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www.nursesed.net

NEO Orange County

3303 Harbor Blvd., Suite G3

Costa Mesa, CA 92626

(714) 979-4022

NEO San Diego 10379 Azuaga St, Suite 143

San Diego, CA 92129

(858) 780-2829

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Agenda

Nurses Educational Opportunities provides BLS classes

Monday through Saturday each week. An appointment is required

and can be obtained by calling the office in San Diego or Orange

County. At the designated appointment time you will be asked to

watch a video, take the written test, and demonstrate skills.

This First Responder prestudy guide in conjunction with

the American Heart Association (AHA) Basic Life Support Text

will nicely prepare you for your upcoming class. You must have

the new 2010 AHA BLS textbook at the time of the class. This

text book is available for an additional charge in both offices. The

text book can be shipped to you.

An American Heart Association provider card will be

presented to you at the completion of the class.

Recertification courses require presentation of your recent

BLS provider card. A copy of that will also be accepted if you do

not have the original.

Lay rescuers may provide Hands-Only CPR™ (chest

compressions only) once the recognition of unresponsiveness is

acknowledged and after 911 is notified. Lay rescuers are not

required to check the victims pulse, open the airway or give rescue

breaths. (2010 Update)

Healthcare Professionals should be trained BLS with the

2010 AHA updates which are described in NEO’s First Responder

study guide.

Recognition of signs and symptoms for the following life

threatening situations is imperative to know:

Acute Coronary Syndrome (Heart attack)

Acute Cerebral Vascular Accident (Stroke)

Foreign Body Airway Obstruction

Cardiac Arrest

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Objectives

At the end of the course the participant will be able to demonstrate

the BLS 2010 updated skills using the adult, child, and

infant manikins. They are as follows:

Describe the links in the AHA Chain of Survival, including

♥♥♥♥♥♥♥♥ Early recognition of the need for BLS

♥♥♥♥♥♥♥♥ Activating emergency response

♥♥♥♥♥♥♥♥ Performing BLS starting with Chest Compressions

♥♥♥♥♥♥♥♥ Early defibrillation with the AED or manual defibrillator

Describe the steps of CPR

♥♥♥♥♥♥♥♥ Recognition

♥♥♥♥♥♥♥♥ In less than 10 seconds, check the pulse

♥♥♥♥♥♥♥♥ Immediate High Quality Chest Compression

Push Hard

Push Fast

Allow the chest to recoil

Minimize interruptions

♥♥♥♥♥♥♥♥ Open the airway and provide ventilations 3

Describe the signs and symptoms of 4 major emergencies in adults

♥♥♥♥♥♥♥♥ Heart attack (ACS)

♥♥♥♥♥♥♥♥ Stroke (ACVA)

♥♥♥♥♥♥♥♥ Cardiac arrest

♥♥♥♥♥♥♥♥ Foreign-Body Airway Obstruction

In addition, the participant will be able to demonstrate the

following skills using an adult, infant, or child manikin

♥♥♥♥♥♥♥♥ Rescue breathing

Mouth-to-mouth

Mouth-to-mask

Bag-mask: adult, child, infant

♥♥♥♥♥♥♥♥ Use of an AED for adults as well as children

♥♥♥♥♥♥♥♥ Relief of FBAO in the responsive and unresponsive victim

of any age.

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Adult Basic Life Support Team Resuscitation

The steps of BLS have traditionally been presented as a sequence

for the single rescuer. There is increased focus on providing CPR

as a team because resuscitation in most EMS and healthcare

systems involve teams of resuscitators with rescuers performing

several actions simultaneously. (2010 Update)

Recognition:

The first rescuer who arrives at the side of the victim

must quickly be sure that the scene is safe. You don’t

want to become a victim yourself.

Check for response

Tap and shout “are you alright.”

Scan chest for movement (2010 Update)

The victim that is unresponsive with no breathing

and/or only gasping, you must immediately

activate the EMS and immediately start chest

compressions. When you check for breathing, you must assess quickly.

We no longer open the airway with the head-tilt,

chin-lift. We no longer check for the rise and fall of

the chest. This takes to long. (2010 Update)

For the victim that is unresponsive and breathing activate

the EMS and continue monitoring the victim for

cessation of breathing until EMS arrives.

