Basic life support (BLS) is the level of medical care which is used for patients with life-threatening

illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment. Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. The guidelines outline algorithms for the management of a number of conditions, such as Cardiac arrest, choking and drowning. BLS generally does not include the use of drugs or invasive skills, and can be contrasted with the provision of Advanced Life Support (ALS). Most laypersons can master BLS skills after attending a short course. Firefighters and police officers are often required to be BLS certified. BLS is also immensely useful for many other professions, such as daycare providers, teachers and security personnel. CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of theautomated external defibrillator or AED. This improves survival outcomes in cardiac arrest cases. Basic life support consists of a number of life-saving techniques focused on the medicine "ABC"s of pre-hospital emergency care:  Airway: the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the atmosphere.  Breathing: inflation and deflation of the lungs (respiration) via the airway  Circulation: providing an adequate blood supply to tissue, especially critical organs, so as to deliver oxygen to all cells and remove metabolic waste, via the perfusion of blood throughout the body. Healthy people maintain the ABCs by themselves. In an emergency situation, due to illness (medical emergency) or trauma, BLS helps the patient ensure his or her own ABCs, or assists in maintaining for the patient who is unable to do so. For airways, this will include manually opening the patients airway (Head tilt/Chin lift or jaw thrust) or possible insertion of oral (Oropharyngeal airway) or nasal (Nasopharyngeal airway) adjuncts, to keep the airway unblocked (patent). For breathing, this may include artificial respiration, often assisted by emergency oxygen. For circulation, this may include bleeding control or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action. Basic Life Support Atmospheric air that is essential for life contains approximately 21% oxygen. When you breathe in (inhale) only a quarter of the air is taken by the blood in the lungs. The air you breath out (exhale) contains approximately 16% oxygen. Enough to support life! Seconds after being deprived of oxygen, the heart is at risk of developing irregular beats or stopping. Within four to six minutes, the brain is subject to irreversible damage. Basic life support is maintenance of the ABCs (airway, breathing, and circulation) without auxiliary equipment. The primary importance is placed on establishing and maintaining an adequate open airway. Airway obstruction alone may be the emergency: a shipmate begins choking on a piece of food. Restore breathing to reverse respiratory arrest (stopped breathing) commonly caused by electric shock, drowning, head injuries, and allergic reactions. Restore circulation to keep blood circulating and carrying oxygen to the heart, lungs, brain, and body. This course is not a substitute for formal training in basic life support. Airway Obstruction Airway obstruction, also known as choking, occurs when the airway (route for passage of air into and out of the lungs) becomes blocked. The restoration of breathing takes precedence over all other measures.. The reason for this is simple: If a casualty cannot breathe, he or she cannot live. Individuals who are choking may stop breathing and become unconscious. The universally recognized distress signal (Fig. 2-1) for choking is the casualty clutching at his or her throat with one or both hands. The most common causes of airway obstruction are swallowing large pieces of improperly chewed food, drinking alcohol before or during meals, and laughing while eating. The tongue is the most common cause of obstruction in the casualty who is unconscious. A foreign body can cause a partial or complete airway obstruction. Partial Airway Obstruction If the casualty can cough forcefully, and is able to speak, there is good air exchange. Encourage him or her to continue coughing in an attempt to dislodge the object. Do not interfere with the casualty's efforts to remove the obstruction. First aid for a partial airway obstruction is limited to encouragement and observation. When good air exchange progresses to poor air exchange,

demonstrated by a weak or ineffective cough, a high-pitched noise when inhaling, and a bluish discoloration (cyanosis) of the skin (around the finger nails and lips), treat as a complete airway obstruction. Complete Airway Obstruction A complete airway obstruction presents with a completely blocked airway, and an inability to speak, cough, or breathe. If the casualty is conscious, he or she may display the universal distress signal. Ask "Are YOU choking?" If the casualty is choking, do the following: 1. Shout "Help"-Ask the casualty if you can help. 2. Request medical assistance - Say "Airway is obstructed" (blocked), call (Local emergency number or medical personnel).

