American Heart Association, San Diego County
Outline For Basic Life Support
I. BASIC INFORMATION
- Why CPR? Nearly 50% of
all deaths are due to cardiovascular disease (978,000), 60%-70% before
hospitalization, often within 2 hours...."The communty has the
potential for being the ultimate coronary care unit."
- Basic Life Support: The
basic life saving first aid technique-recognition & prevention of
heart disease, management of heart and lung cessation, application of the
ABCs of cardiopulmonary resuscitation (CPR) until help arrives.
basis for sudden death and CPR.
- brain's need for
continuous oxygen and how that need is satisfied
- biological and
- Call For Help, who
responds, information required, what response to expect.
- Emergency Phone Numbers,
the 911 system, paramedics, local numbers.
II. HEART ATTACKS-RECOGNITION AND PREVENTION
- Early Warning Signs and
Symptoms Of Heart Attack:
- Denial is common,
causing delay, leading to death, often within 2 hours!
- Pain: crushing,
oppressive, mid chest, often prolonged, perhaps radiating.
- Shortness of
breath, sweating, nausea,
- Apprehension and
feeling of doom.
- Actions To Take if
- If patient has
angina, and carries nitroglycerin, advise victim to take medication.
- it no angina
history, or nitro doesn't relieve, suspect heart attack-get help-activate
EMS or transfer to nearest hospital emergency room & check it out!
- May Progress To Cardiac
Arrest: No pulse, No breathing. Some have a good prognosis, others poor.
CPR is not 100% successful, but is the only alternative.
- Cardiac Risk Factors:
factors: Heredity, Gender, Race, Age.
factors; Cigarette smoking, High blood pressure, Serum cholesterol, lack
of exercise, (High Risk: Diabetes, Prior M.I., Premature Cardiovascular
Factors: Stress, Obesity, Stroke.
- Prudent Heart Living:
"prevention" of heart attacks.
III. STARTING AND STOPPING CPR
- CPR Is Rarely Not
lndicated: the following are not contraindications, flail chest, broken
ribs, open chest wounds, pacemakers, neck injuries, mouth or throat
wounds-the alternative is death.
- If Obviously Dead:
(Beyond doubt; decapitation, rigor mortis, etc.) if unsure, always begin
- CPR Should Be Stopped By
Non-physician Only If:
- P: Physician (MD,
DO, and Coroner) pronounces victim dead and assumes responsibility.
- E: Exhaustion,
rescuer unable to continue without collapsing and no other help is near.
- A: Assistance
arrives (relieved by paramedics or other personnel qualified to continue
efforts at a more advanced level).
- R: Recovery:
(breathing and heartbeat successfully restored).
IV. BASIC LIFE SUPPORT AND CARDIOPULMONARY' RESUSCITATION (ABC'S)
- Check For
Unresponsiveness: gently shake and shout
- Call For Help: Dial 911,
Return and start CPR
- Establish An Airway:
Chin-lift (lifting tongue and epiglottis of back of throat).
- Fingers on bony
part of chin, not soft tissues.
- If there is
concern over neck fracture trauma, use Jaw-Thrust method, NO HEAD TILT!
(see VI-3 below).
- Check For Breathing: 3-5
- Look, Listen. and
Feel, rise and fall of chest, air movement on ear.
- If breathing,
maintain an airway and monitor until EMS response arrives.
- Initiate VentiIations:
Mouth-to-Nose, Mouth-to-Stoma, (Infant; Mouth-to-Mouth & Nose).
- Maintain airway,
pinch nostrils with 2 fingers, deliver 2 slow breaths
- Observe rise and
fall of chest; if obstructed (use steps outlined in V-5 below).
- Check Circulation and
Activate EMS: Carotid or Brachial pulse for 5-1O seconds on adult; Peds,
- Adult & Child
- "neck groove" on closer side with 2 fingers, never use thumb;
lnfant - 2 fingers on inside of upper arm.
