Notes

During this lesson, you’ll learn the BLS procedure for a one-person adult rescue. In this lesson, the BLS procedure is divided into the following steps:
Verify the scene is safe.
Check for responsiveness.
Simultaneously check pulse and breathing and determine next action.
Perform high-quality CPR.
Attempt defibrillation.
Assist to recovery position.

Personal Protective Equipment
Whenever dealing with an emergency, rescuers should use personal protective equipment, or PPE. PPE is specialized clothing and equipment that prevents direct contact with potentially infectious materials. PPE can include gloves, breathing barriers, shirts, pants, face shields, and protective eyewear.

Step 1 - Verify the Scene is Safe replay
Survey the scene around the victim and verify that it's safe to approach. Is there evidence of a fire or a gas leak nearby? Is anyone holding a weapon? Are the victim’s hands concealed? If the scene doesn't seem safe to approach, back off and activate the emergency response system. Don't take any action that might lead to you also becoming a victim.
Also, observe the victim, which includes looking for life-threatening bleeding. Life-threatening bleeding should be treated immediately. Look for clues as to what may have caused the emergency. Ask bystanders what happened.

Step 2 – Check for Responsiveness replay
Tap the victim's shoulder and ask loudly, "Are you OK?"
If the victim does not respond and you are alone, shout for nearby help.
Note: Lack of oxygen to the brain can cause movements that make a victim appear to be conscious, such as the quick raising of arms. Do not mistake these movements for a response.
Activate the emergency response system appropriate to the setting. For example, in a health facility you may need to activate a specific code. In a public setting, you may need to call 911.
If someone answers the call for help, send that person to retrieve an AED. Otherwise, if you are alone, leave the patient and retrieve an AED.


Step 3 – Simultaneously Check Pulse and Breathing
Position the victim:
Make sure the victim is in the supine, or face-up, position. If the victim needs to be rolled, take care not to worsen any suspected injury.
Give the victim a chance to breathe by opening their airway using the head-tilt/chin-lift technique:
Place one hand on the victim’s forehead and the fingers of the other hand on the bony part of the lower jaw by the chin. replay
Tilt the forehead back, lift the chin, and open the mouth.
The head should be slightly past neutral with a slight flex in the neck. Avoid a hyperextension of the neck.
If spinal trauma is suspected, use the jaw-thrust technique.

Step 3 - Simultaneously Check Pulse and Breathing (continued)
Check for a carotid artery pulse.
Use two or three fingers to locate the trachea on the side closest to you.
Slide these fingers down in between the trachea and the muscle at the side of the neck to feel for a carotid pulse.
At the same time, check for normal breathing.
Look at the chest for a consistent rise and fall. During normal breathing, the chest will rise and fall about two times every 10 seconds.
The victim may experience agonal respiration, which is characterized by snorting or groans, strange vocalizations, and jaw and head movement. Agonal respiration is not normal breathing.
Feel for a pulse and check for normal breathing for at least 5 seconds but no longer than 10 seconds.

Determine Next Action
The pulse and breathing checks are used to determine the next course of action:
If the victim is breathing normally and has a definite pulse, do not begin CPR. Place the victim in the recovery position and monitor. Re-evaluate their pulse and breathing every 2 minutes.
If the victim has a definite pulse but no normal breathing:
Give one rescue breath every 5 to 6 seconds, or about 10 to 12 breaths per minute. Each breath should last about one second. (Lesson 4 provides more information on rescue breathing.)
If an opioid overdose is suspected, administer naloxone according to local protocol. Naloxone is a drug that can reverse the effects of the opioid. (Lesson 6 provides more information about opioid overdoses.)
Re-evaluate their pulse and breathing every 2 minutes.
If the victim lacks a pulse and normal breathing, the victim is in cardiac arrest – begin CPR

Step 4 – Perform High-Quality CPR
At this point, the emergency response system is activated and an AED is being retrieved.
Perform high-quality adult CPR until an AED is available:
Generally, the victim should not be moved. However, if their current position or location does not allow for effective CPR, move them as needed.
Expose the victim’s chest to bare skin. Any type of clothing or under garments will hinder CPR and the use of an AED.
Perform chest compressions and rescue breaths at a ratio of 30 compressions to 2 breaths, or 30:2. Do not stop chest compressions for longer than 10 seconds to give rescue breaths. replay
Continue CPR until one of the following occurs:
An AED becomes available.
The victim shows signs of ROSC.
Care is transferred to an advanced life support team.
You are unable to continue because of exhaustion or the scene becomes unsafe.
A valid document stating that resuscitation should be stopped is presented.

Step 5 – Attempt Defibrillation
When an AED is available, it should be used immediately. Follow all the prompts provided by the AED. The general procedure is:
Turn on the AED.
Attach the AED electrical pads.
Check for a shockable rhythm.
If the heart rhythm is shockable, deliver one shock.
After delivering a shock, or if the rhythm is not shockable, immediately start CPR.
After about 2 minutes, the AED will request to check the rhythm again.
When the AED is checking the heart’s rhythm or delivering a shock, the rescuer should stop working on the victim and stand clear.

Step 6 – Assist to Recovery Position
If the victim begins to show signs of ROSC, such as coughing, normal breathing, or movement, assist the victim to the recovery position. Always follow local protocols, but generally use the following procedure:
Place the arm that is closest to you straight out from the body.
Bend the other arm across the chest with the back of the hand against the opposite cheek.
Bend the victim’s knee that is farthest from you.
Pull the knee toward you and roll the victim to the side. Be sure to protect the victim's head with your hand by keeping the head in line with the spine.
Tilt the head slightly upward on the back of the victim’s hand. This will keep the airway open.