PALS: BLS for Healthcare Providers

Recommended CPR sequence

[CABD: Circulation, Airway, Breathing, Defibrillation as soon as possible]

[Circulation]

Info: compressions are given before ventilations, using compression:ventilation ratios shown below

[Airway]

Info: use head tilt-chin lift in non-injured or injured patients; if suspected cervical spine trauma, use jaw thrust without head extension; if jaw thrust inadequately opens airway, use head tilt-chin lift technique; verify adequate chest rise or breathing

foreign-body airway obstruction: check for signs of severe FBAO (weak or absence of cough, unable to cry/talk, cyanosis, altered mental status, apnea); give 5 back blows followed by 5 chest thrust (infant) or abdominal thrust (child), repeat until object is expelled; if infant/child becomes unresponsive, start CPR until EMS arrives

[Breathing]

Info: compressions are given before ventilations; give each breath over 1sec; verify adequate chest rise, reposition if needed; mouth-to-mouth-and-nose technique preferred for infants; ventilation rate for rescue breaths only (pulse present), give 1 breath q2-3sec (20-30 breaths/min), assess pulse rate after 2min

[Defibrillation]

Info: use pediatric attenuator if available in children <8 yo; use largest paddles/pads to fit on patient's chest while maintaining good separation between them; use anteroposterior or anterolateral pad placement; AED analyzes rhythm; if shockable rhythm, give 1 shock, resume CPR x2min or until AED prompts for rhythm check, continue until EMS takes over or victim starts to move; if non-shockable rhythm, resume CPR immediately x2min or until AED prompts for rhythm check, continue until EMS takes over or victim starts to move

High-Quality CPR for Infants 1-12 mo

[initial response]

witnessed or unwitnessed collapse: verify scene safety; check for responsiveness; shout for nearby help and activate emergency response system via mobile device if appropriate; get defibrillator or AED; look for no breathing or only gasping; simultaneously check brachial pulse; if pulse not definitively felt, start CPR within 10sec; Info: perform actions simultaneously if 2 or more rescuers or rescue team

[compression-ventilation ratio without advanced airway]

Info: if 1 rescuer, use 30:2; if 2 rescuers, use 15:2

[compression-ventilation ratio with advanced airway]

Info: perform 100-120 continuous compressions/min; give 1 breath q2-3sec (20-30 breaths/min)

[compression rate]

Info: 100-120 compressions/min

[compression depth]

Info: at least 1/3 anterior-posterior diameter of chest (1.5 inches or 4 cm)

[hand placement]

Info: use 2 thumb-encircling hands technique with hands at center of chest, just below nipple line; if rescuer cannot physically encircle chest, use 1-hand technique with heel of 1 hand on sternum

[chest recoil]

Info: allow full recoil after each compression

[minimize interruptions]

Info: limit interruptions in chest compressions <10sec

[ventilation rate abnormal or breathing absent, but pulse present]

Info: provide rescue breathing 1 breath q2-3sec (20-30 breaths/min); add compressions if pulse 60/min or less with signs of poor perfusion; check pulse q2min; if no pulse, begin CPR; if suspected opioid overdose, administer opioid antagonist if available

High-Quality CPR for Children 1 yo - puberty

[initial response]

witnessed or unwitnessed collapse: verify scene safety; check for responsiveness; shout for nearby help and activate emergency response system via mobile device if appropriate; get defibrillator or AED; look for no breathing or only gasping; simultaneously check carotid pulse; if pulse not definitively felt, start CPR within 10sec; Info: perform actions simultaneously if 2 or more rescuers or rescue team

[compression-ventilation ratio without advanced airway]

Info: if 1 rescuer, use 30:2; if 2 rescuers, use 15:2

[compression-ventilation ratio with advanced airway]

Info: perform 100-120 continuous compressions/min; give 1 breath q2-3sec (20-30 breaths/min)

[compression rate]

Info: 100-120 compressions/min

[compression depth]

Info: at least 1/3 anterior-posterior diameter of chest (2 inches or 5 cm)

[hand placement]

Info: 2 hands or 1 hand (optional for very small child) on lower half of sternum

[chest recoil]

Info: allow full recoil after each compression

[minimize interruptions]

Info: limit interruptions in chest compressions <10sec

[ventilation rate abnormal or breathing absent, but pulse present]

Info: provide rescue breathing 1 breath q2-3sec (20-30 breaths/min); add compressions if pulse 60/min or less with signs of poor perfusion; check pulse q2min; if no pulse, begin CPR; if suspected opioid overdose, administer opioid antagonist if available

High-Quality CPR for Adolescents

[initial response]

witnessed or unwitnessed collapse: verify scene safety; check for responsiveness; shout for nearby help and activate emergency response system via mobile device if appropriate; get defibrillator or AED; look for no breathing or only gasping; simultaneously check carotid pulse; if pulse not definitively felt, start CPR within 10sec; Info: perform actions simultaneously if 2 or more rescuers or rescue team

[compression-ventilation ratio without advanced airway]

Info: if 1 or 2 rescuers, use 30:2

[compression-ventilation ratio with advanced airway]

Info: perform 100-120 continuous compressions/min; give 1 breath q6sec (10 breaths/min)

[compression rate]

Info: 100-120 compressions/min

[compression depth]

Info: at least 2 inches (5 cm)

[hand placement]

Info: 2 hands on lower half of sternum

[chest recoil]

Info: allow full recoil after each compression

[minimize interruptions]

Info: limit interruptions in chest compressions <10sec

[ventilation rate abnormal or breathing absent, but pulse present]

Info: provide rescue breathing 1 breath q6sec (10 breaths/min); add compressions if pulse 60/min or less with signs of poor perfusion; check pulse q2min; if no pulse, begin CPR; if suspected opioid overdose, administer opioid antagonist if available