Sequence of actions for adult BLS

For the purposes of these guidelines an adult is considered to be any individual 8 years of age or older. The male pronoun has been used for ease of reading.

If you are alone:
Check that it is safe to approach, ensuring safety of rescuer and client	To prevent injury to self
Check the client and see if he responds. Gently shake his shoulders and ask loudly: ‘Are you all right?’	To ensure that the client has not merely fainted
If he responds by answering or moving leave him in the position in which you find him (provided he is not in further danger), check his condition, get assistance if needed and reassess him regularly
If he does not respond shout for help	To alert others and to increase the client’s chances of recovery
Unless you can assess the client fully in the position you find him, turn him onto his back and open his airway by placing your hand on his forehead and gently tilting his head back, keeping your thumb and index finger free to close his nose if rescue breathing is required
Remove any visible obstruction from the client’s mouth, including any dislodged dentures. Leave well-fitting dentures in place, and, with your fingertips under the tip of the client’s chin, lift the chin to open the airway. Avoid tilting the head if injury to the neck is suspected	To open the airway Well-fitting dentures can assist in obtaining a seal To avoid further injury (see ‘Cervical spine injury’)
Keeping the airway open, look, listen and feel for breathing (as described in Chapter 1)	To ensure absence of breathing
If he is breathing normally turn him into the recovery position (see Chapter 2) and send or go for help. Check for continued breathing	To maintain airway
If the client is not breathing or is only making occasional gasps or weak attempts at breathing send someone for help or, if you are on your own, leave the client and go for help. On return start rescue breathing as described in Chapter 1. Do not make more than five attempts in all to achieve two effective breaths. Even if unsuccessful, move on to assessment of the circulation	To ensure that others are alerted Failure to restore circulation if absent will increase the potential for cerebral damage
Assess the client for signs of a circulation. Only if you have been trained to do so, check the carotid pulse, taking no more than 10 seconds to do this	To ascertain whether cardiac massage is required
If you are confident that you have detected signs of circulation continue rescue breathing until the client starts breathing on his own. About every 10 breaths (or about every minute) recheck for signs of a circulation; take no more than 10 seconds each time. If the client starts to breathe normally on his own but remains unconscious, turn him into the recovery position. Be ready to turn him on to his back and restart rescue breathing if he stops breathing	To maintain oxygenation To maintain airway
If there are no signs of a circulation, or you are at all unsure, start chest compressions. With your hand that is nearest the client’s feet, locate the lower half of the sternum (breastbone)	To restore circulation
Using your index and middle fingers, identify the lower rib edge nearest to you. Keeping your fingers together, slide them upwards to the point where the ribs join the sternum. With your middle finger on this point, place your index finger on the sternum itself.
Slide the heel of your other hand down the sternum until it reaches your index finger; this should be the middle of the lower half of the sternum. Place the heel of the other hand on top of the first. Extend or interlock the fingers of both hands and lift them to ensure that pressure is not applied over the client’s ribs.
Do not apply any pressure over the upper abdomen or bottom tip of the sternum. Position yourself vertically above the client’s chest and, with your arms straight, press down on the sternum to depress it 4–5 cm. Release all the pressure without losing contact between the hand and sternum, then repeat at a rate of about 100 times a minute (a little less than two compressions a second); it may be helpful to count aloud. Compression and release should take an equal amount of time	To prevent further injury and ensure that pressure is applied in the most effective place
Combine rescue breathing and chest compression. After 15 compressions tilt the head, lift the chin, and give two effective breaths	To oxygenate the blood
Return your hands without delay to the correct position on the sternum and give 15 further compressions, continuing compressions and breaths in a ratio of 15:2	Only stop to recheck for signs of a circulation if the client makes a movement or takes a spontaneous breath; otherwise resuscitation should not be interrupted
Continue resuscitation until: qualified help arrives and takes over; or the client shows signs of life; or you become exhausted

Resuscitation with two persons: Two-person cardiopulmonary resuscitation (CPR) is less tiring than single-person CPR. However, it is important that both rescuers are proficient and practised in the technique. It is therefore recommended that this technique is only used by trained healthcare providers and those lay persons who are members of trained teams, such as first aid and rescue organizations.

• Summon help: this may mean that one rescuer has to start CPR alone whilst the other leaves to find a telephone.

• A ratio of 15 compressions to 2 inflations should be used. By the end of each series of 15 compressions, the rescuer responsible for ventilation should be positioned ready to give 2 inflations with the least possible delay. It is helpful if the rescuer giving compressions counts out aloud. It is preferable that the rescuers work from opposite sides of the client.

• Chin lift and head tilt should be maintained at all times as in Chapter 1, ‘Maintenance of an airway’. Ventilations should take 2 seconds each during which chest compressions should cease. Compressions should be resumed immediately after the second inflation of the chest, waiting only for the rescuer to remove his or her lips from the client’s face to maintain patency of airway.

• If the rescuers wish to change places, usually because the one giving compressions becomes tired, this should be undertaken as quickly and smoothly as possible. Resuscitation SHOULD NOT BE INTERRUPTED.