Cognitive Objectives
(1 of 4)
1. Identify the need for basic life support, including
the urgency surrounding its rapid application.
2. List the EMT-B’s responsibilities in beginning and
terminating CPR.
3. Describe the proper way to position an adult
patient to receive basic life support.
4. Describe the proper way to position an infant and
child to receive basic life support.
Cognitive Objectives (2 of 4)
5. Describe three techniques for opening the airway
in an infant, child, and adult.
6. List the steps in providing artificial ventilations in
an infant, child, and adult.
7. Describe how gastric distention occurs.
8. Define the recovery position.
9. Describe infectious disease issues related to
rescue breathing.
Cognitive Objectives
(3 of 4)
10. List the steps in providing chest compressions in
an adult.
11. List the steps in providing chest compressions in
an infant and child.
12. List the steps in providing one-rescuer CPR in
an infant, child, and adult.
13. List the steps in providing two-rescuer CPR in
an infant, child, and adult.
Cognitive Objectives (4 of 4)
14. Distinguish foreign body obstructions from other
conditions that cause respiratory failure.
15. Distinguish a complete airway obstruction from a
partial airway obstruction.
16. Describe the steps in removing a foreign body
obstruction in an infant, child, and adult.
Affective Objectives
17. Recognize and respect the feelings of the
patient and family during basic life support.
18. Explain the urgency surrounding the rapid
initiation of basic life support measures.
19. Explain the EMT-B’s responsibilities in starting
and terminating CPR.
20. Explain the rationale for removing a foreign body
obstruction.
Psychomotor Objectives (1 of 2)
21. Demonstrate how to position the patient to open
the airway.
22. Demonstrate how to perform the head tilt-chin
lift maneuver in an infant, child, and adult.
23. Demonstrate how to perform the jaw-thrust and
modified jaw-thrust maneuvers in infants,
children, and adults.
24. Demonstrate how to place a patient in the
recovery position.
Psychomotor Objectives (2 of 2)
25. Demonstrate how to perform chest
compressions in an adult.
26. Demonstrate how to perform chest
compressions in an infant and child.
27. Demonstrate how to perform one-rescuer CPR
in an infant, child, and adult.
28. Demonstrate how to perform two-rescuer CPR
in an infant, child, and adult.
29. Demonstrate how to remove a foreign body
obstruction in an infant, child, and adult.
BLS Review
• Airway
• Breathing
• Circulation
Elements of Basic Life Support
AED Use
• Consider use when medical cardiac arrest is
suspected.
• Should not be used on children younger than
1 year of age.
• Pediatric pads and equipment should be
used if available for children younger than 8
years.
Initial Assessment
• Determine responsiveness.
• An alert and oriented patient does
not need CPR.
• You may also suspect cervical
spine injury.
• Protect the spine.
Age Guidelines
• Anyone younger than 1 year is
considered an infant.
• A child is between 1 year and
the onset of puberty.
• Adulthood is from the onset of
puberty and older.
When BLS Should Not Be Started
• BLS should not be started if the following situations
exist:
– Rigor mortis or stiffening of the body
– Dependent lividity
– Putrefaction or decomposition of the body
– Evidence of a nonsurvivable injury
– Existing DNR or no-CPR order
When Should CPR Be Stopped?
• S — Patient Starts breathing and has a
pulse
• T — Patient is Transferred to another
person
• O — You are Out of strength
• P — A Physician asks you to stop
Positioning the Patient
• Kneel beside the patient.
• First EMT-B: Place your hands behind the
patient’s back, head, and neck.
• Second EMT-B: Place your hands on the distant
shoulder and hip and turn the patient toward you.
• First EMT-B: Control the head and neck and place
the patient in a supine position.
Opening the Airway (1 of 2)
• Head tilt–chin lift maneuver
Opening the Airway (2 of 2)
• Jaw-thrust maneuver
Opening the Child or Infant Airway
Recognizing an Obstruction
Removing a Foreign Body (1 of 4)
• If the patient is sitting or standing:
– Stand behind the patient.
