ashi manual

CPR Profor the Professional Rescuer

Student Handbook

BLS for Healthcare Providers

DIGITAL STUDENT HANDBOOK –

Online Version

American Safety & Health Institute is amember of the HSI family of brands.

ISBN 978-936515-23-3 PRN2054 (8/11)

CPR ProStudent Handbook, Version 7.0

Purpose of this HandbookThis ASHI CPR Pro Version 7.0 Student Handbook is solely intended to facil-itate certification in an ASHI CPR Pro training class. The information in thishandbook is furnished for that purpose and is subject to change without no-tice.

ASHI certification may only be issued when an ASHI-authorized Instructorverifies a student has successfully completed the required core knowledgeand skill objectives of the program.

Notice of RightsNo part of this ASHI CPR Pro Version 7.0 Student Handbook may be repro-duced or transmitted in any form or by any means, electronic or mechanical,including photocopying and recording, or by any information storage and re-trieval system, without written permission from the American Safety & HealthInstitute.

TrademarksAmerican Safety & Health Institute and the ASHI logo are registered trade-marks of the American Safety & Health Institute.

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E-mail: [email protected] our website at hsi.com/ashi

Copyright © 2011 by the American Safety & Health Institute.All Rights Reserved. Printed in the United States of America.

First Edition—2011

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Section 1 — Sudden Cardiac Arrest Sudden Cardiac Arrest and Early Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Chain of Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Personal Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Section 2 — BLS SkillsChest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Rescue Breaths — CPR Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Rescue Breaths — Bag-Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Rescue Breaths — Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Primary Assessment — Unresponsive Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Skill Guide 1 — Chest Compressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Skill Guide 2 — Rescue Breaths — CPR Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Skill Guide 3 — Rescue Breaths — Bag-Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Skill Guide 4 — Rescue Breaths — Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Skill Guide 5 — Primary Assessment — Unresponsive Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Section 3 — BLS CareUnresponsive and Breathing — Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Unresponsive, Not Breathing, and Pulseless — CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Skill Guide 6 — Unresponsive and Breathing — Recovery Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Skill Guide 7 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Adult . . . . . . . . . . 17Skill Guide 8 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Child . . . . . . . . . . 18Skill Guide 9 — Unresponsive, Not Breathing, and Has a Pulse — Rescue Breathing Infant . . . . . . . . . . 19Skill Guide 10 — Unresponsive, Not Breathing, and Pulseless — CPR Adult . . . . . . . . . . . . . . . . . . . . . 20Skill Guide 11 — Unresponsive, Not Breathing, and Pulseless — CPR Child . . . . . . . . . . . . . . . . . . . . . 21Skill Guide 12 — Unresponsive, Not Breathing, and Pulseless — CPR Infant . . . . . . . . . . . . . . . . . . . . . 22

Section 4 — DefibrillationAutomated External Defibrillators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Basic AED Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Troubleshooting and Other AED Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Skill Guide 13 — Using an AED — Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Skill Guide 14 — Using an AED — Child and Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Section 5 — Team ApproachTeam Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Skill Guide 15 — Team Approach — Adult Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Skill Guide 16 — Team Approach — Chid or Infant Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

BLS Adult Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30BLS Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Section 6 — Foreign Body Airway ObstructionChoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Skill Guide 17 — Choking — Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Skill Guide 18 — Choking — Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Skill Guide 10 — Choking — Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Table of Contents

Table of Contents CPR Pro for the Professional Rescuer i

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Legal Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Good Samaritan Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Abandonment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Duty to Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Assault and Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Starting CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Stopping CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Advanced Directives and Living Wills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) Orders . . . . . . . . . . . . . . . . . . . . . . . . 38

Emotional Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

References and End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Rate Your Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Table of Contents

CPR Pro for the Professional Rescuer Table of Contentsii

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Sudden Cardiac Arrest CPR Pro for the Professional Rescuer 1

Section 1 — Sudden Cardiac Arrest

Sudden Cardiac Arrest and Early DefibrillationSudden cardiac arrest, or SCA, can occur without warning to anyone, at any time. It is one of the leading causes of death amongadults in the United States.

Each year, an estimated 295,000 out-of-hospital cardiac arrests inthe United States are treated by Emergency Medical Services, orEMS. Many additional arrests occur and are treated in medical of-fices or hospitals.

Sudden cardiac arrest happens when the normal electrical im-pulses in the heart unexpectedly become disorganized. The nor-mally coordinated mechanical contraction of the heart muscle islost, and a chaotic, quivering condition known as ventricular fibril-lation can occur. Blood flow to the brain and vital organs abruptlystops. The lack of blood and oxygen to the brain causes someoneto quickly lose consciousness, collapse, and stop breathing.

Brain tissue is especially sensitive to a lack of oxygen. When oxy-gen is cut off, brain death can occur quickly, within a matter of min-utes. Without early recognition and care, the person will not survive.

Cardiopulmonary resuscitation, or CPR, allows a provider to restoresome oxygen to the brain through a combination of chest compres-sions and rescue breaths. By itself, CPR is only a temporary meas-ure that can buy time until more advanced care can be provided.

The most effective treatment for ventricular fibrillation is defibrilla-tion. To defibrillate, electrode pads are applied to the chest and anelectrical shock is sent between the pads through the heart. Thisshock stops ventricular fibrillation so the heart’s normal electricalactivity can return and restore blood flow.

Successful defibrillation is often dependent on how quickly a pa-tient is defibrillated. For each minute a patient is in cardiac arrest,his/her chance of surviving decreases by about 10 percent. Afteras little as 10 minutes, defibrillation is rarely successful. The amountof time it takes to recognize a problem, activate EMS, and haveEMS respond and defibrillate is usually longer than 10 minutes. Inmost cases, it’s too late.

Respiratory and Circulatory SystemsBecause the human body cannot store oxygen, it must continually supply tissues and cells with oxygen through the combined actionsof the respiratory and circulatory systems.

The respiratory system includes the lungs and the “airway,” the passage from the mouth and nose to the lungs.

Expansion of the chest during breathing causes suction, which pulls outside air containing oxygen through the airway and into thelungs. Relaxation of the chest increases the pressure within and forces air to be exhaled from the lungs.

The circulatory system includes the heart and a body-wide network of blood vessels. Electrical impulses stimulate mechanicalcontractions of the heart to create pressure that pushes blood throughout the body.

Blood vessels in the lungs absorb oxygen from inhaled air. The oxygen-rich blood goes to the heart and then out to the rest of the body.

Large vessels called arteries carry blood away from the heart. Arteries branch down into very small vessels that allow oxygen to beabsorbed directly into body cells so it can be used for energy production. Veins return oxygen-poor blood back to the heart and lungswhere the cycle repeats.

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An automated external defibrillator, or AED, is a small, portable,computerized device that is simple to operate. Turning on an AEDis as simple as opening a lid or pushing a power button. Once it ison, an AED will provide voice instructions to guide you through itsuse.

An AED automatically analyzes the heart rhythm, determines if ashock is needed, and charges itself to be ready to defibrillate. Anoperator simply pushes a button to deliver the shock when told toby the AED.

In many cases of sudden cardiac arrest, if defibrillation could bedelivered sooner, more people would survive. Immediate, high-quality CPR and early defibrillation with an AED can double or eventriple the chance for survival.

Chain of SurvivalThe Chain of Survival is used to describe the most effective ap-proach for treating sudden cardiac arrest. It consists of five inter-dependent links:

• Immediate recognition and activation of EMS quickly initi-ates the treatment process.

• Early CPR with effective chest compressions buys time foraccessing an AED and improves the chance that defibrilla-tion will work.

• Rapid defibrillation provides the best chance to return theheart to a normal rhythm.

• Effective advanced life-support procedures and medica-tions used by paramedics, nurses, or doctors help sustainthe chance for recovery and survival.

• And finally, integrated post-cardiac arrest care increasesthe likelihood of long-term survival.

If any one of the links is weak or missing, the chances for survival are greatly re-duced. The greatest chance for survival exists when all the links in the Chain of Sur-vival are working together.

When describing treatment guidelines for children, someone younger than 1 yearof age is referred to as an infant. Someone between 1 year and the onset of pubertyis referred to as a child. The onset of puberty can be indicated by breast develop-ment in females and the presence of armpit hair in males. Anyone at or beyond pu-berty is considered an adult.

Cardiac arrest occurs less frequently in children and is usually the result of a blockedairway or the loss of breathing, such as in drowning, choking, or a severe breathingproblem.

Without oxygen, the heart weakens and slows. A child can collapse and, by assess-ment, appear to be in cardiac arrest. If done early enough, ensuring an open airwayand providing effective rescue breaths as part of CPR can actually prevent cardiacarrest from occurring. However, if cardiac arrest does occur, CPR and the applicationof an AED is the appropriate care.