Figure 2-1 Universal Distress Signal

Figure 2-2 Abdominal Thrust 3. Abdominal thrusts (Heimlich Maneuver) a. Stand behind the casualty. b. Place your arms around the (Fig. 2-2) casualties waist. c. With your fist, place the thumb side against the middle of the abdomen, above the navel and below the tip (xiphoid process) of the (sternum) breastbone. d. Grasp your fist with your other hand. e. Keeping your elbows out, press your fist (Fig. 2-3) into the abdomen with a quick upward thrust. f. Repeat until the obstruction is clear or the casualty becomes unconscious. If the casualty becomes unconscious, do the following:

1

8. Perform abdominal thrusts a." 5. Tilt the head and lift the jaw. 7. Conscious . If the casualty is overweight or pregnant. do the following: 1. above the navel and below the tip of the breastbone.If the casualty is found unconscious. 3. "Help" . take a deep breath. Look at the chest. backward thrust until the obstruction is clear or casualty becomes unconscious. Give 2 full breaths. open your mouth. 2 .Pinch nose. Request medical assistance . Place your ear over the casualty's mouth and nose. say. Give breaths . Pause between each breath.Kneel midway between his or her hips and shoulders facing casualty. lift jaw. lift jaw with your index finger into the mouth along inside of cheek to base of tongue. bring (Fig. Place your ear over the casualty's mouth and nose. Look at the chest. Straddle the casualty's thighs. a. listen. Place the fingers of your other hand under the bony part of the chin. avoid closing the casualty's mouth. Unconscious . you are exhausted. Avoid putting pressure under the chin.Pinch nose. b. Place your other hand directly on top of the first (Fingers should point towards the casualty's head). Figure 2-5 Jaw Thrust 6. 5. perform abdominal thrusts. If unsuccessful. Continue steps 7 to 9 . Finger sweep . Give breaths . or by medical personnel. 10. Pause between each breath. 2-5) jaw forward. Note that the head is not tilted and the neck is not extended.If you suspect the casualty may have an injury to the head.Lying. open the casualty's mouth and grasp the tongue and lower jaw between your thumb and fingers. reposition head.Pinch nose. listen and feel for breathing. 7. place your elbows on the surface. Grasp your fist with your other hand. and move arm closest to you above casualty's head. 6. 2. shout. b. each lasting 1 to 1 1/2 seconds.Say "Airway is obstructed" (blocked). or back. Place the casualty's arm nearest you alongside his or her body. Tilt the head and lift the jaw. c. or by medical personnel. c. Figure 2-3 Abdominal Thrust Figure 2-4 Head Tilt-Chin Lift 4. Press abdomen 6 to 10 times with quick upward thrusts. Manual pressure to the abdominal area in these individuals can be ineffective or cause serious damage. 8. take a deep breath. open casualty's mouth and grasp the tongue and lower jaw between your thumb and fingers. Open airway (Head-tilt/Chin-lift) -Place your hand on the casualty's forehead. you are exhausted. 3 to 5 seconds. e. Avoid putting pressure under the chin.Tap or gently shake the casualty. "Not Breathing.Standing or Sitting. If not breathing. move your hand from the shoulder to support the back of the head and neck. Place your other hand directly on top of the first (fingers should point towards the casualty's head).Until successful. Give 2 full breaths. Straddle the casualty's thighs. and give 2 full breaths. do the following: 1. you are relieved by another trained individual. 2-6) with quick upward thrusts. Finger sweep . each lasting 1 to 1 1/2 seconds. d.Place the casualty on his or her back. and make an air-tight seal around the casualty's mouth. Place your fingers behind the angle of the jaw or hook your fingers under the jaw. Perform abdominal thrusts a. Roll casualty toward you as a unit. open your mouth. Open airway (Head-tilt/Chin-lift or Jaw-thrust) . 9. Kneel. Separate the lips with your thumbs to allow breathing through the mouth. avoid closing casualty's mouth. Give breaths . and make an air-tight seal around the casualty's mouth. Figure 2-6 Abdominal Thrust Reclining 4. d. Press your fist against the chest with a sharp. insert your index finger into the mouth along the inside of cheek to base of tongue. above the navel and below the tip of the breastbone. neck. "Not Breathing. Place your hand on the casualty's shoulder and one on the hip. Use "hooking" motion to dislodge object for removal. "Are you OK?" 2. each lasting 1 to 1 1/2 seconds. you are relieved by another trained individual. you must minimize movement of the casualty when opening the airway. Kneeling at the top of the casualty's head. Chest Thrusts The chest thrust is the preferred method. Stand behind the casualty. Give 2 full breaths. Position casualty . Shout. If unsuccessful. take a deep breath. 3 to 5 seconds. it may cause an obstruction of the airway. 2-4) bony part of the chin." (jaw-thrust maneuver) . say. Check unresponsiveness . place the thumb side against the middle of the breastbone.Place your hand on the casualty's forehead. Continue steps 4 to 7 -Until successful. Place your arms under the casualty's armpits and around the chest. Place the heel of your hand against the middle of the abdomen. Straighten legs. facing the casualty's chest. Place the fingers of your other hand under the (Fig. Press abdomen 6 to 10 times (Fig. If not breathing. and feel for breathing. a. d. and make an air-tight seal around the casualty's mouth. open your mouth. for individuals who are overweight or pregnant. Place the heel of your hand against the middle of the abdomen. Use "hooking" motion to dislodge object for removal. b. in place of the abdominal thrust. c.If there is no response from casualty. With your fist. it may cause an obstruction of the airway. call local emergency number or medical personnel.Place the casualty on his or her back. Pause between each breath.

locate the Adam's apple with your middle and index fingers. until medical assistance arrives. listen. say. with elbows locked and arms straight.Used when the casualty has had surgery to remove part of the windpipe. do the following: Rescue Breathing Rescue breathing is the process of breathing air into the lungs of a casualty who has stopped breathing (respiratory arrest). Place the heel of your hand. Look at the chest. g. Give breaths . Keep your fingers off the casualty's chest. drowning. shout. If the casualty is not breathing. Repeat the last three steps until the obstruction is clear. 9. Grasp your fist with your other hand and give a quick upward thrust. 3. take a deep breath.During rescue breathing and CPR. two one-thousand. 6. and feel for breathing. recheck pulse every minute. Roll casualty toward you as a unit. Give 1 breath every 5 seconds. you can perform an abdominal thrust (Fig. and feel for breathing. Self Abdominal Thrusts If you are alone and choking. drug overdose. Take a deep breath and seal your mouth around the casualty's nose and slowly breathe into the casualty's nose using the procedures for mouth-to-mouth breathing. each lasting 1 to 1 1/2 seconds. try not to panic. Cover the casualty's mouth with your hand. Feel for a carotid pulse for 5 to 10 seconds. avoid closing the casualty's mouth. and seal your mouth over the stoma and slowly breathe using the procedures for mouth-to-mouth breathing. Open the airway and give 2 full breaths. has a pulse. Figure 2-8 Mouth-to-Mouth Ventilation Figure 2-7 Self-Help for Airway Obstruction If the casualty is not breathing. you should cover his or her mouth and nose and continue breathing through the stoma). you are exhausted. If pulse is absent. Open airway (Head-tilt/Chin lift or Jaw thrust) . give 1 breath every 5 seconds. Look for the chest to rise. "Has pulse. Special Situations 1. on the side closest to you. If not breathing. 