– Make a fist with one hand.
– Press your fist into the patient’s
abdomen.
– Repeat thrusts in sets of five.
Removing a Foreign Body (2 of 4)
• Chest thrusts
– Stand behind the patient.
– Wrap your arms around the patient’s chest.
– Make a fist with one hand; grasp the fist
with the other hand.
– Press your fist into the patient’s chest with
backward thrusts until the object is
expelled or patient becomes unconscious.
Removing a Foreign Body (3 of 4)
• If the patient is unconscious:
– Place the patient in a supine position.
– Begin steps of CPR.
– If first ventilation does not produce visible chest
rise, reposition the head.
– If both breaths fail to produce visible chest rise,
perform 30 chest compressions then look in the
mouth.
Removing a Foreign Body (4 of 4)
• If an object is visible,
attempt to remove it.
Do not perform blind finger
sweeps.
• Reattempt to ventilate.
• Continue chest
compressions, opening the
airway and looking inside
the mouth, and attempts to
ventilate until the airway is
clear or ALS help arrives.
Manual Removal
Mild Airway Obstruction
•
•
•
•
Breathing is noisy.
Patient may be coughing.
Encourage patient to cough.
Give 100% oxygen using a
nonrebreathing mask.
• Provide prompt transport.
Removing Foreign Bodies
in Children
Removing Foreign Bodies
in Infants
•
•
•
•
Place one hand on infant’s back and neck.
Deliver five quick back slaps.
Turn infant face up.
Give five quick chest thrusts on the sternum.
Assessing for Breathing
• Open airway.
– Look.
– Listen.
– Feel.
Ventilations
•
•
•
•
•
Use a barrier device.
Open the airway.
Pinch patient’s nostrils together.
Take a deep breath.
Give slow rescue breaths (1 second each).
– Rate of 10-12 breaths/min for adults
Stoma Ventilations
Gastric Distention
• Gastric distention is most likely to occur if:
– You blow too hard as you ventilate.
– You give breaths too rapidly.
– The patient’s airway is obstructed.
Pediatric Needs
• If the child is breathing, let the child
maintain his or her position.
• Ventilate infants using mouth-tonose-and-mouth ventilations.
• Ventilate once every 3 seconds or
20 times per minute.
• If air does not enter freely, check the
airway for obstruction.
Recovery Position
Assess Circulation
• Assess after delivering rescue
breaths.
• Feel for palpable pulse in the carotid
artery.
Chest Compressions
• You can provide artificial circulation by applying
rhythmic pressure and relaxation to the lower
half of the sternum.
• External chest compressions only provide 25%
to 33% of the blood normally pumped.
• Chest compressions must be accompanied by
artificial ventilation.
Hand Position
Performing Chest Compressions
One-rescuer Adult CPR
• Perform initial assessment.
• Determine whether the patient
is breathing.
• Determine whether the patient
has a pulse.
• Place your hands on the chest.
• Give 30 compressions,
followed by two ventilations.
Two-rescuer Adult CPR
•
•
•
•
First EMT-B is positioned at patient’s head.
Second EMT-B is positioned at patient’s side.
First EMT-B delivers two rescue breaths.
Second EMT-B begins chest compressions at a
ratio of 30 compressions to two breaths.
• After 2 minutes, the first EMT-B reassesses
breathing and pulse.
Switching Positions
• Switch during pulse checks.
• First EMT-B moves into position to deliver
compressions after giving two breaths.
• Second EMT-B delivers 30th compression
then moves to patient’s head.
• Second EMT-B checks pulse.
Pediatric Needs
• Opening the airway is
your top priority.
• Assess circulation
using the brachial
artery in infants.
Pediatric Hand Positions
Pediatric Compressions
• Deliver at a rate of 100 per minute.