CPR Pro for the Professional Rescuer Sudden Cardiac Arrest2

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The Chain of Survival for children includes the following links:

• Effective prevention of the typical causes for airway andbreathing emergencies, to reduce occurrence.

• Early CPR and defibrillation with an AED, to reverse the ef-fects of a weakened heart.

• Prompt activation of EMS, to quickly get professional care.

• Rapid pediatric advanced life-support procedures andmedications used by paramedics, nurses, or doctors, tohelp sustain the chance for recovery and survival.

• Integrated post-cardiac arrest care, to increase the likeli-hood for long-term survival.

Personal SafetyEmergency scenes are often unsafe. Your personal safety is alwaysthe highest priority, even before the safety of a patient. Puttingyourself in danger to aid someone can make the situation worse.Always pause for a moment before approaching an emergency andlook for obvious hazards. Consider the possibility of hidden dan-gers. If the scene is unsafe, do not approach. If the location youare already in becomes unsafe, get out!

When caring for patients, you can be exposed to blood or otherpotentially infectious body fluids. Infectious bloodborne diseasesinclude Hepatitis B, Hepatitis C, and HIV, the virus that causesAIDS. While the risk of contracting a disease is extremely low, it isprudent to take simple measures to avoid exposure in the firstplace.

Reducing exposure reduces the risk of infection. “Universal Pre-cautions” is an approach that recommends managing all blood andother body substances as if they are infectious. Use protective bar-riers between yourself and an ill or injured patient. To be effective,the approach is the same for everyone, regardless of relationship orage.

Disposable gloves are the most commonly used barrier. Make surethere is always a fresh supply of gloves available. If a patient re-quires rescue breaths, use a CPR mask with a one-way valve tominimize direct mouth-to-mouth contact.

According to the Occupational Safety and Health Administration,or OSHA, direct mouth-to-mouth contact is not advised for re-sponding emergency personnel when providing rescue breaths.Equipment designed to isolate providers from direct contact needsto be made available to all personnel who potentially respond tomedical emergencies.

Sudden Cardiac Arrest CPR Pro for the Professional Rescuer 3

Latex Allergy

Natural rubber latex allergy is a serious medical problem.Anyone who uses latex gloves frequently is at risk fordeveloping it. Simple measures such as the use of non-powdered latex gloves or non-latex alternatives can stopthe development of latex allergy and new cases ofsensitization.i

Decontaminating Surfaces

Decontaminate all surfaces, equipment, and othercontaminated objects as soon as possible. Clean with adetergent and rinse with water. Use a bleach solution ofone quarter cup (.06 liter) of household bleach per onegallon (3.79 liters) of water to sanitize the surface. Sprayon the solution and leave it in place for at least 2 minutesbefore wiping.

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CPR Pro for the Professional Rescuer BLS Skills

Section 2 — BLS SkillsWhen breathing and circulation stop, there are two critical life-supporting skills you will learn to replace them: chest compressionsand rescue breaths.

Chest CompressionsIf the heart stops, it is possible to restore at least some blood flow through the circulatory system by way of external chest compres-

sions. The most effective chest compressions involve the rhythmicapplication of downward pressure on the center of the chest. Ex-ternal compressions increase pressure inside the chest and directlycompress the heart, forcing blood to move from the heart to thebrain and other organs.

Compressions on adult patients are done at a rate of at least 100compressions per minute. The chest is compressed at least twoinches on each compression.

High-quality compressions are a critical component of effectiveCPR. Always compress fast and deep and allow the chest to re-bound to its normal position at the top of each compression.

Blood pressure is created and maintained with well-performedcompressions. If compressions stop, pressure is quickly lost andhas to be built up again. Minimize any interruptions when doingcompressions.

When compressing properly, you may hear and feel changes in the chest wall. This is normal. Forceful external chest compression isnecessary if the patient is to survive.

The compression technique for children is to use the heel of a single hand on the lower half of the breastbone. Compressions are lessforceful than on an adult. The compression rate is also at least 100 compressions per minute and a child’s chest needs to be com-pressed at least 1⁄3 of its depth or about 2 inches.

Compressions can be tiring. If necessary, you can use two hands to perform compressions on a child. To perform chest compressionson an infant, use two fingertips on the breastbone just below the nipple line.

Rescue Breaths — CPR MaskRescue breaths are artificial breaths given to someone who is notbreathing or not breathing normally. They are given by blowing airinto the mouth to inflate the lungs. The air you breathe containsabout 21% oxygen. Your exhaled air still contains up to 16–17%oxygen. This exhaled oxygen is enough to support someone’s lifefor a short time.

Before giving rescue breaths, you need to make sure the patienthas an open airway. The airway is the only path for getting air intothe lungs.

Someone who is unresponsive can lose muscle tone. When some-one is flat on his or her back, the base of the tongue can relax andobstruct the airway. This is the most common cause of a blockedairway in an unresponsive patient.

The tongue is attached to the lower jaw. Moving the jaw forward lifts the tongue away from the back of the throat and opens theairway.

You can open a patient’s airway by using the head-tilt, chin-lift technique. Place one hand on the forehead. Place the fingertips ofyour other hand under the bony part of the chin. Apply firm, backward pressure on the forehead while lifting the chin upward. This willtilt the head back and move the jaw forward.

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BLS Skills CPR Pro for the Professional Rescuer 5

Maintain the head-tilt with your hand on the forehead. Leave themouth slightly open. Avoid pressing into the soft tissue of the chinwith your fingers, as this can also obstruct the airway.

As a trained provider, you should use a protective barrier, such asa CPR mask, when giving rescue breaths. This will minimize yourexposure to infectious disease. Before using a mask to give rescuebreaths, quickly inspect it to make sure the one-way valve is inplace.

When giving rescue breaths, avoid blowing too hard or too long.Air can be pushed into the stomach, making additional breathsmore difficult and increasing the chance of vomiting. Each breathshould be 1 second in length and provide only enough air to createa visible rise of the patient’s chest.

If you remove your hands from the head, the airway will close again. Open the airwayeach time you give rescue breaths. If you cannot get the chest to rise with your firstbreath, reposition the head further back by using the head-tilt, chin-lift techniqueagain, and try another breath.

Rescue breaths for children and infants are performed in the same manner as foradults. It is recommended that the size of the CPR mask is appropriate for the sizeof the patient. Special care should be taken not to give too much air in a singlebreath. Provide only enough air to make the chest visibly rise, but no more.

Rescue Breaths — Bag-MaskA bag-mask device allows rescuers to provide rescue breaths with-out having to blow into a patient’s mouth. It is not recommendedwhen performing CPR alone. A CPR mask should be used instead.

It takes significant practice to effectively use a bag-mask. Theprovider should consider his or her level of experience before usinga bag-mask. A bag-mask can be used by a single provider, but isbest used by two providers.

Bag-mask rescue breaths for children or infants are done in thesame manner as an adult. It is recommended that the size of thedevice is appropriate for the size of the patient.

The use of an oropharyngeal airway, or OPA, is highly recom-mended with the use of a bag-mask device to help maintain anopen airway. Follow local protocols on the use of OPAs in your set-ting.

Healthcare providers may use an advanced airway device such asa laryngeal mask airway, esophageal-tracheal-combitube, or en-dotracheal tube to maintain an open airway when providing rescuebreaths. When an advanced airway device is in place, remove themask from the bag-mask device and attach the bag directly to theairway device to ventilate. As with other breaths, provide onlyenough air to make the chest rise, but no more.

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CPR Pro for the Professional Rescuer BLS Skills6

Rescue Breaths – Other ConsiderationsWhen caring for someone who is seriously injured, establishing anopen airway is a higher priority than protecting a possible injury tothe spine. Without an airway a patient will not survive, regardlessof illness or injury.

When the potential for a neck injury exists, a jaw-thrust, withouthead-tilt, can be used to open the airway.

Another barrier option for rescue breaths is to use an overlay CPRshield. Shields minimize direct contact with a patient, but may notcompletely reduce the risk of infection.

When using an overlay shield or providing mouth-to-mouth rescuebreaths for an infant, cover both the infant’s mouth and nose withyour mouth.

Primary Assessment — Unresponsive PatientA primary assessment helps you assess for immediate life-threat-ening problems, activate the EMS system, and rapidly provide pri-ority care. It is the same for all ages and is performed quickly.

Before anything else, always pause and assess the scene for haz-ards. If the situation is not safe, do not approach. Help keep othersclear.

A general impression is a quick sense of what has occurred, or isoccurring, when you first observe an emergency scene. This im-pression can help guide you in your approach.

