cpr pro handbook

8/2/2019 CPR Pro Handbook

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Student

Handbook

A M E R I C A N S A F E T Y & H E A LT H I N S T I T U T E

CPR Pro

for the Professional Rescuer

E L E C T R O N I C S T U D E N T H

A N D B O O K

—

O n l i n

e V e r s i o

n



American Safety & Health Institute

1450 Westec Drive

Eugene, OR 97402 USA

800-246-5101

ashinstitute.org

Copyright © 2009 by American Safety & Health Institute. All Rights Reserved. Revised September 2009.

No part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including pho-

tocopying, recording or by any information storage and retrieval system, without written permission from the American Safety & Health Insti-

tute. Some images used under license ©2006 Custom Medical Stock Photo. The procedures and protocols in this book are furnished for

informational use only and are subject to change without notice. The publisher, however, makes no guarantee as to, and assumes no respon-

sibility for, the correctness, sufficiency or completeness of such information or recommendations. Other or additional emergency, safety or

health measures may be required under particular circumstances.

Printed in the United States of America. PRN2007 (9/09)

La certificación de American Safety and Health Institute (ASHI) sólo puede seremitida cuando un Instructor autorizado por ASHI verifica que usted haculminado competente y exitosamente el conocimiento esencial y los objetivosen habilidades del programa.



Preface

Preface CPR Pro for the Professional Rescuer 1

Table of Contents

Section 1 — Introduction Sudden Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Circulatory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Barrier Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Proper Removal of Contaminated Gloves — Skill Guide #1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Section 2 — Cardiovascular Disease Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Acute Coronary Syndromes (ACS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Sudden Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Chain of Survival for Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Chain of Survival for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Section 3 — Resuscitation Skills

Resuscitation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Opening the Airway — Skill Guide #2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Protecting the Airway — Skill Guide #3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Rescue Breaths — Skill Guide #4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Bag-Mask — Skill Guide #5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

External Chest Compressions — Skill Guide #6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Section 4 — Defibrillation Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Section 5 — Emergency Action Steps Assess, Alert, and Attend to the ABCD’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

When Using Advanced Airways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Summary of CPR/AED Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Adult Rescue Breathing — Skill Guide #7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Child Rescue Breathing — Skill Guide #8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Infant Rescue Breathing — Skill Guide #9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Adult CPR/AED — Skill Guide #10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Child CPR/AED — Skill Guide #11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Infant CPR — Skill Guide #12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Section 6 — Choking Foreign Body Airway Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Adult Choking: Severe Blockage — Skill Guide #13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Child Choking: Severe Blockage — Skill Guide #14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Infant Choking: Severe Blockage — Skill Guide #15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Section 7 — Legal and Emotional Aspects Legal Aspects of Providing Basic Life Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Emotional Aspects of Providing Basic Life Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

End Notes End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40



Section 1 — Introduction

CPR Pro for the Professional Rescuer Introduction2

Sudden Cardiac Arrest

Sudden cardiac arrest is one of the leading causes of

death among adults in North America. It can occur

randomly, to anyone, at any time. It occurs when the

heart’s electrical system malfunctions and the heart’snatural electrical signals become disorganized. The

coordinated mechanical contraction of the heart mus-

cle is lost and a chaotic quivering condition known as

ventricular fibrillation occurs.

The heart abruptly stops pumping blood and oxygen

to the body. Brain tissue is especially sensitive to a

lack of oxygen. When oxygen is cut off, brain deathcan occur quickly, within a matter of minutes.

The lack of available oxygen to the brain causes the

patient to quickly lose consciousness, stop breathing,

and collapse. Unless immediate care is provided to

restore the heart’s regular rhythm, the chance to sur-

vive is lost.

Cardiopulmonary resuscitation, or CPR, allows a

trained bystander to immediately begin restoring

some circulating oxygen to the brain through a com-

bination of external chest compression and rescuebreaths. By itself, CPR is only a stop-gap measure

that can buy critical time in which to provide more

specific treatments to re-establish a normal heart

rhythm.

The most effective treatment to end ventricular

fibrillation and restore a normal heart rhythm is defib-rillation, an electrical shock sent through the heart

muscle. The sooner defibrillation can be provided, the

greater a chance that patient can survive.

An Automated External Defibril lator, or AED, is a

small, portable computerized device that is designed

to allow initial responders to defibrillate.

Attached with wires and adhesive pads to the chest

of a sudden cardiac arrest patient, the AED checks

the heart’s electrical activity, decides if ventricular fib-

rillation is present, and allows for a defibrillation

shock to be delivered.

Sudden cardiac arrest victim.

Cardiopulmonary resuscitation (CPR).

Defibrillation with an AED.



Introduction CPR Pro for the Professional Rescuer

Respiratory System Because the body cannot store oxygen, it must con-

tinually supply itself through the actions of the respi-

ratory and circulatory systems.

The respiratory system brings air, containing oxygen,

into the body, and removes carbon dioxide, a waste

product created by the body’s use of oxygen. When

you take a breath, muscles in the chest contract, and

create a vacuum that draws air through the windpipe,

and into the lungs. In the lungs, oxygen from the air is

absorbed into the bloodstream and circulated

throughout the body. Carbon dioxide is transferred

from the bloodstream back into the lungs. Chest

muscles relax and air is exhaled out of the lungs and

back into the environment. Carbon dioxide is released

in the exhaled air.

Not all of the oxygen is used by the body in the

breathing process. Inhaled air contains approximately

21% oxygen. Exhaled air contains about 16–17%

oxygen. When delivered through rescue breaths,

there is still enough oxygen to support life.

Circulatory System

The circulatory system uses the blood stream to

deliver oxygen and nutrients to body tissues and

remove waste products.

The driving force of the circulatory system is the

heart. Special tissue runs throughout the heart that is

capable of creating and conducting electric current.

This electric current triggers the rhythmic mechanical

contractions that create the flow of blood through the

body.

Arter ies carry oxygenated blood from the heart to

body tissues. Veins return used blood back to the

heart where carbon dioxide is released and fresh oxy-

gen is picked up. The fresh blood is returned to theheart and the cycle repeats.

If the heart stops, it is possible to return at least some

of the blood flow through the circulatory system by

compressing the chest cavity. Increased pressure in

the chest and direct compression of the heart causes

blood to move out of the chest and into the rest of the

body.

CPR, the combination of rescue breaths and external

chest compressions, has proven to be capable of

providing oxygenated blood flow to vital organs dur-

ing cardiac arrest. Immediate CPR by a bystander

could double or triple a patient’s chance of survival.

Respiratory system.

Circulatory system.



Infectious Diseases

Bloodborne pathogens are viruses or bacteria that

are carried in blood and can cause disease in people.

There are many different bloodborne pathogens, but

Hepatitis B (HBV), Hepatitis C (HCV), and the Human

Immunodeficiency Virus (HIV) are the ones most com-

monly addressed.1,2

The estimated risk for acquiring HIV, HBV, or HCV

infection from performing CPR is extremely low,

about one in one million. There have been no reports

of infection acquired during CPR training.3

“Universal precautions” is a way to limit the spread of

infectious diseases by preventing contact with blood

and certain body fluids. To “observe universal precau-

tions” means that whether or not you think the patient’s

blood or body fluid is infected, you act as if it is.

Barrier Devices

Simple infection-control measures, including the use

of barrier devices, can reduce the risk of an infectious

disease during CPR.

A simple but effective barrier for skin-to-skin contact

is the use of disposable gloves. Quickly inspect

gloves before putting them on. If a glove is damaged,

don’t use it. When taking contaminated gloves off, do

it carefully. Don’t snap them. This may cause blood to

splatter.

Make sure gloves are always available. If you find

yourself in an emergency and you don’t have any

gloves, improvise. Use a plastic bag, or some otherbarrier to help avoid direct contact.

Masks allow you to provide rescue breaths without

direct skin-to-skin contact. They come with a replace-

able one-way valve and possibly a filter to block con-


Never wash or reuse disposable gloves. Throw away

both gloves in an appropriate container.

Use an alcohol-based hand rub, or soap and water, to

clean your hands and other exposed skin.4

Disposable gloves.

Compared with soap and water, alco-hol–based hand rubs are more effec-tive in reducing bacteria on hands andcause less skin irritation.

Mask and shield.

Blood spill.



Introduction CPR Pro for the Professional Rescuer

taminated fluids. All emergency response kits should

include at least one mask.

Disposable face shields do not prevent contamination

of the rescuer’s side of the shield. To reduce the risk

of transmitting infection, professional rescuers should

use a face shield only as an emergency substitute for

mouth-to-mouth breathing, and should switch to a

mask or bag-mask device as soon as possible.