• Compress the infant or child’s chest 1/3 to
1/2 the depth of the chest.
• Give two breaths every 30 compressions
for one rescuer, and two breaths every 15
compressions for two rescuers.
Interrupting CPR
• CPR is an important holding action.
• Transport immediately if ALS is not available at
the scene.
• Try not to interrupt CPR for more than a few
seconds.
• Do not move the patient until transport
arrangements are made.
Review
1. You respond to the library where a 75-year-old
woman has collapsed and is unconscious. As you
approach her, you can see that she is breathing
inadequately. You should:
A. attach an AED.
B. open her airway.
C. begin rescue breathing.
D. assess for a carotid pulse.
Review
Answer: B
Rationale: The FIRST step in airway management is
to open the airway. Sometimes a simple maneuver,
such as the head tilt-chin lift, can restore adequate
breathing. If manual head positioning does not
restore adequate breathing, begin rescue breathing
and assess for a pulse.
Review
1. You respond to the library where a 75-year-old woman has
collapsed and is unconscious. As you approach her, you can
see that she is breathing inadequately. You should:
A. attach an AED.
Rationale: Only attach an AED after determining that the patient is
pulseless and apneic.
B. open her airway.
Rationale: Correct answer
C. begin rescue breathing.
Rationale: You must open the airway first.
D. assess for a carotid pulse.
Rationale: Assess for a pulse only after opening the airway and
providing rescue breathing.
Review
2. Early, effective basic life support measures are
NOT likely to resuscitate a patient who has:
A. dependent lividity.
B. been struck by lightning.
C. a severe airway obstruction.
D. had a near-drowning accident.
Review
Answer: A
Rationale: Dependent lividity—pooling of blood in
dependent parts of the body—is a sign of obvious
death, and indicates that a person has been dead
for a prolonged period of time. Resuscitation is not
indicated for patients with lividity.
Review
2. Early, effective basic life support measures are NOT likely to
resuscitate a patient who has:
A. dependent lividity.
Rationale: Correct answer
B. been struck by lightning.
Rationale: The patient has a good chance of surviving.
C. a severe airway obstruction.
Rationale: The patient has a good chance of surviving.
D. had a near-drowning accident.
Rationale: The patient has a good chance of surviving.
Review
3. You are performing one-rescuer CPR on a middleaged man in cardiac arrest. What should you do when
a second rescue arrives to assist you?
A. switch to a compression to ventilation ratio of 15:2.
B. apply the AED and deliver up to 3 shocks in a row.
C. stop CPR and check for a pulse for up to 15 seconds.
D. ensure that you switch rescuer roles every 2 minutes.
Review
Answer: D
Rationale: In order to avoid unrecognized rescuer
fatigue, it is important to switch rescuer roles every
2 minutes (five cycles of 30 compressions and 2
breaths in the adult). All adult (one- and tworescuer) and all one-rescuer CPR is performed at a
compression to ventilation ratio of 30:2. If the AED
advises a shock, deliver a single shock and
immediately resume CPR. Pulse checks, if
indicated, should not exceed 10 seconds.
Review
3. You are performing one-rescuer CPR on a middle-aged man in
cardiac arrest. What should you do when a second rescue
arrives to assist you?
A. switch to a compression to ventilation ratio of 15:2.
Rationale: Adult CPR is performed at a ratio of 30:2.
B. apply the AED and deliver up to 3 shocks in a row.
Rationale: An AED will deliver a single shock and then indicate to
continue CPR.
C. stop CPR and check for a pulse for up to 15 seconds.
Rationale: Pulse checks should not exceed 10 seconds.
D. ensure that you switch rescuer roles every 2 minutes.
Rationale: Correct answer
Review
4. When attempting to relieve a severe foreign body
airway obstruction in an unresponsive infant, you
should:
A. deliver 5 back slaps and 5 chest thrusts.
B. sweep the mouth with your finger every 30 seconds.
C. perform chest compressions and visualize the mouth.
D. administer abdominal thrusts until the obstruction is
relieved.