8. begin CPR. and feel for breathing 3 to 5 seconds. three one-thousand. Position your shoulders over your hands. Mouth-to-nose breathing . Position casualty . Continue sequence . Pause between each breath. lasting 1 to 1 1/2 seconds. 2-8). and make an air-tight seal around the casualty's mouth (Fig. f. Check unresponsiveness . or your mouth is too small to make an air-tight seal." 10. With the fist of your hand. i. Never give rescue breathing to a person who is breathing normally.b. Place your middle finger on the notch. on top of the heel of your other hand. 3 . Place the casualty's arm nearest you alongside his/her body." Quickly examine the casualty for signs of bleeding." Look at the chest. Slide your fingers down into the groove (Fig.While maintaining an open airway. say. electric shock. each Figure 2-9 Check Carotid Pulse 7. If the casualty begins to breathe. each should compress the chest 1 1/2 to 2 inches. Give 6 to 10 quick and distinct downward thrusts. take a deep breath. Maintain head tilt with your hand on the forehead. continue rescue breathing. Finger sweep. keep the casualty's head tilted back.Tap or gently shake the casualty. They breathe through an opening in the front of the neck. c. Rescue breathing (mouth-to-mouth) Maintain an open airway with headtilt/chin-lift or jaw-thrust maneuver. "Help" . If you feel a pulse.Kneel midway between his or her hips and shoulders facing the casualty. Place the heel of your hand on the breastbone next to the index finger. 2. "Not breathing.Maintain an open airway. "No breathing. pinch nose. "Are you OK?" 2. listen. Do not attempt to expel stomach contents by pressing on the abdomen. Continue for 1 minute/12 breaths.If there is no response from casualty. 3. Mouth-to-stoma breathing . place the thumb side against the middle of your abdomen. 1." 5. above the navel and below the tip of the breastbone. h. Place your hand on the casualty's shoulder and one on the hip. Slide your fingers up the rib cage to the notch at t d. listen. a railing. and chest or lung (trauma) injury." take a breath. Place the fingers of your other hand under the bony part of the chin. locate and feel the carotid pulse for 5 seconds. called a stoma. is bleeding from the mouth. listen. Avoid putting pressure under the chin. say. and feel for breathing. take a deep breath. 2-7) on yourself by doing the following: 1.Pinch nose. To avoid this. and your index finger next to it. Straighten legs and move arm closest to you above casualty's head. Tilt the head and lift the jaw.Used when the casualty has mouth or jaw injuries. and do not give breaths too fast. Request medical assistance . The common causes are air-way obstruction. With the middle and index fingers of the hand nearest the casualty's legs. and then give a breath. 2. locate the lower edge of the rib cage on the side closest to you. Give 2 full breaths. or by medical personnel.While maintaining an open airway. j. e. Air in the stomach (Gastric Distention) . "No breathing. 4. used to locate the notch. use your other hand to seal the casualty's mouth and lift the chin. You also can lean forward and press your abdomen over the back of a chair (with rounded edge). Place your ear over the casualty's mouth and nose. Shout. Open your mouth. maintain an open airway. breathe only enough to make the chest rise. Recheck pulse . four one-thousand. move your hand from the shoulder to support the back of the head and neck. also known as artificial respiration. open your mouth. If you feel a pulse. air may enter the stomach in addition to the lungs." call (Local emergency number or medical personnel). but there is a pulse.Place your hand on the casualty's forehead. Do not tilt the head back. Look at the chest. it may cause an obstruction of the airway. If the casualty's chest does not rise. k. If pulse is present but breathing is absent. 2-9). and make an air-tight seal around the casualty's mouth.Say "No breathing. or a sink. (In some situations a person may breathe through the stoma as well as his or her nose and mouth. Check pulse . 3 to 5 seconds. Count aloud "one onethousand. you are relieved by another trained individual. say.

If the casualty is to survive. f.Used when rescue breathing is required in a contaminated environment. The signs of cardiac arrest include unconsciousness. and the absence of breathing. g. Dentures . remove them. immediate action must be taken to restore breathing and circulation. Place the heel of the hand used to locate the notch on top of the heel of your other hand. they provide support to the mouth and cheeks during rescue breathing. which carry the blood throughout the body.Leave dentures in place. Circulation Circulation is the movement of blood through the heart and blood vessels. the absence of a pulse. Place your middle finger on the notch. Give 15 compressions. Continue CPR . each should compress the chest 1 1/2 to 2 inches at a rate of 80 to 100 compressions per minute. e. Slide your fingers up the rib cage to the notch at the end of the breastbone. The circulatory system consists of the heart.4. 5.If the casualty has no pulse. d. and your index finger next to it. such as after a chemical or biological attack. Figure 2-11 Xiphoid Process Chest Compressions a. and the blood vessels. A resuscitation tube is used to deliver uncontaminated air to the casualty. Keep your fingers (Fig 2-12) off the casualty's chest. 2-11) of the hand nearest the casualty's legs. If the pulse is present but breathing is 4 . give 2 full breaths and continue CPR. This course is not a substitute for formal training in cardiopulmonary resuscitation (CPR). Position shoulders over your hands. Cardiopulmonary Resuscitation (CPR) is an emergency procedure for the casualty who is not breathing and whose heart has stopped beating (cardiac arrest). Place the heel of your other hand on the breastbone next to your index finger. Mouth-to-mask breathing . This resuscitation tube has an adapter at one end that attaches to your mask and a molded rubber mouthpiece at the other end for the mouth of the casualty. The casualty must be lying face up on a firm surface. Do not assume that a cardiac arrest has occurred simply because the casualty appears to be unconscious. Continue 4 complete cycles of 15 compressions and 2 breaths. b. facing the casualty's chest. Compressions should be smooth. c. "One and two and three. Count aloud. With your middle and index fingers (Fig. Figure 2-12 Interlocking fingers to help keep fingers off the chest wall h. deliver 2 full breaths. After each 15 compressions. which pumps the blood. locate the lower edge of the rib cage on the side closest to you. If they become loose and block the airway or make it difficult to give breaths. and uninterrupted." until you reach 15. Check for a carotid pulse and breathing for 5 seconds. Check for a pulse every few minutes. Kneel. j. Cardiac arrest is the failure of the heart to produce a useful blood flow or the heart has completely stopped beating. The procedure involves a combination of chest compressions and rescue breathing. i. with elbows locked and arms straight. rhythmic.

