I. Elements of BLS

A. Basic life support (BLS) is noninvasive emergency lifesaving care used to treat airway obstruction, respiratory arrest, or cardiac arrest.

1. This care focuses on the ABCs:

a. Airway (obstruction)

b. Breathing (respiratory arrest)

c. Circulation (cardiac arrest or severe bleeding)

2. BLS follows specific sequences for adults and for infants and children.

3. Only seconds should pass between the time you recognize that a patient needs BLS and the start of treatment.

4. Permanent brain damage may occur if the brain is without oxygen for 4 to 6 minutes.

5. If a patient is not breathing well or at all, you may simply need to open the airway.

6. If the patient has no pulse, you must combine artificial ventilation with artificial circulation.

7. CPR is a series of steps used to establish artificial ventilation and circulation in a patient who is not breathing and has no pulse.

B. BLS can be given by one or two EMT-Bs, by first responders, or by alert and well-trained bystanders.

1. BLS does not require any equipment.

2. You should use a barrier device to perform rescue breathing.

3. When done correctly, BLS can maintain life for a short time until ALS measures can be started.

4. BLS measures are only as effective as the person performing them.

C. BLS differs from advanced life support (ALS), which involves advanced lifesaving procedures, such as cardiac monitoring and administration of intravenous fluids and medications.

II. Automated External Defibrillation

A. Most out-of-hospital cardiac arrests occur as the result of sudden cardiac rhythm disturbances.

B. Early defibrillation can improve survival rates.

C. The automated external defibrillator (AED) should be used on any adult in nontraumatic cardiac arrest as soon as possible.

D. AED use

1. Consider use when medical cardiac arrest is suspected.

2. Not likely to help patients with traumatic cardiac arrest

3. Children younger than 1 year of age should not have an AED applied.

4. For children between ages 1 and 7 years and those who weigh less than 55 pounds (25 kg), only use if special pediatric pads and equipment are available and protocols allow it.

III. Assessing the Need for BLS

A. Complete an initial assessment as soon as possible.

1. Evaluate the patient’s airway, breathing, circulation, and level of consciousness.

2. The first step is determining responsiveness.

3. A patient who is alert and oriented does not need CPR.

4. You may also suspect the presence of a cervical spine injury.

5. You must protect the spinal cord from further injury as you perform CPR.

B. Basic principles of BLS are the same for infants, children, and adults.

1. Age guidelines

a. Anyone younger than 1 year is considered an infant.

b. A child is between the ages of 1 and 8 years.

c. For children older than 8 years, you can usually use the same techniques you use for adults.

2. The two basic differences in providing CPR for infants, children, and adults are:

a. Emergencies in which infants and children require CPR have different underlying causes.

b. Anatomically, the airways of infants and children are smaller than those of adults.

3. Cardiac arrest in adults usually occurs before respiratory arrest.

a. The reverse is true in infants and children.

b. Full cardiac arrest in children younger than 9 years results from respiratory arrest.

4. Respiratory arrest in infants and children has a variety of causes, including:

a. Aspiration of foreign bodies into the airway

b. Airway infections, such as croup and epiglottitis

c. Near-drowning incidents

d. Electrocution

e. Sudden infant death syndrome (SIDS)

IV. When to Start and Stop BLS

A. Start CPR in almost all patients who are in cardiac arrest.

1. Two general exceptions to the rule

a. Do not start CPR if the patient has obvious signs of irreversible or biological death.

i. Signs of irreversible or biological death include “clinical” death, absence of a pulse, and absence of breathing, along with any one of the following:

     (a) Rigor mortis: Stiffening of the body

     (b) Dependent lividity (liver mortis): A discoloration of the skin due to pooling of blood

     (c) Putrefaction or decomposition of the body

     (d) Evidence of nonsurvivable injury, such as decapitation

     (e) Rigor mortis and dependent lividity develop after a patient has been dead for a long period of time.

b. Do not start CPR if the patient and his or her physician have previously agreed upon DNR (do not resuscitate) or no-CPR orders.

i. This can be a complicated issue.

ii. The safest course is to assume that an emergency exists and begin CPR under “implied consent.”

iii. Learn your local protocols and the standards in your system for treating terminally ill patients.

2. In all other instances, you should begin CPR on anyone in cardiac arrest.

3. You will usually be unable to determine how long the patient has been without oxygen.

4. Factors such as air temperature and the basic health of their tissues and organs can affect a patient’s ability to survive.

