Chapter 1

5 Lecture

Book Title
Edition

Basic Life Support:

Cardiopulmonary
Resuscitation
(CPR)
Slide Presentation prepared by
Randall Benner, M.Ed., NREMT-P

© 2012 Pearson Education, Inc.

Cardiac arrest

• Cardiac arrest is a condition

in which the heart has
stopped beating.
• Causes:
- the heart muscle not getting
the blood–and therefore the
oxygen and nutrients–
- a sudden and serious heart
rhythm abnormality.
Cardiopulmonary Resuscitation (CPR)
• You should perform CPR when a victim is in
cardiac arrest (heart stops beating).
• Cardiac arrest symptoms may be preceded:
– Chest pain; heaviness or tightness that radiates to the
neck, shoulders, jaw, or arms
– Nausea and/or vomiting
– Cool, pale, moist skin
– Weak or irregular pulse
– Breathing difficulty
– Light headedness

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The characteristics of the victim with
cardiac arrest
• unresponsive
• without breathing activity or with extremely
abnormal breathing.
• Absent carotid pulse
Cardiopulmonary Resuscitation (CPR)

• Consists of three important skills

– Providing artificial circulation via chest
compressions
– Opening and maintaining the airway
– Providing artificial ventilation through
rescue breathing
• oxygenating and circulating blood until
defibrillation and advanced cardiac life
support can be provided.
• Defibrillation is the application of
electricity to the chest of victim whose
heart has stopped.
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• The keys to survival of a cardiac arrest
victim are:
- Immediate recognition of cardiac arrest
with early summoning of EMS
- Early CPR with emphasis on quality chest
compressions
- Rapid defibrillation
- Effective advanced life support care
- Integrated post—cardiac arrest care
Defibrillation
• Normal efficient heartbeats are replaced
by electrical impulses that are chaotic,
disorganized
• Dysrhythmia results in tremors within the
heart.
• These tremors are ineffective at creating
any kind of cardiac output, so the pulse
ceases.
• Defibrillation, by literally
shocking the heart
- eliminate the disorganized
electrical activity
- promote the resumption of a
normally contracting and
beating heart.
Basic Life Support (BLS) Sequence
• The major steps in the BLS sequence are
– Determine responsiveness and breathing.
– Activate the EMS system and retrieve AED
(automated external defibrillator) if needed.
– Perform two minutes of CPR.
– Utilize the AED if available and appropriate.
– Resume chest compressions for another two minutes
after AED use.

© 2012 Pearson Education, Inc.

Determining Responsiveness and Breathing

• tap the victim gently on the shoulder, and

ask loudly, “Are you okay?”
• Determine breath-lessness and other
signs of life.
Chest Compressions

• If a victim’s heart is not beating, deliver chest

compressions to keep them alive.
• Compressions are rhythmic compressions over the lower
half of the sternum that keep the victim’s blood
circulating.
• Chest compressions work on two principles
– Increase chest cavity pressure, causing the heart to
pump
– Provide direct compression to the heart itself

© 2012 Pearson Education, Inc.

CPR Chest Compressions for Adults

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CPR Guidelines

• 2010 Chest Compression Guidelines for Adults

– Compressions should be fast and deep
– Rate of at least 100 per minute
– Depth should be at least 2 inches

© 2012 Pearson Education, Inc.

To perform CPR, follow these steps:

1. Position your hands properly on the

victim’s chest.
2. Deliver two minutes of constant chest
compressions
3. After delivering two minutes of CPR:
• check for circulation and apply AED
4. Position your hands on the victim’s chest
again, and deliver another two minutes of
compressions
• 5. Repeat this cycle,
Terminating CPR

• Perform compressions until victim is breathing

and has a pulse, or until
– Another trained professional assumes BLS
– A physician instructs you to stop
– Victim is taken to a medical facility
– You are exhausted and unable to continue
– Conditions make it unsafe to continue
– Victim is declared dead by a physician

© 2012 Pearson Education, Inc.

Performing CPR on Infants and Children

In an infant or child, unresponsiveness is

characterized by the following signs and
symptoms:
• Gasping, absent, irregular, or slow
breathing
• No brachial or carotid pulse (assessed by
health care providers only)
• No chest movements Blue or pale skin
• No response to gentle tapping (tap, but
never shake, an infant)
CPR for Infants and Children

• Perform CPR for two minutes before activating

EMS.
• Place fingers of one hand in center of infant’s
chest, just below nipples.
• Place other hand on infant’s forehead or under
shoulders.
• Depress the sternum at least 1/3 the depth of
the chest.
• Deliver at least 100 compressions per minute.

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CPR Techniques for Adults, Children,
and Infants

© 2012 Pearson Education, Inc.

CPR Complications

• Even when performed properly, CPR may cause

complications such as
– Fracture of ribs or sternum
– Separation of rib cartilage
– Pneumothorax
– Hemothroax
– Bruising of the lung
– Lacerations of the liver
• Even with these risks, effective CPR is
necessary; the alternative may be death.

© 2012 Pearson Education, Inc.

The most common ventilation mistakes are:
• Failing to tip the head back far enough in
adults
• Failing to maintain an adequate head tilt
• Failing to maintain an adequate seal over
the mouth and/or nose, letting air escape
• Not giving slow, full breaths
• Failing to watch and listen for exhalation
Common chest compression
mistakes are:
• Bending the elbows
• Not having the shoulders directly
over the hands on the victim’s
chest improperly
• Letting the fingers touch the
victim’s chest during
compressions
• Not compressing fast enough Not
compressing deep enough
• Lifting or moving the hands
between compressions
Withholding CPR

• As a First Aider, you’re legally required to

perform CPR on any victim who needs it,
unless a legal or medical reason exists,
such as
– Rigor mortis or other signs of death appear
– Victim is decapitated
– Victim has obviously fatal wounds

© 2012 Pearson Education, Inc.

Defibrillation

• One of the most important interventions for

cardiac arrest
• Performed by an automated external defibrillator
(AED)
• Often performed in public places and/or by
people with no formal training
• AED functioning can vary; follow the specific
instructions posted on each defibrillator.

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• If the victim collapses in your presence or
within a few minutes of your arrival
apply the defibrillator.
• If you believe the victim has been down
longer than a few minutes recommend
two minutes of CPR prior to defibrillation.
Using an AED

Two EMTs using an AED with a victim. When an AED is

analyzing the victim's data, no one should touch the victim.

© 2012 Pearson Education, Inc.