Cardiopulmonary Resuscitation
Before acting in any way, it is important to recognize if there is an emergency situation. You
may recognize that there is an emergency situation by many ways, such as unusual sights,
unusual appearance or behavior, a peculiar odor, strange noises, etc. Most importantly, if
you think something is wrong, check the person. Don’t be afraid to ask questions and DON’T
FORGET that if a person denies anything is wrong, he/she may still be having a problem, so
be persistent until you are satisfied that there is no emergency situation present.
Each of the 50 states has enacted what are known as the “Good Samaritan Laws”. These
laws give legal protection to people that give emergency care to an ill or injured person
without accepting anything in return. It’s very important that you understand that no
compensation of any kind can be accepted for performing emergency care or the Good
Samaritan Laws may no longer protect you! These laws vary from state to state and usually
protect citizens that act in the same way that a “reasonable and prudent person” would if
that person were in the same situation. Developed to encourage people to help, these laws
require the “Good Samaritan” to:
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Act in Good Faith
Not be deliberately negligent or reckless
Act within the scope of his/her training
Not abandon the person after starting to give care
You should investigate the Good Samaritan Laws in your state and possibly contact a
legal profession to find out more about your state’s Good Samaritan Laws.
Key Principles
There are "Key Principles" of Basic Life Support. Remember that Basic Life Support is
considered care given to a person who is not breathing. We will demonstrate them later in a
video but for now, it’s a good idea to mention them so that you can take notes and review
them at your leisure so that you can simply watch the video later.
There are 4 basic goals when helping a victim:
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Keep the victim alive
Keep the situation from getting worse
Promote recovery
Insure that the victim receives medical care.
Things to Remember!
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Call 9-1-1 for an unresponsive victim
Call 9-1-1 for any life-threatening condition
Move an unresponsive person ONLY if the scene is unsafe
Open the airway with the tilt-chin lift to check for breathing
Look, listen, and feel for breathing for not more than 10 seconds
Use a barrier device to give breaths whenever possible
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Give each breath for at least 1 second, watching the chest rise and fall.
Give chest compressions 2 inches deep midway between the nipples. Allow the chest
to rise and fall all the way between compressions.
Use cycles of 30 compressions and 2 breaths (COMPRESSIONS FIRST)
Use the AED as soon as it is available and ready to use
Follow the AED prompts to give a shock when indicated and then give CPR again
before the AED again analyzes the victim’s rhythm
If the victim moves and begins breathing, position the victim in the recovery position
and monitor breathing until help arrives. If the victim does not begin to breathe on
his/her own, CONTINUE CPR UNTIL HELP ARRIVES.
When you call 9-1-1, it is important to give complete information to the EMS
dispatcher. This information should contain:
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Your name and the phone number that you are using
The location and number of victims
What happened to the victim and any other special circumstance or condition
What is presently being done for the victim
The Change from "A-B-C" to "C-A-B"
THIS IS A SIGNIFICANT CHANGE IN THE 2010 GUIDELINES
1. We begin the basic steps by determining if a victim needs help. Shaking the victim’s
shoulders and asking, "Hey, are you OK? Are you OK?" is a good start.
REMEMBER, THE CARDIAC CHAIN BEGINS WITH EARLY RECOGNITION AND
ACCESS! It’s important to access quickly if there is an emergency situation.
2. Call 9-1-1 (this should be done as soon as you recognize a life threatening situation).
The newest development in the 2010 AHA Guidelines for CPR and ECC is a change in the
basic life support (BLS) sequence of steps from "A-B-C" (Airway, Breathing, Chest
compressions) to "C-A-B" (Chest Compressions, Airway, Breathing) for adults and pediatric
patients (that includes children and infants but not newly borns). (This will be on the quiz,
please read it again and remember it).
Why the change in the change in the guidelines?
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The vast majority of cardiac arrests occur in adults. In these patients the critical
initial elements of CPR are chest compressions and early defibrillation.
In the A-B-C sequence (no longer recommended), chest compressions are often
delayed while the responder opens the airway to give mouth-to-mouth breaths or
retrieves a barrier device or other ventilation equipment. By changing the sequence
to C-A-B, chest compression will be initiated sooner and ventilation only minimally
delayed until the first cycle of chest compressions (30 chest compressions should be
accomplished in approximately 18 seconds).
Fewer than 50% of persons in cardiac arrest receive bystander CPR. Fewer than
50%!! It’s felt that the cause of this may be the A-B-C sequence which starts with
the procedure most rescuers find the most difficult: opening the airway and
delivering rescue breaths. Starting with chest compressions might ensure that more
victims receive CPR because more rescuers that would be unwilling to perform
rescue breaths will at least perform chest compressions.