5. Most legal advisers recommend that, when in doubt, you should always provide rather than withhold care.

B. Once you begin CPR in the field, you must continue until one of the following events occurs:

1. S: The patient Starts breathing and has a pulse.

2. T: The patient is Transferred to another person trained in BLS, to a person trained in Advanced Life Support (ALS) techniques, or to another emergency medical responder.

3. O: You are Out of strength or too tired to continue, which does not
mean that you are merely weary; rather, it means you are “no longer physically able to perform CPR.”

4. P: A Physician who is present assumes responsibility for the patient.

C. CPR should always be continued until the patient’s care is transferred to a physician or higher medical authority in the field.

D. A designated medical control physician may order you to stop CPR based on the patient’s condition.

V. Positioning the Patient

A. The next step is to position the patient to ensure the airway is open.

1. The patient must be lying supine on a firm surface, with enough clear space around the patient for two rescuers to perform CPR.

2. If the patient is crumpled up or lying face down, you will need to reposition him or her.

a. Kneel beside the patient.

b. First EMT-B should place his or her hands behind the patient’s back, head, and neck to protect the cervical spine.

c. Second EMT-B should place his or her hands on the distant shoulder and the hip.

d. Second EMT-B should turn the patient toward himself or herself by pulling on the distant shoulder and the hip.

e. First EMT-B should control the head and neck so that they move as a unit with the rest of the torso.

f. The first EMT-B should place the patient in a supine position.

B. If possible, log roll the patient onto a long backboard as you are positioning him or her for CPR.

C. Once the patient is properly positioned, you can easily assess the ABCs and start CPR if necessary.

VI. Opening the Airway in Adults

A. The most important element for successful CPR is immediately opening the airway.

B. Three techniques can be used for opening the airway in adults.

1. Head tilt–chin lift maneuver

a. Use in patients who have not sustained trauma.

b. Quickly remove any vomitus or foreign material from the mouth.

i. For liquids, use a piece of cloth.

ii. For solids, use your hooked index finger.

c. Technique

i. Make sure the patient is supine.

ii. Place one hand on the patient’s forehead and apply firm backwards pressure with your palm to tilt the patient’s head back.

iii. Place the tips of the fingers of your other hand under the lower jaw near the bony part of the chin.

iv. Lift the chin forward, bringing the entire jaw with it, which helps to tilt the head back.

d. The chin lift has the added advantage of holding loose dentures in place, making obstruction by the lips less likely.

i. Ventilation is much easier when dentures are in place.

ii. Dentures that do not stay in place should be removed.

2. Jaw-thrust maneuver

a. In cases of suspected spinal injury, a jaw thrust may be needed.

b. Technique

i. Kneel above the patient’s head.

ii. Place your index or middle finger behind the angle of the patient’s lower jaw on both sides.

iii. Forcefully move the jaw forward without manipulating the patient’s neck.

iv. Use your thumbs to open the mouth to allow breathing.

v. The nose can be sealed with your cheek during rescue breathing if you are using the jaw-thrust maneuver.

C. Pediatric needs are slightly different.

1. You can open the airway in an infant or child with the same techniques.

2. However, because a child’s neck is so flexible, the head-tilt maneuver should be changed.

3. Tilt the head back slightly into a neutral or a slightly extended position.

4. You may also use the jaw-thrust maneuver without a head tilt.

5. This is the best method to use if you suspect a spinal injury.

6. If a second rescuer is present, he or she should immobilize the child’s cervical spine.

VII. Foreign Body Airway Obstruction in Adults

A. Many things may cause airway obstruction.

1. Obstructions that are visible in the mouth should be swept forward and out with your gloved index finger.

2. Use suctioning to maintain a clear airway.

3. Care of a conscious patient with an airway obstruction

a. Sudden airway obstruction is usually easy to recognize in someone who is eating or who just finished eating.

i. The person is suddenly unable to speak or cough.

ii. He or she will grasp the throat.

iii. The lips and skin will turn cyanotic.

iv. The person makes exaggerated efforts to breathe.

b. Ask the patient, “Are you choking?”

i. Patient will usually answer by nodding yes.

ii. Patient may use the universal sign to indicate airway blockage.

4. Care of an unconscious patient with an airway obstruction

a. First step is to determine whether the patient is breathing and has a pulse.

b. Suspect an airway obstruction if the standard maneuvers to open the airway and ventilate the lungs are not effective.

