CPR

2010 Sequence of Chest compression : A- Airway ,B- Breathing, C- chest Compression

(ABC) After 2015 that had changed : C-Compression , A- Airway , B – breathing ( CAB)

Ratio of Chest compression Two Rescue breath for one rescue CPR in all age group and for
two rescue CPR in adult

15 Chest compression to 2 rescue breath two rescuer CPR in children and infant

BLS for adults focuses on doing several tasks simultaneously. In previous versions of BLS,the focus was
primarily on one-rescuer CPR. In many situations, more than one person is available to do CPR. This
simultaneous and choreographed method includes performing chest compressions, managing the
airway, delivering rescue breaths, and using the AED, all as a team.
By coordinating efforts, a team of rescuers can save valuable seconds when time lost equals damage to
the heart and brain.

Simple Adult BLS Algorithm

CPR Steps

 Check for the carotid pulse

 Give Compression
  Between each compression , You completely Stop pressing on the chest and aloe the chest wall to
return to its natural position
 Stop After 30 compression
 Open the airway by using the head –tilt-chin –lift maneuver
 Don’t do the head –tilt-chin –lift maneuver if you think that the individual may have a neck injury
 Jaw- Thrust maneuver
 Give a breath while watching their chest raise up , repeat while giving the second breath
 Resume the chest compression

Be Safe

 Move the person out of traffic.

 Move the person out of water and dry the person. (Drowning persons should be
removed from the water and dried off; they should also be removed from
standing water, such as puddles, pools, gutters, etc.)
 Be sure you do not become injured yourself.

Assess the Person

 Shake the person and talk to them loudly.
 Check to see if the person is breathing. (Agonal breathing, which is occasional
gasping and is ineffective, does not count as breathing.)

Call EMS
 Send someone for help and to get an AED.
 If alone, call for help while assessing for breathing and pulse. (The ILCOR
emphasizes that cell phones are available everywhere now and most have a
built-in speakerphone. Call for help without leaving the person.)

CPR

 Check pulse.
 Begin compressions and delivering breaths.

Defibrillate
 Attach the AED when available.
CPR STEPS

1. Check for the carotid pulse on the side of the neck. Keep in mind to not waste time trying
to feel for a pulse; feel for 5 but no more than 10 seconds. If you are not sure you feel a
pulse, begin CPR with a cycle of 30 chest compressions and two breaths (Figure 4a).
2. Use the heel of one hand on the lower half of the sternum in the middle of the
chest (Figure 4b).
3. Put your other hand on top of the first hand. (Figure 4c).
4. Straighten your arms and press straight down (Figure 4d). Compressions should be at
least two inches into the person’s chest and at a rate of 100 to 120 compressions per
minute.
5. Be sure that between each compression you completely stop pressing on the chest and
allow the chest wall to return to its natural position. Leaning or resting on the chest
between compressions can keep the heart from refilling in between each compression and
make CPR less effective.
6. After 30 compressions, stop compressions and open the airway by tilting the head and
lifting the chin (Figure 4e, 4f, 4g).
o a. Put your hand on the person’s forehead and tilt the head back.
o b. Lift the person’s jaw by placing your index and middle fingers on the lower
jaw; lift up.
o c. Do not perform head-tilt/chin-lift maneuver if you suspect the person may have
a neck injury. In that case the jaw-thrust is used.
o d. For the jaw-thrust maneuver, grasp the angles of the lower jaw and lift it with
both hands, one on each side, moving the jaw forward. If their lips are closed,
open the lower lip using your thumb.
7. Give a breath while watching the chest rise. Repeat while giving a second breath. Breaths
should be delivered over one second.
8. Resume chest compressions. Switch quickly between compressions and rescue breaths to
minimize interruptions in chest compressions.
CPR STEPS

