Step-by-Step Adult CPR
When to Perform (and a Disclaimer)
Cardiopulmonary resuscitation (commonly known as CPR) is to be performed if you encounter an UNCONSCIOUS ADULT WHO IS NOT BREATHING AND IS UNRESPONSIVE.
Please note--this guide is no replacement for real training and real practice.
Also, please be aware of the dangers of performing CPR. Unless proper technique is utilized, a patient may come out of treatment with broken ribs or damaged internal organs.
I have been certified in BLS (Basic Life Support)--the following are the steps and procedures taught to me by my instructor.
As a general rule, the safety of the rescuer comes before that of the victim. If you are in a dangerous situation, do not hesitate to save yourself before trying to save the victim.
Checking for a Response and Activating the ERS
Upon finding an unconscious adult, the first step is to CHECK FOR A RESPONSE. The most common method is to tap the person (vigorously, you are checking to see if they are conscious) and saying "Hey, hey, are you okay?!" Do not be gentle--this person may really be in need of your help.
Activate the ERS (Emergency Response System) by CALLING FOR HELP AND INSTRUCTING ANOTHER PERSON TO CALL 911. Do not be generic in asking someone to call (ie, "I need someone to call 911!") because it is likely that, in such a frightening situation, no one will be willing to take responsibility and make the call. Therefore, be direct--use someone's name, or say "YOU go call 911." That way there is no confusion.
Head tilt-chin lift and Look Listen Feel
After activating the ERS, the next step is to OPEN THE AIRWAY and then LOOK, LISTEN, AND FEEL.
Note: Proper CPR position--sitting on your knees with one knee by the victim's head and the other by their chest. Try not to move around much while performing CPR.
To open the airway:
1. Place side of hand on person's forehead, just above the browline, and push back gently, tilting their head back.
2. Place two fingers beneath their chin and tilt the head back futher. This helps move the jaw forward so air can pass in and out of the mouth.
The head tilt-chin lift is a difficult technique and it requires a lot of practice to do it successfully.
IF YOU SUSPECT HEAD OR NECK INJURIES, DO NOT PERFORM HEAD TILT- CHIN LIFT! This could make the victim's condition even worse. Instead:
1. Place thumb on one end of the jaw and the middle or ring finger on the other. Push the jaw forward. This opens the airway and helps to keep the tongue from covering the back of the throat.
LOOK LISTEN AND FEEL-- When you LLF, you are checking to see if the victim is breathing on their own. After performing the Head tilt-chin lift, lean down and place your ear close to the victim's mouth and nose. LOOK for a rise in the chest; LISTEN for air passing through the mouth and nose; FEEL any air passing over your face.
Preliminary RB and Checking for a Pulse
If you do not think that the victim is breathing on their own, it is time to administer preliminary rescue breathing. Make sure your head tilt-chin lift is sufficient, then create an air tight seal over the victim's mouth with your own (this is not the most pleasing aspect of CPR, but try to remember that you are saving their life). Administer TWO BREATHS, ONE SECOND EACH IN DURATION. Look for rising and falling of the chest to confirm that the breaths have not gone in.
IF TWO BREATHS DO NOT GO IN, READJUST THE HEAD TILT-CHIN LIFT AND TRY AGAIN. IF THE AIR STILL DOES NOT GO IN, THERE MAY BE AN OBSTRUCTION OF THE WINDPIPE.
After getting two breaths in, while still leant over the victim, place two fingers (any two besides the thumb) on the carotid artery on the side of the victim's neck. This artery is very prominent in most people, and can be located halfway between the ear and chin.
Place two fingers on the carotid artery (again, NOT THE THUMB--it has a pulse of its own) and apply very gentle pressure. Applying too much pressure may cut off the artery or make the pulse difficult to feel out; applying too little pressure will not allow you to feel the pulse at all.
Feel for a pulse for NO LESS THAN FIVE SECONDS AND NO MORE THAN TEN. If a distinct pulse is not found within that time, begin chest compression CPR; if a pulse is found, being rescue breathing.