- if pulse is
present, continue ventilations only: In adult, every five seconds (10-12
x per minute); child, every 3 seconds (20 x per minute); infant, every 3
seconds (20 x per minute).
- If no pulse,
start full CPR (external chest compressions and ventilations).
- Administering External
- Patient must be
flat on a firm surface (not bed, in water etc.)
- Hand position is
important. Heel of bottom hand on lower half of sternum, above xiphoid;
keep fingers off chest wall; maintain skin-to-skin contact at all times.
- Sternum must be
depressed 1-1/2 to 2"; in average adult for adequate flow.
Artificial circulation is only 20 - 30% of normal).
complications: fractured sternum or ribs, liver laceration.
- After one minute,
check pulse and breathing for 5 seconds, if no pulse, give 2 slow breaths
and continue CPR.
- CPR should not be
interrupted for more than 7 seconds; except in certain circumstances.
- One Rescuer CPR:
- 30:2 compression
to ventilation cycle, at least 100 compressions/minute.
- Useful acronym is
1 and-2-and-3-and 4 and...breathe;, any will do.
- lnfant and Child Variations:
infant 0-1 year, child ages one to puberty.
compression/ventilation cycle: infants 100/minute; child 100/minute.
- 2 fingers for
infant compressions; 1 OR 2 hands for child; hand position is one finger
below nipple line for infant, and on the lower sternum for child.
- Sternum depressed
half the depth of chest.
- Use brachial pulse
between shoulder and elbow of infants (not carotid).
- Avoid over
inflation (gastric distention), watch for rise and fall of chest.
Distress Signal For Choking: throat grasped between thumb and forefinger.
- Airway Anatomy -
Susceptibility To Choking: the leading cause of accidental death.
Coronary"actually airway problem - drinking, inattention, poor
- If victim Is
Inquire: (Are you choking??)-assess good or poor air
If good: do not interfere unless it becomes total,
or condition worsens to poor air exchange (turns blue, weak cough,
If poor air exchange or total obstructions send for
help and begin Heimlich Maneuver.
- If Victim Is
Victim flat on back-open airway by head tilt: tongue
is the #1 airway obstructor!
Do not waste time looking for obstruction, unless
very obvious-immediately attempt to ventilate.
If unsuccessful, reposition head and try again.
Open mouth and finger sweep the throat attempting to
hook object and pull out.
Open airway (head-tilt, chin-lift) and attempt to
If unsuccessful. continue alternation of steps until
EMS response arrives.
- Infant and Child
Modification: 90% of deaths in this group are caused by airway
No blind finger sweeps, in infants and children,
(visualize and grasp): Infants only-5 back slaps and 5 chest thrusts,
- Near Drowning:
cold water (hypothermia), salt/fresh water differences, don't compress in
water, possible neck injury.
- Electric Shock:
victim may still be electrified so turn off power. Use non-conductor to
remove wires, burns, falls.
- Neck Injury: don't
tilt head, use Jaw-Thrust technique only.
Distention: don't relieve unless ventilations are compromised.
- Traumatic Injury:
direct pressure for serious bleeding, If pinned in vehicle don't move
unless victim is in immediate danger.
- Vomiting. turn
entire victim onto side and turn as a unit.
VII. HEALTHCARE PROVIDER SKILLS (PROFESSIONAL
- Two Rescuer CPR:
Opposite sides of victim is best; at end of 30:2
compression/ventilation cycle, rescuer #1 opens airway and verifies lack of
pulse and breathing for 5 seconds if no pulse, give I breath.
Rescuer #2 may come in at any point.
30:2 compression-to-ventilation cycle (100
Position: If compressor becomes fatigued, rescuers should exchange
positions as soon as possible.
- Cricoid Pressure:
area of adams apple on throat, two+ rescuers only.
- Mouth to Mask:
Insure tight seal over mouth (and nose). Watch for adequate ventilation.