After completing this course, you should have an understanding of:

 the purpose of conducting cardiopulmonary resuscitation (CPR)

 the steps involved in conducting effective basic life support
 how to assess a situation, identify dangers and call for help
 different techniques to clear a patient’s airway and assess breathing
 how to perform chest compressions and rescue breathing
 procedures and risks for using an automatic external defibrillator, and
 the steps involved in the techniques of CPR with a stoma.

 Basic life support

 This course is based on the Australian Resuscitation Council (ARC) guidelines.
 In order to successfully complete this basic life support (BLS) course you need to achieve a
mark of 100%.
 Following successful completion of this course it is expected that you will then undergo a
face-to-face clinical assessment by an approved assessor. Health care workers are expected
to undertake this combined theoretical and clinical BLS assessment process annually.
 Cardiopulmonary resuscitation, or CPR, is the technique of chest compressions combined
with rescue breathing. It is an essential component of basic life support.
 Keep in mind, the primary purpose of CPR is to temporarily maintain a circulation sufficient to
preserve brain function until specialised treatment is available. All of the steps involved with
conducting effective BLS are aimed at achieving this outcome.
The first thing you need to know about basic life support is that all the information in the process is
covered by:
 Danger
 Responsive
 Send for help
 Open Airway
 Normal Breathing
 Start CPR, and
 Attach Defibrillator.
During this course, we're going to look at each of these stages and identify what you need to do in
each stage.
Dangers are also referred to as hazards and they can take on many different forms and appearances.
Dangers may include:
 manual handling
 access issues
 blood and bodily fluids
 smoke
 escaping gas
 broken glass
 electrical dangers
 sharps, and
 weapons.
If you assess the situation and find there is danger present, then you need to act. Depending on the
situation, you can:
 remove the danger, or
 remove the patient from the danger.
In order to manage the danger, you may need to ask for help from other people or staff in the vicinity.
The most important thing in relation to danger is that you must never put yourself, or others, at risk.
If you try to remove someone from danger, and end up becoming a second patient, the situation is
only getting worse, not better.
Personal protective equipment

During an emergency, you should assess the risk to yourself and take necessary precautions.
This means wearing appropriate personal protective equipment (PPE) to minimise the risk of
exposure to dangers, such as blood and other bodily fluids. PPE may include face shields, gloves and
gowns.
In order to put on PPE quickly, you should know where all of this equipment is kept. Make sure you
become familiar with the location of PPE when you first start in a new work area, and follow all
relevant standard precautions when you are providing care to a patient.
When checking for a response, undertake a rapid assessment to determine if the patient is conscious
or unconscious. ‘Talk and Touch’ is used to assess a response. For example, to assess verbal
stimulus you might say:
 ‘open your eyes’
 ‘squeeze my hand and let it go’, or
 ‘can you hear me?’
Tactile stimulus

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If the patient displays no response to the verbal stimulus, initiate a tactile stimulus by firmly squeezing
the patient’s shoulders.
It's important to remember that this should not exacerbate an existing injury, or cause further injury.
A patient showing no response, or responding with only minor signs, such as groaning without eye
opening, should be managed as if they are unconscious.
Send for help

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Depending on the situation you find yourself in, sending for help may include:
 calling a code response
 calling for assistance from other staff
 phoning ‘000’, or
 asking another competent person to phone ‘000’ in a community setting.

There will be a different procedure for responding to emergencies in each organisation, and it's
important that you are familiar with the procedure in your workplace.
If you are unsure of the procedure in your organisation, make sure you find out from your manager or
supervisor.
Send for help

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Depending on the situation you find yourself in, sending for help may include:
 calling a code response
 calling for assistance from other staff
 phoning ‘000’, or
 asking another competent person to phone ‘000’ in a community setting.

There will be a different procedure for responding to emergencies in each organisation, and it's
important that you are familiar with the procedure in your workplace.
If you are unsure of the procedure in your organisation, make sure you find out from your manager or
supervisor.