Bag-mask devices are designed for use in clinical and

emergency settings to provide oxygen and ventilation

to a patient who is not breathing or is not breathing

adequately. When used with supplemental oxygen,

the bag-mask device can provide up to 100% oxy-

gen. They are available in different sizes for adult,

child, and infant patients.

Any time there is a risk of spraying or splatter of blood

or body fluids, you should use goggles or safety

glasses with side protection to help protect your

eyes.

Eye protection.

To reduce the risk of infection,

you should:• Always wear barrier protection in

emergency situations.

• Carefully remove gloves, clothingand any other contaminated mate-rial. Place them in appropriatelylabeled bags or containers.

Decontaminating SurfacesDecontaminate all surfaces, equip-ment, and other contaminated objectsas soon as possible. Clean with adetergent and rinse with water. Use ableach solution of one quarter cup

(.06 liter) of household bleach per one gallon (3.79liters) of water to sanitize the surface. Spray on thesolution and leave it in place for at least 2 minutesbefore wiping.

Bag-mask devices.




Proper Removal of Contaminated Gloves

2

Skill Guide #1

• Gently pulling the glove away from the palm and towardthe fingers, remove the glove inside out. Hold on to theglove removed with the fingers of the opposite hand.

1

• Without touching the bare skin, grasp either palm withthe fingers of the opposite hand.

3• Without touching the outside of the contaminated glove,

carefully slide the ungloved index finger inside the wristband of the gloved hand.

4

• Gently pulling outwards and down toward the fingers,remove the glove inside out.

5• Throw away both gloves in an appropriate container.

• Use an alcohol-based hand rub to clean your hands andother exposed skin after providing first aid. If an alcohol-based hand rub is not available, wash with soap andwater.



Section 2 — Cardiovascular Disease

Cardiovascular Disease CPR Pro for the Professional Rescuer 7

Cardiovascular Disease

Cardiovascular disease directly affects the heart and

the large vessels of the circulatory system. The term

generally reflects a progressive deterioration of the

tissues involved.

The most common problems associated with cardio-

vascular disease are stroke and acute coronary syn-

dromes. They are the leading causes of death for

both men and women in the United States, and

account for nearly 40% of all deaths.5

You can lower your risk for cardiovascular disease by

making healthy lifestyle choices.

• Eat a healthy diet to prevent or reduce high

blood pressure and high blood cholesterol.

• Maintain a healthy weight.• Control your alcohol intake.

• Don’t smoke.

• Exercise as directed by your doctor.

Stroke A stroke occurs when the blood supply to part of the

brain is suddenly interrupted, or when a blood vessel

in the brain bursts and spills blood into the surround-

ing tissue.6 A stroke can result in serious issues with a

patient’s ability to feel, move, or communicate. Dam-

age can be limited by early recognition and promptprofessional medical treatment.7

Signs and symptoms of a stroke may occur suddenly:8

• Numbness or weakness on one side of the body

• Trouble speaking or understanding

• Trouble seeing in one or both eyes

• Loss of balance or coordination• Severe headache

If you suspect a stroke may be occurring, ask the

patient to:

• Smile.

• Raise both arm.

• Speak a simple sentence.

If the patient has any trouble with any of these tasks:

• Alert EMS immediately.

• Position the patient comfortably.

• Comfort, calm, and reassure the patient.

• Provide supplemental oxygen if it is available.

Acute Coronary Syndromes (ACS) The term acute coronary syndromes applies to a

number of serious conditions involving the heart.

These include unstable chest pain, or angina, and

myocardial infarction (heart attack).9 A heart attack

occurs when oxygenated blood flow to part of the

heart is severely diminished or cut off. If not resolved,

heart tissue will die. This could result in a serious dis-

ability or sudden cardiac arrest.

Stroke graphic.

Heart attack.



Chain of Survival for Adults

The Chain of Survival is a concept that is used to

communicate the key factors that must be in place to

increase survival from sudden cardiac arrest.11 The

links in the chain of survival include:

• Early recognition and activation of EMS

• Early CPR

• Early defibrillation

• Early advanced life support

The chain of survival begins with early recognitionand rapid activation of EMS or an Emergency Action

Plan. Early activation may include assistance by an

emergency operator, specially trained to provide CPR

instructions over the phone.12

Early CPR will buy some time for a defibrillator to

arrive and improve the chance that defibrillation will

work.

CPR Pro for the Professional Rescuer Cardiovascular Disease8

Signs and symptoms can vary in intensity. Suspect a

heart attack if the following signs and symptoms

appear:

• Chest pain or a dull discomfort behind the

breastbone that may spread to the arms, back,

neck, jaw, or upper abdomen

• Shortness of breath

• Weakness, nausea, or dizziness

• Heavy sweating

• Anxiety

• Uncertainty and embarrassment

• Denial that something serious is occurring,

which can delay treatment and increase the risk

of death

If you suspect a heart attack is occurring, do the

following:

• Alert EMS immediately.

• Have the patient sit and rest quietly.

• Loosen any tight clothing.

• Help patient take existing heart medication. Usu-

ally this is nitroglycerin, placed or sprayed under

the tongue.

• If the patient does not have a history of aspirin

allergy, advise the patient to chew and swallow a

half or whole adult aspirin tablet (162–325 mg).

• Provide supplemental oxygen if it is available.

Sudden Cardiac Arrest

Sudden cardiac arrest is an emergency that occurs

abruptly and without warning.10

Without early recogni-tion and treatment, most likely from a bystander, a

patient will not survive.

Suspect a sudden cardiac arrest has occurred if

someone:

• Collapses without warning,

• Is unresponsive to voice and touch,

• Appears to not be breathing or is making shal-

low, ineffective attempts to breath, and

• Looks dead.

If you suspect a sudden cardiac arrest has occurred,

immediately alert EMS, perform CPR, and defibrillate

as soon as possible with an AED.

Sudden cardiac arrest (SCA).

Family members ofpatients who havehad a recent heartattack should takeCPR training andbe familiar with the

use of an AED. Employers shouldconsider the use of AEDs at their worksites to reduce

the time to defibrillation, with the goal of improving sur-vival.

All professional responders should be equipped withand trained in the use of an AED.



Cardiovascular Disease CPR Pro for the Professional Rescuer

Early defibrillation can return the heart to a normal

rhythm. Survival rates are highest when CPR is start-

ed immediately and defibrillation occurs within three

to five minutes.

Advanced life support involves medical procedures

and medications used by paramedics, nurses, or

doctors to help protect survival and recovery.13

If any one of these links is weak or missing, the

patient is unlikely to survive. When all the links are

strong, the greatest chance for survival occurs.

Chain of Survival for Children

A chi ld’s heart does not usually stop suddenly, as is

most often the case in adults. Typically, a child’sbreathing will be lost first, by a situation such as

drowning or choking. In these cases, the heart slows

over an extended time and then stops from the lack

of oxygen in the blood. Rapid treatment should

include CPR with a particular emphasis on establish-

ing an open air passage to the lungs and providing

rescue breaths that create a visible rise of the chest.

Early care could reverse the effects of a weakening

heart.

The Chain of Survival in children emphasizes:

• Prevention

• Early CPR

• Early activation of EMS

• Early pediatric advanced life support

Injury is a leading killer of children aged 14 and under

worldwide. Most injuries can be prevented by taking

simple safety measures.14 Death rates for drowning

are highest in children less than five years old. Placing

infants on their backs to sleep and giving them a

pacifier significantly reduces the risk of Sudden Infant

Death Syndrome.15,16

When a child is found unresponsive and not breath-

ing, performing CPR is the priority. Immediate CPR,

with effective rescue breaths, has been shown to sig-

nificantly increase survival for infants and children.17

When available, have another bystander alert EMS.

However, if you are alone, provide about two minutes

of CPR before alerting EMS yourself. As with an adult,prompt professional treatment will help protect sur-

vival and recovery.



Jaw Thrust with head-tilt can be a convenient and

effective method of opening the airway when using aventilation mask, or bag-mask, during rescue breath-

ing or multi-rescuer CPR.

If a patient is unresponsive or semi-responsive and

fluids are endangering his airway, immediately turn

the patient on his side to allow fluids to drain. Roll the

patient like a log without twisting the spine or head

out of alignment. Sweep the mouth with your finger to

remove any foreign material collecting there.