B. Removing a foreign body obstruction can be done in several ways.

1. Two manual maneuvers are recommended for removing a foreign body airway obstruction.

a. Abdominal-thrust maneuver (the Heimlich maneuver)

b. Finger sweeps and manual removal of the object

2. Abdominal-thrust maneuver

a. Abdominal-thrust maneuver is the preferred way to dislodge and force food or other material from the throat of a choking person.

b. Residual air, which is always present in the lungs, is compressed upward and used to expel the object.

c. Give abdominal thrusts in sets of five until the foreign body is dislodged.

d. Sitting or standing patient

i. Stand behind the patient and wrap your arms around his or her waist.

ii. Make a fist with one hand, and grasp it with your other hand.

iii. Press your fist into the patient’s abdomen with a quick inward and upward thrust.

iv. Repeat in sets of five until the object is expelled or the patient becomes unconscious.

e. Unconscious patient

i. Place the patient in a supine position.

ii. Perform a tongue-jaw lift, then a finger sweep.

iii. Open the airway and attempt to ventilate.

iv. Straddle the patient’s hips or legs.

v. Place the heel of one hand against the patient’s abdomen above the umbilicus and below the xiphoid process.

vi. Press the hand into the patient’s abdomen with quick inward and upward thrusts.

vii. Repeat five times.

3. Chest thrusts are another way to dislodge an airway obstruction.

a. Use chest thrusts for:

i. Women in advanced stages of pregnancy

ii. Patients who are very obese

iii. Children younger than 1 year of age

b. To perform chest thrusts when the patient is standing or sitting:

i. Stand behind the patient with your arms directly under the patient’s armpits.

ii. Wrap your arms around the patient’s chest.

iii. Make a fist with one hand, and grasp it with the other hand.

iv. Press your fist into the patient’s chest with backwards thrusts until the object is expelled or the patient becomes unconscious.

c. To perform chest thrusts when the patient is lying down:

i. Place the patient in a supine position.

ii. Kneel next to the patient.

iii. Perform a tongue-jaw lift, then a finger sweep.

iv. Open the airway and attempt to ventilate.

v. Use the same hand position as that for chest compressions.

vi. Deliver slow, deliberate chest thrusts to expel the object.

C. Manual removal of foreign objects can also be done.

1. Use of finger sweeps should be limited to unconscious patients.

2. If you can see a foreign object, remove it carefully with your gloved fingers.

3. Manual technique to remove the foreign material

a. Place the patient in a supine position.

b. Open the patient’s mouth with the tongue-jaw lift.

c. Use the index finger of your opposite hand to sweep down inside the cheek to the base of the tongue.

d. Dislodge any impacted foreign material up into the mouth.

e. When the foreign body comes up within reach, grasp and carefully remove it.

4. “Blind” finger sweeps are not recommended for infants and small children.

5. Look first and then reach for the object.

6. If you do not see anything, do not reach.

D. Partial airway obstruction also requires attention.

1. Breathing is noisy and the patient may be coughing.

2. Your main concern is to prevent a partial airway obstruction from becoming a complete airway obstruction.

3. The abdominal-thrust maneuver is generally not effective in these situations.

4. Manual removal is dangerous because you could force the object farther down the airway.

5. Partial airway obstruction

a. Encourage patient to cough.

b. Do not interfere with the patient’s attempts to expel the foreign body.

c. Stay with and monitor the patient.

d. Give 100% oxygen to the patient using a nonrebreathing mask.

e. Provide prompt transport.

f. Treat a partial airway obstruction with poor air exchange as a complete airway obstruction.

VIII. Foreign Body Obstruction in Infants and Children

A. Foreign body airway obstruction is a common problem in infants and children.

B. Try to identify the cause of the obstruction.

C. In patients with signs and symptoms of an airway infection, do not waste time trying to dislodge a foreign body; the child needs immediate transport.

D. A previously healthy child who suddenly has difficulty breathing has probably aspirated a foreign body.

1. With good air exchange, the patient can cough forcefully, although there may be wheezing between coughs.

2. Do not interfere with a patient’s own attempts to expel the foreign body.

3. Encourage the child to continue coughing and breathing.

4. Give the patient oxygen.

5. Provide transport.

6. If poor air exchange is present, treat the patient as though a complete airway obstruction exists.

E. Follow these steps to remove a foreign body airway obstruction in a child.

1. A sitting or standing child

a. Stand behind the patient.

b. Place your arms under the patient’s armpits, and wrap your arms around the patient’s chest.

c. Make a fist with one hand; grasp the fist with the other hand.

d. Place the thumb side of your fist against the patient’s abdomen, just above the umbilicus and well below the xiphoid process.

e. Press your fist into the patient’s abdomen with a set of five quick upward thrusts.

f. Repeat the thrusts in sets of five until the object is expelled or the patient loses consciousness.

