The document provides guidelines for performing basic cardiac life support, including how to recognize cardiac arrest, provide chest compressions and rescue breathing, assess for breathing and pulse, and properly position victims. It also covers foreign body airway obstruction for both conscious and unconscious adult, child, and infant victims, with steps for back blows, chest thrusts, and CPR. The chain of survival and importance of early defibrillation, emergency medical services activation, and high-quality CPR is emphasized.

1. Basic Cardiac Life Support
for Health Care Providers
Adults / Child / Infant

2. Introduction
 Cardiac emergencies are the most common
medical emergencies in the U.S., with over
600,000 deaths each year and more than
half of them occur outside of hospitals.

3. EMERGENCY CARDIAC CARE-
Involves:
 Recognizing early warning signs of
cardiac arrest (reassure
victim/activate EMS).
 Provide immediate BLS.
 Provide ACLS.
 Transfer to hospital

4.  Early signs of cardiac arrest
 Unresponsiveness
 No breathing
 No signs of circulation
 Causes of cardiac arrest:
 Trauma, drowning, choking, heart
attack….etc

5. CARDIOPULMONARY
RESUSCITATION (CPR)
 CPR: Consists of series of assessments &
interventions that support cardiac and
respiratory functions.
 Main purpose of CPR is to provide
oxygenated blood to the brain and heart
 NO SPECIAL EQUIPMENTS ARE NEEDED-
JUST HANDS AND MOUTH & STEP BY STEP
PROCEDURE.

6. Chain of Survival for Adult

8. Assessment of unresponsiveness
 Tap or gently shake
the victim and shout
“Are you ok”. To elicit
a response a painful
stimulus can be
applied such as
pinching the earlobe
and pressing over the
eyelid and observing
for grimacing. Other
associations
recommend rubbing on
the sternum using the
knuckles of the
fingers.

9. Activate EMS
 Rescuer who is alone should
alter sequence of rescue
based on most likely cause.
 Sudden witnessed collapse
(likely VF) arrest activates
EMS, get AED, do CPR.
 Hypoxic arrest (i.e.,
suffocation give 5 cycles of
CPR (about 2 minutes)
before alerting EMS.
 If there is no response, Call
***** and return to the
victim. In most locations the
emergency dispatcher can
assist you with CPR
instructions

10. Positioning the victim:
 Place the victim
first on His/ Her
back on hard
surface. If the
victim is lying face
down, turn or roll
the victim as unit,
supporting the
head and neck

11. AIRWAY
 Open the airway by the head tilt /
chin lift maneuver for all victims
 Health care personnel use:
 Jaw thrust in trauma patient
 CHIN LIFT

12. Cont. AIRWAY

13. BREATHING
 Assessment of
breathlessness (5-10
seconds)
 Place your ear just one
inch above the mouth
and the nose of the
victim and perform the
following:
 LOOK: for the chest
to rise and fall
 LISTEN: for air
escaping during
exhalation, and
 FEEL: for the flow of
air on your cheek

14. Cont BREATHING
 If breathing is not present
or is inadequate, begin
rescue breathing by giving
two slow breaths: pinch
nose and cover the mouth
with yours and blow until
you see the chest rise. Give
2 breaths.
 Time:
Each breath should take one
second and watch for chest
rise and allow time for
exhalation.
 Volume:
 Sufficient volume.
 No large volume or forceful
breathing.

15. Circulation
 Assessment of pulselessness
(5-10 secs.): check for
carotid/femoral artery pulse.
 While maintaining the head tilt
with one hand, locate the
victim’s Adams apple (thyroid
cartilage) with two or three
fingers of the other hand.
Slide your fingers into the
groove between the Adam’s
apple and the muscle on the
side nearest you where the
carotid pulse can be felt.
Femoral artery pulse also can
be checked.
 If pulse is not definitely felt
within 10 seconds, proceed
with chest compression

16. TO LOCATE THE LANDMARK FOR
EXTERNAL CHEST COMPRESSION
 The technique of costal
margin that is as
follows:
1. Run your index and
middle fingers up the
lower margin of the rib
cage and locate the
sternal notch with your
middle finger. The
index finger is place
next to the middle
finger on the lower
and of the sternum.

17. CONT. TO LOCATE THE LANDMARK FOR
EXTERNAL CHEST COMPRESSION
2. The heel of the other
hand (the one nearest
the victim’s head) is
placed on the lower
half of the sternum,
and the other hand is
placed on the top of
the hand on the
sternum so that the
hands are parallel.

