Nursing Foundation - BLS & CPR Nursing Notes: Complete Guide

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BLS & CPR Nursing Notes – Complete Guide, Algorithm, AED & MCQs

Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) are essential emergency lifesaving skills for nurses, nursing students and healthcare professionals.

These complete BLS and CPR notes cover adult CPR, pediatric CPR, infant CPR, AED, high-quality CPR, choking management, respiratory arrest, Chain of Survival, nursing responsibilities, post-cardiac arrest care, latest updates, FAQs and MCQs for examination preparation.

Updated Topic: These notes include important updates from the 2025 AHA CPR & ECC Guidelines.

Quick Revision – BLS & CPR

  • Adult compression rate: 100–120/minute
  • Adult compression depth: At least 5 cm
  • Adult compression depth upper limit: Avoid >6 cm
  • Adult CPR ratio: 30:2
  • Pulse assessment: Maximum 10 seconds for trained healthcare professionals
  • AED: Use as soon as available
  • Child/Infant compression rate: 100–120/minute
  • Two-rescuer pediatric CPR: 15:2
  • Adult/Child severe choking: 5 back blows + 5 abdominal thrusts
  • Infant severe choking: 5 back blows + 5 chest thrusts

1. Introduction to BLS & CPR

Cardiac arrest is one of the most serious medical emergencies. During cardiac arrest, effective circulation stops and the brain and other vital organs rapidly become deprived of oxygen.

Basic Life Support (BLS) is the initial level of emergency care provided during cardiac arrest, respiratory arrest and certain life-threatening airway emergencies.

Cardiopulmonary Resuscitation (CPR) is the central intervention used during cardiac arrest to maintain blood circulation and oxygen delivery until return of spontaneous circulation or advanced resuscitation care is available.

For nursing students, BLS and CPR are important for clinical practice as well as B.Sc Nursing, GNM, ANM, NORCET, NCLEX-RN and other nursing examinations.

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2. Definition of BLS

Basic Life Support (BLS) is a group of emergency interventions used to recognize and manage cardiac arrest, respiratory arrest and certain life-threatening airway emergencies until advanced medical care becomes available.

BLS focuses on rapid recognition, activation of emergency response, high-quality CPR, early defibrillation when indicated, and appropriate airway and ventilation support.

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3. Definition of CPR

Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving procedure consisting primarily of chest compressions and appropriate ventilation to maintain circulation and oxygen delivery during cardiac arrest.

CPR is a temporary lifesaving intervention and does not replace definitive treatment. Its purpose is to maintain circulation and oxygenation until spontaneous circulation returns or advanced resuscitation care is provided.

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4. Objectives of BLS & CPR

  • Recognize cardiac arrest as early as possible.
  • Activate the emergency response system.
  • Maintain circulation to the brain and heart.
  • Provide appropriate ventilation.
  • Prevent irreversible organ damage.
  • Provide early defibrillation when indicated.
  • Restore spontaneous circulation.
  • Maintain the patient until advanced care is available.
  • Improve survival and neurological outcomes.

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5. Cardiac Arrest

Cardiac arrest occurs when the heart suddenly loses effective mechanical activity and can no longer maintain adequate circulation.

Cardiac arrest is different from myocardial infarction. A myocardial infarction occurs because blood flow to part of the heart muscle is blocked or severely reduced. Cardiac arrest means effective cardiac activity and circulation have stopped. A myocardial infarction can cause cardiac arrest.

Common Causes

  • Acute coronary syndrome
  • Severe hypoxia
  • Respiratory failure
  • Severe shock
  • Major trauma
  • Electrolyte abnormalities
  • Drug toxicity or overdose
  • Drowning
  • Severe airway obstruction
  • Pulmonary embolism
  • Serious cardiac arrhythmias

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6. Signs of Cardiac Arrest

  • Sudden unresponsiveness
  • Absence of normal breathing
  • Abnormal or agonal gasping
  • Absence of a definite pulse in a trained healthcare professional's assessment
  • Loss of consciousness
  • No purposeful movement
Important Clinical Point:

Agonal gasping is not normal breathing. An unresponsive patient who is only gasping should be treated as being in cardiac arrest according to the appropriate resuscitation algorithm.

