Cop-5-Policy On Uniform Use of CPR

Title Uniform Use of CPR
Document Number COP-5

Revision Number R1
Revision Date 8th July 2018
Version Number V1
Issue/effective Date 02 August 2017
nd
Page Number Page 1 of 23

Document Control Status
UNIFORM USE OF CPR

1.0 Purpose:
To define the policy of giving cardiopulmonary resuscitation for patients in
need.
2.0 Scope:
All the personnel involved in giving care to a patient in need of CPR.
3.0 Responsibilities:
All the members of Apollo Hospitals, Visakhapatnam Care team including
Consultants, Nurses, Paramedical staff and allied health personnel and
services
4.0 Policy
4.1 Policies and procedures guide the use of resuscitation services throughout the
organization.
4.2 All the employees of the hospital involved in direct patient care shall have a
BLS certification.
4.3 All the Critical care consultants, Anaesthesia Registrar / Residents, Medical /
Surgical Residents, Critical Care Unit nurses, Emergency staff,, Care
Managers shall have an ACLS Certification / Training ( in side organization)
Sign.
Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

Name.
PREPARED BY REVIEWED BY APPROVED BY
All information in this document is confidential and property of Apollo Hospitals, Visakhapatnam.
Reproduction in any form, either in part or full to be done only with written permission.
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5.0 Procedure:
5.1 The hospital has uniform use of resuscitation services throughout the
organization. “CODE BLUE” is an emergency mode of alerting all medical,
nursing, paramedical, allied health sciences personnel (House keeping,
transport) of a cardiac arrest occurring within the hospital premises.
5.2 The staff nurse on duty or the resident doctor or any other staff member, may
suddenly find a patient in any area of the hospital, becoming unresponsive due
to cardiac arrest. He/she shall provide basic life support and seek assistance by
announcing “Code Blue” on the public address system.
5.4 As an immediate response to the announcement, all concerned people from the
associated departments shall rush to the place of incidence within less than 2
minutes. The first responder who is BLS trained and certified shall begin the
Cardio Pulmonary Resuscitation. The Critical Care Specialist / Anaesthetist
on duty shall be the team leader. The doctor on duty, the nursing supervisor,
transport boy with a stretcher and an ECG technician if designated, shall reach
the place of incidence as soon as possible.
5.5 The crash cart with all emergency care equipment shall be moved
instantaneously to the concerned area. After the use of crash cart, the
concerned staff nurse/nursing supervisor shall inform the pharmacy. The
pharmacy shall determine the drugs used. The nurse shall raise an indent for
the used drugs. The Pharmacy shall replenish the crash cart and seal it after the
code is stood down.
5.7 The Critical Care Specialist/ Anesthetist on duty shall work as the code blue
team leader, to coordinate the CPR. Overcrowding and confusion created by
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too many physicians giving conflicting orders to the nursing personnel shall be
discouraged.
5.8.1 Consultant shall be informed by the nursing supervisor and the relatives are
counseled by the respective MSW or concerned medical personnel.
5.8.2 Code Blue Running sheet shall be filled by the nurse supervisor, who
participated in the code, however Nurse-in-charge is responsible for
documentation of code blue events and the same is filed in the patient’s
medical record. A copy is sent to Dy.MS office for Analysis in the Code Blue
Committee meet. The analysis shall be presented in Code Blue Committee
meeting and discussed once in three months.
6.0 Composition of Team:
BLS Team
1. Floor Residents on duty
2. Nurse taking care of the particular patient
3. Nursing supervisor of that floor on duty
4. ECG technician if designated
5. Security officer on duty
6. Area House keeping Supervisor on duty.
ACLS Team
1. Critical Care Specialist / Anaesthetist
2. Cardiologist on Duty
3. Emergency Physician if required
4. CICU/ MICU Nurse in charge.
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7.0 Team Leader:

