FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING
2ND SEMESTER 2021-2022
NUR 1221- EMERGENCY DISASTER NURSING

BASIC LIFE SUPPORT/ CPR

Basic life support entails a series of medical operations performed on patients who have life-
threatening physical problems that cause pain or dysfunction. All of these techniques are aimed at
assisting patients or ensuring their survival until more specific medical treatment can be started.

According to the American Red Cross*, BLS generally refers to the type of care that first-responders,
healthcare providers and public safety professionals provide to anyone who is experiencing cardiac
arrest, respiratory distress, or an obstructed airway. It requires knowledge and skills in cardiopulmonary
resuscitation (CPR), using automated external defibrillators (AED) and relieving airway obstructions in
patients of every age.

Cardiopulmonary Resuscitation (CPR)

 CPR should be administered when someone’s breathing, and pulse stops. When these stops
“Sudden Death” has occurred.

Possible Causes:
1. Drowning
2. Electrocution
3. Poisoning
4. Choking
5. Smoke Inhalation
6. Severe Injury
7. Heart attack (most common)
 CPR is an emergency lifesaving procedure performed when the heart stops beating.
Immediate CPR can double or triple chances of survival after cardiac arrest.

 Keeping the blood flow active – even partially – extends the opportunity for a successful
resuscitation once trained medical staff arrive on site.

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Chain of Survival
CPR is a critical step in the AHA’s Chain of Survival. The term Chain of Survival provides a
useful metaphor for the elements of the ECC systems concept.

The 6 importance in the adult out-of-hospital Chain of Survival are:

 Recognition of cardiac arrest and activation of the emergency response system

 Early CPR with an emphasis on chest compressions

 Rapid defibrillation

 Advanced resuscitation by Emergency Medical Services and other healthcare providers

 Post-cardiac arrest care

 Recovery (including additional treatment, observation, rehabilitation, and psychological

support)

A strong Chain of Survival can improve chances of survival and recovery for victims of cardiac arrest.

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How is CPR Performed?

There are two commonly known versions of CPR:

1. For healthcare providers and those trained: conventional CPR using chest compressions and
mouth-to-mouth breathing at a ratio of 30:2 compressions-to-breaths. In adult victims of cardiac
arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min
and to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest
compression depths (greater than 2.4 inches [6 cm]).

2. For the general public or bystanders who witness an adult suddenly collapse compression-only
CPR, or Hands-Only CPR. Hands-Only CPR is CPR without mouth-to-mouth breaths. It is
recommended for use by people who see a teen or adult suddenly collapse in an out-of-hospital
setting (such as at home, at work, or in a park).

Hands-Only CPR consists of two easy steps:

1. Call for help (or send someone to do that)

2. Push hard and fast in the center of the chest

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How Do I Know if my CPR Administration is Effective?

1. The chest will rise and fall with each ventilation.

2. Check the pulse after 2 minutes of each 5 cycles and every few minutes afterwards to
determine if circulation has returned.
3. Have a second rescuer check the pulse when you are doing compressions. If you are
giving adequate compressions a pulse should be detected.

When should I Stop CPR?

1. If victim regains pulse.

2. You are replaced by another trained responder.
3. A physician tells you to stop.
Note: The National Association of Emergency Medical Service Physicians recommends starting and
continuing CPR for more than 30 minutes in the following situations:

 Cold water submersion of less than 1 hour

 Avalanche victim
 Hypothermia 9slow body’s metabolism
 Lightning strike

How can I tell if CPR shouldn’t be started?

CPR should be started immediately when you cannot detect pulse. However, if possible, signs of
death are obvious to you, do not start CPR.

Positive signs of Death:

 Rigor mortis
 Tissue decompression
 Severe mutilation
 Lividity – lack of circulation that results to pooling of blood on the downside of
the body. Usually, reddish-purple color

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What if the victim vomits:

1. Roll victim his/her side until vomiting ceases.

2. Clear the mouth by wiping out. Check the mouth to be sure it’s clear
3. Resume CPR/ Rescue breathing if needed

Note: Vomiting may be the result of a condition called

Gastric distention which is common to children.

Quite often during rescue performance responders give

Breaths too fast and too forcefully which pushes air into the stomach.

How does CPR work?

 When the heart stop beating, oxygen is still available in the blood, but the heart is not
moving it around
 CPR is a combination of simulating the breathing of the lungs and the beating of the
heart
 This is done by performing chest compression to keep the blood going to the cells
 These compressions provide oxygen for the blood and vital organs such as the lungs and
brain

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BASIC LIFE SUPPORT – ADULTS

CPR Skill Guide:

1. Assessment.
 Determine unresponsiveness
 Tap or gently shake shoulders
 Ask “Are you Ok?”
If unresponsive, no breathing or no normal breathing (only gasping) , No
pulse palpated within 10 seconds
2. Alert emergency response system and get AED- check rhythm /shock if indicated
3. Start CPR – Performs at a ratio of 30:2 (30 chest compressions + 2 rescue
breaths

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Chest Compression.

