BLS Study Guide

Chapter 7: One Rescuer Adult CPR

If you are alone and come across an unresponsive victim, follow the steps below:

Step 1: Check for consciousness. To check for consciousness, tap on the victim's shoulder firmly and ask, "Are you OK?" loudly.

Step 2: Call 911 or ask someone else to call before performing CPR. Even if you perform CPR on the spot, getting paramedics to the scene as quickly as possible is crucial. If possible, ask a bystander to look for an AED.

Step 3: Check for breathing and open the airway. Check the breathing for about 10 seconds. If the breathing is normal, put the victim in the recovery position and wait for the responders to arrive. If you do not hear breathing or the victim has abnormal breathing, begin CPR immediately.

Step 4: Begin CPR Place the victim on their back on a firm, flat surface. Alternate between 30 chest compressions and two rescue breaths, with 2 inches of compression depth at a rate of 100-120 compressions per minute. Blow until the chest rises.

Step 5: Use AED if available If an AED is available, a bystander in a public place or a family member can use it to deliver an electric shock to the heart to restore regular rhythm.

Chapter 8: 2-Rescuer CPR for Adult

If you encounter an unconscious victim and another rescuer is available to help, ask them to call 911 and find an AED while assessing whether the victim needs high-quality CPR. If the victim requires CPR, start with compressions.

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How to perform CPR when there are two rescuers present?

Step 1: Check for consciousness.Tap the victim's shoulder and ask if they are okay. If the victim is not breathing, gasping (agonal breathing, or has abnormal breathing, stay with the victim.

Step 2: Call 911. Rescuer 2 will call 911 and leaves to retrieve an AED.

Step 3: Check for breathing and pulse. Rescuer 1 checks for a pulse. If there's no pulse, the rescuer will begin CPR, starting with chest compressions.

Step 4: Begin CPR Rescuer 1 will give chest compressions and rescue breaths until Rescuer 2 returns with an AED.

Step 5: Use an AED

• When the 2nd rescuer arrives with an AED, place it on the side opposite Rescuer 1, who is performing CPR.
• Rescuer 2 will turn on the AED and attaches the pads to the victim's chest. Rescuer 1 will continue CPR until it is time to analyze the heart rhythm.
• Rescuer 2 clears the victim, ensuring neither rescuer touches the victim and waits for the AED to analyze.
• Rescuer 2 will push the SHOCK button if a shock is indicated.
• If no shock is needed, rescuer 2 will resume chest compressions.
• During analysis, Rescuer 2 and Rescuer 1 should switch positions to prevent rescuer fatigue and ensure that rescuers provide high-quality chest compressions at the proper rate and depth.

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When the second rescuer returns without an AED:

• Continue performing chest compressions and count the compressions aloud.
• Rescuer 2 must keep the victim's airway open to give 2 rescue breaths after every 30 compressions.
• Rescuers should switch positions every two minutes to avoid fatigue.

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Chapter 9: One-Rescuer Child CPR

If you are the only person available to help a child, do the following:

1. Check for responsiveness. Check the child's responsiveness by shaking their shoulders, calling their name, and asking if they are okay. Check for breathing. If there is no breathing or the child is just gasping, call 911
2. Activate EMS. If you see the child’s collapse, leave the victim to call 911 and retrieve an AED. If you did not witness the child collapse, give 2 minutes of CPR then call 911 and get an AED and return to the victim to resume CPR

‍Chest compressions:

• Compression to Ventilation Ratio: 30:2
• Hand Placement for Child CPR: You can use 1 or 2 hands on the lower half of the breastbone (sternum)

• Compression Rate: 100-120 compressions per minute.
• Chest recoil: Allow a full recoil after each chest compression
• Minimizing interruptions: Limit compression interruptions to less than 10 seconds.

Rescue Breathing:

• Open the airway using the head tilt-chin lift.
• Place the bag-mask device or barrier device on the child’s face using the bridge of the nose as a guide.
• Create a proper seal to avoid the air from escaping
• Rescue breath should last 1 second, enough to make the chest rise.
• Avoid excessive ventilation
• Chest rise should appear natural and gradual rather than sudden and forceful.

