BLS

Airway Management Lec | Midterm

● Allow complete chest recoil after each

WHAT IS CPR? compression.
● Minimize interruptions in compressions (try
CPR or Cardiopulmonary Resuscitation – is an to limit interruptions to less than 10 seconds)
emergency lifesaving procedure performed when the ● Give effective breaths that make the chest rise
heart stops beating. Immediate CPR can double or triple ● Avoid excessive ventilation
chances of survival after cardiac arrest.
COMPRESSION DEPTH
WHY IS CPR IMPORTANT?
● Chest compressions are more often too shallow
Keeping the blood flow active – even partially – extends than too deep. However, research suggests that
the opportunity for a successful resuscitation once compression depth greater than 6cm in adults
trained medical staff arrive on site. may cause injuries.
● Optimal to target your compression depth from 5
WHAT IS CARDIAC ARREST? to 6 cm
● High-quality CPR, improve patient outcomes
Occurs when the heart malfunctions and stops beating and save more lives.
unexpectedly. Cardiac arrest is an “ELECTRICAL”
problem. CHAIN OF SURVIVAL

WHAT IS A HEART ATTACK? ● CPR is a critical step in the AHA’s Chain of

Survival. The term Chain of Survival provides a
Occurs when blood flow to the heart is blocked. A heart useful metaphor for the elements of the ECC
attack is a “CIRCULATION” problem. systems concept.
● Notice that the links in the Chain of survival are
BASIC LIFE SUPPORT (BLS) not separate, but connected. Each link describes
an action during the resuscitation attempt that is
● BLS is the foundation of saving lives after critical to a successful outcome.
cardiac arrest. ● If one link is broken, the chance for a good
● The BLS Course focuses on what rescuers need outcome is decreased. These mutually
to know to perform high-quality CPR in a wide dependent link represents the most important
variety of settings. actions in the management of cardiac arrest.
● You will also learn how to respond to choking
emergencies. ADULT CHAIN OF SURVIVAL

HIGH QUALITY CPR IHCA

● Surveillance, prevention and treatment of pre
● Start compressions within 10 secs of arrest conditions
recognition of cardiac arrest. ● Immediate recognition of cardiac arrest and
● Push hard, push fast: Compress at a rate of activation of Emergency response system
100-120/min with a depth of ● Early CPR with an emphasis on compression
➔ At least 5 cm for Adults ● Rapid defibrillation
➔ At least one third the depth of the chest, ● Multidisciplinary post-cardiac arrest care
about 5cm, for childreN.
➔ At least one third the depth of the chest, OHCA
about 4cm, for infants ● Immediate recognition of cardiac arrest and
activation of Emergency response system

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 ● Early CPR with an emphasis on compression Basic Framework for CPR
● Rapid defibrillation with AED 1. Hands-Only CPR
● Effective Advance Life support 2. 30:2 CPR
● Multidisciplinary post-cardiac arrest care 3. Teamwork

SIGNS OF CARDIAC ARREST

● Unresponsive
● No normal breathing
● No pulse

MAIN COMPONENTS OF CPR

Compressions. Airway, Breaths

PEDIATRIC CHAIN OF SURVIVAL

In children, cardiac arrest is often secondary to

Respiratory Failure and shock. Identifying children with
these problems is essential to reduce the likelihood of Assess for Breathing and Pulse- to minimize delay in
arrest and maximize survival and recovery. starting CPR, you may assess breathing, scan the
● Prevention of Arrest victim’s chest for rise and fall, as you check the pulse.
● Early-high quality bystander CPR No more than 10 seconds.
● Rapid activation of the emergency response
system CHECK PULSE
● Effective Advance Life Support
● Integrated post-cardiac care To perform a pulse check in Adult, palpate a carotid
pulse.
Locating carotid pulse:
1. Locate the trachea (on the side closest to you),
using 2 or 3 fingers
2. Slide these 2 or 3 fingers into the groove
between the trachea and the muscles at the
sides of the neck, where you can feel the carotid
pulse.
3. Feel for a pulse for at least 5 but no more than
10 seconds. If you do not definitely feel a pulse,
begin CPR, starting with chest compressions.

