THEORETICAL GUIDELINES FOR TRAINING AND ASSESSMENT

ADULT BASIC LIFE SUPPORT

Organisational Learning Unit

Northern Sector Office: Level 2, Campus Centre, Randwick Hospitals Campus. Phone: 93825313 Fax: 93825280

BASIC LIFE SUPPORT

GUIDELINES

Version Control
Released by Version Release Date Review Date

OrganisationalLearningUnit OrganisationalLearningUnit

1 1.1

September2008. January2009.

January2009 June2009

Acknowledgements
The following people have contributed to the development of these learning resources: SESIH Education Assessment and Training Subcommittee (EATS). Committee members as of July 2008:
Michelle Brady Jenny Broe David Collins Lynette Higgs Jon Magill Catherine Molihan Kim OLeary Alex Pile Suzanne Schacht Garry Skinner Carolyn Smith Jayne Tesch Gai Vereker Bruce Way Lis Woodhart Lian Zheng The Sutherland Hospital The Prince Of Wales Hospital The Prince of Wales Hospital Sydney/Sydney Eye Hospital Prince of Wales Hospital Royal Hospital for Women Shoalhaven Hospital St Vincents Hospital SESIAH War Memorial Hospital Sydney Childrens Hospital Organisational Learning Unit SESIAH The Wollongong Hospital Prince of Wales Hospital The Sutherland Hospital War Memorial Hospital

Published by the Organisational Learning Unit, SESIAHS 2008 Organisational Learning Unit ALL RIGHTS RESERVED
This publication is protected by copyright. No part may be reproduced, stored in a retrieval system or transmitted in any form by any means electronic, mechanical, photocopying, recording or otherwise without the written permission of the publisher. Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 2

BASIC LIFE SUPPORT

GUIDELINES

Contents
SESIH Facility Emergency Numbers Glossary Basic Life Support Mandatory Training and Assessment Foreword to Guidelines Basic Life Support Flowchart Steps in Adult Basic Life Support APPENDIX 1 APPENDIX 2 APPENDIX 3 References: Diagrams and Appendices: 5 7 9 11 13 15 24 25 26 29 30

IMPORTANT NOTE
The provision of Basic Life Support within SESIH Facilities and Services must take into account applicable aspects of the setting in which Basic Life Support is provided, which include:

Local emergency response systems; The use and availability of resuscitation equipment and resources; Occupational Health and Safety Requirements (e.g. situational risks associated with electrical and biological hazards and the use of personal protective equipment); and Infection Control Policies and procedures (e.g. the use of standard and additional precautions).

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 3

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 4

BASIC LIFE SUPPORT

GUIDELINES

SESIH Facility Emergency Numbers

Albion Street Center Bulli Hospital Calvary Healthcare Kogarah Coaldale Hospital David Berry Hospital Garrawarra Centre Kiama Hospital Langton Centre Milton Ulladulla Hospital Prince of Wales Hospital Port Kembla Hospital Royal Hospital for Women Shellharbour Hospital Shoalhaven District Hospital St George Hospital St Vincents Hospital Sydney Childrens Hospital Sydney/Sydney Eye Hospital The Sutherland Hospital The Wollongong Hospital War Memorial (Waverley) Dial 0-000 Dial 666 Dial 777 Dial 0-000 Dial 0-000 Dial 333 Dial 0-000 Dial 0-000 Dial 0-000 Dial 777 Dial 222 Dial 777 Dial 222 Dial 9222 Dial 666 Dial 555 Dial 777 Dial 55 Dial 777 Dial 222 Dial 777