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7. Chain of Survival

The Chain of Survival describes the major actions that contribute to successful resuscitation and recovery after cardiac arrest.

  1. Recognition of cardiac arrest and activation of emergency response
  2. Early high-quality CPR
  3. Rapid defibrillation
  4. Advanced resuscitation
  5. Post-cardiac arrest care
  6. Recovery

Early recognition, immediate CPR and rapid defibrillation when appropriate are critical components of modern resuscitation.

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8. Initial Assessment Sequence

Step 1 – Ensure Scene Safety

Before approaching the patient, make sure the environment is safe for the rescuer, patient and other people.

Step 2 – Check Responsiveness

Tap the patient appropriately and speak loudly to determine whether the patient responds.

Step 3 – Call for Help

Activate the emergency response system. Send someone to obtain an AED or defibrillator when available.

Step 4 – Assess Breathing

Determine whether the patient is breathing normally. Occasional gasping is not considered normal breathing.

Step 5 – Check Pulse if Trained

A trained healthcare professional should check the pulse while evaluating breathing. The pulse check should not take more than 10 seconds.

Step 6 – Determine the Correct Pathway

Finding Action
Unresponsive + not breathing normally + no definite pulse Start CPR
Unresponsive + abnormal breathing + definite pulse Provide rescue breathing and monitor
Responsive Assess the condition and provide appropriate care

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9. Adult BLS Algorithm

  1. Ensure scene safety.
  2. Check responsiveness.
  3. Shout for help.
  4. Activate the emergency response system.
  5. Send someone for an AED/defibrillator.
  6. Assess breathing.
  7. Healthcare professional: check pulse for no more than 10 seconds.
  8. If there is no normal breathing and no definite pulse, begin CPR.
  9. Perform 30 chest compressions followed by 2 breaths.
  10. Apply AED as soon as available.
  11. If a shock is advised, deliver the shock according to AED instructions.
  12. Immediately resume CPR after the shock.
  13. Continue until advanced care takes over or signs of life/ROSC occur.

Simple Adult BLS Flow

Safety → Response → Help → Breathing/Pulse → CPR → AED → Advanced Care

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10. High-Quality CPR

High-quality CPR is the foundation of effective resuscitation. Good compression quality helps maintain blood flow to the heart and brain.

  • Compression rate: 100–120/minute
  • Adult compression depth: at least 5 cm
  • Avoid excessive adult compression depth greater than 6 cm
  • Allow complete chest recoil
  • Minimize interruptions
  • Avoid excessive ventilation
  • Use AED/defibrillator as soon as available
  • Coordinate the resuscitation team effectively

100–120/min + Adequate Depth + Complete Recoil + Minimal Pauses

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11. Chest Compression Technique

  1. Place the patient on a firm surface when possible.
  2. Kneel beside the patient's chest.
  3. Place the heel of one hand in the center of the chest.
  4. Place the other hand over the first hand.
  5. Interlock the fingers.
  6. Keep the arms straight.
  7. Position the shoulders directly over the hands.
  8. Compress at 100–120/minute.
  9. Compress the adult chest at least 5 cm deep.
  10. Allow complete recoil after every compression.
  11. Minimize interruptions.

Why Complete Recoil Is Important

Complete chest recoil allows venous blood to return to the heart. Leaning on the chest between compressions can reduce effective circulation.

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12. Rescue Breathing & Ventilation

When ventilation is provided during CPR, each breath should generally be delivered over approximately one second and should produce visible chest rise.

30 Compressions → 2 Breaths

Important Points

  • Avoid excessive ventilation.
  • Each breath should produce visible chest rise.
  • Do not unnecessarily interrupt chest compressions.
  • Use appropriate barrier devices or bag-mask ventilation according to training and clinical setting.