BLS GENERAL CONCEPTS

Learning Objectives
1. Recognize the signs of someone needing CPR
2. Perform high-quality CPR
3. Provide effective ventilations by using a barrier
device
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 CHEST
SIGNS OF POOR PERFUSION

● Temperature : Cool extremities

● Altered mental status : continued decline in

●
consciousness/responsiveness
Pulses: weak pulses
COMPRESSION
● Skin: Paleness, mottling, (patchy appearance),
and later cyanosis (turning blue) IMPORTANCE OF CHEST COMPRESSION

CHECK PULSE CONT… Each time you stop compressions, the blood flow to
the heart and brain decreases significantly. Once you
To perform a pulse check in Infant resume compressions, it takes several compressions to
Locating the Brachial Artery pulse: increase blood flow to the heart and brain back to the
1. Place 2 or 3 fingers on the inside of the upper levels present before the interruption. Thus, the more
arm, midway between the infant’s elbow and often chest compressions are interrupted and the longer
shoulder. the interruptions are, the lower the blood supply to the
2. Then press fingers to attempt to feel pulse for at heart and brain is.
least t but no more than 10 seconds
IMPORTANCE OF FIRM SURFACE
To perform a pulse check in Child
Locating the Femoral Artery pulse: Compressions pump the blood into the heart to the
1. Place 2 fingers in the inner thigh, midway rest of the body. To make compressions as effective as
between the hipbone and just below the crease possible, place the victim on a firm surface, such as the
where the legs meet the torso. floor or backboard. If the victim is on a sift surface, such
2. Feel pulse for at least t but no more than 10 as a mattress, the force used to compress the chest will
seconds. If you do not definitely feel a pulse, simply push the body into the soft surface. A firm surface
begin high-quality CPR, starting with chest allows compressions of the chest and heart to create
compression blood flow.

CHEST RECOIL

Chest recoil allows blood flow into the heart.

Incomplete chest recoil reduces the filling of the heart
between compressions and reduces the blood flow
crated by chest compressions. Chest
compressions/relaxation should be about equal.

ADULT CHEST COMPRESSION

High-Quality Chest Compressions

● Compress at a rate of 100 to 120/min.
● Compress then chest at least 5 cm.
● Allow the chest to recoil (re expand) completely
after each. Compressions.
● Minimize interruptions in compressions.

Hand placement
2 hands on the lower half of the breastbone (sternum)

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 CHILD CHEST COMPRESSION 2 THUMB ENCIRCLING HANDS TECHNIQUE

1 or 2 hands (whatever is needed to provide The 2 thumb-encircling hand technique is recommended

compressions of adequate depth) when CPR is provided by 2 rescuers. This technique is
● Compress at a rate of 100 to 120/min. preferred over the 2-finger technique because it,
● At least one third the AP diameter of the chest or ● Produces better blood supply to the heart
about 5cm. muscle
● Allow the chest to recoil (reexpand) completely ● Helps ensures consistent depth and force of
after each. Compressions. chest compressions
● Minimize interruptions in compressions. ● May generate higher blood pressures.

AIRWAY
Hand position
2 hands or 1 hand (optional for the very small child) on
the lower half of the breastbone (sternum)
OPENING THE AIRWAY
INFANT CHEST COMPRESSION
For breaths to be effective, the victim’s airway must be
2- finger chest compressions (single rescuer) open. Two methods for opening the airway are
● Compress at a rate of 100 to 120/min. ● Head tilt-chin lift
● At least one third the AP diameter of the chest or ● Jaw thrust
about 4cm If head or neck injury is suspected, use the jaw-thrust
● Allow the chest to recoil (reexpand) Chest maneuver to reduce neck or spine movement. Switch to
compression/relaxation time should be about a head tilt-chin lift maneuver if the jaw thrust does not
equal. open the airway.
● Minimize interruptions in compressions.
HEAD TILT CHIN LIFT
Hand position
2 finger in the center of the chest, just below the nipple Follow these steps to perform a head-tilt chin lift:
line 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.

