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For anyone who has taken CPR prior to , there have been a few key changes since the Guidelines were instituted. These changes include:. Decreasing the delay in beginning compressions increases survival rates.

It is often hard for even trained providers to identify effective breathing. It is no longer recommended to look, listen and feel to determinewhether a victim is breathing. Rather, if the victim is not responsive, has no pulse, and is not breathing or is breathing in an irregular fashion i.

Emphasis on high-quality CPR. It has been recognized that health care professionals should call for assistance when they come upon an unconscious victim, but they may also simultaneously assess breathing and check for a pulse before fully activating the emergency response system.

This may encourage efficiency in assessment and response, rather than following a step-by-step response. Health care professionals may tailor their response to an unconscious victim by altering the response sequence to fit the situation or scenario using an AED immediately when one is close by and the arrest is witnessed, or providing ventilations first when the cause of arrest is known to be an anoxic event i. Rescuers should provide 1 breath every 6 seconds when an advanced airway is in place and compressions are ongoing continuously rather than trying to remember a range of ventilations for adults, children and infants.

The Adult Chain of Survival. The Adult Chain of Survival represents a continuum of care, from early recognition of the victim in cardiac arrest to post-resuscitation care to provide the best chance of survival from cardiac arrest. In the diagram above, the first two of five steps are visualized The five links in the Adult Chain of Survival include:.

Note that in the diagram above, the first two of the five steps early recognition of cardiac arrest and activation of the emergency response system have been combined to acknowledge the fact that these steps often occur simultaneously when multiple rescuers are present.

In many situations, there may be only one rescuer who will carry out the normal sequence of assessments and actions. However, in many situations, there is often more than one rescuer trained and willing to help. This is when a team approach can be used. The first rescuer should take the role of team leader and delegate tasks. One rescuer can provide compressions, one can prepare to give breaths with a bag-valve mask, and one can prepare the AED.

By working together, the most efficient care can be given to the patient. Chest compressions are the most important component of CPR. Chest compressions are an attempt to mimic the normal activity of the heart. When pressure on the chest is released, blood is allowed to return to the heart.

A small amount of oxygen will be present in the bloodstream for several minutes after the heart ceases to beat, just enough to keep the brain alive. Compressions can keep vital organs functioning until higher level care is available. Then place your other hand on top of the first and interlace your fingers.

The heel of your hand should be pressing on the bottom two-thirds of the sternum, avoiding the xiphoid process the small bony prominence at the very bottom of the sternum breastbone.

Lock your elbows and press down hard, depressing the sternum at least 2 inches 5 cm , but no more than 2. Your shoulders should be positioned directly over your hands in a straight line.

Push hard and fast to times per minute, counting out loud as you do so. If you do not allow the chest to recoil, the heart will not fill completely, which means that less blood and therefore oxygen will be pumped out of the heart to vital organs with the next compression. Performing compressions is exhausting. Most people find that they become very fatigued after providing compressions for 2 or 3 minutes.

When a person performing compressions becomes fatigued, there is a tendency to compress less firmly and more slowly; for this reason, it is recommended that rescuers trade off doing compressions every 2 minutes to prevent fatigue and optimize the quality of compressions. If you are alone, you will have to do the best you can- keep performing compressions until help arrives or you are physically unable to do so. If you are alone and come across an individual who is down, follow the steps below.

Stay Safe : If you come upon an individual who may need CPR, look around and make sure you and the victim are in a safe place. If the victim is in water or on a road, try to move the victim to a safer area. Simply roll him over onto his back. Make sure the victim is on a firm surface, in case compressions are needed. Assess the Victim : To quickly assess the victim, shake his shoulder and yell at him. Check for breathing. If someone responds, tell him to call for help by dialing Make sure you tell the person to return to assist you as soon as possible.

If you are alone, call for help by dialing and run to get the AED if you know where one is nearby. An AED, or automated external defibrillator,is a device that has the ability to detect and treat, through electrical energy, the lethal arrhythmias known as ventricular fibrillation and ventricular tachycardia. Ventricular fibrillation is a condition in which the lower chambers of the heart, the ventricles, quiver in an unorganized fashion, which renders them incapable of pumping blood to the rest of the body.

Untreated, ventricular fibrillation rapidly causes cardiac arrest. Ventricular tachycardia is a rapid rhythm originating in the ventricles. In ventricular tachycardia, the ventricles contract so quickly, albeit in a somewhat organized fashion, that inadequate blood flow is produced. Ventricular tachycardia often precedes ventricular fibrillation. Both rhythms are lethal if not treated. Early defibrillation is key to survival in cardiac arrest.

Rescuers should immediately begin chest compressions, and use the AED as soon as it is available and ready to use. AEDs can be found wherever crowds of people gather- swimming pools, airports, malls, sporting arenas, schools, hotels…More and more businesses are also investing in these life-saving machines.