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13. Respiratory Arrest With Pulse

Respiratory arrest means the patient is not breathing adequately but still has a pulse. This situation requires ventilatory support and continuous monitoring for deterioration.

Adult Rescue Breathing:

Provide approximately 1 breath every 6 seconds and reassess the patient and pulse according to the applicable BLS protocol.

If the pulse disappears or cardiac arrest develops, immediately begin CPR.

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14. AED – Automated External Defibrillator

An Automated External Defibrillator (AED) is a device that analyzes the cardiac rhythm and delivers a shock when a shockable rhythm is detected and a shock is indicated.

Steps for AED Use

  1. Turn on the AED.
  2. Expose the patient's chest.
  3. Apply the AED pads according to the manufacturer's diagram.
  4. Allow the AED to analyze the rhythm.
  5. Ensure nobody touches the patient during analysis.
  6. If a shock is advised, make sure everyone is clear.
  7. Deliver the shock according to the device instructions.
  8. Immediately resume CPR.
  9. Follow further AED prompts.
AED Safety:

Nobody should touch the patient during rhythm analysis or shock delivery.

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15. Two-Rescuer CPR

  • One rescuer performs chest compressions.
  • The second rescuer manages ventilation and AED-related tasks.
  • Adult ratio remains 30:2 before an advanced airway.
  • Change the compressor approximately every 2 minutes or sooner if fatigued.
  • Keep role changes rapid.
  • Communicate clearly with the resuscitation team.

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16. Pediatric BLS

Pediatric BLS applies to infants and children before signs of puberty. When signs of puberty are present, adult BLS recommendations are generally used.

Pediatric CPR Parameters

  • Compression rate: 100–120/minute
  • Compression depth: approximately one-third of the anterior-posterior chest diameter
  • Child compression depth: approximately 5 cm
  • Allow complete chest recoil
  • Minimize interruptions

Two-Rescuer Pediatric CPR

15 Compressions : 2 Breaths

For a single rescuer, the standard compression-to-ventilation ratio remains 30:2 before an advanced airway.

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17. Infant CPR

Infant CPR requires an age-appropriate compression technique and depth. The 2025 guidance removed the two-finger technique from the recommended infant chest-compression techniques.

Recommended Infant Compression Techniques

  • Heel of one hand
  • Two-thumb encircling-hands technique

Compression Depth

Compress the infant chest to approximately one-third of the anterior-posterior chest diameter, approximately 4 cm.

Compression Rate

100–120 compressions per minute.

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18. Adult vs Child vs Infant CPR

Parameter Adult Child Infant
Rate 100–120/min 100–120/min 100–120/min
Depth ≥5 cm; avoid >6 cm ≈5 cm ≈4 cm
Single rescuer 30:2 30:2 30:2
Two rescuers 30:2 15:2 15:2

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19. Choking / Foreign Body Airway Obstruction

Foreign Body Airway Obstruction (FBAO) occurs when a foreign object partially or completely blocks the airway.

Signs of Severe Airway Obstruction

  • Unable to speak
  • Unable to breathe normally
  • Ineffective or silent cough
  • Unable to cough effectively
  • Increasing cyanosis
  • Loss of consciousness

Conscious Adult or Child With Severe Choking

5 Back Blows

↓

5 Abdominal Thrusts

Repeat until the object is expelled or the patient becomes unresponsive.

If the Patient Becomes Unresponsive

  1. Lower the patient safely to the ground.
  2. Activate the emergency response system.
  3. Begin CPR.
  4. Before ventilation, open the airway and look for a visible object.
  5. Remove an object only if it can be seen.
  6. Never perform a blind finger sweep.
  7. Continue CPR according to the appropriate emergency algorithm.

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20. Infant Choking

For a conscious infant with severe foreign-body airway obstruction, use the recommended infant choking sequence.

5 Back Blows

+

5 Chest Thrusts

Repeat until the object is expelled or the infant becomes unresponsive.