கழுத்தின் பக்கத்தில் உள்ள கரோடிட் துடிப்பு சரிபார்க்கவும். ஒரு துடிப்புக்கு உணர

முயற்சிக்கும் நேரத்தை வணாக்காதீ
ீ ர்கள் என்பதை நினைவில் கொள்ளுங்கள்; 5 க்கு
உணருங்கள், ஆனால் 10 வினாடிகளுக்கு மேல் இல்லை. நீங்கள் ஒரு துடிப்பு
உணர்கிறீர்கள் என்று உறுதியாக தெரியவில்லை என்றால், 30 மார்பு சுருக்கங்கள் மற்றும்
இரண்டு சுவாசங்களின் சுழற்சியுடன் சிபிஆரைத் தொடங்குங்கள் (படம் 4 அ).மார்பின்
நடுவில் உள்ள ஸ்டெர்னத்தின் கீ ழ் பாதியில் ஒரு கையின் குதிகால் பயன்படுத்தவும்
(படம் 4 பி).உங்கள் மற்றொரு கையை முதல் கையின் மேல் வைக்கவும். (படம் 4 சி).
உங்கள் கைகளை நேராக்கி நேராக கீ ழே அழுத்தவும் (படம் 4 டி). அமுக்கங்கள் நபரின்
மார்பில் குறைந்தது இரண்டு அங்குலங்கள் மற்றும் நிமிடத்திற்கு 100 முதல் 120
சுருக்கங்கள் என்ற விகிதத்தில் இருக்க வேண்டும்.ஒவ்வொரு சுருக்கத்திற்கும் இடையில்
நீங்கள் மார்பில் அழுத்துவதை முற்றிலுமாக நிறுத்திவிட்டு, மார்புச் சுவரை அதன்
இயல்பான நிலைக்குத் திரும்ப அனுமதிக்கிறீர்கள் என்பதை உறுதிப்படுத்திக்
கொள்ளுங்கள். அமுக்கங்களுக்கிடையில் மார்பில் சாய்வது அல்லது ஓய்வெடுப்பது
ஒவ்வொரு சுருக்கத்திற்கும் இடையில் இதயத்தை மீ ண்டும் நிரப்புவதைத் தடுக்கிறது
மற்றும் சிபிஆரை குறைவான செயல்திறன் கொண்டதாக மாற்றும்.30 அமுக்கங்களுக்குப்
பிறகு, சுருக்கங்களை நிறுத்தி, தலையை சாய்த்து கன்னத்தை தூக்குவதன் மூலம்
காற்றுப்பாதையைத் திறக்கவும் (படம் 4 ஈ, 4 எஃப், 4 கிராம்).a. நபரின் நெற்றியில் கை
வைத்து தலையை பின்னால் சாய்த்துக் கொள்ளுங்கள்.b. உங்கள் ஆள்காட்டி மற்றும்
நடுத்தர விரல்களை கீ ழ் தாடையில் வைப்பதன் மூலம் நபரின் தாடையை உயர்த்தவும்;
மேலே தூக்கு.c. நபருக்கு கழுத்தில் காயம் இருக்கலாம் என்று நீங்கள் சந்தேகித்தால்,
தலை-சாய் / கன்னம்-தூக்கும் சூழ்ச்சி செய்ய வேண்டாம். அந்த வழக்கில் தாடை-உந்துதல்
பயன்படுத்தப்படுகிறது.d. தாடை-உந்துதல் சூழ்ச்சிக்கு, கீ ழ் தாடையின் கோணங்களைப்
புரிந்துகொண்டு, இரு கைகளாலும், ஒவ்வொரு பக்கத்திலும் ஒன்று, தாடையை
முன்னோக்கி நகர்த்தவும். அவற்றின் உதடுகள் மூடப்பட்டிருந்தால், உங்கள்
கட்டைவிரலைப் பயன்படுத்தி கீ ழ் உதட்டைத் திறக்கவும்.மார்பு உயர்வதைப்
பார்க்கும்போது ஒரு மூச்சு கொடுங்கள். இரண்டாவது மூச்சு கொடுக்கும்போது மீ ண்டும்
செய்யவும். ஒரு நொடிக்கு மேல் சுவாசம் வழங்கப்பட வேண்டும்.மார்பு சுருக்கங்களை
மீ ண்டும் தொடங்குங்கள். மார்பு சுருக்கங்களில் உள்ள குறுக்கீ டுகளைக் குறைக்க
சுருக்கங்களுக்கும் மீ ட்பு சுவாசங்களுக்கும் இடையில் விரைவாக மாறவும்.