An unconscious patient is further at risk because they are unable to swallow or cough out
foreign material in the airway. This may cause airway obstruction, or laryngeal irritation and
foreign material may enter the lungs. (ARC 2012) Assessing the airway

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In an unconscious patient, care of the airway takes precedence over any injury, including the
possibility of spinal injury.
This means when assessing the airway:
1. leave the patient on their back or in the position in which they have been found, and
2. you do not routinely roll the unconscious patient onto their side to assess the airway.
If you must move the patient, for example for safety reasons, ensure they are handled gently with no
twisting or bending of the spinal column and especially the neck.
If the patient is face down you will need to move the patient to access the airway.
Fluid in the airway

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Although it is important to avoid wasting time in positioning an unconscious patient to assess the
airway, there is one exception to this rule.
In submersion injuries or where the airway is obstructed with fluid, for example, vomit or blood, the
patient should be promptly rolled onto the side to clear the airway. This is looked at more closely in
advanced life support and is not covered in this course.
In the clinical setting the patient should only be rolled onto their side if suctioning is not available.
However, only those trained in correct suctioning techniques and who understand potential
complications should undertake the suction procedure.
Clearing the airway

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Once you've positioned the patient so the airway is open, it is then essential to check the airway
patency.
Foreign objects, such as teeth, dentures, or food should be removed if they are blocking patency.
Suction can then be applied to the oropharynx to clear secretions if necessary.
The finger sweep can be used in the unconscious patient with an obstructed airway if solid material is
visible.
Airway management

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Airway management is required to provide an open airway when the patient is unconscious or has an
obstructed airway.
For unresponsive adults and children, you should open the airway using the head tilt, chin lift
manoeuvre, which involves:
 placing one hand on the forehead, or the top of the head, and
 using the other hand to lift the chin.

Look at the diagram to see the correct manoeuvre.

Please note the head is tilted backwards, not the neck. It is also important to avoid excessive force,
especially where a neck injury is suspected.
An alternative technique for head tilt, chin lift

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Let’s explore another technique for performing a head tilt, chin lift.
This technique involves placing the thumb over the chin, below the lip, and supporting the tip of the
jaw with the middle finger. The index finger lies along the jaw line.
Care is required to prevent the ring finger from squashing soft neck tissues, as the jaw is held open
slightly and pulled away from the chest.
In this technique, the chin is held up by the rescuer’s thumb and fingers so the mouth can be opened,
and the tongue and soft tissues are pulled away from the back of the throat.
Airway management for infants

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For infants, the head should be kept neutral and maximum head tilt should not be used.
The lower jaw should be supported at the point of the chin with the mouth kept open. There must be
no pressure on the soft tissues of the neck.
If this doesn’t clear the airway, the head may be tilted backwards very slightly with a gentle
movement.
Maintaining airway patency with an oropharyngeal airway

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If required, an oropharyngeal airway may be inserted by trained staff to help maintain a patient's
airway when they are unconscious.
An oropharyngeal airway is a rigid, plastic, semi-circular shaped device that is used only in
unconscious patients who lack a gag reflex.
Potential complications

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The oropharyngeal airway must be the correct size for the patient. If it is the wrong size it will impair
airway patency. The correct size can be determined by measuring the length of the oropharyngeal
airway from the corner of the mouth to the tip of the earlobe.
The OPA is sized by measuring from the centre of the mouth to the angle of the jaw, or from the
corner of the mouth to the earlobe.
Potential complications of inserting an oropharyngeal airway include:
 laryngospasm, or
 vomiting with aspiration in patients who still have a gag reflex.
1st method of inserting an oropharyngeal airway

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Only staff trained in oropharyngeal airway insertion should undertake an insertion procedure.
There are two correct ways to insert an oropharyngeal airway.
The first method requires the airway to be inserted upside-down with the open curve of the ‘C’ facing
the top of the head, as shown in picture A. The airway is then rotated gently through 180 degrees so
the airway matches the natural tongue curve after placement, as shown in pictures C and D.
The major risk with this approach is damaging the mouth and tongue when the airway is rotated.
2nd method of inserting an oropharyngeal airway