Important:

Abdominal thrusts are not recommended for infants.

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21. Opioid-Associated Emergency & Naloxone

Suspected opioid-associated emergencies may present with severe respiratory depression, respiratory arrest or cardiac arrest.

  • Recognize respiratory depression or arrest early.
  • Activate emergency medical response.
  • Provide appropriate ventilation and CPR when indicated.
  • Administer naloxone when available and permitted by local protocol and training.
  • Do not delay CPR or ventilation while attempting to obtain or administer naloxone.
  • Continue monitoring because respiratory depression can recur.
Clinical Reminder:

Naloxone is an adjunct in suspected opioid emergencies. It does not replace effective ventilation, CPR or emergency medical care.

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22. BLS/CPR in Special Situations

Drowning

  • Ensure rescuer safety.
  • Remove the patient from the water safely.
  • Assess responsiveness and breathing.
  • Start CPR when indicated.
  • Provide ventilation because respiratory compromise is central to drowning.
  • Use AED when available and appropriate.

Pregnancy

Maternal cardiac arrest requires immediate high-quality CPR and activation of appropriate emergency and obstetric teams. Follow current institutional pregnancy-specific resuscitation protocols.

Electrical Injury

Ensure the electrical source is disconnected before approaching the patient. Once the scene is safe, assess and provide appropriate resuscitation.

Trauma

Resuscitation should address immediately reversible life threats while maintaining high-quality CPR when cardiac arrest is present.

Anaphylaxis

Activate emergency care and treat according to the current emergency protocol. If cardiac arrest occurs, immediately begin CPR and follow the cardiac arrest algorithm.

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23. Common CPR Errors

  • Delayed recognition of cardiac arrest
  • Delayed activation of emergency response
  • Starting compressions too late
  • Incorrect compression rate
  • Compression depth too shallow
  • Excessive compression depth
  • Incomplete chest recoil
  • Frequent unnecessary interruptions
  • Excessive ventilation
  • Delayed AED application
  • Touching the patient during AED analysis or shock
  • Failure to resume CPR immediately after shock
  • Blind finger sweeps during choking
  • Poor communication between team members

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24. Nursing Responsibilities During BLS/CPR

Before an Emergency

  • Maintain current BLS training according to institutional requirements.
  • Know the location of emergency equipment.
  • Know the location of AED/defibrillator.
  • Check emergency trolley readiness according to hospital policy.
  • Participate in mock codes and resuscitation drills.

During Cardiac Arrest

  • Recognize cardiac arrest promptly.
  • Activate the emergency response system.
  • Start high-quality CPR.
  • Bring and apply the AED/defibrillator as trained.
  • Maintain airway and ventilation support.
  • Monitor rhythm and patient response.
  • Administer medications according to authorized clinical protocols and scope of practice.
  • Communicate clearly with the resuscitation team.
  • Record important events and times.

After Resuscitation

  • Monitor airway and breathing.
  • Monitor oxygenation and circulation.
  • Monitor vital signs.
  • Assess neurological status.
  • Prepare the patient for higher-level care.
  • Document the resuscitation accurately.
  • Participate in team debriefing when appropriate.

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25. Post-Cardiac Arrest Care

Return of spontaneous circulation, or ROSC, does not mean the emergency has completely ended. Patients require continued monitoring and post-cardiac arrest care.

  • Maintain airway and adequate ventilation.
  • Monitor oxygenation.
  • Monitor blood pressure and circulation.
  • Assess neurological status.
  • Identify and treat the underlying cause.
  • Monitor temperature according to the clinical protocol.
  • Perform appropriate investigations.
  • Prepare for critical care or higher-level monitoring.

ROSC = Return of Spontaneous Circulation

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26. Documentation of CPR

Accurate documentation is an important nursing responsibility following resuscitation.