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 5

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 6

BASIC LIFE SUPPORT

GUIDELINES

Glossary
Airway Aspiration The passage from the nose and mouth through which air passes into the lungs. The act of inhaling fluid and particles into the lungs. A device that analyses the electrical rhythm of the heart and charges automatically if a shockable rhythm (ventricular fibrillation or ventricular tachycardia) is recognised. The device provides the operator with audible and /or visual prompts on actions required for safe delivery of and electrical shock. Cessation of heart function. The pulse that can be felt over one of the two main arteries in the neck located either side of the windpipe (trachea). Life threatening blockage of the airway. The application of a controlled electric shock to the heart through the chest wall in order to stop a cardiac arrhythmia (ventricular fibrillation or ventricular tachycardia). The aim of the shock is to restore the heart's normal rhythm. Rhythmic pressure applied through the heal of both hands over the sternum (breastbone) during cardiac arrest in an attempt to circulate blood around the body. Using the fingers to attempt to dislodge a foreign body from the mouth or throat of an unconscious person. The backward tilting of the head in an attempt to open the airway in an unconscious person. The movement of air into a persons lungs using a rescuers expired air or with the aid of special ventilation equipment. The forward pressure applied behind the boney part of the jaw (below the ears) to move the jaw upward and away from the chest in order to open the airway in an unconscious person. An abnormal irregular heart rhythm where very rapid uncoordinated fluttering contractions of the ventricles (lower chambers of the heart), are insufficient to pump blood and oxygen to the vital organs. If not immediately treated death will occur within 3-5 minutes.
~ VERSION 1.1 ~ January 2009 Page 7

Automatic External defibrillator (AED)

Cardiac Arrest Carotid pulse Choking

Defibrillation

External Cardiac compressions Finger sweep Head Tilt Inflation

Jaw thrust

Ventricular Fibrillation

Basic Life Support Theoretical Guidelines for Training and Assessment

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 8

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Mandatory Training and Assessment

These guidelines provide the foundation for the South East Sydney and Illawarra Health Service (SESIH) Basic Life Support Mandatory Training and Assessment Program which consists of: 1. A theoretical component 2. A practical component 3. An assessment component

Learning outcomes
The learning outcomes for the SESIH Basic Life Support (BLS) Mandatory Training and assessment program are as follows:

1. Theoretical Foundations
Outline the responsibilities of the single rescuer in a Cardiac Arrest; Outline each step in the ARC Adult Basic Life Support algorithm (DRABCD); Identify the process for summoning assistance in a Cardiac Arrest; Discuss the use of personal protective equipment during resuscitation.

2. Skills Assessment
Identifies hazards to health and safety of self and others; Minimises immediate risk to health and safety of self and others by isolating hazards; Assesses vital signs of collapsed person; Recognises the need for CPR; Summons assistance; Performs CPR in accordance with ARC guidelines.

See Appendix 1 for the SESIH Adult Basic Life Support Assessment Criteria

Skills assessment frequency:

All staff for whom Basic Life Support is deemed a mandatory skill are required to have their Adult BLS skills assessed on a yearly basis.

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 9

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 10

BASIC LIFE SUPPORT

GUIDELINES

Foreword to Guidelines
Basic Life Support
Has been defined by the Australian Resuscitation Council (ARC) as the preservation of life by the initial establishment of and /or maintenance of airway, breathing and circulation, and related emergency care. (ARC, 2006: Glossary of Terms: p2)

Cardiopulmonary Resuscitation
Cardiopulmonary resuscitation (CPR) includes the technique of combining rescue breathing with chest compression. The aim of CPR is to maintain temporarily a critical amount of circulation to the heart and the brain (Handley et al, 2005:S7; ARC, 2006: Guideline 7)

About the Chain of Survival

The European Resuscitation Council (ERC) describes the steps involved in successful resuscitation as the Chain of Survival (Nolan, 2005: S3). Each step is outlined below. 1. Early Recognition of Collapse/Emergency: Recognising those at risk of cardiac arrest and calling for help has the potential to avert a cardiac arrest. 2. Early Initiation of Cardiopulmonary Resuscitation: Effective CPR can dramatically increase survival from ventricular fibrillation in sudden cardiac arrest by buying time until successful defibrillation. 3. Early Defibrillation: Survival rates can be improved (49-75%) if CPR and defibrillation are initiated within 3-5 minutes. 4. Early Advanced Life Support and Post Resuscitation Care: Effective post resuscitation care can preserve function particularly of the heart and brain.

