The document provides information on basic life support (BLS) including definitions, the adult chain of survival, call or CPR first considerations, signs requiring CPR, approaching a victim, and high quality CPR techniques. It discusses refining the recognition of cardiac arrest and initiation of CPR or calling emergency services. Emphasis is placed on minimizing interruptions during chest compressions and avoiding excessive ventilation.

1. Basic
Life
Support

2. BLS: Definition
• level of medical care which is used for
victims of life-threatening illnesses or
injuries until they can be given full
medical care at a hospital. It can be
provided by trained medical personnel,
including emergency medical
technicians, paramedics, and by
laypersons who have received BLS
training.

3. Adult Chain of Survival
1.Early intervention
2.Immediate recognition of cardiac arrest and activation of the
emergency response system (EMS)
3. Early CPR with an emphasis on chest compressions
4. Rapid defibrillation
5. Effective advanced life support
6. Integrated post–cardiac arrest care

4. Adult Chain of Survival

5. TIME IS GOLD!!!

6. Call First or CPR First?
Call First
1. Activate EMS
2. Return to victim
3. Provide CPR
CPR First
1. Give 5 cycles (2
minutes) of CPR
2. Leave victim
3. Activate EMS

7. Call First or CPR First?
Call First!!!
• Sudden collapse in adult
or child
• Collapse likely cardiac in
origin
CPR First!!!
• Drowning victim
• Asphyxial (primary
respiratory) arrest in any
age

8. When to CPR?
• In the absence of
breathing and pulse in
an unresponsive victim
• If the victim has agonal
gasps
• If victim is in cardiac
arrest

9. How to approach victim?
• *HAZARD
• *HELLO
• *HELP
• *CIRCULATION/
COMPRESSION
• *AIRWAY
• *BREATHING
• *DEFIBRILLATION

10. HIGH QUALITY CPR
• A compression rate of at least 100/min (a change from
“approximately” 100/min)
• A compression depth of at least 2 inches (5 cm) in
adults and a compression depth of at least one third
of the anterior-posterior diameter of the chest in
infants and children(approximately 1.5 inches [4 cm]
in infants and 2 inches [5 cm] in children). Note that
the range of 1. to 2 inches is no longer used for
adults, and the absolute depth specified for children
and infants is deeper than in previous versions of
AHA Guidelines for CPR and ECC
• Allowing for complete chest recoil after each
compression
• Minimizing interruptions in chest compressions
• Avoiding excessive ventilation

11. HIGH QUALITY CPR
There has been no change in the recommendation for
a compression-to-ventilation ratio of 30:2 for single
rescuers of adults, children, and infants (excluding
newly born infants). The 2010 AHA Guidelines for
CPR and ECC continue to recommend that rescue
breaths be given in approximately 1 second. Once
an advanced airway is in place, chest compressions can be continuous (at a rate of at least
100/min) and no longer cycled with ventilations.
Rescue breaths can then be provided at about 1
breath every 6 to 8 seconds (about 8 to 10 breaths
per minute). Excessive ventilation should be
avoided.

12. Key issues: LR’s Adult CPR
• The simplified universal adult BLS algorithm has
been created
• Refinements have been made to recommendations
for immediate recognition and activation of the
emergency response system based on signs of
unresponsiveness, as well as initiation of CPR if the
victim is unresponsive with no breathing or no
normal breathing (ie, victim is only gasping).
• Continued emphasis has been placed on highquality CPR (with chest compressions of adequate
rate and depth, allowing complete chest recoil after
each compression, minimizing interruptions in
compressions, and avoiding excessive ventilation).

13. Key issues: LR’s Adult CPR
• “Look, listen, and feel for breathing” has been
removed from the algorithm.
• There has been a change in the recommended
sequence for the lone rescuer to initiate chest
compressions before giving rescue breaths (C-A-B
rather than A-B-C). The lone rescuer should begin
CPR with 30 compressions rather than 2 ventilations to reduce delay to first compression.
• Compression rate should be at least 100/min (rather
than “approximately” 100/min).
• Compression depth for adults has been changed
from the range of 1. to 2 inches to at least 2 inches
(5 cm).