Pulse Found--Rescue Breathing
If a pulse is found between five and ten seconds, you are to begin rescue breathing.
The standard rate of rescue breathing in adults is ONE BREATH EVERY FIVE SECONDS FOR TWELVE CYCLES. Make sure your head tilt-chin lift is sufficient (if it is not, the windpipe will not be open properly and the air will not go in) and repeat the rescue breathing steps as described before the pulse was taken.
1. Create an air tight seal over the victim's mouth with yours.
2. Breath in over the span of one second, looking for a rise in the chest to confirm that the air has gone in.
3. Repeat Step 2 every five seconds for twelve cycles (or one minute) and then check for a pulse.
4. If PULSE IS FOUND, CONTINUE RESCUE BREATHING. If not, begin chest compression CPR.
Check for a pulse regularly between twelve-cycle sets while doing rescue breathing; if the victim's heart stops, the sooner you begin chest compressions, the better chance the victim has of surviving.
Pulse Not Found--Chest Compressions
If a pulse is not found within five to ten seconds, BEGIN CHEST COMPRESSIONS.
Like the head tilt-chin lift, chest compressions are a difficult technique, but they can also be very dangerous to the victim.
1. Locate bottom of rib cage.
2. Trace finger up rib cage to the base of the sternum, or the xiphoid process (a small nub of bone).
3. Place heel of one hand two finger widths above the xiphoid process.
4. Lace the fingers of your other hand with those of the hand on the victim's chest. Pull back your fingers to avoid putting pressure on the victim's ribs.
5. Begin chest compressions at a rate of 100 per minute, or 30 in less than 23 seconds. Press down firmly on the chest, putting your weight over your arms. Allow for full chest recoil between compressions.
6. Finish a set of 30 compressions in less than 23 seconds, then administer two rescue breaths over a time span of one second each.
7. Repeat Step 6 four times (or for one minute) before checking for a pulse. IF PULSE IS FOUND, BEGIN RESCUE BREATHING; IF PULSE IS NOT FOUND, RESTART CHEST COMPRESSIONS.
A Brief Review
1. Check for a response and activate the ERS.
ex: "Hey, hey, are you okay?! Help, you/person's name call 911!!!"
2. Head tilt-chin lift; LOOK LISTEN AND FEEL.
3. Two rescue breaths
4. Check for a pulse
5. PULSE FOUND--begin rescue breathing at a rate of one breath per five seconds for twelve cycles, or one minute. Recheck pulse after first cycle.
5. PULSE NOT FOUND--begin chest compressions at rate of 100 per minute or 30 in less than 23 seconds for four cycles or one minute. Recheck pulse after first cycle and fourth cycle.
When is it Okay to Stop CPR?
You may stop performing CPR if and only if:
1. Another rescuer arrives and takes over.
2. The ambulance arrives.
3. The victim begins to respond (regains consciousness and is breathing normally).
4. The area in which you are working becomes dangerous (ie fire danger and the like). In this instance, try to move the victim to a safer area, but please remember that your own safety comes first.
5. You become too exhausted to continue.
A True CPR Story
This story was told to me by my CPR instructor. This case still weighs heavily on his mind to this day.
While at a restaurant on a lake, Steve stepped out of the men's bathroom to see a woman at the phone, frantically flipping through a phone book. Walking up to her, he offered her his help, telling her that he was an EMT. Panicked, the woman looked at him and said "Help me--my husband just shot himself."
Expecting an accidental shot to the leg or something of that sort, Steve followed the woman out to the lakeside. He was shocked to see her husband lying in a pool of blood. He had put the muzzle of a gun beneath his right ear and pulled the trigger.
Steve immediately began performing CPR, but when he gave rescue breaths, he could hear air whistling out the top of the man's head. "At least I knew I was giving good breaths," Steve said grimly, wincing at his own attempt at humor. Our class was too horrified by his tale to laugh.
"I knew the guy was dead, guys, I could hear the air coming out the top of his head because he'd blown his own brains out. But I didn't stop CPR. And you know why?
"Because it was my duty not to."