart Association Guidelines for
Cardiopulmonary
Resuscitation
and
Emergency
Cardiovascular Care recommendations for healthcare
providers include the following key changes and issues:

Changes in basic life support (BLS sequence)

Continued emphasis on high-quality CPR, with minor changes in compression rate and depth
Additional changes regarding cricoid pressure, pulse check and AED use in infants

Changes in Sequence:
C-A-B NOT A-B-C

In the A-B-C sequence, chest compressions were often delayed while the rescuer opened the airway to
give mouth-to-mouth breaths, retrieved a barrier device, or gathered and assembled ventilation
equipment. By changing the sequence to C-A-B, rescuers can start chest compressions sooner, and the
delay in giving breaths should be minimal (only the tie required to deliver the first cycle of 30 chest
compression, or approximately 18 seconds or less; for 2-rescuer infant or child CPR, the delay will be
even shorter).
Emphasis on High-Quality CPR

A compression rate of at least 100/min (this is a change from

approximately 100/min)
The Routine use of cricoid pressure in
A compression depth of at least 2 inches (5cm) in adult and a
cardiac arrest is not recommended

compression depth of at least one third of the anterior-posterior

It may block ventilation

diameter of the chest in infants and children. This is

Delay the placement of an

approximately 1 inches (4cm) in infants and 2 inches (5cm) in
advance airway
children. Note that the range of 1 to 2 inches is no longer used

Difficult to train rescuers how to

for adults, and the absolute depth specified for children and
do this
infants is deeper than in previous versions of the AHA Guidelines
for CPR and ECC.
Allow complete chest recoil, minimizing interruptions in
compressions, and avoiding excessive ventilation continues to be important components of
high-quality CPR.
Continued de-emphasis of the pulse check

Use of an AED for infants

For infants, a manual defibrillator is

preferred to an AED for defibrillation.

If a manual defibrillator is not available,
an AED equipped with a pediatric dose
attenuator is preferred

If neither is available, you may use an
AED without a pediatric dose
attenuator

It can be difficult to determine the presence or

absence of pulse within 10 seconds, especially in an
emergency, and studies show that both healthcare
providers and lay rescuers are unable to reliably detect a
pulse
If a victim is unresponsive and not breathing or only
gasping, healthcare providers may take up to 10 seconds to
attempt to feel for a pulse (brachial in an infant and carotid
or femoral in a child)
If within 10 seconds you dont feel a pulse or are not
sure if you feel a pulse, begin chest compressions.

BLS/CPR for Adults

BLS Consist of these main parts

Chest Compressions
Airway
Breathing
Defibrillation

Follow these initial BLS steps for adults

1. Assess the victim for a response and look for normal or abnormal breathing. It there is no
response and not breathing or no normal breathing (i.e., only gasping), shout for help.
2. If you are alone, activate the emergency response system and get an AED (or defibrillator) if
available and return to the victim.
3. Check the victims pulse (take at least 5 but no more than 10 seconds)
4. If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of compressions and
breaths (30:2), starting with compressions (C-A-B sequence)
Step 1: Assessment and Scene Safety

The first rescuer who arrives at the side of the victim must quickly be sure that the scene is safe.
The rescuer should then check the victim for a response.
o Shout, Are you all right?
If a victim is not breathing or not breathing normally (i.e., gasping), you must activate the
emergency response system.

IF IN THE HOSPITAL, CALL THE CODE!!

Step 2: Activate the Emergency Response System and Get and AED

If you are alone and find an unresponsive victim not breathing, shout for help
If no response activate the emergency response system, get an AED
Return to the victim to check a pulse and begin CPR (C-A-B sequence).

Step 3: Pulse Check

Healthcare providers should take no more than 10 seconds to check for

pulse

Step 4: CPR

Begin cycles of 30 chest compression and 2 breaths (CPR)

Lone rescuer should use the compression-ventilation ratio of 30
compressions to 2 breaths when giving CPR to victims of any age.
Put the heel of one hand on the center of the victims chest on the lower
half of the breastbone.