14. Key issues: HCP BLS
• Because cardiac arrest victims may present with a
short period of seizure-like activity or agonal gasps
that may confuse potential rescuers, dispatchers
should be specifically trained to identify these
presentations of cardiac arrest to improve cardiac
arrest recognition.
• Dispatchers should instruct untrained lay rescuers
to provide Hands-Only CPR for adults with sudden
cardiac arrest.
• Refinements have been made to recommendations
for immediate recognition and activation of the
emergency response system once the healthcare
provider identifies the adult victim who is

15. Key issues: HCP BLS
unresponsive with no breathing or no normal
breathing (ie, only gasping). The healthcare
provider briefly checks for no breathing or no
normal breathing (ie, no breathing or only gasping)
when the provider checks responsiveness. The
provider then activates the emergency response
system and retrieves the AED (or sends someone to
do so). The healthcare provider should not spend
more than 10 seconds checking for a pulse, and if a
pulse is not definitely felt within 10 seconds, should
begin CPR and use the AED when available.

16. Key issues: HCP BLS
• “Look, listen, and feel for breathing” has been
removed from the algorithm.
• Increased emphasis has been placed on highquality CPR (compressions of adequate rate and
depth, allowing complete chest recoil between
compressions, minimizing interruptions in
compressions, and avoiding excessive ventilation).
• Use of cricoid pressure during ventilations is
generally not recommended.
• Rescuers should initiate chest compressions before
giving rescue breaths. Beginning CPR with 30
compressions rather than 2 ventilations leads to a
shorter delay to first compression.

17. Key issues: HCP BLS
• Compression rate is modified to at least 100/min
from approximately 100/min.
• Compression depth for adults has been slightly
altered to at least 2 inches (about 5 cm) from the
previous recommended range of about 1. to 2
inches (4 to 5 cm).
• Continued emphasis has been placed on the need
to reduce the time between the last compression
and shock delivery and the time between shock
delivery and resumption of compressions
immediately after shock delivery.
• There is an increased focus on using a team
approach during CPR.

19. The ABC’s of CPR (2005 AHA)
A irway
Does the victim have an open airway?
B reathing
Is the victim breathing?
C irculation/ C ompression - Ventilation
Is the victim’s heart beating?
Is the victim bleeding severely?
D efibrillation

20. The CAB’s of CPR (2010 AHA)
C irculation/ C ompression
Is the victim’s heart beating?
Is the victim bleeding severely?
A irway
Does the victim have an open airway?
B reathing
Is the victim breathing?
D efibrillation

21. Badger County/Mayo Clinic
H azard
H ello
H elp!!!
C irculation Check
C ompression for 2
minutes (200
compressions)

22. Position the Victim / Rescuer
• Supine and on a firm
surface
• Head & neck should be in
the same plane
• Rescuer kneeling at
victim’s thorax to perform
both rescue breathing &
chest compression

23. CIRCULATION

24. Adult BLS Sequence
• Pulse check
• Take at least 5 seconds & NOT more
that 10 seconds

25. The way of finding the position of the
heart massage
The two finger upper side from the xiphisternal tip

26. The way of crossing a hand and
the way of the oppression

27. Put hand(s) in correct position for chest
compressions

28. Give 30 chest compressions at rate of 100 per
minute
Then give 2 ventilations

29. Chest Compressions Alert
• Be careful with your
hand position
• For adults/children,
keep your fingers off
patient’s chest
• Do not give
compressions over
bottom tip of
breastbone

30. Chest Compressions Alert
• When compressing,
keep elbows straight
and hands in contact
with patient’s chest at
all times

31. Chest Compressions Alert
• Compress chest hard
and fast, but let chest
recoil completely
between
compressions.
Minimize amount of
time used giving
ventilations between
sets of compressions.

32. Locating hand position for chest
compressions
• Place heel of hand in the center of the chest with the heel of
the other hand on top
• Interlace your fingers or lift them off the victim’s chest

33. Chest compressions
• Position your body directly
over your hands
• Shoulders should be
above the hands
• Elbows should be straight
• Look down on your hands

34. Chest compressions
• Push hard & push fast
• Depress sternum to 2
inches (5 cm) at a rate of
100 compressions per
minute

35. Chest compressions
• Allow chest wall to recoil
completely
• No interruption with the
compression

36. Roles of Each Rescuer
Rescuer
Location
Actions
Rescuer 1
At the victim’s
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
Rescuer 2
At the victim’s
head
- Maintains an open airway
- Gives breaths, watching for chest rise
& avoiding hyperventilation
- Encourages Rescuer 1 to perform
compressions that are fast & deep
enough & to allow full chest recoil
between compressions
- Switches duties with Rescuer 1 every 5
cycles of 2 minutes, taking less than 5
seconds to switch