Many times there will be a second person available that can act as a rescuer. The
ILCOR emphasizes that cell phones are available everywhere now and most have a
built-in speakerphone. Direct the second rescuer to call 911 without leaving the person
while you begin CPR. This second rescuer can also find an AED while you stay with the
person. When the second rescuer returns, the CPR tasks can be shared:

1. The second rescuer prepares the AED for use.

2. You begin chest compressions and count the compressions out loud.
3. The second rescuer applies the AED pads.
4. The second rescuer opens the person’s airway and gives rescue breaths.
5. Switch roles after every five cycles of compressions and breaths. One cycle
consists of 30 compressions and two breaths.
 6. Be sure that between each compression you completely stop pressing on the
chest and allow the chest wall to return to its natural position. Leaning or resting
on the chest between compressions can keep the heart from refilling in between
each compression and make CPR less effective. Rescuers who become tired
may tend to lean on the chest more during compressions; switching roles helps
rescuers perform high-quality compressions.
7. Quickly switch between roles to minimize interruptions in delivering chest
compressions.
8. When the AED is connected, minimize interruptions of CPR by switching
rescuers while the AED analyzes the heart rhythm. If a shock is indicated,
minimize interruptions in CPR. Resume CPR as soon as possible.

Adult Mouth-to-Mask and Bag-Mask Ventilation (5A)

ADULT MOUTH-TO-MASK VENTILATION (5A)

In one-rescuer CPR, breaths should be supplied using a pocket mask, if available.

1. Give 30 high-quality chest compressions.

2. Seal the mask against the person’s face by placing four fingers of one hand across the top of the
mask and the thumb of the other hand along the bottom edge of the mask (Figure 5a).
3. Using the fingers of your hand on the bottom of the mask, open the airway using the head-
tilt/chin-lift maneuver. (Do not do this if you suspect the person may have a neck injury) (Figure
5b).
4. Press firmly around the edges of the mask and ventilate by delivering a breath over one second as
you watch the person’s chest rise. (Figure 14c).
5. Practice using the bag-valve-mask; it is essential to forming a tight seal and delivering
effective breaths.
Figure 6
If two people are present and a bag-mask device is available, the second rescuer is
positioned at the victim’s head while the other rescuer performs high-quality chest
compressions. Give 30 high-quality chest compressions.

1. Deliver 30 high-quality chest compressions while counting out loud (Figure 6a).

2. The second rescuer holds the bag-mask with one hand using the thumb and
index finger in the shape of a “C” on one side of the mask to form a seal between
the mask and the face, while the other fingers open the airway by lifting the
person’s lower jaw (Figure 5b).
3. The second rescuer gives two breaths over one second each (Figure 6c).

Adult Basic Life Support (BLS) Algorithm

Adult BLS Algorithm

Ventricular fibrillation, caused by disorganized electrical activity in the main pumping
chambers of the heart, is a common cause of cardiac arrest. The treatment for
ventricular fibrillation is defibrillation or the delivery of an electric shock to the heart
through the person’s chest wall. This shock attempts to stop the disorganized electrical
activity and allow the heart’s normal rhythm to resume.

The automated external defibrillator (AED) is a device that recognizes ventricular

fibrillation and other dysrhythmias and delivers an electric shock at the right time. The
AED has become a common sight in public buildings. The AED is nearly foolproof and
will not allow you to make a mistake. It is safe for anyone to use. In a witnessed cardiac
arrest, where the person is observed to suddenly collapse, the most common cause is
likely to be ventricular fibrillation and a defibrillator should analyze the person as soon
as possible.

Using the team concept, one rescuer should coordinate all available rescuers so that
one rescuer performs chest compressions while the second rescuer prepares the AED
for use. Although there are many different brands of AEDs, all are utilized in a similar
way. Be sure to move the person and yourself to a safe place before using the AED.
Electricity and water can be lethal when combined. Ensure that the person is not wet
(quickly wipe dry) or in close proximity to water before using the AED. It is safe to use
an AED if the person is lying in snow. If the person has an implanted device, such as a
pacemaker, you will see a bulge over their chest. Place the defibrillator pads as close to
the correct position as possible without being directly over the device. For persons with
medication patches, remove the patch, wipe the skin dry, and apply the AED pad.
AED STEPS

1. Retrieve the AED (Figure 8a).

o a. Open the case
o b. Turn on the AED
2. Expose the person’s chest (Figure 8b).
o a. If wet, dry chest.
o b. Remove medication patches.
3. Open the AED pads (Figure 8c).
o a. Peel off backing.
o b. Check for pacemaker or defibrillator
4. Apply the pads (Figure 8d).
o a. Apply one pad on upper right chest above the breast.
o b. Apply the second pad on lower left chest below the armpit.
5. Ensure the wires are attached to the AED box (Figure 8e).
6. Move away from the person (Figure 8f).
o a. Stop CPR.
o b. Clear the person. Tell others not to touch the person.

