Renato D.

Lacanilao, RN, MAN

BLS/CPR for Adults

Objectives:
At the end of this session participants should be
able
1. To assess and manage the collapsed victim
2. To perform chest compression and rescue
breathing (CPR)
3. To apply basic first aid to a person under an
emergency situation.
4. To evaluate patient condition after giving
necessary nursing care management.
Background
• Approximately 700,000 cardiac arrest
per year in Europe
• Survival to Hospital Discharge presently
approximately 5 to 10%
• Bystander CPR vital intervention before
arrival of medical services – double or
triple survival from SCA (Sudden Cardia
Arrest)
Basic Life Support
• Sequences of procedure performed to
restore the circulation of oxygenated
blood after a sudden pulmonary and/or
cardiac arrest.
• Chest compression and pulmonary
ventilation performed by anyone who
knows how to do it, anywhere,
immediately without any other
equipment.
• Protective devices
Cardio Pulmonary Resuscitation
is a technique of basic
life support for the
purpose of
oxygenating the brain
and heart until
appropriate, definitive
medical treatment can
restore normal heart &
ventilatory action.
 Indications

Cardiac Arrest
a. Ventricular fibrillation
b. Cardio Vascular Collapse
c. Cardiac Standstill
Respiratory Arrest

A. Obstruction

a. Anatomical (Epiglotitis)

b. Mechanical (Foreign body airway

obstruction)
B. Diseases

a. Bronchitis
b. Pneumonia
c. COPD & other Respiratory illnesses
C. Other causes

a. Drowning
b. Stroke
c. smoke inhalation
d. drug overdose
e. Electrocution/injury by lightning
f. Suffocation
g. Accident/injury (Chest compression)
h. Coma
i. Poisoning
 Types of CPR

1. Basic Life Support (BLS)

 Basic life support (BLS) is the

level of medical care which is
used for victims of life-
threatening illnesses or injuries
until they can be given full
medical care at a hospital.

 involves the use of hands,

mouth and the sincere desire to
give the person a second chance
for life.
2. Advance Cardiac Life Support

ACLS
involves BLS and the
use of equipment,
emergency drug and
fluids to monitor the
client and stabilize his
condition.
• AHA – American Heart Association
– Recognized leader in resuscitation, science &
training
– Recognized as the international standard
Emergency Cardiovascular Care

Cardiovascular disease (CVD)

– A collection of conditions that involve the
circulatory system, which contains the heart
(cardio) and blood vessels (vascular).
Coronary heart disease (CHD)
– Disease of the coronary arteries and their resulting
complications, such as angina pectoris and acute
myocardial infarction.
Coronary artery disease (CAD)
– Disease that affects the arteries that supply the
heart muscle with blood.
SUDDEN CARDIAC ARREST
• SCA occurs when the normal electrical
impulses in the heart unexpectedly become
disorganized; the normally coordinated
mechanical contraction of the heart is lost,
and chaotic, quivering condition known as V-
Fib can occur. Blood flow from the brain in
body stops abruptly, characterized by a
stoppage of breathing, sudden collapse and
loss of consciousness
Components of Systematic Approach

• BLS Assessment
• Primary Assessment
• Secondary Assessment
Systematic Approach
• Initial Impression (Provider visually checks
while approaching the patient)
For Unconscious Patient (Appearance)
• BLS Assessment
• Primary Assessment
• Secondary Assessment
Systematic Approach
• Initial Impression (Provider visually checks
while approaching the patient)
For Conscious Patient (Appearance)
• Primary Assessment
• Secondary Assessment
ASSESSMENT

• Check for responsiveness

• Shout for nearby help activate the
emergency response system/get an
AED
• Check breathing and pulse
• Use a defibrillator
• Ideally, check breathing and pulse
simultaneously
• Ventilate once every 5 to 6 seconds
PRIMARY ASSESSMENT

• Airway
• Breathing
• Circulation
• Disability
• Exposure
SECONDARY ASSESSMENT

• Signs and symptoms

• Allergies
• Medications
• Past Medical History
• Last Meal
• Events
PATIENT ASSESSMENT

