Thorough discussion on Basic Life Support according to AHA guidelines (with videos)

2. Training Course Objectives:
At the end of the training, the participants will be able:
1. To recognize cardiac arrest
2. To activate the emergency response system early
3. To respond quickly and confidently
4. To perform effective and high quality Cardiopulmonary Resuscitation
(CPR)
to adult and child

3. CARDIOPULMONARY RESUCITATION (CPR)
It is a lifesaving procedure for a victim who has signs of
cardiac arrest:
Unresponsive; no normal breathing; and no pulse
The 2 key components of CPR are:
 CHEST COMPRESSION
 BREATHS

4. 1. Start compressions within 10 seconds after recognizing
cardiac arrest
2. Push hard, push fast: Rate of 100 to 120/min with depth of:
Adults: at least 5cm but no more than 6cm
Children: at least one third the depth of the chest,
approximately 5cm
Infants: at least one third depth of the chest, approximately 4cm

5. 3. AVOID leaning on the chest between compressions
4. Minimize interruptions to less than 10 seconds
3. Give effective breaths:
 Deliver each breath over 1 second  enough to make the victim’s
chest rise
Avoid excessive ventilation

7. The Main Components of CPR are:
Chest Compression
Airway
Breathing

8. Step 1. Verify the
scene: Check for
danger
Always make sure the area is
safe
Step 2.a Shout for help!
Step 2.b Activate
Emergency Response
System + get AED
(yourself or send
someone)
Determine next step base
on whether breathing is normal
and if pulse is felt.
Step 3. Breathing and Pulse
Assess for breathing and pulse at the
same time  should take no more
than 10 seconds
Step 2. Responsiveness
Check the casualty’s response:
Ask questions and gently tap
shoulders. Say “Are you okay!”

9. Victim NOT breathing normally + pulse felt:
Rescue breath 1 breath every 6 seconds or 10 breaths/min
Check for pulse about every 2 minutes
Victim is NOT breathing normally or if gasping + No pulse:
Begin High quality CPR
STEP
3a
Victim breathing normally + pulse felt  MONITOR

10. 1. Kneel
By the side of
your casualty
2. Angle arm
Put the arm nearest to
you to make a right
angle. Palm
facing upwards
3. Hand to cheek
Bring the arm furthest
away across the chest
and place the back of
their hand against the
cheek nearest to you
Hold it there
4. Knee bend
With other hand,
bend their far knee
up so that the foot is
flat on the floor
5. Knee pull
Pull on the knee to roll
the casualty towards you
onto their side
Adjust them as
necessary
6. Ensure airway is open
Recheck breathing
Call for help
Stay and monitor casualty
until help arrives

12. 1. Position self at the victim’s side.
2. Make sure the victim is lying face up on a firm and flat
surface.
3. Position your hands and body to perform chest
compressions.

13. a. Place the heel of one hand in the
center of the victim’s chest, on the
lower of the breastbone.
b. Put the heel of your hand on op of
the first hand
c. Straighten your arms and position
your shoulders directly over your hands.

14. Give Chest Compression at a rate of 100 to 120/min.
Press down at least 5cm with each compression.
At end of each compression, always allow chest recoil 
AVOID LEANING ON THE CHEST!
Minimize interruptions in each compression
GIVE 30 COMPRESSIONS FOLLOWED BY 2 BREATHS

16. Locate the trachea (on the side closest to you)  using 2 or 3
fingers
Feel for a pulse for at least 5 but no more than 10 seconds.
If pulse is not felt  begin CPR
Slide those fingers into the groove between the trachea and
muscles at the side of the neck

18. Open the Airway, via:
Head tilt-chin-tilt
Jaw Thrust
Note: If you suspect a head or neck injury  use the jaw-thrust maneuver

19. Steps:
1. Place one hand on the victim’s 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

21. STEPS:
1. Position yourself at the victim’s head
2. Place one hand on each side of the victim’s head. (you may
rest you elbows on the surface where the victim’s
3. Place your fingers under the angle of the victim’s lower jaw
and lift both hands displacing the jaw forward.
4. If the victim’s lips close, push the lower lip with your thumbs
to open the lips

23. STEPS For 1 Rescuer:
1. Position yourself directly above the victim’s
head
2. Place the mask on the victim’s face, using the
bridge of the nose as a guide for correct
positioning.
3. Use the E-C clamp technique to hold the mask in
place while you lift the jaw to hold the airway
open.