Does the person appear to be unconscious? A person who appearsto have collapsed and is not moving could have experienced a sud-den cardiac arrest. Your immediate assessment and care can behis/her only chance for survival.

If injured, how was the patient injured? The way in which force cre-ates an injury is called the “mechanism of injury.” Consider the pos-sibility of spinal injury when you suspect there has been significantforce applied to the head, neck, or back.

If it is safe to do so, approach the patient. If he or she appears un-conscious, tap or squeeze the shoulder and ask loudly, “Are youokay?” Use the patient’s name if you know it. For an infant, tap thefoot.

Quickly look at the face and chest for normal breathing. Normalbreathing is effortless, quiet, and regular. If normal breathing isfound, place the patient on his or her side in the recovery position.

Weak, irregular gasping, snorting, or gurgling sounds can occurearly in cardiac arrest. These actions provide no usable oxygen.This is not normal breathing.

If there is no breathing, or only gasping, have another bystanderactivate EMS and get an AED. If you are alone with an adult patient,immediately call EMS yourself. Get an AED, if one is available, andquickly return to the patient. The same is true when you are alone,witness the sudden collapse of a child or infant, and you suspectventricular fibrillation as the cause.

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BLS Skills CPR Pro for the Professional Rescuer 7

If you are alone with a child or infant and have not witnessed the collapse, or yoususpect an airway or breathing problem as the cause, continue your assessmentand provide about two minutes of care before leaving to call EMS and get an AEDyourself.

Finish your assessment by feeling for a carotid pulse in the neck. Locate the bony“Adam’s Apple” and slide the flats of your fingers into the groove between the wind-pipe and the muscle on the side of the neck closest to you. Compress downward.For infants, feel for the brachial pulse on the inside of the upper arm. Lay your fingersacross the arm and compress inward.

Pulse checks can be difficult in emergency situations, even for ex-perienced providers. If a pulse is clearly felt and breathing is absentor abnormal, provide continuous rescue breaths, or rescue breath-ing. If the pulse is absent, or you are not certain within 10 seconds,perform CPR, starting with compressions.

When a pulse is clearly felt but is less than 60 beats per minute fora child or infant, the heart may not be providing enough blood flowto the body. Look for signs of poor perfusion, such as pale or bluetissue color. Perform CPR, starting with compressions, if rescuebreathing alone does not improve the patient’s appearance.

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CPR Pro for the Professional Rescuer Skill Guide 18

Adult • Position patient face up on flat, firm surface.

Kneel close to chest. Place heel of one hand oncenter of chest. Place heel of second hand on topof first. You can interlace your fingers to helpkeep off chest.

• Position your shoulders directly above yourhands. Lock your elbows and use upper bodyweight to push.

• Push hard, straight down at least 2 inches. Lifthands and allow chest to fully rebound. Withoutinterruption, push fast at a rate of at least 100times per minute.

Child • Position child face up on flat, firm surface. Place

heel of one hand on lower half of breastbone, justabove the point where the ribs meet.

• Position your shoulder directly above your hand.Lock your elbow and use upper body weight topush.

• Push hard, straight down at least 1⁄3 the depth ofthe chest, or about 2 inches. Lift hand and allowchest to fully rebound. Without interruption, pushfast at a rate of at least 100 times per minute.

• Compressions can be tiring. If desired, use twohands, as with adults.

Infant• Place the tips of two fingers on the breastbone

just below the nipple line.

• Push hard, straight down at least 1⁄3 the depth ofthe chest, or about 11⁄2 inches. Lift fingers andallow chest to fully rebound. Without interruption,push fast at a rate of at least 100 times perminute.

• With two or more providers, compress thebreastbone using two thumbs, with your fingersencircling the chest.

Chest CompressionsSkill

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Skill Guide 2 CPR Pro for the Professional Rescuer 9

Position Mask• Inspect mask to make sure one-way valve is in

place.

• Place mask flat on patient’s face by laying top ofmask over bridge of nose.

• Use thumb and forefinger to control the top ofmask.

• Use thumb of other hand to control the bottom ofthe mask.

Open Airway• Tilt head and lift chin.

• Bring face up into mask to create an airtight sealand open airway.

Give Breath• Take a normal breath and blow through valve

opening to deliver breaths.

• Each breath should be 1 second in length. Createa visible rise of chest, but no more.

• Remove your mouth and let patient exhalecompletely. Take a fresh breath in betweenbreaths.

Jaw-Thrust Technique• An alternative method to open an airway for rescue

breaths is the jaw-thrust technique. It is aconvenient and effective approach when using aCPR mask or bag-mask.

• Positioned above the patient, place mask flat onpatient’s face.

• Place your palms and thumbs on both sides of themask. Hook your fingers under the angles of thejaw, just below the ears.

• Lift and tilt head. Use counter pressure againstcheeks to displace the jaw and move it forward.

• If you suspect the possibility of spinal injury in theneck, use jaw-thrust without head-tilt to open theairway. If this does not establish an airway, usehead-tilt to do so.

Rescue BreathsCPR Mask

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Prepare Bag-Mask• When possible, have two providers use bag-

mask.

• Provide rescue breaths with CPR mask until bag-mask is ready.

• Inspect bag-mask to make sure it is ready for use.

• If using supplemental oxygen, connect to bag-mask, adjust flow rate to at least 10-12 liters perminute, and allow reservoir bag to fill completely.

• Position yourself above patient’s head.

Position Mask• While a second provider holds bag with both

hands, place mask flat on patient’s face.

• Place your palms and thumbs on both sides ofthe mask. Hook your index fingers under theangles of the jaw, just below the ears.

• Lift and tilt head. Use counter pressure againstcheeks to displace the jaw with your fingers andmove it upward.

• If you suspect the possibility of spinal injury in theneck, use jaw-thrust without head-tilt to open theairway. If this does not establish an airway, usehead-tilt to do so.

Deliver Breaths• Have second provider squeeze bag to deliver

breaths.


Using Bag-Mask with One Provider• Prepare bag-mask. Position yourself above

patient. Place mask flat on patient’s face.

• Use thumb and index finger of one hand aroundvalve in a “C” shape to press mask against face.

• Use remaining fingers in an “E” shape to hookbony part of chin.

• Lift and tilt head. Lift and displace jaw upwardwith fingers on chin. If you suspect neck injury donot tilt head unless needed to open airway.

• Squeeze bag to deliver breaths. Each breathshould be 1 second in length. Create a visible riseof chest, but no more.

Rescue BreathsBag-Mask

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Jaw-Thrust without Head-Tilt• If you suspect neck injury, position yourself above

patient’s head and place mask flat on patient’sface.

• Place your palms and thumbs on both sides ofthe mask. Hook your index fingers underneaththe angles of the jaw, just below the ears.

• Use counter pressure against the cheeks todisplace the jaw with your fingers and move itupward without tilting the head.

• If you find the jaw-thrust does not open theairway, use jaw-thrust with head-tilt, or the head-tilt, chin-lift technique instead.

Using a CPR Shield• Place breathing port of shield over or into mouth.

• Spread shield flat over face.

• Place one hand across forehead.

• Hook fingertips of your other hand under bonypart of chin.

• Tilt head and lift chin to open airway.

Give Breath• Seal nose by pinching nostrils closed over or

under shield.

• Take a normal breath. Open your mouth wide.Press it on shield around patient’s mouth tocreate airtight seal. Blow through shield to deliverbreath.


• Remove your mouth and let patient exhalecompletely. Take a fresh breath in betweenbreaths.

• When providing rescue breaths for an infant,cover infant’s mouth and nose with your mouth.

Note: The same technique can be used to provide mouth-to-mouth rescue breaths if you elect not to use a barrier device.

Rescue BreathsOther Considerations

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Assess Scene• Pause and assess scene for safety.

• If unsafe, or if it becomes unsafe at any time,GET OUT!

• If safe, approach the patient.

Check for Response• If patient appears unresponsive, tap or squeeze

shoulder. Ask loudly, “Are you okay?”

• Use patient’s name if you know it.

• For infants, try tapping foot.

Look for Normal Breathing• Position patient face up on a firm, flat surface.

• Look quickly at face and chest for normalbreathing. Normal breathing is effortless, quiet,and regular.

• Weak, irregular, gasping, snorting, or gurgling isNOT considered normal.

• If normal breathing is found, place an uninjuredpatient on side in a recovery position.

Activate EMS and get an AED• If unresponsive, send another person to activate

EMS and get an AED.

• If alone with an adult, place in a recovery positionand do this yourself.

• When alone with a child or infant, provide 2minutes of care first.

Feel for Pulse• Slide fingers into groove on side of neck. For

infants, lay fingers across inside of upper arm.

• If pulse is not obvious within 10 seconds, assumeit is absent.