2. A child who is lying down or unconscious

a. Place the child in a supine position.

b. Perform a tongue-jaw lift and look for an object in the pharynx.

c. Open the airway and attempt to ventilate.

d. Straddle the patient’s hips.

e. Place the heel of one hand against the patient’s abdomen.

f. Press the hand into the patient’s abdomen with five quick inward and upward thrusts.

g. Repeat five times.

h. Open the airway, and attempt rescue breathing.

i. If the obstruction is not cleared, repeat abdominal thrusts.

3. If the foreign body is not expelled, open the child’s mouth

a. If you see the foreign body, perform the tongue-jaw lift and then use a finger sweep to remove it.

b. Do not use blind finger sweeps on infants and children.

c. When you cannot remove the foreign body, perform mouth-to-mask ventilation en route to the hospital.

d. Abdominal-thrust maneuver might injure the liver or other abdominal organs in an infant.

4. Removing a foreign body in an infant

a. Place one hand on the infant’s back and neck and the other on his or her chest, jaws, and face; this sandwiches the infant between your arms and hands.

b. Deliver five quick back blows between the shoulder blades with the heel of
your hand.

c. Turn the infant face up, and support the head and neck.

d. Give five quick chest thrusts on the sternum, as with CPR, only at a slightly slower rate.

e. With an unconscious infant, perform the tongue-jaw lift to open the mouth, and then remove the object manually.

5. If the infant does not start breathing after these maneuvers, open the airway again and give artificial ventilation.

6. If the chest does not rise, reposition the head and attempt ventilation again.

7. If the chest still does not rise, continue giving back blows followed by chest thrusts.

IX. Rescue Breathing in Adults, Children, and Infants

A. Once you open the airway, the patient may start to breathe on his or her own.

1. To assess, place your ear about 1” above the patient’s nose and mouth.

2. Listen carefully for sounds of breathing.

3. Turn your head so that you can watch for movement of the patient’s chest and abdomen (look, listen, and feel technique).

4. You know the patient is breathing if:

a. The chest and abdomen rise and fall.

b. You feel and hear air move during exhalation.

5. With airway obstruction, there may be no movement of air, even though the chest and abdomen rise and fall.

6. You may see very little or no chest movement in patients with chronic lung disease.

7. This evaluation should take no more than 10 seconds.

B. Ventilation

1. Ventilations are now done routinely with a barrier device.

a. A plastic barrier covers the patient’s mouth and nose, and a one-way valve prevents backflow of secretions and gases.

b. Providing ventilations without a barrier device is appropriate only in extreme conditions.

c. Technique

i. Open the airway with the proper maneuver (head tilt-chin lift or jaw-thrust).

ii. Press on the forehead to maintain the backward tilt of the head.

iii. Pinch the nostrils together.

iv. Depress the lower lip with the thumb of the hand that is lifting the chin.

v. Open the patient’s mouth widely and place the barrier device over the patient’s nose and mouth.

vi. Take a deep breath, seal your mouth around the barrier device, and give two slow rescue breaths (2 seconds each), at a rate of 10 to 12 breaths/min.

vii. Remove your mouth and allow the patient to exhale passively.

viii. Turn your head slightly to watch for movement of the patient’s chest.

d. If you use the jaw-thrust technique, you must move to the patient’s side to provide ventilations.

i. Keep the patient’s mouth open with both thumbs.

ii. Seal the nose by placing your cheek against the patient’s nostrils.

iii. Practice this maneuver with a manikin.

C. Stoma ventilations

1. Patients who have undergone surgical removal of the larynx often have a permanent tracheal stoma at the midline in the neck or at the front base of the neck.

2. A stoma is an opening that connects the trachea directly to the skin.

3. The stoma is the only opening that will move air into the patient’s lungs.

4. Patients with a stoma should be ventilated with a BVM device, as described in Chapter 7.

D. Gastric distention

1. Artificial ventilation often results in the stomach becoming filled with air (gastric distention).

a. Gastric distention is most likely to occur if:

i. You blow too hard as you ventilate.

ii. You give breaths too rapidly.

iii. The patient’s airway is obstructed.

b. If massive gastric distention interferes with adequate ventilation, you should contact medical control.

c. Check the airway again and reposition the patient.

d. Avoid giving forceful breaths.

e. Continue to provide slow rescue breaths without trying to expel the stomach contents.