18. CONT. TO LOCATE THE LANDMARK FOR
EXTERNAL CHEST COMPRESSION
3. Your fingers may
be either extended
or interlaced but
must be kept off
the chest.

19. CONT. TO LOCATE THE LANDMARK FOR
EXTERNAL CHEST COMPRESSION
4. Lock your elbows into
position, the arms are
straightened and
shoulders directly over
the victim’s sternum.
Keep the heel of your
hand lightly in contact
with the chest during
the relaxation phase of
chest compression to
maintain correct hand
position.

20. CONT. Circulation
 PUSH HARD- PUSH FAST: equal
compression and relaxation allowing
recoil of chest wall.
 Chest compression – ventilation 30:
2, for 5 cycles (2 minutes rate of 100
per minute.
 Depth of 1.5 to 2 inches.

21. Reassessment
 After 5 cycles of compressions and
ventilations (30:2), check for
return of carotid pulse/ femoral
pulse and spontaneous breathing.
 According to the findings (after 2
minutes):
 There is pulse – place in the
recovery position, monitor vital
signs until EMS arrives.
 There is pulse but no breathing:
continue rescue breathing every 5-
6 seconds (10-12 breaths).
Recheck pulse every 2 minutes.
 No pulse or breathing continue
CPR 30:2. , until AED arrives or
ACLS provider arrives.

22.  HOW TO
PLACE THE
VICTIM IN
THE
RECOVERY
POSITION

23. ONE MAN CPR, CHILD BELOW 8 YEARS
OLD
 Assessment of unresponsiveness
 Tap the child and shake and shout “ARE YOU
OK” to elicit a response, the same as in adult.
 If unresponsive shout for help and start CPR
immediately. If second rescuer or some one is
available, have him or her activate the EMS system.
Remind the activator the number is (********).
 Activate EMS after 2 minutes CPR except in
sudden witnessed collapse, activate
immediately.
 Position the victim in supine, on a firm, flat
surface. Careful handling of the neck during
positioning of victim

24.  AIRWAY
 Open the airway: perform head-tilt, chin lift maneuver
 BREATHING
 Assessment of breathlessness – (5-10 seconds)
 Place your ear just one inch above he mouth and the
nose of the victim and perform the following.
1. LOOK for the chest to rise and fall
2. LISTEN for air escaping during exhalation, and
3. FEEL for the flow of air on your cheek
 If breathing is not present or is inadequate, begin
rescue breathing by giving two slow breaths: pinch
nose and cover the mouth with yours and blow until
you see the chest rise. Give 2 breaths.
 Time: Each breath should take one second and watch
for chest rise and allow time for exhalation.
 Volume – sufficient volume. No large volume or
forceful breathing.

25.  Assessment of Pulselessness (5-10
seconds) CHECK COROTID/ FEMORAL
PULSE
 If the pulse is weak or absent begin external
chest compressions
 Nipple line technique is not to be used; that
is as follows:
 Run your index and middle fingers along the lower
rib cage until the middle finger reaches the notch.
The index finger is placed next to the middle
finger.
 The heel of the same hand is placed next hand is
placed next to the point where the index finger
was located. (One or two hands can be used.)
CIRCULATION

26.  Lock your elbows into
position, the arms are
straightened and
shoulders directly over
the victim’s sternum.
Keep the heel of your
hand lightly in contact
with the chest during
the relaxation phase
chest compression to
maintain correct hand
position.

27.  PUSH HARD- PUSH FAST
WITH OUT ANY
INTERUPTION
 RATE OF COMPRESSION:
100 PER
MINUTE
 DEPTH OF COMPRESSIN:
1/3 -1/2
THE DEPTH OF THE CHEST
 COMPRESSION
/VENTILATION RATION:
30:2
 COMPRESSION /
RELAXATION CYCLE
SHOULD BE EQUAL
 Reassessment:-
 After 5 cycles of compressions
and ventilations (30:2), check for
 Return of carotid pulse/ femoral
pulse and spontaneous breathing.
 According to the findings (after 2
minutes):
 There is pulse – place in the
recovery position carefully;
monitor vital signs until EMS
arrives.
 There is pulse but no breathing:
continue rescue breathing every
3-5 seconds (12-20 breaths per
minute). Recheck pulse every 2
minutes.
 No pulse or breathing continue
CPR 30:2. , until AED arrives or
ACLS provider arrives

28. ONE MAN CPR, INFANT (TO
APPROXIMATE 1 YEAR)
 Cardio pulmonary arrest in infants and children is not
usually a sudden event. Instead, it is often the end-
result of a progressive deterioration in respiratory an
circulatory function.
 Assessment of unresponsiveness.
 Tap the child and shake and shout “ARE YOU OK” to
elicit a response,
 If unresponsive start CPR immediately. If second
rescuer or some one is available, have him or her
activate the EMS system.
 Activate EMS after 2 minutes CPR except in
sudden witnessed collapse, activate immediately.
 Position the victim in supine, firm and flat surface.

