DEPARTMENT OF HEALTH

Health Emergency Management Bureau

BASIC LIFE SUPPORT

TRAINING
PARTICIPANT’S WORKBOOK

2018 Edition
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FOREWORD
The DOH Basic Life Support Training Course is
categorized into two: BLS Training for Healthcare
Providers and BLS Training for Lay Rescuers. This
workbook was prepared for the participants of both
training categories. The contents are basically high-
lights of important things to remember from the
units of competencies of the course.

The participant’s workbook has been de-

signed to facilitate the learning and understanding of
the topics presented in the units of competencies.
The workbook has “fill-in” information for the partici-
pants to answer while the lecture-discussion is on
going. This will later serve as a trainee’s notes and
reviewer.

THE DEPARTMENT OF HEALTH

Health Emergency Management Bureau

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TABLE OF CONTENTS
FOREWORD………………………………….………………………...….……. 2

TABLE OF CONTENTS……………………………………………...….……… 3

DOH-HEMB MISSION & VISION…..………………………………....………. 4

LEGAL BASIS OF BASIC LIFE SUPPORT TRAINING………..…...……… 4

.
UNIT OF COMPETENCY I
Part A: PRINCIPLES OF EMERGENCY CARE…………….......………. 5
Part B: INTRODUCTION TO BASIC LIFE SUPPORT….………..….…. 8

UNIT OF COMPETENCY II
DEPARTMENT OF HEALTH Part A: CARDIOPULMONARY RESUSCITATION………..……..……. 13
Part B: AUTOMATED EXTERNAL DEFIBRILLATOR.…….....…….... 23
Health Emergency Management Bureau
Building 12, San Lazaro Compound, Rizal Avenue, UNIT OF COMPETENCY III
Sta. Cruz, 1003 Manila Part A: RESPIRATORY ARREST & RESCUE BREATHING………… 29
Part B: FOREIGN BODY AIRWAY OBSTRUCTION…….………..….. 32

For Inquiries and Comments:

Office of the Director: 740-5030
Trunk line: 651-7800 loc. 2200-2204
Telefax: 743-0568; 743-0538
Operation Center: 711-1001-02
Website: www.hems.doh.gov.ph

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HEALTH EMERGENCY MANAGEMENT BUREAU FBAO MANAGEMENT

VISION 1. Determine scene safety.

2. Introduce yourself patient, guardian and or bystander.
Health Disaster Safety in the Hands of the Community a.k.a. 3. Determine level of breathing difficulty by checking:
“Kaligtasang pang-Kalusuguan sa Kalamidad sa Kamay ng Komunidad (5K)” Infant – ineffective coughs, weak or absence of cry.
If so, tell parents/guardian that you are there to help.
MISSION Child/Adult – by asking if the victim is choking, “can you cough?”
If so, tell the victim that you are there to help.
To support community health resilience building. 4. Properly position the patient.
a. Infant- support the infant on rescuer’s knee or lap.
GOAL b. Child/Adult - Assume straddle position behind.
5. Locate proper site:
1. Guarantee uninterrupted health service delivery during emergencies and disasters; a. Infant- give 5 back slaps and 5 chest thrusts using 2 fingers techniques.
2. Avert preventable morbidities, mortalities and other health effects secondary to
emergencies and disasters; and
3. Ensure no outbreaks secondary to emergencies and disasters.

POLICY DIRECTION
To institutionalize Disaster Risk Reduction Management for Health (DRRM-H) at all
levels.

STRATEGIC OBJECTIVES
1. To strengthen HEMB capacity to sustain its continued relevance in DRRM. b. Child/Adult- for abdominal thrust, properly position balled fist on the patient.
2. To enhance RO’s capacity to support LGU’s disaster resilience building . Properly perform abdominal thrust ( At least 5 thrusts ).
3. To scale up the Hospital capacity to manage health risks of disasters.
4. To build the capacity of LGU to institutionalize DRRM-H. 6. If patient becomes unconscious, carefully lay him/her down.
7. Call for help to activate Medical Assistance and perform 30 Chest Compression.
5. To develop capacity of community/family to prepare, respond and cope with emer- 8. Check oral cavity for presence of obstruction. If foreign body is visible perform
gencies and disasters.
finger sweep, if not visible properly administer first RB.
9. If air bounces back, re-position patient’s head and properly administer second RB.
LEGAL BASES IN THE CONDUCT OF BASIC LIFE SUPPORT TRAINING 10. If air goes in, assess for pulse and consciousness.
1. Administrative Order (A.O.) 155 s. 2004, Section VI Implementing Guidelines — 11. If patient becomes conscious, properly place patient in recovery position.
“The Basic Life Support (BLS) Training is mandatory to all health workers”
2. Republic Act 10871 “Basic Life Support Training in Schools Act“

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UNIT OF COMPETENCY I

PART A: PRINCIPLES OF EMERGENCY CARE

FINGER SWEEP a technique recommended for
relieving foreign body airway obstruction.
EMERGENCY ACTION PRINCIPLES

1. Survey the Scene. Once you recognized that an emergency has occurred
and decide to act, you must make sure that the scene of the emergency is
safe for you, the victim/s, and the bystander/s.
Take time to survey the scene and answer these questions:
RESCUE BREATHING (RB) is a technique of  Is the scene safe?
breathing air into person lungs to supply him  What happened? Nature of incident
or her with the oxygen needed to survive.  How many people are injured?
 Are there bystanders who can help?
www.health.howstuffworks.com
 Then identify yourself as a trained first aider.
 Get consent to give care.