Placing an unresponsive person in a recovery position

uses gravity to help protect the airway from becoming

blocked by the tongue, vomit, or secretions. Use the

recovery position only if the patient is uninjured and

breathing normally.

Section 3 — Resuscitation Skills

CPR Pro for the Professional Rescuer Resuscitation Skills10

Resuscitation Skills

Before looking at the process of resuscitation, it is

helpful to focus on each of the individual skills that

are involved.

Because patients will vary in age, CPR guidelines use

the following age ranges:

• Infants are less than about 1 year of age.

• Children are about from 1 year of age to about

the onset of puberty.

• Adults begin with the onset of puberty.

Airway

The airway is the passageway between the mouth

and lungs. The airway must be open so air can enter

and leave the lungs freely. Blockage of the airway ismost commonly caused by the relaxation of the

tongue when a patient becomes unresponsive. The

Head-tilt, Chin-lift airway maneuver will pull the

tongue away from the back of the throat and open the

airway.

When the potential for a neck injury exists, Jaw

Thrust without head-tilt can be used to open the air-way. If the Jaw Thrust does not open the airway, use

the Head-tilt, Chin-lift maneuver.

Jaw Thrust maneuver.

Log-roll.

Opening the airway.



Using a barrier device such as a mask or bag-mask to

give rescue breaths is recommended for professional

healthcare providers. Rescuers can consider using a

face shield until a mask or bag-mask is available.

Face shields minimize direct contact with a patient

but may not reduce the risk of infection.

Do not take deep breaths when providing rescue

breaths. Taking deep breaths is unnecessary. It could

result in over ventilation and may cause you to hyper-

ventilate. When working with other rescuers, rescue

breaths can be done from above the patient’s head

using Jaw Thrust. When supplemental oxygen is avail-

able, attach a connecting tube to the mask and pro-

vide a minimum flow rate of 10-12 liters per minute.

A bag-mask device allows rescuers to provide posi-

tive pressure ventilations without having to blow into

it. Bag-masks come in adult, child, and infant sizes.

Use the size most appropriate for the size of the

patient. It takes significant practice to effectively use

bag-mask and that should be a consideration in its

use. A bag-mask can be used by a single rescue but

is ideally used by two.

When available, use supplemental oxygen with a bag-

mask. Provide a minimum flow rate of 10-12 liters per

minute. Use a reservoir system to provide 100% oxy-

gen delivery.

Depending on your relationship to a patient and the

availability of a barrier device, you may elect to pro-

vide mouth-to-mouth rescue breaths, using the same

technique as with a face shield.

Mouth-to-nose rescue breaths may be useful if a res-

cuer has difficulty with mouth-to-mouth. Tilt the

patient’s head back with one hand and use the other

hand to lift the chin and close the patient’s mouth.

Seal your lips around the patient’s nose and blow.

11Resuscitation Skills CPR Pro for the Professional Rescuer

Recovery position.

Once in the recovery position, check the patient’s

breathing regularly. Make sure there is no pressure on

the chest that could make it harder to breath. Also

make sure the patient’s body position is stable so he

does not roll onto his face or back.

As a rule, you should not move an injured patient

unless you determine you absolutely have to.

When you suspect injuries are present, use a modi-

fied recovery position called the HAINES position.

HAINES stands for “High Arm In Endangered Spine.”

When using the HAINES position, there is less neck

movement and less risk of spinal-cord damage.

Breathing

Rescue breaths use your exhaled air to force oxygen

into the lungs of a person who has stopped breath-ing. Not all of the oxygen is used by the body in the

breathing process. Inhaled air contains approximately

21% oxygen. Exhaled air contains about 16–17%

oxygen. When delivered through rescue breaths,

there is still enough oxygen to support life.

Rescue breaths using a mask.

Bag-mask with two rescuers.



A stoma is a surgical opening in the front of the neck

through which a person can breathe. Rescue breaths

can be directly given into the stoma using a child-

sized face mask. Direct mouth-to-stoma rescue

breaths can be considered if a mask is not available.

Air can be forced into the stomach instead of the

lungs when giving forceful breaths. This can reduce

the effectiveness of the breaths and may cause a

patient to vomit. To prevent this, give each breath in

one second and give only enough air to see a visible

chest rise, but no more than that. Allow the patient to

exhale completely between breaths.

Pressure applied to the cricoid cartilage in the neck

can compress the esophagus against the spine and

help prevent air from being forced into the stomach

with ventilation. This will lower the chance that vomit-

ing will occur.

Locate the patient’s Adam’s apple, or thyroid carti-

lage, with your finger. Sliding your finger downward,

you will feel an indentation just below the thyroid car-

tilage and then another rigid structure. This is the

cricoid cartilage. Using the tips of your thumb and

index finger, firmly press the cricoid cartilage directly

backwards and hold it in place. Take care to not push

to one side or the other. If the patient coughs or gags

at anytime, release the pressure.

Circulation

To assess for circulation of an adult or child, try to

locate the carotid pulse found on either side of the

windpipe in the neck. Locate the thyroid cartilage.

Slide your fingers into the groove between the wind-


pipe and the muscles on the side of the neck and

compress inward. Pulse checks can be difficult in

emergency situations, even for experienced rescuers.

If you are not certain that a pulse is present within 10

seconds, assume it is absent.

For infants, use the brachial pulse in the inside of the

upper arm. Lay your fingers across the arm and com-

press inward.

External chest compressions are done by applying a

rhythmic application of pressure over the lower half of

the breastbone. Chest compressions result in forward

blood flow as a result of increased pressure in the

chest and direct compression of the heart.

Cricoid pressure.

Child/infant pulse check.

Adult chest compressions.




Opening the Airway

Skill Guide #2

Head-Tilt, Chin-Lift• Blockage of the airway is most commonly caused by the

relaxation of the tongue when a patient becomesunresponsive.

1• Tilting the head and lifting the chin will pull the tongue

away from the back of the throat and open the airway.

2• Don’t press too hard on the soft area under the chin.

Doing so can block the airway. Don’t push the mouthcompletely closed.

3Jaw Thrust

• When the potential for neck-injury exists, Jaw Thrustwithout head-tilt can be used to open the airway.1

• Positioned above the patient, place your hands on eitherside of the head. Hook your fingers underneath theangles of the jaw, just below the ear.

2• Use counter pressure against the cheeks to displace the

jaw and move it upward without tilting the head.

• If the Jaw Thrust does not open the airway, use theHead-tilt, Chin-lift maneuver instead.3

Jaw Thrust with Head-Tilt• The Jaw Thrust maneuver with head-tilt can be a con-

venient and effective method of opening the airwaywhen using a mask, or bag-mask, during rescue breath-ing or multi-rescuer CPR.4



Resuscitation Skills CPR Pro for the Professional Rescuer 15

Protecting the Airway

Skill Guide #3

Log Roll• When a patient is unresponsive or semi-responsive and

fluids are endangering the airway, immediately turn thepatient on his side to allow fluids to drain.

• Roll the patient to avoid twisting of the spine. Keep thehead in line with the body.

• Sweep the mouth with your finger to remove any foreignmaterial collecting there.

12

Recovery Position (No Injuries)• Kneel beside patient and make sure legs are straight.

• Place arm nearest to you out at a right angle to thebody, palm up.

• Bring far arm across chest and hold back of handagainst patient’s cheek nearest you.

• Grasp far leg just above knee and pull it up.

• Keeping patient’s hand pressed against the cheek, pullon far leg to roll the patient toward you.

• Adjust the upper leg so both the hip and the knee arebent at right angles.

• Adjust upper leg so patient’s body is stable.

• Assess breathing and monitor patient.

12

3HAINES Position (Suspected Injury)

• Kneel beside patient. Place patient’s closest arm abovehead and furthest arm across chest.

• Lift patient’s nearest leg just above the knee.

• Place your hand under hollow of patient’s neck to helplift and control head.

• Roll patient toward you and rest head on the extendedarm.

• Bend legs at knees to stabilize patient’s body.

• Assess breathing and monitor patient.

1

23




Rescue Breaths

Skill Guide #4

Using a Face Shield• Place face shield over patient’s mouth and nose.

• Tilt patient’s head and lift chin. Pinch patient’s nose.

• Take a normal breath, open your mouth wide, and placeyour mouth on the face shield around patient’s mouth.

• Press down to create an air tight seal, and blow throughthe opening on the shield. Make chest visibly rise, butno more than that.

• Remove your mouth from shield with each rescue breathand allow patient to exhale.

• If the patient is an infant, place your mouth over theinfant’s mouth and nose.

Using a Ventilation Mask• Place mask over the patient’s mouth and nose.