29. AIRWAY
 Open the airway:
apply head tilt-
chin lift to ‘sniffing’
or neutral position.
 HCP CAN USE
JAW THRUST IN
TRAUMA
PATIENT

30. BREATHING
 Assessment of breathlessness (5-10 seconds)
 Place your ear just one inch above the mouth and the
nose of the infant and perform the following.
 LOOK for the chest to rise and fall
 LISTEN for air escaping during exhalation
 FEEL for the flow of air on your check
 If the breathing is not present or is inadequate , make
a tight seal over the mouth and the nose of the infant
and begin rescue breathing by giving two slow
breaths.
 Time 1 second per breath and watch chest rise and
allow time for exhalation.
 Volume enough to see the chest of the infant rise
during ventilation.

31. CIRCULATION
 Assessment of
pulselessness: Brachial
pulse (5-10 seconds)
 Feel for the brachial pulse
while maintaining head tilt
with the other hand,
 The brachial pulse is
located on the inside of the
upper arm, between elbow
and shoulder.
 If pulse is absent or below
60 per minute give 5
cycles of external 30 chest
compressions followed by
2 slow breaths. Each
breath over one second.

32. LAND MARK FOR EXTERNAL
CHEST COMPRESSIONS
 Nipple line technique.
 The area of compression is
just below the imaginary line,
using the middle and ring
fingers.
 RATE OF COMPRESSION:
100 PER MINUTE
 DEPTH OF COMPRESSION:
1/3-1/2 THE
DEPTH FO THE CHEST
 COMPRESSION /
VENTILATION RATIO: 30:2
 COMPRESSION /
RELAXATION CYCLE SHOULD
BE EQUAL

33. REASSESSMENT
 Reassess the infant after every 5 cycles of
30 compressions and 2 ventilations (2
minutes).
 According to the findings:
 There is pulse and breathing, place the infant in
the recovery position, monitors vital signs until
EMS arrives
 There is pulse but no breathing continue rescue
breathing one breath every 3-5 seconds (12-20
per minute) and reassess.
 No pulse or breathing continue CPR 30:2. ratio,
assess for pulse and breathing after 5 cycles
(2minutes)

34. FOREIGN BODY AIRWAY
OBSTRUCTION
 CAUSES:
 Meat is common cause of obstruction
 Other food & foreign body may cause obstruction in
children and adults.
 Alcohol elevated blood level
 Elderly with dysphagia may be at risk
 Air way obstruction may be
 Partial /Mild
 Patient choking but able to cough,
 Low pitch sound during inhalation
 Gaseous exchange is normal
 Treatment: Do not interfere at this stage. Encourage the
victim to cough. If condition of the victim is worsening,
immediately interfere.
 Complete / severe- It can be mild gradually or
severe from the start.

35. UNIVERSAL SIGN OF CHOKING
 The victim clutches his
neck with the thumb &
index finger.
 Inability to speak,
inability to cough.
 High pitched sounds or
no sound during
inhalation
 Increased difficulty to
breathe
 Bluish skin color
(cyanosis)

36. ADULT CONSCIOUS CHOKING VICTIMS
 Stand behind the adult/ child
victim. Try to release his/ her
hands clutching the neck and
wrap our arms around the
waist. Head should be bent
forward and slightly downward.
 Apply the Heimlich maneuver
as described below.
 Make a fist with one hand
and place the thumb side of
the fist against the victim’s
abdomen above the navel
and well below the xiphoid
process.
 Grasp the fist with the other
hand exert a series of
inward upward thrusts until
the foreign body is expelled,
or the victim becomes
unconscious.

37.  CHEST THRUSTS FOR
SPECIAL CASES
 Chest thrusts should
be used in the
following conditions
 Advanced stages of
pregnancy
 Markedly obese victim
THE VICTIM BECOMES OR IS
FOUND UNCONSCIOUS
 If the victim with FBAO
becomes unresponsive, the
rescuer should carefully
support the patient to the
ground , immediately
activate EMS , and then
begin CPR. Each time the
airway is opened during
CPR, the rescuer should look
for an object in the victim’s
mouth and remove it.