PRIMARY SURVEY
➢ Rapid hands-on assessment
➢ Usually requires less than 60 seconds to
complete
➢ Purposes are to detect the presence of life-
threatening problems and to immediately
correct them
➢ Assess responsiveness
➢ Gently tap or squeeze the victim’s shoulder
and ask, “Are you all right?” or “Can you hear
me?”
Use the AVPU acronym:
• A = Alert
• V = Responds to Verbal stimuli
• P = Responds to Painful stimuli
• U = Unresponsive
Responsive Patient
• Airway
• Breathing
• Circulation
• Disability
• Exposure
Unresponsive Patient
• Circulation
• Airway
• Breathing
• Defibrillation
SECONDARY SURVEY
➢ Airway
➢ Breathing
➢ Circulation
➢ Differential Diagnosis and diagnostic
procedures
➢ Evaluate interventions and pain
management
➢ Facilitate family presence for invasive and
resuscitative procedures
STEPS IN CPR

Approach Safely
Check Response
Shout for Help
Call 119
Chest Compression (30)
Open the Airway
Breathing (2)
 APPROACH SAFELY!

Approach Safely
Check Response
Shout for Help
Call 119
Chest Compression (30)
Open the Airway
Breathing (2)
Assessment and Scene Safety

1. Make sure the scene is safe for you and the

victim
2. Tap the victim’s shoulder and shout, “ Are
you alright?
3. Check to see if the victim is breathing. If the
victim is not breathing or not breathing
normally (ie, only gasping), you must
activate the emergency response system.
Initial BLS Steps for Adults

1. Assess the victim

for a response and
look for normal or
abnormal
breathing. If there
is no response and
no breathing or no
normal breathing
like only gasping,
shout for help
CHECK RESPONSE

Approach Safely
Check Response + Pulse
Shout for Help
Call 119
Chest Compression (30)
Open the Airway
Breathing (2)
CHECK RESPONSE

• Shake Shoulders
gently
• Asked “Are you
alright?”
• If he responds
– Leave as you find him
– Find out what is wrong
– Reassess regularly
Check for Pulse
Step 3: Pulse Check

• To perform a pulse check in the adult, palpate

a carotid pulse. If you do not definitely feel a
pulse within 10 seconds, start chest
compressions.
• A. locate the
trachea, using 2 or 3
fingers
• B. slide these 2 or 3
fingers into the groove
between the trachea
and the muscles at the
side of the neck, where
you can feel the carotid
pulse
• C. 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
compression (C-A-B
sequence)
1. Check for response and breathing and
activate the emergency response system
• A. tap the victim’s shoulder and shout, “Are
you all right?” at the same time look for
breathing.
• B. If adult victim does not respond and has
no breathing or no normal breathing. Shout
for help. If another rescuer responds, send to
activate Emergency response system and get
AED. If no responds, activate Emergency
response system, get AED and return to
victim to check a pulse & begin CPR
Step 4: Begin cycles of 30 Chest
Compression and 2 Breaths (CPR)
• 1. Position yourself at the victims side
• 2. Make sure the victim is lying face up on a
firm, flat surface. If the victim has a head or
neck injury, try to keep the head, neck, and
torso in a line when rolling the victim to a
faceup position.
SHOUT FOR HELP

Approach Safely
Check Response + Pulse
Shout for Help
Call 119
Chest Compression (30)
Open the Airway
Breathing (2)
CALL 119
Approach Safely
Check Response +
Pulse
Shout for Help
Call 119
Chest Compression
(30)
Open the Airway
Breathing (2)
Activate the Emergency Response
System and Get an AED
• If you are alone and find an unresponsive
victim, shout for help. If no one responds,
activate the emergency response system, get
an AED (or defibrillator) if available, and the
return to the victim to check a pulse and
begin CPR (C-A-B)
Basic Life Support (BLS)
•Airway
•Breathing
•Circulation (CAB)
3. Check the victims
pulse
4. If you do not
definitely feel a
pulse within 10
seconds, perform 5
cycles of
compressions and
breaths (30:2 ratio)
CAB sequence
30 CHEST COMPRESSION