  • Time patient was found unresponsive
  • Initial patient condition
  • Initial rhythm, if available
  • Time CPR was started
  • Time AED/defibrillator was applied
  • Shocks delivered
  • Airway and ventilation interventions
  • Medications administered by authorized personnel
  • Time of ROSC, if achieved
  • Vital signs after ROSC
  • Neurological status
  • Personnel involved in resuscitation
  • Patient disposition

Documentation should be objective, accurate, chronological and consistent with hospital policy.

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27. Latest BLS & CPR Updates – 2025

Major Updates

  1. Universal Chain of Survival: The 2025 guidelines emphasize a universal Chain of Survival for adult and pediatric cardiac arrest in both in-hospital and out-of-hospital settings.
  2. Updated choking sequence: For conscious adults and children with severe foreign-body airway obstruction, alternate 5 back blows and 5 abdominal thrusts.
  3. Infant choking: Alternate 5 back blows and 5 chest thrusts.
  4. Infant CPR technique: The two-finger technique has been removed from the recommended infant chest-compression techniques.
  5. Infant compression techniques: The heel of one hand or two-thumb encircling-hands technique may be used.
  6. Opioid emergencies: Naloxone considerations are incorporated into BLS guidance for suspected opioid-associated emergencies.
  7. High-quality CPR: Adult compression rate remains 100–120/minute with adequate depth, complete recoil and minimal interruptions.
  8. Post-cardiac arrest care: Appropriate post-arrest assessment, monitoring and temperature management remain important parts of care.

Always follow the current guidelines, local emergency system and institutional protocol during actual patient care.

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28. Important BLS/CPR Exam Points

  1. Adult compression rate = 100–120/minute
  2. Adult compression depth = at least 5 cm
  3. Avoid adult compression depth > 6 cm
  4. Adult CPR ratio = 30:2
  5. Healthcare professional pulse check = maximum 10 seconds
  6. Allow complete chest recoil.
  7. Minimize interruptions.
  8. Use AED as soon as available.
  9. Resume CPR immediately after shock.
  10. Child/infant compression rate = 100–120/minute
  11. Child compression depth ≈ 5 cm
  12. Infant compression depth ≈ 4 cm
  13. Two-rescuer pediatric ratio = 15:2
  14. Adult/child severe FBAO = 5 back blows + 5 abdominal thrusts
  15. Infant severe FBAO = 5 back blows + 5 chest thrusts
  16. Never perform blind finger sweeps.

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29. Frequently Asked Questions – BLS & CPR

Q1. What is BLS?

BLS is a set of emergency interventions used to recognize and manage cardiac arrest, respiratory arrest and certain life-threatening airway emergencies.

Q2. What is CPR?

CPR is an emergency lifesaving procedure involving chest compressions and appropriate ventilation to maintain circulation and oxygenation during cardiac arrest.

Q3. What is the adult CPR compression rate?

The recommended adult compression rate is 100–120 compressions per minute.

Q4. What is the adult compression depth?

Adult chest compressions should be at least 5 cm deep, while avoiding excessive depth greater than approximately 6 cm.

Q5. What is the adult CPR ratio?

The standard adult compression-to-ventilation ratio is 30:2 before an advanced airway is placed.

Q6. How long should the pulse be checked?

A trained healthcare professional should check for a pulse for no more than 10 seconds.

Q7. When should an AED be used?

An AED should be used as soon as it becomes available.

Q8. What is the pediatric CPR compression rate?

The recommended pediatric compression rate is 100–120/minute.

Q9. What is the two-rescuer pediatric CPR ratio?

For two-rescuer pediatric CPR without an advanced airway, the ratio is 15:2.

Q10. What is the updated choking sequence for adults and children?

For severe choking in a conscious adult or child, alternate 5 back blows and 5 abdominal thrusts.

Q11. How is severe choking managed in an infant?

Alternate 5 back blows and 5 chest thrusts. Abdominal thrusts are not recommended for infants.

Q12. Should CPR stop after an AED shock?

No. CPR should be resumed immediately after shock delivery unless the AED requires a brief pause for rhythm analysis.