The head tilt chin lift relieves airway obstruction in

The 2 Thumb-Encircling technique (2- rescuer) an unresponsive victim
Compress at a rate of 100 to 120/min.
● At least one third the AP diameter of the chest or
about 4cm
● After each compression, completely release
pressure on the breastbone and allow the chest
to recoil completely.
● Minimize interruptions in compressions.
A. Obstruction by the tongue. When a victim is
unresponsive the tongue can block the upper
Hand position
airway.
2 thumb-encircling hands in the center of the chest, just
B. The head tilt chin lift maneuver lifts the tongue,
below the nipple line
relieving the airway obstruction.
CAUTION
Things to avoid with head tilt chin lift
● Do not press deeply into the soft tissue under
the chin because this might block the airway.

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 ● Do not close the victim’s mouth completely. Use of a Pocket Mask
To use a pocket mask, position yourself at the
JAW THRUST victim’s side. This position is ideal when performing
1-rescuer CPR because you can give breaths and
● The jaw-thrust maneuver is used when the head perform chest compressions without repositioning
tilt-chin lift doesn’t work or a spinal injury is yourself every time you change from compressions to
suspected. giving breaths.
● Rescuers may perform a jaw thrust to open the
airway in a victim with a head or neck injury if a Follow these steps to open the airway with a head-tilt
spinal injury is suspected. If the jaw thrust does chin lift and use a pocket mask to give breaths to the
not open the airway, use a head tilt-chin lift. victim.
1. Position yourself at the victim’s side
2. Place the pocket mask on the victim’s face,
using the bridge of the nose as a guide for
correct position.
3. Seal the pocket mask against the face.
➢ Using your hand that is closer to the top
of the victim’s head, place the index
finger and thumb along the edge of the
mask.
JAW THRUST MANEUVER ➢ Place the thumb of your other hand
Follow these steps to perform jaw thrust. along the edge of the mask.
1. Place one hand on each side of the victim’s 4. Place the remaining fingers of your second hand
head. You may rest your elbows on the surface along the bony margin of the jaw and lift the jaw.
on which the victim is lying. Perform a head tilt-chin lift to open the airway.
2. Place your fingers under the angles of the 5. While you lift the jaw, press firmly and
victim’s lower jaw and lift with both hands, completely around the outside edge of the mask
displacing the jaw forward. to seal the pocket mask against the face.
3. If the lips close, push the lower lip with your 6. Deliver each breath over 1 second, enough to
thumb to open the lips. make the victim’s chest rise.

PROTECTIVE BARRIERS
POCKET MASK

● For mouth-to mask breaths, use a pocket mask.

Pocket masks usually have a 1-way valve, which
diverts exhaled air, blood, or bodily fluids away
from the rescuer. The 1-way valve allows the
rescuer’s breath to enter the victim’s mouth and
nose and diverts the victim’s exhaled air way BAG MASK DEVICE
from the rescuer. Some pocket masks have an
oxygen inlet that allows you to administer ❖ A bag mask device is used to provide
supplementary oxygen. positive-pressure ventilation to a victim who is
● Pocket masks are available in different sizes for not breathing or not breathing normally. It
adults, children, and infants. Effective use of the consists of a bag attached to a face mask. If the
pocket mask barrier device requires instruction bag is self-inflating, a bag-mask device may be
and practice. used with or without an oxygen supply. If not
attached to oxygen flow, it provides about 21%
oxygen from room air. Some bag-mask devices
include a 1-way valve. The type of valve may
vary from one device to another.