Activate the EMS

Activate the EMS and call for an AED

Remember, you have a team. One of your first

responders can call for EMS and/or retrieve the

AED.(2010 Update)

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Check the carotid pulse

When you check for pulse, you must take less than 10

seconds to assess. Anything greater than 10 seconds

takes to long and prolongs initiation of chest

compressions. (2010 Update)

The key is to keep the blood circulating and minimize

interruptions (2010 Update)

Do not spend more than 10 sec. checking for a pulse

If you find a pulse, support the victim with rescue

breathing

If you can’t get a pulse within 10 seconds, initiate

CPR starting with 30 chest compressions

followed by 2 breaths (2010 Update)

Immediately!!! Place your hands in the lower half of the breast

bone of the chest and begin chest compressions (2010 Update)

♥♥♥♥♥♥♥♥ Push hard – at least 2 inches in depth for the adult.

♥♥♥♥♥♥♥♥ Push fast – at a rate of at least 100 X minute. When

reading the questions on the test, be careful. Look for

the word “rate”. That must alert you to the answer of

100X min.

♥♥♥♥♥♥♥♥ Allow the chest to fully recoil

♥♥♥♥♥♥♥♥ Minimize interruptions

♥♥♥♥♥♥♥♥ One-man and two-man adult CPR compression to

ventilation ratio should be 30:2

♥♥♥♥♥♥♥♥ Provide ventilations

Open the airway – head tilt, chin lift or jaw thrust

Seal your mouth over the victims mouth and give

two rescue breaths – just enough to make the

chest rise and fall

The healthcare provider should use the barrier device

for one-man CPR

Two healthcare provider should ventilate using the

bag/mask

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With advanced airway in place, compression rate

remains at 100 X min with one breath every 6-8

sec.

When the AED or Crash Cart arrives, connect the

device to the victim as soon as possible. The

probability of successful defibrillation

diminishes rapidly over time.

After the AED delivers a shock, immediately restart

CPR beginning with chest compressions.

When the AED or Crash Cart arrives

♥♥♥♥♥♥♥♥ Place the AED at the head of the victim

♥♥♥♥♥♥♥♥ Power on the AED – That means you “turn it on”

♥♥♥♥♥♥♥♥ Choose the correct size pads/paddles

♥♥♥♥♥♥♥♥ Attach the pads/paddles to the chest

♥♥♥♥♥♥♥♥ Attach the electrode cable to the AED

♥♥♥♥♥♥♥♥ Clear to analyze

♥♥♥♥♥♥♥♥ If shock indicated, clear the victim and self .

♥♥♥♥♥♥♥♥ Deliver a shock. Do not touch the victim during the

“shock” or it could shock you while shocking the

victim.

♥♥♥♥♥♥♥♥ If the AED gives you a “no shock indicated” continue

BLS

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Life Threatening Emergencies

The major components of the circulatory system are the

heart, arteries and veins. The heart pumps blood to the arteries. The

arteries take the oxygenated blood to the muscles. The veins take

blood back to the heart, thus releasing carbon dioxide in the lungs.

When a person goes into cardiac arrest their circulatory system is

no longer moving oxygen via the blood through the body. When

you give a person rescue breaths you are pushing oxygen into the

lungs. When you give a person chest compressions you cause the

heart to pump so that it can move the blood in its normal path and

keep the person oxygenated. Immediate Chest Compressions are

imperative to provide a flow of oxygen-rich blood to the heart and

brain and “buys time’ until defibrillation.

The rescuer should not take the time to “open the

airway, look, listen and feel for the rise and fall the chest, and

should not provide rescue breaths.” That takes to long!!!

Immediate chest compressions are needed to keep the oxygen

rich blood pumping to the heart. Instead of AIRWAY –

BREATHING – CHEST COMPRESSIONS (ABC’S) we should

now focus on CHEST COMPESSIONS – AIRWAY –

BREATHING (CAB).(2010 Update)

The Four Life Threatening Adult Emergencies are as follows:

Cardiac Arrest

In cardiac arrest circulation ceases and vital organs

do not get enough oxygen. Therefore, the victim

will not be breathing and will not have a pulse.