If there is no pulse. rhythmic.Open your mouth. 3) acid-base and electrolyte abnormalities. Infant: Do not overextend the head and neck. you are exhausted. Give 5 compressions. until medical assistance arrives. Quickly examine the casualty for signs of bleeding. and aspiration pneumonitis).If the infant or child has no pulse. and make an air-tight seal around the casualty's mouth and nose. Request medical assistance . f. INTRODUCTION 1. continue rescue breathing (Infant: 20 breaths/min. Face infant's chest. i.Infant: Tap or shake shoulder only. lift that hand and place your heel (on breastbone at nipple line) next to where your index finger was. This arrest may be the result of primary cardiac disease or diseases which affect other organs. While looking at the position of your index finger. c. The second person should call the local emergency number or medical personnel for assistance if it has not already been done. 5) trauma. 6. ("I know CPR. the head and neck. do the following: 1. listen. h. listen. and following cardiac dysrhythmias. 6. Check unresponsiveness . The person doing CPR will indicate when he or she is tired. bradycardia. Tilt the head and lift the jaw. or the casualty is pronounced dead. Place your ear over the casualty's mouth and nose.Place your hand on the casualty's forehead. Pause between each breath. "Are you OK?" 2. by medical personnel. Check for a pulse every few minutes. and uninterrupted. Chest compressions (children) a. shout. Check for a brachial pulse for 5 seconds. Shout. Look at the chest. neoplasia. Open airway (Head-tilt/Chin-lift or jaw thrust) . or the infant or child is pronounced dead. With your middle and index fingers of the hand nearest the child's legs. Compressions should be smooth. The first person will monitor the effectiveness of CPR by looking for the chest to rise during rescue breathing and feeling for a carotid pulse (artificial pulse) during chest compressions. Define cardiopulmonary arrest and list the three phases. CPR with Entry of Second Person When a second person who is trained in administering CPR arrives at the scene. laryngeal paralysis. Place casualty on a firm surface. Compressions should be smooth. give 1 breath and continue CPR. and uninterrupted. 10. Continue CPR . 2-13) on the inside of the upper arm. Give breaths . 4. Place the fingers of your other hand under the bony part of the chin. 7. the second rescuer should give 2 full breaths and continue CPR. 2) vagal stimulation. maintain an open airway until medical assistance arrives. d. deliver 1 breath. b. Check pulse . and your index finger next to it. In animals.While maintaining an open airway. maintain an open airway. The second person should kneel next to the casualty opposite the first person. Figure 2-13 Check Infant's Pulse d. with elbow locked and your arm straight. Child: 15 breaths/min. Which animals are at risk to suffer cardiopulmonary arrest and what are the predisposing factors? Cardiopulmonary arrest is usually the result of a cardiac dysrhythmia. Continue CPR until successful. Child: Tap or gently shake the shoulder. Continue CPR until successful. you are relieved by another trained in CPR. supporting. hypotension. Check for a carotid pulse for 5 seconds. "Help" .) If the infant or child begins to breathe. Continue for 10 complete cycles of 5 compressions and 1 breath.Turn casualty on back as a unit. unexplained changes in the depth of anesthesia. After each 5th compression. 3. Look for the chest to rise. g. b. The second person shall identify himself or herself as being trained in CPR and that they are willing to help. 5. 4) anesthetic agents. you are relieved by another trained in CPR or medical personnel.If someone responded to your call for help. CPR for Children and Infants If the casualty is an infant (0-1 year old) or child (1-8 years old). 9.absent. 3 to 5 seconds. it may cause an obstruction of the airway. e. deliver 1 breath. and feel for breathing. each lasting 1 to 1 1/2 seconds. Cardiopulmonary arrest is defined as the abrupt. and should stop CPR after the next 2 full breaths. Keep your fingers off the child's chest. each should compress the chest 1 to 1 1/2 inches at a rate of 80 to 100 compressions per minute. depth. Place your middle and index fingers on the breastbone at the nipple line. Avoid putting pressure under the chin. 5. take a breath. or pattern. avoid closing the casualty's mouth. trauma. rhythmic. Feel for a pulse for 5 to 10 seconds. WARNING SIGNS AND DIAGNOSIS OF CARDIOPULMONARY ARREST 1. y y y Basic life support Advanced life support 5 . CPR is divided into three support stages: Prolonged life support. This course is not a substitute for formal training in cardiopulmonary resuscitation (CPR). each should compress the chest 1/2 to 1 inch at a rate of at least 100 compressions per minute. 3. do the following: 1. and hypothermia. you are exhausted. tilt the casualty's head back. send them to call the local emergency number or medical personnel. Do not interrupt CPR for more than 7 seconds except for special circumstances. locate the lower edge of the rib cage on the side closest to you. Slide your fingers up the rib cage to the notch at end of the breastbone. Return to Table of Contents RISK FACTORS 1. 4. After each 5th compression. 6) systemic and metabolic diseases. arrest most frequently occurs with diseases of the respiratory system (pneumonia. Position your shoulder over your hand. Chest compressions (infant) a. Predisposing causes of cardiopulmonary arrest include the following: 1) cellular hypoxia. thoracic effusions.If there is no response from infant or child. Cardiopulmonary resuscitation (CPR) provides artificial ventilation and circulation until advanced life support can be provided and spontaneous circulation and ventilation can be restored. Face child's chest. Can I help?") 2. cyanosis. If the casualty begins to breathe. Place your middle finger on the notch. continue rescue breathing. c. Position casualty . Continue for 10 complete cycles of 3 compressions and 1 breath. between the elbow and shoulder). as a result of severe multisystem disease. Give 2 breaths (puffs for infants). locate the carotid pulse (Infants: Locate the brachial pulse (Fig. and check for a carotid pulse for 5 seconds. If the pulse is present but breathing is absent. 8. unexpected cessation of spontaneous and effective ventilation and systemic perfusion (circulation). Give 5 compressions. and feel for breathing. a weak or irregular pulse. What are the warning signs of cardiopulmonary arrest? Changes in the respiratory rate.

