How to Perform CPR

Cardiopulmonary Resuscitation, or CPR, is used when a victim's heart has stopped beating. Just follow the steps on this page to learn the basics of this lifesaving technique, and consider taking a course in how to perform CPR to gain valuable hands-on experience.http://www.americanheart.org/presenter.jhtml?identifier=4479

CPR, which stands for Cardiopulmonary resuscitation, is a technique to keep oxygenated blood flowing to a person's brain and other vital organs when their heart is not beating. After a person's heart stops beating, irreparable brain damage can occur within minutes, and death occurs within eight to ten minutes. Traditional CPR is comprised of both artificial breathing and chest compressions, but recent research by the American Heart Association suggests that hands-only CPR, meaning chest compressions without the artificial breathing, is also effective.http://www.americanheart.org/presenter.jhtml?identifier=3033740 The three main parts of performing CPR can be remembered as the ABCs of CPR. The A stands for airway, B is for breathing, and C is for circulation.http://www.ulsterredcross.org/courses.asp

A new protocol has been developed at the University of Arizona's Sarver Heart Center, that stresses the importance of chest compression without the interruption of breathing into the victim's mouth. Paramedics in Arizona alternate two minutes of 200 chest compressions with a shock from a defibrillator. The American Heart Association has not totally embraced the procedure for the layperson, as an airway is placed into the heart patient which is not possible for the average rescuer to do.http://www.cnn.com/2008/HEALTH/conditions/03/31/moh.cpr/index.html

• No matter the situation, do not forget your own personal safety. Use a CPR mask (sometimes called a pocket mask) if it's available. A CPR mask prevents the person performing CPR from coming in contact with the victim's bodily substances, like blood or vomit. Also, remember check your surroundings to make sure the situation is safe before beginning.

1. First, attempt to wake victim if they are unconscious by tapping their shoulder or rubbing your knuckles across the victim's sternum, and asking loudly "Are you OK?"
2. Checking for a pulse before performing CPR is no longer expected unless you are a health care professional.
3. If the victim does not wake up, call 911 (or your region's emergency number) immediately and then proceed to performing the steps below. If two people are available, one person should begin CPR while the other calls 911. In a situation where you feel the person has suffocated (drowned), then perform CPR for one minute before calling 911.
4. If the victim is conscious, CPR is not necessary; call for emergency assistance if they are confused or injured.

• Remember the basic steps of CPR as the ABCs of CPR: A for airway, B for breathing, and C for circulation.

1. The first letter, A, is for clearing the airway. The person should be lying on their back on a firm surface.
2. Look into the victim's mouth and check for a foreign object obstructing the person's airway, and, if necessary, use your finger to sweep the object out.
3. Kneeling next to their neck and shoulders, open the airway by placing your palm on their forehead to carefully tilt their head back, and lifting their chin gently forward with your other hand.
4. Determine if the person is breathing normally by listening for breath sounds, watching for the chest to rise and fall, and feeling for the person's breath on your ear.
   • Do not spend more than 10 seconds waiting for breath, and remember that gasping for air is not considered normal breathing.

1. B is for breathing. If the person isn't breathing normally, begin mouth-to-mouth breathing unless you have reason to believe that the victim has suffered a heart attack, in which case you should proceed directly to chest compressions.
2. To begin mouth-to-mouth breathing, pinch the victim's nostrils shut and cover the person's mouth with your own.http://www.firstaidweb.com/adult2.html
   • Rescue breathing can be performed either from mouth-to-mouth, or, if the mouth can't be opened, mouth-to-nose.
3. Give one breath for one second, watching to see if the victim's chest rises.
   • If it does, give a second rescue breath.
   • If not, the airway may not be clear. Repeat the head-tilt, chin-lift maneuver before giving a second breath.
4. One of the most common complications encountered when performing CPR is that the victim vomits. This may be caused by over-inflating the victims lungs so that air is forced into the stomach. If the victim vomits as you're performing CPR, turn their head to one side and try to sweep out the vomit before continuing.http://depts.washington.edu/learncpr/comp.html

1. The third letter in the ABCs of CPR stands for circulation. Restore the victim's blood circulation with chest compressions.
   • Begin by putting the heel of your hand on the center of the person's chest between their nipples.http://www.nlm.nih.gov/medlineplus/ency/article/000013.htm
2. Then place your other hand on top of the first, being sure to keep your elbows straight and position your shoulders directly above your hands.
   • Push straight down on the victim's chest using your upper body weight, not just your arms. Push down hard and push fast—compressing the chest two inches (approximately five centimeters).
   • Give 100 compressions a minute.
3. Give 30 compressions, then repeat the head-tilt, chin-lift maneuver again and give another two rescue breaths. This "30 compressions followed by two rescue breaths" is one cycle of CPR.
   • If another person is available, you can alternate cycles or have one person perform chest compression and the other perform rescue breathing.
4. After completing five cycles, if the victim is still not moving or showing other signs of life, apply an automatic external defibrillator (AED) if it is available.
   • Follow the prompts on the AED. The American Heart Association recommends administering one shock, then resuming CPR (beginning with chest compressions portion of the cycle) for two more minutes before administering a second shock.
   • A 911 operator may be able to help you administer the AED if you are not trained in its use.
   • If no AED is available, continue the CPR cycle. Repeat until the victim begins to move or until help arrives.