Importance of a Firm
Surface
Compressions pump the blood in
the heart to the rest of the body.
If a firm surface is under the
victim, the force you use will be
more likely to compress the chest
and heart and create blood flow
rather than simply push the
victim into the mattress or other
soft surface.

Moving the Victim

Do not move the victim while CPR is in progress unless the victim is in dangerous environment
(such as a burning building) or if you believe you cannot perform CPR effectively in the victims
present position or location.

Opening the Airway for Breaths: Head Tilt-Chin Lift

1. Place on hand on the victims forehead and push with your palm to tilt the head back
2. Place the fingers of the other hand under the bony part of the lower jaw near the chin
3. Lift the jaw to bring the chin forward
Giving Mouth to Mask Breaths
1. Position yourself at the victims side
2. Place the mask on the victims face, using the bridge of the nose as a guide for correct position.
3. Seal the mask against the face:
a. Using the hand that is closer to the top of the victims head, place your index finger and
thumb along the edge of the mask.
b. Place the thumb of your second hand along the bottom edge of the mask
4. 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
5. While you lift the jaw, press firmly and completely around the outside edge of the mask to seal
the mask against the face.
6. Deliver air over 1 second to make the victims chest rise.
Using the Bag-Mask During 2-Rescuer CPR

The bag-mask ventilation
1. Position yourself directly above the victims head
2. Place the mask on the victims face, using the bridge of the as a
technique requires instruction
guide for correct position
and practice and is not
3. Use the E C clamp technique to hold the mask in place while you
recommended by a lone
lift the jaw to hold the airway open
rescuer during CPR
a. Perform a head tilt
b. Place the mask on the face with the narrow portion of the
bridge of the nose
c. 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.
d. Using 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
4. Squeeze the bag to give breaths (1 second each) while watching for chest rise. Deliver all
breathes over 1 second whether or not you use supplemental oxygen.


Rescuer
Rescuer 1

Location
At the victims side

Rescuer 2

At the victims side

Duties
Perform chest compressions.
Compress the chest at least 2 inches (5cm)
Compress at a rate of at least 100/min
Allow the chest to recoil completely after each
compression.
Minimize interruptions in compressions (try to limit
any interruptions in chest compression to <10
seconds)
Count Compressions aloud
Switch duties with the second rescuer every 5 cycles or
about 2 minutes, taking <5 seconds to switch
Maintain an open airway using either
Head tilt-chin lift
Jaw thrust
Giving breaths, watching the 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 compressions.
Switch duties with the first rescuer every 5 cycles or about
2 minutes, taking <5 seconds to switch

Analysis of thousands of rhythm strips recorded

before and after shock delivery has shown that if
rescuer can keep the time between the last
compression and shock delivery to 10 seconds or less,
the shock is much more likely to be effective (i.e. To
eliminate ventricular fibrillation and result in return
of spontaneous circulation)

To avoid gastric inflation DO NOT GIVE breathes too quickly or with much force.

Automated External Defibrillator

Steps
1

5
6

Actions
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)
ATTACH AED pads to the victims 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 victims bare chest.

Place on AED pad on the victims 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
Attach the AED connecting cables to the AED box (some are preconnected)

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; others will do that automatically. The AED may take about 5 to 15 seconds to
analyze.
The AED then tells you if a shock is needed.
If the AED advices to 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, much 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 victims muscles
If no shock is needed, and after any shock delivery, immediately resume CPR, start with chest
compressions
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.

Choosing the AED Pads or AED Child System

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


BLS/CPR for Children From 1 Year of Age to Puberty
Child BLS
The child BLS sequence and skills are similar to the sequence for adult
BLS. The key differences between child and adult BLS are:

Compression-ventilation ratio for 2-rescuer CPR: 15:2 ratio

for 2-rescuer child CPR
Compression depth: For children, compress at least one third
the depth of the chest, approximately 2 inches (5cm)
Compression technique: May use 1 or 2 handed chest
compressions for very small children
When to active the emergency response system:
o If you did not witness the arrest and are alone,
provide 2 minutes of CPR before leaving the child to
activate the emergency response system and get the
AED (or defibrillator)
o If the arrest is sudden and witnessed, leave the child
to activate the emergency response system and get
the AED (or defibrillator), and then return of the
child.

