Marikina

City

Reduction

&

Disaster

Risk

Management

Office

BASIC
SUPPORT -

LIFE

CPR
Administrative and Training Division

LIFE SUPPORT
1. BASIC LIFE SUPPORT (BLS)
- An emergency procedure that consists of recognizing respiratory or
cardiac arrest or both and the proper application of CPR to maintain life
until a victim recovers or advanced life support is available.
2. ADVANCE CARDIAC LIFE SUPPORT (ACLS)
- The use of special equipment to maintain breathing and circulation for
the victim of a cardiac emergency.
3. PROLONGED LIFE SUPPORT (PLS)
- For post resuscitative and long term resuscitation.

SUDDEN CARDIAC ARREST AND CPR AWARENESS

BACKGROUND

HEART DISEASES are the number 1 killer in our

country, accounting for close to 20% of all
causes

of

death

according

Department of Health statistics.

to

the

latest

Approximately half of all deaths from cardiovascular occur as Sudden

Cardiac Arrest.

Sudden Cardiac Arrest

It is associated with low survival rate, and major long term severe
mental impairment due to delays in cardiopulmonary resuscitation

(CPR) and treatment.

Majority of cardiac arrests occur outside the hospital at home, in the
work place, in public institutions.
According

to

the

American

Heart

Association (AHA), almost 80% of out of

hospital cardiac arrest occur at home and
are

witnessed by a family member.

Unfortunately, less than 10 % of sudden

cardiac arrest victims survive

because

majority

of

the

arrest

witnessing

those
are

people who do not know how to

perform CPR.

Sudden Cardiac Arrest

Can happen at anytime, to anyone, anywhere without warning

Most common mode of death in patients with Coronary Artery

Disease
Although pre existing heart disease is a common cause, it may strike

people with no history of cardiac disease or cardiac symptoms.

In sudden cardiac arrest or sudden cardiac death, the heart usually
goes into a fatal arrythmiacalled Ventricular Fibrillation (VF)
wherein

it

suddenly

goes

into

very

irregular

fast

ineffective

contractions, the heart stops beating, the victim loses consciousness,

and if untreated, dies.
THE CHAIN OF SURVIVAL

This is a concept which aims to improve the outcome for victims of

cardiopulmonary arrest.

It involves a series of events which are interconnected to each other like the

Pediatric Chain of Survival

Prevention

Early

Rapid access

of Arrest

CPR

to EMS

Rapid PALS
Support

Integrated
Post-cardiac
Arrest

Care

RESPIRATION AND CIRCULATION

1. The Respiratory System
It delivers oxygen to the body, as well as removes carbon dioxide from the
body. The passage of air into and out of the lungs is called respiration.
Breathing in is called inspiration or inhaling. Breathing out is called expiration
or exhaling.

2. The Circulatory System

It delivers oxygen and nutrients to the bodys tissues and removes
waste products. It consists of the heart, blood vessels, and blood.

Breathing and Circulation

Air that enters the lungs contains:

21% O2
trace
of CO2
Air
exhaled
from

the

lungs
contains:

16% O2
4% CO2

Clinical death

(0 - 4 min.- brain damage not

likely,
4 - 6 min. - damage probable).

Biological death

(6 - 10 min. - brain damage

probable;
over 10 min. - brain damage is

CARDIOVASCULAR DISEASE
RISK FACTORS:
1. Risk factors that cannot be changed (Nonmodifiable):
Age
Heredity
Gender

2.Risk factors that can be changed (Modifiable):

Cigarette
smoking

Lack of
exercise

Elevated blood cholesterol

levels
2.Risk

factors

that

changed (Modifiable):

Stre
ss

can

be

Obesi
HEART ATTACK ( Myocardial Infarction)

Hyperten
sion

It occurs when the oxygen supply to the

heart muscle (myocardium) is cut-off for a
prolonged period of time. This cut-off results
from a reduced blood supply due to severe

narrowing or complete blockage of the diseased artery. The result is

death (infarction) of the affected part of the heart.
Warning Signals of Heart Attack
Management of