• If patient is not breathing, or only gasping, andhas an obvious pulse, perform rescue breathing.

• If patient is not breathing, or only gasping, andhas no pulse, perform CPR.

Primary AssessmentUnresponsive Person

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BLS Care CPR Pro for the Professional Rescuer 13

Section 3 — BLS Care

Unresponsive and Breathing – Recovery PositionEven if a patient is breathing normally, a lack of responsiveness is still considered to be a life-threatening condition that requires im-mediate care.

There are a variety of things that can result in unresponsiveness,including medical conditions such as stroke or seizures, or externalfactors, such as alcohol or drug overdose. Regardless of the cause,the greatest treatment concern is the ability of the patient to main-tain a clear and open airway.

Positioning an uninjured, unresponsive, breathing patient in the re-covery position can help maintain and protect the airway. This po-sition uses gravity to drain fluids from the mouth and keep thetongue from blocking the airway.

If an unresponsive person has been seriously injured, do not movehim or her unless you are alone and need to leave to get help.

Frequently assess the breathing of anyone placed in the recoveryposition. The condition can quickly become worse and require ad-ditional care.

Unresponsive, Not Breathing, andHas a Pulse — Rescue BreathingWhen a patient is unresponsive, not breathing or only gasping, buthas a pulse you can clearly feel, he or she is in a condition knownas respiratory arrest. Without immediate intervention, this canprogress quickly to cardiac arrest. The treatment is to provide on-going rescue breaths, or rescue breathing.

For an adult patient, provide 1 rescue breath every five to six sec-onds, or about ten to twelve breaths per minute. Deliver eachbreath over one second and make the chest visibly rise, but nomore.

The rate of rescue breaths for children and infants is one breathevery three to five seconds, or about twelve to twenty breaths perminute.

When performing rescue breathing, assess the pulse about every two minutes. Take no longer than ten seconds to do so. If the pulseis absent, or you are unsure, perform CPR starting with compressions.

If rescue breathing does not improve the appearance of a child or infant (such as pale or blue tissue color) with a heart rate under 60beats per minute, perform CPR instead.

Unresponsive, Not Breathing, and Pulseless — CPRWhen a patient is unresponsive, is not breathing or only gasping, and has no pulse, he or she is considered to be in cardiac arrestand requires CPR.

Once you start CPR, do the best you can. A patient without breathing or circulation cannot survive. Nothing you do can make theoutcome any worse.

Without interruption, perform continuous cycles of 30 chest compressions and 2 rescue breaths. Remember to compress hard andfast, and allow the chest to rebound to its normal position after each compression. After 30 compressions, tilt the head, lift the chin,provide two rescue breaths, and resume compressions. Do this quickly, in less than 10 seconds.

Continue CPR until an AED is ready, another provider or EMS personnel take over, or you are too tired to continue. If an AED becomesavailable, turn it on immediately and follow the AED’s voice instructions for using it.

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If you are unable or unwilling to give rescue breaths, performcompression-only CPR. Without interruption, provide ongoingcompressions at a rate of at least one hundred compressions perminute until an AED is ready, another provider or EMS personneltake over, or you are too tired to continue.

Performing CPR on a child or infant is very similar to performingCPR on an adult. When performing CPR alone, provide continuouscycles of 30 chest compressions and 2 rescue breaths.

CPR Pro for the Professional Rescuer BLS Care14

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BLS Care CPR Pro for the Professional Rescuer 15

Fluids in AirwayIf vomiting has occurred, gurgling is heard, or fluids are visible in the mouth, log-roll the patient on to his or her side to quickly drainfluids. Roll the patient without twisting, keeping the head, neck, and torso in line. Remove any material still in the mouth with a glovedfinger.

Neck BreatherSome people breath through a surgically created opening in the neck called a stoma. Use a CPR mask over the stoma to give rescuebreaths.

PregnancyChest compressions may not be effective when a woman who is 6 months pregnant or more is lying flat on her back. This is becausethe baby puts pressure on a major vein that returns blood to the heart.

If possible, prop up the woman slightly on her left side using a rolled blanket (or similar) when performing chest compressions. This willreduce this pressure and provides the most blood flow to mother and baby. Perform chest compressions higher on the breastbone,slightly above the center.

HypothermiaHandle cold people gently to prevent cardiac arrest. Get inside or out of the wind. Prevent additional heat loss by removing wet clothesand insulating the patient from further exposure.

If the body is frozen solid, the nose and mouth are blocked with ice, and chest compression is impossible, do not start CPR. Whendefibrillating, if the patient does not respond to one shock, focus on continuing CPR and re-warming the patient before repeating thedefibrillation attempt.

DrowningDue to the hypoxic nature of drowning, and the effective treatment of rescue breaths, the initial approach for a person who has drownedfocuses on getting rescue breaths initiated as rapidly as possible.

With personal safety as a priority, get to the patient as quickly as you can and remove from the water as soon as possible. If you aretrained to do so, and it does not delay removal, provide rescue breaths while still in the water.

Do not attempt to provide chest compressions in the water. Do not attempt to remove water from the airway or lungs using abdominalthrusts.

Once a drowning patient is removed from the water, establish an open airway and assess for normal breathing. If absent or only gasping,provide two rescue breaths that make the chest visibly rise. Assess for a pulse for no longer than 10 seconds. If the pulse is absent, orif you are not certain, begin chest compressions. Provide continuous cycles of 30 compressions and 2 rescue breaths. If performingCPR with two rescuers for a child or infant, provide continuous cycles of 15 compressions and 2 rescue breaths instead.

Attach an AED as soon as one is available. Dry the chest before applying pads.

Be prepared for vomiting when caring for someone who has drowned. If vomiting occurs, quickly roll the person onto his or her side todrain fluid from the mouth. Sweep solid matter out with your gloved finger.

Anyone who has received some form of resuscitation for drowning needs to have follow-up evaluation and care in a hospital, regardlessof his or her condition after the event.

Electric ShockConsider any fallen or broken wire extremely dangerous. Do not touch (or allow your clothing to touch) a wire, patient, or vehicle thatcould be energized. Do not approach within 8 feet of it.

Notify the local utility and have trained personnel sent to the scene. Metal or cable guard-rails, steel wire fences, and telephone linesmay be energized by a fallen wire and may carry the current a mile or more from the point of contact. Never attempt to handle wiresyourself unless you are properly trained and equipped.

Start CPR if indicated, as soon as it is safe to do so.

Lightning StrikeWhen multiple patients are struck by lightning at the same time, give the highest priority to those without signs of life. Start CPR ifindicated, as soon as it is safe to do so. Because many patients are young, they have a good chance for survival if immediate CPR isgiven. Remove smoldering clothing, shoes, and belt to prevent burns.

Cardiac Arrest and InjurySomeone in cardiac arrest due to injury is unlikely to survive. If it is clear injury has caused the arrest, do not start CPR.

Special CPR Considerations

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Assess Patient• Pause and assess scene. Scene is safe!

• Tap or squeeze shoulder. Ask loudly, “Are youokay?” No response!

• Look quickly at face and chest for normalbreathing. Occasional gasps are NOT considerednormal. Normal breathing present!

• Have someone alert EMS and get an AED.

Prepare• Extend arm nearest to you up alongside head.

• Bring far arm across chest and place back ofhand against cheek.

• Grasp far leg just above knee and pull it up sofoot is flat on ground.

Roll• Grasp shoulder and hip and roll patient toward

you. Roll in a single motion, keeping head,shoulders, and torso from twisting.

• Roll far enough for face to be angled forward.

• Position elbow and knee to help stabilize headand body.

Suspected Injury• If patient has been seriously injured, do not move

unless fluids are collecting in airway, or you arealone and need to leave to get help.

• During roll, make sure head ends up resting onextended arm and head, neck, and torso areinline.

Unresponsive and BreathingRecovery Position

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• Look quickly at face and chest for normalbreathing. Occasional gasps are NOT considerednormal. Normal breathing absent!


• Check for obvious carotid pulse in the neck.Pulse present!

Open Airway• Tilt the head; lift the chin to establish an airway.

• If you suspect neck injury, use jaw-thrust withouthead-tilt.

Give Rescue Breaths• Provide 1 rescue breath every 5-6 seconds

(10-12 breaths per minute).

• Give each breath in 1 second. Make the chestvisibly rise, but no more.

• Don’t stop! Continue until another provider or thenext level of care takes over, the patient clearlyshows signs of life, or you are too tired.

• Reassess carotid pulse about every 2 minutes.Take no longer than 10 seconds.

Unresponsive, Not Breathing, and Has a PulseRescue Breathing – Adult

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• Check for a carotid pulse in the neck. Pulsepresent and 60 BPM or greater!