1. Anesthesia doctor is responsible for running the code and he
shall give all medication and fluid orders.
2. He / She shall decide which doctor shall stay for the Code and
who all can leave immediately.
3. He/She is also the one who shall call off the Code.
4. He/She shall write a detailed note in the progress sheet
describing the Code process and the medication given.
5. He/She shall verify the accuracy of the Code Running Sheet
and sign it.
6. He/She shall counsel the family/ relatives on site.
7.0 Responsibilities:
1. Critical Care specialist / Anesthetist: He shall be Team Leader running the
code. He shall maintain airway and ventilation. He shall assign people from
the team on site to take care of Airway, Breathing, Circulation and
defibrillation.
2. Floor Residents: shall follow the orders of the team leader and do
resuscitation as per BLS/ ACLS guidelines.
3. Nurse: Administers drugs and I/V Fluids as ordered by the Team Leader and
do resuscitation as per BLS/ ACLS guidelines.
a. Do a Glucometer check for blood sugar estimation.
4. Nursing Supervisor:
a.Records all the events of the Code in the Code Running Sheet
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b. Labels and sends blood samples as desired by Team Leader.

c.Fills out Incident Form for any violation of Code Protocols and also for
non-arrival of a Team Member.
8.0 Cardiopulmonary Resuscitation Sheet (Code Running Sheet)

8.1 Purpose:
To facilitate accurate and complete documentation of code occurrences and
action taken.
To provide a record for review and evaluation of CPR and Advanced Life
Support measures.
8.2 Maintenance of Crash Carts:

1. Pharmacy shall be responsible for stocking the crash carts with drugs and
other equipment.
2. The list of drugs and equipment shall be reviewed as required by the
Medical Administrator / Code Blue Chairperson
3. The Pharmacy shall place a breakable seal on the crash cart cover. An
intact seal indicates to the users that the cart is ready for use.
4. Pharmacy shall be responsible for ensuring that the drugs kept in the crash
carts are within the expiry dates and shall maintain a log of when a crash
cart is to be recalled for removal of expired drugs, etc. The pharmacy shall
check the drugs and consumables in the crash cart for their expiry dates
every month. They shall recall a medication from the crash cart 3 months
before the date of expiry.
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5. Once a crash cart is used, it shall be immediately replenished / replaced by

the Pharmacy. This is of the highest priority and Floor Nurse / Nursing
Supervisor shall ensure compliance. The Pharmacy shall immediately
replenish / replace the used cart ensuring the integrity of the breakable seal.
9.0 Technique of Cardiopulmonary Resuscitation

One Man CPR
 Assess responsiveness, by shouting near the victim ‘ ARE YOU OK’
tap, or gently shake the shoulders
 If the victim responds, ask his about his/her main complaints, and
check victim thoroughly. If the victim does not respond to attempts of
arousal, CALL FOR HELP, even if no one is in sight. Call out in the
hope that someone will hear. Who can assist or call for CPR Team.
 If the victim is lying on his face, roll him onto the back as one unit, by
supporting the neck with one hand, and the other hand placed on the
victim’s hip. Place him on a firm flat surface.
 Open airway (use head tilt/ chin lift man oeuvre)
 Place hand nearest victims head over the forehead, and pull
backwards to tilt the head.
 Support the lower jaw by placing the index finger and middle
finger under the bony part of the jaw. Avoid pressing on the
soft tissues
 If you suspect neck injury do not move head or neck , try to do
jaw thrust without tilting the head.
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 Clear airway
 If you see liquid or semi liquid wipe it out with fingers covered
with a cloth
 If you see foreign body or if the tongue has fallen back in the
airway, hook it out with your index finger.
 Leave dentures in place unless they are loose, and cannot be
kept in place.
 Assess breathing by placing you cheek ion front of the victim’s

mouth:
 LOOK for any chest movement
 LISTEN to breathing sound
 FEEL any flow of air expired form the victim airway
 If the victim is not breathing

 Maintain open airway (head tilt/chin lift)
 Take a deep breath; seal your lips victims’ mouth attempt to
give two rescue breaths.
 If the first breath enters the victim’s tracheas give another
breath.
 Breathe slowly 1 sec per breath - adequate time should be
allowed to provide good chest expansion as this decrease the
possibility of gastric distention.
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 ASSESS CIRCULATION (CHECK FOR CAROTID PULSE)

