Adult CardioPulmonary

Resuscitation

Out-of-hospital Chain of Survival

Adult BLS Sequance

1.
2.
3.
4.
5.
6.

D Danger
R Response
s Shout for help
A Airway
B Breathing
C Circulation

Danger
Assessing Danger and Safety to Health Care
Worker Prior to Resuscitation
Provider shall ensure their safety from danger
while providing CPR, these includes:
Wear PPE (gloves, apron, mask) if available.
Look out for blood spills, sharps, electric wires.
Unsteady beds, trolley, ambulance Cots
Note: It is difficulty in providing effective chest compressions
while moving the patient during CPR, the resuscitation should
generally be conducted where the patient is found.

Response
Provider required to assess the victims
responsiveness by gently tapping the shoulder
and ask loudly: Are you ok?

Shout for Help

Provider need to activate the Emergency
Medical Services (EMS) or to shout the
following words after suspecting a cardiac
arrest. Help me to call 999 and inform to the
emergency call centre this is a Cardiac Arrest
Event
Retrieval of AED

Positioning
Victims found on the floor should be initially
managed on the floor.
Face down victims shall be rolled over to the
supine position.
Air filled mattresses should be deflated during
CPR.

Airway
Open Airway:
Head tilt-chin lift: Non-trauma patient
Jaw thrust: Any victim with suspected cervical
injury.

Breathing
Absent or abnormal breathing shall be determined
simultaneously while opening the airway by looking
at the chest, neck and face for not more than 10s.
Absence of breath or presence of abnormal breathing
(Agonal Breathing/Gasping) should treat as a sign of
cardiac arrest.
Chest compression shall begin with absence of normal
breathing.
Note: In cases if in doubt whether breathing is normal, act as if
it is they are not breathing normally and prepare to start CPR.

Effective of CPR
Effective chest compressions are essential for providing
blood flow during CPR. For this reason all patients in
cardiac arrest should receive quality of chest
compressions.
High Quality of Chest Compression:
Location of hand on chest compression
Rate of Chest Compression
Depth of Chest Compression
Allow the Chest to fully Recoil
Minimize interruption on chest compression
Synchronized Chest Compression with Ventilation

Position of hand during Chest Compression

Lower half of the chest shall be the site for
hand placement.
The rescuer should place the heel of one hand
on the centre (middle) of the victims chest
(Which is the lower half of the sternum) with
the heel of the other hand on top of the first.
So that the hands are overlapped and parallel.

Chest Compression Rate: 100 to 120/min

In adult victims of cardiac arrest, it is reasonable
for rescuers to perform chest compressions at a
rate of 100 to 120/min.

Chest Compression Depth

During manual CPR, rescuers should perform
chest compressions to a depth of at least 2 inches
(5 cm) for an average adult while avoiding
excessive chest compression depths (greater than
2.4 inches [6 cm]).

Chest Recoil
Allow spontaneous recoil of the chest wall in
between compression.
It is reasonable for rescuers to avoid leaning
on the chest between compressions, to allow
full chest wall recoil for adults in cardiac
arrest.

Minimizing Interruptions in Chest

Compressions
Rescuers should attempt to minimize the frequency and duration of
interruptions in compressions to maximize the number of
compressions delivered per minute.
In adult cardiac arrest, total Preshock and Postshock pauses in
chest compressions should be as short as possible, should LESS
than 10 seconds
For adults in cardiac arrest receiving CPR without an advanced
airway, it is reasonable to pause compressions for less than 10
seconds to deliver 2 breaths
In adult cardiac arrest with an unprotected airway, it may be
reasonable to perform CPR with the goal of a chest compression
fraction as high as possible, with a target of at least 60%.

 Ratio of chest compression to ventilation:

The compression-ventilation ratio shall be
30:2 if the airway is not secured.
Ventilation:
Each breath shall be given within 1 second
inspiratory time until a chest rise is observed.
In areas without bag-mask device, provider shall
perform chest compression only CPR.

Defibrillator
Early defibrillation is an essential step in the
chain of survival for victims of cardiac arrest.
Provider should deliver defibrillation as soon as
it is available in shockable rhythm and resume
chest compression immediately after
defibrillation.
Minimize interruption of chest compression
during attachment of defibrillator and rhythm
analysis.

 For witnessed adult cardiac arrest when an AED is immediately

available, it is reasonable that the defibrillator be used as soon as
possible.
For adults with unmonitored cardiac arrest or for whom an
AED is not immediately available, it is reasonable that CPR be
initiated while the defibrillator equipment is being retrieved and
applied and that defibrillation, if indicated, be attempted as soon
as the device is ready for use.
When 2 or more rescuers are present, one rescuer should begin
chest compressions while a second rescuer activates the
emergency response system and gets the AED (or a manual
defibrillator in most hospitals).

Reassessment of during CPR

After every 5 cycles or 2 minutes of CPR,
provider shall check for normal breathing.

Stopping CPR
CPR can be stopped in following
circumstances:
Victim recovers with normal breathing.
Provider is exhausted.
Assistance arrives to take over CPR.
Note: Provider shall switch the role of chest
compressions every 5 cycles or 2 minutes to avoid
fatigue.

Recovery Position
Recovery position is applied when victims resume
normal breathing but remain unresponsive.
The technique of recovery position must ensure the
following:
Victim is in the true lateral position.
Head in the dependant position.
Position is stable.
Position is safe and comfortable to the victim.
Position should not pressure on the chest to impair
breathing.