First
Aid
1. Recognized the
signals
Heart
Attack
of heart
attack
and
take action

2. Have patient stop what

he or she is doing and
sit or lie him/her down
in a comfortable
Pressure at the
position. Do not let the
center
patient move around.
3. Have someone call the
physician or ambulance
for help.
4. If patient is under
medical care, assist
him/her in taking
his/her prescribed

 Pain in shoulders,
abdomen,
neck or arms

Chest discomfort
with fainting,

GUIDELINES IN GIVING EMERGENCY CARE

GETTING STARTED
1. Plan of Action
Emergency plans should be established based on anticipated needs
and available resources

2. Gathering of Needed Materials

The emergency response begins with the preparation of

equipment and personnel before any emergency occurs.
3. Initial Response:

Ask for HELP

Intervene

Do no further HARM

4. Instruction to Helper/s
Proper information and instruction to a helper/s would provide
organized first aid care.

EMERGENCY ACTION PRINCIPLES

If you see a person drop dead, or lose consciousness, with presumed sudden
cardiac arrest.

1. CHECK

AREA

SAFETY

2.

CHECK

UNRESPOSIVENESS

Rescuer shouts
are you OK?

Survey the scene

See if the scene is safe to

Get

an

idea

Tap or gently
shake the victim

of

what

Quick check for

normal breathing
If the victim
is
unconsciou
s, rescuer
call for
help.

do CPR.

happened.

3. CALL FOR HELP: (AMBULANCE, EMERGENCY SERVICES, DOCTOR)

Rescuer Activates the EMERGENCY MEDICAL
SERVICES.
GET AED OR DEFIBRILLATION

Both trained and untrained bystanders should be instructed

to Call for Help as soon as they have determined that an
adult victim requires emergency care CALL FIRST. While
Information to be remembered in Activating Medical Assistance :
for infant and children a CARE FIRST approach is
recommended.

WHAT happened?
LOCATION?

NUMBER of Persons Injured?

EXTENT of Injury and First Aid given?
The TELEPHONE no. from where you
are calling?
PERSON

who

activated

Medical

Assistance must identify him/herself and drop phone last.

PRIMARY SURVEY:
PULSE CHECK

Palpate for
Carotid pulse (ADULT/CHILD),
Brachial (infant) with 10
seconds.
At the same time (check for
Breathing)
Check
for no longer than 10
After determining
Unconsciousness:
seconds

(7 seconds better)

C
A

COMPRESSION

Do Chest compression

AIRWAY

Does the victim have an open airway

(air passage that allows the victim to

breathe?)
B

BREATHING

is the victim is breathing?

C CHEST COMPRESSION
( TO ASSIST CIRCULATION)
After determining
unconsciousness
and calling for help,
proceed immediately to
do

CHEST
COMPRESSION
S!

Kneel facing victims

chest

Place the heel of

your hand on the
center of the
victims chest. Put
your other hand
on top of the first
with your fingers

Give chest compressions at 100 per minute

Compress breastbone at least 2 inches deep
Compress at a rate of 100 per minute or more

Give 30 compressions

Compress 30 times initially

Allow the chest to return to its normal position

Compress the
breastbone at least 2
inches

(30 compressions
should take
15-18secs)

A - AIRWAY

Count aloud 1, 2,
3,4,5,6,7,8,9,10,11,1
2,13,14,15,16,17,18,
19,20,21,22,23,24,25
, 26, 27,28,29 and
ONE!

Minimize
interruptions

OPEN THE AIRWAY : use the head-tilt /

chin-lift method

 Place one hand on the

victims forehead
Place fingers of other
hand under the bony part
of lower jaw near chin
Tilt head and lift jaw
avoid closing victims
mouth

B - BREATHING

Give 2 : one second

breaths

Maintain airway
Pinch nose shut

Open your mouth wide,

take a normal breath, and
make a tight seal around
outside of victims mouth
Give 2 full breaths (1
sec/breath)
Observe chest rise and fall,
listen and feel for escaping
air.

