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The equipment we'll need

Roles around the patient

Main CPR / AED Protocol - page 10

Page 3 - CPR for adults

Page 4 - chest

Page 5 - chest
and critical

Page 6 - head tilt
and chin lift

Page 7 - mouth to
mouth breathing

Page 8 - mouth to
mask breathing

Page 9 - mouth to
mask ventilation - compressions

Page 11 - patient

Page 12 - open airway

Page 13 - cycles of
compressions and

Two Person CPR








Notes: 1) If you're performing one person CPR, you - that one person - will be doing several things, like: opening the airway, breathing for the patient and giving compressions (2 breaths for every 30 compressions at a rate of about 100 compression a minute). See video page to review 1 person CPR.

The ABC's are something we all have to keep in mind during every stage of an emergency situation where the patient is unconscious. The main goal of BLS is quality CPR that results in resuscitation. What's quality CPR? Giving adequate compressions (1.5 to 2 inches depth), 2 unforced breathes given for every 30 compressions and maintaining circulation.


The roles performed around the patient
are the following:

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1) The person doing compressions (the first person to the scene, the one checking for level of consciousness, pulselessness, respiratory status - and generally not always the clinician).

We'll assume for now it's the clinician or experienced personnel. This person will be the one making requests of, directing and delegating the next helpers arriving. For example she/he gives orders like "call 911, please grab the stabilization kit and AED, please take over breathing, load up 1 milligram epinephrine in 10 cc's of saline...", etc.

If there's already one person doing CPR, and only one other person available, the person doing CPR
continues compressions and breathing for the patient while the second person calls 911,
gets the AED, etc.

Review the 1 person CPR video here if you need to:



Person 2: the airway person - (or persons). This is the second or third person to arrive at the scene. In two person CPR this will be the airway persons job: controlling the airway and giving quality ventilations. In two person CPR (i.e. when only two people are available) this person will be the one initiating the EMS system (calling 911 or telling someone to call 911, grabbing the AED and the stabilization kit. After those tasks are done, this person takes over the breathing and airway control.
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To review 2 person CPR click the screen below:


(To review airway control go to BLS video link page and click on the liks that talk about airway and respirations.)

Things this person needs to bring or perform:

-- bag mask or pocket mask,
Two breaths every 30 compressions.

In most codes adrenaline moves care givers to over-ventilate the patient. Even when giving the best possible chest compressions, the rate of blood circulating equals about 20 - 25 % of normal. So forcing breaths only serves to over inflate the chest. Two slow breaths every 30 compressions are more than adequate aeration for the amount of cardiac output. (See this link for a graphic demonstration of ventilation: http://www.youtube.com/ventilations)

Note: The "E-C" grip is experience dependant. It may take 2 people to get the best respirations: one person to squeeze the bag and the other to maintain a good mask seal over the patients mouth and nose.
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3) The third (and more) person arriving...
This is the most likely scenario in our Urgent Cares: there will be more than enough help available.
The third person arriving can start an IV, get meds ready (i.e. load epinephrine, prepare to inject via IV), as mentioned can help with maintaining a good airway and mask seal.

If there's three people available immediately, the third person will call 911, and grab the AED. This person can help setup the AED, even apply the pads while the compressions person is still doing compressions. This person could also start an IV.

...and a fourth...If we're really getting sophisticated :-) Here we start bridging the gap between BLS and ACLS. * See the ACLS Mega Code video below and see how the 3rd person is actually applying the AED defibrillator pads while person one is still performing compressions:


Fourth or Fifth person...
In the best of all worlds a fourth or fifth person should pick up a progress note and clipboard and start
documenting every treatment, every treatment request, every order and write down the time it was requests, given, any events, etc. If we're ever in a situation where we're running a code for 8 - 10 minutes, and rounds of e.g. epi are being given, this person can watch the clock and announce "it's been 3,4,5 minutes since the last dose". Again with the fast response of local EMS, we're rarely in that situation. But it's important to be prepared.
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