Cardiopulmonary resuscitation

When someone’s blood flow or breathing stops, seconds count. Permanent brain damage or death can happen quickly. If you know how to perform cardiopulmonary resuscitation (CPR), you could save a life. CPR is an emergency procedure for a person whose heart has stopped or is no longer breathing. CPR can maintain circulation and breathing until emergency medical help arrives.

Even if you haven’t had training, you can do “hands-only” CPR for a teen or adult whose heart has stopped beating (“hands-only” CPR isn’t recommended for children). “Hands-only” CPR uses chest compressions to keep blood circulating until emergency help arrives. If you’ve had training, you can use chest compressions, clear the airway, and do rescue breathing. Rescue breathing helps get oxygen to the lungs for a person who has stopped breathing. To keep your skills up, you should repeat the training every two years.

 

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A – AIRWAY

• Place victim flat on his/her back on a hard surface.
• Shake victim at the shoulders and shout “are you okay?”
• If no response, call emergency medical system -911 then,
• Head-tilt/chin-lift – open victims’ airway by tilting their head back with one hand while lifting up their chin with your other hand.

B – BREATHING

• Position your cheek close to victims’ nose and mouth, look toward victims’ chest, and
• Look, listen, and feel for breathing (5-10 seconds)
• If not breathing, pinch victim’s nose closed and give 2 full breaths into victim’s mouth (use microshield).
• If breaths won’t go in, reposition head and try again to give breaths. If still blocked, perform abdominal thrusts (Heimlich maneuver)

C – CIRCULATION

• Check for carotid pulse by feeling for 5-10 seconds at side of victims’ neck.
• If there is a pulse but victim is not breathing, give Rescue breathing at rate of 1 breath every 5 seconds Or 12 breaths per minute
• If there is no pulse, begin chest compressions as follows:
• Place heel of one hand on lower part of victim’s sternum. With your other hand directly on top of first hand, Depress sternum 1.5 to 2 inches.
• Perform 15 compressions to every 2 breaths. (rate: 80-100 per minute)
• check for return of pulse every minute.
• CONTINUE UNINTERRUPTED UNTIL ADVANCED LIFE SUPPORT IS AVAILABLE

 

Figure A: The victim should be flat on his back and his mouth should be checked for debris.

Figure B: If the victim is unconscious, open airway, lift neck, and tilt head back

Figure C: If victim is not breathing, begin artificial breathing with 4 quick full breaths

Figure D: Check for carotid pulse

Figure E: If pulse is absent, begin artificial circulation by depressing sternum.

How to Perform ADULT CPR

1. Make sure the scene is safe for you to help.
2. Make sure you have universal precautions: gloves, pocket mask, etc.
3. Make sure you know how many patients you have.
4. Determine if they are conscious by tapping and shouting “Are you OK?”
5. If no response have someone call 911.
6. Position the patient on their back.
7. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver.
8. LOOK-LISTEN-&-FEELING for breaths.CHECK BREATHING FOR 5-10 SECONDS.
9. If they aren’t breathing VENTILATE TWICE.
10. Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.
11. If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS.
12. Recheck the pulse after ONE MINUTE.
13. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE.

Videos: American National Red Cross Putting It All Together: CPR—Adult (2:03)

 

How to Perform CHILD CPR

1. Make sure the scene is safe for you to help.
2. Make sure you have universal precautions: gloves, pocket mask, etc.
3. Make sure you know how many patients you have.
4. Determine if they are conscious by tapping and shouting “Are you OK?”
5. If no response have someone call 911.
6. Position the patient on their back.
7. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver.
8. LOOK-LISTEN-&-FEELING for breaths.CHECK BREATHING FOR 5-10 SECONDS.
9. If they aren’t breathing VENTILATE TWICE.
10. Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.
11. If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 5 COMPRESSIONS to 1 BREATH.
12. Recheck the pulse after ONE MINUTE.
13. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE.

 

 

How to Perform INFANT CPR.

