Bls Cpr Lecture

8/13/2019 Bls Cpr Lecture

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Basic Life Support

Cardiopulmonary Resuscitation

BLS – CPR

• 2 Kings, Chap. 4, . !4, that "li#ah $... %ent up, and lay upon the child, and put his mouth upon

his mouth, and his eye upon his eyes, and his hands upon his hands& and he stretched himself

upon the child' and the flesh of the child %a(ed %arm.• )*+), r. -riedeich aass successfully performed e(ternal chest compression on a human.

• )+/!, the first successful resuscitation using e(ternal chest massage 0y r. 1eorge Crile.

• )+/s %hen the research team of rs. Peter Safar and 3ames "lam made the 0iggest leaps

for%ard 0y demonstrating that e(pired air could proide adeuate o(ygenation follo%ed in )+4

0y the deliery of mouth5to5mouth resuscitation %ith predicta0le results.

• )+6/, r. Kou%enhoen et al perfected the techniue for closed5chest massage, the last piece of

the pu77le %as put into place. odern cardiopulmonary resuscitation 8CPR9 %as 0orn, and

consistent results %ere finally achiea0le.

:;<= B>?

Body Systems

• Respiratory System – it deliers o(ygen to the 0ody a s%ell as remoes car0on dio(ide from the

0ody. @he passage of air into and out of the lungs is called respiration. Breathing in is called

inspiration, 0reathing out is called e(piration.

• Circulatory System – it deliers o(ygen and nutrients to the 0ody tissues and remoes %aste

products. At consists of the heart, 0lood essels and 0lood.

• =erous System – composed of the 0rain spinal cords and neres.

Breathing and Circulation

• <ir that enters and lungs contains&

2) >2

D+ nitrogen and other mi(ed gases

• <ir e(haled from lungs contains&

)D >24 C>2

Relationship of :ypo(ia to Brain

-unction

• /54 minutes – 0rain damage unliEely

• 456 minutes – damage pro0a0le

• 65)/ minutes 5 0rain damage is certain

C<RA>F<SC;L<R AS"<S"

yocardial Anfarction 8:eart <ttacE9>ccurs %hen the o(ygen supply to the heart muscle 8myocardium9 is cut off for a period of time

resulting into reduced 0lood supply due to narro%ing and or complete 0locEage of a diseased artery



resulting in death of the muscle tissue supplied 0y the essel.

RisE -actors for Cardioascular isease

• RisEs that can not 0e changed 8non modifia0le9

:eredity<ge

1ender

•RisE factors that can 0e changed 8modifia0le9Cigarette smoEing:@=

"leated cholesterol and triglyceride leels

LacE of e(ercise>0esity

Stress

KA=S >- LA-" S;PP>R@

Basic Life Support (BLS)

<n emergency procedure that consist of recogni7ing respiratory or cardiac arrest or 0oth and the proper application of CPR to maintain life until a ictim recoers or adanced life support is aaila0le.

BLS includes recognition of signs of sudden cardiac arrest 8SC<9'heart attacE, stroEe, andforeign50ody air%ay o0struction 8-B<>9cardiopulmonary resuscitation 8CPR9' and defi0rillation %ith

an automated e(ternal defi0rillator 8<"9.

Advanced Cardiac Life Support (ACLS)

An addition to BLS, it utili7es drugsGmedications and special euipment to maintain 0reathingand circulation

C:<A= >- S;RFAF<L

• "arly access and recognition of the emergency and actiation of the emergency medical

serices 8"S9 or local emergency response system& Hphone +)).I

• "arly CPR 5 ost effectie %hen started immediately after collapse and can dou0le or triple the

ictimJs chance of surial from SC<.

• "arly efi0rillation CPR plus defi0rillation %ithin ! to minutes of collapse can produce

surial rates as high as 4+ to D.

• "arly <CLS follo%ed 0y postresuscitation care deliered 0y healthcare proiders.

CPR5 Cardio Pulmonary Resuscitation

• CPR is a series of sEill assessments and interentions

• CPR proides a small 0ut critical amount of 0lood flo% to the heart and 0rain.

• -or eery minute %ithout CPR, surial from %itnessed SC< decreases D to )/.

• CPR has 0een sho%n to dou0le or triple surial from %itnessed SC< at many interals to

defi0rillation.