Victims of early cardiac arrest will often have

agonal breathing.

Heart Attack (ACS)

This occurs when an area of the heart is deprived of

blood flow. When the blood flow to the heart

muscle is blocked for a sufficient period, the muscle

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is damaged from the inadequate oxygen supply.

The signs and symptoms may include the following:

♥♥♥♥♥♥♥♥ Sweating

♥♥♥♥♥♥♥♥ Nausea

♥♥♥♥♥♥♥♥ Vomiting

♥♥♥♥♥♥♥♥ Shortness of Breath

♥♥♥♥♥♥♥♥ Chest pain possibly radiating to the arm or jaw

♥♥♥♥♥♥♥♥ Skin that is cool, clammy

Have any victim with these symptoms sit or lie

down while you call 911.

The key issue in treating Acute Coronary Syndrome

is preventing major adverse cardiac events. (2010 Update)

Stroke (CVA)

This happens when there is a blood clot or bleeding in

the brain. Recognizing the signs and symptoms of a

stroke is critical to early intervention and treatment.

The presentation of stroke may be subtle. The signs

and symptoms are as follows:

♥♥♥♥♥♥♥♥ Headache

♥♥♥♥♥♥♥♥ Weakness

♥♥♥♥♥♥♥♥ Trouble speaking

♥♥♥♥♥♥♥♥ Hypertension, elevated blood pressure, is a

major risk factor for stroke. The best chance the

stroke victim has for survival is fibronolytic

therapy within 3 hours of onset. A non-contrast

CT-Scan is required before treatment can be

administered. A window of 3.5-4 hours has not

been approved by the U. S. Food and Drug

Administration.(2010 Update)

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Choking

♥♥♥♥♥♥♥♥ Early recognition of foreign-body airway

obstruction (FBAO), or choking, is the key to

successful outcome.

♥♥♥♥♥♥♥♥ It is important to distinguish this emergency

from fainting, stroke, heart attack, seizure, drug

overdose, or other conditions that cause sudden

respiratory failure but require different

treatment.

♥♥♥♥♥♥♥♥ An adult choking victim will not be able to

cough or talk. The choking victim will often

place one of their hands on their neck/throat.

This is the universal sign for choking. If the

responsive adult is choking, ask if they are

choking. If they nod “yes” immediately

perform as many abdominal thrusts to remove

the obstruction.

♥♥♥♥♥♥♥♥ If the adult becomes unresponsive and the

foreign body has not been removed by

abdominal thrust, gently support the

unresponsive victim to the ground, call 911

immediately, begin chest compressions for 2

minutes or until the foreign body is forced out.

♥♥♥♥♥♥♥♥ After 2 minutes of chest compressions open the

airway, if you can see the foreign body remove

it and give 2 rescue breaths followed by 30

compressions until the victim becomes

responsive or 911 arrives.

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Infant and Child Basic Life Support Team Resuscitation

Many key issues in pediatric BLS are the same as adult BLS

Keep in mind it is a “Team Effort” for the child as well as in the

adult.

Children are consider 1-12 years of age

Infants are considered <1 year of age

Recognition:

Check for scene safety

Check for response

Tap and shout “are you alright.”

Scan chest for movement. (2010 Update)

The victim that is unresponsive with no breathing and a

heart rate less than 60 bpm, you must

immediately activate the EMS and start both

chest compressions and breaths (2010 Update)

When you check for breathing, you must assess quickly.

We no longer open the airway with the head-tilt,

chin-lift. We no longer check for the rise and fall of

the chest. This takes too long. . (2010 Update)

When you check for pulse, you must take less than 10

seconds to assess. Anything greater than 10 seconds

takes to long, and prolongs the initiation of chest

compressions.(2010 Update)

The key is to keep the blood circulating and minimize

interruptions.

Activate the EMS

Activate the EMS and call for an AED

Remember, you have a team. One of your first

responders can call for the AED or the EMS.

