OBJECTIVES

Establish/maintainperfusiontobrain&heart
Provideadequateven8la8on

PETER R. FIGUEROA, MD
Department of Surgery
UST Faculty of Medicine & Surgery

Technique

Technique

Airwayhead8lt,chinli@orjawthrust
Fingersweep
Breathing

Mouthtomouthormouthtonose
Low8dalvolume500ccto700cc
Watchchestrise
25breathsini8ally:1sec/breath
Withadvanceairwayi.e.ETtube,laryngealmaskairway
(LMP),give810breathing/min.nointerrup8onof
compressionwhilebreathing

Special Circumstances

Forrescuersnotwillingtogivemouthtomouthbreathing,
con8nuouschestcompressionCPR(ccc)orminimally
interruptedcardiacresuscita8on(MICR)areacceptable
200chestcompressions,thenAED,then200more
compressionsandevaluaterhythm

BLSincervicalspineinjurymaintainingairwayand
adequateven8la8onistheoverridingpriorityinmanaging
pa8entswithasuspectedspinalinjury.Thehead8ltchin
li@orjawthrusttechniquesarefeasibleandmaybe
eec8vealbeitbothtechniquesareassociatedwith
cervicalspinemovement.Useofmanualinline
stabiliza8on(MILS)tominimizeheadmovementis
reasonableifsucientnumberofrescuersareavailable

Compression

Vic8mposi8onsupinermsurface/bedboardoroor
Rescuerposi8onsideofvic8mschest;kneeling,heelof
dominanthandinthecenterofchestoverthesternum
betweenthenipplesandthenplacetheheelofthe2ndon
thetopofrstsothatthehandsoverlappedandparallel
Rate30:2compression:ven8la8onwithadvanceairway
100/min.nointerrup8onforven8la8on
Depth12inches(45cms)or1/3theAPdiameterof
chest
Decompressionallowcompletechestrecoila@ereach
compression
Dutycyclera8obetween8mespentcompressionand
release=50%

Special Circumstances

Infant and pediatric basic life support: Most cardiac

arrests in children are caused by asyphyxia unlike in
adult where underlying etiology is usually VF or
pulseless VT. Therefore in pediatrics, start CPR
immediately then call to AED. For chest compression,
in infants 2-two thumbs encircling hands is utilized for
2 rescuers. The 2-fingers technique for single rescuer.
For children, both the 1-and 2-hand techniques are
acceptable. Compress over the lower part of the
staneum just below the nipple-line to a depth of
approximately 1/3 the anterior=posterior diameter of
chest

Principles:

Defibrillation (AED)

Automated external defibrilllator (AED) is part

of BLS as well as ACLS
One immediate precordial thump (closed fist
delivered from a height of 5-40 cms) after a
monitored cardiac arrest if AED is not
available

Principles:

Use of 12cms electrodes (paddles) better than

8cms. Small paddles (4.3cms) harmful to the
myocardium
Use 150J to 200J biphasic waveform; with
monophasic = 360J. For pediatrics = 2J/kg 4J/
kg
Place paddles antero-lateral position
Defibrillation should not be attempted in an O2
enriched atmosphere. Turn off O2 supply
momentarilly. Do not disconnect ET/respirator
tubes.

Basic Life Support (BLS)

Recognition of sudden cardiac arrest
(SCA)
Cardiopulmonary Resuscitation (CPR)
Defibrillation (AED)

CRITERIA FOR WITHHOLDING

CPR

GOALS OF BLS
Preserve life
Restore Health
Limit disability

A1to3minsperiodofCPRbeforeagemp8ngAED
withoutofhospitalVForpulselessVTifresponse
intervalismorethan45mins.
WitnessedinhospitalSCAwithVF/pulselessVT,use
ofAEDearlyinCPRisrecommended
Minimalinterrup8onofchestcompression
1shockprotocolpreferredversus3shocksequence
Immediatecon8nua8onofchestcompressiona@er
1schokdebrilla8on

Valid do not attempt resuscitation (DNAR)

Signs of irreversible death (e.g. rigor
mortis, decapitation or dependent lividity)
Medical futility (e.g. terminal septic shock
or cardiogenic shock)
Attempts to perform CPR would place the
rescuer at risk of physical injury

SUMMARY OF BLS FOR INFANTS

CHILDREN AND ADULTS
Maneuver

Adult

Child 1 yr. to
16 yrs.

Airway

Head Tilt-Chin
Lift

Trauma-use
jaw thrust

Breathinginitial with
advance
Airway
FBAO

Infant under
1 yr.

2 breaths
(1 breath/sec)
10-12breaths/min
Abdominal
thrusts

12-20/mins
Back slaps:
chest thrust

SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS

Maneuver

Circulationpulse check
< 10 sec.
Compression

Method

Adult

Depth

1 to 2 inches
1/3 chest diameter

Rate
C:V

100/min
30:2

Child 1 yr. to 16
yrs.

Child 1 yr. to
16 yrs.

Brachial or
femoral

Carotid
Lower half of
sternum-between
nipples

just below
nipple line
lower half
sternum

Heel of one hand:

other on top

2 fingers or
2 thumbs
encircling

Unresponsive?SCA

Infant under
1 yr.

Shoutforhelp

OpenAirway:Lookforsignsoflife
CallEMS/CPRteam

Give25ini8albreaths
Ifnotbreathing

30:2 (single
rescuer)

1 or 2 rescuer

15:2 (2 rescuers)

8-12 inches
Adult pads
150J-200Joules

Pediatric pads

Infant under
1 yr.

ILCORUNIVERSALCARDIACARRESTALGORITHM

SUMMARY OF BLS FOR INFANTS CHILDREN AND ADULTS

Maneuver

Adult

Reasonabledura8onforBLS
=20mins.IfnoROSC,
terminateresuscita8on
Reasonabledura8onforACLS
=40minutesto1hour

Give30chestcompressions2compressions/sec.followedby2breaths.
Con8nueun8lAEDisagached
Assesrhythm

Defibrillation
AED

2J/kg :4J/kg
For subsequent

Shockable
(VForVT)
Give1shock

No
recommenddation

TERMINATION OF CPR IN BLS

Immediately
ResumeCPR
30:2for5cycles

Restoration of spontaneous circulation ( ROSC) and

ventilation.
Reliable criteria indicating irreversible death are present.
No ROSC after more than 10 minutes of intensive
resuscitative efforts. Exceptions are drug overdose, pre
arrest hypothermia, recurring VF/VT and ROSC of any
duration occurs.
Rescuer is unable to continue because of dangerous
hazards or risks to other lives.
Care is transferred to a more senior level emergency
medical professional.

ResumeCPR
30:2for5cycles

Glossary:

Nonshockable
(PEAorasystole)
ACLSarrives
Maintainairway
Vascularaccess
Verifyelectrodes
Drugs

SCA Sudden cardiac arrest

VF Ventricular fibrillation
VT Ventricular tachycardia
PEA Pulseless electrical activity
AED Automated external defibrillation
BLS Basic life support
ACLS Advanced cardiovascular life support
CCR Cardio-cerebral resuscitation
MICR Minimally interrupted cardiac resuscitation
PALS Pediatric advanced life support
ACS Acute coronary syndrome
ILCOR International Liasson Committee on Resuscitations
ROSC Return of spontaneous circulation

References:
Circulation supplement vol.112, No. 22, Nov. 29, 2005
Circulation supplement vol. 112, No. 24, Dec. 13, 2005
hrttp://circ.ahajournals.or
Prepared by:
Peter R. Figueroa, MD
Department of Surgery