R"SC;" BR"<@:A=1

Rescue breathing – a techniue of 0reathing air into a persons lungs to supply a patient %ith >2.

<?S @> F"=@AL<@" @:" L;=1S

Mouth-to-Mouth Rescue Breathing • >pen the ictimJs air%ay, pinch the ictimJs nose, and create an airtight mouth5to5mouth seal.

• 1ie ) 0reath oer ) second, taEe a HregularH 8not a deep9 0reath, and gie a second rescue

0reath oer ) second.

• @aEing a regular rather than a deep 0reath preents you from getting di77y or lightheaded.

• @he most common cause of entilation difficulty is an improperly opened air%ay, so if the

ictimJs chest does not rise %ith the first rescue 0reath, perform the head tilt5chin lift and gie

the second rescue 0reath.

Mouth-to-Barrier Device Breathing

• Barrier deices may not reduce the risE of infection transmission, and may increase resistance

to air flo%.• <aila0le in 2 types&

-ace Shields and -ace asEs. -ace shields are clear plastic or silicone sheets that reduce

direct contact 0et%een the ictim and rescuer 0ut do not preent contamination of the rescuerJs side of

the shield.

Some masEs include an o(ygen inlet for administration of supplementary o(ygen. asEs used for mouth5to5masE 0reathing should contain a )5%ay ale that directs the

rescuerJs 0reath into the patient %hile dierting the patientJs e(haled air a%ay from the rescuer.

Mouth-to-Nose and Mouth-to-Stoma enti!ation

• outh5to5nose entilation is recommended if it is impossi0le to entilate through the ictimJs

mouth 8eg, the mouth is seriously in#ured9.

• @he mouth cannot 0e opened, the ictim is in %ater, or a mouth5to5mouth seal is difficult to

achiee.

• 1ie mouth5to5stoma rescue 0reaths to a ictim %ith a tracheal stoma %ho reuires rescue

0reathing.

• <n alternatie is to create a tight seal oer the stoma %ith a round pediatric face masE.

enti!ation "ith Bag a!ve Mas#

• < 0ag5masE deice proides positie5pressure entilation.

• elier each 0reath oer a period of ) second and proide sufficient tidal olume to cause

isi0le chest rise.• Capa0le of creating a tight seal coering 0oth mouth and nose.

• asEs should 0e fitted %ith an o(ygen inlet, hae a standard )5mmG225mm connector, and

should 0e aaila0le in one adult and seeral pediatric si7es.

• At may produce gastric inflation and its complications.

• asEs should 0e made of transparent material to allo% detection of regurgitation.

:? BLS5CPR



• Sudden cardiac arrest 8SC<9 is a leading cause of death in the ;nited States and Canada.

• CPR should 0e proided until an "S or an automated e(ternal defi0rillator 8<"9 or manual

defi0rillator is aaila0le.

• <ge elineation

• ifferences in the etiology of cardiac arrest 0et%een child and adult ictims necessitate some

differences in the recommended resuscitation seuence for infant and child ictims compared

%ith the seuence used for adult ictims.

Differences in CPR for Lay Rescuers and Healthcare Providers

La$ Rescuer

• @he lone rescuer should telephone the emergency response system and retriee an <" 8if

aaila0le9. @he rescuer should then return to the ictim to 0egin CPR and use the <" %henappropriate.

• @he lay rescuer should open the air%ay and checE for normal 0reathing. Af no normal 0reathing

is detected, the rescuer should gie 2 rescue 0reaths.

• Ammediately after deliery of the rescue 0reaths, the rescuer should 0egin cycles of !/ chest

compressions and 2 entilations and use an <" as soon as it is aaila0le.

• Lay rescuers are not taught to assess for pulse or signs of circulation for an unresponsie ictim.

• Lay rescuers %ill not 0e taught to proide rescue 0reathing %ithout chest compressions

• -or the unresponsie infant or child, the lay rescuer seuence for action is as follo%s&

• @he rescuer %ill open the air%ay and checE for 0reathing' if no 0reathing is detected, the

rescuer should gie 2 0reaths that maEe the chest rise.

• @he rescuer should proide cycles 8!/ compressions & 2 0reaths9 of CPR, a0out 2 minutes.

• Leae the pediatric ictim to phone +)) and get an <" for the child if aaila0le.

%ea!thcare &rovider

• @he lone healthcare proider should alter the seuence of rescue response 0ased on the most

liEely etiology of the ictimJs pro0lem.