Check a carotid or femoral pulse if the child is >1 y/o

Check for a brachial pulse if the child is <1y/o

Do not spend more than 10 seconds checking for

a pulse. (2010 Update)

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If a pulse cannot be detected, or is less than 60 bpm,

healthcare providers should begin CPR. A heart rate

less than 60 bpm is an ominous sign. (2010 Update)

If the child has a heart rate greater than 60 and is

not breathing the healthcare provider must give

breaths without chest compressions. . (2010 Update)

If you can’t get adequate pulse within 10 seconds,

initiate BLS starting with 30 chest compressions

followed by 2 breaths. (2010 Update)

♥♥♥♥♥♥♥♥ Immediately!! Place your hands on the lower half of

the breastbone.

♥♥♥♥♥♥♥♥ Push hard - for the child

at least one third the anterior to posterior of the

chest approximately 2 inches in depth

for the infant, at least one third the anterior to

posterior depth of the chest

approximately 1 ½ inches.

♥♥♥♥♥♥♥♥ Push fast – at a rate of at least 100 X minute. (2010 Update)

♥♥♥♥♥♥♥♥ Allow the chest to fully recoil

♥♥♥♥♥♥♥♥ Minimize interruptions

♥♥♥♥♥♥♥♥ One-man CPR the compression to ventilation ratio

should be 30:2

♥♥♥♥♥♥♥♥ Two-man CPR the compression to ventilation ratio

for the child and the infant should be 15:2.

♥♥♥♥♥♥♥♥ Compressions for a child can be accomplished using

one hand or two hands, depending on the size of

the child to accomplish the appropriate depth.

♥♥♥♥♥♥♥♥ Compressions for an infant can be accomplished

using 2-finger or 2-thumb encircling technique

(which produces better blood flow).

Provide ventilations

Open the airway – head tilt-chin lift, or jaw thrust

Give two rescue breaths – just enough to make the

chest rise and fall.

The healthcare provider should use the barrier

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device for one-man CPR

Two healthcare providers should use the bag/mask

to ventilate.

Ventilation with bag/mask should be 1 breath every

3-5 seconds.

As soon as possible, connect an AED or defibrillator.

If indicated deliver a shock.

For infants, a manual defibrillator is preferred over an

AED. (2010 Update)

If using an AED for a child , a pediatric dose attenuator is

preferred. . (2010 Update)

If neither is available an AED without a pediatric dose

may be used. . (2010 Update)

When the AED or Crash Cart arrives

♥♥♥♥♥♥♥♥ Place the AED at the head of the victim

♥♥♥♥♥♥♥♥ Power on the AED (that means you turn it on)

♥♥♥♥♥♥♥♥ Choose the correct size pads or paddles

♥♥♥♥♥♥♥♥ Attach the pads or paddles to the chest

♥♥♥♥♥♥♥♥ Attach the electrode cable to the AED

♥♥♥♥♥♥♥♥ If shock indicated, clear the victim and yourself .

♥♥♥♥♥♥♥♥ Deliver a shock. Do not touch the victim during the

“shock” or it could shock you while shocking the

victim.

♥♥♥♥♥♥♥♥ Return to CPR beginning with Chest Compressions

♥♥♥♥♥♥♥♥ You may reanalyze with pulse checks in 2 minutes (5

cycles) of CPR

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Many healthcare providers will argue that ventilation is

more important than chest compressions for the child because of

the frequency of respiratory distress leading to respiratory arrest.

This proposed major change in CPR sequencing to

compressions before ventilations (C-A-B) led to vigorous debate

among experts in pediatric resuscitation. Because most pediatric

cardiac arrest are asphyxial, rather than sudden primary cardiac

arrest, both intuition and clinical data support the need for

ventilations and compressions for pediatric CPR.

However, pediatric cardiac arrests are much less common

than adult sudden cardiac arrest, and many rescuers do nothing

because they are uncertain or confused. Most pediatric cardiac

arrest victims do not receive any bystander CPR so any strategy

that improves the likelihood of bystander action may save lives.

Therefore, the C-A-B approach for victims of all ages was adopted

with the hope of improving the chance that bystander CPR may be

performed.

Lay Rescuer: Hands-Only CPR (2010 Update)

(High-quality Compressions-Only)

Push Hard

Push Fast

Allow the Chest to Recoil

DO NOT check the pulse.

