bls study guide

BASIC LIFE SUPPORT HC STUDY GUIDE

To renew your Healthcare Provider Basic Life Support card you must pass a written exam and a performance check-off. This guide was created to help you review the basics of BLS. Please be familiar with the information in this packet and complete your pretest before coming to renew. It takes an average of two hours to complete the written post-test and performance check-offs for the following: adult, child, infant, AED, mask-mouth and bag-mask ventilation.

To register for a BLS renewal or initial course, please call 360-537-5438 or MOX Angel Tracy

Healthcare Provider Information

INSIDE THIS GUIDE:

Performance Guidelines on:

Adult and Child CPR (1 and 2 rescuer)

AED (Automated External Defibrillator) Use

Infant CPR (1 and 2 rescuer)

Adult Foreign Body Airway Obstruction

Infant Foreign Body Airway Obstruction

2006

Reproduced with permission, Heartsaver Guide, 2006, Copyright American Heart Association

2

ADULT: 1-Rescuer CPR

Determine unresponsiveness Activate EMS System

Get the AED

Position the victim Open the airway

head tiltchin lift or jaw thrust if a neck injury is suspected

Check for adequate breathing

(Take at least 5 and no more than 10 seconds)

Look, listen, and feel

If the victim is NOT breathing, give 2 one-second breaths enough to make the chest rise

Tap or gently shake shoulder. Shout Are you OK?

Turn on back, supporting head and neck. Lift the chin up gently with one hand while pushing down on the forehead with the other to tilt the head back. Look at the chest for movement. Listen for the sounds of breathing. Feel for breath on your cheek. Open Airway

Remember your A,B,C,Ds!

Airway Breathing Circulation

Defibrillation

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ADULT: 1-Rescuer CPR continued

Check carotid pulse.

If victim has a pulse, but is not breathing, perform rescue breathing.

If NO pulse, begin first cycle of compressions and ventilations. Press HARD and FAST. Full recoil on decompression.

30 compressions and 2 ventilations. At the end of 5 cycles (2 minutes), check for return of pulse.

Place 2 or 3 fingers on the Adams apple (voice box). Slide fingers into the groove between Adams apple and muscle. Feel for the carotid pulse (approx. 510 seconds). Provide about 10 breaths per minute (1 breath every 5-6 seconds). Recheck pulse every 2 minutes Place the heels of both hands (one on top of the other) over the lower half of the sternum. Compress with weight transmitted downward. Depress the sternum 1 to 2 inches, at a rate (speed) of 100 compressions per minute. After every 30 compressions, deliver 2 onesecond rescue breaths.

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CHILD CPR 1 Rescuer CPR performed on children (1 to puberty) is similar to CPR for adult victims with some differences: 1. Amount of air for breaths 2. Use the heel of one hand for chest compressions on very small children rather than both

hands. 3. Depress the sternum 1/3 to 1/2 the depth of the chest (about 1 to 1 inches). 4. Provide 100 compressions per minute, giving 2 rescue breaths for every 30 chest compressions.

Determine unresponsiveness. If another person is available, have them activate EMS system. One Rescuer

Tap or gently shake shoulder. Shout Are you OK?

Turn on back, taking care to support the head and neck in case of injury. Lift the chin up gently with one hand while pushing down on the forehead with the other to tilt the head back. With your ear over the childs mouth, look at the chest and Look at the chest for movement. Listen for the sounds of breathing. Feel for breath on your cheek.

: For SUDDEN COLLAPSE, PHONE 911, Get AED Position the victim. Open the airway using the head tilt-chin lift maneuver. If you suspect a cervical spine injury, use the modified jawthrust maneuver instead.

Determine breathlessness.(Look, listen, and feel).

If victim is breathing and there is no evidence of

trauma, place the victim

in the recovery position.

Roll victim on his or her side, using the victims arm and leg for stabilization.

A child is considered someone

erty between

1 to Pub

2006


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CHILD 1 rescuer CPR continued If the victim is NOT breathing, give 2 breaths (approximately 1 second each) that make the chest rise. Check the carotid pulse (at least 5 seconds and no more than 10 seconds).

If NO pulse or if heart rate is less

than 60 beats per minute with signs of

poor perfusion, begin first cycle of compressions and

ventilations.