Figure 1: ERC Chain of Survival (Nolan, 2005, S 5.)

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 11

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 12

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 13

BASIC LIFE SUPPORT

GUIDELINES

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 14

BASIC LIFE SUPPORT

GUIDELINES

Steps in Adult Basic Life Support

When a person collapses, his/her life may depend on the successful application of the principles of the DRABCD of resuscitation: D = Danger R = Response A = Airway B = Breathing C = Circulation D = Defibrillation with AED (in facilities where AEDs available)
(ARC, 2006, Guideline 7)

If someone collapses in your presence, or you find someone collapsed, take the following steps:
Assess for danger and remove the person and yourself to a safe environment if necessary (ARC, Guideline: 2.1 2002; Guideline 2.3 2005). Note: Do not attempt to move someone by yourself, wait until help arrives to assist you.

Danger

Response

Determine responsiveness: Gently grasp and squeeze the persons shoulders, speak to the person by name if it is known. (ARC, 2006, Guideline: 3.1). Ask loudly are you all right?

If Responsive Make the person comfortable and

observe airway breathing and circulation (ABC); (ARC, 2004, Guideline: 3.1)

If Unresponsive Summon HELP first (ARC, 2006, Guideline: 2.1) Call/send for help; or If unlikely to get help easily, dial the emergency number for your facility or service (See Page 5); - State the nature of the emergency - Give location - Identify whether emergency involves an adult or child Note the time; Assess Airway Breathing and Circulation.

Check Blood pressure and pulse; Call for nursing/medical help to

review person promptly.

Airway Open the airway

When a person is unconscious, all muscles are relaxed. If the person is lying on their back the tongue falls against the back of the throat and obstructs the airway. To open the airway: Lay person flat on the back on firm surface (do not roll onto side); Apply head tilt /chin lift (see Figure 2) and/or jaw thrust (see Figure 3),
Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 15

BASIC LIFE SUPPORT

GUIDELINES

Airway (cont) Manoeuvres to open Airway

Head Tilt/ Chin lift The simplest way of ensuring an open airway in an unconscious person is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat:

Place your hand on the persons forehead and gently tilt the head back. With your fingertips under the point of the persons chin, lift the chin to open the airway.
Figure 2: Head tilt chin lift

Jaw thrust In the jaw thrust manoeuvre the jaw is displaced forward, pulling the tongue away from the back of the throat:

Position yourself behind the head of the person; Place fingers behind the bony part of the jaw (below the ears) and thrust the jaw upward and away from the chest.

Figure 3: Jaw Thrust

Clearing the airway:

Visually inspect airway; If safe to do so manually remove any visible solids or loose fitting dentures using gloved hands. Note: Only perform a finger sweep if there is a visible obstruction. (Handley et al, 2005:s17). Use suction if available to clear secretions/vomitus from the airway. If suction not available roll person on side, if safe to do so, and drain fluid from the mouth.

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 16

BASIC LIFE SUPPORT

GUIDELINES

Breathing
Once the airway is cleared and open, check for normal breathing for a period of up to 10 seconds, using the following method. Note that an occasional gasp or noisy breathing is not considered normal breathing.

