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Basic Life Support: Theory

(Practical competence is required also.)

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Welcome to this FSHC/CareShield training workbook.
To complete this workbook, please read all sections and complete the knowledge test.
This training workbook covers the following topics:
1. Introduction
2. Adult Cardiopulmonary Resuscitation
3. Adult Foreign Body Airway Obstruction (FBAO)
4. Knowledge test

page 4 to 6
page 7 to 12
page 13 to 15
page 16 to 18

Please sign and date this page to show you have read and understood the policies and
procedures mentioned in this workbook, and have answered all questions to the best of
your knowledge.
Job role.................................................................................................
Section to be completed by management.
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Once the learner has completed all questions and the knowledge test, they
must be signed off by management.




16 - 18

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If you were walking down the street and someone collapsed in front of you, would you
know what to do?
Are you going to be the one to do something, or are you going to stand back and hope
that someone else takes action?
Do you stand back because you are afraid and hesitant or you dont know how to deal
with the situation?
If you want to know how to deal with an emergency, then this course is right for you.
However, this course assumes that you have already covered the basics of first aid. The
aim of this course is to familiarise you with the procedures of performing
Cardiopulmonary Resuscitation (CPR) and Foreign Body Airway Resuscitation (FBOA).
Note: the contents of this module are based closely on the relevant sections of the First
Aid Manual, 9th. Edition, from St John Ambulance, St Andrews Ambulance Association,
and the British Red Cross.

Cardiac disease is one of the leading causes of death in the UK. The majority of these
deaths occur out of hospital. Actions taken during the first few minutes of a sudden
attack are critical to a victims survival.

Symptoms of Heart Attack:

The following are some of the ways to recognise a heart attack:
Chest discomfort or pain accompanied with uncomfortable pressure, squeezing,
fullness, tightness or pain.
It is usually in the centre of the chest behind the breastbone, and may spread to
the shoulder, neck, lower jaw and arm, or occasionally to the upper abdomen. It
usually lasts longer than 20 minutes.
Sweating associated with shortness of breath, nausea or vomiting, is also a
possible symptom of a heart attack.

What is Cardiopulmonary Resuscitation (CPR)?

Cardiopulmonary Resuscitation, usually referred to as CPR, consists of a series of
assessments and interventions supporting the bodys cardiac and pulmonary functions.
It helps restore the flow of oxygenated blood to the brain and heart. It is used to save
victims from sudden death.

CPR and the chain of survival

If CPR is performed promptly and correctly, the cardiopulmonary function can be
restored and maintained until advanced cardiac life support (ACLS) is provided.
The four links in the chain of survival describe the process used to assist a victim
suffering from cardiac arrest or heart attack.

Early Recognition and Access

This refers to shortening the time interval from the onset of heart attack or cardiac
arrest to the arrival of a trained emergency care team. It includes:
Recognition of early warning signs of heart attack: e.g., chest pain associated
with sweatiness, shortness of breath, nausea and vomiting.
Recognition of cardiac arrest: e.g. unconsciousness, no breathing, no pulse or
signs of circulation.
Immediate call for the first response team.
Allowing paramedics rapid access and priority in use of lifts in high-rise

Early CPR
When the heart stops pumping, the brain starts to die within minutes. CPR needs to be
initiated as soon as possible to provide oxygen, restart blood flow to the brain and
heart, and remove excess carbon dioxide from the lungs.
CPR cannot always restart the heart. However, it can buy the crucial time needed to
keep the vital organs alive until appropriate help arrives.

Early Defibrillation
This procedure can often restart the heart, particularly if it is implemented in the first
two minutes after the onset of the cardiac arrest.
Every emergency vehicle transporting a cardiac arrest patient should be equipped with
a defibrillator, as studies have shown that early defibrillation is most likely to improve
survival rates for patients whose cardiac arrest occurs out of hospital.

Did you know?

For every minute of delay in delivering defibrillation following collapse, the
survival rate decreases by 7 10%.
If a cardiac arrest is untreated, irreversible brain damage can occur within 4 6

Early Advanced Care

Advanced cardiac life support stabilises the resuscitated victims condition in the most
critical phase.
Consisting of advanced airway management and administration of medication, this
procedure is frequently carried out in hospital.