If no one has called EMS, after 5 cycles of 30: 2 then leave the victim and call. If someone has called EMS, and there is no pulse or signs of circulation, then use AED/defibrillator after 5 cycles of CPR (use AED as soon as it is available for sudden, witnessed collapse)

Pinch the victims nose. Make a tight seal around victims mouth. Watch for victims chest to rise. Allow the lungs to deflate between breaths. Rescue breathing rate is one breath every 3 seconds

To check for a pulse, use 2 or 3 fingers, feel for the carotid pulse with one hand while maintaining head tilt with the other. (approx. 35 seconds). Place the heel of one hand over the lower 1/2 of the victims sternum. Compress sternum 1/3 to 1/2 of chest depth (approx. 1 1 1/2) and release. Do this 30 times, followed by 2 breaths. Repeat the 30:2 cycle for 2 minutes Target compression rate: at least 100 + compressions per minute. RECHECK pulse every 2 minutes

Check rhythm: Shockable rhythm?

- If shockable, give 1 shock and then resume CPR immediately for 5 cycles

- If not shockable, resume CPR immediately for 5 cycles. Check rhythm every 5 cycles ) continue until ALS providers take over or victim starts to move)

2006


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2 Rescuer CPR for Adults and Children

Gently tap or shake victim, asking Are you okay? At victims side:

Performs chest compressions Counts out loud Switches duties with rescuer #2 every 5

cycles or 2 minutes, taking less than 5 seconds to switch

Rates for 2 rescuer CPR: Adult 30 2 Child 15 2 No Advanced Airway in Place:

Compression rate: approximately 100 per minute

Ventilation rate: 2 breaths following 30 compressions

Pause compressions to give 2 breaths. The first exhalation occurs between the 2 breaths and the second during the first chest compression of the next cycle of CPR.

Activate EMS or send a bystander to do so & get the AED. At the victims head:

Maintains an open airway Gives breaths, watching for chest rise and

avoiding hyperventilation Encourages rescuer #1 to perform

compressions that are fast and deep enough and to allow full chest recoil between compressions

Switches duties with rescuer #1 every 5 cycles or 2 minutes, taking less than 5 seconds to switch

Advanced Airway in Place:

Compression rate: approximately 100 per minute

Ventilation rate: approximately 1 breath every 6 to 8 seconds (8 to 10 breaths per minute)

Do not pause chest compressions to provide breaths

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AED Use

1. POWER ON the AED (this activates voice prompts for guidance in all subsequent 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 electrode pads to the victims bare chest.

Choose correct pads (adult vs child) for size/age

of victim. Use child pads or child system for children less than 8 years of age if available. Do not use child pads or child system for victims 8 years and older.

Peel the backing away from the electrode pads. Quickly wipe the victims chest if it is covered

with water or sweat. Attach the adhesive electrode pads to the

victims bare chest. Place one electrode pad on the upper-right

side of the bare chest to the right of the breastbone, directly below the collarbone.

Place the other pad to the left of the nipple, a few inches below the left armpit.

Attach the AED connecting cables to the AED box (some are pre-connected)

3. Clear the victim and ANALYZE the rhythm. Always clear the victim during analysis. Be sure

that no one is touching the victim, not even the person 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.

4. If the AED advises a shock, it will tell you to be sure to clear the victim.

Clear the victim before delivering the shock: be sure no one is touching the victim to avoid injury to rescuers. Loudly state a clear the patient message,

such as Im clear, youre clear, everybodys clear or simply Clear.

Perform a visual check to ensure that no one is in contact with the victim.

Press the SHOCK button. The shock will produce a sudden contraction of

the victims muscles.

5. As soon as the AED gives the shock, begin CPR starting with chest compressions.

6. After 2 minutes of CPR, the AED will prompt you

to repeat steps 3 and 4.

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2-Rescuer CPR Sequence With an AED

1. Check for response: if the victim does not respond:

The first rescuer stays with the victim and performs CPR until the AED arrives.

The second rescuer activates the emergency response system and gets the AED. (Either rescuer may operate the AED once it arrives.)