Look and Feel for movement of lower chest or upper abdomen; Listen and Feel: for escape of air from nose and mouth.
(ARC, 2008, Guideline: 5)

If Breathing Normally Place person in the recovery position

(see Figure 4):

If Breathing Absent or not normal Ensure person is on a firm surface; Using mouth to mask resuscitation
method, give 2 rescue breaths each of 1 second duration (See Figure 5; See also Appendix 2);

Figure 4: Recovery position

Check for continued breathing and

give oxygen flow rate to 15 litres/minute, if available;

Note: Stay with the person until help

arrives. Figure 5: Mouth to mask method
(ARC, 2008, Guideline: 5)

If there is an oxygen source available

attach to the mask (flow rate to 15 litres/minute);

Deliver a breath of sufficient volume

to see the chest rise;

Note: If the chest does not rise

recheck head tilt and chin lift; recheck mask seal; and do not attempt more than two breaths each time before commencing or returning to chest compressions;

Care should be taken not to use too

much force to inflate lungs. If excessive force is used there is a risk that air will inflate the stomach resulting in regurgitation of stomach contents and aspiration into the lungs. ARC, 2008, Guideline: 5; Nolan et al, 2005)
~ VERSION 1.1 ~ January 2009 Page 17

Basic Life Support Theoretical Guidelines for Training and Assessment

BASIC LIFE SUPPORT

GUIDELINES

KEY POINT: RESCUE BREATHING WITHOUT CHEST COMPRESSIONS

Information for Experienced Clinicians
In the event an experienced clinician determines that an adult person with palpable pulses requires support of ventilation:

rescue breaths can be delivered at a rate of approximately 10 breaths per minute (one breath every 5 to 7 seconds); each breath should be of sufficient volume to see the chest rise. If the chest does not rise, head tilt /chin lift and mask seal should be rechecked; Avoid inflating lungs with too much force as there is a risk that air will inflate the stomach resulting in regurgitation of stomach contents and aspiration into the lungs; Reassess for a pulse every 10 breaths but spend no more than 10 seconds doing so; Be prepared to commence compressions if a pulse is no longer palpable; If the person resumes breathing normally place in recovery position.
(ARC, 2006, Guideline 6; Nolan et al, 2005:S 44)

Circulation
Ensure person is on a firm surface. Keeping the airway open, check for signs of life. If no signs of life present (i.e. person is unconsciousness, there is no movement and no normal breathing or coughing) commence chest compressions immediately. Experienced clinicians may choose to check for a carotid pulse but are advised to spend no more than 10 seconds doing so.

Performing Chest compressions

Visualise and locate the centre of the persons chest (i.e. between the nipples); Kneel or stand vertically over the person so that your shoulders are over the sternum and your arms are straight;

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 18

BASIC LIFE SUPPORT

GUIDELINES

Performing Chest compressions (cont)

Place the heel of one hand in the middle of the sternum and place the other hand on top for additional force;

Figure 6: Hand placement for compressions

Do not apply pressure over the ribs; Compress the sternum, hard and fast, to at least 1/3 the depth of chest at a rate of 100 per minute. Ratio of compressions to breaths should be 30:2;

Figure 7: Depth of compressions

Compressions should be rhythmic with equal time for compression and relaxation.
Note: Do not lift your hands from the sternum during compressions
(ARC, 2006, Guideline 6)

KEY POINT: RESUSCITATION IN LATE PREGNANCY

In the obviously pregnant woman the pregnant uterus causes pressure on the major abdominal vessels when she lies flat, reducing venous return to the heart. The pregnant woman should be positioned on her back with her shoulders flat and sufficient padding (pillow or wedge) under the right buttock to give obvious pelvic tilt to the left.
(ARC, 2006, Guideline 7: p3)

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 19

BASIC LIFE SUPPORT

GUIDELINES

Additional Points on Compression

Effective chest compressions generate a small, but critical amount of blood flow to the myocardium and brain and increases the likelihood of effective defibrillation; Both one operator and two operators should perform the same compression to ventilation ratio of 30:2; Once an advanced airway has been secured (i.e. tracheal intubation) continue compressions uninterrupted. Ventilations should be delivered at approximately 10 breaths per minute or one breath every 5 to 7 seconds. Note : Compressions should only be interrupted to perform rhythm analysis or to defibrillate; (Nolan et al 2005:S 44). Performing chest compressions and rescue breaths at a ratio of 30:2 is tiring; it is therefore recommended that the person doing compressions be changed every 2 minutes or when he/she becomes fatigued.
(ARC, 2006, Guideline 6)

