Cardiopulmonary resuscitation (CPR): First aid


Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of mouth-to-mouth rescue breathing and chest compression that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.


When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED).





What to do?


AIRWAY: Clear the airway


1.Put the person on his or her back on a firm surface.

2.Kneel next to the person's neck and shoulders.

3.Open the person's airway using the head tilt-chin lift. Put your palm on the person's forehead and gently push down. Then with the other hand, gently lift the chin forward to open the airway.

4.Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Do not consider gasping to be normal breathing. If the person isn't breathing normally or you aren't sure, begin mouth-to-mouth breathing.


BREATHING: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

1.With the airway open (using the head tilt-chin lift), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

2.Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head tilt-chin lift and then give the second breath.

3.Begin chest compressions — go to "CIRCULATION" below.


CIRCULATION: Restore blood circulation

1.Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

2.Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 1 1/2 to 2 inches. Push hard and push fast — give two compressions per second, or about 100 compressions per minute.

3.After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn’t rise, repeat the head tilt-chin lift and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.

4.If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, open the kit and follow the prompts. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. If pediatric pads aren't available, use adult pads. Do not use an AED for infants younger than age 1. If an AED isn't available, go to Number 5 below.

5.Continue CPR until there are signs of movement or until emergency medical personnel take over.



To perform CPR on a child:


The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

Perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or the local emergency number, unless someone else can call while you attend to the child.

Use only one hand to perform heart compressions.

Breathe more gently.

Use the same compression/breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths. Continue until the victim moves or help arrives.


To perform CPR on a baby:


Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR.

To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child.

If there's no response, follow the ABC procedures below and time the call for help as follows:

If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.


If another person is available, have that person call for help immediately while you attend to the baby.


AIRWAY: Clear the airway


1.Place the baby on his or her back on firm, flat surface, such as a table. The floor or ground also will do.

2.Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.

3.In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

If the infant isn't breathing, begin mouth-to-mouth breathing immediately.




Before you begin


Assess the situation before starting CPR:

Is the person conscious or unconscious?

If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

If the person doesn't respond, call 911 (or your local emergency number), or have someone else do it. But if you're alone and the victim is an infant or a child age 1 to 8 who needs CPR, perform two minutes of CPR before calling for help.

Remember the ABCs

Airway, Breathing and Circulation — to remember the steps explained below.



An infant


BREATHING: Breathe for the infant



1.Cover the baby's mouth and nose with your mouth.

2.Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head tilt-chin lift and then give the second breath.

3.If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.

4.Begin chest compressions — go to "CIRCULATION" below.


CIRCULATION: Restore blood circulation


1.Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.

2.Gently compress the chest to about one-third to one-half the depth of the chest.

3.Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 times a minute.

4.Give two breaths after every 30 chest compressions.

5.Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.

6.Continue CPR until you see signs of life or until a professional relieves you.


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