38. AIRWAY
• First thing to check in initial assessment
• You may need to open airway, maintain its patency, or clear it when it
is compromised

39. Check Airway for Patency
• Open mouth with gloved
hand
• Listen for sounds
indicating liquid in airway
• Look inside for fluids,
solids, or objects
• Clear using finger sweep
or suction

40. AIRWAY
• Open the airway
• Head-tilt chin lift
• Jaw thrust WITHOUT head extension

41. Head Tilt-Chin Lift
• Simple, safe,
easily learned and
effective
• Choice unless
trauma to neck is
suspected

42. Head Tilt-Chin Lift
• Place your hand on victim’s
forehead
• Gently tilt head back
• With your fingertips under point
of victim’s chin, lift chin to open
airway

43. Jaw Thrust
• For suspected trauma
to the neck
• Place one hand on
each side of victim’s
head
• Rest elbows on the
surface on which the
victim is lying
• Grasp angles of
victim’s lower jaw &
lift with both hands

44. BREATHING
• Look for adequate
breathing in adults
• Look for presence or
absence of breathing in
children and infants

46. Face Masks
• Resuscitation mask seals over mouth/nose with port through which
you blow air to give ventilations
• One-way valve allows your air through mouthpiece, patient’s exhaled
air exits through different opening.
• When using face mask, seal mask well to face while maintaining an
open airway
• Use bridge of nose as guide for correct placement

47. FACE MASKS

48. Position at Top of Victim’s Head:
Head-tilt-chin-lift

49. Position at Top of Victim’s Head: Jaw Thrust

50. BREATHING

51. LLF
• Check breathing
• Look, listen, & feel
• Evaluation should
take at least 5
seconds & NOT last
more than 10
seconds

52. Adult BLS Sequence
If with adequate breathing
• Put in Recovery Position

53. Adult BLS Sequence
If adequate breathing is NOT detected within
10 seconds OR patient has occasional gasps
• Give 2 rescue breaths; each over 1 sec
• Enough volume to produce visible chest rise
• Avoid rapid / forceful breaths

54. Mouth-to-Mouth Rescue Breathing
Note:
• Pinch nostrils closed
• Make tight seal around
victim’s mouth
• Open nostrils after
giving rescue breath

55. Mouth-to-Mouth Rescue Breathing
•
•
•
•
•
Open airway
Create airtight mouth-to-mouth seal
Give 1 breath over 1 second
Take REGULAR (not deep) breath
Give 2nd rescue breath over 1 second

56. Mouth-to-Mouth Rescue Breathing
• Most common cause
of ventilation difficulty
is an improperly
opened airway
• If NO chest rise with first
rescue breath: Perform
head-tilt chin lift again
then give 2nd rescue
breath

57. Defibrillation

59. Ventricular Fibrillation
• Most common rhythm found in adults with witnessed non-traumatic
sudden cardiac death
• Treatment of choice: DEFIBRILLATION
• Higher survival rate if immediate bystander CPR plus defibrillation
occurs within 3-5 minutes

60. Arrest NOT Witnessed
• CPR x 2 minutes
• Check rhythm
• Give 1 shock if needed
• Immediate CPR x 2 minutes
• Recheck rhythm
Witnessed or In-Hospital Arrest
• Use defibrillator as soon as it is
available
• Check rhythm
• Give 1 shock if needed
• Immediate CPR x 2 minutes
• Recheck rhythm

61. When do you STOP CPR?
• Spontaneous breathing is present (ROSC)
• The rescuer is exhausted
• Orders from the Doctor/DNR Order is presented
• Paramedics or advanced team arrives
• Patient obviously dead

63. Severe Airway
Obstruction
• Victim is getting no air at
all
• Victim will soon become
unresponsive
• Heart will soon stop

64. Mild Airway Obstruction
• Victim is still getting some air into lungs around object
• Victim may be able to cough out object

65. Assessing An Airway Obstruction
• Most cases in adults occur while eating
• Most cases in infants and children occur while eating/playing
• Often someone is present recognizing choking event while patient
responsive

66. Mild Obstruction
• Victim is coughing forcefully
• Victim is getting some air
• Wheezing or high pitched sounds with breath
• Do not interrupt coughing or attempts to expel object