2. Open airway: head tiltchin lift. 3. Check for breathing: provide breathing if

needed:

Look, listen, and feel for breaths. If not breathing, give 2 breaths using

appropriate barrier device. 4. Check for pulse: if pulse not definitely felt in

5 to 10 seconds: Perform chest compressions and

prepare to attach the AED: The first rescuer starts chest

compressions while the second rescuer prepares to use the AED.

Remove or move clothing covering the victims chest to allow rescuers to provide chest compressions and apply the AED electrode pads.

5. Attempt defibrillation with the AED: When the AED arrives, place it at the

victims side near the rescuer who will be operating it. The AED is usually placed on the side of the victim opposite the rescuer who is performing CPR.

There are 2 exceptions: For a child who suffered an

unwitnessed, out-of-hospital cardiac arrest, complete 5 cycles (or about 2 minutes) of CPR before attaching and using the AED.

For an adult who suffered an unwitnessed, out-of-hospital cardiac arrest and with EMS call-to-arrival interval great than 4 to 5 minutes, EMS personnel may complete 5 cycles (or about 2 minutes) of CPR before attaching and using the AED

POWER ON the AED and follow

voice prompts. Some devices will turn on when the AED lid or carrying case is opened.

ATTACH the AED: Select the correct pads for the

victims size and age (adult vs child), and/or turn a key or switch to deliver a child shock does if appropriate.

Peel the backing from the pads.

ATTACH the adhesive pads to the bare skin of the victims chest

Attach the electrode cable to the AED (if not pre-connected).

Allow the AED to ANALYZE the victims rhythm (clear the victim before analysis)

Deliver a SHOCK if needed (clear the victim before shock)

If no shock is needed and after any shock delivery, resume CPR beginning with chest compressions.

2006


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INFANT 1 rescuer CPR

Determine unresponsiveness. Call for HELP! If someone is available, send them to call 9-1-1

Position the infant on his or her back on a firm surface, supporting the

head and neck if turning is necessary. Open the airway using head tilt-chin lift. Take care not to tilt the head too far back.

Determine breathlessness. Look, listen, and feel (Approx. 5-10 seconds).

If victim is breathing and there is no evidence of trauma, place the victim in the recovery position. If the victim is NOT breathing, give 2 breaths.

Tap feet Turn on back, taking care to support the head and neck in case of injury. Lift the chin up gently with one hand while pushing down on the forehead with the other to tilt the head back. If suspected cervical spine injury, use the modified jaw-thrust maneuver instead. Look at the chest for movement. Listen for the sounds of breathing. Feel for breath on your cheek. Roll victim on his or her side, using the victims arm and leg for stabilization. Maintain an open airway and cover the infants mouth and nose with your mouth.

CPR in infants must be performed with special

consideration for size and vulnerabilities.

2006


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INFANT: CPR 1 Rescuer continued

Check the victims pulse (take at least 5 and not more than 10 seconds).

If there is no pulse or if heart rate is less than 60 beats per minute with signs of poor perfusion, perform cycles of compressions and ventilations (30:2 ratio).

Compress the sternum approximately 1/3 to 1/2 the depth of the chest (about 1/2 to 1 inch) at least 100 times/minute.

After 5 cycles, if someone has not already done so, activate the emergency response system.

Feel for the brachial pulse on the inside of the upper arm that is closest to you with two fingers of one hand.

Maintain the head tilt with the other hand.

To find the correct location for chest compressions: Imagine a line drawn between the nipples. Place your index finger on that line in the center of the chest. Place the middle and ring fingers next to the index finger, then lift the index finger. Use the middle and ring (third and fourth) fingers to compress the sternum at that point.

2006


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INFANT CPR: 2 Rescuers

At the victims side Performs chest compressions with 2 thumb

encircling hands technique Counts out loud Switches duties with rescuer #2 every 5 cycles

or 2 minutes, taking less than 5 seconds to switch

2 Thumb Encircling Hand Technique: Encircle the infants chest, use both thumbs to depress the breastbone approximately 1/3 to 1/2 the depth of the infants chest. As you push down with your thumbs, squeeze the infants chest with your fingers.

After each compression, completely release the pressure on the breastbone and chest and allow the chest to fully recoil.