(12–20 breaths per minute).


• Don’t stop! Continue until another provider or thenext level of care takes over, the child clearlyshows signs of life, or you are too tired.

• Reassess carotid pulse about every 2 minutes.Take no longer than 10 seconds.

Unresponsive, Not Breathing, and Has a PulseRescue Breathing – Child

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• Tap foot. Shout loudly. No response!



• Check for a brachial pulse on inside of upper arm.Pulse present and 60 BPM or greater!




(12-20 breaths per minute).


• Don’t stop! Continue until another provider or thenext level of care takes over, the infant clearlyshows signs of life, or you are too tired.

• Reassess brachial pulse about every 2 minutes.Take no longer than 10 seconds.

Unresponsive, Not Breathing, and Has a PulseRescue Breathing – Infant

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Assess Patient• If safe to do so, tap or squeeze shoulder. Ask

loudly, “Are you okay?” No response!



• Check for an obvious carotid pulse in neck. Takeno longer than 10 seconds. No pulse!

Give 30 Chest Compressions• Place heel of one hand on center of chest. Place

heel of second hand on top of first.

• Using upper body weight, push hard, at least 2inches in depth.

• Push fast, at least 100 times per minute. Allowchest to fully rebound.

Give 2 Rescue Breaths • Tilt head; lift chin to establish airway. If you

suspect neck injury, use jaw-thrust without head-tilt.

• Make chest visibly rise over one second witheach breath, but no more.

• Take a fresh breath between breaths.

• Take no longer than 10 seconds to give breaths.

Repeat Cycles• Provide continuous cycles of 30 compressions

and 2 rescue breaths.

• Don’t stop! Continue until an AED is ready,another provider or the next level of care takesover, the person clearly shows signs of life, or youare too tired.

Unresponsive, Not Breathing, and PulselessCPR — Adult

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• Check for an obvious carotid pulse in the neck.Take no longer than 10 seconds. No pulse (orless than 60 BPM with signs of poor perfusion)!

Give 30 Chest Compressions• Place heel of one hand on lower half of

breastbone.

• Using upper body weight, push hard, at least 1⁄3the diameter of the chest, or about 2 inches.


• Compressions are tiring. If desired use twohands, as with adults.

Give 2 Rescue Breaths• Tilt head; lift chin to establish airway. If you

suspect neck injury, use jaw-thrust withouthead-tilt.






• Don’t stop! Continue until an AED is ready,another provider or the next level of care takesover, the child clearly shows signs of life, or youare too tired.

Unresponsive, Not Breathing, and PulselessCPR — Child

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Assess Patient• If safe to do so, tap foot. Shout loudly.No response!



• Check for an obvious brachial pulse on inside ofupper arm. Take no longer than 10 seconds.No pulse (or less than 60 BPM with signs ofpoor perfusion)!

Give 30 Chest Compressions• Place two fingertips on breastbone just below

nipple line.

• Push hard, at least 1⁄3 the diameter of the chest,or about 2 inches.


Give 2 Rescue Breaths• Tilt head; lift chin to establish airway. If you

suspect neck injury, use jaw-thrust without head-tilt.






• Don’t stop! Continue until an AED is ready,another provider or the next level of care takesover, the infant clearly shows signs of life, or youare too tired.

Unresponsive, Not Breathing, and PulselessCPR — Infant

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Defibrillation CPR Pro for the Professional Rescuer 23

Section 4 — Defibrillation

Automated External DefibrillatorsAEDs are designed to be simple to operate. Voice instructions, lights, and screen prompts guide an operator through use. There aremany different brands of AEDs, but the same basic steps for operation apply to all of them.

• Turn on the AED. This starts voice instructions and readies the device for use. Opening the lid will turn on the power withsome AEDs. With others, a power button is pressed.

• Adhere the defibrillation pads to the patient’s bare chest.Pads are placed in specific locations to direct the electricalshock through the heart. Most pads are pre-connected tothe device, but some AEDs require you to plug in a con-nector.

• Allow the AED to analyze the heart rhythm. An AED auto-matically starts analyzing once the pads are in place. If de-fibrillation is required, the AED will charge to get ready forshock delivery.

• Deliver a shock if directed to by the AED. While keepingothers clear, a button is pressed on most AEDs to deliver ashock.

Immediately after a shock is delivered, CPR is resumed, startingwith chest compressions. Voice instructions and additional analysisby the AED will guide you through further care.

Basic AED OperationHigh-quality CPR along with rapid defibrillation using an AED provides the most effective early treatment for sudden cardiac arrest.

Defibrillation pads must be applied to a bare chest. If needed, quickly tear or use scissors to remove clothing, including undergarments.

The pads have pictures on them to assist in proper placement.Carefully look at the pictures to ensure the pads are properlyplaced. Peel the pads from the backing sheet one at a time andplace them exactly as indicated in the pictures.

AEDs automatically start analyzing once the pads are in place.Movement can interrupt the analysis. Be certain that no one istouching the patient.

If defibrillation is required, an AED will charge to deliver a shock.Give a verbal warning and look to make sure no one, including you,is in contact with the patient before delivering the shock. Immedi-ately after delivering the shock, resume CPR, starting with chestcompressions. When a shock is not indicated by the AED, simplyresume CPR as well.

Continue to follow any additional AED voice instructions. Don’t stopuntil the patient shows signs of life, another provider or EMS per-sonnel take over, or you are too tired to continue.

If the patient responds, stop CPR and place him or her in a recovery position. Leave the AED on and attached in case cardiac arrestoccurs again.

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Cardiac arrests involving children are primarily caused by the initialloss of the airway or breathing. Well-performed CPR with effectiverescue breaths may be the only treatment required for successfulresuscitation of a child. However, conditions can occur for whichdefibrillation of a child or infant is warranted.

Most AEDs have specially designed pads or mechanisms availablethat reduce the defibrillation energy to a level more appropriate fora smaller body size. If an AED specifically equipped for use on achild or infant is not available, an AED configured for an adult canbe used instead, placing the adult pads on the front and back ofthe child’s or infant’s chest.

Troubleshooting and OtherAED ConsiderationsAEDs are designed to detect problems during use and guide youthrough corrective actions. If a troubleshooting message occurs,stay calm and follow the AED’s voice instructions.

If the AED indicates a problem with the pads, the pads are not com-pletely adhered to the skin or there is a poor connection to the AED.Press pads firmly, especially in the center, to make sure they areadhering well. Make sure the pads cable connector is firmly con-nected to the AED.

If the chest is wet, remove the pads and wipe the chest dry. Applya new set of pads. If pads do not stick due to chest hair, pull thepads off and quickly shave the hair. Attach another set of pads.

Another troubleshooting message may indicate that analysis hasbeen interrupted due to movement. Stop all sources of movement,such as chest compressions or rescue breaths.

If a message indicates the need to replace a battery, there may onlybe enough energy for a limited number of shocks. If the AED failsto operate, the depleted battery should be removed and replacedwith a new one.

A patient should be removed from standing water before an AEDis used. It is okay to use an AED when a patient is lying on a wetsurface, such as in the rain or near a swimming pool. An AEDshould never be immersed in water or have fluids spilled on it.

AEDs can also be used safely on metal surfaces, such as gratingsor stairwells. Make sure the pads do not directly touch any metalsurface.

Someone may have a surgically implanted device in the chest, suchas a pacemaker or an implantable cardioverter-defibrillator. A no-ticeable lump and surgical scar may be visible. If an implanted de-vice is in the way of normal pad placement, adjust the placementso the pad edge is at least one inch away from the device.

Defibrillating over medication patches could reduce the effective-ness of the shock. If a medication patch is interfering with place-ment, use a gloved hand to peel off the patch. Quickly wipe awayany remaining residue before placing pads.

CPR Pro for the Professional Rescuer Defibrillation24

Automatic Shock DeliverySome AEDs deliver a shock automatically after charging.An accidental shock can be prevented by making sure noone is in contact with the person being defibrillated.

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Assess Patient• If safe to do, Tap or squeeze shoulder. Ask loudly,

“Are you okay?” No response!



• Check for an obvious carotid pulse in neck. Nopulse!

Perform CPR• Provide continuous cycles of 30 compressions


• Continue until AED begins to analyze heart.

When Available, Attach AED• Position AED close to head. Turn on power to

start voice instructions. Bare chest. If wet orsweaty, wipe dry.

• Remove pads from packaging. Look at pictureson pads to ensure accurate placement.

• Peel first pad from backing and place below rightcollarbone, above nipple, and beside breastbone.

• Place second pad on left side, over ribs, and afew inches below armpit.

