CPR

These guidelines are meant to help you review your skills. Reading them is not a substitute for taking an American Heart Association-certified or American Red Cross-certified CPR class.

Cardiopulmonary resuscitation (CPR) is a basic life-support technique that is used when the victim is not breathing and the heart may have stopped. CPR allows you to manually perform the functions of the heart and lungs, which send blood and oxygen to all parts of the body.

All of the body's cells, especially the brain cells, need a steady supply of oxygen. CPR opens and clears the victim's airway, and restores breathing and blood circulation through mouth-to-mouth breathing and repeated pressure on the chest.

CPR for Adults and Children Over 8 Years Old

Check for consciousness. Gently shake the victim and shout, "Are you OK?" If there is no response or if the victim is not breathing, shout for help and ask someone to call 911 immediately. The order of action to take in an emergency can be remembered as the ABCs — Airway, Breathing, and Circulation.

Airway: Open the Airway (Head Tilt/Chin Lift)

1. Tilt the victim's head back if no neck or spinal injuries are suspected.

2. Place your hand on the forehead and apply firm, backward pressure to tilt the head back.

3. Push down on the forehead and, with your other hand, lift the victim's chin.

4. Place 2 fingers of your other hand on the bony part of the victim's chin. Pull the victim's chin forward and support the jaw, helping to tilt the head back.

Breathing: Check Breathing/Perform Rescue Breathing

Place your ear over the victim's mouth and nose while keeping up an open airway. Look for the chest to rise and fall. Listen for air escaping during exhalation, and feel for the flow of air. Watch for 5 seconds. If there is no sign of breathing, perform rescue breathing as follows:

1. Keep the airway open by using the head tilt/chin lift maneuver described above. Gently pinch the victim's nose shut using your thumb and index finger on the forehead.

2. Take a deep breath and seal your lips tightly around the victim's mouth.

3. Give 2 full breaths — 1 1/2 to 2 seconds per breath, 10 to 12 breaths per minute. Take a breath for yourself after each 2 breaths for the victim. Watch for the victim's chest to rise with each breath. Let the victim's chest fall between breaths.

Clearing a Blocked Airway for an Unconscious Victim

If the victim's chest doesn't rise during rescue breathing, the airway is blocked. Re-tilt the victim's head and try again. If the airway is still blocked, perform the Heimlich maneuver (steps 1 and 2) as follows:

1. Kneel and straddle the victim, placing the heel of your hand on the victim's stomach above the navel and below the ribs.

2. Place your other hand over your fist. Keeping your elbows straight, give 4 quick, downward thrusts toward the chest.

3. Open the victim's mouth by grasping both the tongue and lower jaw between your thumb and fingers, and lift. This will draw the tongue away from the back of the throat and away from any object that might be lodged there. Look to see if an object is visible in the back of the throat.

4. Next, perform the finger-sweep maneuver as follows: Insert the index finger of the other hand down along the inside of the cheek and deeply into the throat to the base of the tongue. Use a hooking action to dislodge the object, and move it into the mouth so that you can remove it.

5. Attempt rescue breathing again. If you are still unable to breathe air into the victim's lungs, reposition the head and try again. Repeat the sequence of Heimlich maneuver, finger sweep, and rescue breathing. Perform this cycle until the object is dislodged, and you are able to continue rescue breathing.

Circulation: Check for Pulse

1. While keeping the head tilted, move 2 fingers from the Adam's apple to the side of the neck between the windpipe and the neck muscles. Press down gently and gradually for 5 to 10 seconds. A pulse shows that the heart is beating.

2. If the victim has a pulse but is not breathing, continue rescue breathing at a rate of 10 to 12 times per minute, or once every 5 or 6 seconds. If the victim has no pulse and is not breathing, begin CPR.

3. Find the notch where the victim's ribs meet the breastbone in the center of the chest. Place the heel of your hand 2 finger-widths above the notch. Place your other hand on top of this hand, interlocking your fingers.

