CPR: Step by Step

First aid. Artificial breath.

It’s just another ordinary day. You do not have anything else to do, so you decided to go strolling at the park. While you’re enjoying the good weather and the luxury of being free today, you hear someone scream and another asking for help. You run towards where the voices are coming from and finally see the scenario. Someone unconscious is lying on the floor. You know you need to help, but you don’t know exactly how. What should you do? Should you just leave and enjoy the rest of your day off? Or should you go to them and help?

According to the American Heart Association, effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a victim’s chance of survival, yet less than one-third of out-of-hospital sudden cardiac arrest victims receive bystander CPR. However, an alarming 70% of Americans don’t know how what to do if somebody is experiencing a cardiac emergency because they don’t know how to administer CPR or they forgot the exact technique.

Below are some of the things you need to take into consideration when performing CPR (adults):

Before starting CPR, check:

• 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 and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911 or the local emergency number.
• If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

Remember CAB

Remember the acronym of CAB, which stands for compressions, airway, breathing when remembering the order to perform the steps of CPR.

For the:

Untrained.

• If you’re not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive (described in more detail below). You don’t need to try rescue breathing.

Trained and ready to go

• If you’re well-trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.

Trained but rusty.

• If you’ve previously received CPR training but you’re not confident in your abilities, then just do chest compressions at a rate of about 100 a minute.

Compressions: Restore blood circulation

1. Put the person on his or her back on a firm surface.
2. Kneel next to the person’s neck and shoulders.
3. 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.
4. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.
5. If you haven’t been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway

1. If you’re trained in CPR and you’ve performed 30 chest compressions, open the person’s airway using the head-tilt, chin-lift maneuver. Put your palm on the person’s forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.
2. Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person’s breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn’t breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven’t been trained in emergency procedures, skip mouth-to-mouth breathing and continue chest compressions.

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 maneuver), 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 maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.
3. Resume chest compressions to restore circulation.
4. If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you’re not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn’t available, go to step 5 below.
5. Continue CPR until there are signs of movement or emergency medical personnel take over.

Sources:

http://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

What Do You Think?