If Indicated, Deliver Shock• Allow AED to analyze heart. Stop all movement,

including CPR.

• If shock is advised, CLEAR everyone from patientand press shock button to deliver shock.

• If a shock is NOT advised, immediately resumeCPR, starting with chest compressions.

Resume CPR• Immediately after delivering shock, resume CPR,

starting with chest compressions. Follow anyadditional voice instructions from AED.

• Continue until another provider or the next levelof care takes over.

• If patient responds, stop CPR and place inrecovery position. Leave AED on and attached.

Using an AEDAdult

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• Check for obvious carotid pulse in the neck. Nopulse (or less than 60 BPM with signs of poorperfusion)!

Perform CPR • Provide continuous cycles of 30 compressions


• Perform CPR for at least 5 cycles or about 2minutes before attaching an AED.

• Continue until AED begins to analyze heart.

Attach AED • Position AED close to head. Turn on power to

start voice instructions. Bare chest. If wet orsweaty, wipe dry.

• Remove pads from packaging. Look at pictureson pads to ensure accurate placement.

• Peel first pad from backing and place in center ofchest just below collarbones.

• Roll child and place second pad on center ofback between shoulder blades.

If Indicated, Deliver Shock • Allow AED to analyze heart. Stop all movement,

including CPR.

• If shock is advised, CLEAR everyone from childand press shock button to deliver shock.

• If a shock is NOT advised, immediately resumeCPR, starting with chest compressions.

Resume CPR • Immediately after delivering shock, resume CPR,

starting with chest compressions. Follow anyadditional voice instructions from AED.

• Continue until another provider or the next levelof care takes over.

• If child responds, stop CPR and place in recoveryposition. Leave AED on and attached.

Using an AEDChild and Infant

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Team Approach CPR Pro for the Professional Rescuer 27

Section 5 — Team Approach

Team ApproachIt is common for multiple healthcare providers to respond during a basic life-support emergency. Patient management can be adjustedas more providers become available.

Begin with single provider care. If additional providers become available, perform CPR using two providers. One provider performschest compressions while another gives rescue breaths. For adults, the CPR ratio remains at 30 compressions and 2 rescue breaths.

Jaw-thrust with head-tilt can be a convenient and effective method of opening the airway of a non-injured patient when using a CPRmask, or bag-mask, during two-rescuer CPR. When giving rescue breaths, pause compressions to allow the breaths to be given.Give breaths quickly, in less than 10 seconds.

CPR can be tiring. When other providers are available, take turnsperforming compressions. Switch compressors about every twominutes. Do this quickly, in less than 5 seconds.

For children and infants, switch the CPR ratio to 15 compressionsand 2 rescue breaths when more than one provider is available.When giving chest compressions to an infant, compress the lowerhalf of the breastbone using both thumb tips and your hands en-circling the sides of the chest. The rate and depth remain the sameas with a single provider.

Multiple treatment interventions can be done at the same time. Itis important to work as a team. When an AED becomes available,continue CPR, if possible, until the AED is ready to analyze the pa-tient’s heart.

If you are using a bag-mask device, have one provider maintain theairway and control the mask while another squeezes the bag.

Once an advanced airway device is in place, it is no longer necessary to pause compressions to give breaths. Provide continuouscompressions at a rate of at least 100 compressions per minute. Regardless of patient’s age, provide a single breath every six toeight seconds, or about eight to ten times a minute.

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Single-Provider CPR• If alone, begin with single provider care.

• As other providers become available, integrateroles and perform actions simultaneously.

• Work together efficiently as a team.

Two-Provider CPR• Perform CPR using two providers. One provider

compresses the chest and the other gives rescuebreaths. The ratio remains 30 compressions and2 rescue breaths.

• Jaw-thrust with head-tilt can be used from abovethe head to open the airway.

• Pause compressions to give rescue breaths. Takeno longer than 10 seconds to give breaths.

• Rotate compressors about every 2 minutes. Dothis quickly, in less than 5 seconds.

Integrating Other Interventions• Integrate other interventions without disruption.

If an AED becomes available, continue CPR, ifpossible, until the AED is ready to analyze thepatient’s heart.

• If you are integrating the use of a bag-maskdevice, it is best used by two providers. A thirdprovider needs to continue chest compressions.

• If an advanced airway device is in place, providecontinuous chest compressions of at least 100compressions per minute. Independent ofcompression, provide a single rescue ventilationevery 6–8 seconds creating a visible rise of thechest, but no more.


Team ApproachAdult Cardiac Arrest

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Single-Provider CPR• If alone, begin with single provider care.

• As other providers become available, integrateroles and perform actions simultaneously.

• Work together efficiently as a team.

Two-Provider CPR• Perform CPR using two providers. One provider

compresses the chest and the other gives rescuebreaths. With two providers, the ratio changes to15 compressions and 2 rescue breaths.

• For an infant, compress the lower half of thebreastbone with both thumb tips and handsencircling the chest.

• Jaw-thrust with head-tilt can be used from abovethe head to open the airway.

• Pause compressions to give rescue breaths. Takeno longer than 10 seconds to give breaths.

• Rotate compressors about every 2 minutes. Dothis quickly, in less than 5 seconds.

Integrating Other Interventions• Integrate other interventions without disruption.

If an AED becomes available, continue CPR, ifpossible, until the AED is ready to analyze thechild’s heart.

• If you are integrating the use of a bag-maskdevice, it is best used by two providers. A thirdprovider needs to continue chest compressions.

• If an advanced airway device is in place, providecontinuous chest compressions of at least 100compressions per minute. Independent ofcompression, provide a single rescue ventilationevery 6–8 seconds creating a visible rise of thechest, but no more.


Team ApproachChild or Infant Cardiac Arrest

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CPR Pro for the Professional Rescuer BLS Adult Algorithm30

BLS Adult Algorithm

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BLS Summary CPR Pro for the Professional Rescuer 31

Adult Child Infant

Age Determination Begins with onset of puberty. About 1 year of age to the onsetof puberty.

Less than 1 year of age.

Scene Safety? If the scene is unsafe or atany time becomes unsafe,GET OUT!

If the scene is unsafe or atany time becomes unsafe,GET OUT!

If the scene is unsafe or atany time becomes unsafe,GET OUT!

Response? Tap shoulder, shout name. Tap shoulder, shout name. Tap foot, shout out.

Breathing? Look at face and chest for nobreathing or only gasping.

Look at face and chest for nobreathing or only gasping.

Look at face and chest for nobreathing or only gasping.

Normal BreathingPresent?

Place person in recoveryposition and monitor breathing.

Place child in recovery positionand monitor breathing.

Place infant in recovery positionand monitor breathing.

Activate EmergencyResponse System/Get an AED

Send a bystander. When alone,do it yourself immediately.

Send a bystander. When alone,perform about 2 minutes of CPRbefore doing it yourself.

Send a bystander. When alone,perform about 2 minutes of CPRbefore doing it yourself.

Normal BreathingAbsent?

Palpate for carotid pulse in neckfor no more than 10 seconds.

Palpate for carotid pulse in neckfor no more than 10 seconds.

Palpate for brachial pulse in upperarm for no more than 10 seconds.

Pulse Present? • Perform rescue breathing;1 breath every 5-6 seconds

• Monitor carotid pulse every2 minutes

• If pulse rate is 60 beats perminute or greater, performrescue breathing; 1 breathevery 3-5 seconds

• Monitor carotid pulse every2 minutes

• If pulse rate is 60 beats perminute or greater, performrescue breathing; 1 breathevery 3-5 seconds

• Monitor brachial pulse every2 minutes

Rescue Breaths • Tilt head, lift chin to openairway first; use jaw-thrustfor suspected neck injury

• 1 second in length• Make chest visibly rise, but

no more

• Tilt head, lift chin to open air-way first; use jaw-thrust forsuspected neck injury


no more

• Tilt head, lift chin to open air-way first; use jaw-thrust forsuspected neck injury


no more.

Pulse Absent? • Perform CPR starting withcompressions

• Single or multiple rescuers -provide continuous cyclesof 30 compressions and 2rescue breaths

• If pulse is absent, or lessthan 60 BPM with poor per-fusion, perform CPR startingwith compressions

• Single rescuer — providecontinuous cycles of 30:2

• Multiple rescuers — providecontinuous cycles of 15:2

• If pulse is absent, or lessthan 60 BPM, with poor per-fusion, perform CPR startingwith compressions.

• Single rescuer — providecontinuous cycles of 30:2.

• Multiple rescuers — providecontinuous cycles of 15:2.