67. Severe Obstruction
• Victim getting little air or none
• Victim may look frantic and be clutching at throat
• Victim may have pale or bluish coloring around mouth and nail beds
• Victim may be coughing weakly and silently or not at all
• Victim cannot speak

68. Assessing Airway Obstruction in
Unresponsive Patient
• If patient’s head is positioned to open airway but patient is not
breathing, give 2 ventilations
• If first breath doesn’t go in, try again and give a second breath
• If it still does not go in, assume that there is obstructed airway

69. Care for FBAO
• Depends on whether patient is responsive or unresponsive; whether
the obstruction is mild or severe
• For responsive, choking patient who is coughing, encourage coughing
• For responsive, choking patient who cannot speak or cough forcefully,
give abdominal thrusts
• For unresponsive patient with an FBAO, if ventilations do not go in,
ensure additional EMS personnel have been summoned and begin
CPR

70. Management of Severe Airway Obstructions
in Responsive Patients
• Ask for consent, tell patient what you intend to do, and give
abdominal thrusts
• With child/someone much shorter than you, kneel behind patient
• If patient is much taller than you, ask patient to kneel/sit

71. Management of Severe Airway
Obstructions in Responsive Patients
• Abdominal thrusts can cause internal injury, patient should be
examined by a healthcare provider
• When severe obstruction is not cleared, patient will become
unresponsive within minutes

72. Skill: Body
Severe Foreign
Airway Obstruction
(Responsive Adult or Child)

73. Stand behind victim.
One leg between
victim’s legs.
Head to one side.

74. Abdominal Thrust
• Stand behind victim & put both
hands around upper part of
abdomen
• Lean victim forwards
• Clench fist & place it thumb
side against victim’s abdomen
between the umbilicus &
xiphoid

75. Abdominal Thrust
• Grasp this hand with the other
• Pull sharply inwards & upwards
• Repeat until object is expelled
or victim becomes
unresponsive

76. Abdominal Thrust
• If you find a
CONSCIOUS choking
victim lying on the
ground, do
abdominal thrusts in
the supine position

77. Relief of FBAO
• Do CHEST THRUSTS if:
• Abdominal thrusts are NOT
effective
• Rescuer is unable to
encircle obese victim’s
abdomen
• Victim is in late stages of
pregnancy

78. Management of Airway Obstructions in
Unresponsive Patients
• Make sure additional EMS personnel have been called
• Provide CPR
• Begin by opening airway
• When opening patient’s mouth, look first for an object in mouth
• If you see an object in mouth, remove it with finger sweep
• Then give 2 breaths and check for a pulse

79. CPR for Airway Obstructions in Unresponsive
Patients
• Chest compressions given in CPR may expel object
• While giving CPR, each time you open mouth, check to see if object is
visible, and remove it if so

80. Foreign Body Airway Obstructions in
Infants/Children
• Most child deaths from FBAOs occur under age 5,
mostly in infants
• Foreign bodies include:
• Toys and other small objects
• Pieces of popped balloons
• Food such as hot dogs, round candies, nuts, and
grapes

81. Foreign Body Airway Obstructions in
Infants/Children
• Suspect FBAO in an infant/child with onset of
respiratory distress associated with coughing,
gagging, stridor, or wheezing
• If responsive infant can cry/cough, watch carefully to
see if the object comes out

82. Responsive Choking Infant Who Cannot
Cry/Cough
• Ensure that additional EMS personnel have been summoned
• Give alternating back slaps/chest thrusts to expel object
• If Choking Infant Becomes Unresponsive
• Give CPR, start with chest compressions
• Check for object in mouth, remove any object you see

83. Unresponsive Infant when Encountered
• Open airway; check for breathing
• If not breathing, give 2 breaths
• If first breath doesn’t go in, try again after repositioning head to open
airway
• If second breath doesn’t go in, assume an airway obstruction—
provide CPR

84. Skill:
Severe Foreign Body
Airway Obstruction
(Responsive Infant)

85. Severe Foreign Body Airway Obstruction in
Responsive Infant
• Check for expelled object
• If not present, continue with next step

86. Give up to 5 back slaps between shoulder blades

87. Roll infant face up.

88. Check for expelled object.
If not present, continue
with next step.

89. Give 5 chest thrusts. Check mouth for
expelled object.
Repeat back slaps and chest thrusts
as necessary.