3. Use the AED as soon as possible.

Chapter 10: Two-Rescuer Child CPR

When two rescuers are available to respond, the procedure of two rescuer child CPR is the same adults:

• Compression to ventilation ratio: 15:2
• Hand Placement: One or two hands may be used to compress the chest to
• Compression Depth: 2 inches deep
• Compression Rate: 100-120 compressions per minute

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Chapter 11: How to Administer CPR on Infants?

Infant CPR has many similarities with child and adult CPR, but special accommodations must be made in hand position and compression depth due to the infant's small size. When administering infant CPR, use the same cycles of compressions and rescue breaths.

• Checking for responsiveness: Do not shake the infant as it may cause brain damage. To check if the infant is responsive, tap the bottom of the feet while talking to the infant loudly.
• Activating EMS: When to call EMS depends on whether you witnessed the infant's arrest or not. If you did not witness the infant collapse and are alone, you should provide 2 minutes of CPR before calling EMS and finding an AED. If you witness the arrest, you should call EMS and get an AED before returning to the child to start CPR.
• Depth of Compression: 1 ½ inch deep or at least one-third of the depth of the infant's chest.
• Hand placement: Compressed using two fingers on the lower half of the sternum, avoiding the xiphoid process.
• Compression to ventilation: 15:2 if two rescuers are present.

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Chapter 12: What is an Automated External Defibrillator (AED)?

An AED is a mechanical device designed to assess the electrical output of a victim's heart and provide an electrical shock if needed. It is utilized when a victim experiences sudden cardiac arrest.

An AED is a mechanical device designed to assess the electrical output of a victim's heart and provide an electrical shock if needed. It is utilized when a victim experiences sudden cardiac arrest.

• Heart Rhythm: The heart's rhythm is determined by electrical impulses spontaneously generated from a certain point in the upper heart, called the sino-atrial node.
• Arrhythmias: When the electrical impulses occur too fast, the heartbeat becomes irregular. Abnormal heart rhythms are referred to as Arrhythmias.
• Ventricular fibrillation: During Ventricular fibrillation is disordered electrical activity in the ventricles. As a result, the heartbeat is completely unsynchronized, and the heart begins to quiver instead of pumping blood.
• Pulseless Ventricular Tachycardia: A type of arrhythmias when the ventricles begin to contract at an extremely fast pace. This results in inefficient pumping of blood. You won't be able to feel a pulse due to the fast pace.

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When ventricular fibrillation and pulseless ventricular tachycardia are present, the AED can "shock" the heart into regaining its normal rhythm.

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How to use an AED?

• Assess the victim for SCA.
• Immediately call 911. If more than one rescuer is present, provide CPR while the AED is retrieved and prepared.
• Once powered on, the machine will instruct the rescuer to place the electrodes (pads) over the victim's heart. If the victim has a hairy chest, shave the area that will be covered by electrode pads.
• Choose adult pads for victims who are eight years of age or older. You may use adult pads for children below eight years old, if child pads are not available but you should ensure the pads do not touch or overlap.
• A manual defibrillator is preferred in infants.
• The AED will scan the victim's heart, checking if the shock is necessary. Ensure that no one is in contact with the victim while the AED assesses the victim.
• Rescuers should follow the prompts given by the machine. AED will charge and automatically shock the victim if necessary. Ensure that no one else is touching the victim to reduce the risk of bystanders being shocked.
• Following the initial shock, the machine will reassess the victim to determine if an additional shock is necessary.
• Continue CPR when prompted.

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Chapter 13: Conscious Choking

Choking is caused when an object blocks the victim's throat or windpipe. For example, adults often choke on large pieces of food. However, children swallow small toy parts or other objects. The universal sign for choking is mimicking choking yourself. First, ask the patient if they are choking because the person is merely coughing. If the patient is unconscious, call 911 and perform CPR.