Duration of CPR
Cardiopulmonary resuscitation should continue until:

Signs of life return; Qualified help arrives; It is impossible to continue (e.g. exhaustion); An authorised person pronounces life extinct.
(ARC, 2006, Guideline 7)

KEY POINT: PERFORMING CHEST COMPRESSIONS ONLY

In cases where there is no barrier device or mask available for performing mouth to mask ventilations, an acceptable alternative is to give uninterrupted chest compressions at a rate of 100/minute (Koster et al, 2008) until qualified help arrives to secure an airway and commence rescue breathing. Note that the ARC states Ventilation remains important in a significant proportion of cardiac arrests. These include cardiac arrests due to drowning or airway obstruction, in-hospital cardiac arrests and resuscitation attempts beyond the first 3 to 4 minutes. Compression-only CPR is insufficient in these circumstances
(ARC Advisory Statement Compression only CPR: April 2008)

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 20

BASIC LIFE SUPPORT

GUIDELINES

Automated External Defibrillation (AED)

Note: The following section applies only to those facilities where AEDs are available and staff have been trained in their use.

Introduction
Along with early initiation of cardiopulmonary resuscitation, early defibrillation is a key link in the Chain of Survival following cardiac arrest (Nolan 2005:S4). Ventricular Fibrillation (VF) is the most frequent initial rhythm in sudden cardiac arrest with defibrillation being the most effective treatment. Survival rates following cardiac arrest can be improved provided CPR and defibrillation is initiated early (within 3-5 minutes). Every minute a person remains in cardiac arrest represents a 10 % reduction in the likelihood of their survival to discharge from hospital (ARC, 2004: Guideline 10). An Automated External Defibrillator (AED) is a portable automatic device that uses voice and visual prompts to guide the lay rescuer or heath care professional in safely attempting defibrillation in cardiac arrest (ARC: 2004, Guideline 10; Hadley et al , 2005 ) Sequence for using an AED

Verify that the person has no signs of life (i.e. unconsciousness, no movement, no normal breathing or coughing) Initiate DRABC according to the guidelines outlined in pages 16 20 of this document; As soon as the AED arrives the staff member operating the machine should switch it on and follow the spoken or visual prompts provided;

Whilst continuing CPR, expose the patients chest and attach the electrode pads in the following positions:

Sternal Pad Right Mid-clavicular line over 2nd intercostal space (See Figure 8); Apex Pad Left Mid-axillary line over 6th intercostal space (See Figure 8).
(Deakin & Nolan, 2005: S28)

Figure 8: Placement of Defibrillator Electrodes

Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 21

BASIC LIFE SUPPORT

GUIDELINES

Sequence for using an AED (cont)

The staff member operating the AED should ensure all personnel stand away from the patient and bed while the AED analyses the rhythm. Incorrect or delayed diagnosis may occur if the patient is moved or handled during this process.

CAUTION
Note that some intermittent radio transmissions can interfere with rhythm analysis function of an AED if a transmitter or receiver (i.e. two- way radio/ walkie talkie) is used within 2 metres of patients during this process
(Circulation, 2000, 102 :(8))

If shock is indicated:
The staff member operating the AED should advise all personnel to Stand Clear before any shock is delivered; This warning should be followed by a visual inspection of the area by the staff member operating the AED to ensure:

no-one is in contact with the bed or the patient; there is no free flowing oxygen in the vicinity of the AED electrodes; there is no water in the vicinity of the patient.

The staff member operating the AED should then push the Shock button as directed; Upon delivery of shock, external cardiac compression and rescue breathing should be resumed immediately and all AED prompts should be followed until qualified help arrives;

If shock not indicated, and there are no signs of life, immediately resume external cardiac compression and rescue breathing until qualified help arrives.