 While maintaining head tilt/ chin lift with one hand over the
forehead
 Locate the victims Adams apple with 2 or 3 fingers of the
opposite hand
 Slide your fingers down into the groove lateral to the tracheas.
(Between the trachea and the Stern mastoid muscle).
 Feel for carotid pulse, at the side nearest to the rescuer (this
should take 5-10 sec ) the pulse must be probed gently avoiding
compression of the artery
 If pulse is not present, announce cardiac arrest, and commence
external chest compressions
 Locate the proper hand position on the victim’s chest. Proper hand
placement is established using the following guidelines.
 Use your index and middle fingers of the hand near the victim’s
chest.
 Slide your fingers up the edge of the rib cage till you reach the
sternal notch
 Place your middle finger on the sternal notch, and your index
finger next to it.
 While placing index and middle fingers in place, the rescuer
positions the base of the palm of the free hand next to it over
the lower half of the sternum.
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 Rescuer removes his/her index and middle fingers from the

sternal notch, and place over the other hand.
 Interlace fingers together by holding in extension position,
pointing across the victim’s chest a way from rescuer. Do not
place fingers on the victim’s chest, as pressure here may cause
fracture of the ribs remember to keep your hands in position on
the sternum to avoid losing the proper land mark
 Commence external chest compressions the most pressure with the

least effort could be achieved by the following guidelines
 Lean forward until the rescuer shoulders are positioned directly
over the hands, elbows are locked and the arms straightened.
 Start applying downward pressure over the sternum. The
sternum must be depressed 1 ½ to 2 inches the weight of the
rescue’s back creates the necessary pressure to make
compression easier on the arms and shoulders. The natural
body weight of the rescuer falling forward provides the force to
depress the sternum.
 Release chest compression to allow blood flow into the heart.
 Equal compression and relaxation should be provided and no
pause between compressions.
 Provide 30 compressions at a rate of 80-100 times / minute. Count
while applying pressure and say and when pressure is released e.g.
ONE, AND, TWO, AND, THREE, etc.
 Open airway and deliver two rescue breaths
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 Repeat compression /breathing cycles to continue CPR for 2 min (5

cycles)
 Reassessment: after five cycles of compressions and ventilations (30:2
ratio) re-evaluate the victim
 Check for return of the carotid pulse
 If pulse is absent resume CPR with 30 compressions followed
by 2 rescue breaths.
 If pulse is present check for spontaneous breathing
 If breathing is present place the victim in the recovery position,
monitor pulse and breathing closely.
 If breathing is absent, perform rescue breathing at a rate of 12
breaths min (once every 5 sec.) and monitor pulse closely.
10. Two-man CPR:
In two man CPR, one rescuer is positioned at the victim’s side, performs external
chest compressions, (named compressor) and the other rescuer is positioned at the
victim’s head maintains an open airway and performs ventilations,(named
ventilator).
 Sequence of two man CPR
 When one two man CPR
 Allow the initial rescuer to complete the full cycle of 30
compressions and 2 ventilations
 One rescuer moves to the victim’s head, maintains airway
open, and checks for the ventilator.
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 Whilst the second rescuer, locates the proper hand position

over the victim’s chest and prepares to act as the chest
compressor
 If no pulse is felt, the compressor gives chest compressions at
the rate of 80-100/ min, counting ‘’one’’ and, ‘’two’ and,
‘’three ‘’ and, ‘’four’’ and, ‘’five’’…….
 At the end of the 30th compression, a pause should be allowed
for ventilation. The ventilator gives 2 ventilations.
 Compression / ventilation cycle to be continued (30:2 ratio)
 To allow assessment of return of circulation, and spontaneous
breathing, chest compression and ventilation must be stopped
for 5 sec; at the end of the 2 min and very few minutes
thereafter.
 When no CPR in progress
 If no CPR in progress, and both rescuers arrive on the scene at
the same time
 One rescuer should ensure CPR is activated
 If this person leaves the area, the other should start one-man
CPR
 If both rescuers are available, one should
 Determine unresponsiveness
 Assess circulation. If there is no pulse, say “no pulse’.
 The rescuer should go to the victim’s chest, to act as the compressor.
 Locate the proper hand position
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 Start external chest compressions, after the first rescuer says ‘