and will result in blood being squeezed from both ventricles into the pulmonary arteries and aorta as the pulmonary and aortic valves open. What is the "cardiac pump theory"? The original hypothesis. What are the determinants of vital organ perfusion during CPR? Cerebral blood flow (cerebral perfusion pressure) is dependent on the gradient between the carotid artery and the intracranial pressure during systole (thoracic compression). Accurately place the endotracheal tube. Increasing the rate of chest compressions will significantly increase the arterial pressure. What are the determinants of improved vital organ perfusion during CPR? Force. How is cardiopulmonary arrest diagnosed? The classical description of arrest includes the following: 1) absence of ventilation and cyanosis ("respiratory arrest"). It is easy to develop "simulated" arrests using "stuffed" toy animals in which you can practice the ABC's of CPR. No comparable studies are yet available in animals. What is "interposed abdominal compression"? To improve venous return and to decrease arterial run-off during external thoracic compression. 5. As we all know. Aortic pressure is efficiently transmitted to the carotid arteries.5 . pulmonary artery. blood clots. However. In small dogs receiving vigorous chest compressions. Position the animal in a ventral recumbency in preparation for intubation with an endotracheal tube. Advanced Life Support: D -. begin to ventilate the animal with two long breaths (1. the rate of compression and ventilation is 80 . For brain blood flow to occur during resuscitation. renal and hepatic blood flow during CPR is 1% to 5% of prearrest values. intrathoracic pressures fall toward zero. there is no pressure gradient across the heart and thus the heart acts mearly as a passive conduit. H -. a modest gradient also develops between the intrathoracic aorta and the right atrium providing coronary (myocardial) perfusion. it has been noted there is a correlation between the rise in intrathoracic pressure during compression and the apparent magnitude of carotid artery blood flow and pressure. Eg. this has shown to improve hospital discharge rates as much as 33%. B -.Breathing support. and lateral pleural space pressures with no transcardiac gradient being developed. Retrograde flow of blood is prevented by closure of the left and right atrioventricular valves. and prolonged life support. PHASES OF CARDIOPULMONARY RESUSCITATION AND GOALS 1. The technique involves using a small (22 . How is circulation supported during CPR? Assessment is necessary to determine the pulselessness of the animal prior to initiating external cardiac compression. thoracic compression ("artificial systole") is similar to internal cardiac massage. assess that the animal is apneic and requires assisted ventilation. it is important to record this information. Assessment Airway support. the rise in vascular pressures likely is a result of compression of the heart during chest compression and is likely not a result of rising intrathoracic pressure. This requires practice by your staff. 4. What if there is only one person available to do CPR? 6 . while elevated arterial pressure closes the aortic and pulmonic valves. collapse of the venae cavae. What is involved with each of the phases of cardiopulmonary resuscitation? Basic Life Support: A -. 3. When thoracic compression is released ("artificial diastole").0 seconds each). one should ASSESS prior to initiating basic. If the animal does not begin to breathe within 5 to 7 seconds. 3. 4. Should you keep accurate records for each cardiopulmonary arrest animal? Yes! Although you won't likely be recording every action during the arrest.2. When no peripheral pulse is felt during CPR. but retrograde transmission of intrathoracic venous pressure into the jugular veins is prevented by valves at the thoracic inlet and possibly by venous collapse. Prolonged Life Support: G -. during "artificial systole" a peripheral arterial venous pressure gradient appears. It is believed that both the cardiac and thoracic pump are interactive and each contributes to the pressure gradients responsible for blood flow during CPR. 4) dilatation of the pupils. rate. aortic.100 times each minute. The needle is twirled strongly and moved up and down while monitoring for improvement in respiration. 1 1. vomitus). Experimental studies in large dogs have shown that thoracic compression during CPR results in an essentially equal rise in central venous. suggests that blood flow to the periphery during external cardiac compression of the heart results from direct compression of the heart between the sternum and vertebrae (dorsal recumbency) or between the right and left thoracic wall (lateral recumbency) of the dog and cat. Irrespective of the mechanism of forward blood flow during CPR.Intensive care. consider changing the animal's position and your technique. Through these practice sessions the staff can all be trained to rapidly respond to this serious emergency. C -. 2) absence of a palpable pulse (pulse will disappear when systolic pressure < 60 mm Hg).Fibrillation control.Gauging a patient's response.Diagnosis and Drugs. and opening of the pulmonary. Placing a needle in acupuncture point Jen Chung (GV26) may reverse respiratory arrest under clinical conditions. Currently there are two theories to explain the mechanism of forward blood flow during CPR: 1) Cardiac pump theory and 2) thoracic pump theory. Use of accupuncture to stimulate respirations has been reported. and duration of chest compression during CPR will determine the effectiveness of organ perfusion during CPR. What is the optimal compression/relaxation ratio for administering external cardiac compression? Studies have shown the best ratio of cardiac compression to ventilation is 1:1 (simultaneous compression-ventilation) in animals. 