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 22

BASIC LIFE SUPPORT

GUIDELINES

Points on Defibrillation Safety

Ensure defibrillator electrode pads are completely adhered to the skin. Air pockets between the skin and the pads can result in burns to the skin during defibrillation or an ineffective shock to be delivered. If the patients chest is excessively hairy it may be necessary to clip hair so the electrode pads will adhere to the chest. If the patient is diaphoretic, wipe the chest carefully before attaching pads (AHA, 2005, Part 5). Avoid positioning defibrillator pads over any of the following:

Monitoring electrodes and/or leads; Transdermal patches containing glyceryl trinitrate, nicotine, analgesics, hormone replacements or antihypertensives; Any implanted medical device such as an implantable defibrillator or pacemaker.

Doing any of these things may cause electrical arching and/or burns during defibrillation and may also cause the defibrillation current to be diverted away from the heart (AHA, 2005, Part 5).

Remove any free flowing oxygen from the vicinity of the defibrillator electrode pads, as this presents a fire hazard during defibrillation (AHA, 2005, Part 5).

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 23

BASIC LIFE SUPPORT

GUIDELINES APPENDIX 1

Adult Basic Life support Assessment Criteria

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 24

BASIC LIFE SUPPORT

GUIDELINES APPENDIX 2

Airway management: Mouth to Mask Ventilation

Use this method to deliver rescue breaths until help arrives. Follow facility guidelines for assembly and use of mask. Ensure a disposable bacteria/viral filter is inserted between the mask and the operator.

Mouth to Mask resuscitation sequence (see Figure 9):

Position yourself at persons head (See figure 9); If there is an oxygen source available, attach to the mask; Place mask (with filter/one way valve attached) over persons mouth and nose; Ensure an adequate seal over mouth and nose using both hands; Place your mouth around the filter/valve attached to the mask (See Figure 9); Blow through filter/valve giving enough volume to see the persons chest rise. Note: Allow time for the person to exhale before delivering next breath; If chest does not rise re-check head tilt, chin lift and mask seal.
(ARC, 2008, Guideline: 5)

Figure 9: Mouth to Mask Ventilation

Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 25

BASIC LIFE SUPPORT

GUIDELINES APPENDIX 3

Airway Management: Adult foreign body obstruction

Foreign body airway obstruction (FBAO) is an uncommon but potentially treatable cause of accidental death. The signs and symptoms of obstruction will depend on the cause and the severity of the condition. For example, in the conscious person who has inhaled a foreign body, there may be extreme anxiety, agitation, gasping, coughing or loss of voice. However in the unconscious person FBAO may not be apparent until rescue breathing is attempted.

The Adult FBAO sequence (see also Figure 10):

If the person shows signs of mild airway obstruction, (i.e. they have an effective cough), encourage him/her to cough but do nothing else; If the person shows signs of severe airway obstruction and is conscious apply up to five back blows: stand to the side and slightly behind the person: lean the person well forward, give up to 5 sharp blows between the shoulder blades with the heel of your hand; check to see if each back blow has relieved the airway obstruction. If the person at any time becomes unconscious:

Support the person carefully to the ground do not place yourself in danger by catching the person; Summon HELP: - Call/send for help; - Dial the facility emergency number state Cardiac Arrest and give location; Begin CPR at a compression to ventilation ratio of 30:2
(ARC, 2008 Guideline 5; ARC, 2006 Guideline 4, 6, & 7).
Figure 10. Adult FBAO Management Assess Severity
Severe airway obstruction (ineffective cough) Mild Airway obstruction (effective cough)

Unconscious Start CPR

Conscious 5 back blows If not effective , give 5 chest thrusts.

Encourage Cough Continue to check for deterioration to ineffective cough or until obstruction cleared

After: Australian Resuscitation Council (2006)

Basic Life Support Theoretical Guidelines for Training and Assessment ~ VERSION 1.1 ~ January 2009 Page 26

BASIC LIFE SUPPORT

GUIDELINES

Adult Basic Life Support Quiz Questions

The following Quiz in designed to assess the readers understanding of the Guidelines outlined in this document. The quiz can be undertaken as a self directed exercise or as part of a facilitated question and answer session with other learners.