no pulse’
 While primary rescuer is doing chest compressions the second
rescuer Position the victim
 Open airway
 Assess breathing (look, listen, feel). If breathing is absent, give
two rescue breathes.
 The ventilation / compression cycle should be continued
(30:2ratio)
 To determine if the victim regains spontaneous breathing and
circulation, chest compressions must be stopped for 5 sec; at
the end of the second min.
 The rescuers should exchange positions every 2 mins
11. Switch Procedure:
The rescuers should exchange their positions, at the end of the 2 nd min i.e.,
after 5 cycles of 30:2 (compressions: ventilations)
 Start external chest compressions, after the first rescuer says ‘
no pulse’
 While primary rescuer is doing chest compressions the second
rescuer Position the victim
 Open airway
 Assess breathing (look, listen, feel). If breathing is absent,
give two rescue breathes.
 The ventilation / compression cycle should be continued
(30:2ratio)
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 To determine if the victim regains spontaneous breathing and

circulation, chest compressions must be stopped for 5 sec; at
the end of the second min.
The rescuers should exchange positions every 2 min.
12. Monitoring The Victim: The victim’s condition must be monitored to

assess the effectiveness of the rescue effort. The ventilator responsible to
check the pulse and breathing during the procedure, so as
 To check the effectiveness of chest compression.
 Determine if the victim regains his pulse.
 Stop compression for 5 sec. At the end of the second minute and
every two minutes, to allow checking of the pulse.
 WHEN TO CHECK FOR PULSE IN TWO MAN CPR: After the
second minute(after 5 cycles of 30 compressions : 2 ventilations) i.e.,
when changing positions
 FOR HOW LONG CPR CAN BE INTERRUPTED: Not more than
7-10 seconds.
 WHAT DO I DO IF THE VICTIM BEGINS TO VOMIT: Turn the
victim on his/ her left side, perform a finger sweep then continue
CPR.
 WHAT SHOULD I DO IF THE VICTIM DEVELOPS GASTRIC
DISTENSION: if slight distension, reposition the head, and continue
CPR; if severe distension, turn the victim entirely on his/her side and
apply a gentle pressure to the abdomen.
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13. Infant CPR: Rescue methods differ according to age and size. Infant
techniques are used on those from birth to 1 year of age child techniques are
used on those from 1 year to 8 years of age.
 INFANT CPR: If you find a motionless infant quickly check the scene
for:
 Dangerous hazards
 Clues to what happened
 ASSESS RESPONSIVENESS
 Tap or gently shake the infant’s shoulder or tap the sole of the
foot.
 If the infant responds then check from head to toe for other
injuries, monitor vital signs and level of consciousness. Have
the infant examined by a doctor
 If no response then start CPR for 2 mins and then shout for
help
 SHOUT FOR HELP

 Shout for help even if no one is in sight, someone may hear you
and come to your assistance.
 TURN INFANT ONTO HIS HER BACK: Infant CPR is best done
with the infant lying on his / her back on a firm flat surface desk, floor
and his her head on the same level as the heart or slightly lower than
the heart.
 Just below nipple line on breast bone
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 Give 30 chest compressions with two fingers(1 rescuer CPR) or

with both thumbs, encircling hands over chest(2 rescuer CPR)
 Depth 1/3rd to ½ of chest
 Rate 100 / minute
 Count one and two and …..
 When compressing the chest bend from the hips not the knees
 Do not remove the hand form the sternum between
compressions.
 OPEN THE AIRWAY: Use head tilt / chin lift procedure

 Place the hand nearest the infants head on the infant’s forehead
and apply backward pressure to tilt the head back
 Place the index finger of the other hand under the bony
prominence of the chin and lift to slightly extend the neck. Do
not press on the soft tissues under the jaw. Care should be taken
not to over extend or under extend the neck, as this will cause
decreased air entry or complete blockage.
 If you suspect a neck injury then use the jaw thrust method, ie
with both hands, one on each side of the face place your fingers
behind the angel of the jaw and lift upward slightly opening the
mouth as you do.
 CLEAR THE AIRWAY
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 If you see liquid or semi-liquid secretions wipe it out with

either your secretions wipe it out with either your fingers or a
soft cloth
 If you see solid foreign bodies then remove it by scooping it out
with your little finger.
 ASSESS THE BREATHING: Maintain the head tilt / chin lift position
and place your cheek and ear over the infant’s nose and mouth for 3-5
seconds
 LOOK for chest movement
 LISTEN for breath sounds
 FEEL for the expired breath on your cheek
 If the infant is breathing, maintain open airway and monitor vital signs.
If the infant is not breathing or breathing is inadequate then initiate
rescue breathing.
 INITIATE RESCUE BREATHING
 Make a seal over the infant’s mouth and nose with your mouth
 Give 2 slow breaths lasting 1-1 ½ seconds each.
 Turn your head to the side to watch the chest fall between
breaths. You must take a fresh breath after each breath given
 If the infant is so large that an airtight seal cannot be made over
the nose and mouth, then pinch the nostrils together ( as in an
adult)
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 If there is no chest movement then the rescuer should check for