If with definite pulse but

No BREATHING
DO MOUTH TO MOUTH
BREATHING
Give one breath every 5-6
secs
(about 12 breaths/min.)
MOUTH TO MOUTH BREATHING AND PULSE
CHECK
As short as quick as possible
DO Acheck
SECONDARY
ASSESSMENT
Pulse
no more than
10 secondsTO THE VICTIM
If unsure,
proceedof
directly
to CHEST
It is a systematic
method
gathering
additional information about
injuries or conditions that may need care.
1. Interview the Victim
2. Checking for the vital signs
3. Perform head to toe assessment

FOREIGN BODY AIRWAY OBSTRUCTION

a life-threatening emergency which follows
the lodgement of a foreign object in the
casualty's airway. In some instances, the

object lodges at the epiglottis, the entry to the airway, but does not
actually enter the airway itself.
CAUSES OF OBSTRUCTION:

Improper chewing of large pieces of food.

Excessive intake of alcohol.

The

presence

of

loose

upper

and

lower

dentures.

For children running while eating.

For smaller children of hand to mouth stage left unattended.

TWO TYPES OF OBSTRUCTION

1. Anatomical Obstruction
It happens when the tongue drops back and obstruct the throat.
Other causes are acute asthma, croup, diphtheria, swelling and
cough (whooping).
2. Mechanical Obstruction
When foreign objects lodge in the pharynx or airways: fluids
accumulate in the back of the throat.

CLASSIFICATION OF OBSTRUCTION

1. MILD/PARTIAL OBSTRUCTIONS

2.

SEVERE/COMPLETE OBSTRUCTION

difficulty in breathing

unable to breathe, speak or

cough

wheezing

agitated and distressed

snoring sound

may grip the throat

persistent cough

bluish skin colour

rapid loss of consciousness

cyanosis (blue skin colour)

in children and infants
flaring of the nostrils
in-drawing of the tissues
above the sternum and in
between the ribs

HEIMLICH MANEUVER
(abdominal thrusts)
The

Heimlich maneuver

is

recommended

for

relieving foreign-

body airway obstruction. By elevating the diaphragm, the

Heimlich maneuver can force air from the lungs to create an
artificial cough intended to expel a foreign body obstructing the
airway. Each individual thrust
intent

should

be

administered

with

the

of relieving the obstruction. It may be necessary to repeat

the thrust several times to clear the airway. Five thrusts per
sequence is recommended.

HEIMLICH MANEUVER WITH

VICTIM STANDING OR
SITTING

HEIMLICH MANEUVER (ADULT)

HEIMLICH MANEUVER WITH

VICTIM LYING DOWN

HEIMLICH MANEUVER

(INFANT)
PERFORMING THE ABDOMINAL THRUST UNDER SPECIAL
CIRCUMSTANCES
OBVIOUSLY PREGNANT AND VERY OBESE PEOPLE
The main difference in performing the Abdominal Thrust on this group
of people is in the placement of the fists.
Instead of using abdominal thrusts, chest thrusts are used.

 The fists are placed against the middle

of the breastbone and do the chest
thrust

If the victim is unconscious, the chest

thrusts are similar to those used in CPR.

RESPIRATORY ARREST
Is the condition in which breathing stops or inadequate.
RESCUE BREATHING
Is a technique of breathing air into a person lungs to
supply him or her with the oxygen needed to
survive.
ARTIFICIAL RESPIRATION (ADULT)
ARTIFICIAL RESPIRATION (CHILD / INFANT)

Breath

Breath,

1, 1001,

Breath,

1, 1002, 1003, 1001,

Breath,

1, 1002,

Breath,

1, 1003,

Breath,

1, 1004,

Breath,

1, 1002, 1003, 1002,

Breath,
1, 1002, 1003, 1003,
Breath,
1, 1002, 1003, 1004,
Breath,
Check for breathing and pulse
10 seconds
Cardiopulmonary Resuscitation (CPR)

1, 1005,

Breath,

1, 1040,

Breath

Check breathing and pulse for 10

seconds after each cycle.