Complications from Abdominal Thrusts 2. Activate Medical Assistance (AMA). In some emergencies, you will need to
1. Incorrect application of the Abdominal Thrust can damage the chest, ribs and internal call for specific medical advise before administering first aid. But in some situ-
organs. ations, you will need to attend to the victim first.
2. May also vomit after administering the Abdominal Thrust.
3. They should be examined by a Physician to rule out any life-threatening complica-  Call First and CPR First. Both trained and untrained bystanders should be
tions. instructed to Activate Medical Assistance as soon as they have determined
that an adult victim requires emergency care.
Performing The Chest Thrust In Obviously Pregnant And Very Obese People
 The main difference in performing the Abdominal Thrust on this group of people is
in the placement of the fists.
 Instead of using Abdominal Thrusts, Chest Thrusts are used.
 The fists are placed against the middle of the breastbone and do the Chest Thrust.
 If the victim is unconscious, the chest thrusts are similar to those used in CPR.

**Caution: If the pregnant or obese victim becomes unconscious, call for help and
perform 30 Chest Compression.

https://refresher.profaw.co.uk

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2. Do not interfere with the victim’s own attempts to expel the foreign body, but
CALL FIRST CPR FIRST stay with the victim and monitor his or her condition.
3. If patient becomes unconscious/unresponsive, activate the emergency
 Adults and Adolescents with response system.
 Adults and Adolescents likely asphyxial arrest (e.g.
drowning) 2. SEVERE OBSTRUCTION
 Witnessed collapse of chil- A. Signs:
dren and infants  Unwitnessed collapse of 1. Poor or no air exchange,
children and infants 2. Weak or ineffective cough or no cough at all,
3. High-pitched noise while inhaling or no noise at all,
 If you are alone with no mo- 1. Give 5 cycles (2 minutes) of 4. Increased respiratory difficulty,
bile phone, leave the victim CPR 5. Cyanotic (turning blue)
to activate emergency re- 6. Unable to speak
sponse system and get AED/ 2. Leave the victim to activate 7. Clutching the neck with the thumb and fingers making the
emergency equipment before emergency response system universal sign of choking.
beginning CPR and get the AED 8. Movement of air is absent.

 Otherwise, send someone 3. Return to the child or infant B. Rescuer Actions:

and begin CPR immediately; and resume CPR; use the 1. Ask the victim if he or she is choking.
use the AED as soon as it is AED as soon as it is availa- 2. If the victim nods and cannot talk, severe airway obstruction is present and you
available ble must perform abdominal/chest thrust and once becomes unconscious /
unresponsive activate the emergency response system.

 Use of Social Media to Summon Rescuers.

UNIVERSAL SIGN OF CHOKING is a sign wherein the
 Use of Mobile Phone in Activation of Emergency Medical Service victim is clutching his/ neck with one or both hands and
(EMS). gasping for breath.
 Information to be remembered in activating medical assistance:
 What happened?
 Location?
 Number of persons injured? ABDOMINAL THRUST is an emergency proce-
 Extent of injury and first aid given? dure for removing a foreign object lodged in the
 The telephone number from where you are calling? airway that is preventing a person from breathing.
 Person who activated medical assistance must identify him/
REMEMBER :
herself and drop the phone last.
Abdominal thrust should not be used in infants
under 1 year of age due to risk of causing injury.

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UNIT OF COMPETENCY III 3. Initial Assessment of the Victim. In every emergency situation, you must first
PART B: FOREIGN BODY AIRWAY OBSTRUCTION find out if there are conditions that are of immediate threat to the victim’s life.

Foreign Body Airway Obstruction. Is a condition when solid material like chunked Check for Pulse and Breathing, perform Chest Compression, open the Airway,
foods, coins, vomitus, small toys, etc. are blocking the airway. and perform Rescue Breathing.

