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PROVIDER MANUAL
Table of Figures
Figure 1: Adult Chain of Survival ................................................................................................................. 3
Figure 2: Pediatric Chain of Survival ........................................................................................................... 4
Figure 3: 2010 BLS Changes ........................................................................................................................ 4
Figure 4: Adult BLS ...................................................................................................................................... 6
Figure 5: One Rescuer CPR .......................................................................................................................... 7
Figure 6: Using an AED for Adults ............................................................................................................... 9
Figure 7: Differences in BLS for Adults and Children ................................................................................ 10
Figure 8: One Rescuer BLS for Children .................................................................................................... 11
Figure 9: One Rescuer Infant BLS .............................................................................................................. 13
Figure 10: Compression to Breath Ratios with/without Advanced Airway .............................................. 14
Figure 11: Adult & Older Child Mouth to Mouth ...................................................................................... 15
Figure 12: Rescue Breathing ..................................................................................................................... 16
Figure 13: Adult and Child Airway Obstruction ........................................................................................ 17
Figure 14: Abdominal Thrusts for Adult/Child Choking ............................................................................ 18
Figure 15: Infant Airway Obstruction ....................................................................................................... 19
Figure 16: Back Blows/Chest Thrusts for Choking Infant.......................................................................... 20
Rapid
Defibrillation
Effective
Advanced Life
Support
Post Cardiac
Arrest Care
Typically, pediatric victims begin the collapse process after suffering dehydration or respiratory
problems. This population will rarely have a primary cardiac arrest. If respiratory events and
dehydration can be prevented, cardiac arrest can often be avoided. Therefore, it is critical to prevent
the need for resuscitation in infants and children.
Prevent the
need for
resuscitation
Perform High
Quality CPR
Call 911 to
activate the
emergency
system
Provide
Advanced Life
Support
Provide Post
Cardiac Arrest
Care
Old Guideline
ABC (airway, breathing,
compressions)
"Look, listen and feel" for breathing
with two rescue breaths
Slower rate, less depth
Ofte used during difficult intubation
For at least 15 seconds
2010 Guideline
CAB (compressions, airway, breathing)
Begin CPR if the victim is unresponsive,
pulseless, and not breathing or if the
breathing is gasping
High Quality CPR (see definition below)
No longer recommended during the
advanced care of the victim
10 seconds or less and start CPR if not
certain that pulse is present
Use an AED as soon as it is available for
all ages
Research shows that beginning compressions early increases the chance of survival so the
sequence has been changed from ABC to CAB (Chest Compressions, Airway, Breathing).
The importance of high-quality CPR is stressed. High quality CPR includes:
o Perform compressions at a rate of AT LEAST 100 per minute regardless of the age of the
victim;
o Increase the compression depth to AT LEAST 2 inches for adults and children over the
age of one, and 1.5 inches for infants (under the age of 1 year old);
o Allow the chest to completely recoil between compressions to ensure that the heart can
completely refill;
o Do not interrupt compressions except to use an AED or change providers even at
those times, perform the actions quickly to minimize interruptions;
o Prevent over-inflation of the lungs by avoiding rapid ventilations;
o Perform CPR as a team to perform activities more quickly and to ensure the victim
receives definitive care as quickly as possible.
The time for pulse checks has been shortened since it is not always possible to know if you can
feel a pulse. Do not delay CPR for more than 10 seconds if you are not sure that a pulse is
present.
A manual defibrillator is preferred for infants, but if one is not available an AED should be used.
If a pediatric dose attenuator is available on the AED, use it. If the dose attenuator is not
available, use an adult AED for a victim of any age.
No respirations or
Only grasping breathing
Get AED
Pulse
Present?
NO
YES
Continue to Monitor
Perform CPR
Perform cycle of
30 compressions
And 2 breaths
Every 2 minutes
Resume compressions
Do not interrupt
compressions until
AED is available
YES
Shock
Advised?
NO
Adult
30 compressions: 2
breaths
30 compressions: 2
breaths
Always use 2 hands for
compressions
At least 2 inches
Child
15 compressions : 2 breaths
30 compressions: 2 breaths
Immediately
Immediately
Immediately
No respirations or
Only grasping breathing
Pulse Present
and greater than
60/minute?
Feel for
Carotid or
Femoral pulse
YES
NO
Perform CPR
For 2 minutes
Continue to Monitor
Perform cycle of
30 compressions
And 2 breaths
Every 2 minutes
Child Ventilation
Adult masks should not be used for small children. If the mask covers the eyes or chin of the child, it is
too big and ventilations will not be optimal. Breaths for a child will typically not be as deep, but should
be over 1 second each and should result in a visible rise of the childs chest. Unless a neck injury is
suspected, open the airway using the head tilt/chin lift technique.
Compression depth
Child
Carotid or femoral artery
Infant (0 to 12 months)
Brachial artery on inside of upper
arm
For small children, may use May use 2 fingers or 2 thumbs by
one hand for compressions the encircling hands technique if
your hands are big enough to circle
the infants chest
1/3 of the depth of the
1/3 of the depth of the chest
chest (usually about 1 to (usually about 1 inches)
2 inches)
After performing CPR for 2 After performing CPR for 2 minutes
minutes
Immediately
Immediately
No respirations or
Only grasping breathing
Pulse Present
and greater than
60/minute?
Feel for
brachial pulse
NO
YES
Perform CPR
For 2 minutes
Continue to Monitor
Perform cycle of
30 compressions
And 2 breaths
Every 2 minutes
No Advanced Airway
30 compressions : 2
breaths
15 compressions : 2
breaths
NO
Chest rises?
YES
Resume compressions
Rescue Breathing
Early recognition of and intervention for respiratory distress may prevent deterioration into cardiac
arrest. During assessment, if the victim has a strong pulse but has ineffective breathing, open the
airway using the head tilt/chin lift technique and begin rescue breathing.
Victim Age
Adult
Child or Infant
Breathing Rate
Every 5-6 Seconds
Every 3-5 Seconds
Evaluation
Check for chest
rise and
breathing;
Check pulse and
begin CPR if
victim becomes
pulseless
Relief of Choking
If a victim is choking, the condition may deteriorate into respiratory arrest and cardiac arrest. Early
and proper intervention can prevent this series of events. Proper intervention depends on the age of
the victim and the amount of obstruction of the airways.
Symptoms
Severe
Breathing may be
accompanied by wheezing
Coughing and making noise
Exhibiting universal sign of
choking (holding neck and
throat)
Weak or absent cough
May be making highpitched noise but unable to
talk
Ineffective or no breathing
Skin may be blue around
lips and finger tips
Recommended Actions
NO
Obstruction
Relieved?
YES
Monitor Victim
Symptoms
Breathing may be
accompanied by wheezing
Coughing and making noise
Recommended Actions
Severe
In an infant less than 12 months old who is choking but responsive, attempt to use back blows and
chest thrusts to relieve an obstruction.
NO
Obstruction
Relieved?
YES
Monitor Victim