Activity 1
Select the correct option:

If cardiac arrest is untreated, irreversible brain damage can occur within:

A. 2-4 minutes
B. 4-6 minutes
C. 10 minutes
Answer: _______

Adult Cardiopulmonary Resuscitation

In this section, we will look at how you would deal with a collapsed casualty.
In particular, we will look at how to administer Cardio-Pulmonary Resuscitation (CPR) to
an unconscious adult casualty.
Collapsed casualty
On discovering a collapsed casualty, you should:
Make sure the scene is safe
Establish if he is conscious or unconscious by gently shaking his shoulders
Ask, What has happened? or give a command such as Open your eyes
Always speak to the casualty loudly and clearly.
The actions you then need to take depend on whether or not there is a response from
the casualty.
If the casualty responds:
Leave the casualty in the position in which he was found
Check for life-threatening injuries
Summon help if needed.
If there is no response:
Shout for help
Leave the casualty in the position in which he was found
Open the airway.
Opening the casualtys airway
Step 1:
Place one hand on the casualtys forehead and gently tilt his head back.
As you do this, his mouth will fall open slightly.
Step 2:
Place the fingertips of your other hand on the point of the casualtys chin and lift the
Check the casualtys breathing.

Do not press deeply into the soft tissues under the chin, as this could obstruct the
Checking the casualtys breathing
Keeping the airway open:
Look for chest movement
Listen for sounds of breathing, and
Feel for breaths on your cheek.
Do this for no more than ten seconds before deciding if the casualty is breathing
If the casualtys breathing is agonal, or if there is any doubt, act as if the breathing is
not normal.
Agonal breathing
This type of breathing usually takes the form of short, irregular gasps for breath, and is
common in the first few minutes after a cardiac arrest.
Do not mistake agonal breathing for normal breathing.
If it is present, CPR should be started without hesitation.
If the casualty is breathing
Step 1:
Check the casualty for any life-threatening injuries, such as severe bleeding, and treat
as necessary.
Step 2:
Place the casualty in the recovery position and call 999/112 for emergency help.
Step 3:
Monitor and record vital signs while waiting for help to arrive:
Level of response
The recovery position
Steps 1-3
Step 1:Kneel beside the casualty. Remove his spectacles and any bulky objects, such
as a mobile phone or large bunch of keys. Do not search his pockets for small items

Step 2: Make sure that both of the casualtys legs are straight. Place the arm that is
nearest to you at right angles to the casualtys body, with the elbow bent and the palm
facing upwards.
Step 3: Bring the arm that is farthest from you across the casualtys chest and hold the
back of his hand against the cheek nearest to you. With your other hand, grasp the far
leg just above the knee and pull it up, keeping the foot flat on the ground.
Steps 4-6
Step 4: Keeping the casualtys hand pressed against his cheek, pull on the far leg and
roll the casualty towards you and onto his side.
Step 5: Adjust the upper leg so that both the hip and the knee are bent at right angles.
Step 6: Tilt the casualtys head back and tilt his chin so that the airway remains open.
Steps 7-9
Step 7
If necessary, adjust the hand under the cheek to keep the airway open.
Step 8
If it has not already been done, call 999/112 for emergency help. Monitor and record
his vital signs while waiting for help to arrive.
Step 9
If the casualty has to be left in the recovery position for longer than 30 minutes. Roll
him onto his back and then roll him onto the opposite side (unless other injuries
prevent you from doing so).
Monitoring vital signs
You need to monitor and, if possible, record three of the casualtys vital signs.
Level of response
Assess the level of response using the AVPU scale, making a note of any deterioration
or improvement:
A: Is the casualty Alert? Are his eyes open; does she respond to questions?
V: Does the casualty respond to Voice? Can he answer questions and obey commands?
P: Does the casualty respond to Pain? Does he open his eyes or move if pinched?
U: Is the casualty Unresponsive to any stimulus (i.e., unconscious)?
Check the rate of breathing and listen for any breathing difficulties or unusual noises by
listening for breaths and watching the casualtys movements. Record:

Rate: Count the number of breaths the casualty takes in one minute (an adults
normal breathing rate is 12-16 breaths per minute).
Depth: Are the breaths deep or shallow?
Ease: Are the breaths easy, difficult or painful?
Noise: Is the casualtys breathing quiet or noisy. If noisy, what types of noise is
he making?
The pulse may be felt at the wrist (radial pulse) or the neck (carotid pulse). When
checking a pulse, use your fingers (not your thumb) and press lightly against the skin.
Rate: Number of beats per minute (the normal rate in adults is 60-80 beats per
Strength: Strong or weak.
Rhythm: Regular or irregular.
If the casualty is not breathing
Step 1:
Send a helper to call 999/112 for emergency help. Ask the person to bring an
automated external defibrillator (AED) if one is available.
If you are alone, make the call yourself unless the condition is the result of drowning.
In this case, you should give CPR for one minute before making the emergency call.
Step 2:
Begin CPR with chest compressions.
How to give CPR to an adult who is unconscious:
Step 1:
Kneel beside the casualty level with his chest.
Place the heel of one hand on the centre of the casualtys chest.
Step 2:
Place the heel of your other hand on top of the first hand and interlock your fingers,
making sure your fingers are kept of the ribs.
Step 3:
Leaning over the casualty with your arms straight, press down vertically on the
breastbone and depress the chest by 5-6cm (2-2.5 inches).
Release the pressure without removing your hands from his chest. Allow the chest to
come back up fully (recoil) before giving the next compression.


Step 4:
Compress the chest 30 times at a rate of 100-120 compressions per minute.
The time taken for compression and release should be about the same.
Step 5:
Move to the casualtys head and make sure that the airway is still open.
Put one hand on his forehead and your index and middle fingers of the other hand
under the tip of his chin.
Move the hand that was on the forehead down to pinch the soft part of the nose with
your finger and thumb.
Allow the casualtys mouth to fall open.
Step 6:
Take a break and place your lips around the casualtys mouth, making sure you have a
good seal.
Blow steadily into the casualtys mouth until the chest rises. This should take one
If you are unable or unwilling to give rescue breaths, you can give chest compressions
only at a rate of 100-120 per minute until help arrives.
Step 7:
Maintaining the head and chin tilts, take your mouth off the casualtys mouth and look
to se the chest fall. If the chest rises visibly as you blow and falls fully when you lift
your mouth away, you have given a rescue breath.
If the chest does not rise, you may need to re-check the casualtys:
Head tilt and chin lift
Mouth: Remove any obvious obstructions, but do not do a finger sweep.
Make no more than two attempts to achieve rescue breaths before repeating the chest
Step 8:
Repeat 30 chest compressions without delay.
How to give CPR
Continue the cycle of 30 chest compressions followed by 2 rescue breaths until:
Emergency help arrives and takes over, or
The casualty starts to breath normally, or
You become too exhausted to carry on.
When an ambulance arrives:


If you have completed the necessary training, tell the personnel that you are a
first aider
Give a full report of what has happened
Do not stop CPR unless they tell you to do so
Listen carefully to what they ask you to do and follow their instructions.

Activity 2
Select the correct option.
What is the first thing you should do if you find a collapsed casualty?
Move him to the nearest safe place.
Roll him over to see where he is hurt
Make sure the scene around the casualty is safe
Try and make him stand up.

Activity 3
Select three options.
Which of the following are the casualtys vital signs that you should monitor while
waiting for help to arrive?
Blink rate
Level of response

Activity 4
Select the correct option.
When giving CPR chest compressions, how deeply should you depress the casualtys
1-2 cm
3-4 cm
5-6 cm
7-8 cm


Activity 5
Select the correct option.
When giving CPR chest compressions, how many compressions a minute should you try
to achieve?

What is Foreign Body Airway Obstruction (FBAO)?

What is Foreign Body Airway Obstruction?
A foreign body that is stuck in the throat may block it and cause a muscular spasm.
If the blockage of the airway is mild, the casualty should be able to clear it; if it is
severe, he will be unable to speak, cough or breath, and will eventually lose
If the casualty does lose consciousness, his throat muscles may relax and the airway
may open enough for you to do rescue breathing.

Recognising FBAO
Partial airway obstruction
Signs :

Complete airway obstruction



Cannot speak


Cannot breathe

Steps to be taken:

Cannot cough

Do not interfere

Cyanotic (skin turns blue)

Allow victim to cough out the

object himself.