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The second method of inserting an oropharyngeal airway is to insert the airway laterally with the open
curve of the ‘C’ facing an ear, as shown here in picture A. Once you've partially inserted the airway,
you then need to rotate it 90 degrees so that airway matches the natural tongue curve after
placement, as shown in pictures B and C.
No matter which method you choose you must ensure you do not push the tongue backwards as this
will occlude the airway.
Remember, only those trained in this technique should undertake the insertion of an oropharyngeal
airway.
When you assess breathing, you need to look, listen and feel. You should:
 look for movement of the upper abdomen or lower chest
 listen for the escape of air from nose and mouth, and
 feel for movement of the chest and upper abdomen and feel for the movement of air from the
mouth on your cheek.
Remember to maintain airway patency with head tilt, chin lift techniques while you are checking for
breathing. The patient may be trying to breathe but will be unable to if their airway is blocked.
If a patient is breathing

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The Australian Resuscitation Guidelines, Managing Emergencies (November 2012), state that all
unconscious patients breathing normally should be placed gently on their side in the recovery
position, with no twisting or bending of the spinal column and especially the neck.
As you do this, you will need to support the head to keep the airway open. Use head tilt and chin lift to
achieve this. Supplemental oxygen should be applied when available.
Support and reassess the patient

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Where possible, 3 or more people can be used to support the head and neck, chest, pelvis and limbs
of the person when moving them.
Even though you've established that the patient is breathing, it is important to remain with them and
continuously check and reassess airway patency and breathing.
The recovery position should be administered by one person only, unless you suspect a spinal injury.
If trained in the appropriate method of assisting a spinal injury one person can assist with the recovery
position as required.
If a patient is not breathing, start CPR

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Do not check or rely on peripheral pulses, as they are unreliable and should not be used to confirm
the need for resuscitation. If a patient if not breathing begin cardiopulmonary resuscitation (CPR).
If full CPR is initiated, the internationally accepted compression to ventilation ratio is 30:2 for all ages,
regardless of the number of rescuers present. This means for every 30 compressions, the rescuer
gives two breaths, then the process is repeated. Aim for approximately 100 chest compressions per
minute or almost two compressions per second.
Chest compressions and rescue breathing for advanced life
support (ALS)
60%

Please note that in advanced life support (ALS), the order and rate in which the rescuers carry out
chest compressions and rescue breathing may vary for children and infants.
However, this training is specifically aimed at the provision of basic life support (BLS), where the
recommended order and rate of compression to ventilation for all ages is 30:2.
Let’s explore CPR in adults, children and infants in more detail.
Positioning for CPR

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To perform chest compressions on adults:

 place the patient on their back on a firm surface, for example, a backboard or floor, to optimise
the effectiveness of compressions
 locate the lower half of the sternum. Avoid compression beyond the lower limit of the sternum.
Compression applied too high is ineffective and if applied too low may cause regurgitation or
damage to internal organs, and
 place the heel of one hand in the centre of the chest with the other hand on top, and interlace
fingers as shown in pictures A and B.

Your shoulders must be directly above the patient's sternum, as shown in picture C.
Performing compressions on adults

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Once in position, to perform compression on adults you should:

 compress the lower half of the sternum approximately one third of the depth of the chest with
each compression, which equates to more than 5cm in adults
 give 30 chest compressions followed by two breaths, and allow complete recoil of the chest after
each compression, and
 minimise interruptions to chest compressions as compressions should be rhythmic with equal
time for compression and relaxation.