This is a combination of chest compression and rescue breathing. This must

be combined for effective resuscitation of the victim of cardiac arrest.

It is a series of lifesaving actions that improve the chance of survival

following
cardiac
arrest.

REPEAT 5 CYCLES OF
30 COMPRESSIONS AND
CPR
Adult / Child / Infant

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 1 2 breaths

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 2 2 breaths

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 3 2 breaths

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 4 2 breaths

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 5 2 breaths.

Check for breathing and pulse 10 seconds

PULSE CHECK

RECHECK PULSE EVERY 2 MINUTES

(equivalent to 5 cycles CPR)

Very brief check pulse should take less than 10 seconds (at
the same time check for normal
breathing)

In case there is any doubt about the

presence or absence of pulse,
CONTINUE CHEST COMPRESSIONS

Continue CPR
Until.

HELP ARRIVES.
(Emergency Services, Ambulance, Doctor, AED)

Person is REVIVED!

THE RECOVERY POSITION

Maintain open airway and position

the victim.
* The unresponsive victim with
spontaneous respirations should be
placed in the recovery position if no
cervical trauma is suspected.
* Placement in this position consists of
rolling the victim into his or her side to

COMPRESSION ONLY CPR

If a person is unwilling or unable to perform mouth-tomouth ventilation for an adult victim, chest
compression only CPR should be provided rather
than no attempt of CPR being made.
Is recommended only in the following circumstances:

When a rescuer is unwilling or unable to perform

mouth-to-mouth rescue breathing, or

For use in dispatcher-assisted CPR instruction.

WHEN TO S.T.O.P. CPR

Criteria for not

starting CPR

- SPONTANEOUS signs of
circulation are restored

Patient has a valid Do

Not Attempt
Resuscitation (DNAR)
order.

-TURNED over to medical services or

properly trained and authorized
personnel

Signs of irreversible
death: Rigor Mortis,
Decapitation, or
Dependent Lividity.

- OPERATOR is already exhausted

and cannot continue CPR

- PHYSICIAN assumes responsibility

(declares death, takes over, etc.)

- SCENE becomes unsafe (such as

traffic, impending or ongoing

violencegun fires, etc)

No physiological benefit
can be expected
because the vital
functions have
deteriorated despite
maximal therapy for
conditions as
progressive septic or
cardiogenic shock.

- SIGNED waiver to stop CPR

SIMPLIFIED ADULT BLS ALGORITHM

Donts in giving CPR

Memorize the Steps!

Survey the Scene.

Do not be a rocker

Do not be a bender

Do not be a massager

Do not be a double crosser

Do not be a bouncer

Do not be a jerker

(introduce yourself as a Trained First Aider.)

Check Responsiveness Hey Hey are you OK?

Call for Help!.. Activate EMS

(Quick check pulse within 10secs of the same time check for
breathing).. IF NO BREATHING NO PULSE.

C CHEST COMPRESSION: 30X 100/min; 2 inches deep; push hard

and fast, COUNT 1,2, 3..27,28,29 and 1.

A AIRWAY: Head tilt-Chin lift

B BREATHING: 2 BREATHS (1sec/breath)

Continue cycles 30:2 compression ventilation., , COUNT 1,2,

3..27,28,29 and 5.

(quick check pulse every 2 mins approximately 5 cycles)

IF NO BREATHING NO PULSE. Do CPR.

If NO BREATHING BUT WITH PULSE. Do Artificial breathing.. Give 1

breath every 5 seconds. COUNT 1-2-3----1 Blow up to 1-2-3--- 12blow
(12cycles)

Until:

EMS arrives (AED, doctor ,ambulance)

Patient has signs of life.