2. Manual pressure over the upper part of the abdomen is likely to result in vomiting.

 

E. Pediatric needs

1. Children in respiratory distress are usually struggling to breathe.

2. They usually position themselves in a way that keeps the airway open enough for air to move.

3. Let them stay in that position as long as it does not become a complete airway obstruction.

4. For infants, the preferred technique of artificial ventilation is mouth-to-nose-and-mouth ventilation.

a. Make a seal over the mouth and the nose.

b. If the patient is a large child and you cannot make a tight seal over both mouth and nose, perform mouth-to-mouth ventilations as you would in an adult.

c. After you have made an airtight seal over the mouth, give two gentle breaths 1 to 1¹/2 seconds.

5. The lungs of infants and children are much smaller than those of adults; you do not need to blow in a great amount of air.

6. A child’s airway is also smaller than that of an adult.

a. There is greater resistance to airflow.

b. You will need to use a bit more ventilatory pressure to inflate the lungs.

c. You are giving the correct amount of air volume as soon as you see the chest rise.

d. Ventilate once every 3 seconds or 20 times per minute.

7. If air enters freely and the chest rises, the airway is clear.

8. Check the pulse.

9. If air does not enter freely, check the airway for obstruction.

a. Reposition the patient to open the airway and give another two breaths.

b. If air still does not enter freely, you must then clear the airway.

F. Recovery position

1. Use the recovery position once a patient begins breathing on his or her own.

2. It helps maintain a clear airway in a patient with a decreased level of consciousness who has not had traumatic injuries.

3. It also allows vomit to drain from the mouth.

4. Roll the patient onto his or her side.

5. The head, shoulders, and torso should move as a unit, without twisting.

6. Place the patient’s hands under his or her cheek.

7. Never place a patient with a suspected head or spinal injury in this position.

 

X. Adult CPR

A. After you begin rescue breathing, assess the patient’s circulation.

1. Cardiac arrest is determined by the absence of a palpable pulse in the carotid artery.

2. Feel for the carotid artery.

3. Light pressure is sufficient to palpate the pulse.

4. Excessive pressure can obstruct the carotid circulation.

B. If there is no circulation, begin external chest compressions.

1. Provide artificial circulation by applying rhythmic pressure and relaxation to the lower half of the sternum.

a. At its best, external chest compressions provide only 25% to 33% of the blood normally pumped.

b. It is very important to do it properly.

2. The patient must be placed on a firm, flat surface in a supine position.

a. The head should not be elevated above the heart.

b. Surface can be the ground, the floor, a backboard, or a stretcher.

3. A patient who is in a bed should be moved to the floor or have a board placed under the back.

4. External chest compressions must always be accompanied by artificial ventilation.

C. Hand position is very important for successful chest compressions.

1. Slide the index and middle fingers of your hand that is nearer the patient’s feet along the edge of the rib cage until they reach the xiphoid notch in the center of the chest.

D. Apply chest compressions.

1. Slide your index and middle fingers along the rib cage to the notch in the center of the chest.

2. Push the middle finger high into the notch, and lay the index finger on the lower portion of the sternum.

3. Place the heel of the second hand on the lower half of the sternum, touching the index finger of your first hand.

4. Remove your first hand from the notch and place it over the hand on the sternum.

5. With your arms straight, lock your elbows, and position your shoulders directly over your hands.

6. Depress the sternum 1¹/2˝ to 2˝, using a rhythmic motion.

E. Proper compression technique

1. Complications are rare but can include fractured ribs, a lacerated liver, and a fractured sternum.

2. Depress the sternum using direct downward movement and allow an equal period of relaxation.

3. Do not remove the heel of your hand from the patient during relaxation.

XI. One-rescuer Adult CPR

A. When performing CPR alone, give both chest compressions and artificial ventilations in a ratio
of 15:2.

B. Perform an initial assessment to determine the need for CPR and then call for additional help.

C. Position the patient to open the airway.

D. Determine whether the patient is breathing by using the look, listen, and feel technique.

E. If the patient is not breathing, begin rescue breathing by delivering two breaths, each lasting 2 seconds.

F. Determine whether the patient has a pulse by checking the carotid pulse.

G. If there is no pulse, apply your AED. If there is no AED, begin artificial circulation.

H. Place hands in the proper position.

I. Give 15 compressions at a rate of 100/min for an adult.

J. Open airway and give two ventilations, each lasting 2 seconds.

K. Locate hand position and begin another cycle of chest compressions.

L. After four cycles of compressions and ventilations, reassess the patient.

M. Depending on the patient’s condition, continue CPR, continue rescue breathing only, or place the patient in the recovery position and monitor.