The rescuer must avoid rocking backwards and forwards, or using thumps and quick jabs.
CPR for children – BLS recommendations

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If the patient is a child, unresponsive, and not breathing normally, the rescuer must apply the
recommended order and rate of compression to ventilation of 30:2.
Where the rescuers are two healthcare professionals a ratio of 15:2 is used except in the instance of
the patient being a newborn.
Either a one-handed technique, as shown in picture A, or two-handed technique, as shown in picture
B, can be used for performing chest compressions in children.
You still compress the lower half of the sternum approximately one third of the depth of the chest with
each compression. In children, this equates to about 5cm.
CPR for infants – BLS recommendations

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If the patient is an infant, unresponsive, and not breathing normally, the BLS rate of compression to
ventilation is the same as for all ages, 30:2, aiming for approximately 100 compressions per minute.
However, the two-finger technique should be used, as shown in this picture.
Where the rescuers are two healthcare professionals a ratio of 15:2 is used except in the instance of
the patient being a newborn.
The rescuer places two fingers on the lower half of the infant’s sternum and compresses the chest
one third of the depth of the chest. This equates to about 4cm in infants.
Chest compressions without rescue breathing

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Rescuers who are unwilling or unable to do rescue breathing should do chest compressions alone.
If only chest compressions are given, they should be continuous at a rate of approximately 100 per
minute.
Rescue breathing in CPR

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There are a number of ways to perform rescue breathing, including:

 mouth to mouth, with or without a face shield, as shown in picture A
 mouth to mask, as shown in picture B
 bag and mask, as shown in picture C
 mouth to nose, as shown in picture D, and
 mouth to stoma as shown in picture E.

Most health, community and aged care organisations discourage staff from performing mouth to
mouth breathing during CPR, and staff may be unwilling or unable to perform mouth to mouth
breathing.
You should check your organisation’s CPR and BLS policy and procedure for further information.
The most common and accessible method for performing rescuing breathing is mouth to mask, and
this is the only technique we will cover in this course.
Mouth to mask resuscitation is a method of rescue breathing, which avoids mouth to mouth contact by
the use of a resuscitation mask.
The procedure for using a resuscitation mask will vary slightly according to the situation you are in.
For example, in a hospital or a client’s house, and having one or two rescuers.
No matter what the situation, the basic steps to carry out mouth to mask rescue breathing are
essentially the same.
Mouth to mask rescue breathing

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To carry out mouth to mask rescue breathing you should:

 position yourself either beside the patient or at the patient’s head
 use both hands to maintain an open airway and hold the mask in place to maximise the seal
 maintain head tilt and chin lift
 place the narrow end of the mask on the bridge of the nose and apply the mask firmly to the face,
and
 inflate the lungs by blowing through the mouthpiece of the mask with sufficient volume and force
to achieve chest movement.
Exhalation during rescue breathing

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After blowing into the mouthpiece and inflating the lungs you should:
 remove your mouth from the mask to allow exhalation, and
 turn your head to listen and feel for the escape of air.

If the chest does not rise, recheck head tilt, chin lift and mask seal before repeating the process.
Failure to maintain head tilt and chin lift is the most common cause of obstruction during resuscitation.
Two people performing CPR

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When two people are performing CPR, it is important to work together as a team.
Rescuers are encouraged to swap roles as the person performing compressions will tire quickly, and
this in turn reduces the efficacy of compressions. The rescuers should frequently swap roles,
changing over every 3 to 5 cycles of 30 compressions to 2 breaths.
It's important to make sure that when you do change over, there's no pause in the compressions. To
achieve this, the best approach is for the rescuer at the head to move to the opposite side of the chest
immediately after giving 2 rescue breaths.
Defibrillation using an AED on an adult or patient above 25 kg

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When providing BLS, it is of great importance to attach the AED pads to the patient as early as
possible for rhythm detection and interpretation.
Turn the AED on, and then the AED will provide instructions to apply the pads with chest leads to the
patient’s chest.
The pads are to be placed on the upper right chest and lower left ribs for adults. The correct pad
placement is pictured on the pads.
Once the pads have been placed, the AED will give you directions on what you need to do next.
Defibrillation using an AED on an infant / child patient under 25
kg

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When providing BLS, it is of great importance to attach the infant AED pads to the patient as early as
possible for rhythm detection and interpretation.
Turn the AED on, and then the AED will provide instructions to apply the pads with chest leads to the
patient’s chest. The pads are to be placed on the upper right chest and lower left ribs for adults. The
correct pad placement is pictured on the pads.
Once the pads have been placed, the AED will give you directions on what you need to do next.
A safe environment for safe defibrillation

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Rescuer and patient safety is paramount when performing defibrillation. When using an AED, it is vital
that you are aware of the various safety issues.
Before providing basic life support you need to secure a safe environment by ensuring the
surroundings are free from moisture and flammable materials.
You should consider the safety of:
 patients
 rescuers, and
 bystanders.