• -or suddenG%itnessed, collapse in ictims of all ages, the lone healthcare proider should

telephone the emergency response num0er and get an <" 8%hen readily aaila0le9 and thenreturn to the ictim to 0egin CPR and use the <". Call first.

• -or unresponsie ictims of all ages %ith liEely asphy(ial arrest 8eg, dro%ning9 the lone

healthcare proider should delier a0out cycles 8a0out 2 minutes9 of CPR 0efore leaing the

ictim to telephone the emergency response num0er and get the <". @he rescuer should then

return to the ictim, 0egin the steps of CPR, and use the <". Call fast.

• <fter deliery of 2 rescue 0reaths, :C should attempt to feel a pulse in the unresponsie,

non0reathing ictim not more than )/ seconds.

• Af no pulse %ithin )/ seconds, 0egin cycles of chest compressions and entilations.

•:C %ill 0e taught to delier rescue 0reaths %ithout chest compressions for the ictim %ithrespiratory arrest and a perfusing rhythm 8ie, pulses9.

• Rescue 0reaths %ithout chest compressions should 0e deliered at a rate of a0out )/ to )2

0reaths per minute for the adult and a rate of a0out )2 to 2/ 0reaths per minute for the infant

and child.

• >nce an adanced air%ay is in place for infant, child, adult ictims, 2 rescuers no longer delier

compressions interrupted %ith entilation.

• Compression should 0e deliered at )// compressions per minute continuously, %ithout pauses

for entilation. @he rescuer deliering the entilations should gie * to )/ 0reaths per minute.



=>@"

@he 2 rescuers should change compressor and entilator roles 2 minutes to preent

compressor fatigue and deterioration in uality and rate of chest compressions.

hen multiple rescuers are present, they should rotate the compressor role a0out eery 2

minutes. @he s%itch should 0e accomplished as uicEly as possi0le 8ideally in less than seconds9 to

minimi7e interruptions in chest compressions.

S"M;"=C" >- <C@A>=

). Surey the scene2. @aEe time to surey the scene and ans%er these uestions&

• As the scene safeN – personal safety, 0ody su0stance isolation precautions, safety of patient,

safety of 0ystanders

• hat happenedN 5 mechanism of in#ury or nature of illness trauma or medical.

• :o% many people are in#uredN – surey the scene for num0er of patients and determine

additional resources needed

• <re there any 0ystanders %ho can help meN

• Adentify your self as trained BLS proider • 1et consent to care

• Perform Primary Surey

• >nce the rescuer has ensured that the scene is safe, checE for responseGconsciousness.

!. @o checE for response, asE the ictim $Sir <re you >KI

4. Af there is no response, tap the ictim on the shoulder and asE, H<re you all rightNH

. Af the ictim responds 0ut is in#ured or needs medical assistance, leae the ictim to phone +))G8))D9. Return as uicEly as possi0le and rechecE the ictimJs condition freuently.

6. Af there is no response at all, moe to <BC.

<BC5

•

< – ChecEG>pen <ir%ay:ead tilt chin lift

odified #a% thrustLR

• @he lay rescuer should open the air%ay using a head tilt5chin lift maneuer for in#ured and

non5in#ured ictims.

@he #a% thrust is no longer recommended for lay rescuers 0ecause it is difficult for lay rescuers to learnand perform, is often not an effectie %ay to open the air%ay, and may cause spinal moement.

:C

• < healthcare proider should use the head tilt5chin lift maneuer to a ictim %ithout

eidence of head or necE trauma.

D. >pen the <ir%ay and ChecE Breathing

• @o prepare for CPR, place the ictim on a hard surface in supine position. Af an unresponsie

ictim is prone, roll the ictim to supine.

• B 5 ChecE for Breathing

LooE listen and feel for no more than )/ sec.

=otea. Af ictim is 0reathing or resumes effectie0reathing, place in recoery position.

0. Af ictim is not 0reathing, gie 2 0reaths that maEe chest rise.



c. Release completely allo% for e(halation 0et%een 0reaths.

LR

• LooE for normal 0reathing. @his should help the lay rescuer distinguish 0et%een the ictim

%ho is 0reathing 8and does not reuire CPR9 and the ictim %ith agonal gasps 8%ho is liEely incardiac arrest and needs CPR9. An infant or child they should looE for the presence or a0sence

of 0reathing.