• Tilt patient’s head and lift chin into mask to create an air

tight seal.

• Take a normal breath and place your mouth around theone–way valve on the mask.

• Blow through valve and make chest visibly rise, but nomore.

1

2

3

12

• Remove your mouth from the valve with each rescue

breath and allow patient to exhale.

3



Resuscitation Skills CPR Pro for the Professional Rescuer 17

Bag-Mask

Skill Guide #5

2 or More Rescuers

Rescuer 1

• Position yourself above patient’s head. Place maskover patient’s mouth and nose.

• Place your hands on either side of the head. Use yourthumbs and heels of your hands to hold mask inplace. Hook your fingers underneath the angles of the

jaw, just below the ear.

• Lift and tilt head backward. If you suspect a neckinjury, do not tilt head.

• Use counter pressure against cheeks to displace jawand move it upward.

Rescuer 2

• Squeeze bag to ventilate. Give each breath in 1 sec-ond. Make chest visibly rise, but no more.

1 Rescuer

• Position yourself above patient’s head. Place mask overmouth and nose.

• Use thumb and first finger of one hand around valve in a“C” position to press mask against patient’s face.

• Use your remaining three fingers in an “E” position to liftup jaw.

• Tilt head back to open airway. If patient is injured, useJaw Thrust only.

• Squeeze bag with your free hand to ventilate. Give eachbreath in 1 second. Make chest visibly rise, but no more.

1

2

3

12




External Chest Compressions

Skill Guide #6

Adults

• Place heel of one hand in center of chest between nipples. Put other

hand on top of first. Your fingers can be straight or fastened together, butkept off chest.

• Position your shoulders directly over your hands. Straighten your armsand lock your elbows. Use upper body weight to help compress chest.

• Push straight down on chest approximately 11 ⁄ 2–2 inches or 4–5 centi-meters. Release your pressure and allow for full recoil of chest. Withoutinterruption, compress at a rate of about 100 times per minute.

• Do not push over the lower part of the breastbone. Keep up the force andspeed of compressions.

Children

• Use heel(s) of either 1 or 2 hands to compress. Place hand(s) on the cen-

ter of the chest, between the nipples.• Using upper body weight, compress about 1 ⁄ 3–1 ⁄ 2 the depth of the chest at

a rate of about 100 compressions per minute.

Infants

• Compress the center of chest with two fingertips just below the nipple

line.• Compress about 1 ⁄ 3–1 ⁄ 2 the depth of the infant’s chest at a rate of about

100 per minute.

• With two or more rescuers, compress the breastbone using two thumbs,with your fingers encircling the chest.



Defibrillation

Ventricular fibrillation is the most common heart

rhythm that occurs in sudden cardiac arrest.

AEDs allow healthcare providers who are not trainedin advanced techniques to defibrillate. Integrated

voice prompts help make them simple to operate.

Survival rates for sudden cardiac arrest are highest

when immediate CPR is performed and defibrillation

is provided within 3–5 minutes.

If you witness the collapse of a patient who is found

to be in cardiac arrest, initiate CPR and defibrillate as

soon as an AED is available.

If you respond to an arrest that you have not wit-

nessed, your protocols may require you to perform

about 2 minutes of CPR prior to using an AED.

There are many different brands of AEDs, but the

same basic steps apply to all of them.

• Turn on the AED.

• Adhere the AED pads to the patient’s bare chest.

• Allow the AED to automatically analyze the heartrhythm.

• Deliver a shock if directed to by the AED.

Turning on an AED wil l begin voice prompts that will

help guide you through the steps of care.

Defibrillation is provided through adhesive pads

attached to the patient’s bare chest and connected

by wires to the AED. These pads typically have pic-

tures on them that indicate the proper placement of

Section 4 — Defibrillation

Defibrillation CPR Pro for the Professional Rescuer 19

the pads on the chest. Pads need to be removed from

their protective lining to ensure proper adherence to

the chest wall.

When pads are properly attached, an AED will auto-

matically begin to analyze a patient’s heart rhythm to

decide if a shock is needed. No one should touch the

patient during analysis.

A voice prompt and warning sound will inform you a

shock is recommended. All rescuers need to be safe-

ly “cleared” from the patient before delivering the

shock. Immediate CPR is recommended following an

initial defibrillation shock. Additional shocks may berequired. Listen carefully to the AED voice prompts

and provide any indicated care.

Automated External Defibrillator (AED).

Placing pads.

Deliver shock.



Ventricular f ibrillation is uncommon in children, but it

can occur. AEDs can be used for children older than 1

year of age.18 An AED may have special pads or a key

to deliver a lower, child-sized amount of electricity.19 If

a child-specific AED is not available, it is okay to use

an AED set up for an adult.

Troubleshooting

Troubleshooting prompts from the AED can help

guide you through some common problems with its

use. Stay calm and do what the AED tells you to do.

Hair on the chest may prevent the electrode pads

from making effective contact. If a voice prompt indi-

cates a pad problem, press the pads firmly against

the chest. If the prompt continues, quickly remove the

pads tearing out the hair, and apply a second set ofpads. If the problem continues, quickly shave the hair

off of the chest underneath and attach another set of

pads.

CPR Pro for the Professional Rescuer Defibrillation20

Moisture on the victim’s chest can reduce the ability

of the pads to adhere. If the victim’s chest is sweaty

or wet, quickly dry it before attaching the pads. Move

a victim out of standing water before attaching the

pads.

If a message indicating motion occurs, make sure

CPR has been stopped and the cables are not being

moved.

If a message regarding the battery is displayed, the

battery is probably low. If the AED will not charge to

deliver a shock, change the battery.

Remove medication patches and wipe the skin clean

before attaching pads. Medication patches may block

the shock and can cause burns to the skin.

A noticeable scar and lump on the chest may indicate

an underlying implanted medical device such as a

pacemaker or defibrillator. Place the edge of the pads

at least 1 inch or 2.5 centimeters away from any

implanted device.

To prevent the accidental ignition of bedding or

clothes divert emergency oxygen away from the vic-

tim when shocks are delivered with an AED.

AEDs can be used safely on metal surfaces as long

as the electrode pads do not come into contact with

the metal.

Children defibrillation devices.



Section 5 — Emergency Action Steps

Emergency Action Steps CPR Pro for the Professional Rescuer 21

Assess, Alert, and Attend tothe ABCD’sThe emergency action steps are intended to help you

manage life-threatening problems of the airway,

breathing and circulation.

Always pause for a moment as you approach and

assess the scene for safety. If the scene is not safe,

make sure it is before you enter. Assess any patients.

Form an initial impression of the severity of their

problems.

Signs that CPR may be needed include:

• Patient is not moving.

• Tissue color is bluish or ashen, especially around

the lips.

• Breathing is shallow, gasping, or absent.

Adults

Kneel next to the patient. Gently tap or squeeze the

patient’s shoulder and ask, “Are you all right?” Use

the patient’s name if you know it.

If the patient is unresponsive, have another person

alert EMS if it has not already been done. If available,

have the person return with an AED and emergency

oxygen. If you are alone with an unresponsive adult,

immediately alert EMS yourself. Get an AED and

oxygen, if they are available, and quickly return to the

patient.

Attend to the ABCD’s. Make sure the patient is face

up on a firm, flat surface. If the patient is on his face,

roll him over but minimize twisting of the head and

neck.

Attend to the airway. Open the airway using Head-tilt,

Chin-lift. Use the Jaw Thrust if you suspect a neck

injury.

Attend to breathing. Lean close to the patient and

look for chest movement, listen for air leaving the

mouth and nose, and feel for air blowing on your

cheek. Check for at least 5, but no more than 10

seconds.

Assess victim.

Alert EMS.

Open the airway.



It may be difficult to determine whether an adult

patient is breathing normally or not. Normal breathing

is effortless, quiet, and regular. Occasional gasps are

not normal and are not capable of supplying the

patient with enough oxygen to sustain life.

If the patient is breathing normally, place him on his

side in a recovery position. If you are not positive that

the patient is breathing or breathing normally, quickly

give two rescue breaths. If the patient’s chest does

not rise with the first rescue breath, re-tilt the patient’s

head, lift the chin, and give the second breath.

Attend to circulation. After the delivery of the two res-cue breaths, check the patient’s pulse. Check the

pulse for no more than 10 seconds. If a pulse is pres-

ent, perform rescue breathing. Provide 1 rescue

breath about every 5 to 6 seconds.