Let’s take a look at defibrillation techniques for use on adults.

When placing pads you should:
 minimise all delays to shock delivery as a priority, but also recognise a need to remove moisture
and excessive hair prior to the application of pads
 remove any medication patches and wipe the area before applying the pad, as patches may block
the delivery of energy from the electrode pad and cause small burns to the skin, and
 remove bras because the defibrillator may cause the bra wire to burn.
When removing any clothing item, for example, a bra, ensure the privacy and dignity of the patient is
maintained.
Things to avoid when placing pads

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When you are placing pads you must further ensure patient safety by:
 not placing pads over implantable devices, such as pacemakers – if there is an implantable
device the pads should be placed at least 8cm from the device, and
 not placing the pads over items, such as jewellery, ECG electrodes and leads, ports, and
medication patches as the shock can be inhibited or a burn to the skin may result.
The rescuers’ safety during defibrillation

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The rescuers’ safety must always be considered before administering a shock from the AED. If a
shock is to be delivered, all rescuers must stand clear until this has occurred. Each person should
have their hand up, indicating they are clear from the patient, and take one step back.
The healthcare rescuer must advise all people to ‘stand clear’ and confirm the safe environment by
performing a 360 degree visual check around the patient and attached equipment.
Once you have checked that nobody is touching the patient or equipment, you can push the shock
button. Fully automatic AEDs will deliver the shock automatically.
Immediately after the shock has ceased, restart CPR.
When do you stop performing chest compressions?

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Sometimes it is clear to see that a patient is recovered and showing signs of life. If this happens, BLS
can be stopped and the patient may be placed in the recovery position. Do this gently with no twisting
or bending of the spinal column, especially the neck, and ensure the patient is monitored continuously
after they have recovered.
Unfortunately, sometimes the rescuer has no-one to help them, or help is just too far away.
Performing CPR can be an extremely physical activity, and if help doesn't arrive in time, sheer
exhaustion of the rescuer may prevent BLS from continuing.
Reflecting on the situation

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After an incident you may be required to help emergency services with an assessment of the
situation. This could involve:
 describing the situation
 recalling techniques that were used during the response, and
 discussing your actions.

If you find yourself analysing your own performance, and feeling emotionally affected by your
involvement in the response you may benefit from counselling and contact with support services.
Talk to your local practitioner, employer or a relevant government organisation if you need assistance.
Assessment

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You should now have a good understanding of CPR and defibrillation.

Before we move on you'll need to complete a short multiple-choice assessment. You'll need to pass it
to complete the course.
Click 'Next' when you're ready to begin.
DRSABCD

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DRSABCD covers the following steps:

 Danger – ensuring your safety, and the safety of the patient and bystanders
 Responsive – checking the patient for a response
 Send for help – raising awareness by shouting or calling a code response
 Open Airway – allowing air into the lungs
 Normal Breathing – looking, listening and feeling for breathing; if breathing is normal, put the
patient in the recovery position, but if not, start compressions
 Starting CPR – using the recommended compression to ventilation rate of 30 compressions
followed by 2 rescue breaths for all ages, and
 Attach Defibrillator – using an AED as soon as available and following the prompts.
What we’ve covered

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You should now have a good understanding of:

 the purpose of cardiopulmonary resuscitation (CPR)
 the steps involved in conducting effective basic life support
 how to assess a situation, identify dangers and call for help
 different techniques to clear a patient’s airway and assess breathing
 how to perform chest compressions and rescue breathing, and
 risks and procedures for using an AED (automatic external defibrillator).