:C

• Should assess for adeuate 0reathing in the adult.

Rescue Breaths@he purpose of entilation is to maintain adeuate o(ygenation. 1ie 2 rescue 0reaths, each

0reath deliered in ) second, %ith enough olume to produce isi0le chest rise. >ther ne%

recommendations for rescue 0reaths are these&

• :ealthcare proiders should proide effectie 0reaths in infants and children.

• <sphy(ial arrest is more common than cardiac arrest in infants and children.

• An infant, if no chest rise and fall is noted during entilation, reopen and reposition the air%ay

and reattempt entilation.• @he rescuer may need to try a couple of times to delier 2 effectie 0reaths for the infant and

child.

• hen rescue 0reaths are proided %ithout chest compressions to a ictim %ith a pulse, the

healthcare proider should deliver 12 to 20 breaths/minute - infant or child 10 to 12 breaths/

minute - adult.

• "ach 0reath should 0e gien oer ) second regardless of %hether an adanced air%ay is in

place.

• "ach 0reath should cause isi0le chest rise.

• <oid deliering 0reaths that are too large or too forceful. At may may cause gastric inflation

and its resultant complications

• C 5 ChecE for CirculationGCompression

HC

ChecE pulse for no more than )/ sec.

Carotid in child and adult, 0rachial and femoral infant

Af pulse is present 0ut 0reathing is a0sent, Proide rescue 0reathing&

• ) 0reath to 6 sec for adults,

• ) 0reath ! to sec for infants or child.

RechecE pulse 2 minutes

Af pulse is a0sent, 0egin chest compressions if no definite pulse after )/ seconds.

Cycles of !/ compressions and 2 0reaths until <" or <LS arries. -or infants, if pulse is present 0ut less than 6/ 0pm, 0egin chest compressions.

LR

LR %ill not checE pulse on ictims

Lay rescuers fail to recogni7e the a0sence of a pulse in )/ of pulseless ictims 8poor sensitiity for

cardiac arrest9 and fail to detect a pulse in 4/ of ictims %ith a pulse 8poor specificity9. -or ease of training, the lay rescuer %ill 0e taught to assume that cardiac arrest is present if the

unresponsie ictim is not 0reathing



Chest Compression

• < rhythmic applications of pressure oer the lo%er half of the sternum.

• Creates 0lood flo% 0y increasing intrathoracic pressure and directly compressing the heart.

• Blood flo% generated 0y chest compressions deliers a small 0ut critical amount of o(ygen and

su0strate to the 0rain and myocardium.

• Pts %ith F- SC<, chest compressions increase the liEelihood that defi0rillation %ill 0esuccessful. Chest compressions are especially important if the first shocE is deliered 4 minutes

after collapse.

@echniue @o ma(imi7e the effectieness of compressions&

• @he ictim should lie supine on a hard surface 8eg, 0acE0oard or floor9 %ith the rescuer

Eneeling 0eside the ictimJs thora(.

• Compress the lo%er half of the ictimJs sternum in the center 8middle9 of the chest, 0et%een the

nipples.

• Place the heel of the hand on the sternum in the center 8middle9 of the chest 0et%een the nipples

and then place the heel of the second hand on top of the first so that the hands are oerlapped

and parallel.

• epress the sternum appro(imately ) to 2 inches 8appro(imately 4 to cm9 and allo%ing

complete chest recoil that allo%s enous return to the heart.

• Compression and chest recoilGrela(ation time should 0e eual.

• Lay rescuers should continue CPR until an <" arries, the ictim 0egins to moe, or "S

personnel taEes oer CPR.

• Lay rescuers should no longer interrupt chest compressions to checE for signs of circulation or

response.

• :ealthcare proiders should interrupt chest compressions as infreuently as possi0le, limit

interruptions to no longer than )/ seconds e(cept for interentions such as insertion of an

adanced air%ay or use of a defi0rillator.• At is recommended that patients not 0e moed %hile CPR is in progress unless the patient is in a

dangerous enironment or is a trauma patient in need of surgical interention .

• hen 2 or more rescuers are aaila0le, it is reasona0le to s%itch the compressor a0out eery 2

minutes 8or after cycles of compressions and entilations at a ratio of !/&29.