If the pulse is absent, or you are not sure after 10 sec-

onds, perform CPR. Give 30 chest compressions at a

speed of about 100 per minute. Keeping up the force,

length, and speed of compressions helps create the

best blood flow possible. After 30 compressions,

open the patient’s airway and give two rescue breaths

that make the chest visibly rise. Without delay, return

to the chest and begin compressions again.

Compressions need to be hard and fast. Allow the

chest to fully recoil at the top of each compression

and minimize any interruptions to compressions. Pro-

vide continuous cycles of 30 compressions to 2 res-

cue breaths until an AED is available, you are relieved

by another rescuer, or the patient responds.

When another rescuer is available, perform CPR with

2 rescuers. One rescuer performs rescue breaths and

the other performs chest compressions. When giving

rescue breaths, pause compressions, and allow the

breaths to be given. Change places every few min-

utes to prevent fatigue. Do this quickly, in less than 5seconds.

When an AED becomes available, use it immediately,

unless your protocols indicate otherwise. Turn the

AED on and listen to the voice prompts. Expose the

chest by tearing or cutting the shirt.

Check for breathing.

Give two rescue breaths.

Single rescuer CPR.

Two-rescuer CPR.

CPR Pro for the Professional Rescuer Emergency Action Steps22



Emergency Action Steps CPR Pro for the Professional Rescuer

Attend to the child. Open the airway. Check for the

presence or absence of breathing. Take at least 5

seconds and no longer than 10. If the child is breath-

ing, place her in the recovery position.

If breathing is absent give 2 rescue breaths. For chil-

dren, you may have to try a couple of times to give

breaths that make the chest visibly rise. It is critical

that rescue breaths make an infant or child’s chest

rise during resuscitation.

Check the child’s pulse for no longer than 10 sec-

onds. If the pulse is present and is 60 beats per

minute or greater, perform rescue breathing, providing

1 rescue breath every 3 to 5 seconds.

If the pulse is less than 60 beats per minute, absent,

or you are not sure, begin CPR. Provide continuous

cycles of 30 compressions to 2 rescue breaths until

an AED is available, you are relieved by another res-

cuer, or the child responds.

When performing CPR on a child with 2 rescuers,

provide continuous cycles of 15 compressions to 2

breaths. When giving rescue breaths, pause com-

pressions and allow the breaths to be performed.

If the collapse of the child was witnessed, use an AED

as soon as one is available. If the collapse was not

witnessed, perform about two minutes of CPR before

using the AED.

Turn the AED on and listen to the voice prompts.

Expose the chest. Remove the defibrillation pads

from their packaging, peel them from their backing,

and apply them to the child’s bare chest. With most

AEDs, place one pad on the center of the chest, just

below the collarbones. Place the other pad on the

center of the back between the shoulder blades.

Remove the defibrillation pads from their packaging.

Look at the pictures on the pads to see exactly how

to place them. Remove the self-adhesive backing and

attach the electrodes to the patient’s bare chest.

Make sure the electrode attaches firmly to the skin.

Allow the AED to analyze the patient’s heart rhythm.

Ensure nobody touches the patient during analysis. If a

shock is indicated, warn everyone out loud to stay

“CLEAR” of the patient. Make sure no one, including

you, is touching the patient. Press the shock button on

the AED to deliver the shock. Immediately resume CPR

and follow any instructions given by the AED. If the

patient becomes responsive at any time, stop CPR.

Defibrillation.

Child CPR.

Supplemental Oxygen

Even the best chest compression pro-vides only about 25%–33% of the nor-mal blood and oxygen flow from theheart. The combination of low bloodflow and low oxygen causes organs to

fail and leads to death. Giving rescue breaths withsupplemental oxygen permits the rescuer to provide ahigher concentration of oxygen. Oxygen-rich breathsdeliver critically needed oxygen to the heart and brain.For this reason, when available, healthcare providers,first responders, and professional rescuers should usesupplementary oxygen when performing rescuebreathing. Ideally a bag-mask device should beattached to an oxygen reservoir to allow delivery of

100% oxygen to the patient.

Children

The emergency action steps for children are similar to

adults with a few key differences. Assess the scene

for safety. Assess the child for response. Have a

bystander alert EMS. When alone, stay with the child

and, if indicated, provide about two minutes of CPR

before leaving to call for EMS.



Allow the AED to analyze the child’s heart rhythm.

Ensure nobody touches the child during analysis. If a

shock is indicated, warn everyone to stay “CLEAR” of

the child. Make sure no one, including you, is in con-

tact with the child. Press the shock button on the

AED to deliver the shock.

Immediately resume CPR and follow any instructions

given by the AED.

Infants The emergency action steps for an infant are similar

to an adult or child. Assess the scene for safety.

Assess the infant for response. You may try tapping

the foot.

Have a bystander alert EMS. When alone, stay with

the infant and, if indicated, provide about two minutesof CPR before leaving to call for EMS.

Attend to the infant. Open the airway. Check for the

presence or absence of breathing. Take at least 5

seconds and no longer than 10. If the infant is breath-

ing, place him in the recovery position. If breathing is

absent, provide 2 rescue breaths.

Check the infant’s brachial pulse for no longer than 10

seconds. If the pulse is present and is 60 beats per

minute or greater, perform rescue breathing, providing

1 rescue breath every 3 to 5 seconds.

If the pulse is less than 60 beats per minute, absent,

or you are not sure, begin CPR.

Provide continuous cycles of 30 compressions to 2

rescue breaths until you are relieved by another res-

cuer or the infant responds.

When performing CPR on an infant with 2 rescuers,

provide continuous cycles of 15 compressions to 2

breaths. When giving rescue breaths, pause com-

pressions to allow the breaths to be performed.

When Using Advanced Airways Professional rescuers may use an advanced airway

device such as the laryngeal mask airway,

esophogeal-tracheal-combitube, or endotracheal

tube to provide rescue ventilations. When an

advanced airway is in place, remove the mask from

the bag-mask device and attach the bag directly to

the airway to ventilate.

Give ventilations at a rate of 6 to 8 times a minute,

regardless of the patient’s age.

When performing CPR with an advanced airway in

place, it is no longer necessary to pause compres-

sions. Ventilations and compressions can be per-

formed independently.


Child defibrillation. Infant two-rescuer CPR.

Bag-mask to advanced airway.




Special CPR ConsiderationsPregnancy — Chest compressions may not be effective when a woman who is 6 months pregnant ormore is lying flat on her back. This is because the baby puts pressure on a major vein that returns bloodto the heart. If possible, prop up the woman slightly on her left side using a rolled blanket (or similar)when performing chest compressions. This will reduce this pressure and provides the most blood flow tomother and baby. Perform chest compressions higher on the breastbone, slightly above the center.

Hypothermia — Get inside or out of the wind. Prevent additional heat loss by removing wet clothes and insulating thevictim from further exposure. If the body is frozen solid, the nose and mouth are blocked with ice, and chest compres-sion is impossible, do not start CPR. When defibrillating, if the victim does not respond to one shock, focus on continu-ing CPR and re-warming the victim to a range of 30°C–32°C (86°F–89.6°F) before repeating the defibrillation attempt.

Submersion/Near-Drowning — Because the scene may be unsafe (waves, currents, cold water, bad weather), propertraining in the use of personal lifesaving equipment, such as torpedo buoys and personal flotation devices, is critical fora safe rescue. If available, get the victim into a boat or other vessel. If no boat is available, get the victim to shore. StartBLS/CPR when indicated, as soon as it is safe to do so.

Expect vomiting. When it occurs, turn the victim’s mouth to the side and remove the vomit with a gloved finger sweep orcloth.

If a head, neck, or back injury is suspected, use the HAINES method or roll the victim like a log. Minimize movement. Avoid twisting the head, neck, or back.

Do not attempt to drain water from the lungs using abdominal thrusts. They are unnecessary and potentially dangerous.Move victim out of freestanding water and dry chest before attaching AED.

Electric Shock — Consider any fallen or broken wire extremely dangerous. Do not touch (or allow your clothing to touch)

a wire, victim, or vehicle that could 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, andtelephone lines may be energized by a fallen wire and may carry the current a mile or more from the point of contact.Never attempt to handle wires yourself unless you are properly trained and equipped.

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

Lightning Strike — When multiple victims are struck by lightning at the same time, give the highest priority to those with-out signs of life. Start CPR if indicated, as soon as it is safe to do so. Because many victims are young, they have a goodchance for survival if immediate CPR is given. Remove smoldering clothing, shoes, and belt to prevent burns.