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Infants 12 months or younger

• Rest the infant on your forearm
• Perform 5 thumps with the heel of your hand upon the infant's back.
• If the patient is still choking, turn the infant over, face-up, and perform 5 chest compressions.
• Repeat the process until the object is removed.

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Children and Adults

• Stand behind the victim.
• Lean the victim slightly forward and wrap your arms around their waist.
• Press hard with a closed fist into the abdomen, then grab your fist with your other hand.
• Perform five quick abdominal thrusts.
• Repeat the cycle if the object hasn't cleared the patient's throat.

Chapter 14. Unconscious Choking

If you are helping a choking victim and they lose consciousness, do the following steps:

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For Unconscious Choking Adult or Child

1. Lower the victim to the ground
2. Begin CPR starting with chest compressions
3. Every time you open the airway to give rescue breaths, open the victim's mouth and check for the obstruction.
4. If you see the obstruction, turn the victim's head to the side and sweep it out of their mouth using your index finger.
5. Do not perform a blind finger sweep. This may push the object farther down the airway.
6. Suppose you do not see the object, attempt to provide breaths. If the chest doesn't rise, resume compressions.
7. Call 911 after five cycles of CPR
8. Check for responsiveness, normal breathing, and pulse if the obstruction is relieved.
9. Perform CPR if needed

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For unconscious choking infant

1. Call 911
2. Place the infant on a flat, firm surface.
3. Perform CPR, starting with chest compressions.
4. Each time you open the airway to give rescue breaths, open the infant's mouth and check for the obstruction.
5. If you see the obstruction, turn the infant's head to the side and sweep it out of the infant's mouth with your index finger.
6. Do not perform a blind finger sweep. This may push the object farther down the airway.
7. Suppose you do not see the object, attempt to provide breaths. If the chest doesn't rise, resume compressions.
8. Check for responsiveness, normal breathing, and pulse if the obstruction is relieved.
9. Perform CPR if needed

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Chapter 15: Recovery position

If the victim is breathing and has a pulse, put him in the recovery position while waiting for EMS to arrive. The recovery position will keep the victim's airway open, prevent the aspiration of fluids into the lungs, and allows fluid to drain from the mouth.

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How to put the victim into a recovery position:

1. Kneel beside the victim. Empty any pockets to prevent objects from pressing uncomfortably on the victim.
2. Straighten the victim's legs and place the arm closest to you at a right angle to the victim's body. The victim's hand should fall toward and parallel to the victim's head. Lift the victim's chin to open the airway.
3. Move the victim's other arm across his chest. Place the back of his hand against his opposite cheek. Pull the victim's far leg up, bending at the knee with your other hand. Keep his foot flat on the ground.
4. Continue to use one hand to hold the victim's hand against his cheek. Grasp the victim's raised knee with the other hand and gently roll the victim toward you, onto his side.
5. You may need to use your knees to prevent the victim from rolling too far forward.
6. Tilt the head back to ensure an open airway. You may need to adjust the hand under the chin or the position of the top leg. Keep the top knee and hip and right angles.

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Chapter 16: Airway Management

Airway management refers to maneuvers and medical procedures to prevent and relieve airway obstruction. Airway management ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway or preventing airway obstruction caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents.

Airway management refers to maneuvers and medical procedures to prevent and relieve airway obstruction. Airway management ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway or preventing airway obstruction caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents.

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Bag Valve Mask: A bag valve mask (BVM) or self-inflating bag is a hand-held device commonly used to provide positive pressure ventilation to a person who doesn't have normal breathing. The device requires resuscitation kits for trained professionals in out-of-hospital settings, such as paramedics. It is also frequently used in hospitals as part of standard equipment found on crash carts, emergency rooms, or other critical care settings.

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Nasopharyngeal Airway: A hollow plastic or soft rubber tube that healthcare providers can utilize to assist in patient oxygenation. It provides ventilation in patients who are difficult to oxygenate or ventilate via bag-mask ventilation.

