Highlights of the 2010 American Heart Association Guidelines for Basic Life Support

What are the KEY CHANGES in the 2010 BLS Guidelines?

1. Change in Sequence from A-B-C to C-A-B

What are the KEY CHANGES in the 2010 BLS Guidelines?

2. Emphasis on High Quality CPR
Compression rate of at least 100/minute (this is a change from approximately 100/min)

Compression depth of at least 2 inches (5 cm) in adults and at least 1/3 of the antero-posterior diameter of the chest in infants and children (the depth of 1 to 2 inches in adults is no longer used and the depth used for children and infants is deeper than in previous versions of the guideline)
Allowing complete chest recoil, minimizing interruptions in chest compressions, and avoiding excessive ventilations continue to be important components of highquality CPR.

What are the KEY CHANGES in the 2010 BLS Guidelines?

3. Removal of Look, Listen, and Feel for breathing
Removed because bystanders fail to start CPR when they observe gasping in a victim

Look, listen, and feel delay the start of chest compressions

The new chest compressions first sequence encourages rescuers to activate the emergency response system and begin CPR immediately if the victim is unresponsive and not breathing or not breathing normally and has no pulse.

Adult BLS Overview

Step 1 Action

Assess the victim for a response and look for normal or

abnormal breathing. If there is no response and no breathing or no normal breathing, shout for help.

If you are alone, activate the emergency response system/call a code, and get an AED/Defibrillator if available and return to the victim. If there are multiple rescuers, ask someone to call a code and get an AED/Defibrillator.

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Check the victims pulse (5-10 secs)

If there is no pulse, perform CPR starting with compressions first.

Algorithm for Adult BLS

Pediatric BLS Overview

Step 1 Action

Assess the child for a response and check breathing. If

there is no response and no breathing or only gasping, shout for help. If someone responds, send that person to activate the emergency response system and get an AED/Defibrillator. In a child who suddenly collapses and you are alone, first activate the emergency response system and get an AED/Defibrillator. Check the childs pulse (5-10 secs) If there is no pulse, or despite adequate ventilation and oxygenation heart rate is <60 bpm, perform CPR starting with compressions first. After 5 cycles, if someone has not already done so, activate the emergency response system and get an AED/Defibrillator.

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Algorithm for Pediatric BLS

Pulse Check (Adult and Child)

Step 1 2 Action Locate the trachea, using 2-3 fingers. Slide these 2 fingers into the groove between the trachea and the muscles at the side of the neck. Feel for the carotid pulse. Check the pulse for 510 secs. If there is no pulse, start CPR.

Pulse Check (Infant)

Step 1 Action Place 2-3 fingers on the inside of the upper arm, between the infants elbow and shoulder. Press the index and middle fingers gently on the inside of the upper arm for 5-10 secs when attempting to feel the pulse.

Chest Compressions (Adults)

Step 1 2 Action Position yourself at the victims side. Make sure the victim is lying face up on a firm, flat surface.

Put the heel of one hand on the center of the victims chest on the lower half of the breastbone.
Put the heel of your other hand on top of the first hand.

Chest Compressions (Adults)

Step 5 Action Straighten your arms and position your shoulders directly over your hands. Push hard and fast. Allow complete chest recoil. Minimize interruptions.

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2 Finger Chest Compressions for Single Rescuer (Infant)

Step 1 2 Action Place the infant on a firm flat surface. Place 2 fingers on the center of the infants chest just below the nipple line. Do not press below the breast bone. Push hard and fast at least 1/3 of the AP diameter of the chest. Allow complete chest recoil. Minimize interruptions.

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2 Thumb-Encircling Hands Chest Compressions for 2 Rescuers (Infant)

Step 1 Action Place both thumbs side by side in the center of the infants chest on the lower half of the breastbone.

Encircle the infants chest and support the infants back with the fingers of both hands.
Use both thumbs to depress the breastbone at least 1/3 the AP diameter of the infants chest.

Push hard and fast.