Cardiac Arrest and Injury — Be sure to clear mouth of blood, vomit, and other secretions. It is unlikely for someone whois in cardiac arrest caused by a serious injury to survive.



Adult

Begins with onset

of puberty

Child

About 1 year of age to

onset of puberty

Infant

Less than

1 year of age

Assess

Assess Scene If the scene is unsafe or at

anytime becomes unsafe,

GET OUT!

If the scene is unsafe or at any-

time becomes unsafe,

GET OUT!

If the scene is unsafe or at any-

time becomes unsafe, GET

OUT!

Assess PatientTap shoulder, shout name. Tap shoulder, shout name. Tap foot, shout out.

Alert

Alert EMS or Emergency PlanGet an AED and/or emergency oxygen

Send a bystander. When

alone, do it yourself

immediately.

Send a bystander.

When alone, perform about

2 minutes of care before doing

it yourself.

Send a bystander.

When alone, perform about

2 minutes of care before doing

it yourself.

Attend

Open Airway • Head-tilt, Chin-lift

• Jaw Thrust for

suspected neck injury

• Head-tilt, Chin-lift

• Jaw Thrust for


• Head-tilt, Chin-lift

• Jaw Thrust for


Check Breathing Look, listen, and feel for at

least 5 seconds, but no

more than 10.

Look, listen, and feel for at


more than 10.

Look, listen, and feel for at


more than 10.

Breathing Present? Place patient in recovery

position and monitor

breathing.

Place patient in recovery


breathing.

Place patient in recovery


breathing.

Breathing Absent? Provide 2 rescue breaths. Provide 2 rescue breaths. Provide 2 rescue breaths.

Rescue Breaths • 1 second in length

• Make chest visibly rise,

but no more

• 1 second in length


but no more

• 1 second in length


but no more

Check Circulation Palpate carotid pulse in

neck for no more than

10 seconds.

Palpate carotid pulse in

neck for no more than

10 seconds.

Palpate brachial pulse in

upper arm for no more than

10 seconds.

Pulse Present? Perform Rescue Breathing;

1 breath every 5–6 seconds.

Perform Rescue Breathing;


Perform Rescue Breathing;


Pulse Absent? Perform CPR

• 1 Rescuer — 30:2

• 2 Rescuer — 30:2

Perform CPR

• 1 Rescuer — 30:2

• 2 Rescuer — 15:2

Perform CPR

• 1 Rescuer — 30:2

• 2 Rescuer — 15:2

Compressions • Center of chest, between

nipples; 2 hands

• 11 ⁄ 2 to 2 inches

• 100 times per minute

• Hard, fast, complete

recoil, minimize

interruption

• Center of chest, between

nipples;

1 or 2 hands

• 1 ⁄ 3 to 1 ⁄ 2 depth of chest



recoil, minimize

interruption

• Center of chest,

2 fingers just below

nipple line or 2 thumbs

with hands encircling

chest (2 rescuers)

• 1 ⁄ 3 to 1 ⁄ 2 depth of chest



recoil, minimize

interruption

Defibrillation with an AED

• Turn on power

• Attach pads

• Analyze

• If indicated, deliver shock

• Resume CPR and

follow voice prompts

• Use Child system; if not

available, use an AED

• Turn on power

• Attach pads

• Analyze

• If indicated, deliver shock

• Resume CPR and follow

voice prompts

No recommendation


Summary of CPR/AED Procedures



Emergency Action Steps CPR Pro for the Professional Rescuer 27

Adult Rescue Breathing

Perform these steps quickly — in a minute or less Emergency Action Steps

• Assess Scene. If the scene is unsafe or at anytime becomes unsafe, GET OUT!

• Assess Patient. Tap shoulder, shout name. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, do this yourself.

• Attend to the ABCs.

Skill Guide #7

Airway — Open Airway• Tilt head, lift chin.

• If you suspect a neck injury, use Jaw Thrust.

Breathing — Check Breathing• Look, listen, and feel for 5, but no more than

10 seconds. No breathing!

• If the patient is not breathing, or not breathing ade-quately, give 2 rescue breaths that make chest visiblyrise.

Circulation — Check Pulse• Check the carotid pulse in the neck for no more than 10

seconds. Pulse is present!

A

B

C

Perform Rescue Breathing• Give each breath in 1 second. Make the chest visibly

rise each time.

• Perform 1 breath every 5–6 seconds (10-12 breaths perminute).

• Reassess the carotid pulse about every 2 minutes. Takeno longer than 10 seconds to do so.C



Child Rescue BreathingPerform these steps quickly — in a minute or less Emergency Action Steps


• Assess Child. Tap shoulder, shout name. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, stay with the child

and provide 2 minutes of care before doing this yourself.


Skill Guide #8





• If the child is not breathing, or not breathing adequately,give 2 rescue breaths that make chest visibly rise.


seconds. Pulse is present and ≥ 60 bpm!

A

B

CPerform Rescue Breathing

• Give each breath in 1 second. Make the chest visiblyrise each time.

• Perform 1 breath every 3–5 seconds (12–20 breaths perminute).

• Reassess the carotid pulse about every 2 minutes. Takeno longer than 10 seconds to do so.C

CPR Pro for the Professional Rescuer Emergency Action Steps



Infant Rescue BreathingPerform these steps quickly — in a minute or less Emergency Action Steps


• Assess Infant. Tap shoulder, shout name. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, stay with the infant



Skill Guide #9





• If the infant is not breathing, or not breathing adequate-ly, give 2 rescue breaths that make chest visibly rise.

Circulation — Check Pulse• Check the brachial pulse on the inside of the upper arm

for no more than 10 seconds. Pulse is present and≥ 60 bpm!

A

B

CPerform Rescue Breathing

• Give each breath in 1 second. Make the chest visiblyrise each time.

• Perform 1 breath every 3-5 seconds (12-20 breaths perminute).

• Reassess the brachial pulse about every 2 minutes.Take no longer than 10 seconds to do so.C




Adult CPR/AED



• Assess Patient. Tap shoulder, shout name. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, do this yourself.

• Attend to the ABCDs.

Skill Guide #10

Airway — Open Airway• Tilt the head, lift the chin.


Breathing — Check Breathing

• Look, listen, and feel for 5, but no more than 10 sec-onds. No breathing!

• If the patient is not breathing, or not breathingadequately, give 2 rescue breaths that make chestvisibly rise.

Circulation — Check Pulse• Check the carotid pulse in the neck for no more than

10 seconds. No pulse!

DPerform CPR

1 Rescuer (30:2)

– Push hard and fast (100x per min.) 11 ⁄ 2–2 inches deep.

– Allow chest to recoil completely. Minimize interruptions.

– Provide continuous cycles of 30 compressions and2 rescue breaths until AED arrives, EMS arrives, orpatient responds.

2 or More Rescuers (30:2)

– One rescuer performs compressions; the other rescuebreaths. Pause compressions when breaths are given.

– Quickly change positions at least every two minutes.

A

B

Defibrillation — Use an AED if Available• Turn on AED and follow voice prompts.

• Attach pads to bare chest; allow AED to analyze heart.

• If shock advised, CLEAR patient and deliver shock.

• Immediately resume CPR. Follow AED voice prompts.D

C



Child CPR/AED


• Assess Scene. If scene is not safe or at any time becomes unsafe, GET OUT!

• Assess Child. Tap shoulder, shout name. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, provide two minutesof care before doing this yourself.


Skill Guide #11





• If the child is not breathing, or not breathing adequately,give 2 rescue breaths that make chest visibly rise.


seconds. No pulse!

DPerform CPR

1 Rescuer (30:2)

– Push hard and fast (100x per min.) 1 ⁄ 3 to 1 ⁄ 2 the depthof chest.

– Allow chest to recoil completely. Minimize interruptions.

– Provide continuous cycles of 30 compressions and2 rescue breaths until an AED arrives, EMS arrives, orchild shows signs of life.


– One rescuer performs compressions; the other rescuebreaths. The compressor pauses while breaths are

given.– Quickly change positions at least every two minutes.

A

B

Defibrillation — Use an AED if Available• Turn on AED and follow voice prompts.

• Attach pads to bare chest; allow AED to analyze heart.

• If shock advised, CLEAR child and deliver shock.

• Immediately resume CPR. Follow AED voice prompts.D

C




Infant CPR



• Assess Infant. Tap foot, shout. Not moving? No response?

• Alert. Have someone alert EMS and get an AED and emergency oxygen. If alone, stay with the infant



Skill Guide #12





• If the infant is not breathing, or not breathingadequately, give 2 rescue breaths that make chestvisibly rise.

