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BLS ABCD Maneuvers
  1. Age definitions
    • Healthcare providers:
      • Children 1 year of age to the onset of puberty, about 12 to 14 years old.
      • Adults are adolescent and older
      • Infants are under one year of age.
    • Lay rescuers:
      • Children are 1 year of age to age 8.
      • Adults are age 8 and older.
      • Infants are under one year of age.
  2. “A” Maneuvers
    • Activating EMS
      • Activate EMS first when an adult victim is found unresponsive
        • HCPs Only: Lone healthcare provider should call after 5 cycles – about 2 minutes – of CPR if asphyxial arrest is likely.
      • For children, rescuers should activate EMS after performing 5 cycles (about 2
        minutes) of CPR.
        • HCPs Only: Lone healthcare provider who witnesses a child suddenly collapse should activate the EMS system after verifying that the victim is unresponsive.
    • Opening the Airway
      • Lay rescuers use the head tilt-chin lift to open the airway in all unresponsive victims.
      • Lay rescuers are no longer taught to use a jaw thrust for injured victims.
      • HCPs Only: Should use jaw-thrust for suspected spine injury,
        • Use head tilt-chin lift if ventilations will not go in
  3. “B” Maneuvers
    • Check for Normal Breathing
      • Lay rescuers will check for normal breathing in an unresponsive victim.
        • Should take no more than 10 seconds to check for normal breathing
        • Adult victims may gasp for the first few minutes of collapse. This is not effective breathing. Victims who gasp probably need CPR.
        • Gasping does not occur as often in for infants and children victims of cardiac arrest. Look for the presence or absence of breathing instead of normal or abnormal breathing.
    • Rescue Breathing
      • If not breathing, then give 2 breaths that make the chest rise.
      • Give each breath over 1 second
      • If the chest does not rise after the 1st breath, reopen the airway and try again
    • HCPs Only: Rescue Breathing Without Compressions
      • Perform rescue breathing for unresponsive victims with a pulse.
        • Adult: Deliver10-12 rescue breaths per minute (1 breath every 5-6 seconds).
        • Infant/Child: Deliver 12-20 breaths per minute (1 breath every 3-5 seconds).
    • HCPs Only: Ventilating during CPR with an Advanced Airway
      • Compressor delivers uninterrupted compressions at a rate of 100/minute
      • Deliver 8-10 breaths/minute or 1 every 8 seconds
    • Choking
      • Adults and children over 1 year of age: abdominal thrusts.
      • Infants under 1 year of age: back slaps and chest thrusts.
      • Unresponsive adult, activate EMS then perform CPR.
        • Check the mouth before each breath.
        • Remove any object seen.
      • Unresponsive infant or child, perform 5 cycles of CPR then activate EMS.
  4. “C” Maneuvers
    • Pulse check for HCPs Only
      • Pulse check in 10 seconds or less
        • Adult: carotid
        • Child: carotid or femoral
        • Infant: brachial or femoral
      • The ACLS provider will determine when it is appropriate to perform additional pulse checks.
    • Lay rescuers
      • Should be instructed to proceed directly to chest compressions and then continue cycles of chest compressions and rescue breaths.
      • Should NOT ATTEMPT to check for signs of circulation, signs of life or a pulse.
    • Compression Landmarks
      • Adults & Children: Rescuers should press in the centre of the chest, between the nipples.  Rescuer may use 1 or 2 hands to give compressions.
      • Infants: Rescuers should press on the breastbone just below the nipple line using 2 fingers.
    • Compression Method
      • “Push hard and push fast” at a rate of 100 per minute
      • Allow chest to recoil
      • Adults: 2 handed chest compression method
        • Child:
          • Use 1 or 2 hands to give chest compressions.
          • Hand placement for 2 hands is the same as that used for adult compressions.
          • Press on the breastbone at about the nipple line.
        • Infants: Use 2 fingers placed just below the nipple line
          • HCPs Only: Use 2 thumb-encircling hands technique for 2 rescuer CPR.
    • Compression Depth
      • Adult: 1 ½” – 2”
      • Child/Infant: 1/3 – 1/2 the depth of the chest
    • Compression Rate
      • Compressions delivered at a rate of 100/min
    • Compression: Ventilation Ratio
      • Adult 1- and 2-rescuer: 30:2
      • Child/Infant: single rescuer 30:2
        • HCPs Only: 2-rescuer 15:2
  5. “D” Maneuvers
    • Adult AED Use
      • Use adult AED pads on adults. Do not use child pads or a child AED system on adults.
      • It is reasonable for EMS personnel (out-of-hospital) to give 5 cycles of CPR before attempting defibrillation if the call-to-response interval is greater than 4 to 5 minutes.
    • Child AED Use
      • Child victim out-of-hospital arrest
        • Lay rescuers will give 5 cycles of CPR before using the AED
        • Use child AED pads/system if available for a child 1-8 years of age.
        • If child AED system or pads are not available, use adult pads.
      • HCPs Only:
        • Child witnessed sudden collapse: Use an AED as soon as possible.
        • Child found unresponsive: Use AED after 5 cycles or about 2 minutes of CPR.

Note: No recommendation for use of an AED on infants (less than 12 months old).