BLS for Children 1 – 8 Years

Many similarities exist between the BLS guidelines for Adults and Children. The
main differences between the two are:

 For children, if two rescuers are available to do CPR, the compression to breaths ratio is 15:2; if
only one rescuer is available, the ratio is 30:2 for all age groups.
 For very small children, you can use one-handed chest compressions.
 The depth of compression may be different. For a child, compress the chest at least one-third the
depth of the chest. This may be less than two inches for small children, but will be approximately
two inches for larger children.
 If you are the only person at the scene and find an unresponsive child, perform CPR for two
minutes BEFORE you call EMS or go look for an AED.
 In children, primary cardiac events are not common. Cardiac arrest is most commonly preceded
by respiratory problems. Survival rates improve with early intervention for respiratory problems.
Remember that prevention is the first link in the Pediatric Chain of Survival!
 If you witness a cardiac arrest in a child, call EMS and get an AED just as you would in the Adult
BLS sequence.
 
One & Two Rescuer BLS for Children
If you are alone with a child at the scene, do the following:

1. Tap and talk loudly to the child to determine if they are responsive.

2. Assess if they are breathing.
3. If the child does not respond and is not breathing (or only gasping), yell for help.
If someone answers, send them to call 911 and to get an AED.
4. Feel for the child’s carotid pulse (on the side of the neck) or femoral pulse (on the
inner thigh in the crease between their leg and groin) for 5 but no more than 10
seconds.
5. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30
compressions followed by two breaths. If you can feel a pulse but the pulse rate
is less than 60 beats per minute, you should begin CPR. This rate is too slow for
a child.
6. After doing CPR for about two minutes (usually about five cycles of 30
compressions and two breaths), and if other help has not arrived, call EMS while
staying with the child. The ILCOR emphasizes that cell phones are available
everywhere now and most have a built-in speakerphone. Get an AED if you know
where one is.
7. Use and follow AED prompts when available while continuing CPR until EMS
arrives or until the child’s condition normalizes.
TWO-RESCUER BLS FOR CHILDREN

f you are not alone with a child at the scene, do the following:

1. Tap and talk loudly at the child to determine if they are responsive.

2. Assess if they are breathing.
3. If the child does not respond and is not breathing (or if only gasping), have the
second rescuer call 911 and get an AED. (The ILCOR emphasizes that cell
phones are available everywhere now and most have a built-in speakerphone, so
you or the second rescuer can call 911 without leaving the scene)
4. Feel for the child’s carotid pulse (on the side of the neck) or femoral pulse (on the
inner thigh in the crease between their leg and groin) for 5 but no more than 10
seconds.
5. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30
compressions followed by two breaths.
 6. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR.
This rate is too slow for a child.
7. When the second rescuer returns, begin doing CPR by performing 15
compressions by one rescuer and two breaths by the second rescuer.
8. Use and follow AED prompts when available while continuing CPR until EMS
arrives or until the child’s condition normalizes.

Child Ventilation
If masks are available, they should be used in children as in adults; however, you must ensure
the mask is the correct size for the child. The mask should cover the child’s mouth and nose
without covering the eyes or chin. You will not be able to get a good seal with a mask that is too
big. As with an adult, use the head-tilt/chin-lift maneuver to open the child’s airway. Each breath
should last one second and should cause the child’s chest to rise. As with an adult, avoid giving
breaths too quickly, as this may result in distention of the stomach, vomiting, and possible
aspiration of stomach contents

One & Two Rescuer BLS for Infants (0 to 12 months old)

BLS for both children and infants is almost identical. For example, if two rescuers are
available to
perform CPR, the breath to compression ratio is 15:2 for both children and infants. (The
ratio is 30:2
for all age groups if only one rescuer is present.) Following are the main differences
between BLS for
children and BLS for infants:

 Check the pulse in the infant using the brachial artery on the inside of the upper
arm between the infant’s elbow and shoulder. (Figure 11a)
 During CPR, compressions can be performed on an infant using two
fingers (Figure 11b), if only one rescuer; or with two thumb-encircling
 hands (Figure 11c), if there are two rescuers
and rescuer’s hands are big enough to go around the infant’s chest.
 Compression depth should be one third of the chest depth; for most infants, this
is about 1.5 inches.
 If you are the only rescuer at the scene and find an unresponsive infant, perform
CPR for two minutes before calling 911 or using an AED.
 In infants, primary cardiac events are not common. Usually, cardiac arrest will be
preceded by respiratory problems. Survival rates improve when you intervene
with respiratory problems as early as possible. Remember that prevention is the
first step in the Pediatric Chain of Survival.
 If you witness a cardiac arrest in an infant, call 911 and get an AED as you would
in the BLS sequence for adults or children.

