BLS/CPR Study Guide
This study guide prepares you for the
AHA Healthcare Provider exam.
Revised April 2011
Important!
• “CPR recertification is required every two years. Employees
are expected to maintain current certification for jobs
requiring CPR”.
• “Failure to do so will result in a written warning and
removal of the employee from the work schedule until such
time that the certification is renewed. PTO may NOT be
used during these periods.”
• You may speak to your supervisor if you have any questions.
• It is important to register for CPR, the classes are limited in
size. If you are unable to attend class, please un-enroll to
allow others to take your place
Call Education Department if you are unsure how to enroll/un-enroll. x1847
Learning Objectives
• Name the links in the American Heart Association Adult & Pediatric Chain
of Survival
• List the C – A – B ‘s of CPR
• Show and tell the basic steps of one and two rescuer adult, child and infant
CPR
• Show and tell the proper use of an AED for adult, child, and infant victims
• Discuss the correct method of opening the airway when head or neck injury
is suspected.
• Discuss the proper technique for rescue breathing of adults, children, and
infants.
• Identify the proper compression depth, compression rate and compressionto-ventilation ratio for adult, child and infant CPR.
• Discuss common signs of airway obstruction (choking).
• Relieve choking in responsive and unresponsive victims of all ages.
• Discuss compression rate and ventilation with advanced airway in place
• How to give mouth to mouth breaths.
The Adult Chain of Survival
Immediate recognition of cardiac arrest and activation
of the emergency response system.
Early CPR with an emphasis on chest compressions.
Rapid defibrillation.
Effective advanced life support.
Integrated post-cardiac arrest care.
The Pediatric Chain of Survival




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Prevention of arrest
Early high-quality bystander CPR
Rapid activation of the EMS system
Effective advanced life support
Integrated post-cardiac arrest care
STEPS OF CPR
C = Chest Compressions
A = Airway
B = Breathing
Defibrillation
The course focuses on team-based CPR. Many
work places and most EMS and in hospital
resuscitation involves teams of providers who
should perform several actions simultaneously.
CHANGE IN SEQUENCE
Not ABC
The 2010 AHA Guidelines for CPR and ECC
recommend a change in the BLS sequence of steps
from A-B-C(airway, breathing, chest compressions)
to C-A-B(chest compressions, airway, breathing) for
adults, children, and infants.
Assessment & Scene Safety
• Make sure the scene is safe for you and the victim.
This should be done when the rescuer first sees a
potential victim.
STEP
• Do not move the victim while CPR is in progress
unless the victim is in dangerous environment.
• Tap the victims shoulder and shout, “Are you all
right?”
• Check to see if the victim is breathing. If the victim
is not breathing or not breathing normally (i.e.,
only gasping), you must activate emergency
response system, get AED, and return to victim.
Activate the Emergency Response
System and Get an AED
STEP
• If you are alone and find an unresponsive victim
not breathing, shout for help. If no one responds,
activate the emergency response system, get an
AED if available, and return to the victim to check
a pulse and begin CPR (C-A-B sequence).
• In children and infants…if you did not witness the
arrest and are alone, provide 2 minutes of CPR
before leaving the child or infant to activate the
emergency response system and get the AED.
• If the arrest is sudden and witnessed, leave the
child or infant and activate the EMS and get the
AED, and then return.
• Check for a pulse no more than 10 seconds.
• Adult : Carotid pulse
• Child : Carotid or femoral pulse
• Infant : Brachial or femoral pulse
STEP
• In child and infant, if despite adequate oxygenation
and ventilation, the heart rate is <60/min with
signs of poor perfusion, perform cycles of
compressions and breaths (30:2 ratio), starting with
compressions.
If you do not definitely feel a pulse within 10 seconds,
Start Compressions.
COMPRESSION RATE FOR ALL VICTIMS IS 100/MIN
START CHEST COMPRESSIONS
IT IS IMPORTANT TO PUSH THE CHEST HARD AND FAST, AT A RATE
OF 100 COMPRESSIONS PER MINUTE.
COMPRESSION LANDMARKS
ADULT – BREASTBONE IN CENTER CHEST
CHILD –BREAST BONE IN CENTER CHEST
INFANT – JUST BELOW NIPPLE LINE CENTER CHEST
STEP
COMPRESSION DEPTH
ADULT – AT LEAST 2 INCHES
CHILD – ABOUT 2 INCHES (1/3 DIAMETER OF CHEST)
INFANT – AT LEAST 1 ½ INCHES (1/3 DIAMETER OF CHEST)
**APPROPRIATE DEPTH DURING CPR IS NEEDED TO CREATE
BLOOD FLOW**
Compression/Ventilation Ratio
Child/Infant Victim
1 rescuer
30 to 2
Adult Victim
1 or 2 rescuer
30 to 2
(30 compressions to 2 breaths)
(30 compressions to 2 breaths)
2 rescuer
15 to 2
(15 compressions to 2 breaths)
Airway
• For Adult, Child, or Infant: Use Head Tilt-Chin
Lift technique is the best way to open the
airway when cervical spine injury is not
suspected
• For Suspected Trauma with Cervical Spine
Injury: Use Jaw Thrust without head extension
• If Jaw Thrust does not open airway, use a Head
Tilt-Chin Lift technique
Breaths
• The victim in cardiac arrest may demonstrate agonal gasps.
Agonal gasps are not adequate breathing.
• Adult, child or infant; 2 breaths at 1 second per breath,
watching for chest rise. Adequate ventilation is seen when
chest rise is observed in any victim.
• Standard precautions include using barrier devices, such as a
face mask or a bag-mask device, when giving breaths.
– **A lone rescuer should never use a bag-mask device for the rescue,
only 2 rescuer teams should use the bag-mask device.