24. E-C CLAMP TECHNIQUE:
a. Perform a head tilt
b. Place the mask on the face with the narrow
portion at the bridge of the nose
c. Use the thumb and index of one hand to
make a “C” on the side of the mask, pressing
the edges of the mask to the face
d. Use the remaining fingers to lift the angles of
the jaw (3 fingers form an “E”).
e. Open the airway, and press the face to the
mask

25. Once the Bag-Mask Valve is placed:
Squeeze the bag to give breaths while watching the chest
rise.
Deliver each breath over 1 second with or without the use of
oxygen supplemental

26. 1. Rescuer 1 positioned directly above the
victim, opens the airway and positions
the bag-mask device
2. Rescuer 2 positioned at the victim’s
side, squeezes the bag

28. Additional rescuers can help with the bag-
mask ventilation, compression, and using
AED
The first rescuer who arrives at the side of
the victim  Assess for scene safety and
check for patient responsiveness
The first rescuer should also send another
rescuer to activate the emergency
response system and get the AED.

29. Rescuer 1: Provide Compression
Switch compressors about every 5 cycles or every 2 minutes (more
frequently if fatigued).
Note: TAKE LESS THAN 5 SECONDS TO SWITCH!

30. Rescuer 2: Provide Breaths
1. Position yourself at the victim’s head
2. Maintain open airway using: Head-tilt-chin-lift or Jaw Thrust
3. Encourage the first rescuer to:
Perform compressions that are deep enough and fast enough
Allow complete chest recoil between compressions
4. Switch with the compressor every 5 cycles or every 2 minutes

33. AED – is a lightweight, portable,
computerized device that can identify
an abnormal heart rhythm that needs
shock.
Defibrillation – medical term for interrupting or
stopping an abnormal hearth rhythm by using
controlled electrical shocks

34. 1. Open the carrying case (if applicable).
Power the AED, then follow the AED
Prompts.
2. Attach the AED pads to the victim’s bare
chest.
Note: AVOID placing over clothing, medication patches, or
implanted devices; Choose adult pads for victims 8 y.o and
above.
Steps:
a. Peel the backing away from the AED
pads.
b. Attach the AED Pads to the victim’s bare
chest.
c. Attach the AED connecting cables to the
AED device.
CHILDREN BELOW 8 years old

35. 3. Clear the victim and allow
the AED to analyze the
rhythm.
4. If the AED advises shock, it
will tell you to clear the
victim and then deliver shock.
Before delivering shock, make sure no one is
touching the victim by: Loudly stating a “clear
the victim” and “Everybody clear”.
Press the shock button.
When the AED prompts
you, clear the victim
during analysis.

36. 5. If the AED prompts that no shock is
advised, or after shock is delivered
immediately resume Chest compression.
6. After about 5 cycles or 2 minutes of CPR,
the AED will prompt you to repeat the Steps
3 and 4.

39. Position of Victim: Face up on a firm and flat surface.
Chest Recoil: To allow the chest to expand every after compression.
DO NOT LEAN ON THE PATIENT EVERY AFTER COMPRESSION!
Compression-to-Ventilation Ratio: 30 compressions to 2 breaths
Compression Rate: 100 to 120 rate/minute
Compression Depth: At least 5cm
Minimize Chest compression interruptions

40. Scenario: A 53-year old man collapse and unresponsive. You witness his collapse and are the first
rescuer at the scene where the man is lying motionless on the floor.
1. Which is the first action you should take in the situation?
a. Activate the emergency response system
b. Start CPR
c. Verify that the scene is safe
2. The man doesn’t respond when you tap his shoulders and shout, “Are you ok?”- What is the
best next action?
a. Start providing CPR
b. Check his pulse
c. Shout for nearby help
d. Start providing rescue breaths
3. Several rescuers respond, you ask them to activate ERS and get the AED. As you check for a
pulse and breathing, you notice that the man is gasping for air and you do not feel the pulse.
What is your best next action?
a. Monitor the victim until additional help arrives
b. Provide rescue breathing
c. Start high quality CPR starting with chest compression.