1. You find an adult person collapsed in a hospital corridor. What should you do first? Determine responsiveness Assess for danger Commence CPR Call for help (Need help? See Page 15) 2. What is your first priority after you determine the person is unresponsive? Make a note of the time Assess airway and breathing Call for help Give two breaths (Need help? See Page 15) 3. Of the options listed below indicate which one is recommended for opening the airway of a collapsed adult who isnt breathing? Roll person onto the left side and perform a backward head tilt Perform a Heimlich manoeuvre Use Head tilt /chin lift or jaw thrust manoeuvre Use a finger sweep of the mouth to clear any obstruction (Need help? See Page 15, 16)

4. If the person does not commence breathing after you have opened the airway, what should you do? Check the airway again Put the person in the coma position Start chest compressions Start rescue breathing (Need help? See Page 17) 5. When commencing rescue breathing, how many initial breaths do you give? 2 3 4 5 (Need help? See Page 17)

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 27

BASIC LIFE SUPPORT

6. A person with no signs of life is: Unconsciousness/unresponsive Not moving Not breathing normally All of the above (Need help? See Page 18)

GUIDELINES

7. You determine the collapsed person has no signs of life, what is it recommended that you do now: Call for Help Feel for a pulse Start chest compressions Check their pupils (Need help? See Page 18) 8. When locating the site for chest compressions in an adult it is recommended to visualise the centre of the chest. True False (Need help? See Page 18) 9. When performing CPR the recommended ratio of compressions to breaths is? 100 compressions to 2 breaths 30 compressions to 2 breaths 15 compressions to 2 breaths 5 compressions to 2 breaths (Need help? See Page 18) 10. It is recommended that CPR continue until: An authorised person pronounces life extinct Qualified help arrives to assist Exhaustion prevents you continuing Signs of life return All of the above (Need help? See Page 19) 11. Basic Life support now includes defibrillation: True False (Need help? See Page 20) 12. What number do you call in your facility in the event of a Cardiac Arrest?

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 28

BASIC LIFE SUPPORT

GUIDELINES

References:
Anonymous (2000) Part 4: The Automated External Defibrillator: Key Link in the Chain of Survival, Circulation, Vol. 108: (8) pp. 160-176. American Heart Association (2005), American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol.112, (22): Supplement 1: 1136. [http://circ.ahajournals.org/cgi/reprint/112/22_suppl/III-5] Accessed: March 5th 2008. American Heart Association (2005), Part 4: Adult Basic Life Support Circulation, Vol.112, (24): Supplement 1:IV19-IV-34. [http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-19] Accessed: March 5th 2008. Australian Resuscitation Council (2008). Advisory Statement: Compression only CPR, The Australian Resuscitation Council Online. [www.resus.org.au] Accessed July 9th 2008 Australian Resuscitation Council (2008). Index of Guidelines, The Australian Resuscitation Council Online. [www.resus.org.au] Accessed July 9th 2008 Australian Resuscitation Council (2006). Glossary of Terms Australian Resuscitation Council Online. [www.resus.org.au] Accessed July 9th 2008 Deakin, C.; Nolan, J. (2005), European Resuscitation Council Guidelines for Resuscitation 2005 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation (2005) 67S1, S25S37 Handley, A.J.; Koster, R.; Monsieurs, K; Perkins, G. D.; Davies, S.; Bossaert, L. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 2. Adult Basic Life support and use of automated external defibrillators. Resuscitation Vol. 67 (S1): S10. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Koster R.W. Bossaert, L.L.; Nolan, J.P. Zideman, D. (2008). Advisory Statement of the European Resuscitation Council on Basic Life Support. [http://www.erc.edu/index.php/docLibrary/en/viewDoc/775/3/] Accessed, March 5th 2008. Nolan, J. (2005). European Resuscitation Council Guidelines for Resuscitation 2005: Section 1. Introduction. Resuscitation, Vol. 67: (S1) [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed March 5th 2008. Nolan, J. and Baskett, P. (2005), European Resuscitation Council Guidelines for Resuscitation. Resuscitation, Vol. 67: (S1) [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed March 5th 2008. Nolan, J.; Deakin, C.D.; Soar, J.; Bottiger, B.W.; Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 4. Adult Advanced Life Support. Resuscitation Vol. 67 (S1): S51. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008.