CAUSES OF OBSTRUCTION
1. Improper chewing of large pieces of food. 4. Secondary Assessment of the Victim. It is a systematic method of gathering
2. Excessive intake of alcohol. additional information about the injuries or conditions that may need care.
a. relaxation of tongue back into the throat
b. Aspirated vomitus (stomach content) 4.1 Head-to-toe examination
3. The presence of loose upper and lower dentures. D– deformity
4. Children who are running while eating. C– contusion
5. For smaller children of “hand-to-mouth” stage left unattended. A– abrasion
P– puncture
TWO TYPES OF OBSTRUCTION B– burn
T– tenderness
1. Anatomical Obstruction. When tongue drops back and obstruct the throat. Other L– laceration
causes are acute asthma, croup, diphtheria, swelling, and cough (whooping). S– swelling

2. Mechanical Obstruction. When foreign objects lodge in the pharynx or airways; fluids 4.2 Check vital signs
accumulate in the back of the throat. Every 15 minutes for stable condition and every 5 minutes if unstable.

4.3 Interview the victim

CLASSIFICATION OF OBSTRUCTION S– signs and symptoms
A– allergies
1. MILD OBSTRUCTION M– medications
A. Signs: P– past medical history
1. Good air exchange L– last meal taken
2. Responsive and can cough forcefully E– events prior to injury
3. May wheeze between coughs.
4. Has increased respiratory difficulty and possibly cyanosis. 5. Proper referral to advance medical authority for further evaluation and manage-
ment.
B. Rescuer Actions:  Endorsement to EMS / ambulance team / emergency response team or
As long as good air exchange continues, physician.
1. Encourage the victim to continue spontaneous coughing and  Refer / transport victim to nearest health facility
breathing efforts.

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UNIT OF COMPETENCY I TABLE OF COMPARISON ON RESCUE BREATHING

PART B: INTRODUCTION TO BASIC LIFE SUPPORT (BLS)
ADULT CHILD INFANT
Three Kinds of Life Support
Opening of air- Head Tilt-Chin Lift
1. Basic Life Support. A set of emergency procedures that consist of recognizing way (HCP: for suspected spine injury, perform Jaw Thrust Maneuver)
respiratory or cardiac arrest and the proper application of Cardio-Pulmonary Re-
suscitation (CPR) with or w/o Automated External Defibrillation (AED) or Foreign Mouth-to-mouth and
Method Mouth-to-mouth or mouth-to-nose
Body Airway Obstruction Management (FBAOM) and Rescue Breathing (RB) or to nose
maintain life until a victim recovers or advanced life support is available.
2. Advance Cardiac Life Support. A set of clinical interventions for the urgent treat- Amount of
Normal breath enough to make the chest rise
ment of cardiac arrest and other life threatening emergencies, as well as the Breath
knowledge and skills to deploy those interventions. 1 breath every 5 – 6
3. Prolonged Life Support. For post resuscitative and long term resuscitation with seconds (24 breaths 1 breath every 3 - 5 seconds (40
the use of adjunctive equipment such as ventilator, cardiac monitor, pulse oximeter Rate for 2 min) breaths for 2 min)
etc. then reassess every then reassess every 2 minutes
Out of Hospital Cardiac Arrest (OHCA) 2 minutes
Adult Chain of Survival Breathe
1002,1003,1004,
1001, breathe, Breathe, 1002, 1001,
Counting for 1002,1003,1004,
Breathe, 1002, 1002,
Teaching Pur- 1002,
poses Breathe,… Breathe, 1002, 1003,
up to 1024 and Breathe,… up to 1040 and breathe
breathe

The FIRST LINK: Recognition and Activation of the Emergency Response System
Lay rescuers must recognize the patient’s arrest and call for help. If the victim is unre-
sponsive with absent or abnormal breathing, the rescuer should assume that the victim CAUTION: If you give breaths too quickly or with too much force, air is likely to enter the
is in cardiac arrest. Rescuers can activate an emergency response (ie, through use of a stomach rather than the lungs. This can cause gastric inflation. Gastric inflation fre-
mobile telephone) without leaving the victim’s side. quently develops during mouth-to-mouth, mouth-to-mask, or bag-mask ventilation. Gas-
tric inflation can result in serious complications, such as vomiting, aspiration, or pneumo-
The SECOND LINK: Immediate High-quality CPR nia. Rescuers can reduce the risk of gastric inflation by avoiding giving breaths too rapid-
If the lay rescuer finds an unresponsive victim is not breathing or not breathing normally ly or too forcefully.
(e.g., gasping), high quality CPR shall be started immediately. The probability of sur-
vival approximately doubles when it is initiated before the arrival of EMS.