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 ❖ Face masks are available in a variety of sizes. BAG MASK VENTILATION TECHNIQUE
Common sizes are infant (small), child (2 RESCUERS)
(medium), and adult (large). The mask should
extend from the bridge of the nose to the cleft of When 3 or more rescuers are present, 2 rescuers can
the chin. It should cover the nose and mouth but provide more effective bag-mask ventilation than 1
not compress the eyes. The mask contains a rescuer. When 2 rescuers use the bag-mask device, 1
cup that should provide an airtight seal. If the rescuer opens the airway with a head tilt-chin lift (or jaw
seal is not airtight, ventilation will be ineffective. thrust) and holds the mask to the face while the other
❖ All BLS providers should be able to use a rescuer squeezes the bag. The first rescuer uses both
bag-mask device. Proficiency in the bag-mask hands to seal the mask to the patient’s face and lift the
ventilation technique requires practice. During jaw. The thumbs and index fingers of each hand form a
CPR, 2 rescuers are recommended to deliver “C” to seal the mask against the face. The 3 remaining
effective ventilation. One rescuer opens the fingers of each hand form an “E”, lifting both sides of the
airway and seals the mask against the face, jaw into the mask. The rescuer should be careful not to
while the other squeezes the bag. press too hard on the mask, because that could push the
patient’s jaw down and block the airway.

VENTILATION
TECHNIQUES
VENTILATION TECHNIQUES
Follow these steps to open the airway with a head
tilt-chin lift and use a bag-mask device to give breaths to Techniques for giving breaths without a barrier
the victim: device
1. Position yourself directly above the victim’s
head. Mouth-to-mouth Breathing for Adults and Children
2. Place the mask on the victim’s face, using the 1. Hold the victim's airway open with head tilt-chin
bridge of the nose as a guide for correct lift
position. 2. Pinch the nose closed with your thumb and
3. Use the E-clamp technique to hold the mask in index finger (using one hand on the forehead)
place while you lift the jaw to hold the airway 3. Take a regular(not deep) breath and seal your
open. lips around the victim’s mouth, creating at air
➔ Perform a head tilt tight
➔ Place the mask on the face with the 4. Deliver one breath over 1 second. Watch for the
narrow portion at the bridge of the nose. chest rise as you give the breath.
➔ Use the thumb and index finger of one 5. If the chest does not rise, repeat head tilt-chin
hand to make a “C” on the side of the lift.
mask, pressing the edges of the mask to 6. Give a second breath (blow for about 1 sec).
the face. Watch for the chest rise.
➔ Use the remaining fingers to lift the 7. If you are unable to ventilate the victim after 2
angles of the jaw (3 fingers form an “E”), attempts, promptly return to the chest
open the airway, and press the face to compression.
the mask.
4. Squeeze the bag to give breaths (1 second
each) while watching for chest rise. Deliver each Mouth to
breath over 1 second, whether or not you use mouth
breaths
your supplementary oxygen.

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Breathing techniques for infants
1. Mouth-to-mouth
● Maintain a head tilt-chin lift to keep the
airway open.
● Pinch the victim’s nose tightly with
thumb and forefinger.
● Make a mouth-to-mouth seal.
● Deliver each mouth-to mouth breath,
making sure the chest rises with each
breath.
● If the chest does not rise, repeat the
RESPIRATORY ARREST
head tilt-chin lift to reopen the airway
and try to makes the chest rise. It may
● Respiratory Arrest occurs when the normal
be necessary to move the infant’s head
breathing stops, preventing essential oxygen
through a range of positions to provide
supply and carbon dioxide exchange. Lack of
effective breaths. When the airway is
Oxygen to the brain eventually causes a person
open, give breaths that make the chest
to become unresponsive.
rise.
● If not treated immediately, this can result in brain
injury, cardiac arrest, and death.
2. Mouth-to-mouth-and-nose
● Respiratory Arrest can be identified when the
● Maintain a head tilt-chin lift to keep the
victim is found to be unresponsive or only
airway open.
gasping, but still has a pulse.
● Place your mouth over the infant’s
mouth and nose and create an airtight
RESCUE BREATHING
seal.
● Blow into the infant’s nose and mouth
Rescue breathing is giving breaths to an unresponsive
(pausing to inhale between breaths),
victim who has a pulse but is not breathing.
just enough to make the chest rise with
Note:
each breath.
● Give each breath over one second.
● If the chest does not rise, repeat the
● Each breath should result in visible chest rise.
head tilt-chin lift to reopen the airway
● Check the pulse about every 2 minutes.
and try to makes the chest rise. It may
be necessary to move the infant’s head
through a range of positions to provide ADULT CHILD/INFANT
effective breaths. When the airway is
open, give breaths that make the chest Give 1 breath, every 6 Give 1 breath every 2 to 3
seconds (10 breaths/min) seconds (20-30
rise.
breaths/min