1. Place the victim on a firm surface on their back. Kneel beside them
2. Move or remove all clothing to victim’s chest. You must be able to see the skin.
3. Locate compression site by doing the following:
 Slide your fingers on the lowest rib on one side until you reach where
the ribs meet at the center. You will feel a notch or an upside down “v”
 Place the middle finger and inde finger on the notch or where the ribs
meet
 Place the heel of your other hand (one closest to victim’s head) on the
breastbone next to the index finger
 Remove hand from notch and place on top of the other hand
 Interlock fingers. Fingers should not be directly on the chest. Just the
heel of one hand should be touching directly to the breastbone or
Simply place heel of hand right between the nipples

4. Place your ither hand on top. Straighten your arms and position yourself over the
casualty’s chest. Lock your elbows.
5. Use the weight of your body to press straight down onto their chest by 1/3 depth of
their chest or by 5cm or 2 inches
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6. Release the pressure. Allow for a full chest recoil by lifting your hands slightly off the
chest between each compression. Pressing down and releasing comprises one
compression. The time spent on chest compressions and release phases should be
equal. Full chest recoil allows more blood to refill the heart between chest compression
7. Perform 30 chest compressions hard and fast, at a rate of almost 2 compressions per
second or 100-120 per minute. It is helpful to count aloud

8. After the 30 compressions, give 2 rescue breaths.

9. Open the casualty’s airway. Ensure the head is tilted back and the chin is lifted by
placing one hand on their forehead and the other hand under their chin to tilt the head
back.

10. Use your index finger and thumb to pinch closed the soft part of the casualty’s nose. Use
your other hand to open the casualty’s mouth.

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11. Take a breath and with your mouth form a tight seal over the casualty’s mouth. Blow at
a steady rate for about 1 second and look for the chest to rise. Now look for the chest to
fall. Repeat and give a second rescue breath.

12. Keep repeating this process and aim to do 5 cycles of CPR in roughly 2 minutes.

2 – Rescuer CPR for Adults:

In 2-rescuer CPR each has specific roles:

Rescuer Location Action

Rescuer 1 At the victim’s side  Perform CPR
 Count loud
 Switches duties with
rescuer 2 every 5 cycles
or 3 minutes taking less
than 5seconds to switch
Rescuer 2 At the victim’s head  Maintains and open
airway
 Give breaths, watching
for chest rise and
avoiding
hyperventilation
 Encourages rescuer 1 to
perform CPR that are
hard and fast and to
allow full chest recoil
between compressions

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 Switches duties with

rescuer 1 every 5 cycles
or 2 minutes taking less
than 5 seconds to
switch

CPR FOR CHILDREN:

1. Check to see if the child is conscious
 Make sure you and the child are in safe surroundings.
 Tap the child gently.
 Shout, “Are you OK?"
 Look quickly to see if the child has any injuries, bleeding, or medical
problems.
2. Check breathing
 Place your ear near the child’s mouth and nose. Is there breath on your
cheek? Is the child’s chest moving?
3. Begin chest compressions
If the child doesn’t respond and isn’t breathing:
 Carefully place the child on their back. For a baby, be careful not to tilt
the head back too far. If you suspect a neck or head injury, roll the baby
over, moving their entire body at once.
 For a baby, place two fingers on breastbone. For a child, place heel of
one hand on center of chest at nipple line. You also can push with one
hand on top of the other.

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 For a child, press down about 2 inches. Make sure not to press on ribs,
as they are fragile and prone to fracture.
 For a baby, press down about 1 1/2 inches, about 1/3 to 1/2 the depth
of chest. Make sure not to press on the end of the breastbone.
 Do 30 chest compressions, at the rate of 100 per minute. Let the chest
rise completely between pushes.
 Check to see if the child has started breathing.
 Continue CPR until emergency help arrives.

4. Do rescue breathing
 To open the airway, lift the child’s chin up with one hand. At the same
time, tilt the head back by pushing down on the forehead with the other
hand. Do not tilt the head back if the child is suspected of having a neck
or head injury.
 For a child, cover their mouth tightly with yours. Pinch the nose closed
and give breaths.
 For a baby, cover the mouth and nose with your mouth and give
breaths.
 Give the child two breaths, watching for the chest to rise each time.
Each breath should

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5. Repeat compressions and rescue breathing if the child is still not breathing
 Two breaths can be given after every 30 chest compressions. If
someone else is helping you, you should give 15 compressions, then 2
breaths.
 Continue this cycle of 30 compressions and 2 breaths until the child
starts breathing or emergency help arrives.
 If you are alone with the child and have done 2 minutes of CPR (about 5
cycles of compressions and breathing), call 911 and find an AED.
6. Use an AED as soon as one is available

For children aged 9 and under, use a pediatric automated external defibrillator
(AED), if available. If a pediatric AED is not available, or for children aged 1 and
older, use a standard AED.

 Turn on the AED.