The THIRD LINK: Rapid Defibrillation

It is recommended that public access defibrillation (PAD) programs be implemented in

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communities with individuals at risk for OHCA. This would enable bystanders to
WAYS TO VENTILATE THE LUNGS
retrieve nearby AEDs and use it when OHCA occurs.
1. Mouth-to-Mouth. Is a quick, effective way to provide oxygen and ventilation to the
victim. The FOURTH LINK: Basic and Advance Medical Services
If provided by highly trained personnel like Emergency Medical Technicians EMTs
2. Mouth-to-Nose. Is recommended when it is impossible to ventilate through the vic- and paramedics, provision of advanced care outside the hospital would be possible.
tim’s mouth, the mouth cannot be opened (trismus), the mouth is seriously injured, or
a tight mouth-to-mouth seal is difficult to achieve. The FIFTH LINK: Advance Life Support and Post-arrest Care
Post cardiac arrest care after return of spontaneous circulation (ROSC) can improve
3. Mouth-to-Mouth and Nose. If the victim is an infant (1-year-old), this is the best way the likelihood of patient survival with good quality of life.
in delivering ventilation by placing your mouth over the infant’s mouth and nose to
create a seal. In-Hospital Cardiac Arrest (IHCA)
Adult Chain of Survival
4. Mouth-to-Stoma. It is used if the patient has a stoma; a permanent opening that con-
nects the trachea directly to the front of the neck. These patients breathe only
through the stoma.

5. Mouth-to-Face Shield. It could provide very low resistance ventilations to a patient by

using a thin and flexible plastic.

6. Mouth-to-Mask. It could deliver ventilation to a patient by using a pocket facemask

with a one-way valve to form a seal around the patient’s nose and mouth.
7. Bag-valve Mask Device. It could deliver ventilation to a patient by using a hand– The FIRST LINK: Surveillance and Prevention
operated device consisting of a self-inflating bag, one-way valve, facemask, and oxy- Patients with IHCA depend on a system of appropriate surveillance and prevention
gen reservoir.
of cardiac arrest, which is represented by a magnifying glass in the first link.
SPECIAL CONSIDERATIONS
 Rescuer should avoid pressing soft tissue under the chin this might obstruct the The SECOND LINK: Recognition and Activation of the Emergency Response
airway. System
 Rescuer not to use the thumb to lift the chin. When cardiac arrest occurs, prompt notification and response to a cardiac arrest
 Rescuer not to close the victim’s mouth completely (unless mouth to nose is the should result in the smooth interaction of a multidisciplinary team of professional
technique). providers, including physicians, nurses, respiratory therapists, and others.
 Each rescue breath should give enough air to make the chest rise and be given at 1
second. The THIRD LINK: Immediate High-quality CPR
 Rescuer should avoid delivering more breaths (more than the number recommend- Chest compression fraction (the percent of total resuscitation time spent compress-
ed) or breaths that are too large or too forceful. ing the chest), chest compression quality (rate, depth, and chest recoil), and ventila-
 Rescuers should take a normal breath (not a deep breath) mouth to mouth or mouth tion rate are fundamental metrics defining high-quality CPR.
-to-barrier device rescue breaths.
The FOURTH LINK: Rapid Defibrillation
It is the cornerstone therapy for patients who suffered cardiac arrest probably due
to ventricular fibrillation and pulse-less ventricular tachycardia.

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The FIFTH LINK: Advance Life Support and Post-arrest Care

Comprehensive post–cardiac arrest care requires optimization of hemodynamics, UNIT OF COMPETENCY III
treatment and reversal of precipitating factors, and targeted temperature manage- PART A: RESPIRATORY ARREST AND RESCUE BREATHING
ment. (For Health Care Providers only)

PEDIATRIC CHAIN OF SURVIVAL Introduction

Respiratory arrest can result from a number of causes, including submer-

sion/near-drowning, stroke, FBAO, smoke inhalation, epiglottis, drug over-
dose, electrocution, suffocation, injuries, myocardial infarction, lightning
strike, and coma from any cause. When primary respiratory arrest occurs,
the heart and lungs can continue to oxygenate.
The FIRST LINK: Prevention of Arrest Respiratory Arrest. Is the condition in which breathing stops or inade-
In children, the leading cause of death is injury, and vehicular accidents are the
quate.
most common causes of fatal childhood injuries and child passenger’s safety seats
can reduce the risk of death.
CAUSES of Respiratory Arrest
The SECOND LINK: Immediate CPR 1. Obstruction
It is most effective when started immediately after the victim’s collapse. The proba- 1.1 Anatomical Obstruction
bility of survival approximately double when it is initiated before the arrival of EMS. 1.2 Mechanical Obstruction
It is associated with successful return of spontaneous circulation and neurologically
intact survival in children. 2. Diseases
2.1 Bronchitis 2.3 Chronic Obstructive Pulmonary Dis-
The THIRD LINK: Rapid Access to EMS 2.2 Pneumonia ease (COPD) and other respiratory
It is the event initiated after the baby collapsed to recognize that the victim has ex- illnesses.
perienced a cardiac arrest until the arrival of Emergency Medical Services person-
nel competent to provide care. 3. Other causes of Respiratory Arrest
The FOURTH LINK: Rapid Pediatric Advance Life Support 3.1 Chest compression (by physical 3.4 Electrocution
Initial steps in stabilization provide warmth by placing baby under a radiant heat forces). 3.5 External strangulation.
source, position head in a “sniffing” position to open the airway, clear airway with 3.2 Circulatory collapse. 3.6 Poisoning
bulb syringe or suction catheter, dry baby and stimulate breathing. 3.3 Drowning 3.7 Suffocation

