CPR
(Rescue Breathing/Chest Compressions)
Chapter 22. Emergency Procedures

These emergency procedures for cardiopulmonary resuscitation (CPR), which are based on procedures recommended by the American Heart Association, are reprinted from Home Organizer for Medical Emergencies. Copyright © 1992 by the American College of Emergency Physicians. Used with permission.

The information below is designed as a reminder of and not a substitute for formal training in CPR (cardiopulmonary resuscitation). The American Heart Association and the American Red Cross offer courses in CPR. All family members should take one of these courses. You should have both your skill in and your knowledge of CPR tested at least once a year.

A. Airway
1. If you find a collapsed person, determined if the victim is unconscious. If there is no response, shout for help. Call 9-1-1 or your local emergency number.

2. If the victim is not lying flat on his or her back, roll the victim over, moving the entire body at one time as a unit.

3. Open the victim's airway. Lift up the chin gently with one hand while pushing down on the forehead with the other to tilt the head back.

NECK INJURY: If the victim may have suffered a neck injury - in a diving or automobile accident for example - open the airway using the chin-lift without tilting the head back. If the airway remains blocked, tilt the head slowly and gently until the airway is open.

4. Once the airway is open, check to see if the person is breathing.
5. If opening the airway does not cause the victim to begin to breathe, you must provide rescue breathing.

B. Breathing (Rescue Breathing)
1. Pinch the victim's nose shut using your thumb and forefinger. Keep the heel of your hand on the victim's forehead to maintain the head-tilt. Your other hand should remain under the victim's chin, lifting up.

2. Immediately give two full breaths while maintaining an air-tight seal with your mouth on the victim's mouth.

C. Circulation (Chest Compressions)
1. After giving the two full breaths, locate the victim's pulse to see if the heart is beating. To find the pulse, use the hand that is supporting the chin to locate the Adam's apple (voice box). Slide the tips of your fingers down into the groove beside the Adam's apple. Feel for the pulse. If you cannot find the pulse, you must provide artificial circulation in addition to rescue breathing.

2. Kneel at the victim's side near the chest.
3. With the middle and forefingers of the hand nearest the legs, locate the notch where the bottom rims of the rib cage meet in the middle of the chest.

4. Place the heel of the hand on the breastbone (sternum) next to the notch. Place your other hand on top of the one that is in position. Be sure to keep your fingers up off the chest wall. You may find it easier to do this if you interlock your fingers.

5. Bring your shoulders directly over the victim's sternum. Press downward, keeping your arms straight. For an adult victim, depress the sternum about 1 1/2 to 2 inches. Then relax pressure on the sternum completely.

Do not remove your hands from the victim's sternum, but do allow the chest to return to its normal position between compressions. Relaxation and compression should be of equal duration.

6. If you must provide both rescue breathing and external chest compressions, the proper ratio is 15 chest compressions to 2 breaths. You must compress at the rate of 80 to 100 times per minute.
7. Continue CPR until advanced life support is available.

For Infants (Birth to 1 year) and Children (1 to 8 years)
A. Airway
With infants, be careful that you do not tilt the head backward too far. An infant's neck is so pliable that forceful backward tilting might block breathing passages instead of opening them.

B. Breathing
Do not try to pinch the nose of an infant who is not breathing. Cover both the mouth and the nose with your mouth and breathe slowly (1 to 1 1/2 seconds/breath), using enough volume and pressure to make the chest rise. With a small child, pinch the nose closed, cover the mouth with your mouth and breathe at the same rate as for an infant.

C. Circulation
PULSE
In an infant, check for a pulse by feeling on the inside of the upper arm midway between the elbow and the shoulder. The pulse check in the small child is the same as in the adult.

Chest Compressions
Infants:
1. Use only the tips of the middle and ring fingers of one hand to compress the chest at the sternum (breastbone) as described in the table below. The other hand may be slipped under the back to provide a firm support.
2. Depress the sternum between 1/2 to 1 inch at a rate of at least 100 times a minute.
3. Breaths should be given during a pause after every fifth chest compression.
4. Continue CPR until advanced life support is available.

Small Children (ages 1-8):
1. Use only the heel of one hand.
2. Depress the sternum between 1 and 1 1/2 inches, depending on the size of the child. The rate should be 80 to 100 times per minute.
3. Breaths should be given during a pause after every fifth chest compression.
4. Continue CPR until advanced life support is available.
 

*Make sure not to depress the tip of the sternum
Illustrations are reproduced with permission from Basic Life Support Heartsaver Guide, 1993. Copyright © American Heart Association.

HEALTH AT HOME - Your Complete Guide to Symptoms, Solutions, and Self-Care © 1999 by Don R. Powell. American Institute for Preventive Medicine. 

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Date updated 02/01/99