Approach Safely
Check Response +
Pulse
Shout for Help
Call 119
Chest Compression
(30)
Open the Airway
Breathing (2)
CHEST COMPRESSION
• 4. Straighten your arms and position your
shoulders directly over your hands
HIGH QUALITY CPR

• Compress the chest at an adequate rate 100-

120 compressions/min and depth Adult/child
2inches (5cm) Infant 1.5 inches (4cm)
• Allow full chest recoil after each compression.
• Minimize interruptions in chest compressions
for at least 5 sec. But not more than 10secs.
• Avoid excessive ventilation.
High Quality CPR

• Switch Compressors every 2

minutes
• Use audio and visual feedback
devices
• 6. Push hard and fast
– Press down at least 2
inches (5cm) with each
compression (this
requires hard work). For
each chest
compression, make
sure you push straight
down on the victim’s
breastbone
– Deliver compression in
a smooth fashion at a
rate of at least 100/min
• 7. At the end of each compression, make
sure you allow the chest to recoil (re-expand)
completely. Chest recoil allows blood to flow
into the heart and is necessary for chest
compression to create blood flow. Incomplete
chest recoil is harmful because it reduces the
blood flow created by chest compression.
Chest compression and chest
recoil/relaxation times should be
approximately equal
8. Minimize interruptions
Opening the Airway for Breaths

• 2 methods for opening the Airway to provide

Breaths
• 1. Head Tilt-Chin Lift maneuver
• 2. Jaw Thrust
Head Tilt-Chin Lift Maneuver
OPEN THE AIRWAY

Approach Safely
Check Response +
Pulse
Shout for Help
Call 119
Chest Compression
(30)
Open the Airway
Breathing (2)
Airway Opening by Neck Extension
Opening Airway
Head Tilt and Chin lift
- Lay rescuers
- Non-health rescuer

No need for finger sift

unless solid material
can be seen
Opening Airway
• For professional Health Care Provider
Steps to Perform a Head Tilt-Chin Lift

• 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
 Steps to perform jaw Thrust

1. Place one hand on each

side of the victim’s head,
resting your elbows on the
surface on which the victim
is lying.
2. Place your fingers under
the angles of the victim’s
lower jaw and lift with both
hands, displacing the jaw
forward
3. If the lips close, push the
lower lip with your thumb to
open the lips
CHECK FOR BREATHING
Approach Safely
Check Response +
Pulse
Shout for Help
Call 119
Chest Compression
(30)
Open the Airway
Check for breathing
Breathing (2)
2 RESCUE BREATHING
Approach Safely
Check Response +
Pulse
Shout for Help
Call 119
Chest Compression
(30)
Open the Airway
Check for breathing
Breathing (2)
RESCUE BREATHING
• Pinch nose
• Take a normal breath
• Place Lips over the
mouth
• Blow until the chest
rises
• Take about 1 second
• Allow chest recoil
• Repeat
Breathing: Mouth to Nose (when
to use)
• Can’t open mouth
• Can’t make a good seal
• Severely injured mouth
• Stomach distention
• Mouth to stoma (tracheostomy)
RESCUE BREATHS
• Recommendations
– Tidal volume 500-600 ml
• Respiratory
– Give each breath about 1 sec with
enough volume to make the victim
chest rise
• Chest Compression only
– Continuously at a rate of 100 per
minute
 Steps in resuscitation (DRS C-A-B)

• - Check for Danger

• - Check for Response
• - ‘S’ has been added for Send for help
• - ‘C’ directs rescuers to perform 30 Compressions to
patients who are unresponsive and not breathing
normally, followed by 2 rescue breaths
• - ‘A’ directs rescuers to open the Airway
• - ‘B’ directs rescuers to check Breathing but no
need to deliver rescue breaths
• - ‘D’ directs rescuers to attach an AED as soon as it
is available and follow prompts
Foreign Body Airway Obstruction
Foreign Body Airway Obstruction:

• a partial or complete blockage of the

breathing tubes to the lungs due to a
foreign body (for example, food, a bead,
toy, etc.). The onset of respiratory
distress may be sudden with cough.
There is often agitation in the early
stage of airway obstruction.
Classification of Obstruction

• Partial obstruction
• Complete obstruction
 Causes of Obstruction

1. Improper chewing of large pieces of food

2. Excessive intake of alcohol
3.The presence of loose upper and lower dentures
4. For children-running while eating
5. For smaller children of “hand-to-mouth” stage
left unattended
Choking
Management of Foreign-Body Obstruction

• The Heimlich Maneuver

• Finger Sweep
 Heimlich Maneuver

Adult Child Infant

Abdominal Thrust Maneuver

For unconscious person

For obese person
How to Remove Obstruction when alone?
Finger Sweep (Hooking motion)
 Summary of Steps of CPR
Component Adults Children Infants
Recognition Unresponsive
No Breathing No breathing or only gasping
No Normal breathing
(ie, only gasping
Summary of Steps of CPR
No pulse felt within 10 seconds
CPR Sequence Chest Compression, Airway, Breathing (C-A-B)
COMPRESSION At least 100/min
RATE
Compression At least 2 inches (5cm) At least 1/3 AP diameter At least 1/3 AP diameter
Depth About 2 inches (5cm) About 1 ½ inches (4cm)

Chest wall recoil Allow complete recoil between chest compressions

Rotate compressors every 2 minutes
Compression Minimize interruptions in chest compressions
Interruptions Attempt to limit interruptions to <10 seconds
AIRWAY Head tilt-chin lift (suspected trauma; jaw trust)
Compression- 30:2 30:2
ventilation ratio 1 or 2 rescuers Single rescuer
(until advanced 15:2
airway placed) 2 rescuer
Ventilations with 1 breath every 6-8 seconds (8-10 breaths/min)
advanced airway Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
DEFIBRILLATION Attach and use AED as soon as available
Minimize interruptions in chest compressions before and after shock.
Resume CPR beginning with compressions immediately after each shock
 Artificial Resuscitation

Adult Child Infant

Ratio 5sec : 1 blow/vent 3 sec: 1 blow 3 sec : blow

Cycle 10 – 12/min 20/min 20/min

Manner
of Blowing mouth to mouth mouth to mouth m to m to nose

Location of Pulse carotid carotid brachial

Counting 1,1002,1003,1001,blow 1,1001,blow 1,1001,blow

1,1002,1003,1002,blow 1,1002,blow 1,1002,blow
↓ ↓ ↓

1,1002,1003,1012,blow 1,1020,blow 1,1020,blow

 Cardio Pulmonary Resuscitation

Adult Child Infant

Ratio 30 comp: 2 blows 30:2 (1 rescuer) 30 :2 (1 rescuer)
(1 or 2 rescuers) 15:2 (2 rescuers) 15:2 ( 2 rescuers)
Rate Approx. 100/min Approx. 100/min Approx. 100/min
Cycle 5 cycles 5 cycles (1 rescuer) 5 cycles (1 rescuer)
(1 or 2 rescuers) 10 cycles (2 rescuers) 10 cycles (2 rescuers)
Manner of 2 hands 1 hand 3rd & 4th finger
Compression
Depth 1 ½ to 2 inches 1 to 1 ½ inches ½ to 1 inch

Counting 1,2,3,4,5,6,7,8,9,10 1,2,3,4,5,6,7,8,9,10 1,2,3,4,5,6,7,8,9,10

11,12,13,14,15,16, 11,12,13,14,15,16, 11,12,13,14,15,16,
17,18,19,20,1,2,3,4,5 17,18,19,20,1,2,3,4,5 17,18,19,20,1,2,3,4,5
6,7,8,9&1 – 2 blows 6,7,8,9 & 1 – 2 blows 6.7.8.9 & 1 – 2 blows
↓ ↓ ↓
Up to 4 cycles up to 20cycles up to 20 cycles
Complications

1. Fracture of ribs.
2. Most commonly punctured internal organ is
the Liver.
3. Post resuscitation distress syndrome
4. Neurologic impairment, brain damage
When to stop CPR?