Review
Answer: C
Rationale: Proper treatment for an unresponsive
infant with a severe (complete) foreign body airway
obstruction involves performing chest
compressions (30 if you are alone; 15 if two
rescuers are present), opening the airway and
visualizing the mouth, and attempting to ventilate.
DO NOT perform blind finger sweeps on any
patient—regardless of age. Back slaps and chest
thrusts are appropriate for a responsive infant with
a severe airway obstruction.
Review
4. When attempting to relieve a severe foreign body airway
obstruction in an unresponsive infant, you should:
A. deliver 5 back slaps and 5 chest thrusts.
Rationale: This is only performed on a responsive infant.
B. sweep the mouth with your finger every 30 seconds.
Rationale: Do not perform blind finger sweeps, regardless of the
patient’s age.
C. perform chest compressions and visualize the mouth.
Rationale: Correct answer
D. administer abdominal thrusts until the obstruction is relieved.
Rationale: Abdominal thrusts are not performed on infants. They are
only performed on children and adults.
Review
5. Which of the following ventilation techniques
should be used for a patient who has had a
laryngectomy?
A. Mouth-to-nose
B. Mask-to-stoma
C. Mouth-to-mask
D. Mouth-to-mouth
Review
Answer: B
Rationale: Patients who have had a laryngectomy
(surgical removal of the larynx) often have a
permanent stoma (a hole in the center of the neck)
through which they breathe; they do not breathe
through the nose and mouth. Therefore, mask-tostoma (preferred over mouth-to-stoma) ventilations
would be necessary. If any of the other techniques
listed were used, little or no air would reach the
lungs.
Review
5. Which of the following ventilation techniques should be used
for a patient who has had a laryngectomy?
A. Mouth-to-nose
Rationale: It will be ineffective since little or no air will reach the
lungs.
B. Mask-to-stoma
Rationale: Correct answer
C. Mouth-to-mask
Rationale: It will be ineffective since little or no air will reach the
lungs.
D. Mouth-to-mouth
Rationale: It will be ineffective since little or no air will reach the
lungs.
Review
6. Gastric distention during rescue breathing can be
minimized by:
A. delivering each breath over 1 second.
B. increasing the volume of each breath.
C. delivering at least 24 breaths per minute.
D. allowing partial exhalation in between breaths.
Review
Answer: A
Rationale: Gastric distention—inflation of the stomach
with air—can cause regurgitation of stomach
contents, which may be aspirated into the lungs. To
minimize the incidence of gastric distention, deliver
each rescue breath over a period of 1 second—just
enough to produce visible chest rise—and allow for
complete exhalation. For the adult, give one breath
every 5 to 6 seconds (10 to 12 breaths/min). For
the infant and child, give one breath every 3 to 5
seconds (12 to 20 breaths/min).
Review
6. Gastric distention during rescue breathing can be minimized
by:
A. delivering each breath over 1 second.
Rationale: Correct answer
B. increasing the volume of each breath.
Rationale: Increasing the volume will increase the amount of
gastric distention.
C. delivering at least 24 breaths per minute.
Rationale: Adults are 10 to 12 breaths/min, and children are 12
to 20 breaths/min.
D. allowing partial exhalation in between breaths.
Rationale: Exhalation is a passive process since the patient is
not breathing, allow for complete exhalation.
Review
7. You assess a 56-year-old man and determine that he
is apneic and pulseless. As you begin CPR, his wife
presents you with a living will that appears to be valid.
You should:
A. continue CPR and contact medical control for advice.
B. obtain a signed release from the wife and then stop
CPR.
C. stop CPR if the patient does not respond within 5
minutes.
D. respect the patient's wishes and cease resuscitative
efforts.