• "ery effort should 0e made to accomplish this s%itch in O seconds. Af the 2 rescuers are

positioned on either side of the patient, one rescuer %ill 0e ready and %aiting to reliee the

H%orEing compressorH eery 2 minutes.

'nfant and Chi!d

• Lay rescuers and healthcare proiders should delier chest compressions that depress the chest

of the infant and child 0y one third to one half the depth of the chest.

• Because children and rescuers can ary %idely in si7e, rescuers are no longer instructed to use a

single hand for chest compression of all children. Anstead the rescuer is instructed to use ) handor 2 hands 8as in the adult9 as needed to compress the childJs chest to one third to one half its

depth.

• LR& should use a !/&2 compression5entilation ratio for all 8infant, child, and adult9 ictims.

• :C& should use a !/&2 compression5entilation ratio for all )5rescuer and all adult CPR and

should use a )&2 compression5entilation ratio for infant and child 25rescuer CPR.



ConclusionGfindings on research presented at the 2// Consensus Conference a0out chest

compressions& H"ffectieH chest compressions are essential for proiding 0lood flo% during CPR

• @o gie HeffectieH chest compressions, Hpush hard and push fast.H Compress the adult chest at a

rate of a0out )// compressions per minute, %ith a compression depth of ) to 2 inches8appro(imately 4 to cm9. <llo% the chest to recoil completely after each compression, and

allo% appro(imately eual compression and rela(ation times.

•inimi7e interruptions in chest compressions.

-urther studies are needed to define the 0est method for coordinating entilations and chest

compressions and to identify the 0est compression5entilation ratio in terms of surial and neurologic

outcome.

• – efi0rillation 5 efi0rillation using <utomated e(ternal defi0rillators 8<"9 is an integral

part of 0asic lifesupport.

SP"CA<L C>=SA"R<@A>=S, Resuscitation Situations&

Compression >nly CPR

@he outcome of chest compressions %ithout entilations is significantly 0etter than the outcome of noCPR for adult cardiac arrest.

Laypersons should 0e encouraged to do compression5only CPR if they are una0le or un%illing to proide rescue 0reaths, although the 0est method of CPR is compressions coordinated %ith

entilations.

ro%ning

Rescuers should proide CPR, particularly rescue 0reathing, as soon as an unresponsie su0mersion

ictim is remoed from the %ater.

hen rescuing a dro%ning ictim of any age, the lone healthcare proider should gie cycles 8a0out2 minutes9 of CPR 0efore leaing the ictim to actiate the "S system.

outh5to5mouth entilation in the %ater may 0e helpful %hen administered 0y a trained rescuer.

Chest compressions are difficult to perform in %ater, may not 0e effectie, and could potentially causeharm to 0oth the rescuer and the ictim.

Rescuers should remoe dro%ning ictims from the %ater 0y the fastest means aaila0le and should 0egin resuscitation as uicEly as possi0le.

>nly ictims %ith o0ious clinical signs of in#ury or alcohol into(ication or a history of diing,%aterslide use, or trauma should 0e treated as a Hpotential spinal cord in#ury,H %ith sta0ili7ation and possi0le immo0ili7ation of the cerical and thoracic spine.

Some ictims aspirate nothing 0ecause they deelop laryngospasm or 0reath5 holding.

<ttempts to remoe %ater from the 0reathing passages 0y any means other than suction 8eg,

a0dominal thrusts or the :eimlich maneuer9 are unnecessary and potentially dangerous.



:ypothermia

Seere hypothermia 0ody temperature O!/C Q*6-, associated %ith marEed depression of critical 0ody functions

that may maEe the ictim appear clinically dead during the initial assessment

An some cases hypothermia may e(ert a protectie effect on the 0rain and organs in cardiac arrest

An an unresponsie hypothermic pt, :C should assess 0reathing and pulse for !/ to 4 seconds 0ecause

heart rate and 0reathing may 0e ery slo%, depending on the degree of hypothermia.

Af the ictim is not 0reathing, initiate rescue 0reathing immediately.

Af the ictim does not hae a pulse, 0egin chest compressions immediately. Af there is any dou0t a0out

%hether a pulse is present, 0egin compressions.

o not %ait until the ictim is re%armed to start CPR.

Preent further heat loss, remoe %et clothes' insulate or shield the ictim from %ind, cold' and if

possi0le, entilate the ictim %ith %arm, humidified o(ygen.

<oid rough moement.