After every 15 compressions, pause briefly for

the second rescuer to open the airway with a head tilt chin lift and give 2 breaths (the chest should rise with the breath). Coordinate compressions and ventilation to avoid simultaneous delivery and to ensure adequate ventilation and chest expansion, especially when the airway is unprotected.

Activate EMS or send a bystander to do so. At victims head:

Maintains an open airway Provides breaths that make the

chest rise Encourages rescuer 1 to perform

compressions that are fast and deep enough and to allow full chest recoil between compressions

Switches duties with rescuer 1 every 5 cycles or 2 minutes, taking less than 5 seconds to switch.

After 2 minutes, check for return of pulse. If no pulse, or other signs of circulation, resume CPR. Continue compressions and breaths in a ratio of 15:2 (for 2 rescuers) switching roles every 2 minutes. (100 compressions per minute)

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Foreign Body Airway Obstruction CONSCIOUS (Adults & Children over 1)

Determine if victim is able to speak or cough (Universal Choke Sign). Perform abdominal thrust until the foreign body is expelled or the victim

unresponsive.

Perform Chest Thrusts until the foreign body is expelled or the victim becomes unresponsive.

Ask only one Yes or No question of the victim, for example: Are you choking? Stand or kneel behind victim and wrap your arms around victim under victims arms. Make a fist with one hand and place thumb side of fist against victims abdomen in the midline just above the beltline. Grab fist with other hand. Press fist into abdomen with quick upward thrusts, then release. Give each new thrust with a separate, distinct movement to relieve the obstruction. Stand behind victim. Wrap arms around victims chest under the arms. Make a fist and place thumb side on breastbone at armpit level. Grab fist with other hand. Press inward with quick thrusts, then release.

For victims who are pregnancy or who are obese:

2006


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Foreign-Body Airway Obstruction UNCONSCIOUS Adults & Children over 1

Position victim on back, face up and arms at side. Activate EMS or other number.

Open the airway

Remove any object if you see it Begin CPR

Attempt rescue breathing.

Every time you open the airway to give breaths, open the mouth wide and look for the object.

If you see the object, remove it with your fingers.

If no object can be seen, continue CPR.

2006


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INFANT Foreign-Body Airway Obstruction CONSCIOUS Assess for complete obstruction. Look, listen, and feel for air movement,

coughing or gagging. If no air movement, coughing or gagging is present, start the rescue.

Supporting the head and neck with Place infant face down over one forearm. one hand, place the infant face down, head lower than trunk, over your forearm supported on your thigh.

Deliver 5 back slaps rapidly and forcefully between the infants shoulder blades using the heel of the hand.

Turn infant face up, supported on your arm, and deliver 5 chest thrusts.

Continue the cycle of back blows and chest thrusts until the foreign body is expelled or the infant loses consciousness

Deliver back blows with the intent of removing the object. Do not be afraid of hurting the baby. Support the head, sandwich the infant

between your hands/ arms and turn on his or her back, head lower than trunk.

Deliver 5 thrusts in the midsternal region. (Imagine a line drawn between the nipples. Place your index finger on that line in the center of the chest. Place the middle and ring fingers next to the index finger, then lift the index finger. Use the middle and ring (third and fourth) fingers to compress the sternum at that point).

2006


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INFANT: Foreign-Body Airway Obstruction UNCONSCIOUS

Establish unresponsiveness. Tap on feet or gently rub torso.

While calling out for help, position the infant by placing them on their back on a firm, hard surface while supporting the head and neck.

If second person is available have them activate the EMS system.

If a suspected cervical spine injury, use the modified jaw-thrust maneuver instead.

Open airway to a neutral position using the head tilt-chin lift but do not tilt the head too far back. Look, listen and feel for breathing (approx 3-5 seconds)

If no breaths are heard, use the

tongue jaw lift, look into the mouth and remove the object if you see it. Do not perform a blind finger sweep in an infant

Begin CPR with 1 extra step: Each time you open the airway, look for the object in the back of the throat. If you see the object, remove it.

After 5 cycles (about 2 minutes) of CPR, activate the EMS system.

To register for a BLS renewal or initial course, please call 360-537-5438 or MOX Angel Tracy CHILD CPR 1 RescuerINFANT 1 rescuer CPR

Foreign Body Airway Obstruction CONSCIOUS (Adults & Children over 1)

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