 Wipe the chest dry and attach the pads.
 The AED will give you step-by-step instructions.
 Continue compressions and follow AED prompts until emergency help
arrives or the child starts breathing.

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This is used as
last resort if AED
pads available is
for adults

If the child resumes normal breathing, then place them in the Recovery Position and monitor
breathing until help arrives.

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Automated External Defibrillator

Automated external defibrillators can help save lives during sudden cardiac arrest

How to Use An AED:

AED steps should be used when caring for a non-breathing child aged 8 or older who
weighs more than 55 pounds, or an adult.
After checking the scene and ensuring that the person needs help, you should ask a
bystander to call for help, then:

1. As soon as an AED is available, turn it on and follow the voice prompts

2. Remove clothing and attach pads correctly
 Remove all clothing covering the chest. If necessary, wipe the chest dry
 Place one pad on the upper right side of the chest
 Place the other pad on the lower left side of the chest, a few inches below the left
armpit
3. Plug the pad connector cable into the AED if necessary.
Prepare to let the AED analyze the heart’s rhythm

 Make sure no one is touching the person

 Say, “CLEAR!” in a loud, commanding voice
4. Deliver a shock, if the AED determines one is needed
 Make sure no one is touching the person
 Say, “CLEAR!” in a loud, commanding voice
 Push the “shock” button to deliver the shock
5. After the AED delivers the shock, or if no shock is advised, immediately start CPR,
beginning with compressions

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CHOKING

A step-by-step guide explaining what to do in a choking emergency.

Choking occurs when a foreign object lodges in the throat or windpipe, blocking the
flow of air. In adults, a piece of food often is the culprit. Young children often swallow small
objects. Because choking cuts off oxygen to the brain, give first aid as quickly as possible.

The universal sign for choking is hands clutched to the throat. If the person doesn't
give the signal, look for these indications:

 inability to talk
 Difficulty breathing or noisy breathing
 Squeaky sounds when trying to breathe
 Cough, which may either be weak or forceful
 Skin, lips and nails turning blue or dusky
 Skin that is flushed, then turns pale or bluish in color
 Loss of consciousness

If the person is able to cough forcefully, the person should keep coughing. If the person is choking
and can't talk, cry, or laugh forcefully, the American Red Cross recommends a "five-and-five" approach to
delivering first aid:
1. Give 5 back blows - Stand to the side and just behind a choking adult. For a child, kneel
down behind. Place one arm across the person's chest for support. Bend the person over
at the waist so that the upper body is parallel with the ground. Deliver five separate back
blows between the person's shoulder blades with the heel of your hand.
2. Give 5 abdominal thrusts - Perform five abdominal thrusts (also known as the Heimlich
maneuver).
3. Alternate between 5 blows and 5 thrusts until the blockage is dislodged.

The American Heart Association doesn't teach the back blow technique, only the abdominal
thrust procedures. It's OK not to use back blows if you haven't learned the technique. Both
approaches are acceptable.

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To perform abdominal thrusts (Heimlich maneuver) on someone else:

 Stand behind the person. Place one foot slightly in front of the other for balance.
Wrap your arms around the waist. Tip the person forward slightly. If a child is
choking, kneel down behind the child.
 Make a fist with one hand. Position it slightly above the person's navel.
 Grasp the fist with the other hand. Press hard into the abdomen with a quick,
upward thrust — as if trying to lift the person up.
 Perform between six and 10 abdominal thrusts until the blockage is dislodged

To clear the airway of an unconscious person:

 Lower the person on his or her back onto the floor, arms to the side.
 Clear the airway. If a blockage is visible at the back of the throat or high in the throat, reach
a finger into the mouth and sweep out the cause of the blockage. Don't try a finger sweep if
you can't see the object. Be careful not to push the food or object deeper into the airway,
which can happen easily in young children.
 Begin CPR if the object remains lodged and the person doesn't respond after you take the
above measures. The chest compressions used in CPR may dislodge the object. Remember
to recheck the mouth periodically.

If the child is older than age 1 and conscious, give abdominal thrusts only. Be careful not to
use too much force to avoid damaging ribs or internal organs.

To clear the airway of a choking infant younger than age 1:

 Assume a seated position and hold the infant face down on your forearm, which is resting
on your thigh. Support the infant's head and neck with your hand and place the head lower
than the trunk.
 Thump the infant gently but firmly five times on the middle of the back using the heel of
your hand. The combination of gravity and the back blows should release the blocking
object. Keep your fingers pointed up to avoid hitting the infant in the back of the head.
 Turn the infant faceup on your forearm, resting on your thigh with the head lower than the
trunk if the infant still isn't breathing. Using two fingers placed at the center of the infant's
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breastbone, give five quick chest compressions. Press down about 1 1/2 inches, and let the
chest rise again in between each compression.

 Repeat the back blows and chest thrusts if breathing doesn't resume. Call for emergency
medical help.
 Begin infant CPR if one of these techniques opens the airway but the infant doesn't resume
breathing.

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