The FIFTH LINK: Integrated Post-cardiac Arrest Care RESCUE BREATHING

Post cardiac arrest after return of spontaneous circulation (ROSC) can improve  Is a technique of breathing air into person lungs to supply him or her oxygen
the likelihood of patient survival with good quality of life. needed to survive.
 Given to victims who are not breathing or inadequate but still have pulse.
 Crucial tool to revive the individual or keep him or her until the help comes.

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AED Maintenance BODY SYSTEMS

1. Become familiar with your AED and how it operates.
The Respiratory System
2. Check the AED for visible problems such as signs of damage. It delivers oxygen to the body, as well as
3. Check the “ready-for-use” indicator on your AED (if so equipped) daily. removes carbon dioxide from the body.
The passage of air into and out of the
4. Perform all user-based maintenance according to the manufacturer’s recom- lungs is called respiration. Breathing in is
mendations. called inspiration or inhalation. Breathing
5. Make sure the AED carrying case contains the following supplies at all times: out is called expiration or exhalation.
 2 sets of extra electrode pads (3 sets total)
 2 pocket face masks
 1 extra battery (if appropriate for your AED); some AEDs
have •batteries that last for years
 2 disposable razors
 5 to 10 alcohol wipes
 5 sterile gauze pads (4X4 inches), individually wrapped
 1 absorbent cloth towel
The Circulatory System
It delivers oxygen and nutrients to the
Remember: AED malfunctions are rare. Most AED “problems” are caused by
body’s tissues and removes waste prod-
operator error or failure to perform recommended user-based mainte-
ucts. It consists of the heart, blood ves-
nance.
sels, and blood.

Breathing and Circulation

1. Air that enters the lungs contains about 21% oxygen and only a trace of carbon
dioxide. Air that is exhaled from the lungs contains about 16% oxygen and 4%
carbon dioxide.
2. The right side of the heart pumps blood to the lungs, where blood picks up oxy-
gen and releases carbon dioxide.
3. The oxygenated blood then returns to the left side of the heart, where it is
pumped to the tissues of the body.
4. In the body tissues, blood releases oxygen and takes up carbon dioxide after
which it flows back to the right side of the heart.
5. All body tissues require oxygen, but the brain requires more than any other tis-
sue.

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Clinical death—Stoppage of heart beat, pulse and breathing, most organs 7. Deliver a Shock (if indicated)
 If the AED prompt tells “SHOCK ADVISED”
(eye, kidney) remain alive after clinical death. These organs are used for trans-
plantation. make sure:
0 - 1 min. - cardiac irritability  No one touches the victim!
1 - 4 min. - brain damaged not likely  Verbal warning to co-rescuers/ bystanders:
4 - 6 min. - brain damage possible – “Clear”
– Physical and hand gestures
Biological death—The death caused by degeneration of tissues in brain and – Press the Shock button and immedi-
other part and most organs become dead after biological death. These organs ately resume CPR
 If the AED prompt initially tells “NO SHOCK
can not be used for organ transplantation.
ADVISED”:
6 - 10 min. - brain damaged very likely  Continue CPR for 2 minutes
More than 10 min. - irreversible brain damaged  Follow voice prompt
 If the AED prompt tells “NO SHOCK ADVISED” for the second time:
 Check for pulse
Shock First vs. CPR First
 For witnessed adult cardiac arrest when an AED is immediately available, it is
reasonable that the defibrillator be used as soon as possible.
 For adults with unmonitored cardiac arrest or for whom an AED is not immediately
available, it is reasonable that CPR be initiated while the defibrillator equipment is
being retrieved and applied and that defibrillation, if indicated, be attempted as
soon as the device is ready for use.

AED ALGORITHM

The Nervous System

It is composed of the brain, spinal cord and
nerves. It has two major functions – communica-
tion and control. It lets a person be aware of and
react to the environment. It coordinates the
body’s responses to stimuli and keeps body sys-
tems working together.

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AED PROCEDURES UNIT OF COMPETENCY II

PART A: CARDIOPULMONARY RESUSCITATION (CPR)
1. Continue CPR until an AED is available.
2. Once the AED is available, Power on the AED and follow the voice prompts
3. Expose chest. Dry the skin or shave, if necessary. CPR is a series of assessments and interventions using techniques and maneuvers
4. Attach pads in victim’s bare chest. made to bring victims of cardiac and respiratory arrest back to life.

Cardiac Arrest. Is the condition in which circulation ceases and vital organs are
deprived of oxygen.