Compressions • Two hands on centerof chest

• At least 2 inches in depth• Rate of at least 100 times a

minute• Hard, fast, full rebound,

minimize interruption

• One or two hands on lowerhalf of breastbone

• At least 1⁄3 diameter of chestor about 2 inches in depth

• Rate of at least 100 times aminute

• Hard, fast, full rebound,minimize interruption

• Two fingers on breastbonejust below nipple line

• At least 1⁄3 diameter of chestor about 11⁄2 inches in depth

• Rate of at least 100 times aminute

• Hard, fast, full rebound,minimize interruption

Defibrillation with AED • Turn on power• Attach pads• Analyze• If indicated, deliver shock• Immediately resume CPR• Follow voice instructions

• Use pediatric system; if notavailable, use AED for adult

• Turn on power• Attach pads• Analyze• If indicated, deliver shock• Immediately resume CPR• Follow voice instructions

• Use pediatric system; if notavailable, use AED for adult

• Turn on power• Attach pads• Analyze• If indicated, deliver shock• Immediately resume CPR• Follow voice instructions

BLS Summary

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CPR Pro for the Professional Rescuer Choking

Section 6 — Foreign Body Airway Obstruction

ChokingChoking can occur when a solid object, such as a piece of food, or small object, enters a narrowed part of the airway and becomesstuck. On inhalation, the object can be drawn tighter into the airway and block air from entering the lungs.

A forceful thrust beneath the ribs and up into the diaphragm can compress the air in the chest and create enough pressure to “pop”the object out of the airway. Direct compression of the chest over the breastbone can also create enough pressure to expel an object.

You must be able to recognize the difference between a mild block-age and a severe blockage. With a mild blockage, a patient canspeak, cough, or gag. This type of blockage is typically cleared bycoughing. Encourage someone with a mild blockage to coughforcibly. Stay close and be ready to take action if things worsen.

When a severe blockage occurs, a patient cannot dislodge the ob-ject on his or her own. Signs of severe obstruction include very littleor no air exchange, high-pitched wheezing or lack of sound, andthe inability to speak or cough forcefully. A patient with a severeblockage may hold his or her hands to his or her throat as he orshe attempts to clear an obstruction. Your help is required to savethe patient’s life.

Young children are particularly at risk for choking because of thesmall size of their air passages, inexperience with chewing, and anatural tendency to put objects in their mouths. For a choking child,the approach is nearly the same as for adults. It might be easier to

kneel behind a choking child to deliver thrusts.

Since infants do not speak, it may be more difficult to recognize choking. A sudden onset differentiates it from other breathing emer-gencies. Signs include weak, ineffective coughs, and the lack of sound, even when an infant is clearly attempting to breathe.

If you suspect an infant is choking, perform continuous cycles of five back blows and five chest thrusts to expel the object. Do notperform abdominal thrusts on an infant.

Abdominal and chest thrusts can cause internal injury. Anyone who has been treated with these maneuvers for choking should beevaluated by EMS or a physician to ensure there are no injuries.

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Assess Patient• Ask, “Are you choking?”

• If patient nods yes, or is unable to speak orcough — act quickly!

• If available, have a bystander activate EMS.

Position Yourself• Stand behind patient.

• Make a fist with one hand and place thumb sideagainst abdomen, just above navel and below ribs.

• Grasp fist with other hand.

Give Thrusts• Quickly thrust inward and upward into abdomen.

• Repeat. Each thrust needs to be given with intentof expelling object.

• Continue until patient can breathe normally.

If Patient Becomes Unresponsive…• Carefully lower to ground. Position face-up on a

firm, flat surface.

• If not already done, activate EMS.

• Begin CPR, starting with compressions.

Remove Any Object if Seen• Look in mouth for an object after each set of

compressions, before giving rescue breaths.

• Continue until patient shows obvious signs of life,or another provider or the next level of care takesover.

ChokingAdult

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Assess Child• Ask, “Are you choking?”

• If child nods yes, or is unable to speak or cough— act quickly!


Position Yourself • Kneel behind child.

• Make a fist with one hand and place thumb sideagainst abdomen, just above navel and belowribs.

• Grasp fist with other hand.

Give Thrusts • Quickly thrust inward and upward into abdomen.

• Repeat. Each thrust needs to be given with intentof expelling object.

• Continue until child can breathe normally.

If Child Becomes Unresponsive… • Carefully lower to ground. Position face-up on a

firm, flat surface.

• If alone, provide at least two minutes of care beforeactivating EMS.




• Continue until child shows obvious signs of life,or another provider or the next level of care takesover.

ChokingChild

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Assess Infant• Look at infant’s face.

• If infant is silent, unable to cry, or has blue lips,nails, or skin — act quickly!


Give 5 Back Blows • Straddle infant face-down over your forearm, with

head lower than chest.

• Support head by holding jaw.

• Using heel of other hand, give 5 back blowsbetween shoulder blades.

Give 5 Chest Thrusts • Sandwich infant between your forearms and turn

onto back, with legs and arms straddling yourother arm.

• Place 2 fingers on breastbone just below nippleline and give 5 chest thrusts.

• Repeat back blows and chest thrusts until infantcan breathe normally.

• Back blows and thrusts need to be given withintent of expelling object.

If Infant Becomes Unresponsive… • Carefully lower to ground. Position face-up on a

firm, flat surface.

• If alone, provide at least two minutes of CPR beforeactivating EMS.




• Continue until infant shows obvious signs of life,or another provider or the next level of care takesover.

ChokingInfant

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Legal Considerations CPR Pro for the Professional Rescuer 37

Legal Considerations

Good Samaritan LawsAll states have passed what are known as “Good Samaritan laws,” to help encourage bystanders to assist those in need. These lawshelp protect anyone who:

• Voluntarily provides assistance, without expecting or accepting compensation,

• Is reasonable and prudent,

• Does not provide care beyond the training received, and

• Is not “grossly negligent,” or completely careless, in delivering emergency care.

Good Samaritan laws vary slightly from state to state. Become familiar with the laws in your state and other states where you workor travel.

AbandonmentOnce care has begun, and it is safe to do so, remain with the person until someone with equal or greater emergency medical trainingtakes over. If alone, it is okay to leave to activate EMS, but return to the person as soon as you can.

ConsentIt is appropriate to ask a responsive person if they want help before providing care. To get consent, first identify yourself. Then tell thepatient your level of training and ask if it’s okay to help. “Implied consent” means that permission to provide care to an unresponsivepatient is assumed. This is based on the idea that a reasonable person would give permission to receive lifesaving care if able. Consentfor children must be gained from a parent or legal guardian. When life-threatening situations exist and the parent or guardian is notavailable, care should be given based on implied consent. When suffering from a disturbance in normal mental functioning, likeAlzheimer’s disease, a patient may not understand your request for consent. Consent must be gained from a family member or legalguardian.

Duty to ActThis is a requirement to act toward others and the public with the watchfulness, attention, caution and prudence that a reasonableperson in the same circumstances would use. If a person’s actions do not meet this standard, then the acts may be considered neg-ligent, and any damages resulting may be claimed in a lawsuit for negligence. If you are a state-licensed healthcare provider, first re-sponder, or other professional rescuer expected to give emergency medical care, including CPR, you almost certainly have a duty toact. However, BLS performed voluntarily on a stranger in need while off duty is generally considered a “Good Samaritan Act.”

Assault and BatteryA criminal act of placing a person in fear of bodily harm. A conscious and aware adult has the right to refuse medical treatment.Forcing care on a person against his wishes may be considered grounds for this.

Starting CPRStart CPR for all patients in cardiac arrest unless signs of irreversible death are present, including rigor mortis (limbs of corpse stiffand impossible to move), dependent lividity (settling of blood in lower portions of body, causing a purplish red discoloration), or con-ditions are present that are incompatible with life (decomposition, decapitation, massive head injury, etc.). Do not start CPR if it putsyou in danger of injury, or the patient has a valid DNR order. In a mass casualty incident with limited resources, patients requiringrescue breathing or CPR are considered dead and attempts to resuscitate them should not be started.

Stopping CPRDo not stop CPR until a healthcare provider or other professional rescuer with equal or more training takes over, you are exhausted,the scene becomes too dangerous to continue, or the patient shows signs of life. You can also stop if the physician in charge of thepatient decides to order the resuscitation effort stopped (follow local protocol, standard operating procedures, and/or medical direc-tion).

Except when death is obvious, irreversible brain damage or brain death cannot be reliably assessed or predicted. Rescuers shouldnever make an impulsive decision about the present or future quality of life of a cardiac arrest patient, because such decisions maybe incorrect.