@ransport the ictim to a hospital as soon as possi0le.

-or the hypothermic patient in cardiac arrest, continue resuscitatie efforts until the patient is ealuated

0y adanced care proiders.

R""B"R& < patient is not dead until he is %arm and dead.

Fomiting 0y the Fictim uring Resuscitation

@he ictim may omit %hen the rescuer performs chest compressions or rescue 0reathing.

< )/5year study in <ustralia, t%o thirds of ictims %ho receied rescue 0reathing and *6 of ictims%ho reuired compressions and entilations omited.

Af omiting occurs, turn the ictimJs mouth to the side and remoe the omitus using your finger, acloth, or suction. Af spinal cord in#ury is possi0le, logroll the ictim so that the head, necE, and torso

are turned as a unit.

CPR in Pregnancy

uring attempted resuscitation of a pregnant %oman, proiders hae t%o potential patients, the mother



and the fetus.

@he 0est hope of fetal surial is maternal surial.

-or the critically ill patient %ho is pregnant, rescuers must proide appropriate resuscitation, %ith

consideration of the physiologic changes due to pregnancy.

<t 2/ %eeEs of gestation and 0eyond, the pregnant uterus can press against the inferior ena caa andthe aorta, impeding enous return and cardiac output.

;terine o0struction of enous return can produce prearrest hypotension or shocE and may precipitatearrest in the critically ill patient.

An cardiac arrest the compromise in enous return and cardiac output 0y the graid uterus limits theeffectieness of chest compressions.

@he graid uterus may 0e shifted a%ay from the inferior ena caa and the aorta 0y placing the

patient ) to !/ 0acE from the left lateral position

or 0y pulling the graid uterus to the side. @his may 0e accomplished manually or 0y placement of a

rolled 0lanEet or other o0#ect under the right hip and lum0ar area.

@o treat the pt&Place the patient in the left lateral position.

1ie )// o(ygen.

"sta0lish intraenous 8AF9 access and gie a fluid 0olus.

Consider reersi0le causes of cardiac arrest and identify any pree(isting medical conditions that may 0ecomplicating the resuscitation.

-oreign5Body <ir%ay >0struction 8ChoEing9

eath from -B<> is an uncommon 0ut preenta0le cause of death.

ost reported cases of -B<> in adults are caused 0y impacted food and occur %hile the ictim is

eating.

ost reported episodes of choEing in infants and children occur during eating or play, %hen parents or

childcare proiders are present.

Commonly %itnessed, and the rescuer usually interenes %hile the ictim is still responsie.

Recognition of -oreign5Body <ir%ay >0struction

Signs of seere air%ay o0struction include&

Signs of poor air e(change and increased 0reathing difficulty.



Silent cough, cyanosis, or ina0ility to speaE or 0reathe.

@he ictim clutches his necE, demonstrating the uniersal choEing sign.

<sE, H<re you choEingNH

Af the ictim indicates HyesH 0y nodding his head %ithout speaEing, this %ill erify that the ictim hasseere air%ay o0struction.

Relief of -oreign5Body <ir%ay >0struction

o not interfere %ith the spontaneous coughing and 0reathing efforts.

<ttempt to reliee the o0struction only if &

the cough 0ecomes silent, respiratory difficulty increases and is accompanied 0y

stridor, or the ictim 0ecomes unresponsie.

<ctiate the "S uicEly if the patient is haing >B. Af more than one rescuer is present, one rescuer

should phone +)) 8))D9 %hile the other rescuer attends to the choEing ictim.

<0dominal thrust must 0e applied in rapid seuence until the o0struction is relieed.

Af a0dominal thrusts are ineffectie, consider chest thrusts.

<0dominal thrusts are not recommended for infants O) year of age 0ecause it may cause in#uries.

Chest thrusts should 0e used instead of a0dominal thrusts for o0ese patients if the rescuer is una0le toencircle the ictimJs a0domen. Af the choEing ictim is in the late stages of pregnancy'

Fictims of -B<> treated %ith a0dominal thrusts should 0e encouraged to undergo an e(amination 0ya physician for in#ury.

Af the adult ictim %ith -B<> 0ecomes unresponsie, carefully support the patient to the ground,

immediately actiate "S, and then 0egin CPR.

:C proider should use finger s%eep only %hen he can see solid material o0structing the air%ay.

Bls Cpr Lecture

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