ONE PERSON COMPRESSION

If you are alone with the infant at the scene, do the following:

 Tap and talk loudly at the infant to determine if they are responsive.

 Assess if they are breathing (Figure 11d).
 If the infant does not respond and is not breathing (or only gasping), yell for help.
If someone responds, send the second rescuer to call 911 and get an AED. (The
ILCOR emphasizes that cell phones are available everywhere now and most
have a built-in speakerphone, so rescuers do not have to leave the scene).
 Feel for the infant’s brachial pulse for 5 but no more than 10 seconds (Figure
11e).
 If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30
compressions followed by two breaths. If you can feel a pulse but the rate is less
 than 60 beats per minute, begin CPR. This rate is too slow for an infant. To
perform CPR on an infant, do the following:
o a. Be sure the infant is face-up on a hard surface.
o b. Using two fingers, perform compressions in the center of the infant’s
chest (Figure 11f); do not press on the end of the sternum as this can cause injury
to the infant.
o c. Compression depth should be about 1.5 inches and at least 100 per minute.
 Perform CPR for about two minutes (usually about five cycles of 30
compressions and two breaths). If help has not arrived, call 911 and get an AED.
(The ILCOR emphasizes that cell phones are available everywhere now and
most have a built-in speakerphone, so you can call while attending to the infant.)
 Use and follow AED prompts when available while continuing CPR until EMS
arrives or until the infant’s condition normalizes.

 Automated External Defibrillator (AED) Infants & Children

An AED can be used on children and infants and should be used as early as possible for the
best chance of improving survival. Check the AED when it arrives at the scene. Pediatric pads
should be used if the person is less than eight years old. Standard (adult) pads may be used if
pediatric pads are not available. If using standard (adult) pads, do not let the pads touch. For
infants less than a year old, a manual defibrillator should be used if available. If a manual
defibrillator is not available, an AED may be used. Some AEDs have a switch that can be set to
deliver a pediatric shock. If available, turn the switch on when using on children younger than
eight years old. If the AED cannot deliver a pediatric shock, an adult shock should be given. It is
important to remember an electric shock may be the cure for a fatal heart rhythm.
AED STEPS FOR CHILDREN AND INFANTS

1. Retrieve the AED (Figure 12a).

o a. Open the case.
o b. Turn on the AED.
2. Expose the person’s chest (Figure 12b).
o a. If wet, dry the chest.
o b. Remove the medication patches.

3. Open the Pediatric AED pads (Figure 12c).

 a. Peel off backing.

 b. Check for pacemaker or defibrillator.

4. Apply the pads (Figure 12d).

a. Apply one pad on the upper right chest above the breast. For infants,apply on upper left chest

b. Apply the second pad on lower left chest below the armpit. For infants, apply second pad to
back (Figure 12e).

5. Ensure wires are attached to the AED box (Figure 12f).

6. Move away from the person (Figure 12g).

 a. Stop CPR.
 b. Instruct others not to touch the person.

7. Let AED analyzes the rhythm.

8. If AED message reads “Check Electrodes,” then:

a. Ensure electrodes make good contact.

9. If AED message reads “Shock,” then:

 a. Press and hold flashing shock button until shock is delivered.

10. Resume CPR for two minutes (Figure 12h).

11. Repeat steps 1-10.

 Airway Management

Take Note
The compression rate for all persons is always at least 100 per minute.

COMPRESSION TO NO ADVANCED
ADVANCED AIRWAY
BREATH RATIO AIRWAY

30 compressions
Adult
followed by two breaths One breath every 6 to 8
seconds without pauses
15 compressions in compressions
Child/Infant
followed by two breaths

Table 1

Mouth-to-Mouth Rescue Breathing

When a pocket mask or bag-mask is not available, it may be necessary to give mouth-to-mouth

breaths during CPR. Mouth-to-mouth breathing is very effective in delivering oxygen into the

person’s lungs without putting the rescuer at a high level of risk. The rescuer’s exhaled air

contains approximately 17% oxygen and 4% carbon dioxide. This is in contrast to the 100%

oxygen available with ventilation with 100% high flow oxygen.