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 2.5 - 3 hours to complete the entire DVD lead program including 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 course, please call log into CiNOW, go to the Catalog, find the
BLS section, and then click the ENROLL link next to the class that you would like to register
for (you must see a Thank you for enrolling screen for confirmation that you have been
enrolled in the class).


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



















































2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
2

ADULT: 1-Rescuer CPR

Determine unresponsiveness





Position the victim



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

Activate EMS System OR CALL A CODE BLUE




Check carotid pulse



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.













Tap or gently shake shoulder.
Shout Are you OK?




Turn on back, supporting head
and neck.





Send someone to get the AED

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).


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 at least 2
inches, at a rate (speed) of at
least 100 compressions per
minute.

After every 30 compressions,
deliver 2 onesecond rescue
breaths.














At least 2 inches
Remember CAB!
Compressions
Airway
Breathing

2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
3
ADULT: 1-Rescuer CPR continued


.
Give 2 one-second breaths enough to make the chest rise












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








Lift the chin up gently with one
hand while pushing down on the
forehead with the other to tilt the
head back.
Open Airway










Provide about 8-10 breaths per
minute (1 breath every 6-8
seconds).

Recheck pulse every 2 minutes
















2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
4
CHILD CPR 1-Rescuer
CPR performed on children (1 to puberty) is similar to CPR for adult victims with some differences:
1. Use the heel of one hand for chest compressions on very small children. (both hands may be
used too)
2. Chest compression are 1/3 the depth of the chest!


Determine unresponsiveness.

If the victim is NOT breathing:

If another person is available, have them activate
EMS system. One Rescuer: For SUDDEN
COLLAPSE, PHONE 911, Get AED

Position the victim.


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



Open the airway using the head tilt-chin lift
maneuver. If you suspect a cervical spine injury,
use the modified jawthrust maneuver instead.





Tap or gently shake shoulder.
Shout Are you OK?





Turn on back, taking care to support the head
and neck in case of injury.

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. (two hands may
be used)
Compress sternum 1/3 to of chest
depth (about 2 inches) and release.
Do this 30 times, followed by 2 breaths.
Repeat the 30:2 cycle for 2 minutes
Target compression rate: 100 +
compressions per minute.


Lift the chin up gently with one hand while
pushing down on the forehead with the other to
tilt the head back.








RECHECK pulse every 2 minutes

A child is
considered
someone
between ages
1 to Puberty
2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
5


CHILD 1-Rescuer CPR continued


If no one has called EMS, after 5 cycles of 30: 2 then
leave the victim and call 911.



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)









If victim is breathing and there is no evidence of
trauma, place the victim in the recovery position
.






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)



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



2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
6
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: at least 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.









Call a Code BLUE or
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




















2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
7
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.








2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
8
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. 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.





3. 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 greater 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 for 2
minutes beginning with chest
compressions.



2011
R 011, Copyright American Heart Association
9
INFANT 1-Rescuer CPR

eproduced with permission, Heartsaver Guide, 2
Determine
unresponsiveness.

Call for HELP!




















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






Compress the sternum
approximately
1/3 the depth of the chest
(at least 100 times/min.)




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


Call a Code Blue
If someone is available, send them
to call 9-1-1

Turn on back, taking care to support
the head and neck in case of injury.

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.



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



2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
10

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 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)
2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
11
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:

2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
12
Foreign-Body Airway Obstruction UNCONSCIOUS
Adults & Children over 1


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













START CPR with chest compressions first. The first time that
you give open the airway, check for the object, and remove it (if
seen) before you give a rescue
breath.

































REMEMBER C-A-B!
(Compression, Airway,
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.









2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
13
INFANT Foreign-Body Airway Obstruction CONSCIOUS

Assess for complete obstruction.





Place infant face down over one forearm.




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



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


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

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).


2011
Reproduced with permission, Heartsaver Guide, 2011, Copyright American Heart Association
14
INFANT: Foreign-Body Airway Obstruction UNCONSCIOUS


Establish unresponsiveness.


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





BEGIN CPR with chest
compressions

When checking the airway
make sure to look for the
object and, if you see it,
remove it before giving
rescue breaths. Do not
perform a blind finger sweep in an infant!





Open airway to a neutral
position using the head tilt-chin
lift but do not tilt the head too far
back.










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.









Additional 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.


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