1. Make sure the scene is safe for you to help.
2. Make sure you have universal precautions: gloves, pocket mask, etc.
3. Make sure you know how many patients you have.
4. Determine if they are conscious by tapping and shouting “Are you OK?”
5. If no response have someone call 911.
6. Position the patient on their back.
7. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver.
8. LOOK-LISTEN-&-FEELING for breaths.CHECK BREATHING FOR 5-10 SECONDS.
9. If they aren’t breathing VENTILATE TWICE-CHEEK PUFFS.
10. Check for a pulse by palpating (feeling) the brachial(arm) artery. CHECK THE PULSE FOR 10 SECONDS.
11. If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 5 COMPRESSIONS to 1 BREATH.
12. Recheck the pulse after ONE MINUTE.
13. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE.

This is intended as a supplement to information learned in a complete CPR course instructed by the American Heart Association. It is not to be used as your only guide for CPR unless in emergency situations. Please use this only as a guideline for the proper steps in CPR. For more information please contact your local American Heart Association for class information.

Videos: American National Red Cross.Putting It All Together: CPR—Infant (1:52) 

 

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Specifics

Adult First AidCPRAED Ready Reference (American Red Cross) – PDF

CPR & ECC Guidelines | American Heart Association – website

Cardiopulmonary resuscitation U.S. National Library of Medicine – website

 

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Facts about CPR

• Sudden cardiac arrest is the leading cause of death in adults. Most arrests occur in persons with underlying heart disease.
• CPR doubles a person’s chance of survival from sudden cardiac arrest.
• 75% of all cardiac arrests happen in people’s homes.
• The typical victim of cardiac arrest is a man in his early 60’s and a woman in her late 60’s.
• Cardiac arrest occurs twice as frequently in men compared to women.
• CPR was invented in 1960
• There has never been a case of HIV transmitted by mouth-to-mouth CPR.
• In sudden cardiac arrest the heart goes from a normal heartbeat to a quivering rhythm called ventricular fibrillation (VF). This happens in approximately 2/3rds of all cardiac arrests. VF is fatal unless an electric shock, called defibrillation, can be given. CPR does not stop VF but CPR extends the window of time in which defibrillation can be effective.
• CPR provides a trickle of oxygenated blood to the brain and heart and keeps these organs alive until defibrillation can shock the heart into a normal rhythm.
• If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minutes a person has a 40% chance of survival.

 

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Answers to Frequently asked questions about CPR

When did the CPR guidelines change?

In October, 2015 the American Heart Association issued new guidelines for the performance of CPR. The major change compared to the prior guidelines is to start with chest compressions rather than ventilations. Thus the new sequence is:

1. Check for unresponsiveness and lack of breathing or abnormal breathing.
2. Activate emergency response (call 911 in the US and Canada).
3. Perform 30 chest compressions – push hard and push fast in the center of the chest at a rate of 100-200 per minute and a depth of 2-2.4 inches.
4. If you are trained give 2 ventilation and then alternate 30 compressions with 2 ventilations.
5. If you are not trained in ventilations continue with chest compressions.

Why did these guidelines change?

Recent animal and human data suggests that CPR is more likely to succeed if the heart is full of blood, especially just prior to a defibrillatory shock, and the best way to accomplish this is with adequate chest compressions. Since it is very difficult for an untrained persons to perform adequate mouth-to-mouth ventilations it is better that emphasis be placed on continuous chest compressions.

When should I do hands-only CPR?

The American Heart Association recommends hands-only CPR in the following circumstances: If a bystander, not trained in standard CPR, sees an adult suddenly collapse or come upon a collapsed person then he or she should call 911 and provide chest compressions by pushing hard and fast in the center of the chest. Interruptions should be kept to a minimum until trained rescuers arrive. For bystanders previously trained in standard CPR, hand-only CPR may be performed if the bystander is not confident or is unwilling to perform mouth-to-mouth ventilation.

What is the correct action where someone needs to be moved to perform CPR, such as a car accident? Does the risk of additional harm (such as spinal injury or bleeding) outweigh the benefits of CPR if nobody qualified is on scene?

If the person is in need of CPR and must be moved, move the person and begin CPR. Remember if you don’t do CPR the person will die. The neck injury is only theoretical if you move the person. Death, if you don’t do CPR, is 100% certain. Whenever you move a person with a possible neck injury try to support the head during movement and keep it as straight as possible.

During the CPR, what is the percentage of heart efficiency as a pump?

The best estimate of the heart efficiency during CPR is 20-30% of normal.

I heard that no matter if a person is unconscious that you should perform CPR. Is this true? When should you not perform CPR?