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Laryngeal Tube: The laryngeal tube is an alternative to the anesthesia facemask. It is a potential tool for ventilation in patients with difficult airways. In addition, healthcare providers can use Laryngeal Tube during spontaneous or controlled ventilation.

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Oropharyngeal Airway: An oropharyngeal airway or oral airway (OPA) is an airway adjunct used to maintain or open the patient's airway by stopping the tongue from covering the epiglottis. In this position, the tongue may prevent an individual from breathing.

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Combitube: Also known as the esophageal tracheal airway or esophageal tracheal double-lumen airway, the combi tube is a blind insertion airway device (BIAD) used in the pre-hospital and emergency setting. Combitube is designed to provide an airway to facilitate the mechanical ventilation of a patient in respiratory distress.

Also known as the esophageal tracheal airway or esophageal tracheal double-lumen airway, the combitube is a blind insertion airway device (BIAD) used in the pre-hospital and emergency setting. Combitube is designed to provide an airway to facilitate the mechanical ventilation of a patient in respiratory distress.

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Cricothyrotomy: Also called cricothyroidotomy, Cricothyrotomy is a procedure where healthcare providers place a tube through an incision in the cricothyroid membrane to establish an airway for ventilation.

Chapter 17: Management of Opioid-Associated Emergencies

Opioids are substances that act on opioid receptors to produce morphine-like effects. They are medically used for pain relief, including anesthesia. Other medical uses include suppressing diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough.

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How to identify opioid overdose?

1. Ask the bystanders. They may have information on the patient's actions before the collapse.
2. Examine the scene for drug receptacles such as syringes or bottles.
3. Observe the patient. Injection marks may indicate drug abuse, especially on the forearm.

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CPR for patients with suspected opioid overdose:

1. Trained rescuers may perform both compressions and rescue breathing (artificial ventilation) for adults.
2. Untrained rescuers should perform hands-only CPR.

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The algorithm for managing opioid overdose in children is similar to adults. The only difference is the method of CPR that is carried out. Both trained and untrained rescuers must alternate compressions with rescue breathing for infants and children.

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Frequently Asked Questions

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Are BLS and CPR the same thing?

While both Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) involve essential life-saving techniques, they serve different purposes. CPR is a component of BLS, which is a broader training encompassing various lifesaving skills necessary in emergency situations. CPR, on the other hand, primarily focuses on maintaining circulation and ventilation in the absence of spontaneous breathing and heartbeat. BLS training typically includes CPR but goes beyond by incorporating additional skills relevant to healthcare providers, such as the use of automated external defibrillators (AEDs) and managing choking. Healthcare professionals often opt for BLS training to gain a more comprehensive set of skills applicable to medical or hospital settings.

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What is the difference between adult and pediatric CPR?

The difference between adult and pediatric CPR lies in the specific techniques adapted for the age and size of the victim. For infants, the rescuer forms a seal over both the mouth and nose, using their mouth, and uses two fingers for chest compressions. When performing CPR on a child, the rescuer still provides breaths but seals the mouth only, and chest compressions are administered using one hand. These adjustments are made to ensure the effectiveness of the CPR intervention while considering the anatomical and physiological differences between adults, children, and infants.

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How do you provide high-quality compressions on a child during CPR?

Providing high-quality chest compressions during child CPR involves specific guidelines to maximize effectiveness. The rescuer should aim to compress the chest to a depth of about 1/3 to 1/2 of the child's chest at a rate of 100-120 compressions per minute. It is crucial to allow the chest to rise completely between compressions. The compressions should be firm, quick, and delivered without pauses to maintain a consistent flow of blood circulation. This emphasis on high-quality compressions is vital for optimizing the chances of a successful resuscitation and achieving return of spontaneous circulation (ROSC).

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How long should a pulse check last?

The recommended duration for checking a pulse during CPR, according to the American Heart Association, is about 10 seconds. This brief pause in chest compressions allows the rescuer to assess the presence or absence of a pulse. However, the overall goal during CPR is to minimize interruptions in chest compressions. Current guidelines emphasize maintaining a compression-to-ventilation ratio of 30:2 for single rescuers or continuous compressions with asynchronous ventilation for two rescuers. This ensures that at least 80% of the total CPR duration is spent on compressions, increasing the likelihood of achieving ROSC and survival to hospital discharge.

