Presence Regional EMS

February 2014 BLS CE

Review the steps to performing quality CPR.

Demonstrate techniques of quality CPR.
Using a variety of scenarios demonstrate
the use of an AED.
Discuss the steps to take once the patient
has return of a pulse after a cardiac arrest
event.

The complete cessation of cardiac activity

Absence of a carotid pulse

Was terminal before CPR and external

defibrillation were developed in the 1960s

Few cardiac arrest patients survive outside

a hospital without a rapid sequence of
events.
Chain of survival:
Early recognition and activation of EMS
Immediate bystander CPR
Early defibrillation
Early advanced cardiac life support
Integrated post-arrest care

CPR prolongs period during which

defibrillation can be effective.

Has resuscitated patients with cardiac

arrest from ventricular fibrillation

Nontraditional responders are being

trained in AED use.

Hearts and Brains

are going to die
Peter Safar MD

EMS has the most

opportunity to
perform CPR, so we
should be good at
performing good,
quality CPR

Why is CPR Important

Studies have shown that the general population
will start CPR only 1/3 of the time and only 15% of
that total is done correctly
Chest Compressions can be started within 18
seconds of arriving at the patient, whereas Airway
first can delay compressions by 1-2 minutes or
more

1.
2.
3.
4.

Make sure the scene is SAFE!

Check responsiveness and breathing
If alone call 9-1-1 and get an AED
Check for a pulse and if no pulse present
begin CPR
Always start CPR with Compressions First!

Chest compressions and breaths are the

same for adults, child, and infant if you are
alone
Adult age starts at the onset of puberty
(12-14 years of age)
Child is age 1year to the onset of puberty
Infant is anyone under the age of 1year

Push hard and fast

Rate should be at least 100 per minute
Provide 30 compressions then 2 breaths
Make sure you allow the chest to re-expand
completely at the end of each compression

5.
6.
7.
8.

Open the airway with head tilt-chin lift

Place the mask on the patients face
Use the E-C clamp technique
Deliver each breath over 1 second

Practice good CPR on manikins with your

group.

The AED should be applied as soon as

possible to the patients bare chest
Make sure the pads adhere to the skin
Remove all clothing from the area where the pads
need to be placed
Remove any medication patches from the area
Shave any chest hair, the pads need to be on as
much bare skin as possible
If the patient has an implanted pacemaker, place the
pad at least inch away

While there are many styles of AEDs they all

work the same. The first step is to turn the
unit on and follow the voice prompts.

Assess compression effectiveness if CPR is in progress. If

the patient is unresponsive and CPR has not been started,
begin providing chest compressions and rescue breaths at
a ratio of 30 compressions to 2 breaths, continuing until an
AED arrives and is ready for use.

Turn on the AED. Apply the AED pads to the chest

and attach the pads to the AED. Stop CPR.

Verbally and visually clear the patient. Push the Analyze button, if there
is one. Wait for the AED to analyze the cardiac rhythm. If no shock is
advised, perform five cycles (2 minutes) of CPR and then reanalyze the
cardiac rhythm. If a shock is advised, recheck that all are clear, and push
the Shock button. After the shock is delivered, immediately resume CPR
beginning with chest compressions.

After five cycles (2

minutes) of CPR,
reanalyze the cardiac
rhythm. Do not interrupt
chest compressions for
more than 10 seconds.

If shock is advised, clear the

patient, push the Shock
button, and immediately
resume CPR. If no shock is
advised, immediately resume
CPR. Transport, and contact
medical control as needed.

Practice using the AED trainer on the

manikin in various cardiac arrest scenarios.

If a patient is breathing independently:

Administer oxygen.
Check pulse.

If a patient has a pulse but breathing is

inadequate, assist ventilations.

1.
2.
3.
4.

Make sure the scene is SAFE!

Check responsiveness and breathing
If alone call 9-1-1 and get an AED
Check for a pulse and if no pulse present
begin CPR
Always start CPR with Compressions first!
If despite adequate ventilation and oxygenation,
pulse is <60, begin chest compressions

One rescuer: Begin cycles of 30 chest

compressions and 2 breaths
Two rescuers: Begin cycles of 15 chest
compressions and 2 breaths
Rate should be at least 100 per minute

Place the heel of one or both

hands in the center of the chest,
in between the nipples, avoiding
the xiphoid process.

Compress the chest one third the

anterior-posterior diameter of the
chest at a rate of at least 100
times/min. Coordinate compressions
with ventilations in a 30:2 ratio (one
rescuer) or 15:2 (two rescuers),
pausing for ventilations.

Position the infant on a firm

surface while maintaining the
airway. Place two fingers in the
middle of the sternum just below
a line between the nipples.

Use two fingers to compress the

chest one third to one half its depth
at a rate of at least 100 per minute.
Allow the sternum to return to its
normal position between
compressions.

There are some safety considerations

with the use of an AED on children:
If the AED has child pads, use these on
children between the ages of 1-8 years.
A manual defibrillator is preferred for
defibrillation of infants.
Some AEDs have a key or switch that will
deliver a child shock dose.

If the AED does not have child pads or a

child key or switch, adult pads may be used.

Use of adult dose is better than no

attempt at defibrillation!

Answer the following questions as a group.

IDPH site code: Use site code assigned to your
agency for 2014.
If doing this CE individually, please e-mail your
answers to:
Shelley.Peelman@presencehealth.org
Use February 2014 BLS CE in subject box.
You will receive an e-mail confirmation. Print this
confirmation for your records, and document the CE
in your PREMSS CE record book.

1.
2.
3.
4.
5.

What is the ratio of compressions to

ventilations in adult CPR?
True/False: Never use an AED on a patient
with an implanted pacemaker.
True/False: AEDs can be used on children
even if child pads arent available.
True/False: AEDs can be placed on awake
talking patients to monitor their rhythm.
List the 5 links in the Chain of Survival.

6.

7.

8.

True/False: Always remove medication

patches from the patients chest before
applying an AED.
True/False: Chest compressions should be
initiated on children 8 years and younger if
their heart rate is <60 despite adequate
oxygenation and ventilation.
True/False: It is acceptable to continue
chest compressions while an AED is
analyzing.

9.

A patient with cardiac arrest secondary to

ventricular fibrillation has the greatest
chance for survival if:

A.

CPR is initiated within 10 minutes.

oxygen and rapid transport are provided.
defibrillation is provided within 2 minutes.
paramedics arrive at the scene within 5
minutes.

B.
C.
D.

10.

When using the AED to defibrillate a

patient in cardiac arrest, you should:

A.

analyze the cardiac rhythm every 60

seconds.
check for a pulse following each
defibrillation.
deliver up to three shocks in a row if
indicated.
immediately resume CPR following
defibrillation.

B.

C.
D.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

30 compressions to 2 breaths
False
True
False
Early access, Early CPR, Early Defib, Early
Advanced Care, Integrated Post-Arrest Care
True
True
False
C
D