It is true that sometimes a person may be unconscious and their heart is still beating and they may still be breathing. Such a situation, for example, may occur in someone who has just had a grand mal seizure. If you tried to do CPR on such a person he or she would probably groan and even try to push you away. This would be your clue that CPR was not needed. CPR is intended only for someone whose heart and breathing has stopped. If the victim moves or pushes you away, you should stop CPR.

What is the ratio of 2-person CPR?

The ratio of chest compressions to mouth-to-mouth is the same for 2 person CPR as for 1 person CPR, namely 30:2.

How do I perform CPR on a person who has a tracheal stoma? Do I have to cover their mouth or just breath directly into the stoma?

There are two types of stomas, one which communicates to the nose and mouth and one which doesn’t. Since you won’t know which type you are dealing with, it is best to pinch the victim’s nose closed, keep the victim’s mouth closed and breathe directly into the stoma opening.

When you are giving mouth to mouth are you actually breathing oxygen into the victim’s lungs or are you trying to stimulate breathing by breathing carbon dioxide into their lungs?

You are breathing oxygen into the lungs. Your exhaled breath contains 16% oxygen which is close to the 20% contained in the air you breathe in.

When performing CPR, how do I know if it’s working?

You can tell if the chest rises with ventilation. It is hard to determine if the chest compression results in a pulse. Do the best you can and don’t stop. It’s better to perform CPR imperfectly than not at all.

If a person has had bypass surgery, and a situation occurs that they require CPR, are there any special considerations that need to be made?

No, CPR should be done in the regular fashion.

Is it easier to break an overweight person’s ribs or a skinnier persons ribs when performing cpr?

The weight of the victim has little to do with the chances of breaking a rib, instead the age of the victim seems to determine the fragility of the bones.

Can I kill someone if I do CPR incorrectly?

No. Remember the person in cardiac arrest is already clinically dead. CPR can only help. Even if it’s not done “letter perfect” it will probably provide some benefit to the victim.

What if I crack a rib when I do CPR?

Frequently ribs are broken with the pressure CPR places on the sternum. Some studies quote up to 30% of cardiac arrest victims have broken ribs as a result of CPR. This happens more frequently the older the victim since the cartilage is less compliant and the bones more easily crackable. But remember, it’s better to have a cracked rib than be dead.

Will CPR always save a life?

No, in fact, most instances of CPR for cardiac arrest are unsuccessful.

What is the recovery position?

Assuming the person has a pulse and is breathing, the recovery position means placing the person on his or her side. This allows for the person not to choke on saliva and helps keep the airway open. The downside arm may be raised to suport the head.

What should you do for a person who has been accidentally shocked by electricity?

A person with electric shock (assuming the shock doesn’t severely damage the body) often dies from the heart going into ventricular fibrillation. Such a person needs CPR and it should be performed in the regular fashion. If CPR begins quickly and if a defibrillator arrives quickly this person has an excellent chance of survival.

I want to know what the current teachings are on helping a choking victim. I have heard conflicting information on back blows for an adult. Is it still recommended, or discouraged?

The first action to take in adults and children is the Heimlich maneuver. Back blows are the first thing to do only in infants who are conscious. In doing the back blows the infant should be in a face down position with the head lower than the body.

What if the victim vomits?

Vomit is obviously unpleasant. If it happens (and it may in one out of 20 cardiac arrests) merely turn the head to the side and wipe out the vomit as best you can with your finger.

If someone has an asthma attack and collapses, what should a person do? Will CPR help?

If someone collapses from an asthma attack, it is because he or she is not getting enough oxygen. This is because all the lung’s small airways have narrowed and are not allowing enough air to reach the air sacs. Mouth to mouth respiration may help a little. The real need is to get this person to an emergency department so that the patient can receive medications and emergency endotracheal intubation (a tube in the main airway).

What are some of the causes of CPR being used for in infants and children?

Usually CPR in infants and children is performed for respiratory arrest such as severe asthma. Ventricular fibrillation is rare in children but very common in older adults.

In regards to administering the Heimlich Maneuver to a victim while they are lying down, should the head be facing up, as when administering CPR (in order to clear the airway), or to the side?

The victim’s head should be facing up with the victim on his/her back. Since the airway is blocked you shouldn’t spend much time positioning the head. The Heimlich maneuver is the most important thing to do and should unblock the airway

What if the victim is wearing dentures?