4. Lean forward until your shoulders are directly over your hands. The weight of your body falling forward provides the force to depress the breastbone.

5. Do 30 chest compressions (at a rate of 80 to 100 per minute), continuing to lean over the victim so your shoulders are over your hands. Note: Don't rock back and forth or pause between compressions. Lock your arms straight and press hard on the breastbone 1 1/2 to 2 inches or one third of the chest depth. Count out loud, "one and, two and, three and, four and" as you push straight down. Allow the chest to return to its normal position after each compression. Do not lift your hands from the chest or change position, or the correct hand position may be lost.

6. Open the airway again using the head tilt/chin lift and give 2 slow rescue breaths. Watch for the chest to rise. Repeat this sequence of 30 compressions and 2 breaths for 4 cycles. Recheck for pulse.

7. When the victim is breathing and has a pulse, stop performing CPR. If the victim has a pulse but is not breathing, continue rescue breathing. Recheck the pulse every 60 seconds. Start CPR again if pulse stops. If the victim has no pulse and is not breathing, repeat sequence of 30 compressions and 2 breaths, checking for pulse every 4 cycles. Continue until the victim is revived or help arrives.

CPR for Children Under 8 Years Old

Shout for help and ask someone to call 911 immediately. Then provide the basic ABC's (Airway, Breathing, Circulation) of life support.

Airway: Open the Airway

If no neck or spinal injuries are suspected, open the airway by placing your hand on the child's forehead and tilting the head back into a neutral position. Place the fingers of your other hand under the bony part of the lower jaw at the chin and lift upward and outward.

Breathing: Check Breathing/Perform Rescue Breathing

1. After the airway is opened, check to see if the child is breathing. Look for a rise and fall of the chest and abdomen, listen for exhaled air, and feel for exhaled air flow at the mouth.

2. If no spontaneous breathing is detected, begin rescue breathing while keeping the chin lifted. If the victim is less than 1 year old, place your mouth over the mouth and nose. If the victim is 1 to 8 years old, make a mouth-to-mouth seal and pinch the child's nose tightly with your thumb and forefinger, maintaining head tilt.

3. Give 2 slow breaths (1 to 1 1/2 seconds per breath) to the child. Pause to take a breath after the first breath. If the air enters freely and the chest rises, the airway is clear. If air does not enter freely or if the chest does not rise, either the airway is blocked or more breath pressure is necessary.

Note:Improper opening of the airway is the most common cause of airway blocks. Re-attempt to open the airway and try rescue breathing again. If you suspect an object is blocking the airway, use the self-care steps for choking. If a child loses consciousness or has more difficulty breathing, have someone call 911 immediately and perform the Heimlich maneuver.

Circulation: Check for Pulse

Spend only a few seconds checking a pulse in an infant who is not breathing before starting chest compressions.

1. In infants less than 1 year old, gently press your index and middle fingers on the inside of the upper arm, between the infant's elbow and shoulder. In children 1 to 8 years old, find the Adam's apple with 2 or 3 fingers. Slide your fingers into the groove on the side of the neck between the windpipe and neck muscles.

2. If a pulse is present but the child is not breathing, do rescue breathing at a rate of 20 breaths per minute (once every 3 seconds) until spontaneous breathing resumes. After giving 20 breaths, call 911.

3. If there is no pulse, do chest compressions as follows:

• Use one hand to maintain the infant's head position. Use your other hand to compress the chest.

• Place your index finger just below the level of the infant's nipples. Place your middle fingers on the breastbone next to the index finger.

• Using 2 or 3 fingers, compress the breastbone by about one third to one half the depth of the chest-about 1/2 inch to 1 inch.

• Do compressions at a rate of at least 100 per minute.

• Coordinate with rescue breathing by doing 5 compressions to each breath. Newborn infants and those less than 30 days old should receive 3 compressions to each breath.

• Continue until medical help arrives. If the infant starts breathing, place the victim in the recovery position (on one side with the arm supporting the head).