2010 American Heart Association
Guidelines for Cardiopulmonary
Resuscitation and Emergency
Cardiovascular Care
Robert A. Berg, Chair; Robin Hemphill; Benjamin S. Abella; Tom P. Aufderheide;
Diana M. Cave; Mary Fran Hazinski; E. Brooke Lerner; Thomas D. Rea; Michael R.
Sayre; Robert A. Swor
Fundamental
aspects of BLS :
immediate recognition of SCA
activation ERS
early CPR
rapid defibrillation
BLS Guidelines 2010
Key
changed and continued points :
Immediate recognition of SCA unresponsiveness & normal
breathing
look, listen, feel removed
Hands only CPR untrained lay rescuer
ABC CAB
CPR continued ROSC/termination of effort
High quality CPR :
Compression rate & depth
Full chest recoil
Interruption
Avoid overventilation
BLS Guidelines 2010
Key
changed & contiued points :
De-emphasis of pulse check
Simplified algorithm of BLS
Simultaneous & choreographed approach for
resuscitation by integrated trained rescuers
BLS Guidelines 2010 (contd)
leading cause of
Etiologies, circumstances, settings
Single approach to resusc isnt practical ?
universal strategy
Chain of Survival
SCA
Immediate recogniton & activation of ERS
Early CPR chest compression
Rapid defibrilation (indicated)
Effective ALS
Integrated post-SCA care
BLS Guidelines 2010
always straightforward
laypersons
Confusion delay/failure to start CPR
Unresponsive victim immediately
activate the ERS begin CPR
Isnt
Immediate
recognition of
BLS Guidelines 2010
SCA
CPR survival
Often not provided until the arrival of
professional rescuers
The highest priority CHEST
COMPRESSION
Chest compression perfusion during
CPR
push hard & push fast
High quality CPR !!!
Early
BLS Guidelines 2010
Early
CPR
defibrillation predictor of
successful resusc following VF SCA
Reduce interval bw collaps to defibrillation
Depending on the setting & circumstances
Use of AED
AED heart rhythm & lifesaving shock
Rapid
Rapid
Defibrillatio
BLS Guidelines 2010
n
Call
local emergency number
Dispatcher CPR instruction
Misinterpret victims breathing failure
Inquire consciousness & breathing
Unresponsive victim CPR
immediately !!!
Provide hands-only CPR
Include rescue breathing likelihood of
asphyxial (eg, drowning)
Activating
BLS Guidelines 2010
ERS
Sequential
assessments & actions
Easy for any type of rescuers to learn,
remember, and perform
Help a single rescuer to prioritize
EMS/in hospital simultaneously
BLS
BLS Guidelines 2010
Sequence
BLS
BLS Guidelines 2010
Sequence
Immediate Recognition & Activation of
ERS
victim activate the ERS
Absent/abnormal breathing arrest
Dispatcher guide lay-rescuer check
breathing & steps of CPR !!!
ERS activated begin CPR !!!
911 location, the events, number,
condition
Unresposive
BLS
BLS Guidelines 2010
Sequence
Pulse Check
Difficult to detect
Take too long time to check for a pulse
Lay rescuer unresponsive victim
dont check for a pulse !!
Trained no more than 10sec
BLS
BLS Guidelines 2010
Sequence
Early CPR
Chest Compression
Lower
half of the sternum
Intrathoracic pressure & direct compression to
heart blood flow & oxygen delivery
Effective CC providing blood flow during CPR
PUSH HARD & PUSH FAST ~ 2inches/5cm ~
100c/min
Complete Recoil
Minimize frequency & duration of interruption
Compression : Ventilation = 30 : 2
BLS
BLS Guidelines 2010
Sequence
Early CPR
Rescue Breaths
CC started rescue breath m-2-m/bagmask oxygenation & ventilation
Deliver it over 1 sec
Give sufficient tidal volume visible chest
rise
Compression
: ventilation = 30 : 2
BLS
BLS Guidelines 2010
Sequence
Early Defibrillation with an AED
Activating ERS retrieve AED (if nearby &
accessible) return to the victim
1 begin chest
compression
2
rescuers
1 activating ERS
& get AED
Defibrillation
sequence :
Turn the AED on
Follow the AED prompts
Resume compression immediately after the shock
(minimize interuption)
BLS
BLS Guidelines 2010
Sequence
Rescuer Spesific CPR Strategies :
Putting It All Together
Untrained Lay-Rescuer
Provide hands-only CPR PUSH HARD & PUSH
FAST !!!
Follow the directions of dispatcher
Continuously AED arrives/EMS take over care
BLS
BLS Guidelines 2010
Sequence
Trained Lay-Rescuer
Provide chest compression & rescue
breath
Ratio 30 : 2
Continuously AED arrives/EMS
take over care
BLS
BLS Guidelines 2010
Sequence
Healthcare Provider
Provide chest compression & rescue breath
Ratio 30 : 2 advance airway placed
ventilation per 6 to 8 sec
MINIMIZE INTERRUPTION !!!
Suddenly collapse assume as SCA call
AED (if nearby) victim attach&use AED
CPR
Drowning/foreign body obs give 5 cycle ( 2
min) CPR activate ERS
BLS
BLS Guidelines 2010
Sequence
BLS
BLS Guidelines 2010
Skills
Recognition of Arrest (Box 1)
check vics response unresponsive
activate ERS (lays)/check for breath
(trained)
Normal breathing SCA ERS
Deemphasize of checking breath
Occasional gasps
Deemphasize of pulse check
Minimize delays in chest compression
BLS
BLS Guidelines 2010
Skills
Technique : Chest Compression (Box 4)
Firm surface CPR
Kneeling beside the vics chest / standing
beside the bed
Hospital beds backboard
Avoid : delays, interruption, displacement
Heel to heel lower half of sternum
Depth 2 inches (5 cm)
Compression time ~ recoil time
BLS
BLS Guidelines 2010
Skills
Technique : Chest Compression (Box 4)
incomplete recoil
incomplete recoil hemodynamics
Actual no. of CC CC rate + interruption
Interruption : open the airway, rescue breath,
AED analysis
No. of CC/min ROSC
In-hospital : 80c/min; out-hospital : 68-89c/min
Survival 120c/min
Recommended 100c/min
Fatigue
BLS
BLS Guidelines 2010
Skills
Technique : Chest Compression (Box 4)
Fatigue inadequate comp.rate/depth
>>> after 1min of CPR
2/more rescuers switch/2min (5 cycles)
Switch < 5 sec
Lay rescuers do not check for
ROSC !!!
Interruption < 10sec (adv
airway/defibrillator)
BLS
BLS Guidelines 2010
Skills
Compression-Ventilation Ratio (Box 4)
Ratio 30 : 2
Adv. airway dont pause
compression for ventilation !!
Ventilation per 6-8sec (8-10 breaths/min)
BLS
BLS Guidelines 2010
Skills
Hands-Only CPR
Bystander CPR (20-30%) survival
Reluctance to perform m-2-m ventilation
PANIC ATTACK !!
CC > breath O2 level & gas exchange
BLS
BLS Guidelines 2010
Skills
Managing Airway
Open the Airway : Lay Rescuers
Head tilt - chin lift
Open the Airway : Healthcare Provider
Head/neck trauma Head tilt - chin lift
Spinal injury manual spinal motion restriction
Spinal immobilization transport
BLS
BLS Guidelines 2010
Skills
To be continued