2.5 inch) needle in the nasal philtrum at the ventral limit of the nares. begin to ventilate at a rate of 12 . In animals weighing > 7 Kg. How do we breathe for the animal? First. esophageal. What is the optimal position for maximizing blood flow? A lateral recumbency (with the sternum parallel to the table top) is used for animals < 7 Kg and.Establishment of an Airway. E -. cerebral and myocardial flow are less than 5% of prearrest values. the ventricles recoil to their original shape and fill by a suction effect. At what rate should you compress and ventilate when two persons are available to do CPR? In animals weighing less than 7 Kg the recommended rate of ventilation and compression is 120 times per minute. the doral recumbency will provide maximal changes in intrathoracic pressure and thus forward blood flow. The cardiac pump theory is likely most important in the smaller animals (< 7 Kg) and the thoracic pump most important in larger animals (> 7 Kg). advanced.28 gauge. GENERAL GUIDELINES FOR CPR IN ANIMALS 1. intrathoracic vascular pressures are much higher than recorded pleural pressures. In humans. a dorsal recumbency for animals > 7 Kg. Cineangiographic studies in large dogs confirm these observations by demonstrating partial right atrioventricular valve closure. How important is basic life support? Basic life support is the most important phase of cardiopulmonary resuscitation. According to this concept. 5. bone and tissue trauma are more likely. Myocardial blood flow (myocardial perfusion pressure) is dependent on the gradient between the aorta and right atrium during diastole (release phase of thoracic compression). have one person press upon the cranial abdomen between each compression of the chest.Hopeful measures for the brain I -. 8. and venous flow to the right heart and lungs occur. How do we establish an airway? The first step is the establishment of the unresponsiveness and assessment of the airway. F -. a carotid arterial-to-jugular pressure gradient must be present during chest compression. Thus. left atrioventricular and aortic valves during thoracic compression. In these animals. Once you have seen there is no movement to the chest wall. fractured mandible. Quickly check the airway for foreign materials (bones. increasing theforce of chest compressions increases arterial pressures. This means you will breathe for the animal each time you compress the thoracic wall. What is the "thoracic pump theory"? As pressure is applied to the animal's thorax. 2.20 times per minute. assessment breathing support. Below the diaphagm. etc. 3) absence of heart sounds (heart sounds will disappear when systolic pressure < 50 mm Hg). In order to optimize CPR. During "diastole". During conventional CPR. 6.Circulation support. BASIC_LIFE_SUPPORT 1. In such a system. ideally.2. and blood flow occurs consequent to this gradient. During the relaxation phase of thoracic compression ("artificial diastole"). assessment circulation support. 7. right atrial. At pressures >400 newtons (about 40 Kg). 2.Electrocardiography. This is a simple technique and can be employed quickly. it is extremely difficult to maintain a dog in dorsal recumbency without special "V"-shaped troughs or other techniques.

then just do chest compressions at a rate of about 100 a minute. The switch from external to open-chest CPR has not yet improved outcome in human patients.) The above advice applies to adults. but not newborns. Remember to spell C-A-B In 2010. probably because its initiation was too late. In this special case. Circulation: Restore blood circulation with chest compressions 1. Check for normal breathing. monitoring the pulse will be the most commonly employed monitoring for effectiveness. If you haven't been trained in CPR. To learn CPR properly. Then with the other hand. apply only cardiac compressions if cardiopulmonary arrest is present. 2. in which someone's breathing or heartbeat has stopped. With effective CPR you should see anincreased end-tidal CO2. Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies. Place your other hand on top of the first hand. What can you do if there is no pulse. Look for chest motion. 6. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). 3. In fact. take an accredited first-aid training course. and then "implanting" them in the chest of a commercially available stuffed animal purchased at any retail outlet. If you believe the y y y y y 7 . the presence of a pulse during thoracic compression has been the hallmark of effective compression. When applied promptly in operating room arrests. Using pulse oximetry can provide information on hemoglobin saturation. continue chest compressions until there are signs of movement or until emergency medical personnel take over. 5. begin with chest compressions instead of first checking the airway and doing rescue breathing. go on to checking the airway and rescue breathing. open chest CPR. between the nipples.100 times per minute when the animal weighs > 7 Kg. the American Heart Association updated its guidelines to recommend that everyone untrained bystanders and medical personnel alike begin CPR with chest compressions. How can you train your staff in CPR? Periodic training sessions in basic life support should be conducted in each veterinary practice. If you are alone and have immediate access to a telephone. Put your palm on the person's forehead and gently tilt the head back. then provide hands-only CPR. This is not a time-consuming activity and the benefits are tremendous when your "team" can respond quickly and efficiently. You don't need to try rescue breathing. but rusty. or neurological outcome when CPR was applied with or without ventilatory support. CO2. Use a rate of 120 chest compressions per minute when the animal weighs less than 7 Kg and 80 . 48-hour survival . children and infants needing CPR. These teaching aids were developed by simply taking some old corregated anesthetic tubing ("trachea"). During CPR you should see an improvement of oximetry values and mucous membrane color. 