Review
Answer: A
Rationale: Advance directives, such as living wills,
express the patient's wishes should he or she
become incapacitated. If you are faced with a
situation in which a cardiac arrest patient’s spouse
or other family member presents you with what
appears to be a valid living will, the safest course of
action is to contact medical control, apprise him or
her of the situation, and request guidance. In most
cases, the physician will permit you to stop CPR if
a valid document is presented.
Review
7. You assess a 56-year-old man and determine that he is apneic
and pulseless. As you begin CPR, his wife presents you with a
living will that appears to be valid. You should:
A. continue CPR and contact medical control for advice.
Rationale: Correct answer
B. obtain a signed release from the wife and then stop CPR.
Rationale: You should contact medical control, the spouse does not
have to sign the release.
C. stop CPR if the patient does not respond within 5 minutes.
Rationale: Only stop CPR with a valid living will and if medical
control authorizes you to discontinue.
D. respect the patient's wishes and cease resuscitative efforts.
Rationale: Cease resuscitative efforts only after authorization from
medical control.
Review
8. After defibrillating a 60-year-old man with the AED,
you should:
A. assess for a carotid pulse.
B. begin rescue breathing.
C. reanalyze his cardiac rhythm.
D. perform CPR for 2 minutes.
Review
Answer: D
Rationale: After defibrillating any patient with the
AED, you should immediately begin or resume
CPR, starting with chest compressions. After 2
minutes of CPR, reanalyze the patient’s cardiac
rhythm and deliver another shock if indicated. If
signs of life are present (ie, coughing, movement),
assess for a carotid pulse.
Review
8. After defibrillating a 60-year-old man with the AED, you
should:
A. assess for a carotid pulse.
Rationale: Assess only if there are signs of life (coughing,
movement).
B. begin rescue breathing.
Rationale: CPR must be started at a ration of 30:2.
C. reanalyze his cardiac rhythm.
Rationale: Reanalyze the cardiac rhythm after 2 minutes of
CPR.
D. perform CPR for 2 minutes.
Rationale: Correct answer
Review
9. Which of the following diseases poses the
GREATEST threat to the EMT-B who performs
mouth-to-mouth rescue breathing without a barrier
device?
A. HIV
B. Hepatitis B
C. Hepatitis C
D. Tuberculosis
Review
Answer: D
Rationale: Tuberculosis (TB) is transmitted by the
droplet route via aerosol transmission; therefore, it
would pose the greatest threat to the EMT-B who
performs mouth-to-mouth rescue breathing without
a barrier device. HIV and hepatitis transmission
could occur, but is much less likely as they are
primarily transmitted via the blood.
Review
9. Which of the following diseases poses the GREATEST threat
to the EMT-B who performs mouth-to-mouth rescue
breathing without a barrier device?
A. HIV
Rationale: It is a bloodborne pathogen and exposure is minimal.
B. Hepatitis B
Rationale: It is a bloodborne pathogen and exposure is minimal.
C. Hepatitis C
Rationale: It is a bloodborne pathogen and exposure is minimal.
D. Tuberculosis
Rationale: Correct answer
Review
10. Which of the following is a basic life support (BLS)
skill?
A. Intubation
B. IV therapy
C. Sellick maneuver
D. Manual defibrillation
Review
Answer: C
Rationale: All levels of EMS provider are trained to
perform the Sellick maneuver (cricoid pressure)—a
technique used to minimize gastric distention
during rescue breathing. Intubation, IV therapy, and
manual defibrillation are advanced life support
skills. Defibrillation with the AED, however, is a
BLS skill.
Review
10. Which of the following is a basic life support (BLS) skill?
A. Intubation
Rationale: This is an ALS skill.
B. IV therapy
Rationale: This is an ALS skill.
C. Sellick maneuver
Rationale: Correct answer
D. Manual defibrillation
Rationale: This is an ALS skill, while using an AED is a BLS
skill.