airway patency by repositioning the head and increasing the
volume of air delivered (blow a little harder)
 CHECK PULSE: Maintain head tilt with the hand nearest the infant’s
fore head.
 With the index and middle fingers of the other hand palpate the
infant’s brachial pulse- located midway between the elbow and
the underarm on the inner aspect of the arm.
 Count the number of beats in 6 seconds and multiply by 10
(this gives the number of beats in 1 minute) e.g. 4 beats in 6
seconds = 40 / minute
 If pulse and breathing present:
o Maintain open airway
o Monitor vital signs
 If pulse and no breathing
o Give rescue breaths at 40/ minute
o Check pulse every 15-30 seconds
 If no pulse or pulse is below 80/ minutes then commence

cardiac compressions.
 CALL FOR HELP

 If no pulse, or pulse below 80 minute and no breathing start
CPR and then call for help:
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 CHEST COMPRESSIONS
 Keep the hand nearest the head on the infant’s forehead to
maintain head tilt.
 Imagine a line connecting the nipples
 Give 30 chest compressions with two fingers(1 rescuer CPR) or
with both thumbs, encircling hands over chest(2 rescuer CPR)
o Compression depth:1.5 to 2 inches inch
o Compression rate 100 / minute
 Do 30 compressions counting as you depress the sternum one
two three four, five
 Do not lift your hand off the chest between compressions. If
you do then you must re-locate the landmark before continuing
 Maintain head tilt all the time with the hand nearest the infant
head on the infant forehead
 Compression / ventilation ratio = 30:2
 RESCUE BREATHING: After 30 compressions give 2 rescue breaths

(1 rescuer CPR) , After 15 compressions give 2 rescue breaths(2
rescuer CPR )
 REPEAT COMPRESSION / VENTILATION CYCLE: Continue CPR
cycle for 2 mins then recheck the pulse
 Continue process until:Victim regains pulse and respirations
cardiac arrest team arrives and you are told to stop
 Another person trained in CPR arrives and can relieve you
 RECHECK PULSE
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 Infant – brachial pulse

 If another CPR trained person arrives:
o Finish 5 compression : ventilation cycles then ask him
her to take over
o When he / she begins CPR he / she first checks the pulse
for 6 seconds if the pulse is below 80 / minute he gives
30 compressions and continues 5 compression:
ventilation cycles and re checks the pulse every 2 mins.
14. Paediatric CPR: Child techniques are used on those from approximately
1-8 years of age (NB: size and weight must be taken into account.) If you find
a motionless child check the scene for Dangerous hazards and Clues as to
what happened
 ASSESS RESPONSIVENESS
 Tap or gently shake the child’s shoulder
 Shout near the child’s ear are you OK
 SHOUT FOR HELP: Shout for help even if no one is in sight,

someone may hear you and come to your assistance.
 ROLL CHILD ONTO HIS / HER BACK: A firm flat surface is needed
 Child is kept in supine position with the head on the
same level as the heart
 To place the rescuer’s heel of one hand/two fingers on
the breast bone below the nipple line
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 Give 30 chest compressions

 Depth 1- 1 ½ inches
 When compressing the chest bend from the hips not the knees
 Do not remove the hand form the sternum between compressions.
 OPEN THE AIRWAY: Use head tilt / chin lift procedure

 Place hand nearest child’s head on the child’s forehead
and apply backward pressure to tilt the head back
 Place the fingers of the other hand under the bony
prominence of the chin and lift.
 Place the fingers of the other hand under the bony
prominence of the chin and lift.
 Avoid pressure on soft tissues under the jaw
 Tilt the head backward without closing the mouth
 Do not use your thumb to lift the chin
 CLEAR THE AIRWAY