THREE CONDITIONS OF CARDIAC ARREST

Cardio Vascular Collapse. The heart is still beating but its action is so weak that
blood is not being circulated through the vascular system to the brain and body
tissues.

Ventricular Fibrillation. Occurs when the individual fascicles of the heart beat in-
dependently rather than in coordinated, synchronized manner that produces
rhythmic heart beat.

Cardiac Standstill. It means that the heart has stopped beating.

WHEN TO START CPR

5. Keep following voice prompts If you see a victim who is:
6. Once the voice prompt tells 1.Unconscious/Unresponsive
“Analyzing heart rhythm, do not 2.Not breathing or has no normal breathing (only gasping)
touch the patient”, make sure: 3.No definite pulse
 No one touches the victim!
 Remind co-rescuers/ WHEN NOT TO START CPR
bystanders to avoid touching All victims of cardiac arrest should receive CPR unless:
the victim 1. Patient has a valid DNAR (Do Not Attempt Resuscitation) order.
2. Patient has signs of irreversible death (Rigor Mortis, Decapitation, Dependent
NOTE: For Semi-automated AED, Lividity).
clear the victim and manually press 3. No physiological benefit can be expected because the vital functions have dete-
analyze button www.cardiaid.com riorated as in septic or cardiogenic shock.
4. Confirmed gestation of < 23 weeks or birth weight < 400 grams, anencephaly.
(between 37- 41 weeks, 2700 - 4000 grams)
5. Attempts to perform CPR would place the rescuer at risk of physical injury.

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WHEN TO STOP CPR Different Types of AED

1. AED Trainer
S — SPONTANEOUS signs of circulation are restored  Not capable of delivering a shock.
 Do not allow to be confused with real units.
T — TURNED over to medical services or properly trained and authorized personnel 2. Semi-Automated Defibrillator
 Requires the user to press the button for analysis and shock.
O — OPERATOR is already exhausted and cannot continue CPR 3. Fully Automated Defibrillator
 No intervention required for analysis and shock.
P — PHYSICIAN assumes responsibility (declares death, takes over, etc.)  They are programmed to run self-test and they will indicate when mainte-
nance is needed.
S — SCENE becomes unsafe (such as traffic, impending or ongoing violence —gun
fires, etc.) Several Factors That Can Affect AED Analysis
 Patient movement (eg. agonal gasp)
S — SIGNED waiver to stop CPR  Repositioning the patient

COMPRESSION ONLY-CPR Use AED Only When Victims Have the Following 3 Clinical Findings
 No response
If a person cannot perform mouth-to-mouth ventilation for an adult victim, chest com-  No breathing
pression only - CPR should be provided rather than no attempt of CPR being made.  No Pulse
Chest compression only - CPR is recommended only in the following circumstances:
1. When a rescuer is unwilling or unable to perform mouth-to-mouth rescue breath- Note: Defibrillation is also indicated for pulseless ventricular tachycardia (VT)
ing , or
2. For use in dispatcher-assisted CPR instructions where the simplicity of this mod- Special Conditions that Affect the Use of AED
ified technique allow untrained bystanders to rapidly intervene.  The victim is1 month old or less.
 The victims has a hairy chest.
The Compression-Airway-Breathing (C-A-B)  The victim is lying in water, immersed in water, or water is covering the victim’s
 Early CPR improves the likelihood of survival. chest.
 Chest Compressions are the foundations of CPR.  The victim has implanted defibrillator or pacemaker.
 Compressions create blood flow by increasing intra-thoracic pressure and direct-  The victim has a transdermal medication patch or other object on the surface of the
ly compress the heart; generate blood flow and oxygen delivery to the myocardi- skin where the AED electrode pads are placed.
um and brain.
CRITICAL CONCEPTS:
CAB: COMPRESSION The four (4) Universal Steps of AED Operation
 CIRCULATION represents a heart that is actively pumping blood, most often P — POWER ON the AED.
recognized by the presence of a pulse in the neck A — ATTACH the electrodes pads to the victim’s chest.
 Assume there is no CIRCULATION if the following exist: (1)Unresponsive, (2) A — Clear the victim and ANALYZE the heart rhythm.
Not breathing, (3) Not moving and (4) Poor skin color S — Clear the victim and deliver a SHOCK (if indicated)
 ROSC-Return of Spontaneous Circulation-sign of life

