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

ADULT: 1-Rescuer CPR

Tap or gently shake shoulder.
Shout Are you OK?
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

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.

Check for adequate breathing
Listen for the sounds of
(Take at least 5 and no more breathing.
than 10 seconds) Feel for breath on your cheek.
Look, listen, and feel

If the victim is NOT breathing,

give 2 one-second breaths
enough to make the chest rise

Open Airway

Remember your
A,B,C,Ds!
Airway
Breathing
Circulation
Defibrillation

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

2006

ADULT: 1-Rescuer CPR continued

Check carotid pulse.

If victim has a pulse, but is not

breathing, perform rescue breathing.

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

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.

(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.

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

2006

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.

Tap or gently shake shoulder.

Shout Are you OK?

If another person is available, have them activate

EMS system. One Rescuer: For SUDDEN
COLLAPSE, PHONE 911, Get AED
Turn on back, taking care to support the head
and neck in case of injury.

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.

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

Determine breathlessness. the chest and
(Look, listen, and feel). Look at the chest for movement.
Listen for the sounds of breathing.
Feel for breath on your cheek.

A child is
considered
someone
between
1 to Puberty

Roll victim on his or her side, using the victims

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

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

2006

CHILD 1 rescuer CPR continued

If the victim is NOT breathing, give 2 breaths
(approximately 1 second each) that make the chest
rise.

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
Check the carotid pulse (at least 5 seconds and no
more than 10 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.

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.

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

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)

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)

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

2006

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

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

2006

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)

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.

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.

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

2006

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 preconnected).
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.

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

2006

INFANT 1 rescuer CPR

Determine
unresponsiveness.

Tap feet

Call for HELP!

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.
Position the infant on his or her back
on a firm surface, supporting the
head and neck if turning
is necessary.

Lift the chin up gently with one hand

while pushing down on the forehead
with the other to tilt the head back.

Open the airway using

head tilt-chin lift. Take
care not to tilt the head
too far back.

If suspected cervical spine injury,

use the modified jaw-thrust
maneuver instead.

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

Look at the chest for movement.

Listen for the sounds of breathing.
Feel for breath on your cheek.

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.

If the victim is NOT

breathing, give 2
breaths.

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.

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

10

2006

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.

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.

After 5 cycles, if someone has not

already done so, activate the emergency
response system.

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

11

2006

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

Activate EMS or send a bystander to do so.

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 2 minutes, check for return of pulse. If no

pulse, or other signs of circulation, resume
CPR.

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.

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.

Continue compressions and breaths in a ratio

of 15:2 (for 2 rescuers) switching roles every 2
minutes. (100 compressions per minute)

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

12

2006

Foreign Body Airway Obstruction CONSCIOUS

(Adults & Children over 1)
Determine if victim is able to
speak or cough (Universal Choke Sign).

Ask only one Yes or No

question of the victim, for
example:
Are you choking?

Perform abdominal thrust until the

foreign body is expelled or the victim
unresponsive.

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.

For victims who are pregnancy or

who are obese:
Stand behind victim.
Wrap arms around victims

Perform Chest Thrusts until the

foreign body is expelled or the
victim becomes unresponsive.

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.

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

13

2006

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.

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

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.

14

2006

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.

Place infant face down over one forearm.

Supporting the head and neck with

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.

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).

Continue the cycle of back blows and

chest thrusts until the foreign body is
expelled or the infant loses consciousness

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

15

2006

INFANT: Foreign-Body Airway Obstruction UNCONSCIOUS

Establish unresponsiveness.

If second person is available

have them activate the EMS
system.

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 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.

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