10. Trained. gently lift the chin forward to open the airway. Is ventilation really necessary during CPR? For more than 30 years. When should I open the chest and do CPR? Chest compressions raise the venous (right atrial) pressure peaks almost as high as arterial pressure peaks and increase intracranial pressure. (Details described below. More recently. 4. consider changing the position of the animal. the difference between your doing something and doing nothing could be someone's life. two anesthetic rebreathing bags ("lungs"). listen for normal breath sounds. including CPR and how to use an automatic external defibrillator (AED). When blood flow stops. A person may die within eight to 10 minutes. and feel the expanding "lungs" as you apply chest compression. Give 15 chest compressions and then 2 long ventilations. 9. In veterinary medicine. Currently. However. If you've previously received CPR training but you're not confident in your abilities. Keep your elbows straight and position your shoulders directly above your hands. but under conditions of prolonged untreated cardiac arrest. Open chest CPR does not raise atrial pressures. Someone in your practice can manufacture this model and practice sessions can be called at any time to simulate the sudden. These devices can then be used to practice CPR techniques with your staff. tap or shake his or her shoulder and ask loudly. chin-lift maneuver. An effective means to provide training is to develop an inexpensive "CPR Animal". Put the person on his or her back on a firm surface. it affects return of spontaneous circulation and is important for survival. and pH of arterial and venous blood and may affect intracellular environment in the presence of low rates of blood flow. begin mouth-to-mouth breathing. the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. How can one monitor the effectiveness of my external thoracic compressions? Traditionally. "Are you OK?" If the person doesn't respond and two people are available. an anesthetic Y-piece ("tracheal bifercation"). which was introduced in the 1880's until 1960 yielded good clinical results in people. End-tidal carbon dioxide monitoring has proven to be the most effective means for measuring the effectiveness of CPR. This device fits in-line with the endotracheal tube and will measure carbon dioxide levels. breathing to help people remember the order to perform the steps of CPR. 8. one should call 911 or the local emergency number and one should begin CPR. the researchers were unable to detect a difference in hemodynamics. the force or the rate of thoracic compression. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths. see the thorax expand with each breath. and feel for the person's breath on your cheek and ear. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive (described in more detail below). When the heart stops. then begin CPR. Airway: Clear the airway 1. while monitoring peripheral pulses using quantitative Doppler techniques have shown the pulse generated during compression was in fact from venous flow and not arterial. In 2010. One can place foreign materials in the "mouth". provides better cerebral and coronary perfusion pressures and flows than external CPR in animals. Trained. If you're not trained in CPR. Chest compression alone and spontaneous gasping provides some pulmonary ventilation and gas exchange. change in oximetry or end-tidal CO2? As mentioned above. can practice "Gen Chung" manuveurs. Kneel next to the person's neck and shoulders. check: Is the person conscious or unconscious? If the person appears unconscious. It would seem logical that ventilation has the potential to improve the success of resuscitation from cardiac arrest by improving tissue oxygenation and acidosis. 2. thus causing low cerebral and myocardial perfusion pressures. Here's advice from the American Heart Association: y y Untrained. blood oxygenation can be improved with supplemental oxygen. deliver one shock if instructed by the device. If an AED is immediately available. including heart attack or near drowning. Remember. the American Heart Association changed its long-held acronym of ABC to CAB circulation. Ventilation may be unnecessary during the first few minutes of CPR. If you're trained in CPR and you've performed 30 chest compressions. emergency ventilation has been considered an essential component of basic life support CPR. 7. open the person's airway using the head-tilt. begin CPR for one minute and then call 911 or the local emergency number. It's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. and ready to go. The ratio of ventilation to chest compression is 15:2. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. call 911 before beginning CPR unless you think the person has become unresponsive because of suffocation (such as from drowning). A recent report in experimentally induced cardiopulmonary resuscitation in swine has shown an excellent resuscitation rate through providing only cardiac compression. Push hard at a rate of about 100 compressions a minute. ventilation does not affect tissue conditions.One person CPR in animals is very ineffective. palpate for pulses. There are no comparable studies available for clinicallyemployed open chest CPR in animals. Ventilation does affect oxygenation. This change emphasizes the importance of chest compressions to help keep blood flowing through the heart and to the brain. but this benefit has only recently been studied. With this in mind. unexpected occurrence of an arrest. Gasping is not considered to be normal breathing. airway. Place the heel of one hand over the center of the person's chest. If you're well trained and confident in your ability. if inadequate numbers of professional staff are available. Before you begin Before starting CPR. If the person isn't breathing normally and you are trained in CPR. If you have been trained in CPR. taking no more than five or 10 seconds. open-chest CPR should be restricted to the operating room and in selected instances of penetrating thoracic injury.