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ADULT CPR
Pulseless Ventricular Tachycardia  Kneel facing the victim’s chest
The pulseless ventricular tachycardia rhythm is primarily identified by several criteria:  Place the heel of one hand on the center of the chest
 The rate is usually greater than 180 beats per minute and the rhythm generally  Place the heel of the second hand on top of the first so that the hands are over-
has a very wide QRS complex in ECG tracings. lapped and parallel
 The patient will be pulseless
 The rhythm originates in the ventricles.
CHILD CPR
Causes of VF and Cardiac Arrest  Lower half of the sternum, between the nipples
1. Hypoxia  One hand only/ two hands
 Near drowning  Rebreather malfunction  30:2 for single rescuer, 15:2 for 2-man rescuer (optional for HCP)
 Burst lung  Choking
 Decompression illness  Carbon monoxide poisoning INFANT CPR
2. Bleeding  Just below the nipple line, lower half of sternum (1 finger breadth below imaginary
3. Heart attack nipple line, lower half of sternum)
4. Drug overdose  Two fingers, flexing at the wrist (lone rescuer)
 2 thumb-encircling hands technique (two rescuers)
DEFIBRILLATION
 Shock success CAB: Open AIRWAY
– Termination of VF for at least 5 seconds following the shock  This must be done to ensure an open passage for spontaneous breathing OR
 VF frequently recurs after successful shocks & these recurrence should not be mouth to mouth during CPR.
equated to shock failure  Head-Tilt/Chin-Lift Maneuver
Tilt the head back with your one hand and lift up the
Automated External Defibrillator (AED) chin with your other hand.
 Controlled electrical shock  Jaw-Thrust Maneuver
 May restore an organized rhythm is strictly a Healthcare Provider technique and not for
 Enables heart to contract & pump blood Lay Rescuers (if suspected with cervical trauma).
 Placed in areas of public access Place the index and middle gingers to physically push
 Also called as PAD: Public Access Defibrillator Area the posterior aspects of the lower jaw upwards while
– Railway stations the thumbs push down on the chin to open the mouth.
– Airports
– Shopping centers CAB: BREATHING
 Stored in:  Maintain open airway
– Secured display units  Pinch nose shut (if mouth to mouth RB is preferred)
– Accessible to all trained rescuers  Open your mouth wide, take a normal breath, and make a tight seal around out-
– Clearly marked side of victim’s mouth
 Should always be stored ready to use with a fully charged battery  Give 2 full breaths (1 sec each breath)
 Razors to shave the casualty’s chest should be stored with the defibrillator, along  Observe chest rise
with gloves in various sizes  30:2 (Compression to Ventilation ratio)
 5 cycles or 2 minutes
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BASIC LIFE SUPPORT SEQUENCE UNIT OF COMPETENCY II

PART B: AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
1. Verify Scene Safety
 Survey for scene safety first AEDs are sophisticated computerized devices that can analyze heart rhythms and
 Make sure the environment is safe for rescuers and victim generate high voltage electric shocks.
 Observe standard precautions [wear personal protective equipment (PPE)]
2. Introduce Yourself
 Make sure to introduce yourself first before engaging with the victim.
 “I’m _________. I know BLS/CPR. I can help.”
3. Check for Responsiveness
 Check for responsiveness by tapping the victim and ask loudly, “Are you OK?”
 ADULT, ADOLESCENTS and CHILD BLS
- Tap the shoulders
 INFANT BLS
- Tap the sole of the feet
4. Activate Emergency Response System (EMS)
 Shout for nearby help.
 Activate EMS via mobile phone or phone patch (if available). Indications and Importance
 Send someone to do so. Early defibrillation is critical for victims of sudden cardiac arrest because:
 If you are alone with no mobile phone, leave the victim to activate the EMS,  The most frequent rhythm in sudden cardiac arrest is Ventricular Fibrillation (VF)
and get the AED (if readily available) before beginning CPR.  The most effective treatment for VF is defibrillation
5. Recognition of Cardiac Arrest  Also indicated for Pulseless Ventricular Tachycardia
 Unresponsive.  Defibrillation is most likely to be successful if it occurs within minutes of collapse
 No breathing or only gasping. (sudden cardiac arrest)
 No pulse.  Defibrillation may be ineffective if it is delayed
** Check for breathing and pulse simultaneously for no more than 10 seconds.  VF deteriorates to asystole if not treated
 HOW TO CHECK FOR BREATHING
Observe for chest rise. Shockable Rhythms Non-Shockable Rhythms
Distinguish between normal breathing from no normal breathing (only  Ventricular Fibrillation (VF)  Asystole
gasping).  Pulseless Ventricular Tachycardia  Pulseless Electrical Activity (PEA)
 HOW TO CHECK FOR PULSE
 Adult & Adolescents Ventricular Fibrillation (VF)
- Check for Carotid Pulse  VF is a common and treatable initial rhythm in adults with witnessed cardiac
 Pediatric  Survival rates are highest when immediate bystander CPR is provided and defib-
- Child BLS rillation occurs within 3 to 5 minutes of collapse
 Check for Carotid pulse  Rapid defibrillation is the treatment of choice
- Infant BLS  Rhythm causing ‘all’ sudden cardiac arrest
 Check for Brachial or Femoral Pulse  Useless quivering of the heart no blood flow
6. High Quality CPR  Myocardium is depleted of oxygen & metabolic substrates

