I-22 Circulation December 13. 2005 No movement or response PHONE 911 or emergency number or send second rescuer(if available) to do this Open AIRWAY, check BREATHING If not breathing, give 2 BREATHS that make chest ns Do you DEFINITELY feel pulse within 10 seconds? Recheck pulse every Figure 2. Adult BLS Healthcar No Pulse Algorithm Boxes bordered wit nes indicate actions or steps Give cycles of 30 COMPRESSIONS and 2 BREATHS by the healthcare provider but not the until AED/defibrillator arrives, ALS providers take over, or victim starts to move Push hard and fast (100/min) and release completely Minimize interruptions in compressions AED/defibrillator ARRIVES Shockable rhythm? Give 1 shock Resume CPR immediately resume CPR immediately for 5 cycles providers take over or victim starts to move craniofacial injury, 7 a Glasgow Coma Scale score of <8, 98 or Check breathing both97.99 If a healthcare provider suspects a cervical spine While maintaining an open airway, look, listen, and feel for injury, open the airway using a jaw thrust without head breathing. If you are a lay rescuer and do not confidently extension( Class IIb).96 Because maintaining a patent airway detect normal breathing or if you are a healthcare provider and providing adequate ventilation is a priority in CPR(Class and do not detect adequate breathing within 10 seconds, give D), use a head tilt-chin lift maneuver if the jaw thrust does no 2 breaths(see below ). If you are a lay rescuer and you ar open the airway unwilling or unable to give rescue breaths, begin chest Use manual spinal motion restriction rather than immobi- compressions( Class lla) lization devices for victims with suspected spinal injury Professional as well as lay rescuers may be unable to ( Class IIb). 100, 101 Manual spinal motion restriction is safer, accurately determine the presence or absence of adequate or and immobilization devices may interfere with a patent normal breathing in unresponsive victims (LOE 7)1o9-lll irway(loe 3 to 4). 102-104 Cervical collars may complicate because the airway is not open 12 or the victim has occasional airway management during CPR(LOE 4), 102 and they can gasps, which can occur in the first minutes after SCA and cause increased intracranial pressure in a victim with a head may be confused with adequate breathing. Occasional gasps injury (loe 4 to 5: Class IIb). 105-10s Spine immobilization are not effective breaths. Treat the victim who has occasional devices, however, are necessary during transport gasps as if he or she is not breathing( Class D)and give rescuecraniofacial injury,97 a Glasgow Coma Scale score of 8,98 or both.97,99 If a healthcare provider suspects a cervical spine injury, open the airway using a jaw thrust without head extension (Class IIb).96 Because maintaining a patent airway and providing adequate ventilation is a priority in CPR (Class I), use a head tilt–chin lift maneuver if the jaw thrust does not open the airway. Use manual spinal motion restriction rather than immobi￾lization devices for victims with suspected spinal injury (Class IIb).100,101 Manual spinal motion restriction is safer, and immobilization devices may interfere with a patent airway (LOE 3 to 4).102–104 Cervical collars may complicate airway management during CPR (LOE 4),102 and they can cause increased intracranial pressure in a victim with a head injury (LOE 4 to 5; Class IIb).105–108 Spine immobilization devices, however, are necessary during transport. Check Breathing While maintaining an open airway, look, listen, and feel for breathing. If you are a lay rescuer and do not confidently detect normal breathing or if you are a healthcare provider and do not detect adequate breathing within 10 seconds, give 2 breaths (see below). If you are a lay rescuer and you are unwilling or unable to give rescue breaths, begin chest compressions (Class IIa). Professional as well as lay rescuers may be unable to accurately determine the presence or absence of adequate or normal breathing in unresponsive victims (LOE 7)109–111 because the airway is not open112 or the victim has occasional gasps, which can occur in the first minutes after SCA and may be confused with adequate breathing. Occasional gasps are not effective breaths. Treat the victim who has occasional gasps as if he or she is not breathing (Class I) and give rescue Figure 2. Adult BLS Healthcare Provider Algorithm. Boxes bordered with dotted lines indicate actions or steps performed by the healthcare provider but not the lay rescuer. IV-22 Circulation December 13, 2005