DO NOT open the airway.

DO NOT give rescue breaths.

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Choking

Choking/foreign body obstruction:

♥♥♥♥♥♥♥♥ If victim is choking and still moving air encourage him to

cough

♥♥♥♥♥♥♥♥ When air exchange becomes poor and cough less effective

and the victim is making high pitched noises and has

bluish skin the victim has severe or complete airway

obstruction with inadequate air exchange.

♥♥♥♥♥♥♥♥ Place your fist halfway between bellybutton and sternum

The best way to relieve a foreign body obstruction

is abdominal thrust, formerly referred to as the

Heimlich

Push up and inward.

Do as many as it takes to relieve the FBAO

♥♥♥♥♥♥♥♥ When victim looses consciousness the rescuer should

send someone to activate the EMS and start CPR

beginning with chest compressions

Check the pulse within 10 sec

If there is no pulse for the adult or a pulse of less than

60 for the child begin chest compressions (30:2).

Open the airway (head-tilt chin-lift) and try to ventilate

Do not perform finger sweeps to remove any foreign

object that you cannot see. If you can see the

foreign object you may attempt to remove it.

Never do a blind finger sweep on a child. It may push

the object back into the throat.

Always do 5 cycles of CPR before calling 911 for the

child or infant.

♥ If unable to ventilate, begin chest compressions.

When possible always use a barrier device to avoid

communicable diseases

♥ Hospital = bag/mask

♥ Field = shield

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Team Resuscitation of Basic Life Support

for

Adult, Child and Infant

Instructor Presentation and Skills

1. Check for Scene Safety *

2. Check for responsiveness

3. Activate the EMS/AED

4. Check the carotid pulse

Do not take more than 10 seconds to check the pulse*

Provide High Quality CPR

Push hard to create blood flow during compressions*

Push Fast at a rate of 100X min*

Allow the chest to recoil

Minimize interruptions

Compress the lower half of the breastbone!!!*

Provide Effective Ventilation

Give 2 slow easy breaths – just enough to see the chest rise

and fall.

Even Infants!!!!

Give 1 breath every 3-5 seconds*

After the advanced airway is in place – give one breath every 6-8

sec*

5. When AED arrives

Turn it on*

Attach appropriate size pads

Clear to analyze

Clear to shock

If indicated - deliver shock

Return to chest compressions*

If “no shock advised”

Return to chest compression*

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Adult

One Man Two Man

30:2* 30:2*

Depth=2 in* Depth=2 in*

Ventilate with Ventilate with

barrier device* Bag/Mask*

During 2 rescuer CPR the second rescuer must maintain

and open airway and give ventilation*

Child (one year to puberty)

One Man Two Man

30:2* 15:2*

Depth

Compress 1 ½

-2 in. or One third the depth of the chest*

Ventilate with Ventilate with

Barrier device* Bag/Mask*

Heart rate less than 60 bpm is an ominous sign – Begin CPR*

*If you have child with a pulse but not breathing – provide breaths

without chest compressions*

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Infant (birth to one year)

One Man Two Man

30:2* 15:2*

Depth

Compress at least=1 1/2 in or One third the depth of the chest*

Ventilate with Ventilate with

barrier device* Bag/Mask*

Heart rate less than 60 bpm is an ominus sign –

Begin CPR*

Use the 2-thumb encircling and technique for greater

Intrathorasic pressure*

Foreign Body Airway Obstruction (FBOA)

1. Encourage Coughing

2. When the victim becomes stridorous and unable to move air –

begin abdominal thrust (formerly called the Heimlich

Maneuver)

Do as many as it takes to get the obstruction out.

3. When the victim becomes unresponsive – begin CPR starting

with chest compression.*

Remember when we use to straddle the victim? We don’t do that

anymore. Thank God!!!

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Skills Practice

Adult CPR

You’re in the hospital and you see a man lying on the floor as you

round the corner headed to the pharmacy. What do you do?

________Check for scene safety

________ Check for response

________Tap and shout “Are you alright”

________Scan chest for movement. (2010 Update)

He’s not breathing. What do you do?