Why on opioid poisoning, if they have a pulse but are not breathing, you give Narcan, but if they do not have a pulse, you only consider Narcan?

According to the American Heart Association research, patients with no definite pulse may be in cardiac arrest or may have an undetected weak or slow pulse. These patients should be managed as cardiac arrest patients. Standard resuscitative measures should prioritize naloxone administration, focusing on high-quality CPR. It may be reasonable to administer IM or IN naloxone based on the possibility that the patient is not in cardiac arrest.

You should not delay access to more-advanced medical services while awaiting the patient's response to naloxone or other interventions. Unless the patient refuses further care, victims who respond to naloxone administration should access advanced healthcare services.

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If I am the only person there after scene safety and activating emergency response, do I get the defibrillator and then start chest compressions if I am alone?

It's always recommended to perform at least 1 round of high-quality CPR, which takes 2 minutes. Then, you can obtain a defibrillator if you are alone. If the arrest was unwitnessed and you are alone, perform five cycles of CPR, then get the defibrillator ready. On the other hand, if you witness the arrest alone, you go for the defibrillators first.

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What does the initial dose of 2j/kg mean in defibrillation?

2j/kg means you need to dial up 2 joules for each kilogram of the weight patient. When you look at a defibrillator, you will see a button called energy select or some variation. This is how you will select your joules to provide during each shock for the patient when necessary.

For example, if you have a child who weighs 20kg, you will dial up the energy to 40 joules (2 joules x 20 kg = 40 joules). Each subsequent shock (4, 6, 8) will require more energy. But do not go above 10 joules/kg.

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Do you give breaths every 2-3 seconds or give breaths after every round of CPR for pediatrics?

The approach to providing breaths during pediatric CPR depends on the situation and available resources. For individual rescuers or when there are two rescuers without a bag valve mask, it is generally recommended to administer breaths after each round of chest compressions. This is to ensure that the oxygenated blood continues to circulate through the body. However, in a hospital setting where bag valve masks are available, rescuers may opt to provide rescue breaths every 2-3 seconds for pediatric patients, tailoring the intervention to the specific needs of the situation. The decision is influenced by the availability of equipment, the number of rescuers, and the urgency of the situation.

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Do you tap an infant's shoulder and not the underside of their foot

When assessing the responsiveness of an infant, it is recommended to flick the bottom of the foot rather than tapping the shoulder. This method is employed to stimulate the infant and elicit a response. If the infant does not respond and is not breathing or not breathing normally, the rescuer should promptly position the infant on their back and initiate CPR. This emphasizes the importance of quick and decisive action in the face of a potential life-threatening situation, especially in the case of infants who may require immediate intervention.

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Do you not need to put the patient in a recovery position to clear the airway first before CPR?

The sequence of actions during an emergency situation is crucial, and putting a patient in the recovery position is not the first step. The primary concern is to assess and address the patient's circulation, airway, and breathing. Starting with a quick evaluation of responsiveness, the rescuer should check for normal breathing. If the patient is unresponsive or not breathing normally, CPR should be initiated promptly. The recovery position is not suitable during CPR as it impedes the effective administration of chest compressions. Once the patient is stable, and if there is a need to maintain an open airway without the ongoing need for chest compressions, then the recovery position can be considered while awaiting further medical assistance, such as an ambulance. This underscores the importance of prioritizing life-saving measures before considering more advanced interventions or positioning.

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As healthcare providers, it is essential to remember that as real-life emergencies happen, the first order of action is to provide essential care techniques learned through the BLS course, call 911 and perform CPR until paramedics arrive. The participants in this course learn lifesaving techniques as solo or team rescuers.

This Basic Life Support Course aims to impart knowledge that helps healthcare providers provide Basic life support to individuals undergoing life-threatening medical conditions while the person is waiting for more advanced treatment in a hospital setting.