 

XII. Two-rescuer Adult CPR

A. Two-person CPR is always best.

1. Establish responsiveness and take positions.

2. First EMT-B is at the head; second EMT-B is at the side.

3. First EMT-B

a. Opens the airway

b. Looks, listens, and feels for breathing

c. If the patient is breathing, places him or her in the recovery position and monitor.

d. If the patient is not breathing, gives two breaths, each lasting 2 seconds.

4. Second EMT-B

a. Checks for carotid pulse.

b. If there is no pulse, begins chest compressions at about 100/min (15 compressions to two ventilations).

5. After 1 minute of CPR, first EMT-B checks the patient’s pulse.

6. Depending on the patient’s condition, continue CPR, continue rescue breathing only, or place the patient in the recovery position and monitor.

B. Switching positions helps prevent exhaustion.

1. Best time to switch is during a pulse check.

2. After giving two breaths, the first EMT moves into position to give chest compressions.

3. Second EMT gives 15th compression, then moves to patient’s head.

4. Second EMT checks for a pulse.

a. Take 5 to 10 seconds to check.

b. If no pulse, say “No pulse, continue CPR.”

XIII. Infant and Child CPR

A. Children consume oxygen two or three times as rapidly as adults do.

B. You must first focus on opening the airway and providing artificial ventilation.

C. Once the airway is open and you have delivered two artificial ventilations, assess circulation.

D. First, check for a palpable pulse in a large central artery.

E. You can usually palpate the carotid pulse in children older than 1 year.

F. In infants, palpate the brachial artery.

G. External chest compressions require a slightly different technique.

1. Most BLS techniques are the same for infants, small children, larger children, and adults.

2. The patient must be lying on a hard surface for the best results.

3. For an infant, the hard surface can be your hand or forearm, with your palm supporting the infant’s back.

4. Ensure that the infant’s head is not higher than the rest of the body.

5. The technique for chest compressions in infants and children differs due to a number of anatomic differences.

a. Position of the heart

b. Size of the chest

c. Fragile organs of a child

H. Proper hand position

1. Imagine a line drawn between the nipples, over the sternum.

2. The proper area for compressions is one fingerwidth below this line on the sternum.

3. Place your index finger just below this line.

4. Your adjacent middle and ring fingers will be at the proper point for compression.

5. Avoid compressing the xiphoid process.

I. Proper compression technique

1. Do not use both hands to compress the chest.

2. In an infant, use the two-finger technique or the two thumb-encircling hands technique.

3. Compress the sternum ¹/2˝ to 1˝ at the rate of 100/min.

4. After each compression, release pressure on the sternum without removing your fingers from the patient’s chest.

5. Use smooth, rhythmic motions to deliver compressions.

6. For a child older than 1 year, chest compressions differ.

a. You may need to use more force with a child than with an infant.

b. Compress the sternum 1'' to 1¹/2˝ at a rate of 100/min with the heel of one hand.

c. Your other hand should maintain the child’s head position.

7. Larger children or those over the age of 8 years should be given chest compressions as an adult.

8. The rate of compression to ventilation for infants and children is 5:1 for both one-rescuer and two-rescuer CPR.

9. Open the airway and ventilate the patient once after each set of five compressions.

10. One ventilation should take 1 to 1¹/2 seconds.

11. The two thumb-encircling hands technique is the preferred method for performing two-rescuer infant CPR.

a. Place both thumbs side by side over the lower half of the sternum.

b. Do not compress on or near the xiphoid process.

XIV. Interrupting CPR

A. CPR is an important “holding action.”

1. No matter how well it is performed, however, CPR is rarely enough to save a patient’s life.

2. If ALS is not available at the scene, provide immediate transport.

B. Try not to interrupt CPR for more than a few seconds.

1. Interrupt CPR at an agreed-upon signal.

2. Do not move the patient until all transport arrangements are made.

XV. Skill Drills

Remember to maintain an adequate instructor-to-student ratio. A ratio of one instructor to six students is recommended by the DOT EMT-B National Standard Curriculum. Also remember that each student is to be evaluated on each skill before completing the course.