A

BCirculation — Check Pulse

• Check the brachial pulse on the inside of the upper armfor no more than 10 seconds. No pulse!

C

DPerform CPR

1 Rescuer (30:2)

– Push hard and fast (100x per min.) 1 ⁄ 3 to 1 ⁄ 2 the depthof the chest.

– Allow chest to recoil completely. Minimizeinterruptions.

– Provide continuous cycles of 30 compressions and2 rescue breaths until EMS arrives or infant showssigns of life.


– One rescuer performs compressions; the otherrescue breaths. Pause compressions when breathsare given.

– Compress with thumbs and fingers encircling chest.

– Quickly change positions at least every two minutes.



For adults and children, repeated abdominal thrusts

are recommended to relieve the blockage until

the object is expelled or the patient becomes

unresponsive.

For infants, repeat a combination of back blows and

chest thrusts.

If the choking patient is in the late stages of pregnan-

cy or is obese, and you cannot get your arms aroundthe abdomen, you can perform chest thrusts to

remove the blockage.

Section 6 — Choking

Choking CPR Pro for the Professional Rescuer 33

Foreign Body AirwayObstructionChoking occurs when an object blocks the passage

that allows air in and out of the lungs.

Food, especially large pieces, is the most common

cause of choking. Young children are particularly at

risk because of the small size of their air passages,

inexperience with chewing, and a natural tendency to

put objects in their mouths.20,21

Rescuers must be able to recognize the difference

between a mild blockage and a severe blockage of

the airway. A mild blockage can typically be cleared

by the patient through a natural coughing reaction. If

a patient can speak, or has strong coughing or gag-

ging, stay with them and encourage them to try and

cough the foreign object out. Be ready to take actions

if symptoms worsen. If the blockage is not easily

relieved and the patient is struggling, alert EMS.

When a severe blockage occurs, it is impossible to

clear the airway through natural means. Help from a

bystander is required to save the patient’s life.

Signs of a severe blockage include:

• Hands clutching throat

• Patient cannot speak, cough, or make any

sound

• Blue lips, nails, skin

To assess a patient you think may be choking simply

ask, “Are you choking?” If patient nods yes or is

unable to speak, cough, or cry — act quickly!

Choking victim.

Back blows and chest thrusts for infants.

Abdominal thrusts for adults.



If you are alone, it is possible to relieve the blockage

yourself. Attempt to give yourself abdominal thrusts

until the object is expelled. If that does not work,

press your abdomen quickly over any firm surface

(back of a chair, side of a table, etc.).

If a choking patient becomes unresponsive during

treatment, change your approach to care. Carefully

get the patient to the ground and alert EMS. If alone

with a child, give about 2 minutes of CPR, then alert

EMS.

Begin CPR. Each time the airway is opened for res-

cue breaths, look for an object in the patient’s throat.If you see it, remove it. Continue CPR until the AED or

EMS arrives or the patient shows signs of life.

CPR Pro for the Professional Rescuer Choking34

Pregnant choking victim.

Adult CPR.

Abdominal thrusts have been associ-ated with severe and fatal complica-tions. Complications may occur evenwhen abdominal thrusts are per-formed correctly. DO NOT performabdominal thrusts on an adult or child

unless it is necessary. A patient who has had an air-way obstruction that was removed by abdominal orchest thrusts should be evaluated by EMS and seenby a physician to assure no internal injuries resulted

from the event. Abdominal thrusts are not recommended for infants

because you may damage internal organs.




Adult Choking: Severe Blockage

Skill Guide #13

Responsive• Quickly ask, “Are you choking?”

• If patient nods yes or is unable to speak or cough — actquickly.

• Stand behind patient.

• Make a fist. Place thumb side against patient’sabdomen, just above the navel and below ribs. Graspfist with other hand.

• Quickly thrust inward and upward into abdomen.

• Repeat thrusts until object is expelled or patientbecomes unresponsive.

Becomes Unresponsive• Carefully get patient to ground. Alert EMS.

• Begin CPR. Each time airway is opened for rescuebreaths, look for an object in patient’s throat. If seen,remove it.

• Continue CPR until an AED arrives, EMS arrives, orpatient shows signs of life.

1

23

1

23


• Assess Patient. Suspect severe blockage if patient reacts suddenly and is clutching throat.



CPR Pro for the Professional Rescuer Choking36

Child Choking: Severe Blockage

Skill Guide #14

Responsive• Quickly ask, “Are you choking?”

• If child nods yes or is unable to speak or cough — actquickly.

• Stand or kneel behind child.

• Make a fist. Place thumb side against child’s abdomen, just above the navel and below ribs. Grasp fist withother hand.

• Quickly thrust inward and upward into abdomen.

• Repeat thrusts until object is expelled or child becomesunresponsive.

Becomes Unresponsive• Carefully get child to ground. Alert EMS.

• Begin CPR. Each time airway is opened for rescuebreaths, look for an object in child’s throat. If seen,remove it.

• Continue CPR until an AED arrives, EMS arrives, or childshows signs of life.

1

23

1

23


• Assess Child. Suspect severe blockage if child reacts suddenly and is clutching throat.




Infant Choking: Severe Blockage

Skill Guide #15

Responsive• Quickly look at infant’s face.

• If the infant is silent and unable to cry, and has blue lips,nails, and skin — act quickly.

• Lay infant face down on your forearm. Support headand tilt it downward.

• Give 5 firm back blows between shoulder blades.

• Sandwich infant between your arms and roll over ontoother forearm.

• Using two fingertips just below nipple line, give fivechest thrusts.

• Repeat 5 back blows and 5 chest thrusts until object isexpelled or infant becomes unresponsive.

Becomes Unresponsive• Place infant on a firm flat surface. Alert EMS.

• Begin CPR. Each time airway is opened for rescuebreaths, look for an object in infant’s throat. If seen,remove it.

• Continue CPR until EMS arrives or infant shows signs oflife.

1

23

1

23


• Assess Infant. Suspect severe blockage if infant suddenly becomes very quiet.



Section 7 — Legal and Emotional Aspects

CPR Pro for the Professional Rescuer Legal and Emotional Aspects38

Legal Aspects of ProvidingBasic Life SupportGood Samaritan Laws — These are laws to prevent

someone who has voluntarily helped another in need

from being sued for ‘wrongdoing.’ You are generally

protected from liability as long as you act reasonably

and in “good faith” without payment or reward, and

you do not provide care beyond your skill level.

Abandonment — If you decide to help in an emer-

gency, you must not leave the patient until someone

with equal or more training takes over.

Consent — Consent is permission. A responsive

adult must agree to receive emergency medical care.

“Expressed consent” means the patient gives his or

her permission to receive care. To get consent, firstidentify yourself. Then tell the patient your level of

training and ask if it’s okay to help. “Implied consent”

means that permission to provide care to an unre-

sponsive patient is assumed. This is based on the

idea that a reasonable person would give permission

to receive lifesaving care if able. Consent for children

must be gained from a parent or legal guardian. When

life-threatening situations exist and the parent or

guardian is not available, care should be given based

on implied consent. When suffering from a distur-

bance in normal mental functioning, like Alzheimer’s

disease, a patient may not understand your request

for consent. Consent must be gained from a family

member or legal guardian.

Duty to Act — This is a requirement to act toward

others and the public with the watchfulness, atten-

tion, caution and prudence that a reasonable person

in the same circumstances would use. If a person’s

actions do not meet this standard, then the acts may

be considered negligent, and any damages resulting

may be claimed in a lawsuit for negligence. If you are

a state-licensed healthcare provider, first responder,

or other professional rescuer expected to give emer-

gency medical care, including CPR, you almost cer-

tainly have a duty to act. However, BLS performed

voluntarily on a stranger in need while off-duty is gen-

erally considered a “Good Samaritan Act.”

Starting CPR — Start CPR for all patients in cardiac

arrest unless signs of irreversible death are present,

including rigor mortis (limbs of corpse stiff and impossi-

ble to move), dependent lividity (settling of blood in

lower portions of body, causing a purplish red discol-

oration), or conditions are present that are incompatible

with life (decomposition, decapitation, massive head

injury, etc.). Do not start CPR if it puts you in danger of

injury, or the patient has a valid DNR order. In a mass

casualty incident with limited resources, patients requir-ing rescue breathing or CPR are considered dead and

attempts to resuscitate them should not be started.

Stopping CPR — Do 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 the patient decides to order the resuscita-

tion effort stopped (follow local protocol, standard

operating procedures, and/or medical direction).