Keep them in place if possible as they will allow for a better seal of your mouth on his/hers.

Can I get AIDS from doing CPR?

No. There has never been a documented case of AIDS transmitted by CPR.

Can I get sued if I perform CPR?

You theoretically could but there has never been a successful suit brought against someone performing CPR.

Does the Good Samaritan law protect me?

Yes, if you give assistance, including CPR, for a medical emergency Good Samaritan laws cover you.

What are agonal respirations?

When the heart stops beating in cardiac arrest the breathing center in the brain is still alive for a couple of minutes and will cause the victim to take a few abnormal breaths. These abnormal breaths associated in dying are called agonal respirations. They may appear like snoring, gasping, or snorting and will disappear in a couple of minutes. Don’t let abnormal breathing stop you from starting CPR.

In cardiopulmonary arrest occurring outside of a hospital what are statistics regarding successful uncomplicated recovery? Also in this situation how many patients are successfully resuscitated but are then in a vegetative state?

The statistics vary from locale to locale. In New York City or Chicago the survival rate (discharge alive from the hospital) is 2 or 3%. In Seattle the survival rate is 20% overall and 45% for ventricular fibrillation. Less than 5% of those discharged have severe neurologic damage. Over 60% return to their prior level of mental status. Persistent vegetative states are very unusual.

Can CPR be performed on dogs?

CPR can be performed on dogs. To give respiration you will need to keep the dogs mouth and lips closed and breathe through the nose. Cover the dogs nose completely with your mouth to prevent air from leaking out. You should see the chest rise if you are doing it properly. To give chest compressions you might need to press side to side instead of straight down on the chest. This is especially true for funnel chested dogs. The rates of respiration to chest compression are the same as for humans. In general, most instances of CPR for dogs will involve accidents of smoke inhalation or drowning. Respirations may indeed prove life saving especially if the dog has a heart beat. Once the dog’s heart stops beating it is unlikely that CPR will be of benefit. By the way, the name gingy in my address is for my 13 year-old golden retriever.

If a person moves when I do CPR should I stop?

Yes, if a person moves his arms or legs they don’t need CPR.

When should I stop CPR?

When help arrives to take over, or the victim starts to move.

What chance does the person (on whom I perform CPR) have of surviving?

If you do CPR on a person whose heart has stopped beating there is a 40% chance the person will live if a defibrillator can arrive within 10 minutes to shock the heart.

What should I do if I’m alone and I do not know CPR?

If you are alone and don’t know how to do CPR call 911 and ask the emergency dispatcher to give you instructions over the phone.

If a pregnant women chokes should I do the Heimlich Maneuver or can it harm the baby?

You should do the chest thrust in a very pregnant woman. This is like the Heimlich except you grab around the middle chest instead of the upper abdomen.

First Aid for a Choking Conscious Adult

Step 1.
Determine if the person can speak or cough.
If not, proceed to the next step.

Step 2.
Perform an abdominal thrust (Heimlich Maneuver) repeatedly until the foreign body is expelled.

Step 3.
A chest thrust may be used for markedly obese persons or in late stages of pregnancy.

What is the reason calling 911 occurs after 2 minutes of CPR for infants and children whereas for adults, the call is made immediately?

It is because airway problems are the main cause of cardiac arrest in infants and trying to correct that problem takes precedent over calling 911.

If successful CPR is dependent on a defibrillator arriving, are there any portable defibrillators available?

Portable defibrillators which operate automatically (they are called automated external defibrillators – AEDs) are available and may be purchased without a prescription. They cost around $1000. The training is very simple and takes only minutes. You should talk to your doctor as to whether one of these might be indicated in your situation.

In a trekking guidebook I own it states that if there has been a trauma fall and the victim has no pulse, then CPR is futile, is this true?

Doing CPR in the wilderness is futile. I would, however, make an attempt to open the airway and perhaps give several ventilations. You may be dealing with respiratory arrest and a little mouth to mouth could be lifesaving.

Is it true that if a victim “regains” a pulse after doing CPR he/she has probably had a pulse all along?

You are partially correct. The most common cause of cardiac arrest is VF and this cannot be converted with CPR alone. Electricity is required. However there are some instances when the heart is going very slowly and CPR can oxygenate the system enough to get the heart going again.

Answers to Frequently asked questions about CPR source: University of Washington School of Medicine