Critical Concepts
High-Quality CPR
improves the victims
change of survival. The
critical characteristics
of high-quality CPR in
adults includes:

Compression Rate and Ratio for Lone Rescuer

The lone rescuer should use the universal compression-ventilation

ratio of 30 compressions to 2 breaths when giving CPR to victims of all
ages (except newly born infants). The term universal represents a
consistent recommended ratio for all lone rescuers for victims of all
ages.
2 Rescuer Child BLS Sequence Follow these steps to perform the 2
rescuer BLS sequence for a child (no AED)

Steps
1

Action
Check the child for a response and check breathing. If
there is no response and no breathing or only gasping, the
second rescuer activates the emergency response system
Check the childs pulse (take at least 5 but no more than 10
seconds). You may try to feel the childs carotid or femoral
pulse.
If within 10 seconds you dont definitely feel a pulse or if,
despite adequate oxygenation and ventilation, the heart
rate is <60/min with signs of poor perfusion, perform cycles
of compressions and breaths (30:2 ratio). When the second
rescuer arrives, use compressions to breaths ratio of
15:2.

Start compressions
within 10 seconds

Push hard, Push Fast


Allow complete chest
recoil

Minimize
interruptions


Give effective
breaths

Avoid excessive
ventilations

BLS / CPR for Infants

For the purposes of the BLS sequence described in the Pediatric BLS Algorithm, the term infant means
infants to 1 years of age (12 months), excluding newly born infants in the delivery room. For BLS for
children 1 years and older, see BLS/CPR for Children 1 Year of Age to Puberty
The infant BLS sequence and skills are very similar to those used for child and adult CPR. They key
differences for infant BLS are:

The location of pulse check: brachial artery in infants

Technique of delivering compressions: 2 fingers for single rescuer and 2 thumb encircling
hands technique for 2 rescuers
Compression depth: at least one third and chest depth, approximately 1 inches (4cm)
Compression-ventilation rate and ratio for 2 rescuers: same as for child 15:2 ratio for 2
rescuers
When to active the emergency response system (same as for child):
o If you did not witness the arrest and are alone, provide 2 minutes of CPR before leaving
the infant to active the emergency response system and get the AED (or defibrillator).
o If the arrest is sudden and witnessed, leave the infant to phone 911 and get the AED (or
defibrillator), then return to the infant.

2 Finger Chest Compression Technique

Follow these steps to give chest compressions to an infant using the 2-finger technique.
Steps
1
2
3

Actions
Place the infant on a firm, flat surface
Place 2 fingers in the center of the infants chest just below the nipple line. Do not press on
the bottom of the breastbone
Push hard and fast. To give chest compressions, press the infants breastbone down at least
one-third the depth of the chest (approximately 1 inches (4cm). Deliver compressions in a
smooth fashion at a rate of at least 100/min
At the end of each compression, make sure you allow the chest to recoil (reexpand)
completely. Chest recoil allows blood to flow into the heart and is necessary to create
blood flow during chest compressions. Incomplete chest recoil will reduce the blood flow
created by chest compressions. Chest compressions and chest recoil/relaxation times
should be approximately equal.
Minimize interruptions in chest compressions.


2 Thumb Encircling Hands Chest Compression Technique
Follow these steps to give chest compressions to an infant using the 2 thumbs encircling hand
technique.
1. Place both thumbs side by side in the center of the
infants chest on the lower half of the breastbone.
The thumbs may overlap in very small infants.
2. Encircle the infants chest and support the infants
The 2 thumb-encircling
back with the fingers of both hands.
hand techniques is the
3. With your hands encircling the chest, use both
preferred 2-resucer-chest
thumbs to depress the breastbone approximately
compression technique for
one third of the depth of the infants chest
healthcare providers who
(approximately 1 inches {4cm})
can fit their hands around
4. Deliver compressions in a smooth fashion at a rate
of at least 100/min
the infants chest.
5. After compressions, completely release the pressure
on the breastbone and allow the chest to recoil
completely
6. After every 15 compressions, pause briefly for the
second rescuer to open the airway with the head tilt-chin lift and given 2 breaths. The chest
should rise with each breath.
7. Continue compressions and breaths in a ratio of 15:2 (for 2 rescuers), switching roles every 2
minutes to avoid rescuer fatigue.