CPR Process
CPR should only be used on an UNRESPONSIVE PERSON who is not breathing. Victims
are categorized into three age groups; Infants - newly born to the age of one, Child - Ages
one to the onset of puberty (the formation of secondary sex characteristics, ie; pubic hair,
armpit hair, etc.) Adult - puberty and older. THIS IS A CHANGE IN THE 2010
GUIDELINES TO FALL MORE IN LINE WITH HEALTHCARE PROVIDERS. IT WAS
DIFFERENT IN THE 2005 GUIDELINES. The treatment for each age group is slightly
different and we'll go over that later. Once you determine that a victim is unresponsive, you
should begin CPR. You can determine if a victim is unresponsive by shaking the person's
shoulders and asking, "Are you OK? Are you OK?" CPR is as easy as pumping the chest and
breathing air into a victim's mouth. Again, it is very important to understand that you
should first determine that the victim is unresponsive and their normal breathing has
stopped. Listen for breathing but this should be done in 10 seconds or less.
Do not move a victim unless you cannot perform CPR in the position that they are in. For
example, if a victim is in bed, move them to a hard floor to perform chest compressions.
The 2010 AHA Guidelines for CPR And ECC stress immediate activation of the
emergency response system (Call 9-1-1) and starting chest compressions for any
unresponsive adult victim with no breathing or no normal breathing (ie, only gasps).
Chest compression should be initiated before rescue breaths. Remember the change: C-A-B
rather than A-B-C. In the old guidelines of 2005, we used the A-B-C (Airway, Breathing,
Chest Compressions). The new 2010 Guidelines call for C-A-B (Chest Compressions, Airway,
Breathing). Chest compressions should start immediately, whereas positioning the head,
attaining a seal for mouth-to-mouth rescue breathing, or obtaining or assembling a bag
mask device for rescue breathing all take time. Begin CRP with 30 compressions rather than
2 ventilations leads to a shorter delay to first compression.
Once you determine that a victim is not breathing and you've called 9-1-1, kneel next to the
victim's chest and perform 30 compressions before giving two rescue breaths. Place the
heel of your hand on the center of the chest, midway between the nipples. Place the other
hand over the hand touching the chest and interlock the fingers. Place your shoulders
directly over the chest with the arms straight and pump the chest 30 times quickly,
counting out-loud. The recommended depth of compression for adult victims has
increased from a depth of 1 ½ to 2 inches to a depth of at least 2 inches.
Compressions should be delivered at the pace of 100 compressions per minute. Allow
complete recoil of the chest after each compression and minimize any pauses in
compression.
When giving breaths, pinch the nose, lift the chin, and tilt the head back. This will help open
the airway so that you can breathe into the victim's mouth. Blow two breaths into the
mouth. Rescue breaths should be given for at least one second.
Watch as the chest rises with each breath. If you don't see the chest rise and fall, it's
possibly an indication that there is a blockage in the airway and you will have to remove it
before continuing. Remember to check to see if the chest is rising and lowering with each
breath.
Continue this cycle until help arrives. The 30 compressions to 2 breaths ratio
(30:2) should be remembered and maintained. Watch as the chest rises with each breath.
If you don't see the chest rise and fall, it's possibly an indication that there is a blockage in
the airway and you will have to remove it before continuing. Remember to check and see if
the chest is rising and lowering with each breath.
The Recovery Position
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USE THE RECOVERY POSITION FOR ANY VICTIM WHO IS UNRESPONSIVE AND
BREATHING
USE THE RECOVERY POSITION FOR ANY VICTIM WHO IS UNRESPONSIVE AND
BREATHING
Notice we printed this twice? We even printed it again at the bottom of the page. That's 3
times!! This question is on the exam and everyone gets it wrong. It was updated in the ECC
2005 Guidelines and is still maintained in the new guidelines. When asked on the exam
when you place a victim in the recovery position, answer "unresponsive and breathing".
That is the correct answer. Here's the reasoning:
If you determine that the victim begins to breathe during CPR, you should immediately
place that person in the "Recovery Position" until help arrives. This position helps keep the
airway open, allows fluids to drain from the mouth and prevents the victim from inhaling
stomach contents if the victim vomits.
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Extend the victim's arm that is farther away from you straight out or slightly above
the victim's head.
Position the victim's other arm across the chest.
Bend the victim's nearer leg at the knee.