2 Thumb-Encircling Hands Chest Compressions for 2 Rescuers (Infant)

Step 5 6 Action Allow complete chest recoil. After 15 compressions, pause to allow 2nd rescuer to give 2 breaths. Continue CPR in a 15:2 compression to ventilation ratio and switch roles every 2 minutes.

Opening the Airway: Head Tilt-Chin Lift

Step 1 Action Place one hand on the victims forehead and push with your palm to push the head back.

Place the fingers of the other hand under the bony part of the lower jaw near the chin. Lift the jaw to bring the chin forward.

Using the Bag-Mask During 2-Rescuer CPR

Step Action

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Position yourself above the victims head.

Place the mask on the victims face.

Perform a head tilt. Use the thumb and index finger of one hand to make a C on the side of the mask. Use the remaining fingers to form an E and lift the angle of the jaw.
Squeeze the bag to give breaths (1 second each) and watch for chest rise.

Using the AED

Step P A A S Action

Power ON. Attach the pads to the

victims bare chest. Clear the patient and analyze the rhythm. If the AED advises a shock, it will tell you to clear the victim. If no shock is needed, and after any shock delivery, immediately resume CPR.

Rescue Breathing
Adult Rescue Breathing 1 breath every 5-6 secs or about 10-12 breaths/minute Pediatric Rescue Breathing 1 breath every 3-5 secs or about 12-20 breaths/minute

Rescue breathing is used when a victim has a pulse but is not breathing effectively. Rescuers should give ventilations without chest compressions. Give each breath in 1 second Each breath should result in visible chest rise Check the pulse every 2 minutes

CPR with an Advanced Airway (ET/LMA/Combitube)

Adult Rescue Breathing 1 breath every 6-8 secs or about 8-10 breaths/minute independent of chest compressions Pediatric Rescue Breathing 1 breath every 6-8 secs or about 8-10 breaths/minute independent of chest compressions

Recognizing Choking in a Responsive Adult or Child

Mild Airway Obstruction Signs: Good air exchange Can cough forcefully May wheeze between coughs Severe Airway Obtruction Signs: Poor or no air exchange Weak, ineffective cough or no cough at all High pitched noise while inhaling or no noise at all Respiratory distress Cyanosis Unable to speak Universal choking sign Rescuer Actions

Rescuer Actions

Encourage coughing Ask the victim is he or she is Do not interfere with victims choking, if the victim nods attempts to expel the yes and cannot talk, you foreign body must try to relieve the If obstruction persists, obstruction activate emergency response

Relieving Choking in a Responsive Victim 1 Year of Age or Older

Step Action

Stand or kneel behind victim and wrap your arms behind victims waist. Make a fist with one hand.
Grasp your fist with your other hand and press your fist into the victims abdomen with a quick, forceful, upward thrust. Repeat until object is expelled or the victim becomes unresponsive.

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Recognizing Choking in a Responsive Infant

Mild Airway Obstruction Signs: Good air exchange Can cough forcefully May wheeze between coughs Severe Airway Obtruction Signs: Poor or no air exchange Weak, ineffective cough or no cough at all High pitched noise while inhaling or no noise at all Respiratory distress Cyanosis Unable to cry Rescuer Actions

Rescuer Actions

Do not interfere with victims If the infant cannot make attempts to expel the any sounds or breathe, you foreign body must try to relieve the If obstruction persists, obstruction activate emergency response

Relieving Choking in a Responsive Infant

Step Action

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Kneel or sit with the infant in your lap.

Hold the infant face down with the head slightly lower than the chest, resting on your forearm. Support the infants head and jaw with your hand. Rest your forearm on your thigh for support. Deliver 5 back slaps forcefully between the infants shoulder blades using the heel of your hand.

Relieving Choking in a Responsive Infant

Step 4 Action After delivering back slaps, place your free hand on the infants back supporting the back of infants head with the palm of your hand.

Turn the infant carefully supporting the head and neck. Hold the infant faceup, with your forearm resting on your thigh. Keep infants head lower than the trunk.
Provide 5 quick downward chest thrusts over the lower half of the breastbone. Repeat until obstruction is removed or the infant becomes unresponsive.

Summary of Key BLS Components for Adults, Children, and Infants