Basic CPR and AED
According to the AHA, CPR is not a single skill, but a series of assessments and interventions, and cardiac arrest is not just one problem, so the steps of CPR will vary depending on the type or cause of the arrest.
For the purposes of this book, only lay-rescuer techniques and methods will be reviewed. It's worthy to note that lay rescuers are no longer taught to check for pulse or signs of circulation or taught to provide rescue breathing without chest compressions for an unresponsive person.
Take the following steps when you witness anyone over the age of one year old collapse:
Assess that it is safe to approach the fallen person.
Use protective equipment and follow universal precautions. If you are able to, use common sense, and stay away from any obvious hazards.
Attempt to wake the person by rubbing your knuckles firmly against the sternum (breastbone) and shouting, “Are you okay?”
If the person fails to rouse, immediately call 911 or shout for help, depending on your situation. If there is an AED available, also shout for someone to bring it.
If the person becomes conscious, is moaning, or moves, do not start CPR.
Call 911 if the person is not able to speak or appears confused. If the person does not wake, begin CPR and use an AED if available.
An AED is a small, portable electronic device that is used to deliver an electric shock in an attempt to disrupt or stop abnormal electrical activity in the heart. Abnormal electrical activity correlates with an abnormal heart rhythm, and a continual abnormal rhythm is not sufficient to pump blood and deliver oxygen through the body.
An AED shock cannot restart a dead heart; the heart must have a rhythm (even though the rhythm is abnormal). The AED will automatically diagnose any cardiac arrhythmia when attached by leads to an unconscious person.
An AED is used to interrupt a lethal heart rhythm
When you see one of these lethal rhythms, you can then treat the person with the AED electrical therapy or a shock (defibrillation) that may interrupt the arrhythmia and allow the heart to re-establish a normal and effective rhythm. You can learn how to use an AED in many first-aid, first-responder, and CPR classes.
The steps for performing CPR are:
Check for normal breathing by putting your ear to the person's mouth and turning your head to look for chest movement, while listening for air flowing through the mouth or nose and trying to detect breath on your cheek. A person with periodic gasping is most likely in cardiac arrest and needs CPR.
If there are no signs of breathing, begin chest compressions by placing the heel of your hand in the middle of the chest, over the lower half of the breastbone at the nipple line. Place your other hand on top and lace your fingers together (heel of one hand on chest, heel of the other hand on top of that hand) and compress the chest at least two inches. Allow the chest to recoil completely, and then perform 30 compressions, at a rate of at least 100 compressions per minute.
If you are not trained in CPR, just continue compressions until help arrives. If you are trained, continue to the next step.
After 30 compressions, open the airway using the head-tilt, chin-lift method — one hand on the forehead, fingers of the other hand under the bony part of the lower jaw, near the chin. Tilt the head back, gently lift the jaw, making sure not to close the mouth or push on soft parts beneath the chin. Avoid lifting the neck in the case of spinal injury.
Pinch the nose; make a seal over the mouth with yours and give the person a breath strong enough for you to see the chest rise. When the chest falls, repeat the rescue breath once more for a total of two breaths. If available, use a CPR mask as a barrier between your mouth and the person's mouth that you are rescuing. These three steps are called “rescue breathing.”
Then perform at least 30 chest compressions again, and immediately repeat the two rescue breaths. Open the airway with head-tilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another.
Perform the cycle of 30 compressions followed by two breaths for about two minutes. Then stop and recheck for breathing. If the person is not breathing, continue chest compressions and rescue breaths.
Essential
The AHA recommends that rescuers push hard, push fast (at least 100 compressions per minute), and allow complete chest recoil between compressions, with minimal interruptions in compressions, for all persons.
Steps of CPR
Other Considerations
The AHA now recommends that a series of 30 compressions followed by two breaths (compression-ventilation ratio of 30:2) be given to all persons, regardless of age. Continue the cycle of compressions and rescue breathing until professional help arrives or until the person recovers and begins breathing.
In children age one to eight, use one or two hands as necessary to compress the chest one-third to one-half the depth of the chest. For the unresponsive infant or child, perform five cycles of 30 compressions and two breaths for about two minutes before leaving the child to call 911 and get an AED if one is available.
CPR for Newborns and Infants
Newborn CPR has different recommendations than those for infants. But the recommendations for newborn CPR only apply to newborns in the first hours after birth until the newborn leaves the hospital, so the general public needs only to be concerned with infant CPR guidelines that apply to babies less than approximately one year of age.
The rescue-breathing rate for infants with pulses is about 40 to 60 breaths per minute, with chest compression to one-third the depth of the chest. Deliver 90 compressions and 30 ventilations per minute. Compress the infant chest just below the nipple line (on lower half of sternum) using two fingers (rather than a whole hand) to compress the chest with a compression-ventilation ratio of 30:2.
Problems Associated with CPR
Some of the problems the AHA has identified regarding performing CPR are excessive ventilation given during CPR and compressions that are interrupted too frequently and that are often too slow and too shallow.
Alert!
If you or a family member have a preexisting heart condition or are at high risk for heart failure, your doctor may be able to prescribe an AED that's at least partially covered by your medical plan.
It's believed that bystanders may be reluctant to perform CPR because it seems too complicated and difficult to remember. That's why in recent updates the AHA has made attempts to simplify the steps by making the compression-ventilation ratio used the same for infants, children, and adults. The same update has been issued for chest compressions in children and adults.
While it's been surmised that the public is afraid of contracting diseases and is therefore reluctant to perform mouth-to-mouth resuscitation, the data illustrates that transmission of infection is very low; nonetheless, use of a barrier device (CPR mask) while giving ventilations is still encouraged. If you are still reluctant to give mouth-to-mouth ventilations, at least call for help and start chest compressions immediately.