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 29

BASIC LIFE SUPPORT

GUIDELINES

Diagrams and Appendices:

Basic Life Support Flow Chart (Page 13) Australian Resuscitation Council (2006) [http://www.resus.org.au/public/arc_basic_life_support.pdf] Accessed March 5th 2008. Figure 1: Chain of Survival Nolan, J. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 1. Introduction. Resuscitation Vol. 67 (S1): S5. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Figure 2: Head Tilt Chin Lift Nolan, J.; Deakin, C.D.; Soar, J.; Bottiger, B.W.; Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 4. Adult Advanced Life Support. Resuscitation Vol. 67 (S1): S51. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Figure 3: Jaw Thrust Nolan, J.; Deakin, C.D.; Soar, J.; Bottiger, B.W.; Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 4. Adult Advanced Life Support. Resuscitation Vol. 67 (S1): S51. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Figure 4: Recovery Position Handley, A.J.; Koster, R.; Monsieurs, K; Perkins, G. D.; Davies, S.; Bossaert, L. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 2. Adult Basic Life support and use of automated external defibrillators Resuscitation Vol. 67 (S1): S10. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Figure 6: Hand Placement for Chest Compressions Handley, A.J.; Koster, R.; Monsieurs, K; Perkins, G. D.; Davies, S.; Bossaert, L. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 2. Adult Basic Life support and use of automated external defibrillators Resuscitation Vol. 67 (S1): S10. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Figure 7: Depth of Compressions Handley, A.J.; Koster, R.; Monsieurs, K; Perkins, G. D.; Davies, S.; Bossaert, L. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 2: Adult Basic Life support and use of automated external defibrillators. Resuscitation Vol. 67 (S1): S11. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th, 2008. Figure 8: Placement of Defibrillator electrodes Phillips Medical Systems (2004), Heartstart Home Automated External Defibrillator: Instructions for use. Edition 6. Phillips Electronics, North America. [http://www.heartstarthome.com/resources/HeartStart/docs/InstructionsForUse.pdf] Accessed, March 10th 2008. Figure 10: Adult Forign Body Airway Obstruction Nolan, J.; Deakin, C.D.; Soar, J.; Bottiger, B.W.; Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 4. Adult Advanced Life Support. Resuscitation Vol. 67 (S1): S53. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed, March 5th 2008. Appendix 1: Adult Basic Life Support Assessment Criteria South Eastern Sydney and Illawarra Area Health Service (2005) Adult Basic Life Support Assessment Criteria, Incorporating the Automated External Defibrillator (AED).

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 30

BASIC LIFE SUPPORT

GUIDELINES

Appendix 2: Mouth to Mask Ventilation Nolan, J.; Deakin, C.D.; Soar, J.; Bottiger, B.W.; Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation: Section 4. Adult Advanced Life Support. Resuscitation Vol. 67 (S1): S53. [http://www.erc.edu/index.php/guidelines_download_2005/en/] Accessed March 5th 2008. Appendix 3: Adult Foreign Body Obstruction Management flow chart After: Australian Resuscitation Council (2006). Management of Foreign Body Airway Obstruction Choking: Guideline 6. Australian Resuscitation Council Online. [www.resus.org.au] Accessed July 9th 2008

Basic Life Support Theoretical Guidelines for Training and Assessment

~ VERSION 1.1 ~

January 2009

Page 31