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In this lesson, we're going to cover adult CPR, including exactly how to provide care. A patient who is unconscious, not breathing normally, and has no pulse is in cardiac arrest and needs CPR. At the end of the lesson, we'll provide you with a Word on high-quality CPR.
CPR is a combination of chest compressions and ventilations that circulates blood and oxygen to the brain and other vital organs for a person whose heart and breathing have stopped.
Remember the five links in the Adult Cardiac Chain of Survival:
- Recognize the cardiac emergency and call 911
- Early CPR
- Early defibrillation
- Advanced life support
- Integrated, post-cardiac arrest care
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally (as you now know, agonal respiration is not breathing normally and should be considered the same as NO respirations), and has no pulse, continue immediately with CPR.
CPR Technique for Adults
1. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
2. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
Pro Tip #1: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
3. Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
4. Perform 30 chest compressions.
Pro Tip #2: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.
5. Grab the rescue mask and seal it over the victim's face and nose.
6. Lift the victim's chin and tilt his or her head back slightly.
7. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
8. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.
A Word About High-Quality CPR
It's important to understand what constitutes high-quality CPR, as performing CPR correctly will give the victim the best chance of survival.
High-Quality CPR
- Performing chest compressions at a rate of 100-120 per minute
- Compressing to a depth of at least 2 inches but not exceeding 2.4
- Allowing for full recoil after each compression
- Minimizing pauses in compressions
- Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise
Low-Quality CPR
- Compressing at a rate slower than 100 per minute or faster than 120 per minute
- Compressing to a depth of less than two inches or greater than 2.4 inches
- Leaning on the chest between compressions or performing compressions while not directly over the victim's heart
- Interrupting compressions for greater than 10 seconds
- Providing excessive ventilation – too many breaths or breaths with excessive force
Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue.