CPR With an Advanced Airway
Ventilation
Compressions to Breaths (Adult)
Compressions to Breaths (Child
Technique
and Infant)
No Advanced

15 compressions to 2
Airway (mouth-
breaths
30 compressions to 2 breaths
to-mouth,


mouth-to-mask,
Compression rate of at least 100/min
Compression rate of at
bag-mask)
least 100/min
Advanced

airway
Compression rate of at least 100/min without pauses for breaths
(endotracheal

intubation,
1 breath every 6 to 8 seconds (8 to 10 breaths per minute)
laryngeal mask
airway,
supraglottic)

In infants and children, if, despite adequate

oxygenation and ventilation, the pulse is
<60/min with signs of poor perfusion, START
CPR
Adult, Child, and Infant Rescue Breathing
Rescue Breathing
When an adult, child, or infant has a pulse but is not breathing effectively, rescuers should give breaths
without chest compression. This is rescue breathing.

Rescue Breathing for Adults

Rescue Breathing for Infants and Children
Given 1 breath every 5 to 6 seconds
Given 1 breath every 3 to 5 seconds
(about 10 to 12 breaths per minute)
(about 12 to 20 breaths per minute)
Give each breath in 1 second
Each breath should result in visible chest rise
Check the pulse about every 2 minutes

Relieving Choking in an Unresponsive Victim 1 year of Age or Older
Choking victim initially may be responsive and then become unresponsive. In this circumstance you
know that choking caused the victims symptoms, and you know to look for a foreign object in the
throat.
If a choking victim becomes unresponsive, activate the emergency response system. Lower the victim to
the ground and begin CPR, starting with compressions (do not check for a pulse)
For adults or child victim, every time you open the airway you give breaths, open the victims mouth
wide and look for the object. If you see an object that can easily be moved, move it with your fingers. If
you do not see an object, keep doing CPR. After about 5 cycles or 2 minutes of CPR, activate the
emergency response system if someone has not already done so.
Sometimes the choking victim may be unresponsive when you first encounter him or her. In this
circumstance you probably will not know that an airway obstruction exists. Activate the emergency
response system and start CPR (C-A-B sequence).

Component
Recognition

CPR Sequence
Compression Rate
Compression Depth
Chest wall recoil
Compression
interruptions
Airway
Compression-
ventilation ratio (until
advanced airway
placed)

Ventilation with
Advanced Airway

Defibrillation

Recommendations
Adult
Children
Infants
Unresponsive (for all ages)
No breathing or no
No breathing or only gasping
normal breathing (i.e.,
only gasping)
Chest compressions, Airway, Breathing (C-A-B)
At Least 100/min
At least 2 inches (5cm) At least 1/3 AP diameter At least 1/3 AP diameter
About 2 inches (5cm)

About 1 inches (4cm)

Allow complete recoil between compressions

Rotate compressors every 2 minutes
Minimize interruptions in chest compressions
Attempt to limit interruptions to <10 seconds
Head tilt-chin lift (suspected trauma: jaw thrust)
30:2
30:2
1 or 2 rescuers
Single Rescuer
15:2
2 rescuers
1 breath every 6 8 seconds (8-10 breaths/min)

Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
Attach and use AED as soon as available.
Minimize interruptions in chest compressions before and after shock;
Resume CPR beginning with compression immediately after each shock.

Credits:
All diagram and lingo

taken from American

Heart Association

textbooks: BLS for

Healthcare Providers
2010)

The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional m aterials for this purpose. Use this m aterials in an educational course does not represent course sponsorship by the American Heart Association.