Tends to clutch the neck with

thumb and fingers (universal sign
of choking).
Steps to be taken:
Be prepared to begin CPR


Relieving the FBAO of a conscious adult

To help an adult with a foreign body airway obstruction while he is still
Step 1
If the casualty is breathing, encourage him to continue coughing. Remove
any obvious obstruction from his mouth.
Step 2
If the casualty cannot speak or stops coughing or breathing, carry out back
Abdominal thrust
Support his upper body with one hand, and help him to lean forward
Give up to five sharp blows between his shoulder blades with the heel of your
Stop if the obstruction clears, and check his mouth
If the choking persists, consider whether to give the casualty abdominal thrusts.
Issues with abdominal thrusts
There are two key issues to bear in mind when deciding whether to give a choking
casualty abdominal thrusts:
1. Do not give abdominal thrusts to:
A person who is obese, or
A pregnant woman.
Use back blows only in this situation.
2. If you decide to give abdominal thrusts, follow Step 3 below.
Step 3
Stand behind the casualty and put both arms around him
Put one fist between his navel and the bottom of his breastbone
Grasp your fist with your other hand
Pull sharply inwards and upwards up to five times
Seek medical advice for any adult who has received abdominal thrusts.
Step 4
Check the casualtys mouth.
If the obstruction has not cleared, repeat Steps 2 and 3 up to three times, checking
his mouth after each step.

If the casualty loses consciousness

If the casualty loses consciousness at any point in the process:
Open their airway
Check their breathing
Prepare to give CPR.

Activity 7
Select three options
Which of the following could be an indication that someone has a complete obstruction
of their airway?


are clutching their neck

are coughing
are wheezing
can become cyanotic
cannot speak.

Activity 8
Select the correct option.
You come across an individual who is choking but conscious. Should you administer

Activity 9
To which of the following casualties would you consider giving abdominal thrusts?

An unconscious man of average build.

A woman who is seven months pregnant.
A young, athletic woman.
A middle-aged, obese man.
A slim, active elderly man.


Knowledge Test
Question 1 of 10
Complete this sentence by dragging in the correct figure from the options below:
For every minute of delay in delivering defibrillation following collapse, the casualtys
survival rate decreases by ___________%.





Question 2 of 10
If she cannot clear the obstruction by coughing, how many back blows should you then
give her?
o 1
o 5
o 10
o 30
Question 3 of 10
You find a casualty lying beside his motorbike on a busy road. He is conscious. Should
you move him away from the road?
o Yes
o No
Question 4 of 10
Select the correct option.
When giving CPR chest compressions, what is the correct pattern to follow?
o 2 rescue breaths, followed by 30 chest compressions at 100-120 compressions
per minute
o 30 chest compressions at 100-120 compressions per minute, followed by 2
rescue breaths
o 5 rescue breaths, followed by 50 chest compressions at 100-120 compressions
per minute
o 50 chest compressions at 100-120 compressions per minute, followed by 5
rescue breaths


Question 5 of 10
Select three options.
How do you check if a casualty is breathing?
o Feel for breaths on your cheek.
o Give him a blow to his chest.
o Listen for sounds of breathing.
o Look for chest movement.
Question 6 of 10
Select the correct option.

is the normal pulse rate in adults?

40-60 beats per minute
60-80 beats per minute
80-100 beats per minute
100-120 beats per minute

Question 7 of 10
You give the young woman two cycles of back blows and abdominal thrusts, and she is
finally able to clear the obstruction. What should she do next?
o Continue with her meal.
o Go home and get some rest.
o Go to hospital.
o Drink plenty of water.
Question 8 of 10
Select the correct option.
A young woman has an obstruction in her throat and is wheezing. What is the first
thing you should do?
o Encourage her to cough.
o Give her a sharp blow between her shoulder blades.
o Phone 999/112.
o Put your hand into her mouth to try and remove the obstruction.
Question 9 of 10
Select three options.

are the symptoms of a heart attack?

Chest discomfort
Shortness of breath

Question 10 of 10
Select the correct option.
The casualty, whose injuries are not too serious, has been in the recovery position for
30 minutes. What should you do?
o Encourage him to stand up.
o Nothing: he seems to be fine where he is.
o Roll him carefully onto his other side.
o Suggest that he roll over onto his back

You have now completed this workbook on Basic Life Support.
If you have any queries about anything you have learned in this workbook, please
speak with your line manager.