38. INFANT FOREIGN BODY AIRWAY
OBSTRUCTION
CONSCIOUS CHOKING INFANT
 Determine airway obstruction,
observe breathing difficulties.
 If breathing difficulty
increases or persists or
breathing is absent perform
back slaps and chest thrusts.
 Hold the infant in a prone
position, resting on your
forearm. Support the infant’s
head firmly by holding the
jaw. The rescuer’s forearm
should rest on / her thigh to
support the infant. Deliver
five back slaps forcefully
between the infant’s shoulder
blades, using the heel of the
hand.

39. Cont. INFANT FOREIGN BODY
AIRWAY OBSTRUCTION
 After delivering the back
slaps, turn the infant while
the head and neck are
firmly supported between
your hands, with the head
lower than trunk. Deliver
up to 5 quick chest thrusts
in the same location for
infant’s CPR. The series of
5 back slaps and 5 chest
thrusts should be continued
until the foreign is expelled
or infant becomes
unconscious.

40. WHEN THE INFANT BECOMES
OR FOUND UNCONSCIOUS
 Call out “HELP” if others respond, activate
the EMS system.
 Position the infant: keep the infant face up.
 Immediately start CPR. For 5 cycles (2
minutes) then activate EMS if you are
alone.
 Each time the airway is opened during CPR,
the rescuer should look for an object in the
victim’s mouth and remove it.

41. USE OF BARRRIER DEVICES
 If breathing is not
present or is
inadequate, begin
rescue breathing by
giving two slow
ventilations using any
available barrier
device, e.g. Bag-
valve-mask, pocket
mask or face shield.
 Be sure the proper size
of mask to provide a
good fitting to prevent
leakage during
ventilation.

42.  HEALTH CARE
PROFESSIONAL
SHOULD NOT
PERFORM MOUTH
TO MOUTH
BREATHING. THE
USE OF A BARRIER
DEVICE IS HIGHLY
RECOMMENDED, E.G.
FACE SHIELD,
POCKET MASK OR
BAG VALVE MASK.

43. AUTOMATED EXTERNAL DEFIBRILLATION
(AED)
 AED is recommended to be used in adults and children 1 year of age
and older.
 Not recommended for infants below one year and neonates.
 Indications: unresponsiveness, absence of breathing, absence of
detectable pulse.
 Contra indications: responsiveness, presence of breathing,
presence of detectable pulse.
 For sudden witnessed collapse in adult and child, use the AED once it
is available.
 For un-witnessed cardiac arrest in the pre-hospital setting, use the
AED after 5 cycles of CPR (about 2 minutes)
 The AED machine must be able to accurately and reliably recognise
paediatric shockable rhythms and be capable of delivering energy
dose.
 Uses: for adult and children 1 year and above, anywhere,
 Health care provider who holds valid certificate in BLS.
 Most AEDs are equipped with small pads and means of reducing the
energy dose.
 If child pads/ system is not available, adult's pads/system can be
used but paediatric pads can not be used for adults.

44. Cont. AED
 Check for shockable rhythm only after completion of
5 cycles of CPR
 If indicated for shocks deliver one single shock and
continue CPR.
 TYPE OF WAVEFORM:
 Monophasic Shock 360 Joules
 biphasic truncated 150 – 200 Joules
 No shock is indicated
 Check for pulse and breathing. If breathing is adequate,
place the victim carefully in the recovery position.
 If breathing and pulse not present, continue CPR.
 (Reassessment of patient is carried out if recovery was
not achieved. CPR to continue for 2 minutes, recheck for
pulse and analyze for shockable rhythm and if required,
single shock and CPR 5 cycles to be continued.)

45. DEFIBRILLATION
 It is the therapeutic use of kinetic energy in
the form of joules to be delivered to a
chaotic rhythm in the heart known as
ventricular fibrillation immediately using a
proper defibrillator by qualified ACLS
providers.
 Physiologically the shock depolarizes the
myocardium, terminating ventricular
fibrillation or pulse less Ventricular
tachycardia allowing normal sinus electrical
activity to be restarted.
 It is part of the chain of survival

46. Types of defibrillators
 A manual machine which necessitates the
presence of certified physician to diagnose
and interpret the rhythm and properly use
the defibrillator to shock the patient. It has
two modes of delivering the shock:
asynchronized defibrillation and
synchronized cardioversion
 AED has been introduced as an effective
DC. It has only a synchronized mode of
shock which allows paramedics, first
responders, public at large trained,
equipped with and authorized to use such
a device in pre- hospital setting.

47. PRECAUTIONS
 Wet person or wet conditions
 Excessive hair on the chest
 Moving vehicle
 Pacemaker and GTN patch
 In presence of inflammable
anaesthetics or concentrated oxygen