Q13. What does ROSC mean?

ROSC means Return of Spontaneous Circulation.

Q14. What is the difference between cardiac arrest and heart attack?

Cardiac arrest is the sudden loss of effective cardiac activity and circulation. A heart attack occurs when blood flow to part of the heart muscle becomes blocked or severely reduced. A heart attack can cause cardiac arrest.

Q15. What is the most important principle of CPR?

Recognize cardiac arrest quickly, start high-quality CPR promptly, minimize interruptions and provide rapid defibrillation when indicated.

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30. BLS & CPR – 10 MCQs for Practice

Try all questions first and check the answer key after completing all 10 questions.

1. What is the recommended adult chest compression rate during CPR?

A. 60–80/min

B. 80–100/min

C. 100–120/min

D. 120–150/min

2. What is the minimum recommended adult compression depth?

A. 1 cm

B. 3 cm

C. At least 5 cm

D. 8 cm

3. What is the standard adult CPR ratio before an advanced airway?

A. 5:1

B. 15:2

C. 20:2

D. 30:2

4. For how long should a healthcare professional check the pulse?

A. 5 seconds maximum

B. 10 seconds maximum

C. 20 seconds

D. 30 seconds

5. Which device should be used as soon as available during cardiac arrest?

A. Nebulizer

B. AED

C. Pulse oximeter

D. Oxygen concentrator

6. What is the two-rescuer pediatric CPR ratio before an advanced airway?

A. 30:1

B. 30:2

C. 15:2

D. 10:2

7. What is the recommended compression rate for infants and children?

A. 40–60/min

B. 60–80/min

C. 80–100/min

D. 100–120/min

8. According to the updated guidance, severe choking in a conscious adult is managed with:

A. 5 chest thrusts only

B. 5 abdominal thrusts only

C. 5 back blows followed by 5 abdominal thrusts

D. Blind finger sweep

9. Which technique is recommended for infant chest compressions?

A. Two-finger technique only

B. Heel of one hand or two-thumb encircling-hands technique

C. Fist compression

D. Abdominal compression

10. What should be done immediately after an AED delivers a shock?

A. Wait for 2 minutes

B. Check blood pressure

C. Immediately resume CPR

D. Remove AED pads

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31. Answer Key

  1. C – 100–120/minute
  2. C – At least 5 cm
  3. D – 30:2
  4. B – 10 seconds maximum
  5. B – AED
  6. C – 15:2
  7. D – 100–120/minute
  8. C – 5 back blows followed by 5 abdominal thrusts
  9. B – Heel of one hand or two-thumb encircling-hands technique
  10. C – Immediately resume CPR

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32. One-Minute BLS/CPR Revision

Recognize → Call for Help → CPR → AED → Advanced Care → Recovery

  • Adult rate = 100–120/min
  • Adult depth = ≥5 cm; avoid >6 cm
  • Adult ratio = 30:2
  • Pulse check = ≤10 seconds for trained healthcare professionals
  • Complete chest recoil
  • Minimal interruptions
  • AED as soon as available
  • Child/infant rate = 100–120/min
  • Child depth ≈ 5 cm
  • Infant depth ≈ 4 cm
  • Two-rescuer pediatric ratio = 15:2
  • Adult/child severe choking = 5 back blows + 5 abdominal thrusts
  • Infant severe choking = 5 back blows + 5 chest thrusts

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Learn CPR. Practice CPR. Be Ready to Save a Life.

These BLS & CPR notes are useful for B.Sc Nursing, GNM, ANM, NORCET, NCLEX-RN and other nursing examination preparation.

Share these notes with your nursing friends and classmates.

Knowledge + Practice = Safe Patient Care ❤️

Educational Disclaimer: This article is intended for nursing education, revision and examination preparation. BLS and CPR are practical clinical skills and should be learned and practiced through recognized hands-on training under qualified instructors. During an actual emergency, follow the current local emergency response system, institutional protocol and applicable professional resuscitation guidelines.
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