The skills presented in this lesson may be reviewed only if your students have already completed a BLS-CPR certification program. If students still require certification, then you may follow the skills contained in this lesson or those provided by the American Heart Association.

The infant/child CPR skills are noted in this activity; however, the skill drills can be found in Chapter 32:Pediatric Assessment and Management.

Purpose

To allow students opportunity to observe, practice, and perform patient care skills associated with basic life support.

Materials Needed

1. BSI supplies (gloves, mask, goggles, gowns)

2. CPR manikins (adult, child, infant)

3. Airway resuscitation equipment (assorted airways, BVM devices, oxygen-powered devices)

Instructor Directions

1. Demonstrate each skill, placing emphasis on describing to the students any critical points or procedures.

2. Based on the specific skill, assign each student to a partner or team. Provide each partner/team with necessary equipment or materials.

3. Direct students to practice each skill using team members as patients and observers. Closely monitor the practice sessions and provide constructive comments and direction.

4. As individual students achieve success, conduct skill proficiency exams. Students who fail the exam should be given direction and opportunity to practice before being retested.

Skills

A. Positioning the Patient (Skill Drill A-1)

B. Performing Chest Compressions (Skill Drill A-2)

C. Performing One-Rescuer Adult CPR (Skill Drill A-3)

D. Performing Two-Rescuer Adult CPR (Skill Drill A-4)

Note: The following skills are associated with pediatric resuscitation and can be found in Chapter 32.

E. Performing Infant Chest Compressions

F. Performing CPR on a Child

I. Lesson Review

A. What are the three focal points of BLS? (Lecture I-A-1)

B. List the causes of respiratory arrest in children and infants. (Lecture III-B-4)

C. Describe the obvious signs of irreversible/biological death. (Lecture IV-A-1)

D. Define the acronym STOP (Lecture IV-B-1)

E. Describe the head tilt––chin lift maneuver. (Lecture VI-B-1)

F. Describe the jaw-thrust maneuver. (Lecture VI-B-2)

G. Describe the methods for removing a foreign body airway obstruction. (Lecture VII)

H. Describe the preferred method for ventilating an infant. (Lecture IX-E-4)

I. Describe the recovery position. (Lecture IX-F)

J. List the ratio of ventilations to compressions for an adult with one and two rescuers. (Lecture XI/XII)

K. List the ratio of ventilations to compressions for a child and infant. (Lecture XIII)

II. Instructor Keyed Quiz

1. When considering which CPR technique to use, what is the age range for a child?

Answer: 1 to 8 years of age  p. A-6

2. Under what situations would you not begin CPR?

Answer: rigor mortis; dependent lividity; decomposition; evidence of nonsurvivable injury; patient has a valid DNR or “no CPR” order  p. A-6

3. What does the acronym STOP stand for?

Answer: patient Starts breathing, patient is Transferred, you are Out of strength, a Physician assumes responsibility  
p. A-8

4. Over how much time should a rescue breath be delivered for an adult?

Answer: 2 seconds  p. A-17

5. What complications may arise from chest compressions?

Answer: fractured ribs, lacerated liver, fractured sternum  p. A-21

6. When is the best time to switch positions when performing two-person CPR?

Answer: during pulse checks  p. A-27

7. How deep are chest compressions for an infant?

Answer: 1/2˝ to 1˝  p. A-28

8. For which patients are chest thrusts appropriate?

Answer: women in advanced pregnancy, obese patients, and children younger than 1 year  p. A-13

9. If a patient has a partial airway obstruction with good air exchange, what should you do?

Answer: encourage the patient to cough; simply stay with and monitor the patient; give 100% oxygen using a nonrebreathing mask; provide prompt transport  p. A-14

Student Quiz

1. When considering which CPR technique to use, what is the age range for a child?

2. Under what situations would you not begin CPR?

3. What does the acronym STOP stand for?

4. Over how much time should a rescue breath be delivered for an adult?

5. What complications may arise from chest compressions?

6. When is the best time to switch positions when performing two-person CPR?

7. How deep are chest compressions for an infant?

8. For which patients are chest thrusts appropriate?

9. If a patient has a partial airway obstruction with good air exchange, what should you do?