Put the forearm that is nearer the victim's head under the victim's nearer shoulder,
with your hand under the hollow of the neck.
Carefully roll the victim away from you by pushing on the victim's flexed knee and
lifting with your forearm while your hand stabilizes the head and neck. The victim's
head is now supported on the arm.
While continuing to support the head and neck, position the victim's hand palm-down
with fingers over the arm and supporting the chin. This can be modified and the
hand can be placed under the armpit with forearm on the surface at 90 degrees to
the body
With victim now in position, check the airway and open the mouth to allow drainage.
REMEMBER, USE THE RECOVERY POSITION FOR ANY UNRESPONSIVE VICTIM WHO
IS BREATHING!
Differences In CPR Based On Age
The 2010 AHA guidelines define Adult, Child & Infant as the following:
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Adult - The onset of puberty and older
Child - 1 year old to the onset of puberty (development of secondary sex
characteristics, ie; pubic hair, armpit hair, etc.)
Infant - Less than 1 year
CPR Hand Placement
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Adult - 2 hands on the breastbone, between the nipples
Child - 1 or 2 hands on the breastbone, between the nipples
Infant - (less than 1 year old) 2 fingers on the breastbone just below the nipple line
Compression Depth:
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Adult - 2 inches
Child - 2 inches
Infant - 1 1/2 inches
AED USE (the use of an AED differs in age from that of the
CPR process)
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Adult - (8 years or older) AED use recommended. Adult pads only. Do not use
Pediatric Pads on an adult. Deliver 1 shock as soon as possible, follow immediately
by 2 minutes (5 cycles of 30:2 ratio) CPR.
Child - (1-8 years) AED use recommended. Pediatric Pads if available. If not, it is
OK to use adult pads. Deliver 1 shock as soon as possible followed by 2 minutes (5
cycles of 30:2 ratio) CPR.
Infant - (less than 1 year old) Pediatric pads are now recommended, even
for infants. In the past, the use of an AED was not recommended for
infants. It changed in the 2010 guidelines.
Choking (Responsive Victim)
If you think a person is choking, you should always ask that person:
"Are you choking?"
"Can I help you?"
If the person responds that they are choking, you should immediately try and get the
person's permission to help them. For self-protection, it's always a good idea to ask for
permission to help, even if they're having trouble responding. That holds true for an adult
AND child. If a parent or guardian of the child is present, identify yourself, tell them you are
trained in CPR or First Aid and ask for their permission to help their child.
If you receive permission OR if the person is unable to respond (the inability to respond
is assumed permission to help), you should immediately come to their aid. You should
perform chest thrusts on a choking person. This procedure is commonly referred to as the
Heimlich Maneuver.
Choking Care for a Responsive Adult & Child
Stand behind the victim with one leg forward between the victim's legs. Keep your head
slightly to one side.
Make a fist with one hand and place the thumb of the fist against the victim's abdomen, just
above the navel.
Grasp your fist with the other hand and thrust inward and upward into the victim's abdomen
with quick jerks. Continue abdominal thrusts until the victim can expel the object or
becomes unresponsive.
For a responsive pregnant victim, any victim you cannot get your arms around, or for whom
abdominal thrusts are not effective, give chest thrusts from behind the victim. Take care
NOT to squeeze the ribs with your arms.
Choking Care for an Infant
Place the infant face down on your forearm so the baby's head is lower than his or her
chest. Support the baby's head in your palm, against your thigh. Do not cover the baby's
mouth or twist his/her neck.
Us the heel of one hand to give up to 4 firm thumps (back blows) between the shoulder
blades. (See illustration "A" below).
If the object does not pop out, support the baby's head and turn him/her on the back,
facing up while lying on your thigh. The top of the baby's head should point towards the
floor.
Place 2 or 3 fingers, depending on the baby's size, on the lower part of the baby's
breastbone and give 5 upward thrusts (See illustration "B" below). Look for an object in the
baby's mouth. If you can see one, remove it. Then give 2 rescue breaths.
To give rescue breaths:
Place one hand on the baby's forehead and tilt the baby's chin up to keep the airway open.
Place your mouth over the baby's mouth and nose and slowly blow air in until the baby's
chest rises. Between breaths, remove your mouth, take a breath, and watch for the baby's
chest to fall.
If the object does not come out after following these steps, call 9-1-1 or other emergency
services.
Continue with back blows and chest thrusts while looking for the object. Continue giving
rescue breaths as well. Continue these steps until the baby coughs up the object and starts
breathing on his/her own or until help arrives.