● Give each breath in 1 second

● Each breath should result in visible chest rise.
● Check the pulse about every 2 minutes
COMPARISON OF COMPRESSION TO VENTILATION
RATIO DURING CPR WITH OR WITHOUT ADVANCED RISK OF GASTRIC INFLATION
AIRWAY
If you give breaths too quickly or with too much force,
air is likely to enter the stomach rather than the lungs.
This can cause gastric inflation(filling of the stomach with
air).
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To reduce risk of gastric inflation:
1. Deliver each breath over 1 second
2. Deliver just enough air to make the victim’s
chest rise

BLS
ALGORITHM

ADULT BLS - SINGLE RESCUER

1. Verify Scene is safe for you and the victim. You

don’t want to become a victim yourself.
2. Check for responsiveness. Tap the victim’s
shoulder and shout, “Are you OK?”
3. If the victim is not responsive, shout for nearby
help.
4. Activate the emergency response system via
mobile device (if possible)
● Hospital: activate specific hospital
code, mechanical emergency team or
rapid response team
● Prehospital: Activating EMS,
Paramedics, Medic units or ACLS
calling back for backup
● Workplace/Facility: Calling for local
emergency number or activating specific
workplace emergency response
protocol.
5. If you are alone get the AED/defibrillator and
emergency equipment. If someone else
available, send that person to get it.
6. Assess for Breathing and Pulse
● Palpate carotid artery (locate the
trachea, slide 2-3 fingers into the groove
between the trachea and muscles at the
side of the neck)
● Scan victim’s chest for rise and fall while
you feel for a pulse (at least 5 but no
more than 10 seconds)
A. If the victim is breathing normally and a pulse is
present.
➔ Monitor the victim.
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 B. If the victim is not breathing normally, but a pulse ● The first rescuer assesses the victim and, if not
is present mobile phone is available, sends the second
➔ Open the airway by Head tilt-chin lift, rescuer to activate the emergency response
Jaw thrust (if head and neck injury is system and retrieve the AED and emergency
suspected) equipment.
➔ Deliver each breath over 1 second Assess for Breathing and Pulse
➔ Deliver just enough air to make the ● Palpate carotid artery (locate the
victim’s chest rise trachea, slide 2-3 fingers into the groove
➔ Provide rescue breathing every 6 secs between the trachea and muscles at the
per minute (10 breaths/min side of the neck
➢ Confirm that the emergency ● Scan victim’s chest for rise and fall while
response system has been you feel for a pulse (at least 5 but no
activated more than 10 seconds)
➢ Continue rescue breathing and ● If the victim is not breathing normally or
check pulse about every 2 is only gasping and has no pulse,
minutes. Be ready to perform immediately do the following.
high-quality CPR if you do not Begins high-quality CPR, starting with chest
feel the pulse. compressions. Remove or move the clothing
➢ If opioid use is suspected, covering the victim’s chest so that you can
consider naloxone if available locate appropriate hand placement for
and follow your local protocols compression. This will also allow placement of
7. Begins high-quality CPR, starting with chest AED pads when AED arrives.
compressions. Remove or move the clothing covering ● 2 hands on the lower half of breastbone
the victim’s chest so that you can locate appropriate (sternum)
hand or finger placement for compression. This will also ● Compress at a rate of 100-120/min
allow placement of AED pads when AED arrives. ● Compress the chest at least 5 cm (2
● 2 hands on the lower half of breastbone inches)
(sternum) ● Allow chest recoilMinimize interruptions
● Compress at a rate of 100-120/min in compressions
● Compress the chest at least 5 cm (2 inches) ● Use 30:2 ventilation compression ratio
● Allow chest recoil When second rescuer returns:
● Minimize interruptions in compressions ● Open the airway using Head tilt-chin-lift
● Use 30:2 ventilation compression ratio or Jaw thrust (if head or neck injury is
suspected)
8. Attempt Defibrillation with AED ● Deliver each breath over 1 second
● Use AED as soon as it is available (Power on, ● Deliver breath just enough to make the
Attached pads, Clear, Analyze, deliver Shock if victim’s chest rise
advised) ● Use compression-to-ventilation ratio of
30:2
9. Resume High-quality CPR ● Rescuers should switch compressors
● After shock delivery or no shock advised, about every 5 cycles or 2 minutes
immediately resume high quality CPR, starting (earlier if needed)
with chest compressions when advised by AED. ● If opioid use is suspected, consider
naloxone if available and follow your
ADULT BLS - 2 RESCUER local protocols
Attempt Defibrillation with AED
Verify Scene is safe for you and the victim. You ● Use AED as soon as it is available
don’t want to become a victim yourself. (Power on, Attached pads, Clear,
Check for responsiveness. Tap the victim’s Analyze, deliver Shock if advised)
shoulder and shout, “Are you OK?” Resume High-quality CPR
If the victim is not responsive: ● After shock delivery or no shock
advised, immediately resume high
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 quality CPR, starting with chest activating specific workplace
compressions when advised by AED. emergency response protocol.