________Initiate someone to activate the EMS and get the AED

________Check for pulse within 10 seconds

________ Start Chest Compressions

________ Demonstrate your high quality chest compressions

What is your next step in resuscitation?

_________Open the airway

_________Give 2 rescue breaths

_________Demonstrate ventilation with Barrier Device

_________Demonstrate ventilation with Bag/Mask

The AED has arrived. What do you want the second responder to

do?

________ Open AED and Turn it on

________Attach Pads

________Clear to Analyze

________Clear to Shock

________Shock if indicated

________Continue chest compressions (30:2).

In 2 minutes (5 cycles), you reanalyze. There is a pulse. What do

you do?

_______Check breathing. Support breathing until advanced help.

_______ Place in the recovery position.

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Adult Choking

You are at a restaurant and the woman at the table next to you

stands up holding her throat. What do you do?

_________Encourage coughing

She then becomes stridorous and unable to move air. What do you

do?

__________Provide abdominal thrust.

She then becomes unresponsive. What do you do?

________Initiate someone to activate the EMS and get the AED

________Check for pulse within 10 seconds. If not pulse, begin

CPR starting with chest compressions.*

Child CPR

You are at the soccer field, watching children play on the field.

Suddenly, a child collapsed on the ground. He doesn’t appear to be

moving. What do you do?

_________Check for scene safety

________ Check for response

________Tap and shout “Are you alright”

________Scan chest for movement. (2010 Update)

He’s not breathing. What do you do?

________Initiate someone to activate the EMS and get the AED

________Check for pulse within 10 seconds

________ Start Chest Compressions

________ Demonstrate your high quality chest compressions

What is your next step in resuscitation?

_________Open the airway

_________Give 2 rescue breaths

_________Demonstrate ventilation with Barrier Device

_________Demonstrate ventilation with Bag/Mask

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The AED has arrived. What do you want the second responder to

do?

________ Open AED and Turn it on

________Attach Child Pads

________Clear to Analyze

________Clear to Shock

________Shock if indicated

________Continue chest compressions (15:2).

In 2 minutes (5 cycles), you reanalyze. There is a pulse. What do

you do?

_______Check breathing. Support breathing until advanced help.

_______ Place in the recovery position.

Child Choking

You are at a child’s soccer field and you find a child choking.

What do you do?

___________ Pat him/her on the back and encourage him to cough

He/She then becomes stridorous and unable to move air. What do

you do?

__________Provide abdominal thrust.

He/She then becomes unresponsive. What do you do?

__________Initiate someone to call EMS.

__________Check the mouth for FBO and begin CPR starting

with chest compressions.

Infant Choking

You are in the hospital, and you see a baby choking in his mother’s

arms. She is panicked, and does not know what to do. What should

you do?

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_______ Hold the baby face down, support the head and neck.

_______ Give 5 back slaps.

_______ Turn the baby, with the chest facing up, support the head.

________Give 5 chest thrusts.

The baby can’t cough out the object, and becomes unresponsive.

What do you do?

_______ Call for help. Call the Code.

_______ Check the pulse. If no pulse, start 30 chest compressions.

_______ Give 2 ventilations with a barrier device.

A nurse comes to the rescue! Now it’s both of you doing CPR on

this baby. How many compresisons : ventilations do you do?

_______15:2 for 2-rescuer CPR for the infant.

Infant CPR You are babysitting your neighbor’s 6 month old daughter when

you notice that she is no longer breathing. What should you do?

_________ Check for responsiveness

_________ Tap and Shout “Are you alright?”

__________Scan chest for movement. (2010 Update)

Baby’s not breathing and no signs of circulation. What do you do

if you’re a healthcare provider?

_________ Call out for someone to activate EMS

__________Check for pulse within 10 seconds

_________ Start Chest Compressions

What is your next step in resuscitation?

__________Give 2 rescue breaths

The AED has arrived. What do you do now?

________ Open AED and power up

________Attach Pads

________Follow prompts

________Continue with chest compressions.

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Notes

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The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and

PALS and has developed instructional materials for this purpose. Use of these materials in an

educational course does not represent course sponsorship by the American Heart Association. Any

fees charged for such a course, except for a portion of fees needed for AHA course material, do not

represent income to the Association.