In some communities, private AED owners are registering their AEDs with ambulance dispatch, so that they can be easily located by bystanders when needed. Make it a point to learn where the AEDs in your neighborhood or town are located- you never know when you might need one! All you need to do as a rescuer is turn on the machine the most important step and listen as the machine guides you through the steps to use the AED safely and effectively. Although there are many brands of AEDs on the market, they all work in a similar fashion and are designed to be used by lay rescuers.

When an AED becomes available i. In this way, the other rescuer can continue performing CPR until the AED is ready to analyze and deliver a shock if needed. There are four universal steps to using any AED. These will be highlighted in the following list of steps so they are easily recognizable. There are times when using an AED may present special challenges. Because children are more prone to respiratory arrest and shock, it is essential to recognize airway and breathing problems before they occur to prevent cardiac arrest and ensure survival and full recovery.

For this reason, an extra link in the chain of survival- prevention- has been added. Therefore, the Pediatric Chain of Survival includes:. Note that puberty is defined as the presence of underarm or chest hair in boys and any breast development in girls. When two rescuers are present, performing CPR on a child is the same as performing CPR on an adult, except that the compression ventilation ratio when 2 rescuers are present drops to There are a few differences as follows:. Some AEDs have been modified so that they can deliver different shock dosages to adults and to infants and children.

If you use an AED that is pediatric-capable, it will have special features that you will need to know about in order to operate the AED. For example, some AEDs may come with child pads, which are smaller in size.

In some AEDs, there may be a key or switch that you will need to activate to use the AED on children or infants; in others you will plug the child AED pads into a separate receptacle when using the AED on infants or children. All AEDs typically come with instructions, so when all else fails, read the instructions!

If the AED you are using has pads designed for use in children, use them for children under 8 years of age. If the AED does not have child pads, you may use adult pads; however, you should ensure the pads do not touch or overlap. If the pads are too large, you can use alternative placements, such as the anterior-posterior pad placement:.

For infants, a manual defibrillator is preferred; however, if a manual defibrillator is not available, an AED designed for use on children and infants is the next best thing. When nothing else is available, and adult AED may be used- after all, the alternative is death, and studies have not shown that infants and children resuscitated with an adult AED suffer any permanent damage to the heart.

Try to immobilize the spine and protect the head, neck, and back if it is necessary to move a victim. An unconscious victim who is breathing and has a pulse should be assisted into the recovery position to protect the airway. This position keeps the airway open, prevents aspiration of fluids into the lungs and allows fluid such as saliva or blood that could occlude the airway to drain from the mouth.

Look for gasping, abnormal breathing, or absence of chest movement. Activate EMS — Call for help! If cardiac event is witnessed , follow same steps as for adults. Same as for child. Check pulse Check for a pulse for no more than 10 seconds in the carotid artery of the neck. Same as adult — Can also use femoral artery. Check brachial artery in the upper arm for no more than 10 seconds.

Check mouth for obstruction, foreign matter. Use roll under shoulders to maintain proper positioning. Breathing 2 breaths over 1 second each, following 30 compressions. Watch for chest rise. When an advanced airway is present, give 1 breath every 6 seconds while continuous chest compressions are being performed. When an advanced airway is present, give 1 breath every seconds while continuous chest compressions are being performed.

Same as child. May use anterior-posterior pad placement. Manual defibrillator is preferred. Face masks provide a barrier between the rescuer and the victim.

These masks also prevent contact with vomitus and blood, which could pose an infection risk to the rescuer. It takes practice to learn how to use these masks effectively to provide ventilations. Using a Face Mask:. A bag-mask device or BVM, bag-valve mask consists of a mask attached to a reservoir bag. They are commonly used to provide positive-pressure ventilations during CPR. As with the face mask, it takes practice to be able to use a bag-mask device.

It can also be very difficult for one person to use a bag-mask device; therefore, it is recommended that use of a bag-mask device be used only when there are two rescuers available.

If you suspect that a victim may have a neck or spinal cord injury i. This could further damage the neck or spinal cord. Many bystanders are reluctant to perform CPR. There are many reasons why bystanders are reluctant to get involved.

Fear of Disease: Use universal precautions when the possibility exists of coming into contact with bodily fluids. Download Download PDF. Translate PDF. Adult Rescue breathing: It is done only when the victim is not breathing adequately but has a pulse.

Agonal Gasps are inadequate breaths associated with Cardiac Arrest not Choking. Minimize the interruptions in chest compressions. Minimize interruptions in chest compressions. Performance CPR Training. AEDs are designed for adults but most can be adapted for children and infants with pediatric pads. If a manual defibrillator is not available, an AED with a pediatric dose attenuator is desirable.

If neither are available, an AED without a dose attenuator may be used. Note: Adult AED pads can be used on children and infants but pediatric pads are preferred.

Pediatric pads cannot be used on adults. What are the signs of a heart attack? What is happening when you notice the abdomen rising on your victim as you breath? If the chest does not rise when you give a breath, what should you do?

What is the purpose of 1 second breaths just making the chest rise when ventilating a victim? Where do you place your hands when doing chest compressions on a child and adult A. Are agonal gasps adequate breathing? Can you use adult AED pads on a child or infant? When do you shock a child or infant with an AED?