BLS FOR INFANTS AND CHILDREN 4. Assess for Breathing and Pulse
● Infant: Brachial pulse - place 2-3 fingers
Infants are less than 1 year of age (excluding the newly on the inside of the upper arm, midway
born). between the infant elbow and shoulder.
● Child: Carotid- Palpate carotid artery
Children are from 1 year of age to puberty. (locate the trachea, slide 2-3 fingers into
● Signs of Puberty include chest or underarm hair the groove between the trachea and
for males and any breast development in muscles at the side of the neck)
females. ● Child: Femoral: place 2 fingers in the
inner thigh, midway between the
hipbone and just below the crease
where the legs meets the torso
➔ Scan for victim’s chest rise and
fall, while you feel for a pulse (at
least 5 but no more than 10
seconds)
If the victim is breathing normally and a
pulse is present
➔ Monitor the victim.
If the victim is not breathing normally, but a
pulse is present
➔ Provide rescue breathing
➔ Open airway head tilt-chin-lift or jaw
thrust (if head or neck injury is
suspected)
➔ Give 1 breath over 1 second, just
enough to make chest rise, every 2-3
seconds (20-30 breaths/min)
➔ Add compressions if pulse remains
60/min or less with signs of poor
PEDIATRIC BLS - SINGLE RESCUER perfusion (cool extremities, decrease in
responsiveness, weak pulses, paleness,
1. Verify Scene is safe for you and the victim. You mottling and cyanosis)
don’t want to become a victim yourself. ➔ Confirm that the emergency response
2. Check for responsiveness. Tap the child’s system has been activated
shoulder or the heel of the infant’s foot and ➔ Continue rescue breathing and check
shout, “Are you OK?” pulse about every 2 minutes. Be ready
3. If the victim is not responsive, shout for near by to perform high-quality CPR if you do
help. Activate the emergency response system not feel the pulse or if there is a heart
via mobile device (if possible) and get rate less than 60/min with signs of poor
AED/defibrillator. perfusion.
● Hospital: activate specific hospital If the victim is not breathing normally or is
code, mechanical emergency team or only gasping and has no pulse
rapid response team If you are alone and the arrest was sudden and
● Prehospital: Activating EMS, witnessed:
Paramedics, Medic units or ACLS ➔ Leave the victim to activate the
calling back for backup emergency response system in your
○ Workplace/Facility: Calling for setting. For example, call your local
local emergency number or emergency number from your phone,
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 mobilize the code team, or notify PEDIATRIC BLS - 2 RESCUER SEQUENCE
advanced life support
➔ Get the AED and emergency 1. Verify Scene is safe for you and the victim. You
equipment. If someone is available, don’t want to become a victim yourself.
send that person to get it. 2. Check for responsiveness. Tap the child’s
If you are alone and the arrest was not shoulder or the heel of the infant’s foot and
sudden and unwitnessed: shout, “Are you OK?”
➔ Continue the next step: Begin 3. If the victim is not responsive:
High-quality CPR for 2 minutes. ● The first rescuer initiate the resuscitation
5. Begin High-Quality CPR, starting with chest attempt.
compressions ● The second rescuer . Activate the
● Infant: 2-finger chest compressions (2 emergency response system and
fingers at the center of the chest, just retrieve the AED and emergency
below the nipple line) equipment, and returns to the victim to
● Child: 1 or 2 hands (whatever is needed help in CPR and the use of AED.
to provide compressions of adequate 4. Assess for Breathing and Pulse
depth) on the lower half of the Infant: Brachial pulse - place 2-3 fingers
breastbone (sternum) on the inside of the upper arm, midway
● Compress at a rate of 100 to 120/min. between the infant elbow and shoulder
● At least one third the AP diameter of the Child: Carotid- Palpate carotid artery
chest or about 4cm (locate the trachea, slide 2-3 fingers into
● Allow the chest to recoil (re expand) the groove between the trachea and
Chest compression/relaxation time muscles at the side of the neck)
should be about equal. Child: Femoral: place 2 fingers in the
● Minimize interruptions in compressions. inner thigh, midway between the
6. Attempt Defibrillation with AED hipbone and just below the crease
● Use AED as soon as it is available where the legs meets the torso
7. Resume High-quality CPR ➔ Scan for victim’s chest rise and
● After shock delivery or no shock fall, while you feel for a pulse (at
advised, immediately resume high least 5 but no more than 10
quality CPR, starting with chest seconds)
compressions when advised by AED. a. If the victim is breathing normally and a pulse is
present
● Monitor the victim
b. If the victim is not breathing normally, but a pulse
is present
Provide rescue breathing
Open airway head tilt-chin-lift or jaw
thrust (if head or neck injury is
suspected)
Give 1 breath over 1 second, just
enough to make chest rise, every 2-3
seconds (20-30 breaths/min)
Add compressions if pulse remains
60/min or less with signs of poor
perfusion (cool extremities, decrease in
responsiveness, weak pulses, paleness,
mottling and cyanosis)
➔ Confirm that the emergency
response system has been
activated

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 ➔ Continue rescue breathing and
check pulse about every 2
minutes. Be ready to perform
high-quality CPR if you do not
feel the pulse or if there is a
heart rate less than 60/min with
signs of poor perfusion.
c. If the victim is not breathing normally or is only
gasping and has no pulse :
The first rescuer
5. Begins high-quality CPR, starting with chest
compressions. Remove or move the clothing
covering the victims chest so that you can locate
appropriate hand or finger placement for
compression. This will also allow placement of
AED pads when AED arrives.
● For infant, use the 2 finger technique,
until the second rescuer returns to
provide 2-rescuer CPR, use 2
thumb-encircling technique (just below
the nipple line)
● For Child, use 1 or 2 hands on the lower
half of the breastbone

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