AHA BLS Provider cheat sheet

Adult out-of-hospital Chain of Survival: recognition and activation of emergency response, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery.

Adult in-hospital Chain of Survival begins with surveillance and prevention of cardiac arrest, then recognition and activation, high-quality CPR, defibrillation, advanced resuscitation, post-arrest care, and recovery.

Pediatric Chain of Survival adds prevention and early high-quality bystander CPR as a distinct link before defibrillation.

High-quality CPR targets a compression rate of 100 to 120 per minute and a compression depth of at least 2 inches (5 cm) for adults, avoiding depth greater than 2.4 inches (6 cm).

Full chest recoil is required after every compression; leaning on the chest between compressions reduces venous return and cardiac output.

Minimize interruptions: keep all pauses in compressions under 10 seconds, including pauses for ventilations, rhythm checks, and AED pad placement.

Compression fraction should exceed 60% of total resuscitation time; the ratio of compressions to ventilations for adults without an advanced airway is 30:2.

For adults with an advanced airway in place, give 1 breath every 6 seconds (10 breaths per minute) with continuous compressions.

Switch the compressor role approximately every 2 minutes, or sooner if fatigued, to limit decay in compression quality.

Verify unresponsiveness and absent or abnormal breathing (no breathing or only gasping) before activating the emergency response system and starting CPR.

Check the carotid pulse for no more than 10 seconds; if unsure whether a pulse is present, begin compressions.

Hand position: heel of one hand on the lower half of the sternum, second hand on top, shoulders directly over the hands with arms straight.

Adult compression-ventilation ratio without an advanced airway is 30:2; with an advanced airway, continuous compressions plus 1 breath every 6 seconds.

Use an AED as soon as available; resume compressions immediately after each shock and do not pause to recheck a pulse until the next rhythm check.

For an adult with an advanced airway, perform a rhythm check approximately every 2 minutes and minimize the pause to under 10 seconds.

Adult BLS sequence: verify scene safety, check responsiveness, activate emergency response and get an AED, check breathing and pulse, begin 30:2 CPR, then defibrillate when the AED arrives.

If a lone rescuer has a mobile phone, call for help while starting CPR; if no phone is available, leave the victim briefly to activate the emergency response system, then return.

Pediatric victims include infants (under 1 year, excluding newly born infants in the delivery room) and children (1 year to puberty).

For a lone rescuer, perform about 2 minutes of CPR before leaving a child or infant to activate the emergency response system, because asphyxial arrest is common.

Compression depth is at least one third of the anterior-posterior chest diameter, roughly 1.5 inches (4 cm) for infants and 2 inches (5 cm) for children.

Infant compressions: two fingers in the center of the chest just below the nipple line, or the two-thumb encircling technique when two or more rescuers are present.

Child compressions: one or two hands on the lower half of the sternum, chosen by rescuer size and the force needed to reach one third of chest depth.

Pediatric compression-ventilation ratio is 30:2 for a single rescuer and 15:2 for two rescuers (infants and children) until an advanced airway is placed.

With an advanced airway in place, give 1 breath every 2 to 3 seconds (20 to 30 breaths per minute) for infants and children with continuous compressions.

For an unresponsive infant or child with a probable foreign-body airway obstruction and no effective cough, give CPR compressions rather than blind finger sweeps.

Infant pulse check: palpate the brachial artery; child pulse check: palpate the carotid or femoral artery, for no more than 10 seconds.

Open the airway with a head tilt-chin lift; use a jaw thrust without head tilt when a cervical spine injury is suspected.

Each rescue breath should be delivered over about 1 second and produce visible chest rise; avoid excessive volume and excessive rate.

Adult rescue breathing without an advanced airway: 1 breath every 6 seconds (10 breaths per minute); for infants and children, 1 breath every 2 to 3 seconds.

If the first breath does not produce chest rise, reopen the airway and attempt a second breath before concluding the airway is obstructed.

Gastric inflation is reduced by delivering breaths just until the chest rises and by avoiding high airway pressures.

Use a pocket mask or bag-mask device with a high-efficiency particulate air filter when available; a bag-mask device delivers approximately 21% oxygen from room air and up to nearly 100% with an oxygen reservoir.

Effective bag-mask ventilation requires an adequate mask seal, a head tilt-chin lift, and squeezing the bag over about 1 second while watching for chest rise.

Oropharyngeal airways are appropriate only in patients without a gag reflex; nasopharyngeal airways may be used when an oropharyngeal airway cannot be inserted.

Suspected opioid overdose with inadequate breathing: give rescue breaths and administer naloxone, then continue CPR if the pulse is absent.

Turn on the AED and follow its prompts; attach pads to a bare, dry chest, one below the right clavicle and one on the left lateral chest below the axilla.

Anterolateral placement is the standard; anteroposterior placement is an acceptable alternative.

Clear everyone from the patient before the AED analyzes the rhythm and before delivery of a shock.

Resume chest compressions immediately after a shock or after a no-shock advisory, and do not delay CPR to recheck a pulse.

Remove transdermal medication patches from the pad sites and wipe away moisture; do not place pads over an implanted pacemaker or defibrillator generator.

Hairy chests may prevent adequate pad contact; if pads do not adhere, quickly shave or use a second set of pads.

AEDs are safe to use on a wet chest after moving the patient from standing water and drying the chest; do not use an AED in a flammable atmosphere.

For a victim with a pacemaker or implantable defibrillator, place pads at least 1 inch (2.5 cm) away from the device.

Do not use an AED on a patient with a palpable pulse; the device is intended for victims in cardiac arrest with a shockable rhythm.

Closed-loop communication: the team leader directs a specific person by name and the receiver confirms the message and reports back when the task is complete.

Roles in a resuscitation team include compressor, airway/ventilation, monitor/defibrillator, IV/IO and medications, timekeeper/recorder, and team leader.

A clear handoff and shared mental model reduce duplication and error; the team leader should assign roles explicitly and confirm understanding.

Constructive intervention: any team member may speak up when a harmful action is observed, and the leader should acknowledge and correct it.

Opioid-associated emergency: check for responsiveness and breathing; if breathing is inadequate but a pulse is present, give rescue breaths and administer naloxone.

Naloxone can be given intranasally or by intramuscular injection and may be repeated if breathing does not improve; it has no effect on cardiac arrest.

If the opioid-overdose victim is unresponsive with no pulse or only gasping, begin CPR and use an AED; naloxone is not a substitute for CPR.

After naloxone, continue to monitor breathing because its duration may be shorter than that of the opioid, and renarcotization can occur.

Debriefing after a resuscitation, focused on what went well and what to improve, supports team performance and quality improvement.