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CPR Pro for the Professional Rescuer Legal Considerations38

Advanced Directives and Living WillsThese are documents authorized by state law that allow a person to appoint someone as his or her representative to make decisionson resuscitation and continued life support in a situation where a person has lost decision-making capacity (for example, if in a coma).These documents may also be referred to as “a durable power of attorney.” Advanced directives are statements about what thepatient wants done or not done when the patient can’t speak on his or her own behalf. Laws about advanced directives are differentin each state. You should be aware of the laws in your state.

Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) OrdersThe DNR/DNAR order is a kind of advanced directive. This is a specific request not to have CPR performed. In the United States, adoctor’s order is required to withhold CPR. Therefore, unless the patient has a DNR order, EMS providers and hospital staff shouldattempt resuscitation. Patients who are not likely to benefit from CPR and may have a DNR order include those with terminal conditionsfrom which they are unlikely to recover.

Outside the hospital, healthcare providers, first responders, and other professional rescuers should begin CPR if there is a reasonabledoubt about the validity of a DNAR order or advanced directive, if the patient may have changed his or her mind, or the patient’s bestinterests are in question.

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Caring for someone in an emergency can create emotional distress, even for healthcare providers. More serious emergencies or aconnection to those involved can intensify these feelings.

Common reactions include:

• Anxiety

• Trembling or shaking

• Sweating

• Nausea

• Fast breathing

• Pounding heartbeat

This is a normal human reaction to a traumatic event. Simply remember to stay calm and accept your limitations as a provider.

After an emergency is over, you may begin to experience a variety of reactions. These include:

• Feeling abandoned or helpless,

• Recalling the event over and over

• Self-doubt about not doing enough

• Difficulty concentrating

• Heaviness in the chest

• Upset stomach or diarrhea

• Difficulty sleeping or nightmares

It is important to understand that these feelings are normal and will pass with time. However, there are actions you can take to helpcope with and work through the difficulty.

Informally speak to someone you trust to listen without judgment, such as a family member, friend, or coworker. Get back to a normalroutine as soon as possible. Accept that it will take time to resolve these emotions.

If unpleasant feelings persist, formal assistance from a professional counselor may be helpful as you work through your emotionssurrounding the event.

Emotional Considerations

39Emotional Considerations CPR Pro for the Professional Rescuer

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CPR Pro for the Professional Rescuer References and Resources40

References and End Notes

ReferencesThe ASHI CPR Pro for the Professional Rescuer Student Handbook is based upon the following standards, guidelines, and treatmentrecommendations:

• “2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treat-ment Recommendations.” Circulation 122, suppl. 2 (2010): S250-S581.

• “2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Sci-ence.” Circulation 122, suppl. 3 (2010): S639-S946.

• ANSI Standard Z490.1. “Criteria for Accepted Practices in Safety, Health, and Environmental Training.” American NationalStandard, 2009.

• ASTM Standard F2171-02. “Standard Guide for Defining the Performance of First Aid Providers in Occupational Settings.”ASTM International, 2009.

• OSHA 3317-06N. “Best Practices Guide: Fundamentals of a Workplace First-Aid Program.” U.S. Department of Labor, Oc-cupational Safety and Health Administration, 2006.

• Other recommendations or sources as referenced by end notes.

End Notesi. Centers for Disease Control and Prevention. “Preventing Allergic Reactions to Natural Rubber Latex in the Workplace.” The Na-

tional Institute for Occupational Safety and Health (NIOSH) Alert. http://www.cdc.gov/niosh/docs/97-135/pdfs/97-135.pdf

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Glossary CPR Pro for the Professional Rescuer 41

GlossaryAbdominal Thrust

Thrusts administered to the abdomen of a responsive, choking person to force air in the lungs to dislodge an object blocking a per-son’s airway.

Acute Coronary Syndrome (ACS)

Often described as a heart attack, ACS occurs when there is reduced blood flow to the tissues of the heart.

Airway

The passageway between mouth and lungs that allows life-sustaining oxygen into the body.

Automated External Defibrillator (AED)

A portable, computerized device that automatically analyzes for life-threatening heart rhythms and provides corrective treatmentthrough adhesive pads on a person’s chest.

Bloodborne Pathogens

Potentially infectious body fluids.

Bystander

Someone who is present but not taking part in a situation or event.

Cardiopulmonary Resuscitation (CPR)

A combination of rescue breaths and chest compressions performed on a person experiencing cardiac arrest, intended to restoresome oxygen to the brain.

Chain of Survival

A concept of five interdependent links (early access to EMS, early CPR, rapid defibrillation, effective advanced care, and integratedpost-cardiac care) that describe the most effective approach for treating sudden cardiac arrest.

Chest Compression

Pressing down on a person’s chest in a rhythmic motion to increase pressure inside the chest and directly compress the heart tokeep blood circulating to the brain and other internal organs.

Chest Thrust

Thrusts administered on the breastbone of a responsive, choking person to force air in the lungs to dislodge an object stuck in theperson’s airway.

Compression-only CPR

An alternative to conventional (compressions and rescue breaths) CPR in which immediate ongoing chest compressions are pro-vided for a person who has collapsed and is unresponsive and not breathing (or breathing inadequately).

CPR Mask

A protective barrier device used to prevent contact with potentially infectious body fluids while performing rescue breaths on a per-son. The mask fits over the mouth and nose of the person and includes a breathing valve for the first aid provider to safely administerrescue breaths.

CPR Shield

A protective barrier device used to prevent contact with potentially infectious body fluids while performing rescue breaths on a per-son. The shield consists of a flat square of malleable plastic with either a hard plastic breathing valve or a filter.

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CPR Pro for the Professional Rescuer Glossary42

Defibrillation

The process of passing an electrical shock through the heart to restore a normal pumping rhythm.

Emergency Action Plan (EAP)

A site-specific plan for workplace or home that contains specific procedures on how to respond to internal emergencies and activateEMS.

Emergency Medical Services (EMS)

The emergency medical response system developed within your community, typically using a specialized emergency communicationnetwork to gather information and dispatch appropriate emergency resources. A first aid provider can activate EMS in an emergency,usually by calling an emergency number.

Good Samaritan Law

A law enacted in all states to legally protect trained providers who voluntarily stop to help, act prudently, do not provide care beyondtraining, and are not completely careless in delivering emergency care.

Head-tilt, Chin-lift

A technique intended to open the person’s airway, involving tilting the person’s head back and lifting the person’s chin. Techniqueresults in the base of the tongue lifting away from the back of the throat.

Heart Attack

Reduced blood flow to the tissues of the heart, also known as acute coronary syndrome. It is usually characterized by pain, severepressure, or discomfort in the chest.

Implied Consent

A legal concept referring to the legitimate assumption that an unresponsive person would give permission to be helped if responsive.

Pacemaker or Automated Internal Defibrillator

A surgically implanted device, which may be noticeable by a lump or surgical scar.

Primary Assessment

Checking for immediate life-threatening problems.

Protective Barrier

Anything that helps reduce the risk of exposure to potentially infectious body fluids. Some examples of effective protective barriersinclude latex (or non-latex) gloves, and ventilation shields and masks.

Recovery Position

The position in which an unresponsive breathing person is placed to drain fluids from the mouth and keep the tongue from blockingthe airway; place the person on his or her side with head slightly forward.

Rescue Breaths

Artificial breaths given to someone who is not breathing; administered by blowing air into the mouth to inflate the lungs.

Stroke

Occurs when the blood supply to a portion of the brain is suddenly interrupted. Commonly occurs when a blood clot gets caughtin a blood vessel. In most cases, brain cells die. Signs can include numbness of face, arm, or leg, especially on one side of thebody; confusion; change in the ability to speak or understand; change in sight and balance; and severe, sudden headache.

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Sudden Cardiac Arrest

Occurs when the normal electrical impulses in the heart unexpectedly become disorganized; the normally coordinated mechanicalcontraction of the heart muscle is lost, and a chaotic, quivering condition known as ventricular fibrillation can occur. Blood flow tothe brain and body stops abruptly. It is characterized by a stoppage of breathing, sudden collapse, and loss of consciousness.

Trained Provider

Someone who is trained in the delivery of CPR and use of an AED, until personnel are available to provide more advanced care.The trained provider is often the first emergency caregiver on the scene and plays a critical role in survival.

Universal Precautions

An approach that recommends handling all blood and other body substances as if they are infectious. To be effective, use protectivebarriers between yourself and an ill or injured person, regardless of relationship or age.

Unresponsive

A condition in which the person does not respond in any manner when addressed or tapped by the trained provider.

Ventricular Fibrillation

A chaotic, quivering heart rhythm that interferes with the heart’s ability to pump blood.

43Glossary CPR Pro for the Professional Rescuer

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Documents

acute coronary syndrome

coordinated mechanical contraction

additional voice instructions

american safety

automated external defibrillator

blue tissue color

perform continuous cycles

sudden cardiac arrest