Except when death is obvious, irreversible brain dam-

age or brain death cannot be reliably assessed or

predicted. Rescuers should never make an impulsive

decision about the present or future quality of life of a

cardiac arrest patient, because such decisions may

be incorrect.

Advanced Directives and Living Wills — These are

documents authorized by state law that allow a per-

son to appoint someone as his or her representative to

make decisions on resuscitation and continued life-

support in a situation where a person has lost deci-

sion-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 the patient wants done or not

done when the patient can’t speak on his or her own

behalf. Laws about advanced directives are different in

each state. You should be aware of the laws in your

state.

Do Not Resuscitate (DNR) or Do Not Attempt

Resuscitation (DNAR) Orders — The DNR/DNAR

order is a kind of advanced directive. This is a specif-

ic request not to have CPR performed. In the United

States, a doctor’s order is required to withhold CPR.

Therefore, unless the patient has a DNR order, EMS

providers and hospital staff should attempt resuscita-

tion. Patients who are not likely to benefit from CPR

and may have a DNR order include those with termi-

nal conditions from which they are unlikely to recover.

Outside the hospital, healthcare providers, first

responders, and other professional rescuers should



Legal and Emotional Aspects CPR Pro for the Professional Rescuer

begin CPR if there is a reasonable doubt about the

validity of a DNAR order or advanced directive, if the

patient may have changed his or her mind, or the

patient’s best interests are in question.

Emotional Aspects ofProviding Basic Life SupportRescuers trained in CPR are often unwilling to per-

form it — both in and outside the hospital setting.

There are a variety of reasons given, including fear of

disease, fear of hurting the patient, fear of performing

the skills incorrectly, and fear of liability. It is important

to remember that the risk of getting disease while giv-

ing CPR is extremely low and observing universal pre-

cautions for patients of all ages will make it lower.

Fears associated with CPR skill performance can be

reduced through regular participation in quality train-

ing that focuses on simple, practical skills and confi-

dence building.22 Still, when resuscitation is attempt-

ed, doctors, nurses, EMS providers and bystanders

can experience a wide range of negative reactions

and emotional stress.

Failed resuscitation attempts often leave rescuers —

especially those who perform resuscitation infre-

quently — feeling guilt when CPR was not “done

right.” This distress is normal and usually temporary.

Although CPR should be “done right” and at a high

quality, it is helpful to remember that a person in car-

diac arrest is already dead (without breathing or a

pulse). It is not possible to make the patient worse.

You can only help.23

Traumatic stress reactions are a normal, human

response to a traumatic event and are usually tempo-

rary. Symptoms begin within minutes of the traumatic

event and should disappear within hours or a couple

of days.

During Incident

• Anxiety/worry

• Trembling/shaking

• Sweating

• Fast breathing

• Pounding heartbeat, shock, anger

• Excitement, intense fear

• Nausea

Following Incident

• Thinking about event repeatedly

• Worry about self or loved ones

• Guilt for not having done more

• Tense muscles, diarrhea/constipation,

nausea/vomiting, headaches, fatigue

• Easily startled

• Lack of interest in usual activities

• Sadness, feeling detached

• Sleep problems/nightmares

• Problems concentrating

• Hyperactive/depressed

During the incident, remain calm and act sensibly.

Accept your own limitations as a rescuer. Following

the incident, remind yourself that stress reactions are

normal and will pass. Get back into a normal routine

as soon as possible. Be kind to yourself. Allow your-

self time to deal with memories of the incident.

Accept every person’s right to his or her own feelings.

Keep what happened in a realistic perspective. Be

sure to exercise, eat, drink, and rest. Have a connec-

tion to professional resources for continued care if

necessary.



End Notes

CPR Pro for the Professional Rescuer End Notes40

End Notes1 U.S. Department of Labor; Occupational Safety & Health

Administration Regulations (Standards — 29 CFR)

Bloodborne pathogens — 1910.1030; Available:

http://www.osha.gov/ [23–Mar–05].

2 Division of Healthcare Quality Promotion, National Center

for Infectious Diseases Centers for Disease Control and

Prevention; Standard Precautions; January 1996;

Available: http://www.cdc.gov/ncidod/dhqp/

gl_isolation_standard.html [26–Aug–08].

3 Mejicano GC, Maki DG; Infections acquired during

cardiopulmonary resuscitation: estimating the risk and

defining strategies for prevention; Ann Intern Med; 1998

Nov 15;129(10):813–28.

4 Hand Hygiene in Healthcare Settings; Division of

Healthcare Quality Promotion, National Center forInfectious Diseases Centers for Disease Control and

Prevention; Available: http://www.cdc.gov/handhygiene/

[26–Aug–08].

5 Preventing Heart Disease and Stroke Addressing the

Nation’s Leading Killers; National Center for Chronic

Disease Prevention and Health Promotion; Available:

http://www.cdc.gov/dhdsp/library/toolkit/index.htm

[26–Aug–08].

6 National Institute of Neurological Disorders and Stroke;

National Institutes of Health; Available:

http://www.ninds.nih.gov/disorders/stroke/stroke.htm

[26–Oct–05].

7 Liferidge AT, Brice JH, Overby BA, Evenson KR; Ability of

laypersons to use the Cincinnati Prehospital Stroke

Scale; Prehosp Emerg Care; 2004 Oct–Dec;8(4):384–7.

8 Learn To Recognize A Stroke; ©2005 American Heart

Association, Inc; Available:

http://www.strokeassociation.org/ [13–Jun–05].

9 The Merck Manual; Section 16; Cardiovascular

Disorders; Ch. 202; Coronary Artery Disease; Available:

http://www.merck.com/mmpe/sec07/ch073/ch073a.html

[26–Aug–08].

10 Diseases and Conditions Index; National Heart Lung and

Blood Institute; National Institutes of Health; U.S.

Department of Health and Human Services; Available:

http://www.nhlbi.nih.gov/health/dci/Diseases/scda/scda_

whatis.html [09-16-09]

11 Newman MM; The Chain of Survival takes hold; JEMS;

1989;14 (8):11–13.

12 Hau SR, et al.; Factors impeding dispatcher–assisted

telephone cardiopulmonary resuscitation; Ann Emerg

Med; 2003 Dec;42(6):731–7.

13 Heart and Stroke Foundation of Canada; Available:

http://ww2.heartandstroke.ca/ [24–Oct–05].

14 Safety Tips; Safe Kids Worldwide: www.safekids.org/.

[8–Dec–05].

15

SIDS: “Back to Sleep” Campaign; The National Instituteof Child Health and Human Development (NICHD);

Available: http://www.nichd.nih.gov/sids/ [19–Apr–05].

16 Hauck FR, Omojokun OO, Siadaty MS; Do pacifiers

reduce the risk of sudden infant death syndrome?; A

meta–analysis; Pediatrics; 2005 Nov;116(5):716–23.

17 Lopez–Herce J, et al.; Long–term outcome of paediatric

cardiorespiratory arrest in Spain; Resuscitation; 2005

Jan;64(1):79–85.

18 Samson RA, et al.; Use of automated external

defibrillators for children: an update: an advisory

statement from the pediatric advanced life support taskforce; International Liaison Committee on Resuscitation;

Circulation; 2003 Jul 1;107(25):3250–5.

19 Atkins DL, Jorgenson DB; Attenuated pediatric electrode

pads for automated external defibrillator use in children;

Resuscitation; 2005 Jul;66(1):31–7.

20 CDC; Nonfatal choking–related episodes for children 0 to

14 years of age; United States; 2001; Available:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a

1.htm [26–Aug–08].

21 Chiu CY, Wong KS, Lai SH, Hsia SH, Wu CT; Factors

predicting early diagnosis of foreign body aspiration inchildren; Pediatr Emerg Care; 2005 Mar;21(3):161–4.

22 Attitude toward Performing CPR; 2005 International

Consensus Conference on Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care

Science with Treatment Recommendations; hosted by

the American Heart Association in Dallas, Texas; January

23–30, 2005; Circulation; 2005;112:III–100–III–108 and

Resuscitation; Volume 67; Supplement 1; Pages

S1–S190; (December 2005); © 2005; International Liaison

Committee on Resuscitation, American Heart

Association®, Inc. and European Resuscitation Council.

23 Shenefelt, R; Emotional Aspects of Basic Life Support;

Presentation; Scientific Program of the New Zealand

Resuscitation Council Conference; Wellington, NZ;

November, 1999.

http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html


http://www.nhlbi.nih.gov/health/dci/Diseases/scda/scda_whatis.html


http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a1.htm







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