41. Infant – are younger than 1 year of age (but not newly born)
Children – from 1 year old to puberty

42. 1. Verify scene safety
2. Assess for breathing and pulse at the same
time. (Should not take more 10 seconds)
3. Assess for breathing and pulse at the same
time. (Should not take more 10 seconds)
PRESENCE AND ABSENCE OF
PULSE AND BREATHING WILL
DETERMINE NEXT ACTION

43. Victim NOT breathing normally + pulse felt:
Rescue breath 1 breath every 2 to 3 seconds or 20 to 30 breaths/min
Check for pulse rate for 10 seconds, every 2 minutes.
STEP 3a &
b
Victim breathing normally + pulse felt  MONITOR

44. Step 4: Is the heart rate LESS THAN 60 beats/min with signs of poor perfusion?
If YES: START CPR
IF NO: Continue Rescue breathing. Check pulse every 2 minutes.
Step 5: Was the sudden collapse witness?
If YES: Activate Emergency Response system, then get AED
IF NO: Start CPR with cycles of 30 compressions and 2 breaths.
Then use AED as soon as available
Less than 60 beats/min = LESS THAN 6 BEATS IN 10 SECONDS

45. Step 9:
If AED detects nonshockable rhythm  continue high quality CPR for 2
minutes  then use AED
Step 6:
After about 2 minutes, if you are still alone, activate the emergency response
system (carry infant/leave child) and get AED.
Step 7:
Use AED as soon as it is available (same step in adult BLS)
Step 8:
If the AED detects a shockable rhythm  give 1 shock, then resume CPR
immediately for 2 minutes  then use AED

46. Pediatric Breathing: Gasping is NOT NORMAL BREATHING and signs for cardiac arrest
Pulse Checking in Infants: Feel for BRACHIAL PULSE
Steps:
1. Place 2 or 3 fingers on the inside of the upper arm,
midway between the infant’s elbow and shoulder
2. Press your fingers down and attempt to feel the
pulse for at least 5 seconds but no more than 10
seconds
For Kids (older than 1 year old): Carotid pulse

47. Signs of Poor Perfusion:
Temperature: Cool extremities
Altered mental status: Continued decline in consciousness/responsiveness
Pulse: Weak Pulse (less than 60beats/min
Skin: Paleness, mottling and later cyanosis

48. For most Children: 2 hand
compression (same with
adult)
For small child: 1-handed
compression

49. For infants:
Singe rescuer can use 2-finger or 2 thumb-encircling
technique.
For multiple rescuer 2-thum-encircling technique is
preferred.

50. 2-Finger Technique Chest Compression:
1. Place the infant on a firm, flat surface
2. Place 2 fingers in the center of the infant’s chest (below nipple line)
3. Give compressions at a rate of 100 to 120/min
4. Compress at least one third of infant’s chest (4cm)
5. At end of each compression, allow chest to re-expand – DO NOT LEAN ON THE CHEST!
6. Minimize chest compression interruptions to less than 10 seconds
7. After every 30 compressions, open airway with head-tilt-chin-lift technique and give 2
breaths each over 1 second. (Note: Chest should rise)
8. After about 5 cycles or 2 minutes of CPR and if alone, bring infant and call for
emergency help.
9. Then continue CPR 30:2 ratio. Use AED if available. Continue until ALS providers take
over or infant begins to move/react.

52. 2 Thumb-encircling hands Technique: (2 rescuers)
1. Place the infant on a firm, flat surface
2. Place both thumbs side by side in the center of the infant’s chest, on the lower
half of the breastbone. With the fingers of both hands, encircle the infant’s chest
and support the infants back
3. With your hands encircling the chest, use both thumbs to depress the breastbone
at a rate of 100 to 120/min
4. Compress at least one third of infant’s chest (4cm)
5. At end of each compression, allow chest to re-expand – DO NOT LEAN ON THE CHEST!
6. Minimize chest compression interruptions to less than 10 seconds
7. After every 15 compressions, pause briefly for the 2nd rescuer to open airway with a
head-tilt-chin-lift technique and give 2 breaths, each over 1 second.
8. Then continue CPR 15:2 ratio. The 2 rescuers should switch role of chest compression
and giving breaths. Continue CPR until infant moves/react, or ALS providers arrive.

56. Compression-to-
ventilation Ratio:
• For single rescuer
– 30:2 ratio
• For 2 rescuers or
more – 15:2 ratio
Compression Rate:
• 100 to 120/min
(same with adult)
Compression
Depth:
• For infant – 1/3 of
the chest
diameter (or 4cm)
• For child (more
than 1yo) –
approximately
5cm

58. 1. What is the correct compression-to-ventilation ratio for a 7-year old child
when 2 or more rescuers are present?
2. What is the correct chest compression depth for an infant?
3. What is the correct chest compression depth for a child?
4. What are the two techniques of chest compression for infants?