Note:
We study chest thrusts now, even though it's considered a "First-Aid" procedure because we
feel it's important. You may upon a scene where immediate Basic Life Support is required
but you may be unable to perform it properly because there is a blockage in the airway.
These basic steps should be learned, even in the CPR/AED course so that you can dislodge
an object in the airway in order to continue with Life Support.
Key Changes in the 2010 AHA Guidelines for CPR and ECC
ECC (Emergency Cardiovascular Care)
1) “Look, Listen & Feel” has been removed from the BLS algorithm. Performance of these
steps is inconsistent and time consuming. The 2010 AHA guidelines stress immediate
activation of the emergency response system (calling 9-1-1 in most cases) and starting
chest compressions for any unresponsive adult victim with no breathing or no normal
breathing (ie, only gasps).
2) Hands-Only (compression only) CPR for the untrained lay rescuer is encouraged. (If you
are unable to, or un-willing to perform rescue breaths, we encourage hands-only also,
rather than doing nothing). Hands-only CPR is easier to perform by those with no training
and can be more easily guided by dispatchers over the telephone.
3) Initiate chest compressions before giving rescue breaths (C-A-B: compressions,
airway breathing)rather than the former method of A-B-C (airway, breathing,
compressions). Chest compressions can be started immediately whereas positioning the
head, attaining a seal for mouth-to-mouth rescue breathing, or obtaining or assembling a
bag-mask device for rescue breathing all take time. Beginning with 30 compressions rather
than 2 ventilations leads to a shorter delay to first compression.
4) There is an increased focus on methods to ensure that high-quality CPR is performed.
Adequate chest compressions require that compressions be provided at the appropriate
depth and rate, allowing the complete recoil of the chest after each compression and an
emphasis on minimizing any pauses in compressions and avoiding excessive ventilation. The
recommended depth of compressions for adult victims has increased from a depth of 1
½ inches to 2 inches.
AED: Automated External Defibrillator
AED: Automated External Defibrillator
A demonstration video for the AED will follow immediately after this section.
An AED is used to correct or restart a person’s heart rhythm. AEDs can be used for adults
and children over 1 year of age. All AED units have 4 things in common, a start button,
voice prompts, a shock button and pads.
When using an AED:
Position the victim away from contact with water and metal.
Place the unit by the person’s shoulder, turn it on and follow the prompts.
The unit will first prompt to “Call for help now”. Call 9-1-1 (Don’t forget that the AHA 2010
guidelines call for immediate call to activate EMS for adults. If the victim is an adult, you
should have called already).
The unit will now prompt to “Remove all clothing from person’s chest”. Expose victim’s chest
and dry or shave the area if necessary. This step is recommended for extreme
circumstances.
Prompt will advise to “Pull red handle to open bag”. Open the bags and apply pads to
victim’s chest as indicated on the diagram provided. The AED will walk you through the
placement of the pads.
Stand clear during rhythm analysis. The AED will walk you through the analysis and advise
you to “DO NOT TOUCH THE PATIENT DURING ANALYSIS”.
Follow prompts from AED unit to either a) press the shock button or b) do not shock but
immediately give CPR with the pads remaining in place, starting with chest compressions. If
the AED advises to shock, make sure everyone is clear of the victim’s body. The AED will
advise to “Press Red Button” and then “Shock Delivered”.
Follow the AED’s prompts to analyze the rhythm again after 5 cycles of CPR, (approximately
2 minutes).
Continue to follow the prompts and continue CPR until the victim moves or professional help
arrives and takes over.
If the victim recovers (moves), check for breathing and put breathing, unresponsive victim
in the recovery position (with pads remaining in place) and continue to monitor breathing.
If you have help at an emergency situation, send the other person to call 9-1-1 and get an
AED if one is available. Listen and feel for breathing for about 5-10 seconds. If the person is
not breathing, normally, pinch the nose, tilt the head back and give two breaths. For an
adult, start compressions first (C-A-B). Perform 30 compressions and continue this cycle
until the AED arrives. Place the unit next to the victim’s chest, open the unit and follow the
prompts as you’ve seen above.
ON AN ADULT, USE ADULT PADS. ON A CHILD, AND INFANTS (newly born to the onset of
puberty), USE PEDIATRIC PADS IF AVAILABLE. IF YOU ARE GIVING CPR TO A CHILD
(OLDER THAN ONE YEAR) AND YOU DO NOT HAVE CHILD PADS, USE ADULT PADS. DO NOT
USE CHILD PADS FOR ADULT VICTIMS OF CARDIAC ARREST.