 If you see liquid or semi-liquid secretions wipe it out
with either your fingers or a soft cloth
 If you see a solid foreign body then removes it by
scooping it out with your little finger.
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 ASSESS THE BREATHING: Maintain the head tilt / chin lift position and
place your cheek and ear over the child’s nose and mouth for 3-5 seconds
 LOOK - for chest movement
 LISTEN -for breath sounds
 FEEL - for the expired breath on your cheek
 If the child is breathing maintain open airway and
monitor vital signs.
 If the child is not breathing or breathing is inadequate
then initiate rescue breaths
 INITIATE RESCUE BREATHING: Maintain head tilt / chin lift position

with one hand on the child’s forehead
 Take a deep breath and seal your lips tightly around the
child’s mouth
 Give 2 slow breaths, each lasting 1- 1 ½ seconds (you
should take a breath after each breath given to the
victim)
 Turn your head towards the chest to watch the chest rise
and fall between breaths
 Allow for chest deflation between breaths
 CHECK PULSE: Maintain head tilt / chin lift position with your hand on
the child’s forehead. Palpate the carotid pulse
 Locate the Adam’s apple with 2 fingers of the hand
nearest the child’s feet
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 Slide your fingers down into the groove of the neck on

the side closest to you
 feel the carotid pulse for 6 seconds and multiply the
number of beats counted by 10 ( this will give you the
pulse for1 minute )
 If there is a pulse and no breathing is inadequate then
give rescue breaths – 20 / minute
 if there is no pulse and no breathing then begin CPR
 SHOUT FOR HELP

 CHEST COMPRESSIONS
 Use your fingers of the hand nearest the child’s chest

to slide up the rib cage edge to the notch at the end of
the sternum
 Place your middle finger on the notch and the index
finger next to ithe heel of the same hand is placed next
to the point where the index finger was located, with
the long axis of the heel parallel to the sternum. The
fingers should be held up off the ribs while the heel of
the hand remains in contact with the sternum.
 Keep the arm straight and the elbow locked
 Give 30 chest compressions
 Depth 1- 1 ½ inches
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 When compressing the chest bend from the hips not the knees
 Do not remove the hand form the sternum between compressions.
 GIVE 1 SLOW RESCUE BREATH: See step number: 10.7 for

procedure
 REPEAT COMPRESSION / VENTILATION CYCLE
 Ratio = 30 compressions : 2 ventilations
 Repeat cycle 5 times then recheck pulse
 IF pulse below 80 / minute then continue CPR repeating steps 10
and 11 Until :
 Victim regains pulse and respirations
 Cardiac arrest team arrives and you are told to stop
 Another person trained in CPR arrives and can relieve
you
 If pulse is above 80 / minute then discontinue CPR and
assess breathing.
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Title Uniform Use of CPR

Document Number COP-5

Page Number Page 1 of 23

UNIFORM USE OF CPR

Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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7.0 Team Leader:

Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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b. Labels and sends blood samples as desired by Team Leader.

8.0 Cardiopulmonary Resuscitation Sheet (Code Running Sheet)

8.2 Maintenance of Crash Carts:

Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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5. Once a crash cart is used, it shall be immediately replenished / replaced by

9.0 Technique of Cardiopulmonary Resuscitation

Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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 Assess breathing by placing you cheek ion front of the victim’s

 If the victim is not breathing

Dr.Balakrishna V Dr. Narendra Bendi Dr. Sandeep.C

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 ASSESS CIRCULATION (CHECK FOR CAROTID PULSE)

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 Rescuer removes his/her index and middle fingers from the

 Commence external chest compressions the most pressure with the

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 Repeat compression /breathing cycles to continue CPR for 2 min (5

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 Whilst the second rescuer, locates the proper hand position

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 Start external chest compressions, after the first rescuer says ‘

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 To determine if the victim regains spontaneous breathing and

12. Monitoring The Victim: The victim’s condition must be monitored to

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 SHOUT FOR HELP

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 Give 30 chest compressions with two fingers(1 rescuer CPR) or

 OPEN THE AIRWAY: Use head tilt / chin lift procedure

 CLEAR THE AIRWAY

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 If you see liquid or semi-liquid secretions wipe it out with

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 If there is no chest movement then the rescuer should check for

 If no pulse or pulse is below 80/ minutes then commence

 CALL FOR HELP

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 RESCUE BREATHING: After 30 compressions give 2 rescue breaths