59. Tilt the infant’s head in a neutral position (Sniffing position). DO NOT hyper-extend!
Adult Head-tilt-chin-lift

60. For Adults:
Give 1 breath every 6 seconds
Give each breath over 1 second
Each breath should result in visible
chest rise
Check for a pulse about every 2 mins.
For Infants and children:
Give 1 breath every 2 to 3 seconds
Give each breath over 1 second
Each breath should result in visible
chest rise
Check for a pulse about every 2 mins.
When to switch from only rescue breathing to CPR in infant/child? If:
 There is signs of poor perfusion despite giving rescue breaths
 The infant’s or child’s heart rate is less than 60beats/min with signs of poor perfusion
 Pulse is NOT felt

61. 1. Hold the victim’s airway open with head-tilt-chin-lift
2. Pinch the nose closed with your thumb and index finger (leaning hand on
the forehead)
3. Take a regular (not deep) breath and seal your lips around the victim’s
mouth.
4. Deliver 1 breath over 1 second  watch for chest rise as breath is given
5. If the chest does not rise, repeat the head-tilt-chin-lift
6. Give a second breath  watch for chest rise
7. If you are unable to ventilate the victim after 2 attempts, immediately
return to chest compression

62. CAUTION: Don’t give breaths too quickly or with too much force 
gastric inflation

64. 1. Which victim would need ONLY rescue breathing?
a. Gasping with no pulse
b. No breathing and a pulse
c. No Breathing and no pulse
2. How often should rescue breaths be given in infants and children when pulse is
felt?
a. 1 breath every 2 to 3 seconds
b. 1 breath every 3 to 5 seconds
c. 1 breath every 5 to 6 seconds
3. Which action can rescuers perform to potentially reduce risk of gastric inflation?
a. Giving rapid breath
b. Delivering each breath over 1 second

65. Signs of choking:
Type of Obstruction Signs Rescuer Actions
Mild airway obstruction Good air exchange
Can cough forcefully
May wheeze between coughs
Encourage victim to continue
coughing
Do not interfere with victim’s own
attempt to relieve the obstruction
If mild obstruction continues or
progress to severe case  activate
emergency response system

66. Signs of Choking
Type of Obstruction Signs Rescuer Actions
Severe Airway
Obstruction
Clutching the throat
with thumb and fingers
 universal choking
signs
Unable to speak or cry
Weak or ineffective
cough or no cough at all
Increase respiratory
difficulty
Take steps immediately to relieve
the obstruction
If severe and it continues making
victim unresponsive  start CPR
If you are not alone, send someone
to activate emergency response, if
alone CPR for 2minutes before going
to call help

67. ABDOMINAL THRUSTS
- Use in adult and child BUT NOT ON AN INFANT
- May be necessary to repeat several times to clear airway

68. Steps to perform Abdominal Thrusts: (victim standing or sitting)
1. Stand or kneel behind the victim and wrap your arms around the victim’s
waist.
2. Make a fist with one hand. Place the thumb side of your fists against the
victim’s abdomen, in the midline (slightly above navel and below
breastbone)
3. Grasp your fist with your other hand and press your fist into the victim’s
abdomen with a quick, forceful upward thrust.
4. Repeat thrust until the object is expelled from the airway or the victim
becomes unresponsive
5. Give each new thrust with a separate , distinct movement to relieve the
obstruction.

73. STEPS:
1. Shout for help. If someone else is available, send that person to activate
the emergency response system
2. Gently lower the victim to the ground if you see that they are becoming
unresponsive
3. Begin CPR, starting with chest compressions. DO NOT check for pulse. Each
time you open the airway to give breaths, open the victim’s mouth wide
and look for the object.
If you see an object that looks easy to remove, remove it with fingers.
If you do not see an object, continue CPR
4. If alone, after about 5 cycles or 2 minutes of CPR, activate emergency
response system

74. For Responsive Infant, Steps:
1. Kneel or sit with the infant in your lap.
2. Hold the infant facedown with the head
slightly lower than the chest, resting on your
forearm.
3. Support the infant’s head and jaw with your
hand. Rest forearm on your lap or thigh to
support the infant.
4. With the heel of the hand, deliver up to 5
forceful back slaps between the infant’s
shoulder blades.

75. 5. After delivering up to 5 back slaps, place your
free hand on the infant’s back, supporting the
back of the infant’s head with the palm of
your hand, then turn over the infant while
carefully supporting the head and neck.
6. Hold the infant faceup, with the forearm
resting on your thigh, and infant head lower
than the trunk
7. Provide up to 5 quick downward chest thrust
in the middle of the chest (same location for
chest compression during CPR). Deliver thrust
at a rate of 1 per second.

77. Same with adult choking relief for unresponsive:
Note: Do not check for pulse before starting CPR!