– **For mouth-to-mouth ventilation, rescuer opens the airway, seals his
or her mouth over the victim’s mouth, pinches the victims nose closed,
and give 2 breaths while watching for chest rise.
– **When using bag/mask ventilation to minimize gastric inflation give
a breath just until you see chest rise.
Definitions of Age Groups
• Adult: Puberty and older
• Child: 1 year to onset of puberty
Puberty is defined as:
• Breast development in Girls
• Armpit, chest or facial hair in Boys
• Infant: Under 1 year of age
Rescue Breathing
(Without Chest Compressions – Victim has a pulse)
• Adult: 10 to 12 breaths/minute
– (approximately 1 breath every 5-6 seconds)
• Child: 12 to 20 breaths/minute
– (approximately 1 breath every 3 to 5 seconds)
• Infant: Same as child
Rescue Breathing with CPR
(With Advanced Airway in Place)
• Adults:
– Deliver 100 compressions per minute, continuously
– Do Not pause compressions for ventilations
– Deliver one breath every 6-8 seconds
(8 to 10 breaths per minute)
• Rationale:
– **Rescue breaths are not as important as effective chest
compressions that create blood flow.
– **When chest compressions are interrupted, blood flow
stops and coronary artery perfusion pressure quickly falls.
• Child: Same as adult
• Infant: Same as adult
Circulation Checks
• Perform pulse check < 10 seconds
• Adult: Carotid pulse
• Child: Carotid or Femoral pulse
• Infant: Brachial or Femoral pulse
Compression Method
• For Everyone:
– Push Hard, Push Fast
– Allow complete chest recoil between compressions
– Minimize Interruptions of compressions
• Adult:
– 2 Hands: Heel of 1 hand on chest with other hand on
top
• Child:
– 2 Hands: Heel of 1 hand with second hand on top – OR
– 1 Hand: Heel of 1 hand only
• Infant:
– 1 Rescuer: 2 fingers
– 2 Rescuers: 2 thumbs, encircling hands
Steps of AED Use
1. Power on the AED
2. Attach pads to the victim/plug connector
3. Allow the AED to analyze the rhythm while stopping CPR.
4. Clear the victim and press the shock button if indicated
****If no shock is indicated and immediately after any shock
delivered, rescuers start CPR, beginning with chest
compressions (C-A-B).
AED Use for Adults
• Adult AED pads can be used on adult or children.
• Never use child pads for adult victim.
AED Use for Children from
1-8 years of age and Infants
• Use child pads and a child system, if available, for infants and
for children less than 8 years of age.
• For infants, a manual defibrillator is preferred to an AED for
defibrillation.
• If a manual defibrillator is not available, an AED equipped
with a pediatric dose attenuator is preferred.
• If neither is available, you may use an AED without a pediatric
dose attenuator.
AED Safety
 AEDs are sophisticated, computerized devices that are reliable
and simple to operate, allowing lay persons and healthcare
providers to attempt defibrillation safely.
 If the AED advises a shock, it will tell you to clear the victim.
This is important to avoid injury, such as a shock, to the rescuer
and others near the victim.
 Water is a good conductor of electricity. Do not use an AED in
the water. If there is water on the victim’s chest, quickly wipe
the chest before attaching the electrodes.
 If you identify an implanted defibrillator/pacemaker, place the
AED electrode pad at least 1 inch to the side of the device.
 Do not place AED electrodes directly on top of a medication
patch as it may block delivery of the energy, remove the patch
and clean the area before attaching the pads.
Defibrillation with AED
• For Out of Hospital response for
Adults:
Provide 2 minutes of CPR before
shock, if arrival/response time
(time to defib) is greater than 4-5
minutes and arrest was NOT
witnessed (hypoxic situation).
How Do I Recognize Severe
Airway Obstruction?
•
•
•
•
•
•
Poor air exchange
Increased breathing difficulty
Silent cough
Cyanosis
Inability to speak
Ask 1 question: “Are you choking?”
If victim nods YES, help is needed.
Foreign Body Airway Obstruction
Adults:
• Responsive victim:
Ask 1 question: “Are you choking?” If answer is Yes,
deliver abdominal thrusts.
• If victim with becomes Unresponsive:
– Activate 911(If you are alone, do 5 cycles/2
minutes of CPR, then activate EMS)
– Begin CPR (C-A-B sequence)
– *Look for object in mouth each time the
rescuer opens the airway to deliver breaths and
remove the object (if seen)
– Do Not use blind finger sweeps
Foreign Body Airway Obstruction
Child:
• Responsive Victim:
– Ask 1 question: “Are you choking?” If answer is Yes,
deliver abdominal thrusts.
– If signs of Severe Airway Obstruction are present:
Deliver Abdominal Thrusts
• If victim becomes Unresponsive: (same process as Adult)
– Begin CPR
– Activate 911 (If you are alone do 2 minutes of CPR
then activate 911.
– *Look for object in mouth each time the rescuer
opens the airway to deliver breaths
– Do Not use blind finger sweeps
Foreign Body Airway Obstruction
Infant:
• Responsive Victim:
– If signs of Severe Airway Obstruction are present:
Deliver Back Slaps and Chest Thrusts
• If infant becomes Unresponsive:
– Begin CPR
– Activate 911(If you are alone, do 2 minutes of CPR then
activate 911)
– *Look for object in mouth each time the rescuer opens
the airway to deliver breaths
– Do Not use blind finger sweeps
High Quality CPR
• Start compressions within 10 seconds of recognition
of cardiac arrest.
• Push hard, push fast.
• Allow complete chest recoil after each compression.
• Minimize interruptions in compressions(try to limit
interruptions to <10 seconds).
• Give effective breaths that make chest rise.
• Avoid excessive ventilation.