• Performing CPR on a child (age one and up) is basically the same as procedure as performing CPR on an adult. However there are a few differences to keep in mind:

1. When performing CPR on a child, breathe more gently and use only one hand to perform the chest compressions. Use the same 30-compression/two breaths per cycle as adult CPR.http://www.nlm.nih.gov/medlineplus/ency/article/000012.htm
2. If no one else is available to assist you, perform five back-to-back cycles of compressions and breaths on the child (approximately two minutes) before calling 911 or using an AED.
3. When using an AED on a child, use pediatric pads. If pediatric pads aren't available, then use adult pads.

• The most common reason an infant's heart stops beating is lack of oxygen, from causes like choking, suffocation, or drowning. If you believe the infant has an obstructed airway, immediately perform first aid for choking.http://www.babycenter.com/0_infant-first-aid-for-choking-and-cpr-an-illustrated-guide_9298.bc However, if you don't know why the infant is not breathing, then proceed to infant CPR. Performing CPR on an infant is notably different from performing CPR on an adult.http://depts.washington.edu/learncpr/infantcpr.html

1. To clear the baby's airway, place the baby (lying on his or her back) on a firm, flat surface, like a table or the ground.http://www.mayoclinic.com/health/first-aid-cpr/FA00061
2. Then, carefully tip the baby's head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
   • Be sure not to overextend the baby's neck, as tilting the head too far back can close off the airway.
   • 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.
   • Don't take more than 10 seconds to check for breathing, and if you determine the baby is not breathing, immediately begin rescue breathing.

1. To breathe for the infant, cover the baby's mouth and nose with your mouth.
   • Use only the strength of your cheeks to gently deliver puffs of air into the baby's mouth , one at a time. http://www.firstaidweb.com/infant2.html
   • Do not give deep breaths from your lungs, and take one second for each breath.
2. If the baby's chest rises, give a second rescue breath.
   • If you cannot see the baby's chest rise, repeat the head-tilt, chin-lift maneuver before giving another rescue breath.
3. If, after repeating the head-tilt, chin-lift maneuver and giving another rescue breath, the infant's chest still does not rise, look into the baby's mouth and throat to make sure that no foreign object is inside.
   • If an object is visible, sweep it out with your finger.
   • If this doesn't help but the airway seems blocked, perform first aid for a choking baby.http://www.babycenter.com/0_infant-first-aid-for-choking-and-cpr-an-illustrated-guide_9298.bc
4. If the baby vomits, turn the infant's head to one side and sweep out the vomit before continuing.http://depts.washington.edu/learncpr/comp.html vomits

1. Next, perform chest compressions to restore the baby's circulation. Place two fingers of one hand on the infant's chest.http://www.mayoclinic.com/health/first-aid-cpr/FA00061
   • To help you know where to place your fingers, imagine that a horizontal line is drawn between the baby's nipples. Put your fingers just below this line, in the center of the chest.
2. Gently, push down to compress the chest to about one-third to one-half the depth of the baby's chest.
   • Pump in a rapid rhythm.
   • Count out loud as you compress, pumping at a rate of 100 to 120 pumps per minute.
3. After performing every 30 chest compressions, give the baby two rescue breaths.
   • If you are alone, perform CPR for about two minutes before calling for 911 or your local emergency number.
   • If there is someone else there that can assist you, have them call for help immediately while you attend to the infant.
4. Once you begin CPR, continue until the baby shows signs of life or until medical help arrives. Do not use an AED for infants younger than age one.

1. In order to gain hands-on experience, and the confidence to perform CPR correctly in an emergency situation, consider taking a course in CPR.

2. In a typical CPR course, students practice CPR techniques on mannequins and may also watch videos, demonstrations, and be provided printed study materials.

3. To become certified in CPR, participants must pass a final test, which is a combination of demonstrating CPR skills and taking a written test. The American Heart Association's basic life support course that includes CPR is one session that lasts approximately three hours.

4. There are many choices in CPR classes, from CPR classes for health care professionals to CPR classes for those with no medical experience at all. Be sure to find a CPR class right for your experience and ability level.

5. CPR is a hands-on skill that improves with practice. Because of this, experts recommend repeating a CPR course at least every two years to refresh your skills. To find CPR courses available near you, check with your local Red Cross chapter or nearby hospitals.

The content in this page is not a substitute for professional medical advice. Please contact your doctor before using the information presented here.