Give the first rescue breath lasting one second and watch to see if the chest rises. Commence 15 compressions. 3. children and infants 80-100 per minute. 1003 1010 Still breathless and without pulse. If unresponsive. To perform CPR on a baby Most cardiac arrests in babies occur from lack of oxygen. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to Cardio Pulmonary Resuscitation A particularly important aspect of CPR is that the rescuer's hands are positioned correctly in relation to the casualty's heart. about y y If another person is available. perform first aid for choking. Place two fingers of one hand just below this line. If you know the baby has an airway obstruction. CPR can be performed by a single rescuer. the pressure is modified to reflect the fragility of the child's chest. 6. 5. chin-lift maneuver). 1003. listen. Compressions rate of 60-80 per minute. perform five cycles of compressions and breaths on the child this should take about two minutes before calling 911 or your local emergency number or using an AED. Use pediatric pads. If the object is seen. two fingers should be placed over the casualty's xiphoid process. perform first aid for a choking baby. 8. skip mouth-to-mouth rescue breathing and continue chest compressions. 11. If breathless. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby. then resume CPR starting with chest compressions for two more minutes before administering a second shock. Breathing: Breathe for the infant 1. follow the CAB procedures below and time the call for help as follows: If you're the only rescuer and CPR is needed. such as from drowning or choking. the small 'bump' at the base of the sternum. 5. Do not use an AED for babies younger than age 1. The second hand is placed over the first. "Hey. 1002. gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.5 inches (about 4 cm). 13. and feel for breath on your cheek and ear. Watch to see if the baby's chest rises. 2. chin-lift maneuver and then give the second breath. in the center of the chest. Gently compress the chest about 1. Airway: Clear the airway 1. Prepare to give two rescue breaths. Breathe more gently. put your ear near the baby's mouth and check for breathing: Look for chest motion. look. Stroke the baby and watch for a response. Following the two breaths. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available. Administer one shock. 4. hey. or by two rescuers. Open airway (head-tilt/chin-lift). 2. If there's no response. Do Primary and Secondary Survey. The chest is compressed 4 5cm. If it does. chin-lift maneuver and then give the second breath. slowly breathe into the baby's mouth one time. immediately begin the next cycle of compressions and breaths. 4. 2. To perform CPR on a child The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. the second hand grips the wrist of the first hand. Breathing: Breathe for the person Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. examine the mouth to make sure no foreign material is inside. y y y y y If you're alone. The pulse is detected by placing a finger directly over the left nipple. Procedure for CPR (Philippine National Red Cross) 1. Position victim in flat area. Continue CPR until you see signs of life or until medical personnel arrive. If the baby's chest still doesn't rise. Continue cycles (back to #6) and recheck pulse every 2 minutes 8 . 14. sweep it out with your finger. use adult pads. 1002. Thirty chest compressions followed by two rescue breaths is considered one cycle. go to step 5 below. Use only one hand to perform heart compressions. 6. Locate sternum. Continue CPR until there are signs of movement or emergency medical personnel take over. give aid and get help (doctor/physician). and change operators after ten minutes or so. This position should then approximate the location of the heart. If you're not trained to use an AED. do CPR for two minutes five cycles before calling 911 or your local emergency number. Imagine a horizontal line drawn between the baby's nipples. apply it and follow the prompts. making a seal. 1. perform CPR. such as a table. give the second breath. 10. 12. The differences are as follows: 3. For the rescuer to locate the correct position for the hands. such as movement. Resume chest compressions to restore circulation. 15. pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours. To begin. Circulation: Restore blood circulation 1. 7. Hand position for a child is on a point centrally located on the lower 1/2 of the sternum. above the two fingers. 2. examine the situation. hey are you okay? (tap/shake shoulder)" 4. If an AED isn't available. repeat the head-tilt. flat surface. The floor or ground also will do. have that person call for help immediately while you attend to the baby. Lean over casualty. for children ages 1 through 8. Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. with even pressure until resistance is felt. fingers entwined. Place ears above victim s mouth. As two-person CPR requires a degree of synchronized technique. Count aloud as you pump in a fairly rapid rhythm. repeat the head-tilt. if available. arms straight. With the airway open (using the head-tilt. An infant's heart is located by placing two fingers centrally on the lower 1/2 of the sternum. elbows locked. 1005. Check for ABC. Use pediatric pads if available. a 911 operator may be able to guide you in its use. and feel for breathing. lying if necessary. If the airway seems blocked. If pediatric pads aren't available. but don't shake the baby. give 2 long full breaths: (1 breath = 1 1 ½ sec) 9. apply it and follow the prompts. In no more than 10 seconds. it is usually more effective for first aid providers to perform individual CPR. 2. Give two breaths after every 30 chest compressions. Compressions are performed at a depth of 2 3cm using the heel of one hand only. 4. Feel carotid pulse (5-10 sec) 1001. 3. Cover the baby's mouth and nose with your mouth. Place hands centrally over heart (2 fingers from sternum). 3. If the chest does not rise. This is one cycle. Place the baby on his or her back on a firm. If it does rise. and the fingers entwined for stability. After 30 compressions. listen for breath sounds. If the chest doesn't rise. give a second rescue breath. Prepare to give two rescue breaths. taking one second for the breath. the pressure is modified so as not to cause damage to the ribcage. After five cycles (about two minutes) of CPR. Continue until the child moves or help arrives. 1004. Compressions are then performed by pressing with the fingers 1 2cm deep. if there is no response and an AED is available. 5. (3-5 sec) 1001. or alternatively. You should pump at a rate of 100 compressions a minute. A hand is then placed centrally on the chest. If you don't know why the baby isn't breathing.person is unconscious from a heart attack and you haven't been trained in emergency procedures.

(A) Open airway (head-tilt/chin-lift). Still breathless and without pulse. (B) The other positions on the opposite side of the body beside the chest and performs compressions. 1005. Compressions rate of 60-80 per minute. and feel for breathing. 13. 1002. Continue cycles (back to #6) and recheck pulse every 2 minutes 9 . (3-5 sec) 1001. 16.Procedure for two-person CPR (Philippine National Red Cross) (A) One rescuer positions close to the casualty's head and delivers breaths. (A & B) Position victim in flat area. elbows locked. 2. (A) "Hey. (A) If breathless. lying if necessary. 15. fingers entwined. 1003. give aid and get help (doctor/physician). 3. hey. 1002. hey are you okay? (tap/shake shoulder)" 4. (A) Feel carotid pulse (5-10 sec) 1001. 1003 1010 10. (A) Check for ABC. children and infants 80-100 per minute. 6. arms straight. (A) Place ears above victim s mouth. (A) If unresponsive. 12. 1. with even pressure until resistance is felt. 8. (B) Lean over casualty. (B) Commence 5 compressions. look. (B) Place hands centrally over heart (2 fingers from sternum). listen. 14. 11. 7. 1004. give 2 long full breath: (1 breath = 1 1 ½ sec) 9. (B) Locate sternum. 5. (B) Do Primary and Secondary Survey.