Dealing With Emergencies

Rescue Breathing and CPR

The American Heart Association recommends these guidelines for CPR.

Doing CPR the wrong way or on a person whose heart is still beating can cause serious harm. Do not do CPR unless:

1. An adult is not breathing normally (may be gasping for breath), or a child is not breathing at all.
2. The person does not breathe or move in response to being touched or talked to (Step 1, below).
3. No one with more training in CPR than you is present. If you are the only one there, do the best you can.

The CPR Ready Reference has the basic steps for CPR. Use it for quick information on rescue breathing rates, hand placement for chest compression, compression rates, compression depth, and ratio of compressions to breaths.

Step 1. Check to see if the person is conscious.

Tap or gently shake the person and shout, "Are you okay?" But do not shake someone who might have a neck or back injury. That could make it worse.

If the person does not respond, follow these steps.

Adults and older children who have reached puberty

• For an adult or an older child who has reached puberty (body hair or breast development), call 911 or other emergency services.

Babies and young children until the age of puberty

• For a baby or young child who has not reached puberty, give 2 breaths and 30 chest compressions, 5 times in a row (about 2 minutes). If the child is still not breathing, call 911 or other emergency services. Note: If you see a child collapse, call 911 before starting rescue breathing or CPR.

Step 2: Check for breathing for 5 to 10 seconds.

• If an adult is not breathing normally or if a child is not breathing at all, roll the person onto his or her back on a firm, flat surface. If you think the person might have a neck or back injury, gently roll the person's head, neck, and shoulders together as a unit (logroll).
• Kneel next to the person with your head close to his or her head.
• Look to see if the person's chest rises and falls.
• Listen for breathing sounds.
• Put your cheek near the person's mouth and nose to feel whether air is moving out.

If the person is breathing, watch him or her for any changes until emergency services arrive.

Step 3: Rescue breaths.

Note:

If you feel comfortable doing CPR with rescue breaths, then use them. If you are not comfortable doing them, then just do chest compressions. Studies have shown that CPR can work well with chest compressions alone.

• To do rescue breaths, put one hand on the person's forehead and push with your palm to tilt the head back. Put the fingers of your other hand under the bony part of the lower jaw near the chin. Tilt the chin upward to keep the airway open.
• Take a normal breath (not a deep one), and place your mouth over the person's mouth, making a tight seal. For a baby, place your mouth over the baby's mouth and nose. Blow into the person's mouth for 1 second, and watch to see if the person's chest rises.
• If the chest does not rise, tilt the person's head again, and give another breath.
• Between rescue breaths, remove your mouth from the person's mouth and take a normal breath. Let his or her chest fall, and feel the air escape.
• If the person is still not breathing normally after 2 rescue breaths, check for a pulse and be ready to start chest compressions. Note: For an adult and child older than 1 year, check for a pulse in the neck to the side of the windpipe. For a baby, check for a pulse on the inside of the upper arm between the elbow and shoulder.

Step 4: Start chest compressions.

For an adult or an older child who has reached puberty:

• Move or remove all clothing covering the chest. You need to be able to see the chest move.
• Kneel next to the person. Use your fingers to locate the end of the breastbone, where the ribs come together. Place two fingers at the tip of the breastbone.
• Put the heel of one hand just above your fingers on the center of the person's chest between the nipples.
• Use both hands to give compressions. Stack your other hand on top of the one that you just put in position. Lace the fingers of both hands together, and raise your fingers so they do not touch the chest.

Positioning your arms and body for doing chest compressions:

• Straighten your arms, lock your elbows, and center your shoulders directly over your hands.
• Press down in a steady rhythm, using your body weight. The force from each thrust should go straight down onto the breastbone, pressing it down 1.5 in (3.8 cm) to 2 in (5 cm). Give 30 compressions at a rate of 100 compressions a minute. Be sure to let the chest re-expand at the end of each compression.
• After 30 compressions, give 2 rescue breaths. If you are not doing rescue breaths, keep doing compressions at 100 a minute.
• Keep repeating the cycle of 30 compressions and 2 breaths until help arrives or until the person is breathing normally.

For a child 1 year of age to puberty:

• Move or remove all clothing covering the chest. You need to be able to see the chest move.
• Kneel next to the child. Use your fingers to locate the end of the child's breastbone, where the ribs come together. Place two fingers at the tip of the breastbone.
• Put the heel of one hand just above your fingers on the center of the child's chest between the nipples.
• Use the heel of one hand to give compressions. If you need more force for a larger child, use both hands as you would for an adult.

Positioning your arms and body for doing chest compressions:

• Straighten your arm, lock your elbow, and center your shoulders directly over your hand.
• Press down in a steady rhythm, using your body weight. The force from each thrust should go straight down onto the breastbone, pressing down one-third to one-half of the depth of the child's chest. Give 30 compressions at a rate of 100 compressions a minute. Be sure to let the chest re-expand at the end of each compression.
• After 30 compressions, give 2 rescue breaths. Note: Make sure you do rescue breathing with babies and children.
• Keep repeating the cycle of 30 compressions and 2 breaths until help arrives or until the child is breathing normally.

For a baby younger than 1 year:

• Picture a line connecting the nipples, and place two fingers on the baby's breastbone just below that line. Press the chest one-third to one-half of the way down. Give 30 compressions at the rate of 100 compressions a minute. Be sure to let the chest re-expand at the end of each compression. See a picture of hand placement for baby CPR .
• After 30 chest compressions, give 2 rescue breaths. See a picture of rescue breathing for a baby . Note: Make sure you do rescue breathing with babies and children.
• Keep repeating the cycle of 30 compressions and 2 breaths until help arrives or the baby is breathing normally.

Using an automated external defibrillator (AED)

Automated external defibrillators (AEDs) are now often found in public buildings. They are usually located in a visible area. Each AED gives you instructions for that machine. Before using an AED, be sure to follow all the steps for rescue breathing and CPR. Do not delay rescue breathing and CPR to find an AED. To use an AED, place it next to the person, turn it on, and follow the commands. The AED will tell you when to continue CPR and when to check again for a heart rhythm.

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Author:	Jan Nissl, RN, BS	Last Updated: May 1, 2008
Medical Review:	Adam Husney, MD - Family Medicine Patrice Burgess, MD - Family Medicine
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