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ADULT CARDIAC ARREST ALGORITHM – 2015 UPDATE

CARDIOPULMONARY RESUSCITATION
 Continue CPR until:
– AED arrives and is ready for use
– EMS providers take over the care of the victim
 Reassess victim every 2 minutes
 Rescuers may switch roles (for Two-Man Rescuers)
 If patient becomes conscious, place patient in recovery position

CPR with Advanced Airway

 Cycles of 30 compressions:2 ventilations should be continued until an advanced
airway is placed
 If an advanced airway is already in place:
- Continue chest compressions at a rate of 100-120 per minute, without
pauses for ventilation.
- Ventilation rate of 1 breath every 6 sec. (10 breaths per minute)

Alternative Techniques and Ancillary Devices for CPR

 Hands-Only (Compression-only) CPR:
- Outcome is better than outcome of NO CPR
- Lay rescuers should do compression-only if they are unwilling or unable to
provide rescue breaths
2. Mechanical Piston Device:
- A mechanical piston device consists of a compressed gas or electric-
powered plunger mounted on a backboard; it is used to depress the sternum.
3. Load-Distributing Band Device:
- A circumferential chest compression device composed of a pneumatically or
electrically actuated constricting band and backboard.
- Easy to use and battery operated, it squeezes the patient’s entire chest to
improve blood flow to the heart and brain

Recovery Position in CPR

Adult and Child

 Bend the arm of the patient and place the back of the victim’s hand against his/
her cheek and hold there
 Turn the victim towards you as one unit

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PEDIATRIC
TABLE OFCARDIAC ARRESTON
COMPARISON ALGORITHM FOR THE SINGLE
CARDIOPULMONARY RESCUER
RESUSCITATION FOR ADULTS & ADOLESCENTS, CHILDREN, AND INFANTS
CHILDREN INFANT
(Age 1 year to Puberty) (<1 year excluding newborns)
Make sure the environment is safe for rescuers and victim
Check for responsiveness
No breathing or only gasping (ie, no normal breathing)
No definite pulse felt within 10 seconds
(Breathing and pulse check can be performed simultaneously in less than 10 seconds)

Witnessed collapse — Follow steps for adults and adolescents on the left
Unwitnessed collapse — Give 5 cycles (2 minutes) of CPR

1 rescuer (30:2)
2 or more rescuers (15:2)
Continuous compressions at a rate of 100-120/min
Give 1 breath every 6 seconds (10 breaths/min)
100-120/min.
At least 1/3 of the AP diameter of the
At least 1/3 of the AP diameter of the chest
chest
or About 2 inches (5cm)
or About 11/2 inches (4 cm)
1 rescuer
2 fingers in the center of the chest, just
2 hands or 1 hand (optional for very below the nipple line.
small child) on the lower half of the breastbone 2 or more rescuers
(sternum) 2 thumb-encircling hands in the center
of the chest, just below the nipple line
Allow the recoil of chest after each compressions; do not lean of the chest after each compression
Limit interruptions in chest compressions to less than 10 seconds
Carotid Pulse or Femoral Pulse Brachial Pulse or Femoral Pulse
1 rescuer 1 rescuer
1-29 up to 5 cycles 1-29 up to 5 cycles
(30 compressions within 18 seconds) (30 compressions within 18 seconds)
2 or more rescuers 2 or more rescuers
1-14, 1 up to 10 cycles 1-14, 1 up to 10 cycles
(15 compressions within 9 seconds) (15 compressions within 9 seconds)

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TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATION FOR ADULTS PEDIATRIC CARDIACCHILDREN,

& ADOLESCENTS, ARREST ALGORITHM FOR 2 OR MORE RESCUERS
AND INFANTS

COMPONENT ADULTS AND ADOLESCENTS

Scene safety Make sure the environment is safe for rescuers and victi

No breathing or only gasping (ie, no normal

Recognition of cardiac arrest
(Breathing and pulse check can be performed simultaneously in less than 1
If you are alone with no mobile phone, leave
Activation of emergency response the victim to activate the emergency response
system system and get the AED before beginning
CPR
Compression-Ventilation ratio with- 1 or 2 rescuers
out advanced airway 30:2
Compression-Ventilation ratio with Continuous compressions at a rate of 100
advanced airway Give 1 breath every 6 seconds (10 breaths/min)
Compression rate

Compression Depth At least 2 inches (5cm)

2 hands on the lower half of the breastbone

Hand placement
(sternum)

Chest recoil Allow the recoil of chest after each compressions; do not lean of the chest after each
Minimizing interruptions Limit interruptions in chest compressions to less than 10 seconds
Location for Pulse Check (HCP only) Carotid Pulse
1 or 2 rescuers
1-29 up to 5 cycles
Counting for standardization Pur- (30 compressions within 18 seconds)
pose

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