• Spontaneous breathing is restored

– when the client is revived
• Turn over to Medics
– when the EMS has been activated; victim is
transferred to ER
• Operator is exhausted
– when rescuer gets exhausted
• Physician assumes responsibility
– when physician declares the client is dead
• Scene becomes unsafe
Automated External Defibrillator
 Automated External Defibrillator

AED – are
computerized
devices that can
identify cardiac
rhythms that need a
shock, and they can
then deliver the
shock.
• Once the AED arrives, place it at the victim’s
side, next to the rescuer who will operate it.
• This position provides ready access to the
AED controls and easy placement of AED
pads.
• It also allows a second rescuer to perform
CPR from the opposite side of the victim
without interfering with AED operation.
Special Considerations

The victim has a hairy chest

The victim is immersed in water or water is
covering the victim’s chest
The victim has an implanted defibrillator or
pacemaker
The victim has a transdermal patch or other
object on the surface of the skin where the
AED pads and placed
Hairy Chest

1. If the pads stick to the hair instead of the

skin, press down firmly each pad
2. If the AED continues to prompt you to “check
pads” or “check electrodes” quickly pull off
the pads. This will remove large amount of
hair and should allow the pads to stick to the
skin.
3. If a large amount of hair still remains where
you will put the pads, shave the area with
razor in the AED carrying case
4. Put on a new set of pads. Follow the AED
voice prompts
Water

• Water is a good conductor of electricity.

• Do not use an AED in water. If the victim is in
water, pull the victim out of the water.
• If the victim is lying in water or the chest is
covered with water, the water may conduct
the shock electricity across the skin of the
victim’s chest. This prevents the delivery of
an adequate shock dose to the heart.
• If water is covering the victim’s chest, quickly
wipe the chest before attaching the AED pads
• If the victim is lying on snow or in small
puddle, you may use the AED.
Implanted Defibrillators and Pacemakers

• Avoid placing the AED pad directly over the

implanted device
• Follow the normal steps for operating an AED
Transdermal Medication Patches

• Do not place AED pads directly on top of a

medication patch (nitroglycerin, nicotine, pain
medication, hormone replacement therapy, or
antihypertensive medication)
• It may block the transfer of energy from AED
pad to the heart and may cause small burns
to the skin.
• If it won’t delay shock delivery, remove the
patch and wipe the area clean before
attaching the AED pad.
Switch on AED

• Some AEDs will automatically switch

themselves on when the lid is opened
Attach pads to victims bare chest
Analysing Rhythm: Do not touch victim
 Shock indicated

• Stand clear
• Deliver shock
Shock delivered: Follow AED instructions

30 2
No shock advised: Follow AED instructions

30 2
If victim starts to breathe normally place in
recovery position
 CPR in children

• Adult CPR techniques can be used on

children

• Compressions at least 1/3 of the depth of the

chest
 AED in children

• Age > 8 years

• use adult AED

• Age 1-8 years

• use paediatric pads /
settings if available
(otherwise use adult
mode)

• Age < 1 year

• use only if manufacturer
instructions indicate it is
safe
2 Rescuer BLS Sequence with an AED

• 1. Check for response and check breathing

• 2. Check for pulse
• 3. Attempt defibrillation with AED
• 4. Power ON the AED
• 5. Attached AED pads to the victim’s bare
chest
• 6. “Clear” the victim and ANALYZE the
rhythm
• 7. If the AED advises a shock, it will tell you to
clear the victim
• 8. Press the SHOCK button
• 9. if no shock is needed, and after any shock
delivery, immediately resume CPR, starting
with chest compression.
• 10. after 5 cycles or about 2 minutes of CPR,
the AED will prompt you to repeat 6 and 7.

• If no shock advised, immediately restart CPR

beginning with compression.
Any questions?